Social Media and Health

Julian Knight Excerpts

Tuesday 30th April 2019 Commons Chamber

[Matt Hancock]

The short answer is yes. My responsibilities as Health Secretary are to do with the impact on health, especially mental health, and eating disorders and self-harm are part of that. A separate but connected matter is anti-vaccination messages, which are a type of misinformation, or in some cases disinformation —actively pushed false information.

The social media companies say that they are removing this material from being promoted. For instance, graphic self-harm imagery will be taken down from Instagram. Our challenge is to make sure that that is done properly, because ultimately only if social media companies change their algorithms can we make this happen. That is why the new regulator is so important.

[Julian Knight (Solihull) (Con)]

I welcome the Secretary of State’s initiative in this area and what he has told the House today. Through my work on the Digital, Culture, Media and Sport Committee, I have been utterly horrified looking at online content relating to bulimia and eating disorders, and to what I describe as extreme online misogyny. That relates to the algorithms that Members have mentioned. Does the Secretary of State agree that we need to see inside those companies’ black boxes? Unlike areas such as taxation, in which companies go to the easiest regime, if we set the bar high on online content, they have to comply and put their house in order.

[Matt Hancock]

I pay tribute to the work that the Digital, Culture, Media and Sport Committee has done in this area, both when I was Culture Secretary and since. Its work and the approach it has taken are groundbreaking, and that has played a part in the change in attitudes that we have seen from the social companies, which at least now accept that it is their responsibility, as well as the principle that they have a duty of care to people on their sites.

As my hon. Friend says, there is clearly an awful lot to do to get to where we need to be. If we step back from this whole question, the technology that has brought about social media companies is still relatively new; it is only 15 or 20 years old. Around the world, the way in which society has responded to it has not yet matured. The good social media companies now get the fact that they have such an impact on society that a regulatory framework is necessary, and in fact have welcomed the White Paper that we introduced as an approach that could be replicated around the world. My hon. Friend is quite right that, once one country or jurisdiction gets this right, it will be taken as a model elsewhere, so that, ultimately, the power of this amazing new way in which we communicate—by God, Mr Speaker, in this House we all use it—can be for the good, and we can mitigate all the downsides that come with it.

NHS Pension Scheme: Tapered Annual Allowance

Julian Knight Excerpts

Tuesday 2nd April 2019 Westminster Hall

[Paul Masterton]

I thank the hon. Gentleman for raising another specific case. I hope the Minister will bear in mind the added weight of evidence.

Another of my constituents, who has worked as an NHS constituent for 14 years at the Queen Elizabeth University Hospital in Glasgow told me that he is employed on a 40-hour per week full-time contract and provides eight hours per week of additional clinical work, making 48 hours in total. He does not do any private practice outside the NHS, but he was hit with an unexpected bill of nearly £17,000 as a result of the tapered annual allowance. The only way the consultant can avoid those charges is to reduce his income below the various thresholds, and the only way he can reduce his income is to reduce the amount of work he does for the NHS. He has told me that he has no desire to do that and would happily volunteer to do extra work occasionally at weekends to tackle waiting lists or fill gaps in the service, but the tax implications make that impossible and he has already stopped doing any extra work.

Another consultant from East Renfrewshire with 16 years’ experience—eight as a consultant—told me that he was actively declining extra work to support stretched services in order to avoid the tax penalties. That means that he does not apply for the discretionary points that are awarded for additional work that is taken on above the normal daily remit, such as developing new services, research and teaching. As the hon. Member for Glasgow North East (Mr Sweeney) said, that impacts not just on the daily running of services, but on the development of a culture of excellence within the NHS.

[Julian Knight (Solihull) (Con)]

I apologise for missing the first couple of minutes of the debate. My hon. Friend is a great thinker on pensions, which is the main reason I wanted to come here today, and I want to ask him a very simple question. Does he wish to dispense with the annual allowance and lifetime limit, or does he want a special dispensation for senior NHS workers, who are quite high-income earners?

[Paul Masterton]

I thank my hon. Friend for his kind comments, which are undeserved. There is a wider issue of the general complexity of the systems of reliefs and allowances in the UK pensions system. I hope not that there will be one single dispensation for one area of the public sector, but that we start to recognise that we need to look at the way the system is operating more generally and to work out whether some of the allowances and reliefs are actually necessary or effective, and whether they should be subject to a broader review.

A recent report showed that over 50% of respondents reported using the NHS “scheme pays” facility to pay off their unexpected tax charges. However, this does not work for all cases, and the amount is effectively treated as a loan that is then paid back from the retirement benefit, with interest charged against the pension at high rates. That means it is usually costlier than paying up front, particularly for younger members. I fear that this issue could see us sleepwalk into a deepening workforce crisis in the NHS and result in consultants leaving the NHS early, even though they still have the skills and experience we need. Those individuals are important not just for patients, but for junior doctors in terms of the training and mentoring they receive on the job.

The British Medical Association firmly believes that long-term changes to the pensions taxation system are required in order to remove the disincentives that exist, and I certainly agree. The Library’s excellent briefing on pensions taxation makes reference to the impact of changes in the annual allowance on the public sector, and notes that the 2017 report of the Doctors and Dentists Review Body requested more evidence about the impact of the annual and lifetime allowance on early departure rates. The Treasury indicated that it would consider revisions to the NHS pension scheme if there was evidence that the number of doctors and dentists taking early retirement as a result of its inflexibility was substantial.

I want to ask the Minister a series of questions, and I appreciate that she might not be able to cover them all today. A number of them fall within the remit of the Treasury, but hopefully she will be able to take those away and arrange for either herself or a Treasury Minister to get back to me. First, what discussions did the Treasury have with the Department of Health and Social Care when the tapered annual allowance was introduced, and was this ever flagged as a potential problem? Secondly, what evidence has the Treasury collected on the numbers of doctors and dentists taking early retirement, following the 2017 report? If the answer is none, why is that the case and when will analysis be carried out of the impact on changes to the lifetime and annual allowances on the NHS? If evidence has been collected, what were the findings of that analysis, and are any changes being considered?

Thirdly, what consideration has the Treasury given to a review of the annual allowance taper more generally, perhaps as part of a wider review into simplifying the incredibly complex system of reliefs and allowances in the UK pensions system? Finally, have the relevant Government Departments had any discussions with the relevant parties on whether permitting more individual flexibility in the NHS pension scheme could be a solution? That is something that NHS Employers is calling for. This issue is not specific to the NHS—I have heard in recent days from armed forces personnel—but it does appear to be an area with a particular problem.

Although I appreciate that many people will not hold great swathes of sympathy for individuals on such high earnings who will still receive high levels of retirement pension that most of our constituents can only dream of, the reality is that if this results in consultants with much-needed expertise turning down work or leaving the NHS altogether, it will have major implications for the provision of services and the quality of care our constituents receive right across the UK, whichever colour of Government is in control of their NHS.

I am sure that the Treasury did not intend these changes to force experienced and committed consultants, surgeons and GPs to do less work for the NHS, but this is the reality being faced in the hospitals that serve my constituents and the Minister’s. It is good that the British Medical Association and NHS Employers recognise that this is a serious concern and met last week to discuss it, but they have not agreed a solution or a joint action plan. In reality, the ball is in the Treasury’s court.

I absolutely respect and agree with the Government’s position that we need to get the balance right between encouraging saving and managing Government finances, but this issue cannot be easily ignored. Legitimate aims to restrict tax perks for the wealthiest in society are exposing ever increasing numbers of long-serving and highly experienced NHS workers to massive tax charges. If we want high quality care in the NHS in Scotland and across the UK, we need senior doctors who have devoted their professional lives to the care and wellbeing of our constituents. It is ludicrous for us to face a situation in which the pensions system is acting as a disincentive and effectively forcing consultants to choose between working for nothing and affecting patient care.

I hope that this debate provides the first opportunity for us to say clearly that, whether the answer lies in adding flexibility to strict NHS pay and pension terms or with the Treasury using this as a reason to take a fresh look at the ridiculously complicated tapered annual allowance, this is an unintended consequence of the UK’s complex pension regime, which we need to sort out quickly to let those consultants get back to work.

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

It is a pleasure to serve under your chairmanship, Sir Roger. I thank my hon. Friend the Member for East Renfrewshire (Paul Masterton) for securing the debate; he made a characteristically thoughtful contribution.

We are the custodians of taxpayers’ money and need to manage the country’s finances in a way that gives value for money and allows us to live within our means. We also need to accept that when we make changes to the tax system, it changes people’s behaviour. I am grateful for the opportunity to look at these issues through the prism of the impact on the workforce in the national health service.

As my hon. Friend said, the annual allowance is a fiscal measure that operates across all pension schemes in both the public and private sectors. Alongside the lifetime allowance, the Government keep this measure under review to ensure that the benefit of tax relief on pension scheme contributions remains affordable. It is in fact one of the most expensive tax reliefs in the personal tax system. In 2015-16, income tax relief and employer national insurance contributions relief cost the Exchequer around £50 billion, with around two thirds going to higher-rate taxpayers. That is an important point to bear in mind, because we need to ensure that our tax system is progressive and managed efficiently. We will want to look at tax reliefs that favour the highest-rate taxpayers to ensure that our overall burden of tax is appropriate.

The reforms made to the lifetime and annual allowances in the previous two Parliaments are expected to save over £6 billion a year, and are necessary to deliver a fair system and to protect public finances. To ensure that the benefit the wealthiest pension savers receive is not disproportionate to that of other pension savers, the Government restrict the amount of tax relief available. The annual allowance does not taper below £10,000, and fewer than 1% of pension savers will have to reduce their saving or face an annual allowance charge because of this policy.

[Julian Knight]

Does the Minister agree that a potential issue is that this acts as a cap on the amount of tax relief that is given out? We know that this is not progressive in terms of higher-rate tax relief on pensions. Would it not be better for us to look at a system in which we have a flat rate of 25p, 28p or 30p in the pound, rather than the higher rate? That would mitigate, or mean that we did not need, those lifetime and annual allowances?

[Jackie Doyle-Price]

I shall not stray into policy that is not mine and that belongs to Her Majesty’s Treasury—that is a very convenient way for me to duck the issue. It comes back to the point that the moment we start to introduce complexity into our tax and allowance system, it brings perverse incentives. The overall goal in recent years has been to bring our public finances back into kilter, having had excessive deficits. It is only natural that the Exchequer looks at where reliefs that are funded by the state are going to higher-rate taxpayers. That is where we have got to with regard to the impact on public sector pension schemes, which by their nature are as we describe.

The NHS pension scheme is a generous and valuable part of staff reward packages, and is one of the best schemes available, notwithstanding the issues raised by my hon. Friend the Member for East Renfrewshire. It is right and proper for all hard-working NHS staff to expect financial security in retirement after dedicating a lifelong career to looking after the nation’s health.

For some senior clinicians, the generosity of the scheme, combined with their comparatively high levels of pay, means that their pensions build up to a level that breaches tax limits. Both the annual and lifetime allowances encourage pension growth at a steadier rate that is more aligned with typical pension growth experienced across the general population. To illustrate that, under the 1995 section of the NHS pension scheme, members who accumulate pension benefits worth near the £1 million lifetime allowance will have built up a pension of around £46,000 a year, plus a tax-free lump sum of £138,000 on retirement. Pensions of that size provide substantial financial security in retirement, and it is right that the Government take steps to limit the tax incentive to save further.

My hon. Friend raised concerns about the impact on our NHS workforce. With respect to discussions between the Treasury and the Department on the introduction of the allowance, the 2015 manifesto committed to

“reducing the tax relief on pension contributions for people earning more than £150,000.”

That was a manifesto commitment we had to deliver. The tapered annual allowance fulfils that commitment and applies to all contributors to pensions, in both the public and private sectors. The impacts of the change, including on the public sector, were carefully considered at the time.

My hon. Friend asked about the number of doctors and dentists taking early retirement. Data from the NHS pension scheme administrator shows that 494, 490 and 424 hospital doctors took voluntary early retirement in the financial years ending 2016, 2017 and 2018 respectively. Those early retirements represented approximately a third of all hospital doctor retirements in those years. With respect to GPs, in 2016, 695 took early retirement; in 2017, 721 took early retirement; and in 2018, 588 took early retirement. Those figures represented more than half of all GP retirements in those financial years. With respect to dentists, 145 retired early in 2016, followed by 143 and 115 in 2017 and 2018 respectively. Those retirements represented approximately 40% of dental practitioner retirements in those years. There is clearly an impact on the behaviour of practitioners.

My hon. Friend asked what consideration the Treasury has given to a general review of the annual allowance taper and the broader system of reliefs in relation to pension saving. Those are matters for the Chancellor, and the Government will continue to review all aspects of pensions policy, in line with our annual assessment of the public finances.

Organ Donation (Deemed Consent) Bill

Julian Knight Excerpts

3rd reading: House of Commons & Report stage: House of Commons
Friday 26th October 2018 Commons Chamber

[Julian Knight (Solihull) (Con)]

It is a great pleasure to follow my good and hon. Friend the Member for Torbay (Kevin Foster), who made a typically thoughtful, telling and long contribution.

The question of organ donation, as with so many debates about what the Government can tell us to do with our bodies, can be contentious. There are deeply held beliefs on both sides of the debate. A move towards a system of presumed consent is exceptionally worth while, but the right to opt out must be clearly and consistently protected at every stage. There are three factors to consider: first, is there a clear need for the Government to pursue an increase in donations; secondly, does the available evidence suggest that an opt-out donation policy will lead to such an increase; and, thirdly, is such a policy compatible with the private right of the individual citizen to ultimate ownership of their own body?

On the first question, I believe that the only answer is a resounding yes. Every year, hundreds of people die waiting for a transplant and many thousands more languish on waiting lists that create a bottleneck for life-changing—indeed often life-saving—surgery. Even worse is something that I see my own constituency and have raised with the new Birmingham and Solihull clinical commissioning group: black and minority ethnic patients, who are more likely to suffer diseases that require transplants, such as kidney diseases, face an even more acute shortage due to lower take-up of voluntary donation among their communities. Such insufficiencies and inequalities demand that we address them in whatever way we can.

It was a great pleasure to see my good friend the hon. Member for Birmingham, Perry Barr (Mr Mahmood) in the Chamber and to hear his intervention. I know the circumstances of the individual donation, and the story is even more remarkable than we have heard in the Chamber today. The hon. Gentleman’s vibrancy, which we see day in, day out, is a testament not only to him, but to the medical staff who helped him through the operation.

Of course, there has been a consistent trend of more people opting in under our current regime. Indeed, there are more than 25 million people on the NHS organ donor register, and we thank every single one of them, but it is an unfortunate fact that only a fraction of people die in circumstances that make their organs suitable for transplant—just 1% percent of that 25 million, according to NHS figures. Would a shift to presumed consent address that problem? The available evidence is promising, although not wholly conclusive, but I am willing to go with an act of faith.

Several countries that have moved to an opt-out donation model have seen a rise in donations, including—this is most pertinent to us—Wales, which introduced an opt-out system only recently and has seen increases in both deceased donors and transplants. Countries such as Spain have coupled the approach with other measures, such as heightened public awareness campaigns and an overhaul of the infrastructure underpinning the donation system. That obviously muddies the waters, as does the fact that any uptick in donations often occurs years after the switch to the new system. In some countries, such as Brazil, donation levels have actually fallen slightly after the change to the new system. However, I feel that there is enough positive evidence to suggest that a switch to an opt-in system for England would be very worth while, provided that the rights of individuals to refuse consent are adequately safeguarded.

It is important that the deceased’s family has a role to play. For example, if they are aware of an expressed opposition to donation that was not formally registered with the NHS, I believe that they should have the right to register it. Over the longer term, the right to opt out must be reinforced by robust protections to ensure that doing so remains a simple and easy thing to do, with no questions asked. The hon. Member for Barnsley Central (Dan Jarvis) was very particular about that, which I was grateful to hear.

Individuals who refuse consent should not be subject to any pressure to change their minds or asked at intervals to think again. We must never lose sight of the fact that our bodies are ours, however valuable and useful they might be to others, and that they are not the property of the state in any way.

In summary, I support the Bill. I have considered the evidence, and while it is contradictory in part, we should look at the examples from Wales and Spain. The system should be married up with the correct procedures, encouragement and public information, and an under- standing that it is our body. I believe wholeheartedly that this Bill should be passed and that there should be a fundamental change in this area.

[Neil O'Brien (Harborough) (Con)]

It is a pleasure to support this important Bill. I grew up in Huddersfield, and Barnsley are our great rivals, but despite that it is a pleasure to congratulate the hon. Member for Barnsley Central (Dan Jarvis) on this hugely important Bill. As my hon. Friend the Member for Solihull (Julian Knight) said, it protects important rights. He made the incredibly important point that our bodies are not for the state. They belong to us, and it is essential that we have the right to say no if we have objections, but I believe that the Bill includes safeguards to achieve that.

The hon. Member for Barnsley Central mentioned the case of Max Johnson, just nine years old, whose life was saved by a heart donation from Keira Ball, who had been tragically killed. I wonder whether I might also mention the Leicestershire case of Albert Tansey, whose life was saved by a heart transplant at the amazing Glenfield Hospital when he was just four years old. The hospital is home to the now saved children’s heart unit, which we have all strongly supported in Leicestershire. Thanks to the miraculous work done at Glenfield, he is now enjoying his ninth birthday, and his family are strongly in favour of the Bill. It has already been said that this could be called the “Getting on with your life Bill”, or the “Being a Member of Parliament Bill”, but it is also the “Enjoying your ninth birthday Bill”.

Although this debate could be rather bleak, there is some good news: 50,000 people are alive today thanks to organ transplants, including the hon. Member for Birmingham, Perry Barr (Mr Mahmood), who is looking very well on it, I must say. The number of people registered as donors is rising—we thank them for that—and the numbers on the transplant waiting list have fallen steadily over the past eight years. However, the Bill is still necessary because some people are missing out. Between 2005 and 2010, some 49,000 people had to wait for an organ transplant, and 6,000 died while waiting, of whom 270 were children. We could save more lives if we had more donations. I am particularly conscious that for some groups, particularly ethnic minorities, it can be particularly difficult to find a transplant. I have seen the good work done by the NHS and visited a temple just north of my constituency to see the outreach work it is doing to try to find more donations, but none the less there is still a big problem.

In 2008, only one of the top eight countries with the greatest number of organ donors per capita had an opt-in system. All the others had opt-out systems, so there is strong evidence that such systems can increase the number of donations. In 2017, we know that 1,100 families refused to allow an organ donation because they were not sure whether their relatives would have wanted to donate. My hon. Friend the Member for Torbay (Kevin Foster) made the important point that asking people to make a proactive decision to donate at an incredibly emotional and difficult moment is harsh and unfair. I think that many families would later come to value the fact that a loved one’s organs had gone on to help someone else to live.

[Julian Knight]

Does my hon. Friend agree that sometimes in that situation, relatives could make a decision that they later regret, because in the emotion of the moment, they might not make the decision to say, “Let’s go ahead and make the donation.”?

[Neil O'Brien]

I absolutely agree.

Let us also think about the medical staff who need to have these incredibly difficult conversations. A long time ago, I was a medical student. I remember the first time I ever saw someone who had died and the medical staff’s incredibly difficult conversations with his family in the hospital. Imagine then having to ask the family to make the donation of an organ to save another life. It is almost an unbelievable thing to have to ask people to do.

We know that, since the introduction of the opt-out system in Wales, the number of deceased donors is up from 60 to 74. Those are small numbers, but none the less that is a rise of 23%. It is early days, but the opt-out system does seem to help. Obviously, we need the safeguards that my hon. Friend the Member for Solihull described, but at the end of the day, the Bill will save lives—it is as simple as that.

It is ironic that often on a Friday, when there are relatively few of us here, we talk about matters of life and death. This is one of them. This Bill will save lives. It means more careers, more lives and more ninth birthdays. If I can have a moment of poetry, it is what one poet called the

“million-petalled flower of being here”.

This Bill will save people’s lives, and it is a pleasure to support it.

Social Care Funding

Julian Knight Excerpts

Wednesday 17th October 2018 Commons Chamber

[Matt Hancock]

Part of the social care system is, of course, tax payer-funded, but I also value the contributions that people make to social care. They are an important part of keeping the system strong. We dismiss those contributions at our peril, but I agree with my hon. Friend that we need to make sure we get more funding and better integration between the healthcare and social care systems. We can do that with different funding sources, as long as we have better organisation on the ground.

We must make sure we have the appropriate amount of care available so that people can leave hospital at the right time; people should not have to stay in hospital longer than necessary, as it reduces their dignity and quality of life and leads to poorer health outcomes, as well as putting unnecessary pressure on the NHS.

Since February 2017, more than 1,900 beds have been freed up in hospitals by reducing NHS and social care delays, yet we know that the winter months bring increasing pressure on adult social care services, which can have a knock-on impact on hospitals. On top of the rising social care budget, we are providing an additional £240 million for adult social care capacity this winter, which will help councils to get patients home quicker and free up hospital beds for more urgent and acute cases.

Today I have published the allocation for every local authority in England, and the Barnett formula will apply to allocations in Scotland, Wales and Northern Ireland. Individual allocations include, for example, £1.3 million in Salford and £1.5 million in Leicester.

[Julian Knight (Solihull) (Con)]

My constituents and my local council are thankful for the funding increase of £870,356, which will help the adult social care situation in Solihull. We have a lot of people over the age of 65, including 40% of the Silhill ward alone.

[Matt Hancock]

I am grateful for my hon. Friend’s work in making the case for more support for adult social care in Solihull, and to support the NHS in Solihull through that. I hope the funding we have announced today will help in Solihull, and the people of Solihull should know they have an excellent champion who has helped them to get that funding.

--- Later in debate ---

[Julian Knight (Solihull) (Con)]

It is a great pleasure to follow the hon. Member for Blaydon (Liz Twist), who made a very good speech. It is a shame that we have such a short time to debate this, because it is one of the key issues of our lifetimes and will impact all of us in many different ways—it is impacting my life. I am absolutely blessed with the most wonderful in-laws, and I am saying that not just because I am having dinner with my wife in an hour, but because, frankly, they are absolutely golden people. We are dealing with issues of social care as a family, often from far away. The challenges, which are multifarious, varied and deep, affect every part of our life in ways that cannot be understood until one is in that situation.

We are part of the sandwich generation, and my town is at the frontline in that respect. We have an ageing population. I was told by a member of my staff that we have an older population than Eastbourne—I am not sure what that is supposed to imply, but we do. According to Solihull Council, by 2036 one in four of our population will be over 65 and fully 5% will be over 85.

Time and again I encounter on the doorstep what Age UK has dubbed the “silent crisis”—people quietly trying to look after elderly loved ones behind closed doors. They often do so just out of pure love and decency, and often they have care issues themselves. My experience, from knocking on some 30,000 doors across my constituency and from my family, has driven home how essential it is that Members on both sides of the House, despite dogma and party politicking, try to come to a long-term solution. We have to work together to find the bold solutions needed to put social care on a stable, sustainable footing. That is why I welcome the report from both Select Committees. Many of its recommendations make a lot of sense. It is essential that we accept that this problem cannot be met with a patch-and-mend approach, yet providers and local authorities need support to ensure that the level and quality of social care provision match need in the short and medium term. However, unless these measures are accompanied by a serious root-and-branch strategic review of how we fund and deliver social care services—one that recognises that many of the problems currently facing the sector are not down merely to insufficient funds —they will provide, at best, only a temporary reprieve.

That is the challenge we all face. We will have to debate this for many years to come, but we have to get there. We owe it to our kids; we owe it to our parents.

Clinical Waste Incineration

Julian Knight Excerpts

Tuesday 16th October 2018 Commons Chamber

[Stephen Barclay]

The right hon. Lady raises an important point. I am happy to meet her to discuss these issues, given her constituency interest. I understand that she met members of staff on Friday. I very much urge HES employees who are listening to the debate to phone Mitie’s dedicated helpline and provide their details. The key issue is that Mitie has requested information from HES that it has not provided. To assess whether TUPE legally applies and the work patterns and issues of the staff involved, Mitie relies on HES providing information that, to date, has not been provided. The key issues in giving reassurance to staff are for them to contact the helpline and for HES to provide the information requested.

[Julian Knight (Solihull) (Con)]

I congratulate the Minister on the measured way in which he is dealing with this unpleasant situation. Can he confirm that the Environment Agency will suspend HES’s remaining permits if enforcement action does not return it to full compliance?

[Stephen Barclay]

My hon. Friend will be aware that the Environment Agency is an independent body, so it will be for the Environment Agency to reach a decision on whether such a suspension should be raised. I can reassure the House that the issue is subject to great scrutiny at present and that the Environment Agency is looking at it very closely.

NHS Outsourcing and Privatisation

Julian Knight Excerpts

Wednesday 23rd May 2018 Commons Chamber

[The Secretary of State for Health and Social Care (Mr Jeremy Hunt)]

I welcome the opportunity of this debate to dispel some particularly pernicious myths.

May I say how much I enjoyed the shadow Health Secretary’s speech? If they had listened to his denunciation of privatisation and outsourcing, I think my children would have said that Alice in Wonderland has nothing on the Labour party when it comes to taking totally contradictory positions on an identical issue. My favourite thing was the stirring way in which he said, “What concerns me most is contracts handed out that are poor value for taxpayers,” after his Government left £80 billion-worth of PFI contracts for the NHS to pick up the pieces. That costs the NHS £2 billion every year—money that cannot be used for good patient care. He had lots of other gems and we will return to them during the course of this speech.

I want to start with the motion. I am afraid that it is a transparent attempt to set hares running about NHS privatisation that is not happening. He used the phrase “creeping toxic privatisation”, but the truth is that we know it is not happening and the Opposition know it is not happening. With all the pressures facing the NHS today, to scare staff and the public with fake news is breathtakingly irresponsible.

In the motion, the Opposition use the Humble Address mechanism to ask for the release of documents, knowing full well that it will fuel wild conspiracy theories if we refuse to release those documents, as we must for reasons that are nothing to do with the NHS, but to do with good governance. However, there is a flaw in their Machiavellian logic. When I asked officials for advice on what submissions we as Ministers hold on privatisation—this great swathe of secret plans that the Opposition constantly allege—this is the written advice that I got back: “Officials have, since the Humble Address was received, sought to find submissions about the privatisation of clinical or patient services within the period specified, but to this point none have been identified. Her Majesty’s Government has no plans to privatise the NHS.” That was the official advice, but don’t take it from me. The respected King’s Fund said in 2015 that

“claims of widespread privatisation are exaggerated.”

Another way in which the Labour party loves to try to scare the public is to deliberately muddle up privatisation and outsourcing, which of course are quite separate. I think the shadow Health Secretary knows that, going by some of his comments. What are the facts on outsourcing? The Prime Minister did indeed wax lyrical about the possibility of 40% of acute operations in the private sector being done under the NHS banner—not this Prime Minister, but Tony Blair in 2006. Had we followed Tony Blair’s advice, we would be spending nearly £2 billion more on outsourcing than we currently spend. The Secretary of State from that period also said quite openly, “We intend to use the private sector when it can bring expertise or resources to help improve services.” That is not me, but Alan Milburn in 2002.

And boy, did team Labour set about that outsourcing with enthusiasm: not just increasing the PFIs we have talked about and not just giving the first contract for an NHS acute hospital to the private sector in 2009—that was Andy Burnham—but increasing the amount spent on outsourcing by 50% in the last four years of that Government. [Interruption.] Fifty per cent. These are the facts. I know the hon. Member for Dewsbury (Paula Sherriff) wants to do the fake news and the scare stories, but let us just listen to the facts. Let us talk about what has been happening under this Government. In my first year as Health Secretary, the proportion going to the independent sector went up by 0.6%. In the second year it was 1.2%, in the third year it was 0.4% and last year it was 0%.

I need to correct the record. During Prime Minister’s questions, I hurriedly passed the Prime Minister a note about the increase in Wales in the use of the independent sector. She said at the Dispatch Box that in Wales it had gone up last year by 0.8%. I need to correct that, because in fact it went up by 1.2%—50% more than I thought. Wales, where Labour is in government, is racing ahead. In fact, in pounds spent, the use of the independent sector last year in Wales went up by a third. What that shows is not just that these allegations are nonsense, but that Labour knows they are nonsense. If there was any truth to them they would not be increasing outsourcing in Wales by one third at the same time as branding it as verging on the criminal in England. With the huge pressures facing the NHS and immense efforts by frontline staff to cope with flu, winter and an ageing population, can the Labour party really be trusted with the NHS when it spends its time putting out fake news?

Unlike Labour, we do not believe that the NHS should close its ears to innovation in other sectors or other countries. We want the NHS to be the best in the world and there are things to learn from others that will help patients and help the NHS. Sometimes those innovations will even come—dare I say it?—from America. But to copy global best practice from one small part of what is happening in America does not mean that we want to copy its system itself, which I think, and I think most people in this House think, is an affront to that great country, with poor outcomes, lack of coverage and high cost.

To stop ideology trumping the needs of patients, the Conservative-led Government in 2012 legislated to stop politicians choosing whether to boost the private or the public sector, formally and legally giving that decision to clinicians who run clinical commissioning groups. I will tell the House why we did that. What would happen if we followed what the shadow Chancellor advocated last year, when he said

“we will reverse Tory privatisation by renationalising the NHS”

is that 120,000 people would have to wait longer for operations on their hips, knees and for other elective surgery. The price of Labour ideology, putting ideology before patients, would be nearly 200 people waiting longer in every constituency in this House.

[Julian Knight (Solihull) (Con)]

The Secretary of State touches on a point that is very pertinent in my constituency. I met a former police officer who had an NHS operation on his hip. The operation went wrong, so the local NHS trust paid privately for the officer to have the operation done correctly. Does that not show that at times it can be a very good thing to involve the private sector? The key is that the NHS is free at the point of need.

[Mr Hunt]

That is exactly the point. Sometimes the quality is high in the private sector and sometimes it is low. When it is low, we will clamp down hard just as we do with the NHS.

Education (Student Support)

Julian Knight Excerpts

Wednesday 9th May 2018 Commons Chamber

[Robert Halfon]

Like me, my hon. Friend is a big champion of further education and understands it completely. This could be an incredible moment for our further education colleges because, along with some very good private providers, they could be leading the way in providing degree apprenticeships.

[Julian Knight (Solihull) (Con)]

My wife was a renal nurse for 15 years, and she says that one of the key changes that happened in her time as a nurse was the university-fication of the nursing profession. Does my right hon. Friend agree that having this diverse route is a much better way to do things and brings in people from all backgrounds?

[Robert Halfon]

My hon. Friend is right. My hope is that, rather than 50% of all students just going to university, one day 50% of all students will be doing degree apprenticeships in all subjects, but especially in the subjects we need, particularly in coding, healthcare, science, engineering and nursing.

Social Care

Julian Knight Excerpts

Wednesday 25th April 2018 Commons Chamber

[Andrew Selous]

I think Germany absolutely has something to teach us, and it has a private insurance scheme on top of that as well.

We need to see weekend discharges in hospitals, on Fridays, Saturdays and Sundays, with local authorities and social care being available over the weekend, so that we do not get a bulge on Monday morning, causing our hospitals huge problems. We need proper pay for care home staff. They have a choice, but there is no choice for us as a country about whether we look after our frail elderly people and those who need social care. We have to do it, but people do not have to choose social care as a profession. Therefore, we need some proper labour market analysis and parity between similar jobs in the NHS and social care. The lowest-paid workers in the NHS have just had a 29% pay rise. If we are to have true parity, we need to treat the social care workforce as well as we treat the NHS workforce. Independent living schemes, which my own local authority of Central Bedfordshire is pioneering, are showing the way, and the Housing, Communities and Local Government Committee was impressed when it went to see Priory View in Dunstable. I gather that in East Sussex there is data to show that this type of extra care scheme—

[Julian Knight (Solihull) (Con)]

Does my hon. Friend think that there is also a role for the greater use of co-operatives such as the CareShare organisation, which matches those in need of care with care givers so that they can swap time with each other?

[Andrew Selous]

That is an excellent scheme. Returning to East Sussex, I understand that data suggests that its extra care scheme is now saving about £1,000 per resident. We have seen examples from overseas—Germany and Japan in particular—and we have a Government who are committed to finding a solution. I eagerly look forward to seeing those solutions in the Green Paper and to our implementing them quickly.

--- Later in debate ---

[Julian Knight (Solihull) (Con)]

It is a great pleasure to follow the hon. Member for Leicester West (Liz Kendall), who made a typically passionate speech, and I echo what she said about the need for a cross-party approach. When she mentioned that anyone talking about social care almost has to do it out of election time because otherwise they can end up being torpedoed by their opponents, I was reminded of one particularly vile leaflet issued in the Cheltenham constituency during the 2017 election, which stated, “First dementia will take your mind. Then the Prime Minister will take your house.” That sort of politics is pretty low and does a disservice. So I firmly believe that we need cross-party working on these very long-term issues.

Building a social care system for the mid-21st century–it is incredible to be talking about the upcoming mid- 21st century; this feels very old in that respect—is one of the most important tasks facing this Government and any subsequent Government. Many Members have mentioned the fact that our population is ageing, and indeed it is. The number of people aged 75 and over is expected to increase by 70% between 2015 and 2035, and the figure for older people as a share of the population is expected to rise from 28% in 1971 to more than 36% in 2037, when I reach retirement age. Not only are people living longer, but there will be fewer working-age citizens to support them through the taxation system. That is particularly acute in my constituency. In the Silhill ward, from which the constituency takes its name, 40% of people are over 65, and I regularly come into contact with people who are dealing silently with huge care issues. Solihull rests and survives on a sea of volunteers and those who are willing to give of their time in order to help people in this vulnerable situation.

I welcome the Government’s decision to invest an extra £2 billion in our social care sector over the next few years. That is a first step, but this is not a problem that can be fixed just by spending money. We need not only to explore why some councils are perfectly able to provide quality care on their current budget whereas others are not, but to futureproof our social care system against demographic trends that will place huge strains on it.

I wish to focus on the two structural reforms that Ministers should consider as they draw up their Green Paper, the first of which is providing more support for the co-operative movement in this sector. There has not been a great deal of debate on that, although I mentioned it to my hon. Friend the Member for South West Bedfordshire (Andrew Selous). I am thinking of examples such as CareShare, which helps to match those in need of care with care givers and which fosters that peer-group support—it is a social care platform owned by its members. There are working international examples of that in areas that do not have an NHS, such as Spain, Italy and Latin America, which also have strong family networks and strong family connections. The social care co-operatives have proved very popular and could augment rather than replace state and other systems. It is about a network, effectively, moving us forward, because the state alone cannot solve or resolve this.

On the subject of creating variety in the sector, I would also like to see support for the growth of mass market social care insurance. That could be provided by both the state and, to a degree, private suppliers. The state approach should follow a National Employment Savings Trust model for funding and for distributing that funding to the carers. That is a solid example that we can follow, and we need to look closely at the examples we have seen in Germany and Japan. That can help people to prepare for their old age while they are still able to set appropriate funds aside and make meaningful decisions about their future care.

Ministers are rightly trying to ensure that individual service users are at the heart of the reforms as we go forward. Making patients equal partners in the care process and instituting principles such as “No decision about me without me” are all about empowering people and delivering higher quality, greater transparency and more accountability as a result. Supporting a wider variety of providers and care methods is the next step in that process. That is the lesson of the free schools movement, where the Government recognised that supporting a wide range of schools was essential in giving parents and pupils meaningful choices about their education. Ministers must ensure not only that the new social care system properly supports the work of excellent third sector providers such as Mencap, but that it uses tax breaks and other incentives to help to foster alternatives such as the patient-led co-operatives I talked about earlier.

We also need to restore the market for long-term care insurance products to fund social care. That used to exist to some degree, but it was never able to achieve substantial economies of scale. Since the disintegration of independent financial advice, it has basically also disintegrated. That must change, for two reasons. First, people need a realistic idea of how much they will need to set aside to fund the level and style of social care that they want, and a properly functioning market with a wide variety of products is by far the most successful way of achieving that. Without it, that essential planning will be the preserve of the well-informed few.

At present, too many people put off thinking about social care until they have no other choice. I had this happen in my own family. At a moment of crisis, they are suddenly in need of extra support, but leaving all the decisions to this late stage hugely reduces a patient’s scope to make decisions about their care and choose a model that works for them. I believe, having echoed the point made by the hon. Member for Leicester West about the need to work across parties and not torpedoing ideas, that we need an honest conversation in this country about when we need care, and to plan it, rather than reaching those crisis points.

NHS Staff Pay

Julian Knight Excerpts

Wednesday 21st March 2018 Commons Chamber

[Mr Hunt]

What is a matter of fact is that the NHS in Wales would have £1 billion more if the Welsh Government had matched the increases that have taken place in England and that Welsh patients waiting for both elective and emergency care are 40% more likely to wait too long.

[Julian Knight (Solihull) (Con)]

I have the great good fortune to be married to a former renal nurse, and she tells me regularly that much of retention is about work-life balance, training and interactions with management. Will the Secretary of State tell us what progress he is making in those areas?

[Mr Hunt]

I am happy to do so. Work-life balance is something that we need to handle a lot better. I think we have been slow to recognise that today’s NHS staff are likely to live in households in which both partners are working and that juggling life and work has therefore become much more complex than it was 30 or 40 years ago. The reform of the increments system means that there will be more focus on training and skills, which will be much more motivating for NHS staff, so I hope that my hon. Friend’s wife is pleased.

Hospital Car Parking Charges

Julian Knight Excerpts

Thursday 1st February 2018 Commons Chamber

[Robert Halfon]

That is the sad thing. Many private companies are making profits from the taxpayer and the most vulnerable people in our society. That must stop. The PFI things that have happened under Governments of both main parties have caused huge amounts of problems to many people, particularly when they park at hospitals up and down the country.

There is still a postcode lottery on car parking charges; different hospital trusts set wildly different fees. The core principle of the NHS is to provide free healthcare for all at the point of access but the charges are a stealth tax on drivers using the health service. The parking charges are the bane of people’s lives. No one goes to hospital out of choice; they go because they have to. No one chooses to be ill, and we rely on our doctors and nurses to look after us. I urge the Health Secretary and the Minister to take urgent action to end this social injustice once and for all, and to introduce substantive legislation to ensure hospitals scrap their parking charges.

[Julian Knight (Solihull) (Con)]

rose—

[Robert Halfon]

Mindful of the advice from the Chair, I shall give way one last time.

[Julian Knight]

My right hon. Friend is being most generous. I should declare that I am the joint chair of the all-party parliamentary group for fair fuel for UK motorists and UK hauliers. I have tremendous sympathy with my right hon. Friend in this respect and have campaigned hard on hospital parking charges in my own constituency. However, one difficulty I have in squaring the circle is the fact that my hospital is located right in the town centre and, if it is free, people use it as a base to go off shopping. That has happened in the past. Does my right hon. Friend have any solutions or ideas to deal with that?

[Robert Halfon]

I am very proud to have worked with my hon. Friend on the FairFuelUK campaign to keep fuel duty low. The point he has just made is very broad, so if he could wait a few minutes, I hope to be able to address the concerns that he has expressed.

I mentioned earlier that, in 2014, the Government had offered guidelines on concessions for patients and visitors. I welcomed that, as it was a sign that the Government were aware of the extortionate costs facing hospital users, but the problem with the guidance is that none of it is mandatory. In fact, the guidance encourages the postcode lottery. The guidelines state that charges should be reasonable for the area. Trusts are free to set their own fees, which means that patients and staff living in London and the south-east are charged the most. I have asked the Government on a number of occasions what constitutes a reasonable charge, and I consistently receive responses along the following lines: first, that hospital car parking charges are a matter for individual NHS trusts; secondly, that local NHS trusts are expected to follow the published guidance; and thirdly, that the Department of Health and Social Care has not discussed car parking charges with local NHS trusts.