Ultra-processed Food

Jo Gideon Excerpts

Wednesday 21st June 2023 Westminster Hall

[Jo Gideon (Stoke-on-Trent Central) (Con)]

I thank my hon. Friend the Member for Stourbridge (Suzanne Webb) for securing this important debate on a subject that is really close to my heart.

Most people are now aware of the health impacts of HFSS diets, yet it is increasingly clear that the primary cause of diet-related disease is not a diet that is high in fat, salt and sugar, but rather one that is high in UPF. However, as has been said, I wonder how many people know what UPF is and what it stands for, even though it represents 60% of the average UK diet.

To put it simply, if a food is wrapped in plastic, has at least one ingredient that we would not usually find in a standard home kitchen, or has a health claim on the packet, it is likely to be UPF. Much of it will be familiar as junk food, but there are also plenty of organic, free-range and “ethical” ultra-processed foods that might be sold as healthy, nutritious, or useful for weight loss.

Home-made chips, lasagne and cake are not the same as their UPF equivalents. The processing is what is important—so we do not have to all give up cake, as long as we make it ourselves. When we think about food processing, most of us think about the physical and chemical things done to food, but the definition of ultra-processing includes its purpose: to create profitable, convenient, hyper-palatable products. Those indirect processes—marketing, legal challenges and lobbying—all make the issue of how to tackle the health impacts of ultra-processed foods more complicated.

The evidence on ultra-processed food is robust. It is not just a couple of trials; hundreds of papers and high-quality data show the wide-ranging health impacts. Many people are unaware of how artificial the designs of ultra-processed foods are. They typically contain little, if any, whole food. The food’s structure is destroyed by industrial processing, meaning that UPFs are usually soft. They are therefore easy to eat quickly, which means that people eat far more calories per minute and do not feel full until long after they have finished eating. UPFs contain drastically reduced levels of phytochemicals, which are essential for dietary health and cannot be replaced through supplementation. There are also extensive environmental effects. The monocultural food system necessary for the production of UPFs is a leading cause of declining biodiversity and the second-largest contributor to global emissions.

If they are so bad for us, why do we eat them? Highly processed foods are on average three times cheaper per calorie than healthier foods. People from households with lower financial security or food security report consuming fewer fruit and vegetables, less fish and more sugar-sweetened soft drinks than those who are more financially secure.

The rise of UPFs is an emergent property of today’s commercialised and commodified food systems. Many people feel food systems have become more profit driven, with natural and fresh food less accessible. For example, buy-one-get-one-free offers in supermarkets often tempt us to buy more but, in 2015, supermarket promotions in Britain were the highest in Europe, with around 40% of our food expenditure going on promoted products.

Lord Hague recently wrote a fabulous article that argued that it now seems extraordinary to us that tens of millions of people used to smoke cigarettes without realising the serious harm they could cause. I suspect that when people look back a few decades from now, they will have a similar sense of incredulity about the food we eat.

One in 20 UK cancer cases is down to excess weight, which is the second largest preventable cause of cancer after smoking. Diet-related disease is the leading cause of early mortality, with the primary cause being high-UPF diets. Two in five children in England face ill health as a result of the food they eat. Those children are five times more likely to develop serious and life-limiting diet-related conditions in adulthood.

We must re-design our food system to put health first. That our diets should be made up mainly of real food seems simple. Individual responsibility is important but, to facilitate it, we must ensure that as many children as possible finish school with the knowledge and ability to cook healthy and nutritious food for themselves. I am arguing for a proactive approach to public health that equips people with the tools and information they need to make informed, healthier choices. We must also increase the powers of local authorities to empower their communities to address their unique health challenges by, for example, tackling the flood of unhealthy food and drink advertising in outdoor areas, especially near areas where children congregate.

The levy on sugar and soft drinks has been an enormous success. The sugar removed from the national diet as a result is estimated to be equivalent to the weight of 4,000 double-decker buses, without leading to a fall in sales. Fiscal measures can incentivise—

[Carol Monaghan]

I am sorry to interrupt the hon. Lady’s flow. Sugar may have been removed from soft drinks, but other things have gone in. We have already heard about aspartame, which is a particularly horrible sweetener. We know that the levy has taken a huge amount of sugar out, but it has not had any impact on obesity, particularly childhood obesity, so maybe we need to look at other things too.

[Jo Gideon]

I entirely agree with the hon. Lady. If I had my way, fizzy drinks would be banned from all schools and would be hugely discouraged wherever they are sold, but at least the money raised from that tax helps to educate people that we need to look at what we are drinking and eating.

I will not take up more time, but I want to make the case that we have good reason to look closely at the food that finds its way on to the nation’s plates, and we should take ways to tackle the health impacts of ultra-processed foods seriously, renew our commitment to halving childhood obesity by 2030, reduce diet-related inequality and create a long-term shift in our food culture.

Down Syndrome Bill

Jo Gideon Excerpts

3rd reading
Friday 4th February 2022 Commons Chamber

[Jo Gideon (Stoke-on-Trent Central) (Con)]

We have had some amazing contributions today. First, I obviously thank my right hon. Friend the Member for North Somerset (Dr Fox). This is an incredibly important Bill. At the beginning of the debate, he said that the narrowness of the Bill was important to getting it through as a private Member’s Bill, and I want to reflect on that.

I have my own private Member’s Bill, the Button Batteries (Safety) Bill, for exactly the same reason: when we talk about protecting the vulnerable, sometimes we have to be very specific. Following the tragic death of Harper-Lee Fanthorpe at the age of two after swallowing a button battery, I hope my Bill will protect more children by making parents, carers and others aware of the dangers. I was lobbied by others to broaden my Bill to include things such as magnets, because they are also things that young children ingest. The more vulnerable the children, the more likely they are not to recognise the dangers of things such as button batteries, so I have been campaigning long and hard on that important issue.

I recognise that it is important to focus on the key issue. In this case, that is the rights of people with Down syndrome, and my right hon. Friend the Member for North Somerset makes a very good point about life expectancy. I do not know whether Members saw “Call the Midwife”, where it looked at how Down syndrome was viewed back in the ’50s and ’60s and how far we have come in understanding and on life expectancy. It means we have to protect, as well as ensuring that there is much better preparation, I guess, for a longer life—and that preparation starts in school. As chair of the all-party parliamentary group on youth affairs, I have looked at the issues with education. Sadly, only one in four young people with Down syndrome finds themselves in mainstream education.

[Mr Mohindra]

My hon. Friend mentioned APPGs. Does she agree that the role of APPGs is important in ensuring that we have an informed debate? They give colleagues and professionals the platform to go in depth into topics, so that when we are discussing them in this place we come from a position of experience and knowledge.

[Jo Gideon]

I absolutely agree. The key thing is that APPGs by their very nature are cross-party. On issues such as those we are discussing today with this Bill—this is a cross-party topic—the more that we can find consensus, the better it is for the people we represent.

Looking at schools, the Bill asks for a curriculum tailored more towards children with Down syndrome and for more teachers to be trained to understand how to teach children with the condition and the specific learning profiles of that condition. It is a fact that Down syndrome pupils in mainstream schools achieve on average at two years above the academic level of those in special schools.

Having said that, there are some fabulous special schools, and I want to give a shout-out to Aurora Hanley School in Bucknall in my constituency. There is some wonderful work going on. I also want to mention Stoke and Staffordshire Down syndrome social group, who have posted a lot about this issue. They meet regularly at the Bridge Centre in Birches Head, and they make a difference to about 50 families. It is a massively important contribution that everybody can make.

[Dr Fox]

Is the very point that my hon. Friend makes about the lack of knowledge one of the key reasons why the amendment to the Bill is so important? It will mean there is a named individual on the integrated care board who can act as an advocate, but also spread knowledge to other members of the integrated care process about the condition and the needs and wants of those involved.

[Jo Gideon]

My right hon. Friend makes a hugely important point. The integrated care boards will have a huge amount of responsibility for care across the board, and the understanding of the specific needs of those with Down syndrome requires a named lead. It is essential, because otherwise, sadly, the detail may get lost in the breadth of what the boards have to cover.

[Brendan Clarke-Smith (Bassetlaw) (Con)]

My hon. Friend mentions education and ensuring that those with Down syndrome have access that is adequate for their needs, whether in a special school or a mainstream school. Does she agree that it is vital that these choices are offered and that parents and people are fully informed of what is available for them? It is important that we provide a choice that is the best for their needs and that we make sure it is available to them?

[Jo Gideon]

My hon. Friend is absolutely right. All the statutory authorities need to understand that the statutory duty in this Bill will require them to provide guidance and a level playing field for people with Down syndrome.

[Edward Timpson]

As a fellow member of the Health and Care Bill Committee that looked at the new integrated care systems that are being introduced, my hon. Friend will know that they have been delayed slightly until April this year. Does not that present an opportunity for the Minister to write to all the chairmen and chief executives of the interim boards, or those who have been appointed to the new interim care boards about the Bill; and, hopefully, for them to act in due course so that they are prepared for the guidance that is coming and can inform the wider board about that at the earliest opportunity?

[Jo Gideon]

I thank my hon. Friend. It is absolutely right that the integrated care boards and the Health and Care Bill need to accommodate what is suggested in this private Member’s Bill. The integrated care boards, as I have said, will have a huge breadth of responsibility. Unless we are quite specific on certain duties, they may get lost and that cannot be allowed to happen.

[Jonathan Gullis]

I would like to associate myself with my hon. Friend’s comments regarding the fantastic organisations based in the great city of Stoke-on-Trent. I give a particular shout-out to Watermill School, based in the Stoke-on-Trent North, Kidsgrove and Talke area, which is being extended as part of a £7.5 million refurbishment to increase our SEND provision in the city, which is sorely lacking at present.

My hon. Friend specifically mentioned the education of teachers. As someone who spent eight and a half years in the teaching profession in state schools both in London and in Birmingham, I am sad to say that, at no stage, as a head of year or as a frontline teacher, was I ever given training about engaging with and looking after a child with Down syndrome. In fact, with some learning needs, the teacher would have that conversation only if they had a child in their class or year group with that learning need. It is simply not right, and nor is it fair on those young people, who deserve to have their full potential unlocked. Does she agree that, as part of the legislation that my right hon. Friend the Member for North Somerset (Dr Fox) is putting forward—this fantastic legislation—we need to have a serious conversation with the Department for Education, working with local authorities, not just about what type of training is done at the start of term or when a student enters a school, but about how the continuous training and development of teachers happens all year round?

[Jo Gideon]

I thank my hon. Friend. I absolutely agree. I think we need to look at the whole pathway from education to work, as we said earlier.

I would like to mention a very interesting and important project that I was involved with a few years ago in a very isolated community in the Brecon Beacons called Myddfai. The challenge was to create sustainable employment and regenerate a very isolated village. As part of the project, we created a trading company, and within that trading company we were able to employ a number of young people. I am glad to say that, eight years on, there are still young people employed there today, some of whom have Down syndrome. Members can see if they look on the website, myddfai.com, how happy they look in the photographs. It is really satisfying to see how the right employment can fulfil.

[Lia Nici (Great Grimsby) (Con)]

My hon. Friend is making an excellent speech. Talking about employment, does she agree that this landmark Bill identifies that people who have Down syndrome have specific needs and that employment is a vital part of everybody’s life, as is having rewarding, independent living and good employers? We need more employers to consider people with special needs.

[Jo Gideon]

My hon. Friend makes a good point and we touched on it earlier. An understanding of what support is needed specifically is probably not good enough in the world of employment, education and local authorities as statutory providers. What this Bill will do, I believe, is put a duty of care on everybody, but also a duty of education. In my experience, employers genuinely want to be helpful to everybody in their communities, but there is a role for all of us to play in understanding what additional support might need to be provided to people with Down syndrome. I am sure that there are good local examples, but it is challenging for employers if they do not have that knowledge. We should consider that as part of the duty to develop personal development paths for young people with Down syndrome.

[Lia Nici]

What my hon. Friend says is vital. Does she agree that Members of Parliament are well placed to be that conduit with education organisations and employers to help and guide them, and to give them confidence in how to get help to ensure they can employ and support people with Down syndrome in their workforce?

[Jo Gideon]

I entirely agree. We are in an incredibly privileged place to highlight that need and to work with those who will help us take forward this massively important agenda. I congratulate my right hon. Friend the Member for North Somerset on his Bill.

Health and Care Bill (Twelfth sitting)

Jo Gideon Excerpts

Committee stage
Thursday 23rd September 2021 Public Bill Committees

[Jo Gideon (Stoke-on-Trent Central) (Con)]

I have listened with great interest to the points made by the hon. Lady and by the shadow Minister, the hon. Member for Ellesmere Port and Neston, but I do not recognise my NHS as being a sort of binary choice between public and private sectors.

During the pandemic, we have seen the incredible work across sectors; I am glad that the shadow Minister mentioned the voluntary and community sector, and charities, because that sector has largely been left out of people’s comments. Possibly it was convenient to leave it out because it shows that the breadth of the NHS family is more than the NHS itself; it is very much about everybody working together. For me, that is what integrated care is all about. I welcome the mention of the voluntary and community sector.

When we look at NHS procurement, we also need to focus on prevention as well as on clinical treatments because the wording of new clause 12 seems to focus very much on clinical treatments. We all agree, I think, that the purpose of integrated care is to have a big focus on the prevention piece, and the NHS family must surely include the third sector and private sector providers that are specialists in that area. For me, there is no conflict.

[Edward Argar]

I welcome the sentiments underpinning some of Opposition Members’ comments about our changes to section 75. I am nothing if not prepared to listen and be pragmatic, and I am glad that they at least welcome that aspect of the Bill.

I will address directly a number of Opposition Members’ points. My right hon. Friend—I mean my hon. Friend the Member for Stoke-on-Trent Central, but it is surely only a matter of time before she is right honourable—was absolutely right about the NHS family being wider than the NHS itself. All these organisations are involved; to be fair to the shadow Minister, the hon. Member for Ellesmere Port and Neston, he mentioned the voluntary sector and particular organisations that have done amazing work in the past year and a half. In fact, they do that work every year, and day in and day out, working hand in hand with the NHS. I put on the record my appreciation of the independent sector providers for what they have done during this pandemic to support the pandemic response.

The shadow Minister asked a very specific question about what activity had been undertaken, what money had been spent and what assessments had been made, including of value for money. I do not know whether I have written to him already, but a number of colleagues from across the House have written to me and I have set out, in broad terms, the number of patient episodes that have been provided by the independent sector. If he would like me to write to him in a similar vein, I am very happy to do so; my officials have heard that commitment and I will adhere to it. Regarding the broader point that he made about value for money, cost and how money has been spent, those details will be published later in the year in the usual way, when the accounts for the last year have been audited. They will be published; I make that commitment to him.

The shadow Minister raised a number of other specific issues and I will address one head-on before addressing the substance of the amendments. Essentially, he said that the NHS should be deemed the preferred provider by default almost, citing the words of Dr Chaand Nagpaul. Dr Nagpaul and I have our differences of opinion, shall I say, but he is an eminent clinician and performs a very important role, and I put on the record my respect for him and for the principles that he articulates on many occasions.

I believe that the key defining feature should be what delivers the best outcomes for patients, rather than simply having a default presumption. Now, that may well regularly be, as Dr Nagpaul asserted, the NHS. However, I think we should start from the presumption of what delivers the best services and the best outcomes for patients.

The shadow Minister asked—I think he asked this, but if it was the hon. Member for Bristol South I hope she can forgive me—what regime would apply to the Department. My understanding is that that would continue to be the Public Contract Regulations 2015 in the context of the Department itself. The hon. Member for Ellesmere Port and Neston suggested that in the next couple of years we would do the next reorganisation; I can reassure him that I am not necessarily sticking to the new Labour playbook of 1999, 2001, 2003—doing something almost every two years.

The hon. Gentleman’s broader point was about the involvement of private sector providers. He will be aware of this, because he knows his NHS and health history, but one of the key points came in 2004—the first time the then Government opened up clinical services to tendering by the private sector, in that case for out-of-hours services. Again, “any qualified provider” dates back to 2009, under the title “any willing provider”, as it then was. It was exactly the same scheme, and all that happened in 2012 was that the name was changed from “any willing” to “any qualified” provider; the scheme was brought in under the Government led by Prime Minister Brown.

Governments of all complexions have amended and changed the clinical regime to recognise that there is a role, as there always has been, for private and voluntary sector providers and, of course, for the NHS at the heart of it. None of that puts at risk a taxpayer-funded NHS that is free at the point of delivery. For the record, I reassure the hon. Gentleman, as he would expect me to, that in the context of trade deals the NHS is not for sale: it never has been, and it never will be.

Turning to the detail of the amendments, amendment 95 would change the scope of the regulation-making powers in this clause. Currently, these will govern the procurement of healthcare services for the purposes of the health service; this amendment would broaden the provision so that it extends to all services required by the health service.

The NHS procures many services, but has specifically asked us to introduce a new, tailored provider selection regime that would replace section 75 and enable it to arrange healthcare services in a more flexible manner and one that fosters integration and collaboration. The NHS has told us that the current competition and procurement rules, particularly the PCR 2015 rules, are not well suited to the way healthcare is arranged in the context of the services the NHS provides. They create barriers to integrating care, disrupt the development of stable collaborations and can cause protracted processes with wasteful legal and administration costs, while adding little value to patients or the taxpayer.

Regarding the hon. Gentleman’s specific question, I am afraid the individual costs over the years since 2012 would have been borne at a local systems level, so I suspect that they are not agglomerated together in a national figure. However, I understand his reasons for asking.

When NHS England consulted on the new provider selection regime earlier this year, it suggested specific key criteria to be used in decision making under the regime, tailored towards the effective arrangement and delivery of healthcare services. The proposed criteria include integration and collaboration, and that services should protect patient choice and focus on tackling inequalities. Having a power to introduce procurement measures specifically for healthcare services will enable procurement decisions to focus on such tailored criteria, and to create a regime that works best for the health service.

However, it is right that non-healthcare services—cleaning services, administrative services and others—should, and will, still fall under the PCR 2015 and, in future, the new Cabinet Office procurement regime, which is currently being considered. This will ensure that these services are still arranged in a way that continues to add the best value to the healthcare system.

We know there may be cases in which it is essential that a service is procured as part of a healthcare service contract—I think that was one of the hon. Gentleman’s points. It is for this reason that we have included the ability for regulations made under this power to include provision in relation to mixed procurements, where other goods and services are procured together with healthcare services.

We are working closely with the Cabinet Office and with stakeholders across the health service to ensure that the regulation of mixed procurements of healthcare and other services works effectively for the appropriate arrangement of healthcare services and for the arrangement of wider public services, with respect to their distinct characteristics. Should the hon. Gentleman wish to write to me and ask me to forward his letter to the Cabinet Office to ensure it is cognisant of his views, I am happy to do that.

Amendments 96 and 99 and new clause 12 in effect make statutory NHS providers and general practitioners the preferred provider of NHS-funded services, but our intention is not quite as rigid as what the hon. Gentleman would wish. As I have said, the vast majority of NHS care has and will continue to be provided by public sector organisations, but successive Governments of all political affiliations have allowed the NHS to commission services from the private and voluntary sector, to improve accessibility and experience for patients, to increase capacity swiftly or to introduce innovation.

It is the strong view not just of this Government but of the NHS that local commissioners are the best people to determine what services a local population needs. The best interests of patients, the taxpayer and the population, rather than dogma or ideology, should guide those decisions, and that is what this Bill aims to deliver. I know that the hon. Gentleman is certainly not dogmatic—he may be ideological, but he is certainly not dogmatic—so I hope he appreciates the sentiment behind that statement.

Amendment 99 would mean that a contract for the provision of healthcare services could not be awarded to a body other than a relevant body as defined in the clause unless a full formal competitive tendering process had been followed. This requirement would need to be set out in the regulations made under proposed new section 12ZB.

Amendment 96 would require that regulations include the power for ICBs to commission services provided by an NHS trust or foundation trust without retendering. Regulations would also need to require an ICB to conduct a public consultation and publish a business case where it wished to put out to competitive tender a service currently provided by an NHS provider for contracts over an agreed value. They would also need to require an assessment to be made of alternative ways of providing a service using NHS providers before a contract with a non-NHS provider were extended or renewed. It would require any procurement regulations to be based on the assumption that the NHS is the preferred provider. Regulations would also need to add a requirement on providers to pay and provide terms and conditions of employment to their staff that are at least in line with those of the NHS.

In addition, the amendment would require NHS England to publish a report on the proportion of contracts subject to the regulations made under the new power that are awarded to different types of providers, and would require both NHS England and ICBs to publish a plan for reducing private providers’ provision and increasing the capacity of NHS providers to provide those services. As the shadow Minister set out, it would require ICBs to publish in full bids received for contracts, contracts signed and reports of contract management.

By way of context, the NHS has told us that the current competition and procurement rules are not well suited to the way healthcare is arranged. That is why we are creating a new provider selection regime that provides greater flexibility, reduces bureaucracy on commissioners and providers alike, and reduces the need for competitive tendering where it adds limited or no value. I fear that the amendments would start reimposing a degree of that bureaucracy. The absence of competitive tender processes does not mean an absence of open, transparent and robust decision making. Our proposed new regime is designed to allow transparency, scrutiny and due diligence in decision making, but without all the barriers and limitations associated with running full tender exercises.

NHS England has laid out a series of reasons in its public consultation why competitive tendering may not be suitable in every case. We do recognise the value of competition in particular cases, but this is about introducing an element of greater flexibility, rather than rigidity. NHS England has proposed that, having considered a set of key criteria, the decision-making body may have reasonable grounds for choosing either to continue with the incumbent provider where it is doing a good job and the service is not changing, or alternatively, where the service is changing, of selecting one provider or group of providers or of course holding a competitive tendering process.

Structuring the new provider selection regime around such criteria will ensure that the factors taken into account by commissioners are those relevant to the health service, while still retaining flexibility in the types of provider from which commissioners can commission. Amendment 99 would mean that these regulations go further than the existing rules under the PCR 2015. Those regulations allow for an exception to competitive tendering where competition is absent for technical reasons, but this provision would not allow for that, nor for an exception in relation to a procurement for an extremely urgent case.

Transparency was a keen concern of the hon. Gentleman. Regulations and statutory guidance made under new clause 68 will set out rules to ensure transparency and scrutiny of decisions to award healthcare contracts under the new provider selection regime. The regulation-making powers specifically allow for the imposition of requirements for the purposes of ensuring transparency and fairness in arranging services, which will allow us to design a regime to ensure open, transparent and robust decision-making, including requiring decision-making bodies to keep records of the rationale for their decisions.

We do not consider it necessary to publish all bids received for contracts or the detailed content of all contracts. Doing so would have the potential to prejudice the commercial interests of the parties involved, including NHS commissioners and providers as well as those bidding.

We consider these amendments to be unnecessary. Indeed, we fear that they might actively undermine what the NHS is telling us it needs from the private selection regime to secure high-quality, safe and good-value services. Therefore, I hope that I might tempt the hon. Members not to press their amendment to a vote. I have a feeling, though, that we might face a Division on it in the near future.

Let me move briefly to the clause 68 stand part debate. The clause inserts a new section, 12ZB, into the National Health Service Act 2006.

Health and Care Bill (Eighth sitting)

Jo Gideon Excerpts

Committee stage
Thursday 16th September 2021 Public Bill Committees

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

We will not oppose the amendments or, indeed, clause 15. I think it is important, as the Minister said, to make it very clear that the relevant provision in clause 15, proposed new section 3(1), on ICBs providing services that they consider necessary, does not mean that they can unilaterally withdraw services. That is the concern that has been raised, and I think it is important that it is on the record that that is not what is intended.

[Jo Gideon (Stoke-on-Trent Central) (Con)]

It is a pleasure to serve under your chairmanship, Ms Elliott. I seek some clarification. With demand for palliative care set to soar because of our ageing population, I would be very grateful for any assurances that my hon. Friend the Minister can give that the reference in clause 15, in line 30 on page 13, to “after-care” includes palliative care and end-of-life care services.

[Mary Robinson (Cheadle) (Con)]

In supporting my hon. Friend the Member for Stoke-on-Trent Central, I also ask our hon. Friend the Minister to clarify this matter. As we all know, the voluntary sector is hugely important for palliative care. So many people at the end of life want to go home. We also know, in relation to discharge from hospital, that we need to get people into the right place, with the right care, so it is hugely important that we do everything we can to support that sector and to relate it to end-of-life care and palliative care.

From a personal and local perspective, I will also say, on the care that is provided, that my constituency has an excellent hospice—St Ann’s hospice. It is celebrating its 50th anniversary this year, and lots of events are taking place. The hospice relies on funding from donations from local people and the wider public. It does an enormous amount of work.

If we are to provide the personalised care that we want to achieve, and if we are to enable people to be at home and to be cared for in different settings at the end of their life, it is really important that we consider this matter in relation to the Bill, so I welcome this change to clause 15.

Health and Care Bill (Fourth sitting)

Jo Gideon Excerpts

Committee stage
Thursday 9th September 2021 Public Bill Committees

[The Chair]

I am really sorry, Karin, but I think we have to move on, because we have about seven minutes left for Back Benchers, and three indicating. Jo Gideon.

[Jo Gideon (Stoke-on-Trent Central) (Con)]

Q We have had a pretty large consensus across a large number of organisations that the Bill is welcome as an enabler. Also, earlier this morning, we had a comment that no Bill has ever changed people’s behaviour. To what extent do you think the Bill will enable people’s behaviour to change, in terms of how partners work together at a local level?

Richard Murray: It will certainly make it easier. You remove some of the unnecessary impediments that have got in people’s way and pushed them into complex workarounds. It creates a structure through ICBs and integrated care providers to bring people together, so in that sense, it enables these things and makes them easier. However, if I am honest, you could still have NHS England and the Department deciding to run everything through ICBs and making them behave an awful lot like NHS bodies of the past. It enables those things, but the legislation by itself cannot prevent some of the older behaviours from living on. That is why implementation and what happens afterwards is critical, to try to ensure that it delivers on the things that I genuinely think it is trying to do. There is a heavy weight from the past of very centralised control that focuses very much on the independent republic of the NHS. That is the cultural issue that the people who will have to implement this will have to work against.

[Jo Gideon]

Q How might we implement the changes that you suggest?

Richard Murray: I would really ensure that local government is part of this. It is an independent voice, and has already been a useful counterweight to some of those centralising forces, as local government comes closer to the NHS. Ensure that people from the voluntary sector are there. They do not follow the orders that come out of NHS England, so you are putting people directly into the system who carry some of that independence and are looking out fundamentally to their local communities. That really is the strength of some of the ICP structures—that you have those people round the table and, indeed, some of them on the ICB itself. Really invest in that place-level work. That is where a lot of the excitement will come from working with local government, and again with the voluntary sector and primary care. Do not get too focused on the ICS as this interim middle step, because it is quite distant from where a lot of the action goes on.

Nigel Edwards: It is not just upper tier local authorities that have an important voice in this. I think that Richard is right: a lot of the most interesting and bigger changes are likely to happen at the place level. It is probably the case that quite a lot of legislation has not really affected how patients are cared for or how professionals work. In some senses, that is not a bad thing. I think this does remove some of the behavioural oddities of the hybrid market and other systems that we had.

It will introduce some other hazards, in particular—Richard sort of referred to this—the slight danger of ICSs becoming inward looking, and some organisations, and the independent and voluntary sector, being excluded and not feeling that they have a voice. The challenge that local authorities can bring to that will be important, as will behavioural change from NHS England and some of the regulatory machinery, but you cannot legislate for that. That is a cultural change that is probably beyond the scope even of legislators.

Nick Timmins: Yes, and you can see that in evidence that you have already heard about the construction of the board and the partnership. It seems clear to me—you have heard from the Local Government Association—that some local authorities were happy to join a single board and others felt that that was too much of a loss of sovereignty, which is why we have ended up with this slightly complicated system of an NHS board and a partnership board. Probably, in an ideal world, it would have been better if it was one, but you have to live with what people are prepared to do.

[Dr James Davies (Vale of Clwyd) (Con)]

Q Nigel Edwards, you mentioned the word “reconfiguration” earlier. In an ideal situation, from your point of view, how would you see a reconfiguration decision being reached, and how do you balance that with the need and expectation for ministerial accountability?

Nigel Edwards: The current system dates back to Andrew Lansley, who set up four tests. Do not ask me what they are. I can look them up, but I cannot remember them. However, they were good. They involved local people and clinical support. You had to make an evidence-based case. Then there was a process that involves local stakeholders, and then there was the opportunity for review by the Secretary of State and referral by local authorities and the independent reconfiguration panel, which has been a remarkably longstanding innovation, given the way that NHS organisations are formed and then abolished. It has done, I think, a very good job.

The current system seems to me to work quite well. The Secretary of State still has a say, particularly around controversial decisions, but they do not get sucked into every small reconfiguration and change. You also do not have a point where there is an opportunity for local participants to say, “I’m not going to contribute to this conversation any more. I’m going straight to the top,” and undermine people working together locally. I am of the view that the current system works quite well. I think we said to the previous Secretary of State, “You need to be really careful what you wish for. You may think that your intervention is going to help to move things along and improve innovation. It’s quite likely, from both previous experience and experience in other similar types of systems, to have the opposite effect.”

Richard Murray: I would not disagree with anything that Nigel said. Also, the clauses in the Bill as they stand at the moment are really, really unhelpful. There may be things you could do to make reconfiguration easier, but I think they would be working around the margins of what Nigel said. It would not be wholescale intervention without limit by Ministers in local decisions—that would mean any change, of any service, could go up to the Secretary of State. Also, if you need to make an emergency move for an operational reason, you would need to write to the Secretary of State in advance—you kind of think the clue is in the fact that it is an operational crisis. I think that the legislation as drafted would not give Ministers what they want, so I really think it is not helpful at all.

Nick Timmins: Can I just add to that? I think it is really dangerous for both Ministers and the NHS. Not many people know about the Independent Reconfiguration Panel. It has worked very well. It has dealt with about 80 controversial cases. It quite often suggests some amendment, and the Secretary of State does not have to take its advice, but the Secretary of State almost invariably does take its advice. I think that if we end up with lots and lots of reconfigurations hitting Ministers’ desks, Ministers will come to regret that. If you listen to the views of previous Secretaries of State, they almost always say, “It’s ludicrous we ended up having to make a decision about what was going to happen”—in Nether Wallop or wherever—which was the case before the Independent Reconfiguration Panel was around.

--- Later in debate ---

[The Chair]

I think I am going to move on. Jo Gideon.

[Jo Gideon]

Q Thank you, Mr McCabe. How do you think the public voice should be represented across the integrated care system at board and partnership level?

Sir Robert Francis: Healthwatch England welcomes the requirement for Healthwatch and representatives of the public to be “involved”—that is the word—in the strategy, but we would like to see that enhanced, as I am sure many people would, and we just heard that expressed very articulately. In order for these new reforms to work, it is absolutely essential that the public whom the system serves are able to engage with it and participate in the design of the services that they are going to receive. In order to do that, in our view, they need a visible presence on the ICB board and the ICB partnership. Although that can of course be done by local discretion and local arrangement, we think it would be a powerful boost to the importance given to the people’s voice if there was a representative on the ICB—not as a voting member but, in NHS England’s parlance, as a “participant”. It would be a requirement that one of the participants be such a representative, and you will not be surprised to know that we would advocate that person being a representative of Healthwatch.

That can be done through a coalition of local healthwatches—in many places there will be more than one—so that they have a presence on the board and are able to raise things. It is not just a question of the ICS deciding what to ask people about; they need to have a flow of intelligence coming in about what people are actually concerned about, and those two things are often different. It should be someone who is able to question what is happening in a constructive way.

Of course, part of that is done by local government representatives, and this is not a substitute for local democracy, but we consider that Healthwatch has a local and national ability to reach out to groups who do not often get considered, for instance, and that is particularly relevant if you are seeking to tackle health inequalities. Through the relationships that a good local healthwatch has with groups who feel—rightly or wrongly—that they have often been ignored, the questions that they pose can be put and the answers given back to them. That is a two-way process; you need someone who is independent from the system but in the room, and they also need to be able to transmit into the room information from patient services and the public, and transmit information back. They are part of the mechanism for explaining to the world at large this extremely complicated new concept—namely, a system of which the public has no understanding at all at the moment. A lot of professionals do not either.

[Edward Timpson]

Q Sir Robert, a shift away from competition towards collaboration and integration is very much at the heart of the Bill. We heard earlier that competition is not just about the constant tendering for services but also has the element of patient choice. From the evidence you have gathered from your local healthwatches and more generally across the country, where do you think patient choice needs to sit within these reforms? I am particularly interested in children and young people from the ages of nought to 25, because we are talking about all our health system’s service users.

Sir Robert Francis: Clearly, patient choice and view include information about people’s experience of the service they have had, where they think the gaps are, and their needs. The less you have a competitive exercise with different organisations coming in and saying, “We can provide this better than X or Y,” the more you need to know what people think about what you are proposing, or indeed the more you need to know to inspire creative thought about how you meet the needs that people are telling you they have.

Our view is that while we actually welcome the removal of the requirement for tendering and all the bureaucracy that, quite often in our healthwatches’ experience, interferes with and delays getting solutions to things, that should not mean that we do not have a concentrated effort to involve patient services and the public in the design of what they are being provided with. In effect, that would include how you commission the service that they are going to be provided with. You then need a constant flow of information and dialogue about whether that is working. Frankly, I do not see a great deal of clarity in the Bill about how performance will be monitored after having commissioned services and worked out your strategy and so on.

Health and Care Bill (Second sitting)

Jo Gideon Excerpts

Committee stage
Tuesday 7th September 2021 Public Bill Committees

[The Chair]

We will now hear from Ian Trenholm, the chief executive of the Care Quality Commission, and Keith Conradi, the chief investigator at the Healthcare Safety Investigation Branch, both of whom are appearing in person. We have until 4 o’clock for this session. May I ask you both to introduce yourselves for the record?

Ian Trenholm: Good afternoon. My name is Ian Trenholm and I am the chief executive of the Care Quality Commission.

Keith Conradi: I am Keith Conradi, the chief investigator for the Healthcare Safety Investigation Branch.

[Jo Gideon (Stoke-on-Trent Central) (Con)]

Q Thank you for attending. Can you characterise the contribution this Bill will make, in your opinion, to patient safety and quality of care?

Ian Trenholm: The Bill will add value to patients in a number of different ways. There are four areas that we have particular interest in. The first is around the work we expect the Government to ask us to do on oversight of the individual ICSs. Building on the comments that have just been made, our contributing to the assurance around ICSs will be an important part of how we can add value. We will do that by drawing to the attention of local communities both the good work that is going on in a particular place, and areas where there are some challenges. We will also be able to look across the country, demonstrate where things are going well and help with improvement, as we do with the regulation of individual providers.

The Bill also contains a provision for us to provide assurance regarding the way local authorities discharge their Care Act 2014 duties. Again, that gives local people the certainty that local authorities are discharging their responsibilities. If you bring those two things together and connect local authority duties around the Care Act and social care with what is going on in healthcare, you get a whole-system view, and we are able to give an independent overview of that, which we report to Parliament and the public.

There is also a provision in the Bill relating to food standards in hospital. It is well known that people’s recovery is aided by good-quality hydration and nutrition that is appropriate for the social and cultural needs of that particular place. As part of our work, we will be asked to look at that.

Finally, building on the comments Mr Madden made a couple of witnesses ago, the miscellaneous provisions within the Bill on data sharing and the requirement to co-operate are also powerful and enable us to do our job as an intelligence-driven regulator. From the point of view of reducing bureaucracy, they mean that we collect data once and then we can share it among the many partners involved in regulating different parts of the health and care system. Those are four particular points where I think the public would see value in the work we do.

Keith Conradi: From our perspective at the Healthcare Safety Investigation Branch, we welcome the introduction of this part of the legislation. We have been working in shadow form for the past five years, without any real powers, and the things we have missed there are likely to be introduced in the Bill, such as power of entry, so that we can access people quickly in an investigation. Any investigator will tell you that the quality of the investigation evidence, particularly interviews, degrades quickly over time, so the ability to go in quickly is hugely important. Also, not being able to access data that we know people hold has been quite frustrating in our current guise. We have sometimes had to wait for months and months for data in order to be able to complete an investigation.

The other thing that we are particularly keen on is being able to properly protect information that people give us in a protected environment, so that we can ask them to be as candid as possible with their experiences. We want to be able to protect that information from being released more publicly.

[Jo Gideon]

Can I ask just one more question, Chair?

[The Chair]

I am not being flooded with a whole array of hands, so why not? On you go. I will come to you in a second, Edward.

[Jo Gideon]

Q I just want to come back on the hospital food standards. I know that malnutrition is an issue that has been raised within the hospital setting. Would you be able to set parameters for what the reporting requirement is in order to measure standards in that regard, for instance?

Ian Trenholm: We will be inspecting against the hospital food standards—is that what you mean? We are not going to be setting individual nutritional standards; we will be inspecting against the NHS’s food standards. We are going to deliberately make sure that our work does not overlap with organisations such as the Food Standards Agency, for example. To be very specific about it, we are not going to be inspecting vending machines or taste-testing food in canteens. What we are going to be doing is looking at the hydration and nutrition strategies that, say, a board in a hospital has set for its particular area. As we go around the hospital, we will be looking at whether that strategy is being enacted for the cultural and social needs, in particular, of the people in that hospital. Does that answer the question?

[Jo Gideon]

Yes. Well, it was more from a medical point of view than from a vending machine point of view. That is absolutely helpful. Thank you.

[The Chair]

Do you have anything to add to that, Mr Conradi?

Keith Conradi: I think that is outside the HSIB’s experience.

Health and Care Bill (First sitting)

Jo Gideon Excerpts

Committee stage
Tuesday 7th September 2021 Public Bill Committees

[The Chair]

Thank you. We now go to Jo Gideon.

[Jo Gideon (Stoke-on-Trent Central) (Con)]

Q Thank you, Chair. I would like to expand on the previous questions. It is my understanding that the integrated cared boards are the accountable bodies when the funds come in. But is the spending—the actual allocation funds—to be delegated down to integrated care partnerships, or is that at the discretion of individual integrated care boards?

Amanda Pritchard: Again, I will ask Mark to add to this if he would like to. At the moment, the proposal is that funding would go formally through the integrated care board. The expectation is that, in developing the constitution and the detailed ways of working for each integrated care board, they would describe how the decision making is done, at not just the ICB level, but the place level, with the expectation that part of the principle would be subsidiarity.

If you are looking at the most sensible place for making decisions, for big, strategic investment the oversight of the overall allocative decision making may well sit best at ICB level; if you are talking about something that might have more of a borough footprint—thinking about London—you would want a lot of the decisions about local services, community primary care services and capital decision making to support those local initiatives to be made there. There would be a number of layers within the ICB involved in that decision making, but ultimate accountability would sit with the ICB itself.

Mark Cubbon: The only thing I would add is that this is essentially why we are bringing leaders together to form the ICS body. The key thing will be how the resources allocated to that ICS can be deployed in such a way that strategic objectives can be delivered. The allocation down to place, as you have said, is important so that decision making can be as local as possible to where the service is, so clinicians and frontline staff can make the changes they want in order to deliver improved outcomes for their patients.

[Jo Gideon]

Q If I understand you correctly, place sits within the partnership rather than the board? I know the design has been about flexibility for each local board and partnership, to involve as many people as is relevant for local priorities. Do you think there is a tension about who sits on which, and what level of clinical representation do you think should be specified on boards?

Amanda Pritchard: I will start off, but Mark has led the work for NHS England and NHS Improvement on developing guidance to support local systems exactly in the area you ask about, on how to bring this to life and plan now for what we hope will be legislation coming into effect in April ’22. I do not want to steal his thunder on any of this.

One thing we warmly welcomed in the proposed legislation, and something we have heard about time and time again from our key stakeholders, is the flexibility. There is a minimum mandated legal set of requirements and structures, but, as you say, also an expectation that local systems will develop for themselves the structures and ways of working that make most sense for them. This is an obvious point, but what will work in Devon will by necessity look quite different from what you would want to put in place in somewhere such as Greater Manchester.

On behalf of our stakeholders, we have already welcomed the flexibility around that that has been described, but we have rightly said that, in addition to the suggested roles written into the legislation, there are some roles we would expect to see included on boards—we describe this as “mandatory guidance”. We have used that partly as an opportunity to pick up on exactly the point you make about clinical leadership and clinical representation. As a national health service, it is clearly right that we ensure that we have that strength of clinical voice.

At the moment, the mandatory guidance describes the need for a medical director and a director of nursing in addition to the expectation written into the legislation, which is that there would already be a representative from primary care as part of that ICB. Mark, you have done all the work thinking about how this is going to work in practice; do you want to pick up on that?

Mark Cubbon: Right at the core of the new working arrangements, we believe that clinical decision making and clinical input and engagement are an essential part of how the new arrangements will be put in place, so that frontline clinicians can shape how services should look and be involved in the planning and delivery of those services. In the guidance that we have put out, we are leaving a lot of flexibility for the ICB to bring in the appropriate number of clinical professionals to support those endeavours, and that is in the shaping of services, the planning and the execution of plans to deliver them.

While we talk a lot about doctors and nurses, there are 14 other allied health professions, and it is quite difficult to allow everyone to have a seat around the top table. We are strongly encouraging all ICBs to ensure that they have the right level of engagement and the right forum in place to ensure that the voices of all those professionals can be incorporated in the development of plans to deliver better services for patients and improve outcomes for members of the community. That is what we are asking all the organisations to do, and it has all been built on evidence that we have gathered from the clinical community over quite an extensive period of engagement. In fact, we published the guidance that Amanda referenced only last week, and it refers to the importance of clinical leadership at all levels: where the services are delivered at place; where services are planned for more local arrangements in the way that we have described; and then sitting more strategically at the ICS board as well.

[The Chair]

Thank you. I call Dr James Davies.

Covid-Secure Borders

Jo Gideon Excerpts

Tuesday 15th June 2021 Commons Chamber

[Jo Gideon (Stoke-on-Trent Central) (Con)]

It is a pleasure to take part in the debate and to follow my hon. Friend the Member for Runnymede and Weybridge (Dr Spencer). It is remarkable to hear how extrapolations are presented as facts in this debate. The Opposition, the party of the crystal ball, would have us believe that in their hands the pandemic would have been brought under control more quickly and more lives would have been saved. However, there is no evidence that even the Labour party could stop mutations of the virus reaching these shores, nor that it could ever overcome its ideological contempt for private sector involvement in the health service, whether in delivering world-class research and development or in supporting NHS testing, track and trace, and the vaccination roll-out.

Without the Government bringing together all sectors, we would not have had the incredible progress in vaccinating our nation that we have had. It is difficult to disprove hypotheticals, and if we look to other countries that have tried different approaches, we must recognise that their geography, population density and underlying health issues make effective comparisons impossible. No country found an easy answer to beating the pandemic. The strategy of reducing the spread until a mass vaccination can beat the virus has been adopted globally.

The Government’s investment in the research that delivered the AstraZeneca vaccine, the early purchase of more than 100 million doses while they were still under development, the speedy licensing of vaccines and the phenomenally successful roll-out have saved many, many thousands of lives. That is a fact, yet the Opposition fail to credit the Government for it, preferring to focus on the negatives. If we had imposed earlier lockdowns, they claim, we would have saved thousands of lives; if we had banned travel to and from India earlier, they claim, we could have stopped the delta variant reaching our shores.

We know that the challenge is far more complicated when it comes to closing UK borders. Should we have prevented British nationals who were returning from India from entering the country before the delta variant had been identified as a variant of concern? They were already required to quarantine at home for 10 days. As the Health Secretary told the Select Committee on Science and Technology last week:

“It is harder in a democracy to take some of the steps that some of the authoritarian countries took. Geography matters. Britain is an island…but we are a highly interconnected island…and a huge amount of our freight comes accompanied.”

This Government have always sought to keep the public informed about any decisions relating to the pandemic. In our democracy, we strive to impose any restrictions on people’s freedoms by consent rather than force, which is how we have seen such a high level of compliance, with exceptionally high levels of vaccine uptake among many age groups. Our decisions have been informed throughout by the advice of our scientific and medical experts, and as the advice has changed in line with the epidemiology, so have the guidelines.

We have a tough approach to our borders. The Opposition criticise the Government for moving Portugal’s categorisation from green to amber, and now seek to turn travel into a binary decision by removing the amber category, but life is not binary. Decisions about the road map as we emerge from the worst of the pandemic need to be more nuanced. We have moved on from the phase when choice was a simple one of lives versus livelihoods, to a plan to build back people’s confidence—a plan to re-engage cautiously with normal activities while the vaccination programme powers on to provide the ultimate protection against the virus.

As a global trading nation with an amazing, diverse population, we have to consider travel not just as a holiday activity, but as one that is hugely important to our economy and our mental health. Many people, including me, have family abroad and are desperate to reconnect in person after 16 months of Zoom calls. Many have urgent family business, including, sadly, attending funerals. With the removal of the amber category, the cost of hotel quarantine might preclude many from such urgent travel and would also mean that families travelling to green destinations this summer could find themselves facing bills of thousands of pounds if the status of the country they visit changes before their return. That will hit those who can least afford it, because they will either have to decide not to risk travel or face a debt crisis as a result. I do not believe we should be penalising those who can least afford it.

The Opposition are consistent in their inconsistencies on the issue, guided, I imagine, by focus groups rather than the science: demanding certainty where there can be none as we tackle a completely novel virus; calling for more financial support for businesses while demanding greater lockdown measures, which would hit the economy hard; calling for extensions to furlough schemes and measures to keep workers at home rather than backing our plan for jobs and the gradual reopening of the country; and calling for the Government to introduce quarantine and then criticising its introduction and then calling for it to be expanded. We are looking to a cautious and irreversible route out of the pandemic, building back the confidence of the nation as we emerge from the restrictions; they are looking to scaremonger.

The Government’s approach is the right one, and I urge the Opposition to back it.

Obesity Strategy 2020

Jo Gideon Excerpts

Thursday 27th May 2021 Commons Chamber

[Jo Gideon (Stoke-on-Trent Central) (Con)]

As a member of the all-party parliamentary group on obesity and chair of the APPG on the national food strategy, I welcome the opportunity to contribute to this vital debate. We have heard many statistics this afternoon that underline the need for decisive and urgent action by the Government, so I will focus my comments on the complexity of the challenge and the need to tackle obesity with the same collective approach that we have seen work so well during the last year in response to covid-19.

I was pleased to see the importance of prevention acknowledged in the Queen’s Speech, in the words:

“Measures will be brought forward to support the health and wellbeing of the nation, including to tackle obesity”.—[Official Report, House of Lords, 11 May 2021; Vol. 812, c. 1.]

I particularly welcome the introduction of the office for health promotion, which acknowledges that our health is shaped by many factors and that the ability to make healthy choices is not simply a matter of individual behaviour change. Regional and community variations in obesity are strongly linked to the structural inequalities that we seek to address through our levelling-up agenda. Poor diet affects our ability to achieve our full potential, so tackling obesity is central to our commitment to level up.

However, to improve the nation’s health, we need to work together in the same way we did during the pandemic. From schools to local authorities, food producers, manufacturers and marketeers, health professionals and community groups, sports clubs, influencers, families and individuals, the battle to tackle obesity needs to be grasped by us all. That battle should not be framed as a war between the nanny state and personal freedom, as many more of our behaviours were during the pandemic, and I think that the majority of people acknowledge that.

I am reminded of a previous and ongoing health campaign, and the shift of public opinion, on the issue of smoking. I recall that it took many years and some Government legislation to alter the narrative significantly, even though the health risks associated with smoking have been widely known for decades. That is why I support, as part of a comprehensive approach to obesity prevention, the restriction of retail promotions on food and drinks high in fat, salt and sugar, the banning of junk food adverts on television before 9 pm, and a total ban online. Young people are particularly vulnerable to highly targeted online junk food advertising whenever they access social media.

If we are to see generational improvements in obesity levels, we must start with early years, so I welcome the recent increase in the Healthy Start payments made available to pregnant women and those with children under the age of four to help them buy fruit and vegetables, and the investment in school holiday clubs to ensure that many more children receive healthy food and exercise during the holidays.

Education has a vital part to play in behaviour change, with all schools offering healthy meals in their canteen and teaching about nutrition, underpinned by cooking skills for all. The latter must be measured as a key curriculum requirement, and the nutritional value of school meals needs to be included in Ofsted or local authority inspections to ensure that school food standards are met.

I also welcome the Government’s commitment to a health incentives and reward approach and the use of innovative tools to effect behaviour change, as well as the plan to build on existing digital solutions available via GPs to widen access to digital dietary support programmes to those who wish to improve their health, rather than to the clinically obese only. This Government are committed to winning the battle against the nation’s obesity crisis with a wide range of measures. It is a battle we cannot afford to lose.

Oral Answers to Questions

Jo Gideon Excerpts

Tuesday 23rd February 2021 Commons Chamber

[Helen Whately]

I agree that we need a sustainably funded social care system. I know that my hon. Friend is very well informed of the options. We are committed to taking forward social care reform, and will be publishing proposals later this year.

[Jo Gideon (Stoke-on-Trent Central) (Con)]

What progress his Department has made on improving the health service capital estate.

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

What progress his Department has made on improving the health service capital estate.

[The Minister for Health (Edward Argar)]

A total of £600 million has been allocated to tackle almost 1,800 urgent maintenance projects across 178 trusts, all due for completion by March 2012, while £450 million has been invested to upgrade A&E facilities, with funding awarded to over 120 trusts, and improve over 190 urgent treatment sites this winter. In addition, of course, the Prime Minister has confirmed that 40 new hospitals will be built by 2030, with an additional eight further schemes to be identified. Six of these are already under construction. With your permission, Mr Speaker, may I group this question with Question 21?

[Jo Gideon [V]]

NHS staff at Royal Stoke University Hospital in my constituency have been using the old Stoke Royal Infirmary site, which stopped delivering clinical services in 2012, for car parking. However, with the demolition of buildings on the site in readiness for the creation of many new houses, hospital staff really need the University Hospitals of North Midlands NHS Trust’s proposed plans for a multi-storey car park to come to fruition. Will the Minister ensure that the necessary investment is forthcoming for additional staff car parking facilities at Royal Stoke University Hospital to support our wonderful NHS staff and unlock this vital regeneration project for the people of Stoke-on-Trent?