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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“Although the quantum of patients may be modest, that leads to delay. The hon. Gentleman recognised other things we have been doing over the summer, such as the St John Ambulance contract that has been put in place to help with auxiliary ambulances, the work on international recruitment—I do not accept that people are being paid less; that is bringing people in to work in important roles in our care sector—and the consultation on retire and return. Finally, the hon. Gentleman mentioned the cost of living. He will know that the new Prime Minister has made it clear that she will have further things to say on that over the next week, and I know there will be ample opportunity to debate that further in the House.”
“Gentleman did not mention mental health, but I know he takes an interest in it, so he will be pleased to know that over the summer we have particularly targeted action that can be taken in emergency departments and across the hospital estate in support of mental health, led by Claire Murdoch in NHS England. We have increased staffing by 16% and there is an extra £2.3 billion going into mental health next year compared with 2016. There is additional funding and workforce, because we recognise the pressures. There is also bespoke action with NHS colleagues. Sometimes, relatively low numbers of patients—for example, patients needing palliative care, patients with dementia and patients with Parkinson’s—are particularly challenging in terms of delayed discharge, and their discharge may be delayed for an extended period of time.”
“Gentleman recognised, some factors are beyond the trusts’ control, whether that is variance in performance on conveyancing by ambulance trusts, differences in hear and treat or see and treat, or the challenges in social care. We recognise that, as I said in my opening remarks, the heatwave and a covid infection rate of one in 25, compared with one in 60 now, created significant pressure on the ambulance system. In addition to the taskforce, we have enacted a whole range of other measures. NHS England has tasked the system with putting in place an additional 7,000-bed capacity for the winter. We have been expanding emergency department capacity. One thing we funded in spending review 2020, when I was in the Treasury, was additional funding for trusts where there are emergency department constraints. The hon.”
“Let me start with the areas where the hon. Gentleman and I agree. The David Wakeley case was shocking, and we accept that there have been severe pressures, particularly linked to certain trusts; just 10% of trusts account for 45% of ambulance handover delays. His second charge was about what the Government have been doing on this over the summer. We have had a 100-day sprint with NHS colleagues, a taskforce has been set up and I have met those troubled trusts, particularly Cornwall, to look at how we better support them. Some of the factors affecting ambulance delays are within the trusts’ control. Those include understanding why delayed discharge is much lower at the weekend, and things that they can do within the emergency department. However, as the hon.”
“I know my hon. Friend is a strong champion for this issue; when I was Chief Secretary to the Treasury, I remember him lobbying me about how a bridge from one bit of the hospital estate to another could provide additional capacity to meet the pressures his trust has faced. That is partly why we have been working intensively with the trusts that have the most severe cases of ambulance delays, looking through the work of the taskforce at best practice and what works best in those settings, and ensuring that the trust chief execs have the right level of support. It is important to recognise that the problem does not always manifest where it is caused. Quite often, challenges on the social care side, or further upstream in the conveyancing rate, put pressure on an emergency department and on the trust.”
“The hon. Member makes a very fair point. Within the question he raises is the unmet need where an ambulance does not reach a patient in the community, as opposed to the known risk once the patient is within the hospital trust’s purview. On capacity in A&E, as I touched on in my statement, we put in £450 million at the 2020 spending review to upgrade A&E facilities at 120 trusts. With respect to the hon. Member’s specific point, he may be aware of the letter that the NHS medical director Professor Stephen Powis and the chief nurse Ruth May sent at the time of the heatwave about where risk sits within hospitals. The taskforce has been doing further work on pre-cohorting, post-cohorting and observation bays so that we can better free up that ambulance capacity and get it back on the road.”
“I am very happy to join my hon. Friend in thanking the staff for their work and in condemning the completely unacceptable violence, intimidation and abuse to which people are subjected. There should be zero tolerance of that from any hospital trust.”
“What I can guarantee is that, through the taskforce, we are prioritising how we get ambulances back on the road and how we speed things up to reduce handover delays. We are looking in particular at the 10 trusts in which the issue is most acute, because there is an unmet need in the community if the ambulance is not there. On the hon. Member’s point about the backlogs with electives, we announced over the summer, as part of the work that we have been doing, a whole series of surgical hubs and community diagnostic centres. We are working with the Getting It Right First Time team, under Professor Sir Tim Briggs, on different patient pathways. A whole range of work is being done to reduce waiting times, which is why we have already cleared the longest waits—the two-year waits—and are now turning to the 18-month waits.”
“I am happy to join my hon. Friend in thanking the paramedics in Medway, in Maidstone and beyond for all their fantastic work, especially given the pressures the system has been under during the summer. As for levelling up, a number of Members have raised with me the need to ensure that developers are making a sufficient contribution as part of their housing plans, and I shall be happy to draw that to the attention of my colleagues in the Department for Levelling Up, Housing and Communities.”
“It is not just a question of having more money, although that is often the default; it is a question of thinking about how to get flow into the system in a way that will deliver not only patient care, but a more efficient service.”
“This obviously involves debates with Treasury colleagues about pay—not just on the social care side, but in respect of the NHS and the interplay with pensions—but it is not just about that; it is also about ensuring that we have the right data, and through the integrated care systems we are acquiring much better data to improve our ability to join up what is being spent on delayed discharge within the NHS with what is being done in the social care setting. I am sure Members will agree that not only is it often very damaging for frail elderly patients to spend a long time in hospital, but hospital is usually the most expensive place in the system for them to be.”
“That, I think, relates to the point that I just made about the need for flow in the system and an appropriate step-down capacity. Sometimes patients are not yet ready to be discharged to their homes, but some additional physio or other support may enable them then to go home, which is where they usually want to be. This is all part of taking a much more integrated approach, and part of that must be improving the quality of data in relation to the activity that takes place within community settings.”
“One of my reasons for going out with the London Ambulance Service—among others—over the summer was to answer the charge about what Ministers were doing, and to observe at first hand the challenges that the service had been facing. As the hon. Lady will know, performance has improved since the summer, but the service remains challenged. That is why we are considering a range of measures, such as boosting emergency departments, looking at pre and post-cohorting, looking at how we work with the taskforce, and looking at single points of access. One issue that paramedics emphasise to me is the need for, in particular, a better way for frail elderly patients to gain access to a single point for social care provision. We are working closely on that range of measures with colleagues in the London Ambulance Service.”
“I am very happy to ensure that that specific case, which is obviously concerning, is looked at. As my hon. Friend will know from my earlier remarks, we are boosting the number of 999 call handlers—those numbers are up and there are around 350 more call handlers than in September 2021—and we are also training more paramedics. Numbers are going up, but obviously demand has increased exponentially as well.”
“We are putting in additional funding, whether that is the additional £1.5 billion put into GP capacity in 2020, the £450 million to upgrade A&E facilities across 120 trusts, the extra £150 million specifically put into the ambulance service, the £30 million put into the St John Ambulance contract over the summer, or the further £50 million that has gone into call handling to boost the 111 service. Significant additional funds are going in as part of the support for the significant pressure that we recognise there has been over the summer.”
“First I acknowledge on the record the campaigning that my hon. Friend and colleagues have done for a new hospital at Kettering. They particularly demonstrated the urgency of addressing issues with the energy plant, so I was pleased that we were able to get that enabling work done. All A&E facilities have been under pressure over the summer, which is why we have announced the additional funding. It is about boosting capacity in call centres, looking at how we address variation in performance among ambulance trusts, particularly on conveyancing, and looking at how we get more flow into hospitals. That is why, along with the hospital, I also visited a care home in my hon. Friend’s constituency, in order to look at how we better address the issue of delayed discharge.”
“As I said in my statement, additional funding has been put in to boost A&E capacity. There was some £450 million of funding in the spending review in 2020, which has been applied across 120 trusts. Of course, the ICSs will look at the commissioning priorities in particular areas, and the NHS England taskforce is looking at trusts where there is acute pressure.”
“The hon. Lady makes an important point about variation not just between regions but within regions. As a rural Member of Parliament, I get the point that there is often significant variation within a region. That has been a key area of focus. The federated data platform, which is due to come on stream in April, will give her local ICS much better data on what is happening and on what community capacity there is. Over the summer, we have worked with ambulance trusts to look at operational performance data on a much more granular level. That is why I have flagged to the House the issue that a small number of trusts are driving a large proportion of the handover delays. That is exactly the sort of variation that we are looking at.”
“As my hon. Friend knows, my parents live very near the hospital in question. I know he has been a huge champion of the additional funding. If the opportunity arises, I would be very happy to visit. I pay tribute to the work he has done to secure the additional facility, which will benefit his constituents and those across the Fylde coast.”
“A good example from Hull, which I visited over the summer, shows that this is not simply about money, although that is obviously a relevant factor. The hon. Lady will be familiar with the Jean Bishop integrated care centre in Hull, where the social care staff say that no one has left the service because they really enjoy working in an integrated way. The patient feedback is also extremely strong. That shows the sort of innovation we should apply across the system. I hope the hon. Lady would welcome that innovation in Hull being applied more widely.”
“My hon. Friend is absolutely right that a central role for the integrated care systems in future is to look at how they best use the better care fund, how we better integrate around step-down provision, and how we ensure that best practice is being followed through the delayed discharge, including regarding some of the additional pressures that Warrington faced specifically, as I know from when we spoke over the summer. He will also know that there had been additional funding for new capacity at Warrington, which strangely was not highlighted in the media coverage that I saw.”
“Friend the Member for Chelsea and Fulham (Greg Hands) will know, was about £400 billion. Significant funding has gone in, and the statement today has shown that a number of factors, in particular the integration between social care and the NHS, are at the heart of solving the issue of delays on ambulance handovers.”
“I fear that the question was written before the statement. In the course of the statement, we have covered the significant additional funding that is going in, whether that is in primary care with the £1.5 billion on GP capacity, the £450 million on A&E capacity, the £150 million on ambulances, the £50 million on 111 call-handling or the £30 million on St John auxiliary ambulance capacity—to name just a few areas. As to the hon. Gentleman’s wider charge on Government funding for the NHS, I remind him that health funding is on track to be £4 in every £10 of day-to-day Government expenditure, which is a significant increase on 2010. We have also just been through a pandemic in which the fiscal response, as the former Chief Secretary to the Treasury, my right hon.”
“I have set out a range of things that we are doing to tackle what we recognise are significant pressures facing the NHS, whether that is through the taskforce that we have set up, which is targeted on delayed discharge; the intensive work that has been undertaken with, in particular, the 10 trusts that account for 45% of ambulance delays; the improved capacity within our call handling; or looking at our data, as was raised earlier, on the variation in performance between ambulance trusts on areas such as conveyancing or within the integration between the NHS and social care. I pay tribute to the huge amount of work that is being done within the NHS and social care in recognising that there are significant challenges within the system, which is why so much work has gone into addressing that over the summer.”
“On the hon. Gentleman’s second point, I will ensure that that particular letter to the Department is highlighted following this statement. On his first point, as I said in my statement, I agree that the greater risk is the unmet need if an ambulance does not arrive, rather than a patient who is in hospital. That is why Professor Stephen Powis and chief nurse Ruth May wrote to the system when there was pressure during the heatwave, flagging that as a specific issue. We have been working with trust leaders, including leading figures such as Anthony Marsh, on pre-cohorting and post-cohorting, capacity in emergency departments, and where risk sits in the system. I recognise the hon. Gentleman’s point.”
“We have procured doses, we are getting them out and it is fortuitous that cases are falling, but we are obviously keeping the situation under close watch.”
“Far from there being a lack of planning, the very essence of integration between social care and the NHS through the ICSs is that we recognise the importance of both aspects working much more closely together. That is why we are bringing forward initiatives such as the federated data platform. Monkeypox is outside the scope of today’s statement, but I know the issue is of particular interest to the hon. Gentleman. He will know that, fortunately, we have not yet had any fatal cases in the UK and the rate of infection has been falling. We purchased the maximum number of vaccines that we could; I wrote to the relevant charities with the details. Although smaller doses are being delivered compared with the initial 50,000, we still have doses in the system. We expect a further 20,000 very shortly and a further 80,000 later this month.”
“Again, despite that colourful language, we have more doctors, more nurses and more paramedics. We are training more and meeting more demand, and significant additional funding has been applied to ambulance trusts, call handling and other parts of the system, including primary care. Part of reducing the demand on the ambulance system is related to GP capacity, which is why—to take that as an example—an additional £1.5 billion of funding has gone in.”
“I very much agree with the hon. Gentleman on the importance of the air ambulance. As a rural MP, I know full well the importance of the service it provides across the Cambridgeshire fens, and I know that it provides an essential service for his constituents. Again, if there are any specific issues, I am happy to ensure that the Department looks at them, but he is absolutely right to draw attention to the importance of the air ambulance within the wider response.”
“Friends the Members for West Suffolk (Matt Hancock) and for Bromsgrove (Sajid Javid), the latter of whom is in his place, for their commitment to this important issue, even during the pressures of the pandemic. This is a landmark strategy, which lays the foundations for change and helps us to tackle the injustices that have persisted for too long. I commend this statement to the House.”
“We will need the NHS and local authority commissioners to expand the use of women’s health hubs; the medical schools, regulators and Royal Colleges to help us improve education and training for healthcare professionals; the National Institute for Health and Care Research to help make breakthroughs that will drive our future work; and many others to play their part. I would like to finish by thanking everyone involved in the development of this important strategy, including the Minister of State, Department for Health and Social Care, my hon. Friend the Member for Lewes (Maria Caulfield), who is on the Front Bench with me today, for the determination she has shown in taking this strategy forward. I would also like to pay tribute to my predecessors, my right hon.”
“At the moment, although parents whose babies are stillborn must legally register the stillbirth, if a pregnancy ends before 24 weeks’ gestation there is no formal process for parents to legally register their baby, which I know can be distressing for many bereaved parents. So we will be accepting the interim update of the independent pregnancy loss review and introducing a voluntary scheme to allow parents who have experienced a loss before 24 weeks of pregnancy to record and receive a certificate to provide recognition of their tragic loss. This is a significant programme of work but we cannot achieve the scale of change we need through central Government alone. We must work across all areas of health and care.”
“It also shows how we are putting an extra £10 million of funding towards 25 new mobile breast screening units that will target areas and communities with the greatest challenges on uptake and coverage. Finally, as well as these cross-cutting priorities, the responses to our call for evidence also highlighted a number of specific areas where targeted action is needed. Those include fertility care, where we will be removing barriers that restrict access that are not health-based but based, for example, on whether someone has had a child from a previous relationship, and making access to fertility services much more transparent. Another of our priority areas is improving care for women and their partners who experience the tragedy of pregnancy loss.”
“So we will be focusing our health and wellbeing fund over the next three years on projects to support women’s wellbeing in the workplace, and we will be encouraging businesses across the country to take up best practice such as the menopause workforce pledge, which was recently signed by the NHS and the civil service. Sixthly, we will place an intense focus on the disparities in women’s health. We know that although women in the UK on average live longer than men, they spend a significantly greater proportion of their lives in ill health and disability than men. Even among women there are marked disparities and our strategy shows our plans to give targeted support to the groups who face barriers accessing the care they need, for example, disabled women and women experiencing homelessness.”
“It is also important that medical professionals have the best possible understanding of women’s health, and I am pleased that the General Medical Council will be introducing specific assessments on women’s health for medical students, including on the menopause and on gynaecology. Fifthly, our strategy sets out how we will support women at work. In the call for evidence, only one in three respondents felt comfortable talking about health issues with their workplace, and we also know that one in four women has considered leaving their job as a result of the menopause.”
“Our call for evidence showed that fewer than one in 10 respondents feels they have enough information about conditions in areas such as the menopause and that many people wanted trusted and accessible information about women’s health. The NHS website is currently a trusted source of health information for many people, and we will transform the women’s health content to improve its existing pages and add new pages on conditions that are not currently there. But we know that the NHS will not be everyone’s first port of call for health information, so we will expand our partnerships, such as the one between YouTube and NHS Digital, who are working together to make sure that credible, clinically safe information appears prominently for UK audiences.”
“We are encouraging the expansion of those hubs, and indeed I visited Homerton University Hospital this morning to see the benefits these local one-stop clinics bring, enabling women to have all their health needs met in one place. Thirdly, it is essential that we address the lack of research into women’s health conditions and improve the representation of women’s data in all types of research. Currently, not enough is known about conditions that only affect women, as well as about how conditions that affect both men and women impact them in different ways. The strategy sets out how we will tackle the women’s health data gap to make sure that health data is broken down by sex by default. Fourthly, we will provide better information and education on issues relating to women’s health.”
“We are working with NHS England to embed shared decision making where patients are given greater involvement in decisions relating to their care, including when it comes to women’s health. Secondly, we want to see better access to services for all women and girls. Women and girls have told us that the fragmented commissioning and delivery of health services can impact their ability to access them. That means they have to make multiple appointments to get the care they need, adding to the NHS backlog. There are better ways to deliver women’s health through centres of excellence in the form of women’s health hubs, designed specifically to holistically assess women’s health issues and where specialist practitioners can be more attuned to concerns being raised.”
“We are publishing the first ever women’s health strategy for England, which sets out a wide range of commitments to improve the health of women and girls everywhere. I take this opportunity to pay tribute to the almost 100,000 women who took the time to share their stories with us, as painful as it may have been. Your voices have been heard and were vital in shaping this strategy. I will now set out the key components of the strategy. First, we are putting in place a range of measures to ensure that women are better listened to in the NHS. Indeed, 84% of respondents to our call for evidence recounted instances where they were not listened to by healthcare professionals. We need to do more to tackle the disappointment and disillusionment that many women feel.”
“We are embarking on an important mission to improve how the health and care system listens to women’s voices and to boost health outcomes for women and girls, from adolescence all the way through to later life. This is not only important for women and girls; it is important for everyone. This work is already well under way. Last month we announced the appointment of Professor Dame Lesley Regan, one of the country’s foremost experts in women’s health, as the first ever women’s health ambassador for England. On top of this, we are investing an extra £127 million in the NHS maternity workforce and neonatal care over the next year, and we are creating a network of family hubs in local authorities in England. Today we are announcing the next step.”
“With permission, Mr Speaker, I will make a statement on the women’s health strategy for England. I know that many hon. and right hon. Members will agree that, for too long, women’s health has been hampered by fragmented services and women being ignored when they raise concerns about their pain. On too many occasions, we have heard of failures in patient safety because women who raised concerns were not heard, as with the Ockenden review into the tragic failings in maternity care and the independent inquiry into the convicted surgeon Ian Paterson. I also remember the outstanding work of my constituent Kath Sansom and her Sling the Mesh campaign where, once again, the response was too slow when women raised issues with their care.”
“We have put in place a maternity disparities taskforce, and ministerial colleagues have already met three times as part of that taskforce, so the characterisation that Ministers are not engaging on the issue is, I am afraid, wide of the mark. The hon. Gentleman mentioned breast cancer. He will have noted from my statement that an additional £10 million has been targeted specifically at that issue, with a further 25 mobile units. Again, that is about addressing the disparity in women’s health data in different parts of the country. Overall this is an important strategy. We have listened to the very large number of responses to the consultation, and that is reflected in the strategy. I think this is an area on which there is much common ground on both sides of the House.”
“In the strategy, Professor Dame Lesley Regan makes the point that the irony is that we could deliver services that are far better for the patient but also cheaper for the taxpayer if we embraced a women’s hub model of the sort we see in Homerton. I very much look forward to taking the data we have forward in conversations with other commissioners around the country. I am pleased that the hon. Gentleman recognised and welcomed the removal of barriers to IVF, as will Members on both sides of the House who have seen the challenges that that issue presents in constituency cases. On speed of service, community diagnostic centres have an important role to play. The hon. Gentleman also raised the issue of ethnic minorities.”
“That is why I signalled in my statement our desire to work with the royal colleges and others to make sure that that continuing professional development is there. The hon. Gentleman raised the issue of access to HRT. He will be aware that we have put prepayment certificates in place from April next year so that someone will pay only the equivalent of two prescription charges for their HRT supply. Officials in the Department have done considerable work on supply chain issues to tackle some of the difficulties that were there in the past. On the hon. Gentleman’s point about how we address outcomes for patients, I saw a good illustration this morning at Homerton. Redesigning services avoids the need for invasive and more expensive theatre treatment, and the use of new equipment allows a better service to the patient.”
“That is why we have taken the first step of appointing a women’s health ambassador—Professor Dame Lesley Regan, who is an extremely respected figure in women’s health—to better champion women. It is also why I signalled in my statement the importance of data and of breaking it down by sex by default to better target our research on conditions that impact women differently from men or that affect only women and that are often not as well researched as they should be. Again, I think there is common ground on both sides of the House on the issue of research. I agree with the hon. Gentleman about the need to improve training for existing clinicians as well as for those new to the profession.”
“I do not want those on the Opposition Front Bench thinking that their points have not been addressed. I think there is much common ground on both sides of the House on the importance of this strategy and the need for a culture and system change in the NHS to address many of the concerns raised in past debates in the House on issues such as mesh, Paterson and Ockenden. I also think there are a lot of areas where colleagues on both sides of the House will work together to encourage commissioners in our constituencies to reshape services in a way that better reflects the needs set out in this strategy. The hon. Member for Ilford North (Wes Streeting) is right to highlight the fact that many respondents felt they had not been heard in the past.”
“Having hubs, centres of excellence and the ability to look at that data and identify it early, alongside the other initiatives in which he played a major role as Secretary of State, such as the diagnostic hubs, are all a key part of the delivery of this strategy.”
“The work on this strategy was done before I arrived in the Department, so it was down to my right hon. Friend and to the Minister of State, my hon. Friend the Member for Lewes (Maria Caulfield). It is great to have this opportunity to pay tribute to my predecessor for all that he did to drive this agenda forward. He is absolutely right about the importance of training and early diagnosis. That is why addressing the issue of fragmented services is so important. As a respondent said, where women raise concerns, they often feel like a lone voice in the wind—that was a phrase in the strategy that really resonated with me.”
“That is why we have such a relentless focus on data, why we have a women’s health ambassador to give greater voice to these issues, and why we have brought forward specific measures, such as the family hubs and mobile breast screening units, to better address those disparities.”
“I well recall, when I was a Treasury Minister, being asked to move at pace in response to covid, because of the cash-flow pressures on businesses, and sometimes having the same colleagues complaining that forward controls and other issues had not been put in place. We need to put the right IT in place. We will do that for April, and the work is under way. The issues that she raises are being addressed, but in an effective way. As I said to the shadow Secretary of State, we will work with the royal colleges to address the issue of training. It is a perfectly fair point, and I do not think there is disagreement in the House on that. On the wider issue of addressing disparities, that is exactly what the taskforce is about.”