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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“I welcome my hon. Friend’s comments. There is £645 million of funding over the next two years to support the expansion of this work through Pharmacy First. As I said a moment ago, the estates programme is more an issue for the integrated care boards. We should not try to determine all the decisions on estates from Westminster; it is right that we let the 42 ICBs have more discretion over what is the right estate strategy in their area. I am sure that his local ICB will hear his representations.”
“I have touched on the numbers a few times, but let me give the hon. Gentleman the precise figures. There are 335 more pharmacists than there were in 2010, so it is simply not the case that there are fewer. There are 2,000 more doctors in general practice, and there are also the extra 25,000 in additional roles. As I have said, someone who wants a prescription review should see a pharmacist, and someone with back pain should see a physiotherapist; not everything has to go through a GP, and it is better for GPs’ time to be used more effectively. There are also more doctors in training: 4,000 are receiving training in primary care, as opposed to 2,600 in 2014. So we are seeing more staff, more effort on recruitment, more effort on retention through the pension changes, and better use of the additional roles.”
“In respect of my hon. Friend’s first point, these plans will not make any changes. As for the second, about prescribing, that will be part of the consultation, and we will be learning lessons from what is being done elsewhere: for instance, Pharmacy First is already up and running in Scotland. We are looking into what tests can be performed alongside those prescribing rights so that antimicrobial resistance is targeted effectively.”
“There seems to be a slightly confused response from the Opposition. They challenge this announcement on the grounds that they are not happy with it, and in the same breath claim that it is part of Labour’s plan or a step in the right direction. They need to make up their mind. As I said in response to two earlier questions, it is for the integrated care boards to adopt estate strategies in their areas. Not all decisions about estates should be made centrally. However, one of the changes that we are setting centrally involves embracing more modern methods of construction and a more modular approach. The unit cost of that approach is much lower, and when the level of confidence is higher, the contingency cost is much lower as well. So we are changing the way in which we build our estate, but the estate strategy is an issue for the ICBs.”
“My hon. Friend is right to draw attention to the practice in other countries, and the fact that patients are very happy to visit pharmacists when that is more appropriate for the treatment that they are using. That is what the Pharmacy First strategy and the learning of lessons are all about, although we must also think about how to mitigate some of the risks connected with antimicrobial resistance. In the context of the impact on pharmacy, I refer my hon. Friend to what has been said by those in the sector. This is a move that they have called for and have now welcomed, and it responds very much to our discussions with pharmacists who have said that they can do more and are keen to do more, but need the funding to enable them to do so—which is what Pharmacy First delivers.”
“There is funding in other parts of the Department’s budget, not least for tech innovation and the work we are doing on artificial intelligence. There is further scope to use AI in demand management, for example to relieve pressure on GPs by looking at changes in the behaviour of frail or elderly patients and picking up changes early. The use of AI presents a significant opportunity. There are questions about how we can use data better; indeed, there are challenges for those across the House in how we can use data better to manage pressure within primary care. So there is funding elsewhere in the Department’s budget, in addition to what I have announced here.”
“I am happy to recognise the scope for Mrs Bristow and many others to make more use of the NHS app. That app is all about empowering the patient and enabling them to get the right care, in the right place, at the right time, whether from a pharmacist, one of the additional primary care roles we are creating or a GP where applicable. The NHS app can free primary care practices from many of the tasks that are currently placed on them, such as people phoning for their records or repeat prescriptions. It is a key part of streamlining such tasks.”
“Far from ducking Whipps Cross, I have actually been and visited in person, so I am very familiar with the issue and I recognise the importance of the new hospital programme. I hope to make an announcement about that programme and about the workforce plan shortly, just as I am doing today about the primary care recovery plan. In today’s plan, the hon. Gentleman may want see at the proposals to look at the contribution to pressures on primary care from new housing developments, and at what changes might be made to ensure that where such developments take place, funding from them goes not only to new schools, as it frequently does, but into primary care, and particularly GPs.”
“We plan to change planning guidance this year to address that specific issue. I have visited my hon. Friend’s constituency, and we resolved one of the issues in relation to the estate, which was extremely constructive. I know he has been discussing a further issue with the Department, but I hope he can take some comfort that his representations have been heard. The Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Harborough (Neil O’Brien), is planning to make changes to the guidance to better ensure that, where there is new housing, a contribution is made to primary care.”
“As I said in my statement, we have 4,000 doctors training in primary care, compared with 2,600 in 2014. We are also looking at how we can better retain the GPs we have. That is why we made the pension changes, which will affect around 9,000 GPs. It is also why we are looking at additional roles to take pressure off GPs, and at how we can reduce some of the burden of bureaucracy, too. We are training more doctors, and we are looking at retention and bureaucracy. No one is suggesting that this is solely an issue of telephony or online booking, as the hon. Lady suggests, but all of this will help to relieve pressure on extremely busy primary care.”
“My hon. Friend has a great deal of experience, and he is right to focus on the amount of clinical time often spent on non-clinical issues. Sending reminders through the NHS app will reduce non-attendance. We are also looking at the key interface between secondary care and primary care, as well as considering which appointments can be done elsewhere, such as through pharmacies and the additional roles. The online booking system can better triage people to the right place, and there will be some self-referral in order to take pressure off GPs—not for things that carry a clinical risk, such as internal bleeding, as the Opposition suggest; but for things like hearing aids. If a person has taken a hearing test, they will not need to clear an appointment for a hearing aid through their GP.”
“I have recognised throughout that demand has increased. Primary care is treating 10% more patients than before the pandemic, with around 1 million appointments a day. There is more demand, not just because of the pandemic but, as I said in my opening remarks, because we have a third more people over the age of 70, and they are five times more likely than younger people to go to their GP. That demographic change, the impact of the pandemic and a change in public expectations of advances in medicine are all creating additional pressure, which is why it is right that we use the full range of additional roles and that we invest in technology, in addition to the 2,000 more doctors in general practice.”
“My hon. Friend is absolutely right on this and we plan to have a communications campaign. The front door to the NHS can often be confusing for people—whether they should go to primary care, a pharmacy, accident and emergency or elsewhere. We will have a campaign, not just linked to the opportunity to access care through Pharmacy First, but looking at the technology innovations we are bringing on stream, particularly on the NHS app. We are also making changes to 111. So there will be a communications campaign, on exactly the lines she references.”
“I join the hon. Lady—as I did the other colleagues from across the House who have done this—in paying tribute to the primary care staff in her constituency for the work they do. We have touched a number of times on the fact that there are both more pharmacies and more pharmacists than there were in 2010, so there is more capacity. However, we also recognise the scope to better use the expertise within pharmacy, which is why an additional £645 million of investment—new funding—is going into pharmacies over the next two years.”
“That is why a key part of this recovery plan is about the investment in not just the tech, but in locums, to provide cover so that staff can make the transition to that new way of working.”
“My hon. Friend is right about the opportunity that tech offers to deliver changes at scale and the fact that this is proven technology that is working and already up and running in many primary care settings. So often within the NHS the challenge is not the initial innovation—we get pockets of wonderful innovation—but how we industrialise it across the wider NHS. This recovery plan focuses on that, looking at how we scale the case studies to which he refers. About half of primary care does have digital telephony. The opportunity here is to target that funding at the other half; that is often the smaller GP practices, as well as those in coastal communities, because they find the transition to tech more difficult.”
“As I have said several times, we will publish a workforce plan shortly. We are committed to that and the Chancellor set that out in the autumn statement. Of course, when he was doing this job and when I was previously in the Department, we expanded medical undergraduate places by a fifth, so there was an increase then. I have said that we will also set out a dental recovery plan in due course.”
“My hon. Friend touches on an extremely important point. The measures will provide, for all Members of the House, much greater transparency on the variation between primary care settings. I am keen that we should publish much more information showing, within constituencies, the differences in the services offered by different primary care settings. We already see that between those that have digital telephony and online booking and those that do not, but we also see that in other indicators, and I am keen that he and other Members of the House get visibility of that.”
“The hon. Member is right to recognise the importance of access to medical records. It is a key part of the functionality that we are delivering through the NHS app. He is correct that that is focused on England and not on Northern Ireland, but I am very happy for us to have discussions with him and his colleagues in Northern Ireland on any shared practice.”
“The funding will include for prescriptions for the seven common conditions, which form part of Pharmacy First. That will be part of a new NHS service that will be offered, as set out in this plan. That is what the £645 million over the two years is targeted at, and obviously we will have further discussions with the sector on the roll-out.”
“My hon. Friend has raised this issue previously, and he is quite right to champion it—I know that it is hugely important to his constituents. I hope the ICB will take heed of the issue he raises, particularly in relation to the level of visibility on the estate plan. Based on our conversations, I think that more can be done to share that with him. I urge the ICB to engage closely with him to make sure that the estate plan addresses the very real needs that his constituents have identified.”
“The Government are committed to our levelling-up mission to narrow the gap in healthy life expectancy by 2030. That is why, in October, we committed an additional £50 million to 13 local authorities to tackle inequalities and why we are also setting out our plans through the major conditions strategy.”
“My hon. Friend is absolutely right to highlight the importance of targeting health inequalities. Let me give the House a practical example. For lung cancer, patients are 20 times more likely to survive five years if we catch it early rather than late. Before the pandemic, those in the most deprived communities had the worst diagnosis. However, as a result of the targeted action we took with lung cancer check vans, they now have the best early diagnosis, which obviously has a big read-across for the five-year survival rate.”
“The hon. Gentleman raises a very important point. He can see the success of the representations I made to Cabinet colleagues from the Chancellor’s Budget statement, when he announced additional funding to tackle, in particular, health impediments to access to the labour market. He will also have seen the recent announcement of targeted action on, for example, smoking cessation, which is a particular driver of health inequalities. That includes our financial incentive scheme to pregnant mums, which obviously has a big impact on both their health and the health of their baby.”
“This issue concerns Members across the House. We have already started to reform the dental contract. We have introduced the £23 minimum value for units of dental activity and created more UDA bands, reflecting the fair cost. We are seeing more patients nationally—to March, up nearly a fifth on the year. But I recognise that there is more to do, and the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Harborough (Neil O’Brien), is undertaking that work as we speak.”
“The hon. Gentleman is right that we should narrow the health inequalities gap, and we are committed to doing that. That is why in the women’s health strategy, which I set out in the summer, we committed to having women’s health hubs as one-stop shops to tackle some of the gender inequality. It is also why, whether on obesity, smoking or lung cancer, we are targeting our screening and public health interventions to close the gap, which he is quite right to highlight.”
“In the Budget we announced extra funding for a whole load of digital apps— [ Interruption. ] The shadow Minister keeps chuntering about children. Let me talk about the roll-out of our mental health support in schools, which is targeted at getting that early mental health intervention to school children.”
“There is consensus in the House on our desire to close the health inequality gap—everyone agrees that is a key aim. The hon. Gentleman seems to have written the question before hearing my answer. I just gave a practical example of how we have transformed the early detection of lung cancer. He raised the public health grant, and I am happy to update the House that we are delivering 2.8% funding growth in the public health grant to help local authorities. It is also about areas such as obesity and access to employment, which can have a big impact on mental health. The Chancellor announced specific funding— [ Interruption. ] The shadow Minister chunters away about children; I am conscious that one does not want too long an answer, but let me give the example of mental health.”
“The urgent and emergency care recovery plan sets out how we will invest more than £1 billion in increasing capacity, including 800 new ambulances, an additional 5,000 core beds and a further 3,000 virtual wards, to provide more than 10,000 out-of-hospital care settings.”
“My hon. Friend is right to highlight the importance of UTCs. Nationally, they are above the national standard: 95.5% of patients are seen within four hours. He is a highly effective campaigner on health issues—he helped to secure the £2.8 million of investment for a new paediatric emergency department in his local area—and I know that he will be making a similar case to his local commissioners.”
“As the House knows, I am extremely committed to modern methods of construction and modular building capacity. We are using that as a central component of our new 40 hospitals programme. My hon. Friend will know that the RAAC—reinforced autoclaved aerated concrete—hospitals are very much part of that discussion, not just at Frimley but at King’s Lynn, at Hinchingbrooke and in a whole range of other settings. He will also know that we are in a purdah period, so we are constrained in what we can say, but we will have more to say on this very shortly.”
“The hon. Gentleman talks of 13 years. People are nearly twice as likely to be waiting for treatment in the Labour-run Welsh NHS as people seeking treatment in England, and, indeed, waits are longer in Wales: we have virtually eliminated two-year waits in England, whereas more than 41,000 people in Labour-run Wales are waiting more than two years.”
“Lady has raised an extremely important issue through her survey, and one on which we are focusing in our urgent and emergency recovery plan.”
“I know we have clinicians in the House who do second jobs, but I did not know that the hon. Lady had expanded that definition to such an extent! She is right to highlight, through her survey, the importance of timely care. There is currently a range of initiatives, such as the development of the NHS app, the review of the 111 service, and the examination of innovations such as artificial intelligence. We are looking into how we can manage demand in the case of, in particular, frail elderly people by noting changes in behaviour patterns, which will allow us to ensure that, for example, someone who has a fall at home receives care much earlier before arriving in the accident and emergency department, because we know that once frail elderly people have been admitted they will often be in hospital for about 14 days. The hon.”
“As a result of the fantastic work of Sir Jim Mackey and Professor Tim Briggs through the Getting It Right First Time programme, we have been making significant progress in respect of elective procedures. When it comes to urgent and emergency care, there are lessons coming out of the various strikes which we are keen to adopt, but this situation is also clearly having an impact on patients and the number of cancellations. As my hon. Friend well knows, we publish the figures. We have been working constructively with the NHS Staff Council. Unison voted by a majority of 74% to support the deal, there will be further votes this week from other key trade unions, and there will be a decision from the staff council on 2 May. Obviously, that will be extremely important when it comes to addressing the concern highlighted by my hon. Friend.”
“To be honest, I think the position is mixed. In certain areas we have seen significant improvements in performance: the faster diagnosis standard, for example, was hit for the first time this month. Purdah prevents me from going into the details of the 78-week wait, but I expect to be able to update the House very soon on the progress that has been made. As the hon. Gentleman says, there are still challenges as a consequence of the pandemic, but we are seeing much more progress than the NHS in Wales, and it is also worth reminding the House that, through Barnett consequentials, the Welsh NHS receives more funding that the NHS in England.”
“There are two separate issues there: what we are doing for mental health in-patients and the point we just touched on about A&E. On mental health, it is good of the hon. Lady to give me the opportunity to remind the House of the significant increase in funding we are making to mental health. In the long-term plan, the former Prime Minister, my right hon. Friend the Member for Maidenhead (Mrs May), made a major strategic choice to invest more in mental health—an extra £2.3 billion per year. The hon. Lady is right to highlight the need for more capacity for mental health in-patients— [ Interruption. ] She asked a question on what we are doing on mental health. I am able to tell her that we are spending far more and investing far more in it, but it seems that she does not want to hear that answer.”
“In February, the faster diagnosis standard was met for the first time. In addition, we are investing in additional screening, testing and tech in order to detect cancer much earlier.”
“My hon. Friend is right to highlight the interaction of workforce and capacity in equipment. That is why we have 810 more consultant training places over three years, and we have grants to enable more than 1,000 nurses to train, for example, in chemotherapy and 1,400 new recruits to the cancer diagnostic workforce. Obviously, that sits alongside the expansion in capacity, including both in our surgical hubs and our expanded diagnostic centres.”
“The whole House will send their best wishes to the hon. Lady’s constituent. She raises an important point about genomics, which is why we have invested in Genomics England and 100,000 babies are being screened—that is a key programme of work. The Minister for Health and Secondary Care, my hon. Friend the Member for Colchester (Will Quince) recently hosted a roundtable with key stakeholders on that, but I am happy to write to her with more detail, because the prevention and capability that is offered through screening is a great way of getting early treatment to people.”
“I think the question is about GPs and workforce capability, and that is why we are investing in more doctors. We have recruited over 5,000 more doctors, including an additional 2,000 doctors in primary care.”
“Now that I have found the right page in my notes I can be precise in telling my right hon. Friend that it is a 75.7% increase in his constituency, so he is absolutely right about that. Nationally, we have recruited an additional 25,262 full-time equivalent primary care professionals, so that is expanding the workforce capability in primary care. As my hon. Friend the Minister for Health and Secondary Care said a moment ago, it is part of our £1.5 billion investment in the workforce in primary care.”
“The hon. Lady raises an important issue related to MS. I am happy to write to her with a more detailed answer about the capability and the plan. There is always a tendency within government to lurch to a strategy rather than to look at what is needed for immediate delivery. I will happily set out what steps we are taking now as part of our pandemic recovery in order to target the workforce within the constraints that she raises.”
“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 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.”
“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.”
“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.”
“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. ]”
“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.”