Public Health

Mark Harper Excerpts

Monday 4th May 2020 Commons Chamber

[Mr Mark Harper (Forest of Dean) (Con) [V]]

It is a great pleasure to follow my hon. Friend the Member for Witney (Robert Courts) and relatively close geographic neighbour, because what I want to stay chimes with the sentiments that he has just set out. I fully support the regulations in front of the House, but it is worth emphasising what an enormous restriction on our liberty they are—the greatest restriction on our liberty that there has been in British history. That restriction is there for a very good reason, but in a democratic country such as ours, where we have to have consent, it is the Government’s task each time they bring forward such regulations to remake the case as to why we are doing it. It is also worth saying that with each of the review periods, it is not for others to justify the regulations going away; the Government must rejustify why they have to remain in place so we do not consider that they become the new norm.

In that spirit, and I hope that the Minister will address this when he winds up, I request that before any changes to these regulations come into force —indeed, there has already been one set of amendments—any amended regulations are brought forward and debated and decided on by the House. I understand why that did not take place when the regulations were first brought in, but any subsequent amendments should be debated by the House. I was pleased that the Opposition have taken that view. I would prefer the process to remain consensual, but it will only if the Government behave in that way. Scrutiny is important because, as we have already seen with the current regulations, there has been confusion and debate about the guidance that the Government set out and the meaning of the regulations—that is, the law and what has therefore been interpreted by the police.

The Prime Minister confirmed last week, when he addressed the nation on his return to Downing Street, that he was in favour of the greatest transparency as we debate these measures. I therefore say to the Minister that it was disappointing that the seven documents that have been created to set out safe ways of working—the guidance for employers—have reached the public domain, whether that was through leaks or briefing. I think that those documents should have been published by the Government. They could have been published in draft form for discussion. That would have been a better way of conducting the debate than to have those documents reach the public in the way that they have. If we want to take the public with us, the more open and transparent we are about the trade-offs and the difficult decisions that we have to take, the better.





The final point that I want to make is about this House. When I spoke in the House last week, I said that we should pay great tribute to Mr Speaker, the House staff and those who have supported the ability to get the House up and running in this virtual way. It is clearly better to have the House back in virtual form than not at all, but we do lose something. Ministers are not under the same pressure or same level of scrutiny that they are when we are in the Chamber—[Interruption.] I can see that the Minister is laughing in his seat. The sooner that we can work out ways to enable the House to function with more of us physically present, albeit in a more socially distant way, the better. I urge the Government to consider ways in which we can do that.

The Prime Minister has set a decision point this week: for the regulations that we are debating today to be considered, and for the Government to take decisions about whether they wish to continue with them in force or to make changes. Either decision—keeping them in force unchanged, or making changes—is very significant, and has an impact on everyone in the country and on businesses around the country. I think that that statement should be made in Parliament so that Members of Parliament can ask questions, not our own behalf, but on behalf of all those whom we represent. I hope that the Government will bear that in mind when they are making those decisions.

Covid-19 Update

Mark Harper Excerpts

Tuesday 24th March 2020 Commons Chamber

[Matt Hancock]

Yes, it is acceptable. It is right that volunteers in that sort of work, for example Samaritans, should travel to do it.

[Mr Mark Harper (Forest of Dean) (Con)]

The Secretary of State will know that, following the Prime Minister’s statement yesterday, all tourism and leisure providers have closed. I commend those in my constituency that closed before the advice was given, in order to protect people. However, those who take lots of deposits are obviously being pressed by our constituents to return that money, and that may put them in financial distress, but equally our constituents need the money back given their financial circumstances. I accept that the Secretary of State may not have an answer for me now, but will he at least commit to take the issue away and see whether an answer is forthcoming, perhaps with the support of the Treasury?

[Matt Hancock]

Yes, I will get my right hon. Friend an answer from the Department for Business, Energy and Industrial Strategy.

Coronavirus

Mark Harper Excerpts

Tuesday 3rd March 2020 Commons Chamber

[Mr Mark Harper (Forest of Dean) (Con)]

The Secretary of State will know there are two confirmed cases in Gloucestershire, and I put on record my thanks to the public health professionals who have dealt with those cases in a professional, calm and considered manner.

My specific question is about the action the Department for Work and Pensions will take for those members of the public who, whether because of business downturn or because of self-isolation, have to access the benefits system. Will frontline DWP staff and systems accommodate the fact that self-isolation, as the Secretary of State says, should be treated as an illness and that no inappropriate sanctions should be applied?

[Matt Hancock]

We are absolutely clear that that is the rule, and I frequently talk to the Secretary of State for Work and Pensions about this matter.

Health and Social Care

Mark Harper Excerpts

Thursday 16th January 2020 Commons Chamber

[Sir Desmond Swayne]

rose—

[Mr Mark Harper (Forest of Dean) (Con)]

rose—

[Jonathan Ashworth]

I give way first to the right hon. Member for New Forest West (Sir Desmond Swayne) and then I will make some progress because I know that many Members want to speak.

[Jonathan Ashworth]

We have long argued for a cap on care costs, but of course the Government, as the right hon. Gentleman says, dropped their support for this policy.

On the issue of social care, the Prime Minister said at the Dispatch Box yesterday that he wanted cross-party talks, although in his BBC interview the day before he said that he had a plan that he would bring forward in the next 12 months. The Government want a consensus. I say to the Government that the Labour party has proposed free personal care. We have a version of free personal care in Scotland. There is a similar version of it in Northern Ireland. There is a version of it in Wales. The House of Lords Economic Affairs Committee, which includes Thatcherites such as Michael Forsyth and Norman Lamont, alongside the former Labour Chancellor, Alistair Darling, has proposed free personal social care. There already is a political consensus. It is the Secretary of State and the Prime Minister who stand outside that consensus. If the Secretary of State wants to engage with us on that basis, then my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley) is happy to do so. I will now take the intervention from the former Chief Whip.

[Mr Harper]

Given that the hon. Gentleman’s party is undergoing a leadership election and that will clearly mean—[Interruption.] No, I am trying to say this helpfully. If the Secretary of State has made a commitment to start the process of cross-party talks within the next 100 days, that will obviously be before that leadership election is concluded. So my serious point is that if we wish to engage on a cross-party basis on whether to implement the Dilnot proposals, as my right hon. Friend the Member for New Forest West (Sir Desmond Swayne) mentioned, or on the basis that the hon. Gentleman just said, is he in a position to start that engagement with the support of his current party leader so that we can make progress urgently? The social care problems in the country are not going to wait, frankly, for another Leader of the Opposition to be elected. That is meant as a really serious and cross-party point.

[Jonathan Ashworth]

It is a serious point, and I am grateful for the way in which the right hon. Gentleman has put it. Of course, we are very happy to engage. My hon. Friend the Member for Worsley and Eccles South, who sits in the shadow Cabinet and leads on social care, is happy to sit down with Ministers at any point.

I am suggesting to the Secretary of State, rather gently, that there is a degree of political consensus on free adult personal social care. The House of Lords Committee, which includes Michael Forsyth and Norman Lamont, not socialists red in tooth and claw by any means, alongside Alistair Darling, has proposed it. We, as a Front-Bench team, have proposed it. There are forms of it in some of the devolved nations. It is the Secretary of State who is standing outside that consensus. If he wants to engage with us on those terms, and on the point about a cap as proposed by Dilnot, then of course we are prepared to have those levels of engagement.

There is also a degree of consensus around the need for better integration between health and social care, and better co-ordination of health and social care. That is why we are intrigued by the Secretary of State’s proposal to consult on the NHS Funding Bill.

--- Later in debate ---

[Matt Hancock]

The cash boost that we are giving now is bigger. I think today is the anniversary of Prime Minister Tony Blair sitting on the couch of a TV show, talking about increasing funding for the NHS, which was opposed by Gordon Brown, who was Chancellor of the Exchequer at the time. We will not take any lectures.

I am thrilled that the public comprehensively rejected the Labour party’s baseless scaremongering, which was repeated through the election campaign and worried some of the most vulnerable people who rely on our NHS. I lost count of the number of times I had to debunk some politicised nonsense put about by the Opposition across the country because they had nothing positive to say. The hon. Member for Leicester South was at it again yesterday and in his speech. He said that the settlement in the NHS Funding Bill is a cap, although clause 1 states that it is a minimum. Clause 1(1) states:

“In making an allotment to the health service in England for each financial year…the Secretary of State must allot an amount that is at least the amount specified”.

Did the hon. Gentleman even read the Bill? Did he get to clause 1? I am not sure he bothered reading it.

Let us look specifically at the amendment. It calls for reform of social care and for the Government to bring forward a plan, and that is precisely what the Queen’s Speech provides for. It also calls for additional funding for the NHS, which is what we are legislating for. The long-term plan is fully funded by the largest cash injection in the history of the NHS, and I urge Members across the House to support it fully. We can only fund the NHS with a strong economy, and that is exactly what we will do.

[Mr Harper]

The Secretary of State will have heard my earlier exchanges with the shadow Secretary of State, which I hope were helpful. He will be aware that more than half the budget for adult social care in England is spent not on older people but on those of working age, as we try to enable people to be more independent and to work. Will he confirm that the social care plan that he plans to discuss with other parties, and which he will bring forward this year as the Prime Minister committed to do, will cover older people and those of working age, and will probably entail different solutions for those two groups?

[Matt Hancock]

The proposals that we are working on include solutions for the provision of social care for older and retired people as they decline in the later years of their lives, and for people of working age. Part of the point about consensus building is that we must be open to options and look right across the piece. It was a disappointment that the Labour party proposals that came out in the autumn only covered older people and not working-age adults, and that point must be addressed. I hope we can do that in a spirit of cross-party discussion, and that those on the Opposition Front Bench will engage positively with that. We will engage right across the House when trying to bring forward a solution.

Learning Disabilities Mortality Review

Mark Harper Excerpts

Wednesday 15th May 2019 Commons Chamber

[Caroline Dinenage]

This is not a mess; the Department of Health and Social Care requested that NHS England commission the whole LeDeR programme. The report is an independent document, which is very important because we are talking about people’s lives and about deaths that could have been prevented. It is really important that the work is done by an independent group and that it is carefully scrutinised, and that that scrutiny and work to look at the recommendations—[Interruption.] If the shadow Minister would like to bob up and ask some questions, I will happily answer them, but if she is going to keep murmuring from a sedentary position, I will not be able to address anything that she says.

It is so important to do this process in an independent way, because we are talking about people’s lives. NHS England says that the LeDeR report has not been published yet because it contains some serious recommendations, as have other such reports, and NHS England needs to make sure that the correct people will be responsible for implementing those recommendations and that the document can be scrutinised in the correct way before it is published. I understand that the shadow Minister is always keen to get things published as quickly as possible, and not always with the benefit of their being done as thoroughly as possible, but in this case we will not be pushed. This is an independent document and I cannot control when it will be published, but the shadow Minister can rest assured that when it is published, I will be happy to answer any questions that arise from it.

Members will feel, as I do, that recent press reports are a clear indication that we need to do more on this, and I assure the House that we recognise that. The LeDeR programme confirms how seriously we take the issue of premature mortality and differences in life expectancy. We will continue to work with partners across Government and throughout the health and social care system to consider any recommendations that improve care for people with learning disabilities and autism and address the shameful inequalities that they experience. Everybody has a right to expect effective, compassionate and dignified care. If someone has a learning disability, their expectations should be no different.

I have already stated that I do not intend to comment on the specifics of the leaked bits of the document, which is independent and has not yet been published. However, like other Members, I am particularly concerned about any suggestion that doctors have recorded learning disability or Down’s syndrome as the reason for a “do not attempt cardio-pulmonary resuscitation” order—a DNACPR, as they call it. People with a learning disability have exactly the same right to enjoy a meaningful life as everyone else, and their disability should never, ever be used as an acceptable reason for a “do not resuscitate” order. We are taking immediate steps to ensure that doctors are reminded of their responsibilities and avoid any form of discrimination. [Interruption.] The shadow Minister says from a sedentary position that doctors should not need reminding. That is the whole point of commissioning the LeDeR review. Sometimes there are systematic or cultural ways of going about things in everyday life, whether in the medical profession or anywhere else, that mean people are not treated with the dignity and respect that they deserve. The whole point of the LeDeR review is to learn from every single preventable death and to make sure that no one else suffers in the same way.

The LeDeR programme published its second annual report in May 2018, and the Government’s response, which we published in September 2018, set out a range of actions for the Department of Health and Social Care, NHS England and other national partners to help to reduce premature mortality and improve outcomes for people with learning disabilities. Many of those actions have now been completed—for example, we recently closed our consultation exercise on plans to introduce mandatory training in learning disability and autism awareness for health and care staff, and we will set out plans to move forward on that later in the year.

The latest report will no doubt reinforce what we already know: that the Government and our health and care system need to do more to ensure that people with a learning disability receive good-quality, informed and safe care. There has been a significant improvement—there has been a tenfold increase in the number of LeDeR review cases that have been covered, the backlog has improved, and in 2018-19 NHS England invested an additional £1.4 million to support the local teams to accelerate the process, as well as to train 2,100 experts to carry out reviews. The process is new, but we are pushing forward and putting in the necessary resources to make sure that we deliver on time. The LeDeR programme is there to help to achieve what we have set out, which is to make sure that those with a learning disability should never expect to receive worse health outcomes. We will respond to the full version of the report as soon as it is published.

[Mr Mark Harper (Forest of Dean) (Con)]

I share the concern of the hon. Member for Worsley and Eccles South (Barbara Keeley) and the Minister about the fact that it appears that at least 19 patients had “do not resuscitate” orders specifically because of their learning disabilities. I welcome the fact that the Minister has made it clear that there will be an immediate notice to remind clinicians that that should never be a reason to not resuscitate a patient. May I ask her to go further, though? My understanding is that doctors should make “do not resuscitate” decisions only after a full discussion with their patient. It appears that, in these cases—without wishing to prejudge them—a doctor has made that decision without having had that discussion. Will the Minister also make it clear in her communication that the assumption should be that someone with a learning disability is just as capable of making these difficult decisions as everyone else? Their lives are worth as much as everyone else’s. That should be the assumption of everybody working in the national health service.

Learning Disabilities Mortality Review

Mark Harper Excerpts

Tuesday 8th May 2018 Commons Chamber

[Caroline Dinenage]

It is sad that the hon. Gentleman has sought to politicise this issue. It is nothing to do with funding cuts or cost-saving measures. We have actually invested more money into this programme. We are the first Government in the world to publish a learning from deaths programme so that healthcare trusts are held accountable and have to publish their data on people who die unnecessarily in their care. Making short-sighted party political points is therefore very unfair and does not get to the heart of the issue, which is about supporting people with learning disabilities and making sure that their health outcomes are the same as those of the population as a whole.

[Mr Mark Harper (Forest of Dean) (Con)]

The all-party parliamentary group on learning disability, which I have the honour to chair, will be looking at this area of policy later this year. Mencap, which provides the group’s secretariat, has a Treat Me Well campaign, which is about improving the position, and I know it is keen to work with the NHS. Drawing on some of the other questions, may I ask the Minister what she can do to get the NHS and all the providers to act with a real sense of urgency in making improvements in this regard with the speed that we would like?

[Caroline Dinenage]

My right hon. Friend is right to raise the Mencap report, because in many cases it reflects the recommendations that have been put forward in this particular report. The mandate to NHS England requires a reduction in the health gap between people with mental health problems, learning disabilities and autism and the population as a whole, and requests support for them to live full, healthy and independent lives. That is something that NHS England has a mandate to deliver, and we of course support it in doing that.

Breast Cancer Screening

Mark Harper Excerpts

Wednesday 2nd May 2018 Commons Chamber

[Mr Hunt]

I thank the hon. Lady for her comments. We have many other occasions to have a broader discussion about resourcing of the NHS, but I recognise what she says: in the specific situation we are in now, with the people who will need additional scans and additional treatments over and above what the NHS would have otherwise done, we will need to find additional resources to make sure others are not disadvantaged.

[Mr Mark Harper (Forest of Dean) (Con)]

May I add my words of support to the Secretary of State for the way he has approached this issue, and to Opposition Members for their approach too?

On the scope of the independent review, will it look at other screening programmes? It might be the case that this particular issue is not replicated, but I think people will want assurances about other screening programmes. Also, as the NHS looks to use IT as a powerful way to combat illness and disease, will the Secretary of State make sure that appropriate checks are in place so that there are proper assurances in the system and these kinds of problems do not arise in the future?

[Mr Hunt]

My right hon. Friend is absolutely right, and I assure him that the review being done by Lynda Thomas, one of the most senior cancer campaigners in the country, and Professor Gore, one of the most senior oncologists in the country, will look at what lessons can be learned for the entire cancer programme, and not just at the specific issue of why this particular IT problem occurred.

Oral Answers to Questions

Mark Harper Excerpts

Tuesday 20th March 2018 Commons Chamber

[Caroline Dinenage]

The hon. Gentleman is right to say that the integration of health and social care is vital, and I think that the renaming of the Department is a symbol of how seriously the Government take our commitment to it. I am keen to talk to him about funding, given that the figures for Liverpool show that it is raising £7.4 million from the social care precept and has received approximately £21 million in grant from the Government.

[Mr Mark Harper (Forest of Dean) (Con)]

I agree that the social care system needs more funds. In recent Budgets, the Chancellor of the Exchequer has found those funds and put them into the system. May I urge my hon. Friend, as she looks at the Government’s proposals in the Green Paper, to ensure that the Dilnot proposals are included? Those proposals, for which we have already legislated, will give us the best chance of a sustainable system in the current Parliament.

[Caroline Dinenage]

The Secretary of State was with Andrew Dilnot yesterday, and we are looking carefully at his proposals. My right hon. Friend is right: although 81% of adult social care providers are registered as good or outstanding, it is unacceptable for levels of care to fall below the standards that we would expect, and in preparing the Green Paper, we will look closely at how we can improve the system.

Oral Answers to Questions

Mark Harper Excerpts

Tuesday 6th February 2018 Commons Chamber

[Mr Hunt]

Public money is public money, and Members have a right to know how it is being spent, so we will absolutely ensure that those contracts are signed in a fair way.

[Mr Mark Harper (Forest of Dean) (Con)]

As the Secretary of State carries out his social care funding review, I urge him to look carefully at whether we should look again at implementing the Dilnot commission’s proposals. Given that we legislated for them, they are the only way that we are going to tackle the issue with the sufficient urgency.

[Mr Hunt]

At the heart of the Dilnot proposals was the idea of risk pooling—that there is a randomness in the illnesses that affect us in the later years of our life that we would want, as a society, to do something about. I will confirm what the Prime Minister said in the election campaign: we will consult on a cap on social care costs.

Social Care

Mark Harper Excerpts

Wednesday 25th October 2017 Commons Chamber

[Barbara Keeley]

I will come on later to discuss how we should proceed and whether we should proceed on a cross-party basis. The hon. Gentleman’s point about carers and family carers is important. The plain fact of the matter is that there was nothing for carers in his party’s manifesto. We had announced that we were going to lift carer’s allowance at least to the level of jobseeker’s allowance. That is the only improvement that was discussed during the general election. He should turn to his own Minister and his own party and ask them what they will do for carers.

[Mr Mark Harper (Forest of Dean) (Con)]

I welcome the hon. Lady’s tone in this debate. It is very valuable. I know that she has taken an enormous interest in this subject, even when it has not fallen within her Front-Bench responsibilities. These debates are very helpful in educating people about difficult issues. I am happy to accept that we did not handle this issue well in the general election. The mistake that we made was not being clear about the current system, which is why her reference in the motion to our proposal without setting out the current system in which people can potentially lose all but £23,000 of their assets is disappointing. Such information would have helped to contribute to the public debate.

[Barbara Keeley]

We will come on to that. If the right hon. Gentleman wants to get into the mess that his party made, the truth is that we legislated a number of years ago to lift the asset floor to £118,000. What his party did during the election was drop that to £100,000. At the weekend, we learned that there was an intention to make it only £50,000. He should be clear about what his Front-Bench colleagues were trying to do. Since then, all we have heard is a deafening silence.

We need to focus on the crisis in social care now. We on the Labour Benches have raised many times just how fragile the care sector is after years of swingeing budget cuts by the Government. A survey by the Association of Directors of Adult Social Services reported that more than two thirds of councils had reported closures of care providers in the first five months of the financial year. Nearly half those councils had had homecare providers handing back contracts.

--- Later in debate ---

[Jackie Doyle-Price]

My right hon. Friend is indeed correct.[Official Report, 3 November 2017, Vol. 630, c. 3MC.]

The ageing population presents one of our nation’s most profound challenges. It raises critical questions as to how, as a society, we enable all adults to live well into later life, and how we deliver sustainable public services that support them to do so.

[Mr Harper]

In a spirit of cross-party consensus, may I add my support to the issue raised by the hon. Member for Stretford and Urmston (Kate Green) by urging that when we bring forward our consultation we cover the nearly 50% of social care spending that is spent on adults with disabilities? I share the view that we must make sure that they are properly supported and able to live full lives, including, where they are able, moving into work. That sometimes gets lost in the debate when we completely focus on people towards the ends of their lives. We must deal with everybody. The hon. Lady made a really important point.

[Jackie Doyle-Price]

I could not agree more. I share my right hon. Friend’s support for the hon. Lady’s comments. There are still many opportunities to get working-age adults with disabilities into work. We have set ourselves a target of getting 1 million more people with disabilities into work, and we are very committed to doing that.

In response to the point made by the hon. Member for Worsley and Eccles South in her opening remarks, yes, much of the debate has focused on how we care for the elderly, but, as she and the whole House will be aware, support for working-age adults is becoming an increasingly big proportion of local authority spending in this area, and it is very important that we focus on it. Alongside the preparations we are making for consultation in the new year, we have a parallel work stream looking specifically at working-age adults, because some of the solutions will be similar and some will be different.

[Jackie Doyle-Price]

There needs to be a separate work stream because it is connected to the desire to get more people into work, but the two programmes are working in parallel. As I said, today is a great opportunity to get that on the record. Certainly, it has been very much a focus of my conversations with voluntary groups in the sector.

[Mr Harper]

Picking up the point about the work being separate but parallel, in thinking about how we are going to fund the care, it is really important to make sure that we do not inadvertently put in place any barriers to work, whereby somebody would find that moving into work would increase the cost of their care to the extent that working was of no consequence. That would not be an issue of funding care for older people, where there are some different challenges. A separate but parallel structure may well be the right one to go for.

[Jackie Doyle-Price]

Again, I agree with everything that my right hon. Friend says.

To reassure the hon. Member for Worsley and Eccles South, we will have plenty of opportunity to discuss all these issues in the new year. We want to progress this by building a real consensus, because it is a strategic challenge facing us all. Not only are we all living longer, but working-age adults with disabilities are living longer. That is a matter for celebration, and we must do everything we can to make sure that we can meet all our obligations to them.

--- Later in debate ---

[Jackie Doyle-Price]

I think it matters a great deal that we have made £9.25 billion available.

[Mr Harper]

Will the Minister give way on the funding issue?

[Jackie Doyle-Price]

I need to make progress. I apologise to my right hon. Friend.

On delayed transfers of care, the Government are clear that no one should stay in a hospital bed for longer than is necessary. Doing so removes people’s dignity and reduces their quality of life. It leads to poorer health and care outcomes, and it is more expensive for the taxpayer. I will set out in more detail the work we are doing to reduce delayed transfers of care. That is critical, because a well-functioning social care system enables the NHS to provide the best possible service.

We are clear that we must make much faster and more significant progress well in advance of winter to help to free up hospital beds for the sickest patients and reduce pressures on overcrowded A&E departments. Last year, there were 2.25 million delayed discharges, up 24.5% from the 1.81 million in the previous year. Just over a third of those delays were attributable to social care. The proportion of delays attributable to social care increased over the last year by four percentage points to 37% in August 2017.

We have put in place an agile and supportive improvement infrastructure, and I have been very clear about priorities. First, in this year’s mandate to NHS England we set out a clear expectation that delayed transfers of care should equate to no more than 3.5% of all hospital beds by September. Those in the system have worked extremely hard to agree spending plans and put in place actions to make use of the additional funding, and they deserve real congratulation for their efforts. Since February, there have been significant improvements in the health and care system where local government and the NHS have worked together to tackle the challenge of delayed transfers of care, with a record decrease in month-on-month delayed discharges in April 2017.