New Hospitals

Iain Duncan Smith Excerpts

Thursday 25th May 2023 Commons Chamber

[Steve Barclay]

Thank you, Madam Deputy Speaker. We recognise the importance of the Imperial bid; that is why we are starting to build the temporary ward capacity at Charing Cross and the first phase of work is under way on the cardiac elective recovery hub, to bring cardiac work on to the Hammersmith site. On St Mary’s Hospital, we have already put in some initial funding to explore the new site with Transport for London and Network Rail. That will go into the rolling programme, of which St Mary’s will be part, alongside the redesign that is needed, taking on board the changes at Charing Cross and Hammersmith.

[Sir Iain Duncan Smith (Chingford and Woodford Green) (Con)]

I unreservedly welcome this announcement for my Whipps Cross University Hospital, for my constituents and all the other residents. I know secretly, in his heart, the hon. Member for Ilford North (Wes Streeting) rejoices with me—I want to out him on that point. He stood on the line with me when we tried to stop the last Labour Government closing that hospital, so together we will rejoice over this. I know he will; he is a decent chap. I simply say to my right hon. Friend the Secretary of State that for 30 years I have campaigned for the hospital to be rebuilt. To build it now will be a fantastic delivery for our constituents. I have badgered him about it, as I have badgered his predecessors—who also include him—as Secretary of State down the past 30 years. Can he please answer one simple question? Will the work start physically, shovels in the ground, on this hospital in the autumn of this year?

[Steve Barclay]

Yes, we expect enabling works to start at Whipps Cross. I have been to the site with my right hon. Friend. We have seen the urgency of it. As he said, he has campaigned vigorously on this and championed it throughout. We are very keen, now that we have unblocked the issue around the RAAC hospitals, to start the enabling works on the cohort 3 sites as soon as possible. Obviously, we will, now that we have clarity, discuss with trusts the precise timetable, but the funding for the enabling works to progress will now be available, and we will work with the trust to take that forward.

Brain Tumour Research Funding

Iain Duncan Smith Excerpts

Thursday 9th March 2023 Commons Chamber

[Derek Thomas]

Sadly, I have met far too many parents who have lost loved ones. It is heartbreaking to speak to them, and to see how a juggernaut has charged through and destroyed much of their lives. They give me so much hope that we can do this work because of the commitment they have to this subject.

Before I address the specific recommendations of the report, may I thank colleagues—many of them are here today—who have given up the last year to interrogate witnesses and to take evidence? I want particularly to mention my hon. Friend the Member for Scunthorpe (Holly Mumby-Croft), the right hon. Member for Leeds Central (Hilary Benn), my hon. Friend the Member for Buckingham (Greg Smith), the hon. Member for Ceredigion (Ben Lake) and Lord Polak CBE from the other place, but also Sue Farrington Smith MBE of Brain Tumour Research, Dr David Jenkinson of the Brain Tumour Charity, Professor Garth Cruickshank, Dr Antony Michalski and Professor Tony Marson, who took part in the inquiry, and most importantly, Peter Realf, whose son was lost and who triggered the petition back in 2015.

To turn to the findings, the Government must recognise brain tumour research as a critical priority. Five years ago, a remarkable effort was made by Government to respond to the shocking statistics that surround brain tumours. Brain cancer remains the biggest cancer killer of children and adults under 40. In order for survival rates to increase, the Government must go further and treat brain tumours as a key priority. This has been achieved in other countries through legislation, and I urge the Minister to see what can be achieved here. A brain tumour champion, which has already been hinted at, is needed to co-ordinate the funding and implementation of a strategy between the Department of Health and Social Care and the Department for Science, Innovation and Technology.

In order for brain tumour research to lead to tangible changes in survival rates for patients, it needs to receive funds across the research pathway, including discovery, translation and clinical research. I recognise the recent advances and improvements in molecular testing and prognostic information, but there is a requirement for further discovery research. That will improve the understanding of disease biology, and how best to frame and support pre-clinical trial research. For instance, a particular issue for tackling brain tumours is the complexity of drug absorption through the blood-brain barrier.

It is crucial that the Government enable the building of critical mass in these elements of the research pipeline. With no ringfenced funding to support poorly funded disease areas such as brain tumours, investment in the disease is not always prioritised. Focused calls for multidisciplinary research into brain tumours through organisations such as the MRC would support this. Additionally, making the blood-brain barrier a strategic priority and encouraging investment in cutting-edge research could yield game-changing results in the treatment of brain tumours and other neurological diseases.

On translational research, on average, it takes 15 years for an idea to move from the pre-clinical stage to helping a patient. Patients have not got that long to wait. Researchers have said they found it challenging to access Government funding for translational research, relying on charities to fund risky elements of the pipeline. More must be done to support this valley of death element of the research pipeline. That seeks to move basic science discoveries more quickly and efficiently into practice, and that shift would increase interest among the research community, ensuring a greater concentration of research expertise in this area.

The inquiry also found that there is a perception that review panels have a lack of understanding about the unique nature of brain tumour research, due to a deficit of specialists on panels. That was reported to account to some degree for low application success rates. During oral evidence sessions, it was also highlighted that a lack of feedback disincentivised unsuccessful applicants from reapplying, bearing in mind that they would potentially have spent a year on such work before their original application was ready for submission.

Positive and proactive engagement with the research community should be nurtured through a continued programme of workshops and funding toolkits for researchers, supporting navigation of the funding system and increasing success rates. Currently, due to many of those issues, and a lack of funding and support, early stage researchers, especially post-doctoral researchers, are moving away from the field of brain tumour research. They are attracted by more readily available and secure funding in other disease areas. A solution for that would be the MRC and the NIHR ringfencing opportunities, such as specific brain tumour awards, across the research pipeline.

Funding could also be prioritised for a fellowship programme, supporting early stage researchers to develop their skills in the field. There is an example within the Cancer Mission, where two teaching fellowships, match-funded by the NIHR, are taking place. That number needs to increase. Learning about brain tumours early in careers results in researchers going on to choose the discipline.

Currently, only 5% of brain tumour patients are entering the limited number of trials available. Clinicians stated that many trials that patients with brain tumours are eligible to enter are not accessible to patients, who often have physical disabilities, as participants are expected to travel long distances across the UK. Poor health and the cost implications were key barriers to patients entering studies that were available to them.

A survey carried out by Brain Tumour Research highlighted that 72% of patients who responded would consider participating in research or a clinical trial if offered the opportunity. Only 21% believed that healthcare professionals gave sufficient information about opportunities to participate in clinical research, including trials.

That approach does not take account of the benefits that new and repurposed therapeutics could provide for brain tumour patients. If brain tumour patients are excluded at an early stage, possible benefits for such patients are not identified and carried forward in later trials. Access to trials should be assessed not by the location of the tumour, but by other individual criteria such as genomic profile and medical history.

It was also demonstrated that clinicians are risk-averse to children accessing early phase trials, despite parents’ wishes. As a result of those limitations, patients are encouraged to travel overseas in pursuit of treatment not available in the UK. Some small improvements to both systems would allow many more clinicians to successfully support patients to access trials across the country.

We have touched on this briefly, but paediatric brain cancer is viewed by researchers as different from adult brain tumours because brain tumours in children are linked to physical development, rather than ageing. Current treatments for children have significant long-term side effects and much more research is needed into kinder treatments and novel drug delivery for children. Additionally, more must be done to tackle brain injury issues and the consequences of brain tumour treatments.

In this place, we often talk about the need to support people to meet their potential and to live life to the full to address issues that curtail life chances. That is no less important for children and young people who have experienced a brain tumour or brain cancer. Using the method adopted by the NHS to measure survival rates, children’s survival following a tumour is positive. However, they are often left with a brain acquired injury caused by the surgery and treatment of the brain tumour itself.

Once the child is discharged from the hospital, there is no guaranteed pathway of rehabilitation or access to suitable education, therapies, services or physio. That causes tremendous additional strain on the family as they seek to access and fight for the appropriate step-down care. In many cases, the lack of those therapies means that the recovery and life chances of the child or young person are nowhere near as good as they could or should be.

In this place, we want life to be a success. I pay particular tribute to Success Charity and Dr Helen Spoudeas, who has worked tirelessly to ensure that these brain acquired injuries are taken more seriously and that a concerted effort is made to ensure the best possible recovery. Success Charity exists to advocate for survivors and provide them with the care and support that they need and deserve. It has its annual conference at the Royal College of Physicians this Saturday, which will give families an opportunity to share experiences and make friends with other survivors, siblings and parents, and to listen to inspirational speakers.

Having given some thought to this issue, and having discussed it with others, I think that an appropriate approach would be to introduce a commitment that every child and their family would be entitled to a carefully crafted package that ensures that all the needs of a growing and developing child are met, including access to education services, and that the best person to ensure the implementation of this package would be an occupational therapist.

This Government want the UK to be considered a science and technology superpower. The UK must start setting the pace for recovery rather than fall further behind. Business as usual threatens the UK’s ability to lead clinical trials for brain tumours. Brain tumour research must be seen as a critical priority, with Government developing a strategic plan for adequately resourcing and funding discovery and translational and clinical research. Robust tissue collection and storage facilities must be put in place across the country. As a Government Minister said in this place only last week, every willing patient must automatically be part of a clinical trial, and that includes collecting and storing tissue for research. There must be equity of access to clinical trials and a robust and up-to-date clinical trial database. The regulatory process must be simplified, with the introduction of tax relief and incentives for investors to encourage investment for the longer-term periods necessary to develop and deliver new brain tumour drugs.

There is so much more that could be said, and I am sure that much more will be covered this afternoon. I hope that the Minister will take the report and our recommendations seriously, and that he will have an opportunity to come back to us at a later date—when he may have more time than that afforded to him at the close of this debate—to set out how the Government intend to respond to our recommendations. Will he also agree to meet me and members of the all-party group to discuss the recommendations of our Brain Tumour Research report? Thank you, Mr Deputy Speaker.

[Sir Iain Duncan Smith (Chingford and Woodford Green) (Con)]

On a point of order, Mr Deputy Speaker. I apologise to my hon. Friend the Member for St Ives (Derek Thomas) and to the House for intervening on this very important debate—like others, I am fascinated by what is being said—but may I ask whether the Government have notified the Speaker’s Office that they intend to make a statement about the semi-briefings being made to the media that they have decided to pause or stop whole elements of HS2? Surely that would be best done through a statement to the House, rather than through elements of the media. I would be grateful for your guidance as to whether a statement should be made, and whether the Speaker’s Office has received any notification that the Government are inclined to do so.

[Mr Deputy Speaker (Sir Roger Gale)]

I am grateful to the right hon. Gentleman for raising this issue and for giving me advance notice of his intention to do so. So far as I am aware, as we stand no such request has been made to the Speaker’s Office. Mr Speaker has made it abundantly plain on very many occasions that he expects information of this kind to be given from the Dispatch Box to this House, as a courtesy, before it is made available to anybody else. The right hon. Gentleman has made his point. Mr Speaker will have heard it, and I do not doubt that those on the Government Front Bench will have heard it as well.

Health and Care Bill

Iain Duncan Smith Excerpts

Consideration of Lords amendments
Monday 25th April 2022 Commons Chamber

[Sir Iain Duncan Smith (Chingford and Woodford Green) (Con)]

I will speak briefly to Government amendment 48A, which is in lieu of amendment 48B. Essentially, it requires the health service to ensure that it does not use products made under forced or slave labour anywhere in the world. That is a big statement by the Health Department, and one that I think we all welcome—I have certainly campaigned on this issue for some time.

In the great sweep of this health legislation, on which there are agreements and disagreements across the board, that may not seem to be something that will directly affect our lives, but in truth it will resonate beyond our shores. It is already resonating among the Uyghur, who have found themselves under distinct pressure, with husbands often separated from wives and families broken apart for forced labour thousands of miles away from their homes. This measure will speak to them; it is, in a way, a sign that Governments in the free world are taking up this real cause and recognising that it is intolerable for us to turn a blind eye and buy equipment, clothing and so on simply because it is cheaper and helps our cost balance. I do not believe that it will in the end; the trade-off between cost and the human rights of those who have suffered so much under the heel of those totalitarian states is an abysmal one.

Child labour is used in rare-earth mines; when we use those rare-earth materials for the manufacture of our computers, we turn a blind eye to it. When slave labour is used in the Xinjiang region to produce the cotton and the cloth for our personal protective equipment, making it quicker and easier to get, we turn a blind eye to it. It is not just done there; it is done in many countries around the world because it is easier and cheaper, and we tolerate it. I therefore welcome that my right hon. Friend the Secretary of State and the Ministers have tabled the amendment. It will speak volumes to those who are oppressed. It will say to them, “The free world has not forgotten you.” I am certain that in due course the rest of this Government will do the same, and other Governments will then follow suit. I congratulate us for making the right decision.

[Daisy Cooper (St Albans) (LD)]

I will speak to the workforce amendment and the amendment on the social care cap.

The Lords have compromised on the workforce amendment—they have now asked for projections every three years instead of every two, and they no longer require independent verification of the projections—so it is deeply disappointing that the Government have not moved to meet them halfway, especially when outside the Government there is so much cross-party consensus that the amendment is badly needed. I know from my constituency of St Albans, as I am sure many Members know from theirs, that our NHS and care staff are burnt out. They are understaffed and overworked. Those people, who continue to turn up every single day, need to know that the cavalry is coming, and without this workforce amendment, they simply will not.

There have been worrying reports that NHS trusts have been silenced when they have tried to talk about the numbers of staff that they need to recruit, so will the Minister address this question in his response: if the Government will not produce workforce planning numbers, will they at least commit to not interfere with or silence any part of the NHS or care sector that decides that it wants to produce its own workforce projections? I look forward to hearing the Minister’s assurances on that point.

When it comes to the social care cap, Ministers have stated time and again that their changes would save the Treasury £900 million a year by 2027-28, but that saving comes at the expense of people with fewer assets and savings, including those who will have been paying five years of increased national insurance contributions, which were put in place partly to fund these care reforms. The Government continue to say that that improves on the current situation, but they conveniently ignore that it is much worse than their original proposal. The social care cap provision does nothing to generate more care; it does nothing to give protections to unpaid carers, who are often on lower incomes but save the Government millions of pounds; and it does nothing to help the social care workforce. I know from my constituency that hospitality, the NHS and social care are all fighting for the same people, and nothing in the Bill will help to improve that situation.

Health and Care Bill

Iain Duncan Smith Excerpts

Consideration of Lords amendments
Wednesday 30th March 2022 Commons Chamber

[Edward Argar]

As ever, the hon. Lady makes her point courteously but clearly. As I said, depending on the time available at the end of the debate, I will endeavour to respond more fully to the points that she and my right hon. Friend make.

[Sir Iain Duncan Smith (Chingford and Woodford Green) (Con)]

I hope to speak on this subject if I catch your eye, Madam Deputy Speaker, but I want to make the point that right now, even though it is not meant to be allowed, the NHS is using products made by slave labour. Only two days ago, The Spectator demonstrated that products being used in King’s College Hospital actually came from providers in Xinjiang, so it is happening now. Like the hon. Member for Lewisham East, I want to emphasise the urgency of this issue, so I intend to bring it up with my hon. Friend the Minister during the debate.

[Edward Argar]

I should say at this point that I was grateful for the opportunity to talk to my right hon. Friend about this subject a week or two ago, and I suspect that our conversations will continue.

I want to cover the rest of this group of amendments. Lords amendment 57 would exclude statutory functions of NHS Digital from the transfer of powers in the Bill. I urge the House to reject that amendment. I have assured Members of this House and in the other place that the proposed transfer of functions of NHS Digital to NHS England would not in any way weaken the safeguards we have in place for the safe and appropriate use of patient data. NHS Digital’s current obligations in terms of its data functions, and particularly the safeguards that apply to patient data, will become obligations on NHS England. The merger, which has been announced as Government policy, is in response to the recommendation of the Wade-Gery review. It is essential to simplify a complex picture of national responsibilities for digital and data services in the NHS, bringing them together in a single organisation that leads on delivery and the data needed to support it.

--- Later in debate ---

[Wes Streeting]

I really do understand the hon. Member’s point. She would like to be able to save her services and lobby her colleagues in Government to make those decisions, but—speaking from experience—saving our accident and emergency department was not about using politics or political pressure to change the decision. Public support was really important and we did our fair share of parliamentary petitions, marches and everything we could to keep the pressure up, but in the end it was about the evidence base that we put together to save the department.

When it comes to matters of clinical provision and of providing the best services for patients, clinical factors have to be paramount. I worry about how decisions turn into a political football either side of a general election and become a party political knockabout, when the primary consideration should be patients’ safety and concerns. Although I have cited an example in which saving our A&E was the right decision, I can think of cases right across the country in which communities feel very strongly, and we understand why, but passion, emotion and sentimental attachment to particular services do not always align with the clinical interests of local populations. Patient safety and evidence must come first. I really worry about the introduction of a party political knockabout in that context.

Ministers have argued that the new powers are necessary to ensure democratic oversight of health service decisions, but the existing system allows appropriate democratic oversight and allows contentious service change decisions to be resolved. I do not believe that the wholesale upheaval of the system and the introduction of sweeping new powers for the Secretary of State are justified.

Let me now deal with some of the other amendments— very briefly, as I am conscious of time. We support Lords amendment 48, which requires the Secretary of State to ensure that health service procurement does not violate the UK’s international genocide obligations. The amendment is consistent with the UK’s obligations under the convention on the prevention and punishment of the crime of genocide.

Lords amendment 89 deals with a related issue, prohibiting organ tourism involving both forced organ harvesting and black market organ trafficking. We welcome this change in the Bill, which amends the Human Tissue Act 2004 to prohibit UK citizens from travelling to countries such as China—although the wording of the amendment is not country-specific—for the purpose of organ transplantation. The restrictions are based on ensuring that there is appropriate consent, no coercion, and no financial gain. In some parts of the world, organs are not given freely but are taken by force, and we must bear that in mind in the drafting our legislation.

Lords amendment 57 is intended to retain the current safe haven for patient data

within NHS Digital, and to prevent NHS England from taking on responsibility for it. Keeping patient data safe is important. It can be powerful when it is used well, and has enormous potential for better population health and better clinical outcomes in individual cases, if data is used wisely, safely and ethically. The amendment will keep statutory protections in place for a patient data “safe haven” across health and social care, required for national statistics and for commissioning, regulatory and research purposes. It also ensures that NHS England does not take on this responsibility, because of a potential conflict of interest in its role.

Lords amendments 42 to 46 deal with procurement. We welcome these changes. The years of the pandemic have also been years of crony contracting. After the scandal of billions in taxpayers’ money being handed out to mates for duff PPE and testing contracts, and PPE literally going up in smoke—along with taxpayers’ money—we hope that this is the start of Ministers’ looking again at where they went wrong during the pandemic.

This afternoon the House faces a simple choice. We must decide whether we are going to be honest with ourselves, with the NHS and with the country about the genuine staffing challenge in health and social care—and whether we are going to have a more responsible and grown-up political debate about how we meet that challenge—or whether we prefer to be the ostriches of the Treasury, with our head in the sand, pretending that these issues will go away, hoping for the best, hoping to squeeze a bit more efficiency out of the NHS through new efficiency targets. That really will not cut it. The recruitment of staff already announced by the Government really will not cut it.

For as long as we allow this situation to continue, patients will wait longer. They wait in agony. Their health outcomes are worse, and they lose confidence in the national health service. It is the greatest institution that this country has ever built, and it is going through the greatest crisis in our history. Let us be honest about that—with ourselves, with the NHS, and with the country—and support their lordships in their amendment.

[Sir Iain Duncan Smith]

I shall try to be brief. I rise to speak to amendments (a) and (b) in lieu of Lords amendment 48, which refers to genocide. Along with 19 colleagues, some of whom are present, I tabled amendment (b) to recognise first a problem for the Government, and secondly an absolute imperative for all of us here.

The problem for the Government with Lords amendment 48 is, I understand, the inclusion of genocide. There is a reason for that. I disagree with the Government about this, but that is where they are. The Government talk of a “competent court” having to decide questions of genocide. We have been through this again and again recently, but the fact is that we will never get a decision from a competent court when it comes to countries of the scale and dimension of China, either because they veto it in the Permanent Assembly or because they are not members of the International Criminal Court, so we cannot get them that way.

I recognise that the purpose of this is really more to do—quite rightly—with slave labour, so the title of my amendment alludes to slave labour. That is much more focused, and makes clear what I should like to think we are all after. I abhor the genocide that I absolutely believe to be taking place in Xinjiang, and I think we need to take much greater action on that, but in the context of the Bill, the purpose of the amendment was to make clear to the Government that a significant number of Members—and more would have signed it had I bothered to ask them—are very keen to see such a measure included. I say those words carefully, because I have read what the Government have written down and I have discussed this at length with the Minister and the Secretary of State, and I fully accept what they are trying to do here with this amendment on review, but that amendment on review cannot tighten up the time because it can only be post hoc, as it were, after the Bill goes through. My determination is that, by the time this Bill comes back from the Lords, we will have an amendment specific to modern slavery in it.

The reason I say that is that this is clear, with a reference even in the last two days to the use of equipment made by slave labour in Xinjiang in at least one of our hospitals. That equipment has been tested, so there is no excuse for not knowing. There is a company called Oritain—there are others—that now has the digital and genetic fingerprints of all the products from these areas. It has spent 10 years getting this information, and it can test a product and tell us not only where in rough terms it comes from but even which factory made it. There is no excuse now. This is being used in the United States, which has declared genocide, for testing these products.

The NHS is a phenomenal purchaser and has huge capability to change people’s direction. I say to the Minister that I understand that behind closed doors—if any closed doors exist in Government generally, but these ones—some members of the Government have asked the Secretary of State to do an impact assessment. We love impact assessments in Government. Most times they mean absolutely nothing because they tell us what happened before, but not what will happen in the future. That is because almost every time the Government try to forecast the future, we get it wrong. Even the Office for Budget Responsibility manages that quite regularly.

What difference would an impact assessment make to this amendment in my name and that of 19 other Members? For example, an impact assessment might tell us that we should no longer buy from a particular area because we are certain it provides through slave labour, but that the procurement would be, say, £20 million more expensive as a result. Does that impact assessment then mean we cannot do that because we do not want to lose £20 million—or £20 billion or whatever it happens to be—because that is too expensive, and that we will on balance therefore purchase from a known slave labour provider? Is that what we are saying? Is that what the impact assessment will say to us? I say to those who call for an impact assessment: be careful what you call for. There is a simple impact here: are we to purchase equipment made by slave labour?

I have also heard that someone else in the Government has said that the balance is between provision for those who need it here in the UK and our use of a product that comes from a place using slave labour. I say: be careful of that comment. It is not a choice we have to make. Our choice is to care for those here in the UK, but also to care for those who are being brutalised and beaten into product production and often losing their lives; we have to have a care for them as well. There is no choice here. It is simple: do we or do we not wish to have products in circulation in our NHS, of which we are all very proud, that were made by slave labour? This is the single point.

I understand the problem with Lords amendment 48; it is that the Government will never recognise genocide, so that amendment would never have a bearing or an effect because they would simply say, “We do not recognise that genocide has taken place in that area and therefore we are let out.” It is let-out for them. This amendment of ours is very specific. It deals with slave labour, and we can prove slave labour. So I say to my hon. and right hon. Friends: this unites the whole House. If this comes back amended either by the Government or by somebody in the House of Lords, I give a little warning—not a threat—to my Government that the choice when this comes back will be: do you support the use of slave labour or do you not support the use of slave labour? There is no other choice. It is not a moderated choice. It is very simple for us. I will vote against slave labour for an amendment coming back from House of Lords, and I believe that many of my colleagues here—all of them, I hope—will do the same. I am certain that that will be the case for those on the Opposition Benches.

I have huge regard for my hon. Friend the Minister, and very much so for the Secretary of State. I have spoken to them at length, and I believe them to be completely onside with my argument. I ask a wider group in the Government to stop it. This is more important than moderated impact assessments, which mean nothing; this is about human lives. When it comes to human lives, the best impact we can have is ending brutality, intolerance and slave labour. If we can bring that to an end, it would be the biggest impact we ever have, and we could be proud of it.

[Several hon. Members rose—]

--- Later in debate ---

[Edward Argar]

As ever, I thank hon. and right hon. Members from all parts of the House for all their contributions to this important debate on an important set of amendments. Even if I do not always agree with everything he says, I welcome in particular the contribution from the hon. Member for Ellesmere Port and Neston (Justin Madders). He and I spent a productive period—I was going to say happy—sitting opposite one another for two days a week over many weeks in Bill Committee, taking this legislation through. While I miss him from his previous role as effectively my shadow, I wish him well in his current shadow ministerial role. I also put on record my gratitude, although he cannot be here today, to the hon. Member for Nottingham North (Alex Norris) for his work on the Bill.

I gently tease, and this is no reflection on the current shadow Minister, that in Committee it took two shadow Ministers to try to keep me on my toes. It appears today that it takes three, but in saying that I cast no aspersions on the shadow Secretary of State, the hon. Member for Ilford North (Wes Streeting), who I am fond of, even when he is gently or less so gently pushing me on certain issues.

I turn first to the organ tourism amendment, and I am grateful to the shadow Secretary of State for his approach on this issue. We have a shared objective here, and I assure Members that our approach would target not only transplant tourists, but anyone involved in making the arrangements for the purchase of the organ who may be a British national. The Government amendment, paired with our commitment to work with NHS Blood and Transplant to make more patients aware of the legal, health, and ethical ramifications of purchasing an organ, will send an unambiguous signal that complicity in the abuses associated with the overseas organ trade will not be tolerated.

Turning to reconfigurations, I strongly believe that the public rightly expect Ministers to be accountable for the health service, which includes the reconfigurations of NHS services. This House rightly voted to retain these clauses on Report. The reconfiguration power will ensure that decisions made in the NHS that affect all our constituents are subject to democratic oversight. Without it, the Secretary of State’s ability to intervene and take decisions will remain limited, and usually be at a very late stage in the process. Although I hear what hon. Members have said, I note that many hon. Members from both sides of the House none the less seek to persuade the Secretary of State and seek to raise issues relating to their local services with the Secretary of State with a particular outcome in mind.

As now, the Secretary of State would not be alerted to a potential change in services until the change had become a relevant issue and would not be able to intervene without that formal referral. We have retained the independent reconfiguration panel. The shadow Secretary of State raised the issue of the clinical appropriateness of the changes. Nothing that is proposed here alters the fact that clinical appropriateness and clinical and patient safety remain central to any decisions and remain an obligation on the Secretary of State in any decisions that he or she makes in that context.

Briefly, on the remarks of the shadow Secretary of State about waiting lists, he will be aware that we published a comprehensive and ambitious but realistic elective recovery plan that is backed by record funding and resources for the NHS to tackle those waiting lists, which have grown as a result of the pandemic. I am straight enough with him to recognise that there were waiting lists before the pandemic. He always makes that point and I highlight that we have a plan to fix that, which is exactly what we are doing.

The shadow Secretary of State also highlighted several other factors relating to the workforce and the workforce clause, as did my right hon. Friend the Member for South West Surrey (Jeremy Hunt), the shadow Secretary of State—sorry, the Chair of the Health and Social Care Committee; I do not think we will be fielding shadow Secretaries of State from the Conservative Benches for some time yet. I entirely understand where my right hon. Friend is coming from on this issue, but I believe the approach that the Government have adopted, with the framework 15 commission and review and the broader commission that the Secretary of State has set out to look at drivers of workforce supply and demand, absolutely reflects our recognition of the centrality and importance of the workforce, and the right workforce, to the delivery of all our ambitions for constituents and for recovering waiting lists and waiting times.

We have not waited for any projections to get on with that; we are already investing in increasing our workforce and we are seeing record numbers of people working in our NHS. I have already highlighted that we are well on target to meet the commitment of 50,000 more nurses, with a current increase in the number of nurses of 27,000. The hon. Member for St Albans (Daisy Cooper) highlighted the same issues in her remarks.

I am particularly grateful to my right hon. Friend the Member for Chingford and Woodford Green (Sir Iain Duncan Smith) for his contribution on a challenging issue. There is a considerable degree of consensus on both sides of the House about the abhorrence of modern slavery, slavery or anything linked to it. We remain of the view that this is not the right legislation for the proposed changes.

As I set out in my previous remarks, new rules for transforming public procurement will further strengthen the ability of public sector bodies to exclude suppliers from bidding for contracts where they have a history of misconduct—or extreme misconduct in the case of slavery, forced labour or similar. In developing the modern slavery strategy review, it will continue to be important to engage across Government and civil society, nationally and internationally, to collect the necessary evidence to agree an ambitious set of objectives. It is right that the Government take action on the crime of modern slavery and it is right that the NHS is in step with all public bodies in doing so.

From listening to my right hon. Friend, I expect the issue to reappear when their lordships consider our amendments. In that context, I hope that he and other hon. Members are willing to continue to engage with the Government and my Department on this hugely important issue. As he rightly said, it is important not just in this House but outside this House to those we represent. I look forward to continued engagement with him.

[Sir Iain Duncan Smith]

Will the Minister give way?

[Edward Argar]

I have literally 30 seconds left, so if my right hon. Friend’s intervention can be in five seconds, I will give way.

[Sir Iain Duncan Smith]

Can the Minister tell his colleagues in the Government that there is never a good time? Now is the right time, and let us get on with it.

[Edward Argar]

I think that was exactly five seconds, and I am grateful to my right hon. Friend. I suspect that colleagues across Government will have heard what he said and will pay very careful attention to it, as I know Ministers across Government do to all that my right hon. Friend says in this House.

With that in mind, I ask the House to accept the motions in my name on the amendment paper.

Covid-19 Update

Iain Duncan Smith Excerpts

Monday 13th December 2021 Commons Chamber

[Sajid Javid]

Yes. The hon. Gentleman will appreciate that this is a very fast-moving situation. The NHS made the final decision to go on the expansion—this expansion of the booster programme that I referred to earlier—yesterday, and the system letter has gone out today.

[Sir Iain Duncan Smith (Chingford and Woodford Green) (Con)]

First, I say to my right hon. Friend that it is welcome he has come here today, but I am a bit concerned about the mixed and heavy messaging coming from the Government, the unintended consequences of which can be dire. I notice, as has my right hon. Friend the Member for Harlow (Robert Halfon), the Chairman of the Education Committee, that the Centre for Social Justice has produced a report about the huge damage done to young children, particularly in the poorest communities, when schools start locking down and shutting them out. Will the Secretary of State please ensure that the message is clear to schools that they are not to lock down?

Secondly, when I spoke this morning to GPs in my constituency, I asked them, “What is the one thing that you would like the Secretary of State to do now if you’ve got to get all these people through?” They said, “Do we really need to have the 15-minute wait? Can we end that? We would triple our way through this, and you would get it going straight away?” Will the Secretary of State please act on that now?

[Sajid Javid]

First, I very much agree with my right hon. Friend on the importance of never losing sight of potential unintended consequences. He points to an excellent report by the Centre for Social Justice, which looked at this in the light of past actions. That is certainly not lost on me or my colleagues in Government, but he is right to highlight that to the House once again. I hope he agrees, however, with the messages we have set out so far. They are measured and they are proportionate. The focus should be on the booster campaign because that is our way out of this. On the 15-minute wait, it is being very actively looked at, and I am sure that I will have something more to say on that very shortly.

Covid-19 Vaccinations: 12 to 15-year-olds

Iain Duncan Smith Excerpts

Monday 13th September 2021 Commons Chamber

[Nadhim Zahawi]

I am grateful for the right hon. Member’s question. Actually, quite the opposite is the case. First, he will know that school bubbles have gone. The school-age vaccination programme and those clinicians are really very well equipped and very well versed in dealing with vaccines in schools, so this will not be a new thing for them. Their ability to gain consent and communicate exactly why the chief medical officers have gone ahead is, in my view, an important element of the decision to accept the recommendation tonight. So I would say quite the opposite: it is right that we accept the recommendation tonight.

As I said in my statement, no one—no parent or child—should be stigmatised for making a decision. We have been transparent all the way through this process, and we have been incredibly careful, as we have demonstrated. Many other countries now boast that their vaccination programmes have reached far higher numbers than ours. I have always said that this is not a race; it is about doing the right thing for children and adults to transition this virus from pandemic to endemic.

[Sir Iain Duncan Smith (Chingford and Woodford Green) (Con)]

I welcome my hon. Friend’s statement, but I want to return to the issue of where the children will make this decision. The reality is that we have parents taking responsibility for their children, and at the end of the day we say we are going to ask them whether or not they give responsibility for their child on this matter. However, where there is a dispute, we say that the school will decide whether or not that child has the capacity to make that decision. This is the point: the pressure will grow on the child. There is no way of legislating for this greater good concept that says, “The school may be in trouble, and your class may be in deep difficulty, if you do not take the vaccine.” I simply say to my hon. Friend that this is a real problem for us. It will lead to disputes in families and real problems about children’s mental health in the opposite direction, as they are put under pressure. I wonder whether he and the Government will think again about this. Without serious, clear guidance, it will lead to children being in a worse state than they would have been without the vaccine.

[Nadhim Zahawi]

I am grateful for my right hon. Friend’s really important question. I want to spend a few seconds explaining this to the House, because it is really important. He mentioned that the decision would lead to teachers having to explain; actually, it is quite the opposite. It is not the teacher’s responsibility to do that; it is a qualified clinician’s. The school-age vaccination programme is very well equipped to do that in a discreet and careful way with parents and with the child. However, that will be on very rare occasions; the bulk of vaccinations will be conducted only if there is parental consent.

Covid-19 Update

Iain Duncan Smith Excerpts

Monday 14th December 2020 Commons Chamber

[Matt Hancock]

I think that this argument against testing is wrong. I think that we should test, test, test, and that is what this Government are doing. We are working very closely with the Government in Scotland, from the same party that the hon. Lady represents, to make sure that we use testing as widely as possible to find people who have this virus. Yes, of course different tests have different characteristics. The lateral flow tests find around 70% of those who are infectious. That means that if we test people who would not otherwise have been tested, we find the positive cases, we can get them to isolate and we can break the chains of transmission. I strongly urge the hon. Lady to go back, to study the details and to back the testing programme that we have in this country.

[Sir Iain Duncan Smith (Chingford and Woodford Green) (Con)]

I fully recognise my right hon. Friend’s serious dilemmas—it is not an enviable position—but the application of tier 3 to London raises some questions. I have had long conversations in my borough with public health and the hospitals, and they maintain that the infection rate is now almost exclusively among secondary schoolchildren, who pass it on to their parents—those two least at-risk groups—so the hospitals are not overcrowded, with spare beds in the intensive care units and a very low level of covid patients in the hospitals.

Tier 3 will hammer down on the one area that does control what happens, which is hospitality. The key here, surely, is that doing that will cause people to shift back to their homes, and it is that area that we would worry about, with off-licences selling alcohol late in the evening. Will my right hon. Friend try to seek some kind of flexibility so that these measures target better the real risk and do not just hammer those who have been doing the right thing?

[Matt Hancock]

We are always open to finding new ways to protect the economy as much as possible and bring the virus under control. I share my right hon. Friend’s desire to get it under control and to keep it under control until a vaccine can make us safe, but unfortunately this is no longer just a problem among school-age children in Waltham Forest and north-east London, which it has been until the last week’s data. The case rate among the over-60s in Waltham Forest is now over 250 and we are seeing that rising over the last week. We are also seeing rising admissions to hospital.

I have a huge amount of sympathy for everybody affected by these decisions in Waltham Forest, but it is absolutely essential to get this under control now to protect the NHS from being overwhelmed in the future. We must break the inexorable link from cases now to hospitalisations in the future—and, sadly, deaths—by using the vaccine and by testing. Until we can have the vaccine fully rolled out and people inoculated by having their second dose, and until enough vulnerable people have had that second dose and have therefore become inoculated, unfortunately measures like this are necessary.

Covid-19 Update

Iain Duncan Smith Excerpts

Thursday 15th October 2020 Commons Chamber

[Matt Hancock]

Yes, absolutely. The hon. Lady rightly raises the issues in Tower Hamlets. The good news is that the testing being delivered in Tower Hamlets is going up. The bad news is that both the number of people testing positive and the positivity are also going up. Because of today’s decision on putting London into level 2, further resources will be available for local test and trace.

[Sir Iain Duncan Smith (Chingford and Woodford Green) (Con)]

Thank you, Mr Speaker, for allowing me to get in at the last minute, because this is a London statement. When a Minister gets a collection of London MPs together, it would be great if they could actually be allowed in to ask a question for a long enough time to save them having to scrabble into the House of Commons.

I want to follow on from the comments of my hon. Friend the Member for Bromley and Chislehurst (Sir Robert Neill). London is huge. Whether people like it or not, it is very diverse, and many of the boroughs are bigger than most of the towns in the rest of the UK. Surely we need to look again at the London-wide nature of this tier 2 position. Even regional areas could be taken out. There are big disparities. I ask that we please think again. Otherwise people will say, like one constituent who rang me today, “Is this in fact a London-wide tier 2 to stop the north-south divide argument running?”

[Matt Hancock]

On the last point, absolutely not. This decision has been taken on the basis of the data across London. We did consider the borough by borough approach that my right hon. Friend understandably advocates, but the decision that we came to was that because cases are rising throughout the capital, it was therefore right for the capital to move as a whole. That was supported by the cross-party team who are working on this at a London level.

Social Distancing: 2 Metre Rule

Iain Duncan Smith Excerpts

Monday 15th June 2020 Commons Chamber

[Edward Argar]

I am grateful to the shadow Minister, as always, for his remarks and for, as ever, the constructive tone that he adopts on these occasions. I share his view that we do want to see the United Kingdom reopening for business, but we want to see it do so in a way that is safe for those going out and shopping—and I encourage people to go out and frequent their shops from today. I also want to ensure that when we are able to safely open hospitality again, we get it going and do so in a safe way based upon the evidence.

On timescales, as my right hon. Friend the Member for Tunbridge Wells (Greg Clark), the Chair of the Select Committee, and the shadow Minister have said, we recognise the importance of getting this information and this decision out there as swiftly as possible, because it is important to give businesses all the time we can to prepare for it. Equally, however, the shadow Minister would not expect me to set a particular deadline while the work is being done. I have said that that will be within a matter of weeks and that we recognise the urgency for business, but it is important that those conducting the review can do so properly and rigorously, so that it is useful for the decision we have to make. Once that review has reported and the Prime Minister has had the opportunity to consider it, I would, of course, expect the findings to be made public.

On the WHO’s comments, the hon. Gentleman is absolutely right to highlight that the 2 metre distance is only one part of the measures—only part of the complex package that is in place to reduce risk and to protect public health. As we have seen, different countries around the world have adopted different approaches, such as on whether to reduce the distance and have imposed different requirements on the wearing of face masks. Therefore, there is, in a sense, a menu of different options all of which can reduce risk, and the question is how to come up with the most appropriate balance between reducing risk while also opening up business. On the Committee we see economists and clinical and scientific expertise feeding into that balance-picture. As the Chancellor said at the weekend, it is not binary; we must consider this in the round, considering all relevant factors.

The hon. Gentleman mentioned test and trace. It is a hugely important part of the armoury of options to chase down this disease and allow our economy to reopen. As he will have seen last week, we made a very good start in the first week of the operation of the new test and trace system. We also saw a very, very high willingness on behalf of members of the public to self-isolate when asked to do so, and I pay tribute to everyone who has done that and thank them for doing so.

Finally, I say to the hon. Gentleman that I believe that throughout this pandemic we have been learning every day about how the disease behaves, about what is needed to tackle it and what steps are most effective, and I am confident that we have done the right thing at the right time throughout. However, like any responsible Government, of course there will be lessons to learn and it is important that we are willing to learn them.

[Sir Iain Duncan Smith (Chingford and Woodford Green) (Con)]

I congratulate my right hon. Friend the Member for Tunbridge Wells (Greg Clark) on securing this urgent question, because this is the most important and significant strategic decision the Government are going to have to make as they unlock the economy. The problem is that so much of this debate has been shaped around the idea of the economy as an economic tool, but it is not just economic. The reality is that, with our focus on covid, we are in danger of losing sight of what will happen, probably to the poorest in society, if people start to fall unemployed and suffer depression and increased illness. This will have a major effect on the ability of people to be able to manage their lives. So this is not just economic. It could be six weeks before we discover the outcome of a review, but I do not believe that a single fact is going to change in that six weeks. The reality is that the advisers are all divided; the Government must make a decision and get this one right.

[Edward Argar]

I am grateful to my right hon. Friend. I have huge respect for him and for his campaigning on this issue, particularly in the context of the extraordinary work he has done on social justice over many years. He highlights the importance of looking at the impact of covid-19, not just in the immediate context of health outcomes, but at its broader social and economic impact. He is absolutely right. He is also right to emphasise the need for urgency, and that is exactly how we will conduct this review.

On his final point, he is right: the science is mixed. There are different scientific opinions, and a balance must be struck between the best scientific advice and consideration of the impact on the economy. As a great former Prime Minister once said:

“Advisers advise, and Ministers decide.”

Covid-19

Iain Duncan Smith Excerpts

Tuesday 12th May 2020 Commons Chamber

[Sir Iain Duncan Smith (Chingford and Woodford Green) (Con)]

I wish to make a few quick points. First, I wish to welcome the Chancellor’s statement today, because this is an area where a lot of us have been pushing him to give some security to businesses as they go forward. The idea of the furloughing scheme going on and, we hope, reducing as it does, as businesses go back to work, is an important one. However, we must bear in mind that there is a huge cost to it, at some £13 billion every month. He is right to say that he is prepared to extend the scheme, but we must be careful that we do not end up spending so much money that it makes it difficult for the economy to thrive.

I also wish to raise with the Government a few areas where I have concerns. The work they have done so far has been remarkable, and they have rightly received the full support of people in this House and, I believe, in the country at large, but I wish briefly to raise some issues with them. They say they have been guided by the science, but a number of people have concerns that this is not just about the science alone; there needs to be a much broader sense of where we are—the balance between the economy and covid. Some of the language has been loose on that, with the idea that it has been a choice—this is a false choice—between saving lives and saving the economy. Both are about saving lives; the point is when one becomes so big that we need to deal with it. I think we are at that moment now, and have been for a little while, in terms of the economy.

My concern is that we seem to have been wedded in the early days to the Imperial College model, which has had some quite significant criticisms and a poor record in the past of forecasting in these areas. I am glad that the Government have now widened this out. I note that Sweden ran the figures on the Imperial model and found that it was wrong by about 15 times, overestimating the number of deaths as against what they had witnessed—the same applies in respect of what Edinburgh University and others had managed to do. I am therefore concerned that there is a deal of pressure on that, but I am also glad the Government have moved on from there.

Another point to make is about testing, where the Government have had to shoulder a lot of difficulty and blame, but quite a lot of that should also be targeted, in due course, at Public Health England. The big mistake they made early on was the decision not just on having more testing, which they should have done from day one, but the decision not to include all the private laboratories. They should have done that straightaway; even though they were building their own and getting their own, we should have maximised and gone out to the private laboratories, which would have helped enormously.

The other thing I do not understand at the moment is that at the beginning of lockdown we did not close the airports but now we are looking to make coming into the airports more difficult as we come out of lockdown. It is a puzzle why it was not right at the beginning but it is now right as we try to open the economy. I am particularly concerned about that.

I just want to say to the Government that for four weeks I have been arguing that they need to open the economy and be talking to the public to bring them with them and give them a sense of what is coming. The paper produced yesterday and the statements that have been made at last are the right indication. I am with the Government: people should use their common sense. There are going to be areas and times when we cannot always meet that argument and that deal about social distancing. I want to ask one question: why does every other country have a lesser distance than we do? That makes a big difference on things such as public transport. Ours is the only country that has a 2-metre rule—Germany’s rule is 1.5 metres, some countries use 1 metre and the World Health Organisation says that 1 metre is enough. Such an approach would help enormously with public transport—on the tube and so on—where there is a great problem. I urge the Government to get on with opening the economy and with giving people the opportunity to get back to their livelihoods. We should trust them, with their common sense, to be able to implement these sets of guidance and to make sure they do the right thing as they go back to work.