Kettering General Hospital

Edward Argar Excerpts

Wednesday 2nd February 2022 Westminster Hall

[The Minister for Health (Edward Argar)]

It is a pleasure to serve under your chairmanship, Mr Twigg. I congratulate my hon. Friend the Member for Kettering (Mr Hollobone) on securing this debate. By my tally, this is the fourth debate I have responded to that he has secured on the future of Kettering General Hospital and its redevelopment. That fact reflects his commitment to this issue on behalf of his constituents, and his typically courteous but tenacious approach to the matter. I will put on record, as they are unable to be here, the work done by my hon. Friends the Members for Wellingborough (Mr Bone) and for Corby (Tom Pursglove) in this respect. I welcome the intervention from my hon. Friend the Member for Northampton South (Andrew Lewer).

The topic is not a new one for this House to discuss, but it is an extremely important one. I hope that I might move matters a little bit further forward in this debate for my hon. Friend the Member for Kettering. It was a pleasure to meet him, my hon. Friends the Members for Wellingborough and for Corby and Simon Weldon on 17 January to discuss Kettering General Hospital and receive an update on its plans. I join my hon. Friend the Member for Kettering in paying tribute to Simon and all of the team at Kettering General Hospital and at Northampton General Hospital for the work they have done, not only in the past two years, but day in, day out every year, to support the local community and provide first-class care.

My hon. Friend the Member for Kettering made, as ever, a generous offer to visit Kettering General Hospital with him. It was a pleasure to do so in 2019, when he gave me a very warm welcome in Kettering. I also take his suggestion of visiting Northampton at the same time. Without setting a specific date, my aim is to try to visit him during the February recess—I will discuss this with him. It is not a long haul for me from my constituency in Leicestershire to his in Kettering or Northampton, so that is what I will hope to do, subject to that working for the trust. Ministers are often surplus to operational requirements in a busy trust at busy times, but I suspect that Simon will welcome me to explain what progress he has made. That is my commitment to my hon. Friend.

As my hon. Friend set out, Kettering General Hospital is part of the broader foundation trust, and continues to work closely with the central programme team in taking forward the rebuild of Kettering General as a new hospital for his community. It is part of the broader programme to build 40 new hospitals by 2030. On 13 January, Natalie Forrest, who is the senior responsible owner for the new hospital programme, and officials attended a virtual meeting with the chief executive and staff from Kettering General to discuss progress and provide an update on the scheme in the context of the programme. As my hon. Friend knows, Kettering General Hospital NHS Foundation Trust has received £4.4 million of funding to develop its plans for the rebuilding of Kettering General Hospital. They were successful in securing funding back in 2019, at that stage for a new urgent care hub, which would transform the provision of urgent and critical care in the area. I know that officials are in discussion with the chief executive of the hospital trust regarding the trust’s plans for enabling works on the Kettering General Hospital site and have set out what will be required for these proposals to be assessed as quickly as possible, once business cases are received from the trust, which is in line with what my hon. Friend would expect of appropriate processes for spending public money.

I will provide a little background. The Department wrote to the chief executive on 16 June last year to confirm that, at his request, the urgent care hub and new hospital programme schemes could be brought together as a single pot of money, to maximise the benefits that local people could derive.

Essentially, my hon. Friend asked why things have not progressed since 2019. That is largely because the trust changed its plans. That money was ringfenced for an urgent treatment centre. We had discussions about that with the trust and accepted its proposal to merge the two pots of money. That then necessitated their coming forward with proposals about how they would spend that money as part of the enabling works for a broader scheme. If changes are made, it is right that those changes are justified, in the context of the appropriate stewardship of public money.

The hub and the new hospital that are to be built both share a set of common enabling works, which have been factored into the new hospital development plans. As a result, the trust is incorporating the urgent care hub delivery into that broader plan. It means that the hub will now be part of the first stage of the building of the new hospital, enabling the more efficient use of resources to deliver better results.

In respect of the business case for that plan—I know that my hon. Friend is keen that there is progress on that as swiftly as possible—my officials have been in touch with the trust recently, most recently yesterday and before that on 26 or 27 January, asking the trust to put forward its proposals for those enabling works. We need those to progress the business case. My officials continue to nudge the trust gently, saying, “Please submit your proposals for that and the business case for it”. My commitment is that my officials will consider those proposals as swiftly as they can, once they have received them. As I understand it, given the scale of the enabling works, they would not need to go through the full internal approvals process, but the trust needs to submit a business case for that element.

The second element, which I know my hon. Friend and the trust are keen to see being advanced as swiftly as possible, is the new boiler room and power plant. Essentially, that would have to go through the full approvals process, but I understand that the board of the trust is due to meet in April to agree and finalise its proposal and business case on that work. As soon as it submits that, I can commit to my hon. Friend that—assuming that it is up to scratch, which I am sure it will be—it will go before the first joint investment committee of the Department following its submission, so that it can be considered as swiftly as possible.

At the moment, if I may put it this way, the ball is in the trust’s court, for it to send its proposal and business case over. However, my commitment is that as soon as the trust does so, I will task officials with considering them as swiftly as possible.

[Mr Hollobone]

I thank the Minister for his very helpful comments. I think that the ball, in part, may be in the trust’s court, but there is perhaps another ball with the new hospitals programme team. I say that because the hospital submitted its strategic outline case to the NHS a year ago and what the trust requires is feedback on that, to inform the development of its outline business case. So would the Minister be kind enough to look at that feedback?

[Edward Argar]

I am happy to look at that. The point I am making to my hon. Friend is that for the moneys that he and the trust wish to draw down from the £46 million, we do not have the business cases from the trust that would enable that work. I suspect that they will be winging their way to the Department pretty swiftly following this debate and as soon as they arrive we will look at them. Regarding the broader business case for the overall scheme, I will turn to that, if I may, in just a moment.

All the new hospitals that will be delivered as part of the programme, including Kettering, are required to work with the central team and, with the support of regional and local trust leadership, to design and deliver their hospitals in keeping with a consistent and standardised national approach. This collaborative approach is intended to help each trust to get the most from its available funding, while avoiding repetition of work and design, and ensuring that adherence to the principles, which my hon. Friend alluded to, of repeatable design, modern methods of construction and net carbon zero, is embedded from the outset, to maximise the potential benefits of the programmatic approach, as well, of course, as providing better value for money for the taxpayer.

All the projects that are part of that 40-hospital programme need to ensure that their approach is consistent with the programme, which that has been developed over the past year and has reached a greater level of maturity. Therefore, there will be individual conversations with trusts about where they align with the programme, or where they may need to adapt to meet that national approach.

My hon. Friend touched on the trust’s desire to go faster and begin the main project construction in 2023. In the spirit of openness, my only caveat to that is that, in the nature of funding through multiple spending review periods, it is not the case that a pot of money is earmarked for each programme and is just waiting to be drawn down; there is a profiling of moneys made available by the Treasury. I appreciate the trust’s eagerness to go faster, and I appreciate my hon. Friend’s clear steer that he believes it is capable of going further and faster, but we need to look at it in the context of all the other schemes and the availability and profile of moneys being made available. I just sound that slight note of caution, so I will not commit to a date, much though he tempts me to do so.

[Mr Hollobone]

I appreciate the Minister’s comments. I would just highlight that there are some very large new hospital programmes out there that will not be achieved on time. Kettering is a relatively small, flexible and modular scheme that is perfectly placed to pick up on any slippage from some of the larger schemes.

[Edward Argar]

I am grateful to my hon. Friend, because I was about to turn to his final ask, which was whether the Department would look favourably on Kettering’s scheme if there was slippage from other schemes in the course of the spending review period. Although I cannot prejudge in this place that Kettering will be top of the list, he makes a strong case. It is absolutely right that we look at schemes and have a list of schemes that we believe could fill the gap if moneys are not going to be spent in year. It is important that that contingency is built in, and my hon. Friend makes a strong case for Kettering to be one of the hospitals that is considered for acceleration if it is ready and the moneys become available. I will not prejudge the advice that I will be given by officials as to which schemes are most mature, but he makes his case clearly and forcefully on the Floor of the Chamber.

I am grateful to my hon. Friend not only for the opportunity to discuss and debate Kettering General Hospital, but for the opportunity to visit Kettering. On my last visit, I received a very warm welcome from him and the team at the hospital. In what I have said today, I hope I have ensured that I get an equally warm welcome when I come and see him this month. Like him, I am keen to see all these schemes progress, and I am keen to see the benefits that the schemes will realise.

In the context of Kettering General Hospital, my hon. Friend continues to be an incredibly powerful advocate for the interests of his constituents and those in the wider area of Northamptonshire who are served by the hospital. I look forward to continuing to work with him very closely in the future, as well as with the trust’s chief executive and team, other hon. Friends from Northamptonshire and my team in the Department, to help progress these very exciting and important plans, which will make a huge difference to his constituents’ lives in the years ahead.

Question put and agreed to.

Future of the NHS

Edward Argar Excerpts

Monday 31st January 2022 Westminster Hall

[The Minister for Health (Edward Argar)]

It is a pleasure to serve under your chairmanship, Mr Gray. I pay tribute to my hon. Friend the Member for Stockton South (Matt Vickers) for leading this debate on behalf of the Petitions Committee. I am pleased we were able to find time to hear from the hon. Member for Middlesbrough (Andy McDonald); I offered to take an intervention from him, which I suspect was a brave offer on my part given the intervention that might have come my way. I am pleased he got to give his speech.

I am grateful to the shadow Minister, the hon. Member for Denton and Reddish (Andrew Gwynne). I think this is the first time we have properly been opposite one another since his appointment to this role on the Opposition Front Bench. Although I did not agree with everything he said, he made a typically well-informed and well-argued speech. He is right to pay tribute to all hon. Members who have spoken today, regardless of whether one agrees with the positions advanced. This has been a passionate debate. At its heart is, perhaps, the most precious of our country’s institutions; understandably, right hon. and hon. Members and our constituents have very strong views on the subject.

Before turning to the substance of the debate, and although I may not agree with their position, I pay tribute in a broader context to the work of Unite, Unison and other trade unions. I do not always agree with the stance they adopt, but they play a hugely important role in our democracy and society. It is right to put that on the record. As always in these debates, and as the shadow Minister has done very clearly, I also put on the record our gratitude—from both sides of the Chamber equally—to all NHS staff and those working in social care, local government and other key workers across the country for what they have done across the past two years and, indeed, what they do every year, day in, day out.

As I have said before, the Health and Care Bill reflects evolution, not revolution. It supports improvements already under way in the NHS and, crucially, builds on what the NHS recommended and consulted on back in 2019.

[Margaret Greenwood]

Will the Minister give way?

[Edward Argar]

I will make a little progress before giving way; I will always give way to the hon. Lady. The Bill is backed by not only the NHS but many others working across health and social care. In a joint statement, the NHS Confederation, NHS providers and the Local Government Association state that they

“believe that the direction of travel set by the bill is the right one”,

noting that local level partnership is the only way we can address the challenges of our time.

[Margaret Greenwood]

The Minister is talking about a consultation that, as I recall, took place over the Christmas period, when NHS staff are absolutely exhausted. He talks about these changes being requested by the NHS, but what percentage of NHS staff does he actually think took part in the consultation?

[Edward Argar]

As the hon. Lady will know, the former chief executive of the NHS, Lord Stephens, was clearing in saying that the

“overwhelming majority of these proposals are changes that the health service has asked for.”

We should do the right thing by them and by patients. It is the right time for the Bill: it is the right prescription at the right time.

The substance of the petition, which has framed many speeches by hon. Members today, calls for the Government to renationalise the NHS. I have to say that it has never been denationalised. The NHS is and always will be free at the point of use. The Government are committed to safeguarding the principles on which the NHS was created. The hon. Member for Denton and Reddish set that out very clearly. We have no plans for privatisation.

[Catherine West]

Will the Minister give way?

[Edward Argar]

I will make a little progress; if I have time, I will give way to the hon. Lady, with whom I sat on a committee of London councils when we were looking at social care reform way back in 2010.

We all recognise the importance of preserving this great national asset for the future and ensuring that the NHS remains comprehensive and free at the point of use, regardless of income, on the basis of need. The Government remain steadfast in their commitment that the NHS is not, and never will be, for sale to the private sector.

We are determined to embrace innovation and potential where we find it, but that is different from many of the accusations in the speeches we have heard today. I know it is tempting to scaremonger and set out accusations about what this Act does, even when people know better, as I know hon. Members do, but that reflects scaremongering rather than reality. There has always been an element of private provision in healthcare services in this country. Labour Members should know that because, as the Nuffield Trust said in 2019,

“the available evidence suggests the increase”—

in private provision—

“originally began under Labour governments before 2010”.

[Catherine West]

Will the Minister give way?

[Edward Argar]

I will just finish this point and then give way to the hon. Lady. The hon. Member for Liverpool, West Derby (Ian Byrne) made the point, which the hon. Member for Middlesbrough touched on as well, that it is important to look at the extent of the involvement of private sector providers, which accelerated when the Labour party was in power. The hon. Member for Liverpool, West Derby talked about the 2012 legislation and “any qualified provider”, but that was not brought in by the 2012 legislation; it was brought in by the Gordon Brown Government in 2009-10, under the term “any willing provider.” The name was changed, but nothing substantive changed from what the Labour Government had introduced in terms of the ability to compete for contracts.

[Christian Matheson]

Will the Minister give way?

[Edward Argar]

One more sentence and I will give way to the hon. Member for Hornsey and Wood Green (Catherine West); then I will try to bring in the hon. Gentleman.

One of the key changes allowing private sector organisations to compete for and run frontline health services came in 2004, again under a Labour Government, when the tendering for provision of out-of-hours services by private companies was allowed.

[Catherine West]

The Minister is being very gracious. How is the Act going to ensure that there is no conflict of interest between private providers who sit on integrated care boards and who then provide services? Are we going to end up with another Randox scandal?

--- Later in debate ---

[Edward Argar]

The hon. Lady will know that when it comes to integrated care boards we, as a Government, introduced an amendment building on the already clear provisions in the Bill to prohibit conflicts of interest. I do not know whether she voted for the Government amendment, but it did exactly that, making it clear when the Bill was on Report that private providers and those with significant private interests could not sit on NHS integrated care boards.

[Christian Matheson]

The Minister is being generous with his time. Let us get the history right. The reason why the Labour Government increased the involvement of private sector bidders was simply to be able to increase capacity quickly—to get the waiting list and waiting time backlogs down, which they had inherited from the previous Conservative Government and that were massive. In terms of the 2009 Bill, I seem to remember that there was a provision in there that gave preference to NHS bidders.

[Edward Argar]

I am grateful to the hon. Gentleman. Although we occasionally cross swords in the main Chamber or here, he knows I have a great deal of respect for him. All I would say gently on the point about the 2004 changes is that they came seven years into a Labour Government, so I do not know the reason why they had not been able to make progress before then.

We continue to work closely with the NHS to implement the changes that it has asked for, so that we can build back better and secure our NHS for future generations. As the shadow Minister, the hon. Member for Denton and Reddish, rightly said, the covid-19 pandemic has tested our NHS like never before, and all our NHS staff have risen to meet these tests in extraordinary new ways.

Hon. Members on both sides have rightly raised the point about the pressure that NHS staff have been under. Those who have been under pressure dealing with this pandemic are the people who will also be working flat out to deal with waiting lists and backlogs. We need to ensure that we are honest with the British people and that those staff have the time and space to recover, emotionally and physically, from the pressures they have been under. That is hugely important and we acknowledge the workforce.

[Margaret Greenwood]

Will the Minister give way?

[Edward Argar]

I will not give way to the hon. Lady now. I have given way to her before. I will try to make progress, but if there is time I will try to give way to her.

We have seen innovative new ways of working: new teams forged, new technologies adopted and new approaches found to some old problems. There is no greater example of that than the phenomenal success of our vaccine roll-out. That would not have been possible without the staff, who are the golden thread that runs through our NHS. As we look to the future and a post-pandemic world, we know that, as the shadow Minister said, there is no shortage of challenges ahead of us: an ageing population, an increase in people with multiple health conditions and, as he rightly says, the challenge of deep-rooted inequalities in health outcomes and the need to look at the broader context. I do not know the shadow Minister as well as I knew his predecessor, but both his predecessor and I had a career in local government as councillors. I suspect that the shadow Minister may have had one too, so he may well know that I understand his point about the broader context.

[Jim Shannon]

Will the Minister give way?

[Edward Argar]

I will make a little more progress. If I can, I will then try to give way to hon. Members.

More needs to be done, and we are giving the NHS the support that it needs and has asked for. In addition to our historic settlement for the NHS in 2018, which will see its budget rise by £33.9 billion a year by 2023-24, we have pledged a record £36 billion for investment in the health and care system over the next three years. The funding will ensure that the NHS has the long-term resources that it needs to tackle the covid backlogs and build back better from the pandemic.

[Jim Shannon]

The hon. Member for Stockton South referred to recruitment within the NHS. What is the Government’s response to that, to ensure that we have the recruitment and the staff in place?

[Edward Argar]

As the hon. Gentleman will know, there are 1.2 million full-time equivalents in the NHS—a record number of staff. Take one example: our pledge for 50,000 more nurses by the time of the next scheduled general election in 2024. Last year alone, we saw the number of nurses in our NHS increase by 10,900. We have a plan in place, and we are recruiting and training more staff through increased numbers of places—at medical schools, for example.

[Margaret Greenwood]

Will the Minister give way?

[Edward Argar]

I will not, because I have only two or three minutes left. If I make sufficient progress, I will try to give way, but I cannot promise the hon. Lady.

We know that different parts of the system want to work together and deliver joined-up services, and we know that when they do, it works; we have seen that with non-statutory integrated care systems over the past few years. The petition calls for the Government to “scrap integrated care systems”, but to do so would be to let down our NHS. The reforms have been developed by the NHS, and integrated care systems are already in place. The Health and Care Bill places them on a statutory footing to allow for that integration and joined-up working to continue.

In the minute or two I have left before I hand back to my hon. Friend the Member for Stockton South, I will touch on PFI contracts, which is an issue that he and other hon. Members have raised. In 2018, the Government announced that PFI and PF2 will not be used for any future public sector projects, including those in the NHS. The Government will honour existing PFI contracts, as wholesale termination would not necessarily represent good value for money. We need to look at each on its merits; many have clauses for early termination, which would cost a lot more than the life of the contract.

However, we have committed to undo the worst of the contracts inherited from the previous Government. The hon. Member for City of Chester (Christian Matheson)—I hope he will let me tweak his tail a little on this—chided my hon. Friend the Member for Stockton South by saying he should be careful about references to PFIs. Of the 124 significant PFIs currently in place, 122 were signed between 1997 and 2010.

Mr Gray, I think you want me to give my hon. Friend the Member for Stockton South some time to sum up, so I will conclude. We believe that this Government are doing everything necessary to ensure that the NHS remains free at the point of use. We are working with the NHS to deliver what it has asked for through the Health and Care Bill. There is huge support from those working in the system for the direction of travel. The Bill will create a more efficient and integrated healthcare system that is less bureaucratic, and allegations that this is privatisation by the back door are simply misleading. Through the legislation, we will ensure better and more joined-up services, improving health and care outcomes for all.

Covid-19: Purchase of Critical Supplies

Edward Argar Excerpts

Monday 31st January 2022 Written Statements

[The Minister for Health (Edward Argar)]

This statement is on the accounting impairment impact of equipment purchased in response to the covid pandemic

Today, we are publishing information relating to our purchasing efforts for critical supplies that have helped this country in our fight against the pandemic.

Since this unprecedented global pandemic erupted our absolute priority throughout has always been saving lives.

In a highly competitive global market, where many countries imposed export bans, we secured billions of items of PPE and have delivered over 17.5 billion items so far to protect our frontline workers. The Government acted quickly to achieve the target of obtaining 30,000 ventilators by the end of June 2020. The supply of these vital items has helped to keep the NHS open throughout the pandemic and enabled it to deliver a world-class service to the public.

The scale of the challenge we faced in sourcing these goods should not be underestimated. Globally there were significant logistical challenges in sourcing, procuring and distributing goods. The rapid rise in international infection rates during the early stages of the pandemic created unparalleled demand.

The disruption to the market, coupled with the unprecedented spike in demand, resulted in a huge inflation in price for goods and intense global competition to secure scarce supplies. For example, the average cost of a nitrile glove increased over six-fold at the height of the pandemic compared with pre-pandemic levels.

In this unique situation, we had to change our approach to procurement and our appetite for risk. The risk that contracts might not perform and that supplies were priced at a premium needed to be balanced against the risk to the health of frontline workers, the NHS and the public if we failed to get the PPE we so desperately needed. We make no apology for procuring PPE at pace and volume so that we could protect thousands of frontline healthcare workers in the NHS and social care.

The Department assessed PPE requirements at the beginning of the pandemic. However, as this was a new disease, we did not have data on actual levels of need. The Department of Health and Social Care developed a sophisticated model to assess demand. Our estimates of demand relied on reasonable worst-case scenario planning, information about the prevailing IPC guidance and the likely number of patient interactions in every healthcare setting. The Department’s approach to cover all settings for healthcare workers means that we have additional stock of £0.8 billion.

Our planning also had to take into account the likely non-performance of contracts. Our buying activities were more successful than we predicted, such that 97% of the units purchased have been assessed as adequate to provide protection for health care workers. A small proportion (3%) of items have been deemed not suitable for use, equivalent to £0.7 billion.

We are now in a position where we have high confidence that we have sufficient stock to cover all future covid-19 related demands, even in the face of the omicron variant. The PPE stocks we secured have allowed us to meet demand through 2020-21 and 2021-22. Our existing PPE stocks will continue to support us throughout 2022-23. Indeed, the high standards of protection we set for NHS workers means that we have an additional 10% of units that may not be suitable for use within the health and social care sectors but may have alternative uses than those we originally envisaged—£2.6 billion.

Within the Test and Trace and Ventilators programme the high standards we have set means that we have items of kit and other equipment that are not suitable for use—£0.3 billion.

As part of the Department’s annual reporting, we have prepared a statement outlining the diminishment in value of the Department’s covid stock holding at 31 March 2021 due to:

For stock we expect to use, changes in global prices between the point of purchase and market prices at 31 March 2021. As the world market has now stabilised and we are returning to more “business as usual” conditions, the value of some categories of goods is now much lower than the price they were purchased for. For example, we now estimate the value of aprons that we purchased is a third of what we paid during the height of the pandemic.

Stock that has failed quality testing and/or technical assurance and is considered not fit for use in any setting. In these cases we are seeking recovery of funds from suppliers wherever possible.

Stock that we do not intend to use for its original intended purpose, perhaps because it was bought as a contingency or has characteristics that prevent its use in a UK healthcare setting but could be considered for alternative use or resale; and,

Stock in excess of current forecast requirements where alternative use or resale is required to maximise the value of the stockpile and prevent wastage through future date expiry.

Our efforts to manage the stockpile effectively, and in doing so maximise its value, are ongoing. The Department has established a redistribution team to identify alternative uses and resale potential for inventory we do not intend or expect to use. For example, donating masks to both the Department for Transport and Department for Education to aid the reopening of the economy on public transport and to support schools following their reopening in March 2021. Any repurposing or resale of inventory is carefully considered as maintaining adequate supplies for frontline workers remains our priority.

Medical professionals within the Department’s quality control and assurance function and colleagues within Medical Surveillance Authorities have recognised that stock which has exceeded its manufacturers use-by date, is not necessarily unusable. The Department has begun a tender for a third-party medical laboratory to provide official testing of PPE products with a view to extending shelf life to maximise the usefulness and therefore value for money from the PPE purchased without compromising the quality of goods made available for use.

In addition, the Department is currently working through a revision to the pandemic preparedness stockpile, incorporating the learnings from this pandemic. We now have a more strategic approach to our supplier base, signing contracts with over 30 UK-based companies, reducing our reliance on established manufacturers in the far east and our carbon footprint. Environmental considerations are at the heart of the Department’s strategy for the ongoing management of the covid inventory stockpiles, including inventory disposals.

[HCWS572]

NHS Constitution and Handbook

Edward Argar Excerpts

Thursday 27th January 2022 Written Statements

[The Minister for Health (Edward Argar)]

Statutory report on the effect of the NHS constitution and updates to the constitution handbook

In accordance with the Health Act 2009, I have laid before Parliament a report on the effect of the NHS constitution. The report has also been published on the gov.uk website, alongside an updated version of the handbook to the NHS constitution.

The NHS constitution, like the NHS, belongs to us all. It empowers patients, public and staff by bringing together in one document the founding principles and values of our NHS. It sets out the legal rights to which patients, the public and staff are entitled and the pledges that the NHS has additionally made towards them. Just as importantly, it makes clear the responsibilities which we all have for supporting the NHS to operate fairly and effectively.

Throughout this extraordinary time where we have seen the huge impact of the pandemic on staff, patients and society as a whole, our NHS workforce have strived tirelessly to protect the people we love. It is therefore more important than ever that patients, public and staff know their rights, responsibilities and what they can expect from their NHS.

The report is based on an independent survey of staff, patients and the public. It describes how they view the impact of the NHS constitution, and its value in promoting and raising standards of care.

While the report shows that public awareness of the constitution is still low, we are pleased to see it has increased since the 2018 report, and staff awareness remains significantly higher than public awareness. We know that those informed about the NHS constitution are more likely to use it and so there is further work to do in improving awareness to ensure we all get the most out of our interactions with the NHS.

Looking forward, a full review of the NHS constitution itself is due in January 2025. The scoping for this review, including a statutory consultation with patients, carers and staff will begin this year. We will use the findings from today’s report to shape the consultation and explore how to increase awareness and use of the NHS constitution across all public and staff groups.

Alongside this report we have also published a revised version of the handbook to the constitution. The handbook explains each right, pledge and responsibility in the NHS constitution. It is designed to give the public, patients, their carers and families, and NHS staff fuller information about what the constitution means for them. This revision ensures the information given in the handbook remains accurate and up to date.

[HCWS564]

Oral Answers to Questions

Edward Argar Excerpts

Tuesday 18th January 2022 Commons Chamber

[Craig Tracey (North Warwickshire) (Con)]

9. What steps his Department is taking to help (a) maximise NHS capacity and (b) increase the NHS’s resilience during the covid-19 outbreak.

[The Minister for Health (Edward Argar)]

Alongside measures to reduce demand and admissions, such as the vaccine roll-out and new therapeutics for covid, the NHS is creating the maximum possible capacity and investing in improved discharge arrangements, the use of independent sector beds, virtual wards and Nightingales to provide surge capacity, alongside our investment in delivering more than 20,000 more clinical staff this year compared with August 2020.

[Craig Tracey]

I thank the Minister for that answer. As he knows, one of the main challenges facing hospitals is delays in the transfer of patients back to care homes due to historic restrictions, particularly where there has been an outbreak, although there may have been only one case. As we move to treating covid as more of an endemic condition, what steps can be taken to stop restricting admissions to these care homes, which would undoubtedly relieve pressure on hospitals?

[Edward Argar]

There is local flexibility to allow residents to be safely admitted to a care home during outbreak restrictions, following a risk-based approach that takes into account the size of outbreaks, who is affected, care home size and layout, rates of booster vaccination and current Care Quality Commission rating. The CQC supports risk-based decisions made on admissions to support the discharge of people with a negative covid test result, but, of course, we must continue to ensure the safety of those in care homes.

[Martyn Day (Linlithgow and East Falkirk) (SNP)]

The workforce are absolutely central to growing NHS capacity. The advice in a Migration Advisory Committee report was to amend migration policies, make

“Care Workers and Home Carers…immediately eligible for the Health and Care Worker Visa and place the occupation on the Shortage Occupation List.”

When will the UK Government start listening to their advisers and change migration policies to alleviate the pressures facing our NHS?

[Edward Argar]

I am grateful to the hon. Gentleman for his question and for the tone of his question. He is absolutely right to highlight the importance of the workforce. The workforce are the golden thread that runs through the heart of everything we do in our NHS, which is why we have already taken a number of steps to increase our workforce. We are well on target to meet our target of 50,000 more nurses. As I mentioned in my initial answer, in August last year we had over 20,000 more clinically qualified staff compared with August 2020, so we continue to grow the workforce.

[Luke Hall (Thornbury and Yate) (Con)]

Delivering new community hospitals is a key part of upgrading and expanding NHS capacity. The Department is currently examining a bid to rebuild and expand services at Thornbury Hospital, which is desperately needed due to the expansion of the town. Will my hon. Friend meet me to discuss the next steps in delivering this vital infrastructure improvement in south Gloucestershire?

[Edward Argar]

I am grateful to my hon. Friend. He is absolutely right that, in looking to meet the demand challenges imposed on our NHS, it is not just about district, general or acute hospitals, but about all our hospital facilities, including community hospitals. He has raised this subject with me on a number of occasions. He is a doughty champion for Thornbury and, of course, I am always happy to meet him.

[John Cryer (Leyton and Wanstead) (Lab)]

On the issue of capacity, the argument has always been floating around that bed numbers can be cut on the basis of medical and technological advances. That was always deeply suspect, but in the context of covid-19 and its aftermath, can the Minister assure the House that there will be no cuts in bed numbers in any future hospital reconfiguration?

[Edward Argar]

Decisions on hospital reconfigurations and changes to local hospital systems are a matter for the local NHS, following full consultation and consideration of the needs of local communities. The hon. Gentleman is right to highlight the importance of bed capacity in the NHS. The NHS as a whole will continue to look at what bed capacity is needed to meet future need.

[Mr Gagan Mohindra (South West Hertfordshire) (Con)]

My constituent David Hulbert contacted me to ask that I pay tribute in the Chamber to the phenomenal NHS teams from both Mount Vernon Hospital and Watford General Hospital for the care he has received, following his admission for cancer. Will the Minister join me in thanking the NHS for its tireless, backlog-clearing work, and for continuing with lifesaving non-covid operations, alongside its ongoing heroic actions leading our covid fight and vaccine roll-out?

[Edward Argar]

I am always happy to take the opportunity, as I know the Opposition Front-Bench team and my colleagues are, to thank the amazing NHS workforce for the work they have done. I pay tribute to the work of the teams at Mount Vernon and Watford General and, in the context of the pandemic, I pay tribute to my hon. Friend the Member for Watford (Dean Russell), who volunteered to help out at the hospital.

[Dame Meg Hillier (Hackney South and Shoreditch) (Lab/Co-op)]

The Minister highlighted the use of independent care providers. Last week, the Department announced that 150 hospitals would be on standby for three months to provide additional resource. Can the Minister tell the House when he or his Secretary of State asked NHS England to investigate standing up the 150 hospitals, which will receive a minimum income guarantee of £75 million to £90 million a month?

[Edward Argar]

I think I heard the hon. Lady correctly and she asked when those discussions began. That was last year, prior to the peak of this wave. We believe that the use of the independent sector to assist our NHS and provide additional capacity is absolutely the right thing to do. Thus far, during the course of the pandemic, it has provided, I believe, over 5 million procedures to patients. Therefore, we think this is a valuable and important addition to our capacity, and it is right that we have this surge capacity insurance policy in place to help to meet further demand.

[Dr Andrew Murrison (South West Wiltshire) (Con)]

10. What assessment he has made of the effectiveness of the covid-19 vaccination programme in reducing hospitalisations.

--- Later in debate ---

[Caroline Ansell (Eastbourne) (Con)]

T7. My hospital trust is looking to redesign ophthalmology and cardiology services across its two hospitals, Eastbourne District General Hospital and Conquest Hospital in Hastings. The trust puts forward an important clinical case for the change, but given the realities—the road, the distance and the public transport options, which mean that it can be a journey of two hours via two buses for the one in four households in Eastbourne that do not have a car—any change can present a real problem and create issues for local people. Ahead of his visit to Eastbourne, will my hon. Friend the Minister meet me here to discuss this vital question of access to hospital services?

[The Minister for Health (Edward Argar)]

I am grateful to my hon. Friend. Public consultation on the reconfiguration in East Sussex was launched on 6 December last year and will close on 11 March. She is right to highlight access and transport links as a key factor in such decisions, and I would of course be delighted to meet her.

[Chris Law (Dundee West) (SNP)]

T3. Only 9% of people in low-income countries have received one vaccine dose. The UK Government have delivered less than one third of their pledged contributions to COVAX. Given that no one is safe until everyone is safe, what assessment has the Secretary of State made of the risk to public health from emerging variants from the unvaccinated worldwide, and will he ensure that all doses pledged will be delivered to COVAX by the end of June?

--- Later in debate ---

[Cherilyn Mackrory (Truro and Falmouth) (Con)]

T8. Building the women’s and children’s hospital at the Royal Cornwall Hospital was a key promise of this Government, and the Secretary of State’s predecessor was very supportive of it. Will my hon. Friend reaffirm the Department’s commitment to the building and agree to meet me to ensure that everything is done to get this vital project delivered on time?

[Edward Argar]

We remain fully committed to the delivery of the important new women’s and children’s hospital in Truro for the Royal Cornwall Hospitals NHS Trust as part of our new hospital programme. My right hon. Friend the Secretary of State remains committed to it, and of course I would be delighted to meet my hon. Friend.

[Chi Onwurah (Newcastle upon Tyne Central) (Lab)]

T10.   I hope you are watching “Geordie Hospital”, Mr Speaker—the Channel 4 series that follows the talented, highly skilled, dedicated and wonderfully witty staff of Newcastle upon Tyne Hospitals NHS Foundation Trust. As we enter our third pandemic year, after a decade of under-investment and low pay, and with staff shortages, absences and NHS waiting lists all rising, I hope that the Secretary of State recognises that what NHS staff need, as well as a great sense of humour, is a long-term workforce plan. Will he bring one forward?

--- Later in debate ---

[Dan Jarvis (Barnsley Central) (Lab)]

Sheffield’s Weston Park Cancer Centre is one of just four specialist cancer facilities in the country, but it desperately needs a £50 million upgrade, as the Secretary of State will know because I raised the matter with his predecessor and wrote to the Secretary of State in October and again just last week. Will he urgently respond to the proposal, which is vital for cancer outcomes in South Yorkshire?

[Edward Argar]

We will endeavour to respond swiftly, but if the hon. Gentleman would like to meet me about capital funding for those sorts of projects, I am always happy to meet him.

[Lee Anderson (Ashfield) (Con)]

Now then: the Health Secretary will be aware that King’s Mill Hospital in Ashfield was built under a disastrous private finance initiative deal under the last Labour Government. It now costs us about £1 million a week to service the debt—money that could be spent on social care in Ashfield. Will he meet me to discuss how we can rid my trust of this crippling debt of £1 million a week and spend it on social care?

[Edward Argar]

My hon. Friend is absolutely right to highlight the impact of yet another of Labour’s disastrous PFIs on the funding available to our NHS, and indeed to social care. We continue to work hard to deliver our manifesto commitment to improve on those disastrous PFI schemes. I am very happy to meet him to discuss the matter.

[Rachel Hopkins (Luton South) (Lab)]

Just last month, Luton lost an outstanding champion in the other place with the sad passing of Lord Bill McKenzie of Luton. Just 21 months previously, he had been diagnosed with pulmonary fibrosis.

Last week I met the chair of the Pulmonary Fibrosis Trust, one of my constituents in Luton South, who told me that there is no current cure for the disease and that for most people there is no known cause. Will the Secretary of State outline what steps his Department is taking to support research into a cure and to improve diagnosis, support and care for people living with pulmonary fibrosis?

Implementation of Statutory Integrated Care Systems

Edward Argar Excerpts

Wednesday 5th January 2022 Written Statements

[The Minister for Health (Edward Argar)]

Since 2018, Integrated Care Systems (ICSs) have been developing more integrated ways of working, bringing together NHS organisations and partners from local government and beyond to plan and provide services around residents’ needs as locally as possible. This integrated approach to person-centred care brings together actors in health and social care, alongside local and voluntary partners, to support people to retain their independence, health and wellbeing for longer.

The Health and Care Bill supports the move towards integration by providing measures to put integrated care systems on a statutory footing through the establishment of Integrated Care Boards and Integrated Care Partnerships. The Bill is currently being considered by Parliament and will soon be subject to line-by-line scrutiny at Committee Stage in the House of Lords. It is essential that Parliament is given sufficient time to properly consider the Bill.

Therefore, subject to the passage of the Bill, NHS England and the Department of Health and Social Care have continued to plan for the establishment of the proposed Integrated Care Boards. This includes a joint decision to set a target date for the introduction of statutory Integrated Care Systems in July 2022.

Joint working arrangements have been in place at system level for some time and significant steps have already been taken in preparing for the introduction of statutory Integrated Care Boards, if and when the Bill is enacted. This progress towards the proposed statutory Integrated Care Systems will continue in the new year. The target date for establishment of Integrated Care Boards in July 2022—which, as indicated earlier, is subject to the successful passage of the Bill—will provide greater certainty to systems and staff that are preparing for statutory Integrated Care Systems. NHS England and Improvement will of course continue to support systems with preparing for the proposed statutory Integrated Care Systems.

[HCWS516]

Medicine Supplies to Northern Ireland

Edward Argar Excerpts

Thursday 16th December 2021 Written Statements

[The Minister for Health (Edward Argar)]

Under the Northern Ireland protocol (NIP), medicines moving from Great Britain to Northern Ireland are required to comply with the EU pharmaceutical acquis. This creates a number of additional and duplicative regulatory barriers which risk the continuity of supply for medicines moving into NI.

Negotiations are under way to seek a bilateral agreement with the EU to tackle these problems. In order to support this, it is essential that we do everything we can to ensure that our regulations are fit for purpose, regardless of the outcome of these negotiations, and that the supply of medicines to patients in Northern Ireland is not put at risk.

The Medicines and Healthcare products Regulatory Agency (MHRA), and officials from my own Department for Health and Social Care (DHSC), have been working closely with officials from the Northern Ireland Department of Health (DHNI) in recent months to design a robust contingency measure which can be operational, if necessary, to support the flow of medicines into Northern Ireland from 1 January 2022.

Today the UK Government will be introducing a statutory instrument titled the Human Medicines (Amendment) (Supply to Northern Ireland) Regulations 2021 to establish the Northern Ireland MHRA Authorised Route (NIMAR).

NIMAR provides a route for the lawful supply of prescription only medicines that are unlicensed in NI, where no licensed alternative is available. This route will be tightly governed, with all medicines supplied via NIMAR already complying with the strong regulatory safeguards required for a product to enter the GB market. All medicines supplied this way into Northern Ireland will meet the MHRA’s robust standards that are in place for the rest of the UK.

Supply using the NIMAR route will be closely monitored by DHSC, in partnership with officials at DHNI. It will only be used where clinical need cannot be met by a licensed alternative, in the interests of public health.

It will allow citizens in NI to continue to access the prescription only medications that they require for their individual treatment.

The required statutory instrument will be laid before the house today, along with the accompanying explanatory memorandum, and I invite members to refer to this for more detail on the functionality and detail of NIMAR.

[HCWS507]

Food and Feed Safety (Miscellaneous Amendments and Transitional Provisions) Regulations 2021

Edward Argar Excerpts

Tuesday 14th December 2021 Written Statements

[The Minister for Health (Edward Argar)]

Following the end of the transition period, the Government continue to regard food and feed safety and standards as a top priority. This statutory instrument corrects and addresses deficiencies both in the retained EU law as well as in the domestic legislation that provided for its execution and enforcement in England.

The Food and Feed Safety (Miscellaneous Amendments and Transitional Provisions) Regulations 2021 will be made under powers in the Food Safety Act 1990 and the European Union (Withdrawal) Act 2018.

The purpose of this instrument is to:

amend article 53 of the retained general food law to correct a deficiency that has arisen as a result of the Northern Ireland protocol. The amendment will ensure that the emergency measures that may be applied where a serious risk to health is identified can be applied to all goods entering into GB;

amend the authorisation provisions for feed additives and GM food/feed, so that the decisions made by Ministers will be enacted through legislation making these consistent with other retained EU food and feed law; and

provide a time-limited period of adjustment, up until 30 September 2022, for businesses to meet new UK address labelling requirements for certain food products. This would allow businesses to use up old labelling stocks, without facing enforcement action for failure to label affected products with a UK address during this time.

As required under the “enhanced scrutiny procedure” set out in schedule 8 to the European Union (Withdrawal) Act 2018, the draft instrument and explanatory memorandum have been published online for a period of at least 28 days before the instrument is formally laid in Parliament. To read the full draft statutory instrument and explanatory memorandum, please visit: https://www.gov.uk/government/publications/regulations-on-food-and-feed-safety

[HCWS481]

West Suffolk NHS Foundation Trust: Publication of Independent Review Report

Edward Argar Excerpts

Thursday 9th December 2021 Written Statements

[The Minister for Health (Edward Argar)]

Today NHS England and NHS Improvement have published the report of the independent investigation to review whistleblowing at West Suffolk NHS Foundation Trust. This review was commissioned by NHS England and NHS Improvement at the request of the Department for Health and Social Care. It followed widely reported events arising from an anonymous letter sent to the relative of a patient who had died at the trust.

The review led by Christine Outram MBE has considered as its starting point the appropriateness and impact of the actions taken by the trust and other relevant bodies in response to the issues raised by and connected with the October letter. The review was also asked to produce advisory recommendations and learnings.

The findings of the review describe a breakdown in working practices and shine a light upon an executive team that was not sufficiently held to account by its board. In particular, the review found that fingerprinting and use of biometrics such as handwriting experts is not appropriate in any NHS context. The review also found that in handling whistleblowing material made available through unconventional or even inappropriate means, the NHS should still focus on what and why something is being raised, rather than who has raised it.

There is significant learning to be gathered from the report in relation to how freedom to speak up was implemented in the trust; and how freedom to speak up concerns should be separated from performance and disciplinary matters. The report also emphasises the importance of having strong board governance and checks and balance processes in place.

The trust and other relevant organisations including NHS England and NHS Improvement, the GMC and CQC will need to take stock of the findings of this important report. Indeed, this is a lesson for all NHS organisations to actively work to promote an open culture.

The Government take the issue of speaking up extremely seriously and have put in place clear sources of support for staff to help them raise a concern, including the speak up direct helpline and website and the National Guardian to help drive positive cultural change across the NHS so that speaking up becomes business as usual. The National Guardian also provides support and leadership to a network of over 700 local freedom to speak up guardians, covering every trust, whose role is to support staff who want to speak up about something.

The Government have also enhanced the legal protections available for those who speak up to prohibit discrimination against job applicants on the grounds that they have raised concerns. This is additional to the longstanding provisions of the Employment Rights Act 1996, amended by the Public Interest Disclosure Act 1998, which gives legal protection against detriment to all workers who speak up. We will continue to support the right of all workers in the NHS and wider health and care sector to speak up.

This review and its report have been delayed in part by the covid pandemic and complicated by the sheer scale of the issues that have emerged from this investigation. I would therefore like to thank Christine Outram and her team for their diligence, commitment, and hard work in getting to the heart of these matters.

This is a comprehensive report describing a complicated set of circumstances. Much has happened in the trust since the review was first commissioned. The report outlines the changes and actions the trust has taken to improve its HR, culture and leadership practices. These are encouraging signs that that the trust is learning and should be better placed in the future.

Whilst the response to the anonymous whistleblowing letter represents an unusual set of events specific to one organisation, the Department will absorb the report and consider the learning for the wider system and discuss with NHSEI what the next steps might be.

I have placed a copy of the report of the independent review into West Suffolk Hospital NHS Foundation Trust in the Libraries of both Houses.

[HCWS463]

Asthma Outcomes

Edward Argar Excerpts

Tuesday 7th December 2021 Westminster Hall

[The Minister for Health (Edward Argar)]

It is a pleasure to serve under your chairmanship once again, Mr McCabe, after our many hours in Committee. I thank my hon. Friend the Member for Strangford (Jim Shannon) and congratulate him on securing this debate and for his work on the APPG. As ever, in speaking of his and his family’s experiences, he was typically open for the benefit of the House and those watching our proceedings, and I pay tribute to him for that.

I also welcome the hon. Member for Enfield North (Feryal Clark) to her role on the Opposition Front Bench. She has big shoes to fill, but on the basis of today and what I know of her from her time in this House, I have no doubt that she will do so with skill and dedication and with her typical courtesy while holding us to account as a Government. I wish her all the best in the role.

The Government are dedicated to improving asthma outcomes. In the past 10 years, we have rolled out guidance and initiatives to improve in this area. In 2011, the Department for Health, as it then was, published an outcome strategy for COPD and asthma. It set out a proactive approach to early identification, diagnosis, intervention, proactive care and management. All stages of the disease, as we have heard from hon. Members on both sides of the House, can affect anyone. When it does, it has a huge impact on their lives.

I pay tribute to the hon. Member for Blaydon (Liz Twist) for bringing to life this issue and what it means for individuals with the examples she used, and for talking about her own experience, which is incredibly powerful. I pay tribute with her, as ever, for being willing to share that with this House.

A wrong diagnosis will result in patients not getting the care they need. That is why in 2013 “A Guide to Performing Quality Assured Diagnostic Spirometry” was produced by the NHS with several charities and stakeholders. It was published to support the accurate diagnosis of respiratory conditions to tackle the effects of misdiagnosis.

In 2014, the national review of asthma deaths—the first UK-wide investigation—was published. It aimed to identify avoidable factors, and make recommendations to improve care and patient self-management. NHS England and NHS Improvement commissioned the national asthma audit programme in 2018. It provides data on a range of indicators to show improvements and opportunities in asthma outcomes. The audit’s data are used by providers to assess their quality and support improvement.

More recently, as a number of hon. Members have alluded to, the NHS long-term plan, published in 2019, includes respiratory disease as a national clinical priority with the objective to improve outcomes for people with respiratory diseases including asthma. The respiratory interventions proposed in the NHS long-term plan include early and accurate diagnosis of respiratory conditions. Diagnosing conditions earlier may help to prevent avoidable emergency admissions for asthma.

As part of the long-term planning commitment, pharmacists in primary care networks will undertake a range of medicine reviews, including teaching patients the correct use of inhalers and contributing to multidisciplinary work. I can give my hon. Friend the Member for Loughborough (Jane Hunt) and constituency neighbour the reassurance she sought that we continue to work closely with the NHS in the delivery of that long-term plan, specifically on these objectives set out in it.

To deliver on that objective, NHS England has established 13 respiratory networks across the country. They will provide clinical leadership for respiratory services and are focused on improving clinical pathways for asthma. Since the long-term plan was published, a number of initiatives and publications have been announced.

Before making further progress, I will turn briefly to some of the comments made by hon. Members—I suspect this is a timely way of responding to them. My hon. Friend the Member for Loughborough talked about Kindeva, based on the Charnwood campus in Loughborough in her constituency. I know it well, as the neighbouring Member, and know that it is something she and Jonathan Morgan, the leader of Charnwood Borough Council have championed as a huge asset to our national economy and national effort in this space. She talked about the pMDI market, F-gases and the transition. We commit to our net zero ambitions, but she is right to highlight the need for the transition to be done in a sensible and measured way, and we continue to work closely with industry partners and industry-representative bodies in order to manage that process. I hope that gives her at least a degree of reassurance on this important issue.

NHS England’s national patient safety team has prioritised its work on asthma. This work is part of the adoption and spread safety improvement programme, which aims to identify and support effective and safe evidence-based interventions and practice across England. The asthma ambition is to increase the proportion of patients in acute hospitals receiving every element of the British Thoracic Society’s asthma discharge care bundle to 80% by March 2023.

The quality outcomes framework—QOF—ensures that all GP practices establish and maintain a register of patients with an asthma diagnosis. The QOF for 2021-22 includes improved respiratory indicators. The content of the QOF asthma review was amended to incorporate key elements of basic asthma care for better patient outcomes, including an assessment of asthma control, a recording of the number of exacerbations, an assessment of inhaler technique, and a written, personalised asthma action plan.

Since April 2021, the academic health science networks and patient safety collaboratives have been working with provider organisations to increase take-up of the British Thoracic Society’s asthma care bundle for patients admitted to hospital in England. Centres’ compliance with the elements of good care outlined in the bundle is measured in the national asthma audit.

[Jim Shannon]

I thank the Minister for his responses. He mentioned the 2023 target, to which I referred. Is it possible to shorten that timescale?

[Edward Argar]

As ever, the hon. Gentleman tempts me to be more ambitious. We have set 2023 as a realistic and achievable target. If it were possible to achieve it sooner, that would of course be a positive. Both in my Department and beyond, everyone will have been encouraged by the hon. Gentleman’s ambition and encouragement to go further and faster on that target, if they can. He makes his point well. I will make a little progress and then come back to several of the hon. Gentleman’s questions.

We recognise the particular effect of asthma on children and young people, which is why NHSEI’s children and young people’s transformation programme is promoting a systemic approach to asthma management. The first phase of the national bundle of care for children and young people with asthma has been developed with clinical and patient experts. A complete version of the bundle of care will be published in spring next year. The children and young people asthma dashboard, developed alongside the bundle, will be able to identify asthma care by race, geography, age and social deprivation, which goes to a number of points highlighted by the shadow Minister, among others. That will help ensure that children and young people with asthma who face the starkest health inequalities are prioritised.

The national care bundle has an environmental impact section that sets out three key standards around air pollution, which is an issue raised by Members on both sides of the House, including the hon. Member for Rutherglen and Hamilton West (Margaret Ferrier), who is no longer in her place. We set out the Government’s clean air strategy in 2019, recognising the impact of air pollution on health and a range of other factors that affect people’s lives. In this space specifically, we recognise three key standards. First, all healthcare professionals working with children and young people with expected or diagnosed asthma should understand the sources and dangers of air pollution. Secondly, patients and their parents or carers should always receive information on how they can manage asthma with regards to air pollution. Thirdly, integrated care systems should ensure that they are linked with schools, where education around asthma should also be provided.

The NICE guidance, entitled “Air pollution: outdoor air quality and health”, provides advice for people with chronic respiratory or cardiovascular conditions on the impacts of air pollution. It is important that we recognise that there are ways that, in a health context, we can care for people who face those impacts. Going back to the 2019 clean air strategy, however, we as a society have a much broader obligation to tackle the root causes of those problems and to improve the quality of our air, particularly in our cities but across our whole country.

Given the pivotal role of respiratory medicine in treating patients with covid-19, some centres’ ability to commence patients on biologics may have been impacted at the peak of the surge. I think all Members will recognise that.

The pandemic obviously revolves around a respiratory illness. Those who treat respiratory illnesses, including asthma, have been on the frontline, along with all our health and care staff. I join the shadow Minister and others in paying tribute to the amazing work they have done. As we seek to recover elective services and get more routine services back to normal, we are ambitious but also recognise, in the face of uncertainties over winter and the new variant, that respiratory services can be some of the hardest to recover and bring back to normal operation, because those are the services affected by the disease and the nature of its transmission.

[Liz Twist]

Will the Minister be a little more specific about the opportunity for those with severe asthma to access biologic services? That is a very specific ask. Without wanting to minimise the impact of covid-19 and the size of the need for a recovery plan, that is a specific issue for a group of people.

[Edward Argar]

I always give way to the hon. Lady, occasionally with a little trepidation, because I know she will ask a measured and difficult question. That is a very important question. During the pandemic, specialist respiratory services for severe asthma have continued to run, but she asked a specific question about biologics, a subject raised by several colleagues. Prescription and access to biologics is co-ordinated through severe asthma centre multidisciplinary teams. They should ensure all treatments, conditions and options are considered when prescribing. I am perhaps less clear about that than she might want, because I would caveat that by saying it would be a clinical judgment.

We do recognise the value of biologics. That goes to what the hon. Member for Strangford said: all treatments and options should be considered by clinicians on an individual, case-by-case basis, rather than what may have happened in the past, which was a presumption in favour of inhalers as a way of managing the condition rather than treating it or getting to the root causes. Although not eliminating the condition, that could deliver the improvements that make a difference based on an individual’s condition.

[Liz Twist]

As the Minister has said he is unable to be specific, will he write to us with a little more information on that issue, and how we could attempt to put it right? We have heard about the huge impact for the better on people’s lives.

[Edward Argar]

That is one of the easier things to do, given that this policy area belongs to the Minister for Care and Mental Health, my hon. Friend the Member for Chichester (Gillian Keegan), so I can commit to her writing to the hon. Lady. I am happy to do that, though I suspect that response will come back to the point about clinical judgment and decision making. I will also commit my hon. Friend to writing to the hon. Member for Strangford on the detailed and specific point he made about the annual review.

The use of remote consultations and biologic medication that can be taken at home mean we have been able to support most people with severe asthma during the pandemic. At the start of the pandemic, NICE published “COVID-19 rapid guideline: severe asthma”, which provided guidance on starting or continuing biological treatment. In writing that guidance, particular attention was paid to streamlining the process of moving patients on to biologic therapies, to compensate for any barriers that may have occurred because of changes to the NHS in response to covid-19.

The hon. Member for Strangford raised the subject of unified guidelines. NICE’s updated guidance is produced jointly with the British Thoracic Society and SIGN, so it will update all three key areas. They are working with other UK expert bodies to develop a joint guidance for the diagnosis, monitoring and management of chronic asthma, which will update and replace existing guidance.

Community diagnostic centres or CDCs—another theme raised by several hon. Members—which diagnose a number of conditions, are to be launched in place of asthma diagnostic hubs. Diagnostics for respiratory conditions are part of the proposed core services to be provided by CDCs. I hope that gives reassurance.

A review of diagnostics in the NHS long-term plan highlighted that patients with respiratory symptoms would benefit from that facility due to the number of diagnostic tests involved. At the spending review, we announced an extra £5.9 billion of capital support for elective recovery, diagnostics and technology over the next three years, with £2.3 billion of that to increase the volume of diagnostic activity and to roll out CDCs. The planned increase will allow the NHS to carry out 4.5 million additional scans by 2024-25, enhancing capacity, enabling earlier diagnosis and benefiting asthma patients.

I am conscious that I need to leave the hon. Member for Strangford at least three or four minutes for his winding-up speech. One point that has come up among hon. Members this morning has been about prescription charges: a challenging area. Currently, we have no plans to review or extend the NHS prescription charge medical exemption list to include asthma. I heard the points made by hon. Members, but a number of conditions are analogous to asthma, in terms not of their effects, but of their chronic or lifelong impact.

Equally, a balance has to be struck with proportionate charges and the contribution that makes to the NHS drugs budget to facilitate the provision of new treatment. Approximately 89% of prescriptions are dispensed free of charge already, and arrangements are in place to help those most in need. My hon. Friend the Member for Loughborough alluded to the fact that to support those who do not qualify for an exemption, the cost of prescriptions can be capped by purchasing a prescription pre-payment certificate, and that can be paid for by instalments. A holder of a 12-month certificate can get all the prescriptions they need for just over £2 a week.

When we started the debate, I wondered whether we would use the full hour and a half. It is testament to the hon. Member for Strangford, and the contributions of all hon. Members, that we have, and I should stop here to give him a few minutes to come back. To conclude, it is right for him to bring this debate to the House. I am grateful, as other hon. Members are, because asthma affects many of our constituents, day in, day out, and while we have made huge progress, it is right for him and other hon. Members to continue to press for even more ambition and even more progress. I pay tribute to him for that.