Covid-19: Military aid to Civil Authorities

Edward Argar Excerpts

Tuesday 8th February 2022 Westminster Hall

[The Minister for Health (Edward Argar)]

It is a pleasure, as ever, to service under your chairmanship, Mr Hollobone. I congratulate my hon. Friend the Member for West Dorset (Chris Loder) on securing this debate, and I pay tribute to him for the manner in which he conveyed some challenging personal experiences on the part of his constituents and others. I will turn first to the situation faced by ambulance services, before clarifying for my hon. Friend that many of the expectations in terms of specialist posts are not realistically achievable within the constraints on the military’s resources.

Ambulance services have faced extraordinary pressures over the past 18 months, and I know that all hon. Members will join me in paying tribute to all the staff for their dedication and hard work. The pandemic placed significant demands on the service. In December 2021, it answered almost 1 million calls—a 22% increase on December 2020—placing significant pressures on ambulances services and the wider NHS.

We know the background reasons for that: infection prevention and control measures, higher instances of delays in the handover of ambulance patients into A&E and, crucially, the staff absence rate. Flow through our hospitals, which is always the key determinant of the ability of ambulance services to offload patients to the safety of A&E, is about the ability of that A&E to either get those patients discharged safely or admitted to hospital. A combination of those factors has placed unprecedented stress on the service and driven increased response times to patients in the community. Despite those pressures, performance for category 1 calls—the most serious calls, classified as life-threatening—has been largely maintained at around nine minutes on average over the last several months, despite a 16% increase in these calls compared with before the pandemic, although we are clear that there has been a significant increase in response times across other categories.

It is exactly because of those pressures that we have put in place strong support to improve ambulance response times, including a £55 million investment in staffing capacity to manage winter pressures to March. All trusts will receive part of this funding, which will increase call handling and operational response capacity, boosting staff numbers by 700. NHS England will also strengthen health and wellbeing support for ambulance trusts, investing £1.75 million to support the wellbeing of frontline ambulance staff during these pressured times. More broadly, NHS England is undertaking targeted support for the most challenged hospitals, where delays are predominantly concentrated, to improve their patient handover processes, helping ambulances to get swiftly back out on the road. That includes a £4.4 million capital investment to keep an additional 154 ambulances on the road this winter.

The crux of my hon. Friend’s speech was to acknowledge those pressures and to look to the military, through the MACA system, for further assistance. The scale of the challenge we faced, and continue to face, cannot be overestimated. The UK, like every other country in the world, saw its health systems and capabilities stretched to the limit. As many of our civilian agencies and institutions struggled to cope, we should take great pride in the role our armed forces played in assisting them in responding to the pandemic, reacting with skill and agility. However, we must be cautious about the limitations on the numbers of those who are qualified to drive blue-light ambulances, and indeed clinicians. I have to say that, of the 20,000 personnel my hon. Friend spoke of, only a small proportion would be clinically qualified to assist as paramedics or qualified to drive a blue-light service.

[Chris Loder]

I completely understand some of the difficult points the Minister makes, but does he agree that St John Ambulance has a wonderful suite of resources and could play a much more substantial role in supporting our emergency services?

[Edward Argar]

I will address that point and then return to the military point. I had a very productive meeting with St John Ambulance in the past couple of weeks to discuss exactly that. We should not underestimate the huge role it has already played throughout the pandemic in supporting our ambulance and other emergency services.

[Jim Shannon]

This does not cover the constituency of the hon. Member for West Dorset (Chris Loder), but Northern Ireland has a Territorial Army medical regiment based in Belfast. The majority of people in it are probably NHS staff—they are doctors, nurses or whatever —and that is where their interest in being in the TA comes from. Will there be circumstances on the mainland in which the TA medical corps could be used to our advantage and to address staffing shortcomings?

[Edward Argar]

It is important that we take advantage of all opportunities in terms of those qualified professionals and their ability to support our more regular frontline services.

To pick up on the point raised by my hon. Friend the Member for West Dorset about MACAs and military capacity, a large number of those 20,000 were used for testing and helping to build Nightingale hospitals, and they have recently been helping in vaccine testing centres. However, capacity in terms of, for example, clinically qualified Army medics is limited, and they often already serve in the NHS and in hospitals, so there is not a huge pool to draw on. It is important that we are clear about that. Secondly, I mentioned to my hon. Friend the point about those qualified as blue-light drivers. Again, that is not all the 20,000 or anywhere near. We have to be—realistic is the wrong word—careful in our expectations of the capacity to support specific requests, such as the specific types of support that his ambulance service put in for.

More broadly, considerable support has been offered by the military for tasks such as logistics, which my hon. Friend highlighted—for example, in supporting the ambulance service in a range of roles. Currently, the Ministry of Defence provides support to ambulance services in the following ways: 366 personnel in a range of roles, including non-driving roles; 96 personnel continuing non-blue-light ambulance driving support for the Scottish Ambulance Service; and 313 personnel in driver support to the Welsh ambulance service.

My understanding of the specific matter to which my hon. Friend referred is that it was incorporated into the broader request for ambulance drivers between 10 and 31 August last year. The element of that request to be granted was the 28 category C drivers who were provided by the Ministry of Defence. However, I come back to the point that, while he is right that the military are always there to assist us in times of need, we equally need to be realistic about their capacity in specific places.

[Chris Loder]

I appreciate the Minister’s candour. I respectfully remind him that the fundamental issue is that we have constituents—patients—who are in great difficulty for a long time. I fully appreciate the many pressures that he outlined, but what I am looking to achieve through the debate, especially for those families and individuals who have gone through painful experiences —I hope the Minister can help me a little further with this—is that we do not get into this position again, with constituents on their own waiting for such a long time.

[Edward Argar]

My hon. Friend will have heard me set out exactly how we have done that with the extra investment in our ambulance services. That is the key—to reinforce the strength and resilience of our existing ambulance service provision. He is absolutely right to highlight the impact—the patient and familial impact—of long waits for an ambulance, but the real answer is the measures that we are taking to invest in the ambulance service, with the £55 million more, the investment we put into hospitals to ensure that they were ready for winter, and the broader funding across the piece for our healthcare system to strengthen it further. Today, we saw another element of that package in the announcement of waiting list recovery and how we intend to approach that.

My hon. Friend is absolutely right to highlight the military. In extremes, they are there to help in very specific and pressured circumstances, but they are not the solution to the problem in the long term or to avoiding the challenges recurring. That is why we have our plan not only for the ambulance service, but for improving urgent and emergency care. We saw £450 million invested in that over the past 18 months or so to improve A&Es across the country, helping them to function more effectively, in particular in the context of IPC—infection prevention and control—measures. More broadly, we are investing in our acute hospitals to allow for the flow of patients out of A&E and into the hospital or, we hope, home. That is the key to solving this.

[Chris Loder]

I am pleased that the Minister highlighted that. I highlight and thank him again for the £65 million that the Government have dedicated to Dorset County Hospital to address that very difficulty.

[Edward Argar]

I am grateful to my hon. Friend. He is right to highlight that, not least because of his role in continuing to argue for it and in supporting Dorset hospitals in that context.

The military have done, and continue to do, a fantastic job in the context of this pandemic. However, as I say, the key to this issue is long-term investment, which is exactly what we are putting in place. I am very conscious of the challenges faced by all ambulance services over the winter, but I know that my hon. Friend’s local ambulance trust faces specific challenges of geography, distance and location of hospitals, which can be difficult for it on occasion. I appreciate the particular complexities of the system in the south-west, and we continue to work closely with the local system, but also with the military where appropriate, to see where they can support us and help add additional resilience into the system.

However, there is no substitute for the investment we are putting into making those systems more resilient in the long term, the need for which my hon. Friend has highlighted again today. We continue to focus on outcomes for patients—which is, I think, exactly where he is coming from—to avoid or reduce the risk of people having to wait a long time for an ambulance in very challenging circumstances. Tackling and improving the performance of our ambulance trusts remains a high priority in my ministerial inbox. That is in no way a criticism of the amazing work their staff are doing, but they face significant challenges. We continue to focus on those, and I look forward to working with my hon. Friend and his colleagues in Dorset to meet the challenges in the south-west.

Question put and agreed to.

Elective Care Recovery in England

Edward Argar Excerpts

Monday 7th February 2022 Commons Chamber

[Wes Streeting (Ilford North) (Lab)]

(Urgent Question): To ask the Secretary of State for Health and Social Care if he will make a statement on the publication of his Department’s plan for elective care recovery in England.

[The Minister for Health (Edward Argar)]

The covid-19 pandemic has had a huge impact on healthcare systems everywhere. The NHS has performed incredibly, caring for covid and non-covid patients alike and delivering the vaccination programme that has helped us to open up this country once again. Throughout the pandemic, we had to take steps to ensure that we could treat those with the greatest clinical need and that we provided a safe environment for those who needed covid care.

As a result, there is undeniably a huge covid backlog that needs urgent attention. The number of people waiting for care in England now stands at about 6 million, and we know that that figure will get worse before it gets better. Furthermore, our best current estimate is that about 8.5 million people who would normally come forward for treatment have not done so during the pandemic. However, we are pulling out all the stops to help the NHS recover and ensure that patients are receiving the right care at the right time.

Hon. Members will be aware that the Government will have invested more than £8 billion in the NHS in the three years from 2022-23 to 2024-25. As part of the new health and social care levy, we will be putting huge levels of investment into health and social care over the coming three years, and all the time we are announcing new solutions to the problem of how we can ensure that the NHS is on the firmest possible footing for the future.

On Friday we launched a call for evidence that will inform an ambitious new vision for how we lead the world in cancer care. As the Prime Minister announced earlier today, we are setting out some tough targets for the NHS on cancer. We want to ensure that 75% of patients are diagnosed or have cancer ruled out within 28 days of a GP referral, and to return the backlog of people waiting more than two months for their cancer treatment to pre-pandemic levels by March 2023. Today the NHS has also announced the launch of a new platform, My Planned Care, which will provide patients and their carers with relevant and up-to-date information ahead of planned treatment, including information on waiting times for their provider.

I am under no illusions about the fact that our health system is facing an enormous and unprecedented challenge. That is why we are doing everything in our power to support the NHS and its patients, recovering services to reduce waiting times and deliver more checks, operations and treatments. We are faced with a once-in-a-generation challenge. We know that we must get this right. We are working with the NHS and across Government to deliver a targeted and far-reaching plan for elective recovery, and we will update the House at the earliest possible opportunity.

[Wes Streeting]

Thank you for granting the urgent question, Mr Speaker.

This is not a covid backlog; it is a Tory backlog. We went into the pandemic with NHS waiting lists already at a record 4.5 million, and now 6 million people are waiting on those lists—more than ever before. More than 1 million are waiting for scans and tests used to diagnose cancer, and the NHS itself is waiting—waiting for the Government’s plan to deal with the backlog. So where is it? It was due to be published today but was pulled last night. It is like something from “The Thick of It”, but the reality is worse than fiction—a photo op without a plan; the Government’s own NHS recovery plan just another cancelled operation. But there is no need to worry, because there is a website coming that will tell people that they are waiting a long time, even if there is no plan to ensure that they do not-.

Then there is the “reason” for the delay. Briefings from the Department for Health and Social Care claimed that the Chancellor had blocked the plan. As one Government official said,

“it’s pretty obvious it’s about Treasury reluctance to rescue the PM”.

Is this where the shambles of the Conservative party is taking us? Is the Chancellor seriously playing political games while 6 million people wait for care? No wonder the Health Secretary has not bothered to show his face this afternoon. He is probably still recovering from the embarrassment of this morning’s media round, where the big announcement was literally that there was no announcement. So it has been left to the Prime Minister to clear things up, which tends to go almost as well as breakfast television with the Culture Secretary. No wonder she has been dispatched to the middle east.

Let me turn to the “tough targets” that the Minister mentioned. Today the Prime Minister announced a new target that no one should wait longer than two months for cancer diagnosis, but there is already a target for the vast majority of cancer patients to be treated within two months of referral, and it has not been hit since 2015. Is this not just another example of the Conservatives lowering standards for patients because they consistently fail to meet them? The Prime Minister has also announced that three out of four patients should receive a cancer diagnosis within 28 days, but that is an existing target that was introduced last April and has never been met.

The waiting list crisis is the chickens coming home to roost after more than a decade of Tory failure. The Treasury blocked a plan for staffing and it is now blocking the plan to cut waiting times. Is it not now clear, amid the chaos, confusion and spectacular incompetence on display, that the longer we give the Conservatives in government, the longer patients will wait?

[Edward Argar]

I am grateful to the shadow Secretary of State. As he said, 2 million of those on the waiting list have entered that waiting list since the pandemic began. There is undoubtedly a huge covid backlog, as we had to put in place infection prevention and control measures and ensure the availability of beds for those with covid. I am with him, I suspect, on at least one point, which is that I, like him, entirely understand the impact that this has on people’s lives, their anxiety and their health outcomes. That is why this Government are determined to tackle that waiting list. As I said, this is a once-in-a-generation challenge and it is absolutely right that we make sure we get the plan right. We need to ensure that we have the right plan, delivering the right outcomes.

The hon. Gentleman mentioned delays, and I have to say that this plan is delayed. This is a plan we anticipated publishing in December. The reason that we did not do that was because of the omicron variant and the impact it has had on our health services over the winter. We have made sure that we get this plan right.

The hon. Gentleman also mentioned Her Majesty’s Treasury. I have to say, speaking as a Minister in the Department of Health and Social Care, that we could not wish for better partners than Her Majesty’s Treasury and this Chancellor. They have shown strong support to our health and care system throughout the pandemic, with record levels of funding to support it through the pandemic and to help performance to recover subsequently.

Even before the pandemic, when the current Secretary of State for Health was Chancellor, this Government had already put in place a £33.9 billion increase in funding, enshrined in law. It was one of the first pieces of legislation passed by this Government after the election. We have also set out our long-term funding plans through the health and care levy, which I recall the hon. Gentleman’s party did not support.

[Sir Peter Bottomley (Worthing West) (Con)]

We are grateful to the Opposition spokesman, the hon. Member for Ilford North (Wes Streeting), for his sub-leadership bid in raising this important topic. I say to the Minister that today was not an unusual day, in that a constituent wrote saying that she had nothing but praise for the hospital treatment she was getting. Can I pass on my thought, which is that instead of using the word “elective” we should use the words “planned care”, as my hon. Friend did in his response? Through him, I also remind the House that two years into the last Labour Government there was an edict saying that no hospital could do elective care—planned care—until two years past the time when it was booked. Things are much better now and most of us are grateful.

[Edward Argar]

I am grateful to the Father of the House, who once again brings his typical wisdom and experience in this House to our deliberations in the final point that he makes. He is absolutely right. I am happy to join him and his constituents in expressing gratitude to all those who work in the NHS for the work they have been doing throughout the pandemic and that they do every day, irrespective of the pandemic. I know that those on both sides of the House will share in that. The term “elective” is a technical term used within the NHS, but I take his point that it is easy for us in this House to use the technical terms used within our Departments or in the system, but that it is often helpful if we talk in rather more simple terms that mean something to all our constituents.

[Barbara Keeley (Worsley and Eccles South) (Lab)]

As a survivor of breast cancer that was treated in 2019, I was grateful to be seen within 10 days of the referral by my GP and to start treatment within a month. It is frightening that in the months between April and November last year over 90,000 women who might have breast cancer were not seen by a specialist within the target of 14 days of being urgently referred by a GP, and that this year half a million people with suspected cancer will wait longer than the supposed two-week maximum to see an oncologist. The Minister will know that an early diagnosis can be life-saving. What does he think the impact for potential cancer patients will be of the delay to the NHS recovery plan when waiting times are spiralling so much?

[Edward Argar]

The hon. Lady and I often exchange views across the Dispatch Box, and she always asks sensible and reasonable questions. She is right to highlight the importance of cancer care, and that there are some illnesses and diseases like cancer where delay can have a significantly detrimental impact on the outcomes experienced by patients.

Between March 2020 and November 2021, more than 4 million urgent referrals were made for cancer, and over 960,000 people received cancer treatment. Thanks to the amazing work of NHS staff, we maintained cancer treatment at 99.7% of pre-pandemic levels in the latest month for which I have statistics, which is November 2021.

As well as looking to the future with the announcement of community diagnostic hubs and a range of other measures, the plan is not necessary for us to do the work, as we are already doing it. The plan is important for mapping out the future direction of care, but we are not waiting for the plan to improve services, to build back better and to tackle the waiting lists.

[John Redwood (Wokingham) (Con)]

If the Treasury was not holding up the plan, can we be told what was holding it up? When will we get the plan?

[Edward Argar]

I am grateful, I think, to my right hon. Friend for his question. As I set out, it is important that this is the right plan and that it does the job for which it is intended. We are working closely with other Departments to make sure the plan, when it is published, does the job for which it is intended, and I look forward to its imminent publication.

[Grahame Morris (Easington) (Lab)]

It is essential that we address cancer treatment capacity. The Minister talks about diagnostics, which is important, but it is a horse and cart or a hand and glove. I know he is aware of the enormous unharnessed potential of high-tech radiotherapy as a solution to time-critical cancer backlogs, but it still receives only 5% of the cancer budget. Such investment could take enormous pressure off the NHS, especially at this time. Will he arrange a meeting with the Secretary of State so that we can explain to him the important role that advanced radiotherapy could play in tackling the cancer backlog?

[Edward Argar]

The hon. Gentleman and I have previously met to discuss this issue, and I share his view on the value of radiotherapy in helping to tackle the cancer backlog, and more broadly as a treatment. Ministers and I are always happy to meet him.

[Dr Caroline Johnson (Sleaford and North Hykeham) (Con)]

My hon. Friend spoke earlier of this Government’s record level of investment in the NHS, but each patient waiting for cancer treatment is undergoing a very long and frightening experience as they wait longer than needed. As he focuses on reducing this backlog, how will he ensure that the record level of investment is focused directly only on measures that will reduce the backlog and is not wasted?

[Edward Argar]

My hon. Friend knows of what she speaks, as a serving consultant in our NHS. She is right that investment is important but that the outcomes are what really matter. We have set out measures such as the community diagnostic hubs, which are bringing diagnostic capacity to local communities and making it more accessible. That is just one example of how we will ensure that the money delivers the required outcomes.

[Daisy Cooper (St Albans) (LD)]

Health conditions do not wait until a medic or a bed is available. They deteriorate, often very quickly, and every single one of the 6 million people on the waiting list will have to rely on their GP for extra appointments and extra treatment, and they will possibly rely on their GP to deal with severe complications. What support will there be for primary care while all these people are waiting for their planned secondary care?

[Edward Argar]

The hon. Lady makes a very important point, and I take this opportunity to put on record my gratitude to all those in general practice for the amazing work they have been doing over the past two years. Again, they are the front door to the NHS for patients and all our constituents. Last year we set out the additional funding being made available to help general practice recover from the changes that had to be made during the pandemic, and we continue to look at the system as a whole, not in its component parts. She is right that general practitioners are often the people our constituents go to if their operation is delayed or if they need additional care while waiting for an operation, so it is important that we provide support to general practice, too.

[Dr Jamie Wallis (Bridgend) (Con)]

Given that health service waiting lists are higher in Labour-controlled Wales and that my Bridgend constituents are being told that they are going to have to wait until at least 25 March to find out what Labour’s plan is in Wales, does my hon. Friend agree that much of what the Opposition have said here today would be better directed down the M4 towards their Welsh Labour colleagues?

[Edward Argar]

I am grateful to my hon. Friend, who puts his finger on an extremely important point. I believe that one in five in Wales is on a waiting list. This Government have put in place measures already to help bring down waiting lists, and the plan is due to published imminently, but we are still waiting to see what the Welsh Government intend to do—or whether they even have a plan.

[Chris Bryant (Rhondda) (Lab)]

May I urge the Government to abandon this talk of a “war on cancer”? It was Richard Nixon’s term and it was thought to be outdated back then. To many people, when Ministers talk about fighting cancer and how somebody has been particularly plucky or courageous for fighting cancer, it feels as though they are telling off the people who do not survive for not being courageous enough. I know that that is not what anybody means, so may we completely change that language? As I understand it, the Prime Minister has also announced another cancer target today: to get to 75% of all cancer diagnoses being made at stage 1 or stage 2. How on earth is he intending to get to that?

[Edward Argar]

I am grateful to the hon. Gentleman for his remarks. He speaks often on this topic from experience, and it is right that we listen carefully to him. I take his point about the importance of language and how different terms and approaches to it will be interpreted by people who are undergoing treatment or a diagnosis for cancer, and I take the point in the spirit in which he meant that observation. On the Prime Minister’s target, the Prime Minister is unapologetically ambitious in seeking to tackle waiting lists and improve performance on cancer care. That is why we are investing record levels in our NHS and bringing forward new diagnostic hubs. It is also why the hon. Gentleman will see measures in the plan, when it is published imminently—coupled with the plan that the Secretary of State set out on Friday—that will help to reassure him, but I am always happy to talk to him about these issues.

[Mr Andrew Mitchell (Sutton Coldfield) (Con)]

My hon. Friend is surely absolutely right, first, to prioritise this vital catch-up programme for our constituents and, secondly, to ensure that we deliver real value for money. At a time of high taxation overall, my constituents want to ensure that for every pound of hard-earned taxpayers’ money spent on this vital programme they are really getting 100p of value as a result in delivery. I assume it is for that reason that this programme is slightly delayed.

[Edward Argar]

The reason this plan is delayed is, as I have alluded to, the omicron variant and the impact it had on our NHS. My right hon. Friend makes an important point about our prioritising tackling waiting lists and waiting times. He is also absolutely right: this is a once-in-a-generation challenge, and it is right that we get the right answer—the right outcomes for patients and for taxpayer. That is what we will do with this plan.

[Chi Onwurah (Newcastle upon Tyne Central) (Lab)]

These waiting times are misery, pain, frustration and agony for my constituents, and then there is the mental anguish of not knowing what is happening or going to happen. I have constituents who are begging and borrowing the money to go private because they cannot stand the pain. Is that the Minister’s plan for the NHS: driving people into the private sector? If it is not, what is his plan?

[Edward Argar]

The hon. Lady is right in some of what she says. We can all appreciate what she says about the impact that a wait for treatment can have on those waiting, in terms of health outcomes and, as she rightly mentions, challenges for people’s mental health as they worry about their diagnosis or when they are going to receive the treatment they need. That applies not only to those who are diagnosed with a life-threatening condition, but to those who have a life-limiting condition or who need orthopaedic surgery, eye surgery or similar, where it has an impact on their quality of life, their ability to work and so on. She makes an important point about that.

As I have set out to the House, we have already made significant strides, as we have come out of this pandemic, in setting out—through the community diagnostics hub and through our approach to surgical hubs—how we can rapidly ramp up the number of planned surgeries that are undertaken. We have to be honest with people that that list will get worse before it gets better, because people who have not come forward will do so. Equally, the golden thread running through is our NHS workforce, and we have to recognise that the people who will be tackling this waiting list are the same people who were working flat out through the pandemic. We have to make sure we give them the space and the support to recover physically and emotionally.

[Holly Mumby-Croft (Scunthorpe) (Con)]

I thank my hon. Friend for his work on this matter. He will know that in order to tackle waiting lists, our NHS staff need the very best buildings and equipment. We have seen some fantastic investment in Scunthorpe General Hospital, but will he meet me to discuss our plans for a longer-term investment in and upgrade to the hospital?

[Edward Argar]

My hon. Friend is a champion in this House for Scunthorpe General Hospital, and since her election she has never ceased to lobby, politely but firmly, on its behalf. I am delighted to agree to meet her.

[Clive Efford (Eltham) (Lab)]

If we are going to deal with this backlog, we need to deal with vacancies in the NHS. That means we do not have time to wait for doctors and nurses to be trained; we need qualified staff now. Can the Minister say where he is going to get those staff? Is he looking abroad? Where is he going to find them?

[Edward Argar]

The hon. Gentleman makes a sensible and serious point. As I said earlier, it is about the workforce. Buildings and technology are fantastic, but it is the people who operate them who really make the difference. I can offer him the reassurance that we are already well on target to meeting our 50,000 nurses pledge from the 2019 manifesto. In October 2021 there were thousands more doctors and thousands more nurses in our NHS compared with October 2020. We continue to grow that workforce from a whole range of sources, including the additional medical school places that this Government delivered a few years ago.

[Steve Brine (Winchester) (Con)]

There is no question but that the waiting list is impacting on my constituents’ quality of life, but I fail to see how taking £36 billion out of the system would help. Can I ask my hon. Friend to look further upstream and tell me how the very welcome 10-year cancer plan announced on Friday will improve our health and prevent more complex future interventions? Will he confirm that the 28-day cancer standard, which does sound familiar—I left office three years ago next month—is a maximum, not a target? In other words, we always want to do much, much better, because we know that the quicker cancer is caught, the better the outcome.

[Edward Argar]

I am grateful to my hon. Friend for touching on the 10-year cancer plan. He is absolutely right that the earlier the diagnosis, the better the outcome, as a rule, in cancer treatment. Yes, we set targets, but we always hope to exceed them. It has been incredibly challenging to do that over recent years, and that is why we as a Government are not only investing the resources, but putting in place the reforms that are needed to achieve these targets.

[Kim Johnson (Liverpool, Riverside) (Lab)]

I start by thanking all the NHS workers, who have done a tremendous job throughout the pandemic. My mum has been waiting for shoulder replacement surgery for more than two years, and the delay in this plan means that she will live with excruciating pain. Can the Minister give us assurances that this backlog will be dealt with in a timely fashion, and that that work will be adequately resourced and funded?

[Edward Argar]

I join the hon. Lady in gratitude towards all those working in the NHS. I am sure that every Member of this House will receive correspondence from constituents who are in the position she outlined. Understandably, they will be distressed and often in pain. This plan is not a necessary precursor for work to be done to bring that waiting list down and get it under control; such work is already under way. As I said, not only is record investment in resources going into it but, while the Government focus to a degree on that, we also focus on what that taxpayers’ money does in delivering outcomes for people—hence why we have already announced the community diagnostic hubs and set out plans for surgical hubs. We are very grateful to all the charities and campaigning organisations that have, over recent months, engaged with us to help to advise on interventions that they think can make a genuine difference to waiting lists, but also to keeping patients informed and supported while they do wait.

[Dr Julian Lewis (New Forest East) (Con)]

How much greater would the backlog be if we had not successfully resisted the entreaties of those modellers, and indeed politicians, who wanted another shutdown over the Christmas period?

[Edward Argar]

It is always hard to prove a counterfactual, as my right hon. Friend will know, but we do know that the necessary measures we took during the pandemic to help to tackle this dangerous virus inevitably had a significant impact on waiting lists. Due to infection prevention and control measures and a range of other things, normal levels of surgery and planned surgery were not able to go ahead. He may be able to extrapolate from that, but, as I say, it is slightly difficult to come up with a detailed counterfactual.

[Mr Toby Perkins (Chesterfield) (Lab)]

My mother died prematurely of lung cancer in her early sixties, so I know, as many others in this House do, that when it comes to cancer, waiting times do not just inconvenience; they literally mean the difference between life and death. I agree with the Minister that this is about not just investment but outcomes, and it is purely on outcomes that this Government are failing. Does he agree that the briefings from his Department suggesting the political games at the top of the Conservative party—“Who’s up, who’s down, who’s going to be the next leader?”—are influencing and impacting on the Government’s ability to get this plan out, and that that will not be forgiven by those people who are waiting for cancer treatment right now?

--- Later in debate ---

[Edward Argar]

I am grateful to the hon. Gentleman for his willingness to share with the House his personal experience in respect of his mother. I think that in doing so he probably speaks for a number of Members of this House, and certainly a number of our constituents. He said it is important that we focus on cancer, and he is absolutely right. Clinical prioritisation will be a key part of how we address bringing the waiting lists down, because it is right that we focus on the illnesses and diseases where the longer the delay, the greater the risk of not making a full recovery or of a negative outcome. He is right to highlight the focus on cancer as on certain other key areas. On his final point, I do not share that view. I believe it is right that we get this plan right so that it delivers the outcomes we need. As I have said to a number of hon. and right hon. Members, I do not believe that the plan is a necessary precursor for getting on with taking a number of steps, as we have done as a Government, to start to bring the waiting lists down.

[Mark Pawsey (Rugby) (Con)]

Does the Minister agree that there must be an important role in this programme for smaller hospitals such as St Cross in Rugby, where on a recent visit I saw some brand new operating theatres providing important extra local capacity?

[Edward Argar]

I am grateful to my hon. Friend for his shout-out for his local hospital. He is absolutely right: we need to utilise the resources and the capacity of the whole system, and this is the approach we are adopting. Often, the debate can focus on the large, acute district general hospitals, but he is absolutely right that smaller hospitals, community hospitals and indeed community facilities all have a part to play in helping to tackle this waiting list.

[Carol Monaghan (Glasgow North West) (SNP)]

Long delays in diagnosis and inappropriate and sometimes outdated treatment are typical for those living with the condition ME. As chair of the all-party parliamentary group on ME, I was pleased to see the new National Institute for Health and Care Excellence guidelines on treatment of the condition. Can the Minister detail what steps are being taken to implement those and to ensure speedy diagnosis and appropriate treatment?

[Edward Argar]

The hon. Lady raises an important point. I know that the House is grateful for her work on this important issue. She highlights the NICE guidelines, which are an important step forward. We continue to work with NHS England on how to most effectively ensure that patients with ME get the early diagnosis and treatment that they need. I or the relevant policy Minister will be happy to meet her to discuss progress and her and the APPG’s thoughts and ideas in that space.

[Mr Peter Bone (Wellingborough) (Con)]

The Minister is right in what he says again and again. I remember a few years ago, a close relative had liver cancer. They went to see the consultant and were given a one in three chance of surviving but managed to pull through. At the same time, another Government plan for the NHS was announced. I said, “What about that?”, and they said, “Well, we just ignore it, because they’ll change it again in a few years. What we actually do is get on and do best practice now.” I think what the Minister is saying is happening at the moment. What the Government could do in the plan is cut red tape in the NHS, which might speed up the construction of the hospital that we need in Kettering, which is so welcome.

[Edward Argar]

I am grateful to my hon. Friend not only for his well-timed plug for his local hospital in Kettering but for his important point. The NHS and the Government have been getting on with improving things and trying to bring service levels back to pre-pandemic levels. Notwithstanding his comment about plans more broadly, it is important for us to have a clear long-term strategic approach to it, because the sums of money involved are significant. The waiting lists and the impact on those are significant. It is right to ensure that we have a clear plan and clear metrics to show how that public money will deliver the outcomes that we all want to see delivered and that those patients want to see.

[Cat Smith (Lancaster and Fleetwood) (Lab)]

Waiting lists for joint replacements are at a record high. I have been contacted by dozens of constituents with arthritis who are waiting in a lot of pain. What can the Minister say specifically about joint replacements to the more than 600,000 people who are waiting for them nationally? Has he met Versus Arthritis about the issue?

[Edward Argar]

The hon. Lady makes an important point. Orthopaedic surgery, for want of a better way of putting it, is a hugely important part of the planned care and surgery that the NHS does. Although it does not have a direct impact on someone’s life chances in the same way that oncology does, it certainly affects their quality of life and their ability to enjoy it. I hope that I can give her some good news: I believe that I am due to meet Versus Arthritis, with which I have spoken in the past, later this week to discuss its work in this space and its ideas on how we can incorporate that in our work.

[Alun Cairns (Vale of Glamorgan) (Con)]

One in nine people in England are on a waiting list, which is clearly too high. I take confidence from my hon. Friend’s statement and the constructive tone with which he is responding. The figure in Wales is one in five. Does he share my disappointment and dismay at the tone that has been taken by the shadow Front-Bench team in particular, when waiting times in Wales are much longer and the number of people waiting is much higher?

[Edward Argar]

My right hon. Friend makes an important point, which was made by my hon. Friend the Member for Bridgend (Dr Wallis) earlier. I am sure that the shadow Secretary of State will be asking his colleague in the Welsh Government where their plan is.

[Munira Wilson (Twickenham) (LD)]

The Minister will be aware of the shocking 77% rise in the number of children needing specialist mental health care for suicidal thoughts and self-harm between 2019 and 2021. Headteachers in my constituency cite that as a No. 1 issue, but their staff simply cannot cope with the numbers and severity of need. Parents are beside themselves as their children in crisis are sometimes waiting a year to access treatment. As it is Children’s Mental Health Week, will the Minister make a commitment to children, young people and their parents up and down the country that children’s mental health will be an urgent priority alongside all the urgent operations that need to be done?

--- Later in debate ---

[Edward Argar]

Since the hon. Lady was elected, she has had a long track record of interest and campaigning on that issue. She is absolutely right to raise children’s mental health. Before I was a Minister, I took a close interest in eating disorders, which are an element of that—I worked with Beat the eating disorder charity—and in the challenges that parents face in getting access to child and adolescent mental health services for a first consultation and for the required treatment. I absolutely reassure her that mental health, including children’s mental health, remains a priority for the Government.

[Henry Smith (Crawley) (Con)]

I very much welcome the record high levels of funding the Government are putting into the national health service and the rolling out of rapid-diagnostic centres throughout the country. May I seek an assurance from the Minister that the diagnosis and treatment of blood cancers will be a key element of that rapid diagnosis?

[Edward Argar]

I can give my hon. Friend that reassurance. The clinical decision making will rightly inform the approach we adopt to the diagnosis and treatment of cancers, as my hon. Friend would expect, but he is absolutely right that we cannot neglect blood cancer in that context, and nor will we.

[Rachael Maskell (York Central) (Lab/Co-op)]

The elective recovery fund had perverse thresholds written into it, so those hospitals that really struggled and battled with the pandemic were the very ones that did not get any money. Will the Minister ensure a fair distribution of funding in his plan, so that hospitals such as my local one in York that are still battling with very high levels of covid get the resources they need?

[Edward Argar]

I am happy to reassure the hon. Lady that our approach, and that of NHS England and Improvement, is designed to ensure that all hospital trusts can make progress—hopefully rapid progress—in tackling their waiting lists and get the resources they need to do that.

[Jacob Young (Redcar) (Con)]

A key way in which we could get more money directed towards frontline services and elective care would be to fix Labour’s disastrous private finance initiative deals. Will the Minister meet me and the South Tees Hospitals NHS Foundation Trust so that we can look into how we can fix Labour’s PFI debt at hospitals such as the James Cook?

[Edward Argar]

My hon. Friend is right to draw attention to the huge financial challenges that trusts were saddled with following Labour’s PFI deals and I am of course delighted to agree to meet him to see what we can do to try to untangle the worst of them.

[Jim Shannon (Strangford) (DUP)]

I thank the Minister for his answers, which reflect the fact that he understands the need to do better and wants to improve. Will he outline what discussions have taken place among the devolved Assemblies and the Government here to prevent healthcare from becoming a postcode lottery in the UK? Does he acknowledge the fact that, although waiting lists for appointments were worsened by the covid crisis, they were poor beforehand, so all regions need to work together to address the issue of recovery?

--- Later in debate ---

[Edward Argar]

I am being open and honest at the Dispatch Box about the scale of the challenge and about the challenge for us in tackling it, and the hon. Gentleman is right to highlight that. In respect of the devolved Administrations, I regularly speak to—I would like to meet in person but we regularly meet remotely—the Northern Ireland Health Minister, Robin Swann, whose work in this space I pay tribute to. We talk about a range of issues, not just waiting lists and the impact of covid, but the hon. Gentleman is absolutely right and I am always happy to have conversations with my opposite numbers in the devolved Administrations.

[Tom Hunt (Ipswich) (Con)]

I appreciate the fact that 2 million people have been added to waiting lists throughout the pandemic—it is foolish to try to pretend that that has not made a big difference—and I also appreciate the Government’s £12 billion-a-year plan to help to address the situation. Needless to say, many of our constituents continue to wait in pain for elective surgery, including hip and knee replacements. The Minister will know my views about orthopaedic services in Ipswich and some of the concerns I have had about the new centre in Colchester. It could be that the increased capacity in Colchester cuts waiting times, but there is still an issue about people getting to Colchester so that surgery can take place. Will the Minister meet me to update me on how he is ensuring that Ipswich people are at the heart of all future developments when it comes to the hospitals trust?

[Edward Argar]

I am always happy to meet my hon. Friend. Following his election in 2019—a fantastic result in Ipswich—he was one of the first new colleagues I was able to visit and, with him, I saw Ipswich Hospital for myself. He makes an important point: in looking at the healthcare system in Ipswich and Colchester, it is important that we ensure that the people of both Ipswich and Colchester get access to the best possible facilities, which is exactly what my hon. Friend campaigns for.

[Selaine Saxby (North Devon) (Con)]

I thank the Minister for the work he and his Department are doing to support our NHS. Can he confirm that the 100 new community diagnostic hubs will speed up referrals processes, particularly in coastal communities with historically poorer health outcomes, ensuring that residents receive diagnoses and treatments swiftly?

[Edward Argar]

My hon. Friend is exactly right in what she says. The whole purpose of these community diagnostic hubs is to bring cutting-edge diagnostic facilities to the heart of our towns, our rural communities, our seaside communities and our cities to make it much easier for people to access the diagnostic tests they need.

[Duncan Baker (North Norfolk) (Con)]

Cromer Hospital is the jewel in the crown of our hospital facilities in North Norfolk, but as my hon. Friend will know, it is 25 miles from the nearest main hospital, the Norfolk and Norwich, and I have many older residents. Will he meet me to discuss the viability of an urgent treatment centre? That would not only be a huge benefit to my demographic, but would go hand in hand with tackling the elective backlog.

--- Later in debate ---

[Edward Argar]

I am always cautious to caveat any example with “subject to funding available and Her Majesty’s Treasury”, but I am always happy to meet hon. and right hon. Members to discuss their ideas in respect of their local communities and the services those communities need, because it is hon. and right hon. Members who know their communities best.

[Ruth Edwards (Rushcliffe) (Con)]

I draw the Minister’s attention to an exciting new proposal for a model surgical hub in the east midlands, which would tackle the backlog by focusing solely on elective surgery. The plan is being developed by surgeons in Derbyshire, Nottinghamshire and Leicestershire, including my constituent Dr Tony Westbrook. Will the Minister join me in welcoming this innovative plan and thanking everyone involved in drawing it up? Will he join me in calling on regional health authorities to give it serious consideration?

[Edward Argar]

My hon. Friend makes an important point. What we have seen throughout this pandemic, and we continue to see it now as we look to tackle the waiting lists, is people across the health and care system innovating and coming up with exciting new ideas and new ways to achieve the outcomes that we desire. I will certainly look into the specifics that she talks about, and I congratulate all those involved on their willingness to innovate and come up with new ways of doing things.

[Stephen Metcalfe (South Basildon and East Thurrock) (Con)]

I welcome today’s statement, and I take this opportunity to thank all those healthcare workers who have worked on the frontline throughout the pandemic, particularly nurses, who have worked so hard to keep services operating. I am therefore reassured that we have seen a 21% increase in nursing applications in the past year alone. Will my hon. Friend confirm first that that will help us meet our manifesto commitment to recruit 50,000 extra nurses, but, more importantly, that it will help make their lives easier by reducing their workload somewhat?

[Edward Argar]

My hon. Friend is right on a number of counts: first, to pay tribute to the work of nurses up and down the country during this pandemic; and, to highlight the significant progress we have made on the trajectory to meeting our 50,000 nurses manifesto commitment. The reason we made that commitment is exactly as he says: we know we need more nurses in the NHS, and we are committed to recruiting them, which will have a positive impact on all those already in our NHS as they are joined by many newly qualified professionals to help share that load.

[Scott Benton (Blackpool South) (Con)]

Blackpool was one of the first areas to receive additional funding to tackle the NHS covid backlog, and this funding is already making a difference on the ground for my constituents. When further moneys are allocated, will the Minister commit to prioritising those areas, such as Blackpool, that have some of the worst health outcomes in the entire country?

[Edward Argar]

My hon. Friend is a strong champion and a strong local voice for Blackpool in this House. We are clear in this Government that in the investment decisions we make, we are committed to making sure that we level up across this country and that that money goes to where it can make the greatest difference in improving outcomes for all patients and all those who use our NHS.

Covid-19: Purchasing Effort

Edward Argar Excerpts

Thursday 3rd February 2022 Commons Chamber

[The Minister for Health (Edward Argar)]

With permission, Mr Deputy Speaker, I will update the House on our purchasing efforts in response to the covid-19 pandemic.

A little over two years ago, we and the whole world found ourselves in unprecedented circumstances. We were faced with a virus about which we knew very little, but we knew from day one that our absolute priority was to save lives and protect our most vulnerable. Throughout the pandemic we have worked night and day to make sure those performing heroics on the frontline have the protection they need. This includes making the tough but necessary decisions needed to keep the country safe.

With the pandemic pushing health systems across the world to breaking point, we acted quickly and decisively to protect the NHS and to help it continue providing world-class care to the public. In a highly competitive global market, and with many countries imposing export bans, we were none the less able to secure the personal protective equipment needed. We secured billions of items of PPE, we obtained 30,000 ventilators by the end of June 2020 and we delivered more than 17.5 billion items to protect our frontline workers.

The supply of these vital items helped to keep the NHS open throughout the pandemic, but the scale of the challenge we faced in sourcing them should not be underestimated. The unique and unprecedented situation during the early days of the pandemic led to huge inflation in prices and intense global competition to secure scarce supplies. For instance, the average cost of nitrile gloves increased over sixfold at the height of the pandemic, compared with pre-pandemic levels.

At that time of national emergency, when lives were on the line, we simply had to change our approach to procurement and our appetite for risk. We had to balance the risk of contracts not performing and supplies being priced at a premium against the risk to the health of frontline workers, the NHS and the public if we failed to get the PPE we so desperately needed.

We make no apology for procuring PPE at the pace and volume we did, based on the information we had at the time. The action we took protected thousands of frontline healthcare workers in the NHS and social care. However, now that the world market for PPE has stabilised, the value of some categories of goods is inevitably much lower than the price at which they were originally purchased.

I reinforce to the House that 97% of the PPE we ordered was suitable and fit for use, with only a small proportion deemed unsuitable, and we are actively seeking to recover costs from suppliers wherever possible in those cases. Throughout the pandemic, the Department’s anti-fraud unit acted quickly to investigate all allegations of fraud, and we will be looking to recover any money for damaged or inadequate stock.

We are now in a position where we are confident that we have sufficient stock to cover all future covid-19-related demands, even in the face of the omicron variant. The PPE stocks we secured allowed us to meet demand through 2020-21 and 2021-22, and our existing PPE stocks will continue to support us throughout 2022-23.

We will keep working to maximise value from our stockpile, as the high standards of protection we have set for NHS workers mean that some of it may be able to be used in alternative settings. The Department has set up a redistribution team to identify alternative uses for stock that we do not intend or expect to use. For example, we are donating masks to both the Department for Transport and the Department for Education to aid compliance with face covering requirements on public transport and to support schools following their reopening in March 2021.

Medical professionals in my Department have also been working closely with colleagues in medical surveillance authorities to review stock that has exceeded its manufacturers’ use-by date but is not necessarily unusable. We have also begun a tender for a third-party medical laboratory to provide official testing of PPE products, with a view to extending their shelf life.

During the pandemic, we have taken steps to strengthen this country’s PPE supply chain, including manufacturing more PPE here in the UK. We have now signed contacts with more than 30 UK-based companies, reducing our reliance on manufacturers overseas, and we now have high confidence that we have sufficient stock to cover all future covid-19-related demands.

Getting PPE to those who need it has been one of the toughest logistical tasks of the pandemic. We make no apologies for taking the steps that were necessary so that we could save lives and protect this country in its time of need.

I commend this statement to the House.

[Wes Streeting (Ilford North) (Lab)]

I thank the Minister for advance sight of the statement. But what a disgrace that the Secretary of State did not come to the House today, to account for the inexcusable and unacceptable level of waste in his Department, or when the Department first published the accounts, or two days afterwards, when they were reported on the front pages of several newspapers and on broadcast news. Perhaps the Secretary of State’s silence and absence tell us that he is relaxed about losing billions of pounds of taxpayers’ money, or perhaps it is simply that he is too ashamed to show his face. He had to be dragged to the House and when he was, he bottled it and sent his deputy.

The Department of Health and Social Care snuck out its annual accounts on the final day on which they were legally required, 10 months after the end of the financial year, and, I am sure by total coincidence, at 5.30 pm on the day Sue Gray published her update. Buried on page 199 was the revelation that the Department lost a staggering £8.7 billion on PPE. That is more than two thirds of the Department’s total spend on PPE written off as losses, double the amount it is spending on the hospital building programme, and almost as much as we spend on the salaries of every nurse in England for an entire year. Why? Because the PPE was unusable, going out of date, and bought in at eye-watering prices because the Government were in a state of desperation having run down our supplies before the pandemic arrived.

We know that many Conservative Members privately—sometimes even publicly—agree with Labour that the national insurance rise is an unfair hit on working families facing a cost of living crisis. How will they explain to their voters that, taken together with the £4.3 billion they handed out to fraudsters, this Government have thrown away more than a year’s receipts of the national insurance rise that they are now imposing on working families?

It is not just that the Conservatives are the party of high taxes because they are the party of low growth; they are the party of high taxes because they are the party of waste and incompetence. Think of what the NHS could have done with those funds. It could have reduced waiting lists and waiting times, improved access to GPs and rebuilt hospitals for the 21st century.

Of course covid came as a shock, but that does not explain why the Conservative Government ran down Britain’s supply of PPE before the pandemic, leaving us exposed to price hikes and profiteering. Perhaps the Minister can explain why a global pandemic necessarily leads to Conservative party donors and the former Secretary of State’s pub landlord receiving special treatment and hundreds of millions of pounds of taxpayers’ money.

It is not just PPE. Why did the Department fail to collect shipments from ports on time, costing taxpayers £111 million in additional fees? Why did the Department fail to pay its bills on time and incur late fees of £1.6 million as a result? Why did the Department spend £250 million on testing materials, ventilators and medical equipment, none of which can be used?

Is not it the case that when this Conservative Government thought no one was watching, they abandoned any pretence of being careful stewards of public finances, bunged millions to their mates and donors, and now working families are footing the bill? What would Mrs Thatcher, the grocer’s daughter, whose father instilled in her the value of thrift, make of this lot?

Is not the truth that the Conservative party has changed? You cannot trust this Conservative party to show respect to the people or to Parliament. You cannot trust this Conservative Party to keep taxes low. You cannot trust this Conservative Party to spend taxpayers’ money wisely. Indeed, the only thing that has not changed about the Conservatives is the age-old truth that you cannot trust the Tories with the NHS.

[Edward Argar]

It is always a pleasure to appear opposite the shadow Secretary of State. I will not take it as a personal affront that he would prefer it to be the Secretary of State rather than me.

The hon. Gentleman raised a number of important points. He cited Mrs Thatcher, and suggested that the Government had changed their position. If we are talking about sudden changes in position, I feel that I should quote the present shadow Chancellor, the hon. Member for Leeds West (Rachel Reeves)—formerly shadow Chancellor of the Duchy of Lancaster—who, in April 2020, wrote to my right hon. Friend the Chancellor of the Duchy of Lancaster:

“We need Government to strain every sinew and utilise untapped resources in UK manufacturing, to deliver essential equipment to frontline workers. This must be a national effort which leaves no stone unturned.”

She was right. I agreed with her sentiment then, and I still do—and we did do that—but it appears that the Opposition do not agree with it any more.

Let me turn to the hon. Gentleman’s other points. He kept suggesting—it makes a good headline for him, I am sure, but sadly I fear it is simply inaccurate—that this is money lost or wasted. It is not. As the hon. Gentleman knows from his days as a shadow Treasury Minister, this is a reflection of buying PPE at the height of the market, at the height of a global pandemic—

[Wes Streeting]

Why? Were there not enough masks?

[Edward Argar]

I will come to that point in a moment. It is a reflection of that, and now, in accounting terms, a reflection of what its value is today.

The hon. Gentleman should also be aware that the vast bulk of that £8.7 billion is down to exactly the same reason: PPE purchased at the height of the market. Now that we have a stable market, we have a sustainable supply. I make no apologies, and I know that my right hon. and hon. Friends will make no apologies, for doing exactly what the shadow Chancellor said we should do, which was to strain every sinew to make sure that the NHS had the PPE that it needed. We achieved that.

[Wes Streeting]

She did not say “by giving a contract to a pub landlord”.

[Edward Argar]

That is an important point, and I will turn to it in just a second.

The hon. Gentleman was also wrong to say that the money was thrown away. He knows that that is not what has happened here. He knows that this is about stock that has been written down in value, not written off. He knows that the vast bulk of that remaining is fit for use. We set very high standards in the NHS, but it is fit for use in other settings, and we are ensuring that we explore those other avenues, so that it can be used.

The hon. Gentleman talked about pub landlords. He will have heard my right hon. Friend the Member for West Suffolk (Matt Hancock) make this point in the Chamber. No contract was awarded to that individual, so I would caution him to be a little bit careful about the allegations he makes, and to check his facts before he does so.

Let me now turn to one of the broader themes raised by the hon. Gentleman. He talked about running down PPE stocks. Can he name any country in Europe that did not also have to buy vast amounts of PPE at the height of the pandemic, at the height of the market? This pandemic was unprecedented. We learned more about it with every day that passed. When we first started purchasing PPE, we were confronted with horrific pictures from hospitals in Bergamo in Italy. We saw the challenges that were faced, and we moved fast to ensure that our frontline had what it needed. We strained every sinew, and we got the PPE that our country needed.

[Andrew Jones (Harrogate and Knaresborough) (Con)]

Does my right hon. Friend agree that the revaluation of the stock simply reflects global market price fluctuations? Will he confirm that the PPE is being used? Will he also disregard the comments from Opposition Members, who are peddling known inaccuracies and whose comments on the finances show them to be utterly economically illiterate?

--- Later in debate ---

[Edward Argar]

My hon. Friend puts it even better than I could have done. He is absolutely right to emphasise that this is a reflection of our straining every sinew to buy what we needed at the height of the pandemic, with inflated global prices, to give our NHS workers the protection that they needed. The global market has now returned to normal levels, and that, coupled with the fact that we have helped to stimulate and build a UK manufacturing base for PPE in this country, is a simple fact of economics. The shadow Secretary of State, who I think was formerly a shadow Exchequer Secretary, should know that. Sadly, the fact that that is not reflected in his comments, for whatever reason, causes me to question how much the Labour party has really learned about how to manage our nation’s finances and economy.

[Steven Bonnar (Coatbridge, Chryston and Bellshill) (SNP)]

I thank the Minister for advance sight of his statement. Yet again, this Government are set rigid on making the working poor pay for their ineptitude and mismanagement. We know that £4.3 billion has been wasted, written off as covid loan fraud. We know that the Government spent £12 billion on PPE in England up to March 2021, of which £9 billion has been declared by the Government themselves as “wasted”—[Interruption.] We have some chuntering from those in a sedentary position, but I will continue.

Does the Minister believe that wasting all that money spent on PPE is a sign of good governance, when £2 of every £3 spent on VIP lane contracts was wasted due to so-called errors in supply? Now hard-working people will be taxed £12 billion by this Government to pay for their mismanagement, when the Bank of England has just told us that UK households must be warned to “brace themselves” for the biggest annual fall in living standards in 30 years, since records began, and inflation is set to soar to 7%. Why is his Government not vigorously pursuing companies that provided £9 billion-worth of useless PPE equipment to ensure that they pay it back? Will he assure the House that his Government will pursue that with complete vigour?

Kleptocracy is defined as a situation where politicians enrich themselves or their associates through the funnelling of public money and assets to their connections outside the rule of law—a statement we know all too well in this House. Given that the UK Government’s VIP, Tory crony fast lanes for Tory party associates have been declared unlawful in the Court of Session and seen billions of pounds wastefully funnelled to politically connected friends of this Tory Government, does the Minister agree that his Government are fast becoming a kleptocracy?

[Edward Argar]

In general, and certainly after that contribution, I will take no lessons in financial illiteracy from the SNP. The hon. Gentleman regularly, in that contribution, referred to £8.7 billion or £9 billion—rounding, if he wishes to—as wasted. He will know that, as I have set out, it is not wasted. It is a write-down on the value of stock, but it is not wasted. That stock is available. That is the point I make to him. The vast majority of that stock is available and in warehouses. This is an accounting point about the value of what was paid at the time compared with its value in a recovered market.

I will pick up one point I missed with the shadow Secretary of State, who I hope will forgive me. He mentioned ventilators, and I apologise for not answering that point. In the case of ventilators, we followed the scientific advice at the time, which was that ventilators were the most effective way of treating those who were severely ill. Thankfully, due to amazing advances by our clinicians and scientists and to the action taken by this Government, we did not need them and the treatments available improved significantly. Again, I make no apologies for our being prepared for all eventualities.

To conclude on the contribution of the hon. Member for Coatbridge, Chryston and Bellshill (Steven Bonnar), I reiterate the same thing: we make no apologies for having strained every sinew—in a global pandemic, at the height of the market, when some countries were imposing export bans—to purchase the PPE to protect our frontline workers. I also pay tribute to the officials who worked flat out, often through the night, sourcing the PPE. They were the ones assessing it, and they were rigorous in their assessments. I put on record my tribute and my gratitude—

[Steven Bonnar]

indicated assent.

[Edward Argar]

I think the hon. Gentleman nodded assent, so we may be in agreement on that point. I put on record my tribute and my gratitude to them for all their hard work to protect the frontline.

[Mr Peter Bone (Wellingborough) (Con)]

In reality, back at the beginning of the pandemic, the Opposition were calling for the Government to go faster. It seems to me that one of the great success stories of this Government is that they got the PPE and the ventilators and, by doing so, saved a lot of lives. Does the excellent Minister agree that, unfortunately, the rhetoric coming from the Opposition now is completely different from what it was at the time of the pandemic?

[Edward Argar]

I am grateful to my hon. Friend. Far be it from me to suggest that hindsight characterises the approach adopted by Opposition Front Benchers, but he is absolutely right. I mentioned the shadow Chancellor, the hon. Member for Leeds West (Rachel Reeves). She also said in this place:

“Those who look after the sick and the vulnerable deserve our protection, and getting PPE to them is the priority of all of us.”—[Official Report, 4 May 2020; Vol. 675, c. 412.]

She was absolutely right and remains right, and that is why this Government did exactly that. Protecting the taxpayers’ pound is hugely important. Equally, so too is procuring the kit that protects lives. In the unique circumstances that we faced at the time in 2020, I believe that this Government made the right choices.

[Barbara Keeley (Worsley and Eccles South) (Lab)]

For context, £9 billion would have given every NHS nurse a 100% bonus on their salary or it could provide the funding needed to solve the issue of autistic people and people with learning disabilities being detained in inappropriate units because no funding is available to support them in the community. Instead, it is clear that large amounts were wasted on unused and unsuitable PPE, some of which, we understand, will have to be burned. I remind the Minister that we could have had a stockpile of PPE in this country if Exercise Cygnus in 2016 had been handled responsibly. Exercise Cygnus showed gaping holes in our emergency preparedness and we have to learn the lesson from that.

[Edward Argar]

I am grateful to the hon. Lady; to be fair, we may not always agree, but she always makes thoughtful points and knows this subject well. However, many right hon. and hon. Members across the House have regularly said that Exercise Cygnus gave everyone everything they needed to know in how to manage this pandemic, which is completely not the case. That was a flu pandemic exercise with a number of preconditions, one of which was that, at a certain point, it was assumed that antivirals would become available within—I think, off the top of my head—nine weeks of the pandemic beginning. That was not the case, because we were dealing with a completely new virus, so although there are valuable lessons to be learned, we need to be very careful about drawing direct parallels.

The hon. Lady rightly talked about the sum of money and highlighted the impact. She is right that £8.7 billion is a very significant sum of public money, but she also must acknowledge that that £8.7 billion was not wasted, because the PPE exists. This is an accounting point about what the purchase price was compared with the value now, with a stable marketplace for that. Only a very small fraction of that stockpile has been deemed not fit for use and, in those cases, we continue to investigate, through contractual mechanisms and elsewhere, what we can do to recover that money.

[Mike Wood (Dudley South) (Con)]

The embassy of one of our major international partners had to send staff to Sofia with a suitcase of money handcuffed to their wrist in order to procure PPE for their health and social care. Does my hon. Friend not think that the Opposition would be better off celebrating the herculean efforts that meant that PPE could be got to our NHS providers and our local authority and social care providers, rather than engaging in such transparently cynical party political point scoring?

[Edward Argar]

I agree entirely with my hon. Friend. As I said in response to the SNP Front-Bench spokesman, the hon. Member for Coatbridge, Chryston and Bellshill (Steven Bonnar), I hope the whole House could agree on paying tribute to all those civil servants and others who moved heaven and earth to ensure that we got the PPE that we needed for the frontline. That is the most important factor. We did what we needed to get the PPE to protect people and to protect lives.

[Nick Smith (Blaenau Gwent) (Lab)]

Private Eye has uncovered £600 million of PPE contracts awarded to Unispace Global, an interior design company, through the VIP lane. The Department has paid the money to Unispace but it is not shown on the company accounts, so will the Minister strain every sinew and will there be an investigation to account for the £600 million of public money?

[Edward Argar]

In any circumstance where a contractual obligation has not been met or where goods that have been supplied do not meet that—I am not suggesting that is the case in this situation—we will look into it. The hon. Gentleman mentions company accounts, but that is a matter for the company and its filing of accounts; it is not a matter for Her Majesty’s Government.

[James Sunderland (Bracknell) (Con)]

There has been a lot of unhelpful speculation about loss and wastage of PPE in recent weeks. Some of this speculation is blatantly false, and it is important that we do not overly politicise the issue, because the Government acted to do the right thing at the right time. The use of language is also really important. Does the Minister agree that this is not about outright loss and that it is about accounting write-down?

[Edward Argar]

My hon. Friend puts his finger on the issue absolutely. I mentioned in response to the hon. Member for Worsley and Eccles South (Barbara Keeley), who is no longer in her place, that a small proportion of this £8.7 billion went on PPE that did not meet the standard, and we continue to pursue those contracts and investigate them. However, my hon. Friend is right to say that the vast majority of this money purchased PPE that was delivered and is usable, and the difference in money reflects the fact that we bought at the height of a global pandemic, doing whatever was needed to get the supplies we needed. Of course, in the two to two and a half years since, that market has stabilised, with significantly more manufacturing also in this country.

[Florence Eshalomi (Vauxhall) (Lab/Co-op)]

The Minister mentioned in his statement that the Government took these difficult decisions to keep the country safe. The hard-working staff in St Thomas’ Hospital in my constituency took the decision to come to work every day during this pandemic to keep the country safe. The Minister mentions that this is a value of accounting and it is not real money. Can he tell me: how much more could we have got for nurses for that £8.7 billion? My local nurses who are watching this statement are thinking that they could have done with that pay increase.

[Edward Argar]

The hon. Lady will know that I have not said that this is not real money; I have said that what has been published here in the accounts is what is required for an accounting purpose. The PPE was purchased, and that was done at the height of a global pandemic and at extremely inflated prices, because every country was desperately seeking to acquire the PPE that was needed. That situation has stabilised over the past two years and PPE can now be purchased for a much, much cheaper rate. Again, I make no apology for our purchasing this PPE to protect these very nurses, who did an amazing job in her local hospital, from the effects of covid.

[Jacob Young (Redcar) (Con)]

This Government acted quickly and decisively to secure as much PPE for the frontline as possible and as many vaccines as possible, while the Labour party carped from the sidelines, attacked the vaccine taskforce and played politics, just as it is doing today. On vaccines, will the Minister join me in welcoming the decision by the Medicines and Healthcare Products Regulatory Agency to approve the Teesside vaccine, Novavax, which is being manufactured in Teesside for use in the UK?

[Edward Argar]

That was a dexterous way of weaving together PPE and vaccines, but my hon. Friend is right to pay tribute to the amazing work done by the vaccine taskforce and by officials and others across Government in meeting the needs of our population during the pandemic. Of course I join him in welcoming the Novavax vaccine and the opportunities it presents for wonderful Teesside.

[Owen Thompson (Midlothian) (SNP)]

I do not think anyone in this Chamber has said, at any point, that things should not have moved quickly to secure PPE. Nobody, on this side at least, has said that this should involve the use of a VIP lane, crony contracts or contracts for pals. I am sure that the Minister will say that all these allegations are entirely unfounded, and I understand his point of view on that. Given that, will he put Government backing behind my Ministerial Interests (Emergency Powers) Bill, to ensure that such actions could not happen in the future without this House being made fully aware of them?

[Edward Argar]

I pay tribute to the hon. Gentleman for, as ever, dextrously mentioning his Bill. I think he has done that to me once before when I have been at the Dispatch Box discussing similar issues. I am sure that Ministers, and indeed the Leader of the House, will read it very carefully.

[Mr Philip Hollobone (Kettering) (Con)]

In the early months of the pandemic, getting PPE to Kettering General Hospital and local care homes was the absolute No. 1 priority. A very sophisticated distribution network had to be established involving the Army to ensure PPE was delivered to the right place at the right time, as best as possible. I believe that, starting from scratch, only 1% of certain PPE products were actually made in this country and over the course of the pandemic that has been increased to 70%-plus. Can my hon. Friend the hospitals Minister assure me that, God forbid, were we ever to have a pandemic again, we could source most of our PPE requirements from British manufacturers and that we now have a robust and resilient supply and distribution chain?

[Edward Argar]

I am grateful to my hon. Friend and join him in paying tribute to the work of his local healthcare system during the pandemic. He makes a couple of points. First, he is absolutely right to highlight that this was ramped up at pace. Initially, the NHS supplied PPE directly to about 250 hospital trusts and other trusts. In the early months of the pandemic, that was ramped up to supplying it to well over 50,000 different settings. That is a phenomenal ramping up of logistics and distribution capabilities. To his second point, he is absolutely right that, from about 1% of PPE being manufactured in the UK before the pandemic, we now have the capacity to manufacture about 70% of the PPE it is currently assessed we need in this country. That is a great British success story.

[Clive Efford (Eltham) (Lab)]

What is absolutely clear from Exercise Cygnus is that the specific recommendations on PPE were not implemented by the Government. That led to the massive rush to purchase PPE during the pandemic. That added to the problem; it was not the only reason for it. The Government’s defence on the scandals of the contracts seems to be that we had to act very quickly. If that is the case, it does not explain why a disproportionate number of the contracts ended up in the hands of people who were members of the Conservative party, close associates of members of the Conservative party, or had given money to the Conservative party. If you were casting your net far and wide, you would not expect that to come to light, would you? You would expect there to be quite a wide number of contracts being issued. So the Government’s excuse does not hold water, does it?

[Edward Argar]

I take the hon. Gentleman’s point about speed and the context in which we were operating. I have to say all contracts were assessed through an eight-stage process undertaken by neutral civil servants. As the National Audit Office found, Ministers were not involved in the award of contracts.

[Helen Morgan (North Shropshire) (LD)]

As a chartered accountant, I am au fait with the concept of an accounting write down and the scale of this one really does indicate reckless waste. I am sure that, in my constituency of North Shropshire, the £9.7 billion carelessly wasted could have been put to better use. It could have been used to tackle the extremely high ambulance waiting times, to help the local accident and emergency tackle the huge challenges it faces in getting patients through, or to deal with the £50 million black hole that social care in Shropshire is facing in two years’ time. Across the country, the story is very much the same. Local health services are struggling to find the money to deal with those issues. I am sure Members across the House know those issues all too well. That is why £9.7 billion wasted on PPE is so shocking. What are the Government doing to allocate resources to sufficiently recover that money?

[Edward Argar]

I welcome the hon. Lady to her place. I do not think I have had the opportunity to respond to a question or a speech from her previously, so I congratulate her, slightly belatedly, on her election and welcome her to this place. I will just correct one thing. She mentioned £9.7 billion. The sum involved is actually £8.7 billion.

To the hon. Lady’s point, first, it is not wasted. As I made clear, it purchased PPE. There is a small amount in these accounts which has been made clear. The shadow Secretary of State said that it was snuck out. If I recall, I tabled a written ministerial statement to draw attention to these issues to be open and transparent with the House, as I always endeavour to be. We did whatever was needed at the time, in the context of the highly inflated pricing in the midst of a global pandemic.

More broadly, the hon. Lady touched on NHS funding and pressures. I appreciate that she was not a Member of this House at the time, but this Government have put in record funding for our NHS. One of the first Acts after the 2019 election enshrined in law a £33.9 billion increase by 2023-24, and we are also putting in place the health and care levy to both assist our NHS and provide that sustainable footing for social care in the future. I acknowledge entirely that she was not a Member of this House, so it would be wrong to draw any inference as to how she may have voted, but I want to put that record investment on the record.

I also gently say that the Liberals’ stance on this issue shows, even by their standards, a degree of political contortion and a stretching of credibility. I think I am the only Member who has been a Health Minister throughout this pandemic, and I recall them desperately calling in 2020 for whatever it took to get and buy more PPE to protect the frontline. I agreed with that stance, but now they are suggesting that the Government got it wrong by prioritising whatever it took to get the PPE that the frontline needed.

[Seema Malhotra (Feltham and Heston) (Lab/Co-op)]

The Minister has said that we were prepared for all eventualities, but I think he knows that the truth is that that was not the case. As illustrated in comments by Members across the House, we did not plan ahead sufficiently for what was needed in a pandemic.

The Minister said in his statement that 97% of the PPE ordered was suitable for use. Obviously, that means that 3% was not. He also said that the Government are actively seeking to recover costs from suppliers where possible in those cases. Does he not realise that that is a very weak way of responding to that challenge? What safeguards were put in place in those contracts, and will he publish for the House updated data on suppliers that are not refunding the taxpayer—suppliers that took public funds and did not deliver the goods?

[Edward Argar]

I am grateful to the hon. Lady for asking a sensible and serious question. We have already recovered, through prevention or termination of contracts, £157 million of potential fraud. We continue, with our anti-fraud unit, to look into a number of contracts where there is either a contractual dispute or a risk of fraud. There are contractual mechanisms for reconciling or trying to manage situations in which both parties have different interpretations of whether what was delivered is what was ordered. We are already looking into more than 100 contracts in that respect. As those investigations develop, I hope I will be able to update the House further, but it necessarily takes time to have conversations with contractors through those contract dispute mechanisms and to investigate. I hope that, as we are able to bring forward more information, we will make it available to the House.

[Allan Dorans (Ayr, Carrick and Cumnock) (SNP)]

Good afternoon, Madam Deputy Speaker. Can the Minister confirm whether any of the promised £350 million a week advertised on the side of a bus as a benefit of leaving the European Union has been used to purchase PPE for the NHS?

[Edward Argar]

The NHS and the Department get their annual budgets and spend them on what is necessary to meet the health and care needs of the nation. On the hon. Gentleman’s specific point, he might characterise the £33.9 billion increase by 2023-24, which we have enshrined in law, as part of the Brexit dividend.

[Madam Deputy Speaker (Dame Eleanor Laing)]

And finally, I call Jim Shannon.

--- Later in debate ---

[Jim Shannon]

It grieves me in my heart, and I suspect that it grieves the Minister in his heart as well.

[Edward Argar]

I am grateful to the hon. Gentleman for his question. I have made it clear throughout that our priority was getting the PPE that we needed to give that protection and to save lives but, equally, every pound of taxpayers’ money is valuable. Where fraud or failure to deliver contracts is evidenced, we will go after that money, quite rightly, and seek to recoup it for the taxpayer.

On the amount that is, for want of a better way of putting it, lost through goods not being fit for use, that is £673 million, but that is what we are investigating through those contract dispute resolution mechanisms and through anti-fraud work. The other amounts of money in here did purchase PPE, which was delivered and which we have. Different settings require different standards of PPE, so some that was purchased may not be of the standard for the NHS but can be used elsewhere. We are exploring all options to make sure that the PPE we have, where it can be, is used.

Cystic Fibrosis: Prescription Charge Exemption

Edward Argar Excerpts

Wednesday 2nd February 2022 Westminster Hall

[The Minister for Health (Edward Argar)]

It is a pleasure as always to serve under your chairmanship, Mr Sharma. I congratulate my hon. Friend the Member for Blackpool North and Cleveleys (Paul Maynard) on securing this important debate and thank all hon. Members who have taken part. Although this issue falls within Lord Kamall’s ministerial portfolio rather than mine, it is privilege to answer in this place and to engage in this debate.

Nobody here today, and nobody viewing our proceedings or reading them when they are written up in Hansard, can fail to have been moved by the experiences and stories that we have heard. Hon. Members on both sides of the House told moving stories about their constituents—in the case of my hon. Friend the Member for Ashfield (Lee Anderson), who spoke of his very personal experience, it was his wife, Sinead. As hon. Members have said, it is always incredibly powerful and moving in this place when an hon. Member is willing to share their own experiences, not just with this House and colleagues but essentially with the public. It was powerful, it was personal and it was poignant, and I thank him for that.

I also thank the hon. Member for Bristol East (Kerry McCarthy) for her contribution, in which she set out—again, very movingly—very personal stories, to make this real. It is very easy in this place for us to slip into talking about policies and grand strategies and to not always relate that to people and individual lives and experiences. I am very grateful to the hon. Lady. I do not always agree with her on everything in a political context, but I certainly agree with her on EDMs. I share the experience. I remember Bob Russell from the time before I was a Member, when I worked for previous Members in this place. I admire his belief in the power of EDMs, although I have to say that I do not share it and, like the hon. Lady, I occasionally have to explain to constituents and others who understand-ably think that an EDM moves the agenda forward, that it rarely does, but that it may, on occasion, put down a marker.

As ever, I am grateful to the hon. Member for Strangford (Jim Shannon) for his comments. He mentioned that he has been in just about every debate on this subject, along with the hon. Member for Bristol East. Given his assiduity in attending debates in this House, that could be said for a vast array of subjects, on which he has given well-informed and eloquent contributions, not only representing his constituents, but putting issues of national concern on the agenda.

[Jim Shannon]

The Minister referred to the former Member, Bob Russell. I recall him standing at the door to be No. 1 on EDMs. I put in at least two EDMs every week. Their purpose is not to change policy, but to raise awareness or congratulate some person or group that has been active in the community. For me, that is what EDMs are about.

[Edward Argar]

I am grateful to the hon. Gentleman for his spirited defence of early-day motions, of which he makes powerful use, as he does with every opportunity he has to speak in this place.

My right hon. Friend the Member for South Holland and The Deepings (Sir John Hayes) is no longer able to be here, but he made a valuable contribution, and I am grateful to you, Mr Sharma, for allowing him to speak—even if, as a former Minister, he should have known better the consequences of seeking to tempt me to make policy at the Dispatch Box without cross-Government agreement, which might have led to an early termination of my ministerial career. He made a powerful point, as all hon. and right hon. Members have done, and I will turn to some of those points in a moment.

Before I do so, I want to recognise the fantastic work undertaken by the Cystic Fibrosis Trust, which does a fantastic job on behalf of people living with cystic fibrosis and their families, and in bringing the condition and the needs of people with it to the attention of this House, and more widely. I also acknowledge the work of the Prescription Charges Coalition, of which the Cystic Fibrosis Trust is a member. It has worked tirelessly to raise awareness of the help available to patients with the cost of their prescriptions and campaigns on an issue that its members feel strongly about. In our democracy, whether or not we agree on the policy position, it is right that we recognise those who get out there, campaign and seek to drive change and policy. It is important to recognise those who are active in our democracy in that way.

As we have heard, cystic fibrosis is a life-limiting condition affecting many thousands of people in the UK. It is not only a life-limiting disease but, as we heard from my hon. Friend the Member for Ashfield, a disease that can impact on the quality of life and the life experiences of those affected and their families. While there is no cure for cystic fibrosis, there are treatments available on the NHS to help reduce the effect of symptoms and make it easier to live with.

It is not that long ago that conditions such as cystic fibrosis saw life expectancy so low that many were advised not to expect to live beyond their teens. Thanks to advancements in treatments, better care and the work of organisations such as the Cystic Fibrosis Trust, people with cystic fibrosis are now living for longer, with a better quality of life, with half of those with the condition living past the age of 40. Children born with cystic fibrosis today are likely to live longer than that. That is a positive story and a reflection on our medical and scientific advances.

I turn to the crux of the debate. When the medical exemption list was drawn up in 1968 in agreement with the British Medical Association, it was limited to readily identifiable, permanent medical conditions that automatically called for continuous, lifelong and, in most cases, replacement therapy without which the patient would become seriously ill or even die. As the shadow Minister, the hon. Member for Enfield North (Feryal Clark), alluded to, there has been a review since 1968—only one—which resulted in the addition of cancer in 2009.

When the exemption list was drawn up, decisions on which conditions to include were based on medical knowledge at the time—for instance, children with cystic fibrosis were not expected to live to see adulthood—and it is entirely understandable that, given advances in treatment and increases in life expectancy, those who are now living with cystic fibrosis for a lot longer should wish to pursue exemption from prescription charges to help them maintain their quality of life with the drugs that are essential to their quality of life. The issue of prescription charges was reviewed more broadly in the round in the 2010 Gilmore report, which did not recommend further changes at that stage.

As the hon. Member for Enfield North alluded to, I know that the answers that Ministers have given, stating that the Government have no immediate plans to review the list, will have caused disappointment to right hon. and hon. Members and to those with this condition. We do think it would not be right in this context to look at one condition in isolation, separate from other conditions, because others would rightly argue that their condition was potentially equally deserving of an exemption if it fitted the same criteria. My hon. Friend the Member for Blackpool North and Cleveleys has rightly advanced the case of cystic fibrosis, and I entirely understand why, but I know that he will also recognise that other conditions might qualify for consideration in the same way, or for the same case to be made for them by right hon. and hon. Members.

When the exemption list was first put in place in 1968, 42% of items on prescription were free; now 89% are free. There has been considerable change in that space, but to go to the heart of what right hon. and hon. Members have asked for today, were my right hon. Friend the Member for South Holland and The Deepings in his place, I would disappoint him by saying that, as he will appreciate, I cannot make policy standing at the Dispatch Box. It is important that everything is considered carefully. Although this is not my policy, I will continue to reflect on the points that have been made by right hon. and hon. Members today and by campaigners on this issue. I will also ensure that I will not only speak to my noble Friend, the Minister with portfolio responsibility for this issue, but draw to his attention the transcript of today’s debate.

[Kerry McCarthy]

I have just realised that it is groundhog day—I missed an ideal opportunity to weave that fact into my speech, as I think all of us would have done. Is there anything the Minister could say that does not makes us feel like we have been here many times before? He has said that he will reflect on these points, but is there not something a little bit more concrete that he can give us a commitment on, so that we feel that we are perhaps making some progress?

[Edward Argar]

I am grateful to the hon. Lady. She may or may not always agree with me, but I will always endeavour to be straight with the House, even when the message may not always be the one that Members want to hear. I cannot stand here now and say that there will be a review of that list; it is important for me to be honest with her. What I can say—which she may feel is insufficient, and I entirely respect her if she does—is that I will reflect on the points made today and the issues raised. I will discuss this issue with my noble Friend and ensure that the points that have been made in this debate are conveyed to him, but it would be wrong of me to commit to something that I am not in a position to commit to. The hon. Lady rightly presses her case, but I know that she will appreciate my position, and it is important that I am honest with the House in that respect.

I touched on the help with prescription costs previously, and the number of items. While I know that this is not at the heart of the point made by my hon. Friend the Member for Blackpool North and Cleveleys, it is still important that I put on record the point that I alluded to: when medical exemptions were introduced, only 42% of all NHS prescription items were dispensed free of charge. That figure is now around 89%, and around 60% of the English population do not pay prescription charges at all. Many people with medical conditions not on the exempt list already get free prescriptions on other grounds, as my hon. Friend the Member for Blackpool North and Cleveleys said, with current exemptions providing valuable help for those on the lowest incomes.

[Jim Shannon]

In my contribution, I referred to Scotland, Wales and Northern Ireland, where prescription charges are free. I have knowledge of Northern Ireland, though not of Scotland and Wales, and understand that we follow the rules of the National Institute for Health and Care Excellence in the UK but have some liberty about what we add on. I understand that the Minister is not responsible for this. He is a good man who has been honest with us. What we wish to be conveyed from this debate, to the person who is responsible, is that the same should happen here as in Northern Ireland, Scotland and Wales.

[Edward Argar]

I am grateful to the hon. Gentleman. I will finish the point I was making and then respond to his. We have already heard about the annual certificate, which can be purchased by direct debit in instalments, meaning that a person can have all the prescribed items they need for just over £2 a week. I take the point from the hon. Member for Bristol East that that may still not solve the problem for everyone, but that route provides a significant potential reduction in costs.

I shall now respond to the point raised by the hon. Member for Strangford on the devolved Administrations, and the broader approach to prescription charges. Although we have surprisingly managed to stray away from it for quite a while, any debate on this subject will touch on the different positions of England and the devolved Administrations, given the latter’s abolition of charges for prescriptions. I suspect that many people will ask why there is that difference in approach. Health is a devolved matter and the devolved Administrations have full discretion over how they spend their budgets and the choices they make, presumably choosing to spend a proportionately larger share of those budgets on prescriptions.

We have opted for a different approach in England. We also recognise that prescription charges, more broadly, raise significant revenue, which provides a valuable contribution directly to NHS services in England. In 2019-20, they contributed just over £600 million in revenue to NHS frontline services. There is always a balance to be struck, and I suspect that we shall return to this topic, with Members taking different views.

With regard to the key point made by the hon. Member for Strangford, although I am not directly responsible for this area of policy I will continue to reflect on that. In this House, there are times when individual debates or speeches—I look at my hon. Friend the Member for Ashfield—resonate, and cause Ministers to turn them over in their head and reflect on the points made. All hon. Members will be able to point to speeches they have heard on different topics in the main Chamber that stay with them. They go away from that debate, still reflecting on what that right hon. or hon. Member has said. My hon. Friend the Member for Ashfield has had that effect today. I will reflect carefully on what he said, within the context that I cannot make policy at the Dispatch Box. In response to the point made by the hon. Member for Strangford, I will pick up that issue and convey the sentiments of Members speaking today to my noble Friend Lord Kamall, and ensure that he has a copy of the transcript of the debate.

I conclude by thanking all hon. Members for their contributions. Often, people judge what goes on in this place by the half an hour or 40 minutes that they see at 12 noon on a Wednesday on both sides of the Chamber and what happens there. Many people do not see what happens in Westminster Hall, where, in a measured and sensible way, people can discuss, debate and sometimes disagree on issues that really matter and impact on the lives of individuals or particular groups of people. This debate is one that those that clears a very high bar for the quality of the contributions, for the importance of the subject and for its ability to cause us to leave this Chamber continuing to reflect on what we have heard.

[Paul Maynard]

I thank all those who have participated, particularly my hon. Friend the Member for Ashfield (Lee Anderson). We are all grateful to him for not just speaking on a personal basis, but illuminating a debate far better than I could from my more dry, academic analysis. I thank him for his personal contribution, and I thank all hon. Members for a constructive debate. I recognise the point that the Minister made; making a commitment on the hoof at the Dispatch Box can be career-limiting. I know that myself, as I reflect on what I once said on rail and aviation, which I suspect led to my defenestration. Saving High Speed 2 can be terminal for a career, perhaps. None the less, I hope he will take the issue back to Lord Kamall, and that he might encourage him to meet me and other interested Members to hear what the Gentleman whose brief it is thinks of the matter.

[Edward Argar]

I am happy to reassure my hon. Friend that I will certainly convey his request for a meeting to my noble Friend.

[Paul Maynard]

We have something concrete on which to conclude the debate.

Question put and agreed to.

Resolved,

That this House has considered prescription charge exemption and cystic fibrosis.

Kettering General Hospital

Edward Argar Excerpts

Wednesday 2nd February 2022 Westminster Hall

[The Minister for Health (Edward Argar)]

It is a pleasure to serve under your chairmanship, Mr Twigg. I congratulate my hon. Friend the Member for Kettering (Mr Hollobone) on securing this debate. By my tally, this is the fourth debate I have responded to that he has secured on the future of Kettering General Hospital and its redevelopment. That fact reflects his commitment to this issue on behalf of his constituents, and his typically courteous but tenacious approach to the matter. I will put on record, as they are unable to be here, the work done by my hon. Friends the Members for Wellingborough (Mr Bone) and for Corby (Tom Pursglove) in this respect. I welcome the intervention from my hon. Friend the Member for Northampton South (Andrew Lewer).

The topic is not a new one for this House to discuss, but it is an extremely important one. I hope that I might move matters a little bit further forward in this debate for my hon. Friend the Member for Kettering. It was a pleasure to meet him, my hon. Friends the Members for Wellingborough and for Corby and Simon Weldon on 17 January to discuss Kettering General Hospital and receive an update on its plans. I join my hon. Friend the Member for Kettering in paying tribute to Simon and all of the team at Kettering General Hospital and at Northampton General Hospital for the work they have done, not only in the past two years, but day in, day out every year, to support the local community and provide first-class care.

My hon. Friend the Member for Kettering made, as ever, a generous offer to visit Kettering General Hospital with him. It was a pleasure to do so in 2019, when he gave me a very warm welcome in Kettering. I also take his suggestion of visiting Northampton at the same time. Without setting a specific date, my aim is to try to visit him during the February recess—I will discuss this with him. It is not a long haul for me from my constituency in Leicestershire to his in Kettering or Northampton, so that is what I will hope to do, subject to that working for the trust. Ministers are often surplus to operational requirements in a busy trust at busy times, but I suspect that Simon will welcome me to explain what progress he has made. That is my commitment to my hon. Friend.

As my hon. Friend set out, Kettering General Hospital is part of the broader foundation trust, and continues to work closely with the central programme team in taking forward the rebuild of Kettering General as a new hospital for his community. It is part of the broader programme to build 40 new hospitals by 2030. On 13 January, Natalie Forrest, who is the senior responsible owner for the new hospital programme, and officials attended a virtual meeting with the chief executive and staff from Kettering General to discuss progress and provide an update on the scheme in the context of the programme. As my hon. Friend knows, Kettering General Hospital NHS Foundation Trust has received £4.4 million of funding to develop its plans for the rebuilding of Kettering General Hospital. They were successful in securing funding back in 2019, at that stage for a new urgent care hub, which would transform the provision of urgent and critical care in the area. I know that officials are in discussion with the chief executive of the hospital trust regarding the trust’s plans for enabling works on the Kettering General Hospital site and have set out what will be required for these proposals to be assessed as quickly as possible, once business cases are received from the trust, which is in line with what my hon. Friend would expect of appropriate processes for spending public money.

I will provide a little background. The Department wrote to the chief executive on 16 June last year to confirm that, at his request, the urgent care hub and new hospital programme schemes could be brought together as a single pot of money, to maximise the benefits that local people could derive.

Essentially, my hon. Friend asked why things have not progressed since 2019. That is largely because the trust changed its plans. That money was ringfenced for an urgent treatment centre. We had discussions about that with the trust and accepted its proposal to merge the two pots of money. That then necessitated their coming forward with proposals about how they would spend that money as part of the enabling works for a broader scheme. If changes are made, it is right that those changes are justified, in the context of the appropriate stewardship of public money.

The hub and the new hospital that are to be built both share a set of common enabling works, which have been factored into the new hospital development plans. As a result, the trust is incorporating the urgent care hub delivery into that broader plan. It means that the hub will now be part of the first stage of the building of the new hospital, enabling the more efficient use of resources to deliver better results.

In respect of the business case for that plan—I know that my hon. Friend is keen that there is progress on that as swiftly as possible—my officials have been in touch with the trust recently, most recently yesterday and before that on 26 or 27 January, asking the trust to put forward its proposals for those enabling works. We need those to progress the business case. My officials continue to nudge the trust gently, saying, “Please submit your proposals for that and the business case for it”. My commitment is that my officials will consider those proposals as swiftly as they can, once they have received them. As I understand it, given the scale of the enabling works, they would not need to go through the full internal approvals process, but the trust needs to submit a business case for that element.

The second element, which I know my hon. Friend and the trust are keen to see being advanced as swiftly as possible, is the new boiler room and power plant. Essentially, that would have to go through the full approvals process, but I understand that the board of the trust is due to meet in April to agree and finalise its proposal and business case on that work. As soon as it submits that, I can commit to my hon. Friend that—assuming that it is up to scratch, which I am sure it will be—it will go before the first joint investment committee of the Department following its submission, so that it can be considered as swiftly as possible.

At the moment, if I may put it this way, the ball is in the trust’s court, for it to send its proposal and business case over. However, my commitment is that as soon as the trust does so, I will task officials with considering them as swiftly as possible.

[Mr Hollobone]

I thank the Minister for his very helpful comments. I think that the ball, in part, may be in the trust’s court, but there is perhaps another ball with the new hospitals programme team. I say that because the hospital submitted its strategic outline case to the NHS a year ago and what the trust requires is feedback on that, to inform the development of its outline business case. So would the Minister be kind enough to look at that feedback?

[Edward Argar]

I am happy to look at that. The point I am making to my hon. Friend is that for the moneys that he and the trust wish to draw down from the £46 million, we do not have the business cases from the trust that would enable that work. I suspect that they will be winging their way to the Department pretty swiftly following this debate and as soon as they arrive we will look at them. Regarding the broader business case for the overall scheme, I will turn to that, if I may, in just a moment.

All the new hospitals that will be delivered as part of the programme, including Kettering, are required to work with the central team and, with the support of regional and local trust leadership, to design and deliver their hospitals in keeping with a consistent and standardised national approach. This collaborative approach is intended to help each trust to get the most from its available funding, while avoiding repetition of work and design, and ensuring that adherence to the principles, which my hon. Friend alluded to, of repeatable design, modern methods of construction and net carbon zero, is embedded from the outset, to maximise the potential benefits of the programmatic approach, as well, of course, as providing better value for money for the taxpayer.

All the projects that are part of that 40-hospital programme need to ensure that their approach is consistent with the programme, which that has been developed over the past year and has reached a greater level of maturity. Therefore, there will be individual conversations with trusts about where they align with the programme, or where they may need to adapt to meet that national approach.

My hon. Friend touched on the trust’s desire to go faster and begin the main project construction in 2023. In the spirit of openness, my only caveat to that is that, in the nature of funding through multiple spending review periods, it is not the case that a pot of money is earmarked for each programme and is just waiting to be drawn down; there is a profiling of moneys made available by the Treasury. I appreciate the trust’s eagerness to go faster, and I appreciate my hon. Friend’s clear steer that he believes it is capable of going further and faster, but we need to look at it in the context of all the other schemes and the availability and profile of moneys being made available. I just sound that slight note of caution, so I will not commit to a date, much though he tempts me to do so.

[Mr Hollobone]

I appreciate the Minister’s comments. I would just highlight that there are some very large new hospital programmes out there that will not be achieved on time. Kettering is a relatively small, flexible and modular scheme that is perfectly placed to pick up on any slippage from some of the larger schemes.

[Edward Argar]

I am grateful to my hon. Friend, because I was about to turn to his final ask, which was whether the Department would look favourably on Kettering’s scheme if there was slippage from other schemes in the course of the spending review period. Although I cannot prejudge in this place that Kettering will be top of the list, he makes a strong case. It is absolutely right that we look at schemes and have a list of schemes that we believe could fill the gap if moneys are not going to be spent in year. It is important that that contingency is built in, and my hon. Friend makes a strong case for Kettering to be one of the hospitals that is considered for acceleration if it is ready and the moneys become available. I will not prejudge the advice that I will be given by officials as to which schemes are most mature, but he makes his case clearly and forcefully on the Floor of the Chamber.

I am grateful to my hon. Friend not only for the opportunity to discuss and debate Kettering General Hospital, but for the opportunity to visit Kettering. On my last visit, I received a very warm welcome from him and the team at the hospital. In what I have said today, I hope I have ensured that I get an equally warm welcome when I come and see him this month. Like him, I am keen to see all these schemes progress, and I am keen to see the benefits that the schemes will realise.

In the context of Kettering General Hospital, my hon. Friend continues to be an incredibly powerful advocate for the interests of his constituents and those in the wider area of Northamptonshire who are served by the hospital. I look forward to continuing to work with him very closely in the future, as well as with the trust’s chief executive and team, other hon. Friends from Northamptonshire and my team in the Department, to help progress these very exciting and important plans, which will make a huge difference to his constituents’ lives in the years ahead.

Question put and agreed to.

Future of the NHS

Edward Argar Excerpts

Monday 31st January 2022 Westminster Hall

[The Minister for Health (Edward Argar)]

It is a pleasure to serve under your chairmanship, Mr Gray. I pay tribute to my hon. Friend the Member for Stockton South (Matt Vickers) for leading this debate on behalf of the Petitions Committee. I am pleased we were able to find time to hear from the hon. Member for Middlesbrough (Andy McDonald); I offered to take an intervention from him, which I suspect was a brave offer on my part given the intervention that might have come my way. I am pleased he got to give his speech.

I am grateful to the shadow Minister, the hon. Member for Denton and Reddish (Andrew Gwynne). I think this is the first time we have properly been opposite one another since his appointment to this role on the Opposition Front Bench. Although I did not agree with everything he said, he made a typically well-informed and well-argued speech. He is right to pay tribute to all hon. Members who have spoken today, regardless of whether one agrees with the positions advanced. This has been a passionate debate. At its heart is, perhaps, the most precious of our country’s institutions; understandably, right hon. and hon. Members and our constituents have very strong views on the subject.

Before turning to the substance of the debate, and although I may not agree with their position, I pay tribute in a broader context to the work of Unite, Unison and other trade unions. I do not always agree with the stance they adopt, but they play a hugely important role in our democracy and society. It is right to put that on the record. As always in these debates, and as the shadow Minister has done very clearly, I also put on the record our gratitude—from both sides of the Chamber equally—to all NHS staff and those working in social care, local government and other key workers across the country for what they have done across the past two years and, indeed, what they do every year, day in, day out.

As I have said before, the Health and Care Bill reflects evolution, not revolution. It supports improvements already under way in the NHS and, crucially, builds on what the NHS recommended and consulted on back in 2019.

[Margaret Greenwood]

Will the Minister give way?

[Edward Argar]

I will make a little progress before giving way; I will always give way to the hon. Lady. The Bill is backed by not only the NHS but many others working across health and social care. In a joint statement, the NHS Confederation, NHS providers and the Local Government Association state that they

“believe that the direction of travel set by the bill is the right one”,

noting that local level partnership is the only way we can address the challenges of our time.

[Margaret Greenwood]

The Minister is talking about a consultation that, as I recall, took place over the Christmas period, when NHS staff are absolutely exhausted. He talks about these changes being requested by the NHS, but what percentage of NHS staff does he actually think took part in the consultation?

[Edward Argar]

As the hon. Lady will know, the former chief executive of the NHS, Lord Stephens, was clearing in saying that the

“overwhelming majority of these proposals are changes that the health service has asked for.”

We should do the right thing by them and by patients. It is the right time for the Bill: it is the right prescription at the right time.

The substance of the petition, which has framed many speeches by hon. Members today, calls for the Government to renationalise the NHS. I have to say that it has never been denationalised. The NHS is and always will be free at the point of use. The Government are committed to safeguarding the principles on which the NHS was created. The hon. Member for Denton and Reddish set that out very clearly. We have no plans for privatisation.

[Catherine West]

Will the Minister give way?

[Edward Argar]

I will make a little progress; if I have time, I will give way to the hon. Lady, with whom I sat on a committee of London councils when we were looking at social care reform way back in 2010.

We all recognise the importance of preserving this great national asset for the future and ensuring that the NHS remains comprehensive and free at the point of use, regardless of income, on the basis of need. The Government remain steadfast in their commitment that the NHS is not, and never will be, for sale to the private sector.

We are determined to embrace innovation and potential where we find it, but that is different from many of the accusations in the speeches we have heard today. I know it is tempting to scaremonger and set out accusations about what this Act does, even when people know better, as I know hon. Members do, but that reflects scaremongering rather than reality. There has always been an element of private provision in healthcare services in this country. Labour Members should know that because, as the Nuffield Trust said in 2019,

“the available evidence suggests the increase”—

in private provision—

“originally began under Labour governments before 2010”.

[Catherine West]

Will the Minister give way?

[Edward Argar]

I will just finish this point and then give way to the hon. Lady. The hon. Member for Liverpool, West Derby (Ian Byrne) made the point, which the hon. Member for Middlesbrough touched on as well, that it is important to look at the extent of the involvement of private sector providers, which accelerated when the Labour party was in power. The hon. Member for Liverpool, West Derby talked about the 2012 legislation and “any qualified provider”, but that was not brought in by the 2012 legislation; it was brought in by the Gordon Brown Government in 2009-10, under the term “any willing provider.” The name was changed, but nothing substantive changed from what the Labour Government had introduced in terms of the ability to compete for contracts.

[Christian Matheson]

Will the Minister give way?

[Edward Argar]

One more sentence and I will give way to the hon. Member for Hornsey and Wood Green (Catherine West); then I will try to bring in the hon. Gentleman.

One of the key changes allowing private sector organisations to compete for and run frontline health services came in 2004, again under a Labour Government, when the tendering for provision of out-of-hours services by private companies was allowed.

[Catherine West]

The Minister is being very gracious. How is the Act going to ensure that there is no conflict of interest between private providers who sit on integrated care boards and who then provide services? Are we going to end up with another Randox scandal?

--- Later in debate ---

[Edward Argar]

The hon. Lady will know that when it comes to integrated care boards we, as a Government, introduced an amendment building on the already clear provisions in the Bill to prohibit conflicts of interest. I do not know whether she voted for the Government amendment, but it did exactly that, making it clear when the Bill was on Report that private providers and those with significant private interests could not sit on NHS integrated care boards.

[Christian Matheson]

The Minister is being generous with his time. Let us get the history right. The reason why the Labour Government increased the involvement of private sector bidders was simply to be able to increase capacity quickly—to get the waiting list and waiting time backlogs down, which they had inherited from the previous Conservative Government and that were massive. In terms of the 2009 Bill, I seem to remember that there was a provision in there that gave preference to NHS bidders.

[Edward Argar]

I am grateful to the hon. Gentleman. Although we occasionally cross swords in the main Chamber or here, he knows I have a great deal of respect for him. All I would say gently on the point about the 2004 changes is that they came seven years into a Labour Government, so I do not know the reason why they had not been able to make progress before then.

We continue to work closely with the NHS to implement the changes that it has asked for, so that we can build back better and secure our NHS for future generations. As the shadow Minister, the hon. Member for Denton and Reddish, rightly said, the covid-19 pandemic has tested our NHS like never before, and all our NHS staff have risen to meet these tests in extraordinary new ways.

Hon. Members on both sides have rightly raised the point about the pressure that NHS staff have been under. Those who have been under pressure dealing with this pandemic are the people who will also be working flat out to deal with waiting lists and backlogs. We need to ensure that we are honest with the British people and that those staff have the time and space to recover, emotionally and physically, from the pressures they have been under. That is hugely important and we acknowledge the workforce.

[Margaret Greenwood]

Will the Minister give way?

[Edward Argar]

I will not give way to the hon. Lady now. I have given way to her before. I will try to make progress, but if there is time I will try to give way to her.

We have seen innovative new ways of working: new teams forged, new technologies adopted and new approaches found to some old problems. There is no greater example of that than the phenomenal success of our vaccine roll-out. That would not have been possible without the staff, who are the golden thread that runs through our NHS. As we look to the future and a post-pandemic world, we know that, as the shadow Minister said, there is no shortage of challenges ahead of us: an ageing population, an increase in people with multiple health conditions and, as he rightly says, the challenge of deep-rooted inequalities in health outcomes and the need to look at the broader context. I do not know the shadow Minister as well as I knew his predecessor, but both his predecessor and I had a career in local government as councillors. I suspect that the shadow Minister may have had one too, so he may well know that I understand his point about the broader context.

[Jim Shannon]

Will the Minister give way?

[Edward Argar]

I will make a little more progress. If I can, I will then try to give way to hon. Members.

More needs to be done, and we are giving the NHS the support that it needs and has asked for. In addition to our historic settlement for the NHS in 2018, which will see its budget rise by £33.9 billion a year by 2023-24, we have pledged a record £36 billion for investment in the health and care system over the next three years. The funding will ensure that the NHS has the long-term resources that it needs to tackle the covid backlogs and build back better from the pandemic.

[Jim Shannon]

The hon. Member for Stockton South referred to recruitment within the NHS. What is the Government’s response to that, to ensure that we have the recruitment and the staff in place?

[Edward Argar]

As the hon. Gentleman will know, there are 1.2 million full-time equivalents in the NHS—a record number of staff. Take one example: our pledge for 50,000 more nurses by the time of the next scheduled general election in 2024. Last year alone, we saw the number of nurses in our NHS increase by 10,900. We have a plan in place, and we are recruiting and training more staff through increased numbers of places—at medical schools, for example.

[Margaret Greenwood]

Will the Minister give way?

[Edward Argar]

I will not, because I have only two or three minutes left. If I make sufficient progress, I will try to give way, but I cannot promise the hon. Lady.

We know that different parts of the system want to work together and deliver joined-up services, and we know that when they do, it works; we have seen that with non-statutory integrated care systems over the past few years. The petition calls for the Government to “scrap integrated care systems”, but to do so would be to let down our NHS. The reforms have been developed by the NHS, and integrated care systems are already in place. The Health and Care Bill places them on a statutory footing to allow for that integration and joined-up working to continue.

In the minute or two I have left before I hand back to my hon. Friend the Member for Stockton South, I will touch on PFI contracts, which is an issue that he and other hon. Members have raised. In 2018, the Government announced that PFI and PF2 will not be used for any future public sector projects, including those in the NHS. The Government will honour existing PFI contracts, as wholesale termination would not necessarily represent good value for money. We need to look at each on its merits; many have clauses for early termination, which would cost a lot more than the life of the contract.

However, we have committed to undo the worst of the contracts inherited from the previous Government. The hon. Member for City of Chester (Christian Matheson)—I hope he will let me tweak his tail a little on this—chided my hon. Friend the Member for Stockton South by saying he should be careful about references to PFIs. Of the 124 significant PFIs currently in place, 122 were signed between 1997 and 2010.

Mr Gray, I think you want me to give my hon. Friend the Member for Stockton South some time to sum up, so I will conclude. We believe that this Government are doing everything necessary to ensure that the NHS remains free at the point of use. We are working with the NHS to deliver what it has asked for through the Health and Care Bill. There is huge support from those working in the system for the direction of travel. The Bill will create a more efficient and integrated healthcare system that is less bureaucratic, and allegations that this is privatisation by the back door are simply misleading. Through the legislation, we will ensure better and more joined-up services, improving health and care outcomes for all.

Covid-19: Purchase of Critical Supplies

Edward Argar Excerpts

Monday 31st January 2022 Written Statements

[The Minister for Health (Edward Argar)]

This statement is on the accounting impairment impact of equipment purchased in response to the covid pandemic

Today, we are publishing information relating to our purchasing efforts for critical supplies that have helped this country in our fight against the pandemic.

Since this unprecedented global pandemic erupted our absolute priority throughout has always been saving lives.

In a highly competitive global market, where many countries imposed export bans, we secured billions of items of PPE and have delivered over 17.5 billion items so far to protect our frontline workers. The Government acted quickly to achieve the target of obtaining 30,000 ventilators by the end of June 2020. The supply of these vital items has helped to keep the NHS open throughout the pandemic and enabled it to deliver a world-class service to the public.

The scale of the challenge we faced in sourcing these goods should not be underestimated. Globally there were significant logistical challenges in sourcing, procuring and distributing goods. The rapid rise in international infection rates during the early stages of the pandemic created unparalleled demand.

The disruption to the market, coupled with the unprecedented spike in demand, resulted in a huge inflation in price for goods and intense global competition to secure scarce supplies. For example, the average cost of a nitrile glove increased over six-fold at the height of the pandemic compared with pre-pandemic levels.

In this unique situation, we had to change our approach to procurement and our appetite for risk. The risk that contracts might not perform and that supplies were priced at a premium needed to be balanced against the risk to the health of frontline workers, the NHS and the public if we failed to get the PPE we so desperately needed. We make no apology for procuring PPE at pace and volume so that we could protect thousands of frontline healthcare workers in the NHS and social care.

The Department assessed PPE requirements at the beginning of the pandemic. However, as this was a new disease, we did not have data on actual levels of need. The Department of Health and Social Care developed a sophisticated model to assess demand. Our estimates of demand relied on reasonable worst-case scenario planning, information about the prevailing IPC guidance and the likely number of patient interactions in every healthcare setting. The Department’s approach to cover all settings for healthcare workers means that we have additional stock of £0.8 billion.

Our planning also had to take into account the likely non-performance of contracts. Our buying activities were more successful than we predicted, such that 97% of the units purchased have been assessed as adequate to provide protection for health care workers. A small proportion (3%) of items have been deemed not suitable for use, equivalent to £0.7 billion.

We are now in a position where we have high confidence that we have sufficient stock to cover all future covid-19 related demands, even in the face of the omicron variant. The PPE stocks we secured have allowed us to meet demand through 2020-21 and 2021-22. Our existing PPE stocks will continue to support us throughout 2022-23. Indeed, the high standards of protection we set for NHS workers means that we have an additional 10% of units that may not be suitable for use within the health and social care sectors but may have alternative uses than those we originally envisaged—£2.6 billion.

Within the Test and Trace and Ventilators programme the high standards we have set means that we have items of kit and other equipment that are not suitable for use—£0.3 billion.

As part of the Department’s annual reporting, we have prepared a statement outlining the diminishment in value of the Department’s covid stock holding at 31 March 2021 due to:

For stock we expect to use, changes in global prices between the point of purchase and market prices at 31 March 2021. As the world market has now stabilised and we are returning to more “business as usual” conditions, the value of some categories of goods is now much lower than the price they were purchased for. For example, we now estimate the value of aprons that we purchased is a third of what we paid during the height of the pandemic.

Stock that has failed quality testing and/or technical assurance and is considered not fit for use in any setting. In these cases we are seeking recovery of funds from suppliers wherever possible.

Stock that we do not intend to use for its original intended purpose, perhaps because it was bought as a contingency or has characteristics that prevent its use in a UK healthcare setting but could be considered for alternative use or resale; and,

Stock in excess of current forecast requirements where alternative use or resale is required to maximise the value of the stockpile and prevent wastage through future date expiry.

Our efforts to manage the stockpile effectively, and in doing so maximise its value, are ongoing. The Department has established a redistribution team to identify alternative uses and resale potential for inventory we do not intend or expect to use. For example, donating masks to both the Department for Transport and Department for Education to aid the reopening of the economy on public transport and to support schools following their reopening in March 2021. Any repurposing or resale of inventory is carefully considered as maintaining adequate supplies for frontline workers remains our priority.

Medical professionals within the Department’s quality control and assurance function and colleagues within Medical Surveillance Authorities have recognised that stock which has exceeded its manufacturers use-by date, is not necessarily unusable. The Department has begun a tender for a third-party medical laboratory to provide official testing of PPE products with a view to extending shelf life to maximise the usefulness and therefore value for money from the PPE purchased without compromising the quality of goods made available for use.

In addition, the Department is currently working through a revision to the pandemic preparedness stockpile, incorporating the learnings from this pandemic. We now have a more strategic approach to our supplier base, signing contracts with over 30 UK-based companies, reducing our reliance on established manufacturers in the far east and our carbon footprint. Environmental considerations are at the heart of the Department’s strategy for the ongoing management of the covid inventory stockpiles, including inventory disposals.

[HCWS572]

NHS Constitution and Handbook

Edward Argar Excerpts

Thursday 27th January 2022 Written Statements

[The Minister for Health (Edward Argar)]

Statutory report on the effect of the NHS constitution and updates to the constitution handbook

In accordance with the Health Act 2009, I have laid before Parliament a report on the effect of the NHS constitution. The report has also been published on the gov.uk website, alongside an updated version of the handbook to the NHS constitution.

The NHS constitution, like the NHS, belongs to us all. It empowers patients, public and staff by bringing together in one document the founding principles and values of our NHS. It sets out the legal rights to which patients, the public and staff are entitled and the pledges that the NHS has additionally made towards them. Just as importantly, it makes clear the responsibilities which we all have for supporting the NHS to operate fairly and effectively.

Throughout this extraordinary time where we have seen the huge impact of the pandemic on staff, patients and society as a whole, our NHS workforce have strived tirelessly to protect the people we love. It is therefore more important than ever that patients, public and staff know their rights, responsibilities and what they can expect from their NHS.

The report is based on an independent survey of staff, patients and the public. It describes how they view the impact of the NHS constitution, and its value in promoting and raising standards of care.

While the report shows that public awareness of the constitution is still low, we are pleased to see it has increased since the 2018 report, and staff awareness remains significantly higher than public awareness. We know that those informed about the NHS constitution are more likely to use it and so there is further work to do in improving awareness to ensure we all get the most out of our interactions with the NHS.

Looking forward, a full review of the NHS constitution itself is due in January 2025. The scoping for this review, including a statutory consultation with patients, carers and staff will begin this year. We will use the findings from today’s report to shape the consultation and explore how to increase awareness and use of the NHS constitution across all public and staff groups.

Alongside this report we have also published a revised version of the handbook to the constitution. The handbook explains each right, pledge and responsibility in the NHS constitution. It is designed to give the public, patients, their carers and families, and NHS staff fuller information about what the constitution means for them. This revision ensures the information given in the handbook remains accurate and up to date.

[HCWS564]

Oral Answers to Questions

Edward Argar Excerpts

Tuesday 18th January 2022 Commons Chamber

[Craig Tracey (North Warwickshire) (Con)]

9. What steps his Department is taking to help (a) maximise NHS capacity and (b) increase the NHS’s resilience during the covid-19 outbreak.

[The Minister for Health (Edward Argar)]

Alongside measures to reduce demand and admissions, such as the vaccine roll-out and new therapeutics for covid, the NHS is creating the maximum possible capacity and investing in improved discharge arrangements, the use of independent sector beds, virtual wards and Nightingales to provide surge capacity, alongside our investment in delivering more than 20,000 more clinical staff this year compared with August 2020.

[Craig Tracey]

I thank the Minister for that answer. As he knows, one of the main challenges facing hospitals is delays in the transfer of patients back to care homes due to historic restrictions, particularly where there has been an outbreak, although there may have been only one case. As we move to treating covid as more of an endemic condition, what steps can be taken to stop restricting admissions to these care homes, which would undoubtedly relieve pressure on hospitals?

[Edward Argar]

There is local flexibility to allow residents to be safely admitted to a care home during outbreak restrictions, following a risk-based approach that takes into account the size of outbreaks, who is affected, care home size and layout, rates of booster vaccination and current Care Quality Commission rating. The CQC supports risk-based decisions made on admissions to support the discharge of people with a negative covid test result, but, of course, we must continue to ensure the safety of those in care homes.

[Martyn Day (Linlithgow and East Falkirk) (SNP)]

The workforce are absolutely central to growing NHS capacity. The advice in a Migration Advisory Committee report was to amend migration policies, make

“Care Workers and Home Carers…immediately eligible for the Health and Care Worker Visa and place the occupation on the Shortage Occupation List.”

When will the UK Government start listening to their advisers and change migration policies to alleviate the pressures facing our NHS?

[Edward Argar]

I am grateful to the hon. Gentleman for his question and for the tone of his question. He is absolutely right to highlight the importance of the workforce. The workforce are the golden thread that runs through the heart of everything we do in our NHS, which is why we have already taken a number of steps to increase our workforce. We are well on target to meet our target of 50,000 more nurses. As I mentioned in my initial answer, in August last year we had over 20,000 more clinically qualified staff compared with August 2020, so we continue to grow the workforce.

[Luke Hall (Thornbury and Yate) (Con)]

Delivering new community hospitals is a key part of upgrading and expanding NHS capacity. The Department is currently examining a bid to rebuild and expand services at Thornbury Hospital, which is desperately needed due to the expansion of the town. Will my hon. Friend meet me to discuss the next steps in delivering this vital infrastructure improvement in south Gloucestershire?

[Edward Argar]

I am grateful to my hon. Friend. He is absolutely right that, in looking to meet the demand challenges imposed on our NHS, it is not just about district, general or acute hospitals, but about all our hospital facilities, including community hospitals. He has raised this subject with me on a number of occasions. He is a doughty champion for Thornbury and, of course, I am always happy to meet him.

[John Cryer (Leyton and Wanstead) (Lab)]

On the issue of capacity, the argument has always been floating around that bed numbers can be cut on the basis of medical and technological advances. That was always deeply suspect, but in the context of covid-19 and its aftermath, can the Minister assure the House that there will be no cuts in bed numbers in any future hospital reconfiguration?

[Edward Argar]

Decisions on hospital reconfigurations and changes to local hospital systems are a matter for the local NHS, following full consultation and consideration of the needs of local communities. The hon. Gentleman is right to highlight the importance of bed capacity in the NHS. The NHS as a whole will continue to look at what bed capacity is needed to meet future need.

[Mr Gagan Mohindra (South West Hertfordshire) (Con)]

My constituent David Hulbert contacted me to ask that I pay tribute in the Chamber to the phenomenal NHS teams from both Mount Vernon Hospital and Watford General Hospital for the care he has received, following his admission for cancer. Will the Minister join me in thanking the NHS for its tireless, backlog-clearing work, and for continuing with lifesaving non-covid operations, alongside its ongoing heroic actions leading our covid fight and vaccine roll-out?

[Edward Argar]

I am always happy to take the opportunity, as I know the Opposition Front-Bench team and my colleagues are, to thank the amazing NHS workforce for the work they have done. I pay tribute to the work of the teams at Mount Vernon and Watford General and, in the context of the pandemic, I pay tribute to my hon. Friend the Member for Watford (Dean Russell), who volunteered to help out at the hospital.

[Dame Meg Hillier (Hackney South and Shoreditch) (Lab/Co-op)]

The Minister highlighted the use of independent care providers. Last week, the Department announced that 150 hospitals would be on standby for three months to provide additional resource. Can the Minister tell the House when he or his Secretary of State asked NHS England to investigate standing up the 150 hospitals, which will receive a minimum income guarantee of £75 million to £90 million a month?

[Edward Argar]

I think I heard the hon. Lady correctly and she asked when those discussions began. That was last year, prior to the peak of this wave. We believe that the use of the independent sector to assist our NHS and provide additional capacity is absolutely the right thing to do. Thus far, during the course of the pandemic, it has provided, I believe, over 5 million procedures to patients. Therefore, we think this is a valuable and important addition to our capacity, and it is right that we have this surge capacity insurance policy in place to help to meet further demand.

[Dr Andrew Murrison (South West Wiltshire) (Con)]

10. What assessment he has made of the effectiveness of the covid-19 vaccination programme in reducing hospitalisations.

--- Later in debate ---

[Caroline Ansell (Eastbourne) (Con)]

T7. My hospital trust is looking to redesign ophthalmology and cardiology services across its two hospitals, Eastbourne District General Hospital and Conquest Hospital in Hastings. The trust puts forward an important clinical case for the change, but given the realities—the road, the distance and the public transport options, which mean that it can be a journey of two hours via two buses for the one in four households in Eastbourne that do not have a car—any change can present a real problem and create issues for local people. Ahead of his visit to Eastbourne, will my hon. Friend the Minister meet me here to discuss this vital question of access to hospital services?

[The Minister for Health (Edward Argar)]

I am grateful to my hon. Friend. Public consultation on the reconfiguration in East Sussex was launched on 6 December last year and will close on 11 March. She is right to highlight access and transport links as a key factor in such decisions, and I would of course be delighted to meet her.

[Chris Law (Dundee West) (SNP)]

T3. Only 9% of people in low-income countries have received one vaccine dose. The UK Government have delivered less than one third of their pledged contributions to COVAX. Given that no one is safe until everyone is safe, what assessment has the Secretary of State made of the risk to public health from emerging variants from the unvaccinated worldwide, and will he ensure that all doses pledged will be delivered to COVAX by the end of June?

--- Later in debate ---

[Cherilyn Mackrory (Truro and Falmouth) (Con)]

T8. Building the women’s and children’s hospital at the Royal Cornwall Hospital was a key promise of this Government, and the Secretary of State’s predecessor was very supportive of it. Will my hon. Friend reaffirm the Department’s commitment to the building and agree to meet me to ensure that everything is done to get this vital project delivered on time?

[Edward Argar]

We remain fully committed to the delivery of the important new women’s and children’s hospital in Truro for the Royal Cornwall Hospitals NHS Trust as part of our new hospital programme. My right hon. Friend the Secretary of State remains committed to it, and of course I would be delighted to meet my hon. Friend.

[Chi Onwurah (Newcastle upon Tyne Central) (Lab)]

T10.   I hope you are watching “Geordie Hospital”, Mr Speaker—the Channel 4 series that follows the talented, highly skilled, dedicated and wonderfully witty staff of Newcastle upon Tyne Hospitals NHS Foundation Trust. As we enter our third pandemic year, after a decade of under-investment and low pay, and with staff shortages, absences and NHS waiting lists all rising, I hope that the Secretary of State recognises that what NHS staff need, as well as a great sense of humour, is a long-term workforce plan. Will he bring one forward?

--- Later in debate ---

[Dan Jarvis (Barnsley Central) (Lab)]

Sheffield’s Weston Park Cancer Centre is one of just four specialist cancer facilities in the country, but it desperately needs a £50 million upgrade, as the Secretary of State will know because I raised the matter with his predecessor and wrote to the Secretary of State in October and again just last week. Will he urgently respond to the proposal, which is vital for cancer outcomes in South Yorkshire?

[Edward Argar]

We will endeavour to respond swiftly, but if the hon. Gentleman would like to meet me about capital funding for those sorts of projects, I am always happy to meet him.

[Lee Anderson (Ashfield) (Con)]

Now then: the Health Secretary will be aware that King’s Mill Hospital in Ashfield was built under a disastrous private finance initiative deal under the last Labour Government. It now costs us about £1 million a week to service the debt—money that could be spent on social care in Ashfield. Will he meet me to discuss how we can rid my trust of this crippling debt of £1 million a week and spend it on social care?

[Edward Argar]

My hon. Friend is absolutely right to highlight the impact of yet another of Labour’s disastrous PFIs on the funding available to our NHS, and indeed to social care. We continue to work hard to deliver our manifesto commitment to improve on those disastrous PFI schemes. I am very happy to meet him to discuss the matter.

[Rachel Hopkins (Luton South) (Lab)]

Just last month, Luton lost an outstanding champion in the other place with the sad passing of Lord Bill McKenzie of Luton. Just 21 months previously, he had been diagnosed with pulmonary fibrosis.

Last week I met the chair of the Pulmonary Fibrosis Trust, one of my constituents in Luton South, who told me that there is no current cure for the disease and that for most people there is no known cause. Will the Secretary of State outline what steps his Department is taking to support research into a cure and to improve diagnosis, support and care for people living with pulmonary fibrosis?

Implementation of Statutory Integrated Care Systems

Edward Argar Excerpts

Wednesday 5th January 2022 Written Statements

[The Minister for Health (Edward Argar)]

Since 2018, Integrated Care Systems (ICSs) have been developing more integrated ways of working, bringing together NHS organisations and partners from local government and beyond to plan and provide services around residents’ needs as locally as possible. This integrated approach to person-centred care brings together actors in health and social care, alongside local and voluntary partners, to support people to retain their independence, health and wellbeing for longer.

The Health and Care Bill supports the move towards integration by providing measures to put integrated care systems on a statutory footing through the establishment of Integrated Care Boards and Integrated Care Partnerships. The Bill is currently being considered by Parliament and will soon be subject to line-by-line scrutiny at Committee Stage in the House of Lords. It is essential that Parliament is given sufficient time to properly consider the Bill.

Therefore, subject to the passage of the Bill, NHS England and the Department of Health and Social Care have continued to plan for the establishment of the proposed Integrated Care Boards. This includes a joint decision to set a target date for the introduction of statutory Integrated Care Systems in July 2022.

Joint working arrangements have been in place at system level for some time and significant steps have already been taken in preparing for the introduction of statutory Integrated Care Boards, if and when the Bill is enacted. This progress towards the proposed statutory Integrated Care Systems will continue in the new year. The target date for establishment of Integrated Care Boards in July 2022—which, as indicated earlier, is subject to the successful passage of the Bill—will provide greater certainty to systems and staff that are preparing for statutory Integrated Care Systems. NHS England and Improvement will of course continue to support systems with preparing for the proposed statutory Integrated Care Systems.

[HCWS516]