PARLIAMENTARY DEBATE
Topical Questions - 25 April 2023 (Commons/Commons Chamber)

The Government support the right to take industrial action within the law, but equally the law is there to protect patients and NHS staff alike. Following legal advice, NHS Employers and my Department are confident that the proposed strike action by the Royal College of Nursing goes beyond the mandate it secured from its members, which expires on 1 May at midnight. While NHS Employers has sought to resolve the issue through dialogue, the RCN’s failure to amend its planned action has led NHS Employers to request my intervention. Even as we work to resolve those issues through dialogue, I can tell the House that I have regretfully provided notice of my intent to pursue legal action. None the less, I am hopeful that discussions can still be productive, especially those between the RCN and NHS England on patient safety, and that they will continue to be guided by the imperative to keep people who use the NHS safe.

The right to choose sounds attractive, but when diabetic eye disease and glaucoma seriously threaten the sight of millions, the fact that any qualified provider can and does cherry-pick reversible cataract work leaves the NHS with astronomical bills and all the complex cases. Will the Secretary of State praise award-winning clinicians Christiana and Evie at Central Middlesex Hospital and visit to see for himself how effectively writing a blank cheque for private treatment is destabilising NHS budgets and jeopardising the NHS’s ability to do award-winning research and to train junior doctors, who need routine work?

I am always happy to praise the brilliant work of clinicians up and down the NHS, who do a formidable job. Given the huge scale of the backlogs we face as a consequence of the pandemic, it is important that we not only use the full capacity available within the NHS, empowering patients through patient choice and technologies such as the NHS app to better enable that, but maximise the capacity in the independent sector.

My hon. Friend makes a brilliant point, and that is something that we are committed to doing. There is a huge amount of expertise within the pharmacy network, which is why we are looking, through technology such as the NHS app, at how we can better enable people to get the right care from the right place at the right time. Quite often, that is not by seeing the GP, but it might be by seeing those in additional roles in primary care or going to a pharmacist who can offer the right services.

I call the shadow Secretary of State.

A 13-year-old girl who has already waited more than a year for spinal surgery has seen her operation cancelled twice because of the Government’s failure to negotiate an end to the junior doctors’ strike. Why on earth is the Secretary of State still refusing to sit down and negotiate with junior doctors?

Like others in the House, my heart goes out to any 13- year-old girl in that situation. As the parent of a 12-year-old girl, I can only imagine how distressing it is to the family concerned to see that operation cancelled. That is why it is important that we have dialogue. The hon. Gentleman has said that the demands of the British Medical Association are unaffordable and unrealistic at 35%, as has the Leader of the Opposition. We have been clear on that, but the House saw that in our negotiation with the Agenda for Change staff unions we had meaningful, constructive engagement; that was how we reached an agreement with the NHS Staff Council, and we stand ready to have similar discussions with the junior doctors.

So why is the Secretary of State not sat down with them today? He says that he cannot negotiate because the BMA will not budge on 35%, but that is not true, is it? He says that the junior doctors have to drop their preconditions; they do not have any, do they? And he says that strike action will have to be called off before he can sit down; there are no strike days planned, are there? So is it not the case that he is quite happy to see hundreds of thousands of operations cancelled so that he can blame the junior doctors for the NHS waiting lists rather than 13 years of staggering Conservative incompetence?

It is slightly odd that the hon. Gentleman talks about 13 years when we are actually talking about a current industrial dispute. We have shown, through our negotiation with the NHS Staff Council, our willingness to engage and to reach a settlement. Indeed, the general secretary of the RCN recommended the deal from the AfC unions to her members. Unison—the union of which the hon. Gentleman is a member—voted for the deal by a margin of 74%. We stand ready to have engagement with the junior doctors, but 35% is not reasonable. He himself has said—[Interruption.]

Order. I do not need the Minister for Social Care, the hon. Member for Faversham and Mid Kent (Helen Whately), shouting from the end of the Treasury Bench. Okay? I call Henry Smith.

Successfully containing antimicrobial resistance requires co-ordinated action across all sectors. That is why the UK takes a “one health” national approach to AMR across humans, animals, food and the environment. Since 2014, the UK has reduced sales of veterinary antibiotics by 55% and has seen a decrease in antimicrobial resistance as a result.

I call the SNP spokesperson.

The British Medical Journal has warned that the comprehensive and progressive agreement for trans-Pacific partnership trade deal will make it harder for the UK to regulate tobacco and alcohol or banned products such as those containing harmful pesticides. Given that no health impact assessment has been carried out, The BMJ recommends that one should be performed now. Will the Secretary of State commit to assessing the deal’s threat to public health?

We do not plan to debate any of our existing standards. We have some of the strongest standards for control anywhere in the world. We have no plans to get rid of any of those things.

Notwithstanding the work that the Government have done, the feedback that I am receiving from Suffolk-based NHS dentists is that there is still a very long waiting list for overseas dentists waiting to take the overseas registration examination, with more than 3,000 applicants and only 150 exams taking place each month. I urge my hon. Friend to leave no stone unturned in working with the General Dental Council to eliminate the waiting list as quickly as possible.

We are leaving no stone unturned. Last month, we passed legislation enabling the GDC to increase the capacity of the ORE. We have also made it easier for overseas dentists to start working in the NHS: as of 1 April, no dentist will need to pay an application fee. We also want to radically reduce the time that dentists spend in performers list validation by experience, and we will set out further steps in our dentistry plan.

We are spending an additional £2.3 billion a year on mental health services, and we have recently announced £150 million for crisis community support, because we are trying to reduce the number of people being admitted in the first place by treating them at an earlier point in their mental health illness. That will free up beds, but it will take time. Community crisis intervention is the way in which we want to make progress.

Investors need certainty and the British people need access to more medicines. The growth cap in the voluntary pricing agreement for branded medicines between the pharmaceutical industry and Government makes the size of the medicines rebate unpredictable. Will the Minister remove the growth gap from the 2024 voluntary scheme for branded medicines pricing and access, to supercharge investment that is currently leaking to Germany and Ireland?

I can certainly ensure the House that we are seeking a mutually beneficial voluntary scheme that supports patient outcomes, a strong life sciences industry and a financially sustainable NHS. We have been working directly with industry to understand the impact of changes to VPAS on investments into the UK life sciences sector, and we remain firmly committed to VPAS, which, it is important to say, has saved the NHS billions of pounds and saved millions of lives by supporting patients with life-threatening conditions and giving them rapid access to new medicines.

First, I very much welcome the good care that the hon. Gentleman received, and it is great to see him back in the Chamber. On the wider issue, that is why we have an elective recovery plan, in which we have applied a boost in capacity, particularly through the surgical hubs. We are looking at how we build greater resilience, especially in winter, when elective beds are often under pressure. We are also investing in areas such as eye treatment, and we are rolling out through Getting It Right First Time a programme of improvement in a range of areas, including that one.

Provision for special educational needs and child and adolescent mental health services is one of the biggest issues in my inbox in Leicestershire, particularly in respect of delays in assessment and diagnosis. One of the Government’s plans was to introduce school mental health support teams. The Health and Social Care Committee heard that the aim was that 35% of pupils should be covered by 2023. May we have an update on progress and on when we are likely to reach 100%?

My hon. Friend makes an important point, and I am happy to update the House, as we have already achieved 35% coverage. By the end of the month, we expect to have 399 operational mental health support teams, covering 3 million children and young people. We plan to go further, with over 500 such teams by spring 2024.

Absolutely. We have already taken action to increase the provision of dentistry, and that has begun to have an effect. Activity—the number of people seen—is up by a fifth over the past year as a result of the reforms that we have begun to make by reforming the old contract, but we must go further.

One of my constituents, Bethany Whitehead, suffers from functional neurological disorder, which often presents with a number of debilitating symptoms. Bethany has often been left waiting two to three years before seeing a consultant. Will the Minister meet me to discuss this further?

My hon. Friend makes a really important point. I can say to her here and now that functional neurological disorder was previously regarded through a diagnosis of exclusion. It now has a rule-in diagnosis with available treatments, which is a major step forward in destigmatising the disorder. I am very happy to meet her to discuss this further.

We have increased real-terms spending on general practice by over a fifth since 2016, and as a result there are now 10% more appointments happening every month. We are grateful to GPs for that. We have more doctors and clinicians, but we want to keep going, and I am happy to discuss this with anyone who has useful ideas to keep us powering forward.

Yesterday, when the Prime Minister met business, the huge value of the NHS database was highlighted. Unfortunately, the previous occasions on which the NHS has tried to open its database have been unmitigated disasters. Will the Secretary of State give an undertaking to stick closely to the recommendations of the Goldacre report so that we can deliver the database while protecting the privacy of patients?

It is a huge opportunity. My right hon. Friend and I have discussed this matter outside the Chamber, and I met Ben Goldacre in the summer to discuss his fantastic work in the context of covid. It is absolutely right that, given the potential of artificial intelligence, there are huge opportunities in relation to health inequalities and allowing us to better target provision. I think my right hon. Friend would agree that we should do that through the prism of patient consent. One thing that we are trying to build into the NHS app is the ability to better empower the patient to decide what they wish to sign up to and what they would like their data shared with.

We are committed to a major conditions paper, not least because many people with cancer have multiple conditions; that is why it is important that we look at these issues in the round. With the Minister for Social Care, I had a very useful roundtable with key stakeholders, including the cancer charities. The key issue is that as part of our work on cancer checks, over 320,000 more people are receiving treatment for cancer compared with last year—that is around fifth higher—and we are expanding our capacity through the diagnostic centres, the surgical hubs and the expansion of the workforce. All of that fits within the strategy we have through the major conditions paper.

St Rocco’s Hospice in Warrington provides invaluable palliative and end-of-life care for families. However, the charities that run hospices around the UK are finding it incredibly difficult to raise funds. Will the Minister give us an assurance that she is working very closely with the sector to ensure that those services continue to be provided?

My hon. Friend makes a really important point about the very important work that hospices do in our communities, and I fully support hospices as a sector. The funding for hospices generally comes through the NHS and the local integrated care boards that commission the services they provide, as well as, of course, from their own fundraising efforts. I am speaking to NHS England about the support it provides to hospices, because I am very keen to make sure that they get the support that they need.

Yes, I am very happy to meet the hon. Member.

Building on the novel approach to clinical trials that was so successful for the covid-19 vaccines, what more is the Department doing to capture that success and the willingness of volunteers to come forward, as well as to streamline processes across participating bodies for clinical trials of future medicines?

My hon. Friend is right to raise this issue. Over 12,000 more participants a month are recruited into clinical trials than before the pandemic, but we recognise that there is much more to do in order to be internationally competitive, including around regulation and speed of approval. I am pleased to say that in the coming weeks, Lord O’Shaughnessy will publish his independent review into UK clinical trials, and I very much look forward to receiving his recommendations.

I am very happy to meet the right hon. Lady as we work towards the workforce plan and the dental plan.

I call Mark Fletcher to ask the final question.

The Minister is aware that BUPA recently closed the dental practice in Bolsover, leaving a severe shortage of NHS dentistry in the constituency. I met the ICB yesterday to discuss the various options for the constituency, but will the Minister commit to meeting me and the ICB to talk through those options and see what we can do to maintain NHS dentistry in Bolsover?

I have already met my hon. Friend, but I am very happy to meet him and his ICB to make sure that we commission the services that are so needed locally.

Bill Presented

Digital Markets, Competition and Consumers Bill

Presentation and First Reading (Standing Order No. 57)

Secretary Kemi Badenoch, supported by the Prime Minister, the Chancellor of the Exchequer, Secretary Michelle Donelan, Secretary Lucy Frazer, Kevin Hollinrake, Paul Scully and Julia Lopez, presented a Bill to provide for the regulation of competition in digital markets; to amend the Competition Act 1998 and the Enterprise Act 2002 and to make other provision about competition law; to make provision relating to the protection of consumer rights and to confer further such rights; and for connected purposes.

Bill read the First time; to be read a Second time tomorrow, and to be printed (Bill 294) with explanatory notes (Bill 294-EN).