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Category: Health

  • Liz Kendall – 2022 Speech on Cancer Services

    Liz Kendall – 2022 Speech on Cancer Services

    The speech made by Liz Kendall, the Labour MP for Leicester West, in the House of Commons on 8 December 2022.

    I thank the Backbench Business Committee for granting this hugely important debate and the hon. Member for Winchester (Steve Brine) for securing it. Ever since he was elected in 2010—the same year as me—he has championed health issues. We have sat on several Bill Committees together and I know that he will continue to champion health issues in his new role as Chair of the Health and Social Care Committee. I was particularly pleased to hear him say he is determined to continue focusing on cancer care as that issue touches so many of our lives personally and professionally. I wish him well in his role.

    The central point made in the Select Committee report is that early diagnosis and prompt treatment of cancer is critical to improving survival chances and to bringing the UK up to the standards of other countries. The grim reality is that patients are having to wait longer at every stage of the process and the fundamental reason for that is a shortage of staff. The report says:

    “Neither earlier diagnosis nor additional prompt cancer treatment will be possible without addressing gaps in the cancer workforce and we found little evidence of a serious effort to do this.”

    I am afraid this is a terrible indictment of the Government’s record on cancer care, and that is despite repeated warnings not only from Members on this side of the House but from cancer charities, NHS staff and a range of other organisations.

    Members may know that the former Chair of the Select Committee and now Chancellor used to rightly say that the Government needed to do far more in terms of the workforce and that they did not have a proper workforce strategy; indeed, I think he may have joined Labour Members in the Lobby in voting to try to make that happen. Since becoming Chancellor he has been more silent on the issue. Labour, on the other hand, does have a clear workforce plan that would help make serious improvements in cancer care alongside many other parts of NHS treatment. I will say more about that later.

    I want to start, however, by setting out some of the current situation on waiting times for cancer care, and there are problems every step of the way. More than 60% of cancers are diagnosed following a GP referral, yet the report rightly says pressures on general practice mean there is a big increased risk of cancer being missed in primary care. The report says:

    “The NHS has lost 1,704 fully-qualified full-time GPs since 2015 despite repeated commitments to recruit more”.

    The impact of these GP shortages is clear.

    The standard is supposed to be that 93% of patients should wait two weeks between initial referral from a GP to cancer treatment. As of October this year only 77.8% of patients were seen within two weeks. That means 53,128 patients waited longer than they should. That is in contrast to when Labour last left Government, when over 95% of patients were seen within two weeks. The Government will no doubt say that that is entirely down to the covid pandemic. I am absolutely clear that covid has had a huge impact on cancer care, but let me remind the House that the Government were failing to hit the two-week referral target even before the pandemic. There are many problems in many other steps along the way. The Government have never hit their diagnosis target of at least 75% of patients being told whether they have cancer within 28 days of an urgent referral from either their GP or a cancer screening programme.

    As hon. Members have said, patients are waiting longer and longer for treatment. If we look at the two-month target, we see that in the East Kent Hospitals University NHS Foundation Trust, which serves the Minister’s constituents, 27% of patients are waiting longer than two months to have their treatment. That is two months when people will be terrified and anxious about what will happen to them. Will their cancer be getting worse? Their family members will be worried, too. In Leicester, the city that I represent, more than half of patients are waiting longer than two months for their treatment. I am afraid that the human cost of that has yet to be fully recognised by the Government.

    The key reason for that is a lack of staff. Alongside the shortages of GPs that I mentioned, the report says that

    “the NHS is estimated, on a full-time equivalent basis, to be short of 189 clinical oncologists, 390 consultant pathologists and 1,939 radiologists, and will be short of 3,371 specialist cancer nurses by 2030.”

    It adds that there is “no detailed plan” to address that. When the Minister rises, I hope that she will set out what she intends to do about that. The Labour Party has set out its long-term workforce plan, which will have independent workforce projections, new career paths in the NHS and new types of health and care professionals to help solve those problems. That includes doubling the number of medical school places to 15,000 a year, doubling the number of district nurses who qualify each year and creating 10,000 more nursing clinical placements, paid for by scrapping the non-dom tax status, because we believe that people who come and live in this great country should pay their fair share of tax.

    I could say far more about transforming cancer care and the need to fundamentally shift the focus of support towards prevention and early intervention, with more action on tobacco, on obesity, on exercise, and on alcohol —all the things that we know make such a difference. I could say far more about end-of-life care, which the hon. Member for Erewash (Maggie Throup) spoke about, and the need to join NHS services with social care and support so that people have choice about how and where they die. Within these time constraints, I want to say that I am optimistic about the future facing cancer patients in this country. There have been huge advances in science, medicine and technology, and Britain has been leading the way in much of that. It gives us hope for the future, but cancer patients and their families need the Government to act to solve the huge problems in the NHS, starting with the workforce, to get those waits down, get early diagnosis up and transform survival rates for cancer treatment.

  • Taiwo Owatemi – 2022 Speech on Cancer Services

    Taiwo Owatemi – 2022 Speech on Cancer Services

    The speech made by Taiwo Owatemi, the Labour MP for Coventry North West, in the House of Commons on 8 December 2022.

    It is a pleasure to follow the hon. Member for Erewash (Maggie Throup), a former Health Minister, who spoke with so much authority about the current workforce challenges, but also the need to improve and invest in better diagnostic equipment. I also commend the Select Committee Chair, the hon. Member for Winchester (Steve Brine), for perfectly outlining the Committee’s report.

    As somebody who worked in our NHS as a cancer pharmacist before entering this House and has worked as a regular volunteer pharmacist at my local hospital in Coventry, I know just how overwhelmed and over- stretched NHS cancer services are. The recently published report from the Health and Social Care Committee on cancer services uncovered that, in September, only 60.5% of patients started treatment within 62 days of urgent referral. In Coventry this year, only 57.2% of patients at University Hospitals Coventry and Warwickshire NHS Trust began their treatment within two months of being referred to the hospital by their GP. That is against a national target of 85%, so in Coventry and across the country cancer patients are being failed, making the Government’s declaration earlier this year of a war on cancer look more like a retreat than a tactical advance.

    The reality is that waiting lists are up, referrals are slower than ever, screening is in crisis, patient satisfaction has plummeted, medical professionals are leaving the sector in droves and the sector faces major structural challenges. If the Government are serious about making inroads into improving cancer care over the long term, it is crucial that they build a cancer workforce that is fit for the future. I welcome the Government’s commitment to publish a workforce plan next year, but they must commit to publishing the plan in full and deliver the much-needed funding for any workforce growth to succeed.

    Just to take clinical directors as an example, 99% have said that they are concerned about morale and burnout across the clinical radiology workforce. If we continue to treat our medical professionals with contempt, no one should be surprised if they decide to look for pastures new. If allowed to worsen, I fear that this workforce crisis will lead to expensive outsourcing and it will inevitably place greater strains on the public finances. Equally, I am deeply concerned that the Government have so far failed to recommit to a long-term cancer strategy.

    Under the last Labour Government, there was a long-term strategy and by and large we delivered it. That was reflected in record high patient satisfaction, record low waiting times, speedy referrals and improving survival rates across the board, so that is exactly what cancer services deserve.

    We know that one in two of us will get cancer in our lifetime, yet cancer outcomes in the UK continue to lag behind those of comparable European countries, as many Members have mentioned. This is disappointing to hear and highlights why we need a 10-year cancer plan. I am concerned that there are rumours that the plan may have been scrapped; given how many resources and how much energy have been put into developing the plan, I hope the Minister will confirm whether that is the case.

    Many Members have spoken about prevention, which is at the heart of the Committee’s latest cancer report. Four in 10 cancers in the UK are preventable, yet only through taking action to prevent cancer developing in the first place will we save lives and reduce pressure on our NHS. I welcome the successful public health campaigns on smoking and obesity in recent years, but much more needs to be done to ensure patients are made aware of the risk factors in developing cancer and can recognise its early signs and symptoms.

    Shockingly, smoking is still the biggest cause of cancer and death in the UK, causing around 150 cancer cases every day and 125,000 deaths each year. Recent Cancer Research UK modelling suggests that England will miss its smoke-free 2030 target by seven years for the population as a whole and by almost double that for the most deprived communities, who will not meet this target until the mid-2040s. So I urge the Government to invest in the resources and services that encourage and support people to quit smoking for good. Only through this long-term investment are we going to see the preventive results we urgently need.

    As the recently elected chair of the all-party pharmacy group and a former oncology pharmacist, I will briefly focus on drugs. As Health and Social Care Committee Chair the hon. Member for Winchester said earlier, drug research and development is not within the remit of the NHS. However, much investment is needed on research and development for new drug treatments, particularly for rare cancers such as liver cancer.

    I also want to speak briefly about aseptic services. I still work in aseptic pharmacy and understand the challenges and difficulties facing pharmacy aseptic services. The failure of the firms who make the cancer drugs to meet demand and the subsequent delays in patient treatment mean many treatments are repeatedly rescheduled. Frustratingly, this also means more work for NHS staff, who are already under enormous pressure. Also, increasing vacancy rates in aseptic services mean that services are working at, or above, capacity. These posts are hard to fill due to the fact that only a small group of healthcare professionals have the specific skills required, and given the small number of new staff entering aseptic services the filling of a vacancy at one hospital often results in a vacancy at a neighbouring hospital. I urge the Minister to take this challenge seriously, and to recognise that delays to treatment and referrals and cancellations must be addressed as they impact the ability of hospital pharmacy teams to supply these vital treatments.

    The Government must also take note and understand that the relationship with the firms supplying these drugs and NHS units is of fundamental importance. Hospitals must work in partnership with these companies to ensure that all parties do all they can to make sure the treatment is available on time and when patients need it; at the moment this is not happening. Pharmacy teams must be part of all capacity planning discussions; they are the ones on the frontline and they know what patients need. Aseptic units with capacity must also have the power to support other hospitals within their integrated care system areas. There will always be a small number of products that have to be prepared locally on a patient-specific basis; however, currently no mechanism exists for these products to be made without relying upon the manufacturers. I would welcome the opportunity to discuss these issues with the Minister further, and I hope she recognises the serious challenges aseptic pharmacies currently face.

    I have covered a lot of ground in my remarks today, but that is because of the scale of the challenge facing cancer care across the NHS. Whether driving down waiting times and eliminating needless delays, growing the workforce to treat cancer patients, boosting cancer prevention services, or facing down the challenges facing aseptic services, the Government certainly have a lot to do to improve cancer services and patient outcomes. I know the Minister is committed to improving those services and outcomes, and as a member of the Health and Social Care Committee I look forward to seeing, I hope, the much-awaited cancer plan and scrutinising it. I sincerely hope that this time next year the situation has improved for my constituents and all cancer patients nationally.

  • Maggie Throup – 2022 Speech on Cancer Services

    Maggie Throup – 2022 Speech on Cancer Services

    The speech made by Maggie Throup, the Conservative MP for Erewash, in the House of Commons on 8 December 2022.

    It is a pleasure to follow the hon. Member for Easington (Grahame Morris), who speaks with much knowledge and personal experience, which makes a huge difference. I welcome the report of the Health and Social Care Committee on cancer services, and the subsequent response from the Government. I commend all Select Committee members involved in producing that excellent report and I have every confidence that more quality reports will be produced on this subject and many others under the leadership of my hon. Friend the Member for Winchester (Steve Brine).

    I am grateful for the opportunity to discuss the report further. I will focus on community diagnostic centres and the role of diagnostics more generally in supporting cancer services. With 91 community diagnostic centres already open, a further 19 announced yesterday and 40 more to come before March 2025, this is definitely a good news story. I am delighted to have a community diagnostic centre in my constituency at Ilkeston Community Hospital. It opened a year ago. In its first eight months, it delivered more than 6,500 tests, checks and scans. To date, across all the community diagnostic centres that have opened, 2.4 million tests, checks and scans have been carried out. That is excellent news, but not the full story.

    The success of the upcoming 10-year cancer plan—we hope that it is upcoming and has not been shelved—as well as tackling the backlog, elective recovery plans and levelling up, depends heavily on diagnostics. Diagnostics, whether in vivo or in vitro, are crucial to the overwhelming majority of patient pathways and are central to health outcomes. I know that the royal colleges, specifically the Royal College of Radiologists, and many other organisations support investment in improving cancer services across England and, at the same time, addressing historic postcode lotteries created over recent decades.

    Community diagnostic centres have an important role to play in this, but they bring their own problems. There are already existing chronic workforce shortages and ageing equipment that prevent cancer diagnosis and improvements in cancer care. There is a shortfall of 30%—1,453—full-time equivalent clinical radiologists and a 17%—148—shortfall of clinical oncologists. Those shortfalls vary in severity for each region, but I take a particular interest in the east midlands, where my constituency is. The east midlands has the same shortfall of clinical radiologists as the national average, which is 30%, but the shortfall in clinical oncologists is above the national average, at 28%, while 19% of clinical radiologists and 18% of clinical oncologists are forecast to retire in the next five years, adding even further pressure on a workforce already struggling to meet demand.

    A global study has found that a treatment delay of four weeks, which could be caused by a workforce shortage, is associated with a 6% to 13% increase in the risk of death, and that worries me as it could have a detrimental impact on the outcomes for cancer patients across Erewash, however hard those in post work. If we are to improve cancer services in England, we must invest in clinical radiology and clinical oncology training places to ensure that there are enough clinicians throughout a cancer patient’s pathway. I know there is competition for clinicians across all disciplines, but, if we are to improve outcomes for our cancer patients, we need to attract radiologists and oncologists.

    I pay tribute to everyone involved in this aspect of medicine, whatever their role, and of course our NHS workforce across all disciplines. I include all the amazing people, whether healthcare professionals or volunteers, at my local hospice, Treetops Hospice Care, who each day make the end of life a better experience for so many of my constituents—a huge thank you to everybody.

    I have mentioned that one of the other barriers to community diagnostic centres reaching their full potential is the lack of investment in equipment in the existing system. The UK has fewer scanners than most comparable countries in the OECD: it has 8.8 CT scanners per million of the population while France has 18.2 and Germany has 35.1; it has 7.4 MRI scanners per million of the population, while France has 15.4 and Germany has 34.7. Industry surveys have shown that one in 10 CT scanners and nearly a third of MRI scanners in UK hospitals are over 10 years old, and 10 years is usually the age at which this equipment can be considered obsolete and must be replaced.

    In June, the Royal College of Radiologists surveyed a representative sample of its members in England about equipment needs, revealing that 49% of clinical radiologists and 21% of clinical oncologists said they do not have the equipment they need to deliver a safe and effective service for patients in their department or cancer centre. Only 32% of clinical radiologists and 54% of clinical oncologists said their equipment is fit for purpose, with the rest saying it is substandard or only acceptable to some extent. There must be a comprehensive audit of all diagnostic equipment across England so that investment is made in the right equipment where it is needed most.

    I have some questions for the Minister, for whom I have great respect. I know just how much she cares about getting it right for patients. First, are clinical radiology and clinical oncology training places being invested in to ensure there are enough clinicians throughout a cancer patient’s pathway and, if so, will that investment include both the 50% of trainee costs covered by Health Education England and the other expenses incurred by trusts? When it comes to equipment, are community diagnostic centres taking the investment preference over and above the replacement of obsolete diagnostic equipment in hospitals, and will an audit of all diagnostic equipment be carried out? Of course, as has been mentioned, one of the elephants in the room—or, more correctly, in the Chamber—is: how do we help to prevent people from getting cancer in the first place?

    Across the UK, there are huge health disparities. When heat map after heat map is laid over the UK —whether for high smoking rates, high levels of obesity, high rates of cardiovascular disease, high rates of cancer, excess alcohol consumption or poorer health outcomes—they all show that the same areas are affected detrimentally. Therefore, we need to consider how we are going to achieve the Government’s targets to become smoke-free by 2030 and to halve childhood obesity by 2030. Perhaps, after the festive season, there can be a fresh look at measures to tackle excess alcohol, because alcohol, smoking and obesity are all markers of and can all cause cancer. If we are serious about tackling cancer, we need to be serious about preventing it as well, and it is never too late. We are always excited to hear about new therapies that have been proved to be effective, but surely we need to get as excited about preventing cancer in the first place, so my final question for the Minister is: when can we expect the health disparities White Paper to be published?

    There are many innovations to harness across all diagnostics, while community diagnostic centres, genomics and AI have a role to play, as do many more innovations, but until the unprecedented challenges—including the huge workforce pressures, out-of-date equipment and preventive measures continuing to be watered down—are addressed, cancer diagnosis and treatment will never reach their true potential. The Government state in their response to the Select Committee’s report that

    “the Government’s forthcoming 10 Year Cancer Plan will set a new vision for how we will lead the world in cancer care, including ensuring we have the right workforce in place.”

    That is an admirable ambition, and we all want the Government to succeed. Indeed, they must succeed, as this will be transformational for the life chances of my constituents in Erewash and those of the whole nation. As my hon. Friend the Member for Winchester has said, I look forward to reading the Government’s 10-year cancer plan very soon.

  • Grahame Morris – 2022 Speech on Cancer Services

    Grahame Morris – 2022 Speech on Cancer Services

    The speech made by Grahame Morris, the Labour MP for Easington, in the House of Commons on 8 December 2022.

    It is a privilege to speak in this debate, and I want to express my appreciation for the work of the Select Committee and for the way its Chair, the hon. Member for Winchester (Steve Brine), presented the report and the way forward. It is very instructive and informative, and I cannot disagree.

    I must make some declarations of interest. I am, and have been for some time, vice-chairman of the all-party parliamentary group for radiotherapy. I want to confine my remarks to radiotherapy, although I do have a broader interest as vice-chairman of the all-party parliamentary group on cancer. People might not believe this, but I worked for almost 15 years in an NHS diagnostic laboratory, so I have a little bit of knowledge of the front- line. I served for five years as a member of the Health Committee when I was first elected, under the chairmanship of Stephen Dorrell initially and then Sarah Wollaston. I found that to be one of the most interesting and rewarding things I have done in the House of Commons since being elected.

    I also served on the Health and Social Care Public Bill Committee—I must thank you, Madam Deputy Speaker, for putting me on that Committee—which was a marathon. I remind Members who were not around at the time that part of the justification put forward by the then Prime Minister and the coalition Government for those major reforms and restructuring of the national health service, including the commissioning of cancer services, was the poor outcomes on cancer. The system we have now was born out of a recognition that we needed to do better.

    I pay tribute to the hon. Member for Westmorland and Lonsdale (Tim Farron), who chairs the APPG for radiotherapy, and the hon. Member for Strangford (Jim Shannon), who is an assiduous advocate for improved cancer services, not just in Northern Ireland but throughout the country.

    I am delighted that this report signposts the way to future work. I am very pleased that the hon. Member for Winchester indicated that it is his intention, with the agreement of the Committee, to do further work on how we might achieve the laudable 75% diagnosis target by 2028. I am pleased that the Minister of State, Department of Health and Social Care, the hon. Member for Faversham and Mid Kent (Helen Whately), is responding to the debate. I am sure that, like some of her predecessors, including the hon. Member for Winchester, she will grow tired of me banging the drum for cancer services, and for radiotherapy in particular, but there are some very important points and sound advice that come not from me, although I should say that I am a cancer survivor. I have had lymphatic cancer on three occasions, and I have benefited from surgery, chemotherapy and radiotherapy, so I understand what is involved and I value the vast improvements there have been in all those pillars of cancer treatment.

    The sexy thing on cancer services is early diagnosis. It captures a lot of headlines, and the hon. Member for Winchester was right to point that out, but it goes hand in glove with having the requisite treatment capacity. With the best will in the world, the investment in new diagnostic hubs, which I welcome and is laudable, will simply increase the number of patients in the system. If we are to improve outcomes for cancer patients, we simply must address the issues around cancer treatment capacity.

    I believe the Minister has a copy of the six-point plan for improving outcomes from the APPG and the charity Radiotherapy UK. We are not saying that radiotherapy is somehow in competition with the other pillars of cancer treatment; rather, it complements them. Advancements in science, technology and skills, with the introduction of artificial intelligence, the ability to map tumours precisely and incredible advancements in MRI scanning facilities, used in parallel with precision radiotherapy machines, gives us an opportunity to make a quantum leap in treatment and to improve productivity.

    The cancer workforce is very small; it is only around 6,500 nationally. They are a highly skilled, highly motivated group of individuals who are doing a fantastic job, and I pay tribute to the cancer workforce, particularly those who work in the field of radiotherapy, who are holding the line at the moment and facing growing pressures in the system.

    As a country, we spend about 5% of our dedicated cancer budget—not 5% of the entire NHS budget—on radiotherapy. If we look at international comparators, which we must do, we see that the OECD average is about 9%, so we are spending about half as much as other similar developed industrial nations. To put that into context—because sometimes we get lost in the figures—the NHS spends more on a single cancer drug, Herceptin, than on the entire radiotherapy service across the country.

    I want to touch on commissioning, which is an issue that can be readily addressed and that came about as a consequence of the 2012 Lansley reforms. We took that up directly with the Minister when she kindly met a delegation earlier this week. Cancer services are currently nationally commissioned by NHS England, but there are things that could be done rapidly to increase treatment capacity by addressing some of the anomalies in the current tariff system.

    Perversely, NHS trusts that have the latest advanced precision radiotherapy equipment are financially disadvantaged from using it because of the tariff system. Bizarrely, patients are being treated with 30 fractions of radiotherapy when it is perfectly possible to treat them with four, five or six fractions of precisely delivered radiotherapy if the machines are available and the staff are trained to do it. In many cases, the machines are there but the tariff system works against rolling out that facility. That is completely perverse and it is crazy that we do not do that.

    We can learn from examples of what is happening in similar European countries. The Chair of the Select Committee mentioned the rapid improvements that have been made in Denmark as a result of having a well-thought-through, well-developed and well-scrutinised plan to improve cancer services. Rightly, some European countries also have diagnostic hubs, but in many cases they are combined diagnostic and treatment hubs, so it is conceivable that patients go in for diagnosis and rapidly begin their treatment—in some European countries, on the same day. Many patients here wait a month, and far too many wait more than two months—62 days—before their treatment starts.

    I have some particular points to make to the Minister, which we also raised with her directly. The Chair of the Select Committee mentioned the new cancer plan. As a House and as a nation, we need some clarity on whether there will be a new 10-year cancer plan and whether the Department and the Ministers are making the case to the Treasury to secure the necessary funding. I hope that, as part of that, the Minister will look at the six-point plan for improved radiotherapy services that she has in her possession. Even without a cancer plan, however, there are things that could be done immediately to address the issues around the tariff system and the bureaucracy that holds back technology, which NHS England could easily resolve.

    We are going to move to a new commissioning system with integrated care boards over large areas, but they have no capital budget and their funding is revenue based, so we must address the issue of those centres across the country. It is wonderful if people live near the Royal Marsden, which is one of the finest hospitals not just in the country or in London, but probably in the world, but if people live in the south-west, Cumbria or the north-east, they cannot readily access such a tremendous centre. We must address some of those health inequalities before the new commissioning arrangements come in, so that we have a systematic approach to replacing machines that are more than 10 years old, rather than having to make out a business case and compete against other centres that may already be well provided with the latest technology.

    We are on a time limit, so I will wrap up, because I do not want to incur the wrath of Madam Deputy Speaker. I give the Minister credit for her commitment and aspiration to improve cancer outcomes and to have a first-class service. I hope that the Health and Social Care Committee will play its role in scrutinising the cancer plan, or the Minister’s plans to improve cancer services. I am pleased that she recognises the validity of the representations that have been made already and that there is an urgent need to address the tariff issue. I would like an assurance that that will be done quickly, not in a year or two, because there is clear evidence that it could improve outcomes and it is what we call low- hanging fruit.

    There is a lot more that I could say and lots of figures that I could quote—for example, I am concerned about the latest cancer waiting times; the Minister attended our presentation where it was shown graphically that there are huge variations across the regions. The Government must address that. I think we could get cross-party support for a sensible cancer plan, so I look forward to seeing the proposals that she comes up with when she has consulted with her colleagues and the Treasury.

  • Steve Brine – 2022 Speech on Cancer Services

    Steve Brine – 2022 Speech on Cancer Services

    The speech made by Steve Brine, the Conservative MP for Winchester, in the House of Commons on 8 December 2022.

    I beg to move,

    That this House has considered the Twelfth Report of the Health and Social Care Committee, Session 2021-22, Cancer services, HC 551, and the Government Response, HC 345.

    I am very grateful to the Liaison Committee for selecting this topic for debate in the Chamber today. We know that one in two people in the UK will develop cancer at some point in their lives. It is no exaggeration to say that this is an issue that affects everyone in the House—indeed everyone in the country in one way or another—and it has touched my life for the worse many times, as I will talk about later. That is why the Health and Social Care Committee produced a report on cancer services earlier this year, and I pay tribute to my predecessor as Chair, my right hon. Friend the Member for South West Surrey (Jeremy Hunt), for his leadership in producing that work. That awful statistic is also why I have made cancer a priority as the new Chair of the Committee.

    Our report found great strides had indeed been made in improving survival from cancer. Thanks to the tireless work of our scientists, researchers, doctors and nurses and others, including Ministers, over many years, more than half of people diagnosed with cancer now live for five years or more, compared with only one in three people 50 years ago.

    We also heard that cancer survival in England, and indeed in the rest of the UK, continues to lag behind comparable countries around the world. The International Cancer Benchmarking Partnership explains that just under 60% of people diagnosed with bowel cancer in England, for instance, will live for five years or more, compared with 66.8% in Canada and almost 71% in Australia. The pattern is seen in many other cancer types, including lung cancer, which, of course, took our great friend James Brokenshire last year; pancreatic cancer, which took my own father, who was diagnosed in September 2019 and was dead three days after the general election that December; and ovarian cancer, which has also touched my family and so many people.

    The charity Target Ovarian Cancer came to the House last month—my good friend the hon. Member for Washington and Sunderland West (Mrs Hodgson), who chairs the all-party parliamentary group on ovarian cancer, led the reception downstairs in the Churchill Room—and launched its pathfinder study, “Faster, further, and fairer”. The study notes that 4,000 women a year still lose their lives to ovarian cancer. I highly recommend that excellent report to Members.

    We know that one of the biggest reasons for the survival gap—I have just quoted some comparative figures—is that the NHS tends to diagnose fewer cancers at an early stage, when cancer is, of course, much more treatable. Early diagnosis is cancer’s magic key, as has been said so many times from these Benches. NHS England has set a target of diagnosing 75% of cancers at an early stage by 2028, compared with about 54% today. We say that achieving that would make a huge difference to outcomes. I agreed that target when I was the Minister with responsibility for cancer a few years ago, and I firmly believe that it is the right target to give more people the best possible chance of surviving their cancer. But we need to be much more ambitious and get upstream of many cancers—I will return to that point.

    Last month, Dame Cally Palmer, the excellent national cancer director who also works at the Royal Marsden, told us in a special topical session of the Select Committee that she remained “cautiously optimistic” that the 75% target would be met, and told us about some great progress being made on programmes such as targeted lung screening—we have all heard about the supermarket checks—which is diagnosing lots of early-stage lung cancers in the pilot studies and is showing great promise. Dame Cally’s optimism was not, I have to say, entirely shared by many of the experts who gave evidence to our inquiry on cancer services. John Butler, a specialist in ovarian cancer, thought it was “extremely unlikely” that the 75% would be reached, and Dr Jeanette Dickson, an oncologist, said the NHS was doing “very badly” against the target. That is a worry. Regrettably, we concluded in our work that the NHS is not on track to meet the 75% target, and that judgment was shared by the Committee’s independent panel of experts, who evaluated Government progress on cancer services.

    The Government said in their response to us that it was premature to say that progress towards that target is off-track, but the National Audit Office found that, so far this year, 56% of patients are being diagnosed at stages 1 or 2, which is the same proportion as when I made the target in 2019. Of course, that is below the level of improvement required to reach that three-quarters target of early diagnosis by 2028. I do not agree that it can ever be premature to call for more to be done to make progress on early diagnosis when failing to achieve the target could mean many hundreds of thousands of people missing out on early diagnosis and, of course, on a better chance of surviving their cancer and living for longer.

    The Committee heard extremely powerful examples of why it is so important to make more and faster progress on diagnosing cancers earlier. In December 2020, Andrea Brady’s daughter Jess died of stage 4 adenocarcinoma at the age of just 27 years old. Before her diagnosis, Jess had been passed from pillar to post, consulting repeatedly with multiple GPs and other clinicians before her mother was finally forced to pay for a private consultation just to get Jess a diagnosis. By that point, tragically, it was too late. Jess passed away in hospital three and a half weeks after she was diagnosed.

    Meeting the target of diagnosing 75% of cancers at an early stage would mean giving thousands of people a better chance of surviving their cancer, and thousands fewer families having to suffer such terrible losses. That is why we called in our report for the then promised 10-year cancer plan to kickstart progress on early diagnosis. We called for it to consider more radical proposals on how to diagnose more cancers at an early stage, and to include an associated workforce plan to reduce diagnostic bottlenecks in the system.

    Good work is ongoing, and I know that the Minister will talk about it later. New research, such as the NHS-Galleri blood test trial, could be transformative. Indeed, last month our colleagues at NHS England would not be drawn on whether there is a need for a new 10-year cancer plan, as previous Governments have promised. They seemed to imply that a new plan was not needed given the focus of the long-term plan on early diagnosis. I contest that. The consultation on a new 10-year cancer plan was responded to by the sector, charities, royal colleges and many other organisations, and it has set many hares running and created great expectation about a future cancer plan. We on the Committee—I see other Committee members here—are concerned about that. We are not hung up on plans, but in my experience of being a Minister, the NHS loves a plan, the NHS needs a plan, and critically, that would allow this House to see where we are against the plan.

    Achieving early diagnosis is not just about what NHS England can do from the centre. It is also about improving public awareness about the many signs and symptoms of cancer across all communities. It is about making sure that GPs have good systems in place for managing patients with possible cancers and are able, without barriers, to refer them on for tests. It is about the continuous improvement of screening programmes, and hard work—really hard work—in local areas to encourage people to come forward. Of course, one of the great promises of the new integrated care systems is to work with the cancer networks and alliances to deliver on that system of early diagnosis and prevention.

    Achieving early diagnosis is also about focusing research and innovation on developing new ways of detecting cancer—especially cancers that are hard to diagnose—and ensuring that the NHS is set up to roll out new tests quickly. I referred to Galleri earlier, and mentioned upstream cancer. Next year, we will do a piece of work that I loosely call “Future cancer”. It is, of course, important that we diagnose cancers early—that is the basis of my remarks. At the moment, however, we largely diagnose cancers and treat them when they are symptomatic, and we hope to catch those symptoms and treat them early. Many cancers, but not all, are preventable, and I am interested in future cancer. Where can we get upstream of this? Where can we use the NHS’s new genomics strategy? Where can we use biomarkers to get ahead of that? That poses big moral and ethical questions to us as a society, but that is no reason not to go there or not to have that ambition.

    All this is about making sure that there are enough staff and machines in the system to do even more tests and give many more people the best possible chance of being diagnosed with cancer at an early stage. The 10-year cancer plan should look again to make sure that the Government are truly pulling out all the stops to get to 75% early-stage diagnoses by 2028. I hope the Minister will confirm that the Government are still committed to doing that work.

    Early diagnosis means little if there is not sufficient capacity to provide people with the right treatments at the right time. Unfortunately, the latest data suggests that there has been a decline in the NHS’s ability to provide this treatment. While the vast majority of people do still receive timely treatment following a cancer diagnosis, in September nearly 10% of people waited more than a month for their first treatment following their diagnosis, compared with less than 5% in 2019. That is more than 2,400 people having to wait more than an entire month to begin their cancer treatment—more than double the number who were waiting that long two years prior. As the former cancer director, Professor Sir Mike Richards—a giant in this area—often says, when someone is waiting for a cancer diagnosis or treatment, it is not the 31 days that really matter, but the 31 nights. I know that people around the country will understand that.

    Grahame Morris (Easington) (Lab)

    I commend the hon. Member, the Chair of the Select Committee, on an excellent report and an excellent analysis of the problems and the way forward, but he referred to the latest cancer waiting times. It is timely that we are having this debate, because the new cancer stats have been published by NHS England today. They show that the position is worsening. In October this year, 39.7% of cancer patients waited beyond 62 days between urgent referral and cancer treatment. There is an urgency in addressing some of the issues that the Chair raises.

    Steve Brine

    Indeed. The reason why we had Dame Cally and Professor Peter Johnson, who is the national clinical director for cancer, into the Select Committee a couple of weeks ago is that the NHS has set itself a deadline of next spring—it was this spring—to get back to the 62-day wait. I have everything I have crossed that they can get there, but they need to make it happen. I know they are relentlessly focused on that, and the Minister is relentlessly focused on that, but we have got to help them get there.

    The Committee also heard about the challenges facing surgery and radiotherapy services, which makes it rather timely that the hon. Gentleman intervened on me at that point, as I suspect he will speak about it later. Professor Pat Price, who he and I are going to meet early in the new year, is a consultant oncologist at Imperial College in London. She told us that radiotherapy services were lacking staff and machines to be able to deliver the best possible care and that services were struggling to deliver the level of activity needed to catch up with the cancer backlog. I will let the hon. Gentleman expand on that a bit later. Professor Mike Griffin, professor of surgery at Newcastle University, also highlighted workforce shortages as a significant barrier to effective cancer surgery, but he also told us about the organisation of services. Because cancer surgery is often co-located within general, acute and emergency care, it can be subject to delay because of capacity shortage, and that was a particular problem during covid in some places, but not everywhere.

    My trust, Hampshire Hospitals, did a brilliant job to keep cancer surgery on track at all times by doing it offsite. I pay tribute to Alex Whitfield and her team at Hampshire Hospitals for the way they organised with Sarum Road private hospital in particular to ensure that patients continued to get their cancer treatment. Professor Griffin called for more ringfenced hubs to be developed so that cancer surgery can continue even when there are severe pressures on acute care, and I hope the Minister refers to that when she winds up.

    Growing the workforce, investing over the long term in machines and IT and reorganising services to create more cancer surgery hubs are all in the Government’s gift, which is why we recommended that they consider those actions in developing the 10-year plan. Without a wider focus on removing the barriers to the NHS delivering the best possible cancer treatments, the potential gains of earlier diagnosis might not be realised. Given the number of people presenting with suspected cancer at the moment—it is good that they are presenting, and many of them will turn out not to have cancer— if it is found that they do have it, we need to move on that. That is why treatment is the other side of the same coin.

    Just as further progress on early diagnosis will depend on research and innovation to develop new tests, improving cancer treatments will require new and more advanced techniques to be developed and implemented by the NHS. We found in the Committee report that the UK is a genuine world leader in research. There are unique aspects to the NHS that make it an effective partner for research organisations. We also heard that there are significant barriers to researchers accessing the data they need for quick and equitable patient recruitment to clinical trials and for staff having the time they need to take part in research. The Government have set out several steps they are taking to improve access to data and improve flexibility for staff wanting to take part in research, and that is welcome, but research by Cancer Research UK has found that the UK’s recovery from the pandemic in clinical trials continues to be outpaced by other comparable countries.

    NHS England told us that supporting clinical research into cancer is not its responsibility, so it is clear that a wider effort is needed to make sure that cancer research taking place in the NHS is well supported and aligned with the priorities for cancer services. That is another reason why the plan is important.

    Finally, we heard that there is significant variation in outcomes for people diagnosed with cancer, depending in part on the type of cancer they are diagnosed with, but also demographic factors. The Government told us that they would be addressing these differences through the levelling-up White Paper, but also through the health disparities White Paper, by addressing issues such as smoking and obesity, which are more prevalent in our more deprived communities.

    On that, there is a story in today’s press which suggests that Britain has the biggest increase in early onset diabetes in the western world. That is a huge concern. I am not suggesting that diabetes is cancer; I am saying that we have many suggested actions to reduce obesity around junk food advertising and stuff that follows on from the sugar tax. Much of that has still not been implemented. Rumours abound—there are always rumours around here—that the Government are seeking to delay junk food advertising restrictions until 2025. I hope that is wrong. I invite the Minister to respond to that when she winds up and, if not, to take that away.

    Maggie Throup (Erewash) (Con)

    Will my hon. Friend give way?

    Steve Brine

    I give way to somebody who possibly shares that view.

    Maggie Throup

    I agree 100% with his concerns about the potential watering down of the much-needed anti-obesity measures. Does he agree that it is important that we reflect what the public want? The public are in agreement with banning advertising on TV for particular foods that cause obesity. If we want to keep the public on our side, surely we have to follow their wishes, as well.

    Steve Brine

    I think that is right. The public are clear on this. I get that there are different views across this House and that there are those who disagree with much of the work that my hon. Friend and I did in government to push some of those measures on preventing obesity. I could agree with them, but then we would both be wrong. At the end of the day, obesity is a driver of diabetes, and obesity is a driver of certain cancers. We must take that seriously. Next year, the Select Committee will be doing a huge piece of work on prevention, and we will be returning to that. I hope that Ministers are aware of that.

    The recognition of the importance of health in the levelling-up White Paper is welcome, but without specific actions to address health disparities, this agenda will be at risk, so it is vital that the Government take up the prevention agenda again to stop people developing cancer in the first place. I hope the Minister will have some good news for us on that front, and I recommend that she returns to the prevention Green Paper that we published back in 2019, which contains lots of helpful ideas in that respect.

    Richard Foord (Tiverton and Honiton) (LD)

    On that point about health disparities and levelling up, I want to draw attention to the Royal Devon University Healthcare NHS Foundation Trust, which serves my constituency. The staff who work there do a fantastic job of cancer diagnosis but, given that the target for the number of people seeing a cancer specialist within two weeks is 93%, it is tragic that only fewer than 60% of people who are served by that trust see a cancer specialist within two weeks of a referral. Does the hon. Member agree that we need to level across, as well as level up, and think about health disparities across the country?

    Steve Brine

    Yes, of course. I hate the term, but this should not be a postcode lottery. We do have integrated care systems and cancer networks, and good, strong, experienced MPs should be driving those local health economies to ensure that they level themselves up and make use of what is there in the system to deliver as well for their population as other parts of the country do. There could be a lot more sharing among us of how we use that ability as Members of Parliament to drive our systems. I do it in my area, and I am sure the hon. Member does it in his. I thank him for his intervention.

    There are issues of variation affecting cancer specifically, such as proper screening uptake among certain groups, lower referral rates for some cancers and in certain areas, and higher rates of less survivable cancers among more deprived groups. We called for NHS England and the Office for Health Improvement and Disparities to produce an action plan for addressing disparities in cancer and for the much talked about 10-year cancer plan to include a specific action schedule for rarer and less survivable cancers. That remains, for us, a vital aspect of improving cancer services, and we hope that the long-term cancer plan—should one arrive—makes that part of its work.

    Last month, NHS England made it clear to us that it was focusing on delivering the NHS long-term plan for cancer. In many ways, that emphasis on delivery is welcome. The programmes being implemented as part of that work are positive, and I have covered some of them today, but recent research from the International Cancer Benchmarking Partnership has shown that national cancer plans are worth far more than the paper they are written on. The ICBP found that the countries that have made the biggest improvements in cancer since 1995 are those that have ambitious, detailed and costed plans for improving cancer services that are open to scrutiny by those whose job it is to do that—namely, us. Denmark and England used to be at the bottom of the league table for cancer, but thanks to consistent national cancer plans with associated long-term investment, the Danes have made rapid improvements, and they now leave us lagging behind.

    In conclusion, the Health and Social Care Committee’s report on cancer services found that there are many areas where the Government and the NHS are doing really good work and using the unique benefits of our national health service, but there are too many other areas where we can go further and faster to improve cancer services and outcomes. I hope the Minister will confirm that the Government intend to do so through the promised 10-year cancer plan.

  • Wendy Morton – 2022 Parliamentary Question on Support for Victims of the Infected Blood Scandal

    Wendy Morton – 2022 Parliamentary Question on Support for Victims of the Infected Blood Scandal

    The parliamentary question asked by Wendy Morton, the Conservative MP for Aldridge-Brownhills, in the House of Commons on 8 December 2022.

    Wendy Morton (Aldridge-Brownhills) (Con)

    What steps he is taking with Cabinet colleagues to support victims of the infected blood scandal.

    The Minister for the Cabinet Office and Paymaster General (Jeremy Quin)

    The Government ensured that all infected and bereaved partners who are registered on the UK support schemes received an interim payment of £100,000 in October, thus meeting Sir Brian Langstaff’s interim recommendation in full. That builds on support already provided, but I want to make it absolutely clear that those interim payments are the start and not the end of this process. Work continues.

    Wendy Morton

    As my right hon. Friend knows, there are thousands of victims of this historic blood scandal up and down the country. I know from some of my constituents just how traumatic that is, and how hard they have been campaigning, for a long time, to right what we recognise as an historic wrong. Does my right hon. Friend agree that it is critical for the Government to be ready to respond to the Langstaff report as soon as possible?

    Jeremy Quin

    It is indeed critical, and we commissioned the compensation framework study to ensure that we could be ready to respond quickly to the inquiry’s recommendations. It was a pleasure to meet the co-chairs of the all-party parliamentary group on haemophilia and contaminated blood, from whom we may hear shortly. Work is ongoing, and I hope to give the House a further update as soon as possible on how that work is progressing and how we will continue to take it forward.

    Dame Diana Johnson (Kingston upon Hull North) (Lab)

    I thank the Paymaster General for meeting the Father of the House and me last week. May I remind him how difficult it has been to build trust with this group of people who have been infected and affected and have been treated so badly over so many decades? The Government promised a statement to the House in response to the review by Sir Robert Francis KC of the framework for compensation. Can the Paymaster General specify a date on which we will be given that statement?

    Jeremy Quin

    Let me first acknowledge all the tireless work done by campaigners—those infected and those affected—and by those who supported them in the House and outside, including the right hon. Lady and the Father of the House, my hon. Friend the Member for Worthing West (Sir Peter Bottomley). These are dreadful circumstances, and we are determined to be ready for Langstaff’s report, which, presumably, will be published midway through next year. That is why Sir Robert Francis was commissioned to undertake his study.

    I think that, in part, our actions in making the interim payment—thus meeting the interim recommendations in full—speak for themselves, but I understand the right hon. Lady’s point. I look forward to updating the House as soon as possible about the work we have done and will continue to do, and to updating it further on the progress towards the completion of Langstaff’s report.

  • Lyn Brown – 2022 Speech on the NHS Workforce

    Lyn Brown – 2022 Speech on the NHS Workforce

    The speech made by Lyn Brown, the Labour MP for West Ham, in the House of Commons on 6 December 2022.

    Across north-east London, our population is set to grow by the total of the population of Dover in just the next five years. By 2042, the added population will be the size of Milton Keynes. We have the highest rate of NHS vacancies in London. We simply cannot go on without long-term workforce planning and investment in staff and in services. We have lost a large number of international staff since Brexit, and retention is a massive problem, with an annual staff turnover of almost 17% in the Government’s recruitment campaign for nurses.

    We have the highest spend on agency staff in the region—10% of some staffing budgets goes to agencies. But even with all that money being spent, our operating theatres are struggling to find enough bank and agency staff to fill the gaps. How on earth are we going to tackle the backlog if our theatres cannot be used to full capacity? How are we going to get patients in and out of hospital quickly if their operations are being delayed?

    In Newham, maternity is one of the worst affected NHS services. As we know, high-quality accessible maternity care saves lives, and local need is massive. We have very high levels of poverty, as well as demographic pressures from our rapid population growth. There is a 19% vacancy rate on our maternity wards; almost a fifth of roles have no one to do the job, so non-specialist nurses are filling in for midwives. Surely, that has an impact on the quality of care. Sometimes, even women who have been assessed as having a higher risk cannot be admitted because there are, frankly, not enough fully staffed beds, so they are sent home instead, with an obvious increased risk.

    One of our birth units is being closed repeatedly so that staff can transfer elsewhere and keep hospital services running. Those forced closures took place for almost 10% of the year to August. Surely, that increases costs for the NHS, as lower-risk births end up having to take place in hospital.

    Every part of the NHS is creaking, and we are getting closer to collapse because workforce issues have been neglected. We have known that these problems have been getting worse for years now, exacerbated by austerity. This ain’t just about midwives and doctors; there is a shortage of admin staff, too, which is leading to a higher number of antenatal appointments being missed. So, when patients have to go into hospital even though they could be treated more effectively in less expensive settings, and when appointments are missed and preventive care does not take place, what happens? Costs go up for our NHS. The Government’s failure to recruit and retain enough staff is making our NHS less effective in terms of value for public money and is, let us face it, putting lives at risk, too.

    In north-east London, we have the most diverse integrated care system population and the highest birth rate in the country. We know that if maternity patients do not get the care that they need, the risks are high. We have all heard the terrible statistics about women from black communities being four times more likely to die in childbirth than women from white communities. If we are to address that shameful injustice and end those deaths, Newham is one of our frontlines. But the reality is that our response is being held back and women put in greater danger because our NHS simply does not have the staff. The Government need to understand that many of those difficulties could get even worse without change. As we know, so many of our health and care staff are simply exhausted. They are working all the harder to fill in for vacancies. Often, they are offered less flexible work because the demand on services is so acute and no one can fill in the gaps.

    A decade of austerity and the cost of living crisis have taken a huge toll. Locally, 17% of our skilled and experienced nursing staff are over 55. Many of those who keep our services going—or barely running—do not have many working years left in them. We can see that this is completely and utterly unsustainable. The dedication of our NHS staff, for which we rightly praised them so highly during the pandemic, has its limits. How much closer to collapse will our NHS get if these pressures continue to build? How many more patients will be let down? Frankly, a Labour Government cannot come soon enough.

  • Steve Brine – 2022 Speech on the NHS Workforce

    Steve Brine – 2022 Speech on the NHS Workforce

    The speech made by Steve Brine, the Conservative MP for Winchester, in the House of Commons on 6 December 2022.

    It has been interesting to hear the exchanges between the Front Bench speakers, although I am surprised that there are not more Members in the Chamber for what is a very important debate. [Interruption.] Actually, where are they on both sides of the House? Given that this is the No. 1 priority of the Opposition, where are they?

    Richard Burgon (Leeds East) (Lab)

    Is it not the hon. Gentleman’s No. 1 priority?

    Steve Brine

    Without the heckling from the back row of the Labour Benches, I can say that this has always been my No. 1 priority.

    Back in July, the Health and Social Care Committee, which I now chair, published a crucial report entitled, “Workforce: recruitment, training and retention in health and social care”—I urge colleagues across the House to take a look at it, if they have not already done so. We looked at workforce issues right across the NHS, and the findings were stark. The report found that the NHS workforce is facing the biggest challenge in its history. It made the same point about the social care workforce. Although social care is not the focus of today’s debate, it is important to stress, as others have during today’s opening exchanges, that the two sectors are closely intertwined and the workforce problems in the NHS cannot be considered in isolation.

    We had NHS Providers before the Select Committee this morning to discuss the industrial action. I asked them whether they support the independent pay review process. I would have intervened on the shadow Secretary of State with that question, but his speech had already gone on for an hour, so I thought he deserved to sit down. More than 1 million NHS workers under Agenda for Change have had, as the Secretary of State said, a £1,400 pay rise this year. That has come out of the independent pay review process. The question I asked NHS Providers this morning, to which the answer was yes, was: do they still believe in the independent pay review process?

    Either we have that process, we believe in it and we respect it, or we do not. Are we saying that we have that process and it sticks until something else comes along? If Ministers then become directly involved in negotiating pay for NHS workers, that is a very different proposition. That is not the place we want to be, although the Select Committee is very happy to scrutinise that proposal if it is coming from the Treasury Bench. I would be interested to hear in the winding-up speeches what the Labour party’s position is on the independent pay review process, because it is independent for a reason.

    The Committee’s report cited research by the Nuffield Trust suggesting that the NHS in England could be short of 12,000 hospital doctors and more than 50,000 nurses and midwives. The number of people on a waiting list for treatment rose to a record of just over 7 million in September, and the 18-week target for treatment has not been met, as is well known and is on the record, since 2016. Yet, as our report noted, the demand on the sector continues to grow relentlessly. There are estimates that an extra 475,000 jobs will be needed in health by the early part of the next decade.

    One of the Committee’s most urgent recommendations was that the Government should do proper workforce planning. We noted that without workforce plans that are independently verified and publicly available, there would be little confidence among the public, the profession or NHS workers themselves that the Government have a grip on the problem.

    I must say that the Select Committee has not yet had a Government response to our workforce report—it is a little overdue. The Secretary of State is on the Front Bench, and I know he is busy, but hopefully he will take that back to his officials. We look forward to receiving that response, because it is important that Select Committees get responses to reports in as timely a manner as possible, notwithstanding the fact that there has been a change of Administration.

    However, I am encouraged that the Government are paying attention to what the Committee recommended, and I was delighted to hear my predecessor in this role, now Chancellor of the Exchequer, say in his autumn statement that he agreed with himself—his words—and that the Government would now be publishing an independently verified workforce plan for the NHS for the next five, 10 and 15 years, something the Committee has long called for. The Treasury outlined that the plan would

    “include measures to make the best use of training to get doctors, nurses and allied health professionals into the workforce, increase workforce productivity and retention.”

    Excellent—that is progress.

    Questions remain, however—maybe the Minister can touch on this in her winding-up speech—about what the independent workforce planning will look like in practice. We need to know more about who will provide the independent verification once the work has been done. I understand the work has largely been done by the NHS, but we need to know who will be doing the independent verification, when it will be published and how regularly it will be reviewed. When we know that, we will look forward to talking to him or her in the Select Committee.

    Our report contained a number of other important and detailed recommendations about how to tackle the NHS workforce crisis. I do not want to go into all of them today—as I have said, the report is on the record and published in the House—but among them I wanted to highlight the radical review of working conditions that was touched on by both the shadow Secretary of State and the Secretary of State.

    Work conditions are critical. We talked about the need to reduce the intensity of work felt by so many people in the service—which I hear about both as a constituency MP and as Chair of the Select Committee—and the need to boost retention and of course recruitment of people who are looking at where they might work when they have done training. We recommended that the review should start with an overhaul of flexible working, which would mean that NHS workers were not driven to join agencies or become locums to gain control over their working lives. I often hear those words, “We just need control over our working lives.”

    We also said it is a huge problem that senior doctors are being forced to reduce their working contribution to the NHS or to leave it entirely because of the long-standing problem around pension arrangements, which was a problem when I was a Minister in the Department. We accept that the Government have made some progress on pensions, with changes to the taper rate and the annual allowance, and credit to them for that, but we note that the problem persists and have called on the Government in our workforce report to address it.

    In that context, to give credit where it is due, I was very pleased to see on Monday that the Government have announced plans to amend NHS pension rules to retain senior doctors and encourage staff to return from retirement. The Secretary of State was slightly mocked when he said that was subject to a consultation, but that is how government works. If the hon. Member for Ilford North (Wes Streeting) were to become Secretary of State—I like him very much, but I hope he does not—he would also publish consultations, because that is how proper government is done, and he knows that. We look forward to seeing the Government response to that consultation, which I know the Secretary of State is keeping a keen eye on.

    The Secretary of State is right to say that there are a record number of doctors in training, with five new medical schools, two of them focused on training GPs. That is true, but the Select Committee will return to our workforce work next year, and we will be taking evidence from anyone who wishes to contribute about the cap on training places. I have said to Ministers and to No. 10 that I think the Government are going to have to look again at that issue. I hear in my constituency from bright young boys and girls who wish to train as medics, whose parents have maybe worked in the profession and who have that ambition for themselves. The cap is a problem.

    My other point is about demand. We had somebody from the British Medical Association’s GP committee before the Select Committee this morning, as part of our ongoing inquiry into integrated care systems, who was talking about the NHS being underfunded. That depends on which end of the lens we look at, does it not? We spend £150 billion or so of taxpayers’ money on the NHS. We could spend £300 million; that would be a choice. We would have to fund it, of course, because we know what happens when people make unfunded spending pledges from the Dispatch Box—the markets go into meltdown, and rightly so.

    We need to have a serious and honest conversation with ourselves about how much of our national wealth we wish to spend on our health service and whether that would achieve the desired outcomes. We are the fifth-largest spender on health services in the OECD, but we do not get the fifth-best outcomes. I can give the House a bit of an exclusive here, because in the new year the Select Committee will be launching a big inquiry into prevention. Anyone who knew me when I stood at the Dispatch Box as a Minister will know that cancer and prevention are the two things that most get me out of bed in the morning, so we will do a big piece of work on prevention.

    My view and the view of many others is that the NHS will have long-term sustainability challenges if we do not get serious about prevention. I do not just mean returning to the argument around obesity and all the things I wrote about in the child obesity plan when I was a Health Minister, although they are important and I urge the Government not to backtrack on any of those policies but to implement them, because weight is a major problem in our ill health. We need to get upstream of ill health.

    I will say more about this in the debate in the House on Thursday, but when the Committee returns to cancer work, we must look at future cancer and at getting upstream of cancers. At the moment, we want to diagnose quickly, but people have to have symptoms in order to be diagnosed quickly and then we need to treat very quickly as well, within the 28-day standard. The Secretary of State and I have talked several times already about how we need to get far ahead of that.

    We need to bring together predictive medicines, biomarkers and some of the life sciences work that is going on with the NHS’s genomic strategy, and get ahead of some of the illnesses that drive ill health in our country. Without that, in my humble opinion, the NHS has long-term sustainability problems.

    Emma Hardy

    This is a perfect point for me to lobby the hon. Gentleman on also looking into diagnosis times for people with endometriosis, who are waiting on average seven and a half years to receive a diagnosis, and women’s health treatment generally. That would be a wonderful inquiry for his Select Committee to look into and take under observation.

    Steve Brine

    Duly lobbied, thank you. The hon. Lady has mentioned this to me many times before; I take the point on board and other members of the Committee in the Chamber will have heard her too.

    In all the work that we are doing on the Select Committee, whether on ICSs, prevention or cancer, or the work done by my predecessor chairing the Committee, workforce is without question the common theme that runs through all of that. We cannot get away from that. I think there are encouraging signs that the Government are listening to the Committee, and of course we have a great advocate in No. 11 Downing Street and in the Secretary of State, who I was pleased to see reappointed to his position.

    I urge the Government to continue to listen to the Select Committee. We are a cross-party Committee, looking at things in a sober, calm, evidence-based way, and we look forward to the Secretary of State coming to see us soon to talk about these issues. The invitation is always there, as he knows.

    The workforce challenges that the NHS faces are the bottom line. Without tackling them, we are not going to move forward on many of the challenges that I know the system has. I welcome this debate; I hope we can keep it sober, keep the party politics out of it and focus on the NHS, because ultimately that is what our constituents demand of us.

  • Chris Stephens – 2022 Speech on the NHS Workforce

    Chris Stephens – 2022 Speech on the NHS Workforce

    The speech made by Chris Stephens, the SNP MP for Glasgow South West, in the House of Commons on 6 December 2022.

    It was noticeable that the Secretary of State talked very little about the workforce in the speech we have just heard, although he spoke about many other things. I want to confine my remarks to the workforce, staff wellbeing and their pay.

    Let us recognise, first, the impact on the NHS and staff of not just decisions made in this place on the economy, but of Brexit—that cannot be ignored. For example, the director of the CBI has called on the UK to use immigration to solve worker shortages. The Secretary of State did touch on that, but we really need assurances about the work being done between the Department of Health and Social Care and the Home Office to resolve the many visa issues that the Royal College of GPs had outlined, as other Members have said. According to that research, 17% of international graduates are considering leaving the UK altogether as a result of the challenges they are facing within those visa processes.

    Research by the Nuffield Trust has revealed that Brexit has worsened the UK’s acute shortages of doctors in key areas of care and led to more than 4,000 European doctors choosing not to work in the NHS in the UK. Martha McCarey, the lead author of that Nuffield Trust analysis, has said:

    “The NHS has struggled to recruit vital specialists…and Brexit looks to be worsening longstanding workforce shortages in some professional groups.”

    That has been backed up by a number of organisations that have those very concerns, because the challenges in health and social care are felt in many sectors. What we certainly do not need is some of the right-wing rhetoric on immigration that we hear in this place, because in many areas of the UK we need more rather than less migration.

    Clearly, staff pay is a real concern. In Scotland, we have seen discussions between the Scottish Government and the trade unions; a pay offer is on the table to staff and the trade unions have recommended that the staff accept that latest offer. In England, as an excellent Unison briefing is outlining, we are seeing a number of NHS workers considering leaving the service because they do not believe they should be subjected to a pay rise of 70p an hour. That is a very real concern to them and I believe it is simply not enough—it is not enough when food inflation is at 16%, and we have the high energy costs and housing costs that many people across the country are being subjected to.

    Jamie Stone

    The hon. Gentleman is making an interesting contribution, and I am thinking about what he has just said about Scotland. The fact remains, as I illustrated in a question earlier today, that the consultant-led maternity service based in Caithness, which has a close connection to his family, was downgraded to its current deplorable state because it could not hire the people. He has just mentioned housing, and I believe that in order to fill the gaps in the most rural areas of the UK we are going to have to offer a more comprehensive package to encourage them, involving housing, something on the mileage rate people are paid and even transport. If we just go down the ordinary route of recruited people from overseas, they will tend to go to the more central parts of the UK, where there is housing and where transport is much easier. We cannot have the rural, faraway corners of the UK left out.

    Chris Stephens

    The hon. Gentleman knows of my affection for his constituency—many members of my family live there. He raises an important point about rural communities, and in relation not just to the NHS but to the other challenges he outlines. He makes a pertinent point about what all the health services need to consider when applying their services to the areas that he has the privilege of representing, and I thank him for that.

    The Secretary of State talked about the autumn statement, but it will not deal with the increasing cost of food and energy, and all the other pressures facing staff. There must be a serious discussion about the NHS workforce, about retention, about giving staff career opportunities and also about wellbeing. I thank NHS staff for what they have done not just during the pandemic, but when I and family members have had health challenges. The work they do and the miracles they perform on a daily basis should be recognised in this place.

    Dr Evans

    It is worth stressing that point. For all the Daily Mail headlines about the NHS, we must not lose sight of all the good work that goes on unrecognised for the countless thousands of people who go to hospitals, GP surgeries or mental health services and get excellent care. If two patients are on similar pathways but one receives excellent care and the other receives poor care, should not the emphasis be on moving more towards excellent care and less—if not an outright stop—towards poor care?

    Chris Stephens

    The hon. Gentleman is right; everybody should have excellent care.

    As we debate the NHS workforce, we need to recognise what the challenges of the workforce are: whether they are paid adequately and whether there is a real retention strategy. We need to ensure that we have as many staff as we can and that we pay them properly. I did not hear much from the Secretary of State about the state of play of the pay negotiations and what the Government are doing to try to resolve disputes. I see him sighing; he is more than welcome to intervene. [Interruption.] Oh, he was yawning. I am sorry. [Interruption.] Oh, he was not yawning either. He was making a facial expression. I do apologise. We really need a serious debate about pay for public sector workers, and NHS workers in particular.

    Richard Foord (Tiverton and Honiton) (LD)

    When we think about pay for NHS staff, we also need to consider pay for those who work in NHS dentistry. The Government claim to have reformed the NHS dentistry contract earlier this year, but they brought no new money to bear. Does the hon. Gentleman accept that the Government should be measuring not only the number of dentists who are employed to carry out NHS dentistry, but the number of hours that are committed to NHS dentistry? We need to see whether there is a correlation between that and the poor pay that they are receiving for NHS dentistry.

    Chris Stephens

    The hon. Gentleman makes an excellent point; it is all about pay. What he says about hours is pertinent as well. We know that NHS staff go the extra mile. We know that they work long hours, and we should recognise that. His point about the dentistry service is also important.

    As I outlined earlier, the Scottish Government are listening to feedback from the trade unions on pay, and there is a new offer on the table. That means that, in Scotland, porters who are at the top of band 2 will be making £2,502 more a year, nurses or midwives at the top of band 5 will be making £2,431 more, and a paramedic at the top of band 6 will be making £2,698 more. Currently, that is the best deal across the UK, and it is significantly more than the uplift on offer in England—the average value in England is around 4.5%, whereas in Scotland it will be 7.5%.

    The Secretary of State also had his usual kick at Wales, but it should be noted that the Welsh Health Minister and the Scottish Health Secretary have written to the UK Government, calling for additional funding this year to support pay deals for NHS staff. I wonder whether, in his response, the Minister will give us an update on the answer to that letter.

    I will conclude, because I know that this is a heavily subscribed debate. It is important that we deal with the mental wellbeing of our NHS staff. The Scottish Government have published a wellbeing strategy. We need to show more compassionate and collaborative leadership across the health, social care and social work sectors on these islands. I shall leave it there, Mr Deputy Speaker. The SNP will be supporting the motion submitted by the Labour party today.

  • Steve Barclay – 2022 Speech on the NHS Workforce

    Steve Barclay – 2022 Speech on the NHS Workforce

    The speech made by Steve Barclay, the Secretary of State for Health and Social Care, in the House of Commons on 6 December 2022.

    The hon. Member for Ilford North (Wes Streeting) said that Labour has a plan. Let us look at that plan. More than a fifth of the entire population of Wales are waiting for planned care, and 60,000 people in Wales are waiting for more than two years. So we can see exactly what Labour’s plan in government delivers. He asked us to remember when Labour was last in power, and we still do. We remember the letter that said there was no money left. [Interruption.] He has just had plenty of time in which to discuss these matters. I did not feel the need to hector him, because I thought his points had so many flaws that it was important for the House to be able to hear them. He obviously feels that he did not make his case effectively, and would like to have another go. Does he want to have another go?

    Wes Streeting indicated dissent.

    Steve Barclay

    He does not want to intervene, so let me deal first with what he left out. His speech, like his motion, ignored a number of salient points. He did not mention, for example, the autumn statement, which one would have thought was fairly significant, providing an extra £6.6 billion for the NHS over the next two years. The NHS Confederation, no less, has described the day of that settlement as a “positive day for the NHS”, and the chief executive of NHS England has said that it should provide “sufficient” funding to fulfil the NHS’s key priorities.

    The hon. Gentleman chose not to mention that significant funding. He also—much to the surprise of the House, perhaps—chose not to mention the uplift for social care that was announced in the autumn statement. Opposition Members often call for more funding, so I would have thought that they would be keen to hear about the extra £6.6 billion of additional funding for the NHS, about the biggest funding increase for social care provided by any Government in history, and about the £8 billion that we have committed to elective care. That, bizarrely, was also missing from his speech. He talked about the backlogs—those in England, that is; the backlogs in Wales are much greater—but he did not talk about that £8 billion for elective care, which will fund the building of diagnostic centres and surgical hubs in the constituencies of many Opposition Members.

    Debbie Abrahams (Oldham East and Saddleworth) (Lab) rose—

    Steve Barclay

    I do not know whether there is a community diagnostic centre for a surgical hub in the hon. Lady’s constituency, but perhaps she will share with the House what extra investment is being made there.

    Debbie Abrahams

    As someone who worked in the NHS during the last period of Labour government, I was proud of being able to ensure that my constituents would have an appointment with a GP within 24 hours. I was proud of the fact that someone who needed elective care would receive it within 18 weeks. I was proud of the fact that the treatment of someone diagnosed with cancer would start within 60 days. That is not what is happening on the Secretary of State’s watch. Can he tell me why my constituency has fewer GPs than it had in 2015, along with an increase in demand? How is this delivering the quality care that I know we had on my watch and that of the last Labour Government?

    Steve Barclay

    We are investing in more doctors. We have 2,300 more doctors—a 3% increase. We also have 3% more nurses than we had last year. In fact, under the former Prime Minister, my right hon. Friend the Member for Maidenhead (Mrs May), there was the biggest ever increase in medical undergraduate places—a 25% increase—along with the opening of five new medical schools. Of course, the training takes about seven years, so that is still in progress. As was pointed out during Health questions this morning, we are dealing with the consequences of the pandemic, which is why we are investing in more checks, scans and other procedures, and there will be an extra 9 million of those by March 2025.

    Emma Hardy

    The right hon. Gentleman might recall that, when he was previously Health Secretary before his short break, I raised concerns around the criteria to reside and the number of people remaining in Hull Royal Infirmary who were unable to move into adult social care. At the moment, we have 30% vacancies in adult social care. The problem is that, although the money is promised, it is not delivered. That is partly because of the chaos that we have seen in the Government. He must acknowledge that, although this money was promised, it was not delivered and that we have 30% vacancies in adult social care across Hull and East Riding. Those vacancies always increase before Christmas because retail makes an attractive offer to those same workers. The money has not been delivered in time, and those 30% vacancies are only going to increase. With the greatest respect to the Secretary of State, there is little point in making promises if they are not quickly delivered in time to make a difference.

    Steve Barclay

    The hon. Lady mentioned the summer, and I think she knows that I visited the Jean Bishop integrated care centre and looked at the great innovations and brilliant work that her constituents, among others, are doing there. I looked at how it is bringing social care and the NHS together through an integrated model and how there has been new investment, supported by the amazing fundraising within the local community and by NHS funding. It would be great to get a bit of balance about the amazing feedback I heard from both staff and patients at the Jean Bishop integrated care centre who are working innovatively. I hope the hon. Lady would agree that the innovation of a centre such as the Jean Bishop is what we need to see in more places across the NHS. To her wider point, there are challenges in social care; she raises a fair point. That is why, despite the many competing pressures that the Chancellor faces, he has allocated £500 million for this year. It is also why he then committed the £2.8 billion for next year and the £4.7 billion for the year after—the biggest ever increase in that funding. But it is not simply about the funding increase; it is also about using new models such as that integrated care model to deliver far better care.

    Dr Luke Evans

    Is that not precisely the point? The NHS will gobble up the money, so it is about how we use the system. The integrated care systems and integrated care boards—established through the White Paper that the NHS asked for—are doing exactly that. They are trying to join up primary care, secondary care, social care, preventive health, county councils and borough councils all in one place to make a better stand on how we can produce healthcare that is better for our constituents and better for the taxpayer. Will my right hon. Friend make sure that, when he goes to the integrated care board chairs, he gives them the chance to solve the problems and unleashes the power to do exactly that, because they know best?

    Steve Barclay

    My hon. Friend raises an extremely important point. It is not just about the significant funding increase that the Chancellor has allocated; it is also about how that funding is deployed, in particular through using population level data for the integrated care system to bring health and care together. One area that the hon. Member for Ilford North and I agree on is the impact of delayed discharges across health and our hospital trusts as a whole. We often see that manifested in ambulance handover times, which are so impacted by that.

    On the investment that is going in, my hon. Friend the Member for Bosworth (Dr Evans) is right to say that it is also about how it is deployed. Again, missing from the Opposition motion was any reference to the commissioning of the former Labour Secretary of State, Patricia Hewitt, to look at how to take on board how that funding is spent in an integrated way. It would also be remiss of me not to draw the House’s attention to the £5.9 billion of capital funding that we are using to transform diagnostic services by making the most of new technologies and improving the equipment for our frontline staff, making it easier for them to deliver the patient outcomes that we need. That is investment, along with the investment in care, that this Government can be proud of.

    In the motion, the shadow Secretary of State refers to a shortage of workforce, but he ignores the locum doctors and bank nurses that make up a significant proportion of the NHS workforce. He ignores the record numbers of doctors and nurses that we now have working in the NHS, with a 3% increase on last year in both doctors and nurses.

    I am sure you will be surprised, Mr Deputy Speaker, given your background in Wales, to discover that we cannot see what the vacancy rate is in Wales because the Welsh Government stopped collecting workforce vacancy statistics in 2011. You would have thought that the motion would be an opportunity for the Opposition to encourage their Welsh colleagues, given the importance that they say applies to vacancy statistics. You would have thought they would be keen to see that information from across the Union of the United Kingdom. I thought that Labour was a party of the Union. Why would it not want to have that transparency across Wales on the vacancy figures? But the motion was silent on that point. Perhaps in closing, the relevant shadow Minister will make a commitment to encourage the Welsh Government to have that same level of transparency.

    Dr Evans

    The Secretary of State hits the nail on the head when it comes to comparing the different countries across the Union, because different countries choose to use different statistics on waiting times to manage their staffing. Does this not confirm the argument we should have a unified way of using those statistics across the four nations?

    Steve Barclay

    I very much agree. In fact, in the spirit of co-operation, I would be happy to write to Sir Ian Diamond at the Office for National Statistics to encourage that, if the Welsh Government were willing to make that commitment. I do not know whether the Opposition would be willing to sign up to encouraging the Welsh Government to have that level of transparency. They seem reticent about having that transparency.

    Karin Smyth (Bristol South) (Lab)

    Going beyond the party knockabout, I think that the issue of statistics across the Union is a really important one, and I have raised it in the House many times. Can the Secretary of State tell us what the vacancy rate is in North East Cambridgeshire?

    Steve Barclay

    Well, it depends on what we are talking about. Are we talking about doctors or nurses? Are we talking about locums? Are we talking about the churn within care? There is a range of factors. The reality is that we do not have a major hospital in North East Cambridgeshire. We are served by four different hospitals, at King’s Lynn, Peterborough, Hinchingbrooke and Addenbrooke’s. Someone particularly interested in data would need to look across those ranges.

    Karin Smyth rose—

    Steve Barclay

    Let me make some progress.

    There is a fair list of omissions in the motion. It did not talk about how the Government are on track to deliver their manifesto commitment of 50,000 nurses by 2024, with nursing numbers over 32,000 greater than they were in September 2019, and the fact that there are over 9,300 more nurses and almost 4,000 more doctors than there were a year ago. There has also been a 47% increase in the number of consultants since 2010.

    Wera Hobhouse (Bath) (LD)

    The biggest problem for my constituents is access to GPs because there are not enough GPs in the system, so rather than talking about statistics, how can the Secretary of State make sure that my constituents can see a GP in time and not walk away in desperation because they cannot get an appointment?

    Steve Barclay

    I agree that it is not simply about statistics, but I think it is remiss not to point to the increase in doctor numbers, with 2,300 more in primary care—

    Karin Smyth

    Will the Secretary of State give way?

    Steve Barclay

    Can I just answer the hon. Member for Bath (Wera Hobhouse)? I have taken a number of interventions. The hon. Lady is intervening on an intervention.

    We must look at the increase in doctors in primary care of over 2,300, and we currently have over 9,000 GP trainees, but the hon. Member for Bath’s wider point is correct. It is not simply about the number of GPs; it is about ensuring that the wider primary care force operate at the top of their licence. It is also about access for patients, and avoiding the 8 am Monday crunch when lots of people make calls at the same time. That is why we are looking at the better use of telephony in the cloud and the latest that technology offers. It is also why we have the opportunity, through Pharmacy First, to make better use of what the pharmacists throughout our pharmacy network can do. It is about increasing the number of GPs, yes, but it is about the wider workforce, the use of technology and the use of different patient pathways, too.

    Another omission from the motion is that there are around 90,000 more GP appointments every working day, excluding covid vaccinations, than there were last year. When I hear people say that they cannot see their GP, it is worth putting it in context—[Interruption.] The shadow Secretary of State is chuntering again. Does he want to have another go?

    Wes Streeting

    I am surprised and grateful that the Secretary of State has given way. His position seems to be, “You’ve never had it so good.” People cannot get an appointment to see their GP, they are waiting for ambulances and they cannot get into A&E and be seen within a reasonable period of time, but under this Government patients have apparently never had it so good.

    Steve Barclay

    As the hon. Gentleman knows, I have been at pains to point to the huge pressure the pandemic has generated, which he seems unwilling to accept.

    In Wales, 60,000 people have been on a waiting list for more than two years, which is a huge example of what a Labour Government deliver in practice. Everyone recognises the huge demand for GP appointments, and there is no single solution, but GPs are seeing more people. Forty per cent. of appointments are booked for the same day, and almost 40% of patients have continuity of care.

    Paul Bristow

    Does my right hon. Friend agree that the £45.6 billion invested in health and social care is a phenomenal investment? The key to addressing the challenge is to make sure the money is spent wisely. If a Labour Government were in charge of making sure the money is spent wisely, with their record of wasting public money, it would be like putting Dracula in charge of the blood bank.

    Steve Barclay

    My hon. Friend raises an important point. The Government have increased the funding, which will be used in new, innovative ways to deal with the huge challenge we face as a consequence of the pandemic. That is why we have the elective recovery plan, on which we hit our first milestone over the summer in terms of two-year waits. We have rolled out 91 community diagnostic centres, which have delivered more than 2 million tests and scans.

    The workforce is, of course, a vital component of this mission, which is why the ambulance workforce has increased by more than 40% since 2010, but we recognise there are significant pressures, particularly as a consequence of delayed discharges, which are having such an impact on the wards and in A&E. That reads across into the challenge of ambulance handover delays.

    Margaret Greenwood (Wirral West) (Lab)

    I have spoken to nurses who tell me that, when they get to the end of a shift, insufficient staff arrive for the night shift, so they have to hang on. They are working extra hours without being paid because of the shortage of staff. What would the Secretary of State say to them? They are in such a stressful situation. They want to ensure the safety of their patients, but they simply do not have sufficient colleagues to do so.

    Steve Barclay

    The hon. Lady raises a fair point. Nurses are under huge pressure, and I want to say how much we respect and value the work they do. The pandemic has placed huge strain on the NHS, which manifests in the pressures staff face. I am ready to speak further to trade unions about many of these issues and their impact on staff—there are sometimes concerns about safety and staffing levels—and about how we can have better investment in tech and the NHS estate.

    I was up in Liverpool the week before last, and £800 million has gone into the Royal Liverpool Hospital. What a difference that is making to working conditions. We need to see more of that investment elsewhere. A range of things are contributing to the very real pressures staff face, which is why we have committed to investment in capital, both on the estate and in areas such as tech, which can make such a difference to working conditions.

    Karin Smyth

    Will the Secretary of State give way?

    Steve Barclay

    The hon. Lady has had a go, so I will make some progress.

    The hon. Member for Ilford North says that Labour would free up £3.2 billion by making changes in respect of non-doms—that was raised both at Question Time and in this debate. It will not surprise the House that the Opposition have now spent that money several times on their various pledges. His proposal ignores the fact that we need a tax system that is internationally competitive. His Majesty’s Revenue and Customs figures show that non-dom UK residents are liable to pay more than £6 billion in UK income tax, capital gains tax and national insurance contributions, so the proposal would leave us as a less attractive destination to people who, by their nature, are mobile and can go elsewhere. If they did, we would lose the tax they currently pay into the UK Exchequer.

    The hon. Gentleman criticises the Government’s track record on medical training places, but it is worth reminding the House that it was this Government who, in 2018, funded a record 25% increase in medical school places and, in doing so, opened five new medical colleges. Of course, it will take time for that to bear fruit, and the first of those students will shortly enter the foundation programme training. This is an important investment for the long term, and it is why we now have a record number of medical students in training.

    The motion covers nursing and midwifery placements. Here, too, we have seen progress, with more than 30,000 students accepting places on courses in England in the last year, a 28% increase compared with 2019. All eligible nursing and midwifery students will receive a non-repayable grant of at least £5,000 per academic year. NHS England has invested £127 million in the NHS maternity workforce and in improving neonatal care, on top of last year’s £95 million investment to fund 1,200 midwife posts and 100 consultant obstetrician posts.

    As well as developing talent at home, we must also look to attract talent from abroad. In a motion focused on workforce, it is interesting that there seems to be no mention of recruiting from overseas. People hired from overseas make a fantastic contribution to our NHS, as I hope the House would agree. Unlike the Labour party, the Conservative party recognises the talent that international doctors, nurses and care workers offer, which is why we have been doing more international recruitment. It is interesting that the motion does not seem to welcome that fact, and does not seem keen on more international recruitment.

    Wera Hobhouse

    Will the Secretary of State give way?

    Steve Barclay

    The hon. Lady had a go earlier, but I will let her have a final go.

    Wera Hobhouse

    Yesterday I had a meeting with the Royal College of General Practitioners, which raised the issue of overseas talent wanting to work here and stay here. The Government and the visa system are making that very difficult. The Secretary of State might want to talk to the Royal College of General Practitioners about that point.

    Steve Barclay

    As part of making things easier, I set up a taskforce in the Department over the summer to look at how we can increase the numbers. We have increased the number of nurses recruited internationally, and care workers are on the shortage occupations list. If there are particular issues that the hon. Lady wishes to highlight, I would be happy to look at them with her, but we are keen to attract talent.

    Wes Streeting

    For clarity, is it the Secretary of State’s position that we are turning away thousands of talented people who want to study medicine and other health professional courses because we do not need them as we are recruiting from overseas?

    Steve Barclay

    No, of course not. The hon. Gentleman knows that is not the case. It is a bit like when he goes around the media to charge the Government with refusing to talk to the unions. Simply misrepresenting our position is not a fair reflection of Government policy.

    The motion talks about workforce, and this Government have committed to increasing the number of international recruits in the NHS. The Leader of the Opposition seems to think we should not be encouraging that. That is the wider point to make. Of course, that sits alongside domestic recruitment, which is why, as I said a moment ago—again, the hon. Member for Ilford North has chosen to ignore this—we have had a 25% increase in medical undergraduate places, with five new medical colleges set up by the former Prime Minister, my right hon. Friend the Member for Maidenhead (Mrs May). That underscores this Government’s commitment to increasing the number of doctors in training.

    Chris Stephens (Glasgow South West) (SNP)

    The hon. Member for Bath (Wera Hobhouse) raised an important point about problems with the visa process, so will the Secretary of State outline what work he is doing with the Home Office to resolve some of these issues?

    Steve Barclay

    I discussed this issue with the Home Secretary this week: how we work together across Departments, not just on the visa system, but on other equities. For example, the amount of time spent by police on mental health is an issue of concern to not just the Home Office, but wider government. So there is scope across Departments to work more closely together and we are doing that, both on the issue of international recruitment, which is a key equity within the Department of Health and Social Care, and on mental health pressures on the police, which is an issue within the Home Office. That is how we are working more collaboratively across government, but we are clear that we are boosting the numbers in the short term while, in parallel, increasing the domestic supply of recruits, for example, with the boost in medical undergraduate places. We are also looking at what more we can do in areas such as apprenticeships: how we hire more nursing apprentices and boost supply through that as well.

    Finally, the motion does not reflect the pay uplift that was awarded, where the Government accepted in full the recommendation of the independent NHS Pay Review Body. More than 1 million staff have seen an increase of at least £1,400 in their pay. Of course, that comes on top of the 3% rise last year, at a time when pay was frozen across the wider public sector.

    Munira Wilson rose—

    Dr Luke Evans rose—

    Steve Barclay

    I will give way to the hon. Lady first and then to my hon. Friend.

    Munira Wilson

    One bit of feedback that my colleagues in outer London constituencies and I have had from health leaders in our area is that the high-cost area supplement, which is available for many inner-London boroughs but is not available for outer London boroughs, is causing huge problems with recruitment and retention. For example, somebody can earn £2,000 more for the same job in Wandsworth than they can in neighbouring Richmond or Merton. Health leaders are calling for a review of the high-cost area supplement, so is that something the Secretary of State is willing to look at?

    Steve Barclay

    The hon. Lady raises a fair point. That fund has been set up because there is an issue with how recruitment sometimes applies between different areas. We always face the challenge of where one draws that boundary, but I will of course look at specific data on any particular case she wants to raise. The fund is there more widely to recognise that often some areas—

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

    Steve Barclay

    I have said that I am going to give way to my hon. Friend the Member for Bosworth (Dr Evans), and then I am going to wrap up. As I was saying, sometimes there are areas where it is more difficult to recruit and we need to look at the data on that.

    Dr Evans

    When it comes to retention, pensions are a big issue, and the Opposition Front-Bench team have picked up on that. One recommendation from the Select Committee was to mandate for recycling to try to help with that. What other work is being done to try to ensure that senior colleagues with the most experience are incentivised to take on the extra lists and try to deal with the backlog, in all four corners of the country?

    Steve Barclay

    We are uniquely placed in having a Chancellor who has not only a deep understanding of health issues, but an understanding of recent Health and Social Care Committee reports. Obviously, that is an issue that we, with Treasury colleagues, will keep under review.

    The motion ignores the vital work that the Government are doing to back health and care, the £6.6 billion of investment in our NHS that was announced in the autumn statement, and the social care investment of £2.8 billion and £4.7 billion next year. This Government are investing in our health and social care. We have always put the NHS workforce first and we always will.