Covid-19

Edward Argar Excerpts

Tuesday 12th January 2021 Commons Chamber

[The Minister for Health (Edward Argar)]

I beg to move,

That this House has considered covid-19.

Thank you, Madam Deputy Speaker, for your courtesy in slightly drawing out your introduction to allow me to take my mask off as I came to the Dispatch Box.

It is less than a year since the coronavirus was first mentioned in a debate in this House, on 22 January 2020. The House has debated this issue, which has affected all aspects of our national life, on many occasions since then. I would say at the outset that, throughout, it is important that we remember that all Members of this House share a common goal. They may have differences of opinion and there may be different perspectives on how best to achieve that goal, but it is important that we are clear that every Member of this House is clear in their determination to see this virus beaten and to see our country recover economically and in every other sense. I pay tribute to all right hon. and hon. Members and to the strength and sincerity of their views on this important topic. Since that first debate, novel SARS-CoV-2, which of course we all now know too well as covid-19, has caused untold disruption to all our lives and our way of life in this country. It is right, at this point, that we remember all those who, sadly, have lost their lives to the disease.

In this first general debate on covid-19 of 2021, it is worth reflecting that despite our painful familiarity with the challenges we face, the situation today is markedly different from many occasions in the past. For a start, and perhaps most importantly, we now see the way out. We have not one but two safe and effective vaccines being injected into people’s arms up and down the country as we speak.

[Sir Charles Walker (Broxbourne) (Con)]

Sorry, Madam Deputy Speaker, just let me take my mask off.

I thank my hon. Friend for his introductory remarks. The vaccine is being rolled out across the country, and in Broxbourne, but a number of my constituents are waiting to be informed by post, as I understand will be the case across the country. There are difficulties with the post at the moment, through nobody’s fault but the virus’s, so could he keep an eye on the postal service to ensure that, if post is not the best way, another way can be found to let people know that their number is coming up in the draw for the vaccine?

[Edward Argar]

It is always a pleasure to hear from my hon. Friend, who is also my friend, in this House, and he raises an extremely important point. I can give him the reassurance that I, other Ministers and particularly the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Stratford-on-Avon (Nadhim Zahawi), who is leading the vaccine deployment effort, will continue to look at ensuring that every means appropriate is utilised to ensure that people in my hon. Friend’s constituency and across the country get notified when their turn is up, so that they have every opportunity to get that life-saving injection.

[Catherine West (Hornsey and Wood Green) (Lab)]

rose—

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[Bob Stewart (Beckenham) (Con)]

rose—

[Edward Argar]

I will give way briefly to the hon. Lady, and then to my hon. and gallant Friend.

[Catherine West]

Does the Minister agree with the suggestion that, given that youth unemployment is shooting up, this might be the time for Royal Mail to take on some extra staff to cover those who are off sick? It is crucial that people know when their appointments are so that they do not miss that golden opportunity to get the jab.

[Edward Argar]

I had the pleasure of working with the hon. Lady in a past life before either of us were Members of this House, and she makes a typically sensible suggestion, which I am sure Royal Mail will have heard. I hope that it will reflect carefully on what she has said.

[Bob Stewart]

The real problem is that people will not know whether they have been called, because the post has not arrived. In my constituency, several instances have come to my notice of people not getting post for over a week. If they are called forward in that week, they are stymied, aren’t they?

[Edward Argar]

I reassure my hon. and gallant Friend that, while there may on occasions be challenges with the post, we are persistent in our determination, and the NHS is persistent in its determination, to ensure that everyone has the opportunity to get this jab. Where someone does not respond, or does not turn up for an appointment, we will keep trying, because it is really important that everyone has the opportunity to have that injection, which could save their life.

[Andrew Griffith (Arundel and South Downs) (Con)]

rose—

[Edward Argar]

I will give way to my hon. Friend, but then I will make some progress.

[Andrew Griffith]

I thank my hon. Friend for giving way; I know he will want to make progress. One group is further away from receiving a vaccine: undergraduates who would otherwise be returning to college today. A significant proportion of their education has been disrupted already. Is there any hope that the Minister can offer to the nation’s undergraduates?

[Edward Argar]

I am grateful to my hon. Friend. I seem to be taking multiple interventions today from people I have known in a past life in different ways and forms, which is always a pleasure. He will be aware that the prioritisation and roll-out of vaccines in that context are guided by the clinical advice of the Joint Committee on Vaccination and Immunisation, which, as he will appreciate, at the current time, and rightly, is clearly focused on what will do the most to save lives. We have seen—I will turn to this in my speech shortly—that age is the single biggest determinant of risk of death, so it is right that we are prioritising those most at risk as we roll out the vaccine. When I come to them later, he will hear about the very ambitious and deliverable plans, which he heard about from the vaccines Minister yesterday, to ramp up the roll-out across our country.

[James Sunderland (Bracknell) (Con)]

rose—

--- Later in debate ---

[Edward Argar]

I did promise my hon. Friend that I would take an intervention from him—then I will make progress.

[James Sunderland]

In 1940, when our small boats set sail for Dunkirk, nobody stopped to check through health and safety paperwork or institutional red tape. Will my hon. Friend the Minister please confirm that the Government will cut through unnecessary bureaucracy as we embark on the vaccine roll-out, and that we will throw the kitchen sink at this with the help of our armed forces?

[Edward Argar]

I am incredibly grateful to my—if I recollect correctly—hon. and gallant Friend, who has served in the past with distinction. He is absolutely right to highlight the amazing work of our armed forces, which was highlighted in the Chamber earlier this afternoon. He is also right to highlight the spirit of getting things done. He will have seen that my right hon. Friend the Secretary of State for Health and Social Care has been very clear that, while making no compromises on safety for patients and for those receiving the vaccine, he is working very hard to make sure that any bureaucratic barriers that do not support patient safety are removed to ensure the speedy and effective roll-out of the vaccine. So I am grateful to my hon. Friend for his point.

We have vaccinated more people than the rest of Europe put together—well over 2 million individuals, including more than a quarter of the over-80s in this country. I think that is a record to be proud of, but there is no room for complacency. We continue to work hard to get more injections in more people’s arms.

In that context, I pay tribute not just to the Secretary of State and to the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Stratford-on-Avon, but to Kate Bingham and the Vaccine Taskforce, who have done so much to make sure that this country was at the forefront of being able to purchase and deploy vaccines to help save lives. Yet, just as we accelerate the deployment of the vaccine further and faster, we must also recognise that the new variant of the coronavirus does present us with a renewed challenge.

Our strategy has always been, and continues to be, to suppress the virus to protect the NHS and save lives until a vaccine can make us safe, but with a new variant that is more than twice as transmissible, we must be clear that that task becomes considerably harder. The figures from the Office for National Statistics are stark: more than one in 50 of the UK population has the virus and an even higher proportion than that in places such as London. So, just as the virus has evolved, so must our response. We find ourselves once again in a difficult and challenging national lockdown, taking steps that I do not think anyone could have imagined in January last year—steps that, understandably, are truly testing the patience and forbearance of every person in this country but that are essential to relieve the pressure on our NHS, allow for the vaccine to be effectively deployed and, ultimately, set us free from the need for these restrictions.

Before I turn to those steps in a little more detail and the deployment of our vaccines, I am sure the whole House will, as always, join me in paying tribute to the heroic responses we continue to see from people in every walk of life. The return of the clap for carers initiative last Thursday, under the new guise of clap for heroes, is a reflection of the shift in our collective understanding of just what heroism and service look like and a tribute to everyone who is helping us push through this difficult time.

I know that my constituency neighbour, the hon. Member for Leicester West (Liz Kendall), will join me in paying tribute to and thanking everyone who works in our NHS in this country and all those who support not just the NHS but social care, in care homes, social care settings and domiciliary care—people in a range of roles up and down our country who, day in, day out, selflessly care for those who need it. In a past life, I was a local councillor, and I had the privilege of being the cabinet member for adult social care, health and public health for the council on which I served. I saw at first hand the amazing work that our social care workforce do, and it is right that we recognise that at every opportunity in this Chamber.

It is also important to highlight the great British scientists who are at the forefront of humanity’s fight against this virus, developing not only the Oxford-AstraZeneca vaccine but life-saving treatments for those who become infected with covid, first in the form of dexamethasone and now tocilizumab and sarilumab—I have considerable sympathy with the Prime Minister in his attempts to pronounce those—both of which have been found to reduce the risk of death for critically ill patients by almost a quarter and cut time spent in intensive care by as much as 10 days. Those life-saving drugs are now available through the NHS, and it is an example of the huge debt of gratitude we owe people from all walks of life—not just those on the health and social care frontline, but people who are working under very different but no less considerable pressures for our country. The Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Bury St Edmunds (Jo Churchill), who is the Minister for prevention, public health and primary care, will no doubt reflect on that when she winds up the debate.

In terms of the context, I must first turn to the pressures in our acute hospital settings. Across the UK, there are more than 32,000 patients in our hospitals with covid. That is over a third of the NHS’s available beds of all types. On 31 December last year, the total reported admission to hospital and diagnosis of covid in English hospitals was 2,536—on one day. That increased by 46% in the week that followed, so on 9 January, we were seeing 3,718 people admitted. The pressures on our acute hospitals and those who work in them are intense. Patients are therefore currently being treated in Nightingale hospitals in Manchester, Exeter, Bristol and Harrogate to cope with these numbers, and NHS England has confirmed that the Nightingale in London is also open for patients.

Last Monday, all four UK chief medical officers recommended that we move the country to covid-19 alert level 5, meaning that in their expert view, there is a material risk of healthcare services being overwhelmed. In this place, we have often talked about the most frightening of possibilities, but frankly, we have never been this close to seeing it happen, although we are all doing everything we can to ensure that the NHS continues to be able to cope during this time. Quite rightly, we have thanked our NHS staff, and people in this country have expressed gratitude and clapped them, but I think it is fair to say—echoing some of the intensive care doctors and nurses I have seen in the media recently—that the best way we can all say thank you to our NHS is to follow the rules and stay home in line with those rules, to ease the pressure on them.

That is why the choice that this House took last Wednesday to vote overwhelmingly for new regulations, placing England into a national lockdown alongside the action taken in each of the devolved nations, was the right choice. The key message is and must be as it was in the spring, as I have just enunciated: you must stay home. We have always said, and I have always been clear, that it is right that schools should be the last thing to close, and we deeply regret that we have had to close them, but as we begin to move out of lockdown, when we can safely do so—and, as the Prime Minister has promised, through the gradual loosening of restrictions when we can—schools will be the first thing to reopen.

Our regulations provide for these new restrictions until 31 March 2021. I hope that they may not be needed for as long as that, but that time allows us to take steady, controlled and evidence-led decisions, including moving places down through tiers on a local basis—again, when it is safe to do so. As you would expect, Mr Deputy Speaker, we will of course keep these restrictions under continuous review, with a statutory requirement to look at them every two weeks and a legal obligation to remove them if they are deemed no longer necessary to limit transmission of the virus.

[Sir Edward Leigh (Gainsborough) (Con)]

On that point, to me, the right strategy to stop the NHS being overwhelmed seems to be to have a flexible tier system, whereby we work out whether local hospitals in each region are about to be overwhelmed; and, if they are, we go into lockdown. Does my hon. Friend understand what I am saying? Is there going to be this flexible approach, rather than this mass lockdown nationally?

[Edward Argar]

I am grateful to my right hon. Friend for his intervention. With the new variant identified before Christmas, we are seeing hospital admission rates and demand for hospital services rising across our country. That is why it was absolutely right that we instituted the measures that we did, which have seen what it is effectively called a national lockdown at this time. The Prime Minister and the Secretary of State for Health have been clear that they hope, and would expect, that as we get the infection under control and ease the pressure on the NHS, when it is safe to do so we will be able to look to returning to that tiering system. Exactly as my right hon. Friend says, one of the five key factors in whether an area went up or down among the tiers was local hospital capacity—and I emphasise the “local” in that context—but, sadly, we are not in that place as we stand here and debate this matter today.

[Mr William Wragg (Hazel Grove) (Con)]

My hon. Friend is being very generous with his time. Could he perhaps say more about what percentage of those vaccinated in the vulnerable categories will count towards such a consideration?

[Edward Argar]

If my hon. Friend will show a little forbearance as I make a little progress, I will come to vaccinations and the vulnerable in a moment. I will seek to address his point then; if I do not, I am sure that he will prompt me.

I think every Member of this House fully appreciates and understands the huge burden that these restrictions now place on people today and every day: on pupils, on parents, on businesses, on individuals and on families. The Secretary of State for Education has set out our plan to support people in education settings, including with the provision of new equipment for remote learning. For businesses such as those in retail, hospitality and leisure that have been forced to close their doors once again, we are providing an additional £4.6 billion of support. There will be not a single Member in this House who has not received correspondence and pleas from their constituents who run businesses, be it in hospitality or the self-employed—a whole range of people. Members on both sides of the House will be working flat out to seek to assist them. I do appreciate the pressures that they are under. Of course, that support comes on top of our unprecedented £280 billion plan for jobs, including the extension of the furlough scheme until April.

Let me turn to vaccines. We know that in the long run the best way to help everyone in this country is to suppress the virus and to vaccinate people against it. The NHS is committed to offering, by 15 February, a vaccination to everyone in the top four priority groups, who currently account for more than four out of every five—roughly 88%—covid fatalities. The groups include older care home residents and staff, everyone over 70, all frontline NHS and care staff, and all those who are clinically extremely vulnerable. In working towards that target, there are already more than 1,000 vaccination centres throughout the country, including more than 200 hospital sites, which will increase to 270, and some 775 GP-led sites. Of course, pharmacies are already working with GPs to deliver the vaccine in many areas of the country. As vaccine supply increases, community pharmacies will continue to play an essential role.

Before my hon. Friend the Member for Hazel Grove (Mr Wragg) prompts me, let me turn briefly to the question he asked. The Prime Minister and ministerial colleagues will take into consideration a number of factors when looking at the right time—the safe time, based on the scientific and clinical advice—to ease the current restrictions and to move to a tiered system. One factor that I know will weigh with them and play a part in that decision will be the extent to which vaccination has significantly reduced the risk of death in those groups most likely to be affected by the virus. It would, though, be premature—indeed, it would go well beyond my pay grade—for me to set out the detail of what precise considerations the Prime Minister will be looking at as we reach that point, hopefully in a few months’ time.

This week has seen the announcement of the opening of seven mass vaccination hubs in places such as sports stadiums and exhibition centres, and yesterday we launched our full vaccine deployment plan, which includes measures that we will take, together with local authorities, to maximise take-up among harder-to-reach communities, and our new national booking service, which will make it easier to book and access appointments. In that context, I should pay tribute to one of the great strengths of this country, which is the willingness of the people of this country to step up, pull together and volunteer to assist in times of great need for this country. We are seeing that happening now. In that context, I also pay tribute to The Sun’s “Jabs Army” campaign, through which The Sun is doing its bit to encourage people to sign up and to volunteer—I believe it has got more than 30,000 people to sign up. All this is a reflection of the innate strength of community in this country: when something needs to be done, the people of this country step up and do their bit.

Another part of the plan is our new vaccinations dashboard, which gives daily updates on our progress in the biggest vaccination effort in British history.

[Mark Tami (Alyn and Deeside) (Lab)]

The Minister has not touched on the covid deniers out there. No doubt we are all getting emails from them, and they are obviously on social media as well. It is important that we get across the message about the safety of the vaccine and the importance of everybody getting a vaccine. It is not just about someone’s personal freedom and what they do; it is about what they can give to somebody else as well.

[Edward Argar]

The right hon. Gentleman is absolutely right. I say to those who may doubt or speculate about this disease: it is real and it has, sadly, taken more than 80,000 of our fellow citizens from us. Watch the news coverage that we all see every night of our amazing frontline NHS staff explaining just what they have seen, what they have had to do on their shift, how they have fought valiantly to save people’s lives, often successfully but on occasions sadly not, and what that has meant for them. I reflect on an incredibly dignified elderly gentlemen whom I saw on the news before Christmas—I think his name was Mr Lewis from the Rhondda—who, in the space of a week, had lost his wife and two other members of his family to this cruel disease. I say to those who say that it is not serious and that it is not as dangerous as some people say: watch those news clips and listen to those people who have been bereaved, and to all those people who have been in hospital and thankfully have recovered but have been through hell and back with this disease. The right hon. Gentleman is absolutely right. We all have a part to play in following the rules and beating this disease. I, for one, as soon as I am eligible to have my vaccination—I fear that the grey hair may not get me higher up the list and that I am too young, along with my shadow, and we may have a while to wait—will certainly take up that offer.

[Sir Charles Walker]

The Minister is being so generous in giving way. Long covid will take another form: there will be mental health consequences. May I make one suggestion? We have the two eminent professors flanking the Prime Minister, Professors Whitty and Vallance. At some stage, could we have someone of equal eminence from the mental health field to talk about how we are going to do the mental health piece of the recovery?

[Edward Argar]

My hon. Friend makes a hugely important point. He, of course, has been a huge champion in this House for the cause of mental health. I know that, as we speak, the Minister for Patient Safety, Suicide Prevention and Mental Health, my hon. Friend the hon. Member for Mid Bedfordshire (Ms Dorries), is involved in discussions and meetings about exactly that. There is already support in place, but she is very clear that we need to recognise, in the context of long covid and the impact of this disease, including its indirect impacts, that the future mental health of our nation is hugely important, so my hon. Friend is right to highlight it.

At this Dispatch Box, we have often had occasion to exchange grim statistics: cases, hospitalisations and, sadly, deaths. Of course, behind every one of those numbers is a person—a person with hopes, fears, dreams, families and friends—but I know that the whole House will join me in looking forward to exchanges about perhaps more positive statistics in the weeks to come, of more vaccines given, more people safe and more lives saved.

Before too long I hope we will find ourselves in a situation where we can look at the curve of a graph going up and up not with fear and trepidation about what it means but with tremendous hope, as we look at a graph of vaccines delivered. That prospect is within our grasp, and although we are not yet out of the woods and must not blow it now but must stick to the rules for a little longer until we can be safe, I believe that that prospect should cheer us through the difficult weeks ahead.

[Mr Deputy Speaker (Mr Nigel Evans)]

I pay tribute to the volunteers in Clitheroe whom I saw on Friday helping GPs to roll out the vaccine there.

Some housekeeping notes. To those MPs who are contributing virtually: we will be able to see the clock on the screens in the Chamber, at the bottom of the right-hand side; you should be able to see the clock as well, and please try to finish before three minutes is up. It is a lot cleaner if you do that. To those contributing in the Chamber, the timer will be on the usual monitors in the Chamber, and there is a three-minute limit on all Back-Bench contributions.

Reciprocal Healthcare Arrangements

Edward Argar Excerpts

Thursday 17th December 2020 Written Statements

[The Minister for Health (Edward Argar)]

Today I am notifying the House about arrangements the Government have made to support people who require ongoing, routine healthcare treatment in order to be able to travel to the European economic area or Switzerland after the end of the transition period, should there be no further negotiated outcome with the EU. These arrangements would commence from 1 January 2021.

Current reciprocal healthcare arrangements enable large numbers of UK-insured individuals to access healthcare when they live, study, work or travel in the European economic area or Switzerland, and vice versa when European economic area or Switzerland-insured individuals come to the UK. Although some people are covered under the withdrawal agreement, for everyone else these arrangements will come to an end on 31 December 2020.

Negotiations on future arrangements with the EU are ongoing and include necessary healthcare provisions. If agreed, such provisions would provide effectively the same healthcare cover as the European health insurance card (EHIC). The Government continue to work hard to secure these arrangements.

In the event we have not reached an EU-wide agreement on reciprocal healthcare, the Government will implement a time-limited healthcare scheme that supports UK residents with ongoing, routine treatment needs, who are visiting the European economic area or Switzerland from 1 January 2021. This type of treatment was previously covered under the EHIC scheme.

This Government will introduce the scheme with the intention that it is used by individuals who are certain to require treatment while abroad, such as regular dialysis, oxygen therapy or certain types of chemotherapy. The Government recognise that these ongoing, routine treatment costs can be expensive, and makes travelling abroad extremely challenging for many people.

The scheme will be temporary and will cover travel that takes place between 1 January 2021 to 31 December 2021. People applying for the scheme must be ordinarily resident in England, Wales, Scotland or Northern Ireland and entitled to the treatment on the NHS. Individuals will need to work with their NHS clinician to agree their treatment requirements and confirm they meet the criteria in the scheme.

The NHS Business Services Authority (NHSBSA) will deliver this scheme for the whole of the UK. NHSBSA is an arm’s length body of the Department of Health and Social Care. It provides a range of critical central services to NHS organisations, NHS contractors, patients and the public.

The exception to the new scheme is travel to Ireland as the UK and Irish governments are committed that UK and Irish residents should continue have access to necessary healthcare when visiting the other country.

The Government will assess its options for reciprocal healthcare if we do not achieve an EU-wide arrangement. This includes the possibility of negotiating bilateral arrangements on social security coordination, including reciprocal healthcare, with individual EU member states.

The Department of Health and Social Care will publish further guidance on the scheme, its criteria and application process shortly.

[HCWS670]

Walthamstow Toy Library Eviction: NHS Role

Edward Argar Excerpts

Wednesday 16th December 2020 Westminster Hall

[The Minister for Health (Edward Argar)]

It is always a pleasure to serve under your chairmanship, Mr Hollobone. I will endeavour not to qualify for the Grinch’s green suit in what I am about to say to the hon. Lady. I congratulate her on securing this debate. It is always a pleasure to appear opposite her and she has always been a strong and vocal champion for her constituents in this House.

The hon. Lady has raised a number of points, and I am grateful to her for highlighting in advance the outline and contours of the issue, which means that I have had an opportunity to look into some of it. I will come back to this point later, but I make the offer that I am very happy, as soon as we return after the Christmas recess, to meet her to go into more detail about the issues she has raised and some of the history and chronology of what has happened here, if that is helpful to her.

I know the hon. Lady has been an active supporter of and campaigner for the Walthamstow toy library, which is an important local charity, and she started the campaign to save it from possibly having to move from the current premises, as she has talked about today. As she highlighted, the building is owned by one of the NHS local improvement finance trust companies, CHP, and that is one of the companies that is managed by the Department for Health and Social Care, or owned by the Secretary of State for Health and Social Care. It is now the head tenant for the property, having taken over from the PCT in 2013, when PCTs were abolished. CHP sublet to GPs and other providers of NHS services that received the majority of their income from the local CCG.

I note at the outset that the hon. Lady may wish to challenge some of these points when we meet, as she has done today. As has been related to me, in 2005, the toy library was incentivised to relocate to the new building following the destruction, for want of a better way of putting it, of its old building, by being offered a lease at a peppercorn rent, with a small contribution towards running costs for 10 years, which started on 27 September 2005. It occupies about 9% of the building.

That original lease was between the PCT and the toy library, meaning the PCT bore the cost. In 2013, when the lease was transferred to CHP and the local CCG, they agreed to honour that previous subsidy. My understanding is that during 2015 there were extensive negotiations between CHP, the toy library, the CCG and Waltham Forest children’s services on the expiry of the lease. It was recognised then by the CCG that the toy library would at the very least need time to review the options available to it and to explore securing alternative accommodation, other funding sources to increase its income or, for example, a contract for commissioned services from the council in order to pay its rent. As such, the CCG agreed to subsidise the occupancy for a further three years, beginning on 1 April 2015, at a cost of £50,000 per annum, with contributions also coming from the LIFT company and CHP for the balance of that.

By 2018, my understanding is that no progress had been made in sourcing alternative accommodation, and that the CCG agreed to a further three years of subsidising the rent on similar terms, continuing to contribute £50,000 per annum to costs, with a continued contribution from the LIFT company. The position of the CCG and the LIFT company is that this was always intended to be an interim measure for three years. They state that they sent a clear message to the toy library that, by March 2021, it was expected to pay the full cost of occupancy if it was to remain a tenant. The hon. Lady has put on the record a different interpretation of that, which I am happy to explore with her. If she wants to intervene, I will happily allow it.

[Stella Creasy]

It may be useful to clarify that at no point has the CCG told the toy library that it is to leave the building; indeed, the CCG keeps telling me that it is not evicting the toy library. More importantly, in the chronology that the Minister talks about, if the toy library had been told to find an alternative building, why was it working on commissioning services together with the CCG? I fear that the Minister has been sadly misled by Selina Douglas and the Waltham Forest CCG on this matter.

[Edward Argar]

I was about to make one final point, which is that I understand that a further three-month extension was agreed until 30 June 2021. However, I highlight what the hon. Lady said, not only just now but previously, which clearly suggests that a different complexion has been put on this issue. That is why my meeting her would be useful.

I will put on the record one or two points. It is important to note that the subsidy paid by the CCG is an arrangement that is not offered to any other charitable or voluntary group within the borough. I recognise, as the hon. Lady set out, the value that this charity brings. In my distant past when I was a Westminster city councillor, before I was a Leicestershire MP, I recognised the value that toy libraries and similar charities brought to the local community in London. I put that on the record because we must always remain conscious of fairness. There are specific circumstances, but I just wanted to highlight that point.

The hon. Lady talked about social prescribing, and she is absolutely right. That goes to my experience in seeing the huge value that charity facilities such as this can bring not only to those who are in need, but to others within the community more broadly who access the toy library and come together in that context. Such facilities are hugely important in the communities where they exist. They bring people together and provide mutual support, often to families and individuals who may not have a medical need, or who may not want their needs to be dealt with through medical means, but who find the support they need—help through a difficult time, or just more broadly—through such facilities. I recognise their value.

During the time that the toy library has been in this building, the CHP and the CCG suggest that a substantial debt for service charges and utility bills has accrued, which they assert that the toy library clearly agreed to pay as part of the original lease, separate from the rent. I see from the hon. Lady’s expression that that will feature in our discussion. I appreciate that there are different perspectives on the form that engagement has taken. CHP and the CCG have engaged with the toy library on a number of occasions to explore solutions to the issues that have arisen. Those solutions have included moving to a more sustainable business model, becoming a social enterprise or having the council commission services. They state that the toy library has been supported in those discussions to find alternative premises, with options explored including whether it could be relocated or co-located with other services for children and families.

The toy library of course has the first option on this space, certainly until the end of that period of extension, but I understand that, in the meantime, a feasibility study has been commissioned by the CCG on prioritising use of the building for health purposes. There are no signed agreements yet, but NHS parties state that they are reserving the right to reconfigure the building for what they deem to be its primary purpose: in their words, to get best value for the local health economy. However, to the hon. Lady’s point, we must always be conscious of the need to look at value not just in financial terms or in purely primary care terms, but in terms of broader health benefits and broader benefits to the community. Value, for want of a better way of putting it, takes many forms, not always with pound signs involved: there are broader, more intangible measures of value. Again, I am very happy to explore that aspect of the issue with her when we meet.

The view and perspective of CHP, the local CCG and the LIFT is that they have sought to engage constructively with the toy library since they first assumed that relationship—in 2013, if my memory of what I just said serves me—but they do need to look to the future. The suggestion of finding an alternative space at a similar peppercorn rent, for example, may be a way forward. However, I again note what the hon. Lady said: this is a purpose-built space for the toy library, and a shared space with others coming in and coming out would not necessarily work with the model for the services that are provided to the people who use it. I hope that as we look to the future, both the toy library and—equally, and hugely importantly—the CCG and CHP will try to engage, genuinely and openly, to explore options around either finance or genuinely viable alternative premises. I also hope that throughout, they will engage directly, and indeed courteously, with the hon. Lady as a representative of her constituents in this House.

The hon. Lady raised two specific points that I am happy to look at and discuss with her: one was about the IRR, and one was about levels of management fees. If she will permit me, I will take those away and look at them, and when we meet we can discuss those points.

This is a challenging situation, and clearly, some compromises may have to be made on both sides to move us forward. I have therefore already asked the CCG, CHP and the LIFT company to engage further with the toy library, openly and constructively, and to report back to me with a jointly agreed update on progress at the end of February. The hon. Lady has raised some significant issues, and I would hope to meet with her well before that stage, because I am keen to hear from her in a way that is not always possible in debates in this House. Although debates may raise the profile of an issue and highlight scrutiny of it, we can sometimes get into more detail in a private conversation. I am very happy to meet her and see whether we can find a constructive way forward that genuinely meets the needs of her community. Thank you, Mr Hollobone.

--- Later in debate ---

[Mr Philip Hollobone (in the Chair)]

Order. I am afraid that the hon. Lady is not allowed a right of reply. Generously, I will allow her to intervene on the Minister, if he agrees that he has not finished his speech, but the intervention has to be brief.

[Edward Argar]

Apologies; when I said “Thank you, Mr Hollobone”, I thought that I had caught your eye and you were about to stand, so I sat down. If I may, I will finish my conclusion, and should the hon. Lady wish to intervene on me, I am happy to take that intervention.

[Stella Creasy]

I thank the Minister for letting me intervene, and for the good Christmas cheer that he is bringing. Can I confirm that a side letter was sent by the CCG to the Walthamstow toy library in, I think, 2018, committing to paying all the costs of it being in the building? As such, the suggestion that charges were outstanding is another misleading statement. When he looks into the issue, could he also clarify who will own the building after 2030, when the original lease runs out? We are fewer than 10 years away, and surely any redevelopment of the building has to take place in that context.

I will very much take the Minister up on his offer of a meeting, because I think a way forward can be found to save the Walthamstow toy library where it is. I hope CHP and Waltham Forest CCG are listening very clearly, and that they will finally start to engage properly with my community. In view of that, I wish everybody a merry Christmas.

[Edward Argar]

I am grateful to the hon. Lady. If she is able and happy to forward me a copy of that letter—she may have to do so in confidence—I am very happy to look at it, because it will be useful for me to see it before we meet. She has raised a number of other questions; forgive me, because I did not pick up on that one when I answered. Again, in so far as I am able to discuss that issue with her, I will do so, and my office will get in touch with hers after this debate to try to get us a meeting in January. I hope that, as I say, we will be able to find a constructive and positive way forward that works for the NHS, for her community and for all parties involved, including the toy library.

Motion lapsed (Standing Order No. 10(6)).

Covid-19: Hospital Parking Charges for NHS Staff

Edward Argar Excerpts

Tuesday 1st December 2020 Westminster Hall

[The Minister for Health (Edward Argar)]

It has always been a pleasure to serve under your chairmanship, Sir Charles, not least on the Procedure Committee, which you chaired when I was first elected to this House.

I congratulate the hon. Member for Coventry South (Zarah Sultana) on securing this important debate. I know that this is an issue that she in particular, with other hon. Members, has taken a very close interest in, and it is a timely debate. Before I turn to the specifics of the issue and the hon. Lady’s points, like her, I would like once again to put on record my gratitude and thanks to our NHS and care workers, including those at her local hospital trust. They, as always, continue to do an amazing job in the face of this incredibly challenging pandemic.

To address one of the hon. Lady’s points, I know she will very much welcome and be encouraged by the fact that the Government have put in place a £33.9 billion increase in investment in the NHS, the biggest increase in investment by any Government of recent years. I know she will welcome that very clear investment by this Government in our NHS. However, as she said, it is important that, in the face of this pandemic, as well as thanking our NHS workers, we have taken practical steps as a country and as a Government to further support them. One of those steps has been funding the provision of free parking for NHS staff at work during the pandemic since the spring, as she set out.

As the hon. Lady will know, parking is determined at trust level. While I appreciate she is critical of trust decisions in this space, and that of course is her right, in acknowledging that, I also express gratitude to the trusts that did, following the Government’s clear statement, provide free parking, and to local councils whose provision of free parking space for NHS staff made that possible. As the Prime Minister stated in the House on 8 July:

“The hospital car parks are free for NHS staff for this pandemic—they are free now—and we are going to get on with our manifesto commitment to make them free for patients who need them as well.”—[Official Report, 8 July 2020; Vol. 678, c. 966.]

That remains the policy of Her Majesty’s Government.

I am conscious that the hon. Lady has previously raised a specific question about her own trust, which she also asked today, and which I will seek to address. NHS trusts have control of their parking policies. We, the Government, have made it very clear that we expect individual trusts to follow the approach that I have just outlined and that the Prime Minister set out. To her specific point, trusts have received and continue to receive additional funding to do so, to ensure that they do not lose income. I hope that her trust and others will recognise that, but if it is helpful to her, I will write to her after the debate with more specific information about her local trust and the specific points she raised about its income and funding and the position it has taken on this.

It is, however, also important to set out the broader context, while not losing sight of the clear expectation that trusts will fulfil that policy position. As I say, as the hon. Lady knows, the decision rests with trusts.

[Zarah Sultana]

What I hear from the conversations I have had at University Hospitals Coventry and Warwickshire is that the money has not continued to come; it has stopped. The Minister makes the point that NHS trusts have decision-making powers around parking, and I want to clarify that point, because I find that it then becomes a decision on whether to fund parking or frontline services, and it should not be a choice between those two. There should be enough funding for frontline services and additional funding for parking, so that trusts do not have to make a decision between those.

[Edward Argar]

I am grateful to the hon. Lady. I will come on to the specific point about funding for this commitment in probably about a page or so’s time in my notes, but I go back to the £33.9 billion increase by 2023-24. The Government have given the NHS the money it said it wanted and needed to fund its services and, in addition, we have funded covid costs over and above that settlement.

Turning to the broader context, which is not just about funding, during the first wave of the pandemic, not only were hospital car parks largely empty of patients and visitors, but high streets are empty and so were council and commercial car parks, which local authorities were able to make available to NHS workers for free. That helped to address the fundamental challenge, which is not primarily funding, but capacity in hospital car parks.

While some trusts have significant capacity in their car parks, a very large number, even before the current situation, saw demand for spaces significantly exceed a limited capacity. By way of a little statistical context, overall, the NHS has around 440,000 spaces on its estate. That is set against over 1.3 million staff, and that is even before visitors or patients are factored into the demand side of the equation.

In recent months, we have seen patient and visitor usage of commercial car parks return. As activity has returned to shops and high streets since the summer, we have seen increased demand for those parking spaces that were available during the height of the first wave. This all means a return to significant demand exceeding a finite supply of available parking spaces. As set out in our manifesto, it is important that the patients and visitors who most need parking can access it, alongside our amazing NHS staff.

I will briefly address the issue of funding that the hon. Lady raised, and the concerns about a potential loss of trust income or trust funding. During the pandemic, we have provided trusts with specific funding for free parking for NHS staff. They continue to receive funding for that, currently as part of the overall system of funding allocation we have put in place. However, as I said, I will look into the hon. Lady’s specific point about her trust and how the allocation of the funding coming through that system is done, to reassure her that her trust continues to be supported through that overall pot.

Alongside the Prime Minister’s clearly stated commitment on NHS staff parking, he referenced our manifesto commitment, the context of which I will touch upon, including what we are doing to increase capacity to address that fundamental, underlying challenge. Some trusts began implementing the manifesto commitment earlier in the year. However, we fully recognise—and did recognise—the need for trusts, given the pandemic, to focus both on implementing the staff parking measures and on their operational response to the pandemic and ensuring they were there for all patients who needed them. We understand that, for reasons that I am sure all reasonable people would understand, many trusts delayed the planned phased roll-out due to take place over the course of this year, reflecting that external context.

The commitment will ensure that, in the course of this Parliament, disabled blue badge holders, frequent outpatient attendees, parents of children staying overnight, as well as night shift NHS staff, will be given free parking at hospitals. This will be the first time that hospital car parking has been completely free in this country for those groups who need it most. It will be mandated by NHS England and NHS Improvement on trusts from 1 January 2021. That mandating process, which takes considerable time, is the only lever by which trusts can be compelled to do this. That is why I say that the decision rests with trusts.

However, we recognise that in the midst of a second wave, flexibility is required. To have both policies operating at the same time will be a challenge for some sites, particularly in urban areas where capacity is limited. As we face this second wave, trusts’ clear focus is on operationally tackling the pandemic and responding to it. I am sure that all reasonable people will recognise the need for roll-out flexibility in the context of the mandating, and given the focus of our NHS on their responsibilities in tackling the pandemic.

On the capacity issues, the Government are committed to increasing hospital car parking capacity. I set out the challenge earlier, but we have set aside over £200 million of capital funding for the financial year to do this. This money is available to trusts to modernise and expand their car parking facilities, and to utilise technology, such as automatic number plate recognition systems, to make parking easier for patients. Trusts will be invited to bid for this funding in the usual way, and we will ensure that they have full details of how they can do that.

The Government have been clear on their commitment on staff parking. We have adhered to that commitment, and continued to provide the funding for it. I will give the hon. Lady more detailed granular information for her trust. We have made significant progress since the announcement of our manifesto commitment. We remain committed to providing free car parking for NHS staff during the pandemic, as the Prime Minister made very clear, and to ensuring that NHS hospital parking is free for those who need it the most, in line with our manifesto commitment that we are clear we will deliver. We must do that while ensuring that the NHS has the necessary resources to deliver the commitment successfully, both in terms of capacity and meeting the revenue funding cost.

Again, I thank the hon. Member for Coventry South for securing the debate and for the tone, by and large, that she adopted. I know she feels passionately about this matter, and it is right that she brings that passion, her knowledge and her constituents’ specific concerns to the House. I hope I have answered her points from the Dispatch Box, but I will of course come back to her about any that I have not been able to provide specific detail on in due course.

Question put and agreed to.

Draft Human Medicines (Amendment etc.) (EU Exit) Regulations 2020 Draft Medical Devices (Amendment Etc.) (EU Exit) Regulations 2020

Edward Argar Excerpts

Thursday 26th November 2020 General Committees

[The Chair]

Good morning. Before we begin, I remind Members to observe social distancing and only sit in places that are clearly marked. Hansard colleagues would be most grateful if all Members sent their speaking notes to [e-mail] after the sitting.

[The Minister for Health (Edward Argar)]

I beg to move,

That the Committee has considered the draft Human Medicines (Amendment etc.) (EU Exit) Regulations 2020.

[The Chair]

With this it will be convenient to consider the draft Medical Devices (Amendment etc.) (EU Exit) Regulations 2020.

[Edward Argar]

It is always a pleasure to serve under your chairmanship, Mr Rosindell.

The statutory instruments concern the regulations for human medicines and medical devices. They form part of a legislative programme to ensure there is a functioning statute book at the end of the transition period to provide certainty for businesses and the public. Most of the changes they make are technical in nature.

It is a pleasure, as ever, to serve in Committee opposite the shadow Minister, the hon. Member for Nottingham North. We have become something of a double act in these Delegated Legislation Committees covering the legislation for the end of the transition period.

I believe that everyone in this Committee Room shares the Government’s intention to protect patient safety and preserve patients’ access to innovative new treatments. That could not be more important than in the context of the covid-19 response. The statutory instruments have been developed to maintain our world-leading standards in the regulation of medicines and medical devices now that we have left the European Union and as the transition period comes to an end.

The statutory instruments broadly achieve three things: they make minor amendments to existing regulations to take account of the implementation period agreed under the withdrawal agreement; they implement our obligations under the Northern Ireland protocol; and they implement specific policy changes to the regulatory regime in Great Britain to ensure that the regulatory framework is up-to-date and functioning correctly at the end of the transition period. The regulations do not prevent the need for future changes, but preserve the solid foundations of the UK regulatory environment to ensure patient safety—something I suspect the shadow Minister will speak about—and to ensure that the UK remains one of the best places in the world for science and innovation.

I will mention briefly the most notable policy changes that the instruments set out in law, for the benefit of Members. The instruments are long and technical, so I am unable to address all elements of them in the time available, but I will endeavour to cover the main points.

The medical devices instrument will allow us to maintain the current standards of regulation. We will ensure that patient safety and health outcomes are not adversely impacted, and we will continue to recognise the CE marking on medical devices and in vitro diagnostic devices, which have demonstrated their conformity with EU regulatory requirements, for a further two and a half years. That approach is both sensible and pragmatic. It provides time for industry to adapt to future regulations and eliminates any delay in access to devices for UK patients, while maintaining continuity.

A policy change that I note for the Committee is the adoption of the new conformity assessment marking for medical devices. The Government have created their own product safety marking, which will be used across goods regulation. The UK conformity assessment—UKCA—mark will be available for industry to use for devices placed on the market in Great Britain from the end of the transition period.

The medical devices instrument, as it applies to Great Britain, removes certain provisions from the previous EU exit instrument, which would have inserted regulations similar to the EU’s medical devices regulation, or MDR, and in vitro diagnostic regulation, or IVDR. That is because the full application of the two EU regulations will now fall outside the transition period.

The independent medicines and medical devices safety review, which delivered its report in July, highlighted the importance of strengthened regulations that do more to protect patients. The regulations, as amended by the medical devices instrument, will be built on using the powers of the Medicines and Medical Devices Bill, which is currently continuing its passage in the other place.

The Bill will provide the opportunity to develop a robust, world-leading regulatory regime for medical devices that prioritises patient safety and innovation. Our plans are in development, and will take into consideration both international standards and global harmonisation in the establishment of our future system. We will of course consult closely with stakeholders within the life sciences and healthcare sectors on that future regime.

I now turn to the human medicines instrument to note a few further changes that will help the UK to maintain its excellent regulatory system for medicines and clinical trials. From 1 January 2021, marketing authorisations granted by the EU will continue to apply in Northern Ireland; however, all medicines to be placed on the market in Great Britain must be authorised through the UK national route.

The human medicines instrument allows the Medicines and Healthcare products Regulatory Agency to have regard to decisions taken by EU member states on products approved via decentralised and mutual recognition procedures when considering whether to authorise those products in Great Britain. That policy is to ensure that the UK can continue to take effective regulatory and safety action on those products.

The instrument will also ensure that novel and innovative medicines continue to come to the UK market after the end of the transition period. That will be achieved by allowing recognition of decisions by the European Medicines Agency to grant UK marketing authorisations for centrally authorised products.

Both the human medicines and the medical devices instruments uphold the Prime Minister’s commitment to unfettered access for Northern Ireland’s businesses to the whole of the UK market. In doing so, they provide for transparency requirements for medicines and medical devices moving from Northern Ireland to Great Britain, which will allow the MHRA to maintain oversight of products on the GB market and thus protect patient safety.

For medicines, the MHRA will still retain regulatory powers, such as carrying out a targeted assessment of a medicinal product where it is deemed necessary for safety reasons. For medical devices, non-UK manufacturers placing devices on the UK market will be required to appoint a UK responsible person. The UK responsible person will be required to register devices with the MHRA in accordance with a transitional timetable set out in the regulations.

To fulfil the requirements of the Northern Ireland protocol, both instruments make relevant changes to ensure that the relevant EU laws will continue to apply in Northern Ireland after the end of the transition period and, additionally, the instruments grant the MHRA powers to continue to regulate medicines and devices in Northern Ireland in order to ensure that there is clear continuity for patients and businesses.

Members will be aware that the MHRA charges fees to cover the costs associated with the regulation of medicines. To reflect the regulatory changes that will take effect after the transition period ends, the instrument reduces some of the fees to ensure that they will still be commensurate with the cost of the work performed by the MHRA.

The devolved Administrations have been kept informed of the drafting of the instrument, and I put on record my gratitude for their continued collaborative approach. In particular, I thank the Minister of Health in Northern Ireland, Robin Swann, who agreed, despite policy for human medicines being a devolved matter, that the human medicines instrument should be signed solely by the Secretary of State for the Department of Health and Social Care.

We have also been working closely with industry through the development of the statutory instruments. In September and since then, we have published a number of guidance documents that go into further detail on those changes on gov.uk. We have held an accompanying series of webinars to engage directly with more than 11,500 industry representatives, providing them with an opportunity for their questions to be asked and answered. My officials continue to meet regularly with the major industry suppliers and key trade associations, including the Association of the British Pharmaceutical Industry, the BioIndustry Association and the Association of British HealthTech Industries.

It is also important to note that the instruments amend pre-existing EU exit legislation made in 2019, taken through on behalf of the Opposition, I think, by the hon. Member for Ellesmere Port and Neston (Justin Madders)—the other half of the Opposition double act on these instruments. A full consultation process was conducted for the pre-existing legislation and, moreover, full impact assessments were conducted for the underlying legislation.

As the nature of the changes in the instruments that we are discussing today are in many instances technical, the impact of the instruments, above and beyond the existing legislation, is not assessed to meet the threshold for further impact assessments; hence they have not been provided for. I commend the draft regulations to the Committee.

--- Later in debate ---

[Edward Argar]

I am grateful to the shadow Minister for his typically reasonable and measured comments. He repeated a number of questions that are familiar to me, but he did not repeat his jokes from previous Committees, which is a relief for hon. Members. I will deal with his points in order.

In respect of a deal or a future relationship agreement, the hon. Gentleman knows me very well and can predict my response. I will, of course, say to him that the negotiations continue, and it would be wrong to prejudge them. However, I know that Her Majesty’s Government continue to negotiate actively and positively with the European Union.

The hon. Gentleman is right in his key point about the importance of patient safety. I reassure him that the Minister for Patient Safety, Mental Health and Suicide Prevention is, as he will know, a passionate advocate for patient safety. She takes it incredibly seriously both in her role as a Minister and given her background in medicine and nursing—it is deeply important to her. As I speak, I suspect she is on the Front Bench with my right hon. Friend the Secretary of State. I will certainly pass on the hon. Gentleman’s request and comments in respect of the Cumberlege review when I see her after the statement.

The hon. Gentleman reflected on a number of other factors. He often asks me in these Committees, quite reasonably, whether we are going to deliver our obligations under the Northern Ireland protocol. I reassure him that this is the penultimate Delegated Legislation Committee—we have one more to go—in fulfilling this Department’s obligations under the protocol by putting through the necessary regulations.

The hon. Gentleman asked for reassurances. I reassure him that I am confident that these statutory instruments and the regime that follows the end of the transition period will not make patients less safe and will not have a negative impact on our life sciences sector and businesses. The whole approach we are adopting in this country is to strengthen patient safety and put it at the heart of what we do, while also supporting our fantastic life sciences sector and its competitiveness and innovation. I reassure him of my confidence that we will continue to deliver on those objectives.

On responsible persons, the hon. Gentleman rightly said it is important that that process and that individual do the job they are there to do, and do it properly. He mentioned the period of two and a half years on top of the transition period. That was reached in discussion with industry about what it needs and with the regulators about how to make the transition to a new regime effective.

Finally, the hon. Gentleman talked at length about the MHRA and asked several questions, so I will spend a few minutes responding to them. He will be aware that the UK has substantial capacity and expertise to regulate and evaluate the quality, safety and efficacy of medicines and medical devices. The MHRA is expert in many areas, including the licensing of medicines, pharmaco- vigilance and clinical trials regulation. That already provides benefits to patients. The MHRA is the lead regulator on more than 3,500 medicines currently on the EU market.

The hon. Gentleman asked about the impact on the MHRA and its workload. I reassure him that it will receive additional funding of just under £13 million by the end of March next year to help it prepare for the end of the transition period and meet its obligations under the regulations. Among other activities, that is being used to fund investments in new and improved IT systems to enable better regulation of medicines and medical devices in Northern Ireland under the protocol. It has also contributed to additional staffing requirements to manage all aspects of the new regime to which he alluded.

The MHRA is taking robust steps to ensure that it is ready to continue to perform, as it always has done, at the highest level, putting patient safety first, and we have given it the resources to do that.

Question put and agreed to.

Draft Medical Devices (Amendment etc.) (EU Exit) Regulations 2020

Resolved,

That the committee has considered the draft Medical Devices (Amendment etc.) (EU Exit) Regulations 2020.—(Edward Argar.)

Pectus Deformity Treatment: NHS Funding

Edward Argar Excerpts

Tuesday 24th November 2020 Westminster Hall

[The Minister for Health (Edward Argar)]

It is a pleasure to serve under your chairmanship, Ms McVey.

I am grateful to my hon. Friend the Member for Middlesbrough South and East Cleveland (Mr Clarke) for bringing to the attention of the House the issue of funding for the treatment of pectus deformity and the impact that that has on people with that condition. I also pay tribute to my hon. Friend the Member for Bury South (Christian Wakeford), who, in what is a week or two shy of being in the House for a year, has already made a huge impact on behalf of his constituents. I hope that, through him, I can wish his constituent well and a full and speedy recovery from her surgery.

Before I discuss the particular case and issue, I want to place on record my thanks and gratitude to the hard work of NHS staff across the country, who as always have gone above and beyond in supporting us all during the pandemic. We remain indebted to them for their service.

I also want to be clear that the Government have and always will support our NHS, providing it with the finance and resources it needs to continue to provide high-quality, life-changing care. As hon. Members will know, through the NHS long-term plan, we committed to and then legislated for increasing investment in the NHS by £33.9 billion in cash terms by 2023-24.

A fundamental principle of the NHS is that, for people who live in the UK, treatment is free at the point of need regardless of an individual’s ability to pay. That is the basis on which our NHS is built. At the same time, however, clinical commissioning groups have a duty to commission responsibly and to use the funding they have to deliver the best service they can to meet the needs of the overall local population. As such, there will be some treatments or services that are not routinely commissioned locally. These decisions can be difficult but must be subject to rigorous assessment. Surgery for those patients with severe physical complications arising from pectus excavatum is one such area, as my hon. Friend the Member for Middlesbrough South and East Cleveland set out.

NHS England Improvement—which I will refer to as NHSEI for brevity—recognised that a small number of patients might benefit more from surgery and, as my hon. Friend, set out has explored this area in depth. He mentioned that in August 2018 NHSEI launched a clinical commissioning group policy consultation for surgery for pectus deformity and sought feedback on that proposition for surgery for pectus deformity for all ages. In developing its policy proposition, NHSEI commissioned two evidence reviews to ensure that evidence-based surgical outcomes and psychological benefits were considered. The reviews considered whether scientific research has shown treatments to be of benefit to patients and whether its use represents the best use of NHS resources. In that context, I hear very clearly the points made by my hon. Friend about, in his view, the limitations imposed on that by the nature of the process and the evidence base.

As my hon. Friend set out, the findings of the NHSEI findings review concluded, after careful consideration, that for the surgical correction of pectus deformity there was not sufficient evidence to routinely commission that intervention. He has clearly set out his counterpoint to that position. The study, published in February of last year, noted that in most cases, although surgery can correct the chest wall deformity, surgical intervention does not always take. That is because the majority of people experience only mild physical or psychological symptoms associated with having a pectus deformity, according to the evidence put forward by the review. I understand that the review also discovered areas where further evidence was required, and NHSEI has been working with clinicians and the National Institute for Health Research to further build the evidence, to support commissioning decisions.

I want to be clear that although, based on the existing evidence, the current evidence base, surgery for this condition is not currently routinely commissioned, that does not mean that patients cannot access it if it is deemed clinically necessary in particular circumstances, as my hon. Friend the Member for Bury South was able to set out in the case of his constituent. There are processes in place to ensure that, if it is deemed clinically appropriate, patients can still access the treatment even if it is not routinely commissioned by the individual CCG. The process is, as he set out, the individual funding request or IFR, which can be an alternative route, although as my hon. Friend the Member for Middlesbrough South and East Cleveland set out, this clearly has not worked for Autumn.

I turn now to the particular circumstances of my hon. Friend’s constituent’s case. I am incredibly sympathetic to the case that he raises. I understand both his concerns and the need for pace in finding a solution to help Autumn. I will at this point, if I may, pay tribute to my hon. Friend. He is a doughty fighter on behalf of his constituents, as we have seen in respect of this case. We in the House are incredibly lucky, as are his constituents, to have him representing them. I would say that he has made very good use of what I hope will be a very short period of freedom from ministerial office, allowing him to speak in debates such as this. He has used that freedom powerfully once again on behalf of his constituents in bringing Autumn’s case to the House. I hope that his constituents will not take it amiss if I say that although I know that that has been incredibly useful to them and he has been a powerful advocate, as he always is, I hope that his freedom will be short-lived and he will return to the bonds of ministerial office soon, because he was a fabulous Minister while he was fulfilling his various roles.

I also want to place on the record my recognition of and tribute to the courage that Autumn and her mother Sarah have shown. It takes incredible bravery, incredible courage, to speak out and, as Autumn has done through my hon. Friend, to speak out under her own name and her family’s and her mother’s name. That shows a courage that it is very rare to see in any walk of life and in anyone, and I think it deserves recognition by the House. I hope that my hon. Friend will pass on to her my words in respect of that. She is an incredibly brave young lady.

Let me turn to the specifics of the points that my hon. Friend made. Although he will know, and it is only right, that I will caution him that decisions and the response on this of course sit with NHSEI and are not within my gift as a Minister to give, he makes an incredibly powerful case, so what I will say to him is that I am very happy to convey very clearly, as my right hon. Friend the Secretary of State has done, to NHS England and NHS Improvement and to the chief executive, Sir Simon Stevens, his and his constituent’s very clear request that the position be reviewed once again, with additional evidence considered. I will also put to them his very sensible, or what seems to me very sensible, suggestion of an approach in the short term and then in the longer term. As I have said, I have to be honest with him; I cannot make a commitment on what the NHS response will be, because quite rightly it is independent and will make those decisions itself. But what I can promise him is that I will put his case to it very clearly.

I can also reassure my hon. Friend that I am of course always delighted to meet him, and if he feels that it would be useful, I will be very happy to meet him again. We may do that in the next few weeks, while he enjoys a few more weeks of freedom from the red boxes, but I am very happy to do that for him, because this is an incredibly moving case. He has put the case in very human and very moving terms, but I suspect that, if I may put it this way, Autumn in a sense represents probably many more cases, as my hon. Friend the Member for Bury South has set out. They may not have felt able to come forward and may not be publicly known, but there are others who are in Autumn’s position and will be listening to what my hon. Friend the Member for Middlesbrough South and East Cleveland said. I pay tribute to him, as always, for his eloquence, but I have to say I am afraid that although he put the case very powerfully, Autumn’s words put it even more powerfully to the House. There will be people listening to what she said and identifying with that and feeling the same things, so I am always happy to meet my hon. Friend if he feels that that would be helpful.

To conclude, I will reassure my hon. Friends that we will continue to work with clinicians and researchers to build the evidence base and understanding of this condition, to support future commissioning decisions but also, hopefully, within the confines of the clinical evidence base and decisions by NHSEI, to be able to better help people like Autumn in the future. I am grateful to the House.

Question put and agreed to.

DHSC Answers to Written Questions

Edward Argar Excerpts

Thursday 19th November 2020 Commons Chamber

[Sir Christopher Chope (Christchurch) (Con)]

(Urgent Question): To ask the Secretary of State for Health and Social Care if he will make a statement on his Department’s performance in answering written questions from right hon. and hon. Members.

[The Minister for Health (Edward Argar)]

Parliamentary questions are a key element of Parliament’s ability to scrutinise Government on behalf of the people of the United Kingdom. As the House would expect, we take them very seriously, and as you, Mr Speaker, and hon. Members will know, I take seriously all aspects of my and the Government’s accountability to this House. Prior to the pandemic, my Department had an exemplary record of providing accurate and timely answers. In the last full parliamentary Session, despite receiving more PQs than any other Department, we had the highest response rate in Whitehall. However, as hon. Members will be aware, DHSC, its Ministers and officials have been at the forefront of responding to this pandemic, with the attendant additional workload that has brought.

As such, it is a matter of regret that we have been unable to sustain previous PQ performance, for which I rightly apologise to you and the House. However, it is explicable in the face of a trio of concurrent challenges. The first is volume: between March and October this year, we received over 8,000 written parliamentary questions across both Houses. This compares with 4,000 for the equivalent period last year. The second challenge is timeliness: we have met a rapidly, almost daily, changing situation, and answers drafted by officials are sometimes out of date shortly after they are drafted. We have been prioritising accuracy of response to Members over speed, but this can mean that responses have to be redrafted, with attendant delays.

The third challenge is policy input: despite increasing the administrative resources to respond to parliamentary questions, it remains the same policy officials who are responding to the pandemic operationally and drafting regulations and are the only people with the requisite policy expertise to input into parliamentary questions and responses.

That said, Mr Speaker, although we continue to field exceptional volumes of parliamentary questions, I want to reassure you and the House that we are not making excuses in providing these explanations, and are taking every possible step to recover our performance. We have instituted a parliamentary questions performance recovery plan and are delivering against it by increasing resource where we can and clearing the backlog, focusing on the oldest parliamentary questions first.

More broadly, throughout this challenging time the Secretary of State and Ministers have sought to make themselves regularly available in the House to be questioned and held to account. Between March and October, the Secretary of State made 18 statements and answered seven urgent questions. We have also seen seven general debates on covid since March, and that is not including junior Ministers’ appearances in the Chamber. This is not an alternative to written parliamentary questions, but it is an important reflection of our accountability to this House.

To conclude, written parliamentary questions will continue to be a top priority on which I am briefed weekly. I thank you, Mr Speaker, and hon. Members for your and their patience and recognition of the exceptional circumstances of recent months. In the weeks and months ahead, we will work hard to restore our leading performance, which hon. Members have a right to expect.

[Sir Christopher Chope]

Thank you, Mr Speaker, for granting this urgent question, which was born of extreme exasperation. I thank my hon. Friend for his response, his contrition and his apology, and for his offer to do better in the future.

If other Departments can answer 90% of named day questions on time, why cannot the Minister’s? Will he set a date for the clearance of the backlog to which he referred and guarantee future compliance with the rules and the spirit of the rules? This is not just about timeliness; it is about the quality of the answers. Since this is the week of resets, will the Minister now tell his ministerial colleagues and officials to abandon their tactic of, basically, dumb insolence towards those of us who ask challenging questions?

Does my hon. Friend accept that these questions and answers increase public trust in our democracy, and should be a catalyst for improving public policy? If his Department is in the lead in suppressing liberty in this country, is it surprising that there are more questions to his Department than to others? Because issues of liberty are at stake, surely it is all the more important that these questions are answered quickly.

[Edward Argar]

I am grateful to my hon. Friend. As he will be aware, other Departments, while they have heavy workloads, are not leading the response to the pandemic. In response to his final point, he will not be surprised that I do not characterise it in that way. Instead, I would characterise it as the Department of Health being in the lead in saving lives and protecting the NHS in this country.

My hon. Friend asked two other substantive questions. I think his language was a little intemperate in respect of the serious efforts that officials undertake every day to try to provide accurate and timely answers. There is no suggestion that they seek to stonewall or to avoid responding. They do their best, but it is difficult and the situation changes day by day. Where answers are deemed to be inadequate, hon. Members often revert to me directly or table their questions again, and we endeavour to fulfil our obligation to provide accurate answers.

On my hon. Friend’s question about recovery, we have set a trajectory for each month in order to recover performance over the coming months. Of course, that depends to a degree on the workload of officials in responding to the pandemic, as well as in providing answers, but I do not see it as an either/or; we intend to recover performance in parallel with tackling the pandemic.

[Justin Madders (Ellesmere Port and Neston) (Lab)]

I thank the Minister for his response and for the hard work he and his Department put in. However, as he acknowledges, the performance here, like in so many other areas, is just not good enough. We know it is tough, but there comes a point when it begins to look like departmental scrutiny is being used as a cover for evading giving answers.

This morning, I looked at the Department’s response times to my own written questions over the past six months. I have had to wait over one month for an answer 29 times, over two months 11 times and over three months four times. I was actually thinking of putting in a question asking for the average response times to questions, but then I thought I would just be waiting a long time for that answer as well. I have even had to wait five months for the answer to what I thought was a pretty simple question asking what tests for covid-19 had been used. One hundred and sixty-eight days later, I received the utterly unrevealing answer:

“A large number of different tests have been used throughout the programme.”

I was lucky; my hon. Friend the Member for Sheffield, Brightside and Hillsborough (Gill Furniss) waited 18 weeks for an answer to a question on tests, only to be told:

“The information is not held in the format requested.”

Why did it take so long just to say that? Do Ministers even read the answers that they sign off?

This is not just about the time; the quality of the answers that we get back also needs improving. On dozens of occasions, I have been told that the Department does not hold the data, or no real attempt is made to answer the question that was asked. I accept that sometimes that information may not be easily acquired, but too often it looks as though the Department wants to keep us in the dark. I remind the House that the ministerial code requires Ministers to be

“as open as possible with Parliament”,

even when that may be inconvenient to them. In the spirit of openness, will the Minister also look at restarting NHS England and NHS Digital publications?

In conclusion, we all understand that the Department is dealing with many pressing issues, but scrutiny is important. Accountability matters, and if the pandemic is used too often as an excuse for standards to slip, that is how we go from questions not being answered to major policy changes being announced by media leaks, until we end up with the shameful spectacle of spivs and cronies pocketing millions from PPE contracts. Government must do better.

[Edward Argar]

I was going to say that, as ever, I was grateful to the hon. Gentleman for his tone, right up to almost the end of his remarks. On his substantive points, when it comes to accountability to this House, he will know from our regular double acts at this Dispatch Box and in Committee that I and fellow Ministers do not shy away from our accountability to this House in all its forms.

On volume, as I have said, during the same period last year we received 4,000 written questions; this year, the figure has been 8,000. That cannot be addressed by increasing administrative resource alone, because the technical expertise of policy experts is required to provide accuracy in the answers that the hon. Gentleman and other hon. Members seek. The same policy officials are dealing, day to day, with all aspects of the response to the pandemic.

The hon. Gentleman talked about accuracy, and he is right about the importance of accurate and timely answers. Given that we have answered 8,000 parliamentary questions between March and, I believe, October, some may, sadly, not live up to his expectations. I know that he will hold me and other Ministers to account when that is the case.

In answer to another of the hon. Gentleman’s question, yes, I and other Ministers read not only the answers and the questions, but the background to those questions. If we do not, we will quite rightly end up at the Dispatch Box, being asked those questions again and being challenged on the Floor of the House. In view of that, and in view of our obligations to the public and under the ministerial code, it is absolutely right that we take the answering of written parliamentary questions very seriously.

On the hon. Gentleman’s final point about NHS Digital and the publication of data and so on, I am happy to take that away and look at it for him.

[Karen Bradley (Staffordshire Moorlands) (Con)]

I thank my hon. Friend for his answer to my hon. Friend the Member for Christchurch (Sir Christopher Chope), who is a fellow member of the Procedure Committee. I was pleased to hear the Minister say that the Department takes the answering of questions seriously, because the answering and the monitoring of written questions and correspondence from MPs will help Ministers to identify problems in the implementation and roll-out of their policies.

The Procedure Committee, which I chair, has shown some leeway to the Department in recognition of the pressures that it faces, but I invite my hon. Friend to come to the Committee in the next few weeks to explain how he is going to address the backlog.

[Edward Argar]

I am grateful to my right hon. Friend. As a former member of the Procedure Committee, I recall when she kindly appeared before the Committee to answer questions on parliamentary questions at the Home Office. I look forward to the reversal of the position in the coming weeks.

[Chris Bryant (Rhondda) (Lab)]

Was she any good?

[Edward Argar]

I would say that she gave exemplary answers, which fully satisfied the Committee. I have received the letter that she recently sent to my right hon. Friend the Secretary of State. We are grateful for the pragmatic and reasonable approach that her Committee has adopted. She will, quite rightly, want to scrutinise performance, and I look forward to appearing before her Committee to answer detailed questions on the matter.

[Martyn Day (Linlithgow and East Falkirk) (SNP)]

I am grateful for the Minister’s answer at the beginning of the debate. I initially thought that it was perhaps a tad unfair to single out his Department in the circumstances. In my experience, others have been worse—I hope his Treasury colleagues are listening. However, I will confine my remarks to his Department. My hon. Friend the Member for Central Ayrshire (Dr Whitford), the SNP health spokesperson, was delighted yesterday to receive an answer to a named day question that she tabled on 22 June. It referred her to a table of data that, unfortunately, was absent from the answer. Perhaps the Minister could ask his colleagues to get that table over to her, rather than her having to wait six months for a response.

[Edward Argar]

I am again grateful for the tone that the hon. Gentleman adopts. We have adopted in our recovery plan an attempt to deal with the oldest questions first, to try to get as up to date as we can. If he or the hon. Member for Central Ayrshire (Dr Whitford) lets me know the detail of that question, I will be happy to look into what he raises and to get that table to her.

[Shaun Bailey (West Bromwich West) (Con)]

No one could underestimate the challenges that the Department of Health and Social Care faces at the moment. I thank my hon. Friend for the way in which he has engaged with me and other colleagues during this time. However, there are clearly operational challenges as a result of this pandemic. My hon. Friend talked about the review that the Department is undertaking. Will he ensure that he shares the lessons learned from that not only with Members but across Government? We will have to look at being diverse in our operational structures, particularly within Government, to ensure that we expediently answer Members’ questions.

[Edward Argar]

I am happy to give my hon. Friend that assurance. Perhaps the best mechanism by which lessons learned can be shared will be through my written response—in due course—to and my appearance before the Procedure Committee, chaired by my right hon. Friend the Member for Staffordshire Moorlands (Karen Bradley). If appropriate, Mr Speaker, I will of course share that response with you and with the Leader and shadow Leader of the House.

[Chris Bryant (Rhondda) (Lab)]

On the plus side, because I have the Minister’s and the Secretary of State’s mobile numbers, when I really want an answer, I just text them. To be fair to them, they have been phenomenally helpful at key moments. I think many hon. Members feel that. At the same time, to be honest, the comms strategy this year has been a complete mess and a disaster. I urge the Minister to go back to the Department and say that Parliament should not be used only for accountability but to try to speak to the people of this country and to get across clear messages in a timely fashion. In that regard, will he tell us when he will publish the national cancer recovery plan, because lots of people have major anxiety at the moment about when their cancer will be treated?

[Edward Argar]

I am always pleased to receive messages and inquiries from the hon. Gentleman. He raises two important points. The Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Bury St Edmunds (Jo Churchill) is working on the national cancer recovery plan at pace. I am happy to revert to the hon. Gentleman when I have had an opportunity to speak to her. On his broader point, he is right that it is important that we in this House recognise that, in our democracy, people consent and comply because they are persuaded. It is important that we use this House and all the mechanisms within it to persuade and bring the public with us.

[Mike Wood (Dudley South) (Con) [V]]

We have all had enormous increases in constituency correspondence during the pandemic, so I can only imagine what it must be like at the Minister’s Department. However, in looking at how his Department responds to MPs’ questions, will my hon. Friend reassure the House that any changes will not come at the expense of his Department’s excellent parliamentary engagement and briefings for Members with Ministers and scientific experts that allow us to question advisers on detailed scientific and medical matters?

--- Later in debate ---

[Edward Argar]

My hon. Friend highlights that the workload from constituents has increased for all Members. I recognise that. It is important that we do our bit in trying to answer questions in as timely a fashion as possible, to assist colleagues in the House with responses to constituents. In response to his second point, he is absolutely right. As I alluded to, it is not only through attending the House and through its mechanisms that Ministers have been accountable; as a Department, we have sought to use multiple channels—briefings to colleagues, WhatsApp and a whole range of newsletters and other mechanisms—to get messages out and to communicate with colleagues and answer their questions.

[Jim Shannon (Strangford) (DUP)]

I thank the Minister for his departmental response to covid-19 and many issues. As one of the Department’s most prolific questioners, I am aware of the pressure on the Minister’s Department to respond to a vast array of complex medical and social issues. Perhaps to assist the Minister, his team could work closely with the health trusts to provide up-to-date data in a timely manner.

[Edward Argar]

The hon. Gentleman is indeed a prolific questioner, but his questions are always welcome and to the point. He highlights an important aspect that affects the response of the Department, which is that a significant number of questions, and the information required to answer them, is not held within the Department but by various health trusts, NHS England or other external bodies, which can occasionally introduce additional slight delays in the system. We are working closely with them to minimise that and get answers as quickly as we can to hon. Members.

[Dehenna Davison (Bishop Auckland) (Con)]

I thank my hon. Friend the Member for Christchurch (Sir Christopher Chope) for raising this matter and I recognise the importance of parliamentary questions for their role in parliamentary scrutiny, but it is only right that we recognise the substantial weight on the shoulders of the Department of Health and Social Care as it leads the charge against this pandemic. I personally have been blown away by the readiness and willingness of Ministers to engage through a whole range of communications, including Zoom, email and WhatsApp. I am grateful, in particular, for their engagement when it looked as though Bishop Auckland residents might have been teetering on the edge of tier 3 over the summer, which we thankfully avoided. Can my hon. Friend confirm that efforts are being made to clear the PQ backlog, but that other communication channels will remain open for MPs and their engagement?

[Edward Argar]

I am grateful to my hon. Friend, and I pay tribute to the officials in the Department, who are working hard to clear the backlog and do take this very seriously. As I say, we are trying to clear the older PQs first, and then get back up to the performance we had before. She is absolutely right to highlight the other methods of communication. I may not be the most technological Minister in this House, but we have been seeking to use every means we can to try to answer colleagues’ questions and to give them the information they need.

[Cat Smith (Lancaster and Fleetwood) (Lab)]

In my time in this House, I have campaigned alongside women and families affected by sodium valproate. Many of the victims of this scandal have felt for decades that Governments have tried to push it under the carpet, so can the Minister understand the frustration and suspicion that these victims feel when written parliamentary questions about the Cumberlege review, which was published on 8 July, continue to take a long time to answer—and when those answers come, they are very poor—and their frustration that since July there has been no progress, beyond the apology in this House, in implementing that review? Can the Minister update the tens of thousands of victims of the Primodos, surgical mesh and sodium valproate scandals and assure them that their campaigns for justice remain high on his Department’s agenda?

[Edward Argar]

Again, I am grateful to the hon. Lady for the tone she adopts on what is actually a very sensitive and very important issue. I can reassure her that that issue does remain very high on the Department’s agenda. At risk of tempting fate, if she wishes either to write to me or to table a question to me, I will endeavour to get it answered very quickly so she has something on the record on that.

[Mr Speaker]

Let us head up to Harrow East with Bob Blackman and see if his replies have landed.

[Bob Blackman (Harrow East) (Con) [V]]

Thank you, Mr Speaker. Can my hon. Friend also look at the quality and at the repeat questions that have to be asked to clarify the answers that are given to written parliamentary questions? In my case, I have had to submit often detailed letters to Ministers because WPQs basically do not supply the information required. Some that are now coming back after six months of waiting have been about, for example, offers to supply PPE to the national health service and people who have had tests but not actually got the results—and I could go further. The reality is that the quality of the answers to WPQs as well as the quantity have not been good enough, so will he look at those two aspects, please?

[Edward Argar]

I am grateful to my hon. Friend, who landed his question very effectively. He is absolutely right to talk about the balance between speed and accuracy. In some cases where the issue is complex, a letter may be more appropriate for getting detailed information, rather than the short factual response to a parliamentary question. Sometimes the delay can be because Ministers—this goes to the point made by the shadow Minister, the hon. Member for Ellesmere Port and Neston (Justin Madders)—on reading the question and the answer, and looking at it as a constituency MP as well, may realise that they want to send it back for redraft because it does not answer an hon. Member’s question. That can cause delays, but we endeavour to provide accurate answers as swiftly as we can.

[Munira Wilson (Twickenham) (LD)]

I absolutely understand and appreciate the pressures on the Minister’s Department. However, it does grate that I regularly hear, in debates in this Chamber, Conservative Members saying how quickly and easily they can get direct responses from Ministers. He himself referred to a WhatsApp group a few moments ago, and I suspect that that is for Conservative Members. For those of us on the Opposition Benches, written questions and letters are often the only means to scrutinise, secure detailed information and hold the Government to account. Over a third of replies to my questions have been delayed for more than a month, and the longest delay was 190 days. I have had replies to letters outstanding for up to five months. Do my constituents have any less of a right to a response? Does the Minister have any advice for me as an Opposition spokesperson about how I can get more timely and detailed information?

[Mr Speaker]

Mr Bryant might have the mobile number for you.

[Edward Argar]

I am a little bit surprised by the hon. Lady’s tone, because she and I regularly speak, and she has very easy access to me around the House, which she regularly uses, as do all Members. She has been on various briefing calls and other calls where we answer data questions and any question that Members wish to ask, and this House is for that purpose. Her constituents have exactly the same right to answers as anyone else, and they get exactly the same response as those of any other Member. Although this urgent question is about written parliamentary questions, I would flag that the Department has received more than 63,500 pieces of correspondence so far this year, compared with just 30,000 in the entirety of 2019. We have increased resourcing for that team, as we have for the PQ teams, and we are getting through the backlog as swiftly as possible.

[Robert Halfon (Harlow) (Con) [V]]

I refer Members to my entry in the Register of Members’ Financial Interests in terms of support for my local party association. I have recently tabled written questions on suicide prevention on the railways; earlier in November, a person in my constituency sadly died after being hit by a train. Will my hon. Friend pay tribute to Land Sheriffs, a Harlow-based security company which, through its railway security programme, has intervened and prevented close to 300 suicides on the railways across England?

[Edward Argar]

As my right hon. Friend mentioned, he has recently tabled a number of written questions on this issue, which I look forward to responding to in a timely fashion. I am happy to pay tribute to Land Sheriffs in his constituency for its impressive work in helping to tackle and prevent suicide on the railways. I know that the Minister for Patient Safety, Mental Health and Suicide Prevention will be very interested to hear about its work.

[Andrew Gwynne (Denton and Reddish) (Lab) [V]]

I thank the Minister for his answers today. I understand the pressure on his Department—I really do—but of the 28 questions that I have tabled to the Department of Health and Social Care, 86% were answered late, and if those due today are not answered, that figure will rise to 88%. I have to say that the quality of some of the responses is pretty poor too. Will he consider starting up the NHS England and NHS Digital statistical publications that were paused during the pandemic, so that we can get some of the information ourselves?

[Edward Argar]

I think the hon. Gentleman has four parliamentary questions outstanding. By his timely intervention, he may find that when I get back to the Department this afternoon, I will ensure that the figure does not rise to 88% overdue. His substantive point is the same one made by the hon. Member for Ellesmere Port and Neston, which I said I will take away and look at.

[Scott Benton (Blackpool South) (Con)]

I understand that since the start of the pandemic the Secretary of State has made 16 oral statements in the House on coronavirus and there have been seven urgent questions and five general debates on the topic. It is, of course, important that Members receive timely responses to inquiries, but does my hon. Friend agree that there have been significant opportunities for Members to raise concerns on the Floor of the House and to seek answers from Ministers?

[Edward Argar]

I think it is fair to say that no one could accuse Ministers in the Department or the Secretary of State of not being willing to be accountable to Members in a multitude of ways. But of course, it is not an either/or, so we will endeavour to continue to perform well in attending this House and also to improve performance on written parliamentary questions.

[Mr Speaker]

Some might argue that it is the number of urgent questions we have allowed in order for debate.

[Carla Lockhart (Upper Bann) (DUP) [V]]

Openness and transparency around the sharing of data is key to ensuring that the public and the business community buy into the draconian measures that we have introduced in the fight against covid. I genuinely thank the Minister for his and the Department’s efforts in ensuring that we get timely information, but on 21 October, I asked the Health Secretary for data relating to positive cases among those who had not been in the UK 72 hours before their test, and I still have had no answer. Will the Minister agree to provide that data, which will be key to informing the full reopening of our airports, getting our airlines flying again and kickstarting our aviation sector and its supply chain?

[Edward Argar]

I am grateful to the hon. Lady for her question. My understanding is that there are, I think, five outstanding written answers due to her, dating from November. She mentions one from October, so I will check whether that has been answered overnight. If not, I will go back to the Department and look into that particular written question.

[Mrs Flick Drummond (Meon Valley) (Con)]

May I thank you, Mr Speaker, for allowing so many urgent questions and statements, which allow so many Back Benchers to ask questions? I am very grateful for that.

All Departments have had a higher volume of questions, not least the Department of Health and Social Care, because of the health pandemic. What assessment has my hon. Friend made of the uptake of other forms of communications that have been made available?

[Edward Argar]

My hon. Friend rightly raises the other methods of communication with right hon. and hon. Members and the other ways they can access information—not as an alternative to written questions and scrutiny in this Chamber— which appear to have been extremely popular with Members on both sides of the House. We intend to continue to make such briefings and access available to all right hon. and hon. Members.

[Marion Fellows (Motherwell and Wishaw) (SNP) [V]]

Does the Minister accept that questions are sometimes tabled to Departments in response to issues raised by our constituents, and that by failing to engage with Members in this way—I understand all the reasons why it is taking longer—it is ultimately the public who suffer the consequences?

[Edward Argar]

I am grateful to the hon. Lady for her question. I refer her to the answer I gave to my hon. Friend the Member for Dudley South (Mike Wood). We recognise both the increased workload on hon. Members from their constituents and the importance of timely answers to written questions in helping them to discharge that obligation to them.

[Mr Peter Bone (Wellingborough) (Con) [V]]

I thank the excellent Minister for his response, but may I suggest that the covid situation is allowing the Government to dodge issues they do not want to answer? On the Floor of the House, I asked the Secretary of State how many tests with false positives and false negatives there are. He dodged that question, so I tabled a named day question on 21 October, asking for his estimate of how many tests with false positives and false negatives there are. Yesterday, I received a response saying that they had no idea. They must have known they had no idea on 21 October, so it seems to me that that delay had more to do with not wanting to put that information out than any other reason. Can we have accurate and timely answers, not politically motivated delays?

[Edward Argar]

It is always a pleasure to see my hon. Friend and to be questioned by him, both at this Dispatch Box and in other forums. I have to say to him that I do not think it is a fair reflection to suggest that the Government or others are dodging answers. We are at this Dispatch Box regularly. We do answer questions regularly. I will look into the particular question he raises, but often to answer we require information from external bodies or other NHS bodies, which can take time.

[Chi Onwurah (Newcastle upon Tyne Central) (Lab)]

The Minister emphasises other means of engagement to written questions, delays to which I too have experienced far too often. In April, I wrote to the Minister for Care, the hon. Member for Faversham and Mid Kent (Helen Whately) with the concerns of a constituent of mine over personal protective equipment for care homes. I received a response in October. Will the Minister acknowledge that those kinds of delays undermine the confidence of my constituents in the Government’s public health measures? Will he commit, which I do not think he has done so far, to putting in place the capacity and resources to respond to constituents’ concerns in a timely manner, in whichever format they are expressed?

[Edward Argar]

I hear what the hon. Lady says, but we have already put in place that capacity. We have doubled the capacity for parliamentary questions and I have significantly increased capacity for correspondence. The only thing I would say on correspondence, which she alluded to, is that at any normal time we have 850 pieces of correspondence open. Reflecting the volume that comes in at the moment, that is about 10,000. We have increased the capacity in the Department, but, of course, as long as volume remains high it will always be a challenge to keep up with that demand. We are doing our very best.

[Mr Speaker]

I thank the Minister, because he has been courteous in the way that he has dealt with this matter. He certainly has had the short straw.

In order to allow the safe exit of hon. Members participating in this item of business and the safe arrival of those participating in the next, I am suspending the House for a few minutes.

Independent Reconfiguration Panel

Edward Argar Excerpts

Thursday 19th November 2020 Commons Chamber

[The Minister for Health (Edward Argar)]

I congratulate the hon. Member for Mitcham and Morden (Siobhain McDonagh) on securing this important debate. I recognise her continued interest in local health matters and her championing of her constituents’ interests. She knows that I have considerable respect for her and her work in this House on behalf of her constituents. However, she will perhaps not be surprised that I cannot fully agree with the picture that she painted to the House today.

Before I get into the meat of the debate, let me pay tribute to all the staff at the trust and across our entire NHS for the amazing work they do day in, day out, particularly at this time. I know that is a sentiment that the hon. Lady would share.

As the hon. Lady said, all proposed service changes should be based on clear evidence that they will deliver better outcomes for patients and should meet the four tests for service change: they should have support from GP commissioners, be based on clinical evidence, demonstrate patient and public engagement, and consider patient choice. It is right that these matters are addressed at a level where the local healthcare needs are best understood, rather than emanating from Whitehall. I should point out that in cases where these proposals are referred to Ministers, they are considered impartially and on their merits, and that is what has happened in this case.

Without recounting all the background that the hon. Lady has set out for the House this evening and on previous occasions, in December 2017, the “Improving Healthcare Together 2020-2030” programme was established to address the significant estate quality and finance challenges that Epsom and St Helier University Hospitals NHS Trust is currently facing. NHS Surrey Heartlands and NHS South-West London clinical commissioning groups are the organisations responsible for making decisions about local healthcare. They led the development of proposals for any potential service changes, and it is right that they did so at that local level, including appropriate consultation. As she set out, following a period of sustained engagement and options development, on 3 July 2020 local NHS leaders approved plans that will see a brand new state-of-the-art hospital built in Sutton to treat the sickest patients and most services staying put in modernised buildings at Epsom and St Helier hospitals.

The hon. Lady raised a number of concerns about this decision—in particular, around transport and travel, bed numbers, acute services, and the impact on more deprived communities and health inequalities. As she said, she also raised these issues at our meeting in July, which it was a pleasure to undertake with her. When the decision was made, measures to address these issues were also set out, including extending the H1 Epsom and St Helier hospital bus route into Merton and further south into Surrey, beyond Epsom, and increasing the frequency of travel between the three hospital sites; reviewing car parking on all three sites; increased bed capacity to care for an extra 1,300 in-patients a year; advances in technology and treatment; closer working with community services so that fewer patients will need an overnight stay and will be able to get home sooner; exploring further opportunities for primary care services at Epsom and St Helier hospitals; and expanding child and adolescent mental health services on the St Helier site. Under the proposals, about 85% of current services would stay put at Epsom and St Helier, with six major services being brought together in the new specialist emergency care hospital, including A&E, critical care, and emergency surgery. The capital investment for those proposals is not only to fund the new hospital but to invest in and improve the current sites at both Epsom and St Helier, including funding for the A&Es.

I can reassure the hon. Lady that the Treasury is and will remain fully engaged with not only this proposal but all 40 of the Government’s hospital proposals. As she would expect and know from her long career in the House, the Treasury takes a close interest in any proposals that entail the spending of significant amounts of public money. This is a significant investment in improving healthcare across the communities served by these hospitals, which is why my hon. Friends the Members for Carshalton and Wallington (Elliot Colburn) and for Wimbledon (Stephen Hammond) have recently set out their and their communities’ strong support for these proposals.

The Independent Reconfiguration Panel was at the crux of the case made by the hon. Member for Mitcham and Morden. As she set out, the IRP is the non-departmental public body set up in 2003 to provide the Secretary of State with expert independent advice on contested NHS service changes and reconfiguration. There are currently 15 panel members who review referral cases. They have a mix of clinical, lay, patient representative or engagement, specialist and managerial backgrounds. The IRP has provided independent advice more than 80 times since it was established. With reconfigurations referred to the IRP, there is an open and transparent process, which people expect to be carried out to the most rigorous standards of integrity, honesty and impartiality. We must adhere visibly to those standards, and I believe, on the evidence I have seen, that those standards were met in this case.

As the hon. Lady will know, local authorities have a power to refer certain proposals to the Secretary of State where they consider that there has been inadequate consultation, where reasons given for non-consultation are inadequate or where they believe that the proposal is not in the interests of their area and communities. The Secretary of State can then choose whether to commission advice from the IRP, which is normally provided in 20 working days, and Ministers are clear about the need for that advice to be swiftly and efficiently given. Following collection of evidence, the IRP submits its report either with advice not to proceed or containing recommendations to the Secretary of State on specific proposals. I emphasise that the IRP’s role is advisory, and the Secretary of State ultimately makes the decision.

In July—at roughly the same time as my meeting with the hon. Lady, which slightly limited the conversation we were able to have—Merton Council referred the scheme to the Secretary of State, who referred it to the IRP, which provided its advice on 28 October. Following thorough consideration of that advice, the Secretary of State accepted the IRP’s impartial advice, which was that there was no reason to contradict the proposed choice of Sutton—Belmont—as the location for the new specialist emergency care hospital. I know that there have been some noises locally about the possibility of subsequent legal review or legal action, so I will not dwell on that aspect. I do not believe that any judicial review has been tabled at this point, so I feel that I can comment a little further on the issues she raised. I must emphasise that the IRP provides impartial, independent advice.

I turn to the specific points that the hon. Lady made about Sir Norman. It is up front and totally clear in the IRP report that Sir Norman Williams, the chair of the IRP, declared openly to IRP members what was already a matter of public record: that between May 2016 and September 2019, he had been a non-executive director of St George’s University Hospitals NHS Foundation Trust, which neighbours the Epsom and St Helier University Hospitals NHS Trust, and he made it clear to the panel that that was a linkage. However, Sir Norman clearly left some time before the proposals were considered by the panel and, indeed, before the March date of this year that the hon. Lady referred to. As she said, independent panel members considered that matter and the issues that she had raised, and confirmed that in their view the historic connections with the case did not represent a conflict of interest and agreed that they were not relevant to Sir Norman’s role in chairing the formulation of the advice.

I have to say that I think it would be wrong to question in any way the integrity, impartiality or independence of the panel or the chair, who I believe is more than capable, rightly fulfilled his previous role to the best of his ability and fulfils his current role entirely to the best of his ability, recognising and fulfilling the requirement to be independent in the view he takes. I have seen no reason—or no compelling reason—to suggest that his behaviour has in any way contradicted that need for independence and objective guidance.

It is of course right that all reconfiguration decisions are taken in the best interests of patients and the local population, following due process. The people affected by the changes need to be involved in making the key decisions, and the IRP advice concluded:

“Patients and the public will need to be engaged in shaping and understanding the new landscape of services to gain maximum benefit from them.”

I believe that they will be.

I know that the hon. Lady’s constituents are and will continue to be strongly represented by her. I recognise the strength of her views, but I do believe that the process has been carried out fairly, independently and appropriately, in seeking to reach the best decision for the people who use the hospitals.

Question put and agreed to.

Oral Answers to Questions

Edward Argar Excerpts

Tuesday 17th November 2020 Commons Chamber

[Mike Wood (Dudley South) (Con)]

What steps his Department is taking to increase NHS capacity for winter 2020-21.

[The Minister for Health (Edward Argar)]

The Prime Minister has announced £3 billion to support NHS capacity this winter. Among other things, that money funds our Nightingale hospitals, so that surge capacity is available, and the NHS’s ongoing access to additional independent sector capacity. It also supports the safe discharge of patients, helping to reduce pressure on beds. In addition, £450 million of capital funding has been announced to upgrade and expand A&Es across the country, to help prepare the NHS for winter, and that money is already being spent.

[Mike Wood [V]]

The £3 million announced to increase winter capacity in Dudley is hugely welcome, but will my hon. Friend also look at Dudley’s bids for capital funding for a hybrid theatre and reconfiguration of critical care? Will he join me on a visit to Russells Hall, so that he can see the transformative effect that those projects would have on care for patients in Dudley South?

[Edward Argar]

I am delighted that my hon. Friend’s constituents will benefit from £3 million to increase capacity at Russells Hall Hospital in Dudley as part of the investment to upgrade A&Es ahead of winter. Future NHS capital spending will, of course, be determined at the upcoming spending review, but once our settlement has been confirmed with the Treasury, we will consider carefully how projects are prioritised within it. In the meantime, I encourage the Dudley Group NHS Foundation Trust to discuss its proposals with NHS England and NHS Improvement. I would be happy to meet my hon. Friend to discuss this, because I know how hard he campaigns on this issue, and I would be delighted to take him up on the offer of a visit when I am able to.

[Justin Madders (Ellesmere Port and Neston) (Lab)]

The NHS will only survive the winter if its workforce are valued and supported. The evidence from the British Medical Association to the Health and Social Care Committee this morning was stark. So does the Minister understand how demoralising it is for staff to hear reports that they may face yet another two-year pay freeze? I asked those on the Government Benches to rule this out last week. I got no answer, so I ask them again today: will they rule out a pay freeze for NHS staff?

[Edward Argar]

I am grateful to the hon. Gentleman. He is quite right to highlight the amazing work that our NHS and social care workforce have done throughout this pandemic, as they do every year, and I pay tribute to them for that. As he will know, the NHS agrees with its staff multi-year pay deals set by independent recommendations, and we continue with that process.

[Sarah Olney (Richmond Park) (LD)]

If he will allocate additional funding to local authorities to support the roll-out of lateral flow covid-19 testing.

--- Later in debate ---

[Stephen Hammond (Wimbledon) (Con)]

What progress his Department has made on building new hospitals.

[The Minister for Health (Edward Argar)]

On 2 October, £3.7 billion-worth of funding was confirmed for 40 new hospitals, with a further eight schemes invited to bid for future funding, to deliver a total of 48 hospitals by 2030. Four in the programme are already in construction, and three others have commenced early, enabling works on site. The hospital building programme is, of course, in addition to significant upgrades to 20 hospitals, which will be complete by March 2024, and is part of a wider programme of investment.

[Philip Dunne [V]]

I am grateful to the Minister for those clarifications, and I obviously welcome this programme, but before he came into office, in March 2018, his Department allocated £312 million for a major capital programme at the Royal Shrewsbury Hospital and the Princess Royal Hospital in Telford. Now that an independent reconfiguration panel has confirmed that these decisions were properly made and should proceed, the trust is seeking approval from his Department for advance of funds for enabling work by architects, structural engineers and others. Can he confirm when this requested £6.3 million will be forthcoming?

[Edward Argar]

I am pleased to confirm to my right hon. Friend, a distinguished predecessor of mine in this office, at this Dispatch Box that £6 million-worth of funding has been approved in principle, allowing Shrewsbury and Telford Hospital NHS Trust to develop its plans and produce a business case for this scheme. The Department will continue to work closely with the trust to understand how the right support can be provided centrally to develop an affordable case for the overall scheme and to maximise the impact of this funding, and I will be writing to my right hon. Friend with more detail later today.

[Stephen Hammond]

The independent reconfiguration panel overwhelmingly backed the plans for the development at the Epsom and St Helier trust; does my hon. Friend agree that the Labour party should take away the threat of a judicial review and allow this investment to take place so that my constituents and the constituents of south-west London can benefit from greater access and better-quality healthcare?

[Edward Argar]

I am delighted that my right hon. Friend the Secretary of State recently gave these plans the green light following independent advice from the IRP, and I am pleased that this will mean my hon. Friend’s constituents and, indeed, many others will benefit from a new state-of-the-art NHS hospital in Sutton. Patients and the public will now be engaged in shaping the detail of the new services; I encourage all local people to participate positively in that process and the council and others to get behind that scheme and that record investment by this Government in his area.

[Kevin Hollinrake (Thirsk and Malton) (Con)]

What recent discussions he has had with the Chancellor of the Exchequer on reducing the economic effect of the covid-19 outbreak.

--- Later in debate ---

[Jerome Mayhew (Broadland) (Con)]

What steps his Department is taking to support the provision of non-covid-19 healthcare treatment.

[The Minister for Health (Edward Argar)]

The Government are supporting the NHS’s ambition to continue to restore elective services for non-covid patients, while of course recognising the pressure on services from covid-19 infection control, with September statistics showing services already restored to about 80% of last year’s levels. Some £2.9 billion of additional funding has been made available from 1 October to manage ongoing covid-19 pressures, alongside recovering non-covid activity levels.

[Gareth Bacon]

I thank my hon. Friend for his response. Given the difficulties faced by the NHS because of covid-19, what considerations are being given to additional initiatives or the management of existing resources to address patient demand and break the backlog of non-covid-related treatments, such as diagnostic interventions for cancer?

[Edward Argar]

The NHS is working hard to maintain elective activity as far as possible during the second wave with extra funding, as has been set out. As shown in published September data, hospitals are carrying out more than 1 million routine appointments and operations per week, with around three times the levels of elective patients admitted to hospitals than in April, with many hospitals innovating to get through their lists. For example, Buckinghamshire, Oxfordshire and West Berkshire sustainability and transformation partnership has set up additional bespoke cataract units to deliver services. In addition, we have been making use of independent sector sites to assist the NHS with almost 1 million NHS patient appointments taking place within those facilities.

[Jerome Mayhew]

One adverse consequence of the first lockdown was that many people failed to seek treatment because they were afraid of the virus, but due to good planning and hard work, the staff of the Norfolk and Norwich University Hospital are able to treat covid patients while still undertaking the normal work of the hospital. Does my hon. Friend agree that the people of Broadland should continue to seek medical assistance when they need it, confident in the knowledge that it will be provided in a covid-safe and effective manner?

[Edward Argar]

I share my hon. Friend’s fulsome praise of the staff at Norfolk and Norwich University Hospital and the work that they are doing. They have a strong champion in him. Indeed, I pay tribute to all the health and social care staff who have worked so magnificently throughout the pandemic. I can wholeheartedly agree with everything he says. My right hon. Friend the Secretary of State has been clear throughout this pandemic that anyone who needs medical help should continue to seek it in the knowledge that they will be treated in a safe and effective manner appropriate to their needs. To put it bluntly, it is a case of help us to help you.

[Alex Norris (Nottingham North) (Lab/Co-op)]

For cancer care, we are still dealing with the backlog from the first wave, but we are now hearing of treatments being cancelled during the second wave. Extremely vulnerable immuno-compromised cancer patients need covid-free wards and staff need regular testing. Similar backlogs to the first wave could be the difference between life and death. I ask this at every Health questions but am yet to receive a persuasive answer. What will the Government do differently in order to restore cancer services?

[Edward Argar]

I am grateful to the shadow Minister, who always asks measured and sensible questions. He is right to ask that particular question, but I am very happy for him to raise with me any specific incidents of where urgent cancer care is being cancelled in the current situation. We have worked extremely hard, as has the NHS, to ensure that treatments such as that and emergency and urgent treatment can continue. He asked what we are doing differently. We have learned a huge amount, as has the whole country, over the past six to nine months. We have increased capacity in our hospitals, which is why, with the measures that we have taken, we can continue far more surgery and far more treatments, particularly cancer treatments, than we could in the first wave.

[Mr Speaker]

Unfortunately, we do finish at quarter past 12, so I will start topical questions, slightly late, with Steve McCabe.

Smokefree England: Covid-19 and PHE Abolition

Edward Argar Excerpts

Thursday 12th November 2020 Commons Chamber

[The Minister for Health (Edward Argar)]

It is a pleasure, as always, to appear opposite the shadow Minister, the hon. Member for Nottingham North (Alex Norris). It is happening with regularity: three times on three different days last week and again today. Indeed, it is happening with a fair degree of regularity that I am speaking in front of you in this Chamber, Madam Deputy Speaker, which is always a pleasure.

I thank all hon. Members for their participation in today’s debate with typically well-informed and important speeches. As the shadow Minister has alluded to, the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Bury St Edmunds (Jo Churchill), within whose portfolio this matter would normally fall, has been taking a simultaneous debate in Westminster Hall, so it is a rare pleasure for me to be able to speak at the Dispatch Box on this matter.

I thank the hon. Member for City of Durham (Mary Kelly Foy) for securing this important debate. As the hon. Member for Strangford (Jim Shannon) said, I think this is her first debate in her name in this Chamber, and, consistent with the principled approach that she adopts in this place to raising issues that she passionately cares about, she has done that today, and I pay tribute to her for doing that.



We should all recognise the significant achievements made on tobacco control over the past two decades through cross-party working. In that context, as my hon. Friend the Member for Winchester (Steve Brine) said, while I may not agree with everything that the former Prime Minister Tony Blair did, it is right that I recognise and pay tribute to him for his work in this space when he was leading the country. Smoking rates are now at their lowest ever level in England and the UK, and that is a great public health success story.

However, as Members have highlighted powerfully, there is no room for complacency. Smoking still causes more than 78,000 deaths each year, and there is much more still to do, which is why we announced our smokefree 2030 ambition. As Members will know, the UK is a global leader in tobacco control. Our commitment to tough tobacco control will continue after 1 January 2021. We laid the Tobacco Products and Nicotine Inhaling Products (Amendment) (EU Exit) Regulations 2020 on 28 September to reaffirm that commitment, which the hon. Member for Nottingham North and I debated recently.

The covid-19 pandemic, as we well know, has put a huge strain on our health and care system. The Government have published guidance regarding covid-19 and the risks from smoking, so this debate is very timely. The message has been clear that quitting smoking will improve a person’s health and recovery prospects if they are unfortunate enough to contract covid-19. It is important that we recognise the great work of local authorities—I will come to that later—and the NHS, along with the third sector, in their support to help smokers quit during these exceptionally challenging times. They have ensured that stop smoking services have continued and used the opportunity of the pandemic to reach out to more smokers to encourage them to quit. I thank them for the work they have done and continue to do.

Action on Smoking and Health has estimated that around 1 million smokers may have made a quit attempt during the pandemic, and that is good news. The Government have provided funding to support ASH’s “Today is the Day” campaign, to enable the stop smoking message to reach as many smokers as possible in some of the most deprived areas, and I pay tribute to ASH for its work. Public Health England’s Better Health Stoptober annual campaign has also continued at a national and local level to support people quitting during the pandemic.

I thank the hon. Member for Strangford for his speech, which brought an important perspective from Northern Ireland to this issue. He mentioned two things that I want to pick up on. He asked whether I would engage with the Health Minister in Northern Ireland, Robin Swann, on this issue. Although this comes under the portfolio of the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Bury St Edmunds, I am due to talk to Robin Swann next week about other matters, so I will endeavour to shoehorn it into the conversation in the way that the hon. Gentleman so elegantly does with a number of topics in this Chamber in various debates. I thank and pay tribute to Robin Swann for all the work he is doing in partnership with us at this difficult time.

The hon. Gentleman also mentioned the role of Ofcom. I know that the Under-Secretary of State for Digital, Culture, Media and Sport, my hon. Friend the Member for Mid Worcestershire (Nigel Huddleston), who is due to respond in the Adjournment debate, is very near to the Chamber, if not present at this moment, and I suspect he will have heard the points made by the hon. Gentleman and will reflect on those in his work.

The Government are committed to levelling up society to ensure that no communities get left behind. That is why we announced our bold ambition for England to be smokefree by 2030 in the prevention Green Paper consultation. I am grateful to the hon. Member for Nottingham North for rightly highlighting the importance of this being a cross-party issue, which typifies the approach that he takes to these matters in the House.

I pay tribute to my hon. Friend the Member for Winchester, who was an incredibly effective public health Minister. He is missed in that role and in Government, and I hope one day he will return to the Dispatch Box. He played a hugely important role in drawing up the current tobacco control plan for England. He also gave us some very good tips on how to speed up delivery within our excellent civil service if a Minister decides that he wants to accelerate clearance and implementation of a policy. The recent prevention Green Paper highlighted the urgency of tackling disproportionate smoking rate harms in deprived areas, which the hon. Members for City of Durham and for Blaydon highlighted. The Green Paper also highlighted the disproportionate smoking harm rates among the LGBT community, pregnant women and those with mental health conditions, which again goes to points that hon. Members made. I will endeavour to address those in just a moment.

In terms of that tobacco control plan, the points made about what happened last time and the fear of a gap, I reassure Members who highlighted the need for no gaps and for continuity that it is something of which my hon. Friend the Member for Bury St Edmunds is very much aware. I know she would want me to reassure the House that she is working extremely hard on ensuring that effective measures and effective planning continue to be in place to address the challenges of smoking. Smoking, as has been alluded to, is one of the biggest behavioural drivers of health inequality in England and reduces life expectancy by 10 years on average. That accounts for half the difference in life expectancy between the richest and the poorest, which again Members have made very clear.

Turning to some of the points made by the hon. Member for Blaydon, although rates for smoking in pregnancy are the lowest recorded, they remain around 10%. Clearly she is right to highlight that that must remain a concern for all of us in government, in this House and in this country. More needs to be done to reach our national ambition of a rate of 6% for smoking in pregnancy by the end of 2022.

Public Health England continues to work closely with NHS England and NHS Improvement on their long-term planning commitments to offer all patients NHS-funded treatment services over the coming years, including a new smokefree pathway for expectant mothers and their partners. I am confident that progress will continue to be made to hit that target, but I know from experience that the hon. Lady, in her typically courteous but firm way, will continue to hold Ministers to account in achieving that.

[Steve Brine]

While we are on the subject, as the song goes:

“The saddest thing that I’d ever seen / Were smokers outside the hospital doors”—

name the band. It is not a national problem, but it is a big problem in some areas, which is why I made the point to the Minister—will he convey this to the public health Minister?— that it has to be a regional and local approach through the directors of public health. It is a much bigger problem in some towns than it is in others.

[Edward Argar]

I will not seek to outdo my hon. Friend in his knowledge of music or, possibly, his expertise in this area, but I will certainly convey that point to my hon. Friend the Member for Bury St Edmunds.

Alongside tackling smoking in pregnancy, a big challenge is to reduce smoking rates in those with mental health problems, as the hon. Member for Blaydon said, which remain significantly higher than the general population at 42%. The NHS long-term plan will also offer a new universal smoking cessation offer, available as part of specialist mental health services for long-term users of those services and in learning disability services. The Minister for Patient Safety, Mental Health and Suicide Prevention, my hon. Friend the Member for Mid Bedfordshire (Ms Dorries) will be looking into that, working in close partnership with my hon. Friend the Member for Bury St Edmunds, because it is important that we have a joined-up approach. The hon. Member for Blaydon highlighted in her speech the excellent practice in some parts of the country and in some parts of the NHS and the fact that that is not replicated everywhere, which goes to the point made by my hon. Friend the Member for Winchester. It is important that we level up, to coin a phrase, across the country in using and sharing that best practice.

The Government are committed to a smokefree 2030, and we are developing the plans to ensure that is a reality. The plans will build on the good work already under way in the tobacco control plan and the commitments being delivered in the NHS long-term plan, to which, while the pandemic has obviously impacted on the NHS, we remain committed.

I said in my introduction that the UK is a world leader in tobacco control. That is demonstrated by how seriously the Government take our obligations as a signatory and party to the World Health Organisation’s framework convention on tobacco control, the FCTC. Tackling the harms caused by smoking is a global effort, with 8 million deaths a year worldwide linked to tobacco, 80% of which are low and middle-income country deaths.

The Government have invested up to £15 million in official development assistance funding to support the WHO’s FCTC 2030 five-year project, supporting up to 24 countries to improve their tobacco control and improve their population’s health. The project has received considerable praise from global public health and development communities and helped to raise the UK’s profile and strengthen our global reach. I am proud to say that the Department recently received a UN Inter-Agency Task Force on the Prevention and Control of Noncommunicable Diseases award for 2020 for the project. The project is in its final year and we are considering plans to extend it, depending on the Department’s spending review settlement for official development assistance. In a second, I shall address the point about the spending review raised by the hon. Member for City of Durham—I shall be very brief, as I am conscious that I need to leave a couple of minutes for her to reply at the end.

We continue to review the evidence on e-cigarettes, including their harms and usefulness in aiding smoking cessation. Although they are not risk-free, there is growing evidence that they can help people stop smoking, and they are particularly effective when combined with expert support from a local stop smoking service. The Government’s approach to the regulation of e-cigarettes has been and will remain pragmatic and evidence-based. The current regulatory framework aims to reduce the risk of harm to children, protect against the re-normalisation of tobacco use, provide assurance on relative safety for users and provide legal certainty for businesses. We will continue our work to appraise the evidence on new products, including e-cigarettes, and their role in helping smokers quit.

I note comments about proposals for future regulatory changes to help smokers quit smoking. Post transition period, this country will no longer have to comply with the EU’s tobacco products directive, and there will be opportunities to consider in the future regulatory changes that can help people quit smoking and address the harms from tobacco. Although there are no current plans for divergence, I would reassure the House that any future changes will be based on robust evidence in the interests of public health and will maintain this country’s ambitious and world-leading approach in this area.

The Department will be carrying out a post-implementation review of the Tobacco and Related Products Regulations 2016 and the standardised packaging of tobacco products by 20 May 2021 to see whether the regulations have met their objectives. Part of this review process will involve a public consultation to start before the end of the year for people to submit their views and evidence, and I hope that gives some greater clarity about timescales.

The Department has already conducted another post-implementation review and public consultation on various tobacco legislation, as the hon. Member for City of Durham mentioned, and we will publish a Government response shortly. I understand that the aim is to do so before the end of this year, although obviously a lot of work is being put into tackling the pandemic.

I hear what Members have said about the importance of public health grants and local authorities. Like the shadow Minister, I am a former cabinet member for public health. He would not, I suspect, like me to be tempted to try to fulfil the role of the Chancellor of the Exchequer by pre-empting the spending review. As for Public Health England and the future, we are engaging with stakeholders and will consider the best future arrangements for the wide range of non-health protection functions that currently sit in PHE. Our commitment to smokefree 2030 and to working collaboratively to maintain our ambitious agenda and our high standards in this area is undiminished; indeed, it is enhanced.