Budget Resolutions

Jamie Stone Excerpts

Tuesday 30th October 2018 Commons Chamber

[Brendan O'Hara]

I refer the hon. Gentleman to the commission’s report and advise him to read it, rather than simply taking the crib sheet handed out by his party.

Much has been made of the Chancellor’s announcement that £20 billion of new funding would be made available to the NHS over the next five years. We are told that that funding will be transformational for the national health service, but let us put it into perspective. The new money, which we welcome, averages out at a 3.4% increase per annum for the next five years. That is actually still less than the average funding increases received by the NHS in the first 60 years of its existence. All the Chancellor announced is that NHS funding, having been squeezed mercilessly by the Tories in the past decade, is returning to a position that is a little below its historical average. The reality is that in releasing this money, the Chancellor has simply removed the Treasury’s heavy boot from the neck of the national health service. If the Chancellor had had the good manners to remain in the Chamber until my right hon. Friend the Member for Ross, Skye and Lochaber (Ian Blackford) had spoken yesterday, he would have heard him ask why the Scottish national health service is being short-changed in the Budget to the tune of £50 million a year, which makes a cumulative shortfall of £250 million over the five-year period. That £50 million is enough money to pay for 1,200 nurses in Scotland.

In his Budget, the Chancellor had the perfect opportunity to do the right thing: stop the roll-out of universal credit dead in its tracks until the well-publicised faults in the system, which are hurting the poorest and most vulnerable in our society, have been fixed properly, once and for all.

[Jamie Stone (Caithness, Sutherland and Easter Ross) (LD)]

Further to that point, is it not a scandal that the Highland Council has to fork out £2.5 million of its carefully hained resources to pay for the roll-out of universal credit? What might that £2.5 million have done for some of the poorest people in areas such as Argyllshire and my constituency?

[Brendan O’Hara]

I could not agree more. The hon. Gentleman is absolutely right to highlight the cost to councils and individuals of the appalling roll-out of universal credit. The Government know that it is wrong, but they are pigheadedly determined to see it roll out. The Budget was the Chancellor’s perfect opportunity to stop it, but he refused. For reasons best known to himself, he decided instead to tinker around at the edges, with the promised money coming nowhere close to meeting the shortfall that was created by his predecessor. The Chancellor has decided to do almost nothing for those who are currently on universal credit and are struggling under the work allowance, the two-child cap and the benefit freeze.

As Gillian McInnes, the manager of the citizens advice bureau in my Argyll and Bute constituency, said:

“The Government has still not done enough to address the real problems of universal credit, which are causing serious hardship for many families. Without further support for families, many parents and children will be left in a desperate situation, with many”—

indeed, many more—

“forced into using food banks.”

This was the Chancellor’s opportunity to end austerity—he chose not to. This was his opportunity to stop and fix universal credit—he chose not to. Instead, he and the UK Government chose to hand out tax cuts to the wealthy while continuing to try to balance the country’s books on the backs of the poorest in our society. Heaven help us all if this was the Chancellor’s “good guy Budget”—the one that was based on the Government securing a half-decent Brexit deal. One shudders to think what he has up his sleeve when we are all forced to reconvene in this place early next year for his fiscal event, if and when the Brexit negotiations go totally pear-shaped.

Clinical Waste Incineration

Jamie Stone Excerpts

Tuesday 16th October 2018 Commons Chamber

[Stephen Barclay]

My hon. Friend will be aware that the Environment Agency is an independent body, so it will be for the Environment Agency to reach a decision on whether such a suspension should be raised. I can reassure the House that the issue is subject to great scrutiny at present and that the Environment Agency is looking at it very closely.

[Jamie Stone (Caithness, Sutherland and Easter Ross) (LD)]

It seems to me that there are two ways of looking at such issues. Factoring in numbers, statistics and logic is one way and leads to one conclusion, but when we think about human decency and human dignity it becomes something entirely different. The public’s confidence in the methodology is absolutely paramount at this stage. First, does the Minister recognise that, and secondly, can he tell me what he is doing to restore that public confidence?

[Stephen Barclay]

The hon. Gentleman is absolutely right, and I very much recognise that. The emotive nature of the topic and the way in which some of the headlines have been written do cause alarm. We are being very strategic. First, we are ensuring that our key priority, which is continuity of service in hospitals, is maintained. Secondly, we are ensuring that a supplier is mobilised as quickly as possible. He will recognise that to mobilise a supplier over so many contracts, where those contracts are not uniform—there are different legal provisions in them—is a complex issue. Thirdly, where there is an interregnum with regard to contingencies and waste that needs to be stored on site, we are ensuring that that is done in the safest way possible and that the waste is then cleared at the earliest opportunity.

Baby Loss Awareness Week

Jamie Stone Excerpts

Tuesday 9th October 2018 Commons Chamber

[Jamie Stone (Caithness, Sutherland and Easter Ross) (LD)]

It is a great privilege to take part in this debate. The hon. Member for Eddisbury (Antoinette Sandbach) and others have set an almost unsurpassable standard in their comprehensive, thoughtful and moving accounts of the issue before us tonight. When I thought about what I was going to say today, I found myself strangely circumspect, reticent and shy about what I might or might not say, possibly because I am old fashioned—probably more so than I should be. At the back of one’s mind there is always the thought, “Is it in good taste? Should I go there? Should I not?” But in a flash it came to me: I have only one sibling, my younger brother, who is nine and a half years younger than me, and all my mother ever said about this—she is dead now—was that she had a number of miscarriages between me and my brother. It is very much to my detriment, to my dishonour, that I never broached this subject with my mother and said, “What happened?” I very much regret that. My parents were immensely British, and they got on with it and suffered in silence, but I wonder how many miscarriages she had and what that agony was like. It is too late now, and “too late” are some of the saddest words in English.

The point has been made about parents, and I am a parent, all three of whose children were born relatively easily and successfully. As one or two Members of this place know, I am also a grandparent and a brother-in-law, and for that reason am not untouched by the type of tragedy that has been described today. One thinks, “It is not going to affect me”, but it comes damned close. So I have the experience. The second thing I found to be almost like a searing wound to me personally: witnessing the extraordinary grief of what happened. This was a searing, dreadful, ghastly grief. The hon. Member for Colchester (Will Quince) has said that we must reach out, give people a hug and ask how we can help, but that grief has to be seen to be believed and it is terrible.

[Victoria Prentis]

I have really appreciated the hon. Gentleman’s input into our group. We should, of course, have mentioned the importance of grandparents and wider family. They have been present in the all-party group, in the form of my father, right from its inception in the middle of the night, when we were waiting for a late vote, and they play a crucial role in helping parents and others to get through the awful loss of a baby. Of course grandparents matter!

[Jamie Stone]

The hon. Lady makes the point much better than I can. I take great comfort in the thought that I may be slightly more than just a doddering old fellow who amuses the kids. I like to think, and I hope, that I helped my two daughters through their trauma.

The hon. Member for Colchester made the point about the partner—about the man in the equation—several times, and nothing was ever truer. How terrible it must be to witness a stillbirth—a child who arrives too early to survive. I would dare to suggest that the man is emotionally every bit as bruised as the woman.

I wish to conclude simply by saying that in a debate such as this the House is at its best, and I give credit to the hon. Member for Eddisbury and others for that. I hope and believe that if people out there chance upon this debate online or read the record of it, they will find some human comfort—some milk of human kindness—which shows that we care. The hon. Member for Banbury (Victoria Prentis) mentioned to me the service in the Crypt on Thursday, and I will take part in the service and contribute a reading with the greatest of pleasure. Finally, I cannot even begin to surmise how, but when we had my family traumas, to my great surprise several Members, from all parts of the House, came up to me and said, “We understand. We know what you are going through.” When a completely unexpected hand reaches out like that, it is pure gold and reminds one of what friendship is really all about.

Acquired Brain Injury

Jamie Stone Excerpts

Monday 18th June 2018 Commons Chamber

[Mrs Sharon Hodgson (Washington and Sunderland West) (Lab)]

Thank you, Madam Deputy Speaker. That is now in Hansard. I am sure the Minister will enjoy it in the months and years to come.

It is an honour to speak in this very important debate, and I thank the Government for allowing the time for it. I pay tribute to my hon. Friend the Member for Rhondda (Chris Bryant) for calling for it and for his tenacity in ensuring it went ahead, against all the odds, when we all doubted it would and even though we are very pushed for time. I thank the all-party group on acquired brain injury and the right hon. Member for South Holland and The Deepings (Mr Hayes) for all their work and for their excellent campaign for better support and recognition for people living with ABI. I join the Minister in praising the work of the late and great Baroness Jowell. I, too, will never forget her last appearance in this Chamber in the Under Gallery.

Last month, along with colleagues from across the House, I was pleased to attend the rally for people with acquired brain injury at which they, along with their families, friends and carers, talked about their conditions and the services available to them. As we have heard, 1.3 million people in the UK live with the consequences of ABI, and each year approximately half a million patients attend UK emergency departments for traumatic brain injury. That is nearly 1,500 patients with traumatic brain injury attending A&E departments in the UK each day; one every minute. Brain injury can happen to anyone at any time, and all Members will have constituents living with the consequences of an ABI.

Despite the fact that so many people are living with ABI, it is little understood, which is why I am so pleased that the time has been allowed to discuss it in this place this evening. A brain injury can happen in an instant, but its effects can be devastating and last a lifetime. Thankfully, due to excellent advances in emergency and acute medicine, more and more children, young people and adults now survive and live with an ABI, but this brings its own challenges. As ever more people survive an ABI, further pressure is put on the vital services that people require.

For example, many individuals with an ABI require early and continued access to neuro-rehabilitation to optimise their recovery. The United Kingdom Acquired Brain Injury Forum says that the average cost of the initial rehabilitation programme is offset by savings in the cost of ongoing care within just 16 months and that this leads to an average saving over a lifetime in care costs of £1,475,760. That is a huge amount of money. Neuro-rehabilitation is therefore one of the most cost-effective services the NHS provides and one of the few services in medicine that result in long-term decreased costs to the economy. However, as is the case for many health conditions, the number of available beds across the UK is inadequate, service provision is variable and consequently long-term outcomes for brain injury survivors are compromised. What plans do the Government have to address those issues and improve the lives of patients living with an ABI? The UKABIF recommends a review of neuro-rehabilitation to ensure that service provision is adequate and consistent throughout the UK. Does the Minister agree that that is needed?

Many children and young people with an ABI are in education, and therefore the majority will receive most of their rehabilitation at school. Yet among education professionals there is a lack of awareness and understanding of ABI, its consequences, and its impact on learning. A pupil with an ABI may also require extra support when transitioning between primary, secondary and further education. What discussions has the Minister had with his colleagues in the Department for Education to ensure that children with an ABI receive the support that they need throughout their journey through the education system? Will he discuss with them the inclusion of ABI in the code of practice for special educational needs co-ordinators?

Brain injuries can be difficult to detect for people who are not already aware of them, which is why all education professionals should have a minimum level of awareness and understanding of ABI. In fact, that requirement goes beyond education and into everyday life. People living with ABI are discriminated against because of the general lack of understanding of their condition. For example, earlier this year Grace Currie was escorted out of a pub on a Saturday night because the bouncers believed that she was “too drunk”. In fact, Grace, who had suffered life-changing injuries after being hit by a car in 2010, had had just one drink. The incident must have been extremely upsetting and embarrassing for Grace, and I am sure that it really knocked her confidence.

Sadly, such encounters are not rare, and the level of misunderstanding of brain injuries is high among the general public, including assessors for employment and support allowance and personal independence payments. A study conducted by Headway found that 71% and 60% of respondents felt that assessors for ESA and PIP, respectively, did not have an understanding of brain injury. Further, assessors were widely reported to lack empathy and patience, resulting in a stressful and even traumatic experience for many brain injury survivors. Many respondents also said that their medical evidence was not taken into consideration, and that the assessment location and environment were not suitable for them, despite requests made in advance. Consequently, a strong sense of frustration and anxiety was reported by brain injury survivors and their carers about the failure to recognise or respect their needs throughout the application process. Has the Minster had any discussions with his colleagues in the Department for Work and Pensions about that issue? Will he look into those concerns with his colleagues, and ensure that they are properly addressed?

Living with a brain injury is difficult enough for people without their having to struggle to explain and prove their disability to anyone who lacks understanding of the condition. Each brain injury is different, which is why it is so important to raise awareness of ABIs. However, it is also important to recognise that such injuries affect not just the people directly concerned, but their families and friends. Headway aimed to highlight that during brain injury week last month for its “you, me, and brain injury” campaign. Headway found that 69% of brain injury survivors reported breakdowns in their friendships after the injury, and that 28% of relationships ended after an ABI. However, it is not all doom and gloom: 47% of survivors reported improvements in their relationships with family members. It was clear from Headway’s study that a little bit of understanding and time really can go a long way. That is the kind of service that is provided by its 127 groups and branches across the country.

Headway Wearside, whose representatives I met recently at the rally in Parliament, provides information, support and social activities for brain injury survivors, and works with the local community, relevant professionals and organisations to promote understanding of ABI. I spoke to Neil and Jimmy, who use the Headway Wearside service, and was touched when they explained that Headway had brought them together as a community, and they had formed friendships that they never expected to form. Headway Wearside does not just teach new skills, but helps people to form and develop friendships at a time when doing so might otherwise be hard. When I met with Neil and Jimmy we feared that this service might soon be lost, and I am pleased to say that it has been extended to June 2019, and I hope it will be extended still further so that patients can have access to this life-changing service. I pay tribute to Headway Wearside and all the work it does for the local community, and I will continue to support it so that this vital service can continue to support its 4,000 patients.

[Jamie Stone (Caithness, Sutherland and Easter Ross) (LD)]

My wife suffered exactly this problem in 1999. The eldest of my three children was sitting her exams—her highers—at school, and while that school and the education system in general supported them fantastically well, there is the issue of supporting the children, quite apart from supporting the sufferer of an injury like this. Will the hon. Lady elaborate on how we might increase the support and help for families caught up in such situations? My children got through it, but it was touch and go, and I remember these events without much happiness.

[Mrs Hodgson]

I thank the hon. Gentleman for sharing such a personal anecdote from his own experience. It demonstrates why it is important that we support the Headways across the country that are giving this vital support to families in the position his family was in, and he is right to mention the children of people with acquired brain injuries; they must not be forgotten in all of this.

Unfortunately, not every patient with an ABI will have access to a service like Headway Wearside. If the Minister is to take away one thing from this debate, I urge him to recognise the need for services such as Headway Wearside and the other 126 across the country, so that the more than 1 million people living with a brain injury can access the support they need and deserve.

--- Later in debate ---

[Dr Lisa Cameron (East Kilbride, Strathaven and Lesmahagow) (SNP)]

It is an absolute pleasure to speak in this debate on behalf of the Scottish National party. I worked in the NHS as a psychologist for many years, and I was involved in carrying out assessments of people who had acquired brain injuries. This is often a hidden disability. I would describe it as invisible much of the time and that contributes to much of the discrimination. It can have a major impact on people’s cognition, their personality—particularly if it is a frontal lobe injury—and their planning ability. It can have an impact on individuals’ speech. Some have to relearn vocabulary and the names of people they once knew. In severe cases, it can have a significant impact on someone’s memory. Consequent to all that is the impact on people’s mental health and their confidence.

I pay tribute to the agencies that work so hard with those individuals and their families, because a systematic and systemic family approach is what is needed to support individuals. The hon. Member for Strangford (Jim Shannon) is absolutely right in that regard, as he is in so many others. It is important to provide support to all members of the family. I also pay tribute to the hon. Member for Rhondda (Chris Bryant), who has played a crucial role in bringing this debate to the House. He is vociferous on this important issue, and he has again made sure that we have time to debate it.

My own husband suffered a head injury when he was serving in the armed forces many years ago, when his tank was overturned. He was a member of the Royal Electrical and Mechanical Engineers and is now a local veterans’ spokesperson. He was fortunate to have fast, intense rehabilitation. It is important that that is provided not only to those in the armed forces, but to the general population. I am interested in what the Minister has to say about medical spending on our veterans and their access to rehabilitation services in this regard, alongside our NHS trauma units.

There are also difficulties in relation to welfare benefit assessments, particularly for employment and support allowance and for personal independence payments. Those with an acquired brain injury often feel that their difficulties are not understood and not well assessed under the current procedures, so we need not only further training for assessors, but possibly to review the assessment process itself. Assessment sometimes does not pick up the fine changes that can have such a crucial impact on the daily living skills of people with an acquired brain injury. Support will be necessary because it can be difficult for those with such injuries to complete forms, gather adequate evidence and so on. The Minister for Disabled People is in her place this evening, so I will be grateful if she will meet with me, as chair of the all-party parliamentary group for disability, to discuss that further.

[Jamie Stone]

Does the hon. Lady agree that there is some evidence that the mobility aspect of PIP is not being recognised in this regard?

[Dr Cameron]

Yes, that is a fair point. Mobility is about not just how far someone can walk, but being able to plan a journey and many other aspects of day-to-day living skills that people can find so difficult. People may require support for such things, but that may not currently be picked up properly by an assessment.

Psychology is important in the assessment of such cases, because access to neuropsychology means that individuals can have memory and cognitive assessments at the time of injury and six and 12 months later to examine which functions have been recovered. That is important because different parts of the brain can take on functions that have been lost and because the individual’s pattern of recovery can be mapped, meaning that a rehabilitation plan can be specifically adapted to their needs. Access to neuropsychology is a key part of rehabilitation, so I will be interested to hear the comments of the Under-Secretary of State for Health and Social Care on neuropsychology services, particularly for those with an acquired brain injury.

Prisoners have been mentioned. Yes, there is a high level of acquired brain injury within that population and that has an impact in three ways: acquired brain injuries can increase impulsivity, they can lead to people making the wrong decisions and not thinking through the consequences, and they can lead to difficulty in undertaking the normal treatments available in prisons, such as cognitive behavioural therapy, meaning that such treatments may have to be adapted for prisoners to benefit from them. I am unsure whether that is occurring in our prison system, but it should happen right across the United Kingdom if cognisance is taken of such difficulties.

NHS Outsourcing and Privatisation

Jamie Stone Excerpts

Wednesday 23rd May 2018 Commons Chamber

[Mr Hunt]

I can give the hon. Lady that assurance. I am most grateful to her for raising that issue and reassure her that my hon. Friend the Minister of State responsible for hospitals was at the hospital on Friday, going into detail about how we make sure that there are no delays on that issue.

[Jamie Stone (Caithness, Sutherland and Easter Ross) (LD)]

rose—

[Mr Hunt]

I will give way one last time and then I will make some progress.

[Jamie Stone]

I thank the Secretary of State for giving way. On the issue of freedom of access and equality of access, would he at least concede that where there are issues of distance, rurality and remoteness of location, that is a challenge—although health is devolved to the Scottish Parliament—which means that it is not quite as free for some of my constituents as it is for people who live in Glasgow, Edinburgh or London?

[Mr Hunt]

The hon. Gentleman makes a fair point, which would be echoed by many Government Members who represent rural constituencies. There is a balance to be struck between the benefits of specialist surgery, where greater volumes of a particular procedure are done, leading to better outcomes for patients, and the trade-off that we make with travel times. I know that that is something that the local NHS, in all parts of the UK, thinks through very carefully.

There is another myth we always get from the Labour party that I think it is very important to dispel: the narrative about the NHS being in total decline. Let us be clear about the pressures facing the NHS. We had to deal with the financial crisis of 2008, which left this country’s coffers empty. We have had to deal with the fact that over the last seven years, we have had half a million more over-75s. We had to deal with a crisis of care at Mid Staffs, which turned out to be a problem affecting many other parts of the NHS.

Yes, it is true that we are missing some important targets at the moment, but let us not forget the extraordinary things that have been achieved despite that pressure, such as for cancer. We inherited some of the lowest cancer survival rates in western Europe. In 2010, only 10% of patients got intensity-modulated radiotherapy; that figure is now 44%. We have two new proton beam therapy machines—at the Christie and University College London Hospitals—and there are 7,000 people alive today who would not be had we stayed with the cancer survival rates of 2010. Every day, 168 more people start cancer treatment than did in 2010. This is a huge step forward.

On mental health, previously we had no national talking therapy service for people with anxiety and depression; today, 1,500 more people are starting or benefiting from talking therapy services every single day, and we have huge plans to extend mental health provision to 1 million more people.

NHS 70th Anniversary

Jamie Stone Excerpts

Wednesday 16th May 2018 Westminster Hall

[Jamie Stone (Caithness, Sutherland and Easter Ross) (LD)]

It is a pleasure to serve under your chairmanship, Mr Hosie. I am grateful to the hon. Member for Blaenau Gwent (Nick Smith) for securing this important debate. I wish the NHS a very happy birthday. I cannot understand—I get angry—when I hear politicians on the other side of the Atlantic rubbishing the NHS as a service. It is one of the greatest achievements of this country and, as has been said, credit is due to Clement Attlee’s Government for doing what they did.

Being born when I was, and being brought up in the Highlands, as a child I was part of the nascent NHS service. My late father told me what it was like before I was born. He spoke of the inequalities—how, if someone did not have enough money, their life would be shorter, because they could not pay for the doctor. That is how unfair it was. The NHS is about fairness, and that is why it is such a great achievement for this country.

I extol the virtues of the staff. Through my wife’s illness, I know how dedicated the neurosurgery team in Aberdeen Royal Infirmary is, and how fantastic the nurses were at a critical time in my wife’s life. She recovered, thank God. If there are angels on this earth, they wear nurses’ and doctors’ uniforms, believe you me.

The issue for Scottish Members is that the NHS is of course devolved, but I want to touch on something I mentioned in the summer when I questioned the Prime Minister. Within my vast and scattered constituency, we face really big challenges owing to remoteness and distance. There was a story in the national press recently about a mother who lived in Wick who had to make a 520-mile round trip to Livingston to give birth. That was due to an accidental coincidence of unavailability of services more locally. I do not want to give the staff a hard time—staff morale is crucial—and, for the record, I am not getting at the staff, but the fact that it happened should worry us all.

What we see in remote parts of Scotland, including my own constituency, is that there seems to be an impression that our network of local hospitals is not being used to the maximum it could be, in terms of treating people locally. I believe it is an issue of funding, which other hon. Members have also highlighted. What bothers me about what I think is happening in my constituency is that it seems to be taking us rather worryingly near to the sort of inequalities that my father spoke of. In other words, a person who lives in a very remote area of Caithness or Sutherland might not get the same deal as someone who lives in Glasgow, Edinburgh or Aberdeen, because it is harder to access services. That is the challenge for the Scottish Government, and for us all. Surely to goodness a person should not be disadvantaged because of where they live. That is what lay behind the Beveridge report, which in a way was influential on Nye Bevan bringing into being the NHS: the idea that no matter who someone was, or where they lived, they had an equal right to the service.

I do not know the answer. Health is devolved to Scotland, which I accept. It is rightly the property of Members of the Scottish Parliament and Ministers in the Scottish Government, who I am sure do their level best, but if there is a perception in Westminster that one part of the UK—it may be Wales, Northern Ireland or Scotland—is perhaps not functioning quite as it should, and on something as fundamental to our lives as the NHS, at the very least there has to be a conversation between UK Ministers and Scottish Government Ministers to say, “Is it going okay for you? Is there something we could do better? Is there something that can be co-ordinated better throughout the UK to make sure that whether someone lives in Scotland, Wales, England or Northern Ireland, they have the same access to health services?”

I give notice that this is an issue to which I will return, while of course always recognising the difficulty of the fact that health is a devolved matter and there are therefore limits on what I can say. I do not intend to be silent on the issue.

Surgical Mesh

Jamie Stone Excerpts

Thursday 19th April 2018 Commons Chamber

[Emma Hardy]

The right hon. and learned Gentleman is completely right, because mesh was given to lots of young women following childbirth—many women were still in their 30s—and it has left them feeling disabled.

[Jamie Stone (Caithness, Sutherland and Easter Ross) (LD)]

I am delighted the hon. Lady has this debate. Does she agree that, as well as young women, lots of males are caught in this sorry and ghastly trap? I have personally heard some terrible tales from my constituency, although I will not go into them just now.

[Emma Hardy]

The hon. Gentleman is absolutely right. After we have moved on from looking at vaginal mesh, we need to look at rectopexy mesh and mesh that has been used in men as well. I completely agree.

GP Recruitment and Retention

Jamie Stone Excerpts

Wednesday 28th March 2018 Westminster Hall

[Jamie Stone (Caithness, Sutherland and Easter Ross) (LD)]

It is a pleasure to speak under your chairmanship, Mrs Moon. I compliment the hon. Member for Houghton and Sunderland South (Bridget Phillipson) on a real tour de force around the issues before us today. Like the hon. Member for Strangford (Jim Shannon), I will dwell on an aspect of the issue that affects a constituency that is part of a devolved Administration. I hope that what I am about to say will be helpful at the UK level and possibly at the Scottish Government level.

I come from the basic premise that no matter where someone lives they have an equality of right to decent health services. I represent the second biggest constituency in the UK, and there is a particular challenge in the north of Scotland in terms of access to GPs and other medical services. In that context, within the past few days a big issue has developed—it has been fairly well reported in one of Scotland’s main newspapers. In the Caithness part of my constituency, in the top right- hand corner of Scotland, GP provision and access to other health professionals is not what it should be, notwithstanding the best efforts of the professionals that we do have. In no way do I want anything I say to denigrate their efforts because they work exceedingly hard, but the issue is a big concern for my constituents, and they raise it with me repeatedly.

Out of fairness to the Scottish National party represented here, the matter is devolved, but I hope that what I suggest will be helpful. A group called the Caithness Health Action Team has been formed and it outlines the problem on its Facebook page probably more succinctly and better than I can during the brief time available to me. I give credit to the fact that the group is campaigning in a constructive way to try to help matters.

NHS Highland has recently admitted that the recruitment and retention of GPs and similar professionals in other branches of medicine is proving a real challenge in that remote area. It really prompts the question of whether we say there is nothing we can do about it. Do we have to walk away and accept that some parts of the UK or Scotland will not have equality of provision, or do we say we will roll up our sleeves and tackle it? In my book, the answer is the latter.

Before I return to recruitment specifically, one of the most irritating things, or perhaps encouraging things, is that when we recruit a health professional in somewhere like my part of the world—although I daresay it is also true of Plymouth—after a while they begin to love it. There is every chance they might settle and their children be educated locally, and that is good for the community. That is a prize worth remembering.

I want to mention two specific points. Several Members have already mentioned a kind of bursary, a cash incentive to encourage someone to do GP training. We all know how expensive medicine is, how student debt can be built up and the length of time it takes to qualify. This is just a suggestion and it might not be possible within UK recruitment law—I am prepared to be corrected—but I am keenly aware that the armed forces can offer a bursary to go to college or university to be trained, but part of the deal is that when the person graduates the armed forces can send them to where they are needed most. I have a daughter who is serving in the armed forces and she knew right from the start that that was part of the deal. Whether that can be done within UK law, I do not know, but it might be worth looking at. A given health authority could help someone through their five years of GP training, but then have the right to say that for the next two or three years they will be placed in Plymouth, Wick or wherever in the UK. I think a cross-border UK-wide solution is best in that respect.

My second point is an old one. I remember that when I was a kid the nurse got a house. There were doctors’ houses, and that made a difference in recruiting people. As far as I am aware, the nurses’ houses have all gone and no longer exist, but it was part of the local authority’s responsibility to allocate such housing.

The answer in the Scottish context is for NHS Highland and probably the Scottish Government to take a co-ordinated and targeted approach to a specific problem in a specific part of the highlands. I think the willingness is probably there, to give credit where it is due. As and when a solution is found as to how we get people into the area, that experience could be useful to UK Government Ministers as well. There is everything to be learnt from each other. Should the Minister or the UK Government find a way to deal with these problems before the Scottish Government do—

[Ross Thomson]

As a constituency MP, the hon. Gentleman has no doubt had the same correspondence that I have had from Scottish students who have been denied access to Scottish medical school. I do not know whether he shares my concern that the current cap by the Scottish Government on Scottish domiciled student places means that only 51% of current medical places at university are filled by Scots.

[Jamie Stone]

That is a relevant point, and I share that experience. I do not want to go into the specifics, but within the past two days I have encountered the case of a sixth-year pupil at a school in my constituency who, because of the curriculum limitations in the sixth year, will be unable to pursue the tertiary education in the medical field that she would like to. It is a worry, but I shall take that up with the director of education.

The matter we are debating is a big issue in my constituency. It is particularly acute because of the distances involved, and it is at the forefront of my constituents’ concerns. I accept that it is devolved, but I feel duty-bound to air the matter in this place.

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

It is a pleasure to serve under your chairmanship for the first time, Mrs Moon.

I declare an interest, in that my other half is a GP. He is German and has been here in our service for 32 years. That highlights a particular problem that we shall face in the next few years because of Brexit. As the hon. Member for Houghton and Sunderland South (Bridget Phillipson) mentioned, GPs are not just gatekeepers, but are the core and heart of general practice, which is where most interactions occur. They specialise in teamwork and continuity. They may know their patients for years and over generations. All UK health services face three key problems. We all face tight budgets and increasing demand because of an ageing population, and the workforce is bringing those things to a head in relatively short order.

There is a drive in Scotland and England to rebalance the proportion of funding that goes towards primary care, to approximately 11% of the budget. With the climbing complexity of cancer care, emergency care, A&E and targets, more money has been moving into secondary and, indeed, tertiary care. The demand is still there. Having worked as a breast cancer surgeon for more than 30 years I can tell the House that we also face shortage and increased demand, so there is no easy solution—but if primary care fails, the entire system fails.

In Scotland the new GP contract was designed by working with the British Medical Association, and at the moment it is in phase 1, which is trying to stabilise the system. Two thirds of practices will have a significant increase in income, and the others will be protected so that no one experiences a fall. Phase 2, which will start next year, is an attempt to consider something a bit more radical. It touches on issues that have been raised by some Members, to do with changing the shape of primary care, and the system. The income of GPs varies hugely. Some practices are immensely profit-making and have a good income. In other areas the GP, despite perhaps working longer hours, may earn £20,000 or £30,000 a year less. That means that the area in question becomes relentlessly harder to recruit to. Consideration is being given to whether there should be a range of income, perhaps similar to what consultants have—an NHS salary.

That is obviously a huge change from the situation at the moment—the independent contractor status. Older GPs who have lived with independent contractor status certainly do not want it to go. They welcome the independence and the ability to design and run their practice as they see fit. However, it is important to recognise that the younger generation feel utterly differently. As has been mentioned, they are not interested in buying into a practice or even, necessarily, in being partners. They are not attracted to the businessman side of being a GP. Therefore we need contracts that do not destroy independent contractor status for those who already have it, or those who want it, but that enable people to work in practices where perhaps the building is provided by the health board, and where they are salaried and can create a more predictable work-life balance.

One of the small-print issues that is arising in England is the fact that no new general medical services contracts have been awarded since 2013; everything has been done on the basis of alternative provider contracts, which means that they are only for five years. It might be attractive to a big multinational to take on a franchise and hope that it gets the contract again; but there is no possibility that a family doctor would be interested in setting up or taking on a practice for a mere five years.

[Jamie Stone]

I am greatly interested in what the hon. Lady is saying, which is very constructive, good stuff. Would she, at this stage in her planning, factor in the extreme rural issue that I mentioned, in any way?

[Dr Whitford]

If the hon. Gentleman will bear with me, I shall come to that naturally later.

The issue of indemnity has been touched on. I am not sure whether it is realised how extreme the position is. GPs in England are paying three to four times the indemnity that GPs in Scotland are paying. The range in Scotland would be £1,500 to £2,300 on a range of half a dozen to 14 sessions, but in England that would be £5,500 to £9,500. That is a considerable chunk of money to ask of someone, and it is very significant when it comes to taking on the extra weekend surgeries of seven-day working, or out-of-hours work.

Leaving the EU: NHS

Jamie Stone Excerpts

Thursday 22nd March 2018 Westminster Hall

[Mr Bradshaw]

My hon. Friend is absolutely right. The uncertainty not only bedevils business decisions, but is having a huge effect on the NHS, the pharmaceutical industry and the staff in all these sectors.

[Jamie Stone (Caithness, Sutherland and Easter Ross) (LD)]

I represent the most remote constituency on the UK mainland. The recruitment and retention of qualified staff is a huge issue in my constituency. Does the right hon. Gentleman agree that a crash out, and the problems he outlines, will be even more emphasised in the north of Scotland?

[Mr Bradshaw]

Coming from a peripheral region, I completely understand the challenges that the hon. Gentleman and his constituents face and the difficulty that our health and social care systems already have in recruiting and retaining staff.

I will give the example of midwives. EU midwives provide care for 40,000 mothers in England every year. The Royal College of Midwives has reported that the number of EU midwives registering to practise in the UK has fallen “off a cliff’ since the referendum, and that at the current rate of loss there will be

“no EU midwives left in the UK within a decade.”

We must have a clear assurance from the Government that, whatever the deal or no deal, the vital flow of EU medical and other staff to this country will not be affected. EU nationals already here also need an absolute assurance that their current status and that of their families will not change.

Thirdly, we would suffer the relocation of significant parts of our pharmaceutical industry—one of Britain’s most important and successful sectors—to the continent. Indeed, as part of our inquiry we were told by GlaxoSmithKline and other companies that they have already spent tens of millions of pounds moving research and medicines licensing work to other EU countries as part of their contingency planning for a hard Brexit. That money would otherwise be spent on medical research in this country. It is investment that they told us will not come back.

Fourthly, UK citizens visiting or living in the rest of the EU, including a large number of British pensioners, could lose their eligibility for reciprocal free health care. If they could not afford to pay, they would be forced to fall back on our health and social care system. The average cost to the UK of a British citizen being treated in the rest of the EU is £2,300. The cost of treating a pensioner in Britain is almost double that at £4,500.

Our report highlights a lot of other areas where there will be a serious impact if we get Brexit wrong: the potential loss of European Reference Networks, access to and participation in clinical trials, research funding, the mutual recognition of qualifications and data sharing. The loss or diminution of any or all those areas would damage Britain’s leading role as a medical research centre and the cross-fertilisation of knowledge and expertise that is so important for medical advances and patient safety.

I know that many other hon. Members want to speak, so I will bring my contribution to a close. Before I do, it is important to note that there are areas that the Health Committee’s latest report does not cover: concern that future trade deals with countries such as America could open up the NHS to wholesale privatisation; the possible impact of diverging from EU standards on the environment and food safety on public health, which the Committee plans to return to later this year; and, most significantly, the economic and fiscal impact of Brexit and the knock-on effect on health and social care funding as whole.

We know from the Government’s leaked impact studies that all Brexit options will hit Britain’s GDP over the next 15 years by between 2% and 8%—that is, 2% if we stay in the single market and customs union, 5% for the Government’s preferred option, and 8% in the case of a no-deal scenario. Unless the Government propose to significantly increase taxes or borrowing, or to cut other public services to move money to the NHS and social care, that can mean only that there will be less money available for health and social care, and not the extra that was promised on the side of that bus.

All in all, the next few months of Brexit negotiations will be absolutely critical for the future of our NHS for years to come. Our constituents expect us to hold the Government closely to account, and we will.

Acute and Community Health

Jamie Stone Excerpts

Thursday 8th February 2018 Commons Chamber

[Stephen Barclay]

My hon. Friend is absolutely right. That is why we are increasing the number of doctors we train by 25%. We are also looking into how we can increase the number of clinicians in leadership positions in trusts, and how we can reduce variance. That is one of the key issues. The NHS has some brilliant leaders, but the variance between trusts is far too wide.

[Jamie Stone (Caithness, Sutherland and Easter Ross) (LD)]

Given that health is devolved to the Scottish Government, Mr Speaker, you may wonder why I am asking this question. Will the Minister reassure me first that the report will be shared with NHS Scotland and the Scottish Government, and secondly that, as and when senior appointments are made, there will be an ongoing, constructive and informed dialogue across the border? Now you will see why I asked the question, Mr Speaker.

[Stephen Barclay]

I am happy to reassure the hon. Gentleman, but he has raised an important point. The question of people moving within the United Kingdom is not the only issue; another potential issue is the question of people moving to a charity or a private company that is providing services for the NHS, or taking up other roles in the healthcare landscape.