Thirlwall Inquiry Update
Steve Barclay Excerpts(6 months, 1 week ago)
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The Secretary of State for Health and Social Care (Steve Barclay)
I am today announcing the terms of reference for the Thirlwall inquiry into the wider circumstances around what happened at the Countess of Chester Hospital, following the convictions of Lucy Letby.
When deciding to launch a statutory inquiry at the request of the families, I was clear that they must be involved in shaping its scope. I am pleased that Lady Justice Thirlwall and her team have worked closely with the families and key stakeholders to ensure that the inquiry will get them the answers that they need and that lessons are learned from these horrific events.
The inquiry will investigate three broad areas:
1. The experiences of the parents of the babies named in the indictment.
2. The conduct of clinical and non-clinical staff and management, as well as governance and escalation processes in relation to concerns being raised about Lucy Letby and whether these structures contributed to the failure to protect babies from her.
3. The effectiveness of governance, external scrutiny and professional regulation in keeping babies in hospital safe, including consideration of NHS culture.
The terms of reference have today been published on gov.uk. I have deposited copies of the terms of reference in the Libraries of both Houses.
The inquiry’s work will now be a matter for the judge. Lady Justice Thirlwall has indicated that she does not currently intend to appoint a panel to support her in this work, though the appointment of an assessor will be kept under review. I will ensure that the inquiry has the resources it needs to carry out this important work and to continue to support the families.
I know Lady Justice Thirlwall and her team will undertake the inquiry thoroughly and as swiftly as possible.
[HCWS1078]
Oral Answers to Questions
Steve Barclay Excerpts(6 months, 1 week ago)
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Theo Clarke (Stafford) (Con)
The Secretary of State for Health and Social Care (Steve Barclay)
The NHS long-term workforce plan sets out a path to double the number of medical school training places, increase GP training by 50% and double the number of adult nursing training places.
Theo Clarke
What steps are the Government taking to increase the recruitment of midwives, given the closure of Stafford County Hospital’s freestanding midwifery birthing unit due to shortages, and how is the Secretary of State going to ensure that all midwives are trained to deal with birth injuries to reduce risk?
Steve Barclay
My hon. Friend raises an important point, and I know she has secured a debate in the House this week to further explore these issues. She will be aware that there has been a 13% increase in the number of midwifery programme place starters since two years ago. That is alongside the £165 million added to the maternity budget since 2021 and the key increase in midwifery places in the long-term workforce plan.
Derek Twigg (Halton) (Lab)
It is obviously welcome to train and recruit as many staff as possible, but part of the problem is actually retaining the staff. We are increasingly seeing among the reasons given for leaving, particularly by nurses, their work-life balance. What is the Secretary of State doing to address that?
Steve Barclay
Just yesterday, I met leaders of the NHS Staff Council, who represent trade unions under Agenda for Change, as part of our ongoing discussions on the agreement we will reach with them, which includes working together on retention and how we address some of the challenges the workforce face.
Matt Hancock (West Suffolk) (Ind)
May I congratulate the Secretary of State on being ahead of track to hire 50,000 more nurses this Parliament, as we committed to in the 2019 manifesto? However, can I push him by asking him where he is up to on ensuring that enough staff are trained to do clinical trials, as set out in the excellent O’Shaughnessy review, and can he give us an update of where implementation of that review is up to?
Steve Barclay
I very much welcome my right hon. Friend signalling that we are ahead of the manifesto commitment not just in nurses being recruited, but in key additional roles in primary care, where the target was 26,000 and actually 31,000 have now been recruited. He is right about the importance of clinical research. The O’Shaughnessy review speeds that up and reduces the cost. It better leverages the taxpayer pound in investment from the private sector, and standardises contracts across NHS trusts to bring the time down. We are also looking at innovation in areas such as the NHS app to better empower patients to take part in clinical research trials. That ensures they are at the front of the queue in getting the latest medicine, which is exactly where we want the NHS to be.
Barbara Keeley (Worsley and Eccles South) (Lab)
The Secretary of State did not mention the increase planned in the number of physician associates. The Norfolk and Waveney integrated care system has posted:
“Got abdominal pain that isn’t going away? A Physician Associate based in your GP practice can help…They are highly skilled at diagnosing conditions”.
After the tragic case of Emily Chesterton, who was misdiagnosed after seeing a physician associate twice at a GP practice and no GP at any point, when will the lesson be learned that the NHS workforce cannot be safely expanded by this route of associates with only two years’ medical training?
Steve Barclay
All clinical roles need to have the right regulation around them, and we need to ensure that patient safety is to the fore. The hon. Lady gives a very good illustration of how the Labour party talks about reform, but not when it comes to the reform of new roles, having new roles in the NHS and having a ladder of opportunity for people to come into the NHS. Physician associates are people with masters’ degrees: these people are highly skilled. Of course, we need to get the regulation right. However, the Labour party talks about reform, but when it comes to standing up to the trade unions, it is not willing to do so, which is why, when there is an innovation such as physician associates, it wants to block it.
Paul Howell (Sedgefield) (Con)
Ian Lavery (Wansbeck) (Lab)
The Secretary of State for Health and Social Care (Steve Barclay)
We are determined to address the safety issues caused by RAAC. We are prioritising the seven worst-affected hospitals and have a fund of just under £700 million covering the four-year programme of replacement.
Ian Lavery
Can the Secretary of State tell the House how many of the hospitals where RAAC is an issue also have issues with asbestos being present? What assessment has his Department made of the impact should asbestos spores be released in a RAAC collapse?
Steve Barclay
The hon. Member raises an interesting point about asbestos, because much of the NHS estate dates from a time when asbestos was widely used. Of course, asbestos is considered safe if it is undisturbed. It is a similar issue with RAAC.
On RAAC, we are following the guidance from the Institution of Structural Engineers and monitoring it. The advice is not that all RAAC needs to be replaced; the point is that it needs to be monitored. Where there is deterioration, we have a fund of just under £700 million to tackle that. The asbestos is being monitored, as is the RAAC. We have been monitoring this since 2019 and have a four-year national programme backed up with £700 million to address issues as and when they arise.
Jonathan Gullis (Stoke-on-Trent North) (Con)
The residents of Stoke-on-Trent North, Kidsgrove and Talke would like me to place their thanks on the record to the Secretary of State for having ensured that the Haywood walk-in centre, which has RAAC present, has just received £26.5 million for a new build out-patient building, which will do a lot to improve the care of residents locally. As spades are already in the ground, will the Secretary of State commit to coming to visit so that we can show off this fantastic progress?
Steve Barclay
It is always a pleasure to visit my hon. Friend’s constituency. He highlights a good illustration of how the national programme is working, backed with that £700 million of funding. We are closely monitoring the estate and, where RAAC mitigation is required, that work is taking place. He brings a good example of that to the House’s attention.
Karin Smyth (Bristol South) (Lab)
Not only are the hospital buildings crumbling after 13 years of neglect, creating huge capacity challenges; it seems that those still standing do not have enough beds. As we heard from The Times this morning, the number of
“hospital beds…has fallen by almost 3,000 since ministers promised 5,000 before winter”.
It feels pretty much like winter to me. Is that just another broken promise?
Steve Barclay
First, we have got more than £1 billion of investment in an additional 5,000 permanent beds going into the NHS estate as part of our urgent and emergency care recovery programme. More widely, the Government are committed to the biggest ever investment in the NHS estate, backed with more than £20 billion—the biggest of any Government. Of course, we will not take lectures from Labour, which bequeathed the NHS the consequence of expensive private finance initiative deals that many trusts are still paying for to this day.
Patrick Grady (Glasgow North) (SNP)
Suzanne Webb (Stourbridge) (Con)
The Secretary of State for Health and Social Care (Steve Barclay)
We are making the most significant public health intervention in a generation by creating a smoke-free generation. To put that in context, every five cigarettes a day increases the risk of stroke by 12%. We are also rolling out free blood pressure checks to people over 40 in community pharmacies, which will help to detect much earlier thousands more people living with high blood pressure.
Suzanne Webb
I thank the Secretary of State for that answer. Many commercial infant and toddler foods are ultra-processed, which sets alarm bells ringing as ultra-processed food is strongly associated with cardiovascular diseases and 40% of 10 to 11-year-olds are obese. I strongly believe that parents are being misled by companies that put health claims on ultra-processed infant food, when in fact the food is anything but healthy—it is high in fat, salt and sugar. What steps are the Government taking to address the disingenuous and grossly misleading marketing and labelling of commercial infant and toddler food and drink?
Steve Barclay
As my hon. Friend knows, there is no agreed definition for ultra-high processed food. As a general principle, I do not think we should be taxing and banning things—smoking is an outlier. We have to empower the patient and recognise the pressures from the cost of living. We are also rolling out anti-obesity drugs to give patients access to the most innovative drugs as part of our wider response to the challenge of obesity.
Andrew Bridgen (North West Leicestershire) (Reclaim)
What is the Secretary of State’s view of the worrying trend of increased cardiac-related deaths in the UK and around the world since 2021, which correlates closely with the roll-out of the experimental mRNA vaccines?
Steve Barclay
It is always important to follow the science. That is why, at the G20, Health Ministers agreed to look at the various research being done in multiple countries, particularly on long covid but also on the lessons from that period, to ensure that research from that period is shared internationally so we can learn best practice from other countries as well as within the NHS.
Tim Farron (Westmorland and Lonsdale) (LD)
The Secretary of State for Health and Social Care (Steve Barclay)
Our primary care recovery plan supports GP practices in addressing the 8 am rush for appointments, cutting bureaucracy for GPs and expanding community pharmacy services. We have recruited over 31,000 additional primary care staff and have over 2,000 more doctors working in general practice, compared with before the pandemic.
Mr Dhesi
People are finding it nigh-on impossible to see their GP when they need to. Labour has pledged to guarantee face-to-face appointments when people want them by training more NHS GPs but, as my constituents point out to me, under the Tories, a two-tier healthcare system is emerging where some are forced to pay to be seen quicker while those that cannot afford it are left behind in agony. Why have the Conservatives broken their promise, made in 2019, to deliver 6,000 more GPs, and when will this GP crisis finally be resolved?
Steve Barclay
There is a two-tier approach within the UK, between what is going on with the NHS in Wales and what is going on in England. We have more appointments, more staff—over 2,000 more doctors and over 31,000 additional roles—and more tech, with £240 million invested in delivering the digital telephony and the online booking system so that we can get patients to the right level of care with an appointment as part of our commitment to 50 million more appointments in primary care.
Rob Butler
In my constituency of Aylesbury we have some absolutely fantastic GPs and some brilliant services being delivered, thanks in part to many of the policies that have been introduced under this Government. I thank my right hon. Friend for continuing with that. However, there are still challenges for constituents to get through to their GP surgery to make an appointment in the first place. He has just mentioned digital telephony. Could he update the House on the progress that is being made on rolling out this technology to health centres to end the incredibly frustrating waits that people have, sometimes being on hold on the phone for hours at a time?
Steve Barclay
Through that £240 million, we have 100% adoption from GP practices that want to take part in receiving those funds and putting digital telephony in place if they have not already done so. This includes call-back, which allows people to know where they are in the queue, and links to online booking, which allows us to maximise the 31,000 additional roles that we have put into primary care so that people can see the specialist that they need. In my hon. Friend’s own integrated care board, appointments for July increased from 768,000 last July to 816,000 this July, so more patients are being seen, more appointments are taking place and more tech investment is going into the practices in his area.
Wes Streeting (Ilford North) (Lab)
To listen to the Secretary of State, you would think it was all going so well, so let me give him a reality check. In Tamworth last year, only a third of patients said it was easy to get through to their doctor on the phone, one in three GP appointments were not conducted face to face and fewer than half of patients were offered a choice of appointment. The Government are not listening to the people of Tamworth. Perhaps the Secretary of State would like to explain to the people of Tamworth why, after 13 years of Conservative Government, this is the case, and better still, adopt Labour’s plan to cut red tape, incentivise continuity of care and bring back the family doctor.
Steve Barclay
I am glad that the hon. Gentleman raised GPs in Tamworth. The GP lead for the Doctors Association said that his plans for general practice filled them with despair, and his proposal for GP nationalisation was mocked by the Nuffield Trust, one of the respected think-tanks. The reality is that this Government are investing in more tech in primary care, have recruited 31,000 additional roles into primary care and have over 2,000 more doctors working in primary care than before the pandemic. Those are the facts. His plans have been mocked by respected think-tanks because he talks a good game on reform but we know that he will never stand up to the trade unions.
Luke Hall (Thornbury and Yate) (Con)
Aaron Bell (Newcastle-under-Lyme) (Con)
The Secretary of State for Health and Social Care (Steve Barclay)
First, may I welcome Opposition Front-Bench Members to their new roles, as there have been changes since we last met? Since then, we have launched a new £30 million fund to speed up the adoption of tech across the NHS. Even when local pilots prove their effectiveness, it often takes too long for those innovations to be rolled out nationally. This fund can change that, giving integrated care systems across England the chance to invest in tech that is proven to improve care, for instance in detecting cancer sooner. These investments will be made this financial year, getting patients care faster. We are also making more than 200 more medical school places available for universities from next September, accelerating a commitment that we made in the NHS long-term workforce plan and delivering more doctors to areas that need them most.
This Government are listening to patient voices too, particularly on the importance of biological sex in healthcare. That is why, following a consultation later this year, we will amend the NHS constitution to make sure that we respect the privacy, dignity and safety of all patients. The Prime Minister has also unveiled plans to introduce a new law to prevent children who turn 14 this year from ever legally being sold cigarettes, creating the first smokefree generation. Last week, my Department launched an expedited consultation to crack down on youth vaping.
Aaron Bell
I thank the Secretary of State for his statement, particularly what he said about tech. On dental provision, I recently met with Dr Khan of Westbury Park dental practice in my constituency to discuss access to NHS dentistry, which is becoming more difficult for many of my constituents. I welcome the plans we have to increase the number of dentists and I reiterate my support for a dental school at Keele University, but those plans will take time. In the short term, there is a huge backlog of overseas clinicians waiting to take the registration exam so that they can practise here. What steps is the Secretary of State taking to expedite this?
Steve Barclay
He is right that we are taking both long-term and short-term actions. A key part of the long-term workforce plan is to boost the number of dentists being trained. In the more immediate term, earlier this year we made legislative changes that give the General Dental Council the flexibility to improve the way professionals are registered, giving more flexibility in terms of the skills mix and, for example, tripling the number of people sitting part 1 this year, so that more overseas professionals can be recognised and qualified to practise in the UK.
Wes Streeting (Ilford North) (Lab)
In Mid Bedfordshire last year, 165 children—[Interruption.] I do not know why Government Members are laughing; perhaps they should listen, as it is not our party that has let down the people of Mid Bedfordshire. Last year, 165 children in Mid Bedfordshire had teeth removed due to tooth decay. Some 800 patients were forced into A&E for the same reason and 100,000 people across the region cannot get access to an NHS dentist. Instead of laughing, the Government might like to adopt Labour’s plan to provide 700,000 extra dentistry appointments every year.
Steve Barclay
Since 2010, we have had 6.5% more dentists, a quarter more appointments and, as we have just touched on, increasing flexibility in regulation and boosting overseas recruitment. It is striking that one area of the country that the shadow Secretary of State does not want to talk about is Wales, which has a record of what a Labour Government will deliver. Indeed, the Leader of the Opposition says that he wants Wales to be the “blueprint” for what the NHS would be in England. There, this week, we have seen a fiddling of the figures on health. Even without that fiddling, we know people are twice as likely to be on a waiting list in Wales as in England—
Mr Speaker
Order. One of us has got to sit down and it is not going to be me. I let you have a good crack at the beginning, Secretary of State. Your opening statement took quite a long time, which I do not mind. I do not mind your having a go about Wales, but I am certainly not going to open up a debate between the Government and Opposition Front Benches. Topical questions are for Back Benchers and about short questions with short answers. I want it to be kept that way, so please understand that. There must be too many by-elections, because Members are getting carried away.
Wes Streeting
It is not just Mid Bedfordshire. Across the country, the No.1 reason children aged six to 10 are admitted to hospital is tooth decay. Given that, will the Secretary of State at least adopt the modest measure that Labour has proposed to introduce national supervised tooth brushing for small children—low cost, high impact—to keep their teeth clean and keep children out of hospital?
Steve Barclay
We are reforming the NHS workforce more fundamentally, looking at how we expand the roles that dental hygienists and dental therapists can perform. We are looking at how we can boost training, which is why we have made the commitment for more dentists in the long-term workforce plan, backed by £2.4 billion. How does that help? It increases the number of dentists being trained and we have a quarter more activity compared with last year.
Philip Dunne (Ludlow) (Con)
Amy Callaghan (East Dunbartonshire) (SNP)
New research by UNICEF UK has made clear how badly the cost of living crisis has hit the mental health of families with young children. Rising prices and services gutted by austerity have left 60% of parents feeling overwhelmed, anxious, unsupported and lonely all or most of the time. What representations has the Secretary of State made to his Cabinet colleagues ahead of the upcoming autumn statement to support families and to improve health outcomes?
Steve Barclay
That shows just how divorced the SNP line of questioning is from the reality of funding. The funding for mental health is £2.3 billion more this year than it was four years ago. We are funding 160 mental health crisis cafés and we have a programme of mental health support teams being rolled out in our schools, all of which is subject to Barnett consequentials on which the Scottish Government receive money. This Government are committed to investing in mental health. That is what we are doing. The question for the Scottish Government is why they are not getting the same results that we are.
Suzanne Webb (Stourbridge) (Con)
Clive Lewis (Norwich South) (Lab)
I was going to ask a question about the shocking statistic of 85,000 people on the waiting list at Norfolk and Norwich University Hospital, but so poor was the Secretary of State’s response to the question of my hon. Friend the Member for Ilford North (Wes Streeting) about the dental desert that I will tell him a quick story. Ukrainian refugees who come to my constituency are travelling back to war-torn Ukraine to have their teeth seen to because there is a better dental service there than in Norfolk and Norwich. What does he have to say to that?
Steve Barclay
As I have said, we have 6.5% more dentists now than when we came to power. There is also a quarter more dental activity this year compared with last year. I understand why the hon. Gentleman does not want to talk about the investment that we are making on the elective programme in Norfolk, because it includes funding for two new hospitals in Norfolk through our new hospitals programme and significant funding into diagnostic capacity, with a number of diagnostic centres being opened in Norfolk, which he does not want to mention.
Matt Vickers (Stockton South) (Con)
Rachael Maskell (York Central) (Lab/Co-op)
Ten years on from the Francis report, the National Guardian’s Office—for freedom to speak up—reports that last year there were 937 cases where whistleblowers were not listened to and experienced detriment. If we add that to 170,000 complaints, with 30,000 reaching the Parliamentary and Health Service Ombudsman, we can see that the complaints system across the NHS is defensive and dangerous. Will the Secretary of State review the NHS complaints system, and embed a listening and learning culture and early intervention?
Steve Barclay
I discussed this with Henrietta Hughes, the patient safety champion, just yesterday as part of the sprint that we have commissioned in the Department in response to Martha’s rule. We are doing considerable work with NHSE colleagues on how we better respond to the concerns of patients, whether it is through the work on Martha’s rule or the complaints process, and a significant amount of work is ongoing as part of that.
Mr Philip Hollobone (Kettering) (Con)
Steve Barclay
Yes I will. I pay tribute to my hon. Friend for the way he has championed this issue. I have visited the hospital; I have seen it for myself. As he will be aware, the full business case was received by the Department this morning. While the cost has increased, it is still within the wider funding envelope for the scheme on that site and I will do everything I can to expedite the process as he asks.
Paula Barker (Liverpool, Wavertree) (Lab)
In recent months, there was a concerted campaign from the public to prevent the closure of Park View Medical Centre in Liverpool, which was subsequently closed by the Merseyside and Cheshire integrated care board. Not long after the conclusion of the campaign, during which members of the public were turning up to board meetings, the ICB announced that 50% of its meetings would now be held exclusively in private. I for one do not believe that that is a coincidence. What would the Secretary of State’s advice be to Merseyside and Cheshire ICB on transparency and accountability, and is it not time we looked at strengthening the guidance?
Steve Barclay
The hon. Lady raises an important point. I was not aware of that decision by the local ICB. As a principle, I think we can agree across the House that greater transparency on such meetings is important, so I will follow up on that. The Government are making significant investment into Merseyside; both Alder Hey Children’s Hospital and the Royal Liverpool University Hospital have been rebuilt at significant cost as part of this Government’s commitment to investing in the NHS estate in that area.
Chris Loder (West Dorset) (Con)
Steve Barclay
I am happy to join my hon. Friend; indeed, I am sure the whole House is happy to pay tribute to the exemplary public service Mr Warrender has provided, both in the Royal Navy and with the ambulance trust, and to wish him a very happy retirement.
Daisy Cooper (St Albans) (LD)
Immunocompromised patients are facing their fourth winter without adequate protection from covid, despite a new study showing that they now comprise approximately 25% of all covid hospitalisations, intensive care unit admissions and deaths. In the last few days, some hospitals have been giving guidance to their staff that they should not even test for covid unless they are working on specific wards. After three and a half years, what are the Government going to do to put an end to this appalling situation, where some of the most clinically vulnerable patients are scared of accessing the healthcare they need for fear it could literally be a death sentence?
Steve Barclay
During the pandemic, as the hon. Lady knows, the Government prioritised the clinically extremely vulnerable and significant investment went in there. We follow the guidance from the UK Health Security Agency about the right level of infection control. More widely, we need to look at what medicine is effective. If it relates to immunosuppressants, there was a big debate in summer 2022 about that issue and we keep the science under active review.
John Penrose (Weston-super-Mare) (Con)
Judith Cummins (Bradford South) (Lab)
Having 100% fracture liaison services coverage in England would prevent an estimated 74,000 fractures, including 31,000 hip fractures, over five years. Will the Minister finally commit to 100% FLS coverage across England?
Steve Barclay
In the interests of brevity, I will actively look at that issue and write to the hon. Lady about it.
Minimum Service Levels: Hospital Settings
Steve Barclay Excerpts(7 months, 1 week ago)
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The Secretary of State for Health and Social Care (Steve Barclay)
The Strikes (Minimum Service Levels) Act 2023 allows the Secretary of State to make regulations to establish minimum service levels for relevant services in the event of strike action. They must consult with such persons as they consider appropriate before making regulations. Minimum service levels aim to limit the impacts of strike action on the lives and livelihoods of the public and to strike a balance between the right of unions and their members to strike and the need for the wider public to be able to access key services during strikes.
A key priority for this Government is to ensure that our health services can continue to deliver vital services to treat and support patients at their time of need, particularly during challenging times. On Tuesday the Department of Health and Social Care launched a consultation seeking views to inform decisions on the introduction of regulations on minimum service levels in England, Scotland and Wales, to protect patient safety in key hospital-based services during strike action.
Our proposal is that most essential and time-critical hospital services should be covered by minimum service levels regulations. This consultation will help to inform decisions on whether hospital services should be covered and, if so, which services, and the appropriate minimum service levels required. The consultation will also seek views on whether any health services outside ambulance services and hospital services should be included in minimum service levels.
The consultation will run for eight weeks and will close on 14 November 2023.
Copies of the consultation will be deposited in the Libraries of both Houses.
[HCWS1046]
Countess of Chester Hospital Inquiry
Steve Barclay Excerpts(7 months, 3 weeks ago)
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The Secretary of State for Health and Social Care (Steve Barclay)
With permission, Mr Speaker, I would like to make a statement on the inquiry into the circumstances surrounding the crimes of Lucy Letby.
On 18 August, as the whole House is aware, Letby was convicted of the murder of seven babies and the attempted murder of six others. She committed these crimes while working as a neonatal nurse at the Countess of Chester Hospital between June 2015 and June 2016. As Mr Justice Goss said as he sentenced her to 14 whole life orders, this was a
“cruel, calculated and cynical campaign of child murder”
and a
“gross breach of the trust all citizens place in those who work in the medical and caring professions.”
I think the whole House will agree it is right that she spends the rest of her life behind bars.
I cannot begin to imagine the hurt and suffering that these families went through, and I know from my conversations with them last week that the trial brought these emotions back to the surface. Concerningly, that was exacerbated by the fact the families discovered new information about events concerning their children during the course of the trial.
Losing a child is the greatest sorrow any parent can experience. I am sure the victims’ families have been in the thoughts and prayers of Members across the House, as they have been in mine. We have a duty to get them the answers they deserve, to hold people to account and to make sure lessons are learned. That is why, on the day of conviction, I ordered an independent inquiry into events at the Countess of Chester Hospital, making it clear that the victims’ families would shape it.
I arranged with police liaison officers to meet the families at the earliest possible opportunity to discuss with them the options for the form the inquiry should take, and it was clear that their wishes are for a statutory inquiry with the power to compel witnesses to give evidence under oath. That is why I am confirming this to the House today.
The inquiry will examine the case’s wider circumstances, including the trust’s response to clinicians who raised the alarm and the conduct of the wider NHS and its regulators. I can confirm to the House that Lady Justice Thirlwall will lead the inquiry. She is one of the country’s most senior judges. She currently sits in the Court of Appeal, and she had many years of experience as a senior judge and a senior barrister before that. Before making this statement, I informed the victims’ families of her appointment, which was made following conversations with the Lord Chief Justice, the Lord Chancellor and the Attorney General.
I have raised with Lady Justice Thirlwall the fact that the families should work with her to shape the terms of reference. We hope to finalise those in the next couple of weeks, so that the inquiry can start the consultation as soon as possible. I have also discussed with Lady Justice Thirlwall the families’ desire for the inquiry to take place in phases, so that it provides answers to vital questions as soon as possible. I will update the House when the terms of reference are agreed and will continue to engage with the families.
Today, I would also like to update the House on actions that have already been taken to improve patient safety and identify warning signs more quickly, as well as action that is already under way to strengthen that further. First, in 2018, NHS England appointed Dr Aidan Fowler as the first national director of patient safety. He worked with the NHS to publish its first patient safety strategy in 2019, creating several national programmes. Those included requiring NHS organisations to employ dedicated patient safety specialists, ensuring that all staff receive robust patient safety training and using data to quickly recognise risks to patient safety. Last summer, to enhance patient safety further, I appointed Dr Henrietta Hughes, a practising GP, as England’s first patient safety commissioner for medicines and medical devices. Dr Hughes brings leaders together to amplify patients’ concerns throughout the health system.
Secondly, in 2019, the NHS began introducing medical examiners across England and Wales to independently scrutinise deaths not investigated by a coroner. Those senior doctors also reach out to bereaved families and find out whether they have any concerns. All acute trusts have appointed medical examiners who now scrutinise hospital deaths and raise any concerns they have with the appropriate authorities.
Thirdly, in 2016, the NHS introduced freedom to speak up guardians, to assist staff who want to speak up about their concerns. More than 900 local guardians now cover every NHS trust. Fourthly, in 2018, Tom Kark KC was commissioned to make recommendations on the fit and proper person test for NHS board members. NHS England incorporated his review findings into the fit and proper person test framework published last month. It introduced additional background checks, the consistent collection of directors’ data and a standardised reference system, thus preventing board members unfit to lead from moving between organisations.
Finally, turning to maternity care, in 2018 NHS England launched the maternity safety support programme to ensure that underperforming trusts receive assistance before serious issues arise. Also since 2018, the Government have funded the national perinatal mortality review tool, which supports trusts and parents to understand why a baby has died and whether any lessons can be learned to save lives in the future. Furthermore, the Government introduced the maternity investigations programme, through the Health Safety Investigation Branch, which investigates maternity safety incidents and provides reports to trusts and families. In 2020, NHS England’s Getting It Right First Time programme was expanded to cover neonatal services. It reviewed England’s neonatal services using detailed data and gave trusts individual improvement plans, which they are working towards. Indeed, Professor Tim Briggs, who leads that programme, has confirmed that all neonatal units have been reviewed by his programme since 2021.
Let me now turn to our forward-facing work. We have already committed to moving medical examiners to a statutory basis and will table secondary legislation on that shortly. It will ensure that deaths not reviewed by a coroner are investigated in all medical settings, in particular extending coverage in primary care, and will enter into force in April.
Secondly, on the Kark review, at the time the NHS actively considered Kark’s recommendation 5 on disbarring senior managers and took the view that introducing the wider changes he recommended in his review mitigated the need to accept that specific recommendation on disbarring. The point was considered further by the Messenger review.
In the light of evidence from Chester and ongoing variation in performance across trusts, I have asked NHS England to work with my Department to revisit this. It will do so alongside the actions recommended by General Sir Gordon Messenger’s review of leadership, on which the Government have already accepted all seven recommendations from the report dated June last year. This will ensure that the right standards, support and training are in place for the public to have confidence that NHS boards have the skills and experience needed to provide safe, quality care.
Thirdly, by January all trusts will have adopted a strengthened freedom to speak up policy. The national model policy will bring consistency to freedom to speak up across organisations providing NHS services, supporting staff to feel more confident to speak up and raise any concerns. I have asked NHS England to review the guidance that permits board members to be freedom to speak up guardians, to ensure that those roles provide independent challenge to boards.
Fourthly, the Getting it Right First Time programme team will launch a centralised and regularly updated dataset to monitor the safety and quality of national neonatal services.
Finally, we are exploring introducing Martha’s rule to the UK. Martha’s rule would be similar to Queensland’s system, called Ryan’s rule. It is a three-step process that allows patients or their families to request a clinical review of their case from a doctor or nurse if their condition is deteriorating or not improving as expected. Ryan’s rule has saved lives in Queensland, and I have asked my Department and the NHS to look into whether similar measures could improve patient safety here in the UK.
Mr Speaker, I want to take the first opportunity on the return of the House to provide an update on the Essex statutory inquiry. In June, I told the House that the inquiry into NHS mental health in-patient facilities across Essex would move forward on a statutory footing. Today, I can announce that Baroness Lampard, who led the Department of Health’s inquiry into the crimes of Jimmy Savile, has agreed to chair the statutory inquiry. I know that Baroness Kate Lampard will wish to engage with Members of the House and the families impacted, and following their input I will update the House on the terms of reference at the earliest opportunity.
The crimes of Lucy Letby were some of the very worst the United Kingdom has witnessed. I know that nothing can come close to righting the wrongs of the past, but I hope that Lady Justice Thirlwall’s inquiry will go at least some way towards giving the victims’ families the answers they deserve. My Department and I are committed to putting in place robust safeguards to protect patient safety and to making sure that the lessons from this horrendous case are fully learned. I commend this statement to the House.
Wes Streeting (Ilford North) (Lab)
I strongly echo the sentiments of the Secretary of State and thank him for advance sight of his statement. I welcome the appointment of Lady Justice Thirlwall to lead the inquiry into the crimes committed by Lucy Letby, and I strongly welcome his appointment today of Baroness Lampard to lead the statutory review in Essex. I look forward to receiving further updates from the Secretary of State as soon as possible.
Turning to the case of Lucy Letby, there are simply no words to describe the evil of the crimes that she committed. They are impossible to fathom. Although she has now been convicted and sentenced to a whole-life order, the truth is that no punishment could possibly fit the severity of the crimes she committed. With Cheshire police’s investigation having expanded to cover her entire clinical career, we may not yet know the extent of her crimes. What we do know is that her victims should be starting a new school term today. Our thoughts are with the families who have suffered the worst of traumas, whose pain and suffering we could not possibly imagine, and who will never forget the children cruelly taken from them. We hope that the sentencing helped to bring them some closure, even though the cowardly killer dared not face them in court.
I wish to pay tribute to the heroes of this story: the doctors who fought to sound the alarm in the face of hard-headed, stubborn refusal. This murderer should have been stopped months before she was finally suspended. Were it not for the persistent courage of the staff who finally forced the hospital to call in Cheshire police, more babies would have been put at risk. I am sure the whole House will want to join me in recognising Dr Stephen Brearey and Dr Ravi Jayaram, whose bravery has almost certainly saved lives.
Blowing the whistle on wrongdoing is never easy, which is why it should not be taken lightly. Indeed, we can judge the health of an institution by the way that it treats its whistleblowers. The refusal to listen, to approach the unexplained deaths of infants with an open mind and to properly investigate the matter when the evidence appeared to be so clear is simply unforgivable. The insult of ordering concerned medics to write letters of apology to this serial killer demonstrates the total lack of seriousness with which their allegations were treated.
I welcome the fact that the Secretary of State has changed the terms of the inquiry and put it on a statutory footing. There must be no hiding place for those responsible for such serious shortcomings. It is welcome that the inquiry will have the full force of the law behind it, as it seeks to paint the full picture of what went wrong at the Countess of Chester Hospital, and it is right that the wishes of the families affected have been listened to. I welcome the fact that they will be involved in the drawing up of the terms of reference.
I ask the Secretary of State, people right across Government and people who hope to be in government to make sure that, in future, in awful cases such as this, families and victims are consulted at the outset. Can he assure the House that the families will continue to be involved in decisions as the inquiry undertakes its work?
Mr Speaker, no stone can be left unturned in the search for the lessons that must be learned, but it is already clear that there were deep issues with the culture and leadership at the Countess of Chester Hospital. This is not the first time that whistleblowers working in the NHS have been ignored, when listening to their warnings could have saved lives. Despite several reviews, there is no one who thinks that the system of accountability, of professional standards and of regulation of NHS managers and leaders is good enough.
Why were senior leaders at the Countess of Chester Hospital still employed in senior positions in the NHS right up to the point that Lucy Letby was found guilty of murder? The absence of serious regulation means that a revolving door of individuals with a record of poor performance or misconduct can continue to work in the health service. Does the Secretary of State agree that that is simply unacceptable in a public service that takes people’s lives into its hands?
The lack of consistent standards is also hampering efforts to improve the quality of management. I am sure the Secretary of State will agree that good management is absolutely vital for staff wellbeing, clinical outcomes, efficient services and, most of all, patient safety. The case for change has been made previously. Sir Robert Francis, who led the inquiry into the deaths at Mid Staffs, argued in 2017 that NHS managers should be subject to professional regulation. In 2019, the Kark review, commissioned by the Secretary of State, called for a regulator to maintain a register of NHS executives, with
“the power to disbar managers for serious misconduct”.
In 2022, the Messenger review commissioned by the right hon. Member for Bromsgrove (Sajid Javid) recommended a single set of core leadership and management standards for managers, with training and development provided to help them meet these standards. We must act to prevent further tragedies, so I welcome the Secretary of State’s announcement that his Department is reconsidering Kark’s recommendation 5. Labour is calling for the disbarring of senior managers found guilty of serious misconduct, so I can guarantee him our support if he brings that proposal forward.
The Secretary of State should go further. Will he now begin the process of bringing in a regulatory system for NHS management, alongside standards and quality training? Surely we owe it to the families and the staff who were let down by a leadership team at the Countess of Chester Hospital that was simply not fit for purpose.
Finally, I know that I speak for the whole House when I say that the parents of Child A, Child C, Child D, Child E, Child G, Child I, Child O and Child P are constantly in our thoughts, as are the many other families who worry whether their children have also been victims of Lucy Letby. We owe it to them to do what we can to prevent anything like this from ever happening again. As the Government seek to do that, they will have our full support.
Steve Barclay
I thank the hon. Gentleman for the content of his response and the manner in which he delivered it. I think it underscores the unity of this House in our condemnation of these crimes, and our focus on putting the families at the centre of getting answers to the questions that arise from this case. I join him in paying tribute to those consultants who spoke up to trigger the police investigation and to prevent further harm to babies. I note the further work that the police are doing in this case, and also pay tribute to the police team, which I had the privilege of meeting. They have worked incredibly hard in very difficult circumstances in the course of this investigation.
As the hon. Gentleman said, the families are absolutely central to the approach that we are taking. That is why I felt that it was very important to discuss with them the relative merits of different types of inquiry, but their response was very clear in terms of their preference for a statutory inquiry. I have certainly surfaced to Lady Justice Thirlwall some of the comments from the families in terms of the potential to phase it. Of course, those will be issues for the judge to determine.
On the hon. Gentleman’s concerns around the revolving door, clearly a number of measures have already been taken, but I share his desire to ensure that there is accountability for decisions. As Members will know, I have been vocal about that in previous roles, and it is central to many of the families’ questions on wider regulation within the NHS.
The hon. Gentleman mentioned the importance of good management. I am extremely interested in how, through this review and the steps we can take ahead of it, we give further support to managers within the NHS and to non-exec directors. The Government accepted in full the seven recommendations of the Messenger review. The Kark review was largely accepted. There was the issue of recommendation 5, which is why it is right that we look again at that in the light of the further evidence.
It is clear that a significant amount of work has already gone in. A number of figures, including Aidan Fowler and Henrietta Hughes, have focused on safeguarding patient safety, but in the wake of this case we need to look again at where we can go further, which the statutory inquiry will do with the full weight of the law. I am keen, however, that we also consider what further, quicker measures can be taken. Indeed, I have been in regular contact with NHS England to take that work forward.
Madam Deputy Speaker (Dame Eleanor Laing)
I call the Chair of the Health and Social Care Committee.
Steve Brine (Winchester) (Con)
I place on record my sympathy to the families, who have conducted themselves with the utmost dignity throughout this process and who remain in my thoughts and prayers as well. I welcome the judge-led statutory inquiry that my right hon. Friend has announced. It is the right thing to do, as are the phases of the inquiry, which prevent stuff from taking too long to move fast. As that work moves forward, and the debate rightly continues to touch on how we regulate managers working in the NHS, and remove them, I ask that Ministers remain alert to any “us and them” thinking between managers and clinicians. Surely any successful hospital trust is one team working together, so that defensive medicine is all but impossible.
Steve Barclay
I very much agree with the Chair of the Select Committee on the need for a one-team approach, and on looking at how we encourage more clinicians into management roles. We need to be clear-eyed that often some of those in management positions were already regulated, because they were in medical or nursing regulatory positions, but it is important that we consider the right approach to ensure accountability for the families. That is why NHS England will look at this further.
Samantha Dixon (City of Chester) (Lab)
Terrible crimes have been committed in the Countess of Chester Hospital in my constituency—my hospital. I thank the Secretary of State for meeting and listening to the families at the heart of this tragic case and for instituting a statutory inquiry into the circumstances surrounding these crimes. Serious questions about NHS accountability and governance have arisen that the inquiry will need to address. Given that the scope of Cheshire police’s Operation Hummingbird has now broadened, what reassurance can the Secretary of State offer my community about our hospital?
Steve Barclay
First of all, I pay tribute to the hon. Lady for the work she has done with the families and the staff in response to these terrible events. It is important that we reassure patients who are using the Countess of Chester Hospital now about the measures that have been put in place; that is why I wanted to bring to the House’s attention House the steps that have already been taken.
However, it was also striking in my discussions with family members that they were at pains to point out that some of the other staff they had been treated by in the Countess of Chester Hospital had been exceptional in their care. There were specific issues that raised very serious concerns, but the families were at pains to point out that there were other staff who had treated them extremely well. Indeed, as the shadow Health Secretary said, there were staff also raising concerns and ensuring that the police investigated. With NHS England colleagues, we are working closely with the Countess of Chester Hospital on next steps, but it is important that the measures we have taken provide reassurance about the quality of care that is available at Chester now.
Andy Carter (Warrington South) (Con)
I commend the Secretary of State on his decision to upgrade the inquiry and put it on a statutory footing, something I know many of the families wanted. I am keen to understand what steps he can take to give assurances that there is consistency in all hospitals around the UK on the freedom to speak up guardians. What steps is he taking to ensure consistency right across the NHS estate?
Steve Barclay
My hon. Friend raises an extremely important point. That is why in 2022 the guidance around the national freedom to speak up policy was strengthened —I mentioned the appointment in September 2022 of Henrietta Hughes as the Patient Safety Commissioner—and why significant work has been done on the quality of data, looking at the work for example of the getting it right first time teams, so that the data can be analysed more effectively to alert investigation.
Looking at the timeline, there are further lessons around, for example, who had visibility of the Royal College of Paediatrics and Child Health report and when. Clearly there are further lessons that we need to look at, but already the guidance, particularly on freedom to speak up, has been strengthened. Back in 2018 both the Public Interest Disclosure Act 1998 and alongside it the child death overview panel, which reviews all child deaths, were also strengthened.
Justin Madders (Ellesmere Port and Neston) (Lab)
As the Secretary of State will be aware, my constituency is served by the Countess of Chester Hospital and many of my constituents work there and are being treated there. There is no doubting the impact this case has had on the whole community, as my hon. Friend the Member for City of Chester (Samantha Dixon) has mentioned. However, as a constituency MP, when I was briefed by the management at the time the issues first emerged, I can say a very different picture was painted from the one we see today. It has been a huge concern that management involved at the time have gone on to work in other parts of the NHS, seemingly with approval from NHS England. I hope the Secretary of State will look into that and that the Kark review recommendations will finally be implemented, because there are serious lessons to be learned from what went on with the senior management.
Steve Barclay
The hon. Gentleman raises an extremely important point. It is right that we focus on that and ensure that the concerns about the revolving door are addressed. On the decision taken by my predecessor, my understanding is that the recommendations accepted from Kark were viewed as effective in addressing that—obviously, the events to which this statement relates have happened since—but I have asked NHS England colleagues in the Department to look again at testing them further in the light of the evidence that has come through from the court case in particular.
Priti Patel (Witham) (Con)
My heartfelt prayers and thoughts are rightly with the families, whose heartbreak and suffering is just unimaginable. I really welcome the tone that the Secretary of State has taken on ensuring that no stone is unturned in the quest for justice. Likewise, I thank him for the support that he has given us in Essex through the Essex mental health trust statutory inquiry that he announced just before recess—we look forward to working with Baroness Lampard on the terms of reference. Can he some provide some assurance so that the 80-plus families who did not engage with the inquiry previously come forward, give evidence and have confidence that their evidence will lead to justice for the loved ones they are missing because of what happened at the mental health trust?
Steve Barclay
I am keen to give my right hon. Friend that assurance. I know that she has personally championed —as have a number of colleagues across the House—the interests of families in Essex to ensure that they get the answers they need. Indeed, she very effectively conveyed to me the concerns about the inquiry in Essex hitherto. Our focus—I think this is an area of consensus across the House—has to be on ensuring that families get the answers that they legitimately deserve. The reason that it was proportionate to shift the Essex inquiry from a non-statutory footing to a statutory footing was the concern of the chair that there was insufficient engagement, particularly from staff but also, as my right hon. Friend just said, from families who did not have confidence in the inquiry as it was. That is why that inquiry has been strengthened and we have put in a very senior chair with experience of the Savile inquiry. I know that my right hon. Friend will be at the forefront in ensuring that the families’ voices are heard moving forward.
Mike Amesbury (Weaver Vale) (Lab)
I and my Cheshire West and Chester constituents are served by the Countess of Chester Hospital, so I welcome the inquiry’s having been put on a statutory footing, but like other hon. Members across the House, and, in particular, the families of the victims of this horrendous situation, I want to ensure that those managers who have somehow recycled themselves into leadership positions face stronger regulation and accountability. I look forward to the Secretary of State’s expanding on that.
Steve Barclay
It will not surprise the hon. Gentleman that a central concern of the families when I met them was the extent to which they felt fobbed off when concerns were raised and the ability of those managers either to continue in post or to move to new posts. I think that concern is shared across the House. It is very much central to some of the safeguards that have been put in place through the recommendations from Kark that have already been accepted. It also opens up questions about the role of boards and how we strengthen non-executive directors, the training and induction, and the other provisions that we can put in place. Of course, some of those issues are the reason we are having the inquiry, and through the statutory process, there will be the opportunity to call people to give evidence and for the judge-led inquiry to put questions on behalf of the families.
Mary Robinson (Cheadle) (Con)
I am grateful to my right hon. Friend for the statement and for the announcement of the judge-led inquiry. The shocking murders of those babies and the attempted murders of so many others have shocked the nation. A major concern for me is that managers ignored consultants who had raised serious issues. It appears that there is in some hospitals a culture of people not being listened to when they raise concerns. Dr Stephen Brearey, one of the whistleblowers in this case, says that he has been inundated with emails from people who say that they have not been listened to when they have spoken about really serious issues. I thank the Secretary of State for everything that he has said today, but does he support a strengthening of the whistleblowing legislation so that all whistleblowers know that they will be heard and protected?
Steve Barclay
To provide some reassurance to my hon. Friend, the Public Interest Disclosure Act 1998 was strengthened in 2018. Obviously, that is post the appalling events covered today, but that Act has already been strengthened. The freedom to speak up guardians have also been implemented since these events, and their role has been strengthened further in the guidance. Significant work has also been done on the role of the child death overview panel and the role of data through the Getting It Right First Time team, picking up data where there are concerns. A significant amount of work has been done on that, but of course through the inquiry, we also need to interrogate more clearly why the concerns raised by clinicians were not acted on by those in leadership positions. I am sure that is something that the judge will want to test in significant detail.
Mark Tami (Alyn and Deeside) (Lab)
I certainly welcome the Secretary of State’s change of heart on the statutory inquiry: that is vital to get the answers that all the parents deserve. It is also vital that any other parents who have concerns about the treatment of their child when Letby was working at Chester and Liverpool have those concerns fully investigated or reinvestigated by the police, so will the Secretary of State ensure that the Home Secretary provides whatever resources the police need to make that happen?
Steve Barclay
Given the gravity—the seriousness—of the cases before the House, this issue is something that all Ministers are very seized of, but I will of course relay the right hon. Gentleman’s point to the Home Secretary. From talking to the team, I know that specific funding had been allocated for that in response to the seriousness of these cases, but of course, I will relay that point to my right hon. and learned Friend.
Vicky Ford (Chelmsford) (Con)
It is impossible to imagine the depths of the grief of the families of the babies who were murdered, and it is absolutely right that we try to help them to get the truth, to find out the facts and to make sure that it does not happen again, so I thank the Secretary of State for agreeing to the statutory inquiry and making sure that the parents are involved. In the Essex case, 2,000 people lost their lives and families have waited many years for that truth, so I thank the Secretary of State for progressing with the statutory inquiry and announcing the new lead of that inquiry today. Can he put that same energy into saying that the families will be involved in the terms of reference; that those terms of reference will be agreed swiftly; and that the inquiry will have the resources it needs to get to the truth, too?
Steve Barclay
Again, my right hon. Friend raises an extremely important point. I am extremely keen that the families, as well as the Members of Parliament in Essex, are able to engage with the chair of the inquiry and to shape that inquiry.
As part of the discussion in Chester with families about the relative merits of a statutory or a non-statutory inquiry, one concern was that a statutory inquiry sometimes takes much longer, which is why the point around phasing is important. Of course, the court case itself will have established significant areas of factual information that can be used by the inquiry. I hope my right hon. Friend can see that the decision to put the Essex inquiry on to a statutory footing underscores our commitment to getting families the answers they need.
Tim Farron (Westmorland and Lonsdale) (LD)
My prayers remain with the families who live each day with the consequences of this unspeakable evil. Among the most chilling aspects of this tragic outrage was, as we have heard, the actions of trust leaders and managers, who ignored warnings and belittled whistleblowers. We have to ask ourselves how many lives could have been saved if people had been believed sooner.
I have to say that this feels horrifically similar to the failings in maternity services in my own local trust of Morecambe Bay during the 2000s, when we saw several mothers and babies needlessly lose their lives. Since then, despite the freedom to speak up measures that have been instituted across the country, I still see whistleblowers in other departments in trusts in the north-west marginalised, bullied, unfairly treated and having their careers trashed, all because it would appear there is a culture of defending the reputation of institutions rather than protecting the safety of patients. What confidence will the Secretary of State give to potential future whistleblowers that, when they speak out in order to save lives, they will not then be singled out?
Steve Barclay
Again, colleagues across the House know that protecting whistleblowers, including whistleblowers in the NHS, is something I have long championed. As I said earlier, the guidance has been strengthened, but one of the best mitigants is having much more transparency on the data, because the more transparent the data is, the more difficult it is for concerns to be ignored. There is a number of issues. We have strengthened the data. We have the freedom to speak up guardians. We need to look at whether, in Chester, if a freedom to speak up guardian were on the board, that would be the right approach. Do we need to look at whether these roles should be on the board? But significant work has already been done since these events and since Morecambe to strengthen the safeguards around speaking up and the Public Interest Disclosure Act. Alongside that, having organisations such as the Getting It Right First Time team looking at the neonatal data is a further important safety process to have in place.
Sir Robert Buckland (South Swindon) (Con)
It is difficult to imagine a more horrendous set of crimes than the ones committed by Letby, and her cowardly refusal to attend her sentence added grievous insult to the huge injury and misery she has caused to all the families. Can we put on record our thanks to the trial judge and the jury for the incredible work they did? I welcome my right hon. Friend’s commitment to a full statutory inquiry under the Inquiries Act 2005 and commend Lady Justice Thirlwall. Does he agree that it is important open justice is maintained fully so that we and the wider public can fully understand what on earth happened here, because this affects not just those families on the indictment—or the victims on the indictment—but hundreds of families across the entire region, and open justice has to be at the heart of judicial process?
Steve Barclay
First, I join my right hon. and learned Friend in paying tribute to the trial judge and the jury; it must have been a very harrowing case for them to sit on and deal with. He makes, as ever, an important point about open justice. I just have one caveat; I hope he will forgive me. It is that it is also important we get the balance right in respecting the privacy of families where that is their wish, particularly given that quite often these families will have other young children who may or may not know about aspects of this case. So it is important that we have open justice, but at the heart of our approach is ensuring that we are following the wishes of the family, and that includes respecting privacy where that is appropriate.
Rachael Maskell (York Central) (Lab/Co-op)
It is all too tragic, and my prayers are also with the families who have suffered so much over this time. It is 10 years since Sir Robert Francis’s report was published, and of course he put forward the duty of candour, yet the duty of candour of seven consultants was ignored and overridden. As a result of that, will the Secretary of State ensure there is an independent external route through which concern can be raised? Further to that, will he look at the accountability, scrutiny and supervision of clinicians throughout the health service, because the pressures on the service at the moment mean that those vital double checks are often missed?
Steve Barclay
Again, I agree. It is extremely important that we have the right levels of escalation and the right routes available to those raising concerns. I have already signalled to the House a number of safeguards that have already been put in place following various reviews, including the Francis review. Indeed, I spoke to Sir Robert about the lessons from his report, as I have with a number of other chairs in recent weeks. It is important and a number of safeguards are already in place, but of course the inquiry will look at how those fit together and whether any further steps are required.
Dr Caroline Johnson (Sleaford and North Hykeham) (Con)
I welcome the dashboard the Secretary of State has announced, which will identify outliers so that trusts that have abnormal events can be looked at, but in this particular case the fact that events were happening unexpectedly was identified, staffing analysis was done and seven consultants raised that this was a problem. They identified Lucy Letby as potentially causing this harm and they were repeatedly, repeatedly and repeatedly ignored. We also need to bear it in mind that, if they had not been ignored, some of these babies might not have died, and that is not good enough. As the Secretary of State seeks answers to how this can be prevented, I urge him to focus on three things: how he can develop clear lines of medical, nursing and managerial accountability; how he can prevent poor managers from moving from trust to trust to evade such accountability; and how, if seven consultants find themselves in a similar position in future, they can escalate beyond their trust—outside their trust—to get some attention.
Steve Barclay
A number of steps have already been taken; I am thinking, for example, of the role of medical examiners working in conjunction with the role of the coroner. Those are the sort of areas that the inquiry will look at: the roles of the coroner, the medical director, the Royal College of Paediatrics and Child Health report in 2016, who had sight of that and what action was taken, and the role of the board, including the non-exec lead, in terms of issues around patient safety. So a range of areas will be looked at, which is the whole purpose of having this inquiry. A number of steps have already been put in place, but it is important that we learn the lesson where clinicians have raised concerns and those concerns were not acted on.
Barbara Keeley (Worsley and Eccles South) (Lab)
I co-signed a letter to the Health Secretary from Salford MPs and the Salford City Mayor detailing that two senior managers from the Countess of Chester Hospital who were accused, as we have been discussing, of repeatedly ignoring warnings about Ms Letby’s actions then left that hospital and were employed or seconded to NHS trusts in Greater Manchester, including Salford Royal NHS Foundation Trust and the Northern Care Alliance. The two managers were re-employed well after the police had launched their investigation into Lucy Letby. This raises serious questions about NHS governance, HR processes, safety, risk assessment and the role of regulators, as already raised by the Labour Front Bench and my hon. Friend the Member for Weaver Vale (Mike Amesbury). I want to join our concerns from Salford with the concerns the Health Secretary says are already being expressed about the governance issues raised by the re-employment of managers at that time and ask for assurances that this will be fully explored in Justice Thirlwall’s inquiry.
Steve Barclay
The hon. Lady raises extremely important issues and I am happy to give her the assurance that these issues will be explored. NHS England is looking at that. On the concerns expressed around the regulation of managers, the chief exec of NHS England hosted a meeting last week with key stakeholders to discuss these very issues and I will of course relay to the chief exec the points she has raised.
Andrew Selous (South West Bedfordshire) (Con)
A few years ago, I was a whistleblower myself against an orthopaedic surgeon in my local hospital who was putting the same metal implant into patients’ backs whether they needed it or not. No other hospital was doing it; the specialist hospital only ever took it out. From that work, I was a parliamentary advocate with my constituent Tim Briggs for Getting It Right First Time. We pushed that for eight years before the NHS took it up, so I am pleased to hear the Secretary of State talking about it. What I discovered then was that the desire of trust management to cover things up to protect the reputation of their institution seemed to trump doing the right thing and throwing the spotlight of transparency on what was happening. What are the key reforms the Secretary of State spoke about today that will mean that will not happen in future and those brave clinicians who spoke up will be listened to in future cases like this?
Steve Barclay
The key reforms include Getting It Right First Time, the work of Professor Tim Briggs—I raised with him the issue around Chester and the fact that his team have been reviewing that data—the strengthening of the freedom to speak up guardians, the appointment of a new patient safety commissioner, the strengthening of the Public Interest Disclosure Act, the role of child death overview panels and the scrutiny they provide, and the expanded role of medical examiners, which were not in place. So significant actions have been taken, but it is right that through the inquiry we look at the specific issues raised at Chester and any further steps that are appropriate.
Mr Ben Bradshaw (Exeter) (Lab)
When I saw the list of hospitals that the former chief executive of Chester hospital went on to after the Lucy Letby case, I could tell—I speak as a former Health Minister—that it had an eerily familiar ring about it, because failed managers from previous scandals went on to at least some of the same hospitals. Why is the Secretary of State waiting for another review or for the inquiry before finally closing this revolving door and introducing independent regulation for hospital managers similar to that to which medical staff are subjected?
Steve Barclay
Just to reassure the right hon. Gentleman, it is not that we are waiting. Having discussed it with NHS England, not least in last week’s meeting looking at the Kark recommendations that were accepted and why recommendation 5 was not accepted, the view at the time was that the accepted recommendations were sufficient in addressing the concern about the revolving door. It is right that we test that, but it is also right that we get the balance right.
The right hon. Gentleman mentions concerns that certain trusts may be seen as more difficult to manage. We do not want to create an environment where people are unwilling to go to those more difficult trusts because they fear the risk that they carry. It is important that we get the right support for managers, particularly around some of the more difficult trusts to manage, alongside having the accountability. Getting that detail right requires us to work closely with NHS England and the wider NHS family. [Interruption.]
Madam Deputy Speaker (Dame Eleanor Laing)
Order. There is a lot of noise in the Chamber. People who have come in for the next piece of business are forgetting just how very serious and sombre this piece of business is. Have some thought for others.
Shailesh Vara (North West Cambridgeshire) (Con)
The Secretary of State has rightly spoken of the enormous pain and suffering of the parents in this horrific case. He will appreciate, however, that during the course of the Lucy Letby trial, they have had to relive all that pain and suffering. As the statutory inquiry progresses, that pain will be continuing for weeks and months ahead. Will the Secretary of State give an assurance to the House that in the period ahead—during the course of the inquiry and beyond—these parents will receive all the support they need to get through this ordeal?
Steve Barclay
My right hon. Friend is absolutely right about the way that the trial re-triggered a lot of pain and suffering for the families. What I found particularly powerful when talking to them was the fact that they discovered new information during the course of the trial, including harm to their children that they had not been told about hitherto. That was particularly concerning, and clearly serious lessons need to be learned from that. In terms of the support, one of the reasons for wanting to engage with them at the earliest opportunity was to ensure we are doing all we can to support them, and that is central to how I understand the judge will look to structure the inquiry to ensure that the wishes of the families are central to the approach that is taken.
Liz Saville Roberts (Dwyfor Meirionnydd) (PC)
Letby’s crimes freeze the heart, and I commend the Secretary of State for the inquiry being statutory. Although health is devolved, babies from across north Wales are regularly sent to hospitals in north-west England, including the Countess of Chester for specialist care and treatment. What assurance can the Secretary of State give to Welsh families that the statutory inquiry’s terms of reference will include cross-border patient safety and the safety of babies in hospitals possibly hours away from their families in Wales?
Steve Barclay
I am grateful to the right hon. Lady for raising that extremely important point, because the cases of five of the babies concerned in the trial were cross-jurisdictional. It is important that we take on board those lessons and look at how those cases that apply to a baby or family from Wales are captured, and I know that is something that Judge Thirlwall will give consideration to, shaped by her discussions with the families.
Luke Hall (Thornbury and Yate) (Con)
Having a child in neonatal intensive care is absolutely terrifying. A parent in that situation is completely reliant on the professionalism and compassion of the NHS staff, and that is what makes the crimes of Letby so evil and unfathomable. None of us can imagine what the families are going through right now and what they will have to relive during the course of this statutory inquiry. Can the Secretary of State give an assurance to the House that the anonymity of the families will be protected in the course of this inquiry, if they want it to be, so that they can have the privacy they need during this very difficult time?
Steve Barclay
I absolutely agree with my hon. Friend’s sentiment in putting families and their wishes central. I hope he will understand that as part of an independent inquiry, it will be for the judge to decide which hearings are held in public and which are in private. In essence, part of the initial discussion on a non-statutory inquiry and my discussion with the families was about balancing privacy concerns versus the more adversarial and public nature of a statutory enquiry. I know that Justice Thirlwall will be sensitive to the families’ wishes and what is the appropriate balance between hearings held in public and those held in private.
Dame Diana Johnson (Kingston upon Hull North) (Lab)
After all that has happened, it was surely a mistake not to implement recommendation 5 of the Kark review. Why does the Secretary of State not just get on with it and bring it in to disbar senior managers in the NHS?
Steve Barclay
The Kark recommendations that were accepted, which cover events since those covered at Chester, are believed to have addressed the concerns about the revolving door, but given the issues that have come to light through the case in Chester, I have asked NHSE colleagues to revisit that decision without waiting for the inquiry to look at that. Of course, the inquiry will also look at what is the right balance of regulation for managers.
Anna Firth (Southend West) (Con)
I wholeheartedly welcome the Secretary of State’s announcement that there will be a full, judge-led statutory inquiry into these horrifying, despicable crimes. It defies belief that senior NHS managers and leaders could have ignored the concerns of senior clinicians in the NHS for so long. I look forward to reassurance that this statutory inquiry will not hold back in holding those senior managers to account, to ensure that this does not happen in any hospital ever again.
I also welcome today’s update that the Essex NHS mental health inquiry has also moved to a statutory footing and that Baroness Lampard will chair that inquiry. Parents will be reassured to know that she is in the House listening to Members’ concerns.
Steve Barclay
I hope that my hon. Friend will note that the appointment of a Court of Appeal judge underscores the seriousness of the inquiry into the murders by Letby. The decision before the summer to place the Essex inquiry on a statutory footing again underscores our commitment to giving answers to those families in Essex, particularly where there are concerns that staff have hitherto not engaged with the inquiry in the way they need to do.
Helen Morgan (North Shropshire) (LD)
My thoughts and prayers, and those of my party, are with everyone affected by the unspeakably evil crimes of Lucy Letby. In this instance, we have had a serial killer in play, and that makes it unique, but it is clear that there have been management failings—a failure to listen to senior clinicians, and potentially even a cover-up—and that unfortunately is not a new situation for the NHS. As the MP for North Shropshire, I have seen management failings at the Shrewsbury and Telford Hospital NHS Trust, and my hon. Friend the Member for Westmorland and Lonsdale (Tim Farron) has highlighted the failings at Morecambe Bay. We have had numerous inquiries into management failures in the NHS, we have said “never again” so many times, and we are still here. How can the Secretary of State reassure parents and people being treated in the NHS that this time, when we say “never again”, we will mean it?
Steve Barclay
Again, I very much agree on the imperative of learning from the various reviews that have taken place. That is why I have personally spoken to the chairs of those reviews over recent days and weeks. I point out that these events took place before a number of the reviews’ recommendations were made and given to the Government, and those recommendations—whether on the medical examiner role, strengthening under the Public Interest Disclosure Act 1998, the use of “get it right first time” to review the data, the freedom to speak up guardians or the new patient safety commissioner role—have been implemented. So significant actions have been taken following those reviews, and those actions have been taken since these events. However, through the inquiry we will of course test whether further action is needed.
Alison McGovern (Wirral South) (Lab)
As my hon. Friends the Members for City of Chester (Samantha Dixon) and for Ellesmere Port and Neston (Justin Madders) explained, for those of us whose constituents use and work at the Countess, this has been the most dreadful time. But only those who have lost a child could even begin to understand the pain that the families have experienced. It is right that there is unanimity in this House about what is done.
Could I come back to the question asked by my hon. Friend the Member for York Central (Rachael Maskell) about duty of candour? Ten and a half years ago, I stood here in this House and listened to the now Chancellor talk about duty of candour. I am at a loss to understand how it could be that families were not entitled to every bit of information when they asked for it. What review has the Secretary of State already conducted into the effectiveness of duty of candour? What is his conclusion about what has gone wrong over the past 10 years?
Steve Barclay
As I have said, significant action has been taken over those 10 years to strengthen transparency, action taken on data and the ability of freedom to speak up guardians to ensure that more safeguards are in place. Part of the purpose of the inquiry is to test whether further action is needed. I have already asked NHS England to look again at areas where recommendations have been made and what further action we can take.
Jim Shannon (Strangford) (DUP)
First of all, I thank the Secretary of State very much for the tone and the compassion of all his answers. He has encompassed all our thoughts and emotions in a very positive way, and I thank him for that. Can he confirm that any procedural changes that come from lessons learned from this dreadful case will be shared throughout the trust areas? It is a horror that has shaken every parent, pregnant mother and midwife in every corner of this United Kingdom of Great Britain and Northern Ireland. They want to know how they can protect the most vulnerable in our society. How can Government ensure that finances do not preclude precautions being taken to protect babies and also staff on the wards? Will the inquiry’s findings be shared with all devolved Administrations?
Steve Barclay
I am happy to commit that the inquiry findings will be shared with the Administrations across Great Britain and Northern Ireland. It is important that the lessons are learned. It is also important that we look at where staff move—that includes not just within England but in Northern Ireland—and at where patients from one jurisdiction may be treated in another for a period of time. Those issues apply across the United Kingdom. We should have a UK-wide approach, including to data and looking at variation across the United Kingdom. I know that the hon. Gentleman will take a keen interest in that.
Departmental Update
Steve Barclay Excerpts(7 months, 3 weeks ago)
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The Secretary of State for Health and Social Care (Steve Barclay)
I would like to inform the House of several updates from the Department of Health and Social Care over the summer recess.
Cutting waiting times across the United Kingdom
I have offered to work with the devolved Administrations in Wales, Scotland and Northern Ireland to share lessons on how we are tackling the elective waiting list across the UK, including on where our approaches differ. For example, in England we allow patients a choice of provider—NHS or independent sector—provided they meet NHS costs and standards. I am open to considering any request from Ministers in the devolved Administrations to extend this choice to patients across the UK who are waiting for lengthy periods, building on current arrangements for UK-wide healthcare. I also believe we need to ensure that health data is made more comparable across the UK, and welcome the support of the devolved Administrations in doing so.
Major conditions strategy interim report
As the House is aware, in January I announced my intention for the Department to develop and publish a major conditions strategy. On 14 August, I set out the next steps for this work through the publication of our interim report. This report makes our case for change based on the assets and capabilities of our health and care system, and the needs of the public. It is rooted in a clear understanding of the key areas where making strategic choices over the next five years will deliver real value for the people we serve.
We will continue to work with patients and partners across the health and care system, building on our existing engagement and our call for evidence, and we expect to publish our major conditions strategy early next year.
Mandating quit information messages inside tobacco packs
Earlier this year, the Government announced a series of measures to help the country achieve becoming smoke-free by 2030. This included consulting on introducing mandatory inserts inside tobacco packs to encourage more smokers to quit. On 14 August, we launched a consultation to seek views on the introduction and design of tobacco pack inserts. Inserts provide information on the health and financial benefits of quitting, along with advice on how to quit.
Smoking remains the single leading preventable cause of illness and mortality in the UK. The draft impact assessment published alongside the consultation estimates that the inserts could lead to an additional 30,000 smokers quitting, delivering health benefits worth £1.6 billion.
Expanding capacity to support A&E
Further to our delivery plan to recover urgent and emergency care services and the record funding allocated to the NHS, I am pleased to update the House that £250 million of capital funding has been targeted to support urgent and emergency care capacity this winter.
Thirty schemes across England have received funding to create 900 beds to relieve pressure on A&E and to develop urgent treatment centres and same-day emergency care services that can avoid the need for overnight admission.
Modernising cancer waiting time standards
Following a consultation last year, clinical experts in NHS England recommended modernising and simplifying cancer waiting time standards to focus on three outcome-based standards. These standards will give clinicians greater flexibility to adopt new technologies such as remote image review and AI, and avoid disincentivising modern working practices such as one-stop shops and straight-to-test. I support these changes and will amend the relevant statutory regulations in due course.
There will be a new faster diagnosis standard of a maximum 28-day wait for communication of a definitive cancer/not cancer diagnosis for patients referred urgently or those identified by NHS cancer screening. The faster diagnosis standard, currently set at 75%, will be rising to be set at 80% in 2025-26. There will continue to be a maximum 62-day wait to first treatment from urgent GP referral, NHS cancer screening or consultant upgrade and a maximum 31-day wait from a decision to treat to any cancer treatment starting for all cancer patients. Where services have reduced their backlogs to manageable levels, focus should now be shifted back on to improving performance against the headline 62-day standard. Nationally, we are expecting to achieve 70% by March 2024.
Suicide prevention grant fund launch
On 25 August, we launched a £10 million suicide prevention grant fund to support voluntary sector organisations in helping to prevent suicide in England. Organisations can apply online for funding in 2023 to 2025.
The voluntary sector plays a crucial role in providing support to people experiencing suicidal thoughts or mental health crisis, as well as intervening early to prevent people reaching these points. This grant builds on the success of the fund from 2021-22 that supported over 100 voluntary sector organisations, helping to address demand after the covid-19 pandemic, support innovative ways to widen access to services and help identify those in need quicker.
Supporting efficiency in primary care
In our delivery plan for recovering access to primary care, we announced £240 million of support to help GP surgeries invest in new technology to end the 8 am phone line rush. I can now confirm that more than 1,000 practices in England have committed to making use of this funding to switch from analogue telephony systems to modern, easy-to-use digital telephony. We have also published new statistics on the increases in patient care staff in GP surgeries by constituency since March 2019.
Earlier this year, we published our ambitious NHS long-term workforce plan, which set out how we will invest in more staff and in reforming the way they work. We are now moving forward with our reform plans. We have launched a consultation on allowing pharmacy technicians to deliver more services and secondary legislation on dispensing in original packs has been laid before Parliament so that pharmacy staff will not need to spend time splitting boxes, snipping blisters and repackaging medicines in order to dispense the exact quantity prescribed. We have also launched a consultation on making better use of skilled dental professionals and improving access to dentistry, ahead of a dental recovery plan that is due to be announced shortly.
[HCWS1001]
Health and Social Care
Steve Barclay Excerpts(9 months, 1 week ago)
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Kate Hollern
In May last year I wrote to the then Health Secretary and the Prime Minister about the case of a young man in my constituency, Elliott Simpson, who was misdiagnosed with a water wart in a telephone consultation with a GP. When Elliott was finally able to see someone face-to-face, he found that he had late-stage skin cancer. He passed away on 28 April, aged just 27.
Between January and March this year, both the two-week wait target and the 62-day target were missed at East Lancashire Hospitals NHS Trust. Does the Secretary of State accept that delays are costing lives?
Steve Barclay
The whole House will be hugely saddened to learn of the passing of Elliott, especially at such a tender age.
The hon. Lady is right to highlight the importance of speedy diagnosis, and I was pleased that we met the faster diagnosis standard in February for the first time and again in March, with three in four patients receiving their diagnosis within two weeks and nine in 10 starting treatment within a month. She is also right to point out that there is still variation between trusts, and we are focusing on that in particular, but it is good that nationally we are hitting the faster diagnosis standard.
[Official Report, 6 June 2023, Vol. 733, c. 664.]
Letter of correction from the Secretary of State for Health and Social Care, the right hon. Member for North East Cambridgeshire (Steve Barclay):
Errors have been identified in my response to the hon. Member for Blackburn (Kate Hollern).
The correct information should have been:
Steve Barclay
The whole House will be hugely saddened to learn of the passing of Elliott, especially at such a tender age.
The hon. Lady is right to highlight the importance of speedy diagnosis, and I was pleased that we met the faster diagnosis standard in February for the first time, with three in four patients receiving their diagnosis within 28 days and nine in 10 starting treatment within a month, and virtually met it in March. She is also right to point out that there is still variation between trusts, and we are focusing on that in particular, but it is good that nationally we are hitting the faster diagnosis standard.
Doctors' and Dentists' Remuneration
Steve Barclay Excerpts(9 months, 2 weeks ago)
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The Secretary of State for Health and Social Care (Steve Barclay)
The 51st report of the Review Body on Doctors’ and Dentists’ Remuneration (DDRB), the 45th report of the Review Body on Senior Salaries (SSRB), and the 36th report of the NHS Pay Review Body (NHSPRB) are being published today. The reports will be presented to Parliament and published on gov.uk.
This is further to Staff Council accepting the offer made to “Agenda for Change” staff, which was announced to the House on 3 May 2023.
I am grateful to all the chairs and members of the DDRB, SSRB and NHSPRB for their reports. I am accepting their pay recommendations in full, recognising the vital contribution that NHS staff make to our country.
The DDRB has recommended a 6% increase to national salary pay scales, pay ranges or the pay elements of contracts for all groups included in their remit this year, with a further consolidated uplift of £1,250 for doctors and dentists in training.
The SSRB recommended a 5% uplift for very senior managers (VSMs) and executive senior managers (ESMs) for 2023-24, and that an additional 0.5% of the ESM and VSM pay bill in each employing organisation is used to address pay anomalies.
These recommendations are broadly in line with pay growth in the private sector.
Doctors and dentists
After careful consideration of the pay review body reports, we have decided to accept their pay recommendations in full. In doing so, we have committed to:
uplifting pay points for doctors and dentists in training (c. 67,000 doctors) by 6% plus £1,250 on a consolidated basis;
uplifting the salaries of consultants (c. 55,000 doctors) by 6% on a consolidated basis;
uplifting the pay range for salaried GMPs (c. 15,000 doctors) by 6% on a consolidated basis;
uplifting the pay element of the general dental practitioners contract (c.24,000 dentists) and the minimum and maximum pay scale for salaried dentists by 6% on a consolidated basis;
uplifting the pay scales of specialist and associate specialist (SAS) doctors on pre-2021 contracts (c.6,000 doctors) by 6% on a consolidated basis and uplifting the salaries of SAS doctors on the 2021 contract (c.4000 doctors) by 3% on a consolidated basis on top of the increase for 2023-24 already agreed as part of the multi-year deal.
Senior managers
After careful consideration, we have decided to accept the pay recommendations of the SSRB in full. In doing so, we have committed to:
Uplifting the salaries for VSMs and ESMs in the NHS by 5%;
Recommending 0.5% of the ESM and VSM pay bill in each employing organisation is used as a pot to address specific pay anomalies.
Additionally, the SSRB recommend that central approval or rejection of proposed VSM or ESM pay is provided within four weeks of submission of the pay case. I agree that improvements should be made to the process, but cannot accept this recommendation in full as the Department will need sufficient time to review and scrutinise any bid we receive.
All pay awards will be backdated to 1 April 2023. This pay award is only applicable to NHS staff in England. The 2023-24 pay uplift for NHS staff directly employed by NHS providers will be funded by NHS England through system allocations.
While it is right we accept the PRB recommendations, this needs to be proportionate and balanced with the manage the country’s long-term economic health. Sustained higher levels of inflation would have a worse impact on people’s real incomes in the long run, which is why we need proportionate and balanced pay increases as recommended by the independent pay review bodies.
In written and oral evidence to the pay review bodies, the Government set out what was affordable within the NHS spending review settlement. The pay review bodies have recommended pay awards above this level. This Government are committed to living within our means and delivering value for the taxpayer. More borrowing would add pressures on inflation at exactly the wrong time, risking higher interest rates and higher mortgage rates. We plan to increase the main rate of the immigration health surcharge—to ensure it covers the full healthcare costs of those who pay it, having been frozen for the last three years despite high inflation and wider pressures— to £1,035, and the discounted rate for students, their dependents, those on youth mobility schemes and under-18s to £776. We will fund this pay award through prioritisation within existing departmental budgets and will protect frontline services.
Accepting the full DDRB recommendations is the fair and reasonable way to determine pay for doctors and dentists across the country. Ongoing industrial action should now be urgently called off, to avoid any further unnecessary disruption to NHS services. We expect that the medical trade unions’ trade disputes with the Government should cease.
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Health and Social Care
Steve Barclay Excerpts(9 months, 2 weeks ago)
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Holly Mumby-Croft (Scunthorpe) (Con)
We have a superb new accident and emergency in Scunthorpe, and we are pressing ahead with plans for a large, state-of-the-art community diagnostic centre. I have lived locally all my life, and those are some of the most significant upgrades we have seen in a generation. But there are things to do—we certainly need more NHS dentists. Would the Secretary of State consider a tie-in so that newly qualified dentists spend a minimum percentage of their time delivering NHS care?
Steve Barclay
I am pleased to see those services going into Scunthorpe. That underscores the investment we are making now while preparing for the long term, through the largest ever expansion in workforce training in the NHS’s history. My hon. Friend is right about the importance of tie-ins. Let me explain why that matters in particular for dentists: around two thirds of dentists do not go on to do NHS work. That is why the plan has looked at tie-ins for dentistry, which we will explore in the weeks and months ahead.
[Official Report, 3 July 2023, Vol. 735, c. 580.]
Letter of correction from the Secretary of State for Health and Social Care, the right hon. Member for North East Cambridgeshire (Steve Barclay):
An error has been identified in my response to my hon. Friend the Member for Scunthorpe (Holly Mumby-Croft).
The correct response should have been:
Steve Barclay
I am pleased to see those services going into Scunthorpe. That underscores the investment we are making now while preparing for the long term, through the largest ever expansion in workforce training in the NHS’s history. My hon. Friend is right about the importance of tie-ins. Let me explain why that matters in particular for dentists: around one third of dentists do not do NHS work. That is why the plan has looked at tie-ins for dentistry, which we will explore in the weeks and months ahead.
Topical Questions
The following is an extract from Health and Social Care topical questions on 11 July 2023.
Steve Brine (Winchester) (Con)
Back to NHS dentistry, I am afraid. Later this week, the Select Committee will publish its report on NHS dentistry services. Spoiler alert: it will be uncomfortable reading for some. Will the Secretary of State tell us when and how he plans to bring forward plans for the tie-in of newly qualified dentists? Could that go hand in hand with a “return to the NHS” campaign for dentists who have already left that part of the service?
Steve Barclay
It is characteristically astute of my hon. Friend to zero in on the tie-in, which is an important part of the long-term workforce plan. Around two thirds of dentists do not go into NHS work after training, so having a tie-in is more pertinent there than it might be elsewhere in the NHS workforce.
[Official Report, 11 July 2023, Vol. 736, c. 174.]
Letter of correction from the Secretary of State for Health and Social Care, the right hon. Member for North East Cambridgeshire (Steve Barclay):
An error has been identified in my response to my hon. Friend the Member for Winchester (Steve Brine).
The correct response should have been:
Steve Barclay
It is characteristically astute of my hon. Friend to zero in on the tie-in, which is an important part of the long-term workforce plan. Around one third of dentists do not do NHS work, so having a tie-in is more pertinent there than it might be elsewhere in the NHS workforce.
Oral Answers to Questions
Steve Barclay Excerpts(9 months, 3 weeks ago)
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Helen Morgan (North Shropshire) (LD)
The Secretary of State for Health and Social Care (Steve Barclay)
Last year, we announced a number of reforms to the NHS dental system, making the NHS more attractive and helping patients to access care. Treatments and dental care delivered in England went up by a fifth between 2021 and 2022.
Helen Morgan
In North Shropshire, the number of adults seen by a dentist between 2019 and 2022 fell by more than 10%, from 47.5% to 35.4%, and the number of children seen by a dentist in that time has fallen by just about 10%, from 59% to 49.8%. Constituents report not being able to access a dentist, and are being turned away from their NHS dentists as they seek to take on only private work. Can the Secretary of State reassure me that he is taking steps to ensure that dentists in rural areas will continue to provide NHS services, because this healthcare problem will continue into the future?
Steve Barclay
We recognise that we need to do more. That is why we are making NHS dentistry more attractive by creating more bands of units of dental activity, having a minimum UDA value, and increasing to 110% the amount of activity that dentists can do. Indeed, Shropshire, Telford and Wrekin NHS trust, for example, was above the national average in the 24 months until June 2022. We are putting reforms in place to build more capacity.
Ruth Cadbury (Brentford and Isleworth) (Lab)
The Secretary of State for Health and Social Care (Steve Barclay)
The elective recovery plan sets out clear steps to eliminate long waits, and that is supported by £8 billion of revenue funding and £5.9 billion in capital over three years.
Ruth Cadbury
The waiting list for elective care has risen to more than 7 million people, including one constituent who is unable to work while waiting months for an orthopaedic assessment, and another who has been waiting three years for a prostate operation. Both have had to seek emergency care while they wait for an agonisingly long time. Is it not true that the longer the Conservatives stay in power, the longer patients will wait?
Steve Barclay
On the last bit of the question, the average waits in Wales are 20.4 weeks as of April, and in England they are 13.8 weeks, which is the exact opposite of the point the hon. Lady raises. We are taking action. We are boosting diagnostic capacity; 111 community diagnostic centres are now open. We are increasing treatment capacity through our surgical hubs programme. We are giving patients choice, which is not available in Wales under the Labour Administration—we are giving them more choice. We are also making better use of the independent sector, which some on the Labour Front Bench support but others do not.
Mr Mohindra
One of my constituents has now been waiting 14 months for a hysterectomy, while another waited years to receive a much-needed hip replacement. That is way over the 18-week standard set out by the NHS Constitution. Can the Secretary of State tell the House what is being done to get wait times down to that 18-week mark?
Steve Barclay
We recognise the challenges from the pandemic, and that is why we are boosting capacity, particularly through our community diagnostic centres. The additional capacity has already delivered more than 4 million extra tests and scans. We are rolling that programme out with the target of 160, and 111 are already in place.
Mr John Baron (Basildon and Billericay) (Con)
Alex Cunningham (Stockton North) (Lab)
The Secretary of State for Health and Social Care (Steve Barclay)
The hon. Gentleman raises a point of concern across the House that we recognise. That is why we have already taken action, through £3 million to crack down on those selling vapes illegally to children, closing the loophole that allowed free samples to be offered to children, and our call for evidence, so that we can examine what further measures we can take, particularly on the concerns about disposable vapes, which are prevalent among children.
Alex Cunningham
That is helpful, but Labour proposed a new clause to the Health and Care Bill that would have given the Government the primary powers needed to stop the use of sweet names such as gummy bears and Skittles, bright colours and cartoon characters on packaging and labelling of e-cigarettes. The Minister will agree that such promotion aimed directly at young people is highly unacceptable and takes us back to the worst days of cigarette advertising. If the Government are so committed to acting in this space, why did they vote down that new clause?
Steve Barclay
As I say, we have already taken action. We took measures in April, and the Prime Minister announced further measures in May. We are keen to follow the evidence. That is why we have had a call for evidence. The ministerial team are looking extremely closely at this, and we will take further action to clamp down on something that we all recognise is a risk to children, which is why we are acting on it.
Maggie Throup (Erewash) (Con)
Vapes are smoking-cessation products; they are not confectionery to be sold to children or a way of replacing one generation hooked on nicotine with another. Will my right hon. Friend update the House on the progress that the Medicines and Healthcare products Regulatory Agency has made on licensing e-cigarettes and other inhaled nicotine-containing products as medicines, which would put out a strong message that vaping is a dangerous pastime?
Steve Barclay
As a former Health Minister, my hon. Friend is well aware of the risks posed by vaping. As the chief medical officer has said,
“If you smoke, vaping is much safer; if you don’t smoke, don’t vape”.
That is why we are toughening up the regime. We are also working with industry as part of our call for evidence, but we are clear on the need to go further. That is exactly what we will do.
Steve Barclay
Again, I agree that disposable vapes are a particular concern: in our view, the growth in youth vaping is largely due to the growth in the use of disposable vapes. That is why we have particularly focused on that issue in our call for evidence, and that is what we are considering.
Daisy Cooper (St Albans) (LD)
Mrs Flick Drummond (Meon Valley) (Con)
The Secretary of State for Health and Social Care (Steve Barclay)
Last week, on behalf of the Government, I signed a landmark partnership agreement with the pharmaceutical giant BioNTech. It aims to deliver 10,000 personalised mRNA cancer immunotherapies, including vaccines, to UK patients by 2030. This work will harness the groundbreaking mRNA technology that BioNTech used in its world-first cancer vaccine. Cancer vaccines work by stimulating patients’ immune systems to recognise and eliminate cancer cells, preventing their spread. Trials for BioNTech’s colorectal cancer vaccine are under way at multiple sites across the UK. To accelerate trials further, BioNTech is partnering with NHS England’s new cancer vaccine launch pad, a platform that makes it easier for both early and late stage cancer patients to join vaccine trials. In the coming years, hundreds of patients identified by the launch pad will join trials for BioNTech’s personalised cancer therapies, broadening the treatment options available to cancer patients. I hope the whole House will welcome the opportunity the deal offers future patients.
Mrs Drummond
The announcement that a new hospital between Winchester and Basingstoke is going ahead is much welcomed by my constituents who will use it, as well as by those from other constituencies. It will provide a centre of excellence with better medical outcomes. Will my right hon. Friend meet local MPs, so we can update him on why the hospital needs to be built as soon as possible?
Steve Barclay
I am always very happy for my hon. Friend and other colleagues to meet me or Lord Markham, who leads the capital programme. It is an important scheme. We are delivering it through the standardised Hospital 2.0 approach, using modern methods of construction. We are keen to progress early supported works on site, working closely with colleagues.
Wes Streeting (Ilford North) (Lab)
Last week, the Health Secretary said that he was willing to offer doctors a higher pay rise. Last night, the Chancellor slapped him down, saying that any increased offer will have to be paid for by cuts. How can the Health Secretary negotiate an end to the NHS strikes when he cannot even negotiate with his own Chancellor?
Steve Barclay
We have been clear throughout that Government decisions on the pay review bodies’ recommendations are taken on a cross-Government basis. The agreement that we reached with the largest group of NHS staff, those on “Agenda for Change”, has demonstrated that we are willing to work constructively with trade union colleagues, but the demand from junior doctors for a 35% increase is not affordable—indeed, the hon. Gentleman himself has said that he does not support it.
Wes Streeting
But the worst strikes in the history of the NHS are still to come. The impact of the junior doctors’ strikes and the consultants’ strikes will be devastating for patients. The Secretary of State has failed to stop these strikes for seven months. He has lost the confidence of nurses, radiologists, junior doctors and consultants, and he cannot even successfully negotiate with his Chancellor, so what is his plan to stop these strikes going ahead?
Steve Barclay
The hon. Gentleman’s message is not even consistent with what he said at the weekend in the media: that he was not in a position to offer more money to the NHS, and that the shadow Chancellor had made that clear—in a vain attempt to demonstrate some sort of fiscal responsibility. The hon. Gentleman has been clear that he does not support the 35% demand from doctors in training. We are demonstrating that we are working constructively with groups such as the “Agenda for Change” group—the largest staff group, made up of over 1 million staff—with which we have reached a deal. We have also been responding constructively to the British Medical Association’s principal demand for consultants, which was for changes to pension taxation. We are willing to engage constructively with trade union colleagues, but the 35% demand is not affordable. He needs to decide on his position. Which is it: his position at the weekend that the Opposition are not offering more money, or his position today, which seems to be that they will?
Kirsten Oswald (East Renfrewshire) (SNP)
Steve Barclay
Of course we have regular discussions, not just with Cabinet colleagues, but with our counterparts across the UK. I had a meeting just yesterday with Health Ministers, including my counterpart in Scotland, on the shared challenges. On the issue that the hon. Lady raises, as the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Harborough (Neil O’Brien) said a moment ago, we are providing significant support for households—over £3,300 in support—but we also have measures that target schools, including holiday support measures and wider health and wellbeing measures, such as our significant investment in school sport.
Julian Sturdy (York Outer) (Con)
Steve Barclay
We are taking action, which is why the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Harborough met my hon. Friend recently. In his area of Humber and North Yorkshire, there has been an increase in the number of children seen by NHS dentists over the previous 12 months, so the picture is improving, but we recognise that there is more to do; that is why we have made a number of reforms to the dental contract and why we will announce further plans shortly.
Mike Kane (Wythenshawe and Sale East) (Lab)
A recent freedom of information request by the Labour party revealed that mental health patients were left waiting more than 5.4 million hours for treatment in A&E last year. Last week, one of my constituents spent five days in A&E waiting for a bed on a psychiatric ward. When will the Government bring an end to this shameful situation?
Steve Barclay
We are taking significant action on mental health, which is why we are investing £2.3 billion more, compared with four years ago. We have targeted measures as part of our urgent and emergency care recovery plan, including 100 mental health ambulances. We are putting in additional capacity, such as crisis cafés, to support emergency departments. We are also making mental health support available through 111 for the first time, which will allow us to get to issues early, before people are admitted to hospital.
Matt Vickers (Stockton South) (Con)
Marsha De Cordova (Battersea) (Lab)
Four in 10 people who visit low vision clinics have been diagnosed with clinical depression. It is vital that blind and partially sighted people have access to psychological therapies throughout their sight loss journey to address the impacts. However, National Institute for Health and Care Excellence guidance does not include psychological support in the eye care pathway. Will the Secretary of State commit to reviewing the NICE guidance to ensure that psychological therapies are integrated into the eye care pathway?
Steve Barclay
The hon. Lady raises an important issue. I would be keen to take it away and look at it to see how we can work together to pick it up.
Jason McCartney (Colne Valley) (Con)
Steve Barclay
Not only do I agree, but I have been with my hon. Friend to see this scheme at first hand. He has championed the scheme vociferously and helped to secure that investment for his constituents. I look forward to working with him to ensure it is delivered as quickly as possible.
Tim Farron (Westmorland and Lonsdale) (LD)
Plans to remove overnight primary care clinicians from Westmorland General Hospital three nights a week are a massive risk to our community and mean that, overnight, people will be reliant on Barrow or Penrith for an out-of-hours doctor. Will the Secretary of State instruct the ICB to intervene to protect people in South Lakeland from this massive reduction in the quality and accessibility of services?
Steve Barclay
Some of us remember when the Lib Dems were for greater localism. One of the things we are looking at is how to empower commissioners, on a place-based basis, to make decisions on where best to place services. We need to move more services into the community upstream, to address the frail elderly before they get to hospital and to have more community services. I am happy to look at the specific issue the hon. Gentleman raises, but I would have thought the Lib Dems would support the general trend of empowering integrated commissioning systems to make place-based decisions.
Greg Clark (Tunbridge Wells) (Con)
Several important pharmacies in my constituency, including the one in Hawkhurst, have been experiencing pressures, with long queues of customers sometimes going outside the door. It is said that access to trained pharmacists is proving very challenging. Will the Secretary of State comment on the situation and say what steps he might be able to take to alleviate the pressure?
Steve Barclay
There are a number of measures in the primary care recovery plan, from how we better use the skills mix within pharmacies to how we deregulate some of the tasks that take up pharmacists’ time, such as the requirement for a pharmacist to be present after drugs have already been prepared or to clip out tablets because they do not match the number prescribed by a GP. There are a number of areas in which we can better use the skills mix, and there are areas where we can take load off pharmacists. We are also funding additional services through Pharmacy First to support the pharmacy model.
Rachael Maskell (York Central) (Lab/Co-op)
The number of deaths increased by 13.5% in December 2022, particularly around influenza and pneumonia—up by 26.2%—so York’s public health team want to know what the Government are going to do about winter planning and when.
Steve Barclay
We set out comprehensive plans for winter preparation in the urgent and emergency recovery plan. Similar to what I said a moment ago, this includes making much better use of community schemes, particularly those targeted at the frail elderly, and making better use of technology through schemes such as virtual wards. It has also put additional bed capacity into hospitals, with more than £1 billion of funding for 5,000 more permanent beds to help alleviate the pressure on bed occupancy and get flow through hospitals, which is so important to addressing the pressure on ambulances.
Steve Brine (Winchester) (Con)
Back to NHS dentistry, I am afraid. Later this week, the Select Committee will publish its report on NHS dentistry services. Spoiler alert: it will be uncomfortable reading for some. Will the Secretary of State tell us when and how he plans to bring forward plans for the tie-in of newly qualified dentists? Could that go hand in hand with a “return to the NHS” campaign for dentists who have already left that part of the service?
Steve Barclay
It is characteristically astute of my hon. Friend to zero in on the tie-in, which is an important part of the long-term workforce plan. Around two thirds of dentists do not go into NHS work after training, so having a tie-in is more pertinent there than it might be elsewhere in the NHS workforce. I look forward to the Select Committee’s report but, with some of the reforms already in place, we are boosting the number of patients treated. There were a fifth more dental treatments in 2022 than in the previous year. We are also making NHS dentistry more attractive with some of the changes to the previous 2006 contract, but we recognise that there is more to do, which is why we will shortly set out our dental recovery plan.
Barbara Keeley (Worsley and Eccles South) (Lab)
I have received a wave of concern from clinicians on the safety of using physician associates, following my Adjournment debate last week in which I raised the death of Emily Chesterton, the 30-year-old daughter of my constituents Marion and Brendan. Emily died of a pulmonary embolism after being seen twice by the same physician associate at her GP practice. The physician associate failed to refer her to a doctor or to a hospital emergency unit for tests, which the coroner concluded could have prevented her death.
Yesterday, on “Good Morning Britain”, the Secretary of State boasted of increasing the number of people working in primary care, presumably including the workforce plan proposal to triple the use of physician associates. Will he look urgently at the details of Emily Chesterton’s case and ask himself whether lessons can be learned to avoid other preventable deaths?
Steve Barclay
Dr Alex George does a lot of fantastic work. I am due to meet him shortly in the coming days, and I look forward to that discussion. My hon. Friend is right to highlight the importance of getting more mental health support into the community, which is exactly what our additional funding is focused on delivering.
Mike Amesbury (Weaver Vale) (Lab)
Eighteen community pharmacists in my constituency are reporting challenges on medicine supplies. What more is the Minister going to do to get a grip of this situation?
Steve Barclay
We have a long-standing team in the Department focused on medical supplies, which are a continual issue; as a matter of routine business, there are often challenges in that area. If the hon. Gentleman has specific issues he wishes to raise, we would be happy to look at them, but we have a dedicated team in the Department that focuses on that exact point.
Anna Firth (Southend West) (Con)
As my right hon. Friend knows, I have been campaigning for £118 million of capital funding, the majority of it for Southend University Hospital, ever since I was elected. I am grateful that he has recently confirmed that the funding is secure. A new business plan is being submitted, including £9 million of enabling funding. Will he look upon that favourably and swiftly?
Steve Barclay
As my hon. Friend knows, I have already met her to discuss this scheme, and the impediment was the business plan that came forward from the local trust—further work was being done on that. She is right to highlight our capital investment more widely. This Government have committed to investing in the biggest ever hospital building programme, with more than £20 billion. That is in addition to our long-term workforce plan—the first time the NHS has done this—in which we are making a further £2.4 billion of investment.
Mary Kelly Foy (City of Durham) (Lab)
Is the Minister aware that the NHS North East and North Cumbria mental health and wellbeing hub is due to close this September? With mental health care in crisis in County Durham, that is an insult to the health and social care staff who desperately rely on those services. Will the Minister reverse that decision?
Steve Barclay
There are two issues here. One is how much investment we are prioritising towards mental health; the other is how local commissioners choose to prioritise services within those communities, and whether we try to run all of those decisions from the centre in Whitehall or embrace the 42 integrated care systems and allow them to make commissioning decisions. The bottom line is that we are spending much more on mental health, with an increase of £2.3 billion compared with the position four years ago. That is allowing us to replace 500 dormitory beds and provide 100 mental health ambulances, three new mental health hospitals, 160 projects such as crisis cafés to support accident and emergency, and £75 million to help those with mental health challenges get back into work, which is one of the best prevention measures we can take for people who are suffering with their mental health.
NHS Long-term Workforce Plan
Steve Barclay Excerpts(9 months, 4 weeks ago)
Commons ChamberRead Full debate Read Hansard Text Watch Debate Read Debate Ministerial Extracts
The Secretary of State for Health and Social Care (Steve Barclay)
The Government note the comments that you have made from the Chair, Mr Speaker.
Steve Barclay
That is also noted, Mr Speaker.
May I, on behalf of the Government, note the passing of the former head of the civil service, Lord Kerslake? He had a distinguished career in public service, including as chief executive of Sheffield Council and chair of King’s College Hospital NHS Foundation Trust, as well as being head of the civil service. We send our condolences to his family and friends both in Whitehall and across the civil service.
With permission, Mr Speaker, I wish to make a statement on our long-term workforce plan for the NHS.
This week marks the 75th birthday of the NHS. We should celebrate its achievements, its founding principles and its people. From doctors and dentists to pharmacists and physios, NHS staff devote their lives to caring for others. I am sure the whole House would agree that the NHS holds a special place in our country due to the care offered by the people who work for it.
It is said that, in 1948, the NHS had fewer than 150,000 staff and a budget of around £11 billion. Today, the NHS employs closer to 1.4 million people with a budget of more than £160 billion. The transformation of the care offered by the NHS through advances in medicine is reflected in the fact that people now live 13 years longer than on average in 1948.
Today, alongside the increase in the number of staff, the range of treatments and the improved patient outcomes, demand on the NHS has also increased. People live longer, they live with more complex medical conditions, and we are also dealing with the challenges left behind by a once-in-a-generation pandemic.
One in four adults lives with two or more health conditions. Although our population is forecast to grow by around 4% over the next 15 years, the number of those over 85 is forecast to grow by more than 50%. In addressing the challenges both of today and of the longer term, it is right that we have a recovery plan focused on the immediate steps as we rebuild from the pandemic, and longer-term plans to ensure that the NHS is sustainable for the future. This will ensure that the NHS is there for future generations in the way that it has been for us and our families over the past 75 years.
We have already set out detailed recovery plans to reduce long waits for operations, improve access to urgent and emergency care and make it easier to see GPs and specialists in primary care. On electives, we have virtually eliminated the two-year wait, which we did this summer, and cleared more than 90% of 80-week waits from their peak at the end of March—in marked contrast to the much longer waits we see in Wales, where the NHS is run by Labour.
On urgent and emergency care, we are investing £1 billion in 5,000 additional permanent beds, alongside expanding virtual wards to improve discharge from hospital and investing in community services to prevent admissions, especially for the frail and elderly. On primary care, we are investing more than £600 million, including in improving technology to address the 8 am rush. We have already exceeded our manifesto target by 3,000, with 29,000 additional roles in primary care to enable patients to access specialists more quickly, and we are reducing burdens on GP surgeries through the development of the NHS app and improving the range of services offered through Pharmacy First, enabling pharmacists to prescribe drug treatments for seven minor illnesses.
Alongside the recovery plans, we are taking action to improve prevention through early diagnosis of conditions, whether through the 108 community diagnostic centres that are already open, or the 43 new and expanded surgical hubs planned for this year. Our national roll-out of our lung cancer screening programme has helped to transform patient outcomes, turning on its head the previous position where 80% of lung cancers in our most deprived communities were detected late, with 76% now being detected early.
Alongside the immediate measures we are taking to deal with demand in the NHS, as we celebrate the 75th anniversary we are also investing in the NHS to make sure it is sustainable for the future. Last month, I announced to the House the largest-ever investment in the NHS estate, with more than £20 billion committed to our new hospitals programme.
Today I can confirm to the House that, for the first time in the NHS’s history, the Government have committed to publishing a long-term workforce plan, setting out the largest-ever workforce training expansion in the NHS’s history, backed by £2.4 billion of new funding. The plan responds to requests from NHS leaders and has been developed by NHS England. I would like to take this opportunity to thank Amanda Pritchard, the chief executive of NHS England and her team, Gavin Larner and colleagues within the Department of Health and Social Care, and the more than 60 NHS organisations that have engaged closely in the plan’s development, including many of our Royal Colleges.
The plan sets out three priorities: to train more staff, to retain and develop the staff already working for the NHS and to reform how training is delivered, taking on board the best of international practice. Let me deal with each in turn. We will double the number of medical school places, increase the availability of GPs being trained by 50%, train 24,000 more nurses and midwives and increase the number of dentists by 40%.
When it comes to improving retention, we recognise the importance of flexible working opportunities, especially for those approaching retirement. The plan will build on proposals in the NHS people plan and build on steps already taken by the Chancellor at the spring Budget on pension tax reform.
In respect of reform, the plan sets out policies to expand the number of associate roles, which provide greater career progression for existing staff and in turn reduce the workload of senior clinicians, allowing them to focus on the work that only they can do. Both measures will improve productivity by enabling more staff to operate at the top of their licence. A constant theme across the long-term workforce plan is our focus on apprenticeships and vocational training, including a commitment to increasing the number of staff coming through apprenticeships from 7% today to 22% by 2031-32. That reflects the strong commitment of the Secretary of State for Education and myself to facilitate greater career progression through apprenticeships. It will also help to recruit and retain staff in parts of the country that often find it harder to recruit
In the week in which we celebrate the 75th anniversary of the NHS, today’s announcement confirms the Government’s commitment to the first ever comprehensive NHS long-term workforce plan. The plan sets out detailed proposals to train more staff, offers greater flexibility and opportunity to existing staff, and embraces innovation by reforming how education and training are delivered across the NHS. The plan will be iterative; we will return to it every couple of years to enable progress to reflect advances in technology such as artificial intelligence so that the numbers trained can be best aligned with patient services. It also reflects a growing need for more general skills in the NHS, as patients with more than one condition require a more holistic approach.
The NHS long-term plan, backed by £2.4 billion of new funding, comes in addition to our record investment in the NHS estate. It ensures that we put in place the funding required for a sustainable future for the NHS, alongside the steps that we are taking in the immediate term to reduce waiting lists and ensure that the NHS is there for patients. As the chief executive of NHS England has said herself, the long-term workforce plan is a truly historic moment for the NHS. As such, I commend this statement to the House.
Liz Kendall (Leicester West) (Lab)
I thank the Health Secretary for advance sight of his statement. I say “statement”, but what I really mean is “admission”—an admission that, after 13 long years, the Conservatives have run out of road, run out of ideas, and turned to Labour to clear up the mess that they have made. Make no mistake: at its heart, this is Labour’s workforce plan. It is a plan that we have called for since last September; a plan that we have begged the Government to adopt again and again. They say that imitation is sincerest form of flattery, and I, for one, am relieved that the Government have finally seen sense, but the question that the Health Secretary and Conservative Members need to answer today is: what on earth took them so long?
This week, the NHS celebrates its 75th anniversary as it faces the biggest crisis in its history—a crisis that has been building for years under this Government: a staff shortage of 154,000, 7.4 million patients stuck waiting for treatment, people across the country finding it virtually impossible to see a GP, and families desperately worried that if they need an emergency ambulance, it just will not arrive on time. Ministers constantly blame covid for those problems, but the truth is that waiting list numbers were rising and staff shortages increasing long before the pandemic struck.
Patients now want to know when they will finally see a difference. Can the Health Secretary confirm that, under his proposals, the NHS will not have the staff that it needs for at least eight years? Does he now regret the cut in medical school places that his Government brought in in 2013? Does he regret the decision taken last summer to cut the number of medical school places by 3,000 just when the NHS needed them most?
The Health Secretary claims that this is the first long-term NHS workforce plan, but let me set the record straight. In 2000, the last Labour Government produced a 10-year plan of investment and reform—a plan that delivered not only 44,000 more doctors and 75,000 more nurses, but the lowest-ever waiting times and the highest-ever patient satisfaction in the history of the NHS. That was a golden inheritance that Conservative Members can only dream of and that they have squandered through a decade of inaction and incompetence.
Let me turn briefly to what is missing from the proposals. Without a serious strategy to keep staff working in the NHS, Ministers will be forever running to catch up with themselves. Yet the Secretary of State has completely failed to put forward a proper plan to end the crippling strikes that are having such a huge impact on patient care. Six hundred and fifty thousand operations and appointments have been cancelled because of industrial action. Next week, junior doctors will walk out for five days, followed by two days of consultants’ strikes. After seven months of disruption, can the Health Secretary tell us when he and the Prime Minister will finally do their job, sit down and negotiate with staff, and bring an end to this Tory chaos?
The one part of Labour’s workforce plan that Ministers have not stolen is our plan to fund it by scrapping the non-dom tax status. In fact, when the Health Secretary was touring the media studios yesterday, he was asked nine times how he was going to pay for the plan and he completely failed to answer. He has had a little more time to prepare, so I am going to try again. Will he fund it through higher taxes, when we already have the highest tax burden for 70 years, or will he fund it through higher borrowing, when our nation’s debt is at record levels? Labour will introduce plans only when we can show how they will be paid for, because that is what taxpayers deserve. It is high time that Conservatives did the same.
From the windfall tax to help for mortgage holders to a proper plan for the NHS workforce, where Labour leads, the Conservatives only follow. This tired, discredited Government have had their day. The public know that it is time for change, and in their hearts Government Members too know that it is time for change. It is time for them to move aside and let Labour finally deliver.
Steve Barclay
Well, that really was a confused response. The hon. Lady began with reference to Labour’s proposals and the claim that our plan followed them. I took the precaution of bringing Labour’s announcement with me to the Chamber. Members can look at it in their own time, but it does not use the word “reform” once, despite the fact that “Train, retain, reform” is a key part of our proposals. Proposals for reform include moving from five-year to four-year medical undergraduate training; the expansion of roles such as physician associate; a significant expansion in the use of apprenticeships; and flexibility for retiring consultants, so that they can return to roles in, for example, out-patient services. A wide range of reforms came about as a result of the consultation with 60 different NHS organisations and are a key feature of the plan, but in Labour’s proposals reform is not mentioned once.
In addition, Labour’s proposals are for a 10-year period. Our plan covers 15 years. Its proposal covered 23,000 additional health roles; our proposal deals with 50,000. I could go on and talk about the fact that the Labour proposal does not even mention GP trainees. Labour Members keep coming to the House and saying that primary care is important, but their proposals did not even touch on the workforce with regard to GPs. They did not even mention pharmacists, even though, as part of a primary care recovery plan, a key chunk of our proposal is Pharmacy First. It is extremely important that we can deliver services to patients in innovative ways. The ultimate irony is that the shadow Health Secretary, in one of his many interviews, including interviews to promote his book, said that the NHS “must reform or die”. He said that it must reform, yet Labour’s proposals do not mention reform at all.
Labour welcomes the plan, but it goes on to say that it will take too long to implement, while claiming that it is its plan, which, again, points to the confusion among Labour Members. Let me remind the House of what has been done. We had a manifesto commitment for 50,000 additional nurses—we are on track to deliver that, with 44,000 in place. We had a manifesto commitment to have 26,000 additional roles in primary care, and we have met that, with 29,000 roles in place. In 2018, we made a commitment to five new medical schools in parts of the country where it is hard to recruit. We have delivered that—a 25% expansion in the number of medical students, who will come on stream in hospitals next summer. However, as we celebrate the 75th anniversary of the NHS, it is right that we also look beyond that to the longer-term needs of the NHS. That is exactly what the plan does with its doubling of medical places, but alongside that, it innovates by embracing things like a medical apprenticeship so that we can look at different ways of delivering training.
The hon. Lady talked about strikes, which is a further area of confusion on the Labour Benches. Labour Members say that they do not support a 35% pay rise for junior doctors, on the grounds that the shadow Chancellor, the right hon. Member for Leeds West (Rachel Reeves), says that they should not. Either Labour Members want to support the junior doctors, or they do not—once again, their position seems confused.
I will finish with one final area of confusion on the Labour Benches. The hon. Lady talked about the elastic non-dom revenue raiser, despite the fact that the former shadow Chancellor, Ed Balls, has said that it would not raise the funds that are claimed. He has said that it would do quite the opposite: it would deter investment in the UK. In addition, Labour has already spent those funds on a range of measures, such as the breakfast clubs that Labour Members come to the House and talk about. The reality is that it would not fund Labour’s proposals, whereas we have made a commitment to back our plan with £2.4 billion of funding from the Treasury.
This is a historic moment as we celebrate the 75th anniversary of the NHS. It is a long-term commitment from a Government who are backing the NHS through the biggest investment in the NHS estate—over £20 billion —and a series of recovery programmes, expanding our diagnostic capacity and our surgical hubs. That is why the workforce plan is truly innovative. It does not just train more staff or offer opportunities to retain more staff; it reforms as well—something that is sadly lacking in Labour’s proposals.
Steve Brine (Winchester) (Con)
This is a serious piece of work, and it is very welcome. Despite calls from people like me to get on with it, it was right for the Government to take their time and get it right. The Select Committee will scrutinise it—as we do—on 12 July.
The training piece is very strong. Doubling the number of medical school places has to be right, and I am glad that the Secretary of State thought of it. On retention, if we are saying—rightly, I would contest—that it is not all about pay, what role does he envisage the integrated care systems and, therefore, the trusts having in supporting staff as he makes the “one workforce” that is mentioned in section 5, with which I agree, come to pass?
Steve Barclay
Characteristically, my hon. Friend the Chair of the Health and Social Care Committee makes an extremely pertinent point about the role of the ICSs. As we move to place-based commissioning and look to integrate more, the interplay between the workforces in the NHS and in social care will be a key area where the ICSs will be extremely important.
The ICSs will have a particular role in the apprenticeship and vocational training, which are key retention tools in those parts of the country where it is hard to recruit, as well as in offering more flexibility to staff. When I talk to NHS staff, they often talk about having different needs at different stages of their career—whether for childcare commitments, which relate to the measures the Chancellor set out in the Budget, caring for an elderly relative, or wanting to retire and work in more flexible ways—and the ICSs have a key role to play in that. I welcome my hon. Friend’s comment that this is a serious and complex piece of work, and that it was right that we took our time to get it correct.
Rachael Maskell (York Central) (Lab/Co-op)
Despite the significant desert of dentists, I note from the plan that we will not see an increase in dental training places next year, the year after or the year after that, meaning that we will not see more dentists for nearly another decade. We have a crisis now, so what is the Secretary of State going to do about it?
Steve Barclay
We are already seeing a fifth more work than last year, due to the flexibilities that the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Harborough (Neil O’Brien) announced, including the ability for dentists to take on more work within their commission and the changes to the units of dental activity pricing to better reflect more complex work. Of course, we have 6.5% more dentists than in 2010, but we also recognise that within the £3 billion budget, we want to go further. That is why we are looking at proposals to go further than the measures announced, but progress is being made, with a fifth more activity than last year.
Maggie Throup (Erewash) (Con)
I welcome the workforce plan and applaud NHS England’s ambition. However, for the plan to be successful, it is vital that we promote career options that often go unseen. I therefore urge my right hon. Friend to work with the Education Secretary and NHS England to ensure that young people are better informed about the myriad opportunities in the allied health professions and as healthcare scientists before choosing GCSE, A-level or university options.
Steve Barclay
My hon. Friend raises a brilliant point. I do not know if Members know, but there are 350 different types of role in the NHS. It is really important that we get the right information to children whose parents are perhaps not informed about those opportunities. One point on which I slightly take issue with my hon. Friend is that it is not just those at the start of their career who need to be aware of the opportunities. This is about offering opportunities to people throughout their careers to progress and to take on more advanced roles. I strongly believe that we should not define people’s future career by where they are at 21 or 22; they should have the opportunity to progress. That is a key part of the workforce plan, and I think it is a key Conservative principle that they have that ladder of opportunity throughout their time in the NHS.
Valerie Vaz (Walsall South) (Lab)
I associate myself with the remarks the Secretary of State made about Bob Kerslake. He was a true public servant, and his death is our loss.
What is the point of a workforce plan if the Secretary of State is not actually talking to the workforce? When will he talk to the junior doctors and the consultants? Can I also ask whether the work on the workforce plan will start forthwith or sometime in the future?
Steve Barclay
The fact that we are talking to the workforce is shown by the fact that we have reached agreement with the largest workforce group in the NHS.
Steve Barclay
The right hon. Lady, for whom I have a huge amount of respect, is shaking her head, but it is a fact that the largest workforce group in the NHS are those on “Agenda for Change”, which covers more than 1 million healthcare workers from nurses, midwifes and paramedics through to porters, cleaners and many others. We have reached agreement with the NHS Staff Council, and those sums—the 5%, plus the lump sum in recognition of their tremendous work—is going into pay packets this month. So we have reached agreement, notwithstanding discussions with the junior doctors. They still demand 35%, and that is not affordable.
James Morris (Halesowen and Rowley Regis) (Con)
I welcome this long-term plan, particularly its recognition that the skillsets required in the NHS over the next 10 or 15 years, with the requirement for multidisciplinary working and generalised clinical skills, are going to change. Does my right hon. Friend agree that two things are needed for implementation? One is to improve the sense of culture in the NHS, which could lead to better retention. The second element is to ensure that digital innovation, particularly the use of artificial intelligence to improve clinical skills and other skills, is rolled out more generally in the NHS. We need to diffuse that innovation a lot more to support the critical new skillsets that are required for a modern health service.
Steve Barclay
My hon. Friend is exactly right. As a former Health Minister, he knows these issues extremely well. There is a requirement—this is something the chief medical officer, Professor Sir Chris Whitty, has spoken about—for more generalist skills in the NHS, not least given that one in four adults now has two or more health conditions. We need flexibility to respond to changes not just in technology, but in service design, which will evolve as well.
My hon. Friend is also right about the wider issues of culture. I think the whole House was concerned about recent reports of sexual assaults linked to the NHS. One of the key features of the agreement we have reached with the NHS Staff Council is to work more in partnership on violence against members of NHS staff. I know there will be consensus in the House that that is unacceptable, so we are working with trade union colleagues on how we tackle it. Again, with racism, we still have too many cases of concern. There are a number of areas of culture that we are working constructively with trade union colleagues and others to address.
Paul Blomfield (Sheffield Central) (Lab)
I thank the Secretary of State for his comments about Bob Kerslake, whose spell in public service included his time as chief executive of Sheffield City Council. He continued to have many roles in the city, where he will be much missed.
After this Government’s 13 years in charge, morale in the NHS is clearly at rock bottom, with the value of pay falling, pressures increasing and a record number of staff—almost 170,000—leaving the NHS last year. The CEO of NHS Providers said that that must be reversed, but all the Secretary of State talks about is a little bit of working flexibility. Does he recognise that he has to address the crisis in morale to stem the tide of people leaving the NHS?
Steve Barclay
It is simply not correct to say that this is simply about flexibility—for example, look at the very significant changes made on pension tax. That was the No.1 demand of the British Medical Association consultants committee, and the Government agreed to it. A significant amount of work is going on. The NHS people plan talked about not just flexibility but some of the cultural points that are important. Some roles that have been introduced need to expand, such as some of the advanced positions like advanced clinical nurse or physician associate, where there are opportunities for people to progress their careers. It is worth pointing out that, once again, not a single Welsh Labour MP has turned up to defend their party’s record in Wales. As we set out a long-term workforce plan, we are setting out that ambition for England, but we see very little from the Labour party in Wales.
Damian Green (Ashford) (Con)
I congratulate my right hon. Friend on this welcome announcement. I was happy to join his celebration of the 75th anniversary in the most practical way by visiting the new children’s emergency department at the William Harvey Hospital in my constituency. It is opening for patients this week and will be extremely welcome. He will be aware that some of the problems of the NHS can be solved only if we solve problems in the social care system as well. I urge him to follow up this extremely useful and welcome workforce plan for NHS workers with a similar idea for the social care system, because unless we fix one, we will not fix the other.
Steve Barclay
My right hon. Friend makes a valid point about the integration between health and social care, and that was a flagship part of the reforms in 2022, which brought the NHS and social care together through the integrated care system. I join him in welcoming the news about William Harvey Hospital, which is extremely important to the local area. On social care more widely, we must also be cognisant of the differences. The NHS and social care employ roughly similar numbers at around 1.5 million people, but one is one employer and the other is 15,000 employers, so the dynamics between the two are different. The prioritisation of that integration is exactly right. That is why my right hon. Friend the Chancellor announced up to £7.5 billion for social care in the autumn statement, recognising that what happens in social care has a big impact on discharge in hospitals and hospital flow, which in turn impacts on ambulance handovers.
Daisy Cooper (St Albans) (LD)
After promises of new hospitals that have not got off the ground and 6,000 more GPs that never came to pass, it is fair to say that the British public will judge the Government on their actions not their words. Let me press the Secretary of State further on social care. He will remember that at the start of this year, people were dying in the back of ambulances and in hospital corridors, in part because people could not be discharged from hospitals into social care. If the Government believe, as I do, that we cannot fix the NHS if we do not fix social care, will he also bring forward a workforce plan for our social care sector?
Steve Barclay
That repeats the previous question, so I will not repeat the answer. It is slightly ironic to call for a plan for a new hospital programme and for a long-term workforce plan, and then criticise us when we deliver on both of those, as we have done with more than £20 billion of investment in the new hospitals programme, which we announced last month, £2.4 billion in the first ever long-term workforce plan and the biggest ever expansion of workforce training in the history of the NHS. Of course we need to take action in the short term to deal with the consequences of the pandemic. That is what our recovery plan does. The urgent emergency care plan that I announced in January takes specific action on demand management in the community. There are measures upstream on boosting capacity in emergency departments and downstream on things such as virtual wards. A huge amount of work is going on. We are putting more than £1 billion into 5,000 more permanent beds to get more bed capacity into hospitals. On social care, in the autumn statement the Chancellor committed up to £7.5 billion of further investment over two years, and it was part of our reforms to better integrate health and social care.
Mr Philip Hollobone (Kettering) (Con)
I welcome the NHS long-term workforce plan and in particular its emphasis on training, retention and reform. At the moment, about a quarter of NHS staff are recruited from abroad. Can the Secretary of State confirm to the House and my constituents that this plan enables the development of a strong pool of homegrown talent, so that we can reduce foreign recruitment more towards 10%, which would be a lot more sustainable for the long-term future of the NHS?
Steve Barclay
My hon. Friend is absolutely right. As we boost our domestic workforce training, there will be scope to reduce the number recruited internationally. From 1948 onwards, international recruitment has always played an important role in the NHS, and we are hugely grateful for the service offered by those recruited internationally, but we also recognise that as demography changes in other countries, there will be increasing competition for healthcare workers around the world, so it is right that we boost our domestic supply. That is what this plan does, and it is why this is a historic moment for the NHS in making that long-term commitment that will in turn reduce the demand on the international workforce.
Clive Efford (Eltham) (Lab)
I, too, add my condolences to the family of Bob Kerslake, who did excellent work in my borough tackling poverty. I would congratulate the Secretary of State on this announcement if it did not come 13 years into a Conservative Government. It is a bit like Bobby Ewing coming out of the shower, the way the Secretary of State is saying, “I’ve just realised there’s a crisis in the NHS.” We went into covid with 2.4 million people on waiting lists, which was a record. It is now up to 7.4 million. The report itself says that we have 154,000 fewer staff than we need today in the NHS. After 13 years in government, if the Tories really cared about the NHS, it would not be in the state it is in, would it?
Steve Barclay
The hon. Gentleman ignores the fact that since 2010, there has been a 25% increase in the NHS workforce. More than a quarter of a million more people now work in the NHS than was the case in 2010. There is a 50% increase in the number of consultants working in the NHS today compared with 2010, but the reality is that demand has increased as a result of an older population, advances in medicine and in particular the demands of the pandemic, and that is what we are responding to. We are also taking measures in parallel. We are on track to deliver our manifesto commitment for 50,000 more nurses, with 44,000 now in place. We also have beaten our manifesto target on primary care, with 29,000 additional roles in place. That means that people can get to the specialist they need, which in turn frees up GPs for those things that only GPs can do and ensures that patients can access care much more quickly.
Sir Edward Leigh (Gainsborough) (Con)
According to the King’s Fund, the proportion of GDP taken by the NHS has increased in the past 50 years from 3.4% to 8.2%. On the same trajectory, in 50 years’ time, it will take a fifth of all our GDP. That is totally unsustainable, especially as someone’s only right, despite the fact they are paying ever increasing amounts of tax, is to join the back of the queue. I ask again: will the Secretary of State launch a study—and, if necessary, appoint a royal commission—on fundamental reform of the whole nature and funding of our health system, so that we can learn from every other developed country, such as Australia, France, Italy and Germany, where they unleash private sector investment into healthcare and give people rights to their healthcare, while ensuring that those who need it get free healthcare at the point of delivery?
Steve Barclay
I hope my right hon. Friend is pleased to see the measures we are taking with the Lord O’Shaughnessy review on clinical research trials to make it easier and faster to do research in the NHS. That in turn attracts private investment to the NHS. He will have seen the announcement I made on Tuesday of £96 million for 93 different research projects, such as at Great Ormond Street Hospital, where we have allocated £3.5 million for research into rare conditions in children. That translates into research that is then deployed, usually in adults. We are investing there, and we are screening 100,000 children through Genomics England. We have got a deal with Moderna and BioNTech so that we can have bespoke cancer vaccines. On Monday, we rolled out national lung cancer screening. Previously, in our most deprived communities we were detecting lung cancer late—80% were diagnosed late—but in those pilots we turned that on its head with 76% detected earlier.
I know that my right hon. Friend, as a former Chair of the Public Accounts Committee, will agree that by detecting earlier, not only are patient outcomes far better but treatment is far cheaper, whether that is for lung cancer or through our innovation on HIV screening in emergency departments picking up HIV in people who do not realise that they have it. When we treat it early, the patient outcomes are better, and it is fiscally much more sustainable. That is how we will address some of his concerns.
Stella Creasy (Walthamstow) (Lab/Co-op)
The Secretary of State could do something now—not in eight years’ time—to relieve the pressure on our NHS, and it has nothing to do with pension funds. Figures from the Royal College of General Practitioners show that 53% of GPs think they cannot work in a flexible way to balance family and work commitments. It is little wonder that GPs aged 35 to 44 are the biggest group on the retention scheme who are leaving the profession—it does not take a rocket scientist to work out that it is the mums.
When I asked the Secretary of State’s Department what he was doing to monitor flexible working and whether we are getting roles that people can do—not just sitting with their 16 hours but finding ways to work and balance family—it said that it did not monitor the situation. It was not even looking at it. We are losing brilliant staff and wasting billions of pounds, and we will have a delay before our constituents see the benefit of any workforce plan unless that changes. I have listened to him and looked at the statement that does not make a single mention of childcare, although he did refer to it in passing. What will he actually do not just for retirees but for doctors with families to get them back into the NHS so that we can all benefit?
Steve Barclay
I think there is actually a lot of agreement between the hon. Lady and I. She talked about the plan, and having read it a number of times—that is part of my role—I know that childcare is specifically referred to in the summary, no less, in terms of the key issues that it goes on to set out. It goes into detail about our proposals, including linking up to the NHS people plan and greater flexibility in terms of roles and people retiring. One aspect of the NHS Staff Council deal is the expansion of pension abatement rules. So there is a huge amount.
The hon. Lady calls for more flexibility. I set out a number of the areas, and she does not seem to realise that there are three sections to the plan, with the second being all about giving greater flexibility to help retain our staff. So the plan addresses the points she raises; that just does not seem to be the answer she wants to hear. As for flexibility being important to mums, yes it is, and the NHS has a largely female workforce, but it is also important to dads. It is important to all NHS staff that we have that flexibility.
Richard Fuller (North East Bedfordshire) (Con)
The NHS today, at 1.4 million employees, is the fifth-largest employer in the world, and if the ambitions in this welcome plan are met, it will be the largest employer in the world. That raises the question of how effective the management of those human resources is. It is a little disappointing that there is so little commentary in the plan on two important management issues: the ambitions on improving the quality of management systems, and particularly clarification of decision rights and responsibilities; and the quality of accounting control systems and how the NHS seeks to improve them. Will my right hon. Friend ensure that the NHS looks at those two important matters?
Steve Barclay
Those are both fair points. I know that my hon. Friend comes at this with great commercial experience, and I hope he knows that I have an interest in those issues. Just to reassure him, the plan is iterative; it is not a one-off. It is a framework from which we will do further work. Indeed, one of the areas that I am often criticised for is my interest in data and variation in data across the NHS—he and I probably agree on that more than some of those who are critical. That speaks to his point—the Chair of the Health and Social Care Committee’s point relates to this—that in a system the size of the NHS, data on the performance of the integrated care boards and their role in terms of the workforce is one area that the House will want to return to.
Mr Tanmanjeet Singh Dhesi (Slough) (Lab)
We know a Government are out of ideas when they copy the Opposition’s plan to train the doctors and nurses that the NHS so desperately needs. The majority of those policies will not be implemented until after the general election—long after the British public have booted the Conservatives out of power because of their industrial-scale incompetence, which included crashing the economy.
The Secretary of State will be aware that the NHS is short of more than 150,000 staff right now. Will he take responsibility for those shortages and admit that, had the Government acted more than a decade ago, the NHS would have the staff that it needs right now?
Steve Barclay
All I can say is that the hon. Gentleman clearly has not read the plan. If he had, he would have seen that it is developed by NHS England. That the Labour party is claiming authorship of it is slightly odd. As I pointed out in response to the shadow Health Minister, the hon. Member for Leicester West (Liz Kendall), Labour’s plan fails to mention reform at all, or GP training or physios. Our plan is 15 years, Labour’s is 10; it is a fraction of the size and it is flawed in many other ways. This plan has been developed by NHS England with contributions from 60 different organisations across the NHS. That is why it has been so widely welcomed by many in the NHS, who have called for it for some time.
Holly Mumby-Croft (Scunthorpe) (Con)
We have a superb new accident and emergency in Scunthorpe, and we are pressing ahead with plans for a large, state-of-the-art community diagnostic centre. I have lived locally all my life, and those are some of the most significant upgrades we have seen in a generation. But there are things to do—we certainly need more NHS dentists. Would the Secretary of State consider a tie-in so that newly qualified dentists spend a minimum percentage of their time delivering NHS care?
Steve Barclay
I am pleased to see those services going into Scunthorpe. That underscores the investment we are making now while preparing for the long term, through the largest ever expansion in workforce training in the NHS’s history. My hon. Friend is right about the importance of tie-ins. Let me explain why that matters in particular for dentists: around two thirds of dentists do not go on to do NHS work. That is why the plan has looked at tie-ins for dentistry, which we will explore in the weeks and months ahead.
Marsha De Cordova (Battersea) (Lab)
Despite what the Secretary of State says, the Conservatives have finally admitted that they are out of ideas, and are adopting Labour’s workforce plan. The NHS is short of more than 150,000 staff right now. More worryingly, the plan includes no mention of eye health, despite the crisis. In ophthalmology, 80% of eye units do not have enough consultants to meet current demand. Will the Secretary of State say how many years it will take for the NHS to have enough ophthalmologists? Why will he not back my Bill for a national eye health strategy for England, which will seek to tackle the crisis in eye health?
Steve Barclay
The question started by saying that we do not want plans for the future, we want to deal with the present, and finished by asking if we can have a plan for the future rather than for the present. The plan sets out significant additional numbers. Significant investment is going into eye services here and now. Let me give the House one example: at King’s Lynn hospital, in addition to our investment in a new hospital to replace the reinforced autoclaved aerated concrete hospital, and in addition to the new diagnostic centre, I had the opportunity in the summer to open a new £3 million eye centre, which is doubling the number of patients who receive eye care in King’s Lynn. That is just one practical example of our investment in eye services now.
Martin Vickers (Cleethorpes) (Con)
May I add my words of condolence for Lord Kerslake, who served on the greater Grimsby regeneration board, which oversees regeneration in the Grimsby-Cleethorpes area? We greatly valued his experience and advice. Following the question from my hon. Friend the Member for Scunthorpe (Holly Mumby-Croft), it is important that we tie in dentists—and I would suggest GPs—to NHS services, but could they also be directed to areas of greatest need, such as northern Lincolnshire?
Steve Barclay
The Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Harborough (Neil O'Brien) is looking at how we deliver more services within the existing contract, and at what incentives and reforms can be put in place to ensure that the parts of the country that find it hardest to recruit dentists are best able to do so, through both our domestic supply and international recruitment.
Jim Shannon (Strangford) (DUP)
I welcome the Secretary of State’s statement and the positivity he is trying to bring forward. The NHS workforce plan has concluded that the number of places in medical schools each year will rise from some 7,500 to 10,000, but in Northern Ireland it is a very different story: I know it is a devolved matter, but the Royal College of Nursing is facing cuts that could result in the number of places falling to 1,025 per academic year. Will the extra money that the Secretary of State announced be subject to Barnett consequentials? I know he is always keen to promote all this great United Kingdom of Great Britain and Northern Ireland together, so what discussions has he had with the Northern Ireland Department of Health and the Northern Ireland Assembly to ensure that Northern Ireland is not left behind? When we are crying out for staff, our students should have a real opportunity to learn and work in the NHS field.
Steve Barclay
Barnett consequentials will apply to the £2.4 billion funding over the five years. In respect of new roles, regulatory changes apply on a UK-wide basis. The plan itself is for the NHS in England, but we stand ready to work with partners across the United Kingdom where there is shared learning on which we can work together.
Andrew Selous (South West Bedfordshire) (Con)
I am really pleased to see the 50% increase in the number of annual training places for GPs—it is music to my ears—but they will need somewhere to work. The £20 billion for the hospital programme is great, but when I look at section 106 applications for my constituency, I still see health getting a tiny proportion compared with education and the environment. May I have an assurance from the Secretary of State that as we increase the number of GPs in the primary care team, they will not have to scrabble around trying to get little bits of money for planning applications here and there, but that there will be a guaranteed capital budget for new doctors, in the way that we are sorting that out for hospitals?
Steve Barclay
My hon. Friend raises a perfectly valid point. As we expand the primary care workforce, there is a capital consequence. The 50% expansion he talks about builds on the expansion from 2,100 in training in 2014 to 4,000 now, so there has already been an expansion, but we are taking that further by 50%—and on the higher figure. His point about section 106 applications is absolutely valid, and that is part of the primary care recovery plan. I understand that he is discussing the importance of getting that funding in place with the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Harborough.
Grahame Morris (Easington) (Lab)
Given the number of pressures and crises that our NHS faces, it would be a mistake for the Secretary of State to be seen as complacent in how he delivered his workforce plan. Our job as MPs is to speak the truth to power, so I want to raise with him the lack of cancer treatment capacity, particularly in radiotherapy. International comparators suggest that between 55% and 60% of cancer patients should be able to access radiotherapy either directly or in tandem with other treatments. Currently, only 27% do. What is the Secretary of State doing to increase the size of the highly specialised and relatively small radiotherapy workforce? The target is for 85% of patients to start their first treatment within 62 days of an urgent GP referral. What is the current figure?
Steve Barclay
To take the hon. Gentleman’s first point, the plan does not get into individual specialties. That was a Health Committee recommendation, which I have discussed with the Committee’s Chair, my hon. Friend the Member for Winchester (Steve Brine). There is a clear reason for that. Within the framework of numbers, the impact of AI and service design will evolve over the 15 years, so it is right that we commit to the number and then the NHS take that work forward with individual specialities and have discussions with the royal colleges.
The hon. Gentleman made a perfectly valid point about boosting capacity. We have already rolled out 108 of the 160 community diagnostic centres that we have committed to deliver. We are also looking to innovate, and I will give two practical examples. Our deal with Moderna, which is looking at individual bespoke vaccines for hard to treat cancers such as pancreatic cancer, will allow us to get ahead on that. We are already seeing a significant reduction in cervical cancer as a result of prevention measures. Likewise, by going into deprived communities with a high preponderance of smoking, the lung cancer screening programme is detecting lung cancer, which often presents late, much earlier, which in turn is having a significant impact on survival rates.
Margaret Greenwood (Wirral West) (Lab)
I recently met a constituent who raised the issue of children’s oral health and shared with me her concerns about the staffing crisis in specialist paediatric dentistry. According to the Government’s own statistics, which were released in March, 29.3% of five-year-olds in England have enamel and/or dentinal decay, and the figure was as high as 38.7% in the north-west. The workforce plan talks of expanding dentistry training places by 24% by 2028-29, and by 40% by 2031-32. I note the Secretary of State’s response to my hon. Friend the Member for Easington (Grahame Morris). However, there is no specific mention of specialist paediatric dentistry in the plan, so what will the Secretary of State do to help those children who are desperate for specialist dental treatment right now?
Steve Barclay
Without repeating my previous answer on specialty, we are boosting a number of areas. There are 5,000 more doctors and almost 13,000 more nurses this year than last year. I have already touched on increasing the numbers in primary care. There are 44,000 more nurses, so we are on track to deliver our manifesto target of 50,000. There are 25% more within the workforce of the NHS compared with 2010. We are boosting the workforce overall. The plan is iterative and further work will go into which specialities are developed and how resource is prioritised as services are redesigned.
Helen Morgan (North Shropshire) (LD)
The Secretary of State will be aware that the recruitment and retention issues facing the NHS are particularly bad in rural areas. We felt the brunt of that in North Shropshire, with some of the worst ambulance waiting times, cancer treatment rates and diabetic care rates in the country. The plan does not go into much detail on what will be done to help rural areas, but it does acknowledge that by 2037, a third of all over-85s will live in rural places. I urge the Secretary of State to rural-proof this plan and to find ways to work on both the retention and the recruitment of healthcare professionals across the whole spectrum in North Shropshire and the rest of rural Britain.
Steve Barclay
The hon. Lady raises a fair point. It also applies to the issue of stroke. The elderly population has increased in many coastal and rural communities. That has created significant pressure: for legacy reasons, services are often in other parts of the country. We have five new medical schools in place, and we have looked at those parts of the country where it is often hard to recruit. Part of the expansion will be to look further at what services are needed in different areas. The hon. Lady’s point also speaks to that raised by the Chair of the Health and Social Care Committee. By giving greater autonomy to place-based commissioning through the integrated care systems, we will enable people at a more local level to design the services and the workforce that they need, and that includes the flexibilities required to retain local staff.
Debbie Abrahams (Oldham East and Saddleworth) (Lab)
I welcome the workforce plan. Given that it has taken 13 years, one tends to wonder why it has taken so long, but then of course we remember that there is a general election on the horizon.
Page 121 sets out a labour productivity rate of 1.5% to 2% per year. That has never been achieved by the NHS or any other comparable health system, so what assumptions is the Health and Social Care Secretary making in relation to achieving that?
Steve Barclay
First, this is a plan developed by colleagues in NHS England, so these are assumptions that have been agreed by those who lead within the NHS. It is about ensuring that people operate at the top of their licence. It is about having new and expanded roles, such as advanced practitioners and associate roles, that allow people to progress in their careers and, in doing so, freeing up capacity for senior clinicians, who often spend time doing things that do not need to be done by people in those roles.
Of course, there are also rapid changes in technology. We often talk about the developments in artificial intelligence, and I have touched on developments in the life sciences industry. I have also mentioned advances in screening and genomics. All those developments will in turn help us to prevent health conditions, and treating those conditions early will be not only better for the patient, but better value for money for the taxpayer.
Mr Speaker
I thank the Secretary of State for his statement, and for responding to questions for 59 minutes.