Category: Health

Edward Argar – 2022 Speech on Ambulance Services

The speech made by Edward Argar, the Minister for Health, in the House of Commons on 10 February 2022.

Reflecting the rest of the week, Mr Deputy Speaker.

I am grateful to the hon. Member for Ellesmere Port and Neston (Justin Madders) for securing this important debate. In the same spirit, this is rather nice; it is like déjà vu: he used to shadow me at that Dispatch Box and in Committee. It is a pleasure to respond to his debate on this occasion.

However, I must say that responding to the hon. Gentleman is a pleasure slightly tempered by caution on my part, because I know the depths of his expertise on this subject after his many years shadowing the Minister for Health—I think he shadowed my predecessors as well. He has great depth of knowledge in this space. He is and has been a notable advocate for our ambulance service and what it needs, and he looks forensically into those issues. I also know that he is a diligent reader of The BMJ, the Health Service Journal and various other excellent trade and specialist publications. It is a genuine pleasure to respond to him on this extremely important issue. It is a shame that the way in which the House allocates debates means that this is the last debate of the day, so there are few Members in the Chamber for it, because it is important. However, those we have in the Chamber are quality, and I look both at the shadow Minister—sorry, the former shadow Minister—and the hon. Member for City of Chester (Christian Matheson).

As the hon. Member for Ellesmere Port and Neston highlighted, ambulance services have faced extraordinary pressures during the pandemic. I am sure that the House will join me and the shadow Minister—the former shadow Minister; by force of habit, I keep calling him the shadow Minister. The hon. Gentleman and I have not always agreed, but we have been as one in paying tribute to all those who work in our ambulance services up and down the country. They have done an amazing job over the past two years, during the pandemic, to the very best of their ability. Of course, they do that amazing job day in, day out; irrespective of pandemics, they always do everything they can to support those who need them.

The hon. Gentleman rightly highlights that the pandemic has placed significant demands on the service. In January 2022, it answered more than 800,000 calls. That is an increase of 11% on January 2020 and is one of the factors placing significant pressures on ambulance services, the wider NHS and the A&E departments to which they will take people when they feel that there is a clinical need. Although 999 calls tend to highlight the demand related to more serious medical conditions, many ambulance services are also responsible for 111 calls, which, in December last year, saw an increase of 15.5% compared with December 2019.

I use those statistics to illustrate the demand pressures, but I understand that behind those numbers, in every case, lies a human story—someone in need of care, someone worried and anxious, with friends and family anxious for them—so before I seek to go into the reasons, statistics and our plans and support, I want to say that I am sorry for patients who have suffered the impact of those service pressures. I want to be very clear that patients should expect and receive the highest standards of service and care.

The hon. Gentleman highlighted some specific examples, including the case of Bina Patel. He is right that the right hon. Member for Ashton-under-Lyne (Angela Rayner) has raised that with me. I have asked for full information because I want to get back to her with as full an answer as I can, and I hope that he can convey that to her, if he speaks to her before I do. I am fully aware of her correspondence raising this on behalf of the family.

Let me turn to ambulance response times and the reasons sitting behind some of the pressures. The ambulance service is facing a range of challenges that are impacting on its performance. The hon. Gentleman will be familiar with many of them, including the impact, still, of infection prevention and control measures not only in the ambulance service but particularly in A&E departments and wider acute clinical settings. Higher instances of delays in the handover of ambulance patients into A&E as a result of some of those factors, which I will turn to, are therefore leading to ambulances waiting for longer in queues and not being as swiftly out and about on the road and able to respond to calls. So there are knock-on effects there.

One of the key challenges, which the hon. Gentleman will be very familiar with, remains the question of flow through an A&E and through a hospital. I am referring to the flow of patients out of ambulances into the A&E, who are then able to be treated in the A&E and discharged, hopefully, or who are then, in some cases, able to be admitted to a bed in a hospital ward. To do that, we have to see discharges continue of patients who no longer meet the criteria to reside because they have recovered sufficiently, and the national discharge taskforce has done a huge amount of work on addressing that challenge.

In recent months, we have seen the combined pressures of winter—the hon. Gentleman and I are familiar with those on an annual basis—and the impact of the omicron variant on the number of hospitalisations, which have not been as high as many feared and predicted, thankfully, but which have still had a significant impact on hospital beds. The combination of those factors, coupled with a high level of workforce sickness absence rates, including through positive covid tests—particularly over recent months with omicron—has created pressures that we would not expect to be systemic or built into the system. That partly reflects longer term pressures, and I will move on to what we are doing to address those, but a large element of it is down to the specific circumstances of the past winter.

The hon. Gentleman touched on the support in place to improve services, and asked what we are going to do about it, and what is being done to address these issues. He is true to form from when he shadowed me, as he will always set out the challenge and ask me what I am going to do or am doing about it, rightly holding the Government to account. Because of the pressures I mentioned we have put in place strong support to improve ambulance response times, including a £55 million investment in staffing capacity to manage winter pressures to the end of March. All trusts are receiving part of that funding, which will increase call handling and operational response capacity, boosting staff numbers by around 700.

NHS England has strengthened its health and wellbeing support for ambulance trusts, recognising the pressure of the job on those working in the ambulance services, with £1.75 million being invested to support the wellbeing of frontline ambulance staff during the current pressures. NHS England and Improvement is undertaking targeted support for the most challenged hospitals, to improve their patient handover processes, helping ambulances to get swiftly back out on the road. That is focused on the most challenged hospital sites where delays are predominantly concentrated, with the 29 acute trusts operating those sites being responsible for more than 60% of the 60 million-plus handover delays nationally. That is targeted support for trusts that have particular challenges, either from the current situation or where there are underlying issues that we need to resolve.

There is capital investment of £4.4 million to keep an additional 154 ambulances on the road this winter, and a £75 million investment in NHS 111 to boost staff numbers by just over 1,000, boosting call taking and clinical advice capacity that will better help patients at home, and better help triage those who genuinely need an ambulance and those who can be treated safely in a different context. There is continuous central monitoring and support for ambulance trusts from NHS England’s national ambulance co-ordination centre, and we have also made significant long-term investments in the ambulance workforce. The number of NHS ambulance staff and support staff has increased by 38% since July 2010.

More broadly, alongside the ambitious plan set out by the Government earlier this week, showing how we will invest the significant additional resources in outcomes for patients, just over a year ago we invested £450 million in A and E departments, to help mitigate the impact through increased capacity of infection prevention and control measures. I have regular direct meetings about discharge rates, and what we can do further to improve the flow of patients through hospital trusts within NHS England, with members of the taskforce on that.

I am pleased to reassure the hon. Gentleman that those measures have had an impact, and we are seeing improvements in response times from the peak of the pressures in December. Performance data for January, published today, shows significant improvement against all response time categories. Performance for category 1 calls—the most serious calls, classified as life-threatening—has largely been maintained at around nine minutes on average over the past several months, and improved to eight minutes and 31 seconds in the latest figures. That is despite a 19% increase in the number of incidents in that category compared with December 2019. Average responses to category 2 calls improved by more than 15 minutes compared with December, and the 90th centile responses to category 3 calls by more than two hours.

We recognise that that is welcome progress, as I am sure the hon. Gentleman would agree, but there is much further to go to recover fully from the pandemic’s impact on response times and to sustain that improvement. We welcome the service’s hard work and dedication and pay tribute to it for making those changes and delivering the significant improvements on which I am updating the hon. Gentleman.

Justin Madders

As always, the Minister is being courteous and comprehensive in his response. Will he comment on the concern expressed earlier about patients being told, when visited by the service, that they needed to go to hospital but should find their own way there? That is extremely worrying, and we should be clear that it is not what we expect to happen.

Edward Argar

I am grateful to the hon. Gentleman—I keep feeling tempted to say shadow Minister; he is a shadow Minister but he is no longer my shadow—for that point. He is right that when people ring 999 they should be given the appropriate clinical advice on whether they need to go to hospital, and if they do, an ambulance should be sent. I suspect that in individual cases a call handler may have made a tough clinical decision about the fastest way to get someone to hospital given the availability of ambulances, but the hon. Gentleman is right that if someone rings 999 and their condition is clinically deemed to require an ambulance and swift transfer to hospital, they should be able to expect an ambulance to come, assist them and take them to hospital.

At a time when the NHS is facing unprecedented demand, ambulance services are absorbing some of the increase in pressure. They are treating more people over the phone and finding other ways to reduce pressure in a clinically safe way. With clinical support in control rooms, the ambulance service is closing around 11% of 999 calls with clinical advice over the phone. That is far more than the 6.5% achieved in January 2020 and saves valuable ambulance resources for response to genuinely more urgent clinical needs.

Let me say a little about North West Ambulance Service, if that is helpful to the hon. Gentleman—I know that he and the hon. Member for City of Chester take a close interest in their local ambulance service. Our support and investment has benefited the North West Ambulance Service. The hon. Member for Ellesmere Port and Neston’s local trust received £6.2 million of funding, which it has used to increase its workforce for operational and contact centre teams. The trust is also engaged with regional NHS England and Improvement and commissioning teams to develop a six-point winter plan that seeks to address six key areas throughout the winter period. As it starts to get a little warmer and the daffodils start to come out, it is tempting for people to think that winter has passed, but winter pressures in the NHS can continue into late February and occasionally a bit beyond. I wanted to add that caveat.

Three systems-led initiatives focus on the reduction of hospital handover times, the improvement of pathways for patients with mental health presentations and ensuring that alternatives to emergency departments—including access to primary care and other non-emergency-department pathways—are available to North West Ambulance Service in a timely and responsive manner.

Hospital handover delays continue to challenge the North West Ambulance Service footprint. Through its Every Minute Matters collaboration, which began three years ago, the trust has been working with other hospital trusts on improvements by working with senior leadership teams in hospital trusts to ensure there is a shared understanding of the risks of handover delays and a lack of ambulance resources to respond to patients in the community, to revisit action cards for operational commanders and, crucially, to recognise and thank staff for their continued reporting of delays and willingness to highlight problems to their managers or to the trust.

The trust’s strategic winter plan has been activated and includes details of the measures in place to handle winter pressures and mitigate the effects of increased demand and a loss of capacity. The plan is comprehensive and covers a wide range of topics and details on the preparation for various scenarios. It includes several continuous improvement initiatives for support during the winter period.

In summary, North West Ambulance Service is increasing its double-crewed ambulance capacity in line with winter funding arrangements, reducing conveyance to emergency departments and reducing the number of lost operational hours caused by day-to-day operational challenges. The trust has already seen significant improvements in the number of patients managed effectively through telephone advice, which helps free up ambulances to be deployed to where they are most needed. The trust has recruited additional paramedics and emergency medical technicians and upskilled its ambulance care assistants to blue light driving standard, thereby enabling the trust to deploy 269 additional frontline staff by the end of December.

I close by reiterating the Government’s commitment to support the ambulance service. We retain regular contact with ambulance services, trusts and those delivering on the frontline to help to ensure that patients and the ambulance service receive the care and support that they need. I am grateful to the hon. Member for Ellesmere Port and Neston for bringing this matter to the House.

February 12, 2022
Justin Madders – 2022 Speech on Ambulance Services

The speech made by Justin Madders, the Labour MP for Ellesmere Port and Neston, in the House of Commons on 10 February 2022.

I am pleased to see the Minister for Health, the hon. Member for Charnwood (Edward Argar), in his place. He and I have debated many issues on health and social care over the last couple of years, and ambulance services have perhaps not had the attention that we would have liked. I know the Minister has had an extremely busy week, possibly because of the new trend for Ministers having multiple jobs, so I am grateful that he is here to deal with the points that will be raised.

It is an important and timely debate. We are regularly seeing images of long delays, with ambulances stacking up outside hospitals for long periods of time. Those images demonstrate wider difficulties throughout the whole system, but on an individual level they mean that patients are not getting the care they need as quickly as they should. The blame for that does not lie with the staff—the paramedics, the first responders and the call handlers—all of whom do a magnificent job in very demanding circumstances. We say thank you for their service, not just in the last couple of years but throughout their time in the NHS.

Despite their efforts, we are in a crisis. Last week ambulance waiting figures outside hospitals reached their highest level in five years. The latest NHS figures show that record numbers of patients in England—over 150,000 of them—have waited in the back of an ambulance for at least half an hour so far this winter, because emergency departments are too busy to admit them. That is the equivalent of one in every five patients—that is the scale of the challenge that we are facing. Those figures sound extraordinary because they are. They are 14% higher than the previous highest total for the number of patients forced to wait during the same period, with the previous high being in the winter of 2019-20.

As awful as those headline figures sound, the figures for the number of ambulances waiting more than 60 minutes are even worse: they are up 82% compared with the last two winters. These are exceptional and concerning statistics.

In my constituency, the British Heart Foundation has told me that it is concerned about reports from the North West Ambulance Service that patient flow in and out of emergency departments is currently very slow, with ambulances being held for long periods, which has the knock-on effect, of course, of causing higher category 1 and category 2 stacks. Worryingly, we have heard reports of delays of up to four hours in these queues.

I am sure these figures, as shocking as they are, will not surprise hon. Members who, like me, have probably had many emails of concern and complaint from worried constituents. Behind these statistics are tens of thousands of seriously unwell people in dire need of help. As the chief executive of the Patients Association said:

“Going to A&E can be frightening. To then be stuck in an ambulance unable to get immediate medical help once you get there must add to the trauma of an emergency visit.”

I think we can all understand where they are coming from. The Royal College of Nursing’s director for England also points out:

“Having to wait outside in an ambulance because A&E is already dangerously overcrowded is distressing, not just for patients but also for staff, who can’t provide proper care.”

It must be so frustrating for those staff, knowing there are other urgent calls they could be going to, that they cannot leave their current patient because the hospital is already at capacity.

I agree with those comments. Not only does having an ambulance stuck outside A&E as it waits to offload a patient mean that it is unable to answer 999 calls, which leads to slower response times, but it means we lose ambulance hours. We lost 8,133 ambulance hours in the last week of January due to crews having to wait outside busy A&Es. That is an incredible statistic.

As NHS Providers points out:

“safety risk is being borne increasingly by ambulance services.”

We know that people are dying in the back of ambulances or soon after their admission to hospital because of these long waits. We heard from ambulance chiefs in November that 160,000 patients come to harm each year because ambulances are backed up outside hospitals.

The shocking report from the Association of Ambulance Chief Executives, which is based on NHS figures, did not report how many patients die each year because of ambulances stuck outside hospitals, but it did say:

“We know that some patients have sadly died whilst waiting outside ED”—

emergency departments—

“or shortly after eventual admission to ED following a wait. Others have died while waiting for an ambulance response in the community.”

The report acknowledges that, whether or not those deaths were inevitable

“this is not the level of care or experience we would wish for anyone in their last moments.”

The report also highlights that around 12,000 patients suffered serious harm because of delays, sometimes with a risk of permanent disability. In the same month, more than 40,000 people in England who called 999 with a category 2 condition such as a stroke or heart attack waited more than one hour and 40 minutes for an ambulance. Of course, the NHS target is to reach them within 18 minutes.

Just last week, NHS figures revealed that thousands of people are dying because ambulances are taking too long to answer emergency calls. The official statistics show that only three of England’s 32 ambulance services are reaching a majority of immediately life threatening call-outs within eight minutes. In fact, the latest available NHS England data for December 2021 shows that the average ambulance response time for category 2 emergencies —suspected heart attack and stroke patients—is 53 minutes and 21 seconds: three times the 18-minute target. Those are incredibly worrying figures.

The British Heart Foundation also reports that there were 5,800 excess deaths from heart and circulatory diseases in England during the first year of the pandemic alone. Although it acknowledges that these excess deaths were driven by a multitude of factors across the entire patient pathway, it also says it is very plausible that some of the deaths could have been prevented if these people had been able to access urgent and emergency care in a timely manner. If we are to avoid more preventable deaths and disability from heart conditions, it is vital that the most critically ill patients can access the care that they need when they need it.

Perhaps the Minister will be able to say what action has been taken to address the dangerous impact on emergency heart attack and stroke care and the victims whose lives are being put at risk, what conclusions the Department has reached as to why so many trusts are failing to reach the targets that have been set for them, and what steps are being taken to reduce waiting times for responses to 999 call-outs and ambulance waits. We know that these delays matter. If 90% of 999 calls were answered in time, 3,000 more heart attack victims could be saved each year.

I have reeled off a lot of statistics. Now I want to give a couple of constituency examples to show what this means for people who have experienced long waits. Thankfully neither case ended in tragedy, but these were clearly difficult and distressing times for those involved.

One constituent told me that she had waited more than 10 hours for an ambulance, having first called 111 at about 10.15 am, when she was advised to call 999. When she called 999, it took a few minutes for the call to be answered. The call handler confirmed that an ambulance would be coming, before asking if it was OK for her to hang up and go on to the next call. About an hour later, having seen no sign of the ambulance, my constituent called 111 again and was told to call 999, but was then told that the ambulance waiting time was about eight hours. At 2.30 pm she was forced to call 999 again, as her husband’s condition was becoming noticeably worse. By that stage he could not move or talk because he was in so much pain. The call handler took the details again, but advised my constituent only to call if the condition worsened further.

Another three hours passed, with my constituent’s husband in absolute agony. When she decided to call again at 5.30 pm, she waited more than five minutes for the call to be answered. The call handler asked if the patient was breathing, and said that an ambulance could only be sent if a patient was not breathing, as it was a busy day, although he did also confirm that the request for an ambulance had been prioritised after her call at 2.30 pm—which, by that stage, was three hours earlier.

The ambulance eventually arrived at 8.45 pm, 10 and a half hours after the initial call. Unsurprisingly, my constituent told me that the paramedics were lovely and could see immediately that her husband needed to go to hospital. When he arrived there, he was scanned and treated, and operated on within 24 hours. It was clear that he needed urgent medical treatment; in fact, he probably needed more treatment than he would have needed had he been seen at the right time. However, in the long run, no serious harm has come to him.

That is just one example of a person who waited longer than they should have. It was not an isolated incident; we know that this is happening week in, week out throughout the country. Another constituent told me that he called an ambulance after his wife collapsed at home. They are both pensioners. My constituent called 999 at 11.45 am, and was told that an ambulance would not be able to attend for at least nine hours. He cancelled the call.

The Minister will no doubt be aware of the tragic case of Bina Patel, which has received considerable media coverage, and has been raised by my right hon. Friend the Member for Ashton-under-Lyne (Angela Rayner). Anyone who has heard the calls that were made requesting an ambulance, and the clearly urgent nature of those calls, cannot fail to be concerned about what is happening in our ambulance services. As I have tried to emphasise, these are not one-off incidents; they are part of a wider pattern, and symptomatic of a system unable to cope with the demands placed on it.

Targets are not being met and people are being put at risk or worse, but NHS England’s response is a proposed new standard contract which contains a “watering down” of several waiting-time targets, with standards lower than those that were in place before the pandemic. The proposals include scrapping the “zero tolerance” 30-minute standard for delays in handover from ambulance to A&E and setting it at 60 minutes, and introducing the additional targets that 95% of handovers must take place within 30 minutes and 65% within 15 minutes. I do wonder how performance can be improved if targets are loosened. The pandemic should not be used as a cover for this, as performance across the system was getting worse before the pandemic. Indeed, it is nearly seven years since the normal targets were met. By scrapping standards for delays in handover, the Government are trying to normalise those longer waiting times. My hon. Friend the Member for Ilford North (Wes Streeting) asked the Secretary of State earlier this month whether he really thought it should take an hour just to be transferred from an ambulance into a hospital. It should not take that long. Does anyone really think it is acceptable for people ringing 999 to be told they must make their own way to hospital?

I am sure the Minister is aware of reports in the Health Service Journal last month that several trusts, most notably the North East Ambulance Service NHS Foundation Trust, advised people calling 999 with symptoms of a heart attack or stroke to take a taxi or a lift with family or friends rather than waiting for an ambulance. I am sure the Minister will want to comment that that is not what we want to be hearing from our ambulance services.

The British Heart Foundation told me that it recently reviewed two calls to its heart helpline that highlighted instances where patients with suspected heart attacks called 999 and paramedics did attend, but then asked both to have their family drive them to hospital for further tests because the ambulance services in their area were under so much pressure. Neither person actually went to A&E, which is most unfortunate: one did not want to bother their family and the other thought that, if the ambulance was not taking them, their situation must not be urgent enough, which of course was not the case.

In short, those two patients did not access the care they needed because of the message being sent out about the burden they were placing on the system. That is completely wrong and certainly not the message we should be giving people who are clearly in urgent need of treatment.

A recovery plan has been announced this week, which, if we are honest, does not really address the issues of the wider NHS and social care pressures. It does not have any real plan for this particular area. The recovery plan, such as it is, is one part of the much wider system overhaul that is needed.

The Secretary of State said this week that approximately 10 million people represent missing referrals who did not come forward for treatment during the pandemic. I am afraid they may well end up becoming urgent referrals because they have not been through treatment and been spotted and helped at an earlier stage. I do not know whether the Government have given any thought to whether those 10 million missing referrals will lead to increased pressure on emergency services and A&E attendances.

What about those people whose care was not managed to target? The British Heart Foundation estimates that up to 1,865,000 people with high blood pressure were not managed to target last year, which could mean more than 11,000 additional heart attacks and more than 16,000 additional strokes across England over the next three years if those patients do not get support. Of course, that will again increase pressure on urgent and emergency care services in the longer term.

I appreciate there is quite a lot of ground to cover here, but when the Minister responds I would be interested to hear his analysis of the situation, whether he believes the examples I have given are part of a wider pattern of concern or isolated incidents, and what he believes must be done to put the ambulance service on a sustainable, safe footing for the long term. Are those images that we have seen of ambulances queuing up outside hospitals a temporary feature of a very difficult winter, problems with the ambulance service in particular, or symptoms of a wider health and social care system that is under incredible pressure?

February 12, 2022
Gillian Keegan – 2022 Statement on the Mental Health Strategy

The statement made by Gillian Keegan, the Minister for Care and Mental Health, in the House of Commons on 10 February 2022.

This week, the UK has marked Children’s Mental Health Week with the theme of “growing together.” I am grateful for the brilliant work of our vibrant voluntary and community sector, who are encouraging children and young people to take action to look after their mental health and learn how they can support others.

Across the country, we are talking more about our mental health and wellbeing than ever before. Thanks to the trailblazing courage of campaigners in the public eye, and thousands of quiet conversations in homes, schools and workplaces, more and more people now feel comfortable opening up about their mental health.

Over 4 million people have used our Every Mind Matters resources to make a tailored mind plan to help them take active steps to look after their wellbeing. Initiatives like “Thriving at Work” have driven improvements to workplace wellbeing. The NHS is offering care and support to more people with mental illnesses than ever before, backed by record levels of investment, workforce expansion and the advancing mental health equalities strategy. And we are reforming the Mental Health Act to improve care for people who are acutely unwell and to address ethnic disparities in detention rates.

Since March 2020, the wide-ranging effects of the pandemic and the impacts on mental health have fostered a strong spirit of innovation in the NHS and collaboration across Government. The Government published a cross-Government covid-19 mental health and wellbeing recovery action plan for 2021-22 in March 2021, backed by an additional £500 million. As part of this additional investment, we are accelerating the roll-out of mental health support teams in schools and colleges so that an estimated 3 million children and young people (around 35% of pupils in England) will be covered by these teams by 2023.

But I know there is much more to do. That is why I am announcing my intention to develop a new long-term, cross-Government mental health strategy in the coming year.

The Government will launch a public discussion paper this spring to inform the development of the strategy. This will set us up for a wide-ranging and ambitious conversation about potential ways to improve the nation’s mental health and wellbeing over the coming decade, both within and beyond Government and the NHS. We will be engaging widely, especially with people with experience of mental ill-health, to develop the strategy and build consensus. I will be calling on all parts of society—including teachers, businesses, voluntary organisations, and health and social care leaders—to set out their proposals for how we can shift the dial on mental health.

Alongside this, preventing suicides is a key priority for this Government. I am acutely aware that suicide prevention requires specific, co-ordinated action and national focus, and I am committed to working with the sector over the coming year to review our 2012 suicide prevention strategy for England. I am today announcing around an additional £1.5 million to top up our existing £4 million grant fund, which will help support the suicide prevention voluntary and community sector to meet the needs of people at risk of suicide or in crisis.

February 12, 2022
Paul Scully – 2022 Speech on Neonatal Leave and Pay

The speech made by Paul Scully, the Parliamentary Under-Secretary of State for Business, Energy and Industrial Strategy, in the House of Commons on 9 February 2022.

I congratulate my hon. Friend the Member for Thornbury and Yate (Luke Hall) wholeheartedly on securing today’s debate. This is an important issue, and I am very grateful to him for bringing it to the attention of Parliament in the way he did, baring his soul. I know Roisin will be proud of him today.

We have heard his personal account that the impact of having a young baby in neonatal care has on parents, and the additional pressure that having to balance employment with caring for their child places on them. My hon. Friend has spoken with such depth of personal experience and it brings home that what we do here, when we are looking to bring forward the Employment Bill, and all the work the officials do matters. This really matters on a human scale to people on a day-to-day basis, as we have just heard. I am grateful to him for his candour, and for raising awareness of this issue. It is a shame that the rhythm of this House means that that speech has not had the audience in the Chamber, but I know people will be watching it and reading the account in the Official Report. Bringing this matter to our attention is amazing.

In the UK, an estimated 100,000 babies are admitted to neonatal care every year following their birth. Many of those babies spend prolonged periods of time on a neonatal care unit in a hospital as a result of having been born prematurely, or for other health conditions. It is, as we have heard, an incredibly worrying and stressful time for parents. They will naturally want to be able to focus their attention on getting through that period, supporting each other and their baby. However, some may have concerns about their ability to do that and keep their jobs. I sympathise with anyone who has found themselves in that position.

Currently, parents in those circumstances tend to rely on their statutory leave entitlements, for example maternity or paternity leave. In practice, that means a considerable proportion of their leave may be used while the baby in still neonatal care or that they do not have sufficient leave to remain with their baby for the necessary period.

A survey conducted by the charity Bliss in 2019 found that 66% of fathers had to return to work while their baby was still receiving specialist neonatal care, and that 36% of fathers resorted to being signed off sick in order to spend time with their baby in a neonatal unit. That can, in some cases, have a negative impact on their employment record. Fathers and partners may also experience negative effects on their physical and mental health from trying to combine work with caring for the child and the mother. Other parents of babies in neonatal care have reported that they had to return to work earlier than they had planned due to suffering financial hardship from being away from work.

Considering those different scenarios, it is clear that the current leave and pay entitlements do not adequately support parents of babies in neonatal care. In March 2020, following a Government consultation on the issue, we committed to introducing the new entitlement to neonatal leave and pay, and I can assure my hon. Friend that we remain very much committed to that. Our planned neonatal leave and pay entitlement will allow parents to take additional time off work in circumstances where their child is admitted to neonatal care, ensuring that they are no longer in the incredibly difficult position of having to choose between risking their job and spending much-needed time with their baby.

Neonatal leave and pay will apply to parents of babies who are admitted into hospital up to the age of 28 days and who have a continuous stay in hospital of seven full days or more. Eligible parents will be able to take up to 12 weeks of paid leave on top of their other parental entitlements such as maternity and paid paternity leave. Neonatal leave will be a day-one right, meaning that it will be available to an employee from their first day in a new job. Statutory neonatal pay, like other family-related pay rights, will be available to those employees who meet continuity of service and minimum earnings tests.

While we understand that the introduction of neonatal leave and pay will create a small burden on businesses, we believe that the benefit to business will outweigh any costs. Policies such as neonatal leave and pay that enable parents to participate in the labour market and to succeed and progress in work not only benefit individual employees but give employers access to a bigger pool of talent. Such reforms will also help businesses, because employers who embrace family-friendly policies are so much more likely to see greater employee loyalty, commitment and motivation.

In addition to our plans to introduce neonatal leave and pay, the UK has a range of policies in place that support employees to balance work with family life and other personal commitments and responsibilities. They include: a right to request flexible working; generous family-related leave and pay entitlements; and protections from detriment for parents who take or seek to take family-related time off work. The UK’s maternity leave system is one of the most generous in the world. Pregnant women and new mothers are entitled to take up to 52 weeks of leave—that is a day-one right with no qualifying period of service—and up to 39 weeks of statutory maternity pay if they are eligible. Maternity leave can be started up to 11 weeks before the expected week of childbirth.

Fathers of premature babies have the flexibility to take their one or two weeks of paternity leave and pay within eight weeks of the expected date of birth rather than having to take the leave within eight weeks of the baby’s actual birth, if they wish. We also have a manifesto commitment to make paternity leave more flexible and will set out our response on that in due course.

The right to emergency leave—time off for dependants —allows all employees a reasonable amount of unpaid time off work to deal with an unexpected or sudden emergency involving a child or dependant and to put care arrangements in place. Additionally, all employed parents have a right to up to 18 weeks of unpaid parental leave for each child up to a child’s 18th birthday.

The Government are committed to introducing new employment measures as we seek to build a high-skilled, high-productivity, high-wage economy that delivers on our ambition to make the UK the best place in the world to work and grow a business. I reassure my hon. Friend that further detail on reforms to our employment framework will be published in due course. Naturally, covid-19 has affected our progress in introducing the new entitlement to Parliament, but we remain committed to doing so as soon as parliamentary time allows. In the meantime, we are moving forward with the work. That includes working with lawyers on our legislative approach, which is likely to include both primary and extensive secondary legislation, as well as considering how the entitlement will be implemented. It will also, in due course, require accessible and thorough guidance for both employers and employees.

As I mentioned, delivery of the new entitlement will need primary legislation as well as changes to the HMRC IT payment system to allow employers to administer statutory neonatal pay on behalf of the Government. Officials are in discussion with HMRC colleagues about the establishment of that IT system. It is a large-scale project, and we are ensuring that the relevant teams in HMRC are as prepared as possible, that they fully understand what is required and how much resource will be needed. We are doing the necessary groundwork so that we are in the best position to implement neonatal leave and pay once legislation is in place.

I recognise my hon. Friend’s points about whether the entitlement could be delivered through a stand-alone Bill or alternative measures. Due to pressures on parliamentary time, it might be challenging to introduce a stand-alone Bill, but we remain committed to introducing neonatal leave and pay and will do so as soon as parliamentary time allows. We understand and sympathise with the position of parents with children in neonatal care and remain fully committed to the introduction of neonatal leave and pay. In the meantime, we have other parental leave entitlements that are available to new parents and we encourage employers to continue to respond with flexibility and compassion to parents in that very difficult position. I have spoken to a number of businesses that have great schemes in place to deal with such life events, such as ASOS. I try to showcase that good work, because they do not need to wait for a legislative framework.

I close by thanking my hon. Friend for his incredible contributions to the debate and I thank everyone who has worked hard to raise awareness of the difficult situation of parents remaining in employment when their children are in neonatal care. As always, I would be delighted to meet my hon. Friend and other Members of the House to discuss the issues further as we move towards getting these provisions on the statute book.

February 10, 2022
Luke Hall – 2022 Speech on Neonatal Leave and Pay

The speech made by Luke Hall, the Conservative MP for Thornbury and Yate, in the House of Commons on 9 February 2022.

Every year in the UK, tens of thousands of babies receive neonatal care. For the families of these children, the experience can be life changing. Neonatal care is the type of care that a baby receives in hospital if they are born premature, full-term but with a condition or illness that needs medical attention, or with a low birth weight. Rather than families bringing their child home shortly after birth, the child is admitted to a specialist neonatal care unit to receive the support that ensures they receive the best possible chances of survival and quality of life.

A wealth of evidence already exists that shows that, for children in neonatal care to have the best possible outcomes, they need their parents to be as involved in their care as much as possible and as early as possible. The Government already agree with this, and that the current leave and pay entitlements do not adequately support parents when their child is born sick or premature and requires neonatal care.

Many parents and campaigners have welcomed the proposals wholeheartedly to deliver neonatal leave and pay that will allow parents to take additional time off work when their child is in neonatal care, ensuring that they are no longer in the impossible position of having to choose between keeping their job and spending time with their baby. I am grateful to have secured this Adjournment debate to highlight the importance of delivering the Government’s commitment to delivering neonatal leave and pay by a set target date of 2023, and to make the case for how those in all parts of the House can work together to overcome the challenges and provide this vital support for families at the earliest possible opportunity.

Jim Shannon (Strangford) (DUP)

First, I commend the hon. Gentleman for securing this Adjournment debate. I welcome this discussion as an essential part of employment reform, and I support him fully in his wish to expedite legislation so that both parents can take this leave together as a shared benefit. For that reason, I understand he will have lots of support right across the Chamber to achieve his goal.

Luke Hall

I thank the hon. Gentleman for his support because for me, like for so many parents, this is personal.

In my own family’s case, my wife was admitted to hospital 22 weeks into her pregnancy following a number of complications, and we were completely unprepared to be told at that point—22 weeks in—that she could give birth at any time and that she would have to stay in hospital for the duration of the pregnancy, as well as that if she did go into labour, our baby might not survive long after childbirth, and if they did, the overwhelming likelihood was that they would live with significant disabilities or challenges.

Even with the incredible and compassionate support that you receive from neonatal intensive care unit consultants, taking you through every step and answering every question, there really is nothing that can prepare you for that type of conversation or for the choices that you are asked to make. I know that all parents deal with that in their own different way, but for me it left a mark that I know will never really leave me.

In our case, like so many others, this meant staying in hospital and praying every single day that the pregnancy lasted as long as possible. Every day feels like a month, but also like an incredible accomplishment, and I was in complete awe of my wife and so many other women who handled everything so magnificently. Six weeks later, our son, William, was born on 6 January last year, weighing just 2.4 lbs.

We did not know that our son was not breathing when he was born—we found that out a lot later; I cannot remember exactly when—but I do remember being told that he was going to be okay, and my wife was able to hold him for a few moments before he was taken to neonatal intensive care, where he stayed for 72 very long days before coming home. I would like to take this opportunity to thank the incredible team at Southmead Hospital and our midwife, Bev Alden, who was genuinely superb in going above and beyond the call of duty to support us.

The reason why I have highlighted this point about the journey before birth to the Minister at the start of this debate is to make the serious point that, for so many people, having a premature child is a very long journey. It does not start the day the child is born; it can start weeks or months beforehand. Delivering neonatal leave and pay supports families in one part of that journey, but not for the whole journey. There is more that Government, businesses, organisations and individuals can do to support them, but neonatal leave and pay is one thing the Government can do quickly.

Currently, the parents of a child in neonatal care rely on their existing statutory leave entitlements so they can be off work while their child is in hospital. That means that parents spend a proportion of their maternity or paternity leave with the baby in hospital. Babies who have spent a long time in hospital after birth are usually at an earlier stage in their development when their mother or parents go back to work, in comparison with their peers. That can be particularly challenging for mothers, many of whom would have liked to have additional time with their child but cannot afford to take any more time off. That leads only in one direction—less parental involvement in care, causing immense stress and leaving parents unsupported. It reduces the opportunity for bonding time with their child.

The current system is also a massive barrier for fathers and non-childbearing parents in particular. Earlier this week, 75% of parents who responded to a survey from Bliss, the incredible charity, said that they or their partner went back to work before their baby was home from hospital. Some of those children will still have been on ventilation and receiving critical care. Previous research suggests that the most common reason for that is they simply cannot afford to take more time off work. That is happening every single day, right around the country, to families of premature and sick children.

Paid leave for parents of babies in neonatal care already exists in different countries around the world. In Ireland, paid maternity leave is extended by the amount of time between birth and the original expected birth date, and there is a similar system in Germany. In Sweden, maternity leave begins at the point the baby is discharged from hospital, rather than the birth date. Here in the UK, the Government and we, generally, have a record of supporting parents to be proud of. We have a generous and flexible system for many parents. The Government and the Minister are committed to making the UK the best place possible to live and work, and that includes the ability to grow and raise a family. That is why so many people were delighted by the Government’s commitment to finally deliver on neonatal leave and pay and to put it in the last manifesto.

I want to make the point of the significant mental and emotional toll on parents in the situation of having a child in neonatal intensive care. Research by Bliss back in 2018 shows that 80% of parents who have a child admitted to neonatal intensive care felt that their mental health suffered, and a huge 35% of parents report that their mental health was significantly worse after time on the neonatal unit. Regardless of the circumstances, parents want to be with their children. That is obvious; all parents will say that. But when your child is so small and vulnerable, it is painfully difficult to be apart from them. You just want to be there.

Even when they are in the best possible hands, a NICU can be a really worrying and scary place to be. They take some getting used to, because you are with lots of new people, there are children in very difficult circumstances and just because of the noise—the constant beeping from equipment around the unit takes getting used to. The mental pressure on parents is huge. I would say to anyone trying to understand the experience, imagine having to sit with your child in an incubator or having to learn how to feed your child through a tube, while worrying whether you can afford to pay your bus fare home. For too many people, that is the case.

Imagine going through this journey while feeling guilty about not spending time with the children you have at home, because you are in the NICU every spare minute of the day. You feel guilty, because you are unsure how to hold and support your child. When you do have time at home, I promise every spare minute is spent in a permanent state of worry about receiving unscheduled telephone calls from the hospital bearing bad news, which, for too many, do come. You worry about the pressures that it puts on you as a family, and about how you would cope as a family unit if the worst were to happen. I distinctly remember our darkest day when we were told that our son was going downhill quickly and he was going to be treated for necrotising enterocolitis, and that one potential outcome for which we would have to be prepared was for him to be transferred to a hospice.

Let me make this point to the Minister: we cannot expect parents to be worrying about whether they will have a job to go back to while dealing with these situations. The Government agree with this—there is no disagreement—so it is time for us to work together to deliver it. The Government want to do it, and I know that the Minister does as well. He has been hugely supportive to me and to colleagues on both sides of the House who have talked to him about this issue on a number of occasions. I thank him for his help, and I also thank the Government for the work that they have done on the issue since the general election.

In the March 2020 Budget, the Chancellor reaffirmed the Government’s ambition to deliver this important reform, and earmarked the necessary funding to deliver the policy in 2023-24. In the same month, the response to the consultation was published. It confirmed a number of further details about the delivery of neonatal leave and pay, including the intention to legislate through the Employment Bill. I was pleased to hear the Prime Minister, during Prime Minister’s questions in November last year, repeat the commitment to deliver legislation “one way or another”.

So we all want to do this. The question is how are we going to do it, when, and through what vehicle in Parliament? Ministers have made clear that they want to do it through the Employment Bill. The argument I would advance to this Minister is that the Employment Bill is significant and substantial legislation that will take time to pass through Parliament. While neonatal leave and pay enjoys widespread cross-party support, many wider aspects of the proposed Bill are likely to face far greater opposition. Despite the uncontroversial nature of the proposal, tying its successful delivery to the more controversial Employment Bill is not the fastest way in which to secure its introduction.

Generally when we are introducing reforms of this type, they take effect from April, at the start of the financial year. In order to meet the 2023 target for which the Government have set aside funds and to which they have committed themselves, neonatal leave and pay legislation will need to have passed through Parliament before that date, in enough time to ensure that Her Majesty’s Revenue and Customs and employers are given sufficient notice. If we are to meet the commitment to deliver this on time, we need to start now.

I wrote to the Minister about the issue in October, and he kindly wrote back to me, informing me of the progress that his Department was making. He also made it clear that significant work was required for the policy to be delivered, including the extra work that would have to be done by HMRC to ensure that staff were ready to upgrade the necessary IT systems. The policy will take time to implement, and that is why I think there are legitimate questions to be asked about the delivery vehicle for this reform. I should be grateful if the Minister could confirm that the Government still intend to deliver it from April 2023.

I think that one clear way in which this can be delivered on time is through a stand-alone Bill. The policy development and the consultation have already taken place, and there is a precedent for passing reforms of this type through Parliament quickly. The Parental Bereavement (Leave and Pay) Act 2018 provides a clear model for us to pass this legislation. It is uncontroversial, and it has cross-party and cross-sector support. In the past, the Minister has made a point that I completely appreciate—that this will have to be delivered alongside other measures in the Employment Bill—but I should be grateful if he could explain exactly what those measures are, and also explain why they cannot be delivered as part of stand-alone legislation. I also ask him whether he will meet me, the new Leader of the House—assuming that my right hon. Friend is willing—and other Members to discuss how this can be delivered on time, which is what we all want to see.

I do not want to give too long a list, but I should be grateful if the Minister could update the House on the work that he and his Department have already done in anticipation of delivering this policy, to ensure that it will be ready on time and ready to go once we can find a legislative vehicle to deliver it. I should like to know whether, for example, the guidance is ready for the Department for Business, Energy and Industrial Strategy and HMRC, and how much work has been done. Finally, I should like to know whether the Department is starting to explore alternatives to deliver support for families if it proves difficult to legislate. I hope I have managed to convey at least a sense, on behalf of many families around the country, of how important this commitment is and how grateful we are to the Minister and the Government for making it. We all want to see it delivered and rolled out as quickly as possible. It is down to us to find the right vehicle for that, because delivering neonatal leave and pay will enable the thousands of babies born into neonatal care every year to benefit from their parents’ being where they should be, by their side, providing that vital care. It will also deliver support and reassurance to all those new mothers, fathers and carers who need it the most in the most vulnerable and stressful days of their lives. I say to the Minister, “The solution is clear, it commands widespread support and it is within our grasp—please help us to make it happen.”

February 10, 2022
Wes Streeting – 2022 Speech on Elective Treatment

The speech made by Wes Streeting, the Shadow Secretary of State for Health and Social Care, in the House of Commons on 8 February 2022.

I thank the Secretary of State for advance sight of his statement, but it falls seriously short of the scale of the challenge facing the NHS and the misery that is affecting millions of people stuck on record high NHS waiting lists. We have been waiting some time for his plan to tackle NHS waiting times. We were told that it would arrive before Christmas; we were told that it would arrive yesterday; and it is not clear from his statement today that the delay was worth the wait. There is no plan to tackle the workforce crisis, no plan to deal with delayed discharges, and no hope of eliminating waits of more than a year before the general election in 2024. I wonder whether the Conservatives will be putting that on their election leaflets. The only big new idea seems to be a website that tells people that they are waiting for a long time, as if they did not already know.

Perhaps the Secretary of State can tell us whether the plan itself contains two other measures that have been floated in the press: the cancellation of patients’ follow-up appointments, whether they need them or not, and an offer enabling people to seize the opportunity to travel hundreds of miles around the country, if they can find a hospital in England that does not already have a waiting list crisis of its own. What we did hear was a series of reannouncements, including some perfectly sensible proposals for community diagnostic and surgical hubs. We welcome those, but the Secretary of State cannot pretend that they meet the scale of the challenge.

The Secretary of State reaffirmed the Prime Minister’s commitments on cancer, announced only yesterday. He announced a new target that no one should wait more than two months for cancer diagnosis, but there is already a target for the vast majority of cancer patients to be treated within two months of referral. Can he tell us which target he is aiming to meet? Is it the target that has not been hit since 2015, or the target announced yesterday, which seems to lower standards for patients because the Government consistently fail to meet them? The Prime Minister has also announced that three out of four patients should receive a cancer diagnosis within 28 days, but that is an existing target which was introduced in April and has never been met, and nothing that the Secretary of State has announced today gives me any confidence that it will be met in the future. Given that half a million patients with suspected cancer are not being seen in time, it seems that the Secretary of State declared a war on cancer after more than a decade of disarming the NHS, and is now sending the NHS into battle empty-handed.

Indeed, it is hard to believe that this is the announcement that the Secretary of State wanted to make. One Government official briefed Robert Peston that the plan was being blocked by the Chancellor, who is, “reluctant to rescue the Prime Minister”. Putting to one side the appalling spectacle of the Tory leadership crisis impacting on life and death decision making in Government, it seems from the statement that the Chancellor has won the day. What other explanation can there be for a plan to recover the NHS and bring down waiting lists that does not contain a workforce plan? The single biggest challenge facing the NHS is the workforce challenge. There are 93,000 staffing vacancies in the NHS today. The NHS is understaffed, overworked and, if the Secretary of State is not careful, he will lose more people than he is able to recruit. This is not a new development, and it should not be news to him.

In April, the NHS called for a national workforce plan. Polling from the Health Foundation found that the public want more staff with fewer workload pressures. The Secretary of State himself told the Health and Social Care Committee in November that his plan would include a strategy for the workforce crisis. We know the NHS wants a workforce plan and the public want a workforce plan. He promised a workforce plan, so where is it? There is not even a budget for Health Education England let alone a serious plan to recruit and retain the workforce that we need. Instead, he is proposing new NHS reservists. Who are they? Where are they coming from? How many does he imagine there will be? How does he imagine that they will make a dent in the 93,000 vacancies? It seems more “Dad’s Army” than SAS.

Then there is the issue of wider NHS and social care pressures that impact directly on waiting lists and waiting times: the pressures on GP practices that see people ringing the surgery at the crack of dawn in the hope of getting through before the appointments have gone; the pressures on social care that lead to delayed discharges from hospital, as we saw in more than 400,000 cases in November alone; and the missed opportunities and the wasted money that comes from a failure to invest in community services that lead to people turning up at A&E at greater cost to patient health and at greater cost to the taxpayer.

This plan falls well short of the challenge facing our country. Six million people are waiting for care. Cancer care is in crisis, with half a million patients with suspected cancer not seen in time. Heart and stroke victims are waiting more than two hours for an ambulance when every minute matters. It is clear from what the Secretary of State said today, from what his colleague, the Minister for Health, the hon. Member for Charnwood (Edward Argar), said yesterday, and no doubt what will be heard repeated in the Tory scripts in the days and weeks to come, that the Conservatives are hoping to blame the state of NHS waiting lists on the pandemic—the “covid waiting lists”, they called them. But this is not a covid backlog; it is a Tory backlog. After a decade of Tory mismanagement, the NHS had: record waiting lists of 4.5 million before the pandemic; staff shortages of 100,000 before the pandemic; 17,000 fewer beds before the pandemic; and 112,000 vacancies in social care before the pandemic.

In conclusion, it is not just that the Government did not fix the roof while the sun was shining, they dismantled the roof and removed the floorboards. With the ceiling of their ambition that the Secretary of State outlined today being to go back to where we were before the pandemic, it is now clear that the longer that we give the Conservatives in office, the longer patients will wait.

February 9, 2022
Sajid Javid – 2022 Statement on Elective Treatment

The statement made by Sajid Javid, the Secretary of State for Health and Social Care, in the House of Commons on 8 February 2022.

With permission, Mr Speaker, I would like to make a statement on a new, ambitious elective recovery plan—the NHS’s delivery plan for tackling the covid-19 backlog of elective care.

The NHS has responded with distinction during the country’s fight against the virus, caring for over 700,000 people with covid-19 in hospital in the UK and delivering a vaccination programme that is helping this country to learn to live with the virus, while at the same time doing so much to keep non-covid care going. Nobody—no institution—felt the burden of the pandemic more than the NHS. There have been 17 million cases of covid-19 and the NHS has had to respond to the original variant, the alpha wave, the delta wave and, most recently, of course, the omicron wave. Despite these pressures, we had one of the fastest vaccination programmes in the world, including one of the fastest booster programmes in the world.

Sadly, as a result of focusing on urgent care, the NHS could not deal with non-urgent care as much as anyone would have liked. The British people have of course understood this. Despite those exceptional efforts, there is now a considerable covid backlog of elective care. About 1,600 people waited longer than a year for care before the pandemic. The latest data shows that this figure is now over 300,000. On top of this, the number of people waiting for elective care in England now stands at 6 million, up from 4.4 million before the pandemic. Sadly, that number will continue rising before it falls.

A lot of people understandably stayed away from the NHS during the heights of the pandemic, and the most up-to-date estimate from the NHS is that that number is around 10 million. But I want these people to know that the NHS is open and, as Health Secretary, I want them to come forward for the care they need. We do not know how many will now come forward—we do not know whether it will be 30% or 80%—because no country has faced a situation like this ever before. So in developing this plan, the NHS has had to make a number of assumptions. Even if half of these people come forward, this is going to place huge demand on the NHS, and we are pulling out all the stops so that the NHS is there for them when they do. We have already announced that we are backing the NHS with an extra £2 billion of funding for elective recovery this year and £8 billion on top of that over the next three years. In addition, we are putting almost an additional £6 billion towards capital investment for new beds, equipment and technology.

Today we are announcing the next steps, showing how we will help this country’s health and care system to recover from the disruption of the pandemic but also how we will make reforms that are so important for the long-term future. That will allow the NHS to perform at least 9 million extra tests, checks and procedures by 2025 and around 30% more elective activity each year in three years’ time than it was doing before the pandemic. This bold and radical vision has been developed with expert input from clinical leaders and patient groups. It will not just reset the NHS to where it was before covid but build on what we have learned over the past two years to transform elective services and make sure that they are fit for the future.

This plan focuses on four key areas. The first is how we will increase capacity. On top of enormous levels of investment, we are doing everything in our power to make sure that we have even more clinicians on the frontline. We now have more doctors and nurses working in the NHS than ever before. We have a record number of students at medical school and a record number of students applying to train as nurses. The plan sets out what more we will be doing, including more healthcare support workers and the recruitment and deployment of NHS reservists. We will also be making greater use of the independent sector, which formed an important part of our contingency plans for covid-19, so that we can help patients to access the services they need at this time of high demand.

Secondly, as we look at the backlog, we will not just strive to get numbers down but prioritise by clinical need and reduce the very longest waiting lists. Assuming that half the missing demand from the pandemic returns over the next three years, the NHS expects the waiting list to be reducing by March 2024. Addressing long waits is critical to the recovery of elective care, and we will be actively offering longer-waiting patients greater choice about their care to help to bring down these numbers.

The plan sets the ambition of eliminating waits of longer than a year for elective care by March 2025. Within this, no one will wait longer than two years by July 2022, and the NHS aims to eliminate waits of over 18 months by April 2023 and of over 65 weeks by March 2024, which equates to 99% of patients waiting less than a year.

I have heard the concerns that have rightly been raised, including by many hon. Members, about the pandemic’s impact on cancer care. On Friday, World Cancer Day, I launched a call for evidence that will drive a new 10-year cancer plan for England, a vision for how we can lead the world in cancer care. This elective recovery plan, too, places a big focus on restoring cancer services.

The NHS has done sterling work to prioritise cancer treatment throughout the pandemic, and we have consistently seen record levels of referrals since March 2021, but waiting times have gone up and fewer people came forward with cancer symptoms during the pandemic. The plan shows how we will intensify our campaigns to encourage more people to come forward, focusing on areas where referrals have been slowest to recover such as lung cancer and prostate cancer. It also sets out some stretching ambitions for how we will recover and improve performance in cancer care: returning the number of people waiting more than 62 days following an urgent referral to pre-pandemic levels by March 2023; and ensuring that 75% of patients who have been urgently referred by their GP for suspected cancer are diagnosed or have cancer ruled out within 28 days by March 2024.

I am determined that we tackle the disparities that exist in this backlog, just as I am determined to tackle disparities of any kind across this country. Analysis from the King’s Fund shows that, on average, a person is almost twice as likely to experience a wait of over a year if they live in a deprived area. As part of our recovery work, we are tasking the NHS with analysing its waiting list data according to factors such as age, deprivation and ethnicity to help to drive detailed plans to tackle these disparities.

Thirdly, this new chapter for the NHS provides an opportunity to radically rethink and redesign how services are delivered, to bust the backlog and to deliver more flexible, personalised care for patients. The pandemic has shown beyond doubt the importance of diagnostics. Although over 96% of people needing a diagnostic test received it within six weeks prior to the pandemic, the latest data shows that has fallen to 75%. Our aim is to get back to 95% by March 2025.

A major part of this will be expanding the use of community diagnostic centres, which have already had a huge impact. These one-stop shops for checks, scans and tests help people to get a quicker diagnosis and, therefore, the treatment they need much earlier. Sixty-nine community diagnostic centres are already up and running, and the plan shows our intention to have at least 100 in local communities and on high streets over the next three years.

We will also keep expanding the use of surgical hubs, which will be dedicated to planned, elective surgeries. They will allow us to do more surgeries in a single day than can be carried out in out-patient settings, so that we can fast-track operations and ensure that patients are more likely to go home on the same day. We have already been piloting these hubs, and we will now be rolling them out across the country.

Finally, we will improve the information and support for patients. I know the anxiety that patients feel when they are waiting for care, especially if they feel that they do not have certainty about where they sit in the queue, and I am determined to ensure that, as we enter this next phase, we will be open and transparent with patients. We will be launching a new online platform called My Planned Care, which will go live this month, offering patients and their carers tailored information ahead of their planned surgery. They will be able to see waiting times for their provider, so they can better understand their expected wait. A third of on-the-day cancellations are due to people not being clinically ready for treatment, and the new platform will also be able to link patients to the most appropriate personalised support before their surgery. This shows the approach that we will be taking in the years ahead, putting patients at the heart of their care and giving the support that they need to make informed decisions. We will also put in place a payment system that incentivises strong performance and delivers value for money for the public.

Just as we came together to fight this virus, now we must come together on a new national mission to fight what the virus has brought with it. That will mean waiting lists falling by March 2024, strong action to reduce long waiting times, and stretching targets for early diagnosis and for cancer care. This vital document shows how we will not just recover, but reform and make sure that the NHS is there for all of us, no matter what lies ahead. I commend my statement to the House.

February 9, 2022
Maria Caulfield – 2022 Statement on the Essex Mental Health Inquiry

The statement made by Maria Caulfield, the Parliamentary Under-Secretary of State for Health and Social Care, in the House of Commons on 4 February 2022.

It is normal practice, when a Government Department proposes to undertake a contingent liability in excess of £300,000 for which there is no specific statutory authority, for the Minister concerned to present a departmental minute to Parliament giving particulars of the liability created and explaining the circumstances; and to refrain from incurring the liability until 14 parliamentary sitting days after the issue of the minute, except in cases of special urgency.

I have today laid a departmental minute proposing to provide an indemnity that is necessary in respect of a Department of Health and Social Care established non-statutory, independent inquiry into the care and treatment pathways and the circumstances and practices surrounding the deaths of mental health inpatients in Essex.

The Essex Mental Health Independent Inquiry has been established to investigate deaths which took place in mental health inpatient facilities across NHS Trusts in Essex between 1 January 2000 and 31 December 2020. It will draw conclusions in relation to the safety and quality of care provided locally and nationally to mental health inpatients.

In January 2021, the Minister of State for Patient Safety, Suicide Prevention and Mental Health announced the establishment of the inquiry—HCWS729, 21 January 2021—to be chaired by Dr Geraldine Strathdee CBE. The indemnity will cover the entire duration of the inquiry’s work, from January 2021 until when the inquiry submits its final report, expected in 2023, and for an unlimited period after that date. However, we believe there is a low risk of the indemnity being called upon beyond five years of the inquiry having reported. The indemnity will cover the chair and all other members of the inquiry team, against any liability, including any legal or other associated costs, arising from any act done, or omission made, honestly and in good faith, when carrying out activities for the purposes of the inquiry in accordance with its terms of reference.

The indemnity will only apply to acts done or omissions made during the course of the inquiry and will exclude personal criminal liability, negligence or reckless acts. There will be no cap placed upon the indemnity, so the maximum exposure is strictly unlimited. However, any losses are not expected to exceed a value of £3 million based upon the best estimate currently available at this stage of the inquiry’s work. If the liability is called, provision for any payment will be sought through the normal supply procedure.

The Treasury has approved the proposal in principle. If, during the period of 14 parliamentary sitting days beginning on the date on which this minute was laid before Parliament, a Member signifies an objection by giving notice of a parliamentary question or by otherwise raising the matter in Parliament, final approval to proceed with incurring the liability will be withheld pending an examination of the objection.

February 5, 2022
Sajid Javid – 2022 Comments on Tackling Health Inequalities

The comments made by Sajid Javid, the Secretary of State for Health and Social Care, on 4 February 2022.

The pandemic has shown the resilience of the British public and brought communities together to look after each other in the most challenging times. But it has also exposed chasms in our society – particularly in health.

Where someone is born, their background, their gender, or the colour of their skin should not impact their health outcomes.

Professor Dame Margaret Whitehead and Javed Khan OBE both have vast experience in tackling health inequalities, and I look forward to the outcome of their reviews so we can continue to level up across society and make sure everyone – no matter where they live or come from – can live a long, healthy life.

February 5, 2022
Sajid Javid – 2022 Speech on World Cancer Day

The speech made by Sajid Javid, the Secretary of State for Health and Social Care, at the Francis Crick Institute on 4 February 2022.

Every second counts.

Do you know that every 90 seconds, someone in the UK is diagnosed with cancer.

In the time that it will take me to speak to you today, 13 people will get the news that their world will be turned upside down.

I lost my Dad to this vicious disease, and I know all too well the grief and the heartbreak that that brings.

He had colon cancer, but by the time that he was diagnosed it was too late. It had already spread to his lungs and liver.

I was so moved by the dedicated care that he received in his final days and I will be eternally grateful to Macmillan for the compassion that they showed him and my whole family.

This painful experience also impressed upon me that when it comes to cancer there isn’t a moment to spare.

Who knows, that if he had been diagnosed a bit earlier he may still be with us today and he could have been alive to see me become the Secretary of State for Health and Social Care.

You see my story is one of many.

There are around 166,000 cancer deaths per year, a daunting statistic.

But our experience of COVID-19 has shown us what we can do when we all unite against a common threat.

By putting all of the country’s effort and infrastructure behind one shared goal, we achieve things that would have seemed impossible.

Building Nightingale hospitals in a matter of days sending millions of free rapid flow tests to households across the country and vaccinating over 10% of the adult population in just one week.

Now that COVID-19 is in retreat, we cannot lose that spirit.

And we must capture it and think ambitiously about how we can apply it to other health threats that we all face.

Today is, of course, World Cancer Day.

So, let’s make this the day where we declare a national war on cancer…

The story of the past few years has been one of some progress.

The figures for survival a year after diagnosis have increased by over ten percentage points over the past 15 years, that’s a remarkable achievement.

But we do need to go a lot further.

Despite the very best efforts of the NHS staff who did so much to keep seeing cancer patients throughout the pandemic, throughout the last two years we know that COVID-19 has had a major impact on cancer care.

There are still around, we estimate, some 34,000 people who haven’t come into cancer services for treatment.

And on top of all this – although we lead the way in Europe for some cancers like melanoma and some others we do sit far behind some other countries with some other cancers.

The CONCORD study has ranked the UK 14th out of 28 countries that were studied for the diagnosis of breast cancer and we’re behind other large countries in Europe when it comes to survival rates for ovarian cancer.

so today we’re taking the first step in doing a lot, lot more. And that’s why I’ve published today a call for evidence that will inform a new 10 Year Cancer Plan for England a searching new vision for how we will lead the world in cancer care.

This Plan will show how we are learning the lessons from the pandemic and how we will apply them to improving cancer services over the next decade.

It will take a far-reaching look at what we want cancer care to be in 2032 – ten years from now.

Looking at all stages, looking at prevention looking at diagnosis looking at vaccines and treatments.

First, we must prevent people from getting cancer in the first place.

Traditional interventions have been focused further down the chain, on the treatments that are so vital for those that have already been diagnosed.

But the greatest impact we can have is preventing these people from needing cancer care at all.

The causes of cancer of course they are varied and they’re complex, but we know that for example that smoking is one of the greatest factors.

In 2019, a quarter of deaths from cancers were estimated to be due to smoking.

Although there are positive signs that smoking is declining there are still around six million people who smoke regularly in England.

My ambition is for England to be smoke free by 2030 and this year we will publish a new Tobacco Control Plan for England setting out how we are going to get there.

This will have a focus on reducing smoking rates in the most disadvantaged areas and groups.

And to inform this Plan, I’m pleased to announce that Javed Khan the former Chief Executive of Barnado’s will be leading an independent review looking at what more we can do to drive down those smoking rates and help people give up smoking for good.

Javed will be able to bring to bear his vast experience from the public and voluntary sectors I’m thrilled that he will be leading on this lifesaving work.

Obesity is also a major risk factor, and we are striving to halve childhood obesity by 2030 including through the measures that are in the Health and Care Bill, which is going through Parliament right now.

Alcohol consumption, too, this is linked to many types of cancers and we’re rolling out specialist Alcohol Care Teams in hospitals where rates of alcohol related admissions are highest.

We estimate that this will prevent some 50,000 admissions over the next five years.

And you know as that old adage goes: prevention is better than cure. But this is critical when prevention means sparing patients and their loved ones the anxiety of that cancer diagnosis.

This prevention agenda and this Government’s work to level up across the country, it’s really two sides of the same coin.

Why, because many of those risk factors of cancer that I’ve just talked about like obesity and like smoking they have a strong link with social deprivation.

For instance, in 2020, around 20 per cent of the adult population of Blackpool were smokers, compared to 7 per cent in Barnet.

There are stark disparities when it comes to cancer outcomes too.

The proportion of people whose cancer is diagnosed at any early stage is around 8 percentage points lower in the most deprived areas compared to the most affluent.

To tolerate such disparities for such a major killer is to accept the greater risk of death solely based on your background, where you live, what social group you might belong to…

I cannot accept this. I have made tackling disparities one of my most pressing priorities as the Secretary of State.

And on Wednesday, we announced that we will be publishing a Health Disparities White Paper this year looking at how we can tackle the core drivers of inequalities in health and I see plenty of areas where we can level up disparities on cancer.

Take for instance clinical trials.

We must work harder to get people from a wider range of backgrounds represented.

This is not just a scientific necessity but also a moral one.

Making sure that the clinical trials that take place, that they are developing treatments that are effective for all patients.

But currently some communities are under-represented, which we cannot tolerate when the stakes are so high.

We must also look at what we can do to address the variation in cancer outcomes across the country.

The Targeted Lung Health Checks Programme offers a shining example of what can be done.

Rather than people coming to us, we go to them taking mobile trucks into the heart of local communities.

After successful pilots in Manchester and Liverpool, we rolled them out to targeted areas across the country where we knew people were of the greatest risk.

The results have been phenomenal.

Within this programme, a massive 80 per cent of lung cancers are being diagnosed at an early stage, compared to less than 30 per cent before.

Many of these people were fit and healthy and had no symptoms at all.

One married couple Danny and Christine from Hull they both went to get checked in a supermarket car park and they soon received the sad news that Danny had lung cancer.

But because he was diagnosed early, they were able to act very quickly and now they have both given up smoking and these two, Danny and Christine are encouraging others to come forward and take advantage of this initiative.

When I talk about lung cancer, I can’t also help thinking about my late friend and colleague James Brokenshire, who we still miss very dearly.

Thanks to this programme, we have been able to give far more people a far better chance against cancer and of living a longer and healthier lives with their loved ones.

This approach has so much potential, and I want to look at how we can roll out more of these targeted types of measures.

To right the wrongs that currently exist and to level up on cancer care across the country.

You know one of the privileges of being able to this job, is being able to speak to this country’s brilliant cancer charities and foremost experts in cancer care on a regular basis as I just did a couple of hours ago in a round table that I held just here.

There’s a common consensus and this came through in the round table, there is a common consensus that one of the most important ways of making an impact on cancer outcomes is early diagnosis.

The majority of deaths from cancer come because we sadly catch it too late, like my father. Detecting the disease early can save time, save money, but most importantly, can save lives.

It is likely that early stage diagnoses have reduced over the past 18 months due to the pressures of the pandemic but we’ve taken steps to get us moving in the right direction.

We have announced a new network for example of Community Diagnostic Centres which are already doing amazing work in communities across the country offering patients quicker and easier access to vital cancer tests.

In their first seven months, they have already provided more than 400,000 tests and we expect to see over two million extra scans in their first full year of operation.

The NHS Long Term Plan, it rightly has a big focus on early intervention and commits to diagnosing 75% of cancers at stage 1 and stage 2 by 2028.

The most recent data impacted of course sadly by the pandemic for 2019. It shows that we are currently at 55% but I want to see if we can even set a mission to exceed the 75% target.

And to do this, we’ll have to take every opportunity to give people the certainty that diagnosis can provide.

So that the Call for Evidence, this demonstrates the ambitious plans that we have for the next decade.

Extending screening to more people, for example by extending bowel screening to people aged between 50 and 60 by 2024/2025 launching a new programme for liver surveillance along with working with primary care to trial new routes into the system, like using community pharmacy and perhaps even self-referral.

But if there’s more we can do, we want to hear about it, and that’s why this Call for Evidence is so important.

I’m especially interested in how we can encourage young people to come forward and make sure that when they do they are diagnosed quickly.

I was so moved to meet a very inspiring woman Charlotte Fairall someone I met just before Christmas with her constituency MP.

Charlotte’s daughter Sophie was sadly taken by an aggressive form of cancer at the age of ten.

This went unnoticed by a GP before it was diagnosed in A&E, diagnosed by a paediatrician, who found a tumour that was 12 centimetres long.

Charlotte is now a dedicated fundraiser and a passionate advocate for improving childhood cancer care and by meeting her that had a great impact on me.

Last year the UK Health Security Agency, they produced the first UK-wide report on cancer in young people which showed that every day in the UK ten children or young people are diagnosed with cancer.

We know that patterns of cancer in young people are very different to adults.

We already know this, so treating cancer for young people as a distinct speciality was pioneered in the UK and it has been replicated in many other countries across the world.

But there’s still much more progress that we need to make, especially to improve recognition and on early diagnosis and this is an area where I will be placing a particular focus in the years ahead.

Everyone is different and has their specific own treatment needs.

I want every patient to have the support they need, that’s going to be tailored to them both during and after their treatment.

In the future, more and more people will have cancer alongside other conditions so care centred around the individual is going to be absolutely crucial.

We’ve already made huge strides, and around 83% of all cancer multidisciplinary teams have adopted personalised care and that’s up from 25% in 2017.

But we will keep striving to get this number up and to improve follow-up care for cancer patients so that patients have someone to turn to even in the years after they finish their treatment.

And as we keep working to improve care, we will draw on the innovation and the enterprise that has proved its worth during this pandemic.

As one of the clinical leaders here at the Crick recently said: cancer is “an evolving system that plays by evolving rules”.

As cancer evolves, we must evolve too, and the best way we can do that is by embarking on new technologies and treatments and by making this country the best place in the world to develop them.

The past two years have shown the sparks of ingenuity that can fly when public and private sectors they work seamlessly together.

Now we must use this to transform all parts of cancer care, from referral, through the diagnosis, and then through the treatment.

In the Life Sciences Vision, we identified cancer as an area where we can use cutting-edge technologies to make a real difference.

The Office for Life Sciences and Genomics England have done so much to build bridges with industry and to improve care for patients and if you look around an NHS ward you will see the most incredible technologies being pioneered in this country.

Before I came here today, earlier this morning, I visited University College London Hospital to see how they are using proton beam therapy using high energy protons to precisely target tumours reducing the damage to nearby healthy tissues. I also saw, and it was fascinating technology, I think David the CEO is with us here today. I also saw a few months before that, I saw in a visit to Milton Keynes Hospital. I saw how they have been the first hospital, the first in Europe to use state-of-the-art surgical robots for major gynaecological surgery including complex cancer cases.

Most exciting of all, the NHS is currently embarking on the most important trial of early detection for generations.

This is the NHS-Galleri Trial which explores how we can detect cancer early when used alongside existing cancer screening.

This trial has been set up and recruited at a pace that we have never seen before anywhere in the world, and is showing already great promise with the potential to transform how we detect cancer in this country.

But I don’t want us to just stop there. I want to see many more Galleris.

There are so many other technologies and treatments that have great promise and we do need to make the most of them.

I want us to keep deploying the most cutting-edge technologies like AI, backed by our AI Health and Care Award.

I want to explore how we can do more on personalised treatments such as immuno-oncology using the power of the body’s own immune system to prevent, to control, and eliminate cancer.

Just as we saw during the COVID-19 pandemic, we’ve seen how vaccines gave us a solution.

I also want us to explore every avenue on how vaccines can help us fight cancer too.

You know we already have the HPV vaccine for some forms of cancer, like cervical cancer and here I’m determined to get the uptake of this vaccine back up on track because of the disruption of the pandemic.

And this vaccine, the HPV vaccine is already a true success story.

Data published just a few months ago showed how it is cutting cases of cervical cancer by almost 90%.

Over 80 million people have now received the vaccine worldwide, including my three daughters.

Due to the huge advances in vaccines and testing we have the very real possibility now to all but eradicate cervical cancer in my lifetime.

A really exciting mission that we can all get behind.

Although it might be some way on the horizon, there is also the potential I think to develop vaccines for other forms of cancer too.

Of course cancer vaccines are going to be notoriously difficult.

After all, we know that cancers develop specifically because they evade immune control.

But just because it’s difficult doesn’t mean that we shouldn’t try.

And I want to intensify research in this area, building on the huge advances that were made during the pandemic on mRNA technology.

And that research, you now the technology that had not been deployed until the pandemic came along, and look how fast the world moved to make use of it.

But the latest technologies, it’s also important to remember that they really cannot work without the data that sit behind them and health and care data in particular has so much potential for innovation and for researchers.

While the lessons of the pandemic was how much value there was where we could unlock this data.

Here in the UK, we linked the primary care records of millions of people to the latest COVID-19 data meaning that we were able to conduct the world’s largest analysis of coronavirus risk factors.

And I think we can apply these lessons to cancer too.

This is an area where this country has so many natural strengths.

We have one national health care system which means that we have all this valuable data effectively stored in one place.

This includes one of the best cancer registries in the world which, unlike many comparable countries, logs every single cancer case that’s been diagnosed in England.

The OpenSAFELY analytics platform has shown what can be done.

It has used health and care data to identify which areas of the country have lower rates of testing for prostate cancer so that we can then take targeted action.

What we need now is to build on this and drive the use of data even further.

Including reducing the lag in early diagnosis performance data – which can act as a big barrier for researchers – from years to just a matter of weeks and days.

This Call for Evidence invites views on what more we can do to promote the safe sharing of data to power the most cutting-edge technologies in the NHS.

The document we are publishing today shows our determination to thwart this menace that’s taken so many lives.

This is a big priority for me and my department and I’m delighted also to be able to call on Maria Caulfield and my ministerial team a former NHS nurse that specialised in cancer care.

But you all know that governments cannot do this alone.

We will need a new national mission, that’s drawing on the best of humanity to defeat this threat to us all.

We want to hear views from far and wide to help us shape this work. That’s the point of the call of evidence.

I want to hear from cancer patients, from their loved ones, people working in cancer care, pioneering researchers like those here at the Crick, some I met today. I can’t tell you how impressed I’ve been by them, and many, many more.

So please join us in this new effort so fewer people face the heartache of losing a loved one to this wretched disease.

Because every second counts.

Thank you all very much for listening, thank you.

February 5, 2022