NHS Strikes

Lord Grayling Excerpts

Monday 17th April 2023 Commons Chamber

[Steve Barclay]

The odd thing is that the hon. Lady seems to be disagreeing with the trade union leadership, which is not her usual position. Unison described it as a “decisive outcome” when 74% of its members voted in favour of the deal. It is odd that she wants to deny the GMB and other trade unions the space to vote on what their leaders have recommended—the GMB leadership has also recommended the deal to its members. Even the RCN leadership recommended the deal to its members. As Pat Cullen herself said:

“Negotiations work by compromise and agreement. We did not get everything and nor did the government. Ministers made improvements every day of those three weeks because we were able to say that returning to striking was the clear alternative. No union could enter negotiations and flatly say ‘no’ until you get everything you want. These talks will not be reopened if members reject this pay offer.”

The leadership of the RCN recommended the deal, as did the leaderships of the GMB and Unison. It is odd that the hon. Lady does not want to recognise that.

[Chris Grayling (Epsom and Ewell) (Con)]

It is ironic to hear the British Medical Association complain about staff shortages when it has in the past resisted the expansion of training places for doctors. When there have been disputes in the health service, those involved have always taken steps to ensure that lives were not endangered by the dispute. That appears to be no longer the case. That is, to my mind, a dereliction of professional duty. Will my right hon. Friend send the strong message to those involved that preserving life is a professional duty that must be maintained?

[Steve Barclay]

My right hon. Friend is absolutely right to focus on patient safety and the duty that all involved have to safeguard it. Indeed, I have previously given the Royal College of Nursing’s leadership credit and praise for granting strike exemptions, known as derogations—notwithstanding our disputes, I was happy to recognise that on the record. Given that less than a third of the RCN’s total membership has voted against the deal, and that the RCN’s leadership recommended it, it is very odd that it has now hardened its position and removed those exemptions. I very much hope that it will reflect further on the matter in the coming days, because I think its previous stance of granting exemptions was right.

NHS Winter Pressures

Lord Grayling Excerpts

Monday 9th January 2023 Commons Chamber

[Steve Barclay]

In terms of what is different, there is the block booking that will enable residential care to put the workforce in place and release the delayed discharge of the 13,000 patients who are in hospital but medically fit to be discharged. The accelerated release of those patients will help those at the front door, where the spike in flu is so acute. That is what we are doing; we are responding to what health leaders have said is the key intervention we can take. Of course, that is not being done in isolation. The point is that that is coming on top of the £500 million announced during the autumn statement and is to provide further capacity, recognising the significant pressure that the system is under.

[Chris Grayling (Epsom and Ewell) (Con)]

My right hon. Friend is absolutely right to highlight the fact that this is not purely an English issue but one affecting whole systems across the western world. I welcome many aspects of what he said, and I am grateful to staff at Epsom Hospital and those in the ambulance service in my constituency. So much of the time of those paramedics is spent taking frail elderly people from care homes to A&E where, frankly, they probably should not be. What steps can he take to divert some of those frail and elderly people from A&E to take some of the pressure off and get them to an environment where they will be much better looked after?

[Steve Barclay]

My right hon. Friend is absolutely right. That is where virtual wards have potential significant benefits in both demand management—avoiding elderly, frail patients coming to emergency departments in the first place—and releasing capacity in hospitals. The virtual ward at Watford General Hospital, equivalent to an additional ward of the hospital, is able to release patients with the comfort of knowing that they are still under supervision. Their medical information is being tracked and monitored and they get a daily phone call from a nurse. They also know that, if they need to come back to the hospital, they can do so much more quickly. That gives patients the comfort and confidence to recover at home, which is often where they want to be. Indeed, patient satisfaction from that trial at Watford was over 90%.

Public Health

Lord Grayling Excerpts

Tuesday 14th December 2021 Commons Chamber

[Sajid Javid]

I thank my hon. Friend for sharing that with the House. I think it is important to hear that support from South African experts too.

[Chris Grayling (Epsom and Ewell) (Con)]

We are all, of course, concerned to hear that plan C measures are already being discussed, and I should be grateful if my right hon. Friend could lay that to rest. However, I want to raise the question of hospitalisations. There is a difference between people who have been hospitalised with omicron and those who have hospitalised from omicron. Will my right hon. Friend tell us what he knows about those cases? How many people have been admitted to hospital for other reasons, and how many have arrived in hospital because they are seriously ill with omicron?

[Sajid Javid]

What I can tell my right hon. Friend is that there are approximately 6,000 people in English hospitals who have tested positive for covid, and of those—I have shared information like this with the House before, because I was determined to obtain it when I first became Health Secretary—approximately 80% are there because of covid symptoms, while about a fifth are there for other reasons, but were tested for covid and happened to have it. I hope that that is helpful to my right hon. Friend.

Covid-19 Update

Lord Grayling Excerpts

Monday 6th December 2021 Commons Chamber

[Sajid Javid]

I think we can say that we are leading the way on this. The UK Health Security Agency has established a database that is open for all countries to access to post their data. Even the discovery of the omicron variant and its potential risks was done here in the UK.

[Chris Grayling (Epsom and Ewell) (Con)]

I echo concerns about the travel and aviation sectors. This is a real blow for them. The Secretary of State will remember that back in June or July he took a decision to remove restrictions, in the face of heavy scientific advice that he needed to carry on with restrictions. That decision was the right one. Will he give an undertaking that this time round he will also face down the more conservative elements of the scientific community, do the right thing and keep the restrictions as minimal as possible?

[Sajid Javid]

Yes, I am happy to give that commitment to my right hon. Friend, for all the excellent reasons he gives. We were absolutely right, back at the start of the summer, to open up our country, including removing travel restrictions. That is one of the reasons, with regard to the dominant delta variant, why the UK is in a much better position than many other European countries today.

Adult Social Care

Lord Grayling Excerpts

Wednesday 1st December 2021 Commons Chamber

[Gillian Keegan]

This is a big reform that needs to take place, and it is based on demographic changes in the population all over the world. It is complex, and it will take a lot of time: it is a 10-year vision. I know that the hon. Lady has not had the chance to read our White Paper yet, but I am sure that she will see that there are a lot of things in it.

If we are actually looking to fix something—if we are looking to put a sustainable system in place that offers independence, choice, a great place to work and a great career—we need to fix a lot of solid foundations. I know that the Labour party always wants to throw money at the problem, but actually we need to make sure that the foundations are in place and that proper and sustainable funding is in place. That is what the White Paper delivers.

[Chris Grayling (Epsom and Ewell) (Con)]

I congratulate my hon. Friend on the progress that she has made so far. Care is a real challenge in a county such as mine, where we have high costs and a fast-ageing population; I ask her to bear that point in mind as she works on the next White Paper.

Closer to the immediate challenges, very many families are uncertain about whether they will be able to visit relatives in care homes over Christmas. A patchwork of measures is in place among different care home providers around the country. Obviously we are dealing with a difficult situation right now, but may I ask my hon. Friend to ensure that a very clear set of guidelines is given to care homes for the Christmas period, so that families know where they stand and so that the elderly, who are among those who have suffered the most over the past two years, get the chance to see their family where possible?

[Gillian Keegan]

My right hon. Friend makes a very good point. My grandmother was in a care home with dementia; the thought of not being able to see family has been one of the very difficult things throughout the pandemic. I pay tribute to all the care workers, who in some cases took the place of family during the height of the pandemic and were there with their loved ones day and night.

My right hon. Friend is absolutely right that it is very important that visitors can go into care homes, but of course care homes also have to make sure that they are safe, and we need to get the balance right. We have updated the guidelines for visitors and ensured that there is a named essential care giver who always has access to their loved one in care. We have recently updated that guideline, but obviously we will keep it under review as we learn more about the new variant.

Health and Care Bill

Lord Grayling Excerpts

Report stage
Tuesday 23rd November 2021 Commons Chamber

[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.

Oral Answers to Questions

Lord Grayling Excerpts

Tuesday 23rd November 2021 Commons Chamber

[Helen Hayes (Dulwich and West Norwood) (Lab)]

16. What steps he is taking to tackle the high job vacancy rates in social care.

[Chris Grayling (Epsom and Ewell) (Con)]

20. What steps he is taking to tackle staff shortages in the social care sector.

[The Minister for Care and Mental Health (Gillian Keegan)]

We recognise the considerable challenges the adult social care sector faces in recruiting and retaining staff. We have put in place a range of measures to support local authorities and care providers to address workforce capacity pressures. These include a new £162.5 million workforce recruitment and retention fund, and the latest phase of our national recruitment campaign, launched on 3 November, which highlights adult social care as a rewarding and stimulating place to work.

--- Later in debate ---

[Gillian Keegan]

We have committed to bring forth new measures in the White Paper, and to spend at least £500 million on recruiting that workforce. To address the emergency now, as I mentioned, there is £162 million. In addition, we have put around £500 million particularly to address discharge processes, and to ensure a discharge to assess process, which means it can be much quicker. We must ensure that those teams work together to shorten the discharge process. There is no doubt that our NHS and our whole system is under extreme pressure this winter, and we thank it for all the work it is doing.

[Chris Grayling]

There is a particular challenge in a county such as Surrey that has a rapidly ageing demographic, high housing costs, and where the cost of living is high generally. Could I urge the Minister and the Secretary of State to ensure that they consider all possible avenues to assist with what is becoming an acute shortage of key staff? We cannot end up in a position where the elderly do not receive the care they need, and we need maximum flexibility to ensure they get that care.

[Gillian Keegan]

There is no doubt that the sector is facing extreme pressure. It always faces pressure as the demographic need grows by 1% to 2% every year, but we have set out money to help with the short-term impact of that. Surrey will receive £2,704,702, so just over £2.7 million. We recently started the biggest national recruitment campaign we have ever done, Made with Care, to thank our care workers and to show what a fantastic and rewarding career it would be. We will continue to work with local authorities to help as much as we can.

Health and Care Bill

Lord Grayling Excerpts

Report stage
Monday 22nd November 2021 Commons Chamber

[Edward Argar]

I would like to make a little progress and then I will give way to the hon. Gentleman, who has been bobbing for some time.

We believe—this may not answer the hon. Gentleman’s point, but I will make a little progress and then if there is time—[Interruption.] Well, we will see. Hope springs eternal. A blanket ban on employees of private companies would also, we fear, be arbitrary. It would not cover the full range of people involved in non-NHS providers, some of whom may not be suitable candidates to sit on ICBs because of their involvement, but not employment, within the private healthcare sector. With the complex corporate structures that providers may have established, a narrow definition in the Bill could be unhelpful and risk not capturing the people we wish to capture.

[Chris Grayling (Epsom and Ewell) (Con)]

I support what my hon. Friend is saying. It would be crazy to exclude primary care because it is effectively a private healthcare business, and therefore what he is saying is enormously important. In support of my hon. Friend the Member for Broxbourne (Sir Charles Walker), I believe it would be absolutely wrong, looking at my own county, if the mental health trust did not have a presence in the governorship of the ICB. I hope that the Minister will ensure a presence not only for the conventional trusts in hospitals and in primary care but for the mental health trusts, because their role is vital and the integration of services is essential to the delivery of good mental health care.

[Edward Argar]

My right hon. Friend makes a point that came out in some of the oral evidence sessions on the Bill. Our aim was to create a minimum membership for the ICBs and ICPs, but it is not prescriptive—it can go beyond that—so there is scope for mental health trusts or other health trusts to have seats on those boards. Indeed, Dame Gill Morgan, who runs the integrated care system in Gloucestershire, said that that is exactly what she has done and that she would be surprised if any ICB did not wish to do it. But we wanted to set a de minimis membership to allow for local flexibility.

NHS England Funding: Announcement to Media

Lord Grayling Excerpts

Monday 25th October 2021 Commons Chamber

[Edward Argar]

I am grateful to the hon. Gentleman for welcoming the capital and for his tone. Quite rightly, he highlights the workforce point again. I go back to what I said to the hon. Member for St Albans (Daisy Cooper): on the basis of the figures that I have, since 2010, we have increased the clinical radiology workforce by 48% and the number of diagnostic radiographers is up by 33%. We continue to build on that. The hon. Gentleman is right about the long lead time, which is why it behoves me to say that the increase in numbers is a reflection not just of this Government, but of the previous Government’s investment in this space.

[Chris Grayling (Epsom and Ewell) (Con)]

It is certainly true that vast numbers of NHS staff have done an amazing job in the last 18 months in my constituency and elsewhere, and in secondary and primary care. It is right that we are committing these extra resources to help them to get the job done, and it is certainly the case that in the past we have not trained enough professionals in this world. However, I echo the comments of my right hon. Friend the Member for Forest of Dean (Mr Harper): it is simply not right to have the profession at this stage—when we are all, as taxpayers, making a big new commitment to the health service—demanding more lockdowns and more restrictions. We have got to live with this virus. It is also not right, when these large amounts are found by taxpayers—with some doubts from some of them—that we hear the same representatives still turn around and say, “It’s not enough.”

[Edward Argar]

I entirely appreciate where my right hon. Friend is coming at this from. I hope that, in answering my right hon. Friend the Member for Forest of Dean (Mr Harper), I was clear that we hugely value the amazing work done by all our NHS workforce. This is about providing them with the money and resources they need to do the job, but also stimulating reform and innovation alongside that. The final point made by my right hon. Friend the Member for Epsom and Ewell (Chris Grayling) was about the calls by some for particular policy approaches to this winter by Her Majesty’s Government. He will have heard my response to that on various media outlets on Thursday morning.

Oral Answers to Questions

Lord Grayling Excerpts

Tuesday 19th October 2021 Commons Chamber

[Sajid Javid]

In terms of the challenges of the pandemic and the challenges more generally over winter, the Government have set out a detailed plan. It depends very much on vaccinations, treatments, testing and surveillance, but we keep it constantly under review and, should we need to do more, there are contingencies.

[Chris Grayling (Epsom and Ewell) (Con)]

May I add weight to what my hon. Friend the Member for Newcastle-under-Lyme (Aaron Bell) said earlier? I have a similar situation in my constituency at the Chalk Pit in Epsom. It is really important that we strengthen the public heath duties of the Environment Agency. Will the Secretary of State make that a priority of his discussions with his ministerial colleague?

[Sajid Javid]

Yes.