Category: Health

Dan Poulter – 2023 Speech on the Draft Mental Health Bill 2022

The speech made by Dan Poulter, the Conservative MP for Central Suffolk and North Ipswich, in the House of Commons on 26 January 2023.

I first draw the House’s attention to my entry in the Register of Members’ Financial Interests as a practising NHS psychiatrist.

The Joint Committee on the Draft Mental Health Bill was formed on 4 July 2022 to scrutinise this important and urgently needed reform of mental health legislation. Our Committee has been working hard since that date. We held 21 meetings in just over 12 sitting weeks, spoke with more than 50 witnesses, received more than 100 submissions of written evidence, and engaged with affected communities through surveys, roundtables and a visit to the mental health unit at Lambeth Hospital. We are grateful to everyone who took time to contribute to our inquiry, to the officials and Ministers at the Department of Health and Social Care for their engagement with our work, and to our specialist advisers and secretariat.

Working on the Joint Committee was a collaborative process as we worked together through this complex topic and learned from each other’s expertise. There were differences of opinion, which may be reflected in later debates in this place. However, the fact that we felt it important to agree the report unanimously is testament to the Committee’s dedication to getting this once-in-a-generation piece of legislation on to the statute book. Our work was supported by an excellent team of officials and Clerks from both Houses. The Committee is grateful for their expertise and support in our work and in compiling the report.

The Mental Health Bill has been much anticipated. Detention rates under the Mental Health Act are rising. A disproportionate number of people from black and ethnic minority communities are detained. Our attitude as a society towards mental health has changed and reform is needed. We welcome the principles contained in the draft Bill, which introduces important reforms to improve patient choice, bring down detentions and reduce racial inequality. In our inquiry we heard concerns about implementation, resourcing and possible unintended consequences of the proposed legislation. Our recommendations address those concerns and are intended to make this important Bill stronger and more workable.

However, the process of mental health reform cannot stop or even pause with this Bill; there needs to be further consideration of fusion legislation of the mental health and mental capacity laws. During our evidence it became apparent that someone needs to drive mental health reform on behalf of patients, families and carers. We have recommended the creation of a mental health commissioner to oversee that process and to challenge the stigma that still exists around serious and enduring mental illness.

Proper resourcing and implementation will be crucial for the changes to work. Mental health services are under enormous pressure, and significant changes and improvements are needed to provide high-quality community alternatives to in-patient care, particularly ensuring that there will be a sufficient workforce to deliver the proposed changes. We welcome commitments from the Government to increase spending on health and social care, but most people we spoke to, including mental health providers, were still unconvinced that current resourcing or workforce plans are adequate. The Government must publish a detailed plan for resourcing and implementation on introducing the Bill, including the implications for the workforce. They should report annually to Parliament on their progress against that plan.

The independent review structured its work around four key principles that should shape care and treatment under the Mental Health Act. Those principles were: choice and autonomy, least restriction, therapeutic benefit and the person as an individual. These principles should be included in the Bill to ensure that they endure and become a driver of cultural change.

Tackling racial inequalities in the use of the Mental Health Act must be at the core of the reform. Black people are four times more likely to be detained under the Mental Health Act than white people, and 11 times more likely to be given a community treatment order. Those figures are rising. There has been a collective failure to address this issue. We now feel that the time has come for that to be addressed. Understanding of racial inequality must be included in the Bill. There must be a responsible person in every health organisation to monitor data on inequalities and oversee policies for change. We heard evidence that community treatment orders are ineffective for most patients and disproportionately used for black patients. We have therefore recommended that they are abolished for civil patients and reviewed for use with forensic patients.

On the important issue of the detention criteria, the draft Bill makes changes to the grounds on which someone can be detained for assessment and treatment, with the intention of moving away from a risk-based model and ensuring that detention will benefit the patient. Accountability is welcome, but we heard that it may lead to people being denied the help they need when they most need it, particularly patients with psychotic illnesses and those with chronic and enduring mental illness. We recommend some changes to the criteria and greater guidance in the code of practice to prevent that.

Too many autistic people and those with learning disabilities are detained in inappropriate mental health facilities, and for too long. Change to the way the Mental Health Act works for patients with learning disabilities and autism is long overdue. The Government’s intention to address that, by removing learning disabilities and autism as conditions that can justify long-term detention under section 3 of the Mental Health Act, may lead to benefits in the longer term. However, we heard that without proper implementation, those changes could make the situation worse, and potential displacement of people with learning disabilities into the criminal justice system could occur. There must be improvements in community care before people with learning disabilities and autistic people can be supported to live in the community. It is vital that reforms are not implemented until that is achieved.

Another pressing risk is that those communities may be detained, instead, under different legal powers, and possibly criminalised. That would be the opposite of what the change is intended to achieve. The Government must address that risk before the changes are implemented. We have therefore recommended the introduction of a tightly defined power to allow for longer detention periods in exceptional circumstances, with strong safeguards in place to prevent that happening unnecessarily.

On patient choice, patients should be able to make choices about their care and treatment. The draft Bill makes welcome changes in this area but does not follow through on a White Paper commitment to give patients statutory rights to request an advance choice document. We heard almost unanimous evidence supporting an advance choices document, and made a recommendation that advance choices should be a statutory right.

The number of children and young people experiencing mental distress has risen dramatically since the covid-19 pandemic. Children and young people continue to be placed in adult wards or in hospitals far from home due to the lack of appropriate care placements. The draft Bill misses a crucial opportunity to address that. We also believe that children should benefit from stronger protections in the draft Bill to support patient choice. This is a complex area and the Government need to carefully think through their proposals, consulting further where necessary about this Bill and how it will interact with the Children Act 2004.

In conclusion, it is 40 years since the Mental Health Act 1983. This draft Bill is needed. If the Government are willing to address our concerns in the ways that we have suggested, the Bill can make an important contribution to the modernisation of mental health legislation. Given our suggested amendments, we hope that the Government act swiftly to introduce the Bill to Parliament in this Session, so that it can be further scrutinised and improved.

Dr Rosena Allin-Khan (Tooting) (Lab)

I thank all those patients, campaigners and experts who provided evidence to the Joint Committee. I give special thanks to Alexis Quinn, whose account of her own lived experience with autism touched many Committee members. I also thank the Committee members for what was an incredibly valuable experience and a true example of when cross-party working goes really well.

I am honoured to have worked on a once-in-a-generation opportunity to improve the rights of patients experiencing a mental health crisis, and to tackle the health inequalities enshrined in current legislation. For years the Government kicked updating this legislation into the long grass, and now the draft Bill still does not go far enough to tackle the health inequalities and racial disparities of those detained under the Mental Health Act. I hope the hon. Member for Central Suffolk and North Ipswich (Dr Poulter) will agree that the Government should put patient voices at the heart of this legislation and take the Joint Committee’s recommendations on board.

Dr Poulter

On behalf of the Committee, I thank the hon. Lady for all her work. We were lucky that we had her professional expertise as a frontline clinician, which added to our important scrutiny work. Given that it has been 40 years since there were any changes to the Mental Health Act, I certainly agree that the time has come to make those changes through a Bill. We urge the Government to take on board our well-intentioned recommendations and concerns to strengthen the Bill, and I hope we will continue to see a cross-party, collaborative process to improve mental health care for the patients who most need it.

The Minister of State, Department of Health and Social Care (Will Quince)

I sincerely thank my hon. Friend and the Committee for all the work that has been put into this constructive and important report, and I also thank all those who gave evidence to the Committee. The Government are now considering the Committee’s recommendations on how we can further improve the Bill and modernise the Mental Health Act. The Minister for mental health, my hon. Friend the Member for Lewes (Maria Caulfield), gave evidence to the Committee in November, alongside the Minister for prisons, parole and probation, my right hon. Friend the Member for East Hampshire (Damian Hinds).

I am grateful to see that the final report reflects the support that these reforms have on both sides of the House. The Committee has clearly engaged fully with the complexities involved in this work. It is the Government’s intention to take the next steps in getting this legislation right, so that people with severe mental health needs get the help and support when they need it, with their rights and dignity better respected. It is vital that we continue to progress the work we have started with NHS England and others to address the racial disparities that have for too long been associated with the use of the Act. Does my hon. Friend agree that the reforms proposed in the Mental Health Bill provide for an improved framework in which people experiencing the most serious mental health conditions will have far more choice and influence over their treatment?

Dr Poulter

I agree with the Minister. He is right to suggest that this is an important step forward and this piece of legislation will make a significant difference to patients, but it is part of a process, not the end of the journey. In particular, I draw the Government’s attention to the potential unintended consequences of some of the well-meaning changes being proposed in relation to patients with learning disabilities and autism and to changing the grounds for detention; for example, it might be harder to detain patients who are the most unwell, with chronic and enduring mental illness and psychotic conditions. I hope the Government will take on board those concerns and ensure that what comes back to this place is a stronger Bill that works in the best interests of patients.

Fleur Anderson (Putney) (Lab)

I welcome this report, and in particular the section on racial inequalities, which have been highlighted in my constituency by organisations such as the Wandsworth Community Empowerment Network for many years. Is the hon. Member optimistic after hearing all the evidence from organisations that the inequalities affecting black and minority ethnic groups, especially in terms of culture and policy, will be improved?

Dr Poulter

I am optimistic that if the Government adopt the recommendations we have made, we will have a much stronger Bill that recognises that we need to improve the care that is available to all patients and, in particular, that will deal with some of the racial disparities we currently see in the implementation of the Mental Health Act. We know that black people—particularly black men—are disproportionately detained under the Mental Health Act and are disproportionately likely to receive a community treatment order, or a CTO, as I would term it in professional jargon. There is also a disproportionate use of depot medication for black men. That has caused challenges in building therapeutic relationships and building trust with black communities across London and elsewhere, and it has to be put right.

We have made several recommendations. For example, we believe that the evidence for CTOs is weak for all patients, and there is a disproportionate use of CTOs among the black community, so we have said that we think community treatment orders should not be applied in the civil part of the Bill. We have also recommended greater monitoring of how mental health legislation is used in each mental health provider, to ensure that providers, be they in London or elsewhere, have a proper understanding of how mental health legislation is used. Hopefully, that will start the process of rebuilding the trust of communities—particularly the black community—with mental health providers where it has been lost in the past.

Dr Ben Spencer (Runnymede and Weybridge) (Con)

I draw the House’s attention to my range of interests in this area, which were declared as part of the Committee’s report. I thank my hon. Friend for his statement and join him in thanking all those involved in the Committee, in particular the Clerks and the staff, who were fantastic in supporting us as we put this report together.

Every 20 years or so, we go through a process of reviewing our mental health legislation. I am delighted at the work that has been done over the past few years through the Wessely review panel and driven by the Government, to make real changes in this very important area of law. Notwithstanding the huge step forward that the Bill will hopefully make in this area, does my hon. Friend agree that this is the beginning of a journey of continuous reform, rather than the end point?

Dr Poulter

The Committee was very lucky that we had the professional expertise of my hon. Friend, the hon. Member for Tooting (Dr Allin-Khan), a former president of the Royal College of Psychiatrists and some distinguished lawyers. I know that my hon. Friend has taken a great interest in this issue for many years, and he is right: this is the beginning of a process, not an end in itself. The Committee recognised that much needed to be done by a future Government to bring fusion between mental capacity law and mental health law, of which I know he was a great advocate throughout our work.

Jim Shannon (Strangford) (DUP)

I thank the Committee for its recommendations and the hon. Gentleman for his presentation of this report. Each and every one of us recognises the importance of these recommendations, which are for both patients and staff, and they should be commended to all the devolved Administrations—in particular the Northern Ireland Assembly, as health is devolved. Will that happen, and if not, could he make sure that it does?

Dr Poulter

I thank the hon. Member for his question. As part of our work, we looked at elements of reform that are being considered across the devolved Administrations. The fusion of mental health law and mental capacity law is already well under way in Northern Ireland, so it may be a question of the UK Parliament learning from the Northern Ireland Assembly, rather than the other way round. We in this place will continue to watch with interest how the proposed changes to legislation in Northern Ireland progress, as they may improve what we do when we look in the future, I hope, at a fusion of mental health law and mental capacity law.

January 29, 2023
Wes Streeting – 2023 Parliamentary Question on Charging for Access to NHS

The parliamentary question asked by Wes Streeting, the Shadow Secretary of State for Health and Social Care, in the House of Commons on 24 January 2023.

Wes Streeting (Ilford North) (Lab)

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 one of the Secretary of State’s predecessors has urged him to charge for A&E visits, will he take this opportunity to rule out any extension to user charging in the NHS?

Steve Barclay

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. That is the Prime Minister’s position and the Government’s position.

Wes Streeting

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 Back Benchers 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?

Steve Barclay

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. The hon. Member for York Central (Rachael Maskell), who spoke earlier, contradicted his point. Not only have the hon. Gentleman’s Front-Bench colleagues contradicted it; even the deputy chair of the British Medical Association has said that Labour’s plan would create higher demand and longer waiting times. I am not surprised that the hon. Gentleman does not want to talk about his own plans anymore; that is why he has taken to distorting ours.

January 25, 2023
Sarah Atherton – 2023 Parliamentary Question on a New Hospital for Wrexham

The parliamentary question asked by Sarah Atherton, the Conservative MP for Wrexham, in the House of Commons on 24 January 2023.

Sarah Atherton (Wrexham) (Con)

Wrexham Maelor Hospital was built in 1934 and is no longer fit for purpose. It has been divided and sub-divided with modular add-ons. It is a labyrinth of rooms, ageing departments and corridors. I trained there as a nurse in 1990 and returned during covid, and there has been little improvement. It is no longer fit for a new city. Healthcare is devolved in Wales. The Welsh Labour Government have received the largest funding settlement since devolution began, so will the Minister agree that Welsh Labour needs to listen to the people of Wrexham and build us a new hospital?

Steve Barclay

My hon. Friend makes an extremely powerful point. I hope the Labour-run NHS in Wales takes heed of her comments. She brings professional experience to this issue and is absolutely right that there needs to be investment in the NHS estate in Wales.

January 25, 2023
Toby Perkins – 2023 Parliamentary Question on GP Appointments in Chesterfield, Derbyshire and England

The parliamentary question asked by Toby Perkins, the Labour MP for Chesterfield, in the House of Commons on 24 January 2023.

Mr Toby Perkins (Chesterfield) (Lab)

If he will make an assessment of the adequacy of GP appointment availability in (a) Chesterfield constituency, (b) Derbyshire and (c) England.

The Parliamentary Under-Secretary of State for Health and Social Care (Neil O’Brien)

In November, there were 13.9% more appointments in general practice across England as a whole than in the same month before the pandemic. In Derby and Derbyshire, there were 16.6% more appointments. 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.

Mr Perkins

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?

Neil O’Brien

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 IMD—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.

Maggie Throup (Erewash) (Con)

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

That is an excellent question. As well as having an extra 495 staff across Derby and Derbyshire, it is crucial that we use them effectively by having good triage. That is why 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.

January 25, 2023
Paul Bristow – 2023 Parliamentary Question on the Covid-19 backlog in Elective Care

The parliamentary question asked by Paul Bristow, the Conservative MP for Peterborough, in the House of Commons on 24 January 2023.

Paul Bristow (Peterborough) (Con)

What recent progress he has made on tackling the covid-19 backlog in elective care.

The Minister of State, Department of Health and Social Care (Will Quince)

Since the publication of the elective recovery delivery plan, the NHS has virtually eliminated two-year waits for treatments and is making progress on tackling the next ambition of ending waits of over 18 months by April. To support those efforts, NHS England recently wrote to providers mandating action on 18-month waits. We agreed that appointments must be scheduled as soon as possible to enable that target to be met.

Paul Bristow

The people of Peterborough are looking forward to their new NHS community diagnostic centre supplying an extra 67,000 tests, scans and checks each and every year, but that will shine a light on the need to power through our covid elective backlog. At the Royal Free Hospital, many cases that were previously treated as elective overnight stays are now treated as day cases, improving patient experience and increasing capacity. How will the Minister ensure that such innovation is spread across the NHS?

Will Quince

My hon. Friend is absolutely right to raise this issue, and to highlight the difference being made by the 89 community diagnostic centres that have already been rolled out and the importance of getting up to 160 centres as quickly as possible. He is right that such innovations, including CDCs, surgical hubs, telemedicine and, of course, using spare capacity in the private sector, are helping us to tackle the longest waits and reduce the covid backlogs, and I very much thank him for his support in that endeavour.

Stephanie Peacock (Barnsley East) (Lab)

There are almost 20,000 people on the waiting list for treatment at Barnsley Hospital, but at the beginning of this month, 98% of the hospital’s beds were occupied. How does the Government expect that hospital to solve the treatment backlog when it simply does not have the resources?

Will Quince

We are increasing capacity by introducing an additional 7,000 beds and the £500-million discharge fund. In addition to that, an extra £250 million was announced in January. Over and above that, alternative capacity is being created through the independent sector, we are engaging with patients on choice, and we are working with the most challenged trusts. Of course, I understand the impact that this has on patients, and we are working hard to address the backlog.

Mr Speaker

I call the shadow Minister.

Liz Kendall (Leicester West) (Lab)

Ministers will never deal with the record waits for NHS treatment until they stop older people being stuck in hospital because they cannot get decent social care in the community or at home. Does the Minister understand that this is not just about getting people out of hospital, but about preventing them from being there in the first place? Is he aware that more than half a million people now require social care but have not even had their needs assessed or reviewed? Where on earth is the Government’s plan to deal with this crisis, which is bad for older people, bad for the patients waiting for operations and bad for taxpayers?

Will Quince

As I said, we are creating 7,000 additional general and acute beds. We are investing £500 million in adult social care specifically for discharge, and that goes up to £600 million next year and £1 billion the year after. There is also an extra £250 million. The hon. Lady asks specifically about adult social care. That is exactly why the Chancellor announced £7.5 billion in the autumn statement—the largest investment in social care ever.

January 25, 2023
Alison Thewliss – 2023 Parliamentary Question on the Impact on NHS Recruitment from Brexit

The parliamentary question asked by Alison Thewliss, the SNP MP for Glasgow Central, in the House of Commons on 24 January 2023.

Alison Thewliss (Glasgow Central) (SNP)

What recent assessment he has made of the potential impact of the UK’s departure from the EU on recruitment in the health and social care sector.

David Linden (Glasgow East) (SNP)

What recent assessment he has made of the potential impact of the UK’s departure from the EU on recruitment in the health and social care sector.

The Minister of State, Department of Health and Social Care (Helen Whately)

We have record numbers of staff in the NHS in England. We are on track to hit our target of 50,000 more nurses since 2019. Speaking of 50,000, there are more than 50,000 more people working in social care since 2016. We are boosting the home-grown workforce, recruiting from the EU and welcoming health and social care workers from all around the world.

Alison Thewliss

It is undeniable that EU-trained medics and social care staff face extra bureaucracy and higher costs as a direct result of Brexit, making working and staying in the UK a much less attractive option. Given the pressures on all four NHSs and the social care sector, we cannot afford to turn anybody away right now, so what discussions has the Minister had with the Scottish Government about removing the barriers that the hostile environment places on people who want to come here, work and contribute to our NHS and social care sector in Scotland?

Helen Whately

Of course the hon. Lady would like to make everything about either Brexit or the Union—or, most often, both—but the fact is that a doctor, nurse or care worker from the EU who wants to work here can do so. We are also welcoming people from the rest of the world, and there are 12,000 more staff in the NHS in England from EU and European economic area countries since the referendum.

David Linden

In the Baillieston area of my constituency, one of the biggest issues people raise with me is the difficulty in accessing GPs. Part of the problem is that we do not have enough GPs. The Royal College of General Practitioners shows that 49% of EU-trained medics experienced issues with their visas, which led 17% of them to think of leaving the UK altogether. When will the Minister grasp this issue, speak to the Home Office and get rid of the hostile environment that means many of my constituents do not get access to the GPs they need?

Helen Whately

If the hon. Gentleman had been listening to earlier questions, he would have heard about the increased number of GPs in England, with more than 2,000 more GPs now working in England. Coming to the question of the NHS in Scotland, which is of course run by the SNP-led Scottish Government, I have heard that NHS Scotland is “haemorrhaging” staff, in the words of the chair of the British Medical Association in Scotland.

Mr Speaker

I call the SNP spokesperson.

Martyn Day (Linlithgow and East Falkirk) (SNP)

With more than 4,000 fewer specialist doctors from the EU or the European Free Trade Association in the UK than in pre-EU referendum trends, there is clear evidence that shutting off free movement is a totally unnecessary barrier to recruitment for our care and health services. Have the Minister and Secretary of State made representations to the Cabinet to discuss the disastrous effects of Brexit on the UK?

Helen Whately

Yet again, an hon. Member from the SNP thinks it is all to do with Brexit, when the facts show that that is simply not the case. As I said a moment ago, 12,000 more staff from EU and EEA countries are working in the NHS in England since the referendum. However, I point the hon. Gentleman yet again towards his own party’s record in government in Scotland and the problem of the NHS in Scotland haemorrhaging staff.

January 25, 2023
Debbie Abrahams – 2023 Parliamentary Question on Excess Deaths in 2022

The parliamentary question asked by Debbie Abrahams, the Labour MP for Oldham East and Saddleworth, in the House of Commons on 24 January 2023.

Debbie Abrahams (Oldham East and Saddleworth) (Lab)

What assessment he has made of the implications for his policies of the number of excess deaths in 2022.

Alex Cunningham (Stockton North) (Lab)

What assessment he has made of the implications for his policies of the number of excess deaths in 2022.

The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)

Excess deaths data are published on the gov.uk website, which was most recently updated on 12 January. They show that causes of death from conditions such as ischemic heart disease contributed to excess deaths in England in the past year.

Debbie Abrahams

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.

Alex Cunningham

According to Cancer Research and Action on Smoking and Health, smoking costs the NHS in Stockton £9 million a year and social care £5 million a year, and it costs some £47 million in lost productivity, unemployment and premature deaths. Assuming that one day soon we will get the Government to back a control plan, will Ministers ensure that it includes the desperately needed funding for local smoking cessation services?

Maria Caulfield

Local decisions on public health are taken by local commissioning groups and local authorities, and it is for each local area to decide how it spends the money on public health.

Esther McVey (Tatton) (Con)

The chief medical officer recently warned that non-covid excess deaths are being driven in part by patients not getting statins or blood pressure medicines during the pandemic. However, when looking at the data on statins on OpenPrescribing.net, which is based on monthly NHS prescribing, there appears not to be a drop, so where is the evidence? If there is none, what is causing these excess deaths? Will the Minister commit to an urgent and thorough investigation on the matter?

Maria Caulfield

We are seeing an increase in excess deaths in this country, but we are also seeing that in Wales, in Scotland, in Northern Ireland and across Europe. There is a range of factors. As we saw, there was an increase in December in the number of people being admitted with flu, covid and other healthcare conditions. That was seen not just in this country, but across Europe.

Andrew Bridgen (North West Leicestershire) (Ind)

The Office for National Statistics has not issued mortality data by vaccination status since 31 May last year. Will the Minister confirm that her Department has collected that data for the rest of 2022 and inform the House when it will be published?

Maria Caulfield

I am happy to write to the hon. Gentleman with that information. However, I must be clear that we planned for an increase in admissions this winter. That is why we got on and delivered on our plans for 7,000 extra beds, and why we brought forward our flu and covid vaccination programme and lowered the age of eligibility. There are a number of factors, and they are the same factors that have driven excess deaths across the United Kingdom and across Europe.

Mr Speaker

I call the shadow Minister.

Andrew Gwynne (Denton and Reddish) (Lab)

There were 50,000 more deaths than we would otherwise have expected in 2022. Excluding the pandemic, that is the worst figure since 1951. The Health Secretary—part man, part ostrich—says he does not accept those figures, but as many as 500 people are dying every week waiting for essential care, and we are still getting the same old Tory denial and buck-passing. In her answer, will the Minister finally take some responsibility, accept the ONS excess deaths figure, and recognise the damage that she and her Government are doing to our NHS?

Maria Caulfield

I prefer to deal with facts rather than—[Interruption.] The BMJ has ranked the UK mid-table in Europe for mortality figures, which makes it comparable with Italy. In fact, Germany has higher excess deaths, at 15.6%, as do Finland, at 20.5%, and Poland, at 13.3%. However, if the hon. Gentleman wants to hear about what is happening in Labour-run Wales, the statistics available on the gov.wales website show that Wales, in December, had the highest number of red calls ever and that only 39.5% received a response within eight minutes—the lowest figure on record. Those are clinical reasons for excess deaths, not political ones. Perhaps the hon. Gentleman needs to recognise that fact.

January 25, 2023
Rachel Maclean – 2023 Parliamentary Question on NHS beds Available in the Alexandra Hospital in Redditch

The parliamentary question asked by Rachel Maclean, the Conservative MP for Redditch, in the House of Commons on 24 January 2023.

Rachel Maclean (Redditch) (Con)

What steps his Department is taking to increase the number of NHS beds available in the Alexandra Hospital in Redditch.

The Minister of State, Department of Health and Social Care (Helen Whately)

Right now, we are putting an extra £750 million into our health and social care system to free up beds in hospitals. Looking ahead, we will shift the dial on the decades-old problem of delayed discharge by properly planning for discharge, making more care available at home, and joining up health and social care in a way that has never been done before. That is how we are freeing up beds in hospitals such as the Alexandra in Redditch.

Rachel Maclean

I thank the Minister for that answer. In Worcestershire, we warmly welcome the £2.6 million that has been allocated as our share of the discharge fund. Will the Minister set out when my constituents who use the Alexandra will start to see these changes flowing through? What practical changes will they see and what impact will there be on waiting times and waiting lists?

Helen Whately

I thank my hon. Friend for her excellent and important question about her local share of the £750 million of extra funding for discharge this winter. I can tell her that, in Worcestershire, money is already going into extra placements in homecare, community care and care homes, and into providing practical support to help people when they get home from hospital, in partnership with the voluntary sector. I assure her that we will publish the spending plans for her area and the rest of the country shortly.

January 25, 2023
Peter Aldous – 2023 Parliamentary Question on Access to NHS Dentistry

The parliamentary question asked by Peter Aldous, the Conservative MP for Waveney, in the House of Commons on 24 January 2023.

Peter Aldous (Waveney) (Con)

What steps he is taking to improve access to NHS dentistry.

Gill Furniss (Sheffield, Brightside and Hillsborough) (Lab)

What recent assessment he has made of the adequacy of access to NHS dentistry.

The Parliamentary Under-Secretary of State for Health and Social Care (Neil O’Brien)

The Government are working to improve access. We have made initial reforms to the contract and created more unit of dental activity bands to better reflect the fair cost of work and to incentivise NHS work. We have introduced a new minimum UDA value to help sustain practices where they are low, and we are allowing dentists to deliver 110% of their UDAs for the first time to deliver more activity. Those are just the first steps; we are planning wider reforms.

Peter Aldous

On 20 October, the House passed a motion highlighting the continuing crisis in NHS dentistry and calling on the Government to report to the House in three months’ time on their progress in addressing this crisis. That time has now elapsed. I am grateful to the Minister for that update, but can he confirm that the Government will be producing a comprehensive strategy for the future of NHS dentistry, and can he inform the House when it will be published?

Neil O’Brien

It was very useful to meet my hon. Friend the other day, who is a great expert on this issue. As he knows, we are working at pace on our plans for dentistry. As well as improving the incentives to do NHS work, we are working on the workforce to make it easier for dentists to come to the UK. We laid draft secondary legislation in October to help the General Dental Council with that. We are working on our plans for a centre for dental development in Ipswich and elsewhere in the east of England, as he knows. Although we have not yet set a date to set out the next phase of our plans, my hon. Friend knows from our meeting that this is a high priority area for us and that we are working on it at pace.

Gill Furniss

I was contacted recently by my constituent Helen, who said:

“I don’t know what to do. I have phoned 25 dental practices today and been told the same thing each time: all we can do is put you on a 3 year waiting list.”

What does the Minister say to Helen and the thousands who, like her, cannot access an NHS dentist? When will he get a grip on this crisis?

Neil O’Brien

We are the first to say that the current situation is not satisfactory. That is why we invested an extra £50 million in the last quarter of last year, and it is why we are working at pace. Let us be clear: dentistry has not been right since Labour’s 2006 contract, and until we fix the fundamentals of that and the problems set up by the Opposition, we will not tackle the underlying problem.

January 25, 2023
Mohammad Yasin – 2023 Parliamentary Question on Access to GPs

The parliamentary question asked by Mohammad Yasin, the Labour MP for Bedford, in the House of Commons on 24 January 2023.

Mohammad Yasin (Bedford) (Lab)

What steps he is taking to help improve access to GPs.

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

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.

Mohammad Yasin

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?

Steve Barclay

We have literally just heard in this questions session from my hon. Friend the Member for Walsall North (Eddie Hughes) about the investment the Government are making in infrastructure across the NHS. That is why we have also, 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.

Dame Caroline Dinenage (Gosport) (Con)

Since the beginning of January, 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? Will he please meet me to discuss this issue?

Steve Barclay

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 (Kingston upon Hull West and Hessle) (Lab)

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. Of course the Labour Government will have a plan to resolve this, but in the meantime 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?

Steve Barclay

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. The hon. Lady says that Labour has a plan, but 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 (Blackpool North and Cleveleys) (Con)

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?

Steve Barclay

My hon. Friend brings welcome transparency to the issue. The Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Harborough (Neil O’Brien) was listening intently, and is nodding his head about meeting him to discuss it.

January 25, 2023