The National Health Service

Debate between Jonathan Ashworth and Matt Hancock

Wednesday 23rd October 2019 Commons Chamber

[Jonathan Ashworth]

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

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

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

Yes they do.

[Jonathan Ashworth]

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

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

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

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[Matt Hancock]

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

[Jonathan Ashworth]

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

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

The right hon. Gentleman should be apologising for PFI.

[Matt Hancock]

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

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[Matt Hancock]

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

[Jonathan Ashworth]

indicated assent.

[Matt Hancock]

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

Oral Answers to Questions

Debate between Jonathan Ashworth and Matt Hancock

Tuesday 23rd July 2019 Commons Chamber

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

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

[Matt Hancock]

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

[Jonathan Ashworth]

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

[Matt Hancock]

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

NHS Long-Term Plan: Implementation

Debate between Jonathan Ashworth and Matt Hancock

Monday 1st July 2019 Commons Chamber

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

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

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

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

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

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

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

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

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

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

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

[Matt Hancock]

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

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

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

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

Oral Answers to Questions

Debate between Jonathan Ashworth and Matt Hancock

Tuesday 18th June 2019 Commons Chamber

[Jonathan Ashworth]

Indeed.

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

[Matt Hancock]

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

[Jonathan Ashworth]

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

[Matt Hancock]

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

Listeria: Contaminated Sandwiches

Debate between Jonathan Ashworth and Matt Hancock

Monday 17th June 2019 Commons Chamber

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

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

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

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

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

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

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

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

[Jonathan Ashworth]

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

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

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

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

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

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

[Matt Hancock]

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

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

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

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

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

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

Health

Debate between Jonathan Ashworth and Matt Hancock

Tuesday 14th May 2019 Commons Chamber

[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

Debate between Jonathan Ashworth and Matt Hancock

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

Debate between Jonathan Ashworth and Matt Hancock

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

Debate between Jonathan Ashworth and Matt Hancock

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.

Oral Answers to Questions

Debate between Jonathan Ashworth and Matt Hancock

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?

Oral Answers to Questions

Debate between Jonathan Ashworth and Matt Hancock

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

Debate between Jonathan Ashworth and Matt Hancock

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

Debate between Jonathan Ashworth and Matt Hancock

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

Debate between Jonathan Ashworth and Matt Hancock

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

Debate between Jonathan Ashworth and Matt Hancock

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

Debate between Jonathan Ashworth and Matt Hancock

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.

Oral Answers to Questions

Debate between Jonathan Ashworth and Matt Hancock

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.

Oral Answers to Questions

Debate between Jonathan Ashworth and Matt Hancock

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.