Alcohol Harm

Helen Whately Excerpts

Tuesday 17th March 2020 Westminster Hall

[The Minister for Care (Helen Whately)]

I congratulate my hon. Friend the Member for Congleton (Fiona Bruce) on securing the debate. Despite all that is going on around us, there have been some substantial contributions to the conversation that have made some really important points. I am responding on behalf of the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Bury St Edmunds (Jo Churchill), who is currently working on emergency legislation for coronavirus, and will do my very best to give a full response to the questions that have been raised.

I thank my hon. Friend the Member for Congleton for her comments, particularly about the work that we are doing in response to coronavirus. I should add that, although I am grateful that she thanked the ministerial team, the thanks should go to those on the frontline, such as the NHS and social care workforce. They are the ones who are really taking the issue on.

I commend my hon. Friend for the huge amount of work that she has done on this matter and for her commitment to ensuring that we reduce the harm caused by alcohol. Most people drink responsibly and the good news is that we are seeing an overall decrease in the number of people who drink, especially among young people. However, the Government are not complacent and are determined to do more to support people at risk from alcohol misuse. Our aim is to ensure that people are directed to the appropriate service wherever and whenever they look for help.

[Fiona Bruce]

I thank the Minister for giving way and for stepping in to respond to the debate. She said that most people drink responsibly, but Drinkaware’s statistics, which are very worrying, show that 49% of men are classified as increasing or higher risk drinkers compared with 31% of women. That is a very high percentage.

[Helen Whately]

As I said, I fully appreciate and respect my hon. Friend for the huge amount of work that she does to urge us to recognise the harmful effects alcohol can have.

We know that alcohol misuse can have an impact on hospital care and demand. It contributes to a wide range of conditions including cardiovascular disease, cancer and liver disease, as well as accidents, violence and self-harm. Some 12% to 15% of A&E attendances are alcohol-related, and alcohol is a causal factor in the patient’s diagnosis for more than 1.1 million hospital admissions every year. We absolutely take my hon. Friend’s concerns seriously.

As part of our NHS long term plan, alcohol care teams are being introduced in hospitals with the highest number of alcohol-related admissions. It has been shown that those teams significantly reduce avoidable bed days and re-admissions. The seven-days per week service at Royal Bolton Hospital saved 2,000 bed days in its first year, and modelling suggests that alcohol care teams in every non-specialist acute hospital will save 254,000 bed days and 78,000 admissions per year by their third year of operation.

Thanks to the personal testimony and campaigning by hon. Members present and by others who were unable to attend, the Government have invested £6 million to improve outcomes for children with alcohol-dependent parents. That funding includes £4.5 million for nine local areas to test innovative ways of working and to join up systems to support children and families—promising results are emerging in those areas. We have also allocated £1.5 million to voluntary sector organisations to build resources and capacity at national level, including helpline and contact-centre support through the National Association for Children of Alcoholics. We are also investing £6 million through a capital fund to enable local authorities to improve services and facilities for people with alcohol problems.

We continue to educate the public, ensuring that people are aware of the health risks of alcohol through local and national programmes, such as Public Health England’s One You campaign. The alcohol risk assessment in the NHS health check is used to inform a discussion on reducing the individual’s risk. New guidance encourages referral for liver investigation, where risk is identified. In addition, there is a commissioning for quality and innovation—CQUIN—scheme to incentivise increased cirrhosis and fibrosis tests for alcohol-dependent patients.

My hon. Friend also mentioned labelling. We have worked with industry to communicate the UK chief medical officer’s low risk drinking guidelines on the labelling of alcohol products. The Portman Group and others in the industry have made a commitment that labels will reflect the guidelines and we are closely monitoring progress.

We have also made a commitment in the prevention Green Paper to work with industry to deliver a significant increase in the availability of alcohol-free and low-alcohol products by 2025. A roundtable is being organised to take this work forward. Encouragingly, sales of no or low-alcohol beer are up 30% since 2016 and “nolo” alcohol is set to be one of the driving trends of 2020, although I am sure trends are being reviewed in the light of the pandemic.

Public Health England supports local authorities in their work of needs assessment and commissioning alcohol and drug prevention and treatment services by providing advice, guidance and data. PHE is developing UK-wide clinical guidelines for alcohol treatment. That work will promote good practice and improve the quality of service provision, resulting in better outcomes for patients.

We know that alcohol-exposed pregnancies present a significant public health problem across the country. Foetal alcohol spectrum disorder can have a major impact on the early years development of children and their life chances. There is great work under way at local levels to tackle this. For example, the Greater Manchester health and social care partnership recently launched its #DRYMESTER campaign to raise awareness of drinking alcohol when pregnant. NICE are currently consulting on a draft quality standard on FASD. The voluntary sector also plays a vital role here. As part of the children of alcohol-dependent parents funding programme, over £500,000 is being made available to support work on FASD.

Finally, the good news from the budget is that £46 million in funding is being provided to improve support to individuals experiencing multiple complex needs. That includes tackling homelessness, reoffending and substance abuse, including alcohol misuse. In addition, as part of our rough sleepers programme, there is £262 million of new funding for substance misuse treatment services. When fully deployed, that is expected to help more than 11,000 rough sleepers a year. It will enable people to move off the streets and support them to maintain a tenancy for the long term. The funding complements £237 million announced by the Prime Minister for accommodation for rough sleepers, and a further £144 million for associated support services.

Several hon. Members raised minimum unit pricing, particularly the hon. Member for North Ayrshire and Arran (Patricia Gibson), who drew on her experience in Scotland. There are no plans to implement minimum unit pricing in England at present, but the Government continue to monitor the evidence as it emerges from Scotland and Wales.

Several hon. Members talked about the Government’s alcohol addiction strategy. As announced in November, we are undertaking a UK-wide cross-Government addiction strategy. Plans on the contents of the strategy are being developed and we will have more to say on this shortly.

[Patricia Gibson]

I listened carefully when the Minister said that the Government currently have no plans to implement minimum unit pricing. In the light of that, and given the funding and investment she talks about that will deal with the consequences of alcohol addiction, does she agree that tackling the consequences is less effective than tackling the problem at source? Cider and some of the highest content alcohol is on sale in shops in England for less than a bottle of water or a pint of milk. Does she agree that making alcohol a little bit more expensive could have an impact?

[Helen Whately]

I thank the hon. Lady for her contribution and I take her point. It is important that we continue to look at the evidence and that is the approach we will follow. I thank everyone here today for their contributions to this important debate and for having this conversation.

[Jim Shannon]

I urge the Minister to contact each of the regional devolved Administrations, in Scotland, Northern Ireland and Wales. It would be a good idea for interaction with those three regional Administrations, to gauge a universal policy for the whole of the United Kingdom of Great Britain and Northern Ireland and to take all the evidence from other parts of the United Kingdom, which could gel a strategy that we could all agree on. That would be a substantial way forward.

[Helen Whately]

The hon. Gentleman makes an important point about working together, and the UK Government working with the devolved Administrations, drawing on the lessons that we have all learned and the evidence we all have. I do not think I will make a commitment to do that immediately in the light of the current public health situation, but he does make a very good point.

The Government absolutely are taking action and we are determined to do more to support people who are most vulnerable from alcohol misuse.

Oral Answers to Questions

Helen Whately Excerpts

Tuesday 10th March 2020 Commons Chamber

[The Minister for Care (Helen Whately)]

This Government will be introducing an NHS visa, which will offer reduced fees and fast-track access for overseas doctors, nurses and allied health professionals to work in the UK. My right hon. Friend the Home Secretary will be outlining detailed plans in due course.

[Andrew Bowie]

Scotland has an increasing crisis of GP shortages, and in NHS Grampian—where £1 million had to be spent on agency nurses this winter—we have an increasing nursing crisis. Some people are understandably concerned that the changes to immigration rules will have an adverse effect. Can my hon. Friend confirm that the new NHS visa will be applicable in Scotland as well?

[Helen Whately]

Yes, I can absolutely give my hon. Friend that assurance. The NHS visa will be available for doctors, nurses and allied health professionals coming to work in the NHS across the whole United Kingdom.

[Simon Jupp]

As we all know, nurses, midwives, paramedics and physiotherapists are highly skilled roles, and the Government have been clear that they meet the immigration skills threshold. What steps is the Department taking to dispel the level of fake news on the subject, and to encourage the brightest and best from around the world to apply for these important roles?

[Helen Whately]

The salary threshold for people coming to work in the NHS in the roles that my hon. Friend mentioned are linked to NHS pay bands, and applicants will have more than enough points to apply under the new immigration system. We are working with NHS employers to encourage international applicants. I thank my hon. Friend for giving me the opportunity once again to dispel any myths in this area.

[Justin Madders (Ellesmere Port and Neston) (Lab)]

The Minister will have to try a bit harder, because the Chartered Society of Physiotherapy is certainly very concerned that its positions are not going to be covered. Others, such as care assistants, are also below the salary threshold. We are talking about vital roles. There are 100,000 vacancies across the NHS, so will the Minister go back to the Home Office and ask staff to look at the detail of these proposals so that they do not make the NHS staffing crisis any worse than it already is?

[Helen Whately]

The NHS visa is in place. There are also plans in place to ensure that we have international recruitment alongside investment in a home-grown workforce, and that we increase retention rates and the number of returners to provide the NHS with the staff it needs.

[John Spellar (Warley) (Lab)]

Many skilled health professionals in this country who have been granted refugee status are finding it difficult to get accreditation from the regulating bodies. May I commend to the Minister the healthcare overseas professionals programme of Sandwell and West Birmingham NHS Trust, and invite her to visit that trust? Will she have discussions with the regulating bodies to try to speed up the process for these people, who have the skills and want to work, and whom we need?

[Helen Whately]

Work has already been done by the regulating bodies. For instance, we are already speeding up the process for nurses from overseas who want to come here to work in the NHS. I would be very happy to have further correspondence with the right hon. Member about the specific problem, and would be delighted if he could send me an invitation to make the visit that he mentioned.

[Jeremy Hunt (South West Surrey) (Con)]

I congratulate the Department on securing the NHS visa but, as the Minister knows, it does not apply to nurses and care workers in the social care sector. What is the Department’s assessment of the gap there will be in the social care workforce as a result of this new immigration policy, and how are discussions going with the Home Office and No. 10 on that issue?

[Helen Whately]

I thank my right hon. Friend for his question. I am well aware of concerns in the social care sector, particularly in areas where there are higher vacancy rates. It is important that employers make sure that they are taking the steps they can take to make sure that social care jobs are attractive and, of course, well paid, as they should be. I recognise as well a role for Government in this, supporting the role of working in social care, and overall making sure that we come together and fix the social care crisis.

[Jim Shannon (Strangford) (DUP)]

7. What recent estimate he has made of the number of GP practices that have adopted the care for young carers package.

[The Minister for Care (Helen Whately)]

NHS England outlined the care for young carers offer in GP surgeries in June 2019. The offer includes a package of practical plans and actions to help young carers. Uptake will be monitored at a regional level in England through integrated care systems.

[Jim Shannon]

I am grateful for the Minister’s response. However, can she further break down the number of surgeries that have offered priority appointments for carers for home visits and additional mental health checks, and double appointments for the carer and those they provide for? What is she doing to see this rolled out in every GP surgery throughout the nation, bearing in mind that 40% of carers struggle with their own mental health?

[Helen Whately]

My hon. Friend makes a really important point about support for carers and young carers. I cannot answer on the details of his question right now, but I will take it away, talk to the Under-Secretary of State, my hon. Friend the Member for Bury St Edmunds (Jo Churchill), who is responsible for primary care, and the Under-Secretary of State, my hon. Friend the Member for Mid Bedfordshire (Ms Dorries), who is responsible for mental health, and come up with a better answer for him.

[Julian Sturdy (York Outer) (Con)]

10. What steps his Department is taking to increase the range of medicines available to patients on the NHS.

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[Owen Thompson (Midlothian) (SNP)]

23. What assessment he has made of the potential effect of the proposed points-based immigration system on the provision of health and social care.

[The Minister for Care (Helen Whately)]

The points-based immigration system is designed so that the UK can attract the brightest and best individuals to work here. As the hon. Member no doubt knows, jobs where there is a recognised shortage of supply, such as nurses, are on the shortage occupation list, and people filling those roles will score more than enough points to come to the UK. We are also introducing the NHS visa to make it easier for doctors, nurses and health professionals from all around the world to come to work here.

[Brendan O'Hara]

The sector is understandably worried about what a points-based system will mean for their ability to recruit the workforce they need. Soon I plan to reintroduce my private Member’s Bill, which sought an independent review of the impact of Brexit on the sector, but will also now include an independent evaluation of having such a points-based system. Given the importance of an evidence-based approach to policy making, will the Minister agree to meet me and others to see how we can all work together to ensure that the long-term needs of the health and social care sector are met based on the evidence available?

[Helen Whately]

I thank the hon. Member for his question. I am in contact with stakeholders, as a relatively new Minister in this post, reaching out as much as I can. I am mindful of concerns about vacancy levels but absolutely committed to making sure that, across health and social care, we have the workforce we need.

[Owen Thompson]

Not only do this Government treat the Scottish Government with contempt, but they treat their own Scottish Tory colleagues in the same way, as they were reportedly livid about the points-based immigration system introduced. Given the implications for health and social care staffing in Scotland, will the Minister ask Cabinet colleagues to reconsider our proposals for a Scottish visa?

[Helen Whately]

We have the NHS visa, which applies to the whole United Kingdom. The Migration Advisory Committee has been clear that UK immigration policy must benefit the whole UK, and Scotland benefits from its own shortage occupation list, which will continue to exist.

[Kevin Hollinrake (Thirsk and Malton) (Con)]

Does my hon. Friend agree that a German-style system of social insurance for adult social care would relieve the burden and reduce the requirement for overseas workers, by allowing a loved one, a neighbour or a friend to provide that care and be properly remunerated for it?

[Helen Whately]

I am well aware that my hon. Friend is very keen on that particular approach. He has hopefully received a letter from the Secretary of State, inviting colleagues to come to talk to us about the proposals and options for fixing our social care crisis, and I hope he will take that up.

[Dr Luke Evans (Bosworth) (Con)]

Will the Minister consider waiving the NHS surcharge for overseas staff who want to come to work in our NHS?

[Helen Whately]

I am well aware of concerns about the surcharge. Many overseas nurses coming to work in the NHS do not have to pay the surcharge, as it is covered by their employer.

[Mr Toby Perkins (Chesterfield) (Lab)]

The phrase “brightest and best”, when it appears in immigration talk, is obviously subjective and deliberately vague. What the private sector and local authorities want to know is: under the new Government system, will they be able to get people to come in who want to provide care—people we are desperate for?

[Helen Whately]

For the NHS, we have the NHS visa and a clear route to come to work in the health sector. For social care, there is a job to be done by employers, to make sure that working in social care is an attractive job that is well paid. I also recognise that there is a role for Government and for all of us in Parliament, to come together and support changes to how we fund social care. We need to fix the social care system for the future.

[Dr Kieran Mullan (Crewe and Nantwich) (Con)]

12. What steps his Department is taking to increase the range of healthcare professionals permitted to administer low-risk medicines.

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[The Minister for Care (Helen Whately)]

My hon. Friend is right about both how widespread loneliness is and the costs. The cross-Government loneliness strategy does indeed join up the voluntary sector and many parts of Government, led by the brilliant Baroness Barran in the Department for Digital, Culture, Media and Sport. For our part, in this Department we are particularly supporting the growth of social prescribing, which enables GPs to direct their patient to a host of activities, many of which help people to overcome loneliness.

[Mr Gregory Campbell (East Londonderry) (DUP)]

Let us try to keep a sense of perspective. Last weekend, Government sources indicated that the worst-case scenario would be 100,000 deaths due to the current virus outbreak. Given that China has reported just over 3,000 deaths and that it has been at the epicentre of the virus for 10 weeks but has a population 20 times greater than the United Kingdom, was the 100,000 figure a helpful reference?

--- Later in debate ---

[Siobhan Baillie (Stroud) (Con)]

Workforce pressures are rightly on the agenda at the moment, and we hear a lot about recruiting internationally, but what are we doing to promote the home-grown workforce—through training and lifelong learning—and getting people to enter the health profession at any time of life?

[Helen Whately]

There has been much discussion today of international recruitment, but alongside that we are committed to boosting our home-grown workforce, particularly to achieve our ambition of an extra 50,000 nurses in the NHS and 6,000 more GPs.

[Rushanara Ali (Bethnal Green and Bow) (Lab)]

At a time when the NHS is under pressure as never before because of coronavirus, does the Secretary of State agree that to close Mildmay Mission Hospital in my constituency would be an act of unbelievable folly? It is a specialist unit for people with HIV/AIDS, and to force those patients into the mainstream would endanger lives. Can he commit today to providing the much needed additional funding of £5 million a year to save this very important hospital, which is doing very important work?

[Adam Afriyie (Windsor) (Con)]

In Windsor we have an ageing but distinguished population, and we recognise that adult social care is one of the biggest challenges facing the country and local authorities. I thank the Secretary of State for his dedication to resolving these issues, with the better care fund allocation and his call for input from MPs, among others. In those discussions, will he have an open mind to the concept of a precept for adult social care for local authorities?

[Helen Whately]

My hon. Friend will be aware that already some of the funding that adult social care receives is through a council tax precept, but I would be delighted to meet him as part of the cross-party talks we have initiated to address the challenges in social care.

[Munira Wilson (Twickenham) (LD)]

There are numerous reports of people with symptoms of coronavirus being refused a test by 111 because they cannot name an individual who has been diagnosed with the virus. Yesterday the Secretary of State’s ministerial colleague, the noble Lord Bethell, said about 111 that there must be people who had had “bad experiences”. Will the Secretary of State confirm whether it is indeed policy not to test those with symptoms who cannot be contact traced, or whether many people are simply having a bad 111 experience?

Nursing Workforce Shortage: England

Helen Whately Excerpts

Tuesday 3rd March 2020 Westminster Hall

[The Minister for Care (Helen Whately)]

I congratulate the hon. Member for Bedford (Mohammad Yasin) on securing this debate. I thank him for his tone and his constructive approach to the challenges. I also thank him for giving me this opportunity to speak about a subject that I am truly delighted to have as my responsibility as a new Minister in the Department of Health and Social Care, and about which I feel very strongly—namely, the NHS workforce.

Our NHS is truly fantastic and we as a nation are proud of it. However, as we know, the NHS is really its people. The people of the NHS are the NHS—from the most senior doctor, to the newest healthcare assistant and everything in between. That is particularly true of nurses, who make up nearly one quarter of the NHS workforce, and good healthcare depends absolutely on good nurses.

The NHS should be looking after its nurses, but over many years visiting hospitals and community services—this goes back a long time—I have had too many conversations with nurses who feel that the NHS, or their employer, has not been looking after them. The biggest problem that comes up, going back over many years, is that of staff shortages.

I completely agree with the hon. Member for Bedford that the vacancy rates among NHS nursing teams are too high. They are particularly high for some specialties, such as mental health. There are variations across regions. For instance, in the north-east, Yorkshire and the north-west, the highest vacancies are in ambulance trusts. We also know that there are particular challenges in rural areas, as mentioned by my hon. Friend the Member for North Cornwall (Scott Mann), and across the nations of the UK. As we heard from the hon. Member for Caithness, Sutherland and Easter Ross (Jamie Stone), there are challenges in rural parts of Scotland. We heard from the hon. Member for Strangford (Jim Shannon) about the challenges in Northern Ireland, and there are also parts of Wales that are struggling. This is not just a problem in England, but nevertheless I recognise the problem in England. We need plans to address that, and we have plans, which I will come to.

The hon. Member for Bedford also flagged up the importance of safe staffing in the NHS. I absolutely agree that our first priority must be that the NHS is a safe place for patients, and that care is safe. As he will know, trusts call on bank and agency staff, to make sure that they have enough staff to make wards safe. We must appreciate the work of those staff, who do a really important job of stepping in, but, as I have heard from many a ward sister, although they welcome having agency staff to fill the gaps, that is not the same as having a fully staffed team. That is what we really want in the health service. It will make the NHS a great place to work and enable it to provide the best possible care for patients. That is why the Government have committed to 50,000 more nurses, so that staff shortages and those high vacancy rates will be a thing of the past.

Before I talk about how we will find thousands of new nurses, I want to discuss the most fundamental thing we have to do to succeed, which is to keep the nurses that we already have in the NHS. Some hospitals and teams do not have a problem with staff retention, and some have very low attrition rates. In others, we know that staff turnover is a real problem. There is no point in the NHS training up lots of new nurses if we cannot hang on to those who have already been trained.

In order to retain nurses, we need to make sure that each day is a good day. We need to look out for each and every nurse, which is the day-to-day job of the trusts that employ nurses. I want those trusts that are struggling with high attrition rates to adopt more of the good practices of successful trusts. The Government are also going to help.

First, as we have discussed today and as we have heard directly from nurses, more investment in ongoing training and continuous professional development would make a big difference. That is why the Government have committed to giving every NHS nurse a £1,000 training budget on top of the training that employers usually provide. That extra funding should help nurses to advance their careers, to move more easily between different roles and, of course, to provide better care to patients.

Secondly, there will be a new offer for all NHS staff. It will be released alongside the NHS people plan, which will set out the support each and every NHS staff member can expect from their employer, including for professional development and for more choice and control over shifts and working patterns. As several hon. Members have said, NHS staff want more control and flexibility. The hon. Member for Strangford mentioned the importance of flexibility. Nurses may have other caring responsibilities. Some trusts are doing well in this area, others not so well. We want all employers to do what they can to give staff more flexibility and control over their working hours.

[Jim Shannon]

I thank the Minister for her comprehensive response. I know that tax credits, NVQs and time out are not her responsibility, but would she be willing to speak to the Minister with that portfolio to see whether there is any flexibility in the system to enable nurses, especially those with young children, to continue?

[Helen Whately]

My understanding is that the system in Northern Ireland is different from that in England, so I do not have the answer at my fingertips. I am, however, happy to take up the hon. Gentleman’s question and get back him.

Thirdly, on improving the retention of staff in the NHS, we need to tackle the level of bullying and harassment. The recent NHS staff survey had some really positive results on how NHS staff feel about their work. The Secretary of State and I, however, are greatly concerned about ongoing reports of bullying and harassment that staff experience at the hands of other staff, patients and, sometimes, their families. That is simply not acceptable. We must send out a message, loud and clear, that we will not tolerate the bullying and harassment of staff, whether from other staff or from patients and their families. As a society, we should all be grateful to our NHS staff. Hand in hand with that, we absolutely will not tolerate racism, which is an ongoing problem in some parts of the NHS.

Fourthly, pay has never been the top thing brought up by nurses when I have spoken to them about their concerns, but clearly it is part of the picture. By April this year, we will have increased by 12% the starting salary for new nurses compared with three years ago. More than 200,000 nurses are benefiting from pay rises under the “Agenda for Change” pay deal. Nurses below the top of their pay band have been receiving increases of at least 9%, and those already at the top of their pay band are receiving a pay rise of 6.5% over the course of the “Agenda for Change” pay deal.

I just want to pick up on the point about returning to nursing. The issue of retention also applies to nurses who have, for many reasons, taken time out of nursing. We are very keen that more of those nurses return to work. We are supporting nurses who want to bring back their valuable experience to the NHS. I also want trusts to develop posts that will make the most of those nurses’ experience and to ensure that there is enough flexibility in their shift patterns and ways of working to fit any caring responsibilities they may have.

[Jim Shannon]

For that to happen and for them to return, there would need to be a database of all former nurses. I am mindful that there will be a statement later about the coronavirus, and a Health Minister has mentioned having a list of people who could come in and help in the event of a pandemic outbreak. If there is such a list, then there must also be a list of former nurses who have left the sector but wish to come back. Is there such a database?

[Helen Whately]

I am just digesting what the hon. Member said.

[Jim Shannon]

I talk very fast.

[Helen Whately]

I have not seen a database. The hon. Member refers to the coronavirus plans, which are very much on my mind as we talk about the immediate and longer-term plans to increase the number of nurses in the NHS. Clearly, we also have the short-term challenge of ensuring that the staff are there, and that work is absolutely in hand. Returners are an important part of it and we need to ensure that we make use of nurses who have already been trained, to boost the NHS workforce. All in all, we want to ensure that the NHS is a great place to work for nurses who return to it and for those working in it right now. The absolute foundation for ensuring that we no longer have nursing shortages is to look after the nurses that we currently have. On that foundation, we can seek to recruit and train new nurses.

[Tonia Antoniazzi]

I welcome the Minister to her place. As the chair of the all-party parliamentary group on cancer, I would like to take this opportunity to ask her to come to speak to us about the NHS people plan, if possible.

[Helen Whately]

I thank the hon. Member for her invitation. As I am new to the job, I am trying to ensure that I speak to as many stakeholders as possible. I would be delighted to talk to APPGs such as the one she chairs, as and when I can.

I turn now to the ambition to increase the number of nurses that we train. The latest UCAS stats show that there have been nearly 36,000 applications to study nursing and midwifery courses at English universities this year, which is about 2,000 more than last year. The new students will benefit from the new £5,000-a-year maintenance grant, an extra £1,000 if they study specialist subjects such as learning disability and mental health nursing—where we have shortages—and a further £1,000 if they study in areas struggling to recruit. There is also further funding available to support childcare costs, and that financial support is in addition to the learning support fund, which provides help with travel costs for placements, childcare and exceptional cases of hardship. That is all in addition to being able to apply for a student loan. Unlike other courses, students applying to nursing, midwifery and many allied healthcare professional courses as a second degree will also qualify for the maintenance grant and for student loans.

I set out the financial support we are offering because I recognise that, as the hon. Member for Bedford has said, it can be hard to afford to study nursing, particularly for mature students. We really want more nursing students. Last year, 23,630 people accepted a place to study nursing or midwifery in England. This year, I want to see more. As I have said, there has already been an increase in applicants, but it is not too late for anyone who has yet to apply. UCAS is accepting late applications up to 30 June, and from 6 July people can apply for a course through clearing.

My message goes out to anyone watching this debate who thinks that nursing is for them: please, get applying. If someone wants to become a nurse, we want to help them—no matter who they are or what their background is. However, we know that university is not the route for everyone, so there are other ways to become a nurse. For instance, the Government have developed the apprenticeship pathway, so people can go from being a healthcare support worker to being a nursing associate, and then to being a nurse. If they want, they can then move on to postgraduate advanced clinical practice and nursing. At present there are nearly 2,000 nurse degree apprentices. Although nursing associates are doing a really important job in their own right, they can become registered nurses via a shortened nursing degree.

The things I have just set out are all about increasing our home-grown nurse force, which is absolutely vital step in ensuring that this country has a sustainable nursing workforce. I am fully aware, however, that we will also need to recruit internationally in order to achieve the ambition of 50,000 new nurses. We cannot do that from the home-grown workforce alone. Many of us, including patients and their families, have good reasons to be grateful to nurses who have come from all over the world to work in our NHS. I am grateful to them.

As we look ahead to including international recruitment as a way to boost our nursing workforce, we do so mindful of the ethics of recruiting from elsewhere. We want to ensure that it works not just for us but for the countries that our nurses come from. We are determined to build bridges with health systems across the world, to share NHS expertise and provide staff who come to work in the NHS with a chance to learn from our health system, just as we benefit from their skills.

The hon. Member for Bedford asked how we plan to increase the nursing numbers by 50,000. In essence, the plan is to improve retention, to support returners to the workforce, to boost our home-grown numbers, and to complement that with international recruitment. In response to questions about when we will publish the NHS people plan, that will be done within the next few months. I have also been asked who is responsible for the workforce. I take the responsibility for workforce in my brief very seriously. I feel very strongly that, from day to day, the biggest determinant of the experience of any nurse or member of the NHS workforce is their employer. NHS employers are responsible for their workforce, and I am keen to see every single trust and NHS organisation investing in and supporting and valuing their staff. As I said at the beginning of my speech, the NHS is only as good as its people. They are great, and we must look after them.

I thank all hon. Members for their contributions. This has been an important discussion and some good points have been raised. The mere fact that we are having this conversation demonstrates the importance of nurses to us all and to our health system. Some hon. Members talked about a crisis in our NHS and in nursing, but we have to be careful in getting the right balance in the language we use. Yes, we know that it is tough on the frontline, but we also know that nurses and NHS staff more broadly talk about how very rewarding they find their day-to-day work, and about what a wonderful job it is. I have spoken to nurses who tell me that they would never want to do any other job, so it might be helpful to get the right balance.

The hon. Member for Gower (Tonia Antoniazzi) says that her experience as a teacher means that she knows how to inspire. I call on her and everyone else to follow that guidance, as we need to ensure that everybody knows that working in the NHS is a great career. The NHS is a great place to work. Let us not talk it down. Let us make sure that we spend time talking it up.

[Tonia Antoniazzi]

I appreciate the Minister’s comments. I would never talk down a profession that we need and depend on so much. The nurses I have come across, whether from throughout the UK or from overseas, have been absolutely wonderful. We are being positive and want to retain people, and this issue is important to us. Does the Minister agree that this is not just about our healthcare, but about our teachers and public services? We also have a commitment to our consultants, who have a lot of issues and are always overworking to ensure that frontline services continue. Their dedication is absolutely brilliant and we appreciate it.

[Helen Whately]

I thank the hon. Member for her comments. We can absolutely agree how much we value everyone who works in our public services and with the NHS, including consultants, junior doctors, nurses, nursing associates, healthcare assistants and allied healthcare professionals, as well as every single porter, administrator and member of the management team. I am sure that I have left out some individual roles—healthcare scientists, for example—for which I apologise. The whole NHS workforce has my appreciation.

[Jim Shannon]

The Minister has mentioned the Government’s commitment to increasing national health service funding. It is important to state for the record that we acknowledge the good things they have done.

[Helen Whately]

I thank the hon. Gentleman. As he says, I have spoken not only about how much we value the NHS workforce, but about our commitment to increasing NHS funding. The two go hand in hand.

A few Members have mentioned that the number of vacancies stands at well over 40,000. Although I absolutely recognise that those numbers are still far too high, the latest data shows a steady downward trend over the past year. I state for the record that as of the third quarter of 2019-20, the number of vacancies was under 39,000.

I will finish with one more piece of good news: the increasing number of nurses in the NHS. As of November 2019, the latest workforce data shows that we had 290,474 nurses in the NHS in England, which is an increase of 8,570, or 3%, since November 2018, and an increase of nearly 17,000, or 6%, since 2010. The numbers are going in the right direction. We have a long way to go but I am determined that we should get all the way to the extra 50,000 nurses in the NHS, so that nursing staff shortages will soon be a thing of the past.

Social Care

Helen Whately Excerpts

Tuesday 25th February 2020 Commons Chamber

[The Minister for Care (Helen Whately)]

I am delighted to be here at the Dispatch Box as Minister for Care. I thank the shadow Minister, the hon. Member for Denton and Reddish (Andrew Gwynne), for his welcome, if not for everything else he said. I hope we will be able to work together on fixing social care.

I am aware that my new job comes with great responsibility. I am mindful of the many thousands of people who rely on social care and of all the challenges in our current care system, but with that responsibility comes an opportunity to take forward changes that we know are so desperately needed now and for the future.

Before I say any more, I pay tribute to the countless carers, social workers, nurses, friends and family members who care for people in this country. Their dedication means that so many people who need help receive it. Our social care system is utterly dependent on their skills, compassion and hard work.

[Robert Largan (High Peak) (Con)]

The Minister is generous in giving way.

I visited Goyt Valley House care home in New Mills on Friday and saw at first hand the amazing work done by the staff. I spoke to the relatives and residents and learned just how important the care home is. Unfortunately, its future is currently in doubt. May I invite the Minister to come and visit New Mills and see the care home for herself?

[Helen Whately]

I have already visited two care homes since becoming Minister for Care, and I want to visit many more. I hope I will be able to take up my hon. Friend’s invitation and see that good work for myself.

I pay tribute to my predecessor as Minister for Care, my hon. Friend the Member for Gosport (Caroline Dinenage). I hear that she was visiting a hospice on reshuffle day—her actions illustrate the enormous commitment and compassion she brought to this role. I sincerely hope to follow in her footsteps.

I also thank all the hon. Members who have spoken today. Social care is important to many thousands of our constituents, and their interest and input are incredibly valuable.

[Mr Perkins]

I welcome the Minister to her post, and I welcome what she says about carers. Would it not be wonderful if, rather than just giving them her warm words, support and admiration, she were able to join a cross-party campaign to see that carers get paid more than burger flippers in McDonald’s so that we actually start recognising them with the same prestige as nurses and the same earnings as people in our health service?

[Helen Whately]

I thank the hon. Gentleman for his suggestion. It is almost as if he has seen my notes.

One thing I particularly welcome is the number of hon. Members on both sides of the House who spoke about the importance of careworkers, who provide such important care.

My hon. Friend the Member for Peterborough (Paul Bristow) mentioned that both his parents were nurses in the care sector. He drew on his knowledge of care and rightly said that the profession should be held in higher esteem and that, just as we hugely value NHS staff, we should hugely value careworkers. The hon. Members for Warrington North (Charlotte Nichols), for Blaydon (Liz Twist), for Dulwich and West Norwood (Helen Hayes), for Putney (Fleur Anderson) and for Liverpool, Wavertree (Paula Barker) and my hon. Friend the Member for Bury North (James Daly) spoke along the same lines, and I could not agree more.

Not long after I became the Member of Parliament for Faversham and Mid Kent, I joined a careworker, Kim, on her daily round. By the time I met her at 7.30 am, she had already started washing her first client. By lunch time, she had washed, dressed, fed, medicated and chatted with six or seven men and women. Some of them were grateful and some of them, quite honestly, were not grateful, but they were all utterly reliant on her care. That experience really brought home to me the skill, knowledge and compassion of our social care workers. For those who need help, there are amazing carers with hearts of gold, like Kim.

Our care system depends on an extraordinary workforce of capable and compassionate carers, but we need more people to choose care as a career. That means changing the perception of being a care worker. As a society, we must truly recognise the importance of the work. We must make sure that more people realise the range of jobs in care and the opportunities for progression. The Government are currently investing in an adult social care recruitment campaign with the strapline “When you care, every day makes a difference”. We are working with Skills for Care to support workforce development and there is funding for a workforce development fund. That is really important, but we know that we must go further in making sure that we truly value the important work that the care sector does and to make sure that the care profession attracts the workforce that we need and gives them the opportunities to lead a truly fulfilling career.

Several Members rightly talked about unpaid carers, who also provide so much vital care. We fully recognise the value of that work and know the importance of support for those people who do so much caring. That is one reason why the Government will introduce a statutory right to leave from work for one week a year for the 5 million people who juggle work alongside being an unpaid carer.

My hon. Friend the Member for Bury North talked about quality of care, and it was really important to hear that mentioned as part of the debate. He spoke about how good care is in his constituency, and he is absolutely right that we should talk about how good care is throughout England. Some 84% of adult social care providers are currently rated good or outstanding by the CQC. Let us recognise the high quality of care.

My hon. Friend also spoke about the importance of integration—of the NHS, local authorities and care providers working together—as did my right hon. Friend the Member for Ashford (Damian Green), who is knowledgeable on this subject. The interplay between the NHS and social care is critical. The better care fund and the improved better care fund are a success story in respect of enabling more co-operation between the systems. It is crucial that we continue to build on that success so that our care system meets the needs of the individual, not just of the system.

My hon. Friend the Member for Watford (Dean Russell) made some excellent points about how, paradoxically, we can use technology to help to achieve more human and more personal care for a more cohesive and effective care system.

Both my hon. Friend the Member for Thurrock (Jackie Doyle-Price) and the shadow Minister for Care, the hon. Member for Worsley and Eccles South (Barbara Keeley), mentioned those with learning disabilities and autism who are being cared for in in-patient settings. I am new to this job, but I absolutely appreciate the importance of making sure that we do better in this regard. People should be cared for in the best place for their needs. At the end of last month, the number of those in in-patient settings had been reduced by 24% compared with 2015—

[Barbara Keeley]

indicated dissent.

[Helen Whately]

The shadow Minister is shaking her head; I know that there is more to do.

At times this has been a heated debate, but I heard on both sides truly constructive suggestions for how we can solve our social care challenges. That gives me much hope for cross-party consensus. I heard suggestions from my hon. Friends the Members for Newton Abbot (Anne Marie Morris) and for Meon Valley (Mrs Drummond), my right hon. Friend the Member for Ashford, the hon. Member for Leicester West (Liz Kendall) and my hon. Friend the Member for Bexhill and Battle (Huw Merriman), whom I thank for his kind words welcoming me to my job. He set the bar high for me to meet.

I am fully aware of the challenges that face our care system and I have no illusions as to the scale of the challenge facing us. In the next 10 years, we expect the number of people over 75 to go up by 1.5 million, and the number of people under 65 with care needs is growing, too. We have a system that is under pressure and the demands are only going to grow.

[Liz Kendall]

In the spirit of being constructive, let me mention, as I did during my speech, the huge and rising pressures on social care. There are 120,000 vacancies here and now. We need more than half a million care workers in a decade’s time just to keep up with rising demand—that is not to improve the system, but just to keep pace with demand. The proposed points-based system of immigration will be catastrophic for social care. Will the Minister meet me and others who work in this area to explore the potential for a separate route into social care, so that we can avoid further pressure and worse care for the people for whom we love and care?

[Helen Whately]

What I would like to emphasise in response to the hon. Lady’s point is the importance of our recognising, valuing and making sure that social care is an attractive career. In that way, those who are already working in social care will continue to work in social care. It will be for us to build the workforce that we need for the future.

[Liz Kendall]

rose—

[Helen Whately]

I am conscious of time, so I must now come to my conclusion.

We all bring our experiences to our work, and, as I conclude this debate, I want to mention one of mine. When my grandmother was 100 years old, she was admitted to hospital and she stayed there for five months. She was signed off as ready to leave numerous times, but each time the failure to find a care package delayed her discharge, during which time she would acquire an infection, further delaying her discharge. She was eventually discharged, but only in time for her to die—thankfully, peacefully at home. This is a cycle with which too many people are familiar, and it means that our hospitals are looking after people who would be better off at home.

As I have said, I am under no illusions about the challenges that we face in social care. The problem that I have just described is nothing new, but let us be the generation that solves it. That is a commitment that we as a Government have made. We will fix the crisis in social care. We will deliver the funding that is needed now to stabilise the system. We will find a long-term solution to the growing need for care and seek to build a cross-party consensus on this. We are committed to the view that the prerequisite of that solution is that no one needing care will have to sell their home to pay for that care.

We will not be supporting the Opposition’s motion tonight, but where I think we can all agree is on the importance and the urgency of reform of social care. As we bring forward those plans, I look forward to working with colleagues from all parts of this House. Just as we had a consensus in the 1940s on the NHS, the time has now come for a new consensus on social care. Let us be the generation that works together and makes our care system work for all those who so badly need it.

Question put (Standing Order No. 31(2)), That the original words stand part of the question.

Draft Human Tissue (Permitted Material: Exceptions) (England) Regulations: Government Response

Helen Whately Excerpts

Tuesday 25th February 2020 Written Statements

[The Minister for Care (Helen Whately)]

The Organ Donation (Deemed Consent) Act 2019 heralds a new system of consent for organ and tissue donation in England. Subject to Parliament’s approval of the secondary legislation and code of practice for healthcare professionals, the new system is intended to start in England from 20 May 2020.

Under the new system, known as “opt out” or “deemed consent”, people over 18 in England will be considered to have agreed to donate their organs and tissue after death, except where:

they made a decision to not donate their organs and or tissue, i.e. they have opted out;

they have nominated a representative to make a decision on their behalf after death about whether to donate; or

they are in one of the excluded groups: under the age of 18; ordinarily resident in England for less than 12 months before their death; lacked mental capacity to understand the new system for a significant period before their death.

The Government held a 12-week public consultation from 29 April to 22 July 2019 to seek views on a proposed list of organs, tissues and cells to exclude from deemed consent and which should therefore continue to require express consent before they can be removed, stored or used for transplantation. The list of organs, tissues and cells to exclude from deemed consent was set out in the draft Human Tissue (Permitted Material): Exceptions (England) Regulations. The Government received over 3,200 responses across different demographics which provided rich data on the questions asked.

The Government response to the consultation on the regulations has been laid before Parliament today (CP 224), alongside the revised draft Human Tissue (Permitted Material): Exceptions (England) Regulations 2020 and the Human Tissue Authority’s codes of practice for healthcare professionals setting out practical guidance about deemed consent. Copies of the Government response, the regulations and the codes of practice are available to hon. Members from the Vote Office and to noble Lords from the Printed Paper Office, along with the Government response being published on gov.uk at the following link:

https://www.gov.uk/government/consultations/opt-out-organ-donation-organs-and-tissues-excluded-from-the-new-system.

To address the issues raised in the consultation, the Government have:

updated the list of what is excluded from deemed consent to clarify further that tissue from sexual and reproductive organs (including skin) will not be transplanted without express consent;

expanded the list featuring the parts of the male and the female reproductive system;

reviewed the list to clarify further that specific tissues (for example bone, skin and muscle) will be transplanted under deemed consent if the tissue is to be used for a routine transplant. As now, if the tissue is needed for a rare transplant this will require express consent; and

expanded the list of proposed advanced therapy medicinal products (ATMPs) to exclude from deemed consent. Although the Government recognise the benefits of ATMPs, use of ATMPs from deceased donors is novel and it is appropriate that express consent is in place when cells are donated.

To make the public aware of the new system of consent, NHS Blood and Transplant (NHSBT) launched a communication campaign on behalf of the Government in April 2019. A number of platforms have been used since then to raise public awareness of the new system, more recently through TV and radio adverts, along with public advertising with specific targeting of people with different backgrounds, faith and beliefs. NHSBT will continue their awareness campaign, also working with GP practices, schools and BAME communities to address barriers to organ donation.

[HCWS121]

Mental Capacity (Amendment) Bill [Lords]

Helen Whately Excerpts

Ping Pong: House of Commons
Tuesday 2nd April 2019 Commons Chamber

[Helen Whately (Faversham and Mid Kent) (Con)]

It is always a pleasure to follow the hon. Member for Strangford (Jim Shannon), who makes such thoughtful contributions. I will be brief, as we appear to have a large amount of consensus on this piece of legislation.

First, I want to pay tribute to my hon. Friend the Minister for the work she has done on the Bill, her extremely consensual approach to it and the way she has listened to concerns from Members on both sides of the House and consulted stakeholders widely. It has been a real pleasure to work with her on the Bill, and I thank her for that.

This Bill is critical because it concerns some of the most vulnerable people in our society. We have talked about the fact that there are 125,000 people waiting to be processed for deprivation of liberty orders, and the system is not working, but there are 2 million people who have impaired mental capacity in the country, and we need to get the system right for all of them, not just the 125,000 who are being let down by the current system.

It is also important to say that the Bill builds on more than three years of work and the recommendations of the Law Commission. It has been fully scrutinised by the Joint Committee on Human Rights, and the other place has contributed to it, as have members of the Bill Committee. I have received many emails in support of the fact that it introduces a better system, gets rid of the bureaucratic box-ticking exercises in the old system and should be better for both the individuals who are deprived of their liberty and their families.

[Barbara Keeley]

The work that was done for three years was on a 15-clause Bill that is not this Bill. We discussed that plenty of times in Committee. I think it only fair to be accurate. This five-clause Bill is not the Bill that was consulted on, and it is not the Bill that had three years of work. It is not correct to claim that it is. We spent a lot of time in Committee trying to put right the things that were missing and taken out of the earlier 15-clause Bill, and it is better to be accurate about that.

[Helen Whately]

I thank the hon. Lady for her intervention. Broadly, I was attempting to say that a significant amount of work has gone into this. I have heard overwhelmingly from those working in the sector about the importance of doing something about the current situation, because it is not working and cannot be allowed to continue. This is urgent.

It is right that the NHS and social care providers will be given a bigger role in the decision-making process, so that people under their care receive better care and their rights are protected. The fact that we have people outside the system unprotected at the moment clearly cannot be right and cannot continue. During the passage of the Bill, I raised concerns about how it will work for people with fluctuating conditions, and I have been reassured by the Minister that responsible bodies will be required to keep individuals’ circumstances under review. I welcome the fact that there is further detailed guidance on fluctuating conditions in the code of practice.

I turn to the amendments and particularly the debate about the best way to define “deprivation of liberty”. It feels like a sensible conclusion has been reached in order for us to move forward, with a plan to develop the definition further through the code of practice. These things evolve and are extremely complex, and we need a flexible system that meets the needs of our society.

To sum up, the old system is not fit for purpose. The Bill makes important and timely amendments. It is better for individuals and all those around them to ensure that they have appropriate protections for the very serious matter of depriving individuals of liberty.

Question put and agreed to.

Resolved,

That this House does not insist on its amendment 1 to which the Lords has disagreed, and disagrees with Lords amendment 1B proposed in lieu, but proposes amendment (a) to the Bill in lieu of the Lords amendment.

Resolved,

That this House disagrees with Lords amendment 25A proposed to its amendment 25, but proposes amendments (a) and (b) to its amendment 25 in lieu of the Lords amendment.—(Jo Churchill.)

Oral Answers to Questions

Helen Whately Excerpts

Tuesday 26th March 2019 Commons Chamber

[Jackie Doyle-Price]

As the hon. Lady will know, we have brought that service back in-house, but we should leave no stone unturned in relation to thinking more imaginatively about how we spread the word about the need for screening. I should like to pay tribute to those celebrities who have tweeted pictures of themselves going for their smear tests, because it is only by normalising it and ensuring that everyone realises that it is something they should do that we are going to encourage take-up.

[Helen Whately (Faversham and Mid Kent) (Con)]

12. What steps he is taking to improve access to GPs.

[The Secretary of State for Health and Social Care (Matt Hancock)]

Primary and community care are set to receive an additional £4.5 billion a year of taxpayers’ money as part of the NHS long-term plan, to ensure that we can get the best possible access to GPs.

[Helen Whately]

In parts of my constituency, it is very difficult for people to see their GP. For example, in the area of Park Wood, there is just one GP for 4,000 patients. I welcome the extra money going into primary care that my right hon. Friend just mentioned, as well as the additional GP training places and the fact that a Kent medical school is coming our way, but we need more nurses, physios and other health professionals in primary care. What is he doing to ensure that people can see the right health professional when they need to do so?

[Matt Hancock]

This is an incredibly important agenda that is close to my heart. It is at the core of the prevention of ill health to ensure that we have the right primary care services. Yes, that includes more GPs, but it also includes more of the other health professionals who support them. We have 1,000 extra non-GP clinical staff already working in general practice compared with just two years ago, but there is much more to do.

GP-Patient Ratio: Swale

Helen Whately Excerpts

Tuesday 19th March 2019 Westminster Hall

[Gordon Henderson (Sittingbourne and Sheppey) (Con)]

I beg to move,

That this House has considered the ratio of GPs to patients in Swale.

My constituents have a number of major concerns, including local roads, the level of housing in our area, and the ratio of GPs to patients. The three issues are intertwined, as I will explain, but to set the issue in context, I will explain a little about my area. The local authority district of Swale is on the north-east Kent coast. It covers the whole of my constituency of Sittingbourne and Sheppey and also includes part of the constituency of my hon. Friend the Member for Faversham and Mid Kent (Helen Whately), whom I am delighted to see here today. However, the Swale clinical commissioning group area is not coterminous with Swale Borough Council. Instead, it has responsibility only for Sittingbourne and Sheppey. Faversham falls within the remit of the Canterbury and Coastal CCG.

Swale CCG is one of the smallest CCGs in the country, if not the smallest, because when CCGs were first set up, Medway CCG did not want to include Sittingbourne and Sheppey, nor did any of the east Kent CCGs, because my constituency has, historically, a number of areas with a high incidence of health deprivation. Life expectancy in Swale is the lowest in Kent. Within Swale itself, there is a huge, 10-year gap between the highest and lowest life expectancy. In some of the more affluent areas, life expectancy is 84 years, while in the more deprived areas, life expectancy is just 74 years.

A number of areas in my constituency have been identified as being in the bottom quintile on the national deprivation scale—a clear demonstration that not every area in the south-east is affluent—and there is an above-average incidence of obesity-related illnesses in my area. The number of people admitted to hospital in Kent because of health problems related to obesity has rocketed in recent years—around half of Kent’s 1.5 million population is now overweight or obese—and the highest rate in Kent was recorded by Swale CCG, where 1,726 people per 100,000 were admitted to hospital due to obesity-related conditions. My constituency also has a higher incidence of lung-related disease than many other areas in the country. That is particularly true on the Isle of Sheppey.

Such health problems put huge pressure not only on our local hospitals, but on primary care, yet my constituency has the worst ratio of GPs to patients in the whole country. To give an idea how bad the situation is, in Rushcliffe, the ratio is 1:1,192; in Camden—hardly the most prosperous area in the country—the ratio is 1:1,227; and in Liverpool, it is 1:1,283. By contrast, in Sittingbourne and Sheppey, there is just one permanent GP for every 3,342 patients.

My local CCG recognises that the lack of doctors is a problem and managers are doing everything they can to improve the situation, but to succeed, they need to attract more GPs to our area, and to do that they need more help, and more money.

[Helen Whately (Faversham and Mid Kent) (Con)]

I congratulate my hon. Friend on securing this debate on a really important topic. My constituents also face some difficulties getting access to a GP in my area of Swale borough, and also on the Maidstone side of my constituency, where in one practice the ratio of GPs to patients is 1:4,000. It is a real problem. I am concerned that there is not enough of a sense of urgency among some CCGs about fixing the problem. When the Minister sums up, I would be grateful if she could confirm the CCGs’ responsibility, and what metrics they are held to account for, for access to GPs.

[Gordon Henderson]

I accept and understand my hon. Friend’s concerns, but I would put on the record that Swale CCG is doing everything it can to resolve the problem, and does not fall into the category that she mentions.

I accept that Swale is not alone and that the shortage of GPs is a national problem, and that the reason for that shortage is complex. There is little doubt in my mind that successive Governments, including the Labour Government that was in power from 1997 until 2010, and the coalition Government that followed, which of course had to clear up the financial mess left by its predecessor, failed to invest enough in training the doctors we need today. Let us not forget that it takes 10 years to train a GP. To have them practising today, they would have had to start their training back in 2009.

Although there is a nationwide shortage, the problem is more acute in my constituency, and across Kent generally. Indeed, out of the top five areas in England with the worst GP to patient ratios, three of them—Swale, Thanet and Bexley—are in our county. That cannot be a coincidence.

Why is there such an acute shortage in Kent? I believe that the reason is twofold. First, doctors can earn more working in London than they can in Kent, because of the London weighting allowance. I would like to see the London weighting allowance extended to cover Kent, which would make it easier to recruit not only doctors, but also other public sector professionals, such as nurses, police officers, teachers, fire-fighters and prison officers, all of whom it is difficult for us to recruit.

Secondly, doctors undertake their training in London, so they tend to settle in the capital when they qualify. I am pleased that the Government have recognised that problem and a new medical school will be opening in Kent next year. We hope that doctors training in Kent will be more inclined to stay in the county once they have qualified. However, the reality is that any such newly qualified doctors who do decide to stay in Kent and go into general practice will not be available until at least the year 2030, by which time the need will be even greater because of other factors. That is where the two other concerns I mentioned at the beginning of my speech—roads and housing—come into the equation.

The roads infrastructure in my constituency is close to breaking point. We have continual problems of congestion, particularly on the M2, the A2 and the A249, and that congestion is creating ever higher levels of air pollution. As I mentioned, my constituency suffers from a high incidence of lung-related diseases. Ever more traffic congestion will produce ever more air pollution and increase the number of people who, in the future, will seek medical help. Their first port of call will naturally be a GP, putting even more strain on an already stretched primary care system. Something must be done to improve the strategic roads infrastructure in Sittingbourne and Sheppey in order to reduce congestion and air pollution, and that something must be done soon. Time is running out.

The second concern, and a major contributor to our poor GP to patient ratio, is the huge number of housing developments in my constituency over the past 20 years. The area has been transformed and is changing beyond all recognition. Housing numbers have already grown dramatically, and the housing targets being imposed on Swale Borough Council by the Government will see that growth accelerate. The reality is that we are facing the prospect of an ever-growing population at the same time as the number of GPs is diminishing, because the shortage that I spoke about earlier is being made worse by the number of doctors in our community who will retire in the next few years.

If the Ministry of Housing, Communities and Local Government were represented here today, I am sure that it would insist that any future housing developments should have planning conditions placed on them to require the developers to provide health facilities such as a local health centre, as the Ministry has done in the past. What is the use of section 106 money and the community infrastructure levy if we fail to recognise an inconvenient truth: forcing a developer to build a health centre is all well and good, but without the necessary doctors to staff it, at the end of the day it is just another building? Somehow, we have to ensure that something is done to reduce housing targets in areas in which GPs are in short supply, such as my own, until such times as more doctors come on stream.

I appreciate that the Minister has no responsibility for either roads or housing, but I hope she will at least join me in lobbying her colleagues in the Department for Transport and the Ministry of Housing, Communities and Local Government to provide Sittingbourne and Sheppey with the help that is needed to solve the road congestion problem and reduce the planned level of house building. If we can do that together, we will go some way towards improving the health of my constituents and reducing the pressure on primary care in Sittingbourne and Sheppey.

--- Later in debate ---

[Caroline Dinenage]

My hon. Friend makes an excellent point, and I completely understand that places in the London catchment area can very easily lose key public sector professionals. It is very difficult to compete with the potential extra wages that they might be able to achieve by working in the Greater London area. It is important to acknowledge that diversifying the range of different medical professionals who people can see will immeasurably help general practice to cater for the additional number of patients. It means bigger teams of staff providing a wider range of care options for patients, which effectively frees up more time for GPs to focus on those with more complex needs.

I was very pleased to hear that the CCG general practice in Swale is already using the skills of a wider workforce, including pharmacists working alongside GPs and paramedics providing home visits. We are training more GPs than ever before, and last year Health Education England recruited the highest number of GP trainees ever: 3,473. As my hon. Friend said, a new medical school is opening in Kent next year.

It has been made easier and quicker for qualified doctors to return to the NHS through the national GP induction and refresher scheme. Yesterday NHS England launched a new “Return to Practice” campaign, which is aimed at promoting the support that is available to GPs who have left practice, with a view to trying to tempt them and encourage them back. To bridge the gap while that training is ongoing—my hon. Friend rightly says that it takes a very long time to make a GP—NHS England’s international GP recruitment programme is bringing suitably qualified doctors from overseas to work in English general practice.

[Helen Whately]

I completely agree with what the Minister is saying about the importance of a greater range of healthcare professionals—it is not always about seeing a GP, so there needs to be a shift in expectations—and the plans to increase the number of GPs in the system, including through the Kent medical school, for which I campaigned very hard. I urge the Minister to come, if she can, to my point about an access metric. It would be really helpful to have a better way for patients to know what level of access they should expect. At the moment, we seem to have the proxy of a GP-to-patients ratio, but it is not good enough. It would be helpful if she could address that.

[Caroline Dinenage]

It is quite tricky. As my hon. Friend knows, general practices are independent contractors. Each general practice is required to meet the reasonable needs of their registered population, so there is no exact metric or recommendation for how many patients a GP should have, as the demand that each individual places on a GP can be significantly different. There is obviously much greater pressure on a practice in an area with a much older population—with more retired people and those with more complex needs—than on practices in other areas. That is where the complicating factors arise.

It is really important to work on innovative ways not only to bring in a new raft of GPs, but to hold on to the ones that an area already has. I understand that Swale CCG is working with GP practices across the area to improve retention. Supported by funding from NHS England, it is shortly due to launch a pilot GP recruitment and retention scheme. It is being proactive in recruiting the next generation of general practice staff and has been working with local schools and colleges to encourage local students to consider healthcare, and particularly primary care. I understand that three training practices in Swale offer placements for trainee medics, to give them the opportunity to experience general practice and consider general practice training. As of December, there were 11 direct patient care apprentices working in general practice across Swale.

My hon. Friend the Member for Sittingbourne and Sheppey rightly made the point that three of the areas with the highest patient to GP ratios are in Kent. I have been advised that, alongside the CCG’s work, the Kent and Medway sustainability and transformation partnership has set up a primary care workforce group, and has secured £1.5 million from Health Education England and NHS England to implement its workforce transformation plan.

The range of other issues that deter medical graduates from general practice include the spiralling cost of purchasing professional indemnity cover, which is a major source of stress and financial burden. We have addressed that in the new GP contract and from 1 April this year, the new state-backed clinical negligence scheme for general practice will bring a permanent solution to indemnity costs and coverage. That will help drive recruitment and retention of GPs.

We recognise the huge contribution that the general practice partnership model has made to patients over the lifetime of the NHS, but we also recognise that increasingly that model faces challenges, as fewer young GPs want to become partners. An independent review, led by Dr Nigel Watson, reported in January and made seven recommendations on workforce business models and risk, to which we will respond shortly.

My hon. Friend made the point well that air pollution, road infrastructure and congestion contribute massively to the pressure on general practice. The Government recognise that air pollution poses one of the biggest environmental threats, particularly in the case of frail elderly people and young children. Removing congestion from roads is certainly one of the sure-fire ways to reduce some of the air pollution hotspots. My Department will always be happy to furnish him with data that he needs on the health impact of pollution, to support any of his activities for attracting the local road investment that will tackle the problem and help his constituents.

My hon. Friend also raised a concern that housing targets placed on Swale Borough Council by the Government put additional pressure on doctor’s surgeries. The national planning policy framework, which was published last year, makes it very clear that strategic policies must make sufficient provision for community facilities, such as health education and cultural infrastructure. As he says, it is not enough to build a building; we need staff inside it. The views of local clinical commissioning groups and NHS England must be sought with respect to the impact of any new development on health infrastructure and demand for healthcare services.

Examples of primary care being delivered in an innovative way can be found across the country, for example using other professionals to deliver care or GP practices grouping together to work more collaboratively. That is exactly the kind of innovation and co-operation envisaged in the long-term plan, which seeks to change the balance in how the NHS works by shifting more activity into primary and community care. That is enabled by expanding multidisciplinary team working. The NHS long-term plan also commits to the recruitment of 1,000 social prescribing link workers by 2020-21. I encourage my hon. Friend to have a conversation with Swale CCG to see if any of those innovative measures could be introduced to help his constituents.

Mental Capacity (Amendment) Bill [ Lords ] (Third sitting)

Helen Whately Excerpts

Thursday 17th January 2019 Public Bill Committees

[Helen Whately (Faversham and Mid Kent) (Con)]

My hon. Friend might be coming to exactly this point but, having been involved in some of the conversations about the review of the Mental Health Act 1983, I know that lots of concern was expressed about families feeling that they were not involved enough in the care of their relatives and in decisions about them being detained, for instance. I am keen for her to reassure us that parents will not be overlooked and will be involved, so long as they are acting in the best interests of their child.

--- Later in debate ---

[Dr Williams]

I thank my hon. Friend for referring to the Law Commission’s recommendations.

I am sure that the Government will argue that the substance of the amendment will be reflected in the code of practice, but it is so important and so fundamental that it needs to be reflected in the Bill. Obviously, somebody may well have the capacity to consent to different decisions. Capacity is not just assessed over a period of time; assessments depend on the decision that somebody is going to make. Somebody may well have the capacity to decide whether they want tea or coffee, but may not have the capacity to decide all the time whether they consent to their deprivation of liberty.

Anyone who has ever spent any time with somebody who has capacity issues—we are usually talking about people who have a dementia, as the majority of people who have fluctuating capacity, though not all, have a dementia—will know that people have good and bad days. Sometimes people have good and bad hours. It is common for someone to say, “She was bright and sharp this morning,” or, “He’s not quite himself tonight.”

Acute illness can affect capacity, but so can sleep, stress and nutrition. The very nature of memory issues means that people fluctuate in and out of having capacity sometimes. In the same way, many physical issues have a fluctuating nature. People with arthritis have good and bad hours, and good and bad days. Rheumatoid arthritis is typically worse in the mornings.

The amendment is fundamental because the assessments of capacity that are made as part of the authorised deprivation conditions are likely to determine the length of the liberty protection safeguard. At the least, they may be one of the important determinants of the length of the safeguard—possibly the most important. In deciding how long the safeguards should apply, it is imperative to know whether someone has fluctuating capacity. As I have indicated, that might require more than one assessment of capacity.

[Helen Whately]

I spoke about my concerns about fluctuating capacity on Second Reading. The hon. Gentleman just mentioned that in these discussions, we usually think about someone with dementia, but it has been flagged to me that sometimes the Mental Capacity Act has been used to detain people who have other serious mental health conditions—not necessarily just dementia. Those conditions very much fluctuate, too. It is important that the Bill addresses the fluctuating capacity of people with serious mental illness if they might be detained under the Bill. I am keen for the Minister to respond on that point.

[Dr Williams]

The hon. Lady’s words are wise. The fact that people’s capacity is likely to fluctuate makes them uniquely vulnerable to the wrong decisions being made about them.

My assessment is that it is better to err on the side of caution. People with fluctuating capacity are likely to need regular review. The liberty protection safeguards are likely to be put in place for shorter periods. Unless that assessment of fluctuating capacity is mandatory and put front and centre of the decision-making process about the length of the safeguard, there is a risk that the wrong decisions will be made. For that reason, I support amendment 32 as a fundamental requirement to assess whether the cared-for person’s capacity is likely to fluctuate.

--- Later in debate ---

[Caroline Dinenage]

As I say, I am tempted by what hon. Members have said, so I will take this point away and look at it, but we have to consider this matter very carefully. We have to consider whether there are appropriate protections already in the Bill. That point relates to what I spoke quite a lot about on Tuesday—we have to be really careful about the unintended consequences of putting too much in the Bill, because if we then leave something out, we may create the sort of legal loopholes that caused so many problems with the previous DoLS legislation.

[Helen Whately]

The Minister is discussing whether there is already the necessary content in the legislation. Is she referring to the Act that we are amending or the Bill that we are discussing? It might be helpful to clarify.

[Caroline Dinenage]

Both, really. For example, the Bill lays out how every authorisation has a programme of reviews—if there is a change in the circumstances meaning that authorisation conditions are no longer met, the authorisation is no longer valid, and a review is triggered by reasonable request or significant changes in a person’s circumstances—so it is well within the scope of the Bill to address people with fluctuating capacity and to make sure that there is the necessary capacity.

The other issue that I have to take into consideration is that in a case regarding a patient known as CDM, fluctuating capacity has been considered by the Court of Protection, and that is currently being appealed. We are awaiting that decision, which will give useful guidance on how care workers should assess those with fluctuating capacity. That is something we will want to reflect on.

The hon. Member for Dewsbury spoke about the Law Commission and asked why we have differed a little bit from what it recommended. It is simple. The Law Commission had anticipated an entirely separate scheme for fluctuating capacity, adding a hugely complex dimension to this whole piece of work. Under its recommendations, people with fluctuating capacity would be dealt with in a separate authorisation process not directly linked to the main scheme. That is why there is a bit of confusion there.

There will be an awful lot of detail on this matter in the code of practice, which we consider the most appropriate form of guidance, given the level of detail it will require—this is a very serious matter. That will continue the practice under the current deprivation of liberty safeguards system, where the code of practice addresses fluctuating capacity. As I say, the Bill talks about regular assessment, including a limit of a year in the first instance—that is the maximum. The assessments can be set at very short-frequency time periods in order to deal with somebody who might have fluctuating capacity. Statutory guidance will include cases where a person with fluctuating capacity meets or does not meet the authorisation condition of lacking capacity to consent to arrangements, and will cover whether the authorisation continues in force or ceases to have effect.

Amendments 31 and 33 seek to ensure that medical assessments are completed by a registered medical practitioner. I completely agree that the person who conducts the medical assessment must of course be suitably competent, but the Bill already states that a person carrying out a medical capacity assessment must have “appropriate experience and knowledge”. We expect capacity assessments to be completed by a registered professional such as a nurse, social worker or occupational therapist, and medical assessments must be completed by physicians, such as family GPs and other doctors. However, we have to take into consideration that objective medical evidence does not require a registered doctor in all cases. Case law confirms that it can also include psychologists, for example, as was confirmed by the Law Commission.

In addition, to show the complexity of the issue, registered medical practitioners can include doctors who do not currently have a licence to practise. I know the hon. Member for Stockton South will be aware of that, given his knowledge and profession, but we need to consider carefully the law of unintended consequences when thinking about putting that in the Bill. We could be opening up a whole unwanted can of worms. We need to consider carefully whether we allow that particular group to give medical evidence.

It should also be noted that case law on article 5 of the European convention on human rights already requires that a deprivation of liberty must be based on objective medical expertise. The focus is therefore on competence at every stage rather than on qualifications. We are making it clear that all appropriate medical professionals should be included, which includes the speech and language therapists in the case that the hon. Member for Dewsbury spoke about.

I hope I have provided confirmation that medical and capacity assessments will be completed by somebody with the appropriate experience and knowledge to do the job, and that they will have the competence required to make a reliable assessment. I hope that I have provided Members with the reassurance they need to not press the amendments.

NHS Long-term Plan

Helen Whately Excerpts

Monday 7th January 2019 Commons Chamber

[Matt Hancock]

I enjoyed my visit to Derriford Hospital’s night shift and learned an awful lot from it. One of the consequences of seeing what is happening on the ground is that we are providing it with a new A&E facility. We are putting tens of millions of pounds into the hospital, so it would be a bit better if the hon. Gentleman mentioned that as well as rightly raising concerns about performance. That funding was the result of the campaigning of the hon. Member for Plymouth, Devonport, who is an absolutely brilliant campaigner for his local community—[Interruption.] Yes, the Members for Devonport and for Moor View. I am a big supporter of Derriford Hospital and think it does a brilliant job, and in challenging conditions, but it is going to get a better A&E because we have provided the funding to allow it to do that.

[Helen Whately (Faversham and Mid Kent) (Con)]

I welcome the commitment to mental health in the NHS long-term plan, particularly the badly needed new care model for young adults, the commitment to more care for people with severe mental illnesses and the further expansion of mental health liaison services in A&E. I also welcome the commitment to more performance standards for adults with mental illnesses. Will my right hon. Friend make sure that those mental health standards are introduced sooner rather than later, so that we do not have to wait too long for the waiting time standards? Transparency is so important for the parity of esteem between mental health and physical health.

[Matt Hancock]

My hon. Friend is absolutely right. Those standards are being trialled at the moment. Of course we want to get them right, but we will look at the results of those trials as soon as we can.