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  • Lloyd Russell-Moyle – 2022 Speech on World AIDS Day

    Lloyd Russell-Moyle – 2022 Speech on World AIDS Day

    The speech made by Lloyd Russell-Moyle, the Labour MP for Brighton Kemptown, in the House of Commons on 1 December 2022.

    I beg to move,

    That this House has considered World AIDS Day.

    I declare an interest as the vice-chair of the all-party parliamentary group on HIV and AIDS and honorary patron of the British HIV Association, and of course as someone who is personally affected by these issues.

    I thank the Backbench Business Committee for granting this debate to mark World AIDS Day. Every year, on 1 December, the world commemorates World AIDS Day. People from around the world unite to show support for people living with and affected by HIV, and remember those who lost their lives to AIDS. At 5.30 pm, I, among the community in Brighton, will read out the names of all the people who have died of AIDS in Brighton in the 40 years since the first death, as we do every year. Vigils such as that will be happening up and down the country: in London, in Birmingham, in Manchester, in Oxford, and in other places.

    This year’s theme is “equalise”. It is a recognition of the health inequalities that still affect far too many children, men that sleep with men, transgender people, drug users, sex workers and people in prison. Those are the populations most affected by HIV and AIDS in their respective countries; different countries might have different, more focused populations, but those are the groups. Fundamentally, however, the groups that are most at risk are people who are marginalised from healthcare, and that is what we need to equalise—that is what we need to sort out.

    This year marks the 40th anniversary of the death of the former Hansard reporter Terry Higgins, who died of an AIDS-related illness on 4 July 1982, and the creation of the now well-known Terrence Higgins Trust. On behalf of the APPG, I thank the Terrence Higgins Trust, not only for the work it has done over the past 40 years but for the work it keeps doing, pushing for us to have no new transmissions of HIV by 2030. That seems a remarkable target, but it is within our reach; it will help the estimated 106,000 people living with HIV in England that we know of. The work of the Terrence Higgins Trust, along with the National AIDS Trust and others, continues to lead the way, and I am delighted that the two organisations are working closer together. I hope that collaboration continues.

    Ahead of World AIDS Day in 2018, four years ago now, I spoke in this Chamber about my own diagnosis. I said then that World AIDS Day was

    “deeply personal to me, because next year I will be marking an anniversary of my own”.—[Official Report, 29 November 2018; Vol. 650, c. 492.]

    Now, of course, it is 14 years since I became HIV-positive. It has been a long journey, from fear to acceptance and to today, where I now play a role of advocacy, knowing that my treatment keeps me healthy and protects any partner that I might have, preventing me from passing on the disease. Since then, further developments have taken place in the fight against HIV/AIDS—many of them positive, but there have been some setbacks, which I wish to talk about in a bit.

    We have, of course, a HIV action plan in England, setting clear goals and milestones for achieving our target. Similar plans are set to be launched in Scotland and Wales—we hope they will come quickly. Last year’s HIV action plan for England sets out how we will achieve an 80% reduction in HIV infections by 2025, building to the end of transmissions by 2030. First, that plan will prevent new infections by expanding and improving HIV prevention activities, investing £3.5 million in a national HIV prevention programme up to 2024, and ensure that PrEP—pre-exposure prophylaxis—is expanded to all key groups. Secondly, it will scale up HIV testing in high-risk populations where uptake is low, and ensure that new infections are identified rapidly, including through the expansion of opt-out testing in A&E departments in areas of very high prevalence of HIV. That testing will be backed by £20 million over the next three years.

    Thirdly, the plan will ensure that, once diagnosed, people rapidly receive treatment. When I was first diagnosed, you waited until your CD4 count was below 200, which is when you can start to get infections and AIDS can start to be diagnosed. At that time, we did not know whether the drugs would cause continuing side effects; now, as soon as someone is diagnosed, they go on the drugs, because we know that they have very few side effects. Of course, each person has to get the combination that is right for them, because everyone reacts differently, but we have a good array of drugs with which to do that. That means that very quickly—within a matter of months—new people who are diagnosed can be undetectable, and can effectively go about their life without fear or favour. That is a remarkable change in those 14 years.

    Jim Shannon (Strangford) (DUP)

    I congratulate the hon. Gentleman, and commend him for his stance and leadership in this House—and, indeed, outside of this House—when it comes to HIV/AIDS and how to live with it, as he does. In Northern Ireland, which he did not refer to, the Public Health Agency has responsibility for this area. Its hope and ambition is to reach the target of eliminating HIV transmission by 2030, and it seems confident that it can do so, because of the PrEP that he has referred to. It is good sometimes to mark and record the things that are going well.

    Lloyd Russell-Moyle

    It is remarkable. If we achieve that 2030 target in this country, and if we then achieve a roll-out of it globally—that is a lot of ifs—HIV will be the first disease that we have rolled back via treatment and prevention, rather than vaccines. It would be a world leader, and hopefully a pioneer in how we can treat and test other diseases, particularly with mass testing, which I will come on to in a second.

    If all that happens, we will meet the 2030 target, but—as we always say—the Government need to do more. To start with, they need to expand opt-out testing. That has been trialled in areas with very high prevalence—that is, Brighton, London, Manchester and Blackpool. Not all of London was originally included in the opt-out testing, but it took the decision to expand that to all hospitals in London, sharing out the money. Remarkably, that has shown that, in non-high prevalence areas, the percentage of people coming back with an HIV-positive test is still significant. The argument, therefore, is to roll that out to all areas.

    Over the past 12 months, we have seen real successes in opt-out testing in England. That happens when somebody is already having their blood taken in A&E and the vial is sent off for an additional test. We are testing for HIV and hepatitis B, unless someone opts out. No one is forced to do this, but I understand that very few people opt out.

    The pilot’s results have been astonishing. In just three months, 102 people were newly identified, and 70 people were identified as having dropped out of treatment. If someone drops out of treatment, they are a risk not only to themselves, but to the wider community. Those people have been brought back into treatment and that has saved lives. The results are clear: opt-out testing is working.

    On a side note, it is also possible to test for syphilis with the same vial. However, it was not possible to expand this to syphilis, because syphilis testing is paid for by local authorities, not by NHS England, and the local authorities were unable to identify where people were from, because hospitals are not coterminous with local authorities and it was too complicated. That seems ridiculous. We need the Government to sit down with local authorities or to provide for that through central funding. If we are taking the vial, we can run it through the same machine. If the only reason stopping us is bureaucratic, I do not see why we cannot do this. We should test people routinely for as many things as we can, if we know that it will help people’s lives. We know that there is a spike in syphilis in certain key populations.

    If this vital programme is eventually expanded to all towns and cities with high prevalence, it will be a game- changer. Where London has expanded the programme, it has already been worthwhile financially in areas that do not have very high prevalence. The programme should also be expanded to sexual health clinics to ensure that everyone going to one is tested for HIV. This may be a surprise to many, but that is not always done routinely and it is not an opt-out system. Actually, an HIV test is becoming less, not more common, because more sexual health clinics are moving to online services. Online services have some great advantages, but one downside is that they require people to collect a vial of their blood, which often does not happen, or does not happen effectively, so HIV test rates are lower. We need to ensure that, when people attend a clinic, it is routine and there is an opt-out system. Some clinics do this already, but it is not universal.

    I spoke about the HIV prevention drug, PrEP, in 2018. We have a come a long way since the PrEP impact trial. To remind colleagues, PrEP, which is a pill that people take daily, contains two of the three drugs that someone with HIV would have. In fact, I have now been reduced to two because the latest evidence shows that, when someone gets to “undetectable”, the drug load for people who have HIV can be reduced to, effectively, just the PrEP load. The drugs will not be exactly the same as I take for PrEP, but some people can maintain on those as well. So this is also about new interventions that can reduce the costs and the amount of drugs that we are providing.

    PrEP prevents HIV and the pill is covered by NHS England, but thousands are still missing out. They are struggling to get PrEP appointments because of under-resourced sexual health services. That is laid bare in the latest report from the National AIDS Trust, the Terrence Higgins Trust, PrEPster, Sophia Forum and One Voice Network. Due to the fragmentation of services in England, the drug PrEP is paid for by NHS England. That is a real milestone for the NHS, and I congratulate the Government on getting that out eventually, after our interventions.

    Anyone who is currently sexually active should be tested by sexual health services every three months, and anyone on PrEP should be tested every three months. In theory, therefore, there is no additional resource for sexual health services for someone on PrEP, because the only people on PrEP should be those who are sexually active, or drug-injecting users who should also be tested, and so on—we should not give it to people who do not need it. But our sexual health services in this country rely on balancing the budget through the fact that people do not attend as regularly as they should. Therefore, that limits the places for PrEP appointments and limits the people who can get access to the drug that the NHS is paying for, even though they are entitled to it and should be offered that level of service.

    Awareness of PrEP is far too low and it cannot be given out by GPs, pharmacies, community or maternity services. That means that the burden is solely on local government-funded sexual health services. We all know what is happening with local government and probably do not need to go there today—that is a whole other debate.

    If we are going to meet our 2030 target, it is vital that everyone who is at risk of acquiring HIV and who wishes to access PrEP can do so as a key tool in completely and effectively preventing new HIV transmissions when it is taken as directed. Over the past two years, the all-party group on HIV and AIDS has published three important reports. We published “Increasing and normalising HIV testing across the UK”—which I just touched on—and “Nothing about us without us”, which addresses the needs of black, Asian and minority ethnic communities in the UK. Those communities are some of the hardest-hit by HIV in this country and are the least likely to have HIV testing done routinely. The roll-out and trial of the saliva HIV testing, which the Terrence Higgins Trust did two years ago and last year, was particularly effective in those communities. It was seen as less invasive, more private, easier to get hold of and possible to do through online and postal services. The Government should consider whether that process should be normalised nationally or provided cheaply and accessibly.

    Our other report, “HIV and Quality of Life—What do we mean? How do we achieve it?”, was published today, and my colleagues have been launching that in Brussels with our partners in Europe. Those reports have been made possible only through the evidence provided by the strong HIV sector that we have in the UK. Its continued insights and hard work are appreciated.

    The latest data, however, is not quite as positive. There were 2,692 people diagnosed across England in 2021. That is up 0.7%, from 2,673 in 2020. Some might say that is a small amount but, in 2022, there was a fall of 0.2% and, in 2019, there was a fall of 33%. We are clearly plateauing and there is a danger that we are starting to get more diagnoses. That might be positive because we are delving down to the hardest-to-reach areas, but we need more evidence on why that has plateaued and why it is creeping up before we can be sure that that is something to celebrate, rather than to be worried about.

    To keep on track, it is vital that we use every lever available to end HIV transmission and to ensure that we do not plateau, as the numbers show. As I said, we can end transmission by 2030 and I strongly believe that the UK will be one of the first countries to do so. We are a world leader. At the beginning of the week, I spoke to our London NHS colleagues, who said that it is the first time in their career that people have been phoning up from around the world to say, “How are you doing the opt-out testing? How are you doing the PrEP roll-out? We want to learn from you.” That is remarkable and we should be deeply proud of that. The head of UNAIDS came to London and Brighton and we showed her the HIV testing vending machines that we have in Brighton. She said, “I thought that I would never learn anything for the developing world from a rich country. I was here as a courtesy visit, but I have seen what you are doing and how we can roll that out to parts of Kenya and Uganda, and community settings around the world, with HIV testing vending machines that run using solar panels”.

    Patrick Grady (Glasgow North) (Ind)

    I congratulate the hon. Member on all his work on the issue. Global leadership is incredibly important. He might be coming on to this point, but does he share the disappointment felt by a lot of people in the sector and the wider international development sector—perhaps even the head of UNAIDS—about the cut in the UK Government’s funding for the Global Fund to Fight AIDS, Tuberculosis and Malaria? That risks exactly the kind of backsliding that the hon. Member warns us about.

    Lloyd Russell-Moyle

    I agree exactly. I will come on to the Global Fund at the very end of my speech, but let me move on now to the picture globally, which I am afraid is totally different.

    Back in 2018, I said that

    “one young person every day is still diagnosed with HIV and young people continue to suffer some of the worst sexual health outcomes.”—[Official Report, 29 November 2018; Vol. 650, c. 496.]

    The situation globally has become bleaker. Last year, an adolescent girl or young woman was newly infected with HIV every two minutes. In the past year alone, 650,000 people have died of AIDS-related illnesses and 1.5 million people became infected with HIV. Only half of children living with HIV have access to life-saving medication. Inequality between children and adults in HIV treatment coverage is increasing rather than narrowing.

    Why are people still dying unnecessarily of AIDS? Why are there so many new HIV infections year after year, globally? It is too easy to put the blame on current crises such as covid and war; the reality is that we were already off target before many of those crises hit. The lack of a comprehensive healthcare system, a lack of education and the growing influence of evangelical Christian churches in Africa—often American-backed—have led to an environment that is hostile to an effective HIV response.

    Uganda was the first country to host the world AIDS summit—it was a revolutionary leader. The same President is in power now, but has completely rolled things back. When Uganda hosted the world AIDS conference almost 30 years ago, condoms were given to every delegate and given out into community settings. When I went to Uganda only a few years ago to visit aid projects that we were paying for, I sat at the back of a classroom with Stephen Twigg, the then Chair of the Select Committee on International Development. We heard a teacher tell children that they could prevent AIDS if they washed the toilet seat and observed “sex only after marriage”. I am afraid that things have gone backwards because of the influence of some malign groups. It is concerning.

    One of the inequalities standing in the way of ending AIDS is access to education, particularly for young girls. Six in seven new HIV infections among adolescents in sub-Saharan Africa occur among girls who are outside formal education. Enabling girls to stay in school until they complete secondary education reduces their vulnerability to HIV by more than 50%. All children, including those who have dropped out because of covid and those who were out of school anyway, should get a complete secondary education, including comprehensive sex education.

    Caroline Nokes (Romsey and Southampton North) (Con)

    The hon. Gentleman makes such an important point. Does he agree that we cannot shy away from talking about sexual and reproductive health in the developing world, because that is the single most effective way to ensure that girls stay in school, stay not pregnant and stay free from diseases that will affect them in future? It is crucial that in our role as providers of international aid we do not step back from programmes that talk about contraception.

    Lloyd Russell-Moyle

    I totally agree. As dark forces around the world try, I am afraid, to withdraw money from programmes that talk in a rational and evidence-based way about sex and reproductive rights, we have a greater responsibility. We must step up, because if we do not, others will not. As the right hon. Lady points out, there are two sides to the coin: providing better sexual health education means that girls stay in school, and staying in school allows them to get better education about their health. Those are both positive things. Both issues need to be tackled together.

    Another inequality standing in the way of ending AIDS is the inequality in the realisation of human rights. Some 68 countries still criminalise gay men. As well as contravening the human rights of LGBT+ people, laws that punish same-sex relations help to sustain stigma and discrimination. Such laws are barriers preventing people from seeking and receiving healthcare for fear of being punished or detained. Repealing them worldwide is vital to the task of working against AIDS.

    Of the 68 countries that outlaw homosexuality, 36 are Commonwealth countries. The majority of Commonwealth countries are still upholding laws that we imposed and that never originated in the countries themselves. In fact, before British colonialism—British imperialism, I should say—many of those countries had better customs and practices around homosexuality than they do now. These customs and practices are not native to people’s home countries; they were imposed. They should be discarded with the shackles of imperialism, which we all now recognise was wrong. One in four men in Caribbean countries where homosexuality is criminalised have HIV. Globally, 60% of people with HIV live in Commonwealth countries. Collectively, we have a responsibility to tackle that in the Commonwealth. Barriers undermine the right to health: a right that all people should enjoy.

    Beyond the human rights implications, the laws criminalising homosexuality also have an impact on public health. LGBT+ people end up not seeking health services for fear of being prosecuted. Those who do seek health services often have to lie about how they were infected. Astronomically high numbers of people with HIV in Russia say that they were infected because they were drug-injecting users; that is widely believed to be partly because of the attitude in Russia that it is better to be a drug-injecting user than an LGBTQ person. Without accurately knowing the source of infections, we cannot accurately run public health programmes to save people. Putting people undercover in the dark, hidden in corners, means that the virus lives on. That is a danger for us all.

    In some countries, people living with HIV are at risk of being criminalised even when they take precautions with their sexual partners. That opens them up to blackmail and fraudulent claims from former partners. People with HIV in the UK are not immune to that either, as we have seen in some high-profile cases. We have known for at least 20 years that antiretroviral therapy reduces HIV transmission, and for the past few years we have known that it stops it completely, so there should be no doubt that a person with sustained undetectable levels of HIV in their blood cannot transmit HIV to their sexual partner, and laws should not punish them. However, under Canadian criminal law, for example, people living with HIV can be charged and prosecuted if they do not inform their partner about their HIV-positive status before having sex. The law does not follow the science, and it puts people at risk.

    Laws requiring disclosure perpetuate the stigma against HIV-positive people. With the advent of PrEP and with “Undetectable = untransmittable”, the law should now reflect the fact that everyone has a role in protecting themselves against HIV and everyone must step up. The criminalisation of drug-injecting users and sex workers has an equally negative effect on HIV prevention and treatment, as I have outlined, in LGBT communities. In all these areas, a health and human rights-based approach must be taken if we truly want to see the end of HIV.

    Beating pandemics is a political challenge. We can end HIV and AIDS by 2030 in this country, but only if we are bold in our actions and our investments. We need courageous leadership. We need people worldwide to insist that their leaders be courageous. That is why last month it was so disappointing not to see courageous leadership from this Government. The UK Government were the only donor to the Global Fund to Fight AIDS, Tuberculosis and Malaria to cut their financial settlement—by £400 million. The fund asked donors to raise their pledges by 30% this year, and almost all the G7 nations—which are suffering economic problems that are, in many respects, similar to ours; as the Government often remind us, this is a global crisis, not a crisis of their own making, although in our view it is a bit of both—increased their amounts. For decades the UK was the leader in the global response to these infections and diseases, but that is no longer the case. When our allies met the fund’s request for a 30% increase, the UK went for a 30% cut from their 2019 pledge.

    Anthony Mangnall (Totnes) (Con)

    I thank the hon. Gentleman—my friend—for making this speech; he is an extraordinary advocate in this area. However, I want to put on record the fact that the UK is the third biggest funder of the Global Fund. We have, to date, contributed just under £4.5 billion.

    The hon. Gentleman has said that we are leading the way in respect of our health and our treatment, and that other countries are following. This, too, is a commodity that can be traded and given to other countries. It is not always a question of the value of the money that we give, because we can trade skills, research and development as well. The hon. Gentleman knows where I stand on the development issue, but I think it is worth making that point.

    Lloyd Russell-Moyle

    The hon. Gentleman has been very good on development issues in the past, and I think he is right. He has also touched on the discussion about patents and patent waivers. There is a live discussion about how we can ensure that the poorest countries in the world can gain access to some of the frontline drugs. Long-lasting drugs are one of the latest innovations, with the possibility of either an injection or a set of, effectively, implants—I cannot think of the exact term off the top of my head—which would last for up to a month and a half. That is revolutionary, especially for those who have irregular access to health systems. The problem is that these are the most expensive drugs because of the way our patent system works; but they are also the most useful in the parts of the world that are hardest to reach. In the UK, most people have regular access to medical settings and can receive daily pill medication. The UK has not always been the very best when it comes to seeking patent waivers. We have done it in the case of many HIV drugs, but we should consider doing it more widely. That might be a good compromise, but we will then need to step it up.

    The UK’s decision on the 30% cut is, in my view, a disastrous decision, which stems from the Conservatives’ 0.5% cap on international development. Rather than considering that amount to be a floor and saying that it is the bottom of our ambition, the Government have said that it is the top of our ambition. Moreover, as a result of their insistence on including the Homes for Ukraine scheme, whereby we are housing Ukrainian people here in the UK, in that 0.5% cap, money is flowing out of the international development Department. International development—internationally spent money—should be 0.5%; that would enable us to fulfil many of our commitments quite easily. The additional aid and charity that we provide should be celebrated, but it should not be detrimental to others. This cut will result in the preventable deaths of up to 1.5 million people, and risk over 34.5 million new transmissions of HIV, TB and malaria. It will no doubt harm our credibility, and I hope we will reverse it as soon as we can.

    We in the APPG have the political will to meet the targets set by UNAIDS and the action plans for Wales, Scotland, England and, I was pleased to hear, Northern Ireland. We will continue to work with and challenge the Government in ensuring that they do the same, because it is time we stepped up and pushed for that final mile. When you are at the end of the race, you do not slow down; you speed up. This is a prize that we can win, so let us not allow it to slip through our hands. In the words of the former Prime Minister Boris Johnson, let us end the “dither and delay”. Let us end HIV/AIDS today.

  • Will Quince – 2022 Speech on Accountability in the NHS

    Will Quince – 2022 Speech on Accountability in the NHS

    The speech made by Will Quince, the Minister of State at the Department for Health and Social Care, in Westminster Hall, the House of Commons on 30 November 2022.

    It is a pleasure to serve under your chairmanship, Sir George. I congratulate my right hon. Friend the Member for Hemel Hempstead (Sir Mike Penning) on bringing this important debate to the House today. I know from our numerous conversations over the years that he is a tireless champion of healthcare provision, not just within his own constituency, and an advocate for instilling accountability and a learning culture throughout the NHS as a whole. Today, he has raised some difficult cases, albeit anonymised. I know the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Lewes (Maria Caulfield), who is responsible for patient safety, looks forward to receiving more information and will be happy to meet our right hon. Friend to discuss the cases further.

    I assure my right hon. Friend that this Government share his commitment to ensuring that the NHS delivers excellent care to all of its patients. We will never tire in striving to ensure that patient safety and high-quality care are at the heart of all patient care in our country. I am of the firm view that accountability for excellence applies at all levels of patient care, from the individual clinician caring for an individual patient through to Parliament’s role, as my right hon. Friend set out, in ensuring accountability for healthcare delivery by the NHS. It is essential that the commitment to excellence is central.

    My right hon. Friend rightly says that we love our NHS. Of course we do. However, we recognise that on rare occasions—not as rare as I would like—patient care falls short of the very high standards that we expect. He talked about getting answers for his constituents as a Member of Parliament. That is hugely important. I apologise that ministerial responses have not been as full as he hoped they would be. I will certainly look into that, because those responses are important. As a constituency MP, I too have cases from constituents who have raised concerns, either about their GP or their acute trust, and the level of service provided.

    My right hon. Friend rightly raises questions about why the NHS as an organisation does not more often simply say “sorry” when things go wrong. It is, as he says, a human business and things do go wrong.

    I hear what he said about ministerial responses. He is also right to say that Ministers are unable at present to respond to individual cases. There are reasons for that. As the hon. Member for St Albans (Daisy Cooper) and the hon. Member for Westmorland and Lonsdale (Tim Farron) said, the NHS is a complex organisation. We have NHS England, integrated care boards, integrated care systems, primary care networks, acute trusts, mental health trusts and ambulance trusts, and there is a question about whether Ministers or bodies such as NHS England and individual trusts should hold a level of operational accountability or delivery responsibility. That is a fair question, raised by the hon. Member for Westmorland and Lonsdale, but it is a tricky balance to reach.

    Ultimately, who is responsible for any failings within the NHS? Well, that is me. Who is responsible for delivery of services through the NHS? Not me. That position presents some challenges. Ministers have the ability to set the strategy at national level, but there is a big difference between the strategy, the approach, the culture and the leadership set in Whitehall and what actually happens at grassroots level at individual trusts. However, although I do not have direct operational responsibility, trust me when I say that every single day I am thinking about every single case where an ambulance is delayed and people have to wait too long; about all the 7.1 million people in our elective backlog, and about all those who do not get the excellent care that they rightly deserve and expect through our NHS. That is because I am the one who is responsible for that. I get the letters, and sometimes the responses are not as full as we would want, because I do not have at my fingertips all the information I need to be able to respond in the way I would like. We need to look at that.

    My right hon. Friend rightly says that most people do not want to sue or take legal action against our NHS. They are desperately sad about what has happened, and they may be disappointed or even angry, but that does not mean that they want to seek financial redress or sue a hospital trust. They know the implications of that—the money comes out of operational budgets.

    Having been the responsible Minister, I am acutely aware that we have an annual clinical negligence bill of £2.6 billion, which is huge. Understandably, I would rather spend that £2.6 billion on NHS frontline services. I have huge sympathy with my right hon. Friend’s view that we should collectively put our hands up, explain what went wrong and why, demonstrate how we are learning from that as an organisation, and clearly explain the steps that we are taking to put it right. We collectively as Ministers have a role to play in that. I will reflect on his comments and explore what more we can do.

    The Government have made significant strides to advance patient safety over the last decade. As I said, it remains a top priority not just for the Government but for me personally. We are creating a transparent learning culture across health systems. That is key to avoiding tragedies in the first place, and essential to driving the improvements that we want to see. As my right hon. Friend pointed out, patient feedback has to be at the heart of that. Patients have to have the opportunity to share their experiences.

    It is vital that clinicians reflect upon the lessons learned and translate them into opportunities to improve their practice. That is vital for not just the individual consultant, doctor, nurse or allied health professional, but the NHS as a whole. We have to listen and learn from individual patient stories. Accountability is a thread that has to run through every single level of the NHS—from individual patient complaints and the learning they generate to organisational responsibility for the standard of patient care, through to integrated care boards and the delivery of high-quality outcomes and access to care for their populations.

    The accountability owed to partner organisations and local patients is just as important as accountability to national bodies. As my right hon. Friend pointed out, that is why we passed the Health and Care Act 2022, which embeds the principle of accountability throughout the NHS and our health and care system.

    Sir Mike Penning

    The Minister is being generous in his comments to myself and to colleagues. The issue for colleagues and patients is that the over £2 billion bill, the delayed operations and the waiting lists would be remarkably smaller problems if we had addressed them right at the start. The biggest point, going back to my constituent, is that the wrong operation was done in 1986. That gentleman has been back and forth with the NHS, with help from myself and others, which must have cost the NHS a small fortune in legal fees. Instead of addressing the individual issue to stop it getting bigger, the NHS fobbed and fobbed it off and passed it back around.

    I know we are short on time and the Minister wants to conclude. My final point is that when Ministers send out letters, it is often the trust that we are complaining about that has drafted the letter to their officials, which actually ends up coming to us. In a classic example the other day, I was thanked for being so supportive of the refurbishment of Watford General Hospital, when actually I have opposed it for the last 20 years. The trust wanted to send that message to the Minister, rather than address what we needed to address, which is patient safety. The stress on patients in this particular case is huge.

    Will Quince

    My right hon. Friend is right that there is a lot more that we can do. Reflecting what he has just said, I will touch on some of the measures that have been put in place over recent years.

    In 2019 there was the NHS patient safety strategy. We introduced, for the first time ever, a patient safety commissioner. There is the Health Service Safety Investigations Body, which will be an arm’s length body from April 2023 and which was the brainchild of the Chancellor when he was Secretary of State for Health and Social Care. As my right hon. Friend pointed out, there has also been huge investment in maternity services following those awful cases, not just to boost staff numbers, but to improve leadership and culture. There have also been changes to the Care Quality Commission, with the single framework coming in from January next year.

    My right hon. Friend is absolutely right that some cases take far too long, especially some of the neonatal cases. Those are often the cases that result in the largest payments made, but it can take many years before patients and families get the redress they needed. The Health Services Safety Investigations body is designed to be far more upfront about where something goes wrong. It is much better to learn the lessons in the period immediately after something has gone wrong than several years after the event, looking back retrospectively on what could have been done differently. We need to learn the lessons now and ensure that as few patients as possible go through the same experience. Clinicians, not just within that trust but across the integrated care board, or, where appropriate, across our NHS, should learn those lessons.

    My right hon. Friend the Member for Hemel Hempstead has hammered home the point again about ministerial responses. I hear him, and I will speak with my hon. Friend the Member for Lewes to see what more we can do in that space. Those points are well made. However, it is difficult because of the number of NHS acute trusts and the fact that we rely on information about what happened on the ground. It is a huge and complex organisation, but I understand, recognise and take his point that ministerial responsibility and oversight is important.

    We need to know the facts, and not just the facts as they are presented by a trust, in whose interest it might be to paint a rosier picture than it actually is on the ground—or to not paint the full picture. That is why it is so important that Ministers engage with local Members of Parliament to get the facts. They are the ones who are meeting with the trust executives and the board, as well as their constituents and the clinicians and health professionals on the ground delivering care, who will often—for want of a better word—whistleblow about what is actually happening in a trust, and not give the rose-tinted view that the executives of a trust may want.

    This has been a hugely important debate. It speaks to issues that are at the heart of our NHS. It is about getting it right first time and the excellent and consistent patient care that we rightly expect from our NHS. I hope, to some extent, that I have assured my right hon. Friend the Member for Hemel Hempstead of the importance that the Government place on quality, excellent patient care and accountability. His points have been well made. I will reflect on them, as will my hon. Friend the Member for Lewes. I look forward to working with him to improve the situation across our NHS.

  • Mike Penning – 2022 Speech on Accountability in the NHS

    Mike Penning – 2022 Speech on Accountability in the NHS

    The speech made by Mike Penning, the Conservative MP in Hemel Hempstead, in Westminster Hall, House of Commons, on 30 November 2022.

    I beg to move,

    That this House has considered accountability in the NHS.

    It is a pleasure to serve under your chairmanship, Sir George. I called this debate on accountability in the NHS. As a nation, we love our NHS which does a fantastic job for us, day in, day out. However, like any human being or organisation, sometimes it makes mistakes. When the NHS makes mistakes, the process of trying to get an apology or a mistake rectified is invariably a bureaucratic nightmare.

    I have a couple of examples I would like to raise. I have permission from one to use their name, but I probably will not do so, because I will yet again pass correspondence to the Minister. I appreciate that the Minister here, my hon. Friend the Member for Colchester (Will Quince), is not responsible in the Department for this subject. The relevant Minister, my hon. Friend the Member for Lewes (Maria Caulfield), is on the Floor of the House answering questions, and I thank this Minister for explaining why she is not here.

    We in Parliament are here to speak up for those who sometimes cannot speak up for themselves. When something goes wrong, Sir George, you would think we could get answers for constituents and get matters rectified, but within the NHS there is a lack of ministerial accountability, which I will come to in a moment. The complaints procedure eventually ends up with the ombudsman, but it takes for ever. There is a feeling in my constituency that, when things go wrong, the longer the process can be delayed, the more people will just accept what has happened. In some cases, they will sadly not be around any more. For their families and loved ones, this short debate is very important.

    Probably the most dramatic example for me, not of the physical effects of surgery but of the effect on someone’s life, concerns one of my constituents. The NHS decided in 1986 that he needed an operation on his nose, but the operation that took place was not the one that was supposed to. I will use the language: it was botched. It was probably not intentional; it was a mistake but, to this day, that has had detrimental effects on his quality of life.

    My constituent tried to go through the process of getting it rectified. I have tried to find out what was going on. He has pushed from pillar to post by different trusts: University College London and West Hertfordshire. I have written to previous Ministers over the years, only to be told that Ministers do not interfere in individual cases. I accept that but, when we reach a situation where there is nowhere else to go, ministerial accountability is important.

    Tim Farron (Westmorland and Lonsdale) (LD)

    I am grateful to the right hon. Gentleman, not least for the sensitivity of the issues he is raising. Ministers under Governments of all colours have sought to keep NHS operational matters at arm’s length. Does he agree that that reduces accountability and effectiveness? I am thinking more generally about the current huge backlog in cancer diagnosis and treatment. I do not see any direct and urgent Government intervention. Does the right hon. Gentleman think that is partly the result of the lack direct operational accountability for Ministers to the service?

    Sir Mike Penning

    I thank the hon. Member for his intervention. We have seen during covid that, actually, when things get really bad, Ministers can step in and Prime Ministers can step in, but when we talk about individual cases, they cannot.

    In the case I am referring to, I ended up writing to the Minister, to be told to go to the ombudsman. I got fobbed off by the ombudsman, after we had been to the trust three or four times. I then wrote to the Minister again—this is over the course of years—to be told to take legal advice. This particular person has now been told, “Go back to your GP and get them to re-refer you if you’ve still got problems.” He has problems because they did not do the operation properly in the first place, and it has had a massive long-term effect on this gentleman’s quality of life.

    That is not the only case. I have been here for nearly 18 years, and I worked for a Member of Parliament for many years before that. In every constituency, this sort of case is brought before the MP. I have another example. Last summer, in the middle of heatwave in July, when the temperatures were unbelievably high, a very vulnerable young lady was brought in for a scan at my local hospital. She is the most vulnerable young lady. Her mother cares for her 24/7. She has carers in. She is a wheelchair user or bed-bound. She was left on a trolley in the heat for five hours when her ambulance did not arrive.

    When I contacted the trust and said, “What happened there?” it blamed the ambulance trust. When I contacted the ambulance trust, it said, “No, it was cancelled by the trust—it was their fault.” I do not care whose fault it was. It was the NHS’s fault that this happened to a very vulnerable young lady. She had no drink and no food. She was very, very ill. The ambulance trust said that the return journey was cancelled because she was so poorly on the trolley—well, she was so poorly because she had been left there for five hours!

    Trying to get to the bottom of what happens within the NHS when something goes wrong is so difficult. We have seen terrible situations in maternity services and in trusts around the country. These problems need to be addressed early on, instead of the drawbridge being brought up and people having to go through a massive complaints procedure where they have to complain three times before going to the ombudsman, and then the ombudsman will say it is out of time, and if they are not careful, they cannot go to court because that is out of time too. Is that the way we want our NHS to be seen by the public, who love the NHS?

    The NHS sees the NHS as a single entity. As MPs—and I was a shadow Health Minister for four and a half years—we understand that it is not a single entity. It is a set of silos where everybody passes the buck back and forth. What we need is joined-up thinking. When Members like myself write to Ministers about these issues, the answer is not to say, “Nothing to do with me, guv” and pass it down the line to the ombudsman or a lawyer. That surely costs more money and does not put the NHS in a particularly good light with my constituents who have had their operations botched

    Jim Shannon (Strangford) (DUP)

    I congratulate the right hon. Gentleman on securing the debate. He talks about silos, and I want to give him an example of that in my constituency. Many people await their care packages in order to be released from hospital and get better at home. On the other hand, there are people waiting urgently for hospital beds who cannot get one. Does he agree that there must be greater communication between trust managers and social care workers to ensure efficiency of care in the community, which would free up hospital beds and allow people to be treated quicker? In other words, we should do away with the silos and get things co-ordinated.

    Sir Mike Penning

    I completely agree with the hon. Gentleman. I know that right next to my constituency, my hon. Friend the Member for Watford (Dean Russell) goes to Watford General Hospital and looks at the boards to see whether people can medically be discharged, but they cannot because there is a lack of joined-up thinking.

    This is different. This is about the need for the NHS, when it may or may not have made a mistake, to address it full-on at the start. It should not draw up the drawbridge, with people having to go through the long, drawn-out procedure of making complaints and going to the ombudsman. For a Minister to say to a colleague and fellow MP, “Perhaps this person needs to take legal advice,” is not the attitude we should have towards people who have done the right thing. The NHS has said that they should have an operation, and the NHS has mucked up and botched—I use that word under privilege. At the same time, the person’s life has been detrimentally affected for years and years to come.

    I know the Minister is not the Minister responsible, but because we are all constituency MPs, I guarantee that before he was in his position, people were at his surgeries or wrote to him to say, “This happened to me within the NHS. What can you do to help me do something about it?” Somewhere along the line, perhaps the short debate we are having today will nudge the Department of Health and Social Care and the Government —I was a Minister in several Departments—to look at ministerial oversight.

    Daisy Cooper (St Albans) (LD)

    The right hon. Gentleman is making a fantastic speech. In the light of this week’s shocking reports from Byline Times about the amount of sexual abuse and rapes that have occurred in hospital settings, does he agree that to improve accountability, we need the Government not only to urgently repeal the five-year rule, which limits some people from making complaints to the NHS, but to have clear, systematic and consistent data collection on all sexual misconduct across all hospital settings?

    Sir Mike Penning

    As usual, I agree with the hon. Lady. We do not agree on everything, but we agree on 99% of things.

    This is the crux of the matter, and there are two real issues here. In the case that I spoke about earlier, which goes way back to the ’80s, the gentleman’s mental and physical health has not been great. Other people, including the extreme examples alluded to by the hon. Lady, may be mentally affected in a way that I and many of the people in this room probably cannot understand. To have a block exclusion post five years seems so arbitrary in the modern world. The Government really must look at whether there should be an arbitrary rule and perhaps leave it to others to decide, rather than setting down in regulation the exceptional circumstances that might well have been in place. Trusts do have delegated powers—many more powers than I think they should have—and I know the new Act will help that, but it does not take into consideration the points that we have tried to raise in this morning’s debate.

    If we had this debate on the Floor of the House, I think we would have a full Chamber of colleagues. Rather than talking down the NHS, they would be saying, “When things go wrong, we need to address them.” When I was Police Minister, there was a big mistake under my portfolio, and I went before the House, explained that mistakes were made on the funding formula and put my hands up. I took a lot of flak for that, but it was a way to address things going forward. With the NHS being such a massive organisation, and an organisation that the public want to be able to trust, it must be better for us to address the issues at the start of a complaint.

    The Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Lewes, did not write the letter that I mentioned; it was written by her officials, who desperately want to defend the NHS. The complaint was not about the NHS in general; it was about a specific issue that we need to address. We are all here as Members of Parliament because we are supposed to represent the taxpayer—representation through taxation. I should be able to represent my constituents in that way without being told to go to the ombudsman. I know I have to go to the ombudsman, because I have been here a very long time, so I am capable of working that out. I am also capable of working out that we are outside the time limit, given the five-year rule.

    We need a change of mindset. I do not want individual Ministers to say, “This operation should take place, that one shouldn’t, and the hospital should have this number of wards”, but there has to be ministerial oversight when things go well, and when things go wrong.

    My constituent has given me permission to raise his case. I think it would be more useful not to put his name on the record here, but I will pass another letter to the Minister, which I hope might get a little more positivity when the Minister responsible writes back to me, rather than a response that fobs us off and says, “Please go away.”

  • Marsha De Cordova – 2022 Speech on the National Eye Health Strategy

    Marsha De Cordova – 2022 Speech on the National Eye Health Strategy

    The speech made by Marsha De Cordova, the Labour MP for Battersea, in the House of Commons on 29 November 2022.

    I beg to move,

    That leave be given to bring in a Bill to require the Secretary of State to publish a national eye health strategy for England; and to require that strategy to include measures for improving eye health outcomes, for reducing waiting times for eye health care, for improving patient experiences of eye health care, for ensuring that providers of eye health care work together in an efficient way, for increasing the capacity and skills of the eye health care workforce, and for making more effective use of research and innovation in eye health care.

    The Bill would ensure that regardless of where one lives, everyone can access the right care where and when they need it, eliminating the postcode lottery and addressing the inequalities in access to eye care services. An estimated 2 million people are living with sight loss in the UK. We rely on our eyes every day, yet we do not give much thought to our eye health until our vision changes.

    A report earlier this summer showed that 17.5 million adults in the UK had not had an eye test in the past two years, as recommended. Anyone can be impacted by sight loss, and Members from across the House will have hundreds of constituents affected. Fifty per cent. of all sight loss is avoidable and 250 people begin to lose their sight every day, with a shocking 21 people a week losing their sight due to a preventable cause.

    Eye care services in England are under intense pressure due to huge backlogs as a result of the pandemic, demand from an ageing population and low recruitment and retention of all groups of the ophthalmology clinical workforce. More than 650,000 people are on the waiting list in England, of whom 37% have been waiting for over 18 weeks and over 4% have been waiting for more than a year—that is, 26,000 people who have been waiting for more than 12 months to see a specialist.

    Ophthalmology has been the busiest NHS out-patient clinic for the past three years. Delays to diagnosis and treatment can lead to a complete loss of sight. For example, patients with age-related macular degeneration can experience rapid and sometimes complete central vision loss within weeks if not treated. As well as the social and emotional impact of sight loss, there is a huge economic cost to the UK economy, which is estimated to be £36 billion annually.

    To respond to the crisis in eye health, the Government can commit to implementing a national eye health strategy for England that would include measures to improve eye health outcomes, reduce waiting times, improve patient experiences, increase the capacity and skills of the workforce and make more effective use of data, research and innovation.

    In the first instance, the Government could seek to appoint a single Minister with responsibility for eye health rather than having the current situation where multiple Ministers are responsible.

    The strategy should include the following areas. First, there should be an eye health and sight loss pathway to require care and support for those with sight loss, focusing on the provision of non-clinical community support to complement the work of community optometrists, ophthalmologists in hospitals and rehab officers. The pathway must focus on the physical and emotional impacts of being diagnosed with sight loss, as research has shown that people affected are likely to experience poor mental health lifetime outcomes such as depression and anxiety. It should not only address geographical eye health inequalities, but ensure more equity of access to eye care among communities and populations more at risk of being unable to access NHS sight tests, including people who are homeless and people with a learning disability.

    The second area is to improve connections between primary and secondary care, with an emphasis on integrated care systems and on improving the relationships and collaboration across the two services so that they can work more effectively together while ensuring timely and accurate referrals. That would significantly improve patient experiences and health outcomes.

    The third area is workforce expansion. Limited capacity is a particular concern in eye care because there is a significant shortage of eye doctors. Back in 2018, the Royal College of Ophthalmologists revealed that 434 additional specialist posts were required to meet demand, and we know that the situation is now even worse. The World Health Organisation’s Workforce 2030 plan recognises the fundamental role of the workforce in improving health outcomes. A national strategy for eye health must address that issue, placing emphasis on the recruitment, training and upskilling of medical and non-medical eye health professionals.

    The fourth area is health intelligence and data. Meaningful action starts with good-quality data, but for too long population data has not been used effectively to pinpoint the location of need and places where opportunities for change can be found. A strategy should involve focusing on robust data collection to inform decisions and improve the delivery of the service. Advances in research and technology, from how people are diagnosed to how they receive treatment, must be incorporated. Effective and efficient methods are available, but they are not being used. A strategy would change that.

    Finally, the fifth area is raising awareness of eye health by creating better public health messaging. Nearly 2 million people each year turn up at an accident and emergency department or try to get a GP appointment for a problem that could be dealt with by visiting a community optometrist. We need campaigns to raise awareness of the importance of maintaining good eye health and to educate the public on the differences between eye screening and eye tests, along with improved signposting on where to go for help, should one need it.

    Health strategies have delivered positive outcomes in Scotland, as they have in England for other diseases, but at present England is the only country in the UK without an eye health strategy. It is important to note that for such a strategy to be successful and of value, it must be designed in collaboration with stakeholders, including blind and partially sighted people, civil society groups, care providers and the industry. It must also have sufficient resource and investment.

    Given the scale of the problems, it is in the Government’s interest to commit to a strategy. The benefits would transform lives, alleviate pressures on the health service and reduce economic costs. We should make it our goal to ensure that no one loses their sight unnecessarily. I thank everyone who has contributed to the Bill, including the partnership The Eyes Have It, the Thomas Pocklington Trust, industry leaders such as Specsavers and Roche and, most importantly, people living with sight loss. The sector has been united in the call for a national eye health strategy. It is time for the Government to act.

    Question put and agreed to.

    Ordered,

    That Marsha De Cordova, Kate Osamor, Bell Ribeiro-Addy, Sir Stephen Timms, Rosie Duffield, Janet Daby, Kim Johnson, Ian Byrne, John McDonnell, Clive Lewis, Dr Rupa Huq and Jim Shannon present the Bill.

    Marsha De Cordova accordingly presented the Bill.

  • Alan Brown – 2022 Speech on Government PPE Contracts, Michelle Mone and PPE Medpro

    Alan Brown – 2022 Speech on Government PPE Contracts, Michelle Mone and PPE Medpro

    The speech made by Alan Brown, the SNP MP for Kilmarnock and Loudoun, in the House of Commons on 29 November 2022.

    Alan Brown (Kilmarnock and Loudoun) (SNP)

    I am sure that many MPs on this side of the House had no idea that a VIP lane existed for PPE contracts, but even if I did know about a VIP lane for referring contracts, if a constituent came to me and said, “Alan, I have never worked in a PPE environment. I’ve never ordered it before, but I’ve got a great plan. I can order it from China. Just refer me to a Minister”, I would not have done that because it would be impossible to do proper due diligence. So it beggars belief that this Government accepted recommendations from companies with no involvement and no expertise in PPE contracts, and still awarded these billions of pounds of contracts. Instead of mediation with PPE Medpro, is it not the case that a full investigation is needed and, if the Government are not going to do it, surely we need a public inquiry into PPE procurement.

    Neil O’Brien

    We are prepared to litigate whenever a company did not provide. There is a process, which I set out earlier. In many cases, there were people who did have important contacts in China and in other countries where PPE was being produced, and it was important to pursue all those leads because we needed to have that. But, to the hon. Gentleman’s point, due diligence had to be done and was done on all those cases in the same way. I have talked about the scale of the challenge and the 19,000 companies on which due diligence was initially done, and the huge drop-off between that number and the 2,648 companies that actually made it through that filter. So we can see in the difference between 19,000 and 2,648 that there was a huge amount of filtering done by the team of 400 people who were working so hard to try to get the PPE that we needed to the nurses and doctors in our NHS.

  • Peter Grant – 2022 Speech on Government PPE Contracts, Michelle Mone and PPE Medpro

    Peter Grant – 2022 Speech on Government PPE Contracts, Michelle Mone and PPE Medpro

    The speech made by Peter Grant, the SNP MP for Glenrothes, in the House of Commons on 24 November 2022.

    Peter Grant (Glenrothes) (SNP)

    My colleagues on the Public Accounts Committee are at an important evidence session this morning, otherwise I have no doubt that many more of them would be here. The report on PPE contracts, which was unanimously agreed by the Committee earlier this year, stated:

    “At no point was consideration given to the extent of the profit margin that potential suppliers would be taking on payments for PPE. Neither was consideration of any potential conflicts between individuals making referrals through the VIP lane and the companies they were referring. We”—

    the Public Accounts Committee, unanimously—

    “are therefore unsurprised to see the reports of excessive profits and conflicts of interest on PPE contracts.”

    Yet if today’s Guardian reports are correct, the extent of lobbying of Cabinet Ministers, one of whom is back in the Cabinet, by a senior Conservative politician went significantly further than the Public Accounts Committee was aware of at the time. Can the Minister confirm that the reports of additional lobbying in today’s Guardian are accurate and, if they are not accurate, can he come back with a statement to confirm that?

    Neil O’Brien

    I read the same article as the hon. Gentleman. I notice that it did not lead to a contract—the case that was mentioned in The Guardian—but more generally, absolutely, there are many lessons to learn about this process. However, we were having to pay, in some cases upfront, for PPE because, as part of the global scramble for PPE that I have described, if we were not prepared to go that extra mile, we would simply not have had the PPE and we would have had more nurses without the vital protective equipment that we all needed.

  • Geraint Davies – 2022 Speech on Government PPE Contracts, Michelle Mone and PPE Medpro

    Geraint Davies – 2022 Speech on Government PPE Contracts, Michelle Mone and PPE Medpro

    The speech made by Geraint Davies, the Labour MP for Swansea West, in the House of Commons on 24 November 2022.

    Geraint Davies (Swansea West) (Lab/Co-op)

    The Welsh Labour Government received £874 million for PPE as its population-proportionate share, but spent only £300 million—about a third of the money given. That suggests, says Cardiff University, that the UK Government could have saved £8 billion, or £300 a household across the UK, had they used public authorities, health authorities and councils instead of private profiteering contractors known to Ministers. Will the Minister look carefully at the Welsh model and, in future, use the public sector rather than private sector cronies known to Ministers such as the former Health and Social Care Secretary, the right hon. Member for West Suffolk (Matt Hancock), who is out in the jungle making more money for himself?

    Neil O’Brien

    Inevitably, a huge amount of the PPE that is produced in the world is produced by private companies. There is no world in which we could avoid the use of private companies to supply PPE.

  • Steve Barclay – 2022 Speech at the Spectator Health Summit

    Steve Barclay – 2022 Speech at the Spectator Health Summit

    The speech made by Steve Barclay, the Secretary of State for Health and Social Care, in London on 28 November 2022.

    In the Autumn statement – alongside difficult decisions designed to tackle inflation and keep mortgage rises down – the Prime Minister and the Chancellor made a clear commitment to public services, increasing the NHS budget by an extra £6.6 billion over the next two years and increasing funding for social care by £2.8 billion and £4.7 billion in each of the next two years. So, combined, £8 billion going into 2024.

    That recognises that what happens in our health and care system has a big impact on the wider economy.

    I’m pleased that investment and prioritisation was well-received within the NHS itself, with Amanda Pritchard, the NHS chief executive, welcoming our decision to prioritise health and the NHS Confederation calling it a “positive day for the NHS”.

    But with that financial package a key part now of my job is to make sure those funds are spent effectively.

    That means tackling the pandemic backlogs, operations, access to GPs, and urgent and emergency care. I’m sure this audience recognises that a big part of the challenge we face both with ambulance handovers and in A&E is shaped by what happens with delayed discharge – those patients who are fit to leave hospital but are often still in hospital for many days further.

    Now, efficiency within the NHS is often seen through the lens of finance.

    So, the case I want to make today is that efficiency is not just a finance priority – it’s a patient priority too.

    Because efficiency is an indicator of wider system health.

    An efficient system addresses bottlenecks that delay patient care by designing new journeys for patients that avoid those delays.

    Because quicker – and therefore earlier treatment – will lead to better patient outcomes whether that is from earlier cancer diagnoses, with the announcement a couple of weeks ago on direct access for GPs, or on antibiotics – getting the right antibiotic first time, rather than the third or fourth time. Obviously bringing significant patient benefits, but it is also efficient in terms of cost.

    So an efficient system will get better treatment to the patient and improvement patient outcomes, but in doing so, it will also unlock value for money.

    And for this to happen, we need to move to more personalised care – we can already see examples of this taking shape.

    During the pandemic, people got used to the idea of a Covid test being sent to them at home. Home testing offers the opportunity for patients to be tested for specific things, even before they realise they have the symptoms, enabling them to get care at a much earlier stage than what would have traditionally been the case.

    That kind of fast-tracking is not only potentially life-saving but it also will mean that the NHS over time will pay less for that care.

    Another example is what we set out in the Women’s Health Strategy around one stop shops, enabling women to access a range of services on a single visit. Not only do you improve the speed of care, but we also improve its effectiveness whilst delivering that at a lower cost.

    So we know whether through the Women’s Health Strategy, through Community Diagnostics Centres, through surgical hubs, we can deliver care in different ways – where the treatment is delivered to the patient at an earlier point than is currently the case, but in turn will unlock better value for money.

    And that requires us to think differently about the mix of services. Let me give you an example in terms of Pharmacy First. Pharmacist First you would have thought, in the name, would involve the pharmacy being indeed first, and yet, quite often, the patient goes to the pharmacy before the GP programme referral, suggesting the scope to further streamline the process.

    So, in short, quicker access to treatment means addressing bottlenecks, delivering new pathways, and in doing so, unlocking better outcomes for patients.

    But for this to really take root, we need to be open about our attitude to risk and our risk appetite.

    Currently, I believe the NHS scores the risk of innovation too highly when compared to the risks of the status quo and I think that needs to be recalibrated.

    This is because innovation tends to be judged, in isolation, in a silo.

    Take for example the risks around the introducing machine learning.

    On its own, it may carry some risk. But that risk should be judged against the risk of the status quo, where there may be long delays due to staff shortages, and so the speed of treatment and the ability to better target valuable resource needs to be weighed as part of the risk assessment of that innovation.

    So, we need to be scoring innovation risk within a much wider context than simply looking at it in a silo.

    And as we change our risk appetite for innovation, we also need to change our risk appetite for transparency.

    Because only when we’re transparent about the challenges we face will we empower greater patient choice, particularly in the context of vested interests which are inevitable in a budget of £182 billion.

    It’s also why we need senior clinicians to lead that change too.

    And why I’m so pleased that Professor Sir Tim Briggs – one of the country’s most highly regarded orthopaedic surgeons is taking up his new leadership role as Clinical Lead for the Elective Recovery Programme working closely with Sir Jim Mackey, one of the country’s most respected hospital CEOs.

    Now, one shared point of understanding must be the scale of the Covid backlog, with around now 7.1 million patients.

    We must also be transparent coming out of Covid around excess deaths.

    For example, we know from the data that there are more 50 to 64-year-olds with cardiovascular issues.

    It’s the result of delays in that age group seeing a GP because of the pandemic and in some cases, not getting statins for hypertension in time.

    When coupled with delays to ambulance times we see this reflected in the excess death numbers.

    In time, we may well see a similar challenge in cancer data.

    I want us to innovate around challenges like this.

    We already know that GPs are under pressure. So what else can we do by way of innovation?

    Well, let me give you just one example – we could think about how employers can help us better reach those who might otherwise not come forward?

    So, by being more transparent around who to prioritise on excess deaths, I believe we can engage employers and different ways of reaching key groups.

    When we are collectively understanding the challenges, it becomes easier to find the solutions.

    We also need to be clear about some of the demographic headwinds we face too.

    We have an ageing population.

    By the end of this decade, there are projected to be over four times as many people aged over 80, as a proportion of the population, that there were around the time the NHS was set up.

    On average, treating an 80-year-old is four times more expensive that treating a 50-year-old.

    And as proportion of the population, we have fewer working people to pay for healthcare.

    Around the time the old age pension came in over a century ago in England and Wales, we had 19 people aged 20 to 69, for every person over 70.

    Today that figure is down closer to 5 to 1.

    At the same time, healthcare continues to become more expensive.

    But in the face of such headwinds – from an ageing population or on the legacy of the Covid backlogs – it’s important we also focus on where we have the ability to turn the tide.

    Today I want to pick out on just two of those:

    The expansion of life sciences – and the promise of new treatments and the embrace of technology and the better use of data.

    As today is Life Sciences Day, that’s where I’ll start.

    When we published our Life Sciences Vision last year we also launched ambitious missions, from dementia to vaccine discovery.

    And I’m pleased that we’re seeing four more missions on cancer, obesity, mental health and addiction – and we’re backing those with £113 million of new funds.

    It’s an example of how we’re turning our country’s cutting-edge research capabilities onto the biggest healthcare challenges that we face and doing so in a way where the British people can really experience the benefits.

    And these missions will continue to benefit from the incredible life sciences ecosystem we have built here in the UK, from the MHRA, to NICE, to the NHS.

    And just this morning, that powerful collaboration has seen us give the go ahead to a new life-extending treatment on the NHS for patients with advanced stage prostate cancer. It’s another example of how that ecosystem is working for the benefits of patients.

    Another increasingly important part of that ecosystem is Genomics.

    Whilst Genomics England has been in place since 2014, there is scope to bring forward and apply their science more directly to the immediate challenges the NHS faces, rather than Life Sciences being seen as uneventful research that will emerge in a number of years’ time.

    Genomics in particular offers significant hope to rare diseases, often the diseases that receive less treatment.

    Life sciences offers scope to get the medicines, the right drugs, first time.

    By using genetic insights, we can discover the unique “signature” of a cancer tumour and make sure each patient gets the best course of treatment for them.

    The second area that I wanted to bring up this morning in terms of meeting those headwinds is around tech and big data.

    We are at a historical moment where we have the ability where patients consent to generate big data through the internet of things through new MedTech and wearables.

    We can achieve it because, over the last decade, the cost of computer chips has come down exponentially helping us generate more valuable data, with the ability to store it safely, cheaply and securely in the cloud – which has also increased significantly.

    That in turn combines with machine learning, where we have a new capability to analyse it.

    Generate. Store. Analyse. All of which have been transformed in recent years.

    This is a virtuous triangle that unlocks our ability to move to a more personalised form of care.

    It’s also yet another area where efficiency will actually equate to better patient outcomes, enabling funding to go further.

    Just as genomics can help create more bespoke treatment – like those examples I gave on drug resistance and cancer, so can data.

    And I will encourage the safe and secure sharing of data through the NHS for those patients who consent so that patients can play their part in life-changing medical breakthroughs and become the beneficiaries too.

    Now, we can see this spirit in action with the new Our Future Health research programme, which was launched last month.

    It aims to find new ways to prevent, detect and treat disease.

    Three million people have been invited to join the programme, which will eventually recruit five million or more people from all walks of life.

    Now, throughout the pandemic, the British public showed their willingness to play their part and be part of the solution.

    And it’s great to see them doing so again in our fight against diseases like diabetes, Alzheimer’s and many more.

    Anyone can sign up – so, and I use this as an opportunity for a plug, just go and Google Our Future Health and register online.

    The programme also reflects an innovative new model of funding.

    While about £80 million of the programmes’ funding comes from the UK government another £160 million comes from life sciences companies.

    So, it’s a great example of public and private coming together to strengthen the NHS and help lift some of the burdens of late-stage disease.

    The final thing I want to reflect on this morning is what this embrace of technology and data can achieve for our mental health.

    The pandemic saw us move online like never before – and mental health provision was no exception.

    Our services rapidly adapted to provide patients with support through video consultations, digital models of therapy and self-management apps.

    I know that for patients, it presents a number of advantages, with greater flexibility to use resources at evenings and weekends and greater anonymity too.

    So it’s exciting to explore the future possibilities of technology in the treatment and support of metal heath conditions – from common conditions like depression and anxiety to more complex conditions like eating disorders ad bipolar disorder.

    I recognise that much of the demand for mental health provision comes from children and young people.

    We know that 50 per cent of mental health problems are established by the age of 14, and 75 per cent by the age of 24.

    That’s why mental health provision for children and young people is such a priority for my department.

    And when it comes to our adult population I’m a strong supporter also of social prescribing and the wellbeing agenda.

    Indeed, when I was Chief Secretary, to the slight surprise I think of the Department of Health and Social Care and DEFRA, I chaired a committee trying to get the Treasury to push those departments to go further on social prescribing.

    I think it’s exciting to see the scope that social prescribing offers through the ability of tech to better measure activity now and therefor make the wider economic case around what potential that it unlocks, and that in turn, I think, will help change the Treasury appetite for programmes which were given lower priority in the past.

    In Great Britain, the total cost to our economy of preventable or treatable ill health amongst the working age population is somewhere between £112-153 billion.

    To put that in a different context, it’s equivalent to up to 5-7% of GDP.

    So at a time when we have a shortage of workers, making strides on mental health makes sense on every level. For those more familiar with the Treasury, it is what one might call a double or triple word score – it benefits health, it benefits their agenda on levelling up, and it benefits the economy in terms of GDP.

    In closing, I want to be clear on the central themes through which we will approach the significant challenges the department faces.

    First, a focus on devolving decisions matched with better quality data and more of that data in real time, rather than through a rear-view mirror looking weeks, months – and sometimes even years behind.

    Second, a prioritisation of patient outcomes and empowering much greater patient choice.

    Indeed, when I was Minister for the Cabinet Office, with responsibility for science and technology, I discovered we had 50 different strategies within government for science and technology.

    So, I strongly favour a more agile approach of delivering the initial change and then building from there – rather than looking to what might be delivered in many years’ time, through a particular big change some years hence.

    Third, embracing transparency to help empower patients in supporting the case for change and in particular, for innovation – given that, when spending around £182 billion of public money there will always be defenders of the status quo. And indeed, some of those interests will often be more trusted than, dare I say it, politicians making the case for change.

    What brings those three principles together is the fact that – to meet the scale of the health challenges we face must ensure we don’t slip back into old habits.

    Covid is still with us. And so in particular are its consequences, in the form of pandemic backlogs.

    So we must continue to embrace the pace and risk appetite of the pandemic when it comes to innovating at pace and at scale, and better assessing how risk is scored when we do so.

    That is what I believe the British people rightly expect us to do, and if we are to confront the scale of challenges facing the NHS, that is what we need to do.

  • Tan Dhesi – 2022 Speech on Government PPE Contracts, Michelle Mone and PPE Medpro

    Tan Dhesi – 2022 Speech on Government PPE Contracts, Michelle Mone and PPE Medpro

    The speech made by Tam Dhesi, the Labour MP for Slough, in the House of Commons on 24 November 2022.

    For Tory peers and other chums of the Conservative party to have been profiteering at taxpayers’ expense from shoddy, unusable PPE, especially through the VIP procurement lane, at a time when people were locked down in their homes and tens of thousands of people, including my loved ones, were dying is absolutely sickening, shameful and unforgiveable. Given that The BMJ estimates that the Government have written off approximately £10 billion in unusable, undelivered or shoddy PPE, will the Minister take the opportunity to apologise to bereaved families for the amazing lack of integrity at the heart of the whole process?

    Neil O’Brien

    I set out earlier what the high priority route was and was not: it was absolutely not a guarantee of any kind of contract; it was a way of managing the huge numbers of contacts and offers for help that we were all receiving. It delivered something in the order of 5 billion items of PPE, all of which helped to save lives and protect workers in our NHS and social care settings. Of course, we had to take up those offers of help and respond to them when people wanted to help in the middle of a huge national and global crisis. We had to process those offers, but they were processed in exactly the same way as every other bid for a contract.

  • Sarah Owen – 2022 Speech on Government PPE Contracts, Michelle Mone and PPE Medpro

    Sarah Owen – 2022 Speech on Government PPE Contracts, Michelle Mone and PPE Medpro

    The speech made by Sarah Owen, the Labour MP for Luton North, in the House of Commons on 24 November 2022.

    Sarah Owen (Luton North) (Lab)

    We have all seen the shameful Guardian front page this morning, but the front page that sticks in my mind is the one showing nurses in bin bags—not PPE on the frontline, but bin bags. This was at a time when Luton Borough Council was facing another cut of £11 million. People are struggling, so why are this Government not lifting a finger to get our money back? They could start by releasing the records after the mediation process.

    Neil O’Brien

    The hon. Lady’s question takes us back to that extraordinary moment when we had a huge crisis of PPE, and we were desperate and doing every conceivable thing we could to get the PPE that those nurses needed; that is what I have been referring to in my answers this morning. It is just not true that the Government are not lifting a finger to get the money back. We have a process, and there is a substantial team in the Department working on it right now.