Future of the NHS

Will Quince Excerpts

Tuesday 24th October 2023 Westminster Hall

[Janet Daby (Lewisham East) (Lab)]

It is an honour to speak with you in the Chair, Mr Pritchard. I thank my hon. Friend the Member for Wirral West (Margaret Greenwood) for securing such an important debate.

The NHS was set up in 1948. It was the first of its kind in the western world, leading the way for free medical care—what a great achievement. So many societies still wish that they had what we have.

As has been said by other hon. Members, we have already had 13 years of the Conservatives leading the way—unfortunately with much failure and neglect. We do not have enough doctors or nurses, there are long waiting lists for appointments, and primary care is also not what it should be. People are finding it very difficult to get a GP appointment, there are no NHS dentists, and even pharmacies are really struggling to ensure they have enough medicines to give to people. In addition, mental health services remain the poor relative to the NHS. Under this Government, there has never been enough investment in NHS mental health services.

I will focus my remarks, conversations and questions on the future of the NHS for sickle cell patients. Sickle cell disease is a serious condition which predominantly occurs in people with African and Caribbean backgrounds, and approximately 15,000 to 18,000 people live with it. It has been two years since the “No One’s Listening” report was published by the Sickle Cell Society, which found evidence of serious failings. Failings were found in acute services, and there was evidence of attitudes “underpinned by racism”, meaning that patients were not treated with care. They were ignored, often not believed, and not given the pain relief and oxygen they needed. Unfortunately, we have seen many fatalities because of this.

In January, the NHS Race and Health Observatory found that sickle cell patients undergoing a crisis were deprioritised and undermined. This is in keeping with the “No One’s Listening” report, which presented evidence regarding the death of Evan Nathan Smith in North Middlesex University Hospital in April 2019. The inquest found that Evan’s death would not have happened if it were not for failings in the care that he received. It is shocking every time I say that and every time I mention that.

I have worked with Government Ministers, the NHS and other important bodies to get implemented in full the recommendations that have come out of the “No One’s Listening” report. I ask the Minister to go further and to focus more on those recommendations. If we are looking at the public purse, which has been mentioned a few times in this Chamber, we see that it is more cost-effective to put in preventative measures that help and support people to not get into a crisis where they need to be in hospital.

I therefore ask the Minister: will the NHS develop individual care plans in partnership with the sickle cell patient? Will all NHS trusts require haematology teams to be told when a sickle cell patient accesses outpatient or inpatient care? Will the Minister instruct all integrated care systems to develop plans to provide community care in this area? Will the Minister ensure specialist training opportunities for nurses? Will the Department co-ordinate work between organisations and senior sickle cell service representatives to engage in effective workforce planning for sickle cell services?

If the Minister cannot answer all of those questions towards the end of this debate, I ask him to put it in writing, to do his best, and to also attend the all-party parliamentary group on sickle cell and thalassaemia, which I chair.

[Will Quince]

indicated assent.

[Janet Daby]

The Minister is nodding, so I take that as an indication that he is willing to do that, which is really good. I also implore him to consider that sickle cell is a long-life disease, a hidden disease, a disability, and very serious.

The disease, however, has not had the research funding that it really needs. Looking at people with cystic fibrosis and haemophilia, we that they have had so much more funding invested into medicines to improve the treatment of those illnesses. The National Institute for Health and Care Research funds research programmes, but sickle cell research is woefully inadequate compared with the diseases that I have already mentioned. According to the data produced by that organisation, approximately 18,000 people are living with sickle cell, compared with the 10,000 that are living with cystic fibrosis, but in 2017-18 over a million pounds more was spent on research for cystic fibrosis. In the present day, 2022-23, still over a million pounds more is being spent on research for cystic fibrosis compared with sickle cell. That is entirely unacceptable, especially when there are more people living with sickle cell. I do not wish to take away funding from other research, but I do want equality of funding. I am sure the Minister also wants this as well.

As I draw to a close, I have already mentioned that prevention has to be the ultimate way to help people live a good quality of life and to keep them out of hospital, and it also helps to take of care of the public purse. In conclusion, the NHS is a wonderful creation that has helped every single person in this Chamber, and indeed every single person in our country.

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[The Minister for Health and Secondary Care (Will Quince)]

It is a pleasure to serve under your chairmanship, Mr Pritchard. I am grateful to the hon. Member for Wirral West (Margaret Greenwood) for securing a debate on this important matter. A debate of this nature is almost impossible to respond to in a relatively short period of time—although it is slightly longer now. I could easily fill the 90 minutes on the future of the NHS, as I know could all hon. Members across the Chamber today. I will endeavour to respond to as many of the issues and themes raised as possible in the time left available to me and, if I can, before the Front Benchers in the main Chamber conclude and we are all summoned over to vote.

While we will not always agree on the best approach—in fact, I strongly disagree with so much of what the hon. Lady said in her opening speech—I can assure her and Members across the House that I share her passionate desire to see an NHS that delivers and continues to deliver excellent care to all its patients, both now and in the future. Similarly to the Opposition Front-Bench team, the Government believe that the NHS should be free at the point of delivery and that its offer should be comprehensive, with services provided based solely on need. Let me absolutely clear: that will never change. In response to the themes raised in the debate, I will start by focusing on three broad areas: funding, workforce, and finally transformation and innovation.

Turning first to funding, as my hon. Friends the Members for Shrewsbury and Atcham (Daniel Kawczynski) and for Southend West (Anna Firth) set out, we have invested record amounts in the future of our healthcare system. By the end of this Parliament, core spending will have increased from £140.5 billion in 2019-20 to £193 billion in 2024-25. For those good at maths, that is a cash increase of £52.6 billion or 37%. At the beginning of this debate, several of us got a little excitable when the issue of privatisation was raised, and you rightly shut us down, Mr Pritchard. People have managed to make their contributions, but this is perennial accusation levelled at the Government, so let me absolutely clear: it is not our policy and it is not our plan. The NHS is not, and never will be, for sale.

Look at the actual facts on this. In 2013-14, around 6.1% of NHS funding was spent on the independent sector. Now let us jump to 2021-22, when it was 5.9%. What we are doing, however, is using the independent sector to enable us to fully realise our healthcare system’s capacity, and of course to improve performance. This is an approach that I understand is supported by the shadow Secretary of State for Health, the hon. Member for Ilford North (Wes Streeting). It is an approach that is better for patients and for our NHS. We are giving our patients greater choice and control, and empowering them to shape and manage their own healthcare.

[Daniel Kawczynski]

I am very grateful to my hon. Friend for highlighting the extraordinary increases in Government funding for the NHS, but has he recognised during the course of this debate my concern that, seven years after securing the £312 million for modernisation of A&E services in Shropshire, not a single brick has been laid? How sustainable is this NHS model when the managers of our local trusts are so incapable of delivering the construction with what we have secured for them?

[Will Quince]

I hear my hon. Friend’s concern. I have met with him and other Shropshire MPs on this issue and committed to meet with him to discuss it again. We are very keen to resolve the situation.

Before I move on from privatisation, let me gently say to Opposition Members—some of whom raised it and some of whom did not—that patient choice and the ability to use the private sector has been part of the NHS since its formation. It is a fundamental part of the NHS constitution. Let us be clear what those who call for private sector involvement to be entirely removed from the NHS are calling for: they are calling for charities, independent sector providers, GPs, dentists and community pharmacies to be removed. So let us be very careful, and very clear about exactly what we are calling for, because the independent sector plays an important role.

[Margaret Greenwood]

While the Minister is on the subject of privatisation, I would like him to respond to two points. First, the Health and Social Care Act 2012 allowed NHS foundation trusts to earn 49% of their money from private patients. Can he explain how that benefits ordinary patients? Clearly, if half a hospital is given over to private patients, the waiting time doubles. Secondly, representatives of private companies sit on integrated care partnerships, which are responsible for preparing the integrated care strategy for an area. How can it be right that a private company can influence how a huge amount of public money is spent?

[Will Quince]

I thank the hon. Lady for her question. I have already committed to write to her on some of the points relating to the 2012 Act, because she raised a number of questions. On the broader point about whether the independent sector should be part of integrated care boards and partnerships, I think it is helpful if it is, because individual systems need to know the full capacity available to them, and that includes the independent sector, which plays an important role because it is part of the health ecosystem in an area.

[Margaret Greenwood]

rose—

[Will Quince]

I will come back to the hon. Lady, but I am conscious of time.

The second area widely covered today was workforce. I echo the hon. Lady’s thanks to our NHS staff. I want to put on record my personal thanks to all those working in our health and care system: doctors, nurses, allied health professionals, managers, carers—all those who work in our NHS—for their hard work and dedication. We remain deeply grateful to them for all their work during the pandemic, in facing the new challenges of tackling the backlog, and of course the routinely excellent care they provide day in, day out. Our long-term workforce plan embodies the Government’s commitment to NHS sustainability: we are funding more doctors, more nurses and healthcare workers employed on NHS terms and conditions by NHS providers. That is backed by an additional £2.4 billion over the next five years, and at the heart of it is a significant increase in training places.

The third theme I want to focus on is transformation and innovation, which has also been touched on. We are committed to making our NHS more integrated, more strategic and better able to tackle the challenges it faces. The hon. Lady referenced the Health and Care Act 2022 numerous times—I hear her questions and points, and I will write to her on them. We put those issues on a statutory footing. We know that an increasing number of people are living with chronic medical conditions and complex care needs, which is where more integrated services can and will make an enormous difference. We want partners focusing on improving services rather than competing with each other when it is not in the interest of patients. I believe—we believe—that is the right approach because local areas know best, and certainly know far better than Ministers in Whitehall how best to organise themselves and design and deliver the best possible care for patients.

[Ian Lavery]

Will the Minister give way?

[Will Quince]

I have to make some progress—I am conscious of time.

In addition, we have digital transformation and technology, which are critical to the future of the health and social care system. Embracing digital provides a significant opportunity for us to improve clinical service to deliver better care for patients and reduce pressures on the NHS. That is why we are investing around £1.5 billion a year in digital transformation to run live services and drive those transformation ambitions. That also includes plans to improve our NHS app, digitise the frontline and improve services. We are also working with trusts to deliver things such as electronic discharge and electronic bed management systems, which also improve efficiency within the NHS.

The hon. Member for Lewisham East (Janet Daby) mentioned NIHR research, which I want to touch on briefly. We spend around £1 billion a year on that, but the Government do not commission research directly; indeed, it would be totally wrong for any Minister or shadow Minister to direct our clinicians and researchers to look into a particular area. However, we encourage and rely on organisations to come forward with bids for research, which clinicians then look at. That is rightly independent from Government, and I will be happy to work with the hon. Member to see how we can get more research into that area.

I wanted to say so much more, but time is short and I want to ensure that the hon. Member for Wirral West has time to respond. The hon. Member for Birmingham, Edgbaston (Preet Kaur Gill) touched on the life sciences space. We are putting a huge amount of work into life sciences with the Life Sciences Council and the life sciences vision, and we have launched the dementia, mental health, cancer, obesity and addiction missions, with more than £210 million in Government investment and world-leading chairs to support them. There is also our additional investment in genomic medicine, which the hon. Member rightly touched on and which is a hugely exciting field. The ability to screen for and identify the prevalence of future disease and the ability to screen babies in future will be hugely exciting. This is definitely the future of medicine.

This is a hugely important debate and I have far more to say, as you can tell, Mr Pritchard. The NHS is a vital part of the fabric of our public life. It is beloved by the public and rightly held in the highest esteem. The Government believes in the NHS; I believe in the NHS. That is why we are taking the right long-term decisions to protect its future.

[Mark Pritchard (in the Chair)]

Margaret Greenwood to wind up. The Minister has very generously given the hon. Member three rather than two minutes.

Childhood Cancer Outcomes

Will Quince Excerpts

Tuesday 17th October 2023 Commons Chamber

[The Minister for Health and Secondary Care (Will Quince)]

I thank the hon. Member for South Shields (Mrs Lewell-Buck) for securing this important debate. I begin by sending my sincerest support and sympathy to Ethan’s family and every family involved in the work of Alice’s Arc. Their mission to find a cure and kinder treatment for rhabdomyosarcoma is one that I am sure the whole House can support.

As the hon. Lady rightly mentioned, September was Childhood Cancer Awareness Month, and I think I speak for the whole House when I say that our thoughts are with every family touched by childhood cancer, particularly those who have felt the bitter grief of losing a child. I commend the efforts of so many to bring light to the darkest of situations and support families in need, including the hon. Lady, who made such a powerful and emotive speech. I also join her in paying tribute to my hon. Friend the Member for Gosport (Dame Caroline Dinenage) for her tireless efforts to improve childhood cancer care.

I want to assure the House and all families affected that cancer services for children are an absolute priority for this Government. Working alongside the NHS, we have three priorities to improve childhood cancer outcomes: improving early diagnosis, delivering more research and driving progress in genomic medicine. Let me take each one in turn.

First, improving early diagnosis will give more children the best chance of beating cancer. The NHS is working to deliver the ambition it set in its long-term plan to diagnose 75% of cancers at stages 1 and 2 by 2028. Achieving that will mean 55,000 more people surviving cancer for five years or more. That is why the Government are investing more than £2.3 billion to transform diagnostics services. Thanks to that investment, we have opened 123 new community diagnostic centres, giving millions of patients the chance to access quicker, more convenient checks outside of hospitals, and we are on track to open 160 CDCs by March 2025.

In this year’s operational planning guidance, NHS England announced £390 million of funding to cancer alliances in each of the next two years to support the operational priorities for cancer treatment capacity. That includes commissioning key services in early diagnosis and supporting systems to develop local cancer plans. We are now expanding direct access to diagnostic scans across all GP practices, helping GPs to recognise cancer symptoms, cutting waiting times and speeding up diagnosis.

Secondly, as the hon. Member for South Shields rightly pointed out, delivering more research is key to understanding the causes of cancer and increasing survival rates further. Over the past five years, the National Institute for Health and Care Research has invested almost £14 million in 38 research projects into childhood cancers. Alongside Cancer Research UK, health Departments across the UK are jointly funding a network of 18 experimental cancer medicine centres, collectively investing more than £35 million between 2017 and 2022.

Our world-leading scientists and clinicians are driving the discovery, development and testing of new treatments. That includes the paediatric network that the National Institute for Health and Care Research co-funds with the Little Princess Trust, which is dedicated to early-phase research on childhood cancers. NHS children’s cancer services are provided by highly specialist principal treatment centres that manage care through multidisciplinary teams across diagnosis, treatment and research, making research breakthroughs available to every child.

Turning to our work to drive progress in genomic medicine, the UK is a world leader in that sector, and cutting-edge research already benefits children with cancer. However, the Government are committed to going further: our priority is ensuring that all children with cancer get access to genomic medicine. The NHS now offers all children with cancer whole-genome sequencing to enable comprehensive and precise diagnosis, along with personalised treatments. In July this year, the Government announced a multi-year partnership agreement with the pharmaceutical giant BioNTech, which will accelerate that company’s clinical trials here in the UK and could provide up to 10,000 patients with personalised cancer immunotherapies by 2030. It will work with NHS England’s new cancer vaccine launchpad to improve access to treatments and trials. This Government will continue to support groundbreaking genomic medicine to give children with cancer the high-quality personalised treatments they deserve.

Children with cancer also deserve a supportive experience in hospital, as do their families. That is why I am pleased that NHS England is working with the Starlight Children’s Foundation charity to review and improve play facilities and guidance to hospital trusts, and we will learn from the first under-16 cancer patient experience survey. More than three quarters of children with cancer said they are looked after very well by healthcare staff, and almost 90% of parents or carers rated the care their child received as eight or more out of 10. That shows what our brilliant cancer workforce does so well, and also where we have more work to do.

Once again, I thank the hon. Member for South Shields for tabling this vitally important debate.

[Mrs Lewell-Buck]

I sense that the Minister is coming to the end of his comments. I have listened carefully to him, but he has largely referred to funding and research into cancers overall. He knows full well that childhood cancers are distinct from adult cancer, so could he offer us any clarity on how much money goes into childhood cancer research, and what the workforce plan is for those specialists working in paediatric cancer?

[Will Quince]

I am very happy to take both those questions. First, in relation to childhood cancer research specifically, my officials in the Department are working really closely with the National Institute for Health and Care Research to set up an expert roundtable on childhood cancer research. Many trials will be applicable to both adults and children, but by their nature, some will need to be childhood cancer-specific. I welcome that important initiative, which is designed to encourage more research into cancers affecting children.

The Government do not, in effect, commission research directly. Bids are made to NIHR; around £1 billion a year is spent directly on research through NIHR, but it is reliant on those bids. That is why it is so important that we get more bids for research into childhood cancer coming forward.

[Jim Shannon]

I thank the Minister for his response and also for his clear understanding of the issue. We appreciate his words. On Saturday past, we had our party conference. There were a number of stalls, including for a cancer charity. It has a charter, and at the top of that was a target that 70% of those who have cancer will survive and heal. Can the Minister indicate whether he and his Department have the same ambition to secure 70% of people with cancer surviving and being cured, especially children?

[Will Quince]

Where I very much agree with my hon. Friend is that research is so much at the heart of this matter. The hon. Member for South Shields asked specifically how much funding is going directly into childhood cancer research, and my understanding is that over the past five years, the National Institute for Health and Care Research specifically has funded 38 projects relating to childhood cancers and has spent just under £14 million on research specifically into childhood cancers. She is absolutely right that children’s cancer risk factors are not very well understood, as this group of cancers is rare and diverse—I think it makes up around 1% of all cancers. That is why the expert roundtable on childhood cancer research is so important, and I will continue to consider with colleagues across the House what more we can do on this important matter to get more bids for funding specifically for research into childhood cancers to come forward.

A handful of months ago, the Government published the NHS long-term workforce plan. Although it does not go into specific detail on speciality or cancer services, we are working closely with cancer charities and others to determine what the requirement would be going forward. To ensure that we get it right, I would be happy to meet the hon. Lady and any others with an interest in this area to feed into the team looking at implementation of the NHS long-term workforce plan.

I again thank the hon. Lady for tabling this vital debate, and I thank all Members who have contributed today. Families who have been affected by childhood cancer have a right to know that the Government and everyone across this House stand with them. I assure the House that improving childhood cancer outcomes is a top priority for this Government and for me personally. I will continue to work with the NHS to ensure faster diagnosis, further and broader research and greater access to groundbreaking treatment. I assure you, Mr Deputy Speaker, and the House that we will leave no stone unturned in our mission to beat cancer.

Question put and agreed to.

Oral Answers to Questions

Will Quince Excerpts

Tuesday 17th October 2023 Commons Chamber

[Tim Farron (Westmorland and Lonsdale) (LD)]

10. How many and what proportion of NHS radiotherapy linear accelerator (LINAC) machines will reach the end of their recommended lifespan in 2024.

[The Minister for Health and Secondary Care (Will Quince)]

The Government and NHS England are committed to ensuring cancer patients can receive high quality radiotherapy treatment. Between 2016 and 2021, £162 million was invested which enabled the replacement or upgrade of around 100 radiotherapy machines. Responsibility for investment in radiotherapy machines has sat with local systems since April 2022. I look forward to meeting the hon. Gentleman and the all-party group for radiotherapy on this matter soon.

[Tim Farron]

I am very grateful to the Minister for his reply and in particular for the offer of the meeting coming soon. Radiotherapy UK says that for us to even meet average international standards we must commission 125 additional new linear accelerators. Will he make the commitment to do that and, in doing so, ensure that rural and remote communities do not lose out by placing some of those machines in new satellite centres, such as the Westmorland General Hospital?

[Will Quince]

The hon. Gentleman is hugely passionate on this subject. As I said, integrated care boards are responsible for meeting the health needs of their individual populations, and that includes capital allocation. The 2021 spending review set aside £12 billion in capital funding, and since 2016 over £160 million has been invested in radiotherapy equipment, but of course I want to see more investment in this important technology and the necessary upgrades across England. I very much look forward to our meeting, where we can discuss that further.

[Stephen Hammond (Wimbledon) (Con)]

11. What recent progress NHS England has made on implementing its paediatric cancer strategy for London.

[The Minister for Health and Secondary Care (Will Quince)]

Following Professor Sir Mike Richards’s review, it is now a national requirement for all paediatric cancer services to be co-located with a children’s intensive care unit. The current principal treatment centre for south London and the south-east does not meet those requirements. NHS England has launched a reconfiguration process to identify a new location, which includes a public consultation. The future centre will achieve world class outcomes for children with cancer. I would be very happy to meet Members whose constituents may be affected to discuss that further.

[Stephen Hammond]

I am grateful to the Minister for that offer, because that would have been part of my question.

[Stephen Hammond]

But in true style, Mr Speaker, I was hoping for two bites at the cherry. [Laughter.]

In my recent discussions with the management of St George’s Hospital, one concern about the consultation is that the specialist paediatric cancer surgical unit based at St George’s may be lost if the current proposal goes through. That would potentially affect real outcomes for a number of children. Will the Minister have a look at that and explain to me whether he is concerned about the current scoring by the NHS?

[Will Quince]

I thank my hon. Friend for his supplementary question. While I cannot pre-empt the outcome of the consultation, which closes on 18 December, I can assure him that there will be no sudden changes in the way patients receive their care. Any move will of course be carefully planned with the full involvement of current teams, and clear information will be provided for parents and families. NHS England will help as many experienced staff as possible to move to the future centre, and I can reassure my hon. Friend that that centre will build on all the strengths of the existing service and provide the best quality of care for patients.

[Justin Madders (Ellesmere Port and Neston) (Lab)]

12. What recent assessment he has made of the effectiveness of integrated care systems.

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

14. What steps his Department is taking to provide a new health centre in Thornbury.

[The Minister for Health and Secondary Care (Will Quince)]

I am aware of the project to provide a new health centre in Thornbury and, of course, my hon. Friend’s tireless work to champion it. My officials are working closely with colleagues in NHS England and the integrated care board to help progress the scheme. I understand that he met Lord Markham earlier today to discuss imminent funding for the development of the business case, and we will be in touch in the coming days.

[Luke Hall]

I am grateful to Ministers for taking the time to meet me this morning to discuss the £40 million bid for a new health centre in Thornbury, which is a growing town that desperately needs this new facility. The health centre will provide more GP appointments, more mental health support and, crucially, more out-patient services. Can the Minister update me on the timescales for the announcement on funding for Thornbury health centre so we can get this crucial facility open as quickly as possible?

[Will Quince]

My hon. Friend makes a powerful case, and I know how passionate and determined he is to deliver the new Thornbury health centre. I can assure him that my officials will continue to work closely with him, with the integrated care board and with the NHS to progress the scheme. We will be in contact in the coming days, following the meeting he had earlier today with Lord Markham.

[Mark Menzies (Fylde) (Con)]

15. What recent steps his Department has taken to increase the availability of NHS dentistry services.

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[Jeff Smith (Manchester, Withington) (Lab)]

20. What steps he is taking to improve waiting times for cancer treatment.

[The Minister for Health and Secondary Care (Will Quince)]

Improving cancer treatment waiting times is a top priority for this Government, and it is a key focus of our elective recovery plan, backed by an additional £8 billion in revenue funding across the spending review period. In August 2023, cancer treatment activity for first treatments stood at 105% of pre-pandemic levels on a per working day basis, and the 62-day backlog has fallen 30% since its peak in the pandemic.

[Mrs Hamilton]

Pancreatic cancer is the deadliest type of common cancer, killing more than half of those diagnosed in England within three months. I know the pain of losing close friends and family to pancreatic cancer and how important it is that people are diagnosed and treated quickly. Under this Government we have seen NHS waiting lists go up, not down. What is the Minister doing to ensure that people with pancreatic cancer are seen, diagnosed and treated quickly?

[Will Quince]

I thank the hon. Lady for her question, and, of course, I recognise the importance of early diagnosis and treatment. Cancer checks are up by a quarter on pre-pandemic levels, and in August more than 91% of patients started their first cancer treatment within a month of a decision to treat. We have opened 123 additional community diagnostic centres and an additional 94 surgical hubs, but I accept, of course, that there is much more that we need to do.

[Jeff Smith]

The Minister has again been referring to “pre-pandemic levels”. Ministers have a tendency to blame covid for increased waiting times, including in respect of cancer. I presume they are aware that the number of cancer patients not getting care on time rose in every year since the Conservatives came to power before the pandemic. How can the Government defend that dreadful record?

[Will Quince]

We are continuing to support NHS England in increasing cancer treatment capacity. As I say, I recognise the importance of early diagnosis and treatment of cancer. NHS England has instructed integrated care boards to increase and prioritise the diagnostic and treatment capacity for cancer. As of the middle of this year, we have 93 additional surgical hubs that are currently operational and 123 additional community diagnostic centres, which have delivered more than 5 million additional tests since July 2021, but we know and recognise that we need to do more.

[Dr Caroline Johnson (Sleaford and North Hykeham) (Con)]

Members will know from my entry in the Register of Members’ Financial Interests that I am an NHS consultant and a member of the British Medical Association. I congratulate the Minister on the work he is doing to reduce waiting lists, but BMA strikes have led to the loss of more than 1 million appointments, have delayed the reporting of scans, including scans for cancer, and have disrupted people’s chronic long-term condition treatment. What is he doing to ensure that there are no further strikes? What talks is he having on minimum service levels to expand the provision if further strikes do take place?

[Will Quince]

I thank my hon. Friend for her question, which is better directed at the BMA. However, she is right to suggest that we are taking action on minimum service level legislation. We recognise that industrial action means that services are under increased pressure, with appointments and treatments being cancelled because of the strikes. The NHS is taking action, prioritising urgent and cancer care, and will of course continue to do so. It will do its best to maintain appointments and elective procedures, wherever possible, but she is right to say that these strikes and the actions of the BMA are having a devastating impact on patients.

[Saqib Bhatti (Meriden) (Con)]

My constituent Elaine Lynch was diagnosed with stage 4 lung cancer in September 2021. The drug she needs, Enhertu, is available free on the NHS to treat breast cancer, but not lung cancer, so it is costing my constituent £10,000 a month to get the treatment, without which she will die. The public petition on this matter has received more than 200,000 signatures, so it is very much in the public interest. As the company Daiichi Sankyo does not offer the drug on compassionate grounds, will the Minister meet me to see how we can make this drug available for Elaine as soon as possible, because this is literally a matter of life or death?

[Will Quince]

I have huge sympathy and empathy with the case that my hon. Friend raises. The National Institute for Health and Care Excellence is rightly independent, and strict and robust processes are in place on drug repurposing and clinical trials. Nevertheless, I would of course be happy to meet him to see what can be done.

[Aaron Bell (Newcastle-under-Lyme) (Con)]

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

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[Philip Dunne (Ludlow) (Con)]

T2.   Can the Minister confirm that the £312 million capital investment to transform the Shrewsbury and Telford Hospital NHS Trust acute hospitals is on track through the NHS approval process, with its outline business case, to enable a full business case to be concluded in the coming months so that construction can commence during this financial year?

[The Minister for Health and Secondary Care (Will Quince)]

My right hon. Friend has long championed this cause. I hope it is good news that I am able to confirm that enabling works have recently been approved for the Shrewsbury and Telford Hospital NHS Trust hospital transformation programme and are expected to commence this financial year. I can also confirm that funding has been provided for the development of the full business case and is expected to be submitted in the coming months.

[Mr Speaker]

I call the SNP spokesperson.

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[Matt Vickers (Stockton South) (Con)]

T4. My local hospital, North Tees, is tired, dated and well beyond its life expectancy, with operating theatres too small to meet modern requirements, so I was hugely disappointed that my NHS trust failed even to apply for Government funding that could have built a new state-of-the-art surgical hub on the site. Will my hon. Friend work with me to ensure that the people of Stockton get the healthcare facilities that they need?

[Will Quince]

We will always work with my hon. Friend and the trust on capital improvements where needed, but I am pleased to note that the trust has been allocated significant investment from national programmes in recent years, which my hon. Friend fought hard for, including £32.2 million from our community diagnostic centres programme, which will provide vital testing to local residents close to home, and £3 million from our A&E upgrade programme. We will of course continue to work closely with colleagues in the NHS and the local trust to continue delivering for the people of Stockton.

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

Ten years on from the Francis report, the National Guardian’s Office—for freedom to speak up—reports that last year there were 937 cases where whistleblowers were not listened to and experienced detriment. If we add that to 170,000 complaints, with 30,000 reaching the Parliamentary and Health Service Ombudsman, we can see that the complaints system across the NHS is defensive and dangerous. Will the Secretary of State review the NHS complaints system, and embed a listening and learning culture and early intervention?

Cell and Gene Therapies: Skills Provision

Will Quince Excerpts

Thursday 7th September 2023 Commons Chamber

[The Minister for Health and Secondary Care (Will Quince)]

I start by congratulating the hon. Member for Blaydon (Liz Twist) on securing this important debate. Before I get into the substance of the debate, I wanted specifically to thank her for raising the issue of SMA and Freddie’s case. To answer that specific point directly, because it is an issue that I am alive to—I alluded to it in the previous debate just a few moments ago—my understanding is that the University of Sheffield is currently undertaking work that specifically relates to SMA and the gathering of evidence to present to the National Screening Committee. I hope that will be welcome news, and as there are developments, I will certainly keep the hon. Lady updated.

The hon. Lady is absolutely right when she says that a highly skilled workforce is critical to developing these therapies and making sure that UK patients benefit. The right training and education will also provide those joining this hugely important industry with a rewarding career that they can be proud of. The UK is a leader in cell and gene therapies: nearly a quarter of Europe’s cell and gene therapy developers are headquartered in this country. The number of cell and gene therapy clinical trials conducted in the United Kingdom also continues to increase, from 28 phase 3 trials in 2020 to 44 in 2022.

As the hon. Lady mentioned, the number of cell and gene therapies coming to market is set to increase substantially, with over 1,500 clinical trials ongoing worldwide. Although the Government are funding many skills initiatives to prepare for that expansion, collaborations with industry, charities, the healthcare sector and—crucially—UK academia are also vital. The cell and gene therapy catapult, which is part funded through Innovate UK, is a key part of that collaborative approach, which provides practical training and identifies the skills that are needed across the sector.

The advanced therapies apprenticeship community, which was set up by the cell and gene therapy catapult with £1.5 million from the industrial challenge fund, is the first apprenticeship programme designed to train individuals in developing, manufacturing and—of course —delivering innovative advanced therapies at scale. That award-winning programme has supported over 300 apprentices, employed by 56 companies. In addition, the catapult has set up new state-of-the-art skills and training laboratories in Stevenage to sit at the heart of the world’s third largest cluster of advanced therapy companies.

In its latest cell and gene therapy skills demand survey, the catapult forecast a skills demand of 10,000 bioprocessing jobs by 2026, a growth of 151%. Earlier this year, at the May 2023 life sciences growth moment, we announced £54.5 million to boost UK medicines manufacturing, which included up to £38 million for a new biomanufacturing fund.

On 5 September—this goes specifically to the point about education and schools—we announced that £5.5 million of the life sciences growth funding would be used to establish a medicines manufacturing skills centre of excellence. The hon. Lady is absolutely right: we want to encourage more people, and young people in particular, to consider a career in this field. Upskilling talent from similar industries will also help to increase capacity. Backed by £4.7 million of Government funding, the advanced therapies skills training network is a national initiative to drive growth across the advanced therapies and vaccine manufacturing industry. It has supported over 3,285 learners to date, providing training and supporting uptake of new talent from different sectors while, vitally, also upskilling existing staff.

Clinical staff also need support to conduct research and learn new methods of delivering treatments. The advanced therapy treatment centres network is a world-first network operating within our NHS. Co-ordinated by the cell and gene therapy catapult, it addresses the challenges of bringing advanced therapies to patients. The ATTC has produced learning tools, including a knowledge-sharing platform, with more than 270 resources, which has had more than 28,000 hits worldwide.

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[Will Quince]

As was raised multiple times in the previous debate, the National Institute for Health and Care Research supports the development of researchers, including through its £790 million investment in the biomedical research centres, of which 14 out of 20 currently conduct research into cell and gene therapies. Cell and gene therapies are also a strategic priority for the Medical Research Council, and it will be launching its updated advanced therapeutics strategy, which includes support for skills and training, later this year.

Between 2011 and 2022, the Medical Research Council funded over £30 million in advanced therapy-focused fellowships. It has also recently launched—I am afraid this is going to be difficult to say, as it is a bit of a mouthful—a cell and oligonucleotide therapy fellowship, in partnership with AstraZeneca, which aims to develop links with industry through secondments, training and mentoring. Innovation hubs for cell and gene therapies, which is an £18 million strategic initiative with co-funding from the MRC, the Biotechnology and Biological Sciences Research Council and LifeArc, has published a skills and training strategy that sets out how it will support skills in the sector.

We recognise that we need a skilled, innovative and responsive cell and gene therapy regulatory workforce—that is absolutely key—and I am pleased to say that the Medicines and Healthcare products Regulatory Agency is working with partners across the UK health ecosystem to create faster, risk-proportionate and predictable regulatory pathways, which are underpinned by the recruitment and training of highly qualified expert assessors. This will support innovation and create a compelling reason for companies to introduce new medical products in the UK.

In closing, let me again thank the hon. Member for Blaydon for securing this important debate. The UK already has the skills to deliver new therapies, but she is absolutely right to point out that it is vital that we continue to invest to ensure we have the right staff with the right skills to develop and harness the potential of these hugely exciting new therapies.

Question put and agreed to.

Fibrodysplasia Ossificans Progressiva

Will Quince Excerpts

Thursday 7th September 2023 Commons Chamber

[The Minister for Health and Secondary Care (Will Quince)]

Let me start by thanking my right hon. Friend the Member for Hemel Hempstead (Sir Mike Penning) for securing this important debate on FOP and for his powerful and compelling contribution. As he eloquently and articulately set out, FOP is an incredibly rare and truly devastating condition. He is a champion for people living with it and for their families, and I thank him for that. It is impossible not to be moved when reading about this currently incurable condition and when seeing pictures such as those he sent me about it. I am sure I speak for the whole House when I say that hearing about Lexi Robins and her parents, Alex and David, greatly moved me. I can only imagine what they must be going through, and I send my heartfelt sympathies to them and their entire family.

I also wish to express my admiration for Chris and Helen Bedford-Gay, who established the charity FOP Friends, after their son, Oliver, was sadly diagnosed in 2009. I understand from my right hon. Friend that they have raised more than £700,000 since then to fund research into treatment and to support families impacted by FOP. I am sure that many, many families are incredibly grateful for all their efforts.

At the outset, let me confirm that I am happy to join my right hon. Friend in meeting the Science Minister on this issue. We already work hand in glove on matters of research, and the House would expect nothing less. It would be remiss of me not to also welcome the hon. Member for Bristol South (Karin Smyth) to her place and to congratulate her on her promotion on the Front Bench. I also thank the hon. Member for Blaydon (Liz Twist) and my friend the hon. Member for Strangford (Jim Shannon) for their constructive and powerful contributions to this afternoon’s debate. I will endeavour, with your permission, Mr Deputy Speaker, to give as full and comprehensive a response as possible, given that I have far longer than any Minister usually has to respond to a Backbench Business Committee debate.

Let me kick off with a question asked by the hon. Member for Blaydon about the national genomic test directory. I scribbled those words down at pace as she was speaking. I will check and write to her specifically to confirm this, but my understanding is that FOP is a form of skeletal dysplasia, which is in the national genomic test directory. I will confirm that in writing once I have checked with officials on my return to the Department.

I want to assure the House and, of course, all families affected by rare diseases and conditions—I note my right hon. Friend’s point about FOP being a condition, but “condition and disease” is a phrase that the Department and clinicians often use—that we certainly recognise and understand the challenges they face. These diseases and conditions have wide-ranging impacts, not just on sufferers’ physical health, but on their mental health and on their involvement in the community, as he set out. That is why it is crucial that those affected by this condition receive the best possible care, from swift diagnosis to treatment, to improve their quality of life as diseases and conditions, sadly, progress.

To do that, it is vital that the UK harnesses our research prowess. Today’s debate has largely focused on the power of research and how it is often the key to unlocking so much. Our universities, scientific institutions and healthcare system very much lead the world in this space—we often say that we are world leading in lots of areas, but research is certainly one area where we are. They have enormous potential to develop solutions to improve the lives of people living with rare conditions, including FOP. Let me be clear that the Government are committed to funding this research.

In July, the Medical Research Council and the National Institute for Health and Care Research announced £14 million of investment to launch the UK rare diseases research platform. That is bringing together expertise from across the UK to foster new and innovative treatments for rare diseases and conditions, and to accelerate work to improve diagnosis. What is more, the Government are committed to funding groundbreaking research through nearly £790 million of new investment, again through the National Institute for Health and Care Research’s biomedical research centres. There are 20 centres, all of which research rare conditions and bring together academics and clinicians. Their role is to translate scientific breakthroughs into potential new treatments, diagnostics and technologies.

[Liz Twist]

I thank the Minister for his comments about the UK rare disease funding. It is very welcome, and I am particularly pleased to see that some of those centres are in Newcastle, in the north-east. That is really important, as I will discuss in my Adjournment debate later. Will he talk specifically about research into this condition, which is what the families will want to hear?

[Will Quince]

The hon. Lady pre-empts my next sentence, but let me give way to my right hon. Friend before I continue.

[Sir Mike Penning]

I will await the next sentence with interest. I have been to Oxford and met many of the scientists who are carrying out the research, but bidding for this sort of funding is enormously complicated. It takes forever and a day to fill in the bids—a lot of time, and time is money for a scientific facility—and will not help with FOP because it does not fit into the categories that the Minister refers to. It is so rare that we have to bid for funding across Europe or with the Americans. Is there any way that we could simplify the process, so that researchers could know earlier whether they have a chance of getting the funding or if they are wasting their time?

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[Will Quince]

I thank my right hon. Friend for his question. Given the complexity of the issue he raises, it might be helpful if I respond in greater depth at our meeting, where I will invite Professor Lucy Chappell, who heads up the NIHR, to explain that process. She is always looking at how we can improve routes to research and make it as easy as possible for researchers to come forward with fundable bids that the NIHR is then in a position to fund.

The hon. Member for Blaydon pre-empted my next sentence, which was going to be on FOP specifically. I am pleased to say that the Government are funding dedicated research into FOP. Since 2010, the Medical Research Council has funded three projects relevant to FOP. I will ensure that right hon. and hon. Members get further detail about exactly what the Government have funded.

In the last five years, the NIHR has supported seven studies specifically into FOP. As my right hon. Friend the Member for Hemel Hempstead said, the biomedical research centre in Oxford has supported the STOPFOP clinical trial that is exploring the safety and efficacy of using the new drug Saracatinib, to which the hon. Member for Strangford referred, to treat sufferers of FOP. Both the National Institute for Health and Care Research and the Medical Research Council welcome funding applications into any aspect of human health.

My right hon. Friend the Member for Hemel Hempstead rightly made a point about the challenges of designing trials for rare diseases. The efficacy and mechanism evaluation programme that is funded by the NIHR and the MRC may suit researchers who are interested in FOP, as it looks to attract studies with novel methodology designs that can deliver results efficiently and quickly.

My right hon. Friend and others rightly referred to Horizon Europe. I know that, ideally, he wanted the Minister of State for Science, Research and Innovation to respond to this debate, but I reiterate that I work incredibly closely with that Minister because I have responsibility for all research funded by the National Institute for Health and Care Research and through the Department. Moreover, the NHS is a vehicle for so much of the research that happens.

As my right hon. Friend pointed out, Horizon Europe is a valuable platform for researchers from across the continent to come together to tackle shared challenges, especially in areas of this nature where the number of patients affected, or certainly diagnosed, is very small. It has been an important source of funding for research into rare diseases and conditions, including the STOPFOP study. As my right hon. Friend alluded to, we have been negotiating the UK’s continued involvement in the programme. I am delighted to say that, such is the timeliness of this debate, the Prime Minister this morning announced the successful conclusion of those negotiations with a bespoke deal in our national interest, as the Secretary of State for Science, Innovation and Technology set out in a statement to the Commons earlier today.

Let me respond to my right hon. Friend’s specific point about how quickly research can be stood up. As of today, UK researchers can apply for grants and bid to take part in projects under the Horizon Europe programme, and they can do so with certainty that the UK will be participating as a fully associated member for the remaining life of the programme to 2027.

[Sir Mike Penning]

This is a learning process for all of us, and it is not just about FOP. As I understand it, Horizon asks for bids on certain aspects. A bidder can only bid if they fit into those criteria and then they have to wait for up to two years to run the project. The FOP project had to stop because of covid. To start all over again would be very difficult. I wonder whether the Minister will join me in that meeting to see whether we can slot into the process, rather than start all over again.

[Will Quince]

I thank my right hon. Friend for his intervention. Again, he has pre-empted what I was about to say next. I listened intently to his question to the Secretary of State during the statement earlier today, where he secured a meeting with the Minister of State for Science, Research and Innovation. Of course, I would be very happy to join him at that meeting. I share with him the view that if there is an opportunity for that research to be continued, we certainly do not want to see it start from scratch. At the moment, my understanding is that that research relates only to adults and my right hon. Friend, understandably and rightly, would like it to be extended to children.

Let me turn to the steps that the Government are taking to tackle rare diseases and conditions more broadly. In 2021, we published the UK rare diseases framework, which embodies our commitment to building a brighter future for people living with rare diseases and conditions. The framework identified four key priority areas: helping patients get a faster diagnosis; increasing awareness of rare diseases among healthcare professionals, which is something that my right hon. Friend is particularly passionate about; delivering more co-ordinated care; and, alongside that, improving access to specialist care, treatment and drugs. Since then, as was alluded to by the hon. Member for Inverclyde (Ronnie Cowan), all four nations of the United Kingdom have published rare disease action plans to suit their healthcare systems, and we very much work—and have to work—in collaboration on that.

In England, we published our second rare disease action plan on 28 February this year, which also marks International Rare Diseases Day. In that, we set out 13 new actions to drive improvements across the health system and we are committed to publishing action plans throughout the lifetime of the framework.

I touched on awareness of FOP and rare conditions and diseases more broadly, because my right hon. Friend rightly highlighted how a lack of awareness of FOP in the medical community can lead to under-diagnosis, missed diagnosis and, sadly, unnecessary examinations, which can exacerbate symptoms. That is why improving healthcare professionals’ awareness of rare diseases and conditions is central to the rare diseases framework. I am pleased to inform the House that we are making good progress in that regard. NHS England has developed GeNotes, which is an online resource that puts information about genetic diseases and conditions at the fingertips of healthcare professionals. I am pleased to tell the House that resources dedicated to FOP will be added to GeNotes. That will help more clinicians to diagnose this awful condition, and sufferers will receive the treatment that they need more quickly.

My right hon. Friend has raised newborn screening with me privately. The hon. Member for Bristol South (Karin Smyth) also raised newborn screening for FOP. They are both right that antenatal and newborn screening can be a vital tool in the early diagnosis of rare diseases. National screening programmes are implemented on the advice of the United Kingdom National Screening Committee, which makes independent evidence-based recommendations to Ministers in all four nations. While I understand that there are currently no plans for a national newborn screening programme specifically for FOP, I highlight that proposals for new conditions can be submitted to the National Screening Committee’s annual call for new topics.

[Liz Twist]

On newborn screening, is the Minister aware that there is concern among the rare disease community about the limits of our newborn screening process? This is something that we are speaking about at the moment. We think that there are options for it to be expanded in a positive way.

[Will Quince]

I have heard that from other charities, groups and organisations representing those with rare diseases and conditions. It is right that we respect the independence of the National Screening Committee, which puts forward to Ministers evidence-based decisions, but it is nevertheless important that we listen to organisations that are making valid cases. I am also concerned about the length of time that the National Screening Committee can take to make decisions, review evidence and present recommendations to Ministers. In our meeting, I will happily discuss that issue in greater depth and at greater length.

Let me once again thank my right hon. Friend the Member for Hemel Hempstead for securing today’s hugely important debate, and in particular for securing it on the Floor of the House. I express my heartfelt support for the entire FOP community: those living with the disease, their carers, their families, the clinicians and the charity FOP Friends, which works tirelessly to improve the lives of people affected by this devastating condition. I reiterate my thanks to all Members for shining a light on the condition this afternoon. I very much look forward to our meeting and to discussing this further. I genuinely believe that together we will continue to strive for progress and awareness, and support those living with FOP.

Radiotherapy: Accessibility

Will Quince Excerpts

Tuesday 18th July 2023 Westminster Hall

[The Minister for Health and Secondary Care (Will Quince)]

It is a pleasure to serve under your chairmanship, Dame Maria. I thank my hon. Friend the Member for North Devon (Selaine Saxby) for securing this important debate on the accessibility of radiotherapy. I agree wholly with the hon. Member for Denton and Reddish (Andrew Gwynne) that there are issues in this place that are not by nature party political. The debate has demonstrated that there is huge consensus on all sides of the House on the need for change, and I thank all right hon. and hon. Members for their contributions today.

Let me turn back to my hon. Friend the Member for North Devon for one moment. Whether it is in the meetings—dare I say it, the many meetings—that I have had with my hon. Friend, or through her public contributions in the House and outside, she has been consistent and powerful in her advocacy on health issues. Her constituents, and patients around the country, are very lucky to have her in their corner.

It is rare for the Front Benchers in a Westminster Hall debate to be allowed so much time to respond. I do not intend to take the entire time available, but I would like to try to answer as many of the questions, points and themes raised as possible. Although Members will know that I am not a new Minister, I am relatively new to this brief, having taken on the cancer portfolio in the last few days. I very much look forward to working with parliamentary colleagues from across the House, including those present today and others who I know have specific interests in cancer, to bring about the changes that we all want to see. I echo the words of the hon. Member for Easington (Grahame Morris) and thank him for sharing his personal experience; I certainly agree with him that we all want to see cancer outcomes improve across the country.

My hon. Friend the Member for North Devon raised the matter of performance levels, which I will touch on briefly before turning to specific points raised in the debate. I echo the hon. Member for Westmorland and Lonsdale (Tim Farron) in paying tribute to the brilliant work of NHS staff in this field. Thanks to them, levels of first treatment following an urgent cancer referral have been consistently above pre-pandemic levels, with activity in May standing at 111% of pre-pandemic levels on a per working day basis. Over 52,000 people had their first or subsequent treatment for cancer in May. In total, over 332,000 people received their first cancer treatment in the 12 months up to May, which is up by more than 18,000 on the same period before the pandemic.

As hon. Members have eloquently pointed out, waiting time performance for radiotherapy is influenced by a range of factors, including workforce and equipment—two subjects that I will come on to address in greater detail. My hon. Friend the Member for North Devon referred to the impact of covid and the recovery of cancer services following the pandemic. In February last year, the Government published the delivery plan for tackling the covid-19 backlog of elective care. We will spend more than £8 billion between now and 2024-25 to drive up elective activity, including cancer diagnosis and treatment. My hon. Friend referred to the community diagnostic centres, which make a huge difference, and the building of surgical hubs.

[Grahame Morris]

I am grateful to the Minister for taking the time to answer the points that have been made. Over the years, we have seen every single cancer Minister and probably every Secretary of State, but it seems that just when the penny is about to drop for the responsible Minister, they get shuffled off and nothing actually happens. I hope the Minister will stay in post long enough to deliver the improvements that we want to see.

The community diagnostic hubs are, of course, a wonderful thing, and we have been calling for them, but they must go hand in glove with increased treatment capacity. Otherwise, all that will happen is that the waiting lists will get longer as we diagnose more patients who require early treatment, but without having the treatment capacity to make the inroads that we all want.

[Will Quince]

I will come on to the hon. Gentleman’s specific point, but he is absolutely right. On remaining in post and Government reshuffles, the Prime Minister giveth and the Prime Minister taketh away, but I thank the hon. Gentleman for his best wishes ahead of any future reshuffle. Having been in the Departments of Health and Social Care, for Education and for Work and Pensions, I know that any Minister understandably ends up taking a considerable interest in their work. I assure the hon. Gentleman that whether or not I maintain my position in the Government, I will maintain my interest in all the areas I have worked on as a Minister. I certainly commit to continuing that work from the Back Benches when one day the Prime Minister chooses to dispense with my services.

[Selaine Saxby]

I thank the Minister for all his time and commitment and for meeting me so regularly. When he takes things away and reflects on them, will he bear in mind that although community diagnostic hubs are fantastic, it is still a 120 mile round trip from my constituency to get to one, so there are issues in respect of rurality. In Ilfracombe in my constituency, the healthy life expectancy is 59. Remote coastal communities need to be able to access services, and we are underdiagnosing because it is so hard to access even a diagnosis, let alone the treatment.

[Will Quince]

I will come on to this point in greater depth, but many of the conversations that my hon. Friend and I have had on health issues, and previously on education issues as well, were about rurality and the challenges of rural and coastal communities. Her points are well made—I certainly understand them—and she makes a compelling case. I will address them in greater detail later in my speech.

Not only are we building the community diagnostic centres and surgical hubs—and notwithstanding my hon. Friend’s point about the distance that some have to travel to get to them—but we are creating them deliberately closer to communities; they are not just based in district and general hospitals. In each of the next two years they will be supported by an additional £3.3 billion of funding, which was announced in the autumn statement, and that will enable rapid action to improve emergency, elective and primary care performance towards the pre-pandemic levels.

On cancer specifically, NHS England recently set out the progress made on reducing the number of patients with urgent suspected cancer who wait for longer than 62 days, and announced that the faster diagnosis standard was met for the first time in February this year. It also confirmed the ongoing priorities to improve performance and long waits, prioritise diagnostic capacity for cancer and, of course, focus on the cancer pathway redesign.

The Government and NHS England have pushed to improve the early diagnosis of cancer, which is so important to give patients the best chance of receiving successful treatment and in turn see more people living longer following a cancer diagnosis. However, as my hon. Friend the Member for North Devon eloquently and articulately pointed out—the hon. Member for Easington also made this point—we know that early diagnosis needs to be backed up by high-quality treatment options such as radiotherapy, with its remarkable ability to shrink tumours, as has been set out, and often with minimal side effects.

The hon. Members for Easington and for Denton and Reddish referred to the 62-day cancer target and the changes required to improve cancer outcomes. I hear the strong and compelling arguments that have been made, and I am happy, as I set out at the beginning of my speech, to meet hon. Members to discuss the steps that we are already taking and the further steps that can be taken, alongside NHS England, to improve cancer outcomes.

The hon. Member for Denton and Reddish asked specifically about steps to meet the 62-day target. To target support towards the most challenged trusts in the country, NHS England has developed an intervention model that is designed both to maximise and expand capacity. Challenged trusts have been placed into tiers 1 and 2, and all tiered trusts have weekly or fortnightly oversight calls, and they also have visits with the regional and national teams from NHS England. They receive support on things like the development of a co-ordinated support plan, which is monitored by fortnightly progress meetings. The plans have focused on areas such as pathway improvements, workforce support and targeted capacity increases. That supports the trusts that do not have the resource or bandwidth internally to turn around services.

When my hon. Friend the Member for North Devon made the case for a satellite centre in her constituency, she raised specific challenges in relation to North Devon that are translatable to other parts of the country that have rural and coastal characteristics. I will outline the basis on which provision is reviewed, but before I do let me acknowledge the local efforts that she mentioned. She is rightly proud of her constituents’ initiative in terms of support with travel and other things.

The network oversight group, in conjunction with the relevant specialised commissioning team and cancer alliances, is required to review service provision on a regular basis to ensure that optimal access arrangements are in place. That applies to proposals that relate to the expansion or re-provision of existing services, or to the development of any satellite facilities. The development of any new service location requires the development of a business case, as my hon. Friend pointed out, and business cases must demonstrate, among other criteria, the consideration of the effect on the provision of existing cancer pathways, both within and outside the network geography.

As I have mentioned, that responsibility sits not with the Government but with the integrated care boards, cancer alliances and local specialised commissioning teams. I am happy to meet my hon. Friend, alongside the ICB, to understand the challenges and what can be done in this space. I understand from NHS England that around 450 patients a year travel from my hon. Friend’s constituency to Exeter for treatment, but I am cognisant of the point made by the hon. Member for Westmorland and Lonsdale that many more patients might want to access those services but do not because of the travelling and distances involved. That is why a meeting between me, my hon. Friend and the ICB might be a good starting point.

[Grahame Morris]

The Minister is being generous in giving way. The debate is instructive, and I am glad he has mentioned integrated care boards. As the hon. Member for Westmorland and Lonsdale (Tim Farron) mentioned—sorry, the right hon. Gentleman.

[Grahame Morris]

Well, I am sure it is only a matter of time.

One of the issues has been commissioning. NHS England is responsible for commissioning without having a sensible plan to replace old machines, and there are bizarre disincentives to using the most modern machines, which require fewer visits. Furthermore, the fractionations are smaller, and the radiotherapy could be delivered in a shorter time. Bizarre commissioning arrangements and tariffs apply. Is the advent of the ICBs, with the responsibilities they hold, an important element in deciding where the new treatment centres are going to be? Will the Minister outline their role in the context of access to radiotherapy services?

[Will Quince]

I thank the hon. Gentleman for his question and will jump to the part of my speech that covers equipment, because the issue has been raised by all hon. Members during the debate.

We are absolutely focused on improving cancer treatment and supporting advances in radiotherapy using cutting-edge imagery and technology. As my hon. Friend the Member for North Devon pointed out, since 2016 we have invested £162 million in the most cutting-edge radiotherapy equipment, which is designed to replace or upgrade more than 100 radiotherapy treatment machines so that we can deliver the best possible outcomes for patients. As the hon. Member for Westmorland and Lonsdale said, NHS England is carrying out a stocktake of linear accelerator age, which will be completed in the summer. It is also working with partners to undertake a demand and capacity review, which will complete by the end of the year.

On AI specifically, we want to ensure that we have the best possible cutting-edge, innovative equipment and technologies in the NHS, so we have announced an additional £21 million of funding that will speed up the roll out of AI across the NHS. That will enable us to help to improve diagnosis and to reduce waiting times—one of our top priorities—and clinicians will be freed up to spend more time delivering frontline patient care. The point made by the hon. Member for Easington about AI and the benefits thereof is well made.

The hon. Member for Westmorland and Lonsdale has been campaigning on the issue for around a decade, or perhaps longer, and he has met several Ministers. I am yet to meet with the hon. Gentleman, and I know he was due to meet my hon. Friend the Minister for Social Care, but I am happy to honour that meeting. He recently met his local hospital trust to discuss radiotherapy being part of the new hospital programme. Ultimately, that is a matter for commissioners, but we can certainly have that conversation when we meet and try to find a way forward.

A number of hon. Members raised the issue of the workforce. The hon. Member for Strangford (Jim Shannon) is no longer in his place, but he laboured this point, and rightly so. We have made good progress in growing the cancer workforce. The annual growth rate of the workforce remains steady at between 3% and 4%, but we need to go further. As of February, there were 33,174 full-time equivalent staff in the cancer workforce. In trusts, that is an increase of more than 11,300 since February 2010. Specifically, the number of therapeutic radiography staff grew by 17.4% between 2016 and 2021. As has been referenced, we published our long-term workforce plan, which sets out actions that are backed by £2.4 billion of Government funding up to 2028-29, a couple of weeks ago.

On travel, the travel that a patient needs to undertake is dependent on the type of treatment they need. Decisions about treatment locations are made on a case-by-case basis. As hon. Members have pointed out, specialised services are not available in every local hospital, in part because they have to be delivered by specialist teams of health professionals with the necessary skills and experience and access to the necessary equipment and medicines. Patient-specific requirements are based on what each individual can cope with and are discussed between the patient and clinician.

The Government are, of course, striving wherever possible to reduce any necessity to travel unreasonable distances, which is why our priority continues to be to bolster the specialist workforce and ensure ever-expanding coverage of equipment. That includes by investing in new radiotherapy machines, but the responsibility for investing in that equipment sits with local systems—the ICBs, which I suspect we will discuss in greater detail when we meet. I hear the case that has been made about equality and rurality. We can address some of those issues and work with integrated care boards so that they see the benefits to patients and to outcomes, as well as the cost savings, if we get it right.

We are supporting providers to accelerate the delivery of stereotactic ablative body radiotherapy for targeted cancers, thereby lowering the risk of damage to normal cells. Specialised commissioners have allocated £12 million to support providers to deliver SABR.

[Tim Farron]

The Minister has given a comprehensive response to us all. On the issue of SABR, would he look in particular at the point made by the hon. Member for Easington (Grahame Morris) about commissioning arrangements and the perverse incentives that lead to some cancer treatment centres effectively being paid more for using lesser treatment than they would be for more efficient, less invasive, less frequent but more powerful SABR technology and other similar advanced forms of treatment? It would save an awful lot of money and still do a better job.

[Will Quince]

In short, the answer is yes. There are perverse incentives that exist across Government, and the NHS is no exception. Wherever we identify them, we have to work to drive them out of the system. We have a tendency, unfortunately, to focus on processes and procedures. I want all trusts—I would like us to do this across Government—to focus more on outcomes than on processes. Perhaps when we meet the hon. Gentleman could set out that exact challenge in more detail, because I would be glad to look at it in detail.

Dame Maria, I am conscious that I have gone on for longer than I should have; you have been very generous. I again thank my hon. Friend the Member for North Devon for bringing this matter to the attention of the House, and I thank all hon. Members for their contributions on this hugely important subject. I hope I can assure my hon. Friend and Members from all parties that with the investments we have made and the innovations the NHS has adopted, and the innovations to come, we will continue to improve access to radiotherapy throughout the country. I look forward to meeting the hon. Members present, alongside NHS England, to see what is within the art of the possible in this space. I look forward to working with parliamentary colleagues throughout the House to bring about the improved cancer outcomes that we all want to see.

Oral Answers to Questions

Will Quince Excerpts

Tuesday 11th July 2023 Commons Chamber

[Dame Meg Hillier (Hackney South and Shoreditch) (Lab/Co-op)]

8. What steps he is taking to help improve the effectiveness of brain cancer treatments.

[The Minister for Health and Secondary Care (Will Quince)]

We are working closely with research partners, and although I am pleased to say that more research is being funded, we want to see more research in brain cancer treatments. We continue to encourage more researchers to become involved in what remains a challenging scientific area, with a relatively small research community, but I am confident that the Government’s continued commitment to funding will help us make progress towards effective treatments.

[Dame Meg Hillier]

I thank the Minister for that answer, and I am sure—and I know—he will take this very seriously. I have had three constituents in the last year come to see me who have suffered serious brain tumours, and they have had a very similar pathway, which is basically that after a certain point there is little the NHS can do for them. In particular, there is a shortage of neuro-oncologists, and one has spent their life savings on private treatment, even though that was difficult to find. Is there any hope, in the NHS workforce plan, that there will be more oncology training and more support for neuro-oncology, because the survival rate for this cancer is still woefully low?

[Will Quince]

I thank the hon. Lady for her question, and I am sorry to hear of the experience of her three constituents. There certainly is hope within the long-term workforce plan. As she rightly alludes to, we are reliant on researchers to submit high-quality research proposals, and that requires clinicians specialising in this area. It is something I take very seriously, and I would be very happy to work with her on it.

[Paul Bristow (Peterborough) (Con)]

I refer Members to my entry in the Register of Members’ Financial Interests.

My father, the late Alan Bristow, died of a brain tumour in April 2020. He was 77, and that was incredibly sad, but when a child dies of a brain tumour, it is unbelievably wicked. Brain tumours are still the biggest killer of young people. What can the Minister do to ensure that appropriate funding is being put into research into brain tumours, especially for younger people, and when will the Government respond to the O’Shaughnessy review into clinical trials in the UK, which would help the brain tumour community?

[Will Quince]

I thank my hon. Friend for his question, and I am sorry to hear of his own personal experience. He is absolutely right that, in relation to children, I am very keen to find a way forward. The Government are committed to finding high-quality brain cancer research, and we expect to spend more as new research progresses. The £40 million of funding announced will remain available, and if we can spend more on the best-quality science, we will do so. We worked really closely with Lord O’Shaughnessy on his review, we have accepted his recommendations and we have put in £121 million to support it.

[Mr Speaker]

I call the shadow Secretary of State.

[Wes Streeting (Ilford North) (Lab)]

The Minister is aware, I know, of the outstanding campaigning work that my hon. Friend the Member for Mitcham and Morden (Siobhain McDonagh) is doing, not least because of the experience of her sister—our late great friend Margaret McDonagh—with glioblastomas. Over decades now, we have seen no improvements in outcomes, no drug trials of any seriousness and no mandatory training of oncologists. I have learned through experience that, when the McDonaghs come knocking, it is best to say yes, and if anyone says no, they will be hit by this unstoppable steamroller. With that cautionary note in mind, might the Minister be prepared to meet me, my hon. Friend and relevant stakeholders across the Department, NHS England and the National Institute for Health and Care Excellence to see what more can be done? There are challenges, I know, but what more can be done to make sure that, for families such as my hon. Friend’s and Margaret’s, and for thousands of others each year, glioblastomas are not simply a death sentence?

[Will Quince]

I thank the hon. Member for that question and join him in paying tribute to the hon. Member for Mitcham and Morden (Siobhain McDonagh), especially after the tragic loss of her sister, for all the work that she has done in campaigning on this issue. I have spent significant time on the issue and I have met her, the hon. Member for Leicester West (Liz Kendall), campaigners, charities and other hon. Members from across the House. Funding for research is available and, having spoken with the Secretary of State, I know that he is as keen as I am to work with colleagues from across the House. There are issues that transcend party politics and this is certainly one of them. I would be very happy to meet the shadow Secretary of State, the National Institute for Health and Care Research, NHS England, the Tessa Jowell Brain Cancer Mission and clinical specialists to find a way forward.

[Fabian Hamilton (Leeds North East) (Lab)]

9. What assessment he has made of the adequacy of treatments for complex mental health illnesses in West Yorkshire.

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[Esther McVey (Tatton) (Con)]

18. What recent progress he has made in negotiations with the World Health Organisation on proposed amendments to the International Health Regulations 2005.

[The Minister for Health and Secondary Care (Will Quince)]

The UK continues to negotiate on amendments, alongside other member states of the World Health Organisation. We want to ensure that the International Health Regulations are effective in preventing and responding to potential health threats, leaving the UK better prepared for future health emergencies. We anticipate negotiations to continue until the 77th World Health Assembly in May next year.

[Esther McVey]

Will the Minister assure me that the proposed changes to the International Health Regulations being negotiated will not give new rule-making powers, such as those tabled by Bangladesh, to the WHO director general to make binding directions on matters including border closures, quarantining and vaccine passports? Even the WHO’s own expert review committee has raised concerns over such significant increases in power.

[Will Quince]

As my right hon. Friend will know, the UK has a strong commitment and duty to implement international law, but on this matter we have been absolutely clear. I can certainly assure her that we will not sign up to any IHR amendment or any other instrument that would compromise the UK’s ability to make domestic decisions on national measures concerning public health.

[Andrew Bridgen (North West Leicestershire) (Reclaim)]

Can the Minister confirm whether the House will get a vote on the amendments to the International Health Regulations, or will we not?

[Will Quince]

Should the UK Government wish to accept an IHR amendment, changes to domestic law to reflect proposed obligations may indeed be required. The Government would therefore prepare draft legislation and bring it before Parliament in the usual way. Let me repeat that in all circumstances, the sovereignty of the UK Parliament would remain unchanged and the UK would retain control of any future decisions around national public health measures.

[Tim Loughton (East Worthing and Shoreham) (Con)]

19. If he will publish the results of the consultation on giving powers to coroners to investigate stillbirths.

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[Matt Vickers (Stockton South) (Con)]

T5. I was delighted when the Government awarded Stockton a new £25 million diagnostic hub, but my local Labour council, which is a partner in delivering the project, appears happy to accept months of delays in completing it. Does my hon. Friend agree that Labour’s delays could cost lives? Will he work with me to ensure that all partners understand the urgency of the project?

[The Minister for Health and Secondary Care (Will Quince)]

That is hugely frustrating, because I know how hard my hon. Friend campaigned for the Stockton community diagnostic centre and that he recognises the urgency of increasing diagnostic capacity locally. Delivery plans have to be agreed at a local level, so I urge Stockton council to work with him to meet the ambitious timeline and get Stockton CDC open as soon as possible.

[Steven Bonnar (Coatbridge, Chryston and Bellshill) (SNP)]

A recent report by the Trussell Trust warns that people facing hunger are more likely to be affected by spiralling debt and a decline in their physical and mental health. The same report shows that one in seven people in the UK faced hunger in the last year due to a lack of money. Will the Minister make representations to his colleagues at the Department for Work and Pensions about increasing support for low-income households, thereby improving public health outcomes for all?

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[Barbara Keeley (Worsley and Eccles South) (Lab)]

I have received a wave of concern from clinicians on the safety of using physician associates, following my Adjournment debate last week in which I raised the death of Emily Chesterton, the 30-year-old daughter of my constituents Marion and Brendan. Emily died of a pulmonary embolism after being seen twice by the same physician associate at her GP practice. The physician associate failed to refer her to a doctor or to a hospital emergency unit for tests, which the coroner concluded could have prevented her death.

Yesterday, on “Good Morning Britain”, the Secretary of State boasted of increasing the number of people working in primary care, presumably including the workforce plan proposal to triple the use of physician associates. Will he look urgently at the details of Emily Chesterton’s case and ask himself whether lessons can be learned to avoid other preventable deaths?

[Will Quince]

Having responded to the hon. Lady’s Adjournment debate last Thursday, I hear the calls she has made. I know that she has also written to the Secretary of State, and I will ensure that she gets a full response, with answers to all the questions she raises.

[Mr William Wragg (Hazel Grove) (Con)]

My good friend the mental health Minister—the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Lewes (Maria Caulfield)—will know that I have been busy beavering away, together with the UK Government’s mental health ambassador, Dr Alex George, on the early support mental health hubs project. It will relieve pressure on child and adolescent mental health services and save undue distress and money. The pilot scheme is ready to go. Might I suggest that the shared outcomes fund could be the means to press on with the pilot?

Physician Associates

Will Quince Excerpts

Thursday 6th July 2023 Commons Chamber

[The Minister for Health and Secondary Care (Will Quince)]

Let me start by thanking the hon. Member for Worsley and Eccles South (Barbara Keeley) for securing this important debate and for her very powerful speech. It was very difficult to hear her recite Marion’s words.

First, on behalf of the House, may I pass on my sincere condolences and sympathies to the hon. Lady’s constituents, Marion and Brendan Chesterton, in relation to their daughter Emily. No family should have to suffer the loss of a child, and my heart goes out to them and, of course, to Emily’s friends and wider family. Having personal experience, I know that no words from me could ever take away the pain or the suffering of losing a child, but I certainly understand the need to understand why and how this happened, and the need for an assurance that any lessons that can be learnt will be learnt, that necessary changes are made and that all steps are explored, so that any future families will not go through a similar tragic loss.

I have had sight of the hon. Lady’s recent letter to the Secretary of State for Health and Social Care. Although I will not be able to answer all the specific questions she raised today—not least because I have not yet had a chance to read the coroner’s report or had specific information from NHS England—I will ensure that she receives a full response to the letter and the points and questions contained therein.

Improved patient safety and care lay at the heart of the NHS long-term workforce plan, which, backed by significant Government investment, shows our determination to support and grow the healthcare work- force. As set out in the plan, roles such as physician associate play an important role in NHS provision, but critically, healthcare teams remain supervised and led by clinical experts. It is right that we include a range of roles and skills in our multidisciplinary teams that can offer personalised, responsive care to patients. Giving staff access to continuing development, supportive supervision and, importantly, protected time for training is a core responsibility for all employers in ensuring patient safety.

As set out in National Institute for Health and Care Excellence guidelines, we are clear that the onus is on the individual professionals to properly explain their role to patients, especially if there is a likelihood of this not being automatically understood. I know that NHS England has produced patient-facing materials that have been shared widely with GP practices to support patient awareness and the understanding of roles.

Physician associates are healthcare professionals but with a generalist medical education, who work alongside doctors, providing medical care as an integral part of a multidisciplinary team. Physician associates can work autonomously but, importantly, always under the supervision of a fully trained and experienced doctor. They add new talent to the skill mix within teams, providing a stable generalist section of the workforce that can help ease the workforce pressures that the NHS currently faces.

As the hon. Lady rightly said, across the UK there are currently approximately 1,500 PAs working in hospitals and a further 1,700 PAs working in primary care settings. Physician associates are qualified and trained health professionals, and people will usually need a bioscience-related undergraduate degree to get on to one of the training programmes available, which typically last for two years. The training involves at least 1,600 hours of clinical training, including 350 hours in general hospital medicine and a minimum of 90 hours in other settings, including mental health, surgery and paediatrics. Some become physician associates after working in another healthcare role, such as a nurse, allied health professional or midwife.

As the hon. Lady will be aware, physician associates are not currently subject to statutory regulation, and I heard her call in that regard. It is important to note that, as an unregulated role, physician associates are not able to prescribe. In order to prescribe, as she rightly pointed out, a role needs to be added to the Human Medicines Regulations 2012. Any prescribing decisions must be made by a regulated professional such as a doctor. Work is ongoing to bring this role into regulation under the General Medical Council in an appropriate way.

The Faculty of Physician Associates at the Royal College of Physicians provides professional support to PAs across the United Kingdom. In terms of standards, the faculty reviews and sets standards for the education, training and national certification of physician associates. The faculty also oversees and administers the running of a managed voluntary register, which is a register of fully qualified PAs who have been declared fit to practise in the United Kingdom. I understand that the majority of qualified physician associates are on this register.

When complaints are received and upheld in line with the faculty’s code of conduct processes, it can suspend a physician associate from the voluntary register. We would strongly recommend that employers only consider recruiting PAs who are on the voluntary register. It enables supervisors and employers to check whether a physician associate is qualified and safe to work in the United Kingdom.

[Barbara Keeley]

I take what the Minister has said about the training and voluntary registration aspects, which I did speak to, but could he comment on the situation we seem to have been in? The GP practice had concerns about the physician associate’s knowledge and understanding of what investigations she should perform, her ability to recognise an unwell patient, and her overconfidence and lack of insight into the limitations of her own knowledge. Those are the issues that the GP practice itself reported. Does the Minister share my concern that it is a very serious thing to have had a system like that, and, surrounding that, to have the fact that the reception function in that practice did not realise that it should not refer an unwell patient to a physician associate twice within a short period of time? If these are meant to be safety measures, they are not working, are they?

[Will Quince]

I hear what the hon. Lady says. In response to her questions, we very much need to look into the exact details, and I hope I will be able to respond to her with full answers when I have received both the coroner’s report and further information from NHS England regarding the practice itself. On the face of what she has just said, the situation is concerning and it certainly adds weight to her calls for the register to be non-voluntary and for regulation and legislation in this space. I will come on to that issue in a moment, because it is a case well made.

The physician associate role is in no way a replacement for any other member of the general practice team—that is an important point to make. They work in conjunction with the existing team, and are complementary to it. Physician associates can help broaden the capacity and skill mix within the practice team to help address the needs of patients in response to the growing and ageing population faced by constituencies up and down the country, including the hon. Lady’s constituency and, indeed, mine. However, let me be clear: the employment of a physician associate does not in any way mitigate the need to address the shortage of GPs, nor does it reduce the need for other practice staff.

I will talk, not about the specific case that the hon. Lady described—I do not have those details—but about the generalities of the responsibilities of a supervising doctor, which may be relevant in this case. Physician associates are dependent practitioners: they are working with a dedicated consultant or GP supervisor. They are able to work autonomously but, vitally, with appropriate support, and the General Medical Council has published guidance for doctors who supervise physician associates. The supervision of a qualified physician associate is similar to that of a doctor in training or a trust-grade doctor, in that the physician associate is responsible for their actions and decisions. However, the medical consultant or GP supervisor ultimately retains responsibility for the patient.

The hon. Lady has called for regulation. As she alluded to, the General Medical Council is well advanced in developing regulatory processes for physician associates once the necessary legislation is in place, and regulation will give the GMC responsibility for, and oversight of, physician associates and anaesthesia associates in addition to doctors. That will enable a more coherent and co-ordinated approach to regulation and make it easier for employers, patients, and of course the public to understand the relationship between the roles. The hon. Lady asked specifically when that legislation will come forward. We intend to lay legislation before the House at the end of this year, which will allow the GMC to commence the regulation of physician associates by the end of 2024—legislation by the end of this year, and then a year for it to be put in place.

The General Medical Council has published future professional standards for physician associates. Among other things, that includes working within the bounds of professional competence and knowing when to refer, or indeed to escalate, to a colleague within the practice. Those standards also cover communication with patients, including the importance of physician associates explaining what they do and how their role fits in with other members of the medical team. Once regulation commences, the GMC will be able to investigate concerns raised about physician associates, and in serious cases will be able to prevent a physician associate from practising, either on a temporary or a permanent basis.

[Barbara Keeley]

I want to go back to the point I made to the Minister about the title of physician associate, which I have used a lot and so has he. The point is that it does sound rather grandiose as the name of a role in clinical practice for a person who has trained for only two years, and it is confusing. I have been steeped in health and social care matters in this place—I have been a member of the Health Committee and had Front-Bench responsibility for it—and I had never heard of physician associates, so it does seem confusing. The title itself is confusing.

[Will Quince]

I thank the hon. Lady for her intervention, and I gave careful thought to the point she raised in her speech. Although the terms she used were doctors in training or trainee doctors, physician associates are not doctors in training and they are not doctors. They are very different, but they are a part of a multidisciplinary team. I will take away what she says. She is right that they have been in place for well in excess of 10 years, but nevertheless there is still a relatively small number of them. However, there are plans to significantly grow their number, so I will take that away.

Personally, as part of my own experience of the NHS, I have never seen a physician associate, but when I have been in general practice, I have often seen a paramedic, a physiotherapist or a pharmacist and they have made their position very clear at the outset of the appointment. I think we need to ensure that, regardless of the title— I will take that away and look in some detail at whether it needs to be changed—they are properly introducing themselves and their role, making it very clear to patients that they are not a doctor but are working under the close supervision of one, and making it very clear that they are not able to prescribe but a doctor can. I think that is the most important point, but the hon. Lady raises a very good point about the title and I will consider that very carefully.

[Barbara Keeley]

I think this is actually related to the confidence one has or does not have. The Minister says he takes advice from pharmacists, as do most of us, but we tend to know in that circumstance that it is a pharmacist we are talking to. There are receptionists, physios and all these types of people working in GP practices, but this was a person who to all intents and purposes looked like a doctor. That knowledge of the short period of their training, and of what they can actually do and not do, really ought to be more visible.

[Will Quince]

I hear what the hon. Lady says, and I will certainly take that away and give it considerable thought. If she has any particular ideas in this regard, given her experience on this matter, I would of course be very happy to meet her to discuss this further. It is really important, certainly ahead of legislation, that we get this right.

Before I close, I would again like to reiterate my deepest condolences to the family of Emily, and I thank the hon. Lady once again for bringing this debate to the House. As we develop and progress with changes to the NHS workforce, it is absolutely vital that robust governance and supervision sit at the heart of the multidisciplinary model, because at the heart of everything we do must be patient safety.

Question put and agreed to.

Thornbury Health Centre

Will Quince Excerpts

Wednesday 5th July 2023 Westminster Hall

[The Minister for Health and Secondary Care (Will Quince)]

It is a pleasure to serve under your chairmanship, Mr Sharma. I congratulate my hon. Friend the Member for Thornbury and Yate (Luke Hall) on securing this debate. I know from the many conversations that we have had that it is a hugely important subject to him; he said that he has also raised the issue with the Secretary of State. I know how tirelessly my hon. Friend works for the people of Thornbury and Yate on healthcare and numerous other matters. I join him in referencing why today is very special; it is the 75th anniversary of the formation of our national health service. I too pay tribute and offer thanks to all those who work, or have worked, within our NHS.

My hon. Friend has made a characteristically eloquent and articulate argument for a new Thornbury health centre that would bring together services and provide an integrated service for patients and his constituents. I note that the community is growing, as he said, and that further growth is planned in future years. I also note the specific case my hon. Friend made about the demographics.

Before I turn to the specific issues in Thornbury, I will highlight how the Government are prioritising capital spend in the NHS to transform and improve healthcare outcomes for people, and, importantly, to put healthcare financing on a sustainable footing. The Government are backing our NHS with a significant capital investment that will create a step change in the quality and efficiency of care up and down our country—that, of course, includes South Gloucester. We have already provided record sums to upgrade NHS buildings and facilities so that trusts can continue to provide the best possible quality of care.

[James Gray in the Chair]

Currently, the Department of Health and Social Care’s capital budget is set to reach upwards of £36 billion for the period 2022-23 to 2024-25. That is a record capital settlement. We are using that level of investment to address current care delays—for example, by creating surgical hubs to bring down waiting lists, and an increase in beds that was recently announced as part of the urgent and emergency care recovery plan. That investment will transform the quality of NHS care. We are putting new community diagnostic centres across England, investing in genomic medicine and delivering the new hospital programme.

Despite the eye-wateringly large sums that have been made available for capital within the NHS, demand is high and the calls on that budget from all across the country are significant. That presents us with challenges, as my hon. Friend the Member for Thornbury and Yate rightly alluded to, and therefore we need to work innovatively with local integrated care boards on things such as modern methods of construction. I will come to that in a moment.

I want to touch on wider capital funding, because Bristol, North Somerset and South Gloucestershire integrated care board has been allocated some significant funding in recent years from those national programmes. That is in no small part due to the tireless championing of the area by my hon. Friend the Member for Thornbury and Yate, and MPs in his neighbouring constituencies. The funding includes: over £17 million from our elective recovery targeted investment fund for a period of estate works and digital initiatives; over £20 million in 2020-21 and 2021-22 from our critical risk infrastructure programme for A&E improvement; and over £5 million in 2020-21 to 2023-24 for mental health schemes, such as eradicating mental health dormitories and improving mental health crisis centres. In addition, the integrated care board has been allocated over £70 million in operational capital funding, making a total of over £223 million made available during this spending review period. I know my hon. Friend will agree that this investment has been invaluable in updating outdated infrastructure and, of course, in ensuring modern and sustainable facilities for both staff and patients.

I now turn specifically to Thornbury health centre, which is the crux of my hon. Friend’s speech. I certainly understand the need for investment in the area—my hon. Friend has made that case incredibly powerfully today—and I am of course aware of the plans to integrate community services at Thornbury health centre. Furthermore, I recognise that he is keen to see progress on this investment as soon as possible. That is why my officials at the Department of Health and Social Care are working at pace with NHS England, and of course the local trust, to assess how we can take it forward. To answer one of his specific questions, a meeting to discuss options for that investment is scheduled to take place shortly and we are considering examples from recent similar programmes around the country as a template for how to deliver Thornbury health centre.

My hon. Friend asked about MMC, which I alluded to a few moments ago. Modern methods of construction are considered as part of the business case process, and the Department has already raised this point with his integrated care board and will discuss it further at the meeting, at which next steps will be discussed.

I welcome my hon. Friend’s continued involvement in and support for this project, and I am certain that his efforts will help to ensure that we can find a way forward that delivers quickly for the people of Thornbury and delivers value for money for local taxpayers. I can certainly commit that the Department’s ministerial team will continue to work closely with my hon. Friend, and I will personally ensure that the Primary Care Minister—the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Harborough (Neil O’Brien) —keeps him regularly updated on progress following the meeting to which I referred.

Let me turn to Frenchay Hospital, which my hon. Friend the Member for Thornbury and Yate also referred to. I thank him for his dedicated work in campaigning to secure a return of health services to the site. I understand that the new health and social care facilities at Frenchay Hospital are a key element of the integrated care board’s plans to transform and of course improve rehabilitation care for local people across South Gloucestershire. When those plans are complete, there will be a centre of excellence, with between 40 and 50 beds, for intensive rehabilitation, which will be co-located with new extra care housing. I know that the North Bristol NHS Trust remains committed to its plans for new rehabilitation facilities on the Frenchay Hospital site, and continues to make good progress on its plans, working with the local authority and other partners.

In conclusion, I again pay tribute to my hon. Friend the Member for Thornbury and Yate and the work that he is doing to support healthcare provision across South Gloucestershire. I can certainly confirm that this Government are committed to delivering transformational investment in the NHS estate across the country and that we look forward to delivering a step change in the quality and efficiency of care. The Primary Care Minister and I look forward to working with my hon. Friend to bring about the local changes to healthcare provision that he and his constituents want to see.

Question put and agreed to.

Defibrillators: Public Access

Will Quince Excerpts

Tuesday 4th July 2023 Westminster Hall

[The Minister for Health and Secondary Care (Will Quince)]

It is a pleasure to serve under your chairmanship, Sir Charles. I assure you that, although I will try to address as many of the points and themes raised during this very constructive debate as possible, I do not intend to take the full time available to me.

I congratulate the hon. Member for Erith and Thamesmead (Abena Oppong-Asare) on securing a hugely important debate, and I thank all hon. Members for their contributions. Although I did not agree with all the points made by the Labour Front Bencher, the hon. Member for Tooting (Dr Allin-Khan), I thoroughly agree that there is considerable consensus. What has been displayed is Parliament working at its best, with all hon. Members raising constituency cases and rightly campaigning for greater access to and awareness of defibrillators in their communities and across our country. I put on record my condolences to those who have lost loved ones due to sudden death caused by an undiagnosed heart issue.

As has been said, defibrillators provide vital treatment, with the latest research showing that the use of such devices within three to five minutes of a cardiac arrest increases the chance of survival by over 40%. It is therefore crucial that we have enough defibrillators in public spaces to provide life-saving interventions when needed. I join the hon. Member for Erith and Thamesmead in paying tribute to and thanking the APPG and its members for all their work in this area. She mentioned the need for steady pressure, and I think that she is absolutely right to use that phrase. It is vital that we keep that steady pressure up, not just on the Department or the NHS but on organisations up and down the country, to ensure that we have as much access to these vital AEDs as possible.

The hon. Member for Erith and Thamesmead set out very articulately and eloquently the compelling case for access to and awareness of defibrillators, and I think that she did her constituents and the House a huge service today. I would also like to thank the charities, businesses, clubs and societies that go out and fundraise for AEDs; they are doing their communities a huge service too. Investing in devices and treatments that can prevent the most serious cardiac arrythmias is a priority for the Government. The hon. Lady also rightly raised the issue of inequality. That certainly preys on my mind when considering many aspects of health. She made a very powerful case, and I hope to address that point in my contribution.

As the hon. Member for Tooting mentioned, in December the Government announced a £1 million fund to design a grant scheme for the expansion of publicly accessible AEDs in the community. That fund was designed to provide an estimated 1,000 new defibrillators in spaces across the country. Whether at a town hall, a post office or a favourite green space outside the local Co-op, having access to AEDs in easy-to-reach areas, as we know and as has been very articulately set out this afternoon, can be a lifeline that keeps loved ones with us.

The fund builds on work by the Government, the NHS and stakeholders to improve survival from out-of-hospital cardiac arrests via the use of defibrillators and cardiopulmonary resuscitation—from now on I will use “CPR”, as I do not have the health expertise of the hon. Member for Tooting. The Department of Health and Social Care will invest the funding through an independent partner—I think this directly answers the question from the hon. Member for Erith and Thamesmead—which will be selected from the Government’s Crown Commercial Service list of approved suppliers. Successful applicants will then be asked to demonstrate that the defibrillators will be placed in areas where they are most needed.

To address the hon. Lady’s point about inequality, although Ministers will have no involvement in deciding where defibrillators are sited—it would be totally inappropriate for them to have that kind of involvement— I understand her concerns. It is inevitable to some extent that where an item of medtech is purchased by local communities, there will be a higher prevalence in more affluent areas, where it is easier to fundraise. Where there is Government funding available, it is important that wherever possible we use it to redress the balance in favour of areas that find it more difficult to fundraise. We must ensure that we target areas where there is a shortage of AEDs and do not just top up provision in areas where coverage is already good. I will certainly speak with the Minister for Social Care to see what more we can do to involve local Members of Parliament and interested groups, including the APPG, with the selected partner, to ensure that we get that right, because the hon. Member for Erith and Thamesmead has made a compelling case.

[Abena Oppong-Asare]

That is really good news to hear. Something that I also want to suggest to the Minister, which I think is really important, is about mapping areas of high need, because one of my concerns is that I am seeing community organisations fundraise for defibrillators, unaware that that fund has been available since late last year. I appreciate that these things take time and it is important that we get it right—we are not just flashing money around anyhow—but will review mechanisms be put in place to ensure that over time the funding is going to the right areas and that the right individuals are receiving the benefits of it?

[Will Quince]

I thank the hon. Lady for her intervention. She is absolutely right. It is important that whenever we spend Government money—taxpayer-funded money—in this way, there is a proper evaluation process. Having said that, although looking back and asking if we got it right is key, the most important thing for me is to get it right first time. We do that by ensuring that there are clear criteria.

The hon. Lady is also right that we have to map and look at not just areas where people do not have access to AEDs, but areas of social deprivation and areas with a higher prevalence of cardiovascular disease or higher footfall. Those are all factors that we absolutely need to consider when designing the criteria that the independent third-party provider would scope. I am keen to work with the hon. Lady and the APPG to ensure that we are getting that right.

Alongside that—and this is the reason why the number of AEDs that will be available through the fund is an estimate—there is a plan to ask for the match funding that some organisations receive. I am conscious that some areas will be able to do that but others will struggle, which is why it can be full or partial. Potentially, however, that could double the number of AEDs available. Some communities might be able to make only a small contribution, but others could match-fund it entirely. It is important that we set criteria that make it available as widely as possible to communities, especially those less affluent areas where fundraising is difficult.

[Abena Oppong-Asare]

That is really good. Another thing to highlight is that, as we see in data from The Circuit, not everyone is registering their defibrillators. Is the Minister coming to the point about organisations ensuring that when they receive the funding, they register it as well?

--- Later in debate ---

[Will Quince]

Absolutely. The hon. Lady pre-empts me: I am coming on to The Circuit, because that point has been made by nearly all hon. Members, but I will first conclude my remarks about the fund.

Successful applicants will be encouraged to train or facilitate CPR training in the local community. That is an important element. To expedite the distribution of funding, and in readiness for the appointment of our partner organisation—this touches on the hon. Lady’s question—on 28 June the Department published an invitation for those organisations that wish to bid for an AED to submit an expression of interest.

My hon. Friend the Minister for Social Care wrote to all hon. Members informing them of the AED expression of interest and setting out how organisations can register their interest. It is incumbent on all Members of Parliament to ensure that community groups, organisations and local authorities across our constituencies spread the message loud and clear so that we get as many expressions of interest as possible. I urge any organisation that may benefit from a defibrillator, whether it is a sports club, a local theatre or a community hall, to register and have that opportunity. It is also important that we encourage local councillors to get involved.

The hon. Member for Erith and Thamesmead asked specifically about the Department for Education. I was Schools Minister at the time the decision was made and signed off. On 17 July, the Department for Education announced that it would provide defibrillators to schools in England that do not already have access to one. That is expected to be completed by the end of the 2022-23 academic year. The scheme, of which I am very proud, is the largest distribution of defibrillators to be rolled out across England to date. It will provide more than 20,000 devices, backed by £19 million of funding.

[Dr Allin-Khan]

The end of the academic year is in two weeks’ time, on 17 July. May I ask for an update on the progress to meet the target?

[Will Quince]

I have not been the Schools Minister for many months, but I will gladly ensure that the relevant Minister—or I, having accessed that information—gets it to the hon. Lady.

I remember that a key point in the design of the scheme—this touches on a point made by many hon. Members—was that providing an AED, in and of itself, is not enough. Accompanying the roll-out, we wanted to ensure that there were awareness videos about how easy it is to use an AED. We want teachers, as part of their training and in the staffroom, and pupils in assemblies to see how easy an AED is to use. In a rolling way, we hoped to create a new generation of young people who are confident in their use. As AEDs become more prevalent across communities, that can only be a good thing.

I think it was the hon. Member for Plymouth, Sutton and Devonport (Luke Pollard) who asked about CPR and first aid training. As a Back Bencher, I campaigned to have first aid included on the curriculum. The Schools Minister at the time was not very happy about that—not because he was against having it on the curriculum, but because the curriculum was already very full—but we did manage to get it included. It is important that we upskill young people so they have the confidence to act in the unlikely but possible event that they encounter someone in cardiac arrest.

The question about vandalism of defibrillators is a fair one. I had not given it any thought, but I will certainly have a conversation with my counterparts in the Home Office and the Ministry of Justice and see if there is any scope to take further action in that area.

Turning to The Circuit, I would certainly like to recognise the incredibly important work that charities do in ensuring that the public have access to defibrillators. The British Heart Foundation, in partnership with Resuscitation Council UK, the Association of Ambulance Chief Executives and of course the national health service, set up The Circuit, which is the national defibrillator network database that provides information on where defibrillators are located.

I heard the point that the hon. Member for Tiverton and Honiton (Richard Foord) made about legislation, which I have some concerns about. At the moment, registration is entirely voluntary, so nobody is forced to register their defibrillator with The Circuit. However, registration enables the emergency services and community first responders to locate the nearest publicly accessible external defibrillator when they are treating someone suffering from an out-of-hospital sudden cardiac arrest. In those crucial moments after a cardiac arrest, we know that locating an AED quickly will help save lives.

[Richard Foord]

What are the arguments against making registration compulsory?

[Will Quince]

That is a question that I had not previously been asked. The danger of legislating in an area like this is that often there are consequences of legislation. One consequence would be that all existing defibrillators were registered as part of The Circuit, and that comes with a tick—that is a merit. However, having created legislation and having worked in Government Departments where legislation has been drafted on numerous occasions, I know that there are invariably and inevitably also negative unintended consequences that need to be considered and thought through.

For example, would registration discourage communities from taking a defibrillator? Would it discourage businesses like the one to which the hon. Member for Plymouth, Sutton and Devonport referred from putting one in their shop? We have to think through that kind of thing. What kind of pressure does it put on those organisations? Would it discourage people? If we are going to create legislation, what are the implications of not registering? Will there be a criminal sanction or a civil one? These are all things we would have to work through, and that is why legislating on something like this is complex. We have to remember that most defibrillators are bought by community groups, although in this particular case the Government support them. We would be placing a legal requirement on them for something that they are purchasing through goodwill, for philanthropic or altruistic reasons.

We have just got to be careful. I am not saying that we should not consider it, but it is not quite as simple as saying, “Let’s legislate,” and thinking that that will address the problem. What we need to do, and are doing, is to encourage as many people as possible to register because of the benefits of registration.

[Abena Oppong-Asare]

Would those who receive funding from the £1 million fund for the community be required to register with The Circuit? Where there is Government funding, I think we should be encouraging registration. The more people who are aware, the better.

[Will Quince]

I totally agree. I will check whether registering will be among the conditions for grant funding; I would like to think that it will, and I will work with the Minister for Social Care to ensure that it is. We know that there are many defibrillators that are not on The Circuit, and—short of legislating, which would not be a quick or easy solution—we have to get them on it as quickly as possible. We have to urge as many organisations and individuals as possible to register.

The hon. Lady asked what steps we are taking to promote that. I recently wrote to all local authorities to ask them to check and, if they have not done so already, to consider adding their defibrillators to The Circuit. I also asked them to reach out and share that message with parish councils, town councils, community groups, village halls, businesses and others that may have a defibrillator that is not registered on The Circuit. I am keen to work with local authorities, which have a reach into their communities that neither central Government nor the national charities could possibly have. I also urge all right hon. and hon. Members to encourage those organisations that have a defibrillator to ensure that it is registered. I join hon. Members in paying tribute to and congratulating the Daily Express on its important campaign, which I am happy to support.

I hear what the hon. Lady says about raising more public awareness about AEDs and where they are located, not on just the parliamentary estate but across communities and the country. I will continue to look at what more we can do centrally, but also by working with national and local charities, to raise that awareness.

The hon. Member for Plymouth, Sutton and Devonport asked about businesses. Some organisations—such as the Premier League, which the hon. Member for Erith and Thamesmead referred to—are leading the way, but we want to encourage more to do so. I will give further thought to how we can encourage other businesses to do the same.

The hon. Member for Tiverton and Honiton asked about first aid, and particularly about CPR. Better awareness and education around first aid training is key to improving survival rates from cardiac arrest. I am pleased that NHS England has partnered with St John Ambulance to, in effect, co-ordinate skills development to significantly increase the use of AEDs by individuals in community settings. That includes a national network of community advocates to champion the importance of first aid training. The plan is to reach 60,000 people, which will help to save up to 4,000 lives each year by 2028, empowering local communities to act more quickly to save people’s lives.

Finally, I cannot speak about cardiac arrest without speaking about prevention, which the hon. Member for Plymouth, Sutton and Devonport referred to. The prevention of heart disease is critical to reducing the number of sudden cardiac arrests. I will set out some of the work that NHS England is doing to reduce preventable deaths from heart disease. Currently, £2.3 billion is being spent to increase the number of centres diagnosing heart disease to at least 100 sites by March 2025. NHS England has developed a new fast-track echocardiography training scheme, which has led to 150 additional echocardiographers, with further support available in 2023-24.

The NHS health check programme, which the Secretary of State recently spoke about, is a core component of NHS England’s CVD prevention pathway. Over 15 million people are eligible for a NHS health check every five years. For every 1 million checks delivered, the NHS health check could prevent an estimated 400 heart attacks and strokes. Something like 10.8 million checks have been delivered between 2013 and December 2022, but it is important that we work hard to ensure that more people benefit from that lifesaving service and get a health check. I am keen that we make it easier and more convenient for people to do so.

I hope that today I have demonstrated the Government’s commitment to increasing the number of AEDs in our local communities. I am keen to see how we can turbocharge that and work with businesses and local communities to go much further. We can all agree that this agenda really matters. Once again, I thank the hon. Member for Erith and Thamesmead for highlighting this vital issue. I look forward to working with her to bring about the change in this area that we all want to see.

[Sir Charles Walker (in the Chair)]

I invite the hon. Member who secured the debate to wind up for up to two minutes.

[Abena Oppong-Asare]

I thank the Minister for his remarks about what can be done. This debate was very much about a collaborative approach. Indeed, it is one of the rare debates that I have attended where there has been much consensus.

I thank hon. Members for sharing their experiences, particularly the hon. Member for Tiverton and Honiton (Richard Foord), who also shared some best practices on defibrillators. I am not familiar with the defibrillator dash, but it is something that we can all look into. I thank my hon. Friend the Member for Barnsley East (Stephanie Peacock) for her comments about the community groups fundraising for defibrillators in her constituency, and my hon. Friend the Member for Plymouth, Sutton and Devonport (Luke Pollard), who talked about the importance of corporates, the work that they have done in Plymouth and what can be done in supermarkets.

I thank the Minister for saying that he will consider what engagement and what encouraging conversations there can be with businesses. I am a bit concerned about the £1 million fund, in terms of inequality and little groups being missed out, particularly because we know that the groups that know how to do slick bids are the ones that are very good at getting the money. I am feeling a bit reassured by the Minister that the Government are looking at work to ensure that it is distributed equally, but I think a review needs to be done to make sure that nobody is left behind. It would also be good to get some clarification about whether those receiving funding are being required—

[Will Quince]

indicated assent.

[Abena Oppong-Asare]

They are? That is good to hear.

May I take this opportunity to thank you, Sir Charles, for saying that you will look at defibrillators in Parliament in your role as Chair of the Administration Committee? I am very impressed that you have taken that on board straightaway. I also want to thank the organisations and charities that have been driving this campaign for their excellent work and briefings.

I thank Bonnie for campaigning on this issue in memory of her dad. I want every citizen, no matter where they live or what they do, to know about defibrillators, where they are and how to use them. I want us all to know how to use one, just as surely as we know how to use a cashpoint. I have had training in how to use a defibrillator—it is so easy to use. I also welcome what the Minister says about the Government’s work in schools and particularly about starting with very young people. I remember receiving first aid at school, so it is good to start this from a really young age.

All these things are possible with the political will to make them happen. I know we will keep up the fight on this issue. I thank everybody for their contributions to this debate.

Question put and agreed to.

Resolved,

That this House has considered public access to defibrillators.