Health and Care Bill (Fourth sitting)
Justin Madders ExcerptsThursday 9th September 2021
(2 years, 7 months ago)
Public Bill CommitteesRead Full debate Health and Care Act 2022 View all Health and Care Act 2022 Debates Read Hansard Text Read Debate Ministerial Extracts Amendment Paper: Public Bill Committee Amendments as at 9 September 2021 - (9 Sep 2021)
Justin Madders (Ellesmere Port and Neston) (Lab)
Q
Nigel Edwards: This took us all somewhat by surprise, I think it is fair to say. Richard may have had a different briefing from the Department of Health and Social Care on yesterday’s announcement. I picked it up on reading the document; it was not pointed out to me. I think I read it slightly differently. It seemed to me that the plan was likely to be a formalisation of all the activities that are currently going on, rather than a new direction of policy, but I am probably the wrong person to be asking about that. If it is not that, it would not be very helpful.
Richard Murray: One of the things the documentation speaks about is the planning of the health and social care workforce. You asked where I think the Bill is deficient. One example is its inability to help with the very poor track record, over quite a long time, in planning the health and social care workforce—hence all the problems that we have with the workforce right now. There is a nod in the White Paper to that. It may only be that the crossover between those two workforces is not the fundamentals of the numbers that go through them.
Otherwise, I really hope that the White Paper is not about further legislative change. It might be about setting out, for example, the outcome measures that would really work for an ICS, meaning that it will cover both critical issues for the NHS and critical issues for health, public health and social care, to make sure that you have that rounded and meaningful measure so you know who is doing well. If it is another round of legislation, I must admit that I would pause before saying whether that is a good idea, with the exception of the workforce issue, which remains the critical factor here.
Justin Madders
Anything to add, Nick?
Nick Timmins: The workforce does need to be tackled—it is just a glaring hole in all this. The NHS has plenty of policy at the moment; it has had an eight-year drive towards better integrated care—that is what the Bill is focused on—and a lot of that will not come through legislation, beyond what is in the Bill.
Justin Madders
Q
Nigel Edwards: Each ICS is supposed to have a chief finance officer—a director of finance—and an accountable officer. That is the starting point. I think the question to ask them would be to what extent they are spending money in a way that reduces health inequalities and improves outcomes in an equitable fashion—I think they would want to do that. One of the things that has very much struck me in my conversations with ICSs—this is very much influenced by local government, which will be a powerful advocate for this, as will primary care networks—is that quite a lot of people will be scrutinising this. The person to ask who is clearly accountable for answering that question is the accountable officer of the ICS.
Of course, ICSs do not have a legal obligation to distribute money below place level. You might not want to do that, because there is a need to be flexible, and sometimes you might want to spend more in a particular area if there is a sudden strategic priority, but over the long term, the expectation is that those accountable officers should be able to demonstrate that they are spending money in ways that relate to the objectively assessed needs of their populations.
Justin Madders
Q
Nick Timmins: I think that is exactly the right question to ask. What have Ministers not been able to get the NHS to do without the powers of direction that he is seeking? When they were presented, it was as though the NHS was somehow unaccountable when, as I am sure you all know, Ministers can tell the NHS what to do through the mandate. The difference in the current system is that NHS England has to agree that what it is being asked to do is reasonable. If NHS England does not think it is reasonable, resourceful or doable, it can object, and the Minister then has to come to Parliament and explain why he is, in effect, instructing the NHS to do something. A measure comes before you and is subject to a negative resolution. If someone rejects it, it can be debated, so there is a perfectly good mechanism there right now. I think the really, really important question is: what are Ministers not able to get the NHS to do that means that they now feel the need for new powers of direction?
Justin Madders
Does anyone wish to add to that?
Nigel Edwards: I have no answer to that question.
Richard Murray: If the reason is not made clear, you end up starting to get worried and suspicious: “Are they trying to direct money towards one part of the country rather than another and overturning the allocation mechanism? Do they want powers to intervene in procurements?” Those are all the things that you would not want them to do which, to be honest, health Ministers generally have not done anyway. Even when they had the powers, they tried desperately not to get involved, because it is extremely poor governance and extremely poor value for money. However, without that explanation of why they want it, the temptation is to start worrying about what they want the power for.
Some of the behaviours could be governed through the framework agreement, or they should be able to be. You have the mandate that sets direction over the short to medium term, but the framework agreement also sets out the way NHS England should work with other parts of the system, so there are other things that you can use within this system. As it stands, and if it stays as it is now, to provide comfort to people, the temptation is to start listing the things that Secretaries of State should not direct—they should not direct allocations to individual parts of the country; they should not interfere in procurement decisions. You end up with quite a long negative list, but I would probably rather have a negative list than no list.
Nigel Edwards: The problem with negative lists, of course, is that you will forget something.
The Chair
We have time to squeeze in one very quick one, if anyone has something else to ask.
Justin Madders
Q
Richard Murray: I think a longer-term mandate is a better thing. The idea that each year, sometime between December and March, you can set a different expectation on the NHS is operationally unreal for the system. They cannot do it, so I think we want to get back to something where you set out a clearer medium-term objective for the things you want the NHS to achieve, whether that is reduced waiting times or better health, and allow them to try and work towards it.
Budgets on that basis would also be incredibly helpful—if you are working in the service not knowing what capital you might have two years down the line and what revenue you might have. I think there is a real chance to do that in the spending review. That is a move in the right direction; we just have to make sure that if the budgets are still set on an annual basis, you do not get a diversion between what it is you have been asked and the budget then being suddenly moved on that annual basis. I would strongly encourage the Government to also try and set multi-year settlements for the NHS, as used to be done, so that people can plan at local level.
Nick Timmins: If memory serves me right, the original idea of the mandate was a rolling three-year mandate. You set the objectives of the NHS and what you want it to achieve, and you can have a little review of it each year, but it is clear. I probably should have said that if the money was also planned on the same basis, that would help no end.
The Chair
That brings us to the end of our time. I thank our witnesses very much.
Examination of Witnesses
Dame Gill Morgan and Louise Patten gave evidence.
Dr Whitford
Q
Andy Bell: We have hugely underinvested in it, and indeed very poorly appreciated it. What we have seen in recent years, which we hugely welcome, is huge progress on mental health awareness and understanding. That was not there 10 or 15 years ago. It has not been that long since in a debate in the House of Commons the first Member stood up and spoke about their own experience of mental illness; that was hugely powerful, and began quite a significant social movement. However, we do not yet have literacy around that issue, or indeed a real understanding about what we can do to promote the public’s mental health. With the creation of the new Office for Health Improvement and Disparities—I must remember to get the name right—there is an opportunity to make public mental health as important as public physical health. How we translate that to local areas will be really interesting.
When I talk to people working in local public health departments, I see a huge enthusiasm for and interest in how they can better support mental support in the communities they serve. We have seen incredibly creative work from around the country, such as in Leeds and Bristol, from public health teams that are leading the way who understand that the things that determine our mental health are very much about the society and environments we live in—the families we come from, the schools we go to, the amount of income we have, and the homes and neighbourhoods that we live in. There is a growing understanding of that. However, we have not yet put that into practice on a large scale, and indeed the resources available to public health departments to do that are very threadbare. Many have to be very creative in how they do that.
We very much welcomed the promotion and prevention fund set up recently by the Government, which gave funding to local authorities in the 40 most deprived local areas in England for mental health promotion activities. We are really looking forward to seeing what that money is used for, and we very much hope that it will be the beginning of something much bigger. Our worry, in relation to the Bill in particular, is the understanding of prevention, and indeed the understanding of prevention that I read in yesterday’s Command Paper on the health and social care plan. It is still based on physical health, and the idea that public health is about telling people how to live their lives and how they should behave, rather than what really determines our mental health: how much money we have coming into our home, how safe we feel, and our position in society. It is really clear that very often the way that economic and social inequalities affect our mental health also affects our physical health. Very often it is poor psychological wellbeing that leads to later physical health problems, so we really have to start taking public mental health as seriously as any other part of public health.
Justin Madders
Q
Ed Hammond: The obvious mechanism is the Secretary of State’s power of intervention. It is all about that referral upwards really to the Secretary of State to act. Ideally, these kinds of things can and should be resolved through dialogue, because the Secretary of State can intervene only so much. One of my worries about the focus in certain elements of the Bill on the new and enhanced powers of the Secretary of State is that it sort of assumes that the Secretary of State will need to have fingers in lots of pies to be aware of where these issues are occurring across England, and be prepared to step in where they are happening, which requires the exercise of a significant watching brief across a wide range of areas in a way that does not currently happen.
Ideally, these kinds of things can and should be thrashed out by the people involved at local level. The Secretary of State can intervene but does that intervention persist if relationships have effectively broken down? What do you do then? You cannot run everything from Whitehall; there has to be some kind of mechanism to rebuild relationships and trust. One would hope that it would not get that bad, but I know of past tensions. There are divergent priorities between local authorities, NHS partners and other partners in respect of health and care issues. The logic of ICPs is that you are aligning those priorities better, but that is not guaranteed.
That is one of the reasons we consider that there should be a role sitting with local health scrutiny committees to escalate matters of particular concern to the Secretary of State, so there is not this assumption that the Secretary of State is exercising a continual watching brief over everything that is going on. There is that formal power of escalation from an external body holding the system to account that can, before that escalation, exert some kind of influence at local level to try to knock heads together and bring some form of agreement in place, so that you are not in a situation where you have a persistent assumption that Whitehall will need to step in in every case where these kinds of issues occur.
Justin Madders
Q
Andy Bell: At the moment, it is really impossible to say. I would like to see the Bill achieving parity of esteem for mental health. As I say, the principles of integrated care could certainly enable that to happen, if combined with a lot of other very significant and important activity to shift the culture in the health service, apart from anything else. The lack of specific provisions in the Bill to ensure that parity is taken seriously is a real worry. I think there are still gaps in the Bill that could be very simply addressed and would help to ensure that system leaders, wherever they are—whether they are on integrated care boards or any other three-letter acronym that gets created—realise that their personal responsibility is to bring about parity for mental health.
I think we are at a point now where there is some recognition in most parts of the system that mental health is important, but very often, outside specific mental health services, there is still an assumption that mental health is something other people and other organisations do, and there is not that shared responsibility for it in quite the way that we think would help to move us forward.
Justin Madders
Q
Andy Bell: This is incredibly difficult. We have some very ambitious plans now—the NHS long-term plan ambitions for mental health. There is, quite rightly, an awful lot of money going into that, because we have a very big gap in our ability to meet people’s needs. The only way that is going to succeed is if we have a very significant expansion in the mental health workforce.
We need to remember that that workforce is not just what people think it is. It is obviously nursing and obviously psychiatry, but it is also social work—a lot of really important mental health provision is in local government under social care. We need to think about the importance of advocacy and the importance of peer support, the importance of employment and housing rights workers, who we know make a big difference to people’s lives. There is also the key role of the voluntary sector in providing forms of support that may not come under traditional clinical headings, but none the less make a huge impact in people’s lives. We need to build the workforce.
The Bill gives some steps forward and summary assurances. In some ways, it is not quite the right place to be dealing with this. This is about whether the various parts of the system—the health education system, the NHS itself and its partners in local government—have the resources and the right ways to encourage people to come and work in mental health. It would be great to see the kind of recruitment campaigns we have had for the NHS as a whole to really help bridge that very big gap in the mental health workforce. At the moment, I think the Bill is probably neutral on it. It would be good to see some stronger assurances, at the very least holding the Secretary of State to account for how they are achieving the workforce ambitions set out in the long-term plan and future policies that will have to come.
Edward Argar
Q
Building on what you have already said about the legislation, what would you identify as the opportunities of the legislation, if properly implemented or interpreted in the right way, for furthering that linkage and that joined-up mental health provision? Obviously, that goes beyond local council services and the NHS. There are a whole wraparound series of services that impact on someone’s mental health. What do you see as the opportunities in the legislation that we either need to draw out further or at least not lose sight of?
Andy Bell: This is about building real, sustainable, long-term partnerships. One of the things I know colleagues in the NHS and local government find very frustrating is that they just find a way of working with each other and then the legislation changes again and they have to start all over, so it is about having a system that actually works and stays working, that builds on the best of what is there already. I think there is some frustration in places where they spent a long time building relationships between clinical commissioning groups and local authority colleagues, sometimes with jointly employed staff, and now they have to start all over again because we are moving to a different thing. That will be immensely frustrating for many folk.
If we take the principle that this is about integrating care and equal partnerships between different players, including the voluntary and community sector, and if we give that time to work, we will enable partnerships to form with a clear voice for people—for example, in the case of mental health, for people living with mental health difficulties—so that decisions are being made with and in partnership with the people who use them rather than remotely by professional experts on their own.
Collaboration is incredibly important too. One thing we really welcome about the Bill is that it is moving us away from a system of competing providers to providers working collaboratively—literally, in providing collaboratives. There is a slight risk that all the power will be vested in one organisation and there will not be that check and balance between commissioner and provider. But some of the early provider collaboratives working in children’s mental health services that we have looked at have made really huge strides really quickly to reduce, for example, the number of children forced to go to hospital outside their local area in a mental health crisis. They have come together, looked at what support is needed for children in a crisis and put community services, in particular, in place to achieve that.
One further thing that will be important is that there is some positive provision in the Bill to ensure that ICBs—I think it is ICBs, yes, it is—have to take into account inequalities in access and outcomes. That is great, but there is not that requirement to pay attention to inequalities in health and to go out and identify which groups of people are experiencing health inequalities and what the system can do to deal with that upstream rather than waiting for people to need formal healthcare. That would be the other part that would really help in the Bill—to build on some of the positive noises and moves in the right direction in collaborating at the level of prevention and on the things that determine our health as well as in the provision of services when things have reached a point where people need care.
Dr Whitford
Q
Stephen Chandler: I will come back to you on that. I cannot immediately think of a part.
Justin Madders
Q
Gerry Nosowska: It is a genuine concern, yes—partly because, as Stephen was saying, it was rolled out very rapidly, at scale, during an unusual and very pressured time. Social workers have often been involved in those transitions, and very well, to advocate and to ensure that the person’s voice is heard and that people do not get lost somewhere in the system or forgotten, but the concerns are around the potential weakening of that social work role.
Not everybody will need that, but I advocate for a social worker being available to anybody who might need that kind of co-ordination, therapeutic support and advocacy at the point of such a major life transition. We want a review of the model, but we also have concerns about just taking out wholesale all the elements around notification of social care and everything that was in the care Act. A lot will hinge on what the statutory guidance says about this. We must make sure we do not lose people in the system, because there is always an incentive to free up a valuable resource in hospital, but our statutory job is to promote wellbeing.
Justin Madders
Q
Gerry Nosowska: My understanding was that the discharge to assess was due to be reviewed, but I do not know why there has been a delay on that.
Justin Madders
Q
Gerry Nosowska: I am not aware of a large-scale, formal review of it, no.
Justin Madders
Thank you. That is all I have, Chair.
Stephen Chandler: If I could help, I am aware that the Department of Health and Social Care has undertaken a review of some discharge to assess arrangements. It is not a national review, but I think about eight separate systems have been subject to a review. I have not seen the outcome of it, but a review of a limited capacity has taken place.
Health and Care Bill (Third sitting)
Justin Madders ExcerptsThursday 9th September 2021
(2 years, 7 months ago)
Public Bill CommitteesRead Full debate Health and Care Act 2022 View all Health and Care Act 2022 Debates Read Hansard Text Read Debate Ministerial Extracts Amendment Paper: Public Bill Committee Amendments as at 9 September 2021 - (9 Sep 2021)
Justin Madders (Ellesmere Port and Neston) (Lab)
Q
Dr Chaand Nagpaul: Yes. If you repeal section 75 but do not allow the NHS to be a preferred provider, we believe that opens the door for contracts to be handed out to the private sector and undermines the NHS.
Although it may fall out of scope, the point is that there is every reason for the NHS to be a preferred provider. The point I am making is that the NHS really is effective and cost-effective, and allows for a population approach from providers that have accountability to local populations.
The other problem we have at the moment, unless you put in legislation to make the NHS the preferred provider, is that at the moment a lot of contracts are going out to the private sector and are affecting workforce training. In some areas, cataract operations have been moved en bloc into the private sector, meaning that ophthalmology trainees are not even seeing them, and the providers that are providing cataract operations are being paid the same sum of money but not providing the full service.
Another problem we have at the moment is cherry-picking. It has been there since 2012 and nothing in this Bill is legislatively addressing that. It means that you pay the same amount to a hospital—I am a GP and there is a list of exclusion criteria for any patient who has co-morbidities or complex conditions, so I cannot refer them there—but when something goes wrong in the middle of the night or on a weekend, they end up in the A&E of our local hospital.
That is why we believe it is really important that the Bill is amended to make the NHS the preferred provider; that is what we are referring to. We believe it will allow for a much more co-ordinated, accountable, locally focused and population-approach health service.
Justin Madders
Q
Dr Chaand Nagpaul: If we have a Bill that is designed to support the NHS, we just feel that it does not make sense to then allow a private provider to sit on a commissioning board. We believe that there is an inherent conflict of interest. It is really important to understand that there is a difference between the private provider and the NHS. The private provider is ultimately driven by its financial motives, and to be sitting on a board influencing the spend of money where it may have an interest is a conflict of interest. That does not apply to the NHS. A doctor from a hospital does not have any financial gain to be made. I come back to the fact that we need to support the NHS, not as an ideological principle, but because it actually works.
Justin Madders
Q
Dr Chaand Nagpaul: No, I do not. If the NHS cannot provide a service—if it does not have the capacity—and there is a private sector contract, the private provider needs to be held to account to deliver. As I say, I think the same rules should be applied, so that if there is a complication, they need to be accountable for that complication, rather than the patient going back to the NHS, which picks up the pieces. There is a need to hold private providers to account where they are contracted to provide care, but we do not approve of them sitting on the commissioning board, which is about the use of public resources in the interests of local populations. That should be a commissioning decision, and commissioners who are accountable to the NHS and providers of the NHS should be sitting as part of that arrangement.
Justin Madders
Q
Dr Chaand Nagpaul: Sure. One is the NHS mandate, which spells out how the NHS functions. At the moment, the powers allow the Secretary of State to amend the mandate. We would like that to be affirmative. We would like it to be approved by Parliament, and therefore Parliament would vote to agree changes to the mandate. That is one area.
The other concern is about the local reconfigurations. We know how politically sensitive these things can be. We would not want the Secretary of State to have disproportionate powers in those arrangements, which will often be more susceptible to political influence. We think that those need to be safeguarded by mandated clinician involvement, so that we make the right decisions about local services. It is a counterbalance: we want a health service that has local clinician leadership, but on the other hand the Secretary of State can intervene. We think that is an amendment that needs to be made.
Justin Madders
Q
Sara Gorton: There are a couple of points to raise here. First, we would like to see in the legislation confirmation of what we have been given assurances of in guidance and conversation—that there is no intention for any new parts of the system to undermine the existing collective arrangements and that, for the workforce I represent, the collective agenda for change agreement would apply for their staff. There is a very clear amendment that could be supported to ensure the new bodies are listed as what are called annex 1 employers in the relevant terms and conditions documents. That is one aspect.
The other aspect is the role that the provider selection regime can play—sorry, not the provider selection regime; what are called the people responsibilities, which are set out in some of the guidance materials that have only been recently published to support the legislation. They set out 10 areas relating to workforce over which the new bodies may have scope. We would like to see those areas of scope clearly defined within the legislation. That is why what I said earlier about the commitment to involve staff through the constitution promise is so important. We want to ensure that, if decisions are made at system level that undercut the role that staff have in making decisions within providers—if there are overarching decisions made about workforce—staff have an opportunity, through their representatives, to understand what the impact might be and to influence that conversation.
Justin Madders
Q
Sara Gorton: We are supposed to stick to polite language in here, aren’t we? You can all probably imagine what most of our members feel. Sticking within the scope of the Bill, as we have been asked to, the relevant segue is to go back to the extension of the provider selection regime to the non-clinical services. We are strongly supportive of the measures that have been put in place to ensure that service sustainability and social value are taken into account. Clearly, however, extending those provisions to non-clinical services would create a culture of in-sourcing, of valuing all members of the healthcare team equally, and place those on an equal footing.
Justin Madders
Q
Sara Gorton: As you have hopefully seen in our briefing, we are calling for that to be either explained in much more detail in the guidance, or dropped from the legislation. We are already seeing concerns from regulated occupations that this could lead to a sort of “regulation-lite” scenario, and there are concerns that, without it being clear exactly what the proposals would entail, this could be a hostage to fortune. We would very much like to see some clarity on that, or have it taken out at this stage.
Justin Madders
Q
Sara Gorton: What we are more concerned about is the potential risk that, if involved in the ICBs and in the partnerships, they could exert influence over the exploratory stage of discussions, which could tilt the balance their way. That seems out of kilter when we do not have clarity that staff of the NHS will have the opportunity to be involved at the same sort of level. We are very keen to ensure that we support amendments making any of the processes, and the way that the boards meet, more transparent, and, clearly, subject to the freedom of information process.
Justin Madders
Q
Sara Gorton: At the moment, there is no explicit route through. What is set out in the published guidance documents is that the route for trade unions to be involved will be through the regional structures of NHS England and NHS Improvement. That is at a distance, and potentially after decisions have been made. Putting in a clear link, through that staff pledge in the NHS constitution and having that underpinning in the legislation, would really make clear the principle of staff involvement and engagement at the earliest stage of decisions.
The Minister for Health (Edward Argar)
Q
To both of you, do you think that now is the right time? I know that Chand has answered that, but this second part might apply to him: if it is not, when is the right time?
Sara Gorton: We were strong opponents of the 2012 legislation, so, in our view, the right time to do this would have been to not put that legislation through. However, we have been waiting for this batch of changes for some time. It has been evident, from 2013-14, and certainly since the “Five Year Forward View” was published, that what we were doing was having a structural workaround with people tacitly agreeing to almost ignore legislation. That is just not acceptable in the system.
Certainly, for my members who have been moved into new arm’s length bodies, moved around those bodies, and are now subject to another change, they want the security of knowing who is going to be employing them this time next year. In our view, the changes, both to the competition and procurement regime, and to clarifying how the new bodies will operate and what powers they will have, cannot wait. There are lots of other aspects that, as you can see from our briefing, we suggest could wait for future debate.
Dr Chaand Nagpaul: I want to be clear: we do not support the status quo. There is a pressing need to repeal much of the 2012 Act. However, I cannot overestimate how much the pandemic has affected us. We have not been able to be engaged, so it has to be asked: why do we need the Bill at this moment in time, when we are all absolutely overwhelmed? We know that any reorganisation of the health service means that people get distracted from their core work. The process of reorganisation takes human resource time. We have not been able to engage with this as we should, so we do not think that this is the right time.
The right time would be decided by two factors: first, when we are through the worst of what we are going through at the moment, and secondly, when the legitimate concerns we have are addressed, and there are the amendments that we would like to see. This Bill can shape the future of our health service. Get the right Bill, at the right time.
Justin Madders
On a point of order, Mrs Murray. On the Minister’s question to the BMA witness about previous Acts that the BMA may have endorsed, that would clearly be out of scope as evidence. I would not want Dr Nagpaul to waste time researching an answer that the Committee could not take into account.
Edward Argar
Further to that point of order, Mrs Murray. Would it help if I set out the context in which I believe that question relates directly to the content of the Bill? Much of what is discussed in the Bill relates to previous legislation that has grown up over time; understanding which pieces of legislation the BMA supports will help us to better understand the evidence it has put forward on this legislation, and its context.
Health and Care Bill (First sitting)
Justin Madders ExcerptsTuesday 7th September 2021
(2 years, 8 months ago)
Public Bill CommitteesRead Full debate Health and Care Act 2022 View all Health and Care Act 2022 Debates Read Hansard Text Read Debate Ministerial Extracts Amendment Paper: Public Bill Committee Amendments as at 7 September 2021 - (7 Sep 2021)
Justin Madders (Ellesmere Port and Neston) (Lab)
Q
Dr Navina Evans: I will give you three points that are really important. One is the absolute priority, focus and prominence given to looking after our workforce. Again, we will build on work that we have already been doing in the last few years. For example, in the interim pupil plan, there is a very strong focus on wellbeing, culture, leadership and retention. We have been working, together with Danny’s organisation and others, on thinking with staff about retention. One thing that is really important is looking after people. There are lots of good examples of work being done all around the country to improve wellbeing and therefore retention, and to minimise or prevent burnout. This is quite high on the agenda for our partners in NHS England and NHS Improvement. It is very high on the agenda for us in HEE, because we look after our students, trainees and learners, who are also part of the workforce, and they tell us what helps to keep them well and prevent burnout. We need to start doing that work, which is part of our business, very early on.
I am pleased to say that our partners in the universities, royal colleges and other professional bodies are really mindful of this. They all have work streams around wellbeing and preventing burnout. In the Bill, we can highlight the importance of this, and build on work that is already being done to look after our staff.
The Chair
Thank you. I intend to move to the SNP spokesperson at 10.15 am, and to the Minister at 10.25; the session ends at 10.30. If we can keep questions and answers succinct, that would be appreciated.
Danny Mortimer: Noted, Mrs Murray.
I agree with everything that Navina has said, and it is a huge focus for the health service. In terms of supporting the health and wellbeing of staff, I think the Bill can go further under the terms of clause 33—it represents the conversation that we have had with them a couple of times. Absolutely we should support people and absolutely we should care for them, but if there are gaps in their rotas and in their teams that only increases the pressure on people who are already working flat-out. The pandemic has shown us starkly where those gaps and needs are, but we were experiencing them before the pandemic. There are parts of our workforce—mental health, learning disability nursing and some of our smaller allied health professions, such as therapeutic radiography—that absolutely need urgent long-term investment. We need that investment in staff as well as in the pressing need that we saw covered in social care settings and in hospitals during the pandemic. The requirement for a regular assessment of what the health and social care system requires to meet the needs of the population would help us to support that.
Justin Madders
Q
Danny Mortimer: I do not know to what extent Parliament is able to, or is willing to, pre-commit Governments to funding decisions such as you have described. Absolutely, that would bring clarity for us all in terms of what was needed, and it may well offer clarity in terms of the prioritisations that we have to make on investment in the workforce. We have seen a massive expansion in our medical workforce, particularly in hospitals, in the past 20 years, but we have not seen a similar expansion in the nursing workforce. That is not something that was clearly set out for us and for a Government to help make decisions about. I think a clearer, more effective clause 33 would help a Government to do that, and in turn help a Parliament to support a Government in that.
Justin Madders
Q
Dr Navina Evans: We expect to go back to the Minister with our findings by early March. After that, we will have a clearer understanding of when we will publish our framework.
Justin Madders
Q
Dr Navina Evans: From our perspective in Health Education England, our input is quite confined to the workforce planning. We are able to manage within our existing resources and to redefine and redeploy them. We are also able to work collaboratively with partners who are very willing to help us in this work.
Danny Mortimer: I cannot give you an exact figure, Mr Madders, but I can reassure the Committee that the way in which the proposed change will be implemented is much more about minimising the organisational disruption change that we have experienced with previous reforms, either the one 10 years ago or the one a decade before that. We are seeing a clear commitment to move staff who are currently employed in clinical commissioning groups—the Bill will disband those groups—to the new ICS organisations. That is a very positive way of managing the change rather than that experienced previously, which was hugely time-consuming in terms of management time and hugely unsettling for vital staff in terms of planning services. We are avoiding the problems that we faced in the past. Amanda and her colleagues at NHS England are to be commended for the proportionate and sensible manner in which they are looking to implement the changes, especially in terms of how they impact on people and organisations.
Justin Madders
Thank you. For the last minute, I am going to hand over to my colleague.
Alex Norris (Nottingham North) (Lab/Co-op)
Q
Danny Mortimer: We have a really constructive set of relationships in the NHS with our trade unions, on both terms and conditions and the social partnership forum, which the Minister’s colleague Helen Whately chairs and which brings trade unions and employers together.
There is an interest in how the health service organises itself, and there is an interest in how the health service and our friends in social care can better work together to relieve the pressure that our colleagues were experiencing even before the pandemic. Of course, there are other things that people are interested in as well. There are outstanding questions about long-term pay strategy, and there are other issues around working environments and support that Navina touched on. Those are really important as well.
There is a recognition, when I speak to trade union leaders and representatives, of the opportunities available through system working to improve service delivery, and therefore to help their committed members do their jobs better and relieve the pressure that they have been under for far too long.
The Chair
Thank you. We now move to the shadow Minister, Mr Justin Madders, and Mr Alex Norris.
Justin Madders
Q
Amanda Pritchard: One of the really important things in all of this, of course, is that we do not over-claim for what the Bill will achieve. If I look at what has happened in the NHS over the last 18 months to two years, it is absolutely clear to me that the ability to work together has been critical to the ability of the country to respond to covid, and the opportunity now to strengthen those arrangements, write them into legislation and remove some of the barriers that exist will be an important factor in helping the health service now, in partnership with local government, education and others that we have talked about, absolutely to recover from the challenges of the last year and to continue to build on those really strong local arrangements that have been such a hallmark of the way that things have worked over the last couple of years.
But of course, that is only one part of what it will take for the NHS to respond to the challenges that we have at the moment. It is absolutely right that the NHS staff, who have worked so tirelessly over the past two years and of course beyond to look after what we now know are over 400,000 covid in-patients, get the backing and the funding they need, not just to deal with what is very much still with us, with covid in our hospitals and communities right now, but absolutely to make sure that we are as front-foot as possible in tackling the inevitable backlogs that have built up over the past couple of years.
There is a complex set of things. Workforce is critical: the support we give to the people who have already done so much for us—we continue to invest in them and support them, so that we have the right pipeline for new staff joining, the right skills and the right support. Then there is the funding that we need to do the work that we have, and the capital funding to invest in some of the transformation that has already begun and needs to continue. But also, I think the Bill provides us with the framework to continue to support that really powerful local joint working that we have seen over the last two years, and which we are already seeing really at the heart of the covid recovery within the NHS and more broadly.
Justin Madders
Q
Amanda Pritchard: It is worth saying that there are some big unknowns in the position at the moment. We just do not know, really, how covid is going to play out over the next few months and years. One of the things that colleagues have talked about, and are very aware of, is that a lot of people did not come forward for care over the past two years. One of the messages that I would like to give again is that, for anyone who is concerned about symptoms, the NHS is absolutely open for business. Please do come forward and seek diagnosis, treatment and support.
We do not know, as we sit here today with two big variables, quite how things are going to play out. What we can say for certain is that today we have over 6,000 people with covid in hospitals. It is costing the NHS more both to care for those patients safely, with all of the infection control arrangements that need to be in place—
The Chair
Thank you for that, but I just remind the shadow Minister to keep within the scope of the Bill.
Justin Madders
Q
Amanda Pritchard: Actually, in some ways that does link to what I was just saying, because—you would expect me to say this—just to reflect the reality of where we are now, covid is still with us, but we also have a real commitment and opportunity to lean in now to that recovery of routine services. I think success looks clearly like we now have the platform right to be able to continue to evidence that local partnership working is really making a difference. What does that mean? It means partnership in practice, both to deal with the current challenges that the NHS is facing and will continue to face, and to start to show that we can really eat into the backlog of routine care that we know is with us and make the commitment, which I know is felt so deeply across the NHS, to tackling inequalities and really trying to think about some of those long-term planning commitments that talked about prevention and outcomes.
We want to see progress against all those things, but we also want to continue to support local systems, as they have been all the way through, to partner together to continue to deliver things such as the vaccine programme in really innovative ways. For me, this is all about putting the NHS on a firmer statutory footing, whereby partnership becomes the way that we do things, building on what has happened over the last few years and removing any remaining barriers that we know exist and which stop us progressing with the really important job now of improving care for the population and for our patients.
Justin Madders
Q
Amanda Pritchard: Thank you for that, because from the NHS perspective, the reason we have been supportive, particularly of the integration parts of the Bill, is that it is all about what it enables us to do for patients. Mark and I have done a lot over the last few weeks and months. We have seen so many examples in practice of where it is about the ability to work in partnership, whether that is about mental health crisis lines that are partly delivered through the voluntary sector, with a bit of funding from the NHS, but with support from specialists and mental health trusts as well as primary care. It is about coming together to create those sorts of innovative services, whether it is children’s and young people’s services, such as in south-east London, or whether it is in schools, picking up where children and families have medical and health problems. It is about linking them to the right support within local government, housing and so forth.
That is the sort of thing that we have seen develop over the last few years. As I say, it has been turbocharged through covid, but what we now want to do—this is the critical part of the legislation—is to make that easier. We want to make it the norm and allow people the right opportunities to come together and think about what their population needs and what will make services. It is back to the triple aim of improving the health of the population, the quality of care for patients and the sustainability of services. But ultimately, it is about being able to work together to set up those sorts of innovative arrangements, to see them embedded in practice and to see the NHS working in an integrated way around individuals as the norm. Let me bring in Mark, because this is absolutely his operational space.
Mark Cubbon: Thank you, Amanda. Going back to what patients can expect to see, I think they can expect our local integrated care systems to continue all the efforts to engage with our communities and talk about how we are planning to provide more joined-up care for our communities, because that is one of the key benefits that we will get from the new arrangements. There will be fewer hand-offs in care and fewer organisational boundaries for patients to bump into occasionally, so that we can have joined-up conversations and talk about how things are going to be better. Our local systems, leaders and clinicians will be better placed, so that we really face into and talk about how we will reduce the inequalities and deliver better outcomes. That engagement will be really important, and I think we will build on what works well at the moment and continue to make sure that the patient point is front and centre of all that we are trying to do. We have clinicians leading the charge, in terms of the delivery of those services.
Justin Madders
Q
Amanda Pritchard: Mark, do you want to pick this one up? I know you have been leading on this issue for us.
Mark Cubbon: I will indeed. This is definitely a different change from 2012, and probably different from any other changes that have been put in place in previous times as well. We are very much approaching this in the way that we have done. From the outset, we have given a clear message and reassurance to staff who are working in CCGs on job security, so that they know that almost all posts, and the individuals holding those posts, will transfer over to the new organisations. There are not big redundancy bills attached to these changes. We very much want to make sure that the job security is there and that the roles are transferred—
Justin Madders
Q
Mark Cubbon: We do not have a figure for all the changes, but we know that the CCG cost envelope, which is attributed to every CCG as it stands at the moment, is the cost envelope that will be allocated to each of the ICSs as well. We are not expecting the running costs to be significantly different from those that we have for CCGs.
Dr Whitford
Q
Mark Cubbon: The ICB is essentially how the NHS leaders come together specifically to oversee how resources are allocated and how the NHS delivers its side of the bargain, in terms of how the rest of the ICS works and is able to support integration. The ICP—the partnership—is where we bring together other partners who will have a view, an input and a role to play in that integration agenda. That is essentially, at a very high level, the separation of the partnership and the ICB itself.
On how we get representative views from the whole breadth of the clinical community, again this was published in our guidance—we have further guidance that was published last week—which talks about the clinical community, based on all the engagement that has been done so far. The kind of arrangements that we are very likely to see are where we have clinical reference groups and clinical boards that start to shape all the representative views that give a holistic perspective on how services should be planned and how we should be delivering services for our patients and communities.
Although not every individual will have a seat around the board or partnership table, we are advising the boards and clinicians across the whole footprint to ensure there is deep-rooted engagement. We are trying to galvanise the clinical community and get consensus on the direction of travel in terms of how services should be delivered for patients to deliver better outcomes. That is what we are encouraging our local ICSs to do. We are giving as much guidance as possible, but it will be down to this local flexibility so that our clinicians locally can start to work out how they best come together to do all the things I just set out.
Health and Care Bill (Second sitting)
Justin Madders ExcerptsTuesday 7th September 2021
(2 years, 8 months ago)
Public Bill CommitteesRead Full debate Health and Care Act 2022 View all Health and Care Act 2022 Debates Read Hansard Text Read Debate Ministerial Extracts Amendment Paper: Public Bill Committee Amendments as at 7 September 2021 - (7 Sep 2021)
Justin Madders (Ellesmere Port and Neston) (Lab)
Q
Matthew Taylor: I defer to Saffron on that one.
Saffron Cordery: I think this is one of those elements that we have seen quite a lot of throughout the legislation in terms of where is the recourse—that is not the right word, but I cannot think of another one right now—if things go wrong. Collaboration by its very nature is a positive process where willing parties come together to reach agreement. Everyone’s hope and aspiration is that that is how ICSs will work overall, and that is how the ICB and ICP will work together. It is not currently clear how there will be recourse to arbitration or dispute resolution, if you like, in the process of this legislation. We have seen an optimistic approach to how this legislation has been brought together—rightly in some senses—and of course we do not want a situation where we are anticipating that the evolution of a new way of working will not be functional. At the same time, the role of legislation is to anticipate what can go wrong, as well as to support what needs to be done. It is not yet clear how some of this will shake out in terms of where ICBs and ICPs need to turn to should there be challenges, issues and disagreements. We have to remember that those bodies, once they have their independent chairs and accountable officers and chief executives, sit within the NHS system, so they sit within the regional NHS England system and within the overall NHS system. Routes will be pursued, but at the moment it is not clear to me how disputes, for want of a better word, will be resolved.
Matthew Taylor: The only thing I would want to add is that during covid, we have understood the scale of health inequalities. The evidence has been that those inequalities are growing. That has demonstrated that we need a conversation between the health service in relation to how it deals with the demand that is presented to it and the wider question about how we address population health. In some cases, that might mean that you have some creative tension between those two levels. As Saffron said, it will come down to the quality of relationships, and if those relationships break down, I am sure that the centre will need to intervene to address that because the system cannot work if it breaks down. But the fact that those two bodies might have a slightly different emphasis and focus is probably a good thing because this debate about how we best use our health resources to address population health and health inequalities is an important debate for us to be having nationally and locally. Let us face it, we have not got this right up till now.
Justin Madders
Q
Matthew Taylor: Yes, unfortunately that is our understanding, and we think that it would be a retrograde step. It is not a power that I would want if I were a Secretary of State and I wanted to focus on strategic policy questions. I would not have advised the Secretary of State to want those powers.
Our view would be that we should remove the extension of the Secretary of State’s power entirely, but, failing that, we should put some guard rails on in relation to hearing the views of local health overview and scrutiny committees, getting local clinical advice on what is best and having a public interest test that should be passed. If those guard rails were in place, we could cope with this.
What we do not want is a chilling effect on the capacity of local leaders to make the decisions that they need to make to use their resources effectively. The third element of the triple mandate is the effective use of resources, and that involves making decisions at a whole variety of levels around how you configure services. If you feel you are going to go through that process and potentially engage local populations in difficult conversations, and then at the end of the day a local MP, for whatever reason, is going to kibosh that by appealing to the Secretary of State, why would you embark on the process in the first place? That is why, while we are very supportive of the Bill, as you have heard from both Saffron and me, we do think that the powers of reconfiguration are the Achilles heel. I appeal to you to recognise that that is unnecessary and goes against the spirit of the Bill.
Saffron Cordery: I wholeheartedly support what Matthew says, and it speaks to a point I made earlier about adding to existing structures in a way that really is not necessary. I notice that you have representatives from the Local Government Association as witnesses later on. I am pretty sure that they will have some strong views about what these measures do for the powers of local health overview and scrutiny committees, because they already have the power to refer to the Secretary of State should they need that to happen. The powers that are currently in place are a really effective way of doing it. People getting something past a local health overview and scrutiny committee is a really important hurdle for any service change. It is already well respected, well used and very effective. This is one of those elements that at best is redundant and at worst is going to create a lot of work and a lot of unnecessary tension and friction where we already have challenge.
Edward Argar
Q
Saffron Cordery: As we see a change in the system, obviously the nature of how we have procured services in the past does have to change. It is obviously a complex area, but one of the things that we really need to look at is the effectiveness of the current contracting regime, which for certain parts of the provider sector in particular is incredibly burdensome. If you sit in a mental health or a community trust, you are subject to a whole host of retendering, which can have a potentially far-reaching impact on your trust’s sustainability or the future operation of key services. For many bits of the system, that will be very important.
The procurement regime is fundamental. It underpins how this will operate. We need to make sure that the elements of fairness are upheld and that it does not disproportionately put a burden on any one part of the system in particular.
Dr Whitford
Thank you. In the interests of time, I am happy with that.
Ian Trenholm: If I could make just one point, I think you are absolutely right: the broader responsibilities of an individual provider, particularly around such things as duty of candour, would still stand. Therefore, at an institutional level, people will still need to do the things that they always needed to do, but there is a very specific set of circumstances that Keith was describing where safe space may apply.
Justin Madders
Q
Ian Trenholm: I do not think that there is at an individual provider level. What you have just described is our normal registration regulation process at an individual provider level. As we start to look across individual places and ICSs, we might be able to talk to individual partnership boards about people who are operating locally, but I do not think the Bill explicitly gives us more powers to look at individual providers in any more detail than we already would as part of our normal registration process.
Justin Madders
Q
Ian Trenholm: Not yet. Obviously, as the Bill goes through Parliament the breadth and size of what we will be asked to do will become clear. We are talking to a range of different stakeholders at the moment. The NHS Confederation and NHS Providers are on our list, as are the Local Government Association, the Association of Directors of Adult Social Services and, of course, various representative groups that represent people who use services, so we are having those conversations now around what they would expect from good-quality assurance at a system level—but no, we have not really got to the point of assessing this in any detail.
Justin Madders
Q
Keith Conradi: We see ourselves as very much an independent and impartial investigation body that can sit outside the system and look into it. We would not want to have any barriers really on where we might look to see where patient safety could be improved. As I mentioned earlier, we tend not to dwell on the incident at the trust level, but try to work our way up through the system. Ultimately, we end up making recommendations to the Department of Health and Social Care, and in the future I would like to ensure that we have that complete freedom to be able to make recommendations wherever we think that they most fit. That independence of the system is crucial for the success and the credibility of the organisation.
Justin Madders
Q
Keith Conradi: At the moment, they are monitored fairly informally. There is a part of NHSEI—a patient safety team—that looks at whether the actions that were promised in the response to the safety recommendation have actually been carried out. We believe that that might sit more appropriately with this body in the future—NHSEI receive a rather large number of our safety recommendations, so I do not know whether they are the right body to monitor the actions that are taking place, whereas I think that could sit with us. It is important that that is just monitoring the actions, not judging the outcome, and I think that there needs to be a separate, probably pan-regulation-type body that looks at whether the outcome at the end of the day mitigated the patient safety risk that we first went out to investigate.
Justin Madders
Q
Keith Conradi: Informally, we have a good working relationship, so we are interested. We get the response to the safety recommendation and we internally look at that and consider whether we are happy with it. If we are not, we would send out letters to say that we would like further information. We want to put this on a more formal footing to see that in the future.
Reducing Baby Loss
Justin Madders Excerpts(2 years, 9 months ago)
Westminster HallRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Westminster Hall is an alternative Chamber for MPs to hold debates, named after the adjoining Westminster Hall.
Each debate is chaired by an MP from the Panel of Chairs, rather than the Speaker or Deputy Speaker. A Government Minister will give the final speech, and no votes may be called on the debate topic.
This information is provided by Parallel Parliament and does not comprise part of the offical record
Justin Madders (Ellesmere Port and Neston) (Lab)
It is a pleasure to serve under your chairmanship this morning, Mr Gray. I thank the hon. Member for Truro and Falmouth (Cherilyn Mackrory) for securing today’s debate and the compelling way she spoke both today and in the debate last November. I was not present for that debate, but I read it over the weekend. I never thought that reading Hansard would bring a tear to my eye, but the way that she and many other Members spoke in that debate was incredibly moving and powerful. Today, she said some very important things that we all need to reflect on. She talked about the staff who cared for her during her difficult times, and she used the words “kindness, compassion and professionalism”, which are absolutely the qualities that we need in our NHS workforce in this particularly sensitive area. We should all put on record our thanks to those who do incredible work in incredibly difficult circumstances.
The hon. Member for Truro and Falmouth also mentioned the Select Committee report and noted that progress had been good, but it was from a low base. As a number of Members said, variation still exists across the country. The hon. Member talked about her six priorities. A number of Members talked about some of them, but she set out clearly where we need to do more about staffing the shortfalls. She made an important point about providing not just training, but the back-filling of positions while staff go on training. She also made an important point about parents’ involvement and engagement with such issues, because those who have been through awful experiences have the best input to give us on how to make it a little easier for those who have to face it in the future.
Clinician confidence to report issues was another important point that several Members raised. It is important that clinicians feel able to raise concerns and that they are acted on, which does not always happen. Like most Members, the hon. Member for Truro and Falmouth mentioned continuity of care and the importance of more research. One of the things that parents want to know is why this happened to them.
Lilian Greenwood
Each year, 1,200 babies are stillborn, and a third of those die after a full-term pregnancy. We know how important coroners’ inquiries can be in getting to the truth and preventing future deaths, but they are currently unable to investigate stillbirths. Does my hon. Friend think it would be helpful if the Government now responded to the 2019 consultation on extending coronial powers to cover stillbirths, so that some of that important investigative work can contribute to attempts to reduce the number of stillbirths in this country?
Justin Madders
My hon. Friend is absolutely right. Her speech gave a very clear example of how that can be of benefit not just to the parents, but to the wider system. Parents will always want to know why this has happened to them. It will not always be possible to give an answer, but if we can do more to look at that, it would be of great benefit.
My hon. Friend the Member for Sheffield, Hallam (Olivia Blake) spoke in November’s debate as well as today, and her contribution was incredibly moving. She raised the issue of research and the need for more funding to be brought into this area. Like many Members, she talked about the huge inequalities in perinatal outcomes. She also raised an important point about data collection, which will of course inform policy moving forward. It is not just about collecting data, but about collecting it in a timely manner and accurately.
The hon. Member for Darlington (Peter Gibson) mentioned the experience of his constituents Claudia and Andy, and he made a very important point about statutory bereavement leave, which we ought to look at again.
The comments of my hon. Friend the Member for Nottingham South (Lilian Greenwood) about her own trust, the death of baby Winter, and her constituents Jack and Sarah, who had a similar loss with Harriet in 2016, were telling. That really was a case of many of the issues being repeated, and it sounds to me as if the trust has not done enough to learn the lessons. My hon. Friend also made a vital point about parental involvement in the review process. It seems to me that 2016 is an arbitrary date, and I encourage the Minister to engage in a dialogue with parents to make sure that the scope of the review is as wide as it can be.
My hon. Friend the Member for Putney (Fleur Anderson) made an excellent speech, highlighting just how far we still have to go with obstetrics and how inequalities in outcomes still exist. She made the important point that these issues need to be addressed in conjunction with those who have experienced a loss. Parental involvement is a theme that has come through several times today. She also made a very important point about the culture, which is not always the best for raising concerns and learning from past experiences.
My hon. Friend the Member for Liverpool, West Derby (Ian Byrne) also mentioned continuity of care and the workforce challenge, something that most Members raised. He said that postcode, ethnicity and income should not be telling factors in outcomes. He also told a very moving story about one of his constituents, who suffered their own loss. Unfortunately, it seems that the failings that were identified there will resonate with many trusts.
My hon. Friend the Member for Luton North (Sarah Owen) spoke incredibly movingly today, as she did in the previous debate. She brought home how difficult it is for those who have successful subsequent pregnancies still to have to deal with previous losses, which are still on their minds, as one would expect. Again, continuity of carers and workforce issues were raised. She made a very important point about vaccines and the admissions that we have seen in recent weeks of pregnant women with covid. A very important point was put to the Minister about the priorities for booster jabs, which I hope she will address. The point my hon. Friend made most powerfully was about the three miscarriage rule, and the way she spoke brought home how cruel it is. It really does need revisiting.
Finally, the hon. Member for Strangford (Jim Shannon) gave a very heartfelt speech. Again, he raised a number of issues about staffing.
I am nearly out of time, so I will make just a couple of points. A number of Members touched on issues that have arisen during the pandemic. We know that there has been reduced access to face-to-face appointments. Partners have sometimes been excluded, leaving women to receive this terrible news on their own. That has obviously been deeply isolating for mothers, but also for fathers. Virtual appointments just do not allow for the compassion and assurance that is really needed in those difficult moments. Of course, even if the woman has had her partner with her, the wider family has not always been able to comfort them during those difficult times.
We know that, for those who have had a loss, time is of the essence. There is a direct correlation between when someone receives mental health support and how long it is needed. A survey by Sands found that nearly two thirds of bereaved parents who felt they needed psychological support were unable to access it on the NHS. We really need to do much better on that.
Finally, I want to take a few moments to recognise the fantastic work that the more than 60 charities that collaborate together in this area do and the way they support anyone who has been affected by pregnancy loss or the death of a baby. They work very constructively with health professionals to improve services and reduce deaths. I also pay tribute to Donna Ockenden and her team for the work they are undertaking. There is no doubt that the more work they do, the more it becomes apparent that there is an awful lot more to do.
It is now approaching five years since we had the first of what has become an annual debate on baby loss in the House. Those debates have seen the House at its best. Members recall their own experiences, and no one should underestimate how difficult that must be. That plays a vital role in helping to inform policy, but it also says to those who may be going through these awful experiences that they are not alone.
Health and Care Bill
Justin Madders ExcerptsWednesday 14th July 2021
(2 years, 9 months ago)
Commons ChamberRead Full debate Health and Care Act 2022 View all Health and Care Act 2022 Debates Read Hansard Text Watch Debate Read Debate Ministerial Extracts
Justin Madders (Ellesmere Port and Neston) (Lab)
In today’s debate we have heard from 37 hon. and right hon. Members, as well as the Member for Delyn (Rob Roberts), and another 29 hon. Members registered an interest to speak but were not called. A huge range of topics has been covered, some of which I hope to address briefly. I hope Members will forgive me if I cannot mention each contribution individually.
Many Members have talked about the particular geographic configuration of their ICS, and it is clear that there is lots of unhappiness about that in certain parts of the country. That is hardly surprising, given that has been done without any parliamentary oversight so far. It seems that, under the Bill, Parliament will not even get to approve where the boundaries lie.
There has been no attempt at public consultation or discussion about where these boundaries sit, and that is a theme throughout the Bill. Decisions, money and power move further away from the public and closer to the Secretary of State. He is certainly taking back control but, at the same time, he is silencing the patient voice.
In the Bill, the Secretary of State has a veto on who leads the integrated care systems, and he can stop foundation trusts borrowing money that they desperately need to tackle the £9 billion maintenance backlog. He even has the power to decide whether to instigate the closure of local services.
By contrast, when the 2012 Act was going through Parliament, Lord Lansley, who was then Secretary of State, told the Chamber:
“We want clinicians and their patients to lead the NHS, but they cannot do this while they sit under a vast hierarchy of regional and local organisations, all reporting to Whitehall. Everyone agrees that top-down command and control gets in the way of clinicians doing their job”.—[Official Report, 31 January 2011; Vol. 522, c. 613.]
The Bill supercharges command and control, so it is little wonder that even the British Medical Association has come out against it. It creates a vast web of new organisations, but very few of them will make decisions. It is pretty clear that the integrated care partnerships in particular will be little more than bystanders when it comes to the crunch, and that the boards will have all the power. That is a huge democratic deficit that must not be allowed to go unchallenged. When we hear about companies such as Virgin already having a seat on one of the ICS boards in the south-west we know that the power lies in totally the wrong place. The Bill needs to make it crystal clear that private companies should be a million miles from making decisions about how the NHS is run.
At the same time, the Bill does not legislate for boards to include a representative from a mental health organisation, for example. How will that encourage integration, let alone parity of esteem? There are plenty of others who are not guaranteed a seat at the table but who ought to be in the vanguard of integration: directors of adult social care, directors of public health, carers and, most of all, patients, who seem to have been completely forgotten in all this. How will decisions be made by the boards? Will there be transparency about where the money is spent in those areas which, we should not forget, are much larger than clinical commissioning groups. How can we be sure that the money will go to those parts of the ICS with the most need, and how can that be challenged if it does not?
We have seen the blatant abuse of the levelling-up fund, and party political considerations seep into every decision made by the Government. Will it now be patients who pay the price for that? How will the combined trust deficits of £910 million be met? The danger is that the Bill will force ICSs to close small local services to bail out the bigger trusts.
While we welcome an end to section 75 provision, I wonder exactly how much money has been wasted in convoluted procurement processes and legal challenges. Is it £3 billion, £4 billion or £5 billion? Whatever the final figure, there is no doubt that that money could be better spent on frontline services. While moving away from that monumental mistake is a good thing, it seems as if we are going from one extreme to the other, with the removal of any safeguards at all on who contracts can be awarded to. The Government are legislating for cronyism. I am sure that pub landlords and pest control companies will be delighted, but we cannot give the Secretary of State the blank cheque that the Bill allows.
There is a huge blank sheet of paper where the plan to tackle the workforce crisis ought to be. The Secretary of State will produce a report once every five years, but that is not a serious commitment to the workforce. Indeed, it is not a serious commitment to Parliament either, and the social care workforce is not even mentioned. Let us not forget that we have 122,000 vacancies in that workforce. The Select Committee has set out the kind of people whom we really ought to aim to employ, with annual, independently audited reports that cover the NHS and social care. In the words of the Select Committee:
“The way that the NHS does workforce planning is at best opaque and at worst responsible for the unacceptable pressure on the current workforce which existed even before the pandemic.”
The Bill will only reinforce that position, rather than reverse it.
In the introduction that the Secretary of State gave to the Bill today, it sounded very much as if he thought that it was the panacea that we have all been waiting for, but many more experienced Members could be forgiven for having a sense of déjà vu. Let us remind ourselves of what Lord Lansley told the House about the 2012 reforms:
“Previous changes have tinkered with one piece of the NHS or another, when what was needed was comprehensive modernisation to create an NHS fit for the demands of the 21st century. That is precisely what this Health and Social Care Bill will deliver.”—[Official Report, 31 January 2011; Vol. 522, c. 616.]
The Health and Social Care Bill provided for the constitution and structure of the NHS to work for the long term. How has that worked out? There are record waiting lists and staff vacancies; billions diverted into the private sector away from the NHS; life expectancy has stalled; and A&E targets have been missed five years in a row. The NHS was trying to unpick the last disastrous reorganisation before the ink was even dry on the Royal Assent, so why is this set of reforms going to be any more successful than the last? How is one line of this Bill going to tackle the operation backlog? Is not the truth that without a proper sustained funding settlement to meet the demand in both health and social care, this latest set of reforms is merely another rearrangement of the deckchairs? Why, oh why, is so much time and resource being focused on a wasteful, top-down reorganisation, in the middle of the pandemic? Even the Prime Minister told us on Monday that we are not out of it yet. Only today, planned operations have been cancelled in Newcastle because of a surge in covid cases. Is it not the case that every meeting called, every document written, every minute spent on this top-down reorganisation is less time spent on fighting the increase in covid cases we currently see, bringing down waiting lists, tackling the increase in mental health conditions, solving the workforce crisis and actually delivering the reform to social care that the Prime Minister promised nearly two years ago?
This Bill is the equivalent of someone reorganising the whole interior of their house, spending fortunes on new furniture and decorations, but finding it is all ruined within months because they forgot to put a roof over their head; we cannot fix the NHS if we do not fix social care. We know that, everybody knows that. The Government say they have a plan, but we still do not know what it is. Crucially, for the purposes of today’s debate, we do not know whether it will fit in with what is in this Bill. So are we going to have yet another reorganisation next year because there was no forward thinking? What about learning the lessons from covid? The inquiry is not even going to start until next year, so are we going to see yet another reorganisation when we have learned the lessons from that? The only thing guaranteed from this reorganisation is that another one will surely follow shortly afterwards. So let us reject this Bill, go back to the drawing board and come up with a plan that actually deals with the challenges that we have to face.
Draft Health Security (EU Exit) Regulations 2021
Justin Madders Excerpts(2 years, 9 months ago)
General CommitteesRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Justin Madders (Ellesmere Port and Neston) (Lab)
It is a pleasure to see you in the Chair, Mrs Murray. I thank the Minister for his introduction, and for setting out the effect of the regulations. As he says, in the last 18 months, we have all agreed that we cannot fight transmissible disease alone. We see that in the worldwide effort to develop a vaccine, in the way that covid has gone around the world in waves, and in the fact that most countries with the lowest deaths have been those with the strongest border controls. In many examples, the greater interconnectivity of the world has been one of the biggest challenges, as well as one of the biggest opportunities.
Turning to the substance of the regulations, the Minister will no doubt be aware of the comments by the Secondary Legislation Scrutiny Committee, as set out in the explanatory memorandum:
“Although the Explanatory Memorandum (EM) provided is full of information on future EU-relations, it does perhaps overestimate the average reader’s knowledge of the UK’s plans…Because of the pandemic, coordination of health surveillance is more important than usually, and an EM needs to make it absolutely clear to the House what it is being asked to agree to.”
I have had many concerns about the detail of regulations that have been introduced, so this is not a new issue. The Minister did a valiant job of filling in the gaps, although his speech was a little acronym-heavy at times, but we have some questions outstanding.
We no longer have unconditional access to the EU’s early warning and response system, or the EWRS, as the Minister preferred to call it. The trade and co-operation agreement states that the UK may be granted access to that system on an ad-hoc basis on written request. Will he set out the fall-back position if there is disagreement about a request, or if there is delay in responding to such requests?
The Minister referred to the need for early warnings and early responses. Sometimes, early warnings and an early response are not what we get, although they are clearly critical. Does he have anything to say about how we would deal with that situation? We would hope, of course, never to be in that position, but it is important to understand the Government’s thinking about safeguards in those circumstances. There was also no reference to the World Health Organisation’s role in all this. I wonder whether he can say anything about that.
As we heard, the draft regulations refer to the newly created UK health security agency, or UKHSA, as it will no doubt be commonly known. It will of course undertake functions in relation to future infectious disease threats, but there are still gaps in the detail of how that will work. The Opposition are concerned that the decision to abolish Public Health England and give its role to a security-focused agency could result in important areas of public health not getting the focus and attention that they need. Social inequalities have been clearly exposed by covid, and life expectancy has stalled for almost a decade. Those matters are far too important to be a footnote in UKHSA’s remit, so anything that the Minister can say about that, or even when we can expect more detailed debate about the agency’s role, would be appreciated.
Finally, our four nations continuing to work very closely is just as important as international co-operation. The draft regulations, as the Minister pointed out, set up some measures in respect of that, but putting them into practice is a different thing. There have been many examples over the past 15 months of divergence in the measures taken against covid. Often it is a difference of tone; sometimes it is a difference in timing. Whatever it is, I am afraid that those differences do not recognise that the world is greatly interconnected, and England, Scotland, Wales and Northern Ireland are even more so.
I give one current example: face coverings on public transport, which have been debated recently. I will not drag the Minister into a debate about whether those laws should remain in place, as that is clearly outside the scope of the draft regulations, but it is a very pertinent example of how closer working really should be aimed for. My constituency of Ellesmere Port and Neston is very close to the Welsh border. Many people on both sides of that border travel across it to work. If I were to get on a train to Wales, because of the different approaches to public health there, I would not be legally required to wear a face covering until I reached the Welsh border, but would have to put one on once I got over it. Clearly, that is nonsense position. I think all of us here hope that people will continue to take sensible precautions, and will wear a face covering on public transport, whatever the legal default position. That is a good example of why it is far better for us to work together more closely on public health measures.
Finally, what can be done to ensure that the ambition of joined-up thinking clearly set out in the regulations is reached? In conclusion, we will not oppose the regulations, but I look forward to hearing the Minister’s response to my questions.
Oral Answers to Questions
Justin Madders Excerpts(2 years, 9 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Sajid Javid
The hon. Gentleman talks, understandably, about pressure on the NHS, and he will know that the restrictions we have necessarily had in place during the course of this pandemic so far have also led to considerable pressure on the NHS, especially when it comes to non-covid health problems. He may be aware, perhaps for his own constituents, that mental health problems are up, there are many undiagnosed cancer cases, domestic violence is up and child abuse is up. I hope he will agree with me that one of the things we can look forward to as we gradually start removing restrictions is helping people with their many non-covid health problems too.
Justin Madders (Ellesmere Port and Neston) (Lab)
I also welcome the Secretary of State to his new role. I hope he will soon see that the Department performs best when it follows the scientific advice. This morning, Professor Graham Medley, the chief modeller for the Scientific Advisory Group for Emergencies, said of mask wearing that
“if it’s not mandated it probably won’t do any good.”
That advice would explain why, last year, the Government moved from just guidance on mask wearing in May 2020 to making it compulsory on public transport in June and in shops in July. So if the advice is clear and the Government took that advice last year, why on earth are they moving away from it now?
Sajid Javid
The hon. Gentleman will know that the Government’s decisions are rightly informed by the best possible scientific advice there is and, as well as that, looking at the data and then taking all of that into account when reaching decisions. The hon. Gentleman asks about masks, and I have answered that question a number of times at the Dispatch Box. I am very happy to repeat that we are moving away from a system of regulation to guidance, but in that guidance, which was published yesterday, we have made it very clear that in certain situations masks will still make sense, and we believe that people will use their common sense and follow that guidance.
Draft Coronavirus Act 2020 (Early Expiry) Regulations 2021
Justin Madders Excerpts(2 years, 10 months ago)
General CommitteesRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Justin Madders (Ellesmere Port and Neston) (Lab)
It is a pleasure to see you in the Chair, Mr Robertson.
I thank the Minister for his introduction, and for his kinds words about local government. I say that because, for the record, my wife is a member of a local authority. I absolutely agree with the Minister that, in his words, the country has shown collective endeavour to do its best to fight the virus. That has been clear whether we are talking about the NHS, social care, local government or any of the other key industries that have contributed to the national effort over the past 15 months. As the Minister said, we all owe them a great deal for the efforts that they have put in.
As the Minister said, the matter was debated in the House in March. From reading the Hansard report, I think it is fair to say that a number of right hon. and hon. Members felt short-changed on account of the truncated nature of the debate, especially given that various other measures were discussed at the same time, and it was not possible to vote on amendments. It feels as though parliamentary procedure is operating in a manner that only gives us the thinnest veneer of accountability.
On a related point, I recognise the pressures on the Department of Health and Social Care, but I am not entirely clear why it has taken so long since March for the regulations to appear in Committee. Although that criticism is not as strong as it would have been were we debating the regulations merely to ratify them after their introduction, there is a pattern of delegated legislation procedures being followed weeks, indeed sometimes months, after the event. That has characterised the Government’s approach throughout the pandemic. We need an explanation of that behaviour. On a related point, I draw the Minister’s attention to the fact that although the legislation.gov.uk website shows the Statutory Instrument, it does not include the date on which it was made or will come into force. I appreciate that that website is outside of the Minister’s control, but we need to be clear about when regulations are made and come into force. I hope that he has a correct copy of the legislation to hand to clarify that for us.
I understand, of course, that the Government have had to move very quickly, and have had to make exceptional decisions throughout the pandemic. Time has moved on, however, and that pace of action has become less and less of an excuse and more and more of a habit. It is almost a default position adopted by the Government. I am sure that that is convenient, but that does not do any good at all to accountability.
The timing of today’s debate is apposite, given that the Government have decided that they no longer need emergency powers. Indeed, the Prime Minister’s announcement on Monday seemed to suggest all but the end of virtually all measures on 19 July. We have been told that the roadmap to unlocking would be driven by data not dates, but the Prime Minister has announced that we will basically no longer need any restrictions before he has seen any of the relevant information. Can the Minister tell us whether Government policy has changed from data not dates to “If not now, when?” to quote the Prime Minister? That is the polar opposite.
Regardless of the methodology used to reach the decision that virtually all measures to prevent the transmission of coronavirus are no longer needed, and regardless of the wisdom of that, which I recognise is outside the ambit of today’s regulations, that decision has a direct bearing on those regulations. As we have heard, the regulations remove a number of the emergency powers granted to Government under the Coronavirus Act 2020, but, as the Minister also correctly pointed out, many more powers still remain. I draw the Committee’s attention to the words of the former Secretary of State, the right hon. Member for West Suffolk (Matt Hancock), who said of the powers in the 2020 Act
“we have always said that we will only retain powers as long as they are necessary. They are exceptional powers.”
Indeed, they are exceptional—they are unprecedented, and that means that they should not remain in force for a moment longer than necessary. The Minister said that there will be a review in September, and we know that those provisions are subject to a two-monthly review, but if the Government’s judgment is that we are so far past the worst of the crisis that we can remove all restrictions on people’s movements and interactions, including measures such as compulsory mask wearing that has been shown to protect the most vulnerable, why do the remaining powers need to stay on the statute book for a day longer than 19 July?
The two-monthly review justifies the continued use of emergency powers under the 2020 Act by claiming
“there is further work to do before returning to a more familiar version of normal life, and the ability to respond flexibly and cautiously still exists.”
Those words jar with the noise coming out of Government. Can the Minister confirm today that all remaining emergency powers will be repealed by 19 July? If not, why not? Clearly, we are no longer in the realms of responding cautiously to the virus, so why do those powers need to remain in force a day beyond 19 July?
Has any consideration been given to retaining some of the remaining powers, rather than all of them? It has been said that, shortly, we may expect 50,000 new cases every day. In that case, the powers relating to statutory sick pay may well be worth retaining. If powers have been enacted under emergency legislation, is there now a case for those powers to be permanently on the statute book? Frankly, I think that is how Parliament would want matters to proceed.
The Minister and I are likely to spend a great deal of time together in the coming months debating the Department’s latest effort to reorganise the NHS via the Health and Care Bill, which was published yesterday. The Minister will no doubt be disappointed that I have not yet read it in its entirety.
Justin Madders
Indeed. Would any of the emergency powers contained in the 2020 Act appear in that Bill at a later stage in parliamentary proceedings? I am thinking in particular about the powers in section 14, which I believe the Government have said they found useful. No doubt we can debate the merits of that in some detail at a later stage, but I would be grateful for a response from the Minister today.
The biggest concern raised in the March debate, and which still remains, relates to the powers in section 21 of the 2020 Act to detain potentially infectious persons. That power has been used in a number of prosecutions, and I understand that every one was found to be unlawful by the Crown Prosecution Service. The Joint Committee on Human Rights advised in its report of September last year
“In the absence of any clear evidence to support the retention of these powers”
section 21 powers “ought to be repealed”. It is not at all clear to me why the Government would wish to retain such a draconian, but ineffective, power. That seems at odds with yesterday’s announcement that those who have had both vaccinations will no longer be required to self-isolate. The power to detain under section 21, however, makes no distinction between those who are and are not vaccinated.
The Minister referred to the two-monthly review as being evidence of the Government’s commitment to transparency, but those who studied the latest review in May of section 21 powers raised concerns about the thoroughness of that exercise. The review states:
“Public Health Officers have used these powers a total of 10 times, but have not used them since October 2020…Police have not used these powers to date and they are only to be used after obtaining advice from a Public Health Officer.”
Big Brother Watch, which sends regular briefings to Members on the use of the Government emergency powers, has said that it has documented multiple unlawful use of section 21 by police forces in England to arrest and detain individuals. Members made various references to that in the March debate. It is a little disappointing, and indeed disconcerting, that whoever drew up the two-monthly review did not appear to make any further inquiries about the potential misuse of that power, and indeed its effectiveness.
The two-monthly reviews feel like a bit of a tick-box exercise to me. The Government have serious, unprecedented powers, and despite allegations that those powers are being used unlawfully, the Government review does not appear to be even aware that those powers have been used at all. That is the case before we even get to considering whether those powers are necessary.
The Minister must demonstrate that the Government are not falling into the trap of keeping emergency powers because that is convenient, rather than necessary. The Opposition will not oppose regulations, but I hope that the Minister will address the points I have raised. I hope that he can demonstrate that any emergency powers no longer needed for public health reasons will be revoked as soon as we reach that point.
Edward Argar
As ever, I thank the shadow Minister for his typically measured and sensible contribution and pertinent questions. The 2020 Act has formed a central plank of the Government’s approach to coronavirus and has in many ways often been misunderstood. As I said in the March debate, the vast majority of the measures have been undertaken by the Government under the Public Health (Control of Disease Act) 1984, but the 2020 Act none the less plays an important role. Like the shadow Minister, I and the Government have no desire to see the powers in place a day longer than they are absolutely needed. I have highlighted that the reviews will take place and that September is the next six-monthly review. I do not want to prejudge what will emerge, but I put on the record my view that the powers should not be in place a day longer than they can be justified as essential.
In that context, the hon. Gentleman made a number of points, which I will try to address in turn. He talked about whether some powers might be useful in the longer term—I think he referred to section 14 by way of example. I hope to give him the reassurance he seeks: notwithstanding the six-monthly way point or checkpoint in September, the powers in this Act automatically sunset next spring. There was a two-year sunset clause, and the Government are clear that any powers deemed to be useful in the longer term will be subject to the normal legislative process in this place, with hon. Members having the opportunity to scrutinise, challenge and debate in the usual way, if we wish to retain anything in the long term.
In the context of the legislation to which we gave First Reading yesterday, some aspects shade into this space, but do not explicitly replicate what is there. I suspect that the hon. Gentleman and I will spend many happy days in Committee, along with our hon. Friends the Whips sitting next to us on the Bench, so there will be opportunities to discuss and debate how that might be done.
The hon. Gentleman talked about the timing of the draft instrument after the debate on 25 March. My understanding of the timing is that immediately after that debate we went into recess, but that on our return in April, the statutory instrument was laid on 21 April, so relatively swiftly afterwards. The scheduling of debates on such instruments are a matter for the usual channels and the business managers.
My hon. Friends the Whips will have heard what the hon. Member for Ellesmere Port and Neston said, but I know that both Government and Opposition work hard, and have done throughout, to schedule debates in as timely a fashion as possible. We recognise the point he highlighted, that in the early stages the pandemic, that was extremely difficult to achieve, but I know that this House values timely debates on measures that come before it. The usual channels do everything they can to facilitate that for Members of the House.
On legislation.gov.uk, I will check the point the hon. Gentleman made. I cannot give him an answer off the top of my head, but I will endeavour to look into it. If anything is lacking, I will ensure that it is addressed. I suspect that, since the other place debated this on Monday and we are debating it today, with the dates and everything, the powers will be updated following our—I hope—approval. I take that approval slightly as read, given his kind words that he will not be opposing this piece of legislation.
The hon. Gentleman touched on a couple of other areas. Sections 21 and 22 were challenged by hon. Members, not necessarily saying no to them, but wanting to understand the reasons: were they proportionate, were they necessary and how would they operate? Section 21, he is right, has not been used since October 2020. The key aspect of section 21 is that the powers to do with infectious persons are most useful in the early stages of a pandemic, with small numbers.
Justin Madders
I think the Minister has misunderstood slightly what I said. The two-monthly review says that the power has not been used since October, but my point is that certain reports have it that it has been used, which raises the question of how thorough the review was.
Coronavirus
Justin Madders Excerpts(2 years, 10 months ago)
Commons ChamberRead Full debate Read Hansard Text Watch Debate Read Debate Ministerial Extracts
Justin Madders (Ellesmere Port and Neston) (Lab)
May I start by associating myself with the many Members who have paid tribute to Jo Cox? As we have heard from the tributes, she transcended intake and party in bringing people together, and my thoughts are with her family at this time.
There have been many excellent speeches from both sides of the Chamber. People who will be voting different ways often made many similar points. I believe that shows the disappointment that we all feel that we are here once again, grappling with many overlapping and multiple considerations.
There were some particularly thought-provoking Opposition speeches, by my hon. Friends the Members for Blackley and Broughton (Graham Stringer), for City of Chester (Christian Matheson), for Luton North (Sarah Owen), for Leeds East (Richard Burgon) and for Stockport (Navendu Mishra). I particularly enjoyed the speech by my hon. Friend the Member for Luton North and her repeated use of the word hopeless—a word that I am sure is on many people’s lips at the moment. She was right that we have been here before—at Christmas, with the Prime Minister dangling the carrot of freedom before pulling it away at the last minute. It is the hallmark of a Prime Minister who struggles to deliver bad news to the public.
My hon. Friend the Member for Leeds East made the similar point that there is a pattern here of the Government making the same mistakes over and over again. He also rightly highlighted the continuing failure to provide adequate financial support for those who self-isolate—a point that was also made by my hon. Friend the Member for Stockport and is particularly apposite today, when a Government report has reached the news which states that the current self-isolation policy has “low to medium” effectiveness and that there are “barriers” to self-isolation. That is a point that we have been making since the start of the pandemic, so it is about time the Government listened to us and to their own advisers and fixed it.
It would be remiss of me not to highlight the fantastic contribution from my neighbour and hon. Friend the Member for City of Chester, who drew attention to how the announcement came out, once again, via the media. He also raised an important point about the enhanced measures that a number of areas, including our own county of Cheshire, have been put into this week. Unfortunately, we have seen a surge in cases, but there is apparently no prospect of our getting a rise in vaccines.
Taiwo Owatemi (Coventry North West) (Lab)
When I spoke to my fellow healthcare professionals in my local hospital vaccination centre weeks ago, many expressed their concerns about the delta variant and its possible impact on the local NHS and on delaying lockdown. Does my hon. Friend agree that the Government need to do more to prevent workplace burnout by providing more workplace support to our fellow healthcare professionals, who have spent the past 18 months supporting the Government through their incompetency?
Justin Madders
My hon. Friend is absolutely right. We owe a great debt to those in the NHS and to those who have worked on the frontline during the past 18 months. Last week, the Health and Social Care Committee released a very important report on burnout; I really hope that the Government address it, because without the workforce, the NHS is nothing.
To return to the issues in Cheshire, we have not had the increase in vaccines that the surge in cases requires and that the Government’s own scientific advisers say is the best way to deal with such an outbreak. Our constituents are being sent far and wide to get their first jabs. We have fantastic volunteers and NHS workers ready, willing and able to deliver those jabs, but we need the Government to match that ambition by increasing supply. That will be where we can make the most difference.
My hon. Friend the Member for City of Chester also made a very important point about how we are now in the worst of all worlds with the new guidance that was issued at the same time that the regulations came into force. We are now advised not to meet indoors: again, that diverts people away from the hospitality sector, which was just opening up again, but without a penny more in financial support for it. As he mentioned, other sectors have also been affected by the regulations and are still not getting any additional financial support in recognition of the change in policy.
On the issue of guidance and law, I hope that the Minister will look at last week’s report by the House of Lords Select Committee on the Constitution, which stated that the use of guidance had
“in some instances undermined legal certainty by laying claim to legal requirements that do not exist. The Government does not have, and must not assume, authority to mandate public behaviour other than as required by law. The consequence has been a lack of clarity on which rules are legally enforceable, posing challenges for the police and local government…and potentially undermining public compliance and confidence.”
If living with covid means living with guidance rather than laws, I really do urge the Government to read that report before they proceed down that road.
Will the Minister clarify whether the Government are still making decisions based on data rather than dates? As the shadow Secretary of State, my right hon. Friend the Member for Leicester South (Jonathan Ashworth), pointed out, the Prime Minister was pretty clear that the 19 July was the “terminus date” for restrictions, yet paragraph 7.4 of the explanatory memorandum accompanying the regulations states that the delay is
“to gather more evidence that the…tests can be met”
under the road map in the light of the delta variant. There would be little point in gathering that data if it were not used to inform future decisions, so that rather implies that 19 July might not be the end date after all.
As the right hon. Member for Forest of Dean (Mr Harper) pointed out, there is no mention in the explanatory memorandum or the regulations of the two-week point at which things will be reconsidered. Of course, we all hope that 19 July is the end date, but we have been down the road of false promises many times in the past 18 months, and I do not think it unreasonable to be a little sceptical about what the Prime Minister says and what actually materialises, given his record to date. Any clarity that the Minister can shed on the precise reason for the delay would be much appreciated.
Of course, it did not have to be this way. The delays to our unlocking that we are debating were not inevitable; in fact, they were totally avoidable. The British public have been magnificent throughout the crisis—they have followed the rules and played their part. Yet when they see world leaders ignoring social distancing at a barbecue but are told that the rules cannot yet be relaxed for them, and when they see thousands of people attending football matches but are told that they cannot attend their own children’s school sports day, they grow frustrated at what they see as a lack of consistency from those who make the rules. That frustration grows into anger when they see a Prime Minister who has thrown it all away by keeping the borders open and letting the delta variant run wild through the country. As a result, the delta variant now makes up 96% of new infections. That did not happen by accident, and, as the chief medical officer said on Monday, we would be lifting restrictions now if it were not for the delta variant. All that good work and all the benefits of the vaccine have been blown because the Prime Minister was once again too slow, just as he was too slow with the first lockdown, the second lockdown and the third.
I know that the Government will say that they acted as soon as they could on the information that they had, but the explanation for why they did not act sooner on the delta variant has changed in the last few days. We were initially told on multiple occasions that the data did not support putting India on the red list earlier because the positivity rates of the new variant were three times higher for Pakistan, but now we are told that India was not put on earlier because the variant had not been identified as one of interest or concern.
Neither explanation stands up to scrutiny. The only published data on the Indian variant does not show a positivity rate three times as high for Pakistan, and the idea that action was taken shortly before it was designated as a variant of concern does not explain why Pakistan and Bangladesh were red listed weeks earlier. The only credible explanation I can therefore find for treating India differently is that the Prime Minister did not want to scupper his trade visit and photo opportunity with the Indian Prime Minister.
Instead of excuses, we should be getting an apology. It is beyond doubt that the Prime Minister’s incompetence, dithering and vanity have cost this country dear, and that is the only reason why the full unlocking of this country is not going ahead next week. Having heard today via WhatsApp from Dominic Cummings what the Prime Minister thinks of the Health Secretary, I wonder whether the Health Secretary has at any point in the last few weeks had similar feelings towards the Prime Minister. If he has, at least that is something we can both agree on.