Tuesday 23rd November 2021
(2 years, 12 months ago)
Commons ChamberHealth and Care Act 2022 View all Health and Care Act 2022 Debates Read Hansard Text Read Debate Ministerial Extracts Amendment Paper: Consideration of Bill Amendments as at 23 November 2021 - (23 Nov 2021)
16:31 - The House divided: - Ayes: 240 / Noes: 304 - Question accordingly negatived.
16:46 - The House divided: - Ayes: 219 / Noes: 280 - Question accordingly negatived.
18:00 - The House divided: - Ayes: 191 / Noes: 307 - Question accordingly negatived.
18:16 - The House divided: - Ayes: 239 / Noes: 311 - Question accordingly negatived.
18:57 - The House divided: - Ayes: 294 / Noes: 244 - Question accordingly agreed to.
The Minister for Health (Edward Argar)
I beg to move, That the clause be read a Second time.
Madam Deputy Speaker (Dame Eleanor Laing)
With this it will be convenient to discuss the following:
Government new clause 37—Offence of offering to carry out virginity testing: England and Wales.
Government new clause 38—Offence of aiding or abetting etc a person to carry out virginity testing: England and Wales.
Government new clause 39—Virginity testing offences in England and Wales: penalties.
Government new clause 40—Offence of virginity testing: Scotland.
Government new clause 41—Offence of offering to carry out virginity testing: Scotland.
Government new clause 42—Offence of aiding or abetting etc a person to carry out virginity testing: Scotland.
Government new clause 43—Virginity testing offences in Scotland: penalties and supplementary.
Government new clause 44—Offence of virginity testing: Northern Ireland.
Government new clause 45—Offence of offering to carry out virginity testing: Northern Ireland.
Government new clause 46—Offence of aiding or abetting etc a person to carry out virginity testing: Northern Ireland.
Government new clause 47—Virginity testing offences in Northern Ireland: penalties.
Government new clause 48—Virginity testing: consequential amendments.
New clause 1—Licensing of aesthetic non-surgical cosmetic procedures—
“(1) No person may carry on an activity to which this subsection applies—
(a) except under the authority of a licence for the purposes of this section, and
(b) other than in accordance with specified training.
(2) Subsection (1) applies to an activity relating to the provision of aesthetic non-surgical procedures which is specified for the purposes of the subsection by regulations made by the Secretary of State.
(3) A person commits an offence if that person contravenes subsection (1).
(4) The Secretary of State may by regulations make provision about licences and conditions for the purposes of this section.
(5) Before making regulations under this section, the Secretary of State must consult the representatives of any interests concerned which the Secretary of State considers appropriate.
(6) Regulations may, in particular—
(a) require a licensing authority not to grant a licence unless satisfied as to a matter specified in the regulations; and
(b) require a licensing authority to have regard, in deciding whether to grant a licence, to a matter specified in the regulations.”
This new clause gives the Secretary of State the power to introduce a licensing regime for aesthetic non-surgical cosmetic procedures and makes it an offence for someone to practise without a licence. The list of treatments, detailed conditions and training requirements would be set out in regulations after consultation with relevant stakeholders.
New clause 12—Protection of the title of “nurse”—
“(1) A person may not practise or carry on business under any name, style or title containing the word ‘nurse’ unless that person is registered with the Nursing and Midwifery Council and entered in sub part 1 or 2 of the register as a Registered Nurse or in the specialist community public health nursing part of the register.
(2) Subsection (1) does not prevent any use of the designation ‘veterinary nurse’, ‘dental nurse’ (for which see section 36K of the Dentists Act 1984) or ‘nursery nurse’.
(3) A person who contravenes subsection (1) is guilty of an offence and liable on summary conviction to a fine not exceeding level four on the standard scale.”
New clause 21—Prohibition of virginity testing—
“(1) A person is guilty of an offence if they attempt to establish that another person is a virgin by making physical contact with their genitalia.
(2) A person is guilty of an offence if they provide another person with a product intended for the purpose, or purported purpose, of establishing whether another person is a virgin.
(3) A person is guilty of an offence if they aid, abet, counsel or procure a person to establish that another person is a virgin by making physical contact with their genitalia.
(4) No offence is committed by an approved person who performs—
(a) a surgical operation on a person which is necessary for their physical or mental health; or
(b) a surgical operation on a female who is in any stage of labour, or has just given birth, for purposes connected with the labour or birth.
(5) The following are approved persons—
(a) in relation to an operation falling within subsection (4)(a), a registered medical practitioner; and
(b) in relation to an operation falling within subsection (5)(b), a registered medical practitioner, a registered midwife or a person undergoing a course of training with a view to becoming such a practitioner or midwife.
(6) There is also no offence committed by a person who—
(a) performs a surgical operation falling within subsection (4)(a) or (b) outside the United Kingdom; and
(b) in relation to such an operation exercises functions corresponding to those of an approved person.
(7) For the purpose of determining whether an operation is necessary for the mental health of a girl it is immaterial whether she or any other person believes that the operation is required as a matter of custom or ritual.
(8) This section applies to any act done outside the United Kingdom by a United Kingdom national or resident.
(9) A person who is guilty of an offence under this section is liable, on summary conviction, to imprisonment for a term not exceeding 12 months, to a fine, or to both.
(10) The court must refer the case of any person guilty of an offence under this section who is subject to statutory professional regulation for investigation by the relevant regulator.”
New clause 22—Prohibition of hymenoplasty—
2(1) A person is guilty of an offence if they undertake a surgical procedure for the purpose of re-attaching membrane tissue, creating scar tissue or otherwise attempting to re-create the hymen in the vagina of a patient.
(2) A person is guilty of an offence if they advertise the service of hymenoplasty or any service that purports to ‘re-virginise’ or otherwise re-create or re-attach the hymen of a patient by way of surgical procedure.
(3) A person is guilty of an offence if they aid, abet, counsel or procure a person to undertake a surgical procedure for the purpose of re-attaching membrane tissue, creating scar tissue or otherwise attempting to or re-creating the hymen in the vagina of a patient.
(4) This section applies to any act done outside the United Kingdom by a United Kingdom national or resident.
(5) A person who is guilty of an offence under this section is liable, on conviction, to imprisonment for a term not exceeding 5 years.
(6) The court must refer the case of any person guilty of an offence under this section who is subject to statutory professional regulation for investigation by the relevant regulator.”
New clause 28—Secretary of State’s duty to report on long term workforce planning—
“(1) The Secretary of State must prepare and publish a report each year on projected workforce shortages and future staffing requirements for health, public health and social care sectors in the following five, ten and twenty years.
(2) The report must report projections of both headcount and full-time equivalent for the total health, public health and care workforce in England and for each region, covering all regulated professions and including those working for voluntary and private providers of health and social care as well as the NHS.
(3) The projections must be independently verified and based on projected health and care needs of the population for the following 5, 10 and 20 years, consistent with the Office for Budget Responsibility long-term fiscal projections.
(4) All relevant NHS bodies, arm’s-length bodies, expert bodies, trade unions and the Social Partnership forum must be consulted in the preparation of the report.
(5) The assumptions underpinning the projections must be published at the same time as the report and must meet the relevant standards set out in the National Statistics Authority’s Code of Practice for Statistics.
(6) The Secretary of State must update Parliament each year on the Government’s strategy to deliver and fund the long-term workforce projections.”
New clause 29—Duty on the Secretary of State to report on workforce planning and safe staffing—
“(1) At least every five years the Secretary of State must lay before Parliament a health and care workforce strategy for workforce planning and safe staffing supply.
(2) This strategy must include—
(a) actions to ensure the health and care workforce meets the numbers and skill-mix required to meet workforce requirements,
(b) equality impact assessments for planned action for both workforce and population,
(c) application of lessons learnt from formal reviews and commissions concerning safety incidents,
(d) measures to promote retention, recruitment, remuneration and supply of the workforce, and
(e) due regard for and the promotion of workplace health and safety, including provision of safety equipment and clear mechanisms for staff to raise concerns.”
Amendment 10, in clause 34, page 42, line 12, leave out from beginning to the end of line 17 and insert—
“(1) The Secretary of State must, at least once every two years, lay a report before Parliament describing the system in place for assessing and meeting the workforce needs of the health, social care and public health services in England.
(2) This report must include—
(a) an independently verified assessment of health, social care and public health workforce numbers, current at the time of publication, and the projected workforce supply for the following five, ten and 20 years; and
(b) an independently verified assessment of future health, social care and public health workforce numbers based on the projected health and care needs of the population for the following five, ten and 20 years, consistent with the Office for Budget Responsibility long-term fiscal projections.
(3) NHS England and Health Education England must assist in the preparation of a report under this section.
(4) The organisations listed in subsection (3) must consult health and care employers, providers, trade unions, Royal Colleges, universities and any other persons deemed necessary for the preparation of this report, taking full account of workforce intelligence, evidence and plans provided by local organisations and partners of integrated care boards.”
This amendment would require the Government to publish independently verified assessments every two years of current and future workforce numbers required to deliver care to the population in England, based on the economic projections made by the Office for Budget Responsibility, projected demographic changes, the prevalence of different health conditions and the likely impact of technology.
Amendment 40, in clause 108, page 96, line 9, leave out subsection (2) and insert—
“(2) In this Part ‘protected material’ means—
(a) all statements taken from persons by the HSSIB during a safety investigation or in the course of deciding whether an incident is going to be subject to an HSSIB investigation,
(b) records revealing the identity of persons who have given evidence in the context of the safety investigation,
(c) information that has been collected by the HSSIB which is of a particularly sensitive and personal nature, such as (but not limited to) copies taken by the HSSIB of health records, care records, clinical notes, or personnel records,
(d) material subsequently produced during the course of an HSSIB investigation such as (but not limited to) notes, drafts and opinions written by the investigators, or opinions expressed in the analysis of information obtained through the investigation,
(e) drafts of preliminary or final reports or interim reports, and
(f) information that would be subject to legally enforceable commercial privileges.”
This amendment would define more closely the materials covered by the “safe space” protection provided for by the Bill.
Amendment 41, page 96, line 32, leave out
“information, document, equipment or other item held by that individual”
and insert “protected material”.
This amendment is consequential on Amendment 40.
Amendment 43, in clause 109, page 96, line 43, leave out from “Part” to end of line 24 on page 97.
This amendment would remove the ability of the Secretary of State to make regulations authorising disclosure of protected material beyond that provided for in the Bill.
Amendment 74, page 101, line 1, leave out clause 115.
Government amendments 24 and 127.
Amendment 57, page 110, line 11, leave out clause 127.
This amendment seeks to ensure that a profession currently regulated cannot be removed from statutory regulation and that regulatory bodies cannot be abolished.
Government amendments 86 and 87.
Government new schedule 1—Virginity testing: consequential amendments.
Government amendment 88.
Amendment 42, in schedule 14, page 218, line 30, leave out paragraph 6.
This amendment would remove the provision allowing coroners to require the disclosure of protected material.
Edward Argar
This broad group of amendments concern improving patient safety and the quality of health and care services, both of which are a priority for this Government. For that reason, this Bill will put the Health Services Safety Investigations Body on a statutory footing. The HSSIB will be one of the first independent healthcare bodies of its kind, leading the way in investigating for the purpose of learning, not blaming. For the HSSIB to be able to perform this “no-blame” role, the integrity of safe space is paramount. I look forward to contributions from right hon. and hon. Members from both sides of the House, recognising the depth of expertise, particularly that residing in the hon. Member for Central Ayrshire (Dr Whitford), on how best to make safe space work. As we discussed extensively in Committee, we recognise that ultimately this comes down to: what is the appropriate balance to be struck? Different views are likely to be aired again today.
Within this group, I will also address amendments brought forward by colleagues, including my right hon. Friend the Member for South West Surrey (Jeremy Hunt), on the health and social care workforce. Ensuring we have the workforce this country needs will, in the short-term, tackle the elective backlog. Crucially, in the long-term, as we build back better, it will help to reduce damaging health inequalities. For those reasons, I will later speak in more detail about this Government’s plans on the workforce, some of which of course are already in motion. I hope I can reassure the House that the provisions already made in this Bill, alongside the Government amendments I am about to discuss, do go sufficiently far to address these important issues.
I will begin by addressing new clauses 36 to 48, new schedule 1 and amendments 86 and 87, which comprise the package of Government amendments to prohibit virginity testing in the UK. I offer my deepest thanks to my hon. Friend the Member for North West Durham (Mr Holden) for his tireless efforts in proposing these amendments originally and in supporting the Government in proposing our variations on them, which we believe achieve the right balance—I will turn to that in a moment—as we bring forward this ban.
I should also put on the record my gratitude to the Opposition Front-Bench team for their constructive engagement on this issue, which does not divide us on party political lines but is about doing the right thing. I am grateful to the shadow Ministers on the Opposition Front Bench: the hon. Members for Ellesmere Port and Neston (Justin Madders) and for Nottingham North (Alex Norris).
In July, the Government promised in our violence against women and girls strategy that virginity testing will not be tolerated in the UK and will be banned at the earliest opportunity, so I am delighted that we are introducing amendments that demonstrate the strength of our commitment to the removal of all forms of abuse against women and girls. Our amendments will create three offences: conducting a virginity test; offering virginity testing; and aiding or abetting another person to conduct a virginity test in the UK or on UK nationals overseas. Each offence will carry a maximum penalty of five years’ imprisonment and/or an unlimited fine. This sentencing reflects the long-term physical and psychological damage that this repressive practice can cause.
The offences begin to tackle the harmful misconceptions that surround a woman’s sexuality. This House’s commitment to legislate is a profoundly important step forward in helping to tackle the damaging myths concerning the so-called purity of women’s sexuality. In response to concerns that, once the offence is banned in the UK, vulnerable women and girls will be taken abroad and subjected to virginity testing there, the offences will carry extraterritorial jurisdiction.
The proposals have been discussed by Health Ministers throughout the UK, including in the devolved Administrations, and I am working with them to ensure that the whole of the UK together tackles this abhorrent practice. I put on record my gratitude to the devolved Administrations for the constructive manner in which they have engaged on the issue. I hope that the House will pass the amendments today and allow us to take another step forward in our shared endeavour and important work on safeguarding and improving the lives of women and girls throughout the United Kingdom.
Let me turn briefly to new clause 21, tabled by my hon. Friend the Member for North West Durham—I thank him again for doing so. I hope that what I have said will reassure him and the rest of the House that the package of Government amendments that I have just discussed go further to protect women and girls from this form of abuse and are the most effective vehicle by which we can achieve what we seek to do. Our package of amendments set out that the conducting, offering or aiding of a virginity test is simply indefensible. The amendments ensure that victims are protected on our shores and abroad and that the sentencing of those convicted reflects the detrimental physical and psychological impacts of the practice. I therefore hope that my hon. Friend will feel able not to press his new clause to a vote and instead to support our amendments. I am incredibly grateful to him—as, I am sure, is the House—for his campaigning vigour on this issue.
My hon. Friend also tabled new clause 22, which seeks to ban the practice of hymenoplasty. The Government remain concerned that hymenoplasty is also driven by a repressive approach to female sexuality and is closely related to virginity testing, which we have made clear today is not an acceptable practice in the United Kingdom or elsewhere. We announced in the violence against women and girls strategy that we would set up an independent expert panel to explore the complex clinical, legal and ethical aspects of the procedure in more detail. The panel, which includes key stakeholders with ethical and clinical expertise, has already met and will shortly make its recommendations to Ministers, before Christmas. It is crucial that, having asked the panel to contribute, we carefully consider its views before we make a firm decision to ban hymenoplasty. However, I assure the House that although we cannot accept the new clause today because we await the recommendations of the review panel, we will of course fully reassess our position as soon as the panel makes its recommendations.
If we are to ensure patient safety and quality of care, it is vital that we have the workforce in place to deliver it. That is a priority for the Government and I reassure the House that we are taking the necessary steps to secure the workforce of the health and social care sector. Members throughout the House would all agree that although investment in technology, in new hospitals and buildings, in therapeutics and in kit are all phenomenally important, the golden thread that makes that investment valuable is the workforce—the people who always go above and beyond, particularly in the past 18 months, to make that equipment more than just a shiny piece of kit but something that actually saves lives. They are absolutely the heart of what we are doing.
Chris Grayling (Epsom and Ewell) (Con)
I am particularly concerned about the workforce situation in primary care. In my constituency, the practices are reporting back not only on an acute shortage of locums, but on their ability to recruit new GPs. One reason is that, 10,15, 20 years ago, there was inadequate planning for the future and we did not train enough doctors. That is one reason why I have signed amendment 10 tabled by my right hon. Friend the Member for South West Surrey (Jeremy Hunt). May I urge the Government to go beyond where they have been and to look for any way available to deal with this issue now, and particularly to plan for the future so that this does not happen again?
Edward Argar
My right hon. Friend is perspicacious in his prediction of where I was about to go. I was about to turn to amendment 10 tabled by my right hon. Friend the Member for South West Surrey and new clause 28 tabled by the shadow Minister, which go to the heart of what my right hon. Friend is talking about.
I hope the shadow Minister will agree that amendment 10 and new clause 28 are, essentially, broadly unified in their intention and therefore I hope that he will allow me to take them both together. They require the Government to publish independently verified assessments of current and future workforce numbers for the needs of the health, social care and public health services in England.
There has rightly been much discussion on workforce planning for the NHS and adult social care. That reflects the deep debt of gratitude that the country owes the staff and also, as I said, their absolute indispensability in delivering on all our aspirations for healthcare and social care in this country and for our constituents’ care.
As part of our commitment to improving workforce planning, my Department is already doing substantial work to ensure that we recover from the pandemic and support care. We have already committed to publishing, in the coming weeks, a plan for elective recovery and to introducing further reforms to improve recruitment and support for our social care workforce, with further detail set out in an upcoming social care White Paper. We are also developing a comprehensive national plan for supporting and enabling integration between health, social care and other services, which support people’s health and wellbeing.
Let me turn to that framework, to which my right hon. Friend the Member for Epsom and Ewell (Chris Grayling) was alluding, for a longer-term perspective. The Department has already commissioned Health Education England to work with partners to develop a robust, long-term 15-year strategic framework for the health and social care workforce, which, for the first time, will include regulated professionals in adult social care. That work was commissioned in July by my hon. Friend the Member for Faversham and Mid Kent (Helen Whately) when she was in post in the Department. That work will look at the key drivers of workforce demand and supply over the longer term and will set out how they impact on the required shape and numbers of the future workforce to help identify those main strategic choices, and we anticipate publication in spring of next year.
It is vital that the workforce planning is closely integrated to the wider planning across health and social care and, as such, Health Education England, which has established relationships with the health and care system at a local, regional and national level, is best placed to develop such a strategy. Crucially, following the announcement yesterday of HEE merging with NHS England in improvement, we will, for the first time, bring together those responsible for planning services, for delivering services on the ground, and for delivering on the workforce needs of those services so that we can have a more integrated approach to delivering on that framework.
Richard Fuller (North East Bedfordshire) (Con)
I am grateful to the Minister for giving way. There is much to commend in the amendment of my right hon. Friend the Member for South West Surrey (Jeremy Hunt) and in what the Minister is saying. One thing that is not obvious in either, though, is the focus on labour costs and productivity. For example, how is technology going to reduce labour costs in the delivery of the same quality or higher quality of service? What is the possibility of creating new care pathways, which require less qualified staff to deliver as good or better service? What is going on in terms of reducing the proportion of non-clinical staff by the adoption of technology and other means in healthcare? Perhaps the Minister could address that. I am sure that my right hon. Friend will be doing so later, too.
Edward Argar
My hon. Friend is absolutely right. We see huge opportunities, almost every day, from new technology and new ways of using that technology to deliver more efficient and shorter turnaround times—for tests and diagnostics, for example. He is also right to talk about the need constantly to examine care pathways, and, where opportunities exist, to use highly qualified healthcare professionals but to look carefully at the most appropriate level at which a treatment or test can be carried out; historically, we may have used healthcare professionals for particular tasks for which they were almost over-qualified. It is right that care pathways are informed by clinical and scientific expertise and judgment, but that we continue to review how new technology, new ways of working and new care pathways can improve the productivity of our amazing workforce.
Emma Hardy (Kingston upon Hull West and Hessle) (Lab)
As part of the Minister’s workforce review, will he look at the Carr-Hill formula, which local GPs tell me incentivises GPs to go to areas with longer life expectancy—therefore, wealthier areas—at the expense of areas such as Hull? It feels like the funding mechanism for GPs is not fair.
Edward Argar
The Carr-Hill formula has been through many “almost reviews” over the years and has been looked at by different Governments. Various GP practices in my constituency—as I am sure is the case in the hon. Lady’s—understandably raise opinions about how the formula might be improved. The point does not necessarily goes to the entire heart of what we are discussing, but she has managed deftly to make it within scope, in the context of GPs and so forth.
Finally, the report in clause 34 will increase transparency and accountability of the workforce planning process. It is for those reasons that I encourage—perhaps unsuccessfully—my right hon. Friend the Member for South West Surrey and the shadow Minister, the hon. Member for Ellesmere Port and Neston, to consider not pressing their amendments to a Division.
Rachael Maskell (York Central) (Lab/Co-op)
Fifteen years is a long time in workforce planning. The make-up of the workforce could change significantly over that time, not least as we are trying to address some real workforce crises now. Will the Minister put in place a road map to fill those vacancies over that time, and interim reports so that we can review progress?
Edward Argar
I set out the commissioning of the 15-year framework to look at need. Within that, the House will be regularly updated, as happens now—not least in oral questions, as we saw in the session preceding this debate—with plenty of opportunities for Members to challenge the Government and to see updates. There is also the regular publication of figures and workforce statistics, which will continue. Once we have that 15-year framework back and see what HEE says, we will be able to look at how best that might be interrogated by Members of the House and the wider public. I am hopeful that it will report back in the spring, and I suspect that that may well occasion a debate in this House. If not, I suspect that it may well occasion an urgent question from the hon. Lady or the hon. Member for Ellesmere Port and Neston.
Let me turn to new clause 29, which also addresses the issue of workforce planning. This new clause would place a duty on the Secretary of State to report on workforce planning and safe staffing. I have just elaborated at some length on the substantial work that my Department is doing to improve workforce planning. It remains the responsibility of local clinical and other leaders to ensure safe staffing, supported by guidance and regulated by the Care Quality Commission. The ultimate outcome of good-quality care is influenced by a far greater range of issues than how many of each particular staff group are on any particular shift at any one time, even though that is clearly important, which is why the Government are committed to growing the health workforce. It is also important that local clinical leads can make decisions based on the circumstances in their own particular clinical setting, utilising their expertise and knowledge.
The amendment would also require the report to contain a review of lessons learnt. In the last decade, the Government have introduced significant measures to support the NHS to learn from things that go wrong, reduce patient harm and improve the response to harmed patients, such as: a regulated duty of candour that requires trusts to tell patients if their safety has been compromised and apologise; protections for whistleblowers when they raise safety concerns; the Healthcare Safety Investigation Branch, which we are building on and establishing as a separate statutory body through the Bill; and the first-ever NHS patient safety strategy, with substantial programmes planned and under way to create a safety and learning culture in the NHS.
I hope I have given the House some reassurance that we are doing substantive work to improve safe staffing and workforce planning. Again, I encourage the shadow Minister—perhaps it will be unsuccessful, but it is always worth trying—to consider withdrawing his amendment.
Dr Andrew Murrison (South West Wiltshire) (Con)
New clause 29(2)(d) has merits, as I am sure the Minister will accept, in that we need to incentivise people to join health and care, and, crucially, to be retained with the system. Will he give some consideration to this, particularly given that, for example, somebody working in the care system can work for years and years and still be in the same place when it comes to applying for a training place in a profession allied to medicine as somebody who simply has a couple of A-levels? That seems to be wrong. Does he agree that we need to complete the structure so that there is some prospect of progression with health and care and to try to break down the barriers between the two?
Edward Argar
As ever, my right hon. Friend—my friend—makes his point well, and, as ever, I will commit to taking it away and reflecting on it very carefully. He is always very considered in the points he makes in this House, so I am happy to look at it.
I turn to Government amendment 127, which I bring forward with support of the Welsh Government. Clause 127 on professional regulation provides additional powers that will widen the scope of section 60 of the Health Act 1999 and enable the Privy Council to make additional changes through secondary legislation. One of the powers within this clause is to enable the regulation of groups of workers concerned with physical and mental health, whether or not they are generally regarded as a profession. This element of the clause falls within the legislative competence of the Senedd. When the section 60 powers are used, they are subject to the existing statutory requirements in schedule 3 of the Health Act 1999— namely, consultation and the affirmative parliamentary procedure. When legislation made using section 60 powers also falls within areas of devolved competence, it will be developed in collaboration with the devolved Administrations. Orders may require the approval of the Scottish Parliament where they concern professions brought into regulation after the Scotland Act 1998, or of the Welsh Assembly where the order concerns social care workers. In Northern Ireland, where the regulation of healthcare professions is a transferred matter, the UK Government will continue to seek the agreement of the Northern Ireland Executive when legislating on matters that effect regulation in its territory.
The amendment introduces a requirement to obtain the consent of Welsh Ministers before an Order in Council can be made under section 60 of the Health Act 1999 when it contains a provision that would be within the legislative competence of the Senedd. It would apply if we were seeking to bring into regulation in Wales a group of workers who are concerned with physical or mental health of individuals but who are not generally regarded as a profession. The UK Government recognise the competence of the Welsh Government regarding this provision and are respecting the relevant devolution settlement in making this amendment. For these reasons, I ask hon. Members to support the amendment.
Finally, I turn to the amendments related to part 4 of the Bill on the health services safety investigations body. These are the most significant set of provisions found within this Bill to enhance patient safety. The establishment of an independent healthcare body focused on learning from mistakes to improve safety and quality is a world first. For the health service safety investigations body to be able to perform this “no-blame” role, the integrity of safe space is paramount. Without it, health and care staff will not have confidence to come forward, and potential learning will be lost. This principle runs throughout the drafting of these clauses. We have made a small number of exceptions in the Bill—for example, to ensure that coroners can continue to perform their vital functions as judicial office holders and effectively as part of the judiciary. We have also provided for a regulation-making power to ensure that safe space can evolve in line with innovation in technology or medical practice. However, nothing in the Bill can or will undermine the imperative that the HSSIB is an independent organisation or the fundamental importance of safe space to the effective working of that organisation.
Dr Philippa Whitford (Central Ayrshire) (SNP)
Will the Minister give way?
Edward Argar
Yes, of course, although I do so with a degree of trepidation, because the hon. Lady is well versed in these issues.
Dr Whitford
The Minister does not need to be anxious, because he has already heard it all in Committee. Does he not recognise that there is nothing in HSSIB that takes away from coroners’ investigations that they carry out at the moment, and that HSSIB should not be seen as replacing that work by another health body? Adding coroners to it has already created a campaign relating to the ombudsman and freedom of information, and there is a real danger that it weakens the safe space.
Edward Argar
I am grateful for the manner in which the hon. Lady puts her points. She is right; we have debated this previously. We have been publicly clear that we do not believe that the exemption or exception should be extended to the ombudsman. She is right that there are campaigns saying we should have no exceptions or that we should widen the exceptions. We believe we have struck the right balance with this measure, while respecting the fact that a coroner is a judicial office holder and has a very specific function to perform, as set out in legislation in—this is where my memory may fail me—the Coroners and Justice Act 2009, which recognises their particular and special status. I suspect that she and I may have to agree to disagree on whether the appropriate balance is struck, but that sets out why we have done what we have done.
How best to achieve an effective safe space is complex and the current drafting has been arrived at through years of detailed policy work, including pre-legislative scrutiny before the Health Service Safety Investigations Bill was introduced in the other place in autumn 2019. The issue was also debated at length in Committee, and I look forward to hearing contributions from Members on that, particularly the hon. Member for Central Ayrshire.
Turning to the two minor and technical Government amendments to the health service safety investigations body provisions, amendment 24 is a technical amendment to clarify the definition of “investigation” that applies to part 4 of the Bill. Investigations carried out by HSSIB by agreement under clause 114, which relate to Wales and Northern Ireland, were never intended to be part of the main investigation function of HSSIB and therefore will not be covered by the safe space or other investigatory power provisions provided for in the Bill. The amendment ensures that the drafting of the Bill fully reflects that original policy position. I hope that hon. Members on both sides of the Chamber will be content to pass this technical amendment.
Finally, I turn to Government amendment 88 to schedule 13. Schedule 13 contains a regulation-making power which allows the Treasury to vary the way any relevant tax has effect in relation to associated transfer schemes. Regulations made under this power will be used to ensure that no unintended tax consequences arise. The amendment ensures that value added tax is included in the taxes which the Treasury can, by regulations, vary when considering the transfer schemes in this Bill. Without this amendment, it is possible that complications with VAT bills may arise when transfer schemes are made and transactions take place. It is for those reasons that I ask hon. Members to support this amendment.
I am conscious that other hon. and right hon. Members may wish to speak to their amendments. I look forward to addressing those that I have not directly addressed thus far when I wind up debate on this group of amendments. With that, I conclude.
Justin Madders (Ellesmere Port and Neston) (Lab)
I thank the Minister for his introduction. It seems like only yesterday that we were having a similar exchange across the Dispatch Box.
I will begin with our new clauses 28 and 29 and amendment 10. This discussion about workforce could well be the most important of all today. Just this weekend, Chris Hopson from NHS Providers was trying to get the Government to acknowledge the seriousness of the problem when he tweeted:
“93k NHS staff vacancies. £6bn spend on temporary staff to fill gaps. 55% of staff working unpaid extra hours each week. 44% saying they’ve felt ill with work related stress. NHS desperately needs long term workforce planning. Govt must make this happen this week.”
Everything comes back to workforce and the failure to invest in it consistently over a sustained period. Today we have a chance to correct that.
While we favour our new clause 29, it is obvious that amendment 10 has captured the attention of many and may well be put to a vote. In many ways, as the Minister said, it closely mirrors what we have put forward, so I will be making my general points on both the new clauses and the amendment. In supporting amendment 10, I pay tribute to the right hon. Member for South West Surrey (Jeremy Hunt), the Chair of the Health and Social Care Committee. Given his previous role, he is well placed to have an informed view on what needs to be done, and he has done that with this amendment without undue hype or drama. The support he has obtained more widely from stakeholders outside the House is impressive; indeed, the way he has united just about the entire sector shows not only his powers of persuasion, but the importance of the issue. He has come close to uniting the entire sector in the past, but that was usually in opposition to something he was proposing, rather than in support. There may be many other areas where we have disagreed in the past, but that does not diminish our support for his call.
Jeremy Hunt (South West Surrey) (Con)
May I just comment that it feels a lot better this time?
Justin Madders
Let us just say that the more I hear of the right hon. Gentleman, the more I like what he has to say—I will leave it there.
We all accept the urgent need to address the workforce crisis, but I cannot find anyone who thinks that what the Government have put forward in clause 34 is the solution.
Alex Sobel (Leeds North West) (Lab/Co-op)
A doctor in my constituency, Dr Tom James, told me that he and his colleagues in the hospital were demoralised, exhausted and at the end of their tether, particularly after the covid crisis, in a building that was falling apart around them. He said there was no more goodwill, and the Government needed to grab hold of this crisis and resolve it. Are new clause 29 and amendment 10 not a minimum, rather than a maximum, for what we should be looking to achieve?
Justin Madders
New clause 29 and amendment 10 are the starting point, not the whole answer. They are a framework for getting this right in the future and offering the workforce, which, as the Minister said, has given so much in recent times, some hope that there will be better times along the way. I will refer later to the report by the Health and Social Care Committee on workforce burnout, which brought home just how demoralised the workforce have become and why they need to be given some positive news today.
Rachael Maskell
Anyone who on Sunday was on the March with Midwives will understand the real crisis now facing that profession—a particularly acute once since it is also about women’s health. Is there not a need to ensure that plans are not just on paper, but expedited, so that we are sure of seeing real delivery of those much-needed staff?
Justin Madders
Like just about every profession and sector in the NHS, midwives are under tremendous pressure and are understaffed. We need a clear plan, and a plan that is delivered. Of course, having a plan is not the whole answer, which is why it is important that we hear regular reports back from the Secretary of State on progress. That is why we hope amendment 10 will be supported.
Emma Hardy
One reason I want to emphasise the importance of new clause 28 is that we are anticipating a greater demand for mental health services, and therefore a greater demand for mental health professionals working in the NHS. Only by having regular reviews will we be able to anticipate what that demand will be and prepare accordingly.
Justin Madders
My hon. Friend is correct; we could not have anticipated what has happened in the past 12 to 18 months, but we can see what it means moving forward. Regular reviews of demand are critical, and we know that training these highly qualified and skilled staff takes time, which is why a longer-term view and approach are required.
Richard Fuller
I want to pick up on the increasing demand for mental health services. Does the hon. Gentleman accept that in general, it is utterly impossible to meet the expectation of increasing demand for health services without vast improvements in the efficiency with which people working in the health and care sector deliver that service? Is it not a shortcoming of both the Government and the Opposition that there is not an intense focus on solving that problem of labour cost productivity? Without that, we will not be able to meet current needs and we certainly will not meet future needs.
Justin Madders
We are always looking at ways to improve productivity, but we know that on the current figures there are 100,000 staff vacancies in the NHS. No amount of productivity gains will cover for that.
Munira Wilson (Twickenham) (LD)
The hon. Member for North East Bedfordshire (Richard Fuller) talks about efficiency, but the figures show that in 2019-20, some £6.2 billion was spent on bank and agency staff. If we are talking about efficiency and using all the extra money the Government are saying they will put in to catch-up, we need to provide value for money for the taxpayer. Therefore, long-term planning to recruit the right skills is critical.
Justin Madders
I thank the hon. Member for her intervention. The point about agencies and locum spend is not a new one. It will be interesting to see the figures for the last 12 to 18 months when the Minister has finally ratified them, because I suspect they will be even higher than those we have heard recently.
Dr Whitford
Having spent over three decades in the NHS, I know that this is not just about senior staff and what are called frontline staff. It is said, “We’ll protect frontline staff, but we’ll cut administrative staff or backroom staff.” However, if I am not in a clinic with the right results with the right patient at the right time, I am a waste of space. In actual fact, we need to look at the whole team. There is a sweet spot where I am working flat out but I have a team who are helping me. If we cut any of those, then we lose efficiency, and as the hon. Member for Twickenham (Munira Wilson) said, costs are going up, so we are becoming not more productive, but less productive.
Justin Madders
I thank the hon. Member for her intervention. Indeed, this actually covers some of the debate we had in Committee. There has been a rhetoric coming out of Government in recent months that managers are somehow a cost burden and that administrative staff do not actually help deliver the services. Of course, as the hon. Member has just pointed out, they are a vital source of support for those on the frontline.
Dr Murrison
The hon. Member is being generous in giving way. Would he avoid the temptation to suggest that productivity is in some way simply a demand for hard-pressed people in health and social care to work harder? It is not that at all. It is just doing what they want to do, which is to work smarter and thus get more out of the system, which I think is what the hon. Member for Central Ayrshire (Dr Whitford) has just said.
Justin Madders
I accept what the right hon. Member has said. There has been a gap in investment in IT and other things that make people’s jobs easier and more efficient, and that has been a characteristic of NHS spending over the last decade.
With your permission, Madam Deputy Speaker, I will try to make some progress, but it is important, as we have talked about the staff, that we pay tribute to all those who make the NHS what it is today. On Nursing Support Worker Day, I pay tribute to all those who work in wards, clinics and community settings to support our nurses and provide that essential hands-on care to patients.
Our care system does indeed face a crisis—over waiting times, over recovery—but as with all other crises, the root cause is inadequate funding. The most visible and significant symptom is an inadequate workforce, plus the scandal of social care provision. There is no plan at the moment; it is just a plan for a plan. When we talk about a workforce crisis, that cannot be in any way a reflection on the huge value and contribution of the workforce we have now.
There are particular positive aspects to amendment 10 to which I would like to draw attention. Explicit recognition of the need to consult with the workforce through trade unions is very welcome. The planning covers health and social care, which is also absolutely essential. Given the scope of the review, the timescale is about right—every two years is demanding, but not too onerous—but a regular update each year might be preferable. However, the main point, which I have made already, is to compel a regular report and review of demand. The central role is that the Secretary of State has a duty to get planning done, and we hope that will be a crucial lever for the change we need to see.
If the amendment has a weakness, it is probably the one we have touched on already, which is that it does not ensure that the plan is feasible or delivered. A plan that shows the gap is not a plan unless it has a credible funding solution alongside it. Even if that is not explicit in the amendment, we assume that funding would follow any such assessment and plan that is set out. Our suggestion would be that any such financial projections in a plan are subject to the same level of independent expert verification as we see with the Office for Budget Responsibility. Since all the various think-tanks are going to do an assessment anyway, we may as well have a built-in process for verification.
Rachael Maskell
Does my hon. Friend agree with me that many of the recruitment challenges often sit in outsourced services in the private sector, and as a result it is really difficult to find the complement of staff required because people want to work in the NHS? That needs to be taken into consideration in any workplace plan.
Justin Madders
I thank my hon. Friend for her intervention and I will later talk a little about outsourcing and the role it has to play. We believe that plans should be built from the bottom up, not from the top, and that implies the involvement of ICBs, NHS trusts and foundation trusts. ICBs and their strategic arms, integrated care providers, will not be functional for some time. That is a shame, but it does not mean we should not proceed with the amendment.
The scale of the workforce challenge is well established: high rates of vacancy, inadequate levels of retention, and much more. It goes far deeper than numbers and structures, to issues of workforce terms and conditions, particularly in social care. It must also cover cultural issues, as there is a clear indication that all is not well in the NHS in terms of diversity. There is also whistleblowing, and aspects of how staff are nurtured and supported. At its very best, the NHS is very good, but unfortunately that is not the story across the board. It should be good in every part.
On that theme, let me mention the continuing disgrace in the way that some members of the NHS workforce are treated. I find it unacceptable that cleaners, porters, catering and IT staff are still being outsourced by trusts that are trying to make tax savings or outsource services to the lowest bidder. Perhaps the Minister can look into the current dispute at South Warwickshire in that regard, as we do not think that is a template to follow. Workforce planning is not a problem that can be solved quickly, although increased funding in social care could help that. For the NHS, the long term is indeed a long time—for example, the time needed to develop and train GPs and consultants. More money is not the only answer; technology and reform of the way we work must all be part of the mix. However, the labour-intensive nature of care will not fundamentally change, so we must look at workforce numbers as the priority. It is often said that failing to plan is the same as planning to fail. Some colleagues believe that a failure to plan is exactly that—a route to ending the NHS as we know it by showing that it fails. However, the Bill suggests an acceptance that a plan is needed, and work is under way. Hopefully that work is not being handed out to more consultants, of whom we see enough already.
Labour will support the amendment tabled by the Chair of the Health and Social Care Committee, which we hope will be pushed to a vote. I hope I have not been too effusive in my comments about him—I have a reputation to maintain after all—but I will refer to the excellent report done by his Committee on workforce burnout, which in many ways is the cornerstone of what we are debating. In its conclusion, the Committee said:
“The emergency that workforce burnout has become will not be solved without a total overhaul of the way the NHS does workforce planning. After the pandemic, which revealed so many critical staff shortages, the least we can do for staff is to show there is a long term solution to those shortages, ultimately the biggest driver of burnout. We may not be able to solve the issues around burnout overnight but we can at least give staff confidence that a long term solution is in place.
The way that the NHS does workforce planning is at best opaque and at worst responsible for the unacceptable pressure on the current workforce which existed even before the pandemic.
It is clear that workforce planning has been led by the funding envelope available to health and social care rather than by demand and the capacity required to service that demand. Furthermore, there is no accurate, public projection of what health and social care require in the workforce for the next five to ten years in each specialism. Without that level of detail, the shortages in the health and care workforce will endure, to the detriment of both the service provision and the staff who currently work in the sector. Annual, independent workforce projections would provide the NHS, social care and Government with the clarity required for long-term workforce planning.”
That conclusion shows what we are trying to achieve today. That is the nub of it: if not now, when? When will the Government finally accept the obvious that has been staring them in the face for years?
New clause 29 would require the Secretary of State to lay before Parliament a fully funded health and care workforce strategy to ensure that the numbers, skill and mix of healthcare staff are sufficient for the safe and effective delivery of services. It builds on other amendments, and seeks further assurances by putting patient safety and safe staffing levels at the heart of workforce planning, by setting out how the Government will be required to act to assess and rectify shortages. It seeks to ensure that the workforce will be on a sustainable footing in future. Patient safety should be our primary concern. We have the evidence base: when there are not enough registered nurses, mortality rates change and health outcomes are worse. I accept that the level of detail in the new clause is significant, but we consider that necessary to underscore the importance of setting out how this will be delivered.
Mr Richard Holden (North West Durham) (Con)
I thank the hon. Member for giving way, and I apologise to the Minister for not being here at the very start; I was on a train back from a ministerial visit in my constituency. I would just like to pay tribute to some of the campaigners who are in the Public Gallery at the moment, particularly those from Karma Nirvana, the Iranian and Kurdish Women’s Rights Organisation, the Middle Eastern Women and Society Organisation, and the Royal College of Obstetricians and Gynaecologists. Does the hon. Member agree that it is those campaigners and charities who have worked on this issue for a very long time who have really brought it to the fore—they have just been supported by some Members of this House—and that it is they who deserve the credit?
Justin Madders
I thank the hon. Member for his intervention. I think he is being very modest, but he is absolutely right that these things do not happen by accident. It is often the hard work, over many years, of campaigners and campaign groups who being these issues to the fore and do the diligence and the hard work behind the scenes that leads us to the sort of outcome that we will hopefully get today—an end to this abhorrent practice.
On the hon. Member’s other amendment, new clause 22, we also want to see hymenoplasty ended. It has no medical benefit whatsoever. As the Minister said, there is currently an expert panel looking at the issue, and he is waiting on its recommendations. I think the outcome is in little doubt, to be frank. However, I wonder whether the Minister can give us an assurance that, should those recommendations turn out to be as we would expect, he will be able to act on them quickly and get something down in statute as soon as possible so that we do not miss the boat.
Turning to the amendments on the health services safety investigations body, much of the proposed legislation is the same as that proposed in the other place, and there were extensive debates on this matter in Committee. There are, however, issues that remain, which are covered by amendments we will be debating today. I can imagine the other place having quite a lot to say about some of these issues. In general, we support the move to the new body, but over time attention must be applied to some aspects of the way it will function in practice. Our major reservation is, yet again, with the involvement of the Secretary of State. Our amendment 74 would have the effect of leaving out clause 115, which is another clause that gives the Secretary of State extra powers to interfere.
Our general observation would be that there is far too much extra power going to the Secretary of State in the Bill anyway, but we are particularly concerned at the powers set out in clause 115, which give him what we consider to be wholly unnecessary powers to direct. It is pretty much a blank cheque to enable him to step in and interfere any time he likes as long as he considers that there has been a significant failure. Under subsection (2), the Secretary of State can direct the HSSIB in whatever manner he determines, which I would have said is about as far away from independence as we can get—until we get to subsection (4), which means the Secretary of State can also effectively step into the HSSIB’s shoes and undertake the duties himself. I can do no better than refer to the evidence Keith Conradi gave to the Public Bill Committee, when he said:
“Ultimately, we end up making recommendations to the Department of Health and Social Care, and in the future I would like to ensure that we have that complete freedom to be able to make recommendations wherever we think that they most fit.”––[Official Report, Health and Care Public Bill Committee, 7 September 2021; c. 60.]
We also support the amendments put forward by the spokesperson for the Scottish National party, the hon. Member for Central Ayrshire (Dr Whitford), which are important in preserving the principle and status of protected spaces. We feel it is important that they cannot be nibbled away at, as the Bill currently allows.
The purpose of amendment 57, which we also tabled in Committee, is simply to delete clause 127, which deals with the role of the Secretary of State in professional regulation. So far, we have had no convincing explanation of why the Secretary of State needs these powers. If there are no professions that he wishes to remove, we do not need the clause. If there are, he should say so, so we can have a debate now on whether it is appropriate to hand over those powers to him.
Finally, on new clause 1, I pay tribute to the all-party parliamentary group on beauty, aesthetics and wellbeing, whose work in this area has been influential in producing it. Many of the group’s members have put their name to it. As we know, cosmetic treatments can include a wide range of procedures aimed at enhancing or altering appearance. Many of those procedures are becoming increasingly popular and new clause 1 speaks to the well-articulated concern that non-medically and medically trained practitioners are performing treatments without being able to provide evidence of appropriate training, and without required standards of oversight and supervision.
I hope the Members moving new clause 1 will have the opportunity to speak to it, as there are far too many stories of people suffering horrific, life-changing injuries. There would undoubtedly be a saving to the NHS in reduced visits to accident and emergency and GPs to correct mistakes made by poorly trained and unregulated practitioners. We therefore think the new clause has value. Some of the impacts on the NHS from the lack of regulation include outbreaks of infection at a skin piercing premises, resulting in individuals being hospitalised; disfiguration and partial removal of an ear; second and third-degree burns from lasers and sunbeds; allergic reactions due to failures to carry out patch tests or medical assessments, which led to hospitalisation; and blindness in one eye caused by the incorrect administration of dermal filler.
New clause 1 seeks to put the protection of the public at the forefront by giving the Secretary of State power to bring into force a national licensing scheme for cosmetic procedures. Clearly, given that this is a departure from the wild west we face at the moment, we recognise that significant research and engagement with stakeholders will be needed to develop a scheme, as well as the provision of a practical and efficient system for people to become regulators and practitioners. If that does not make it on to the face of the Bill today, we hope this is an issue the Government will return to shortly.
Jeremy Hunt
I rise to speak in support of amendment 10 but, before I do, I also want to express strong support for amendments 40 to 43, tabled by the hon. Member for Central Ayrshire (Dr Whitford), which will make a big difference in making the new health services safety investigation body a success. I strongly encourage the Minister to listen to what she says later not just with the deference due to an experienced surgeon, but with the enthusiasm to follow a doctor’s advice, because what she says is extremely important.
I also thank the hon. Member for Ellesmere Port and Neston (Justin Madders) for his generous comments about me. Having sat opposite him at the Dispatch Box on many an occasion, I realise how difficult they must have been for him to say. He must have wrestled with those thoughts for a long time, and I am delighted that he has been able to unburden himself today.
The hon. Gentleman was absolutely right to focus on burnout in the NHS workforce. All of us would agree that NHS and care staff have done a magnificent job looking after us and our families in the pandemic, but right now they are exhausted and daunted. They can see that A&E departments and GP surgeries are seeing record attendances. They can see nearly 6 million on waiting lists, which is more than one in 10 of the population. They also have the vaccine programme and covid patients.
Jim Shannon (Strangford) (DUP)
I commend the right hon. Gentleman for amendment 10. With 2,700 vacant nursing posts in Northern Ireland, and 40,000 in the NHS as a whole, will the amendment offer more nursing bursaries, train nurses up to relieve the pressure, and provide a decent working environment?
Jeremy Hunt
I believe it will. I am grateful to the hon. Gentleman for raising that issue, because medical training is relevant to the whole United Kingdom, not just one part of it. I hope the amendment will be beneficial to Northern Ireland as well.
If we put ourselves in the shoes of any frontline doctor, nurse or care worker, we would see that they are all completely realistic that this is not a problem that can be solved by next Monday. It takes a long time to train a doctor or nurse. All they have is one simple request: that they can be confident that we are training enough of them for the future, so that even if no immediate solution is in place, there is a long-term solution. That is the purpose of amendment 10. It simply requires the Government to publish every two years independently verified estimates of the number of people we should be training across health and care.
The Government have recognised the pressures on the NHS by giving generous amounts of extra funding. I commend the Government for doing that, but extra money without extra workforce will not solve the problems that we want to solve. At the moment, the NHS just cannot find the staff.
Munira Wilson
I congratulate the right hon. Gentleman on amendment 10 and on how he has built such a coalition of support. Many of the challenges facing those with mental health concerns are because, as he says, there simply is not the workforce—it has hardly grown over the past decade. There are over 16,600 full-time equivalent vacancies and a waiting list of 1.5 million. His amendment, which would require a report every two years, is so important for ministerial accountability because the targets in the five year forward view have not been met, so we have no chance with the 15-year projection.
Jeremy Hunt
The hon. Lady gives a good example, because mental health is an area that we have all recently come to realise can be immensely beneficial to ourselves, our families and our constituents. However, while there has been explosive growth in demand, we have not had growth in the supply of people able to look after those with mental health issues. We can only do that with the kind of long-term planning that amendment 10 will make possible.
The royal colleges say that, as of today, there are shortages of 500 obstetricians, 1,400 anaesthetists, 1,900 radiologists, 2,00 A&E consultants, 2,000 GPs, 39,000 nurses and thousands of other allied health professionals. That is why this problem has become so acute.
The Minister has engaged thoughtfully with me on the issue on a number of occasions. He and I both know that there is some concern in the Government about the cost of training additional doctors and nurses. I want to take that concern head on. Yes, the amendment would lead to more doctors, nurses and professionals being trained. Yes, that would cost extra money. Yes, it would save the NHS even more money, because every additional doctor we train is an additional locum we do not need to employ. Locums are not only more expensive for the NHS, but less good for patients. Patients prefer to see the same doctor on every visit if they possibly can, which is much harder with a high number of temporary workers.
Dr Whitford
It is not just that patients prefer to see a doctor long term. There are safety issues when locums in acute specialties move from hospital to hospital, particularly if they are dealing with an acute case. They do not know where things are or who to phone; passwords and phone numbers change. There is a real safety issue with having too many locum staff in the very exposed acute services.
Jeremy Hunt
I absolutely agree with the hon. Lady, who knows about acute services. I also point to recent evidence from Norway that shows the same for general practice: patients who see the same GP over and over again go to A&E departments less than patients who see different GPs.
Dr Murrison
The hon. Member for Central Ayrshire (Dr Whitford) is absolutely right about acute safety; I speak from personal experience. My right hon. Friend is right about general practice, but the issues are different. In general practice, the issue is chronic long-term care: patients need to know that practitioners have a view of their condition that spans a long period—sometimes generations. The issues are very different in acute and primary care, but they come to the same thing.
Does my right hon. Friend agree that part of the problem with the workforce is not recruitment, but retention, particularly the retention of senior doctors in their mid-50s? It pains me to say it in this consensual debate, but the root cause is the GP contract and the consultant contract brought in by the last Labour Government. Those contracts incentivise people—in my demographic, as it happens—to leave, potentially leaving the service short of 10% of their entire career.
Jeremy Hunt
My right hon. Friend is right that there are problems with the GP contract. I do not want to get into too many discussions about doctors’ contracts in this very consensual debate, but Conservative Members have to take responsibility for not having remedied the pensions anomaly, which gives people an incentive to retire much earlier than we would want. We have to address that issue.
Lots of people might reasonably ask whether I did enough to address the issues in the nearly six years that I was Health Secretary. The answer is that I set up five new medical schools and increased by 25% the number of doctors, nurses and midwives we train. However, that decision was taken five years ago and it takes seven years to train a doctor, so not a single extra doctor has yet joined the workforce as a result.
That is the nub of the problem: the number of doctors, nurses and other professionals we train depends on the priorities of the current Secretary of State and Chancellor. As a result, we have ended up with a very haphazard system that means that although we spend about the average in western Europe on health, as a proportion of GDP, we have one of the lowest numbers of doctors per head—lower than any European country except Sweden.
Dr Whitford
All Governments in the UK are expanding medical school places and trying to train more students, but that has led to a shortage of foundation places. In the first two years after a doctor graduates, they are not allowed to practise outwith a foundation job, and they can never practise if they do not go through a foundation job. In the summer, about 400 young graduates were still struggling to find a place. It took 19 years from my entering medical school to my becoming a consultant surgeon. We need to think not just about medical school, but about the whole pathway.
Jeremy Hunt
The hon. Lady is absolutely right. Medical school, the foundation years and, as my right hon. Friend the Member for South West Wiltshire (Dr Murrison) said, the retention of staff—all those things need to be built into long-term planning and baked into the system.
That long-term planning strikes a contrast, if I may say so, with some of the short-termism that we have seen recently. Even in the recent Budget and spending review, the budget for Health Education England, which funds the training of doctors in this country, was not settled. Although I think that the proposed merger with NHS England is probably the right thing to do, I fear it will mean that the budget is not settled for many more months, at precisely the moment when the workforce crisis is the biggest concern for the majority of people in the NHS.
Greg Clark (Tunbridge Wells) (Con)
My right hon. Friend is making an excellent speech, and I strongly support his amendment. Will he add to the list of factors that need to be considered in the future the requirement for many research scientists in medical sciences to be trained in medical schools first? If we want to expand and build on the excellence that we have there, it is not just a question of meeting the needs of the NHS workforce; we need to have extra people who can become the brilliant researchers and discoverers of new medicines in the future.
Jeremy Hunt
My right hon. Friend speaks about these issues with a great deal of knowledge, given his former ministerial and Select Committee roles, and he is absolutely right. I think that the big lesson from the pandemic, and indeed an issue that emerged in the report that our Committees jointly produced, is the way in which science can add value to clinical practice and clinical practice can add value to science.
Rachael Maskell
One of the key workforces is, of course, in public health, where the aim is to shift the balance by increasing prevention so that we do not need all the doctors and nurses and other health professionals further down the road. The health visitor delivery programme led to a heavy stream of new health visitors, but it had other consequences. That is another reason why the right hon. Gentleman’s amendment is so important: we see rapid changes in the workforce which could have other consequences.
Jeremy Hunt
I thank the hon. Lady, who before entering this place spent her time campaigning to support NHS and care staff. She speaks with great experience, and I think that the fundamental point she makes is very important. Unless there is long-term strategic planning, when we have a priority such as the one we have at the moment of tackling the backlog, we will often make progress on that priority by sucking in staff from other areas, which then suffer. That is an unintended consequence which happened when I was Health Secretary, and I fear that it will happen again without a long-term strategic framework.
Amendment 10 has wide support. It is supported by 50 NHS organisations, including every royal college and the British Medical Association—an organisation which, to be honest, is not famous for supporting initiatives from me—and by six Select Committee Chairs and all the main political parties in this place. I am sure that the Government will ultimately accept it, because it is the right thing to do, but if they are intending to vote it down today, I would say to them that every month in which we delay putting this structure in place is a month when we are failing to give hope to NHS staff on the front line.
Let me end by quoting the Israeli politician Abba Eban, who said that
“men and nations behave wisely when they have exhausted all other alternatives.”
Let us prove him wrong today by supporting amendment 10.
Dr Whitford
I am delighted to follow the Chair of the Health and Social Care Committee, and, in this rather unnerving outbreak of consensus and good humour, to mirror his speech and add my support to his amendment on workforce planning.
It is important to remember that healthcare is not delivered by hospital buildings or fancy machines; it is delivered by people to people, which is why the most important asset in any health service is its workforce. As I pointed out in an earlier exchange with the right hon. Gentleman, we need a long-term view, because it takes a long time to train senor specialists. As I said to him, it took 19 years from my entering medical school to my becoming a consultant breast cancer surgeon. We will struggle to work out what specialties we might need in 20 years’ time, because medicine is evolving, but many aspects and many sectors of staff do not change. If we do not get even those right, we are constantly in a position of drought and thirst, and it is not possible for staff to evolve—to pick up new rules, to use new techniques and to develop new services.
Although this workforce strategy would apply only in England, I would encourage consultation with the Health Secretaries and the workforce bodies in the devolved nations, because junior doctors in particular tend to move around during their training. During the junior doctors’ strike, which the right hon. Member for South West Surrey (Jeremy Hunt) might remember rather painfully, I talked to students on the picket lines whom I had trained. People move around, and it is important that such a strategy does not end up just sucking staff out of the three devolved health services. Also, many aspects of medical training are controlled on a UK basis. Foundation places for new graduates are decided on a UK basis, for example, so it is important to take that wider view.
The workforce shortage is the biggest single challenge facing all four national health services across the UK. It has been exacerbated by the loss of EU staff after Brexit, with an almost 90% drop in EU nurses registering to come and work in the UK. Early retirements are being taken due to the Government’s pension tax changes, which, as has been highlighted, have not been sorted out and are resulting in senior doctors paying to go to work. There is only so long that they will continue to do that. Finally, there is the exhaustion of dealing with a pandemic for the past 18 months. This is why it is really important, when we talk about NHS recovery, to have a greater focus on staff wellbeing and on their recovery. There can be no recovery of the NHS without them. I am really disappointed to see how the clapping of last spring has turned to severe criticism and attacks directly from members of the public, from sectors of the media, and even from some Members in this place and members of the Government.
I shall now speak to my own amendments 40 to 43, which seek to tightly define the materials covered by the safe space protections as part of Health Service Safety Investigations Body investigations. The idea behind HSSIB was to learn from air accident investigations and to provide a confidential and secure safe space in which healthcare staff could be open and candid in discussing any patient safety incidents. I was on the pre-legislative scrutiny Committee, which was chaired by the hon. Member for Harwich and North Essex (Sir Bernard Jenkin), and the recommendations of that cross-party—and indeed cross-House—Committee were very clear: evidence gathered under the safe space protocols should be protected and disclosed to third parties only in the most pressing situations, such as an ongoing risk to patient safety or criminality. Despite that, there are aspects of this Bill that could undermine the principle of the safe space, and that is what I am seeking to amend.
Amendment 40 would define he safe space materials much more tightly, because it seemed as though anything that HSSIB was using would be covered by the safe space protocol and that exemptions would then be made, whereas it makes much more sense to be very clear about the materials that are defined as protected materials. Therefore, all the original clinical information—medical notes, etc—would still be available to all the other bodies to enable them to carry out their investigations as they do now.
Amendment 43 would remove the ability of the Secretary of State to use regulation at a later date to authorise the wider disclosure of protected materials beyond the provision that is finally passed in this Bill. Amendment 42 would remove the provision allowing coroners to require disclosure of protected materials, as this has already led to calls for access by other health bodies and even freedom of information requests, as I highlighted in my earlier intervention. If a coroner uses safe space materials in their report, that report is public. The question is: how are they going to handle that so that the safe space materials are not further disclosed? It is critical to defend this. It is important to stress that HSSIB does not limit anyone else’s access to original materials, but nor should HSSIB be seen as an easy way for other bodies to avoid doing the legwork and carrying out their own investigations.
HSSIB will not apply in Scotland, where the Scottish patient safety programme is focused more on preventing patient safety issues in the first place. My interest is purely personal, as a surgeon. I experienced the impact of the Scottish patient safety programme when it was introduced to operating theatres in 2007. It cut post-operative deaths by 37% within two years. It has subsequently been rolled out to maternity, psychiatry, primary care and all the main sectors. It has not just reduced hospital mortality, but prevented morbidity—such as pressure sores, leg thrombosis or sepsis, which all in their own way cost the NHS a huge fortune.
Laura Trott (Sevenoaks) (Con)
I will speak mainly to new clause 1, but I cannot start without paying tribute to my hon. Friend the Member for North West Durham (Mr Holden) for his work to ban virginity testing. It is an abhorrent practice and high time it was made illegal.
I speak to new clause 1 in the names of my right hon. Friend the Member for Romsey and Southampton North (Caroline Nokes) and the right hon. Member for North Durham (Mr Jones), among others. The existing situation, absurdly, is that someone may walk into a clinic and easily and legally get a treatment that could blind them, and there is absolutely no regulation whatever. For some time, we have talked about fixing the issue, and my private Member’s Bill—now the Botulinum Toxin and Cosmetic Fillers (Children) Act 2021—which was passed with the support of many Members of the House, has been able to bring some regulation to this space. Under-18s are now able to get only non-cosmetic interventions, and that by legal practitioners alone.
For those over the age of 18, however, there is no protection. Save Face, a campaigning organisation, last year received 2,000 complaints from people. Those are complaints not about the clinics people were in being dirty, but practitioners being uninsured or unable to fix the problems created when patients were given injections or fillers. People had necrotic or rotting tissue, which individuals would have to pay for themselves to get fixed. It is unacceptable that we are in a situation where that can take place with no regulation by Government.
I am afraid that is a pattern over time, across many Governments, of issues that primarily affect women not having the attention that they deserve. I am hopeful that we make some progress today. I pay tribute to my right hon. Friend the Member for Romsey and Southampton North on tabling her amendment.
Margaret Greenwood (Wirral West) (Lab)
The Health and Care Bill allows for
“a profession currently regulated to be removed from statutory regulation when the profession no longer requires regulation for the purpose of the protection of the public.”
Labour voted against the relevant clause in Committee, but we were defeated by the Government. I therefore tabled amendment 57, which would remove clause 127 from the Bill and ensure that a profession currently regulated cannot be removed from statutory regulation, and that statutory regulatory bodies cannot be abolished. I am grateful that the amendment received cross-party support.
The removal of a profession from regulation is deeply concerning because, once a profession is deregulated, we can expect the level of expertise in that field to decline over time, and along with that the status and pay of those carrying out those important roles. It also brings with it serious long-term implications for the health and safety of patients. In the White Paper that preceded the Bill, the Government stated:
“This is not about deregulation—we expect the vast majority of professionals such as doctors, nurses, dentists and paramedics will always be subject to statutory regulation. But this recognises that over time and with changing technology the risk profile of a given profession may change and while regulation may be necessary now to protect the public, this may not be the case in the future.”
It is notable that the Government only “expect” that the vast majority of professionals will be subject to statutory regulation, but they give no guarantee. The fact is, if the Bill passes, Ministers will be able change their mind at any point and make changes through secondary legislation.
The Government appear to be arguing that technological advances may change roles to such a degree that the high level of professional expertise that currently serves the NHS will no longer be needed. I will make two points about that. First, if the work of an NHS profession has changed to such a degree that regulation is no longer needed, I would argue that it is a different profession and needs a new job title. Secondly, when deploying new technology, there is always a need for professional staff with a high level of expertise and understanding of not only the functionality of that new technology, but its shortcomings. Technology has the power to improve productivity, but it should not be used as an excuse to deregulate professions.
It is important to consider where the impetus for that proposal may be coming from. The recent lobbying scandal certainly gives us a clue when we consider the number of MPs on the Government Benches with private interests in medical technology—I do not want to elaborate on that today, but to make the point. Certainly, big business is keen on deregulation, because it allows them to pay lower salaries to staff.
During a seminar on wellbeing, development, retention, and delivering the NHS people plan and a workforce fit for the future, a representative of Virgin Care said:
“We should have flexible working for all. We should consider what that means. We should embrace what that means. Both of those things really push what has been quite a traditional work model across the NHS. We need to be more modern. We need to have a think about how we rip up the old rule book. But change in an area that is very risk averse because the nature of the work we do is really tricky, so we need our leaders and our workforce to embrace trying things”.
That was an alarming statement for her to make. I think we would all agree that healthcare professionals’ understanding of risk and the importance of mitigating risk is incredibly important. It is always a matter of concern when business says that it wants to “rip up” the rule book on employment rights and pay.
Yesterday, in the Minister’s summing up, he said that
“the Bill does not privatise the NHS.”—[Official Report, 22 November 2021; Vol. 704, c. 151.]
I have to say, however, that I disagree. ICBs—integrated care boards—will be able to delegate functions, including commissioning functions, down to provider collaboratives, and provider collaboratives can be made up of private companies. I do not understand what it is that the Minister does not understand about that.
Add to that the fact that the abolition of the national tariff will open up the opportunity for big business to undercut the NHS, this is a potent situation indeed, and one that will be exploited by big business if the Bill goes through. The late Kailash Chand, former honorary vice-president of the British Medical Association said:
“The core thrust of the new reforms is to deprofessionalise and down skill the practice of medicine in this country, so as to make staff more interchangeable, easier to fire, and services more biddable, and, above all, cheaper”.
The removal of professions from regulation is a part of that scenario he described.
I turn now to workforce planning. There is a workforce crisis in the NHS. In fact, that is probably an understatement. Earlier this year, I met members of the Royal College of Nursing in the north-west, who told me of the sheer exhaustion that they are experiencing because of staff shortages. I was struck by how, even at this point when they were describing how they are on their knees with exhaustion, their primary concern was patient safety. We owe it to them to address the matter. The British Medical Association highlighted:
“Burnout has led to significant numbers of medical professionals considering leaving the profession or reducing their working commitments”.
According to the latest figures, there are well over 90,000 full-time equivalent vacancies in England’s NHS providers. The best the Government can come up with is in this Bill is to require the Secretary of State to publish a report, at least once every five years, describing the system in place for assessing and meeting the workforce needs of the health service in England. That is woefully inadequate. The Royal College of Physicians says that this duty on the Secretary of State
“falls short of what is needed given the scale of the challenge facing the health and care system”.
The Royal College of Paediatrics and Child Health is among those who have called for this duty to be strengthened in the Bill. I ask the Government to listen to the expertise of those bodies.
The Government’s plans to remove NHS professions from regulations is wholly unacceptable and it is particularly alarming at a time when there are such acute shortages of staff, right across NHS professions. We all value the NHS highly and respect the high level of professionalism in the service. Instead of looking to deregulate professions, the Government should be investing in the training of the next generation of professionals.
Mr Andrew Mitchell (Sutton Coldfield) (Con)
I draw the House’s attention to my interests, which are set out in the Register of Members’ Financial Interests, and to the fact that my wife is an NHS GP and has been for the past 30 years.
I rise to support amendment 10, tabled by my right hon. Friend the Member for South West Surrey (Jeremy Hunt), as it seems to be absolutely right. I cannot understand why the Minister, an extremely good Minister, is not obliging the Government to accept it in full. It is clear from what is being said across the House that my right hon. Friend has achieved an unexpected unity. Even brilliant junior hospital doctors who in the past have marched against some of his policies are four-square behind what he is saying today and the work his Committee is carrying out so brilliantly.
I wish to make three points about why the House and indeed the Government would be wise to support my right hon. Friend’s amendment today. The first is that, for reasons he has set out eloquently, as has the hon. Member for Central Ayrshire (Dr Whitford), who speaks on these matters for the Scottish National party, burnout in the NHS is an incredibly serious issue. The need for us to project how many people we are going to need in all the different disciplines in the health service has never been greater, and the workforce requirements have never been more uncertain. As has been so eloquently set out, the cost of that uncertainty is paid in locums, with all the difficulties and downsides that have been mentioned.
I wish to quote a note I have had from Dr Rahul Dubb, the lead doctor in Royal Sutton Coldfield. He successfully led the roll-out of the vaccinations in our town hall and he is extremely experienced. He says, “A greater understanding is needed as to why doctors are leaving the profession. It is clearly multi-factorial across the generations. One of the reasons includes pension rules. These penalise staff wanting to work more hours due to capped taxation rules, deterring senior staff from staying, and may lead to a significant exodus from the profession. In these circumstances, it is essential that far more effort is put into projecting future workforce numbers and how many are required to meet future need.” In my judgment, Dr Rahul Dubb is absolutely right in what he is saying.
The second reason is that the Government should listen carefully to what my right hon. Friend has said. During his time as Health Secretary—no one in the House has been so long at the crease and has as much experience as him—he significantly increased the number of doctors who will be trained. We were particularly pleased in Birmingham to see the additional work that Aston University has been able to do to bring those who might have felt themselves excluded from the medical profession into contention, so that they could go to university and achieve their ambition of qualifying as medics. Having that sort of analysis—the analysis that is behind his amendment—is right in securing value for money. I have been dismayed that when we had the measures to increase national insurance earlier this year—this was greatly to the credit of the Government for grasping a nettle that so many have not grasped before—those on the Treasury Bench were extraordinarily disinterested in checking that value for money for this additional taxpayer spend was achieved. When I suggested that we should account to our constituents through the Treasury, making certain that we understood where this £1.2 billion was going, the answer from those on the Treasury Bench was extremely lacklustre. Ensuring value for money and that we get these judgments right will save money and, for the reasons that have been set out, will make medicine and the treatment of our constituents that much safer. As my right hon. Friend set out, the whole sector is united behind this amendment, and the Government should hear that loud and clear.
Dawn Butler (Brent Central) (Lab)
I rise to speak in support of new clause 12, which stands in my name and those of many hon. Members across this House, on the protection of the title of “nurse”. The Government’s response to Alison Leary’s petition implies that we are on the same page on the issue of protecting the title. As the Minister said, this is not a party political thing; it is about the safety and protection of patients and the public. I hope that the Government will vote in favour of new clause 12 today, as it is long overdue and brings nurses into line with paramedics and physiotherapists in terms of the protection of titles.
It is shocking that anybody can call themselves a nurse, whether or not they have any qualifications or a first aid certificate—they may have no qualifications at all and they can call themselves a nurse. As we know, when someone calls themselves a nurse, that gives them a certain standing in society and people automatically think they know what they are doing. The nursing profession has some harrowing stories of parents taking advice from somebody who called themselves a nurse but was not one, and the tragic and devastating consequences. It is really important that we have the opportunity to put this right today—in fact it would be dangerous not to do so. Throughout the pandemic, people have been struck off as nurses, yet they are still using the title of “nurse” as they publicly deliver misleading and dangerous information about the pandemic. The public and patients have the right to know that the treatment and advice they receive is from a registered healthcare professional.
Many other countries protect the title of “nurse”. The protection of the title is supported by more than 70 nursing organisations, including the Queen’s Nursing Institute, the Institute of Health Visiting, charities, those representing the public using health and social care, Unison Health, Unite and the Royal College of Nursing and its Professional Nursing Committee.
Taiwo Owatemi (Coventry North West) (Lab)
I would like to put on record my support for nurses, particularly on Nursing Support Workers’ Day. Does my hon. Friend agree that the priority that nurses are asking for and that NHS staff are looking for is not restructuring, but investment in resources, a plan to address the staff shortages and retention struggles that the NHS has, and a clear strategy to address the winter waiting times and demands on services such as operations and GP services?
Dawn Butler
My hon. Friend makes a valid and valuable point. One way we can show our appreciation for nurses’ work is to protect their title, but we should not do that instead of addressing any of the issues she mentioned, along with ensuring that they receive a pay rise.
I thank the people who have petitioned for the change in my new clause for a number of years, including the former Secretary of State, the right hon. Member for South West Surrey (Jeremy Hunt), who is no longer in his place but supports my new clause; the Labour Front-Bench team; Ann Keen; the chief nursing officer for England, Ruth May; Professor Mark Radford, the chief nurse at Health Education England; the previous chief nursing officer for Northern Ireland, Charlotte McArdle; Andrea Sutcliffe, Matthew McClelland and the Nursing and Midwifery Council; Mr Paul Trevatt; Professor June Girvin; Dr Crystal Oldman; Ms Shamim Donatta Ayiecho; Ms Leanne Patrick; Mr Gerry Bolger; Ms Catherine Eden; and the Florence Nightingale Foundation leadership scholars. The Government know that there is a lot of support for new clause 12 and I hope it passes today.
Caroline Nokes (Romsey and Southampton North) (Con)
It is a pleasure to contribute to this debate and specifically to speak to new clause 1, tabled in my name and the names of the right hon. Member for North Durham (Mr Jones) and many other Members throughout the House. First, though, I pay tribute to my right hon. Friend the Member for South West Surrey (Jeremy Hunt) for his incredibly important amendment on the workforce. I also pay tribute to my hon. Friend the Member for North West Durham (Mr Holden) for his crucial new clauses on virginity testing and hymenoplasty. As the Chair of the Women and Equalities Committee, I was pleased to be able to support those amendments and am delighted that the Government have introduced their own new clauses on those issues.
I wish to talk specifically about aesthetic non-surgical cosmetic procedures, which may seem quite trivial in comparison with the important matters I just referred to, but I vividly remember visiting a doctor in my constituency and talking to her about her experience when a patient came to her after she had had far too much lip filler placed into her lips by an unqualified and inexperience practitioner. The poor girl’s lips had, frankly, exploded, leaving her permanently scarred and with the prospect of many years of corrective surgery to try to rebuild her face. That is the stark reality.
The hon. Member for Brent Central (Dawn Butler) spoke about people being able to call themselves nurses when they are not nurses; aesthetic cosmetic practitioners can not only call themselves that but perform all sorts of procedures, some of which we would find it bizarre and disturbing to talk about and, indeed, at some of which we might look with absolute horror when they are reported on the internet and in the pages of national newspapers. I am talking about semi-permanent make-up and permanent tattooing, which can leave people permanently disfigured. The semi-permanent variety can fade to leave people with bizarre blue eyebrows that require many different procedures to be put back to normal. The list is long: we are talking about tattooing, botox and laser treatment—just imagine the damage that high-powered lasers can do to somebody’s skin when in unqualified, untrained hands.
Dr Whitford
Along with the damage to patients who trustingly go for such procedures, is it not also about the fact that when they go horrifically wrong, as sometimes they do, it is the NHS that ends up having to pick up the pieces?
Caroline Nokes
I thank the hon. Lady for using exactly that term because she is right: it is about the NHS picking up the pieces and spending taxpayers’ money trying to correct something that should not have been done in the first place. If it is to be done to somebody, it should be done only by the qualified, trained and, as my new clause argues, licensed. I call today for some form of licensing or regulation. I absolutely accept that the Minister may view my new clause as deficient and not doing what he would want it to do. I appreciate the fact that he took the time to meet me and other Members last week to discuss the issue, because there are concerns throughout the House.
I pay particular tribute to my hon. Friend the Member for Sevenoaks (Laura Trott), who has done so much work on injectables in respect of under-18s and deserves absolute credit for getting her private Member’s Bill on to the statute book. That is amazing work and I really appreciate the fact that she has done it. Nevertheless, we need to do more and to go further.
I pay tribute to a number of my constituents who, following the work I did last year on the beauty industry, approached me on this issue. In particular, I pay tribute to Dr Chris Rennie of Romsey Medical Aesthetics, and to Dr Mitra Najafi, who has developed an incredible process by which plasma-rich platelets are extracted from a patient’s blood and injected back into them. It is a highly medicalised procedure and her big worry is that if it falls into the hands of somebody who is unregulated and unlicensed, it could be extremely dangerous indeed. Those with medical qualifications absolutely understand how they have to treat blood products; the stark reality is that those without do not.
I pay tribute to aestheticians—I struggle to say that word—such as Naomi O’Hara who came to me, as someone who practises, to call for regulation and licensing.
I pay tribute to a lady who is not my constituent but travelled to Romsey to see me: Tania Gough, who publishes the Image Directory. Her concern was that it is perfectly possible for someone to set themselves up in practice with next to no training whatsoever. She spoke to me of some of the horror stories that she herself had seen and some of the training courses she had gone on that she said were quite simply not worth the money she paid for them or the waste of her time. She said that certificates were issued at the end of such courses that gave the impression that people were qualified and trained when in fact they had had no more than a couple of hours—in one case it was 90 minutes—of training.
I also pay tribute to the Chartered Institute of Environmental Health and the Joint Council for Cosmetic Practitioners; they have been incredibly supportive and helpful in the drafting of new clause 1. The Joint Council for Cosmetic Practitioners says:
“The creation of a national licensing scheme for practitioners of aesthetic non-surgical cosmetic procedures would ensure that all those who practise are competent and safe for members of the public.”
To my mind, that is the abiding word: safe. We want those who receive these sorts of treatments not to be putting themselves in harm’s way.
I look forward to the Minister’s response; I know he is listening on this issue. He can expect me not to push my new clause to a vote, but I very much hope he can show us a constructive way forward that may take us to the regime that we want to see.
Tonia Antoniazzi (Gower) (Lab)
I could speak about so many aspects of the Bill—such as the U-turn on the social care cap, the lack of action to include health inequalities, allowing private healthcare providers to access our NHS and, frankly, whether a reorganisation of the NHS at this time of crisis is what we need to support all our healthcare workers—but I am sure that colleagues will more eloquently cover a lot of those points in their contributions. As the chair of the all-party parliamentary group on cancer, I will restrict my comments to the amendment on the NHS workforce tabled by the right hon. Member for South West Surrey (Jeremy Hunt).
Staffing is the biggest challenge facing the NHS. The Prime Minister claims to be building 40 new hospitals; if that ever happens, they will be of no use to anyone if there are not the doctors, nurses, radiotherapists, pharmacists, porters, cleaners and other staff to look after patients. As we have already heard, the NHS had 100,000 vacancies before the pandemic started. That, coupled with the intense strain and burnout that staff have suffered over the past 18 months, is causing a crisis in staffing that needs bold action now.
The Budget was a missed opportunity to invest in the people who make the NHS great, but amendment 10 would go some way to rectifying that. According to research from Macmillan, it is estimated that we need an extra 3,371 cancer nurse specialists by 2030—that is a doubling of the number of cancer nurses in just over eight years if we are to have any chance of providing the care and support that patients deserve. Macmillan has worked out that it would cost £174 million to train and develop specialist cancer nurses to plug the gap. Any increase in funding would be passed on to devolved Governments through Barnett consequentials. In the grand scheme of things, £124 million in England, £31 million in Scotland, £12 million in Wales and £7 million in Northern Ireland is not too much to ask of the Government—it is probably in the region of the amount of money spent on security for the Prime Minister’s trip to Peppa Pig World at the weekend.
Richard Graham (Gloucester) (Con)
I rise to speak on amendment 10. I want to start by relaying a conversation that I had soon after being elected 11 years ago in Gloucester. I talked to the chief executive of a hospital trust—he has subsequently moved on—and asked him how many nurses a year we needed to replace those who have retired and resigned, and to cope with increasing demand, not just in the hospital trust but including district nurses and nurses to cover the whole panoply of our needs in the county of Gloucestershire. He explained that we needed roughly 400 a year at that time. I asked him how many we were training. He said that the University of the West of England trains around 120 graduates a year from its nursing outlet in Gloucester. How do we meet the gap, I asked, and he said, “Well, we advertise. We try to encourage people from London to look for a change in their lifestyle and we recruit from abroad.” I asked him where that got us to. He said, “Well, it increases the numbers, but it never gets us enough. We struggle with a permanent shortfall of recruitment.”
Over the next few years, I worked on three things. The first was to support the Government push to create nursing associates. The second was to encourage the University of Gloucestershire to become a nursing teaching university and to submit an application to get pilot project status for the nursing associates’ training. Both of those came to pass. They were a credit to the Government, a credit to the university and a credit to the Nursing and Midwifery Council that supported them. None the less, we were, and are, still short; that gap has not been closed.
One other thing that I have done recently is to support the close engagement with the Government of the Philippines, who have kindly allowed us to carry on recruiting nurses from the Philippines to the United Kingdom during the pandemic. I ask everyone here to join me in paying tribute to the roughly 35,000 nurses from the Philippines who have made such a difference to our NHS. All those things have helped, but anyone who has played the role that all of us in this House have over the past two years will know that the people problem is the greatest problem that we have.
I chaired, first every week and now every two or three weeks, a meeting between all the MPs in Gloucestershire, the heads of the NHS trusts, public health and the county council. Time and again, the same issue comes up in a slightly different way: it is about people. Yes, we could build extra wards. Yes, we could convert offices into wards. Yes, we could build bed capacity, but we do not have more people to look after the patients in them. Yes, we have plenty of spaces in care homes, but we need to be able to send people back to their home from hospital, because that is how they recover best, and we do not have enough domiciliary care workers.
We have gone round and round for the past 10 or 11 years on this issue of staff—doctors in primary care surgeries, nurses everywhere and domiciliary care workers. I do not believe that we can resolve this problem until we start planning for the needs in different parts of the country and then working out how we can provide the training, the skills and the recruitment of individuals to make that happen. Of course it will not be perfect. Of course disasters such as the pandemic will make a bad situation much worse. We recognise that, but until we start that process, I do not believe that things will change. For as long as I am MP for Gloucester, I am absolutely certain that I will be having the same conversations about human resources—the people who deliver the care and health that all the people in my constituency and across the county and country need and deserve. It is not the best use of MPs’ time to constantly have to sit down with our health professionals in local NHS trusts to work out how we are going to mind the gap. That whole process has to be started from higher up, in the Department of Health and Social Care.
Today, we have an amendment that has enormous support not just from the Select Committee that my right hon. Friend the Member for South West Surrey (Jeremy Hunt) chairs, but from outside this House from the royal colleges, the NHS trusts and many others beside. I am frustrated that the Government have so far not indicated whether they will accept the amendment. In their hearts, the Minister and his colleagues, all good people trying to do their best, recognise that this problem will have to be tackled. Perhaps part of the solution will be in the White Paper that we are all so eagerly waiting for and that we wish that we had been able to have a few days ago, before the votes last night, on which I supported the Government on the basis of trust. None the less, there comes a time when we have to say and vote for what we believe in. I do believe that we need this change and that the Government can and should do it, and I will vote for it.
Mr Kevan Jones (North Durham) (Lab)
I rise to support new clause 1, which stands in the name of the right hon. Member for Romsey and Southampton North (Caroline Nokes), myself and 18 other right hon. and hon. Members from across the House. I first took an interest in this subject through a constituent, Dawn Knight, from Tanfield in my constituency. Dawn raised issues around the cosmetic surgery industry having been a victim of a particular hospital group. She has been a tireless campaigner in ensuring not only that victims get a voice, but that we press for more regulation.
I join others in paying tribute to the all-party group on beauty, aesthetics and wellbeing for its recent report and to my hon. Friends the Members for Swansea East (Carolyn Harris) and for Bradford South (Judith Cummins) for their work on that report, which highlights what my hon. Friend the Member for Ellesmere Port and Neston (Justin Madders) called the “wild west”. That is exactly what it is: it is a wild west without any regulation. It is a multibillion-pound industry, which is not only putting people at risk, but costing the NHS money.
In April 2013, the Health Secretary at the time—Andrew Lansley, now Lord Lansley—commissioned Sir Bruce Keogh to carry out a review of the regulation of cosmetic surgery. The review came out not only when we were having problems in the sector itself, but when interest was heightened around Poly Implant Prothèse breast implants, which people will well remember. When the review concluded, it explicitly advised the Government to increase regulation of the cosmetic surgery industry to prevent unlicensed treatments and increase patient safety. The review stated that a person having a non-surgical procedure
“has no more protection and redress than someone buying a ballpoint pen or a toothbrush”,
and
“dermal fillers are a crisis waiting to happen.”
As the right hon. Member for Romsey and Southampton North said, that crisis has actually happened already.
I have been campaigning on this issue for a number of years, during which time I have gone through a succession of Health Ministers, all of whom have come back with two points. The first is, “We are going to implement the Keogh recommendations”. But because Ministers were too terrified previously to make any health legislation, they were reluctant to bring those recommendations forward in that way.
The only good news in the area has been private Member’s Bill of the hon. Member for Sevenoaks (Laura Trott), the Botulinum Toxin and Cosmetic Fillers (Children) Act 2021. That legislation was tightly focused—as all private Member’s Bill have to be—and banned botox injections for under-18s. I congratulate the hon. Member on that work. However, any other regulations have been left unfinished. I have sheaves of letters from former Health Ministers saying, “The Keogh recommendations will be implemented”, but they have not been to date. If we do not do that in this Bill, when will it be done? I doubt that the Department will come forward with a Bill just to implement those recommendations; that is wishful thinking.
There is clearly no regulatory framework in the UK at present for those performing aesthetic non-surgical cosmetic treatments. The area is completely unregulated and lacks any national standards. There is no consumer protection, education, training or qualifications for those administering such treatments. As my hon. Friend the Member for Brent Central (Dawn Butler) said, some people call themselves nurses with no qualifications whatever. There is a huge discrepancy between the standards and qualifications of the training of these people. The other side of the issue, to which I will turn in a minute, is the regulated system, which, frankly, is failing as well.
The right hon. Member for Romsey and Southampton North raised the issue of training. If hon. Members visit any website tonight, they will see huge adverts saying, “Become a dermal filler specialist: training and qualification online within half an hour”—even less time in some cases. The people offering such services have no qualifications whatever, because the qualifications are not worth the paper that they are written on, but these people start carrying out invasive procedures without anybody stopping them. They can do it in a kitchen, or in any area that has not been clinically cleaned and is not of a standard that we would expect for medical procedures. It is a multimillion-pound racket that includes both the people offering the training and those carrying out procedures. It is an increasing issue, which needs to be addressed.
We also need to address the issue of advertising. As I have said before in the House, the Advertising Standards Authority is frankly a complete waste of time. If hon. Members go on any website tonight, or even open the national newspapers, they will see people advertising these services—potentially dangerous procedures—without any qualifications. We might ask, “Why would people have these procedures?” Well, I suggest that everyone reads the Mental Health Foundation’s 2019 report on body image, which shows the increasing pressure on young people.
The right hon. Member for Romsey and Southampton North is correct that this issue mainly affects young women, but it is increasingly an issue for some young men. The pressure of factors such as advertising and photo enhancements lead people to think that there is the perfect individual, but—apart from you, Mr Deputy Speaker—I am not sure that there is. The foundation’s reports highlights the pressure that is put on young people, but particularly young women. If they look at prices for procedures, they end up going to people who are completely unqualified. It is a scandal that there is no legislation to prevent this.
Paul Bristow (Peterborough) (Con)
I rise to speak to amendment 10 in the name of my right hon. Friend the Member for South West Surrey (Jeremy Hunt). I refer Members to my entry in the Register of Members’ Financial Interests.
I have spoken in the House before about being involved in health policy for about 20 years. The same thing tends to happen every three or four years: the NHS says it needs more money, it needs more capacity and it needs a plan, and that is what we are doing again in the Bill. When we talk about more capacity, we mean not just more hospitals, more theatres and more diagnostics, but a bigger workforce. Thanks to this Government and the investment that has been made, I do not think anyone with any credibility can now say that the NHS does not have enough money. NHS England’s resource budget will rise to £162.6 billion in 2024-25—a 3.8% average annual real-terms increase. The Government also plan to spend a further £8 billion to tackle the elective backlog. This is the biggest ever catch-up programme in our NHS for elective surgery. Department of Health and Social Care capital spending will rise to £11.2 billion by 2024-25. I repeat: I do not think that anyone can say with any credibility that our NHS is now underfunded. We have the new diagnostic centres. We have the new pathways that should be adopted to increase NHS productivity. A long-term deal with the independent sector can ensure that we have the capacity to power through the elective backlogs—the hip and knee, hernia and cataract procedures that make up the vast majority of cases.
Of course, we need the nurses, the doctors and the consultants—the workforce—to carry out those procedures. This is a historical problem; it did not just happen overnight. All past Governments and, I dare say, past Secretaries of State for Health and Social Care have a degree of responsibility for this. As my right hon. Friend the Member for South West Surrey said, there are an estimated 93,000 vacancies in our NHS—consultants, GPs, nurses and allied health professionals. I was proud to stand on a manifesto at the last election that pledged to increase the number of healthcare workers in our NHS, and I know that considerable progress has been made, but just as the Government are doing with social care by putting in place a plan that focuses, laser-like, on resolving some of the long-term issues we face in that sector, we need the same laser-like focus to deal with some of the challenges with our NHS workforce. Any changes we make to our NHS workforce, or any long-term plans, need to reflect the real needs of our NHS. That is incredibly important. Some sort of duty to report independent figures about how we will make up the workforce is a very sensible measure.
Many years ago, I worked with the British Society of Interventional Radiology. The proposals we made and the work that we called for then were about workforce. Some argued that a lot of people were reaching the end of their professional career and retiring and there was a lack of new people coming through, so ultimately this would have an impact on patient care—on the number of procedures that could be carried out. The same arguments are now being made across a number of disciplines. Since I became an MP, I have met the Royal College of Surgeons and the Royal College of Physicians, and the same arguments are being made there. It is sobering to think about these challenges, and that is why this laser-like focus has to be considered very carefully.
We have talked about overseas recruitment. I heard what my right hon. Friend the Member for Sutton Coldfield (Mr Mitchell), who is no longer in his place, said about that, and he made a very powerful argument. In some ways, we are going to have to use overseas recruitment to plug the gaps in our NHS, but there are other solutions. We have heard hon. Members talk about retention. I was alarmed and shocked by the number of healthcare professionals who—understandably—wish to work part-time because they are parents and they have childcare responsibilities. I understand that, but it is going to leave our NHS with recruitment challenges.
When I speak to clinicians—members of the Royal College of Surgeons and others—they talk to me about the ability to work independently and autonomously. Many clinicians want that ability, but do not feel that they have it. There is also the idea that they want to be part of something bigger than their own small team. It is not that they want to be part of this thing called the NHS and that they are all working towards that goal; it is more that, once we have come through the challenge of the pandemic—once we have got ourselves over that mountain—there is an even bigger mountain ahead of them, which is dealing with the elective backlog, where they feel that things never change. That is what I have been told, and those are very powerful things.
What are the solutions to this problem? Ministers need to think about how we can encourage our consultants, our GPs and our medical professionals to practise at the top of their licence. Speaking to medical professionals, I have been told alarming things. About 40% of a GP’s time is spent on sickness notes or providing medical records to insurance companies and other people. That is admin staff work. As valuable as those admin staff are, that is not what GPs and medical professionals went into their professions, and went to medical school for all that time, to do. It is absolutely right that that burden be lifted from our medical staff and placed elsewhere. Nurse-led prescribing has existed for quite some time, but we have not really had the push and the drive there that we should have. GPs should not be spending their time prescribing very simple things such as the pill. We can certainly be doing a lot better and working a lot more productively, as my hon. Friend the Member for North East Bedfordshire (Richard Fuller) said. This is not about working harder; it is about working smarter.
Clive Lewis (Norwich South) (Lab)
Listening to the hon. Member’s speech, I think he is giving the game away in some ways, because what I am hearing, if I understand him correctly, is that he wants to see a core of healthcare provided by the NHS and then the more lucrative parts of the NHS—administration and other parts—siphoned off to the private sector, which is a model we have seen in the US and which this Bill makes so much easier.
Paul Bristow
I would ask the hon. Member to listen a bit more carefully, because nowhere have I said admin should be carried out by the private sector. I said that it should not be carried out by medical professionals. They did not go to medical school to work in admin; they went to medical school to treat the sick. That is what we want our medical professionals doing—operating at the very top of their licence.
I also do not want to see situations where untold numbers of consultants are spending just one day a week in the operating theatre. I understand that consultants need the opportunity to train junior colleagues and to continue their own professional development, but they should be operating in our theatres a lot more frequently than that.
Dr Whitford
I gently point out that surgeons do not just operate—we run clinics; we run endoscopy lists and colonoscopy lists—so it is not that they are only working one day a week. They investigate the patient before they operate, and that is one of the strengths of the system in the UK in comparison to other countries, where surgeons only operate and someone else has done the diagnostics.
Paul Bristow
I agree with the hon. Lady that surgeons work incredibly hard. What I am talking about is operating at the top of the licence and for our consultants to be able to do the things that we want them to do. She is absolutely right; they are doing vital work in other areas running clinics and so on, but ultimately what we have is an elective challenge, and we need to ensure that we spend as much time addressing that elective challenge.
Dr Ben Spencer (Runnymede and Weybridge) (Con)
Does my hon. Friend agree that one of the challenges for primary care is that general practitioners have absorbed a great deal of the role of social advocacy in our society? People are trying to get a face-to-face GP appointment, and it is sometimes being suggested to them that such things as getting a fitness note or a letter to go to a school might be better served by someone else in the wider multi-disciplinary team. People are getting frustrated, because our messaging about how to use the health service and the different range of roles and responsibilities offered is sometimes getting a bit diluted.
Paul Bristow
My hon. Friend speaks with much experience and makes a powerful point. I think he would agree that that core admin function is not what he went into medicine to do. He went into medicine to treat patients. I am grateful that the Minister laid out some of the plans that the Government have to deal with this issue. It is right that we should be looking to the long term, and the 15-year framework for future workforce is to be welcomed, but there also needs to be a much more regular reporting mechanism attached to that to ensure that we as Members are informed, but more importantly the NHS is informed, about how that challenge is going. The integration between NHS England and Health Education England—aligning the delivery arm and the workforce capacity arm—is probably also the right thing to do.
I end with this point: the challenges around workforce will be addressed not only by employing and training more NHS staff, although that is crucial—that is why I have some sympathy for amendment 10—but by ensuring that we work more productively by asking clinicians to operate at the top of their licence. It is also about ensuring that the NHS works smarter. We have created organisations such as Getting It Right First Time and NICE and asked them to go away and do the hard work of coming up with the most cost-effective and efficient ways of delivering care. If we ask those organisations to come up with the pathways and the ways of doing these things, surely it is only right that the NHS then adopts them instead of sitting there and saying, “These things will not necessarily work here.” We ask experts to come up with the right way of performing procedures; I suggest we go ahead and adopt them.
Sarah Olney (Richmond Park) (LD)
I rise to speak in support of amendment 10, tabled by the right hon. Member for South West Surrey (Jeremy Hunt), the Chair of the Health and Social Care Committee, because the amendment reflects the key issue facing the NHS and all our health and care services at this time: the workforce. Access to healthcare services is the No. 1 issue raised with me by constituents at the moment, and I know that concern is being echoed in other constituencies across the country.
People are experiencing the issue in many different ways. Some are struggling to get a GP appointment. I regularly speak to parents in great distress because of the lack of available help for their children’s mental health needs. The accident and emergency department at Kingston Hospital in my constituency has regularly had to ask patients to consider whether there are more appropriate sources of help for their needs. Patients waiting in the backlog of elective procedures are regularly having appointments rescheduled or cancelled. Ambulances do not always arrive when called.
The impacts are many and various, but when I speak to health service leaders in my local area, the answer is pretty much the same: there is a lack of available staff. Even in cases where lack of funds is not in itself a limiting factor, the lack of people with the relevant skills makes it impossible to fill all the vacancies they are able to pay for.
Many of these problems are covid-related. The current NHS waiting list is estimated to be over 6 million, and it is clear that much of that is because so many elective treatments were delayed during lockdown. Demand for mental health services has accelerated because of the impact of the lockdown, particularly on young people. Covid is still with us, of course, and workforces in every part of the economy are being impacted by the need for individuals to isolate when they have symptoms or test positive. Healthcare staff need to be more vigilant than the rest of us.
Many of these problems are also Brexit related. A lot of young Europeans decided to return to their home countries at the start of lockdown and have not since returned. Brexit has stymied our ability to recruit from the EU, shutting off an extremely important supply for all parts of the labour market, but the effect is being felt most markedly in health and social care, since it is having to manage the extraordinary demand of a global pandemic at the same time.
Many of these problems are also the result of a long-term failure to correctly predict or prepare for workforce demand. One of the huge advantages of a national health service is that it is possible to get clear data from right across the sector and to make appropriate plans and decisions. For some reason, that has not been done, and it is absolutely right that the Government should adopt amendment 10 to start to put that right.
I want to amplify a Backbench Business debate that I was able to bring to this Chamber a few weeks ago, in partnership with the right hon. Member for South Northamptonshire (Dame Andrea Leadsom) and the hon. Member for Newcastle upon Tyne North (Catherine McKinnell). It was on the subject of giving every baby the best start in life, and it was the firm view of all who attended that debate that the health visiting workforce needs to be substantially boosted to enable all new parents to receive a home visit from a trained healthcare professional. During the course of that debate, we heard of the many ways in which a health visiting workforce can support new families and the critical role they play in supporting babies and their families. One estimate is that the cost of poor parental mental health in the first year of life is more than £8 billion. It is clear that the cost of boosting our health visiting workforce would more than pay for itself in a very short time.
I also want to reflect briefly on a conversation I had with a constituent in the street in Richmond town centre on Saturday. Despite having two degrees, she was working in the care sector, and she was talking to me about her terms and conditions of work. She is employed by an agency and is not allowed to engage with any other agency. She is on a zero-hours contract, so she has to sit at home and wait to hear how many hours she might be required to work the following week. For various reasons that suits her, but I feel that it underpins the recruitment crisis we are experiencing in our social care sector, because that is no way to retain skilled and committed staff.
Mr Kevan Jones
Does the hon. Lady agree that it is not just about levels of pay and uncertainty for those individuals, but ensuring that we nationally accredit the qualifications of those individuals and address the career paths that do not exist in those sectors at the moment?
Sarah Olney
The right hon. Gentleman is absolutely right, and that is the point I want to make: we need to boost the status of our care home staff and improve their terms and conditions. We need to improve their pay. This lady who I spoke to on Saturday was telling me that she gets paid for the hours she spends in people’s homes, but not the time spent travelling in between. It is clear to me that the crisis of staffing we are experiencing in our care sector—I think every one of us as MPs is hearing about it regularly from our constituents, who are at the sharp end of that—is as much about workforce planning and improving terms and conditions. The Government needs to give that the most urgent attention, and amendment 10 would go some way to resolving that, although it will not resolve it entirely.
I know that Ministers will push back against the cost of boosting the workforce in all areas of the NHS, but they must surely realise the cost of failing to do so. The right hon. Member for South West Surrey. along with the hon. Member for Central Ayrshire (Dr Whitford), spoke about the cost of locum resource in the NHS. It is not just about the direct cost of locums or of worsening health outcomes as people wait longer for treatment; it is also about the lost productivity of days off sick, the cost of poor mental health as lives are put on hold and, as has been mentioned many times, the cost of exhausted and demoralised staff who are overwhelmed by the demands on the NHS. We cannot afford to continue to fail to effectively plan our healthcare workforce.
I am also very happy to support the amendments tabled by the hon. Member for North West Durham (Mr Holden) on virginity testing and hymenoplasty. I am delighted that the Government are adopting the provisions on virginity testing. We still have much to do to make this country a safe place for women and girls, but all progress is to be welcomed, and I am very glad that this opportunity to bring to an end the degrading practice of virginity testing has not been lost. I congratulate the hon. Member for North West Durham on all the work he has done and, although they may have left the Chamber, the representatives of the other charities referred to earlier. I hope in due course we will see the provisions for hymenoplasty as well, when the review has concluded.
Mr Deputy Speaker (Mr Nigel Evans)
I have three people indicating that they wish to speak. I ask people to make really short contributions, because I want to give the Minister six minutes to wind up and we will then go into the votes at half past.
Matt Warman (Boston and Skegness) (Con)
I will be brief, Mr Deputy Speaker. I should declare that I am married to a doctor.
Staff are the No. 1 priority for the health service, and have been historically for this Government, so I will support the Government today, but somewhat through gritted teeth. I implore the Minister to include a few things in his 15-year review. I ask him to engage with the feeling of staff, which we have all heard about: if there are fundamentally not enough staff within the system, it is impossible for them to feel that they can do the job they went into medicine to do as well as they possibly can. I know his plans in this 15-year review will address some of that, but I hope he will also address the fact that there is a huge role to play for technology and for the increasing integration between health and social care. If more patients are stuck in hospitals because they cannot be sent on to the social care system, then we need more doctors to staff those hospitals.
I hope the Minister will consider those multiple facets in the review, and also consider that perhaps more important than anything else is how we retain staff. Even if we are putting more and more people into the beginning of a career pipeline, we will never be able to fill up that pipeline sufficiently if people, whether for pension-related reasons or a whole host of other reasons, are leaving more rapidly than we currently imagine they will in the planning.
That retention aspect has to be a hugely important part of the review. I hope that the possibility of addressing all those multiple factors will be core to what the Minister has been talking about. As others have said, I also hope he will be as transparent as possible within that, and that he or his Department will come to the House to make those plans transparent. Fifteen years is good, and transcends the political horizon that so often derails good intentions for the NHS, but the more transparent we can be, and the more support we can give to recruitment, retention, technology, social care and a host of other issues, the less my teeth will be gritted as I support the Government today.
Mr Holden
I shall keep my comments very brief. I apologise to the Minister for not having been here for his speech, because I was with one of his colleagues in my constituency earlier today.
I welcome what the Government are doing today in new clauses 36 to 48. There has been a huge campaign for a long time by people from so many different organisations, particularly Natasha Rattu of Karma Nirvana, Sara Browne and Payzee Mahmood from IKWRO, Halaleh Taheri and Natasha Feroze at the Middle Eastern Women and Society Organisation, Rosie Walworth and Zoe Russell from the Royal College of Obstetricians and Gynaecologists, who have worked closely with me over the past few months, Janet Fyle from the Royal College of Midwives, barristers Dr Charlotte Proudman and Naomi Wiseman and consultant gynaecologist Dr Ashfaq Khan, who did some excellent briefing for us in earlier stages of the process. I also thank Adam Mellows-Facer and Huw Yardley from the Public Bill Office, who did some excellent work with my office manager, Robbie Lammas, who has kept going on this throughout.
I am pleased that the Government are coming forward with the amendments on virginity testing today. I particularly welcome the fact that they are UK-wide and have had support from scores of Members, including the hon. Member for Richmond Park (Sarah Olney), the former Health Secretary, my right hon. Friend the Member for South West Surrey (Jeremy Hunt), and many other hon. Members from across the House who I can see here today.
It is excellent that the Government have listened so much and responded so thoroughly. I would like to hear the Minister talk about new clause 22, which I tabled today, on hymenoplasty. I know we are on Report, but I want his assurance that, if all goes well, we should see those amendments to this Bill in the House of Peers before too long. It is vital that banning hymenoplasty and banning virginity testing go hand in hand.
Derek Thomas (St Ives) (Con)
I rise to speak on amendment 10 on workforce planning, in the name of my right hon. Friend the Member for South West Surrey (Jeremy Hunt). However, surely the Government’s urgent priority is to look at effective ways to attract back into the NHS all those consultants, nurses and social care workers who have left, and to find any way they can to bring back that experience and expertise.
With your permission, Mr Deputy Speaker, I would like to talk about some lived experience. Just last Friday, I came across a lady who had fallen over and clearly injured herself. I phoned 999, knowing full well that I would be entering a system under severe stress and pressure. I confess that, as it happened. I put the phone down, because the priority for me was to ensure that she was safe, warm and comfortable.
The ambulance service called me back and told me it would be a wait of several hours. I knew that that was caused by the pressure on the ambulance service and on A&E and the subsequent pressure on beds, hindering the effective and timely treatment of people who go to hospital. The pressure on admission to A&E also affects surgery. All that pressure goes down to one place in Cornwall, and Cornwall will not be unique: delayed transfers of care.
We have been in this place before: in 2016, a system-wide review of the situation in Cornwall found far too many people who would be better off in the community, being looked after in homes or care homes, but were stuck in hospital. In Cornwall today I understand the figure is more than 100 people in that exact situation. The pressure on the whole system is largely to do with those delayed transfers of care. While much has been said about the workforce planning for the NHS, I will quickly touch on workforce planning for the care workforce.
The emphasis on workforce planning should transform the current state of the care workforce, leading to better support, better training, better pay and better status. I am hopeful that the White Paper will address that, as it is the only way to effectively ease the pressure on acute NHS settings. There is an urgent need to understand and address the pressure on care staff, GP practices and community care across the board.
Maybe I should have said this at the beginning, but I chair the all-party parliamentary group on diabetes. Several years ago, we found that, in the whole of the south-west, training for podiatry was coming to an end because of a lack of funding and the way it was delivered across the region. That had an immediate impact on community care and how people could be cared for and enabled to live with and manage their condition, which ultimately puts more pressure on urgent care.
As we look at workforce planning and how to understand exactly what is needed, I particularly thank the NHS staff who have worked so hard, especially those I met at the beginning of the year, who, as they delivered the vaccine roll-out, told me they were doing it for the national effort. Workforce planning and the commitment to ensuring that we have the workforce where they are needed, with the skills they need, is the best way to reward our NHS workforce.
Edward Argar
This is a little more generous than the six minutes I feared I might have to work with, Mr Deputy Speaker.
If I may, I will address each set or theme of amendments in turn. First, I am grateful to my hon. Friend the Member for North West Durham (Mr Holden) for the work he has done. He rightly highlights that in a sense he is but the voice of the campaigners who have worked so hard on this issue over a very long period. I am pleased that today, while it is not his exact amendment, we have been able to work together to table an amendment that I hope will command cross-party support across the House to deliver on what he has campaigned so effectively for.
I have known my hon. Friend a very long time, so I should not have been surprised by the persistence with which he beat a path to my door to seek to secure agreement on exactly this policy issue.
Mr Holden
Can I just say that the Minister has been absolutely superb in engaging throughout this process? I would like to thank the shadow team as well, who in Committee and today—and throughout—have shown real conviction towards this end. I thank the Minister and his team and also the shadow team for all they have done.
Edward Argar
I am grateful to my hon. Friend, who I think covered both bases there very eloquently. He makes an important point on this issue. The change will make a real difference to people’s lives, so I commend him for his work.
New clause 1 was tabled by my right hon. Friend the Member for Romsey and Southampton North (Caroline Nokes) and would give the Secretary of State the power to introduce a licensing regime for aesthetic non-surgical cosmetic procedures, making it an offence for someone to practise without a licence. I thank her for bringing this to the House today. In that context, I also pay tribute to the right hon. Member for North Durham (Mr Jones); my hon. Friend the Member for Thurrock (Jackie Doyle-Price), who has taken a very close interest in the issue; and of course my hon. Friend the Member for Sevenoaks (Laura Trott) not only for taking a close interest in the issue, but for her success, with her private Member’s Bill, in moving the dial further forward on the issue more broadly.
As I said in Committee, I entirely understand the intention behind the amendment and that a strong case has been made for further regulation in this area. I and the Department are keen to work with stakeholders, including Members of this House on both sides, to see whether we can take this forward in the most appropriate way and clarify the scope of any further regulation. We are happy—we had a very positive meeting, which was alluded to—and I hope that we will be able to continue to explore the issue with hon. and right hon. Members.
In this context, I also commend the all-party parliamentary group on beauty, aesthetics and wellbeing for its important work. Its inquiry highlights the huge range of non-surgical cosmetic procedures available, which vary in their level of complexity and invasiveness. We are carefully considering the findings of that report, including, in that context, its recommendation for a licensing system. We look forward to reporting our conclusions from that work early in 2022. I look forward to working with my right hon. Friend the Member for Romsey and Southampton North and others on that.
Amendment 57 was tabled by the hon. Member for Wirral West (Margaret Greenwood). I can entirely understand where she is coming from—that the professions protected in law must be the right ones, with the right regulatory oversight, recognising that regulation is there for safety. We believe there is no immediate case to change the professions that are regulated, but we will consider whether any new groups of workers should be brought into statutory regulation, and the power to remove professions from regulations would only be used where regulation is no longer required for the protection of the public. For these reasons, we think the approach we are adopting is the right one, but I always reflect on what she says. Even when I do not entirely agree with all of it, I always reflect carefully because she has taken a long-standing interest in these issues.
The hon. Member for Brent Central (Dawn Butler) raised the issue of the title of “nurse” and protection for it. The title “registered nurse” is protected in law. Currently —she is right—the title “nurse” is not protected, given that it is used across multiple professions, including dental nurses, school nurses, veterinary nurses and similar. As has been pointed out by the interim chief nursing officer for Scotland, any change would need careful consideration of the impact on other groups currently using the title “nurse” outside healthcare settings.
I can see the benefit in providing reassurance and clarity for both patients and professionals. I would also note that the protection of a title is only one part of the regulatory system and the complexities associated with that. I understand where the hon. Member is coming from with her new clause 12. What I would say is that any subsequent change could form part of the legislative reform programme for the Nursing and Midwifery Council, which will be taken forward by secondary legislation made under section 60 of the Health Act 1999. But we do not feel we are able to accept her new clause, as drafted at the moment, because we do not feel that it addresses those fundamental challenges.
Edward Argar
If the hon. Member is going to be brief, I will of course give way to her.
Dawn Butler
I was going to quickly say that the Government’s response to Alison Leary’s very good petition says that the Government understand it. We could pass the new clause today and then the Minister could amend it in Committee.
Edward Argar
I am grateful to the hon. Lady, but we have had the Committee. We are now at the stage where we have been through this, and I therefore do not think it would be appropriate to pass an amendment that we thought was flawed in its drafting. I can understand the intent behind it, and I have said that I will continue to reflect on that, but we do not feel we can support the amendment as drafted.
On amendment 10 and new clause 28, hon. and right hon. Members who have spoken to those amendments from both sides of the House have raised something that I think is of huge importance to all Members of this House. As I said in my opening remarks, we all recognise that technology, kit and buildings are all wonderful if we invest in them, but they are nothing without the people—the professionals—who know how to care, are able to care and are able to use that kit to provide the best possible outcomes for our constituents. The workforce are in a sense the beating heart of our NHS, and it is important that I again recognise and join the Opposition in paying tribute to the work undertaken by the workforce.
I appreciate entirely the strongly held, sincerely held and, as ever with my right hon. Friend the Member for South West Surrey (Jeremy Hunt), well-informed views that he brings to this debate, based on his extensive experience. I would extend that to the shadow Minister, the hon. Member for Ellesmere Port and Neston (Justin Madders), in a spirit of bipartisan cordiality. I hope I have been able to help to reassure colleagues just how seriously we take this issues. Hon. and right hon. Members have been right to raise the issue. We reflect very carefully on it. We have already, as I have said, not only set out plans for elective recovery and further reforms to improve recruitment and support for our workforce, but announced yesterday the merger of Health Education England with NHS England, which we believe is an important next step in making sure that workforce needs can be considered in the round. The other key element is, as I say, the development, commissioned in July, of a robust, long-term—15-year—strategic framework for the health and social care workforce.
We are in no way complacent or resting on our laurels in the case of the workforce. Despite the significant progress we have made in recruiting more nurses and more doctors, there is clearly a lot more to do. We recognise that, and I believe it was a point well made by my hon. Friend the Member for Boston and Skegness (Matt Warman). He declared his interest. I do not know whether I need to, but his wife is a friend of mine; I should probably declare that too. He made some important points, a key point being that this is not just about projections for recruitment. It is absolutely right that we are focused, as we are, on the retention of our existing highly trained, highly skilled and highly experienced workforce. We look at what measures we can continue to take to address those challenges.
There is the need to recognise that that workforce—the workforce who are delivering on elective recovery and who are delivering on tackling those waiting lists—are the same people who have been working flat out throughout this pandemic, and emotionally and physically need the space and time to be able to recover. We recognise that and take it extremely seriously. I think it was my hon. Friend the Member for Peterborough (Paul Bristow)—he has jumped around the Chamber slightly in taking his seat—who made the point about reporting and monitoring mechanisms to know how the framework is working and that we are doing the right thing. While we are not, I have to say, fully convinced by the case made by my right hon. Friend the Member for South West Surrey, I take the point made by my hon. Friend the Member for Peterborough about that. I will continue to reflect very carefully on that, on what my right hon. Friend has tabled and on the points he made in debate and in his many meetings with me and other ministerial colleagues.
In the minute or so I have left, I want to briefly touch on the HSSIB amendments, which I know are important, particularly to the hon. Member for Central Ayrshire (Dr Whitford), but I think she reflects broader opinion in this House. As discussed in Committee, the definition given in clause 108(2) is intentionally broad. HSSIB will be carrying out a range of investigations, and we believe it would be impossible to prospectively identify the material that will be gathered and should therefore be protected by safe space. Similarly, while I take the point she makes about senior coroners and coroners’ involvement, we believe that we have struck the right balance in not extending the safe space exemptions more widely, but recognising the unique status that those judicial office holders have.
I hope I have been able to cover the main themes of the amendments tabled in this group. I hope I have been able to reassure hon. and right hon. Members on both sides of this House, particularly in respect of the workforce, just how seriously Her Majesty’s Government take that issue, and the points genuinely and sincerely made by Members on both sides of the House in that context.
Question put and agreed to.
New clause 36 accordingly read a Second time, and added to the Bill.
New Clause 37
Offence of offering to carry out virginity testing: England and Wales
‘(1) It is an offence under the law of England and Wales—
(a) for a person in England and Wales to offer to carry out virginity testing in the United Kingdom or virginity testing that has a sufficient jurisdictional connection, or
(b) for a person anywhere to offer to carry out virginity testing if the person is a United Kingdom national or habitually resident in England and Wales.
(2) Virginity testing has a sufficient jurisdictional connection for the purposes of subsection (1)(a) if it is carried out in relation to a person who is—
(a) a United Kingdom national, or
(b) habitually resident in the United Kingdom.
(3) In this section—
“United Kingdom national” has the meaning given by section (Offence of virginity testing: England and Wales)(4);
“virginity testing” has the meaning given by section (Offence of virginity testing: England and Wales)(2).’ —(Edward Argar.)
This new clause creates an offence under the law of England and Wales of offering to carry out virginity testing.
Brought up, read the First and Second time, and added to the Bill.
New Clause 38
Offence of aiding or abetting etc a person to carry out virginity testing: England and Wales
‘(1) It is an offence under the law of England and Wales for a person who is in England and Wales, or for a person who is outside England and Wales but who is a United Kingdom national or habitually resident in England and Wales, to aid, abet, counsel or procure the carrying out of virginity testing that has a sufficient jurisdictional connection.
(2) Virginity testing has a sufficient jurisdictional connection for the purposes of subsection (1) if it is carried out in relation to a person who is—
(a) in the United Kingdom,
(b) a United Kingdom national, or
(c) habitually resident in the United Kingdom.
(3) This section does not affect the application to an offence under section (Offence of virginity testing: England and Wales) of any rule of law relating to aiding, abetting, counselling or procuring.
(4) In this section—
“United Kingdom national” has the meaning given by section (Offence of virginity testing: England and Wales)(4);
“virginity testing” has the meaning given by section (Offence of virginity testing: England and Wales)(2).’. —(Edward Argar.)
This new clause creates an offence of aiding etc a person to carry out virginity testing in circumstances where the carrying out of that testing might not itself be an offence (depending on the location or status of the person carrying out the testing)
Brought up, read the First and Second time, and added to the Bill.
New Clause 39
Virginity testing offences in England and Wales: penalties
‘(1) A person who commits an offence under section (Offence of virginity testing: England and Wales), (Offence of offering to carry out virginity testing: England and Wales) or (Offence of aiding or abetting etc a person to carry out virginity testing: England and Wales), is liable—In subsection (1)(a) “the maximum summary term for either-way offences” means—
(a) on summary conviction, to imprisonment for a term not exceeding the maximum summary term for either-way offences or a fine (or both);
(b) on conviction on indictment, to imprisonment for a term not exceeding 5 years or a fine (or both).
(c) in relation to an offence committed before the time when paragraph 24(2) of Schedule 22 to the Sentencing Act 2020 comes into force, 6 months;
(d) in relation to an offence committed after that time, 12 months.’ —(Edward Argar.)
This new clause sets out the penalties for the new offences under the law of England and Wales relating to virginity testing.
Brought up, read the First and Second time, and added to the Bill.
New Clause 40
Offence of virginity testing: Scotland
‘(1) It is an offence under the law of Scotland for a person to carry out virginity testing.
(2) “Virginity testing” means the examination of female genitalia, with or without consent, for the purpose (or purported purpose) of determining virginity.
(3) An offence is committed under subsection (1) only if the person—
(a) is in Scotland, or
(b) is outside the United Kingdom, and is a United Kingdom national or habitually resident in Scotland.
(4) “United Kingdom national” means an individual who is—
(a) a British citizen, a British overseas territories citizen, a British National (Overseas) or a British Overseas citizen,
(b) a person who under the British Nationality Act 1981 is a British subject, or
(c) a British protected person within the meaning of that Act.
(5) In subsection (2), “female genitalia” means a vagina or vulva.’
This new clause creates an offence under the law of Scotland of virginity testing.—(Edward Argar.)
Brought up, read the First and Second time, and added to the Bill.
New Clause 41
Offence of offering to carry out virginity testing: Scotland
‘(1) It is an offence under the law of Scotland—
(a) for a person in Scotland to offer to carry out virginity testing in the United Kingdom or virginity testing that has a sufficient jurisdictional connection, or
(b) for a person anywhere to offer to carry out virginity testing if the person is a United Kingdom national or habitually resident in Scotland.
(2) Virginity testing has a sufficient jurisdictional connection for the purposes of subsection (1)(a) if it is carried out in relation to a person who is—
(a) a United Kingdom national, or
(b) habitually resident in the United Kingdom.
(3) In this section—
“United Kingdom national” has the meaning given by section (Offence of virginity testing: Scotland)(4);
“virginity testing” has the meaning given by section (Offence of virginity testing: Scotland)(2).’ —(Edward Argar.)
This new clause creates an offence under the law of Scotland of offering to carry out virginity testing.
Brought up, read the First and Second time, and added to the Bill.
New Clause 42
Offence of aiding or abetting etc a person to carry out virginity testing: Scotland
‘(1) It is an offence under the law of Scotland for a person who is in Scotland, or for a person who is outside Scotland but who is a United Kingdom national or habitually resident in Scotland, to aid, abet, counsel, procure or incite the carrying out of virginity testing that has a sufficient jurisdictional connection.
(2) Virginity testing has a sufficient jurisdictional connection for the purposes of subsection (1) if it is carried out in relation to a person who is—
(a) in the United Kingdom,
(b) a United Kingdom national, or
(c) habitually resident in the United Kingdom.
(3) This section does not affect the application to an offence under section (Offence of virginity testing: Scotland) of any rule of law relating to aiding, abetting, counselling, procuring or inciting.
(4) In this section—
“United Kingdom national” has the meaning given by section (Offence of virginity testing: Scotland)(4);
“virginity testing” has the meaning given by section (Offence of virginity testing: Scotland)(2).’ —(Edward Argar.)
This new clause creates an offence of aiding etc a person to carry out virginity testing in circumstances where the carrying out of that testing might not itself be an offence (depending on the location or status of the person carrying out the testing).
Brought up, read the First and Second time, and added to the Bill.
New Clause 43
Virginity testing offences in Scotland: penalties and supplementary
‘(1) A person who commits an offence under section (Offence of virginity testing: Scotland), (Offence of offering to carry out virginity testing: Scotland) or (Offence of aiding or abetting etc a person to carry out virginity testing: Scotland), is liable—
(a) on summary conviction, to imprisonment for a term not exceeding 12 months or a fine not exceeding the statutory maximum (or both);
(b) on conviction on indictment, to imprisonment for a term not exceeding 5 years or a fine (or both).
(2) Where a person outside Scotland commits an offence under section (Offence of virginity testing: Scotland), (Offence of offering to carry out virginity testing: Scotland) or (Offence of aiding or abetting etc a person to carry out virginity testing: Scotland) the person may be prosecuted, tried and punished for the offence—
(a) in a sheriff court district in which the person is apprehended or in custody, or
(b) in a sheriff court district determined by the Lord Advocate,
as if the offence had been committed in that district.
Where subsection (2) applies, the offence is, for all purposes incidental to or consequential on the trial and punishment, deemed to have been committed in that district.
(3) In this section “sheriff court district” is to be construed in accordance with section 307(1) of the Criminal Procedure (Scotland) Act 1995 (interpretation).’—(Edward Argar.)
This new clause sets out the penalties for the new offences under the law of Scotland relating to virginity testing.
Brought up, read the First and Second time, and added to the Bill.
New Clause 44
Offence of virginity testing: Northern Ireland
‘(1) It is an offence under the law of Northern Ireland for a person to carry out virginity testing.
(2) “Virginity testing” means the examination of female genitalia, with or without consent, for the purpose (or purported purpose) of determining virginity.
(3) An offence is committed under subsection (1) only if the person—
(a) is in Northern Ireland, or
(b) is outside the United Kingdom, and is a United Kingdom national or habitually resident in Northern Ireland.
(4) “United Kingdom national” means an individual who is—
(a) a British citizen, a British overseas territories citizen, a British National (Overseas) or a British Overseas citizen,
(b) a person who under the British Nationality Act 1981 is a British subject, or
(c) a British protected person within the meaning of that Act.
(5) In subsection (2), “female genitalia” means a vagina or vulva.’ —(Edward Argar.)
This new clause creates an offence under the law of Northern Ireland of virginity testing.
Brought up, read the First and Second time, and added to the Bill.
New Clause 45
Offence of offering to carry out virginity testing: Northern Ireland
‘(1) It is an offence under the law of Northern Ireland—
(a) for a person in Northern Ireland to offer to carry out virginity testing in the United Kingdom or virginity testing that has a sufficient jurisdictional connection, or
(b) for a person anywhere to offer to carry out virginity testing if the person is a United Kingdom national or habitually resident in Northern Ireland.
(2) Virginity testing has a sufficient jurisdictional connection for the purposes of subsection (1)(a) if it is carried out in relation to a person who is—
(a) a United Kingdom national, or
(b) habitually resident in the United Kingdom.
(3) In this section—
“United Kingdom national” has the meaning given by section (Offence of virginity testing: Northern Ireland)(4);
“virginity testing” has the meaning given by section (Offence of virginity testing: Northern Ireland)(2).’ —(Edward Argar.)
This new clause creates an offence under the law of Northern Ireland of offering to carry out virginity testing.
Brought up, read the First and Second time, and added to the Bill.
New Clause 46
Offence of aiding or abetting etc a person to carry out virginity testing: Northern Ireland
‘(1) It is an offence under the law of Northern Ireland for a person who is in Northern Ireland, or for a person who is outside Northern Ireland but who is a United Kingdom national or habitually resident in Northern Ireland, to aid, abet, counsel or procure the carrying out of virginity testing that has a sufficient jurisdictional connection.
(2) Virginity testing has a sufficient jurisdictional connection for the purposes of subsection (1) if it is carried out in relation to a person who is—
(a) in the United Kingdom,
(b) a United Kingdom national, or
(c) habitually resident in the United Kingdom.
(3) This section does not affect the application to an offence under section (Offence of virginity testing: Northern Ireland) of any rule of law relating to aiding, abetting, counselling or procuring.
(4) In this section—
“United Kingdom national” has the meaning given by section (Offence of virginity testing: Northern Ireland)(4);
“virginity testing” has the meaning given by section (Offence of virginity testing: Northern Ireland)(2).’ —(Edward Argar.)
This new clause creates an offence of aiding etc a person to carry out virginity testing in circumstances where the carrying out of that testing might not itself be an offence (depending on the location or status of the person carrying out the testing).
Brought up, read the First and Second time, and added to the Bill.
New Clause 47
Virginity testing offences in Northern Ireland: penalties
‘A person who commits an offence under section (Offence of virginity testing: Northern Ireland), (Offence of offering to carry out virginity testing: Northern Ireland) or (Offence of aiding or abetting etc a person to carry out virginity testing: Northern Ireland) is liable—
(a) on summary conviction, to imprisonment for a term not exceeding 6 months or a fine not exceeding the statutory maximum (or both);
(b) on conviction on indictment, to imprisonment for a term not exceeding 5 years or a fine (or both).” —(Edward Argar.)
This new clause sets out the penalties for the new offences under the law of Northern Ireland relating to virginity testing.
Brought up, read the First and Second time, and added to the Bill.
New Clause 48
Virginity testing: consequential amendments
‘Schedule (Virginity testing: consequential amendments) contains consequential amendments.’—(Edward Argar.)
This new clause introduces a Schedule of consequential amendments relating to the new virginity testing offences.
Brought up, read the First and Second time, and added to the Bill.
Mr Deputy Speaker (Mr Nigel Evans)
We are now coming on to the next group of amendments. As hon. Members can see, we have only an hour left, so can I plead to everyone who is participating, including the Front Benchers: short contributions, please, so we can get as many people in as we possibly can?
New Clause 62
Pharmaceutical services: remuneration in respect of vaccines etc
“(1) In section 164 of the National Health Service Act 2006 (remuneration for persons providing pharmaceutical services)—
(a) in subsection (8A) for ‘special medicinal products’ substitute ‘any of the following—
(a) drugs or medicines used for vaccinating or immunising people against disease,
(b) anything used in connection with the supply or administration of drugs or medicines within paragraph (a),
(c) drugs or medicines, not within paragraph (a), that are used for preventing or treating a disease that, at the time the regulations are made, the Secretary of State considers to be a pandemic disease or at risk of becoming a pandemic disease,
(d) anything used in connection with the supply or administration of drugs or medicines within paragraph (c), or
(e) a product which is a special medicinal product for the purposes of regulation 167 of the Human Medicines Regulations 2012 (S.I. 2012/1916).’;
(b) in subsection (8D)—
(i) for ‘special medicinal products are’ substitute ‘anything within subsection (8A)(a) to (e) is’;
(ii) in paragraph (b), for ‘special medicinal products’ substitute ‘that thing,’;
(c) subsection (8E), omit the definition of ‘special medicinal product’;
(d) after subsection (8E) insert—
‘(8F) Where regulations include provision made in reliance on subsection (8A)(c) or (d) and the Secretary of State considers that the disease to which it relates is no longer a pandemic disease or at risk of becoming a pandemic disease, the Secretary of State must revoke that provision within such period as the Secretary of State considers reasonable (taking into account, in particular, the need for any transitional arrangements).’
(2) In section 88 of the National Health Service (Wales) Act 2006 (remuneration for persons providing pharmaceutical services)—
(a) in subsection (8A) for ‘special medicinal products’ substitute ‘any of the following—
(a) drugs or medicines used for vaccinating or immunising people against disease,
(b) anything used in connection with the supply or administration of drugs or medicines within paragraph (a),
(c) drugs or medicines, not within paragraph (a), that are used for preventing or treating a disease that, at the time the regulations are made, the Welsh Ministers consider to be a pandemic disease or at risk of becoming a pandemic disease,
(d) anything used in connection with the supply or administration of drugs or medicines within paragraph (c), or
(e) a product which is a special medicinal product for the purposes of regulation 167 of the Human Medicines Regulations 2012 (S.I. 2012/1916).’;
(b) in subsection (8D)—
(i) for ‘special medicinal products are’ substitute ‘anything within subsection (8A)(a) to (e) is’;
(ii) in paragraph (b), for ‘special medicinal products’ substitute ‘that thing,’;
(c) in subsection (8E), omit the definition of ‘special medicinal product’;
(d) after subsection (8E) insert—
‘(8F) Where regulations include provision made in reliance on subsection (8A)(c) or (d) and the Welsh Ministers consider that the disease to which it relates is no longer a pandemic disease or at risk of becoming a pandemic disease, the Welsh Ministers must revoke that provision within such period as the Welsh Ministers consider reasonable (taking into account, in particular, the need for any transitional arrangements).’”—(Edward Argar.)
This amendment replicates the amendments currently made by clause 76 and makes corresponding provision for Wales. As a consequence clause 76 is left out by Amendment 115.
Brought up, and read the First time.
Edward Argar
I beg to move, That the clause be read a Second time.
Mr Speaker
With this it will be convenient to discuss the following:
New clause 13—National self-care strategy—
“(1) The Secretary of State must prepare a National Self-Care Strategy to fully integrate self-care for minor ailments into the wider health system.
(2) The National Self-Care Strategy must have regard to the need to—
(a) address inequalities in health literacy;
(b) enhance the understanding of primary and secondary age children on how to self-care;
(c) introduce self-care modules in healthcare professionals’ training curricula and continuing professional development;
(d) make best use of, and expand, the Community Pharmacist Consultation Service;
(e) improve access to effective self-care treatments;
(f) enable community pharmacists to refer people directly to other healthcare professionals;
(g) ensure better support for primary care networks to deliver self-care;
(h) evaluate the use of technologies that have been developed during the COVID-19 pandemic to promote greater self-care; and
(i) accelerate efforts to enable community pharmacists to populate medical records.”
This new clause would ensure that the Secretary of State for Health and Social Care publishes a national self-care strategy to integrate self-care for minor ailments into the health system.
New clause 18—Secretary of State’s duty to report on access to NHS dentistry—
“(1) The Secretary of State must publish an annual report setting out levels of access to NHS dentistry across England and average waiting times for primary care dental treatment in each region, and describing the action being taken to improve them.
(2) NHS England and Health Education England must assist in the preparation of a report under this section, if requested to do so by the Secretary of State.”
This new clause would require the Secretary of State to report annually on the levels of access to NHS dentistry in England, setting out average waiting times for primary care dental treatment in each region, and describing action being taken to improve them as necessary.
New clause 19—Inclusion in the NHS mandate of cancer outcome targets—
“(1) Section 13A of the National Health Service Act 2006 (Mandate) is amended in accordance with subsection (2).
(2) After subsection (2), insert the following new subsection—
‘(2A) The objectives that the Secretary of State considers NHS England should seek to achieve which are specified in subsection (2)(a) must include objectives for cancer treatment defined by outcomes for patients with cancer, and those objectives are to be treated by NHS England as having priority over any other objectives relating to cancer treatment.’”
This new clause would require the Secretary of State to set objectives for the NHS on cancer treatment which are defined by outcomes (such as one-year or five-year survival rates), and would give those objectives priority over any other objectives relating to cancer treatment (such as waiting times).
New clause 20—Annual parity of esteem report: spending on mental health and mental illness—
“Within six weeks of the end of each financial year, the Secretary of State must lay before each House of Parliament a report on the ways in which the allotment made to NHS England for that financial year contributed to the promotion in England of a comprehensive health service designed to secure improvement—
(a) in the mental health of the people of England, and
(b) in the prevention, diagnosis and treatment of mental illness.”
This new clause would require the Secretary of State for Health and Social Care to make an annual statement on how the funding received by mental health services that year from the overall annual allotment has contributed to the improvement of mental health and the prevention, diagnosis and treatment of mental illness.
New clause 23—NHS Good Governance Commission—
“(1) Regulations shall provide for the establishment of an NHS Good Governance Commission as a Special Health Authority.
(2) The Commission shall have responsibility for ensuring that anyone appointed to, or elected into, a non-executive role on an NHS Body—
(a) is a fit and proper person for that role; and
(b) has been appointed or elected by a process that the Commission considers appropriate.”
This new clause returns to the position prior to 2012 and ensures independent oversight of important NHS appointments.
New clause 24—Appropriate consent to transplantation activities when travelling abroad—
“The Human Tissue Act 2004 is amended as follows—
‘(1) Section 32 (Prohibition of commercial dealings in human material for transplantation) is amended as follows.
(2) In subsection (1), after paragraph (e) insert—
“(f) travels outside the United Kingdom—
(i) to a country with a system of deemed consent for the donation of controlled material which does not meet the criteria in subsection (1A) and receives any controlled material, for the purpose of transplantation, and
(ii) to a country with a system of explicit consent for the donation of controlled material and receives any controlled material for the purpose of transplantation where the material was obtained without—
(A) the free, informed and specific consent of a living donor, or
(B) the free, informed and specific consent of the donor’s next of kin, where the donor is unable to provide consent; and
(g) receives any controlled material for the purpose of transplantation for which, in exchange for the removal of controlled material—
(i) the living donor, or a third party, receives a financial gain or comparable advantage, or
(ii) from a deceased donor, a third party receives financial gain or comparable advantage.
(1A) The Secretary of State must publish an annual assessment of countries with a system of deemed consent for donation of controlled material determining whether each of those countries—
(a) provides a formal, publicly funded scheme for opting out of deemed consent for donation of controlled material, and
(b) provides an effective programme of public education to its population on the deemed consent system and the opt-out scheme which delivers a high level of public understanding of both.
(1B) For the purposes of paragraphs (f) and (g) in subsection (1), it is immaterial whether the offence of dealing in controlled material for transplantation is caused by an act or an omission.
(1C) For the purposes of paragraph (g) in subsection (1), it is immaterial whether the acts or omissions which form part of the offence take place in the United Kingdom or elsewhere.
(1D) In paragraph (g) in subsection (1), the expression “financial gain or comparable advantage” does not include compensation for loss of earnings and any other justifiable expenses caused by the removal or by the related medical examinations, or compensation in case of damage which is not inherent to the removal of controlled material.
(1E) Subsection (1F) applies if—
(a) no act which forms part of an offence under subsection (1) takes place in the United Kingdom, but
(b) the person committing the offence has a close connection with the United Kingdom.
(1F) For the purposes of subsection (1e)(b), a person has a close connection with the United Kingdom if, and only if, the person was one of the following at the time the acts or omissions concerned were done or made—
(a) a British citizen,
(b) a British overseas territories citizen,
(c) a British National (Overseas),
(d) a British Overseas citizen,
(e) a person who under the British Nationality Act 1981 was a British subject,
(f) a British protected person within the meaning of that Act,
(g) an individual ordinarily resident in the United Kingdom,
(h) a body incorporated under the law of any part of the United Kingdom,
(i) a Scottish partnership.
(1G) In such a case, proceedings for the offence may be taken in any criminal court in England and Wales or Northern Ireland.”
(3) In subsection (3), after “subsection (1)” insert “(a) to (e)”.
(6) In subsection (4), after “subsection (1)” insert “(a) to (e)”.
(7) After subsection (4) insert—
“(4A) A person guilty of an offence under subsection (1)(f) or (1)(g) shall be liable—
(a) on summary conviction—
(i) to imprisonment for a term not exceeding 12 months,
(ii) to a fine not exceeding the statutory maximum, or
(iii) to both;
(b) on conviction on indictment—
(i) to imprisonment for a term not exceeding 9 years,
(ii) to a fine, or
(iii) to both.”
(6) Section 34 (Information about transplant operations) is amended as follows.
(12) After subsection (2) insert—
“(2A) Regulations under subsection (1) must require specified persons to—
(a) keep patient identifiable records for all instances of UK citizens who have received transplant procedures performed outside the United Kingdom; and
(b) report instances of transplant procedures performed on UK citizens outside the United Kingdom to NHS Blood and Transplant.
(2B) Regulations under subsection (1) must require NHS Blood and Transplant to produce an annual report on instances of UK citizens receiving transplant procedures outside the United Kingdom.”’”
New clause 25—Regulation of the public display of imported cadavers—
“(1) The Human Tissue Act 2004 is amended as follows.
(2) In subsections (5)(a), (6)(a) and (6)(b) of section 1 (authorisation of activities for scheduled purposes) after ‘imported’ insert ‘other than for the purpose of public display’.”
New clause 26—Report on claims for reimbursement of the immigration health surcharge—
“The Secretary of State must publish and lay a Report before Parliament giving the numbers of completed claims that have been made under the immigration health surcharge reimbursement scheme within 6 weeks of the commencement of this Act.”
This new clause requires the Secretary of State to report the number of completed claims under the Immigration Health Surcharge for NHS and care workers from overseas.
New clause 27—Secretary of State’s duty to report on waiting times for treatment—
“The Secretary of State must prepare and publish a report annually on waiting times for treatment in England, disparities in waiting times for treatment in England and the steps being taken to ensure that patients can access services within maximum waiting times in accordance with their rights in the NHS Constitution.”
New clause 30—Problem drug use as a health issue—
“(1) The UK Government will adopt a cross-government approach to drugs policy which treats problem drug use as primarily a health issue (‘the health issue principle’).
(2) In accordance with the health issue principle, the Prime Minister must, as soon as reasonably practicable—
(a) make the Secretary of State for Health and Social Care responsible for leading drugs policy in England,
(b) lay before Parliament a report on the steps that will be taken to transfer responsibilities to the Department for Health and Social Care from other departments, and
(c) undertake a review of devolution and drugs policy in light of that transfer and in accordance with subsection (3).
(3) The review of devolution and drugs policy must consider—
(a) steps to transfer responsibility for drugs policy to the devolved administrations in a manner consistent with the health issue principle and the transfers of responsibilities in England in subsection (2), and
(b) the consistency of the devolution settlement, including the specific reservation of the misuse of drugs under paragraph B1 of Part II of Schedule 5 of the Scotland Act 1998, paragraph 54 of Schedule 7A of the Government of Wales Act 2006 and paragraph 9f of Schedule 3 of the Northern Ireland Act 1998 with the health principle and any associated recommendations for change.
(4) In undertaking that review, the Prime Minister must consult—
(a) the Scottish Ministers,
(b) the Welsh Ministers, and
(c) the Department of Health in Northern Ireland.
(5) A report on the findings of the review must be laid before Parliament within six months of the passing of this Act.”
This new clause would require the UK Government to approach problem drug use primarily as a health issue and, in so doing, to make the Secretary of State for Health and Social Care the lead minister for drugs policy in England. The Prime Minister would also be required to undertake a review of the devolution of responsibility over drugs policy in the new context of recognising problem drug use primarily as a health issue.
New clause 31—Reduction in upper gestation limit for abortion to 22 weeks’ gestation—
“(1) The Infant Life (Preservation) Act 1929 is amended as follows.
In section 1(2) for ‘twenty-eight’ substitute ‘twenty-two’.
(2) The Abortion Act 1967 is amended as follows.
In section 1(1)(a) for ‘twenty-fourth’ substitute ‘twenty-second’.”
This new clause would reduce the upper gestational limit for abortion in most cases to 22 weeks’ gestation.
New clause 32—Resolution of differences over the care of children with life-limiting illnesses—
“(1) This section applies where there is a difference of opinion between a parent of a child with a life-limiting illness and a doctor responsible for the child’s treatment about—
(a) the nature (or extent) of specialist palliative care that should be made available for the child, or
(b) the extent to which palliative care provided to the child should be accompanied by one or more disease-modifying treatments.
(2) Where the authorities responsible for a health service hospital become aware of the difference of opinion they must take all reasonable steps—
(a) to ensure that the views of the parent, and of anyone else concerned with the welfare of the child, are listened to and taken into account;
(b) to make available to the parent any medical data relating to the child which is reasonably required as evidence in support of the parent’s proposals for the child’s treatment (including obtaining an additional medical opinion);
(c) to refer the difference of opinion to any appropriate clinical ethics committee (whether or not within the hospital) or to any other appropriate source for advice.
(3) Where the responsible authorities consider that the difference of opinion is unlikely to be resolved informally, they must take all reasonable steps to provide for a mediation process, between the parent or parents and the doctor or doctors, which is acceptable to both parties.
(4) In the application of subsections (2) and (3) the hospital authorities—
(a) must involve the child’s specialist palliative care team so far as possible; and
(b) may refuse to make medical data available if the High Court grants an application to that effect on the grounds that disclosure might put the child’s safety at risk in special circumstances.
(5) Where the difference of opinion between the parent and the doctor arises in proceedings before a court—
(a) the child’s parents are entitled to legal aid, within the meaning of section 1 of the Legal Aid, Sentencing and Punishment of Offenders Act 2012 (Lord Chancellor’s functions) in respect of the proceedings; and the Lord Chancellor must make any necessary regulations under that Act to give effect to this paragraph; and
(b) the court may not make any order that would prevent or obstruct the parent from pursuing proposals for obtaining disease-modifying treatment for the child (whether in the UK or elsewhere) unless the court is satisfied that the proposals—
(i) involve a medical institution that is not generally regarded within the medical community as a responsible and reliable institution, or
(ii) pose a disproportionate risk to the child of significant harm.
(6) Nothing in subsection (4) requires, or may be relied upon so as to require, the provision of any specific treatment by a doctor or institution; in particular, nothing in subsection (4)—
(a) requires the provision of resources for any particular course of treatment; or
(b) requires a doctor to provide treatment that the doctor considers likely to be futile or harmful, or otherwise not in the best interests of the child.
(7) Subsection (4)(a) does not prevent the court from making an order as to costs, or any other order, at any point in the proceedings.
(8) In this section—
‘child’ means an individual under the age of 18;
‘health service hospital’ has the meaning given by section 275 of the National Health Service Act 2006 (interpretation);
‘parent’ means a person with parental responsibility for a child within the meaning of the Children Act 1989; and
‘person concerned with the welfare of the child’ means a parent, grandparent, sibling or half-sibling.
(9) Nothing in this section affects the law about the appropriate clinical practice to be followed as to—
(a) having regard to the child’s own views, where they can be expressed; and
(b) having regard to the views of anyone interested in the welfare of the child, whether or not a person concerned within the welfare of the child within the meaning of this section.”
This new clause has a single purpose, which is to make provision about the resolution of differences of opinion between a child’s parents and the doctors responsible for the child’s treatment.
New clause 34—Visits to care homes—
“(1) Regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 is amended as follows.
(2) After Regulation 9, paragraph (3), sub-paragraph (i), insert—
‘(j) facilitating face to face contact between the service user and persons significant to the service user so as to meet the service user’s needs and preferences, having particular regard to their emotional and psychological needs;
(k) where the registered person determines following an individualised risk assessment that unrestricted face to face contact between significant persons and the service user is not possible, facilitating face to face contact with the significant person or persons whom the registered person reasonably believes best meets the needs and preferences of the service user;
(l) where the registered person determines following an individualised risk assessment that no face to face contact between any significant persons and the service user is possible, facilitating contact with significant persons in such other ways as best meets the needs and preferences of the service user and is in accordance with the individualised risk assessment.’
(3) After Regulation 9, paragraph (6), insert—
‘(7) In this regulation
“face to face contact” means contact without fixed physical barriers between the service user and the significant person, but includes contact where the service user and/or relevant person or persons are wearing appropriate personal protective equipment if such is required to prevent or control the spread of infections, including those that are health care associated;
“an individualised risk assessment” means a risk assessment which considers—
(a) the risks to the health and well-being of the service user both of having and not having face to face to contact with either two or more significant persons (for purposes of paragraph 3, sub-paragraph (k)) or one relevant person (for purposes of paragraph 3, sub-paragraph (I));
(b) the risks to the health and well-being of other service users arising from the registered person facilitating face to face contact between the service user and a person or persons significant to that service user; and
(c) the risks to the health and well-being of the service user (and to other service users) of alternative options for contact to minimise the risks identified in (a) and (b).
“significant person” means any person falling within section 4(7) sub-paragraphs (a) to (d) of the 2005 Act (whether or not the service user lacks capacity for purposes of the 2005 Act to decide whether or not to have face to face contact with them) and “person significant to the service user” is to be read accordingly.’”
This new clause would give effect to the recommendation of the Joint Committee on Human Rights to require individualised risk assessments for care home residents, and to ensure procedures are in place for such assessments to be queried where adequate efforts have not been made to enable safe visits to care homes.
New clause 35—Visits to patients in hospital—
“(1) The Secretary of State must by regulations make provision to ensure that arrangements are made to allow visitors to patients staying in hospital.
(2) The regulations must ensure that any such arrangements observe the following principles—
(a) Safety – The approach to visiting must balance the health and safety needs of patients, staff, and visitors, and ensure risks are mitigated.
(b) Emotional well-being – Allowing visitors is intended to support the emotional well-being of patients by reducing any potential negative impacts related to social isolation.
(c) Equitable access – All patients must be given equitable access to receive visitors, consistent with their preferences and within reasonable restrictions that safeguard patients.
(d) Flexibility – The physical/infrastructure characteristics of the hospital, its staffing availability, the risks arising from any outbreak of disease in the hospital and the availability of personal protective equipment are all variables to take into account when setting hospital-specific policies.
(e) Equality – Patients have the right to choose their visitors.”
This new clause would require the Secretary of State to make regulations providing for rights to visit patients in hospital.
New clause 50—Amendment of the law relating to abortion—
“(1) The Offences Against the Person Act 1861 is amended as follows.
(2) In section 58 (administering drugs or using instruments to procure abortion)—
(a) omit the words from the beginning to ‘intent, and’;
(b) at the end insert ‘; but this section does not apply to a woman in relation to the procurement of her own miscarriage.’
(3) In section 59 (procuring drugs, etc. to cause abortion), at the end insert ‘; but this section does not apply to a woman in relation to the rocurement of her own miscarriage.’”
This new clause would have the effect that a woman could not be held criminally liable under the Offences against the Person Act 1861 in relation to procuring, or attempting to procure, her own abortion.
New clause 51—Termination of pregnancy on the grounds of the sex of the foetus—
“Nothing in section 1 of the Abortion Act 1967 is to be interpreted as allowing a pregnancy to be terminated on the grounds of the sex of the foetus.”
This new clause would clarify that abortion on the grounds of the sex of the foetus is illegal.
New clause 52—Introduction of upper gestational limit on abortion on the grounds of disability—
“(1) The Abortion Act 1967 is amended as follows.
(2) In section 1 (Medical termination of pregnancy) at the beginning of sub-paragraph (d) to paragraph (1), insert—
‘that the pregnancy has not exceeded the gestational limit identified in sub-paragraph (a) and’”.
This new clause would introduce an upper gestational limit on abortion on the grounds of disability equal to the upper gestational limit on most other abortions
New clause 53—Review of effect on migrants of charges for NHS treatment—
“(1) Within six months of the passage of this Act, the Secretary of State must conduct a review of the effect on migrants of charges for NHS treatment, and lay a report of that review before Parliament.
(2) Before completing the review, the Secretary of State must consult representatives of groups subject to such charges.”
New clause 54—Equality impact analyses of provisions of this Act—
“(1) The Secretary of State must review the equality impact of the provisions of this Act in accordance with this section and lay a report of that review before the House of Commons within six months of the passage of this Act.
(2) A review under this section must consider the impact of those provisions on—
(a) households at different levels of income,
(b) people with protected characteristics (within the meaning of the Equality Act 2010),
(c) the Government’s compliance with the public sector equality duty under section 149 of the Equality Act 2010, and
(d) equality in different parts of the United Kingdom and different regions of England.
(3) A review under this section must include a separate analysis of each section of the Act, and must also consider the cumulative impact of the Act as a whole.”
New clause 56—Abolition of prescription charges—
“(1) Charges may not be made for NHS prescriptions.
(2) Within six weeks of the passage of this Act, the Secretary of State must exercise the relevant powers under the National Health Service Act 2006 to give effect to subsection (1).
(3) Subsection (1) does not apply to any charges which may be made before the action necessary to give effect to that subsection has been taken under subsection (2).”
New clause 60—Duty to consider residents of other parts of UK—
“For section 13O of the National Health Service Act 2006 substitute—
‘130 Duty to consider residents of other parts of UK
(1) In making a decision about the exercise of its functions, NHS England must have regard to any likely impact of the decision on—
(a) the provision of health services to people who reside in Wales, Scotland or Northern Ireland, or
(b) services provided in England for the purposes of—
(i) the health service in Wales,
(ii) the system of health care mentioned in section 2(1)(a) of the Health and Social Care (Reform) Act (Northern Ireland) 2009 (c. 1 (N.I.)), or
(iii) the health service established under section 1 of the National Health Service (Scotland) Act 1978.
(2) The Secretary of State must publish guidance for NHS England on the discharge of the duty under subsection (1).
(3) NHS England must have regard to guidance published under subsection (2).’”
This new clause places a duty on NHS England to consider the likely impact of their decisions on the residents of Wales, Scotland and Northern Ireland, and to consider the impact of services provided in England on patient care in Wales, Scotland and Northern Ireland.
New clause 61—Interoperability of data and collection of comparable healthcare statistics across the UK—
“(1) The Health and Social Care Act 2012 is amended as follows.
(2) In section 250 (Powers to publish information standards)—
(a) in subsection (3), at the beginning, insert ‘Subject to subsection (3A)’;
(b) after subsection (3), insert the following subsection—
‘(3A) The Secretary of State may also exercise the power under subsection (1) so as to specify binding data interoperability requirements which apply across the whole of the United Kingdom, and an information standard prepared and published by virtue of this subsection may apply to any public body which exercises functions in connection with the provision of health services anywhere in the United Kingdom.’
(c) after subsection (6E) (inserted by section 79 of this Act), insert the following subsection—
‘(6F) The Secretary of State must report to Parliament each year on progress on the implementation of an information standard prepared in accordance with subsection (3A).’
(3) In section 254 (Powers to direct Information Centre to establish information systems), after subsection (2), insert—
‘(2A) The Secretary of State must give a direction under subsection (1) directing the Information Centre to collect and publish information about healthcare performance and outcomes in all parts of the United Kingdom in a way which enables comparison between different parts of the United Kingdom.
(2B) Scottish Ministers, Welsh Ministers and Northern Ireland Ministers must arrange for the information relating to the health services for which they have responsibility described in the direction made under subsection (2A) to be made available to the Information Centre in accordance with the direction.’”
This new clause would enable the Secretary of State to specify binding data interoperability standards across the UK, require the collection and publication of comparable information about healthcare performance and outcomes across the UK, and require Ministers in the devolved institutions to provide information on a comparable basis.
New clause 63—NHS duty to carers—
“NHS bodies must identify unpaid carers who come into contact with NHS services and ensure that their health and wellbeing is taken into account when decisions are made concerning the health and care of the person or people for whom they care.”
New clause 64—Review of public health and health inequalities effects—
“(1) The Secretary of State for Health and Social Care must review the public health and health inequalities effects of the provisions of this Act and lay a report of that review before the House of Commons within six months of the passing of this Act.
(2) A review under this section must consider—
(a) the effects of the provisions of this Act on socioeconomic inequalities and on population groups with protected characteristics as defined by the 2010 Equality Act,
(b) the effects of the provisions of this Act on life expectancy and healthy life expectancy in the UK,
(c) the effects of the provisions of this Act on the levels of relative and absolute poverty in the UK, and
(d) the effects of the provisions of this Act on health inequalities.”
Amendment 89, in clause 4, page 2, line 40, after first “the” insert “physical and mental”.
This amendment requires NHS England to prioritise both the physical and mental health and well-being of the people of England and to work towards the prevention, diagnosis or treatment of both physical and mental illness, replicating the parity of esteem duty introduced in the Health and Social Care Act 2012.
Amendment 67, page 3, line 7, at end insert—
“(d) health inequalities.”
This amendment would modify the triple aim to explicitly require NHS England to take account of health inequalities when making decisions.
Amendment 90, page 3, line 10, after “of” insert “physical and mental”.
This amendment requires NHS England to prioritise both the physical and mental health and well-being of the people of England and to work towards the prevention, diagnosis or treatment of both physical and mental illness, replicating the parity of esteem duty introduced in the Health and Social Care Act 2012.
Amendment 44, in clause 6, page 3, line 40, leave out “person” and insert “relevant public body”.
Amendment 45, page 4, line 1, leave out “person” and insert “public body”.
Amendment 46, page 4, line 4, after “employees”, insert
“, within their terms and conditions of employment,”.
Government amendments 83 and 84.
Amendment 70, page 48, line 34, leave out clause 39.
Amendment 93, in clause 44, page 49, line 31, after first “the” insert “physical and mental”.
This amendment will require NHS Trusts to prioritise both the physical and mental health and well-being of the people of England and to work towards the prevention, diagnosis or treatment of both physical and mental illness, replicating the parity of esteem duty introduced in the Health and Social Care Act 2012.
Amendment 94, page 49, line 36, after first “of” insert “physical and mental”.
This amendment will require NHS Trusts to prioritise both the physical and mental health and well-being of the people of England and to work towards the prevention, diagnosis or treatment of both physical and mental illness, replicating the parity of esteem duty introduced in the Health and Social Care Act 2012.
Amendment 71, page 49, line 39, at end insert—
“(d) health inequalities.”
This amendment would modify the triple aim to explicitly require NHS trusts to take account of health inequalities when making decisions.
Amendment 95, in clause 58, page 55, line 23, after first “the” insert “physical and mental”.
This amendment will require NHS foundation trusts to prioritise both the physical and mental health and well-being of the people of England and to work towards the prevention, diagnosis or treatment of both physical and mental illness, replicating the parity of esteem duty introduced in the Health and Social Care Act 2012.
Amendment 96, page 55, line 28, after first “of” insert “physical and mental”.
This amendment will require NHS foundation trusts to prioritise both the physical and mental health and well-being of the people of England and to work towards the prevention, diagnosis or treatment of both physical and mental illness, replicating the parity of esteem duty introduced in the Health and Social Care Act 2012.
Amendment 97, in clause 66, page 61, line 26, after first “the” insert “physical and mental”.
This amendment will require decisions on licensing of health care to prioritise both the physical and mental health and well-being of the people of England and to work towards the prevention, diagnosis or treatment of both physical and mental illness, replicating the parity of esteem duty introduced in the Health and Social Care Act 2012.
Amendment 98, page 61, line 32, after first “of” insert “physical and mental”.
This amendment will require decisions on licensing of health care to prioritise both the physical and mental health and well-being of the people of England and to work towards the prevention, diagnosis or treatment of both physical and mental illness, replicating the parity of esteem duty introduced in the Health and Social Care Act 2012.
Government amendment 115.
Amendment 60, page 71, line 6, leave out clause 80.
This amendment is to ensure that social care assessments take place prior to discharge from hospital.
Amendment 73, in clause 80, page 71, line 9, at end insert—
“(2A) A social care needs assessment must be carried out by the relevant local authority before a patient is discharged from hospital or within 2 weeks of the date of discharge.
(2B) Each integrated care board must agree with all relevant local authorities the process to apply for social care needs assessment in hospital or after discharge, including reporting on any failures to complete required assessments within the required time and any remedies or penalties that would apply in such cases.
(2C) Each integrated care board must ensure that—
(a) arrangements made for the discharge of any patient without a relevant social care assessment are made with due regard to the care needs and welfare of the patient, and
(b) the additional costs borne by a local authority in caring for a patient whilst carrying out social care needs assessments after a patient has been discharged are met in full.
(2D) The Secretary of State must publish an annual report on the effectiveness of assessment of social care needs after hospital discharge, including a figure of how many patients are readmitted within 28 days.”
Government amendments 116 to 121.
Government amendment 85.
Government amendments 122 to 126.
Government amendment 128.
Amendment 82, in clause 135, page 117, line 14, at end insert—
“(2A) Regulations may only be made under this Act with the consent of the—
(a) Scottish Ministers insofar as they make provision for any matter which falls within the legislative competence of the Scottish Parliament,
(b) Welsh Ministers insofar as they make provision for any matter which falls within the legislative competence of Senedd Cymru, and
(c) Northern Ireland Ministers insofar as they make provision for any matter which falls within the legislative competence of the Northern Ireland Assembly.”
This amendment would require the Secretary of State for Health and Social Care to obtain the consent of the relevant devolved government before powers to make regulations under the Act in an area falling within the legislative competence of a devolved institution, are exercised.
Government amendments 129 to 133.
Amendment 103, in schedule 6, page 186, line 4, at end insert—
“‘relevant Health Overview & Scrutiny Committee’ means any Health Overview and Scrutiny Committee in an area to which the proposal for a reconfiguration of NHS services relates.”.
Amendment 104, in schedule 6, page 186, line 31, at end insert—
“(c) must consult relevant Health Overview & Scrutiny Committees.”
Amendment 105, in schedule 6, page 186, line 43, at end insert—
“(aa) have regard to, and publish, the clinical advice of the Integrated Care Board’s Medical Director in relation to any decision under sub-paragraph (2)(a),
(b) publish a statement demonstrating that any decision made under sub-paragraph (2)(a) is in the public interest, and”.
Amendment 54, in schedule 10, page 204, line 7, after “(1),” insert
“not undermine an NHS provider’s ability to provide a service whilst maintaining the pay rates in Agenda for Change, pensions and the other terms and conditions of all eligible NHS staff and”.
This amendment aims to ensure that the pay rates of Agenda for Change, pensions, and other terms and conditions of all eligible NHS staff are not undermined as a result of the adoption of the NHS payment scheme.
Amendment 55, in schedule 10, page 204, line 39, after “following” insert
“on the likely impact of the proposed scheme”.
This amendment requires NHS England to consult stakeholders on the likely impact of the NHS payment scheme.
Amendment 56, in schedule 10, page 204, line 41, at end insert—
“(ba) all relevant trade unions and other organisations representing staff who work in the health and care sectors;”.
This amendment aims to ensure that all relevant trade unions and other organisations representing staff who work in the health and care sectors are consulted by NHS England on the likely impact of the proposed NHS Payment Scheme.
Edward Argar
Being conscious of the time, I will endeavour to be brief and try to scoop up in my winding-up speech any particular concerns expressed during the debate.
While this Bill is predominantly about the health service in England, and the majority of measures are England-only, a small number of provisions in the Bill will deliver benefits to residents in all four nations of the United Kingdom. The Government have worked with the devolved Administrations to improve services and outcomes for people across the country, and we have now agreed a package of amendments to some provisions in the Bill to address concerns raised by the DAs. Following that constructive engagement, we are pleased that DA Ministers supported our approach. On 15 November, the Northern Ireland Assembly voted to grant legislative consent motions for the provisions on reciprocal healthcare, medicine information systems and professional regulations.
This group of amendments contains the amendments negotiated with the DAs, and I extend my thanks not only to the DA Ministers and officials, but to the territorial Secretaries of State and offices of this United Kingdom in London for their work. There remain a small number of areas in which final agreement is needed, and one area where work is still ongoing. The group also contains technical Government amendments to ensure that no unintended tax consequences arise as a result of the powers in this Bill.
I will speak briefly to new clause 62 and amendments 115 and 129 and then I will pause to allow hon. Members on both sides to make their contributions and seek to address their points subsequently.
New clause 62 replicates the amendments currently made by clause 76 for England and makes corresponding provision for Wales and, as a consequence, clause 76 is removed by amendment 115, so that the changes made by it, together with the corresponding changes for Wales, can be set out in one place.
The new clause amends both the National Health Service Act 2006 and the National Health Service (Wales) Act 2006, enabling regulations to be made in respect of both England and Wales, allowing for further exemptions from the obligation to reimburse pharmacies under the standard NHS arrangements when centrally stocked products have been supplied free of charge to community pharmacies without the need to reimburse them. That will allow the respective Ministers to create limited additional exemptions to those that can already be created by the existing regulation-making powers introduced in 2017 for unlicensed medicines—more commonly known as “specials”. The additional exemptions are restricted to vaccinations and immunisations, medicinal products used for the prevention or treatment of disease in a pandemic, and associated products, such as diluents and syringes.
There are various reasons why we may seek to centrally procure vaccines or products used to treat a pandemic. When supplying products directly to pharmacies free of charge, we do not want to reimburse pharmacies as well as purchasing the stock itself. Currently, the Government would pay twice as the legislative framework makes provision for the reimbursement price paid to pharmacies to be set at zero only for specials and not for other products.
I am conscious that a considerable number of Members will want to speak either on the devolution aspect of this legislation, which was debated extensively in Committee and to which I will respond in my winding-up speech if I have time. I am also conscious that other right hon. and hon. Members have amendments to which they wish to speak at some length—well, hopefully not at some length, but clearly—to put their points across on important issues, because this group of amendments covers a wide variety of matters. With your permission, Mr Deputy Speaker, I will pause now to allow maximum time for Back Benchers and others to speak and then try to pick up any points in my winding-up speech.
Several hon. Members rose—
Mr Deputy Speaker (Mr Nigel Evans)
Fantastic. I am grateful to the Minister for his brevity; he can see how many people are trying to catch my eye.
Justin Madders
Thank you, Madam Deputy Speaker—[Interruption.] It has been a long day, Mr Deputy Speaker, but we will get there.
I will speak to the amendments tabled in my name and those of my right hon. and hon. Friends. As the Minister said, this group of amendments covers a large range of important areas, so I will be brief.
New clause 27 flags up the issues around waiting times. Passing any amendment requiring a report is, of course, not a total solution, but it might be a source of focus. As Labour has said many times since 2010, winter pressures, waiting times and the flight into private healthcare to get earlier treatment have exacerbated the issues.
Mr Tanmanjeet Singh Dhesi (Slough) (Lab)
Many of my constituents find it increasingly difficult to book an appointment with an NHS GP or dentist, forcing them either to go private or to suffer without treatment. Does the shadow Minister agree that, after a decade of failure and misguided policies, the Government must take urgent remedial action? However, the term “waiting time”, to which he has just referred, is not mentioned once in the Bill.
Justin Madders
My hon. Friend is right that one of the criticisms we have levelled against the Bill is that it does not address the issues and challenges facing the NHS. I will take no further interventions, because I am conscious that many Members have contributions to make.
I will move swiftly on to our two amendments dealing with inequality and to new clause 64 in the name of my hon. Friend the Member for Oldham East and Saddleworth (Debbie Abrahams). To show that this is an NHS and social care Bill, not just an NHS Bill, local authorities need to be more involved and more emphasis must be placed on wellbeing and better outcomes. We support the NHS triple aim—improving health, quality of care and cost control are, of course, important functions. Nevertheless, we live in a country where significant inequalities remain, and narrowing those gaps should be a national priority.
Research from the IPPR last month highlighted the 10-year gap in life expectancy between a person living in the poorest community and a person in the best off. That gap doubles when we talk about healthy life expectancy. Tackling that disparity must be a priority in the Bill. The Secretary of State for Health and Social Care said in his first speech that said he wanted to tackle the “disease of disparity”, so why is that missing?
Turning to clause 39—one of my favourites—why it remains in the Bill is a mystery given that the previous Secretary of State, the right hon. Member for West Suffolk (Matt Hancock), who requested these powers, is no longer in the role. Perhaps he will give us his insight into that later on. It is the absolute antithesis of the Lansley view that politicians should be distanced from NHS operational issues and makes a mockery of the overall thrust of this Bill, which is about encouraging local decision making. It is no exaggeration to say that, taken literally, clause 39 and its accompanying schedule 6 require the Secretary of State to be told if there are, or even if there might be, proposals to vary service—even moving a clinic from one location to another nearby.
As has been pointed out by wise heads, the power is not one that many Secretaries of State should want to get involved in. A Secretary of State who used it could be accused of favouring certain areas or decisions for political purposes. The well-articulated fear is that it will be used to block necessary but unpopular changes and that expediency will rule. Such decisions should be left to the clinicians or maybe the health economists but not politicians. Labour opposes this new power and would gently say to the Minister, “Be careful what you wish for.”
Finally, the issues around discharge to assess are complex. As we worked our way through in Committee, we heard evidence from many stakeholders, and it is fair to say that views on the matter were polarised. We are led to believe, and have some confirmation, that this development is working well for some acute settings, helping ease the perennial and disruptive issues around delayed transfers of care, but in other places we hear voices calling for much greater caution and for tougher safeguards or even, as amendment 60 requests, to stop it altogether. While we have sympathy with amendment 60, it would only pose more problems for the NHS if it was passed, so we have opted in our amendment 73 just to tighten up on safeguards.
Of course the real solutions are far more complex and would require higher investment both in the NHS and in social care. It should be mandatory that all aspects of ongoing care have been properly discussed and agreed with the patient and carers prior to discharge. An assessment should include carers with special attention if a child carer is involved, and there is a concern that unpaid carers will not be identified and consulted at the point of discharge.
The system for step-down care outside acute hospitals must be adequate, and there must be sufficient high-quality and funded places in care settings of all kinds. We are literally a whole generation away from having that kind of system, even if the funding started to become available today. On a related point, new clause 63 from the hon. Member for St Albans (Daisy Cooper) also deserves support.
I will leave my comments there, as I know many hon. Members want to speak.
Mrs Theresa May (Maidenhead) (Con)
I rise to speak in support of amendments 93 to 98, whose purpose is very simple.
The Health and Social Care Act 2012 established parity of esteem between physical and mental health in their treatment in the national health service. The Bill is silent on the issue. I know that Ministers have given assurances, in a variety of ways, that it is not the Government’s intention to move away from that parity of esteem, but if that is the case, the answer is simple: accept the amendments. The Government do not even have to write them; they have been written for them. There would then be absolutely no doubt about the continued commitment to ensuring parity of esteem between physical and mental health.
Mental health was clearly in the long-term plan for the national health service that I was pleased to see introduced. It was there because of the need to accept, as Members across the House do, that for too long mental health has not been given the attention that it deserves. People who were suffering with mental health problems were not getting the services that they need.
It will take time to ensure that we can provide for all, but sadly the issue has been exacerbated by the pandemic. In March 2021, there were 26% more referrals for mental health services than in March 2019, before the pandemic. The Centre for Mental Health reckons that 10 million additional people will need mental health care as a result of the pandemic. I am particularly concerned about the impact on young people; I am sure that Members across the House are seeing young people in their constituencies whose mental health may have been suffering anyway, but has suffered even more as a result of the pandemic.
More people now require mental health services. The Government talk a lot about dealing with the backlog that is a result of the pandemic, but it is only ever spoken about with reference to surgery or operations. The great danger is that in their focus on dealing with that backlog, which we all accept is necessary, the Government will push the issue of mental health services to one side.
The amendments stand in the name of my hon. Friend the Member for Broxbourne (Sir Charles Walker), in my name and in the names of Members across the House—there is cross-party concern. I say to the Minister once again: it is very simple. If the Government wish to maintain parity of esteem between physical and mental health and ensure that people with mental health problems are given the services and care that they need, they must put uncertainty to one side, accept the amendments and make it clear that physical and mental health will be treated with parity of esteem in our national health service.
Dr Whitford
I rise to speak to my amendment 82, which is on legislative consent if the Bill is used in the devolved aspects of healthcare in future. The bulk of healthcare—certainly its delivery through the Scottish NHS—is devolved. Having been on the Bill Committee, I was surprised that in the original version of the Bill there was not one mention in that context of the word “consultation”, let alone the word “consent”.
I do welcome amendments 118 and 121. I recognise that the Minister is trying to work constructively with the devolved Governments, but health is devolved. I am sorry, but after the United Kingdom Internal Market Act 2020, because of how the funds to replace EU funding post Brexit are being used to cut the devolved Governments out of decision making, there is a real fear among the public in Scotland that their health services could be changed in future. I ask anyone who supports devolution in principle to support amendment 82.
Matt Hancock (West Suffolk) (Con)
I rise to support new clauses 60 and 61, which relate, like the amendments that the hon. Member for Central Ayrshire (Dr Whitford) spoke about, to the UK-wide application of the Bill.
Health is rightly devolved, and as Secretary of State I worked very closely with Ministers in the three devolved nations, but there are nevertheless areas in which it is vital that the NHS, as a British institution, supports all our constituents right across this United Kingdom. Two areas in particular are critical and, in my view, need legislative attention.
The first area is the interoperability of data. As well as being vital for stronger research, it is necessary not least so that if you travelled to Caerphilly or Glasgow and were ill, Mr Deputy Speaker, the NHS could access your medical records to know how best to treat you. We can see right now, in the application of the NHS app for international travel, what happens without the data interoperability that new clause 61 would require.
Geraint Davies (Swansea West) (Lab/Co-op)
Is the right hon. Gentleman aware that there is concern in Wales, where we are protecting the private personal data of people receiving medicine and healthcare, that in England there will now be a gateway for the private sector to take people’s data and use it for its own reasons? That is one reason that we would not want to give the English our data.
Matt Hancock
On the contrary: data protection laws are UK-wide, so it is appropriate that this should be done UK-wide.
The second area is services. For instance, if a new treatment is available to Scottish patients in Edinburgh, which has one of the finest hospitals in the country, and if on rare occasions it is available to a Welsh person in Wales with a rare disease, should that person not be able to benefit from it? Likewise, if a treatment is available in one of the great London teaching hospitals and somebody from Stirling needs it, should they not be able to get it? At the moment, access to such specialist services is available on an ad hoc basis, but it is not broadly available. That is what new clause 60 seeks to address.
Dr Whitford
I simply point out that it is available; it is just that funding has to follow from the domestic health board to pay for it. I have sent patients to Leeds for MRI-guided biopsy, and patients used to come to Glasgow to have eye melanoma removed without losing their eye. That already exists.
Matt Hancock
It happens on an ad hoc basis, but it is not a right. The NHS is a great British institution, and access should apply right across the board.
Finally, in my last few seconds, may I simply say how strongly I agree with my right hon. Friend the Member for Maidenhead (Mrs May) about amendments 93 to 98?
Barbara Keeley (Worsley and Eccles South) (Lab)
I rise to speak to amendment 73, which would introduce safeguards around the discharge-to-assess process.
The discharge-to-assess process may have been a necessary element of the NHS’s pandemic response, but it contains gaps in safeguarding that leave unpaid carers vulnerable to financial impact and risks to their health. Many unpaid carers have to begin caring overnight, when their relative or friend, who may be quite unwell, is discharged from hospital without a plan for their care at home. Without a carer’s assessment to check whether a person has the capability or capacity to take on such a commitment, weeks can pass before any plan is made, leaving carers and the people they care for struggling in a desperate situation.
The Government’s own impact assessment on discharge to assess states baldly:
“There is an expectation that unpaid carers might need to allocate more time to care for patients who are discharged from hospital earlier. For some, this could require a reduction in workhours and associated financial costs.”
Organisations that support unpaid carers are outraged by that statement. The Government’s expectation that carers can just drop everything to take on a new caring burden is insulting, particularly given the extra caring burden that 3 million people have already taken on during the pandemic.
I recently queried that point with the Secretary of State at the Health and Social Care Committee. In response, the he wrote to the Committee to say that the Government do
“not expect unpaid carers to need to give up work or reduce their working hours to look after friends or family while their long-term health and care needs assessments are completed”.
When the impact assessment says one thing and the Secretary of State, after being questioned about it, says another, I have to question the understanding in the Department and among Ministers of the discharge-to-assess policy and its impact on the 13 million carers in the country.
Daisy Cooper (St Albans) (LD)
Does the hon. Member agree that it would be helpful if the NHS had a duty, as I have attempted to capture in new clause 63, to identify carers, so that their health and wellbeing is taken into account when decisions are made about the people for whom they care? Does she agree that it would be helpful if the Minister responded to new clause 63 in winding up?
Barbara Keeley
I do indeed. The hon. Member may not know that, a few years ago, I introduced a Bill to try to persuade the Government to accept that the NHS should have a duty to identify carers. I have tried to introduce it on two more occasions since then, and I will send her a copy. I hope that the Minister will respond to what she has said.
Carers UK has reported high levels of fatigue and stress among unpaid carers, three quarters of whom feel exhausted and worn out because of' caring responsibilities during the pandemic. It would constitute a poor recognition of the sacrifice and dedication of those carers if discharge to assess was left without adequate safeguarding measures for them. Although discharge guidance already states that unpaid carers must be involved in discharge planning decisions when a patient has new or additional care needs, more than one in four are not consulted prior to discharge, and 60% say that at the point of discharge they received insufficient support to protect the health and wellbeing of the patient, or their own health.
Amendment 73 would protect carers from being left waiting an indefinite amount of time for care plans it would ensure that integrated care boards held responsibility for monitoring and reporting on any failures. I support its inclusion in the Bill, and, like the hon. Member for St Albans (Daisy Cooper), I hope that the Minister will respond to these points when he sums up the debate.
Mr John Baron (Basildon and Billericay) (Con)
Thank you for calling me, Mr Deputy Speaker, and I thank Mr Speaker for selecting my new clause 19. I also thank all those who have kindly supported it.
It remains an inconvenient truth that although our cancer survival rates are improving, we continue to lag behind international comparators. The primary reason for this is that the NHS does not diagnose cancers early enough. New clause 19 seeks to put that right by placing improved outcomes—that is, survival rates—at the heart of the NHS.
Jeremy Corbyn (Islington North) (Ind)
I strongly support the new clause. Does the hon. Gentleman also recognise that there can be delays in obtaining GP appointments in the first place, and someone who feels that they may be suffering from some form of cancer often loses several days—if not, on some sad occasions, weeks— before they get into the NHS system for treatment?
Mr Baron
I tend to agree, and that is in part what the new clause is intended to address.
I chaired the all-party parliamentary group on cancer for nine years. We were painfully aware that the Government had once estimated that if the country matched the best survival rates in Europe, 10,000 lives a year would be saved. In 2013, the OECD confirmed that that our survival rates ranked near the bottom when compared to those of other major economies. As we have improved our rates, so have other countries, and we are not closing the gap. A more fundamental change is required.
Back in 2009, when I first became its chairman, the APPG conducted a major inquiry which showed that the main reason our survival rates lagged behind others was not that the NHS was any worse than other healthcare systems at treating cancer once it was detected, but that it was not as good at catching cancers in the crucial early stages. In other words, late diagnosis lay behind our comparatively poor survival rates. The APPG had some success in getting the one-year survival rates—rates of survival one year after diagnosis—into the NHS DNA.
A key advantage of focusing on this kind of “outcome measure” is that it gives healthcare professionals much greater freedom and flexibility to design their own solutions, which could include running wider screening programmes and better awareness campaigns, and establishing greater diagnostic capabilities at primary care. A further advantage of focusing on outcome measures is that it will better align NHS priorities with patient needs. Survival rates are what really matter to patients. However, clinical commissioning groups are too often focused on “process targets”—the 62-day wait for treatment being an example—because they are often linked to funding. The one-year survival rate measure was not.
Research produced by the House of Commons Library found that nine such process targets were applicable to cancer alone, such as the 62-day wait. Process targets have a role to play in improving the NHS, but all too often they are a blunt tool offering information without context, and they can be exclusive, especially when funding flows are attached. Also, I consider it unacceptable that, in the case of certain cancers at least, patients should have to wait for 62 days—two months, in effect—for treatment. That is simply not right. Furthermore, process targets can easily become a political football between the two Front Benches, and only short-term points are scored. All sides are guilty of this, but it rarely helps patients.
In addition, process targets are not the best way of helping those with rarer cancers, with often fall between the cracks because data on those cancer types have not been routinely collected. That is a real problem. If we want to drive up survival rates, we cannot exclude rarer cancers, if only because they account for more than half all cancer cases.
Given the advantages of outcome measures such as one-year survival rates, I have tabled my simple amendment, new clause 19. Its aim is to ensure that NHS England puts outcome measures above process targets.
Mr Baron
I will not. I do apologise, but time is short.
New clause has been endorsed by the founding chief executive of Cancer Research UK, Professor Sir Alex Markham, who has commented that
“comparable health services abroad continue to outperform the NHS in terms of cancer survival. They all remain focused on cancer outcomes and the UK would be foolish not to do likewise.”
The new clause has also been endorsed by others, including the Teenage Cancer Trust. I assure those who are concerned that it will not detract from process targets; quite the opposite because, by implication, improved outcomes can only be facilitated by improved processes and inputs.
I urge the Minister to adopt the new clause. He will then have more time to assess its impact, and perhaps, following consultation, suggest amendments—if necessary —in the other place. I am confident that sufficient cross-party support could be achieved if acceptable nuances were required. If that is not possible, I intend to press the new clause to a vote, but I sincerely hope that I—we—can work with the Government and other parties to drive up survival rates in the NHS across the United Kingdom.
Mr Deputy Speaker (Mr Nigel Evans)
I must ask for brief contributions from now on. I call Margaret Greenwood.
Margaret Greenwood
Thank you, Mr Deputy Speaker.
The proposed NHS payment scheme in the Bill will, in effect, give private healthcare companies the opportunity to undercut NHS providers, and I believe we will then see healthcare that should be provided by the NHS increasingly being delivered by the private sector, with money going into the pockets of shareholders rather than being spent on patient care. If that happens, NHS staff may well find themselves forced out of jobs that currently provide Agenda for Change rates of pay, NHS pensions and other terms and conditions, and find that only private sector jobs with potentially lesser pay and conditions are available for them to apply for if they wish to continue working in the health service.
My amendments 54, 55 and 56, which are supported by the Royal College of Nursing, are intended to ensure that the pay rates of Agenda for Change, pensions, and other terms and conditions of all eligible NHS staff are not undermined as a result of the adoption of the NHS payment scheme, and that all relevant trade unions and other organisations representing staff who work in the health and care sectors are consulted by NHS England on the likely impact of the proposed scheme.
On hospital discharge, I have tabled amendment 60, which would remove clause 80 from the Bill. The hospital discharge proposals pose risks to patients and staff. In its written evidence given to the Bill Committee, the RCS said:
“In the context of current high vacancy rates across district and community nursing, and poor understanding of workforce shortages across the health service, public health and social care, along with chronic underfunding due to failure of the current service payment model to recognise community nursing, this legislation should not seek to demand a service delivery approach which transfers such disproportionate risk to nursing staff and patients.”
As of May this year, 4 million patients had been discharged since 2020 under discharge to assess and the temporary measures of the Coronavirus Act 2020. I asked the Government how many of those patients had been readmitted within 30 days but they told me that they did not hold the data. In effect, they did not know; they do not have that information. Back in June of this year, the Government told me that the national health service had commissioned an independent evaluation of the implementation of hospital discharge policy, and that the evaluation was under way. It was due to report in autumn 2021—that is, now. Yet the NHS told me last week that the report containing the evaluation had not yet been finalised. It is therefore a matter of extreme concern that the Government are pushing ahead with a policy that is risky to both patients and staff without properly understanding its clinical outcomes, and that they know they are doing so. I ask the Minister to withdraw clause 80 from the Bill.
Fiona Bruce (Congleton) (Con)
I would like to speak to new clause 31 in my name, which would reduce the upper gestational limit for abortion in most cases to 22 weeks gestation. This time limit amendment would replace the current 24-week time limit for abortions on the ground where there is a greater risk of injury to the physical or mental health of a pregnant woman or any of her children of proceeding with the pregnancy, under section 1(1)(a) of the Abortion Act 1967. The current 24-week limit law is based on an outdated understanding of the viability of premature babies, and it needs to be updated.
Sir Edward Leigh (Gainsborough) (Con)
Is it not absurd that in one ward of a hospital doctors can be fighting to save the life of a 22-week gestation baby while arguably, under the law, a 24-week baby can be aborted? That is ridiculous, and whatever anyone’s views on abortion, this is now the time to review this law, which is based on outdated technology and medical practices.
Fiona Bruce
My right hon. Friend makes exactly the right point.
Our law needs to be updated. The current 24-week limit was set over 30 years ago, in 1990. That legislation removed the previous time limit of 28 weeks. In 1990, 24 weeks was considered the point of viability outside the womb, but the scientific advances in those 31 years have been enormous. The latest guidance from the British Association of Perinatal Medicine establishes 22 weeks gestation to be the point of viability and enables doctors to intervene to save premature babies from 22 weeks. A study from a neonatal intensive care unit in London found that survival rates for babies born at 22 and 23 weeks gestation went from zero in the period from 1981 to 1985 to 19% in the period from 1986 to 1990, and then up to 54% in the years from 1996 to 2000. We would no doubt find that the figures had increased substantially since then, were those figures available. Just in the past few weeks, we have seen the incredible story from the American state of Alabama of the birth of a baby boy at just 21 weeks old. Weighing just 14.8 ounces, Curtis Means needs oxygen support and a feeding tube, but he is in good health. New clause 31 is a probing amendment, so I will not be pressing it to a vote on this occasion. However, I would welcome the Minister’s views and I look forward to a greater debate on this issue.
I also want to take a few moments to give my support to new clause 51, in the name of the hon. Member for Upper Bann (Carla Lockhart), which would clarify that abortion on the ground of the sex of the foetus is illegal. This relates to the truly awful exploitative practice whereby women can be pressurised into abortions based on the sex of their unborn child. I also support new clause 52, also in the name of the hon. Member for Upper Bann, which seeks to bring parity to the law in equalising time limits on abortions that take place on the ground of disability, so that they would be equal to the limits on most other abortions. The current law permits abortions up to birth if the baby is deemed likely to be born seriously handicapped. This is interpreted to include entirely non-fatal disabilities such as Down’s syndrome and easily surgically rectifiable conditions such as cleft palate and club foot. One of my sons was born with club foot, and I know how rectifiable it is. The law is plainly inconsistent with the disability discrimination legislation that applies after birth, and it sends a dreadful message to people who are living and thriving with disabilities about how little their lives are valued under abortion law. Again, I look forward to hearing the Minister’s views.
Madam Deputy Speaker (Dame Rosie Winterton)
In order to try to get as many people in as possible, I am going to put on a three-minute time limit.
Ms Marie Rimmer (St Helens South and Whiston) (Lab)
Forced organ harvesting in China is one of the worst crimes against humanity of the 21st century. That is why I wish to speak to new clauses 24 and 25 in my name. It is a crime that no British citizens should be taking part in, and a crime that humanity has a duty to stop. New clause 24 aims to put a dent in the forced organ harvesting trade. It would prohibit UK citizens from receiving a transplant abroad without the clear consent of the donor. The forced organ trade is a big money business. The organs of a young healthy adult are worth in the region of half to three quarters of a million US dollars. That is money that people would, and do, kill for.
China started with political prisoners, with the religious Falun Gong group being the main source. Now it has moved on to Uyghur Muslims, some Christians and other minority groups. Evidence was heard at the China and Uyghur tribunals that mass DNA testing is taking place in the internment camps in Xinjiang, enough to compile a Uyghur organ database and bank ready for withdrawals on demand. The world might believe that China had an ethnical organ donation system based on the World Health Organisation’s assessment, yet that assessment from the WHO is based on a country’s self-assessment—in this case by the Chinese Communist party. It is a barbaric practice, and every democracy in the world should be looking at what it can do to stop it.
I am grateful to Members from every party across this House for supporting my new clause. It will not stop the trade, but it will show that we in Britain are doing our part and helping to influence other countries to do the same. I thank my hon. Friend the Member for Nottingham North (Alex Norris) for raising these new clauses in Committee. The Minister sympathised, but expressed certain concerns. He was worried that countries could have a deemed consent system in which everyone was automatically a donor. Deemed consent is acceptable only if people can opt out. Under a new provision, the Secretary of State will assess the deemed consent of each country. The Minister was also concerned that the recipient of an organ could face criminal consequences. It is the duty of a Government to ensure that people are aware of what is a crime, and supporting or funding a crime against humanity must be illegal.
New clause 25 would make imported cadavers require the same consent as bodies sourced from within the UK. The Minister claimed that a revised code of practice covered this, but a code of practice is not law. Surely the sanctity and dignity of the human body demand the power of legislation. I call on the House and this Government to step up and do their part to stop this crime against humanity.
Robin Millar (Aberconwy) (Con)
I rise to speak to new clauses 60 and 61 in my name. Simply, they would put patients first. I am thankful to my right hon. Friend the Member for West Suffolk (Matt Hancock) for his comments on new clause 60, but as I do not seek to press it to a Division, I will mention no more of it now.
On new clause 61, let me simply say this: good data is needed for good services. Good data allows professionals and planners to assign resources and guide interventions where they are needed most. Good data allows patients to make informed decisions about where to be treated, or where to live. Good data allows politicians to be held to account when services fail. Therefore, new clause 61, at its simplest, is about collecting and comparing data. It would standardise the publication of a set of UK-wide NHS data and ensure the interoperability of that data.
In Wales, unfortunately, Welsh reporting standards mean that waiting list statistics are not available for most procedures. Before the pandemic, it took a journalistic investigation in north Wales to highlight that patients were waiting for more than two years for hip operations. Constituents now report that they are being told that they face a two-year wait just for a first out-patient clinical appointment. That is distressing and disappointing, and it is simply because data is not available.
We must ask the question, if for want of a nail, the shoe was lost, what are we losing for the want of good data? If the Government are to bring digital transformation into the heart of the NHS, the Minister must know that that heart can only be animated when good data courses through its veins.
In the months I have worked with colleagues on new clause 61, we have heard overwhelming support from patients—they agree. Healthcare professionals, IT experts and administrators have told us that they agree. In fact, I do not believe that the clause would divide the House, in compassion or common sense. I accept, however, that there is a challenge in delivering it and I know that the Government are exploring ways to address that.
I note the Minister’s comments at the start of the debate about close working with the devolved Administrations, and I welcome that.
Jonathan Edwards (Carmarthen East and Dinefwr) (Ind)
I do not question that the hon. Gentleman’s new clause is well intentioned. Does he believe that the standardisation would happen in conjunction with the four Governments working together or, in his view, would the process be driven solely from Westminster?
Robin Millar
I thank the hon. Gentleman for his question, which is a good and relevant one, and it speaks directly to the heart of what the Minister said in his opening comments. There is good collaboration and an emerging consensus on this, so I am optimistic that that will be the case. In fact, my concluding remark is to say that I will not press new clause 61 to a Division, but I will listen carefully to the Minister’s response.
Emma Hardy
I will be brief, speaking to new clause 32 in my name. It is an amendment based on the proposed Charlie’s law. I thank my dear friend and colleague, my hon. Friend the Member for Enfield, Southgate (Bambos Charalambous), who has been working on the issue with the Charlie Gard Foundation and the tireless campaigning of Charlie’s parents.
I will be as brief as I can be. In short, my new clause seeks to do five things: first, to require the Secretary of State to put in place measures to improve early access to mediation services in hospitals where conflict is in prospect; secondly, to provide for access to appropriate clinical ethics committees, so that both doctors and parents are supported in making difficult decisions by impartial ethical experts; thirdly, to provide the means necessary to obtain second medical opinions swiftly and to ensure that, when requested, parents receive access to their child’s full medical data, so that the second opinions are fully informed; fourthly, to provide access to legal aid to ensure that families are not forced to employ costly legal representation or to rely on outside interest groups to fund representation in court; and, finally, to create a new legal test of whether an alternative credible medical treatment would cause a child a disproportionate risk or significant harm in deciding whether a parent is able to seek that treatment for their child.
In essence, the provisions set out in the new clause would mitigate conflicts at the earliest stage, ensure that the voices and opinions of parents are listened to, save hundreds and thousands of pounds for parents, doctors and the NHS in protracted legal battles, and ensure that a critically ill child is given the best care and support available at a crucial time in that child’s life. No parent wants to spend time in court or in battle against the NHS when their child is critically ill. There must be a better way to resolve conflict. I hope that the Minister looks seriously at my new clause 32 and at ways to incorporate it into future legislation.
Mrs Maria Miller (Basingstoke) (Con)
I speak to new clause 50, tabled in my name and that of the right hon. Member for Kingston upon Hull North (Dame Diana Johnson).
We badly need a wake-up call, because at the moment we are allowing the criminal law as currently drafted to drive a fundamental wedge between Northern Ireland and Great Britain, treating women in Northern Ireland in a completely different way from women in England and Wales when it comes to abortion. Two years ago, the Government changed the law governing abortion in Northern Ireland after a vote in this place, removing criminal sanctions on abortions in Northern Ireland, while leaving women in England and indeed Wales facing the possibility of the harshest criminal sanctions for abortion in the world, under laws passed more than 50 years before any women was even able to vote for the people representing them in this place.
New clause 50 would change that. It would decriminalise abortion and ensure that women in England and Wales are treated in the same way as women in Northern Ireland when it comes to abortion. Our values and our rights are what unite our four nations. To treat women differently in those nations weakens those ties. That needs to be rectified. The new clause does just that, and it would change nothing about abortion services, access to abortion or the time limits on abortion.
The women most likely to be affected and governed by the criminal law are some of the most vulnerable in our society: victims of domestic abuse, of honour-based violence and of rape, and those who are too poor or marginalised to travel to a clinic to seek help. If a desperate woman attempts to end her pregnancy, do we really want her to not seek medical help for fear of arrest and prosecution? New clause 50 simply removes women from being subject to the criminal law for seeking an abortion, and it is fully supported by the medical experts, the Royal College of Obstetricians and Gynaecologists and the Royal College of General Practitioners.
Peter Dowd (Bootle) (Lab)
Yesterday, regrettably, the Minister did not respond to my exhortations on self-care in his summing up, although to be fair it did not take Sherlock Holmes to work out that he had his mind occupied with more contentious issues. New clause 13 gives him the opportunity to formalise the role of self-care by introducing a national self-care strategy that is more than just a footnote or passing reference in the NHS plan. The new clause would ensure that the Secretary of State for Health and Social Care publishes a national care strategy, to integrate self-care for minor ailments into the national health system. Surveys by the Proprietary Association of Great Britain have shown that people have been more amenable to seeking health advice that is outwith the GP practice, the walk-in centre or accident and emergency. Why not build upon that behavioural change? As shown during the pandemic, self-care is a crucial element of our healthcare system and it reduces the strain on GPs and A&E, so that those with more serious conditions can be treated with greater efficiency.
As the NHS seeks to recover from the most recent waves of the pandemic, there will be a unique opportunity to integrate self-care behaviours into the NHS and people’s lives. So by developing and implementing a national care strategy, the Government can ensure that a vision for self-care is realised whereby individuals understand and are willing to practise self-care, knowing how to take care of themselves and where to go when they are feeling unwell. The system will also be supportive of self-care, with pharmacy being much more embedded into the primary care pathway. What is there not to like in this new clause?
Finally, may I mention new clause 18, on the Secretary of State’s duty to report on access to NHS dentistry and to which I am a signatory. Dentistry is a vital component in people’s health. It is not just about teeth; it is about overall health. It can be the first port of call for many people whose symptoms may appear to be related to their teeth but may in fact be symptomatic of another disease, such as oral cancer. So let us make sure that dentistry gets the recognition it deserve—
Duncan Baker (North Norfolk) (Con)
Will the hon. Gentleman give way?
Peter Dowd
I am afraid that I do not have time. Let the Secretary of State report on access to NHS dentistry and give it a seat at the table on integrated care boards and partnerships, along with other health professionals. In conclusion, these proposals are about a comprehensive national care strategy that will help both patients and the NHS, and giving dentistry the attention that it deserves. Those are the areas we need to focus our attention on. They need a bit of tender loving care.
David Simmonds (Ruislip, Northwood and Pinner) (Con)
I will be exceptionally brief, Madam Deputy Speaker. I wish to speak on amendments 103 to 105. It seems clear to me that when a House has made a decision to impose statutory obligations on local authorities and other local bodies, we need to ensure that they are effectively consulted, in order to bring their expertise and local insight to bear in improving the quality of services that are offered to our patients. I hope that Ministers will be taking that on board in their response tonight.
Carla Lockhart (Upper Bann) (DUP)
I wish to speak to new clauses 51 and 52, both of which stand in my name. New clause 51 relates to the practice of abortion based on sex selection, and it seeks to clarify that abortion on the grounds of the sex of the foetus alone is illegal. Hon. Members from across the House would doubtless agree that aborting a baby on the basis of their sex is immoral, yet the status of this in law remains unclear.
Unfortunately, there is growing evidence that this horrible practice is taking place in Great Britain today. A 2018 BBC investigation found that non-invasive prenatal tests were being used on a widespread basis to determine babies’ sex early in pregnancy. We know that women are being coerced into having abortions based on sex selection. This was confirmed by a 2015 report from the Department of Health that detailed the awful testimonies of women who had been forced into a sex-selective abortion. The problem has been made much worse by the use of abortions pills to be taken at home. Abusive partners who do not want a particular sex of child—usually a girl—can more easily force their partner into having an abortion via telemedicine. The new clause seeks clarification that this practice is illegal, so provides an opportunity for the Government to do more to help women who are pressured into having an abortion on the basis of sex.
I wish briefly to touch on new clause 52—also tabled in my name—which would introduce an upper gestational limit on abortion on the grounds of disability that is equal to the upper limit on most other abortions. It would correct the current deeply discriminatory situation that permits abortion up to birth if
“there is a substantial risk that if the child were born it would suffer from such physical or mental abnormalities as to be seriously handicapped.”
That has been interpreted as permitting abortions up to birth following the diagnosis of either a cleft lip, a cleft palate or a club foot. This is inconsistent with disability discrimination legislation, because it allows for abortion on the grounds of disability more widely than most abortions are allowed.
Jim Shannon
Does my hon. Friend share my concerns that a large number of people throughout the whole United Kingdom object to this? We have had hundreds and hundreds of emails from my constituents about this issue. I commend my hon. Friend and the hon. Member for Congleton (Fiona Bruce) and totally oppose new clause 50—
Madam Deputy Speaker (Dame Rosie Winterton)
Order. That intervention is quite long enough.
Carla Lockhart
I will not push either of my new clauses to a vote. However, legal clarification on sex-selective abortion is urgently needed for the sake of women and the missing girls who are the victims of this abhorrent practice.
I commend the hon. Member for Congleton (Fiona Bruce). As evidence changes, so should the law, and 22 weeks’ gestation is the point of foetal viability. At heart, this is a debate about human rights, and the most basic human right is the right to life.
Sir Mike Penning (Hemel Hempstead) (Con)
I support new clause 19, which I signed, and will wait to see what the Minister says about it.
I want to take issue with the shadow Minister, the hon. Member for Ellesmere Port and Neston (Justin Madders), who turned around and said to Ministers, “Be careful what you wish for.” Our constituents send us here to represent how their taxation is spent in the NHS. When trusts are refusing to build new hospitals in our constituencies when they have the money to do so, and they want to refurbish hospitals and ignore public opinion and their local MPs, that is where the system goes wrong. I am not saying we should go all the way back to the old system, but there should be accountability in trusts when they do not do what our constituents would expect from them. My constituents would expect me to stand up and say this, because we want a new hospital on a greenfield site to look after the people of west Hertfordshire and our trust is refusing. If the shadow Minister ever becomes a Minister, I hope he has those powers.
Edward Argar
This group of amendments has clearly been popular and it is a shame that more right hon. and hon. Members did not get to speak. My remarks will be relatively brief.
On the contributions by my hon. Friend the Member for Congleton (Fiona Bruce), my right hon. Friends the Members for Gainsborough (Sir Edward Leigh) and for Basingstoke (Mrs Miller) and the hon. Member for Upper Bann (Carla Lockhart), those are deeply emotive and important issues. I entirely respect the strength and sincerity of genuinely held feelings on both sides of the debate. It is important that such matters are aired in the House, but they quite rightly remain a matter of conscience for individual Members, so I shall say no more than that it is important that everyone recognises the genuine views on both sides of the debate.
I am grateful to my hon. Friend the Member for Basildon and Billericay (Mr Baron) for tabling his new clause 19 and am happy to say that the Government are content to accept it. I know that my hon. Friend’s first concern is the quality of cancer services in this country and the welfare of the patients that they serve. I am pleased that he is keen for us, in accepting the new clause, to explore ahead of the Lords stages of the Bill whether it may give rise to any unintended consequences, with a view to supporting any changes that might need to be made. I look forward to working with him on that in the coming weeks before the Lords stages.
Mr Baron
I thank the Minister and the Government for listening and for accepting the new clause in its entirety. It is a progressive step. I and the whole group behind the new clause look forward to working with him. If nuanced changes were required, then, by all means, we would consider them.
Edward Argar
I am grateful to my hon. Friend for his intervention.
Let me turn briefly to amendments 93 to 98 in the names of my hon. Friend the Member for Broxbourne (Sir Charles Walker) and my right hon. Friend the Member for Maidenhead (Mrs May). I can reassure all right hon. and hon. Members that the Government remain committed to supporting everyone’s mental health and wellbeing. I pay tribute to my right hon. Friend for the work that she did in advancing this agenda when she was Prime Minister.
Secondly, let me clarify that the current references in the Bill to illness and health cover mental and physical health and, therefore, the view taken was that it was not necessary to make that explicit.
Dr Dan Poulter (Central Suffolk and North Ipswich) (Con)
Will the Minister give way?
Edward Argar
I fear that I do not have time to cover the other amendments in the four minutes that I have left.
Although I appreciate that my right hon. Friend the Member for Maidenhead and my hon. Friend the Member for Broxbourne will continue to press this matter, may I offer them a meeting with me and the Mental Health Minister to discuss further what they are proposing in advance of the Lords stages? I cannot make any promises or say anything beyond that, but I will meet them to further discuss the sentiments that sit behind their amendments.
Let me turn to my hon. Friend the Member for Aberconwy (Robin Millar), who made his points powerfully and eloquently, as he always does. As a Government of the whole United Kingdom, we have a duty of care to all citizens in the UK, which is why I welcome the clauses already in this legislation that will bring benefit to residents across the UK.
Edward Argar
My hon. Friend has made his point. He has made it to me before. I will not forget either him or unavoidably small hospitals, particularly in the Isle of Wight.
On the point made by my hon. Friend the Member for Aberconwy, we do recognise the importance of making sure that health and care data can be shared safely and effectively across the UK to support individual care and improve outcomes for people across the UK.
Edward Argar
I am afraid that I cannot give way, because I literally have two minutes. Forgive me, but if my hon. Friend catches me afterwards, I will happily speak to him.
We are already committed to working with officials across the devolved Administrations, noting the devolved nature of health and care policy, but my hon. Friend the Member for Aberconwy is right and makes a very powerful case for data interoperability and clear data standards. I am happy to speak with him further on this issue if he feels that that would be helpful.
I ask the hon. Member for Bootle (Peter Dowd) to forgive me for yesterday. I heard what he said about self-care and I will continue to look carefully at that. I did not ignore him.
I fear that, in the time that we have, there is little more that I can say.
Peter Aldous
The No. 1 issue in my inbox is access to NHS dentistry. New clause 18 provides a framework for addressing that. May I urge the Minister and the Government to consider accepting it?
Edward Argar
While we cannot accept that new clause as drafted today, I or the Minister for Dentistry will meet my hon. Friend, if that is helpful, to discuss in more detail the concerns sitting behind his intervention.
Question put and agreed to.
New clause 62 accordingly read a Second time, and added to the Bill.
The Secretary of State for Health and Social Care (Sajid Javid)
I beg to move, That the Bill be now read the Third time.
For years, colleagues in health and social care have worked hard and as one to deliver for the benefit of their patients, but their ambition has not always been matched by the structures they have had to work with. This Bill provides the framework in legislation to help them to achieve just that.
We are not only recovering from the pandemic but learning from it, and the principles that underpin the Bill—embedding integration, cutting bureaucracy, boosting accountability—have never been more important. I am hugely encouraged by the support that the Bill has received from so many quarters, from the NHS Confederation to the King’s Fund, the Health Committee and even those on the Opposition Front Bench.
Sajid Javid
Talking of the Opposition, I give way to the hon. Lady.
Margaret Greenwood
Will the Secretary of State comment on the discharge-to-assess proposals? I am concerned, because his Department told me that a report about how the process goes was meant to be published in autumn. His Department told me back in May that 4 million people have been discharged under discharge to assess—that is, having their care needs assessed after they have left hospital rather than before—but the same Department did not know what the clinical outcomes were and it did not know how many people had been readmitted to hospital within 30 days. I would have thought that it was essential that MPs were provided with that information and with a full outline of the clinical outcomes of that policy. Will he comment on that and tell us what he can do about it, so that we really understand what is happening?
Sajid Javid
I listened carefully to the hon. Lady and I will look into the specifics of what she said, but it is clear—I hope she agrees—that if people are clinically ready to be discharged, it is better that they are discharged rather than staying in hospital a moment longer.
I take this opportunity to thank everyone who has helped us to shape this important legislation, including hon. Members across the House and colleagues in Wales, Scotland and Northern Ireland, whose engagement will help us ensure that the Bill delivers for the four nations of the United Kingdom. I also thank members of the Public Bill Committee for their constructive scrutiny. The Bill is a lot better for it.
Let me draw the House’s attention to some of the changes that we have considered since Second Reading.
Jim Shannon
The Secretary of State referred to how the Bill delivers for the four regions of the United Kingdom. I just put it on the record that 60% of people in Northern Ireland are opposed to abortion on demand, so when it comes to representing the views of those in Northern Ireland—elected representatives and the local people—I am afraid that Westminster and the House do not relate to the people of Northern Ireland on abortion.
Sajid Javid
I heard what the hon. Gentleman said. He will know that there are strong feelings on the issue of abortion across the House, on all sides of that issue. If legislation does ever come to the House, it is important that it is always a matter of conscience, and that is how MPs are expected to receive such legislation.
John Redwood (Wokingham) (Con)
Will the Secretary of State confirm that, when carrying through this rather extensive national health service reorganisation, value for money and keeping the costs of reorganisation down will be at the forefront of his mind?
Sajid Javid
Yes, absolutely, I can confirm that. My right hon. Friend is absolutely right to stress the importance of that. The NHS will be spending the best part of £150 billion a year, and it is vital that the best value is achieved with every penny that is spent.
Sir Charles Walker (Broxbourne) (Con)
May I thank my right hon. Friend and his ministerial team for taking into account my concerns about parity of esteem between mental health and physical health? Although I was unsuccessful in amending the Bill at this stage, I thank him for being willing to look at that, or to have colleagues look at it in the other place. I really do appreciate that level of engagement.
Sajid Javid
I am happy to give my hon. Friend the commitment that we will look at that. I think everyone in the House agrees that the principle is vital, and I am sure it is supported across the House.
Let me briefly highlight the changes that we have made. First, we have heard the desire of the House to rate and strengthen the safety and performance of the integrated care systems. Working with members of the Health Committee, we have introduced an amendment that gives the Care Quality Commission a role in reviewing ICSs.
Secondly, we have heard concerns about the independence of integrated care boards. While it has never been our intention that anyone with significant involvement or interests in private healthcare should be on an ICB, following a productive meeting with the hon. Members for Nottingham North (Alex Norris) and for Ellesmere Port and Neston (Justin Madders) we tabled an amendment that ensures we write that principle into the constitution of ICBs.
Thirdly, we heard concerns from hon. Members about the potential impact of our proposed restrictions on advertising less healthy food and drink. We must, of course, do that in a pragmatic way, so we have introduced amendments to ensure we do not unintentionally impact UK businesses when they advertise to overseas audiences. Further, we will consult with stakeholders on any further changes to the nutrient profiling model.
Fourthly, and very importantly, the Bill now reflects our commitment to end the crisis in social care and the lottery of how we all pay for it. It is not right and not fair that the heaviest burdens often fall on those who are least able to bear it, so we are introducing a cap on the costs of care so that no one will have to pay more than £86,000 over their lifetime. That cap that will be there for everyone, regardless of any conditions they have, how old they are, how much they earn, or where they live. We will introduce a far more generous testing system, so that everyone will be better off under the new system.
We move a Health and Care Bill that is stronger than before, with those three underpinning principles reinforced: embedding integration, cutting bureaucracy and boosting accountability. On integration, it is not about simply telling the NHS, local authorities and others to work together; it is about helping them to do it by doing things like merging NHS England and NHS Improvement into a single statutory body and establishing integrated care boards to deliver as one.
Dr Poulter
I declare an interest as a practising NHS doctor. On integration, my slight disappointment with the Bill is that while it pulls people together in joined-up commissioning boards, there is no commitment to put the money into the same place. If we want to drive joined-up commissioning, we need to put the money into the same place. Will the Secretary of State consider that and how true integration can be achieved as the Bill goes to the House of Lords?
Sajid Javid
My hon. Friend makes a very important point and he speaks with deep experience. What I can tell him is that we will shortly be publishing an integration White Paper, which, given what he has just said, I am sure he will welcome.
Dr Murrison
I declare an interest similar to that of my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter). Does the Secretary of State agree that there is an opportunity with integrated care boards and panels to ensure the end of the awful spectacle of people at end of life and frail elderly people coming towards the end of their days being expected to live out those days in an acute hospital ward, when they should be looked after in more homely settings in the community? That has gone on for too long and consecutive pieces of legislation have failed to address it. We have an opportunity here, probably with the help of the other place, to sculpt the measure we are considering today to ensure that stops. It must stop now, so that our frail elderly can have a future that does not involve an end as grisly and as sad as so many are forced to endure.
Sajid Javid
I absolutely agree with my right hon. Friend, who also speaks with deep experience. I very much agree with what he has just shared with the House.
On bureaucracy, we are removing the rules and regulations that make sensible decision making harder. On accountability, our healthcare must be accountable to democratically elected Members of this House. We spend well over £140 billion pounds of taxpayers’ money on our healthcare system, so it is right that there is more accountability to this place.
In closing, the unprecedented challenges of the pandemic have only deepened our affection for everyone working in health and care. They have been the very best of us. It is on us in this place, and on everyone who can make a difference, to give them the best possible foundation to work together to meet the challenges of the future. The Bill does that and a lot, lot more.
Several hon. Members rose—
Madam Deputy Speaker (Dame Rosie Winterton)
Order. Before I call the shadow Secretary of State, I should say that I will probably introduce a three-minute time limit after the shadow Secretary of State and that I am unlikely to call anybody who intervened on the Secretary of State during his opening speech.
Jonathan Ashworth (Leicester South) (Lab/Co-op)
I start by thanking all those who served on the Bill team and the Clerks, the Library and all the staff of the House who supported them. I also thank the hon. Member for Wellingborough (Mr Bone), my hon. Friends the Members for Sunderland Central (Julie Elliott) and for Birmingham, Selly Oak (Steve McCabe) and the hon. Member for South East Cornwall (Mrs Murray) who chaired the Committee deftly. I put on the record Labour’s thanks to the Minister for Health, the hon. Member for Charnwood (Edward Argar)—my constituency neighbour in Leicestershire—who both in Committee and over the past two days in the House has been courteous and patient in responding to the various amendments and in how he conducted himself across the Dispatch Box. We are grateful for that.
Equally, I thank my hon. Friends the Members for Nottingham North (Alex Norris) and for Ellesmere Port and Neston (Justin Madders) for working so hard on this Bill and making the case for our amendments. My hon. Friend the Member for Ellesmere Port and Neston had his birthday yesterday—there is no greater place to celebrate one’s birthday than at the Dispatch Box—and I am told that he may well be putting in an appearance at the Strangers’ Bar after tonight’s vote. I am sure that hon. Members from both sides of the House may want to join him in his celebrations.
Of course, Labour welcomed parts of this Bill. It did indeed scrape some of the worst remaining vestiges of the Lansley reorganisation off the boots of the NHS. The compulsory competitive tendering of contracts, which we warned against nearly 10 years ago, are finally put in the dustbin. Of course, it was this Secretary of State, as an enthusiastic and loyal Back Bencher, who spoke in those debates supporting that reorganisation, but we welcome the ending of section 75.
We also welcome some of the provisions around public health, particularly those on childhood obesity and advertising, but we wish the Bill had gone further on smoking cessation and alcohol. Madam Deputy Speaker, I know it is not the convention to praise Members on Third Reading as one does on Second Reading, but I praise the hon. Member for Bury South (Christian Wakeford)—the constituency in which I grew up and went to school—who spoke with great eloquence, emotion and very personally about the impact of alcohol addiction on his family. It has also had an impact on my own family, as some hon. Members know. Although the Secretary of State did not accept either the hon. Gentleman’s amendments or ours, perhaps he will be prepared to meet us on a cross-party basis to discuss how we can take that agenda forward.
In saying all that, however, we are not minded to support the Bill in the Lobby tonight. We remain unconvinced by the arguments put forward by the Minister for Health in the past 48 hours. We still believe that this is the wrong Bill at the wrong time. As the right hon. Member for Wokingham (John Redwood) said in his intervention on the Secretary of State, this is an extensive reorganisation of the national health service at a time when we are still in a pandemic and when NHS staff are exhausted and facing burnout. We should be prioritising the monumental waiting lists, the huge referrals for mental health treatment, the crisis in A&E, and the huge pressures on ambulance services and general practice. This Bill is not only a distraction, but it contains provisions that Labour thinks are deeply damaging.
Yesterday, the House focused on the care cap amendment. It represents a change to existing policy and differs from the position outlined in the “Build Back Better” document, under which the House was asked to endorse a national insurance rise. The change means that those with wealthier estates and more expensive houses will see a greater proportion of their assets protected. Somebody with a £1 million house will have 90% of that asset protected, but somebody with an £80,000 house in Barrow, Mansfield or Hartlepool will lose nearly everything. That cannot be fair.
The Secretary of State, who was working the phones yesterday, may have won the battle, but I dare say that there are further skirmishes ahead. I suspect that Members in the other place—certainly those on the Labour Benches —will return to the matter, and I hope that they send the Bill back to us so that we can look at it again.
There are other provisions in the Bill with which we are uncomfortable. We are not convinced about the prohibitions on the private sector’s role in sitting on integrated care boards; we do not think that the Government’s amendment is strong enough. We will return to that point at a future opportunity.
Although the Bill gets rid of the Lansley competitive tendering requirements, it still allows the Secretary of State to hand contracts out to the private sector without proper scrutiny. We have seen a £10 billion contract going to the private sector to use 8,000 beds. That money would have been better spent on elective treatment in the national health service.
In conclusion, the Opposition cannot support the Bill, so we will divide the House tonight. On the care issue, I know that the Secretary of State thinks that he got his policy through the House yesterday and that it is all over, but I am afraid that it most certainly is not.
Matt Hancock
I welcome the passage of the Bill and congratulate all those who have been involved in bringing it to this place and getting it to Third Reading: the Secretary of State; the Minister, who has worked on it for an awfully long time; and the official Bill team, who were the best team I ever worked with in government. I am not saying that just because they are sitting in the Box.
The Bill gives the NHS what it needs. Critically, it learns the lessons of the pandemic and embeds them in legislation by removing bureaucracy and silos. I can see that the Secretary of State is already acting on that to merge parts of the NHS so that they can work better together.
I want to make a specific point in response to a comment from the shadow Minister, the hon. Member for Ellesmere Port and Neston (Justin Madders), about accountability. Although the Bill rightly devolves decision making and discretion more locally to the new integrated care boards and panels, it also gives Ministers the right to make sure that the NHS is accountable to them; it removes the so-called independence. That is right, and it is surprising not to see Labour Members supporting it, because it was in the Labour party’s manifesto as well as the Conservative party’s.
When £150 billion of taxpayers’ money is at stake, imposing apparent independence is not just impractical, but wrong. The NHS should be accountable to Ministers so that they can be accountable to the House, which is accountable to taxpayers through the ballot box. That is right constitutionally, morally and practically, which is why it was in both major parties’ manifestos. It is how the NHS operates anyway in practice, but the Bill will remove some of the unnecessary friction in the senior relationships that resulted from the attempt at independence.
Of course clinical voices should always be listened to, but as we saw during the pandemic, we can listen to clinical voices and then make a decision that is held to account on a democratic basis. The Bill will therefore strengthen not just the running of the NHS, but how we constitutionally govern the huge amount of taxpayers’ money that is spent on it. For that reason alone, it is worth supporting the Bill.
Peter Aldous
I am grateful to you for giving me time to speak, Madam Deputy Speaker. I would have liked to speak on new clause 18 on Report, but that was not possible.
Access to NHS dentistry is a problem that has been brewing for a long time and has been exacerbated by covid. There are now parts of the country, particularly in rural and coastal areas, that have dental deserts. It is invariably children from poorer backgrounds and vulnerable adults who suffer the most. The crisis is acute in Suffolk and Norfolk, but is not confined to East Anglia. Sir Robert Francis, who chairs Healthwatch England, commented:
“Every part of the country is facing a dental care crisis, with NHS dentistry at risk of vanishing into the void.”
There are five issues that need to be tackled to address the problem. The Bill can provide the framework to ensure that that happens without delay or prevarication. First, funding must be increased. Secondly, it is vital for the new NHS dental contract, which has been being developed for more than a decade, to be rolled out next April. There are rumours that it will be kicked into the long grass, and I should be grateful for confirmation that that will not happen. Thirdly, we need to step up the recruitment and retention of dental professionals. Fourthly, it is important to highlight the role that water fluoridation can play in improving the oral health of future generations, and in that context clauses 132 and 133 are to be welcomed. Finally, there is a need for greater accountability, and for dentistry to have a voice on integrated care boards and partnerships.
People are currently pulling out their own teeth, while children are having whole-mouth replacements and early signs of cancer are going undetected. We need to act now to put in place an NHS dentistry system that is fit for the 21st century, instead of reversing into the 19th. My hon. Friend the Minister has advised that the Government will not accept new clause 18, and I should therefore be grateful if, without delay, my right hon. Friend the Secretary of State could ensure that his Department comes up with a clear plan for addressing a crisis that is affecting people throughout the country.
Bob Seely
Let me start by thanking my hon. Friend the Member for Waveney (Peter Aldous) for that superb speech. We have a huge problem with NHS dentistry on the Isle of Wight, and also with independent pharmacies. I have written to the Health Minister about that several times, and there is an ongoing conversation, for which I thank him very much.
In the short time that I have, I want to speak about fairness and equality. The Secretary of State spoke eloquently—as he always does—about equality between the four nations. I want to see equality between isolated and non-isolated communities as well, specifically in relation to unavoidably small hospitals. There are about a dozen in England and Wales, and for obvious reasons they tend to be in isolated areas. The most isolated of those hospitals is St Mary’s on the Isle of Wight, which has a 100% isolation factor because it is separated from everywhere else by sea. Such areas tend to have populations of less than 200,000.
Unavoidably small hospitals find it difficult to achieve the economies, and the economies of scale, that are possible elsewhere in the NHS, because they do not receive tariff payments. They have to provide baseline services at a certain cost, but they do it for many fewer people. It is therefore likely that fewer people will use the services of that particular surgeon or those particular nurses, and as a result they are under permanent pressure. On the Island, our additional costs are estimated, at 2019 prices, to be some £12 million a year. That covers acute services, ambulances—including helicopters, for us—and travel to other destinations, which may involve ferries.
The NHS long-term plan—pre covid, back in January 2019, almost a lifetime ago—set out a 10-year strategy, stating that it would develop a standard model for delivery for smaller hospitals. May I ask the Secretary of State and the Health Minister what has happened to that plan and to the community services formula, which we hoped would support unavoidably small hospitals?
I am, however, delighted that, thanks to the excellent work of Maggie Oldham, the superb chief executive of the Isle of Wight NHS Trust, St Mary’s Hospital has been taken out of special measures and is now good. I would welcome either of the Ministers if they came to see us on the Island, not only to congratulate Maggie but to understand the pressure that one of the 12 unavoidably small hospitals in the United Kingdom is under, so that they can work with me to provide a better funding model for it and the other 11.
Jim Shannon
It is a pleasure to be able to make some comments on Third Reading. The Secretary of State and the Minister will know my position on these matters. I should like to commend the hon. Member for Congleton (Fiona Bruce) and my hon. Friend the Member for Upper Bann (Carla Lockhart) for their dedication to these issues. Their passion in this House is matched by many in my constituency who, despite the fact that their view is constantly disregarded, still urge me in their hundreds—I received hundreds of emails yesterday and hundreds today—to do what I can to speak for life. That is what I do here today. I care about the life of the woman and I care about the life of the unborn child. I am starting from the position that both lives matter, and it is one on which I stand firm.
In this House, there is a large number of MPs who are opposed to abortion on demand and who have an opinion on that. They include those who represent Northern Ireland and other parts of the UK in this House. I want to reiterate my position on the last vote that took place in Northern Ireland. An opinion poll found that 60% of constituents were opposed to abortion on demand. I am sure that I am far from being alone in recognising the double standards that our medical guidelines currently endorse, fighting for a life at 22 weeks in one case and ending it at 22 weeks in another case.
There are those who advocate that choice comes above viability, but that view is not replicated even by the many who support abortion in principle. It is a pity that clause 31 and clauses 51 and 52 were not brought to the House today. We expressed our concern some time ago that this House making the decision for Northern Ireland over and above the views of its elected representatives, its constituents and a majority of people across Northern Ireland would have an impact on the abortion rules in this House. We would have had an example of that today if new clause 50 had been approved, which it was not. It would have removed vital safeguards for women and girls seeking abortions up to 28 weeks of pregnancy, such as the requirement for two doctors, or even any medical professional, to be involved. The law change that was agreed in this House for Northern Ireland could have the shocking impact of placing at risk women and girls in abusive situations. It could legalise abortions that women and girls would carry out on themselves up to 28 weeks of pregnancy, for any reason.
Jim Shannon
I have almost finished my speech.
The Health and Care Bill is an opportunity to improve health and wellbeing, and it should not be usurped to remove essential safeguards such as contact with a medical professional, counselling and referral to appropriate care pathways. This House must be mindful, whatever decisions it takes here, that those decisions will have an impact on Northern Ireland. We in Northern Ireland are very concerned, and there is great disappointment at where we are.
Question put, That the Bill be now read the Third time.