Retained EU Law (Revocation and Reform) Bill

Debate between Justin Madders and Mike Amesbury

Report stage
Wednesday 18th January 2023 Commons Chamber

[Justin Madders]

If the Minister is true to her word, she will vote with us and make sure that that is exactly what happens. I refer to the impact assessment, which recognises in three separate paragraphs that the Bill contains a threat to equality, so this is not something we are making up out of our own heads; it is something that is there and to be concerned about.

One set of protections definitely in the sights of those who see employment rights as a burden include the working time regulations, the introduction of the right to paid annual leave, limits on weekly working hours and a legal entitlement to daily and weekly rest breaks. They are some of the greatest achievements of the previous Labour Government, and for Members who are not aware, those regulations originated from concern about workers’ health and safety and the risks associated with working excessively long hours. I am proud that my party tackled that. Do we want to turn the clock back to when people worked 70 or 80 hours a week? We know that some on the Government Benches think there is no moral right to annual leave, but on these Benches we could not disagree more. Also included in our amendment are the Transfer of Undertakings (Protection of Employment) Regulations 2006.

[Mike Amesbury]

I am after my hon. Friend’s help on this: was it a figment of my imagination, or did those on the Government Benches drive through a piece of legislation that curtailed the fundamental freedom and right to strike in the past few days? I just seek his help on that.

[Justin Madders]

Yes, I think that Bill also gives employers the power to sack striking nurses, teachers and doctors. Those are not the actions of a Government who want to protect employment rights.

The amendment includes the 2006 TUPE regulations, which ensure that when one business buys another, there is reasonable certainty about which workers transfer to that new business, so that the purchaser knows which employees it is getting and, critically, workers know that they cannot be dismissed or have their terms and conditions slashed just because they are working for a new employer. Let us make it crystal clear that TUPE will stay. That would ensure protection and certainty for employees, but also certainty for employers. How on earth would someone thinking of buying a business in 2023 know whether to proceed with the purchase if they did not know whether they were obliged to take on the workforce with it? We have a stable, settled, well understood framework of law that helps businesses to operate. Why put that in jeopardy, particularly if, as is claimed, Ministers have no intention of removing it?

To make a general point on employment rights, they are not a burden. They are an essential ingredient of a civilised society. If we want our citizens to play an active role in the country moving forward and in future economic growth, our citizens have to be rewarded fairly and treated fairly. Security and respect at work are the cornerstone of any success we will have as a nation. A secure and happy workforce is a productive workforce. Giving people dignity, certainty and fairness in the workplace is not a burden on businesses; it is what good businesses do, and what good businesses will see the fruits of, if they are allowed to operate on a level playing field.

My constituents will be considerably poorer over the next few years as a result of the economic decisions made by this Government. I do not want them to be poorer in terms of rights, as well. Employment rights ensure that people can participate in the labour market without facing unfair discrimination. They give vulnerable workers more job security and stability of income. They help to encourage a committed workforce and the retention of skilled workers. They are not just about individual dignity and respect in the workplace; they also have social and economic value and are an essential component of a healthy, stable and progressive country.

We need a country where people have the security of knowing that if they do a good job and their employer runs its business well, they will be rewarded properly and be able to stay in work. What we have instead is a culture of disposable commodities and fire and rehire, where loyalty counts for nothing. It is time to draw a line in the sand and say, “No further.” Let us not allow this Bill to open up another line of attack on working people. Let us close it off now once and for all and support amendment 19.

Health and Care Bill

Debate between Justin Madders and Mike Amesbury

Report stage
Monday 22nd November 2021 Commons Chamber

[Justin Madders]

At the moment, ICBs are not a legal entity, so they do not own anything. When the Bill comes into force, they will effectively take over mainly administrative buildings from the CCGs, and the trust will hold ownership of most of the assets. We hope that there will not be the risks that my hon. Friend outlines, although it is not impossible for ICBs to set up their own trusts at some point in the future.

We do not believe that the question of private providers sitting on the place-based boards can be left open in this way, because this is really about who runs the NHS. There is a complete and utter incompatibility between the aims of private companies and what we say should be the aims of the NHS and the ICBs. I can do no better than refer to the evidence of Dr Chaand Nagpaul from the Bill Committee. He identified the concern perfectly:

“We forget at our peril the added value, the accountability, the loyalty and the good will that the NHS provides. We really do…I am saying that it does matter. Your local acute trust is not there on a 10-year contract, willing to walk away after two years. It is there for your population; it cannot walk away.”––[Official Report, Health and Care Public Bill Committee, 9 September 2021; c. 90, Q113.]

Those final words sum it up perfectly. Put a company on the board, and its interest lasts as long as the contract, and those interests will of course not be the same as the NHS’s anyway. A company’s primary concern is the shareholders, not the patients. With that clear and unanswerable concern about conflicts of interest, we invite the Government to withdraw their amendment and support ours.

We have already had some discussion of who goes on the ICB. Apparently, the answer is not the most appropriate people chosen by an independent external process or individuals directly accountable to the public; the answer is left to guidance that leaves open the risk that voices we think need to be heard will slip through the net. Our amendment 76 deals with that by setting out the requirements for ICB membership. Allocating scarce NHS resources should be robustly debated and will always be political. Tough choices have to be made, so we need people on the ICB who will be there to cover all the necessary interests for the wider good.

If Members look at what amendment 76 suggests, I hope nobody would argue that those interests do not have to have some voice. The public, patients, staff, social care, public health and mental health—which of those can be safely ignored and which has no part to play? As I have already mentioned, there is a major area of uncertainty because of the complete absence of anything that sets out how the much-vaunted place-based commissioning will work. Who will sit at the place-based table is, I am afraid, still completely opaque.

The next major area covered in the Bill is a further deconstruction of Lansley with the removal of compulsory competitive tendering for clinical services. We have seen the NHS proposals for a provider selection regime to replace the regulations under section 75 of the 2012 Act. That is to be regarded as a work in progress, so our amendment 72 covers the issue and would reintroduce some safeguards into how our money is spent. Since its inception, the NHS has always relied on some non-NHS providers, with the model developed for GPs being an obvious example. However, in recent decades there has been an increase in the use of private providers of acute care, most notably in diagnostics and surgery.

To be clear, we on the Opposition Benches believe that the NHS should be the default provider of clinical services. If it is not the only provider, it should be the predominant provider in geographical and services terms. Where a service cannot be provided by a public body because the capability or capacity is not there, there is still the option to go beyond the NHS itself, but that should be a last resort and never a permanent solution. Amendment 72 therefore sets out a clear framework for how we could achieve that. We hope that extra transparency and extra rigour would mean we avoid buying stuff that is unsuitable and sits in container mountains, stuff that does not meet specifications, and stuff made by companies that have no experience, but are owned by friends and family. In short, we would stop the covid crony gravy train.

The use of private sector capacity in the covid emergency turned out to be a farcical failure. It became very clear, very quickly that it was not there to support the NHS; it was there just to make profits. Use of private providers through dodgy deals during the PPE scandal has highlighted the need for greater transparency and greater capacity in the NHS. We can never allow a repeat of what we have seen there. We need the rigour set out in the amendment to be put into legislation, rather than left to guidance. We need to be able to challenge NHS bodies that do not comply, as well as Ministers who try to flout the rules.

I will now deal with new clause 49, saving the best—or more accurately, the worst—until last. Because of how Report stage works, it has fallen to me to express our opposition to this measure, rather than my expert colleague, my hon. Friend the Member for Leicester West (Liz Kendall), who shares my dismay at what has been produced and how it has been presented to us. Starting with the process, it is wholly wrong to bring such a fundamental change forward as a last-minute addition to this Bill. That means it cannot be debated properly today. There is no impact assessment and, as we have already heard, this change was not discussed in Committee at all. In fact, in 22 Committee sessions spanning some 50 hours, we never once heard mention of this amendment coming forward or discussion on the care cap. Indeed, when this Chamber was busy debating the social care levy, we were beavering away in Committee on the Bill, oblivious to the fact this measure was coming down the track. If the Government cannot even get their decision-making processes integrated, what hope is there for integrating health and social care?

As we know, the aim of the new clause is to remove means-tested benefits from the costs that count towards the care cap. As has been pointed out far and wide by Members from all parts of the House, that change adversely impacts some more than others. It is a wholly regressive measure, to say the least, to give support through means-testing, but then to penalise people later for receiving it in the first place. We will vote against this iniquity, and I hope many Conservative Members will vote with us. They should be used to the Prime Minister’s broken promises by now; this is their chance to make the point that he should stand by what he says.

[Mike Amesbury]

Does my hon. Friend agree that it is Robin Hood in reverse? I encourage Conservative Members who wax lyrical about levelling up, particularly in the north, to do the right thing.

[Justin Madders]

My hon. Friend must have sneaked a look at my speech, because I will say later that it is Robin Hood in reverse.

Hospital Building Programme

Debate between Justin Madders and Mike Amesbury

Wednesday 3rd November 2021 Westminster Hall

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

It is a pleasure to see you in the Chair, Mr Sharma. I congratulate the hon. Member for Crewe and Nantwich (Dr Mullan) on securing the debate. As a fellow Cheshire Member, our paths will no doubt cross as we get involved in the megalithic integrated care system that covers our area, and it is good to see healthy representation from Cheshire Members, which shows the interest and passion that we have for improved health services in our area. He mentioned that he volunteered to use his medical skills on the frontline during the pandemic, and we thank him for his efforts, just as we thank everyone who contributed to the fight against covid, be it in the NHS, in social care or in any of the other many sectors that played their part. We recognise and value the commitment that was made by so many people over such a long period of time.

As the hon. Member for Crewe and Nantwich set out, hospitals are more than the buildings themselves. It is the staff who make hospitals, and he brought that to the fore in his comments. He said that the site of Leighton Hospital has exceeded its original lifespan—I think it is as old as I am, which is a concern. Hopefully, I will not be up for a rebuild any time soon. It was a common theme of contributions to the debate that a lot of the buildings in Members’ constituencies have reached the end of their natural lifespans. It would be useful to hear from the Minister whether any assessment has been made of how many hospital buildings, and buildings across the wider NHS, have already exceeded their original lifespans. The hon. Gentleman made a compelling case for why a new hospital needs to be built in Crewe, and he mentioned that the local population has grown considerably.

[Mike Amesbury]

I thank my hon. Friend and constituency neighbour for giving way. Of course, Leighton Hospital is part of the Mid Cheshire Hospitals NHS Foundation Trust, which also includes Victoria Infirmary in Northwich. This would be a real opportunity to capture investment across the campuses, which serve a number of our constituents, and I would certainly welcome my hon. Friend’s support on that. As a Cheshire MP, it would certainly be very welcome indeed.

[Justin Madders]

My hon. Friend probably needs to direct his pleas to the Minister more than me—at this stage, of course—but I would be delighted to visit the facility with him. I am sure that he will make a strong case for investment, as other Members have done. There is an issue with how the interplay works between some of the competing bids for what is obviously a very competitive process, which I will return to later. Like the hon. Member for Eddisbury (Edward Timpson), my hon. Friend the Member for Weaver Vale (Mike Amesbury) has shown that there is cross-party support for the case for a new hospital that was made by the hon. Member for Crewe and Nantwich, who also set out why this is good for patients. He talked about some of the issues around privacy, dignity and infection control, and he said that a new build gives us an opportunity to invest in modern digital infrastructure. Of course, he also mentioned important stuff to do with COP26 and the energy efficiency of a new build. Those were all well-made points.

We also heard from the right hon. Member for Hemel Hempstead (Sir Mike Penning), who made a persuasive and passionate case as to why the current plans need to be reconsidered. He made a very interesting point about the accountability of trusts. He is probably not aware that the Minister and I have been debating this issue in Committee for a number of weeks, and it is fair to say that we have differing views as to how accountable the current system is and whether it will actually change at all when the Health and Care Bill receives Royal Assent. There is an issue with how large trusts have their own priorities, which are not necessarily in tune with the rest of the wider population and healthcare system.

The hon. Member for North West Norfolk (James Wild) made a very strong case for the Queen Elizabeth Hospital in King’s Lynn; he highlighted the critical nature of the maintenance issues there, which are clearly having an effect on patient care now. The Minister will not be surprised to know that I will be referring to the maintenance backlog during my comments today. The hon. Member also set out very well how new builds can not only improve infection control, but enhance the patient experience. We should always remember that the patient journey is central to these things. A new hospital always has to have the interests of patients, and their perspective, at the heart of its plans.

The hon. Member for Keighley (Robbie Moore) made a strong case for why a new hospital is needed in Airedale. Again, it is a building that is past its original lifespan; it has critical infrastructure issues. Describing it as the “leakiest hospital is the UK” is not something the hon. Member will want to repeat for much longer. It shows again that many of these issues have been building up for some time.

I was very interested in what the hon. Member for Hartlepool (Jill Mortimer) said about health inequalities; it was an important point, and perhaps a broader one than some of the others that have been made. She is absolutely right that the pandemic has shone a light on the existing health inequalities in this country. I agree that if we are serious about levelling up, reducing health inequalities has to be central to any policy.

The right hon. Member for Basingstoke (Mrs Miller) made a compelling case about how investment is needed for her new hospital, and how the change and growth in local population has created additional demand. It is an important point that, because of the way that her town has built up, there is more demand from an increasingly ageing population.

All the Members have made very good cases today; if it was based on the commitment and passion of individual Members, the Minister’s job would be quite straightforward. However, I know there will be many other demands on the departmental budget. There is a serious point here. We need to have transparency on the criteria that will be applied when the decisions are made. It would be fair to say, if we look at levelling-up bids, there has been some consternation that the decisions are not always made on the merits of the case. It is important that the Department is crystal clear on why particular projects are getting the go-ahead, and why others may have to wait a little longer.

I am sure that the Minister would be disappointed if I did not make a reference to whether the Prime Minister’s claim to be building 48 new hospitals is in fact an accurate one. We take with a large pinch of salt the definitions from the Department’s playbook that the following count as a new hospital: they say this includes

“a new wing of an existing hospital (provided it contains a whole clinical service, such as maternity or children’s services).”

They also say this includes

“A major refurbishment and alteration of all but the building frame or main structure, delivering a significant extension to useful life which includes major or visible changes to the external structure.”

That may well be investment in buildings—which is of course welcome—but it stretches credibility to say that those are new hospitals. I will not repeat the whole debate again on whether those descriptions can be classed as new hospitals, except to say that the Minister will no doubt rely on his VAT notices to reach that figure of 48: we will rely on the good sense of the British public to judge whether a new hospital is indeed a new hospital. When we get to 2030, we will see how many new hospitals we actually have—although it is possible that both the Minister and I will have moved on by that point.

Let us return to the present day, move away from the headlines and the spin, and ask some specific questions about the programme. I will start with the cost issue. It is my understanding that the projects identified in phase 1 have been promised a total of £2.7 billion, although some reports suggest that a £400 million price cap is being applied to each scheme, even though some of the published plans for those schemes have exceeded that limit already. Could the Minister comment on whether there is in fact an upper cash limit on particular projects, and whether it is indeed £400 million?

Almost exactly a month ago, the Prime Minister made an announcement on round 2 of the health infrastructure plan, in which, incidentally, only three out of the 25 hospitals are in the whole of the north of England. I think that says something about the Government’s commitment to levelling up and bolsters the case made by the hon. Member for Crewe and Nantwich to push forward for a new building in Crewe. Could the Minister advise what period and how much of the total programme the £3.7 billion mentioned in that announcement covers? Could the Minister also advise if the £4.2 billion, announced in the spending review last week in relation to new hospitals, is the same money as the Prime Minister announced on 2 October or is in addition to that? If it is additional, what period does that £4.2 billion cover? We want a little clarity on how much has actually been allocated and the period that it covers. I am sure the Minister realises that, even if we add up all those figures, it would not be the total cost of all those projects moving forward to 2030.

We have had three separate announcements over the last year. I make that point because the foreword to the health infrastructure plan talks about ending the “piecemeal and uncoordinated approach”. We have an investment plan spanning a decade, but the necessary investment has been announced for only the first half of that decade, at best, to come out in dribs and drabs. I suggest that the Minister might need to read the foreword to the plan again to see whether the ambitions set out there are being met.

NHS Providers has said that the actual cost of the planned building projects would be around £20 billion, most of which will need to be found in the next few years. Even building an average-sized new hospital costs around £500 million, which rather puts the spotlight on the supposed £400 million cost limit I referred to earlier. I wonder if the Minister could put a total cost—

Income tax (charge)

Debate between Justin Madders and Mike Amesbury

Monday 16th March 2020 Commons Chamber

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

First, I welcome the Minister back to his place after his period of self-isolation. I am sure that all parts of the House will agree that the current coronavirus crisis has demonstrated beyond all doubt just how important our public services are. We all know that this is a very serious time and that our constituents will be concerned. I know many are frightened by the way the crisis has escalated over the past week or so, so I start by sending our condolences to all those who have already lost a loved one including, sadly, one gentleman in my constituency. I also send our gratitude to those who are already working flat out to do their best to limit the impact of coronavirus, whether they are in the NHS, the rest of the public sector or the private and voluntary sectors, which are making a vital contribution as well.

As the Minister will know, we are supportive of the national effort to contain and delay the spread of the virus, and it would be irresponsible of us as an Opposition to make any attempt to exploit the pandemic for party political gain. I thank the Minister for his kind words in that respect. Equally, it would be irresponsible of us to ignore the concerns being raised by the public, the scientific community and the sector more widely. It is critical that we ask important questions on their behalf, especially when the limits of public service will be tested like they have never been tested before.

We know that many aspects of life will have to change or stop altogether, albeit temporarily, but it is hoped that accountability, transparency and the ability of Opposition parties to scrutinise Government decisions will continue. We are under no illusions that, at this time, our ability to do that comes with a particular responsibility, so I hope the House will understand that I will focus mainly on the challenges of the immediate crisis facing us and ask some of the many important questions that have been raised. I appreciate that there will be a statement later, and I will understand if the Minister refers some responses to that, but we will have slightly more time in this debate to discuss important concerns that have been raised with us by many in the country.

Let me turn to the Budget, as this is a financial debate. We have previously acknowledged the extra funding announced in the Budget for the NHS and social care as part of the covid-19 response. That is something we have long called for, but there remain unanswered questions about how that funding will be precisely allocated. Can the Minister tell us exactly how the extra funding will be allocated and what will happen once the money is depleted? The NHS said last week that it needs to scale up intensive care beds sevenfold. That new pot of money is going to run out at some point, and it will need topping up. Will another Budget be necessary then, and what will the process be for determining resources at that point?

While we welcome the extra funding, we are aware that it is in the context of the NHS already facing extreme pressure, as usually happens over a busy winter period. We know from the last NHS winter report two weeks ago that 80% of critical care beds were occupied and that 93% of general and acute beds were also occupied. We know that the proportion of people being seen within four hours at A&E is the lowest on record, and the target has not been met since July 2015—the best part of five years. We know that the number of people on waiting lists in England is the highest it has ever been—nearly 4.5 million people are on a waiting list for treatment—and the waiting list target has not been met for nearly four years. Sadly, some cancer targets have not been met for over six years.

Those figures should tell us that the NHS is already stretched to capacity and that we are not starting from the optimum position. But it also tells us why the Government’s strategy of delay is one that has to be supported. Even if we take at face value the Government’s insistence that they have provided enough NHS resources to deliver the commitments in the long-term plan, we must surely all accept that the covid-19 outbreak will lead to an increased demand on trusts, meaning that resources in the system will have to be reallocated. Should trusts be expending time and resources on working on control totals and end-of-year accounts at this precise moment?

Will beds from the private sector be made available to covid-19 patients, and at what cost? What will the process be for trusts that have particularly large outbreaks and increased demand? Is any audit being undertaken of disused hospitals or other public sector facilities that may be required at some point? For example, is there any way that the brand new Royal Liverpool Hospital building could be brought on stream more quickly? Are the Government sourcing more ventilators, and when can we expect to see those available? Many manufacturers export all around the world. Will steps be taken to ensure that the NHS is at the front of the queue when those goods are produced?

I want to say a few words about the workforce. We know that, before we entered the crisis, the NHS was already short of over 100,000 staff, including 43,000 nurses and 10,000 doctors. The impact of staffing shortfalls manifests itself across the whole spectrum of NHS performance, as I have just outlined. It is therefore more critical than ever that those people who work in the NHS and whose good will we rely on already get adequate protection. It is evident that, in order for patients to have the best care possible, the NHS must support its staff to ensure that they stay well and can provide that vital care. That means a continuous supply of the right equipment and facilities. Personal protective equipment is vital in that respect. I hope we will hear, either in the Minister’s response or the statement later today, about what is being done to secure supplies of equipment and whether there is enough capacity in the system to ensure continued supply.

We would also be grateful for more information on the plans mooted to get retired staff back into the health service. Will some of the money announced in the Budget be used to deal with the anticipated increase in the wage bill that that would mean? Can we have an explanation as to how those people would be protected given that, by definition, the majority of them are likely to be over 70? What oversight will be put in place to ensure that they are delivering safe care if the revalidation process is to be suspended for retired returnees? Those on the frontline who I have spoken to are concerned about identifying the point at which an individual has been away from practice so long that it becomes impractical to reintegrate them in a safe and effective way. Will guidance be issued on what that point might be? What consideration has been given to those in the existing workforce who might be in a more vulnerable category because of their age or an underlying health condition?

A major concern is the lack of clarity about when people should be tested. We are hearing of many frontline NHS staff displaying symptoms but not being tested. What does that do for morale, if nothing else? The World Health Organisation has said that we should be continuing to test and contact-trace those suspected of having the virus. As a matter of importance, we should have a full explanation of exactly why we are currently diverging from WHO advice. It has been reported that labs are overwhelmed and tests are now taking several days to come back with results. Is the current ambiguity on testing policy a question of capacity rather than anything else? Will the Government be putting more resources into those labs, and if so, when will this materialise? It seems to us that continued testing is vital not only to stop the spread of the disease, but to understand when its peak has been reached. It may also be that efficient and accurate testing means fewer people having to self-isolate unnecessarily, which of course has an unnecessary economic knock-on effect.

[Mike Amesbury]

A GP has been in touch with me today to say that they were in close proximity to a patient who is likely to have coronavirus and have been sent home to self-isolate, but they have not been tested. How on earth will they know, when they do return to work, that they are not a risk to others? Surely testing should be extended to such vital GPs.

[Justin Madders]

My hon. Friend makes very well the point that I was making. It is evident that if that particular GP does not have the virus, it would be better for us all if they know that sooner rather than later, so they can get back in and treat patients. It is also worth restating at this point that people who have suspected symptoms should not be turning up at their GP practice because that is one of the ways, unfortunately, that we will spread the virus.