Oral Answers to Questions

Jonathan Ashworth Excerpts

Tuesday 15th January 2019 Commons Chamber

[Matt Hancock]

No, absolutely, we have ensured that there will be aircraft available, and air freight, to make sure that we can get those isotopes that have a short shelf life and cannot be stockpiled, and that there is unhindered supply. I make the following point to the hon. Lady and her colleagues, with an open mind and in a spirit of collaboration: if she is worried about no deal, which she seems to be, she and her party should support the Government tonight.

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

The Secretary of State boasts of being the world’s biggest buyer of fridges to stockpile medicines, but if sterling drops because of the Government’s mishandling of Brexit, the parallel trade in medicines could mean that stockpiles rapidly deplete as medicines are quickly exported back into the EU. Will he impose restrictions and suspend the necessary export licences that he is responsible for? Otherwise, he risks his fridges standing empty.

[Matt Hancock]

Of course, we have the legislative tools and powers the hon. Gentleman describes at our disposal; we know that. Nevertheless, stockpiling is going according to plan—it is going well—and the pharmaceutical industry has responded very well, with great responsibility. But I say, rather like a broken record—[Hon. Members: “You are.”] Yes, and it is important that I say it again and again and again. There is one route open to the House to avoid no deal, which Opposition Members purport to be worried about. They cannot complain about no deal unless they are prepared to do something about no deal, and to do something about no deal, they need to vote with the Government tonight.

[Jonathan Ashworth]

If the Secretary of State has those powers, he should use them now. This is going to be the biggest disruption to patient safety we have ever seen. He is also proposing emergency legislation that means patients might not get access to the medicines their GPs prescribe. Can he tell us whether an insulin patient will be able to get their prescription within a day of presenting at a pharmacy? He is the Secretary of State for Health; why will he not do the responsible thing and rule out no deal, which will do so much damage to the NHS and patients?

[Matt Hancock]

Because of the votes of most of us in the House, including the hon. Gentleman, no deal of course is the law of the land unless the House passes something else. He is a reasonable man. He is a mentor of the old Blairite moderate wing of his party. He is absolutely a centrist. I do not believe that, privately, he believes in the hard-left guff that comes from other Opposition Front Benchers. He is a very sensible man and I like him an awful lot, so after this session and before 7 o’clock tonight, why does he not take a look in the mirror and ask himself, “In the national interest, is it best to vote for the deal and avoid no deal, or is it best to play politics?”

NHS Long-term Plan

Jonathan Ashworth Excerpts

Monday 7th January 2019 Commons Chamber

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

I welcome the advance copy of the Secretary of State’s statement, but may I quickly say at the outset that Churchill’s Tory party voted against Labour’s NHS 22 times?

We welcome many of the ambitions outlined today by NHS England. We welcome the greater use of genomics in developing care pathways. We welcome the commitment to early cancer diagnosis; after all, it was a Labour policy announced at the general election. We welcome the commitment to new CT and MRI scanners; it is a Labour policy. We welcome the greater focus on child and maternal health, including the expansion of perinatal mental health services; again, it is a Labour policy. We welcome the roll-out of alcohol teams in hospitals, because, yes, it is another Labour policy.

The Secretary of State did not mention this, but we will study carefully the details of any new proposed legislation, because we welcome the recognition that the Health and Social Care Act 2012 has created a wasteful, fragmented mess, hindering the delivery of quality healthcare. Healthcare should never be left to market forces, which is why scrapping the competition regime and scrapping the Act’s section 75 procurement regulations, as proposed today by NHS England, are long-standing Labour policies. The Government should be apologising for the Health and Social Care Act. But why stop halfway? Why not commit to fully ending the purchaser-provider split? Why not commit to democratic accountability when planning care? Why not commit to consigning the whole Lansley Act to the dustbin of history?

What about the other holes in today’s announcement? Waiting lists are at 4.3 million, with 540,000 waiting beyond 18 weeks for treatment. A&Es are in crisis, with 618,000 trolley waits and 2.5 million waiting beyond four hours in A&E. So why is there no credible road map today to restoring the statutory standards of care that patients are entitled to, as outlined in the NHS constitution? They were routinely delivered under a Labour Government. Is it not a damning indictment of nearly nine years of desperate underfunding, cuts and failure to recruit the staff we need that those constitutional standards will not be met as part of this 10-year plan?

The Secretary of State boasts of the new budget for the NHS. Will he confirm that once inflation is taken into account, once the pay rise is factored in and once the standard NHS England assumption about activity is applied, there is actually a £1 billion shortfall in the NHS England revenue budget for this coming financial year? When he answers, will he tell the House—I will be listening carefully to what he says—whether he has seen or is aware of any internal analysis from the Department, NHS England or NHS Improvement that confirms that £1 billion shortfall figure?

Can the Secretary of State also confirm that despite his rhetoric about prevention, the public health budget is set to be cut again in the next financial year as part of a wider £1 billion of cuts to broader health spending, and that when those cuts are taken into account, spending will rise not by 3.4%, as he says, but by 2.7%? That will mean deeper cuts again to smoking cessation services, deeper cuts again to drug and alcohol addiction services and deeper cuts again to sexual health services when infections such as gonorrhoea and syphilis are on the rise. By the way, why is HIV/AIDS not even mentioned in the long-term plan? What was the Secretary of State’s answer when asked about public health cuts in his weekend interviews? Targeted Facebook advertising. Given that life expectancy is going backwards, health inequalities are widening and infant mortality is increasing, the public health cuts should have been reversed today, not endorsed.

The NHS long-term plan admits that

“the extra costs to the NHS of socioeconomic inequality have been calculated as £4.8 billion a year in greater hospitalisations alone.”

Does that not confirm that, for all the rhetoric on prevention, the reality is that the Government’s austerity and cuts are making people sicker and increasing the burden on the NHS? Nowhere have we seen greater austerity than in the deep cuts to social care, but where are the Government’s proposals today? They still do not have any.

With respect to social care, surely the Secretary of State agrees that:

“It is not possible to have a plan for one sector without having a plan for the other.”—[Official Report, 18 June 2018; Vol. 643, c. 53.]

Those are not my words, but the words of the Foreign Secretary when he stood at the Dispatch Box last June as the Secretary of State for Health and Social Care. I agree with him; it is a shame that the current Secretary of State does not.

By the way, the Foreign Secretary also promised that:

“Alongside the 10-year plan, we will also publish a long-term workforce plan”.—[Official Report, 18 June 2018; Vol. 643, c. 52.]

Where is it? The Secretary of State has not done it. We all want to know where the staff are coming from to deliver the ambitions that have been outlined today. We are short of 100,000 staff. We are short of 40,000 nurses. The Secretary of State talks of doing more for mental health services; we are down 5,000 nurses in mental health. He talks of doing more for primary and community care; GP numbers are down by 1,000 and district nursing numbers are down by 50%. Now, the Home Secretary wants to impose a £30,000 salary cap on those coming from abroad to work in our NHS, ruling out nurses, care assistants and paramedics. The Secretary of State should do his job and tell the Home Secretary to put the future sustainability of the NHS first, instead of his Tory leadership ambitions, and ditch that salary cap for the NHS.

There are certainly many welcome ambitions from NHS England today, but the reality is that those ambitions will be hindered by a Government who have no plan to recruit the staff we need, who have no plan for social care and who are pushing forward with deep cuts to public health services. Patients have been let down as the Government have run down the NHS for nearly nine years. We do not need 10 more years of the Tories. The NHS needs a Labour Government.

[Matt Hancock]

Well, I think we discovered from that that Labour has absolutely nothing to say about the future health of the nation. The hon. Gentleman did not even deign to thank the people who work in the NHS for their incredible work. Did we hear any acknowledgement of the million more people who are seen by the NHS, of the record levels of activity going on in the NHS and of the fact that we have more nurses and doctors in the NHS than we had in 2010? He had nothing to say. He talked about the workforce. Chapter 4 of the document is all about the workforce plan. He gives me the impression that, like his leader on Brexit, he has not even read the document he is talking about.

The hon. Gentleman asked about targets and legislation. On legislation, when clinicians make proposals on what legislation needs to change to improve the NHS, we listen. We do not then come forward with further ideological ideas. We listen. So we will listen to what they have said. The clinicians have come forward with legislative proposals and we will listen and study them closely.

On the money that the hon. Gentleman talked about, it was a bit like a broken record. He asked about a £1 billion shortfall in the NHS budget. I will tell him what we are doing with NHS budgets: we are putting them up by £20.5 billion. There is an error in the analysis by the Nuffield Trust, because it does not take into account an improvement in the efficiency of the NHS. Is it true that every year we can improve the way the NHS delivers value for taxpayers’ money? Absolutely. We can and we must, because we on the Government Benches care about the NHS and about getting the right amount of money into the NHS, but we also care about making sure that that money is spent wisely. The hon. Gentleman would do well to heed the views of the NHS itself, which says that yes, the NHS is probably the most efficient health service in the world, but there is always more to do.

The hon. Gentleman argued about various budgets. The budgets in the NHS are going up because we care about the future of the NHS. The Labour party called for an increase of 2.2% a year; we are delivering an increase of 3.4% a year. Labour has nothing to say on health, as it has nothing to say on any other area of domestic business. We will make sure that we are the party of the NHS for the long term.

Oral Answers to Questions

Jonathan Ashworth Excerpts

Tuesday 27th November 2018 Commons Chamber

[Matt Hancock]

Yes. General practice will be at the heart of the long-term plan. GPs are the bedrock of the NHS. We will put an extra £3.5 billion, at least, into primary and community services to help keep people healthy and prevent them from going to hospital.

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

The Secretary of State got into a muddle last week with his GP figures, so may I suggest that he download an exciting new app to his phone? It is called a calculator. He has said that there will be more for community and primary care by 2024. Can he guarantee that there will be the extra GPs and district nurses to provide the services that he is promising?

[Matt Hancock]

Yes, I can; given that we have the money coming into the NHS, we are doing everything possible to ensure that we have the people to do the work. I am delighted to say that we have a record number of GPs in training right now.

[Jonathan Ashworth]

But GP numbers have gone down by 700 in the last year, have they not? There are 107,000 vacancies across the NHS, acute trusts are closing accident and emergency departments overnight, the closure of chemotherapy departments is being considered, and Health Education England’s training budget is the lowest that it has been for five years, with more cuts to come next year. Does the Secretary of State agree that if the long-term plan that he will publish next week is to be credible, he must reverse those training cuts and deliver the staff that our NHS needs?

[Matt Hancock]

That was a bit of a surprise, because the hon. Gentleman is normally such a reasonable fellow. I thought that he would welcome the record number of GPs in training, and the record number of nurses in the NHS. Because we love the NHS, of course we want to do more, and we will.

Gosport Independent Panel

Jonathan Ashworth Excerpts

Wednesday 21st November 2018 Commons Chamber

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

I thank the Secretary of State for an advance copy of his statement. I welcome the statement and the tone of his remarks, and I thank him for repeating the unambiguous and clear apology that the previous Secretary of State, the right hon. Member for South West Surrey (Mr Hunt), offered at the Dispatch Box before the summer—it is good to see the previous Secretary of State sitting on the Treasury Bench today.

We welcome the Secretary of State’s apology today. The whole House was shocked when the previous Secretary of State reported the findings of the Gosport inquiry to the House. This Secretary of State is right to remind us that everyone who lost a life was a son or daughter, a mother or father, a sister or brother. As he said, our thoughts are with the families of the 456 patients whose lives were shortened because of what happened at Gosport, and the families of the 200 others who may have suffered—whose lives may have been shortened; because of missing medical records, we will never know for sure. That lingering doubt—never knowing whether they were victims of what happened at Gosport—must be a particularly intolerable burden for those families affected.

Like the Secretary of State, I pay tribute to the victims’ families, who, as he says, have in the face of grief shown immense courage, fortitude and commitment to demand the truth. I think the whole House will pay tribute to them today. I also reiterate our gratitude to the former Bishop of Liverpool, James Jones, for his extraordinary dedication, persistence, compassion and leadership in uncovering this injustice. Finally, I applaud those hon. Members who played a central role in establishing this inquiry, not just the previous Secretary of State, but the right hon. Member for North Norfolk (Norman Lamb) and the Minister for Care, the hon. Member for Gosport (Caroline Dinenage), who in recent years has played an important role in her capacity as a constituency MP.

The Secretary of State is correct to say that lessons must be learned and applied across the whole system. We all understand that in the delivery of healthcare and the practice of medicine, sadly, tragically, things can and do sometimes go wrong, but we also understand, as Bishop Jones said in his report, that

“the handing over of a loved one to a hospital, to doctors and nurses is an act of trust”,

but that that trust was

“betrayed.”

I still believe that that betrayal was unforgivable. Patient safety must always be the priority, so when there are systemic failures, it is our duty to act, learn lessons and change policies.

I wish to respond to the Secretary of State’s announcements today. We welcome his commitment to legislation placing more transparency duties on trusts, and we will engage constructively with that legislation. Is it his intention to bring forward amendments to the Health Service Safety Investigations Bill, and if so when, or should we expect a new bill altogether? We look forward to his proposals on strengthening protection for whistleblowers, but he will know that the NHS has just spent £700,000 contesting the case of whistleblower Dr Chris Day, a junior doctor who raised safety concerns. He will also be aware of the British Medical Association survey showing that not even half of doctors feel they would have the confidence to raise concerns about safety. Moreover, he will be aware of how Dr Bawa-Garba’s case played out, with her personal reflections effectively used in evidence against her. Can he offer more details on how he will change the climate in the NHS so that clinicians feel they can speak out without being penalised?

I welcome the thrust of the Secretary of State’s remarks on medical examiners, and I agree they are a crucial reform, but can he offer us some more details? Is it still the Government’s intention that they will be employed directly by acute trusts? He will be aware that this has provoked questions about their independence. We would urge him to go further and base them in local authorities and extend their remit to primary care, nursing homes and mental health and community health trusts. If legislation is needed, we would work constructively with him.

We welcome the review into improving safety when prescribing and dispensing medicine. Clearly, one of the first questions that comes to mind when reading the Gosport report is: how were these prescriptions monitored? The Government’s own research indicates that more than 230 million medication errors take place a year, and it has been estimated that these errors and mix-ups could contribute to as many as 22,000 deaths a year, so this review is clearly urgent. Can the Secretary of State tell us whether it will be an independent review, who will lead it and when we can expect it to report?



Finally, patient safety is compromised when staff are overworked and overburdened with pressures. He will know that we have over 100,000 staff vacancies across the NHS. Some trusts are proposing closing A&E departments overnight because they do not have the staff, and some are even proposing closing chemotherapy wards because they believe that the lack of staffing means services are unsafe. How does the Secretary of State plan to recruit the staff our NHS desperately needs to provide the level of safe care patients deserve?

In conclusion, I offer to work constructively with the Secretary of State to improve patient safety across the NHS, and we support his statement today.

[Matt Hancock]

I appreciate the tone of the hon. Gentleman, who rightly focuses on the need to ensure that this never happens again, and I join him in thanking Bishop James Jones for his work on this and other inquiries. It was quite brilliant empathetic work. I also thank the right hon. Member for North Norfolk (Norman Lamb), for whom I have an awful lot of respect.

The core of the questions the hon. Gentleman raised, about the need to ensure that whistleblowers are listened to and that people are heard in the NHS, comes down to culture change. A whole series of policies underpins that culture change, and I will come to them, but ultimately it comes down to this: errors happen in medicine—it is a high-risk business—but what matters is behaviour, that everything is done to minimise errors and, when they are made, to learn from them, rather than try to cover them up. The culture change needs to be driven across the NHS. It has changed and improved in many areas, but there is still much more to do.

The hon. Gentleman asked whether amendments would be tabled to the Health Service Safety Investigations Bill or in separate legislation on whistleblowers. We are looking at both options. Partly it comes down to the technicalities of scope and the exact distinction and definition of the amendments, but I look forward to working with him on that legislation.

The hon. Gentleman asked why gagging clauses are still in use. I may well ask the very same question. They were deemed unacceptable by my predecessor—I join in the tributes to him—who did so much on this agenda. Gagging clauses have been unacceptable in the NHS since 2013. Trusts, which are independent, can legally use them, but I find them unacceptable, and I will do what it takes to stamp them out.

The hon. Gentleman said that too many people in the NHS feel unable to speak up. To ensure a route for this, we now have, in every single NHS trust, an individual separate from line management to whom staff can go to raise concerns. This is part of the culture change, but it is not the whole. Line management itself in every hospital should welcome challenge and concerns, because that is the way to improve practice. Challenges and concerns that are raised with managers should be deemed an opportunity to improve the service offered to patients, rather than a problem to be managed.

The hon. Gentleman also mentioned medication errors. Of course, this was not a case of medication error—it would have been far less bad had it been; it was a case of active mis-medication that led to deaths. Medication errors are an important issue, however, and we are bringing in e-prescribing across the board to allow much more accurate measurement, audit and analysis of medication.

Finally, the hon. Gentleman said that pressures often come from staff shortages. Again, that was emphatically not the concern here, and we absolutely must not muddle up the behaviour here with the issue of staff shortages. Nevertheless, I acknowledge the need for more staff in the NHS. Indeed, we are putting £20 billion into it over the next five years to make sure we have the people we need to deliver the NHS that everyone wants.

Prevention of Ill Health: Government Vision

Jonathan Ashworth Excerpts

Monday 5th November 2018 Commons Chamber

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

I thank the Secretary of State for advance sight of his statement. We welcome his remarks on the use of medicinal cannabis and on the appalling, barbaric abuses of those with learning disabilities and autism, by which we have all been shocked. I understand his point about the review and about asking NHS England to carry out some work, but is it not time that these institutions were closed down and proper support provided in the community instead?

Of course we welcome the emphasis and focus on prevention, but these promises are not worth a candle if they are not backed up with real, substantive action. They come on the back of £700 million-worth of cuts to public health services, with more cuts to public health services pencilled in for next year, including £17 million-worth of cuts to sexual health services, £34 million-worth of cuts to drug and alcohol services, £3 million-worth of cuts to smoking cessation services and £1 million-worth of cuts to obesity services.

The Secretary of State did not mention childhood obesity in his remarks.

[Matt Hancock]

indicated dissent.

[Jonathan Ashworth]

I apologise if I missed it. Could the Secretary of State tell us when he plans to outlaw or ban the advertising of junk food on family television and when the consultation will end?

Immunisation rates for children have fallen for the fourth year in a row, so a big part of prevention should surely be a focus on investment in children’s and early years health services, yet Government cuts to those budgets and, indeed, the privatisation of many of those services in our communities have seen health visitor numbers fall by more than 2,000, school nurse numbers go down by 700 and 11% of babies miss out on mandated health checks. What is the Secretary of State’s plan to reverse those cuts to health visitors and school nurses?

All in all, alongside wider Department of Health and Social Care budgets, there will be £1 billion-worth of cuts to health services next year, with public health budgets taking considerable strain. Those £1 billion-worth of cuts should have been abandoned today, and it is a missed opportunity that the Secretary of State has not abandoned them. When he was asked about this in the Budget debate, he said it was a matter for the spending review. Well, today the Association of Directors of Public Health has said that the spending review should allocate an extra £3.2 billion for the public health grant next year. Does he accept that figure?

Of course prevention is about more than just public health; it is also about primary care. But GP numbers are down by 1,000 since 2015, and since 2010 district nurses have been cut by more than 3,000, so can the Secretary of State tell us what his plan is to increase the primary care workforce to support his wider ambitions on prevention? We know he wants a higher proportion of NHS spending to go to general practice, so does he agree with GPs that general practice should again receive around 11% of the overall NHS budget? If not, why not?

Of course, prevention is also about mental health services, but 30% of patients referred to IAPT—improving access to psychological therapies—services never receive treatment. What is his plan to ensure that everyone who needs IAPT services next year gets them?

Finally, on the wider social determinants of ill health, the shameful reality is that people in poorer areas die earlier and get sick quicker. Life expectancy has begun to stall, and has actually gone backwards in some of the poorest parts of the country. Rates of premature mortality are twice as high in the most deprived areas of England compared with the most affluent, and mortality rates for the very sickest of babies are increasing. As laudable as many of the aims that the Secretary of State has announced today are, this document does not even mention poverty or deprivation. It does not even recognise that some of the deepest cuts to public health grants have been in the areas of highest need and highest deprivation.

Yes, we welcome a focus on prevention—we have long called for such a focus—but a genuine commitment to prevention would go hand in hand with a genuine commitment to ending austerity. That must start with reversing the public health cuts and blocking the £1 billion of further cuts to health services to come next year. On that test, the Secretary of State has failed today.

[Matt Hancock]

Great, well I take that as a broadly positive response from the hon. Gentleman, and I will address the points he makes. He asked about money, and we are putting £20.5 billion extra into the NHS—this is the largest and longest financial commitment any Government have made to any public service ever. Of course, as well as the NHS budget, local authorities have budgets for public health; as he said, that will be addressed in the spending review. The increase in funding must ensure that we do more on prevention, which means more going into community services and into primary care, as well as making sure we get the appropriate level of spending into public health.

The hon. Gentleman asked about the consultation on advertising as part of the obesity plan. As he knows, that will be published before Christmas. He also asked about rates of immunisation. I want to see immunisation used right across the country. There is a campaign all of us can take part in to persuade people and ensure that immunisation takes place. We do not have compulsory immunisation in this country. I believe that is right, on civil liberties grounds, but by goodness it means it is incumbent on all of us to persuade everybody of the health benefits of immunisation.

The hon. Gentleman asked about GP numbers. We want 5,000 more GPs, and I am glad to report that we have got record numbers of GPs in training, thanks to action by this Government. Finally, he asked about the economic causes of ill health. The No. 1 economic cause of ill health is not having a job, and there are record numbers of jobs in this country. If he says that inequality has an impact on ill health, he should probably welcome the fall in inequality that we have seen under this Government.

Budget Resolutions

Jonathan Ashworth Excerpts

Tuesday 30th October 2018 Commons Chamber

[Matt Hancock]

I pay tribute again to my right hon. Friend, who has worked tirelessly in support of that project. The Defence and National Rehabilitation Centre in Loughborough will link world-class military medical facilities with our NHS. That means lessons learned in the medical field from treating our brave troops who come back from the frontline can be brought into the NHS—for instance, surgical techniques that were learned in battle can be adapted to help civilians here. I pay tribute to her and others for the work they have done.

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

Here is a representation from a Jonathan from Leicester. Further to the question from the Chair of the Select Committee on Health and Social Care, the hon. Member for Totnes (Dr Wollaston), can the Secretary of State confirm that, in next year’s spending review, the cuts to capital budgets and the £700 million-worth of cuts to public health budgets will be reversed, and that there will be real-terms increases in funding for capital, training and public health? Can he guarantee that?

[Matt Hancock]

The spending review is next year. What I can guarantee is a £20.5 billion increase in NHS spending. That is the biggest increase in any spending commitment for any public service in the history of this country. [Interruption.] It is a pity that the Leader of the Opposition is not interested and does not want to hear about it. If he stayed, he could also hear about the reforms we are going to make. He should hear this more than anyone. We are acutely aware on the Conservative Benches that this is not Government money or NHS money but the hard-earned money of taxpayers, and we need to ensure that it is spent wisely. When he sprays his commitments around, Opposition Front Benchers would do well to remember that this is money from taxpayers.

--- Later in debate ---

[Dr Sarah Wollaston (Totnes) (Con)]

May I start by apologising for being absent for much of this debate because I was chairing the Health and Social Care Committee? I also declare a personal interest, as three members of my immediate family are employed as NHS doctors.

We need to take a whole-system approach to health— to think of it not just as the NHS, but as a system including social care, public health, the prevention arm and training budgets. I return to a point that I made in an intervention: I wholly welcome the uplift in the NHS budget, but the increase in the NHS England budget that will take place between 2018-19 and 2019-20 is £7.2 billion, whereas the uplift in the wider health budget in the Red Book is only £6.3 billion. It concerns me that this might indicate that some of the uplift in the NHS England budget will come by way of being taken out of other aspects of the health budget, particularly the Public Health England budget, as we have seen in previous years. I hope that the Minister will touch on that in his response.

[Jonathan Ashworth]

I think that the hon. Lady may have left the debate to attend her Committee when I re-emphasised her point directly to the Secretary of State, who told us that we would have to wait for the spending review. Would she share my disappointment if the Government tried to pull the same trick that they pulled three years ago, and actually misled us or gave us bogus figures for NHS spending that did not include public health expenditure, capital and training?

[Dr Wollaston]

We need absolute transparency around health spending, and to take not only a whole-system approach but a long-term view.

Public health is the prevention arm of the system, and taking money out of public health has a serious impact on future spending and our ability to tackle health inequalities. It would be very troubling indeed if much of this uplift came directly from a public health cut. We need to be specific about that, and it is not sufficient to wait for the spending review to clarify that point; I hope that the Minister will be able to tell us further about what it means. People need to plan for the future, so if £900 million is going to be taken out of public health grants, we need to know that now.

When we ask the public which parts of the system they prioritise, public health tends to be at the bottom of the list. It is up to the Government to look at the evidence, and they must be clear that the evidence shows that we must focus unrelentingly on the prevention arm of healthcare. That is the right thing to do, and it is where we have the greatest chance of tackling the burning injustices of health inequality, so it is an important point to address.

The other aspect I want to touch on is social care. The Health and Social Care Committee has just had a sitting with the Care Quality Commission on its excellent “State of Care” report. The report comments on “fragility,” and the report of a couple of years ago talked about “a tipping point.” The CQC told us that that tipping point has been passed for many people in social care. The interaction between social care and the health service is so close that, if we do not focus on social care, we are simply tipping more costs on to the health service.

Of course it is welcome that there will be an in-year increase for adult social care of £240 million this year and £650 million next year, but it is widely recognised that, because of the extraordinary increase in demand and pressure—driven not just by the welcome fact that we are living longer but by the great increase in the number of people with multiple long-term conditions living to an older age and by younger, working-age adults living with multiple complex needs—social care needs more than £1 billion a year just to stand still, so we need to go further.

I recognise that much of this will come alongside next year’s social care Green Paper, which we are all looking forward to, but the system is under considerable challenge. I hope the Minister will recognise in his closing remarks that we are not there yet on social care. He needs to say what we are going to do in the long term to address our social care needs. As I have said before, we will require an approach that involves the Labour Front Benchers, too. We need to see political consensus, otherwise the politically difficult decisions on funding will not get through the House.

If there are to be cuts to public health, the Government will have an even greater responsibility to provide other levers in their public health policy to reduce demand in the system. The Chancellor specifically referred to wanting to reduce the tragedy of lives lost to suicide. Unfortunately, at the same time, the delay in the reduction of the maximum stake for fixed odds betting terminals means that we have passed up on an important opportunity to address the misery of gambling addiction. That is a hugely wasted opportunity. Likewise, there is a missed opportunity to look at what has happened in Scotland on minimum unit pricing to make sure we are addressing some of the key drivers of public health problems. The Government cannot duck that if we are to see cuts to the public health grant.

Finally, there is the impact of Brexit. The Chancellor has said that there will be £4.2 billion for preparations for a no-deal Brexit. I am afraid that the costs will be far higher. The Health and Social Care Committee recently heard from the pharmaceutical industry that it is having to plough hundreds of millions of pounds into preparing for no deal. That is phenomenal and inexcusable waste; it is money down the drain. I hope the Government will rethink their policy, because no version of Brexit will provide more money for the NHS. There is a Brexit penalty, not a Brexit dividend, and I hope both Front-Bench teams will come together and agree that, ultimately, we need the informed consent of the British people for whatever version of Brexit we come up with, with the option to remain and properly use the money instead for tackling austerity and improving the lives and the health of our nation.

--- Later in debate ---

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

With your indulgence, Mr Speaker, may I preface my remarks by briefly mentioning the awful tragedy that took place at Leicester City football club in my Leicester constituency this weekend? My city—the city I represent—is grieving. We have lost a much loved friend who enjoyed the respect, affection and admiration of not just Leicester City football fans but everyone across our city. Our condolences go out to the loved ones of all who lost their lives in that terrible helicopter crash, and again I pay my tribute to our extraordinary emergency services—the police, the fire and rescue services, the NHS and all other staff—for their quick response, their dedication and their professionalism.

This was supposed to be the Budget that ended austerity, but instead, as my right hon. Friend the shadow Chancellor outlined, we have more of the same. Cuts to public services will continue. Poverty will increase. The very poorest households in society will lose out. Austerity has not ended; we know austerity has not ended because that is the headline in George Osborne’s Evening Standard this evening.

Members have spoken in this debate with great passion, and I am sure the House will forgive me if I cannot mention each and every one of them, but some did catch my attention. My hon. Friend the Member for Huddersfield (Mr Sheerman) began the debate with a tour de force and reminded the House that PFI was a Tory policy begun by—[Interruption.] Conservative Members are chuntering. Perhaps they should have a word with the International Trade Secretary who from this Dispatch Box used to urge us to pursue PFI because it was

“exclusively to fund private capital projects”—[Official Report, 8 January 2003; Vol. 397, c. 181.]

Perhaps they should have a word with the Chancellor of the Duchy of Lancaster who used to give a “warm welcome” to PFI. Perhaps they should have a word with the former Brexit Secretary; I know he is on the Back Benches now, but he used to say in this House:

“The PFI has many virtues—after all, it was a Conservative policy in the first instance.”—[Official Report, 10 March 1999; Vol. 327, c. 429.]

Perhaps they should have a word with the Business Secretary, who said:

“PFI was initiated by the previous Conservative Government.”—[Official Report, 12 February 2013; Vol. 558, c. 787.]

Perhaps they should also have a word with the Scottish Secretary, who said that PFI was a “successful basis for funding”, or with the Welsh Secretary, who said:

“I am a fan of PFI in general.”—[Official Report, 4 November 2010; Vol. 517, c. 1124.]

We will take no lessons on PFI from the Tories.

We have heard other welcome contributions to the debate today. My hon. Friend the Member for Easington (Grahame Morris), who is no longer in his place, spoke eloquently about the need for investment in radiotherapy and cancer treatments. It was a very constructive speech and I saw the Health Minister on the Front Bench nodding at the time; he has obviously had to leave the debate now. The hon. Member for Redditch (Rachel Maclean)—I do not know whether she is still here—mentioned the importance of more investment in and recognition of the menopause. I entirely agree with her on that.

My hon. Friend the Member for Sheffield Central (Paul Blomfield) talked about the terrible and devastating consequences of gambling addiction. As someone who has spoken out about how addiction has taken a devastating toll on my own family, I completely endorse what my hon. Friend said today. The Government really need to push ahead with changes to fixed-odds betting terminals. My hon. Friend the Member for Oldham East and Saddleworth (Debbie Abrahams) and others talked about health inequalities and how the advances in life expectancy were beginning to stall for the first time in 100 years, and were indeed going backwards in some of the poorest parts of our country. This should shame us as a society, and I endorse the calls for an inquiry. If we had a Labour Government, we would have a specific target for narrowing health inequalities.

The hon. Member for Glasgow Central (Alison Thewliss) spoke eloquently about the effects of the Budget on children. I commend all her work as chair of the all-party parliamentary group on infant feeding. It is shameful in our society that, as we saw on Channel 4’s “Dispatches” last night, one in 100 families are now turning to baby banks in our constituencies for access to baby clothing, food and toys. That is absolutely disgraceful. The hon. Member for Mid Dorset and North Poole (Michael Tomlinson) complained about chuntering from our side as he spoke about the importance of marriage. I agree that marriage is an immensely important institution, but I say to him that children should take priority in social policy and that the Government should be investing in children regardless of the marital status of their parents.

I hope that Members will forgive me if I do not mention everyone, but I did enjoy the passionate speech from my hon. Friend the Member for Kingston upon Hull West and Hessle (Emma Hardy) on the value of public services. At one point, she said, “This is my truth.” I do not know whether she was referring to the Manic Street Preachers or to Aneurin Bevan, who also said:

“This is my truth, tell me yours.”

My hon. Friend’s speech was a superb successor contribution to some of the speeches that Bevan would have made from the Dispatch Box when he created the NHS and the Conservatives voted against its creation.

The Health Secretary does not seem to be in this place to hear the wind-ups, but I am sure that he is on his way. I am told that he is a fan of horse-racing, but I am afraid that his speech fell at the first hurdle day. You see, Mr Speaker, it is not just the Chancellor who can do rubbish jokes in the Chamber. The Health Secretary forgot to tell us what eight years of austerity had delivered for the national health service and what eight years of the deepest and longest financial squeeze in the NHS’s history had delivered. We now have 4.3 million people on the waiting list and 2.8 million people waiting for more than four hours in A&E, of whom more than 600,000 are designated as trolley waits. Over 25,000 people are waiting beyond two months for cancer treatment, which is twice the number in 2010.

Winters are now so bad in the NHS than they were branded a “humanitarian crisis” by the Red Cross. Last winter, 186,000 patients were trapped in the back of cold ambulances and not even able to be admitted to an overcrowded hospital. Hip replacements, knee replacements, cataract treatments and rounds of IVF are being rationed and restricted. There were 84,000 cancelled operations in the past year, including nearly 19,000 cancellations of children’s operations for broken bones, for the removal of rotten teeth, for eye surgery and even for cancer.

Nowhere is the disgraceful neglect of children in our health service more prevalent than in mental health services. Three in four children with a diagnosable mental health condition do not get access to the support they need. The numbers of young people attending A&E with a recorded diagnosis of a psychiatric condition have trebled in the past eight years. A fifth of children and young people referred for an eating disorder wait more than four weeks for treatment, while more than 1,000 children are sent far from home—sometimes more than 100 miles away—for in-patient care. That is what happens after eight years of cuts, closures, service privatisation and failure to invest in staffing. That is what austerity has done, and it will continue.

One really must examine the small print of the spending readjustments for the NHS. The Health Secretary talked about £20 billion extra for the NHS over five years, but there is no new money for the winter ahead, which hospital bosses are already warning will be even tougher than last year’s. According to Ministers, the NHS budget is set to grow by 3.6% next year. If the shadow Chancellor were Chancellor, it would grow by 5% next year.

Let us look at what is not included in the health budget, which the hon. Member for Totnes (Dr Wollaston), who chairs the Health Committee, and others alluded to. First, even though the Health Secretary tells us staffing is his priority, we have 107,000 vacancies across the NHS. We are short of 40,000 nurses and midwives and of 10,000 doctors. The number of GPs is down by 1,000, the number of district nurses by 43% and the number of mental health nurses by more than 5,000. And what has happened to training budgets? They were excluded from that 3.6% allocation and, as my hon. Friend the Member for Lincoln (Karen Lee) pointed out, the Chancellor failed to reinstate the nursing bursary. There is no plan in the Budget to increase NHS staffing.

Secondly, the Health Secretary promised us a “technological revolution”. Our NHS faces a £6 billion repair backlog, relies on 12,000 fax machines and uses at least 1,700 pieces of outdated and often faulty equipment, yet capital budgets are excluded from the 3.6% allocation. In fact, according to the Red Book, capital will be cut by £500 million. The Chancellor boasted that he was ending PFI—I do not why he thought that would embarrass the shadow Chancellor or the Leader of the Opposition; he has obviously not followed the history of the Labour party in recent years—but the Government’s response to the Naylor report on infrastructure needs for primary care signalled that £3 billion would be raised from private finance investment. If PFI is abolished, where will that £3 billion for primary care transformation come from? Or is the reality that the Chancellor has not abolished private financing of public capital projects, but has simply abolished an acronym?

Thirdly, despite the Health Secretary’s hollow commitment to prevention, public health services are still being cut. We have seen £700 million of cuts so far, with another £96 million to come. For example, substance misuse services in our constituencies will be cut by £34 million next year at a time when we have some of the highest drug deaths and alcohol-related hospital admissions on record. Sexually transmitted infections are on the increase, yet sexual health services are set to be cut by £17.6 million next year. We are falling behind internationally on children’s health outcomes, from obesity to immunisations and support for new mums with breastfeeding, and the numbers of health visitors and school nurses are falling, yet early years health services will be cut next year because of cuts to the public health grant. Those cuts should have been reversed in the Budget, not endorsed.

Taken together, there will be £1 billion of cuts to public health, training and capital, which means this health settlement represents an increase next year not of 3.6% but of 2.7%. That is not enough to deliver the level of service that patients expect.

Let us look at what the £20 billion will fund. We have been told there is £2 billion extra for mental health, but growing mental health spending in line with the increase in overall health spending costs an extra £2 billion. That is more spin and smoke and mirrors. The Institute for Public Policy Research says we need £4 billion extra. NHS England advises us that NHS activity increases by 3.1% a year. Demand is rising, the burden of chronic disease is rising and the number of patients with multiple chronic conditions using the NHS is increasing. Those demographic changes and the rising burden of disease will take up £16 billion of that £20 billion. The pay increase, which the Government have been forced into because of campaigning of staff, the trade unions and the Labour party, will take up another £3.5 billion. That is £19.5 billion of the £20 billion already taken up—and still no plan to reduce waiting lists, tackle the A&E crisis, invest in general practice, or deal with the £4.3 billion of underlying deficits of hospitals and loans owed by NHS trusts.

The Chancellor’s answer in the Red Book is to say that we should have 1% efficiencies a year in the NHS. What does that mean? It means more cuts and greater rationing of treatments. In the Red Book, the Chancellor also says that we can create savings through prevention—even though he is cutting prevention budgets—and integration of care. How can we integrate care with the health sector when billions of pounds have been cut from social care? Some £7 billion has been cut from social care, so 400,000 people now go without care support and over 50,000 over-65s with dementia are admitted to hospital because of a lack of social care.

The Chancellor said yesterday that he is giving more to social care, but he is cutting local authority budgets by £1.3 billion with one hand and is offering councils £650 million to be shared between adult and children’s social care with the other. He is literally asking councils to choose between supporting vulnerable children with social care and supporting vulnerable adults with social care. That is not a serious choice; it is callous, cruel, nasty politics. We need a comprehensive settlement for social care, not the ongoing short-term drips from this Government.

We need a plan for the NHS. Yesterday was an opportunity to turn around our greatest institution, but it is not enough to deal with waiting lists or the crisis in recruiting the staff we need. There is no plan to bring waiting lists down and end rationing of treatment, no plan to recruit the doctors and nurses needed for the future, no plan to reverse the cuts to children’s health services and end privatisation, no plan to rebuild social care and improve care for those living with dementia, no plan to expand community health services and general practice, and no plan to transform services for the future. The record will show, yet again, that you simply cannot trust the Tories with the NHS.

Oral Answers to Questions

Jonathan Ashworth Excerpts

Tuesday 23rd October 2018 Commons Chamber

[Matt Hancock]

I pay tribute to the Select Committee for the report on AMR that was published yesterday. Of course, digital tools such as the one that my hon. Friend mentions are important in making sure that we make the best use of antibiotics and counter antimicrobial resistance as much as possible.

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

If we have a “technological revolution”, in the words of the Secretary of State, surely that depends on capital investment, but that has been cut by £1 billion. For example, we have the lowest numbers of CT and MRI scanners on average in the OECD, hospitals are reliant on 1,700 pieces of out-of-date equipment, and the hospital repair bill now stands at £6 billion. If austerity has ended, can he tell us when this maintenance backlog will be cleared?

[Matt Hancock]

Unlike with the failed national programme for IT, we are delivering modern technology in the national health service. That is underpinned by a record commitment of £20 billion extra for the NHS over the next five years, accompanied by a long-term plan that will show how we will support the NHS and make sure that it is guaranteed to be there for the long term.

[Jonathan Ashworth]

But I asked the Secretary of State about capital budgets, not revenue budgets.

Innovative technology can play a role in prevention, but so do public health budgets. With health inequalities widening, infant mortality rising in the most deprived parts of the population, rates of smoking in pregnancy remaining higher than the EU average and child obesity levels getting worse, will the Secretary of State commit, alongside an investment in technology, to reversing the £700 million of cuts to public health, or is the reality that his promises on prevention are entirely hollow?

[Matt Hancock]

I am afraid that the hon. Gentleman has it slightly muddled up, because technology does involve capital investment, but it also includes revenue investment to ensure that the service element of any technology can continue to be delivered. Maybe he should have another look at how technology is delivered these days. Alongside the capital budget, we have record spending on the NHS to ensure that it is there for the long term. Of course public health is an important element of that, and there has been £16 billion for public health over this spending review period because it really matters.

Clinical Waste Incineration

Jonathan Ashworth Excerpts

Tuesday 16th October 2018 Commons Chamber

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

(Urgent Question): To ask the Secretary of State for Health and Social Care to update the House on clinical waste incineration across the NHS.

[The Minister for Health (Stephen Barclay)]

Yesterday evening, the hon. Gentleman, in a point of order, repeated claims made by Healthcare Environmental Services regarding incineration capacity, and the right hon. Member for Normanton, Pontefract and Castleford (Yvette Cooper) raised a point of order on the capability of Mitie to deliver waste management services for the NHS and on TUPE arrangements for staff employed by Healthcare Environmental Services. I would like to clarify why the statement that there is sufficient incinerator capacity is correct, and why the claims made by the company, which is currently subject to criminal investigation, should not be taken at face value, as appears to have been the case yesterday.

With regard to incinerator capacity, there have been quotes from Environment Agency and NHS Improvement officials, cited in the Health Service Journal in May and August 2018, suggesting that there is a shortage of clinical waste incinerator capacity. By the time of my statement on 9 October, far more due diligence had been conducted on the claims made by Healthcare Environmental Services. Analysis carried out by NHSI identified 2,269 tonnes of incinerator capacity in October. The trusts served by Healthcare Environmental Services produced 595 tonnes. The analysis shows that there is sufficient incinerator capacity for clinical waste and that the statement made to the House was therefore correct. The issue is whether HES is willing to pay for that capacity. The fact that Mitie has secured 1,000 tonnes of incinerator capacity demonstrates that it is available.

The right hon. Member for Normanton, Pontefract and Castleford questioned whether Mitie was capable of delivering waste management for the NHS. The Mitie contract was put in place rapidly on 5 October to ensure continuity of service following trusts exercising their step-in and then termination rights to end their contracts with Healthcare Environmental Services. Over that weekend, Mitie visited the NHS sites to understand their business needs and the frequency of collections required, and responded immediately to trusts where waste needed to be collected. It also located bins on those sites so that the collections could start. Putting a new contract in place so quickly clearly means that there needs to be a phased approach to Mitie providing 100% of the service previously provided by Healthcare Environmental Services.

Mitie is working closely with NHSI to ensure that the needs of the trusts are being met, and regular collection schedules are in place at sufficient levels to maintain all patient services safely. The trusts also have additional contingency storage in place on site, with the waste being collected correctly stored so that the NHS can contain its services. This storage contingency will remain in place until Mitie meets 100% of the waste collection frequency required by the trusts. There is no risk to public safety through the action taken by the trusts.

As regards TUPE, Mitie has written to Healthcare Environmental Services and its legal representatives to request complete information, to assess the situation with regard to the potential transferring of employees and to minimise disruption for those employees. Mitie has also set up a dedicated helpline and email address to support Healthcare Environmental Services staff at this uncertain time.

It continues to be the case that there is no risk to public safety through the action taken by these trusts and that all NHS trusts have been able to continue to provide operations in line with meeting our key objective.

[Jonathan Ashworth]

All we are asking for from the Minister is full transparency. Last week, he told the House with great confidence that

“the suggestion in some quarters that this is an issue of a lack of capacity is simply not valid.”—[Official Report, 9 October 2018; Vol. 647, c. 39.]

Subsequently, we read in the Health Service Journal, as he mentioned, that NHS Improvement had concerns about capacity back in August and acknowledged that there were “national market capacity issues”. He has told us today that due diligence has been done since then. Why did he decide not to reveal in his statement last week that concerns were raised with him back in August? Was he aware when he came to the House and made his statement that these concerns had been raised in August? He tells us that extra due diligence has been carried out. Can he explain what that extra due diligence actually is?

The Minister has tried to reassure us again today that there are no public health implications to the measures that have been put in place since HES lost these contracts. Can he therefore explain his view of the various allegations currently circulating on social media, with photos and videos suggesting that waste is not being picked up from a health centre in Keighley, that hospital staff in Leeds are shifting waste in inappropriate overalls, that hazardous waste at Dewsbury is being stored in inappropriate shipping containers and that up to 15 trusts across Yorkshire are storing waste illegally? Has he checked each and every one of those allegations? Can he tell us what his inquiries have revealed about them? If he has not looked into each and every one of those allegations, why not?

Can the Minister assure us that incineration sites to which tonnes of waste from HES facilities are now taken are big enough to safely manage this waste, that the drivers transporting the waste are suitably qualified and that the incinerators now being used are designed to deal with hazardous waste? Last week, I asked him to give us a cast-iron guarantee that there is no risk to public health at any of those sites, or where the waste is currently being incinerated. Will he give us that absolute guarantee today? All we want from the Minister is complete and utter transparency. We have not had that so far.

[Stephen Barclay]

The hon. Gentleman seems to be spending a lot of time on social media and not looking at the data on what is being done. There was a time when Opposition Members were used to the complexity of legal agreements and contracts and would have understood that mobilising 17 NHS contracts and maintaining NHS operations on those sites requires a significant amount of work. It takes time for Mitie to mobilise that contract—[Interruption.] If he gives me a moment, I will address directly the different concerns that he raised.

The hon. Gentleman’s first concern was that a statement given in October, with up-to-date information based on the work done leading up to it, was in some way incorrect because it did not pick up on early discussions within NHSI, which was only notified on 31 July. Obviously the concerns raised by HES about a lack of incinerators needed to be looked into. Having been looked into, those concerns were found not to have merit. The evidence for that is the fact that the new supplier, Mitie, has been able to secure 1,000 tonnes of incinerator capacity. If the hon. Gentleman’s central charge is correct, he will need to explain how Mitie has been able to find available incineration capacity when HES was unable to do so.

The hon. Gentleman asked when I was notified. I was not notified of the internal discussions among officials in August; I was not dealing with the issue at that point. The issue is what the House was informed of when the statement was made.

On the allegations on social media, I have not checked every single tweet that the hon. Gentleman has looked at, but the fact is that of the 17 trusts, three have had the stock of waste on their sites cleared and 12 are due to have theirs cleared by the end of the week, with two remaining, as Mitie mobilises from around 80% of service delivery now to 100% in the coming weeks.

The right hon. Member for Normanton, Pontefract and Castleford has made some legitimate points about TUPE and about Mitie scaling up, which I am sure she will come on to. Those points were not addressed, surprisingly, in the shadow Secretary of State’s comments, but I am happy to pick them up in due course. One of the advantages of Mitie is that it should deliver greater resilience, because it is not looking to deliver all the elements of the contract in the way that HES is. It is bringing in other firms, such as logistics suppliers and disposal firms, so there will be greater resilience in the contract, but we can address any specific concerns that the right hon. Lady has, given her constituency interest.

Dangerous Waste and Body Parts Disposal: NHS

Jonathan Ashworth Excerpts

Tuesday 9th October 2018 Commons Chamber

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

(Urgent Question): To ask the Secretary of State for Health and Social Care to make a statement on the accumulation of hundreds of tonnes of dangerous waste.

[The Minister for Health (Stephen Barclay)]

As I set out in the written statement published this morning, on 31 July the Environment Agency notified central Government of an issue concerning clinical waste disposal. The primary concern was that too much waste was being held by a contractor, Healthcare Environment Services, in a number of waste storage and treatment sites. This included waste collected from hospitals and other public services. Although the waste was stored securely, it was not being disposed of within the correct regulatory timescales.

The Department of Health and Social Care, the NHS, the Department for Environment, Food and Rural Affairs, the Environment Agency and the Cabinet Office have worked together to resolve the issues. Our priority throughout has been to ensure that proper measures were put in place to enable trusts to continue to operate as normal. A major part of the contingency plans concerned commercially sensitive contractual discussions with HES and other providers.

Following the Environment Agency’s partial suspension of HES’s Normanton site, which came into force on 3 October 2018, NHS Improvement wrote to HES to raise its concerns. NHSI gave HES an opportunity to set out how it was complying with its legal and contractual obligations; HES failed to provide that assurance. As a result, 15 NHS trusts served contract termination notices on Sunday 7 October. As part of our contingency arrangements, we ran a tender process with the clinical waste sector before awarding a new contract to Mitie. As contracts with HES were terminated over the weekend, Mitie stepped in and, from Monday morning, provided continuing waste collection and incineration across all of these organisations.

In September, officials from the Department of Health and Social Care visited each of the major trauma centres affected and confirmed that waste was being stored correctly and that contingency plans were in place.

In addition, visits have been undertaken to each of the sites by the Environment Agency this weekend and this week, alongside earlier visits. The Environment Agency is continuing its enforcement action against HES. This includes ensuring that excess waste is cleared from non-compliant sites. The Government are working with the Environment Agency and the NHS to ensure that lessons are learned, and we are reviewing how contracts will be awarded in the future. I have updated the House on this situation today as new contracts were implemented on Sunday following the conclusion of this commercially sensitive process. Our priority throughout has been to ensure that measures were put in place so that the NHS could continue operating as normal. No gap in service provision has been reported and we are working to ensure that that remains the case.

--- Later in debate ---

[Jonathan Ashworth]

This is an absolutely horrific scandal. A private contractor has failed in its responsibilities to a quite staggering degree. Three hundred and fifty tonnes of waste, including human body parts, amputated limbs, infectious fluid and substances of cancer, was left effectively stockpiled and not safely disposed of; it is an absolute scandal. How on earth did we get to this? If the Environment Agency first raised concerns in March, if Ministers were formally informed in July, and if Cobra was convened and chaired by the Health Secretary last month—by the way, I really think that the Health Secretary should be answering questions at the Dispatch Box today—why was the decision taken not to inform Parliament and the public sooner? Given that concerns were raised in March, why did the NHS not intervene earlier? In fact, concerns were raised with NHS England last year, so can the Minister tell us what monitoring, if any, of the HES contract was put in place by the Department and Ministers?

The Minister referred to 15 trusts having terminated their contracts. The Health Service Journal reported that up to 50 trusts were affected. Will he clarify what the status is of the contracts with the remaining 35 trusts? Where Mitie has taken over the contracts, what regulation and oversight of Mitie and its subcontractors is now in place? Is he confident that there are enough incinerators across the country to dispose of waste in a timely manner?

Let me turn now to the public health implications. At the Normanton site, we were told that waste is now in refrigerators, but where was it before if not in refrigerators? Hospitals are now using temporary containers, but questions have been raised about the public safety implications of those containers. Can the Minister give us an absolute guarantee that those containers are safe and that there is no public health risk?

We are picking up the pieces, yet again, of another disastrous procurement of an outsourced contract by a private firm going wrong. What plans are now in place to ensure that something like this never happens again?

[Stephen Barclay]

Let me pick up on the various points that the hon. Gentleman has raised. On when Parliament was told, as I said in my statement, the partial suspension notice was served on the company on 3 October and new contracts were put in place over the weekend. This is, therefore, the first opportunity, following what had been commercially sensitive negotiations, to notify the House. It is also right to remind Members that the key strategic objective throughout has been to maintain operations at NHS hospitals to ensure that clinical waste is being collected. That strategic objective has been maintained at all times.

The hon. Gentleman asked a number of other questions, including whether there is enough incinerator capacity in the system. The answer to that is, yes there is. There are 24 incinerators. The Department for Environment, Food and Rural Affairs estimates that there is more than 30,000 tonnes of spare capacity in the system, and that there is significant capacity over and above that required by HES to perform its contract, so I can be very clear to the House that, moving forward, there is sufficient incinerator capacity.

The hon. Gentleman used some inflammatory language. It is worth reminding the House that just 1.1% of this clinical waste is anatomical, so some of the media headlines are slightly out of step with reality. The partial suspension that has been served on Normanton is solely in respect of the incinerator; it does not apply to the other sites under HES contractual arrangements with the trust.

The hon. Gentleman asked whether the waste was being secured safely. The answer is yes; the Environment Agency has been inspecting the situation. The issue is the overstorage of waste, not that the waste is not being stored in a safe manner. [Interruption.] Well, that is the legal remit of the Environment Agency, which is an independent body. It is right that the law is applied; the hon. Gentleman may not like to apply the law, but this is the legal process. Officials from the Department of Health have been to the major trauma sites to see the contingency plans at first hand, and the storage and capacity is in place at those sites.

The reality is that there was a contractual arrangement with a supplier that stored the waste correctly, but stored too much of it. The Environment Agency is enforcing against that. We have put in place contingency plans within the trusts and set up alternative provision in the form of a contract with Mitie. The key strategic objective of ensuring that NHS operations continue has been secured.

Oral Answers to Questions

Jonathan Ashworth Excerpts

Tuesday 24th July 2018 Commons Chamber

[Matt Hancock]

I would be absolutely thrilled to. I have previously participated in mindfulness training. In fact, the former chairman of my local Conservative association became a mindfulness instructor, which shows how much we take it seriously locally. I pay tribute to my hon. Friend’s work on this issue. He will have seen that, even in my first two weeks in this role I have already spoken out in favour of moves towards social prescribing and the broader prescribing of less intervention and less medicinal methods, where possible, because medicines do of course have their place. The work that he has done on this issue over many years is to be applauded.

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

I welcome the Secretary of State to his post. May I take a moment to thank all the NHS and social care staff who are caring for vulnerable patients in this intense summer heat?

The new Secretary of State inherits waiting lists at 4.3 million, with more than 3,000 patients waiting more than a year for an operation. He inherits a situation in which 1,700 patient requests for hip and knee operations have been refused, and in which patients in Sussex are now expected to endure “Uncontrolled, intense, persistent pain” for six months before they receive hip or knee treatment. Does he consider such increased rationing to be fair?

[Matt Hancock]

I am grateful to the hon. Gentleman for his welcome. Like him, I pay tribute to the work of NHS and social care staff in this summer heat. There are of course pressures on the NHS—I fully acknowledge that—and he raises a couple that I have already raised with NHS England. What he did not mention was that since 2010 there are 6,000 more operations every day and 1,800 more emergency admissions every day.

[Jonathan Ashworth]

Since 2010, the NHS has suffered the biggest financial squeeze in its history, and the rationing that I referred to is a consequence of that squeeze.

Let me ask the Secretary of State about general practice, which he will know is facing a severe workforce crisis, with GP numbers down by 1,000 and many GPs worried about the patient safety implications of the Babylon app, which we have already discussed this morning, and its funding implications for their model of practice. When Babylon itself admits that it is still testing it out, when Hammersmith and Fulham CCG says that

“there is evidence of concern regarding the risk to patient safety”

of expanding the service, and when Birmingham and Solihull CCG questions whether Babylon can operate in an effective and safe manner, why does the Secretary of State dismiss concerns about patient safety and say that the rules simply need to be updated? Will he tell us what specific rules will be updated to allay concerns about patient safety?

[Matt Hancock]

It is almost as if it was not just my hon. Friend the Member for Hitchin and Harpenden (Bim Afolami) who popped out, but the shadow Secretary of State, who obviously was not here for the earlier discussion. Getting more resources and increased resources into primary care and to GPs in particular is absolutely mission critical to the long-term sustainability of the NHS. I am delighted that there is record GP recruitment at the moment and that the work that has been done to increase GP training is bearing fruit. On the question of new technology, as we discussed over a series of questions earlier, yes, it is important to make sure that it works well and that the rules are right but, if we turn our backs on new technology, we are turning our backs on better care.