NHS Pension Scheme: Tapered Annual Allowance

Jonathan Edwards Excerpts

Tuesday 2nd April 2019 Westminster Hall

[Jonathan Edwards (Carmarthen East and Dinefwr) (PC)]

I received an email from a consultant who works in my constituency, informing me that one of the unintended consequences of the new arrangement is that he has reduced the number of hours he works in the NHS.

[Paul Masterton]

That is exactly right. I asked for a Treasury Minister to reply to this debate, because the underlying legislation is a Treasury issue, but it is important to have a Health Minister here today to hear at first hand the stories that are being raised by MPs.

In recent months, it has become increasingly apparent that the pension tax rules are resulting in unexpected tax charges being levied on a large number of GPs, senior doctors, surgeons and consultants right across the UK. I believe that if the issue is not addressed, serious capacity gaps in the NHS will only be made worse.

In Scotland, 7.6% of consultant posts are vacant, and more than half of those have been vacant for more than six months. There is a similar picture in the NHS in all other parts of the United Kingdom. In a recent survey by the Hospital Consultants and Specialists Association, more than 40% of the doctors questioned said that pension taxation changes had led them to change their plans and retire earlier than expected.

The way in which the tapered annual allowance operates means a significantly reduced annual allowance ceiling is hitting many of the NHS professionals that I, and the hon. Member for Strangford (Jim Shannon), mentioned in their mid to late careers. As their entire income is taken into account for the purposes of tapering, the threshold can be breached even by doing non-pensionable work, including covering for absent colleagues, extra programmed activities or waiting list initiatives. NHS staff on pay-as-you-earn cannot avoid the notional pension input amount calculation. As a result, many consultants are being hit with unexpected five-figure tax charges. A number are now dropping extra work, turning down hours or going part-time to negate or avoid the penalties.

Of course high earners should pay their fair share, and all the doctors who have contacted me want to do so, but they are paying rates of more than 60% as a result of the taper. Some are paying effective rates of more than 100%. Many consultants who continue to do non-pensionable overtime are effectively paying the Government to go to work, while receiving no additional pension benefit.

--- Later in debate ---

[Jackie Doyle-Price]

I shall not stray into policy that is not mine and that belongs to Her Majesty’s Treasury—that is a very convenient way for me to duck the issue. It comes back to the point that the moment we start to introduce complexity into our tax and allowance system, it brings perverse incentives. The overall goal in recent years has been to bring our public finances back into kilter, having had excessive deficits. It is only natural that the Exchequer looks at where reliefs that are funded by the state are going to higher-rate taxpayers. That is where we have got to with regard to the impact on public sector pension schemes, which by their nature are as we describe.

The NHS pension scheme is a generous and valuable part of staff reward packages, and is one of the best schemes available, notwithstanding the issues raised by my hon. Friend the Member for East Renfrewshire. It is right and proper for all hard-working NHS staff to expect financial security in retirement after dedicating a lifelong career to looking after the nation’s health.

For some senior clinicians, the generosity of the scheme, combined with their comparatively high levels of pay, means that their pensions build up to a level that breaches tax limits. Both the annual and lifetime allowances encourage pension growth at a steadier rate that is more aligned with typical pension growth experienced across the general population. To illustrate that, under the 1995 section of the NHS pension scheme, members who accumulate pension benefits worth near the £1 million lifetime allowance will have built up a pension of around £46,000 a year, plus a tax-free lump sum of £138,000 on retirement. Pensions of that size provide substantial financial security in retirement, and it is right that the Government take steps to limit the tax incentive to save further.

My hon. Friend raised concerns about the impact on our NHS workforce. With respect to discussions between the Treasury and the Department on the introduction of the allowance, the 2015 manifesto committed to

“reducing the tax relief on pension contributions for people earning more than £150,000.”

That was a manifesto commitment we had to deliver. The tapered annual allowance fulfils that commitment and applies to all contributors to pensions, in both the public and private sectors. The impacts of the change, including on the public sector, were carefully considered at the time.

My hon. Friend asked about the number of doctors and dentists taking early retirement. Data from the NHS pension scheme administrator shows that 494, 490 and 424 hospital doctors took voluntary early retirement in the financial years ending 2016, 2017 and 2018 respectively. Those early retirements represented approximately a third of all hospital doctor retirements in those years. With respect to GPs, in 2016, 695 took early retirement; in 2017, 721 took early retirement; and in 2018, 588 took early retirement. Those figures represented more than half of all GP retirements in those financial years. With respect to dentists, 145 retired early in 2016, followed by 143 and 115 in 2017 and 2018 respectively. Those retirements represented approximately 40% of dental practitioner retirements in those years. There is clearly an impact on the behaviour of practitioners.

My hon. Friend asked what consideration the Treasury has given to a general review of the annual allowance taper and the broader system of reliefs in relation to pension saving. Those are matters for the Chancellor, and the Government will continue to review all aspects of pensions policy, in line with our annual assessment of the public finances.

[Jonathan Edwards]

I am grateful to the Minister for giving way. She is highlighting some of the concerns that have been expressed about the unintended consequence of a capacity problem for the NHS as a result of the changes to pension relief. Given that health is a devolved issue in Wales, have the British Government received any communication from the Welsh Government expressing concern about the changes?

[Jackie Doyle-Price]

I have not, but this is about the impact of the pension and tax regime on the sector. I am not aware of any conversations with the Treasury, but if the hon. Gentleman has concerns, I encourage him to make representations. There are always unintended consequences with any policy, and we always need to challenge the operation of our policies to make sure they are in the right place and to decide whether they need to be refined, tweaked or changed in any way.

The Government recognise that pension tax considerations will contribute to decisions by some senior clinicians to retire early or to reduce their NHS commitments. For those who wish to remain in the NHS pension scheme, the annual allowance is a disincentive to take on additional work and responsibilities —that is very clear. The extra income increases the impact of the tapered annual allowance.

Some clinicians may judge that a reduction in their current NHS commitments, while maintaining scheme membership, better serves their financial interests. Employers tell us that the reduction in service capacity can be difficult and that capacity is expensive to replace. I assure my hon. Friend that the Government are listening carefully to the concerns raised by senior doctors and NHS employers about the impact of the tapered annual allowance.

That doctors may seek to limit or reduce their NHS commitments is of concern to Ministers, and something on which we are keeping a close eye. Maximising the participation of our clinical workforce is clearly essential to the delivery of our ambitions for the NHS. The quality and quantity of our workforce is always an important factor in the extent of the delivery of our objectives.

As an immediate step, the Department has sought to make available to NHS pension scheme members all possible flexibility under Her Majesty’s Revenue and Customs legislation and the current fiscal framework for public sector pension schemes. The BMA asked that we extend the scope of the voluntary “scheme pays” facility—implemented by the NHS pension scheme—to cover the payment of tax charges from breaches of the tapered annual allowance.

We have done that, but we have also gone further. The NHS pension scheme’s voluntary “scheme pays” facility has also been extended to cover tax charges of less than £2,000, which means that, from tax year 2017-18, a member can elect for the scheme to pay 100% of their annual allowance charge to HMRC on their behalf. The “scheme pays” facility allows individuals to settle their tax charge without needing to find funds up front, but HMRC requires an adjustment to the benefits accrued by members if a defined benefit pension scheme pays an annual allowance charge. That adjustment must be just and reasonable, and with regard to normal actuarial practice.

Accordingly, the NHS pension scheme applies an interest rate to the charge paid on the member’s behalf. That charge is deducted from the capitalised value of the pension at retirement, with the interest rate set at the scheme discount rate. I recognise that, for some younger clinicians with many years before retirement, the compounding effect might influence the attractiveness of “scheme pays”, so I encourage members of the pension scheme to seek formal financial advice.

The Government will look at potential further measures. There is clearly considerable interest in this matter, and I assure hon. Members that we keep the impact of public sector pay and pensions policies under constant review, and take account of total reward and fiscal considerations. As my hon. Friend recognises, the issue is complex, and it is difficult for the Government to strike the right balance among competing interests. I do not think, however, that there is a case for exempting high-earning NHS staff, such as GPs and consultants, from a tax measure that is intended to apply to high-earning individuals. I also doubt that clinicians necessarily expect to be treated differently from other taxpayers.

The fiscal framework within which the NHS pension scheme operates is an important consideration. The NHS pension scheme, like most public service pension schemes, does not manage a fund of assets out of which pensions are paid. It is instead financed on a pay-as-you-go basis similar to that of the state pension, with contribution income defraying the cost of pensions in payment. Any change to scheme rules that provides flexibility could therefore have a significant effect on contribution income. That would have an impact on the Exchequer. We must balance that fiscal risk against the benefits of providing additional flexibility. Any proposed pension flexibility would be a matter for the Chancellor.

Clearly, this is a complex subject that we will have to keep under review in recognition of the fact that it drives behaviour in the NHS in a way that could cause us difficulties in the delivery of our overall commitments. We clearly want to retain the best, most qualified and expert staff in the NHS, and we need to be vigilant to ensure that our tax and pension benefits system does not stand in the way of delivering the best possible NHS.

Question put and agreed to.

Budget Resolutions

Jonathan Edwards Excerpts

Tuesday 30th October 2018 Commons Chamber

[Jonathan Edwards (Carmarthen East and Dinefwr) (PC)]

Writing earlier this week in the Welsh edition of The Sunday Times, I labelled yesterday’s fiscal event a “fantasy Budget”. That is because, of course, it did not mention the big elephant in the room, which is Brexit. If the withdrawal agreement does not make it through the House of Commons—that is working on the assumption that there will be a withdrawal agreement between the British state and the European Union—the Chancellor will be back here in a matter of months with an emergency Budget. I hope that, in such a scenario, more sensible minds might prevail with a policy put forward based on extending article 50 coupled with a people’s vote at the end of it with remain as an option.

As always, the most interesting part of the Budget came with the accompanying OBR report. Its projections are based on the most optimistic Brexit scenario envisaged by the British Government, and, basically, it envisages no change in its growth forecasts. Indeed, page 9 of the OBR report shows the UK’s projected economic growth at the bottom of the advanced economies of the world. The Institute for Fiscal Studies, in its green budget, emphasised the decoupling that we have seen between the British economy and the other advanced economies of the world since the 2016 referendum. Growth is now at around half of pre-recession levels, and that is as a result of eight years of austerity, which has permanently sucked out demand from the economy, and now the Chancellor faces Brexit, all of which lead to anaemic levels of business investment.

The British Government are trying desperately to pivot away from their austerity narrative. They know now, in the new climate, that that is a political vote loser. However, yesterday’s spending commitments fell far short. The IFS puts the price of ending austerity at £19 billion per annum by 2022-23, and the Resolution Foundation puts it at about £30 billion. Yesterday’s spending commitments did not match those sorts of sums. Once extra spending on the national health service in England is stripped out, most other Departments faced a flatlining budget, if lucky, or real-terms cuts. We will have to wait for next year’s comprehensive spending review to have a full picture. I look forward to that fiscal event next year. Public expenditure as a percentage of GDP is now basically at the levels seen at the end of the Thatcher years—about 38%. Austerity has enabled the British Government to achieve their objective of remodelling the state but at a huge cost to public services and support for the most vulnerable in society. Far from ending austerity, austerity is now entrenched in the UK taxation and spending model.

Turning to Wales, the vast majority of spending decisions were England-only, highlighting the fact that the major fiscal event for my country is the Welsh Government’s budget. A huge amount of work needs to be done by politicians in Wales and by the Welsh media to promote that event to its rightful status. The BBC proclaimed a half a billion pound bonanza for my country, neglecting the fact that these were Barnett consequentials resulting from spending in England. A magic-money cash giveaway, as portrayed, it most certainly was not. The key point of interest is the remaining inherent unfairness in the Barnett formula as it applies to Wales. The Welsh Government responded by saying that the vast majority of the £500 million was old money previously published following the enhanced funding announcement for the NHS in England over the summer. Funding per head in London, the richest part of the European Union by a country mile, is higher than it is in Wales. The geographical wealth inequalities within the British state should shame Westminster, and there was little in the Budget that is going to lead to a meaningful rebalancing.

I was very disappointed that there was no announcement on the shared prosperity fund. The communities I represent form part of the West Wales and the Valleys European region. We receive £2 billion in convergence funding within the current EU multi-annual financial framework, which runs between 2014 and 2020. During the referendum, we were promised not a penny less. However, it looks increasingly likely that the communities I represent will be significant financial losers and that the British Government will take away powers from Wales over the use of shared prosperity fund money. I put the Treasury on notice that unless it honours the promises of the Brexiteers, it is walking into a political firestorm, and that political control of the powers over that money must reside in Wales.

The Budget highlighted the north Wales growth deal, with £120 million of funding, but neglected to mention that that accounts for only about 10% of the total funding. We saw a similar scenario with the Swansea Bay city deal, with only 10% of the funding coming from the Treasury. Therefore, 90% of the money associated with these growth deals comes from the Welsh public sector and the Welsh private sector.

It was interesting to see that there was no mention in the Budget of the Secretary of State for Wales’s pet project, the western powerhouse. I can only presume that it has gone down in the Treasury as it has in Wales—not particularly well—and I was glad to see its omission yesterday.

We saw the announcement of the £900 million business rates cut. The Secretary of State for Wales immediately called on the Welsh Government to match that promise. I have to be honest—I was completely unaware that tax cuts by the British Government for England led to Barnett consequentials for Wales, but perhaps that shows my lack of understanding of how the Barnett formula works. I would be very grateful if the British Government outlined whether there is indeed some compensation money for English local authorities for the loss of revenues they face as a result of those business rate cuts, because that would then lead to Barnett consequentials that could be applied to Wales.

A major brewing political storm today is the enhanced borrowing powers that were included in the Budget—some £300 million. The British Government are trying to tie that to the M4 relief road. It would completely undermine devolution if those borrowing powers were constrained by being limited to what the British Government want the Welsh Government to spend the money on.

Mental Health

Jonathan Edwards Excerpts

Wednesday 9th December 2015 Commons Chamber

[Luciana Berger]

I know that the right hon. Gentleman has worked hard on these issues, as have many Members across the House. My job is to hold the Government to account for the promises they have made, and that is what I am endeavouring to do. Where there are opportunities for us to work together we should be keen for that to happen, but the Government have not delivered on their previous pledges. I am keen to know the detail of how that £600 million will be allocated and over what period, and we look forward to that information coming forward.

The spend of clinical commissioning groups is just one pledge on mental health that has not translated into reality, and—unfortunately—another is the commitment to spending £250 million on child and adolescent mental health services this year. In response to a parliamentary question, the Government have admitted that there will be a £77 million shortfall on what they have pledged to spend this year. With those spending promises so far unfulfilled, Labour Members are concerned about the lack of transparency on mental health spending. That is why we are calling on the Government to reinstate the annual survey of investment in mental health services.

It is not only in funding that equality for mental health has yet to be achieved, because a huge disparity remains at the heart of our NHS. The NHS constitution sets out the rights to which patients, the public and staff are entitled, and the pledges that the NHS is committed to achieving. The constitution enshrines our rights to access drugs and other treatments, but it does not extend that right to talking therapies. Recently, the Government consulted on adding a right to psychological therapies to the NHS constitution, but they decided not to include it in its latest version. That decision reinforces the existing bias in the system against mental health, and if the Government are serious about fair access to cost-effective mental health treatment, they must address that fundamental disparity.

[Jonathan Edwards (Carmarthen East and Dinefwr) (PC)]

I am disappointed with the tribal attacks on the Scottish health service in the motion, and it does not say much for the new politics promised by the Leader of the Opposition. Has the hon. Lady reflected on the situation in Wales—the only part of the UK where the Labour party is in charge—because the Academy of Medical Royal Colleges in Wales, which represents 16 colleges and facilities, said last month that mental health services in my country face significant inequalities? How will the hon. Lady respond to those concerns?

[Luciana Berger]

I have heard from my colleagues in Scotland about the challenges that they face with mental health services, and it is right that we should raise that issue during this debate. I have also had the opportunity to meet my colleagues in Wales and see the fantastic work that they are doing. Their pioneering piece of mental health legislation, which came into force in 2012, is the first for any developed country in terms of how it treats mental health, and it ensures that patients have a proper dedicated plan that considers not only their health needs, but their support, personal care, wellbeing, education and training. I look forward to working with my colleagues in Wales and to supporting them in the fantastic work that they are doing.

Sugary Drinks Tax

Jonathan Edwards Excerpts

Monday 30th November 2015 Westminster Hall

[Helen Jones]

That is a reasonable approach, and I will come to that in a minute. The right hon. Member for Cities of London and Westminster (Mark Field) mentioned the shrinking size of Mars bars, but I think that has more to do with maximising profits than with concern for people’s health.

As a result of all that I have outlined, our risk of serious diseases is increasing. We are much more at risk than we used to be of cardiovascular disease, certain types of cancers and type 2 diabetes, which is increasing rapidly in this country. In fact, the British Medical Association has estimated that problems with our diet lead to 70,000 premature deaths a year. I put it to the right hon. Gentleman that if the Government were seeing 70,000 deaths a year from something such as a flu epidemic, they would act. This is just as serious.

Serious diseases are not the only problem. The biggest cause of childhood admissions to hospital is dental decay. If we talk to people who operate on those children, we hear horrific stories of young children having all their teeth removed because of decay.

[Jonathan Edwards (Carmarthen East and Dinefwr) (PC)]

A tax on sugary drinks has been Plaid Cymru policy for a number of years in Wales. The Labour party in Wales has responded in the media that such a policy

“is a not sensible way forward”,

and has called it “ill-thought” out, “economically illiterate gibberish”, “a disgraceful con trick” and “fantasy politics”. It has described the policy as “vacuous” and said that it has

“no chance of seeing the light of day”.

What is the hon. Lady’s message to her colleagues in Wales, especially as we are about to gain the powers to introduce a sugary drinks tax in our country?

[Helen Jones]

I never take what Plaid Cymru says about the Labour party in Wales at face value; I am used to its selective quotes.

Dealing with problems caused by poor diet is costing the NHS about £6 billion a year, which is more than the cost of dealing with problems that arise from smoking and alcohol combined. That figure is predicted to rise to £10 billion or £12 billion by 2020. The Government’s response to that, as has been said, was the public health responsibility deal. They have rejected direct intervention, which they refer to as “Whitehall diktat and nannying”. I think that is a profoundly mistaken approach, for this reason. Individuals do not make decisions in a vacuum, and they are making decisions about their diet in a situation where unhealthy foods are often heavily discounted or priced very low, where hundreds of millions is spent on marketing—particularly on marketing to children—and, in some cases, where there is a lack of availability of healthy alternatives. It is true that we need to take responsibility for our own health, but the Government also have a role in ensuring that we have the skills and facilities that we need.

Cardiac Screening: Young People

Jonathan Edwards Excerpts

Tuesday 27th October 2015 Commons Chamber

[Mims Davies (Eastleigh) (Con)]

I am grateful to you, Mr Deputy Speaker, for the opportunity to discuss the crucial matter of cardiac screening for our young people. I am delighted to be able to speak tonight because I did the 10-mile Great South Run on Sunday for CRY—Cardiac Risk in the Young—which raises awareness, supports screening and research, and assists bereaved families affected by cardiac risk in the young. You can look at its website to see its impact on cardiac arrest in our young people.

Cardiac arrest is a preventable and silent killer. There are often no symptoms and there is regularly no warning. At least 12 young people under the age of 35 die unexpectedly every week of the year from a heart condition that they did not know they had. I and various campaign organisations involved in tackling this issue believe that the number may be even higher. Perhaps even as many as 20 young people a week are lost by their families. Some 80% of those deaths occur with absolutely no prior symptoms.

Sudden cardiac death is thought to be caused by a heart condition, and young sudden adult death syndrome occurs when a cardiac pathologist is unable to find a definite cause of death. Thankfully, coroners are becoming more willing to name sudden arrhythmic death syndrome as the cause of death, which is a positive step forward, but we must continue to push for greater awareness.

My constituents, Graham and Anne Hunter, lost their beautiful daughter, Claire, two years ago from sudden cardiac arrest. Claire was only 22 and was newly married to Andy. She was a trained accountant and a mature, beautiful girl with an exciting life ahead of her. She had no prior symptoms. She was in a spa on a hen weekend, relaxing with friends in a jacuzzi after a swim. She said that she felt hot and sick, and she sadly died from sudden cardiac arrest. It took a significant time for the ambulance to arrive. We and her family do not know whether, had the spa had a defibrillator, that would have saved her life.

Claire’s family have since been screened. Heart conditions have been found and preventive measures put in place by the excellent Southampton general hospital. Graham and Anne’s lovely daughter Claire was cruelly and tragically taken from them, and that terrible loss exemplifies what is happening to other families in every community and constituency each week. Graham and Anne are sitting in the Public Gallery listening to and watching this vital debate, and I pay tribute to them and to many other families across the country who have lost their precious children to such a cruel and sudden tragedy. Such losses are often preventable, which only makes them even more heart-breaking.

[Jonathan Edwards (Carmarthen East and Dinefwr) (PC)]

I congratulate the hon. Lady on securing this important debate. Does she agree that this tragic condition seems to hit fit young people, such as my constituent Mr Philip Evans who was a family friend? He was a keen bodybuilder and he tragically died from this condition.

Cities and Local Government Devolution [Lords] Bill

Jonathan Edwards Excerpts

Wednesday 21st October 2015 Commons Chamber

[James Wharton]

My hon. Friend raises a point that I know is close to his heart. He has tabled amendments to the Bill, which we shall discuss later. No area will be compelled to agree a devolution deal. The purpose of the Bill is to enable us to put such a deal on the table for any area that wants one, but it does not give us the power to compel any area to accept it. His comment is in line with the Government’s intentions in the legislation. We want to ensure that devolution and the benefits it can bring are there for everybody, but we will not compel areas to be part of it.

[Jonathan Edwards (Carmarthen East and Dinefwr) (PC)]

The Minister has talked about a bottom-up approach. From what I understand, Manchester is to be offered powers over policing. We had a bottom-up approach in Wales as a result of the Silk commission, which was sponsored by the UK Government, in which all parties agreed that policing powers should be devolved to Wales, just as they are in Northern Ireland and Scotland. However, the draft Wales Bill was published yesterday and the devolution of policing is missing from it. Can the Minister explain the ambiguity of the Government’s position?

[James Wharton]

I recognise the hon. Gentleman’s diligence in raising his concern, particularly given that that is his area of expertise. Rather than my commenting on it in the debate on this Bill, however, I would gently suggest that it is a matter that should be discussed in a Welsh context in the debates on the Wales Bill.

--- Later in debate ---

[Mr Graham Allen]

Before I begin, I should inform the Committee of the breaking news that our good friend Michael Meacher, the right hon. Member for Oldham West and Royton, has passed away. He was a good friend to many people in this House, and I am sure there will be an appropriate moment for us all to pay tribute to a fine parliamentarian and good friend.

This is my first opportunity to put on record my gratitude and the thanks of the House to my hon. Friend the Member for Stockport (Ann Coffey), who seized the opportunity to produce a magnificent report on areas in and around her constituency. I hope she will take great pleasure in the fact that the Government are now actively considering creating a What Works institution to address the sexual abuse of children. It will ensure not only that people are not victimised, but that perpetrators do not repeat their offences. I hope she feels that her work has been rewarded. I know that was not what she was looking for, but she put a great amount of energy and thought into a very difficult subject.

Turning to the Bill, I want us to think about where we might be in 2020. As I said on Second Reading, I suspect there will be at least one more devolution Bill—possibly two—so the Bill under discussion is getting the ball rolling, and as we progress I think that many of the edges to which Members on both sides of the Committee have rightly referred will be knocked off.

If the Government were minded to approve the 38 bids they have received, that would give devolution to about 80% of English local authorities. There is, therefore, not a lot more to do in terms of taking coverage further, but there is a lot more to be done in a number of specific areas. I hope that the Minister, who kindly said he would listen carefully to my remarks on my proposed amendments, will be able to use them and others to ensure that we get a practical devolution settlement that sticks and delivers for people. That cannot happen under this Bill, which is about beginning the evolution of the process. I commend the Government for that.

I am pleased to see present one colleague from the Scottish National party, the hon. Member for Glasgow Central (Alison Thewliss). Whatever our differences with the SNP, it is not the only party that got votes in Scotland at the general election, although one could be forgiven for sometimes thinking that that was the case. In fact, if we were operating under a proportional system, many more Labour, Conservative and Liberal Members of Parliament would be representing Scotland.

Putting that aside, we can learn a great many things from the package given by the Westminster Parliament to Scotland after intense negotiations. It could be used as a template for further English, Welsh and Northern Irish devolution. We should try, with a lot of humility, to understand how the package—which resulted from negotiations prior to the referendum—works, how it came about and how it could be applied to the rest of the UK. The answer to any argument in favour of separatism is that everybody in the United Kingdom should enjoy the maximum amount of devolution and run as much of their own affairs as possible, whether that be nationally—as in Scotland, Wales, England and Northern Ireland—locally, or at the level below that of the local council.

[Jonathan Edwards]

I am grateful to the hon. Gentleman for tempting me to intervene on him. Does he share my disappointment with the draft Wales Bill, which was published with much fanfare yesterday, but which pales into insignificance when compared with the powers made available to Scotland? The ad hoc nature of devolution across the UK is inherently unstable. Of course, my hon. Friend the Member for Glasgow Central (Alison Thewliss) and I want to go further than the Scottish settlement, but surely that is the benchmark we should be working towards.

[Mr Allen]

Unless there is a written settlement, there has to be an evolutionary settlement and someone has to pile in first, make the breakthrough and be a pioneer. In terms of the nations of the United Kingdom, that has been Scotland. All those who contributed to that devolved settlement—including, obviously, Donald Dewar, but also the Scottish Constitutional Convention and many others in civic society—deserve acclaim for their achievements. It is up to the rest of us, whether we are in Wales, England or Northern Ireland, to go through the gap and say, “Devolution is a great thing.” It is not an expedient to buy off Scotland, but a matter of principle that should be applied equally, and at an appropriate pace, to Wales, England and Northern Ireland.

--- Later in debate ---

[Mr Allen]

My hon. Friend is absolutely right. A proper redistribution mechanism—whether it is based on the amount received from income tax, business rates or any other taxation—must be in place; otherwise the system could be distorted and deeply unfair. That is why my amendments, which my hon. Friend will have read, suggest that equalisation should be central to the process; otherwise we will end up with the disjointedness he mentions.

[Jonathan Edwards]

In addition to the point made by the hon. Member for North Durham (Mr Jones), does the hon. Member for Nottingham North (Mr Allen) think there is a relationship between fiscal decentralisation and the geographical wealth of the countries that he mentioned, including the United States, which is far more balanced than the gross imbalances in the UK?

[Mr Allen]

No, I do not believe that is the case. That happens everywhere. Although I am very much an ardent devolver, I believe there is always a place for the federal level. President Clinton was not denied his wish to introduce Head Start to every state in the union. He did not impose it, but he offered it as a federal programme and virtually every state picked it up. Devolution would not diminish our role in this place to do good things, and it certainly should not diminish our role in insisting on the sort of equalisation that my hon. Friend the Member for North Durham (Mr Jones) has in mind.

Drugs: Ultra-rare Diseases

Jonathan Edwards Excerpts

Tuesday 16th June 2015 Westminster Hall

[Jonathan Edwards (Carmarthen East and Dinefwr) (PC)]

That system sounds excellent. I commend the Scottish Government on their work. That could be a great help to my constituent, Mr Trystan James, who suffers from tuberous sclerosis complex and is reliant on a clinical trial drug to deal with a life-threatening tumour. Of course, his drug prescription is therefore completely at the discretion of the drugs company and his family are going from one prescription to the next. That relates to what the hon. Member for Strangford (Jim Shannon) said about emotional pressure on families. I commend the Scottish Government on their work.

[Dr Whitford]

The important thing to remember is that if this is all done by individual requests, the NHS does not go to the companies. We need to realise that companies have often made investment over decades and that nine out of 10 drugs they research will go nowhere, but it is important to have a wider debate with companies to get the best price. Hon. Members mentioned that some companies are willing and able to reduce the price to get a drug in.

Drugs are licensed. We must not mix up licensing with funding. Licensing is about asking, “Is this drug safe and proven at a basic level?”, not anyone coming in and saying, “Rare plant juice will cure everything.” These are licensed drugs that we could prescribe—a doctor has the right to prescribe them—but the NHS has to make the decision about whether to fund them; those are funding decisions, not licensing decisions.

It is important that families know what the pathway is and how they move on when their clinician takes a case forward. It is important that they know they can respect decisions and how to lobby at the next step, and that they feel their voice is being listened to. We feel that PACE has, over more than a year, allowed us to do that. Clinicians in Scotland got frustrated about decisions going through without us informing that decision.

There could be a system that sits on the side of NICE, or a sub-group. One of NICE’s three assessments will never be given over to a drug intended for 88 patients when it is also assessing drugs that might be taken by 500,000 people. Rare diseases would always fall behind, and that is why those must have their own system and why the patient voice must be heard in these ways. Obviously, things have changed with the Health and Social Care Act 2012, but I commend such a structure to the Minister.

National Health Service (Amended Duties and Powers) Bill

Jonathan Edwards Excerpts

Friday 21st November 2014 Commons Chamber

[John Healey]

I would expect these trade negotiations to stretch into at least the end of next year, so I hope and expect that the responsibility for making sure that this deal is good for Britain will become that of a Labour, not a Tory, Government and of Labour Ministers, not Tory Ministers.

[Jonathan Edwards (Carmarthen East and Dinefwr) (PC)]

rose—

[John Healey]

I will give way to the hon. Gentleman before finishing on the issue of the Prime Minister, which my hon. Friend the Member for Edinburgh East (Sheila Gilmore) has just raised.

--- Later in debate ---

[Jonathan Edwards]

I am grateful to the right hon. Gentleman for making a very important point about TTIP. I know that the Scottish Government want the Scottish health service excluded and I would hope that the Welsh Government would have the same position. Is there not an onus on the UK Government to make those representations on behalf of the devolved Governments?

[John Healey]

Indeed. There is an onus, a responsibility and, I would argue, a duty on British Ministers to make those representations and to secure those protections in any deal for the whole of the UK.

Finally, the Prime Minister made his most personal pledges before the last election to protect the NHS and to stop top-down reorganisations. He has broken those pledges to the British people, and the damage that he and his Tory Ministers have inflicted through this NHS reorganisation and legislation has been unwanted, wasteful and wrong. It will fall to a Labour Government, after May, to put right this damage and to rescue the NHS, as my hon. Friend the Member for Eltham said in his opening speech, just as we did in 1997. This Bill—it is why I am pleased and proud to support it—is an essential step towards doing that, but the election of a Labour Government must follow if we are to do the job properly.

--- Later in debate ---

[Andy Burnham]

Yes, I am aware of the deal, and it is a great example of how a Labour council, working with the NHS, can take steps to improve funding for front-line patient care. It happened because of the deal that was struck in the latter stages of the previous Labour Government.

As a result of the Health and Social Care Act 2012, NHS hospitals can earn more money from treating private patients, while NHS waiting lists get longer. Those same hospitals have now been told by competition authorities that they cannot collaborate any more because it is “anti-competitive.” How did it come to this? That is not the health service that we have known for 66 years. Every day that this illegitimate legislation remains in force is a day closer to the demise of the national health service.

[Jonathan Edwards]

In response to an FOI request, I was told by my local health board that between December last year and July this year, 373 ophthalmology patients, 90 pain management patients, 165 neurology patients and 264 orthopaedic patients were transferred to private sector providers at a cost of nearly £600,000. What is the right hon. Gentleman’s message to his Labour colleague, the Health Minister for Wales?

[Andy Burnham]

I will give the hon. Gentleman my message now: the Labour Government in England and in Wales have taken steps to bring down NHS waiting lists. When we left office, they were at the lowest ever level. I make no apology to him for those improvements.

The 2012 Act has put the NHS in danger, which is why it has to go. Back on that March day in 2012, I pledged that the party that created the NHS would repeal that Bill at the first opportunity, and today we honour that promise. The Bill before us, presented by my hon. Friend the Member for Eltham (Clive Efford), restores the right values at the heart of the NHS: collaboration over competition; integration over fragmentation; people before profits.

Care Bill [Lords]

Jonathan Edwards Excerpts

Monday 10th March 2014 Commons Chamber

It is estimated that about 300,000 care workers are on zero-hours contracts. Some people might genuinely want to be employed on that basis, but thousands do not, because it makes it virtually impossible for them to budget for themselves and their families, to secure a home—some cannot even afford to rent a home, never mind get on the housing ladder—or to plan their lives. Those arrangements are also not good for the people using the care services: they need to know who is coming to look after them. Imagine having someone different coming in each morning to get you out of bed, take you to the toilet and wash you. You would want to know who was coming in; you would want continuity of care.

[Jonathan Edwards (Carmarthen East and Dinefwr) (PC)]

The Social Services and Well-being (Wales) Bill is going through the Welsh Parliament. My party tabled an amendment to the Bill that would have prohibited the use of zero-hours contracts in the care sector in Wales, but the Labour Government there voted against it. How disappointed is the hon. Lady with her colleagues in Wales?

[Liz Kendall]

I am sure that my colleagues in the Welsh Assembly want to do everything they can to improve care and support. Today we are discussing the care sector in England, and I hope that the hon. Gentleman will give his support to what we are proposing.