NHS Constitution and Handbook
Edward Argar Excerpts(4 years, 6 months ago)
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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.
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Oral Answers to Questions
Edward Argar Excerpts(4 years, 7 months ago)
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Craig Tracey (North Warwickshire) (Con)
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)
Caroline Ansell (Eastbourne) (Con)
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)
Cherilyn Mackrory (Truro and Falmouth) (Con)
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)
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(4 years, 7 months ago)
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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.
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Medicine Supplies to Northern Ireland
Edward Argar Excerpts(4 years, 8 months ago)
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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.
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Food and Feed Safety (Miscellaneous Amendments and Transitional Provisions) Regulations 2021
Edward Argar Excerpts(4 years, 8 months ago)
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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
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West Suffolk NHS Foundation Trust: Publication of Independent Review Report
Edward Argar Excerpts(4 years, 8 months ago)
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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.
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Asthma Outcomes
Edward Argar Excerpts(4 years, 8 months ago)
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Westminster Hall is an alternative Chamber for MPs to hold debates, named after the adjoining Westminster Hall.
Each debate is chaired by an MP from the Panel of Chairs, rather than the Speaker or Deputy Speaker. A Government Minister will give the final speech, and no votes may be called on the debate topic.
This information is provided by Parallel Parliament and does not comprise part of the offical record
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.
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.
Health and Social Care
Edward Argar Excerpts(4 years, 8 months ago)
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The Minister for Health (Edward Argar)
Madam Deputy Speaker, with permission, I would like to make a statement on the work we are doing to keep our country safe this winter. Today, we have published our health and social care approach to winter. This shows the preparations we are making so that health and social care services remain resilient, joined up and available to patients over the coming months, and it sets out what actions the public can take. As this plan shows, we are also doing everything in our power to give our NHS what it needs and keep it standing strong this winter, including through our plans to recruit more staff, give greater support to the NHS workforce and bolster capacity across urgent and emergency care. For example, the NHS has given ambulance trusts an extra £55 million to boost staff numbers this winter; there is nearly half a billion to fund an enhanced discharge programme; and we have measures to reduce pressure on accident and emergency departments, reduce waiting times and improve patient flow.
This document comes ahead of a critical winter for our NHS. We face the challenge of fighting covid-19, and the new omicron variant, along with the other challenges, such as flu, that winter can bring. We are doing everything we can to strengthen our vital defences. One of our main defences is, of course, our vaccination programmes, and we are expanding our booster programme, which hit the milestone of 19 million doses yesterday, along with delivering the largest flu vaccination programme in UK history. Yesterday, we announced how we will be buying a total of 114 million additional Pfizer and Moderna doses for 2022 and 2023, which will future-proof our Great British vaccination effort and make sure we can protect even more people in the years ahead. Another defence is antivirals, and it was fantastic news that yesterday another covid-19 treatment was approved by the Medicines and Healthcare products Regulatory Agency, after it was found to be safe and effective at reducing the risk of hospitalisation and death in people with mild to moderate covid-19 infection.
Just as we tackle the virus, we are also tackling what the virus has brought with it. The pandemic has put unprecedented pressure on the NHS and led to a backlog for elective care. To fix this, the NHS needs to be able to offer more appointments, operations and treatments, and we need to adopt new, innovative ways of working so patients keep getting the best possible care. We are determined to maximise the capacity of the NHS to keep elective services going over the winter months so that people can keep getting routine treatments such as hip surgery and diagnostic tests. Today, I am pleased to update the House on the £700 million fund that we announced in September for elective recovery. This transformative funding, which is being split across all regions in England, will support 785 schemes across 187 hospital trusts. It will help reduce waiting times for patients by providing more operating theatres and beds, and greater capacity for our NHS. Today, we have published the regional breakdown for this funding, which was allocated on a fair basis, according to weighted population, to make sure there was an equitable spread across the country. This includes £112 million for the north-east and Yorkshire, £131 million for the midlands and £97 million for the north-west. At least £330 million will be invested in the NHS estate and a further £250 million will be spent on digital initiatives that aid elective recovery. Over £600 million from this fund has already been committed to approved bids, such as for new wards at University Hospitals Birmingham, a new South Mersey elective hub and a new, modular unit in Castle Hill Hospital in Hull. This investment will have a huge impact, and this is the beginning not the end of our investment, as we are continuing to identify and assess submitted bids for investment in the remainder of this financial year. It is part of £5.4 billion that we have announced to support the NHS response to the pandemic in the second half of the year and it builds on the work done ahead of last winter, where we invested £450 million to upgrade A&E facilities in over 120 separate trusts, to boost capacity. This is a Government who back the NHS. Ahead of what will be a testing winter, we are putting everything behind our health and care services, so everyone can access the services they need when they need them.
I conclude by urging everyone to play their part this winter by taking simple steps that can help our NHS. People should get the jabs they need for flu and covid-19 when the time comes, and should follow the rules that we have put in place. If they do that, we can protect not only the NHS but the progress that we have all made. I commend the statement to the House.
Wes Streeting (Ilford North) (Lab)
I thank the Minister for advance sight of his statement. I pay enormous tribute to my predecessor, my right hon. Friend the Member for Leicester South (Jonathan Ashworth), who did a tremendous job as Labour’s longest-serving shadow Health and Social Care Secretary and worked constructively with the Government in response to the pandemic’s challenges. I intend to do the same.
In that spirit, I welcome this week’s announcements on the vaccine and booster roll-outs. I know from my own experience this year of kidney cancer and covid that some of the best people in our country work in health and social care. They are at the heart of my response.
NHS waiting lists stand at almost 6 million. Almost one in 10 people in England waits months or even years, often in serious pain and discomfort, because the Government have failed to get a grip on the crisis. Everyone understands that we are in the midst of a global pandemic that has placed the NHS under unprecedented pressure, but that does not excuse or explain why we went into the pandemic with NHS waiting lists at record levels and with unprecedented staff shortages.
Ministers want people to believe that the winter crisis is simply the result of the challenges of covid, but in reality, the entire health and social care system has been left dangerously exposed by their choices throughout the last 11 years. Before the pandemic, there were waiting lists of 4.5 million, staff shortages of 100,000 and social care vacancies of 112,000. This week, the National Audit Office detailed starkly that things are set to get even worse, with waiting lists set to double in three years.
Ministers cannot possibly believe that what we have been given today is a credible plan to meet those enormous challenges. If it were a genuine plan to prepare for the winter, why has it arrived on 3 December? A serious plan to bring down waiting lists would have the workforce at its heart, and would have clear targets and deadlines. A serious plan would recognise that, unless we focus on prevention, early intervention and fixing the social care crisis, Ministers have no chance of bringing waiting lists down to the record low levels we saw under the last Labour Government.
That Government had a serious plan to reduce waiting lists with 45,000 more doctors, 89,000 more nurses and the biggest hospital-building programme in our country’s history. The programme of investment, reform and clear targets delivered a decrease in waiting times from 18 months to 18 weeks. Although bricks and mortar and technology are important, and we do not sniff at the investment the Minister has outlined, the central challenge of the NHS winter crisis is a shortage of professional staff.
A credible plan to tackle the NHS winter crisis, which was foreseeable and foreseen, would have been published long before 3 December. Without a serious strategy to build the health and social care workforce that we need, this plan is not a plan at all.
Edward Argar
I join the shadow Secretary of State in paying tribute to his predecessor, the right hon. Member for Leicester South (Jonathan Ashworth), who is my near neighbour in Leicestershire. Although we may have occasionally crossed swords across the Dispatch Box, he is a deeply honourable and decent man. I also take the opportunity to pay tribute to the hon. Member for Leicester West (Liz Kendall), who is planning to take maternity leave in due course. She is a doughty champion for social care and the sector. I know that she will be much missed in her time away from the Dispatch Box.
I genuinely congratulate the hon. Member for Ilford North (Wes Streeting) on his post, although after that response, I do so with a degree of trepidation about what we might have in store for us in the months ahead from him challenging us—quite rightly. He is extremely diligent in all the roles he performs, so I welcome him to a challenging but fantastic role.
I will be relatively brief in my answers, because I am conscious that Fridays are for private Members’ Bills and private Members’ speeches. We brought the statement to the House because we believe it is important, given that it is going to the media, that we give the House an opportunity to question it.
The shadow Secretary of State was right to pay tribute to the workforce—the social care workforce and the health workforce, as well as all the other key workers who have helped get us to where we are in this pandemic. The workforce are the golden thread that runs through our NHS and through social care. Buildings and technology are important, but they are, essentially, the tools that the workforce use to provide that vital patient care.
We have a clear plan not only for winter, but for the recovery of waiting list times and for driving down those waiting lists. Ours is the party that has given the NHS record funding. Even before the pandemic, we put the £33.9 billion increase into law: we said we would do it, and we did do it. We are backing our NHS to give it the tools that it needs.
One issue on which I agreed with the hon. Gentleman is prevention. He is right: we need to look not only at the symptoms and the consequences in treating people, but at prevention of long-term and serious illness. He was also right in what he said about fixing social care, but I would urge a bit of caution. In 13 years we had two Green Papers, one royal commission and the 2008 spending review, all of which were designed to fix the social care problem. Result: nothing. This Government said they would come forward with a plan, and have come forward with a clear and coherent plan. I pay tribute to the Minister for Care and Mental Health, my hon. Friend the Member for Chichester (Gillian Keegan), and indeed to her predecessor, my hon. Friend the Member for Faversham and Mid Kent (Helen Whately), for the work that they have done in grappling with this very challenging issue.
The hon. Gentleman mentioned hospital buildings. Again, he was right: we are building 40 new hospitals. I would, however, say to him and to other Opposition Members that they should be very careful when talking about this subject. We all know that one of the biggest challenges we face with capital in our NHS is the millstone of PFI debt around the necks of NHS trusts—private finance initiative programmes put in place under the last Labour Government. We are still paying for that.
I welcome the hon. Gentleman to his post, and I suspect that on many occasions in the future we will have further such exchanges across the Dispatch Boxes. I am sorry that on his first outing in his new role he is facing me rather than the Secretary of State, but it is a pleasure to be opposite him.
Edward Argar
Charming as ever.
We are the party of our NHS. We are backing it with the resources and support that it needs to get through this winter.
Madam Deputy Speaker (Dame Rosie Winterton)
Order. I thank the Minister for his undertaking about brief answers, and I urge Members to ask brief questions as well. Otherwise we will not get everyone in, because we do need to return to the private Member’s Bills.
Sir Bernard Jenkin (Harwich and North Essex) (Con)
I thank my hon. Friend for his statement. Can he confirm that it is the Government’s policy to encourage the reopening of mass vaccination centres to get through the bulge of booster jabs that we need? In that regard, will he congratulate the South Suffolk & North East Essex integrated care system, which has once again secured facilities at Harwich international port, and will he thank the port for offering those facilities again? We are hoping for a mass vaccination session on 19 and 20 December, and further sessions in January. Is that not the way to take the pressure off GPs?
Edward Argar
Of course I join my hon. Friend in paying tribute not just to Harwich port but to his local healthcare system, about which he and I have spoken on many occasions. It does an amazing job: its willingness to find innovative solutions to boost our booster rates is exactly what we need to see. I commend everything that his local trusts are doing.
Alison McGovern (Wirral South) (Lab)
When my hon. Friend the Member for Leicester West (Liz Kendall) and I spoke to social care professionals from the Wirral last night, they made it clear that the crisis is not to come; the crisis is right now. They have staff shortages, and those in work are knackered and devastated at what is going on in social care. My hon. Friend the Member for Birkenhead (Mick Whitley) and I wrote to the Secretary of State, but we have received no reply. Will the Minister go back to the Department, obtain a reply to my letter, and tell me now, today, what we are doing to secure more staff and better pay in social care?
Edward Argar
As the hon. Lady knows, I do not have responsibility for social care. The Minister for Care and Mental Health is sitting next to me and will have heard what she said and will take it back to the Department to see whether a letter in response can be expedited.
We are fixing the system for the long term, but my hon. Friend the Minister has announced £162 million that is already going into the bank accounts of organisations to help support the social care workforce. The hon. Member for Wirral South (Alison McGovern) is right that we need short-term support, but we also need a long-term solution. We are putting the money in to support this vital sector.
Gary Sambrook (Birmingham, Northfield) (Con)
I thank the Minister and the Government for the eight successful bids into University Hospitals Birmingham NHS Foundation Trust, which will see new wards opened and will go some way towards helping our local NHS through the winter. What a stark contrast that is with the Labour years. When the Queen Elizabeth Hospital was built it was supposed to cost about £500 million, but that has rolled into billions of pounds’ worth of private finance initiative debt. Is that not the difference between us and the Opposition?
Edward Argar
My hon. Friend is a doughty champion for Birmingham and his local trust. It is always a pleasure to announce more money going into his trust, and he is right to highlight the Labour party’s record on PFI.
Mr Alistair Carmichael (Orkney and Shetland) (LD)
The question that will be asked by people in those parts of the country where the ambulance service is already in crisis, such as Cornwall and Shropshire, is: how quickly can they get this money? We are three weeks from Christmas and we are already seeing a crippling of the service in these areas. When will they see improvement?
Edward Argar
The right hon. Gentleman is absolutely right that ambulance trusts across the country are under pressure, which is why they have already been given an additional £55 million, well in advance of this winter, to help them prepare for and manage the pressures they are experiencing. This money is on top of that, but they already have additional funding to help support them through what will be a very challenging winter.
Felicity Buchan (Kensington) (Con)
This Government are investing an additional £34 billion in the NHS this year alone. Does my hon. Friend agree that this money needs to go to the frontline and that we need to ensure that we get value for money?
Edward Argar
I am grateful to my hon. Friend for highlighting both the investment and the need for us, as the custodians of the taxpayer’s pound, to make sure that the money is well spent by implementing innovation and reform so that it gets to the frontline and delivers patient care, which is exactly what we are doing.
Chris Bryant (Rhondda) (Lab)
I have a sneaking suspicion that we will not get to the second private Member’s Bill today, so I hope it is okay if I mention that I am enormously grateful to the Government. The Secretary of State for Health and Social Care has just texted me with the good news that the Government and I, and all the charities, will be working together on acquired brain injury. We will now have a national strategy across all Departments. It is a miracle that the Government have suggested that I should co-chair it with the Minister for Care and Mental Health, because I can be very irritating—[Laughter.] I see I have united the House. Seriously, this is a really good day and I hope we will be able to make a dramatic difference to the millions of people in this country who have suffered an acquired brain injury. Answer that!
Edward Argar
I have never found the hon. Gentleman to be irritating in any way, and I have always enjoyed my interactions with him on a range of issues. On a serious point, I pay tribute to him for his campaigning work on this issue. It is a huge step forward, and I know the insight he will bring, working with the Minister for Care and Mental Health, will genuinely make this a strategy of which we can all be proud. I congratulate him on his achievement.
Dean Russell (Watford) (Con)
My constituents in Watford will no doubt welcome the £700 million of funding detailed today to support the NHS this winter. Will my right hon. Friend please confirm that the investment will directly improve services for patients across the NHS? Will he also share my thanks to Watford General Hospital and all its staff for the fantastic work they continue to do at this time?
Edward Argar
I am not right hon., but I am grateful to my hon. Friend for the promotion. Of course I pay tribute to the staff at Watford General Hospital and, indeed, to him for his volunteering on the frontline in that hospital trust during the pandemic. He is absolutely right. As I said to my hon. Friend the Member for Kensington (Felicity Buchan), it is vital that this money gets to the frontline and is used to improve patient care, which is exactly what we intend to do.
Lilian Greenwood (Nottingham South) (Lab)
I am shocked and saddened by reports of a 23% increase in physical assaults on staff in Nottinghamshire hospitals in the past year, including 436 assaults on NHS workers in Nottingham hospitals. As we head into the season of Christmas revelry and hopefully responsible celebrations, will the Minister join me in condemning this completely unacceptable violence, which should never be part of any NHS worker’s job, and can he set out what he is doing to prevent such assaults and to protect and support NHS staff?
Edward Argar
I am grateful to the hon. Lady; I had the pleasure some months ago of visiting one of her local hospitals, where I had the opportunity to speak to staff. They do an amazing job. No one, irrespective of the role they perform, should be subject to intimidation or violence in doing their job, still less those who are working hard to save lives, to protect us and to get us through this pandemic. I join with her entirely in condemning both physical and verbal assaults on members of our emergency services. I highlight the important legislation that went through recently to increase the penalties, and pay tribute to those responsible for getting it on the statute book—the hon. Member for Rhondda (Chris Bryant) once again. No one, absolutely no one, particularly in our emergency services, should be subject to abuse of any sort while doing their job.
Mrs Flick Drummond (Meon Valley) (Con)
GPs in Meon Valley are finding it difficult to recruit new GPs to fill vacancies, and as a consequence are working very long hours. Can the Minister ensure that some of the new money goes to primary care and GPs in particular?
Edward Argar
I am grateful to my hon. Friend, who rightly highlights the hugely important contribution of GPs to our health system. We continue to look at the best ways to support them, not only by recruiting more GPs and supporting existing ones, but by investing in general practice buildings to ensure they have the tools to do the job.
Andy Slaughter (Hammersmith) (Lab)
My local hospitals, Hammersmith and Charing Cross, and their staff are under huge pressure. Until two years ago, the Government’s plan was to demolish Charing Cross hospital, so it is a welcome U-turn that it and Hammersmith hospital are now in the creatively titled 40 new hospitals programme. Leaving aside the fact that Charing Cross has been around for more than 200 years and is thus not really a new hospital, all my constituents want to know is how much investment there will be and when it will finally arrive.
Edward Argar
I have not yet had the privilege of visiting the hon. Gentleman’s hospitals in this role; maybe at some point in the coming months, perhaps when they are not quite so busy, I will do so with him—if he will have me. We have committed to the investment, but it is important that that investment programme is run as a programme, with all the hospitals being looked at in terms of the phasing and profile of the investment to ensure it delivers the results we want. On that specific point, knowing the interest he has taken in it, I am happy to meet him to talk specifically about his local hospital project and the improvements to be made.
Peter Gibson (Darlington) (Con)
I welcome my hon. Friend’s statement, particularly the extra £112 million for north-east Yorkshire. Our NHS is a priority for everyone in this House and, indeed, a priority for every one of my Darlington constituents. Does he agree that putting our £33.9 billion cash boost on the statute book demonstrates this Government’s and our party’s unwavering commitment to the NHS?
Edward Argar
I think it does exactly that, and demonstrates this party’s and this Government’s commitment to the NHS. What my hon. Friend has also demonstrated, as always, is his unwavering commitment to his constituents in Darlington and to championing their cause in this House.
Mike Kane (Wythenshawe and Sale East) (Lab)
I was born in the then relatively modern maternity unit at Wythenshawe hospital in my constituency. After 53 years, I am afraid one of us is beginning to look a little old and tired. The Minister knows we have a strategic regeneration framework for the whole site, with world-class breast, cystic fibrosis, heart, lungs and burns care facilities. We have the money in the bank to do it, but because of archaic Treasury rules we cannot get on with it. Come on, Minister—let us change those rules.
Edward Argar
I can reassure the hon. Gentleman that it is not him who is looking a little old or worn around the edges. I understand the point he makes, and he and I have met about this particular issue, which goes back to what counts against capital allocations in terms of accounting. He tempts me to change Treasury rules; I fear that could be career-limiting, as I am not a Treasury Minister, but I will continue to talk to him and work with him to see whether we can find a way to allow the project to proceed.
Angela Richardson (Guildford) (Con)
I am reassured to see that applications to study nursing and midwifery have risen by 21% this year alone. Having recently joined my midwives on their March with Midwives up the high street in Guildford, I know that midwives urgently need their numbers boosted. Will my hon. Friend confirm that we remain on track to deliver 50,000 more nurses by the end of this Parliament, as we promised in our manifesto?
Edward Argar
I can confirm that my hon. Friend is absolutely right in her assessment of the progress that we are making.
Mike Amesbury (Weaver Vale) (Lab)
When are Halton and Warrington going to get their new hospital campuses? We have waited for far too long.
Edward Argar
The hon. Gentleman showed admirable brevity in making his point very clearly, as ever—[Interruption.] I suspect he faces a bit of competition from his hon. Friend the Member for Wythenshawe and Sale East (Mike Kane) for the funding. In my recollection—forgive me if I am off on this—I think that Halton and Warrington have submitted a bid for funding as part of the next eight. There is considerable interest in this. We are evaluating all those at the moment and, in the coming months, we will work that down to a shortlist. It would be wrong for me to prejudge that process, but it is not wrong, of course, for the hon. Member for Weaver Vale (Mike Amesbury) to continue championing his local hospital and its cause.
Mr John Whittingdale (Maldon) (Con)
I welcome today’s announcement and join the Minister in paying tribute to all those working for the NHS. The biggest challenge in mid-Essex, and I suspect nationally, is access to primary care, particularly managing to get through on the telephone line and, after that, obtaining an appointment. Can the Minister say any more about what the Government are doing to address that?
Edward Argar
My right hon. Friend is right to highlight primary care, essentially, as the front door for many people into the NHS system. GPs and general practice have done a fantastic job. They have worked very hard, but it has been very challenging. The Secretary of State announced additional money to support GP practices in returning to face-to-face appointments and in seeing more people—we have seen significant investment in that. The percentage of face-to-face appointments continues to go up, which I know matters to a large number of all our constituents.
Julie Marson (Hertford and Stortford) (Con)
Two weeks ago today, my hon. Friend was very generous with his time and in his support for the tragic case of my constituent, Jessica Brady, who passed away aged 27 from cancer. Will he confirm that the funding to support the NHS and the focus on policies such as the community diagnostic hubs, along with some of the other things that we discussed two weeks ago, will help people, including in Hertford and Stortford, to get the referrals that they need?
Edward Argar
I remember that Adjournment debate very clearly. My hon. Friend made an incredibly moving and powerful speech, highlighting Jessica’s situation, what happened to her and her circumstances. My hon. Friend made the point about the importance of early diagnosis and a holistic approach to a patient’s symptoms, and then diagnosis and treatment. The investment that we are putting into diagnostic hubs will help to do exactly that and bring those diagnostics to the heart of our communities, allowing more people to be seen more quickly.
Nick Fletcher (Don Valley) (Con)
I thank my hon. Friend for the £700 million that he has announced this morning; my Don Valley constituents will be pleased to hear that. While I have the Minister’s attention, will he thank all the volunteers in Doncaster and all the constituents who have come forward to have their jab? And is there any chance of a new hospital?
Edward Argar
I will certainly join my hon. Friend in paying tribute to all the volunteers and all those who have come forward for their jabs. For a brief moment, I thought that that was where he was going to end, but he is a proud champion of Doncaster, just as you are, Madam Deputy Speaker, and it would have been very strange were he not to conclude by lobbying once again for the new hospital that he wants. I pay tribute to him for that.
Ruth Edwards (Rushcliffe) (Con)
I welcome the £131 million for the midlands that the Minister has announced today. I am very aware, though, that my constituents in East Leake are being served by a health centre that is the oldest in Nottinghamshire and which is far too small for the population growth that we have seen in recent years. Twenty months ago, the then Parliamentary Under-Secretary of State for Health and Social Care—my hon. Friend the Member for Bury St Edmunds (Jo Churchill)—promised at the Dispatch Box that we would have a ministerial visit to East Leake so that the Department could see what we were dealing with. I completely understand that that was impossible at the height of the pandemic, but that has long passed, so will the Minister recommit to that visit today and take that request back to his Department, because despite repeated chasing by me and my office staff, we cannot get a date from it in the diary?
Madam Deputy Speaker
Order. It is very important that we do not go off the boil in terms of briefness of questions. The Minister is being very good at being brief in his answers.
Edward Argar
It would be easy to commit the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Lewes (Maria Caulfield), to a visit because she is not here. Equally, I am conscious that East Leake is just up the road from my constituency, so it may be that my hon. Friend gets me instead. I will certainly look into that visit.
Andy Carter (Warrington South) (Con)
Following the point made by the hon. Member for Weaver Vale (Mike Amesbury), the greatest challenge that we face to recovery from covid in Warrington is that our hospital is too small. Warrington trust recently submitted a bid for a new purpose-built hospital. Will my hon. Friend assure me that, in the new year, he will look favourably on Warrington?
Edward Argar
My hon. Friend, along with many right hon. and hon. Members, is doing his bit to push the cause of his local hospital investment bid. As I said to the hon. Member for Weaver Vale (Mike Amesbury), I commend that, but it would be wrong for me to be drawn while the process is still under way.
Dr Ben Spencer (Runnymede and Weybridge) (Con)
I thank my hon. Friend for his statement on health and social care planning. The worry is, of course, that the omicron variant will put a lot of pressure on that planning. Will he update the House on where the Department has got in crunching the data on how dangerous or not omicron will be?
Edward Argar
The latest statistic I have on the number of cases in this country is, I believe, 42. That work is still being done. We have seen various news reports today on things that might be encouraging, but I encourage everyone to wait and see while that analysis is done. It will take two to three weeks for the scientists to do their amazing work in understanding whether this new variant is more infectious and more virulent as well as how it responds to therapeutics and vaccines, and I am afraid that we will have to be patient while they do that work. Hopefully, they will come back with positive news, but it is too early to say.
Rob Butler (Aylesbury) (Con)
I welcome the publication of the health and social care approach outlined by the Minister. The details of the funding breakdown to help tackle a backlog in elective care will undoubtedly provide hospitals with the clarity and support that they need. However, we also need to reduce the number of people remaining in hospital when they no longer require medical care. Does he agree that one possible option to help alleviate that would be intermediate care provision that is a step between hospital and home?
Edward Argar
My hon. Friend is absolutely right to highlight that. My hon. Friend the Minister for Care and Mental Health has done a huge amount of work on both investment and working with local systems to improve hospital discharge for those who do not need to be in hospital any more, to give them that step-down support, be that domiciliary care or in other settings. In the current context, we must do that safely, but she is working extremely hard to deliver that and doing a fantastic job.
Mike Wood (Dudley South) (Con)
The investment that the Minister has announced together with the 100 community diagnostic hubs will make a big difference in helping people to get the referrals that they need. Does my hon. Friend agree that early diagnosis depends on being able to see the appropriate clinician face to face where necessary, whether in hospital or in a GP’s surgery?
Edward Argar
My hon. Friend is right. The key words are “where necessary”, and that is a clinical judgment. I have highlighted the improvements that we are seeing in terms of the number of face-to-face appointments going up in primary care. Equally, we do not want to lose the benefits of telephone appointments or other appointments for those who wish to interact in that way. It is about trying to craft the system around the patient and taking those clinical judgments into account.
Joy Morrissey (Beaconsfield) (Con)
Will my hon. Friend allocate a portion of the enhanced winter discharge funding to mental health support for young people? I have had another secondary school student take their own life—that is my crisis. We need more mental health support and out-of-hospital provision for young people.
Edward Argar
My hon. Friend highlights the hugely important point that over winter we face challenges not just in physical health but in mental health, particularly as we come through the pandemic. One reason that we are investing £500 million in mental health catch-up is that we know how vital it is that we do not just talk about parity of esteem but recognise it in the resources that we put in.
Ian Levy (Blyth Valley) (Con)
My constituents in Blyth Valley will welcome the £700 million in funding for the NHS. May I thank the staff in the sterilisation unit in Cramlington, the A&E hospital for Northumberland, for all the work that they have done? That goes to prove that we are a proactive Government, not a reactive Government, when it comes to healthcare.
Edward Argar
I join my hon. Friend in paying tribute to the team in the sterilisation unit in his local accident and emergency hospital. He is absolutely right: throughout the pandemic and the Government’s existence we have given the NHS the resources and the backing that it needs to get on with the job.
Simon Jupp (East Devon) (Con)
People in East Devon will warmly welcome the £700-million investment in our NHS. Will my hon. Friend outline when patients in Devon will know how that money will improve local services?
Edward Argar
I am grateful to my hon. Friend. This money is being allocated to the regions, then to individual trusts. A large amount of that money has already been allocated to specific projects that have been announced today. The rest of the money, when allocated to local systems, will then be allocated by that local system—the people who know their area best.
Tom Randall (Gedling) (Con)
Staff in hospitals in Nottinghamshire are working hard, as we have heard, sometimes in difficult circumstances. Today’s announcement includes an extra £4 million of spending for hospitals in Nottinghamshire. Does my hon. Friend agree that that will make a real difference to patients in Nottinghamshire, and will he join me in thanking staff in Nottinghamshire hospitals for the hard work that they are doing at the moment?
Edward Argar
I am happy to join my hon. Friend in paying tribute to the work of the staff in his local hospitals. He is absolutely right to highlight the fact that that money will make a huge and real difference to patient care in his local hospital trust and in his local area.
Jacob Young (Redcar) (Con)
Will the Minister join me in thanking our fantastic primary care services across Teesside, without which we would not have had our world-leading vaccine roll-out? Will he come to Redcar and Cleveland to visit fantastic GP surgeries such as Normanby medical centre and the Saltscar surgery in Redcar, which have been doing all that they can under tremendous pressure?
Edward Argar
It looks as if I might be going on tour again; the same thing happened when I last did one of these statements. I am happy to go to “Bluecar”—or Redcar, to call it by its proper name—to see my hon. Friend in his constituency, and to make such a visit when it can be arranged.
Marco Longhi (Dudley North) (Con)
I welcome the Minister’s statement and the gargantuan amounts of money that he, his team and the Government are putting into the NHS. Can he provide me and my Dudley constituents with some assurances that that will translate into additional capacity and bringing down the covid-induced backlogs?
Edward Argar
Absolutely, I can give my hon. Friend that assurance. He rightly alludes to the fact that the inputs are important, but for those of us on the Government Benches, it is the results they bring—the outputs—and what we do with the money that matter. We will ensure that that money is well spent, harnesses innovation and delivers even better patient care and access to his constituents and many others.
Madam Deputy Speaker
I thank the Minister for his statement. We return to debate on the private Member’s Bill.
NICE-Approved Products: Patient Access
Edward Argar Excerpts(4 years, 8 months ago)
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The Minister for Health (Edward Argar)
As ever, I congratulate my hon. Friend the Member for Newton Abbot (Anne Marie Morris) on securing this debate and I pay tribute to her work in this area. That work has been sustained for as long as I have been a Member of the House—I was first elected in 2015—but I suspect that this area was of interest to her long before then. I pay tribute to her for her continued engagement on this area, which is not always top of the news or top of the political agenda, but is hugely important none the less, so I pay tribute to her work in this space.
I reassure my hon. Friend that the Government share this priority. She is right—I characterise this in these terms and I hope that she will not demur from this—that although the NHS workforce is the beating heart of our NHS, it is beholden on us to give them the tools that they need to be able to use their skills to treat and support the maximum number of possible patients in the most effective way. I think that is a fair reflection of the point that she made at the outset.
Edward Argar
That is an encouraging start. That is why NICE exists. It plays a vital role in supporting patient access to new treatments. Through its technology appraisal and highly specialised technologies programme, NICE makes recommendations for the NHS on whether all new medicines represent value for money for the taxpayer.
NICE aims to publish guidance on new medicines as soon as possible after licensing and is committed to publishing draft recommendations on medicines around the time of marketing authorisation, wherever that is possible. It has a well-earned reputation as a world leader in the field of health technology assessment and it is right that, where NICE recommends a medicine or a medical device, it should be available to patients who stand to benefit. Value for money is important and I will come to that. I suggest that whether the NAO or the Public Accounts Committee wish to look at this is a matter for them, but as my hon. Friend said, she may wish to take that up with the hon. Member for Hackney South and Shoreditch (Dame Meg Hillier), who may well share her interest—I would not wish to presume, but the hon. Member may well.
Making treatments available is why NHS England and clinical commissioning groups are already under a statutory obligation to fund any treatment recommended by NICE through its technology appraisal or highly specialised technologies programmes, usually within three months of guidance. I will turn to my hon. Friend’s point on timing shortly. This will also be a statutory obligation for integrated care boards. As my hon. Friend has set out, the NHS constitution states that patients and the public
“have the right to drugs and treatments that have been recommended by NICE for use in the NHS, if your doctor”—
the treating clinician—
“says they are clinically appropriate for you.”
That is an important point, because we rightly rely on clinical judgment in such circumstances. As my hon. Friend will be aware, NICE recommends the vast majority of new medicines—indeed, in 2020-21 it recommended 100% of them, often thanks to commercial agreements negotiated between NHS England, NICE and companies in parallel with the NICE assessment process—but it is right that that clinical appropriateness filter is there.
I am conscious of time, but before I turn to specific points that my hon. Friend made, I would like to say a few brief words about the success of the cancer drugs fund in supporting patient access to new medicines. The cancer drugs fund was originally introduced to support patient access to medicines that NICE was unable to recommend as cost-effective. Since 2016, however, the fund has been linked to the NICE appraisal process and supports patient access to promising new medicines where the evidence is not mature enough for NICE to recommend routine funding at that point. This has benefited more than 73,000 patients, who have been able to access 91 medicines through the cancer drugs fund, treating more than 200 cancers.
We are building on that fabulous achievement with our manifesto commitment to extend the cancer drugs fund model to non-cancer treatments by creating an innovative medicines fund. I think that there are lessons that we can learn from the cancer drugs fund. NHS England has also recently launched a consultation on proposals for the establishment of the innovative medicines fund. I encourage anyone with an interest to engage; knowing my hon. Friend, I suspect that she has probably pre-empted me and done so already.
I turn briefly to medical devices and treatments. The hon. Member for Strangford (Jim Shannon) was quite right to highlight that, although debate often focuses on drugs and specific medicinal or therapeutic treatments, we also need to look more widely at medical devices and at treatments that take other forms than therapeutic treatment. I know that he takes a close interest in the treatment and support of those with dementia, as I did before I was a Minister; I am grateful, as ever, for his contribution to the debate.
As hon. Members will know, NICE can also make recommendations on treatments through its clinical guidelines programme. Guidelines provide authoritative, evidence-based guidance for healthcare professionals and play an important role in driving best practice in the health and care system and supporting improved patient outcomes. However, they often make dozens of recommendations that can be complicated to implement at a local level. For that reason, they are not mandatory, but I assure the House and my hon. Friend the Member for Newton Abbot that the Government expect the healthcare system to take guideline recommendations fully into account in designing services that meet the needs of the local population and in working towards their implementation over time. It is right, however, that that implementation reflects local circumstance and is done at a local level.
I turn to local formularies; time is getting short, but I may also turn briefly to the eight points that my hon. Friend made—let us see how we do. She has raised concerns, not only in this debate but during the Health and Care Bill’s passage through the Commons and in conversations with me, that despite positive NICE guidance, some medicines are not available to NHS patients because they are not included on local formularies. In addition to the statutory funding requirement that applies to NICE-recommended treatments, NICE’S guideline “Developing and updating local formularies” recommends that, when NICE approves the use of a medicine through a technology appraisal, it should be automatically adopted into local formularies.
The standard contract mandated by NHS England for use by commissioners stipulates that providers must ensure that formularies include all NICE-recommended treatments. That process should take place within three months, allowing services a realistic timeframe to prepare for the introduction of a new technology. I appreciate that my hon. Friend went a little further on tightening the timeframe and the compulsion element, but given the complexity of some new treatments, I think that three months probably remains an appropriate timescale. I suspect that she will continue to push me on it, but at the moment I believe it is the right approach.
My hon. Friend is right that the system needs monitoring. She called for an obligation on integrated care boards to report uptake of new medicines annually, which is effectively monitoring. I am pleased to say that the Government support the view that uptake of NICE-recommended medicines should be monitored. Since 2013, NHS Digital has published an innovation scorecard that reports, at a national and a local level, the uptake of selected medicines that NICE has recommended in the last five years. I believe that it is more appropriate and proportionate that that information is collected and published by a single national body using agreed methodology, rather than multiple organisations that may have different ways of measuring and presenting the data.
My hon. Friend made a number of other points. Given the time constraints, I fear that I cannot address them all, but I will reflect carefully, as ever, on what she has said. Given that neither of them are present in the Chamber, it is a pleasure, as always, to agree on their behalf that my noble Friend the innovation Minister and my hon. Friend the Member for Mid Norfolk (George Freeman)—the life sciences Minister—will be delighted to meet her to discuss the matter in more detail. I am very grateful to her for bringing this evening’s debate to the House.
Question put and agreed to.
Oral Answers to Questions
Edward Argar Excerpts(4 years, 8 months ago)
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Siobhain McDonagh (Mitcham and Morden) (Lab)
When the chief inspector of hospitals placed St George’s in Tooting into special measures, he warned that the
“emergency department was not large enough for the number of patients that passed through it and privacy and dignity were compromised.”
Given the report by the British Red Cross in this morning’s edition of The Times highlighting the causal link between A&E attendance and deprivation, does the Minister understand the further huge impact that moving acute services from St Helier to wealthy, healthy Belmont will have on A&E attendances at St George’s?
The Minister for Health (Edward Argar)
Forgive me, but I fear the hon. Lady may not have moved her tabled question.
Edward Argar
I can answer the hon. Lady’s supplementary question, but would it be in order for me to answer her tabled question and then the supplementary?
Siobhain McDonagh
Edward Argar
I am grateful to the hon. Lady. To answer the tabled question, no recent assessment has been made of the changes associated with the Epsom and St Helier reconfiguration, including proposed changes to some services outside the new Sutton site. The hon. Lady will know that these proposals have been through consultation, judicial review and the independent reconfiguration panel, which all supported the plans as being in the local population’s interest. The Secretary of State agreed with their advice.
Turning to the hon. Lady’s supplementary question, I am grateful to her and I know how strongly she feels about the issue, but I take her back to the point I have just made, which is that these proposals have all been through extensive consultation and extensive legal process and been looked at by the independent reconfiguration panel. Those processes all concluded that what is proposed is in the best health interest of the population.
Philip Dunne (Ludlow) (Con)
The Minister for Health (Edward Argar)
I am grateful to my right hon. Friend, who has taken a long-term and consistent interest in the matter. The strategic outline case for transforming the Royal Shrewsbury Hospital and Princess Royal Hospital Telford was received at the end of October 2021. It has been reviewed by the NHS and detailed feedback has been given; I look forward to it coming forward to me early next year. We remain committed to delivering the investment and improvement that Shropshire’s hospitals need and that he and his colleagues have helped to secure.
Sarah Green (Chesham and Amersham) (LD)
Women across the country have lost jobs and life savings as a result of chronic pain and disability caused by complications after the use of medical mesh. Many, including one of my constituents, have had to pay for corrective surgery overseas. The Government have so far refused to set up agencies to provide financial redress, as was recommended in the Cumberlege report. Will the Secretary of State revisit the Cumberlege report, and in particular the need for financial redress?
Daisy Cooper (St Albans) (LD)
Ambulance response times are at their highest since records began. A month ago, on 22 October, I tabled a parliamentary question asking the Secretary of State how many ambulance trusts had moved into level 4—the level at which potential failures creep into the service. I am still awaiting an answer. Will the Minister answer that question today, please?
Edward Argar
If the hon. Lady supplies the number of the question, I will ensure that it is dealt with today. As for her broader point, yes, ambulance services across the country are under significant pressure this winter, which is one of the reasons why we have already invested an additional £55 million in helping them to cope with that pressure.
Mr Speaker
I call the Chairman of the Health and Social Care Committee, Jeremy Hunt.
Daniel Kawczynski (Shrewsbury and Atcham) (Con)
The Minister has heard from my right hon. Friend and neighbour the Member for Ludlow (Philip Dunne) how essential it is that the £320 million we have secured for the Future Fit programme be released, so that construction can start. We are beginning to see a definite negative impact on A&E services because of the seven or eight years of delays. Please will the Minister do everything possible to ensure that the money is finally released and construction can start?
Edward Argar
I am grateful to my hon. Friend, and likewise to my right hon. Friend the Member for Ludlow (Philip Dunne), who has campaigned vigorously this issue. We now have the outline business case from the trust, and we are reviewing it at pace to ensure that we can deliver the investment in both of Shropshire’s hospitals that they need to continue to serve my hon. Friend’s and colleagues’ constituents.
Jeff Smith (Manchester, Withington) (Lab)
My 90-year-old constituent, Jimmy, fell in his garden recently and broke his hip. When his family rang 999, they were told that it would be up to 14 hours before an ambulance could attend. The family got the fire brigade out after two and a half hours to sort him out. When the Government going to get a grip on the crisis in our ambulance services?
Edward Argar
The hon. Gentleman might have done this already, but if he wishes to, I would be grateful if he wrote to me about that case, not only to see whether there is anything I can do, but because it is always interesting and useful to hear from individual Members about specific incidents. To his broader point, as I set out to the hon. Member for St Albans (Daisy Cooper), we have invested £55 million this year ahead of the winter to support our ambulance services, but it is entirely true to say that they are under considerable pressure this winter across the country.