NHS Dentistry: Bristol and the South-west

Maria Caulfield Excerpts

Monday 24th January 2022 Commons Chamber

[The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)]

It is a pleasure to respond to this important debate and I thank the hon. Member for Bristol North West (Darren Jones) for securing it. I acknowledge many of his points but reassure him that dentistry is an absolute priority for the Government. He said he has previously tried to make contact with Ministers; he has not formally asked me for a meeting but I am happy to meet him should that be of assistance.

Let me touch on two of the main reasons why patients up and down the country currently struggle to see dentists. The first relates to covid. This is not a lame excuse for why there are currently difficulties: dentistry and dental services have gone above and beyond during covid. I am sure my hon. Friend the Member for Mole Valley (Sir Paul Beresford), who is a dentist, will back me up when I say that many dentistry procedures are aerosol-generating, so significant infection-control measures have been in place to protect patients and dentists and their teams.

At the start of the pandemic, when we first went into lockdown, only urgent procedures were allowed, so no routine procedures could be carried out. It was not until 8 June 2020 that infection-control measures allowed the reintroduction of some routine care. Even then, dental practices were able to work at only 20% of normal activity. That has of course had knock-on effects throughout England in respect of patient access to routine care.

Later that year, infection-control measures allowed up to 45% of normal activity, but it was not until last year that that proportion went up to 60%. Just before Christmas, NHS England and the chief dental officer wrote to practices to say that they could go up to 85% of normal activity and 90% of orthodontic activity. They are still not up to 100% of activity so they are literally treading water to try to keep the service going. I pay tribute to all those who have done such significant work to try to deliver services to the patients who have needed them.

Urgent care has been back at pre-pandemic levels since December 2020, so the backlog is in respect of routine services, whether fillings, caps, crowns or routine dental-hygiene work. Covid has significantly contributed to that backlog.

[Wera Hobhouse]

I understand from the dentists I speak to in my Bath constituency that the Government funding provided per patient just covers hygiene, not any of the repairs or dental work the Minister has just mentioned. Can she confirm or deny that?

[Maria Caulfield]

I will come to that in a moment, but let me first conclude on the impact of covid on dental services. The hon. Member for Bristol North West may be reassured to hear that the proportion of adults and children accessing dentists in Bristol, North Somerset and South Gloucestershire remains higher than the average for access to dentistry in England. It is probably no consolation to his constituents, but access is slightly higher.

[Darren Jones]

Is the average acceptable or below where the Minister would like it to be?

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[Maria Caulfield]

I have been clear that covid means we are not yet operating at 100% of normal activity. We need to get back to pre-covid levels, when the majority of patients were able to access a dental appointment and around 28 million people saw an NHS dentist every 24 months. That is where we need to get back to but we will struggle, because of infection-control measures due to covid, to get there until we are at 100% of activity.

I reassure the hon. Gentleman that NHS England is supporting local commissioners. There was an intervention about helping to get more service provision; provision is commissioned at a local level, not by the national Government. National Governments provide the funding and then local commissioners commission the services. It is important that Members talk to their local commissioners to understand what services are being commissioned. NHS England provides flexible commissioning toolkits to local commissioners to help to focus the available capacity.

[Darren Jones]

Does the Minister recognise that local commissioners can only commission dental services if the NHS dentists exist and are willing to provide NHS dental services? The core of my debate this evening is not about the impact of the covid pandemic, which we all recognise; it is about the underlying issues of the dental contract and the shortage of dentists. Does she recognise that?

[Maria Caulfield]

I will come on to the contract, which was developed in 2006 under the last Labour Government, and highlight the impact it is still having on dentistry—

[Mr Bradshaw]

You’ve had 10 years!

[Maria Caulfield]

This Government are always clearing up the mess of the last Labour Government. I am hoping to have a constructive debate but obviously Opposition Members are not willing to engage in that.

Despite all our efforts to increase services, we know that patients are experiencing difficulty gaining access to dentists. There are a number of options that are helping patients to locate their nearest dentist. Patients can call 111 to find out which dentists are taking on patients. [Interruption.] If Opposition Members are not serious about this and make funny head-in-hands gestures, it is really not helpful.

[Mr Bradshaw]

rose—

[Maria Caulfield]

No, I will not give way. The right hon. Gentleman is obviously not interested in my response.

In Bristol, North Somerset and South Gloucestershire, a dental helpline has been set up to help patients to find an NHS dentist for routine care and to arrange urgent treatment. In addition, we have written to dental practices asking them to update their online information on the nhs.uk website. It is really important that this is available so that patients can find out which dentists are taking on NHS patients and which are not. It is crucial that that is kept up to date because it does change on a significant timescale.

Dentists are also being asked to maintain a short-notice cancellation list so that they can proactively contact patients who are on their waiting list if a patient cancellation occurs. All these measures help with the underlying problem of gaining access to NHS dentists. Later this week, there will be an announcement on some extra funding so that local commissioners will be able to commission services, because in some areas there would be more capacity if extra funding were available. Colleagues across the House will see the details of that in the coming days. My hon. Friend the Member for Thornbury and Yate (Luke Hall) intervened on a similar point. I am happy to meet him to discuss the issue around Frampton Cotterell, as I am happy to meet all Members if they want to raise specific local issues around dentist availability in their constituencies.

To get to the crux of the long-term issues, we hope to get to 100% capacity at some point post the pandemic. However, as mentioned by many colleagues, there is an issue with the dental contract, which has perverse disincentives within the UDA—units of dental activity—system, which dentists struggle with because they are paid similar rates when they are taking out one tooth or doing one filling as compared with doing extensive dental work. This is a disincentive to dentists to take on NHS patients, or sometimes to hand back NHS contracts.

Work has already commenced on dental contract reform. The Department and NHS England are working with key stakeholders, including the British Dental Association, to look at alternative ways of commissioning services, because only when we address the fundamental of the contract that dentists are working on will we get to the crux of the matter of the poor uptake of dental contracts and the reluctance of dentists to take on NHS work. Our aim in contract reform is to improve patient access, reduce health inequalities and make the NHS a more attractive place to work for dentists, making them feel more valued and helping to recruit and, more vitally, retain the experienced dentists who do so much to protect and promote oral health in this country. I am sure that the hon. Member for Bristol North West will welcome that. We are making some building blocks in terms of work that is already happening.

A number of Members touched on the issue of recruitment and retention of dentists. Only in September last year, Health Education England published its “Advancing Dental Care” review report on a four-year programme of work to recruit, retain and train not just dentists but dental teams. We have identified more effective ways of utilising the skills mix in the dental workforce. We are widening access and participation to training, we are allowing more flexible entry routes, including for overseas dentists, and we are developing training places for dental professionals, not just dentists; we want to upskill dental technicians and dental associates by providing them with more skills so they can provide a greater range of services. We are also looking at providing training in areas where we have dental deserts—where we do not have dental provision that local commissioners can commission. Importantly, we know from GP trainees that those who train in an area are more likely to stay in the area. We want to facilitate that. Health Education England is doing a huge amount of work to make that happen.

[Darren Jones]

I thank the Minister for her answers. One specific question I asked was about the recognition of EU qualifications and the 22% of dentists in the UK who originate from the EU. Can she answer that specific question please?

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[Maria Caulfield]

Absolutely. We want to encourage everyone who wants to come and work in the United Kingdom to be able to do so, and we are working with the General Dental Council to make sure that happens. Currently a period of continued automatic recognition is in place for dentists with EEA and Swiss qualifications wishing to work in the UK and we want that to continue. Those with qualifications which were previously automatically recognised will continue to be recognised in the UK. I have heard from dentists from abroad who want their qualifications to be recognised here and we will work hard as part of the contract reform to make sure that that process is easier than at present.

On preventive work, my hon. Friend the Member for Mole Valley was absolutely right to point out that, as well as dealing with dental issues, oral health is crucial, and the Health and Care Bill is introducing proposals that will transfer the power to bring forward the new water fluoridation schemes, which will transform the oral health of many in the most deprived parts of our country, and could reduce the level of decay among five-year-olds by up to 28%. Simple measures such as that will make a big difference.

Although tonight I am unable to present colleagues with a quick-fix solution, I want to assure them that we are dealing with the issues covid has brought to us and we will be announcing further funding in this financial year to help to deal with some of that backlog, but there are issues with the current dental contract that unless addressed will continue some of the problems Members have raised this evening.

[Darren Jones]

I thank the Minister for giving way one last time. Might I gently suggest that the advice the Minister has this evening given my constituents in Southmead and across Bristol and the south-west who cannot get access to an NHS dentist is to call 111—they have tried that; it has not worked—to try to find a local NHS dentist, which they have tried too, and has not worked, and to wait for reform of the NHS dental contract, which has been in place since 2006 and this Government have been in office since 2010? They have been waiting for many years for that and I am not sure they are going to see it any time soon. I have constituents who are in pain waiting for dental care, and children who are not being seen. What are the immediate interventions the Minister can make? She has not offered any this evening.

[Maria Caulfield]

I would strongly disagree with the hon. Gentleman. He wants to work in a constructive way to deal with the issues facing his constituents, and he has already said that he wanted to meet the Minister, but he has never made an approach to meet me ever—

[Darren Jones]

Will the Minister give way?

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[Maria Caulfield]

I will not give way any further; I think the hon. Gentleman has made his points fairly clear. I have said to him that we are issuing a range of help. I have said there will be announcements later this week about funding in this financial year to help patients to be able to access dentists. I have also said that we are—

[Darren Jones]

On a point of order, Madam Deputy Speaker.

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[Madam Deputy Speaker]

That is not a point of order for the Chair, but I understand why the hon. Gentleman wanted to clarify that. [Interruption.] Order. We will not have any more shouting from people who are sitting down.

[Maria Caulfield]

I think it is very disappointing for the right hon. Member for Exeter (Mr Bradshaw) to say that there is no point in meeting or that it would be a pointless meeting. That is the sort of constructive engagement that Labour MPs in Bristol have. I have been very constructive and very open in offering to meet—my very first line in the response to this debate was that I was willing to meet—the hon. Member for Bristol North West to discuss that. If he was not serious about it, it is a shame that he has not been more constructive this evening. However, I am very clear that we are offering a range of options for patients. I have put on record and I have not shied away from the fact that patients are struggling to see their dentist. I have not shied away from the fact that dentists are not happy with the current contract, and we are instigating contract reform. I have not shied away from the fact that, with the current infection control measures, restrictions are still in place. However, as the Minister responsible for dentistry, I remain committed to playing my part to ensure patients can access NHS dentistry no matter where they live.

Question put and agreed to.

Oral Answers to Questions

Maria Caulfield Excerpts

Tuesday 18th January 2022 Commons Chamber

[Sarah Green (Chesham and Amersham) (LD)]

6. If he will make it his policy that prescriptions will remain free for people aged 60 and over.

[The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)]

At the present time, no decision has been made to increase the upper age exemption for free prescriptions.

[Sarah Green]

Such a policy change would hit a vulnerable age bracket who are more likely to have one or more long-term illnesses requiring medication. A constituent of mine has told me of his concern at the cost of paying for his wife’s Parkinson’s medication, should such a change be introduced. Given that the millions facing a new charge will also be hit by a rise in living costs, will the Secretary of State shelve such proposals and review the list of conditions that qualify for a medical exemption certificate?

[Maria Caulfield]

Can I just reinforce the answer I have just given? There is no decision to increase the upper age exemption for free prescriptions, and the rumour circulating that the Government are removing free prescriptions for pensioners is completely false. The Government are absolutely committed to maintaining free prescriptions for pensioners.

[Stephen Metcalfe (South Basildon and East Thurrock) (Con)]

I am very pleased to hear that no decision has been made on this important topic, and I hope the situation remains as it is. Will my hon. Friend take this opportunity to remind those who are paying for their prescriptions that a pre-payment certificate is available that can save a significant amount of money for those who regularly use their pharmacy?

[Maria Caulfield]

My hon. Friend is absolutely right, and he does well to highlight the pre-payment certificate. If people go for a 12-month certificate, which is about £2 a week, for two items they can save £116.30 and for three items, £228.50, so it is well worth the investment.

[John Mc Nally (Falkirk) (SNP)]

8. What recent steps the Government have taken to progress the introduction of mandatory folic acid supplementation in flour to prevent spinal conditions in babies.

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[Nicola Richards (West Bromwich East) (Con)]

11. What steps his Department is taking to reduce waiting times for face-to-face GP appointments.

[The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)]

In October last year, the Government announced a plan to improve general practice capacity, backed up by £250 million of winter access funds to help GPs and their practices. That can be used to fund more sessions from existing staff, or indeed increase the physical premises at a practice. For my hon. Friend’s area, the Black Country and West Birmingham clinical commissioning group expects an award of £6.5 million from the winter access fund.

[Nicola Richards]

My constituents in West Bromwich East have been raising concerns with me about their ability to access face-to-face GP appointments at local surgeries. Given the significant £250 million winter funding package for general practice announced towards the end of last year, what assessment has the Minister made of whether that support is making a real difference on the ground?

[Maria Caulfield]

I thank my hon. Friend, who is pushing me constantly to improve access for her constituents, but can I reassure her that the announcement, the funds and the support are making a difference? In November last year, there were on average 1.39 million general practice appointments per working day, compared with 1.31 million in November 2019, but crucially, 62.7% of those appointments were face to face, so this is really making a difference for patients.

[Feryal Clark (Enfield North) (Lab)]

A nurse wrote this week about working on covid wards during the height of the pandemic:

“There were no vaccines or treatments then and we worked for hours in full PPE to protect ourselves and try not to bring the virus home to our families. There were no after work drinks for us…It is clear that there was a culture inside Number 10 where even if rules were not technically broken, the spirit of the rules were, and this is completely unacceptable.”

The nurse is the Minister. Surely she must agree that the Prime Minister should now resign.

[Maria Caulfield]

I am very disappointed by the hon. Lady’s question. Serious issues are facing the NHS and patients, and instead of playing party politics at the Dispatch Box, perhaps she needs to ask her own leader what he was doing in May last year.

[Mr Laurence Robertson (Tewkesbury) (Con)]

13. What steps he is taking to help expedite the process of arranging care packages for people waiting to be discharged from hospital; and if he will make a statement.

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[Alex Norris (Nottingham North) (Lab/Co-op)]

14. What recent assessment he has made of cancer outcomes.

[The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)]

Based on the latest available data—I am sure the hon. Gentleman will welcome this—one-year survival rates for all cancers combined are at a record high, with an increase from 63.6% to 73.9%, and the five-year survival rate for all cancers combined has increased from 45.7% to 54.6%.

[Alex Norris]

To ensure the best cancer outcomes, patients need to start treatment as soon as they can. But in the latest data the Minister addresses, the number of those who waited for more than two weeks to see a specialist set a new record high for the third month running, soaring to more than 55,000 people in November, prior to the peak of this wave. Macmillan Cancer Supports states that more than 31,000 people in England are still waiting for their first cancer treatment, which will not do. When will the Government publish a properly resourced, properly staffed national recovery plan for cancer care?

[Maria Caulfield]

I reassure the hon. Gentleman that cancer has been an absolute priority throughout this pandemic, and treatment and services have continued. I thank all those working in cancer care for making sure that has happened. Ninety-five per cent. of people started treatment within a month of diagnosis throughout the pandemic, and there have been more than 4 million urgent referrals and 960,000 people receiving cancer treatment during that time.

[Wes Streeting (Ilford North) (Lab)]

Geoff Cosgrave was admitted to hospital in mid-November with kidney cancer that had spread through his lymph nodes and lungs. Last week, his wife Glynis contacted me in desperation because he was unable to access treatment to clear the blockage in his lungs as the thoracic ward at the nearby hospital had closed because of staffing shortages. After frantic and desperate chasing by his family and NHS staff, he was finally admitted to Bristol Royal Infirmary last week, but unfortunately his condition had deteriorated so he could not receive treatment. Geoff died on Friday and I am sure the whole House will want to send their deepest condolences to Geoff’s family. [Hon. Members: “Hear, hear.”] Glynis wants me to place on record her family’s enormous thanks to the NHS staff who cared for Geoff, and to ask the Minister what the Government are doing to address the serious understaffing in the NHS, and the covid pressures that are having an impact on cancer care, so that no family has to suffer what the Cosgrave family are experiencing right now.

[Maria Caulfield]

I thank the hon. Gentleman for his question. I put on record—I am sure this is shared by the whole House—our sympathy for Geoff and his family. There is no doubt that despite cancer being a priority throughout the pandemic, there have been pressures on the system. I again thank the staff, as Geoff’s family have, for carrying on throughout. I want to reassure the hon. Gentleman that the NHS is focusing on recovering cancer services to pre-pandemic levels; an additional £2 billion of funding was made available to the NHS and there were 44,000 more staff from October 2020. We are absolutely committed to getting back on track for pre-pandemic levels. Cancer has always been a priority. That is no comfort to Geoff and his family, but hopefully they can be assured that we are doing all we can.

[Chris Bryant (Rhondda) (Lab)]

T1. If he will make a statement on his departmental responsibilities.

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[Derek Thomas (St Ives) (Con)]

T5. Vast numbers of children and adults right across Cornwall cannot get access to an NHS dentist. That is not about funding, covid or even a lack of dentists; it is just that the contract under which they work is no longer fit for purpose. Next year, the responsibility for dentistry comes to Cornwall. Could we perhaps have a statement from the Minister about how we can reform that contract, which no longer works and keeps dentistry away from people who need it?

[The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)]

My hon. Friend gets to the nub of the problem. The 2006 contract, which was introduced under the last Labour Government and is dependent on UDAs—units of dental activity—creates perverse disincentives for dentists to take on NHS work. We are already starting work on reforming that.

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

We will not globally defeat covid if large proportions of the global population do not have access to vaccinations. The UK is one of a small number of countries blocking the TRIPS— trade-related aspects of intellectual property rights—waiver. Will the UK Government stop blocking the vaccine intellectual property waiver, and allow nations to manufacture the vaccines themselves?

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[Sir Robert Goodwill (Scarborough and Whitby) (Con)]

Sadly, the situation in Scarborough and Whitby for patients seeking a new NHS dentist is no better than that in St Ives, with thousands of UDAs going unused. Dentists tell me that it would help to have a date for the end of the UDA system so that they could start recruiting staff and, in some cases, building new premises to deliver NHS dentistry to local people.

[Maria Caulfield]

My right hon. Friend is correct. As I said earlier, the disastrous contract of 2006 is causing disincentives for NHS dentists to take on NHS work. I assure my right hon. Friend, however, that dental services in Scarborough are currently being commissioned by NHS England following the handing back of dental regional accountability. Procurement processes are in place, and a new practice is set to be in place by the summer.

Midwives in the NHS

Maria Caulfield Excerpts

Monday 17th January 2022 Commons Chamber

[The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)]

I thank my hon. Friend the Member for Stroud (Siobhan Baillie) for securing this debate and wish her well with her “vested interest” and her pregnancy. I am sure that her experience with her midwife, Jan Partridge, will be positive.

I want to thank all midwives and maternity teams up and down the country. For the past 18 months to two years, they have gone above and beyond their duty. I have visited maternity units, spoken to midwives and heard how difficult it has been, particularly with covid. Being on a maternity ward, particularly a labour ward, is a busy enough experience anyway, but if there are women there with covid, the added infection control measures bring extra pressures. With staff isolating and being off sick, it has been an incredibly busy time, and I have heard at first hand many of the experiences that my hon. Friend raises.

I say to midwives that I fully recognise the pressure that they are under. Sometimes there are not enough staff on the wards, and they are dealing with more complex cases. I hate to use the term “geriatric women”, but we are seeing women becoming pregnant much later in life, with the risks and complications that that brings. We are also seeing babies being born much earlier. The expertise and skills that a midwife brings to those situations mean that we all see the incredible work that they do.

There are three areas that I think we need to address. The first is staff numbers, an issue that the hon. Members for York Central (Rachael Maskell) and for Coventry North West (Taiwo Owatemi) and my hon. Friend the Member for Stroud all raised. I reassure hon. Members that we are trying to get on top of staffing levels. Health Education England undertook a survey based on the Birthrate Plus midwifery workforce planning tool to assess the numbers of current midwives in post, current funded posts and recommended funded posts to try to bridge the gaps between the three. Following that, NHS England invested £95 million to support the recruitment of 1,200 more midwives and 100 more obstetricians and to support multidisciplinary teamwork. There is also £450,000 for a new workforce planning tool at a local level, so that maternity units can calculate their own staffing level requirements.

We are trying to increase the number of midwives in practice. Returners are being encouraged to join Health Education England’s Return to Practice programme, where a payment of £5,000 is given to employers to support returners. Funding is given to the students to pay for their fees and their Nursing and Midwifery Council tests of competence, and they get a stipend while they are learning.

My hon. Friend is right about new students. We have increased student training places to 3,650. We are also recruiting from overseas. Early this year, we are advertising and interviewing for between 300 and 500 overseas midwives to join the NHS in the next 12 months. We are also recruiting extra maternity support workers to support the work of midwives.

We are also trying to improve the environment and to bring in a positive working culture. Some £52 million has been brought in to accelerate the digital maternity programme, so that the burdensome paperwork and paper records that midwives are having to work with will hopefully come to an end. Improving that documentation will improve the outcomes for mums and babies, too.

There is so little time to express how much we are doing. We are trying to bring in a positive working culture; it is not right that midwives are having to go without toilet breaks or are unable to drink during shifts. That is completely unacceptable, and it creates a vicious circle: because working conditions are so tough at the moment, we are losing experienced midwives, which makes trying to recruit and retain more staff even more difficult.

The debate we have had this evening is just the start, and I want to work with Members across the House to ensure that we support midwives as much as we can. We are serious about increasing staffing numbers and improving the working environment for midwives, because that is how we improve the safety of maternity care.

[Mr Deputy Speaker (Mr Nigel Evans)]

The Speaker and his team send their congratulations to the hon. Member for Stroud (Siobhan Baillie).

Question put and agreed to.

Access to GP Appointments

Maria Caulfield Excerpts

Wednesday 12th January 2022 Westminster Hall

[The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)]

It is a pleasure to serve under your chairmanship, Mr Robertson. I thank my right hon. Friend the Member for Chipping Barnet (Theresa Villiers) for bringing the debate to the Chamber. I echo much of what she says, and the Government are delivering on much of it, so perhaps this is an opportune moment to update Members on the progress we are making.

We owe a huge amount of gratitude to general practice staff for their efforts throughout the pandemic, stepping up to run vaccination programmes, continuing with flu vaccinations, looking after house-bound patients and continuing their day-to-day work. They have been absolutely outstanding. Since 30 November last year, more than 52 million covid vaccinations have been delivered by general practice, which is an amazing achievement. They are incredibly busy and have been throughout the pandemic, as reflected in appointment data. In November, general practice delivered an average of 1.39 million appointments nationally per working day, an increase of 6% compared with November 2019. Once covid vaccination appointments are factored in, the increase is greater than 20%. GPs and their teams have been working incredibly hard.

The focus on the booster programme has meant some patients experiencing delays in getting an appointment, but that does not mean that general practice has been closed. GPs and their teams will always be there for patients, alongside NHS 111 and community pharmacy teams. It is important that people do not delay coming forward. We saw patients stay away during the first lockdown, and so unfortunately there was a delay in starting some of their treatment, so it is important that we all get out the message that GP practices are open for business. In my right hon. Friend’s constituency, under North Central London CCG, excluding covid-19 vaccinations, approximately 16% more appointments took place in November last year compared with November 2019, of which 57% were face to face. The crux of the matter that we hear from many constituents is around face-to-face appointments. That is why, in October, the Secretary of State launched the winter support package to tackle many issues my right hon. Friend mentioned. I will just touch on several.

First, we are improving telephone access, because sometimes the problem is that patients cannot get through by phone, rather than their not being able to see a GP. My hon. Friend the Member for Southport (Damien Moore) touched on that. Part of the package is a cloud-based telephony system to help increase that capacity for GPs, who may only have one or two receptionists and a couple of phone lines that get busy pretty quickly as soon as 8 o’clock hits. The improved functionality has the potential to free up existing telephone lines for incoming calls and will be available at no additional cost to practices. We will require GP practices to sign up to this cloud-based telephony system, which will be up and running pretty soon. All those that expressed an interest have been contacted, and we expect many to go live fairly soon. Some practices are already tied into existing contracts, so there may be a slightly delay in roll-out there, but where we can get them up and running, we absolutely will.

Secondly, we are encouraging GPs to offer face-to-face appointments. However, it will not always be a GP that a patient sees. There are a range of healthcare professionals in primary care, from nurses—they do an amazing job, if I say so myself—to paramedics, pharmacists and physios, and the GP is not always the best person for a patient to see. Face-to-face appointments are available, and our message to patients is that they will not always see the GP face to face, but that does not take away from the care that they receive.

On finance, £250 million was announced in the winter support package, which can be used by GPs in a range of ways—whatever suits their local area. For some, it will be a physical expansion of their practice so that they can see more patients. For others, it may be to take on locums, where they are available—that is also a pressure point—or other healthcare professionals or an extra receptionist, or to extend opening times. The money can be used on whatever will help GPs to expand their ability to see patients.

My right hon. Friend touched on bureaucracy and red tape, which is a massive ask for GPs. We have made some temporary changes during the omicron vaccine roll-out period to free up capacity, including extending the sickness self-certification period for people accessing statutory sick pay and suspending requests for medical information from bodies such as the Driver and Vehicle Licensing Agency. We are bringing forth secondary legislation to allow other healthcare professionals to do some of those checks—statutory instruments are going through the system as we speak—and having discussions with other Departments about moving away from always expecting GPs to do medical reports, whether for the Department for Work and Pensions, the Department for Transport or for schools. Patients can do a lot for themselves and a medical report from a GP will not always be required. We are also improving digital technology so that handwritten letters and reports, which take so much time for GPs, can be digitised and made much easier.

One of the most exciting innovations in the package is the promotion of pharmacists, which my right hon. Friend touched on. We have a community pharmacist consultation service whereby patients who phone 111 or contact their GP can be referred direct to pharmacists, who are taking on prescribing skills so that they can prescribe as well as dispense. We are looking towards a more pharmacy-first model as in Scotland and Wales, where patients can go direct to pharmacists without necessarily going first to the GP, opening up primary care and making it much more accessible. I hope that, through a number of the points that I have addressed, it can be seen that we are moving at pace.

Workforce was touched on, and I am pleased that we are making progress on that. We have already recruited 10,000 of an additional 26,000 staff who will be working in general practice by the end of 2023-24. In the North Central London CCG area, 327 additional staff have been recruited to date, with a further 114 anticipated.

[Dr Dan Poulter (Central Suffolk and North Ipswich) (Con)]

I congratulate my right hon. Friend the Member for Chipping Barnet (Theresa Villiers) on bringing the debate to the Chamber and draw attention to my entry in the Register of Members’ Financial Interests as a practising NHS doctor. In 2015, the then Secretary of State said that we would recruit an extra 5,000 GPs to the workforce. Can the Minister update us on how many extra full-time equivalent GPs are working in the NHS?

Pensions is also a real issue that is stopping the current workforce extending their careers as they face punitive tax penalties. Will she please commit to addressing that and raising it with the Treasury?

[Maria Caulfield]

Absolutely. I was going to come to the number of GPs. I am pleased, as is my right hon. Friend the Member for Chipping Barnet, that we have 4,000 doctors in GP training places this year, which is an increase from 2,671 back in 2014. We are getting more GPs through the training process. However, in terms of GPs in place, there were 1,841 more full-time equivalents in September 2021 compared with September 2019, so we are seeing increases coming through.

However, there are issues with retention as well as recruitment. I think my right hon. Friend touched on issues with the Home Office and GP trainees once their visas expire. We met Home Office officials just before Christmas and there is better working now between the NHS and the Home Office to help facilitate those who come on a visa and need help to get into the workforce, get their visas extended or their training finished before their visa expires.

My hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter) made a very valid point about GP pensions. We have discussed that, and we are setting up a meeting with Treasury teams to look at that in more depth. There is no doubt that that is a disincentive to stay in practice, and we will certainly be looking at that further.

I will finish by asking all colleagues to support local GPs. They have had a very tough time. We are taking a zero-tolerance approach to any abuse they receive. That also applies to pharmacists. They have had a difficult time and continued to stay open during the pandemic. Face-to-face appointments were a challenge. We are doing everything we can to support them with the asks to break down some of those barriers. I am optimistic that we will see progress and that patients, who are the most important people in this debate, will see improved access to services in primary care.

Question put and agreed to.

Access to Radiotherapy

Maria Caulfield Excerpts

Wednesday 12th January 2022 Westminster Hall

[The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)]

It is a pleasure to serve under your chairmanship, Mr Davies. I should declare an interest before I start: I am still working as a cancer nurse in the Royal Marsden Hospital in London. I have spent 20 years looking after patients who are having chemotherapy, radiotherapy and surgery, so no one is more passionate than I am about this issue.

I congratulate the hon. Member for Easington (Grahame Morris) on securing this important debate, raising the profile of radiotherapy and the important work that the all-party parliamentary group does. Very few of us have not been impacted by cancer in some way, whether as a patient—the hon. Gentleman and the hon. Member for Rhondda (Chris Bryant) eloquently described their experiences—or as a relative, friend or healthcare professional. We know the devastation that cancer can bring, whether through the diagnosis and living with the disease, experiencing the side effects of treatment or, unfortunately for some, the effects it can have on life expectancy.

I reassure colleagues that during the pandemic, cancer has remained an absolute priority. We have kept cancer services going throughout periods of lockdown. There is no doubt, though, that patients were reluctant to come forward with signs and symptoms, particularly during the first lockdown. We actively encouraged many patients with a cough not to come and see their GP as a first point of contact. Since then, however, an absolute tsunami of patients has come forward—so much so that we are working through more than 10,000 cancer referrals a day.

I encourage Members to look at the data for actual treatment. Data such as that about the 62-day rule shows that the cancer backlog is not necessarily in treatment—in patients waiting for surgery, chemotherapy or radiotherapy—but in the diagnostics procedures. They are where the greatest pressure is at the moment.

[Grahame Morris]

I appreciate the Minister’s giving way. Statistics are important as a tool to identify where the obstructions are in the system. I completely agree about the importance of early diagnosis, but will the Minister publish the radiotherapy datasets that will be available next month, so that we can see the true nature of the backlog?

The profession—the frontline—tell a story rather different from the impression that the Minister has just given: that there are issues with treatment, and not just with diagnosis. The radiotherapy datasets, which have not been published for over a year but are available, will clarify that position.

[Maria Caulfield]

I thank the hon. Gentleman. I am not saying that there are no pressures on the treatments for cancer patients, but the greatest pressure is at the diagnostic end. We will be publishing data, but I caution Members on the data for radiotherapy. A lot of the cancer data is based on first treatment and, as Members will know, radiotherapy is often an adjuvant treatment given further down the line. The measurement of access to radiotherapy, compared with treatments such as surgery or chemotherapy, is much more difficult to establish.

I also caution colleagues, a number of whom have said similar things in this morning’s debate. Radiotherapy is a specific specialist treatment. As the hon. Member for Rhondda pointed out, for many cancers it cannot necessarily be given instead of surgery or chemotherapy; it is part of a package of treatment and these are clear, clinical decisions that need to be made jointly by the oncologist and their patient.

[Grahame Morris]

We have a little bit of time and these are important points. Many of us have been making them, not just to this Minister—who, to be fair, is newly in place—but to her predecessors.

There are points of contention about the effectiveness of radiotherapy, but there have been some incredible advances in recent years. I am not claiming expert technical knowledge, but radiotherapy has been applied very effectively against lung cancers; that was never the case before. There is now a possibility of expanding the service to provide much more effective treatments, for cases which previously could be treated only through surgery and chemotherapy.

[Maria Caulfield]

I do not disagree with the hon. Gentleman. I may be a new Minister, in post for weeks rather than years, but I have 20 years of oncology experience, and in my experience radiotherapy has a fantastic role to play. It is indeed the case that significant progress has been made, particularly in the field of lung cancer, with stereotactic radiotherapy to specific areas. However, radiotherapy will target a specific area; it will not give systemic treatment, like adjuvant treatment to prevent recurrence or neoadjuvant treatment for metastatic disease, where the disease is in multiple parts of the body. As Members of Parliament, we need to be cautious that we do not give patients the impression that they should be asking for radiotherapy instead of surgery and chemotherapy. There needs to be a discussion with their oncologist and their medical teams as to the appropriateness of radiotherapy. Yes, it is often cheaper than chemotherapy to give. Yes, it is a quicker treatment and sometimes—not always—has fewer side effects. But it has to be a clinical decision. There are important reasons why radiotherapy is given to some patients and not others. That is something that patients really need to have a discussion—

[Chris Bryant]

We all understand that clinical decisions have to be made. Our anxiety is that clinical decisions sometimes end up being made because there is not enough availability of facilities or staff, or—the third aspect to this—because lots of patients simply are not presenting at the moment. They are not coming in the doors of the NHS because of covid. That potentially means—for instance, in relation to bowel cancers, lung cancers and melanoma—that we will see people presenting much later and therefore there will be a much more dangerous prognosis for them.

[Maria Caulfield]

I absolutely take that point on board. There are clinical reasons, if a patient has presented later, why radiotherapy may or may not be suitable. Again, they are clinical decisions that a patient needs to be discussing with their oncologist.

The hon. Member for Westmorland and Lonsdale (Tim Farron) raised the issue of satellite units. Again, I would just be slightly careful. Cancer alliances are mapping out cancer services in their areas, and I am very happy to meet colleagues who would like better provision in their local area, but they also need to meet their cancer alliances, which are looking at service provision locally.

I would just caution Members on the issue of having multiple sites for radiotherapy. These are specialist treatments, needing specialist equipment and specialist staff. I went into oncology more than 20 years ago, when surgery was done by general surgeons. They were doing mastectomies on women and colostomies on bowel cancer patients. Moving surgery into being a specialist field, with specialist provision, has transformed the way that we are able to look after women who are going through mastectomies, and bowel cancer patients, who may not necessarily need a colostomy now, because surgical treatments have advanced so much. There is sometimes a rationale for those services to be offered by specialist units, rather than multiple satellite sites.

[Tim Farron]

I want to answer a point that the Minister made earlier. Obviously, during the pandemic, radiotherapy has been used as substitutionary treatment for people who would otherwise have had chemotherapy or surgery, because it is a covid-secure treatment. But my main point is with regard to what the Minister just said about satellites. Has she looked at the data and evidence from those satellite centres that have been opened in the last few years?

For instance, at Hereford, we saw a doubling of the number of patients being treated at that new satellite centre. Why? Well, there was an assumption that the parent centre people, from that postcode, were simply transferred to Hereford. No, it turned out that a lot more people, who would not travel or who were not referred because of the travelling distance for treatment at the original place, were then referred for treatment and therefore had a longer life expectancy because of the satellite centre. With more networking capability, it is of course possible now to treat in specialist ways, with the best people, remotely and through these satellite centres. The Christie has just opened its third satellite, so surely, for more rural communities such as mine, and also in east Lancashire, the time has come to ensure that no one is left behind.

[Maria Caulfield]

There are satellite services—absolutely. We have seen them not just for radiotherapy, but for chemotherapy and even surgery. But it has to be a local decision, because local oncologists have to feel that they are able to support the multidisciplinary team who support the radiotherapy process, ranging from diagnostics through to the treatment itself. That has to be in place, so it does absolutely need to be done on a local basis, but I am happy to meet colleagues if they feel that the case is not being heard locally.

I want to emphasise this point, because a number of hon. Members talked about the commitment to cancer services. Our elective recovery programme has committed £2 billion this year and £8 billion over the next three years to step up activity and tackle backlogs. That will have a knock-on effect in improving radiotherapy access, because some patients cannot have radiotherapy until they have had surgery. Ensuring that we are tackling some of the backlogs to treatment resulting from covid is absolutely important.

There have been huge improvements in radiotherapy over recent years, not just in provision but in technique. We are able to deliver more targeted treatment, resulting in fewer hospital visits, because we can now give radio- therapy to a more targeted area of the body, resulting in fewer side effects from the treatment, and also give fewer fractions of radiotherapy, so that patients can get their total dose much more quickly. That maximises service capacity and minimises patient time in hospital.

Furthermore, we have invested £250 million into two proton beam therapy facilities, one based at the Christie in Manchester and the other at University College London. In addition, all radiotherapy centres in England are now able to deliver stereotactic ablative body radiotherapy. Both these treatments are able to target radiation at cancer cells more accurately, improving patient outcomes. I am really pleased to say that, as part of this year’s spending review, £32 million was made available to support the replacement of 17 linear accelerators aged over 10 years, all of which are on order and will be delivered by the end of March 2022.

NHS England is committed to improving the facilities for cancer patients, and has also offered NHS radiotherapy providers the opportunity to participate in a cloud-based technology called ProKnow. To date, 43 of the 49 radio- therapy providers have joined up. This technology, which will help satellite units, enables clinicians to collaborate virtually within and across organisations, to plan treatments, undertake peer-review assessments and participate in large-scale audits and quality improvement processes, ultimately benefiting patients.

A number of Members talked about the cancer workforce, because it is great to have state-of-the-art technology and multiple units providing radiotherapy, but if we do not have the staff to manage them and provide treatment we shall not make progress. Health Education England is continuing to take forward the cancer priorities identified in the NHS’s long-term plan. It is prioritising the training of 250 nurses to become cancer nurse specialists, 100 chemotherapy nurses and 58 biomedical scientists, and it is updating the advanced clinical practice qualification in oncology.

Further than that, particularly around radiotherapy, Health Education England is investing £52 million in the cancer and diagnostic workforce, increasing the number of clinical endoscopists and training more radiographers in image interpretation. That is all part of the radiotherapy process. As of August there have been an additional 4% of doctors working in clinical oncology, which is the field that manages radiotherapy, and there have been a further 5% working in radiology since August 2020.

We are making progress, but it is not just about the numbers of staff; it is about the skill mix and ongoing staff training. Very often, not being able to expand a role or take on exciting and innovative developments can make staff feel frustrated, but the cancer workforce is growing. Between 2016-17 and 2019-20, the cancer workforce grew by 3,342 full-time equivalents, compared with the ambition of 2,943. We are ensuring that there are more staff coming through into the workforce to deliver radiotherapy.

The shadow Minister touched on the importance of not only recruiting staff but retaining and developing them. I fully take on board colleagues’ comments and concerns. We are committed to investing in radiotherapy equipment, the staff that deliver radiotherapy and the innovation in radiotherapy. We are also committed to making it more accessible to patients, and to reducing the side effects—there are side effects from radiotherapy as well—and to making sure it is a fundamental part of cancer treatment, whether that is in the neoadjuvant setting, adjuvant or for those with metastatic cancer as part of the palliative treatment service.

[Feryal Clark]

I thank the Minister for all the information about the machines and investment into radiotherapy. Are the figures that she set out for replacing what is already out of date, or is there a plan to increase investment in radiotherapy treatment? As we have all said, radiotherapy accounts for 5% of the cancer budget. Is there a plan to increase that, or is it about replacement and keeping up what we already have?

[Maria Caulfield]

It is about replacing existing equipment, but also investing in new. Some of the equipment is 10 years old. Radiotherapy has changed a lot over those 10 years, so the replacement equipment can do more than what it replaces. As I pointed out, we are also investing in new radiotherapy equipment, with £250 million into two proton beam therapy facilities at Christie’s and at UCL—new facilities that will be able to provide state-of-the-art radiotherapy treatment. I hope I have reassured Members that we are addressing this as a top priority.

[Chris Bryant]

Will the Minister give way before she sits down? She sounds very like she is finishing.

[Maria Caulfield]

I was finishing, but I will give way one more time.

[Chris Bryant]

The Minister may not be able to answer the question today about adjuvant provision of immunotherapy for people with stage 2 melanoma, but if she could write to me, I would be very grateful.

[Maria Caulfield]

My understanding is that it is available for stage 3 melanoma, as the hon. Gentleman has highlighted, and that it is still in clinical trials for stage 2. It is available within clinical trials. We expect the data to come forward shortly and then a decision will be made. That is where we are with melanoma.

[Tim Farron]

Will the Minister give way?

[Maria Caulfield]

I will give way one more time.

[Tim Farron]

The Minister is being very kind and I really appreciate it. I have two quick points that I do not think she has mentioned. First, will she take up the request from myself and the hon. Member for Easington for a meeting with the APPG for radiotherapy? We would love to meet her.

Secondly, I do not think she referred to the tariff situation. A lot of the issue is that we need more money. We want the Minister to accept—it is not just her fault; it is the fault of every party in this place, over decades—that we are behind comparable countries and we need to strengthen radiotherapy. The reality is that there are lots of state-of-the-art machines out there, in trusts up and down the country, that are not being used because the tariff is stupid. It incentivises trusts to do second-division radiotherapy, if I can put it that way, because more visits equal more cash, rather than targeted and specific radiotherapy—stereotactic, as she mentioned, for many cancers—because the tariff rewards number of visits, not precision or effectiveness of treatment. Would she look at that? It is free.

[Maria Caulfield]

I am very happy to look at the tariff situation, but my experience is that when a clinical oncologist is referring someone for radiotherapy, that decision is not based on whether they have smaller numbers of fractions as opposed to traditional courses. I am very happy to meet the all-party parliamentary group to discuss that further. I reassure patients that clinical decisions are what decide the type and the number of fractions that a patient needs for their treatment.

Radiotherapy is a priority cancer treatment and this Government are absolutely committed to investing not just in the equipment, but in the workforce that provides it. I say a huge thank you to all the staff across the NHS, particularly in cancer services, who kept going through all the pandemic lockdowns, made sure that cancer patients got their treatment, and helped to support them and their families through what is a very difficult time.

Eye Health and Macular Disease

Maria Caulfield Excerpts

Tuesday 11th January 2022 Westminster Hall

[The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)]

It is a pleasure to serve under your chairmanship, Ms Nokes. I want to start by thanking the hon. Member for Strangford (Jim Shannon) for securing this important debate. Before the Christmas recess, the last sitting in Westminster Hall was on surgical fires, and it is a pleasure, so soon after the recess, to be debating with him again.

The prevention, early detection, access to diagnosis and treatment of eye conditions is such an important issue, and we have heard from many Members, including my hon. Friend the Member for Darlington (Peter Gibson), who raised the impact on people’s day-to-day life, on simple steps such as trying to catch a train, and the impact of e-scooters and street pavement furniture. There was also a very moving speech from my hon. Friend the Member for Great Grimsby (Lia Nici). We cannot replace that insight and knowledge of how living with sight problems has an effect on every aspect of life and the simple improvements that can make a big difference.

There are many conditions that affect the eyes, as we have heard about today, and many of them share common risk factors, including some that are unavoidable, such as age and medical conditions such as diabetes, which the hon. Member for Strangford so eloquently described. However, we have not touched on some lifestyle factors that can impact on eye health—for example, obesity and smoking play their part. After age, smoking is the second-most consistent risk factor for age-related macular degeneration, with an increased risk of up to four times. Obesity is also a risk factor for age-related macular degeneration, but also for diabetic retinopathy, retinal vein occlusions and stroke-related vision loss. Morbid obesity is associated with higher eye pressure, which can increase someone’s risk of glaucoma.

When addressing eye health, it is important to tackle some of the low-hanging fruit of what can be preventable in affecting someone’s eye health. The UK is a world leader in tobacco control, and we remain committed to reducing the harm caused by tobacco. Later this year, we will produce a new tobacco plan that will set out how we will support people to give up smoking or to not start in the first place, because there are still 6 million people in England who smoke, which obviously has a knock-on effect on the possibility of eye problems further down the line.

We are also committed to a healthy living and weight loss management programme through our obesity strategy, building on the progress made on nutrition labelling. New rules on products that are high in fat, salt and sugar will come into force from October this year and, from January next year, we will introduce restrictions on the advertising of such products before the 9 pm watershed. We are also delivering a £100 million investment in promoting healthy lifestyles. In the years to come, all of those measures will have a knock-on effect on the number of people presenting with eye conditions.

That said, as we have heard today, there are many unavoidable causes of eye problems. Diabetes is one of the lead causes, and the diabetic retinopathy screening programme offers annual screening to millions of eligible people with diabetes. I place on record my thanks to all the staff of that screening programme who have carried on during the pandemic, because for the first time in 50 years, diabetic retinopathy is no longer the leading cause of certifiable blindness in adults of working age. That is a tremendous achievement.

There are other causes that can affect people of any age. For children, the healthy child programme sets out the schedule of child health reviews from pregnancy through the first five years of life. That includes examining the eyes of the newborn at six weeks and during the two-year review, as well as recommending that children should be screened for visual impairment between the ages of four and five. As we heard from the hon. Member for East Londonderry (Mr Campbell), we know that at all ages, regular sight testing can lead to early detection of eye conditions. My hon. Friend the Member for Great Grimsby spoke very well about the importance of the appointment with the optician. Combined with early treatment and prevention, we can prevent people from losing their sight, so today’s message of “Attend your eye tests” is very important indeed.

[Jim Shannon]

I thank the Minister for her very positive response. This is not just about a person’s visits to their opticians, but their appointments with their GP as well, especially if they are diabetic like me and attend their GP’s clinic twice a year. They should do a retinopathy test as well: the GP’s clinic can do all the things that can indicate whether that person’s sight is going backwards, staying level, or indeed improving. There are lots of things that people can do, and part of that is attending their GP appointments. Do not miss them: they are equally important.

[Maria Caulfield]

Absolutely: we have heard today about the impact that overall health has on eye health. We know that NHS sight test numbers were impacted at the peak of the pandemic, but there has been a strong recovery, with 9.7 million sight tests carried out between April and December last year. Again, I thank the NHS, and particularly primary eye care providers, for their efforts.

It is vital that once a problem is detected, individuals have access to timely diagnosis and any necessary treatment. Age-related macular degeneration is one of the leading causes of sight loss in the UK, and is a devastating disease that can seriously impact a person’s life. The vast majority of people with age-related macular degeneration suffer from “dry” degeneration, for which there is currently no effective treatment, although vision aids can reduce its impact. For those with “wet” degeneration, this condition can be far more serious and sight-threatening. There are a number of available treatments for that form of AMD, and I point colleagues to the National Institute for Health and Care Excellence’s guidelines: a person should be referred within one day if their condition is considered to be wet active AMD, and offered vascular endothelial growth factor drugs within 14 days of a referral. It is important that patients are able to access that treatment, as indicated by NICE.

Although we do have some effective treatments for macular disease, we do not rest on our laurels. Medicine continues to evolve, and we heard from my hon. Friend the Member for Sedgefield (Paul Howell) about the potential of sleep masks—evidence is still being collected about that treatment. We also heard from my hon. Friend the Member for Great Grimsby, who is the expert in this area, about the exciting developments in stem cell research and the possibilities that they could create in future.

During this time, the NHS has continued to prioritise urgent and life-saving treatments, including for sight-threatening eye conditions. I am pleased that the number of ophthalmology patients seen last October was almost back to a pre-pandemic level.

To help the NHS drive up activity, we have provided £2 billion this year through the elective recovery fund, and a further £5.9 billion of capital funding will support elective recovery, diagnosis and technology. That does include—my hon. Friend the Member for Hendon (Dr Offord) asked about this—the ability to expand capacity for new surgical hubs that will drive through high-volume services, such as cataract surgeries, so that they are high on the agenda in tackling the backlog. The NHS has also been running the £160 million accelerator programme, which includes 3D eye scanners and other innovations that are helping to develop a blueprint for elective activity in the NHS.

Ophthalmology is one of the largest out-patient specialties. Change is needed to ensure the NHS can both be sustainable for the future and deal with the growing numbers of people needing eye care services. To address these challenges, NHS England has developed the national eye care recovery and transformation programme to work across all systems and look at everything from workforce to the services provided. It is working with local systems to prevent irreversible sight loss as a result of delayed treatment.

In recognition of this important work, I am delighted that NHS England is recruiting a national clinical director for eye care. That person will oversee services at a national level, which will filter down to tackle the inequalities and disparities we have heard about in certain parts of the country. Much good work is happening, but it is important that the public health outcomes framework is used to identify gaps in services. The framework tracks the rate of sight loss across the population for three of the commonest causes of preventable sight loss—age-related macular degeneration, glaucoma and diabetic retinopathy. The data is openly available and is being used to match areas where services and outcomes need to be improved.

I want to touch on the points raised by the hon. Member for West Ham (Ms Brown) about her constituent, Darren, and those raised by the right hon. Member for Hayes and Harlington (John McDonnell). I am concerned about issues around laser surgery and the impact they are having. I am happy to meet the right hon. Gentleman and the hon. Lady, and other colleagues, to discuss that. The Care Quality Commission regulates that area, but I am concerned by the information shared today and I am happy to look at the issue further. It is important that the situation of people with minor eye ailments is not made worse by having surgery that may, or may not, be suitable for their needs.

We have had a good debate today. I hope I have reassured colleagues that eye health procedures, treatment and diagnoses are part of the post-covid recovery process. I take on board the points made by my hon. Friend the Member for Great Grimsby that this is about more than just diagnosing and treating; it is about improving the lives of those with sight loss, to enable them to live the most productive and fulfilling lives they possibly can. I am pleased to hear that the Royal National Institute of Blind People and ACAS were instrumental in helping her and others who are trying to improve the workplace experience. My hon. Friend the Member for Darlington also pointed out that technological changes can have a positive impact but that things such as electric cars can have a negative impact on people with sight loss, as those vehicles are so quiet.

To conclude, maintaining good vision throughout our lives is very important. Some preventable factors, such as smoking and obesity, can help improve eye health, but there are many unavoidable issues that we need to deal with.

[Steven Bonnar]

Are there plans in any part of the national strategy to remove the financial impediment, so that English, Welsh or Northern Irish people can get a free eye test?

[Maria Caulfield]

Many people in England qualify for a free eye test. We are not seeing that issue as a barrier to people coming forward, but I have outlined the many measures we are putting in place to improve the outcomes for people with significant sight loss problems. As we emerge from the pandemic, our priority remains tackling the elective backlog and ensuring that we have high-quality, sustainable eye care services for the future.

Our Vision for the Women's Health Strategy for England

Maria Caulfield Excerpts

Wednesday 5th January 2022 Written Statements

[The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)]

“Our Vision for the Women’s Health Strategy for England” was published on 23 December 2021. This sets out our ambitions and next steps for women’s health, mapped against what we have been told through the women’s health strategy call for evidence. It reflects the commitment this Government are making to women’s health and will set the direction of future work.

The vision is informed by the evidence we received in our call for evidence. This was announced in March this year on International Women’s Day, to support the development of the women’s health strategy. It ran for 14 weeks to 13 June 2021 and comprised three components:

A public survey

We received nearly 100,000 responses from individuals in England who wanted to share their own experiences, the experiences of a female family member, friend or partner, or their reflections as a healthcare professional.

Written submissions

We received over 400 written responses from organisations with expertise in women’s health which were used to inform the vision document.

Focus groups

We also commissioned focus groups with women to acquire depth of insight. The resulting independent academic report has recently been published on the University of York website and can be found here:

I would like to extend my thanks to every person and organisation who took the time to share their experiences through the call for evidence and spread the word about the consultation. It is thanks to these participants that we were able to acquire such rich insights into views on women’s health.

Recent progress on women’s health

While we have been working to analyse the huge number of responses for the call for evidence, we have not waited to take action. In July we published the Government response to the Cumberlege report which focused on how the system listens to women when they raise concerns about their health and safety.

In October, I announced several measures designed to improve menopause care. This included amendments to the charging regulations to reduce the cost burden of HRT for menopausal women and a new UK-wide menopause taskforce which will hold its inaugural meeting shortly.

Earlier this year, we committed to ban the abhorrent practice of virginity testing in our strategy for tackling violence against women and girls as part of our commitment to safeguard women and girls. In November 2021, the Government delivered on this commitment by bringing forward a Government amendment to the Health and Care Bill to ban virginity testing, which was passed unopposed in the House.

This activity marks a significant improvement in many areas which touch upon women’s health. However, there is clearly much more to be done.

Our Vision for the Women’s Health Strategy and Analytical Report of the Call for Evidence

On 23 December 2021, the government published the analytical report of the call for evidence and “Our Vision for the Women’s Health Strategy for England”.

The analytical report of the call for evidence sets out the findings from the public survey. This has provided rich insight into women’s experiences and priorities for their health and care, and at times makes for sobering reading.

For example:

84% of respondents said there have been instances when they were not listened to by healthcare professionals.

Nearly two in three respondents with a health condition or disability said they do not feel supported by the services available for individuals with their condition or disability

58% of respondents said they felt uncomfortable talking about health issues with their workplace and 7% were not sure how they felt. These issues do not affect all women equally. White respondents felt the most comfortable discussing health issues at work (37%), while the Asian and Other ethnic group felt the least comfortable (30% and 29% respectively)

There are no quick and easy solutions to some of the entrenched problems within the system. However, I am determined to make sure that we act on the concerns that women have shared with us. This Government and our stakeholders across the system are committed to doing better for women.

Priority topics

Respondents were also given the opportunity to share the conditions which were most important to them. Their responses give us the mandate to look carefully at women’s health across the life course and make meaningful change.

The priority topics for women varied by age, broadly aligning with the stage of their life. However, the overall top five topics respondents want to see prioritised for inclusion in the women’s health strategy are:

gynaecological conditions

fertility, pregnancy, pregnancy loss and post-natal support

the menopause

menstrual health; and

mental health

Insight from the written submissions has also informed the development of the vision. We will publish a separate report, based on the written evidence submitted by organisations and individuals with expertise in this field, in early 2022.

The Vision

Alongside the analysis of the call for evidence, we also published “Our Vision for the Women’s Health Strategy for England” which sets out our ambitions for women and girls’ health in England.

The phenomenal volume of responses to the call for evidence has meant that analysis has taken longer than anticipated. It was essential that we gave the analysis the level of rigour it deserved, in order to understand fully what we have been told by the public.

It was also important to me to share the analysis with Parliament and the public as soon as possible and show the clear direction it has given us. As such, we are publishing our vision now and will follow up with the full women’s health strategy in spring 2022.

The vision document first sets out our life course approach to women’s health, and our thematic priorities which cut across all stages of the life course:

On women’s voices, our ambition is for all women to feel comfortable talking about their health and to no longer face taboos when they do talk about their health. We will also work to better understand the causes of women not feeling listened to make sure any interventions address the root cause.

On healthcare policies and services, our ambition is that women can access services that meet their needs across throughout their lives. We want to support local systems to deliver models of care that work for women. We will also work to explore improvements in care for specific conditions where disparities are greatest.

On information and education, our ambition is to make sure that all women will have access to high quality information and education from childhood through to adulthood, in school and beyond. Further, clinicians must feel confident to deliver information and high-quality care more broadly to women. To do this, clinicians need to have high quality, relevant training on women’s health.

On health in the workplace, our ambition is that ail women feel supported in the workplace and can reach their full potential at work. We are conducting work relating to the menopause in the workplace which we hope will act as best practice for other conditions.

On research, evidence and data, our ambition is to embed routine collection of demographic data of participants in research trials to make sure that our research reflects the society we serve. We are also committed to looking into the gender data gaps further and identifying where there are differences in conditions between genders.

Priority areas

In addition to these themes, the vision sets out our ambitions on priority conditions where the call for evidence highlighted particular issues or opportunities. These include but are not limited to:

menstrual health and gynaecological conditions

fertility, pregnancy, pregnancy loss and postnatal support

the menopause

healthy ageing and long-term conditions

mental health; and

the health impacts of violence against women and girls

On this last point on violence against women and girls, I was pleased to be able to announce on the 23 December 2021 the immediate action that this Government are taking to protect women and girls from harm.

When the Government published the tackling violence against women and girls strategy earlier this year, we committed to establishing an expert panel to review whether we should ban hymenoplasty. This is a procedure to reconstruct the hymen, with the intended purpose of causing bleeding during sexual intercourse.

We established the independent panel due to concerns that the uptake for the procedure, which although it is regulated, is intrinsically linked to virginity testing, and stems from the same repressive attitudes towards a women’s sexuality and the concept of virginity.

In December, the panel recommended to Government that hymenoplasty should be banned.

As announced before Christmas, the Government agreed with this recommendation and will introduce legislation to ban hymenoplasty as soon as parliamentary time allows.

Next steps for developing the Women’s Health Strategy

In spring 2022 we will publish the full women’s health strategy, building on our vision and ambition, and set out in detail our plans for meeting the specific health needs of women throughout the different stages of their lives.

To support this, we will appoint the first ever women’s health ambassador for England.

This person will focus on raising the profile for women’s heath, increasing awareness of taboo topics, and bringing in a range of collaborative voices to develop the women’s health strategy.

The ambassador will develop networks across and outside of Government to champion women’s health and break down stigmas which surround particular areas of women’s health.

I am pleased to announce that we will shortly be launching an expression of interest for this role. I would encourage applications from candidates who have experience in the sector and a passion for women’s health. I look forward to working with the post-holder to drive forward this agenda even further as we develop the strategy.

This vision speaks to the commitment of this Government to women’s health. It sets the direction for the strategy we are developing over the coming months. In spring 2022, we will publish the full women’s health strategy building on our vision and ambition and set out in detail our plans for specific health needs that women experience throughout their lives.

I am excited about the coming months and what we will be able to achieve in the long-term. The publication of “Our Vision for Women’s Health for England” and the analytical publication of the call for evidence marks a key milestone in women’s health.

I am confident that based on the evidence and a clear vision, we will be able to make progress on the issues that matter most to women, in developing the strategy for spring 2022.

[HCWS519]

Independent Inquiry Report into Issues Raised by Former Surgeon Ian Paterson

Maria Caulfield Excerpts

Thursday 16th December 2021 Written Statements

[The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)]

On 4 February 2020, the independent inquiry into the issues raised by the disgraced surgeon Ian Paterson published its report, which was welcomed by the Government. On 28 April 2020, we reluctantly announced a delay in the Government response due to the unprecedented pressures of the covid-19 pandemic. On 23 March 2021, we provided an update on the progress made and committed to publishing a full response during 2021. Today, the Government have published that response.

We want to thank the Right Reverend Bishop Graham James and the inquiry team for their thorough report which provides a detailed analysis of the issues which allowed this malpractice to take place and recommends steps to better protect patients moving forward.

Our thanks also go to the patients who shared their experiences with the inquiry and to their representatives who subsequently continued to engage with the Government through the process of preparing this response. Patient voices have rightly been central to this entire process.

The Government’s response

The inquiry’s findings point to several important themes where action is needed to improve protections for patients being given hospital-based care—whether in the NHS or independent sector. These actions must improve the way our health system works for patients at every stage of their treatment journey.

The health system has to provide patient-centred information to enable patients, their families and carers to make informed decisions about their treatment and care. Medical practitioners should face regular challenge to improve the standard of care they provide as part of their overall learning and development, with concerns about their practice from any source heard and acted upon. There must be accountability across the healthcare system, ensuring quality of service from the frontline to the boardroom. Finally, when things do go wrong, patients must have the confidence that the entire system will work to put things right—meeting the needs of the patient and learning the lessons to prevent the same mistakes being repeated.

Working with patients and stakeholders, we have carefully considered all 15 recommendations the inquiry made for improving the health system. We are accepting 12 of these recommendations either in full or in principle with a further one recommendation still pending. There is one recommendation we are not accepting but keeping under review and one recommendation that we do not accept. Whether we are accepting the recommendation or not, we are taking action to improve healthcare against every recommendation.

The response outlines actions which have been taken since Ian Paterson’s malpractice came to light, in addition to detailing 40 actions for our further implementation plan. The Government will review the progress made in this implementation in a further publication after 12 months to ensure adequate action has been taken and update where additional action is planned.

Recommendation 1

Recommendation 1 calls for a single repository of the whole practice of consultants in England containing critical consultant performance data. This would be made accessible for use by both managers and healthcare professionals, and by members of the public. We accept this recommendation in principle. A significant amount of progress has been made on the collection of consultant performance data in both the NHS and independent sector. We commit to making more progress on the collection of data, use of the information it allows us to develop, and the publication of useful metrics. In 2018, the acute data alignment programme was launched to move towards a common set of standards for data collection and reporting across the NHS and independent sector. This brings together data collection through NHS Digital, with the use and processing of this data in parallel in the NHS and independent sector through the national consultant information programme (NCIP) and the private healthcare information network (PHIN). This is currently in pilot, with the potential to be fully implemented, dependent on the results of that pilot, in 2022-23. This data will be made available for managers and healthcare professionals across the system to support learning and identify outliers. PHIN is already mandated to publish information on consultant practice in the independent sector and will be continuing to roll out the publication of further metrics in the coming years. Over the next 12 months, we commit to reaching a decision with key stakeholders on what further information should be made publicly available and whether further Government action will be needed to achieve this.

Recommendation 2

Recommendation 2 asks that it become standard practice for consultants to write directly to patients about their treatment and care in language they can understand. We are pleased to accept this recommendation. Guidance across the system makes clear that this is best practice and a range of key stakeholders have agreed to write to their members to encourage the uptake of this advice. We will continue to explore with providers how their systems can change to embed this process and to monitor that best practice is being followed.

Recommendation 3

Recommendation 3 requires the publication of information explaining the differences in how care is organised in the NHS and the independent sector, so that patients can make informed decisions. We have accepted this recommendation. We will be commissioning the production of this independent information, to be created in partnership with patients, families and carers. This will be published in 2022 and made widely accessible.

Recommendation 4

Recommendation 4 calls for the introduction of a short waiting period in the decision-making process for surgical procedures, to enable reflection on the diagnosis and treatment options. We are accepting this recommendation in principle. While a specific period for general surgery is not being introduced, as the time required will depend on the patient and the procedure in question, the General Medical Council has updated its guidance to confirm that patients should be given sufficient time to consider their options before making decisions about treatments. During appraisals, doctors must demonstrate they are meeting the principles set out in GMC’s “Good Medical Practice”, and CQC takes all GMC guidance into account during its assessments across the NHS and independent sector.

Recommendation 5

Recommendation 5 relates to multi-disciplinary teams, asking CQC to assure that all hospital providers are complying effectively with national MDT guidance. We have accepted this recommendation. CQC has added more detailed prompts to its inspection framework on multidisciplinary team working. When assessing providers across the NHS and independent sector, CQC will continue to seek assurance that patients are not at risk of harm due to non-compliance in this area.

Recommendation 6

We have considered recommendation 6, which relates to complaints processes, in two parts. The first part calls for more effective communication to patients of the means to escalate a complaint to an independent body. We have accepted this part of the recommendation. The Parliamentary and Health Service Ombudsman is piloting the NHS complaints standards which set out in one place the ways in which the NHS should handle complaints. This includes the need for organisations to ensure people know how to escalate a complaint to the ombudsman. These have been developed with the Independent Sector Complaints Adjudication Service, ISCAS, who have included it in their code of practice.

The second part of recommendation 6 proposes that all private patients are given the right to mandatory independent resolution of their complaints. We have accepted this part in principle. CQC will strengthen its guidance to make clearer that it expects to see arrangements in place for patients to access independent complaints resolution. We will review the impact of this guidance in the coming year and will explore whether legislative action is needed, if insufficient action is taken.

Recommendations 7 and 8

Recommendations 7 and 8 both relate to the recall of patients of Ian Paterson by providers—University Hospitals Birmingham NHS Foundation Trust and Spire Healthcare. These recommendations have already been accepted in full. UHB has contacted all known living patients of Ian Paterson and ensured that all cases had been reviewed by June 2021. Spire had proactively contacted all known living patients by December 2020 and have now reviewed the care of over two-thirds of the patients concerned. We have asked Spire to provide an update on progress in 12 months on reviewing the remaining patients.

Recommendation 9

Recommendation 9 calls for a national framework to be developed for the recall of patients. We have accepted this recommendation. This framework has been developed and outlines actions to be taken by organisations in the NHS and independent sector in the event that a patient recall is necessary. This framework will be published in 2022 and will be owned by the National Quality Board, who will ensure it is periodically updated.

Recommendation 10

Recommendation 10 relates to indemnity products for healthcare professionals and asks for the shortcomings in clinical negligence cover identified by the inquiry to be resolved. The outcome of this recommendation is pending. We recognise that a system needs to be in place to ensure that patients have confidence that they can access compensation if harmed while receiving care, and we will bring forward proposals in 2022. These proposals will build on the consultation at the end of 2018 on “Appropriate clinical negligence cover” for regulated healthcare professionals. The summary of responses to this consultation will be published in early 2022. We have put forward an extended programme of actions in our response to work towards change in this area, and we will ensure any reforms are robust, meeting the needs of both patients and professionals, before implementing them.

Recommendation 11

Recommendation 11 calls for the Government to ensure that the system of regulation in healthcare serves patient safety, that regulators collaborate effectively and that weaknesses identified by the inquiry are resolved. We are accepting this recommendation. The healthcare regulators referenced in the Paterson inquiry (the GMC, Nursing and Midwifery Council, and CQC) exist to protect patient safety and this is reflected in their new corporate strategies. They have also taken a number of actions to encourage collaboration and information sharing between organisations. The Government’s consultation on “Regulating Healthcare Professionals, Protecting the Public” sets out proposals which address issues raised by the inquiry, including a proposed duty to co-operate for all regulators. We plan to bring forward legislation in relation to the GMC in 2022.

Recommendation 12

We have considered recommendation 12 in two parts. The first part required that any investigation of a healthcare professional’s behaviour should result in a suspension, if there is any perceived risk to patient safety. We have not accepted this recommendation. Exclusion and restriction of practice can be a necessary and appropriate response during an investigation in some instances. However, we do not believe it would be fair or appropriate to impose this step as a blanket rule in all cases. It is vital that investigations are robust and conducted in a timely manner. Guidance has been implemented in recent years to ensure concerns are taken seriously and appropriate action taken, including clear advice on when exclusion is the right step to take.

The second part of recommendation 12 proposes that any concerns about a healthcare professional at one provider should be shared with other providers they work with. We accept this recommendation in principle. Where patient safety is at risk, information should be shared. Providers must use their judgement, though, as they are taking on responsibility to ensure the information is appropriate and accurate when shared. Regulators have taken key steps to make it easier for people and organisations to share information regarding patient safety risks.

Recommendation 13

Recommendation 13 identifies a specific issue relating to the engagement of consultants through practising privileges in the independent sector. This is where the consultant is self-employed and allowed to work in the hospital’s facilities, rather than employed by the hospital. In the case of Ian Paterson, this led to a gap in responsibility and liability for the consultant’s actions. The inquiry reported the impression that private providers were just renting consultants a room, and claims for compensation took significant time and effort from patients to resolve. We accept this recommendation in principle. Independent sector providers must take responsibility for the quality of care provided in their facilities, regardless of how the consultants are engaged. The Independent Healthcare Providers Network published the medical practitioners assurance framework in 2019 to improve consistency around effective clinical governance in the independent sector. We encourage all private providers to take up this framework, and CQC will continue to assess the strength of clinical governance in all providers as part of its inspection activity. We will be using the response to recommendation 10 on indemnity products and the programme of action laid out there as the initial response to the challenges faced by patients of Ian Paterson in accessing compensation. We will additionally keep the potential liability held by providers in the independent sector under review.

Recommendation 14

Recommendation 14 says that apologies should be given at the earliest stage of investigation when something goes wrong, and that potential liability should not hold anyone back from apologising. We accept this recommendation. Healthcare organisations have a statutory duty of candour—which sets out specific requirements providers must follow when things go wrong with care and treatment, including providing truthful information and an apology. This duty is regulated by CQC. NHS Resolution consistently advises members to apologise when things go wrong and that this has no impact on potential legal liability. We continue to ensure this guidance is promoted.

Recommendation 15

Finally, recommendation 15 says that private providers should not be eligible for NHS contracted work unless they have implemented all the other accepted recommendations from this response across the entirety of their workload. We are not accepting this recommendation, but will keep it under review. Across all the issues raised in this inquiry report, independent sector providers are fully committed to implementing changes alongside NHS providers. These providers must meet the same regulatory standards as NHS providers, as required by CQC. Independent providers must meet the conditions of the NHS provider license and the NHS standard contract to be able to deliver NHS-funded treatment. Accepting this recommendation would create a duty on the NHS which would need to be carefully implemented to ensure it could be monitored effectively and would not reduce the capacity available to the NHS for providing care—particularly given the numbers of patients waiting for treatment as a result of the pandemic. We do, however, recognise the importance of ensuring change takes place. We will continue to work with the independent sector to implement the changes related to the inquiry’s recommendations and will review progress in 12-months’ time. We commit to taking robust action should progress not meet our expectations.

This response forms part of the Government’s broader commitment to patient safety, including our response to the independent medicines and medical devices safety review as previously published and the measures included in the Health and Care Bill.

Copies of the Government’s full response will be laid before the House and will be available from the Vote Office and at: https://www.gov.uk.

[HCWS499]

David Fuller Case: Update on Actions

Maria Caulfield Excerpts

Thursday 16th December 2021 Written Statements

[The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)]

Yesterday, David Fuller was sentenced at Maidstone Crown court for the murders of Wendy Knell and Caroline Pierce, as well as over 100 sexual offences in a mortuary, and several other sexual offences.

This is a profoundly distressing case and I would like to reiterate my apologies to the friends and families of all of David Fuller’s victims. While nothing can undo the damage that has been done, he has been brought to justice for his crimes.



I would like to provide an update on the steps we are taking to ensure something like this never happens again.

First, all NHS trusts have undertaken risk assessments on their mortuary and body store facilities and assured their practices against existing Human Tissue Authority guidance. NHS England and Improvement is working with all trusts to ensure that the additional steps already requested are in place early in the new year, if they have not already been delivered.

Secondly, we have made good progress in establishing the independent inquiry chaired by Sir Jonathan Michael to look into the circumstances surrounding the offences committed at the hospital. It will help us understand how these offences took place without detection, identify any areas where swift action is necessary and consider wider national issues, including for the NHS. Sir Jonathan has developed draft terms of reference and will seek views on these from families who have been affected in the new year before they are published.

Next, Ministers have received initial advice from the Human Tissue Authority and they will be reviewing this carefully.

Finally, families have quite understandably approached the trust seeking compensation. I have asked NHS Resolution to work with the trust and engage on plans for providing settlements. More details will be set out on this soon.

[HCWS505]

Surgical Fires in the NHS

Maria Caulfield Excerpts

Thursday 16th December 2021 Westminster Hall

[The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)]

It is a pleasure to serve under your chairmanship, Ms Rees. I thank the hon. Member for Strangford (Jim Shannon) for securing this hugely important debate. While he is right that we may be small in number this afternoon, it is the quality not the quantity of the Members that counts.

Health is a devolved matter, so I can really only respond on behalf of the NHS in England to the issues the hon. Gentleman raised, but, as the SNP spokesman, the hon. Member for Coatbridge, Chryston and Bellshill (Steven Bonnar), said, surgical fires are a priority area of concern in all the devolved nations. Patient safety is our absolute focus. We want to provide the public with the safest care possible. As the hon. Member for Strangford said, a fire affects not only patients but the NHS staff working in those units. We traditionally think of surgical fires as taking place in hospital-based settings such as theatres, but more and more minor surgery is taking place in community facilities such as primary care facilities. This issue is expanding to other areas of the NHS, so it is important that lessons learned in hospital trusts are learned in the community as well.

Supporting a culture of safety in the NHS is critical, and we have put in place a number of measures aimed at supporting the NHS. The key is learning from incidents. Where there have been surgical fires in the past, it is important to identify their causes and how they could be prevented in the future. It is also important to hear from staff, who will sometimes not be surprised when an incident occurs or who may have flagged issues a number of times before attention is taken.

We are taking a number of initiatives to improve patient safety across the board. The first is establishing the health safety investigation branch, which conducts independent reviews and investigations into any patient safety concerns, including surgical fires. We are also introducing a statutory duty of candour to ensure that NHS organisations are open and honest towards patients. If a surgical fire happens, as in the hon. Gentleman’s tragic example, a patient who may have been asleep at the time should be made aware of that and receive an apology and support afterwards. Sometimes the fires are quite minor and the patient is not affected, but it is important that they know that an incident happened. We are also setting out in legislation the first ever patient safety commissioner, which will be for England only. They will be a champion for patients in relation to medicines and medical devices and will certainly look at the issue of surgical fires.

Regrettably, despite some of the progress and some of the measures we are putting in place, and despite the high quality of care provided by NHS staff, incidents happen that cause harm to patients and put staff at risk. If a surgical fire is extensive enough to take a theatre out of service for a time, that has a knock-on effect for other patients on surgical waiting lists, who may be delayed as a result. Minimising the risk of surgical fires is an area we take very seriously, and although rare, when they do occur in or around the operating table, they can cause extensive damage and put patients and staff at risk.

The issue is how to best minimise the risk of fires in the first place. As has been pointed out, work is going on into this area. NHS England’s national patient safety team has been involved with the expert working group on the prevention of surgical fires, which the hon. Gentleman referred to and which is chaired by the chief executive of the Association for Perioperative Practice. We will continue to support the development of its guidance. I am happy to meet the hon. Gentleman to follow this up, because as highlighted by the shadow Minister the working group published a report in September last year on the prevention and management of fires and made a number of recommendations. It is the view of the national patient safety team that further work on surgical fire prevention following the report is best developed alongside the wider national safety standards for invasive procedures. Those standards were created to support all aspects of patient safety in the surgical environment and are currently being led by the Centre for Perioperative Care, which is responsible for ensuring that national safety standards for invasive procedures continue to be fit for purpose.

[Jim Shannon]

I am very encouraged by the Minister’s response. I referred to four key recommendations, which she referred to. She also referred to the fact that there are ongoing negotiations and discussions with the expert group. Has there been an opportunity to push for those four key recommendations as part of the change that is needed?

[Maria Caulfield]

That is certainly an area that we can discuss further when we meet. I am very happy to do that. The hon. Gentleman is right that experts in this field are best placed to consider whether we have the right standards in place. Work is ongoing to ensure that the standards in place are the correct approach to minimise the risk of surgical fires happening in the first place and to advise the NHS on the issue.

The hon. Member for Strangford talked about the fire triangle of ignition, heat and oxygen. There are potential risk factors in all three of those areas that can make a fire more likely. As I said at the beginning of my remarks, we are working on learning lessons about where fires have happened, to make sure that we learn from those experiences.

In terms of the data, I am obviously concerned that there is no central record of how many surgical fires are taking place, but a new learn from patient safety events service is coming in next year and will better record patient safety events, improve data collection and help NHS trusts to collect the data, use it and learn from it. Although that is not specific to surgical fires, I am keen that fires in general, including surgical fires, are reduced as much as possible and that we learn from these events when they happen.

I am also keen that staff training is a priority. There is a legal duty on NHS trusts to ensure that their staff are trained in fire safety when first employed but also on an ongoing basis. Very often, particularly in theatre, new equipment comes in. The hon. Member for Coatbridge, Chryston and Bellshill (Steven Bonnar) talked about lasers and diathermy equipment. As those machines and that equipment are introduced and upgraded, it is important that staff are trained properly and are able to flag faults with the equipment and ensure that action is taken quickly, for a whole host of reasons. A theatre is a very risky place not just in terms of fire but for a number of reasons.

All colleagues touched on never events. By its very nature, a never event is something that should never happen, but there are not many classified never events if we look on the list. In theatre, there is a never event on swabs used in theatre procedures. We have very clear guidance and procedures in place when swabs are used—they are counted in and counted out to absolutely make sure that nothing is left behind after an operation. That is key.

Surgical fires are not a never event at the moment because there are no clear guidelines that staff can follow that can absolutely rule out any particular fire from happening. That is the crux of the matter. Fires should absolutely be preventable and we should learn the lessons when a surgical fire takes place, but we do not have the guidelines to be able to say to staff what has to be followed to absolutely prevent a fire from happening in the first place. When I meet the hon. Member for Strangford, we need to look at the guidelines and make sure they are coming forward. I have been informed by NHS England that it cannot classify surgical fires as a never event at the moment, until the national guidance or safety recommendations are in place. It has also confirmed that it always reviews any new guidance when it is published. That is the nub of the issue.

The shadow Minister touched on the Whipps Cross hospital renovation. Sadly, that is not in my portfolio, but it does come in the portfolio of the Minister for Health, the hon. Member for Charnwood (Edward Argar), so I will speak to him to try to get an update on progress.

In conclusion, I want to reassure the House that patient safety remains a top priority for the Government. The risk of surgical fire is a real issue, and surgical fires do put patients and staff at risk. The issue is taken very seriously by the Department, and work continues in this field to ensure that the correct guidance is there to minimise the risk of surgical fires occurring in the first place. I look forward to, hopefully, sharing some progress with Members in the new year.

I thank all Members and staff for their hard work this year. It has been a very tough year for everyone, so hopefully everyone will get to enjoy their Christmas. Like the shadow Minister, I also thank all the staff at the Department of Health and Social Care and across the NHS, who may be having a very tough Christmas this year, and I place on record our thanks and gratitude to them—their hard work has not gone unnoticed. With that, I thank everyone, and especially the hon. Member for Strangford for securing the debate.

[Christina Rees (in the Chair)]

Thank you for your remarks, Minister—they are much appreciated.