Medicine Supplies to Northern Ireland

Edward Argar Excerpts

Thursday 16th December 2021 Written Statements

[The Minister for Health (Edward Argar)]

Under the Northern Ireland protocol (NIP), medicines moving from Great Britain to Northern Ireland are required to comply with the EU pharmaceutical acquis. This creates a number of additional and duplicative regulatory barriers which risk the continuity of supply for medicines moving into NI.

Negotiations are under way to seek a bilateral agreement with the EU to tackle these problems. In order to support this, it is essential that we do everything we can to ensure that our regulations are fit for purpose, regardless of the outcome of these negotiations, and that the supply of medicines to patients in Northern Ireland is not put at risk.

The Medicines and Healthcare products Regulatory Agency (MHRA), and officials from my own Department for Health and Social Care (DHSC), have been working closely with officials from the Northern Ireland Department of Health (DHNI) in recent months to design a robust contingency measure which can be operational, if necessary, to support the flow of medicines into Northern Ireland from 1 January 2022.

Today the UK Government will be introducing a statutory instrument titled the Human Medicines (Amendment) (Supply to Northern Ireland) Regulations 2021 to establish the Northern Ireland MHRA Authorised Route (NIMAR).

NIMAR provides a route for the lawful supply of prescription only medicines that are unlicensed in NI, where no licensed alternative is available. This route will be tightly governed, with all medicines supplied via NIMAR already complying with the strong regulatory safeguards required for a product to enter the GB market. All medicines supplied this way into Northern Ireland will meet the MHRA’s robust standards that are in place for the rest of the UK.

Supply using the NIMAR route will be closely monitored by DHSC, in partnership with officials at DHNI. It will only be used where clinical need cannot be met by a licensed alternative, in the interests of public health.

It will allow citizens in NI to continue to access the prescription only medications that they require for their individual treatment.

The required statutory instrument will be laid before the house today, along with the accompanying explanatory memorandum, and I invite members to refer to this for more detail on the functionality and detail of NIMAR.

[HCWS507]

Food and Feed Safety (Miscellaneous Amendments and Transitional Provisions) Regulations 2021

Edward Argar Excerpts

Tuesday 14th December 2021 Written Statements

[The Minister for Health (Edward Argar)]

Following the end of the transition period, the Government continue to regard food and feed safety and standards as a top priority. This statutory instrument corrects and addresses deficiencies both in the retained EU law as well as in the domestic legislation that provided for its execution and enforcement in England.

The Food and Feed Safety (Miscellaneous Amendments and Transitional Provisions) Regulations 2021 will be made under powers in the Food Safety Act 1990 and the European Union (Withdrawal) Act 2018.

The purpose of this instrument is to:

amend article 53 of the retained general food law to correct a deficiency that has arisen as a result of the Northern Ireland protocol. The amendment will ensure that the emergency measures that may be applied where a serious risk to health is identified can be applied to all goods entering into GB;

amend the authorisation provisions for feed additives and GM food/feed, so that the decisions made by Ministers will be enacted through legislation making these consistent with other retained EU food and feed law; and

provide a time-limited period of adjustment, up until 30 September 2022, for businesses to meet new UK address labelling requirements for certain food products. This would allow businesses to use up old labelling stocks, without facing enforcement action for failure to label affected products with a UK address during this time.

As required under the “enhanced scrutiny procedure” set out in schedule 8 to the European Union (Withdrawal) Act 2018, the draft instrument and explanatory memorandum have been published online for a period of at least 28 days before the instrument is formally laid in Parliament. To read the full draft statutory instrument and explanatory memorandum, please visit: https://www.gov.uk/government/publications/regulations-on-food-and-feed-safety

[HCWS481]

West Suffolk NHS Foundation Trust: Publication of Independent Review Report

Edward Argar Excerpts

Thursday 9th December 2021 Written Statements

[The Minister for Health (Edward Argar)]

Today NHS England and NHS Improvement have published the report of the independent investigation to review whistleblowing at West Suffolk NHS Foundation Trust. This review was commissioned by NHS England and NHS Improvement at the request of the Department for Health and Social Care. It followed widely reported events arising from an anonymous letter sent to the relative of a patient who had died at the trust.

The review led by Christine Outram MBE has considered as its starting point the appropriateness and impact of the actions taken by the trust and other relevant bodies in response to the issues raised by and connected with the October letter. The review was also asked to produce advisory recommendations and learnings.

The findings of the review describe a breakdown in working practices and shine a light upon an executive team that was not sufficiently held to account by its board. In particular, the review found that fingerprinting and use of biometrics such as handwriting experts is not appropriate in any NHS context. The review also found that in handling whistleblowing material made available through unconventional or even inappropriate means, the NHS should still focus on what and why something is being raised, rather than who has raised it.

There is significant learning to be gathered from the report in relation to how freedom to speak up was implemented in the trust; and how freedom to speak up concerns should be separated from performance and disciplinary matters. The report also emphasises the importance of having strong board governance and checks and balance processes in place.

The trust and other relevant organisations including NHS England and NHS Improvement, the GMC and CQC will need to take stock of the findings of this important report. Indeed, this is a lesson for all NHS organisations to actively work to promote an open culture.

The Government take the issue of speaking up extremely seriously and have put in place clear sources of support for staff to help them raise a concern, including the speak up direct helpline and website and the National Guardian to help drive positive cultural change across the NHS so that speaking up becomes business as usual. The National Guardian also provides support and leadership to a network of over 700 local freedom to speak up guardians, covering every trust, whose role is to support staff who want to speak up about something.

The Government have also enhanced the legal protections available for those who speak up to prohibit discrimination against job applicants on the grounds that they have raised concerns. This is additional to the longstanding provisions of the Employment Rights Act 1996, amended by the Public Interest Disclosure Act 1998, which gives legal protection against detriment to all workers who speak up. We will continue to support the right of all workers in the NHS and wider health and care sector to speak up.

This review and its report have been delayed in part by the covid pandemic and complicated by the sheer scale of the issues that have emerged from this investigation. I would therefore like to thank Christine Outram and her team for their diligence, commitment, and hard work in getting to the heart of these matters.

This is a comprehensive report describing a complicated set of circumstances. Much has happened in the trust since the review was first commissioned. The report outlines the changes and actions the trust has taken to improve its HR, culture and leadership practices. These are encouraging signs that that the trust is learning and should be better placed in the future.

Whilst the response to the anonymous whistleblowing letter represents an unusual set of events specific to one organisation, the Department will absorb the report and consider the learning for the wider system and discuss with NHSEI what the next steps might be.

I have placed a copy of the report of the independent review into West Suffolk Hospital NHS Foundation Trust in the Libraries of both Houses.

[HCWS463]

Asthma Outcomes

Edward Argar Excerpts

Tuesday 7th December 2021 Westminster Hall

[The Minister for Health (Edward Argar)]

It is a pleasure to serve under your chairmanship once again, Mr McCabe, after our many hours in Committee. I thank my hon. Friend the Member for Strangford (Jim Shannon) and congratulate him on securing this debate and for his work on the APPG. As ever, in speaking of his and his family’s experiences, he was typically open for the benefit of the House and those watching our proceedings, and I pay tribute to him for that.

I also welcome the hon. Member for Enfield North (Feryal Clark) to her role on the Opposition Front Bench. She has big shoes to fill, but on the basis of today and what I know of her from her time in this House, I have no doubt that she will do so with skill and dedication and with her typical courtesy while holding us to account as a Government. I wish her all the best in the role.

The Government are dedicated to improving asthma outcomes. In the past 10 years, we have rolled out guidance and initiatives to improve in this area. In 2011, the Department for Health, as it then was, published an outcome strategy for COPD and asthma. It set out a proactive approach to early identification, diagnosis, intervention, proactive care and management. All stages of the disease, as we have heard from hon. Members on both sides of the House, can affect anyone. When it does, it has a huge impact on their lives.

I pay tribute to the hon. Member for Blaydon (Liz Twist) for bringing to life this issue and what it means for individuals with the examples she used, and for talking about her own experience, which is incredibly powerful. I pay tribute with her, as ever, for being willing to share that with this House.

A wrong diagnosis will result in patients not getting the care they need. That is why in 2013 “A Guide to Performing Quality Assured Diagnostic Spirometry” was produced by the NHS with several charities and stakeholders. It was published to support the accurate diagnosis of respiratory conditions to tackle the effects of misdiagnosis.

In 2014, the national review of asthma deaths—the first UK-wide investigation—was published. It aimed to identify avoidable factors, and make recommendations to improve care and patient self-management. NHS England and NHS Improvement commissioned the national asthma audit programme in 2018. It provides data on a range of indicators to show improvements and opportunities in asthma outcomes. The audit’s data are used by providers to assess their quality and support improvement.

More recently, as a number of hon. Members have alluded to, the NHS long-term plan, published in 2019, includes respiratory disease as a national clinical priority with the objective to improve outcomes for people with respiratory diseases including asthma. The respiratory interventions proposed in the NHS long-term plan include early and accurate diagnosis of respiratory conditions. Diagnosing conditions earlier may help to prevent avoidable emergency admissions for asthma.

As part of the long-term planning commitment, pharmacists in primary care networks will undertake a range of medicine reviews, including teaching patients the correct use of inhalers and contributing to multidisciplinary work. I can give my hon. Friend the Member for Loughborough (Jane Hunt) and constituency neighbour the reassurance she sought that we continue to work closely with the NHS in the delivery of that long-term plan, specifically on these objectives set out in it.

To deliver on that objective, NHS England has established 13 respiratory networks across the country. They will provide clinical leadership for respiratory services and are focused on improving clinical pathways for asthma. Since the long-term plan was published, a number of initiatives and publications have been announced.

Before making further progress, I will turn briefly to some of the comments made by hon. Members—I suspect this is a timely way of responding to them. My hon. Friend the Member for Loughborough talked about Kindeva, based on the Charnwood campus in Loughborough in her constituency. I know it well, as the neighbouring Member, and know that it is something she and Jonathan Morgan, the leader of Charnwood Borough Council have championed as a huge asset to our national economy and national effort in this space. She talked about the pMDI market, F-gases and the transition. We commit to our net zero ambitions, but she is right to highlight the need for the transition to be done in a sensible and measured way, and we continue to work closely with industry partners and industry-representative bodies in order to manage that process. I hope that gives her at least a degree of reassurance on this important issue.

NHS England’s national patient safety team has prioritised its work on asthma. This work is part of the adoption and spread safety improvement programme, which aims to identify and support effective and safe evidence-based interventions and practice across England. The asthma ambition is to increase the proportion of patients in acute hospitals receiving every element of the British Thoracic Society’s asthma discharge care bundle to 80% by March 2023.

The quality outcomes framework—QOF—ensures that all GP practices establish and maintain a register of patients with an asthma diagnosis. The QOF for 2021-22 includes improved respiratory indicators. The content of the QOF asthma review was amended to incorporate key elements of basic asthma care for better patient outcomes, including an assessment of asthma control, a recording of the number of exacerbations, an assessment of inhaler technique, and a written, personalised asthma action plan.

Since April 2021, the academic health science networks and patient safety collaboratives have been working with provider organisations to increase take-up of the British Thoracic Society’s asthma care bundle for patients admitted to hospital in England. Centres’ compliance with the elements of good care outlined in the bundle is measured in the national asthma audit.

[Jim Shannon]

I thank the Minister for his responses. He mentioned the 2023 target, to which I referred. Is it possible to shorten that timescale?

[Edward Argar]

As ever, the hon. Gentleman tempts me to be more ambitious. We have set 2023 as a realistic and achievable target. If it were possible to achieve it sooner, that would of course be a positive. Both in my Department and beyond, everyone will have been encouraged by the hon. Gentleman’s ambition and encouragement to go further and faster on that target, if they can. He makes his point well. I will make a little progress and then come back to several of the hon. Gentleman’s questions.

We recognise the particular effect of asthma on children and young people, which is why NHSEI’s children and young people’s transformation programme is promoting a systemic approach to asthma management. The first phase of the national bundle of care for children and young people with asthma has been developed with clinical and patient experts. A complete version of the bundle of care will be published in spring next year. The children and young people asthma dashboard, developed alongside the bundle, will be able to identify asthma care by race, geography, age and social deprivation, which goes to a number of points highlighted by the shadow Minister, among others. That will help ensure that children and young people with asthma who face the starkest health inequalities are prioritised.

The national care bundle has an environmental impact section that sets out three key standards around air pollution, which is an issue raised by Members on both sides of the House, including the hon. Member for Rutherglen and Hamilton West (Margaret Ferrier), who is no longer in her place. We set out the Government’s clean air strategy in 2019, recognising the impact of air pollution on health and a range of other factors that affect people’s lives. In this space specifically, we recognise three key standards. First, all healthcare professionals working with children and young people with expected or diagnosed asthma should understand the sources and dangers of air pollution. Secondly, patients and their parents or carers should always receive information on how they can manage asthma with regards to air pollution. Thirdly, integrated care systems should ensure that they are linked with schools, where education around asthma should also be provided.

The NICE guidance, entitled “Air pollution: outdoor air quality and health”, provides advice for people with chronic respiratory or cardiovascular conditions on the impacts of air pollution. It is important that we recognise that there are ways that, in a health context, we can care for people who face those impacts. Going back to the 2019 clean air strategy, however, we as a society have a much broader obligation to tackle the root causes of those problems and to improve the quality of our air, particularly in our cities but across our whole country.

Given the pivotal role of respiratory medicine in treating patients with covid-19, some centres’ ability to commence patients on biologics may have been impacted at the peak of the surge. I think all Members will recognise that.

The pandemic obviously revolves around a respiratory illness. Those who treat respiratory illnesses, including asthma, have been on the frontline, along with all our health and care staff. I join the shadow Minister and others in paying tribute to the amazing work they have done. As we seek to recover elective services and get more routine services back to normal, we are ambitious but also recognise, in the face of uncertainties over winter and the new variant, that respiratory services can be some of the hardest to recover and bring back to normal operation, because those are the services affected by the disease and the nature of its transmission.

[Liz Twist]

Will the Minister be a little more specific about the opportunity for those with severe asthma to access biologic services? That is a very specific ask. Without wanting to minimise the impact of covid-19 and the size of the need for a recovery plan, that is a specific issue for a group of people.

[Edward Argar]

I always give way to the hon. Lady, occasionally with a little trepidation, because I know she will ask a measured and difficult question. That is a very important question. During the pandemic, specialist respiratory services for severe asthma have continued to run, but she asked a specific question about biologics, a subject raised by several colleagues. Prescription and access to biologics is co-ordinated through severe asthma centre multidisciplinary teams. They should ensure all treatments, conditions and options are considered when prescribing. I am perhaps less clear about that than she might want, because I would caveat that by saying it would be a clinical judgment.

We do recognise the value of biologics. That goes to what the hon. Member for Strangford said: all treatments and options should be considered by clinicians on an individual, case-by-case basis, rather than what may have happened in the past, which was a presumption in favour of inhalers as a way of managing the condition rather than treating it or getting to the root causes. Although not eliminating the condition, that could deliver the improvements that make a difference based on an individual’s condition.

[Liz Twist]

As the Minister has said he is unable to be specific, will he write to us with a little more information on that issue, and how we could attempt to put it right? We have heard about the huge impact for the better on people’s lives.

[Edward Argar]

That is one of the easier things to do, given that this policy area belongs to the Minister for Care and Mental Health, my hon. Friend the Member for Chichester (Gillian Keegan), so I can commit to her writing to the hon. Lady. I am happy to do that, though I suspect that response will come back to the point about clinical judgment and decision making. I will also commit my hon. Friend to writing to the hon. Member for Strangford on the detailed and specific point he made about the annual review.

The use of remote consultations and biologic medication that can be taken at home mean we have been able to support most people with severe asthma during the pandemic. At the start of the pandemic, NICE published “COVID-19 rapid guideline: severe asthma”, which provided guidance on starting or continuing biological treatment. In writing that guidance, particular attention was paid to streamlining the process of moving patients on to biologic therapies, to compensate for any barriers that may have occurred because of changes to the NHS in response to covid-19.

The hon. Member for Strangford raised the subject of unified guidelines. NICE’s updated guidance is produced jointly with the British Thoracic Society and SIGN, so it will update all three key areas. They are working with other UK expert bodies to develop a joint guidance for the diagnosis, monitoring and management of chronic asthma, which will update and replace existing guidance.

Community diagnostic centres or CDCs—another theme raised by several hon. Members—which diagnose a number of conditions, are to be launched in place of asthma diagnostic hubs. Diagnostics for respiratory conditions are part of the proposed core services to be provided by CDCs. I hope that gives reassurance.

A review of diagnostics in the NHS long-term plan highlighted that patients with respiratory symptoms would benefit from that facility due to the number of diagnostic tests involved. At the spending review, we announced an extra £5.9 billion of capital support for elective recovery, diagnostics and technology over the next three years, with £2.3 billion of that to increase the volume of diagnostic activity and to roll out CDCs. The planned increase will allow the NHS to carry out 4.5 million additional scans by 2024-25, enhancing capacity, enabling earlier diagnosis and benefiting asthma patients.

I am conscious that I need to leave the hon. Member for Strangford at least three or four minutes for his winding-up speech. One point that has come up among hon. Members this morning has been about prescription charges: a challenging area. Currently, we have no plans to review or extend the NHS prescription charge medical exemption list to include asthma. I heard the points made by hon. Members, but a number of conditions are analogous to asthma, in terms not of their effects, but of their chronic or lifelong impact.

Equally, a balance has to be struck with proportionate charges and the contribution that makes to the NHS drugs budget to facilitate the provision of new treatment. Approximately 89% of prescriptions are dispensed free of charge already, and arrangements are in place to help those most in need. My hon. Friend the Member for Loughborough alluded to the fact that to support those who do not qualify for an exemption, the cost of prescriptions can be capped by purchasing a prescription pre-payment certificate, and that can be paid for by instalments. A holder of a 12-month certificate can get all the prescriptions they need for just over £2 a week.

When we started the debate, I wondered whether we would use the full hour and a half. It is testament to the hon. Member for Strangford, and the contributions of all hon. Members, that we have, and I should stop here to give him a few minutes to come back. To conclude, it is right for him to bring this debate to the House. I am grateful, as other hon. Members are, because asthma affects many of our constituents, day in, day out, and while we have made huge progress, it is right for him and other hon. Members to continue to press for even more ambition and even more progress. I pay tribute to him for that.

Health and Social Care

Edward Argar Excerpts

Friday 3rd December 2021 Commons Chamber

[The Minister for Health (Edward Argar)]

Madam Deputy Speaker, with permission, I would like to make a statement on the work we are doing to keep our country safe this winter. Today, we have published our health and social care approach to winter. This shows the preparations we are making so that health and social care services remain resilient, joined up and available to patients over the coming months, and it sets out what actions the public can take. As this plan shows, we are also doing everything in our power to give our NHS what it needs and keep it standing strong this winter, including through our plans to recruit more staff, give greater support to the NHS workforce and bolster capacity across urgent and emergency care. For example, the NHS has given ambulance trusts an extra £55 million to boost staff numbers this winter; there is nearly half a billion to fund an enhanced discharge programme; and we have measures to reduce pressure on accident and emergency departments, reduce waiting times and improve patient flow.

This document comes ahead of a critical winter for our NHS. We face the challenge of fighting covid-19, and the new omicron variant, along with the other challenges, such as flu, that winter can bring. We are doing everything we can to strengthen our vital defences. One of our main defences is, of course, our vaccination programmes, and we are expanding our booster programme, which hit the milestone of 19 million doses yesterday, along with delivering the largest flu vaccination programme in UK history. Yesterday, we announced how we will be buying a total of 114 million additional Pfizer and Moderna doses for 2022 and 2023, which will future-proof our Great British vaccination effort and make sure we can protect even more people in the years ahead. Another defence is antivirals, and it was fantastic news that yesterday another covid-19 treatment was approved by the Medicines and Healthcare products Regulatory Agency, after it was found to be safe and effective at reducing the risk of hospitalisation and death in people with mild to moderate covid-19 infection.

Just as we tackle the virus, we are also tackling what the virus has brought with it. The pandemic has put unprecedented pressure on the NHS and led to a backlog for elective care. To fix this, the NHS needs to be able to offer more appointments, operations and treatments, and we need to adopt new, innovative ways of working so patients keep getting the best possible care. We are determined to maximise the capacity of the NHS to keep elective services going over the winter months so that people can keep getting routine treatments such as hip surgery and diagnostic tests. Today, I am pleased to update the House on the £700 million fund that we announced in September for elective recovery. This transformative funding, which is being split across all regions in England, will support 785 schemes across 187 hospital trusts. It will help reduce waiting times for patients by providing more operating theatres and beds, and greater capacity for our NHS. Today, we have published the regional breakdown for this funding, which was allocated on a fair basis, according to weighted population, to make sure there was an equitable spread across the country. This includes £112 million for the north-east and Yorkshire, £131 million for the midlands and £97 million for the north-west. At least £330 million will be invested in the NHS estate and a further £250 million will be spent on digital initiatives that aid elective recovery. Over £600 million from this fund has already been committed to approved bids, such as for new wards at University Hospitals Birmingham, a new South Mersey elective hub and a new, modular unit in Castle Hill Hospital in Hull. This investment will have a huge impact, and this is the beginning not the end of our investment, as we are continuing to identify and assess submitted bids for investment in the remainder of this financial year. It is part of £5.4 billion that we have announced to support the NHS response to the pandemic in the second half of the year and it builds on the work done ahead of last winter, where we invested £450 million to upgrade A&E facilities in over 120 separate trusts, to boost capacity. This is a Government who back the NHS. Ahead of what will be a testing winter, we are putting everything behind our health and care services, so everyone can access the services they need when they need them.

I conclude by urging everyone to play their part this winter by taking simple steps that can help our NHS. People should get the jabs they need for flu and covid-19 when the time comes, and should follow the rules that we have put in place. If they do that, we can protect not only the NHS but the progress that we have all made. I commend the statement to the House.

[Wes Streeting (Ilford North) (Lab)]

I thank the Minister for advance sight of his statement. I pay enormous tribute to my predecessor, my right hon. Friend the Member for Leicester South (Jonathan Ashworth), who did a tremendous job as Labour’s longest-serving shadow Health and Social Care Secretary and worked constructively with the Government in response to the pandemic’s challenges. I intend to do the same.

In that spirit, I welcome this week’s announcements on the vaccine and booster roll-outs. I know from my own experience this year of kidney cancer and covid that some of the best people in our country work in health and social care. They are at the heart of my response.

NHS waiting lists stand at almost 6 million. Almost one in 10 people in England waits months or even years, often in serious pain and discomfort, because the Government have failed to get a grip on the crisis. Everyone understands that we are in the midst of a global pandemic that has placed the NHS under unprecedented pressure, but that does not excuse or explain why we went into the pandemic with NHS waiting lists at record levels and with unprecedented staff shortages.

Ministers want people to believe that the winter crisis is simply the result of the challenges of covid, but in reality, the entire health and social care system has been left dangerously exposed by their choices throughout the last 11 years. Before the pandemic, there were waiting lists of 4.5 million, staff shortages of 100,000 and social care vacancies of 112,000. This week, the National Audit Office detailed starkly that things are set to get even worse, with waiting lists set to double in three years.

Ministers cannot possibly believe that what we have been given today is a credible plan to meet those enormous challenges. If it were a genuine plan to prepare for the winter, why has it arrived on 3 December? A serious plan to bring down waiting lists would have the workforce at its heart, and would have clear targets and deadlines. A serious plan would recognise that, unless we focus on prevention, early intervention and fixing the social care crisis, Ministers have no chance of bringing waiting lists down to the record low levels we saw under the last Labour Government.

That Government had a serious plan to reduce waiting lists with 45,000 more doctors, 89,000 more nurses and the biggest hospital-building programme in our country’s history. The programme of investment, reform and clear targets delivered a decrease in waiting times from 18 months to 18 weeks. Although bricks and mortar and technology are important, and we do not sniff at the investment the Minister has outlined, the central challenge of the NHS winter crisis is a shortage of professional staff.

A credible plan to tackle the NHS winter crisis, which was foreseeable and foreseen, would have been published long before 3 December. Without a serious strategy to build the health and social care workforce that we need, this plan is not a plan at all.

[Edward Argar]

I join the shadow Secretary of State in paying tribute to his predecessor, the right hon. Member for Leicester South (Jonathan Ashworth), who is my near neighbour in Leicestershire. Although we may have occasionally crossed swords across the Dispatch Box, he is a deeply honourable and decent man. I also take the opportunity to pay tribute to the hon. Member for Leicester West (Liz Kendall), who is planning to take maternity leave in due course. She is a doughty champion for social care and the sector. I know that she will be much missed in her time away from the Dispatch Box.

I genuinely congratulate the hon. Member for Ilford North (Wes Streeting) on his post, although after that response, I do so with a degree of trepidation about what we might have in store for us in the months ahead from him challenging us—quite rightly. He is extremely diligent in all the roles he performs, so I welcome him to a challenging but fantastic role.

I will be relatively brief in my answers, because I am conscious that Fridays are for private Members’ Bills and private Members’ speeches. We brought the statement to the House because we believe it is important, given that it is going to the media, that we give the House an opportunity to question it.

The shadow Secretary of State was right to pay tribute to the workforce—the social care workforce and the health workforce, as well as all the other key workers who have helped get us to where we are in this pandemic. The workforce are the golden thread that runs through our NHS and through social care. Buildings and technology are important, but they are, essentially, the tools that the workforce use to provide that vital patient care.

We have a clear plan not only for winter, but for the recovery of waiting list times and for driving down those waiting lists. Ours is the party that has given the NHS record funding. Even before the pandemic, we put the £33.9 billion increase into law: we said we would do it, and we did do it. We are backing our NHS to give it the tools that it needs.

One issue on which I agreed with the hon. Gentleman is prevention. He is right: we need to look not only at the symptoms and the consequences in treating people, but at prevention of long-term and serious illness. He was also right in what he said about fixing social care, but I would urge a bit of caution. In 13 years we had two Green Papers, one royal commission and the 2008 spending review, all of which were designed to fix the social care problem. Result: nothing. This Government said they would come forward with a plan, and have come forward with a clear and coherent plan. I pay tribute to the Minister for Care and Mental Health, my hon. Friend the Member for Chichester (Gillian Keegan), and indeed to her predecessor, my hon. Friend the Member for Faversham and Mid Kent (Helen Whately), for the work that they have done in grappling with this very challenging issue.

The hon. Gentleman mentioned hospital buildings. Again, he was right: we are building 40 new hospitals. I would, however, say to him and to other Opposition Members that they should be very careful when talking about this subject. We all know that one of the biggest challenges we face with capital in our NHS is the millstone of PFI debt around the necks of NHS trusts—private finance initiative programmes put in place under the last Labour Government. We are still paying for that.

I welcome the hon. Gentleman to his post, and I suspect that on many occasions in the future we will have further such exchanges across the Dispatch Boxes. I am sorry that on his first outing in his new role he is facing me rather than the Secretary of State, but it is a pleasure to be opposite him.

[Wes Streeting]

We’ve been given the best.

[Edward Argar]

Charming as ever.

We are the party of our NHS. We are backing it with the resources and support that it needs to get through this winter.

[Madam Deputy Speaker (Dame Rosie Winterton)]

Order. I thank the Minister for his undertaking about brief answers, and I urge Members to ask brief questions as well. Otherwise we will not get everyone in, because we do need to return to the private Member’s Bills.

[Sir Bernard Jenkin (Harwich and North Essex) (Con)]

I thank my hon. Friend for his statement. Can he confirm that it is the Government’s policy to encourage the reopening of mass vaccination centres to get through the bulge of booster jabs that we need? In that regard, will he congratulate the South Suffolk & North East Essex integrated care system, which has once again secured facilities at Harwich international port, and will he thank the port for offering those facilities again? We are hoping for a mass vaccination session on 19 and 20 December, and further sessions in January. Is that not the way to take the pressure off GPs?

[Edward Argar]

Of course I join my hon. Friend in paying tribute not just to Harwich port but to his local healthcare system, about which he and I have spoken on many occasions. It does an amazing job: its willingness to find innovative solutions to boost our booster rates is exactly what we need to see. I commend everything that his local trusts are doing.

[Alison McGovern (Wirral South) (Lab)]

When my hon. Friend the Member for Leicester West (Liz Kendall) and I spoke to social care professionals from the Wirral last night, they made it clear that the crisis is not to come; the crisis is right now. They have staff shortages, and those in work are knackered and devastated at what is going on in social care. My hon. Friend the Member for Birkenhead (Mick Whitley) and I wrote to the Secretary of State, but we have received no reply. Will the Minister go back to the Department, obtain a reply to my letter, and tell me now, today, what we are doing to secure more staff and better pay in social care?

[Edward Argar]

As the hon. Lady knows, I do not have responsibility for social care. The Minister for Care and Mental Health is sitting next to me and will have heard what she said and will take it back to the Department to see whether a letter in response can be expedited.

We are fixing the system for the long term, but my hon. Friend the Minister has announced £162 million that is already going into the bank accounts of organisations to help support the social care workforce. The hon. Member for Wirral South (Alison McGovern) is right that we need short-term support, but we also need a long-term solution. We are putting the money in to support this vital sector.

[Gary Sambrook (Birmingham, Northfield) (Con)]

I thank the Minister and the Government for the eight successful bids into University Hospitals Birmingham NHS Foundation Trust, which will see new wards opened and will go some way towards helping our local NHS through the winter. What a stark contrast that is with the Labour years. When the Queen Elizabeth Hospital was built it was supposed to cost about £500 million, but that has rolled into billions of pounds’ worth of private finance initiative debt. Is that not the difference between us and the Opposition?

[Edward Argar]

My hon. Friend is a doughty champion for Birmingham and his local trust. It is always a pleasure to announce more money going into his trust, and he is right to highlight the Labour party’s record on PFI.

[Mr Alistair Carmichael (Orkney and Shetland) (LD)]

The question that will be asked by people in those parts of the country where the ambulance service is already in crisis, such as Cornwall and Shropshire, is: how quickly can they get this money? We are three weeks from Christmas and we are already seeing a crippling of the service in these areas. When will they see improvement?

[Edward Argar]

The right hon. Gentleman is absolutely right that ambulance trusts across the country are under pressure, which is why they have already been given an additional £55 million, well in advance of this winter, to help them prepare for and manage the pressures they are experiencing. This money is on top of that, but they already have additional funding to help support them through what will be a very challenging winter.

[Felicity Buchan (Kensington) (Con)]

This Government are investing an additional £34 billion in the NHS this year alone. Does my hon. Friend agree that this money needs to go to the frontline and that we need to ensure that we get value for money?

[Edward Argar]

I am grateful to my hon. Friend for highlighting both the investment and the need for us, as the custodians of the taxpayer’s pound, to make sure that the money is well spent by implementing innovation and reform so that it gets to the frontline and delivers patient care, which is exactly what we are doing.

[Chris Bryant (Rhondda) (Lab)]

I have a sneaking suspicion that we will not get to the second private Member’s Bill today, so I hope it is okay if I mention that I am enormously grateful to the Government. The Secretary of State for Health and Social Care has just texted me with the good news that the Government and I, and all the charities, will be working together on acquired brain injury. We will now have a national strategy across all Departments. It is a miracle that the Government have suggested that I should co-chair it with the Minister for Care and Mental Health, because I can be very irritating—[Laughter.] I see I have united the House. Seriously, this is a really good day and I hope we will be able to make a dramatic difference to the millions of people in this country who have suffered an acquired brain injury. Answer that!

[Edward Argar]

I have never found the hon. Gentleman to be irritating in any way, and I have always enjoyed my interactions with him on a range of issues. On a serious point, I pay tribute to him for his campaigning work on this issue. It is a huge step forward, and I know the insight he will bring, working with the Minister for Care and Mental Health, will genuinely make this a strategy of which we can all be proud. I congratulate him on his achievement.

[Dean Russell (Watford) (Con)]

My constituents in Watford will no doubt welcome the £700 million of funding detailed today to support the NHS this winter. Will my right hon. Friend please confirm that the investment will directly improve services for patients across the NHS? Will he also share my thanks to Watford General Hospital and all its staff for the fantastic work they continue to do at this time?

[Edward Argar]

I am not right hon., but I am grateful to my hon. Friend for the promotion. Of course I pay tribute to the staff at Watford General Hospital and, indeed, to him for his volunteering on the frontline in that hospital trust during the pandemic. He is absolutely right. As I said to my hon. Friend the Member for Kensington (Felicity Buchan), it is vital that this money gets to the frontline and is used to improve patient care, which is exactly what we intend to do.

[Lilian Greenwood (Nottingham South) (Lab)]

I am shocked and saddened by reports of a 23% increase in physical assaults on staff in Nottinghamshire hospitals in the past year, including 436 assaults on NHS workers in Nottingham hospitals. As we head into the season of Christmas revelry and hopefully responsible celebrations, will the Minister join me in condemning this completely unacceptable violence, which should never be part of any NHS worker’s job, and can he set out what he is doing to prevent such assaults and to protect and support NHS staff?

[Edward Argar]

I am grateful to the hon. Lady; I had the pleasure some months ago of visiting one of her local hospitals, where I had the opportunity to speak to staff. They do an amazing job. No one, irrespective of the role they perform, should be subject to intimidation or violence in doing their job, still less those who are working hard to save lives, to protect us and to get us through this pandemic. I join with her entirely in condemning both physical and verbal assaults on members of our emergency services. I highlight the important legislation that went through recently to increase the penalties, and pay tribute to those responsible for getting it on the statute book—the hon. Member for Rhondda (Chris Bryant) once again. No one, absolutely no one, particularly in our emergency services, should be subject to abuse of any sort while doing their job.

[Mrs Flick Drummond (Meon Valley) (Con)]

GPs in Meon Valley are finding it difficult to recruit new GPs to fill vacancies, and as a consequence are working very long hours. Can the Minister ensure that some of the new money goes to primary care and GPs in particular?

[Edward Argar]

I am grateful to my hon. Friend, who rightly highlights the hugely important contribution of GPs to our health system. We continue to look at the best ways to support them, not only by recruiting more GPs and supporting existing ones, but by investing in general practice buildings to ensure they have the tools to do the job.

[Andy Slaughter (Hammersmith) (Lab)]

My local hospitals, Hammersmith and Charing Cross, and their staff are under huge pressure. Until two years ago, the Government’s plan was to demolish Charing Cross hospital, so it is a welcome U-turn that it and Hammersmith hospital are now in the creatively titled 40 new hospitals programme. Leaving aside the fact that Charing Cross has been around for more than 200 years and is thus not really a new hospital, all my constituents want to know is how much investment there will be and when it will finally arrive.

[Edward Argar]

I have not yet had the privilege of visiting the hon. Gentleman’s hospitals in this role; maybe at some point in the coming months, perhaps when they are not quite so busy, I will do so with him—if he will have me. We have committed to the investment, but it is important that that investment programme is run as a programme, with all the hospitals being looked at in terms of the phasing and profile of the investment to ensure it delivers the results we want. On that specific point, knowing the interest he has taken in it, I am happy to meet him to talk specifically about his local hospital project and the improvements to be made.

[Peter Gibson (Darlington) (Con)]

I welcome my hon. Friend’s statement, particularly the extra £112 million for north-east Yorkshire. Our NHS is a priority for everyone in this House and, indeed, a priority for every one of my Darlington constituents. Does he agree that putting our £33.9 billion cash boost on the statute book demonstrates this Government’s and our party’s unwavering commitment to the NHS?

[Edward Argar]

I think it does exactly that, and demonstrates this party’s and this Government’s commitment to the NHS. What my hon. Friend has also demonstrated, as always, is his unwavering commitment to his constituents in Darlington and to championing their cause in this House.

[Mike Kane (Wythenshawe and Sale East) (Lab)]

I was born in the then relatively modern maternity unit at Wythenshawe hospital in my constituency. After 53 years, I am afraid one of us is beginning to look a little old and tired. The Minister knows we have a strategic regeneration framework for the whole site, with world-class breast, cystic fibrosis, heart, lungs and burns care facilities. We have the money in the bank to do it, but because of archaic Treasury rules we cannot get on with it. Come on, Minister—let us change those rules.

[Edward Argar]

I can reassure the hon. Gentleman that it is not him who is looking a little old or worn around the edges. I understand the point he makes, and he and I have met about this particular issue, which goes back to what counts against capital allocations in terms of accounting. He tempts me to change Treasury rules; I fear that could be career-limiting, as I am not a Treasury Minister, but I will continue to talk to him and work with him to see whether we can find a way to allow the project to proceed.

[Angela Richardson (Guildford) (Con)]

I am reassured to see that applications to study nursing and midwifery have risen by 21% this year alone. Having recently joined my midwives on their March with Midwives up the high street in Guildford, I know that midwives urgently need their numbers boosted. Will my hon. Friend confirm that we remain on track to deliver 50,000 more nurses by the end of this Parliament, as we promised in our manifesto?

[Edward Argar]

I can confirm that my hon. Friend is absolutely right in her assessment of the progress that we are making.

[Mike Amesbury (Weaver Vale) (Lab)]

When are Halton and Warrington going to get their new hospital campuses? We have waited for far too long.

[Edward Argar]

The hon. Gentleman showed admirable brevity in making his point very clearly, as ever—[Interruption.] I suspect he faces a bit of competition from his hon. Friend the Member for Wythenshawe and Sale East (Mike Kane) for the funding. In my recollection—forgive me if I am off on this—I think that Halton and Warrington have submitted a bid for funding as part of the next eight. There is considerable interest in this. We are evaluating all those at the moment and, in the coming months, we will work that down to a shortlist. It would be wrong for me to prejudge that process, but it is not wrong, of course, for the hon. Member for Weaver Vale (Mike Amesbury) to continue championing his local hospital and its cause.

[Mr John Whittingdale (Maldon) (Con)]

I welcome today’s announcement and join the Minister in paying tribute to all those working for the NHS. The biggest challenge in mid-Essex, and I suspect nationally, is access to primary care, particularly managing to get through on the telephone line and, after that, obtaining an appointment. Can the Minister say any more about what the Government are doing to address that?

[Edward Argar]

My right hon. Friend is right to highlight primary care, essentially, as the front door for many people into the NHS system. GPs and general practice have done a fantastic job. They have worked very hard, but it has been very challenging. The Secretary of State announced additional money to support GP practices in returning to face-to-face appointments and in seeing more people—we have seen significant investment in that. The percentage of face-to-face appointments continues to go up, which I know matters to a large number of all our constituents.

[Julie Marson (Hertford and Stortford) (Con)]

Two weeks ago today, my hon. Friend was very generous with his time and in his support for the tragic case of my constituent, Jessica Brady, who passed away aged 27 from cancer. Will he confirm that the funding to support the NHS and the focus on policies such as the community diagnostic hubs, along with some of the other things that we discussed two weeks ago, will help people, including in Hertford and Stortford, to get the referrals that they need?

[Edward Argar]

I remember that Adjournment debate very clearly. My hon. Friend made an incredibly moving and powerful speech, highlighting Jessica’s situation, what happened to her and her circumstances. My hon. Friend made the point about the importance of early diagnosis and a holistic approach to a patient’s symptoms, and then diagnosis and treatment. The investment that we are putting into diagnostic hubs will help to do exactly that and bring those diagnostics to the heart of our communities, allowing more people to be seen more quickly.

[Nick Fletcher (Don Valley) (Con)]

I thank my hon. Friend for the £700 million that he has announced this morning; my Don Valley constituents will be pleased to hear that. While I have the Minister’s attention, will he thank all the volunteers in Doncaster and all the constituents who have come forward to have their jab? And is there any chance of a new hospital?

[Edward Argar]

I will certainly join my hon. Friend in paying tribute to all the volunteers and all those who have come forward for their jabs. For a brief moment, I thought that that was where he was going to end, but he is a proud champion of Doncaster, just as you are, Madam Deputy Speaker, and it would have been very strange were he not to conclude by lobbying once again for the new hospital that he wants. I pay tribute to him for that.

[Ruth Edwards (Rushcliffe) (Con)]

I welcome the £131 million for the midlands that the Minister has announced today. I am very aware, though, that my constituents in East Leake are being served by a health centre that is the oldest in Nottinghamshire and which is far too small for the population growth that we have seen in recent years. Twenty months ago, the then Parliamentary Under-Secretary of State for Health and Social Care—my hon. Friend the Member for Bury St Edmunds (Jo Churchill)—promised at the Dispatch Box that we would have a ministerial visit to East Leake so that the Department could see what we were dealing with. I completely understand that that was impossible at the height of the pandemic, but that has long passed, so will the Minister recommit to that visit today and take that request back to his Department, because despite repeated chasing by me and my office staff, we cannot get a date from it in the diary?

[Madam Deputy Speaker]

Order. It is very important that we do not go off the boil in terms of briefness of questions. The Minister is being very good at being brief in his answers.

[Edward Argar]

It would be easy to commit the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Lewes (Maria Caulfield), to a visit because she is not here. Equally, I am conscious that East Leake is just up the road from my constituency, so it may be that my hon. Friend gets me instead. I will certainly look into that visit.

[Andy Carter (Warrington South) (Con)]

Following the point made by the hon. Member for Weaver Vale (Mike Amesbury), the greatest challenge that we face to recovery from covid in Warrington is that our hospital is too small. Warrington trust recently submitted a bid for a new purpose-built hospital. Will my hon. Friend assure me that, in the new year, he will look favourably on Warrington?

[Edward Argar]

My hon. Friend, along with many right hon. and hon. Members, is doing his bit to push the cause of his local hospital investment bid. As I said to the hon. Member for Weaver Vale (Mike Amesbury), I commend that, but it would be wrong for me to be drawn while the process is still under way.

[Dr Ben Spencer (Runnymede and Weybridge) (Con)]

I thank my hon. Friend for his statement on health and social care planning. The worry is, of course, that the omicron variant will put a lot of pressure on that planning. Will he update the House on where the Department has got in crunching the data on how dangerous or not omicron will be?

[Edward Argar]

The latest statistic I have on the number of cases in this country is, I believe, 42. That work is still being done. We have seen various news reports today on things that might be encouraging, but I encourage everyone to wait and see while that analysis is done. It will take two to three weeks for the scientists to do their amazing work in understanding whether this new variant is more infectious and more virulent as well as how it responds to therapeutics and vaccines, and I am afraid that we will have to be patient while they do that work. Hopefully, they will come back with positive news, but it is too early to say.

[Rob Butler (Aylesbury) (Con)]

I welcome the publication of the health and social care approach outlined by the Minister. The details of the funding breakdown to help tackle a backlog in elective care will undoubtedly provide hospitals with the clarity and support that they need. However, we also need to reduce the number of people remaining in hospital when they no longer require medical care. Does he agree that one possible option to help alleviate that would be intermediate care provision that is a step between hospital and home?

[Edward Argar]

My hon. Friend is absolutely right to highlight that. My hon. Friend the Minister for Care and Mental Health has done a huge amount of work on both investment and working with local systems to improve hospital discharge for those who do not need to be in hospital any more, to give them that step-down support, be that domiciliary care or in other settings. In the current context, we must do that safely, but she is working extremely hard to deliver that and doing a fantastic job.

[Mike Wood (Dudley South) (Con)]

The investment that the Minister has announced together with the 100 community diagnostic hubs will make a big difference in helping people to get the referrals that they need. Does my hon. Friend agree that early diagnosis depends on being able to see the appropriate clinician face to face where necessary, whether in hospital or in a GP’s surgery?

[Edward Argar]

My hon. Friend is right. The key words are “where necessary”, and that is a clinical judgment. I have highlighted the improvements that we are seeing in terms of the number of face-to-face appointments going up in primary care. Equally, we do not want to lose the benefits of telephone appointments or other appointments for those who wish to interact in that way. It is about trying to craft the system around the patient and taking those clinical judgments into account.

[Joy Morrissey (Beaconsfield) (Con)]

Will my hon. Friend allocate a portion of the enhanced winter discharge funding to mental health support for young people? I have had another secondary school student take their own life—that is my crisis. We need more mental health support and out-of-hospital provision for young people.

[Edward Argar]

My hon. Friend highlights the hugely important point that over winter we face challenges not just in physical health but in mental health, particularly as we come through the pandemic. One reason that we are investing £500 million in mental health catch-up is that we know how vital it is that we do not just talk about parity of esteem but recognise it in the resources that we put in.

[Ian Levy (Blyth Valley) (Con)]

My constituents in Blyth Valley will welcome the £700 million in funding for the NHS. May I thank the staff in the sterilisation unit in Cramlington, the A&E hospital for Northumberland, for all the work that they have done? That goes to prove that we are a proactive Government, not a reactive Government, when it comes to healthcare.

[Edward Argar]

I join my hon. Friend in paying tribute to the team in the sterilisation unit in his local accident and emergency hospital. He is absolutely right: throughout the pandemic and the Government’s existence we have given the NHS the resources and the backing that it needs to get on with the job.

[Simon Jupp (East Devon) (Con)]

People in East Devon will warmly welcome the £700-million investment in our NHS. Will my hon. Friend outline when patients in Devon will know how that money will improve local services?

[Edward Argar]

I am grateful to my hon. Friend. This money is being allocated to the regions, then to individual trusts. A large amount of that money has already been allocated to specific projects that have been announced today. The rest of the money, when allocated to local systems, will then be allocated by that local system—the people who know their area best.

[Tom Randall (Gedling) (Con)]

Staff in hospitals in Nottinghamshire are working hard, as we have heard, sometimes in difficult circumstances. Today’s announcement includes an extra £4 million of spending for hospitals in Nottinghamshire. Does my hon. Friend agree that that will make a real difference to patients in Nottinghamshire, and will he join me in thanking staff in Nottinghamshire hospitals for the hard work that they are doing at the moment?

[Edward Argar]

I am happy to join my hon. Friend in paying tribute to the work of the staff in his local hospitals. He is absolutely right to highlight the fact that that money will make a huge and real difference to patient care in his local hospital trust and in his local area.

[Jacob Young (Redcar) (Con)]

Will the Minister join me in thanking our fantastic primary care services across Teesside, without which we would not have had our world-leading vaccine roll-out? Will he come to Redcar and Cleveland to visit fantastic GP surgeries such as Normanby medical centre and the Saltscar surgery in Redcar, which have been doing all that they can under tremendous pressure?

[Edward Argar]

It looks as if I might be going on tour again; the same thing happened when I last did one of these statements. I am happy to go to “Bluecar”—or Redcar, to call it by its proper name—to see my hon. Friend in his constituency, and to make such a visit when it can be arranged.

[Marco Longhi (Dudley North) (Con)]

I welcome the Minister’s statement and the gargantuan amounts of money that he, his team and the Government are putting into the NHS. Can he provide me and my Dudley constituents with some assurances that that will translate into additional capacity and bringing down the covid-induced backlogs?

[Edward Argar]

Absolutely, I can give my hon. Friend that assurance. He rightly alludes to the fact that the inputs are important, but for those of us on the Government Benches, it is the results they bring—the outputs—and what we do with the money that matter. We will ensure that that money is well spent, harnesses innovation and delivers even better patient care and access to his constituents and many others.

[Madam Deputy Speaker]

I thank the Minister for his statement. We return to debate on the private Member’s Bill.

NICE-Approved Products: Patient Access

Edward Argar Excerpts

Tuesday 30th November 2021 Commons Chamber

[The Minister for Health (Edward Argar)]

As ever, I congratulate my hon. Friend the Member for Newton Abbot (Anne Marie Morris) on securing this debate and I pay tribute to her work in this area. That work has been sustained for as long as I have been a Member of the House—I was first elected in 2015—but I suspect that this area was of interest to her long before then. I pay tribute to her for her continued engagement on this area, which is not always top of the news or top of the political agenda, but is hugely important none the less, so I pay tribute to her work in this space.

I reassure my hon. Friend that the Government share this priority. She is right—I characterise this in these terms and I hope that she will not demur from this—that although the NHS workforce is the beating heart of our NHS, it is beholden on us to give them the tools that they need to be able to use their skills to treat and support the maximum number of possible patients in the most effective way. I think that is a fair reflection of the point that she made at the outset.

[Anne Marie Morris]

indicated assent.

[Edward Argar]

That is an encouraging start. That is why NICE exists. It plays a vital role in supporting patient access to new treatments. Through its technology appraisal and highly specialised technologies programme, NICE makes recommendations for the NHS on whether all new medicines represent value for money for the taxpayer.

NICE aims to publish guidance on new medicines as soon as possible after licensing and is committed to publishing draft recommendations on medicines around the time of marketing authorisation, wherever that is possible. It has a well-earned reputation as a world leader in the field of health technology assessment and it is right that, where NICE recommends a medicine or a medical device, it should be available to patients who stand to benefit. Value for money is important and I will come to that. I suggest that whether the NAO or the Public Accounts Committee wish to look at this is a matter for them, but as my hon. Friend said, she may wish to take that up with the hon. Member for Hackney South and Shoreditch (Dame Meg Hillier), who may well share her interest—I would not wish to presume, but the hon. Member may well.

Making treatments available is why NHS England and clinical commissioning groups are already under a statutory obligation to fund any treatment recommended by NICE through its technology appraisal or highly specialised technologies programmes, usually within three months of guidance. I will turn to my hon. Friend’s point on timing shortly. This will also be a statutory obligation for integrated care boards. As my hon. Friend has set out, the NHS constitution states that patients and the public

“have the right to drugs and treatments that have been recommended by NICE for use in the NHS, if your doctor”—

the treating clinician—

“says they are clinically appropriate for you.”

That is an important point, because we rightly rely on clinical judgment in such circumstances. As my hon. Friend will be aware, NICE recommends the vast majority of new medicines—indeed, in 2020-21 it recommended 100% of them, often thanks to commercial agreements negotiated between NHS England, NICE and companies in parallel with the NICE assessment process—but it is right that that clinical appropriateness filter is there.

I am conscious of time, but before I turn to specific points that my hon. Friend made, I would like to say a few brief words about the success of the cancer drugs fund in supporting patient access to new medicines. The cancer drugs fund was originally introduced to support patient access to medicines that NICE was unable to recommend as cost-effective. Since 2016, however, the fund has been linked to the NICE appraisal process and supports patient access to promising new medicines where the evidence is not mature enough for NICE to recommend routine funding at that point. This has benefited more than 73,000 patients, who have been able to access 91 medicines through the cancer drugs fund, treating more than 200 cancers.

We are building on that fabulous achievement with our manifesto commitment to extend the cancer drugs fund model to non-cancer treatments by creating an innovative medicines fund. I think that there are lessons that we can learn from the cancer drugs fund. NHS England has also recently launched a consultation on proposals for the establishment of the innovative medicines fund. I encourage anyone with an interest to engage; knowing my hon. Friend, I suspect that she has probably pre-empted me and done so already.

I turn briefly to medical devices and treatments. The hon. Member for Strangford (Jim Shannon) was quite right to highlight that, although debate often focuses on drugs and specific medicinal or therapeutic treatments, we also need to look more widely at medical devices and at treatments that take other forms than therapeutic treatment. I know that he takes a close interest in the treatment and support of those with dementia, as I did before I was a Minister; I am grateful, as ever, for his contribution to the debate.

As hon. Members will know, NICE can also make recommendations on treatments through its clinical guidelines programme. Guidelines provide authoritative, evidence-based guidance for healthcare professionals and play an important role in driving best practice in the health and care system and supporting improved patient outcomes. However, they often make dozens of recommendations that can be complicated to implement at a local level. For that reason, they are not mandatory, but I assure the House and my hon. Friend the Member for Newton Abbot that the Government expect the healthcare system to take guideline recommendations fully into account in designing services that meet the needs of the local population and in working towards their implementation over time. It is right, however, that that implementation reflects local circumstance and is done at a local level.

I turn to local formularies; time is getting short, but I may also turn briefly to the eight points that my hon. Friend made—let us see how we do. She has raised concerns, not only in this debate but during the Health and Care Bill’s passage through the Commons and in conversations with me, that despite positive NICE guidance, some medicines are not available to NHS patients because they are not included on local formularies. In addition to the statutory funding requirement that applies to NICE-recommended treatments, NICE’S guideline “Developing and updating local formularies” recommends that, when NICE approves the use of a medicine through a technology appraisal, it should be automatically adopted into local formularies.

The standard contract mandated by NHS England for use by commissioners stipulates that providers must ensure that formularies include all NICE-recommended treatments. That process should take place within three months, allowing services a realistic timeframe to prepare for the introduction of a new technology. I appreciate that my hon. Friend went a little further on tightening the timeframe and the compulsion element, but given the complexity of some new treatments, I think that three months probably remains an appropriate timescale. I suspect that she will continue to push me on it, but at the moment I believe it is the right approach.

My hon. Friend is right that the system needs monitoring. She called for an obligation on integrated care boards to report uptake of new medicines annually, which is effectively monitoring. I am pleased to say that the Government support the view that uptake of NICE-recommended medicines should be monitored. Since 2013, NHS Digital has published an innovation scorecard that reports, at a national and a local level, the uptake of selected medicines that NICE has recommended in the last five years. I believe that it is more appropriate and proportionate that that information is collected and published by a single national body using agreed methodology, rather than multiple organisations that may have different ways of measuring and presenting the data.

My hon. Friend made a number of other points. Given the time constraints, I fear that I cannot address them all, but I will reflect carefully, as ever, on what she has said. Given that neither of them are present in the Chamber, it is a pleasure, as always, to agree on their behalf that my noble Friend the innovation Minister and my hon. Friend the Member for Mid Norfolk (George Freeman)—the life sciences Minister—will be delighted to meet her to discuss the matter in more detail. I am very grateful to her for bringing this evening’s debate to the House.

Question put and agreed to.

Oral Answers to Questions

Edward Argar Excerpts

Tuesday 23rd November 2021 Commons Chamber

[Siobhain McDonagh (Mitcham and Morden) (Lab)]

When the chief inspector of hospitals placed St George’s in Tooting into special measures, he warned that the

“emergency department was not large enough for the number of patients that passed through it and privacy and dignity were compromised.”

Given the report by the British Red Cross in this morning’s edition of The Times highlighting the causal link between A&E attendance and deprivation, does the Minister understand the further huge impact that moving acute services from St Helier to wealthy, healthy Belmont will have on A&E attendances at St George’s?

[The Minister for Health (Edward Argar)]

Forgive me, but I fear the hon. Lady may not have moved her tabled question.

[Siobhain McDonagh]

I was just so keen to ask my question!

[Edward Argar]

I can answer the hon. Lady’s supplementary question, but would it be in order for me to answer her tabled question and then the supplementary?

[Mr Speaker]

Yes.

[Siobhain McDonagh]

6. What recent assessment he has made of the impact of the proposed downgrade of services at St Helier hospital on the delivery of acute services at St George's hospital.

[Edward Argar]

I am grateful to the hon. Lady. To answer the tabled question, no recent assessment has been made of the changes associated with the Epsom and St Helier reconfiguration, including proposed changes to some services outside the new Sutton site. The hon. Lady will know that these proposals have been through consultation, judicial review and the independent reconfiguration panel, which all supported the plans as being in the local population’s interest. The Secretary of State agreed with their advice.

Turning to the hon. Lady’s supplementary question, I am grateful to her and I know how strongly she feels about the issue, but I take her back to the point I have just made, which is that these proposals have all been through extensive consultation and extensive legal process and been looked at by the independent reconfiguration panel. Those processes all concluded that what is proposed is in the best health interest of the population.

--- Later in debate ---

[Philip Dunne (Ludlow) (Con)]

T6. The capital transformation of acute hospitals in Shrewsbury and Telford has been eight years in the making. Will the Secretary of State confirm what is now needed to start delivering the £312 million of capital committed by the Conservative Government to improve Shropshire’s healthcare facilities? Will he also confirm that it does not make sense to head down the rabbit hole of a new hospital and start this whole process all over again?

[The Minister for Health (Edward Argar)]

I am grateful to my right hon. Friend, who has taken a long-term and consistent interest in the matter. The strategic outline case for transforming the Royal Shrewsbury Hospital and Princess Royal Hospital Telford was received at the end of October 2021. It has been reviewed by the NHS and detailed feedback has been given; I look forward to it coming forward to me early next year. We remain committed to delivering the investment and improvement that Shropshire’s hospitals need and that he and his colleagues have helped to secure.

[Sarah Green (Chesham and Amersham) (LD)]

Women across the country have lost jobs and life savings as a result of chronic pain and disability caused by complications after the use of medical mesh. Many, including one of my constituents, have had to pay for corrective surgery overseas. The Government have so far refused to set up agencies to provide financial redress, as was recommended in the Cumberlege report. Will the Secretary of State revisit the Cumberlege report, and in particular the need for financial redress?

--- Later in debate ---

[Daisy Cooper (St Albans) (LD)]

Ambulance response times are at their highest since records began. A month ago, on 22 October, I tabled a parliamentary question asking the Secretary of State how many ambulance trusts had moved into level 4—the level at which potential failures creep into the service. I am still awaiting an answer. Will the Minister answer that question today, please?

[Edward Argar]

If the hon. Lady supplies the number of the question, I will ensure that it is dealt with today. As for her broader point, yes, ambulance services across the country are under significant pressure this winter, which is one of the reasons why we have already invested an additional £55 million in helping them to cope with that pressure.

[Mr Speaker]

I call the Chairman of the Health and Social Care Committee, Jeremy Hunt.

--- Later in debate ---

[Daniel Kawczynski (Shrewsbury and Atcham) (Con)]

The Minister has heard from my right hon. Friend and neighbour the Member for Ludlow (Philip Dunne) how essential it is that the £320 million we have secured for the Future Fit programme be released, so that construction can start. We are beginning to see a definite negative impact on A&E services because of the seven or eight years of delays. Please will the Minister do everything possible to ensure that the money is finally released and construction can start?

[Edward Argar]

I am grateful to my hon. Friend, and likewise to my right hon. Friend the Member for Ludlow (Philip Dunne), who has campaigned vigorously this issue. We now have the outline business case from the trust, and we are reviewing it at pace to ensure that we can deliver the investment in both of Shropshire’s hospitals that they need to continue to serve my hon. Friend’s and colleagues’ constituents.

[Jeff Smith (Manchester, Withington) (Lab)]

My 90-year-old constituent, Jimmy, fell in his garden recently and broke his hip. When his family rang 999, they were told that it would be up to 14 hours before an ambulance could attend. The family got the fire brigade out after two and a half hours to sort him out. When the Government going to get a grip on the crisis in our ambulance services?

[Edward Argar]

The hon. Gentleman might have done this already, but if he wishes to, I would be grateful if he wrote to me about that case, not only to see whether there is anything I can do, but because it is always interesting and useful to hear from individual Members about specific incidents. To his broader point, as I set out to the hon. Member for St Albans (Daisy Cooper), we have invested £55 million this year ahead of the winter to support our ambulance services, but it is entirely true to say that they are under considerable pressure this winter across the country.

Health and Care Bill

Edward Argar Excerpts

Report stage
Tuesday 23rd November 2021 Commons Chamber

[The Minister for Health (Edward Argar)]

I beg to move, That the clause be read a Second time.

[Madam Deputy Speaker (Dame Eleanor Laing)]

With this it will be convenient to discuss the following:

Government new clause 37—Offence of offering to carry out virginity testing: England and Wales.

Government new clause 38—Offence of aiding or abetting etc a person to carry out virginity testing: England and Wales.

Government new clause 39—Virginity testing offences in England and Wales: penalties.

Government new clause 40—Offence of virginity testing: Scotland.

Government new clause 41—Offence of offering to carry out virginity testing: Scotland.

Government new clause 42—Offence of aiding or abetting etc a person to carry out virginity testing: Scotland.

Government new clause 43—Virginity testing offences in Scotland: penalties and supplementary.

Government new clause 44—Offence of virginity testing: Northern Ireland.

Government new clause 45—Offence of offering to carry out virginity testing: Northern Ireland.

Government new clause 46—Offence of aiding or abetting etc a person to carry out virginity testing: Northern Ireland.

Government new clause 47—Virginity testing offences in Northern Ireland: penalties.

Government new clause 48—Virginity testing: consequential amendments.

New clause 1—Licensing of aesthetic non-surgical cosmetic procedures—

“(1) No person may carry on an activity to which this subsection applies—

(a) except under the authority of a licence for the purposes of this section, and

(b) other than in accordance with specified training.

(2) Subsection (1) applies to an activity relating to the provision of aesthetic non-surgical procedures which is specified for the purposes of the subsection by regulations made by the Secretary of State.

(3) A person commits an offence if that person contravenes subsection (1).

(4) The Secretary of State may by regulations make provision about licences and conditions for the purposes of this section.

(5) Before making regulations under this section, the Secretary of State must consult the representatives of any interests concerned which the Secretary of State considers appropriate.

(6) Regulations may, in particular—

(a) require a licensing authority not to grant a licence unless satisfied as to a matter specified in the regulations; and

(b) require a licensing authority to have regard, in deciding whether to grant a licence, to a matter specified in the regulations.”

This new clause gives the Secretary of State the power to introduce a licensing regime for aesthetic non-surgical cosmetic procedures and makes it an offence for someone to practise without a licence. The list of treatments, detailed conditions and training requirements would be set out in regulations after consultation with relevant stakeholders.

New clause 12—Protection of the title of “nurse”—

“(1) A person may not practise or carry on business under any name, style or title containing the word ‘nurse’ unless that person is registered with the Nursing and Midwifery Council and entered in sub part 1 or 2 of the register as a Registered Nurse or in the specialist community public health nursing part of the register.

(2) Subsection (1) does not prevent any use of the designation ‘veterinary nurse’, ‘dental nurse’ (for which see section 36K of the Dentists Act 1984) or ‘nursery nurse’.

(3) A person who contravenes subsection (1) is guilty of an offence and liable on summary conviction to a fine not exceeding level four on the standard scale.”

New clause 21—Prohibition of virginity testing—

“(1) A person is guilty of an offence if they attempt to establish that another person is a virgin by making physical contact with their genitalia.

(2) A person is guilty of an offence if they provide another person with a product intended for the purpose, or purported purpose, of establishing whether another person is a virgin.

(3) A person is guilty of an offence if they aid, abet, counsel or procure a person to establish that another person is a virgin by making physical contact with their genitalia.

(4) No offence is committed by an approved person who performs—

(a) a surgical operation on a person which is necessary for their physical or mental health; or

(b) a surgical operation on a female who is in any stage of labour, or has just given birth, for purposes connected with the labour or birth.

(5) The following are approved persons—

(a) in relation to an operation falling within subsection (4)(a), a registered medical practitioner; and

(b) in relation to an operation falling within subsection (5)(b), a registered medical practitioner, a registered midwife or a person undergoing a course of training with a view to becoming such a practitioner or midwife.

(6) There is also no offence committed by a person who—

(a) performs a surgical operation falling within subsection (4)(a) or (b) outside the United Kingdom; and

(b) in relation to such an operation exercises functions corresponding to those of an approved person.

(7) For the purpose of determining whether an operation is necessary for the mental health of a girl it is immaterial whether she or any other person believes that the operation is required as a matter of custom or ritual.

(8) This section applies to any act done outside the United Kingdom by a United Kingdom national or resident.

(9) A person who is guilty of an offence under this section is liable, on summary conviction, to imprisonment for a term not exceeding 12 months, to a fine, or to both.

(10) The court must refer the case of any person guilty of an offence under this section who is subject to statutory professional regulation for investigation by the relevant regulator.”

New clause 22—Prohibition of hymenoplasty—

2(1) A person is guilty of an offence if they undertake a surgical procedure for the purpose of re-attaching membrane tissue, creating scar tissue or otherwise attempting to re-create the hymen in the vagina of a patient.

(2) A person is guilty of an offence if they advertise the service of hymenoplasty or any service that purports to ‘re-virginise’ or otherwise re-create or re-attach the hymen of a patient by way of surgical procedure.

(3) A person is guilty of an offence if they aid, abet, counsel or procure a person to undertake a surgical procedure for the purpose of re-attaching membrane tissue, creating scar tissue or otherwise attempting to or re-creating the hymen in the vagina of a patient.

(4) This section applies to any act done outside the United Kingdom by a United Kingdom national or resident.

(5) A person who is guilty of an offence under this section is liable, on conviction, to imprisonment for a term not exceeding 5 years.

(6) The court must refer the case of any person guilty of an offence under this section who is subject to statutory professional regulation for investigation by the relevant regulator.”

New clause 28—Secretary of State’s duty to report on long term workforce planning—

“(1) The Secretary of State must prepare and publish a report each year on projected workforce shortages and future staffing requirements for health, public health and social care sectors in the following five, ten and twenty years.

(2) The report must report projections of both headcount and full-time equivalent for the total health, public health and care workforce in England and for each region, covering all regulated professions and including those working for voluntary and private providers of health and social care as well as the NHS.

(3) The projections must be independently verified and based on projected health and care needs of the population for the following 5, 10 and 20 years, consistent with the Office for Budget Responsibility long-term fiscal projections.

(4) All relevant NHS bodies, arm’s-length bodies, expert bodies, trade unions and the Social Partnership forum must be consulted in the preparation of the report.

(5) The assumptions underpinning the projections must be published at the same time as the report and must meet the relevant standards set out in the National Statistics Authority’s Code of Practice for Statistics.

(6) The Secretary of State must update Parliament each year on the Government’s strategy to deliver and fund the long-term workforce projections.”

New clause 29—Duty on the Secretary of State to report on workforce planning and safe staffing—

“(1) At least every five years the Secretary of State must lay before Parliament a health and care workforce strategy for workforce planning and safe staffing supply.

(2) This strategy must include—

(a) actions to ensure the health and care workforce meets the numbers and skill-mix required to meet workforce requirements,

(b) equality impact assessments for planned action for both workforce and population,

(c) application of lessons learnt from formal reviews and commissions concerning safety incidents,

(d) measures to promote retention, recruitment, remuneration and supply of the workforce, and

(e) due regard for and the promotion of workplace health and safety, including provision of safety equipment and clear mechanisms for staff to raise concerns.”

Amendment 10, in clause 34, page 42, line 12, leave out from beginning to the end of line 17 and insert—

“(1) The Secretary of State must, at least once every two years, lay a report before Parliament describing the system in place for assessing and meeting the workforce needs of the health, social care and public health services in England.

(2) This report must include—

(a) an independently verified assessment of health, social care and public health workforce numbers, current at the time of publication, and the projected workforce supply for the following five, ten and 20 years; and

(b) an independently verified assessment of future health, social care and public health workforce numbers based on the projected health and care needs of the population for the following five, ten and 20 years, consistent with the Office for Budget Responsibility long-term fiscal projections.

(3) NHS England and Health Education England must assist in the preparation of a report under this section.

(4) The organisations listed in subsection (3) must consult health and care employers, providers, trade unions, Royal Colleges, universities and any other persons deemed necessary for the preparation of this report, taking full account of workforce intelligence, evidence and plans provided by local organisations and partners of integrated care boards.”

This amendment would require the Government to publish independently verified assessments every two years of current and future workforce numbers required to deliver care to the population in England, based on the economic projections made by the Office for Budget Responsibility, projected demographic changes, the prevalence of different health conditions and the likely impact of technology.

Amendment 40, in clause 108, page 96, line 9, leave out subsection (2) and insert—

“(2) In this Part ‘protected material’ means—

(a) all statements taken from persons by the HSSIB during a safety investigation or in the course of deciding whether an incident is going to be subject to an HSSIB investigation,

(b) records revealing the identity of persons who have given evidence in the context of the safety investigation,

(c) information that has been collected by the HSSIB which is of a particularly sensitive and personal nature, such as (but not limited to) copies taken by the HSSIB of health records, care records, clinical notes, or personnel records,

(d) material subsequently produced during the course of an HSSIB investigation such as (but not limited to) notes, drafts and opinions written by the investigators, or opinions expressed in the analysis of information obtained through the investigation,

(e) drafts of preliminary or final reports or interim reports, and

(f) information that would be subject to legally enforceable commercial privileges.”

This amendment would define more closely the materials covered by the “safe space” protection provided for by the Bill.

Amendment 41, page 96, line 32, leave out

“information, document, equipment or other item held by that individual”

and insert “protected material”.

This amendment is consequential on Amendment 40.

Amendment 43, in clause 109, page 96, line 43, leave out from “Part” to end of line 24 on page 97.

This amendment would remove the ability of the Secretary of State to make regulations authorising disclosure of protected material beyond that provided for in the Bill.

Amendment 74, page 101, line 1, leave out clause 115.

Government amendments 24 and 127.

Amendment 57, page 110, line 11, leave out clause 127.

This amendment seeks to ensure that a profession currently regulated cannot be removed from statutory regulation and that regulatory bodies cannot be abolished.

Government amendments 86 and 87.

Government new schedule 1—Virginity testing: consequential amendments.

Government amendment 88.

Amendment 42, in schedule 14, page 218, line 30, leave out paragraph 6.

This amendment would remove the provision allowing coroners to require the disclosure of protected material.

[Edward Argar]

This broad group of amendments concern improving patient safety and the quality of health and care services, both of which are a priority for this Government. For that reason, this Bill will put the Health Services Safety Investigations Body on a statutory footing. The HSSIB will be one of the first independent healthcare bodies of its kind, leading the way in investigating for the purpose of learning, not blaming. For the HSSIB to be able to perform this “no-blame” role, the integrity of safe space is paramount. I look forward to contributions from right hon. and hon. Members from both sides of the House, recognising the depth of expertise, particularly that residing in the hon. Member for Central Ayrshire (Dr Whitford), on how best to make safe space work. As we discussed extensively in Committee, we recognise that ultimately this comes down to: what is the appropriate balance to be struck? Different views are likely to be aired again today.

Within this group, I will also address amendments brought forward by colleagues, including my right hon. Friend the Member for South West Surrey (Jeremy Hunt), on the health and social care workforce. Ensuring we have the workforce this country needs will, in the short-term, tackle the elective backlog. Crucially, in the long-term, as we build back better, it will help to reduce damaging health inequalities. For those reasons, I will later speak in more detail about this Government’s plans on the workforce, some of which of course are already in motion. I hope I can reassure the House that the provisions already made in this Bill, alongside the Government amendments I am about to discuss, do go sufficiently far to address these important issues.

I will begin by addressing new clauses 36 to 48, new schedule 1 and amendments 86 and 87, which comprise the package of Government amendments to prohibit virginity testing in the UK. I offer my deepest thanks to my hon. Friend the Member for North West Durham (Mr Holden) for his tireless efforts in proposing these amendments originally and in supporting the Government in proposing our variations on them, which we believe achieve the right balance—I will turn to that in a moment—as we bring forward this ban.

I should also put on the record my gratitude to the Opposition Front-Bench team for their constructive engagement on this issue, which does not divide us on party political lines but is about doing the right thing. I am grateful to the shadow Ministers on the Opposition Front Bench: the hon. Members for Ellesmere Port and Neston (Justin Madders) and for Nottingham North (Alex Norris).

In July, the Government promised in our violence against women and girls strategy that virginity testing will not be tolerated in the UK and will be banned at the earliest opportunity, so I am delighted that we are introducing amendments that demonstrate the strength of our commitment to the removal of all forms of abuse against women and girls. Our amendments will create three offences: conducting a virginity test; offering virginity testing; and aiding or abetting another person to conduct a virginity test in the UK or on UK nationals overseas. Each offence will carry a maximum penalty of five years’ imprisonment and/or an unlimited fine. This sentencing reflects the long-term physical and psychological damage that this repressive practice can cause.

The offences begin to tackle the harmful misconceptions that surround a woman’s sexuality. This House’s commitment to legislate is a profoundly important step forward in helping to tackle the damaging myths concerning the so-called purity of women’s sexuality. In response to concerns that, once the offence is banned in the UK, vulnerable women and girls will be taken abroad and subjected to virginity testing there, the offences will carry extraterritorial jurisdiction.

The proposals have been discussed by Health Ministers throughout the UK, including in the devolved Administrations, and I am working with them to ensure that the whole of the UK together tackles this abhorrent practice. I put on record my gratitude to the devolved Administrations for the constructive manner in which they have engaged on the issue. I hope that the House will pass the amendments today and allow us to take another step forward in our shared endeavour and important work on safeguarding and improving the lives of women and girls throughout the United Kingdom.

Let me turn briefly to new clause 21, tabled by my hon. Friend the Member for North West Durham—I thank him again for doing so. I hope that what I have said will reassure him and the rest of the House that the package of Government amendments that I have just discussed go further to protect women and girls from this form of abuse and are the most effective vehicle by which we can achieve what we seek to do. Our package of amendments set out that the conducting, offering or aiding of a virginity test is simply indefensible. The amendments ensure that victims are protected on our shores and abroad and that the sentencing of those convicted reflects the detrimental physical and psychological impacts of the practice. I therefore hope that my hon. Friend will feel able not to press his new clause to a vote and instead to support our amendments. I am incredibly grateful to him—as, I am sure, is the House—for his campaigning vigour on this issue.

My hon. Friend also tabled new clause 22, which seeks to ban the practice of hymenoplasty. The Government remain concerned that hymenoplasty is also driven by a repressive approach to female sexuality and is closely related to virginity testing, which we have made clear today is not an acceptable practice in the United Kingdom or elsewhere. We announced in the violence against women and girls strategy that we would set up an independent expert panel to explore the complex clinical, legal and ethical aspects of the procedure in more detail. The panel, which includes key stakeholders with ethical and clinical expertise, has already met and will shortly make its recommendations to Ministers, before Christmas. It is crucial that, having asked the panel to contribute, we carefully consider its views before we make a firm decision to ban hymenoplasty. However, I assure the House that although we cannot accept the new clause today because we await the recommendations of the review panel, we will of course fully reassess our position as soon as the panel makes its recommendations.

If we are to ensure patient safety and quality of care, it is vital that we have the workforce in place to deliver it. That is a priority for the Government and I reassure the House that we are taking the necessary steps to secure the workforce of the health and social care sector. Members throughout the House would all agree that although investment in technology, in new hospitals and buildings, in therapeutics and in kit are all phenomenally important, the golden thread that makes that investment valuable is the workforce—the people who always go above and beyond, particularly in the past 18 months, to make that equipment more than just a shiny piece of kit but something that actually saves lives. They are absolutely the heart of what we are doing.

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

I am particularly concerned about the workforce situation in primary care. In my constituency, the practices are reporting back not only on an acute shortage of locums, but on their ability to recruit new GPs. One reason is that, 10,15, 20 years ago, there was inadequate planning for the future and we did not train enough doctors. That is one reason why I have signed amendment 10 tabled by my right hon. Friend the Member for South West Surrey (Jeremy Hunt). May I urge the Government to go beyond where they have been and to look for any way available to deal with this issue now, and particularly to plan for the future so that this does not happen again?

[Edward Argar]

My right hon. Friend is perspicacious in his prediction of where I was about to go. I was about to turn to amendment 10 tabled by my right hon. Friend the Member for South West Surrey and new clause 28 tabled by the shadow Minister, which go to the heart of what my right hon. Friend is talking about.

I hope the shadow Minister will agree that amendment 10 and new clause 28 are, essentially, broadly unified in their intention and therefore I hope that he will allow me to take them both together. They require the Government to publish independently verified assessments of current and future workforce numbers for the needs of the health, social care and public health services in England.

There has rightly been much discussion on workforce planning for the NHS and adult social care. That reflects the deep debt of gratitude that the country owes the staff and also, as I said, their absolute indispensability in delivering on all our aspirations for healthcare and social care in this country and for our constituents’ care.

As part of our commitment to improving workforce planning, my Department is already doing substantial work to ensure that we recover from the pandemic and support care. We have already committed to publishing, in the coming weeks, a plan for elective recovery and to introducing further reforms to improve recruitment and support for our social care workforce, with further detail set out in an upcoming social care White Paper. We are also developing a comprehensive national plan for supporting and enabling integration between health, social care and other services, which support people’s health and wellbeing.

Let me turn to that framework, to which my right hon. Friend the Member for Epsom and Ewell (Chris Grayling) was alluding, for a longer-term perspective. The Department has already commissioned Health Education England to work with partners to develop a robust, long-term 15-year strategic framework for the health and social care workforce, which, for the first time, will include regulated professionals in adult social care. That work was commissioned in July by my hon. Friend the Member for Faversham and Mid Kent (Helen Whately) when she was in post in the Department. That work will look at the key drivers of workforce demand and supply over the longer term and will set out how they impact on the required shape and numbers of the future workforce to help identify those main strategic choices, and we anticipate publication in spring of next year.

It is vital that the workforce planning is closely integrated to the wider planning across health and social care and, as such, Health Education England, which has established relationships with the health and care system at a local, regional and national level, is best placed to develop such a strategy. Crucially, following the announcement yesterday of HEE merging with NHS England in improvement, we will, for the first time, bring together those responsible for planning services, for delivering services on the ground, and for delivering on the workforce needs of those services so that we can have a more integrated approach to delivering on that framework.

[Richard Fuller (North East Bedfordshire) (Con)]

I am grateful to the Minister for giving way. There is much to commend in the amendment of my right hon. Friend the Member for South West Surrey (Jeremy Hunt) and in what the Minister is saying. One thing that is not obvious in either, though, is the focus on labour costs and productivity. For example, how is technology going to reduce labour costs in the delivery of the same quality or higher quality of service? What is the possibility of creating new care pathways, which require less qualified staff to deliver as good or better service? What is going on in terms of reducing the proportion of non-clinical staff by the adoption of technology and other means in healthcare? Perhaps the Minister could address that. I am sure that my right hon. Friend will be doing so later, too.

[Edward Argar]

My hon. Friend is absolutely right. We see huge opportunities, almost every day, from new technology and new ways of using that technology to deliver more efficient and shorter turnaround times—for tests and diagnostics, for example. He is also right to talk about the need constantly to examine care pathways, and, where opportunities exist, to use highly qualified healthcare professionals but to look carefully at the most appropriate level at which a treatment or test can be carried out; historically, we may have used healthcare professionals for particular tasks for which they were almost over-qualified. It is right that care pathways are informed by clinical and scientific expertise and judgment, but that we continue to review how new technology, new ways of working and new care pathways can improve the productivity of our amazing workforce.

[Emma Hardy (Kingston upon Hull West and Hessle) (Lab)]

As part of the Minister’s workforce review, will he look at the Carr-Hill formula, which local GPs tell me incentivises GPs to go to areas with longer life expectancy—therefore, wealthier areas—at the expense of areas such as Hull? It feels like the funding mechanism for GPs is not fair.

[Edward Argar]

The Carr-Hill formula has been through many “almost reviews” over the years and has been looked at by different Governments. Various GP practices in my constituency—as I am sure is the case in the hon. Lady’s—understandably raise opinions about how the formula might be improved. The point does not necessarily goes to the entire heart of what we are discussing, but she has managed deftly to make it within scope, in the context of GPs and so forth.

Finally, the report in clause 34 will increase transparency and accountability of the workforce planning process. It is for those reasons that I encourage—perhaps unsuccessfully—my right hon. Friend the Member for South West Surrey and the shadow Minister, the hon. Member for Ellesmere Port and Neston, to consider not pressing their amendments to a Division.

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

Fifteen years is a long time in workforce planning. The make-up of the workforce could change significantly over that time, not least as we are trying to address some real workforce crises now. Will the Minister put in place a road map to fill those vacancies over that time, and interim reports so that we can review progress?

[Edward Argar]

I set out the commissioning of the 15-year framework to look at need. Within that, the House will be regularly updated, as happens now—not least in oral questions, as we saw in the session preceding this debate—with plenty of opportunities for Members to challenge the Government and to see updates. There is also the regular publication of figures and workforce statistics, which will continue. Once we have that 15-year framework back and see what HEE says, we will be able to look at how best that might be interrogated by Members of the House and the wider public. I am hopeful that it will report back in the spring, and I suspect that that may well occasion a debate in this House. If not, I suspect that it may well occasion an urgent question from the hon. Lady or the hon. Member for Ellesmere Port and Neston.

Let me turn to new clause 29, which also addresses the issue of workforce planning. This new clause would place a duty on the Secretary of State to report on workforce planning and safe staffing. I have just elaborated at some length on the substantial work that my Department is doing to improve workforce planning. It remains the responsibility of local clinical and other leaders to ensure safe staffing, supported by guidance and regulated by the Care Quality Commission. The ultimate outcome of good-quality care is influenced by a far greater range of issues than how many of each particular staff group are on any particular shift at any one time, even though that is clearly important, which is why the Government are committed to growing the health workforce. It is also important that local clinical leads can make decisions based on the circumstances in their own particular clinical setting, utilising their expertise and knowledge.

The amendment would also require the report to contain a review of lessons learnt. In the last decade, the Government have introduced significant measures to support the NHS to learn from things that go wrong, reduce patient harm and improve the response to harmed patients, such as: a regulated duty of candour that requires trusts to tell patients if their safety has been compromised and apologise; protections for whistleblowers when they raise safety concerns; the Healthcare Safety Investigation Branch, which we are building on and establishing as a separate statutory body through the Bill; and the first-ever NHS patient safety strategy, with substantial programmes planned and under way to create a safety and learning culture in the NHS.

I hope I have given the House some reassurance that we are doing substantive work to improve safe staffing and workforce planning. Again, I encourage the shadow Minister—perhaps it will be unsuccessful, but it is always worth trying—to consider withdrawing his amendment.

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

New clause 29(2)(d) has merits, as I am sure the Minister will accept, in that we need to incentivise people to join health and care, and, crucially, to be retained with the system. Will he give some consideration to this, particularly given that, for example, somebody working in the care system can work for years and years and still be in the same place when it comes to applying for a training place in a profession allied to medicine as somebody who simply has a couple of A-levels? That seems to be wrong. Does he agree that we need to complete the structure so that there is some prospect of progression with health and care and to try to break down the barriers between the two?

[Edward Argar]

As ever, my right hon. Friend—my friend—makes his point well, and, as ever, I will commit to taking it away and reflecting on it very carefully. He is always very considered in the points he makes in this House, so I am happy to look at it.

I turn to Government amendment 127, which I bring forward with support of the Welsh Government. Clause 127 on professional regulation provides additional powers that will widen the scope of section 60 of the Health Act 1999 and enable the Privy Council to make additional changes through secondary legislation. One of the powers within this clause is to enable the regulation of groups of workers concerned with physical and mental health, whether or not they are generally regarded as a profession. This element of the clause falls within the legislative competence of the Senedd. When the section 60 powers are used, they are subject to the existing statutory requirements in schedule 3 of the Health Act 1999— namely, consultation and the affirmative parliamentary procedure. When legislation made using section 60 powers also falls within areas of devolved competence, it will be developed in collaboration with the devolved Administrations. Orders may require the approval of the Scottish Parliament where they concern professions brought into regulation after the Scotland Act 1998, or of the Welsh Assembly where the order concerns social care workers. In Northern Ireland, where the regulation of healthcare professions is a transferred matter, the UK Government will continue to seek the agreement of the Northern Ireland Executive when legislating on matters that effect regulation in its territory.

The amendment introduces a requirement to obtain the consent of Welsh Ministers before an Order in Council can be made under section 60 of the Health Act 1999 when it contains a provision that would be within the legislative competence of the Senedd. It would apply if we were seeking to bring into regulation in Wales a group of workers who are concerned with physical or mental health of individuals but who are not generally regarded as a profession. The UK Government recognise the competence of the Welsh Government regarding this provision and are respecting the relevant devolution settlement in making this amendment. For these reasons, I ask hon. Members to support the amendment.

Finally, I turn to the amendments related to part 4 of the Bill on the health services safety investigations body. These are the most significant set of provisions found within this Bill to enhance patient safety. The establishment of an independent healthcare body focused on learning from mistakes to improve safety and quality is a world first. For the health service safety investigations body to be able to perform this “no-blame” role, the integrity of safe space is paramount. Without it, health and care staff will not have confidence to come forward, and potential learning will be lost. This principle runs throughout the drafting of these clauses. We have made a small number of exceptions in the Bill—for example, to ensure that coroners can continue to perform their vital functions as judicial office holders and effectively as part of the judiciary. We have also provided for a regulation-making power to ensure that safe space can evolve in line with innovation in technology or medical practice. However, nothing in the Bill can or will undermine the imperative that the HSSIB is an independent organisation or the fundamental importance of safe space to the effective working of that organisation.

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

Will the Minister give way?

[Edward Argar]

Yes, of course, although I do so with a degree of trepidation, because the hon. Lady is well versed in these issues.

[Dr Whitford]

The Minister does not need to be anxious, because he has already heard it all in Committee. Does he not recognise that there is nothing in HSSIB that takes away from coroners’ investigations that they carry out at the moment, and that HSSIB should not be seen as replacing that work by another health body? Adding coroners to it has already created a campaign relating to the ombudsman and freedom of information, and there is a real danger that it weakens the safe space.

[Edward Argar]

I am grateful for the manner in which the hon. Lady puts her points. She is right; we have debated this previously. We have been publicly clear that we do not believe that the exemption or exception should be extended to the ombudsman. She is right that there are campaigns saying we should have no exceptions or that we should widen the exceptions. We believe we have struck the right balance with this measure, while respecting the fact that a coroner is a judicial office holder and has a very specific function to perform, as set out in legislation in—this is where my memory may fail me—the Coroners and Justice Act 2009, which recognises their particular and special status. I suspect that she and I may have to agree to disagree on whether the appropriate balance is struck, but that sets out why we have done what we have done.

How best to achieve an effective safe space is complex and the current drafting has been arrived at through years of detailed policy work, including pre-legislative scrutiny before the Health Service Safety Investigations Bill was introduced in the other place in autumn 2019. The issue was also debated at length in Committee, and I look forward to hearing contributions from Members on that, particularly the hon. Member for Central Ayrshire.

Turning to the two minor and technical Government amendments to the health service safety investigations body provisions, amendment 24 is a technical amendment to clarify the definition of “investigation” that applies to part 4 of the Bill. Investigations carried out by HSSIB by agreement under clause 114, which relate to Wales and Northern Ireland, were never intended to be part of the main investigation function of HSSIB and therefore will not be covered by the safe space or other investigatory power provisions provided for in the Bill. The amendment ensures that the drafting of the Bill fully reflects that original policy position. I hope that hon. Members on both sides of the Chamber will be content to pass this technical amendment.

Finally, I turn to Government amendment 88 to schedule 13. Schedule 13 contains a regulation-making power which allows the Treasury to vary the way any relevant tax has effect in relation to associated transfer schemes. Regulations made under this power will be used to ensure that no unintended tax consequences arise. The amendment ensures that value added tax is included in the taxes which the Treasury can, by regulations, vary when considering the transfer schemes in this Bill. Without this amendment, it is possible that complications with VAT bills may arise when transfer schemes are made and transactions take place. It is for those reasons that I ask hon. Members to support this amendment.

I am conscious that other hon. and right hon. Members may wish to speak to their amendments. I look forward to addressing those that I have not directly addressed thus far when I wind up debate on this group of amendments. With that, I conclude.

[Justin Madders (Ellesmere Port and Neston) (Lab)]

I thank the Minister for his introduction. It seems like only yesterday that we were having a similar exchange across the Dispatch Box.

I will begin with our new clauses 28 and 29 and amendment 10. This discussion about workforce could well be the most important of all today. Just this weekend, Chris Hopson from NHS Providers was trying to get the Government to acknowledge the seriousness of the problem when he tweeted:

“93k NHS staff vacancies. £6bn spend on temporary staff to fill gaps. 55% of staff working unpaid extra hours each week. 44% saying they’ve felt ill with work related stress. NHS desperately needs long term workforce planning. Govt must make this happen this week.”

Everything comes back to workforce and the failure to invest in it consistently over a sustained period. Today we have a chance to correct that.

While we favour our new clause 29, it is obvious that amendment 10 has captured the attention of many and may well be put to a vote. In many ways, as the Minister said, it closely mirrors what we have put forward, so I will be making my general points on both the new clauses and the amendment. In supporting amendment 10, I pay tribute to the right hon. Member for South West Surrey (Jeremy Hunt), the Chair of the Health and Social Care Committee. Given his previous role, he is well placed to have an informed view on what needs to be done, and he has done that with this amendment without undue hype or drama. The support he has obtained more widely from stakeholders outside the House is impressive; indeed, the way he has united just about the entire sector shows not only his powers of persuasion, but the importance of the issue. He has come close to uniting the entire sector in the past, but that was usually in opposition to something he was proposing, rather than in support. There may be many other areas where we have disagreed in the past, but that does not diminish our support for his call.

--- Later in debate ---

[Derek Thomas (St Ives) (Con)]

I rise to speak on amendment 10 on workforce planning, in the name of my right hon. Friend the Member for South West Surrey (Jeremy Hunt). However, surely the Government’s urgent priority is to look at effective ways to attract back into the NHS all those consultants, nurses and social care workers who have left, and to find any way they can to bring back that experience and expertise.

With your permission, Mr Deputy Speaker, I would like to talk about some lived experience. Just last Friday, I came across a lady who had fallen over and clearly injured herself. I phoned 999, knowing full well that I would be entering a system under severe stress and pressure. I confess that, as it happened. I put the phone down, because the priority for me was to ensure that she was safe, warm and comfortable.

The ambulance service called me back and told me it would be a wait of several hours. I knew that that was caused by the pressure on the ambulance service and on A&E and the subsequent pressure on beds, hindering the effective and timely treatment of people who go to hospital. The pressure on admission to A&E also affects surgery. All that pressure goes down to one place in Cornwall, and Cornwall will not be unique: delayed transfers of care.

We have been in this place before: in 2016, a system-wide review of the situation in Cornwall found far too many people who would be better off in the community, being looked after in homes or care homes, but were stuck in hospital. In Cornwall today I understand the figure is more than 100 people in that exact situation. The pressure on the whole system is largely to do with those delayed transfers of care. While much has been said about the workforce planning for the NHS, I will quickly touch on workforce planning for the care workforce.

The emphasis on workforce planning should transform the current state of the care workforce, leading to better support, better training, better pay and better status. I am hopeful that the White Paper will address that, as it is the only way to effectively ease the pressure on acute NHS settings. There is an urgent need to understand and address the pressure on care staff, GP practices and community care across the board.

Maybe I should have said this at the beginning, but I chair the all-party parliamentary group on diabetes. Several years ago, we found that, in the whole of the south-west, training for podiatry was coming to an end because of a lack of funding and the way it was delivered across the region. That had an immediate impact on community care and how people could be cared for and enabled to live with and manage their condition, which ultimately puts more pressure on urgent care.

As we look at workforce planning and how to understand exactly what is needed, I particularly thank the NHS staff who have worked so hard, especially those I met at the beginning of the year, who, as they delivered the vaccine roll-out, told me they were doing it for the national effort. Workforce planning and the commitment to ensuring that we have the workforce where they are needed, with the skills they need, is the best way to reward our NHS workforce.

[Edward Argar]

This is a little more generous than the six minutes I feared I might have to work with, Mr Deputy Speaker.

If I may, I will address each set or theme of amendments in turn. First, I am grateful to my hon. Friend the Member for North West Durham (Mr Holden) for the work he has done. He rightly highlights that in a sense he is but the voice of the campaigners who have worked so hard on this issue over a very long period. I am pleased that today, while it is not his exact amendment, we have been able to work together to table an amendment that I hope will command cross-party support across the House to deliver on what he has campaigned so effectively for.

I have known my hon. Friend a very long time, so I should not have been surprised by the persistence with which he beat a path to my door to seek to secure agreement on exactly this policy issue.

[Mr Holden]

Can I just say that the Minister has been absolutely superb in engaging throughout this process? I would like to thank the shadow team as well, who in Committee and today—and throughout—have shown real conviction towards this end. I thank the Minister and his team and also the shadow team for all they have done.

[Edward Argar]

I am grateful to my hon. Friend, who I think covered both bases there very eloquently. He makes an important point on this issue. The change will make a real difference to people’s lives, so I commend him for his work.

New clause 1 was tabled by my right hon. Friend the Member for Romsey and Southampton North (Caroline Nokes) and would give the Secretary of State the power to introduce a licensing regime for aesthetic non-surgical cosmetic procedures, making it an offence for someone to practise without a licence. I thank her for bringing this to the House today. In that context, I also pay tribute to the right hon. Member for North Durham (Mr Jones); my hon. Friend the Member for Thurrock (Jackie Doyle-Price), who has taken a very close interest in the issue; and of course my hon. Friend the Member for Sevenoaks (Laura Trott) not only for taking a close interest in the issue, but for her success, with her private Member’s Bill, in moving the dial further forward on the issue more broadly.

As I said in Committee, I entirely understand the intention behind the amendment and that a strong case has been made for further regulation in this area. I and the Department are keen to work with stakeholders, including Members of this House on both sides, to see whether we can take this forward in the most appropriate way and clarify the scope of any further regulation. We are happy—we had a very positive meeting, which was alluded to—and I hope that we will be able to continue to explore the issue with hon. and right hon. Members.

In this context, I also commend the all-party parliamentary group on beauty, aesthetics and wellbeing for its important work. Its inquiry highlights the huge range of non-surgical cosmetic procedures available, which vary in their level of complexity and invasiveness. We are carefully considering the findings of that report, including, in that context, its recommendation for a licensing system. We look forward to reporting our conclusions from that work early in 2022. I look forward to working with my right hon. Friend the Member for Romsey and Southampton North and others on that.

Amendment 57 was tabled by the hon. Member for Wirral West (Margaret Greenwood). I can entirely understand where she is coming from—that the professions protected in law must be the right ones, with the right regulatory oversight, recognising that regulation is there for safety. We believe there is no immediate case to change the professions that are regulated, but we will consider whether any new groups of workers should be brought into statutory regulation, and the power to remove professions from regulations would only be used where regulation is no longer required for the protection of the public. For these reasons, we think the approach we are adopting is the right one, but I always reflect on what she says. Even when I do not entirely agree with all of it, I always reflect carefully because she has taken a long-standing interest in these issues.

The hon. Member for Brent Central (Dawn Butler) raised the issue of the title of “nurse” and protection for it. The title “registered nurse” is protected in law. Currently —she is right—the title “nurse” is not protected, given that it is used across multiple professions, including dental nurses, school nurses, veterinary nurses and similar. As has been pointed out by the interim chief nursing officer for Scotland, any change would need careful consideration of the impact on other groups currently using the title “nurse” outside healthcare settings.

I can see the benefit in providing reassurance and clarity for both patients and professionals. I would also note that the protection of a title is only one part of the regulatory system and the complexities associated with that. I understand where the hon. Member is coming from with her new clause 12. What I would say is that any subsequent change could form part of the legislative reform programme for the Nursing and Midwifery Council, which will be taken forward by secondary legislation made under section 60 of the Health Act 1999. But we do not feel we are able to accept her new clause, as drafted at the moment, because we do not feel that it addresses those fundamental challenges.

[Dawn Butler]

rose—

[Edward Argar]

If the hon. Member is going to be brief, I will of course give way to her.

[Dawn Butler]

I was going to quickly say that the Government’s response to Alison Leary’s very good petition says that the Government understand it. We could pass the new clause today and then the Minister could amend it in Committee.

[Edward Argar]

I am grateful to the hon. Lady, but we have had the Committee. We are now at the stage where we have been through this, and I therefore do not think it would be appropriate to pass an amendment that we thought was flawed in its drafting. I can understand the intent behind it, and I have said that I will continue to reflect on that, but we do not feel we can support the amendment as drafted.

On amendment 10 and new clause 28, hon. and right hon. Members who have spoken to those amendments from both sides of the House have raised something that I think is of huge importance to all Members of this House. As I said in my opening remarks, we all recognise that technology, kit and buildings are all wonderful if we invest in them, but they are nothing without the people—the professionals—who know how to care, are able to care and are able to use that kit to provide the best possible outcomes for our constituents. The workforce are in a sense the beating heart of our NHS, and it is important that I again recognise and join the Opposition in paying tribute to the work undertaken by the workforce.

I appreciate entirely the strongly held, sincerely held and, as ever with my right hon. Friend the Member for South West Surrey (Jeremy Hunt), well-informed views that he brings to this debate, based on his extensive experience. I would extend that to the shadow Minister, the hon. Member for Ellesmere Port and Neston (Justin Madders), in a spirit of bipartisan cordiality. I hope I have been able to help to reassure colleagues just how seriously we take this issues. Hon. and right hon. Members have been right to raise the issue. We reflect very carefully on it. We have already, as I have said, not only set out plans for elective recovery and further reforms to improve recruitment and support for our workforce, but announced yesterday the merger of Health Education England with NHS England, which we believe is an important next step in making sure that workforce needs can be considered in the round. The other key element is, as I say, the development, commissioned in July, of a robust, long-term—15-year—strategic framework for the health and social care workforce.

We are in no way complacent or resting on our laurels in the case of the workforce. Despite the significant progress we have made in recruiting more nurses and more doctors, there is clearly a lot more to do. We recognise that, and I believe it was a point well made by my hon. Friend the Member for Boston and Skegness (Matt Warman). He declared his interest. I do not know whether I need to, but his wife is a friend of mine; I should probably declare that too. He made some important points, a key point being that this is not just about projections for recruitment. It is absolutely right that we are focused, as we are, on the retention of our existing highly trained, highly skilled and highly experienced workforce. We look at what measures we can continue to take to address those challenges.

There is the need to recognise that that workforce—the workforce who are delivering on elective recovery and who are delivering on tackling those waiting lists—are the same people who have been working flat out throughout this pandemic, and emotionally and physically need the space and time to be able to recover. We recognise that and take it extremely seriously. I think it was my hon. Friend the Member for Peterborough (Paul Bristow)—he has jumped around the Chamber slightly in taking his seat—who made the point about reporting and monitoring mechanisms to know how the framework is working and that we are doing the right thing. While we are not, I have to say, fully convinced by the case made by my right hon. Friend the Member for South West Surrey, I take the point made by my hon. Friend the Member for Peterborough about that. I will continue to reflect very carefully on that, on what my right hon. Friend has tabled and on the points he made in debate and in his many meetings with me and other ministerial colleagues.

In the minute or so I have left, I want to briefly touch on the HSSIB amendments, which I know are important, particularly to the hon. Member for Central Ayrshire (Dr Whitford), but I think she reflects broader opinion in this House. As discussed in Committee, the definition given in clause 108(2) is intentionally broad. HSSIB will be carrying out a range of investigations, and we believe it would be impossible to prospectively identify the material that will be gathered and should therefore be protected by safe space. Similarly, while I take the point she makes about senior coroners and coroners’ involvement, we believe that we have struck the right balance in not extending the safe space exemptions more widely, but recognising the unique status that those judicial office holders have.

I hope I have been able to cover the main themes of the amendments tabled in this group. I hope I have been able to reassure hon. and right hon. Members on both sides of this House, particularly in respect of the workforce, just how seriously Her Majesty’s Government take that issue, and the points genuinely and sincerely made by Members on both sides of the House in that context.

Question put and agreed to.

New clause 36 accordingly read a Second time, and added to the Bill.

New Clause 37

Offence of offering to carry out virginity testing: England and Wales

‘(1) It is an offence under the law of England and Wales—

(a) for a person in England and Wales to offer to carry out virginity testing in the United Kingdom or virginity testing that has a sufficient jurisdictional connection, or

(b) for a person anywhere to offer to carry out virginity testing if the person is a United Kingdom national or habitually resident in England and Wales.

(2) Virginity testing has a sufficient jurisdictional connection for the purposes of subsection (1)(a) if it is carried out in relation to a person who is—

(a) a United Kingdom national, or

(b) habitually resident in the United Kingdom.

(3) In this section—

“United Kingdom national” has the meaning given by section (Offence of virginity testing: England and Wales)(4);

“virginity testing” has the meaning given by section (Offence of virginity testing: England and Wales)(2).’ —(Edward Argar.)

This new clause creates an offence under the law of England and Wales of offering to carry out virginity testing.

Brought up, read the First and Second time, and added to the Bill.

New Clause 38

Offence of aiding or abetting etc a person to carry out virginity testing: England and Wales

‘(1) It is an offence under the law of England and Wales for a person who is in England and Wales, or for a person who is outside England and Wales but who is a United Kingdom national or habitually resident in England and Wales, to aid, abet, counsel or procure the carrying out of virginity testing that has a sufficient jurisdictional connection.

(2) Virginity testing has a sufficient jurisdictional connection for the purposes of subsection (1) if it is carried out in relation to a person who is—

(a) in the United Kingdom,

(b) a United Kingdom national, or

(c) habitually resident in the United Kingdom.

(3) This section does not affect the application to an offence under section (Offence of virginity testing: England and Wales) of any rule of law relating to aiding, abetting, counselling or procuring.

(4) In this section—

“United Kingdom national” has the meaning given by section (Offence of virginity testing: England and Wales)(4);

“virginity testing” has the meaning given by section (Offence of virginity testing: England and Wales)(2).’. —(Edward Argar.)

This new clause creates an offence of aiding etc a person to carry out virginity testing in circumstances where the carrying out of that testing might not itself be an offence (depending on the location or status of the person carrying out the testing)

Brought up, read the First and Second time, and added to the Bill.

New Clause 39

Virginity testing offences in England and Wales: penalties

‘(1) A person who commits an offence under section (Offence of virginity testing: England and Wales), (Offence of offering to carry out virginity testing: England and Wales) or (Offence of aiding or abetting etc a person to carry out virginity testing: England and Wales), is liable—In subsection (1)(a) “the maximum summary term for either-way offences” means—

(a) on summary conviction, to imprisonment for a term not exceeding the maximum summary term for either-way offences or a fine (or both);

(b) on conviction on indictment, to imprisonment for a term not exceeding 5 years or a fine (or both).

(c) in relation to an offence committed before the time when paragraph 24(2) of Schedule 22 to the Sentencing Act 2020 comes into force, 6 months;

(d) in relation to an offence committed after that time, 12 months.’ —(Edward Argar.)

This new clause sets out the penalties for the new offences under the law of England and Wales relating to virginity testing.

Brought up, read the First and Second time, and added to the Bill.

New Clause 40

Offence of virginity testing: Scotland

‘(1) It is an offence under the law of Scotland for a person to carry out virginity testing.

(2) “Virginity testing” means the examination of female genitalia, with or without consent, for the purpose (or purported purpose) of determining virginity.

(3) An offence is committed under subsection (1) only if the person—

(a) is in Scotland, or

(b) is outside the United Kingdom, and is a United Kingdom national or habitually resident in Scotland.

(4) “United Kingdom national” means an individual who is—

(a) a British citizen, a British overseas territories citizen, a British National (Overseas) or a British Overseas citizen,

(b) a person who under the British Nationality Act 1981 is a British subject, or

(c) a British protected person within the meaning of that Act.

(5) In subsection (2), “female genitalia” means a vagina or vulva.’

This new clause creates an offence under the law of Scotland of virginity testing.—(Edward Argar.)

Brought up, read the First and Second time, and added to the Bill.

New Clause 41

Offence of offering to carry out virginity testing: Scotland

‘(1) It is an offence under the law of Scotland—

(a) for a person in Scotland to offer to carry out virginity testing in the United Kingdom or virginity testing that has a sufficient jurisdictional connection, or

(b) for a person anywhere to offer to carry out virginity testing if the person is a United Kingdom national or habitually resident in Scotland.

(2) Virginity testing has a sufficient jurisdictional connection for the purposes of subsection (1)(a) if it is carried out in relation to a person who is—

(a) a United Kingdom national, or

(b) habitually resident in the United Kingdom.

(3) In this section—

“United Kingdom national” has the meaning given by section (Offence of virginity testing: Scotland)(4);

“virginity testing” has the meaning given by section (Offence of virginity testing: Scotland)(2).’ —(Edward Argar.)

This new clause creates an offence under the law of Scotland of offering to carry out virginity testing.

Brought up, read the First and Second time, and added to the Bill.

New Clause 42

Offence of aiding or abetting etc a person to carry out virginity testing: Scotland

‘(1) It is an offence under the law of Scotland for a person who is in Scotland, or for a person who is outside Scotland but who is a United Kingdom national or habitually resident in Scotland, to aid, abet, counsel, procure or incite the carrying out of virginity testing that has a sufficient jurisdictional connection.

(2) Virginity testing has a sufficient jurisdictional connection for the purposes of subsection (1) if it is carried out in relation to a person who is—

(a) in the United Kingdom,

(b) a United Kingdom national, or

(c) habitually resident in the United Kingdom.

(3) This section does not affect the application to an offence under section (Offence of virginity testing: Scotland) of any rule of law relating to aiding, abetting, counselling, procuring or inciting.

(4) In this section—

“United Kingdom national” has the meaning given by section (Offence of virginity testing: Scotland)(4);

“virginity testing” has the meaning given by section (Offence of virginity testing: Scotland)(2).’ —(Edward Argar.)

This new clause creates an offence of aiding etc a person to carry out virginity testing in circumstances where the carrying out of that testing might not itself be an offence (depending on the location or status of the person carrying out the testing).

Brought up, read the First and Second time, and added to the Bill.

New Clause 43

Virginity testing offences in Scotland: penalties and supplementary

‘(1) A person who commits an offence under section (Offence of virginity testing: Scotland), (Offence of offering to carry out virginity testing: Scotland) or (Offence of aiding or abetting etc a person to carry out virginity testing: Scotland), is liable—

(a) on summary conviction, to imprisonment for a term not exceeding 12 months or a fine not exceeding the statutory maximum (or both);

(b) on conviction on indictment, to imprisonment for a term not exceeding 5 years or a fine (or both).

(2) Where a person outside Scotland commits an offence under section (Offence of virginity testing: Scotland), (Offence of offering to carry out virginity testing: Scotland) or (Offence of aiding or abetting etc a person to carry out virginity testing: Scotland) the person may be prosecuted, tried and punished for the offence—

(a) in a sheriff court district in which the person is apprehended or in custody, or

(b) in a sheriff court district determined by the Lord Advocate,

as if the offence had been committed in that district.

Where subsection (2) applies, the offence is, for all purposes incidental to or consequential on the trial and punishment, deemed to have been committed in that district.

(3) In this section “sheriff court district” is to be construed in accordance with section 307(1) of the Criminal Procedure (Scotland) Act 1995 (interpretation).’—(Edward Argar.)

This new clause sets out the penalties for the new offences under the law of Scotland relating to virginity testing.

Brought up, read the First and Second time, and added to the Bill.

New Clause 44

Offence of virginity testing: Northern Ireland

‘(1) It is an offence under the law of Northern Ireland for a person to carry out virginity testing.

(2) “Virginity testing” means the examination of female genitalia, with or without consent, for the purpose (or purported purpose) of determining virginity.

(3) An offence is committed under subsection (1) only if the person—

(a) is in Northern Ireland, or

(b) is outside the United Kingdom, and is a United Kingdom national or habitually resident in Northern Ireland.

(4) “United Kingdom national” means an individual who is—

(a) a British citizen, a British overseas territories citizen, a British National (Overseas) or a British Overseas citizen,

(b) a person who under the British Nationality Act 1981 is a British subject, or

(c) a British protected person within the meaning of that Act.

(5) In subsection (2), “female genitalia” means a vagina or vulva.’ —(Edward Argar.)

This new clause creates an offence under the law of Northern Ireland of virginity testing.

Brought up, read the First and Second time, and added to the Bill.

New Clause 45

Offence of offering to carry out virginity testing: Northern Ireland

‘(1) It is an offence under the law of Northern Ireland—

(a) for a person in Northern Ireland to offer to carry out virginity testing in the United Kingdom or virginity testing that has a sufficient jurisdictional connection, or

(b) for a person anywhere to offer to carry out virginity testing if the person is a United Kingdom national or habitually resident in Northern Ireland.

(2) Virginity testing has a sufficient jurisdictional connection for the purposes of subsection (1)(a) if it is carried out in relation to a person who is—

(a) a United Kingdom national, or

(b) habitually resident in the United Kingdom.

(3) In this section—

“United Kingdom national” has the meaning given by section (Offence of virginity testing: Northern Ireland)(4);

“virginity testing” has the meaning given by section (Offence of virginity testing: Northern Ireland)(2).’ —(Edward Argar.)

This new clause creates an offence under the law of Northern Ireland of offering to carry out virginity testing.

Brought up, read the First and Second time, and added to the Bill.

New Clause 46

Offence of aiding or abetting etc a person to carry out virginity testing: Northern Ireland

‘(1) It is an offence under the law of Northern Ireland for a person who is in Northern Ireland, or for a person who is outside Northern Ireland but who is a United Kingdom national or habitually resident in Northern Ireland, to aid, abet, counsel or procure the carrying out of virginity testing that has a sufficient jurisdictional connection.

(2) Virginity testing has a sufficient jurisdictional connection for the purposes of subsection (1) if it is carried out in relation to a person who is—

(a) in the United Kingdom,

(b) a United Kingdom national, or

(c) habitually resident in the United Kingdom.

(3) This section does not affect the application to an offence under section (Offence of virginity testing: Northern Ireland) of any rule of law relating to aiding, abetting, counselling or procuring.

(4) In this section—

“United Kingdom national” has the meaning given by section (Offence of virginity testing: Northern Ireland)(4);

“virginity testing” has the meaning given by section (Offence of virginity testing: Northern Ireland)(2).’ —(Edward Argar.)

This new clause creates an offence of aiding etc a person to carry out virginity testing in circumstances where the carrying out of that testing might not itself be an offence (depending on the location or status of the person carrying out the testing).

Brought up, read the First and Second time, and added to the Bill.

New Clause 47

Virginity testing offences in Northern Ireland: penalties

‘A person who commits an offence under section (Offence of virginity testing: Northern Ireland), (Offence of offering to carry out virginity testing: Northern Ireland) or (Offence of aiding or abetting etc a person to carry out virginity testing: Northern Ireland) is liable—

(a) on summary conviction, to imprisonment for a term not exceeding 6 months or a fine not exceeding the statutory maximum (or both);

(b) on conviction on indictment, to imprisonment for a term not exceeding 5 years or a fine (or both).” —(Edward Argar.)

This new clause sets out the penalties for the new offences under the law of Northern Ireland relating to virginity testing.

Brought up, read the First and Second time, and added to the Bill.

New Clause 48

Virginity testing: consequential amendments

‘Schedule (Virginity testing: consequential amendments) contains consequential amendments.’—(Edward Argar.)

This new clause introduces a Schedule of consequential amendments relating to the new virginity testing offences.

Brought up, read the First and Second time, and added to the Bill.

--- Later in debate ---

[Mr Deputy Speaker (Mr Nigel Evans)]

We are now coming on to the next group of amendments. As hon. Members can see, we have only an hour left, so can I plead to everyone who is participating, including the Front Benchers: short contributions, please, so we can get as many people in as we possibly can?

New Clause 62

Pharmaceutical services: remuneration in respect of vaccines etc

“(1) In section 164 of the National Health Service Act 2006 (remuneration for persons providing pharmaceutical services)—

(a) in subsection (8A) for ‘special medicinal products’ substitute ‘any of the following—

(a) drugs or medicines used for vaccinating or immunising people against disease,

(b) anything used in connection with the supply or administration of drugs or medicines within paragraph (a),

(c) drugs or medicines, not within paragraph (a), that are used for preventing or treating a disease that, at the time the regulations are made, the Secretary of State considers to be a pandemic disease or at risk of becoming a pandemic disease,

(d) anything used in connection with the supply or administration of drugs or medicines within paragraph (c), or

(e) a product which is a special medicinal product for the purposes of regulation 167 of the Human Medicines Regulations 2012 (S.I. 2012/1916).’;

(b) in subsection (8D)—

(i) for ‘special medicinal products are’ substitute ‘anything within subsection (8A)(a) to (e) is’;

(ii) in paragraph (b), for ‘special medicinal products’ substitute ‘that thing,’;

(c) subsection (8E), omit the definition of ‘special medicinal product’;

(d) after subsection (8E) insert—

‘(8F) Where regulations include provision made in reliance on subsection (8A)(c) or (d) and the Secretary of State considers that the disease to which it relates is no longer a pandemic disease or at risk of becoming a pandemic disease, the Secretary of State must revoke that provision within such period as the Secretary of State considers reasonable (taking into account, in particular, the need for any transitional arrangements).’

(2) In section 88 of the National Health Service (Wales) Act 2006 (remuneration for persons providing pharmaceutical services)—

(a) in subsection (8A) for ‘special medicinal products’ substitute ‘any of the following—

(a) drugs or medicines used for vaccinating or immunising people against disease,

(b) anything used in connection with the supply or administration of drugs or medicines within paragraph (a),

(c) drugs or medicines, not within paragraph (a), that are used for preventing or treating a disease that, at the time the regulations are made, the Welsh Ministers consider to be a pandemic disease or at risk of becoming a pandemic disease,

(d) anything used in connection with the supply or administration of drugs or medicines within paragraph (c), or

(e) a product which is a special medicinal product for the purposes of regulation 167 of the Human Medicines Regulations 2012 (S.I. 2012/1916).’;

(b) in subsection (8D)—

(i) for ‘special medicinal products are’ substitute ‘anything within subsection (8A)(a) to (e) is’;

(ii) in paragraph (b), for ‘special medicinal products’ substitute ‘that thing,’;

(c) in subsection (8E), omit the definition of ‘special medicinal product’;

(d) after subsection (8E) insert—

‘(8F) Where regulations include provision made in reliance on subsection (8A)(c) or (d) and the Welsh Ministers consider that the disease to which it relates is no longer a pandemic disease or at risk of becoming a pandemic disease, the Welsh Ministers must revoke that provision within such period as the Welsh Ministers consider reasonable (taking into account, in particular, the need for any transitional arrangements).’”—(Edward Argar.)

This amendment replicates the amendments currently made by clause 76 and makes corresponding provision for Wales. As a consequence clause 76 is left out by Amendment 115.

Brought up, and read the First time.

[Edward Argar]

I beg to move, That the clause be read a Second time.

[Mr Speaker]

With this it will be convenient to discuss the following:

New clause 13—National self-care strategy—

“(1) The Secretary of State must prepare a National Self-Care Strategy to fully integrate self-care for minor ailments into the wider health system.

(2) The National Self-Care Strategy must have regard to the need to—

(a) address inequalities in health literacy;

(b) enhance the understanding of primary and secondary age children on how to self-care;

(c) introduce self-care modules in healthcare professionals’ training curricula and continuing professional development;

(d) make best use of, and expand, the Community Pharmacist Consultation Service;

(e) improve access to effective self-care treatments;

(f) enable community pharmacists to refer people directly to other healthcare professionals;

(g) ensure better support for primary care networks to deliver self-care;

(h) evaluate the use of technologies that have been developed during the COVID-19 pandemic to promote greater self-care; and

(i) accelerate efforts to enable community pharmacists to populate medical records.”

This new clause would ensure that the Secretary of State for Health and Social Care publishes a national self-care strategy to integrate self-care for minor ailments into the health system.

New clause 18—Secretary of State’s duty to report on access to NHS dentistry—

“(1) The Secretary of State must publish an annual report setting out levels of access to NHS dentistry across England and average waiting times for primary care dental treatment in each region, and describing the action being taken to improve them.

(2) NHS England and Health Education England must assist in the preparation of a report under this section, if requested to do so by the Secretary of State.”

This new clause would require the Secretary of State to report annually on the levels of access to NHS dentistry in England, setting out average waiting times for primary care dental treatment in each region, and describing action being taken to improve them as necessary.

New clause 19—Inclusion in the NHS mandate of cancer outcome targets—

“(1) Section 13A of the National Health Service Act 2006 (Mandate) is amended in accordance with subsection (2).

(2) After subsection (2), insert the following new subsection—

‘(2A) The objectives that the Secretary of State considers NHS England should seek to achieve which are specified in subsection (2)(a) must include objectives for cancer treatment defined by outcomes for patients with cancer, and those objectives are to be treated by NHS England as having priority over any other objectives relating to cancer treatment.’”

This new clause would require the Secretary of State to set objectives for the NHS on cancer treatment which are defined by outcomes (such as one-year or five-year survival rates), and would give those objectives priority over any other objectives relating to cancer treatment (such as waiting times).

New clause 20—Annual parity of esteem report: spending on mental health and mental illness—

“Within six weeks of the end of each financial year, the Secretary of State must lay before each House of Parliament a report on the ways in which the allotment made to NHS England for that financial year contributed to the promotion in England of a comprehensive health service designed to secure improvement—

(a) in the mental health of the people of England, and

(b) in the prevention, diagnosis and treatment of mental illness.”

This new clause would require the Secretary of State for Health and Social Care to make an annual statement on how the funding received by mental health services that year from the overall annual allotment has contributed to the improvement of mental health and the prevention, diagnosis and treatment of mental illness.

New clause 23—NHS Good Governance Commission—

“(1) Regulations shall provide for the establishment of an NHS Good Governance Commission as a Special Health Authority.

(2) The Commission shall have responsibility for ensuring that anyone appointed to, or elected into, a non-executive role on an NHS Body—

(a) is a fit and proper person for that role; and

(b) has been appointed or elected by a process that the Commission considers appropriate.”

This new clause returns to the position prior to 2012 and ensures independent oversight of important NHS appointments.

New clause 24—Appropriate consent to transplantation activities when travelling abroad—

“The Human Tissue Act 2004 is amended as follows—

‘(1) Section 32 (Prohibition of commercial dealings in human material for transplantation) is amended as follows.

(2) In subsection (1), after paragraph (e) insert—

“(f) travels outside the United Kingdom—

(i) to a country with a system of deemed consent for the donation of controlled material which does not meet the criteria in subsection (1A) and receives any controlled material, for the purpose of transplantation, and

(ii) to a country with a system of explicit consent for the donation of controlled material and receives any controlled material for the purpose of transplantation where the material was obtained without—

(A) the free, informed and specific consent of a living donor, or

(B) the free, informed and specific consent of the donor’s next of kin, where the donor is unable to provide consent; and

(g) receives any controlled material for the purpose of transplantation for which, in exchange for the removal of controlled material—

(i) the living donor, or a third party, receives a financial gain or comparable advantage, or

(ii) from a deceased donor, a third party receives financial gain or comparable advantage.

(1A) The Secretary of State must publish an annual assessment of countries with a system of deemed consent for donation of controlled material determining whether each of those countries—

(a) provides a formal, publicly funded scheme for opting out of deemed consent for donation of controlled material, and

(b) provides an effective programme of public education to its population on the deemed consent system and the opt-out scheme which delivers a high level of public understanding of both.

(1B) For the purposes of paragraphs (f) and (g) in subsection (1), it is immaterial whether the offence of dealing in controlled material for transplantation is caused by an act or an omission.

(1C) For the purposes of paragraph (g) in subsection (1), it is immaterial whether the acts or omissions which form part of the offence take place in the United Kingdom or elsewhere.

(1D) In paragraph (g) in subsection (1), the expression “financial gain or comparable advantage” does not include compensation for loss of earnings and any other justifiable expenses caused by the removal or by the related medical examinations, or compensation in case of damage which is not inherent to the removal of controlled material.

(1E) Subsection (1F) applies if—

(a) no act which forms part of an offence under subsection (1) takes place in the United Kingdom, but

(b) the person committing the offence has a close connection with the United Kingdom.

(1F) For the purposes of subsection (1e)(b), a person has a close connection with the United Kingdom if, and only if, the person was one of the following at the time the acts or omissions concerned were done or made—

(a) a British citizen,

(b) a British overseas territories citizen,

(c) a British National (Overseas),

(d) a British Overseas citizen,

(e) a person who under the British Nationality Act 1981 was a British subject,

(f) a British protected person within the meaning of that Act,

(g) an individual ordinarily resident in the United Kingdom,

(h) a body incorporated under the law of any part of the United Kingdom,

(i) a Scottish partnership.

(1G) In such a case, proceedings for the offence may be taken in any criminal court in England and Wales or Northern Ireland.”

(3) In subsection (3), after “subsection (1)” insert “(a) to (e)”.

(6) In subsection (4), after “subsection (1)” insert “(a) to (e)”.

(7) After subsection (4) insert—

“(4A) A person guilty of an offence under subsection (1)(f) or (1)(g) shall be liable—

(a) on summary conviction—

(i) to imprisonment for a term not exceeding 12 months,

(ii) to a fine not exceeding the statutory maximum, or

(iii) to both;

(b) on conviction on indictment—

(i) to imprisonment for a term not exceeding 9 years,

(ii) to a fine, or

(iii) to both.”

(6) Section 34 (Information about transplant operations) is amended as follows.

(12) After subsection (2) insert—

“(2A) Regulations under subsection (1) must require specified persons to—

(a) keep patient identifiable records for all instances of UK citizens who have received transplant procedures performed outside the United Kingdom; and

(b) report instances of transplant procedures performed on UK citizens outside the United Kingdom to NHS Blood and Transplant.

(2B) Regulations under subsection (1) must require NHS Blood and Transplant to produce an annual report on instances of UK citizens receiving transplant procedures outside the United Kingdom.”’”

New clause 25—Regulation of the public display of imported cadavers—

“(1) The Human Tissue Act 2004 is amended as follows.

(2) In subsections (5)(a), (6)(a) and (6)(b) of section 1 (authorisation of activities for scheduled purposes) after ‘imported’ insert ‘other than for the purpose of public display’.”

New clause 26—Report on claims for reimbursement of the immigration health surcharge—

“The Secretary of State must publish and lay a Report before Parliament giving the numbers of completed claims that have been made under the immigration health surcharge reimbursement scheme within 6 weeks of the commencement of this Act.”

This new clause requires the Secretary of State to report the number of completed claims under the Immigration Health Surcharge for NHS and care workers from overseas.

New clause 27—Secretary of State’s duty to report on waiting times for treatment—

“The Secretary of State must prepare and publish a report annually on waiting times for treatment in England, disparities in waiting times for treatment in England and the steps being taken to ensure that patients can access services within maximum waiting times in accordance with their rights in the NHS Constitution.”

New clause 30—Problem drug use as a health issue—

“(1) The UK Government will adopt a cross-government approach to drugs policy which treats problem drug use as primarily a health issue (‘the health issue principle’).

(2) In accordance with the health issue principle, the Prime Minister must, as soon as reasonably practicable—

(a) make the Secretary of State for Health and Social Care responsible for leading drugs policy in England,

(b) lay before Parliament a report on the steps that will be taken to transfer responsibilities to the Department for Health and Social Care from other departments, and

(c) undertake a review of devolution and drugs policy in light of that transfer and in accordance with subsection (3).

(3) The review of devolution and drugs policy must consider—

(a) steps to transfer responsibility for drugs policy to the devolved administrations in a manner consistent with the health issue principle and the transfers of responsibilities in England in subsection (2), and

(b) the consistency of the devolution settlement, including the specific reservation of the misuse of drugs under paragraph B1 of Part II of Schedule 5 of the Scotland Act 1998, paragraph 54 of Schedule 7A of the Government of Wales Act 2006 and paragraph 9f of Schedule 3 of the Northern Ireland Act 1998 with the health principle and any associated recommendations for change.

(4) In undertaking that review, the Prime Minister must consult—

(a) the Scottish Ministers,

(b) the Welsh Ministers, and

(c) the Department of Health in Northern Ireland.

(5) A report on the findings of the review must be laid before Parliament within six months of the passing of this Act.”

This new clause would require the UK Government to approach problem drug use primarily as a health issue and, in so doing, to make the Secretary of State for Health and Social Care the lead minister for drugs policy in England. The Prime Minister would also be required to undertake a review of the devolution of responsibility over drugs policy in the new context of recognising problem drug use primarily as a health issue.

New clause 31—Reduction in upper gestation limit for abortion to 22 weeks’ gestation—

“(1) The Infant Life (Preservation) Act 1929 is amended as follows.

In section 1(2) for ‘twenty-eight’ substitute ‘twenty-two’.

(2) The Abortion Act 1967 is amended as follows.

In section 1(1)(a) for ‘twenty-fourth’ substitute ‘twenty-second’.”

This new clause would reduce the upper gestational limit for abortion in most cases to 22 weeks’ gestation.

New clause 32—Resolution of differences over the care of children with life-limiting illnesses—

“(1) This section applies where there is a difference of opinion between a parent of a child with a life-limiting illness and a doctor responsible for the child’s treatment about—

(a) the nature (or extent) of specialist palliative care that should be made available for the child, or

(b) the extent to which palliative care provided to the child should be accompanied by one or more disease-modifying treatments.

(2) Where the authorities responsible for a health service hospital become aware of the difference of opinion they must take all reasonable steps—

(a) to ensure that the views of the parent, and of anyone else concerned with the welfare of the child, are listened to and taken into account;

(b) to make available to the parent any medical data relating to the child which is reasonably required as evidence in support of the parent’s proposals for the child’s treatment (including obtaining an additional medical opinion);

(c) to refer the difference of opinion to any appropriate clinical ethics committee (whether or not within the hospital) or to any other appropriate source for advice.

(3) Where the responsible authorities consider that the difference of opinion is unlikely to be resolved informally, they must take all reasonable steps to provide for a mediation process, between the parent or parents and the doctor or doctors, which is acceptable to both parties.

(4) In the application of subsections (2) and (3) the hospital authorities—

(a) must involve the child’s specialist palliative care team so far as possible; and

(b) may refuse to make medical data available if the High Court grants an application to that effect on the grounds that disclosure might put the child’s safety at risk in special circumstances.

(5) Where the difference of opinion between the parent and the doctor arises in proceedings before a court—

(a) the child’s parents are entitled to legal aid, within the meaning of section 1 of the Legal Aid, Sentencing and Punishment of Offenders Act 2012 (Lord Chancellor’s functions) in respect of the proceedings; and the Lord Chancellor must make any necessary regulations under that Act to give effect to this paragraph; and

(b) the court may not make any order that would prevent or obstruct the parent from pursuing proposals for obtaining disease-modifying treatment for the child (whether in the UK or elsewhere) unless the court is satisfied that the proposals—

(i) involve a medical institution that is not generally regarded within the medical community as a responsible and reliable institution, or

(ii) pose a disproportionate risk to the child of significant harm.

(6) Nothing in subsection (4) requires, or may be relied upon so as to require, the provision of any specific treatment by a doctor or institution; in particular, nothing in subsection (4)—

(a) requires the provision of resources for any particular course of treatment; or

(b) requires a doctor to provide treatment that the doctor considers likely to be futile or harmful, or otherwise not in the best interests of the child.

(7) Subsection (4)(a) does not prevent the court from making an order as to costs, or any other order, at any point in the proceedings.

(8) In this section—

‘child’ means an individual under the age of 18;

‘health service hospital’ has the meaning given by section 275 of the National Health Service Act 2006 (interpretation);

‘parent’ means a person with parental responsibility for a child within the meaning of the Children Act 1989; and

‘person concerned with the welfare of the child’ means a parent, grandparent, sibling or half-sibling.

(9) Nothing in this section affects the law about the appropriate clinical practice to be followed as to—

(a) having regard to the child’s own views, where they can be expressed; and

(b) having regard to the views of anyone interested in the welfare of the child, whether or not a person concerned within the welfare of the child within the meaning of this section.”

This new clause has a single purpose, which is to make provision about the resolution of differences of opinion between a child’s parents and the doctors responsible for the child’s treatment.

New clause 34—Visits to care homes—

“(1) Regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 is amended as follows.

(2) After Regulation 9, paragraph (3), sub-paragraph (i), insert—

‘(j) facilitating face to face contact between the service user and persons significant to the service user so as to meet the service user’s needs and preferences, having particular regard to their emotional and psychological needs;

(k) where the registered person determines following an individualised risk assessment that unrestricted face to face contact between significant persons and the service user is not possible, facilitating face to face contact with the significant person or persons whom the registered person reasonably believes best meets the needs and preferences of the service user;

(l) where the registered person determines following an individualised risk assessment that no face to face contact between any significant persons and the service user is possible, facilitating contact with significant persons in such other ways as best meets the needs and preferences of the service user and is in accordance with the individualised risk assessment.’

(3) After Regulation 9, paragraph (6), insert—

‘(7) In this regulation

“face to face contact” means contact without fixed physical barriers between the service user and the significant person, but includes contact where the service user and/or relevant person or persons are wearing appropriate personal protective equipment if such is required to prevent or control the spread of infections, including those that are health care associated;

“an individualised risk assessment” means a risk assessment which considers—

(a) the risks to the health and well-being of the service user both of having and not having face to face to contact with either two or more significant persons (for purposes of paragraph 3, sub-paragraph (k)) or one relevant person (for purposes of paragraph 3, sub-paragraph (I));

(b) the risks to the health and well-being of other service users arising from the registered person facilitating face to face contact between the service user and a person or persons significant to that service user; and

(c) the risks to the health and well-being of the service user (and to other service users) of alternative options for contact to minimise the risks identified in (a) and (b).

“significant person” means any person falling within section 4(7) sub-paragraphs (a) to (d) of the 2005 Act (whether or not the service user lacks capacity for purposes of the 2005 Act to decide whether or not to have face to face contact with them) and “person significant to the service user” is to be read accordingly.’”

This new clause would give effect to the recommendation of the Joint Committee on Human Rights to require individualised risk assessments for care home residents, and to ensure procedures are in place for such assessments to be queried where adequate efforts have not been made to enable safe visits to care homes.

New clause 35—Visits to patients in hospital—

“(1) The Secretary of State must by regulations make provision to ensure that arrangements are made to allow visitors to patients staying in hospital.

(2) The regulations must ensure that any such arrangements observe the following principles—

(a) Safety – The approach to visiting must balance the health and safety needs of patients, staff, and visitors, and ensure risks are mitigated.

(b) Emotional well-being – Allowing visitors is intended to support the emotional well-being of patients by reducing any potential negative impacts related to social isolation.

(c) Equitable access – All patients must be given equitable access to receive visitors, consistent with their preferences and within reasonable restrictions that safeguard patients.

(d) Flexibility – The physical/infrastructure characteristics of the hospital, its staffing availability, the risks arising from any outbreak of disease in the hospital and the availability of personal protective equipment are all variables to take into account when setting hospital-specific policies.

(e) Equality – Patients have the right to choose their visitors.”

This new clause would require the Secretary of State to make regulations providing for rights to visit patients in hospital.

New clause 50—Amendment of the law relating to abortion—

“(1) The Offences Against the Person Act 1861 is amended as follows.

(2) In section 58 (administering drugs or using instruments to procure abortion)—

(a) omit the words from the beginning to ‘intent, and’;

(b) at the end insert ‘; but this section does not apply to a woman in relation to the procurement of her own miscarriage.’

(3) In section 59 (procuring drugs, etc. to cause abortion), at the end insert ‘; but this section does not apply to a woman in relation to the rocurement of her own miscarriage.’”

This new clause would have the effect that a woman could not be held criminally liable under the Offences against the Person Act 1861 in relation to procuring, or attempting to procure, her own abortion.

New clause 51—Termination of pregnancy on the grounds of the sex of the foetus—

“Nothing in section 1 of the Abortion Act 1967 is to be interpreted as allowing a pregnancy to be terminated on the grounds of the sex of the foetus.”

This new clause would clarify that abortion on the grounds of the sex of the foetus is illegal.

New clause 52—Introduction of upper gestational limit on abortion on the grounds of disability—

“(1) The Abortion Act 1967 is amended as follows.

(2) In section 1 (Medical termination of pregnancy) at the beginning of sub-paragraph (d) to paragraph (1), insert—

‘that the pregnancy has not exceeded the gestational limit identified in sub-paragraph (a) and’”.

This new clause would introduce an upper gestational limit on abortion on the grounds of disability equal to the upper gestational limit on most other abortions

New clause 53—Review of effect on migrants of charges for NHS treatment—

“(1) Within six months of the passage of this Act, the Secretary of State must conduct a review of the effect on migrants of charges for NHS treatment, and lay a report of that review before Parliament.

(2) Before completing the review, the Secretary of State must consult representatives of groups subject to such charges.”

New clause 54—Equality impact analyses of provisions of this Act—

“(1) The Secretary of State must review the equality impact of the provisions of this Act in accordance with this section and lay a report of that review before the House of Commons within six months of the passage of this Act.

(2) A review under this section must consider the impact of those provisions on—

(a) households at different levels of income,

(b) people with protected characteristics (within the meaning of the Equality Act 2010),

(c) the Government’s compliance with the public sector equality duty under section 149 of the Equality Act 2010, and

(d) equality in different parts of the United Kingdom and different regions of England.

(3) A review under this section must include a separate analysis of each section of the Act, and must also consider the cumulative impact of the Act as a whole.”

New clause 56—Abolition of prescription charges—

“(1) Charges may not be made for NHS prescriptions.

(2) Within six weeks of the passage of this Act, the Secretary of State must exercise the relevant powers under the National Health Service Act 2006 to give effect to subsection (1).

(3) Subsection (1) does not apply to any charges which may be made before the action necessary to give effect to that subsection has been taken under subsection (2).”

New clause 60—Duty to consider residents of other parts of UK—

“For section 13O of the National Health Service Act 2006 substitute—

‘130 Duty to consider residents of other parts of UK

(1) In making a decision about the exercise of its functions, NHS England must have regard to any likely impact of the decision on—

(a) the provision of health services to people who reside in Wales, Scotland or Northern Ireland, or

(b) services provided in England for the purposes of—

(i) the health service in Wales,

(ii) the system of health care mentioned in section 2(1)(a) of the Health and Social Care (Reform) Act (Northern Ireland) 2009 (c. 1 (N.I.)), or

(iii) the health service established under section 1 of the National Health Service (Scotland) Act 1978.

(2) The Secretary of State must publish guidance for NHS England on the discharge of the duty under subsection (1).

(3) NHS England must have regard to guidance published under subsection (2).’”

This new clause places a duty on NHS England to consider the likely impact of their decisions on the residents of Wales, Scotland and Northern Ireland, and to consider the impact of services provided in England on patient care in Wales, Scotland and Northern Ireland.

New clause 61—Interoperability of data and collection of comparable healthcare statistics across the UK—

“(1) The Health and Social Care Act 2012 is amended as follows.

(2) In section 250 (Powers to publish information standards)—

(a) in subsection (3), at the beginning, insert ‘Subject to subsection (3A)’;

(b) after subsection (3), insert the following subsection—

‘(3A) The Secretary of State may also exercise the power under subsection (1) so as to specify binding data interoperability requirements which apply across the whole of the United Kingdom, and an information standard prepared and published by virtue of this subsection may apply to any public body which exercises functions in connection with the provision of health services anywhere in the United Kingdom.’

(c) after subsection (6E) (inserted by section 79 of this Act), insert the following subsection—

‘(6F) The Secretary of State must report to Parliament each year on progress on the implementation of an information standard prepared in accordance with subsection (3A).’

(3) In section 254 (Powers to direct Information Centre to establish information systems), after subsection (2), insert—

‘(2A) The Secretary of State must give a direction under subsection (1) directing the Information Centre to collect and publish information about healthcare performance and outcomes in all parts of the United Kingdom in a way which enables comparison between different parts of the United Kingdom.

(2B) Scottish Ministers, Welsh Ministers and Northern Ireland Ministers must arrange for the information relating to the health services for which they have responsibility described in the direction made under subsection (2A) to be made available to the Information Centre in accordance with the direction.’”

This new clause would enable the Secretary of State to specify binding data interoperability standards across the UK, require the collection and publication of comparable information about healthcare performance and outcomes across the UK, and require Ministers in the devolved institutions to provide information on a comparable basis.

New clause 63—NHS duty to carers—

“NHS bodies must identify unpaid carers who come into contact with NHS services and ensure that their health and wellbeing is taken into account when decisions are made concerning the health and care of the person or people for whom they care.”

New clause 64—Review of public health and health inequalities effects—

“(1) The Secretary of State for Health and Social Care must review the public health and health inequalities effects of the provisions of this Act and lay a report of that review before the House of Commons within six months of the passing of this Act.

(2) A review under this section must consider—

(a) the effects of the provisions of this Act on socioeconomic inequalities and on population groups with protected characteristics as defined by the 2010 Equality Act,

(b) the effects of the provisions of this Act on life expectancy and healthy life expectancy in the UK,

(c) the effects of the provisions of this Act on the levels of relative and absolute poverty in the UK, and

(d) the effects of the provisions of this Act on health inequalities.”

Amendment 89, in clause 4, page 2, line 40, after first “the” insert “physical and mental”.

This amendment requires NHS England to prioritise both the physical and mental health and well-being of the people of England and to work towards the prevention, diagnosis or treatment of both physical and mental illness, replicating the parity of esteem duty introduced in the Health and Social Care Act 2012.

Amendment 67, page 3, line 7, at end insert—

“(d) health inequalities.”

This amendment would modify the triple aim to explicitly require NHS England to take account of health inequalities when making decisions.

Amendment 90, page 3, line 10, after “of” insert “physical and mental”.

This amendment requires NHS England to prioritise both the physical and mental health and well-being of the people of England and to work towards the prevention, diagnosis or treatment of both physical and mental illness, replicating the parity of esteem duty introduced in the Health and Social Care Act 2012.

Amendment 44, in clause 6, page 3, line 40, leave out “person” and insert “relevant public body”.

Amendment 45, page 4, line 1, leave out “person” and insert “public body”.

Amendment 46, page 4, line 4, after “employees”, insert

“, within their terms and conditions of employment,”.

Government amendments 83 and 84.

Amendment 70, page 48, line 34, leave out clause 39.

Amendment 93, in clause 44, page 49, line 31, after first “the” insert “physical and mental”.

This amendment will require NHS Trusts to prioritise both the physical and mental health and well-being of the people of England and to work towards the prevention, diagnosis or treatment of both physical and mental illness, replicating the parity of esteem duty introduced in the Health and Social Care Act 2012.

Amendment 94, page 49, line 36, after first “of” insert “physical and mental”.

This amendment will require NHS Trusts to prioritise both the physical and mental health and well-being of the people of England and to work towards the prevention, diagnosis or treatment of both physical and mental illness, replicating the parity of esteem duty introduced in the Health and Social Care Act 2012.

Amendment 71, page 49, line 39, at end insert—

“(d) health inequalities.”

This amendment would modify the triple aim to explicitly require NHS trusts to take account of health inequalities when making decisions.

Amendment 95, in clause 58, page 55, line 23, after first “the” insert “physical and mental”.

This amendment will require NHS foundation trusts to prioritise both the physical and mental health and well-being of the people of England and to work towards the prevention, diagnosis or treatment of both physical and mental illness, replicating the parity of esteem duty introduced in the Health and Social Care Act 2012.

Amendment 96, page 55, line 28, after first “of” insert “physical and mental”.

This amendment will require NHS foundation trusts to prioritise both the physical and mental health and well-being of the people of England and to work towards the prevention, diagnosis or treatment of both physical and mental illness, replicating the parity of esteem duty introduced in the Health and Social Care Act 2012.

Amendment 97, in clause 66, page 61, line 26, after first “the” insert “physical and mental”.

This amendment will require decisions on licensing of health care to prioritise both the physical and mental health and well-being of the people of England and to work towards the prevention, diagnosis or treatment of both physical and mental illness, replicating the parity of esteem duty introduced in the Health and Social Care Act 2012.

Amendment 98, page 61, line 32, after first “of” insert “physical and mental”.

This amendment will require decisions on licensing of health care to prioritise both the physical and mental health and well-being of the people of England and to work towards the prevention, diagnosis or treatment of both physical and mental illness, replicating the parity of esteem duty introduced in the Health and Social Care Act 2012.

Government amendment 115.

Amendment 60, page 71, line 6, leave out clause 80.

This amendment is to ensure that social care assessments take place prior to discharge from hospital.

Amendment 73, in clause 80, page 71, line 9, at end insert—

“(2A) A social care needs assessment must be carried out by the relevant local authority before a patient is discharged from hospital or within 2 weeks of the date of discharge.

(2B) Each integrated care board must agree with all relevant local authorities the process to apply for social care needs assessment in hospital or after discharge, including reporting on any failures to complete required assessments within the required time and any remedies or penalties that would apply in such cases.

(2C) Each integrated care board must ensure that—

(a) arrangements made for the discharge of any patient without a relevant social care assessment are made with due regard to the care needs and welfare of the patient, and

(b) the additional costs borne by a local authority in caring for a patient whilst carrying out social care needs assessments after a patient has been discharged are met in full.

(2D) The Secretary of State must publish an annual report on the effectiveness of assessment of social care needs after hospital discharge, including a figure of how many patients are readmitted within 28 days.”

Government amendments 116 to 121.

Government amendment 85.

Government amendments 122 to 126.

Government amendment 128.

Amendment 82, in clause 135, page 117, line 14, at end insert—

“(2A) Regulations may only be made under this Act with the consent of the—

(a) Scottish Ministers insofar as they make provision for any matter which falls within the legislative competence of the Scottish Parliament,

(b) Welsh Ministers insofar as they make provision for any matter which falls within the legislative competence of Senedd Cymru, and

(c) Northern Ireland Ministers insofar as they make provision for any matter which falls within the legislative competence of the Northern Ireland Assembly.”

This amendment would require the Secretary of State for Health and Social Care to obtain the consent of the relevant devolved government before powers to make regulations under the Act in an area falling within the legislative competence of a devolved institution, are exercised.

Government amendments 129 to 133.

Amendment 103, in schedule 6, page 186, line 4, at end insert—

“‘relevant Health Overview & Scrutiny Committee’ means any Health Overview and Scrutiny Committee in an area to which the proposal for a reconfiguration of NHS services relates.”.

Amendment 104, in schedule 6, page 186, line 31, at end insert—

“(c) must consult relevant Health Overview & Scrutiny Committees.”

Amendment 105, in schedule 6, page 186, line 43, at end insert—

“(aa) have regard to, and publish, the clinical advice of the Integrated Care Board’s Medical Director in relation to any decision under sub-paragraph (2)(a),

(b) publish a statement demonstrating that any decision made under sub-paragraph (2)(a) is in the public interest, and”.

Amendment 54, in schedule 10, page 204, line 7, after “(1),” insert

“not undermine an NHS provider’s ability to provide a service whilst maintaining the pay rates in Agenda for Change, pensions and the other terms and conditions of all eligible NHS staff and”.

This amendment aims to ensure that the pay rates of Agenda for Change, pensions, and other terms and conditions of all eligible NHS staff are not undermined as a result of the adoption of the NHS payment scheme.

Amendment 55, in schedule 10, page 204, line 39, after “following” insert

“on the likely impact of the proposed scheme”.

This amendment requires NHS England to consult stakeholders on the likely impact of the NHS payment scheme.

Amendment 56, in schedule 10, page 204, line 41, at end insert—

“(ba) all relevant trade unions and other organisations representing staff who work in the health and care sectors;”.

This amendment aims to ensure that all relevant trade unions and other organisations representing staff who work in the health and care sectors are consulted by NHS England on the likely impact of the proposed NHS Payment Scheme.

[Edward Argar]

Being conscious of the time, I will endeavour to be brief and try to scoop up in my winding-up speech any particular concerns expressed during the debate.

While this Bill is predominantly about the health service in England, and the majority of measures are England-only, a small number of provisions in the Bill will deliver benefits to residents in all four nations of the United Kingdom. The Government have worked with the devolved Administrations to improve services and outcomes for people across the country, and we have now agreed a package of amendments to some provisions in the Bill to address concerns raised by the DAs. Following that constructive engagement, we are pleased that DA Ministers supported our approach. On 15 November, the Northern Ireland Assembly voted to grant legislative consent motions for the provisions on reciprocal healthcare, medicine information systems and professional regulations.

This group of amendments contains the amendments negotiated with the DAs, and I extend my thanks not only to the DA Ministers and officials, but to the territorial Secretaries of State and offices of this United Kingdom in London for their work. There remain a small number of areas in which final agreement is needed, and one area where work is still ongoing. The group also contains technical Government amendments to ensure that no unintended tax consequences arise as a result of the powers in this Bill.

I will speak briefly to new clause 62 and amendments 115 and 129 and then I will pause to allow hon. Members on both sides to make their contributions and seek to address their points subsequently.

New clause 62 replicates the amendments currently made by clause 76 for England and makes corresponding provision for Wales and, as a consequence, clause 76 is removed by amendment 115, so that the changes made by it, together with the corresponding changes for Wales, can be set out in one place.

The new clause amends both the National Health Service Act 2006 and the National Health Service (Wales) Act 2006, enabling regulations to be made in respect of both England and Wales, allowing for further exemptions from the obligation to reimburse pharmacies under the standard NHS arrangements when centrally stocked products have been supplied free of charge to community pharmacies without the need to reimburse them. That will allow the respective Ministers to create limited additional exemptions to those that can already be created by the existing regulation-making powers introduced in 2017 for unlicensed medicines—more commonly known as “specials”. The additional exemptions are restricted to vaccinations and immunisations, medicinal products used for the prevention or treatment of disease in a pandemic, and associated products, such as diluents and syringes.

There are various reasons why we may seek to centrally procure vaccines or products used to treat a pandemic. When supplying products directly to pharmacies free of charge, we do not want to reimburse pharmacies as well as purchasing the stock itself. Currently, the Government would pay twice as the legislative framework makes provision for the reimbursement price paid to pharmacies to be set at zero only for specials and not for other products.

I am conscious that a considerable number of Members will want to speak either on the devolution aspect of this legislation, which was debated extensively in Committee and to which I will respond in my winding-up speech if I have time. I am also conscious that other right hon. and hon. Members have amendments to which they wish to speak at some length—well, hopefully not at some length, but clearly—to put their points across on important issues, because this group of amendments covers a wide variety of matters. With your permission, Mr Deputy Speaker, I will pause now to allow maximum time for Back Benchers and others to speak and then try to pick up any points in my winding-up speech.

[Several hon. Members rose—]

--- Later in debate ---

[Sir Mike Penning (Hemel Hempstead) (Con)]

I support new clause 19, which I signed, and will wait to see what the Minister says about it.

I want to take issue with the shadow Minister, the hon. Member for Ellesmere Port and Neston (Justin Madders), who turned around and said to Ministers, “Be careful what you wish for.” Our constituents send us here to represent how their taxation is spent in the NHS. When trusts are refusing to build new hospitals in our constituencies when they have the money to do so, and they want to refurbish hospitals and ignore public opinion and their local MPs, that is where the system goes wrong. I am not saying we should go all the way back to the old system, but there should be accountability in trusts when they do not do what our constituents would expect from them. My constituents would expect me to stand up and say this, because we want a new hospital on a greenfield site to look after the people of west Hertfordshire and our trust is refusing. If the shadow Minister ever becomes a Minister, I hope he has those powers.

[Edward Argar]

This group of amendments has clearly been popular and it is a shame that more right hon. and hon. Members did not get to speak. My remarks will be relatively brief.

On the contributions by my hon. Friend the Member for Congleton (Fiona Bruce), my right hon. Friends the Members for Gainsborough (Sir Edward Leigh) and for Basingstoke (Mrs Miller) and the hon. Member for Upper Bann (Carla Lockhart), those are deeply emotive and important issues. I entirely respect the strength and sincerity of genuinely held feelings on both sides of the debate. It is important that such matters are aired in the House, but they quite rightly remain a matter of conscience for individual Members, so I shall say no more than that it is important that everyone recognises the genuine views on both sides of the debate.

I am grateful to my hon. Friend the Member for Basildon and Billericay (Mr Baron) for tabling his new clause 19 and am happy to say that the Government are content to accept it. I know that my hon. Friend’s first concern is the quality of cancer services in this country and the welfare of the patients that they serve. I am pleased that he is keen for us, in accepting the new clause, to explore ahead of the Lords stages of the Bill whether it may give rise to any unintended consequences, with a view to supporting any changes that might need to be made. I look forward to working with him on that in the coming weeks before the Lords stages.

[Mr Baron]

I thank the Minister and the Government for listening and for accepting the new clause in its entirety. It is a progressive step. I and the whole group behind the new clause look forward to working with him. If nuanced changes were required, then, by all means, we would consider them.

[Edward Argar]

I am grateful to my hon. Friend for his intervention.

Let me turn briefly to amendments 93 to 98 in the names of my hon. Friend the Member for Broxbourne (Sir Charles Walker) and my right hon. Friend the Member for Maidenhead (Mrs May). I can reassure all right hon. and hon. Members that the Government remain committed to supporting everyone’s mental health and wellbeing. I pay tribute to my right hon. Friend for the work that she did in advancing this agenda when she was Prime Minister.

Secondly, let me clarify that the current references in the Bill to illness and health cover mental and physical health and, therefore, the view taken was that it was not necessary to make that explicit.

[Dr Dan Poulter (Central Suffolk and North Ipswich) (Con)]

Will the Minister give way?

[Edward Argar]

I fear that I do not have time to cover the other amendments in the four minutes that I have left.

Although I appreciate that my right hon. Friend the Member for Maidenhead and my hon. Friend the Member for Broxbourne will continue to press this matter, may I offer them a meeting with me and the Mental Health Minister to discuss further what they are proposing in advance of the Lords stages? I cannot make any promises or say anything beyond that, but I will meet them to further discuss the sentiments that sit behind their amendments.

Let me turn to my hon. Friend the Member for Aberconwy (Robin Millar), who made his points powerfully and eloquently, as he always does. As a Government of the whole United Kingdom, we have a duty of care to all citizens in the UK, which is why I welcome the clauses already in this legislation that will bring benefit to residents across the UK.

[Bob Seely (Isle of Wight) (Con)]

Will the Minister take my intervention?

[Edward Argar]

If my hon. Friend can do it in 10 seconds.

[Bob Seely]

Please, Minister, do not forget the unavoidably small hospitals, of which there are 12 in isolated communities.

[Edward Argar]

My hon. Friend has made his point. He has made it to me before. I will not forget either him or unavoidably small hospitals, particularly in the Isle of Wight.

On the point made by my hon. Friend the Member for Aberconwy, we do recognise the importance of making sure that health and care data can be shared safely and effectively across the UK to support individual care and improve outcomes for people across the UK.

[Peter Aldous (Waveney) (Con)]

Will my hon. Friend give way?

[Edward Argar]

I am afraid that I cannot give way, because I literally have two minutes. Forgive me, but if my hon. Friend catches me afterwards, I will happily speak to him.

We are already committed to working with officials across the devolved Administrations, noting the devolved nature of health and care policy, but my hon. Friend the Member for Aberconwy is right and makes a very powerful case for data interoperability and clear data standards. I am happy to speak with him further on this issue if he feels that that would be helpful.

I ask the hon. Member for Bootle (Peter Dowd) to forgive me for yesterday. I heard what he said about self-care and I will continue to look carefully at that. I did not ignore him.

I fear that, in the time that we have, there is little more that I can say.

[Peter Aldous]

Will my hon. Friend give way on that point?

[Edward Argar]

Okay, my hon. Friend has 10 seconds.

[Peter Aldous]

The No. 1 issue in my inbox is access to NHS dentistry. New clause 18 provides a framework for addressing that. May I urge the Minister and the Government to consider accepting it?

[Edward Argar]

While we cannot accept that new clause as drafted today, I or the Minister for Dentistry will meet my hon. Friend, if that is helpful, to discuss in more detail the concerns sitting behind his intervention.

Question put and agreed to.

New clause 62 accordingly read a Second time, and added to the Bill.

Health and Care Bill

Edward Argar Excerpts

Report stage
Monday 22nd November 2021 Commons Chamber

[John Stevenson (Carlisle) (Con)]

I rise to support the amendments in my name: 110, 111, 112 and 113. I draw the attention of the House to the fact that I have a significant number of food and drink manufacturers in my constituency, and that I chair the all-party parliamentary group for food and drink manufacturing. I also support the amendments tabled by my hon. Friends the Members for North East Bedfordshire (Richard Fuller) and for Buckingham (Greg Smith), and fully support and endorse their comments.

In reality, I and many others would have preferred clause 125 and the whole of schedule 16 to have been removed from the Bill. I and I think many others are not convinced that that is really the way forward or that it will achieve very much. That view is shared by many of my colleagues, but also by many in the advertising industry and the food and drink sector. That is not because they are against the Government’s attempts to respond to the challenge of obesity, which is and should be a concern for all of us, but because their impact is likely to be so insignificant that it is disproportionate to what is proposed. We should also remember that the industry has already done a huge amount. It is incredibly innovative—reformulation, reductions in salt and sugar—and the reductions we have already seen are very significant. The industry continues to make changes and I believe it will continue to do so in the future. We should also remember that there is something called personal responsibility.

There is an opportunity, however, for compromise and improvements to schedule 16—hence the various amendments that have been tabled. I very much hope that the Government will be willing to compromise in their approach and see the benefits of the amendments that stand in my hon. Friends’ names and mine. I do not intend to detain the House for long, because my amendments are primarily technical rather than anything greater.

I tabled amendments 111, 112 and 113 because I believe that we want a food and drink manufacturing sector that is competitive and is based in the UK as much as possible. As presently drafted, the Bill exempts certain businesses, but the criteria are based on UK employee numbers. Large multinational companies could therefore be exempt if the UK element of their business has under 250 employees; conversely, a UK business with 250-plus employees would not be exempt. That has the potential to be unfair in many respects to UK businesses from a competition perspective, and could lead them to divert manufacturing abroad. A simple solution would be to take account of turnover as well as staff numbers. I have suggested using the definition in section 465 of the Companies Act 2006, which I believe would deal with the situation.

Under the Bill, paid-for branded adverts for products that are high in fat, salt or sugar would be prevented on retailer-owned spaces, but retailers would still be able to advertise equivalent HFSS own-brand products. That could distort competition directly between retailers’ and manufacturers’ products. Amendment 110 would ensure a level playing field, which in my view would be much fairer.

I hope that the Government will be receptive to my amendments—if not now, via changes introduced in the other place. In anticipation of such a compromise, I do not intend to put them to the vote.

[The Minister for Health (Edward Argar)]

I am grateful for this evening’s debate. More than once during the passage of the Bill, I have put on the record the Government’s commitment to improving and protecting the public’s health and have paid tribute to the hard work and dedication of our NHS and public health professionals in rising to the greatest infectious disease challenge of modern times. I would again like to put on the record those important points, with which I know Opposition Front Benchers agree.

Our commitment to public health is clear in the Bill, in the proposals set out in the Government’s recently published plan for health and care, “Build Back Better”, and in our wider programme of public health reform. A focus on the prevention of avoidable diseases is a central principle in delivering a sustainable NHS and in levelling up health outcomes across the country.

Childhood obesity is one of the biggest health challenges that this nation faces. The latest data from the national childhood measurement programme revealed that approximately 40% of children leaving primary school in England were overweight or living with obesity.

[Catherine West]

The Minister is being generous in allowing interventions. Is the Bill silent on the challenge around prescriptions for exercise? In an earlier intervention, I mentioned the impact of school swimming. Unfortunately, we are going backwards: fewer 11-year-olds can swim 25 metres—that is just an example. On childhood obesity, we need to address both: not just diet, but exercise.

--- Later in debate ---

[Edward Argar]

I am grateful to the hon. Lady, with whom I worked in London local government many moons ago on issues not dissimilar to those that we are debating. The Bill focuses on diet and the obesity that it causes, but she is right to highlight that exercise and a healthy lifestyle also play a key role in tackling obesity. We do not believe that the Bill is the right place to put that role into legislation, but I join in the sentiment underpinning what the hon. Lady says. Schools, local authorities and health bodies need to consider the issue in the round.

Nearly two thirds of adults—64%—are also overweight or living with obesity. I am grateful to my hon. Friend the Member for North East Bedfordshire (Richard Fuller) for gently tempting me to respond to his points about the nanny state, but I would argue that it is not being a nanny state to look out for the health of our citizens. Yes, it is about giving advice and giving people the information to make informed judgments, but it is also about putting in place a proportionate framework in legislation.

As with the speech of my hon. Friend the Member for Harrow East (Bob Blackman), I did not agree with everything that the hon. Member for Central Ayrshire (Dr Whitford) said, particularly her concluding comments, but I listened carefully to her comments about seatbelts. She said that she, as a clinician, saw the impact that legislation on that public health and public safety measure had on reducing injuries.

[John Stevenson]

Does the Minister agree that the industry itself is doing an awful lot now to support the Government’s agenda? Does he also acknowledge that personal responsibility is very important?

[Edward Argar]

I wondered what I was about to have bowled at me there, but my hon. Friend is absolutely right. I entirely agree that a huge amount of progress has been made; we believe that we need to go further with our proposals, but he is right to highlight that progress. He is also right to highlight the relevance of the central role of personal responsibility and the decisions that we and our families all take.

To meet the ambition of halving childhood obesity by 2030, it is imperative that we reduce children’s exposure to less healthy food and drink product advertising on TV and online. We want to ensure that the media our children engage with the most promote a healthy diet. The Bill therefore contains provisions to restrict the advertising of less healthy food and drink products on TV, in on-demand programme services and online.

[Richard Fuller]

The Minister has just mentioned seatbelts, and earlier he talked about alcohol and cigarette smoking, but this is about porridge and muesli. There is a sense that there is no end to what the Department of Health and Social Care feels is its responsibility to legislate on for what people should be able to do for themselves and their family. My point is that this is overreach by the state, as well as perhaps being the incorrect process for achieving the Government’s aims.

[Edward Argar]

I know my hon. Friend well and entirely understand the perspective that he brings, but I would argue as a counterpoint that the Bill strikes a proportionate balance, in the same vein as with seatbelts and other issues. Alongside personal choice and giving people the information to make choices, I believe that it is a proportionate and balanced approach—not the thin end of the wedge, as he might suggest, although perhaps I am characterising his words unfairly.

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

Will the Minister give way?

[Edward Argar]

May I make a little more progress? I have more to say on obesity, so my right hon. Friend should not worry.

We held two consultations, the first in 2019 and the second in 2020, which have informed our policy on introducing further restrictions to the advertising of less healthy food and drink products. I welcome the devolved Administrations’ engagement and support for the policy, which is being brought forward UK-wide. The UK Government have engaged with them extensively on the matter since early 2021; I put on the record my gratitude for the spirit in which they have approached it.

[Dr Lewis]

I happen to agree that there is a question of proportionality on the alleged nanny state issues, but does my hon. Friend agree that where an issue is contentious—such as the fluoridation of water supplies, which has been contentious over many years in this House—it should be properly debated before the state takes control of it, not just tucked away at the end of a very long Bill? That causes me concern.

[Edward Argar]

I take my right hon. Friend’s point, but I would argue that we are placing the matter before the House in a Bill that has been debated and has gone through its stages, including one of the longest Committee stages of a Bill in my time in this House. There is, or was, the opportunity for Members to table amendments on Report on the aspect that he mentions, and I suspect that it will be extensively debated in the other place as well. I take his point, but I would argue that we have provided sufficient time and have brought the issue to the House in that way.

[Dr Lewis]

Would the Minister be as surprised as I was to know that quite a lot of Members of this House are completely unaware that that provision has been added at the end of the Bill?

[Edward Argar]

All I would say—without in any way implying any criticism of right hon. or hon. Members—is that soon after I entered the House I was a member of the Procedure Committee for a year, and one of the first pieces of advice I was given was to read the legislation and go through it in its entirety. I recognise that this is a long and complex piece of legislation, but I would make that point.

Telecommunications and internet services are reserved matters. The UK Government are clear about the fact that the primary purpose of provisions on the advertising of less-healthy food and drink for TV and internet services is to regulate content on reserved media, and on that basis the policy is reserved. The purpose is not incidental. Therefore, the provisions do not fall within the competence of the devolved legislatures or engage the legislative consent process. While the Scottish and Welsh Governments have agreed with our policy ambitions, they disagree with our legal assessment, and thus far we have had to agree to disagree on this matter, but we have had extensive engagement, and I suspect that we will continue to do so. I see that the hon. Member for Central Ayrshire is in her place, and while she is present I would like to thank both Governments for their engagement and offer my assurances that it will continue as we implement the policy for the benefit of citizens across the UK.

--- Later in debate ---

[Sir John Hayes (South Holland and The Deepings) (Con)]

It was my hon. Friend the Member for North East Bedfordshire who inspired my intervention. I just want the Government to make it clear that they are not contributing to a strange paradox which seems to prevail in modern society, that of being simultaneously more puritanical and more prurient. We are prurient in that we let the tech giants corrupt our children in all kinds of ways, and puritanical in that we are censorious about the jokes people tell, the language they use, and how much ice cream—or indeed Christmas cake—they eat.

[Edward Argar]

I am grateful to my right hon. Friend. It has been a while since he intervened while I was at the Dispatch Box, so this has been a pleasure. I have never seen him as in any way a puritan; I suspect that he is rather more a cavalier in his approach to life.

My hon. Friend the Member for North East Bedfordshire has also tabled amendments to schedule 16 which would insert in the Bill an exemption from the advertising restrictions for brand advertising. I am grateful to him, but I can reassure him that the Bill already delivers that exemption, and I therefore believe that his amendments are not necessary to achieve the effect that he seeks. We made that clear in the consultation response published in June this year, and in speeches made in Committee.

My hon. Friend has also tabled new clause 14. As I am sure he and other Members are aware, the Government consulted on different approaches for restricting online advertising in 2019, and considered alternatives submitted through the consultation process. However, it was felt that the alternatives, including the proposal from the Committee of Advertising Practice to use a self-regulatory mechanism based on targeting, were sufficiently similar to the policy options previously consulted on. These were not sufficient to meet the objective of the policy, namely to protect children from advertisements for less-healthy food and drink.

[Alun Cairns]

Does the Minister accept that there is a significant inconsistency between the approach to television broadcasters and the approach to those who use social media and online provision, and that a consistent approach would help? Does he also accept that a considerable array of views has been expressed by those seeking to help him to develop the Bill in a positive way, and will he maintain an open mind as it passes through the other place to establish whether it can be refined to achieve some of these objectives?

[Edward Argar]

I hope I can reassure my right hon. Friend, and other Members, that I always seek to maintain an open mind, and always seek to reflect carefully on the contributions made by Members. I will turn shortly to the challenges posed by television, which is essentially a linear broadcasting medium, in comparison with those posed by online broadcasting. I am conscious that I must conclude my speech before 7 pm.

There is evidence to suggest that the targeting of online adverts does not account for the use of shared devices and profiles between parents and children, the communal viewing of content or false reporting of children’s ages. This, combined with concerns about the accuracy of interest-based targeting and other behavioural data as a way of guessing a user’s age and a lack of transparency and reporting data online, shows why the Government believe that we need to introduce strong advertising restrictions online. Any alternative proposals would therefore need to meet a high bar in terms of protecting children online, and we consider alternatives that rely on a targeting approach to be—currently—potentially insufficient to meet the policy objectives.

Amendments 106 to 109 are relevant to the point that my right hon. Friend has just made. I am grateful to my hon. Friend the Member for Buckingham (Greg Smith) for raising these matters. His amendments mean that liability for online advertisements found to be in breach of the restrictions included in the Bill would shift to become the responsibility of the platforms rather than the advertisers, which some may see as providing parity with the enforcement mechanisms for broadcast television.

During the 2020 consultation, we considered whether other actors in the online advertising sphere should have responsibility for breaches, alongside those of advertisers. However, we concluded that this was not the right place to consider that broader issue.

The online advertising ecosystem is complex and dynamic. The scale and speed of advertising online, as well as the personalised nature of advertising and the lack of transparency in this system, makes it difficult for platforms to have control over what is placed on them. The approach that we are taking in the Bill best aligns with the current enforcement frameworks across TV, online and on-demand programme services advertising, and is familiar to industry. It will ensure that there is limited confusion for broadcasters, platforms or advertisers, as the liable parties for less-healthy food and drink product advertising breaches will be the same as those for any other advertising breaches. The Government intend to consider this issue as part of the wider online advertising programme, on which the Department for Digital, Culture, Media and Sport will consult in the coming months.

[Greg Smith]

I am grateful to the Minister for that commitment to consider the points in my amendments, and with that commitment in place, I will not seek to push them to vote. However, may I ask him, as he makes these considerations along with colleagues in the DCMS, to ensure that broadcasters are fully consulted so that they can point out the loopholes that any online provisions could throw up?

[Edward Argar]

I am grateful for my hon. Friend’s confirmation that he does not intend to press his amendments to a Division, and I will ensure that his point will be heard not only in the Department of Health and Social Care but in DCMS as well.

I am grateful to my hon. Friend the Member for Carlisle (John Stevenson) for his amendments 111 to 113 and for bringing this debate before the House. I would like to reassure him that small and medium-sized enterprises—businesses with 249 employees or fewer—that pay to advertise less healthy food and drink products that they manufacture and/or sell will be exempt from the less healthy food and drink restrictions and can continue to advertise. The definition of SMEs will be provided in secondary legislation and not on the face of the Bill, which will enable Ministers to act promptly in future years if new or emerging evidence suggests that amendments are needed. We will conduct a short consultation as soon as possible on the SME definition to be included in the draft regulations. The Government want to ensure consistency with other definitions for size of business that have been used for other obesity policies, such as the out-of-home calorie labelling policy, to create a level playing field. Our preferred definition, therefore, is a standard definition used by Government across other policies.

[Richard Fuller]

On the point about an industry-led alternative, on which the Minister has kindly made some comments today, I think that this discussion will continue, particularly when the Bill is considered in the other place, so would he be prepared to meet me so that I can continue to make representations about certain improvements that could be made?

[Edward Argar]

I am certainly happy to commit that either I, as the Bill Minister, or the relevant policy Minister will meet my hon. Friend to discuss his views in this space.

Amendment 110 would ensure that advertisements placed on distributor or retailer websites are out of scope of the less healthy food and drink advertising restrictions. Again, I am grateful to my hon. Friend the Member for Carlisle for tabling the amendment, and I would seek to reassure him that the Government’s intention is to ensure that restrictions are proportionate to the scale of the problem. It is not our intention to prohibit the sale of less healthy food and drink products on the internet. Our aim is to reduce children’s exposure to advertisements of less healthy food and drink products, which is why the restrictions are being applied only to paid-for advertising online—namely, where an advertiser pays by monetary or other reciprocal means for the placement of adverts online.

We appreciate that there will be consumers who seek less healthy food and drink products, which is why this restriction applies only to paid-for advertising, and companies will be able to continue to use owned media in the same way as they do now. The restrictions will not apply to spaces online where full editorial control and ownership apply, such as a brand’s own blog, website or social media page. This means that retailers are able to continue promoting their own products on their own website, as this would not be covered by the restrictions.

I shall turn briefly to Government amendments 32, 35 and 37, tabled in the name of the Secretary of State for Health and Social Care. Amendments 32 and 35 will amend the definition of an advertisement placed on television and on-demand programme services to ensure that sponsorship credits around programmes and sponsorship announcements respectively are included for the purpose of this Bill. Members will be aware that sponsorship announcements and sponsorship credits are required so that viewers know which product is sponsoring any particular programme. Although these are not routinely considered to be advertisements in other contexts, the Government’s view is that they could reasonably be considered to be advertising less healthy food and drink products for the purposes of the Bill’s restrictions.

Amendments 32 and 35 will therefore clarify the status of those announcements, in effect to prohibit identifiable less healthy food and drink products from sponsoring programmes before the watershed, in line with the Government’s original policy aims. Amendment 37, meanwhile, will make it clear that UK businesses producing online advertisements intended to be accessed principally by audiences outside the UK fall in scope of the exemption and will not be in breach of the less healthy food and drink advertising restrictions set out in the Bill. This amendment is needed to ensure that the legislation aligns with the Government’s policy intention to exempt advertisements made to be viewed outside the UK. We are confident that the likely frontline regulator already has a clear remit and tests in place that should allow it to apply this exemption effectively.

--- Later in debate ---

[Christian Wakeford]

I reiterate the comment I made earlier that the best way to treat alcohol addiction and dependency is to treat it like a mental health illness, because that is what it is. The best way to do that is to remove the stigma and put more money into mental health, but in trying to overcome the stigma, we need to ensure that there is parity between mental and physical health. If we treat the mental health issue, we treat the alcohol issue. We cannot do one without the other. Will the Minister commit today to going some way towards doing that and to putting more money into mental health to deal with this?

[Edward Argar]

I am grateful to my hon. Friend. He will know that this Government have continued not only to highlight and promote parity of esteem between mental and physical health but to increase the funding available to mental health, reflecting that reality on the ground. He is right to highlight that issue.

We have announced a comprehensive set of reforms to alcohol duty in this year’s Budget which, taken with the steps we have put in place on a public health basis, have put in place a strong regime to tackle the consequences of alcohol misuse. We do not feel that this Bill is the place to legislate further on this issue but, as I have said, I am none the less grateful to the hon. Member for Liverpool, Walton for his amendments and for this opportunity to debate them.

On amendments 11, 12 and 13, this Bill would introduce a 9 pm TV watershed for less healthy food and drink products and a restriction on paid-for advertising of less healthy food and drink online. Those amendments, tabled by the hon. Member for Liverpool, Walton, would expand the definition of a less healthy product to include alcohol. This would have the effect of making alcohol advertising liable to the watershed proposed for TV programme services and the online restriction on paid-for advertising.

I reassure the hon. Gentleman, through Opposition Members, that the Government have existing measures in place to protect children and young people from alcohol advertising through the alcohol advertising code. Material in the broadcast code and the non-broadcast code relating to the advertising and marketing of alcohol products is already robust, recognising the social imperative of ensuring that alcohol advertising is responsible and, in particular, that children and young people are suitably protected. If new evidence emerges that clearly highlights major problems with the existing codes, the Advertising Standards Authority has a duty to revisit the codes and take appropriate action. Furthermore, the Government introduced additional restrictions last year on alcohol advertising on on-demand programme services, through amendments to the Communications Act 2003.

Clause 129 and schedule 16 are aimed at reducing the exposure of children to less healthy food and drink advertising and the impact of such advertising on child obesity. Less healthy food and drink products—

[Jonathan Edwards]

Will the Minister give way?

[Edward Argar]

I fear that I have only a few minutes left, and I have already taken a number of interventions on this. I want to conclude by covering the tobacco amendments as well, which I know that some colleagues are keen to see a response to. I apologise to the hon. Gentleman.

Less healthy food and drink products are not age restricted at the point of purchase, unlike alcohol. Finally, the 2019 and 2020 consultations on advertising restrictions for less healthy food and drink did not consult on alcohol within the restrictions, either online or on TV, so we cannot be sure of the impact these amendments would have on the industry more broadly.

Turning to tobacco in the time I have left, because I know the shadow Minister, the hon. Member for Nottingham North (Alex Norris) , has taken a close interest in the issue, I thank the hon. Member for City of Durham (Mary Kelly Foy) and others, including my hon. Friend the Member for Harrow East, who have tabled a number of amendments that seek to address the harm caused by smoking in this country. I reassure the hon. Member for City of Durham of the Government’s commitment to becoming smoke free by 2030.

We have successfully introduced many regulatory reforms over the past two decades, and the UK is a global leader in tobacco control. Our reforms include raising the age of sale from 16 to 18, the introduction of a tobacco display ban, standardised packaging and a ban on smoking in cars with children, which all place important barriers between young people and tobacco products. The Government are currently developing our new tobacco control plan, and I reassure the hon. Lady that that will reflect carefully on the APPG’s findings and report.

I am afraid I cannot be tempted to go further than the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Erewash (Maggie Throup), did in the recent Westminster Hall debate on this question, but I can reassure the hon. Member for City of Durham that we remain committed to bringing forward the tobacco control plan.

[Geraint Davies]

rose—

[Edward Argar]

Forgive me; I only have a few minutes and I want to cover the amendments from the hon. Member for City of Durham. The hon. Member for Swansea West (Geraint Davies) did manage dexterously to shoehorn air quality more broadly within the scope of these debates, and what he said will have been heard.

New clause 2, which seeks to provide powers for the Secretary of State to impose a requirement for tobacco manufacturers

“to print health warnings on individual cigarettes and cigarette rolling papers”,

is intended, as I understand from the hon. Member for City of Durham, to further strengthen our current public health messaging and encourage smokers to quit. We strongly support measures to stop people smoking, to make smoking less attractive to young people and to educate smokers of its dangers, as we have done through graphic warnings on cigarette packs.

We would need to conduct further research and build a further robust evidence base in support of any such additional measures before bringing them forward. To date, no country has introduced such a measure, so there is currently limited evidence of its impact in supporting smokers to quit. If evidence showed that the requirement would not be effective, it would not be an appropriate power to have in place.

New clause 3, also tabled by the hon. Lady, seeks to provide a power for the Secretary of State to introduce a requirement for manufacturers to insert leaflets containing health information and information about smoking cessation services into cigarette packaging. As I set out in Committee, we believe this power is unnecessary, since the Department could legislate to do that already under the Children and Families Act 2014; inserts could be required for public health messaging through amendments to the Standardised Packaging of Tobacco Products Regulations 2015. We already have in place strong graphic images and warnings of the health harms of smoking on the outside of cigarette packs. As part of the Tobacco and Related Products Regulations 2016, the address for the NHS website, which provides advice for people seeking to quit smoking, is also required on packaging.

The current SPoT regulations prohibit the use of inserts, as there was limited evidence that placing public health messaging inserts inside cigarette packages was more effective than messaging on the outside of packs. Further research would need to be undertaken to help to establish the public health benefit if we were to go further.

Turning briefly to new clause 4, I am grateful again to the hon. Lady for tabling this clause. The Government are clear that they only support the use of e-cigarettes as a tool for smokers who are trying to quit, and we strongly discourage non-smokers and young people from using them. We are committed to ensuring that our regulatory framework continues to protect young people and non-smokers from using e-cigarettes.

Current regulations include requirements on the packaging and labelling of e-cigarettes, along with restrictions on their marketing and the prohibiting of advertising on mainstream media such as TV and radio. While we strongly support measures to protect young people further from cigarettes, we believe the current regime remains appropriate and has the powers in place within it to make changes where required, although I suspect my hon. Friend the Member for Harrow East may yet be proved right when he suggests that the other place may return to this at some point.

I have outlined the many steps this Government are taking to address some of the major lifestyle challenges to our health. The Bill represents another step in the direction of preventive healthcare and building a healthier society, an aim I know we all share. I hope the House will support the amendments we have tabled at this stage to strengthen those measures.

I also want to update the House at this point, in the context of the importance of an integrated approach and how it can improve public health measures, on two steps the Secretary of State has taken today that will put NHS staff and technology at the heart of our long-term planning and allow us to take forward the integrated approach that has proved so vital during this pandemic and is so vital to public health.

[Geraint Davies]

Will the Minister give way?

[Edward Argar]

I am afraid I will not. I suspect that point will be pertinent to the debate on the first group of amendments tomorrow.

First, we intend to merge Health Education England with NHS England and NHS Improvement, putting education and training of our health workforce at the forefront of the NHS. By bringing this vital function inside the NHS, we can plan more effectively for the long term and have clear accountability for delivery.

Secondly, we also intend to take forward the recommendations of the Wade-Gery report, which included merging NHSX and NHS Digital with NHS England and NHS Improvement, building on the huge progress made on digital transformation during the pandemic and bringing together the digital leadership of the NHS in one place. I take this opportunity to pay tribute to all our colleagues at Health Education England, NHS Digital and NHSX for their exceptional work. These changes build on that contribution and allow us to drive forward further integration and changes that will put the NHS on a firmer footing.

I hope I have reassured hon. Members of the Government’s commitment to improving public health. I urge those who have tabled amendments to consider not pressing them to a Division.

[Mary Kelly Foy]

I have listened carefully to the debate, and I beg to ask leave to withdraw the clause.

Clause, by leave, withdrawn.

New Clause 4

Packaging and labelling of nicotine products

“The Secretary of State may by regulations make provision about the retail packaging and labelling of electronic cigarettes and other novel nicotine products including requirements for health warnings and prohibition of branding elements attractive to children.”—(Mary Kelly Foy.)

This new clause would give powers to the Secretary of State to prohibit branding on e-cigarette packaging which is appealing to children.

Brought up, and read the First time.

Question put, That the clause be read a Second time.

--- Later in debate ---

[Edward Argar]

I beg to move, That the clause be read a Second time.

[Madam Deputy Speaker (Dame Rosie Winterton)]

With this it will be convenient to discuss the following:

New clause 33—Support provided by the NHS to victims of domestic abuse—

“(1) Each Integrated Care Board must—

(a) assess, or make arrangements for the assessment of, the need for support for victims of domestic abuse using their services;

(b) prepare and publish a strategy for the provision of such support in its area;

(c) monitor and evaluate the effectiveness of the strategy;

(d) designate a domestic abuse and sexual violence lead; and

(e) publish an annual report on how it has discharged its duties relating to the provision of services to victims of domestic violence under the Care Act 2014.

(2) An Integrated Care Board that publishes a strategy under this section must, in carrying out its functions, give effect to the strategy.

(3) Before publishing a strategy under this section, an Integrated Care Board must consult—

(a) any local authority for an area within the relevant Integrated Care Board’s area;

(b) the domestic abuse local partnership board appointed by the local authority for an area within the relevant clinical commissioning group’s area under section 58 of the Domestic Abuse Act 2021; and

(c) such other persons as the relevant local authority considers appropriate.

(4) For the purposes of subsection (4), ‘local authority’ means—

(a) a county council or district council in England; or

(b) a London borough council.

(5) An Integrated Care Board that publishes a strategy under this section—

(a) must keep the strategy under review;

(b) may alter or replace the strategy; and

(c) must publish any altered or replacement strategy.

(6) The Secretary of State may by regulations make provision about the preparation and publication of strategies under this section.

(7) The power to make regulations under subsection (7) may, in particular, be exercised to make provision about—

(a) the procedure to be followed by an Integrated Care Board in preparing a strategy;

(b) matters to which an Integrated Care Board must have regard in preparing a strategy;

(c) how an Integrated Care Board must publish a strategy;

(d) the date by which an Integrated Care Board must first publish a strategy; and

(e) the frequency with which an Integrated Care Board must review its strategy or any effect of the strategy on the provision of other provision in its area.

(8) Before making regulations under this section, the Secretary of State must consult—

(a) all Integrated Care Boards; and

(b) such other persons as the Secretary of State considers appropriate.”

This new clause would require Integrated Care Boards to publish a strategy for the provision of support for victims of domestic abuse using their services and designate a domestic abuse and sexual violence lead.

New clause 55—Guidance for babies, children and young people—

“(1) The Secretary of State must publish guidance on how integrated care systems should meet the needs of babies, children and young people aged 0-25.

(2) Integrated care systems must act in accordance with the guidance in subsection (1).”

This new clause would require the Secretary of State to publish guidance on how integrated care systems should meet the needs of babies, children and young people aged 0-25 and would require integrated care systems to act in accordance with the guidance.

New clause 57—NHS England’s duty as to reducing inequalities—

“Section 13G of the National Health Service Act (duty as to reducing inequalities), is amended by the addition of the following subsections—

‘(2) NHS England must publish guidance about the collection, analysis, reporting and publication of performance data by relevant NHS bodies with respect to factors or indicators relevant to health inequalities.

(3) Relevant NHS bodies must have regard to guidance published by NHS England under this section.

(4) In this section “relevant NHS bodies” means—

(a) NHS England,

(b) integrated care boards,

(c) integrated care partnerships established under section 116ZA of the Local Government and Public Involvement in Health Act 2007,

(d) NHS trusts established under section 25, and

(e) NHS foundation trusts.’”

Amendment 47, in clause 6,  page 4, line 11, at end insert—

“(5) In paragraph 1(a) ‘relevant public body’ means a public authority listed under the title ‘Health, social care and social security’ in Part 1 of Schedule 19 to the Equality Act 2010 or an NHS Trust.”

This amendment provides that NHS England resources for supporting or assisting organisations that are providing or planning to provide health services may only be directed to public sector bodies.

Amendment 58, in clause 12, page 8, line 6, at end insert—

“(2) An integrated care board may not—

(a) delegate that function; and

(b) exercise that function to enter into an integrated care provider contract with any body other than a statutory NHS body.

(3) In paragraph (2)(b) an ‘integrated care provider contract’ has the same meaning as in Schedule 3A of the National Health Service (General Medical Services Contracts) Regulations 2015.”

This amendment is designed to ensure that an organisation carrying out the functions of an ICB on its behalf is a statutory NHS body.

Amendment 59, page 12, line 29 at end insert—

“(3A) Nothing in——

(a) the rules referred to in subsection (1),

(b) this Act, or

(c) any regulations made under this Act

(none) shall entitle any provider of health services to withhold provision of those services from any individual on the basis of the integrated care board to which that individual has been allocated.”

This amendment is to ensure that any providers of health services cannot withhold provision of those services from any individual because of the integrated care board that they have been allocated to.

Amendment 66, in clause 15, page 13, line 44, at end insert—

“(j) palliative care services.”

This amendment adds a requirement for the commissioning of palliative and end of life care services.

Amendment 21, page 14, line 43, at end insert—

“3AA Duty of integrated care boards to commission approved treatments

‘(1) This section applies where—

(a) a treatment has been approved by the National Institute for Health and Care Excellence, and

(b) an integrated care board has not arranged for the provision of that treatment under section 3 or 3A of this Act, and

(c) a clinician has recommended that treatment for a person for whom that integrated care board has responsibility.

(2) The integrated care board referred to in subsection (1) must arrange for the provision of that treatment to the person for whom it has responsibility.

(3) In subsection (1) “clinician” means a medical professional employed by or acting on behalf of an NHS Trust, NHS Foundation Trust or primary care service from whom the integrated care board has arranged for the provision of services.’”

This amendment would require an integrated care board to arrange for the provision of a NICE-approved treatment to any patient whose NHS clinician has recommended it, even if that treatment is not otherwise available to patients in that ICB area.

Amendment 48, in clause 19,  page 16, line 6, leave out “promotes” and insert

“secures the rights set out in”.

This amendment requires ICBs to act to ensure that health services are provided in a way which secures the rights set out in the NHS Constitution.

Amendment 99, page 16, line 34, at end insert—

“(2) In fulfilling their duties under this section, integrated care boards must have particular regard to the need to reduce inequalities between migrant and non-migrant users of health services.”

Amendment 49, page 16, line 37, leave out “promote” and insert “enable”.

This amendment, together with Amendment 50 provides that ICBs enable the involvement of patients, their paid and unpaid carers, and their representatives in decisions relating to the prevention or diagnosis of illness, care or treatment, rather than promoting their involvement.

Amendment 50, page 16, line 37, after “their”, insert “paid and unpaid”.

This amendment, together with the Amendment 49, provides that ICBs enable the involvement of patients, their paid and unpaid carers, and their representatives in decisions relating to the prevention or diagnosis of illness, care or treatment.

Amendment 22, page 17, line 4, at end insert—

“14Z37A Obligation on integrated care boards to ensure appropriate uptake of all NICE approved products according to population need

‘(1) Each integrated care board must promote uptake of all NICE approved medicines and medical devices in accordance with the need of the population it serves.

(2) An integrated care board must, in each financial year, prepare a report on the uptake of all NICE approved medicines and medical devices, including the number of patients that have accessed each product.’”

This amendment would require ICBs to ensure that all NICE approvals are available and promoted to their population, and report on this uptake annually.

Amendment 19, page 17, line 14, at end insert—

“14Z39A Duty to review latest innovations with a view to local commissioning

(1) Integrated care boards must review all new—

(a) medicines,

(b) medical devices, and

(c) other health care solutions that may benefit the local population.

(2) Integrated care boards must—

(d) appoint a dedicated innovation officer to their board, and

(e) develop and maintain a system to keep up to date with medicines and devices innovation and review suitability for patient usage, including engagement with the relevant—

(i) academic health science network, and

(ii) local pharmaceutical committee.”

This amendment would mandate integrated care boards to monitor and assess innovation for the benefit of the local population.

Amendment 16, page 17, line 19, at end insert—

“(2) Each integrated care board must each year prepare, consult on and adopt a research strategy for patient benefit which—

(a) meets local need;

(b) meets national research undertakings.

(3) In developing a strategy under subsection (2), an integrated care board must engage with—

(a) the National Institute for Health Research,

(b) academic health science networks, and

(c) all other relevant regional and national health research organisations.”

This amendment would require ICBs to establish a research strategy and other connected measures.

Amendment 91, page 18, line 18, after first “the” insert “physical and mental”.

This amendment will require Integrated Care Boards to prioritise both the physical and mental health and well-being of the people of England and to work towards the prevention, diagnosis or treatment of both physical and mental illness replicating the parity of esteem duty as introduced in the Health and Social Care Act 2012.

Amendment 92, page 18, line 23, after first “of” insert “physical and mental”.

This amendment will require Integrated Care Boards to prioritise both the physical and mental health and well-being of the people of England and to work towards the prevention, diagnosis or treatment of both physical and mental illness replicating the parity of esteem duty as introduced in the Health and Social Care Act 2012.

Amendment 68, page 18, line 26, at end insert—

“(d) health inequalities.”

This amendment would modify the triple aim to explicitly require integrated care boards to take account of health inequalities when making decisions.

Amendment 17, page 18, line 38, at end insert—

“14Z43A Duty on integrated care boards to consider requests to engage in clinical trials, and patient participation

(1) An integrated care board must consider any request from the organiser of an authorised clinical trial for the ICB to engage in that trial.

(2) If such a request is accepted, the integrated care board must offer the ability to participate in the trial to any patient within their area who is eligible to take part.”

This amendment would require integrated care boards to consider any requests to engage in clinical trials and offer patients the opportunity to participate.

Amendment 20, page 18, line 38, at end insert—

“14Z43A Duty to update formularies to include all NICE-approved products

(1) Within 28 days of any medicine or device receiving market authorisation from NICE, an integrated care board must update its formulary to include that medicine or device.

(2) On receipt of notice of the market authorisation by NICE of any medicine or device, an integrated care board must immediately instruct providers of health and care services commissioned by the board to update their formularies in such a way that all NICE-approved medicines and devices are available to patients on the recommendation of a healthcare practitioner within 28 days of market authorisation.

(3) An integrated care board must report annually all medicines and devices that have been added and removed from their formulary over the previous year.”

This amendment would mandate integrated care boards and healthcare providers (e.g. hospital trusts) to update their formularies to include all NICE-approved medicines or devices within 28 days of market authorisation to ensure they are available for healthcare practitioners (e.g. physician or prescribing pharmacist) to make available for suitable patients.

Amendment 102, page 21, line 25, at end insert—

“(c) set out any steps that the integrated care board proposes to take to address the particular needs of victims of abuse (including domestic abuse and sexual abuse, whether of children or adults).”

This amendment requires the joint forward plan for an integrated care board and its partners to set out any steps it proposes to take to address the particular needs of victims of abuse (including domestic abuse and sexual abuse, whether of children or adults).

Amendment 51, page 22, line 23, leave out

“in a way that they consider to be significant.”

This amendment requires ICBs and partner NHS Trusts and NHS Foundation Trusts to consult on all revisions to their forward plans.

Amendment 52, page 23, line 42, at end add “on its website”.

This amendment is to require capital resource use plans to be made publicly available on the internet.

Amendment 53, page 24, line 22, leave out

“in a way that they consider to be significant”.

The purpose of this amendment is to require all revisions of capital resource use plans to be published.

Amendment 18, page 25, line 6, at end insert—

“(d) explain what research activity it undertook during the year, including

(i) research to meet local health issues, and

(ii) research to support national research projects.

‘(2A) The annual report prepared by the Secretary of State under section 247D of this Act must include a section which reproduces, and comments on, the sections of the annual reports of each integrated care board prepared under paragraph (1)(d).’”

This amendment would require integrated care boards to publish an account of their research activity, and require the report the Secretary of State must prepare and lay before Parliament under section 247D of the National Health Service Act 2006 to include a section which reproduces, and comments on, the research activity of all ICBs.

Amendment 23, page 25, line 14, at end insert—

“14Z56A Report on assessing and meeting parity of physical and mental health outcomes

(1) An integrated care board must annually set out in a report the steps it has taken to fulfil its obligations to deliver parity of esteem between physical and mental health to its local population.

‘(1) The report must set out—

(a) the number of patients presenting with mental health conditions,

(b) the number of patients presenting with physical health conditions,

(c) the number of mental health patients waiting for initial assessment,

(d) the number of physical health patients waiting for initial assessment,

(e) the number of mental health patients waiting for treatment,

(f) the number of physical health patients waiting for treatment,

(g) the number of mental health patients receiving treatment,

(h) the number of physical health patients receiving treatment,

(i) the number of patients readmitted to mental healthcare settings, and

(j) the number of patients readmitted to physical healthcare settings.

(2) The report must set out performance against nationally set standards in both physical and mental health.

(3) Each year the Secretary of State must lay before Parliament a consolidated report of all the reports made by integrated care boards under this section, and make a statement to each House of Parliament on the report.’”

This amendment would require an ICB to report on assessing and meeting parity of physical and mental health outcomes.

Amendment 15, in clause 20,  page 29, line 20, at end insert—

“(2A) The Secretary of State may by regulations make provision about representation of particular health, social care, and local interests, clinical fields, and types of health or care provision in the membership of integrated care partnerships.”

This amendment would enable the Secretary of State to make provision about the membership of integrated care partnerships.

Amendment 100, page 29, line 22, at end insert—

“(4) A member of the Integrated Care Partnership may not work for, be the representative of or hold financial interest in any private company delivering or seeking to deliver health and care services or services supporting the health and care sector or producing or seeking to produce health and care products, with the exception of general practitioners.”

This amendment seeks to ensure that Integrated Care Partnerships are made up wholly of representatives from public sector organisations and that private companies are not represented on them.

Amendment 1, page 29, line 45, at end insert—

“(c) fully integrate the promotion of everyday wellbeing, self-care for minor ailments and the management of long-term conditions into local health systems.”

This amendment would ensure that everyday wellbeing, self-care for minor ailment and management of long term conditions are integrated and promoted into local health systems.

Amendment 2, page 30, line 3, after “services” insert

“including services provided by pharmacists for minor ailments”.

This amendment would ensure that integrated care partnerships include in a strategy its views on how health-related services, including provision for self-treatable conditions, are integrated into health and social care services in that area.

Amendment 69, in clause 23,  page 35, line 32, at end insert—

“(5) NHS England must publish guidance on the means by which an integrated care board, NHS trust or NHS foundation trust which believes its capital resource limit or revenue resource limit risks compromising patient safety may object to the limit set.”

Amendment 114, in clause 25,  page 37, line 27, at end insert—

“(2A) The priorities set by the Secretary of State under subsection (2)(a) must include priorities relating to leadership, the integration of services and the quality and safety of services.”

The Secretary of State has the function of setting priorities for the Care Quality Commission in carrying out assessments in relation to integrated care systems. This amendment requires the Secretary of State to set priorities relating to certain matters.

Amendment 61, in clause 64, page 59, line 27, leave out from beginning to end of line 28.

This amendment is to ensure that a commissioner cannot also be a provider.

Amendment 62, in clause 69, page 63, line 30, leave out “may” and insert “must”.

This amendment makes it a requirement that regulations make provision in relation to the procurement by relevant authorities of (a) health care services for the purposes of the health service in England, and (b) other goods or services that are procured together with those health care services.

Amendment 63, page 63, line 36, leave out “may” and insert “must”.

This amendment makes it a requirement that regulations make provision in relation to (a) general objectives of procurement, and (b) procurement processes.

Amendment 64, page 63, line 39, leave out “may” and insert “must”.

This amendment along with Amendment 65 makes it a requirement that regulations make provision for the purposes of (a) ensuring transparency and fairness in relation to procurement, and (b) ensuring that compliance can be verified, or managing conflicts of interest.

Amendment 65, page 63, line 41, leave out “or” and insert “and”.

This amendment is to make it a requirement for regulations to make provision to ensure both transparency and fairness in relation to procurement.

Amendment 9, page 64, line 1, at end insert—

“(3A) The regulations must provide that—

(a) there is a presumption—

(i) in favour of contracts being awarded to NHS trusts and NHS foundation trusts, and

(ii) that integrated care provider contracts will not be awarded to a body other than to an NHS trust or an NHS foundation trust, except for under the provisions of paragraph (b);

(b) if an NHS trust or an NHS foundation trust does not consider that it is able, or does not wish, to provide certain services under a contract, it must publish its reasons;

(c) if paragraph (b) applies, the integrated care board must consult the public if it proposes to award any contract for those services to any body other than an NHS trust or NHS foundation trust;

(d) a consultation under paragraph (c) must—

(i) set out the responses of the integrated care provider to the reasons given by the NHS trust or NHS foundation trust under paragraph (b),

(ii) specify the proposed parties to and the full terms and conditions of the proposed contract, and

(iii) specify that the terms and conditions for staff under the proposed contract must be at least equivalent to NHS terms and conditions.”

This amendment would make NHS trusts and foundation trusts the default providers of NHS services.

Amendment 72, page 64, line 1, at end insert—

“(3A) The regulations must make provision in relation to the procurement of the services referred to in paragraph (1)(a) (other than primary medical services, primary dental services and primary ophthalmology services) that before any contract for a service with an annual value in excess of £5m may be awarded to an organisation that is not an NHS trust or NHS foundation trust—

(a) the business case for the award of the contract must be published;

(b) any responses to the proposal in the business case must be considered and published;

(c) the process for awarding the contract must be open and transparent and non-discriminatory at every stage, including (but not limited to)—

(i) procurement strategy and plan,

(ii) invitation to tender,

(iii) responses to invitations,

(iv) evaluation of tenders,

(v) decision to award, and

(vi) contract awarded;

(d) the process for awarding the contract must demonstrate due regard to the principles established in the Public Contracts Regulations 2015 (S.I.2015/102) or any regulations which may supersede them;

(e) in any case where it is claimed that an emergency justifies an award without the process being used then the responsible body must within 14 days publish the business case for the award of the contract and the record of the decision.”

Amendment 101, in schedule 2,  page 125, line 26, at end insert—

“(3) Members of an Integrated Care Board may not work for, be the representative of or hold financial interest in any private company delivering or seeking to deliver health and care services or services supporting the health and care sector or producing or seeking to produce health and care products, with the exception of general practitioners.”

This amendment seeks to ensure that ICBs are made up wholly of representatives from public sector organisations and that private companies, their employees and representatives, and those with financial interests in them, are not represented on ICBs.

Government amendments 25 to 28.

Amendment 76, page 126, line 26, at end insert—

“(d) at least one member nominated by the mental health trust or trusts that provide mental health services within the integrated care board’s area;

(e) at least one member nominated by the Directors of Public Health that serve each local authority within the integrated care board’s area;

(f) at least one member nominated jointly by any NHS trust, NHS foundation trust and local authority that provides social care services within the integrated care board’s area;

(g) at least one member nominated by the trade unions representing the health and social care workforce that serves the integrated care board’s area;

(h) at least one member appointed to represent the voice of patients and carers in the integrated care board’s area.”

Amendment 77, page 126, line 26, at end insert—

“(2A) The constitution must prohibit representatives of GP practices with active Alternative Provider Medical Services contracts from becoming members.”

This amendment would mean that the only GPs able to participate in Integrated Care Boards would be those whose practices are on the standard General Medical Services (GMS) contract.

Amendment 78, page 126, line 26, at end insert—

“(2A) Representatives of private providers of healthcare services, other than general practitioners who hold a contract for the provision of primary medical services in the area, may not be appointed to NHS decision-making boards, integrated care boards, or any place-based committee or sub-committee of the boards.”

Amendment 81, in schedule 2,  page 130, line 14, at end insert—

“(7) An integrated care board may enter into an externally financed development agreement in respect of any Local Improvement Finance Trust relevant to the area for which it has responsibility and receive the income related to that agreement.

(8) An integrated care board may enter into an externally financed development agreement in respect of any proposed Local Improvement Finance Trust relevant to the area for which it has responsibility.”

This amendment would enable integrated care boards to participate in existing and future LIFT schemes and to receive the income that would come to the local area from the local investment in such schemes.

Amendment 79, in schedule 3,  page 132, line 28, leave out “person” and insert

“general practitioner, GP partnership or social enterprise providing primary medical services”.

This amendment would prevent an integrated care board from entering into or renewing any Alternative Provider Medical Services (APMS) contract.

Amendment 80, page 132, line 32, leave out “person” and insert

“general practitioner, GP partnership or social enterprise providing primary medical services”.

This amendment would prevent NHS England from entering into or renewing any Alternative Provider Medical Services (APMS) contract.

Government amendments 29 and 30.

[Edward Argar]

New clause 49 has attracted a slightly fuller House than my previous speech did. This additional clause relates to the cap on care costs for charging purposes.

On 7 September, my right hon. Friend the Prime Minister took the bold step of publishing “Build Back Better: Our Plan for Health and Adult Social Care”. Successive Governments over decades have failed to tackle the reform of social care. This Government are delivering a package—package is the key—of reforms that will not only tackle the wider challenges faced by the adult social care system but reform how social care is funded to ensure that everyone, regardless of where they live or their level of assets, is protected from catastrophic costs. Let me remove all doubt on this issue: no one will lose from these reforms, compared with the system we have now, and the overwhelming majority will win.

Underpinning the reforms set out in the plan is an additional £5.4 billion over the next three years. That funding will end wholly unpredictable care costs and include at least £500 million to support the adult social care workforce. The reforms will make a real difference to the frontline of adult social care, including care users and the dedicated care workforce who have performed heroics throughout the pandemic. A crucial element of the reforms in the plan are the proposals to reform the existing social care charging rules.

[Damian Green (Ashford) (Con)]

I am grateful to the Minister for giving way so early in his speech. I am glad to hear him assert that no one will lose out and most people will win. Will he publish an impact assessment that will allow us to look at the detailed figures? As he will be aware, there is much commentary about the distribution of the possible losses, which seems to me to be an extremely important and sensitive issue for the Government to address.

[Edward Argar]

My right hon. Friend has long taken a close interest in this issue. In a moment, I will come to some of the figures and changes; I hear what he says about giving the House and the other place the information that they need and the aim is to do exactly that.

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[John Redwood (Wokingham) (Con)]

rose—

[Edward Argar]

I will make a little progress and then give way to my hon. Friend the Member for Basildon and Billericay (Mr Baron).

Currently, one in seven adults over 65 faces care costs of more than £100,000 over their lifetime. We are capping the amount that anyone will be forced to spend on personal care costs in their lifetime at £86,000. That is a seismic and historic change in the way we pay for care in England.

[Mr Baron]

The Government deserve credit for grasping this nettle, which has evaded Governments of both parties for too long, but he must understand that there is a real cause on the Government Benches in respect of the distribution of the relative losses and the worry that those who are less well off will be hit hardest by the Government’s new clause. Will he address that issue?

[Edward Argar]

I understand where my hon. Friend and Members from both sides of the House are coming from. This is the first major step forward in the reform of social care that we have seen in decades and must be seen as part of an overall package of changes.

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

rose—

[Edward Argar]

I would like to make a little progress, if I may.

The reforms will make the existing means test far more generous. We are increasing the upper capital limit from £23,250 to £100,000, which will make masses of people with moderate assets eligible for some state support towards the cost of care earlier, and the lower capital limit will also increase, from £14,250 to £20,000. Below that level, people will contribute only from their income, fully protecting their savings and assets below £20,000.

Over recent days, people have compared our policy proposals to previous, abandoned and never-enacted proposals for reform. I am clear that our proposals will deliver the changes needed where others have failed and see a significant improvement on the system that is in place today.

[Barbara Keeley]

rose—

[Catherine West]

rose—

[Edward Argar]

We have considered what help people want and when they want it.

[John Redwood]

rose—

[Edward Argar]

My right hon. Friend rose earlier and I should have taken his intervention then; I hope he will forgive me.

[John Redwood]

I am grateful to the Minister. Will he confirm that the amount of tax that is going to be raised in the immediate future, in national insurance and then in a separate tax, will make up a relatively small minority of the total costs of public social care? Will he also confirm that none of these measures addresses the issue of the hotel costs that people need to pay when they go into care homes?

[Edward Argar]

My right hon. Friend is right to highlight that this is talking about personal care costs, so he is right in his point on that.

Did I see the hon. Member for Hornsey and Wood Green (Catherine West) rise earlier?

[Catherine West]

The Minister did indeed. He is being very generous in giving way. A lot of research went into the work by Mr Dilnot some time ago and a very independent assessment was made. Can he explain why, in this clause, he is going away from those recommendations and taking a fresh look at it?

[Edward Argar]

While the hon. Lady and I do not always agree on everything, she asks a perfectly a reasoned and measured question. I pay tribute to Andrew Dilnot’s work on his report. I just happen to think that, on this point, we diverged from what he proposed and we believe that what we are proposing is the right way forward. We have always intended for the cap to apply to what people personally contribute, rather than on the combination of their personal contribution and that of the state. It will mean that people with fewer chargeable assets meter towards the cap more slowly, because they are paying much less each week than people who are entirely self-funding. This amendment will make it simpler to understand the amount that will go towards the cap and make it fairer.

[Barbara Keeley]

rose—

[Jonathan Ashworth (Leicester South) (Lab/Co-op)]

rose—

[Edward Argar]

If the shadow Secretary of State will forgive me, the hon. Lady has attempted on a number of occasions to get in, so it is only fair that I give way to her.

[Barbara Keeley]

On the point the Minister is making about the Dilnot proposals and a comparison, let me tell him that the Alzheimer’s Society said that 15% of people with dementia in the north-west would reach the cap under the Government’s proposals, compared with 34% under Dilnot’s proposals. That is a massive amount, and those are the people, with their families, who are paying hundreds of thousands and pounds. That is the comparison.

[Edward Argar]

I am grateful to the hon. Lady. I do not think that she posed a question, but she made her point clearly, as she always does.

[Matt Hancock (West Suffolk) (Con)]

rose—

[Sir Robert Neill (Bromley and Chislehurst) (Con)]

rose—

[Edward Argar]

If I may make a little progress, I will then give way to my former boss, the former Secretary of State, and then, if I have time, to my hon. Friend.

To reiterate, as my right hon. Friend, the Prime Minister, said on 7 September, nobody—nobody—will be “worse off” than under the current system. Currently, around half of all older adults in care receive some state support for their care costs. This will rise to roughly two thirds under these reforms. This clause would also make a number of minor technical amendments to other sections of the Care Act 2014.

[Jonathan Ashworth]

Will the Minister give way?

[Edward Argar]

Before I give way to the right hon. Gentleman, I will give way to the former Secretary of State.

[Matt Hancock]

Is not the right way to think about this change to consider the proposal in front of us and compare it with the current system? The reason that the Dilnot system, as previously proposed, was never put in place was that there was never a proposal to pay for it, whereas this package is paid for. That is why this Government have been able to deliver a package where no previous Government have been able to do so.

[Edward Argar]

I am grateful to the former Secretary of State. He is absolutely right. We deal in the reality and we should compare the reality of the system that we have in place now with what we have proposed here, which not only moves us forward, but is funded and sustainable.

[Sir Robert Neill]

Can my hon. Friend help me on two short matters? Can he give us an assurance that there will be no adverse impact on local government financing in relation to this, and that he will talk to the Local Government Association, if necessary, in this regard? Secondly, he says that it is part of a package. My right hon. Friend the Member for Ashford (Damian Green) referred to the impact assessment. Does he agree that it is only fair that, at the very least, we have an impact assessment before the Bill completes its passage through both Houses?

[Edward Argar]

Yes, of course, as we move through this reform process, it is absolutely right and vital that we work with our partners in the Local Government Association and local authorities of all political complexions. In respect of the impact assessment, I do believe that it is important that we have an impact assessment before this legislation completes its passage through both Houses.

[Jonathan Ashworth]

I am extremely grateful to the Minister. He is showing his typical courtesy in giving way. Many across the House are puzzled because we recall this document that the Government placed before the House when they asked the House to endorse the national insurance increase. Indeed, many Members did endorse that national insurance increase, even though they were breaking a manifesto commitment. This document actually says that it will introduce a care cap and

“deliver a core recommendation of the independent Dilnot Commission. It will be implemented using legislation already in place under the 2014 Care Act, which introduces the independent Dilnot Commission’s social care charging reform.”

It goes on to describe that as the “new cap”. Why have the Government moved away from the position of just a few months ago that they published ahead of a vote on increasing national insurance and moved to a policy now that disproportionately benefits those with greater assets, which surely cannot be fair?

[Edward Argar]

I am grateful to the shadow Secretary of State who, while I do not necessarily agree with what he says, as ever puts it courteously. We hold true to what we put in that “Build Back Better” document. It is necessary for this one particular element to see further primary legislation, hence the amendment today.

[Karin Smyth (Bristol South) (Lab)]

Will the Minister give way?

[Edward Argar]

I am afraid that I will not give way because I do need to make some progress.

[Karin Smyth]

Will the Minister give way on that point?

[Edward Argar]

I have been very generous with my time and to the shadow Front Bench, so forgive me, but no.

[Karin Smyth]

On that point, will the Minister please give way? Six weeks in Committee and not a mention.

[Edward Argar]

Forgive me, but no.

To reiterate, as my right hon. Friend the Prime Minister said on 7 September nobody—nobody—will be “worse off” than under the current system. Currently around half of all older adults in care receive some state support. This will rise to roughly two thirds under these reforms. On the minor technical amendments that I made to other sections of the Care Act, I would not wish to belabour each one, but I can reassure the House that those changes will ensure that the legislation works as intended and that everyone who is eligible—

[Karin Smyth]

Will the Minister give way?

[Edward Argar]

I will not give way. I want to make some more progress.

[Paul Bristow (Peterborough) (Con)]

Will my hon. Friend give way?

[Edward Argar]

I want to make a little more progress. I will not give way to one of my hon. Friends or to the hon. Lady at this moment.

This will be done by amending the provisions to clearly describe the information that must be included in a personal budget so that individual contributions count towards the cap at the local authority determined rate, and to ensure that personal budgets and independent personal budgets work as they were originally intended when being used in conjunction with the cap.

Before turning to integrated care boards, let me put it on record that, once again, this must be regarded as part of a package of measures that improves significantly on the current provision in place for those funding care.

[Philip Dunne (Ludlow) (Con)]

I am extremely grateful to my hon. Friend for giving way. Before we leave the subject of the cap, can he just confirm that this proposal includes the costs of domiciliary care, which had not been included under the original Dilnot proposals that are exercising Labour Members?

--- Later in debate ---

[Edward Argar]

My right hon. Friend is exactly right. I am grateful to him for giving me an opportunity to highlight that this improves in this respect on the Dilnot proposals. I put on record my tribute to Andrew Dilnot for his work, but we believe that this is a better package, and, as he highlighted, a sustainable package from a financial perspective.

[Karin Smyth]

Will the Minister give way. We have had six weeks in Committee.

[Edward Argar]

The hon. Lady implores me, saying that after six weeks of having to sit opposite me in Committee, the least I can do is allow her to intervene.

[Karin Smyth]

Several times in that Committee, I offered to help the Government in a cross-party way. The Minister has been dealt a bad blow here tonight, having to come here and defend this proposal. In those six weeks—I think 21 sessions—not one iota of this proposal was mentioned or brought forward. We all know about bad legislation, rushed legislation, and legislation that does not have the commitment on something so important. I have commended the Government for starting this conversation, but this is a poor legislation move. I am sure that Members here would support the Minister tonight if he were to withdraw this proposal, go back to the Chancellor and ask him to think again. We would all be behind him if he took that opportunity.

[Edward Argar]

I did wonder whether I would regret that intervention. It was typically courteous, although I have to say that when a Member of the Opposition says that, “We’re here to help you”, I am not always sure. [Interruption.] Of course, when the hon. Lady does it, I know that she is sincere about it. The point I make is that this important change is necessary to deliver on the pledge we have made. It is being introduced on Report. While ICBs and integrated care systems, which we will speak about shortly, are hugely important, I suspect that this matter will dominate the debate in this group on Report. Equally, I suspect that it will be fully debated and scrutinised in the other place.

[Paul Bristow]

Does the Minister agree that we have been on a journey? The context of this needs to be considered. We are starting a conversation, but other things will come. There will be bumps in the road, but the context that we need to consider is that this is the first Government to tackle the issue of social care in decades. That is the right way to look at this piece of legislation. It should not be looked at in a short-term way.

[Edward Argar]

I am grateful to my hon. Friend, a member of the Health and Social Care Committee, for his intervention. He makes the point well that this is another step on the journey, but it is a journey that only this Government have actually got round to starting. Previous Governments have failed to make that progress. The previous Labour Government produced two Green Papers, one Royal Commission, and one spending review and nothing was done, so this Government are making significant progress.

[Barbara Keeley]

Will the Minister give way?

--- Later in debate ---

[Edward Argar]

I have already given way to the hon. Lady, so I will not do so again.

I thank the hon. Member for Bristol South for her words, but the situation is not as she characterises it with my having been dealt a difficult or challenging hand this evening. I am proud to stand here and defend this Government as the first Government to make changes to tackle the social care challenges that this country faces.

[Paula Barker (Liverpool, Wavertree) (Lab)]

Will the Minister give way?

[Edward Argar]

I have given way a number of times and I want to make some progress. I will be winding up the debate, so hon. Members will have the opportunity to come back in then.

[Liz Kendall (Leicester West) (Lab)]

Will the Minister give way?

[Edward Argar]

I am afraid that I will not give way now.

[Jonathan Ashworth]

For Leicestershire!

[Edward Argar]

I did give way to the right hon. Gentleman, the shadow Secretary of State, and he is my other constituency neighbour in Leicestershire.

Let me turn to integrated care boards and integrated care partnerships. I remind the House of what my right hon. Friend the Secretary of State said on Second Reading. These bodies are critical for delivering the key aims of the legislation: reducing bureaucracy; supporting integration and collaboration; and improving accountability. At the heart of the legislation for these bodies is flexibility—giving systems the scope to shape structures according to their needs. This principle is widely supported across the NHS and local government, and we would not want to imperil that, which is why we will be resisting attempts this evening to constrain more tightly how ICBs and ICPs operate. However, we recognise that there are a number of points of clarification that would be helpful to include, and we have tabled a number of amendments to do just that.

Before we reach the meat of this section, there are a number of minor amendments to deal with. First, minor and technical Government amendment 29 will update a reference in the Health and Social Care (Community Health and Standards) Act 2003 to reflect the changes made to section 99 of the National Health Service Act 2006. Secondly, Government amendment 30 will designate integrated care boards as operators of essential services under the Network and Information Systems Regulations 2018. This will place requirements on ICBs to protect their network and information systems by managing risks to ensure service availability and prevent patient harm.

We expect ICBs to take decisions on IT investment, including on cyber-security, and owning systems—and the associated cyber-risk—that are critical to the provision of healthcare. This includes holding the shared care record. The loss or corruption of data from the shared care record could have clear implications for the delivery of care, and for wider public trust in the digitisation and data-sharing agenda. We must take this risk seriously, and assure ourselves that ICBs are doing so as well.

[Kevin Hollinrake (Thirsk and Malton) (Con)]

May I take the Minister back to new clause 49, very briefly? He is right to point out that some measures that he has brought forward are more generous than previously proposed, but there is no doubt that the way that the cap works means that it is less generous for those with more modest assets. Does he not agree? How can that be fair?

[Edward Argar]

I simply take my hon. Friend back to my previous point: when compared to the current system, this is a significant improvement and step forward, particularly when taken in the round with the overall package of measures that see the floors go from £23,250 up to £100,000 and from £14,250 up to £20,000. We have to look at this issue in the round, considering all those aspects rather than purely one element alone.

[Mel Stride (Central Devon) (Con)]

Will the Minister give way?

[Edward Argar]

I would like to move on to ICBs and ICSs, but I suspect that, assuming there is time, my right hon. Friend, who chairs the Treasury Committee, may have the opportunity to intervene during my winding up, or to give a speech during the course of the debate.

Currently, the NIS regulations cover NHS providers in England, rather than commissioners. Government amendment 30 allows us to mitigate cyber-risk in a wider sense, making cyber-security a responsibility for organisations that have duties across the system, and to drive forward a shared and collaborative effort towards reducing the risk to patients. I hope that Government amendments 29 and 30 will be uncontentious and supported on both sides of the House.

[Liz Kendall]

Will the Minister give way?

[Edward Argar]

On ICBs, which I have moved on to, but not on new clause 49.

[Liz Kendall]

Is the Minister absolutely sure about what he said in response to the hon. Member for Thirsk and Malton (Kevin Hollinrake)—that everybody would be better off under new clause 49 than they are now? Is it not the case, as illustrated by the Health Foundation, that people with very modest homes, worth less than £106,000, will never hit the cap and therefore will not be better off under the Government’s proposed system than they are now?

[Edward Argar]

I make the point to the hon. Lady that I made in my opening remarks; I said that no one would be worse off and the majority would be better off. That is the point that I make to her: people would not be worse off. If she looks at Hansard, she will see that those were my original remarks when I opened this debate.

--- Later in debate ---

[Paula Barker]

Will the Minister give way?

[Edward Argar]

On ICBs, but not on new clause 49. We have moved on and I need to make some progress, because I know that many Members want to speak.

[Paula Barker]

I thank the Minister for giving way; he has been very generous with his time. Does he agree that if true integration and genuine parity of esteem are to be achieved, it should be written into law that local authorities should have a seat on the ICB?

[Edward Argar]

Local authorities will have a seat on ICBs and on ICPs. The approach set out in the legislation is appropriate. We have sought throughout for it to be permissive, not prescriptive, and that remains the right approach.

[John Redwood]

Will the Minister give way on ICBs?

[Edward Argar]

May I make a little bit of progress? Depending on time, I may then give way to my right hon. Friend. I am conscious that hon. and right hon. Members want to speak—I suspect, primarily on new clause 49.

I turn to Government amendment 25. In doing so, I thank the hon. Member for Ellesmere Port and Neston (Justin Madders), whose birthday it is today—I wish him a happy birthday; I am sure that he can think of nothing that he would prefer to be doing—and the hon. Member for Nottingham North (Alex Norris) for their discussions about this issue. I do not know what view they have reached, but I am grateful for the helpful spirit in which they approached those conversations.

Although service provision—I emphasise the word “provision”—by the independent and voluntary sectors has been an important and valuable feature of the system under successive Governments, it was never the intention for independent providers to sit on integrated care boards and it still is not. We were clear that the conflict of interests provisions addressed the issue, despite misleading and inaccurate claims by some campaigners. However, we are happy to put the matter even further beyond doubt.

Government amendment 25 makes it clear that no one may be appointed to an ICB who would undermine the independence of the NHS, either as a result of their interests in the private healthcare sector or otherwise. We expect this to prevent, for example, directors of private healthcare companies, significant stakeholders of private healthcare companies and lobbyists from sitting on the board of an ICB. It would also prevent anyone with an obvious ideological interest that clearly runs counter to the NHS’s independence from sitting on a board of an ICB.

[John Redwood]

Will the Minister give us a brief comment on the recruitment of chief executives and senior management to the boards? Will we be using people who already have senior NHS jobs, meaning that there will be no redundancy and transfer costs, or will there be quite a redundancy bill because we want to change personnel?

[Edward Argar]

I think my right hon. Friend is talking about executive posts. Yes, there will be processes in place to ensure that employment rights are respected. There will be some roles that are completely new and there will be a competition, but I would expect that those with a significant track record and experience would therefore find themselves in a strong position. I will not prejudge any of those individual decisions.

[Sir Charles Walker (Broxbourne) (Con)]

rose—

[Edward Argar]

I will give way to my right hon. Friend.

[Sir Charles Walker]

I am not a right hon. Member, but I am very happy to take the promotion.

I have tabled a number of technical, totemic amendments on parity of esteem that appear on today’s amendment paper and tomorrow’s. They propose taking general references to “health” in the Bill and changing them to “physical and mental health”. I hope that the Minister will receive those amendments with his usual generosity and make the necessary changes over the next two days.

[Edward Argar]

I take my hon. Friend’s amendments in the spirit in which they are of course intended. I recognise the importance and value that those on both sides of this House put on parity of esteem of mental and physical health. I suspect that we may debate the amendments in subsequent groupings and I look forward to responding then.

We have, in the process of drafting this amendment, heard suggestions that we should simply ban private company employees completely from the boards of ICBs. I am afraid that doing so is not so simple, nor would it achieve the desired result in all cases. In fact, our amendment goes further to underline the importance of NHS independence than would an amendment that focused purely on banning employees of private providers. There are clearly some candidates who would be suitable but may have minor interests in private healthcare. GPs, for example, do provide, and have provided, their excellent knowledge and experience of their patients in guiding commissioning decisions, and some may have private practices as well. Excluding them would be to lose their experience from the NHS, and therefore such an involvement with the private sector would clearly not risk undermining the independence of the NHS.

[Dr Dan Poulter (Central Suffolk and North Ipswich) (Con)]

I draw the House’s attention to my declaration in the Register of Members’ Financial Interests as a practising NHS doctor. A number of GPs have, in recent times, sought to group together into confederations of practices, which could create a bloc interest within a local board area. How will that potential conflict of interest in the commissioning and provision of services be addressed by the Government through legislation?

[Edward Argar]

I am grateful to my hon. Friend, who knows of what he speaks in terms of the operation of healthcare services. We would not wish to exclude GPs or groups of GPs from being able to participate in decision making. That expertise, as we have seen with clinical commissioning groups, can be hugely valuable. What we have sought to do, in an amendment that is technically worded, for want of a better way of putting it, is to strike the right balance while also ensuring that the additional measures on the constitutions of the ICBs and ICPs have to be approved by NHS England to avoid any obvious conflict of interest. But we are not seeking to avoid GPs being able to operate in that space and sitting on ICBs.

[Clive Efford (Eltham) (Lab)]

Will the Minister give way?

[Edward Argar]

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

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

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

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

[Edward Argar]

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

[Clive Efford]

We have GP practices that are being privatised now—they are being bought up by private companies, with some foreign interests as well. If the Minister is saying that those companies can have representation on ICBs, we have already seen circumstances where people have tried to redact minutes of meetings, so does this not open up the possibility of private interests being served at these meetings but not being accountable through public scrutiny?

--- Later in debate ---

[Edward Argar]

I entirely understand the point the hon. Gentleman is making. I think he was careful, shall we say, given some litigation that may be going on, not to mention anything specific, but I know what he is talking about. We believe that our amendment will prevent private companies—whatever services they were providing for the NHS—with a significant private interest in this, or their lobbyists, from being able to sit on ICBs. The hon. Member for Bristol South (Karin Smyth) raised the need for transparency in Committee a number of times, and I suspect we may return to that point. We believe that the current transparency requirements on CCGs that will be carried across are sufficient to ensure transparency and public access to the information they need.

[Geraint Davies]

rose—

[Edward Argar]

I am afraid I am about to conclude. I suspect that the hon. Gentleman will come back in with a speech and I will endeavour to pick up on that in the wind-ups.

There are a number of similar amendments, such as amendment 101 in the names of the hon. Members for Wirral West (Margaret Greenwood) and for Brighton, Pavilion (Caroline Lucas). I hope they might feel, to some degree, reassured by our amendment and the intent behind it, but that is obviously for them to say. We believe that the Government’s amendment puts beyond doubt what we believe was already entirely clear but were determined to put beyond doubt—that ICBs will not and cannot be controlled in any way by the private sector, as NHS-accountable bodies guided by the NHS constitution and with NHS values at their heart. These principles, I believe, irrespective of other debates we may have this evening, command respect from both sides of this place. I therefore commend the amendments to the House.

[Justin Madders (Ellesmere Port and Neston) (Lab)]

A wide range of issues that are part of this group of amendments demonstrate the cold reality of this Bill. It is a jumble sale of bits and pieces. Of course a Bill can be wide-ranging, but having breadth is not the same as having coherence, or indeed clarity. Such are the issues within scope in this grouping that I will not comment directly on every new clause and amendment but hope to have time to say at least a few words on those emanating from the Opposition Front-Bench team, as well as on any Government new clauses or amendments that we oppose. Some amendments refer to matters that have been dealt with in Committee where we have expressed our views and put forward amendments that failed to persuade the Government. Sadly, we have insufficient time to go over the same ground again, particularly given the rapid shifting of the goalposts we have seen in the past week.

I turn first to integrated care boards, or ICBs, and, more widely, the issue of governance. The question of governance and accountability remains an important matter to us and needs greater clarity than currently appears in the Bill. For Members who may not be familiar with the detail, the Bill proposes yet another reorganisation of the NHS, creating 42 new integrated care systems where decisions on how NHS and care spending will be made. The decision-making bodies within these systems are the ICBs, replacing the CCGs, which fall away into the annals of history alongside the primary care groups, the primary care trusts and all the other permutations that we have seen.

Our discussions on these matters in Committee showed that our disagreements tended to centre around an intention by Government to limit what is in statute and to leave maximum flexibility at local level, as opposed to our desire to ensure that safeguards and protections were in place for those matters we felt were too important to be left out. It is wholly ironic, therefore, that the Bill proclaims, on the one hand, local freedoms and flexibilities, yet on the other proposes sweeping top-down powers for NHS England and the Secretary of State. Our view remains that some flexibility is fine to allow shaping to local needs, but that some key principles need to be put into the Bill to ensure that there are no misunderstandings or unintended consequences.

We know that the genesis of this Bill has been the realisation that increasingly large parts of the NHS were ignoring the 2012 Lansley Act. Along with changes to procurement and pricing, this grouping deals with the main elements of reversing parts of that Act. We could spend all our time referring to what we said 10 years ago, and how the Health and Social Care Act 2012 has proved to be the disaster that we said it would be, but we will spare the Government the “We told you so” lectures, because even those on the Government Benches are now aware that the 2012 Act has been among the worst policy mistakes in the history of the NHS. Whether that damage was worse than the damage done by a decade of austerity remains to be seen, but repairing the damage done by austerity is not for today, as there is little in the Bill to address the ongoing consequences of a decade of underfunding, particularly the wholly appalling waiting times that we now see across the board.

--- Later in debate ---

[Jeremy Hunt (South West Surrey) (Con)]

Madam Deputy Speaker, I think on this occasion I can oblige you, because I will be very brief. I wish to speak to amendment 114, which may seem a rather technical amendment—as is evidenced by the fact that, out of 650 colleagues, only one has actually signed it, and that is me—but it makes up in quality for what it does not have in quantity. It is about making sure that the new integrated care boards focus their energy on the safety and quality of care of patients. That is very important, because the new integrated care boards will have enormous power. In effect, they will be the local governing bodies of our NHS.

Although the statutory structures matter, what the people running those care boards focus their attention on is incredibly important to all our constituents. The amendment will make sure that when care boards consider their priorities, the things that matter to patients—the safety and quality of care—are put at the very top of their list. We know the way the NHS works. It is the fifth-largest bureaucracy in the world, and there is a plethora of internal NHS—

[Edward Argar]

rose—

[Jeremy Hunt]

I see the Minister wants me to give way. May I make my argument for one moment, and then give way?

There is a plethora of internal NHS targets, there are operational targets and there are financial targets. They often have an excellent purpose, but, as in the case of Mid Staffs and other cases where things went badly wrong, being under a lot of pressure to meet those targets means corners can be cut, and the quality of care experienced by patients can be really damaged. The amendment would make sure that there was discipline in the system, so that whatever pressure NHS managers were under, they were always focused on safety and quality of care.

--- Later in debate ---

[Jeremy Hunt]

Before I come to the Minister, I want to say—and I am very grateful to my right hon. Friend the Member for Wokingham (John Redwood), who gave me consistent support on this agenda when I was Health Secretary—that, in the public sector, the one system that has seemed to make sure we focus public bodies on our constituents’ priorities is the Ofsted system in schools. We have rolled that out, I think reasonably successfully, to hospitals, GP surgeries and care homes, and this amendment makes that possible for the new integrated care boards. I want to give the Minister a chance to intervene to tell us his reflections on whether this system could work.

[Edward Argar]

I am grateful to my right hon. Friend. It is not just my right hon. Friend the Member for Wokingham (John Redwood) who supports him on this; I and the Government do, and we are delighted to accept his amendment.

[Jeremy Hunt]

I am most grateful to my hon. Friend, and I am also grateful to the Opposition, who have indicated that they will not oppose the amendment.

--- Later in debate ---

[Mrs Maria Miller (Basingstoke) (Con)]

I listened carefully to my hon. Friend the Minister for Health earlier as he introduced new clause 49 because the funding of social care has been a huge concern for too many years. The people we represent deserve far more certainty about how their old age will be funded if they require social care.

We have a pension system and a system to support disabled people, but the funding of social care is a real uncertainty. I pay tribute to the Minister for bringing forward these costed proposals to provide some certainty for the future for more people. He is to be commended for being clear that no one will lose out under the proposals and that the majority will be better off because of the issues that we have already gone through—particularly because the means-test threshold is being significantly raised. He can say that with some force because of the more than £5 billion extra being put forward by the Government to fund social care in a sustainable way for the future.

However, there is still clearly some concern, as the Minister can hear from the debate. As my hon. Friend the Member for Gosport (Caroline Dinenage) said, no solution will be perfect, so I was particularly pleased to hear of the Minister’s plans to publish an impact assessment, which will clearly set out the impact of these measures across the board. That is important.

Finally, I want to speak in support of my amendment 102. We all know that the quality of support that we give victims of domestic and sexual abuse is a marker for the health of our society, and it is not just a matter for the NHS. However, the NHS plays a vital part in that support. Amendment 102 requires the joint forward plan for integrated care boards and their partners to properly set out the steps they propose to take to address the needs of victims of domestic abuse—whether domestic violence or sexual abuse, and whether it involves children or adults.

Amendment 102 does not limit the plan to addressing only the victims of domestic abuse; many other types of abuse are equally devastating, and it is permissive enough to allow innovation and improved ways of working to be developed in guidance. I hope that it can be used as a basis for guidance to integrated care boards as part of their general powers.

Amendment 102 is just part of the greater whole. The Police, Crime, Sentencing and Courts Bill in particular will require action across Government, but the amendment will help to ensure that every part of the state is pulling in the same direction when it comes to issues of domestic and sexual abuse. My amendment is similar to new clause 33, which my hon. Friend the Member for Newton Abbot (Anne Marie Morris) outlined earlier, but my amendment is more permissive and less prescriptive, so I hope the Government will find it acceptable.

[Edward Argar]

I am grateful to my right hon. Friend for the case she is making. I should also put on the record my gratitude for the work that my hon. Friend the Member for Newton Abbot (Anne Marie Morris) has done in this policy space and for her proposal. Her Majesty’s Government are happy to accept my right hon. Friend’s amendment 102 on support for victims of domestic abuse.

--- Later in debate ---

[Jess Phillips (Birmingham, Yardley) (Lab)]

I was not expecting to be called, Madam Deputy Speaker, but here we are. I want to tell a little story about my dad. My dad often rings me and tells me the things I should say in Parliament—I am not entirely sure any of you are quite ready for it, but I want to tell a story about my dad. He was born in the war, and they were given a council house by the Attlee Government—my dad could lecture us on it for weeks! He was given a council house, which his very Conservative parents bought in the 1980s. My granny, unbelievably—a lovely, generous woman—was a massive Thatcherite. She bought her council house in the 1980s, and that council house stands in my constituency. It is worth around £120,000.

My dad went on to get an education—a free education—and he moved into an area of Birmingham that was not very trendy at the time. He stayed there, I was born there, and my brothers lived there. All through our lives we watched that area get a little bit trendier, and the price of my dad’s house, which he bought for £30,000, went up and up and up. He didn’t particularly do much work—he likes to woodwork in his garage, but he has not done much. His house is probably worth around £700,000 now, and it was £30,000 when he bought it.

If my dad were here today, what he would say to hon. Members, and what he will almost certainly say to me, because he watches it all, lurking on Twitter, is that he does not deserve to keep his wealth for his children at any greater rate than the people who live in the council house that his parents bought on Frodesley Road in Sheldon. Yet today, the people who live in my constituency and the council house that my granny bought, to try to get a better life, will subsidise the care of my father, who has a £700,000 house that I do not need to inherit. I’m all right. I’ve got quite a good job. It is totally unacceptable that that is the situation we are putting almost all my constituents in, compared with constituents in Chipping Norton, for example, or the constituents of other hon. Members who have stood up and spoken. My constituents will largely be left with nothing. They will not be grateful.

[Edward Argar]

I am conscious of time, Madam Deputy Speaker, so I will try to cover some of the main themes that have emerged from today’s debate. I am grateful for the debate we have had today. The vast majority of what is contained in the Bill is exactly what the NHS said that it wanted and needed, and it is the right legislation being brought forward at the right time, to drive forward those priorities highlighted by the NHS in its 2019 consultation. The Bill drives forward integration not only within the local NHS within a region, but also greater integration with a local authority. It provides the foundations on which we can continue to build, as we move forward with greater integration of health and social care services that are designed to work around the individual, rather than in institutional silos.

Despite misleading claims by campaigners—and, indeed, by some Opposition Members—the Bill does not privatise the NHS. The NHS will always be free at the point of delivery. It has been in the hands of the Conservative party longer than it has been in the hands of any other party, and the Conservative party has put in place record investment in terms of resources in our NHS. What we propose in the Bill continues to build on that. Government Amendment 25 on ICBs is clear: ICBs are NHS bodies. They have always been NHS bodies in our proposals, and we have put in place provisions regarding conflicts of interest. Just to make sure, and given the misleading claims about private involvement, new clause 25 puts beyond doubt that ICBs are NHS bodies and must act in the best interests of the NHS. It is an amendment that is much stronger and much more effectively drafted than the alternatives put forward by the Opposition, because we believe in putting this question beyond doubt.

On the ICBs and ICPs, we have sought to be permissive rather than prescriptive, giving those local systems, within a national framework, the flexibility to deliver what they need to deliver for their local areas, which they know best.

I have been happy to accept amendments 102 and 114. I will continue to reflect on the points made by my hon. Friend the Member for Broxbourne (Sir Charles Walker); in the nicest possible way, I suspect that—rightly—he will not go away. The former Secretary of State, my right hon. Friend the Member for South West Surrey (Jeremy Hunt), set out very clearly the case for his amendment 114, which I was happy to accept, and the importance it places on patient safety.

My right hon. Friend the Member for South Northamptonshire (Dame Andrea Leadsom) has done a huge amount of work in this space—I pay tribute to her—and she is right: we will look very carefully in the statutory guidance at how we can emphasise that. I fear that my hon. Friend the Member for Newton Abbot (Anne Marie Morris) was not in her seat when I paid tribute to the work that she had done previously, but I put that on the record too.

On new clause 49, my hon. Friend the Member for Gosport (Caroline Dinenage), a distinguished former Care Minister, made the point extremely well that this is a significant improvement and step forward on where we currently are in respect of tackling the social care challenge.

[Kevin Hollinrake]

Will the Minister give way?

[Matt Western (Warwick and Leamington) (Lab)]

Will the Minister give way?

[Edward Argar]

I am afraid I will not, because I have only a couple of minutes in which to try to address these points, and I did give way a dozen or so times in my opening remarks.

Equally, I recognise, as always in this House, the strength and genuine sincerity of the views and the points put by hon. Members on both sides, genuinely highlighting and wishing to explore certain aspects of new clause 49 to understand exactly what it does and how it works. I have complete respect for the strength of those views.

I believe that, as my right hon. Friend the Member for West Suffolk (Matt Hancock) set out very clearly, this is a significant step forward. It will make a huge difference, and it must be treated as part of a package of measures rather than in isolation. As he quite rightly highlighted, we must look at the floors as well as the cap, at the support that is available, and at the increases in those floors from £14,250 to £20,000 and up to £100,000.

[Matt Western]

Will the Minister give way?

[Edward Argar]

I am afraid I will not, because I literally have only one minute, and I did give way multiple times in my opening remarks.

I believe that the measures in this Bill, which we have debated with these amendments today, give the NHS what it needs to further integrate to deliver the local services it needs and, crucially, move us a huge step forward in tackling the challenge posed by social care for future generations.

Question put, That the clause be read a Second time.

Cancer Diagnoses: Young People in Hertfordshire

Edward Argar Excerpts

Friday 19th November 2021 Commons Chamber

[The Minister for Health (Edward Argar)]

I thank and pay tribute to my hon. Friend the Member for Hertford and Stortford (Julie Marson) for bringing this debate before us, and for raising this difficult issue in a typically dignified and sensitive way. She has done justice to Jessica and her family.

I join my right hon. and learned Friend the Member for North East Hertfordshire (Sir Oliver Heald) and my hon. Friend the Member for South West Hertfordshire (Mr Mohindra), who intervened, in sending my condolences to Andrea and Simon, and to Jessica’s family and friends, following her death. We know that the passage of time can help, but it can never totally remove that sense of loss. I pay tribute to them for the work that they are doing to highlight the issue. It must be very difficult for them and it is humbling that they—through their excellent Member of Parliament, but also in person—have been willing to share this deeply upsetting experience to seek to build a better future for others. I put on record my tribute and gratitude to them.

As my hon. Friend the Member for Hertford and Stortford has set out, Jessica sadly had a very rare form of cancer. I am advised that the timescale and complexity of diagnosis in this case was due to the rarity of the cancer, especially in younger people, but we are always willing to look more broadly and holistically at other factors that we may have some control over that could help to improve diagnosis in the future. It is absolutely right that we do so because, as my hon. Friend said, sadly no one is too young to fall victim to cancer, so it behoves all of us in this House and beyond to do all we can to improve diagnosis.

As my hon. Friend alluded to, we are working nationally on achieving the long-term plan commitment towards early diagnosis of cancer, including rarer cancers or those that are harder to diagnose, in order hopefully to avoid situations such as Jessica’s being repeated in the future. Hertfordshire’s hospital trusts are working extremely hard to that aim. In delivering the long-term plan for cancer, we have the aim of diagnosing three quarters of cancers at stage 1 or 2, and increasing cancer survival rates so that an additional 55,000 people survive their cancer for five years or more. Delivering those ambitions through earlier and faster diagnosis, rapid adoption of innovation and, crucially, the roll-out of personalised care—looking at someone as an individual—will benefit children and young adults across the country.

Alongside this, as my hon. Friend set out, all cancer systems continue to roll out rapid diagnostic centres or rapid diagnostics services, which are an important part of the clinical commissioning groups’ broader strategy to deliver faster and earlier diagnosis, and an improved patient experience. By summer 2021, there were 102 live rapid diagnostic centre pathways across hospitals in England and a further 98 in development, compared to just 12 in March 2020.

To make the discussion rather more local, in East and North Hertfordshire NHS Trust, the services to support and assist patients whose cancer is of unknown primary origin and those who have what are clinically known as “vague symptoms” are being brought together to make best use of clinical resource. Multi-disciplinary team co-ordinators will track patients on their pathways and ensure that the new 28-day faster diagnosis standard is met. Funding has also been put in place to provide psychological support to support patients earlier, at a time when they may be worried about receiving a potentially life-changing—or, tragically in some cases, life-ending—diagnosis.

Herts Valleys CCG is developing services for patients with non-specific symptoms that could indicate cancer—for example, a 12-month pilot of a primary care-led vague symptoms pathway, with direct access to CT scanning. This began in February and is reported to be working well, and the CCG is looking further to develop this work and integrate it more with the acute trust. There is also a significant amount of work on the site-specific pathways through more efficient diagnostic pathways. This goes to what my hon. Friend was saying, as it supports earlier and faster cancer diagnosis by assessing patients’ symptoms holistically—bringing all the symptoms together when considering them, rather than looking at them in isolation, when it would be understandable if a misdiagnosis were made.

[Sir Oliver Heald]

I want to follow up on the point that I made when intervening on my hon. Friend the Member for Hertford and Stortford (Julie Marson). The project that the Minister is talking about is very good, but I just wonder about disseminating best practice more widely in GP surgeries. Does he think that the idea of having one GP in a practice who takes a lead on cancer—ensuring that the practice is up to date with the latest diagnostics, treatment and so on—is worth pursuing?

[Edward Argar]

My right hon. and learned Friend is also an old friend, so I suspect that he has a slight insight into where I was to be going in a few minutes. I hope to be able to answer that point specifically.

On education in cancer diagnosis within Hertfordshire and on GPs having the necessary skills and keeping them up to date, GPs in the region are encouraged to maintain their knowledge and skills in the field and are supported by Macmillan GPs, who are specialists in cancer care. Cancer education programmes such as Gateway C are available online, and face-to-face education sessions have now resumed, including monthly seminars offered by providers and by Cancer Research UK. A primary care network cancer clinical leads group has also been established to share the latest local issues and best practice.

I turn to specific points highlighted by my hon. Friend the Member for Hertford and Stortford. On face-to-face appointments and the ability to diagnose in that context, £20 million of elective recovery funding has been distributed to cancer alliances in this financial year to help accelerate the implementation of service models that streamline the front end of the pathway and support the management of high referral volumes. Throughout the pandemic, NHS England and Improvement has provided guidance to general practice and continually updated standard operating procedures to ensure that changing services could operate safely. NHS England and Improvement set out clear expectations that general practices offer face-to-face appointments alongside remote appointments—telephone or online—and that clinical necessity and patient preference should be taken into account to determine the most appropriate method.

My hon. Friend raised research and how it could help save lives in the future. NHS England and Improvement is supporting GRAIL’s Galleri trial, where studies have shown the ability to detect more than 50 types of cancers through a single blood test. The Galleri test can, as she said, detect chemical changes in blood as cancer can release small particles of DNA into the blood—known as circulating tumour DNA—which leak from tumours into the bloodstream, to give a vital early warning. The Cancer Research UK and King’s College London cancer prevention trials unit is conducting a randomised control trial along with the NHS and GRAIL. The blood samples from the first subjects in the trial are being obtained at mobile testing clinics in retail parks as well as at various convenient community locations. The trial’s participants must not have had a cancer diagnosis in the last three years. The main trial has now started. As hon. Members will know, I am always cautious about such things, but I am cautiously optimistic and genuinely hope that the trial will yield innovation that will make a huge difference in the ways mentioned by my hon. Friend.

My hon. Friend also raised the central point of GPs handling cases in their entirety or of having a point of contact who can look at a case holistically from the individual’s point of view, with knowledge of all their symptoms, medical history and so on. The general practice contract requires practices to provide a named accountable general practitioner to all registered patients. That GP must take the lead in ensuring that any primary medical services considered necessary to meet the needs of a patient, including appropriate referrals to specialist care and liaison with other health professionals involved in the patient’s care, are co-ordinated and delivered to that patient.

As of 1 April last year, we introduced the supporting early cancer diagnosis service specification for primary care networks to support improvements in rates of early cancer diagnosis. The 2021-22 quality and outcomes framework, which is a reward and incentive scheme for general practices, includes five indicators related to cancer care, including a quality improvement module on early cancer diagnosis. That improvement module was designed specifically to improve referral and safety net practices.

I hope that that answers some of my hon. Friend’s questions. She rightly highlights that there is always more to do in this space, and as we think of Jessica and her family it behoves all of us to continue to work to improve the quality of care provided, improve research, improve early diagnosis and look at each person who comes forward with symptoms or concerns as an individual, bringing all those factors together.

One of the privileges for the Minister responding to the Adjournment debate on a Friday is to speak on a subject outside of their usual portfolio, and this is one such opportunity. It has been a humbling experience, and one that I hope will inspire us all to renewed efforts, thinking of Jessica, to improve services as we go forward.

Question put and agreed to.