Oral Answers to Questions

Jonathan Ashworth Excerpts

Tuesday 29th October 2019 Commons Chamber

[Jo Churchill]

I thank my hon. Friend for all his work leading the all-party parliamentary group on cancer. We are putting more money into diagnostic tests, which means that there will be more than 7.9 million more tests. Making sure that we have the correct data on survivability, in which the one-year test is an important metric, is part of that programme.

[Jonathan Ashworth (Leicester South) (Lab/Co-op)]

In the past year, more than 34,000 cancer patients have waited beyond two months for treatment. Every single waiting time measure for cancer has worsened in the past year. Surely, the Minister should be ashamed that so many more cancer patients are waiting longer for treatment.

[Jo Churchill]

I probably know as well as most that waiting for a cancer diagnosis is traumatic and that it needs to be done as speedily as possible. There is nothing more frightening than that wait, so what have we done? In 2018, 2.2 million people were seen by a specialist for suspected cancer—that is more than 1.2 million more people per annum since 2010. Getting to the specialist an individual needs as quickly as possible is what this Government are focused on, and that is why we have put so much emphasis on having specialist clinical nurses in the cancer workforce. We will carry on making cancer a priority.

[Jonathan Ashworth]

But the problem is that that is not happening, is it? Cancer patients are waiting longer for treatment. In recent weeks, we have had an avalanche of hospital board papers blaming understaffing and George Osborne’s pension tax changes for the deterioration in waiting time standards. The Prime Minister promised to fix Osborne’s pension tax mess. How many more patients need to be added to the waiting list before it is fixed?

[Jo Churchill]

The guidance for doctors’ pensions was changed last month. As I said, making sure that everybody can access a GP as soon as they are worried and then get to a specialist as soon as possible is our top priority, and making sure we have a broad-based cancer workforce is part of that plan. Delivering these things, as well as rapid diagnostic centres with £200 million in new machinery, is how we are going to do it.

The National Health Service

Jonathan Ashworth Excerpts

Wednesday 23rd October 2019 Commons Chamber

[Jonathan Ashworth (Leicester South) (Lab/Co-op)]

I beg to move an amendment, at the end of the Question to add:

“but respectfully regrets that the Gracious Speech does not repeal the Health and Social Care Act 2012 to restore a publicly provided and administered National Health Service and protect it from future trade agreements that would allow private companies competing for services who put profit before public health and that could restrict policy decisions taken in the public interest.”

I am grateful to the Leader of the House for finding time to schedule this important debate. I associate myself with the condolences and sorrow expressed about the horrific tragedy in Essex. I pay tribute to all the emergency services, who must have had to confront the most unspeakable of sights in Essex in the past 24 hours.

In a similar vein, I pay tribute to our hard-working national health service and social care staff, who every day go beyond the call of duty, going the extra mile for each and every one of our constituents, ourselves and our loved ones. They do it after a decade of cutbacks and of the tightest financial squeeze in the history of the NHS, but despite that, our NHS staff are treating more patients every day than ever before. I am afraid, however, that we have a Government who are still expecting our staff to deliver care in the most intolerable working conditions, from bed cuts to staffing shortages and equipment breaking down every day. The dismal consequence of this decade of underfunding and cuts sees patient care suffering and standards of care deteriorating.

Let me share a couple of examples with the House. Somebody from another part of the country got in touch with me and asked me to raise this directly with the Secretary of State, although she asked that we anonymise these exchanges. Her 91-year-old mother fell in her house on a Sunday at around 2.40 pm. She waited two and a half hours for an ambulance. When she got to the hospital, she waited an hour and a half in a cold corridor before being admitted to a bay. Eight hours later, she was seen by a doctor, who recommended an X-ray and scan. She got the result of the X-ray at 1.15 am. Only then was she given pain relief and put on a drip. By 3 am, she still had not been admitted to a ward. At 9 am, she was sent back to her care home—her daughter was not told—with no pain relief or any prescription.

Perhaps I can tell another heartbreaking story, from today’s edition of Pulse. It reveals that a teenage boy—a 16-year-old—was referred to child and adolescent mental health services by his GP, but because his condition was not considered serious enough, CAMHS turned him away. The boy later died by suicide. These are heartbreaking stories, but stories like that are happening far too often in a health system that is under intense pressure.

[Kevin Brennan (Cardiff West) (Lab)]

My hon. Friend is telling tragic stories about the impact on real patients of what is happening in the NHS. Other families who are suffering are those often with children who have very severe conditions, such as epilepsy, who would benefit from access to medical cannabis. The Government have indicated that that access should be available, but it is just not getting to these families, and the children and families are suffering, both because of the pain and financially as a result. Does he agree that the Government should do much more to fast-track availability?

[Jonathan Ashworth]

I completely agree, and I pay tribute to my hon. Friend and to hon. Members such as the right hon. Member for Hemel Hempstead (Sir Mike Penning) who have led the charge in this debate. If medicinal cannabis has a medicinal, therapeutic value, it should be allowed. If there are issues in the bureaucracy that are slowing it down, and if that needs legislation, we will work with the Secretary of State to get it through, if that is where the blockage is. If the blockage is in some other area and he needs our co-operation, we will co-operate with him. We need to resolve this, because too many young people are going without the help they need.

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

The shadow Secretary of State is being very generous, and I thank him for his comments—the families, who are the most important people, will be very conscious of what he has said—but we have to be very careful when describing this: we are after the medical use of cannabis on prescription. The medical use of cannabis often relates to cases where people have felt they would take it in other ways. We are not talking about the casual use of cannabis, about a spliff in the armchair. I will raise this with the Secretary of State when he is on his feet: we are saying that where a qualified consultant feels that cannabis on prescription would benefit the child, particularly if they have epilepsy and fits, it should be available free on the NHS. I think that is what the hon. Gentleman is saying.

[Jonathan Ashworth]

Absolutely. There appear to be blockages in the system, however, and my offer to the Secretary of State is this: if those blockages are there because of legislative or regulatory issues that need resolving in this House, I will co-operate with him to get those resolved. If it is not about regulatory issues in this House, I will continue to reinforce the issues that the right hon. Gentleman is putting to him and urge him to intervene using his good offices.

Many vulnerable people are waiting longer for treatment or being denied treatment, sometimes, sadly, with devasting and tragic consequences. The standards of care enshrined in the NHS constitution are simply not being delivered. A&E waits in September were the worst they have been outside of winter since 2010. Our hospitals have just been through a summer crisis, and with flu outbreaks in Australia expected to hit us here, our NHS is bracing itself for a winter of enormous strain yet again.

Last year, 2.9 million people waited beyond four hours in A&E. Since 2010, over 15,000 beds have been cut from the NHS and bed occupancy levels have risen to 98% under this Government. The number of patients moved from cubicles to corridors and left languishing on trolleys has ballooned under this Government. When Labour left office, around 62,000 patients were designated as trolley waits, which was unacceptable, but today under this Government that number is 629,000.

What about cancer?

[Gareth Thomas (Harrow West) (Lab/Co-op)]

Before my hon. Friend moves on from the situation in A&E departments, can I bring to his attention the situation at Northwick Park Hospital, which serves my constituents? The last time it met the four-hour target was in August 2014 —over five years ago now. Does he have any sense that the Government are still committed to that four-hour target, or will it be another five years before my constituents can expect that target to be met in our hospital?

[Jonathan Ashworth]

My hon. Friend makes a very good point. The targets were routinely met under the last Labour Government—and they were stricter targets as well.

The Secretary of State looked surprised when I mentioned cancer, but he should not be, because we have the worst waiting times on record under this Secretary of State. Every single measure of performance is worse than last year. Shamefully, 34,200 patients are waiting longer than two months for cancer treatment. What about the waiting lists for consultant-led treatment? We now have 4.4 million people waiting for treatment—an ever-growing list of our constituents waiting longer for knee replacements, hip replacements, valve operations or cataract removals. Clinical commissioning groups are rationing more and trusts delaying surgery, which is leaving patients in pain and distress.

[Anna Turley (Redcar) (Lab/Co-op)]

My hon. Friend is absolutely right about the pressure on trusts. The chief executive of my NHS in South Tees has recently resigned, calling the current situation underfunded and unsustainable and warning that any more efficiencies would be a step too far. Does he agree that beneath this spin services are at breaking point?

[Jonathan Ashworth]

I completely agree. I am not surprised that my hon. Friend’s trust’s chief executive has taken that action. We have just been through a decade of the tightest financial squeeze in the history of the NHS. That is why standards of care have so deteriorated. Since the right hon. Gentleman became Health Secretary, the number of patients waiting more than 18 weeks for treatment has jumped from 504,000 to 662,000. Every day he is Health Secretary, another 330 people wait beyond 18 weeks for treatment. People waiting longer for treatment under him—that is his personal record.

[Tom Tugendhat (Tonbridge and Malling) (Con)]

The hon. Gentleman is right to identify the delays that are inevitable in a massive state-led system. Would he agree that there is a huge opportunity for individuals to get treatment in other ways? I have the privilege to represent a couple who have taken themselves to a hospital in Portugal, where they live half the year, and got care there. Their care has been refunded by the NHS at a rate significantly cheaper than that available in the UK. Should we not welcome individuals who are able to do this? Of course it is not for everybody, but should we not welcome it as a possibility?

[Jonathan Ashworth]

I am genuinely pleased for the hon. Gentleman’s constituents, but there are 4.4 million people on the waiting list. There used to be around 2 million. Every day, another 330 people wait longer than 18 weeks for treatment, and when people wait longer than 18 weeks, not only do they wait longer in pain, distress and anxiety, but they run the serious risk that their health will deteriorate further. That is what is going on in the NHS today under this Government.

The Queen’s Speech was heavily spun as being about—[Interruption.] The Secretary of State will get his chance in a moment. The Queen’s Speech was heavily spun as being about the NHS. [Interruption.] He says I am talking nonsense. These are the official figures. He wants to run away from his own failure, from the fact that so many more people are waiting beyond 18 weeks for treatment and from the A&E crisis that he is doing nothing about. He thinks an app will solve it all. That is not a serious approach to the NHS. [Interruption.] And he is not as good as George Osborne used to be.

The Queen’s Speech was heavily spun as being about the NHS, but in fact it was a missed opportunity to rebuild confidence in the NHS and provide the health services we want. We will scrutinise carefully the Bills in the Queen’s Speech and engage constructively. We are pleased that the Health Service Safety Investigations Bill has not been abandoned and is back. We will engage on it and explore with Ministers how to strengthen the independence and effectiveness of medical examiners.

If the Secretary of State wants to deliver safe care, however, we need safe staffing legislation and a fully funded workforce plan. Pressures on staff are immense. He will know that suicide rates for nurses are higher than the national average and that among doctors the rate is rising. I congratulate Clare Gerada on her leadership on mental health support, but yesterday the Secretary of State suggested on Twitter that all NHS staff would be eligible for this new mental health support, when it is actually just doctors and dentists. I hope he will clarify his remarks at the Dispatch Box and tell us when 24-hour support for all NHS staff will be available.

I also hope the Secretary of State will tell us how he will resolve the staffing crisis. As he knows, we have 100,000 vacancies across the NHS. We are short of over 40,000 nurses. Under this Government, we have seen cuts to community and district nurses, learning disability nurses, mental health nurses, health visitors and school nurses. On current trends, we will be short of 108,000 nurses in 10 years, according to the King’s Fund and the Nuffield Trust.

[Andy Slaughter (Hammersmith) (Lab)]

My hon. Friend is making an excellent speech. He is right to talk about rationing. My CCG has started rationing referrals to consultants to clear one of the biggest deficits in the country. Will he also talk about the massive backlog of capital? As he knows, I have two world-class hospitals in my constituency, Hammersmith and Charing Cross. It will cost half a billion pounds to bring them up to standard, but there was not a penny of that in the money the Secretary of State allocated. They are lucky they get a few million pounds of seed money to plan for work for which there is not the money to pay.

[Jonathan Ashworth]

My hon. Friend is absolutely right. Imperial College Healthcare NHS Trust has one of the worst maintenance backlogs of all trusts. I congratulate him and Labour-controlled Hammersmith and Fulham Borough Council on leading the campaign to save Charing Cross Hospital; it is because of the pressure he exerted that it was saved.

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

My hon. Friend may be aware that, just today, the Education Committee published its report on children with special educational needs and disabilities. One of our findings was that the staff shortages are having a serious impact on those children, because the plans that are drawn up for them are now being drawn up on the basis of what is rationed and what is available, rather than on the basis of what they actually need. Does he agree that there should be a review of therapy services around the country, so that we can ensure that, wherever a child lives, it gets the support it needs?

[Jonathan Ashworth]

My hon. Friend is absolutely right. She has brought home the extent of the impact of staff shortages on service delivery at every turn.

[Several hon. Members rose—]

[Jonathan Ashworth]

I am going to make a bit of progress. The Whips are looking slightly askance at me because of the number of Members who want to speak.

There is one Bill that will have a fundamental impact on staffing, and that is the proposed immigration Bill, which will end freedom of movement and introduce a points-based system. Does the Secretary of State recognise that freedom of movement has allowed thousands of staff from Europe—doctors, nurses, paramedics, care workers, hospital porters and cleaners—to come to the UK to care for our sick and elderly? Does he recognise that our NHS and care sector needs that ongoing flow of workers from the EU? How does he reconcile the need for the NHS to continue to recruit with the rhetoric and the proposed restrictive policies of the Home Secretary?

The Secretary of State will know that Conservative campaigners have lobbied for a salary threshold of £36,700. If that were applied, 60,000 current staff in the NHS who are not covered by the shortage occupation list would be affected. Is the Secretary of State really going to allow the Home Secretary to introduce a salary threshold of that order, which will have a huge impact on the ability of the national health service to fill vacancies and recruit, and therefore have an impact on patient care?

[Conor McGinn (St Helens North) (Lab)]

Will my hon. Friend join me and, I am sure, all other Labour Members, in conveying our solidarity to NHS workers—Unison members—in St Helens and other parts of the country who are on strike this week? Despite doing the same job in the same place and wearing the same uniform, they are paid less than their colleagues because they work for an agency. Will my hon. Friend urge Compass to do the right thing and pay those workers properly, and will he commit a Labour Government to ensuring that there is equal pay for equal work in our NHS?

[Jonathan Ashworth]

My hon. Friend is absolutely right. That is what happens when privatisation and outsourcing go wrong: workers are worse off. We should bring an end to it.

[Neil O’Brien (Harborough) (Con)]

rose—

[Vicky Ford (Chelmsford) (Con)]

rose—

[Jonathan Ashworth]

I am going to make some progress.

We need clarification from the Secretary of State on whether he will exempt all NHS staff and all care staff from the shortage occupation list in the immigration Bill.

Safe care also depends on safe facilities, but after years of cuts in capital budgets, hospitals are crumbling and equipment is out of date.

[Neil O’Brien]

rose—

[Vicky Ford]

rose—

[Jonathan Ashworth]

In a few moments.

The repair bill facing the NHS has now risen to £6.5 billion, more than half of which relates to what is considered to be serious risk. NHS capital investment has fallen by 17% per healthcare worker since 2010. Across the NHS, the estate relies on old, outdated equipment, which is having an effect on, for instance, diagnostics. The number of patients waiting longer than six weeks for diagnostic tests and scans has increased from 3,500 under Labour to more than 43,000 under this Government.

[Neil O’Brien]

rose—

[Vicky Ford]

rose—

[Jonathan Ashworth]

I will give way in a few moments.

Even if the Secretary of State replaces all the MRI scanners that are more than 10 years old—he has adopted our policy on that—we will still be struggling with the lowest numbers of MRI and CT scanners per head of population in Europe. Is it not time for a proper strategic health review?

[Neil O’Brien]

rose—

[Vicky Ford]

rose—

[Jonathan Ashworth]

In a few moments.

The Secretary of State will say that he has announced plans for six new hospital reconfigurations and seed funding for other acute trusts to prepare bids, but there is no guarantee that that funding is in place and that the Department will give trusts the go- ahead. “Seed funding” is a curious phrase. Can the Secretary of State confirm that there will be no role for private capital in that seed funding? In their 2017 manifesto, the Government promised £3 billion of capital funding from the private sector. Does that still hold? They claim to have abandoned the private finance initiative. We need clarity today.

[Neil O’Brien]

rose—

[Anneliese Dodds (Oxford East) (Lab/Co-op)]

rose—

[Jonathan Ashworth]

I will give way in a few moments. Let me just finish this point.

When the Secretary of State announces new hospitals in press releases from Conservative campaign headquarters, he should also announce where he is downgrading hospitals. He should go to Telford and explain why the accident and emergency department there is closing and being replaced by an “A&E local”, which is presumably something like a Tesco Express. We would save that A&E department. The Secretary of State went to Chorley recently. The A&E department there is not open overnight. We would provide a rescue package for Chorley. I wonder whether the Secretary of State will also be visiting Canterbury to apologise, because the Prime Minister promised—

[Rosie Duffield (Canterbury) (Lab)]

rose—

[Jonathan Ashworth]

My hon. Friend represents Canterbury, so I will give way to her.

[Rosie Duffield]

Does my hon. Friend agree that the Prime Minister’s recent false promise of a brand-new hospital in Canterbury was extremely irresponsible? It turned out to be fake news, which left my desperate constituents confused and bitterly disappointed.

[Jonathan Ashworth]

The Prime Minister promised that new hospital at the Tory party conference, only for the Department to confirm later that Canterbury was not actually on the list.

[Andrew Griffiths (Burton) (Con)]

Will the hon. Gentleman give way?

[Jonathan Ashworth]

In a few moments.

The Tory candidate for Canterbury, one Anna Firth, helpfully explained that the Prime Minister had “clearly made a mistake”. After all,

“He can’t be on top of every little detail”.

We are talking about the £450 million rebuilding of a hospital.

[Neil O’Brien]

On the subject of £450 million investments, I wonder whether we could have a moment of cross-party positivity, and whether the hon. Gentleman welcomes the £450 million investment in the hospital from which both his constituents and mine will benefit. It is a transformative investment, and we are doing it without PFI. I am sure he agrees that that is wonderful news.

[Jonathan Ashworth]

Of course I welcome that £450 million. [Interruption.] It just shows what an effective Member of Parliament for Leicester South I am.

I know that the Secretary of State gets very excitable about this Leicester point, rather like a semi-house-trained pet rabbit. Let me tell him about Leicester. I did not see him on “Question Time” in Oadby the other evening—I do not often watch “Question Time”. I do not want to be disorderly, so I shall be careful about how I read out the transcript. The audience started shouting—well, it is unparliamentary, but essentially they started shouting that the Secretary of State was not being entirely truthful in what he was saying. I do not want to fall out with him, or to be disorderly, but according to the transcript, there were “jeers” from the audience.

One audience member said that hospitals in Leicester were “falling apart”. Another said, “It’s shameful.” A third said,

“It’s not a case of throwing money at it.”

A fourth said that the Secretary of State was

“saying you will invest loads…into Leicester Royal Infirmary, what about…the General?”

What, that audience member continued, about

“the benefit in terms of beds…as a whole?”

The Secretary of State replied:

“We will do all of those things and we’ve guaranteed the money to Leicester and it’s coming in the next couple of years.”

There was then audience “laughter”.

[Vicky Ford]

rose—

[Jonathan Ashworth]

Let me deal with this point first.

The people of Leicester can see what is happening. Although the Secretary of State is putting money into Leicester Royal Infirmary, Leicester General Hospital in the constituency next door loses maternity services, loses the hydrotherapy pool, loses renal services, loses—[Interruption.]

[Madam Deputy Speaker (Dame Eleanor Laing)]

Order. Remember that we were all going to try to be polite. The hon. Gentleman is talking about hospitals that people care about, and we must listen to him.

[Jonathan Ashworth]

It loses elective orthopaedics, loses urology, loses brain injury and neurological services, loses gynaecology, and loses podiatry.

[David Tredinnick (Bosworth) (Con)]

rose—

[Jonathan Ashworth]

Let me just finish this point and then I will bring in the hon. Gentleman. [Interruption.] He is a Leicester Member of Parliament, after all.

The Leicester General can have a sustainable future under this Secretary of State only if he moves the midwifery unit from St Mary’s Hospital in Melton Mowbray. If that is what he is proposing, I hope he is making it clear to Leicestershire MPs.

[David Tredinnick]

I am most grateful to the hon. Gentleman, who is a Leicester Member, but I have to say that I am astonished by his tone. Almost the entire county and city welcomed this huge, major investment and reorganisation. Years ago, my former right hon. Friend Stephen Dorrell—he is no longer in the House—explained why the General was likely to close. That is not the case—the hon. Gentleman should recognise that massive investment.

--- Later in debate ---

[Jonathan Ashworth]

Well, the General is essentially being downgraded and I want a sustainable future for Leicester.

[Neil O’Brien]

Will the hon. Gentleman give way?

[Jonathan Ashworth]

This will be the last intervention I take because I have to get to the end of my speech, but let me just finish this point: the Leicester General is essentially being downgraded. The only thing that remains at the Leicester General is the diabetes unit, unless the Secretary of State is moving midwifery services from St Mary’s in Melton Mowbray to Leicester and, if he is doing that, he should be clear with the right hon. Member for Rutland and Melton (Sir Alan Duncan).

[Neil O’Brien]

I appreciate the hon. Gentleman being generous with his time. My family used maternity services at the General just last week. We sat on a couch. My wife had not eaten for nearly 24 hours because the General does not have an all-electives list for caesarean sections. That service will be better when services come together in the new maternity hospital that is going to be built. By the way we also used St Mary’s birthing unit in Melton Mowbray. It is a brilliant midwife-led unit and we are not going to close it.

[Jonathan Ashworth]

There we go, but the only way the Leicester General has a sustainable future in their own plans—these are the plans the Secretary of State has signed off from the Leicester trust—is if that midwifery unit at St Mary’s moves to the Leicester General. I am sorry that the hon. Gentleman’s family got a poor service at the Leicester General. My daughter was born at the Leicester General as well and we got an excellent service.

[Several hon. Members rose—]

[Jonathan Ashworth]

I need to move on because I think the House is getting slightly tired of our focusing on our constituency issues and I am abusing my position. I will try to give way again shortly, but I am testing the indulgence of the House on the issue of Leicester.

In the Queen’s Speech, there are also proposals on mental health, and we look forward to the mental health White Paper and hope that Sir Simon Wessely’s review is quickly implemented. He also called for significant capital investment in the mental health estate, yet none of the hospitals the Secretary of State has announced includes mental health trusts.

[The Secretary of State for Health and Social Care (Matt Hancock)]

Yes they do.

[Jonathan Ashworth]

No they don’t; none of the hospitals the right hon. Gentleman announced at the Tory party conference includes mental health trusts. He knows there are 1,000 beds in old-style dormitory-style wards in desperate need of upgrade. He knows that we have problems with anti-ligature works that desperately need doing in mental health trusts because they are putting lives at risk every day.

On social care, we were told we were going to have the big solution to social care. The Secretary of State was briefing that a previous Chancellor, the right hon. Member for Runnymede and Weybridge (Mr Hammond), was holding him back and he was going to give us a solution on social care. And what do the Government say? They say, “We have not got a social care Green Paper, we have not got social care proposals, we will get proposals on social care in due course.” The Secretary of State is kicking the can on social care down the road again.

Let me come to the Health and Social Care Act 2012. On Second Reading, it was described by the new Minister, the hon. Member for Mid Bedfordshire (Ms Dorries)—I welcome her to her elevation to the Treasury Bench; it was remiss of me not to do that earlier—as one of the most exciting Bills to be put before Parliament in the 62 years since the NHS was established. We were told that there was going to be legislation to undo the worst excesses of that Lansley Act, but all we are getting apparently is draft legislation, again, “in due course”—that is the wording in the explanatory notes to the Queen’s Speech.

[Debbie Abrahams (Oldham East and Saddleworth) (Lab)]

I had the privilege of sitting on both Committees that considered the Health and Social Care Bill, as it was then. Section 75 is particularly punitive in terms of its requirements for clinical commissioning groups to put all contracts out to tender. Some £25 billion-worth of public money has gone to the private sector, with the implications of an increase in health inequality, both in access and outcomes. Does my hon. Friend agree that this is an absolute travesty?

[Jonathan Ashworth]

Absolutely.

[Madam Deputy Speaker (Dame Eleanor Laing)]

Order. Let me say before the hon. Gentleman answers the intervention, that he has been very generous in taking interventions, and that is good for the debate, but I am sure he will bear in mind that he has been at the Dispatch Box for nearly half an hour, and I just say to him gently that that is all right with me, but he will incur the wrath of those who are waiting to speak later in the debate when they only get three minutes.

[Jonathan Ashworth]

Thank you for your guidance, Madam Deputy Speaker. You are absolutely right. I will not take any more interventions and I will move to wrap up.

My hon. Friend the Member for Oldham East and Saddleworth (Debbie Abrahams) is absolutely right that the compulsory competitive tendering provisions of that Act have forced through the privatisation of £9 billion-worth of contracts. Everything that was promised in the Act, from delivering on health inequalities to delivering more integrated care, has not come to fruition, which is why everybody understands that it needs to be repealed.

But there is another reason why the Act needs to be repealed: while it is on the statute book, it runs the risk of the NHS being sold off in a Trump trade deal. Under the World Trade Organisation, public services can only be excluded from trade deals where there is no competition with private providers or where they are not run for profit, but the enforced competitive tendering of contracts through the Lansley Act means private health providers already operate in competition with public NHS providers, and the so-called standstill ratchet clauses and the inter-state dispute mechanisms would mean a Trump trade deal would lock in the privatisation of our NHS ushered in by the Health and Social Care Act.

[Several hon. Members rose—]

[Jonathan Ashworth]

I am going to finish.

Any Government seeking to undo that privatisation in a trade deal are liable to get sued in an international tribunal by private international investors, and there is no appeal. It happened in Slovakia, it happened in Canada and it happened in Australia. It is not taking back control—it is a democratic outrage. It is not just about selling off the NHS; we know that Donald Trump wants to break our pharmaceutical market as well, forcing us to buy more expensive drugs from the US and crippling our national health service.

So if Tory MPs want to save the NHS, they should vote with us in the Lobby tonight, because the party that created the NHS, the party that has always rebuilt the NHS, and the party that will end the privatisation of the NHS is the Labour party and no one will trust the Tories with the NHS.

--- Later in debate ---

[Matt Hancock]

I will debate the hon. Gentleman’s involvement in PFI, which hamstrung the hospitals, every day of the week. Now, however, I wish to—

[Jonathan Ashworth]

I am delighted that the Secretary of State has elevated me; I was a 25-year-old adviser in the Treasury at the time. I remember sitting in that box as a special adviser listening to Tory shadow Health Secretaries calling for more PFIs in the NHS. The right hon. Gentleman was an adviser to George Osborne, so what about this quote from 2011:

“George Osborne backs 61 PFI projects…the chancellor, is pressing ahead with private finance initiative…on a multibillion-pound scale”.

The right hon. Gentleman should be apologising for PFI.

[Matt Hancock]

In 2011, I was the MP for West Suffolk. I opposed PFI in opposition and I have opposed it ever since, and I am delighted that the Government are cancelling it. It is just such a shame that the hon. Gentleman spent so many years driving through PFI when we could have built better hospitals for less money if we had properly put them on the books of the nation’s balance sheet, as we are doing now.

--- Later in debate ---

[Matt Hancock]

I very much agree with my hon. Friend. In many trusts, things have gone very well over the past few years and there is a much more open and less hierarchical culture, with less bullying and more openness to challenge. However, that is not the case in every part of the NHS, and that needs to change. The Health Service Safety Investigations Bill addresses that directly. After the welcome given by the shadow Secretary of State, I hope that Bill will proceed on an essentially consensual basis.

[Jonathan Ashworth]

indicated assent.

[Matt Hancock]

The hon. Gentleman is saying yes, which I am grateful for. I am open-minded to changes and improvements, and to listening to the experts and those with constituency cases that they can bring to bear, to make sure that the Bill is the best it possibly can be.

The National Health Service

Jonathan Ashworth Excerpts

Wednesday 23rd October 2019 Commons Chamber

[Tonia Antoniazzi (Gower) (Lab)]

It is an honour to follow my hon. Friend the Member for Reading East (Matt Rodda). I have listened to much of the debate, and it is clear that the NHS is a treasured institution under threat from a hard Tory Brexit, and that having a Labour Government is the only way to secure its future and keep it wholly in public hands.

Today I want to speak about a specific issue that I have been involved with since I was elected in 2017, when I was approached by families in my constituency about getting access to medical cannabis—a medicine that could change the lives of children living with intractable epilepsy. I really could not understand what the problem was until I spoke to my late friend Paul Flynn, who had done a lot of work on this issue, and he explained how it has been an uphill struggle.

[Jonathan Ashworth]

It was remiss of me earlier in the debate not to pay tribute to the leadership my hon. Friend has shown on this campaign, as well as the right hon. Member for Hemel Hempstead (Sir Mike Penning). She brought a group of campaigners to see me earlier in the year. I put on record our thanks for the tremendous work she has put into the campaign.

[Tonia Antoniazzi]

I thank my hon. Friend; I look forward to keeping on working with him.

It has been an uphill struggle. While thousands of people across the world have access to medicinal cannabis, the law was preventing patients in the UK from accessing it.

We have worked with the amazing families of the End Our Pain campaign, spearheaded by the amazing Hannah Deacon, who is mum to Alfie Dingley. Hannah’s campaigning meant that she got a special licence for Alfie to continue to use the cannabis that had transformed his life in the Netherlands. Then Sophia Gibson and Billy Caldwell were given prescriptions for medical cannabis. The highlight came last year, on 1 November, when there was a change in the law to reclassify cannabis so that it was available for medical use.

At the time, we thought that would mean that the children who were suffering would be able to have cannabis prescribed by specialist consultants. It turned out that that was not the case, so many other children were not given access to this life-changing medicine. Children from all over the UK continue to suffer because the Government are dragging their feet. The medicine is proven to work for many types of sufferers, but children are still being pumped full of steroids and unlicensed drugs that leave them severely impaired. The effect on the families has been terrible—on the children, the siblings and the parents. It is just not fair.

No one claims that this is a miracle drug. It is not a cure for epilepsy, but it does make a huge difference to the quality of children’s lives. Everyone has a right to live their best life.

I have worked closely with the parents of Bailey Williams from Cardiff, Rachel and Craig. I have seen at first hand the difference that this medicine has made to their son. When I called at their house one evening, Bailey got out of the chair, picked up a bunch of flowers and brought them to me. I actually cried to see a child who previously could not get out of bed get up out of a chair and give me a gift of thanks.

A lot of other children have the same story. Alfie has been riding a bike and a horse—something that would never have happened when he was on his previous drugs. The problem is that Alfie is getting to a point where the efficacy of this type of medicinal cannabis is dulling. As with all long-term medication, he needs a review and to be put on a new strain. However, the strict restrictions mean that even Alfie will not be able to access a new strain. As his tolerance to his medication builds, he is beginning to have more seizures. What next for Alfie? What will the Secretary of State do?

As we approach the anniversary of the law change, I want to reflect on what has happened to the lives of the families I have worked with, as co-chair of the all-party group on medical cannabis under prescription along with the right hon. Member for Hemel Hempstead (Sir Mike Penning). At the End Our Pain campaign event on 19 March, the Secretary of State told the families that he would make sure they got the medicine they needed. However, more than six months on from that promise and nearly a year on from the law change, not one new NHS prescription has been made, not one child has benefited from medical cannabis, and not one family have been able to move on with their lives.

Health Infrastructure Plan

Jonathan Ashworth Excerpts

Monday 30th September 2019 Commons Chamber

[Jonathan Ashworth (Leicester South) (Lab/Co-op)]

I welcome the Minister to his place and thank him for advance sight of his statement. I know him to be a decent man—we have worked together on many joint Leicester and Leicestershire campaigns—and I consider him a friend, but I am afraid that we have to hold him and his Government robustly to account. What was announced yesterday was not in fact 40 guaranteed new hospitals but six hospital reconfigurations. It was also not the biggest hospital rebuilding programme in history, because that happened under the last Labour Government.

Of course, I welcome investment in Leicester Royal Infirmary—it is a big investment and to have won it shows what an effective Member of Parliament I am—but will the Minister be clear that that also means a downgrade of Leicester General Hospital, with services closing, including maternity services, and a loss of beds? Will he also tell us what happened with the Epsom and St Helier reconfiguration? Will he confirm that that means moving from two acute services to one in a part of London where accident and emergency pressures are increasing? Will he tell us today whether, across these reconfigurations, the end result will be more beds or fewer?

We know that the NHS is facing a repair bill of £6 billion after years of capital cuts under this Conservative Government, but the Government have so far refused to publish the capital allowances for between next year and 2025. Will the Minister guarantee that the £2.7 billion allocated will be additional to the capital baseline, and will he undertake to publish the NHS departmental expenditure limits on capital spending so that we can be reassured, rather than our assuming that this is all smoke and mirrors?

The Minister has also invited 21 other trusts to make use of a £100 million fund to prepare plans for future upgrades, yet he has just admitted that that will be subject to “business case review”. Is not the truth that the Minister and the Secretary of State cannot give any cast-iron guarantee that each and every one of these hospitals will be upgraded between 2025 and 2030, because not a penny piece of extra investment has been allocated to the programme for 2025 to 2030?

Finally, how were the 21 trusts chosen? In our mental health hospitals, 1,000 patients are forced to stay in quite dire old-style dormitory wards—the Minister might have seen the ones at the Leicestershire Partnership NHS Trust, for example—yet not a single mental health trust is on the list of 21 produced yesterday. Does that not show yet again that this Government neglect mental health services and some of the most vulnerable patients in the land?

What is on this list, Mr Speaker? I will tell you. We have: Hastings and Eastbourne—marginal constituencies; Winchester—a marginal constituency; Plymouth—a marginal constituency; Reading—a marginal constituency; Truro—a marginal constituency; Torbay—a marginal constituency; Barrow—a marginal constituency; and Uxbridge—a marginal constituency. What a spooky coincidence it is that all these marginal constituencies are on the list. This is not a serious plan. It is a wing and a prayer ahead of a general election. The Prime Minister over-spins, under-delivers and is not straight with people—the truth is that you cannot trust the Tories with the NHS.

[Edward Argar]

I will at least start by expressing gratitude to the hon. Gentleman for his kind words at the beginning of his remarks. As he says, we work closely together in our city and county, although I suspect that that spirit of co-operation might not extend across these Dispatch Boxes. None the less, it is a pleasure to stand opposite him. Although I would not agree with his characterisation of where the money has gone, is he, on the basis of that characterisation, suggesting that his own seat is a marginal constituency?

I find it extraordinary that the shadow Secretary of State takes opposition to a new level by opposing investment in our NHS, trying to cavil and challenge it. He will forgive me if I do not take his specific questions in the same order as he asked them, but I will run through as many of them as I can recall or as I noted down.

On mental health, I have to say that I find it very difficult to take lessons from the hon. Gentleman when this Government have invested huge additional sums in mental health care. As I mentioned in my opening remarks, we have allocated capital for Greater Manchester Mental Health NHS Foundation Trust—the announcement was made earlier this summer—and for Mersey Care NHS Foundation Trust, so I think the hon. Gentleman is perhaps being a little unfair in suggesting there is no investment in mental health from this Government.

This is an ambitious programme, but unlike the last Labour Government, we will not leave hospitals saddled with masses of private finance initiative debt. That programme was massively expanded under the Labour Government he served as a special adviser. Perhaps he should welcome this Government’s approach, which is to give hospitals the funding they need to deliver without saddling them with debt.

We have made it clear that the hospitals named in HIP 1 have the funding to go ahead, including the hospitals that serve his constituency and mine. I am a little surprised to hear the hon. Gentleman challenge the notion that anyone bidding for huge sums of public money should have to go through a business case. Surely when we are spending public money, it is reasonable of us to make sure it delivers value for money and better outcomes for patients. I know the Labour party does not pay much attention to value for money, but my party and this Government do. We are focused on patient outcomes and delivering investment in our NHS. We can say proudly that, with this raft of announcements, the extra £33 billion and the announcements made already, we truly are the party of the NHS.

Oral Answers to Questions

Jonathan Ashworth Excerpts

Tuesday 23rd July 2019 Commons Chamber

[The Parliamentary Under-Secretary of State for Health and Social Care (Jackie Doyle-Price)]

My hon. Friend is right: the postcode lottery is not acceptable, and patients manage to get around it; my local clinical commissioning group, having funded three courses of IVF, has had to reduce that to two, because demand has doubled owing to the lack of provision in neighbouring CCGs. I have made it very clear that it is unacceptable for any CCG to offer no IVF cycles at all; I have given them that guidance.

[Jonathan Ashworth (Leicester South) (Lab/Co-op)]

My I pursue the question asked by the Chair of the Select Committee, the hon. Member for Totnes (Dr Wollaston)? We know that obesity is a major cause of cancer and other diseases, and we know that we have severe rates of childhood obesity, so why does the prevention Green Paper say only that the sugar tax “may” be extended to milkshakes? The evidence is clear. Is the Secretary of State not kicking this into the long grass?

[Matt Hancock]

I have asked the chief medical officer to review the evidence to ensure that our policy for tackling obesity is evidence-driven. Follow the evidence: that is what we do on this side of the House.

[Jonathan Ashworth]

A year ago the Secretary of State said, to great fanfare, that prevention was one of his priorities. Now the prevention Green Paper has been sneaked out in the night on the Cabinet Office website. Health inequalities are getting wider and wider, and life expectancy is stalling, but the Secretary of State still cannot give us any clarification on the future of the public health ring-fenced grant. Is it not the truth that he has buckled under pressure from the sugar industry, is not taking on the alcohol industry, and is not taking on the tobacco industry? That is more about trying to get in with the new Prime Minister than putting the health needs of the nation first.

[Matt Hancock]

I thought that the hon. Gentleman would welcome the prevention Green Paper, which was published yesterday. We have been working very hard to publish a huge amount of policy, including the Green Paper, which contains about 80 different policies to ensure that we prevent people from becoming ill in the first place. However, it is also part of a broader drive, which Conservative Members support, to ensure that we are the healthiest of nations, and that people can take personal responsibility for their health, as well as relying on the NHS, so that it is always there when people need it.

NHS Long-Term Plan: Implementation

Jonathan Ashworth Excerpts

Monday 1st July 2019 Commons Chamber

[Jonathan Ashworth (Leicester South) (Lab/Co-op)]

I am grateful to the Secretary of State for an advance copy of his statement. I had hoped for a greater sense of urgency from him. He talks about the 100-year anniversary of the Ministry of Health, but this year is the first time in 100 years that the advances in life expectancy have begun to stall, and even go backwards in the poorest areas. Just the other week, we saw that infant mortality rates have risen now for the third year in a row. As this is the first time that they have risen since the second world war, I would have hoped for a greater focus on health inequalities in his statement today, not least because public health services—the services that, in many ways, lead the charge against health inequalities—are being cut by £700 million. Now he says that we should wait for the spending review for the future of public health services, but we do not know when the spending review is. The Chief Secretary to the Treasury has said that it will be delayed, so it could be next year.

In the past, the Secretary of State has talked about a prevention Green Paper. Will that prevention Green Paper be before the spending review or after the spending review? Will he also tell us whether it is still the intention of the Department to insist that local authorities fund their public health obligations through the business rates?

At the time of the publication of the long-term plan last year, the then Secretary of State for Health said that we cannot have one plan for the NHS without a plan for social care, yet we still have no plan for social care. We have been promised a social care Green Paper umpteen times. We are more likely to see the Secretary of State riding Shergar at Newmarket than see the social care Green Paper. Where is it?

The Secretary of State talks about the better care fund revenue increase. May I press him further on that? Is he saying that the clinical commissioning group allocations to the better care fund, which tend to be the bulk of the better care fund, will increase in line with the NHS revenue increase, or is he saying that there will be new money available for the better care fund? Adult social care has been cut by £7 billion since 2010 under this Tory Government, which is why hundreds of thousands of elderly and vulnerable people are going without the social care support that they need. Presumably, we will have to wait for the spending review for proposals on social care.

The Secretary of State talks about the workforce. We have 100,000 vacancies across the NHS. We have heard about the interim people plan, but of course we have seen the bursary cut, the pay restraint, and the continuing professional development cut. That plan is all good and fine, but when will it be backed up by actual cash?

The Secretary of State talks about IT systems and apps—we know that he is very fond of that—but again he gives us no certainty on capital investment. Hospitals are facing a £6 billion repair bill—ceilings are falling in and pipes are bursting. The repair bill designated as serious risk has doubled to £3 billion. When will we have clarity on NHS capital?

We broadly welcome what the Secretary of State said about mental health, but 100,000 children are currently denied mental health treatment each year because their problems are not designated as serious enough, and over 500 children and young people wait more than a year for specialist mental health treatment. He talks of a fundamental shift, so can he guarantee that clinical commissioning groups will no longer be allowed to raid their child and adolescent mental health services budgets in order to fill wider gaps in health expenditure? On mental health resilience and prevention, only 1.6% of public health budgets is currently spent on mental health, so will he mandate local authorities, when setting their public health budgets, to increase the money they spend on mental health?

On cancer, we broadly welcome what the Secretary of State has said, but patients are waiting longer for treatment because of vacancies and out-of-date equipment. Today we learned that consultant oncologists with shares in private hospitals are referring growing numbers of patients to those hospitals. Is that not a conflict of interest? When will we see tougher regulation of the private healthcare sector?

The Secretary of State talked about the clinical review of standards that is being piloted in 14 hospitals, yet those hospitals are not publishing the data. If he wants to abandon the four-hour A&E target, will he insist that those pilot hospitals publish all the data? He did not mention waiting lists. We have seen CCGs rationing treatment because of the finances. We have seen 3,000 elderly people refused cataract removals. We have seen CCGs refusing applications for hip and knee replacements. We have even seen a hospital that until last week was inviting patients to pay up to £18,000 for a hip or knee replacement—procedures that used to be available on the NHS. When is he going to intervene to stop that rationing of treatment, which we are seeing expand across the country because of the finances?

Finally, there are many laudable things in the long-term plan that we welcome. Alcohol care teams were a Labour idea. Perinatal mental health services were a Labour idea. Gambling addiction clinics, which the Secretary of State announced last year, were a Labour idea. Today he is talking about bringing catering back in-house, which is also a Labour idea. Why does he not just let me be Heath Secretary, and then he could carry on being the press secretary for the right hon. Member for Uxbridge and South Ruislip (Boris Johnson)?

[Matt Hancock]

Well, it is great that by the end of his questions the hon. Gentleman finally got to the future of the NHS, which is what we are here to discuss. However, what I did not hear—unless I missed it—was a welcome for the extra £33.9 billion that we are putting into the NHS. I did not hear him welcome the fact that life expectancies are rising, or our plan to drive up healthy life expectancy still further. I did not hear him say whether the Labour party supports our efforts to ensure that the NHS is properly funded and supported not only now but into the future, because that is what this Government are delivering.

I will go through some of the questions that the hon. Gentleman did raise. He asked about the prevention Green Paper. Indeed, he will know that preventing people getting ill in the first place is a central objective of mine, and it will be forthcoming shortly. He mentioned the better care fund. I was very precise in what I said about the better care fund, because its funding is rising in line with NHS revenue growth. In fact, the overall funding available to deliver social care in this country has risen by 11% over the past three years. Of course there is more to do to ensure that we have a social care system that is properly funded and structured to ensure that everybody can have the dignity of the care they need in older age, and that people of working age get the social care they need, but the Labour party ought to welcome the increase in funding, as well as the aim of ensuring that we get the best possible value for every pound.

The hon. Gentleman mentioned the clinical review of standards, which he welcomed when it was announced recently. The pilots that he mentioned started just four weeks ago, and of course we will be assessing the results and ensuring that we get the right structures in place in future. I am glad that he welcomed it, but in relation to publishing data, after just four weeks it is unsurprising that we are still in the early stages.

The hon. Gentleman asked me to ensure that the increase in funding for mental health will happen and that CCGs will be required to see that increase flowing through to make sure that patients get better service. I can confirm that NHS England is already intervening. The £2.3 billion increase that we have set out in the long-term plan will be required to flow through to the frontline. This implementation framework is part of the system that we are putting in place to make sure that that happens.

Oral Answers to Questions

Jonathan Ashworth Excerpts

Tuesday 18th June 2019 Commons Chamber

[The Parliamentary Under-Secretary of State for Health and Social Care (Jackie Doyle-Price)]

I thank the Committee for its report, which follows the health ombudsman’s report on the tragic death of Averil Hart. It is clear that we have made significant improvements in eating disorder provision since then, but there is still more to do. We have made considerable progress with regard to treating children, and that progress now needs to be translated to the care of adults with eating disorders. My hon. Friend is right that it is the mental health disorder that has the highest mortality rate. At any one time, 1% of the population will be suffering from an eating disorder, and we need to make this more of a priority to make sure that services are available.

[Jonathan Ashworth (Leicester South) (Lab/Co-op)]

rose—

[Mr Speaker]

I know the shadow Secretary of State will be brief, because he will not want to crowd out his colleagues. That would be an uncomradely thing to do—inegalitarian no less—and he would not do that.

[Jonathan Ashworth]

Indeed.

I dare say that this is the Secretary of State’s final outing at Health questions, because we believe he has secured transfer to pastures new. In his time here, he has failed to deliver a social care Green Paper and failed to deliver a prevention Green Paper, while he is privatising Oxford cancer scanning services and we have hospitals charging £7,000 for knee replacements. Does he really think that is a record deserving of Cabinet promotion?

[Matt Hancock]

I am agog—and aghast. Over the last year, we have not only delivered £33.9 billion of increased funding, but we have produced the long-term plan for the future of the NHS. Starting this year, with the money already flowing, we are seeing the biggest increase in funding for community, primary care and mental health services. We have developed our work on the prevention agenda, and we have instituted a new verve and energy into the adoption of new technology in the NHS. I look forward to driving forward all these things in the future.

[Jonathan Ashworth]

Will the Secretary of State tell us about the verve and energy in his own constituency in Suffolk, where 32 health visitors are being cut because of his cuts? He is apparently now supporting a candidate who wants £10 billion-worth of tax cuts for the richest in society. Will that not mean further cuts to public health, further cuts to social care and, ultimately, cuts to the NHS as well?

[Matt Hancock]

For the majority of its 71-year history, the NHS has been run under the stewardship of a Conservative Secretary of State. At this moment, it is getting the biggest funding increase and the longest funding settlement in its history, along with the reforms to make sure that everybody can get the health care that they need.

Listeria: Contaminated Sandwiches

Jonathan Ashworth Excerpts

Monday 17th June 2019 Commons Chamber

[Jonathan Ashworth (Leicester South) (Lab/Co-op) (Urgent Question)]

To ask the Secretary of State for Health and Social Care to make a statement on the listeria outbreak related to contaminated sandwiches in hospital trusts.

[The Secretary of State for Health and Social Care (Matt Hancock)]

I would like to update the House on the actions the Government are taking to protect the public following cases of listeria in hospitals linked to contaminated food. The NHS has identified nine confirmed cases of listeria in seven different hospitals between 14 April and 28 May this year, all linked to contaminated sandwiches from a single supplier. All the known cases involve in-patients. Very sadly, five people have died. I would like to express my condolences to the families of those who have lost a loved one. I promise that there will be a full and thorough investigation, with severe consequences if there is any evidence of wrongdoing.

Lab testing indicated a link between two cases in Manchester Royal Infirmary and one case in Liverpool. Contaminated sandwiches were identified as the likely cause by Public Health England. The manufacturer—The Good Food Chain—and its supplier, North Country Cooked Meats, have withdrawn the sandwiches, and voluntarily ceased supply of all products on 7 June. They are both complying with the Food Standards Agency on a full product withdrawal. The other cases have been identified at these hospitals: Royal Derby, Worthing, William Harvey in Ashford, Wexham Park, Leicester Royal Infirmary, and St Richards in Chichester.

The risk to the public is very low, but any patients or members of the public with concerns should contact NHS 111 or, of course, 999 if they experience severe symptoms. Listeria infection in healthy people may cause mild illness but is rarely fatal. However, for certain groups it can be much more serious, as we have tragically seen. The NHS, Public Health England and the Food Standards Agency have acted swiftly to identify, contain and investigate the cause of this listeria outbreak. These deaths should never have happened. People rightly expect to be safe and looked after in hospitals, and we must ensure that we take the necessary steps to restore that trust that the public deserve to be able to hold.

This is not just about ensuring that the food we serve in hospitals is safe—the NHS served 140 million main meals to in-patients last year—but, importantly, is also about ensuring that food given to patients is healthy, nutritious, and aids their recovery. So I can inform the House that we are launching a root-and-branch review of all the food in our hospitals—both the food served and the food sold. The Government will work with the NHS to build on progress in three vital areas. First, there is eliminating junk food from hospitals. Since the introduction of the NHS action on sugar scheme, we have halved the sale of high-sugar soft drinks, and trusts are taking action to remove unhealthy food and drink items and replace them with healthier alternatives. After all, hospitals are places for good health. Secondly, on improving nutrition, new national standards for all healthcare food will be published this year. All patient menus will have to ensure that minimum patient nutrition standards are met. Thirdly, on healthier choices, we will work closely with the Hospital Caterers Association and others to ensure that healthier food choices are available across the NHS.

The review will identify where we need to do more, where we need to do better to improve the quality of food in our hospitals, and how we help people to make healthier choices. I know that this is an issue that many colleagues in the House feel strongly about, as do the public. We will do everything we can to ensure that the food we eat in hospitals is both safe and healthy.

[Jonathan Ashworth]

Let me say at the outset that despite our often sharp political differences across the Dispatch Box, the Secretary of State has my commiserations over his entirely noble ambition to want to be the Prime Minister of this country—but perhaps, given Brexit, he has had a lucky escape.

Moving on to the substance of what we have to discuss today, our thoughts really must be with the families of those who have lost their lives. This is, first and foremost, an issue of patient safety and standards of care. Every patient deserves the very safest possible care and absolute confidence about the quality and safety of the food that they are offered. I am pleased that there is an investigation, and I welcome what he said about serious consequences if wrongdoing is found. I am also pleased that he talked about a root-and-branch review, which we have been calling for. As I understand it, NHS Improvement was already reviewing the hospital food plan, which was delayed from April. Is this a new review or an existing review that now has new obligations? Can he explain to the House how the review he has announced interacts with the existing NHS Improvement review?

I know that the investigation will want to get to the bottom of what went wrong and why, and it will no doubt make recommendations for the future, but we would be grateful if the Secretary of State offered some clarification. The first case showing symptoms of listeria was on 25 April, and sandwiches and salads were withdrawn on 25 May. When were Ministers informed, and what action was taken?

I am grateful that the Secretary of State listed the other hospital trusts affected, which include the one in my Leicester constituency. As I understand it, the Good Food Chain was supplying sandwiches to 43 trusts. Can he tell us the status of investigations or what investigations have gone on in the other trusts that he has not listed today? Does he expect cases to emerge in more trusts, and what action is currently under way to contain the spread?

What advice has the Secretary of State received from officials that microbiological controls for listeria need to be improved with respect to pre-packaged sandwiches? Will he consider introducing mandatory testing on all batches of high-risk food? Of course, this is not the first time that there has been a listeria outbreak. There was an outbreak back in 2016, and in response, the Food Standards Agency investigated and issued a report warning Ministers of the dangers posed by pre-packed sandwiches. Can he outline what measures were taken by Ministers in response to that report in 2016?

I have been speaking to hospital catering staff in recent days, and they raised concerns that tight finances and years of capital cuts have left kitchens substandard, which has driven a move to greater outsourcing of catering, with sandwiches and soups steadily replacing hot meals. Recent data show some hospitals spending less than £3 per patient per day. Does the Secretary of State agree that the review he has announced today should be backed up by investment in hospital catering facilities and legally backed, clear minimum-quality standards for hospital food? Healthcare is not just about medicine, surgery, bandages and procedures; it is about nutrition and hydration too. Patients will need urgent reassurance. Can he provide that today?

[Matt Hancock]

The shadow Secretary of State raises important questions, and I will try to address them all. Ultimately, I strongly agree with him that this is about standards of care. People deserve to be able to trust that the food they eat and are given in hospital is safe and, indeed, nutritious and good for their health—that is an important part of this too. Clearly, the most acute aspect of what we are discussing is safety and the lack of listeria in food, but it is part of a much bigger picture, which is why we are having a root-and-branch review.

The hon. Gentleman asked about the hospital food plan, which NHS Improvement has been leading. The review will be wider than, but will encompass, some of the existing work that is ongoing. It is about not only how food is procured by hospitals, but the quality of food. Work on the national standards in hospital food is important. It has been ongoing for several years and will come to fruition very soon. More broadly, dozens of hospital trusts have brought their catering in-house and found that they get better quality food that is more likely to be locally produced and is better value for money. We will be examining that model closely, because I am very attracted to it, and it has the potential to reduce the risk of safety concerns such as this.

The hon. Gentleman asked about timings. The Under-Secretary of State for Health and Social Care, my hon. Friend the Member for South Ribble (Seema Kennedy), was made aware of this outbreak on 4 June. I was informed on 6 June, and we published the details of the outbreak on 7 June.

Before that, Public Health England very swiftly identified that there was a link between these particular listeria outbreaks. It is only because of recent advances in genomic medicine and testing that we could work out—that Public Health England could work out—that the outbreak in Liverpool and the outbreak in Manchester were connected, and therefore identify that the source was outside those hospitals, rather than inside the hospitals, and that is what then identified that this was from the food source. The truth is that there are just over 150 listeria cases a year. It is a notifiable disease, so we are confident that we are properly notified of the various cases. Frankly, it was cutting-edge work by Public Health England that allowed us to connect these different cases and work out that a single source was causing these deaths.

The hon. Gentleman mentioned the 43 trusts that we know bought from the Good Food Chain. We have of course been in contact with all hospital trusts, whether or not they bought from this individual company, to try to make sure that we have confidence in their supplies. The Good Food Chain has confirmed that it has followed advice and has disposed of all products. That is what the Good Food Chain company has said to us, but we are of course reconfirming that with the trusts because we want to get this right.

Finally, the hon. Gentleman asked about investment in food and catering facilities. The truth is that it is important to have the best-quality food in hospitals. I am completely open to upgrading hospital equipment if that is what is necessary, and if it provides value for money. I have been struck by the number of hospital chief executives who have said that from the point of view of patient satisfaction, staff morale, and nutrition and the quality of food, bringing such food supplies in-house is the best thing they have done.

Interim NHS People Plan

Jonathan Ashworth Excerpts

Wednesday 5th June 2019 Commons Chamber

[Jonathan Ashworth (Leicester South) (Lab/Co-op) (Urgent Question)]

To ask the Secretary of State for Health and Social Care to make a statement on the interim NHS people plan.

[The Minister for Health (Stephen Hammond)]

The NHS published its interim people plan on Monday, and I laid a written ministerial statement at the earliest opportunity yesterday.

The plan is a first, but critically important, step in ensuring that the NHS has the people, leadership and culture it needs to deliver the NHS long-term plan. The interim people plan has been developed by Baroness Dido Harding, the chair of NHS Improvement, in partnership with frontline staff, NHS employers and a wider range of other representative groups and stakeholders. It takes a tough look at the challenges facing people working across the NHS. It sets out how leaders will be supported to create cultures that empower staff and make sure that every member of staff, regardless of their background, will be able to progress.

Critically, the plan calls for all NHS organisations to set out how they will ensure that the NHS is the best place to work. The recently appointed chief people officer for the NHS will play a vital role in supporting the NHS to do this. The interim people plan sets out a number of practical steps to increase the supply of clinical staff. This includes an extra 5,000 additional clinical placements for nurse training places by September 2019 and a commitment to further expansion of medical school places.

Ultimately, the plan will ensure that the NHS is best able to retain the highly skilled and dedicated staff who choose a career in healthcare, including the most senior clinicians. Therefore, we have listened to their concerns that pension tax changes are discouraging them from doing extra work for patients. That is why Government will consult on how to introduce new flexibilities for this critically important staff group.

But we are not complacent. We know there is more work to do to secure the people, leadership and culture that the NHS needs. My right hon. Friend the Secretary of State has asked Baroness Harding to lead further work over the summer to prepare the final people plan. As has always been intended, the final people plan will be published soon after the conclusion of the spending review, when there will be further clarity on education and training budgets.

I would like to take this opportunity once again to place on record my thanks, and the thanks, I am sure, of everybody across the whole House, to all the NHS staff who do a wonderful job in ensuring that our constituents—their patients—get excellent care.

[Jonathan Ashworth]

It is a pleasure, as always, to see the Minister of State, but the Secretary of State should be doing his day job and be here answering questions about the health service, not playing his Tory leadership games.

Our NHS is struggling with vacancies of 100,000. Our NHS staff are the very best in the world—and none of them wants to be part of a trade deal with the Americans, of course—but they are working under immense pressure because of these chronic shortages. Shortages put patient care at risk, and that means that standards of care are falling. This means that our constituents wait longer to get a GP appointment because we have lost 1,000 GPs. It means that women are turned away from maternity units because we are short of 3,500 midwives. It means that cancer diagnosis is delayed because of shortages in the cancer workforce. As Dido Harding’s report shows, we are short of 40,000 nurses in the workforce, and that is now critical. It means that at a time when mental health problems are increasing—The Lancet reports today on an increase in non-suicidal self-harm—we have actually lost 5,000 mental health nurses since 2010. We have problems in the learning disability sector. Health Education England today warns that because of the shortages in learning disability nursing, we are set to

“hit critical levels in the next five years”,

with vacancies of 30%. We have an ageing population. Adult social care is short of 110,000 staff, and yet district nursing has been cut by 50%. We do not have enough nurses on our children’s wards. Health visitors and school nurses in our communities have been cut.

This NHS workforce crisis is linked to decisions of this Government. As Dido Harding’s report says,

“applications for nursing and midwifery courses have fallen since the education funding reforms”.

Those education funding reforms include the abolition of the bursary. Is not that therefore a damning indictment of the decision by this Government to abolish the bursary, and will the Minister now commit to bringing it back?

The report also references continuing professional development, where budgets have again been cut, by a third. It says:

“Employers have…been investing less in their people, as pressures on NHS finances have grown.”

Is that not an admission that Tory austerity, with nine years of underfunding in the NHS, has contributed to the workforce crisis of today?

The Health Secretary has said that he wants “a new Windrush Generation” of overseas nurses to fill the staffing gap, so can the Minister explain why a commitment to recruit 5,000 extra nurses a year internationally was dropped from the Dido Harding report? Did the Government put pressure on Baroness Harding? On international recruitment, can he guarantee that no one offered a job in the NHS or care sector will be restricted by the £30,000 salary cap, as the chair of Health Education England called for yesterday at the Health and Social Care Committee?

Finally, the Minister referenced the spending review. He will have seen that the Chief Secretary said yesterday at a Select Committee that the spending review is now unlikely to be ready for 2020-21. That means that new funding for training, for Health Education England and for capital investment in public health and social care will not come on stream until 2021—two years away. Does the Minister think that that is an acceptable way to deal with the NHS crisis we are facing? I urge the Minister, for whom I have a lot of respect, to accept that we cannot keep delaying this situation further. The Health Secretary needs to abandon his leadership games, focus on his day job and get a grip.

Clinical Trials and Clinical Research Capability

Jonathan Ashworth Excerpts

Thursday 23rd May 2019 Westminster Hall

[Jonathan Ashworth (Leicester South) (Lab/Co-op)]

It is a pleasure to serve under your chairmanship this afternoon, Mr Hanson. I congratulate the hon. Member for Bolton West (Chris Green), my fellow London marathon runner. We have run three London marathons together and we always finish in roughly the same time.

[Chris Green]

Over the past three years, it has been a fantastic experience to be always about two or three minutes behind the hon. Gentleman.

[Jonathan Ashworth]

I think the hon. Gentleman beat me three years ago, although I have just beaten him this year.

[David Hanson (in the Chair)]

I didn’t run.

[Jonathan Ashworth]

I have not yet decided whether to run next year’s marathon, but should we decide to run, it would be great to have you running with us, Mr Hanson—or indeed the Minister.

[Marion Fellows]

As a fellow Front-Bench spokesperson, may I withdraw from any suggestion that I might run the marathon next year?

[Jonathan Ashworth]

That is disappointing, but several SNP colleagues ran it this year. Anyway, today’s debate is not about the London marathon—important though it is.

The hon. Member for Bolton West made an excellent speech. I understand that a reshuffle of junior Ministers is going on; based on the quality of his speech, he is very deserving of elevation to the Government Front Bench. He might not want to join it at the moment, but that is a different issue. He well deserves a call from Downing Street.

The hon. Gentleman made some points that muster consensus across the House, as we heard from the hon. Member for Motherwell and Wishaw (Marion Fellows). We agree with what the hon. Gentleman said about R&D investment and the implications for medical research and trials post Brexit. If I may gently tease him, I think that he and I were on different sides of the debate in the Brexit referendum. I believe that some of the issues that he raised today were not given the prominence that they deserved in the referendum campaign the first time round. He may disagree, but I think that many of the concerns that he rightly raised will come to the fore and prove particularly damaging for our clinical research if we leave the European Union on World Trade Organisation terms. If that is the prospect that the country faces, I believe that we should have another opportunity to ask the British people whether that is what they want—but, again, I digress.

The hon. Gentleman made an interesting observation about the history of clinical trials. I did not know where the term “limey” came from, so I am pleased that he has educated me on that front. He could also have mentioned Edward Jenner, who was born 270 years ago and who discovered a vaccine for smallpox through a clinical trial. Because of Edward Jenner’s work, the world was rid of smallpox; the World Health Organisation declared the world free of smallpox in 1980, its first and only such declaration about any human disease.

That example brings home the importance not only of clinical trials, but of understanding and being guided by the science, especially in an age when more and more anti-vaccination propaganda and disinformation is spreading far too rapidly on social media—typing in “anti-vax” on Facebook or Instagram brings up all kinds of disturbing, poisonous nonsense. Sadly, while more and more measles outbreaks are happening throughout Europe and in parts of the United Kingdom, our measles, mumps and rubella vaccination rates are falling. I put on record the importance of being guided by science and understanding the impact and outcomes of clinical trials, which can make a huge difference to saving lives and improving health.

I entirely endorse the hon. Gentleman’s well-made point about the £30,000 visa cap. It is not just that the cap will affect the country’s science base and our ability to attract the best scientists, research technicians and so on to our shores; at a time when we have 100,000 vacancies across the national health service, including 40,000 for nurses and thousands for midwives and paramedics, and when hospital trusts are struggling to recruit, it is completely counterproductive for the Government to propose a £30,000 visa cap.

This country has a proud history of the national health service attracting people from across the world, including clinicians, nurses and technicians. Of course our international recruitment should always be ethical, but to hinder the NHS in this way will do huge damage to our ability to attract the staff we need in the future. We are told that the Dido Harding review of the workforce will propose that the NHS should recruit 5,000 international nurses a year. I presume that the Government would endorse that, but it suggests that one hand of Government does not know what the other is doing. I appreciate that this is a Home Office matter and not necessarily within the Minister’s remit, but I urge Health Ministers to pressure the Home Office on it, because it is not remotely in the interests of our science community or of our NHS generally.

Throughout the 70-year history of the national health service, scientific research and innovation, of which clinical trials have been a part, has made great advances. Sixty years ago, the first mass immunisation programmes offered polio and diphtheria vaccines to under-15s. I think back to the hospital wards full of iron lungs for people suffering from polio; I was not born then, of course, but we have all seen them in grainy black and white photos. What was once an everyday occurrence for too many children in this country is no longer a feature of our national health service—a striking example of the importance of vaccines, research and clinical trials. An everyday aspect of doctors’ and nurses’ care—tending to people in iron lungs in hospital wards—has been completely transformed because of our research and clinical trials.

There have been all kinds of remarkable innovations in the NHS over the past 70 years. We pioneered the first heart transplants here. Forty years ago, we pioneered in vitro fertilisation. We developed CT scanners, MRI scanners and clinical thermometers. We made great advances with DNA. Seminal trials funded by the British Heart Foundation found that aspirin and clot-busting drugs can save lives after a heart attack. Extraordinary, amazing innovations have taken place in the United Kingdom because of the strength of our science base. We must celebrate that, build on it and give it all the support we can.

As the hon. Member for Bolton West rightly said, the issue has become ever more important in the context of an ageing population. In 1948, at the birth of the NHS, 11% of the UK population were 65 or over. Life expectancy was 71 for women and 66 for men. Today, those figures stand at 82 and 79 respectively, and the so-called “oldest old”—those with a substantial risk of requiring long-term care—are now the fastest-growing age group in the UK. It is projected that by 2040 nearly one person in seven will be over 75; the number of over-85s is set to double over the next 20 years. The changing demographic profile of our society will demand greater investment in science to deliver medical advances.

[Chris Green]

Does the hon. Gentleman agree that, with an ageing population, it is not just about additional support and individual treatments? One of the great challenges with an older population is multiple morbidities, where individuals need a whole series of different treatments. It is quite challenging to deliver, because there are side effects, and drugs and treatments have an impact on each other. The whole environment in which the older population gains that support is far more complicated than it is with younger people.

[Jonathan Ashworth]

The hon. Gentleman makes an excellent point. Partly thanks to 70 years of advances in medical research, life expectancy has generally improved. We have seen huge advances—although there are some problems at the moment, as they appear to be tailing off. We have seen huge advances in tackling mortality rates for heart disease, stroke, chronic obstructive pulmonary disease and so on, although there are still problems in the most deprived areas of the country, which is understandable. Medical research has helped to tackle some of the great killers, and people are living longer. That means we have to tackle a different challenge, which brings me to dementia.

It is Dementia Action Week and I pay tribute to all the volunteers across the country who have organised events for people living with dementia. Every three minutes, someone in the UK develops dementia. Almost all of us know someone who has been affected by dementia. Recent mortality statistics show that dementia and Alzheimer’s disease were the leading causes of death in 2017 for the third consecutive year, accounting for more than one in eight of all deaths.

Some 1 million people in the UK will have dementia by 2025, and that figure will increase to 2 million by 2050. That is the equivalent of a 35% increase in the number of people with dementia by 2025, and a 146% increase by 2050. That large projected increase makes finding a treatment to slow or stop dementia as soon as possible absolutely essential. We will not find a cure or a therapy to slow its progress without real investment, innovation, research and clinical trials. There are no treatments yet that can slow the progression or delay the onset of the diseases that cause dementia, but clinical trials are proving crucial for cures and disease-modifying therapies. For example, the progress in understanding the structure of the relevant proteins, by researchers at the MRC Laboratory of Molecular Biology, could help identify areas of the proteins that could be targets for future treatment.

Finding a cure for dementia would be revolutionary and it would touch the lives of every single person in this country. That in itself is enough to make the case for continuing clinical trials—to convince us that we should do all we can to continue to invest in medical research and to support clinical trials, as the hon. Member for Bolton West has said.

Across many types of different diseases and disease groups, the importance of clinical trials to finding cures is obvious. Let us take cancer. Cancer Research UK is currently supporting the international BEACON clinical trial, the first ever randomised clinical trial to treat children with first relapsed neuroblastoma across Europe. This rare form of cancer, which affects young children, has seen significant improvements in treatment owing to scientific research, meaning global survival rates are higher than ever. We should be proud that the UK is considered the leader in clinical trials, ensuring that the most innovative treatments are available to UK patients. We need to continue to hold that enviable global position.

As the hon. Member for Bolton West said, clinical trials are not just about treatments and cures; they are also good for the UK economy. KPMG has estimated that clinical research in the life sciences supported by the National Institute for Health Research clinical research network has generated £2.4 billion, and supports nearly 40,000 jobs.

Our strength in the UK translates into EU strength, because of our co-operation with the EU. The UK contributed to almost 20% of the total research work carried out in EU health programmes between 2007 and 2016. The UK helps maintain Europe’s key registries and research networks on rare diseases. We co-ordinate the highest number of European registries of all EU member states, including those for childhood lung diseases, Huntington’s disease and familial pancreatic cancer. In 2018, the UK accounted for 28% of all new applications for clinical trial authorisation in the EU.

Given the scale of trade and research between the UK and EU on medicines, and given that disease knows no borders and we share many similar health and demographic challenges, will the Minister reassure us that the effective joint working that we have developed with our EU partners over 40 years will be maintained and not hindered by whatever may be our future relationship with the EU? I appreciate that she may not be able to answer the question—things are moving very rapidly on the Conservative Benches, are they not?—but if she can give us some indication, that would be very welcome.

Developing new medicines depends on the international co-operation that is fundamental for access to clinical trials. At the moment, patients in the UK are able to gain access to EU-wide trials for new treatments and the UK has the highest number of phase 1 clinical trials across the EU, as well as the highest number of trials for rare and childhood diseases. It is so important to improving health outcomes in the UK and EU that the UK can continue to access those networks post Brexit. Again, will the Minister give us the reassurances we are looking for?

The Opposition have called for ruling out no deal, and the House supported that; I appreciate that things are going on in the Tory party and we may well get a new Prime Minister who wants no deal, but if that is where we end up, I remind the Minister that the Association of Medical Research Charities has warned that a no-deal, World Trade Organisation-based arrangement would:

“risk patient safety and jeopardise pioneering medical research in the UK.”

The association adds:

“Collectively, members of the Association of Medical Research Charities fund almost half of all publicly funded medical research nationally as well as over 17,000 researchers. A no-deal Brexit could irreversibly damage our relationship with our most important research partner.”

Will the Minister confirm that it is still her position and the position of the Department of Health and Social Care to rule out a no-deal Brexit?

Will the Minister also tell us about the EU clinical trials directive, which, as she knows, governs clinical trials? From 2020, the new EU clinical trial regulation will come into force. As I understand it, the Government have made a commitment to align with the clinical trial regulation, in response to pressure from campaign and charity groups such as Cancer Research UK, the British Heart Foundation and the Wellcome Foundation, which the hon. Member for Motherwell and Wishaw mentioned, and to which I pay tribute.

Will the Government confirm that clinical research will remain a negotiating priority with the EU? Will the Minister also confirm that agreement will be reached in the negotiations on the UK’s participation in the single assessment procedure and access to the shared central IT portal and database, which underpin the cross-national clinical trials regulation and come into operation in the next year? Not having access to the portal will severely reduce the ease of setting up UK-EU trials, and will hurt our thriving life sciences environment. As things stand, UK researchers will enter the implementation period unsure of what regulatory conditions they will face when they exit it next year. If the Minister can offer us some guidance on that, we would appreciate it.

The hon. Member for Bolton West and the hon. Member for Motherwell and Wishaw also mentioned the EU’s Horizon 2020 scheme, which is due to invest billions in health research across the UK over the next couple of years. It is significant funding and its long-term nature is vital to give security to those medical institutions and universities planning major research projects, but institutions are still waiting for clarity from the Government on where we stand with respect to Horizon 2020 post Brexit. Again, I would welcome some clarification from the Minister.

I wonder whether the Minister can say something about transparency. We must ensure there is transparency in all publicly funded medical research. What efforts is the Department making to ensure that UK Research and Innovation and the Medical Research Council publish the results of publicly funded research in a timely manner? She might be aware that a debate is currently raging at the World Health Assembly on an Italian resolution on the transparency of clinical trials, research and development costs, and medicine prices. I understand that the Minister in the Lords, Baroness Blackwood, represented the UK at the World Health Assembly.

The UK is not supporting the resolution that the Italians propose. It might well be that there are very good reasons—around intellectual property rights and so on—why we would not want to support that resolution. However, I would welcome some clarification or explanation from the Minister on why the UK does not support the resolution on transparency, which lots of EU member states including the Netherlands support—others in the EU are not supporting it, but a significant number of EU member states are supporting it. It would be helpful if we could have that on the record, because there is huge concern about the way the pharmaceutical industry operates. We should celebrate its contributions to the economy, but that does not mean we should not hold it to account.

The Minister will know about the very heated debate that has taken place, both in public and between NHS England and Vertex, on the availability of Orkambi for cystic fibrosis sufferers. Frankly, I think Vertex has behaved shamefully. I now understand that the NHS has made Vertex an offer on a two-year managed access arrangement, and I believe it is offering more for Orkambi. I really hope Vertex takes up the offer.

Time after time, we hear stories of pharmaceutical companies acting quite disgracefully. There was another story today, about four pharmaceutical companies colluding over an anti-nausea drug and causing the NHS to spend 700% more on the drug than it should have done. We need more transparency. It might well be that the Government have good reasons for opposing the resolution at the World Health Assembly, and I would welcome the Minister’s explanation. If we cannot support that resolution because of the implications for our life sciences, what are the Government doing internationally to pursue a transparency agenda on R&D, drug pricing and so on?

I thank the hon. Member for Bolton West for securing the debate for this week—I believe we had Clinical Trials Day on Monday. It might well be that other things are going on elsewhere in our constituencies and in the Commons corridors, which is why only a few of us are present, but that does not mean it has not been a high-quality debate. I thank the hon. Gentleman and look forward to the Minister’s response.