Health

Jonathan Ashworth Excerpts

Tuesday 14th May 2019 Commons Chamber

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

I beg to move,

That an humble Address be presented to Her Majesty, that she will be graciously pleased to give directions that the following papers be laid before Parliament: any briefing papers or analysis provided to the Secretary of State for Health and Social Care or his Ministers since 9 July 2018 including impact assessments of public health spending reductions and any assessments made on falling life expectancy and the minutes of all discussions between the Department of Health and Social Care and NHS England on funding pay risks for Agenda for Change staff working on public health services commissioned by local authorities.

A child born at this very moment in the very poorest of communities—whether in inner cities like Manchester or my own city, Leicester, or in towns such as Blackpool or Burnley—will have a life expectancy that is around nine years lower than that of a child born at this very moment in some of the wealthiest communities, such as Chelsea, Westminster or east Dorset, and they will enjoy 18 fewer healthy years of life. Two babies born today could have years of difference in life expectancy and years of difference in healthy living, due entirely to the circumstances into which they are born. The child born in the very poorest of areas is more likely to leave school obese and almost 70% more likely to be admitted to A&E. That child is less likely to receive measles, mumps and rubella vaccinations, more likely to take up smoking as a teenager, and more likely to need the help of specialist mental health services at some point.

Of course, health inequalities have always existed, throughout the 71-year history of the national health service, but nine years of desperate, grinding austerity have brought us record food bank usage and in-work poverty, and seen child poverty increase to 4 million, with 123,000 children today growing up homeless in temporary accommodation—a 70% increase since 2010. Some 4,700 of our fellow citizens sleep rough on our streets, an increase of 15%, and, tragically, nearly 600 of them die on our streets. There have also been savage cuts to public services, including social care, which have left 600,000 elderly and vulnerable people without support. We have seen nine years of all that, and we should be shocked, because the advances in life expectancy that we all take for granted and that have steadily improved for 100 years are grinding to a halt.

[Diana Johnson (Kingston upon Hull North) (Lab)]

My hon. Friend is setting out clearly why the Opposition called for this important debate. Does he agree that the fact that for the first time since Victorian times we are seeing life expectancy falling for the poorest women in the most disadvantaged communities in our country, where the cuts have been heaviest, is a sad indictment of nine years of Conservative rule?

[Jonathan Ashworth]

Absolutely. Not only are there indications that advances in life expectancy are going backwards, particularly for women, but the Institute for Fiscal Studies has been quite clear today in launching its Deaton review:

“In 2001, women born in the 10% most affluent areas could expect to live 6.1 years longer than women born in the 10% most deprived areas; by 2016, the gap stood at 7.9 years.”

That is why we secured this debate.

[Mr Adrian Bailey (West Bromwich West) (Lab/Co-op)]

My hon. Friend is making an excellent case. In my local authority, Sandwell, life expectancy is in the bottom 15% nationally and the childhood obesity rate is more than three times that of the best local authorities, yet although nationally the Government boast that they are investing money in the health service, public health spending seems to be left out. Does my hon. Friend agree that it is essential that there is a big boost to public health spending, so that local area health budgets do not have devastating long-term obligations in future?

[Jonathan Ashworth]

My hon. Friend is absolutely right and, typically, anticipates the argument I am going to make.

Advances in life expectancy look as though they are going backwards for some of the poorest in our communities, particularly women. Let me take as an example our infant mortality rates, which reflect the survival rates for the very sickest of small babies. Those mortality rates have risen again, for the second year in a row.

[Mr Jim Cunningham (Coventry South) (Lab)]

Two or three weeks ago I visited a food bank, one of the biggest in the west midlands, and what amazed me was that it had to provide clothing for babies, which struck me as very profound. In other words, at least 20,000 people in Coventry are using food banks, and that tells us the consequences on people’s health. When they have to go to these centres for clothing and cots, does that not say something about austerity under this Government?

[Jonathan Ashworth]

It most certainly does. We are seeing a huge rise in the number of children living in poverty and an explosion not just in food bank use but in so-called baby banks, where parents arrive to pick up toys, nappies, and so on—even milk. It really is quite shameful.

We are also seeing an increase in the prevalence of mental health conditions among the poorest. Children and adults in the poorest areas are three times more likely to suffer mental health problems. We are also now seeing an increase in so-called “deaths of despair” for those in middle age, that is, deaths from suicide, drug and alcohol overdose, and alcohol liver disease. They are rising—[Interruption.] The Secretary of State says that that is not true, but it is in the report from the Institute for Fiscal Studies today.

Rates of premature mortality, including deaths linked to heart disease, lung cancers, and chronic obstructive pulmonary disease, are two times higher in the most deprived areas of England compared with the most affluent. Growing up and living in poverty means people get sick quicker and die sooner. It is shameful.

[Matt Rodda (Reading East) (Lab)]

I find the picture that my hon. Friend paints deeply disturbing. In my area in Reading, there is exactly the position that has been described by other colleagues; there is a 10-year gap in life expectancy in one town in the south of England between areas that are only two or three miles apart. Does he agree that it is now time for the Government to listen and take urgent action to address these serious problems that are linked to their own policies?

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[Jonathan Ashworth]

Absolutely. Everybody accepts that advances in life expectancy cannot continue indefinitely, but we need urgent investigation into what is happening here in the United Kingdom. As Michael Marmot, the authority on these matters, says:

“Since 2010, this rate of increase has halved. Indeed, the increase has more or less ground to a halt.”

He goes on to say:

The first thing to say is that we have not reached peak life expectancy. A levelling off is not inevitable. In the Nordic countries, in Japan, in Hong Kong, life expectancy is greater than ours and continues to increase.”

We need to understand what is happening in the United Kingdom. Surely it can be no coincidence that this halt in life expectancy advances has come after nine years of desperate austerity in our society.

Many of us are puzzled by the fact that, although we know that growing up in poverty means that people get sick quicker and die sooner, and we all accept that it is shameful—the Prime Minister accepts that it is shameful and talked on the steps of Downing Street about wanting to tackle these burning injustices—the Government continue to cut public health services by £700 million, including cuts of £85 million in the current financial year.

The stark reality is that these inequalities are costing the NHS £4.8 billion a year, and we are seeing a growing burden of chronic ill health in society. The NHS long-term plan, with its many laudable goals and ambitions, is simply undeliverable without investment in local public health services and a reversal of these deep, swingeing cuts.

[Mary Glindon (North Tyneside) (Lab)]

Does my hon. Friend agree that it is disgraceful that while we are talking about all those cuts to the health service the Government have provided more than £4 billion in tax giveaways to alcohol companies, which is the equivalent of the salaries of 160,000 nurses?

[Jonathan Ashworth]

As my hon. Friend indicates, government is about choices. The Government have chosen to give big tax cuts to some of the richest and most privileged people in society while cutting the public health services on which the most vulnerable rely. That tells us all we need to know about the Tory approach to the national health service.

[Geraint Davies (Swansea West) (Lab/Co-op)]

My hon. Friend has eloquently linked poverty and life expectancy. Does he agree that when we look at statistics such as the 64,000 people who die prematurely as a result of air pollution, that is focused on poorer people who live near busy roads? When we look at people who die from diabetes who have been force-fed processed foods, there is another correlation. The common theme is partly the support that the Government give to manufacturers of sugar, diesel and so on. That disproportionately hits poorer areas and ends up killing more people.

[Jonathan Ashworth]

The House has no greater champion of clean air than my hon. Friend. He is quite right—we have to tackle the wider social determinants of ill health, including pollution. We would introduce a clean air Bill. I am disappointed that the Government do not seem to agree that that is necessary.

I shall run through—[Interruption.] The Secretary of State is chuntering. He will have a chance to respond to the points that I have made. We all accept that smoking is a No. 1 cause of ill health and early death, causing about 115,000 deaths a year. Some 480,000 hospital admissions are attributable to smoking, which is an increase of 6% since 2013. That costs the NHS £2.5 billion a year—it costs primary care £1 billion and social care £760 million—but because of public health cuts, smoking cessation services in communities have faced cuts of £3 million. Over half of local authorities have been forced to cut services. Some local authorities have had to decommission smoking cessation services altogether, and 100,000 smokers no longer have access to any local authority-commissioned support. The number of people using smoking cessation services to help them quit has decreased by 11%—the sixth year in a row that the figure has fallen.

That means that smoking cessation services are, in the words of The BMJ,

“withering on the vine as councils are forced to redeploy funding to other areas”

Those cuts will lead to the risk of more people developing cancer and to higher costs for the NHS. It is a similar story with drug and alcohol services, which have seen cuts of £162 million, with more cuts to come this year.

[Gloria De Piero (Ashfield) (Lab)]

A family came to see me to tell me about their alcoholic son who, in the past year, had been taken to hospital by ambulance 35 times, and had spent four weeks over that year in hospital. All that they wanted was support services to help him get his addiction under control. The urgent care was there, but that was not good enough for them. It is devastating for him, but it makes no financial sense for the NHS.

[Jonathan Ashworth]

My hon. Friend makes an eloquent and powerful point. She is absolutely right. It makes absolutely no sense to cut alcohol addiction services, as that fails a number of vulnerable people in society and only increases pressures on the wider NHS.

The NHS recognises the pressures on alcohol services. It announced in its long-term plan that it wanted to roll out alcohol care teams in hospitals—a proposal that I made at the Labour party conference last year. At the same time, public health budgets are cutting alcohol addiction services in our communities. Years of investment under the Labour Government in drug and alcohol treatment and recovery centres helped to reduce HIV, hepatitis and drug-related deaths, and also helped to reduce drug-related crime and wider social harms. Yet the number of those receiving treatment and in recovery for alcohol problems has fallen by 17% since 2013. When alcohol misuse costs wider society £18 billion a year in crime and lost productivity, and when drug misuse is also a factor in so much crime, surely these cuts represent the very worst type of short-term thinking—cutting proven preventive services for a short-term saving but ignoring the bigger and longer-term human and financial cost.

What about weight management programmes? The Government pride themselves on their obesity strategy, but when the NHS spends £5 billion on obesity, when there are 617,000 hospital admissions because of obesity, when 18% of hospital beds are occupied by a person with diabetes, when 25% of care home residents have diabetes, and when we have one of the worst childhood obesity rates in western Europe, why are weight management programmes being cut in communities? One GP told Pulse magazine:

“This is crazy. It makes conversations between GPs and patients very difficult. They say, “you tell me that I need to lose weight, but the only help you can give me is advice and a diet sheet printed off Google.”

Another GP told Pulse:

“You try to refer someone for bariatric surgery but they can only have it if they’ve undergone 12 months of a weight management programme—but there isn’t one.”

[Nick Smith (Blaenau Gwent) (Lab)]

My hon. Friend is doing very well. Does he agree that movement is medicine and we need far more physical activity strategies in our NHS? For instance, if we had more ParkRun activities, particularly in working class neighbourhoods, that would help a lot in improving health inequalities in many parts of the country.

[Jonathan Ashworth]

Absolutely. I hazard a guess that when the Secretary of State stands up, he will talk about the support for social prescribing that he has given to general practice so that GPs can send people for more of this activity. But, at the same time, public health budgets are cutting these very types of activities. One hand does not know what the other hand is doing.

[Alex Sobel (Leeds North West) (Lab/Co-op)]

I met Professor Paul Gately of Leeds Beckett University, who set up the applied obesity research centre. He also established Europe’s longest-running weight loss camp for young people, although only the better-off families can now afford it. He asked me to ask my hon. Friend and the Secretary of State why the sugar tax cannot be used to fund some of that work.

[Jonathan Ashworth]

That is an entirely sensible proposal, and I look forward to the Secretary of State’s thoughts on it. The sugar tax is supposed to be funding more physical activities for young people across the country.

At a time of rising demand, we have also seen £55 million cut from sexual health services. That has meant that half of councils have reduced the number of sites commissioning contraceptive services, with the result that 6 million women of reproductive age live in an area where one or more services have been closed. Prescriptions of long-acting reversible contraceptives—the most effective form of contraception—have decreased by 8% at the same time as abortion rates for women over 30 have been steadily increasing. We have seen an increase in sexually transmitted infections such as syphilis and gonorrhoea while, because of cuts, the number of sexual health checks has dropped by 245,000. I was particularly shocked to hear the evidence given recently at the Health and Social Care Committee by Dr Olwen Williams from the British Association for Sexual Health and HIV, who said:

“We are seeing neonatal syphilis for the first time in decades and neonatal deaths due to syphilis in the UK…We are seeing an increase in women who are presenting with infectious syphilis in pregnancy, and that has dire outcomes.”

That was the evidence presented to the Committee about the impact of these cuts on sexual health services in communities.

What about the cuts to health visitor numbers? Last week, we heard concerns across the House about falling vaccination rates, which fell for the fourth time in a row. Vaccinations are one of the most important public health interventions we can make, and our health visitor workforce is vital to ensuring their take-up. Yet public health cuts and wider local authority cuts have meant that we have lost 25% of our health visitors. Every 12 hours since October 2015, we have lost one health visitor, and there are no proposals to reverse those cuts in the long-term plan. School nurse numbers have gone down, and the case loads of health visitors and school nurses are increasing. As a consequence, parents and small children are missing out. According to the Government’s own figures, 14.5% of children are not receiving a six to eight-week review on time, and 24% are not receiving a 12-month review on time. With high caseloads, there are increased risks of abuse or poor health of babies not being picked up, of maternal mental health issues not being picked up and of domestic violence and trauma not being picked up.





We need investment in the wider public health workforce and we need to expand training opportunities. The Government should honour their commitment to pay the public health workforce properly, and especially those on “Agenda for Change” terms and conditions. Last year, when the Government announced a pay increase for staff, they said they would honour that for all public health staff working for local authorities or in the voluntary sector. We are now told that the Government and the NHS are refusing to honour a pay rise this year. I hope the Secretary of State will tell us whether all public health staff employed on “Agenda for Change” terms and conditions will get a pay rise this year.

We are pleased that the Secretary of State has joined us today from the leadership campaign trail. We look forward to his response but, whenever he is asked about public health cuts, he says, “Well, prevention is better than cure.” Who would disagree with that? He never tells us that he is going to stand up to the Chancellor and demand that these cuts be reversed. He simply says that individuals’ attitudes have to change. But it is not just about individuals; it is about the services that are available in local communities. He gives the impression that he just wants people to look after themselves. For example, he said that those who present at hospital with ailments related to alcohol abuse will be targeted for a “stern talking to”—that is his answer. He needs to take it up with The Sunday Times if that was not what he said.

We know that the Secretary of State loves an app, and one of his solutions is more targeted advertising on Facebook. Whenever there is a problem in the NHS, he says that we are going to have more apps; that is the solution to everything. I am told that he and his old friend George Osborne are now part of a WhatsApp group called “Make Matt Hancock Great Again”—there are some problems that even an app cannot fix.

This is not leadership. Real leadership would be reversing the cuts to public health services and intervening to stop the health inequalities and the rolling back of life expectancy advances. Only Labour is offering that leadership on health inequalities. We will fully fund public health services. We will not cut public health services. We will adopt a health in all policies approach; this Government will not. We will invest in the health and wellbeing of every child and meet our ambition to have the healthiest children in the world. Longer, healthier, happier lives will be our mission. I commend our motion to the House.

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[Matt Hancock]

The public health grant is of course an important part of this, but it is only one part. The overall funding of the NHS is rising by £33.9 billion, the first £6.2 billion of which came on stream last month. I understand the hon. Lady’s point. That is on the money. On the health inequalities, I entirely agree with her that they should be tackled. Doing so is at the heart of the NHS long-term plan. It is a vital task that we do not shirk. Indeed, we embrace it and are addressing it.

Let me turn to the details of the motion. While I care deeply about making sure that we have the best possible health in this nation and the strongest possible NHS—and we are prepared to put the resources in to see that happen—I also care about good governance of the nation. The way that we are run is one of the reasons this country has been strong over generations, and I believe that using the Humble Address to undermine the ability of experts, clinicians, and civil servants to give me the benefit of their frank and wise advice not only undermines me as Secretary of State, but makes it harder to make good decisions. I know the shadow Secretary of State sits on the Front Bench with revolutionaries, but I thought he was a grown-up. I do not know what his mentor, Lord Mandelson, would make of his posturing today. Of course, we will object to the motion and, if he searched the depths of his heart, he would too.

The hon. Gentleman has obviously had a missive from the Leader of the Opposition’s office—LOTO, as it is called—telling him to present the Humble Address, but it is not his style. I hope that we can get back to debating these issues on a proper motion in the future. I respect and like the hon. Gentleman: he is a really nice guy. If he had asked for the information directly—perhaps he could have sent me a message on the app—

[Jonathan Ashworth]

I’m not on it.

[Matt Hancock]

Now that is an insult! There are only two types of people in the world—the people who are on the Matt Hancock app and the people who are not on the Matt Hancock app yet. I can see that the hon. Gentleman falls into the latter category. I digress.

If the hon. Gentleman had asked for the information directly, I would have been more than happy to provide it. To show willingness, I am happy to provide the House with the information requested in the motion. We will republish the impact assessments on the public health grant. They have already been published, but I am happy to do that. We will republish the Office for National Statistics stats and the Public Health England report on life expectancy. We will publish a statement on the “Agenda for Change” decision that he mentioned. It had been released already this week, as it happens, before we saw the motion.

If the hon. Gentleman wants to know about the “Agenda for Change” pay rises, I am delighted to keep talking about them. Perhaps he should ask the 1 million NHS staff who last month received a pay rise of up to 29%, including £2,000 extra a year for new full-time nurses. That came into force at the start of last month. I will debate with him the “Agenda for Change” pay rises any day of the week. Because the Government are running a strong economy, we can afford to put the money in to make sure that under “Agenda for Change” nurses get the pay rise they deserve.

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[Jonathan Ashworth]

I am delighted that the Secretary of State wants me to join his Make Matt Hancock Great Again WhatsApp group. Please add me to it. Perhaps in the group I can get some style tips from him, because he looked rather Alan Partridge-esque in the photos on Friday. I digress.

On Agenda for Change, it was reported in the Health Service Journal that the Government will not honour the pay rise for public health staff such as health visitors, sexual health staff and school nurses—all the sort of staff we have been talking about this afternoon—and that there was a dispute between NHS England and the sector about who will fund that £50 million pay rise. Is he telling us today that the Government will honour that pay rise for public health staff working in public health services?

[Matt Hancock]

We are honouring the pay rise proposed—of course we are. I love the HSJ, which is an absolutely terrific journal, but it was wide of the mark on that. We are putting in record funding.

Tessa Jowell Brain Cancer Mission

Jonathan Ashworth Excerpts

Monday 13th May 2019 Commons Chamber

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

I thank the Secretary of State for an advance copy of his statement. We warmly welcome today’s announcement. His tribute to our much-missed friend and colleague was moving and powerful. It is an extraordinary testament to Tessa’s bravery that in the final harrowing months of her life, faced with a highly aggressive and very-difficult-to-treat cancer, and in full knowledge of the life expectancy associated with such a devastating cancer, Tessa led from the front to campaign for better brain cancer treatment for others. She spoke with extraordinary courage in the Lords, she brought the then Secretary of State and me together, and she convinced Ministers to shift policy, not by garnering sympathy, understandable though that approach would have been, but by persuasion based on facts and policy argument. It was typical Tessa.

Tessa would have been delighted by the Government’s announcement—some 2,000 brain cancer patients a year will now benefit from the “pink drink” solution—but she would be keen to go further still. Almost 11,000 people are diagnosed each year with a primary brain tumour, including 500 children and young people, which is 30 people every day, and more than 5,000 people lose their lives to a brain tumour each year. Brain tumours reduce life expectancy by around 20 years, which is the highest of any cancer, and are the largest cause of preventable blindness in children.

We live in hope of dramatic improvements, but further research is needed, given that less than 2% of the £500 million spent on cancer research is dedicated to brain tumours. I welcome the Secretary of State’s commitments on research, but does he agree that we also desperately need more involvement in clinical trials? The number of brain cancer patients taking part in clinical trials is less than half the average across all cancers. How will the Government encourage more trials and data sharing?

Finally, we know that the NHS remains under considerable strain generally. The 93% target for a two-week wait from GP urgent referral to first consultant appointment was not met once last year. Neurosurgery is no exception. In March 2019, the 18-week completion target for referral to treatment pathways stood at 81.3% for neurosurgery— 5% lower than the average for all specialties—which made neurosurgery the worst performing specialty. This is a question of both resourcing and staffing. I know the Secretary of State has his answer on revenue resourcing—we disagree, but we will leave our political arguments for another day—but on workforce there are vacancies for more than 400 specialist cancer nurses, chemotherapy nurses and palliative care nurses, and there are diagnostic workforce vacancies too.

Meanwhile, the staff who are there are reliant on outdated equipment, and we have among the lowest numbers of MRI and CT scanners in the world. Failing to diagnose early is worse for the patient and more costly for the NHS, so will the Secretary of State update us on when we can expect Dido Harding’s workforce plan? Can he reassure us that the cancer workforce will be a key part of that plan? On equipment and MRI scanners, can he guarantee that the NHS will see increased capital investment budgets in the spending review so that it can upgrade existing equipment and increase the number of MRI and CT scanners?

Overall, however, we welcome today’s announcement. It is a fitting tribute to our friend Tessa Jowell, and like Tessa herself will touch the lives of so many.

[Matt Hancock]

The cross-party tone of this discussion demonstrates what we can achieve when we work together. This is not just about Baroness Jowell, who did so much and was so brave in how she made her case—in the last few months in particular, but before that as well. It is about the many others who have worked together, including the many who were inspired by her words to work harder on brain cancer.

In truth, the amount of research money going into brain cancer—and therefore the number of clinical trials, which the hon. Member for Leicester South (Jonathan Ashworth) mentioned—was too low. There were so few clinical trials because research overall was too low. That is partly because brain cancer is a very difficult disease to treat. Just because it is difficult, however, does not mean we should not try, so we have increased the amount of research money, and I am determined to see an increase in the number of clinical trials and to make sure that the data from them is properly used and openly disseminated.

The hon. Gentleman asked about the cancer workforce. As I mentioned, of course we will need more people to treat cancer. That is partly what the £33.9 billion extra is all about.

The hon. Gentleman is also right to say that we need more early diagnosis. The truth is that, while the NHS is very good at treating cancer once it has been spotted—indeed, it is one of the best in the world—our cancer survival rates in this country need to improve through early diagnosis. That means giving more support to community services, strengthening primary care and ensuring that we have the diagnostic tools that he mentioned. We have more MRI scanners and more Linux machines for treatment purposes, but of course there is always more that we can do.

Oral Answers to Questions

Jonathan Ashworth Excerpts

Tuesday 7th May 2019 Commons Chamber

[Matt Hancock]

Yes, I entirely understand my hon. Friend’s concerns. We are acting to make sure that there is better access. We have a review of access to primary care. But, more than that, the biggest increase of the £39.9 billion of extra taxpayers’ money that we are putting into the NHS is in GP access, primary care and community care to make sure that we get ahead of the curve and help people to stay healthy rather than just treat them in hospital.

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

Can the Secretary of State explain why 200,000 nurses have left the NHS since 2010 and why today we are short of 40,000 nurses?

[Matt Hancock]

The good news is that we have record numbers of nurses in the NHS. We have more staff in the NHS than at any time in its history. While of course in any very large organisation like the NHS there is always turnover, what matters is having the people we need. We are putting more money in, we are going to need more people, and we are developing a plan to make that happen.

[Jonathan Ashworth]

We have about 90 nurses a day leaving the NHS, so rather than posing for the newspapers by the stables like a character from a Jilly Cooper novel, why does the Secretary of State not show some actual leadership and reverse the cuts to development, reverse the cuts to training places and reverse the abolition of the training bursary so that we can start to recruit the nurses and midwives our NHS needs today?

[Matt Hancock]

What I will not reverse is the increase in the number of people who are helping to improve lives and save lives in our NHS. It is only because of the extra money that we in this Conservative Government have put into the NHS that we can be confident that we are securing its future to deliver better care for every single person whom we represent in this House.

Social Media and Health

Jonathan Ashworth Excerpts

Tuesday 30th April 2019 Commons Chamber

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

I am grateful to the Secretary of State for advance sight of his statement. These social media platforms must be made to take responsibility for the harm caused by the dangerous fake news they host, because they are helping to fuel a public health crisis. He talks about the actions that platforms such as Instagram have taken since February, but I have just searched on Instagram and found images and videos of graphic self-harm; there are 8 million posts with the hashtag #suicide—from a quick glance, many are distressing—226,000 posts with the hashtag #killmyself, and 249,000 posts with the hashtag #selfinjury. I found similar pro-anorexia posts and the normalisation of eating disorders. I am sorry to have to share those examples with the House, but I think that we have to understand the scale of the challenge we face. As the father of two beautiful daughters, aged seven and five, I would be devastated if they saw such posts as they grow up.

Dangerous content should be blocked and taken down. I look forward to the Samaritans’ recommendations, so can the Secretary of State update us on the timescale? He talked about the online harms White Paper, but we need action immediately, so can he tell us when the proposed legislation will come before the House? When will the new regulator and duty of care be enforced? Can he guarantee that there will be criminal sentences for executives for serious breaches? In what circumstances would the maximum fine of 4% of global turnover be applied? If, God forbid, something similar to what happened to Molly Russell—I am sure that the whole House will want to praise her father for his brave campaigning—should happen to another child, what action would be taken against the social media companies?

I have also been able to find dangerous anti-vaccination propaganda on platforms such as Facebook, at a time when measles outbreaks are on the increase across Europe and the United States and in parts of the United Kingdom. Unvaccinated children are being turned away from schools in parts of Italy and banned from public areas in parts of New York. I would hate to see that happen here. UNICEF has warned that more than half a million children have missed their measles vaccination, which means the UK now has the third-worst ranking of all high-income countries. As the Secretary of State said, take-up of the MMR vaccine has now declined for the fourth year in a row, making coverage for the vaccine the lowest it has been since 2011-12.

I know that the Secretary of State said on the radio last week that he was considering banning unvaccinated children from schools in England, but we urgently need a clear vaccination action plan from the Government. This cannot be about penalising families. Yes, we need intervention with social media platforms when the legislation is in place, but while we wait for the legislation will he consider instructing Public Health England to launch an online social media campaign, on the platforms that are currently sharing anti-vaccination propaganda, to challenge those dangerous myths?

Will the Secretary of State also accept that our falling vaccination rates are not just about online activity? Public health services have been cut by £800 million. Our health visitors have been cut by 8% in recent years, and our school nurses by 24%. General practice has faced a funding squeeze, and GP numbers are down by 1,000 since 2015. At the same time, 2018-19 marks the first year that we have seen a reversal in the percentage of children receiving vital health check-ups on time since the measurement of these figures began: 14.5% of children are not receiving a six to eight-week review on time; 24% are not receiving a 12-month review on time; and the number of mothers over 28 weeks pregnant receiving their first face-to-face antenatal contact with a health visitor has fallen for the second year in a row. Will he therefore commit today to reversing public health cuts and restoring health visitor numbers, and will he invest in general practice so that we can meet the 95% national vaccination coverage rate, as recommended by the World Health Organisation? When does he expect us to meet that 95% rate?

Children are 20% of our population but 100% of our future. We must always put their health and wellbeing first. Yes, there has been some progress, but we need further action from the Government today.

[Matt Hancock]

I pay tribute to the hon. Gentleman, who has provided leadership on this agenda from his position as shadow Secretary of State. I am glad, listening to his response, that we agree very broadly on the direction we need to take. The agreement across the House is valuable in demonstrating to social media companies the clear consensus on the need for them to act, and to every parent in the land the importance of vaccination. That cross-party support is very, very valuable.

I join the hon. Gentleman in paying tribute to Ian Russell, the father of Molly Russell, whom the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Thurrock (Jackie Doyle-Price), the Minister for suicide prevention, met this morning. He has been brave and eloquent in bringing these issues to light. I pay tribute to him and thank him for how he has spoken about what needs to be done. I know he is as determined as we are to ensure that action translates into saving more lives.

We agreed, after the meeting yesterday, to reconvene in two months’ time, by which time I expect further action from the social media companies. As I said in my statement, we have already seen some progress. I am glad that some of the global algorithms and global terms and conditions have been changed as a result of action taken by the UK Government. It is very important that we keep the pace up. In two months’ time, we expect to see further action from the social media companies and progress by the Samaritans on being able to define more clearly the boundary between harmful and non-harmful content. In each area of removing harms online, the challenge is to create the right boundary in the appropriate place. It is the challenge when tackling terrorist and child abuse material online, so that social media companies do not have to define what is and is not socially acceptable, but we as society do. I am delighted that the Samaritans will formally play that role on material relating to suicide prevention and self-harm, and that Beat will do so on material relating to eating disorders.

The hon. Gentleman asked about the online harms White Paper. We are currently in the middle of a 12-week consultation. I hope he and everybody listening to this who has an interest will respond to it. We are clear that we will have a regulator, but we also genuinely want to consult widely. This is not really an issue of party politics, but of getting it right so that society decides on how we should govern the internet, rather than the big internet companies making those decisions for themselves. I have to say that the tone from the social media companies has changed in recent months and years, but they still need to do an awful lot. I look forward to working with him and others across the House to ensure we can deliver on this agenda.

Government Mandate for the NHS

Jonathan Ashworth Excerpts

Thursday 25th April 2019 Commons Chamber

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

(Urgent Question): To ask the Secretary of State for Health and Social Care if he will make a statement on the Government’s failure to lay before Parliament the NHS mandate for the current financial year.

[The Minister for Health (Stephen Hammond)]

I am grateful to have the opportunity to set out the Government’s approach to setting a mandate for NHS England for 2019-20. The Government’s annual mandate to NHS England for 2019-20 will, for the first time, be a joint document with the annual NHS Improvement remit letter, called an accountability framework. This signals the importance of these two arm’s-length bodies working increasingly closely to maximise their collective impact. It will set one-year transitional objectives to allow the NHS time to implement the long-term plan, and it has been developed to meet the needs of patients, families and staff.

We are committed to the NHS and are funding its long-term plan to ensure that it is fit for the future for patients, their families and NHS staff. The accountability framework sets the expectations that will make that long-term plan a reality. The Government have continued to prioritise funding the NHS, with a five-year budget settlement for the NHS announced in summer 2018 that will see the NHS budget rise by £33.9 billion a year by 2023-24.

The funding settlement and the implementation of the long-term plan are not affected in any way by the short delay in the publication of the accountability framework. We are all engaged to ensure that the accountability framework is published and laid as soon as possible, and I and my ministerial colleagues and officials are working closely with NHS England and Healthwatch England, as statutory consultees, to ensure accountability, improvement and progress to deliver world- class care for patients.

[Jonathan Ashworth]

It is a pleasure to see the Minister of State, as always, but the Secretary of State should be here to defend his failure to produce the NHS mandate. In every previous year, in accordance with section 23 of the Health and Social Care Act 2012—an Act that he supported and voted for despite everyone telling the Government not to support it—the Government have published the NHS mandate before the beginning of the financial year. This mandate outlines the Secretary of State’s priorities for the NHS given the financial settlement, yet this is the first time a Secretary of State has failed to lay before Parliament the Government’s mandate to the NHS for the forthcoming financial year. Is this a failure of leadership or the latest piece of stealth dismantling of the Health and Social Care Act? If it is the latter, why not just take our advice and bin the whole thing and so end the wasteful contracting, tendering and marketisation it ushered in?

The Minister talks of the 10-year long-term plan, but it is no good his telling us he endorses Simon Steven’s vision of the NHS in a decade’s time, when Ministers cannot even tell us what they expect the NHS to achieve in a year’s time. He boasts of the new revenue funding settlement for the NHS but seemingly has not got a clue what he wants the NHS to spend it on in the next 12 months, and at the same time he does not talk about the cuts to public health budgets, training budgets and capital investment.

Will the new accountability framework deliver for patients in the next 12 months? Last year’s mandate pledged that A&E aggregate performance in England would hit 95% in 2018. That pledge was broken, so can the Minister tell us whether, for those A&E departments not trialling the new access standard, the four-hour A&E standard will be met this year, or will the target not be met for the fourth year running?

Or how about the 18-week referral to treatment target? More than half a million people are now waiting more than 18 weeks for treatment. The target that 92% of people on the waiting list should be waiting less than 18 weeks has not been met since 2016. Will that target be met in the next 12 months, or has it also been abandoned? What about cancer waits? Some 28,000 patients are now waiting beyond two months for treatment. The target for 85% of cancer patients to be seen within two months for their first cancer treatment after an urgent referral has been missed in every month but one since April 2014. Will that target be met this year, or will cancer patients be expected to wait longer and longer?

On staffing and pay, will funding be made available in the next 12 months, as it was last year, for a pay rise for health staff employed on agenda for change terms and conditions working in the public health sector for local authorities and social enterprises?

We have no NHS mandate, even though it is mandatory. We have no social care Green Paper, even though it has been promised five times. The big issue has been ducked again. We have no workforce plan, even though we have 100,000 vacancies across the NHS, and the interim plan, which should have been published today, has been delayed again. The Secretary of State parades his leadership credentials around right-wing think-tanks, yet on this record he could not run a whelk stall, never mind the Tory party. It is clearer than ever that only Labour will fully fund our NHS and deliver the quality of care patients deserve.

[Stephen Hammond]

Anyone listening to that will have realised that the hon. Gentleman is more concerned with political points scoring and process than with the substance and funding of the NHS. [Interruption.] The hon. Member for Dewsbury (Paula Sherriff) shouts at me, but she will want to remember that the shadow Secretary of State welcomed the long-term plan—or much of it—back in January.

It is absolutely clear—evidence was provided to the Public Accounts Select Committee yesterday by the permanent secretary and the chief executive of NHS England—that while obviously it would be better to publish by the deadline, it is more important that the mandate be right than published on a particular day. It is more important that we get this document on the long-term strategy of the NHS correct. As Simon Stevens, the chief executive of the NHS, said, there is no problem with this short delay to the mandate. It is an important document, but it is causing him no problems. It is causing no problems.

The hon. Gentleman mentioned access to treatment and treatment times. This winter, more than 7 million patients were seen in under four hours. That is an increase of nearly 6% in attendances. I would have hoped that the Opposition Front Bench might have praised the NHS and its hard-working staff—

[Stephen Hammond]

Rather than shouting political points across the Dispatch Box.

The hon. Gentleman says there are no targets. He is of course wrong.

[Jonathan Ashworth]

I said you were not meeting them.

[Stephen Hammond]

No, the hon. Gentleman said there were no targets likely to be set for the NHS this year. The accountability framework will include detailed and specific annual deliverables and set out in detail a process for delivering future implementation as well as some of the early delivery goals for 2019-20. He is wrong therefore to say that the framework will not have deliverables attached to it. It will. He also mentioned the Green Paper—

[Jonathan Ashworth]

Where is it?

[Stephen Hammond]

I have said, as the hon. Gentleman has heard many times, that we are finalising that. Again, it is more important to get it right. On the long-term plan for workforce implementation, a draft plan is being produced and I expect that plan to be published in the very near future—[Interruption.]

Oral Answers to Questions

Jonathan Ashworth Excerpts

Tuesday 26th March 2019 Commons Chamber

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

May I just take a moment, on behalf of the Opposition Front Bench team, to thank the hon. Member for Winchester (Steve Brine) for all his work? We found him a decent, fair-minded Minister, and I wish to pass on my personal thanks for the work that he did on the children of alcoholics agenda.

We have 100,000 vacancies across the NHS. The Brexit mess means that we have fewer EU nurses and health visitors. Across the NHS, voluntary resignations are up 55% since 2011, and the professional development budgets have been cut by £250 million. Does the Minister agree that for Dido Harding’s review to be taken seriously, those cuts to continuing professional development must be reversed?

[Stephen Hammond]

As the hon. Gentleman heard me say earlier, Baroness Harding is developing the implementation plan, which will then feed into the final implementation plan published after the comprehensive spending review. The cuts, as he describes them, are not cuts. He knows that we are increasing the budget for the NHS in real terms and in cash terms up to 2023-24.

[Jonathan Ashworth]

The Minister is responsible for workforce, but does not seem to understand that training budgets have been cut. Baroness Harding’s review will only be taken seriously if it is backed up by real investment.

Outsourcing and transferring of staff, whether to wholly owned subsidiaries or the privatisation of clinical services, further undermines staff morale and creates a more fragmented workforce. The Secretary of State went to the Health and Social Care Committee and said no more privatisations on his watch, yet cancer scanning services in Oxford are being privatised. Will the Minister reverse those privatisations, or can we simply not believe a word the Secretary of State says?

[Stephen Hammond]

The hon. Gentleman can believe everything my right hon. Friend the Secretary of State says. He has delivered on his promise to work with the NHS to deliver a long-term plan, to deliver the funding that will make it possible, and to deliver the workforce that will ensure the plan is not undermined.

Human Medicines (Amendment) Regulations

Jonathan Ashworth Excerpts

Monday 18th March 2019 Commons Chamber

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

I beg to move,

That the Human Medicines (Amendment) Regulations 2019 (S.I., 2019, No. 62), dated 14 January 2019, a copy of which was laid before this House on 18 January, be revoked.

This motion concerns the serious shortage protocol. I thank the business managers for allowing time for this debate, but it really should not have come about as a result of the Official Opposition tabling a prayer against the regulations. The Government should have brought these proposals to the House for full debate and scrutiny, because the serious shortage protocol is perhaps one of the most far-reaching and contentious of the Government’s changes to medicines regulation in recent times.

The Government are using Henry VIII powers to enable Ministers to issue a serious shortage protocol for pharmacists to follow. The Department of Health and Social Care has stated that the protocol

“could be issued…in instances of serious national shortages and would enable community pharmacists and other dispensers to dispense in accordance with the protocol—rather than the prescription—without contacting a GP.”

These reforms represent a quite extraordinary power grab whereby Ministers can grant themselves the authority to instruct local pharmacists to ration drugs, overrule the GP’s prescription and dispense therapeutic generic equivalents or reduced dosages in the event of a medicines shortage.

[Norman Lamb (North Norfolk) (LD)]

Is the hon. Gentleman aware of the particular concern among people with epilepsy, who require absolute consistency of supply and for whom any change in medication can have dire consequences? The brilliant organisation SUDEP Action has raised very specific concerns about the risks to people with epilepsy.

[Jonathan Ashworth]

I thank the right hon. Gentleman. He is quite right to raise those concerns about patients with epilepsy, which I will touch on in the course of my remarks, echoing the point that he made with great eloquence.

These changes represent an extraordinary power grab. Ministers should have brought them to the House for proper scrutiny, and then, of course, they should have gone out for proper consultation with patients, patient groups and health stakeholder. That is why the Academy of Medical Royal Colleges stated that it is

“inexplicable and unacceptable that an issue of this importance is not the subject of wide consultation and that medical royal colleges as doctors’ professional bodies were not specifically engaged in the process.”

The British Medical Association said that it

“should have far more time to adequately consider the Government’s proposals for change.”

That is why we have brought this prayer motion and why I am pleased that we have the opportunity to debate these proposals today.

It is worth saying a word about the context in which we debate these proposals. Notwithstanding the confusion on the Government Benches about when we actually do exit the European Union—the Under-Secretary of State for Exiting the European Union, the hon. Member for Spelthorne (Kwasi Kwarteng) has given us no greater guidance today in his remarks at the Dispatch Box—it is worth recalling that, as The Lancet said only last month, Brexit, especially a no-deal Brexit, will affect the healthcare workforce, NHS financing, the availability of medicines and vaccines, the sharing of information and medical research.

Our effective joint working with our European partners has been vital for the NHS over recent years, in everything from infectious disease control to the licensing, sale and regulation of medicines. Developing new medicines depends on the international co-operation that is fundamental to accessing clinical trials. Patients in the UK are currently able to access EU-wide trials for new treatments, and the UK has the highest number of phase 1 clinical trials across the EU.

Thanks to the strength of our pharmaceutical base, every month, 45 million packs of medicine move from the UK to the EU, with 37 million packs going from the EU to the UK. We know that 99% of the insulin used in the United Kingdom is not manufactured in the UK. Current EU legislation allows for the legitimate trading of medicines quickly and swiftly cross-border, but the cost of no deal could see pharmaceutical products subject to 44 separate checks and controls at the borders, hugely delaying access to medicines.

[Daniel Zeichner (Cambridge) (Lab)]

My hon. Friend is making some very important points. I wonder whether he has seen the advice from the UK BioIndustry Association, which knows what is going in the life sciences sector and says:

“Despite the expertise and efforts of the MHRA…with 12 days …until Brexit, being prepared for a ‘no deal’ is an impossible task”.

[Jonathan Ashworth]

I thank my hon. Friend. As the Member of Parliament for Cambridge, he works very closely with the life sciences and pharmaceuticals industries and is a great champion for them. He is quite right to raise those concerns—although it is not clear if we are leaving in 12 days because, as I said, the Minister at the Dispatch Box earlier was pretty hopeless in giving the House any clarity on that matter. I suppose we will have to wait for further statements from the Government tomorrow, unless the Health Minister wants to clarify matters for us in a moment.

One of the issues that the organisation my hon. Friend mentioned is concerned about is the parallel trade in medicines, where pharmaceutical exporters seeking to profit from currency fluctuations could see medicines intended to meet UK patient requirements being quickly distributed out to the EU because of the advantage that a fall in sterling, perhaps, could accrue to them in those circumstances. This is why we have seen widespread concerns about medicine shortages in the event of no deal.

[Dr David Drew (Stroud) (Lab/Co-op)]

This is not something just for the future. I am already getting reports that certain medicines are in short supply, and patients are being advised to go back to their GPs to see if there are alternatives because somebody somewhere is already stockpiling and there is not the flow through. Does my hon. Friend accept that?

--- Later in debate ---

[Jonathan Ashworth]

My hon. Friend raises a very important point. There have indeed been reports of shortages in certain medicines. In recent weeks, we have heard of shortages of Naproxen, an arthritis medicine, with similar reports about EpiPens a few weeks ago. I have heard from some community pharmacists, directly themselves, that there is even an shortage of aspirin. I emphasise that these are anecdotal reports rather than information based on any national reporting that I have seen—this is what community pharmacists have told me when I have been in their pharmacies discussing this with them—but yes, there are shortages now as a result of the uncertainty in the pharmaceutical market.

Diabetes UK has warned that

“despite reaching out directly to the Department of Health and Social Care in December, we still have not seen the concrete detail needed to reassure us—or people with diabetes—that the UK Government’s plans are robust enough to guarantee no impact on insulin and medicine supplies in the event of a no-deal Brexit.”.

It was a similar story from the epilepsy bodies, who said:

“We do not have confidence in the current arrangements to ensure the continuity of life-saving medications for people with epilepsy.”

The Government have sought to reassure patients that their contingency plans are failsafe, but the report in The Lancet that I referenced earlier also said that

“stockpiling arrangements cannot cope for more than a few weeks.”

It also noted that some affected products, such as radioisotopes needed for treating some types of cancer, simply cannot be stockpiled. This chimes with the Royal College of Radiologists, which last month issued staggering concerns about the supply of medical isotopes, spelling out how the expected disruption would force clinicians to alter treatment plans and mean the prioritisation of some cancer patients over others. That is why the Government are proposing the serious shortages protocol contained in this statutory instrument and effectively using Henry VIII powers to enable Ministers to issue a protocol to pharmacies for them to follow.

As I said, this is an extraordinary power grab. It will effectively mean that a GP’s prescription can be changed by a pharmacist. No longer would a medicine be prescribed by a doctor who knows the medical history of the patient but instead by a pharmacist acting in accordance with a protocol drawn up by the Government. That is why these emergency measures have, quite rightly, raised alarm among various patient groups—because these changes could cause real problems for people with long- term conditions.

[Anne Marie Morris (Newton Abbot) (Con)]

Does the hon. Gentleman accept that it would be sensible if there was a sunset clause, because clearly giving that much power to a pharmacist as opposed to a physician who knows the patient is very dangerous if it is to be used for the long term or perpetually and not just to deal with the current crisis?

[Jonathan Ashworth]

The hon. Lady makes an entirely reasonable observation. I trust that the Minister took note of it and look forward to her reply to that point.

[Norman Lamb]

Does the hon. Gentleman agree that this puts individual pharmacists into quite an invidious position because they may well be having to make decisions that may impact adversely on a patient’s health and wellbeing when they are not necessarily skilled to make those judgments? My concern particularly relates to epilepsy but it applies to other areas as well.

[Jonathan Ashworth]

The right hon. Gentleman hits the nail on the head. That is exactly the point that has been put to me when I have visited community pharmacists and discussed this with them. Of course there are other pharmacists who have perhaps done more training and want to work at the top of their licence and believe that there is a role for more autonomy. However, there are real concerns about the way in which these changes are being rushed through without any resource put into education, explanation or wider training that may be needed. In those circumstances, it is appropriate that we raise our concerns, support our motion and oppose the Government’s proposal today. He is absolutely right—I have heard that concern expressed directly. Many community pharmacists do not necessarily want this responsibility, given the wider concerns and implications that he highlighted.

[Helen Goodman (Bishop Auckland) (Lab)]

The point made by the right hon. Member for North Norfolk (Norman Lamb) raises two issues. First, what is the point of doctors having all this training if anybody without it is suddenly able to dole out prescriptions? Secondly, are pharmacists insured, and is there an insurance scheme for them if they make mistakes? Doctors have a professional insurance system, and pharmacists presumably have a completely different one.

[Jonathan Ashworth]

My hon. Friend is right. That is exactly the point that community pharmacists put to me in Loughborough about three weeks ago when I visited them to discuss this. Echoing her point, the BMA has said that it does not support a “blanket approach” to allowing pharmacists to provide therapeutic equivalents where a prescribed drug is not available. The National AIDS Trust has said:

“The only person qualified to safely alter the medication prescribed to a person living with HIV is that person’s HIV consultant.”

SUDEP Action, alongside a broader coalition of epilepsy charities, is particularly worried about these proposals.

After facing pressure from those groups, the Government accepted that replacement drugs were unsuitable for epilepsy patients, but they have left it open to pharmacists to reduce the strength or dosage of epilepsy medication. I am not convinced that that will eliminate the big risks faced by these patients. As the right hon. Member for North Norfolk (Norman Lamb) said, many patients with epilepsy—especially the elderly—are on other medications, and any changes require careful management because of the interaction between different medicines. Up to 90% of people with epilepsy state that even a deterioration in their mood can have a negative effect on seizure control. Anti-epileptic medications have more significant interactions than any other group of drugs.

There are situations where the specific brand, type, form or strength of a treatment must be carefully tailored to the individual based on their responses, which is done by the prescriber and the patient over time. If that is changed by a professional who does not know the patient or their individual risks, some have warned that the consequences could be a loss of control of the condition, failed treatment and an unnecessary emergency, with very serious consequences indeed.

[Anne Marie Morris]

The hon. Gentleman is making a first-class point. This puts patients at risk, and it is not appropriate for the pharmacist to make that decision. People think that generics are the same thing as branded drugs, but they are not. For some, a particular brand is crucial. I commend him for what he is doing.

[Jonathan Ashworth]

I am flattered to receive such commendation from the Conservative Benches, and I commend the hon. Lady for her extremely well-made point, with which I agree entirely. I hope that the Minister will respond to the second good point that the hon. Lady has made.

The stakes are too high to get this wrong, yet there has been no impact assessment or risk assessment undertaken on serious shortage protocols for this statutory instrument. This is an unacceptable risk to anyone with a long-term condition and should be recognised by anyone making contingency plans. I was particularly horrified to read in the explanatory memorandum for this SI—it is quite shocking:

“The main benefits of the protocol would be the NHS cost savings associated with GP time.”

In the same breath, it casually goes on to say:

“There may be some risks to patients”.

That is in the Government’s own paperwork. It is astonishing. How can the Government seriously prioritise NHS cost savings over patients’ lives and allow an explanatory memorandum to go out with that sort of wording in it? I hope that the Minister can explain how that got in there and at least reassure us that it is not the Government’s position. If it is the Government’s position that there may be some risks to patients, that suggests that the Government should have come to the House sooner to explain why they are making this regulatory change and not left it to the official Opposition to table a prayer motion to get this debate.

I would like clarity from the Government on a few things. It is not entirely clear from the legislation exactly when these powers would be used. I would like to hear from the Minister whether these powers will be introduced in a no-deal Brexit scenario only or whether we can expect them to be more permanent. I am also concerned that there will only be a review of new powers one year after a serious shortage protocol is issued by Ministers. This speaks to the point made by the hon. Member for Newton Abbot (Anne Marie Morris). One year is too long to wait if this causes serious problems for patients and the wider sector.

Considering that the stakes are so high, it is be essential that the Government deliver extensive communication and training to GPs, pharmacists, other healthcare professionals and the public, to help them understand any new protocols and manage expectations and any dissatisfaction. I would be grateful if the Minister outlined the Government’s plans. I talk and listen to frontline NHS staff all the time, and I know that there is a well-founded fear about the implications of a no-deal Brexit for hundreds of thousands of people in need of life-saving medicines. I am interested to hear from the Minister what information about these protocols has been shared with the health sector and professionals involved.

When the Secretary of State gave evidence to the Health and Social Care Committee a few weeks ago, he informed it that he will prioritise medicines over food. That glib assertion from the Secretary of State hardly offered the reassurance that patients deserve. Brexit should not compromise patient safety in any way. It is up to the Minister to allay the widespread concerns, but if she is not able to do so, we will test the opinion of the House. I commend our motion.

Integrated Care Regulations

Jonathan Ashworth Excerpts

Monday 18th March 2019 Commons Chamber

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

I beg to move,

That an humble Address be presented to Her Majesty, praying that the Amendments Relating to the Provision of Integrated Care Regulations 2019 (S.I. 2019, No. 248), dated 13 February 2019, a copy of which was laid before this House on 13 February, be annulled.

I am grateful that we have found time to debate this prayer motion in my name and the name of my right hon. Friend the Leader of the Opposition. For the Government to have attempted to make these changes without proper scrutiny is a huge discourtesy to the House. These changes are fundamental, with potentially far-reaching implications for the NHS, and they have aroused concern—[Interruption.]

[Madam Deputy Speaker (Dame Eleanor Laing)]

Order. It is not fair to the hon. Gentleman that people who have voted are now having conversations here. I would be grateful if people who wanted to talk about other things left the Chamber.

[Jonathan Ashworth]

The changes in the regulations have aroused considerable concern in the country, and proper parliamentary time should have been made available for a proper debate on them; they should not have been made through secondary legislation.

The Opposition oppose the regulations and will seek to test the House’s opinion on them. We oppose the changes not because we are against integration. We have long called for greater integration of services to offer seamless care to patients, because the demands on the NHS are of a different nature from those of 71 years ago, when a Labour Government created the NHS with a tripartite structure. In those days, life expectancy was so much shorter, and infectious disease was the overwhelming medical challenge. In 2019, we are worlds away from the days when 30,000 hospital beds were set aside for the treatment of tuberculosis, or when wards were filled with row after row of iron lungs to treat those suffering from polio. Today, we are all living longer, with a variety of complex conditions, from diabetes to cardiovascular disease and chronic obstructive pulmonary disease—conditions that increase the risk of a poorer quality of life and mean a greater risk of premature death. Indeed, around 14.2 million people in England—nearly a quarter of all adults—have two or more conditions. More than half of hospital admissions and out-patient visits, and three quarters of primary care prescriptions, are for people living with two or more conditions.

The issue is not just ageing and frailty; poverty takes its toll. People in the most deprived areas of England can expect to have two or more health conditions at 61 years—10 years earlier than people in the least deprived areas. Health inequalities are widening, while advances in life expectancy are stalling. An ageing population, the increase in long-term conditions, and the increasing number of people with multiple health conditions means that we need to integrate services. Sometimes in these debates, when we talk of long-term conditions, we suggest that we are talking about a homo- geneous group, but it is quite the opposite. We could be talking of a 61-year-old man with renal failure and high blood pressure, or a 101-year-old woman with profound deafness and blindness. The way that such conditions affect quality of life, and the extent to which they are amenable to medical intervention, is likely to vary.

If health services are not better co-ordinated and not integrated, there is a greater risk to patient care through the poor co-ordination of medical care and increased time spent managing illness. The need to manage multiple medications may lead to poorer medication adherence, adverse drug events, and the aggravation of one condition by the symptoms or treatment of another. It can also mean damaging self-management regimes in which there are competing priorities, and a bewildering landscape for patients, who are often of an advanced age, with cognitive impairment and limited health literacy, so we support integration.

I have seen integration working on the ground. Just last week, I was in Bolton, where I visited the Winifred Kettle centre to see the model of integrated multi-agency work bring together mental health professionals, pharmacy, physio, occupational therapy and social workers. In Bury, I heard about how the local council’s chief executive doubles up as the chief executive of the clinical commissioning group. In Luton and Dunstable I saw with my own eyes that the hospital trust has various social care workers in its discharge unit, helping to avoid the indignity of huge numbers of elderly patients being trapped in hospital, ready for discharge but delayed for days on end, as happens too often. In Wolverhampton, a fascinating example is being developed: the hospital trust is taking on and employing GPs directly. In Wolverhampton, they call it vertical integration, although some might wish to go as far as to suggest that it is the nationalisation of general practice, something that not even Nye Bevan was able to achieve.

A Labour Government would move away from a competitive landscape of autonomous providers to one of area-based care delivered through integration, collaboration, partnership and planning. We will restore a universal, publicly provided and administered national health service. Locally, we envisage something akin to health and care boards, with a duty to provide health not only for those on a CCG list but for all residents. Nationally, the Secretary of State’s duty to provide care will be reinstated. We are consulting on these matters with patients, staff and wider stakeholders.

[Mr Jim Cunningham (Coventry South) (Lab)]

Very quickly, does my hon. Friend not agree that the big problem with integration, if we support it, is the lack of funding, and the lack of proper training in the various disciplines? Only a couple of years ago, there was a cut in the funding for pharmaceuticals.

[Jonathan Ashworth]

My hon. Friend makes a very important point. Integration is not about saving money. For integration to work properly, it needs to be fully funded, and, of course, the NHS has been through the biggest financial squeeze in its history. We do not oppose integration. Indeed, that is why the previous Labour Government introduced a section 75 partnership arrangement, and why we were so vociferous in our opposition to the Andrew Lansley Health and Social Care Act 2012, which went completely counter to international evidence and exacerbated local fragmentation of health structures. It is a delicious irony that Ministers, all of whom were dragooned through the Lobby to support the Lansley Act, despite expert after expert warning them what a mistake it would be to press ahead with it, are now trying to propose regulatory changes, so that we can essentially work around that Act. The reason why we cannot support the regulations today is that the most damaging part of that Act is still on the statute book.

[Tracy Brabin (Batley and Spen) (Lab/Co-op)]

On the point about the Health and Social Care Act, a third of the contracts have been awarded to private providers, and millions were wasted when they collapsed. The explanatory memo for this statutory instrument says that it is expected that organisations holding an integrated care provider contract will be statutory providers, such as NHS foundation trusts, but that is not legally binding. To protect our NHS, do we not need to know definitively that providers will be public, not private?

[Jonathan Ashworth]

My hon. Friend is absolutely right. Of course, the Minister cannot give that reassurance because of the Lansley Act that Ministers voted for in 2011.

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

I am only sorry that I cannot be with my hon. Friend on the Front Bench tonight. I have really enjoyed working with him; he is a fine shadow Secretary of State, and I know that he will make an excellent Secretary of State. Unfortunately, I cannot be with him, because when we on these Benches vote against the Whip, we have to deal with the consequences.

As my hon. Friend knows from many debates I have taken part in for the Opposition, despite repeated questions to various Ministers, there has been no absolutely no reassurance that the private sector will not continue to be involved in these matters.

[Jonathan Ashworth]

My hon. Friend makes his point typically eloquently and with force. May I say to him that we miss him on the Labour Front Bench? He was a real rock in the shadow Health and Social Care team. It is typical of him that when he decided last week that he could not support the Labour Front Bench position on a referendum, he took the honourable course of action and chose to leave the Front-Bench team. I think that he has the respect of many in the House for that position.

This is the nub of our opposition tonight. Contracts are still being put out to competitive tender, even when some commissioners claim that they do not wish to do this. Here lies the danger: nothing prevents, and some things might encourage, these integrated care partnership contracts being put out to tender and perhaps being won by a private sector provider. Ministers repeatedly tell us that ICPs, and before them accountable care organisations, are not about ushering in a further role for the private sector. If that is the case, and if patients and staff are to have confidence that the ICP contracts will not end up in private hands, the Government’s overarching competition legislation must be changed first. As that legislation has not been changed, and as we will still have commercial contracting for the delivery of medical services, there is a risk that a multi-billion pound contract covering hundreds of thousands of people and packaged up for 10 to 15 years could be handed over to a big provider. That is why the Health Committee, which is broadly supportive of these integrated care models, issued this warning in its report:

“The ACO model”—

it was using the terminology of the time—

“will entail a single organisation holding a 10–15 year contract for the health and care of a large population. Given the risks that would follow any collapse of a private organisation holding such a contract and the public’s preference for the principle of a public ownership model of the NHS, we recommend that ACOs, if introduced, should be NHS bodies and established in primary legislation.”

We agree.

The impetus for this contract comes from the example of Dudley, which I am sure the Minister will want to talk about. When the chief executive of Dudley CCG attended the Select Committee, even he conceded—although he said that it was unlikely—that because of the procurement rules, it would not have been possible to have kept out private providers applying for the contract. When asked whether the contract could go to a private provider, he said:

“In theory, it is technically possible for that to happen”.

Although Mr Nigel Edwards of the Nuffield Trust shared the Minister’s scepticism that the contract could go to a private provider, he did concede before the Select Committee that:

“To privatise in the sense of handing over all the assets and staff to a private contractor is a theoretical possibility.”

NHS England’s own analysis of the contract published at the end of last week concedes:

“However, it should be understood that current NHS law and EU and domestic procurement law prohibits CCGs or NHS England from taking steps, whether through evaluation criteria used in a procurement or otherwise, to disqualify certain categories of provider (e.g. independent sector providers) from bidding or being awarded commissioning contracts.”

This is our first objection, because Labour is not prepared to nod something through when there is a theoretical possibility hanging over us that, in the words of NHS England, an independent sector provider could not be disqualified from being awarded commissioning contracts.

[Liz Twist (Blaydon) (Lab)]

Does my hon. Friend agree that to cure these problems, we need not secondary legislation, but a thoroughgoing review of NHS legislation?

[Jonathan Ashworth]

My hon. Friend is right; we need to sweep away the Lansley legislation and put the NHS on a sustainable public footing. NHS England attempts to reassure those who are concerned about this contract by putting in place some further conditions. It talks about transparency and insisting on a “minimum level of assets”. Note the qualifier “minimum”—not all assets. It also talks of a

“restriction on carrying out any business other than that required by the ICP Contract”.

Again, note the words used—not a prohibition on other business activities, just a restriction. This is in the circumstance when the contract is awarded to a non-statutory provider.

NHS commissioners are obliged by law to advertise many larger NHS contracts, giving firms such as Virgin Care the chance to bid. Since the Lansley Act came in, £10 billion of contracts have gone to private providers, and there is a further £128 million of NHS tenders in the pipeline. It is all very well for the Secretary of State to go to the Health and Social Care Committee as he did a few weeks ago and say:

“There is no privatisation of the NHS on my watch, and the integrated care contracts will go to public sector bodies to deliver the NHS in public hands.”

The Secretary of State is not in a position to make that promise to the Committee, because of the legislation that is in place.

[Dr Sarah Wollaston (Totnes) (Ind)]

As my Committee has already been quoted, I think that it might assist the House if I were also to quote from the conclusions that we came to on this issue. The Committee said:

“We recognise the concern expressed by those who worry that ACOs could be taken over by private companies managing a very large budget, but we heard a clear message that this is unlikely to happen in practice. Rather than leading to increasing privatisation and charges for healthcare, we heard that using an ACO contract to form large integrated care organisations would be more likely to lead to less competition and a diminution of the internal market and private sector involvement.”

[Jonathan Ashworth]

The hon. Lady makes an interesting point. She is correct in as much as there is not currently a long queue of companies lining up to take control of whole health systems, but that could change if some new form of Transatlantic Trade and Investment Partnership is brought in by a post-Brexit deal. A number of these companies are becoming increasingly litigious in the courts, which is why Virgin Care took the NHS in Surrey to court. However, even if a private provider is not gifted a whole contract, which is the point that the hon. Lady is making, there is nothing to prevent it from buddying up with NHS bodies in joint ventures as a way of exercising influence over the way in which local health systems are configured. There is already evidence of private sector involvement in the establishment of the integrated care system, with Centene UK—an offshoot of an American health insurer—working with Capita in the Nottingham ICS.

[Karin Smyth (Bristol South) (Lab)]

Earlier in his remarks, my hon. Friend talked about confidence for people locally in what is happening in the NHS. Further to the point made by the hon. Member for Totnes (Dr Wollaston), only in February NHS England itself issued its case for primary legislative changes in which it says, with regard to these proposals, that it wants to

“start a broad process of engagement with the NHS, its partner organisations and those with an interest in how our health service operates.”

That will hopefully involve patients and the public. In Bristol, we embarked on a 10-year contract for community services on the day after the NHS plan was invoked without consultation with local people, an assessment of basic health needs or alignment with the rest of the situation. The problem is that we have yet another change that people locally do not have confidence in. It really is time for the Government to come forward with a cohesive change for the future.

[Jonathan Ashworth]

That is absolutely right. Notwithstanding the sincere views of the Select Committee, there is a lack of confidence out in the country about the way in which these commercial contracting arrangements work. We are seeing that in Bristol, as my hon. Friend so eloquently outlined. Despite the blasé attitude of the Secretary of State in the Select Committee, this is the same Secretary of State who has sat back and done nothing while a PET-CT cancer scanning contract in Oxford is privatised, leading to a fragmented service putting patient safety at risk.

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

I know my hon. Friend has been working very hard on this issue. I have had droves of patients and staff contacting me with their concern about what is happening. They are astonished that this privatisation is continuing given the comments made by the Secretary of State. There seems to be no willingness at all for any challenge to NHS England’s decision, which is going above the heads of those who deliver the care and which, as my hon. Friend says, would threaten its quality and safety.

[Jonathan Ashworth]

We keep being told by Ministers, by those who are favour of integrated care and by various interested stakeholders that Labour Members are scaremongering and that we have nothing to worry about—that it is all going to be fine and all going to be in the public sector—yet at the same time we are seeing controversial privatisation after privatisation all across the country, of which the one in Oxford is just the latest example. This has happened since the Secretary of State went to the Select Committee and said that there would be no privatisation on his watch.

In south-east London, private companies are in a three-way fight for the biggest-ever NHS pathology contract—a £2.2 billion contract for 10 years. If the Secretary of State was sincere in his commitment to no privatisation on his watch, he would bring forward legislation to ensure that ICPs are statutory public bodies that are publicly accountable. He would first take the advice of the NHS itself, as embodied in the long-term plan and the subsequent proposals for legislative change, and rid our NHS of the morass of competition law and economic regulation that was brought in by the Health and Social Care Act 2012. Everyone agrees that this particular aberration has had its time.

While the NHS proposals do not yet go as far as Labour Members would want and would not resolve all the problems of the internal market and private sector involvement that our NHS struggles with, they would remove the default assumption for competitive tendering that would currently make many ICSs feel obliged to put contracts for ICPs out to tender for fear of falling foul of the competition rules. Overall, they provide a far preferable base from which to pursue integrated care than the maze of contradictions and obstacles that Andrew Lansley’s Act forced on them. Rather than this regulated change, why is the Minister not bringing forward the legislation that NHS England has called for?

I have two other quick points for the Minister. The new secondary legislation seeks to substantially change the regulations underpinning the existing contractual arrangements for the provision of NHS GP services. We should remember that general practice is already hard to recruit for and we are already losing GP numbers, yet the proposal to incorporate GP practices into ICPs appears to cut across the idea of GPs beginning to work in wider networks covering 30,000 to 50,000 patients, retaining their GP contracts but sharing common resources. That was highlighted as a direction of travel to be celebrated by the Prime Minister when launching the long-term plan.

GP practices can already network and collaborate without this new contract. The contract will offer a sweetener to GPs of new money if a GP practice signs up to the new contract, but the proposals have been opposed by the BMA. Dr Richard Vautrey has said:

“We have repeatedly expressed our serious concerns about ICP contracts which leads to practices giving up part or all of their General Medical Services contract as a result. Practices should not feel pressured into entering an ICP contract as to do so could leave their patients worse off.”

Perhaps the Minister can explain why he is correct and Dr Vautrey is wrong.

I want to make a quick point about the pooling of budgets with respect to universal free-at-the-point-of-use NHS and means-tested social care. If the boundaries between health and social care are dissolved, will the Minister mandate ICPs and clearly specify that which is considered healthcare and that which is considered social care? I raise that because we are already seeing CCGs across the country cutting back on their responsibilities to provide continuing healthcare for some of the most vulnerable people. Can he guarantee that some services currently provided free on the NHS—whether rehabilitation care or nursing care provided by district nurses, such as wound care or continence care—will not suddenly be designated as social care, so that charging creeps into the system?

[Kevin Hollinrake (Thirsk and Malton) (Con)]

The hon. Gentleman talked about the funding of social care. One of the recommendations made by the Health and Social Care Committee, in concert with the Housing, Communities and Local Government Committee, as a solution to adult social care funding, was a system of social insurance. Would he support that on a cross-party basis?

[Jonathan Ashworth]

The hon. Gentleman is a passionate campaigner for his social insurance proposal, and I have heard him make that point many times. I say to him gently that when the Government bring forward their Green Paper—I emphasise the word “when”—we will engage fully in the debate, and I am sure he will make that point then, whether the debate happens this year, next year or the year after; we will wait and see.

There is a problem with the dissolving of boundaries between health and social care and what that could mean, with charges creeping into the system for some services that were previously considered NHS services but are now designated as social care services. Is the Minister prepared to mandate ICPs, so that we have clear guidelines about that? Finally, where is the patient voice in any of this? Where are the guarantees that decisions will be made not only in public but with the public involved in the decisions that affect them locally?

We on the Opposition Benches support integration; we have long called for it. We support greater collaboration. We support the planning of health and social care delivery in local areas. We support restoring local area-based health bodies delivering care, rather than the fragmented mess we have today. We have, of course, had such bodies before—we used to have district health authorities and strategic health authorities, and some have suggested rather mischievously that we seem to be going back to what we used to have in the past.

Until the default assumptions of tendering and wasteful procurement exercises are removed from primary legislation, such secondary legislation will always create further dangers of private operators gaining control of NHS services. Until that is done, Ministers will have no one to blame but themselves if the spectre of privatisation continues to haunt their ICP plans. We oppose NHS privatisation. We oppose NHS cuts. We oppose anything that undermines the fabric of a public national health service. We oppose these regulations. We seek to annul them, and I commend our motion to the House.

--- Later in debate ---

[Jonathan Ashworth]

Will the Minister confirm that, because of the competition and procurement rules and the regime brought in by the Andrew Lansley Act, he cannot rule out the possibility of an independent provider winning a contract? He might say it is unlikely, but he cannot rule out the possibility, so why does he not introduce a measure—a simple one-clause Bill, perhaps—to give the assurances that many campaigners want?

[Stephen Hammond]

The hon. Gentleman is right: it is highly unlikely. More than that, it is stated and restated in the long-term plan that NHS England has the clear expectation that the ICP contracts will be held by public statutory providers. He knows that, and others who have discussed this point have made it clear.

--- Later in debate ---

[Lyn Brown (West Ham) (Lab)]

Should my Whip, who is not listening at the moment, wish me to sit down, he needs to indicate that to me and I will do exactly what I am told. The changes that we are discussing today are technical, but important. The creeping fragmentation and privatisation of our NHS, where more and more services are contracted out to unaccountable profit-making companies, has occurred precisely because of such obscure, technical changes.

My constituents need integrated care services across different organisations, as well as more preventive health and public health action. That is urgent, it should be a priority, and there should be legislation and full debate to make it happen. Currently, just 54% of my constituents—barely more than half—receive the breast cancer screenings they need. We have lower rates of physical activity than the national and London averages, as well as higher rates of smoking, and 44% of local children leave primary school obese. If the legislation we are talking about were just about joining up care for patients, creating genuine efficiency by avoiding duplication of services, or enabling patients to receive effective care closer to home in the community, rather than in hospital, I would absolutely welcome it.

[Jonathan Ashworth]

My hon. Friend is making an excellent speech, and I hope she continues to make an excellent speech. On the point about what is happening in east London, there is a very good integrated programme there for dealing with diabetes. The point is this: there are very good examples of integration taking place across the country without the need for this contract, which could usher in greater privatisation.

[Lyn Brown]

My hon. Friend is absolutely right. I believe, and I know he believes, that these changes are important and should not be done by statutory instrument. The goal of healthcare integration can and should be pursued with the full scrutiny provided by primary legislation.

Locally, these plans have raised huge concerns. Currently, Newham is in a sustainability and transformation partnership with seven other boroughs—Havering, Redbridge, Barking and Dagenham, Waltham Forest, Tower Hamlets, Hackney and the City of London. Those are really very different places, not only politically but in terms of age, ethnicity and levels of deprivation. Any integration plan that covers that wide an area will be incredibly difficult to get right.

I understand that the current thinking is more about dividing that eight-borough STP into three new integrated care systems, or ICSs. Newham will be lumped together with Waltham Forest and Tower Hamlets. I am very worried that pushing these areas together, with one extremely overstretched budget, will result in money being taken away from my constituents in Newham, whose needs are extremely high. If the Government were talking about enabling greater integration at local authority level, where democratically elected councillors could be properly involved, the issue would not be that much of a concern.

To be frank, I have absolutely no confidence that there would even be a proper consultation about integrating Newham into a three-borough ICS. I know that that is what local leaders expect only because I asked them about it before the debate. I am told that not one health body locally actually wanted to sign up to the STP—not one local body. But that did not matter to those who are really in control, so it was just put in place anyway as the East London Health & Care Partnership. This supposed partnership was given an incredibly complicated governance structure. Again, no one actually wanted it. That was not because health bodies do not want to collaborate; it was because this Government’s failed reforms do not have the confidence of clinicians.

There are many basic questions that need to be answered and that have not been. I have five for tonight. One, how do the Government plan to prevent fragmentation, given that there are so many different ways that these arrangements could be made? Two, how will existing borough-level partnerships slot into these new structures? Three, how are dedicated NHS staff, elected local representatives or even—horror!—patients themselves going to have control over how these structures are implemented, which areas are joined together and which services are included? Who will have that control?

Four, once one of these integrated bodies has been set up, what actual accountability will there be? As we know, public health and social care services are currently in the hands of councils. Even beyond that, many health and wellbeing objectives are the statutory responsibility of local councils too. Therein lies accountability to local people, but it is totally unclear to me how councillors will be able to hold the new ICPs to account in turn. If those new bodies are going to be responsible for making decisions, they should have to be transparent and accountable. I am not at all opposed to the integration of services, but we must create more accountability, and not risk losing the little that is currently there.

My fifth and final question is this. How will the Government guarantee to my constituents that this change will not become another back-door privatisation? How can they reassure me that the enormous, inefficient, profiteering “health maintenance organisation” monsters that exist in the United States will not be given a foothold here in exchange for, say, a trade deal post Brexit? This is what I find most offensive about the statutory instrument. Ministers have been offered the chance, time and again, to say that private companies will not be able to act as integrated care providers, and will not be able to bid for the huge contracts that will be created. But I have heard no good reason why the Government will not make those commitments.

NHS 10-Year Plan

Jonathan Ashworth Excerpts

Tuesday 19th February 2019 Commons Chamber

[Louise Haigh (Sheffield, Heeley) (Lab)]

The long-term plan acknowledges that life expectancy continues to improve for the most affluent 10% but has either stalled or fallen for the most deprived 10%. In Sheffield, life expectancy for the most deprived women has fallen by four years over the nine years that this Government have been in power. Does the Minister have any analysis of why life expectancy has fallen for the most deprived women on his watch?

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

Very good question.

[Stephen Hammond]

I am sure that there will be a number of excellent questions and interventions, but it was a good question. The plan sets out that all local health systems will be expected to outline this year how they will reduce health inequalities by 2023-24, and the intention is that that process will consider exactly the health inequalities that the hon. Member for Sheffield, Heeley (Louise Haigh) mentions.

Additional money for the primary sector will ensure that funding for primary medical and community health services, such as GPs, nurses and physiotherapists, increases by £4.5 billion in real terms in the next five years. That will mean up to 20,000 extra health professionals working in GP practices, with more trained social prescribing link workers within primary care networks. By 2021, all patients will be offered a digital-first option when accessing primary care. The plan also considers the future of the health system, and the new proposals for integration are the deepest and most sophisticated ever proposed by the NHS.

--- Later in debate ---

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

I thank the Minister for his brevity. I am sure the House will appreciate the way in which he both took a number of interventions and made his remarks speedily. I will endeavour to copy him. [Hon. Members: “Hear, hear.”]

I start where the Minister almost concluded, by thanking NHS staff for the work they do day in, day out. He is a relatively new Minister to the post—so new that you gave him a different surname, Madam Deputy Speaker, but we will gloss over that. He inherits his portfolio after a time in which the NHS has suffered the most severe financial squeeze in its 70-year history. At one point under the Conservatives’ spending plans for national health services the money was set to fall on a head-for-head basis, although they have now revised the spending plans. Because of that financial squeeze over many years, he inherits a portfolio where 4.3 million people are on waiting lists and 2,237 people are waiting more than 12 months for treatment, more than 2.9 million people waited more than four hours in an accident and emergency department, and nearly 27,000 people wait two months for cancer treatment. The 18-week referral to treatment target has not been met since February 2016, the cancer target has not been met since December 2015, the diagnostic target has not been met since November 2013, and the A&E target has not been met since July 2015. Those targets are all enshrined in the NHS constitution and in statute, and they were routinely delivered under the last Labour Government. Under this Government, they have, in effect, been abandoned.

[Gloria De Piero (Ashfield) (Lab)]

People in my constituency have to wait longer than most people in the country for a GP appointment: 23% waited more than two weeks; and 15% waited more than three weeks. Does my hon. Friend agree that one of the many brilliant things the last Labour Government did was introduce the 48-hour target to see a GP?

[Jonathan Ashworth]

The last Labour Government put record investment into the NHS, which was voted against every step of the way by the Conservatives. That Labour Government delivered some of the best waiting times on record and some of the highest satisfaction ratings, and they increased access to GPs in constituencies such as Ashfield.

The A&E standard is important not only for patients waiting in an overcrowded A&E but because it tells us much about flow through a hospital. Last week we had the worst A&E performance data since records began, with just 76.1% of those attending type 1 A&E seen, discharged or admitted to a ward in four hours. Behind the statistics are stories of patients left waiting in pain and distress and of the elderly languishing on trolleys. In fact, we have had 618,000 trolley waits in the past year. Patients have been waiting without dignity, at risk of cross-infection. There is no road map at all in the long-term plan to restoring access standards. Of course, the A&E standard is being revised in the long-term plan, even though the Royal College of Emergency Medicine has said:

“In our expert opinion scrapping the four-hour target will have a near catastrophic impact on patient safety in many Emergency Departments that are already struggling to deliver safe patient care in a wider system that is failing badly.”

I hope that when the review reports we can have a full debate in the House.

[Dr Poulter]

The hon. Gentleman is right to highlight the Blair Government’s injection of cash into the NHS and the meaningful difference that that made to many patients’ lives. On the waiting-time targets, if we are serious about parity for mental health and physical health, we should reflect on the fact that historically there have not been access targets for mental health of anywhere near the same standards that there are for physical health. Will the hon. Gentleman join me in urging a rethink of that and a much greater push for access targets for mental health services as a way to raise standards and improve the time within which patients get care?

[Jonathan Ashworth]

The hon. Gentleman makes an important point. There are elements of the long-term plan that we welcome, including the access targets for mental health. We also welcome the commitment to save 400,000 lives, although there is no detail in the plan about how those lives are going to be saved. We welcome the rolling out of early cancer diagnostic and testing centres—after all, it is a policy that I announced in the 2017 general election campaign. We welcome the roll-out of alcohol care teams in hospitals—a policy that I announced at the Labour party conference last year. We welcome the commitments on perinatal mental health—again, a policy that we announced previously. We welcome the commitment for preferential funding allocated to mental health services—another policy that the Labour Opposition previously announced—but we will need to study the details carefully, as the hon. Member for Oxford West and Abingdon (Layla Moran) said.

The points about mental health from the hon. Member for Central Suffolk and North Ipswich (Dr Poulter) were well made, because currently three in four children with a diagnosable mental health condition do not get access to the support they need. Child and adolescent mental health services are turning away more than a quarter of the children referred to them for treatment by parents, GPs, teachers and others. That is quite disgraceful, so I hope the extra investment in mental health services reaches the frontline quickly, and I hope that in summing up the debate the Minister will give us more details about when we can expect to see progress on that front.

[Darren Jones (Bristol North West) (Lab)]

Does my hon. Friend agree that for hospitals such as Southmead Hospital in my constituency, which is one of the largest hospitals in Europe, frontline delivery requires a workforce that is able to meet the demand? Does he therefore agree with the comments from the King’s Fund, which says that the Government not only failed the test on the workforce but did not even turn up for the exam?

[Jonathan Ashworth]

My hon. Friend makes a good point, and I will come on to discuss the workforce in a few moments. First, let me pick up the point made by my hon. Friend the Member for Sheffield, Heeley (Louise Haigh).

There is recognition in the plan that widening health inequalities are becoming a more important issue, which we need to confront. There is much in the document about widening health inequalities. After years of austerity, with poverty rates increasing and child poverty at 4.1 million, we now see life expectancy in this country stalling for the first time in a hundred years, and actually going backward in the poorest parts of the country. Child mortality rates for children born into the most deprived of circumstances have increased. The truth is that poorer people get sick quicker and die earlier. For me, as a socialist and a Labour politician, that is shameful. We should be creating conditions in which people live longer, healthier, happier lives, which is why we need to end austerity across the board. The focus on health inequalities is therefore welcome, and that includes the stark recognition that inequalities are costing the NHS £4.8 billion a year in admissions—a remarkable figure.

[Matt Rodda (Reading East) (Lab)]

I concur on the benefits of our Labour health policy and how the Government should do much more to fund healthcare in this country. Does my hon. Friend agree that there is a particular problem of retaining public sector workers in many high-cost areas? In areas such as Reading and Oxford—my hon. Friend the Member for Oxford East (Anneliese Dodds) is sitting in front of me—there is severe pressure on the NHS because of the relatively low pay of many skilled staff.

[Jonathan Ashworth]

Absolutely. I will come on to the workforce in a second.

Overall, there are welcome commitments in the long-term plan. We have counted up to 60 commitments to improve, expand or establish new services, but sadly there is no detail on how they will be delivered. There are commitments to expanding access to general practice, but where is the plan to recruit the workforce we need in the national health service?

When the previous Secretary of State came to the House last June, he said that there would be a full workforce plan—not an interim plan shared by Dido Harding, but a full workforce plan to coincide with this long-term plan.

[Hon. Members]

Where is it?

--- Later in debate ---

[Jonathan Ashworth]

It has been delayed. There are no details about training budgets, because the Department has to wait for the spending review. We have 100,000 vacancies across the national health service, with think-tanks warning that we will have 250,000 vacancies unless we do something. We cannot wait for this workforce plan; we need action now.

Also missing from the long-term plan is any serious investment in public health services—this is picking up on another point that the hon. Member for Central Suffolk and North Ipswich made. Public health services are being cut again this financial year under this Government. When we take into account the cuts to public health services, the cuts to infrastructure, and the cuts to training, there is actually a £1 billion cut to health spending this year. The cuts to public health are equivalent to 1,600 fewer health visitors, 1,700 fewer school nurses, and 3,000 fewer drug workers. They mean that our constituents become sicker and demands on the wider NHS become greater. Drug and alcohol services will be cut by £34 million this year, even though the unmet need for treatment for alcohol problems has risen to 600,000 and admissions to hospital where alcohol is a primary factor have increased by 30%.

Also cut are smoking cessation services and obesity services. Cuts to health visitors and early years initiatives correlate with a fall in vaccination rates. Admissions to hospital for whooping cough are up by 59%. There have been deep cuts to sexual health services at a time when infections such as syphilis and gonorrhoea are increasing. These cuts to sexual health services are having an impact on women’s reproductive health, with experts expressing concerns that the use of long-acting reversible contraception is decreasing. Abortion rates among the over-30s are increasing and 8 million women live in areas where funding for contraception has decreased.

Let me read the House a quick extract from the Health Committee involving my friend—I will still call her my friend—the hon. Member for Liverpool, Wavertree (Luciana Berger). I am desperately sad that she felt that she had to leave the Labour party. I hope that the Labour party will get on top of this antisemitism issue. At the Health Committee, she asked about the health consequences of delays in accessing sexual health services. In responding, Dr Olwen Williams from the British Association for Sexual Health and HIV said:

“We are seeing neonatal syphilis for the first time in decades and neonatal deaths due to syphilis in the UK…We are seeing an increase in women presenting with infectious syphilis in pregnancy, and that has dire outcomes.”

These public health cuts were endorsed, not reversed, in the long-term plan.

[Paul Scully (Sutton and Cheam) (Con)]

rose—

[Jonathan Ashworth]

I will give way for the final time.

[Paul Scully]

I am grateful to the hon. Gentleman for giving way. He talked about a few different topics, but I think that I heard him say that there was an overall cut in the health service—I think he did so when he was welcoming some of the Government’s measures. In the 2017 manifesto, Labour committed to a 2.2% increase, whereas this Government committed to a 3.4% increase, so I hope that he welcomes that increase as well.

--- Later in debate ---

[Jonathan Ashworth]

We committed more in our 2017 manifesto than the Tory party did in the manifesto on which the hon. Gentleman fought the election. The Tory party revised its spending plans because of pressure from the Labour Opposition. [Interruption.] Madam Deputy Speaker wants me to hurry up.

The final point that I want to make is this: the most intriguing part of the long-term plan is the remark that the Health and Social Care Act has created a complete mess, hindering integration; and it proposes scrapping the so-called section 75 provisions. We do not want to say, “We told you so,” but we did tell them so, and Tory MPs should apologise for voting to pass the Lansley Act. If they are going to support NHS England’s call to get rid of the section 75 arrangements, which put through a proposed privatisation, why do they not block the £128 million-worth of contracts that are currently out to tender? If they do not, it will be clear that the Tory party is still committed to privatisation in the national health service.

The truth is, the Tories have spent nearly nine years running down the NHS, refusing to give it the spending that it needs. They are privatising it still; there will be a £1 billion cut to the NHS this year. It is Labour who will rebuild the national health service.

Oral Answers to Questions

Jonathan Ashworth Excerpts

Tuesday 19th February 2019 Commons Chamber

[Matt Hancock]

Well, it is getting scrutiny and debate now. The change that is being proposed is about making sure we can get people the drugs they need. Of course the responsibility is on the pharmacist to ensure that it is the appropriate drug and, if necessary, that the GP is involved. However, it is absolutely right that we make changes to ensure that we have an unhindered supply of medicines whenever there are shortages—whether that is to do with Brexit or not.

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

The Secretary of the State spoke with his characteristic self-confidence about the supply of insulin, but at the end of last week Diabetes UK said that

“despite reaching out directly to the Department of Health…we still have not seen the concrete detail needed to reassure us…we cannot say with confidence that people will be able to get the insulin and other medical supplies they need in the event of a no-deal Brexit.”

Why is Diabetes UK wrong and the Secretary of State right?

[Matt Hancock]

Diabetes UK is not a supplier of insulin. Of course, it plays an important role in representing those who have diabetes. We have given Diabetes UK reassurances, including, for instance, that the stockpiles we have for insulin are more than twice as long as we proposed and as required. That is an important assurance.

[Jonathan Ashworth]

I hope the Secretary of State will contact Diabetes UK to give it those reassurances directly.

On the various no-deal medicines statutory instruments that the House will debate today and on other occasions, the Government’s own impact assessments say that, in a no-deal scenario, the NHS will pay more for drugs, UK firms will face more red tape, and NHS patients will go to the back of the queue when it comes to international innovation. Given that the consequences of no deal would be so devastating for the NHS, will the Secretary of State—as, apparently, the Justice Secretary will—resign from the Government if it means blocking no deal?

[Matt Hancock]

If the hon. Gentleman really cared about stopping no deal, he would vote for the deal. There is something else that is worth saying about this shadow Secretary of State. He is a reasonable man—he is a sensible man—and I like him. My politics are probably closer to his than his are to those of the leader of his party, so why does he not have the gumption to join his friends over there on the Back Benches in the Independent Group, instead of backing a hard-left proto-communist as leader of the Labour party?