Oral Answers to Questions

Greg Clark Excerpts

Tuesday 11th July 2023 Commons Chamber

[Steve Barclay]

Some of us remember when the Lib Dems were for greater localism. One of the things we are looking at is how to empower commissioners, on a place-based basis, to make decisions on where best to place services. We need to move more services into the community upstream, to address the frail elderly before they get to hospital and to have more community services. I am happy to look at the specific issue the hon. Gentleman raises, but I would have thought the Lib Dems would support the general trend of empowering integrated commissioning systems to make place-based decisions.

[Greg Clark (Tunbridge Wells) (Con)]

Several important pharmacies in my constituency, including the one in Hawkhurst, have been experiencing pressures, with long queues of customers sometimes going outside the door. It is said that access to trained pharmacists is proving very challenging. Will the Secretary of State comment on the situation and say what steps he might be able to take to alleviate the pressure?

[Steve Barclay]

There are a number of measures in the primary care recovery plan, from how we better use the skills mix within pharmacies to how we deregulate some of the tasks that take up pharmacists’ time, such as the requirement for a pharmacist to be present after drugs have already been prepared or to clip out tablets because they do not match the number prescribed by a GP. There are a number of areas in which we can better use the skills mix, and there are areas where we can take load off pharmacists. We are also funding additional services through Pharmacy First to support the pharmacy model.

Access to GP Services and NHS Dentistry

Greg Clark Excerpts

Tuesday 21st June 2022 Commons Chamber

[Sajid Javid]

I do not have the exact figures to hand, but I know that millions of pounds were drawn down and used to deliver tens of thousands of appointments across the country. That made a huge difference to a great many people.

[Greg Clark (Tunbridge Wells) (Con)]

The urgent care centres are an important innovation, but it is also important for them to be accessible throughout the country. There are seven in Kent, but the one nearest to my constituents is 33 miles away. Could my right hon. Friend intervene with the NHS in the south-east to bring about a more even distribution?

[Sajid Javid]

My right hon. Friend’s point is important and well made, and I will look at the issue closely and get back to him, if I may.

As we have already heard today—but it is such an important point—the challenge for NHS dentistry predated the pandemic. It is not just about the number of dentists in England, but about the completely outdated contracts under which they are working, which were signed under a Labour Government. [Interruption.] Labour Members do not like it, but it is true. These contracts mean that we are operating almost with one hand tied behind our backs. They do not incentivise prevention, they hold back innovation, and they mean that hard-working families cannot get the dental services that they deserve. However, we will now be changing that; our work with the sector, along with the work of Health Education England on recruitment and retention, will be vital for the future.

Covid-19 Update

Greg Clark Excerpts

Thursday 13th January 2022 Commons Chamber

[Sajid Javid]

The Prime Minister stood at the Dispatch Box yesterday and apologised; he set that out very clearly from this Dispatch Box. As he said, and as I think most people have accepted, it is right to wait for the completion of the investigation by Sue Gray.

[Greg Clark (Tunbridge Wells) (Con)]

I join the Secretary of State in his tribute to Professor Jonathan Van-Tam for his remarkable public service, and I welcome the announcements that he has made today. Restrictions have an impact beyond covid, and we should be as responsive in lifting them as we are in imposing them. Given the news he has given us today that over 91% of over-50s have been boosted, can he confirm that we are on track to lift the plan B restrictions when they expire on 26 January, and will he include in that the advice on face masks in classrooms, for which a particularly weak evidence base was published?

[Sajid Javid]

I thank my right hon. Friend for his support for these new measures. He speaks with considerable experience. He is absolutely right to talk about the impact of restrictions beyond health. He has heard me, and other members of the Government, say before that no restrictions—none at all—should be in place for a moment longer than is absolutely necessary. He will know that the plan B restrictions, unless this House were to decide otherwise, will sunset on 26 January. On what happens next in terms of the Government’s own view, we will set that out as soon as we can.

Public Health

Greg Clark Excerpts

Tuesday 14th December 2021 Commons Chamber

[Greg Clark (Tunbridge Wells) (Con)]

My right hon. Friend talks about hospitalisations and the danger they may cause to the NHS, but will he reflect on the fact that it is not just hospitalisations but the length of stay in hospitals that determines how many beds are occupied? Evidence from South Africa suggests not only that there are fewer hospitalisations, but that people are in hospital for a much shorter time. Is that reflected in his calculations?

[Sajid Javid]

Yes, I can confirm that to my right hon. Friend. First, he is absolutely right to make that point. Of course it is not just about individuals entering hospital but about how many days they are likely to stay in hospital. I believe that for the delta variant an individual stays, on average, about nine days in hospital. If that was cut to five or six days, of course it would help with capacity. First, we cannot assume that, because what we are seeing in terms of the impact in South Africa is that hospitalisations there are rising rapidly; there are hundreds of people in intensive care units and on ventilators. It is hard to completely read that across, given that the average age of the South African population is about 27. I hope he would agree that, as with the point I just made on severity, even if the hospital stay is half of what it is at the moment, the rate at which this thing is growing—and if it continues to grow at that rate—means that that benefit could be cancelled out in two days.

--- Later in debate ---

[Greg Clark (Tunbridge Wells) (Con)]

It is a pleasure to follow my right hon. Friend the Member for South Northamptonshire (Dame Andrea Leadsom). I think everyone acknowledges that the Government have a difficult task. Although it is important that we debate the regulations before us, in some ways, they are not the most damaging measure. The advice that the Government gave to work from home has much more significant consequences than any of the relatively minor measures we are discussing. Unlike the regulations, that advice does not have an expiry date or an impact assessment, even though we know the impact on businesses across the country, and on young people who work for firms that are perhaps conscious of what their insurers and regulators might require, once again being confined to their homes. That is significant and it is a shame that the House does not have a chance to vote on it.

On the measures that we have a chance to vote on, there is a lack of clarity about the purpose of the access certificates, if I may call them that. Is it to prompt people to get a vaccine? Is it to give people a nudge and those who have not availed themselves of a vaccine a further incentive to do so? If so, what is the evidence for that working? We know that 90% of the population are vaccinated. What motivates that remaining 10%? Is it the case that the desire to attend a football match or a nightclub will cause them to take up the vaccine? If so, the measure might be a good one. However, we are inconveniencing the 90% of people who are vaccinated when we have no evidence. What are the alternatives? If we really want the remaining people to take up the vaccine, rather than requiring a pass at the entrance to a nightclub or a football ground, perhaps we should have a vaccine centre at the turnstile or the door. That might be better for those who have been too disorganised to arrange their vaccine. We do not know; we have reached for compulsion.

As colleagues have said, the measure cannot just be about obtaining a vaccine. The option of a negative lateral flow test would not be available if the purpose were just to nudge people. There is a certain logic to requiring 100% of people entering a venue to have a negative test, but as we know, it is perfectly possible for people with just two jabs to transmit covid. There is an ambiguity about the purpose of the measures. Given that the consequence for business owners and venue operators of failing to get right some very complex regulations is a fine of £10,000—a huge amount for small business operators—we should not take that lightly.

I wonder whether the Minister can answer, possibly in an intervention, a question that came up in the debate about whether the lateral flow tests are to be self-administered or sent, at some cost, to a third party to administer. Perhaps the Minister will clarify that in his winding-up speech.

Whatever the difficulties, there are flaws in the approach, about which I hope the Minister can provide some reassurance when he winds up.

Sickle Cell Treatment

Greg Clark Excerpts

Wednesday 8th December 2021 Westminster Hall

[Greg Clark (Tunbridge Wells) (Con)]

It is a pleasure to serve under your chairmanship, Mrs Miller. I congratulate the right hon. Member for Wolverhampton South East (Mr McFadden) on securing this debate, on his very powerful speech and on his leadership of the APPG. I agreed with every word that he said. He is right that this issue should unite Members in all parties. I have the honour to have recently replaced our very good friend, Sir David Amess, as the Conservative officer of the APPG; I do so with pride. It is a great responsibility and I look to continue the formidable work that Sir David did for this very important cause, as he did for so many other causes in this House.

The right hon. Member for Wolverhampton South East has given a comprehensive account of a very powerful and impactful report. I want to highlight a number of its observations and recommendations, drawn from the evidence given by people who are living with sickle cell or, in many cases, have suffered the consequences of family members falling victim to the condition. My first point reflects on inequality, as referred to by the right hon. Gentleman. I have the honour of chairing the Science and Technology Committee, and some Members will have read the joint inquiry report that my Committee and the Health and Social Care Committee conducted; one of the chapters of that was about the differential impact of covid on different groups in society. We made some recommendations as to how we could improve our practice in future. As the right hon. Gentleman said, that also applies to sickle cell.

In particular, the report emphasises the need for a—if I may put it this way—geographical strategy for the management and response to sickle cell. As the right hon. Gentleman said, sickle cell disproportionately affects black people; we know that the distribution of people of ethnic minorities is not consistent across the country. That will mean that there are some places that have an ethnically diverse population who are used to coping with and helping people with sickle cell; other places will not. That cannot be left to chance; all places have people who will have sickle cell. It is very important that we put in place connections between those hospitals and trusts that have deep experience and those that do not. That would mean that experience could be accessed immediately when the circumstances arose. That is a very important commitment that we should make. The establishment of 42 integrated care systems across the NHS provides the ideal mechanism for that.

The second point from the report that I wanted to emphasise—which the right hon. Member for Wolverhampton South East also touched on—is the differential practice within hospitals. Some disciplines, such as haematology departments, have very high levels of understanding and expertise in caring for sickle cell patients, but other departments and disciplines within the same hospitals do not. I am particularly concerned by the patchy experience of A&E departments and emergency medicine. That is very important, and I hope that the Minister, in her response, will point to ways in which the diffusion of knowledge across hospitals—rather than its remaining in silos—can be seized on as a practical outcome of this report, as it is clearly attainable.

Thirdly, I want to emphasise the importance of giving timely pain relief to people presenting in A&E with sickle cell. We know that there is an acute need for that to be administered promptly. The National Institute for Health and Care Excellence standard is that that should be within 30 minutes, but the report was striking in noting that only 30% of adults—for example—said that they were given pain relief early enough. It is greatly concerning that people are suffering great distress during that time, and that has longer-term consequences for their health. In this time of covid, and as we enter into the winter when, as we know from our experiences as constituency MPs, A&E departments come under particular pressure and waiting times are understandably longer, there is an especial need for emergency medical practitioners to be able to not only spot but respond to the very immediate needs of people presenting in A&E departments with sickle cell.

For the fourth aspect that I would like to emphasise, I will again draw from our work in our covid inquiry. A consequence of covid and the response to it in hospitals has been that, as we know, there are great restrictions on relatives and carers accompanying people into hospitals. We looked at the experience of people with learning disabilities who did not have people to advocate for them. Obviously we are talking about sickle cell, not about people with learning disabilities; nevertheless, the assistance of their relatives, loved ones and carers is particularly important. They are able to communicate the particular needs of the patient at a time when the sufferer may not be able to express themselves because of intense pain. I hope that might be recognised during the remaining period of this covid pandemic—that there are patients who need people to help communicate their needs if they are in a state that means they cannot do that directly themselves. Of course, one means of doing that is to pay attention to their care plans, so that they are followed. That would be a way in which we can ensure that the right treatment is given.

Those are just four of the themes that come out of a very comprehensive and powerful report, but they are four aspects that have a particular relevance to the immediate weeks and months ahead, as we face some difficulties across the NHS. It is important, as we seek to ensure that covid does not exacerbate inequalities, that this potential further source of inequality is attended to, and that action is taken by the NHS so that conditions during the weeks ahead can be better than they would otherwise be.

--- Later in debate ---

[Maria Caulfield]

The hon. Member makes an excellent point. There are NICE guidelines on sickle cell, so I will ask departmental colleagues to look at how often they are not followed. The issue was raised about analgesia not being given within half an hour of someone presenting. That is in NICE guidance, and the guideline should be followed in A&E or other areas where patients are admitted. I am happy to look at the prevalence of that not happening and why not. Again, I think that a lot of it is not deliberate. Much of it is to do with the education of staff, who might be in busy A&E departments with lots of people in pain, and they might not realise the impact on a sickle cell patient who does not get analgesia in a timely manner.

[Greg Clark]

On the point about A&E, I welcome, as I am sure colleagues do, the commitment to look at the figures. Given that we have APPG reports, could the Minister perhaps circulate them, through the NHS, to A&E departments to remind them of the current NICE guidance?

[Maria Caulfield]

My right hon. Friend makes an excellent point. I am happy to work with departmental officials to look at how, if the NICE guidelines are there, we can make sure they are distributed so that all clinical areas are aware of them, particularly, as the point was made, to areas where there is a high prevalence of sickle cell that are more likely to see someone admitted to A&E. I am happy to take that forward.

I want to reassure colleagues that progress is being made. I want to place on the record my thanks to all those in specialist units who work really hard behind the scenes to improve the care for sickle cell patients and to get information out to the NHS across the board. Where there are gaps, I am happy to work with the APPG to make sure we address those.

Covid-19 Update

Greg Clark Excerpts

Wednesday 8th December 2021 Commons Chamber

[Sajid Javid]

I thank the hon. Gentleman for his constructive tone. He made the important observation that while the emerging data suggests that current vaccines may well be less effective in providing protective immunity, that does not mean that they are ineffective. It is especially important for those who have not had any jabs to have their first vaccination, and for people to have their booster jabs, and the older and more vulnerable people are, the more important that is.

The hon. Gentleman spoke of the need for us to work together. He may well know that I have regular meetings, sometimes more than once a week, with my counterparts across the UK, as does the Prime Minister, who is also the Minister for the Union. That is a well established and, I think, very good way to work together on this pandemic.

[Greg Clark (Tunbridge Wells) (Con)]

A week ago, the Secretary of State assured me from the Dispatch Box that he would not trigger further restrictions based on a rise in infections which was predicted and, in fact, was always inevitable. He said that

“what matters more than anything is hospitalisations.”—[Official Report, 29 November 2021; Vol. 704, c. 683.]

That data is not available yet, so why has the Secretary of State reversed his position and jumped the gun in this way?

[Sajid Javid]

That is a very fair question, and it requires a full explanation. There is new data since I was last at this Dispatch Box on the rate and growth in transmissibility, and there is new data, to which I referred in my statement, on the impact of the variant on vaccines. My right hon. Friend will know that if the vaccines were even a little bit less effective, especially against severe disease and therefore against hospitalisation, and if there was also a hugely growing infection rate, a smaller percentage of what would be a much larger number would still result in significant hospitalisations.

Covid-19 Update

Greg Clark Excerpts

Monday 29th November 2021 Commons Chamber

[Sajid Javid]

First, on the hon. Gentleman’s question on day two testing, we believe that the day two testing requirement for international travel is the proportionate response. He will know that it applies to all arrivals to the UK, and that the individual would have to self-isolate until they got a negative test result, and I think that is the right response.

In terms of meetings and the UK nations working together, that has been one of the successes of the UK’s response to the pandemic. The way that nations across the UK have worked together, especially on vaccines, testing, surveillance and antivirals, shows that we are stronger together.

[Greg Clark (Tunbridge Wells) (Con)]

Sir Andrew Pollard, who developed the Oxford vaccine, predicted in June to my Select Committee that new variants would escape the vaccines by being more infectious, but said that protection against severe illness should continue. Will my right hon. Friend avoid taking any panic measures if we see a rise in infections in the weeks ahead, as seems inevitable, and concentrate instead on the vaccine’s effectiveness against severe illness and hospitalisation?

[Sajid Javid]

My right hon. Friend is absolutely right. As I said in my statement, even in the case of the dominant delta variant, we have seen some rises in infections, but also falls in hospitalisation and death rates, thankfully. The reason for that is the power of the vaccines, and especially our booster programme, which is the largest in Europe. He is absolutely right: with the new variant, as we look ahead, what matters more than anything is hospitalisations.

Health and Care Bill

Greg Clark Excerpts

Report stage
Tuesday 23rd November 2021 Commons Chamber

[Jeremy Hunt]

The hon. Lady is absolutely right. Medical school, the foundation years and, as my right hon. Friend the Member for South West Wiltshire (Dr Murrison) said, the retention of staff—all those things need to be built into long-term planning and baked into the system.

That long-term planning strikes a contrast, if I may say so, with some of the short-termism that we have seen recently. Even in the recent Budget and spending review, the budget for Health Education England, which funds the training of doctors in this country, was not settled. Although I think that the proposed merger with NHS England is probably the right thing to do, I fear it will mean that the budget is not settled for many more months, at precisely the moment when the workforce crisis is the biggest concern for the majority of people in the NHS.

[Greg Clark (Tunbridge Wells) (Con)]

My right hon. Friend is making an excellent speech, and I strongly support his amendment. Will he add to the list of factors that need to be considered in the future the requirement for many research scientists in medical sciences to be trained in medical schools first? If we want to expand and build on the excellence that we have there, it is not just a question of meeting the needs of the NHS workforce; we need to have extra people who can become the brilliant researchers and discoverers of new medicines in the future.

[Jeremy Hunt]

My right hon. Friend speaks about these issues with a great deal of knowledge, given his former ministerial and Select Committee roles, and he is absolutely right. I think that the big lesson from the pandemic, and indeed an issue that emerged in the report that our Committees jointly produced, is the way in which science can add value to clinical practice and clinical practice can add value to science.

Autism and Neurodiversity Research Funding

Greg Clark Excerpts

Tuesday 16th November 2021 Commons Chamber

[Robert Buckland]

My hon. Friend is right. Drawing on her local government experience and having been directly responsible for many of these services she encapsulates the best practice we see in many local areas. The trouble is that we do not see it everywhere and there is, to use the dreaded phrase, a postcode lottery, which is just not good enough for so many families across our country.

I see where we are now as a moment to make a choice. There is a golden opportunity for Government and indeed for society, and I deliberately wanted to include neurodiversity in this debate because I believe it is hugely important. Diagnostic descriptions are vital for many families. Speaking from my own experience, they open a door to statutory services and obligations—statements, as we used to call them, or education, health and care plans as they became under the Children and Families Act 2014. However, the system is in danger of becoming a prisoner of that process. In the natural concern that public authorities have to conserve resources there is a danger that we start to become overly obsessed with labels and then find that if somebody is not labelled there is, to mix my metaphors, a cliff edge and nothing for the person who does not happen to get through the door marked “autism”.

Let us think about that for a moment—think about how wrong that is in terms of the lives we are dealing with. No one person just presents as autistic; they might have a range of conditions and challenges including, for example, epilepsy, which, sadly, is a very common comorbid condition with autism. There are also other conditions that might fall short of autism but if undiagnosed the consequences can be baleful, such as attention deficit hyperactivity disorder, attention deficit disorder, dyslexia and other types of impairment that mean that people cannot access education, for example, in the way that neurotypical people can. These conditions might not be seen as acute compared with some other conditions that are diagnosed but can lead to disaster for the individual if they are not diagnosed.

School exclusion—I see the hon. Member for Croydon Central (Sarah Jones) in her place—is the most obvious consequence. That is a particular issue, and the disengagement with the system that it can lead to all too often leads to a descent into criminality, which, frankly, then brings us back to the criminal justice outcomes that I have been wrestling with all my professional life and in my ministerial incarnation. In devising the right type of support, we need to try to put the process in its proper context. We must remember that this is about the person and centre something on the individual and their needs.

I am delighted after many years to renew my association with Autistica, our country’s leading autism research organisation. Today, by happy coincidence, it published an excellent support plan on autism. Having read it very carefully, I think it is groundbreaking. It is targeted, and it tries to move the debate in a direction in which I think all of us, including the families and those who have autism, would like to see it go. That contribution follows from the Government’s own commitment, in the revised autism strategy published at the end of July, to improve autism research, to improve innovation and to look for examples of best practice.

As we near a very important moment in the life of our country, with the Department’s publication later this year of the long-awaited White Paper on social care, Autistica has identified a gap in research—and guess where the gap is, Madam Deputy Speaker. It is in social care. We have learned so much about genetics and about the causes or the reasons for autism. That has been incredibly important in understanding that this is a condition, not an illness or a disease, and that there is no cure, and in moving away from all that redundant language and understanding the condition for what it is—and celebrating it too, by the way. We do not do enough of that. We tend to view it as some sort of wicked problem. For many people, it is actually their life; it is who they want to be and how they want to be recognised. We must never forget that.

[Greg Clark (Tunbridge Wells) (Con)]

My right hon. and learned Friend is making a powerful speech, and it is good to have him free to contribute in this way. Does he agree that, in so far as there are problems, they can be in people’s responses to those with autism, and that if people were to respond in a better informed and more generous way, then such problems as exist today may not be there in the future?

[Robert Buckland]

My right hon. Friend is absolutely right. There is no doubt that an inappropriate response, or a response, however well intentioned, that results from a lack of evidence or a lack of understanding, can make a bad position much worse for somebody with a condition such as this. Therefore, for me, research is not a luxury or an optional extra; it is essential. If we, as public services, as private enterprise, as business—as an economy that needs a supply of new talent, bearing in mind the announcement today that there are 1.2 million job vacancies in our country—are to really release the potential of people with brain conditions, then this is, to use the phrase, a no-brainer.

[Greg Clark]

I am grateful for my right hon. and learned Friend’s indulgence—

[Madam Deputy Speaker (Dame Eleanor Laing)]

Order. I did not correct the right hon. Gentleman the first time, but it is essential that he faces the Chair rather than the right hon. and learned Member for South Swindon (Robert Buckland), because he cannot be heard if he is speaking to the back of the Chamber. I never understand why, when there is all this space, people want to sit where the occupant of the Chair cannot see them. There must be a reason for it.

[Greg Clark]

I will address you directly, Madam Deputy Speaker. I accept your ruling on that.

One problem people with autism sometimes face is that, when they come to an age where they are looking for jobs, work experience is increasingly important and some employers are reluctant, based on lack of familiarity and nervousness, to give work experience opportunities to young people with autism and other conditions. Work experience is an essential gateway to employment. Will my right hon. and learned Friend join me in encouraging employers to open up and give work experience opportunities to a wider range of young people?

[Robert Buckland]

My right hon. Friend is absolutely right. We have seen that in other areas, for example mental health, where there has been concerted work, including by excellent organisations such as the Mindful Employer Network in my area, to demystify the issue and remove the stigma. Such work allows employers to understand autistic people, some of whom see the world in ways that you and I could not dream of. Going back to my celebratory point, it is all about the potential of people with neurodiverse conditions and what they have to offer.

Covid-19 Update

Greg Clark Excerpts

Monday 15th November 2021 Commons Chamber

[Sajid Javid]

First, may I say to the hon. Gentleman that one of the biggest successes of our national vaccination programme is the UK-wide approach, which has really helped to build confidence? The way that Scotland, England and other parts of the UK have moved together to accept advice is really important. I hope it stays that way.

The hon. Gentleman rightly asked about the unvaccinated and what is being done. I know that Scotland will have an approach as well, but certainly in England it has been very much about making sure that access is as easy as possible, with multiple sources, from vaccination centres to grab-a-jab offers and walk-in centres. It is also about communications to remind people not only of the vaccine’s importance, but of its safety and effectiveness.

I think that in his question about mandating, the hon. Gentleman was referring to the requirement in England for NHS and social care workers to be vaccinated. That whole issue was looked into very carefully. There was a consultation, which received more than 30,000 responses, and I have explained in detail how the Government reached the decision. I think it is vital for patient safety, and I hope that Scotland is able to take a similar approach and protect its patients in hospitals and care homes in the same way as England has.

[Greg Clark (Tunbridge Wells) (Con)]

It is excellent that the new vaccines are effective and safe, and I welcome this announcement. On the theme of fleetness of foot, however, will the Secretary of State address two important practical matters? First, when will the NHS certification app be updated to record third doses, given that some countries require that for admission purposes? Secondly, when will it be possible for third primary doses to be booked via the NHS website, rather than, as at present, having to be booked through GPs? We are all aware of some of the pressures that GPs face.

[Sajid Javid]

As my right hon. Friend will know, the reason that third doses, or boosters—however they are classified—are not currently shown on the app is that they are not required for domestic purposes to demonstrate someone’s vaccine status. However, I fully understand the significance of my right hon. Friend’s point. I recognise that this is now a requirement in some countries, and I think it important that we respond. I want to reassure my right hon. Friend, and other Members, that we are considering how best to make such information available, and I will have more to say about that shortly.