Steve Barclay
MP for North East Cambridgeshire · Conservative · United Kingdom
“I speak to my brief exchange earlier with the Minister. As the previous speaker, the hon. Member for Harpenden and Berkhamsted, said, the draft regulations are fairly benign and very welcome to help people who are struggling with their bills.”
“The issue is not the lack of will; the issue is the alignment between procurement, regulation and clinical leadership, particularly in the colleges, as well as the ability to scale innovation—it is not about having more ministerial pilots.”
“Just to localise it to my own constituency, the Cambridgeshire and Peterborough ICB alone paid out £14 million in redundancies last year. It merged with a number of other ICBs to form the Central East ICB, yet we know hear from the Government that it should align with metro mayors, which means going back to exactly what it was before: the…”
“My right hon. Friend is absolutely right: the Government are spending millions of pounds and there is no plan. The measure was announced without working that out, it came as a surprise to many within the system, and it has had a chilling effect on many decisions. That is not isolated.”
“I rise to speak to clause 1 on the abolition of NHS England and clause 6 on promoting innovation. What characterises the first of those is an announcement without any clear plan. That is what has driven the cost and confusion that a number of Members across the House have spoken about.”
“All this is around 18 months on from the actual announcement. The confusion seems to extend to the Government themselves, because they seem unable to answer pretty straightforward written parliamentary questions. Given the time limit, I will give just a few examples.”
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“It is a very tightly constrained site and it needs a bespoke approach. That is what we are setting out. Where schemes can follow a standardised design, we will have a modular 2.0 approach, but some schemes that need refurbishment have particular site issues, and we will work through them in a more bespoke way.”
“At pretty much every election the hon. Gentleman has stood for, he has said that all the local hospitals will be closed by a Conservative Government, so it is good to have him championing the redesign and refurbishment of those hospitals. What really undermined his question was the question from his colleague, the hon. Member for Westminster North (Ms Buck). The whole point is that we need to look at the interaction between Charing Cross, Hammersmith and St Mary’s Hospitals—the design of services needs to be looked at across the Imperial trust as a collective. Vis-à-vis a potential new site at St Mary’s, there are questions relating to Transport for London and Network Rail. On Charing Cross, we need to create temporary ward capacity in order then to unblock the refurbishments, which we will do floor by floor.”
“It is not just the Eden Project North on which my hon. Friend has been a vigorous campaigner: he has raised this assiduously as well. As he knows, the trust is at a very early stage in its consideration of what public consultation will be needed around the reconfiguration of services across Lancaster. We are not letting that stop our work to open a new surgical hub at the Royal Preston Hospital, for example. [Official Report, 5 June 2023, Vol. 733, c. 8MC.] As he knows, I know the geography very well in terms of the interaction with Lancaster. There are a number of options on consolidation and expanding to two sites. I look forward to discussions with him as we take that forward.”
“The announcement and the manifesto commitment were to build by 2030. The hon. Lady touches on the engagement with industry; Lord Markham has been engaging with industry. We have had a significant team, both within the Department and in NHS England, working on the standardised designs. The whole point is that we have seen in other sectors how standardisation allows us to construct much more quickly. It will also allow internal processes in government to be much quicker because we are not looking at each scheme in a bespoke way; we will have much more standardisation. That is how we will move at a much quicker pace. It has required us to take a little more time over recent months as we have finalised the plan, but now that we have that plan and clarity about the RAAC hospitals in particular, we will be able to move with much more pace.”
“My right hon. Friend has assiduously and passionately led the campaign on this. I stand ready to have further discussions with her. She is right about the trust going into the rolling programme; that is how it will be taken forward. As I touched on in response to the Chair of the Health and Social Care Committee, my hon. Friend the Member for Winchester (Steve Brine), there are some questions that we are keen to work through—not least around junction 7, the land acquisition, and the service design—and I know that she will be at the fore in making representations on those points.”
“I have been before, as the hon. Gentleman knows, not least because I was an unsuccessful candidate in 1997, when he was elected to the House. I am very happy to ensure that a note comes with any further clarification—I will take that away and pick it up with the Department. I know that enabling works commenced in 2022. There have been extensive demolition works, which have continued into 2023. There is, as he is well aware, the key dependency for the Park House mental health project, which also needs to be factored in. The multi-storey car park is under construction, so that work is already under way. I hope that he can see the clarity that the statement will bring to the conversations that we can now have with trusts on enabling works and the next steps, but I am happy to get a more detailed note to him following the statement.”
“I very much agree. My hon. Friend is right to draw attention to the £8 million investment in Southend and the wider capital programme, not least the roll-out of diagnostic centres and new surgical hubs, which are all part of us tackling the pandemic backlog and of our commitment to investing in the NHS estate.”
“I am happy to give my hon. Friend that assurance. I have frequent meetings with the chief exec of Milton Keynes University Hospital, not least because he provides national leadership in our development of the NHS app. I know that he champions the Milton Keynes site and its next steps, and I am keen to continue to work constructively with him.”
“My hon. Friend has not only championed Watford General Hospital; he has worked there as a volunteer on many occasions. He has been compelling in the representations he made to Ministers across Government on the case for investment in Watford. It is a huge tribute to him, and as he says, it is also a tribute to the wider leadership team in Watford. He is right that it will have a transformative effect, and I have seen at first hand, with him, the urgent case for investment in Watford that he has championed.”
“As I touched on a moment ago, there are a range of initiatives across the NHS estate. The leadership team from the Getting It Right First Time programme, including Professor Tim Briggs, recently visited Wycombe to discuss proposals with the senior clinical team, and we look forward to working constructively with the local integrated care system as it designs the right fit for Wycombe and the wider system.”
“As I set out in my statement, the place of Kettering in the new hospital programme is secure. That is in large part a result of my hon. Friend’s campaigning. He has raised this issue with me on a very regular basis and shown me at first hand the issues at Kettering. He has championed investment in Kettering General Hospital, and today’s announcement is a very positive day for the staff and patients of Kettering.”
“I know that my hon. Friend has championed this investment in her health system. She is right that it serves a number of constituencies and is part of the wider system transformation that I set out, with other investments such as in diagnostic centres and surgical hubs. The Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Harborough (Neil O’Brien), who leads on primary care, has been looking at the specific issue of new housing and how we can get the right level of contribution from new housing to local health facilities. I know that he will be happy to discuss that with her.”
“I pay tribute to the work that my hon. Friend has done to champion the case for King’s Lynn. He has raised this issue with me and the ministerial team on a very regular basis, and he has been compelling. I am happy to confirm, as set out in the statement, that this will enable King’s Lynn to be rebuilt, and that is fully funded.”
“My hon. Friend is right on both counts—first, that the Royal Berkshire is part of the rolling new hospital programme, and secondly, that there are complexities with that site. As she knows, part of the site is grade I listed, and there have been some specific issues with the existing site on which survey work has been undertaken. That is having an impact on the target date for work. We are funding a mental health crisis facility this year, along with the survey work, and I look forward to having further discussions with her as that progresses.”
“Today’s announcement is transformative for healthcare in Norfolk, for the reasons my hon. Friend has set out: a new hospital at the James Paget and a new hospital in King’s Lynn. Of course, there will be further work from Government on the diagnostic centres and surgical hubs, about which there will be further discussion. In terms of the quality of the modular design, we are bringing the country’s leading experts together, as well as engaging with the market to finalise those designs so that we can have the best inputs as we standardise the design, and then roll that out as the template for schemes at King’s Lynn and James Paget. The quality of the scheme should be of a very high order.”
“My hon. Friend has campaigned assiduously over the past three years to make a compelling case for Airedale. I very much look forward to having the opportunity to visit in due course, and the commitment in today’s statement is to ensure that that hospital is built to the 2030 timescale.”
“On the issues that my right hon. Friend raises, it is agreed that a replacement is needed and that North and Mid Hampshire will go into the rolling programme for the new hospital programme. As a result, a site will be found, and the intention is to work to a 2032-33 timescale—that is the plan. The original timescale was already stretched because of some of the complexity involved, and I have also signalled just how long previous designs for hospitals have taken, so we are speeding up the construction side but we also need to address some of the issues, particularly around junction 7 and the site design.”
“Again, I pay tribute to my hon. Friend’s campaigning work, as well as the work he did in his local hospital as a volunteer during lockdown, which was extremely well received. It is why he has campaigned—along with my hon. and learned Friend the Member for Eddisbury and my hon. Friend the Member for Congleton —to make the case for this investment. I am very happy to have further discussions with him as liaison with the trust on the next steps moves forward.”
“It is always a pleasure to see my hon. Friend whatever the issue, but he is right that he has assiduously raised the case for Milton Keynes, as has his neighbour, my hon. Friend the Member for Milton Keynes South (Iain Stewart)—they worked very effectively as a team to make that case. I look forward to having further discussions with him as we take the plans forward.”
“My hon. Friend is right to champion the case of Doncaster. As he knows, while it is not in his constituency, the investment we are making in Bassetlaw is for patient care that, in a number of instances, will directly serve his constituents in Doncaster. That is why it is right that we look at capital investment on a system-wide basis, and I am very happy to have further discussions with him in conjunction with his local integrated care system as to that ICS’s future plans regarding its capital investment.”
“For example, patients are often discharged from hospital without fit notes, meaning that they then have to go to their GP to get one. By the end of this year, NHS secondary care services, which understand those patient conditions better, will be able to issue fit notes, and we have streamlined the number of targets on primary care networks from 36 down to just five. Taken together, this work will free up around £37,000 a practice. Today’s primary care recovery plan funds and empowers our GPs and pharmacists to do more, so that we can prevent ill health, keep cutting NHS waiting lists and improve that vital front door to the NHS for many millions of people. I commend this statement to the House.”
“In 2021, we hit our target of 4,000 people accepting GP training places, and our upcoming NHS workforce plan will set out how we will further expand GP training. We are also helping to retain senior GPs by reforming pension rules, lifting 9,000 GPs out of annual tax changes. These are the pension reforms that the British Medical Association welcomed, describing them as “significant” and “decisive” changes and citing them as “transformative for the NHS”. As well as freeing up more staff time, our plan cuts bureaucracy, too, so that GPs spend less time on paperwork and more time caring for patients. We will remove unnecessary targets, improve communication between GPs and hospitals, and reduce the amount of non-GP work that GPs are being asked to do.”
“This is another way in which, in light of our women’s health strategy, we aim to reduce the barriers to women accessing contraception. Pharmacists will also be able to do more blood pressure checks, which is one of the most important risk factors for cardiovascular disease. Not only will those kinds of steps make it easier for people to get the care they need, we expect them to release up to 10 million appointments a year by 2024-25. The third part of our plan is about providing more staff and more appointments. We are making huge investments in our primary care workforce, and are on track to meet the manifesto commitment of 26,000 more primary care staff by next March, meaning that we have more pharmacists, physios and paramedics delivering appointments in primary care than ever before.”
“Referrals might be from GPs, NHS 111 or, from next week, urgent and emergency care settings. Community pharmacies already take referrals for a range of minor conditions, such as diarrhoea, vomiting and conjunctivitis, but with our Pharmacy First approach we can go further still. We will invest up to £645 million over the next two years so that pharmacists can supply prescription-only medicines for common conditions, such as ear pain, urinary tract infections and sore throats, without requiring a prescription from a GP. One of the most significant shifts we are making is on oral contraception. Pharmacists can already manage the supply of contraception prescribed elsewhere; from later this year, they will also be able to start women on courses of oral contraception.”
“Instead, they will get their appointment booked on the same day or be signposted to other services. The second area of the plan is Pharmacy First. As well as giving GPs new technology, I know that we need to take pressure off GPs where possible by making better use of the skills of all clinicians working in primary care. We saw the incredible role that pharmacists played during the pandemic—their capacity to innovate and deliver for the communities that they served, freeing up GP appointments in doing so—so the second part of our plan is to introduce a new NHS service, Pharmacy First, on which we are already consulting with the Pharmaceutical Services Negotiating Committee. Some 80% of people live within a 20-minute walk of a pharmacy, so making it easier for pharmacists to take referrals can have a huge impact.”
“Indeed, many small GP practices in particular find it hardest to fund new technology, or to manage the disruption that comes with transitioning to new ways of working, so we are funding locum cover alongside the tech itself. Notwithstanding that, people will always be able to walk in or ring if they prefer; if someone wants to ring up and see someone face to face, these investments will make that easier, too. We also want to make sure that patients know on the same day that they make contact how their request is going to be handled. Clinically urgent issues will be assessed on the same day, or the next day if raised in the afternoon. If the issue is not urgent, an appointment will be scheduled within two weeks, but crucially, people will not be asked to call back the following day.”
“We are changing that by investing in modern phone systems for all GPs, including features such as call-back options, and by improving the digital front door for even more patients. In the GP practices that have already adopted those systems, there has been a 30% improvement in patient feedback on their ability to access the appointments they need. That also reflects the fact that online requests can help find the right person within the practice, such as being directed to a pharmacist for a medicine prescription review or to a physio for back pain. In doing that, we will make the most of the 25,000 more staff we now have in primary care. Today’s plans fund practices without this technology to adopt it, while also providing them with staff cover to help them manage a smooth transition to the technology.”
“In addition, this January, I came before the House to launch our urgent and emergency care plan, which is focused on how to better manage pressures in emergency departments, with funding to support discharge to improve patient flow in hospitals. Today’s plan is the next important piece of work. Turning to the detail of the plan, our first aim is to tackle the 8 am rush. We will do that by providing GPs with new and better technology, moving us from an analogue approach to ways of working in the digital age. An average-sized GP practice will get around 100 calls in the first hour of a Monday morning. No team of receptionists, no matter how hard-working, can handle such demand. About half of GPs are still on old analogue phones, meaning that when things get busy, people get engaged tones.”
“NHS England and my Department have committed to make over £1.2 billion of funding available to support the plan, in addition to the significant real-terms increases in spending on general practice in recent years. Taken together, our plan will make it easier for people to get the help they need. The plan builds on lots of other important work. Last year, we launched the elective recovery plan, which is making big strides to reduce the backlog brought by covid-19. We eliminated nearly all waits over two years by last July, and 18-month waits have now decreased by over 90% since their peak in September 2021. By contrast, in the NHS in Labour-run Wales, people are twice as likely to be waiting for treatment than in England. They still have over 41,000 people waiting over two years and nearly 80,000 waiting over 18 months.”
“Not only that, but advances in technology and treatments mean that people understandably expect more from primary care systems. Today I can announce our primary care recovery plan, and I pay tribute to the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Harborough (Neil O’Brien), for his work on this plan. I have deposited copies of the plan in the Libraries of both Houses. Our plan will enable us to better recover from the pandemic, to cut NHS waiting lists and to make the most of the opportunities ahead by focusing on three key areas: first, tackling the 8 am rush by giving GPs new digital tools; secondly, freeing up GP appointments by funding pharmacists to do more, with a “pharmacy first” approach; and thirdly, providing more GPs’ staff and more appointments.”
“We are investing more than ever, too, with the most recent figures showing that funding was around a fifth higher than five years before, even once inflation is taken into account. But we know that there is a great deal still to do. Covid-19 presented many challenges across the health service, leaving us with large numbers of people on NHS waiting lists, which need to be tackled. In general practice, patient contacts with GPs have increased between 20% and 40% since before the pandemic. As well as recovering from the pandemic, we face longer-term challenges, too. Since 2010, the number of people in England aged 70 and above has increased by a third, and this group attends five times more GP appointments than young people.”
“With permission, I would like to make a statement on the primary care recovery plan. For most of us, general practice is our front door to the NHS. In the last six months, over half the UK population has used GP services, and GPs in England carry out around 1 million appointments every single day. They are doing more than ever. General practice is delivering 10% more appointments a month than before the pandemic—the equivalent of the average GP surgery seeing about 20 additional patients every working day. There are more staff than ever, with numbers up by a quarter since 2019, and we are on track to deliver our manifesto target, with an additional 25,000 staff already recruited into primary care.”
“That is why we are targeting more than £600 million additional funding into pharmacists, which will allow people to better access the care they need in a timely fashion.”
“On funding, it is slightly bizarre that, although this plan announces more than £1 billion of new funding for primary care, investment in tech, new ways of working, additional staff and empowering our pharmacists, who bring great clinical expertise that we can better harness, the hon. Gentleman, rather than welcoming that, went back to the hackneyed non-dom funding. We have heard that so much before and it has been spent so many times. We have set out ways of best using the skills of our GPs and of the additional roles, where we are delivering on our manifesto with an extra 25,000 already recruited. Above all, we have set out ways of best using our pharmacists, who are a huge resource that we can better use.”
“Friend the Member for Maidenhead (Mrs May) was Prime Minister and a cornerstone of the long-term plan, with an extra £2.3 billion going into mental health. But we did not stop there. At the Budget, the Chancellor further prioritised mental health—for example, mental health digital apps were a cornerstone of the measures for economically inactive people. We are recruiting an additional 25,000 roles into primary care in recognition that specialists are needed, whether physios, pharmacists, paramedics or specialists in mental health support. The hon. Gentleman spoke about other aspects of primary care such as dentistry. We have said frequently that we have a recovery plan for dentistry that we will announce shortly, so that should not be news.”
“It is clear why we need to invest in new forms of working, online booking technology and cutting bureaucracy: it is so that GPs can focus on the aspects of their role that apply purely to GPs and we can better use the 25,000 additional roles that are being recruited into primary care. The hon. Gentleman talked about his direct referral policy. We actually announced our policy guidance in December, a month before his announcement, so it is something of a stretch to say that we are following his approach. He again kindly raised the issue of mental health, which gives me the opportunity to remind the House of the increased funding that this Government are making in mental health. That was a key priority when my right hon.”
“Those who want to see what a Labour Government would mean for the NHS can see it with the performance against the two-year waiting list and the 18-month waiting list in Wales, so it is very generous of him to give me the opportunity to share that once again with the House. The hon. Member talks about what the recovery plan is for. Clearly, the pandemic has placed huge pressure on primary care, and we can see that just from the increased volumes of appointments that primary care faces. Again, I touched in my opening remarks on the fact that GPs and primary care are seeing more than 10% more appointments than before the pandemic—1 million appointments a day.”
“I will give one final quote: the chair of the Royal Pharmaceutical Society says that this plan will be “a real game-changer for patients”, and that is what our focus has been. The hon. Member raised the issue of our delivery against the 18 months target. It is very generous of him to give me the opportunity to share once again with the House the contrast with Wales, but perhaps he missed it first time around. We have reduced the wait for 18 months by over 90%, yet Wales still has vastly more—over 80,000 waiting there—and that is from a much smaller population. Wales still has over 40,000 waiting more than two years, a target that we virtually eliminated as long ago as last summer.”
“The hon. Member started with the message to the public, and the message to the public can be seen by what key figures in the sector say about this recovery plan. Let me just share that with the House. The Pharmaceutical Services Negotiating Committee says that the plan is “the most significant investment in community pharmacy in well over a decade”. The Boots chief executive says that this is “great news that they’ll be able use their clinical expertise more widely”. The Company Chemists Association says that it is a “real vote of confidence for the future profession”. The message to the public from the industries in this sector is clear that this is a well thought through plan which will have a beneficial impact for patients.”
“The short answer is this year, but the Chair of the Health and Social Care Committee is right to focus, as with all recovery plans, on deliverability. I hope he will take comfort from the fact that around half of GP practices already have cloud telephony, which is why we are so confident that it is the right approach. It is one that is already working. We are seeing from patients’ positive feedback that they hugely value online booking and call-back systems, but they also allow primary care to better triage calls to specialists and therefore to use the additional roles we have recruited in an optimum way. That will be rolled out this year, but it is already up and running and we can see that it is working.”
“By enabling pharmacy capability for those who want to get oral contraception, have a blood pressure test or access services for the seven common conditions—including urinary tract infections and ear infections, for which prescriptions can then be given—we will free up GP time for face-to-face appointments. If we look at last year’s patients survey, we see that about two fifths of patients hugely valued continuity of care and face-to-face, which means about three fifths preferred to prioritise speed of access, rather than seeing the same GP or seeing someone face to face. So it is about tailoring the offer to what the patient wants, and patients do not always want the same thing. Some want speed and pharmacies can deliver that.”
“I know the right hon. Lady well, having served with her for four years on the Public Accounts Committee, so I hope that she will not mind me being slightly surprised about being told, as someone who lives in the Fens and not in London, that I am in the bubble. On her points, obviously, we have 37,000 more doctors than when the Government came to power. Directly, the changes to pensions lift about 9,000 GPs out of the tax changes. It is also about training more—4,000, compared with 2,600 in 2014—so being on track in terms of the number we are training. It is also about the additional roles that we are funding, the 25,000 and the manifesto commitment of 26,000. Also, the pharmacy announcement is all about freeing up GP capacity for face-to-face appointments for those who want come in.”
“First, I commend my hon. Friend because this is an issue that she has championed and she has been right to do so. These are degree-qualified clinical roles, so it is sensible that we make far better use of the skills that they offer. We saw during covid just how much value they offer to their communities. I confirm that they will be paid for these roles; that is what the additional funding is all about. She has been right over the years to highlight the importance of pharmacies and what they can offer, and that is what this announcement is all about.”
“It also looks at areas where there are appointments that we do not feel are necessary—so it looks at how secondary care can do fit notes, for example, rather than someone needing to go to the GP to get one. There are areas where we can streamline GPs’ workload and that is what the recovery plan does. On the workforce plan, we have said on a number of occasions that, post purdah, we would set that out very shortly. We will have more to say on that in due course.”
“I agree and thank the hon. Member, who is absolutely right to recognise the huge amount of work done by GPs and their staff, including receptionists. That is why the recovery plan is very much targeted at recognising the workload. I flagged in my statement the additional volume of patients that a typical GP surgery is seeing and that reflects the huge amount of work that is done. I think pensions were a factor, certainly in the feedback from the profession. The issue was raised. The changes the Chancellor announced take 9,000 GPs out of the tax changes, but the hon. Gentleman is right—that was not the only factor; the workload was another. The recovery plan looks to cut bureaucracy and, as I say, reduces the targets to five.”
“Member for Barking (Dame Margaret Hodge) and I remember looking at many a Labour PFI. The regional fire control centres were a case in point; the estate could no longer be afforded and the space was empty. If there is an issue like that, I will be happy to look at it in due course.”
“First, I join my hon. Friend in paying tribute to the work that GPs do in his constituency, as they do elsewhere. On pharmacies, part of the reason for the investment is to support pharmacy, including in rural settings. The more funding going in, the more they can prescribe. The more things they are able to do, the better the business model. There are more pharmacists and more pharmacy shops than there were in 2010, but it is important we make the business model more viable and that is what the announcement does. On estates planning, that is an issue for each integrated care board to consider. He mentions a specific issue locally with a former PFI and how it is being used. That is not a new issue. I sat on the Public Accounts Committee when it was chaired by the right hon.”
“First, I thank the hon. Member for recognising, constructively, that this is a step in the right direction. As the quotes from the sector show, many working within pharmacy welcome it. As I said a moment ago, there are 20,000 more pharmacists than in 2010. The additional funding, including—directly to her question—for prescribing, will make the business model more viable and therefore support the workforce within the pharmacy sector. We are working on IT as part of the recovery plan. There is a big read-across into the NHS app and how we better empower patients both to access their own medical records and to find the right services, including by being directed from the NHS app to pharmacies.”
“My hon. Friend raises a great point. I am extremely keen on how we can improve diagnostic testing and make it more accessible. As she knows from her time in the Department, early treatment is more effective and more cost-effective. Looking at more home testing, more testing at pharmacies and more work with employers to accelerate early detection is a win for patient outcomes and for delivering care in a more affordable way.”
“As I said, there are more pharmacists than in 2010 and more people working in the pharmacy sector—the numbers have gone up by 24,000 since 2010—so to address the hon. Lady’s second question, there are more. On funding, as I said in my statement, this is new funding for primary care. That is the commitment that we made, and it should be welcomed in the primary care sector.”