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Category: Health

  • Matt Hancock – 2021 Statement on Covid-19

    Matt Hancock – 2021 Statement on Covid-19

    The statement made by Matt Hancock, the Secretary of State for Health and Social Care, in the House of Commons on 19 January 2021.

    On 5 January 2020, the Health Protection (Coronavirus, Restrictions) (All Tiers) (England) Regulations 2020 (All Tier Regulations) were amended. These amendments instructed people across England to stay at home and only to leave where they have a legally permitted reasonable excuse, as well as requiring the closure of many businesses and venues.

    Although we are getting the virus under control, the numbers of covid-19 cases, hospital and ICU admissions, and deaths remain extremely high nationally. As a result, our hospitals are now under more pressure from covid than at any time since the start of the pandemic.

    The weekly case rate in England is 520 per 100,000 for all ages and 414 per 100,000 in people aged 60 and over. There are 127 local authorities with case rates greater than 500 per 100,000. Overall positivity for England is 14.4%, with rates remaining high across all regions and continuing to increase in the north-east, west midlands and south-west. The highest positivity is in London (21.7%) and lowest in the south-west (9.5%).

    These figures are significantly higher in comparison to early December and there still remains considerable pressure on NHS systems nationwide as hospitalisations continue to increase. General and acute bed occupancy for covid-19 across England has risen by 1,786 to 31,459 from 29,673 last week. Mechanical ventilation bed occupancy for covid-19 across England has similarly risen to 3,570 from 2,310 in the previous week. Deaths within 28 days of a positive test remain high at 887 on 13 January, the last day of complete reporting.

    In line with our commitments, I have kept the measures in place for the national lockdown under ongoing review. On 19 January I completed a review of both the geographical allocations and the restrictions as required by the regulations and have determined that the measures remain necessary and proportionate for all areas in England. While there are early indications that new infections may have started to decline in those areas which have been under stricter measures for the longest, scientific advice and the latest epidemiological data is clear that lifting restrictions now would be too early. The restrictions are kept under continual review and will be lifted as soon as it is safe to do so.

    On 18 January the Government made some minor technical amendments to the all tier regulations to clarify policy and ensure consistency. The Health Protection (Coronavirus Restrictions) (All Tiers) (England) (Amendment) 2021 were laid before Parliament on 19 January and will come into force on 20 January.

  • Paul Blomfield – 2021 Speech on Dental Services

    Paul Blomfield – 2021 Speech on Dental Services

    The speech made by Paul Blomfield, the Labour MP for Sheffield Central, in the House of Commons on 14 January 2021.

    Can I, too, express my gratitude to my hon. Friend the Member for Putney (Fleur Anderson) for securing this debate? Dentistry often does not get the attention it deserves when we are looking at health provision for the country, and today is an opportunity to address that.

    Clearly, the pressure on dental services preceded covid-19, but the pandemic has exacerbated it. In normal times—if we can remember them—the demand for NHS dentistry in Sheffield was huge, with unmet need amounting to more than 35,000 patients. That clearly has a long-term impact on oral health, and one that is particularly worrying for children.

    Then came covid-19, which has hit the sector hard. Frankly, to choose this time to impose new targets, without warning or consultation, shows either a lack of understanding or a lack of regard for the consequences. The 45% target will disrupt the priorities of dentists by imposing penalties for failing to hit levels of what are described as normal NHS activity in what are blatantly abnormal times. It will threaten the viability of practices, and worsen access to dental care across Sheffield and the rest of England.

    Dental practices have made huge efforts to be covid-secure, with cleaning and air-clearing procedures that mean they cannot see as many patients as usual. Many have therefore prioritised emergency and urgent care, and this normal activity target will skew their priorities away from those patients most in need. As one dentist explained it to me, they will be

    “forced to stop seeing emergency patients…and to push the limits of the sound infection control procedures brought in to protect patients and staff”.

    Another simply said:

    “These targets are the wrong choice at the wrong time”.

    This is not scaremongering, as has been suggested, but a real and genuine concern from dental professionals who care about the services they provide.

    Sheffield Central is in the top 10% of areas where NHS dental care was most impacted by the pandemic, according to a survey, and the Association of Dental Groups says that problems are particularly acute in the most deprived urban, coastal and rural areas. Imposing this target will hit those most in need—levelling down, not levelling up. We need to be growing our dental services, not threatening them with damaging targets.

    I have great regard for the Minister—we have worked together on other issues, and I know she takes her responsibilities seriously—so I do hope that she will listen to the concerns she has heard today from both sides of the House, talk to colleagues and review this contract.

  • Anthony Mangnall – 2021 Speech on Dental Services

    Anthony Mangnall – 2021 Speech on Dental Services

    The speech made by Anthony Mangnall, the Conservative MP for Totnes, in the House of Commons on 14 January 2021.

    I congratulate the hon. Member for Putney (Fleur Anderson) on securing this debate.

    The impact of covid on the dental sector has been profound, from the sector’s closure in March to the 20 million lost appointments, the 15 million-appointment backlog and the year-on-year decrease in those who visit the dentist. In previous years, being able to avoid the dentist may have seemed an art form, but it is rapidly becoming a significant and desperately serious problem, with mouth cancer diagnoses significantly down and major operations being put on hold or just avoided due to lack of access.

    It is right that we have to clear the significant backlog. While I do not oppose the concept of a UDA target, I do oppose the mechanism that penalises dentists who do not meet that target. I respectfully ask the Minister to consider whether the target could be rejigged so that people have the security and understanding that if they are unable to meet it, they will not see a loss of salary or any penalisation from the Government. Of course, we have already heard that 50% of dental practices are meeting that target, so we have seen an ability to deliver.

    The intent is right, but the mechanism is wrong and only adds to the extra stress that those who work in dental practices are already suffering. I do not deny that dental practices in my constituency are safe, but the individual set-up of each is very different; things such as the air purification systems that they implement will mean that they have different fallow times and will therefore also impact the UDA issue. There is a result here whereby different circumstances will mean that the overall target is unable to be met.

    I ask the Government to consider taking away the penalisation mechanism of UDAs, reimbursing the VAT costs faced by dentists on PPE, and ensuring that our dentists are treated as part of the primary healthcare network. We hope to encourage people to stay in this sector. We want them to do so—we do not want them to go towards private alone—so I hope that the Minister will be able to reassure me and many of the dental practices in my constituency.

    Dentists are not asking for any more than anyone else, but they have received significantly less than many of those out there. All that we ask the Government today is to treat our dental sector with the respect that it deserves and to help it deliver for those who most need it across the whole United Kingdom.

  • Sarah Owen – 2021 Speech on Dental Services

    Sarah Owen – 2021 Speech on Dental Services

    The speech made by Sarah Owen, the Labour MP for Luton North, in the House of Commons on 14 January 2021.

    Like so many aspects of our lives over the last year, the pandemic has meant changes for dentists and for our constituents as patients. During the first lockdown last year, dental care was paused and emergency dental hubs were set up as back-up, naturally creating a backlog of patients in the system. Already in this new lockdown, practices are facing patient cancellations and staff sickness and self-isolation. It is clear that Government support is needed. No patient or dental practice should be put out for doing the right thing during the pandemic.

    Over the last year, I have met dentists and heard from practice managers across Luton North, who have told me about the challenges of keeping people’s mouths healthy during a global pandemic. One Luton North practice got in touch this week to tell me that dentists have been told that they must still hit their targets of 45% for dentistry and 70% for orthodontics, even in this new lockdown. That seems grossly unfair.

    Across all health services right now, patients are reluctant to attend appointments for non-emergency treatment. Many GPs are not seeing patients face to face unless absolutely necessary, but the Government and the NHS are asking dental staff to put themselves at risk. The new obstacles that covid has brought are preventing dentists from being able to do their best for their patients. Will the Minister take these issues away and consult dentists?

    I was shocked to find that dentists are not recognised as key workers, so they will not be in the highest priority groups for the covid-19 vaccine. I understand that priority must be given to those most at risk of serious illness or loss of life, but dentists are healthcare workers. Dentists are essential, and they are put in high-risk situations with respect to covid on a daily basis. Will the Minister please lobby her colleagues and NHS England to put dental workers on the same level as healthcare workers when it comes to vaccinations?

    Let me finish with an even bigger ask. We know that dental health is a determinant of other health and public health issues and matches up with other health inequalities that are caused by or can lead to poverty and other kinds of ill health. I therefore want to see the Government listen and rise to the challenge that dentists in Luton North have put to me over the last year.

  • Peter Aldous – 2021 Speech on Dental Services

    Peter Aldous – 2021 Speech on Dental Services

    The speech made by Peter Aldous, the Conservative MP for Waveney, in the House of Commons on 14 January 2021.

    I congratulate the hon. Member for Putney (Fleur Anderson) on securing the debate.

    Before the pandemic, my engagement with the dental sector led me to form a number of views on how it served our communities. Those who work in dentistry are highly competent and well qualified professionals, but there are problems in recruitment, and it is increasingly difficult to find an NHS dentist. When good and highly respected dentists retire, they are hard to replace. There is a lack of accountability in NHS England and NHS Improvement, and the world of UDAs—units of dental activity—is opaque and difficult to understand.

    One readily reaches the conclusion that in normal times, the system does not work in the best interests of local communities and public health. Covid-19 presents those working in dentistry with enormous challenges. They are placed in a position of significant health risk, there is a dramatic reduction in capacity, and there have been some problems with those working in the sector being recognised as key workers.

    The Government were right to set up a network of urgent dental centres, and in many respects this has worked well, although I have received a lot of complaints about where and how to find them, being kept waiting on the phone for seemingly hours on end, and then difficulties getting an appointment. Not only is there the challenge of getting through the current lockdown, but the shadow of covid will hang over the sector for a very long time. There is an enormous backlog of work, and yes, although some of that may be classed as non-emergency, it is important to bear in mind that it is often a routine visit to the dentist that picks up cancer at an early stage.

    The position has been exacerbated by the Government writing to dentists before Christmas seeking to impose a 45% target of UDAs for January, February and March. The proposal has been described to me by dentists in my constituency as “completely irresponsible”, “disrespectful”, “neglectful”, “unsafe” and “inconsiderate”. It should be dropped. The Government need to work with dentists to come up with, first, a short-term plan to get through the immediate crisis, and then a long-term plan that is easy to understand, provides proper accountability and full national coverage of NHS dentistry, and ensures the recruitment and retention of highly trained professional staff.

  • Fleur Anderson – 2021 Speech on Dental Services

    Fleur Anderson – 2021 Speech on Dental Services

    The speech made by Fleur Anderson, the Labour MP for Putney, in the House of Commons on 14 January 2021.

    I beg to move,

    That this House has considered the effect of the covid-19 outbreak on dental services.

    I thank my hon. Friend the Member for Brent North (Barry Gardiner) who co-sponsored the application for this debate, and the Backbench Business Committee for granting it. I also thank many MPs from across the House for their support for this important and timely debate.

    I am speaking on behalf of everyone who has suffered toothache under lockdown, or who will suffer it this year, for all the children whose orthodontal treatment has been delayed or is in disarray—that includes two children in my own house—and for all those whose more serious dental problems would have been spotted in routine check-ups, but who have not yet had them spotted. I speak also on behalf of dental practitioners and laboratories in my constituency and across the country who have felt ignored during the pandemic, and not treated as the frontline health workers they are.

    During the pandemic, one constituent told me that he had to pull out his own tooth, and a local dentist told me of an elderly lady whose dental pain meant that she could not eat solid food throughout the lockdown, and had lost weight as a result. There are serious consequences to the implications of covid-19 on dental practices. I would like to thank the dentists in my constituency and across the country, who have kept going in very difficult and stressful times, and often against all the odds.

    My message today is simple: we are sleepwalking into the biggest oral health crisis since the creation of the NHS. Unless the Government begin to recognise that dentistry is an essential health service, the sector will collapse. For now, the current activity targets are unattainable and need to be scrapped—I am sure other Members will be talking about them today. In the longer term, we also need better targeted financial support to save the sector. Overall, we need a national dentistry recovery plan to provide safety for dentists and patients, funding to stop closures, and ways to address the huge backlog of dental appointments. There is an NHS England phased recovery plan, but it does not address the whole dental sector. Dental care is not a middle-class luxury, but it is moving that way. It is a fundamental aspect of good health and a key indicator of health equality. We neglect it at our peril.

    From March to June last year, all routine dental care in England was paused and according to the British Dental Association over 20 million appointments were lost between March and November. That has created a huge backlog that will take years to clear unless it is addressed now. In my own borough of Wandsworth, nearly 6,000 fewer courses of treatment took place in the final quarter of 2020. It did not have to be this way. For example, in Germany, personal protective equipment and guidance was put in place straightaway and dentists were not shut. Funding of PPE and ventilators remains a major issue for enabling dentists to function and see patients even during the pandemic.

    Dentists have faced acute financial problems. They are both frontline health services and important high street businesses in all our communities, yet they did not receive the same funding as other frontline health services or high street businesses. Financial support remains either absent or uneven. As many as 53% of dental practices estimate that they can only maintain their financial stability for 12 months or less in the face of lower patient numbers and higher overheads. Beyond access to the furlough scheme and Government credit, support for private practice has been close to non-existent. There has been a failure to recognise the mixed economy on which dentistry is based. Dentists are among the only businesses on the high street that continue to pay business rates. That is totally unfair. Many of my local practices have not received any financial support, such as business grants, and this must be renewed.

    Now, on top of that, there are targets. In December, NHS dental practices were instructed by the Government to deliver 45% of all their targets, based on pre-covid levels, to earn their contract value from January to April. This was a hasty, not negotiated and widely discredited target-based dental contract, and it is incompatible with providing safe and sustainable services for patients during the pandemic. I understand that the targets were set before lockdown, but now is the time for the Minister to tell us that they will be reconsidered, they are not achievable and there will be a change of policy. The targets need to be scrapped.

    Most dental practices are small high street buildings and they cannot expand to meet the guidelines on social distancing and fallow time as well as meeting the targets. The British Dental Association found in a recent practice poll that 40% of practices in London alone have seen more than half their capacity wiped out by cancellations, staff sickness, self-isolation and difficulties accessing childcare. If there was ever an excuse not to visit the dentist, we have one now. We have told everyone to stay at home, so they are staying at home and they are not going to the dentist, but that is just building up huge problems for us in the future. Dentists cannot be financially penalised because of that.

    The latest UK data show high levels of cancellation and non-attendance during lockdown. One local dentist told me that at absolutely full stretch before Christmas he was able to meet 30% of pre-covid activity levels. He cannot meet them now, and he is worried about being penalised and losing money retrospectively, because he is obviously having to pay out for those contracts during these months. We would all like more people to be able to see dentists. We would like them to reach 100% of the targets and to clear the backlog, but the targets are simply unachievable at the moment and will put the future of dental practices at risk. By implementing this target, the Government are effectively removing the safety net from NHS dentistry at a time when covid-19 rates are surging. It is important to note as well that the target is set not by the chief dental officer, but by the Government. The wider implications of these issues extend beyond just bad oral health or a bit of toothache. It is predicted that it will increase emergency attendances at hospital A&E, increase antibiotic prescribing, increase admission to hospitals and longer stays, and increase missed oral cancer diagnoses, which is really worrying. The Oral Health Foundation found that mouth cancer referrals fell by 56% during the lockdown.

    In my constituency, the waiting list for tooth extractions by children’s tertiary care is now two years and growing —that is an almost emergency treatment. I met with dentists in my own constituency in the lead-up to this debate, and they made it clear that the 45% target is just unacceptable. One said to me:

    “How can the dental profession be expected to transition to this flawed quota system? Practices that fail to reach targets, through no fault of their own, will face penalties and clawbacks which will result in mass closure of dental practices as the funding to provide dental care will not make it viable to stay open. This is a reckless and unsafe decision”.

    Today, the Faculty of General Dental Practice UK, the College of General Dentistry and the Royal College of Surgeons Of England issued a joint statement saying that

    “safety must take a clear priority over dental activity levels during the…lockdown.”

    There is a universal call to scrap the targets, and I hope that we will hear about that from the Minister later.

    To wrap up, I have five demands of the Minister. First, we need a national plan for dentistry following the pandemic and a way that the backlog of appointments will be addressed, created in full consultation with the national professional dental bodies. Secondly, the activity levels for January to April must be scrapped. The 45% target will undermine patient care and safety. Thirdly, we must provide urgent support to practices to enable them to increase the number of patients that they can see. That means supplies of PPE and ventilation equipment to keep fallow time down. Fourthly, we need to be clear that all dental teams, including receptionists, must be given priority access to covid vaccines alongside other healthcare professionals. Fifthly, we need to maintain and expand the business rates holiday to dental practices and backdate it to late March.

    In conclusion, many parts of the country already had poor access to dental care before the pandemic. Current levels of capacity across the service mean that, unless something is done now, problems are likely to reach an unprecedented scale in every community up and down the country, and we will see a whole generation growing up with poor dental health. Let us recognise the dental sector as the essential frontline health care service that it is and do everything in our power to support it through this crisis and for our future.

  • Matt Hancock – 2021 Statement on the Reform of the Mental Health Act

    Matt Hancock – 2021 Statement on the Reform of the Mental Health Act

    The statement made by Matt Hancock, the Secretary of State for Health and Social Care, in the House of Commons on 13 January 2021.

    With permission, I would like to make a statement on reforming the Mental Health Act. Even amidst the pandemic, I am enormously grateful for the work that my team and the NHS have done, led by Sir Simon Wessely and Claire Murdoch and my hon. Friend the Minister for mental health, to deliver this White Paper, which we published today, to bring mental health legislation into the 21st century.

    We are committed as a Government, and as a nation, to see mental health treated on a par with physical health. We are increasing funding for mental health services to record levels, with £2.3 billion extra each year being invested through the NHS long-term plan, and an immediate £0.5 billion in place to support mental health services with the very significant pressures they are under. Our mental health services are now helping more people than ever before. Services are there for the most serious mental illnesses, although those, of course, are under significant pressure. Services are there for better community support through 24/7 crisis services and establishing liaison in A&E, and supporting people to manage their own mental health.

    This programme of transformation is ambitious, and as we support mental health services now, so we must bring up to date the legislative framework for the long term. The Mental Health Act 1983 was created so that people who have severe mental illness and present a risk to themselves or others can be detained and treated for their protection and the protection of those around them, but so much has changed since the Act was put into place, nearly 40 years ago. We now understand a lot more about mental health. Public attitudes around mental health have changed significantly for the better. We now have a better understanding and practice of how we can best support people with learning disabilities and/or autism. We are also concerned by the growing number of people being detained, inequalities among those who are detained, and the length of time that people are spending detained under the Act.

    So, after a generation, we must bring the Mental Health Act into the 21st century. The previous Prime Minister, my right hon. Friend the Member for Maidenhead (Mrs May), asked Professor Sir Simon Wessely to lead a review into what a modern mental health Act should look like. I thank her for her work, and I am so grateful to Sir Simon and his vice-chairs for their dedication. As I said to the House last year on its publication, the Wessely review is one of the finest pieces of work on the treatment of mental health that has been done anywhere in the world. I know that the review was welcomed across the House. We committed in our manifesto to deliver the required changes, and I am grateful to the Prime Minister for his emphatic support.

    Sir Simon’s review compellingly shows that the Mental Health Act does not work as well as it should for patients or their loved ones—that the Act goes too far in removing people’s autonomy and does not give people enough control over their care. I am delighted to set out our full response to that review in our White Paper, which, together with my right hon. and learned Friend the Lord Chancellor, we have laid before the House.

    The White Paper sets out plans for a landmark new mental health Act. The new Act will ensure that patients are put at the centre of decisions about their own care; that everyone is treated with respect; and that the law is only used to compel treatment where absolutely necessary. The White Paper has been developed in close consultation with those with the greatest expertise—the Royal College of Psychiatrists, Rethink Mental Illness, Mind, the Centre for Mental Health and countless practitioners on the frontline—and I thank them all.

    There are four pillars to this work; I should like to take a moment to update the House on all of them. First, we will give patients a voice in their own care, which we know leads to better engagement in treatment. We will put care and treatment plans and advance choice documents in statute for the first time, so that patients are more closely involved in the development of their care, and so that they can have confidence that if they lose capacity because of illness, their preferences will be properly considered. We are making it easier for patients to challenge decisions about their care, creating a new right to choose a nominated person who is best placed to look after their interests, and increasing patients’ access to the independent tribunal to provide vital independent scrutiny of detention. In his report, Sir Simon recommended that one of the best ways to ensure dignified care is to ensure that patients can expect the privacy of their own en-suite room. We have already committed £400 million of funding to deliver that, and we are building new mental health hospitals, with two schemes already approved and with more to come.

    Secondly, we will address the disparities that currently exist within the application of the Mental Health Act. Black people are currently four times more likely to be detained under the Mental Health Act than white people, and black people are 10 times more likely to be placed on a community treatment order. We also know that people from black and minority ethnic backgrounds can often engage with services later, and our plans to enhance patient choice, increase scrutiny of decisions and improve a patient’s right to challenge will help us to improve service provision for all. On top of that, we have already announced our new patient and carer race equality framework, as recommended by the review, and we are developing the use of culturally appropriate advocates, so that patients from all backgrounds can be supported in making their voice heard.

    Thirdly, it is important that the Act supports patients within the criminal justice system. We will make sure that, where people in prison require treatment in a mental health hospital, they are transferred in a timely way, and we will support rapid diversion from custody to care where appropriate so that people in our criminal justice system can get the right care in the right place at the right time, while we fulfil our fundamental duty to keep the public safe.

    Finally, in our manifesto, we committed to improving how people with learning disabilities and autistic people are treated under the Act. Until now, the use of powers in the Act did not distinguish between people with mental illness on the one hand, and people with learning disabilities and/or autism on the other. That is wrong. Needs are different and the law should be different, too. That is all part of treating everyone with respect. We therefore propose reforms to limit the scope to detain people under the Act where their needs are due to their learning disability or autism alone. In future, there will be a limit of 28 days for these detentions, which would be used to assess clinical need, and, wherever possible, we will work to ensure that appropriate support is available in the community rather than in institutional settings. I thank Baroness Hollins, Ian Birrell, Mencap and the National Autistic Society for their advocacy and for their support for these reforms.

    This Act is there for us all and we want to hear as many views as possible on these plans, so we will consult widely on this White Paper and will respond later this year before we bring forward a new mental health Bill. I believe that everyone in our society has a contribution to make and that everyone should be respected for the value that they bring. It is the role of Government to support people to reach their potential, even at the most difficult of times, and to protect people when they are at their most vulnerable. That is what I believe, and I believe these reforms will help put those values into action and help give patients the dignified treatment that they deserve. I commend this statement and the White Paper to the House.

  • Jonathan Ashworth – 2021 Comments on NHS Performance Statistics

    Jonathan Ashworth – 2021 Comments on NHS Performance Statistics

    The comments made by Jonathan Ashworth, the Shadow Secretary of State for Health and Social Care, on 14 January 2021.

    These figures show the alarming and sustained pressure the NHS has been under for months now – impacting all areas of treatment. Hospitals are struggling to deliver urgent care in the most difficult of circumstances, while over 190,000 people have now been waiting over a year for treatment.

    Years of underfunding, bed cuts and understaffing left our NHS exposed when the Coronavirus epidemic hit us. It is vital that we now have a Herculean effort to roll out at least two million vaccines a week, with NHS staff vaccinations completed in the next week, to ease pressure on our NHS.

  • Nadine Dorries – 2021 Statement on the Independent Medicines and Medical Devices Safety Review

    Nadine Dorries – 2021 Statement on the Independent Medicines and Medical Devices Safety Review

    The statement made by Nadine Dorries, the Minister for Patient Safety, in the House of Commons on 11 January 2021.

    The report of the Independent Medicines and Medical Devices Safety Review (IMMDS Review) was published on 8 July last year. I would like first to sincerely thank Baroness Cumberlege and her team for their work on the review. I also pay tribute to the women and their families who bravely shared their experiences and brought these issues to light. Without their tireless efforts to have their voices heard, this review would not have been possible.

    The overriding question investigated by the review is how the health and care system listens and responds to patient concerns raised by patients, and women in particular. We must not forget that the Cumberlege review, alongside other independent inquiries including the Paterson inquiry, was commissioned because women did not feel listened to or their concerns acknowledged—today is another step towards righting this.

    On the Paterson inquiry, I would also like to provide a very brief update. Work on the Government response was temporarily paused last spring due to the first wave of the covid-19 pandemic. Efforts have since resumed at pace, and I can confirm today that I will announce and publish the Government’s initial response in Parliament shortly.

    Returning to the IMMDS review, many of the report’s recommendations have already been discussed in detail during the Committee stage of the Medicines and Medical Devices Bill, and this has helped us to determine our future direction. We are very grateful to Members from both Houses who have worked with us on this.

    I am today updating the House on the Government’s response to the report of the IMMDS review, taking each recommendation in turn.

    Recommendation 1: The Government should immediately issue a fulsome apology on behalf of the healthcare system to the families affected by Primodos, sodium valproate and pelvic mesh.

    In July, when I introduced this report to the House, I made an unreserved apology on behalf of the health and care system to those women, their children and their families for the time the system took to listen and respond. I assure those affected that the Government have listened, and will continue to listen.

    Recommendation 2: The appointment of a Patient Safety Commissioner who would be an independent public leader with a statutory responsibility. The Commissioner would champion the value of listening to patients and promoting users’ perspectives in seeking improvements to patient safety around the use of medicines and medical devices.

    The central recommendation in the report is for the establishment of an independent Patient Safety Commissioner. This recommendation has rightly ignited much interest and debate in both Houses, and the Government have listened carefully to the arguments made for a Commissioner, and how this might sit within the wider patient safety landscape.

    Patient safety is a key priority for the healthcare system. In my role as Minister of State for patient safety, I often hear from and meet with people who have been affected by issues of patient safety. Their stories have common themes—of suffering avoidable harm, of not being listened to—and of a system that is then difficult to navigate when things go wrong. We want to make the NHS as safe as anywhere in the world, and we must retain an absolute focus on achieving this goal.

    I can therefore confirm that the Government tabled an amendment to the Medicines and Medical Devices Bill before the Christmas recess to establish the role of an independent Patient Safety Commissioner, in line with Baroness Cumberlege’s second recommendation.

    The Commissioner will act as an independent advocate for patients, and strengthen the ability of our health services to listen to the voice of patients. The Commissioner will be established as a statutory office holder, appointed by the Secretary of State for Health and Social Care, and will act independently on behalf of patients.

    The Commissioner’s core duties will be to promote the safety of patients and the importance of the views of patients in relation to medicines and medical devices. To help in carrying out these duties, the Commissioner will have a number of powers and functions, including the ability to make reports and recommendations to the NHS and independent sector, and to request and share information with these bodies.

    The Government look forward to working with Members of both Houses to ensure this new post acts as a beacon for listening and reflecting the safety concerns of patients, so that we can drive positive culture change in our healthcare system.

    Recommendation 3: A new independent Redress Agency for those harmed by medicines and medical devices should be created based on models operating effectively in other countries. The Redress Agency will administer decisions using a non-adversarial process with determinations based on avoidable harm looking at systemic failings, rather than blaming individuals.

    The Government have no current plans to establish a redress agency as set out in recommendation 3. The Government and industry have previously established redress schemes without the need for an additional agency.

    Recommendation 4: Separate schemes should be set up for each intervention—HPTs, valproate and pelvic mesh—to meet the cost of providing additional care and support to those who have experienced avoidable harm and are eligible to claim.

    Recommendation 4 on redress schemes for sodium valproate, mesh, and HPTs remains under consideration.

    Recommendation 5: Networks of specialist centres should be set up to provide comprehensive treatment, care and advice for those affected by implanted mesh; and separately for those adversely affected by medications taken during pregnancy.

    Good progress is being made on establishing specialist mesh services, which are the fifth recommendation in the report. NHS England is working with NHS hospitals to establish specialist mesh services which are currently planned to go live from the spring this year.

    These services will bring together leading experts to provide multidisciplinary care and treatment for all women who have experienced complications due to vaginal or abdominal mesh procedures.

    With a centre in every NHS region, these new services will ensure nationwide provision, and centres will work together to hone their expertise and share best practice.

    We continue to consider the second part of recommendation 5, which is for specialist centres for those adversely affected by medicines in pregnancy.

    Recommendation 6: The Medicines and Healthcare products Regulatory Agency (MHRA) needs substantial revision particularly in relation to adverse event reporting and medical device regulation. It needs to ensure that it engages more with patients and their outcomes. It needs to raise awareness of its public protection roles and to ensure that patients have an integral role in its work.

    Patient safety is the MHRA’s top priority. The MHRA recognises that the major changes highlighted by the report, particularly recommendation 6, are very important.

    The MHRA has already begun a substantial programme of work to improve how it involves patients in all aspects of its work, to reform systems for reporting adverse incidents with medicines and medical devices, and to strengthen the evidence base for its regulatory decisions.

    Within the MHRA’s work to strengthen the evidence base, the safety of medicines in pregnancy is of utmost importance.

    In the UK, three quarters of a million babies are born each year, and more than half of expectant mothers will need to take medicines when pregnant. We must ensure that women have high-quality, accessible information to be able to make informed decisions about their healthcare.

    To that end, I would like to highlight two important developments of MHRA reform.

    Firstly, the MHRA expert working group on optimising data on medicines used during pregnancy is today publishing its report which recommends ways in which healthcare data can be better collected and made available for analysis. This will enable the generation of better evidence on medicines used in pregnancy and will be vitally important when developing clear and consistent advice for women.

    Second, the MHRA has established a safer medicines in pregnancy and breastfeeding consortium. This brings together 16 leading organisations from across the NHS, regulators, and key third sector and charitable organisations. Today, they are launching a strategy setting out how they will work to improve information on medicines for women who are thinking about becoming pregnant, are pregnant, or are breastfeeding.

    Sodium Valproate

    On sodium valproate, in response to concerns raised during the previous debate on the IMMDS review, I am pleased to announce that the National Director of Patient Safety has recently established a Valproate Safety Implementation Group.

    This Valproate Safety Implementation Group will drive forward work to reduce harm from valproate through taking action to reduce the number of women prescribed valproate, and improving patient safety for women for whom there is no alternative medication, for example by increasing adherence to the Valproate Pregnancy Prevention Programme. The programme will ensure that every girl or woman knows about the risks of valproate in pregnancy, that where appropriate she is on effective contraception, and that she has a review by her specialist prescriber at a minimum once a year, when a risk acknowledgement form will be discussed and signed by both prescriber and woman herself. Importantly, the Valproate Safety Implementation Group will work with patients to understand how women can be supported to make informed decisions about their health care.

    In addition, last week the MHRA published the conclusions of a safety review into antiepileptic drugs conducted by the Commission on Human Medicines. This will help clinicians identify safer alternatives to valproate for the treatment of epilepsy in women who may become pregnant.

    I am also pleased to announce that the first data from the new Valproate Registry will become available later this month. The registry is being developed by the MHRA and NHS Digital, and will support work to monitor adherence to the Valproate Pregnancy Prevention Programme, and allow for long-term individual patient follow up.

    Recommendation 7: A central patient-identifiable database should be created by collecting key details of the implantation of all devices at the time of the operation. This can then be linked to specifically created registers to research and audit the outcomes both in terms of the device safety and patient reported outcomes measures.

    The seventh recommendation in Baroness Cumberlege’s report rightly reflects on the importance of collecting the right data for monitoring the safety of medical devices. We recognise the need for improved data collection and analysis for medical devices.

    That is why the Government acted in June last year to amend the Medicines and Medical Devices Bill to create the power to establish a UK-wide medical device information system prior to the review report being published, as we recognised the need to deliver such an information system. This system will mean that in future, subject to regulations, we can routinely collect medical device, procedure and outcome data from all NHS and private provider organisations across the UK, ensuring that no patient in the UK falls through the gaps.

    The Government are grateful to Members in both Houses, including Baroness Cumberlege, for their support for establishing a medical device information system.

    Recommendation 8: Transparency of payments made to clinicians needs to improve. The register of the General Medical Council (GMC) should be expanded to include a list of financial and non-pecuniary interests for all doctors, as well as doctors’ particular clinical interests and their recognised and accredited specialisms. In addition, there should be mandatory reporting for the pharmaceutical and medical device industries of payments made to teaching hospitals, research institutions and individual clinicians.

    The Government are considering recommendation 8, which is that doctors’ financial and non-pecuniary interests should be declared and publicly available.

    Any publication of declarations of interest should cover all clinical decision-making staff, not just doctors: it would also need to be held where patients could most easily access and interpret the information, with appropriate governance arrangements. We will consider these issues in discussion with the GMC, other stakeholders and the patient reference group to ensure the views of patients are listened to and incorporated.

    Recommendation 9: The Government should immediately set up a task force to implement this review’s recommendations. Its first task should be to set out a timeline for their implementation.

    The Government have no plans to establish an independent taskforce to implement the report’s recommendations. A cross-system working group has already been set up, meeting regularly, to develop the Government’s detailed response to the report.

    However, the Government recognise the need for effective patient engagement both to build trust, and ensure effective implementation. I am pleased to announce today that we are establishing a Patient Reference Group, which is part of Baroness Cumberlege’s ninth recommendation. The Patient Reference Group will ensure that patient voices are heard as we move forward towards a full response to the report.

    Conclusion

    The report of the IMMDS review powerfully demonstrates the importance of hearing the patient voice in patient safety matters. The actions outlined here demonstrate the Government’s commitment to learning from this report, and will support vital work already underway to hear the voice of the patient as part of the NHS Patient Safety Strategy. We currently plan to respond further to the report of the IMMDS review during 2021.

  • Alex Norris – 2021 Speech on Vaccinations

    Alex Norris – 2021 Speech on Vaccinations

    The speech made by Alex Norris, the Shadow Health and Social Care Minister, on 11 January 2021.

    I am grateful to the Minister for advance sight of his statement.

    We meet today at a challenging moment in the handling of the pandemic. We have growing infection rates, we are in lockdown, businesses are shut and schools are closed, and tragically more than 80,000 people have already lost their lives to this awful virus. The vaccine provides us with a light, a glimmer of hope, and a way to beat the virus, saving lives and getting us back to normal.

    The Government succeeded in the development of a vaccine—investing in multiple candidates has paid off handsomely—but a vaccine alone does not make a vaccination programme. Given the Government’s failures with the test and trace system and the procurement of personal protective equipment, it is right that we scrutinise the plans carefully.

    The plan is quite conventional: aside from the new big vaccination centres, it uses traditional delivery mechanisms operating within traditional opening and access times. The Opposition have some concerns about that, as we believe that exceptional circumstances call for an exceptional response. At the No. 10 briefing earlier today, 24/7 access was said to be something that people would not be interested in, which surprised me; I would like to hear from the Minister the basis for that view.

    Similarly, there is the mass deployment of community spaces and volunteer mobilisation unprecedented in peacetime. It is the Government’s prerogative to choose their approach, but I am keen to hear from the Minister assurance that the plan as written and set out today will deliver on what has been promised: the top four priority categories covered by the middle of next month.

    On a recent call, the Minister said that the only limiting factor on the immunisation programme would be the speed of supply. Will he publicly reaffirm that and confirm that this plan will make maximum use of the supply as he expects to get it?

    I think we would all agree that our frontline NHS and social care heroes deserve to be protected. At the beginning of the pandemic, our staff were left for too long without adequate personal protective equipment, and we must not repeat that with the vaccine. Protecting them is the right thing to do, reflecting the risks that they face, but it is also pragmatically a point of emphasis for us, because we need them to be well in order to keep doing the incredible job that they are doing.

    We are currently missing about 46,000 NHS staff for covid reasons. The health and social care workforce are in category 2 in the plan, but there does not seem to be a national-level emphasis on inoculating them immediately. There seems to be significant variation between trust areas. Will the Minister commit today to meeting our demand that they all get their vaccines within the next fortnight? We very much welcome the clear and simple metrics that he is going to publish each day so that we can follow the successes of the programme, but as part of that, will he commit to publicising the daily total of health and care staff vaccinated, so that we can see the progress being made against that vital metric, too?

    It was reassuring to see pharmacies included in the plan. They are at the heart of all the communities in our country, they are trusted and they already deliver mass vaccinations. It was disappointing and surprising to see them having to take to the front pages of national newspapers last week to get the Government’s attention, but now, with them in the plan, will the Minister reassure the House that he is fully engaged with their representative bodies and that they are satisfied that they are being used properly? The number that has been trailed publicly is of 200 participating pharmacies, but given that there are 11,500 community pharmacies in England, can that really be right? Why are there not more involved, or is that number wrong? If so, could the Minister share with us what the number is? On social care, 23% of elderly care home residents have been vaccinated, compared with 40% of the over-80s more generally. Given their top prioritisation, is there a reason for this lag? What plans are there to close the gap? Is the Minister confident that all care home residents will be vaccinated by the end of the month, as promised?

    Finally, there has been a high level of consensus across this place, and certainly between the Minister and me, on misinformation, and we will support the Government in whatever they think they need to do to tackle it. We will have a real sense of the impacts of misinformation as the programme rolls along, particularly as we look at who is and is not declining the vaccine. Will the Minister tell us what he will be monitoring in that regard, and what the early feedback is, perhaps from our own care staff, on who has been saying yes and who has been saying no and what that might mean for the future?

    We welcome the fact that the Government have published this plan. We will back them when we think they are right but we will continue to offer constructive ways to improve the process, as I hope I have just done. I hope that the Minister can address the points that I have raised.