Winter Preparedness

Edward Argar Excerpts

Wednesday 18th December 2024 Commons Chamber

[Edward Argar (Melton and Syston) (Con)]

I am grateful to the Minister for early sight of her statement—as I have said before, it is typically courteous of her. I echo the gratitude that she expressed to those in our NHS, and also those in the social care workforce who will be working hard throughout the festive period. As she alluded to, the NHS is already feeling the pressure this winter. We know that winter is always tough for the NHS, irrespective of who is in government, but services are feeling the strain even earlier than in previous years. A tidal wave of flu infections has led to a 70% increase in hospital cases in just seven days, and the national medical director of the NHS has warned of a “quad-demic” of health emergencies as cases of covid, norovirus, RSV and winter flu are all on the rise.

Meanwhile, in October, the longest A&E waits of over 12 hours increased by over a quarter in just one month, reaching the third highest monthly figure since comparable records began in 2010. Of course, all that has come before the cold weather really hits and before more vulnerable pensioners are left in freezing homes, unable to put the heating on after the winter fuel payment was scrapped for a large number. What assessment has the Minister and the Department made of the potential impact of that on hospital admissions this winter?

In government, we recognised that the NHS faces unique challenges in winter. We also recognised, as I know the Minister does from our previous discussions, the importance of flow in the NHS, with all parts of the system working together. That is why last year we provided £200 million to boost NHS resilience specifically during the peak winter months, which was accompanied by £40 million to bolster social care capacity and improve discharges from hospital. That followed the £1 billion announced earlier that year to boost capacity by delivering 5,000 additional beds, 800 new ambulances and 10,000 virtual ward places.

The Secretary of State himself has admitted that there will almost certainly be a winter crisis. There have been warnings from the Royal College of Emergency Medicine, the Royal College of Nursing and directors at NHS England. Yet in today’s statement, in contrast to the steps we took, we heard a lot about data, meetings and co-ordination, but very little in concrete terms to increase capacity specifically over the winter period. That will give scant reassurance to those working in the system or patients needing the system. In fact, earlier this year, the Secretary of State suggested that there would not be any specific new funding for the NHS to cope with winter pressures.

The Minister will know that I have tabled a number of written questions in recent days, met in many cases by what seems to be the standard DHSC response for named day questions of a holding answer. As the pressure continues to grow, I have a number of specific questions for the Minister while she is at the Dispatch Box. Will the NHS receive more resources specifically to increase bed and A&E capacity this winter? Are there enough hospital beds and ambulances for this winter, or is she taking steps to increase them? As of the 1st of the month, how many people who were medically fit to be discharged had not been, for a variety of other reasons?

I am grateful for the update that the Minister provided on winter vaccinations. What assessment has she made of the supply of the flu vaccine? There are some suggestions that pharmacies and others have run out and are waiting for more deliveries. How many additional 111 and 999 call handlers have been recruited specifically for this winter?

We talked briefly about the need for the system to work as a whole. In that context, what is the impact of national insurance contributions on hospices, social care and GPs? The Secretary of State told the Health and Social Care Committee this morning that hospices would get an update from him before Christmas, but at Prime Minister’s questions in response to the Leader of the Opposition, the Prime Minister appeared to say that it will be after Christmas. Can the Minister clarify that for the House, because it is an important point?

Finally, what meetings has the Secretary of State personally had with Julian Redhead and Sarah-Jane Marsh, the NHS winter leads, and when was the first of those meetings specifically on this subject? I am very happy for him to write to me if that is easier, given the complexity.

As seasonal flu piles yet more pressure on NHS systems, it is more important than ever that it gets the resources and support that it needs. There are many promises of reform, but the NHS needs an immediate capacity boost in beds over winter. So far, the Government have kicked reform into the long grass in favour of yet more consultation, and their preparations for winter have lacked the urgency and focus that patients and NHS staff demand. In government, the Conservatives always put extra support in place to keep the NHS going through the tough winter period, boosting capacity and increasing support. This Government need to get a grip and do the same.

[Karin Smyth]

I will do my best to address that range of questions. First, as even a stopped clock is right once—[Interruption.] Yes, twice. On that basis, I agree with the right hon. Gentleman. On correspondence and answers to parliamentary questions, again, the situation we inherited is not satisfactory. I apologise to all Members who are waiting for correspondence—it is something we are taking a grip of. We want to respond positively to questions. The Conservatives did not; we will make sure that starts to happen.

On capacity in the system, again, I remind Members that we came into office in July, which is one quarter of the way through the planning and financial year. We very rapidly looked at the plans that were baked in by the previous Government—I appreciate that the right hon. Gentleman was in the Ministry of Justice at the time, not the Health and Social Care Department—to see whether they were fit for purpose. We wanted to make sure we brought stability to the system. There are, in fact, more beds currently available in the system than last year. If there is a need to increase capacity due to a likely cold snap, the system is absolutely ready to respond in its usual way. That is why we are meeting weekly.

On meetings with clinical and managerial colleagues at NHS England—who, frankly, I see more often than many members of my own family—I can tell the right hon. Gentleman that we started those meetings immediately. I would have to check the exact date, but it was certainly in the summer. I have had fortnightly meetings since September, which, as I said, we can move to monthly meetings, chaired by the Secretary of State. We began getting a grip from day one, knowing that winter was coming, which is why I am monitoring the situation weekly. It is also why we visited the operational centre, to understand in real time what is happening across every single system and every single trust—be that ambulance issues or problems at the front end and in A&E. The one question I do not directly have the answer to is what the daily figures are; I will try to get those figures to the right hon. Gentleman later.

We all know that waiting for discharge to assess is a massive problem. That is why, as I said in my statement, we want to take a grip of the better care fund, to ensure it works better and to stabilise the social care system. I am not particularly versed in issues on supply, so I apologise if that is wrong. We will certainly get back to the right hon. Gentleman on that matter, because we want people to be taking the vaccinations where necessary.

I can confirm that we want an announcement on hospices before Christmas. On winter fuel and its impact, as Opposition Members know, we will continue to monitor the impact of all situations on individuals to ensure they are supported in the community. We urge people to make sure they access pension credit. [Interruption.] I have just addressed that, but if I have missed anything, I will come back to it.

Puberty-suppressing Hormones

Edward Argar Excerpts

Wednesday 11th December 2024 Commons Chamber

[Edward Argar (Melton and Syston) (Con)]

I thank the Secretary of State for advance sight of his statement, and for his courtesy in coming to the House to make an oral statement, which gives hon. Members the opportunity to ask him questions.

When the Secretary of State is wrong, we will challenge him robustly and hold him to account, but when he is right, we will support him. That is responsible opposition. In what he sets out today, he is right, and he has my support for what he is doing. Protecting children is one of the most important priorities that a Health Secretary can have. My predecessor, my right hon. Friend the Member for Louth and Horncastle (Victoria Atkins), worked tirelessly to do just that. She set out that it was her priority to protect children and young people from risks to their safety from the prescription of puberty blockers, given the lack of an evidence base. I welcome the Secretary of State’s continuing the work started under the previous Government, and I welcome his support at the time and all that he has done since, including in his statement on 4 September. I associate myself with the three principles that he enunciated when he opened his statement.

With increasing numbers of young people questioning their gender identity, NHS England, with the support of previous Conservative Health Secretaries Matt Hancock and Sir Sajid Javid, commissioned Dr Hilary Cass to examine the state of services for children questioning their gender. That historic review cut through the noise and ideology to lay bare the clear facts, so that we as policymakers can seek to make decisions based on evidence, safety and biological reality, and create a service that better serves the needs of children, as the Secretary of State set out. In the review, Dr Cass made it clear that not enough is known about the lifelong impacts of using puberty blockers on young minds and bodies to be sure that they are safe, and that the robust evidence base was simply not there. In March, NHS England made the landmark decision to end the routine prescription to children of puberty blockers for gender dysphoria. With the support of the then Government, it announced that it was stopping children under 18 from being seen by adult gender services with immediate effect.

As one of the final acts of the previous Government, my right hon. Friend the Member for Louth and Horncastle used emergency powers under section 62 of the Medicines Act 1968 to extend the ban to private clinics selling puberty blockers to young people questioning their gender. It was the right thing to do, and I agree with and pay tribute to her, as I do to the Secretary of State for what he has subsequently done. The safety and wellbeing of children and young people must come above any other concern. I welcome the fact that the Secretary of State renewed the order; his saying that he will make the ban indefinite, given the absence at present of an evidence base; and his seeking to better understand and build that evidence base.

I have a few questions that I hope the Secretary of State can offer clarifications on in a constructive spirit. I hope—I think he alluded to this—that he will confirm that he intends to implement the Cass review’s recommendations in full. Of course, support must be available to children and young people who are questioning their gender identity, and that support must be holistic, multidisciplinary and evidence-led. The Tavistock clinic closed earlier this year, and as he set out, three new regional NHS children and young people’s gender services have opened to provide better, tailored gender services for children and young people—again, that is based on recommendations in the Cass review. Can the Secretary of State provide more detail on the delivery of the remaining regional centres, and say what order they are due to open in, so that children and families can see what is happening in their region? Again, that is about putting the best interests of young people first.

Can the Secretary of State reassure the House that these measures will be UK-wide and that he is working in tandem with the devolved Administrations? Will he advise on what progress has been made thus far—I appreciate that it is early days—on further research into patient care and increasing that evidence base? Can he update the House on the steps taken to continue the work of his predecessor, my right hon. Friend the Member for Louth and Horncastle, when she announced to the House in May the decision to work to close any online loopholes to the regulations put in place? Finally, will he commit—I suspect I know the answer to this one—to keeping the House updated in the months and years ahead on developments in this space?

Our children and young people deserve healthcare that is compassionate, caring, careful and led by the evidence. I associate myself with the Secretary of State’s concluding remarks on the need for the debate to be conducted in a respectful and sensitive way, with the needs of children and young people at its heart. We will support measures that protect children, and support him in bringing forward such measures; we want to work constructively with the Government to give the next generation access to the right healthcare to meet their needs. I look forward to working with him in the months ahead.

[Wes Streeting]

I thank the shadow Secretary of State for the constructive way in which he has responded to the statement, and for the tone with which he has approached the issue. It is worth everyone bearing in mind that every word of statements in this House, and indeed online, are often hung upon by a particularly vulnerable group of children and young people. Many of them feel afraid about the environment in which they are growing up, as do their families. Establishing an environment in which we can discuss issues with their welfare and wellbeing at its heart is therefore the right way to approach these issues. As I have said many times before—and I am sure the shadow Secretary of State agrees—we need less heat and more light, and we can show leadership together in trying to provide that climate.

I am absolutely committed to the full implementation of the Cass review. The shadow Secretary of State asked about the implementation of new children and young people’s services on gender incongruence. As I said, the north-west London and Bristol services are now open. A fourth service is planned in the east of England for spring next year. We want a specialist gender service in every region by 2026, and of course I will keep him and the House updated on that.

I am working closely with my counterparts in the devolved Governments. I particularly welcome the engagement I have had with my counterpart in Northern Ireland and his predecessor, the hon. Member for South Antrim (Robin Swann), who is within my line of sight. I appreciate the way we have been able to work together on this and many other issues. The shadow Secretary of State asked about loopholes. I will keep the matter under close observation and review.

With regard to sanctions, penalties and enforcement, it is worth pointing out that breach of the order is a criminal offence under the Medicines Act 1968. It is a criminal offence to supply these medicines outside the terms of the order. That means pharmacists who dispense medicines against prescriptions that are not valid may be liable to criminal prosecution. It is a criminal offence to possess the medicines where the individual had responsible cause to know the medicine had been sold or supplied in breach of the terms of the order. There are fines and penalties associated with that, including case-by-case and regulatory enforcement by the General Pharmaceutical Council.

We have approached the matter in an evidence-based and considered way, and with the welfare and interests of children and young people at the heart of our decision making. I urge everyone else involved in the provision of health and care to do the same.

Tobacco and Vapes Bill

Edward Argar Excerpts

2nd reading
Tuesday 26th November 2024 Commons Chamber

[Edward Argar (Melton and Syston) (Con)]

I do not always do this, but I express my gratitude to the Secretary of State for the tone he has adopted in this debate and for recognising the strongly and sincerely held views of right hon. and hon. Members on both sides of it. I am also grateful to him for being typically willing to share with the House in support of his points something as personal as what happened to his grandmother. Sadly, it will not surprise him that no one asks me for my ID these days—I will have to take some tips from him on the moisturiser that he uses. [Interruption.] I will ignore the unkind comment that he has just made.

In many ways, this Bill is like the curate’s egg: it is good in parts—indeed, it is good in many parts—and started from a place of good intentions. As the Secretary of State set out, smoking has a huge cost to society and to individuals. We know that smoking is the single biggest entirely preventable cause of ill health, death and disability in this country, and we see in our NHS the impact of smoking every day. It is responsible for around 80,000 deaths in the UK each year and is estimated to cost the NHS and social care more than £3 billion a year, including 75,000 GP appointments every month. As the Secretary of State said, almost every minute someone is admitted to hospital because of smoking. It substantially increases the risk of many major health conditions throughout people’s lives, such as stroke, diabetes, heart disease, stillbirth, cancers, dementia and asthma.

As the Secretary of State has alluded to in the past, it is often people in more deprived areas who have higher smoking rates, lower healthy life expectancy and higher mortality rates linked to smoking. Some 230,000 households are estimated to live in smoking-induced poverty, and children of smokers are three times as likely to start to smoke, potentially perpetuating the cycle. Over 80% of smokers started before they turned 20—many started as children—yet more than half of current smokers want to quit; as the Secretary of State said, three quarters say that they would never have started smoking if they had the choice again. Let me be clear: reducing smoking, giving people the information and support to quit, and helping to protect children in particular are worthy ambitions.

Among all the doom and gloom, there is some positive news: smoking rates are falling anyway. While around 6 million people in the UK smoke, the number of smokers has been falling for decades. In 2023, just 10.5% of people aged 16 and over smoked, compared with 20.3% in 2010, 20.7% in 2000 and 30% a decade before that in 1990. Likewise, the number of children who smoke is falling. While this trend is welcome, it is understandable that there is a strong desire to see continued action to further drive down the prevalence of smoking and tackle the recent rise in vaping among non-smokers, especially among young people, and to protect future generations.

As was evidenced by the interventions that the Secretary of State kindly took from many hon. Members, I am sure that many of us in the House have been alarmed by the surge in youth vaping, which has doubled in the past five years. Despite it already being illegal to sell nicotine vapes to under-18s, a quarter of children tried vaping in 2023. While nicotine vapes can and do play an important part in helping adults to quit smoking, we are clear that children who do not smoke should not take up vaping. The nicotine content makes those products highly addictive, while the long-term impacts of the colours and flavours being inhaled are highly unlikely to be beneficial. Of course, the full effects may not be known for some years yet.

The uptake in youth vaping has been driven in part by the branding and promotion of products clearly aimed at children, with vapes, packaging, descriptions and marketing all designed to appeal specifically to young people. Grown adults trying to quit smoking are unlikely to see the appeal of cartoon characters on their vapes, but of course, children and young people will. Likewise, the bright colours and fruit flavours are far more likely to appeal to children than to those looking to quit tobacco smoking.

For those reasons, the last Government introduced a Bill that primarily targeted our interventions at young people. It would have restricted who could purchase tobacco products without impacting current adult smokers. It sought to tackle youth vaping by restricting flavours, introducing plain packaging and changing how vapes are displayed in shops so that they do not appeal to children. It would also have prohibited the sale of non-nicotine vapes and vaping alternatives such as nicotine pouches to under-18s, just as it is already illegal to sell nicotine vapes to children. In parallel, it would have introduced new fines for rogue retailers in order to tackle the illegal market, seeking to make sure that the law—such as age restrictions on purchasing vapes—was properly enforced.

That approach was targeted at the next generation of young people and aimed to prevent the take-up of smoking and vaping and break the cycle of nicotine addiction before it had even started. That Bill was not about demonising people who smoke or curtailing current smokers’ rights or entitlements in any way. None the less, it had challenging practical implementation impacts.

I have a lot of respect for the public health Minister, the hon. Member for Gorton and Denton (Andrew Gwynne)—I think that is his new constituency name—and know him well. I hope that when he winds up the debate, he will address some of the points I am about to make. My first point is about the impact on shopkeepers, particularly small shopkeepers, of enforcing and operating within increased restrictions, and the extent to which those restrictions are practically enforceable. In the context of what the Bill sets out to do, how does one avoid the existence of, or an increase in, a black-market economy in vapes or cigarettes?

We introduced our Bill before the general election. Since then, the new Government have introduced a Bill that may have the same name, but is not quite the same Bill that was introduced back in March. The Bill before us today gives the Secretary of State new, or significantly modified, powers under the Health Act 2006. It runs the risk of piling an unknown number of regulations on to retailers through a new licensing scheme, and it creates a whole new registration scheme. The challenge is that right hon. and hon. Members will not be told in detail what those schemes will look like, the specific impact they will have on businesses, or the detailed impact they will have on smoking and vaping rates until after the legislation has been passed. A hefty impact assessment—all 294 pages of it—has been produced. Given that the public health Minister has signed it, I fear he had to read every one of those pages before doing so. However, even with that impact assessment, the detailed impact of the individual regulations that may follow is unclear.

For example, clause 136 amends the Health Act 2006 to give the Secretary of State the power to extend smokefree places to some outdoor spaces. Of course, adults should be mindful and thoughtful about where they smoke or vape to be considerate to those around them, especially in areas with children or vulnerable young people, but the Bill risks giving the Secretary of State expanded powers to expand smokefree areas with minimal oversight. I acknowledge that the affirmative resolution procedure will be used, but as we in this House know, a statutory instrument and the procedures that accompany it are not as rigorous in their scrutiny as primary legislation.

Unlike previous laws, which banned smoking in confined areas such as pubs and bars, the Secretary of State is talking about bans in open spaces where the risks of second-hand smoking may be more limited. Page 64 of the delegated powers memorandum states:

“Under Section 4 of the 2006 Act, the Secretary of State could make regulations to designate additional places as smoke-free provided that they were of the opinion that there was a significant risk persons present in such a place would be exposed to significant quantities of smoke without a smoke-free designation…Section 5 of the 2006 Act gave the Secretary of State powers to make regulations for vehicles to be smoke-free.”

It goes on to say:

“Clause 136 amends the existing power in section 4 of the 2006 Act by omitting the risk condition.”

I would be grateful if the public health Minister could explain in his winding-up speech—I suspect he will be able to do so—why that condition is being removed. It was there for a reason: to give a sense of proportionality to anything that was done and to ensure that a particular bar had to be met, given the impact. Its removal effectively gives the Secretary of State much greater discretion to do as he wishes at a future date. I note that the Secretary of State has said today that he changed his mind on banning smoking in pub gardens or outside hospitality venues. I know him well, and he is an honourable man, so I take him at his word on that, but there is nothing in this proposed legislation to prevent a future Secretary of State from coming back, consulting and expanding beyond the areas where he proposes to restrict smoking to other venues and settings at a future date. Under clause 136, that could be done without the crucial risk criteria being applied. I would be grateful if the Minister could address that point, because it is hugely important. Members are being asked to decide now whether they support expanding smokefree places to an unknown list of outdoor spaces in the future, so it genuinely raises significant challenges and concerns if that gateway is not in place.

[Peter Swallow (Bracknell) (Lab)]

I am listening very carefully to what the right hon. Gentleman has to say. Some 13% of adults in Bracknell smoke, but we know that more than half of smokers would like to give up, so what I and my constituents are listening for is a commitment that his party will back concrete measures to end the public health epidemic of smoking once and for all—or are they just going to wrap up their objections in sophistry?

[Edward Argar]

I am grateful to the hon. Gentleman for most of what he just said. I will address precisely his point in a few paragraphs, but I say to him that my party brought forward legislation in March, which was debated in April, that did not have the mission-creep that I fear the Secretary of State is demonstrating with clause 136 and various other measures in this proposed legislation.

I must also challenge the Government on how they anticipate this measure being enforced. Will members of the public be encouraged to call the police if they see a parent smoking in a prohibited place? If there are no children in a park or playground, will it still be prohibited?

Concerns are also raised by the new licensing and registration schemes. While it is right that we had planned to expand the existing notification scheme to include non-nicotine vapes and nicotine products involved in the supply chain, this Bill goes a number of steps further. The Secretary of State will be able to create a new licensing regime for retailers for tobacco, vaping and nicotine products. Over 70% of convenience stores selling vapes and tobacco products are independent shops. How will they fare and how will they be assisted with the layers of added bureaucracy and cost that will be associated with the Bill? Do local authorities, which are already under pressure, have the capacity and additional funding allocated to administer such a licensing scheme in their areas?

Again, my fear is that we are unable to make a fully informed decision about the impact because the regulations will be set out only after the Bill has passed. The impact assessment states:

“A more restrictive licensing scheme would be expected to have a greater impact on public health and a greater economic impact on businesses.”

However, we simply do not know if that is what the Secretary of State has in mind or what the regulations will look like. Likewise, there is no detail on the impacts of a new registration scheme for all tobacco, vaping, nicotine and herbal products, as well as tobacco-related devices.

In the few months that the Government have been in office, they have sadly shown that they are not particularly a friend of business and have broken a number of their pre- election promises. Although I have confidence in the Secretary of State as an individual and as a right hon. Member of this House, I ask him to forgive the cynicism of those on the Opposition Benches over any attempted reassurances from the Government that they will take businesses’ concerns into account as they consult on their plans.

To the point made by the hon. Member for Bracknell (Peter Swallow), if a Division is called, in line with the precedent set last time this will be a free vote; each Conservative Member may vote as they choose. The Bill, as I have said, comes from a good intention to keep the population healthy, to ease costs for the NHS and to prevent children from taking up addictive habits that may follow them for the rest of their lives. I support those objectives, but I call on the Minister for public health, when he winds up, to give the reassurances I seek and roll back the additional measures that have been put in place, over and above what we were proposing.

It is important that information is available so that people can make informed decisions and that support is available for those who choose to stop smoking. Adult individuals are best placed to make decisions about their own lives, but we recognise that the same is not true for children. I look forward to the responses from the Minister for public health, which I hope will be constructive. I welcome the Secretary of State’s offer to be collaborative and constructive in his approach to the legislation.

[Dr Beccy Cooper (Worthing West) (Lab)]

Will the shadow Secretary of State give way?

[Edward Argar]

I will briefly, because I have one sentence to go.

[Dr Cooper]

I thank the shadow Secretary of State. As a public health doctor, I am delighted to hear him speak so freely, openly and positively about all the great things that this legislation will bring, but I remain unclear whether he will be voting in support of this generation-defining public health Bill this evening.

[Edward Argar]

That will depend on whether the Minister for public health gives the promises I seek that he will withdraw a number of the measures that the Government have added to the Bill. I am grateful to my hon. Friend the Member for Sleaford and North Hykeham (Dr Johnson), who will take the Bill through Committee on behalf of the Opposition, and I know that she looks forward to constructive and collaborative engagement with the Minister. I hope he can offer reassurances when he gets up to the Dispatch Box in a few hours’ time.

Oral Answers to Questions

Edward Argar Excerpts

Tuesday 19th November 2024 Commons Chamber

[Mr Speaker]

I call the shadow Secretary of State.

[Edward Argar (Melton and Syston) (Con)]

The Secretary of State knows that every year, irrespective of which party is in government, winter is challenging for the NHS. Possibly, it will be all the more so this year with the potential impact on older people’s health of the loss of the winter fuel allowance by many. What winter preparedness steps has he taken, like previous Governments, to increase A&E capacity and to increase the number of beds this winter, and can he say by how many?

[Wes Streeting]

It is thanks to this Government and the action we have taken that, for the first time in three years, we go into winter without the spectre of national strikes looming over the NHS, and with NHS staff on the frontline not the picket line. It is thanks to the priority this Government have given to prevention that we have already delivered almost 15 million covid-19 and flu vaccinations, alongside the new RSV—respiratory syncytial virus—vaccination to help vulnerable groups for the first time. The shadow Secretary of State mentions the winter fuel allowance. This Government are protecting support for the poorest pensioners to protect them not just this winter, but every winter, and over the coming years the value of the pension will of course rise with the cost of living.

[Edward Argar]

I am grateful for that response but, just as my hon. Friends have highlighted in respect of the damaging impact of increases in employer national insurance contributions on GPs, hospices and care providers, I fear it was another example of the Government simply not answering the question and not having a plan yet. Either the Government have not done their homework and, as with the impact of NICs increases, they have not thought this through and do not know, or worse, they do not care—which is it?

[Wes Streeting]

This Government are prepared for winter and we are already standing up the operational response to winter pressures. On funding, the right hon. Gentleman was in government just before the general election. Is he saying that his Government did not provide enough funding for the NHS this winter? If not, why not? If he does accept that it is enough money, he will surely welcome the extra investment that the Chancellor is putting into the NHS from next year.

Income Tax (Charge)

Edward Argar Excerpts

Tuesday 5th November 2024 Commons Chamber

[Edward Argar (Melton and Syston) (Con)]

It is a pleasure and a privilege to be working once again in health and social care, although a disappointment to be doing it from the Opposition Benches. It is a privilege because, like the Secretary of State for Health and Social Care now, I had the privilege in government of working with the amazing and dedicated people who work in our NHS and in social care up and down the country. It is a pleasure to be back. It is a pleasure to be opposite the Secretary of State, as he now is. I remember our tussles back in the day, when I was sitting over there and he was sitting here.

I am sufficiently fond of the right hon. Gentleman to encourage him not to get himself fired out of a cannon, as he alluded to. Although I will say one thing for it: it would not only draw attention to his day job, but possibly even aid him in his ambitions to secure his boss’s job in due course. In respect of his comments about the Leader of the Opposition, my right hon. Friend the Member for North West Essex (Mrs Badenoch), I would only say very gently that she should probably take that as a compliment. When the right hon. Gentleman attacks someone in that way, it probably means that they are somewhat frit of her. I think he will see in the coming weeks and months why that is so.

We have already seen and heard over the previous days of debate that this is unequivocally a Budget of broken promises. Despite the pledges made over the course of the election and the commitments given to the British people, in reality those words meant nothing to the Labour party once it secured the keys to No. 10. Instead, we have seen taxes hiked on working people: the people who provide food security and food every day, our farmers, hit hard by the changes that have been made. We see living standards set to fall and mortgage rates likely to rise. We see taxes up, we see borrowing up, we see debt up, and we see that growth will be down on where it could and should be. Unfortunately, I fear, that pattern of broken promises also applies to the NHS and our social care sector.

[Mr Perkins]

I am grateful to the right hon. Gentleman for giving way and congratulate him on his new appointment. He is obviously very critical of the Government’s attempt to alleviate the appalling financial legacy that his party bequeathed to the nation. Does he support the extra investment for the health service, and is it just the ways of paying for it that he is against? Or is he actually opposed to it?

[Edward Argar]

I am very grateful to the hon. Gentleman. In his allusion to the Labour party’s inheritance, he missed the fact that the Office for Budget Responsibility singularly failed to back up the assertions made about the quantum of challenge the incoming Government faced.

Time and again, the right hon. Member for Ilford North (Wes Streeting), both in opposition and now as Secretary of State, has promised that any more money for the NHS has to be linked to reform. He has done that again today. The week before the Budget, he said that

“extra investment in the NHS must be linked to reform”.

In September, the Prime Minister himself said:

“No more money without reform”.

They are right on that. The Opposition support that condition, because it is only with reform that the NHS can sustainably continue to look after us for years to come. Yet I fear that this risks being another broken promise. I say to him now that where he is bold and provides genuine reform to benefit patients, he will have our support. Equally, if he bows to internal pressure and backs away from the radical reform that is needed, we will hold him to account.

[Joe Powell (Kensington and Bayswater) (Lab)]

Will the right hon. Gentleman give way?

[Edward Argar]

I will make a little progress before giving way to the hon. Gentleman.

I congratulate the Health Secretary on winning round 1 with the Treasury—I look across the Chamber and see the Chief Secretary to the Treasury on the Government Front Bench—in securing extra investment. He has secured more than £22 billion announced for the NHS, but without, as yet, any detailed indication of where that funding will go. I look forward to him returning to the House to set out the detail—I think he said that would be next week. What it must do is genuinely improve outcomes for patients and our NHS, rather than simply be focused on the headline figure of the inputs to it. There are, as yet, no clues as to whether it will be spent on wages, recruiting more staff, medicines or equipment; no clues as to how it will deliver the 40,000 additional appointments that have been promised; and no conditions linking the funding, as yet, to productivity improvements, modernisation or better outcomes for patients.

What we need to hear next week from the Secretary of State is an actual plan. As he mentioned, the right hon. Gentleman became shadow Health Secretary three years ago. I hope that in that time he has had an opportunity to think about what he wants to do and that he will actually set that out to the House next week.

[Joe Powell]

I welcome the right hon. Gentleman to his new position. On the theme of broken promises and capital investment, and in the spirit of a fresh start, I wonder whether he will extend an apology to my constituents who were promised a new hospital under the new hospital programme, which was never funded in any forward-looking Budget document?

[Edward Argar]

I am grateful to the hon. Gentleman. If he pauses for just a moment, I will turn to capital investment and seek to address his point.

[Paul Holmes]

Will the shadow Secretary of State give way on that point?

[Edward Argar]

I will make a little progress, but then I will happily give way to my hon. Friend.

Apart from the press releases and the reviews, where is the action? We need to see where the £22 billion will be spent. What plans does the Secretary of State have for additional investment for the NHS this winter? He knows, as I knew when I was a Minister, that winter in the NHS is always challenging. I look forward to him setting out what additional investment he plans.

[Wes Streeting]

On that point.

[Edward Argar]

I will give way to my hon. Friend the Member for Hamble Valley (Paul Holmes) in a second. Nice try, Secretary of State.

Is the right hon. Gentleman directing where that NHS funding goes himself, or will it be for his officials or NHS England to set the priorities for that, and who will be held accountable for ensuring that it is prioritised in the right places?

[Paul Holmes]

I thank my right hon. Friend for giving way and congratulate him on his appointment as shadow Secretary of State. Does he share my concern that, although the extra investment in the NHS is welcome, the lack of clarity from a Budget in which growth has actually been revised down means that in future years we could see additional investment in the NHS actually being cut back, because the Budget does not deliver the growth for public service investment?

[Edward Argar]

My hon. Friend is absolutely right. You cannot tax your way to growth and you cannot invest in public services without that growth. If the predictions we are seeing about growth are borne out, there is a real risk to our public services’ sustainability in future.

The Chancellor said that the funding would help to deliver 40,000 more NHS appointments a week, but again we see no reference to specific actions by which that will be achieved. The Government seem not to know the difference between a target and a plan, and simply restating their ambition while throwing money at the challenge will not be enough to deliver on that commitment.

As I have said, elements of the Budget relating to the Department of Health and Social Care were welcome, one of them being the Secretary of State’s one-nil win over the Chief Secretary in respect of funding. An additional £2 billion to drive productivity is important. I fear that it is a slimmed-down version of the £3.4 billion NHS productivity plans that we announced and funded, but I will study it closely, and, similarly, the Secretary of State’s plan for mental health is deserving of serious study. On both sides of this Chamber, we recognise the importance in mental health investment of not only parity of esteem but parity of services, and it is therefore right for us to scrutinise very carefully how the right hon. Gentleman intends to build further on the success that we had in driving that agenda forward.

Let me now turn to the subject of capital investment, which was touched on by the hon. Member for Kensington and Bayswater (Joe Powell). It concerns me that, as far as I am aware, the Secretary of State has still not told us exactly when his review of the new hospital programme will report and set out the future for each and every one of the hospitals that he committed himself to delivering during the election campaign—the programme to which the previous Chancellor had committed funding, building on the original £3.7 billion allocated in 2019. The question for the Government, and the question for the Chief Secretary to answer when he winds up the debate, is: “When will that review report, and when will each and every one of those colleagues and communities who are looking forward to a new hospital know whether it will be delivered in line with the Secretary of State’s pledge, or whether the programme will be cut?”

Nearly a week after the Budget, Members will be familiar with the verdict of the Office for Budget Responsibility: namely, that the £25 billion assault on businesses risks lower wages, lower living standards and lower growth. And let us not forget what this tax hike will mean for those providing essential services across primary, secondary and social care—the general practices, care homes, adult social care providers, community pharmacists on our high streets, hospices and charities such as Marie Curie and Macmillan which provide additional care for patients alongside the NHS.

I was deeply disappointed that the Secretary of State did not take the opportunity offered by my hon. Friend the Member for Hinckley and Bosworth (Dr Evans) to state clearly that all those groups would be exempt and would not be hit by this hike, and I hope that when the Chief Secretary winds up the debate he will be able to give that reassurance. The Royal College of General Practitioners has warned that the extra costs of the employer’s national insurance hike could force GP surgeries to make redundancies or close altogether, and the Independent Pharmacies Association has warned that community pharmacies will have to find an extra £12,000 a year, on average, to pay for the hike.

[Pete Wishart (Perth and Kinross-shire) (SNP)]

I welcome the right hon. Gentleman to his place. I was waiting for the Health Secretary to turn to devolution issues, but he never quite did. We have a particular issue in Scotland: up to £500 million of extra costs will be forced on to the NHS there because of that national insurance hike. We have heard no commitment from the Secretary of State that he will meet those costs in full, and we look forward to hearing such a commitment. I am sure the right hon. Gentleman will share my concern about what this is doing to devolved services across the United Kingdom.

[Edward Argar]

The hon. Gentleman is right to highlight the ill-thought-out consequences of this hike for hospices and general practices, both in Scotland and elsewhere. I would dearly love to be able to respond to his question. Sadly, however, I am on this the side of the House and not the other side, but I am sure that the Chief Secretary will attempt to do so.

The Nuffield Trust has said that without additional financial support, the tax raid is likely to force social care providers to pass higher costs on to people who pay for their own care, or potentially collapse financially. Charities are not exempt either. As a result of the increases in the national living wage and employer’s national insurance contributions, one of the UK’s largest social care charities says it is facing an unfunded increased wage bill of £12 million a year, and Marie Curie has warned that the rises in employer’s NI contributions will only serve to put the services that it delivers on behalf of the NHS under further pressure. Those charities will be looking to the Chief Secretary to say what succour he can offer them in the form of an assurance that they will not be hit.

[Ms Polly Billington (East Thanet) (Lab)]

I welcome the right hon. Gentleman to his place, but before throwing stones, will he just remind the House that under his Government’s plans, there would have been £15 billion less for the NHS, leaving it broken?

[Edward Argar]

I welcome the hon. Lady to her place as well. I think this is the first opportunity I have had to respond to a intervention or question from her.

In fact, we put record funding into the NHS—£164.9 billion per year—and on top of that we recruited more doctors and more nurses. We did not do that by piling tax hikes on hospices and general practices, among others. I am not sure how hitting primary care, social care or charities supporting NHS services will help the Secretary of State to deliver his aim of cutting waiting lists. I hope that the Chief Secretary will tell the House what steps the Treasury is taking to ensure that those organisations are not hit by these changes.

Let me take a moment to consider what was not included in the Budget.

[Josh Fenton-Glynn (Calder Valley) (Lab)]

Will the right hon. Gentleman give way?

[Edward Argar]

I will make a bit of progress, if I may.

There were no plans for social care reform after the Chancellor broke Labour’s promise to deliver the cap on social care costs. I hear what the Secretary of State says about a willingness to work on what is a challenge facing our whole country and society: with an ageing population, how do we address the challenge of social care? There were no further detailed plans for NHS dentistry, despite the election pledge to deliver more dental appointments. There was no support for pharmacies or for the day-to-day running of general practice, and there were still no additional resources for the NHS this winter—or, indeed, the details of reform to go with them.

[Lizzi Collinge (Morecambe and Lunesdale) (Lab)]

The right hon. Gentleman speaks about the investment that the last Conservative Government put into the NHS. Can he tell me what the outcome of that investment was? From my point of view, the outcome was longer waiting lists, poorer health and bad patient care.

[Edward Argar]

We increased investment significantly, not only to tackle the inevitable consequence of a global covid pandemic—which, as we all know, hit our NHS hard—but to build back better subsequently, which is the task that we began to perform. We have always said that investment in the NHS must be married to reform in order to deliver better patient outcomes and value for money, building on the reforms that we introduced in the Health and Care Act 2022 and ensuring that the NHS will be there to look after us for decades to come. The Secretary of State has worked with me before, and we will work with any party, including his.

[Mr Perkins]

Will the right hon. Gentleman give way?

[Edward Argar]

I gave way to the hon. Gentleman earlier. I am afraid I want to conclude my remarks, because I am keen for others to have a chance to speak.

That offer to the Secretary of State stands. I am always happy to work constructively with him when he is willing to work constructively with me. He knows that we have done that before, not least as we emerged from the pandemic, when I was still a Minister in the Department.

Unfortunately, despite the rhetoric, I fear that the Budget was a missed opportunity that will not achieve the ambitions the Government have set out. As I have said, we cannot tax our way to growth, and without growth we cannot sustainably fund public services. I urge the right hon. Gentleman to be brave, to stand up to those in his party who would have him back down or water down reform, and to deliver a genuinely radical plan for the future of our NHS and for social care that works for those who work in it, but also, crucially, for all the people who rely on it. Our constituents deserve nothing less from him.

[Madam Deputy Speaker (Caroline Nokes)]

I call Kate Osamor.