NHS Procurement and Subcontractor Exclusion
Stephen Hammond Excerpts(4 years, 10 months ago)
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The Minister for Health (Stephen Hammond)
It is a pleasure to respond, and I thank the hon. Member for Bury South (Mr Lewis) for securing this debate to highlight an issue about which he rightly feels very strongly, as it affects a company in his constituency.
The title of this debate highlights the two things the hon. Gentleman wants to raise. The first is the specific issue and, as I have some time, I will talk a little about procurement processes with subcontractors in general, too. He highlights an issue with a specific framework contract that, as he rightly says, is managed by my Department.
The specific issue the hon. Gentleman raises is on the use of subcontractors in the flooring industry under the construction framework ProCure22. The issue was originally raised through the Government public procurement review service, hosted by the Cabinet Office, back in December 2018. A response was provided by officials at the time and is on the Government website.
The hon. Gentleman asked a number of direct questions, which I will tackle later in my speech. I hope to satisfy him but, if not, I will, of course, be very happy to write to him.
The issue, as the hon. Gentleman says, is that one of the suppliers under the P22 framework is using three companies based in the European Union and that a supplier in his constituency is not being used. He is not seeking to suggest that suppliers be excluded for unlawful reasons, but he is suggesting that the supplier in his constituency has been excluded because there was not a fair competition. That is the essence of what he said.
On the competition question, the hon. Gentleman will know that my Department and the Cabinet Office provided a response saying that, although we have some influence over subcontractors under the ProCure22 framework, this only relates to certain tier 1 subcontractors that are primary supply chain members. They are required to pass a certain series of checks with the authority before they can be registered. Those checks are limited to organisations undertaking certain roles and do not extend to the suppliers of flooring products. The principal supply chain partners have been selected through an appropriate procurement process, in line with the Public Contracts Regulations 2015. Those companies are then free to build their own supply chains, which is where the company in the hon. Gentleman’s constituency is at odds. The company leading the supply chain is not always bound by public sector procurement regulations. I am obviously aware of the French authorities imposing a fine on the three companies at the end of 2017, and I want to address some of his remarks on that in a moment.
Officials in my Department have met supply chain partners on a regular basis, and we seek wherever possible to encourage the use of UK-based SME subcontractors. As the hon. Gentleman said, we have a duty to the public sector to deliver value for money. It is for our supply chain partners to demonstrate that that is the case with each of their products.
I think the hon. Gentleman is concerned that my Department has not replied to a letter from Halstead—the aggrieved company in question—of January this year. I can confirm that the Department received the letter from DWF lawyers, acting on Halstead’s behalf. The letter was addressed to me on 16 January, and my Department has a record of a reply being sent on 13 February, referring DWF to the response that had been published on the public procurement review service that I referred to earlier. If the hon. Gentleman does not have a copy of that reply, or if he finds when he speaks to Halstead that it does not have a copy or the lawyers have not passed it on, I will be happy to sort that out.
Officials in my Department have engaged with Halstead directly—that engagement started in March 2018—to explain how the framework operated. I hope that the company will be able to confirm to the hon. Gentleman that officials have responded fairly promptly to any questions that have been raised. I understand that Halstead has used that feedback and is currently bidding to form part of the supply chain.
The hon. Gentleman asked a large number of very specific questions, and given that the House has a little bit of time tonight, I thought I might try to respond to them now rather than writing to him.
Peter Heaton-Jones (North Devon) (Con)
I take an interest in this matter because I have a large and very successful district hospital in my constituency. I listened with care to what the hon. Member for Bury South (Mr Lewis) said. It seems to me that what we want in public procurement—not just in the NHS, but across the public service—is for the best contractor to do the best job at the best price for the public purse, but always in a framework, as the hon. Gentleman wisely said, of fair competition. If that has not happened in this case, does the Minister believe that that is because of a structural problem with the P22 framework, or is a local difficulty to blame?
Stephen Hammond
I want to speak about the overall process later in my speech. Having been to Nottingham to open the national procurement centre for the NHS last week, I am clear that we should have the best procurement processes in place to ensure that money from the public purse is spent wisely. That is even more important in the health service than it is in almost any other part of the public sector, because money spent wisely means better patient care, and that is key.
I hope that I will be able to prove to my hon. Friend and the hon. Gentleman that the problem with this contract was not with the framework itself, but with how one particular company chose to apply the criteria. I am not saying that the company necessarily applied the criteria inaccurately or wrongly, but it did not do so in a way that we would normally encourage.
Mr Ivan Lewis
I thank the Minister for the openness and frankness of his response so far. His last comment was very telling, because he acknowledged that in these circumstances, Kier perhaps did not behave in accordance with best practice or what would usually be expected, even if it did not do anything unlawful. If possible, I want clarity on whether the Minister or his officials have had, or will have, strong words with Kier about what the situation has exposed and the unfairness that has been applied to the company in my constituency. Will he or his officials have that conversation with Kier about what is expected of it, or have they done so already?
Stephen Hammond
To be absolutely clear, I was not suggesting that Kier had not necessarily followed best practice, and it certainly had not acted unlawfully. I was suggesting that, as I said a moment ago, we would encourage all the people who use the frameworks to ensure that there are opportunities for UK firms to be on those frameworks.
Let me try to answer directly some of the hon. Gentleman’s questions. He asked what criteria Kier used to draw up the supplier list. As I explained, in respect of how the framework is set up, the Department ensures that the principal supplier on the framework is there correctly, appropriately and legally. It is not for the Department to comment on the criteria that private sector organisations use to draw up their supplier lists. The Department sets out the expectation of the principal supply chain partners, and our expectation on them is to ensure that supply chains provide value-for-money, quality services for the public sector. Understandably, because of the nature of what is being procured, each supply chain partner will have its own processes and prequalification criteria.
The hon. Gentleman asked me directly what processes were used in the absence of competitive tendering. Again, it is not for the Department to comment directly on the specific processes, but I can confirm that each of the supply chain partners needs to follow its own internal policies, and those policies and procedures must align with the requirements of the framework.
The hon. Gentleman asked directly why Halstead and other suppliers that were not included on the list were not necessarily given the opportunity to put their case. The Department does not have visibility of which suppliers were given the opportunity to put their case; however, Halstead is now discussing that with the supply chain partners. As I said, Halstead has spoken to officials at my Department, and that communication goes back as far as March 2018. I understand that Halstead is now using that feedback and is bidding to form part of the supply chain. We give the undertaking that the application will be considered fairly and scored against the set criteria.
The hon. Gentleman asked me directly about what consideration was given to the probity of the three overseas companies, given that sanctions were imposed on them in France.
Stephen Hammond
As I said earlier in my remarks, each principal supply chain partner must make sure that their internal policies and procedures align with the requirements of the framework, but it is not for the Department to tell each principal supply partner how to set out their criteria, nor the specific processes they should use. The hon. Gentleman rightly made the point that is my Department’s responsibility to ensure that the policy is correct. I hope he is hearing that my Department ensures that the right procedures and processes are in place and that the individual principal supply chain partner must choose the most appropriate one for the right framework it is on. I hope he will accept that.
I was just about to refer to the issue of the three overseas companies that were chosen and the sanctions that were imposed on them. As I said earlier, I am aware that the French authorities imposed the fine on the three companies at the end of 2017, but those convictions were imposed after the preferred supplier list was established. Clearly, the Department does not have sight of the contractual agreements between the supply chain partners and the suppliers. The supply chain partners are not within the scope of the Public Contract Regulations 2015.
The hon. Gentleman asked whether I could assure him that Kier would be instructed to add Halstead to the list as a matter of urgency. He will know, obviously, that it is not within my remit or my ability to instruct private sector organisations to engage with specific companies, but I can reassure him that Halstead is currently bidding as part of the refresh of the Kier supplier list and its application will, I know, be scored on the merit of the criteria set. I hope that that reassures him.
I want to turn briefly to how the Department supports and encourages small and medium-sized enterprises and subcontractors more generally. Clearly, we have been dealing with some very specific issues, and that underlines the complexity of the procurement landscape. The understanding of who exactly subcontractors are, and the work that they undertake, is, by its very nature, not well understood unless it is for a very major significant construction project. NHS organisations would usually expect the Crown Commercial Service or the regional procurement solution to identify and track the supply chain of the suppliers providing the goods, works or services. However, there is currently a limited understanding of the suppliers on locally negotiated contracts.
The Public Contract Regulations 2015 clearly allow public sector organisations to permit subcontracting within supply chains as long as the subcontractors meet the minimum standards set out, and the hon. Gentleman knows that I have just set those out. Where issues in subcontractor performance arise, the regulations also allow for the subcontractor to be excluded.
The Department’s SME action plan for 2019-20 highlights the actions that we are taking to make it easier for SMEs to work with the whole of the health supply system. The Department has a target of 23% of our direct and indirect spend with SMEs by the end of March 2022.
Peter Heaton-Jones
Notwithstanding the note that the Minister might just have been passed—[Interruption.] This is an important point. I have mentioned already the fine hospital that I have in my constituency, but I also have many fine SMEs, which need to be on a level playing field when it comes to being able to tender for these sorts of procurement contracts. What I am looking for the Minister to give me and, I am sure, to other hon. Members with fine SMEs in their constituencies is an assurance that they have that level playing field and that they can get these contracts.
Stephen Hammond
I am happy to give my hon. Friend that assurance. It is absolutely the commitment of the Government to ensure that small and medium-sized enterprises are not excluded from any form of public sector procurement. I am pleased to say that the Department has published an action plan to that effect. I am actually the Minister in charge of ensuring that that action plan is implemented, and I am pleased to say that the Cabinet Office holds meetings of ministerial champions across Whitehall to ensure that, as a Government, we meet our targets.
Mr Lewis
May I ask the Minister about a really important point of clarification? Are Kier or similar organisations fulfilling that function required to publish the basis on which they make these decisions? The Minister has said that it is not for the Department to tell such organisations how to fulfil their responsibilities in drawing up these lists, but are those organisations required to publish, openly and transparently, the basis on which they make decisions about their preferred suppliers?
Stephen Hammond
What I can say to the hon. Gentleman—he has heard me say this twice, and I am happy to have a longer discussion with him outside this debate—is that there is a process in place whereby principal supply chain partners are on the framework. If they are on that framework, they have to ensure that their policies, procedures and the criteria they intend to use align with that framework. As private sector organisations that have been contracted by the public sector, they in turn have subcontractors, and they have to ensure that the processes they use to contract those subcontractors are compliant with the framework. I am happy to set that out in writing for the hon. Gentleman, if he would like me to. Clearly, the Department cannot and does not instruct principal supply partners to detail every aspect but, as I have said to him before, we have to be reassured that the processes and procedures they use are compliant with what we have set out in the framework.
This has been a fascinating debate because it gets to the heart of what we want to do. If we want to have a vibrant economy, we must have transparency regarding how companies contract for public sector contracts and the supply thereof. What the hon. Gentleman has rightly done on behalf of his constituents is to ensure that the Department is clear and has investigated that the processes and procedures being used were the correct ones, and that if, as he believes, his constituents were unfairly treated, the Department looks into the case. My officials have been in regular contact with Halstead since 2018 and I am pleased that it is now able to refresh its application for the subcontract list. I am also pleased to have had the chance briefly to set out the Government’s overall ambitions to ensure that all small and medium-sized enterprises are able to bid for Government contracts.
Question put and agreed to.
NHS Pensions
Stephen Hammond Excerpts(4 years, 10 months ago)
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The Minister for Health (Stephen Hammond)
As ever, Mr Gray, it is a pleasure to see you in the Chair for this important debate, and I congratulate my hon. Friend the Member for Poole (Sir Robert Syms) on securing it. It is a topic that the House has previously considered, when my hon. Friend the Member for East Renfrewshire (Paul Masterton) introduced a debate on the matter.
Colleagues should be reassured that the Government have been listening carefully to senior doctors and their employers. We recognise the actions clinicians are taking in response to their concerns about, and experience of, the annual allowance tax charges and how they are affecting frontline services. My hon. Friend the Member for Poole is right: although we are talking about tax changes for consultants, clinicians and GPs, the reason why this is so serious is that ultimately, if we do not get it right, it impacts on the quality of patient care. We all share that ambition to get it right.
Mr Sweeney
The Minister says that the tax changes are likely to have an impact on patient care. They are already having an impact; my constituent has said that he is seeing anaesthetic cancellations on theatre lists at his hospital in Glasgow, which have never been seen before in the NHS. He has had to resign as a foundation programme director, supervising junior doctors, to reduce the number of paid hours he does.
Stephen Hammond
Let me make it clear that not only are the changes having an impact, they are likely to continue to have an impact. I recognise that; the hon. Gentleman will hear later in my remarks that we recognise that point.
My hon. Friend the Member for Poole was right to talk about the long-term plan and the cash settlement that goes with it. He was also right, though, to mention that any plan will work only if it works: if we make sure the people delivering it can do so with the numbers and experience required. The hon. Member for Newport West (Ruth Jones), although she said she was not expecting to speak this morning, made a thoughtful speech and raised a number of issues from her direct experience that informed the debate.
My hon. Friend the Member for Winchester (Steve Brine) represents the place where I was born and spent my childhood, so for that and other reasons, I always listen carefully to what he says. He was right to stress at the start of his speech that this is not about tax breaks for particular people, although that is the headline; the reality is that perverse disincentives are being created against providing the care that we need. I listened carefully to the hon. Member for Glasgow North East (Mr Sweeney), who has just intervened on me to reiterate the point he made in his speech about the experiences of some consultants, and I recognise that those experiences are not unique to Glasgow North East.
The hon. Member for Central Ayrshire (Dr Whitford) always makes many informed remarks, given her experience. She made a point that perhaps has not been picked up, but is important in informing the debate: this is not just about losing a number of potential outpatient appointments and clinicians to service them, but about the impact on training. In many of the places that I have had the honour to visit as Health Minister, it is clear that the mentoring and support provided by senior staff to more junior staff is an important contribution, not only to the wellbeing of those junior staff, but to their education and, therefore, to the benefit of patients. That is undoubtedly one of the consequences of what we are talking about today.
Dr Whitford
Obviously, senior clinicians are critical to clinical teaching, which is part of the work. However, as other Members have highlighted, consultants are refusing to take on the extra sessions involved in organising that teaching and running rotas for either junior doctors or medical students. Without that, it will just be chaos.
Stephen Hammond
The hon. Lady is right to make that point; as I said in my remarks about her speech, I recognise the impact on training. There is clearly concern that unless we address this matter, it will have a number of impacts, of which that is one.
The hon. Member for Oxford East (Anneliese Dodds), speaking for the Opposition, rightly opened her remarks by pointing out the scale of the cost of tax release for pensions to the Treasury. She made valid points about doctors’ knowledge about that liability, and about the interaction of core tax principles with particular schemes. I was rather hoping that she would also welcome the long-term plan and the cash settlement, but I suspect that element of unity was probably a step too far.
As my hon. Friend the Member for Poole may have mentioned at the beginning of his speech, we have fewer Members here and a lower number of contributions. However, those contributions, combined with some of the interventions, have meant that we have had a debate of high quality.
Needless to say, I have heard the representations from everyone in the Chamber. It will not surprise anyone that I have received, as has the Department, representations from NHS employers reporting exactly what we have been discussing—that consultants are increasingly no longer willing to work additional sessions. The lost capacity is clearly difficult to replace, especially in some clinical areas where there are already shortages, and it can be expensive, as employers can pay a premium for locums to fill the gap. It is obvious and right that where there is evidence of an impact on the delivery of services, the Government should be prepared to take action.
At the outset, I reiterate that the Secretary of State and I take seriously the concerns of doctors. That is why we have been involved in a number of discussions with the Treasury, which has resulted in the 50:50 flexibility and the consultation. I will come to that in a moment, but, as Members will hear as I develop my remarks, that will not be the end of our conversation with other Departments.
Looking at the case for pension flexibility, it is true that outside public service, employers in some cases have flexibility to adjust benefit packages to allow high-earning employees to target a lower level of pension saving and so reduce the potential for large regular annual allowance tax charges. That flexibility is not currently present in the NHS. The NHS pension scheme does not allow any flexibility over the level of pension growth. Staff who participate in the scheme must pension all regular earnings from their employment. The Government are right to take the view that it is important to ensure that staff have a good level of pension savings, but senior clinicians, particularly consultants and GPs, have a unique degree of flexibility over their workloads and obviously can reduce their commitments. Consultants can reduce the number of additional sessions undertaken, and many GPs are self-employed. That can create incentives for clinicians to seek to control their income and pension growth by limiting or reducing their NHS work to avoid breaching their annual allowance. As a number of Members have discussed, that clearly has an impact on the delivery of patient care.
It is clear that retaining and maximising the contribution of our highly-skilled clinical workforce is crucial to the NHS and the long-term plan for the NHS. While any pension tax regime should seek to achieve the fiscal ambition of distributing pension saving incentives fairly, it has to be recognised that, in combination with the fixed structure of the NHS pension scheme, that could produce—listening to the evidence today and the evidence I have directly received—unintended consequences for service capacity and the delivery of patient care. The Government are prepared to change the rules to give clinicians more flexibility.
Alongside the publication of the “Interim NHS People Plan” earlier this month, my right hon. Friend the Secretary of State announced our intention to consult on new flexibility for clinicians. The consultation will be published in the coming days—I hope very shortly—and will set out proposals for a 50:50-style option, offering 50% pension accrual and halved contributions. Earlier this year, as part of the new five-year GP contract, the BMA and NHS England asked the Government to consider introducing that option. While I recognise that the BMA has not been unequivocal in its support, it has welcomed the proposal as a step in the right direction.
The Government believe that a 50:50 option balances the benefit of flexibility with the fiscal impact to the Exchequer. The 50:50 option will allow clinicians to build up their pensions more slowly and at a lower cost. Clinicians will still need to make their own personal assessment as to whether their financial interests are best served by taking advantage of the 50:50 model or continuing with full-rate accrual, but I have heard—not necessarily in the debate today, but directly from a number of consultants—that the 50:50 option is not flexible enough and that other measures should be considered.
The new pension flexibility should be viewed as a positive development for clinicians. My hon. Friend the Member for Winchester mentioned that he has asked me about the consultation period on the Floor of the House and that he has spoken to consultants about it. The consultation will be an opportunity to listen to a range of views before any final proposition is agreed. I encourage all Members here today to encourage their local clinicians to take part in that consultation. Equally, I encourage anyone from the health system in its widest context to take note of the debate and take part in the consultation. We want not only to hear any suggestion that there is a generic case for tax changes, but to listen carefully to what clinicians say using their own personal examples to provide evidence for any change they seek.
Steve Brine
Is the consultation discussing the merits or otherwise of a 50:50 option, or is it genuinely open to discussion about whether that option in itself is a good idea? As I said in my speech, the initial responses I have seen have not broadly welcomed, to put it politely, the idea of 50:50.
Stephen Hammond
The consultation is both. I recognise, as I said a few moments ago, that the 50:50 option has not received unequivocal support from the BMA, but to its great credit, it has asked us to consider that. We have come forward with this proposal. The BMA has welcomed it, but has said that it would want to discuss further options for flexibility and other pension matters. We have said that the consultation will look at the merits of the 50:50 option—or question it—but we will rightly open up that consultation to other suggestions. My hon. Friend will have just heard me say that I hope Members will encourage their local clinicians to use the consultation as a way of expressing their concerns about the 50:50, if they have any, and to express their views on other measures they would like to see introduced in terms of pension contributions. I stress that point again in response to his intervention. He will probably be interested in my next set of remarks, which are on flexibility.
Although the 50:50 option provides a new flexibility, we recognise that it does not provide unlimited flexibility for clinicians to target their own personalised level of pension growth and contributions. The financing model for the scheme means that any flexibility that reduces contribution income has an immediate fiscal impact on the Exchequer. The 50:50 option does not set aside the annual and lifetime allowance tax policies, but will give clinicians a new flexibility to manage their pension growth.
Where 50% accrual reduces pension growth by more than they wish, clinicians can use the contribution savings from the 50:50 model to buy additional pension to customise their own pension growth incrementally. Additional pension can be purchased in units of £250. That clearly adds some flexibility to their ability to manage their own contributions. However, some clinicians may continue to experience annual allowance tax changes, even with accrual rates reduced to 50%. For that group, while 50:50 reduces the charge, it does not eliminate it. We recognise that a number of individuals may wish to target a lower level of pensions growth. We will listen carefully to that suggestion through the consultation.
Dr Whitford
Is the Minister suggesting that senior consultants in three pension schemes sit and manage whether they are going to use the 50:50 or add in top-ups? That creates a whole job for people who work often 50 to 60 hours a week doing the thing that they are actually meant to do; it would give them almost a side job to try to manage their pension. Could we not go back to something simpler, whereby they get their payslip with a fair amount of pension tax taken off, but not what is happening at the moment?
Stephen Hammond
I have listened carefully to what the hon. Lady has just said, and she will want to listen to my next remarks, but I think she will reflect on the fact that a system of annual and lifetime allowances has been in place for some time. They were first introduced by the previous Government, although there have been some changes. Whether or not she thinks it would be better to have an even simpler system, some people will have recognised over time that it is important to look at their own pension contributions. Although tax relief on pensions is one of the most expensive reliefs, and the NHS pension scheme is rightly one of the better schemes available, I absolutely recognise that annual allowances and negative tax rates have a huge impact on some clinicians and consequently on the services for patients.
Consultants have raised with me the issue of the tapered annual allowance that Members have spoken about. I have been asked why the taper threshold is currently set at £110,000, which cuts across, as many people have pointed out, the typical earnings of an NHS consultant, although some people might perceive £100,000 as a high level of income. Unsurprisingly, tax policy is not something that I can speak to, but I have asked the Treasury and it advises that the threshold income test is designed to ensure that only those on the highest incomes can be affected by the annual taper. In the Treasury’s opinion, the £110,000 threshold balances the desire to restrict the annual allowance taper to those on the highest incomes, while trying to minimise the reduction in the value of the individual’s annual allowance.
I have also been asked why the annual allowance taper calculation takes into account both pensionable and non-pensionable earnings. Again, with the obvious proviso that I cannot design tax policy, the Treasury advises that if non-pensionable pay is excluded from the annual allowance taper calculation, there is the possibility that an unscrupulous employer could reclassify some pay as non-pensionable. To ensure fairness, the Treasury includes all sources of income in the taper calculation. However, hon. Members will not be surprised to hear that I think the concern about unscrupulous employers is not one that applies to the NHS. I recognise the issues raised by hon. Members on behalf of their consultants with regard to the taper threshold, and I am grateful to the Treasury for the discussions we have had, which have resulted in the 50:50 flexibility, but I can assure hon. Members that that discussion has not concluded. We rightly recognise that other pension issues need to be resolved.
I am grateful that the Treasury continues to engage with concerns about the taper threshold and how it impacts upon the workforce. I am happy to assure hon. Members that the Department intends to continue having discussions so that the matter can have a resolution that we hope will sort the matter out in an equitable and fair way, and not only for tax principles. We want to ensure that the dedicated staff working in the NHS feel valued and understand that they will not be penalised through the creation of perverse incentives so that they do not do what we want them to do, which is to provide excellent patient care.
In closing, I again thank my hon. Friend the Member for Poole for raising this important issue. I hope that I have been able to do three things: first, show hon. Members that the Department and I as the Minister responsible for people in the health system recognise the concerns raised by hon. Members on behalf of their consultants. The issues have also been raised with me directly. Secondly, I hope people will recognise that the 50:50 option is an important first step in looking at issues associated with lifetime contributions. I urge hon. Members to encourage their consultants to use the consultation. Thirdly, I recognise there are still issues around the taper threshold and the annual allowance, and I give the Chamber a commitment that the Department will continue to discuss with the Treasury ways in which we might be able to resolve those matters. I conclude by reiterating how important the debate has been this morning.
Oral Answers to Questions
Stephen Hammond Excerpts(4 years, 10 months ago)
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The Minister for Health (Stephen Hammond)
Our junior doctors work incredibly hard caring for patients around the clock. We introduced exception reporting in 2016 and it has been a major step forward in ensuring safe working. The British Medical Association, NHS Employers and the Department reviewed the effectiveness of exception reporting as part of the junior doctor’s contract agreement, which we announced last week. Revisions will be made to exception reporting subject to the endorsement of the BMA.
Justin Madders
Is the Minister aware that research by the Hospital Consultants & Specialists Association shows that, despite thousands of exception reports from junior doctors in unsafe hospital trusts, no changes to shift patterns were made at all. The chief executive of NHS Employers has said that, undoubtedly, there are circumstances where trusts would like to make changes, but because they do not have sufficient staff in place they are unable to do so. What can the Minister do to ensure that, in future, these changes are actually implemented?
Stephen Hammond
The hon. Gentleman is right: every exception report has to be addressed. Changing the rota is one possible outcome. He will recognise that there are other possible outcomes as well: the doctor may agree to work extra hours and be given extra time off; timing of the ward rounds in clinics may be adjusted, so that educational opportunities can be taken: and timing of the ward rounds can be adjusted so that support from other senior staff can be there as well. There are many ways around this.
Anneliese Dodds (Oxford East) (Lab/Co-op)
Greg Hands (Chelsea and Fulham) (Con)
The Minister for Health (Stephen Hammond)
The interim people plan sets out how the NHS will become a great employer with the culture and leadership needed to retain staff. NHS programmes to retain its highly talented staff are already having an impact. There are now more nurses working in the NHS than at any other time in its 70-year history. In addition, about 1 million NHS workers will benefit from the new Agenda for Change pay and contract deal.
Mr Dunne
I welcome the recent announcement of a consultation on NHS pensions arrangements for senior personnel. I hope that that will look at the taper impact, which raises the effective tax rate to an unacceptably high level. Retention of key personnel is critical across the Shropshire health economy, as well as in other parts of the country. Can my hon. Friend reassure me that senior-level changes in Shrewsbury and Telford Hospital NHS Trust’s management will not delay the Secretary of State’s consideration of the Independent Reconfiguration Panel’s report on proposed acute hospital reconfiguration?
Stephen Hammond
I thank my right hon. Friend for his welcome for the pensions proposals and the consultation. The Department has received initial advice from the Independent Reconfiguration Panel on the Future Fit hospital reconfiguration. The Secretary of State is currently considering that. He will respond to the IRP’s advice in due course, and I will ensure that he informs my right hon. Friend.
Greg Hands
May I thank the Secretary of State again for saving the A&E department at Charing Cross Hospital, which was a very, very popular move? Our brilliant hospital will benefit from the work that the Government are doing to increase the number of nursing associates across the NHS. What more can we do to get more nursing associates at Charing Cross Hospital, Chelsea and Westminster Hospital, and across the whole NHS?
Stephen Hammond
I thank my right hon. Friend for his comments on saving the hospital department—that is very important. He is right to raise the important role of the nursing associates, who deliver hands-on care in a range of complex settings. Thousands of nursing associates began training in 2017 and in 2018. Health Education England is leading a programme to recruit more than 7,500 into training in 2019, and I am sure that some of them will benefit his constituency.
Judith Cummins (Bradford South) (Lab)
Stephen Hammond
The hon. Lady knows that a wholly-owned subsidiary is created as a legal entity. It is 100% owned by NHS organisations. It is also the case that local trust board members sit on the boards of those subsidiary entities. It is therefore appropriate that the local organisation takes that decision.
Chuka Umunna (Streatham) (LD)
The King’s Fund says that the earnings threshold in the Government’s immigration proposals, which was mentioned earlier, will definitely impact on the ability to retain and attract NHS staff. The proposals for a transition period during which many social care workers would only be allowed to come here for a limited time with no entitlement to bring dependants will, again, negatively impact on the ability to retain staff. When will this Government realise that immigration is good for our public services and good for our country, and that badly thought out policy in this area that impacts on the retention of NHS staff is wrong and nonsensical?
Stephen Hammond
The hon. Gentleman is right—immigration has benefited the national health service. This Minister, this Secretary of State and this ministerial team celebrate the fact that global immigration has benefited the NHS. From 2021, the new system will allow people with skills to come to the UK from anywhere in the world. It will remove the cap on skilled migrants, abolish the requirement to undertake the resident labour market test, and should improve the timeliness of being able to apply for a visa.
Daniel Zeichner (Cambridge) (Lab)
The Minister for Health (Stephen Hammond)
NHS England is responsible for the allocation of resources to clinical commissioning groups. Funding is distributed on the basis of a weighted capitation formula informed by the Advisory Committee on Resource Allocation. Population estimates are provided by the Office for National Statistics. This year, as the hon. Gentleman will know from a debate that we had last week, ACRA recommended and NHS England accepted a wide-ranging set of changes to that formula. Those changes are likely to benefit his constituency.
Daniel Zeichner
We had a discussion last week, but the Minister was unable to answer my question so I will try again. Is Cambridgeshire’s clinical commissioning group correct that it will have less money to spend on providing health services next year than it does this year?
Stephen Hammond
As I pointed out to the hon. Gentleman last week, we recognise that historically, Cambridgeshire and Peterborough CCG has received less funding per person than neighbouring CCGs, but as I also pointed out to him, the CCG has received an absolute increase of 5.7% in 2019-20, bringing the funding up to £1.1 billion. We had a disagreement about the figures, because I could not agree the figures that he provided. As he knows, I have promised to write to him when I have been able to resolve his figures.
Mr Philip Hollobone (Kettering) (Con)
The Minister for Health (Stephen Hammond)
The House will not be surprised to know that the hon. Gentleman has raised this with me and my right hon. Friend the Secretary of State on a number of occasions. I am happy to reconfirm to him that we do consider it a top priority to make sure that all of his constituents get the care they need.
Diana Johnson (Kingston upon Hull North) (Lab)
Vicky Ford (Chelmsford) (Con)
I declare an interest as a doctor’s wife. If the sub-dean at Chelmsford’s brilliant new medical school continues to teach the students and work in the hospital, she faces a 90% tax rate. If she continues to do the weekend hours the hospital needs, she faces having to pay more in tax than she is earning. Will the Minister look again at the taper, which is driving our consultants out of our hospitals?
Stephen Hammond
As I said in response to an earlier question, we are putting out a consultation on pensions that will allow for looking at a number of issues, including the taper.
Several hon. Members rose—
University Hospital Coventry
Stephen Hammond Excerpts(4 years, 11 months ago)
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The Minister for Health (Stephen Hammond)
I thank the hon. Member for Coventry South (Mr Cunningham) and congratulate him on securing this important debate. I thank the other Members who have contributed. I want to start this debate, as I try to start all debates in the House when talking about the NHS, by congratulating and thanking the staff who work in the NHS—in particular, given the nature of the debate, the staff who work in the hospitals of Coventry and Warwickshire and throughout the west midlands.
The hon. Gentleman made a number of important points that I will try to address. I know that he wrote the Department a letter in May. I will ensure that there is a response to it, but I can tell him now that the response will be that I would be delighted to meet him and the fellow MPs who have signed the letter to discuss its contents and what I am about to say.
The hon. Gentleman raised a number of important concerns regarding the discussions to transfer HPB services from University Hospitals Coventry and Warwickshire NHS Trust to University Hospitals Birmingham NHS Foundation Trust. HPB services treat patients who have disorders of liver, bile ducts and pancreas, including pancreatic and liver cancer. A large volume of HPB services are delivered in local hospitals, but because of their complex nature and the high cost of care, delivery in conjunction with specialist tertiary centres is often necessary.
As the hon. Gentleman indicated, in October last year, NHS England confirmed that no decision had been made to transfer or close the HPB service in Coventry, despite some concerns that national clinical service specifications were not being met. I understand that he is still concerned about that, but I can confirm that there are currently no plans to transfer HPB cancer services away from University Hospitals Coventry and Warwickshire NHS Trust. However, NHS England is actively supporting the trust to work alongside University Hospitals Birmingham NHS Foundation Trust, to ensure that patients have access to safe, high-quality treatment.
University Hospitals Coventry and Warwickshire NHS Trust has said that it is proud—rightly so—of the HPB service, which has excellent outcomes and feedback about the quality of healthcare provided, as the hon. Gentleman mentioned. In 2015, the West Midlands Clinical Senate reviewed the three HPB services across the west midlands and recommended combining them across two sites, because they did not meet national requirements.
The “Improving Outcomes” guideline document specifies that a population base of at least 2 million is required to make a compliant service. Currently, University Hospitals Coventry and Warwickshire NHS Trust treats a population of about 1 million. The guidance also specifies that for a population of around 2 million, around 215 pancreatic and liver resections a year would be expected as a proportion of the population size.
The hon. Gentleman talked about the number of operations and resections done by this unit. Between 2013 and 2018, an average of 80 resections a year were performed in University Hospitals Coventry and Warwickshire NHS Trust. He quoted a rather larger figure, but it was 80 pancreas and liver resections a year. I am happy to discuss with him at the meeting the number he quoted, but it is not one I recognise.
I understand that, over the past two years, teams in both trusts have been discussing how to work together with a view to creating a single point of access and shared multidisciplinary teams for HPB in the local area. Both trusts have agreed that the most complex services should be conducted on University Hospitals Birmingham’s Queen Elizabeth site. However, the trusts are yet to agree on an established definition of the most complex surgery. The clinicians from both hospitals who are currently delivering the service will continue to work together to develop this new combined model of care. NHS England will determine the best way to meet patients’ needs collaboratively, based on specialist surgical skills and the skills that are available at each hospital, as well as on the volume and complexity of clinical cases.
I would like to reassure the hon. Gentleman and, indeed, other Members in the Chamber that I recognise that discussions concerning service change are controversial, and this case is no exception. However, I would also like to reassure hon. Members that all service changes are designed to drive up service quality, meeting the specific requirements of local populations and trying to achieve what is best for specialist service users overall. The hon. Gentleman has set out, with great emphasis, the significant challenges that remain, and it is right that the trusts continue to work together to determine the best method to deliver these highly complex services.
The hon. Gentleman and, I hope, all hon. Members know that cancer is a priority for this Government. Survival rates are at a record high. Since 2010, rates of survival from cancer have increased year on year. However, as we know, there is more to do. That is why, last October, the Prime Minister announced a package of measures that will be rolled out across the country with the aim of detecting three quarters of all cancers at an early stage by 2028.
As part of the NHS long-term plan that we announced in January, the Government have outlined how we will achieve the ambition to see 55,000 more people surviving cancer for five years in England each year from 2028. The Department invests £1 billion a year in health research through the National Institute for Health Research. It spent £136 million of that on cancer research in 2017-18, which is an increase of £35 million on 2010-11. The NIHR is funding and supporting a range of research relevant to liver cancer, including a £1.76 million trial of liver resection surgery versus thermal ablation for colorectal cancer that has spread to the liver and early research on specialised magnetic resonance imaging scanning to detect liver cancer that has spread from colorectal cancer. There is much still to be done, but much is being done.
Mr Marcus Jones
I hear clearly what my hon. Friend says about the improvements that are being made in this area and in wider cancer care, but I am still concerned about the potential loss of what is a good service from Coventry. I am also concerned that at the moment, while no decision has been made, discussions and negotiations are clearly going on in that regard. It is quite obvious from the discussions that the hon. Members for Coventry South (Mr Cunningham) and for Warwick and Leamington (Matt Western) and I have had that not everybody in those organisations is in the loop, actually knows what is going on and is satisfied with this situation. Will my hon. Friend look at what more can be done to make sure, in this situation, that information is disseminated widely between clinicians and organisations so that we ensure we do not unnecessarily lose very high-quality people from organisations such as University Hospital Coventry?
Stephen Hammond
My hon. Friend makes an important and valuable point, and as a result of this debate I pledge to write to the hospitals to ensure that the ongoing discussions between the various parties are as inclusive as possible. As I said earlier, I will happily meet him, the hon. Member for Coventry South, and other Members.
Mr Marcus Jones
My hon. Friend is kind and generous in giving way, and I thank him for the commitment he has made. There has clearly been little public engagement, but that is what we need with regard to any changes that are made, so that the public can understand the rationale behind these changes. I am aware of one person who has been chasing information about this issue, but they have hit a brick wall.
Stephen Hammond
My hon. Friend is assiduous in representing his constituents and making his points. As I have said, these discussions have not yet concluded, and it would be hugely inappropriate for me or any politician to try to prejudge the right clinical outcomes. When those clinical outcomes have been worked through and the discussions finalised, I have no doubt that University Hospitals Birmingham and the Coventry and Warwickshire Partnership NHS Trust will wish to publicise the result of those discussions as widely as possible.
Mr Jim Cunningham
Following the intervention by the hon. Member for Nuneaton (Mr Jones), the Minister mentioned a wider discussion and involving the public. We met some representatives, including Mr Peter Burns, who is the former chair of the local chamber of commerce and a very influential person. Such organisations, as well as other public bodies, must be brought in and consulted. Will the Minister agree to do that?
Stephen Hammond
It would have been inappropriate for me to be involved in clinical discussions, but I hear what the hon. Gentleman says. Before we have that meeting, I will write to him on that point. I hope that we will have a meeting relatively soon, so that we can finalise what should be done.
Service change is often controversial. We should rightly scrutinise any service change, but that should be based on patient safety and the right clinical outcomes. I thank the hon. Gentleman for raising this matter and continuing to hold us to account, and I look forward to meeting him and other hon. Members to discuss the issue further in the near future.
Question put and agreed to.
Cambridgeshire and Peterborough CCG: Funding Pressures
Stephen Hammond Excerpts(4 years, 11 months ago)
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This information is provided by Parallel Parliament and does not comprise part of the offical record
The Minister for Health (Stephen Hammond)
It is a pleasure, as ever, to serve under your chairmanship, Mr Hollobone. I thank the hon. Member for South Cambridgeshire (Heidi Allen) for bringing forward this debate. I know there are not many Members in the Chamber, but that should not in any way undermine or take away from the importance of this debate, which is clearly of great interest to her. She spoke powerfully about the problems that the CCG has had.
I recognise right at the outset that Cambridgeshire and Peterborough CCG has faced a number of difficult, interlocking and historical factors. The historically low funding settlement is obviously taking time to rise to target—there is a commitment to rise to target over time, which I will come on to in greater depth in a moment—and that has combined, as she rightly points out, with the fast rate of population growth across the area, which has put additional demands on the CCG.
I and the Government recognise that the CCG receives less per person than its neighbouring CCGs. As the hon. Lady rightly pointed out, it gets £119 per person less than its neighbouring CCG in Bedfordshire. Although it is moving towards target—as she rightly points out, it is 3.7% below target this year—that figure reflects some of the historical funding patterns. It does not reflect the allocation formula change that the NHS is working to resolve.
The hon. Lady and the hon. Member for Cambridge (Daniel Zeichner) pointed out the growth levels. She is right that Cambridge and Peterborough have seen substantial population growth in recent years, and that growth has been 0.6% above the England average over the past four years. Inevitably, that growth—plus the potential growth from the Oxford-to-Cambridge expressway, which will put more housing along the corridor—will clearly cause additional pressures.
The hon. Lady asked for a commitment from me. I can say that NHS England is committed to bringing all CCGs up to target as soon as possible, while also ensuring that all CCGs receive some additional funding this year. As a result, the CCG has received an additional 2.5% per capita growth in 2018-19, and will receive a further 5% per capita growth in 2019-20. That will bring the CCG funding up to £1.1 billion for 2019, which is below target but moving up. As I think the hon. Lady said, it was previously some 5% away from the target; it is now 3.7% away from the target. Our commitment is to bring all CCGs up to the target as soon as possible.
The hon. Lady will not be surprised to hear me say that it is, of course, a matter for NHS England to allocate funding to CCGs, and that process has been evolving. It might be helpful if I briefly set out how that happens. NHS England must ensure that funding is equitable and fair, taking into account the three main drivers of healthcare demand: population growth, deprivation and an ageing population. As a point of principle, CCG allocations are based on equal access for equal need and reducing health inequalities.
As the hon. Lady pointed out, a complex national formula supports the allocation of resources, and historically that has caused some distortions. That formula is developed by the Advisory Committee on Resource Allocation, known as ACRA, which is an independent body of experts, supported by the population projections of the Office for National Statistics.
The hon. Lady cited some population predictions, which I think come from the Cambridge Research Group as opposed to the Office for National Statistics. She will therefore understand that, although I accept that those numbers are shared locally, Ministers and the NHS have to rely on the independent and academically rigorous body. Otherwise, it could easily be perceived that we were using a local think-tank’s population growth estimates to privilege one group over another.
Heidi Allen
Thank you, Mr Hollobone. Forgive me—I have not led a Westminster Hall debate before. I accept all that the Minister has said, and it is a difficult matter, but the statistics are flawed. The Minister said that he accepts that the growth is 0.6% above the England average; the Office for National Statistics is working on its being 0.1% below. Something is therefore going a little astray.
Stephen Hammond
I am sorry—either I did not make myself clear, or the hon. Lady misheard me. I said that the population growth was 0.6% above the England average over the last four years. The number that she cited of the growth being below the average is from ONS predictions for the next two or three years.
Heidi Allen
Forgive me if I am mistaken, but I thought I heard the Minister agree that the growth was in fact 0.6% above the England average. If it is, why on earth are we working on the ONS figures that it is 0.1% below the England average?
Stephen Hammond
This is prejudging the tennis season, in that we can go backwards and forwards, but let me say for the record that if I misled the hon. Lady I apologise wholeheartedly. I agreed that the population growth of the Cambridge and Peterborough CCG area has been 0.6% above the England average over the last four years; I did not intend to suggest that it is expected to be 0.6% above the England average for the next one, two or three years. I think the ONS number that she cited is one that we recognise; however, as I said, the numbers that she produced from the Cambridge Research Group are different from those of the ONS.
This year, ACRA has recommended a wide-ranging set of changes to the formula, to ensure fairness across the country. In the case of Cambridgeshire and Peterborough CCG, that has led to an increase in NHS England’s estimate of what the fair share of resources should be. That is mainly due to the mental health and learning disability service estimate and the market forces factor.
Changes have also been made to the way population data is used. ACRA now uses the annual average registered list for the most recent year, rather than the size of the list at the time of allocations, to allocate resources on a per capita basis. That change will inevitably benefit Cambridgeshire and Peterborough CCG because it will reflect more recent population growth. The change is obviously also intended better to reflect cyclical patterns in areas with large numbers of seasonal workers or large student populations.
ACRA also now uses specific data regarding age and gender population projections produced by the ONS, so that if population growth in an area is disproportionately in a younger or older population, which will obviously affect the relative need, that will now be reflected in the new way that NHS England calculates the allocations. As I said earlier, the formula changes will more accurately reflect population growth, deprivation and the structure of the population over the next few years.
Heidi Allen
I appreciate the sincerity, and my CCG knows that NHS England intends to improve the formula to make it more representative. However, a question remains, and it is the same question that the hon. Member for Cambridge (Daniel Zeichner) referred to regarding education: what happens in the meantime? Our CCG is talking about significantly cutting community services. That will affect elderly care in the community. That will stop vasectomies. It may take IVF treatment away altogether, as we are at just one round at the moment. Although I appreciate that NHS England is an enormous machine and improving the health formula will take some time, what do I say to my constituents whose health services are being cut while we wait?
Stephen Hammond
I will say two things to the hon. Lady. First, the reflection of the formula and the increase in the money is coming through this year and next year. We have spoken about the additional per capita funding that is coming through.
Daniel Zeichner
There is a complicated set of issues surrounding national health service funding, but the CCG is telling us that it will have less money to spend in 2019-20 than in 2018-19. I really just want confirmation from the Minister that that is his understanding too.
Stephen Hammond
All I have are the percentage increases in additional per capita funding for 2018-19 and 2019-20. I will seek inspiration to confirm the absolute totals, and if that inspiration reaches me while I am still on my feet, obviously I will relay it to the hon. Gentleman. If not, I am happy to confirm that I will write to him.
My point is that the NHS England allocation is based on the ACRA assessment and on the change in the funding formula. The hon. Member for South Cambridgeshire and the hon. Member for Cambridge rightly point out that, historically, the funding of their CCG has not been equivalent to that of local areas. That historical funding disparity is being improved, and is moving back towards the target of funding for CCGs over the next two or three years. I pointed out that last year there was a funding increase of 2.7%, and there will be one of more than 5% this year.
Heidi Allen
While the Minister’s inspiration is working diligently on the back row behind him, may I ask to be included in that? If we do not have time now, perhaps the Minister could come back to us. He is right that some additional funding has been provided to the CCG, but more than that amount is in mandated national programmes over which it has no control, so how much extra will the CCG receive for core services—not for something that has been put on it from a national point of view?
Stephen Hammond
The hon. Lady will know that some of those core mandated services are providing core services as well. I am happy for the hon. Member for Cambridge to correct me, but my understanding is that an additional £8.5 million will go into the CCG. If he wishes to write to me with his figures, I will happily source those numbers for him. However, I have just received inspiration from somewhere, for which I am very grateful, and I can confirm that that is the number.
Daniel Zeichner
We could probably swap numbers for the remaining 11 minutes of the debate, but I am told that the CCG has additional nationally mandated commitments that exceed the extra money that it is getting, which is the nub of the problem. The overall problem, however, is that the Prime Minister has been going around telling people that a huge amount of money is coming into the national health service, but locally it appears that we have less. That is obviously difficult for local people to understand.
Stephen Hammond
The Prime Minister has rightly been telling people that there is a huge commitment to put more money into the NHS. Throughout the debate, I have recognised that the moneys that the CCG historically received were below the target for CCGs. I have stated that more money is now coming into the CCG and that NHS England is committed to moving all CCGs to target. Although he may say that is a historical issue, I hope he would also recognise the fact that the Government are putting more money into the national health service and that that money is coming to his area.
That brings me to the point I wanted to make about wider funding. The Government are making a commitment and backing the NHS with an extra £20 billion a year by 2023, which will be reflected in the resources available to CCGs.
Daniel Zeichner
I note, however, that my reading of what is happening to the CCG is that it has already spent a lot of the money that is coming through, so it will mean not more money, but dealing with past debt. Again, could the Minister confirm that that is in fact the case?
Stephen Hammond
That will partially be a decision for the CCG. I do not recognise exactly what the hon. Gentleman has said; I have said that an additional amount of money is going in. I accept that there are nationally mandated core services that need to be provided by the CCG. I stress again, as I have throughout the debate, that I accept that the CCG has historically been underfunded against population growth and against other local CCGs, as he and the hon. Member for South Cambridgeshire have pointed out.
I have reflected in my remarks that the change in the formula will allow the population growth that has happened in the previous four years to be more accurately reflected. If the hon. Lady’s growth projections prove more accurate than those of the ONS, I have indicated how, through the formula change, that will come through more quickly in the funding that is received by the CCG. Those are the key points. I am happy to write to her and the hon. Member for Cambridge to confirm the financial position as I and the Department understand it, so we are clear. We could spend another joyous eight minutes swapping numbers, but perhaps we will not do that now.
Suffice it to say that the long-term plan also sets out how the NHS will use those resources more effectively. It is clear that there is a huge increase in the commitment to primary care and that the formula change will reflect that more accurately for CCGs. I have no doubt that, if the formula increase does not come through in the way that the hon. Gentleman and the hon. Member for South Cambridgeshire expect, or that I expect, they will continue to make the case to me and will bring me back for another debate. I thank the hon. Lady for securing the debate and I hope she agrees that we have discussed the funding formula.
Question put and agreed to.
Historic Patient Safety Incidents: Liverpool Community Health NHS Trust
Stephen Hammond Excerpts(4 years, 11 months ago)
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The Minister for Health (Stephen Hammond)
The report of an independent review conducted by Dr Bill Kirkup into the widespread failings by Liverpool Community Health Trust was published on 8 February 2018. The report described how over-ambitious cost improvement programmes as part of a bid for foundation trust status placed patient safety at risk, leading to serious lapses in care and widespread harm to patients. A culture of bullying meant that staff were afraid to speak up and safety incidents were ignored or went unrecognised.
Today, I am Informing the House that NHS England and NHS Improvement will establish an independent investigation of previous serious incidents at Liverpool Community Health. This second review will again be led by Dr Bill Kirkup supported by an independent expert oversight panel and will be conducted over three stages. Stages 1 and 2 will identify individual serious patient safety incidents that had not been reported or adequately investigated by Liverpool Community Health and undertake a series of historic, mortality reviews. Stage 3 will fully investigate those individual serious patient safety incidents identified from the previous stages to determine the scale of deaths and patient harm and identify local and national learning.
The independent investigation will also advise regulators where, in the opinion of the panel, the systems, processes and senior leadership within the former Liverpool Health Community Trust may have adversely contributed to the safe delivery of patient care. It will identify any themes, trends or issues that may require further investigation.
This will not be a re-run of the previous independent review, but it will draw upon its findings as well as the new evidence identified by Mersey Care NHS Foundation Trust in its response to the recommendations of the original report. The independent investigation will engage with families of former patients and affected staff to understand their concerns to inform the work of Stage 3.
Local stakeholders will be briefed and the investigation will publish its terms of reference once these have been finalised with the Chair.
NHS England and NHS Improvement expect work on Stages 1 and 2 will commence immediately and the independent investigation will report towards the end of 2020.
I am confident that Dr Bill Kirkup will oversee a thorough and independent investigation of these outstanding issues and deliver his recommendations swiftly.
[HCWS1601]
Interim NHS People Plan
Stephen Hammond Excerpts(4 years, 11 months ago)
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Jonathan Ashworth (Leicester South) (Lab/Co-op) (Urgent Question)
To ask the Secretary of State for Health and Social Care to make a statement on the interim NHS people plan.
The Minister for Health (Stephen Hammond)
The NHS published its interim people plan on Monday, and I laid a written ministerial statement at the earliest opportunity yesterday.
The plan is a first, but critically important, step in ensuring that the NHS has the people, leadership and culture it needs to deliver the NHS long-term plan. The interim people plan has been developed by Baroness Dido Harding, the chair of NHS Improvement, in partnership with frontline staff, NHS employers and a wider range of other representative groups and stakeholders. It takes a tough look at the challenges facing people working across the NHS. It sets out how leaders will be supported to create cultures that empower staff and make sure that every member of staff, regardless of their background, will be able to progress.
Critically, the plan calls for all NHS organisations to set out how they will ensure that the NHS is the best place to work. The recently appointed chief people officer for the NHS will play a vital role in supporting the NHS to do this. The interim people plan sets out a number of practical steps to increase the supply of clinical staff. This includes an extra 5,000 additional clinical placements for nurse training places by September 2019 and a commitment to further expansion of medical school places.
Ultimately, the plan will ensure that the NHS is best able to retain the highly skilled and dedicated staff who choose a career in healthcare, including the most senior clinicians. Therefore, we have listened to their concerns that pension tax changes are discouraging them from doing extra work for patients. That is why Government will consult on how to introduce new flexibilities for this critically important staff group.
But we are not complacent. We know there is more work to do to secure the people, leadership and culture that the NHS needs. My right hon. Friend the Secretary of State has asked Baroness Harding to lead further work over the summer to prepare the final people plan. As has always been intended, the final people plan will be published soon after the conclusion of the spending review, when there will be further clarity on education and training budgets.
I would like to take this opportunity once again to place on record my thanks, and the thanks, I am sure, of everybody across the whole House, to all the NHS staff who do a wonderful job in ensuring that our constituents—their patients—get excellent care.
Jonathan Ashworth
It is a pleasure, as always, to see the Minister of State, but the Secretary of State should be doing his day job and be here answering questions about the health service, not playing his Tory leadership games.
Our NHS is struggling with vacancies of 100,000. Our NHS staff are the very best in the world—and none of them wants to be part of a trade deal with the Americans, of course—but they are working under immense pressure because of these chronic shortages. Shortages put patient care at risk, and that means that standards of care are falling. This means that our constituents wait longer to get a GP appointment because we have lost 1,000 GPs. It means that women are turned away from maternity units because we are short of 3,500 midwives. It means that cancer diagnosis is delayed because of shortages in the cancer workforce. As Dido Harding’s report shows, we are short of 40,000 nurses in the workforce, and that is now critical. It means that at a time when mental health problems are increasing—The Lancet reports today on an increase in non-suicidal self-harm—we have actually lost 5,000 mental health nurses since 2010. We have problems in the learning disability sector. Health Education England today warns that because of the shortages in learning disability nursing, we are set to
“hit critical levels in the next five years”,
with vacancies of 30%. We have an ageing population. Adult social care is short of 110,000 staff, and yet district nursing has been cut by 50%. We do not have enough nurses on our children’s wards. Health visitors and school nurses in our communities have been cut.
This NHS workforce crisis is linked to decisions of this Government. As Dido Harding’s report says,
“applications for nursing and midwifery courses have fallen since the education funding reforms”.
Those education funding reforms include the abolition of the bursary. Is not that therefore a damning indictment of the decision by this Government to abolish the bursary, and will the Minister now commit to bringing it back?
The report also references continuing professional development, where budgets have again been cut, by a third. It says:
“Employers have…been investing less in their people, as pressures on NHS finances have grown.”
Is that not an admission that Tory austerity, with nine years of underfunding in the NHS, has contributed to the workforce crisis of today?
The Health Secretary has said that he wants “a new Windrush Generation” of overseas nurses to fill the staffing gap, so can the Minister explain why a commitment to recruit 5,000 extra nurses a year internationally was dropped from the Dido Harding report? Did the Government put pressure on Baroness Harding? On international recruitment, can he guarantee that no one offered a job in the NHS or care sector will be restricted by the £30,000 salary cap, as the chair of Health Education England called for yesterday at the Health and Social Care Committee?
Finally, the Minister referenced the spending review. He will have seen that the Chief Secretary said yesterday at a Select Committee that the spending review is now unlikely to be ready for 2020-21. That means that new funding for training, for Health Education England and for capital investment in public health and social care will not come on stream until 2021—two years away. Does the Minister think that that is an acceptable way to deal with the NHS crisis we are facing? I urge the Minister, for whom I have a lot of respect, to accept that we cannot keep delaying this situation further. The Health Secretary needs to abandon his leadership games, focus on his day job and get a grip.
Stephen Hammond
The House will have listened to the hon. Gentleman. It is important to put out some facts, which were missing from his fact-free analysis. For example, we have had 52,000 more professionally qualified clinical staff in the last nine years, almost 16,500 more doctors and over 17,000 more nurses on our wards. He set out a list of promises, but with little detail and no means to pay for them. He asked a number of questions, which I will respond to.
The hon. Gentleman talked about the number of nurses and said that there was no plan. There clearly is. Increasing nursing is a priority, and this plan sets out—[Interruption.] If the hon. Member for Dewsbury (Paula Sherriff) would like to listen, this plan sets out a focus to ensure that we can recruit nurses. The hon. Gentleman talked about applications, but he will know that applications for nursing places are up 4% on the previous year. He will also know that the plan sets out 5,000 more clinical placements available in September this year, which is a 25% increase on the previous year. He will know that the plan sets out 7,500 more nursing associates. The plan also quite clearly sets out measures that will ensure that the NHS is the best place to work, and therefore more nurses will want to stay in it.
The hon. Gentleman spoke about a number of other issues. The Migration Advisory Committee has made recommendations, which he will have seen. He will know that the Secretary of State has made a firm commitment that we intend to continue to recruit internationally, as well as increasing domestic recruitment. He mentioned continuing professional development. It would be useful if he had read the plan, which sets out commitments to ensure continuing education and opportunities for education for all staff in the NHS. He will have seen that there will be a final level of commitment.
The hon. Gentleman speculates about the spending review. He speculates about a number of things, but it would be better not to speculate. It would also be better not to make allegations about my right hon. Friend the Secretary of State, who was doing his day job yesterday. I know that the hon. Gentleman is always interested in soundbites, and one soundbite he should have taken notice of was when my right hon. Friend said yesterday:
“the NHS is not on the table in any trade talks. The NHS is not a bargaining chip in negotiations, with the US or otherwise.”
Stephen Hammond
Perhaps that is the soundbite that the hon. Gentleman and his colleagues—including the hon. Member for Dewsbury, who is shouting across the Chamber yet again—should remember.
Mr Kenneth Clarke (Rushcliffe) (Con)
I welcome the Minister’s announcement that the Government are giving higher priority still to the recruitment and retention of staff in the NHS. It is an undeniable fact that there are acute shortages, particularly of nurses, in practically every part of the NHS, and we urgently need to improve our recruitment and retention. With that in mind, will he confirm that in finalising the people plan, serious consideration will be given to the immigration rules that will apply to recruitment after we leave the European Union? About one in 20 of the whole staff of the NHS at the moment are citizens of the European Union, and it would make no sense at all to put new restrictions of any kind on people coming from the European Union who want to make a valuable contribution to our health service. In Nottingham, we used to run recruitment campaigns for nurses in Romania. We are a long way away from being able to in any way put restrictions on staff coming from any part of the continent.
Stephen Hammond
My right hon. and learned Friend the Father of the House is completely correct. We want to make sure it is clear that the EU nationals who work in the national health service—there are more than 63,000 of them—are valued and make a huge contribution to our NHS. He will probably be aware that my right hon. Friends the Secretary of State and the Home Secretary are in continuing negotiations, to ensure that there is no change to that position. I guarantee that we want to see EU nationals continue to work in and contribute to our great health service.
Dr Philippa Whitford (Central Ayrshire) (SNP)
I welcome the interim NHS people plan. Workforce is the greatest challenge across all four health services, but the 41,000 nursing vacancies in NHS England are simply a patient safety issue and cannot be parked on some shelf or kicked into the long grass. The plan identifies the removal of the nursing bursary and the imposition of student fees leading to a drop of over 30% in new student nurses. Will the Minister commit to re-establishing the bursary? Scotland preserved the bursary and free tuition, and our nursing vacancy rate is less than half that. The plan also calls for 5,000 new GPs. I remember the former Secretary of State promising 5,000 new GPs by next year, and rather than being close to delivering that, there are 1,000 fewer. How will the Minister deliver 5,000 extra GPs? Will he increase funding to Health Education England to deliver it?
There is no question but that the NHS across the UK will need non-UK staff. How will the Minister attract both EU and non-EU staff when there has been a 90% drop in European nurses coming here, and non-EU doctors are leaving because of visa charges and the £400 a year they pay per member of their family to access NHS services? What is he going to do about the pension tax allowance rules that are driving young consultants out of the NHS?
Stephen Hammond
I thank the hon. Lady for welcoming the plan. I think she will accept that this is a good interim plan; it is a stepping stone. She asks what we are doing to fill nursing places. I point out yet again that we are increasing applications and ensuring that there are 5,000 extra clinical placements available, which is a 25% increase on last year. Far from being complacent about the number of nursing applicants, we are looking to ensure that more nurses can be trained in this country, beyond the 35,000 who are being trained at the moment.
The hon. Lady asked about doctors. The Royal College of Physicians has made it clear that we need more medical school students. We are committed to increasing the number of undergraduate medical school places for domestic students by 1,500, with the first 630 being taken up last year. By 2020, there will be five new medical schools across England, helping to deliver—[Interruption.] Of course it takes time, but if we do not take that step now, we will never make the end of that journey. That has been a consistent problem for many years. There are still more doctors coming through now, but we need to do more, which is why this plan is being put in place.
The hon. Lady will have heard me say to my right hon. and learned Friend the Father of the House that there are more than 63,000 EU nationals working in the health service. That is more than there were in December 2017, and over 5,000 more than there were in June 2016. She is right to point out that we want those skills in the right clinical areas. I reiterate what I said a moment ago: we wish to make it absolutely clear that the contribution of EU nationals working in the health service is extraordinary and valued and will continue to be so.
The hon. Lady briefly mentioned pensions. She will have noted that we launched a consultation yesterday, setting out some ideas. I am pleased to say that the British Medical Association has welcomed them but asked us to look at other flexibility within the pension rules. I encourage the hon. Lady and all consultants to take part in that consultation.
Steve Brine (Winchester) (Con)
The Minister knows from our time together in the Department how much I welcome the interim people plan. It simply is the turnkey without which our long-term plan just cannot work. He is aware of how important retention is, and that is at the heart of the plan. I know he has mentioned this several times already—and consultations are great, and I will encourage my constituents to take part—but may I ask him to look urgently at the changes to the NHS pension scheme in relation to the annual allowance and the lifetime allowance? My trust has contacted me to say that senior consultant doctors and senior nurses are receiving unexpected tax bills of tens of thousands of pounds—up to £50,000—which is starting to have an impact on decisions about their future and the additional sessional work they are prepared to take up. This is impacting on patient care now, so on behalf of my constituents, I urge him—I know he will take this seriously—to look urgently at the NHS pension scheme issue.
Stephen Hammond
Again, my hon. Friend was absolutely right at the start of his question to point out that this is a key stepping stone to making sure that the long-term plan works. He is also absolutely right to point out that we recognise and have taken extraordinarily seriously the difficulties that a number of clinicians have had with the pension tax changes. He will know from his time in the Department that we have been in continuous discussions with the Treasury about what options may be available. I have set out today that the consultation will propose a new 50:50 option for higher-earning clinicians to halve the rate of pension growth in exchange for halving contributions. I accept that that is only one part of the solution, but it is a step forward. I welcome contributions to the consultation, and I urge him and his consultants to take part.
Yvette Cooper (Normanton, Pontefract and Castleford) (Lab)
In our area, GP practices have had serious problems recruiting, and one constituent has contacted me about surgeries being cancelled and having been told that the next routine appointment, for what is actually a serious condition, will be in August. My constituents cannot wait that long for GP appointments. Frankly, Ministers have had nine years to anticipate this crisis, and instead of making things better, they have in fact made things worse, with the King’s Fund warning that GP shortages could treble in the next five years. Frankly, the warm words the Minister has said are not urgent enough and not substantial enough to turn this around, so what is he going to do in the next six months to make a difference to my constituents, who are waiting far too long for important appointments?
Stephen Hammond
The right hon. Lady is right to be angry because her constituents should not be waiting that long. If she wishes to speak to me afterwards, I will take that up directly, with her, on behalf of her constituents.
The right hon. Lady says that we are not taking this seriously and not acting urgently enough. She will know that this interim people plan makes sure we will have not only more people recruited to the NHS, but more people wishing to stay working within the NHS. One of the key issues the NHS has faced is that a lot of people have decided not to work within it, and the key part of the people plan—this being the interim before the final is published later—is actually about ensuring we have more staff there. I reject what the right hon. Lady says. We are taking this seriously, and we are acting on it now.
Henry Smith (Crawley) (Con)
I welcome the record amounts of investment going into the NHS, but may I seek assurances from the Minister that we will be using those resources to ensure that specialist clinicians in areas such as blood cancer and heart disease are properly supported so that we have the training for those personnel to tackle those conditions in particular? I say that as the chairman of the all-party groups on both conditions.
Stephen Hammond
My hon. Friend will know, because I have been in debates with him before, that I recognise the exceptional work that those two all-party groups do. He will know from the long-term plan that we have set out new commitments on diagnosis for all cancers and for cardiac. He will know that the reason why we have set out an interim people plan and will then set out a final people plan is that a long-term plan cannot work unless we have the people to back it up and are training the right number of people. This plan sets out how to recruit more people, how to train more people, how to give people the skills to deal with what will face the clinicians and the physicians of the 21st century, and that is key to delivering what he has asked for.
Mr Ben Bradshaw (Exeter) (Lab)
Baroness Harding, who is a Conservative peer, and Sir David Behan, the head of Health Education England, told the Health Committee yesterday in absolutely clear terms that both the abolition of nursing bursaries and Brexit are seriously exacerbating the staffing crisis in the NHS. Are they wrong?
Stephen Hammond
I am sure they will also have said that one of the things Health Education England has explicitly set out is that one of the biggest barriers to more nurses was that there was not the placement capacity. I am sure Sir David Behan will also have set out that he therefore welcomes entirely the 5,000 extra clinical placements that are being made available, which is a 25% increase on last year.
The right hon. Gentleman will also know, as I have set out, that there are more EU nationals working in the NHS now than there were at the time of the referendum. However, one of the reasons why we are having an interim people plan is that we are not complacent. There are huge challenges, as I set out not only in my written ministerial statement, but in my opening remarks. That is why this plan is addressing the shortages in nursing, and it is right that we do so.
Lucy Allan (Telford) (Con)
I welcome very much this initiative, and I am delighted by all that has been said. The chief executive officer of Shrewsbury and Telford Hospital announced his departure on Monday, following a catalogue of failings. Despite these failings, formal complaints to Dido Harding and others and a series of calls for his dismissal, the CEO has apparently resigned of his own volition to take up another highly paid job within the NHS and is not going to work his notice because he has too much holiday to take. Does the Minister agree that senior management in any organisation, including the NHS, must be held to account for their performance, and will the people plan deliver this?
Stephen Hammond
My hon. Friend makes a very powerful statement on behalf of her constituents about the change of leadership. I am obviously aware of the change of leadership, including the departure of the chief executive, and I am aware that it raises a number of issues, which she and I may wish to have a meeting to discuss. She is right to ask whether we are tackling the culture to make sure that we have the best leaders in the NHS, whether we are ensuring that they are properly trained for the challenges of the 21st century and whether we are making sure that they are not only held accountable but supported to make sure they are doing the best they can. That is why Sir David Behan led a chapter in the whole draft people plan, which will lead into the final people plan, on leadership. The right leadership for the NHS will make sure that our constituents get better care.
Ellie Reeves (Lewisham West and Penge) (Lab)
It has been reported this week that there has been a dramatic rise in self-harm, with one in five girls cutting, burning or poisoning themselves. Despite this, the NHS trust in my constituency has cut the Lewisham child and adolescent mental health services budget, due to central Government cuts. We desperately need more funding and more staff. Given that the Government are not on track to meet their mental health workforce target for 2020-21, is the Minister really confident that we can meet these new, larger recruitment targets?
Stephen Hammond
I am confident that we are putting in place the measures that will allow those targets to be met. There is a comprehensive expansion of mental health services, with an additional £2.3 billion being invested over the next four years, which will make sure we resolve the problems the hon. Lady has highlighted. In particular, 350,000 more children will get the support they need, which I am sure will translate into dealing with the issues at local level that she has raised.
James Cartlidge (South Suffolk) (Con)
GP retention is a significant challenge in my constituency, and GPs do often raise the impact of the current pension system. May I say to my hon. Friend that I very much welcome the consultation on pension arrangements for clinicians, but can he set out the potential timing of when those changes may come into force? He will be aware that GPs are making decisions right now about things such as early retirement, and we need this as a matter of urgency.
Stephen Hammond
I thank my hon. Friend for that question. The Department will launch the consultation at the end of this month. It will set out the proposals, which we spoke about yesterday, to introduce greater pension flexibility. They are designed to take away the disincentives not only for senior clinicians but clearly for GPs. That consultation will last for the normal length of time, and I hope we will be able to proceed quickly thereafter.
Ann Clwyd (Cynon Valley) (Lab)
When I came to Parliament 35 years ago, I had served for three years on the royal commission on the NHS. We made many recommendations. When I hear the Minister talk about things that will be done and say that notice has been taken of reports, I am reminded that that report landed on Margaret Thatcher’s desk. The recommendations that we made were never carried out. One was about the shortage of doctors. Thirty-five years ago, we knew that there would be a shortage of doctors. We made many other important points, which should have been acted on. What assurances can the Minister give so that on this occasion the recommendations in the report will be acted on? What is the point of all these words and all this work done by people on things such as royal commissions unless the Government take action?
Stephen Hammond
The Government are taking action specifically on the points that the right hon. Lady made. We committed to increase the number of undergraduate medical school places by 1,500, and 630 are already in place.
Paul Masterton (East Renfrewshire) (Con)
I thank the Minister for grappling with the NHS pension scheme issue. I am not convinced that the 50:50 option is a long-term, sustainable option, so will he confirm, as the Secretary of State said yesterday, that the consultation will be open to exploring other mechanisms? In particular, will he keep banging at the Treasury’s door, because the ultimate solution is in its power? The way in which it has tried to dodge this and pass it to the Department of Health and Social Care is a bit of disgrace.
Stephen Hammond
My right hon. Friend—I am sorry, my hon. Friend; I am only presaging something that will happen in future—will know that when my right hon. Friend the Secretary of State speaks he says what he means. The consultation will be open to looking at other schemes and other potential flexibility. My hon. Friend will know that the British Medical Association has welcomed the 50:50 option but would like to see other options. He will also know, much as the Department might like to make tax policy, we do not do so, so it would be injudicious of me to commit, but I am happy to continue our long-standing conversations with the Treasury on this matter.
Dr Rosena Allin-Khan (Tooting) (Lab)
There will be no people plan if Donald Trump gets his hands on our NHS. Unlike Donald Trump, the NHS does not discriminate, and staff value everyone who walks through the door as equal. Does the Minister agree that the NHS was not for sale yesterday, it is not for sale today, and it must not be for sale tomorrow?
Stephen Hammond
The good news is that I think the hon. Lady was agreeing with my right hon. Friend the Secretary of State, who set that out yesterday. I welcome the fact that she supports him.
Steve Double (St Austell and Newquay) (Con)
The fishing village of Mevagissey risks losing its GP surgery because the last remaining doctor there has handed the contract back to the NHS. The people of Mevagissey have launched an incredible campaign to find a new GP for their village. Does the Minister support their campaign, and will he spread the message far and wide that there is an amazing community waiting for a new GP and that all expressions of interest are welcome? Can he reassure me that the new people plan contains measures not only to recruit more doctors but to ensure that rural and coastal communities can find the GPs they desperately need?
Stephen Hammond
My hon. Friend is right, and I am happy to support the campaign by the people of Mevagissey, which is a wonderful part of the country to live in. I am happy, too, to assist him in that campaign if he wishes to come and speak to me about it. He is right that the plan sets out ways to recruit and retain more doctors, including GPs in rural and coastal locations, as well as those in urban locations.
Tom Brake (Carshalton and Wallington) (LD)
Would the Minister join me, first, in congratulating the Royal College of Nursing on backing a people’s vote? Does he accept that one reason for that was doubtless that the number of nurses and midwives from the EU has dropped by 5,000 in the past two years? Will he set out what extra cost and complexity will be associated with the recruitment of nurses and midwives from the European Union, if indeed we leave the EU, in future?
Stephen Hammond
I am sorry, I wholeheartedly apologise to the right hon. Gentleman. I certainly join him in welcoming the RCN’s welcome for a people plan. It is a great and sensible step forward, without being complacent about what needs to be done in the next phase, which will be published later in the year. He will know that we have been working with other EU members to ensure that, after what I hope is an orderly Brexit, there is continued recognition of medical qualifications. He will know that the European Commission has already set out its desire for a wide-ranging, extensive reciprocal healthcare agreement, and the Government continue to work to achieve that ambition.
Dr Paul Williams (Stockton South) (Lab)
I do not think that the Minister is taking this seriously. In the past two years, 5,000 nurses and midwives from EU countries have left the NHS, at a time when we are 40,000 nurses short. Does he agree with David Behan, the chair of Health Education England, who agreed yesterday that Brexit was exacerbating the NHS staffing crisis?
Stephen Hammond
I have already set out the fact that the Department, the whole NHS management, the whole NHS, and we as a country welcome and recognise the huge contribution of EU nationals in the NHS. I have set out our desire to continue to ensure that EU nationals work in the NHS. Alongside that, I know that Sir David Behan will have also said to the hon. Gentleman that it is important that we have more routes into nursing to ensure that those 40,000 vacancies that he discussed do not continue, which is why we have set out in the plan more nursing apprenticeships, more nursing associates and more clinical placements. It is important to have both international and domestic recruitment.
Diana Johnson (Kingston upon Hull North) (Lab)
The Minister has talked a lot about leadership. He said in his opening statement that there was a need to create in the NHS leaders who could create cultures that empowered staff. What is he going to do about the bullying at the top of the NHS, including in NHS England and NHS Improvement, which Dido Harding admitted yesterday at the Health Committee?
Stephen Hammond
The hon. Lady is right: that culture is not acceptable and must be driven out. She will have read the interim people plan, which talks explicitly about ensuring that we create leadership that stops that culture. There is a chapter on making the NHS the best place to work. She will know that we have been working across the country to ensure that all staff know that they are valued, that they have the right to speak up and that the culture of bullying must be driven out. I shall speak with Baroness Harding, as I do regularly, to ensure that that message is spread throughout the NHS and that staff know that they are valued.
Jamie Stone (Caithness, Sutherland and Easter Ross) (LD)
I realise that health is devolved to the Scottish Government. Nevertheless it has to be said that the Scottish Government are having enormous trouble with their workforce planning, which means that doctors and nurses have to pick up the slack and that we are wasting good money on employing agency staff, which need not happen. May I make a plea to Her Majesty’s Government to share workforce planning and best practice with the Scottish Government so that they can get that right?
Stephen Hammond
As the hon. Gentleman rightly pointed out, health matters in Scotland are devolved, but I am delighted to share any of the excellent initiatives that are set out in the draft people plan with the Scottish Government.
Liz McInnes (Heywood and Middleton) (Lab)
Despite the vital role played by carers in society, they merit just a paragraph in the plan. Will the Minister ensure that his Department matches Labour’s commitment to publish a full strategy for carers and to increase carer’s allowance to the same rate as jobseeker’s allowance?
Stephen Hammond
I welcome Labour’s commitment to publish a paper, but the hon. Lady will know that the Department is going to publish a Green Paper on adult social care. We are finalising that. [Interruption.] The hon. Member for Leicester South (Jonathan Ashworth) shouts at me. I know he makes a lot of promises without detail. We want to make promises that have detail and can work.
Grahame Morris (Easington) (Lab)
This is an important report into NHS people planning. It is an interim report, so there is an opportunity to identify any deficiencies. My particular concern is about the cancer workforce, in particular the point made by my hon. Friend the Member for Leicester South about the loss of bursaries not just for nurses but for therapeutic radiographers. May I draw the attention of the Minister, with due respect, to the fact that the radiotherapy and oncology course at Portsmouth University recently closed? Concerns are being expressed and not just by politicians on the Opposition Benches. Mr Richard Evans, chief executive of the Society of Radiographers, said that he has concerns about whether our hospitals and specialist cancer centres will be able to recruit enough skilled and trained personnel. This could even threaten the delivery of cancer treatment and the ambitious plans that the Minister has in the new cancer strategy.
Stephen Hammond
The hon. Gentleman is right: this is a serious plan. As he rightly points out, it is an interim plan. It sets out a number of specific actions for this year. It also sets out a number of clear action paths and trajectories to ensure that the people plan is achieved. I would be delighted to meet him and other officers of the all-party group to ensure that we get the skills in the right places to ensure that the ambitious and deliverable plans in the long-term plan can happen.
Andy Slaughter (Hammersmith) (Lab)
I raised the cost of the Babylon GP at Hand app and the cuts in the number of conventional GPs at Prime Minister’s questions but, with respect to the Minister for the Cabinet Office, he missed the point, astonishingly. Even if NHS England funds £21 million of the shortfall for this year, that is still money from the public purse and it does not address the past cost to Hammersmith and Fulham of at least £12 million or any future costs. Will the Government suspend the Babylon contract while there is a proper investigation into this privatisation of the NHS?
Stephen Hammond
It is not a privatisation of the NHS; it is a scheme allowing greater access to GP services. The hon. Gentleman will know that it is delivering healthcare to a number of his constituents as well.
Interim NHS People Plan
Stephen Hammond Excerpts(4 years, 11 months ago)
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The Minister for Health (Stephen Hammond)
Today I am depositing in the Libraries of both Houses a copy of the interim people plan, which sets out the steps the NHS will take to ensure the health system has the people, culture and leadership it needs to deliver the long term plan.
The interim people plan has been developed by Baroness Harding, the Chair of NHS Improvement, in partnership with front-line staff, NHS employers and representative organisations including trades unions and royal colleges. The plan takes an unflinching look at the challenges facing people working across the NHS and, importantly, for the first time considers what action employers and NHS leaders need to take to make the NHS a great place to work. In future, careers in the NHS will better reflect the different lives, aspirations and expectations of those who choose to work in it.
In addition to the action the NHS will take to ensure the NHS is a great place to work, the interim people plan also sets out a number of practical steps the NHS will take now to increase the supply of clinical staff. A consultation is planned exploring proposals to introduce greater pension flexibility, which are designed to address disincentives that may encourage senior clinicians to limit or reduce their workloads whilst participating in the NHS pension scheme. A final people plan will be published soon after the conclusion of the spending review.
[HCWS1587]
NHS Accountability Framework
Stephen Hammond Excerpts(4 years, 11 months ago)
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The Minister for Health (Stephen Hammond)
I will today lay before Parliament the Government’s 2019-20 accountability framework with NHS England and NHS Improvement. For the first time, this combines the Government’s annual statutory mandate to NHS England with the annual remit set for NHS Improvement.
NHS England oversees the commissioning of health services in England and NHS Improvement oversees and holds to account NHS foundation trusts, NHS trusts, and independent providers of NHS-funded care. Working together they will play a vital role in leading the NHS as it takes forward its long term plan, which has been created in partnership with doctors, nurses, other clinicians and builds on the views and insights of patients and the public. They have come together under a joint senior leadership team to do this effectively and the Government are supporting them with a funding settlement that will see the NHS’s annual budget increase by £33.9 billion by 2023-24, the largest cash settlement in the history of the NHS.
This is an important year for the NHS as it transitions into full implementation of the NHS long term plan while at the same time ensuring that every patient in England will continue to receive vital services as the country leaves the EU. To put it beyond doubt that these are the most important things that the NHS has to deliver this year, the accountability framework sets NHS England and NHS Improvement two objectives for 2019-20: to ensure the effective delivery of the long term plan, and to support the Government in managing the effects of EU Exit on health and care.
The framework clearly demonstrates the Government’s commitment to NHS staff, to the public, to patients and to taxpayers, that the long term plan will be delivered and that the safety and quality of NHS services will be safeguarded through a period of change. As required by the Act, NHS England and Healthwatch England have been consulted on the objectives set in it, along with NHS Improvement.
NHS England and NHS Improvement are co-ordinating a system-wide process of implementation planning, at both local and national level. This will culminate in a national implementation programme for the long term plan to 2023-24, and an NHS workforce implementation plan, by the end of 2019. My intention is then to set a further accountability framework from 2020-21 to 2023-24 taking account of these, the outcome of our spending review, the needs of patients and the public, and the views of Government.
As in previous years, I will also today re-lay the mandate for 2018-19. This is to take account of in-year revisions to NHS England’s budget for 2018-19. There are no other changes.
[HCWS1570]
Oral Answers to Questions
Stephen Hammond Excerpts(5 years ago)
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Lilian Greenwood (Nottingham South) (Lab)
The Minister for Health (Stephen Hammond)
The NHS employs more staff than at any time in its 70-year history. Posts may be vacant for a variety of reasons, including maternity and career breaks. The latest data shows that as of December 2018 about 80% of nursing vacancies and 85% of medical vacancies are filled by a combination of bank and agency staff.
Lilian Greenwood
Recent data from NHS Digital shows that there are 720 fewer GPs in the east midlands than just two years ago. According to NHS England, each month thousands of people wait more than four weeks for a face-to-face GP appointment in Nottingham. In January, 3,206 people had to wait more than 28 days between making the appointment and seeing their doctor. Ultimately, that is leaving the GPs we do have overwhelmed and overworked. I know myself that it is creating huge pressures on the emergency department at Queen’s Medical Centre. What is the Minister going to do to change that system?
Stephen Hammond
The NHS long-term plan will set out vital strategic frameworks to ensure that the needs for the next 10 years are met. The hon. Lady will know that we are training an extra 5,000 GPs to work in primary care and general practice. If she writes to me about the specifics of the numbers she mentioned in respect of Nottingham, I will be happy to respond.
Victoria Prentis (Banbury) (Con)
Those of us who are campaigning to reopen a full obstetric unit at Horton General Hospital know how important the workforce are to safety in our NHS. At an excellent meeting today, Baroness Harding set out some of the things we can do to increase our workforce, one of which was much better leadership and career planning for the staff we are already retaining in the NHS so that they want to stay longer. What is the Department doing about that?
Stephen Hammond
As my hon. Friend has heard, the Secretary of State commissioned Baroness Harding to bring forward the interim workforce plan. One of the workstreams was looking at retention and the staff we currently have. More than 52,000 nurses are in undergraduate training, and it is essential that they stay in the NHS after training. What Baroness Harding outlined today will ensure that that happens.
Mr Ben Bradshaw (Exeter) (Lab)
Can the Minister confirm today’s Daily Mail report that the NHS plans to recruit thousands of overseas nurses over the next five years? How much of that shortage has been caused by the exodus of EU nationals from the NHS, and how much of it by the Government’s disastrous decision to abolish nursing bursaries?
Stephen Hammond
I will not comment on the specifics of a leak from an outdated version of the plan. The NHS has always recruited nurses internationally and there are no plans to change that. The workforce plan will set out how more nurses, doctors and nursing associates will be recruited and retained inside the NHS.
James Heappey (Wells) (Con)
Many surgeries in my constituency augment the work of GPs with nurse practitioners. Will the Minister join me in praising the work of nurse practitioners and say what more the Government could do to grow their number so that they can continue their excellent work in surgeries around the country?
Stephen Hammond
I absolutely agree with my hon. Friend. Nurse practitioners do an extraordinarily valuable job across the country. The Government are committed to training more nurses and more nursing practitioners. As I said in an earlier answer, that will be set out in the workforce plan.
Dr Sarah Wollaston (Totnes) (Change UK)
The workforce shortfall is not evenly distributed across the NHS either geographically or by specialty. The Minister will know that there are particularly serious nursing shortfalls in learning disability and community services. He will also know of the implications of shortfalls—for example, for the ambition to deliver 75% of cancer diagnoses at stages 1 and 2. Will he look again at the evidence on mature students and the impact of losing bursaries on that section of the workforce? Will he meet me to discuss that?
Stephen Hammond
The Chair of the Select Committee is right: the vacancies are not evenly spread and are of particular concern in learning difficulties and a number of other areas. Of course we want to ensure that mature students come back to and stay within the health service. That is why a number of incentives are being put in place to encourage, recruit and retain mature students. I would, of course, be happy to meet her to discuss this matter in more depth.
Nigel Huddleston (Mid Worcestershire) (Con)
I appreciate the Minister’s comments about the need for retention and morale-boosting in the NHS. Does he agree that constantly going around fabricating threats of closures when no such threats exist, or talking down the NHS—as some politicians do—does not exactly help recruitment and retention either?
Stephen Hammond
My hon. Friend is completely right. One would have hoped that all Members on both sides of the House celebrate the fact that the number of nurses and the number of doctors in the NHS are now higher than they have ever been in its 70-year history, and that the Government are backing that up with a commitment to invest £33.9 billion.
Dr Philippa Whitford (Central Ayrshire) (SNP)
Cuts in lifetime and annual pension tax allowances are causing senior doctors to retire earlier and younger consultants to avoid working extra hours, as they can end up paying more in tax than they earn from the extra hours of work. What discussions has the Secretary of State had with the Chancellor about the fact that these recent changes are driving doctors from the profession and increasing workforce shortages?
Stephen Hammond
The hon. Lady raises a very important matter. The Government recognise the concerns that have been expressed by NHS doctors, and my right hon. Friend the Secretary of State is engaging in numerous conversations with the Chancellor. I am reluctant to give a running commentary on the nature of those internal discussions, but I can say that we hope to resolve the matter soon.
Daniel Zeichner (Cambridge) (Lab)
Mr Philip Hollobone (Kettering) (Con)
The Minister for Health (Stephen Hammond)
The Government are committed to transforming the NHS estate. I discussed the urgent care hub with my hon. Friend and other colleagues in January, and, as he knows, I enjoyed my visit to Kettering General. He also knows that future levels of capital will be determined at the next spending review, after which our prioritisation process will be determined, to identify the strongest transformation schemes. We welcome initiatives from local leaders to strengthen and better integrate the local health and care landscape in Northamptonshire.
Mr Hollobone
When Kettering’s present A&E was built 25 years ago, it was designed to cope with 45,000 patients a year. It is now coping with 91,000, and it is estimated that in 10 years’ time, 120,000 will use the facility. The whole NHS in Northamptonshire recognises that an urgent care hub at Kettering General Hospital is urgently required. Will the Government get on and fund it?
Stephen Hammond
My hon. Friend is a diligent and consistent representative of his constituents on this matter. He will know that I have heard his request and that, as I have said to him before, the spending review will take place later in the year. Priorities will be decided at that stage.
George Freeman (Mid Norfolk) (Con)
Greg Hands (Chelsea and Fulham) (Con)
The Minister for Health (Stephen Hammond)
Health Education England is leading a national nursing associate programme with a commitment for 7,500 nursing associate apprentices to enter training in 2019. It is also working with health and care providers to develop a talent pipeline of future nursing associates, as well as sharing how providers are deploying currently qualified nursing associates.
Greg Hands
I thank my hon. Friend for that answer, and I thank the Secretary of State for his welcome announcement last month on “Shaping a Healthier Future” in London, which has gone down very well locally. How many more nurses does the Minister for Health think London will need over the spending review period? What specific measures is he taking to improve London’s offer to would-be nurses?
Stephen Hammond
My right hon. Friend is absolutely correct that the Secretary of State’s announcement has gone down extremely well. He will know that there are now more nurses in training than ever before—over 50,000—and he will know that London, in particular, will get its share of those nurses. He should be reassured that we are creating routes into nursing via nurse training, nursing recruitment and, indeed, nursing associates, and their recruitment into valuable roles across the health service will benefit his constituents.
Mr Barry Sheerman (Huddersfield) (Lab/Co-op)
Does the Minister know that when I went to a restaurant the other night with my wife there was a hum and a buzz coming mainly from the young women there? I asked, “Who are all these young women?” The maître d’ said, “They are all young Spanish nurses who are going home. This is their last evening in Britain.” Nursing associates will not fill that gap; these are young people coming in at the classroom assistant level of qualification. We need more nurses now, and we want to stop this haemorrhaging of nurses who are going back to the rest of Europe.
Stephen Hammond
The hon. Gentleman will know that nursing and nursing associate training places are being increased; that more funding is going in to increase nurse training places by 25% every year, from last September; and that we are announcing an expansion of nursing associates. He will see tomorrow, when new figures are announced, that more nurses are working in the NHS than this time last year.
Patricia Gibson (North Ayrshire and Arran) (SNP)
The Minister for Health (Stephen Hammond)
My hon. Friend will have heard me say in answer to the earlier question that my right hon. Friend the Secretary of State and the Chancellor are in discussions about that matter. It would be unfair of me to comment on the progress of those discussions, but we hope to resolve them soon.
Kate Green (Stretford and Urmston) (Lab)
Nigel Mills (Amber Valley) (Con)
Stephen Hammond
My hon. Friend is absolutely right. That role has been introduced to help build the capacity of the nursing workforce and support nurses and wider multidisciplinary teams. As he will have heard me say earlier, I am delighted that Health Education England is leading the national nursing associate training programme, with a commitment to train 7,500 nursing associates this year.
Bill Esterson (Sefton Central) (Lab)
Stephen Hammond
My hon. Friend raises an important issue. The NHS faced the loss of a contract last year, which was then safely put back into place. The point he makes about guidance is absolutely right, and if he wants to come and talk to me about it, I will be happy to discuss it.
Ellie Reeves (Lewisham West and Penge) (Lab)
It is deeply concerning that in the past 10 years the number of prescriptions for opioid drugs has risen by 9 million. In this time, codeine-related deaths have more than doubled to over 150 a year. While I welcome moves to label opioid medicines, what further measures will the Secretary of State take to protect people from the dangers of opioid addiction?