NHS Long-term Workforce Plan

Steve Barclay Excerpts

Monday 3rd July 2023 Commons Chamber

[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.

[Mr Speaker]

I would love them to take what I have said on board.

[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.

[Mr Speaker]

I call the shadow Minister.

[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.

[Mr Speaker]

I call the Chair of the Select Committee.

[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.

[Valerie Vaz]

indicated dissent.

[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?

--- Later in debate ---

[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.

Mental Health In-patient Services: Improving Safety

Steve Barclay Excerpts

Wednesday 28th June 2023 Written Statements

[The Secretary of State for Health and Social Care (Steve Barclay)]

I refer hon. Members to the oral statement I will make in the House today, 28 June 2023, on improving safety in mental health in-patient services.

[HCWS889]

Mental Health In-patient Services: Improving Safety

Steve Barclay Excerpts

Wednesday 28th June 2023 Commons Chamber

[The Secretary of State for Health and Social Care (Steve Barclay)]

With permission, Mr Speaker, I would like to make a statement on improving safety in mental health in-patient services across England. Before doing so, I want to thank all the right hon. and hon. Members from across the country who have campaigned tirelessly on behalf of their constituents to improve mental health care. Too many people have experienced care in mental health in-patient settings that has been well below the high standard that we all deserve when we are at our most vulnerable. I would also like to put on record my sincere condolences to the families and friends of those who have lost their lives.

First, I will update the House on the independent inquiry into mental health in-patient care across NHS trusts in Essex between 2000 and 2020. I thank my right hon. Friend the Member for Chelmsford (Vicky Ford) for tabling a Westminster Hall debate on the Essex mental health inquiry earlier this year. She and colleagues, including our hon. Friend the Member for Rochford and Southend East (Sir James Duddridge) and our right hon. Friends the Members for Witham (Priti Patel) and for Maldon (Sir John Whittingdale), all spoke passionately about the need to get justice for patients and their families. I know that my hon. Friend the Member for South Suffolk (James Cartlidge) also tabled an Adjournment debate on mental health in-patient care in Essex before the independent inquiry was launched in 2021.

I also pay tribute to my right hon. Friend the Member for Saffron Walden (Kemi Badenoch) and my hon. Friends the Members for Clacton (Giles Watling), for Brentwood and Ongar (Alex Burghart), for Castle Point (Rebecca Harris), and for Southend West (Anna Firth) for their determined campaigning on behalf of their constituents. Of course, we should all remember the important contribution of the former Member for Southend West, and a great friend to many across this house, the late Sir David Amess. He tabled a Westminster Hall debate on mental health services in Essex back in 2014, and he was a passionate campaigner for improving mental health care. I know he is very much in our thoughts.

In 2021 we launched the independent inquiry to investigate the deaths of mental health in-patients across NHS trusts in Essex between 2000 and 2020. The Government appointed Dr Geraldine Strathdee, a former national clinical director for mental health for NHS England, to chair the inquiry. I want to place on the record my thanks to Dr Strathdee and her team, because a lot of good work has been done. I applaud the bravery of all the victims and their families who have come forward to tell their stories.

I also recognise the work that the Essex Partnership University NHS Foundation Trust—EPUT—has done to assist with the inquiry. The trust has been in the spotlight, and progress has already been made to learn lessons and improve in-patient mental health care. EPUT’s chief executive, Paul Scott, joined in 2020, and since then the trust has invested £20 million in its mental health in-patient wards and a further £20 million in community services. Compared with 2019, patients absconding from care has decreased by more than 60%, and the use of inappropriate restraint has fallen by 88%.

However, in January Dr Strathdee raised concerns with me about a lack of engagement with the inquiry by current and former EPUT staff. I know that many right hon. and hon. Members share her concerns. Since then, the inquiry and the trust have worked together in a concerted effort to increase staff engagement. None the less, I have listened to Dr Strathdee’s concerns that the inquiry still needs further staff engagement to get victims’ families the answers they deserve. In a letter to me in March, she said that

“30 percent of named staff, those essential witnesses involved in deaths we are investigating, have agreed to attend evidence sessions. In my assessment, I cannot properly investigate matters with this level of engagement.”

She has also raised with me concerns about ongoing safety issues at the trust. To quote from her letter once again, she said:

“I am very concerned that there are serious, ongoing risks to patient safety. Due to the nature of these issues, I am confident that these cannot be properly investigated by the Inquiry without statutory powers.”

The Government take both concerns extremely seriously, and I agree with Dr Strathdee that we have now reached the point where the only appropriate course of action is to give the inquiry statutory powers.

Statutory inquiries do take longer, but this does not mean that work will start from scratch. Dr Strathdee’s existing findings will inform the next phase of the inquiry. She has informed me that, owing to personal reasons, she will not be continuing as the inquiry’s chair, so I want to thank her once again for all her commitment and hard work. I am sure the House will agree that she is a true public servant. Our work to find her successor is proceeding at pace, and I will update the House on the progress of setting up the inquiry in due course.

I recognise that Members’ concerns about mental health in-patient facilities are not confined to Essex. The Government are committed to improving mental health care across England, which is why we are boosting mental health funding by at least £2.3 billion this year compared with four years ago, why we are making urgent mental health support available through 111, and why we are delivering three new mental health hospitals to provide specialist care and cut waiting lists.

In January, we commissioned a rapid review of how data is used in in-patient mental health settings in England. More effective use of data has the potential to reduce duplication, ensuring that healthcare professionals can spend more of their valuable time with patients. The review team—well led again by Dr Strathdee—heard from more than 300 people representing every part of the in-patient mental health sector, including former patients and frontline staff. Dr Strathdee has made recommendations for how data and evidence can be used to identify risks to patient safety and failures in care more quickly and effectively. The findings and recommendations of the rapid review will be published today, and I will deposit a copy in the Libraries of both Houses. The Government will consider its findings carefully and respond in due course.

We recognise, however, that patients and families want to know how their concerns will be taken forward as soon as possible, and I also recognise that a wide-ranging statutory inquiry relating to other settings, or covering multiple patient safety issues, would not deliver those answers quickly. My Department has therefore agreed to work alongside the Healthcare Safety Investigation Branch to prepare for the launch of a national investigation of mental health in-patient services, which will commence in October, when the HSIB receives new powers under the Health and Care Act 2022.

The new Health Services Safety Investigations Body will investigate the following themes: how providers learn from deaths in their care and use that learning to improve services, including post-discharge services; how young people are cared for in mental health in-patient services and how that care can be improved; how out-of-area placements are handled; and how to develop a safe staffing model for all mental health in-patient services. Across all those areas, it will explore the way in which providers use data. I want to reassure the House that the new body will have teeth and will work at speed, that it will have the power to fine those who refuse to give evidence when they are required to do so, and that its predecessor’s investigations were typically concluded within a year.

I hope that today’s announcements will be of some comfort to the bereaved families who have done so much to raise awareness of the failings of mental health care in Essex and elsewhere. I want them to know that the Government are committed to obtaining for them the answers that they deserve, and to improving mental health across the country. I commend this statement to the House.

[Mr Speaker]

I call the shadow Minister.

[Dr Rosena Allin-Khan (Tooting) (Lab)]

I thank the Secretary of State for advance sight of the statement. However, it beggars belief that it has taken the Government so long to address the House on this matter. It seems that every month there are new scandals regarding needless loss of life and dehumanising behaviour in in-patient mental health settings. That must be stamped out now—these are people’s lives.

That brings me to the subject of Essex Partnership University NHS Foundation Trust. I welcome the announcement today that the inquiry will be given vital statutory powers, because for several years families who have lost loved ones at the trust have been calling for the inquiry to be given those powers. The grieving families I have spoken to have told me about the pain and anguish they have felt during their fight for answers, and that has only been compounded by an inquiry that lacked the necessary powers to seek the truth.

I must pay tribute to those families for their tireless campaigning and effort. In particular, I thank Melanie Leahy, who has fought for too long to achieve the announcement that has finally come today. I hope that Melanie, and every other family, will now start learning the truth.

Dr Strathdee has been a powerful advocate for the Essex inquiry, and we want to express our thanks to her for the work that she has already put in. The next inquiry chair must continue her work, and hold the confidence of the families who have been impacted in Essex.

I have repeatedly called on the Secretary of State to give the Essex inquiry statutory powers, and I am pleased to see that he has finally listened to our calls, but why were families left in the lurch for so long? Following months of scandals in in-patient mental health hospitals, public confidence is falling. More than one in three people say that they do not have faith that a loved one would be safe if they needed hospital mental health care, but every patient must be treated with dignity. I have repeatedly asked Ministers whether they have visited failing trusts. The Minister refused to answer, so will the Secretary of State commit himself to greater transparency? The Secretary of State has announced that urgent mental health support will be made available through 111, but 1.6 million people have been left languishing on waiting lists for mental health treatment, their condition deteriorating and reaching crisis point.

It is welcome that we will finally see the publication of the rapid review today—better late than never—but Labour has been calling for in-patient mental health settings to be reviewed in the light of these serious failings, and any rapid review should have had patient voices at its centre rather than being simply the data exercise that the Government commissioned. When we look at the planned national investigation into in-patient services that they will conduct alongside the Health Services Safety Investigations Body, we see that, yet again, there is no mention of working with patients and their families. Where is the learning? Where is the focus on what staff need in these settings? Are the Government looking at additional training needs, given that mental health care relies on staff and not simply on shiny equipment?

Let me turn briefly to the planned consultants’ strike, about which the Health Secretary has said absolutely nothing. Yet again he has been missing in action. For my consultant colleagues to have voted to strike is extraordinary, and the risk to patients of seven days of strike action is intolerable. Next week marks the 75th anniversary of the NHS, and it has never been in a worse state. The country is clear about who is to blame. It is not nurses, it is not junior doctors, it is not consultants, and it is not paramedics; it is this Conservative Government. They have lost control of the NHS, they have lost the confidence of NHS staff, and they have lost the support of the British people. The only ballot that we need now is a general election.

[Steve Barclay]

It is a shame that the hon. Lady chose to conclude her remarks in such a way. Let me address that head-on. It is bizarre to accuse a Minister who is literally at the Dispatch Box of being missing, particularly when the shadow Health Secretary, having managed to turn up for Prime Minister’s Question Time, has failed to turn up for this statement. It is even more bizarre that, although we are constantly told that the Labour party sees parity between mental health and physical health as a key priority, when it actually comes to debating the issue, the contrary is clearly on show.

This debate is not about the issues normally raised during Prime Minister’s questions about the politics of the day; it is about the families who have tragically lost loved ones, about how we can learn the lessons from that, and about how we can ensure that we get the data right, get the support for staff right, and get the procedures right so that other families do not suffer loss. We have responded to the excellent points made by Dr Strathdee through her rapid review about data. There are two elements to that: there is data that is collected that does not add value, is often duplicative and takes staff away from giving care—that is somewhere that we can free up staff—but there is other data that is needed to better identify issues early, and we need to look at how we improve that data. Specific issues arose in respect of engagement by staff, and we have actively listened and responded to the concerns raised by families and by many Members of the House, particularly about the Essex inquiry. I will come on to those as I go through the wider issues.

The shadow Minister mentioned speed. Of course, there is a balance to be struck between the completeness of a statutory inquiry and the greater speed that is often offered by other independent inquiries. Indeed, the Paterson inquiry was a non-statutory inquiry commissioned through the Department, and that is another vehicle that is often successfully used. There are also inquiries commissioned through NHS England, such as the Donna Ockenden review. There is often a balance to be struck between those inquiries, given the speed at which they can proceed, and a statutory inquiry, which has wider powers but often takes longer.

It was because of our desire to move at pace to get answers to families that we initially commissioned a non-statutory inquiry, in common with Bill Kirkup’s inquiry into Morecambe Bay and inquiries into many other instances in the NHS. However, we have listened to families and to right hon. and hon. Members who have raised concerns about the process and, in particular, the engagement by staff, and decided to make it a statutory inquiry.

The shadow Minister asked about our commitment to transparency. The very reason that we set up the rapid review in January was to bring greater transparency to the data. That is why I will be placing in the Libraries of both Houses the outcome of the rapid review. That speaks to the importance of transparency as we learn the lessons of what went wrong in Essex and in other mental health in-patient facilities.

The shadow Minister made a fair point about waiting times. We are committed to cutting waiting times, including in mental health. That is why we are spending £2.3 billion more on mental health this year than four years ago, we have commissioned 100 mental health ambulances, we have 160 different schemes looking at things such as crisis cafés to support people in A&E, and we have schemes such as the review through 111 and the funding the Chancellor announced in the Budget for mental health digital apps to give people early support. Of course, that sits alongside other mental health interventions, such as our programme to train more people to give mental health support in schools.

The shadow Minister made an important point about working with families. I agree with her about that. HSIB will be meeting families—indeed, Ministers have been doing likewise—and we are keen that that should feed into the terms of reference, both for the statutory inquiry and for the HSIB review.

We have touched on consultants, but let me make a final point on that. As far as I am aware, the Opposition do not support a 35% pay rise, whether for junior doctors or for consultants, but if that is their position, perhaps they will tell us whether this is yet another area that the stretchable non-dom contribution will reach to. Exactly how will it be funded?

This is a serious issue. The measures that we are taking address the concerns of families who have suffered the most tragic loss. It is important that we learn the lessons, both in Essex and more widely. We have actively listened to the points raised by Dr Strathdee, who has done a fantastic job. It is right that the work moves on to a statutory footing, but it is also right that we look more widely at the lessons from other mental health in-patient facilities. That is exactly what we intend to do.

[Priti Patel (Witham) (Con)]

First, let me put on the record my personal thanks to the Secretary of State and Ministers for their honest and frank engagement with colleagues and with bereaved families, whose concerns they have listened to. It was my constituent Melanie Leahy, who was at one stage a constituent of my right hon. Friend the Member for Maldon (Sir John Whittingdale), who brought the issue to our attention and to the attention of the Secretary of State. She deserves a lot of support for the way she has conducted herself. None of us would want to go through the sheer anguish and personal trauma that she has experienced. We owe a lot to her and to others who have come forward.

There are still 80-plus families who did not engage with the inquiry led by Dr Strathdee, to whom I pay tribute. The statutory inquiry will give them the confidence and courage to come forward, speak up and share what will be—we should be frank about this—deeply harrowing evidence. Will the Secretary of State expand on how evidence received by Dr Strathdee’s inquiry will be treated? I know that he said he will come back to the House on the processes. We are interested, in particular, in the inquiry’s terms of reference. Importantly for bereaved families, what measures will be in place to support people to come forward and give evidence? There have been too many barriers in that regard for families and, if I may say so, those who have been employed by EPUT. What involvement will the families have in drawing up the terms of reference? They are the ones that need confidence in the process. Again, I thank Dr Strathdee, and I thank the Secretary of State and Ministers for their engagement.

[Steve Barclay]

In my discussions with my right hon. Friend and colleagues, I found the compassion that they showed and the way they championed the family voice compelling. I absolutely agree that it is important that families take confidence from the decision to move the inquiry on to a statutory footing and come forward with their evidence. I know that she plays an active part in that. Of course, we want families to be part of the discussion on the terms of reference. I know that, with her significant experience, my right hon. Friend is keen to be part of that too, and we are keen to engage with her on it.

My right hon. Friend is right to highlight the evidence that has already been gathered through the excellent work of Dr Strathdee. I had a meeting with her yesterday to ensure that we capture that as part of the work that is moving forward. I hope—I reinforce my right hon. Friend’s point—that families will take confidence from today’s announcement and that those families who have not come forward to date will be able to do so. I know that in my right hon. Friend they will have a resolute champion supporting them to do so.

[Rachael Maskell (York Central) (Lab/Co-op)]

I, too, welcome the Secretary of State’s statement, but I am disappointed that he did not say more about the serious risks that we have raised in the House—not least about timely access to services and the significant risk that many of my constituents have faced out in the community—in respect of Tees, Esk and Wear Valleys NHS Foundation Trust, which serves York. I wonder whether he can expand on that, and on his proposals for taking things forward at the trust. I am meeting one of his Ministers next month, but I would like to hear his position on addressing the serious concerns that have been raised.

[Steve Barclay]

The hon. Lady raises a very valid point. There are real concerns about Tees. We considered that when considering the scope of the statutory inquiry. Given that significant work had been done in Essex, we decided to strike the balance by putting that on a statutory footing but enabling work to proceed at pace through HSIB on Tees and some other areas. The hon. Lady will know that the Care Quality Commission prosecuted the trust in May for a regulation 12 breach, and that significant work has already gone in; the report of the system-wide independent investigation was published last March. They are very serious issues on which I think there is concern across the House, and we stand ready to work with her and other elected representatives from that area as part of the wider work.

[Vicky Ford (Chelmsford) (Con)]

It is a deep, deep tragedy that, over the 20-year period, around 2,000 people lost their life under the care of mental health services in Essex. Families and survivors are right to want transparency and accountability. Given the slow progress of the independent inquiry, it is right that it now moves to a statutory basis.

When I spoke in Westminster Hall, I shared the testimony of a constituent who had been an in-patient in the early 2000s. She described being raped by another patient and being laughed at by staff when she asked for support. She described being able to make many suicide attempts, absconding from the ward and overdosing. She described how staff refused to treat her self-harm injuries and how she was repeatedly restrained and forcibly injected. I put on record my incredible respect for the people who are coming forward to relive their horrors and share their testimony. They are doing this because families and survivors want to know that change is embedded so that lives are safeguarded now and in the future. Will my right hon. Friend give assurance to my Essex constituents that mental health services in Essex will now be given the support they need to keep vulnerable people safe?

[Steve Barclay]

Having discussed that harrowing evidence with my right hon. Friend, I do not think any Minister could either forget it or not be moved. I found it an extremely moving experience to hear her talk about the experiences of a number of her constituents. She is right to praise those who come forward, and to recognise that it is often a difficult ask to relive the most awful circumstances, but it is important that families come forward so that we learn lessons and ensure this is not repeated.

My right hon. Friend is also right to highlight the two broad elements of learning the lessons of what happened in the past and maintaining services for the future. I am therefore happy to give her an assurance that we will work closely with her on support for Essex as lessons are learned through the statutory inquiry and as services continue to be delivered. We are working closely on that with the chief executive.

[Daisy Cooper (St Albans) (LD)]

My thoughts are, first and foremost, with the bereaved families and all those involved, because this process must be utter agony for them. It is right that the inquiry is put on a statutory footing.

In his statement, the Secretary of State quoted from a letter he received from Dr Strathdee, in which she said:

“I am very concerned that there are serious, ongoing risks to patient safety.”

The Secretary of State did not expand on that, and I do not know whether he is able to do so. If I may extrapolate, we know that, more broadly, there are risks to patient safety when there is not enough workforce and when there are not enough beds. Hertfordshire is the most under-bedded area of the country. When we see the workforce plan, potentially this week, will it include estimates of the number of qualified mental health staff we need in in-patient settings, NHS community settings and schools? Will he meet me and my local mental health trust to discuss the number of beds we have in the county and our plan to expand them?

[Steve Barclay]

Dr Strathdee did not particularly focus on staffing numbers, as far as I recall; she focused on some of the issues with care from staff. That was the nature of the concerns. On the ongoing risk, part of the reason why we commissioned the rapid review was to look, in particular, at the quality of data. There was a quantity of data that was not effective, and that often distracted staff from spending time with patients. There were also gaps in the quality of data that needed to be filled, and the document that will be placed in the Libraries of both Houses speaks to that point. That is why we are so keen to move at pace on learning lessons.

[Dr Ben Spencer (Runnymede and Weybridge) (Con)]

I welcome that sentence and the seriousness and speed with which this is being taken forward.

As a now non-practising consultant psychiatrist, I have a variety of declarations in this area, which are best summarised in the pre-legislative scrutiny report on the draft Mental Health Bill. My constituents are waiting for the rebuild of the Abraham Cowley unit in my constituency, but the framework under which patients are looked after is very important. People in in-patient settings are, by definition, some of the most vulnerable people looked after by the NHS, and a fair proportion are a detained population. Could the Secretary of State update the House on how soon we will see the Government’s response to the pre-legislative scrutiny Committee report on the draft Mental Health Bill and when we expect the proper Bill to be brought forward?

--- Later in debate ---

[Steve Barclay]

My hon. Friend is right to highlight the importance of pre-legislative scrutiny, into which he had a personal input. I am hugely grateful for his work and the work of Baroness Buscombe and others. I met Baroness Buscombe some months ago to discuss the outcome of that pre-legislative scrutiny. I do not have a date to share today, but I am happy to write to my hon. Friend with a further update.

[Florence Eshalomi (Vauxhall) (Lab/Co-op)]

Many of my constituents depend on mental health services provided by the South London and Maudsley NHS Foundation Trust, which provides a range of services for very vulnerable people across a large part of south London. The in-patient service includes cleaning and catering facilities, and it is vital that those services are run well so that well-trained professional staff are able to treat mental health patients. Some of the trust’s staff are contracted to a company called ISS, and they have been on strike. Does the Secretary of State agree that ISS should come to the table and discuss the issues of the pay dispute so that staff can provide the cleaning services for mental health professionals to continue with their vital jobs?

[Steve Barclay]

We are investing more in mental health services as a whole, and that includes the important area of cleaning and catering services. Obviously, it would be inappropriate for me to comment on that specific contractual dispute, but industrial action, in its wider sense, is clearly disruptive and I am very keen for it to be resolved as quickly as possible, whether in the context of consultants or cleaning and catering services.

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

I welcome my right hon. Friend’s statement and the move to put the EPUT inquiry on a statutory footing. He mentioned that putting it on a statutory footing means it will take longer. On behalf of constituents and those who are keen to get closure on these important issues, can he give any kind of indication of when the findings might be available?

[Steve Barclay]

The chair is to be appointed, and given that statutory basis and the independence of the chair, it would be wrong for me to pre-empt the terms of reference. People can look to other statutory inquiries and come to a conclusion. The inquiry is not starting from scratch, and part of the reason we originally went with a non-statutory inquiry was because of the desire for speed. Of course, Dr Strathdee has done a huge amount of work and it will be available to the new chair of the statutory inquiry. One can look to other inquiries and draw conclusions, but I would expect it to move more quickly in this instance because a significant amount of work has already been done.

[Luke Pollard (Plymouth, Sutton and Devonport) (Lab/Co-op)]

I welcome the statutory inquiry, which is a step in the right direction. I also welcome the Secretary of State’s focus on families. Ensuring family involvement in the care of mental health in-patients not only improves patient outcomes but enables proper scrutiny and questioning of care. In regions such as the south-west, many patients facing the most serious mental health crises receive care outside the region, which is often a long way for families to travel. Is he considering the increased commissioning of local provision so that families can know their loved ones are being well cared for? Many families will be concerned about the statement and the experiences of patients in Essex. The right care and the best care for many patients is closer to home.

[Steve Barclay]

The hon. Gentleman raises an extremely important point, and he is right that a particular downside of out-of-area placements is often the distance from families. Indeed, one can see in the data that there is often a corresponding uptick in issues of harm. The crux of his point is very valid. That is why we are committed to building new facilities, with three new hospitals for mental health announced in the statement I gave on the new hospitals programme; that included three new mental health ambulances. This is also about preventing people from needing in-patient care through our crisis cafés, our earlier intervention in community services and the interplay with 111. More fundamentally, it is about giving greater power to commissioners on a place-based basis. The reforms through integrating health and social care, having fewer targets from the centre and allowing more devolved decision making mean that those areas that want to put more money into in-patient mental health, for example, have greater flexibility to do so. The point the hon. Gentleman raises is extremely important and it is exactly what we are facilitating.

[Jackie Doyle-Price (Thurrock) (Con)]

As my right hon. Friend observed, a non-statutory inquiry is generally more fleet of foot than a statutory one. It is so disappointing that the failure of staff to engage in that process has brought us to where we are now. That would indicate a very poor culture and sets the tone for how this inquiry will be taken forward. Let me remind him that one reason we are so anxious to get the Mental Health Act reformed is that kind of behaviour towards patients. Too many in-patient settings see patients as an inconvenience to be managed, rather than having their real welfare at heart. Will he therefore redouble his efforts to make progress on this, because many people who have been through the other side want to see that progress?

[Steve Barclay]

First, I do not want to wait for legislation before we make changes. Indeed, under the leadership of Paul Scott, who joined EPUT in 2020, investment has been made, with an extra £20 million being put into the in-patient wards and a further £20 million into community services. We are keen to make further progress on that. On the wider issue of legislation, I know that my hon. Friend, as a former Government Whip, is particularly acquainted with how the legislative process works, but the Government take her comments, and those of the House, on engaging staff in this process seriously, and we are working very actively on that.

[Charlotte Nichols (Warrington North) (Lab)]

It is vital that the Government work with sector experts and those with lived experience of in-patient mental health services in getting this vital area of policy right. As someone who spent almost a month as a psychiatric in-patient back in 2021, I know at first hand how difficult, disorientating and dehumanising these settings are, at a time when you are at your most vulnerable, and how easily things that are well-intentioned can and do go wrong. Will the Secretary of State therefore commit to working with Mind and other organisations giving patients and their families a voice to shape these improvements, to ensure that any changes happen with patients and their families, and not to them?

[Steve Barclay]

I very much agree on that. The hon. Lady speaks powerfully of the importance of engaging with those with experience—the charity sector, the families and those directly impacted by the decisions taken in in-patient mental health facilities. She makes an extremely pertinent point and it is very much part of the approach we are taking.

[Mr Mark Francois (Rayleigh and Wickford) (Con)]

I thank the Secretary of State for mentioning our great friend Sir David Amess. I am sure that, if he were still with us today, he would welcome this statement, as do I, as does his successor and, as is clear, as do all other Essex MPs. The Secretary of State has done the right thing and should be commended. EPUT has been a troubled organisation for some time, although I believe that its chief executive, Mr Paul Scott, is genuinely trying to turn it around. As we look back to find out what went wrong—some things clearly went very badly wrong—will the Secretary of State work with the chief executive, providing support and resources, not just to make sure this does not happen again, but to try to help EPUT improve in the future as well as examine the past?

[Steve Barclay]

I know that my right hon. Friend was particularly close to Sir David and is uniquely qualified to speak of his interest and involvement in these issues. I am happy to give him the reassurance that he seeks on working closely with the chief executive and the leadership team there. I know from my engagement with colleagues across the House that they will be closely involved in this in the weeks and months ahead.

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

South London and Maudsley is the mental health trust that covers my constituency. This year, as a direct result of the Secretary of State’s wider policies, SLaM is cutting £45 million from services. He has said today that he wants to improve mental health care and that he takes safety concerns seriously, but when will those words be meaningful for mental health care for patients and their families in Southwark?

[Steve Barclay]

The meaningfulness of those comments can be seen in the fact that we are putting this inquiry on a statutory basis; the £2.3 billion additional investment compared with what we had four years ago; the crisis cafés and the other schemes we have, as part of the 160 schemes we are bringing forward; and our willingness to innovate in mental health through the use of mental health digital apps. There is a whole range of initiatives because that is the right approach. Across the House, it has been recognised that in the past mental health did not get as much focus as physical health, which is why we are investing more. Again, the House recognises that covid has brought more focus to these issues, which is why this is a priority for the Government. Today’s statement is a further continuum in that effort.

[Sir James Duddridge (Rochford and Southend East) (Con)]

I thank the Secretary of State for his attitude to this issue and the time he has put in. I fully support the points he has made about non-statutory and statutory inquiries. It was right to start off non-statutory and to change when the situation changed and we were not getting what we wanted.

I reflect on the comments of my right hon. Friend the Member for Rayleigh and Wickford (Mr Francois) about, “Where did this go wrong?” Since I first visited Rochford Hospital, part of what is now EPUT, in my constituency, I believe we have had three Secretaries of State visit, as well as at least five Ministers responsible for these areas. What was the South Essex Mental Health Partnership grew to take in more of Essex, and it then reached across the border into Hertfordshire and, if I recall correctly, went further. It perhaps just got too big. Early on, the constituents I spoke to were concerned about getting in; they wanted their children to get in, but there were delays and this was about overall capacity. Now the issue is about the quality of what goes on. The hon. Member for St Albans (Daisy Cooper) mentioned beds and I can tell her that this is not a problem of beds, certainly in Rochford Hospital, where there are plenty of beds; it is about having the clinical psychiatrists specialised in children’s services and the supporting nurses to deliver. We should also pay attention to the fact that things are much better where people have simple mental health problems, but very few people have those. When these problems are combined with drug use or autism, particular challenges are presented while people are in these places and during discharge. I urge the Secretary of State to encourage the inquiry to look into all those issues.

[Steve Barclay]

My hon. Friend makes extremely important points, and I absolutely agree with him. Indeed, I will draw the inquiry’s attention to the points he raises. He is right about the trade-off between non-statutory inquiries giving speed and statutory inquiries having a wider range of powers. We have followed the evidence on that, which Dr Strathdee has shared. There is also a balance between the size of a facility and the quality of the care. Data is a key component within that and the rapid review was focused particularly on it. All of us are focused on, “How do we get the best patient outcomes? Where those have fallen short, how do we ensure the lessons of that?” That is what the statutory inquiry is absolutely focused on and it is important that families then engage with it.

[Kerry McCarthy (Bristol East) (Lab)]

The Care Quality Commission report at the end of last year said that workforce issues and staffing shortages are the greatest challenge facing the mental health sector. I am sure that that would not have come as a surprise to the Health Secretary. The Glenside campus, part of the University of the West of England, is in my constituency, and it runs mental health training courses for nurses. What conversations is he having with the sector about how we can ensure we get enough mental health nurses trained, so that we get the right people coming through and they are encouraged to stay the course?

[Steve Barclay]

The hon. Lady’s point is important, given that in the wake of the pandemic we have seen significant increases in demand, particularly for children’s and young people’s services. For example, in a year, the demand increased by 41%, so there is significant demand, which places pressure on the workforce. That is why the Prime Minister and the Chancellor have committed to the long-term workforce plan, which we will be bringing forward very shortly. We have been engaging with the sector, including the mental health sector, as part of that plan. NHS England has been doing significant work on that in recent months.

[Dean Russell (Watford) (Con)]

The background stories to today’s announcement are truly heartbreaking, and I welcome the statutory inquiry. The Secretary of State referred to recent announcements about funding and the 111 helpline. Will he expand on what support can be accessed by people, especially young people, if they are going through a crisis right now?

[Steve Barclay]

It is extremely important that we get support to young people, because many mental health cases start at a young age. Indeed, data suggests that as many as 50% of mental health cases crystalise by the age of 15, so it is important that intervention is made early. Our programme in schools, for example, is focused on that. It is also important for us to have better community support, which is why we are looking at what mental health support can be offered when people phone 111 and at how we can better scale up the use of digital apps that offer support, given that people often access information through their phones or digital channels in a way that they did not five or 10 years ago.

[Jim Shannon (Strangford) (DUP)]

On behalf of my party, I express my sympathy to all the families who have been bereaved and hurt by what has taken place. I thank the Secretary of State for his announcement about the statutory inquiry and the new powers. It is clear to those of us in the House who listened to his statement that he is committed to making patients’ lives better; we thank him and I put it on the record that he deserves credit for that. I know that the Secretary of State is always keen to share progressive strategies and policies with the regional Administrations; he is on record as having said that. It is clear that many lessons can and will be learned, so does he intend to share them with the regional Administrations?

[Steve Barclay]

I am extremely keen to share our experience, so that we can learn from each other. As the hon. Gentleman knows, this is a shared challenge across our United Kingdom. The pandemic shone a spotlight on the mental health pressures that many people face, and I am extremely keen to work on a UK-wide basis with colleagues to ensure that we learn from each other as we take these measures forward.

[Julian Sturdy (York Outer) (Con)]

Given that a recent report into mental health services in York established that communication is a clear concern that is affecting mental health outcomes and safety locally, what specific steps would my right hon. Friend take to ensure better communication between primary and secondary care services? As we all know, that is vital in delivering faster and better outcomes for patients not only in York but across the country.

[Steve Barclay]

That is an extremely good point. In fact, a key element of the primary care recovery plan looks at the handover points between secondary and primary care, which are often the cause of significant additional work within primary care. We are keen to see where we can ease those pressures, which in turn frees up our experienced GPs to do those tasks that require more time, so that is part of the primary care recovery plan. Through the rapid review and the focus on data, we are better able to identify where there are gaps or areas of duplication that take clinicians away from spending time with patients. That matters both in secondary and primary care, and it is something that the rapid review has been addressing.

[Peter Gibson (Darlington) (Con)]

I welcome my right hon. Friend’s statement and the publication of the rapid review. While Essex is rightly getting its statutory inquiry, it appears that the situation in Tees, Esk and Wear Valleys NHS Foundation Trust will merely be covered by the new powers of the Healthcare Safety Investigation Branch. Will my right hon. Friend confirm that TEWV will be covered by the HSIB review? When can families expect to hear anything from that review? Will he keep the need for a statutory inquiry into TEWV under review?

[Steve Barclay]

It will be covered by the HSIB review. On how long that will take, investigations under the predecessor body typically took around a year, which is one of the advantages of the speed at which these things can be done. I hope my hon. Friend can see from the statement today that we will follow the evidence, given the decision we have taken to put the Essex inquiry on a statutory footing, but the HSIB approach has the benefit of speed. I hope that will benefit his constituents, as we learn the lessons.

It is worth clarifying that the new body will have much greater teeth, as a result of the reforms that were passed by the House in 2022. While it is not on a statutory footing, it actually has more power than was the case in the past. That is why we think it is the right approach for learning the lessons in his constituency and more widely.

[Andrew Percy (Brigg and Goole) (Con)]

The Secretary of State has rightly pointed to the £2.3 billion in extra funding and has reiterated from the Dispatch Box his belief that early support for children’s mental health is vital. Does he agree that this is sadly still patchy across the country? Early access to children’s mental health services needs to be a priority for all new care systems. I commend to him the approach being taken in north Lincolnshire, where that is absolutely the case and where it has been championed by the wellbeing boards and in all our health partnerships. That should be replicated across the country.

[Steve Barclay]

I commend my hon. Friend for the service he gives as a community first responder. Through that, I know he takes a huge interest in these matters. As with the point about data, I am extremely keen that where there is good practice, we are socialising that across the country as a whole, rather than having it in pockets. I would be extremely keen to work with him on the lessons coming out of north Lincolnshire and on how we scale that across the country, so that good practice can be adopted more widely. Indeed, the statement today is about how we will ensure that the lessons from Essex can be applied more widely, so that best practice is socialised across the country.

[Madam Deputy Speaker (Dame Eleanor Laing)]

I thank the Secretary of State for his statement, which will be welcomed by everyone across Essex.

National Institute for Health and Care Research Capital Call

Steve Barclay Excerpts

Tuesday 27th June 2023 Written Statements

[The Secretary of State for Health and Social Care (Steve Barclay)]

Today I am pleased to announce just over £96 million of funding from the National Institute for Health and Care Research (NIHR) for equipment and technology to support NHS organisations to deliver high-quality research to improve the prevention, management and treatment of disease for patient benefit.

This large-scale investment right across the length and breadth of England will support over 90 NHS organisations, including less research-active trusts, to grow research capacity and take research to populations outside of the major teaching hospitals. I want everyone, regardless of where they live, to be able to access the latest innovations in the health and care system through research.

The majority (55%) of funding will go to NHS organisations outside of the greater south-east aligned to the Government’s levelling up commitment. It includes equipment for primary care research expansion in integrated care systems across the east midlands; and mobile research units across seven regions in England, from North Tees and Hartlepool in the north-east to Somerset in south-west, to take research to underserved regions and communities with major health needs, including rural areas.

There is also funding for cutting-edge equipment and technology such as a mobile CT scanner for the north-west coast region to support respiratory, lung cancer diagnostic and cardiology research studies; and state-of-the art equipment in Exeter to transform genomic and transcriptomic sequencing for research into dementia, infectious diseases, cancer and precision medicine. This will enable research that can drive future innovation in the health and care system and allow the UK to remain as one of the most attractive places in the world for innovative commercial companies to invest in research.

I intend to build on this substantial Government investment with a series of further capital calls through the NIHR. The emphasis in future rounds will be on extending the reach of research into our communities, including a focus on reaching those in rural areas, to improve access to clinical research for all. We particularly want to ensure that people outside of major population centres in rural and coastal areas are enabled to take part in clinical research by using innovative ways of designing and delivering our research, fit for the future. Ensuring our world-leading researchers have the right equipment, in the right place, is key to delivering the best, most innovative health and care for our population.

[HCWS886]

Lung Cancer Screening

Steve Barclay Excerpts

Monday 26th June 2023 Commons Chamber

[The Secretary of State for Health and Social Care (Steve Barclay)]

Thank you, Madam Deputy Speaker. May I first address the remarks you made on behalf of Mr Speaker? Of course, any disappointment expressed by Mr Speaker is a matter of concern. No discourtesy was wished on the part of the Government. It may be helpful to clarify that no change of policy is being announced in the statement; it is an expansion of an existing policy, which I hope the House will regard as good news. However, we very much take on board any concerns that Mr Speaker has expressed.

With permission, Madam Deputy Speaker, I would like to make a statement on our national lung cancer screening programme for England. About a quarter of patients who develop lung cancer are non-smokers. We all remember our much-missed friend and colleague, the former Member for Old Bexley and Sidcup, James Brokenshire. He campaigned tirelessly to promote lung cancer screening and was the first MP to raise a debate on that in Parliament. His wife Cathy is continuing the brilliant work that he started in partnership with the Roy Castle Lung Cancer Foundation.

In 2018, after returning to work following his initial diagnosis and treatment, James told this House that the Government should commit to a national screening programme and use the pilot to support its implementation. I am sure many colleagues in the Chamber will recall him saying:

“If we want to see a step change in survival rates—to see people living through rather than dying from lung cancer—now is the time to be bold.”—[Official Report, 26 April 2018; Vol. 639, c. 1136.]

Despite being a non-smoker, James knew that the biggest cause of lung cancer was smoking and that the most deprived communities had the highest number of smokers. That is why I am delighted that today the Prime Minister and I have announced a national lung cancer screening programme, building on our pilot programme, which will target those who smoke or have smoked in the past.

Lung cancer takes almost 35,000 lives across the UK every year—more than any other cancer. Often, patients do not have any discernible symptoms of lung cancer until it is well advanced; in fact, 40% of cases present at A&E. Since its launch in 2019, and even with the pandemic making screening more difficult, our pilot programme has already given 2,000 lung cancer patients in deprived English areas an earlier diagnosis. That matters because NHS England states that when cancer is caught at an early stage, patients are nearly 20 times more likely to get at least five years to spend with their families.

We all know that smoking is the leading cause of lung cancer. It is responsible for almost three quarters of cases, and in deprived areas people are four times more likely to have smoked. We have deployed mobile lung trucks equipped with scanners to busy car parks in 43 deprived areas across England. Before the pandemic, patients from those areas had poor early diagnosis rates, with only a third of cases caught at stage one or two. To put that in context, while a majority of patients diagnosed at stage one and two get to spend at least five more years with their children and grandchildren, less than one in 20 of those diagnosed at stage four are as fortunate. Thanks to our targeted programme, three quarters of lung cancer cases in those communities are now caught at stage one and two.

Targeted lung cancer checks work. They provide a lifeline for thousands of families.

We need to build on that progress, which is why we will expand the programme so that anyone in England between the ages of 55 and 74 who is at high risk of developing lung cancer will be eligible for free screening, following the UK National Screening Committee’s recommendation that it will save lives. It will be the UK’s first and Europe’s second national lung cancer screening programme. If results match our existing screening—there is no reason to think that they will not—when fully implemented the programme will catch 8,000 to 9,000 people’s lung cancer at an earlier stage each year. That means that each and every year around 16 people in every English constituency will be alive five years after their diagnosis who would not have been without the steps we are taking today. That means more Christmases or religious festivals with the whole family sitting around the table.

Alongside screening to detect conditions earlier, we are investing in technology to speed up diagnosis. We are investing £123 million in artificial intelligence tools such as Veye Chest, which allows radiologists to review lung X-rays 40% faster. That means that suspicious X-rays are followed up sooner and patients begin treatment more quickly.

How will our lung cancer screening programme work? It will use GP records to identify current or ex-smokers between the ages of 55 and 74 at a high risk of developing lung cancer, assessed through telephone interviews. Anyone deemed high risk will be referred for a scan, and will be invited for further scans every two years until they are 75.

Even if they are not deemed at high risk of lung cancer, every smoker who is assessed will be directed towards support for quitting because, despite smoking in England being at its lowest rate on record, tobacco remains the single largest cause of preventable death. By 2030, we want fewer than 5% of the population to smoke. That is why in April we announced a robust set of measures to help people ditch smoking for good, with 1 million smokers being encouraged to swap cigarettes for vapes in a world-first national scheme. All pregnant women will be offered financial incentives to stop smoking, and HMRC is cracking down on criminals who profit from selling counterfeit cigarettes on the black market.

The lung cancer screening programme has been a game changer for many patients: delivering earlier diagnoses, tackling health inequalities and saving lives. We are taking a similar approach to tackle obesity, the second biggest cause of cancer across the UK. The pilot we announced earlier this month will ensure that patients in England are at the front of the queue for innovative treatments by delivering them away from hospital in community settings. Together, this shows our direction of travel on prevention, which is focused on early detection of conditions through screening and better use of technology to speed up diagnosis and then treatment, because identifying and treating conditions early is best for patient outcomes and for ensuring a more sustainable NHS for the future, for the next 75 years. I commend this statement to the House.

[Madam Deputy Speaker (Dame Eleanor Laing)]

I call the shadow Secretary of State.

--- Later in debate ---

[Madam Deputy Speaker (Dame Eleanor Laing)]

Order. Before I call the Secretary of State, let me say to the hon. Member for Ilford North (Wes Streeting) that I think the whole House will join him, and me, in sending condolences to the hon. Member for Mitcham and Morden (Siobhain McDonagh).

[Steve Barclay]

On behalf of His Majesty’s Government, Madam Deputy Speaker, I echo your sentiments and those of the shadow Health Secretary in sending the House’s condolences to the hon. Member for Mitcham and Morden (Siobhain McDonagh), and also our fond remembrances of Margaret McDonagh. She played a pivotal role in the 1997 landmark election for the Labour party, and her loss will be keenly felt on the Labour Benches, but also much more widely across the political spectrum.

The hon. Gentleman raised a number of issues relating to screening, on which there is much consensus in the House, but one issue that he did not particularly note is the importance of this programme in closing the health inequality gap. The detection of stage 1 and stage 2 cancers, which has had such a remarkable impact on survival rates, has been targeted at the areas with the highest smoking rates and, therefore, the most deprived communities. I hope there will be a fairly wide consensus across the House that that is a real benefit of the programme. We aim to take the proportion of lung cancer survivors from 15% to 40% over the next 18 months, and to 100% in the years ahead, and we are talking today about a series of measures that have proved to be effective: there is remarkable evidence of the survival rates that they generate.

The hon. Gentleman raised a number of wider issues related to the Government’s record on cancer. The NHS has seen and treated record numbers of cancer patients over the last two years, with cancer being diagnosed at an earlier stage more often and survival rates improving across almost all types of cancer. Indeed, the expansion of the screening programme is a good illustration of the clear progress that the Government are making.

The hon. Gentleman raised the issue of junior doctors—an issue that we have debated a number of times across the House. He says that he does not support the junior doctors in their demand for a 35% pay rise. They have, of course, offered to spread it over an extra year to take 2024-25 into account, but for that they want a 49% pay rise. This is slightly esoteric: the hon. Gentleman says he does not support their demands, but he also criticises the Government for not meeting those demands.

The hon. Gentleman raised the subject of research funding, and I was grateful to him for doing so, because the Government are spending more than £1 billion on research through the National Institute for Health and Care Research. I have met the president of Moderna, with which the Government have signed up to one of our landmark partnerships with the life sciences sector. There is huge potential for us to work with life science partners as part of our health commitment. It is clear that those within the industry see the Government’s commitment and are responding to it, even if Labour Members fail to do so.

We are expanding our programme because it demonstrably works. It is tackling health inequalities and significantly increasing survival rates. It is part of our wider commitment, through our work with Genomics England and our work on the national screening programmes to screen 100,000 babies. The programmes cover not just lung cancer but, for instance, breast cancer. My hon. Friend the Member for Winchester (Steve Brine), the Chair of the Health and Social Care Committee, raised the issue of HIV screening with me last week. That is one of the areas in which early detection is having clear results. We are diagnosing more cases, which is why survival rates are improving in almost all types of cancer.

[Madam Deputy Speaker (Dame Eleanor Laing)]

I call the Chairman of the Health and Social Care Committee.

[Steve Brine (Winchester) (Con)]

I remember dear James Brokenshire saying the words that the Secretary of State repeated today in the House. James made this happen—this is a fantastic prevention announcement. Although this nationally expanded programme cannot prevent lung cancer, will the Secretary of State confirm that we will stick by the principle of making every contact count? When people come forward for a lung risk assessment, we can offer emotional support where a problem has been detected, provide smoking cessation services to those who are still smoking, or just put our arms around people where there are comorbidities. When people come into contact with the health service, will we make every contact count for them?

[Steve Barclay]

I know that my hon. Friend was a Health Minister at the time that James was raising these points, and that he takes a close personal interest in the issue. He is right about the importance of the point at which people come forward. I was having a discussion this morning about the fact that when most patients come forward for screening, they will not be diagnosed with cancer, but it is still an opportunity for smoking cessation services, for example, to work with them on reducing the risk that continued smoking poses. My hon. Friend is right about using the opportunity of screening to pick up other conditions and to work constructively to better empower patients on the prevention agenda.

[Rachael Maskell (York Central) (Lab/Co-op)]

Of course those most at risk must be fast-tracked into diagnostic services, but when we are 2,000 radiologists short, 4,000 radiographers short and 5,000 other health staff short in those diagnostic services, how can people get the diagnostic services they need? When will we have the workforce in place to service this policy?

[Steve Barclay]

Clearly, the earlier we detect cancer, the less pressure it puts on the workforce. There is much more work involved in the treatment of a later cancer than of an earlier cancer. That is why we are investing in our community diagnostic programme, with 108 community diagnostic centres already open and delivering 4 million additional tests and scans. As part of the wider £8 billion investment in our electives recovery, over £5 billion is going into that capital programme. Yes, the workforce plan is a key part of that, but so is getting the CT scanners and the other equipment in place. That is exactly what our community diagnostic programme is doing, and it is being furthered by our screening programme through announcements such as this.

[Maggie Throup (Erewash) (Con)]

Alongside the new lung screening programme, which I welcome, will my right hon. Friend now commit to implementing in full the recommendations made by Dr Javed Khan in his review, so that we can finally stub out the No. 1 cause of preventable cancer and end the suffering for smokers who develop cancer and for their loved ones? Our late colleague requested that we be bold. In taking forward the Khan review in full, I am sure we would be fulfilling his wishes.

[Steve Barclay]

My hon. Friend is quite right to highlight the significance of smoking as a cause of cancer. We have a number of measures, including the programme to move 1 million smokers on to vaping, the financial incentives to encourage pregnant women not to smoke, the tougher enforcement and the consideration of inserts for packaging. The Government are taking a range of measures to address the very important issue that my hon. Friend rightly raises.

[Dan Jarvis (Barnsley Central) (Lab)]

The Secretary of State may be aware that, following work that I have been doing with Cancer Research UK, I have written to him and to the Minister for Social Care to outline my specific concerns about the lack of a cancer strategy. I would be very grateful if he or the Minister came back to me.

As the Secretary of State will know, cancer does not affect everyone equally. When it comes to health outcomes—the Secretary of State made this point—it is often more economically deprived areas, such as coalfield communities like Barnsley, that continue to lag behind. I completely agree and accept his important point about smoking, but studies have also shown that those who worked in the coal industry have a higher risk of lung cancer. I ask the Secretary of State to ensure that ex-miners are considered in the roll-out of the new targeted programme.

[Steve Barclay]

The hon. Gentleman raises a valid and important point on the targeting of mining communities. Of course, the roll-out will be shaped by clinical advice, but I will flag that point as we consider the targeting of the programme as it expands.

On the hon. Gentleman’s first point, the major conditions paper will look at these issues in the round. That matters because one in four adults has two or more conditions, so it is important that we look at conditions. A moment ago, I touched on the fact that obesity is the second biggest cause of cancer after smoking, so it is right that we look at multiple conditions in the round. His point about targeting is well made, and I will make sure the clinical advisers respond.

[Tracey Crouch (Chatham and Aylesford) (Con)]

In Medway, which is an area with high levels of deprivation, mortality rates for lung cancer and chronic obstructive pulmonary disease are significantly higher than the average in England, as is smoking-attributed mortality. Due to the towns’ shipbuilding and heavy industry heritage, to follow on from the point made by the hon. Member for Barnsley Central (Dan Jarvis), we also have one of the highest rates of mesothelioma, which is a type of lung cancer.

Although today’s announcement of the national roll-out is welcome, what plans do the Government have to bring vital lifesaving early detection to the doorstep of the Medway towns, as those most affected by lung disease are probably the least able to afford the 47-mile journey to Dover, where Kent’s screening pilot will be based?

[Steve Barclay]

My hon. Friend speaks with great authority on this issue, and she is right to highlight the importance of mesothelioma. A key theme of the pilots is the importance of convenience of access to screening, and a key part of the programme’s expansion is enabling it to be targeted at those communities that are at highest risk, as we heard a moment ago. I take on board her concerns about some of Medway’s challenges, and I know that she has called for this direction of travel more widely in the past—for the targeting of early detection in the community, because early detection brings far better patient outcomes.

[Sir Chris Bryant (Rhondda) (Lab)]

Screening is obviously important, and early detection is a good thing, but I wish the Secretary of State had not made this announcement today, because it is only a tenth of what we need to do to change things. There is a danger that we will make things worse.

My melanoma was diagnosed late, at stage 3, but my treatment started very quickly, within five days. My anxiety is that if we do not have enough radiographers and radiologists, as my hon. Friend the Member for York Central (Rachael Maskell) said, we will be shifting people from doing one set of tests—those for people who may have a later-stage cancer—to other sets of tests, unless we significantly increase the workforce.

Secondly, as the Secretary of State knows well, the statistics for people starting their treatment when we know they have cancer, because they have been diagnosed, are going in the wrong direction. I wish he had been able to stand at the Dispatch Box today and say, “We are going to have more radiographers and radiologists—I can guarantee that—and we are going to make sure that every single person who gets a diagnosis starts their treatment earlier and on time, otherwise we are failing them.”

[Steve Barclay]

Such is the nature of cancer that it has touched many Members, and I know the hon. Gentleman has taken a long, close interest in this issue. Of course, more than nine in 10 cancer patients get treatment within a month. He is right that it is also about diagnosis, which is why, through the community diagnostic centres, we are rolling out 4 million additional tests and scans, about which I spoke a moment ago. It is also why we have invested over £5 billion through our elective recovery programme, including over £1 billion for the 43 new and expanded surgical hubs. There is additional capacity going in, both on the diagnostic side and on the surgical hub side. We need to do both, and we are making significant progress.

[Miriam Cates (Penistone and Stocksbridge) (Con)]

My constituents in Penistone and Stocksbridge will warmly welcome this initiative to diagnose cancer earlier but, as many hon. Members have said, we also need to reduce the waiting times for cancer treatment after diagnosis. Will my right hon. Friend consider using some of the new community diagnostic centres, such as our amazing flagship centre in the constituency of the hon. Member for Barnsley Central (Dan Jarvis), as radiotherapy treatment centres too, to reduce treatment waiting times?

[Steve Barclay]

As part of expanding our capacity, we are doing both: we are expanding the diagnostic capacity—my hon. Friend is right to highlight that investment in Barnsley, as elsewhere—and boosting the surgical capacity through the expansion of our surgical hubs. In addition, we are looking at the patient pathway and identifying bottlenecks and how we design them out, given the additional capacity that is going into the system. So she is right to highlight the investment that is going in, alongside which we need to look at the patient journey and how we expedite that. The bottom line is that we are treating far more patients, the vast majority of whom—more than nine in 10—are getting treatment within a month.

[Richard Foord (Tiverton and Honiton) (LD)]

We know that 28% of victims of lung cancer have not smoked and do not smoke. My mum was one such victim. She died having contracted lung cancer and having not smoked before. But we were lucky in my family that she was diagnosed early. So, on behalf of the Liberal Democrats, I really welcome today’s announcement. However, on behalf of people in Devon whom I represent, I ask why only 40% of the people who are diagnosed will be subject to screening by 2025? Why do we have to wait until 2030 for the screening to be widespread and available to all?

[Steve Barclay]

First, may I express regret about the hon. Gentleman’s own family experience of this condition? On the roll-out programme, we need to build that capacity and to do so in a sustainable way—that point has been raised by Members across the House. We are following the science in targeting those communities that are most deprived; they have the highest prevalence of smoking. Of course we will look at evidence of other risk factors, which colleagues across the House have highlighted, but it is important that we roll this programme out in a sustainable way. What is clear, however, is that it is making progress and it is welcome that so many communities want the programme to be rolled out to their area as soon as possible.

[Mr Philip Hollobone (Kettering) (Con)]

I welcome the Health Secretary’s announcement. If I heard him correctly, it means that up to 9,000 cases will be caught early, which is equivalent to about a quarter of the 35,000 who sadly die every year from lung cancer. How much will the national lung cancer screening programme cost? Why can it not be paid for in its entirety from the profits of the cigarette companies?

[Steve Barclay]

My hon. Friend, an experienced parliamentarian, opens two different issues there. As he well knows, one is a question of tax, which, rightly, I say as a former Treasury Minister, is a matter for the Treasury. As for the roll-out of the programme, the additional cost of the programme will be £1 billion over the seven years. That is the additional cost of that expansion, but how it is funded will be an issue for the Treasury.

[Derek Twigg (Halton) (Lab)]

Anybody who has lost a loved one through lung cancer will know what a horrible and cruel disease it is. Obviously, we welcome any move to improve screening and get more people screened. But I would be interested to know two things from the Secretary of State. First, in one of my local hospitals—recently, I asked a parliamentary question about this—only 77.8% of patients got an urgent referral within 62 days, so quite a lot of people did not. Secondly, how much of the £1 billion will be used to bring in the extra clinicians and staff who will be needed to do the screening?

[Steve Barclay]

I am sorry, but I missed the second part of the question. On the speed of treatment, that is why significant work is going into the faster diagnosis standard, which was hit for the first time in February. Part of the additional capacity going in—the extra 108 diagnostic centres—is to boost that capacity and speed up that treatment. There has been a surge in demand; a significant uptick in the nature of demand. That is the backlog we have been working through as a consequence of the pandemic, but the additional capacity is to address that exact point.

[Edward Timpson (Eddisbury) (Con)]

I welcome today’s announcement and acknowledge the important contribution made by many charities and organisations that work in the world of cancer, including Cancer Research UK and the Roy Castle Lung Cancer Foundation. The pilot has proved that a national screening programme will make a huge and significant difference to many lives, particularly in places that were not in the pilot areas, such as Eddisbury in Cheshire. One aspect of the pilot programme that enabled a diagnosis to be made more quickly was the screening trucks that went out into the community. Will that continue in the national programme, particularly in rural areas such as the one I represent, where there are health inequalities that need to be addressed?

[Steve Barclay]

My hon. and learned Friend is absolutely right. A key feature of the programme is the use of screening trucks to offer checks within the community. When I was talking to patients this morning, a theme that came through was that the prospect of going to hospital for such a check would have been seen as a more daunting experience. The fact that the check was available, using high-quality equipment, in a vehicle in a supermarket car park made it more accessible to people and, as a result, the uptake was higher than it might have been. He is absolutely right to highlight the proven importance of that in the pilot and that delivering checks through community schemes increases participation; that is a key feature of the programme.

[Nick Smith (Blaenau Gwent) (Lab)]

Will the Secretary of State ask the Treasury if the tobacco companies can stump up for the delivery of the programme?

[Steve Barclay]

All Health Secretaries have regular conversations with the Treasury in terms of wider financing. The departmental budget for Health and Social Care is over £180 billion, which is already a significant investment. Through the long-term plan, we have significantly increased our budget and there are many calls on that, including, as we heard from the Opposition Front Bench, in terms of junior doctors’ pay and other issues. Of course these things need to be looked at in the round, but I am always keen to discuss with Treasury colleagues what more can be done.

[Suzanne Webb (Stourbridge) (Con)]

I thank the Secretary of State for the excellent news about the national targeted lung cancer screening programme. As an ex-smoker, I welcome any intervention and the focus on prevention. When I gave up smoking, it was chewing gum and fizzy drinks that got me through. Today, it is vapes. My concern is that young children are using vapes in the first instance, without having smoked, which can lead them to go on to smoke. Will my right hon. Friend join me in welcoming the recent crackdown on marketing vapes to children and the new illicit vapes enforcement squad, which will clamp down on online shops selling illicit vapes to under-18s?

[Steve Barclay]

My hon. Friend raises an important and topical point. The chief medical officer estimates 50,000 to 60,000 smokers a year may potentially give up through vaping, which is something the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Harborough (Neil O'Brien), is particularly focused on. However, there is a marked distinction between vaping as a smoking cessation tool and vaping products that are targeted at children, which is why we have both toughened the approach and closed some loopholes. A call for evidence closed a couple of weeks ago and we are looking at what further measures we can take.

[Sir Simon Clarke (Middlesbrough South and East Cleveland) (Con)]

I warmly welcome today’s announcement, and know people across Middlesbrough South and East Cleveland will do likewise. Across Teesside, a targeted lung health check programme has been running for over a year, led by the extraordinary Jonathan Ferguson, who is the clinical lead at the outstanding James Cook University Hospital in my constituency. The programme identified a curable cancer every two days, through scanners operating 12 hours a day, 7 days a week, from mobile units in supermarket car parks. As the new programme is established and proves its value to millions of people across the country, will my right hon. Friend commit to speaking to Mr Ferguson, who has valuable practical lessons about how the pilot has worked on Teesside, which could benefit many other communities?

[Steve Barclay]

I welcome the work that Mr Ferguson and those at James Cook University Hospital have been doing on the programme. We would be very keen to learn from any experience that they have to share. My right hon. Friend also draws attention to the innovative ways of working that are being piloted, including using scanners for 12 hours a day and looking at how they can operate in different ways. That is what this programme is about: delivering far better patient outcomes, much earlier detection and, as a result, far longer survival for those who otherwise may not have realised they have lung cancer and would have been diagnosed at too late a stage.

Bill presented

Relationships and Sex Education (Transparency) Bill

Presentation and First Reading (Standing Order No. 57)

Miriam Cates presented a Bill to make provision to require the sharing with parents and guardians of copies of materials used in relationships and sex education lessons in schools in England; to prohibit schools in England from using externally produced teaching resources for relationships and sex education that have not been published; and for connected purposes.

Bill read the First time; to be read a Second time on Friday 24 November, and to be printed (Bill 334).

NHS England: Government Mandate

Steve Barclay Excerpts

Thursday 15th June 2023 Written Statements

[The Secretary of State for Health and Social Care (Steve Barclay)]

I am today laying in Parliament the Government 2023 mandate to NHS England. The Government have promised to cut NHS waiting lists, meaning that people can get the care they need more quickly. That promise is at the very heart of this mandate, which will help us deliver for patients, and we are delivering. To support delivery, the Government have made up to £14.1 billion available for health and social care over the next two years, on top of record funding to improve elective, urgent and emergency, and primary care performance.

In February 2022, NHS England published its delivery plan for tackling the covid-19 backlog of elective care. This set out a clear vision for how the NHS will recover and expand elective care and cancer services in the next three years. Since its publication, hard-working health and care staff have made great progress in recovering elective care despite continued pressures from covid-19, flu and industrial action. The NHS succeeded in meeting the ambition to virtually eliminate waits of two years or more in July 2022, and reduced by over 90% from the peak the number of patients waiting 78 weeks or more by April 2023. Patients will also get more choice about where they have treatment. Alongside this, I have set out that the NHS must recover the cancer backlog to pre-pandemic levels and go further to improve one-year and five-year survival for all cancers, achieved by maintaining and improving performance against the 62 and 31-day standards; diagnosing cancers faster and earlier; and continuing work to expand diagnostic capacity.

In January 2023, we published the delivery plan for recovering urgent and emergency care services, reduce waiting times, and improve patient experience. I want to see a system that provides more and better care in people’s homes, gets ambulances to people more quickly when they need them, sees people faster when they go to hospital and helps people safely leave hospital having received the care they need.

And in May 2023, the delivery plan for recovering access to primary care was published, committing to tackle the 8 am rush and make it easier and quicker for patients to get the help they need from primary care through empowering patients, implementing modern general practice access by making sure patients are either given an appointment immediately when they call or signposted to a more appropriate service, building capacity, and cutting bureaucracy. Later this year, subject to consultation, the NHS will enable patients to access prescription medication directly from a pharmacy, without a GP appointment, for common conditions such as earache, sore throat or urinary tract infections.

All of the above priorities will be enabled by supporting the workforce and by accelerating digitalisation, and this will also support ongoing delivery of the NHS long-term plan, including on maternity and neonatal services, mental health services and prevention. The NHS will need to support the workforce through delivering the long-term workforce plan, and building on the functions formerly held by Health Education England: training, retention, and modernising the way staff work. Following the merger of NHS Digital and NHS England, I have also asked the NHS to do more to utilise the power of technology and the skills, leadership and culture that underpins it, to drive a new era of digital transformation. This will allow the health and care system to thrive long into the future, delivering vast benefits for patients—such as using AI to give better treatment, the latest screening techniques to detect illness sooner and equipment that allows more people to be treated at home.

The mandate meets my duties under section 13A of the NHS Act 2006 to set out objectives that NHS England should seek to meet in carrying out their functions. It will apply from today until the date it is replaced. The mandate complements the general duties on NHS England to provide a comprehensive health service with planning and prioritisation done by integrated care boards and integrated care partnerships for their areas.

I have listened to what the health system has asked for: fewer, focused priorities, giving systems clarity on what I am asking them to deliver. This mandate is deliberately shorter than the previous mandate and both emphasises the Government commitment to delivery on the public’s key concerns while allowing integrated care systems the freedom to deliver effectively. The NHS provides a comprehensive health service, and by focusing on these priorities, we can help to make sure everyone gets the treatment they need.

[HCWS853]

Oral Answers to Questions

Steve Barclay Excerpts

Tuesday 6th June 2023 Commons Chamber

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

2. What assessment he has made of the adequacy of the treatment and care available for young people with complex mental health needs.

[The Secretary of State for Health and Social Care (Steve Barclay)]

We have recruited an extra 4,500 NHS children’s mental health specialists, which is a 40% increase on 2019. That is part of our additional £2.3 billion of investment into mental health services, compared to four years ago.

[Sarah Green]

Earlier this year, I was contacted by a mother who told me how her daughter, who has been both autistic and anorexic, has been receiving treatment since she was 13. Sadly, her condition has significantly deteriorated in that time, and it is her firm belief that closer integration of the different services she was accessing would have resulted in much better outcomes for her daughter. Will the Secretary of State consider a review of mental health services for children and young people, to look at how to better integrate services and ensure continuity of care?

[Steve Barclay]

I am sure the whole House is sorry to hear that her constituent’s condition has deteriorated. The hon. Lady raises a very important point about integration, which is exactly the right approach. The 2022 reforms were about integrating health and social care and empowering commissioners to take a more integrated place-based approach. I am sure her local commissioners will take note of the valid point that she raises.

[Mr Speaker]

I call the shadow Minister for mental health.

[Dr Rosena Allin-Khan (Tooting) (Lab)]

A 14-year old climbing out of hospital windows; a child absconding to a local railway station; a teenager with complex needs brought to A&E, requiring four police officers to spend an entire shift watching them, only for them to abscond the next day. There is a pattern here. At almost every step of the way, children needing mental health services face a perfect storm of delay and treatment in inappropriate settings, fuelled by an under-resourced service with over-stretched staff. In light of the Met’s announcement that they will stop attending emergency mental health calls, is it not time for the Government to get their act together, or simply do the right thing and step aside?

[Steve Barclay]

One can see the way the Government are responding constructively to these issues by looking at the pilots we have been rolling out in Humberside, where police are released within one hour in 80% of section 136 detentions. We intend to roll out that pilot nationally.

The hon. Lady is right on the first part of her challenge, as demand for mental health services is increasing. In fact, there was a 41% increase in new referrals to mental health services in 2021 compared to the previous year. Where she is wrong is on the resourcing. She missed my previous answer that set out how we are committing an extra £2.3 billion of investment into mental health services, compared to four years ago.

--- Later in debate ---

[Mary Glindon (North Tyneside) (Lab)]

19. What steps he is taking to improve cancer waiting times and outcomes.

[The Secretary of State for Health and Social Care (Steve Barclay)]

We are diagnosing and treating patients faster. In March, nearly three in four people were diagnosed or given the all-clear within two weeks—ahead of the 28-day target—and nine in 10 patients start treatment within a month.

[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.

[Mr Betts]

When I was diagnosed with multiple myeloma six years ago, my GP gave me two pieces of advice: keep positive and keep active. The other day, I visited the wellbeing centre in my constituency, which is run by Sheffield Hallam University, the Sheffield Teaching Hospitals NHS Foundation Trust and Yorkshire Cancer Research. It is putting on a programme called Active Together to which people who are diagnosed with cancer can be referred by their consultant and have a bespoke programme of treatment involving physical activity, nutrition and psychological support to prepare them for surgery, and a programme after surgery to help them recover. Would the Secretary of State like to come to my constituency to visit this novel and innovative programme to see how it could be rolled out across the country and treat more cancers well in this way?

[Steve Barclay]

The hon. Gentleman raises an interesting and important point. How we better equip patients pre-surgery and post-surgery, how we look at their wellbeing—the keep positive bit and the social prescribing—and how we think about being active are all are hugely important. I would be keen to learn more about the programme that he highlights and for either me or one of the ministerial team to follow up on his offer.

[Holly Mumby-Croft]

In March, the all-party parliamentary group on brain tumours published its report into research funding, which found that only about £15 million of the £40 million pledged has made its way into the hands of the researchers. Can the Secretary of State set out what we can do to fix these challenges in the funding system so that we can get that money into the hands of the researchers and improve those outcomes?

[Steve Barclay]

I welcome the fact that my hon. Friend has raised this point, because the £40 million of funding is available. That money is there, ready to allocate to quality bids. All the bids that have met the National Institute for Health and Care Research standard have been funded, but she is right to say that there is more money available and we stand ready to work with researchers to get that money allocated as soon as those quality bids come in.

[Mary Glindon]

Analysis by Cancer Research UK projects that, by 2040, cancer cases will rise to over half a million new cases a year. Will the Secretary of State confirm when the NHS long-term workforce plan will be published, that it will set out transparent projections for workforce need for the next five, 10 and 15 years, and that it will be fully funded to ensure that there are enough staff to deliver timely diagnosis and treatment for cancer patients?

[Steve Barclay]

The hon. Lady is correct to say that demand for cancer services is increasing. We have seen demand up a fifth recently. That is why, alongside the long-term workforce plan, to which we are committed—the Chancellor set out that commitment in the autumn statement—we are also putting over £5 billion of investment into diagnostic centres, surgical hubs and equipment in order to better provide, alongside the workforce, the skills and equipment we need to treat cancer.

[Mr John Baron (Basildon and Billericay) (Con)]

What assurance can the Secretary of State give that both the letter and the spirit of section 5 of the Health and Care Act 2022 will be embraced to encourage the NHS to improve early diagnosis and therefore cancer survival rates by focusing on outcome measures such as the one-year survival rate, so that we can start catching up with international averages when it comes to survival?

[Steve Barclay]

I pay tribute to my hon. Friend, who has long championed this issue. Indeed, he secured an amendment to the Health and Care Act as part of that campaign. We will be fulfilling our obligation by including an objective on cancer outcomes when we publish the next mandate to NHS England, and I hope he will see that as a welcome step.

[Maggie Throup (Erewash) (Con)]

To improve cancer waiting times and outcomes, and learning from the success of the covid vaccine roll-out where hard-to-reach cohorts were vaccinated in everyday settings such as shopping centres and football stadiums, will my right hon. Friend look at locating more community diagnostic centres away from formal clinical settings in hospitals and taking them out into the community?

[Steve Barclay]

This is an innovative and exciting development, thinking about how we offer services in different ways and bring those services to patients much more locally. The community diagnostic centres are a huge step forward in that, but we should also be looking at our engagement with employers, at how we use more tests at home and at the successes we have had, for example, with some of the screening programmes in order to offer more services closer to patients.

[Sir Chris Bryant (Rhondda) (Lab)]

The figures on diagnosing people with cancer are certainly improving, but what is getting worse, and has got significantly worse in the last three months, is the starting of treatment for people who definitely have cancer. The figures are now the worst on record, with 19,000 people waiting for treatment, and all the evidence suggests that waiting another week adds 10% to the likelihood of death. Can I please urge the Minister not always to give the rosy, good statistics but to face up to the fact that there are real dangers in the statistics, too?

[Steve Barclay]

I know the hon. Gentleman takes a very close interest in this, and we can all see that there is a shared desire to meet the increasing demand. He recognises the progress on diagnostics. Nine in 10 patients are starting treatment within a month, and the all cancer survival index for England is steadily increasing, but I agree that there is much more still to do, which is why we are investing in diagnostic centres, surgical hubs and the long-term workforce plan. I am very happy to continue working with him and other colleagues as we meet this ongoing challenge.

[Virginia Crosbie (Ynys Môn) (Con)]

Does the Minister agree that one of the ways we can improve cancer care and outcomes is by supporting brilliant charities such as Chemocare Bags? Emma Hart and her team do an outstanding job of putting together bags, which include fluffy socks, puzzle books, colouring books, mints and lip salve, for those starting chemotherapy at Ysbyty Gwynedd in Bangor.

[Steve Barclay]

I am very happy to join my hon. Friend in paying tribute to all those who support Chemocare Bags for the fantastic work they do. That sort of support makes a real difference to patients, and the NHS benefits hugely from the work of volunteers, including those at Chemocare Bags.

[Mr Speaker]

I call the shadow Minister.

[Andrew Gwynne (Denton and Reddish) (Lab)]

As my hon. Friend the Member for Rhondda (Sir Chris Bryant) pointed out, the brutal truth is that the Tories have consistently missed England’s cancer treatment target since 2013. Last year, 66,000 cancer patients waited more than two months for their first treatment following an urgent GP referral, and the UK now has the worst cancer survival rate in the G7. Labour will give the NHS the staff, the technology and the reform it needs, and we make no apologies for expecting cancer waiting times and diagnosis targets to be met once again. That is our mission. Why is theirs so unambitious?

[Steve Barclay]

We are making significant progress. The hon. Gentleman specifically mentions GP referrals, and there were more than 11,000 urgent GP referrals for suspected cancer per working day in March 2023, compared with just under 9,500 in March 2019, so we are seeing more patients.

Let me give an indication of how we are innovating on cancer. We have doubled the number of community lung trucks, which means the detection of lung cancer at stages 1 and 2 is up by a third in areas with the highest smoking rates. In the most deprived areas, we are detecting cancer much sooner, and survival rates are, in turn, showing a marked improvement.

[Judith Cummins (Bradford South) (Lab)]

6. What steps he is taking to improve healthcare for women.

--- Later in debate ---

[Luke Hall (Thornbury and Yate) (Con)]

11. What steps he is taking to provide funding for new hospitals and health centres.

[The Secretary of State for Health and Social Care (Steve Barclay)]

We are investing record sums in the NHS estate, with more than £20 billion in the largest hospital building programme and, in addition, a further £1 billion to put an extra 5,000 bed capacity into NHS trusts, and more than £5 billion as part of our elective recovery plan, including for diagnostic centres and new surgical hubs.

[Luke Hall]

The Secretary of State is aware of the £30 million bid that we have submitted to redevelop Thornbury health centre. That new facility would provide GP appointments, more out-patient services, more mental health support and a proactive frailty hub to keep elderly residents in their homes for longer with the support that they need. Thornbury is a growing town and it desperately needs the new facility. Can the Secretary of State update me on the timescales for the outcome of our bid, and will he meet me to discuss it in more detail?

[Steve Barclay]

I know that is an extremely important scheme. My hon. Friend will know that the costs have risen considerably from when it was first proposed, and it is therefore right that we look at embracing modern methods of construction and at whether a rebuild option is the way forward. I am very happy to meet him to discuss it.

[Mohammad Yasin (Bedford) (Lab)]

The Government have failed to support the East London NHS Foundation Trust’s bid for a new hospital, despite the fact that it has the capital to build the much-needed Bedford health village. We have a mental ill-health epidemic among adults and children. Does the Minister agree that it is reckless to expect my constituents to wait many months and to travel miles to access in-patient mental health services?

[Steve Barclay]

The hon. Gentleman might have missed in the announcement we made a couple of weeks ago that we are building three new mental health hospitals as part of the hospital building programme. That is also a part of our wider support for mental health, including the extra £2.3 billion of funding compared with four years ago.

[Boris Johnson (Uxbridge and South Ruislip) (Con)]

May I thank my right hon. Friend for the rapid progress he is making on the hospital building programme? Can he confirm that he will shortly be announcing a full and final programme of funding so that we can deliver a superb new state-of-the-art hospital in Hillingdon, where, I am proud to say, enabling works are already under way?

[Steve Barclay]

I am delighted to hear that the enabling works are under way. I know that my right hon. Friend has championed both Hillingdon and the new hospital building programme. I am sure that he will welcome the investment of more than £20 billion. I can confirm that Hillingdon will be fully funded. In addition to the enabling works, we are working closely with the trust to incorporate the Hospital 2.0 design into Hillingdon, as we will at Whipps Cross, as part of taking that programme forward.

[Cat Smith (Lancaster and Fleetwood) (Lab)]

When will the Government announce capital funding for the new hospital in Lancaster: before or after 2030?

[Mr Speaker]

And Chorley, of course.

[Steve Barclay]

Chorley is extremely important, Mr Speaker—I am very sighted on that.

Our commitment is that that is part of the new hospital building programme. We said that it is part of the rolling programme, so it will not be completed by 2030 but we are keen to get work started on it, and that is exactly what we will be discussing with Members of Parliament in the weeks ahead.

[Anthony Mangnall (Totnes) (Con)]

12. When he plans to publish a dental recovery plan.

--- Later in debate ---

[Dr Luke Evans (Bosworth) (Con)]

13. What progress he has made on improving hospital facilities.

[The Secretary of State for Health and Social Care (Steve Barclay)]

The Government are providing record investment in NHS hospital facilities to improve staff and patient experiences and provide extra capacity to cut waiting lists, including the more than £20 billion that we announced just under two weeks ago.

[Dr Evans]

I thank the Secretary of State for his serious investment in Leicestershire, with £14 million for the diagnostic centre in Hinckley and now part of that £20 billion going to Leicester Royal Infirmary, Leicester General Hospital and Glenfield Hospital, including for upgrading the car park. But there is one final part. In 2018 we had £7 million allocated to Hinckley for improvements, but due to covid and the community diagnostic centre investment, the business plan has changed to a day case unit. The money is there. Will he remove the red tape and look on this kindly and swiftly?

[Steve Barclay]

My hon. Friend is right to highlight the series of investments that we have made in his local area. On the specific case he raises, he will know that the business case needs regional approval, and that is currently with NHS colleagues, but I am happy to commit to him that once that is received, we will look at it very keenly.

[Andy Slaughter (Hammersmith) (Lab)]

How much of the reduced £20 billion for the 2030 new hospital programme, if any, is secured for Imperial College Healthcare NHS Trust hospitals, and what are the new completion dates for building works to Charing Cross, Hammersmith and St Mary’s hospitals, now that they have been removed from the list of projects to be completed by 2030?

[Steve Barclay]

As I set out in my statement, there are three schemes within the trust proposal. That is part of the rolling new hospital programme. We are keen to get the enabling works started as soon as possible. That includes a decant at Charing Cross to enable floor-by-floor refurbishment to proceed. We also need to discuss with the trust potential sites for St Mary’s. There is a considerable amount of work to be done, but we are keen to get that enabling work done as soon as possible.

[Justin Tomlinson (North Swindon) (Con)]

I warmly welcome the works beginning on the new £26 million A&E facility in Swindon, hot on the heels of the £23 million urgent care and radiotherapy centres. Will the Secretary of State confirm that this is the single largest investment in Swindon healthcare facilities?

[Steve Barclay]

I am very happy to confirm that it is the largest investment in Swindon facilities. My hon. Friend is right to draw the House’s attention to the £26 million investment in A&E and the £23 million investment in radiotherapy. It is a tribute to his championing of the need for those facilities in Swindon that the NHS has responded and this capital funding has been provided.

[Alex Cunningham (Stockton North) (Lab)]

I have seen the wide smiles in the pictures of the Prime Minister, former Health Secretary and other MPs who have been happy to visit North Tees hospital in my constituency, where health inequalities are some of the worst in the country. They know that it is not fit for purpose, so why on earth have the Prime Minister and his Health Secretary turned their backs on the dedicated staff there and rejected their bid to replace our rundown hospital?

[Steve Barclay]

The hon. Gentleman seems to have missed the £12 billion record investment in capital across the NHS, the investment in the NHS app, the investment in tech—

[Alex Cunningham]

That is not North Tees. You cancelled it 13 years ago.

[Steve Barclay]

No, the technology programmes are national programmes that cover everyone, including North Tees. It is slightly odd to suggest that one place alone in the country would be exempt from a national programme; that is simply not the case. We are making record investment, including over £20 billion in the new hospital programme and 160 diagnostic centres and 43 new surgical hubs this year.

[Sarah Owen (Luton North) (Lab)]

T2.   If he will make a statement on his departmental responsibilities.

[The Secretary of State for Health and Social Care (Steve Barclay)]

As Health Secretary, I have been clear that deploying the latest technology and innovation is essential in order to deliver our priorities: to cut waiting lists, improve access to GPs and improve A&E performance. The NHS app is at the heart of this, including the enhancement of patient choice set out in our recent announcement, which is not available to patients in Wales. The Patients Association estimates that by enabling people to select a different hospital in the same region on the app, we can cut their waiting times by as much as three months.

We have been making major improvements behind the scenes, which are already paying off. Today, I can tell the House that between March 2022 and March of this year, there have been 6 million new registrations for the app; repeat prescriptions via the app have increased from 1.6 million a month to 2.5 million a month; and primary care appointments made on the app have increased from 30,000 a month to 250,000, and secondary care appointment from 30,000 a month to 360,000. We continue to work to increase the app’s functionality, including opening more records and test results and enabling more appointments, as part of our commitment to technology.

[Mr Speaker]

I think a statement would be better next time.

[Sarah Owen]

Brain tumours are the biggest killer for people under 40, but we are still waiting for the full £40 million that the Government promised to fund brain tumour research. In March, I raised in the House the heartbreaking experience of my constituents Yasmin and Khuram, whose daughter Amani died from a brain tumour just before her 23rd birthday. Once again, I ask whether the Minister for Health and Secondary Care or the Secretary of State will meet with me and my constituents to hear their calls for the full funding allocation to be given to researchers. That funding would be transformational for the treatment of brain tumours.

[Steve Barclay]

The Minister of State has met with campaigners, and I know he stands ready to have further such meetings. As we touched on earlier, the £40 million is available; obviously, that needs to be allocated to research bids of the necessary quality, and the remaining money is open to researchers to bid for. I hope they will do so.

[Selaine Saxby (North Devon) (Con)]

T3. I thank my right hon. Friend for reconfirming the investment into North Devon District Hospital. Will he meet with me, the hospital trust and my local housing association to ensure that the housing committed to on the Barnstaple site can rapidly commence?

[Steve Barclay]

I am very keen to meet with my hon. Friend. I know this is an extremely important scheme for her constituency, particularly the key worker accommodation, and I look forward to having that discussion with her and the leadership of her trust.

[Mr Speaker]

I call the shadow Secretary of State.

[Wes Streeting (Ilford North) (Lab)]

First, I congratulate the Health Secretary on his recent write-up as the next Leader of the Opposition. According to the i newspaper, his supporters are calling him “Mr Consistent”. Is that because of the consistent rise in waiting lists since he became Health Secretary, the consistently longer waiting times that patients are facing, or the consistent delay to the NHS workforce plan?

[Steve Barclay]

The point of consistency is that we gave a manifesto commitment to have 26,000 additional roles in primary care, and we have delivered that. We made a commitment to the largest ever hospital building programme, and we have announced over £20 billion of investment in it. The Government are standing by their manifesto commitments—that is what we are delivering.

[Wes Streeting]

I am sure that will do it.

I want to turn to the most recent reports about the NHS workforce plan, because apparently not only is that plan delayed, but we now read in the media that it is unfunded. Labour will pay for our workforce plan by abolishing the non-dom tax status. [Interruption.] Conservative Members do not like it, Mr Speaker, but it is the only tax they have been unwilling to put up. We have a plan, and we have said how we will pay for it. How will the Health Secretary fund his plan when it eventually arrives? Will it be cuts to the NHS, more borrowing, or even more broken promises?

[Steve Barclay]

The hon. Gentleman is recycling this question almost as often as he recycles the non-dom funding. As I said at the last Health and Social Care Question Time, it is like the 1p on income tax that the Lib Dems used to promise, which was applied to every scheme going.

We touched on this issue at the last Question Time, and indeed at the one before: we have a commitment to a long-term workforce plan. The Chancellor made that commitment in the autumn statement, but it is a complex piece of work that NHS England is working on. It is important that we get the reforms in that plan right, and that is what we are committed to doing.

[Maggie Throup (Erewash) (Con)]

T4. Just a couple of weeks ago, the Obesity Health Alliance launched its manifesto to tackle the high levels of diet-related ill health and the impact that has on our economy and society. Can my hon. Friend update the House on the progress being made on implementing the measures in section 172 of and schedule 18 to the Health and Care Act 2022 on the advertising of less healthy food and drink?

--- Later in debate ---

[Sir Edward Leigh (Gainsborough) (Con)]

T8. Under the Human Rights Act, do the Government not have a duty of care to deal with the housing of illegal migrants? How can the Government ensure the health of 2,000 migrants cooped up in the former RAF Scampton? In particular, how will they ensure their health given the fact that the site is riddled with asbestos and contamination from 100 years of RAF usage? I see a case coming to the European Court of Human Rights.

[Steve Barclay]

Clearly, an increase in population in a specific area will have an impact on the health needs there. I recognise the concern that my right hon. Friend raises, and I will ask the Minister for Primary Care and Public Health to follow up with him on this important point. While the NHS is well equipped to deal with short-term pressures, this issue highlights the importance of the Prime Minister’s commitment to stop the boats and the Government’s overall strategy on illegal migration.

[Dr Lisa Cameron (East Kilbride, Strathaven and Lesmahagow) (SNP)]

T5. As chair of the all-party parliamentary health group, I have been hearing so much about the importance of artificial intelligence innovation in mental health, and I was pleased to launch the AVATAR2 clinical trials in three universities across the UK. Will the Secretary of State commend this progress being made in digital innovation? It deserves scrutiny, but can make much progress.

[Steve Barclay]

I very much welcome it. I am delighted to hear that constructive approach to AI from the hon. Lady. The importance of AI is why we have been funding more than 80 AI lab schemes with more than £130 million. AI has huge potential to help patients. We are seeing that, for example, in stroke patients getting care much quicker. She is right that there are also some regulatory and other issues that we need to address, but we should not miss the opportunities of AI, and she is right to highlight them.

[Anna Firth (Southend West) (Con)]

T9. Last week, not a single dentist across the city of Southend said that they were taking on new NHS patients, which is concerning for my constituents. Can my hon. Friend confirm again what steps he is taking to make sure that my constituents get the NHS dental treatment that they deserve?

--- Later in debate ---

[Ellie Reeves (Lewisham West and Penge) (Lab)]

T7. One of my constituents with complex health needs has struggled to get GP appointments for years now. On one occasion when they could not get an appointment, they had to resort to taking out-of-date medicine. Last week, they phoned every morning at 8 am, before finally getting just a telephone appointment. When will the Government finally fix the crisis in primary care and make sure that everyone gets access to a GP appointment?

[Steve Barclay]

As the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Harborough, said earlier, through the primary care recovery plan we have specific measures to tackle things such as the pressure at 8 am, particularly on a Monday morning. There is the investment in digital telephony, with call-back features, and online booking, as well as the channel shift to enable pharmacists to do more and to prescribe more, the use of the NHS app and the review of 111. There is a range of initiatives that we are taking to address the increased demand. Ultimately, GPs are seeing more patients—up to 10% more patients—but there is more demand, and that is how we are meeting it.

[Mr Philip Hollobone (Kettering) (Con)]

Kettering General Hospital is aiming to submit its final business case for its £34 million net zero energy centre in December, but has been told that when it does so, it can expect at least a 13-week wait for approval. The Secretary of State has been good enough to see for himself the urgent need for this new power plant. Is there anything he can do to speed up this process?

[Steve Barclay]

I share my hon. Friend’s desire for us to move at pace on the scheme. As he says, I have seen at first hand the importance of the scheme at Kettering, and I stand ready to work constructively with him to expedite that case, because I do not think anyone is in any doubt of the importance of the work at Kettering. It is a huge tribute to him and the way he has championed the case for Kettering that it was such a central part of the new hospital programme announcement.

[Simon Lightwood (Wakefield) (Lab/Co-op)]

In Wakefield, I am pleased to say that our campaign to save our city centre walk-in service has been successful, but every day people are still struggling to get a GP appointment. The latest NHS statistics show that, in April, 12,586 people waited more than 28 days. Quite simply, there are not enough fully qualified GPs. Labour has a workforce plan that is ambitious and costed. Where is the Government’s delayed and fully funded workforce plan?

--- Later in debate ---

[Stephanie Peacock (Barnsley East) (Lab)]

The non-surgical breast cancer service in South Yorkshire is facing a critical shortage of oncologists. The shortage is so severe that patients are being told to expect months between referral and appointment. What immediate steps are the Government taking to ensure that patients, no matter their postcode, see a specialist as soon as they need to do so?

[Steve Barclay]

As reflected in the fact that we met the faster diagnosis standard in February and March for the first time, we are investing more in our cancer services to meet the recognised increase in demand. That is why more patients are being treated sooner and survival rates are improving. I am happy to look at any variation at a local level because of workforce pressure, but the diagnostic centres and surgical hubs are all part of our response to the increase in cancer demand.

[Jack Brereton (Stoke-on-Trent South) (Con)]

A number of dentists across north Staffordshire are stopping NHS treatment, which is extremely concerning. Some of my constituents have reported that they are being told they will have to pay either £120 a year or £14 a month to stay on the books. Will my hon. Friend look into those serious concerns and meet me to discuss the matter further?

--- Later in debate ---

[Daisy Cooper (St Albans) (LD)]

I recently learned that my local integrated care board is not allowed to spend the money it wants to spend on securing the best location for a new GP practice and health centre. The reason is that Treasury rules, which are used by the District Valuer Services, are not keeping up with market rents. Will the Secretary of State speak to his colleagues in the Treasury to fix that, before we face an epidemic of health centres and GPs leaving town and city centres, and moving to ring-road locations away from the populations they serve?

[Steve Barclay]

I am very happy to look at that specific issue and raise it with Treasury colleagues.

Health and Social Care

Steve Barclay Excerpts

Monday 5th June 2023 Ministerial Corrections

The following are extracts from the oral statement made by the Secretary of State for Health and Social Care on new hospitals on 25 May 2023.

[Steve Barclay]

In Lancashire, a new surgical hub will be opened at the Royal Preston Hospital, which is due to be completed this year.

[Official Report, 25 May 2023, Vol. 733, c. 479.]

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 statement.

The correct information should have been:

[Steve Barclay]

In Lancashire, a new surgical hub will be opened at the Chorley and South Ribble Hospital, which is due to be completed this year.

[Steve Barclay]

We recognise the importance of the Imperial bid; that is why we are starting to build the temporary ward capacity at Charing Cross and the first phase of work is under way on the cardiac elective recovery hub, to bring cardiac work on to the Hammersmith site.

[Official Report, 25 May 2023, Vol. 733, c. 485.]

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 the hon. Member for Westminster North (Ms Buck).

The correct information should have been:

[Steve Barclay]

We recognise the importance of the Imperial bids; that is why we will start to build the temporary ward capacity at Charing Cross and the first phase of work is under way on the cardiac catheter lab to help cardiac elective recovery at Hammersmith Hospital.

[Steve Barclay]

We are not letting that stop our work to open a new surgical hub at the Royal Preston Hospital, for example.

[Official Report, 25 May 2023, Vol. 733, c. 486.]

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 Morecambe and Lunesdale (David Morris).

The correct information should have been:

[Steve Barclay]

We are not letting that stop our work to open a new surgical hub at the Chorley and South Ribble Hospital, for example.

Delivering for Patients

Steve Barclay Excerpts

Thursday 25th May 2023 Written Statements

[The Secretary of State for Health and Social Care (Steve Barclay)]

I refer hon. Members to the oral statements I will make in the House today, 25 May 2023, on patient choice and new hospitals.

[HCWS811]

Patient Choice

Steve Barclay Excerpts

Thursday 25th May 2023 Commons Chamber

[The Secretary of State for Health and Social Care (Steve Barclay)]

May I begin by joining colleagues from across the House in paying tribute to the former hon. Member for Redditch? I entered the House at the same time as her. She was a much-loved and popular colleague. I send, as I know so many do, condolences to her family and her many friends.

With permission, Madam Deputy Speaker, I shall make a statement about the action the Government are taking to improve patient choice as a way to help reduce NHS waiting times, one of the Government’s five key priorities.

There are currently significant variations in waiting times across the country, and sometimes even within the same integrated care system. Analysis from the Patients Association suggests that improved patient choice can reduce waiting times by up to three months. When he took office last year, the Prime Minister promised to make it easier for patients to make a meaningful choice and to raise public awareness of the patient’s right to choose.

Because of the pandemic, we have an NHS waiting list of over 7.3 million. Of that number, around 80% are waiting for outpatient appointments and around 20% are waiting for operations. Greater patient choice will help us address this built up demand including, where appropriate, opening more routes for NHS patients to get treatment free at the point of access in the independent sector, provided it meets NHS costs and standards, because we should use all available capacity in tackling the pandemic backlogs. For example, for patients currently waiting for ear, nose and throat treatment in London, the wait could be up to four months shorter with another provider, or with trauma and orthopaedics in the north-west, choosing another provider in the same region could cut someone’s wait by three months.

Empowering patients to exercise their right to choose was one of the recommendations of the elective recovery taskforce, which identified it as a vital way of delivering the post-pandemic recovery. While we were addressing the 78-week backlog, analysis showed that 50% of those who were waiting more than 78 weeks for elective care were in just 11 trusts, which reinforced the opportunity offered by raising awareness of patient choice and making it easier for patients to exercise that choice in a meaningful way.

As well as cutting waiting lists, choice empowers patients to decide which aspects of the hospital service matter most to them. Patients themselves can prioritise the speed of care, alongside other factors such as distance travelled and the Care Quality Commission rating of the provider, or they may have had previous care from a consultant-led team and want to return to that team. We believe that empowering the patient is an intrinsically good thing, and we also believe that it cannot be the preserve of the groups with the sharpest elbows; it must be open to all. Research from the King’s Fund has found that

“older respondents, those with no qualifications, and those from a mixed and non-white background were more likely to value choice.”

When we combine improved patient choice with better real-time data and greater transparency, we can drive up standards. When patients know much more about how their local hospital is performing, the pressure is on poor performers to close the gap with their near neighbours, where patients are often being treated more quickly.

The case for patient choice is clear, so with the aim of improving it, we are announcing significant changes in a number of areas. The first is technology. More than 30 million people have now signed up for the NHS App, and our target is for three quarters of all adults in England to be registered by next March. The app is already giving patients an improved “front door” for NHS services, and we are continuing to build on that. When GPs make a referral, they will make a shortlist of the five most suitable providers, and patients will be able to choose from the shortlist on the app. In March we completed the work of supplying a single list of providers for these shortlists, irrespective of whether the services are commissioned locally or nationally. While the Opposition’s plan to organise waiting lists on a regional basis might look like a good idea on paper, in reality it would add an extra layer of bureaucracy, whereas national lists under this Conservative Government will empower patients to choose treatment wherever they like. For example, a patient registered in Sheffield might happily choose to receive treatment in Manchester, particularly if family members there could help with the patient’s care and recovery.

The second area of work is improving the experience of those who are already on waiting lists, so that they can obtain treatment more quickly. From October this year, patients who have waited more than 40 weeks for an appointment, or who have a decision to treat but do not have a treatment date, will be able to request a transfer to another provider with a shorter waiting list. It is our ambition to expand that offer to other groups of long waiters, progressively lowering the waiting time towards 18 weeks as fast as is clinically possible.

Our third focus is on communications. We want to increase public awareness of today’s announcement through a national campaign, with the particular aim of reaching the groups who are most likely to benefit from greater choice as well as those least likely to exercise it. We will also ensure that general practitioners, and others who refer patients for consultant-led care, are offering more patient choice and are supported with the right training and technology.

Fourthly, we will focus on transparency. Real-time information on performance will be made more transparent to patients so that they can gain a clearer understanding of the variations from place to place, which will help them to exercise informed choice. We have worked to make ratings by the Care Quality Commission available and accessible to all, and we are merging the “My Planned Care” platform with the NHS website.

The Labour party has been busy announcing initiatives that we already have under way, such as expanding the NHS App, embracing virtual wards and stopping kids from vaping, but while its members have been busy talking in England and failing to act on behalf of patients in Wales, we have been busy acting to empower patients, and today’s announcement is another example of that. We are committed to cutting NHS waiting lists, and the measures that we have announced will help us to do that—by empowering patients to gain access to faster treatment in hospitals with available capacity; by giving patients technology enabling them to exercise their right to choose, and giving them the information that will help them to make that choice; by increasing communication to raise public awareness of the right to choose; and by fostering much greater transparency and, through funding, following the patient, to encourage trusts to improve their offer to patients to better match the service offered in hospitals elsewhere.

Taken together, those measures will enable patients to access treatment more quickly and meet the Government’s priority of reducing NHS waiting lists. I commend this statement to the House.

[Wes Streeting (Ilford North) (Lab)]

I thank the Secretary of State for advance sight of his statement. I also join him in paying tribute to the late Karen Lumley and, even more important, extending condolences to her family and her many friends on both sides of the House —but particularly on the Conservative Benches—for their loss. I know that the sadness is felt very deeply throughout the Chamber.

Let me now turn to the first of today’s two statements from the Health Secretary. It seems that quantity is not matched by quality. In a week in which the Leader of the Opposition announced Labour’s plans to give patients more choice, with regional waiting lists for care and more power through the NHS App, the Conservatives’ big idea to cut waiting times is to give patients a choice that they already have. It is thanks to the last Labour Government that patients waiting for planned treatment already have a right to choose an alternative provider if they have been waiting too long.

Beneath the spin, the Health Secretary’s announcement is actually a watering down of the measures that are already in place. He says that patients will have the right to choose an alternative provider if they have been waiting longer than 40 weeks, but in 2019 the Conservatives said that they should have that right after 26 weeks—which, even then, was worse than the 18-week standard to which patients were already entitled thanks to the last Labour Government. Is it not the case that he is once again shifting the goalposts because he cannot even meet his own standards, let alone those that patients expect?

The Health Secretary concluded his statement by talking about his Government’s record. That was a bold move, because 7.3 million people— the highest number on record—are currently waiting for planned treatment in England. As usual, the Health Secretary said that that was because of the pandemic, but the figure was already at a record high before the pandemic. Behind this shocking statistic are real people, waiting, waiting, waiting in agony. It does not matter how often the Health Secretary says that the Government are committed to reducing the waiting lists; people can see with their own eyes the numbers that do not lie, which show that waiting lists are getting higher and things are getting worse, not better.

The Health Secretary’s total incompetence when it comes to preventing strike action in the NHS has inflicted untold misery on patients. So far the total number of appointments affected by NHS strikes in recent months is more than half a million, a figure that the Health Secretary called “deeply disappointing”. Well, that is something on which he and I can agree, for once, but with another round of strike action planned by junior doctors, he must surely see the risk to patient choice and waiting lists. What is his plan? Ministers blame strikes as if they were mere bystanders, but it was their refusal to speak to nurses, paramedics and junior doctors that forced them out on strike in the first place. I am afraid the Health Secretary’s warm words today are not going to cut it, when all he is doing is giving more patients more choice over where their next appointment or operation is to be cancelled because of the strikes that he and the Prime Minister have failed to prevent.

Finally, let me turn to the supermassive black hole that is at the heart of today’s announcement. I will keep on reminding the Health Secretary of this until the penny drops. It does not matter which hospital patients choose; they can only receive care on time if there are enough staff to treat them—so why are we still waiting for the NHS workforce plan that the system is crying out for? Why do we have net migration at the highest level ever, with the Government over-reliant on recruiting staff from overseas because they cannot be bothered to train home-grown talent? Where is the plan to train the doctors and nurses whom the NHS is so desperately short of? Labour has set out our plan to double medical school places and train 7,500 more doctors and 10,000 more nurses a year, which we would pay for by abolishing non-dom tax status. [Interruption.] I am afraid that Conservative Members like non-doms more than they like nurses, but the public are not with them on that. Let me once again, in the spirit of generosity, before we break for the recess, offer the Secretary of State our fully costed, fully funded plan. It is available to him—[Interruption.] Conservative Members should not laugh too much now. I wager that, before we break for the summer, the Government will finally swallow their pride and announce the doubling of medical school places. We will wait and see.

After 13 years of Conservative Government, people can see for themselves where it has landed this country and compare it with 13 years of Labour Government, which delivered the shortest waiting times and the highest patient satisfaction in history. We will offer real choice and cut waiting times, so that the NHS is there when people need it. We did it before; we will do it again. We have the ideas and we have the plan. That is why only Labour can build an NHS that is fit for the future.

[Steve Barclay]

Not since the famous 1p on income tax from the Lib Dems, which was to be spent on every issue going past like a passing bus, have we heard of money being spent in as many different ways as the non-dom money. No wonder the hon. Member for Ilford North (Wes Streeting) said it with a smile; the whole House could see how credible that proposal is.

The theme of the hon. Gentleman’s response was comparison, so I think we should compare the substance of the announcement on patient choice with the situation where Labour is in office. In Wales, patients do not have the ability to choose where they receive treatment; that right is not offered to patients. In NHS Wales, patients registered with a GP in Wales do not have a statutory right to choose at which hospital they receive treatment. We can compare what a Government in England are doing—empowering patients, giving them that choice as well as the information and technology they need to make it—with NHS Wales, run by the Labour party, which deprives patients of their choice.

I hesitate to draw the comparison with Wales, however, because another Labour Front Bencher, the hon. Member for Denton and Reddish (Andrew Gwynne), says that he does not want Labour to be judged on its record in Wales. That is slightly confusing because the leader of the Labour party, no less, says that he wants Labour in Wales to be

“a blueprint for what Labour can do across the UK”.

So they cannot even compare among themselves, never mind compare between England and Wales.

The hon. Member for Ilford North talked about strike action but seemed to skirt around the fact that the Government have reached a deal with the NHS Staff Council in relation to Agenda for Change staff—a deal that his own union, Unison, voted 74% in favour of. His own union—the union that gives him money—supported the deal. He chides us about junior doctors, but those of us who were present in the Chamber the last time heard him say that he did not support the junior doctors’ demand for 35%. When we did negotiate with them, they even increased their demand to 49%, when next year is added in, further confusing the position.

It will come as no surprise to the House to discover that people in Wales are almost twice as likely to be waiting for treatment as people in England. That is the true comparison that we are addressing. We can see that situation play through to people waiting more than 18 months. In England, we have virtually eliminated 78-week waits—at the end of March, it was under 11,000—but in Wales, it will come as no surprise to Members, the number was closer to 75,000, and of course Wales has a smaller population. So we can compare waiting times, which we in England are bringing down. We have an electives plan, we cleared virtually all the two-year waits in the summer and over 90% of the 18-month waits at the end of March, which contrasts with the situation in Wales. We are giving patients choice, enabling them to move if they want to in order to get quicker treatment elsewhere. We are on the side of patients. We can see what the Labour party is doing by its disastrous performance in Wales.

[Madam Deputy Speaker (Dame Eleanor Laing)]

I call the Chair of the Select Committee.

[Steve Brine (Winchester) (Con)]

This form of patient choice has of course been available for at least 15 years; it just has not been made available to patients. Can the Secretary of State confirm that the referral management centres sitting at integrated care board level will be compelled, not asked, either to change that or to get out of the way altogether? Given that the vast majority of people on the waiting lists are already there with a specific trust, how exactly will they be given the option either to stick where they are, or to twist and exercise that choice to receive treatment sooner?

[Steve Barclay]

My hon. Friend, as ever, makes a shrewd point. Yes, the referral centres are part of this system. The key focus is on the initial GP referral and how we facilitate that with better data, transparency and tech, but the referral centres are a part of this. We want to roll it out to the 40-week waits from October, and to bring waits down to 18 weeks. There is a clear plan to achieve that wider scope, and that is what I have set out to the House today.

[Valerie Vaz (Walsall South) (Lab)]

Karen Lumley was indeed a wonderful woman. Our thoughts and prayers are with her family at this difficult time.

The statement is admirable, but how will patients have a choice if the Secretary of State does not address the workforce issue? When will he do that? When will he speak to the junior doctors?

[Steve Barclay]

As I touched on in my statement, the choice is there now; it is available right now, but only about 10% of patients exercise it. There is massive variation in the system now, with the existing workforce. We are increasing the workforce. We have made a commitment to produce a workforce plan, but the point is that there is variation within the system now. What patient choice is about is empowering patients to take advantage of it and to access treatment sooner, for example, by being willing to travel often short distances to access it.

[Greg Smith (Buckingham) (Con)]

I really do welcome the revolution in patient choice that my right hon. Friend has outlined, but as chair of the all-party parliamentary group on minimally invasive cancer therapies, it is clear to me that some cutting-edge technologies and treatments are available only in certain trusts under certain consultants. Can he confirm that, within the choice available to them, patients will be able to choose centres that provide unique treatments, rather than the universal treatments that are available everywhere?

[Steve Barclay]

Yes, I can. Part of this is allowing patients to choose according to a number of factors. Some may have had treatment previously and want to go back to a particular consultant-led team. Some may want to look at CQC ratings and other performance metrics. Some may want the convenience of not travelling—relatively small numbers say they are not willing to travel; far more are willing to do so. Patients will look at a range of factors when shaping their decision. The key is to have transparency and the technology that enables patients to take control.

[Daisy Cooper (St Albans) (LD)]

Of course we all want to see real patient choice, but for millions of people who are waiting in pain, a choice between travelling miles away or paying to go private is no choice at all. We all know that the key to unlocking millions of people from the NHS backlog is tackling the crisis in the workforce. Why on earth are we spending precious parliamentary time talking about the NHS app instead of the NHS workforce?

[Steve Barclay]

We are talking about the wider workforce. The hon. Lady mentions private capacity. This patient choice will enable people to make much better use of the independent sector and to do so free at the point of access. Given the size of the challenge of pandemic backlogs, the question is: how can we make full use of capacity across the NHS and in the independent sector?

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

The problem of variation in waiting times is symbolic of all sorts of variations across the NHS. My previous employer, the national clinic audit programme commissioner, focused on identifying and spreading good practice. Will the Minister join me to meet the programme’s CEO, Jane Ingham, to hear her insights on how to tackle this challenge, and also join me in paying tribute to her as she retires after 10 years of dedicated public service in this role?

[Steve Barclay]

I am very happy to join my hon. Friend in paying tribute to Jane Ingham, who, as he says, is retiring after 10 years in that post. She has a long history of working to improve the quality of healthcare in the NHS and it is right that we pay tribute to her. I am sure the ministerial team are keen to engage with her on lessons to be learnt from her career.

[Marsha De Cordova (Battersea) (Lab)]

The Secretary of State’s words on patient choice will ring hollow until he addresses the NHS workforce crisis. In ophthalmology, 80% of eye units do not have enough consultants to meet current demand, and 65% of eye units had to rely on locums last year. Labour has a fully funded plan for the biggest workforce expansion in NHS history. Where is his plan? He has not answered previous questions. Can he say whether this workforce plan will actually address the deficit in eye health and ophthalmology?

[Steve Barclay]

As the record shows, numbers have been increasing. There are 37,000 more doctors and 52,000 more nurses within primary care than in 2010. We have already reached our manifesto commitment on additional roles in primary care to deliver more appointments. We have repeatedly said that we will bring forward a workforce plan and we are committed to doing so shortly.

[Sir Edward Leigh (Gainsborough) (Con)]

I congratulate my right hon. Friend on promoting more choice than in the socialist republic of Wales, which is a pretty low bar, but can we go further and promote real choice by adopting two previous Conservative policies? Both would be wildly popular. The first is a patient passport, by which a patient could get a free operation on the NHS, or take the same cost to a private or charitable hospital, which would promote choice and accountability. The second is tax relief for private health insurance, which is a matter for the Chancellor, but the Secretary of State could have a quiet word with him.

[Steve Barclay]

My right hon. Friend has lobbied me on this issue a number of times, including outside the Chamber. As such a senior parliamentarian, he well knows that tax is a matter for the Chancellor, who I am sure will have noted his wider point.

[Jim Shannon (Strangford) (DUP)]

I thank the Secretary of State for his very positive statement. He referred to long waiters, the second area of work. One oft-neglected area is access to specialist in-patient services for eating disorders. My constituents in Northern Ireland do not have access to a clinic to allow them a choice between a weekly weigh-in with their GP and specialised treatment. What discussions, and practical and physical assistance, can he offer the Department of Health at the Northern Ireland Assembly to help people with eating disorders?

[Steve Barclay]

As so often, the hon. Gentleman raises an extremely important point about how we tackle the serious issue of eating disorders. As he knows, we are increasing our funding for mental health. It is a key priority in the long-term plan, which is providing an extra £2.3 billion a year. On different approaches, we are looking much more actively at our use of digital apps and platforms, which is an area that the Chancellor specifically funded in the last Budget. We are also looking at how we address mental health issues earlier, particularly for children. We are rolling out mental health support teams in schools because, obviously, early intervention has significant benefits and targeting schools is a great way to do that.

[Kit Malthouse (North West Hampshire) (Con)]

I, too, congratulate the Secretary of State on a profoundly Conservative step forward in dealing with the waiting list issue. Does he agree that the provision of greater patient choice holds out the possibility of stimulating more investment in private sector capacity, particularly for volume procedures such as hips and knees? However, the private sector, to make such heavy investments in facilities, requires long-range certainty. As waiting lists fall, will he review the threshold—the time limit—at which patients can seek private sector assistance in getting their operation done more swiftly, so that the efficiencies of the private sector can be realised for the system as a whole in the longer term?

[Steve Barclay]

My right hon. Friend raises a very good point. As he knows, there is interaction between what is and is not on the balance sheet. His point particularly relates to the roll-out of diagnostic centres. I have looked at the facility in Blackpool that is using artificial intelligence in endoscopy and picking up 20% more cases than would be seen with the human eye. We are thinking about how we use the private sector to add more capacity at scale and pace, and how it can use the latest technology. Obviously, we need to do that in a way that is compliant with Treasury rules. Ensuring there is greater capacity in the system—but doing so where it is free at the point of access to NHS patients—is an area where we have already done quite a lot. However, there is always scope to look at it afresh.

[Robbie Moore (Keighley) (Con)]

I commend my right hon. Friend for the statement, which will undoubtedly help waiting lists in my Keighley and Ilkley constituency. Can he confirm that this expansion will be available first to those who have been waiting longest?

[Steve Barclay]

I can confirm that, from October, we will roll this out to those who have been waiting more than 40 weeks, and we will look to bring down that threshold over time. We will focus first on the longest waits.

[Mr Louie French (Old Bexley and Sidcup) (Con)]

I share my right hon. Friend’s desire to increase patient choice and reduce waiting times. One way to do that in south-east London is to expand further the number of services at Queen Mary’s Hospital, Sidcup, which is an excellent modern hospital with the capacity to expand services. However, there needs to be a will within NHS leadership, especially within the new integrated care boards, to get on with doing so, particularly for community diagnostics. Will my right hon. Friend please agree to meet me to discuss further how we can improve patient choice and patient outcomes in Bexley?

[Steve Barclay]

I share my hon. Friend’s desire. As part of this announcement, payment will follow patients to incentivise trusts to take on more, which further underpins patient choice. We are actively engaged on accelerating the diagnostic centres and, as a result of ministerial intervention, we have speeded up the diagnostic centre programme. I look forward to updating the House on how many additional scans and tests will now be done this year, as opposed to the original plan for those tests to be done in 2024. I am very happy to have further discussion with him.

[Madam Deputy Speaker (Dame Eleanor Laing)]

I normally allow a bit of movement between statements, but it seems that a change of scene and personnel is not necessary as everyone is already in place.