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The Minister for Health (Edward Argar)
I am very grateful to you, Mr Sharma; that was a deft and adept use of the Chair. It is a genuine pleasure to serve under your chairmanship.
I pay particular attention and pay tribute to my hon. Friend the Member for Crewe and Nantwich (Dr Mullan) for securing this debate. The case that he makes for Leighton Hospital has cross-party support, as we have seen, including from the hon. Member for Weaver Vale (Mike Amesbury) and, indeed, from the shadow Minister, the hon. Member for Ellesmere Port and Neston (Justin Madders). This has been a cross-party and very well-tempered debate, and as ever I am grateful to the shadow Minister for the tenor and tone of his comments. We have spent the past couple of months sitting opposite each other in a Bill Committee, which reported yesterday. Clearly, so shocked were we at the prospect of not continuing to sit opposite each other, here we are in Westminster Hall this morning.
I am also grateful to my right hon. Friend the Member for Basingstoke (Mrs Miller) for her kind words in highlighting the fact that I am still in this role. In the same vein, I should say that the hon. Member for Ellesmere Port and Neston is still in his role, having served as shadow Minister even longer than I have served in my role. There is some value in that, because too often in this place we see a very rapid churn of Ministers and shadow Ministers. Issues such as those we are grappling with today need, by their very nature, a long-term view and a long-term understanding.
I join the shadow Minister in paying tribute to my hon. Friend the Member for Crewe and Nantwich, not only for introducing this debate but for his work on the frontline. He was typically humble about that work, but his contribution was significant and he should be proud of it. He quite rightly paid tribute to all of those in our health and care system, as we all should—and should continue to do—for the work that they have done; not only the work they have done throughout the pandemic, which has been incredibly challenging, but the work they do every day, year in and year out, on the frontline to help to keep our constituents safe.
My hon. Friend is absolutely right about the importance of the topic that we are debating today. Buildings are hugely important. They give our clinicians, our frontline staff and our ancillary staff the context or the environment in which they can do their best. Therapeutics, research, new diagnostic kit, technology: all these things are hugely important because, as the shadow Minister alluded to, they allow the beating heart of our NHS—the workforce; the people—to do their job, and who, for want of a better way of putting it, make the magic happen in those environments. It is incumbent on us to give them that environment and these tools, so that they can do their best.
Various right hon. and hon. Members have highlighted the context in which we approach this debate. Many areas are undergoing significant development, growth in housing and increases in demand. There are demographic changes, with ageing populations in some areas needing increased hospital facilities.
Coupled with that, the context was set out again by many right hon. and hon. Members, particularly my hon. Friend the Member for Keighley (Robbie Moore), who spoke about the state of the estate, for want of a better way of putting it. There are hospitals that have, in a sense, served for far longer than they were designed to serve. They have been kept going, but that poses challenges, not just with reinforced autoclaved aerated concrete, or RAAC, planks, which I will turn to in a moment, but operationally with the task of running them, given the day-to-day choices that clinicians and managers have to make to put fixes in place, so that they can continue to provide services.
The shadow Minister asked several questions. I will address one or two of them now, then come on to the others later. He talked about the workforce, whom I have just mentioned. I say to him that the number of doctors is up, the number of nurses is up, and the number of radiographers and radiologists is up since 2010. We have continued to grow our NHS workforce. Do we need to continue to do more to do that? Of course we do. That is why the Government are committed to, for example, the 50,000 more nurses that was a manifesto commitment, and we are on course to deliver that by the end of this Parliament.
We need to be conscious, and I know that the shadow Minister is, that as we talk, for example, about elective recovery and getting waiting lists and waiting times down, we need to be honest with our electors and the British public that that is a huge job that will take time. That is because the workforce who will deliver those things are the same workforce who have been through the pandemic, and they need time to recover, emotionally and physically, from what they have had to do over the past year and a half. Often, we hear some commentators saying, “Ah, yes, but some were in the ICU wards, or in A&E, and a lot of others wouldn’t have been on the frontline.” Well, the reality is that, for example, surgeons who may not have been operating on their usual lists will have gone back to the wards to assist their colleagues, and we know that a team is needed to perform surgery. The anaesthetists will certainly have been working flat out during the pandemic, as will the theatre nurses, so we need to ensure, as we deliver our recovery plan for the NHS, that we give the workforce the support they need to recover.
Let me turn to the specifics of the programme. My hon. Friends the Members for Crewe and Nantwich, for Congleton (Fiona Bruce) and for Eddisbury (Edward Timpson), and the hon. Member for Weaver Vale all made, as one would expect, a passionate, well-informed and cogent case for investment in a new hospital at Leighton. My hon. Friend the Member for Crewe and Nantwich will not be surprised when I say that the expressions of interest period has closed. The expressions of interest are all being considered carefully and a decision will be made next spring on the long list to whittle them down, with further work to determine the final eight. I therefore hope that he will allow me not to be drawn on the specifics of the merits or otherwise of his case while that process is under way, but as ever he makes a strong and powerful case on behalf of his constituents.
In the context of the next eight, the shadow Minister asked about criteria and how the process would take place. That is set out and published on the programme website, but the key considerations are these. Does a scheme or proposal have the potential significantly to transform and improve the quality and quantity of care available to a community? Is there a safety or other pressing need that has to be addressed in the system? Equally, we will be looking to achieve a degree of geographical spread to ensure equity and fairness—levelling up. With any of these schemes, as hon. Members would expect, we will look at whether the proposals are clear and can be delivered on budget, and whether there is the capacity and capability to deliver on them.
Mike Amesbury
One such scheme, for which I and my hon. Friends the Members for Warrington North (Charlotte Nichols) and for Halton (Derek Twigg) and the hon. Member for Warrington South (Andy Carter) have been campaigning, is two campuses for Warrington and Halton trust. They seem to meet those criteria, so I look forward to an assessment and conclusion in the not too distant future.
Edward Argar
I am grateful to the hon. Gentleman, who quite rightly never misses an opportunity to champion his constituents’ interests.
Hon. Members will be aware that the interest around the country is significant. A significant number of expressions of interest have been submitted, so whittling them down will be a competitive and challenging process, but we undertake to be as clear and transparent about that as we can be. I suspect that, when the final list is announced, if I do not come to the House with a statement, the shadow Minister may well UQ me, to give colleagues an opportunity to say they are very pleased or to ask why their hospital is not on the list.
Let me turn to points made by other hon. and right hon. Members. My right hon. Friend the Member for Hemel Hempstead (Sir Mike Penning) will not be surprised that I will not be drawn on the specifics of the internal politics and the plans for his trust at this point. However, he quite rightly made the extremely important point that when trusts develop their plans and bring them forward, they need to carry the communities they serve with them and genuinely reflect on stakeholder input from elected Members and others, rather than—I am not saying that this is or is not the case with this trust—automatically having a preconceived idea of what the right answer is.
Sir Mike Penning
The Minister might not be willing to say that my trust has preconceived the decisions it was going to make; I will, because it made its mind up long before the latest announcement. However, we are in a slightly different position from other colleagues here. We are in HIP 1—part 1 of the health infrastructure plan—and we do not want that money to be wasted. We do not want a sticking plaster; we do not want a refurbishment in the middle of Watford. The community in my part of the world is absolutely solid on that, and if that meant that we slipped out of HIP 1 into HIP 2—I will put my neck on the block—I would be happy with that, as long as we get the right facility on a greenfield site, rather than the wrong facility as a refurbishment in the middle of Watford next to a football ground.
Edward Argar
I did not regret giving way to my right hon. Friend quite as much as I feared I might, although he may yet come back to me. As ever, he makes his point powerfully and clearly, and I suspect that, as well as my having heard it, his trust will also have heard it.
As the shadow Minister said, my hon. Friend the Member for Hartlepool (Jill Mortimer) made broader points, in addition to points about her local hospital and trust, about health inequalities and the role that the right infrastructure and staff—the right people in the right place—can play in tackling that. I have to pay tribute to her. Within a day of her arriving in this place following her fantastic by-election victory, she had pinned me down so she could come and see me and talk about Hartlepool and health services there. Her constituents are extremely lucky to have her. She hit the ground running and has not stopped working since on behalf of her constituents.
My right hon. Friend the Member for Basingstoke and I, as she alluded to, have spoken a number of times about her trust. How can I not accept her kind offer of going to the site and seeing her in her constituency? I have known her for a long time, so it is a pleasure to say yes. I would like to go there and do that, then perhaps we can discuss the plans further. She and I have met on several occasions. She is a great champion for the new hospital in her area, so I am grateful for the invitation.
My hon. Friend the Member for Keighley—I almost said “my hon. Friend the Member for Airedale”, given the frequency with which, he raises and champions in the House at every opportunity the need for a new hospital at Airedale—is right to highlight the challenges that his trust faces, as he has done on many occasions, particularly in the context not only of the needs of his population, the challenges of an old building that has long exceeded its intended lifetime, but also the RAAC plank issue. I know that his trust is keen to be one of the eight. I will only say to him, I am afraid, what I said to my hon. Friend the Member for Crewe and Nantwich, which is that the bids will be considered very carefully. I know that he will continue making the case, as he has done in the past.
Edward Argar
I will give way briefly to my hon. Friend, then I will turn to the contribution of my hon. Friend the Member for North West Norfolk (James Wild).
Robbie Moore
Can the Minister clarify how the final eight will be decided and will structural risk profile be a key consideration?
Edward Argar
My hon. Friend, quite wisely, presses his advantage. I can give him some reassurance on that, as I did to the shadow Minister when talking about the criteria, that safety and risk will not be the only criterion, but that will be a key factor in the consideration.
I turn now to the contribution of my hon. Friend the Member for North West Norfolk. The other day in the Chamber, I inadvertently paid tribute to my hon. Friend the Member for North Norfolk (Duncan Baker) for the work being done by my hon. Friend the Member for North West Norfolk in one of my responses. I pay tribute to my hon. Friend for North West Norfolk, who has quite rightly raised with me on several occasions the Queen Elizabeth Hospital King’s Lynn and the challenges posed by RAAC planks there. I know he is campaigning both in Parliament and locally on that issue. Courtesy of him, I have met his trust in the past and we have provided more than £20 million in this financial year for critical risk remediation. I know that, quite understandably, my hon. Friend is saying very clearly that that is welcome and will help, but it will not solve the problem. He will continue to press the case for a new hospital. He, too, has kindly invited me to his constituency, so I think I am due to go on tour around the country at some point, visiting various hospitals and colleagues.
Turning to some of the broader underlying themes that have emerged in the debate, I will seek to answer some of the questions posed by the shadow Minister. He gently tempted me on definitions. I am clear that the definitions we have—the three key elements he alluded to—not only pass the common-sense test and the understanding of what the reasonable person in the street would consider a new hospital. Equally, he teased me gently about VAT notice 708. I mentioned that at the Dispatch Box because—he says that we should be transparent and have a logical reason for how we define, do and choose things—our starting point was that there can be a VAT exemption for new builds, but not necessarily for refurbishment. I took that as a starting point for developing the common-sense definition. A lot of what he sees in the definitions is reflected in the same one used there, so there is consistency.
The shadow Minister talked about skills and inflation and whether we will have the people to build the hospitals. He is right to do that, because, as we have seen following the bounce back after the pandemic, builders and construction firms are very much in demand. There is pressure on materials as well, not just inflationary pressure, but on quantities. That is one of the reasons why, even before the impact of the pandemic, this is a phased programme. These hospitals will be built over a period of years up to 2030, allowing for market capacity.
Equally, one of the reasons why we have set out this long-term plan is so that we can make the market aware of what our plans are. If there is certainty in the market that the hospitals will be coming through, we will see firms investing, because they know there is potential for long-term business and work for them. That is one of the ways in which we have helped to handle that.
The shadow Minister asked about funding, and what would be available for what period. He will be aware of the initial £3.7 billion that has been allocated to this project, which takes us to 2024. Future funding will be subject to future spending reviews for that period. Between the 2024 period and 2030 there will be a general election at some point, and I suspect that may play a part in the spending review as well. We have the funding up front to get going with this programme, and off the top of my head, I think we already have eight hospitals in construction. The Cumberland Cancer Hospital has already been opened by my right hon. Friend the Health Secretary. Over this period, we will continue to start further construction of new hospitals.
The shadow Minister also alluded to geography and the distribution of the hospitals. Off the top of my head, 30 of the 40 are outside London and the south east, so we have sought to achieve geographical spread for the new hospitals and, equally, will seek to do that with the new eight. He also asked about the quantum needed for a new hospital, and he had a particular figure in mind. If he looks at the list of 40, many of them are very different hospitals, from the major acute district general hospital to a community hospital with in-patient beds; it is clearly a new hospital. The costs vary in the nature of what is built, its scale and size.
The shadow Minister also asked whether there would be a cap and whether trusts have complete freedom. No—as he would expect, there is a balance is to be struck between delivering what a trust wants for its plans and the need for financial prudence and recognition of the need to safeguard taxpayers’ money; it is not a limitless amount. Conversations are going on between the national team and local projects to ensure that their schemes are affordable and not hugely over budget. That is a pragmatic, ongoing process.
The shadow Minister also touched on some of the criteria for the scheme and how we are making the national scheme work. We include in this modular build modern methods of construction. We have a national set of standards for what we would expect from a new hospital, but a degree of local flexibility for the delivery of that. We recognise that each trust is slightly different, but we want to standardise where we can, because that keeps costs down and provides certainty in the market and speeds up construction. We have also built into our plans, since they were originally announced, even more ambitious green targets and energy efficiency targets for those trusts.
Justin Madders
I am grateful to the Minister for giving way. He has made a valiant attempt to answer all my questions.
Justin Madders
No, but there is one that the Minister has overlooked, on the sum announced in the spending review last week. Was that additional money on top of what had been previously announced?
Edward Argar
I omitted to mention two things to the shadow Minister: the spending review and backlog maintenance—he always avails himself of the opportunity to gently raise that issue. We have seen a confirmation of the money already in place for the new hospital programme, but we have also seen further moneys announced for capital in the spending review—new money—for example, just over £5 billion for community diagnostic centres, surgical hubs and the IT infrastructure around that. We have therefore seen a reconfirmation of money, plus new money in the capital space.
I turn now to maintenance, which the shadow Minister rightly always highlights. He will know—he occasionally quotes it at me at the Dispatch Box—that backlog maintenance across the entire estate is around £9 billion-worth. That is pretty constant from the previous financial year; it has not particularly increased. It may have gone up by a tiny fraction, but it has remained broadly constant.
Edward Argar
Let me just finish this point before I take interventions from my right hon. Friend the Member for Basingstoke and then the hon. Member for Weaver Vale.
Our investment in new hospitals will also significantly reduce the backlog maintenance, because it will take out of the total a number of hospitals, some of which have been mentioned, that are being propped up day after day, with money being spent just to patch up and mend.
Mrs Miller
I thank the Minister for agreeing to come to our new preferred site in Basingstoke—we will be grateful for that—and for his comment about backlog maintenance. I think Basingstoke is in the top three in the country for backlog maintenance.
May I press the Minister on the timelines of the next round of seed funding to develop business cases and to be able to start building our new hospital in 2025? Clarity on some of these timelines is essential not only for our communities but for the people developing the plans, because they need to know what will happen next and have clarity on that.
Edward Argar
I am grateful to my right hon. Friend, and I entirely understand her call for clarity. Each case is being looked at on an individual basis, in the allocation of the £3.7 billion. The senior responsible officer of the new hospitals programme, Natalie Forrest, is in regular discussion with each trust, but business cases, more funding to develop business cases, and movement from outline business cases to final business cases are done on a case-by-case basis by trusts. It is not the case that every one must submit them by a fixed time.
Edward Argar
Let me take the hon. Member for Weaver Vale first, because I promised him that I would give way. I also want to leave a few minutes at the end for my hon. Friend the Member for Crewe and Nantwich to wind up.
Mike Amesbury
On the point about maintenance, several hospital buildings built in the 1970s have used Grenfell-style aluminium composite material cladding and high pressure laminate, so I assume that is part of the assessment criteria. Some have roof systems that are in a critical state.
Edward Argar
I am grateful to the hon. Gentleman, who raises a couple of points. Yes, roofs are a factor. In some cases—my hon. Friend the Member for Keighley talked about Airedale—there is a flat roof, which is vulnerable to heat and water, and aerated concrete planks, which is extremely challenging.
The hon. Gentleman mentioned cladding. I might be slightly out, but from memory I think that there are no hospitals with cladding in need of remediation. We put a programme in place following the Grenfell findings. Off the top of my head, I think every hospital trust has either had it removed or been assessed by the fire brigade as not having a risk. If I am wrong about that, I will of course write to him to correct the record.
Sir Mike Penning
On the point the Minister has just made, Natalie Forrest has taken on her new role. I notice that the Minister said she has been in communication with the trusts, but she has not been in communication with the MPs who have emailed her and asked her to respond to them, including me. My hospital action group and I met her predecessor and had very fruitful discussions, and Natalie Forrest would be very welcome to have a discussion with me.
Edward Argar
I am grateful to my right hon. Friend. Understandably, the approach we take with right hon. and hon. Members is that correspondence is replied to by Ministers. Occasionally it is a little belated, but that is the conduit for responses.
On meetings with senior officials, I am always happy to facilitate that. Normally, the approach is that I would attend as the Minister in order to reflect the respect that I have for right hon. and hon. Members—and I suspect that he may be about to ask me whether I will therefore do that.
Sir Mike Penning
The Minister is being very generous in giving way again. Yes, that would be great. However, I did meet Natalie Forrest’s predecessor without a Minister present, and I just want an email back to say, “I acknowledge you.” That might be quite nice.
Edward Argar
I suspect that the Department will have heard my right hon. Friend’s point.
Edward Argar
Very briefly, because I want to leave some time for my hon. Friend the Member for Crewe and Nantwich.
Mrs Miller
This is really important. What the Minister has just said is that no part of the process should be held up because certain projects might be ahead of others. Therefore, the public consultation that stands ready to go live in Basingstoke should not be delayed for any reason other than hopefully getting ministerial approval.
Edward Argar
I take the point, and I think I understand where my right hon. Friend is coming from on this. I said that business cases will be considered on their own merits, but of course there has to be phasing of different trusts at different times and different phases of this programme, because of the profiling of that funding. Only £3.7 billion has been committed so far, with more to come in further spending reviews, so if every trust came forward and said, “We are ready”—as my right hon. Friend knows, many will do so, although I suspect she would say that her trust is genuinely ready compared with some others—we could not commit to every one of those, because we have to look at the financial profiling that the Treasury has given us about when that money becomes available. That is the point. I hope she will forgive me if I did not understand what she was getting at in the first instance, but I hope that is of some help.
I will conclude, in order to leave my hon. Friend the Member for Crewe and Nantwich a little time to wind up. As a Government, we are proud that we have committed to arguably the largest and most ambitious new hospital building programme in decades, with initial moneys of £3.7 billion put in place to get that programme going. Eight of those new hospitals are in construction and one is completed, and we look forward to delivering on that commitment in full by 2030.
Dr Mullan
I thank the Minister and the Opposition spokesperson, the hon. Member for Ellesmere Port and Neston (Justin Madders), for the time they have taken to listen to us all in Westminster Hall today. I particularly thank the Minister for his openness and frankness in discussing this issue. I am sure that, as Members, we all understand why he cannot commit today to the various programmes we have put forward.
I particularly thank my hon. Friends the Members for Eddisbury (Edward Timpson) and for Congleton (Fiona Bruce), who have worked very closely with me on pushing forward this campaign for Leighton Hospital. I also thank the hon. Member for Weaver Vale (Mike Amesbury) for showing cross-party support for Leighton. The contribution from my right hon. Friend the Member for Hemel Hempstead (Sir Mike Penning) reminded us all of what a unique role an MP plays in their constituency, having that individual voice on behalf of their constituents. My hon. Friends the Members for North West Norfolk (James Wild), for Hartlepool (Jill Mortimer) and for Keighley (Robbie Moore) and my right hon. Friend the Member for Basingstoke (Mrs Miller) all spoke powerfully and passionately about their commitment to their local hospital and the investment they are seeking.
There were a couple of common themes that I want to pick out, the first of which was about house building and population growth, which touches on work I have been doing in my constituency to address the postcode lottery when it comes to the voice of the NHS in the planning system. Very often, schools’ education provision is supported by housing development, but it is not very often that our local hospitals are supported financially by developers. Those developers have a role to play, and I encourage the Minister to look at what more he could do centrally to spread best practice. I have been doing that locally, but we need that central drive to make sure that hospital developments, mental health and primary care get the money they deserve where there is new housing.
We are all facing a similar challenge when it comes to the shelf life, so to speak, of our hospital buildings. There is no shame in that—when things are built, they have a timeline—but it is very important that the Minister makes sure that for those of us who may end up disappointed, particularly in relation to the RAAC plank issue, the Government have a clear and strong story about how they are going to tackle that issue and what investment will be put in place, regardless of which hospitals make it into the final round of the hospital building programme. I will finish by inviting the Minister to Leighton Hospital, if he does not mind,
Edward Argar
What is one more visit on a tour? I am delighted to accept; it would be a pleasure.
Dr Mullan
I look forward to seeing him there with my hon. Friends the Members for Eddisbury and for Congleton. I thank the Minister for his time, and thank you, Mr Sharma, for chairing proceedings today.
Question put and agreed to.
Resolved,
That this House has considered the hospital building programme.