Primary Care: Patient Access
(Makerfield) (Lab)
1. What assessment his Department has made of the adequacy of
patient access to primary care services.(901283)
(Harlow) (Lab/Co-op)
8. What assessment his Department has made of the adequacy of
patient access to primary care services.(901290)
(North West Cambridgeshire)
(Lab)
21. What assessment his Department has made of the adequacy of
patient access to primary care services.(901305)
The Secretary of State for Health and Social Care ()
Mr Speaker, I associate myself with your remarks about the war in
Ukraine. I know the whole House stands with Ukraine as it defends
its freedom and democracy. This is precisely why the Prime
Minister's leadership at the G20, and in other international
fora, is vital in standing up not just for our national interests
but for our values across the world.
Over the past decade, the Conservatives' mismanagement has left
the NHS with 1,400 fewer full-time equivalent GPs than in 2015,
hundreds of practice closures, the loss of over 1,000 community
pharmacies, and NHS dentistry a distant memory, which is why this
Government took immediate action to employ 1,000 more GPs.
Through the additional roles reimbursement scheme, through the
Chancellor's Budget measures and through our 10-year plan, we
will shift the focus of healthcare out of hospitals and into the
community.
In my Makerfield constituency, Wigan council and my local NHS
trust are working closely together to pioneer a health system
focused on prevention and delivered through neighbourhood health
centres, but they need help. What is the Secretary of State doing
to improve access to primary care, especially data-driven
preventive care, through neighbourhood health centres?
I agree with my hon. Friend on the importance of prevention at a
local level. We are trialling neighbourhood health centres across
the country to bring together a range of services, ensuring that
healthcare is closer to home and that patients receive the care
they deserve. This is part of our broader ambition to move
towards a neighbourhood health service, with care delivered close
to home. I would be delighted to meet my hon. Friend to hear more
about what is going well in his community and what further action
we need to take.
Does the Secretary of State agree that access to primary care is
hugely important to supporting accident and emergency departments
at hospitals like the Princess Alexandra in Harlow? Does he also
agree that access to primary care is about not just GPs but
dentists? Finally, what are the Government's plans to support
dental surgeries such as the aptly named Harlow dental surgery,
which I visited last week?
My hon. Friend is right that many of the pressures on our
hospitals, such as the Princess Alexandra in Harlow, are a result
of pressures in other parts of the health and social care system.
It is outrageous that the biggest reason for five to
nine-year-olds presenting to hospital is tooth decay, which is
why we need to get NHS dentistry back on its feet, along with the
rest of the NHS.
My hon. Friend the Minister for Care and I have regularly met the
British Dental Association since the general election to consider
how the dental contract can be reformed to retain dentists and
rebuild NHS dental services.
In my local area of Cambridgeshire and Peterborough, GPs are
reporting feeling increasingly burnt out, with working conditions
becoming more extreme. The number of patients per fully qualified
GP in my area has increased by nearly 400 since December 2016, a
higher increase than the national average. Can the Secretary of
State tell me what his Department is doing to make the situation
more sustainable while improving access to primary care?
General practice is a valued part of the NHS, and GPs are a vital
part of our NHS family. In fact, they are delivering more
appointments than ever before, and we recognise the significant
pressures they face. At the same time, we know that patients are
struggling to see their GP, which is why we have invested an
additional £82 million into the ARRS to recruit 1,000 more newly
qualified GPs this year. This will take pressure off general
practice, and we will be announcing further budget allocations in
the not-too-distant future to set out what further support we
will provide for general practice.
Mr Speaker
I call the Chair of the Health and Social Care Committee.
(Oxford West and Abingdon)
(LD)
Last week, I visited Summertown health centre. Staff there
implored me to say to the Government that the issue is not just
more money—we welcome the £100 million that has been allocated
for capital investment in primary care—but the snarled-up process
at integrated care board level and getting investment to the
right places quickly. What will the Secretary of State's
Government do to ensure ICBs deliver that money to where it is
needed, and fast?
The Chair of the Health and Social Care Committee is right that
investment is vital, but so is reform. We tasked ICBs with
leading the development of the new neighbourhood health service.
We are removing their responsibility for performance management
of trusts in order to free up their focus, so that primary and
community services have the attention that is desperately needed.
In the coming weeks, we will be talking to the British Medical
Association and the Royal College of General Practitioners about
how we ensure the investment announced by the Chancellor leads to
improved patient care and a reformed neighbourhood health
service.
(Broxbourne) (Con)
Goff's Oak, in my constituency of Broxbourne, has seen a lot of
development. What steps is the Secretary of State taking to
ensure that GP surgeries are delivered before hundreds of new
homes are built?
Of course we need to deliver both new homes and GP surgeries, but
the previous Conservative Government delivered neither. We have a
housing crisis and an NHS crisis in this country; I would have
thought Conservative Members might have shown some humility and
responsibility for those facts before challenging a Government
who have been in office for only four months.
(St Ives) (LD)
In Cornwall, only 25% of delayed discharges from hospital are
because of lack of social care packages, with the remainder
involving the significant degree of support needed from primary
and community NHS services. The Royal College of Nursing has
pointed out that there has been a 45% reduction in district
nurses in the last decade, so what can the Government do to
replace those essential roles at a primary care level?
The hon. Gentleman is right. Last weekend, I was up in
Middlesbrough with local Members, where we saw a great example of
hospital at home delivered by the community nursing team and the
community health trust. We have to do a lot more in that space to
ensure we provide care closer to peoples' homes—indeed, often in
the home—keeping them out of hospital and close to home, which is
better for them and better value for the taxpayer.
Mr Speaker
I call the shadow Minister.
Dr (Hinckley and Bosworth)
(Con)
The Royal College of General Practitioners has said the national
insurance tax increase is expected to cost 2.2 million
appointments. We know from answers to written questions that have
been submitted that GPs, hospices and care homes are not exempt
from the increases, and will not find out until April what, if
any, mitigation will be put in place, so cutbacks are now being
planned. Will the Secretary of State explain how his choice to
tax GPs will increase GP access?
I can reassure health and care providers that we will be setting
out allocations long before April next year. I recognise that
people need to plan ahead of the new financial year. When
deciding allocations, we take into account the range of pressures
on different parts of the system. People have heard what I have
said already about the need to shift out of hospital into primary
and community services. The shadow Minister talks about choices;
Conservative Members seem to welcome the £26 billion investment,
but oppose the means of raising it. I am afraid they cannot do
both. If they support the investment, they need to support the
way in which we raise the money; if they do not support the way
in which we raise the money, they need to spell out how they
would raise it or be honest about the fact that if they were
still in government, they would continue to preside over a
mismanaged decline.
Dr Evans
One GP described the situation as “Schrödinger's primary care”:
GPs are seen as private contractors, so not exempt from the NI
increases, but they are exempt from the small business relief
because they are deemed to be “public”. Did the Department of
Health team knowingly go along with the Treasury team's plan to
tax primary care without mitigation, leading to cuts? Or did it
not understand or spot the complexity of what is going on, so
mitigations have to be put in place now? Which is it?
I was terribly impolite; I should have welcomed the shadow
Minister to his place in response to his first question.
Conservative Members seem to welcome the £26 billion investment
and are happy to tell us how it should be spent, but they oppose
the means of raising it. They cannot do all those things. They
need to be honest with the country: either they support the
investment in the NHS or they say they would cut it. Which is
it?
NHS Hospital Equipment
(Wells and Mendip Hills)
(LD)
2. What recent assessment he has made of the adequacy of the
condition of NHS hospital equipment.(901284)
The Minister for Secondary Care ()
The Darzi review made it absolutely clear that the NHS has been
starved of capital. It is 15 years behind the private sector in
its use of technology and we have fewer scanners per person than
in comparable countries. That is why at the Budget the Chancellor
announced an investment of £1.5 billion for capital funding,
which will include investment for new artificial
intelligence-enabled scanners, which will help tackle that
backlog.
Residents in Somerset, and in North Somerset, my part of the
world, recognise the £70 million that has been granted for new
radiotherapy machines, as announced in the Budget, which will
fund up to 30 machines. However, 70 machines will pass their
sell-by date—their 10-year recommended life—by the end of this
year. Will the Secretary of State and the Minister agree to meet
Radiotherapy UK, which wants to highlight the huge cost benefits
of having a more consistent, rolling programme of machine
maintenance and replacement in the NHS 10-year plan?
The hon. Lady highlights the important matter of the lifetime of
some of the machines, which we are finally addressing after the
last 14 years of not addressing issues that include providing
support to ensure that the machines work properly. Officials
regularly meet Radiotherapy UK and the Department values its
input. If there are specific incidents that the hon. Lady wishes
to highlight, I am happy to respond to her.
(Ealing Southall)
(Lab)
Does the Minister agree that the NHS cannot continue to rely on
outdated and obsolete equipment? It is ridiculous that GPs still
use pagers and hospitals communicate with each other using fax
machines. After 14 years of decline under the previous
Government, will she commit to bringing our NHS into the 21st
century?
My hon. Friend lays bare an important issue. We all know, and
critically, staff know, that we are asking them to do the most
incredible job with outdated technology. It is bad for staff and
it is bad for patients. That is why moving from an analogue to a
digital system is crucial. I was fortunate to visit colleagues at
NHS England offices up in Leeds last week to see some of the
fantastic work they are doing on the app. We will ensure that the
NHS comes into the 21st century.
Mental Health Support
(Sheffield Central)
(Lab)
3. What steps he is taking to improve mental health support
services.(901285)
The Parliamentary Under-Secretary of State for Health and Social
Care ()
Lord Darzi found that mental health waiting lists have surged,
with more than 100,000 children waiting a year for their first
appointment. That is why we will recruit 8,500 more mental health
workers, provide access to mental health support in every school
and roll out young futures hubs in every community. I am
delighted to tell my hon. Friend that a Bill to modernise the
Mental Health Act 1983 was introduced in the other place on 6
November. That was a promise that we made before the election—a
promise that we kept.
I welcome the Minister's comments. My brother has very complex
mental health needs. We as a family know at first hand the
difficulties not only of accessing the services and of the long
waiting times, but the challenge of support staff who are not
constantly on a churn and the lack of community-funded support
services. Our experience is no different to that of many other
families. Will the Minister meet me to discuss how we will make
mental health services more accessible in communities, invest
more in preventive services and fund more community-based
provision?
I will be pleased to meet my hon. Friend. This Government think
it is unacceptable that too many people are not receiving the
care that they deserve, and we know that waits for mental health
services are far too long. We are determined to change that with
the measures I set out in my opening. The Government have also
introduced NHS 111 for mental health so that people who are in
crisis or are concerned about a family member or loved one can
now call 111 and speak to a trained mental health
professional.
(Eastbourne) (LD)
Facilities such as leisure centres and swimming pools—like the
Sovereign Centre in Eastbourne where I learned to swim—are
critical in supporting people's mental health locally. Will the
Minister support me in putting pressure on the Ministry of
Housing, Communities and Local Government to expand the criteria
of the towns fund to allow us to be able to spend it to invest in
our leisure centres and sports and fitness facilities for local
people?
I am grateful to the hon. Member for his question. We are a
mission-led Government and, of course, tackling health
inequalities is a job not just for the Department of Health and
Social Care, but for all Government Departments. I will be very
happy to raise the role that Ministers can play in improving
mental health and wellbeing in my bilaterals with the Ministry of
Housing, Communities and Local Government.
Dental Training Places: East of England
(Broadland and Fakenham)
(Con)
4. What estimate he has made of the number of new dental training
places needed in the east of England.(901286)
The Minister for Care ()
Fourteen years of Conservative neglect and incompetence have left
huge swathes of the east of England as dental deserts. As part of
our 10-year plan, we will be working with NHS England to assess
the need for more dental trainees in areas such as the east of
England where we know that many people are struggling to find an
NHS dentist. I am aware of the University of East Anglia's plans
to open a dental school and I recently met MPs from the east of
England, including the hon. Gentleman, to discuss that process. I
encourage the UEA to continue with its bid for a new dental
school.
The Minister well knows that there is a lack of dentists in the
east of England, because there is no undergraduate training
facility. The nearest place is either Birmingham or London. He
has kindly mentioned the University of East Anglia, which is
ready to go with a new building under construction. It has wide
cross-party support, as he also knows from the meeting that he
held recently, so when will he make the announcement?
I thank the hon. Gentleman for that follow-up question, but he
will recall that, when we met, I and my officials made it clear
to him that the UEA has not yet submitted its bid for a dental
school. In that meeting, we said: “Please go back to the UEA and
encourage them to submit that bid. When they do, we will look at
it very carefully.”
(Bedford) (Lab)
Many of my constituents in Bedford are struggling to get an NHS
dentist. I am also hearing from those who have tried to book an
appointment only to discover that they have been removed from the
NHS list without any warning. The Government have committed to
improve the dental contract. In doing so, will they ensure that
dentists can no longer drop people from their books—leaving them
without any access to care—without prior notice?
My hon. Friend is right: we will reform the dental contract to
rebuild dentistry in the long term and to increase access to NHS
dental care, with a shift to focusing on prevention and the
retention of NHS dentists. We continue to meet representatives
from the British Dental Association and other representatives of
the sector to discuss how we can best deliver our shared ambition
to improve access for NHS dental patients.
Health and Care Staffing Costs: Employer NI Contributions
(North East Fife)
(LD)
5. What recent assessment he has made of the potential impact of
proposed changes to employer national insurance contributions on
staffing costs for health and care providers.(901287)
The Secretary of State for Health and Social Care ()
The leadership shown by the Chancellor has enabled her and the
Government to fix the foundations of the public finances and fill
the £22 billion black hole left by the previous Government. The
decisions that she took meant that she was able to provide this
Department with an extra £26 billion and a real-terms increase in
core local government spending power by about 3.2%. That was the
right decision for the right reasons in the national interest,
and I am taking into consideration pressures on all parts of
health and social care before making final allocations for the
year ahead.
In North East Fife, we have a particular issue with access to
dental surgeries, especially with the recent closure of a surgery
in Leven. Difficulties stem from recruitment from abroad as a
result of visa changes and also simply from practices going
private and coming out of the system. Obviously, the NHS is
devolved in Scotland, but does the Secretary of State agree that
putting staffing under further strain from increasing national
insurance contributions will only make things worse for dentists?
What in his conversations is he doing to ensure that dentists get
the support that they need?
It is because the Chancellor took the decisions that she did in
the Budget that my Department has received £26 billion to reform
and improve health and social care. As I said before the general
election, all parts of the United Kingdom suffered under the
previous Conservative Government, which is why I am sure that
Members from across Scotland will welcome the extra £1.5 billion
this year and £3.4 billion next year—the biggest funding increase
since devolution. I am sure that the SNP Government will welcome
the increase, and they certainly have no excuses now for not
acting.
(York Central)
(Lab/Co-op)
Fourteen years of neglect have left hospices in a perilous
condition. They are dealing with the rise in national insurance
contributions, pay and other cost pressures, so I welcome the
fact that the Secretary of State is putting in place measures to
ensure that the funding recovers. Will he assure me that
integrated care boards not only will pass on that recovery from
the increased costs to hospices, but will help them catch up from
the Tory years of neglect of the whole sector?
I am grateful to my hon. Friend for her question. I am looking
carefully at the pressures on hospices. In fact, only last Friday
I visited Saint Francis hospice, which serves my constituents and
people right across east London and west and south Essex. I saw
at first hand the brilliant work it is doing on end of life care,
but also the pressures it is under, and I am taking those
pressures into account before deciding allocations for the year
ahead.
Dr (Sleaford and North
Hykeham) (Con)
I have tried repeatedly through written parliamentary questions
to get an answer to this without success, so I will try asking it
face to face: will the Secretary of State tell the House how much
his Chancellor's changes to national insurance contributions will
cost the NHS?
The hon. Member talks about the employer national insurance
contributions as if they were a burden on the NHS. It is thanks
to the decisions taken by the Chancellor that we can invest £26
billion in health and social care. The Conservatives welcome the
investment but oppose the means of raising it. Do they support
the investment or not? They cannot duck the question; they have
to answer.
Dr Johnson
The right hon. Member speaks of ducking questions, but it is
worrying that three weeks after the Budget he still does not
know, or will not tell the House, how much it will cost the NHS.
Of course, changes to national insurance contributions affect not
just the NHS directly, but suppliers, contractors, charities and
other NHS care providers. I know you are a great supporter of
your local air ambulance service, Mr Speaker, as I am of the
Lincs & Notts air ambulance, which now needs to raise £70,000
extra just to fund this Government's ill-advised changes to NICs.
That £70,000 is a lot of cakes to sell, cars to wash and fun runs
to complete, and that is just one example of pressures placed on
lifesaving services right across the country. Will the Minister
confirm that he will meet the Chancellor, explain the disastrous
effects of the policy and insist that she reverses it?
Again, we have not yet announced how we are allocating the budget
for the year ahead, but I remind the Conservatives that it is
thanks to the choices the Chancellor made in her Budget that she
is able to invest £26 billion in health and social care. Would
they cut the £26 billion this Labour Government are investing in
the NHS? If not, how would they pay for it? Welcome to
opposition.
Mr Speaker
We come to the Liberal Democrat spokesperson.
(North Shropshire) (LD)
Hospices provide essential care for people at the most difficult
point of their life, and they are usually only partially funded
by the NHS. Hospice UK says that real-terms funding has fallen by
£47 million since 2022, and hospices are struggling with this
hike in national insurance contributions. Hope House children's
hospice in North Shropshire estimates that it will cost £178,000.
Will the Secretary of State commit to either exempting hospices
from the NICs increase or ensure that they are funded to cover
those additional costs?
I am grateful to the Liberal Democrat spokesperson for her
question. I pay tribute to the children's hospice in her
constituency and, indeed, to Haven House children's hospice,
which serves my constituency.
Mr Speaker
And Derian House children's hospice.
And indeed your very own local hospice, Mr Speaker—I am sure that
will appear on the record. I am particularly thankful for the
advocacy we have received from Hospice UK and charities such as
Together for Short Lives and others that are making their voices
heard about the pressures on the system. I say to all hospices
across the country that I am taking those pressures into account
before deciding allocations for the year ahead, because I want to
ensure that everyone, whatever their age, receives access to the
timely and good-quality end of life care, palliative care and, of
course, support for people with life-limiting conditions that all
of them deserve.
Care Sector: Staff Salaries
(Tipton and Wednesbury)
(Lab)
6. What discussions he has had with Cabinet colleagues on staff
salaries in the care sector.(901288)
The Minister for Care ()
I was proud that the Chancellor raised the salaries of hundreds
of thousands of care workers in the Budget. Last month, the
Government introduced legislation to deliver the first ever fair
pay agreement for adult social care. While we were giving care
workers a pay rise, the Leader of the Opposition was belittling
their work as merely wiping bottoms. I gently say to the
Conservative party that it is better to be wiping bottoms than
talking out of them. This is an important issue, and I am dealing
with ministerial colleagues on it.
According to last month's Skills for Care report, most care
workers are paid only a couple of pennies above the national
minimum wage, while the sector cannot recruit and retain the
people it needs. Will the Minister set out the timetable for
establishing the fair pay agreement and adult social care
negotiating body, and will he give the House an assurance that
the care trade unions will be closely involved in its design?
We took quick action on the Employment Rights Bill, which
includes the fair pay agreement, within 100 days of taking
office. The consultation process on the negotiating body can
begin only once the Bill has become an Act. We are engaging
widely with stakeholders, and I assure my hon. Friend that unions
will play a central role in that process, but let us remember
that, through the national living wage, we are giving the
lowest-paid full-time care workers a pay increase of £1,400 per
year.
(Aberdeenshire North and
Moray East) (SNP)
One barrier to better staff salaries in the care sector is the
additional employer national insurance contributions. Are the
Minister and his colleagues considering an exemption for GP
practices, charities and hospices from national insurance
employer contributions?
As my right hon. Friend the Secretary of State for Health and
Social Care pointed out, when we won the general election on 4
July, we inherited public finances in their worst state since the
second world war. Through the Chancellor, we have taken
responsible action to deal with those issues. My right hon.
Friend the Secretary of State has also said that we are looking
at the Budget in the round, and we will report on that in due
course.
NHS Dentists: Access
(Peterborough) (Lab)
7. What assessment his Department has made of the adequacy of
access to NHS dentists.(901289)
(Glenrothes and Mid Fife)
(Lab)
18. What assessment his Department has made of the adequacy of
access to NHS dentists.(901300)
(Weston-super-Mare) (Lab)
23. What assessment his Department has made of the adequacy of
access to NHS dentists.(901307)
The Minister for Care ()
After 14 years of Tory neglect and incompetence, NHS dentistry in
England has been left in a parlous state. Tooth decay is the most
common reason why children aged five to nine are admitted to
hospital, and 28% of the country—13 million people—have an unmet
need for dentistry. Rescuing NHS dentistry will not happen
overnight. We will expand the provision of urgent dental
appointments across the country, and we are working with the
sector to reform the dental contract in order to increase access
and incentivise more NHS care.
Yesterday, I heard from a disabled constituent who has spent over
a year trying to find an NHS dentist, but without success. The
only solution was to come to London for emergency treatment—that
became a shockingly common story under the previous Government.
As a first step, our integrated care board is putting 12 extra
dentists into Peterborough and the surrounding towns to increase
access. Will the Minister update the House on progress and on how
we will further improve access to NHS dentistry?
I am very pleased to hear about what my hon. Friend's ICB is
doing. Working with the dental sector, we will deliver measures
to improve access, targeting areas that need it most. Those
measures include 700,000 additional urgent appointments and
reform of the dental contract. The golden hello scheme, which
incentivises dentists to work in underserved areas, is under way
across the country, and dentists are also being offered a new
patient premium to treat new patients.
Does the Minister agree that it is unacceptable that more than
40,000 people in Fife are not registered with an NHS dentist?
Will he share any learning from this Government's action to
increase access to dentistry with his colleagues in the Scottish
Government, and urge them to fulfil their responsibilities so
that people in my constituency can get the dental treatment that
they need?
Responsibility for dental services in Scotland is of course a
matter for the Scottish Government, but Governments across the UK
work together to spread best practice and deliver on our common
goals. The Scottish National party Government have an extra £1.5
billion this year, and £3.4 billion next year, through the
Barnett formula. I hope that they will prioritise health,
including dentistry, and undo some of the damage that they
themselves have done to dentistry in Scotland.
Some 37% of five-year-olds in Weston-super-Mare have enamel or
dental decay—a figure well above the national average. The Better
Health North Somerset team does amazing work to promote good oral
health, but regular dentist check-ups are the oral health silver
bullet. Will the Minister explain and outline the work he is
doing to ensure that children in Weston and Worle and across the
country get the dentistry service that they so desperately
need?
My hon. Friend is absolutely right to raise this vital issue.
Prevention is of course always better than cure, so I am very
proud of the fact that we are introducing supervised
toothbrushing for three to five-year-olds in the most deprived
communities and where there is the most unmet need. We are also
working to sort out the NHS contracts so we can ensure that
children get the care they need.
(North West Norfolk) (Con)
Having training locally at the University of East Anglia is
important for my constituents, but in the short term, what steps
is the Minister taking to speed up the process by which dentists
get on the dental performers list, so that they can work in the
NHS and not just privately? Is he also considering bringing in a
provisional overseas registration scheme?
I thank the hon. Gentleman for that question. We are looking at
provisional registration. As I also mentioned to his hon. Friend
the Member for Broadland and Fakenham (), we are very open to the
idea of a dental training school at the University of East
Anglia. We need to ensure that we push on the full spectrum of
all these measures, because there is a crisis in NHS dentistry
and we need to get on and fix it.
(Huntingdon) (Con)
Toothless in Huntingdon in my constituency has written to me
highlighting that 36% of patients under Cambridgeshire and
Peterborough integrated care system no longer have an NHS
dentist. It wants dental practices to provide access to those
needing emergency treatment and a priority pathway for referrals
from hospital departments such as cardiology and oncology. To
that extent, what steps are being taken in Huntingdonshire to
improve dental access across rural Cambridgeshire? How are the
Government helping the Cambridgeshire and Peterborough integrated
care system to address those issues?
Obviously the golden hello scheme for rural areas is very
important. We are pushing forward on that, and I am pleased to
say that hundreds have expressed interest in it and appointments
are starting on that basis. The hon. Gentleman is right about
training places. As I have already mentioned, we are very open to
establishments and institutions coming forward with proposals for
that. We are living in a country where the biggest cause of
hospital admission for five to nine-year-olds is having their
rotten teeth removed. That is a truly Dickensian state of
affairs, and it needs to be fixed as a priority.
(Harrogate and Knaresborough)
(LD)
Earlier this year, I was at an orthodontist's practice that
carries out work on behalf of the NHS. It said the issue is that
when people are referred to it by their general dentist, it
cannot go on to do the orthodontic work because their teeth are
in too bad a state, so they are referred back to the dentist, but
they cannot get in because of waiting lists and issues. When we
look at reforming dental contracts, will we look at orthodontic
ones too?
Absolutely. As my right hon. Friend the Secretary of State has
said, we have already met with the British Dental Association,
and no issues are off the table. We absolutely need to look at
orthodontists in the round as part of the contract negotiations,
and we will certainly report back on that in due course.
NHS Health and Social Care Reform
(Chatham and Aylesford)
(Lab)
9. What plans he has to reform NHS health and social care
services.(901291)
(Stevenage) (Lab)
22. What plans he has to reform NHS health and social care
services.(901306)
The Secretary of State for Health and Social Care ()
Before the election, we made it clear that investment and reform
were needed in the NHS. The Chancellor announced the investment
in the Budget, and since the general election we have confirmed
the introduction of new league tables of NHS providers, with
high-performing providers being given greater freedom over
funding and flexibility. We are sending turnaround teams into
struggling hospitals, giving the best performers greater freedoms
over funding to modernise technology and equipment. We are
creating a new college of executive and clinical leadership that
will help to attract, keep and support the best NHS leaders. We
are banning NHS trusts from using agencies to hire temporary
entry-level workers in bands 2 and 3, such as healthcare
assistants and domestic support workers. We are sending crack
teams of top clinicians to areas with long waiting lists and high
economic inactivity to improve the productivity of their clinics,
and we are running a GP red tape challenge to slash bureaucracy.
I could go on, because this is a Government who are walking the
talk on NHS reform.
Mr Speaker
I think you already have, but there we are.
I wish my right hon. Friend would go on. Irresponsible promises
were made by the Opposition about capital investment in hospitals
and elective surgeries across the country, including in the three
Medway constituencies. Will my right hon. Friend meet me and my
hon. Friends the Members for Rochester and Strood () and for Gillingham and
Rainham () to discuss the much-needed
NHS investment in our area?
I would be delighted to meet my hon. Friend and other Members
from across Medway to discuss the challenges that their part of
the south-east faces, and to explain why our predecessors made
promises they could not keep, with timetables that were
completely fictitious and funding that runs out in March. I am
really sorry for the way that communities were let down by the
previous Government. This Government will not make the same
mistakes.
I am grateful to my right hon. Friend for his earlier answer.
Last week, I spoke to one of my constituents, Norman Phillips,
who has been an unpaid carer for his wife Ros for the past 18
years. Like many unpaid carers across Stevenage, Norman has been
put through absolute hell by the previous Tory Government's
complete inaction on social care for over 14 years. Does the
Secretary of State agree that unpaid carers such as Norman play a
vital role in providing care, and that unpaid carers need to be
at the heart of any reforms to the social care system—reforms
that are much needed?
I, too, pay tribute to Norman and to family carers like him, who
play such a vital role supporting loved ones. Through the carer's
allowance uplift in the Budget, the Chancellor announced the
largest increase to the weekly earnings limit since the
introduction of carer's allowance in 1976. As well as that
investment, we will have a 10-year plan for social care, and I
see the care workforce, care providers and family carers as all
being important partners in building that plan.
(Godalming and Ash) (Con)
I welcome the Secretary of State's plans to reform the NHS, but
may I caution against the idea that the answer is to fire more
incompetent managers? The problem is not bad management: it is
micromanagement from the centre that sees hospitals managed with
more than 100 targets by NHS England, making ours one of the most
micromanaged healthcare systems in the world. Will the Secretary
of State's plans allow managers more autonomy, helping them to
innovate, save money and improve care for patients?
I am happy to confirm that it is my view that, when there are too
many targets and everything is being measured, nothing ends up
being measured. We need to give more freedom and autonomy to good
leaders, including clinical leaders and managers in the NHS who
are coming up with some of the best productivity gains in the
system. That is why we have announced new support for, and
investment in, the college of leadership for both clinical and
executive leaders in the NHS. I would be delighted to meet the
right hon. Gentleman to discuss those issues. He was a great
Chair of the Health and Social Care Select Committee, but back in
July, we saw a great example of how we can improve things by
sacking bad managers.
(Harrow East) (Con)
One of the lessons from the pandemic is the importance of NHS
communications. Last week, I joined victims of the sodium
valproate scandal to hand in a petition. They tried to download
from the website the Medicines and Healthcare products Regulatory
Agency's yellow card adverse drug reactions literature, but were
unable to do so. Will the Secretary of State look at this as a
matter of urgency? People need to be warned about the risks of
taking certain drugs.
As the hon. Gentleman knows, I am a great champion of patient
power, and a key part of giving patients more power and control
over their healthcare is better access to information. That is
why, as well as improvements to the NHS app—which will provide
far easier interaction with the NHS for patients—I am working
with my right hon. Friend the Secretary of State for Science,
Innovation and Technology to make sure all the information held
by Government is more accessible for our citizens, particularly
where that includes vital safety information and guidance, as the
hon. Gentleman has mentioned.
Autumn Budget Impact
(Motherwell, Wishaw and
Carluke) (Lab)
10. What assessment his Department has made of the potential
impact of the autumn Budget 2024 on health and care
services.(901292)
The Secretary of State for Health and Social Care ()
Thanks to the decisions that the Chancellor took in the Budget,
we are able to provide an additional £26 billion to give the NHS
the funding it needs. This will support the NHS in England,
enabling it to deliver an extra 40,000 appointments a week to cut
waiting lists. Of course, for my hon. Friend and her
constituents, the Budget has given Scotland the biggest
real-terms increase in funding through the Barnett formula since
devolution began. I hope the Scottish Government will use that
investment to deliver improved services for the Scottish
people.
The Labour party is the party of the NHS, and the significant
additional investment announced in the recent Budget has
reaffirmed that. The Secretary of State has made it very clear in
this question session that the benefits of that additional
funding must be felt across the UK. Will he join me in urging the
Scottish Government to ensure that that funding reaches the
frontline and creates the badly needed additional appointments in
GP, dental and hospital services that my constituents and people
across Scotland badly need?
I am grateful to my hon. Friend for her question. It is thanks to
the people of Scotland sending 37 Labour Members of Parliament
here at the last election—not only have they shown that they
value the NHS and are demanding change, but they voted for
change—that we are now delivering that change through the Budget.
I say to Scottish Government Ministers that, as they know, I said
before the election that all roads lead to Westminster and that
we all suffered under the Conservative Government, but this year
that road is carrying an extra £1.5 billion to the Scottish
Government and next year it will carry an extra £3.4 billion to
the Scottish Government, so they have no excuse not to act.
(Meriden and Solihull East)
(Con)
Approximately 220,000 people currently reside in the Solihull
borough, and if Government planning reforms go through, the
number will increase significantly. My hon. Friend the Member for
Solihull West and Shirley (Dr Shastri-Hurst) and I have written
to the Health Secretary about the need for infrastructure and
A&E services at Solihull hospital. Will he agree to meet us
to see how we can make this Budget work for the people of
Solihull?
I know, not least because of the mismanagement of the NHS during
the last 14 years, that communities right across the country,
including the hon. Gentleman's constituents in Solihull, are
struggling with poor services and crumbling estates. We would be
happy to receive representations from him, but he has to level
with his constituents. If he wants money to be spent in his
community, he must support the investment and be honest about the
fact that he supports the means of raising it. If he does not
support the means of raising it, he should tell us where that
investment would come from.
Mr Speaker
We have been very slow to get to topicals, so let us see if we
can speed it up. will set a good example.
Topical Questions
(Chipping Barnet) (Lab)
T1. If he will make a statement on his departmental
responsibilities.(901308)
The Secretary of State for Health and Social Care ()
This weekend, we launched the first in-person consultation as
part of change.nhs.uk, the biggest national conversation about
the future of the NHS we have ever seen. We know that the Leader
of the Opposition wants a conversation about whether the NHS is
free at the point of use, and I can tell her, from that first
conversation, that no one agreed with her.
Earlier this month, I visited Barnet hospital to see the way in
which it is changing the emergency care department so that more
patients can be seen more quickly, freeing up capacity in
accident and emergency. What steps are the Government taking to
ensure that trusts such as the Royal Free and others across the
country get the support they need, through investment and reform,
to improve patient care?
I am grateful to my hon. Friend for his question. The Royal Free
hospital saved my life when I went through kidney cancer, so it
holds a special place in my heart. Thanks to the Chancellor's
decision and the investment she put into the NHS at the Budget,
and the reform my Department is delivering, we will deliver the
change and improvement that his constituents and mine, and the
rest of the country, deserve.
Mr Speaker
I call the shadow Secretary of State.
(Melton and Syston) (Con)
The Secretary of State knows that every year, irrespective of
which party is in government, winter is challenging for the NHS.
Possibly, it will be all the more so this year with the potential
impact on older people's health of the loss of the winter fuel
allowance by many. What winter preparedness steps has he taken,
like previous Governments, to increase A&E capacity and to
increase the number of beds this winter, and can he say by how
many?
It is thanks to this Government and the action we have taken
that, for the first time in three years, we go into winter
without the spectre of national strikes looming over the NHS, and
with NHS staff on the frontline not the picket line. It is thanks
to the priority this Government have given to prevention that we
have already delivered almost 15 million covid-19 and flu
vaccinations, alongside the new RSV—respiratory syncytial
virus—vaccination to help vulnerable groups for the first time.
The shadow Secretary of State mentions the winter fuel allowance.
This Government are protecting support for the poorest pensioners
to protect them not just this winter, but every winter, and over
the coming years the value of the pension will of course rise
with the cost of living.
I am grateful for that response but, just as my hon. Friends have
highlighted in respect of the damaging impact of increases in
employer national insurance contributions on GPs, hospices and
care providers, I fear it was another example of the Government
simply not answering the question and not having a plan yet.
Either the Government have not done their homework and, as with
the impact of NICs increases, they have not thought this through
and do not know, or worse, they do not care—which is it?
This Government are prepared for winter and we are already
standing up the operational response to winter pressures. On
funding, the right hon. Gentleman was in government just before
the general election. Is he saying that his Government did not
provide enough funding for the NHS this winter? If not, why not?
If he does accept that it is enough money, he will surely welcome
the extra investment that the Chancellor is putting into the NHS
from next year.
Dr (Gravesham) (Lab)
T2. What steps are Ministers taking to address the ongoing
shortages of medications for attention deficit hyperactivity
disorder, which have been going on for 18 months?(901309)
The Minister for Secondary Care ()
The Department has been working with suppliers of medicines used
to treat ADHD to seek commitments from them to address the
issues, expedite deliveries and boost supplies. We are working
with NHS England to approve the modelling for industry and
communications regarding ADHD medicine supply issues. We will
continue to engage with industry to address the remaining issues
as quickly as possible.
Mr Speaker
I call the Liberal Democrat spokesperson.
(North Shropshire) (LD)
The Conservatives' disastrous legacy on dentistry means that more
than 4.4 million children have not seen a dentist in the past
year. In Shropshire, dentists continue to hand back their
contracts, including one in Wem in recent weeks. Will the
Minister outline his plan to reverse that terrible decline and
ensure that the issue is addressed in rural areas where there are
dental deserts?
The Minister for Care ()
There will be 700,000 extra urgent appointments, golden hellos,
and a prevention and supervised toothbrushing scheme for three to
five-year-olds.
(Birmingham Erdington)
(Lab)
T3. Many of my constituents are worried that online GP
appointments are too often used as a substitute for face-to-face
consultation, which risks adding pressures to NHS waiting lists
further down the line. Will the Secretary of State reassure my
constituents that they will receive timely, in-person GP access
and the quality of care that they deserve?(901310)
We all know that general practice is under enormous pressure, and
that will be a big part of this Government's agenda. I reassure
my hon. Friend that our view is that there should be patient
choice, patient control and different courses for different
horses. I value online and over-the-phone appointments, but they
will not be right for everyone on every occasion. Patients should
have a voice and a say.
(Spelthorne) (Con)
T4. I recently met a GP who was in the market to hire a new seven
to eight session GP to meet demand. Following the Budget and the
increase in national insurance contributions for employers, he
can now only afford a three to four session GP. What advice does
the Secretary of State have for my friend the GP?(901311)
I would say to GPs who are thinking about staffing for the next
financial year that they should hold tight and wait for funding
allocations shortly, so that they can make informed decisions
about staffing and care for patients.
(Bristol North East) (Lab)
T6. On the doorstep in Bristol North East, people regularly talk
to me about the difficulties they have getting a GP appointment.
Will the Minister assure primary care services in my
constituency, such as Kingswood health centre, that the Budget
will help them and marks the first steps in transforming our
NHS?(901313)
We have pledged to bring back the family doctor, and we have
already invested an additional £82 million in the additional
roles reimbursement scheme to recruit 1,000 more newly qualified
GPs in 2024-25. We are also committed to fixing the front door of
the NHS, for example through £100 million of capital funding that
was announced in the Budget. We are fully aware of the pressures,
and we will set out further details on funding allocations for
next year in due course.
(Witney) (LD)
T5. Will the Secretary of State give a clear date by which QR
codes will be incorporated into the NHS app at the point of care,
thereby making the process faster and safer, as was highlighted
to me by Dr Steve Bright at the Windrush health centre in
Witney?(901312)
I might resist the invitation to give a specific date today, but
the hon. Gentleman makes a valuable point about the ease of use
of the NHS app, and I will write to him further on that
point.
(Gateshead Central and
Whickham) (Lab)
T7. Usher syndrome is a rare inherited disease that can lead to
both deafness and blindness. As chair of the Usher syndrome
all-party parliamentary group, I have met many of those who
suffer from Usher syndrome. What assessment has the Department
made of the adequacy of support for those suffering from Usher
syndrome and their family members?(901314)
The Parliamentary Under-Secretary of State for Health and Social
Care ()
The UK rare diseases framework aims to improve the lives of
people living with all rare diseases. I am more than prepared to
meet my hon. Friend to look at the adequacy of support available
to people with Usher syndrome.
(Richmond Park) (LD)
T8. Last Friday, I met GPs at the Fairhill medical practice in
north Kingston in my constituency. They have told me that the
increase in national insurance contributions will add £50,000 a
year to their costs. Can the Secretary of State tell me whether
GPs can expect to see an across-the-board cut in the NICs payable
by GPs to help them manage to continue delivering services for
families in the area?(901315)
We have not yet announced allocations for general practice for
the year ahead, and we are taking into account all the pressures
that general practice is under.
Dr (Worthing West) (Lab)
T10. The renewed focus on prevention in our health system is
welcome, but under the previous Government, the public health
grant that facilitates much of that work was cut by 28%. Has the
Minister, in partnership with the Treasury, considered when we
might be able to address that public health funding issue, which
is essential to enabling progress in prevention?(901317)
We will confirm the 2025-26 local authority public health grant
allocations in due course. Local government plays a critical role
in delivering the Government's health mission and driving action
on the prevention of ill health. We are committed to working in
partnership with local government to tackle the wider
determinants of ill health.
(Newton Abbot) (LD)
T9. I have been shocked this week by all the major GP groups in
my constituency detailing their financial situations. They are
all close to the edge and are considering the options of
bankruptcy, redundancies or handing in their contracts. What
urgent respite can the Secretary of State give them?(901316)
I am in no doubt about the state that general practice was left
in by our Conservative predecessors. That is why, in making
decisions about funding allocations for the year ahead, we are
taking into account all the pressures that general practice is
under, as we clean up the mess left by the Conservatives.
(Norwich North)
(Lab/Co-op)
In summer 2023, I spoke to Rachel, who suffers from
endometriosis. She was told that she might have to wait 18 months
for urgent surgery. She is still waiting. In fact, she has had
the menopause induced to help tackle her symptoms. Can the
Minister tell me what the Government are doing to improve the
diagnosis and treatment of women, including Rachel, who have had
to wait far too long?
My hon. Friend makes an excellent point on behalf of Rachel and
many other women suffering from this disease. We are looking
urgently at gynaecological waiting lists. They are far too high,
including for endometriosis. I welcome the new National Institute
for Health and Care Excellence guidelines. We will be looking at
women's health hubs and how they work, and future guidelines will
help women to get a diagnosis more quickly and help with
situations like Rachel's.
(Bath) (LD)
Respiratory health conditions are one of the main drivers of NHS
winter pressures, yet only 32% of asthma sufferers in Bath and
across the country can access the most basic level of care. What
will the Government do to improve access to basic levels of care
for the 68% of asthma sufferers who are currently missing
out?
NICE is reviewing its guidelines for the diagnosis, monitoring
and management of chronic asthma, and an updated version is due
to be published in late November 2024. I am happy to meet the
hon. Lady to discuss it further.
(Middlesbrough and Thornaby
East) (Lab)
Women with spinal cord injuries face significant challenges in
accessing core health services, including breast screening,
cervical screening and gynaecological care. Research shows that
women with disabilities, including spinal cord issues, are 30%
less likely to attend routine breast screening appointments, in
significant part due to the physical inaccessibility of the
screening equipment. Will the Minister meet me and
representatives of the all-party parliamentary group on spinal
cord injury to discuss these unacceptable disparities and ensure
that women receive the equitable and accessible care they
deserve?
My hon. Friend highlights a shocking example of inaccessibility
in these important services. I will make sure that the Department
responds to him and that either me or a ministerial colleague
meets him.
(South Shropshire)
(Con)
Ludlow community hospital in my constituency provides a great
service for the local community, but it is restricted by its
location and its building. There is a business model that would
be more cost-effective in the long term that involves moving the
facility to the eco park. Will the Secretary of State meet me,
healthcare stakeholders and the league of friends in Ludlow to
take that forward?
The hon. Member is welcome to make representations to the
Department for the capital investment that he is calling for, but
he should welcome the means of providing it, which was the
Chancellor's decision in the Budget.
(Bermondsey and Old Southwark)
(Lab)
I welcome Ministers' leadership in attacking the record waiting
times inherited from the Tories. Will they in turn recognise
Guy's and St Thomas' efforts to reduce delays, especially in the
ear, nose and throat and paediatric spinal surgery teams? Will
the Secretary of State outline measures to protect our NHS from
cyber-attacks, which was another issue neglected by the last
Government but is affecting patients in Southwark?
I am grateful to my hon. Friend for the question and pay tribute
to the work being done by Guy's and St Thomas'. He is right to
raise cyber-security. That is why the capital investment
announced by the Chancellor is welcome and necessary, and joint
working across Government, including with security colleagues and
my right hon. Friend the Secretary of State for Science,
Innovation and Technology, is vital to keep patients' data and
information safe and to keep critical systems running.
Mr (Newbury) (LD)
When the Secretary of State reviews GP funding, will he also
consider the burden that sits on GP practices when they have to
hold the lease for their surgeries and what role integrated care
boards could have in holding that risk, which is stopping the
recruitment of GPs to join practices as partners?
NHS England currently accepts ICBs holding leases only as a last
resort or by exception due to the significant capital required.
While we know that is not the most effective use of ICB
resources, it is an important safeguard. We are committed to
fixing the front door of the NHS by supporting GPs and ICBs
through, for example, the £100 million of capital funding
announced at the Budget for GP estate upgrades.
(Burton and Uttoxeter)
(Lab)
My constituent Ollie Horobin's life has been completely
transformed after contracting covid, leaving him wheelchair-bound
with a feeding tube and battling debilitating symptoms every
single day. His story is a stark reminder of the devastating
impact that long covid can have. Will the Minister commit to
meeting Ollie and me to hear about his experience at first hand,
and prioritise further research into the causes, treatments and
long-term impacts of extreme long covid?
As somebody who still suffers from long covid, I know how
debilitating and complex it can be, and I am committed to
improving support for people affected by it. There are now more
than 100 long covid services across England, and £57 million is
being invested in long covid research. I recently co-chaired a
roundtable on strategies to stimulate further research into
treatments. I am more than happy to meet my hon. Friend and Ollie
for further discussion.
(Dumfriesshire, Clydesdale
and Tweeddale) (Con)
Opt-out testing for HIV at A&E has been a great success since
it was announced last year, particularly in identifying those who
were not aware they had the disease and among difficult-to-reach
communities. Can the Health Secretary confirm whether the
programme will continue?
Opt-out HIV testing has been a great success so far. Of course,
we will make further announcements on its future in due course. I
would like to say, as a former member of the HIV commission that
made the representations to the previous Government, that he has
me at a real advantage—or disadvantage, depending on the side of
the spending fence. I very much welcomed the approach taken by
the previous Government, which this Government plan to
continue.
(Bury St Edmunds and
Stowmarket) (Lab)
Will the Secretary of State explain what plans he has—if any—to
limit the scope of practice of anaesthetic associates and
physician associates, about whom there has been such publicity
lately?
Indeed there has. Medical associate roles can and do play a
valuable role in freeing up other clinicians' time to do the
things that only they can do, but there are legitimate concerns
within the professions about scope of practice, doctor
substitution and transparency for patients. We need to grip that
and address it. We will have a further announcement to make about
that shortly.
Mr (Basildon and Billericay)
(Con)
South Green surgery in my constituency has been given notice by
its landlord that it has to move by the end of March next year.
Will the Secretary of State meet me to see what we can do to
ensure that other facilities can be provided if available, or to
do the best for those local patients?
That would be a matter for the right hon. Gentleman's ICB. I know
that he is new to the area, so I am happy to make some
introductions.
(Kingston upon Hull East)
(Lab)
My constituent Craig Eskrett was diagnosed with motor neurone
disease 12 months ago. He says that the services are there in the
local NHS trust, but there is a distinct lack of co-ordination.
Will the Minister meet me to discuss what improvements can be
made to co-ordinate those services for sufferers of MND?
My hon. Friend raises a real issue about how we join up the whole
of the patient journey. Once diagnosed, patients need appropriate
treatment and wraparound care. I am more than happy to meet him
and his constituent.
(Honiton and Sidmouth)
(LD)
At the weekend in Devon, I met a psychiatric nurse who previously
worked in London and has been recruited to the south-west. She
does not have a start date, and is still subject to routine
checks after waiting months. Can the Secretary of State expedite
these routine checks, given waiting lists for mental health?
Absolutely. That is a good example of why investment needs to be
matched with reform to speed things up, improve productivity and
get staff to the frontline, where they want to be.
(Huddersfield) (Lab)
Last week, the chief executive of Forget Me Not children's
hospice visited Parliament with local dad Steve, whose son is
supported by the hospice. The hospice provides vital services to
families such as Steve's, but its services are at risk in the
longer term without sustainable funding, including the NHS
England children's hospice grant. Can the Health Secretary take
urgent steps to improve funding for hospices?
I am grateful for the steps that my hon. Friend is taking to make
representations on behalf of her local children's hospice, both
on the Floor of the House and outside the Chamber. I recognise
the pressure she describes. We are determined to help hospices to
overcome them.
(Strangford) (DUP)
Can the Secretary of State confirm what assessment has been made
of the number of women waiting for endometriosis surgery across
the United Kingdom? What has been done to reduce waiting
lists?
As my hon. Friend the Minister for Secondary Care said, the wait
for women with common conditions such as endometriosis is far too
long. That is why we are taking steps to cut waiting times and
stop the merry-go-round of repeat visits to the same clinician to
get the same answer, until someone finally listens to what a
woman has to say.
