NHS Wholly Owned Subsidiary Companies

Karin Smyth Excerpts

Tuesday 6th March 2018 Westminster Hall

[Stephen Barclay]

I will happily take interventions, but first I will finish this point, addressing the previous issue. The recent staff survey was extremely positive: 86% felt part of the Gateshead Health NHS Foundation Trust group. Furthermore, the figure for those with a positive response to the level of pay was 15% higher than the NHS comparator. The idea that the arrangement is exploiting people when the staff survey shows them to be 15% more approving than in other areas is again not a fair representation of the case.

[Karin Smyth (Bristol South) (Lab)]

In the short time remaining, I would like to move the Minister on to the issue of accountability for public money. Following a freedom of information request, in the case of Yeovil we understand that the benefit to the trust is several million pounds-worth of income, which is a lack of income from the Treasury—I have written to the Minister about this and I will be grateful for an answer. Is the Government’s position that they would be happy to forgo the expected income to the Treasury so that those companies can be set up to undercut wages?

[Stephen Barclay]

As I set out in my reply to the hon. Lady, the Department has been clear that setting up a subsidiary is not a vehicle to avoid VAT—that is not acceptable. In the autumn, we sent out guidance to make that clear. As a former Treasury Minister myself, I assure her that Treasury Ministers would take a very close interest if they felt that an abuse of VAT was taking place.

The reality is that commissioners and regulators are responsible for ensuring that NHS providers act in the best interests of patients and taxpayers. We would expect providers to work closely with their employees in any developments.

Diabetes

Karin Smyth Excerpts

Monday 26th February 2018 Commons Chamber

[Liz McInnes]

My hon. Friend makes an excellent point. It is actually the fifth point of the survey—support and understanding at work and school—and I will go on to talk about that. He explained the whole point very well, and I totally agree with him.

To go back to the education programmes, the National Institute for Health and Care Excellence recommends that people should be offered a course around the time of diagnosis of type 2 diabetes, and six to 12 months after diagnosis for people with type 1 diabetes, with annual reinforcement and review. The Care Quality Commission survey found that, in general, people who had attended structured education courses were very positive about their experiences. The majority of people said that it was helpful in improving their knowledge and ability to self-manage. People identified benefits, including improved understanding and knowledge about their condition; improved self-control and management, such as diet and exercise; and the opportunity to discuss concerns and share information with other people. However, there was a clear theme of people saying that, although the courses were helpful, they wanted more opportunities to attend refresher sessions.

The fifth point is that people living with diabetes want more support and understanding at work and school. Good care at school is vital and all schools should have an effective care plan in place. For those in work, an understanding and informed employer can make the difference between that person being able to continue in productive work, and being forced to leave because of difficulties in managing their condition while at work.

Finally and most importantly of all, people living with diabetes want hope for the future. Once diagnosed, people live with diabetes for the rest of their lives. They want to know what is being done to work towards a world where diabetes can be prevented and cured. It is for that reason that I asked for this debate—so that we can discuss research, funding, awareness, treatment, support, information and education for those living with diabetes.

[Karin Smyth (Bristol South) (Lab)]

Does my hon. Friend agree that groups such as the Bristol South Diabetes Support Group are really important in bringing together volunteers to support people across the country? Does she support those volunteers, who not only supplement the work of the NHS but give people the confidence to manage their work?

[Liz McInnes]

My hon. Friend makes a very important point. It is up to healthcare professionals to encourage those voluntary groups to get together, to enable people to give each other support. That was one of the findings of the Diabetes UK survey: people wanted to come together to offer each other support.

--- Later in debate ---

[The Parliamentary Under-Secretary of State for Health (Steve Brine)]

I thank the hon. Member for Heywood and Middleton (Liz McInnes), whom I know well and have worked with already on this in my time as a Minister, for giving us the opportunity to debate such an important issue. The turnout for this Adjournment debate suggests that it is of great interest to the House. It is normally just me, the Member introducing the debate, my Parliamentary Private Secretary and the hon. Member for Strangford (Jim Shannon). Tonight’s turnout has been a revelation. In November, I remember the hon. Lady introducing me and leading the event in the Terrace pavilion for the launch of the “Future of Diabetes” report by Diabetes UK, which is the biggest study of its kind. I promised then that I would respond recommendation by recommendation to the report, which I believe I have done. The offer I gave then is the offer I repeat now, which is to work with the all-party group and the charity on each and every one of those recommendations. I hope she knows I am sincere in saying that.

I would like to use this opportunity to pay tribute to Diabetes UK—led by the excellent Chris Askew, whom I have known for many years wearing other hats when he used to lead the breast cancer charity Breakthrough—which continues to work both with us in government and independently to improve the lives of so many people who are at risk of this increasingly common condition.

Diabetes is one of the biggest health challenges facing the country, and the figures are truly sobering. There are currently 3.5 million people in the UK who have been diagnosed with diabetes. If nothing changes, by 2025 more than 5 million people will have the condition. That is a significant public health challenge. Type 1 diabetes affects 400,000 people in the UK and its incidence is increasing by about 4% a year. It is not preventable, so the emphasis is on improving the lives of people with type 1 diabetes and helping them to manage their condition. During half-term recess, I paid a visit to a brilliant charity in your constituency, Mr Speaker, called Medical Detection Dogs. I met a brilliant dog who looks after a lady with diabetes. As if on cue, when I walked into the room to meet her he sat and put his paw on her knee, which was him assessing her levels and indicating that she needed to take action. It was incredible to watch. If Members are not familiar with Medical Detection Dogs, please do look it up.

Type 2 diabetes, as we have heard, is much more common. It is a leading cause of preventable sight loss in people of working age and a major contributor to kidney failure, heart attacks and strokes, among the many other conditions the hon. Lady read out in her cheery list. Diabetic foot disease, including lower limb amputations and foot ulcers, accounts for more days in hospital than all other diabetes complications put together. According to Diabetes UK, 11.9 million people in the UK are at high risk of developing type 2 diabetes, which is largely preventable.

Aside from the human impact on people’s lives, the financial cost of diabetes and its complications is huge. It already costs the NHS in England over £5.5 billion a year and that figure continues to rise. Managing the growing impact of diabetes is one of the major clinical challenges for us in the 21st century. That is why, as the hon. Lady and the right hon. Member for Leicester East (Keith Vaz) who chairs the all-party group so well rightly say, preventing type 2 diabetes and promoting the best possible care for all people with it is a key priority for the Government.

The hon. Lady mentioned the child obesity plan. She was absolutely right to do so. She knows I am passionate about delivering part 1 of the plan. We always said that it was the start of a conversation and that it was called part 1 for a reason. I am absolutely committed to taking further action if necessary, particularly across marketing, reducing portion sizes and price promotions, to help young people and to make healthy choices become the easiest choice of all. I think she knows me well enough to know I mean what I say and I say what I mean. If we need to take further action we will do so and she should watch this space.

[Karin Smyth]

I just inform the House that this morning, Committee D of the British-Irish Parliamentary Assembly, of which I am vice-chair, had a session in Portcullis House on childhood obesity with Members from all parts of the islands. We produced a report recently and are doing further work. If I may be so bold, I will make sure that the Minister has a copy of that report. He will be interested in some of the reflections that we are bringing together from across the Republic of Ireland, Northern Ireland, Scotland and Wales, and they might help to inform that work.

[Steve Brine]

That would be very interesting—if the hon. Lady did that, I would be grateful. We are working hard to improve diabetes services. The Government are strongly committed to taking action to prevent diabetes and to treat it more effectively. The Government’s mandate to NHS England for 2017-18 includes an objective for NHS England to

“lead a step change in the NHS in preventing ill health and supporting people to live healthier lives.”

Oral Answers to Questions

Karin Smyth Excerpts

Tuesday 6th February 2018 Commons Chamber

[Mr Hunt]

The hon. Lady is absolutely right to highlight that area. It is one of six high-impact areas we are focusing on throughout the country. We are making progress, but we know we could do a lot better.

[Karin Smyth (Bristol South) (Lab)]

9. If he will hold discussions with the Chancellor of the Exchequer on the VAT status of NHS trusts.

[The Minister of State, Department of Health and Social Care (Stephen Barclay)]

There are no plans to hold discussions with the Chancellor of the Exchequer on the VAT status of NHS trusts.

[Karin Smyth]

I am grateful for that reply, although I suggest it ought to be reconsidered. NHS trusts desperate to avoid financial difficulties appear to have found a new magic money tree: setting up wholly owned subsidiaries to avoid paying substantial amounts of tax to the Treasury. Rather than encouraging this tax dodging and further fragmenting the NHS, why do the Secretary of State and his friend the Chancellor not either ban this practice or agree to let them all have the VAT exemptions?

[Stephen Barclay]

The Department wrote to all NHS and foundation trusts in September 2017 to remind them that tax avoidance schemes should not be entered into in any circumstances, but the hon. Lady makes a slightly strange point. She seems to be arguing that NHS hospitals are, in essence, paying too much tax to the Treasury, rather than having that money within the NHS. These subsidiaries are 100% owned by trusts themselves.

NHS Winter Crisis

Karin Smyth Excerpts

Wednesday 10th January 2018 Commons Chamber

[Karin Smyth (Bristol South) (Lab)]

It seems like only yesterday that I was working in the NHS, leading a group of GP commissioners preparing for the Health and Social Care Act 2012 and, every year, preparing for winter. Such was my experience of preparing for that Act that it led to my giving up my day job and deciding to become an elected politician and to enter this House. My colleagues at the time said to me, “Try to bring some sense to the debate going on, which is often so ill informed.” Today, we have heard some very well informed contributions, and I hope to offer some prospect of moving forward.

I want to talk about the 2012 Act. Its purpose was to modernise and avoid a future crisis, as well as to put clinicians at the centre of commissioning, free up providers to innovate, empower patients and give a new focus to public health, and it has categorically failed on all counts. Does the Act matter to patients? All reorganisations take people’s eye off the ball, but this one has been in an altogether different league. Long-standing problems have persisted and necessary changes have been put on hold as managers try to put back the infrastructure that was so wantonly destroyed by the Act.

In my constituency, South Bristol Community Hospital, a long-awaited community hospital, serves an area of very high health need. It is intended to support those with chronic illness in the community and to work with GPs, as well as to provide an urgent care centre and access to therapies. Much has been achieved by those on the frontline in the hospital, but it falls between five NHS bodies.

This week, a constituent highlighted a problem after she was told that her appointment had been cancelled because the person it was with was no longer in post. She persevered with the booking, but it was not possible to tell her whether another appointment would be forthcoming. I have taken the matter up on her behalf, but I have to write to three different people to try to find an answer. Colleagues know that that is the situation across the piece.

No one body is assessing health needs, talking to the local population and ensuring that services meet those needs and are reversing health inequalities, so how do we move forward? My strong view is that we should not be talking about the superstructures or the money, although the money is important. We are at a critical point. We have had centralised planning and control. It did not work, ultimately, and the era of the market and competition is also not working. We need now to put accountability at the very heart of the system.

Accountability can be a key driver of change and improvement, and it is vital in a functioning democracy. All the bodies involved spend taxpayers’ money, but no one understands who is responsible and who is accountable for how they spend that money. That includes us in the House; we are also mystified.

Local MPs are expected by their constituents to stand up for local services, ensuring that there are enough resources, and to be able to make a difference when things go wrong, but we have no role locally in how the mandate is delivered or in the alignment of the voted national budget with local delivery. Critically, neither do local people. They do not understand how their national taxes relate to the local service.

We are pivotal in helping with that understanding. Local managers should be supported in sharing the great work that they do, but they also need to share the realities of cost and quality with MPs and local people so that we are all well informed. However, that will happen only if national leaders are supported when they fulfil their duty of candour and speak out about the reality of choices, which national leaders have done.

It is no secret that the money the NHS is allocated is insufficient to do all that is promised in the NHS constitution, to the quality that we expect. It is also well evidenced that we have the most effective and efficient service in the world, with productivity outstripping other sectors of our economy. So on behalf of our constituents, we should be putting the public centre stage, considering how to actively improve the NHS and understanding what the money can deliver. We have to give patients and the public genuine influence over decisions affecting the care that they, their families and their communities receive, and the responsibility that goes with that influence.

Being able to follow the money is a key part of accountability. We should all be part of that to help to inform the next stage in the development of the NHS.

Oral Answers to Questions

Karin Smyth Excerpts

Tuesday 19th December 2017 Commons Chamber

[Mr Hunt]

I can reassure the hon. Lady that we are putting a lot of extra funding into mental health— £575 million last year alone—to meet those and other obligations.

[Karin Smyth (Bristol South) (Lab)]

NHS Property Services exists on a merry-go-round of taxpayers’ money. Will the Secretary of State give us all a Christmas present by closing it down and returning the control of property to local health communities?

[Mr Hunt]

I understand why the hon. Lady has asked that question. I think it fair to say that NHS Property Services has been on a journey and needs to do even better, but we also want to ensure that NHS land is made available for housing for NHS staff.

King’s College Hospital Foundation Trust

Karin Smyth Excerpts

Tuesday 12th December 2017 Commons Chamber

[Mr Dunne]

The NHS is the largest organisation in the country and everybody who works in it will have their own political views and persuasions. Very few of them are brought to the board table. It is the case that when in government parties on both sides appoint individuals with political representation from the other side, so I think we have to be balanced about this. I would gently point out that Lord Kerslake sits as a Cross Bencher, although he may provide advice to one party more than another.

[Karin Smyth (Bristol South) (Lab)]

Does the Minister believe that the duty of candour extends to NHS leaders?

[Mr Dunne]

The duty of candour applies right across the NHS.

Social Care

Karin Smyth Excerpts

Thursday 7th December 2017 Commons Chamber

[Jackie Doyle-Price]

I do not disagree with much of what my hon. Friend says. Colleagues are talking about a crisis, but local authorities and the care sector have been put under a lot of pressure this year getting ready for winter, and they have stepped up to the plate. I pay tribute to everybody who works in that sector. They work incredibly hard and with real care. The work they do is not putting us in crisis but delivering great care outcomes for many people.

[Karin Smyth (Bristol South) (Lab)]

This is a shocking statement for thousands of families who live in this country with the misery of social care. The Minister referred to the previous Government, but the 2015 Conservative party manifesto was clear about what it was seeking to do, and about introducing a cap on care costs in 2016. A few weeks into office, the Government changed that, and moved the cap forward until 2020. I have written to the Minister about her exchanges in the House on 25 October with the right hon. Member for New Forest West (Sir Desmond Swayne), during which she inadvertently misled Parliament about the 2020 date and legislation—that was subsequently changed when I went to the Library. The key issue is that this issue is causing silent misery for thousands of people now. I am 53. Will my children be suffering the same level of misery about my care costs in the next 30 years? When will we see the actual date published?

[Jackie Doyle-Price]

I think we made it clear in the recent general election that we will be revisiting this issue. The hon. Lady wants certainty about how we fund the care system in future, and on what obligations individuals and their families will or will not have. It is therefore important to have that full public debate, and work together to bring forward proposals that will put our long-term care system on a sustainable footing. In the absence of that we will not achieve any resolution, and that is contributing to misery for people who do not currently have a limit on their overall care costs. That is what we are trying to address through this process. [Interruption.] I hear noise from Labour Members about needing cross-party consensus, then I look at the behaviour of those on the Front Bench—lacking.

Oral Answers to Questions

Karin Smyth Excerpts

Tuesday 14th November 2017 Commons Chamber

[Mr Dunne]

There has been a continuing involvement of private provision of health services since the very origins of the NHS, when GP partnerships came in, as private businesses, to provide their services. Of course, competitive tendering was introduced to NHS contracts by the last Labour Government, and the rate of private provision under that Government grew faster than it has under this Government. According to the last figures, 7.7% of services were provided by the independent sector.

[Karin Smyth (Bristol South) (Lab)]

Where a foundation trust or other NHS provider sets up a wholly owned subsidiary within the public sector, would the Minister expect to see all those papers in the public domain?

[Mr Dunne]

As I said to the hon. Member for Keighley (John Grogan), the trust, which would consolidate subsidiaries in its accounts, would publish the accounts of subsidiaries as part of its consolidated accounts each year.

Social Care

Karin Smyth Excerpts

Wednesday 25th October 2017 Commons Chamber

[Jackie Doyle-Price]

I agree that we want to learn from examples in other countries. As I have said, the spirit of the consultation will be to allow a well-informed debate, as a result of which consensus can be established. In view of that, we will consider a wide variety of options, covering not just funding but lifestyle solutions and other issues.

[Karin Smyth (Bristol South) (Lab)]

Will the Minister give way?

[Jackie Doyle-Price]

I must make some progress, because I have taken many interventions. I do apologise.

Adult social care funding is made up of Government grant, council tax and business rates. The better care fund, which was announced in 2013, has further helped to join up health and care services so that people can manage their own health and wellbeing and live independently in their communities for as long as possible. The 2015 spending review introduced an adult social care precept that enabled councils to raise council tax specifically to support social care services. By 2019-20, that could raise up to £1.8 billion extra for councils each year. As a further boost to social care, the Chancellor announced in the Budget earlier this year that local authorities in England will receive an additional £2 billion for social care over the next three years. This year, £1 billion has been provided to ensure that councils can fund more care packages immediately. The additional money means that local authorities in England will receive an estimated increase of £9.25 billion in the dedicated money available for social care over the next three years. Statistics produced today show that spending on adult social care increased in real terms last year by 1.5% thanks, in part, to the precept.

--- Later in debate ---

[Jackie Doyle-Price]

I am sorry, but that is not the case. The money will be retained by local government, but we will direct the spending to achieve the outcome the money is intended to deliver. That is exactly what we should do as a Government, and it is how we ensure value for money.

The health and care system has committed staff and managers up and down the country who are working every single day to deliver the best outcomes for people.

[Karin Smyth]

Will the Minister give way?

[Jackie Doyle-Price]

I have already taken too much time.

The measures I have set out have given our hard-working workforce and their leaders clarity about how the Government expect the NHS and local government to work together to achieve the joint ambition of reducing delayed transfers of care, which will be instrumental in delivering high-quality care.

To summarise, we accept that there are significant challenges in the health and care systems, which is why we are increasing funding in real terms over the lifetime of this Parliament, but this is not just about money. It is about sharing innovation and best practice; it is about integration and defining new models of care; it involves thinking about a long-term sustainable solution to the care system; and, most importantly of all, it is about supporting the 1.5 million people who work in the care system, as well as the millions of people who selflessly look after families and friends with little or no reward. We are committed to all of these.

Surgical Mesh Implants

Karin Smyth Excerpts

Wednesday 18th October 2017 Westminster Hall

[Emma Hardy]

Absolutely; that is a really important point. The BBC programme “Inside Out West” that aired just this Monday evening highlighted some of the problems with rectopexy, which is a form of rectal mesh, and the investigation a local trust is carrying out on the surgeon, Mr Dixon. I understand that one of the allegations it is looking into is that girls as young as 17 and 18 have had rectopexy.

[Karin Smyth (Bristol South) (Lab)]

On that point and the case that is being investigated in Bristol, I understand from my constituent that NHS England will set up 17 regional teams to look at this. Does my hon. Friend agree that that cannot be done on a local, ad hoc basis? There needs to be national co-ordination on this.

[Emma Hardy]

I absolutely agree with that. That hospital would neither confirm nor deny that those young girls had been operated on. For background information, all the colorectal surgeons who the programme spoke to said that the young women should have been offered other avenues before surgery. The programme also highlighted the extremely concerning practice of one surgeon attaching part of the rectal mesh to the soft tissue on the wall of the vagina. The shocking reason for subjecting women to this was explained by one consultant, who stated that if the rectopexy mesh is fitted in that way, the surgeon can charge for vaginal repairs as well as for fitting the mesh. Some of the patients being operated on were not aware of where the mesh was being attached, which raises serious questions about the warnings patients are given.

We must remember that it is not only women affected by this issue; men and women are suffering from chronic pain after having mesh surgery for hernias, using the same material—usually polypropylene plastic—used in vaginal mesh surgery. Research shows that between 10% and 15% of people who have had hernia mesh surgery suffer from chronic pain and complications after surgery. However, as with vaginal mesh surgery, not enough information is available to understand the extent of the risks of surgery.

Thankfully, there are organisations that help those affected to tell their stories. The Sling the Mesh campaign has done an incredible job in highlighting the problems, but there must be a wider effort from the Government to inform members of the public that this is an issue and to encourage them to speak out if they experience problems. Thousands of people have had the procedure over the past two decades without knowing what would happen if their body rejected the plastic mesh or if the mesh harmed their internal organs, leading to many people wanting the mesh removed. However, mesh removal is not a simple solution.