NHS Funding Bill

Justin Madders Excerpts

2nd reading & 2nd reading: House of Commons
Monday 27th January 2020 Commons Chamber

[Justin Madders (Ellesmere Port and Neston) (Lab)]

We have had many Back-Bench contributions today, including from the right hon. Member for South West Surrey (Jeremy Hunt), my hon. Friends the Members for Nottingham South (Lilian Greenwood), for Mitcham and Morden (Siobhain McDonagh), for Feltham and Heston (Seema Malhotra), for Easington (Grahame Morris), and for Rhondda (Chris Bryant), and the hon. Members for Newton Abbot (Anne Marie Morris), for Darlington (Peter Gibson), for Ashfield (Lee Anderson), for Kirkcaldy and Cowdenbeath (Neale Hanvey), for Dover (Mrs Elphicke), for St Ives (Derek Thomas), for Birmingham, Northfield (Gary Sambrook), for Banbury (Victoria Prentis), for Carshalton and Wallington (Elliot Colburn), for West Aberdeenshire and Kincardine (Andrew Bowie), for Ipswich (Tom Hunt), for Waveney (Peter Aldous), for Watford (Dean Russell), for Bishop Auckland (Dehenna Davison), for South Thanet (Craig Mackinlay), for Stoke-on-Trent Central (Jo Gideon), for Northampton South (Andrew Lewer), for Stoke-on-Trent North (Jonathan Gullis), for South Dorset (Richard Drax), for North Dorset (Simon Hoare), for Isle of Wight (Bob Seely) and for Crawley (Henry Smith). As you would expect, Mr Speaker, time constraints mean that I will not be able to go through each of those contributions, but there are a few that I would like to pick up.

My hon. Friend the Member for Nottingham South expressed her concern that the Bill was more about presentation and substance, and she is absolutely right. She also said, as did several Members, that we need a sustainable long-term settlement for social care, and we will return to that later. My hon. Friend the Member for Feltham and Heston rightly pointed out that the real-term size of the capital budget is less than it was in 2010 and that there have been five raids on it in recent years. She neatly moved on from that to the need for a new health centre in her constituency.

Once again, my hon. Friend the Member for Easington made a compelling case for more funding for radiotherapy, and he is right to highlight the low survival rates for certain types of cancer and the need for more specialist staff in this area. My hon. Friend the Member for Rhondda also pointed out our poor record on cancer outcomes. Although, as he said, we are improving on survival rates, the gap between us and the best-performing countries is not narrowing. Both he and my hon. Friend the Member for Easington pointed out our huge shortages in radiologists.

It was startling to hear from my hon. Friend the Member for Rhondda that only 3% of pathology labs currently have enough staff. He took us through a list of specialisms in which the NHS has huge vacancy rates. There is no doubt that the workforce challenge is a huge challenge for the NHS.

My hon. Friend the Member for Mitcham and Morden is right to highlight the scandal of growing health inequalities in this country. We do not talk enough about that, and it will be interesting to hear the Minister’s answers to her important questions.

The right hon. Member for South West Surrey gave a very thoughtful speech, but I wish he had been candid enough to admit that the NHS did not always have the funding it needed when he was Secretary of State. He is right that we need an equivalent plan for social care, without which this funding will not do the trick.

The hon. Member for Newton Abbot made some interesting points. She asked about the assumptions behind the underlying figures and how we know whether they are right. She also made an interesting suggestion about an annual report, to which we may return in Committee.

We have heard three excellent maiden speeches tonight. The hon. Member for Darlington spoke with great passion and sincerity about his constituency, which he clearly knows well. If he does half as good a job as his predecessor, Jenny Chapman, he will be able to consider himself a success.

The maiden speech of the hon. Member for Ashfield was characterised by a great sense of humour. I agree with him that talent is spread evenly across this country but opportunity is not. His predecessor, Gloria De Piero, would agree with that, too.

The hon. Member for Kirkcaldy and Cowdenbeath made a compelling, powerful and hugely impressive maiden speech. He will have a lot of contributions to make in the years to come.

As my hon. Friend the Member for Leicester South (Jonathan Ashworth) said, this Bill could not demonstrate more clearly the Government’s lack of commitment to the NHS. I did not think it possible to get so much wrong in such a short Bill, but somehow the Government have managed it.

What is wrong with the Bill? First, after a decade of austerity, any increase in funding is positive, but the song and dance being made about this Bill could lead people to think the funding settlement will restore the NHS’s fortunes and put an end to the dismal record of failure we have heard about this evening. We know the money on offer simply will not be enough.

The Health Foundation has said:

“Investing in and modernising the health service as set out in the NHS long term plan requires around 4.1% a year”.

This settlement falls well below that. It is around 25% short of that 4.1%, which we should remind ourselves is not an outrageous, unrealistic figure but was the long-term average funding for the NHS prior to 2010. That matters, because every year we sell ourselves short is another year that the mountain gets a little bit higher to climb.

We will not even stand still on these figures. The awful performance targets we have heard about this evening could actually get worse, because the committed increase of 3.1% falls short of what the IFS and a host of other experts have said is needed just to maintain current levels of performance. The Government are setting out on a course of action that they know will, in the long run, lead to more misery for patients. The NHS deserves more ambition than we are seeing here. Let us be clear that the NHS is in crisis, and this is not the solution. Committing funds that will not even maintain the status quo is simply not good enough.

Secondly, the Bill is based on a set of inflation assumptions that even Mystic Meg would find hard to predict. That is an issue, because there is no commitment in the Bill to preserving the current real-terms increases should there be a sharp rise in inflation. We hope that does not happen but, of course, if it does come to pass, this inadequate settlement will become even worse. I note that when the Secretary of State was given the opportunity to provide reassurance, he pointedly failed to do so. We will need to return to that.

Thirdly, the Bill does not help the Government’s aim, which we support, of achieving parity of esteem for mental health. As we know, mental health equates to 23% of demand but takes up only 11% of the budget—that is a long way off parity of esteem. We know that the Government plan to put an extra £2.3 billion a year into mental health by 2023-24, but that is not enough, and of course there is a risk that there will be further raids on the mental health budget, such as we have seen in previous years. Given those raids, it is not surprising that more than half of mental health professionals say that they are too busy to provide the level of care they would like to give to their patients. When the number of staff working in mental health services has fallen by nearly 8,000, despite demand rising, we know that it is not good enough. We need to see a commitment to ring-fencing in this Bill.

Fourthly, the Bill does not address existing NHS debt. As we know, trusts are about £14 billion in debt to the Government and, as we have heard, it is only short-term fixes that have stopped the situation getting worse. It is not clear what assumptions have been made about existing provider debt in these figures, and it would be a crying shame if much of this extra money being heralded by the Government as being for use in the NHS actually ended up going back to the Government in debt repayments.

The final issue is that the Bill looks at matters in isolation. If we are really going to get the NHS back to the level it was the last time Labour was in government, funding settlements should be looked at in the round, and that means including capital, training and public health as part of the picture. We know that the NHS capital budget is lower today in real terms than it was a decade ago and that the maintenance backlog has spiralled out of control, topping £6.5 billion. We have all heard the stories of ward ceilings falling in and of sewage pipes bursting, with the consequent delays to treatment. If this settlement is as good as the Government clearly think it is, surely they also need to fix the roof while the sun is shining.

Of course there is also concern about public health, which is excluded from the Bill, in an incredibly short-sighted decision. I know that Members will not need to be reminded of the savage cuts this Government have made in public health over the past decade—about £870 million in real-terms funding reductions. We are not going to solve the long-term challenges this country and the NHS faces if we do not prioritise prevention in this Bill, but it contains no commitment to funding in that area at all.

Another puzzling omission relates to the training budget. As we have heard many times tonight, workforce is one of the greatest challenges we have in the NHS, with more than 100,000 vacancies and huge pressures on workforce retention. We have 44,000 nursing vacancies, falling numbers of GPs, and professional associations such as the Royal College of Nursing, the Royal College of Physicians and the British Medical Association urging the Government to tackle unsafe staffing. There is plenty more we can do on that. There is a critical need for investment in the workforce, yet the training budget is apparently outside the scope of this Bill. That matters because the last Health Secretary was forced to scrap the nurse bursary, which exacerbated the workforce crisis, because the then Chancellor whipped a billion pounds out of Health Education England budgets. There is nothing in this Bill to prevent that sort of thing happening again.

It is a bit ironic that although there is a degree of consensus that we need greater integration in health and social care, this Government do not seem to be able, within this Bill, to join up existing NHS budgets, let alone integrate them with social care. A number of Members have referred to social care tonight, so let us remind ourselves of what the Health Foundation recently said:

“No plan for the NHS will work while social care remains the Cinderella service. Long overdue action on social care is needed to.. .reduce the pressures on the NHS.”

The NHS Confederation put it more succinctly:

“you can only fix the NHS if you fix social care”.

That is the gaping hole in the middle of these plans, so let us sort out social care as soon as possible.

In conclusion, the Bill fails to deliver the investment our NHS needs. It does not invest enough in cash terms; it has a paucity of ambition; it applies only to revenue and not to capital investment, training or other areas of spending; it does not account for inflation; and vital spending is not ring-fenced. We will not be opposing the Bill; we are not going to fall into the rather obvious trap the Government have laid for us, but we will hold them to account over their continued failure to properly fund the NHS and the adult social care system. Patients and staff deserve better than this.

Baby Loss Awareness Week

Justin Madders Excerpts

Tuesday 8th October 2019 Commons Chamber

[Justin Madders (Ellesmere Port and Neston) (Lab)]

It is a privilege to follow the hon. Member for Eddisbury (Antoinette Sandbach), who speaks from personal experience on this matter. Every year, she identifies the main issues that we still need to improve on. She is absolutely right to talk about the evaluation that shows where things are getting better, but it is also fair to say that the good practice is not consistently felt across the board, and that is what we need to aim for. She also spoke about the need to change the culture, which is really important. The right hon. Member for South West Surrey (Mr Hunt) also referred to that, and I welcome him to the Back Benches—I know that we had our disagreements as Front Benchers, but on this issue, there was a great deal of unanimity, and that is the spirit that we should carry forward. Both spoke about the need to change the culture and the length of time that that will take, but that is absolutely the right approach, because with all tragedies in the health service, most of the time people just want to know why something happened and how it can be stopped from happening again. The more that we can move away from the blame culture and get into a proper analysis of why things have happened and how we can prevent them from happening in future, the better the experience will be for everyone.

When I first spoke in a baby loss awareness debate back in 2016, I expressed the hope that this would become an annual fixture, and I am pleased to see that we have managed to do that despite the unpredictable timing of Parliament at the moment. This gives us a real opportunity to take stock of where we are and hopefully to set some benchmarks for future progress, because, as we know, every year there are thousands of tragedies. Tommy’s estimates that a quarter of pregnancies end in miscarriage. The Ectopic Pregnancy Trust tells us that one in 80 pregnancies is ectopic and Sands tells us, as we have heard, that 15 babies are stillborn or die shortly after birth every day. Those charities are just some of the 60-plus charities that collaborate to support this extremely important week. I echo the comments of hon. Members who have praised their work in this vital area, not just how they support people who have experienced their own personal tragedies, but how they work across the board to secure better outcomes for everyone. They not only raise awareness of baby loss, but work with health professionals to improve services and bereavement care and, critically, to reduce the number of preventable deaths.

Like others, I want to focus on bereaved parents and mental health support. As we all know from meeting bereaved parents, the feelings of loss and isolation are understandably overwhelming, and nothing can take away from that, but that does not mean that we cannot do more to ensure that the right care and support are in place at the right time so that those people can come to terms with their loss as best they can. We know from the evidence that good bereavement care can make a difference to parents and families and their experiences at this tragic time.

The sooner we can support more healthcare professionals in delivering good-quality care, the better. I welcome the roll-out of the pathway, but I urge the Government to redouble their efforts to ensure that all trusts and health boards adopt the pathway and ensure that all our healthcare professionals feel properly equipped to deal with bereaved parents, so that everyone across the board gets the correct and best level of support, which is what they truly deserve.

Not all bereaved parents will develop a mental health problem, but we must ensure that those who do can access specialist psychological support, that they can access it as soon as possible and at a time and place that is right for them, and of course that it is freely available to them. Sadly, as we know, not all parents can do that at the moment. Parents have told me that they are often not aware of the services available. Many leave hospital with no information about where they can seek support. Some are given information but then find that the support is not available for them at the time they need it—because of course there is a waiting list.

A survey by Sands earlier this year found that nearly two thirds of bereaved parents felt that, although they needed specialist psychological services, they could not access them on the NHS. This is equally a challenge for those who seek bereavement counselling for adult deaths, urgent referrals for which can take up to six months to process, which is far too long, I think we would all agree. In the words of one mother who contacted me:

“we weren’t offered any specialist help in terms of bereavement support. I visited my GP on a number of occasions and was advised I could see a counsellor but there was a waiting list. I was prescribed antidepressants which I refused to take as I was grieving, I wasn’t depressed”.

Many listening to this debate will recognise that experience. I hope we can learn that it is vital that the right support and treatments are available at the right time.

A new report from the Baby Loss Awareness Alliance reveals that nearly nine out of 10 clinical commissioning groups do not commission talking therapies specifically for parents, and where the services do exist, they are mostly for mothers only, meaning that the needs of fathers are often overlooked, as the hon. Member for Colchester (Will Quince) has spoken about in the past.

There is of course much good practice out there, but it is sometimes reliant on charitable grants and third parties, meaning that the provision is patchy and at risk from wider funding decisions. I therefore support a call for a review of the current provision, including an evaluation of the models of best practice, involving parents and professionals in those conversations. We know that the need for psychological support following pregnancy loss and stillbirth is recognised in the NICE guidance and that the “Better Births” report, the maternity transformation programme and the NHS long-term plan all highlight the need to improve perinatal mental health care. These plans must translate into action to ensure that the needs of bereaved parents are explicitly addressed in quality standards and national guidance, in the training for the relevant healthcare professionals and in guidance and support for local services.

Beyond the major transformational strategies we have been talking about, we can also make simple, small changes that will make a difference to parents’ experiences. In the words of another constituent after her own bereavement:

“That moment, I know myself, stays with you as much as the birth and most of us end up bumping into other new parents carrying their bundles home on the way out. I feel a support worker or midwife could do with walking the parents out, helping the transition into the hands of family or friends go more smoothly would be extremely beneficial. Most of us are left with not even so much as a leaflet of where to turn to in crisis. Most of us haven’t had a follow up with a midwife or healthcare professional even though we have given birth and these unfortunate administrative errors occur far too often. I suppose support is the key issue.”

Those comments show that some simple, straightforward things can be done that need not cost the earth or require massive national strategies, but actually just need a bit more thought and organisation. I think we can all recognise the difficulty that that mother must have experienced.

Having participated in debates on this subject over the last three years, I know that Members have shown a great deal of personal courage by speaking about their own experiences. Three years on, we have shown that the message is going out to people that they are not alone. I pay tribute to my hon. Friends the Members for Lewisham, Deptford (Vicky Foxcroft) and for Washington and Sunderland West (Mrs Hodgson), and to the hon. Members for Eddisbury, for Colchester and for Banbury (Victoria Prentis), for their work and for the way in which they have spoken about their own experiences. That contributes greatly to increasing awareness of Baby Loss Awareness Week, which has itself led to some local groups getting together. Next Tuesday my constituents will take part in the Wave of Light outside Ellesmere Port civic hall, which I think is a very good way of encouraging more people to come and talk about what they have been through. The more people who engage in that dialogue, the better.

I should like to be with those constituents next week, but I suspect that I shall be here, although my thoughts will be with them. I think that what we can show them today is that when the House puts its mind to it, we can work across parties and make things better for our constituents. Anyone who has heard the debate today will understand why it is so important that we do that.

Health Infrastructure Plan

Justin Madders Excerpts

Monday 30th September 2019 Commons Chamber

[Justin Madders (Ellesmere Port and Neston) (Lab)]

The two Budgets in 2017 allocated some £3.9 billion for estates planning and also to tackle the huge maintenance backlog that has been allowed to mushroom under the Government. As of now, how much of that allocation from 2017 has been spent, and how much of it has been announced in today’s statement?

[Edward Argar]

I am happy to tell the hon. Gentleman that the announcements we are making today are for new money.

NHS Long-Term Plan: Implementation

Justin Madders Excerpts

Monday 1st July 2019 Commons Chamber

[Matt Hancock]

NHS dentistry is incredibly important. Ultimately, dentistry is part of prevention; it prevents oral ill health. We are doing a lot of work on what further we can do to support oral health. In fact, I had a meeting with the Minister with responsibility for public health on that subject this morning. I would love to meet my hon. Friend to discuss it further.

[Justin Madders (Ellesmere Port and Neston) (Lab)]

The Secretary of State clearly identified three critical areas for improvement to cancer survival rates. He is absolutely right about early diagnosis. I do not want to make my hon. Friend the Member for Rhondda (Chris Bryant) any more sweaty than he already is, but it cannot be repeated enough times that spotting these issues early on is critical to improving survival rates. The Secretary of State is also right about the importance of mental health. The third point he touched on was that the workforce is key to underpinning all this. In that regard, does he know how many specialist mental health and specialist cancer nurses we will have at the end of the 10-year period?

[Matt Hancock]

The answer to that question is being worked on as part of the people plan, which Baroness Dido Harding is putting together. We published the interim plan last month. The full people plan will be available after we have settled, in the spending review, the budget of Health Education England. The hon. Gentleman raises an incredibly important point.

Oral Answers to Questions

Justin Madders Excerpts

Tuesday 18th June 2019 Commons Chamber

[Jackie Doyle-Price]

As the hon. Lady and I have discussed previously, I would be the first person to recognise that we are not where we would like to be in respect of the provision of mental health services, but that is why we are investing an additional £2.3 billion to expand access for children by 345,000. In addition to that, we are investing in a brand new workforce in all our schools so that we can have exactly the kind of early intervention that will not require more lengthy periods of care and treatment. It is essential that we equip all schools and young people with tools to manage their wellbeing.

[Justin Madders (Ellesmere Port and Neston) (Lab)]

6. What recent assessment he has made of the effectiveness of the exception reporting process in the junior doctor contract 2016.

[The Minister for Health (Stephen Hammond)]

Our junior doctors work incredibly hard caring for patients around the clock. We introduced exception reporting in 2016 and it has been a major step forward in ensuring safe working. The British Medical Association, NHS Employers and the Department reviewed the effectiveness of exception reporting as part of the junior doctor’s contract agreement, which we announced last week. Revisions will be made to exception reporting subject to the endorsement of the BMA.

[Justin Madders]

Is the Minister aware that research by the Hospital Consultants & Specialists Association shows that, despite thousands of exception reports from junior doctors in unsafe hospital trusts, no changes to shift patterns were made at all. The chief executive of NHS Employers has said that, undoubtedly, there are circumstances where trusts would like to make changes, but because they do not have sufficient staff in place they are unable to do so. What can the Minister do to ensure that, in future, these changes are actually implemented?

[Stephen Hammond]

The hon. Gentleman is right: every exception report has to be addressed. Changing the rota is one possible outcome. He will recognise that there are other possible outcomes as well: the doctor may agree to work extra hours and be given extra time off; timing of the ward rounds in clinics may be adjusted, so that educational opportunities can be taken: and timing of the ward rounds can be adjusted so that support from other senior staff can be there as well. There are many ways around this.

--- Later in debate ---

[Mrs Sharon Hodgson (Washington and Sunderland West) (Lab)]

rose—

[Justin Madders (Ellesmere Port and Neston) (Lab)]

rose—

[Mr Speaker]

The hon. Gentleman will think it is a conspiracy, but he will get his moment in a moment. I call Mrs Hodgson.

[Seema Kennedy]

We have a very ambitious aim to halve childhood obesity by 2030. We are still considering all the answers to the consultations, and we are hoping to respond to them very shortly.

[Justin Madders (Ellesmere Port and Neston) (Lab)]

T1. If he will make a statement on his departmental responsibilities.

[The Secretary of State for Health and Social Care (Matt Hancock)]

This week is Children’s Hospice Week, Loneliness Awareness Week, National Breastfeeding Week and Learning Disability Week, and today is International Fathers Mental Health Day. The Government have made plans to more than double funding for children’s palliative care and end-of-life care services, developed a loneliness strategy and launched a consultation on folic acid in flour to support expectant mothers, and yesterday the Prime Minister announced a package of further work to support people from all backgrounds in the UK with their mental health. I and my brilliant ministerial team will continue to drive forward the health of the nation.

[Mr Speaker]

We are indebted.

[Justin Madders]

I want to bring to the Secretary of State’s attention some mental health waiting times that my constituents have recently come to me with. Someone with an urgent referral for trauma counselling is looking at a minimum six-month wait. A teenager who has attempted to take her own life is waiting over a year to see a psychiatrist. Several adults have been told there is a three-year wait just to get a diagnosis of attention deficit hyperactivity disorder. These waits are appalling. The Secretary of State billed himself as the leadership candidate for the future, but he is the Secretary of State for Health now. What is he going to do to address this appalling waiting system?

[Matt Hancock]

The hon. Gentleman is right that we need to ensure that access to mental health services improves. As part of the increase in funding we are putting into the NHS, the biggest increase is in mental health services, and it is a critical part of what we need to do to address the sorts of problems he rightly raises.

Oral Answers to Questions

Justin Madders Excerpts

Tuesday 7th May 2019 Commons Chamber

[Jackie Doyle-Price]

I have always viewed the ring fence as a ceiling rather than a protection. We have the mental health investment standard and NHS England is challenging clinical commissioning groups that are not spending what we would expect.

This is a systemic weakness. We have treated children up to 18 and then considered them as adults, but the reality is that people do not suddenly achieve majority overnight. We intend through the forward plan to have the children and young people service from nought to 25. That should enable transition and stop people falling off the cliff edge at 18.

[Justin Madders (Ellesmere Port and Neston) (Lab)]

5. What recent assessment he has made of the availability of prescription drugs.

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

Over 2 million prescription items are successfully dispensed in England every day, and we have well-established procedures to deal with medicine supply issues should they occur. We work closely with all those involved in the supply chain to help ensure any risks to patients are minimised when supply issues arise.

[Justin Madders]

I welcome the Minister to her place. She will know from written questions I have tabled that my constituents have real concerns about the availability of the epilepsy drug Sabril, which has been in short supply. She told me last month that supplies would be resolved by mid-April; she has now told me in a written answer that supplies will be resolved by mid-May. It seems there is a disconnect between what the Minister is saying and what is actually happening on the ground. When can she guarantee that this drug will be widely available again?

[Seema Kennedy]

I thank the hon. Gentleman for raising this issue again. We have expressed our great concern to the suppliers about this problem, and we are working alongside them to ensure that, although there is enough Sabril nationally, we get it in the right place at the right time. We will go back to them and express our concern again.

Oral Answers to Questions

Justin Madders Excerpts

Tuesday 26th March 2019 Commons Chamber

[Caroline Dinenage]

All NICE guidelines are permanently kept under review. If the research we are investing in throws new light on any issues, that will always be taken into consideration.

[Justin Madders (Ellesmere Port and Neston) (Lab)]

10. What assessment he has made of the implications for his Department’s policies of the conclusions of the “Clinically-led review of NHS access standards: interim report from the NHS national medical director”; and if he will make a statement.

[The Secretary of State for Health and Social Care (Matt Hancock)]

It is a great pity to see the hon. Gentleman back up there on the Back Benches as he was such a force—and a rare force—for reason and progress on the Opposition Front Bench until recently.

Standards in the NHS should be based on clinical evidence, and NHS England’s proposals will be rigorously field-tested to gather further evidence on clinical, operational, workforce and financial implications, all with the goal of improving the quality of care.

[Justin Madders]

I thank the Secretary of State for his tribute—although it is not going to change the question I am going to ask. He will be aware that since July 2015 the four-hour A&E target has not been met and last month saw the worst performance on record, so regardless of any clinical reviews, is it not time that Ministers admitted that the four-hour A&E target has effectively been abandoned?

[Matt Hancock]

Of course, we are aiming to meet and improve against the targets, including with the injection of the extra money—£34 billion extra in cash terms over the next five years. At the same time, we must make sure that the standards to which we hold the NHS are the right ones clinically for the times, and that is what this review of standards is all about.

Healthcare (International Arrangements) Bill (Changed to Healthcare (European Economic Area and Switzerland Arrangements) Bill)

Justin Madders Excerpts

Ping Pong: House of Commons
Tuesday 26th March 2019 Commons Chamber

We will not vote against the Lords amendments—they are necessary; the work needs to get done—but it still makes me sad, because all the measure does is highlight what we are losing.

[Justin Madders (Ellesmere Port and Neston) (Lab)]

It is a pleasure to speak in this debate—from the Back Benches on this occasion. Although I would have preferred to contribute from the Front Bench as I did during previous stages of the Bill, the Opposition are in safe hands, thanks to my hon. Friend the Member for Burnley (Julie Cooper).

It is curious that both the Minister who led for the Government on Second Reading and I, as Opposition spokesperson, have moved on since then, him to become Brexit Secretary and me to become a Back Bencher. We could have a debate—perhaps even a Division—on who got the better deal.

However, perhaps most curious is that, along the way, the measure has gone from being an international arrangements Bill to an EEA and Swiss arrangements Bill. I have been here for only four years, but I have never heard of a Bill changing its name—but then before this year, I had never heard of Cabinet Ministers breaking collective responsibility and staying in their job, or Parliament taking control of the Order Paper. There are obviously many other examples of the strange times we live in, and this is just another curiosity to add to the list.

The Lords amendments pick up on many of the anxieties we expressed previously about the implications of the sweeping powers in the Bill. I pay tribute to Baroness Thornton and her team who have obviously got greater powers of persuasion than us. They have come up with a series of amendments that rightly curtail the breathtaking powers the Government sought to claim for themselves.

When the Bill began its progress in November, there was a clear assumption on the part of the Government that agreement with the EU would have been reached by now and that arrangements would be in place to carry on very much as we are, at least in the interim period. That in itself raised serious questions about why the scope of the Bill was so wide, and it would not be an understatement to say that the orderly exit envisaged at the time is now not quite so certain. That makes it all the more important that we have a Bill with proportionality and transparency at its heart.

It is worth reminding ourselves that when the Bill first surfaced, the Delegated Powers and Regulatory Reform Committee in the other place set out very clearly its potential impact if it remained unamended. It said that the measure gave the Secretary of State the power to fund the cost of all mental health provision in the state of Arizona, or the cost of all hip replacements in Australia. Although we pushed the Minister on the reason for the need for such wide powers—accepting of course that they would be unlikely ever to be used—the only justification given was that they might prove useful at some future time in trade deals. Although that might be the case, without a clear objective, debated and agreed in Parliament, the powers were unnecessarily broad, so it is right that the Lords raised those concerns and amended the Bill accordingly.

We all have constituents who regularly raise concerns about access to the NHS being used as a bargaining chip in trade negotiations. If the Bill had remained unamended, it would only have given those people more reason to be concerned about such deals. Restricting its scope to EEA countries and Switzerland is therefore proportionate and sensible.

I want to say a few words about amendment 12, which is very similar to an amendment that the Opposition tabled in Committee. It deserves support because even under the current arrangements, cost recovery has not always been handled satisfactorily. Indeed, the Public Accounts Committee described it as “chaotic”. The Law Society of Scotland was clear on the importance of that issue when it gave evidence to the Lords Committee. It said that

“as the NHS has never been very effective in reclaiming the fees owed to it by overseas visitors to the UK, the UK may find itself substantially worse off financially when new arrangements for funding cross-national use of health services are put in place.”

The case for greater accountability is there and has been strengthened by the Government’s impact assessment, which seemed to seriously underestimate the consequences of a no-deal scenario. It set out that the cost of establishing future reciprocal healthcare arrangements on the same basis as now would be £630 million a year, but it went on to estimate that, in the event of a no-deal scenario, the costs are expected

“to be similar or less, depending on the number of schemes that are established.”

I do not think it has ever been clear why the costs might be less unless we stopped reciprocating with some countries, and I do not believe that has ever been an express policy objective of the Government. In fact, they have often—rightly—said the opposite, but the reality is that, in that scenario, the costs could be significantly higher. Both the BMA and Royal College of Paediatrics and Child Health stated that if no EU-wide reciprocal agreement was achievable, the significant extra costs of establishing bilateral reciprocal arrangements with EU and EEA countries in future could fall on the NHS. We need, but have never had, a commitment that, in those circumstances, any extra costs would not be borne directly by NHS trusts. I hope that today the Minister can give such an assurance.

The Lords picked up on a related issue, which we have raised previously, on the lack of clarity about how dispute resolution will work in the event of bilateral agreements being necessary. We know from what the Minister has previously told us that, if we manage to reach full agreement with the EU27, there will still be a limited role for the European Court of Justice, but we do not know what the dispute resolution procedure will be if we do not.

The Lords rightly pointed out that there would be little incentive for other countries to agree to a brand new dispute resolution procedure, and they would certainly be loth to do that if they were expected to pay for it, so in the event of a no-deal scenario, is it not the case that there will be significant additional costs for the UK taxpayer in setting up and resourcing a new dispute resolution scheme? Does the Minister envisage those costs being part of the reporting requirements under amendment 12 and again, can he give a commitment today that those costs will not be directly borne by NHS trusts?

The Bill is in a much better condition than when it started. It does what it is supposed to do, and no more. Crucially, it gives much greater parliamentary oversight than we originally had. I think it is called taking back control.

Lords amendment 1 agreed to.

Lords amendments 2, 8 to 10, 18 to 20, 3 to 7 and 11 to 17 agreed to.

Offensive Weapons Bill (Money)

Queen’s recommendation signified.

Resolved,

That, for the purposes of any Act resulting from the Offensive Weapons Bill, it is expedient to authorise the payment out of money provided by Parliament of any increase attributable to the Act in the sums payable under any other Act out of money so provided.—(Amanda Milling.)

Offensive Weapons Bill (Programme) (No. 3)

Motion made, and Question put forthwith (Standing Order No. 83A(7)),

That the following provisions shall apply to the Offensive Weapons Bill for the purpose of supplementing the Orders of 27 June 2018 (Offensive Weapons Bill (Programme)) and 28 November 2018 (Offensive Weapons Bill (Programme) (No. 2)):

Consideration of Lords Amendments

(1) Proceedings on consideration of Lords Amendments shall (so far as not previously concluded) be brought to a conclusion two hours after their commencement at today’s sitting.

(2) The proceedings shall be taken in the following order: Lords Amendments Nos. 27, 28, 1 to 26 and 29 to 95.

Subsequent stages

(3) Any further Message from the Lords may be considered forthwith without any Question being put.

(4) The proceedings on any further Message from the Lords shall (so far as not previously concluded) be brought to a conclusion one hour after their commencement.—(Amanda Milling.)

Question agreed to.

Integrated Care Regulations

Justin Madders Excerpts

Monday 18th March 2019 Commons Chamber

[Jonathan Ashworth]

My hon. Friend is absolutely right. Of course, the Minister cannot give that reassurance because of the Lansley Act that Ministers voted for in 2011.

[Justin Madders (Ellesmere Port and Neston) (Lab)]

I am only sorry that I cannot be with my hon. Friend on the Front Bench tonight. I have really enjoyed working with him; he is a fine shadow Secretary of State, and I know that he will make an excellent Secretary of State. Unfortunately, I cannot be with him, because when we on these Benches vote against the Whip, we have to deal with the consequences.

As my hon. Friend knows from many debates I have taken part in for the Opposition, despite repeated questions to various Ministers, there has been no absolutely no reassurance that the private sector will not continue to be involved in these matters.

[Jonathan Ashworth]

My hon. Friend makes his point typically eloquently and with force. May I say to him that we miss him on the Labour Front Bench? He was a real rock in the shadow Health and Social Care team. It is typical of him that when he decided last week that he could not support the Labour Front Bench position on a referendum, he took the honourable course of action and chose to leave the Front-Bench team. I think that he has the respect of many in the House for that position.

This is the nub of our opposition tonight. Contracts are still being put out to competitive tender, even when some commissioners claim that they do not wish to do this. Here lies the danger: nothing prevents, and some things might encourage, these integrated care partnership contracts being put out to tender and perhaps being won by a private sector provider. Ministers repeatedly tell us that ICPs, and before them accountable care organisations, are not about ushering in a further role for the private sector. If that is the case, and if patients and staff are to have confidence that the ICP contracts will not end up in private hands, the Government’s overarching competition legislation must be changed first. As that legislation has not been changed, and as we will still have commercial contracting for the delivery of medical services, there is a risk that a multi-billion pound contract covering hundreds of thousands of people and packaged up for 10 to 15 years could be handed over to a big provider. That is why the Health Committee, which is broadly supportive of these integrated care models, issued this warning in its report:

“The ACO model”—

it was using the terminology of the time—

“will entail a single organisation holding a 10–15 year contract for the health and care of a large population. Given the risks that would follow any collapse of a private organisation holding such a contract and the public’s preference for the principle of a public ownership model of the NHS, we recommend that ACOs, if introduced, should be NHS bodies and established in primary legislation.”

We agree.

The impetus for this contract comes from the example of Dudley, which I am sure the Minister will want to talk about. When the chief executive of Dudley CCG attended the Select Committee, even he conceded—although he said that it was unlikely—that because of the procurement rules, it would not have been possible to have kept out private providers applying for the contract. When asked whether the contract could go to a private provider, he said:

“In theory, it is technically possible for that to happen”.

Although Mr Nigel Edwards of the Nuffield Trust shared the Minister’s scepticism that the contract could go to a private provider, he did concede before the Select Committee that:

“To privatise in the sense of handing over all the assets and staff to a private contractor is a theoretical possibility.”

NHS England’s own analysis of the contract published at the end of last week concedes:

“However, it should be understood that current NHS law and EU and domestic procurement law prohibits CCGs or NHS England from taking steps, whether through evaluation criteria used in a procurement or otherwise, to disqualify certain categories of provider (e.g. independent sector providers) from bidding or being awarded commissioning contracts.”

This is our first objection, because Labour is not prepared to nod something through when there is a theoretical possibility hanging over us that, in the words of NHS England, an independent sector provider could not be disqualified from being awarded commissioning contracts.

--- Later in debate ---

[Stephen Hammond]

The hon. Gentleman is right: it is highly unlikely. More than that, it is stated and restated in the long-term plan that NHS England has the clear expectation that the ICP contracts will be held by public statutory providers. He knows that, and others who have discussed this point have made it clear.

[Justin Madders]

I have a simple question and we would like a simple answer. Yes or no: do the Government intend to repeal section 75 of the Health and Social Care Act 2012?

[Stephen Hammond]

As the hon. Gentleman knows, the NHS has proposed in a recent legislative document that it looks at a number of issues. It is important that that round of engagements takes place, and the Government will consider what is said.

The majority of the amendments we propose simply ensure that the regulatory framework that applies to contractual arrangements for the provision of healthcare services continues to apply where services are provided under the new ICP contract and to those organisations that hold a contract. That is an important safeguard that, in simple terms, helps to ensure that care provided under an ICP contract is subject to all the same rules as care provided under existing and other NHS contracts, such as those governing the handling of complaints and the reimbursement of travel expenses.

The shadow Secretary of State has asked me to comment on the substantive change being proposed, underpinning the existing contractual arrangements for the provision of NHS GP services. The regulations will allow GPs who are currently providing services under existing contractual general medical services or personal medical services arrangements to suspend, rather than terminate, those arrangements in order to provide services under an ICP in what is known as a fully integrated arrangement. The British Medical Association has underlined that GPs should not be pressured into joining an ICP arrangement, and we want to make it clear to the House tonight that the participation of any individual GP practice is entirely voluntary. Any role in any ICP will be for them to decide. Allowing the suspension of GP contracts allows GPs to take part in an ICP arrangement but keeps the option available to them of returning to their previous contract.

The hon. Gentleman expressed a number of concerns about the ICPs. He implied that they had been brought in by stealth. In fact, the proposals have been subject to significant scrutiny by Parliament and the public, particularly in the past year. We have already discussed the examination of the evidence by the Health and Social Care Committee, which published a report last summer, which is, I believe, largely supportive of ICPs, recognises potential benefits and sets out helpful recommendations on introducing them in England. I have described the consultation processes previous iterations of the ICP contract and the regulations have gone through.

Moreover, as the Health and Social Care Committee was promised, NHS England has completed a full public consultation on the ICP contract and announced through the long-term plan that the ICP contract will be available for use. NHS England’s full response to the consultation was published on 15 March.

Various people have made points tonight about the privatisation of the NHS and said that ICPs are a route to privatising the NHS. They are clearly not.

Health and Care Professions Council: Registration Fees

Justin Madders Excerpts

Thursday 14th March 2019 Westminster Hall

[Justin Madders (Ellesmere Port and Neston) (Lab)]

It is a pleasure to serve under your chairmanship, Mr McCabe.

As have many other hon. Members, I congratulate my hon. Friend the Member for Coventry South (Mr Cunningham) on securing this important debate, and on the way in which he has led the campaign. As he rightly pointed out, 114 Members have signed an early-day motion on this topic, which shows the level of concern about the proposals across the House.

My hon. Friend set out the five main reasons why the HCPC argues that the increase is justified. However, as he correctly pointed out, it cannot be justified, particularly in the context of what he referred to as excessive redundancy packages and refurbishment costs within the organisation. He was right that it is irresponsible of the Government to hide behind the HCPC. Recent events may give us cause to believe that the Government are completely powerless in everything and unable to govern, but surely there is something they can do about this; it is a question of political will.

As always, it was a pleasure to hear from the hon. Member for Strangford (Jim Shannon). He put it aptly when he described the increases as having no sense of fairness or balance, and he is right that increases in the cost of everyday items make it difficult to find any justification for these fee increases.

My hon. Friend the Member for Heywood and Middleton (Liz McInnes) brought her experience to the debate, as she often does. I am sorry to hear that she has called time on her NHS career, but the NHS’s loss is no doubt her constituents’ gain. She was right to remark on the correlation between public sector pay restraint and increased fees, and she highlighted what I would characterise as the opaque way in which the HCPC operates. It does not recognise trade unions, we do not know what its pay rates are and, as she said, many registrants do not see any value in what it does. I join my hon. Friend in paying tribute to the healthcare scientists and allied health professionals who work in the NHS, and agree with her that they provide a vital part of the service.

We heard from another former NHS professional, my hon. Friend the Member for York Central (Rachael Maskell). She brought her own frontline experience to the debate and highlighted the importance of maintaining the integrity of the register, to protect both the professions and the public. She rightly pointed out that the number of those whose professional standards are brought into question is minuscule, and made the pertinent point that the risk for professionals is probably greater now than in the past, due to the continual challenges with workforce numbers.

We also heard from my hon. Friend the Member for Blaydon (Liz Twist), who made the point—as did many others—that although the staff we are concerned with today are not the typical NHS staff we spend a lot of our time talking about, they are just as important as every other member of the NHS family. She was right that this fee increase is out of proportion, and that such fees can only be seen by staff as a disincentive to stay in the professions. She also made the perfectly reasonable point that cash reserves could be used to prevent a fee increase this year and to make time for a more open and detailed examination of how such eye-watering increases can be avoided in future.

Professional regulation plays a vital role in setting and enforcing the standards of professional behaviour, competence and ethics that underpin the day-to-day interactions between patients and health and social care services in the UK. There are nine regulators in the UK, which regulate 32 professions and are independent of Government under the law. Their roles, functions and powers vary, but all set standards of competence, conduct and ethics that professionals must abide by. Professionals must register with them to practise. They monitor the quality of all education and training courses, maintain a public register of professionals, investigate complaints, and make decisions about whether registered professionals should be allowed to continue to practise. In short, they play a vital role in upholding public trust and confidence in the professions.

The HCPC currently regulates 15 health and care professions across the UK, as well as social workers in England, although as we have heard, social workers are due to move to a new regulator later this year. At the moment, that represents 366,000 health and social care professionals, including paramedics, occupational therapists, biomedical scientists, chiropodists, dieticians, physiotherapists, radiographers, prosthetists, orthotists, speech therapists and social workers—Members will be glad that they were not the only ones to struggle with some of those names. All those professionals are vital to the day-to-day running of the national health service. Registrants have to pay a fee to join the register and must then pay a yearly retention fee to remain on it and be able to practise.

A massive 18% increase in the registration fee is due to take effect from October 2019, taking the fee to £106, although that increase is subject to parliamentary approval. It comes on the back of above-inflation increases in 2014 and 2015, the second of which occurred despite the HCPC reassuring registrants that their fees would not be reviewed again for a period of two years. If the proposed increase is imposed, HCPC fees will have increased by 40% since 2014, which not only outstrips inflation—which, according to the Office for National Statistics, has averaged about 2.5% over the past few years—but is well above the pay rises that our hard-working NHS staff have received over that period. Let us not forget that the modest pay award that those staff recently secured came only after many years of campaigning, during which time their wages consistently fell behind the cost of living.

I can understand why, in that context, an 18% increase seems disproportionately high. Would the Minister care to comment on whether, in the context of the years of pay restraint that we have talked about, such an unprecedented increase in fees is indeed indefensible, and whether it is right that pay rises will not keep up with the increases in fees?

I appreciate the concern expressed by some Members that there is no real mechanism to stop the HCPC imposing fees at whatever level it sees fit. As my hon. Friend the Member for Heywood and Middleton has said, and as we all regularly hear from staff-side union members, modest pay rises are being eroded by a series of other costs, including increased pension contributions, student loan repayments and increasing car parking charges. Another increase, at a time when pay is not keeping up with the cost of living, will only reduce the disposable income of those staff. The Government must acknowledge the crisis in recruitment and retention, and that all those factors are conspiring against any improvement in the serious staff shortages the NHS faces.

The need to retain staff has never been greater; we should be doing all we can to attract new people, and to encourage those who already work in the NHS to stay. As we have heard, that is a particular concern for part-time staff. Over the years, the HCPC has declined to consider introducing a pro rata structure. Unison has expressed concern that some registrants might be pushed to move into non-regulated posts, work in posts where there is no requirement to renew their registration or decide not to continue to practise, even on reduced hours. Again, that might have a negative effect. Will the Minister comment on that disparity between part-time and full-time staff, and make representations to the HCPC about it? Does he agree that it creates a disincentive for people who might not want to work full time, but could still play a valuable role in the NHS?

Some 90% of respondents to the consultation argued against the fee rise, but the HCPC is going to press ahead with it. When Unison carried out a survey of its registered members at the end of last year, 99% did not support an increase in registration fees. Those large fee increases raise concerns about whether the HCPC is operating as efficiently as it could be, so when he responds, will the Minister comment on whether the HCPC represents value for money?

The HCPC has given a number of reasons for the proposed increase, including improving capacity and service in the area of fitness to practise, keeping pace with inflation, and costs associated with the impending transfer of the regulation of social workers to Social Work England this year. The HCPC became the regulator for social workers in 2012, and has had to invest in additional staff and accommodation to fulfil that role. The reasons why, four years later, the Government announced that they would be transferring the regulation of social workers to a new regulator are not clear to me, but it is unacceptable that HCPC registrants should effectively be paying the price for a political decision. Several Members mentioned that 73% of HCPC resources are spent on fitness-to-practise cases, and social worker cases account for 59% of that amount, so it seems reasonable to conclude that costs ought to decrease this year. In that context, it is incumbent on the Minister to see whether any justification can be put forward for the fee increase.

As my hon. Friend the Member for York Central mentioned, the Law Commission made recommendations back in 2012 that would have enabled regulators to become more agile, to modernise and to reduce the costs associated with fitness to practise. I recall the Conservative party signalling its intention to reform in its 2017 general election manifesto. As we know, the Queen’s Speech following that election did not include any reference to that legislation. Will the Minister indicate whether that reform will now see the light of day?

Does the Minister agree that the Government should accept responsibility for the lack of action on reforming healthcare regulation and for their decisions on social work regulation, which have had a negative impact on the HCPC? Will he do what he can to ensure that registrants do not pay the price for that failure? Our dedicated and hard-working NHS staff deserve better than that.