Category: Health

The statement made by Steve Barclay, the Secretary of State for Health and Social Care, in the House of Commons on 4 September 2023.

With permission, Mr Speaker, I would like to make a statement on the inquiry into the circumstances surrounding the crimes of Lucy Letby.

On 18 August, as the whole House is aware, Letby was convicted of the murder of seven babies and the attempted murder of six others. She committed these crimes while working as a neonatal nurse at the Countess of Chester Hospital between June 2015 and June 2016. As Mr Justice Goss said as he sentenced her to 14 whole life orders, this was a

“cruel, calculated and cynical campaign of child murder”

and a

“gross breach of the trust all citizens place in those who work in the medical and caring professions.”

I think the whole House will agree it is right that she spends the rest of her life behind bars.

I cannot begin to imagine the hurt and suffering that these families went through, and I know from my conversations with them last week that the trial brought these emotions back to the surface. Concerningly, that was exacerbated by the fact the families discovered new information about events concerning their children during the course of the trial.

Losing a child is the greatest sorrow any parent can experience. I am sure the victims’ families have been in the thoughts and prayers of Members across the House, as they have been in mine. We have a duty to get them the answers they deserve, to hold people to account and to make sure lessons are learned. That is why, on the day of conviction, I ordered an independent inquiry into events at the Countess of Chester Hospital, making it clear that the victims’ families would shape it.

I arranged with police liaison officers to meet the families at the earliest possible opportunity to discuss with them the options for the form the inquiry should take, and it was clear that their wishes are for a statutory inquiry with the power to compel witnesses to give evidence under oath. That is why I am confirming this to the House today.

The inquiry will examine the case’s wider circumstances, including the trust’s response to clinicians who raised the alarm and the conduct of the wider NHS and its regulators. I can confirm to the House that Lady Justice Thirlwall will lead the inquiry. She is one of the country’s most senior judges. She currently sits in the Court of Appeal, and she had many years of experience as a senior judge and a senior barrister before that. Before making this statement, I informed the victims’ families of her appointment, which was made following conversations with the Lord Chief Justice, the Lord Chancellor and the Attorney General.

I have raised with Lady Justice Thirlwall the fact that the families should work with her to shape the terms of reference. We hope to finalise those in the next couple of weeks, so that the inquiry can start the consultation as soon as possible. I have also discussed with Lady Justice Thirlwall the families’ desire for the inquiry to take place in phases, so that it provides answers to vital questions as soon as possible. I will update the House when the terms of reference are agreed and will continue to engage with the families.

Today, I would also like to update the House on actions that have already been taken to improve patient safety and identify warning signs more quickly, as well as action that is already under way to strengthen that further. First, in 2018, NHS England appointed Dr Aidan Fowler as the first national director of patient safety. He worked with the NHS to publish its first patient safety strategy in 2019, creating several national programmes. Those included requiring NHS organisations to employ dedicated patient safety specialists, ensuring that all staff receive robust patient safety training and using data to quickly recognise risks to patient safety. Last summer, to enhance patient safety further, I appointed Dr Henrietta Hughes, a practising GP, as England’s first patient safety commissioner for medicines and medical devices. Dr Hughes brings leaders together to amplify patients’ concerns throughout the health system.

Secondly, in 2019, the NHS began introducing medical examiners across England and Wales to independently scrutinise deaths not investigated by a coroner. Those senior doctors also reach out to bereaved families and find out whether they have any concerns. All acute trusts have appointed medical examiners who now scrutinise hospital deaths and raise any concerns they have with the appropriate authorities.

Thirdly, in 2016, the NHS introduced freedom to speak up guardians, to assist staff who want to speak up about their concerns. More than 900 local guardians now cover every NHS trust. Fourthly, in 2018, Tom Kark KC was commissioned to make recommendations on the fit and proper person test for NHS board members. NHS England incorporated his review findings into the fit and proper person test framework published last month. It introduced additional background checks, the consistent collection of directors’ data and a standardised reference system, thus preventing board members unfit to lead from moving between organisations.

Finally, turning to maternity care, in 2018 NHS England launched the maternity safety support programme to ensure that underperforming trusts receive assistance before serious issues arise. Also since 2018, the Government have funded the national perinatal mortality review tool, which supports trusts and parents to understand why a baby has died and whether any lessons can be learned to save lives in the future. Furthermore, the Government introduced the maternity investigations programme, through the Health Safety Investigation Branch, which investigates maternity safety incidents and provides reports to trusts and families. In 2020, NHS England’s Getting It Right First Time programme was expanded to cover neonatal services. It reviewed England’s neonatal services using detailed data and gave trusts individual improvement plans, which they are working towards. Indeed, Professor Tim Briggs, who leads that programme, has confirmed that all neonatal units have been reviewed by his programme since 2021.

Let me now turn to our forward-facing work. We have already committed to moving medical examiners to a statutory basis and will table secondary legislation on that shortly. It will ensure that deaths not reviewed by a coroner are investigated in all medical settings, in particular extending coverage in primary care, and will enter into force in April.

Secondly, on the Kark review, at the time the NHS actively considered Kark’s recommendation 5 on disbarring senior managers and took the view that introducing the wider changes he recommended in his review mitigated the need to accept that specific recommendation on disbarring. The point was considered further by the Messenger review.

In the light of evidence from Chester and ongoing variation in performance across trusts, I have asked NHS England to work with my Department to revisit this. It will do so alongside the actions recommended by General Sir Gordon Messenger’s review of leadership, on which the Government have already accepted all seven recommendations from the report dated June last year. This will ensure that the right standards, support and training are in place for the public to have confidence that NHS boards have the skills and experience needed to provide safe, quality care.

Thirdly, by January all trusts will have adopted a strengthened freedom to speak up policy. The national model policy will bring consistency to freedom to speak up across organisations providing NHS services, supporting staff to feel more confident to speak up and raise any concerns. I have asked NHS England to review the guidance that permits board members to be freedom to speak up guardians, to ensure that those roles provide independent challenge to boards.

Fourthly, the Getting it Right First Time programme team will launch a centralised and regularly updated dataset to monitor the safety and quality of national neonatal services.

Finally, we are exploring introducing Martha’s rule to the UK. Martha’s rule would be similar to Queensland’s system, called Ryan’s rule. It is a three-step process that allows patients or their families to request a clinical review of their case from a doctor or nurse if their condition is deteriorating or not improving as expected. Ryan’s rule has saved lives in Queensland, and I have asked my Department and the NHS to look into whether similar measures could improve patient safety here in the UK.

Mr Speaker, I want to take the first opportunity on the return of the House to provide an update on the Essex statutory inquiry. In June, I told the House that the inquiry into NHS mental health in-patient facilities across Essex would move forward on a statutory footing. Today, I can announce that Baroness Lampard, who led the Department of Health’s inquiry into the crimes of Jimmy Savile, has agreed to chair the statutory inquiry. I know that Baroness Kate Lampard will wish to engage with Members of the House and the families impacted, and following their input I will update the House on the terms of reference at the earliest opportunity.

The crimes of Lucy Letby were some of the very worst the United Kingdom has witnessed. I know that nothing can come close to righting the wrongs of the past, but I hope that Lady Justice Thirlwall’s inquiry will go at least some way towards giving the victims’ families the answers they deserve. My Department and I are committed to putting in place robust safeguards to protect patient safety and to making sure that the lessons from this horrendous case are fully learned. I commend this statement to the House.

The statement made by Steve Barclay, the Secretary of State for Health and Social Care, on 8 August 2023.

I have now accepted the advice from the Joint Committee on Vaccination and Immunisation on eligibility for the 2023 autumn booster programme, to protect those most vulnerable from Covid.

NHS England will confirm details on how and when eligible people can access the autumn booster vaccine shortly, and I would urge anyone invited – including those yet to have their first jab – to come forward as soon as possible.

The speech made by Steve Barclay, the Secretary of State for Health and Social Care, on 15 June 2023.

Thank you, Matthew [Taylor] – it’s great to be with you today.

Tuesday’s incident in Nottingham has shocked us all.

I am sure everyone’s thoughts have been with the families of those who have lost their lives so tragically and all who have been affected.

And I wanted to take this opportunity to thank in particular everyone in the NHS who responded from the ambulance crews and paramedics – to the staff at the Queen’s Medical Centre.

I also recognise that this week brings additional challenges to many in the room due to the industrial action and I acknowledge that this creates additional pressures for you and your teams.

Many people will be working particularly hard to ensure the impact on patients is mitigated as far as possible.

And I know this work comes after an incredibly challenging period.

While the World Health Organisation has announced that the Covid-19 pandemic is officially over, its after effects are still very much being felt – including the scale of delays it has caused for patients waiting for treatment and the pressures on staff.

Thank you to everyone – across the whole health and care system – for the way you’re rising to meet these challenges.

My motivation as Secretary of State is clear: to enable people to access the right care faster.

Because when for example I think of cancer treatment, I am thinking of the constituent in her 20s with a young daughter who was told not to worry about her symptoms, only to later find that the cancer had spread.

I challenge myself as to what more I can do in this job to get the right treatment to people like her as fast as possible.

That challenge sits at the heart of our three recovery plans.

And whether it’s electives, UEC or primary care, patients are – rightly – demanding improvements.

They also want to see care that is better joined up.

And with our Integrated Care Systems now taking proper statutory form, we are moving in the right direction.

Last August, I visited the Jean Bishop Integrated Care Centre in Hull which is one of a number of fantastic examples of how health and social care can come together under one roof.

NHS staff, care workers and volunteers are working to care for local people, including keeping thousands of frail and elderly patients out of hospital and helping them live at home with the independence and dignity they deserve.

And with ICSs now fully operational, we can make this type of approach more commonplace across the country.

Despite the difficulties we face, there are signs of progress.

On electives we’ve virtually eliminated waits of over 2 years, and we’ve reduced 18 month waits by over 90%,

But we know the overall number remains high.

This has a material impact, like, for example, for the self-employed worker who is waiting for their operation before they return to work.

This is why we are taking further action to expand patient choice and making information on patient choice much more transparent.

On urgent and emergency care, ambulance handover delays have improved.

But again we know it has been particularly difficult in the past few days.

In primary care, more appointments are being delivered by GPs and the wider clinical team, with on average an extra 20 per practice per day.

But demand remains high.

I recognise many in this room will have played a direct part in bringing these additional services to patients.

Alongside these plans, I know other important work continues apace.

You will have heard yesterday from Amanda about the improvements in cancer, including the doubling of cancer checks.

In the 21st century, with the technology at our disposal, we can go further.

Thanks to your hard work, we’re already moving in the right direction.

Take lung cancer as one example.

Through our screening programme, we are now seeing more diagnoses at stage one and stage two in the most deprived communities.

This is a positive step and a practical example of how we are addressing health inequalities.

We’ve also made particular progress in areas like breast cancer and research this week shows that most women diagnosed in England will beat the disease.

Now we must build on this, by getting people potentially life-saving tests, checks, and scans more quickly and bringing those checks closer to people.

Community Diagnostics Centres are an example of this.

There are now 108 in operation, and they’ve delivered more than 4 million tests, checks and scans and they will help us build on these hard-won gains in the years to come.

Now, I don’t think there’s anything original about a Secretary of State being fixated on tech.

But for me, this isn’t tech for tech’s sake.

It is the way to get care to people quicker – and do so at scale.

Take for example, the way we’re expanding the NHS App. Contrary to what you may have heard from one speaker yesterday, over 2.4 million repeat prescriptions were ordered in April alone.

Alongside a quarter of a million primary care appointments that were booked on the app, with numbers increasing rapidly.

Tech is also the way we can tackle the many frustrations that I hear from staff – and that I’m sure many of you in the room hear too.

The reason I care about tech is simple: it improves outcomes and helps you do your jobs.

And let me say this: when budgets are tight, tech is often the first thing to go.

That is not my approach.

I am protecting the tech budget – and those key investments that will help us in the long term.

From ensuring every NHS Trust uses electronic patient records and investing more in bed management systems.

To the significant investment we’re making in our new data platform.

And digitising the front line – from speeding up staff logins to staff passporting.

Because I am acutely aware that when it comes to tech it is often how we make the job of local teams easier that that really matters.

Despite what you may have read, I believe strongly in devolving decision-making.

Equally, I think this should sit alongside greater transparency.

We need more devolved decision making to enable a place based approach with decisions taken closer to patient need.

Equally there are areas of great innovation but we have a challenge in scaling that so it is widely adopted. And this challenge is reflected in too wide a variation in performance between similar areas.

For me the opportunity is to devolve much more and to trust local decision makers. In return to expect more meaningful transparency.

Let me give you a practical example of where I have applied this, even where it could be uncomfortable.

I listened to those suggesting we publish the number of patients waiting for 12 hours or more from arrival in Emergency Departments.

Together with NHS England colleagues, we acted on that and from April we started publishing that information.

This is particularly relevant in the context of mental health patients, who we know are at greater risk of longer waits in A&E, and we’re taking targeted action to reduce that risk to reduce that risk to reduce that risk to reduce that risk.

Including the roll out of mental health ambulances, mental health cafes and mental health crisis hubs.

NHS leaders have been clear with me about what they want to see from government.

Fewer targets and more trust in the system.

As Matthew referenced, we published a new NHS mandate this morning which reflects this.

For over a decade, governments have used the mandate to make asks of the system.

Sometimes these asks have been excessive, with long documents with many pages full of tests and targets.

I’m sure you won’t be alone if you’re sat there thinking: it doesn’t matter I don’t read it anyway.

But what we’ve done this year is make it short and clear, setting out our priorities:

Cutting waiting lists; the three recovery plans; tech; and workforce.

It gives a clear direction and backs it up with the freedom and flexibility to deliver it.

We know that change happens when people are trusted, have a common purpose and are free to innovate.

It was something that Matthew highlighted yesterday as a lesson coming out of Covid. And it is something I very much agree with.

Trusting ICSs with greater freedom from devolved decision-making alongside greater transparency was one of the reasons we commissioned the Hewitt Review. Thank you to all those who contributed to it.

Before I wrap up, I just want to reflect that – as we sprint to address the present it would be easy to lose sight of foundations we can lay now to build hope for the future.

Some – such as the Long-Term Workforce Plan – have been well debated by colleagues in this room.

It offers significant opportunities not just to boost overall numbers, but to better use the full skills mix and deliver training and career progression in completely different ways.

And there are other opportunities – such as the rapid developments in AI – that are exciting and fast-moving and generating much interest.

One example of the work we’re doing with AI in the department is how we can use AI to improve patient safety in maternity services.

And we’re also working closely with the life science industry to enable both population-level treatments and more bespoke and targeted medicine.

And this is reflected in our recent deals agreed with Moderna and BioNTech, Lord O’Shaughnessy’s review to speed up and expand the adoption of clinical research trials we launched last month.

And indeed the Chancellor’s citing of Life Sciences as one of his key growth sectors.

The NHS has changed massively over the last 75 years, all while remaining true to its founding principles.

Covid showed that we can deliver change very rapidly when it matters and that trust in local systems to make decisions allows them the freedom to better adopt innovation.

It is the culture of innovation which gives us a strong foundation for the next 75 years.

In closing, I want to reinforce my message today on the importance of trusting integrated care systems more.

What that means for you is:

• Greater freedom
• Fewer targets from the centre
• More meaningful transparency on performance

That is the approach I am taking as we work with you on our shared challenge of making it easier for patients to access the care they need.

Thank you.

The speech made by Steve Barclay, the Secretary of State for Health and Social Care, to the Association of the British Pharmaceutical Industry annual conference held on 27 April 2023.

Well thank you, Richard [Torbett] – good afternoon, it’s great to be able to join you.

As you’ve just been touching on some of my past roles, it’s over five years since I was last in the Department of Health working then as a Minister of State.

And in those five years, we’ve seen game-changing breakthroughs in science and technology.

We’ve seen a once-in-a-generation pandemic.

We’ve seen Britain depart, as you’ve just mentioned, from the European Union.

And we’ve also seen the full consequences of the pandemic itself.

And those factors have come together to shape a landscape that is very different today, than it was five years ago in 2018.

The application of AI into almost every aspect of our lives might be receiving lots of attention today, particularly with things such as ChatGPT.

But the potential of AI in life science is something we in this room have long been alive to, from detecting cancers to scanning potential transplant organs.

Equally, pharmaceutical breakthroughs and their rapid deployment through the NHS have been turning the tide on diseases like HIV and Hep-C, and helping to bring us to a point where we can realistically talk about elimination – something which 10 years ago would have been unimaginable.

Next, the pandemic has ushered in some powerful new ways of working. The Vaccines Taskforce brought many of us in government to working very closely with industry and academia in ways that we had not done before.

And in its simplest terms we learned a lot about how to make things happen at pace.

And it offers much promise for breakthroughs in some other areas dealing with health challenges that we face in the months and years ahead.

And the third big shift is that the UK left the European Union, just as the pandemic began to take hold across Europe.

And as Brexit Secretary leading our exit at that time, I recognised that in taking control of our rules and regulations we have a chance to show global leadership in important areas including life science.

Now, with your help and support, we are doing just that. Building a more bespoke regulatory system that’s ready for the innovations of today but is also building the agility to respond quickly to the innovations of tomorrow.

Now the question we’ve been trying to answer today, in the sessions I’ve been hearing that you’ve been having is how do we seize those opportunities?

And I know you heard from some of my colleagues, from June Raine and Ros Campion earlier, on ‘How we build on the UK’s global strengths’. And we’ve heard about the Medicine and Healthcare products Regulatory Agency’s (MHRA) laser-like focus on ‘process, partnerships and people’.

And this afternoon, I want to add some of my own thoughts on how we seize the opportunities that are in front of us.

The first way is with an unashamedly pro-innovation approach to regulation.

Now the theme of today’s conference is ‘Growing the UK as a Global Hub for Life Sciences’ and we have the largest life sciences sector in Europe.

And the benefits of that to the UK economy are vast, not just from the jobs created, but from the transformative change it offers for the NHS. A key priority is to ensure that great science is then fast-tracked into the very bloodstream of our NHS.

And that is why in the Budget, we announced an extra £10 million of funding for MHRA, so they can put in place a quicker, simpler, regulatory process for all approvals for innovative treatments, without compromising, in any way, patient safety. And that is building on the ever-closer working relationship that the MHRA and NICE have developed through the ILAP pathway.

Now we aim to develop the most effective regulatory approvals process of anywhere in the world. And we are fortunate to have the MHRA – one of the most respected drug regulators globally – and, of course, the first to license a vaccine for Covid.

From next year, the MHRA will set up a swift new approval process for the most cutting-edge medicines and devices to grow the UK’s role as a global hub for their development. And at the same time, from next year, they will allow the near-automatic sign-off for medicines and technologies already approved by trusted regulators in other parts of the world such as the United States, Europe, and Japan.

And the real value is that near-automatic recognition of other regulators in some areas, such as license extensions, will in turn free up valuable regulatory resource to focus on other cutting-edge areas, like AI in medical devices.

And this kind of smart regulation – made possible by the greater agility brought by our Brexit freedoms – meets our twin goals: Growing the UK as a global life sciences hub, while ensuring patients in the NHS have access to some of the most innovative medicines and treatments that can be found anywhere in the world.

Now many of you will be aware that this coming change was an interim recommendation from the report into Life Sciences regulations, which is going to be published next month. And I want to put on record, Richard, my thanks to everyone who played their part in that important piece of work.

Not least the ABPI, who have been so keenly engaged, including how you worked with the independent champions.

I’m looking forward to hearing further recommendations and the benefits they can bring to the sector and patients alike.

Now today, I also want to briefly comment on VPAS. The government and the pharmaceutical industry came together to negotiate a voluntary agreement, which has endured for many decades and created a stable basis for investment, access, and uptake. And it has done so while saving the NHS billions of pounds – which in turn has been reinvested into patient care.

The negotiations for a successor agreement will begin soon and I very much welcome the appointment of Sir Hugh Taylor, who brings vast experience in this area, and I hope assures Richard, colleagues, as to the seriousness with which we are taking these negotiations.

And you heard a little earlier from the Prime Minister, which I hope further underscores our desire to deliver a successor to VPAS – which needs to be a deal that is good for patients, good for the NHS, and good for you too.

The core value that sits at the heart of all of this – whether it’s innovative regulation or VPAS – is that the government is a committed partner.

And we are guided by our Life Sciences Vision, which sets out our ten-year plan for the sector, including seven missions for all of us – government, industry, the NHS, academia, medical research charities and others – to solve together.

And together, our work on everything from cancer to dementia, cardiovascular disease to mental health will not only support the NHS but it will help the wider economy by improving productivity and life expectancy.

Now we’ve already been putting this into practice.

In January we signed a memorandum of understanding with BioNTech to bring innovative vaccine technology to this country, with the potential to transform outcomes for cancer patients. The partnership means that, from as early as this September our patients will be amongst the first to participate in trials and tests to provide targeted, personalised and precision treatments. And that will use transformative new therapies to both treat existing cancers – and to help stop them from returning.

That deal builds on the 10-year partnership we struck with Moderna in December to invest in the mRNA research and development in the UK and establish a state-of-the-art vaccine manufacturing centre here.

We want to partner with those who share our commitment to scientific advancement, innovation, and cutting-edge technology.

We’re the third biggest investor of government funding into health R&D as a proportion of GDP in the world and we’re upholding our promise to increase research and development spending to £20 billion a year. And that is at a time when there are many competing challenges for the Chancellor to meet.

It’s not just something I’m proud of for its own sake, but something I’m determined we use to its full potential, so we can transform people’s lives and opportunities both here and abroad.

And if there’s one message I want you to take from my speech today it’s this: we need companies – including a great many represented by you in this room today – to invest in UK clinical trials.

I know there are challenges, and we are listening, not least on how we can support those consultant clinical academics who drive medical breakthroughs.

It is why we have commissioned James O’Shaughnessy to conduct an independent review of the UK commercial clinical trials landscape.

And James has been kind enough to share some of his early findings and we will formally respond in the coming weeks.

And I know you’ve also heard from June Raine earlier about the MHRA’s work to simplify requirements and remove barriers.

There’s a lot of potential around clinical research and the changes ahead can bring a huge number of wins.

Wins for patients – who will get access to the latest innovative medicines that will become the Standard of Care in years to come.

Wins for the NHS – not just to boost to their income, but also because we know that hospitals that are active in research have better outcomes.

And wins for industry – who can work with a single NHS – from leading institutions and hospitals to primary care.

Because, with its unrivalled scale, breadth and potential, the NHS should be the research partner like no other on Earth. But I recognise that, for those of you in the room, that has too often not been the case.

Notwithstanding the need for change, clinical research in the NHS has already been responsible for some of the UK’s biggest successes – like the RECOVERY trial. And since Covid, public engagement in health research is at an all-time high.

But I want that to go further – so we’ll build in a clinical research environment that is people-centred, that is digitally enabled, and all embedded within the NHS.

And you can see that coming to life through initiatives like the NIHR’s ‘Be Part of Research’ which makes it even easier for people in England to find and register their interest in suitable research opportunities – including through the NHS App that we are developing at pace.

Seizing these opportunities on clinical trials will not only leave patients and the NHS stronger but give us a much more joined up life sciences sector and a more dynamic economy too.

So, we have a coming together of giant technological leaps:

Innovative new ways of working from the pandemic.

A post-Brexit regulatory environment that offers the agility to design a more bespoke and effective environment.

And a new way forward for clinical trials through implementing the James O’Shaughnessy review.

Taken together, it means the UK is well-placed to seize these opportunities – working in partnership with the talent we have within the Department of Health and its arm’s length bodies, with our fantastic NHS – including frontline medical staff, and in partnership with you on behalf of the industries that you represent.

I look forward to working with you Richard, to colleagues in the room, to achieve that shared common goal. Thank you very much.

The statement made by Steve Barclay, the Secretary of State for Health and Social Care, in the House of Commons on 17 April 2023.

I am grateful to the hon. Gentleman for his question. On its first part, we will not have firm figures on the number of patient appointments postponed until later today, because the NHS guidance has been to allow trusts a full working day to collate the data on those impacts. We do know from the previous three-day strike that 175,000 hospital appointments were disrupted and 28,000 staff were off. There is an initial estimate that 285,000 appointments and procedures would be rescheduled, but it is premature to set out the full impact of the junior doctors’ strike before we have that data. I am happy to commit to providing an update for the House in a written statement tomorrow. In the coming days, I will also update the House on the very significant progress that has been made on the successful action taken over recent months to clear significant numbers of 78-week waits, which resulted from the covid pandemic.

It is regrettable that the British Medical Association junior doctors committee chose the period immediately after Easter in order to cause maximum disruption, extending its strike to 96 hours and asking its members not to inform hospitals as to whether they intended to strike, thus making contingency planning much more difficult. Let me put on record my huge thanks to all those NHS staff, including nurses and consultants, who stepped up to provide cover for patients last week.

I recognise that there are significant pressures on junior doctors, both from the period of the pandemic and from dealing with the backlogs that that has caused. I do want to see a deal that increases junior doctors’ pay and fixes many of the non-pay frustrations that they articulate. But the junior doctors committee co-chairs have still not indicated that they will move substantially from their 35% pay demand, which is not affordable and indeed is not supported by those on the Opposition Front Bench.

Let me turn to the second part of the hon. Gentleman’s question and the steps we are taking to prevent further strike action in the NHS. We have negotiated a deal with the NHS Staff Council; it is an offer we arrived at together, through constructive and meaningful negotiations. It is one on which people are still voting, with a decision of the NHS Staff Council due on 2 May. The largest union, Unison, has voted in favour of it, by a margin of 74% in favour. So we have agreed a process with the trade unions, which I am keen to respect, and we should now allow the other trade unions to complete their ballot, ahead of that NHS Staff Council meeting on 2 May.

Wes Streeting

Thank you, Mr Speaker, for granting this urgent question.

Finally, the invisible man appears; the Secretary of State was largely absent last week during the most disruptive strikes in NHS history. He was almost as invisible as the Prime Minister, who previously said he does not want to “get in the middle” of these disputes—what an abdication of leadership during a national crisis. An estimated 350,000 patients had appointments and operations cancelled last week—that is in addition to the hundreds of thousands already affected by previous rounds of action. Having failed to prevent nurses and ambulance workers from striking, the Government are repeating the same mistakes all over again by refusing talks with junior doctors. Patients cannot afford to lose more days to strikes. The NHS cannot afford more days lost to strike. Staff cannot afford more days lost to strikes. Is it not time for the Secretary of State to swallow his pride, admit that he has failed and bring in ACAS to mediate an end to the junior doctors’ strike?

Last week also saw the Royal College of Nursing announce new strike dates with no derogations and a new ballot. What does the Secretary of State plan to do to avert the evident risks to patient safety? Government sources briefed yesterday that they are prepared to “tough it out”. That is easy for them to say. Will the Secretary of State look cancer patients in the eye, while they wait for life-saving treatment, and tell them to tough it out, as they are the ones who will pay the price for his failed approach?

Finally, writing in The Sun on Sunday, the Secretary of State said that he is worried about patient safety, but he offered no plan to get this matter resolved. He is not a commentator; he is nominally the Secretary of State for Health and Social Care with the power and responsibility to put an end to these strikes. When will he put his toys back in the pram, stop blaming NHS staff, sit down with junior doctors and negotiate a fair resolution to this terrible, damaging and unprecedented dispute?

Steve Barclay

The shadow Secretary of State seems to ignore the fact that we have negotiated a deal with the NHS Staff Council, and it is a deal that it has recommended to its members. Indeed, the largest health union has voted in favour of the deal—indeed it is his own health union that has voted in favour of it—and yet he seems to suggest that we should tear it up even though other trade unions are voting on the offer, and their leadership had recommended it.

Secondly, the shadow Secretary of State says that we should sit down and negotiate. We have made an offer of 10.75% for last year, compared with the Labour Government in Wales, who have offered just 7.75%, which means that, in cash terms, the offer in England is higher than that put on the table by the Welsh Government, whom, I presume, he supports. He says that he does not support the junior doctors in their ask of 35%, and neither does the leadership there. We need to see meaningful movement from the junior doctors, but I recognise that they have been under significant pay and workforce pressures, which is why we want to sit down with them.

The bottom line is that the deal on the table is reasonable and fair. It means that just over £5,000 across last year and this year will be paid for a nurse at the top of band 5. The RCN recommended the deal to its members, but the deal was rejected by just under a third of its overall membership. It is hugely disappointing that the RCN has chosen not to wait for the other trade unions to complete their ballot and not to wait for the NHS Staff Council, of which it is a member, to meet to give its view on the deal. It has chosen to pre-empt all that not only with the strikes that come before that decision of the NHS Staff Council, but by removing the derogations—the exemptions—that apply to key care, including emergency care, which is a risk to patient safety.

Trade unions are continuing to vote on the deal. The deal on the table is both fair and reasonable, including just over £5,000 across last year and this year for nurses at the top of band 5. The deal has been accepted by the largest union in the NHS, including, as I have said, the shadow Health Secretary’s own trade union. It pays more in cash to Agenda for Change members than the deal on the table from the Labour Government in Wales. It is a deal that the majority of the NHS Staff Council, including the RCN’s own leadership, recommended to its members. We have always worked in good faith to end the disruption that these strikes have caused and we will continue to do so. None the less, it is right to respect the agreement that we have reached with the NHS Staff Council and to await its decision, which is due in the coming weeks.

The letter sent by Steve Barclay, the Secretary of State for Health and Social Care, to the General Secretary of the Royal College of Nursing on 16 April 2023.

Dear Pat,

Thank you for your letter of 14 April.

The offer that we arrived at together through negotiations in March, and which as the General Secretary of the Royal College of Nursing you recommended to your members, is a fair and reasonable settlement that acknowledges the dedication of NHS staff.

It would mean that a nurse at the top of Band 5 would get over £5,000 in extra pay across last year and this year – including over £2,000 in bonus payments arriving as a lump sum in pay cheques by the summer.

After you recommended the deal be accepted, I am disappointed that given the turnout, a rejection from less than half of your members was sufficient for a narrow rejection overall.

This offer was of course negotiated with and put to all Agenda for Change trade unions. Unison’s members decisively accepted it on Friday, and other unions are yet to conclude their consultations. I hope that this fair and reasonable offer will secure their members’ support, and I will therefore await the collective outcome and extraordinary Staff Council meeting that will follow. As you know from when you and your colleagues negotiated this offer, the lump sum payments for 2022/23 are payable if the NHS Staff Council ratifies this offer.

Given that you supported the offer we reached together, and that your ballot saw a very narrow result, I am also both disappointed and concerned that the Royal College of Nursing has chosen to announce 48 hours of continuous strike action without consultation of other Staff Council unions or waiting for the full Staff Council consultation to complete. The decision to refuse at this stage any exemptions for even the most urgent and life-threatening treatment during this action will, I fear, put patients at risk.

We have so far worked together constructively, and I hope this can continue. The strike action you have called will cause significant disruption at a time when the NHS is already under extreme pressure. I urge you to reconsider your planned strike on 30 April – 2 May and, like the remainder of the Agenda for Change unions, wait until the collective outcome of the extraordinary Staff Council meeting.

I would therefore welcome a meeting with you to discuss how we can avoid this escalatory action – recognising that the offer we negotiated with you and other unions stands, and I hope to see it implemented in the interests of all Agenda for Change staff once other consultations conclude.

Yours ever,

RT HON STEVE BARCLAY MP