Breast Cancer Diagnosis and Services: Covid-19

Kieran Mullan Excerpts

Thursday 12th November 2020 Westminster Hall

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

It is a pleasure to serve under the chairmanship of a fellow Cheshire Member, Ms McVey. I congratulate my hon. Friend the Member for North Warwickshire (Craig Tracey) on securing the debate.

I think we all agree that the NHS is facing probably the most challenging period in its history. During the previous lockdown, the Government and the NHS leadership were dealing with enormous levels of uncertainty and, like all of us, had in their minds the images of what happened in Italy, with parts of its health service totally overwhelmed by covid cases. Enormous effort was put into preparing the NHS for that possibility: wards were reorganised, whole new systems for moving patients through hospitals were instigated and staff were redeployed. I pay tribute to the hard work, commitment and flexibility shown by so many NHS staff as part of all this. The changes made and the approach taken can only be described as a success, in terms of the NHS managing the wave of covid cases as it did. Our NHS was not overwhelmed, and no patient with covid who needed more intensive treatment was prevented from getting it.

However, we are here to talk about the wider picture of healthcare for our constituents during the pandemic. Colleagues of mine noticed almost immediately enormous drop-offs in patient attendance that simply could not be explained away by the lockdown. The first time I went to help in A&E, the department was quite simply the quietest I had ever seen it. It seems clear that there were people at home experiencing things such as heart attacks and strokes, which do not always present in a calamitous way that would cause one to definitely seek help.

[Steve McCabe in the Chair]

Of course, the debate is specifically on cancer diagnosis, and even in the best and most proactive health systems in the world, the journey often consists of experiencing a wide range of minor symptoms that only over time become apparent as something more serious. That is why it matters that, over the last few months, there has been an inevitable downturn in people seeing doctors and nurses, because people think they can put off seeing them about these symptoms.

In discussing breast cancer, we can at least take some comfort from our relative success in educating people about the symptoms to watch out for, which by comparison with other cancers are a little bit more specific. We have a proactive screening programme, because we know that we can spot cancers earlier and save more lives if people are screened, rather than waiting for symptoms. Most breast screening services were suspended due to the coronavirus, and Breast Cancer Now estimates that, while screening was paused, almost 1 million women missed out on their mammogram, and that around 8,600 women caught up in the screening appointment backlog could be living with undetected breast cancer. Thankfully, screening has now restarted across the UK, and I understand that more than 400,000 women were invited for breast cancer screening between June and August, with thousands more invitations being sent every month.

I will finish by focusing on two points. First, backlogs—I just described them for breast cancer; we have all described them today—affect a wide range of treatments. We must ensure that the NHS gets the additional resources that will be vital for it to catch up on the backlog of care and treatment built up during the lockdown, and which I am afraid is still building up in some areas. The record numbers of nurses and doctors now working for the NHS will be needed, and we will have to deliver on our manifesto commitments to keep building that workforce in primary and secondary care.

Secondly, we must make it clear to the public that the choice is not between tackling coronavirus or tackling the other healthcare needs of our constituents. Tackling coronavirus will allow us to carry on meeting the wider healthcare needs of our constituents. Any hospital faced with a choice between providing critical care for patients very sick with covid, who are at risk of dying there and then, and providing screening and non-urgent treatments will have to prioritise that immediate and critical healthcare need. That is why keeping the coronavirus suppressed is absolutely vital.

The NHS has moved on from where it was at the start of lockdown and every week is getting better and better at doing both things at the same time. We must all carry on giving it the room to manoeuvre that it needs to build on that further, enabling it to look after patients with and without covid, patients with urgent healthcare needs and planned healthcare needs, and patients requiring things such as screening.We will only stand a chance of being able to do that if we can continue to keep coronavirus suppressed, following the guidance that we have all been given—hands, face and space. Let us ensure that it is clear to constituents: this is not a choice between one or the other, but about supporting both groups of patients.

Local Contact Tracing

Kieran Mullan Excerpts

Wednesday 14th October 2020 Commons Chamber

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

I welcome the opportunity to take part in this important debate.

Effective contact tracing is going to help us to tackle this virus, and all of us here want the best possible version of that tool in the toolbox. The question is how best we do that. Despite what the Opposition might have people believe, there are no easy answers to this problem. It is easy to stand up in this place or go on TV and say, “Fix it”, but anyone with any real-world experience of organising any kind of project or undertaking that is even a fraction of the scale and size of this one understands the incredible challenges that are inevitably faced. Over recent months, the Government have built a huge testing regime capable of processing 340,000 tests a day that has tested over 7 million people in a matter of months. At the start of this epidemic, the yardstick for all this was Germany. Now that we are testing more people than Germany, France, Italy and Denmark, and many others, that yardstick has quietly disappeared.

Yes, there are challenges. Supply and demand are not uniform across the country and supply needs to be increased, but, whatever Labour Members think about the Government’s approach to testing and tracing, if they describe testing 69% as a complete failure, what does that say about the Welsh Labour Government’s programme? To be brutally honest, I am struggling to understand what exactly Labour Members are trying to say today, beyond of course, “We could have done it differently. It would all have been different and fantastic, and nothing would have gone wrong.” That is basically their position on everything to do with the coronavirus.

Let us talk about some of Labour Members’ common criticisms. They say we should not have the private sector involved, and that there is insufficient capacity. At the same time as criticising the Government for not having enough testing capacity, they are telling them that they should immediately and drastically cut out a chunk of that capacity because it does not suit their ideology. This is all based on their blinkered mentality that if the private sector does something it will automatically be bad and if the public sector does something it will automatically be good.

That brings me to the question of whether doing everything locally would have been the right approach at the outset of the programme. I simply do not accept that asking all 152 directors of public health to go off and set up their own approach at the outset would have been in any way feasible. Were they all supposed to come up with their own laboratories, their own contracts and their own apps? That just is not a credible solution in the short term. It was common sense to begin with a central programme, although even at the outset, when it was clear that something centrally driven was needed to kickstart the process, the Government recognised that local systems had a role to play. Many months before Labour was calling for it, £300 million was provided to help local authorities to develop their own test and trace programmes and, importantly, we have now 93 local authority test and trace regimes up and running.

So what is it that Labour Members are saying? Is it that we should immediately hand over everything that is being run nationally to local authorities?

[Chris Bryant (Rhondda) (Lab)]

No.

[Dr Mullan]

Well, it is.

Many of us in this place who have had dealings with local authorities—as well as lots of our constituents and probably millions of people across the country—would agree that getting everything done by the local authority is by no means a guarantee of success. Just this morning, in news that I am sure was greeted with groans in the Labour Whips Office, it was revealed that Birmingham City Council’s local programme dropped off 25 used swab kits to homes in Selly Oak. Does that mean that local authorities are incapable of delivering? No, of course not. We have problems in the private sector, and that should not bar them from involvement, and we have problems in the public sector too.

Local authority solutions are not a magic bullet. The quality of leadership, management and organisation varies enormously among local authorities. We all know this, and the Opposition know it. At the election, so many bricks in their red wall fell because residents were fed up not just with Labour at national level but with inept, Labour-led local authorities. After decades in power, they were taking people for granted, with leaders and councillors who were not even up to the job of taking away the bins on time, let alone organising a test and trace programme. The national programme inevitably has challenges, but do Labour Members really think that each and every one of the local authorities will deliver on this flawlessly?

Local leaders are political. Sadly, time and again we see Members on the Opposition Benches putting politics first. In the past 24 hours alone, they have said that they support local lockdowns but then did not vote for local lockdowns; that national lockdowns were a disaster, but now they want a national lockdown—and they cannot even make up their minds whether they want a two-week or a three-week lockdown. And they want the country to believe that if they had been in charge, all this would have been going smoothly. That is not accurate. When it came to getting children back to school, the national Labour party was kowtowing to national union leaders and doing what they said, and we all know that the local Labour parties are just as likely to be influenced by the unions. I absolutely recognise that there is work that needs to be done, but I am afraid the idea that if we just flick a switch and give it all to local authorities everything will be fine is complete and utter nonsense.

Public Health: Coronavirus Regulations

Kieran Mullan Excerpts

Tuesday 13th October 2020 Commons Chamber

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

I want to focus my remarks on whether there is currently any viable alternative to the lockdown measures that have been put in place in my constituency. In my view, there is not. The argument put forward by some is that we could somehow isolate or protect the vulnerable, to allow the rest of us to carry on with our lives as normal, but how realistic is that? We have to be clear about the number of people that we are talking about. This is not just about people in their 80s. Our current understanding is that approximately one in every 200 people in their 50s and 60s affected by coronavirus will die. For people in their 70s and above, that figure is more like one in 10. Taken together, those age groups add up to something like 25 million people. How viable is it to keep them safe?

In answering that question, we must not compare it with how successfully we have been able to do that so far, because if we abandon lockdown measures for everyone else, there will be one key difference. Right now, as we are all involved in the national effort to stop the spread of the virus, we all play a part in keeping the levels of the virus low. That means that when a grandparent meets up with their grandchildren, their grandchildren probably do not have the virus. It means that when a plumber turns up to fix a pensioner’s boiler, they probably do not have the virus. It means that when a carer arrives to help get an infirm person out of bed, they probably do not have the virus. Most importantly, it means that when an older person managing their chronic illnesses turns up to their next GP or hospital appointment, the receptionist, the nurses, the doctors and the people in the waiting room probably do not have the virus. That is because we are all playing our part in trying to stop the spread.

If we were to let the virus spread among the rest of the population, we can forget all of that. We would reach a point where, in every single one of those examples, the vulnerable person would stand a very real chance of catching the virus because it would be rampant. That is the reality of the strategy that some are proposing. We would effectively be telling 25 million people to play Russian roulette every time they step outside their door—they can hug their grandchildren, but they run a real risk of catching a deadly disease if they do that. They can go to work, but they run a very real risk of catching a deadly disease if they do that. Most importantly, if they go to their cancer screening, their radiotherapy or their chemotherapy, again, they run a very real risk of catching a deadly disease. That is no choice at all.

But we do have a choice, and that is to persevere. It is not easy, and I have no doubt that we are paying a terrible price in terms of the economy, our wellbeing and our health, but I simply cannot see how that price would be outweighed by the loss of life on the scale we would see and the restrictions we would have to put in place on 25 million people if we were to give up. I do not think we can justify abandoning the older members of our society to their fate—not when, if we buy them more time, I believe we will find other ways forward. Whether it is a vaccine or mass daily testing, science will provide us with the solutions. I could be wrong. We could lose that battle in the long run, but we have not lost it yet, and I do not think the British people are ready to surrender; I know I am not. We must push on with these measures.

Public Health

Kieran Mullan Excerpts

Wednesday 7th October 2020 Commons Chamber

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

I welcome this opportunity to speak, because while Cheshire East remains one of the few regions in the north-west not in lockdown, it is now on the watch list, and concern among my residents about what might happen is growing. Some have criticised the Government, but it is fair to describe the choice currently facing the Government as either acting to stop the spread of the virus or letting it rip. Whether it doubles every seven days, every 14 days or every 21 days, we know that it will speed up, that it will eventually speed up rapidly and that it will then grow exponentially. We must remember that the lower the R rate and the incidence when the Government act, the more likely those actions are to be successful and the less severe they will need to be.

I do not underestimate the impacts of the measures on mental and physical health, or on livelihoods. They are very significant, but I think we need to take some comfort from the fact that the chief medical officer frequently, if not always, references this when he is talking about the impact of the virus. I think the Government understand this, and they are weighing the impacts against the cost of the virus spreading. So far, it is thought to have affected 6% of the population, and our estimates are that that has led to the death of approximately 40,000 people. There is some scepticism about that figure, so let us halve it. That would be a generous response to the scepticism. If the rest of the 94% of the population were to get the virus, we are talking about something like 300,000 deaths in the next 12 months. But let us be even more sceptical and halve the number of people who are going to get it. Again, we are looking at something like 150,000 people who would pass away. That does not take into account the enormous strain that that would put on the health service as people became unwell and were admitted to hospital.

I do not think that the hospitality sector would not survive that kind of daily reporting of the health impact of a communicable virus. And can we really ask the 2.5 million people aged over 80 to stay at home? Those people are, on the whole, still living full, active lives, and we also need to consider the 10 million people in their 60s and 70s who would also need to stay at home. The more we let everybody else act in a normal way, the greater the restrictions on those people would be. If the virus was spreading rapidly through the younger population, we would be telling those older people that they effectively could not have anything to do with anyone else because they would be at such a high risk of catching the disease. I do not think that that is realistic, so until we have an alternative, whether it be a vaccine or mass testing, it is quite right that the Government act as they have been doing.

However, the Government need to work harder on explaining and justifying the steps they are taking, both locally and nationally. Where is the detailed explanation of why they have not excluded children from the rule of six? Where is the detailed explanation around the 10 pm lockdown?

This statutory instrument obviously relates to local lockdown measures, but if we do not have the confidence and the faith of the public in the national measures, we have very little chance of getting them to listen to us on the local measures, and it is Members in this place who will be out there explaining and justifying the measures and the approaches that the Government have taken. If we cannot explain them, do not understand them and do not have that detailed information, what chance do we have of successfully doing that for the public? I ask the Minister to get the Government to work harder on bringing this House with them on these measures, which I ultimately think are justified.

Covid-19 Update

Kieran Mullan Excerpts

Thursday 17th September 2020 Commons Chamber

[Matt Hancock]

The right hon. Lady says she is doing that. I am very glad that she is, and I thank her for doing that. I am very happy to work with the right hon. Lady to ensure that her constituent who works in the NHS can get a test through the NHS, because that is the role of the NHS for provision for those who work within it.

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

I welcome the confirmation today that Leighton Hospital will receive £9 million extra to help it prepare for winter. That funding will make a huge difference. I think everyone in this House and in the whole country hopes that we manage to find a vaccine, so I would be grateful for an update on vaccine development. Can my right hon. Friend also confirm my understanding that Test and Trace has found that the virus is spreading in our own homes, when we mix with friends and family, and that, as much as it is difficult for us, that is why the lockdown is focusing on those types of interactions?

[Matt Hancock]

My hon. Friend is absolutely right. Of course, as an emergency doctor himself, he knows more than almost anyone in this House about the needs of emergency care, not least because he spent lockdown working on the frontline of our NHS. I know that everybody is grateful to him for that. I know that the £9 million expansion to Leighton Hospital, which he and I visited in November or December, is much needed, and I hope that it brings good benefits, but it is also critical that people listen to my hon. Friend’s wise words.

Covid-19 Update

Kieran Mullan Excerpts

Thursday 10th September 2020 Commons Chamber

[Matt Hancock]

This programme will be rolled out by the Ministry of Housing, Communities and Local Government, because we will be working very closely with local authorities to make it happen, and we will publish the details in due course.

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

I know how hard the hospital and A&E leaders are working at Leighton Hospital to prepare the hospital for winter in the context of covid, which is why I was incredibly disappointed to see the local Labour party telling residents that they were not going to get any extra funding to do that. Can the Secretary of State assure my local residents that that is not the case, but also agree to meet me to discuss the issue of much-needed longer-term investment in the Leighton Hospital site?

[Matt Hancock]

I am very happy to meet my hon. Friend, who speaks so strongly for Crewe and all of its residents, on the need for a high-quality NHS. Of course, my hon. Friend is a qualified doctor who, during lockdown, spent a huge amount of time in hospital and working on the frontline of the NHS, and I think we should all applaud him for that work. I am absolutely happy to meet him. He knows, with enormous expertise, of what he speaks. We are all grateful for his service, and I hope that we can continue to make improvements to Leighton Hospital.

Independent Medicines and Medical Devices Safety Review

Kieran Mullan Excerpts

Thursday 9th July 2020 Commons Chamber

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

I welcome the report and its wide-ranging recommendations, particularly those focused on a medical-devices registry and the need to improve our post-market surveillance of drugs and treatments in this country. However, I urge caution in respect of the risk of creating new posts and bureaucracy when we already have an extensive number of organisations—including the CQC, the ombudsman and Healthwatch—and hospitals themselves have a responsibility to listen to complainants, whatever the cause of their complaint might be. In my time at the Patients Association, we ran a survey of complainants across a number of hospitals to compare and pick up those hospitals that were not as good at listening as others. Does the Minister agree that, if all healthcare providers had to survey their complainants and we could compare how well providers were listening to them, we might see improvement on the frontline for patients, in respect of all different causes of complaint?

[Ms Dorries]

My hon. Friend makes a really important point. It is a recurring theme—over and over again—that when patients complain, the first point of complaint is to the trust where they were treated, but that is often where the logjam is. A patient-safety campaigner told me recently that it was seven years before the chief executive of a trust would even acknowledge his complaint or meet him. That is where we see the logjam happening. I will take away my hon. Friend’s point and consider it, because it is a very important one.

Health and Social Care Workers: Recognition and Reward

Kieran Mullan Excerpts

Thursday 25th June 2020 Commons Chamber

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

I thank all the people who have signed the petitions that we are debating for expressing their support for NHS and social care staff and for the generosity of spirit that they have shown. It has given everyone in this place another chance to show our appreciation for NHS and social care staff. From working alongside colleagues, I know that it makes a difference: they notice these things.

We have seen an astonishing contribution over recent months, but many NHS and social care staff make fantastic contributions every day as part of their normal work. People go into the NHS and social care with open eyes—they are not naive about what their roles entail—but that does not mean that we should not try harder to understand better how some roles and areas of work do not give staff the work-life balance that we would expect or the ability to deliver the care that we would want them to be able to deliver. As the workforce more generally moves towards greater flexibility and better work-life balance, NHS and social care staff will increasingly compare their work experiences and will perhaps not recommend that future generations go down the same route. We must tackle that.

That is why I am glad that at the most recent election the Government made some incredibly ambitious commitments for NHS staffing levels, particularly GP and nursing staff levels. The successful delivery of those goals will make an enormous difference. To get there, the Government will really have to get to grips with recruitment and retention in the NHS in a way that in recent years no party has done. We have made some good progress already: we have seen some good figures today on the increases in NHS and doctor numbers; junior doctors’ pay scales will have increased by at least 8% by 2023; and nurses will have received increases of between 6.5% and 9% by next year. The reward package also includes things such as pensions, some of which are the best available: members of the scheme can generally expect to receive £3 to £6 in pension benefits for every £1 that they contribute.

It is not just about pay, though. For example, in GP practice we see an enormous shift among new recruits to part-time work, because people want more flexibility. They want to live a different style of life, and that will have an enormous impact on the workforce across NHS. I want to use the focus on NHS and social care staff that has come about in the light of the pandemic and the extraordinary contributions that have been made to get everybody in this place to engage with the significant workforce challenges that we will face given an ageing population and an increase in demand.

Pay is never easy for any Government—there is always a need to look after the nation’s finances—but a recognition of the important role that healthcare can have in stimulating the economy and creating jobs and innovation should be given greater weight in the Treasury’s calculations. We do not yet know what the underlying finances are going to be in future years, as all the impacts of the pandemic play out, but within those constraints I want the Government to do everything they can to go as far as they can to reward and recognise the contribution of NHS and social care staff.

Testing of NHS and Social Care Staff

Kieran Mullan Excerpts

Wednesday 24th June 2020 Commons Chamber

[Jonathan Ashworth]

The hon. Gentleman is ahead of me in making the points that I was hoping to go on to make. I am not surprised that he has made those points given that he is a Leicester City fan. I am very proud to have Leicester City football club in my constituency— hopefully we will do better next season. He is absolutely right in what he says, because the statistics on cancer are absolutely terrible.

Around 2 million people in England are currently waiting for cancer screening tests or cancer treatment, including chemotherapy. Today, we have a published analysis, which shows that those waiting more than six weeks for diagnostic tests—some of these will be for cancer of course—have increased from 30,000 to 469,000 as a result of the lockdown. Cancer referrals are down 60%, and 1 million people are missing out on breast, bowel and cervical cancer screening. That means that about 1,400 cases of cancer are going undiagnosed every month. In March and April alone, there were at least 500 more deaths from cancer than average, and research from University College London predicts that an estimated 17,915 additional deaths of existing and newly diagnosed cancer patients could occur in England in the next 12 months. That is why resetting our NHS and getting it started again is so vital.

We also know that covid attacks the lungs, so this is an especially frightening time for those with serious asthma, chronic obstructive pulmonary disease and emphysema. One in four people with COPD have had a regular GP or hospital appointment cancelled, or both. Some 24% of people on pulmonary rehab programmes have had their classes cancelled, and 600,000 people with asthma or COPD have missed their annual review. The more we know about coronavirus, the more we know it is also a cardiovascular issue. Those with cardio- vascular problems are the second biggest group of those with an underlying condition dying from covid now, yet about 30,000 elective procedures for heart disease have been deferred. Referrals to stroke units have declined, and excess stroke deaths in care homes are 39% higher than the five-year average. We are making these points not in a spirit of blame, but to re-emphasise the point that lockdown has come with huge costs and will inevitably mean that people will die or develop long-term illnesses unless there is now a plan to get the NHS up, running and working again.

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

It is important that we are clear as to exactly what the Opposition are calling for today. The motion asks for “routine weekly testing”, with no ifs, ands, buts or qualifications. Yet the hon. Gentleman said in his opening remarks that he is seeking routine testing weekly if it is necessary. So are the Opposition calling for weekly testing, no matter what? Or are they calling for what he said in his opening remarks, which is the possibility of weekly testing?

[Jonathan Ashworth]

We are calling for weekly routine testing, as have many organisations and the Chair of the Select Committee on Health and Social Care. He penned an excellent article in The Daily Telegraph today, and I hope the hon. Gentleman has had time to study it, because it is superb. May I also take this moment to pay tribute to the hon. Gentleman, because I know he has returned to the frontline? I am sure all of us, from across the House, are grateful for everything he is doing on the frontline.

The other point I wish to make on this growing burden of unmet clinical need is that there is a social gradient in this, as always; there is a higher mortality rate among those who are poorer and more deprived. Through all these different conditions, the poorer someone is, the more likely they are to become ill quicker and die sooner. So we need urgent action from the Government to tackle this, and we believe that regular testing of NHS staff is a key part of that.

We also need a broader plan to tackle the growing burden of sickness and unmet need. Our NHS will need more resources. We have had years of financial starvation in the NHS. The Government’s funding plan of two years ago fell short of the annual 4% increase that experts said was needed before the pandemic, and the settlement of that long-term plan is surely inadequate post pandemic. We must remember that we entered this crisis after 17,000 bed cuts and years of budget cuts to capital settlements, which have left hospitals crumbling, reliant on out-of-date equipment and grappling with a £6.5 billion repair bill. NHS land and buildings have been sold off. Last year, more than 890 hectares of NHS land was put up for sale. So we will need large-scale investment in the real estate of the NHS to allow health services to reconfigure to treat covid and non-covid patients alike.

Ministers will say that the NHS will get what it needs, but the reality on the ground is very different. I am sure the Minister for Care will have studied today’s Health Service Journal ahead of the debate and will have seen trust chief executives complaining that the cash that they were promised has not been delivered. They need this cash now if they are to restructure any of their services ahead of the winter. I hope that she will update the House on when those chief executives are going to get the cash they were promised by her Department.

We will also need real investment in rehabilitation services for those suffering from covid. The more we know about this disease, the more we know that those coming out of hospital are probably doing so with significant long-term chronic conditions. They are going to need support, be it respiratory, neuromuscular or psychological. Community health services are going to see a huge peak in demand now that many have moved out of the community health sector.

Crucially, to reset services—this comes to the point that the hon. Member for Crewe and Nantwich put to us—we need to ensure that care can be delivered safely, which is why we believe that a mass-testing infrastructure for staff is now so important. We know that around a fifth of covid infections in hospitals are caught in hospital settings. Given the levels of significant asymptomatic and pre-symptomatic transmission, we need a proper targeted testing strategy as well. All healthcare workers should be tested regularly—weekly—because a study from Imperial suggested that that would reduce transmission in healthcare settings by up to a third.

--- Later in debate ---

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

I want to begin by thanking all the staff at Leighton Hospital, which serves my constituents in Crewe and Nantwich, who were so welcoming to me during my time on the wards recently. Because I am an MP and because I have a public profile, I have received a lot of thanks for going back, when actually the real thanks and gratitude should go to those staff who are there day in, day out full-time.

I know coronavirus presented a very real risk that was not an ordinary part of the job, but one of my key aims in this place is to get across to all Members of this House that the day-to-day stresses many face working in public services are there all the time. NHS staff often go above and beyond, and take decisions and carry a weight of responsibility that would be quite alien to most people. I want to use the recognition of the incredible work of NHS staff at this time to highlight the need to continue with this recognition going forward. We are at risk of finding it increasingly difficult to recruit and retain staff, as the rest of our modern workforce sees shifts towards a better work-life balance and flexibility in their employment.

We know that testing and tracing is key to the battle against coronavirus. We also know that health and social care settings are going to be the area that will need particular attention. In fact, I saw during my brief time back treating patients that, as services begin to look more like they did before coronavirus, the challenge for health and social care providers will increase in some ways. For a period, the task was clear and focused. Almost everything being done was geared towards treating coronavirus patients and keeping as many people as possible safe. Now, individual staff and managers need to weave steps to contain coronavirus throughout the increasing return of normal services. Organising wards into covid and non-covid is actually a simpler way of managing the flow of patients when that is the primary and overriding concern. When we reach the point of needing to be vigilant and to isolate individual patients among the delivery of normal services, that presents unique challenges of its own.

It is important that, wherever possible, normal services do return, because we know there is increasing evidence that diagnoses have been missed or delayed. This was an unfortunate inevitability of the clear and necessary message to the public about being careful in making use of the NHS at the height of the pandemic. So we must see how we can target messages. There is an increasing tendency to rely on social media online advertising for our public health messaging, and we need to use media that are going to best reach the at-risk groups for not seeking health advice.

On delivering rapid and ongoing testing, I feel compelled to challenge the narrative that the Secretary of State in Whitehall can click his fingers and instigate a flawless testing regime across the many thousands of individual wards, units, GP practices, treatment centres, care homes and in-home care providers that make up our health and social care sector. Clearly, the long time in opposition and the loss of so many previous Labour Secretaries of State for Health from their Benches have led to amnesia among the Opposition about the reality of instituting national approaches uniformly in the NHS. Any guidance is sent to hundreds of thousands of staff and is interpreted by them individually and locally by their managers.

Weekly testing is not a magic bullet. We must not let there be any distraction from the key and overriding concern that keeping outbreaks contained is most importantly about individual NHS staff and patients maintaining social distancing as much as possible within healthcare settings, because without that, even with regular testing, we will lose groups of staff from frontline services at times when we cannot afford to do so. We must not underestimate the enormous task a weekly testing regime would place on the NHS. There needs to be clear evidence for its benefits over other approaches. I note that the British Medical Association and others have said the same thing—that actually the evidence base for a mandatory weekly approach is not necessarily there. I hope, when responding, the Opposition spokes- person, the hon. Member for Tooting (Dr Allin-Khan), will spell out exactly what evidence they feel they have that means weekly testing is the one and only way to do it.

Oral Answers to Questions

Kieran Mullan Excerpts

Tuesday 10th March 2020 Commons Chamber

[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.

[Jo Gideon (Stoke-on-Trent Central) (Con)]

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

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

We are currently considering all options to increase the range of healthcare professionals permitted to administer low-risk medicines. This is all part of making sure that our NHS workforce is as flexible as possible, and we will do that in the light of what can be done, while of course keeping a highlight on patient safety.

[Dr Mullan]

My constituent Jessica Warr works as an operating department practitioner in Leighton Hospital. She and her colleagues make a huge contribution to patient care. Would the Secretary of State agree to meet Jessica and other ODPs to hear their case for why allowing them to prescribe would allow them to enhance the care they provide for patients even further?

[Matt Hancock]

Yes, of course, I would be very happy to meet my hon. Friend and those he represents to make sure that we can get the right balance—the maximum possible flexibility, subject of course to patient safety.