Health and Social Care Questions
All answered by the Rt Hon Steven Barclay MP, Secretary of State for Health and Social Care unless otherwise stated.
Labour Shadow Health Ministers
Wes Streeting (Lab: Ilford N) – Shadow Secretary of State for Health and Social Care
Labour founded the NHS to be free at the point of use, and we want to keep it that way. Given that the Prime Minister has advocated charging for GP appointments, and [Sajid Javid] has urged him to charge for A&E visits, will he rule out any extension to user charging in the NHS?
I can see from your reaction, Mr Speaker, and the reaction of colleagues in the House, that that is a misrepresentation of the Prime Minister’s position. For the majority of its existence, the NHS has been run by Conservative Governments. We remain committed to treatment free at the point of use.
I note that the Secretary of State did not rule out any future extension of user charging, and I am sure that patients will have noticed too. Given that the chief executive of NHS England has said that the NHS needs to expand training; that many of the Secretary of State’s own backbenchers are echoing Labour’s calls to double the number of medical school places; and that he has no plan whatsoever to expand NHS medical school training places, nursing and midwifery clinical training places, to double the number of district nurses qualifying, or to provide 5,000 more health visitors, is it not time for the Conservatives to swallow their pride, admit that they have no plan and adopt Labour’s workforce plan instead?
I am not surprised that the hon. Gentleman wants to misrepresent the Government’s plan, not least because his own plan is disintegrating before his own Front Bench. Even the deputy chair of the BMA has said that Labour’s plan would create higher demand and longer waiting times.
Dr Rosena Allin-Khan MP (Lab: Tooting) – Shadow Minister for Mental Health
In mental health we rely on staff, not shiny machinery, so why is the Secretary of State rehashing old announcements and scrapping plans? It is because the Government have run out of ideas. Labour will recruit 8,500 more mental health professionals, ensuring a million more patients get treated every year. We will double the number of medical school places. We will train 10,000 extra nurses and midwives every year, and we will focus on retaining the fantastic staff we already have. Where is the Government’s plan?
It is slightly odd for the hon. Lady to talk about a plan when she does not agree with the plan of the shadow Health Secretary. He plans to use the private sector, which he describes as “effective and popular,” whereas the hon. Lady said: “In my own brief in mental health we have use of the private sector, which ultimately often lets patients down.” First, the hon. Lady does not agree with the shadow Secretary of State. The hon. Lady chunters, but she asked about a plan when she does not agree with her own Secretary of State. Secondly, the hon. Lady talked about shiny new equipment. I am delighted that she allows me to draw the House’s attention to yesterday’s announcement of a fleet of 100 new mental health ambulances, which will relieve pressure on A&E. I am delighted that she gave me an open door to highlight that investment, which is part of our £2.3 billion investment in mental health.
Feryal Clark (Lab: Enfield N) – Shadow Minister for Primary Care
The women’s health strategy was an opportunity to fundamentally change the inequalities women face. Women were promised a clinical women’s health lead in the NHS, yet a former Health Minister admitted that there has not even been a discussion about establishing the role. Women in east Kent were promised change after the damning review of local maternity services, yet the CQC is now threatening the trust there with enforcement action. Time after time, women’s voices are at best being ignored and at worst being silenced. When will this Government stop letting women down with empty promises? Is the women’s health strategy worth the paper it was written on?
Maria Caulfield, Minister for Mental Health and Women’s Health Strategy:
Perhaps the shadow Minister will reflect on her comments when she receives the “Dear colleague” letter later today outlining the eight priorities areas for our first year of the strategy, with work such as the prepayment certificate for hormone replace treatment being done already; it is launching in April and saving women hundreds of pounds on the cost of HRT.
Janet Daby (Lab: Lewisham E)
Will a plan to increase retention and recruitment of NHS staff be brought forward?
The long-term workforce plan that is being developed by NHS England will help to ensure that we have the right staff numbers with the right skills to deliver high-quality services in the future.
Is the Secretary of State fully aware that under this Government every part of the NHS is in crisis? Are the Government satisfied with the fact that, as medical students in their second year told me recently, the shortage of staff on hospital wards and the pressures on those wards are affecting their training? The students also told me that they had little aspiration to work as junior doctors in the UK after qualifying, because of the acute strain on the NHS and because they felt undervalued. Does the Secretary of State know about this, and what is he going to do about it?
We see a considerable number of applications for medical undergraduate places, far in excess of the number of places available. We have boosted the number of places… when I was last in the Department and the Chancellor had my role, we increased the number of medical undergraduate places by 25%. Indeed, we have more doctors and nurses than we had last year, and 3.5% more full-time equivalent staff: we have over 42,000 more people working in the NHS than we had last year.
Ellie Reeves (Lab: Lewisham West and Penge)
What recent steps have been taken to implement the Women’s Health Strategy for England?
Maria Caulfield: Last summer we published the first Government-led women’s health strategy for England, which sets out our 10-year ambition to boost the health and wellbeing of women and girls and to improve how the health and care system listens to them. I am pleased that we have set out the first eight priorities for the first year of the women’s health strategy, and that we are already delivering on many of them.
After 13 years of Conservative Government, more than half of maternity units now consistently fail to meet safety standards. Almost 40,000 women now wait over a year for gynaecological treatment, up from just 15 women 10 years ago. Women in the poorest areas are dying earlier than the average female in almost every comparable country. At every stage of a woman’s life, her health is being compromised. When will these failures be reversed, and when will we see real investment in the NHS workforce and in women’s health?
We have eight priorities for this year. We are rolling out women’s health hubs around the country as a one-stop shop to make healthcare more accessible to women. We are improving women’s health provision by setting out a women’s health area, with reliable information, on the NHS website. We are working with the Department for Work and Pensions to support women’s health in the workplace. We are recognising pregnancy loss by developing the first ever pregnancy loss certificate for babies who are born and lost before 24 weeks. We are improving and standardising access to IVF for same-sex couples around the country. And we are launching the first ever HRT prepayment certificate in April. That is some of the work we are doing, and I am disappointed the hon. Lady does not recognise that effort.
Louie French (Con: Old Bexley and Sidcup)
One of the biggest issues my local hospitals raise with me in outer London is the impact of Sadiq Khan’s ultra-low emission zone expansion, with nurses and other staff facing charges of £12.50 per shift or £25 if they are working nights. Given that 50% of London’s emergency service workers live outside the capital, does the Minister agree that the Mayor and the Labour party should stop ignoring Londoners and drop their ULEZ tax rate?
My hon. Friend raises an important point about the additional costs that the London Mayor is imposing not just on NHS staff but on all staff working in the capital, in contrast to the approach the Chancellor has taken to energy support to help staff across the workforce, including in the NHS, with the cost of living.
Rupa Huq (Ind: Ealing Central and Acton)
In the light of the Government’s welcome announcement of the Strathdee rapid review of in-patient mental health services, can we revisit West London NHS Trust’s decision to make the covid closure of the Wolsey wing permanent, which leaves Ealing, the third biggest borough in London, with no acute mental health beds for under-65s? (903250)
Maria Caulfield: Local healthcare decisions are made by local commissioning groups, but I am happy to raise that on behalf of the hon. Lady. We are putting an additional £2.3 billion a year into expanding and transforming mental health services in the community and patient services.
Mohammad Yasin (Lab: Bedford)
What steps are being taken to help improve access to GPs?
We recognise that increased demand has had an impact on GP services. That is why we are investing at least £1.5 billion to create an additional 50 million GP appointments by 2024.
There is a clear failure to invest in critical infrastructure across the primary care estate, for example, in modernising in-patient mental health services and GP hubs. To make matters worse, Government bureaucracy is holding up capital funding allocations. My constituents deserve better community care and hospitals need relief, so when will the Government finally release the funding to build the facilities desperately needed in Bedford and Kempston?
We have, alongside the investment we are making in primary care, invested in the new hospitals programme, as part of this Government’s commitment to the NHS estate.
Toby Perkins (Lab: Chesterfield)
Will an assessment be made of the adequacy of GP appointment availability in Chesterfield, Derbyshire and England?
Neil O’Brien, Minister for Primary Care:
In November, there were 13.9% more appointments in general practice across England as a whole than in the same month before the pandemic. Our GPs are doing more than ever, and, compared with 2015-16, we are investing a fifth more in real terms. But we know that demand is unprecedented, and we are working to further support our hard-working GPs.
I thank the Minister for that answer. We know that there are GP appointment difficulties everywhere, but we also know that it is much more difficult in more deprived communities. Social Market Foundation research shows that GPs in more deprived communities have twice as many patients on their books than those in more affluent areas. This means that, in addition to the greater health inequalities in those communities, people are finding it very difficult to get appointments, including at the Royal Primary Care practice in Staveley. Why should patients in more deprived communities be expected to tolerate far greater difficulties in getting GP appointments than those in more affluent areas?
In Derby and Derbyshire, for example, there are 495 more doctors and other patient-facing staff than in 2019. Step 1 is to have more clinicians, which we are doing through that investment. The hon. Member raises a point about Carr-Hill and the funding formula underlying general practice. There is actually heavy weighting for deprivation, and the point he raises is partly driven by the fact that older people tend not to live in the most deprived areas, and younger people tend to live in high index of multiple deprivation areas. That is the reason for the statistic he used. Funding is rightly driven by health need, which is also heavily driven by age. We are looking at this issue, but the interpretation he is putting on it—that there is not a large weighting for deprivation—is not quite right.
Dr Luke Evans (Con: Bosworth)
I declare an interest as a GP and the immediate family of a GP and doctors. GPs are working incredibly hard in tough times. It is true that supply has gone up, but so too has demand. Change needs to happen in primary care, but one of the bedrocks is the GP partnership model. Does this Government agree?
Neil O’Brien: Unlike the Opposition, we do not regard GPs’ finances as murky and we do not want to go back to Labour’s policy of 1934 by trying to finish off the business that even Nye Bevan thought was too left-wing. We do not believe in nationalising GPs; we believe in the current model. We do not believe that people with a problem should immediately go to hospital, driving up costs and undoing the good work of cross-party consensus in the last 30 years. A plan that was supposed to cause a splash has belly-flopped.
Gary Streeter MP (Con: SW Devon)
Most of the GP practices in South West Devon report to me that their biggest challenge is recruiting new doctors. Does my right hon. Friend have an estimate of the number of young doctors finishing their training this year who are likely to want to become GPs, and can he reassure us that that is a greater number than the number who are likely to retire in the next 12 months?
My hon. Friend raises two important themes. The first relates to how many are in training, and I think it is around 4,000. We have boosted the number of GP training places and we have looked at medical schools as a specific issue. Also, he will have seen some of the changes being made around pensions in order to better retain staff, mindful of those clinicians who are leaving the profession, and further discussions are taking place with Treasury colleagues in that regard.
Helen Morgan (Lib Dem: N Shropshire)
In Shropshire there are 14% fewer GPs and 29% fewer GP partners than in 2019, yet in the period from April to November 2022, they provided 6% more appointments. It is this additional workload that is causing burnout in GP practices and a flight from the profession. What is the Secretary of State doing to improve the retention of GPs as well as recruitment?
It is important to look at the number of doctors in general practice, and those numbers are up. There are 2,298 more than there were in September 2019, so we are increasing the number of doctors. What is also important is getting the right care at the right time within primary care, which is about the wider workforce—the paramedics, the mental health support and others working in primary care—and there are an extra 21,000 there. This is enabling GPs to see more patients a day and allowing more patients to get the right primary care, perhaps not from a doctor but from others who can offer specialised support.
Dame Caroline Dinenage (Con: Gosport)
Gosport patients have learnt that one of our GP practices is threatened with closure, while another is about to merge with an already very subscribed group of practices. Partners are retiring, with no replacements. Will the Secretary of State confirm what he is doing to ensure that my constituents can access a GP?
My hon. Friend raises an important point, and we are investing over a fifth more than in 2016, as part of our wider investment programme. I am very keen to work with her on the role of her ICB. It was set up operationally last summer, and its role is to commission primary care services for the community and to assess the needs of her Gosport constituents. I am very happy to work with her and her ICB on the issues she raises.
Emma Hardy (Lab: Hull West and Hessle)
Hull has the second highest ratio of GPs to patients in the country. Even though GPs see 46 people a day on average, it is clear that demand for their services outstrips supply. Will the Secretary of State look at giving women direct access to specialist nurses and services, such as endometriosis or menopause specialists, to prevent them from having to go via their GP each time they need renewed treatment and updated medication?
First, that is exactly what the women’s health strategy is doing through designing women’s health hubs. It is exactly why we are appointing a wider portfolio of roles into primary care. Labour’s plan is to divert £7 billion out of primary care property, which will not improve services for women and will actually impede the ability to deliver exactly the sort of services she is calling for.
Paul Maynard (Con: Blackpool N and Cleveleys)
Thornton Cleveleys will see a 17% increase in new patients registering for primary care in the next five years, exceeding the physical capacity. Cost-effective solutions have been found, but the obstacle is the integrated care board, which keeps changing its mind as to whether money is or is not available. The clock is ticking on the need for this new capacity. Will the primary care Minister meet me to resolve this impasse and get the ICB to sort its act out?
The Minister for Primary Care was listening intently and is nodding his head about meeting him to discuss it.
Maggie Throup (Con: Erewash)
In south Derbyshire there are now 133 more full-time equivalent clinical staff in general practice than in 2015. That includes nurses, physios and clinical pharmacists. What more is my hon. Friend doing to encourage more people to book an appointment with the most appropriate healthcare professional, rather than simply defaulting to booking a GP appointment?
Neil O’Brien: We are getting NHS England to financially support GPs to move over to better appointment systems. That is not just better phone systems, but better triage.
Debbie Abrahams (Lab: Oldham E & Saddleworth)
The UK’s all-cause mortality for working-age people was 8.3% above the average for the previous five years and the fifth highest in Europe. On top of that, excess deaths are disproportionately experienced by the most deprived and by people of African, Caribbean and Asian descent. Given that these figures are driven by structural inequalities, and that those inequalities are getting worse—the richest 1% have bagged nearly twice as much wealth as the remaining 99% in the past two years—does the Minister think that it is appropriate to recommend that people pay for their GPs?
Maria Caulfield: The Government are not recommending that people pay for their GPs. In fact, we are investing more in primary care than ever before, unlike the shadow Secretary of State who wants to dismantle the GP system and privatise the healthcare system as well. I think the hon. Lady needs to have a conversation with those on her own Front Bench. Not only did the shadow Secretary of State insult primary care teams for running up their vaccination programme, calling it “money for old rope”, but we are the ones who are investing in primary care services and making them more accessible to people.
Martyn Day (SNP: Linlithgow & E Falkirk)
When I brought up pension tax rules in November, the Secretary of State agreed that pensions were an important issue and said that he would meet the Chancellor later that day. Can he give an update on the progress that his Cabinet colleagues are making to provide a permanent solution that will help retain NHS staff?
Those discussions are ongoing with the Chancellor. We made progress in the summer on a couple of areas in relation to pensions.
The Secretary of State published a written statement on the Government’s response on major conditions and diseases, ahead of publishing a new publish a new Major Conditions Strategy.
Statement on winter pressures in the NHS
Rt Hon Steven Barclay MP – Secretary of State for Health and Social Care
There is no question but that it has been an extraordinarily difficult time for everyone in health and care. Flu has made this winter particularly tough: first, because we are facing the worst flu season for 10 years—the number of people in hospital with flu this time last year was 50; this year, it is over 5,100. Secondly, it came early and quickly, increasing sevenfold between November and December. It also came when GPs and primary and community care were at their most constrained. When flu affects the population, it affects the workforce too, leading to staff sickness absence that constrains supply just as it also increases demand.
Wes Streeting (Lab: Ilford South) – Shadow Secretary of State
What has been announced today is yet another sticking plaster when the NHS needs fundamental reform. The front door to the NHS is blocked, the exit door is blocked, and there are simply not enough staff. Where is the Conservatives’ plan to fix primary care, so that patients can see the GP they want in the manner they choose?
Secretary of State
[Streeting] talks about a fresh start, but even his own shadow Cabinet colleagues do not seem to agree with his plans… his own shadow Chancellor seems to have distanced herself from his plans for GPs. Perhaps he can share with the House exactly how much his unfunded plans for GPs will cost, because the chief executive of the Nuffield Trust has said: “It will cost a fortune” and is “based on an out of date view”.
Richard Graham (Con: Gloucester)
What progress has the department made with the Home Office to prioritise tier 2 health visas and to provide a grace period for international GP trainees?
Secretary of State
Work is ongoing with Home Office colleagues on the visa component.
Sir Robert Syms (Con: Poole)
Community pharmacists… have always wanted to do more. They can take a lot of the burden off GPs and, if access to GPs were improved, fewer people would turn up at A&E. It seems to be a win-win-win situation, so let’s do it.
Secretary of State
I could not agree more. There is a huge opportunity for pharmacists to do more, and I have asked the Department and NHS England to explore that at pace. I expect to say more on that when I announce our recovery plan at the end of the month.
Shaun Bailey (Con: West Bromwich West)
The most pressing issue for my constituents during the winter has still been access to their GPs, as I am sure members on both sides of the House will agree. I welcome what he has said about the use of technology to ensure that people are seen, but fundamentally, people still want face-to-face appointments, because if they are digitally disconnected, they cannot access that technology. It is as simple as that. I ask him to commit… to ensure that we enable people who are digitally disconnected to access GPs.
Secretary of State
We are working actively with the primary care community. Indeed, that was a key focus of the Prime Minister’s summit in No. 10 on Saturday [7/1] and it is part of the work that the [Minister for Primary Care] is leading through the primary care recovery plan. Last year’s GP patient survey suggested that continuity of care and face-to-face appointments were extremely important for two fifths of patients, but that suggests that for three fifths—often younger patients—speed of access is more pertinent. Continuity of care is important for those with multiple conditions, particularly elderly patients.
Prime Minister’s Questions
Cat Smith (Lab: Lancaster and Fleetwood)
There are no NHS dentists taking on patients in Lancaster and Fleetwood, and those constituents of mine who are lucky enough to have one are waiting months for an appointment. How long did the Prime Minister have to wait for his last NHS dentist appointment?
As a result of the new reformed NHS dentistry contract, there are now more NHS dentists across the UK, with more funding, making sure that people can get the treatment they need. Let me answer the hon. Lady directly. I am registered with an NHS GP. I have used independent healthcare in the past. I am registered with an NHS GP. I have used independent healthcare in the past, and I am grateful to the Friarage Hospital for the fantastic care that it has given my family over the years. The truth is, I am proud to come from an NHS family, and that is why I am passionately committed to protecting the NHS with more funding, more doctors and nurses and a clear plan to cut the waiting lists.
We have a very clear plan to bring the waiting lists down and it is one that the NHS supports. I tell you what the NHS does not need: Labour’s only idea, which is for another completely disruptive, top-down, unfunded reorganisation buying out every single GP contract. Those are not my words. The CEO of the Nuffield Trust said it “will cost a fortune” and it is “out of date”—just like the Labour party.
Keir Starmer (Lab: Holborn and St. Pancras)
Last month, 1.4 million people waited more than four weeks for a GP appointment. When Labour left Government, you were guaranteed an appointment in two days. When does the Prime Minister expect to get back to that?
We have already eliminated two-year wait lists: that was done last year. We are on track this spring to eliminate waits of 18 months, with a clear plan to go further and eliminate waits of 52 weeks by next spring. We are doing that with record funding, more community diagnostic centres, more surgical hubs and more patient choice. That is why I have made tackling wait lists one of my five priorities.
Keir Starmer (Lab: Holborn and St. Pancras)
I heard the Prime Minister saying that he is now registered with an NHS doctor, so he will soon enjoy the experience of waiting on hold every morning at 8 am to get a GP appointment. I can tell him that those who are waiting now do not want another round of empty promises or boasting about what he has done; they just want to know when they will be able to see a doctor.
This is not just about routine care. There can be nothing more terrifying than being told you might have cancer: that is why the last Labour Government brought in a guarantee that people would be seen by a specialist within two weeks. Today, 50,000 people are waiting longer than that. Everyone in this House will appreciate the anxiety that they are feeling. When will cancer patients once again get the certainty of quick care that they got under Labour?
Why is there a challenge with cancer times right now? Again, the right hon. and learned Gentleman just has absolutely no understanding of the situation. What happened to cancer referrals during covid? They went down by almost two thirds. That was because of a pandemic.
Health and Social Care Select Committee
On 17 January, the committee held an oral evidence session on integrated care systems. The session can be watched back here.
On 24 January, the committee held an oral evidence session on the situation in A&E departments. The session can be watched back here.