The National Health Service

Anneliese Dodds Excerpts

Wednesday 23rd October 2019 Commons Chamber

[Vicky Ford]

rose—

[Anneliese Dodds (Oxford East) (Lab/Co-op)]

rose—

[Jonathan Ashworth]

I will give way in a few moments. Let me just finish this point.

When the Secretary of State announces new hospitals in press releases from Conservative campaign headquarters, he should also announce where he is downgrading hospitals. He should go to Telford and explain why the accident and emergency department there is closing and being replaced by an “A&E local”, which is presumably something like a Tesco Express. We would save that A&E department. The Secretary of State went to Chorley recently. The A&E department there is not open overnight. We would provide a rescue package for Chorley. I wonder whether the Secretary of State will also be visiting Canterbury to apologise, because the Prime Minister promised—

--- Later in debate ---

[Matt Hancock]

I would love to. I pay tribute to the hon. Gentleman’s work not only on the prevention agenda and public health in government, but on ensuring that the long-term plan approach to capital investment, with a new hospital in Winchester over the next decade, will give the time to ensure that that investment brings the whole health system together in Winchester and really delivers for the people. With him as the local representative, I have absolutely no doubt that that is what will happen.

[Anneliese Dodds]

On the subject of strategic capital investments, the Secretary of State will be well aware that static PET-CT cancer scanning equipment is world renowned for helping people, particularly at the Churchill Hospital, and is much more effective than mobile scanning technology. Why, therefore, have I discovered, having been told that there would be no privatisation of services at the Churchill and that we would not see that material change, that a private provider with mobile scanning equipment will be the back-up to the NHS service? It will be dealing with complex cases from across the Thames valley. Even worse, the chief exec of the local hospital has had to accept a non-disclosure arrangement around the contract negotiations. How can the Secretary of State justify that?

[Matt Hancock]

That is a decision taken by the local NHS. The proposals that we are putting forward in law, for debate under this Queen’s Speech, are to change the regulations. We must absolutely get the best solutions for local patients, and I will address the hon. Lady’s point before taking some more interventions, because I want to refer specifically to the amendment tabled in the name of Opposition Members. Not only is it unnecessary, but it is counterproductive. It would do the opposite of what they say that they intend.

The Government believe—I think this is true across the House—in a publicly funded NHS that is free at the point of use according to need, not ability to pay. The Opposition say that they want a publicly provided NHS. I think what matters is what delivers best for patients, and let us look at this point of—

NHS Pensions

Anneliese Dodds Excerpts

Wednesday 26th June 2019 Westminster Hall

[Anneliese Dodds (Oxford East) (Lab/Co-op)]

I congratulate the hon. Member for Poole (Sir Robert Syms) on securing this important debate, and I underline the fact that I am a shadow Treasury Minister responding on behalf of the Opposition.

We are here today to discuss the impact of changes to allowances on tax relief on pensions specifically in regard to NHS pensions. As people in this Chamber will know, in 2016-17, an estimated £38.6 billion in tax relief was provided on contributions to approved pension schemes; obviously that is the overall figure and does not cover just those who work for the NHS. It is a very substantial amount of relief.

As I am sure Members will also know, the last Labour Government introduced the annual allowance and lifetime allowance back in 2006. The annual allowance was initially set at £215,000 and the lifetime allowance at £1.5 million. Since then, as other Members have discussed, we have seen gradual reductions. Under the coalition Government and the Conservative Government, the lifetime allowance was reduced from £1.8 million to £1.5 million in April 2012, then to £1.25 million in 2014, and to £1 million in April 2016. It has actually floated up a little bit with inflation up to 2019-20, when it will be—as has been mentioned—£1,055,000. There has been a similar trend with the annual allowance, which was reduced from £255,000 to £50,000 in April 2011 and it then went right down to £40,000 in 2014.

Of course, the particular changes that we have focused on today are around the interaction of all of these measures with the taper, which George Osborne introduced in the summer Budget of 2015. From April 2016, the annual allowance would be tapered at a rate of £1 for every £2 of taxable income, including pension benefits and not subtracting employee pension contributions, received over £150,000 in adjusted income, going right down to £10,000 for those with an income of more than £210,000. As has also been mentioned, that final change affects those people whose pay is more than £110,000 a year, excluding pension benefits and employee pension contributions, and who see an increase in their pension benefits of more than £40,000 in a given year.

As my hon. Friend the Member for Newport West (Ruth Jones) said, and the hon. Member for Central Ayrshire (Dr Whitford) underlined, all that obviously amounts to a considerable number of changes in a very short time. So we have seen the tax treatment of pensions for all high-paid workers changing very substantially, indeed in a way that they probably could not have envisaged when they first joined their pension scheme. The hon. Member for Central Ayrshire was right to indicate the parallels between this situation and what has happened to several other groups of taxpayers.

I see that the Minister is kindly scribbling things down at the moment. I hope that he will pass on to his Treasury colleagues that it is simply unacceptable if, at the very least, these taxpayers do not receive adequate information about what their liabilities will be. I was deeply concerned to hear from the hon. Member for Central Ayrshire that, for example, people are not receiving their pension statements. Surely that is the very minimum that is required.

On principle, it is surely necessary for the pension allowance to decline gradually for those people who earn very high incomes. It is fair, and consistent with other core principles of our tax system, that tax charge exemptions should be reduced for people who have very high incomes. However, there is of course the issue about the interaction of that system with other pension schemes, especially the NHS pension scheme, and given the fact that we have a very tight labour market for those in the NHS with substantial expertise. As has been mentioned, about 30% of doctors earn £110,000 or more, and nearly 10% earn more than £150,000. Clearly, this group of staff are the people who have the necessary expertise, as has also been mentioned a number of times.

I am aware of course that official representations have been made on this issue. We have heard what has been stated by the British Medical Association and the British Dental Association, and I think that the polling to which the hon. Member for Winchester (Steve Brine) referred was very interesting in that regard. It was also helpful to hear from my hon. Friend the Member for Glasgow North East (Mr Sweeney) about the impression that he received from his local NHS trust about what is going on.

When we consider this issue, it is very important that we do not just talk about tax treatment; we must also consider how it inter-relates with what is a very complex NHS pension scheme, one that, as I understand it, was not fully consulted on with representative organisations when it was introduced.

As has been mentioned, we now have three different schemes, and my hon. Friend the Member for Newport West indicated how working out how these schemes relate to each other and how that will impact on tax outcomes is very difficult for individuals. As the hon. Member for Poole rightly said, the impact of these changes—related to this combined test of both the threshold and the annual income, plus the taper—makes it very difficult for individuals to work out what their liability is without any kind of professional help. Of course, that professional help is also expensive.

We need to look at NHS pensions, and I hope that it will be possible for the Minister to take that issue away and discuss it with his Treasury colleagues. However, I will just say to those in this Chamber that, as well as talking about the problems for high-paid NHS staff, we of course also need to look at the issues for low-paid NHS staff. The pension situation is quite concerning for them. The annual report on retirement by Scottish Widows indicated that overall one in five young people are saving nothing for their later life, and many of those people who are working in our NHS on low pay have opted out of pension schemes, because they feel that they need the cash now to make sure that they can make ends meet.

A freedom of information inquiry in 2018 found that more than 245,000 workers from across the NHS in England had opted out of the NHS pension scheme in the previous three years. A lot of those were low-paid workers, so that is enormously concerning. Although I agreed with much of what the hon. Member for Winchester said, I do not agree with him that the levels of resource currently being considered by his Government will be adequate in the future.

Let us consider the current situation. We obviously have the cumulative impact of the pay cap over many years. The Government finally saw sense on that, but it took them a long time to do so. There are also groaning waiting lists, extended waits for accident and emergency, and the rationing of NHS services, with many procedures no longer being offered by the NHS. Until we see a change in that situation, it will be difficult for many of us to argue that the NHS is heading in the right direction resource-wise.

I know that the Government have made a commitment to improve funding in the future, but the Opposition continue to believe that that commitment is not sufficient.

[Steve Brine]

My point was that the NHS long-term plan has been significantly funded, with record funding, which, for the record—seeing as the hon. Lady has gone there—is significantly more than was promised by the Opposition. Yes, other resources will be required, around public health for instance, and around the people plan, but perhaps the hon. Lady can tell us what Labour’s fiscal promise is to the NHS, and how it will be paid for.

[Anneliese Dodds]

Absolutely. I am grateful to the—

[James Gray (in the Chair)]

Obviously, in the context of the debate.

[Anneliese Dodds]

Great. I will keep it within the context of the debate as much as possible, because in fact this debate is around taxation—

[James Gray (in the Chair)]

Order. The hon. Lady will not keep it within the context of the debate “as much as possible”; she will keep it within the context of the debate.

[Anneliese Dodds]

I certainly will, Mr Gray. Thank you.

As I was saying, this debate is broadly around the contours of the taxation system and how they affect high-paid workers in particular. I am sure that the hon. Member for Winchester is aware that Labour has a different approach from that of the current Government around progressive taxation. We set out our proposals at the last general education: we indicated how, by increasing the tax paid by the very best-paid workers, we would free up the resources that are necessary. I am sure that he has seen what Labour produced in that regard—in particular, we would not pay for the boost in spending that the NHS needs only through a short-term windfall, which in practice is what the Chancellor did, because all the commitments that the Government made to the NHS were as a result of lower than projected spending and higher than projected taxation receipts.

That is not a sustainable way to fund our NHS in the long run. Instead, we should look at the longer-term measures that are necessary, which is exactly what we have been doing.

We need to ensure that NHS workers on lower incomes can save properly for retirement, but we also need to look at the situation that has been the focus of today’s debate. We need to focus on the changes that were made in the 2015 pension scheme, and how they interact with the variety of alterations that have been made to tax release. It is especially important to do so in the context of staff retention, and I understand the comments that Members have made about that topic. We have a particular problem with NHS staff leaving their jobs early, which in my experience is not merely because of these issues, although of course they are important. When I talk to senior staff in the NHS, they also mention stress, a general lack of resource, having to deal with short-term changes such as operating theatres being closed because of a lack of staff, and so on. A whole variety of features is driving those retention problems.

[Dr Whitford]

I accept that there are many other issues, and obviously all four UK health systems are stretched because workforce is their No. 1 issue, but this problem comes on top of that. People who feel stretched—people who feel they have a terrible work-life balance, who are working late and so on—suddenly find that the extra sessions they do are costing them money. That is a final slap in the face.

[Anneliese Dodds]

I am aware of that; for many, this issue can be the straw that breaks the camel’s back, especially when it is not anticipated.

I hope that the Government will look carefully at the impact of threshold effects, particularly cliff edges that lead to radical changes in the amount of tax paid, which is a significant problem with the UK tax system generally. The situation for incurring VAT is analogous to this one: small businesses are deliberately staying below the threshold because as soon as they go over it, they have to start paying VAT—not necessarily at a very high rate, but with all the bureaucracy and so on that comes with it. This situation is very similar: there is that cliff edge, where tax treatment suddenly becomes very different from what it was before.

In the long run, Government should aspire to learn from the best of what happens in other countries that have a more granular approach; where income is more tightly tied— and sometimes entirely tied—to tax treatment, so that as one’s income goes up, tax liability goes up stepwise. That seems a very sensible approach, but of course, getting there is a long-term aspiration. In the short term, I hope that the Minister—who I know is an open-minded person—will ask his Treasury colleagues to sit down with the experts and representative organisations, and talk to them about how these problems arise because of the interaction of the complex pension system with the complex treatment of tax release, so that there can be some kind of short-term fix with a view to, in the long term, having a much more rational approach to tax release on pension contributions.

Oral Answers to Questions

Anneliese Dodds Excerpts

Tuesday 18th June 2019 Commons Chamber

[Stephen Hammond]

The hon. Gentleman is right: every exception report has to be addressed. Changing the rota is one possible outcome. He will recognise that there are other possible outcomes as well: the doctor may agree to work extra hours and be given extra time off; timing of the ward rounds in clinics may be adjusted, so that educational opportunities can be taken: and timing of the ward rounds can be adjusted so that support from other senior staff can be there as well. There are many ways around this.

[Anneliese Dodds (Oxford East) (Lab/Co-op)]

7. For what reason he chose not to refer the Thames Valley PET-CT scanning contract to the independent reconfiguration panel.

[The Parliamentary Under-Secretary of State for Health and Social Care (Seema Kennedy)]

I am aware of the views that have been expressed on this matter. I can confirm that, having taken advice, we considered that the letter received from the Oxfordshire health overview and scrutiny committee does not constitute a valid referral under the relevant regulations. However, I have emphasised to NHS England, Oxford University Hospitals and InHealth the importance of continuing local discussions and working together at pace to find a service offer that works best for patients.

[Anneliese Dodds]

The Churchill’s PET-CT cancer scanning service is world renowned, yet NHS England, apparently with the consent of this Government, is forcing it into partnership with a private company. That is what is happening. It is not a discussion; it is being forced into a partnership. NHS England has even warned the trust against staff raising their voice on this issue because of their concerns about patient safety. Surely this unprecedented partnership is illegitimate and must be called in by this Government.

[Seema Kennedy]

As I have said to the hon. Lady, we do not consider it to be a valid referral. What I would say is that NHS England remains committed to ensuring that the public are involved in decision making. Part of the extensive public engagement included completing a 30-day engagement about the phase 2 procurement proposals in 2016. I understand the strong passions that this has raised on both sides of the House and I urge all parties to continue working together.

Cystic Fibrosis Drugs: Orkambi

Anneliese Dodds Excerpts

Monday 10th June 2019 Westminster Hall

[Paul Scully]

The hon. Gentleman has absolutely nailed it. That is very much the point. This is about human beings, and we are dangling something in front of them that they just cannot access. The fact that people go off to Argentina and spend their own money to get the drug is ridiculous. That is a really important point.

[Anneliese Dodds (Oxford East) (Lab/Co-op)]

rose—

[Paul Scully]

I will make two more points about mental health, and then I will let someone else intervene.

As I said earlier, Oli Rayner said that he effectively spent 10 years preparing to die. He even cold-called a vicar to plan his own funeral. He is now 43 and has a relatively clean bill of health after having a lung transplant. It is outrageous that he had to do that.

I want to raise with the Minister the case of Carlie Pleasant, who ironically works for the NHS. She has CF and has had to go to the hospital a number of times. Her HR manager has told her that she has had too many days off sick, and that she has reached the trigger point. Basically, she has been told that she may be able to make up for it if she is not off for the next couple of months. She has a husband and a young child, she is running a home and she is trying to keep her job and pay her mortgage. How much pressure does that put on her mental health?

There must be thousands of sufferers in a similar situation across the country. We are talking about a life-saving, quality-of-life drug. When we, and especially the Government, try to ensure parity of esteem between mental and physical health, we must all ensure that that balance is reflected not just by treatments but by everybody in the health system and every employer.

[Anneliese Dodds]

I am very grateful indeed to the hon. Gentleman for giving way. He is making a very persuasive case, and it is obviously supported by many of us. Returning briefly to his point about buyers’ clubs, he will be aware that many sufferers and their families have already made significant financial contributions to CF research. The Oxford group, made up mainly of parents and grandparents of people with CF, has raised more than £174,000 for research just since 2003. They are obviously very upset at the current impasse, as they have made that contribution and they now feel that they have to do it again through buyers’ groups. Does the hon. Gentleman agree that that is totally unacceptable?

[Paul Scully]

The hon. Lady is right. The fact that people have to resort to such things is ridiculous given that we have a comprehensive health system. It is about time Vertex recognised that there is plenty of time for it to make a reasonable profit on its drugs portfolio. It is not helping the situation. There are a number of people from the Cystic Fibrosis Trust in the Public Gallery, but unfortunately, as the hon. Member for Bury North (James Frith) said, many sufferers cannot be here because of the danger of cross-infection. They are hopefully watching the debate on television or on their computers.

Learning Disabilities Mortality Review

Anneliese Dodds Excerpts

Wednesday 15th May 2019 Commons Chamber

[Caroline Dinenage]

I do not think I could have said it any better than my right hon. Friend. Mencap has put out a fantastic tweet featuring a particularly special young man who has Down’s syndrome. He is incredibly brilliant in the way that he articulates how very proud he is to live with Down’s syndrome and to be just as useful, just as important and just as special as everybody else, and how that makes him just as much a valued member of society as others—in fact probably more so.

[Anneliese Dodds (Oxford East) (Lab/Co-op)]

It is six years since Connor Sparrowhawk died, yet these leaks—yes, leaks—indicate that 8% of the cases reviewed showed that people with learning disabilities had been harmed or even killed by the care that they received. What was meant to be helping them was actually harming them. That raises enormous questions, of course, about all the cases that have not been reviewed. The Minister said that action is being taken to deal with the backlog, but she knows that it is enormous. She must also know that the time that elapses after a death really counts for the amount of learning and the amount of change that will follow. Will she tell us exactly what she is doing to speed up the review of these cases, as it is just so important?

[Caroline Dinenage]

The hon. Lady is absolutely right to raise the case of Connor Sparrowhawk, which was an absolutely tragic lack of care. I have met his mum, Dr Sara Ryan, and I greatly value her feedback on how we move forward with the LeDeR programme, because she has such an important insight into the matter. As I have said, NHS England is putting in additional funding to clear the backlog, and the NHS planning guidance for 2019-20 is very clear that clinical commissioning groups must have robust plans in place to make sure that LeDeR reviews are undertaken within six months of a notification of death in their local area. The resources are going in and the guidelines are there to ensure that that happens.

Integrated Care Regulations

Anneliese Dodds Excerpts

Monday 18th March 2019 Commons Chamber

[Jonathan Ashworth]

That is absolutely right. Notwithstanding the sincere views of the Select Committee, there is a lack of confidence out in the country about the way in which these commercial contracting arrangements work. We are seeing that in Bristol, as my hon. Friend so eloquently outlined. Despite the blasé attitude of the Secretary of State in the Select Committee, this is the same Secretary of State who has sat back and done nothing while a PET-CT cancer scanning contract in Oxford is privatised, leading to a fragmented service putting patient safety at risk.

[Anneliese Dodds (Oxford East) (Lab/Co-op)]

I know my hon. Friend has been working very hard on this issue. I have had droves of patients and staff contacting me with their concern about what is happening. They are astonished that this privatisation is continuing given the comments made by the Secretary of State. There seems to be no willingness at all for any challenge to NHS England’s decision, which is going above the heads of those who deliver the care and which, as my hon. Friend says, would threaten its quality and safety.

[Jonathan Ashworth]

We keep being told by Ministers, by those who are favour of integrated care and by various interested stakeholders that Labour Members are scaremongering and that we have nothing to worry about—that it is all going to be fine and all going to be in the public sector—yet at the same time we are seeing controversial privatisation after privatisation all across the country, of which the one in Oxford is just the latest example. This has happened since the Secretary of State went to the Select Committee and said that there would be no privatisation on his watch.

In south-east London, private companies are in a three-way fight for the biggest-ever NHS pathology contract—a £2.2 billion contract for 10 years. If the Secretary of State was sincere in his commitment to no privatisation on his watch, he would bring forward legislation to ensure that ICPs are statutory public bodies that are publicly accountable. He would first take the advice of the NHS itself, as embodied in the long-term plan and the subsequent proposals for legislative change, and rid our NHS of the morass of competition law and economic regulation that was brought in by the Health and Social Care Act 2012. Everyone agrees that this particular aberration has had its time.

While the NHS proposals do not yet go as far as Labour Members would want and would not resolve all the problems of the internal market and private sector involvement that our NHS struggles with, they would remove the default assumption for competitive tendering that would currently make many ICSs feel obliged to put contracts for ICPs out to tender for fear of falling foul of the competition rules. Overall, they provide a far preferable base from which to pursue integrated care than the maze of contradictions and obstacles that Andrew Lansley’s Act forced on them. Rather than this regulated change, why is the Minister not bringing forward the legislation that NHS England has called for?

I have two other quick points for the Minister. The new secondary legislation seeks to substantially change the regulations underpinning the existing contractual arrangements for the provision of NHS GP services. We should remember that general practice is already hard to recruit for and we are already losing GP numbers, yet the proposal to incorporate GP practices into ICPs appears to cut across the idea of GPs beginning to work in wider networks covering 30,000 to 50,000 patients, retaining their GP contracts but sharing common resources. That was highlighted as a direction of travel to be celebrated by the Prime Minister when launching the long-term plan.

GP practices can already network and collaborate without this new contract. The contract will offer a sweetener to GPs of new money if a GP practice signs up to the new contract, but the proposals have been opposed by the BMA. Dr Richard Vautrey has said:

“We have repeatedly expressed our serious concerns about ICP contracts which leads to practices giving up part or all of their General Medical Services contract as a result. Practices should not feel pressured into entering an ICP contract as to do so could leave their patients worse off.”

Perhaps the Minister can explain why he is correct and Dr Vautrey is wrong.

I want to make a quick point about the pooling of budgets with respect to universal free-at-the-point-of-use NHS and means-tested social care. If the boundaries between health and social care are dissolved, will the Minister mandate ICPs and clearly specify that which is considered healthcare and that which is considered social care? I raise that because we are already seeing CCGs across the country cutting back on their responsibilities to provide continuing healthcare for some of the most vulnerable people. Can he guarantee that some services currently provided free on the NHS—whether rehabilitation care or nursing care provided by district nurses, such as wound care or continence care—will not suddenly be designated as social care, so that charging creeps into the system?

NHS 10-Year Plan

Anneliese Dodds Excerpts

Tuesday 19th February 2019 Commons Chamber

[Justin Madders]

I thank my hon. Friend for his contribution. Of course, we were not actually meant to be here at all this week, but it is absolutely right that this debate took place tonight. We need another one and we will very shortly need a debate on the social care Green Paper, when that is published. We also need a debate on what we are going to do about some of the legislative changes that the Government have promised, because all these things need to take place in the public eye.

[Anneliese Dodds (Oxford East) (Lab/Co-op)]

Does my hon. Friend agree that we also need a debate on privatisation, given that we are seeing no public consultation on very significant changes, such as what is purported to happen to the PET—positron emission tomography—scan centre at Oxford University Hospitals NHS Foundation Trust, causing a huge amount of local concern?

[Justin Madders]

I thank my hon. Friend for her intervention. She is absolutely right. The Secretary of State has said on the record that he wants to stop privatisation, but we have identified a number of very important contracts lasting many years and costing millions of pounds that should be halted if the Government are going to stick to their word. It has not happened and it should.

The timetable for the publication of the plan has itself not gone to plan. Again, when the Foreign Secretary was Health Secretary, he said:

“we now intend to publish the social care Green Paper in the autumn around the same time as the NHS plan.”

I am not sure which autumn he was talking about for the social care Green Paper, but the intention was right, because, as he also said:

“It is not possible to have a plan for one sector without…a plan for the other”—[Official Report, 18 June 2018; Vol. 643, c. 52.]—

but here we are.

In conclusion, whatever fine words, gimmicks and spin we have in the 10-year plan, we know that the reality is that the NHS is on its knees and that it cannot survive another decade of Tory Government. It is time for Labour to come to the rescue again.

Orkambi

Anneliese Dodds Excerpts

Monday 4th February 2019 Commons Chamber

[Bill Wiggin]

I have. This drug would cost £104,000 if bought from Vertex and about £5,000 if it were made generically, so there is a huge saving.

[Anneliese Dodds (Oxford East) (Lab/Co-op)]

I am grateful to the hon. Gentleman for giving way. He is making an excellent case. Those of us who have been active on this issue—it is wonderful to see so many of them in the Chamber—have faced the argument from the company that it wants to have a licence for a whole class of these medicines, so that it can plan that future investment. He seems to suggest that that is not necessarily a valid argument. I wonder if he could respond to that argument, which has been used against those of us who have suggested that there should be a fairer way of proceeding.

[Bill Wiggin]

I am not quite sure I follow. I would have been much more sympathetic to Vertex if it had not been doing share buybacks. If a company expects to make $13 billion of profit, it will have factored into its calculations a reasonable profit margin. I believe that Vertex has an unreasonable profit margin. I support the private sector, and I like the idea of that R&D going on to benefit the shareholders, but I also recognise that we have a responsibility. As people who want to see patients cured, we want to see this deal done ideally by Vertex and NICE. This is a £500 million gamble for Vertex, because it will not get the money if it does not do the deal.

Mental Capacity (Amendment) Bill [Lords]

Anneliese Dodds Excerpts

2nd reading: House of Commons & Money resolution: House of Commons & Programme motion: House of Commons & Ways and Means resolution: House of Commons
Tuesday 18th December 2018 Commons Chamber

[Anneliese Dodds (Oxford East) (Lab/Co-op)]

It is a pleasure to follow my hon. Friend the Member for Stoke-on-Trent Central (Gareth Snell), who spoke with characteristic concern for his constituents and characteristic courtesy. I am grateful to him.

In the brief time available, I will argue why it is inappropriate for the Government to be rushing this Bill through Parliament. There are three reasons: the potential for an under-scrutinised Bill to have unintended consequences; the Bill’s lack of clarity on responsibility and resourcing; and the lack of calibration between this Bill and the much more carefully thought through and inclusive approach of the recent review of the Mental Health Act. As I detail those objections, I will refer to the specific concerns mentioned to me by my constituents.

I am well aware, as is everyone who has spoken on this Bill, that the current system is not functioning appropriately, but there has been a need for change since at least 2014. The question is whether we have had sufficient time to consider whether these measures are the appropriate ones, and I would argue that we have not. We had a discussion about the equalities impact assessment just now. I saw that a webpage was produced just yesterday with an equalities impact assessment allegedly produced in December—presumably giving the impression that it was produced yesterday. It refers to the independent review of the Mental Health Act being sure to report at the end of this year, but it has already reported. This is a dog’s dinner, and we cannot have it in relation to such a significant piece of legislation. We know about all the amendments made in the other place, which we have discussed. In that context, the time allocated to this Bill is just insufficient.

Even in this debate, we have seen the lack of clarity. The Secretary of State, who is no longer in his place, seemed to be unaware of expert calls for advocates being available to all, not just those objecting. He also did not agree with a comment made by a colleague who said that the new approach would potentially allow the deprivation of liberty for three years. However, the equalities impact assessment I just referred to, albeit that it is a flawed one, says that the Bill provides that authorisations could last up to three years where appropriate—after two initial authorisations of up to one year—compared with a maximum of one year under the existing DoLS system. The Government seem to be rushing this new approach in because of the existing backlog of DoLS cases dating from 2014, but it is not clear to me that the new measures will deal with that.

The Secretary of State said earlier that there would be a larger role for healthcare providers, but that seems to contradict what was stated in the other place. I am confused, and I think others are too, and that ambiguity is leading to the significant concerns expressed by many stakeholders about the potential for a conflict of interest. He said he would deal with that by tabling amendments in Committee, but in my experience we have not always seen that collaborative approach in Committee from the Government. I hope we will see a change, but presumably others can understand why there might be concerns about that.

It is unclear how local authorities and clinical commissioning groups will be able to perform their role expeditiously under these measures in the current financial climate. No fewer than 38% of assessments under DoLS in Oxfordshire required more than a year to be performed, according to the latest statistics. That is not just because of the regime; it is also because of funding constraints. Oxfordshire County Council has just announced that it will be cutting its contribution to mental healthcare funding. It has one of the lowest levels of mental health funding in its budget compared with other healthcare funding. Just as with lengthening waiting lists for accessing mental health provision, if we do not deal with this resource issue we will only hit the brick wall of inadequate funding.

Lastly, I wish to say that that review of the Mental Health Act involved thousands of service users from the off. In fact, it had someone who had been sectioned as a vice-chair. We have not had that level of inclusion in respect of this Bill.

NHS Outsourcing and Privatisation

Anneliese Dodds Excerpts

Wednesday 23rd May 2018 Commons Chamber

[Anneliese Dodds (Oxford East) (Lab/Co-op)]

It is a pleasure to follow the hon. Member for Faversham and Mid Kent (Helen Whately). She spoke with characteristic gusto, even if—I am sorry to say it—I did not agree with a single word she said.

I want to underline how privatisation is sapping resources from our NHS, in Oxford East and elsewhere in the country, at the very time it needs them more than ever, because of demographic change and the knock-on impact of cuts elsewhere in our public services. Oxford has particular problems with staff recruitment and retention because of the very high cost of living and the historically high number of EU staff in our local NHS, who are under threat from the Government’s shambolic approach to Brexit. Too few staff for high demand has led to clear reductions—that is right: reductions—in patient care in my local area.

Between January and March this year, 273 non-urgent surgical operations were postponed in my city. Rather than the response being additional resources for the local trust that was working so hard in trying to provide a decent service, in the topsy-turvy world of this Government, my trust lost £1 million because of what happened during that period. Meanwhile, Virgin Care has taken £1.5 million away from our NHS through court action against it. That is an absolute disgrace.

The hon. Member for Cheltenham (Alex Chalk), who, sadly, is no longer in the Chamber, wilfully misconstrued the impact of privatisation. The clue is in the word: it means privatising—making private—something that was public before. We are not talking about the great British biomedical industry, which has always been private. In fact, my hon. Friend the Member for Leicester South (Jonathan Ashworth), the shadow Health Secretary, came to my constituency to see an operation this very week. In fact, the innovation that is promoted by that industry would be aided by an end to inappropriate privatisation. If we stopped sucking out resources and putting them into the pockets of profiteers, they could be spent on the high-quality healthcare and technologies of the future that would actually benefit patients.

The delays in operations in Oxford have become substantially worse over time. Between the end of February 2017 and February 2018, the acute hospital trust had to postpone 952 non-urgent operations; 536 were postponed in the previous year. As the situation has worsened, it has become harder and harder to establish whose responsibility it is. It is no longer the Health Secretary’s responsibility, because, following the Lansley reforms, he has no overall responsibility for the NHS. Oxfordshire’s joint health overview and scrutiny committee, which is meant to oversee services, has just decided to hold many of its meetings in secret, so the public do not even know what is going on at that level.

There are constant arguments about who is responsible for the provision of various essential services. As we all know, breastfeeding support is incredibly important to both babies and mums, but my local clinical commissioning group and my local council cannot agree whose responsibility it is to pay for it, so it is not being delivered properly. That is happening throughout the country. Of course, those services used to be available in children’s centres, but we do not have them any more in Oxfordshire since they were got rid of.

The crisis in Oxford’s NHS has been intensified by all the cuts in social care. Even with all those pressures, however, local NHS staff are working incredibly hard. We are not scaremongering when those staff are coming to our surgeries in tears. When they are telling us how much pressure they are under, it is our duty as parliamentarians to stand up and say “Enough is enough: an end to privatisation and an end to cuts.”