Covid-19 Update

Barry Gardiner Excerpts

Thursday 17th December 2020 Commons Chamber

[Matt Hancock]

Yes, if my right hon. Friend has the test reference number I will get on to it right away. If NHS Test and Trace has not contacted the owner, that might imply that he does not have to self-isolate, but of course I will want to look into the details of the case before making such a recommendation. I will ensure that my right hon. Friend’s constituents get a full, clinically approved recommendation ASAP.

[Barry Gardiner (Brent North) (Lab)]

Mr James Canning became our first octogenarian in Brent to receive the vaccine earlier this week. While congratulating him and the Wembley Practice team who delivered it, does the Secretary of State share my concern that care homes in Brent have been advised that the 970 doses that are in the vaccine packs cannot be split because of the licensing conditions, meaning that those in our care homes who are over 80 may have to wait until February or for the Oxford vaccine before they get vaccinated? Is that the case? If so, why? That is hardly the “protective ring” around care homes that he promised.

[Matt Hancock]

I am glad to say that we are making significant progress on tackling this issue. When the hon. Gentleman says it is a licensing concern, that should not be read to imply that it is some bureaucratic rule; it is about ensuring that things are done safely. If the vaccine is not delivered safely to the site, it is not an effective vaccine. Therefore, we are taking it carefully to be able to vaccinate in care homes. There has been some vaccination in care homes across the UK, so it can be done, and I hope we can make good progress soon.

NHS Dentistry and Oral Health Inequalities

Barry Gardiner Excerpts

Wednesday 25th November 2020 Westminster Hall

[Judith Cummins (Bradford South) (Lab)]

I beg to move,

That this House has considered access to NHS dentistry and oral health inequalities.

It is a pleasure to serve under your chairmanship, Mr Gray. I am delighted to have secured this debate on access to dentistry and oral health inequalities. I have spoken about this issue many times in this place, and it is more urgent now than ever. I will shortly turn to the effects of the coronavirus pandemic on dentistry in this country and, in particular, on access and oral health inequalities, but first I would like to set the scene a little.

In 2017, I held an Adjournment debate entitled “Access to NHS Dentists”. In that debate, I said:

“Millions of people each and every year are being left without access to an NHS dentist.”—[Official Report, 12 September 2017; Vol. 628, c. 812.]

I urged the Government to get on with dental contract reform and bring forward a coherent strategy to tackle the inadequacies and inequalities in the dental health system. That was three years ago, and of course no one could have foreseen the events of this year, but I am making the point at the outset of this debate that NHS dentistry in this country was already in a sorry state before covid struck. It was therefore extremely vulnerable to what has happened since March, the effects of which have been disastrous. The crisis in access that people were experiencing prior to March has been turbocharged. Solving it now requires the Government to dramatically change their approach to oral health treatment and prevention. In discussing the impact of covid on dentistry, I will focus mainly on England.

[Barry Gardiner (Brent North) (Lab)]

My hon. Friend is a student of the Old Testament, and she will know Proverbs 25, verse 19:

“Confidence in an unfaithful man in time of trouble is like a broken tooth”.

We are certainly in a time of trouble. It is not for me to call the Prime Minister an unfaithful man—

[James Gray (in the Chair)]

Certainly not. You must be brief.

[Barry Gardiner]

But the lack of support for dentistry and dental technicians has certainly resulted in a few broken teeth. What does my hon. Friend believe is the single most important thing that the Government can do to support dentistry and the oral health of the nation?

[Judith Cummins]

The single most important thing that the Government can do is reform the dental health contract with a view to more prevention.

During the initial period of lockdown, between March and June, all routine dental care in England was paused and urgent dental care hubs were set up to provide emergency treatment to patients. That period of closure has clearly led to an enormous backlog of patients requiring treatment. The British Dental Association estimates that in April and May only about 2% of patients were able to access dental care, compared with last year, and that between March and October 19 million appointments were lost. One local Bradford dentist told me:

“Our phones are ringing hot with new patients who have no dentist access, which has certainly been made worse by this year’s lockdown. On top of this we are facing significant staffing pressures, due to increased triage requirements and the need to thoroughly clean the practice between patients.”

Just yesterday, I was contacted by one of my constituents who has been trying to get a dental appointment for five months and is living with gum disease and toothache. That is simply unacceptable.

--- Later in debate ---

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

It is a pleasure to serve under your chairmanship, Mr Gray. I congratulate the hon. Member for Bradford South (Judith Cummins) on securing this important debate. I know her long-standing and grounded interest, shared by many across the House, in helping individuals access better health care broadly and in particular for their oral health. She has much support, as my hon. Friend the Member for North Cornwall (Scott Mann) showed.

This is a challenge which, as the hon. Lady neatly articulated, has become much worse under the pandemic. I hope to go into more detail about the fact that dentistry has faced specific challenges while delivering what care it has been able to. There are particular long-standing concerns about access to dental treatment in Yorkshire, including the hon. Lady’s area. She gave credit to my hon. Friend the Member for Winchester (Steve Brine) for the work that he did with her, because flexible commissioning has been operated in that area, and it is agreed that most dentists would prefer to move in that direction. As she said, there are challenges with units of dental activity, and arguably an evolution towards capitation, looking at dentistry in the round, and highlighting prevention would start to address those. The Department, NHS England and NHS Improvement are committed to the growth of access to dental services. There have been a number of actions, and seeing them come to fruition in Yorkshire is helpful in understanding how they might benefit a wider population.

As I said, the pandemic had a significant impact on dentistry. That reduced drastically, as the hon. Lady explained, the number of patients whom dentists can safely see each day. The dental risks were new. At the start of the pandemic we stopped dentistry because of the risk of transmission being much higher, owing to the aerosol-generating procedures used. That applies to extraction, but there is even such a risk in scaling and polishing.

During spring, urgent dental care centres were quite rapidly set up. Up to 635 centres were set up across the country and the remainder of high-street practices were asked to deal with the three As—telephone advice, antibiotics and analgesics. I understand that that was a challenge for patients, but I am sure that the hon. Lady will agree that it was vital to ensure the safety of dentists, dental technicians, nurses and entire teams at the beginning of the pandemic.

[Barry Gardiner]

It is really good to hear the Minister giving a straight response to the questions raised by my hon. Friend the Member for Bradford South (Judith Cummins). She mentioned dental technicians. Is she as concerned as many of us are that because of the lack of work for them now, people are leaving that employment, and the skills base is being lost in such a way that it will be difficult to cope with the expansion of demand once we move from present circumstances beyond the epidemic?

[Jo Churchill]

I believe that the workforce, more broadly, is something we must look at properly in the round.

Aerosol-generating procedures present a high risk, as I said, and under initial guidance issued by Public Health England, infection control required that rooms should be rested for up to an hour, as the hon. Member for Bradford South said, to allow the airborne spray to settle. NHS dental practices were allowed to start offering services from 8 June providing that they had appropriate PPE and infection prevention and control measures in place.

In response to the hon. Member for York Central (Rachael Maskell) I would say that all NHS dentists can access the portal. Registration is voluntary, and 5,500—equating to about 81% of all NHS dentists—have signed up, and 50 million items of personal protective equipment have been dispensed. Making sure that our frontline services have what they require is vital, but the e-portal is being used, and I urge the remaining dentists to sign up.

There are more than 6,000 NHS practices in England that should now be offering face-to-face care, in other than exceptional circumstances. Guidance to practices has made it clear that during the difficult period they should prioritise care for vulnerable groups and then address the delayed routine check-ups; but that remains a challenge.

I recognise the comments that the hon. Member for Bradford South made about expectant mothers; I have asked my officials to look at that at speed, and I will come back to her on that. I am determined that we mitigate widening oral health inequalities as much as we can during this difficult period because, as we have alluded to, we know we had a problem beforehand.

NHSEI is keeping more than 600 urgent dental centres stood up to provide additional capacity in the system. My hon. Friend the Member for North Cornwall said he has problems too—and we have them across the country—so making sure that we have that universal coverage with UDCs is important. I must put on record my gratitude to dentists, dental nurses, technicians and all the team, because this has been a really difficult period. Dentists and their staff have kept vital care going through the initial peak, both remotely and in frontline urgent dental centres; many also volunteered to be deployed if needed on the frontline of covid services, and their contribution was very much appreciated.

It is important to ensure that NHS dentists are financially supported as businesses. NHSEI has continued to pay dental contracts in full, minus the running costs for downtime in the initial lockdown, whatever the volume of service to be delivered, and NHS dentists holding NHS contracts have welcomed that support. However, I am mindful that that support was for NHS dentists, and there are challenges in the private sector—and many practices are a mixture of both.

The focus now is on increasing dental provision as fast and as safely as possible. Key work has been done to establish ways to reduce room resting times, and that advice has been made available to the profession. I regularly meet with the chief dental officer, the BDA and other stakeholders, because it is vital that we keep looking at how we can get volumes up. That also means updating the existing dental infection prevention and control guidance, but it does not solve the challenge of delivering dental care at volume through the pandemic. It is an important step forward, but part of the problem is the variability in the estate, as the hon. Member for Bradford South alluded to—the different sizes of practices, where they are located, and so on. NHSEI is in discussion with the profession and is taking clinical advice on the expectations for delivery of services to the end of March.

I met the BDA and other dental stakeholders last week to progress conversations further, and I heard those messages. The challenge is to make sure that we can get the optimal amount of care for our constituents and patients while safely ensuring that dental teams can be protected, but we do need to see increased provision. I am keen to understand what further work can be done to solve the challenges in dentistry and how it faces the pandemic, and I have asked officials and NHSEI to look at potential solutions, including testing, increased use of ventilation and the financing thereof.

I understand the constraints under which the profession is operating and how vital services are. We know without doubt that oral health inequalities are likely to have increased over the period of the pandemic and NHSEI is working hard to ensure that caring for vulnerable communities is prioritised. Poor oral health can have a devastating impact on somebody’s quality of life, particularly a child’s, and dental disease is entirely preventable. In the Green Paper published in 2019 we committed to looking at those barriers, to fluoridation and to consulting on rolling out supervised tooth-brushing schemes in more preschool and primary settings. We are working as hard as we can to make sure we hit the consultation dates, but there are challenges.

Covid-19 Update

Barry Gardiner Excerpts

Tuesday 10th November 2020 Commons Chamber

[Matt Hancock]

There is absolutely no doubt that we have worked together as a United Kingdom to put ourselves in a strong position when it comes to access to the Pfizer vaccine, and we have worked together to ensure that, should it come off, the Oxford-AstraZeneca vaccine will be available across all parts of this United Kingdom. I pay tribute to the work that I anticipate the NHS in Wales will be doing to deliver the shots into arms across Wales, but it is a UK-wide programme and is yet another example of why the UK is so strong when it works together.

[Barry Gardiner (Brent North) (Lab)]

The Secretary of State is aware that priests have been unable to administer the sacrament to those dying in care homes and rabbis have been unable to secure a minyan in order to say the Kaddish. How will his Government now try to ensure they recognise that a person’s spiritual needs are critical for their mental health and that this is just as important for people’s physical health?

[Matt Hancock]

Of course we recognise exactly that, and the hon. Gentleman puts it well. Ministers are working with faith leaders on how we can come to an arrangement, as soon as possible, to allow both communal prayer, which was discussed in the House as we brought in the regulations relating to the lockdown, and all other aspects of nurturing worship.

Covid-19 Update

Barry Gardiner Excerpts

Tuesday 8th September 2020 Commons Chamber

[Matt Hancock]

I understand why grandparents in Bury and across the country want to see that happen. The challenge is that the support bubbles are there primarily so that when people are living on their own, they can get that emotional and mental-health support from having some people with whom they can closely communicate, whereas a couple living together have each other for that.

The challenge in terms of childcare is that although children rarely experience any negative impacts of covid, they can transmit the disease. Grandparents are typically at risk if they are over about 70, so we are quite cautious about encouraging them to look after their grandchildren, because of the problem of transmission. That is the challenge that we are trying to address, but I understand why people want to see that.

[Barry Gardiner (Brent North) (Lab)]

On 3 July, the Secretary of State said that asymptomatic testing in residential care homes would give staff the confidence to continue their work. Yesterday, the Transport Secretary said that Public Health England now believes that asymptomatic testing might capture only 7% of those infected, leaving 93% of those infected to go about their business. If asymptomatic testing is as confidence-building as the Secretary of State says, and if a care home is a goose and an airport is a gander, why is the sauce of asymptomatic testing not good for both?

[Matt Hancock]

The question is about the timing of the tests. The proposal for care homes is for repeat asymptomatic testing. As I said in my statement, we have sent test kits out to eligible care homes. The challenge for asymptomatic testing at the border is that if we do it just once, that does not give confidence. The proposal on which we are working with the industry is for a way to do that with repeat testing to test that people have not later developed symptoms that they might have been incubating previously.

Oral Answers to Questions

Barry Gardiner Excerpts

Tuesday 1st September 2020 Commons Chamber

[Matt Hancock]

Yes, I would love to come up to Stockton and have a look round. I have enjoyed my many visits, especially the one in December, which went particularly well, just before the House reconvened after the general election.

[Barry Gardiner (Brent North) (Lab)]

Yesterday, a dear friend of mine died of stage 4 pancreatic cancer. It has the lowest survival rate of all common cancers, yet it receives less than 2% of funding for cancer research. Half of all the diagnoses come about only after emergency admissions to hospital, because patients commonly visit their GPs three or four times with symptoms before being referred to a consultant. What will the Secretary of State do to improve early diagnosis of this disease, because it is killing 10,300 people a year, which is 28 people a day?

[Matt Hancock]

My heart goes out to the hon. Member and to the family and friends of his friend, about whom he spoke so movingly just now. He is absolutely right to raise this. The early diagnosis of cancer is a critical part of improving cancer survival rates in this country. We have talked an awful lot in this House over the last six months about the testing and diagnosis of covid, but frankly this country needs to increase its testing and diagnosis of all diseases, including cancer. For a generation, we have not had enough testing. He is quite right to raise this issue, because it is not just about people coming forward; it is also about the problems being spotted earlier. We are investing £2 million in more rapid diagnostic centres, and we are trying to get diagnostics not just in the major hospitals but out into the community so that they are closer to primary care. There is also a major piece of work under way to recover the backlog that was necessarily built up during covid—that is under way and the backlog is down by about half—and also to go further and never give up on trying to have earlier diagnosis of cancer.

Covid-19 Response

Barry Gardiner Excerpts

Tuesday 2nd June 2020 Commons Chamber

[Matt Hancock]

That is an incredibly important point, because the backlog has of course built up as we had to protect the NHS in the heat of the crisis. The independent sector has played a critical role in helping us get through the crisis and will play a critical role in future. That has put to bed any lingering, outdated arguments about a split between public and private in healthcare. What matters is the healthcare that people get. We could not have got through the crisis without the combined teamwork of the public and private sectors.

[Barry Gardiner (Brent North) (Lab)]

Professor Newton spoke today of the vital importance of increasing serology to tackle the virus. Capillary blood from fingerprick tests has long been used to test and control viruses, from measles to dengue fever. Will the Secretary of State therefore explain why the Medicines and Healthcare Products Regulatory Agency guidance asks providers of fingerprick tests to stop offering the service? Can he point to any published scientific data that suggests a clinical difference between capillary and venous blood? If not, why is he blocking the serology roll-out that Professor Newton considers so important?

[Matt Hancock]

First, serology tests are very important, and I am glad we are now doing over 40,000 a day. Given that they first got approval only two weeks ago, that has been a fantastic effort by the NHS and social care to get the roll-out going out so quickly. Secondly, fingerprick tests would be a big step forward. We are currently assessing the clinical validity of a number of fingerprick tests, because a bad test is worse than no test at all. I am sure the hon. Gentleman will agree with that.

Coronavirus and Care Homes

Barry Gardiner Excerpts

Tuesday 19th May 2020 Commons Chamber

[Matt Hancock]

Yes, we are doing a huge amount of work now to ensure that there is protection in the future should there be a further increase, and in particular in advance of winter in case there is strong seasonality to this disease. As a clinician himself, my hon. Friend understands the importance of these areas and we will absolutely take the idea he put forward and run with it.

[Barry Gardiner (Brent North) (Lab) [V]]

Brent Council was at the epicentre of the initial covid outbreak, with one of the highest hospital death rates in the country, but back in February it spent £1.5 million to purchase PPE, which it made available to its care homes. In March, it established a separate care facility to provide 14 days’ isolation for any patients discharged from hospital back into the care system, whether or not they had tested positive for coronavirus. Now Brent has one of the lowest number of care home deaths in London. I know the right hon. Gentleman will want to congratulate Brent, which actually did put in place a protective ring around its care homes, but what he must answer is: if Brent Council had the good sense and foresight to get this right, why didn’t he?

[Matt Hancock]

The hon. Gentleman makes a really important point and it comes to the nub of the challenge around care home policy. I do want to congratulate Brent. I think that the work it did was important, but, of course, formally and in the law responsibility for care homes is for local councils and some local councils, like Brent and others, have done a magnificent job. However, I also understand that it is a reality of political life and our constitution that I as Secretary of State for Health and Social Care am also responsible, and I take that responsibility very seriously. However, when it comes to longer-term reform, this does bring a conundrum because the policy levers that I have as Secretary of State are only through councils, which themselves have to then act.

On the funding side we have seen this challenge. We put in £1.6 billion at the start of this crisis through councils without a ring fence, and there are questions being raised about how much of that has got to the frontline, so for the £600 million we put through on Friday we have put in a very firm ring fence, so it must be paid in a timely manner through to care providers. I think this actually raises a question not just for the crisis but for the longer term. When I am held accountable at this Dispatch Box for the actions of local authorities, I can give support, but we do not have the direct levers. We have not even had the direct data flows through to the centre, and we are putting that right too.

The National Health Service

Barry Gardiner Excerpts

Wednesday 23rd October 2019 Commons Chamber

[Sir Mike Penning (Hemel Hempstead) (Con)]

It is a pleasure to follow the hon. Member for Huddersfield (Mr Sheerman). I fully agree with many of the points that he made, and I think that everyone in the House would agree with them.

I am not usually confrontational politically, so I will do only a tiny bit of that. This fear thing that is being thrown around about a privatisation of the NHS is very damaging. It is not particularly damaging to my party, but it is damaging across politics. I was at the Opposition Dispatch Box as a shadow health Minister for four and a half years, and during that time all those PFIs went through. Under the private finance initiative, private companies were being paid for surgery that was not even carried out. They were contracted for 1,000 knee operations or 1,000 hip replacements which did not take place, and they were still paid. That is what happened under the previous Labour Administration.

We need to admit that we make mistakes when we are in government. We have made mistakes before. I made mistakes as a Minister when I was in seven different Departments—it will probably not be eight now. Governments sometimes make mistakes for the best of reasons. One of the great mistakes was that era of privatisation, with PFI deals that were off the balance sheets, and Darzi clinics. Lord Darzi was a great surgeon, a great medical man; I just happened to disagree completely with many of his proposals which were implemented by the Government, and which, frankly, have not worked. There are still many clinics out there to which trusts have to pay huge amounts of money, not to get out of their contracts but just so that they can carry on. That is something that we need to admit. So, in this House, let us admit that Governments make mistakes and that the PFI privatisation carried out by the Labour party was wrong, although it was probably done for the best of reasons. A PFI hospital was promised to my constituents; it never came even though the Labour party closed the A&E at Hemel Hempstead hospital, in the largest town in Hertfordshire. We were promised that that would be looked after, because St Albans had had its hospital closed. However, it was closed and the whole thing moved to a Victorian hospital in the middle of Watford, which cannot cope today and has not been able to cope since then.

Adding little bits to hospitals, as the hon. Member for Huddersfield (Mr Sheerman) said, and putting a new A&E on the front can sometimes work, but when there is serious funding around, which is what we are talking about now, a modern, new, environmentally proper hospital that can actually have sufficient footfall to enable the medics to work in their specialties is what we need.

I am one of the few Conservative MPs to have been offered the £400 million for a new hospital. I have said to the Secretary of State and to my trust that it is not a new hospital; it is a refurbishment of a Victorian hospital in the middle of Watford next to a football ground, and my community does not want that. The people of Watford might, but if they thought outside the box—I am not being rude to them—I am sure they would agree that it would be better to have a brand spanking new hospital that looks after the communities of Watford and the surrounding areas of Hemel Hempstead and St Albans in that massive growing area just north of the M25.

So I do not want my old hospital reopened. It is still sitting there boarded up; it is just sitting there like a running sore in my constituency. It was a wonderful new hospital when the new town was built, but there she sits now with two wards, out-patient facilities and a minor injuries unit that does not even open for 24 hours even though we were promised it would.

What we want is a tiny bit more money—the Secretary of State knows this; I am not saying anything to the Minister that he does not know. We should not keep frightening people by saying it will cost £750 million or £1 billion to build a new acute hospital on a greenfield site, because we know it will not. We have the experts working for the new hospital action group and I am going to meet the experts in the Department in the next couple of days. So I am saying to the Department, “Hold back for a second on this new hospital for us, because if you hold back a second, we might get a completely different result.”

[Barry Gardiner (Brent North) (Lab)]

The right hon. Gentleman is speaking very candidly and with great integrity. My mother died in the Hemel Hempstead hospital that he speaks of many years ago. He talked about PFI and some of his remarks are absolutely spot on, but does he now recognise that the money owed on the PFI liabilities is actually £9 billion, as opposed to the £11 billion, which is the backlog of what hospitals are paying to the Department itself because of the borrowings they have had to take out as a result of the financial problems they are facing?

[Sir Mike Penning]

As was said in debate with the Scottish National party spokesman earlier, the Government can borrow money much cheaper than any private organisation.

I am thrilled that there is some honesty in the Chamber, because we have argued about PFI for donkey’s years; it was a way of getting things off balance sheet, and let us move on from that. There is no more PFI—we can all agree on that—but actually we are not privatising the NHS, as everybody with an ounce of common sense knows. The NHS is perfectly safe; it has been safe under this party for the majority of its time since inception, and it will stay perfectly safe. There are massive demands on it, however, and I cannot allow all this money—taxpayers’ money—to be put into a Victorian hospital next to a football stadium in the middle of Watford. Anybody who knows our part of the world knows that Watford football club is in the premiership. It might be struggling a little bit at the moment, although it did very well against Spurs the other evening. Let us pause, get the experts around the table and stop scaring people with costs that are completely unrealistic—new hospitals were built in Birmingham for £425 million and a new one can almost certainly be built in Harlow for similar amount. Let us have a 21st-century hospital. Let us be honest with each other and move that forward.

--- Later in debate ---

[Barry Gardiner (Brent North) (Lab)]

At the opening of the London Olympics, Danny Boyle wanted to show the world what it meant to be British, and he chose the NHS because it illustrates all that is best in our country. Watching on TV, millions marvelled at our nurses, our doctors and our carers, and in the stadium, thousands cheered. That is how proud we are of our NHS. All the people who work in it—cleaners, consultants, nurses, night porters, radiographers and receptionists—play a vital role in caring for our society. They are our national symbol of community and our model of selfless service.

This debate has reflected that, with 34 speeches and 49 interventions. There have been some wonderful speeches, including personal testimonies from the right hon. Member for Old Bexley and Sidcup (James Brokenshire), the hon. Member for Dudley South (Mike Wood) and my hon. Friend the Member for North Tyneside (Mary Glindon)—my dear friend—who if she did not quite move herself to tears, certainly moved the rest of us.

However, millions now worry that the NHS could be up for grabs in a future free trade agreement. At the heart of those fears is the Health and Social Care Act 2012, passed by the Conservative and Liberal Democrat coalition. It puts costs before quality and commercial competition at the heart of health commissioning. Just after the Act was passed, our local 111 service in Brent North was outsourced to a private company, the majority of the directors of which sat on the local clinical commissioning group—the very group that had awarded them the contract.

The Health and Social Care Act has allowed perverse commissioning decisions like that up and down the country. Today, our local CCG in north-west London faces not the £51 million deficit at year-end set out in its operational plan, but £112 million—an additional £61 million overspend as a result of an increase in acute activity of 18% against a population increase of 5%. When Conservative Members and their Liberal Democrat partners told us that the NHS was not for sale, those assurances were worthless. People may not be able to buy it, but privatisation is tearing it apart. My CCG has announced the closure of the 24-hour service at the urgent care centre in Middlesex Hospital.

[Craig Whittaker (Calder Valley) (Con)]

Will the hon. Gentleman give way?

[Barry Gardiner]

I cannot give way because of time.

It is this legislation that now exposes our NHS to foreign competition and undermines our public healthcare system. It is Donald’s door into our NHS. Some 170,000 people already know this, and they have signed a parliamentary e-petition calling on this Government to introduce safeguards that will protect it from new trade deals. Trade agreements lock in privatisation, and open up access to foreign investors and speculators. That is why we need safeguards.

[Matt Western (Warwick and Leamington) (Lab)]

Does my hon. Friend agree with me that one of the great threats to our NHS is a trade deal with the US that, as happened in Australia 10 years ago, will drive up the price of medicines significantly?

[Barry Gardiner]

I agree with my hon. Friend.

In 2007, Slovakia wanted to move from a private health system, modelled on the USA’s, to a system more like ours. Slovakia was sued for millions of euros by a Dutch company that thought the move might affect its future profits. Trade deals often contain clauses that give foreign investors the right to sue Governments for decisions that might affect their profits. These investor-state dispute settlement—ISDS—clauses are common in modern free trade agreements.

Policy decisions such as legislating for the plain packaging of cigarettes have been subject to ISDS claims. Labour believes the UK should be free to make public health policy based on the health needs of the British people. We should not have to bend to some company that is profiting from keeping our people ill, whether from tobacco, polluted air or too much sugar.

More than 750 cases are known to have been brought under ISDS clauses in other countries, and more than half resulted in compensation for foreign investors or in financial settlements out of court. Labour will not sign up to any free trade agreement that uses these ISDS-style rules, which are wrong in principle and, even where they are not used, can lead to regulatory chill.

Incredibly, the right to sue the Government under these ISDS clauses does not extend to our own UK companies, only to foreign companies in separate private courts. Labour has confidence in our courts and thinks foreign companies should have no greater rights of redress than British companies.



Free trade agreements also typically include market access clauses and national treatment provisions. These would set out the extent to which overseas businesses can operate in our markets, and they would insist that we afford at least the same treatment to foreign businesses as we do to our own businesses. In the past that was done by listing all those services that had been agreed. If an NHS service was not on the list, it could not be the subject of foreign competition. Agreements used to set out only those services that we were prepared to open up to competition, but modern trade agreements do not work that way.

Instead, modern trade agreements adopt a negative list system that says every service is opened up to competition unless it is placed on the negative list. Anything missed off the list is automatically open to competition. Once missed, a service can never be put back on the list. Any new service that comes as a result of technological or scientific breakthrough, if it is not on the list, is automatically open to foreign competition.

Imagine if we had agreed a negative list before the age of the internet and before digital technology had changed how patients can be screened and tested. If we lose our capacity and skill to provide these services directly, we will become a captive market and vulnerable to the abuse of private monopoly and spiralling costs.

Governments cannot intervene where there has been a clear failure in the sector or where patient health has been compromised. We need legal guarantees that no such negative list trade agreement will be concluded. That is why Opposition Members sought to introduce measures into the Trade Bill to achieve this protection. Conservative Members voted down every single one.

When their lordships secured essential provisions for proper scrutiny of trade agreements and a defined parliamentary procedure for ratification, what did the Government do? They abandoned the Bill entirely. Now they want to bring back the same legislation, but without those safeguards.

A potential deal with the US is of major concern to those who care about our health service. The American model is renowned for its pursuit of profit and its indifference to the poor. The US ambassador told national TV that the NHS would be on the table and that the US had already looked at all the components of the deal. President Trump confirmed it, and the Office of the US Trade Representative has published its list of negotiating objectives for any such deal. One objective is to stop the NHS using its bulk purchasing power to negotiate lower drug prices. The US Secretary of Health and Human Services actually said that the US would “pressure” other countries in trade negotiations so that Americans pay less and we pay more.

The USA wants to stop the UK regulating the pharmaceutical industry unless the US industry has agreed. So much for taking back control. In one of their first acts after establishing the Department for International Trade, this Government opened three new offices in the US, in Raleigh, in Minneapolis and in San Diego—biopharma hubs where major healthcare providers, biotech, pharmaceutical manufacturers and health insurers are headquartered. What made those cities so attractive if it was not an attempt to attract players from those sectors into our NHS? The Labour party created the NHS. We will not allow this Government’s trade agreements to damage it. Under Labour, the NHS will remain a universal service, free at the point of use, and based on medical need, not ability to pay.

NHS in London

Barry Gardiner Excerpts

Thursday 24th March 2016 Westminster Hall

[Barry Gardiner (Brent North) (Lab)]

It is a great pleasure to serve under your chairmanship, Ms Buck, but it is an even greater pleasure for all of us to see our hon. Friend the Member for Ilford South (Mike Gapes) back in his proper place in the House, doing what he does so well: representing his constituents.

I wish to make two points in this debate, and I am grateful for your indulgence, Ms Buck, in letting me come in at the end of the debate; I had other engagements. First, I wish to mention the case of Dr Chris Day v. NHS and Health Education England, which has exposed a particular lacuna in the protection for whistleblowers in the NHS. HEE oversees the training placement of doctors, and I understand that its role will increase under the new contracts. If a junior doctor blows the whistle, HEE will be able to terminate the doctor’s training as a punishment with absolute impunity. I know that the Minister would not wish to see that and that she is keen to ensure that whistleblowers get appropriate protection. I simply ask that she looks at that issue and takes the necessary action to remedy it.

The main focus of my remarks is the recruitment process for GP surgeries in north-west London. Specifically, I refer to Integrated Health CIC, which is known locally as the Sudbury surgery, and the number of problems that have arisen with that and the commissioning thereof. In 2013, the surgery was given to two doctors, Dr Omodu and Dr Akumabor, until March 2016. In fact, the contract on the surgery expires in precisely seven days’ time. I have been in correspondence with NHS England and Dr Anne Rainsberry, and the local council’s health scrutiny committee has been in correspondence with Monitor, to try to ensure that the concerns of local people are respected in relation to the surgery and the procurement process, and that is what I want to bring to the Minister’s attention.

There has been a lack of clarity in the handling of conflicts of interest in relation to the procurement. According to Brent CCG’s website, in February this year, five of the seven local GPs who have declared interests in relation to their Brent CCG activity have interests in Harness, which is the name of another surgery. They include the chair and vice-chair of the CCG.

It is noted that the practices that have been removed from the commissioning timetable are also associated with Harness, and that in October, Harness Harlesden and Harness Acton Lane surgeries were withdrawn from the timetable. It was reported that they were to merge and procure a service from either current Harness Harlesden premises or from primary care hub. In March 2016, it was confirmed that Brent GP Access Centre, run by Harness, was also removed from the timetable to align it with the service start of the walk-in service contract, also run by Harness, that is provided on the same site, but is being procured and commissioned by the CCG. This is to reduce the chance of any confusion about accessing the services and to avoid any unnecessary disruption to either service. It would appear that Harness Locality, representing 21 of the 69 GP practices in Brent, has disproportionate representation on the CCG governing body. It is the belief of members of the scrutiny committee, and a concern of mine and of residents, that there needs to be clarity on commissioner-provider interrelationships to ensure a fair procurement process and the retention of public confidence in that process.

GP practice leaders have expressed misgivings about the ability of local practices to meet the demands of the London key performance indicators. It has been suggested to Members that the London KPI regime is intended to favour larger bidders with the infrastructure to offer economies of scale. If that is the case, it puts NHS England and Brent CCG in direct conflict with residents in my constituency, especially in relation to the Sudbury surgery.

It is the clearly expressed opinion of local residents that the practice has served the community incredibly well, and they are extremely distressed, angry and puzzled by NHS England’s treatment of it. To give an example of just how well regarded the surgery is locally, in the three years that the two doctors have been running it, its list has increased from 3,500 to more than 8,000. That is by word of mouth, and that is success in action. People are rightly concerned about how the surgery has been treated.

On 11 March, I received a letter from Dr Anne Rainsberry of NHS England, in which she confirmed to me that

“in undertaking the decision making processes with the local CCG related to this time limited contract, the NHS England standard operating procedure ‘Managing the end of time limited contracts for primary medical services’…was followed.”

She goes on in her letter to talk about key stages 1 and 2, which she says were

“completed to enable a decision on how the services should be provided after the end of the contract and to implement that decision.”

I refer to stages 1 and 2 and the time standards for that contract. Stage 1 lists four requirements to be carried out a minimum of

“9 to 15 months before contract end (all essential)”.

Those requirements are:

“Needs assessment…Value for money…Impact assessment… Consultation proposal.”

The first contact that NHS England had with the surgery is noted in Dr Rainsberry’s letter, in the fourth paragraph from the bottom of the second page, which states:

“NHS England wrote to the current contractors in September 2015 regarding their contract and the proposal to re-procure the contract when it expired.”

On that page, she has outlined the fact that the procedure was not followed within the set time period. Yet on the first page of her letter, she told me that it was followed. That is not good enough.

Procurement does not have the confidence of local people or patients certainly in north-west London. I have enormous respect for the Minister—she is one of the Ministers I respect most across the House. She deals with things in a straightforward, plain-dealing manner. I urge her to look at the process I have outlined, because I do not think it has been done properly. I trust her to get it done right.

Junior Doctors Contracts

Barry Gardiner Excerpts

Thursday 11th February 2016 Commons Chamber

[Mr Hunt]

I thank my hon. Friend for her very constructive comments. She is right. A 13.5% increase in basic pay is very significant, because, unlike overtime and premium pay, it is pensionable. It will help when applying for a mortgage and will mean more money on maternity leave. I think it will be much better for junior doctors.

The review that Dame Sue Bailey is doing, which was much-derided by the Opposition when I mentioned it in my statement, is actually very significant. One of the things that has gone wrong in training is that since the implementation of the European working time directive, we have moved away from the old “firm” system, which would mean that junior doctors were assigned to a consultant, who they would see on a regular basis and who was able to coach them on a continuous basis over weeks and months. That has been lost and many people think that that has led to much lower morale. We want to see what we can do to sort that out.

Finally, I want to echo what my hon. Friend said about going forward in a positive and constructive spirit. When, as a Government, we took the decision to proceed with implementing new contracts, we had the choice of many different routes, because, essentially, we can decide exactly what to choose. We have chosen to implement the contract recommended by NHS chief executives as being fair and reasonable. That is different from our original position. We have moved a considerable distance on most of the major issues, but it is what the NHS thinks is a fair and reasonable contract and we need to move forward.

[Barry Gardiner (Brent North) (Lab)]

The Secretary of State, I am sure, has the grace to acknowledge that the application rate for specialty training has fallen since the Government put forward their proposals last year, but does he have the logic to accept that if he gets fewer junior doctors the problem he is trying to solve will only get worse?

[Mr Hunt]

We now have 10,600 more doctors working in the NHS than we did five years ago and we are investing record amounts going forward. There has been a lot of smoke and mirrors about what is actually in our contract proposals. I hope all trainees and medical students will look at the proposals and see that independent people have looked over them and believe they are fair and reasonable—actually better—for junior doctors, and that we will continue to be able to recruit more doctors into the NHS.