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Category: Health

  • Alan Chambers – 2022 Comments in Support of Striking Nurses

    Alan Chambers – 2022 Comments in Support of Striking Nurses

    The comments made by Alan Chambers, the Ulster Unionist Health Spokesperson, on 15 December 2022.

    I was happy to stand in support of an official Royal College of Nurses picket line at Bangor Community Hospital this morning.

    During my time there I witnessed overwhelming public support for their action. Many gifts of food and beverages were being handed to them by generous members of the public.

    None of the staff were happy that they had been forced into taking such drastic action at this time. Rather than enduring the freezing conditions on the picket line they would all rather have been in their place of work providing the high level of care for their patients that we are so aware and grateful for.

    Listening to their stories it was obvious that this strike is not just about pay but also about the conditions that they have to deal with on a daily basis. They have major concerns over patient safety in hospital emergency departments, they feel no one is listening to them and strike action is their weapon of last resort.

    Retention of the current workforce should be a major obligation on local trusts. The welfare of staff, especially our valued overseas recruits, should be paramount rather than an attitude of just get on with it.

    Ward ratio of nurses to patients is also higher than is fair to nurses who carry the responsibility if things go wrong in the daily care of patients. These are all issues that are causing concern on top of cost of living pressures.

    There is an acceptance that many of these issues can’t be fixed in the short term but NHS staff want to see a political road map created that will plot a way forward. It is a matter of huge frustration that reform of the NHS will remain stalled while the Assembly is in cold storage with no Executive in place. The nurses want to see political leadership provided as soon as possible.

    Former Health Minister Robin Swann MLA was putting many elements of that road map in place but was denied the opportunity to finish the job by the collapse of the Executive and a lack of political support from some quarters in relation to much needed reform of how NHS services are delivered.

  • Alan Milburn – 1999 Speech to the Further Education Funding Council

    Alan Milburn – 1999 Speech to the Further Education Funding Council

    The speech made by Alan Milburn, the then Chief Secretary to the Treasury, on 13 July 1999.

    Thank you for inviting me to speak at your important conference today. I hope it will see the further education sector picking up the opportunities afforded by the Private Finance Initiative. Today I want to outline to you the Government’s approach to modernising key public services like education, the part that PFI can play and the reforms we are making to PFI to give it an even bigger role.

    Modernising public services

    When we came into office two years ago, we did so on a promise to modernise our public services. That is why after running the economy well, delivering top quality public services is this Government’s most important political priority. This government believes in our public services and in those who work in them. But we also believe that our public services have to prove their worth. They have to dramatically improve their productivity, their efficiency and their performance.

    Today people rightly expect public services to be tailored to their needs, delivered efficiently and to the highest standards. They expect modern, convenient, quality services delivered in modern, convenient, quality premises. The Government wants that too. We want to shape our public services around the needs of the people who use them. We will play our part in that process. We are making record extra resources available for key services like health and education. But it is investment for a purpose. This is money for modernisation.

    The Private Finance Initiative has a key role to play in our modernisation agenda. It is a modern way of investing to produce modern public services.

    That is why the government is committed to public private partnerships in general and PFI in particular. In the past, the dogma of the right insisted that the private sector should be the owner and provider of public services. And the left insisted this was all the responsibility of the state. The modern approach to public services rejects these arguments both of the new right and the old left.

    In some areas, the private sector is best able to provide the services. In others, the public sector is in the best position. And in many cases the best way forward is through new partnerships between the public and the private sectors. Where each brings something to the table. Where we combine private sector enterprise experience with public service values. For this Government, the key test is what works.

    This is where PFI fits in. One of the main drivers behind it is to give the public sector what the private sector has long expected to be the norm – modern, well-designed purpose-built buildings that maximise savings over the whole life of the project. Better design means less wasted space, more efficient energy management, lower maintenance costs. It also means more savings that can then be reinvested in frontline services.

    This is what the PFI offers. A better deal for taxpayers and better services for the public. Since we came to office in May 1997, we have revitalised PFI so that today we can rightly say that it is a key tool in helping provide effective and good value public services. Since the election, we have signed £4 billion worth of PFI deals and we have got PFI working in sectors like health where it had not worked before. We are now seeing its benefits spread to other parts of the public services such as schools and colleges. In your own sector, further education, the 7 signed projects alone have a capital value of £37m, and there is also much PFI and PPP activity in the Higher Education and Schools sectors. By the end of this year, we estimate private sector investment in PFI projects will account for around 14% of overall public sector investment. Accompanying this turnaround has been a tremendous upsurge in confidence both in the public and private sectors that PFI can deliver the goods.

    Getting PFI to work has not been a painless process. When we came to office the PFI was in a mess. In health for example not a single major hospital deal had been signed. But £30 m had been spent on consultancy fees. Two years on – after we took the tough decision to prioritise which schemes should get the go ahead – we have set underway the biggest hospital building programme in the history of the NHS. 31 major hospital developments worth £2.9bn. Only last week, the Prime Minister announced the latest tranche of six hospitals to be built by PFI. Purpose built, well designed, high quality buildings that will enable those at the frontline of service delivery, our nurses and our doctors, to deliver better healthcare.

    Prioritisation was one of a number of major steps that we have taken to reform the PFI in order to revitalise it. Our reform programme also included ending the previous Government’s insistence on universal testing. We only use PFI where it is the right thing to do.
    We have also taken head on some of the logistical problems that bedevilled PFI in the past. As you know, one of our first actions was to appoint Malcolm Bates to review the PFI process. He did a great job in analysing problems and more importantly finding solutions. Since Malcolm reported we have fully implemented all of his recommendations.

    Following Malcolm’s recommendation we established the Treasury Taskforce to provide the public sector with much-needed private sector expertise. We have been very privileged to have Adrian Montague and his team working over the last two years to grease the cogs of PFI and get it working properly.

    All of these changes have helped instill new confidence in the ability of PFI to deliver the goods. We have acted to improve confidence too among the local staff and local communities involved with PFI deals. We have taken action to publish information about PFI deals in a way that is compatible with the needs of commercial confidentiality. PFI should not be a secret process because it is about providing better services to the public. We have published guidelines for the consultation of staff and other interested bodies. We have taken action to give a fairer deal on pensions for staff transferring between the public and private sectors as part of a PFI deal. And we have made it clear that is no longer a requirement for staff providing soft facilities management services, in hospitals for example, to have to transfer at all.
    Just a fortnight ago we also resolved the thorny issue of the accounting treatment of PFI deals. The new guidance that we published will provide a platform of certainty for PFI in the future.

    So, step by step, we have been improving and reforming the Private Finance Initiative. We want the PFI to work even better. That is why with the impending expiry of the Taskforce’s 2 year mandate this summer, we asked Sir Malcolm Bates to take a second look at the PFI and public private partnerships more generally to see how the government could further improve our approach. We have been studying his recommendations and I will be making an announcement in due course.

    In the meantime I can tell you that the PFI reform process will take another step forward tomorrow when the Treasury Taskforce launches its guidance on the Standardisation of PFI Contracts. Consultation with hundreds of interested parties has produced guidance which provides the public sector with a practical toolkit for delivering the very best value to the taxpayer. The guidance will avoid the pitfalls of the past – where the public sector, let alone those in the private sector, have had to re-invent the wheel at considerable expense every time a hospital or a college entered into a PFI arrangement. Standardised contracts will take time the effort and expense out of doing PFI deals. They will save both time and money.

    The new guidance will do something else too. It will end once and for all the argument that PFI is about mortgaging the future. Nothing could be further from the truth. PFI is about securing a better future. It does so by providing modern high quality public service facilities for staff and public alike. Assets built through the PFI already come complete with a money-back guarantee of quality through the life of the contract. Unlike conventional procurement, PFI provides a legal guarantee that facilities are maintained as new. That is one of the great advantages of PFI. Nor is it true – as some have alleged – that PFI is just a rental scheme where the public sector pays money out but gets nothing back. It is already possible for PFI contracts to specify that the asset should return to public ownership at the end of the contract.

    Now though the new guidance makes it clear that this should be the norm where it is in the public sector’s interest to do so and where there is no alternative use for the asset. In the future, where it is appropriate, ownership of assets built through the Private Finance Initiative will revert to the public sector at the end of the PFI contract. This further reform to the PFI will guarantee that the taxpayer inherits top quality fully maintained schools, hospitals and colleges capable of serving local communities for many years to come. It will give the public a lasting stake in the services they fund through the PFI.

    So our commitment to PFI – just like our commitment to our public services – remains undiminished. But both have needed substantial reform. The reforms we are making to the PFI will allow it to play a key role in helping modernise our vital public services. We have taken action to get PFI moving. We have put it on a modern and stable footing. In place of public versus private we now have public and private in partnership. We have removed the obstacles that have stood in the way of PFI delivering to its full potential.

    Now the challenge for both the public and the private sectors – now that the road is clear – is to expand the PFI. We want to see more deals done. We want to see PFI working in sectors like further education where it has not worked before. And we want to see it making an even greater contribution to producing modern public services that are shaped around the needs of the public. The challenge now is to use the PFI to drive forward the Government’s modernisation programme for our public services. We do not want to see business as usual in our public services. We want to see change for the better. The PFI is part and parcel of that change process.

    After years of neglect this Government is massively increasing investment in our public sector infrastructure. We are doubling the level of public sector capital investment. On top of that, the PFI should help lever in billions of pounds worth of extra investment.

    But it is not just extra investment that we are making. By bringing in private sector management, finance and skills, public private partnerships, such as the PFI, help to improve the efficiency and quality of public services; and they help deliver the best return for the economy as a whole from assets and enterprises currently in the public sector.

    That is why the Government is committed to developing a whole range of PPPs. We are taking forward public private partnerships for many of the remaining commercial organisations in the public sector – such as London Underground, National Air Traffic Control, British Waterways and the Commonwealth Development Corporation. The particular form the PPP takes depends upon the particular problem and the particular setting. Although each project is different they are all united by the public and private sectors working together.

    Conclusion

    In further education partnership is nothing new. Colleges work effectively with businesses throughout the country. Now there is a new opportunity for the two to work together on modernising the infrastructure of the FE sector. We want to see this Government’s commitment to further education mirrored by a new commitment from PFI partners and colleges alike to make the Private Finance Initiative as much a success story in education as it has been in health. There is huge potential here. I hope that today’s conference will help to realise it.

  • Neil O’Brien – 2022 Speech on NHS Dentistry in Salford and Eccles

    Neil O’Brien – 2022 Speech on NHS Dentistry in Salford and Eccles

    The speech made by Neil O’Brien, the Parliamentary Under-Secretary of State at the Department for Health and Social Care, in the House of Commons on 19 December 2022.

    Let me start by congratulating the hon. Member for Salford and Eccles (Rebecca Long Bailey) on securing this important debate. I share her frustration and am aware that some areas in the country face serious difficulties with access to NHS dental care. She used some powerful examples, which are exactly the kinds of things that we are trying to fix.

    As we recover from the pandemic, activity is going back up again and we want it to go up faster. Dentistry is an important part of the NHS. We are committed to addressing the challenges that NHS dentistry faces in some parts of the country. We are continuing to take important steps to improve access for patients. There are variations around the country, which was already an issue before the pandemic.

    The specific risks from covid in dentistry, for obvious reasons given the nature of the treatment—looking down people’s throats and breathing in the same air—resulted in the need to reduce the amount of care that could be delivered, in line with infection prevention and control measures to keep patients and the workforce safe. The pandemic placed further pressure on the system. However, NHS dentistry provision has been increasing gradually and safely. I am pleased to say that NHS England asked all dental practices to return to 100% of their contracted activity in July this year. Many practices are already delivering at that level and, in some cases, beyond. I will go on to talk about delivering beyond.

    To support the industry during this testing time, we took unprecedented action and provided over £1.7 billion in income protection, to ensure that NHS dentist capacity was retained and services were provided and available after the pandemic. We made an additional £50 million available for NHS dental services at the end of last year, to increase capacity in NHS dental teams. Appointments were given to those in most urgent need of dental treatment, including vulnerable groups and children. As a result of that funding, I am pleased that say that an additional 1,110 patients were seen in Salford. To support the provision of urgent care, more than 170 urgent dental care centres remain open across the country. One of those centres is in the Salford locality, as the hon. Lady knows.

    Across the nation, the system is recovering and delivery of dental care is increasing. In 2021-22, 24,272 dentists performed NHS activity—an increase of 539 on the previous year. In the 12 months to 30 June this year, 5.6 million children were seen by an NHS dentist, compared with 3.9 million children in the same period the previous year. That represents a 43% increase.

    John McDonnell (Hayes and Harlington) (Lab)

    There have been reports in a number of our constituencies of almost a dental health epidemic. Can the Minister explain whether there will be targeted resources for a number of our constituencies where there is such a high level of child dental ill health?

    Neil O’Brien

    I am exploring how we can best target the places with the most acute problems. There are problems in a lot of different places, and we are thinking about that actively at the moment. I will come back to that as I make progress.

    Jamie Stone (Caithness, Sutherland and Easter Ross) (LD) rose—

    Madam Deputy Speaker (Dame Rosie Winterton)

    Order. I gently say to the hon. Gentleman that if he wanted to intervene, he ought to have been here right at the beginning, because it is the hon. Lady’s Adjournment debate, and it is about Salford and Eccles? I leave it to him to decide whether he wishes to intervene.

    Neil O’Brien

    I am happy to take whatever interventions are appropriate.

    We know that there are still further improvements to be made. Although I am pleased that over 75% of the patients who tried to get a dental appointment over the last two years were successful, this is not back to the level that we were seeing pre-pandemic, which was 92%. That is why in July and in our plan for patients, which the hon. Lady mentioned, we announced some improvements to the 2006 contract to ensure that patient access was improved, although I want to reassure her that we do not regard those as the end of the story; they were a stepping stone.

    Those changes included: making sure that dentists were remunerated more fairly for complex work, which will improve access for patients; implementing a minimum value of £23 for each unit of dental activity, boosting incomes in the places where the UDA value is lowest; and enabling dental practices to deliver up to 110% of their contract levels, to increase activity and allow those practices that are delivering NHS care most effectively to deliver more. This effectively takes away the cap that has been in place since the 2006 contract, which the hon. Lady mentioned.

    This package will increase and improve access to dental care for patients across the country. We have already taken action to implement these changes, including through regulations that came into effect on 25 November. The changes have all been decided with careful consideration, working collaboratively with the dental sector. The Department has worked with the General Dental Council on legislative proposals that will make registration processes for dental professionals qualified outside the UK more proportionate and streamlined, making the process to join the UK workforce more efficient for dentists from overseas. These changes are another way in which we are seeking to improve access for patients.

    Finally, to make it easier for patients to find dentists taking on new patients, we have made it a requirement for NHS dentists to update their information on the NHS website, which has historically been out of date, but of course we are looking to go further to ensure that those appointments are there. These changes are just the beginning. They are the necessary first steps of our work to improve NHS dentistry. These are the measures that we can take immediately, and they will have a noticeable impact, but we will go further.

    Looking forward into the new year, we have been working with NHS England and the sector on further changes to improve access. Our priorities for this next phase of reform include: improved access to urgent care for patients who need to see someone immediately; better access to care for new patients; and further workforce and payment reform. We aim to take the necessary steps to implement these changes next year, but I am keen to seek every opportunity to take action wherever I can, and ahead of those reforms we are also actively considering what support we can offer to help patients who do not currently have access to the dental system and those who are not attached to a practice, who have the worst access. We are also considering how the recruitment and retention of dentists can be improved, particularly in the parts of the country where the need is greater. We are also thinking further about how overseas qualified dentists can be supported to start working in the NHS more quickly.

    I am strongly committed to improving our NHS dental system wherever I can for all those who need it. The hon. Lady has set out a powerful case today on why we need to go further, and we will go further. I thank her for raising this important debate, and I hope that she will be reassured that although the reforms we have made so far will make a difference, they are far from being the end of the story, and that we will continue to take action to improve access to NHS dentistry across the nation.

  • Rebecca Long-Bailey – 2022 Speech on NHS Dentistry in Salford and Eccles

    Rebecca Long-Bailey – 2022 Speech on NHS Dentistry in Salford and Eccles

    The speech made by Rebecca Long-Bailey, the Labour MP for Salford and Eccles, in the House of Commons on 19 December 2022.

    The British Dental Association states that NHS dentistry is facing an existential threat. It says that the threat predates the pandemic, when only enough dentistry for about half the population of England was commissioned. Access to NHS dental services was already very poor in many parts of the country, but access problems have now reached an unprecedented scale, with existing deep inequalities in access and outcomes set to widen. Sadly, nowhere are those access problems more acutely felt than in my constituency of Salford and Eccles. I have been receiving unprecedented levels of casework from people who simply cannot access an NHS dentist.

    One constituent works night shifts on minimum wage. She had required urgent root canal treatment for some time but could not find an NHS dentist and could not even contemplate the cost of a private dentist, so, like millions across the country, she struggled on. The problem is now so severe that her tooth is beyond saving with root canal treatment. She is having to consider having it removed, which she is told will cost her several hundred pounds. She has not got several hundred pounds. She does not know where to turn.

    Another constituent, who is also on a low income, had been trying to find an NHS dentist for over two years. They had two broken teeth and other dental issues that they could not afford to have treated privately, so they called the emergency dentist helpline. The helpline advised them to go for private treatment. Now, at only 21 years of age, my constituent cannot afford any dental treatment at all, and they fear that they will end up losing their teeth.

    Another constituent, who is registered with a disability and who works full-time for the NHS on low pay, tried as far as Rochdale and Oldham but eventually had to pay £250 for a private tooth removal that left her with little money to live on until her next pay cheque.

    To assess the severity of the situation, my office rang every single dental practice listed on the NHS website as falling within my constituency, to inquire if they were accepting new adult NHS patients. Every single one said no, and only two said that they were taking on new NHS child patients. What is worse, when I raised that very issue with the Government back in October 2021, I was informed that they had not made an assessment of the numbers of people refused NHS dental treatment, nor did they hold any waiting list data at all on access to NHS dental services in Salford or Greater Manchester. Not even to be aware of the scale of the problem is, in itself, somewhat staggering.

    As I am sure the Minister is aware, this is not just a Salford problem, but a national one. Researchers for the BBC documentary “Disappearing Dentists”, which aired in August, attempted to call every one of the dental practices in the UK that holds an NHS contract. Of the 26 dental practices with NHS contracts across Salford, 96% were not taking new adult NHS patients, and UK-wide, 90% of practices were not taking new adult NHS patients.

    I must pay full credit to the local staff and teams across Salford: all the dentists, hygienists, therapists, nurses and administrators, and the Greater Manchester integrated care partnership’s dental commissioning team. They are giving their absolute best in incredibly difficult circumstances. However, our dental services are under unprecedented strain.

    I would be grateful if the Minister addressed the following issues in his response. First, there has been chronic underfunding of NHS dental services. In real terms, net Government spend on general dental practice in England was cut by over a quarter between 2010 and 2020. It is also important to note that England invests significantly less in dental services per head of population than other parts of the UK. For example, before the pandemic Government spend on NHS dentistry per capita was £37 in England, compared with £49 in Wales, £56 in Northern Ireland and £59 in Scotland. The Minister might respond by saying that in January the Government pledged £50 million for a “dentistry treatment blitz”. However, that was a time-limited, one-off injection of funding which had very modest take-up, as practices were so overstretched in trying to hit unrealistic activity targets that they struggled to find any additional capacity. The British Dental Association estimates that it would take £1.5 billion a year just to restore dental budgets to their 2010 levels. I hope that the Minister will agree to take back a proposal to his Department for the ringfencing of long-term funding on that scale.

    Secondly, the current target-based NHS dental contract is causing serious problems in the recruitment and retention of staff. The British Dental Association says that we are facing an “exodus” of dentists from the service: 75% of dentists surveyed are thinking of reducing their NHS commitments next year alone. Central to this is not only the issue of chronic underfunding that I have already mentioned, but the current discredited target-based dental contract that was imposed on the profession in 2006 and was widely considered unsustainable and unfit for purpose even before the pandemic. Indeed, in 2010 both Labour and the Conservatives committed to amending the contract. It sets restrictions on the number of NHS patients that a dentist can see, and it punishes dentists for taking on new patients with high needs.

    The Minister may, of course, refer to a package of marginal changes that the Government introduced in November, including dentists’ updating a “find a dentist” website regularly with details of the availability of appointments, a higher reward for treating three or more teeth, and a new payment rate for complex treatment. While those are of course welcome changes, sadly there is little point in setting up a “find a dentist” website for appointments when the Government know that no appointments are actually available.

    Furthermore, the British Dental Association states that the changes will do little to arrest the exodus of dentists from the service or to address the crisis in patient access, given that they have been introduced with no additional funding. With that in mind, I would be grateful if the Minister told me when formal negotiations on fundamental long-term reform of the dental contract are due to begin.

    A constituent contacted me to express concern about the Government’s plan to go ahead with proposed changes pursuant to the recent consultation on changes to the General Dental Council’s international registration legislation despite the large number of respondents who have raised issues relating to the proposal. I hope that the Minister will take those concerns on board, and will agree to review it.

    Thirdly, let me stress to the Minister that NHS dentistry must cease to be treated as an afterthought in healthcare policymaking. Changes in primary care commissioning in the Health and Care Act 2022 must not lead to further cuts, and dental services must be represented adequately in the governance structures of the new integrated care systems.

    Let me finally point out that prevention is key, but has lost its way somewhat in recent years. The Government must undertake to build on historical commitments to prevention, in parallel with support for dental services. That must include supervised brushing in early years settings, dedicated funding for new water fluoridation schemes, and measures to reduce sugar consumption.

    I hope that the Minister has listened to the concerns I have raised and will address each point in turn, rather than reiterating previous Government responses on what they have done so far. What the Government have done so far clearly is not working. If my constituents cannot get access to an NHS dentist across Salford and Eccles, something needs to change urgently. Access to dental treatment should be a right, not a luxury.

    As I set out at the start, NHS dentistry faces an existential threat. My constituents are not receiving the access to care that they deserve. It is clear that urgent action is required. Finally, let me take this opportunity to wish you, Madam Deputy Speaker, a fantastic Christmas and a happy New Year, and the same to the Minister and all staff in the House.

  • Wes Streeting – 2022 Speech on the Supply of Strep A Treatments

    Wes Streeting – 2022 Speech on the Supply of Strep A Treatments

    The speech made by Wes Streeting, the Shadow Secretary of State for Health and Social Care, in the House of Commons on 19 December 2022.

    May I wish you, Mr Speaker, and all staff of the House a merry Christmas? I also thank the hon. Member for St Albans (Daisy Cooper) for securing this urgent question. I put on record my deepest condolences to the families of the children who have tragically passed away with strep A. The news that cases are surging has been deeply worrying for parents of children showing symptoms, and it comes at a time when the NHS is facing unprecedented pressure.

    We first heard about shortages of antibiotics to treat strep A almost two weeks ago, but when my right hon. Friend the Leader of the Opposition raised the issue with the Prime Minister, he said:

    “There are no current shortages of drugs available”.—[Official Report, 7 December 2022; Vol. 724, c. 333.]

    At the same time, parents were going from pharmacy to pharmacy to find the antibiotics their children had been prescribed, and they simply were not available. Why did the Prime Minister not know that there was a problem, when it was plain to see for parents of young people across the country? Had the Government been aware of the problem sooner, surely they could have acted to secure supplies earlier? The Minister said that there has been no shortage, just a supply chain issue. For a parent turning up to a pharmacy and finding that it does not have the antibiotics, it does not make much difference whether this is called a shortage or a supply chain issue, as the antibiotics are not there. The Government must get a grip on this situation and be honest with the public about the reality on the ground.

    In addition to the export ban, will the Minister tell the House exactly what the Government are doing to shore up supply of drugs needed to treat strep A? During the past couple of weeks, as desperate parents have been looking for antibiotics, prices have disgracefully shot up. Will the Minister assure the House that the Government will come down like a ton of bricks on any company found to be exploiting this situation by jacking up prices for medication?

    This is about access to not just medicine, but GPs and A&E. Parents concerned about symptoms are advised to seek prompt medical advice, yet about one in seven patients cannot get a GP appointment when they need one, a record 2 million patients are made to wait a month before they see a GP and A&E departments are overwhelmed. So will the Minister assure parents of children with symptoms of strep A that they will be able to see a GP when they need to? Finally, given that there are strikes planned in the NHS this week, may I ask the Minister whether the Secretary of State plans to update the House tomorrow and explain the Government’s disgraceful inaction on that issue too?

    Maria Caulfield

    Let me reassure Members that, as I said in my opening remarks, there is no shortage of antibiotics to deal with strep A. There have been pressures on supplies; there have been five to six times the amount of prescriptions that are normally issued at this time of year. Let me give the House an idea of the sorts of figures we are talking about. This season, we have seen 74 deaths across all age groups in England, with 16 of them, unfortunately, having been deaths of children under 18—the vast majority have been among the over-65s. In the 2017-18 peak, we had 355 deaths of all ages, with 27 of those being deaths of children under 18. That just gives us an idea of the scale of the difference compared with the peak of 2017-18. We have put significant measures in place to expedite that supply. Manufacturers are ramping up production lines. Deliveries to pharmacies have been happening every day, but often when the supplies arrive there they go very quickly. That is why we have issued the SSPs already, so that pharmacies can allow the different medication to be dispensed, and the alternative antibiotics are there as well. May I also put on record my thanks to GPs and A&E staff, who have seen record numbers of people, particularly children, with concerns about strep A? We did lower the threshold to prescribe antibiotics and they have gone above and beyond in seeing as many children as they can, as quickly as possible.

  • Daisy Cooper – 2022 Speech on the Supply of Strep A Treatments

    Daisy Cooper – 2022 Speech on the Supply of Strep A Treatments

    The speech made by Daisy Cooper, the Liberal Democrat MP for St. Albans, in the House of Commons on 19 December 2022.

    Across the country, parents are worried sick about the sharp rise in strep A infections. Tragically, strep A has caused the death of at least 19 children since September.

    Last Thursday, just a few days after insisting there were no shortages, the Government finally admitted that there were indeed serious shortages of three penicillin medicines and issued serious shortage protocols to give pharmacists emergency powers to deal with supply issues. Why on earth did they take so long?

    The Government will have seen the data on the number of prescriptions for strep A antibiotics, which started to rise more than a month ago. Health professionals, including Leyla Hannbeck, the chief executive of the Association of Independent Multiple Pharmacies, have been raising the alarm publicly for more than two weeks, and I called for a strep A summit to resolve the supply issues. Because the Government did not come clean sooner about the shortage of antibiotics, parents who are worried about their children have been left to travel to multiple pharmacies, GPs have had to find time to rewrite prescriptions and A&E departments have been overwhelmed by anxious parents and children who cannot access medical help when they need it.

    Why have the Government taken so long to act? Did they not look at prescription data, or did they just ignore it? Why did the Secretary of State insist on television that there were no shortages, when GPs, pharmacists, directors of public health and parents all said that there were? After shortages of lateral flow tests, hormone replacement therapy and so on—you name it—why are we in this position again? The Government seem incapable of forward planning, and we are stuck in a shortage groundhog day. Can the Minister update us on the Competition and Markets Authority investigation into the sharp rise in the prices of antibiotics?

    Finally, we are in the lead-up to Christmas. Pharmacists have told me that some key contacts in the manufacturing companies are already on leave for the Christmas holiday. Families are making difficult decisions about the safety of their children and extended family. What action will the Government take now to ensure that families across the country can access the antibiotics they might need over the entire Christmas period?

    Maria Caulfield

    I reassure the hon. Lady that we have not waited to act. We have already issued serious shortage protocols, which are routine mechanisms when there is pressure on supplies. We have the stock of antibiotics in the country—as I outlined in my opening remarks, it is about supply issues. We are seeing five to six times the amount of antibiotics being prescribed at the moment. That is because the UK Health Security Agency has issued guidance to GPs, A&Es and healthcare professionals to lower the threshold of when they would normally give antibiotics. We are seeing significantly increased use of antibiotics. That is in addition to the prophylactic use of antibiotics by directors of public health, if they have had an outbreak locally. That is why we issued the initial SSPs already a couple of weeks ago so that pharmacists had flexibility in how they dispensed that medication. It is why on Friday we issued the new SSPs, which allow amoxicillin, clarithromycin, flucloxacillin, cefalexin, co-amoxiclav and erythromycin to be issued instead, if pharmacists do not have Penicillin V on their shelves. We are being as flexible as possible to give pharmacists that scope.

    We are monitoring this issue on a daily basis. May I reassure people that while these are higher than usual incidences for this time of year, overall for this season we are not yet at the 2017, 2018 levels, where we had a significantly higher number of deaths? Strep A occurs not just in—[Interruption.] Hon. Members do not want to listen. I think I have said enough.

  • Maria Caulfield – 2022 Statement on the Supply of Strep A Treatments

    Maria Caulfield – 2022 Statement on the Supply of Strep A Treatments

    The statement made by Maria Caulfield, the Parliamentary Under-Secretary of State at the Department of Health and Social Care, in the House of Commons on 19 December 2022.

    I thank the hon. Lady for her question. I know families are concerned about the recent outbreak of strep A in children. Although the vast majority of strep A cases are mild and can easily be treated with antibiotics, a small number of children have gone on to develop serious infections.

    The UK Health Security Agency has already declared a national enhanced incident to co-ordinate our public response. Increased demand has led to some temporary supply issues, but I reassure Members on both sides of the House that we have stock of antibiotics and have taken a number of steps to deal with some of the supply issues.

    First, we have worked at pace to help to ensure that there are supplies of vital medicines to meet the increased demand. Earlier this month, we convened roundtables with manufacturers of the preferred treatment, penicillin V, and with major UK wholesalers. We continue to work with manufacturers and wholesalers to boost supply to meet demand. The key issue is getting stock to pharmacies across the country. We have brought forward stock to make sure it gets to where it is needed, and we are expediting deliveries. Deliveries to wholesalers and pharmacies continues to be made, with more expected in the coming days and weeks.

    Secondly, we have issued eight serious shortage protocols to allow pharmacists to supply not only alternative forms of penicillin, but alternative antibiotics. This will make things easier for pharmacists, general practitioners and, of course, patients. We have also added a number of antibiotics to our list of medicines that cannot be exported or hoarded.

    Finally, we have updated advice across the board. Further guidance was given to GPs and pharmacists on Friday as part of the new SSPs. My Department has provided advice to colleagues in primary and secondary care on the management of the current supply issues. We have also held a cross-party briefing for MPs, and a “Dear Colleague” letter will go out later today.

    I know this is a worrying time for families across the country, but I reassure them and people across the healthcare sector that we are managing the higher-than-normal number of strep A cases this winter and we have a range of medicines available.

  • Will Quince – 2022 Statement on the NHS Workforce

    Will Quince – 2022 Statement on the NHS Workforce

    The statement made by Will Quince, the Minister of State at the Department of Health and Social Care, in the House of Commons on 19 December 2022.

    The NHS workforce are the key component of the NHS. The NHS is one of the largest single employers in the country and globally. Around 5% of the England workforce are employed by the NHS, so the way in which we value the workforce matters, both in ensuring delivery of health services and as a role model for other employers.

    The autumn statement has made up-to £14.1 billion available to Health and Social Care service over the next two years. This funding will help enable us to continue to support the NHS in England. I am therefore pleased to report that there are a record number of people working in the NHS. Latest data for September 2022 show almost 1.4 million full time equivalent staff working across NHS hospital trusts and primary care in England.

    Within this workforce there are a record number of over 168,000 full time equivalent doctors across hospitals and general practice. This includes over 131,000 in NHS hospitals and over 37,000 in general practice. There is also a record number of over 333,000 nurses across the NHS, with over 316,000 working in NHS hospital and over 16,000 across primary care.

    We have over 32,000 more nurses now than we had in September 2019, putting us well on the way to meeting the Government’s commitment of 50,000 more nurses across hospital and general practice settings by March 2024. Over the last three years, this speed of growth in nursing numbers is faster than we have seen since 2009 when current recording began.

    Internationally trained staff are an important component of the 50,000 nurse target. They have been an integral part of the NHS since its inception in 1948 and continue to play a vital role. We hugely value their contribution to providing excellent care. While we are working hard to increase our homegrown supply of health and social care staff, ethical international recruitment remains a key element of achieving our workforce commitments.

    I am also pleased to see that other key NHS hospital workforce groups continue to grow, such as the now almost 18,000 professionally qualified ambulance staff, 12% more than in 2019 and over 81,000 allied health professionals, 20% more than 2019. These staff work hand in hand with the over 380,000 clinical support staff who are so vital to the effective delivery of patient care.

    We are also growing new professions to support patient care and I am pleased to see over 2,500 physician associates and over 4,600 nursing associates working across hospitals and primary care.

    We also have a very healthy pipeline of people training to work in the NHS. There are record numbers of medical students in undergraduate training and graduates from recent expansion in medical school places and schools are starting to enter foundation training. Large numbers of candidates also continue to choose courses in nursing and midwifery in England, and since September 2020 all eligible nursing, midwifery and allied health profession students have received a non-repayable training grant of a minimum of £5,000 per academic year.

    For the third consecutive year we have seen over 26,000 acceptances to undergraduate nursing and midwifery programmes. There were 3,700 more acceptances in 2022 than in 2019—a 16% increase. This is alongside substantial expansion of nursing apprenticeships, with over 3,000 people starting in 2021-22 compared to less than 1,000 in 2019-20.

    However, in spite of the growth we are seeing, we know health and care staff are facing ongoing challenges. The rising demand for services due to the pandemic, service recovery and an ageing population means that staff continue to work under pressure.

    Therefore, alongside expanding the workforce we must therefore work to retain the staff that we have and ensure the NHS is an attractive place to work.

    The NHS People Plan and the NHS retention programme are focused on improving the experience of staff working in the NHS, as well as seeking to address the reasons they leave. This means ensuring we support staff health and wellbeing, improve the leadership and workplace culture of NHS organisations, and increase opportunities to work flexibly.

    To help with flexible working, we are making changes to NHS pension rules to help retain experienced doctors and nurses, and remove barriers for retired staff who want to return. We have therefore launched a consultation on detailed proposals to enable staff to work more flexibly up to and beyond retirement age, and protect them from unintentionally higher annual allowance pension tax charges driven by inflation.

    Looking to the future, we must ensure that the future workforce is both large enough to meet the challenges it will face and has the right people with the right skills working in the right places to address future demand.

    To that end, we have commissioned NHS England to develop a long-term workforce plan for the NHS workforce for the next 15 years. This will look at the mix and number of staff required across all parts of the country and will set out the actions and reforms that will be needed to reduce supply gaps and improve retention. We have committed to independently verifying this report, and publishing it next year.

  • David Ramsbotham – 2021 Speech on the Health and Care Bill (Baron Ramsbotham)

    David Ramsbotham – 2021 Speech on the Health and Care Bill (Baron Ramsbotham)

    The speech made by David Ramsbotham, Baron Ramsbotham, in the House of Lords on 7 December 2021.

    My Lords, when you are number 55 in a 74-strong speakers’ list, you have not got much new to say. As other noble Lords have said, there is much to be welcomed in this Bill—certainly including its intention and stated aims of integration and innovation, particularly for those who require rehabilitation.

    However, as always, the devil is in the detail. I must thank Nicola Newson for an outstanding Library briefing. I also join others in congratulating my noble friend Lord Stevens of Birmingham on a superb maiden speech.

    Yesterday, the Prime Minister announced in his speech that drug users were to be offered rehabilitation, but I did not hear him refer to the Bill. This is a pity, because I can think of no other form of rehabilitation that is so subject to local conditions and arrangements and therefore so natural to be included in an integrated care system along with speech and language and all the other subjects requiring rehabilitation.

    As other noble Lords have pointed out, when the Bill was in the other place there was considerable concentration on workforce issues, which seem to me to be paramount. There are simply not enough doctors, nurses or other healthcare professionals to go round, particularly in the midst of a pandemic, and the future looks very worrying, particularly where replacements are concerned.

    It seems to me that we will have our work cut out to try to improve the Bill, bearing in mind the fate of perfectly reasonable amendments tabled in the other place. Yet try we must, because there are too many long-term and national issues at stake.

  • Gordon Brown – 1997 Comments on Increasing NHS Spending

    Gordon Brown – 1997 Comments on Increasing NHS Spending

    The comments made by Gordon Brown, the then Chancellor of the Exchequer, on 14 October 1997.

    This new money for NHS patient care will go to where it is needed most.

    The Government’s approach is clear.

    We will maintain the control totals we set and therefore achieve the public spending discipline needed for sustainable finances. Savings will be found from within existing resources.

    And we will use money saved to fund our priorities, of which NHS patient care is one.

    Indeed, we will continue to be relentless in our search for savings, where money can be redirected to priorities.

    The new initiatives, including the appointment of best practice teams, will ensure better use of resources. We are satisfied that the money announced today will go to where it is needed most, for patient care during the winter months.