British Sign Language Users: Access to NHS Services

Seema Kennedy Excerpts

Wednesday 15th May 2019 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Ms Ryan. I will begin with the observation that I was wondering how to include square sausage in my speech. I do not think it will fit in anywhere, but I am very much looking forward to speaking to the hon. Member for Falkirk (John Mc Nally) and finding out more.

I thank the hon. Member for Newcastle upon Tyne North (Catherine McKinnell) for securing the time for this important debate. I know that she has wanted to raise the matter for some time. As last week was Deaf Awareness Week, the debate could not be more timely. What a pleasure it is that we have two interpreters here today; we welcome them. I know that Mr Speaker is committed to making Parliament accessible to all. It was great to see that one of the senior Clerks was present just now. Let us hope that she takes what was happening back to the Speaker. I am sure that the shadow Minister, the hon. Member for Burnley (Julie Cooper), and I can speak to the House authorities about the possibility of a pilot in Westminster Hall. We have discussed whether we might ask even a team of interpreters to interpret busy sittings in the main Chamber—I do not think that some interventions deserve interpretation anyway, but this is an important issue, and it is wonderful that we have subtitling and interpreters here today.

Ensuring fair and equitable access to public services, including but not limited to the NHS, is of critical importance to disabled people. I thank the hon. Member for Newcastle upon Tyne North for all the efforts that she has made in her constituency to use BSL to be more accessible to her constituents. I will definitely reflect on that with my team. I also want to thank the hon. Member for Poplar and Limehouse (Jim Fitzpatrick) for his careful stewardship of the all-party parliamentary group on deafness, and for the group’s work. It has done a lot of work to raise awareness and improve the way that we support people with hearing loss or deafness.

I shall attempt to answer several points raised by hon. Members, but I hope they will bear with me if I do not answer them all, in which case I will write to them. I am afraid there was nothing on the Department’s website about Deaf Awareness Week, but if I am still in post next year, I and the Minister for Care, who was due to respond to this debate, will ensure that that is no longer the case. NHS England highlighted Deaf Awareness Week on social media, including advice on how the NHS can help the one in six people who are estimated to have hearing loss. On Twitter, the NHS Business Services Authority published a video highlighting how its technology team have been learning BSL to support deaf colleagues.

The Government consider that current legislation is sufficient—I will speak more about that issue—but the challenges raised by hon. Members today mean that I will look carefully at what more we can do to communicate obligations under existing legislation to individual NHS trusts. The issue of BSL as a language is probably a matter for the Department for Digital, Culture, Media and Sport rather than the Department of Health and Social Care, but all Departments have a responsibility to create inclusive communities. I will take away the comments made by hon. Members and discuss them with ministerial colleagues in other Departments.

The hon. Member for Newcastle upon Tyne North brought up a distressing example of the gentleman in Essex, and mentioned issues of deafness and mental health—of course, we are thinking about mental health this week. The Government are committed to that issue, and addressing mental health is at the heart of the long-term plan. We are investing £2 billion over five years to improve mental health services, and NHS England commissioned specialist mental health services for deaf people, including in-patient and outreach services. The hon. Lady and the shadow Minister asked me to ask NHS England to look at health services for deaf people, and I am happy to raise those points and look at what the Care Quality Commission is doing. The hon. Member for Poplar and Limehouse set me several challenges, and I will attempt to address the performance results later in my remarks. If I do not, I will be happy to talk to him after this debate or hold a meeting, and I would also be happy to speak to the Minister for Disabled People.

I was asked how we can help more people to know about British Sign Language—indeed, the hon. Gentleman mentioned that his grandchildren are learning it at school. The Department for Education has confirmed that it will begin working with experts to develop subject content for a British Sign Language GCSE, and that will be assessed against the rigorous subject content criteria that apply to all GCSEs. Ofqual will also need to consider the proposal against its assessment criteria. Schools have asked for a period of stability to provide them with a chance to embed the extensive reforms to GCSEs and A-levels, and in March last year, the Education Secretary confirmed that the Government will not introduce further reforms to GCSEs or A-levels beyond those committed to during this Parliament. However, if a British Sign Language GCSE can be developed in line with GCSE requirements, the Government will consider making an exception to their rule on stability, and introducing it this Parliament, and I hope hon. Members will be encouraged by that.

As hon. Members have said, British Sign Language is the primary form of communication for many deaf people and fundamental to the way that they communicate with their families and loved ones. I thank everybody—interpreters, teachers and users of BSL—for their work, which helps people with hearing impairments to lead fulfilling lives in our communities. About 24,000 people in the country have BSL as their first language, and it is essential that they can communicate with NHS staff and services to access the best possible healthcare.

This Government are committed to a truly world-class health service that must be equally available to all. People must be able to communicate their needs and access the information, advice and support that they need to complement the hands-on work of health professionals. Some people may need additional support or to be supported in a different way. We must take proactive steps to provide support for reasonable adjustments —hon. Members highlighted examples of where that is perhaps not happening, and I will take note of that.

Let me focus on the robust framework that we have in place to ensure that reasonable adjustments are made to permit access to NHS services for those with hearing impairments and those who use BSL. Existing equality legislation means that employers, service providers and public bodies must provide services in BSL when it is reasonable for them to do so. That was underpinned by the Equality Act 2010, which places a duty on all public bodies to make reasonable adjustments so that disabled people are not put at a disadvantage compared with those who live without a disability. Commissioners of NHS services must pay due regard to the needs of their population, including those living with a disability, when planning and commissioning services.

Service providers must consider what disabled people who use their services might need and make reasonable adjustments accordingly. That includes, where appropriate, access to BSL services. The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 further expand on how the NHS should implement the Equality Act and make reasonable adjustments. Such provisions help to ensure that people are treated at all times with the dignity and respect that they deserve. A key part of that is the accessible information standard, which is essential for an effective high-quality health service. It was introduced in 2015 and clarifies what health and care services must do under the Equality Act to make reasonable adjustments so that people with additional communication needs are not put at a disadvantage.

All organisations that provide NHS care or publicly funded adult social care are required to comply with the accessible information standard, which sets out how patients and service users—including carers, where appropriate—should receive information in a way that is accessible to them. The Care Quality Commission, which monitors how the standard is put into place, specifically highlights that that includes users of British Sign Language. One wonderful example of that is the fact that BSL users can use the NHS 111 BSL language service, which provides telephone advice on when to seek further medical help, advises on medication use and provides tips on self-care. BSL users can download an app that enables them to connect to an interpreter via a webcam, and the interpreter then relays the conversation to the 111 adviser. Such technology is a great passion of the Secretary of State, and I will take away the comments that have been raised about that during the debate.

For standards and duties to be effective, compliance must be monitored and action taken where needed. When it inspects a service, the CQC uses five steps to identify whether it is complying with the accessible information standard to ensure that people with disabilities can access health and care services. Those five steps focus on how services identify and assess needs and how they are planned, how services clearly record identified needs, what steps are in place as part of the assessment and care planning service, and how services flag information and communication needs and their records, given that the method used must make it possible for all staff to be quickly made aware of and work to meet those needs. Finally, the CQC assesses whether services meet an individual’s needs, ensuring that people receive information in a way that they understand. That might mean arranging communication support if people need it, and it could include access to a BSL interpreter or lip reader, or using a hearing aid.

Organisations are required to publish an accessible communications policy and establish a complaints process. It is important that organisations support users to provide feedback and help to improve those services. In 2017, NHS England led a post-implementation review of the accessible information standard, which provided an invaluable opportunity to assess its impact and ensure that it remains fit for purpose. Following the review, a revised specification was issued. Although there were no substantive amendments, there were changes to the definition of some terms, and clarification of requirements regarding the Mental Capacity Act 2005 and data sharing. The review showed that there was widespread support for the aims of the standard and that patients and carers were clear that receiving accessible information is essential if they are to receive high-quality, safe care.

More generally, there is an action plan on hearing loss, which sets out key objectives including prevention, early diagnosis, maximising independence—a point the hon. Member for Newcastle upon Tyne North made—and enabling people to take part in everyday activities, such as gaining access to work. There is already a commissioning framework published as part of the action plan, and a joint strategic needs assessment for local authorities and NHS commissioners is expected this summer.

The National Institute for Health and Care Excellence published “Hearing loss in adults: assessment and management” in June 2018, which will form the basis of developing a quality standard for adult onset hearing loss that clinical commissioning groups can use to support commissioning. The action plan on hearing loss consortium is led by NHS England, which works with stakeholders across a system to tackle this important issue and galvanise action, given the rising prevalence of hearing loss.

[Jim Fitzpatrick]

I commend the framework document and the action plan published last year; the Department of Health got a lot of plaudits for putting in place a plan to ensure that that which everyone has been raising is delivered on the ground. I would be very grateful for reports on how well the Department is doing, on cross-government support, and on progress in the NHS, because what is on paper is very good and got huge support from the deaf and hard-of-hearing community last year.

[Seema Kennedy]

I thank the hon. Gentleman for his comments. Once plans are put in place, it is important that we monitor them, assess them and review them. I am happy to ensure that the Department keeps lines of communication open with the hon. Gentleman and his group on this matter.

I hope that I have provided some reassurance that there is a robust legislative framework, standards that enact it and a monitoring regime in place. This debate has highlighted where we can sponsor greater responsiveness—I appreciate the important point that the hon. Gentleman in particular made about the market for interpreters. I take these concerns very seriously and I am committed to communicating with colleagues across Government. I will finish by thanking the hon. Member for Newcastle upon Tyne North for highlighting such an important issue.

Health

Seema Kennedy Excerpts

Tuesday 14th May 2019 Commons Chamber

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

It is a great pleasure to respond to this important debate, which has covered a wide range of issues, showing the depth of the passion shared by hon. Members across the House for public health.

I want to address some of the points made by hon. Members. I should like to begin with the shadow Secretary of State, the hon. Member for Leicester South (Jonathan Ashworth), who opened the debate and began by mentioning towns such as Burnley and Blackpool. I was born in Blackburn, as the hon. Member for Westmorland and Lonsdale (Tim Farron) referred to. Like him, I am a slightly disappointed Blackburn Rovers fan, and I represent a Lancashire constituency. I share his concerns about health inequalities, which I see in my constituency. That is what motivates me in this job, and it is what motivates my right hon. Friend the Prime Minister, which is why she set the ageing society grand challenge. The Government share the commitment to prevention and public health that the debate has highlighted, because the costs, both to individual lives and to the NHS, are simply too great to ignore.

I want to address some of the points that hon. Members have raised. My hon. Friend the Member for Fareham (Suella Braverman) spoke about her local services. I am looking forward to reading the report and wish her well as she becomes a mother.

The hon. Member for Bury South (Mr Lewis) spoke about local mental health provision and the experience of his young constituent. NHS England’s planned spend on mental health in the year ending 2019 was just over £12 billion. For children’s mental health services, it is nearly £7 billion—an increase of 5.6% on the previous year. I would like to reassure him that we are definitely not aiming for a one-size-fits-all service.[Official Report, 16 May 2019, Vol. 660, c. 4MC.]

I can reassure my right hon. Friend the Member for Chipping Barnet (Theresa Villiers) that we are absolutely committed to training more GPs. In September last year, we had the highest ever number of students in training. We are also committed to allied healthcare professionals and working to retain the GPs that we have as well as releasing them to give them more time for frontline care.

In response to the hon. Member for Wolverhampton South West (Eleanor Smith), let me say that this Government are absolutely committed to the NHS remaining free at the point of delivery. I would like to put to bed the myth that there is any aim towards privatisation. On the specific constituency case that she raised, I remind her that almost 90% of prescriptions are dispensed free of charge.

My hon. Friend the Member for Chichester (Gillian Keegan) spoke with her usual passion. She paid tribute to Dame Marianne Griffiths, and I join her in paying tribute to everyone at Western Sussex Hospitals NHS Foundation Trust.

I can tell the hon. Member for Westmorland and Lonsdale that we do take prevention extremely seriously. I know that he and I have a meeting scheduled to discuss healthcare in his constituency. We have published our vision for prevention, setting out how we will put that at the heart of the health and social care system, and later this year, we will launch a Green Paper on prevention.

My hon. Friend the Member for Taunton Deane (Rebecca Pow), who is an assiduous parliamentarian as well as constituency Member of Parliament, talked about screening for bowel cancer—something that has touched her family. The long-term plan will modernise the bowel cancer screening programme to detect more cancers by lowering the starting age from 60 to 50. The hon. Member for Birmingham, Edgbaston (Preet Kaur Gill) touched on mental health. I would like to reiterate again that that is at the heart of the long-term plan.

I had never noticed my hon. Friend the Member for Lewes (Maria Caulfield) being critical, but she is definitely a candid friend to the Government. I thank her for her work as a cancer nurse and for highlighting the improvements in the diagnosis of breast cancer, stroke and other diseases.

The hon. Member for Rotherham (Sarah Champion) is a great champion for survivors of sexual abuse. I will take away the specific points that she raised and discuss them with the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Thurrock (Jackie Doyle-Price), who is responsible for mental health, inequalities and suicide prevention.

My hon. Friend the Member for St Ives (Derek Thomas), who is also a great champion for the healthcare of his constituents—as I know from the number of letters to him that I sign—spoke about podiatry and the importance of prevention in amputations.

The hon. Member for Stockton South (Dr Williams) is obviously, with his background in medicine, extremely passionate about public health. Like him, the Government are committed to early years provision. He mentioned the work that my right hon. Friend the Leader of the House is doing on this. Yes, there are inequalities in life expectancy, but it is as high as it has ever been in this country.

I congratulate my hon. Friend the Member for Redditch (Rachel Maclean) on the work that she has done on highlighting the issue of menopause, which has not been raised in this Chamber nearly enough. I reiterate to the hon. Member for Oldham East and Saddleworth (Debbie Abrahams) that reducing health inequalities remains central to our strategy for public health, and we continue to require councils to use their grant with a view to achieving that.

I agree with my hon. Friend the Member for Chelmsford (Vicky Ford) that we need to resolve the uncertainty about Brexit, and I thank her for highlighting the importance of research.

To the hon. Member for Swansea West (Geraint Davies), all I will say is that the World Health Organisation said that our air quality strategy is an example for the world to follow. To the hon. Member for Heywood and Middleton (Liz McInnes), let me say that we are in no way complacent, and I draw her attention to the targeted lung health checks in Manchester, which are producing excellent results.

To the hon. Member for York Central (Rachael Maskell), let me say that public health funding for 2020 onwards, including the local authority public health grant, will be considered carefully in the next spending review, in the light of all available evidence. To the hon. Member for Bethnal Green and Bow (Rushanara Ali), let me say that we are taking serious steps on obesity. I share the passion of the hon. Member for Washington and Sunderland West (Mrs Hodgson) for improved health outcomes in the north; I represent a seat in the north-west, and she represents one in the north-east.

The most important thing to remember is that public health is about more than the health service and public health grant. It is about the whole of government. It is about more than a single pot of money. Even within local government, improving health is not all about the grant, because local authorities can use the whole range of their activity—including on transport, planning and the economy—to promote better health. Spending across the board in local government, central Government and the NHS can all be far more influential in improving and protecting health.

Equality issues remain central to our strategy for public health. Our overarching twin ambition is to raise healthy life expectancy while reducing the inequalities in life expectancies across different groups of the population. In its long-term plan, the NHS has already committed to strengthen action on prevention and health inequalities. All local health systems will be expected to set out in 2019 how they will reduce health inequalities. This Government’s commitment to improving public health, working with the NHS, local authorities and others, is rock solid. We will set out further steps in the Green Paper, and I urge all Members to oppose the motion.

Question put.

Draft Food and Feed Hygiene and Safety (Miscellaneous Amendments) (EU Exit) Regulations 2019

Seema Kennedy Excerpts

Monday 13th May 2019 General Committees

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

I beg to move,

That the Committee has considered the draft Food and Feed Hygiene and Safety (Miscellaneous Amendments) (EU Exit) Regulations 2019.

It is a pleasure to serve under your chairmanship, Mr Robertson. This instrument, which concerns food and feed law, is made under the powers in the European Union (Withdrawal) Act 2018 to make necessary amendments to UK regulations. The Government’s priority is to ensure that the high standard of food and feed safety and consumer protection that we enjoy in this country is maintained when the UK leaves the European Union. This statutory instrument will correct deficiencies in certain regulations to ensure that the UK is prepared in the event of leaving the EU without a deal. Amendments are limited to the necessary technical amendments to ensure that the legislation is operative on EU exit day. No major policy changes are made through this instrument, and we do not intend to make any at this point.

As hon. Members know, the Government have negotiated a deal with the EU and are in the process of taking it through Parliament. This deal is designed to secure a smooth and orderly exit from the EU. However, it is the job of a responsible Government to prepare for all possible scenarios, including the potential outcome that we leave the EU without a deal. We are committed to ensuring that our legislation continues to function effectively in the event of no deal and that public health remains protected. This instrument has been laid for such a scenario.

Fifteen EU exit-related instruments have been laid previously, addressing various aspects of food and feed safety and hygiene. This instrument will address a range of minor deficiencies in retained EU law relating to food and animal feed that have not been addressed by earlier instruments or by very recent changes made to EU law and that could not have been addressed by previous instruments. As with previous SIs recently laid before the House, I wish to make it clear that no policy changes are made through this instrument, which makes only the essential changes necessary to ensure an effective and fully operable statute book on exit day.

The primary purpose of the instrument is to ensure that legislation continues to function effectively after exit day. The proposed amendments are critical to ensuring minimal disruption to food controls in the event that we leave the EU without a deal. The changes also ensure a robust system of controls, which will underpin UK businesses’ ability to trade both domestically and internationally. The contents of the instrument cover several policy areas, which I will address.

The health mark for carcases of animals such as cattle, pigs and sheep, and the identification mark for all foods of animal origin, will change once the UK has left the EU, with the letters “EC” no longer used. The Specific Food Hygiene (Amendment Etc.) (EU Exit) Regulations 2019 retain the requirement for health and identification marks to contain either “UK” or “United Kingdom”. The instrument allows for the abbreviation GB to be used in such marks, as this is the International Organisation for Standardisation’s two-letter country code for the United Kingdom. The instrument also provides for a transitional period of 21 months after exit day, during which UK food businesses can apply their current health and identification marks on carcases and food of animal origin in the UK domestic market. This transitional period will assist businesses by providing a smoother transition to the new marking requirements and permitting them to use up existing labels and packaging.

Let me turn to the trichinella pork nematode worm parasite provisions and the transitional provisions for official laboratories. This SI addresses deficiencies in retained EU law on trichinella testing requirements to ensure that these rules are fully enforceable, replacing references to EU institutions and bodies with appropriate UK bodies and authorities.

[Ms Angela Eagle (Wallasey) (Lab)]

Can the Minister explain how virulent and how difficult for human health that particular issue is? I am a bit unsure, and the more difficult it is, clearly the more we have to be careful about how we deal with it.

[Seema Kennedy]

The hon. Lady raises the point that trichinella—a parasitic nematode worm—can be extremely serious. It can cause disease in people who eat raw or undercooked meat from trichinella-infected domestic animals or game. The instrument will provide assurance that testing requirements that ensure protection will continue after EU exit. Maintaining the requirements of the existing regulations will retain confidence in the pork industry. Confidence in food safety is our Government’s priority.

[Ms Eagle]

Is the Minister confident that we have enough capacity in this country to continue testing for that worm and its associated health risks, as we do not have time to put in place our own testing facilities? Will she tell the Committee how much extra resource her Department has allocated to make sure that we do not allow a loss of control during the transition?

[Seema Kennedy]

I am confident that the Foods Standards Agency will be able to cope. It has done sterling work, and I met the chairman of the FSA this morning. An extra £14 million was provided to the FSA for EU exit in 2018-19, and £16 million for 2019-20. The FSA has had an additional grant fund of £2 million for local authorities for the year ending 2019, and again for the year ending 2020. That is just to support food safety-related activity related to EU exit pressure.

[Ms Eagle]

The Minister is very well briefed. Although that is an increase, she gives general figures for the Food Standards Agency, not the amount of extra resource that would be available to ensure that those particular nematodes do not infect meat that might be imported into this country and eaten by people here. Does she have a more broken-down version of those figures, so we can have some idea of whether her Department has allocated enough resource to ensure there is not increased risk to food safety as a result of the changes?

[Seema Kennedy]

I am confident that there will be no increase in risk. I do not have to hand the exact figures on the amount that the FSA has spent on trichinella.

[Ms Eagle]

Could the Minister write to me?

[Seema Kennedy]

I am very happy to write to the hon. Lady with those figures.

Let me turn to the rules for businesses and official controls relating to products of animal origin, or POAO. EC regulation 2704/2005 is an EU tertiary implementing measure that provides certain technical and administrative refinements to EU regulations for food products of animal origin. It sets out specific rules on analytical methods, rules relating to fishery products used in the production of fish oil, and more. The instrument will assign powers and responsibilities currently incumbent on EU entities to appropriate UK entities to ensure that diverse regulation is fully operational.

The model import health certificates for certain products of animal origin under EC regulations 2074/2005 and 2016/759—for imports of certain products of animal origin such as fishery products, gelatine and collagen for human consumption—are amended so that they can be used solely to import foods to the UK.

[Ms Eagle]

Clearly, people worry about food irradiation. I suspect that what the Minister is talking about is irradiating things such as collagen, so that they are safe for human consumption, rather than irradiating meat for human consumption. The Americans do a lot of that, and I suspect that many of our consumers would not want that. Can she give us some clarity on the irradiation regulations that she is talking about in this particular context?

[Seema Kennedy]

The hon. Lady anticipates that I was about to turn to food irradiation. The instrument amends the definition of imports in existing legislation so that it is clear that any new facilities approved by EU member states in the future will no longer be automatically approved for food imported into the UK. Without the instrument, there could be a lack of clarity on the status of newly approved facilities.

The instrument includes provisions to set minimum charging rates for hygiene controls for fishery products by amending the Fishery Products (Official Controls Charges) (England) Regulations 2007. It updates provisions for the charges. For example, the rates are currently set in euros with an exchange rate to sterling. The instrument also updates the exchange rate from 2008, as it is now somewhat out of date and would not be in line with central Department for Exiting the European Union and Her Majesty’s Treasury guidance on amending outstanding references to euros.

[Ms Eagle]

Will the Minister give way on the irradiation point again?

--- Later in debate ---

[Seema Kennedy]

Can I just finish the point I am on?

The Food Safety (Sampling and Qualifications) (England) Regulations 2013 are national and stipulate the necessary qualifications and experience required for an official control laboratory analyst in England. The instrument corrects inoperabilities in the legislation, replacing references to EU institutions and bodies with UK authorities and bodies.

[Ms Eagle]

When people look at irradiation issues, they worry about whether it is the kind of practice one sees in America, where a lot of food is irradiated to make it last longer in a way that our consumers in Europe and particularly in the UK do not like. I am trying to establish—I hope the Minister can make this a bit clearer for me—whether the irradiation she is talking about with this instrument relates to food safety, such as with animal-derived collagen. That might have to be irradiated, but it is not the same as having prime steak irradiated to make it last longer, so that it might be much older when it is eaten. Will she clarify whether the irradiation amendments are about a food safety issue or about allowing food, particularly meat, to survive longer on the shelves, which would worry consumers?

[Seema Kennedy]

I think it is important that the hon. Lady wants to draw out what people are worried about, which is food safety. There is only one approved food irradiation establishment in the UK, and it does not currently treat food on an entirely commercial basis. Its main business is medical sterilisation. Only a small proportion of food is irradiated and that should be robustly regulated. The overall message I would like the hon. Lady to take away is that the Government are absolutely committed to food safety. There is no suggestion in this instrument or any other that has been laid that there will be any watering down of, or reneging on, the Government’s absolute commitment to the very robust regulation of food. That is something we pioneered and are very proud of.

The proposed amendments for smoke flavourings address minor drafting errors in the previously laid Food Additives, Flavourings, Enzymes and Extraction Solvents (Amendment etc.) (EU Exit) Regulations 2019. Those errors were identified by the Joint Committee on Statutory Instruments. In its response, the FSA provided an undertaking to the JCSI that the deficiency would be addressed.

EU authorisation decisions relating to genetically modified food and feed have come into force since the laying of the Genetically Modified Food and Feed (Amendment etc.) (EU Exit) Regulations 2019, which will implement retained EU law on exit day. The instrument introduces amendments to make the decisions fully operable by specifying the UK entity to which authorisation holders must submit annual reports on activities set out in their environmental monitoring plans and to remove references to the European Community in connection with the register of authorised GM food and feed.

The instrument makes equivalent changes to the relevant Northern Ireland legislation to ensure that the body of Northern Ireland food law can function properly and is enforceable once the UK leaves the EU. It also inserts a definition of “Northern Ireland devolved authority” or, where appropriate, identifies the Department that is the correct appropriate authority, replacing references to EU institutions and bodies in various EU regulations. The amendments also include naming the relevant legislature for Northern Ireland where the regulation-making procedure is provided in various EU regulations. The instrument transfers powers to UK entities to support a UK regulatory regime. It also transfers responsibility for risk assessment from the European Food Safety Authority to the food safety authorities, the FSA and Food Standards Scotland. [Interruption.] Yes, “All You Need Is Love”. They will continue to deliver independent, open and transparent, science and evidence-based advice.

The instrument additionally changes references regarding the import of food and feed into the EU as references to the import of food and feed into the United Kingdom. It does not introduce any changes for food businesses in how they are regulated and run. The formal public consultation carried out by the FSA covering changes to UK health and identification marking received overwhelming support for the proposal. The instrument will provide continuity for businesses and protection of consumers’ interests and ensure that enforcement of the regulations can continue in the same way. The changes will ensure the retention of a robust system of controls that will underpin UK businesses’ ability to trade both domestically and internationally.

It is important to note that the devolved Administrations have provided their consent for the instrument. Furthermore, we have engaged positively with the devolved Administrations throughout its development. The ongoing engagement has been warmly welcomed.

The instrument will ensure that regulatory controls for food continue to function effectively after exit day and that public health is protected. It is therefore key to ensuring that the high standards of food safety and consumer protection that we enjoy in this country are maintained when the UK leaves the European Union. It will protect public health from risks that may arise in connection with the consumption of food. I ask hon. Members to support the amendments proposed in this instrument to ensure the continuation of effective food and feed safety and public health controls. I commend the regulations to the Committee.

--- Later in debate ---

[Seema Kennedy]

There were several points raised by the shadow Minister and by the hon. Member for Wallasey, and I shall try to address them. This SI is only on health marks, which have only recently been clarified by the Commission. The hon. Member for Washington and Sunderland West said that she and my predecessor debated lots of these before. However, we need this instrument to address recent changes to EU law that were not applicable when the previous SIs were drafted. It makes some small corrections that have come to light since the earlier SIs were laid, and provides for similar changes in Northern Ireland legislation. The overarching message is that the Government are absolutely committed to high standards in the entire food chain, now and after EU exit.

On dialogue with other authorities, the Food Standards Agency continues that with local authorities and other agencies. It also has a continual dialogue with industry. On lab capacity, which the shadow Minister brought up, the UK is developing alternative approaches to deliver the necessary functions provided by EFSA and the European Commission, building on our own capacity and capability to carry out risk assessment and manage and control food and feed safety risk through scientific advisory structures. The UK already has national reference laboratories in place that help to ensure the safety of our food and feed and to prevent the entry and spread of infectious diseases in crops, livestock and feed. Those laboratories are internationally recognised for their scientific expertise.

[Ms Eagle]

Will the Minister give way on that point?

[Seema Kennedy]

I fear that I might be disappointing the hon. Lady with my answer but yes, I am happy to give way.

[Ms Eagle]

I thank the Minister for her generosity in giving way. Opposition Members do not doubt the excellent science available in many of our labs; we doubt that enough resources and people are in place to do the kind of job that will be required when this stuff all comes back. I suppose the reassurance that we seek is that she will ensure that an appropriate amount of resource and capacity will be in place to do the job properly.

[Seema Kennedy]

I will address funding and capacity later in my remarks. On fisheries, the charges are set out in detail in retained EU law, and various rates apply to different products. The devolved Administrations have been involved in the preparation of the draft regulations, and we engaged positively with all those Administrations throughout the statutory instrument’s development.

[Neil Coyle (Bermondsey and Old Southwark) (Lab)]

Is the Minister including Northern Ireland?

[Seema Kennedy]

Obviously, because there is no sitting Assembly—

[Neil Coyle]

You said all of them.

[Seema Kennedy]

I will correct the record: consent was sought from the Northern Ireland civil service, and was provided by the permanent secretary of the Department of Health of Northern Ireland.

To address the point made by the hon. Member for Wallasey, as I have said before, in 2018-19 additional funding for the FSA for EU exit was of the order of £14 million, and in 2019-20, £16 million. The FSA also had the extra £2 million in 2018-19 and in the year ending 2020 just to support food safety activity. We are therefore confident that it can meet the novel tasks that it will be expected to perform after EU exit.

Previous staff changes reflected efficiencies that were appropriate at the time. A careful assessment has been made of the additional work that we will now need to carry out when we leave the EU. The FSA has strengthened its capacity and capability for risk assessment and risk management by recruiting more policy and science experts, as well as strengthening processes and procedures that underpin the risk-analysis process. An extra—

[Ms Eagle]

Will the Minister give way?

[Seema Kennedy]

May I finish this point? An extra 140 staff have been recruited, and the majority of them are already in place. I—

[Ms Eagle]

Will the Minister give way?

[Seema Kennedy]

I would first like to address the other points that the hon. Lady made.

[Ms Eagle]

But my intervention is on this very point— I thank the Minister for her generosity in giving way. I note from the figures that she gave us that £14 million has been allocated for one year and £16 million for the next, but then it goes down to virtually nothing, £2 million. That gives the impression that a lump of work needs to be done and that the funding can then go back to the way it was before. Is she happy that that is the right level of funding allocation, and that the FSA can go back to where it was before this lump of money? Does she think that gives the Opposition the reassurance that we seek? Is she happy with that?

--- Later in debate ---

[Seema Kennedy]

I am very happy that the FSA will be able to cope with the additional duties that it will have after EU exit and that it is properly funded.

On irradiation, EU legislation provides for EU approval for irradiation facilities for food and specific foodstuffs. Nothing is changing, and no new foods can be irradiated. I hope that gives the hon. Lady the reassurance that she seeks. That applies to imports and to domestic foods.

On GM foods, which I know worry many people, the draft SI is not about changing the robust controls that we have in place for GM food and feed. It corrects a further two retained EU authorisations, in addition to the 68 covered by the main Genetically Modified Food and Feed (Amendment etc.) (EU Exit) Regulations 2019, which have already been approved by Parliament.

I hope that I have answered all the questions asked by hon Members. As I said, while the Government continue to work for an orderly exit from the EU and until we have final agreement, it is important to prepare for the possibility that we will leave with no deal. To reiterate, this instrument makes no changes to policy or to how food businesses are regulated and run. The draft regulations are limited to the necessary technical amendments to ensure that regulatory controls for food and feed continue to function effectively after exit day if the UK leaves the EU without a deal, and that public health is protected.

Question put and agreed to.

Resolved,

That the Committee has considered the draft Food and Feed Hygiene and Safety (Miscellaneous Amendments) (EU Exit) Regulations 2019.

Acquired Brain Injury

Seema Kennedy Excerpts

Thursday 9th May 2019 Commons Chamber

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

It is a real pleasure to respond to this excellent debate on behalf of the Government. I would like to begin by thanking the hon. Member for Rhondda (Chris Bryant) for securing the debate. I commend him for the all the work he has undertaken as chair of the all-party group on acquired brain injury. He began by giving us a very vivid description of the physical impact of brain injuries, and went on to describe a whole gamut of mental health and emotional effects they have on people—and, of course, their families. He set me a challenge and I shall endeavour to meet it.

My right hon. Friend the Member for South Holland and The Deepings (Sir John Hayes) spoke with his usual eloquence. He reminded us about the scale of ABI, and emphasised the complexity of the issue and how it touches on many areas. The hon. Member for Swansea East (Carolyn Harris) told us all about George, reminding us that ABI can have extremely unexpected and devastating effects on the people who live with it and their families.

My hon. Friend the Member for Ayr, Carrick and Cumnock (Bill Grant), with his long career in the fire service, saw many people who had an ABI. He set us a very interesting challenge about having compulsory helmets for cyclists. I will take that point away and speak to my colleagues in the Department for Transport about it. The hon. Member for Blaydon (Liz Twist) outlined how people “just don’t get it”. That is a very important point, and it shows how important it is that we are debating ABI here today. She made a point about carbon monoxide poisoning, and I am due to have a meeting with the hon. Member for Rhondda on that very issue.

The hon. Member for Mitcham and Morden (Siobhain McDonagh) told us that the excellent charity Headway, which was mentioned very many times during the debate, is based in her constituency. She reminded us that a brain injury can strike any of us at any time. We also heard from the hon. Member for Caithness, Sutherland and Easter Ross (Jamie Stone). He spoke very movingly, as he did in the debate last year, about his wife’s experience and his. All I can say is keep going on the crossword.

Brain Injury Awareness Week is from 20 to 26 May. I welcome the time Parliament that has set aside to discuss this issue. Prevalence estimates for ABI are problematic to make, but it is likely that the number living with ABI is definitely over half a million and could be as high as 1 million. The total cost of brain injury in the UK is estimated to be at least £1 billion per year. Charitable organisations such as Headway and the UK Brain Injury Forum, as well as other local and national groups that hon. Members have referred to, are highly valued by those affected. They raise awareness and provide help to those with the condition, as well as to their families and carers, and I want to put on the record our appreciation for everything they do.

As we have heard, in 2018 the APPG held a wide-ranging inquiry into the causes, impact and treatment of ABI. My predecessor, my hon. Friend the Member for Winchester (Steve Brine), to whom I pay tribute for the energy he brought to this matter, agreed to respond to that report, and my Department co-ordinated with officials across Whitehall to deliver that response on 19 February. In responding today, I will draw on key areas of the response to set out the relevant activity that is under way.

[Sir John Hayes]

I thank my hon. Friend for giving way, and I know she will address these matters with her usual acumen and assiduity. I spoke about dynamic disability and the pace of recovery, but will she take into account the fact that aligned with that is the subtlety of the effects of brain injury? Sometimes a person may be deemed to have recovered completely and to have returned to normal—whatever normal is—but their manner, meter and mood might have changed and their sense of appropriateness might have altered, and that has effects in education and employment, in particular, as well as in personal relationships.

[Seema Kennedy]

My right hon. Friend makes an extremely important point, showing that this is an issue not only for the health system and my Department but for others across Government.

While the majority of rehabilitation care is locally provided, NHS England commissions specialised services for patients with the most complex levels of need. For people who have ABI, neuro-rehabilitation that is timely and appropriate is an important part of their care. Access to high-quality rehabilitation improves outcomes for patients and can save money. The shadow Minister mentioned rehabilitation prescriptions. RPs reflect the assessment of the physical, functional, vocational, educational, cognitive, psychological and social rehabilitation needs of a patient and are an important element of rehabilitation care. The APPG report was clear that all patients with ABI should benefit from an RP.

NHS England’s major trauma service, where acute phase rehabilitation begins, sets out that patients should be reviewed by a rehabilitation consultant. The shadow Minister asked about this. The development of major trauma centres, which the hon. Member for Rhondda supported, has improved recruitment to this specialty, while the national clinical audit of specialist rehabilitation recommended that all trauma networks review access to rehabilitation consultants and make improvements. Patients should have either a rehabilitation consultant or an alternative clinician with skills and competencies in rehabilitation to provide an initial formulation and plan to complete and perform the initial RP. At discharge, all patients should have a patient-held record of their clinical information and treatment plan from admission as they move to specialised or local rehab.

The “National Clinical Audit of Specialist Rehabilitation for Adults Patients with Complex Needs Following Major Injury”, published in 2016, found that on average 81% of patients had a record of a rehabilitation prescription. The audit recommended that MTCs take action to improve compliance. The audit report appears to have had a significant impact. The latest data, from the last quarter of 2018, from the trauma and audit research network shows that the national average rose to a 95% completion rate for RPs. This is good news. NHS England has worked with patients, clinicians and charities to improve the RP design and set new standards for communication and involvement of patients, families and carers. It is hoped that the new RP will support the development of a rehabilitation dashboard to monitor the performance of the system. Audits play an important role in helping services to improve. The report also recommended that all organisations within a trauma network work together to review capacity.

The majority of rehabilitation care is commissioned and managed locally. To support commissioners to plan services for local populations, NHS England has produced a document, “Principles and Expectations for Good Adult Rehabilitation”, that describes what good rehabilitation looks like. Additional guidance covering adults and children sets out a commissioning model and the evidence base for delivering high-quality rehabilitation services.

The hon. Member for Rhondda mentioned that ABI spans many Departments, and I shall take away all the comments that concern my ministerial colleagues and will ask them to respond. On support for children with ABI in school, the special educational needs and disabilities system is designed to support all children and young people with additional needs. The arrangements for SEND are intended to support joint working between health, social care and education; multi-professional assessment of a child or young person’s needs involving relevant experts; and the development of an individual education, health and care plan to meet those needs. This should provide a basis for the sharing of information and expertise to ensure the needs of children and young people with ABI are supported in school.

The hon. Member for Blaydon mentioned the ABI card. The Department for Education has said that promotion of the card is a matter for individual schools, but as far as my Department is concerned, Professor Chris Moran, a national trauma director, said that he would be happy to promote the card in trauma networks, working with the Brain Injury Trust. The statutory guidance on supporting children with medical conditions at school covers a range of areas, including the preparation and implementation of school policies for supporting pupils, the use of individual healthcare plans, consulting with parents, collaborative working with healthcare professionals and staff training. The Department for Education continues to work with organisations such as the Health Conditions in Schools Alliance to help to raise further awareness of the duty on schools.

On prisons, there is an increasing body of evidence linking ABI to offending behaviour. NHS England’s liaison and diversion service has collaborated with Headway to develop workshops to improve awareness and identification of ABI in vulnerable offenders and the support available. The “train the trainer” workshops were designed so that attendees could return to their services and cascade workshop learning to their colleagues. Representatives of all NHS England-commissioned liaison and diversion services attended. Over the past two years, the Ministry of Justice has also piloted approaches to improve screening and support for prisoners through new link worker roles at six sites on the male secure estate. I take the point about female offenders and will speak to the relevant Minister. There was a pilot at a female prison between 2016 and 2018, but I will take away the point about the female estate.

I want briefly to touch on the point raised by my right hon. Friend the Member for New Forest East (Dr Lewis), the Chair of the Defence Select Committee. The veterans trauma network delivers comprehensive medical care to veterans, including those suffering from brain tumours, and, as he knows, the Prime Minister opened the successor Defence centre to Headley Court last year. We do not recognise his statistic that there are only two machines, but I will take that away and report back to him.

[Dr Julian Lewis]

I was not talking about tumours; I was talking about traumatic injury caused in explosions. My understanding is that only Nottingham and Aston Universities have the special types of scanners that can detect that particular injury. Will the Minister check that point and consider a screening programme for such people?

[Seema Kennedy]

I will happily take away that challenge from my right hon. Friend and will write to him.

The hon. Member for Rhondda spoke passionately about sport, although he claims not to be a sportsman. It is important that we do more to reduce the risk of ABI in sport. The Department for Digital, Culture, Media and Sport asked Baroness Grey-Thompson to carry out an independent review of the duty of care that sport owes to its participants; her report dedicated a chapter to safety, injury and medical issues. National governing bodies are responsible for the regulation of their sport and for ensuring that appropriate measures are in place to protect participants from harm. The DDCMS expects everyone in the sports sector to think carefully about the recommendations in Baroness Grey-Thompson’s report and in the all-party group’s report. Progress has been made over the years, for example through the Rugby Football Union’s Headcase campaign and action by other groups.

It is important that the welfare system appropriately supports people with ABI. Work capability assessments for the employment and support allowance are conducted by healthcare professionals for the Centre for Health and Disability Assessments. Case discussions about claimants with ABI form part of new entrant training for all healthcare professionals who undertake such assessments. They should all have access to a self-directed learning module on ABI, which was updated in 2018 and quality-assured by Headway.

Since September 2017, those who are placed in the ESA support group and the universal credit equivalent, who have the most severe and lifelong health conditions or disabilities and are unlikely ever to be able to move into work, will no longer be reassessed. Changes have been introduced so that existing claimants with the most severe lifetime disabilities whose functional ability has remained the same are more likely to have their evidence reviewed by a Department for Work and Pensions decision maker, and not need a face-to-face assessment with a healthcare professional.

I hope that this debate demonstrates how seriously the Government take the issue and the devastating impact that it can have on people’s lives. We are committed to ensuring that people are better protected. I look forward to responding to further debates.

Oral Answers to Questions

Seema Kennedy Excerpts

Tuesday 7th May 2019 Commons Chamber

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

Over 2 million prescription items are successfully dispensed in England every day, and we have well-established procedures to deal with medicine supply issues should they occur. We work closely with all those involved in the supply chain to help ensure any risks to patients are minimised when supply issues arise.

[Justin Madders]

I welcome the Minister to her place. She will know from written questions I have tabled that my constituents have real concerns about the availability of the epilepsy drug Sabril, which has been in short supply. She told me last month that supplies would be resolved by mid-April; she has now told me in a written answer that supplies will be resolved by mid-May. It seems there is a disconnect between what the Minister is saying and what is actually happening on the ground. When can she guarantee that this drug will be widely available again?

[Seema Kennedy]

I thank the hon. Gentleman for raising this issue again. We have expressed our great concern to the suppliers about this problem, and we are working alongside them to ensure that, although there is enough Sabril nationally, we get it in the right place at the right time. We will go back to them and express our concern again.

[Chris Philp (Croydon South) (Con)]

May I add my congratulations to my hon. Friend the Member for South Ribble (Seema Kennedy) on her appointment? I am sure the whole House wishes her well in her important work.

Related to the question of prescription drugs is that of vaccinations, where rates have been falling, partly driven by alarming and inaccurate material posted on social media, including Facebook. Will the Minister join me in calling on Facebook to remove material that deters people from vaccinating their children? If it refuses to do so, does she agree that legislation may be needed?

[Seema Kennedy]

I thank my hon. Friend for his question. As he will know, my right hon. Friend the Secretary of State met Facebook last week.

On the issue of vaccination broadly, in 2017 we met the 95% rate for vaccination. Immunisation for everybody is absolutely crucial, but some children cannot be immunised because they are too young and others because they are immune-suppressed; so everybody who can be immunised should be immunised.

[Julie Cooper (Burnley) (Lab)]

I also welcome the hon. Lady to her place.

Close to 100 commonly prescribed medications are in seriously short supply, including painkillers, antibiotics and antidepressants. Worries about Brexit outcomes have led to the stockpiling of medications, which has undoubtedly exacerbated the problem, but I know from my own experience in community pharmacy that there have been concerns about the supply chain for several years, long before Brexit was ever dreamed of. The Government have, however, consistently turned a blind eye to these problems, which place additional pressures on GPs and pharmacists and are most certainly detrimental to patient care. Can the Minister assure me today that she understands the scale of the problem and outline the steps she is taking to resolve it?

[Seema Kennedy]

I thank the shadow Minister, my Lancashire neighbour, for her welcome. The Department takes this extremely seriously; we have a whole team working on it. There are about 12,500 prescribed medicines in this country, with only between 50 and 100 being looked at by the medicines supply team at any one time. There is no cause for complacency, though. In January this year, we took further steps to make it mandatory for pharmaceutical companies to report any supply issues to us as soon as possible.

[Mr Philip Hollobone (Kettering) (Con)]

6. If he will make provision for (a) a new urgent care hub at Kettering General Hospital and (b) a health and social care pilot in Northamptonshire with the Ministry of Housing, Communities and Local Government. [R]

--- Later in debate ---

[Patricia Gibson (North Ayrshire and Arran) (SNP)]

13. What recent discussions he has had with Cabinet colleagues on recognising 17 May as diffuse intrinsic pontine glioma awareness day.

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

The NHS long-term plan makes it clear that cancer survival is a Government priority, and we wholly support any activity to raise awareness of devastating cancers such as DIPG. The overwhelming message from two powerful debates last year, here and in the other place, spearheaded by the late Baroness Tessa Jowell, was that better outcomes for children and adults with brain tumours lie in better research. That is why we announced £40 million, over five years, to stimulate innovative brain tumour research, working alongside the Tessa Jowell Brain Cancer Research Mission.

[Patricia Gibson]

As the Minister will be aware, having DIPG awareness day on 17 May is very important in raising the awareness of this fatal illness, which is often overlooked and where the prognosis has not improved in the past 40 years, despite 40 children in the UK dying from it each year. How will the people suffering from DIPG benefit directly from the funding that she has outlined? Does she commit to keeping the House updated on measures to combat this serious illness?

[Seema Kennedy]

Let me begin by paying tribute to my constituent Paula Holmes, who made me aware of DIPG, and to all the work she has done in memory of her daughter Katy, one of the 40 children who died from it. We rely on researchers to submit high-quality research proposals in this difficult area, and the National Institute for Health Research has put out a highlight notice asking for research teams. We stand ready to translate any new discoveries as quickly as possible into new treatments and diagnostics for patients, and I am happy to keep the House updated.

[Stuart C. McDonald (Cumbernauld, Kilsyth and Kirkintilloch East) (SNP)]

14. What his policy is on the mandatory fortification of flour with folic acid.

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

We have announced our intention to consult on the mandatory fortification of flour with folic acid. We are fully committed to this and we will be launching the consultation as soon as possible.

[Stuart C. McDonald]

I am grateful to the Minister for that answer, but the Government said in January that the consultation would happen soon. As it was originally announced in October, people are becoming frustrated. Can she say that this will happen before the summer? Can she confirm that it will be about how we go about mandatory fortification, rather than about whether we should do it?

[Seema Kennedy]

I share the hon. Gentleman’s frustration, and I know that Members have been waiting for this. I am reassured by my right hon. Friend the Secretary of State that this will happen. I am going to be making it happen before the summer, and I will return to the House to update it.

[Judith Cummins (Bradford South) (Lab)]

23. The Healthy Start scheme, which provides food vouchers and coupons for free vitamins, reaches only about a third of children living in poverty. It is also woefully out of date; it is worth only £3.10 and it has not been updated since 2009. What are the Government doing to improve both the scale and impact of this important scheme?

[Seema Kennedy]

I thank the hon. Lady for her question. The Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Thurrock (Jackie Doyle-Price), says that she is looking into it and that we will report back.

--- Later in debate ---

[Bambos Charalambous (Enfield, Southgate) (Lab)]

Today I met representatives of the Teenage Cancer Trust. As we await the publication of the workforce implementation plan following the publication of the NHS long-term plan, what plans does the Minister have to ensure sustainable funding for the teenage and young adult cancer specialist workforce?

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

I thank the hon. Gentleman for his question; I had the pleasure of meeting representatives of the Teenage Cancer Trust recently as well. Cancer is an absolute priority for the Government. Our aim is for 75% of all cancers to be detected at an early stage by 2028. As my right hon. Friend the Secretary of State has said, the workforce plan will be reporting imminently.

NHS: North-West London

Seema Kennedy Excerpts

Wednesday 24th April 2019 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Sir Christopher. I thank the hon. Member for Hammersmith (Andy Slaughter) for securing this important debate, and all hon. Members for speaking so passionately. I welcome the campaigners, who have been following our deliberations this afternoon. Everybody has spoken passionately about NHS services in north-west London, and the hon. Gentleman spoke about his area of Hammersmith and Fulham. I am under considerable time pressure, and if I do not answer all the questions that hon. Members raised, which ranged over primary and acute care, I am happy to write to them later.

I would like to start by thanking everybody who works in the NHS—in primary, secondary and community care—for everything they do, particularly in north-west London, which is a busy area with a lot of demand on services. It is exposed to unique pressures, but there are also unique opportunities. It has some of the country’s busiest services and is used by an increasing, complex and dynamic population. Our capital city challenges our NHS, but it is also home to transformation and innovation that has delivered important benefits for patients.

“Shaping a healthier future” looked at the pressures on the NHS in and around the hon. Gentleman’s constituency. It achieved significant benefits for patients in north-west London. It delivered 24/7 urgent care centres in every local borough and improvements in maternity and emergency paediatric care, and introduced a range of initiatives to help people obtain the specialist care they need closer to home. The NHS in north-west London is now in agreement to move on from the “Shaping a healthier future” programme. The hon. Gentleman asked specifically what the future will hold. In January, the Government announced that there will be an extra £20 billion a year for the NHS by 2024. As part of that, every area in the country will need to develop its own local plan for the next five years for how to spend the extra money. The north-west London sustainability and transformation partnership, working with clinicians and the public, will develop a new long-term, five-year plan for how best to spend that money, working together as a single health system.

I want quickly to address the points that the hon. Gentleman made about the lack of honesty in the north-west London process. Reconfiguration processes are, by their very nature, contentious, and raise many passions locally and nationally. His passion was evident from his contribution. The consultation process in north-west London involved extensive public consultation and clinical engagement throughout. It is important to recognise the high level of clinical engagement. It was never a political exercise or a fait accompli. Its underpinning principle was what was best for patients with the available resources. We need to support NHS staff and managers as they face the challenges before us. We must help them to manage service change responsibly. General practice primary care is the front door to and the cornerstone of the NHS, which is why the long-term plan addressed it when it was published in January.

I want to speak about Babylon GP at Hand. The hon. Gentleman raised a number of issues, and I will do my best to answer them. He spoke about the cost to the CCG. I wrote to one of his council colleagues this morning about the issues he raised. I understand that the CCG has reported that it overspent by £10 million in 2018-19, specifically in relation to GP at Hand. NHS England will of course have to look at the year’s final accounts and any overspend in more detail to understand better the precise financial impact of changes in the borough. For 2019-20, the CCG’s target allocation has increased, all else being equal, in line with the growth in its overall registered population up to the 12-month average for November 2017 to October 2018. NHS England does not believe that the CCG has had to scale back services because of any extra financial burden from GP at Hand, but we will continue to work with the CCG and other partners to explore options for maintaining the robustness of the commissioning system, both now, while GP at Hand is focused in London, and in the future.

I just want to address the hon. Gentleman’s point about safety.

[Andy Slaughter]

I suspect the Minister was referring to my colleague, Councillor Ben Coleman, the cabinet member for health and adult social care, who wrote to the Secretary of State on 15 April specifically asking for the money spent—£10 million—to be refunded, and for a commitment to reimburse the CCG fully for the cost of GP at Hand. I did not hear the Minister say that, so will she give that assurance?

[Seema Kennedy]

I cannot give that reassurance, and I would only reiterate what I have just said to the hon. Gentleman.

On the safety of the app, all NHS providers are held to account through a robust network of systems, including, and not limited to, the inspections of the Care Quality Commission. Any apps providing video consultations must be evaluated and regulated to ensure that the patients who access those services can be confident that they receive safe, effective and high-quality care. Hammersmith and Fulham CCG, along with NHS England, has commissioned an independent evaluation of GP at Hand, which will report shortly.

I question what the shadow Minister said. Digital technology is part of the solution, but the Department is looking at other ways of transforming primary care. We are looking at how we look at partnership models and at how we pivot to primary in future. All patients will have a right to digital-first primary care, including web and video consultations, from April ’21. All patients will be able to have digital access to their full records from 2020. They can, from this month, order repeat prescriptions electronically as the default.

By the end of the next decade, digital innovations are likely to have transformed the NHS. They will allow clinicians to work more efficiently and flexibly so they have more time to spend caring for patients. Every pound spent will go further. That will allow for greater responsiveness and personalisation for patients. We need to design services for patients and things that are available for people when they want them and at times that are convenient for them. I am pleased that the Government have committed to saying that all patients will have access to digital-first primary care from April 2021.

I acknowledge the hon. Gentleman’s concerns about the effect of GP at Hand on primary care as a whole in his constituency. The challenge for the Government and NHS England is to ensure that the way we commission, contract and pay for care keeps up with the opportunities digital innovation offers, ensuring that the new technology is safely integrated into existing pathways without unduly destabilising the services it works alongside. Two important principles within the NHS are that a patient can choose which practice they register with, and that funding follows the patient. The emergence of digital-first providers, which register patients who may live some distance from the practice, raises the question of whether these funding arrangements are fair. This year, NHS England is analysing and reviewing the out-of-area registration.

Primary Care: Plymouth

Seema Kennedy Excerpts

Wednesday 10th April 2019 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mr Hollobone. I thank the hon. Member for Plymouth, Sutton and Devonport (Luke Pollard) for securing this important debate and for his kind words. I wish him a very happy birthday.

The hon. Gentleman spoke passionately about his constituency, as he always does, and he raised a number of pressing issues related to GP provision in Plymouth. I join him in thanking GPs and all the 1.3 million dedicated NHS staff for how they coped with increased demand on services over a challenging winter. The Government will continue to give the NHS all the additional support it needs over winter to ensure that patients continue to receive high-quality care.

The Government recognise the vital role primary care plays at the heart of our NHS, but a growing and ageing population, and increasing numbers of patients with long-term conditions, are putting strain on the system and adding to the challenges we face in recruiting and retaining GPs. Those real pressures can affect the quality of care that patients receive. We fully recognise those huge challenges, which is why we have made primary care a clear priority.

I will set out the significant measures that we are taking to support and reinvigorate general practice, which will improve GP services for patients across England, including the hon. Gentleman’s constituents. In 2015, we set an ambitious target to recruit 5,000 more GPs. That is challenging, but it is vital to ensure that we have more GPs in the NHS, so we remain committed to delivering that commitment as soon as possible. The NHS long-term plan, which was published in January, made a clear commitment to the future of general practice, with primary and community care set to receive at least £4.5 billion more a year in real terms by 2023-24.

In January, we launched the new five-year GP contract, which was agreed with and widely welcomed by the profession. It will see billions of pounds of extra investment for improved access, expanded services at local practices, and longer appointments for patients who need them. We have listened to GPs about the biggest pressures they face and where we must focus to deliver reform of general practice. GPs have told us that one of the biggest pressures they face is an often unsustainable workload, which is a key reason why many dedicated GPs leave the national health service. Our new GP contract seeks to address the workload pressures that have resulted from a workforce shortfall. NHS England has committed to further expanding community-based multi-disciplinary teams and will provide funding for up to 20,000 other staff, such as physician associates and social prescribers, in primary care networks by 2023-24. Those bigger teams of staff will provide a wider range of care options for patients and free up more time for GPs to focus on their true passion—treating patients.

Another huge cause of concern for GPs has been professional indemnity. In recent years, the spiralling cost of purchasing professional indemnity cover has been a major source of stress and financial burden for GPs. That is why we addressed it in the GP contract and why just last week, on 1 April, we launched the new state-backed clinical negligence scheme for general practice. That brings a permanent solution for indemnity costs and coverage and includes all staff delivering primary medical services, including out of hours. It will remove a huge cause of worry for GPs, which will help with the recruitment and retention of GPs.

As the hon. Gentleman mentioned, we are looking at how to make the general practice partnership model fit for GPs working in the NHS in the 21st century. We recognise the huge contribution that the partnership model has made over the last 70 years of the NHS, but we know that it faces huge challenges, because many GPs, like other NHS doctors, want more flexible and varied portfolio careers; perhaps they do not want the long-term financial and geographical commitments of joining a GP partnership. That is why we commissioned Dr Nigel Watson to lead an independent review of the partnership model to understand those challenges.

As part of that review, Dr Watson visited more than 25 practices around the country, some of them small and some super-partnerships. As the hon. Gentleman alluded to, Dr Watson visited areas that are experiencing the greatest difficulty in recruiting GPs, including meeting some in Plymouth. Those visits played a key role in informing the work of the review, which reported in January and made seven key recommendations about workforce, business models and risk. We are grateful to Dr Watson for his important work, and we will respond to his recommendations in due course, with a view to reinvigorating the partnership model and making it fit for the 21st century.

I have set out that general practice is a priority for the Government, but what does that mean for Plymouth, and the hon. Gentleman’s constituents? GPs know the needs of their patients best, which is why the long-term plan seeks to change the balance of how the NHS works by shifting more activity into primary and community care. That will be enabled by expanding multidisciplinary teams working within general practice.

In Plymouth, the funding linked to the new GP contract will create extra capacity, with a 25% increase in staff numbers expected over the next five years across Devon as primary care networks employ pharmacists, physician assistants, physiotherapists, paramedics and social prescribers. I commend the valuable work being undertaken in Plymouth to open a network of local wellbeing hubs, aimed at giving residents easier and earlier access to health advice and support.

I understand that in a meeting with the former Health Minister, my right hon. Friend the Member for North East Cambridgeshire (Stephen Barclay), there was a specific proposal for funding to develop a hub in Plymouth city centre. I understand that following that discussion the clinical commissioning group has undertaken further work on the case for investment with the local sustainability and transformation partnership, in anticipation of the next capital funding bidding process.

I am encouraged by the number of promising local recruitment schemes that Devon CCG has put in place both to recruit more GPs and to retain those already in the workforce. I am very happy to meet the hon. Gentleman, hopefully along with my hon. Friends the Members for South West Devon (Sir Gary Streeter) and for Plymouth, Moor View (Johnny Mercer), and some GPs. Other schemes include investment in portfolio careers for GPs, supported by funding from NHS England; investment in GP coaching to support retention, and a scheme to entice those who have left the primary care workforce to return to the profession, which will launch this year. It will also offer flexible working and alternative employment arrangements.

[Luke Pollard]

Flexible working is a huge opportunity. May I ask the Minister to look also at whether flexible working schemes with acute hospital trusts, such as part-time GPs and part-time acute hospital doctors, could be included in that scheme? I think there is real merit in that.

[Seema Kennedy]

I will take that salient point away and write to the hon. Gentleman.

The CCG is also working closely with the Devon Community Education Provider Network and Health Education England to develop primary care training hubs to support GP training, as well as the broader primary care workforce. Furthermore, the targeted enhanced recruitment scheme in England—an initiative that offers a one-off payment of £20,000 to GP trainees for committing to work in a specific area—has offered 24 places in Plymouth from August 2019. I am delighted to tell the House that 22 of the 24 places have been filled ahead of schedule, which is excellent news for Plymouth. It is the second highest number of places for any one area in England.

It is important to note that, despite the difficulties that the hon. Gentleman has raised, primary care in Plymouth is improving. Provision has been reviewed by the local authority’s health scrutiny committee regularly over the last five years. Most recently, the committee concluded that it was assured that the system in Plymouth—in particular, general practice—had made substantial improvements since its last review, and that although the system was fragile, significant work was under way to address recruitment issues.

I hope that I have made it clear what an absolute priority supporting and reinvigorating primary care is for the Government. We know that there are challenges with GP recruitment and retention, and other important issues facing general practice as the hon. Gentleman has outlined. However, the commitments made in the NHS long-term plan and the significant extra funding to back them up mean that we are well placed to address them. We can anticipate real improvement and reform of general practice, ensuring better access and improved services for patients in Plymouth and across England. It is such an exciting time for me as the new Minister responsible for primary care to come in and see those new commitments begin to be put into effect, and to ensure that they are delivered. I thank the hon. Gentleman for bringing such an important matter for debate, and I wish him a very happy birthday.

Question put and agreed to.

Age-related Macular Degeneration: NHS Funding

Seema Kennedy Excerpts

Tuesday 9th April 2019 Westminster Hall

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

It is a particular pleasure to serve under your chairmanship, Mr Walker, as I respond to my first debate as the new Public Health and Primary Care Minister. I thank all hon. Members for their good wishes and reassure my officials that, although I have found my voice again, I will try not to alarm them too much.

I thank the hon. Member for Enfield, Southgate (Bambos Charalambous) for bringing this important matter forward for debate. Age-related macular degeneration—AMD—is a devastating disease that seriously affects the lives of many people, particularly older people. It is the leading cause of sight loss in the UK and affects over 600,000 people. As the hon. Gentleman outlined, the two main types are dry, or early, degeneration, and wet, or late, degeneration.

Around 75% of people with AMD suffer from dry generation. For most of them, it causes milder sight loss or even near-normal vision. Although there is currently no effective treatment for that form of AMD, its impact can be reduced with vision aids. A minority of those with dry degeneration, however, will progress to wet degeneration, which can be far more serious and threaten their vision. A number of treatments for it are available, including regular eye injections or a light treatment called photodynamic therapy.

The National Institute for Health and Care Excellence has recommended a class of drugs, anti-VEGF therapies, as the clinically appropriate and cost-effective treatments for wet AMD. Currently, there are two licensed options: Lucentis and Eylea. As such, NHS commissioners are legally required to fund those treatments for patients where necessary to comply with NICE’s recommendations. NICE is currently considering whether to examine a further drug, brolucizumab, for treating AMD and recently consulted stakeholders on the suitability of referral to its technology appraisal work programme, and a decision will be taken shortly.

There is some dispute about whether nutritional therapy and a healthy diet high in antioxidants, or the prescription of supplements, can assist with the management of AMD. NHS England has advised me, however, that it has informed CCGs not to prescribe lutein or antioxidants to patients with AMD, as evidence suggests that those treatments have low clinical effectiveness.

Although we have some effective treatments for AMD, we do not rest on our laurels. Medicines continue to evolve, and we continue to look for better treatments to improve outcomes for people living with AMD. The Department provides significant funding for medical research, mainly through the National Institute for Health Research. NIHR welcomes funding applications for research into any aspect of human health, including AMD. It is important to set out some of the ways in which NIHR engaged in advancing learning in that area and is funding research.

In 2017-18, the total spend by NIHR for eye-related research was just over £20 million. That covered a wide range of studies and trials, including research relating to AMD. In that year, the NIHR clinical research network supported 38 clinical studies and trials related to the treatment and care of people with AMD and other retina-related conditions. Since 2014, NIHR has provided £9.6 million for seven research grants and awards related to AMD, including five health technology assessment studies.

I pay tribute to the excellent work of the NIHR Moorfield Biomedical Research Centre, which is a partnership between Moorfields Eye Hospital, with its unique clinical resources that support over half a million patient visits per year, and the University College London Institute of Ophthalmology, which is one of the largest and most productive eye research institutions. The partnership was awarded £19 million over five years from April 2017. It is now conducting a wide range of ground-breaking biomedical research on AMD through several of its research themes, which will ultimately translate into significant improvements in the treatment, diagnosis and management of people with eye diseases.

Prevention is an absolute priority, both for me as the new Minister for Public Health and Primary Care, and for the Secretary of State, as we prepare to publish our prevention Green Paper later this year. At the heart of the NHS long-term plan that was published earlier this year is the idea that prevention is better than cure. AMD is one of the top four causes of sight loss, alongside glaucoma, diabetic retinopathies and cataracts. All of those conditions are most prevalent in older people and we know that, once lost, vision is especially hard to restore. The Royal National Institute of Blind People suggests that 50% of cases of blindness and serious sight loss could be prevented if they were detected and treated earlier. Research shows that almost 2 million people in the UK are living with sight loss, which is vision less than six out of 12. As the hon. Member for Enfield, Southgate and the hon. Member for Battersea (Marsha De Cordova) mentioned, by 2020 that number is predicted to increase by 22% and to double to 4 million people by 2050. Those increases are due mainly to an ageing population. Eye health will be particularly relevant to these matters, given that more than 80% of sight loss occurs in people aged over 60.

I pay tribute to Galloway’s, a charity in my constituency that does amazing work with people on sight loss. My hon. Friend the Member for Tonbridge and Malling (Tom Tugendhat), who is no longer in his place, also mentioned the Kent Association for the Blind in this capacity.

[Marsha De Cordova]

I thank the Minister for giving way. She is picking up on some really important points. She talks about prevention, but there is a national need for a vision strategy. We cannot have prevention in isolation, nor living with sight loss in isolation. Everything needs to be joined up. Does the Minister agree that it is now time for a vision strategy to be part of the long-term NHS plan?

[Seema Kennedy]

I will respond to the question that the hon. Lady raised in her intervention later on in my remarks. We know that regular sight testing can lead to early detection of these conditions. In his capacity as chair of the all-party group, the hon. Member for Strangford (Jim Shannon) referred to the importance of regular eye tests, given that, combined with early treatment, they can prevent people from losing their sight. That is why we continue to fund free sight tests for people over 60 and, alongside NHS England, are fully supporting the aims of the UK Vision Strategy to improve the eye health of people in the UK. A mark of the priority that the Department places on eye health is the inclusion in the Public Health Outcomes Framework of an indicator of the rate of avoidable blindness, both as a headline measure and by main cause, to highlight and track the direction of travel at national and local level.

The hon. Member for Enfield, Southgate has raised a number of wider important issues for the eye care sector. Many of those were highlighted in the report from the all-party parliamentary group on eye health, “See the Light”, which was published last summer. The Department welcomes this report and, along with NHS England, is carefully considering the key recommendations.

The hon. Gentleman said that eye clinic capacity was insufficient. I of course share any concerns about delays to treatment. National guidance is clear that all follow-up appointments should take place when clinically appropriate, and patients should not experience undue delay at any stage of their referral, diagnosis or treatment. To help address that issue, two key initiatives—“Getting it Right First Time”, led by NHS Improvement, and the elective care transformation programme, led by NHS England—have been set up to consider what can be done to ensure that patients do not suffer unnecessary delays in follow-up care. My Department is following that work closely.

The hon. Gentleman also asks that we establish a national target to ensure that patients requiring follow-up appointments are seen within a clinically appropriate time. As I am sure he will appreciate, the intervals for follow-up appointments will vary between different services or specialties, and between individual patients, depending on the severity of their condition. That is why all follow-up appointments should take place when clinically appropriate. For patients who require further planned stages of treatment after their “referral to treatment” waiting time clock has stopped, treatment should be undertaken without undue delay and in line with when it is clinically appropriate and convenient to the patient to do so.

The hon. Gentleman and the hon. Member for Battersea both raised the matter of a national eye health strategy. The Department takes sight loss very seriously. We are working with NHS England to ensure that the commissioning and development of eye services are of high quality and sustainable. I look forward to meeting the hon. Lady to discuss all matters relating to vision and sight loss.

CCGs are responsible for commissioning all secondary care ophthalmology services, and are also available to commission primary care services such as minor eye services and monitoring, in the community, to meet identified need. It is therefore right that the planning and commissioning of high-quality eye care services that meet the needs of the local population should happen locally, not at a national level.

The hon. Member for Enfield, Southgate, also referred to the national ophthalmology database, and asked that it be expanded to collect data on AMD. Data is currently collected on cataracts as part of a five-year programme funded by NHS England. I understand that at an earlier stage the programme funding panel considered expanding the focus, but decided that the focus should remain on cataracts in that time-limited audit.

I recognise the hon. Gentleman’s concerns and thank him for raising the matter. We are working incredibly hard, alongside NHS England, Public Health England and other partners, to ensure that eye care policy is focused both on preventing disease and, where disease develops, on ensuring that there are high-quality, sustainable eye care services for people across the country. I hope that the significant focus on effective treatment, prevention and AMD research that I have outlined means that he can reassure his constituents that we take AMD incredibly seriously. Maintaining good vision throughout life is of the utmost importance, especially as we grow older.

[Jim Shannon]

It might be helpful to give the Minister the report of the inquiry by the all-party parliamentary group on eye health and visual impairment. Perhaps she would agree to meet the officers of the all-party group, so that they can advance that case.

[Seema Kennedy]

I very much look forward to reading the report of the APPG that the hon. Gentleman chairs, and to sitting down with him in due course.

My Department remains committed to preventing sight loss and to ensuring that anyone and everyone living with AMD has access to the very best treatment and support.

Question put and agreed to.

NHS and Social Care Funding

Seema Kennedy Excerpts

Wednesday 11th January 2017 Commons Chamber

[Jonathan Ashworth]

I will give way in a few moments. Sir Bruce continued:

“I do not consider that there is a case for changing the 4 hour standard at this time.”

Does the Secretary of State still agree with Bruce Keogh? If he does, why did he make his remarks on Monday about needing to have a discussion about the future of the A&E standard?

[Seema Kennedy (South Ribble) (Con)]

rose—

[Jonathan Ashworth]

I will give way in a few moments. If the Secretary of State wants to lead a discussion about the future of the four-hour A&E standard, will he tell us what discussions he has had with the Royal College of Emergency Medicine? It argues that the four-hour standard is a vital measure of performance and safety, and believes the standard should apply to at least 95% of all patients attending emergency departments. If he says he is still committed to that four-hour standard, is he still committed to maintaining it at 95%?

--- Later in debate ---

[Jonathan Ashworth]

I will give way in a few moments.

Does the Secretary of State agree that the four-hour standard is a reasonable proxy for patient safety? Does he agree that every breach of the four-hour standard can be regarded as a potentially elevated risk?

[Seema Kennedy]

rose—

[Jonathan Ashworth]

I will give way to the hon. Lady, as she has been very persistent.

[Seema Kennedy]

If the hon. Gentleman were to read the Government amendment, he would see that the Secretary of State says he “supports and endorses” the 95% target for A&E waiting times.

[Jonathan Ashworth]

I pay tribute to the hon. Lady for the work she is doing on tackling loneliness. I know that all Labour Members very much appreciate the work she is doing on that, along with my hon. Friend the Member for Leeds West (Rachel Reeves). The Government amendment is conspicuous in not referring to all patients.

The Secretary of State did distinguish between “urgent” and “minor”—[Interruption.] The hon. Member for Beverley and Holderness (Graham Stuart) says I should get a haircut. Did he say that? No? I beg his pardon, but he heckles so much it is sometimes difficult to hear what he is saying. Can the Secretary of State tell us how he would define the difference between urgent and minor care for instances relating to this four-hour standard? Can he tell us what will be the minimum severity of physical injury or other medical problem which will be needed for a patient to qualify for access to an A&E? How will we determine these new access standards? How quickly will they be available? Will patients with visible injuries be exempt from a new triage system? If so, which injuries will qualify? If the Secretary of State is not moving away from this four-hour standard, he needs to clarify matters urgently, because the impression has been given that he is doing so. [Interruption.] Not by me, but by his own remarks in the House on Monday. If he is not moving away from that standard, will he guarantee that he will not shift away at all from it throughout this Parliament and that it will remain at its current rate?

Mental Health and NHS Performance

Seema Kennedy Excerpts

Monday 9th January 2017 Commons Chamber

[Seema Kennedy (South Ribble) (Con)]

Does my right hon. Friend acknowledge the damaging effect that loneliness can have on mental health, and will he join me in welcoming the launch of the Jo Cox loneliness commission at the end of this month?

[Mr Hunt]

I am happy to do that and to acknowledge the importance of this issue. The latest figures I have seen are that 5 million older people say that their main form of company is the television, which is not acceptable, and we all have a responsibility to do better. It is not just a moral but a practical issue, as loneliness makes people more likely to need hospital treatment, which is of course expensive and challenging for the NHS.