Childhood Obesity Strategy
Lindsay Hoyle Excerpts(8 years, 3 months ago)
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Mr Deputy Speaker (Mr Lindsay Hoyle)
Order. It is meant to be a 15-minute opening speech. Mr Davies will want to speak and he will not want me to take any minutes off him, so I am sure this will be a very quick intervention.
Geraint Davies
The debate is often between reformulation and tax. I agree with the tax on fizzy drinks, but if we had a tax on overall sugar input—for the sake of argument, let us suppose that sugar makes up half a Hobnob and the tax is at 10%—that would give an incentive to the manufacturers to reformulate without the price going up and we could get the sugar content down.
Several hon. Members rose—
Cities and Local Government Devolution Bill [Lords]
Lindsay Hoyle Excerpts(8 years, 5 months ago)
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Mr Brady
The Minister has to understand that this is endemic in the nature of the process. It will become more and more commonplace as we see more powers being transferred from the local authorities to combined authority level, and the new arrangements will become entrenched. That is why it is so important that we ensure that the safeguards are in place at this point—
Mr Deputy Speaker
Unfortunately it is me that makes the decisions—we could do this over two days—but I would have thought the Minister had at least some indication.
Alistair Burt
I rest my case with my hon. Friend: I believe that legislation currently provides the reassurance that he seeks. However, I undertake that, before the matter is concluded in the House of Lords, we will ensure that that assurance is there so that he is covered. He is absolutely right to make sure that his local authority has the opportunity to make representations when it needs to. I am sure that the legislation does that, but we will make doubly certain that it does.
Mr Allen
That is exactly the difference between decentralisation and devolution. This proposal is the Secretary of State pushing some power to the locality, purely on the basis that he can suck it back; it is not giving power and, as of right, allowing the local authority to exercise that. There is no way in which the local authority can intervene in this process. It is a bystander, as an agent of central Government.
Mr Deputy Speaker (Mr Lindsay Hoyle)
The interventions must be shorter, as I still have to get the Front Bencher in.
Alistair Burt
The hon. Gentleman is coming at this from the wrong point of view. He is coming at it from the point of view that the Secretary of State is deliberately pushing something towards an authority, but he is not—the authorities are asking him for something. He would not be doing that unless authorities came to him and said, “We want to do this.” The Secretary of State would not agree unless he thought it was in the best interests of healthcare, because it is not his personal judgment but his duty. If those functions are not performed properly, his ultimate duty, which the House has already agreed, must be to take the powers back. The hon. Gentleman is approaching it from the point of view that there is something malevolent about the Secretary of State which means he wants to challenge the authority. The duties he has, which are contained in statute and which the House says he must retain when NHS powers are devolved, are what impels the amendment, nothing else.
Hospital Parking Charges (Exemption for Carers) Bill
Lindsay Hoyle Excerpts(8 years, 6 months ago)
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Philip Davies
I suspect it means that people are parking in places where they should not be parking within the car park because there are not enough spaces, so they park somewhere where there is not a space.
Mr Deputy Speaker (Mr Lindsay Hoyle)
Order. I do not think we need to worry too much about going over the capacity of 100%. We need to concentrate on the Bill and worry about carers’ parking.
Philip Davies
I very much agree, Mr Deputy Speaker. I will move on. I will discuss how it might work with my hon. Friend in the Tea Room afterwards.
Philip Davies
Whether it is or not, Mr Deputy Speaker, I will move on.
I asked my local hospital how many carers already use its car parking spaces, which very much is our concern today. It replied:
“The Foundation Trust is currently unable to determine how many carers use the designated hospital car parks. It would therefore be difficult to assess the potential impact on car parking revenue”.
That goes some way towards answering the question my hon. Friend the Member for Christchurch asked. The honest answer is that we do not know what the impact will be on any particular hospital. My local hospital certainly does not know.
Julian Knight
My hon. Friend is making the important point that his foundation trust does not know how many carers park at the hospital. I have asked similar questions and have not received any answers. That shows that we do not know how much the Bill would cost the country if it were put in statute.
Mr Deputy Speaker
In fairness, we have had an hour of explaining that we do not know the cost. I am sure that we do not want to rerun that.
Philip Davies
Absolutely, Mr Deputy Speaker.
Although there are no official statistics on this matter, in the NHS car parking impact assessment for 2009, the Department of Health provided an estimate of the revenue raised from hospital car parking charges as a whole, which was in the range of £140 million to £180 million. University Hospitals Birmingham NHS Foundation Trust raised £1.5 million from car parking in 2004-05. This measure would clearly leave a substantial hole in NHS hospital budgets.
As I have made clear, one consequence of the Bill would be increased car parking charges for people who do not apply for the free parking. One of my concerns is that we have already seen considerable increases in car parking charges at hospitals. Wye Valley NHS Trust has increased its average hourly rate from 33p in 2013-14 to £3.50 in 2014-15. I would be loth to put any additional cost on people who are using that car park. The Whittington health trust in London doubled its average hourly rate from £1.50 to £3, and Medway Maritime hospital in Gillingham increased its price for a five-hour stay from £5 to £8. Given that we are already seeing such huge increases in parking fees, I would not want to pass a Bill that would see people paying even more.
That point was highlighted by the British Parking Association in 2009, following the scrapping of hospital car parking charges in Scotland. It said:
“Car parks need to be physically maintained, somebody somewhere has to pay. Charges were not introduced to generate income but rather to ensure that key staff, bona fide patients and visitors are able to park at the hospital. Without income to support car park maintenance…funds which should be dedicated to healthcare have to be used instead.”
Barbara Keeley
On a point of order, Mr Deputy Speaker. The hon. Gentleman has been speaking for an hour and nine minutes, and we are now getting a lot of repetition. Many other people want to speak.
Mr Deputy Speaker (Mr Lindsay Hoyle)
In fairness, it is for me to decide whether there is repetition. I certainly do not need any advice. You should not be questioning the Chair’s ability to hold the speaker to account. I am sure that Mr Davies is well aware that many people wish to speak and that he wants to hear those other voices. He is in order, but I am worried that we will get into repetition. I certainly do not want to get bogged down in the maintenance of Scottish car parks. I am sure that he will move on quickly.
Philip Davies
I am grateful for that guidance, Mr Deputy Speaker. The hon. Lady has intervened on me more often than anybody else, which has held me up in making my remarks. My advice is that if she wants me to crack on, she should not keep intervening on me so that I have the opportunity to do so.
A big geographical inequality would result from the Bill because car parking charges vary wildly from one part of the country to another—from £4.26 in the north-east to £11.85—
Mr Deputy Speaker
Order. The hon. Gentleman has given a great number of examples. I do welcome examples, but there is a limit to how many we need. I think that people can get a flavour of the arguments from the examples he has used. Hopefully he will bring something new to the Chamber. If not, I am sure that he would like to hear somebody else. I am sure that some of his colleagues are desperate to speak.
Philip Davies
I am very grateful, Mr Deputy Speaker.
I will turn to the example that the hon. Member for Burnley used in her remarks, which she encouraged me to reflect on. As she said, at the end of last year, Torbay and South Devon NHS Foundation Trust announced that it would offer free parking to registered carers at Torbay hospital. I should point out that that scheme, unlike the Bill, is offered specifically to unpaid carers, rather than people who receive carer’s allowance. That is not what the Bill proposes, despite the impression the hon. Lady wanted to give. The interim chief executive of Torbay hospital, Dr John Lowes, said in December 2014:
“Family members and friends who provide unpaid care to our patients at home are invaluable, so we wanted to do something to make their hospital visits a little less stressful, and to demonstrate that we really do value what they do.”
He explained that the system was being implemented with the involvement of the established local care providers and that
“if someone is registered with either Devon or Torbay Carers Services, they just need to display their Carers Card on the car dashboard whilst they are parked in the public pay and display areas, and they will not be charged for parking.”
There are two points to make about that. First, the hon. Lady argued that what happens in Torbay shows why we can happily roll out the scheme across the country, but my view is that it is a perfect illustration of why we do not need legislation. Torbay has managed to do it without any legislation in a way that suits its local requirements, which is what I want to see.
Secondly, I know from my own experience that there is a problem with having a card displayed on a dashboard in a pay and display area, which is effectively what happens with blue badges. Anybody who has been involved in that area knows that people hand their badge to someone else to use—a member of their family, or whoever. It is not right—it is a terrible thing—but it happens, and we cannot ignore the fact that it would happen under the system proposed in the Bill.
Mr Rees-Mogg
I just want to say that I am sure things like that do not happen in Somerset.
Mr Deputy Speaker (Mr Lindsay Hoyle)
Order. And I am sure that it is not part of the debate for today.
Philip Davies
Thank you, Mr Deputy Speaker. Again, I will move on.
As the Torbay scheme is the nearest to the one that the hon. Member for Burnley proposes, I asked some questions through freedom of information requests about the impact and take-up of the scheme. I asked how many people had used the scheme since it was introduced, and the reply from Torbay was:
“We are unable to provide you with the information requested as it is not held electronically or in a central location. We do not record the details of carers, only a verification that they are on the register.”
We do not even know how many people take up the scheme that has been introduced.
Philip Davies
That is my reading of the situation. Because the definition of carers in the Bill is different from that used by Torbay—
Mr Deputy Speaker
Order. May I just say that we have covered Torbay? The hon. Gentleman has moved on, but unfortunately the hon. Member for North East Somerset (Mr Rees-Mogg) keeps wanting to drag him back to what he has already covered. I know that he does not want to go back to that.
Philip Davies
I am pleased that you have acknowledged that I am being led astray, Mr Deputy Speaker.
Philip Davies
In which case we must look at the Bill itself, Mr Deputy Speaker, if that is what you are urging me to do.
The Bill is called the Hospital Parking Charges (Exemptions for Carers) Bill, but it would actually apply to all health service providers, both public and private, and not just hospitals. I do not think many people appreciate its true scope. Clause 1 states that bodies that provide healthcare must
“make arrangements to exempt qualifying carers”
from car parking charges. That applies to
“any National Health Service hospital, walk-in centre, GP practice or other health care facility to which patients are admitted, or which they attend, for diagnosis, testing, treatment or other appointment relating to their health”,
so we are not just talking about hospital car parking charges. It also extends to private hospitals, so not only are we dictating what should happen in the NHS, but we are telling private hospitals what they should do. Many people might argue that those who can afford private healthcare treatment can also pay for car parking. Whether that is a legitimate use of resources is a different matter.
Mr Rees-Mogg
Can my hon. Friend explain whether under clauses 2 and 5 somebody can quality for this allowance but not be eligible, or be eligible but not qualify?
Mr Deputy Speaker
If the Bill goes to Committee, such points can be teased out and straightened out there, rather than on the Floor of the House today.
Philip Davies
My hon. Friend makes an interesting suggestion. I contend that the Bill is so flawed that it cannot be rescued in Committee, or that rescuing it would involve filleting it to such an extent that it would come out barely recognisable, which would be a pointless exercise. I appreciate that such issues could be considered in Committee—as ever, Mr Deputy Speaker, you are perfectly right.
Clause 7 says that the Act must come into force
“12 months after the day on which this Act receives Royal Assent.”
There are two pertinent points about that. If it is so unjust for carers to pay hospital car parking charges, how can the hon. Lady justify requiring them to pay charges for another year? Why not introduce the change much sooner? I think I know the answer to that question, and it reinforces my argument. I think the hon. Lady realises that the provisions in the Bill would be a logistical nightmare to implement, for some of the reasons that I have already mentioned—I am sure there are also many others. She probably realises that to make anything of the Bill it would require at least a year to come up with anything that makes any sense. It is interesting that such a measure is part of the Bill, and it justifies my concerns. The hon. Lady said that she would like the measures in her Bill to be extended in future to cover other people. She made the point that this is a good start—
Mr Deputy Speaker
Order. That is speculation for another day. We are dealing with the Bill before the House, not what might be before us in future. I know that the hon. Gentleman is desperate to hear the views of other hon. Members, and I am sure his colleagues are desperate to speak.
Philip Davies
I agree. This is hard work, Mr Deputy Speaker, and you are right—I am anxious to press on.
Mr Deputy Speaker
I reassure the hon. Gentleman that we are not going to open that can of worms today. Philip Davies, I know that you want to get beyond clause 7 and to your conclusion.
Philip Davies
I knew it was a mistake giving way to my hon. Friend, and that he would try to lead me astray once again. I will leave him to consider Barnett consequentials in his remarks—I am desperately trying to reach a conclusion.
I appreciate that the hon. Lady genuinely wants to help carers, and if the principle behind her Bill is to support carers, I will happily support that principle. However, of all the worthwhile issues and campaigns championed by different carers organisations and charities, it seems that she has picked the one dud. I would have been happy to support many other campaigns for carers had she raised them. For example, parent carers could be offered an assessment rather than having to request one for their children, and we could introduce measures such as:
“Clear recognition in law that parent carer assessments and services must have the promotion of their well-being at the heart of what they do.
Consolidation of legislation on parent carers from three different Acts”.
I would have been prepared to support such worthwhile campaigns to help carers, but I fear that the hon. Lady has picked the wrong campaign. For future reference I urge her to consider some of the other campaigns that carers organisations would like to be raised. I think she would get a lot of support from across the House and—I hope—from the Government.
In conclusion, the Bill is ill-thought through and many areas are far too vague. It will be a logistical nightmare to enforce and implement, and it would cost NHS trusts up and down the country millions of pounds, forcing higher charges on other visitors, or risking patient services. It would exempt a lot of people who are just as worthy recipients of parking concessions—I think that the Government’s guidance on hospital car parking is far more sensible than the provisions in the Bill, and they encompass more people who deserve to be considered. Hospitals already have power to implement the policy suggested by the hon. Lady if they wish, and perhaps on reflection she should go away and come back at some point in future with a different Bill. I have not mentioned the money resolution consequences of this Bill, but I hope that others will consider that issue. I have not seen any money resolution proposals.
Finally—very finally—I have people visiting Parliament today, so I apologise in advance if I cannot be here for the entire debate. I will try to stay for as much as possible because it is an interesting discussion.
Philip Davies
Perhaps they are, perhaps they are not—I do not know. I genuinely wish the hon. Lady well in her time in the House, and I do not doubt the worthy sentiment in this Bill. We all support what carers do in this country, but I think the Bill is misguided.
Mr David Nuttall (Bury North) (Con)
It is a pleasure to follow the hon. Member for Birmingham, Perry Barr (Mr Mahmood), who gave us his take on the Bill, although I feel the matter is a little more complicated than he would have the House believe.
I congratulate the hon. Member for Burnley (Julie Cooper) on coming fourth in the ballot for the right to bring in a private Member’s Bill—as a new Member entering the ballot for the first time, she has done very well indeed—and on choosing such an important topic. I do not know if she does the national lottery, but if she does—
Mr Deputy Speaker (Mr Lindsay Hoyle)
Order. Obviously, congratulating the hon. Lady is a good way of taking up time, but actually I did the draw, so if the hon. Gentleman is going to congratulate anybody, I think it should be me. However, I do not want us to get bogged down in that, because I know he wants to get straight into the Bill, on which I would welcome his comments. I know he would rather talk about the Bill.
Mr Nuttall
Of course, you were there, too, Mr Deputy Speaker, doing the draw, and very well you did it as well. As you know, however, because it is done in reverse, coming first actually means coming 20th.
Mr Nuttall
I will move on.
This is the first Bill to come before the House for its Second Reading since the new Standing Orders were introduced last week on what generally is referred to as “English votes for English laws” but what I prefer to call, more accurately, “English vetoes for English laws”. The new Standing Orders make it clear that the new procedures do not apply to private Member’s Bills, but it is worth noting—
Mr Deputy Speaker
Order. They do not apply to private Members’ Bills, so we do not need to discuss them. Seriously, a lot of Members still wish to speak, and I do not want any filibustering. I know that people are interested in the Bill and want to concentrate on it.
Mr Nuttall
I am grateful for the work carers do in my own constituency, particularly at the carers centre I visited recently, which provides a wide range of activities and support for those who undertake the often unsung job of caring for a loved on. I also pay tribute to the work that Carers UK does, as the principal national charity for carers. Of course, it very much supports the Bill, in this its golden jubilee year.
The aim of the hon. Lady’s Park the Charge campaign, which has resulted in the Bill, is to improve the financial position of carers who have to use hospital car parks by exempting them from car parking charges. Without doubt, the Bill is well intentioned, and no one from across the House would disagree with the proposition that helping those who selflessly care for others is a worthy aim. The first difficulty, however, facing anyone determining the size and nature of a group is that of definition, and that applies to carers as much as to any other. Carers UK says there are 6.5 million carers in the UK, with 5.4 million of them living in England. As I tried to mention earlier, the Bill only applies to England so that is the relevant figure.
Carers UK goes on to state that these people are providing unpaid care for their loved ones, saving the economy an enormous £119 billion each year, yet its research found that 48% of carers were struggling to make ends meet, and 45% said that financial worries were affecting their own health. It is no surprise, therefore, that Carers UK and the Bill seek to alleviate one of the financial pressures on carers—hospital car parking charges. However, I have several concerns, ranging from the Bill’s drafting to its financial implications and potential impact on other groups.
It is not clear to me how we can objectively determine who should and should not be expected to pay for car parking, as we would be doing if we started centrally exempting one particular group as being more deserving than another group. It would seem preferable to allow individual NHS trusts to continue making such decisions locally. Otherwise, on the face of it, we seem to have here a fair and reasonable proposal. Indeed, my initial thought was that it sounded like a good thing to do, and I suspect that most people’s instinct would be to support the Bill simply because of the title.
I know that the hon. Lady has campaigned on this issue with the best intentions, but I want to deal precisely with the exemptions she seeks to introduce. The Bill would exempt two groups of carers. The first is defined in clauses 1 to 3. Clause 2 states that beneficiaries of an exemption would either be in receipt of carer’s allowance or have an underlying entitlement to it. Carer’s allowance is a taxable benefit currently set at £62.10 a week to help a carer look after someone with substantial caring needs, and it is paid to the carer, not the recipient of the care. To qualify, the applicant must be over 16, spend at least 35 hours a week caring for someone, have been in England, Scotland or Wales for at least two of the last three years and not be in full-time education or studying for 21 hours a week or more. The person in receipt of care must receive qualifying benefits, such as the daily living component of the personal independence payment, the middle or highest care rate of the disability living allowance, attendance allowance or the armed forces independence payment.
That is the first group to which we can start to put a number. According to Department for Work and Pensions figures, as of February, 721,000 people were receiving carer’s allowance, so these people would be the first group that would clearly qualify under the criteria. However, the Bill would go further, by also including within the first group all those who have what is referred to as an underlying entitlement to carer’s allowance. The term “underlying entitlement” refers to the fact that a claimant cannot usually receive two income-replacement benefits together—for example, carer’s allowance and the state pension. This is called the overlapping benefit rule. If a person is not entitled to be paid carer’s allowance because of this rule, they are said to have an underlying entitlement to carer’s allowance instead. This might mean they could get the carer’s premium in jobseeker’s allowance and income support, the extra amount for carers in pension credit or the carer’s allowance element of universal credit. The importance of including those people is that the Bill would otherwise exclude carers in receipt of other benefits, such as the state pension, bereavement allowance, contribution-based employment and support allowance, contribution-based jobseeker’s allowance, incapacity benefit, industrial death benefit, maternity allowance, severe disablement allowance, universal credit, war widow’s or widower’s pension or widow’s pension.
Not surprisingly, the inclusion of these people significantly increases the number of those eligible under the Bill. DWP figures, as of February, estimate this group to number 409,000. Taken together, therefore, clauses 1 to 3 could exempt approximately 1.13 million people. These people are either receiving carer’s allowance or have an underlying entitlement to it. As the hon. Lady will be aware, in the north-west, where both our constituencies are located, there are 163,000 such people. To give some idea of the massive increase in the number of carers in recent years, I should add that the figure of 1.13 million is up from 451,000 in February 2000.
If, however, the definition of entitlement is applied in strict accordance with clause 2, the Bill would exclude, a university student caring for a disabled parent, for example. I suspect that the second group of potential beneficiaries was defined for people in such a position. The Bill therefore draws a distinction between a “qualifying carer”—someone caught by clause 2—and an “eligible carer”, as defined in clauses 4 to 6. My hon. Friend the Member for Shipley (Philip Davies) touched on this, and I pointed out in an intervention that the figure of 1.13 million—the figure quoted by Opposition Members as being the total number involved—seemed to ignore completely those included under clauses 4 to 6.
Clause 5(1)(a) defines the eligible carer as someone who
“has been assessed for free hospital parking”
by virtue of an amendment to the Care Act 2014, which this Bill would insert. The Bill proposes to amend section 10 of the 2014 Act, which deals with carer’s assessments. A carer’s assessment is made by a trained person either from the council or another organisation that the council works with. The Bill will make it a mandatory requirement for the assessor to assess
“whether the carer should be eligible for free hospital…parking”.
This is in addition to assessing, as outlined in the rest of section 10—
“(a) whether the carer is able, and is likely to continue to be able, to provide care for the adult needing care,
(b) whether the carer is willing, and is likely to continue to be willing, to do so,
(c) the impact of the carer’s needs for support on the matters specified in section 1(2),
(d) the outcomes that the carer wishes to achieve in day-to-day life, and
(e) whether, and if so to what extent, the provision of support could contribute to the achievement of those outcomes.”
It is not clear at all on what basis the assessor is expected to make this decision. If only eligibility or underlying eligibility to carer’s allowance is going to be checked, this provision is superfluous, as such people would be covered in the first group. If some other criteria are to be applied, there is nothing in the Bill or in any guidance notes—no such notes have been issued—to suggest what that might be.
Returning to my example of the student who is caring for a parent but cannot get carer’s allowance because of their studies, clause 5(1)(b) perhaps comes to the rescue. It says an “eligible carer” is a person who
“provides or intends to provide substantial care on a regular basis, other than by virtue of a contract or as voluntary work and has been certified as such by an appropriate clinician.”
I believe that the meaning is ambiguous. What does “intend to provide” mean? How far into the future is it expected that the care will be delivered—within the next week, the next month, the next year, or what? The Bill does not say. Or is a fixed timescale not required; is consideration of caring enough? What constitutes “substantial care” in this provision? Is it the 35 hours a week required to be eligible for the carer’s allowance, or is it fewer than 35 hours a week? We need to know, because the Bill is asking an assessor to be the ultimate arbiter of whether someone is entitled to free hospital parking charges.
Suddenly, the number of people who might benefit from free hospital parking becomes a lot less certain. The first group gave us 1.13 million people. How many more of the 5.4 million carers estimated by Carers UK to be living in England would be included in the second group? We simply do not know.
Julian Knight
My hon. Friend is providing a forensic discussion of the Bill and all its parts. Does he agree that we could end up with hospital trusts seeing staff members taken off the front line in order to administer these schemes, or even with administration staff, who would be better deployed in the hospital, being brought in to ensure that the right people get the free hospital parking?
Mr Deputy Speaker (Mr Lindsay Hoyle)
Order. I think we have heard this question before. Mr Davies was asked whether staff would be taken from the front line. We are going over ground that has already been covered. This is about a Bill, about car parking, and about the benefit of carers. What I do not want to do is become involved in speculation. We are not here to speculate about the future.
Mr Nuttall
I was about to say exactly the same thing, Mr Deputy Speaker, but I do not think that my hon. Friend the Member for Solihull (Julian Knight) was in the Chamber when someone made what I agree was a very similar point. I will merely say that, undoubtedly—I think that Members in all parts of the House will agree with this—the scheme will have to be administered somehow. It is not going to run itself. Someone, somewhere, will be required to run it, either someone new who has been brought in or someone who is currently doing another job in the hospital.
I do not know whether, as part of her preparation for the Bill, the hon. Member for Burnley ascertained how many national health service trusts in England might have to alter their price structures—that is, increase their parking charges to avoid falling foul of the income- generation principle—if the number of exempted carers were to be as significant as it appears. I do not know whether she proposes to scrap the principle of not running a scheme at a loss, as required by the 2006 guidance from the Department of Health. The NHS Confederation, which is the membership body for some 500 organisations that plan, commission and provide NHS services, says:
“NHS principles and Government policy are clear that healthcare is funded through taxation, not through patient charges. Surpluses from parking charges should only be a by-product of covering costs and managing space fairly.”
Most trusts make it clear that the income they receive from car parking charges goes towards covering the maintenance of the car park: for instance, the security, facilities and staff. To be specific, we are talking about the ongoing costs of anything from lighting to CCTV, footpath and cycle path maintenance, car park surfacing, and the employment of enforcement and security staff. If there is any money left over—and some trusts have no surplus from their car parking—it must, in accordance with the guidance, be used to improve local health services.
The Government have already been active in ensuring that information about parking is made very clear to members of the public, and I think it perfectly fair and reasonable to require trusts to ensure that that information is clearly visible on websites and in patient information in, for instance, letters. Patients are entitled to the reassurance of knowing that the purpose of the car park charge is not to provide the NHS with an additional, excessive income stream, but to provide for the car park in the first place. Charges, therefore, are used primarily to cover the running costs of the car park, and if there is a surplus, it cannot be used for other pet projects.
I referred earlier to the 2009 NHS car parking impact assessment. The then Labour Government commissioned the detailed, 61-page assessment of the costs of introducing free car parking. It concluded:
“On the available evidence there is scope for this policy to have both a positive and negative impact, both for older people and the disabled.”
Despite that rather mixed finding, Labour’s 2010 manifesto pledged to scrap hospital car parking charges. Five years later, however, at the time of this year’s May general election, Labour appeared to reverse its view, and to decide that the policy was unworkable. I look forward to hearing from the shadow Minister later whether that is still the position of the official Opposition. In fact, the Bill runs contrary to the principle that individual trusts feel that it is right to set parking charges according to their own financial situations. Only yesterday it was reported that the Oxford Health NHS Foundation Trust was consulting on the introduction of parking charges at its community hospitals.
What are hospital car parking charges actually paying for? That is a perfectly legitimate question for people to ask. It is reasonable to say that visitors and patients do not generally have a great deal of choice when it comes to parking at a hospital. There is usually just one car park operator, and patients, staff and visitors are therefore a captive audience. In some town centres, one might be fortunate enough to have the choice of a cheaper place in which to park, but for hospitals there is no market incentive to keep costs under control.
In December 2010, the British Parking Association, which is the largest professional association in Europe representing parking and traffic management organisations, released a charter of best practice for parking in hospital car parks. Understandably, given the large number of disabled users, it set high standards. The Charter for Hospital Parking stated that hospital parking operators should provide
“good lighting, high standards of maintenance for structures and surfaces, payment systems and equipment that are easy to use and understand, signs that are clear and easy to understand”
and
“clearly marked parking bays.”
Patients and visitors will understandably want a safe and secure environment in which to park when they go to their local hospital, or, potentially, a hospital that is out of their immediate area if they are receiving specialist treatment. As Carers UK points out, attending hospital can be a stressful experience for patients and visitors. The last thing they want is to have their car broken into, or to spend 20 minutes driving round in circles because entrances and exits are not marked properly, or to be stuck facing a ticket machine that does not work with the threat of an unfair penalty charge looming. Patients, and their carers, visitors and staff, will quite reasonably expect a properly maintained car park with proper lighting and adequate security, along the lines of what is set out in the charter, whether the purpose is to guide a daytime visitor with proper and effective signage or to protect the doctor or nurse who gets into the car at 3 am in the dark after a long shift.
The charter also states:
“Parking charges can help to pay for maintenance and management services, and prevent these from becoming a drain on healthcare budgets. Therefore, we encourage NHS Trusts and car park operators who manage hospital car parks to sign up to this charter and to abide by its letter and spirit.”
So far, 24 hospital trusts have signed up to the charter.
Mr Deputy Speaker (Mr Lindsay Hoyle)
Order. This is very worthy, and it is great to acquire this extra knowledge, but it is not really anything to do with carers. The hon. Gentleman has got on to nurses and lighting, and I understand all that, but, worthy as it is, it is not in the spirit of what we are meant to be discussing.
Mr Nuttall
Parking places are finite, Mr Deputy Speaker. If the Bill encouraged more carers to visit hospitals, which is what I think would happen, it would make it easier for them to gain access to car parks, and one consequence of that might be a knock-on effect on the income that would—
Mr Deputy Speaker
Order. I understand the point that the hon. Gentleman is trying to make, but it has already been well thumbed. As the hon. Gentleman knows, it was covered very thoroughly by Mr Davies, and I do not want him to repeat everything that Mr Davies covered. I think that, in his hour and a half, Mr Davies did not leave a lot of scope, but this is one point that he made sure we were well aware of.
Mr Nuttall
The problem with selecting a group to exempt from parking charges is the necessity of considering other groups, and deciding which groups it is fair to charge and which groups should be exempt. Is it fair to exempt a particular visitor, albeit a carer, but to charge a clinical support worker who parks at the hospital every day? It could be someone with children or other dependants, working and acting as a carer but not in receipt of carer’s allowance.
Fairfield general hospital in my constituency comes under the Pennine Acute Hospitals NHS Trust. According to figures from the northern commissioning region for the latest available year, I understand it is one of the trusts that charges on average 11p per hour for staff to park. I have to say that the trust sets out very clearly what its charges are for hospital car parking, and it provides a range of concessions. I take note of your stricture, Mr Deputy Speaker, so I will not read them out, but it is fair to say that it has obviously looked at this question and considered the various groups that should be entitled to a concession. For example, it has picked out blue badge holders, patients and visitors who need to attend on a frequent or regular basis and those who need to visit because they have suffered the bereavement of a loved one.
Such a scheme would be put in danger, and the trust would have to revisit it, which would undoubtedly have an effect on the viability of that scheme. Is it fair to charge a spouse or partner of a cancer patient who is still working and does not get carer’s allowance if they are too busy to get certified as eligible for hospital parking charge exemption, as required under clause 5 of this Bill? The Bill would require them to be approved in advance, and there will be many other deserving cases not covered by the Bill. The Bill does not seek to exempt people because of their low incomes, which is one a weakness. Some of the carers may well be in straitened circumstances, but there may be others who would be able to pay the charge, whereas some members of other groups would not be in that position.
The conclusion may well be that the fairest answer is not to exempt any groups but to make car parking free for everyone, as has happened in Scotland and Wales. Aligning us with those countries would be a popular idea with many people, but we must not forget that it would mean taking hundreds of millions of pounds out of the healthcare budget. The 2009 impact assessment suggested that the cost then would be between £140 million and £180 million. In six years’ time, it is reasonable to assume that cost would have increased enough to pay for 13,000 band 1 clinical support workers or 9,000 band 5 nurses. We have to ask what we think it is right to spend the healthcare budget on: patient care or free or reduced car parking.
Mr Nuttall
My hon. Friend is right. The fact is that in September 2014 the then Health Minister, my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter), noted in a debate that 40% of hospitals now do not charge for hospital car parking. They are likely to be in rural areas where there is less demand for parking—where it is easier to provide parking and there is less pressure on it. I suspect the reality is that a hospital with a car park in a central location in a busy town or a major city centre has no choice but to have a car parking charge. That is the reality of life. If it were be free, there would just be chaos; essentially, it would mean that those who really needed to get close to the hospital would not be able to do so. There has to be some system in place to protect the spaces that are close to the hospital for those who need them. Whatever system we have, there is no simple answer to that.
What we do know is that the present system of having local decision making is working. Fairfield hospital allows 30 minutes of free parking for everyone; then it costs just £1 for up to one hour. In the constituency of the hon. Member for Burnley, by contrast, people would pay £1.90 for up to three hours’ parking. There is a huge disparity across the country. We heard earlier—in an intervention from the hon. Member for Streatham (Mr Umunna), I think—about the costs in central London, which are understandably very much higher than in the provinces.
While the Bill does explain the generality of what is required, it does not explain how the system would work in practice. In the opening remarks of the hon. Member for Burnley, she mentioned that the system would work by way of having a badge in the car window. I am happy to be corrected if I misheard. That is the first time I had heard that. It would perhaps have helped all of us if that had been in an explanatory note saying this was how the scheme would work. She also mentioned that in some hospitals people have to pay on entry—I think the hon. Lady is nodding. That is all very well, but I am not quite sure how simply having a voucher in the car window would help in that scenario. It must be more complex than that, and some sort of token would be needed in order to get through the barrier.
Mr Deputy Speaker (Mr Lindsay Hoyle)
Order. The question is not how people get into a car park; it is whether there is free concessionary parking for carers. We are dealing with that, not the detail of how we get there. Obviously if the Bill were to go into Committee, these would be the areas that Members would want to cover there. I want to concentrate on where we are now and how we keep to where we want to be within the Bill.
Mr Nuttall
I will move on from that detail. I accept it is a detail, but it is an important detail.
Mr Deputy Speaker
Order. I agree, but we have heard about all the different scenarios previously and in detail. That is what worries me. We can get bogged down in repeating details, and I know the hon. Gentleman does not want to do that.
Mr Nuttall
I want to move on to the devolution of healthcare. It was only very briefly touched on earlier, but it is of particular significance to my constituency, because, as Members will be aware, it is proposed to devolve healthcare to Greater Manchester. From April next year, it will be the first English region to get full control of its health spending. The situation in this regard is not at all clear. The Bill states that it will apply to the whole of England, but if healthcare is devolved, will Greater Manchester be exempt on the same basis that Scotland and Wales are exempt? Healthcare spending has been devolved to those countries and they are then excluded from this Bill.
Junior Doctors’ Contracts
Lindsay Hoyle Excerpts(8 years, 6 months ago)
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Lucy Frazer (South East Cambridgeshire) (Con)
I do not think that any of us dispute the fantastic work that doctors do day in, day out, but we need to debate the motion that the hon. Lady has proposed. She said there were three points that she wants to put to the Secretary of State, but she failed to mention the one in the last line of the motion, which is that she wants proposals to be put forward that are “safe for patients”. Given that there was an article just last month on 5 September in the BMJ, put together by seven experts, including three professionals, that said that there was a clear association between weekend admission and worse outcomes for patients—
Mr Deputy Speaker (Mr Lindsay Hoyle)
Order. I am sorry, but hon. Members should know that interventions should be short. You cannot make a speech in an intervention, and that should be a lesson for us all. Many Members want to speak and I want to get everybody in.
Heidi Alexander
The problem with how the Government have handled the negotiations is that they have provided absolutely no clarity to junior doctors about what the proposals would mean for them individually. Everyone thinks that they are going to lose out.
The Government say that they want to reduce the number of hours defined as “unsocial” and thereby decrease the number of hours that attract a higher rate of pay. They say that they will put the rate of pay for plain time up to compensate, but there is no guarantee that the amount by which basic pay goes up will offset the loss of pay associated with fewer hours being defined as unsocial. Does the Secretary of State understand that those who work the most unsociable hours, the junior doctors who sacrifice more of their weekends and nights, feel that they have the most to lose?
Mr Hunt
I am happy to deal with that. We went into the election in May saying that on the back of a strong economy we were prepared to commit £10 billion extra to the NHS in real terms over the course of this Parliament. That was £5.5 billion more than the hon. Lady’s party was prepared to commit. In the last Parliament, when the increase in NHS spend was half that amount, we increased the number of doctors by 9,000, so we are increasing the number of doctors, but as we do so we need to ensure that we give the right care to patients.
I want to give a word of caution to the shadow Secretary of State. The tragedy of John Moore-Robinson, the gentleman I have mentioned, happened not only on a Saturday, but at Mid Staffs. The last time the House discussed the difference between excess and avoidable deaths was under a Labour Government, when they tried to brush the problems at Mid Staffs under the carpet, saying that we should not take the figures on excess deaths too seriously because they were a statistical construct and different from avoidable deaths. I would have hoped that the Labour party learned the lessons of Mid Staffs and would not make the same mistakes again. [Interruption.]
Mr Deputy Speaker (Mr Lindsay Hoyle)
Order. The hon. Member for Islington South and Finsbury (Emily Thornberry) may shake her head, but I expect voices in the Chamber to be a little quieter. I want to hear the Secretary of State, and I think all our constituents do. I understand that you might not agree.
Mr Hunt
Let us look at some of the facts. What is the most important thing for people admitted to hospital at the weekend? It is that they are seen quickly by a consultant. Currently, across all key specialties, in only 10% of our hospitals are patients seen by a consultant within 14 hours of being admitted at the weekend. Only 10% of hospitals provide vital diagnostic services seven days a week. Clinical standards provide that patients should be reviewed twice a day by consultants in high-dependency areas but, at weekends, that happens in only one in 20 of our hospitals across all key services.
Mr Hunt
I thank my hon. Friend for his consistent support for his local hospital. It has had many troubles, but it is beginning to show signs of turning a corner. If we want to turn things around, we must first be honest about the problem.
I welcome the shadow Health Secretary to her place. Her predecessor tried to minimise the care problems that took place under a previous Labour Government, and he described our attempts to put them right as trying to “run down the NHS”. I hope that she does not do the same. Labour used to be the party that stood up for ordinary men and women; it cared enough about them to set up the NHS, so that no one had to worry about getting good medical care, whatever their circumstances. People need to know that they can depend on our NHS seven days a week. Instead of making mischief about a flawed doctors contract that was introduced by a Labour Government in 2000, the hon. Lady should stand with us as we sort out this problem. Be the party not of the unions but of the patients who depend on high quality care, day in, day out. Professor Bruce Keogh talked about the moral and professional case for concerted action. Surely in that context, she might reconsider this rather ill-judged attempt to make party political capital out of a very real problem.
Everyone who cares about the NHS should want the same thing. The hon. Lady should tell the BMA to get around the negotiating table, something she conspicuously failed to do. In doing so she would stand alongside the many independent voices calling on the BMA to return to the table and discuss a solution with the Government—the Royal College of Surgeons, the Royal College of Physicians, NHS providers and the Academy of Medical Royal Colleges. If she does not do that, the British people will draw their own conclusion about which party is backing the NHS with the resources it needs, which party is supporting hospitals to become safer at the weekends, and which party is standing four-square behind doctors and nurses in their ambition to deliver high quality standards of care for patients. There is only one party that can be trusted, one true party of the NHS, and that is the Conservative party.
Mr Deputy Speaker (Mr Lindsay Hoyle)
There will be a four-minute limit on Back Bench speeches.
Epilepsy
Lindsay Hoyle Excerpts(9 years, 2 months ago)
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Mr Deputy Speaker (Mr Lindsay Hoyle)
Order. I am bringing in an eight-minute limit. I call Kate Hoey.
GP Services
Lindsay Hoyle Excerpts(9 years, 3 months ago)
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Mr Prisk
On the development of local plans, in east Hertfordshire and elsewhere, the problem is that our rather nice, but historical and inadequate, premises restrain the ability of practices to provide modern facilities. Is that my hon. Friend’s experience of the local planning process in his constituency?
Mr Deputy Speaker (Mr Lindsay Hoyle)
Order. May I make a suggestion? The Speaker suggested a time limit of about 10 minutes, and the hon. Gentleman has now had 13 minutes. I hope there will not be too many more interventions, and that the hon. Gentleman is coming to the end of his speech.
John Howell
Thank you, Mr Deputy Speaker. I am coming to the end, but let me respond to my hon. Friend’s intervention. It depends on where the practice is and what its buildings are like. Some are quite modern, and one would not want to change their facilities. Even those practices may need to add an extra surgery, if the village is going to grow by several thousand people, so they need to plan for where it will go and for the doctor that will use it.
The trend in the population has been towards more elderly patients and more patients with long-term, chronic or multiple conditions. That leads to an increase in the number of patients per year. There is no doubt that the age profile is having an impact. The Government’s allocation of a named doctor to a patient is useful for the co-ordination of services, even though in an emergency the patient may not be able to see that doctor on the day when they require them.
Yes, there is a need for money to be provided for GP services, but this is possible only if we have a strong economy. The Government have evened out the payments between practices so that they do similar things in similar parts of the country and there are not wide variations between them. That has to be the right way to go. It also has to be right to increase the strength of the economy in order to provide these services.
Douglas Carswell (Clacton) (UKIP)
I am very interested in what the hon. Lady is saying, because it sounds ominously like the situation in Clacton. Indeed, in one Frinton surgery in my constituency, one doctor was trying to serve 8,000 patients. She is absolutely right to avoid the temptation to blame the patients or to suggest that they are the problem. Does she agree that part of the answer is to ensure there are far more attractive terms for would-be GPs? That does not necessarily mean higher salaries—
Mr Deputy Speaker (Mr Lindsay Hoyle)
Order. Mr Carswell, interventions are meant to be short, not speeches. I am sure you have got to the point.
Stella Creasy
It is unusual for me to agree with the hon. Gentleman, but I agree that we need to look at how we can attract and retain doctors. We also need to look at what these problems do to the rest of the NHS.
Let me tell the hon. Gentleman about a constituent of mine who had a problem with his eyesight that was caused by high blood pressure. Because he could not get a doctor’s appointment, he left the condition alone. He has now gone blind in one eye and his other eye is at risk. His elderly wife came to me because she did not want to bother the doctor. We have to change that culture and to consider the consequences of not using our resources to deal with those early problems. When we leave somebody like that and they end up going blind, the cost to all of us to help them is much greater than if they had been able to access a GP. We must look at the terms of the job, but also at where the resources are not going. I have been raising those questions with local health care providers.
Mr Deputy Speaker (Mr Lindsay Hoyle)
Order. May I just stress that if we stick to 10 minutes, I can give everybody 10 minutes? If we run over, people will end up having their speeches cut and I do not want to do that to anybody.
NHS (Government Spending)
Lindsay Hoyle Excerpts(9 years, 3 months ago)
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Mr Deputy Speaker (Mr Lindsay Hoyle)
I remind Members that there is a seven-minute speaking limit. We should get everybody in, unless there are interventions, in which case we may have to change it.
Mr Deputy Speaker (Mr Lindsay Hoyle)
Order. I must now introduce a six-minute time limit on speeches.
Charlie Elphicke (Dover) (Con)
When I was first campaigning in Dover and Deal, I found that the previous Government’s legacy was that they had run down the much-loved Buckland hospital in Dover. Wards had been axed one by one; services had been withdrawn one by one; and the hospital had been decimated for more than a decade. There had been talk of plans to build a new hospital, but they had gone nowhere for the better part of a decade. It was a total disgrace; we did not get a fair share of health care in Dover and Deal.
In addition, an agreement appeared to have been made by the hospital trust in 2006 to take away the out-patient services at Deal’s hospital. There were claims of a consultation with the then MP and the then elected representatives to withdraw those out-patient services. So when I was elected I faced a situation where the hospital trust wanted to axe out-patient services and people were very concerned that Deal’s hospital was so undermined that it would be lost altogether. That was unacceptable.
What did the Conservatives do about it? Thanks to our funding of the NHS—the amount of money we have put in and the increase in spending in real terms—we managed to get a new hospital built and it opens in March. That is a real achievement, ensuring that we will have a fairer share of health care back in Dover. After the years of going backwards, we will go forwards, and people in our community will be able to be seen and cared for in our community. Rather than have Deal’s hospital being run down and closed, as people feared, because Labour left it teetering on the edge, we campaigned hard.
I undertook a large survey across the whole of Deal and I listened to people’s views. Thousands responded and we had hundreds in a meeting in a church to listen to the doctors and put the case for keeping the hospital, and now the clinical commissioning group, using its new funding powers, is ensuring that that hospital is safeguarded for the future. In that way, under the Conservatives, we have safeguarded Deal’s hospital and we are getting a new Dover hospital.
We also had difficult times in our local hospital trust—the East Kent Hospitals University NHS Foundation Trust had the CQC come in and investigate. In the past there would have been a cover-up and things would all have been swept under the carpet, just as they were in Staffordshire. That was the disgrace under the previous Government; the shadow Health Secretary oversaw that shameful episode. This Government have been open, honest and frank about the situation, and have ensured that special measures are taken and that we will have more nurses, more investment and better health care as a result. That is an important milestone. It shows not only that we have a new Dover hospital and that we have safeguarded Deal’s hospital, but that we have a better trust thanks to the reforms the Government have put in place.
But I think we should go further. I want to see five-star health care in Dover and Deal, so that rather than the cold wards of old, we should have new individual care and recovery suites, which can enable flexibility. People could be there for short-time observation; for step-down care for a week or two, rather than blocking up the acute hospital; for re-ambulation over a two to three-month period; or for much longer-term palliative care or perhaps end-of-life care. I am working with Kent county council, the local CCG and other health stakeholders to examine how we can bring forward that sort of innovative proposal. It will help with NHS funding because it will save money lost through bed-blocking; it will save money because its beds will be less expensive than elsewhere in the NHS; and it will provide a better experience for patients because they will be able to get better and recover within the community.
We need to rethink A and E more generally, by having more local emergency centres. My plan is that at the new Dover Buckland hospital, which opens in March, we should see a local emergency centre being used as an out-of-hours base for the doctors and CCG. It should be beefed up so that it has a much more emergency flavour to it, rather than a minor injuries one, so that more people use it, more people have trust and confidence in it and fewer people will inappropriately admit themselves to A and E down the road in Ashford. In that way, we will be able to get the right kind of cascading, the right level of treatment and the right places, given how our health system works. Such an approach would allow simpler stuff to be carried out more locally in our communities, whereas the more complicated accident and emergency problems would be dealt with in a more centralised A and E unit. That kind of modernisation in how we deal with out-of-hours care and A and E-type care is something I hope we will think about and see more of in future. I do not see this as a left/right issue, just as I do not see community hospitals, which I believe in, as a left/right issue. I see it as being about people who are concerned about localism, and the localisation of health care and bringing it closer to the patient and to the community. That is the way we should be building the future of our NHS. It is a great shame we have seen so much politicisation and weaponisation of this—
Mr Deputy Speaker (Mr Lindsay Hoyle)
Order. I call Grahame M. Morris. You have five minutes.
Grahame M. Morris
I would rather weaponise it than privatise it, which is what I accuse the Government of doing. That would not have been possible without the active support of the Liberal Democrat party—talking of which, the hon. Member for Redcar (Ian Swales) has just taken his place in the Chamber. I feel bitter about what has happened. The hon. Gentleman and I both served on the Health and Social Care Bill, which has now been enacted. The lead advocates were the right hon. Members for Chelmsford (Mr Burns) and for Sutton and Cheam (Paul Burstow). That Act was a really dangerous move, because part 3 opened up our national health service to the full force of competition. Conservatives may say that the difference is only marginal, but the truth is that that Act allows hospital trusts to have up to 49% of their income come from private patients.
I know that we are desperately short of time, but I want to set out some political dividing lines. Labour and the Conservatives are making very different offerings for the NHS. Labour’s offering is that it will provide more nurses and GPs, and I think it will find favour. In the next general election—
National Health Service
Lindsay Hoyle Excerpts(9 years, 3 months ago)
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Mr Deputy Speaker (Mr Lindsay Hoyle)
Order. Speeches of up to eight minutes would be helpful if we are to try to get everybody in—do not worry, you did very well, Paul.
Andy Burnham
On a point of order, Mr Deputy Speaker. I have always to correct the record when these statements are made. I apologise for delaying the House, but I am going to carry on doing it. I did not put it out to tender; it was a process I inherited, and in the middle of that process I changed the policy from “any willing provider” to “NHS preferred provider”. Contrary to what the Secretary of State said at the Dispatch Box, NHS Peterborough and Stamford was still in the race.
Mr Deputy Speaker (Mr Lindsay Hoyle)
You have certainly corrected that. It is a point of correction, rather than a point of order. It is all on the record now and everyone can continue. Let us see whether we can turn the heat down a bit.
Sir Oliver Heald
Further to that point of order, Mr Deputy Speaker. I just do not accept the point of order that the shadow Secretary of State has made. May I just—
Mr Deputy Speaker
Order. No—I said straight away that it was not a point of order, but a point of correction. The point is that it is all on the record for people to read tomorrow, to continue a debate on who is right and who is wrong. Both parties, quite rightly, have stated what their belief is. Mr David T.C. Davies has not much time to go and I am very worried that he will not get to the end of his speech. He has only eight minutes in total.
David T. C. Davies
Thank you, Mr Deputy Speaker. I am grateful, because I want to talk about quite a few other things. We did not hear very much about waiting time comparisons, but of course the waiting times in England and Wales are very different. In Wales, people wait at least 26 weeks, with 14,745 having been waiting for more than nine months for treatment; in England, people wait about 18 weeks. One hundred and fifty people have died in Wales waiting for cardiac surgery.
Rehman Chishti
I pay tribute to the work my hon. Friend does in his constituency. I often see it on Facebook and read about it on the internet. He is a tireless campaigner for the health service in his constituency. He mentioned the A and E in his constituency. A linked issue is that of resources. In my constituency, £13.4 million has just been invested in resources for the A and E department—
Mr Deputy Speaker (Mr Lindsay Hoyle)
Order. I do not want such long interventions. If the hon. Gentleman wishes to speak, we can always put him on the list. If he wants, he can save something for later.
Stephen McPartland
My hon. Friend makes a fantastic point, and he is a fantastic campaigner, too. I am sure that that money would not have arrived without a huge effort on his part.
The Leader of the Opposition was in my constituency last week, and we were grateful to him for his visit. He came and celebrated the £150 million investment that I had secured for my hospital. He can come as much as he likes, because I got more donations, supporters and volunteers from his visit. Perhaps he could come on a weekly basis. Incidentally, let me talk about the Lister treatment centre, which the right hon. Gentleman visited. It was privatised under the previous Government. I ran an 18-month campaign to have this private facility returned to the NHS, and I succeeded. I am probably the only Tory MP in history who has managed to renationalise a part of the NHS that had been privatised under a Labour Government. I worked very hard on that campaign, but it was lonely work. The local Labour council did not back me; the local Labour candidate did not back me; the Labour shadow Secretary of State did not back me; the Leader of the Opposition did not back me; but the GMB union did and for that I am very grateful.
Three people died in that facility and 8,500 patients’ records were lost. It was a complete and utter shambles. Clinicenta Carillion, the organisation that was responsible for running that facility, destroyed the lives of thousands of people in Hertfordshire; that must never be repeated. That is what we talk about when we talk about the NHS. Who did I stand up for? I stood up for the patients, for the staff and for their families. Where did I get my information from? From members of staff who were working in that facility daily, under huge pressure, suffering and working as hard as they could to provide the best service they could. They could not do it, because their hands were tied behind their back—the contract was so bad. The local hospital was not even allowed sight of the contract until it was signed, sealed and delivered by the previous Government. They did not even know what they were being signed up to, which is a disgrace. I am proud of my hospital and the staff who work in it, but we must always remember that, at the end of the day, these are human beings, who are working incredibly hard to deliver real improvements in services.
Fortunately, that facility is being handed back to my local hospital. The Secretary of State for Health worked with me. He allowed me to come and see him, and we had a variety of meetings. I argued with the Care Quality Commission. I was very lonely throughout that campaign, but at the end of the day the Secretary of State worked with me and he nationalised that private facility, which the previous Government—disgracefully—privatised. I am proud of the Secretary of State, and I am only sorry that he is not in his place, because I wanted him to come and open one of our wonderful new facilities in February. The Prime Minister can come in March.
The facility that I was discussing got so bad that GPs lost confidence and wrote to each other saying, “Do not refer patients to this facility or you will put them at risk.” The CQC started proceedings to revoke the licence. That facility was falling apart—a facility that was privatised by the previous Government. It was nationalised by the Conservatives.
So I am proud of the NHS and proud of the staff who work in it. I am proud of the £150 million development in my constituency, which is making my hospital one of the most modern facilities in the UK. I am disgusted that the Leader of the Opposition wants to weaponise our local NHS and never once backed my campaign to bring that shameful private contract back to the NHS. The Labour party should apologise to my local community for playing Russian roulette with our local health service and politics with my constituents and patient safety.
Ms Diane Abbott (Hackney North and Stoke Newington) (Lab)
I am in no turmoil whatever. I will be walking through the Lobby with pride behind my hon. Friends. We cannot know exactly how much a mansion tax, if levied, would raise towards the national health service. What we do know is that the British people who want to save the national health service from the depredations of Government Members have to vote Labour. We have to vote for my right hon. Friend the Member for Leigh (Andy Burnham) to become Secretary of State for Health—
Mr Deputy Speaker (Mr Lindsay Hoyle)
Order. We do not need a statement; we have got the message.
Mr Burns
In conclusion, it is sad that the hon. Lady has completely undermined the case and the costings of the right hon. Member for Leigh (Andy Burnham). I have no doubt that when she has swallowed her pride and gone through the Lobby today, she will battle as hard as she is renowned for battling and will hit the leader of her party over the head to try to get him to see common sense and abandon this ridiculous policy that she also thinks is ridiculous.
Mr Deputy Speaker
Order. I have tried to work within the spirit of the previous announcement, but I think the time has come to introduce the eight-minute limit.
Angela Smith
I thank my hon. Friend for that intervention and I am really sorry to hear of the cases she raises. The situation really does need to be sorted out, because the Yorkshire ambulance trust goes on to say that
“the service was experiencing a high level of demand in the South Yorkshire area around the time of Mr Bailey’s incident. Overall, demand was 12% above predicted levels and the level of ‘Red’ call demand was 55% above predicted levels…Rising demand on all health care resources continues which requires changes to deliver improvements in urgent and emergency care.”
I shall say no more about Mr Bailey’s case because it will be referred elsewhere and it may well go to law—I have simply set out the facts of the case as they have been put to me—but the point is this: why are we experiencing these problems with response times in the ambulance service? Why are we hearing, week after week in Prime Minister’s questions and on the Floor of the House in other debates, that the ambulance service is letting people down—even in the most serious cases, when people are going into cardiac arrest or having a major stroke?
We need to establish the reasons, and I suggest that there are three obvious ones. There may be more—there may be problems with the management of ambulance services, and in many cases there clearly is a problem in the case of YAS—but I would suggest that there are three obvious problems. One problem is the increasing difficulty that people have in getting access to GPs’ surgeries. The evidence was laid before the people present for this debate earlier, by the shadow Secretary of State, so I will not go through it again.
Secondly, there has been the closure of NHS Direct and the establishment of NHS 111. There is no way that NHS 111 can be compared with NHS Direct; it is like comparing apples and pears. I have used NHS Direct in the past. It was a superb service that enabled me to decide which was the appropriate place to go to for my treatment and to get the right treatment at the right time. I can assure hon. Members that the one place I did not end up, having used NHS Direct, was A and E—that would have been the last place I had to go to.
Thirdly, social care cuts represent one of the most fundamental problems of our time. As my right hon. Friend the Member for Wentworth and Dearne (John Healey) said, £1 in every £10 has already been cut from social care budgets. It is obvious, even to the most disinterested observers of the debate on health, that cutting social care budgets at local authority level will ultimately impact on the health service. I was in local government for 10 years, and I saw for myself the importance of the local authority and the local NHS working together to enable elderly people to stay in their own homes and to keep them out of the health system—the acute health system, in particular—as much as possible.
The shadow Secretary of State, my right hon. Friend the Member for Leigh (Andy Burnham), outlined what needs to be done in the very long term, strategically, to get the NHS in the right shape. He also outlined the more immediate actions that a Labour Government would have to take if they gained power in May: providing more clinically trained staff to handle NHS 111 calls; restoring the GP guarantee of an appointment within 48 hours; and ensuring that councils, the NHS and the local voluntary sector work together to identify older people at the highest risk of hospital admission and link them up with the right support. I cannot wait for 8 May to see that strategy for the short term being put in place.
Ambulance services are crucial to the trust that people have, and need to have, in their local health services. One can broadly measure the trust that people have in their local health service by how much they can rely on their ambulances. Everybody likes to think that if they need an ambulance they will get one, and get it quickly. I was disappointed this afternoon that the Prime Minister used my question to indulge in petty political point-scoring. These issues are too serious for that. He did not even express sympathy for the family affected and instead made a cheap point about NHS staff. That was disgraceful. It is not good enough, and it is not good enough—
National Health Service (Amended Duties and Powers) Bill
Lindsay Hoyle Excerpts(9 years, 5 months ago)
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Dr Whiteford
The points the Minister is making about competition take us back to the transatlantic trade and investment partnership. He must be aware that the NHS across these islands is developing in very different directions, and competition has not been at the heart of what has happened in other parts of the UK. I want him to give us cast-iron guarantees today that there will be no obligation on the NHS in Scotland to open up because of that trade agreement, even if the UK decides in its favour. What opportunities are there, if the treaty exposes the Scottish Government to—
Dr Poulter
I will come to TTIP shortly, and I think that I will be able to reassure the hon. Lady and the hon. Member for Angus (Mr Weir).
The Health and Social Care Act put in place an alternative route to the courts, through Monitor, to address abuses of the rules around procurement. The Bill would remove that alternative route, meaning that future complaints under the law would result in hugely costly legal processes for health care commissioners, and complaints would be considered by the courts, rather than by Monitor, a health expert regulator. That cannot be good for patients. The Bill would result in more money for the lawyers, and much less money for our NHS and the patients that it looks after.
Another important point is that by favouring NHS over non-NHS providers, the Bill would be a move against the voluntary and charity sector providers, such as Macmillan and Marie Curie, who have done so much to help care for patients for many years.
Dr Poulter
I am going to make some progress—I hope the hon. Lady will forgive me—because Mr Deputy Speaker is looking at me.
Dr Poulter
Points were made about the voluntary and charitable sector supporting innovative new models of care. Through the Newquay pathfinder project Age UK has provided volunteer support to vulnerable older people considered at risk. Under the home scheme the British Red Cross provides volunteer support to patients in their homes, which is aimed at preventing admission to, or facilitating discharge from, hospital. The charity has care in the home contracts with more than 30 NHS trusts and social services departments, and the scheme enables reduced admissions, increased convenience to patients, and many other associated benefits.
My hon. Friend the Member for Stafford (Jeremy Lefroy) mentioned Macmillan. I like to talk about Macmillan, which has long provided vital support to patients right across the UK. It is collaborating with doctors in Staffordshire to transform cancer care and end-of-life care, and together they aim to commission care right across the patient journey. In cancer, that means commissioning prevention and health promotion, ensuring early diagnosis and prompt treatment through survivorship and improving end-of-life care.
In reality, the only route proposed in the Bill for recourse against unfair treatment by commissioners is to take us back to the previous Labour Government’s competition laws in 2006 and open up legal challenge through the courts. Only private providers with enough resource behind them are likely to be able to afford to exist in that court-based system, to pay high legal fees, and to invest in providing NHS care to patients, and smaller providers, especially charities, will lose out. Surely we do not want to see that in our NHS—an NHS in which, I hope we all agree, charitable and small local health care organisations have something important to contribute for the benefit of patients.
Before I conclude, I must briefly address some of the misleading commentary that has surrounded TTIP, which is serving only to distract from the real debate about our NHS. First, may I state that there is absolutely no agenda whatsoever to privatise our NHS through the back door? TTIP cannot force the privatisation of public services by EU member states. This position has been made explicitly clear by us and by the relevant negotiating parties. To suggest otherwise would be disingenuous and, frankly, wrong. I encourage Members to look at the recent negotiating mandate published by the European Commission, where this position is made absolutely clear. I note the comments of Ignacio Garcia Bercero, EU chief negotiator, on the record at the end of round 7 negotiations—
Mr Barry Sheerman (Huddersfield) (Lab/Co-op)
On a point of order, Mr Deputy Speaker. I do not know what is going on with this speech. I know that the Minister is a distinguished medical person, but he is presenting the speech with so much jargon and such technical terms that very few people out there will understand the main thrust of it. The only thing many people have understood in the last few minutes is the back-door privatisation.
Mr Deputy Speaker (Mr Lindsay Hoyle)
That is absolutely not a point of order, but we will hear from some other speakers if we can get to the end of this speech. We might then hear some other parts of the debate.
Dr Poulter
Thank you, Mr Deputy Speaker.
I have mentioned the benefit to patients many times in my speech, because that is, after all, what I care about as a doctor and what I care about as a Health Minister, and what I hope all hon. Members care about; I know that the hon. Member for Huddersfield (Mr Sheerman) does so.
Additionally, and contrary to claims made by some, TTIP will not prevent any future Government from changing the legal framework for the provision of NHS services. Neither will it prevent the termination of the private provision of such a service in accordance with the law or contracts entered into, as is already the case today. The reassurances that we and the European Commission offered were sufficient for the right hon. Member for Wentworth and Dearne (John Healey), a previous shadow Health Secretary, when he stated:
“On the NHS....my direct discussions with the EU’s chief negotiator have helped produce an EU promise to fully protect our health service including, as the chief negotiator says in a letter to me, so that: ‘any ISDS provisions in TTIP could have no impact on the UK’s sovereign right to make changes to the NHS.”
If it was good enough for the right hon. Gentleman—
Barbara Keeley (Worsley and Eccles South) (Lab)
I congratulate my hon. Friend the Member for Eltham (Clive Efford) on his excellent opening speech—I think it was one of the best speeches I have heard in the House—and on introducing his Bill so that we can review and reform some of the more pernicious effects of the Health and Social Care Act 2012. One of the worst was to force market tendering of services, meaning that millions of pounds are wasted on the process, money that should be spent on improving front-line patient care.
As a member of the Health Committee, I am very concerned about the increasing role that private companies are paying in providing NHS services. We recently looked at what is happening in Stoke and Staffordshire. There have been a few references to that in this debate and I will talk some more about it, but we looked at it under the label of the integrated care pioneers pilot. I want to talk more about that development as an example of just what can happen under this Government’s market framework—[Interruption.]
Mr Deputy Speaker (Mr Lindsay Hoyle)
Order. There are a lot of conversations and I am struggling to hear the hon. Lady. If we need to have the conversations, can we turn them down a little?
Barbara Keeley
Thank you, Mr Deputy Speaker.
The clinical commissioning groups involved plan to tender by summer 2015 a £1.2 billion contract to deliver cancer services and end-of-life care for 876,000 people across the area. The witnesses we heard from made it clear that commissioning on a disease-specific basis like this is risky. There are only a few small-scale examples of that being done anywhere, and nothing on the scale of this project. Despite the risk, we heard some worrying things about local people or local MPs not being listened to and about a lack of consultation with or involvement of hospital-based clinicians. The Minister has just referred a number of times to letting doctors get on with running the NHS, but the CCGs involved in driving this pilot are not even involving or listening to local clinicians. I and other colleagues on the Committee found that bodies such as Healthwatch England and Macmillan Cancer Support were cheerleaders for—and in Macmillan’s case, a funder of—development work on a project that could end up privatising cancer and end-of-life care for almost a million people. I for one found that disturbing. I felt, and I know that some of my colleagues did too, that there was a conflict of interest. Healthwatch England was meant to be the consumer champion of health and care.
By contrast with what Government Members have said, there was also a fair amount of concern among Committee members about the role of Macmillan Cancer Support in funding the development work when many believe that the money they give to Macmillan goes directly to cancer care. Indeed, the example I saw on the Macmillan website yesterday was that a donation would pay for a Macmillan nurse for a period to help people living with cancer and their families receive essential medical, practical and emotional support. It does not appear to be a selling point for that charity that funds would be used on a project to privatise end-of-life and cancer care in Staffordshire and Stoke.
Clive Efford
claimed to move the closure (Standing Order No. 36).
Question put forthwith, That the Question be now put.
The House proceeded to a Division.
Mr Deputy Speaker (Mr Lindsay Hoyle)
I ask the Serjeant at Arms to investigate the delay in the No Lobby.
Mr Deputy Speaker (Mr Lindsay Hoyle)
I ask the Serjeant at Arms to investigate the delay in the No Lobby.
Clive Efford
On a point of order, Mr Deputy Speaker. I understand that, in order to go into Committee, this Bill requires a resolution from the Government. Given the overwhelming number of people who turned up on a Friday to support it, would it not be churlish of the Government not to pass that resolution and make sure that this Bill goes into Committee forthwith?
Mr Deputy Speaker (Mr Lindsay Hoyle)
As you pointed out, it is something for the Government, but not me, to take on board.
Mitochondrial Replacement (Public Safety)
Lindsay Hoyle Excerpts(9 years, 8 months ago)
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Mr Deputy Speaker (Mr Lindsay Hoyle)
Order. Nineteen Members wish to speak and other Members are trying to catch my eye to intervene. It is an important debate and we need to allow the allotted speakers in, so Members should think very hard before trying to intervene.
Fiona Bruce
Thank you, Mr Deputy Speaker.
Parliament should be allowed to deliberate on and debate this issue at length, but that might not happen. I understand that the Government propose to lay regulations permitting PNT and MST before the end of this year. Sir John Tooke, president of the Academy of Medical Sciences has said:
“Introducing regulations now will ensure that there is no avoidable delay in these treatments reaching affected families once there is sufficient evidence of safety and efficacy.”
In other words, Parliament should vote blind and sign off legislation permitting these procedures before the recommended experiments—some of them critical, regarding safety—have been completed.
Mr Deputy Speaker (Mr Lindsay Hoyle)
Order. I will bring a four-minute limit in to give us a chance to maximise the number of speakers. If Members can cut the length of their speech, all the better.