Draft Social Security Coordination (Reciprocal Healthcare) (Amendment etc) (EU Exit) Regulations 2019 Draft National Health Service (Cross-Border Healthcare and Miscellaneous Amendments etc.) (EU Exit) Regulations 2019 Draft Health Services (Cross-Border Health Care and Miscellaneous Amendments) (Northern Ireland) (EU Exit) Regulations 2019

Neil Coyle Excerpts

Monday 25th March 2019 General Committees

[Stephen Hammond]

Where my hon. Friend is absolutely right is that, of course, it has always been the advice that people should purchase travel insurance when they travel, wherever they travel, including within the EU. The EHIC card is clearly in place. If the withdrawal agreement is signed, that arrangement will continue, but it has always been the Government’s advice that people should take out the appropriate travel insurance when travelling abroad, and he is absolutely right to make that point.

[Neil Coyle (Bermondsey and Old Southwark) (Lab)]

I thank the Minister for giving way; he is being very generous in doing so. There are particular British expatriates living in other countries. As he said, some people have long-term conditions, including skin conditions that are temperature-sensitive and lung issues, for example. Just to be absolutely clear, he has said that there may be circumstances in which some of those people with long-term conditions may have to make other arrangements. So there is a direct disadvantage for disabled British people who are supported under the current framework who may not be supported, even under the Government’s plan. Is that correct?

[Stephen Hammond]

It is correct only in the unlikely circumstance of a no-deal scenario, and only in that there may not be interim arrangements put in place immediately after exit in a no-deal scenario. That is why I am setting out what the possibility might be, but I stressed that this is not what the Government hope for. Neither is it something that the Government expect or that is the Government’s ambition. What I have said is that, in the unlikely circumstance of a no-deal scenario, there may be some changes that some people need to make.

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[Stephen Hammond]

Of course I do not take umbrage at the hon. Gentleman’s criticism or scrutiny. After all, that is what he is here to do. I would just say to him, though, that his characterisation of what the Government are putting in place is wrong. He can say to his constituents that if the withdrawal agreement is passed, there will be no interruption to their healthcare. In a no-deal situation, these instruments will allow—

[Neil Coyle]

For a fixed period.

[Stephen Hammond]

I made it very clear that it is the intention—the expectation—of both the UK Government and the EU and EFTA states that there will be an agreement about reciprocal healthcare.

The hon. Member for Walthamstow raised a number issues about Northern Ireland. As she rightly pointed out, healthcare is fully devolved to Northern Ireland. These statutory instruments would normally be dealt with by the Northern Ireland Assembly. In the absence of the Northern Ireland Assembly, and in the absence of a Northern Ireland Executive, statutory instruments under the European Union (Withdrawal) Act 2018 have to be laid in Westminster to allow for debate and scrutiny. She has heard that that Act was consented to by the Secretary of State for Northern Ireland. The Northern Ireland consent for social security regulations was provided by the permanent secretary for the Northern Ireland Department of Health, which is the appropriate place in the absence of the Northern Ireland Assembly. Her characterisation of direct rule is incorrect.

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[Stephen Hammond]

I can clarify that the permanent secretary for the Northern Ireland Department of Health was consulted, as I said.

The hon. Member for Dewsbury asked about arrangements for cancer and paediatric heart surgery. The north-south arrangements provide that services such as paediatric heart surgery on the island of Ireland are not impacted by the UK’s withdrawal from the EU or these statutory instruments. Those arrangements operate under memorandums of understanding and service level agreements between the Irish and Northern Irish health authorities, which will continue to operate after exit day. The UK and Irish Governments are committed to continuing access to healthcare services within the common travel area, and both Governments are taking steps to enable us to implement these arrangements in time for exit day.

The hon. Member for Southwark and Old Bermondsey asked me about—sorry, Old Bermondsey and Southwark—

[Neil Coyle]

Bermondsey and Old Southwark.

[Stephen Hammond]

I’ll get there in the end. The hon. Gentleman asked about a number of chronic conditions. The statutory instruments allow the Government to fund the treatment of UK nationals who are in the middle of treatment on exit day or who have pre-authorised treatment in another member state. That could include the chronic conditions he mentioned.

Finally, I am not sure which part of the website the hon. Member for Dewsbury was looking at, but I am happy to ensure that we guide her to the right place. There is advice on www.gov.uk and www.nhs.uk to UK nationals living in the EU, to UK residents travelling to the EU and to EU nationals living in the UK. That advice explains how the UK is working to maintain reciprocal healthcare arrangements and sets out the options people might have to access healthcare under local laws in member states that they live in. I am happy to ensure that the hon. Member for Dewsbury can see that guidance.

Oral Answers to Questions

Neil Coyle Excerpts

Tuesday 19th February 2019 Commons Chamber

[Matt Hancock]

My hon. Friend makes an incredibly important point. As important as new technology is and new ways of working and nurse practitioners are, we still need more GPs, and we need more GPs especially in rural and coastal areas. The targeted enhanced recruitment scheme offers a £20,000 salary supplement to attract GPs to parts of the country where there are serious shortages, including in Somerset.

[Neil Coyle (Bermondsey and Old Southwark) (Lab)]

T5. The Terrence Higgins Trust has made it clear that men are being diagnosed with HIV as a direct result of the limited number of places on the current PrEP trial. The Secretary of State has already said this morning that the doubling of the places on that trial is being implemented now, but that commitment was made over three weeks ago; when will implementation be completed across all trial sites including Burrell Street in my constituency?

[Matt Hancock]

I want to see this being implemented as soon as possible. It has already started, but we need commitment from local authorities as well as the NHS to deliver. I am very happy to work with the hon. Gentleman and all other interested Members to see it happen.

Oral Answers to Questions

Neil Coyle Excerpts

Tuesday 15th January 2019 Commons Chamber

The Secretary of State was asked—

[Neil Coyle (Bermondsey and Old Southwark) (Lab)]

1. What recent steps he has taken to tackle NHS workforce shortages.

[Helen Jones (Warrington North) (Lab)]

8. What steps he is taking to recruit and retain additional staff in the NHS.

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[The Minister for Health (Stephen Hammond)]

Good morning, Mr Speaker. The NHS employs more staff now than at any time in its 70-year history, with a significant growth in newly qualified staff since 2012. We have increased the number of available training places for doctors, nurses and midwives, and taken further actions to boost the supply of nurses, including offering new routes into the profession and encouraging those who have left nursing to return. The long-term plan, which was announced last week, sets out the framework to ensure that the NHS has the staff it needs.

[Neil Coyle]

Guy’s and St Thomas’s, which is based in my constituency, offers globally renowned, first-class healthcare, but the trust has seen a massive drop in applications from other EU member states, including of almost 90% in midwives alone. All vacant posts across the NHS present the risk of longer waiting times and risk patient safety, so why did the Government not publish the workforce strategy in the so-called long-term plan? When will it appear? Will the Government reinstate nursing bursaries to address the shocking staff shortfall across the NHS?

Mental Health Act: CQC Report

Neil Coyle Excerpts

Tuesday 27th February 2018 Commons Chamber

[Jackie Doyle-Price]

As I have said, we have increased the amount of funding for mental health. That is separate, of course, to the commissioning decisions at local level by local authorities, who also have a role to play in this, as the hon. Gentleman knows. I am very conscious of the needs of people on the autism spectrum. We must give that support, and the things we are doing in terms of improving provision in schools will help identify people who are struggling with that. Planning for the future is great, but we are where we are now, and I join the hon. Gentleman in wholeheartedly congratulating staff up and down the country on their efforts in delivering a good service.

[Neil Coyle (Bermondsey and Old Southwark) (Lab)]

This CQC report shows that the bad old days of poor mental health care are creeping back: insufficient staff, a doubling of restriction, and a third of patients not involved in their care plan. Why do the Government continue to fail people with mental health conditions, and when do they expect all mental health services to be made safe—the most basic of requirements?

[Jackie Doyle-Price]

I disagree profoundly with the hon. Gentleman. This report shows that patients have increased access to advocates, that more attention is paid to the physical health of people with mental health treatment, and that there is better planning for aftercare and discharge, but we are being honest: we still need to do better, and I expect Members to hold me to the findings highlighted in the report.

Oral Answers to Questions

Neil Coyle Excerpts

Tuesday 7th February 2017 Commons Chamber

[Mr Hunt]

I will tell the hon. Lady what is happening in the NHS compared with when her party was in power: 130 more people are starting cancer treatment every single day; 2,500 more people are being seen in A&Es within four hours every single day; and there are 5,000 more operations every single day. None of that would be possible if we cut the NHS budget, which is what her party wanted to do.

[Neil Coyle (Bermondsey and Old Southwark) (Lab)]

Norfolk and Suffolk NHS Foundation Trust has been taken out of special measures, despite continued growth in the number of people with mental health problems dying in unexpected or avoidable circumstances from things such as suicide. “Panorama” and the Health Foundation have shown that in 33 trusts the number of avoidable deaths has doubled in the last three years as those trusts have collectively experienced a real-terms cut of £150 million. What specific measures is the Secretary of State taking to tackle the problem of avoidable deaths of people with mental health problems?

[Mr Hunt]

We have committed, and the Prime Minister affirmed the commitment only last month, to spend £1 billion more every year on mental health services, but we recognise that it is not just about money. It is also about having a proper suicide prevention plan—we have updated the plan—and making sure that, across the NHS, we properly investigate and learn from avoidable deaths. That is why, following the tragedy of what happened at Southern Health, we have now started a big new programme—the first of its kind in the world—whereby every trust will publish its number of avoidable deaths quarterly.

NHS and Social Care Funding

Neil Coyle Excerpts

Wednesday 11th January 2017 Commons Chamber

[Jonathan Ashworth]

Because they were being told by NHS England, which was in turn told by the Secretary of State.

[Neil Coyle (Bermondsey and Old Southwark) (Lab)]

The right hon. and learned Member for Rushcliffe (Mr Clarke) mentioned infections spreading in the NHS. Does my hon. Friend share my concern about the infection that is spreading on the Government Benches? It is the infection of arrogance, complacency and being completely out of touch with the patients and their families who are suffering under the current crisis. We are witnessing inaction on an epic scale.

[Jonathan Ashworth]

My hon. Friend makes his point extremely well, although I would not want to be so mean about the Secretary of State—[Hon. Members: “Go on!”] No, I am not going to be mean about the Secretary of State.

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[Mr Hunt]

All I would say is that I hope that people in the NHS do not listen too much to what the Labour party says about the state of the NHS and that they listen to what the Government are saying, which gives a much more accurate picture, as I will go on to explain.

[Neil Coyle]

Will the Secretary of State give way?

[Mr Hunt]

I will make some progress before giving way again.

The second part of the motion talks about funding. There is no doubt at all that we will need to look after 1 million more over-65s in five years’ time and we will need to continue to increase investment in the NHS and social care system. That is happening with an extra £3.8 billion going into the NHS this year. Can I just remind Labour Members that that is £1.3 billion more than they promised when they stood for election last year? I just say this: it is not enough to talk about extra funding—you have to actually deliver it. Labour Members have to answer to their constituents as to why, for two elections in a row, they have promised less money for the NHS than the Conservatives, and why, in the one area where they are responsible for the NHS, they have cut funding.

Community Pharmacies

Neil Coyle Excerpts

Wednesday 2nd November 2016 Commons Chamber

[Jonathan Ashworth]

My hon. Friend is right, and even after this scheme is in place pharmacists who are eligible for the mitigating funds are still saying that they will have to close despite them.

We believe in the importance of community pharmacies, because

“pharmacies have a big role to play in this, as one in 11 or 12 A and E appointments could be dealt with at a pharmacy”—[Official Report, 25 February 2014; Vol. 576, c. 162.]—

and:

“Pharmacies have an important role to play, because they could save a significant number of A and E and GP visits.”—[Official Report, 23 October 2014; Vol. 586, c. 1049.]

Those are not my words: they are the words of the Health Secretary, said from that Dispatch Box over the last two years.

If the message the Health Secretary has been giving at that Dispatch Box is that community pharmacies are a way of relieving pressure on A&Es and GP surgeries, why is he now coming to the House to support cutting community pharmacies? It is a complete false economy. I will give way if he wants to explain that. He does not, probably because he knows it is a completely false economy.

[Neil Coyle (Bermondsey and Old Southwark) (Lab)]

Arundhati Patel runs the Jamaica Road pharmacy in my constituency and an alcohol cessation service is one of the services it provides to the local community. He pointed out there were 1,400 hospital stays in Southwark due to alcohol harm. On the point about efficiencies and avoiding visits to hospital that Members have talked about, is this not another example of what my right hon. Friend the Member for Exeter (Mr Bradshaw) called a false economy?

[Jonathan Ashworth]

My hon. Friend is right, and Government Ministers, including the Health Secretary even on Monday, justify these as part of a package of efficiencies. Indeed when I raised this a few months ago with the previous Minister, the right hon. Member for North East Bedfordshire, he told me in correspondence that these cuts were necessary as part of delivering the £22 billion-worth of efficiency savings. So this is more proof that when they talk of efficiency savings, they are actually talking of cuts to frontline services.

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[Dr Whitford]

I need to make a bit of progress.

We need to design the services with the people who work in them. Some 18% of Scotland’s population—nearly 1 million people—are registered with and do access the minor ailment service, which takes pressure off accident and emergency, because there is availability out of hours, and GPs. The fourth service that we have is the public health service, with 70% of all smoking cessation work in primary care being carried out in our community pharmacies. These four services together—minor ailments, chronic medication, acute medication and public health—represent a huge breadth of service for a community. It is important that pharmacies in England that are currently just retail and dispensing pharmacies are encouraged to go in that direction, because it brings benefit for the NHS.

My biggest concern is the random nature of how this process might develop. If the Government simply cut and let the dice fall where they will, the problem is that they will not end up with an integrated service. Scotland still has health boards, so if a community pharmacy is to open there, an application needs to be made to the health board. When the project started, the boards decided which places got to become community pharmacies, and they decide whether there is a need to open a new community pharmacy. The biggest mistake in this scheme is its randomness.

One issue raised by the hon. Member for South West Wiltshire (Dr Murrison) was the profits made when drugs are sold on. The Government could look at the vertically integrated wholesalers—the big chains. In the mid-2000s, they were not considered. The Government do not know how much profit they make or where that profit is made, and the system is totally unregulated. These chains control about 40% of the pharmacy market. One of the biggest chains, Walgreens Boots Alliance, has declared profits of almost £1 billion, yet it has somehow been able to reduce its tax bill by more than £1 billion in this country. We are talking about people who are make almost half their profit from taxpayers yet do not pay their full share of tax. I absolutely agree that under this proposal the big chains will survive and the small, independent, very community-based pharmacies will be lost.

[Neil Coyle]

The Minister accused those who highlight concerns of “scaremongering”. Atul, who runs St George’s pharmacy at the Elephant and Castle in my constituency, says:

“We may survive the first set of”—

in-year—

“cuts by compromising on our services. But the second set of cuts next April will most definitely place us at a real risk of closure.”

Does the hon. Lady agree with Atul that it is right for us to highlight our concerns, especially in constituencies such as mine, where we face losing 18 community pharmacies?

[Dr Whitford]

Losing that many pharmacies in any area would be a disaster. This is a bit like groundhog day, because this is our third discussion on this topic in as many weeks. The Minister said that there absolutely would be protection, but the pharmacy access scheme still largely comes down to the amount of dispensing that is done and the distances. It does not take account of which pharmacies are providing a good service, which ones are set up to provide a good service and how to encourage others to develop. This is what is completely wrong in the Government’s approach. They are just slicing money off and leaving individual businesses to decide whether they think they will be profitable. The danger would be that we get a whole lot of pharmacies deciding to sell out and walk, instead of someone saying for a particular area, “Eighteen is too many”—especially if they are all around one town square—“so which ones are best able to develop a service? Let them bid for it and let them be inspected, and let’s see how they take it forward.”

The Government could make a lot of savings by addressing the wholesalers. In Scotland, we have margin sharing, which means that a price control group looks at the profit that is made at various stages, and some of it has to be shared back. We do have people who are trading on the open market and moving drugs around, especially in the big chains. As we heard earlier, we would get a better result by sitting down with the profession and designing a service. STPs could provide the model within which to look at how many community pharmacies there should be and where they should be, and then it would be a case of working backwards.

The danger of the Government’s approach is that it is the wrong way round. Just calling something an “efficiency cut” does not make it efficient, and the danger is that we just slash something and it falls over. The pharmacy access scheme is not enough of a protection or of an intervention. There needs to be planning. I commend the idea of a proper services-based pharmacy system, but the aspiration should be not just that a few pharmacies choose to do it and others do not. It should be that a patient who walks into a community pharmacy will know what services they can get, and we should aim to have that right across the country.

NHS Commissioning (Pre-Exposure Prophylaxis)

Neil Coyle Excerpts

Tuesday 7th June 2016 Commons Chamber

[Jane Ellison]

Not for the first time, may I clarify that no decision has been made about the commissioning of PrEP? I am therefore not sure why the hon. Gentleman would say that. I have been very clear about the clinical effectiveness. What I am saying is that there is more work to do to understand the wider cost-effectiveness of this in the context of the commissioning of HIV prevention more broadly.

[Neil Coyle (Bermondsey and Old Southwark) (Lab)]

My constituency falls wholly within the borough of Southwark, which has the second highest HIV prevalence in the country. What assessment are the Minister and the Department making of the potential impact of this policy change not only on my constituents, but on the long-term costs for the NHS if PrEP is not available?

[Jane Ellison]

There is no policy change and I have laid out the position. It is important to understand that even in the modelling work that has been done, PrEP is not a silver bullet. It has an important part to play, but it is not a silver bullet in terms of HIV prevention and it does not affect some of the broader issues that I mentioned in my response, for example in respect of STIs.

Mental Health

Neil Coyle Excerpts

Wednesday 9th December 2015 Commons Chamber

[Mr Hunt]

Let me make some progress, and I shall give way later.

We need to look at the use of police cells, which has often been spoken of here. We have seen a 55% reduction in the use of police cells over the last three years, but they were still used 4,000 times last year. Particularly for children, that is totally inappropriate, and it is often inappropriate for adults, too. Out-of-area placements for non-specialist care are another issue, and the Minister for Community and Social Care is working extremely hard and is committed to implementing a plan to turn this around by March next year.

[Neil Coyle (Bermondsey and Old Southwark) (Lab)]

The Secretary of State talked about cross-party support for action to tackle suicide and related issues. In our debate on assisted dying, there was a lot of support for doing more to tackle the problems of anyone who suggested that they wished to commit suicide. Why, then, does the right hon. Gentleman refuse to acknowledge the impact of benefit cuts and changes in assessment processes, as mentioned by my hon. Friend the Member for Oldham East and Saddleworth (Debbie Abrahams)?

[Mr Hunt]

The BMJ was very clear in saying that conclusions about cause and effect should not be drawn, but let me make a broader point about suicide. Suicide rates—under the last coalition Government and the previous Labour Government—have been above and below the 20-year long-term average, but I think they are an important bellwether of the effectiveness of mental health services. I think we should be bold and ask whether we could have a zero-suicide ambition. No country in the world has delivered that, and it would require a big rethink of the way we approach mental health services. Nevertheless, I think that we should be bold and ambitious and think in terms of that objective, and then think about all the factors that may contribute to people being in a highly distressed state and unable to get the support that they want.