Health and Care Bill (First sitting)

Karin Smyth Excerpts

Committee stage
Tuesday 7th September 2021 Public Bill Committees

[The Chair]

Thank you. I call Karin Smyth.

[Karin Smyth (Bristol South) (Lab)]

Q I appreciate that people working together and perhaps substantiating some of those informal arrangements might, in theory, do some of what you hope. However, the employers remain the institutions that make up the integrated care boards—that is the effect of the Bill. You have started to talk about the process. Could you perhaps talk a bit more about how that is enforced, what that means in practical terms for employers and how employers might behave? I am partly thinking of one of the trusts in my area, which, a number of years ago, set up a wholly owned subsidiary company, with the benefit for them of different terms and conditions for staff as a way of saving money. That was obviously detrimental to the healthcare system generally because you are competing for the same sorts of staff. We made the trust stop doing that because we wanted the staff to be treated the same. My point is: the employers, the terms and conditions, the benefits and the way that they will attract staff remain the same. The Bill does not make the ICB the employer or the way to deliver those terms and conditions or ways of recruitment. I think it is a theory. Can you convince us otherwise and show how in practical terms the Bill solves some of those problems?

Danny Mortimer: It is absolutely the case that the individual organisations in the NHS, social care, charitable organisations and local authorities that make up the partnership as well as the board will remain separate legal entities. We do not see that it is desirable for the NHS to move from having 250 separate employers to having 42 employers. What we have in the NHS is a set of national terms and conditions. My organisation has a particular responsibility on behalf of the Secretary of State to negotiate those with our trade union colleagues. We see that they work well for the NHS and I detect no movement among my membership to move large scale away from those national terms and conditions, which cover the vast majority of staff who work in the statutory NHS.

What we see with ICSs is that organisations are increasingly coming together to address shared challenges. We observe that those challenges are not about pay and conditions but about supply. They are about working together to think about how to promote a specific area for people to come and work in, whether that is Nottinghamshire or West Yorkshire and Harrogate, where there has been some fantastic work in promoting careers in the sector as a whole. We see people coming together to work with directly elected Mayors around the skills agenda. There has been some really fantastic work, for example, in the west midlands, with health and social care organisations coming together with local authorities. We see similar work and engagement with the Mayor of London on the skills agenda that he is taking forward. Again, that is being done by organisations working together. That helps partners—local authorities are engaging with health and social care as a team rather than dozens of separate organisations. It also helps us promote careers that span the whole range of settings that we operate in and speaks to the particular priorities of our colleagues in social care. We see some really fantastic examples of that in various parts of the country.

Finally, we see a real opportunity to take forward the work that I have just talked to Dr Davies about. Systems, as they look at their services and their knowledge of the things that they are providing in their communities to your constituents, can inform the national plans that Navina described in her answer to Dr Davies. We can have a much greater connection between local priorities and some of the decisions that are made nationally about how we invest longer term in education. Of course, the NHS workforce is about 50% degree educated or degree equivalent. So there are significant investments that the Department of Health and Social Care, the Office for Students and the education sector make in our workforce. Being able to root that in what it is that local services need and how they are developed seems to us like a fantastic opportunity, and would help us to avoid the problems that we have got into in the last couple of decades with pressure points in various parts of our workforce.

Dr Navina Evans: I will build on what Danny has just described. You have given some really good examples of how local employers are coming together in systems to address workforce issues. I would add a bit more about how we do it and how we can do it even better going forward. Health Education England has a role in developing careers and attracting young people—all people—into the health and care workforce. We play a really big part in that. First, we have found that doing that locally, at a very local level with the communities and organisations that really understand their local populations, has been a really good thing to do. Some of the examples that Danny gave have built on that and we will move forward on that.

Secondly, we have structures in which people boards, at integrated care system level and definitely at regional level, now bring collections of the different organisations together. We have systems that are starting to think about themselves as anchor systems, which means that they can influence employment, the economy and the success of local communities.

Finally, the population health issue has been something that we have really woken up to, and we are cognisant of the fact that we have to focus on and rebalance the health and wellbeing of the population. Through the pandemic, we have learned a lot more about where we need to target our efforts to reduce inequalities. That can only be done really well through collaboration at a local level. Organisations such as mine need to work closely with our partners in NHSE, with the Department and with other national organisations to make sure that we support those local efforts to be sensitive to the needs of their particular population. It is bringing the national priorities, principles and policy into life at a very local level by making sure that we have the systems and structures in place to deliver what is needed locally. We had already started working on that—the work is well under way—and the Bill will enhance our ability to get on with doing that.

[Chris Skidmore (Kingswood) (Con)]

Q I want to return to the issue of workforce planning, which obviously is integral to both of your organisations. You have discussed the strategic framework you have been working on, and hopefully that will evolve into a workforce strategy, which is addressed in clause 33 of the Bill. I have tabled an amendment to clause 33 which is to make the workforce report annual rather than once every five years. I think that the pandemic has demonstrated the futile nature of trying to produce a report once every five years, when we know that the nature of the workforce could change radically during that period. Would your organisations agree that it would be better for that report to be produced on an annual basis? Clause 33 states that NHS England and Health Education England

“must assist in the preparation…in this section,”

but only

“if requested to do so by the Secretary of State.”

You have talked about locally led decision making and planning. Do you both agree that we need better co-creation? My amendment covers the fact that a plan should be developed and agreed by stakeholders in particular. Would your organisations welcome this amendment, which would result in an annual workforce strategy and require it to be developed by all other healthcare organisations working in this sphere?

Dr Navina Evans: From HEE’s perspective, we will deliver on the duties that Parliament decides that we ought to deliver. We feel that we have the capacity and the capability. We can organise ourselves to deliver whatever is required of us by the Bill. The work that we do is lithe—it is iterative. We do iterative planning, in a meaningful way, at the national and system level, so we will be able to respond and fit in with whatever is required of us by the Bill and Parliament.

Danny Mortimer: Thank you for the question. Absolutely, there is an opportunity for the Bill to define a wider range of stakeholders. The systems at the centre of the Bill—integrated care boards and integrated care partnerships—are central to that, and their perspectives, as we have just talked about with Ms Smyth, in terms of the needs of their population and the services they need to put in place to respond to them, need to be at the centre of the process that Navina and others would lead on behalf of the Secretary of State. That is the first thing. Secondly, there is an opportunity through those systems to broaden our conversation to include social care as well as health. That is really important to us on this day of all days, in terms of the announcements later.

In terms of the regular appraisal, we absolutely believe that five years is absolutely insufficient for the task. We also believe that it cannot just be about process. It has to be about setting out clear requirements and clear specificity about those requirements over different time periods. There is something about the short-term need, and there is also something about five, 10 and 20 years. It needs to be regular. We have proposed two years because it is a huge amount of work and that feels to us to be a minimum in terms of how regular the perspective could be, but it may well lend itself to an annual update, as you have described.

We also see that organisations such as Health Education England and Skills for Care, which operates in the social care sector, absolutely have the capacity and capability to lead this work. Their way of working, similar to the Department’s way of working throughout the preparation of this Bill, is about engaging, convening and trying to bring stakeholders together to get a broad range of perspectives. That is our experience of the long-term process that Navina and her colleagues are leading on behalf of the Department at the moment. The Bill confirming that would confirm ways of working that we are starting to see develop with stakeholders in a really healthy and constructive way.

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[The Chair]

Thank you very much.

[Karin Smyth]

Q Welcome to our witnesses. Ms Pritchard, welcome to your new role.

We have just heard some interesting evidence, and I want us to be very specific about our terminology when we refer to integrated care systems, integrated care partnerships and the integrated care board. In your view, who is accountable for the spending in my local area under the new arrangements? Approximately £1.5 billion is spent in the local area. In the new system, who is accountable for that spend?

Amanda Pritchard: Thank you. If I start, Mark can come in and add. In the new proposals, the integrated care board carries the statutory responsibility, on behalf of the NHS, for the allocation of spending, performance management and the delivery of NHS services within the system. That, of course, has a delegated set of responsibilities, as per the current commissioning arrangements, down to individual organisations—be they groups of GPs, hospitals or community services— for the spend within those organisations, but the accountable part of the system is the integrated care board. As the proposals set out, it has a very important relationship with the integrated care partnership, but without the line accountability for the funding flowing through that part of the structure.

[Karin Smyth]

Q That is really helpful and very clear. The chief executive and the finance director of the integrated care board are clearly accountable. To whom are they accountable?

Amanda Pritchard: In the current structure, they are accountable through the NHS—sorry, not the current structure, because you are talking about the future structure. In the proposed future structure, they would be accountable to a combined NHS England and NHS Improvement structure. At the moment, we operate that through seven regions, and then through to the national NHSEI executive. We are, in turn, accountable to Parliament.

[Karin Smyth]

Q So when I have an issue that I want to bring to my local integrated care board’s finance director and chief executive, I will take it through to NHS England and then back to Parliament, of which I am obviously a Member. At what stage does the Secretary of State get involved with my issue?

Amanda Pritchard: We have a clear accountability to Parliament through the Secretary of State in the current structure, and the Bill is not proposing that that will change. The other thing that we should say is that CCGs have a clear accountability to involve the public and patients in their decision making. Again, in the current proposals, that responsibility would transfer through to the new integrated care system, and particularly the integrated care board. While we just talked about formal line accountability, that does not detract from the clear expectation that flows through, that the integrated care board would have accountability to involve the public and to consult with them. The transparency that is expected now of the CCGs and NHS organisations is written into the expectations and would flow through to the expectations of the new integrated care boards.

[Karin Smyth]

Q Can I ask about clause 20, which is about externally financed development agreements? In your view, is there a role in that clause to develop primary care and community estate? I am particularly interested in whether that provides the ability to continue the LIFT arrangements that were undertaken by primary care trusts but not by CCGs.

Amanda Pritchard: I do not believe, although I may ask Mark to come in on the detail, that there is any proposed change to those arrangements. Mark, would you like to pick this one up?

Mark Cubbon: Thank you, Amanda. I am not aware that there is any significant change proposed by the Bill to the arrangements in place at the moment.

[Karin Smyth]

Q So how do we, in the system, ensure the development of primary and community estate? Are we in the queue with the Treasury, behind the 40 or whatever hospitals? Is there any way in which we can develop primary and community estate within the scope of the Bill? If we cannot do that through the Bill, how do we do it?

Amanda Pritchard: I will give you a headline answer, because I think this is really important. Part of what we would welcome in the Bill is that, by working as a system, one of the things that all partners will want to do is to come round the table together to make some of those important decisions about where the investment goes. In particular, if we are thinking about capital, I know there are examples already of where organisations have chosen to invest in community estate, additional diagnostics facilities or other parts of primary care estate. In fact, Mark and I were on a visit a few weeks ago to an ICS where they were telling us about some of the work they have done on that.

Moving to looking at system funding envelopes, particularly around capital, allows much more flexibility about how some of that resource is used in the interests of the whole population and the whole health system, rather than, at the moment, where putting things into slightly more siloed funding arrangements can end up being detrimental to certain parts of the system.

That comes back to some of the guiding principles of why the NHS has welcomed, certainly, the thrust of these proposals where integrated care is concerned, because it is all about building on some of the direction of travel that has been in the NHS for some time about trying to work much more collaboratively together. This helps remove some of the barriers that currently exist, for local systems to do that.

[Karin Smyth]

Q Just to be clear, where would this capital come into the system? Presumably it would come to the ICB, as the accountable body. Where would the capital separately come from?

Amanda Pritchard: Through the existing capital allocation processes. Rather than just going to each individual organisation to then make their own decisions about how they spend it, it would now go through the ICB, so there is a process that allows consideration in the round of how the system spends that money most effectively on behalf of its entire population.

[The Chair]

Thank you. We now go to Jo Gideon.

Health and Care Bill (Second sitting)

Karin Smyth Excerpts

Committee stage
Tuesday 7th September 2021 Public Bill Committees

[The Chair]

Hang on a second. I had better give somebody from another party a chance.

[Karin Smyth (Bristol South) (Lab)]

Chair, I have another question.

[The Chair]

I will come to you in a second, Karin. I am just trying to balance it between the respective parties.

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[Dr Whitford]

Q But by whom? That is the public concern. They have no issue with a public body. They are anxious and it goes right back to care.data. The danger is that it will set back your whole digital agenda if you get hundreds of thousands of the public all opting to not take part.

Simon Madden: I completely understand. That is why I mentioned that it is incumbent on us to have not only the right safeguards in place but the right narrative and to engage with the public so that they understand what those safeguards are, how they operate and how they can opt out of the system. One of the things we have been looking at in developing the final version of the data strategy following the engagement is how we can do much more on public trust and transparency. It is not just about a one-off marketing campaign; it is about an ongoing public dialogue and involvement of the public in future policy considerations. Again, it goes back to that resetting point; I think this is a reset moment. Technology now allows us to go that bit further than we have ever been able to go before in terms of protecting privacy, but we have to be in a stronger position to explain that to the public and how it all works.

[Karin Smyth]

Q I hope that this is in scope, Mr McCabe. I have just come from the Chamber, where the Prime Minister is still on his feet. He talked about integrated care records, but I am not quite sure if we are discussing the same thing. This may not be news to you, Mr Madden, but could you clarify whether we are all talking about the same thing? I appreciate that you were not there to hear the Prime Minister, but is it your understanding that what we are hearing today about social care is the same as the conversation we have been having about integrated care records, personal care records and so on?

Simon Madden: Forgive me, but I will take full advantage of the fact that I was not there and have not seen the statement that the Prime Minister made. A feature of our plans set out in the data strategy—not so much in terms of the Bill itself—is for each integrated care system to have a basic shared care record, so that throughout their whole health and care journey a patient or citizen does not have to do simple things like repeat test results or repeat their prescriptions, and so that their care journey between health and social care, with provisions for safeguarding and safeguarding information, is seamless.

[The Minister for Health (Edward Argar)]

I will ask a couple of questions, if I may, Mr McCabe, and then perhaps the hon. Member for Nottingham North can come back in if we have time. Moving away from what has been explored by colleagues so far on the extremely important protections around data sharing and data use, can you set out how the changes set out in the Bill relate to and will help you deliver the data strategy that you have in place?

Simon Madden: It is important to set out that these provisions alone, while they do much within the Bill, must be seen in the context of that wider data strategy. They support our ambitions, and the integration and collaboration that is described in the Bill will be a huge enabler for the ambitions set out in the strategy itself.

The provisions themselves focus to some extent on tidying things up and providing a degree of clarification. I mentioned the provisions for clarifying NHS Digital powers: currently, there is sometimes confusion around what data NHS Digital can share and in what circumstances it can share it. Sometimes, that leads to problems when data may need to be shared for very good reasons—for justifiable reasons—but NHS Digital is sometimes not convinced that it has the legal power to be able to share the data. This puts beyond doubt its ability to share data appropriately.

Another provision is on information standards. We are making a provision in the Bill to mandate standards for the storage and collection of data. That is important to ensure that data can flow between different IT systems and organisational boundaries in the health and care system. That will then help individual patients and improve health outcomes. We want to ensure that providers of health and care services purchase only technology that adheres to that set of standards, so that we have that interoperability, and those improved outcomes for patients, through that mandation of information standards.

We have also put in clauses around sharing anonymous health and care information, which help to essentially set a duty to share anonymous information when it is legally permitted to do so. One of the lessons that we have learned over the pandemic has been that, although it is perfectly permissible for data to be shared—it is legally permissible to do so—the shift from “can” to “should” has a great impact within the system.

Our invoking of the control of patient information regulations under existing legislation, to enable that sharing of data and to say, “You should share data in these circumstances,” has significantly helped the free flow of data safely and securely within the health system. That has had an impact on patient care. I think that the duty to share anonymous data will help to put on a more permanent footing some of those provisions that we have seen during the pandemic.

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[Karin Smyth]

Good to see you both. Thank you for coming. I want to talk about accountability. I asked NHS England this morning about how accountability works in the new system and it was clear that local accountability lies with the integrated care board—the chief executive and the finance director, in the first instance. We were then taken through the system up to NHS England and Ms Pritchard then said “through Parliament”, which she corrected to “through the Secretary of State through Parliament”. I asked at what stage the Secretary of State becomes involved in the accountability, a question that she did not answer and which I would like you both to answer for me.

We have also heard that the Bill is something the NHS asked for. I have not met a single person working at any level in the NHS who says that the powers given to the Secretary of State directly, added to the Bill after conversations with the NHS, are a good thing and are clearly workable. That is my pretext.

Perhaps I can give the example of a constituent who came to me about ear wax removal, which was a subject that concerned him greatly. Will I write to the Secretary of State as a Member of Parliament to ask him about the lack of ear wax removal services in my integrated care board area, or will the chief executive be the final arbiter of such decisions? Mr Taylor, do you want to go first on behalf of the confederation?

Matthew Taylor: Yes. There are two points here. The first is around the structure of accountability at the centre and while that is important, ultimately, it is a less important consideration for health service leaders than the relationship between central accountability and local accountability. That is the focus of the major concern we have about the Bill: the extension of the Secretary of State’s powers in relation to reconfiguration, which we think is a mistake. We think the system, as it is, is not perfect but works pretty well. For the Secretary of State potentially to be embroiled in making decisions not just about major reconfigurations, but really relatively minor reconfigurations runs the risk not only of delaying necessary changes in the system, but of putting less emphasis on the views of local people and of clinical advice.

Representing my members, while the question of the relationship between the Secretary of State, Parliament and NHS England is one that we take an interest in, the issue of the relationship between the centre and local accountability is stronger. Where constituents write to their MPs, the Secretary of State or wherever when they have a problem, they will continue to do so, but I hope in such a system that the first thing to happen to such a letter is that it would be sent back to people locally who could address that issue in a local way. It would be ill-advised for a Secretary of State to try to involve themselves in a question like that.

Saffron Cordery: I agree with Matthew’s point. It is this central-local relationship that is absolutely critical to those who are working on the frontline—trust leaders from my perspective, and from NHS Providers’ perspective. Coming back to some of your points about the NHS supporting the legislation, I think that is absolutely right. The NHS has come together to support the direction of travel of this legislation, but I think it is worth saying that that agreement was based around an August 2019 set of proposals, when the whole NHS came together on the basis of some recommendations from the Health Committee. It is important to remember that the legislation has changed somewhat since then. We have had a number of elements added to the Bill that sit around the central bit that the NHS agreed with, which probably changed the context somewhat. It is worth remembering that the local reconfigurations issue that Matthew Taylor raised is a very important one.

There are elements as well in the nature of the relationship between the Secretary of State and NHS England in terms of the operating context and its ability to intervene in what goes on nationally, and the knock-on effect locally on trusts. There are some really big issues there, which come together.

The other thing to say is that, often, Secretary of State powers may seem like small elements, but taken together, the cumulative impact can be seen to erode that local accountability. We would hope, whatever happens, that if someone has an issue with ear wax removal, they speak to someone at the most appropriate level to get something done. That is what subsidiarity is about: the delegation of powers to the most appropriate level, and it is really important. It is also important for accountability, because you cannot have a Secretary of State saddled with taking a thousand tiny decisions in an organisation and a system as complex as the NHS. That is one of the challenges of this local reconfiguration issue that is arising.

[Karin Smyth]

Chair, can I come back?

[The Chair]

I will come to you if there is time, but I want to move on. Dr Davies.

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[Chris Skidmore (Kingswood) (Con)]

Q I wanted to turn to workforce planning and your views on clause 33. The NHS Confederation, in its written evidence, has suggested that the five-year period for a strategic review on workforce planning is too long. That mirrors my amendment, which has a crack at this. I have suggested an annual review. It was suggested this morning that two years might be the right time length. I see that the NHS Confederation has suggested three years. I want to get your organisations’ views on what a strategic review should look like, but also on the format and how a strategic review should be undertaken so that it actually works as an act of co-creation, rather than being directed centrally by the Secretary of State on to Health Education England.

Matthew Taylor: My area of expertise before coming to the NHS Confederation was work and the future of work, on which I advised the Government, and one of the things I know from that work is how quickly the world of work is changing. It is impacted by a whole variety of things—not least, of course, substantial technological change. In a world where work is evolving very quickly and population needs are evolving, five years is simply far too long. If it were one year, we would be happy. We have fastened on to two years. That would be the minimum that we would want as a gap between assessments of workforce need.

It is also—to emphasise the point that I think you are making—important that this review gathers evidence from a whole variety of bodies, because an enormous amount of extremely good work is taking place around work. Predictions of workforce need are imprecise, so hearing from a variety of voices is important. This should be an independent process, in which independent expertise is brought to bear; there should be wide consultation with those who think about these issues; and a two-year plan would, I think, be an improvement on what is in the Bill.

Saffron Cordery: We also support this amendment and the work that has been done by the confederation and others on this. There is one other element that I would add to this that supports this perspective. It has been really hard, across NHS workforce planning, to light upon one version of the truth, in terms of workforce numbers. Anything that starts to move towards a collective perspective on workforce needs and workforce planning will be absolutely critical.

Getting an agreed perspective on how we create that figure will be fundamental. In my time working across the health service, there have been many different perspectives on workforce—on the gaps, the numbers who are in roles, and what those roles need to be. It is important to have lots of views, but I think this is also important. Although, as Matthew says, it is not a precise science, we need to light upon a version that is independently agreed, but that we all sign up to as the numbers we are working to.

[Karin Smyth]

Q If I may, I will return to the permissiveness and place conversation. I agree with the Bill’s direction of travel around place. I do not like the word “permissiveness”, because we have essentially a local cartel of healthcare providers deciding on resources and their allocation, and that locks out local communities. I am a bit suspicious of the NHS being given permission to do as it sees fit. That is why I put forward the example about ear wax removal—because that matters to local people, as we all know; that is what some of these things come down to.

The Bill falls apart because of the governance arrangements and the accountability, which does not follow the logic of place-based commissioning. My solution for the Government, should they wish to take it, is something around a good governance commission, based on the previous appointments commission-type process. It would bring in skilled people, with clear role descriptions, clear skills and a degree of independence. It would have the trust of local people, and would bring these very powerful chief executives together with local leaders to explain why, in Bristol, you cannot have ear wax removal, or why you are closing certain provision and opening it in Derbyshire or wherever. Have you had an opportunity to look at my proposal for a good governance commission and locally accountable chairs—perhaps elected, or appointed? What do you think of that as a solution that would bring power and accountability closer to local people?

Saffron Cordery: The issue of accountability is absolutely fundamental. One of the things we have not talked about much in this sitting, and which is not talked about that much, is the presence of two bodies in the system. We have the ICB, but also this partnership body that brings together a number of wider partners—particularly local government—with democratic accountability, which I think is really important.

I am wary of adding too much into the structures in the Bill. I understand your perspective on permissiveness, and we need to make sure that there are checks and balances across the whole system, but I would be wary of adding in another structure alongside everything we have. One of the features of this legislation, as I have said throughout the process—we have met the Department of Health and Social Care and talked to their Bill team, who have been very open and helpful—is that it does not really streamline in the way that it thinks it might. It adds to existing structures and processes, rather than starting from a clean sheet of paper and building something that might be deemed to be a good enough model; we will never get to the perfect model.

Right now, what we do not need is a root-and-branch dismantling of NHS structures and something wholly new put in their place, but I think there has been a missed opportunity to look at where we could streamline more. On that basis, I think it is important not to add more in, and it is fundamentally important that we look at the different roles and structures that already exist. From a trust provider perspective, working both at place and within provider collaboratives, and looking at the governance of unitary boards with non-executives and in some places also with governors and members, we see that there is that element of engagement with the community that you perhaps do not see in other places. I do not think it speaks entirely to your cartel point, but it is a step along the way that is well established and well used in many places.

This is a thorny and tricky issue. Using existing structures of accountability will be really important, as well as using the new ones, but I would not want to see anything new added in there.

Matthew Taylor: I largely agree with that, but another point is that if there is a broad policy thrust in this legislation, it is away from a medical model of health towards one that focuses more on social determinants. In the best partnerships—we talk often about West Yorkshire and Harrogate, for example—there is an incredibly strong relationship between health service leaders and local authority leaders. That will be a critical factor in the success of the system. When I look at the best practice emerging in the integrated care systems on issues such as prevention and population health, I see leaders starting to talk about issues such as housing, employment and public space, recognising their importance to health. In one way, that is a progressive move, and one that will probably lead to a louder voice for a variety of local interests, if we understand health much more in these socially determined terms, rather than simply through the medical model.

We had a big announcement today about social care reform, and there is a set of issues that are not in this Bill—issues around health and social care integration, how it will work and how accountability will work. It remains to be seen how the Government address that question.

[Dr Whitford]

Q Matthew, you mentioned that the degree of local integration varies, and that it is impacted by things such as boundaries—particularly the relationship between NHS and local government boundaries in the shift to a wider view of wellbeing. How much of a problem is it that the number and the footprints of the ICSs are different from those of the proposed sustainability and transformation plans? Are people who were growing together suddenly finding that they are no longer working together, and that they will have to start working with someone else? Do you not see that as something that will hold things back?

Matthew Taylor: It is a challenge.

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[Karin Smyth]

Q Mr Conradi, could you talk a little about what the branch will be doing in relation to maternity cases and how that is seen to be investigated? You have talked about systems, but will there be a look at all maternity cases in a system? Could you elaborate a little on that? If I may have a second bite, you could also talk a little about discussions now as to where we think the relationship lies with the health service ombudsman and being clear on the roles within this Bill and how that might look in the future.

Keith Conradi: We currently have a maternity programme that investigates about 1,000 cases a year, based on quite specific criteria. At the moment, the Department is deciding what it wants to do with that programme—where its future lies. As far as we know, it will stay with us, certainly until the HSSIB—the health service safety investigations body—starts, but I think a decision has yet to be made on whether it will actually just fall into the work that the HSSIB does, or whether it will do something separately with it, so I am not aware of that at the moment.

On the second point, I am aware that the ombudsman would like the same power to access the statements that we take under safe space. I think that is a major concern. Over the last five years, the ombudsman has been able to investigate any complaint brought against us in our current guise. It has not seen fit to do so, so I would suggest that on the rare occasion that might be necessary, the provision for the High Court to carry out the balancing test and decide whether to disclose information or not is the appropriate way ahead.

[Dr Davies]

Q Mr Trenholm, you referred to the fact that the CQC will be assessing ICSs in future, which was a recommendation of the Health and Social Care Committee. You also referred to oversight of social care provision. Can you clarify whether that is by virtue of your assessment of the ICSs as a whole, or is it through a local authority-targeted assessment that the Health and Social Care Committee has also called for in an Ofsted-style rating?

Ian Trenholm: Can we not call it a CQC-style rating? There are two separate things. The Bill currently contains an explicit provision about providing assurance on how a local authority is discharging its responsibilities in relation to the Care Act. That is important because the way in which care is commissioned is as important for outcomes as the way in which it is delivered. That is one part and that is a discrete piece of work. There is a broader piece of work that we are expecting Government to ask us to bring forward on assurance on ICSs. It will look at the ICS partnership board, how that works, the ICS strategy and so forth. They are two complementary pieces of work, but they are separate, as you describe.

--- Later in debate ---

[Edward Timpson]

Q This is principally for Councillor Jamieson, if I may, in relation to the role of local government in the new integrated care structure. As you will be aware, there was initially a one-part structure, and partly through the input of the LGA, I think, we have ended up in the Bill with a two-part structure, with both the board and the partnership. For the first time, in many respects, that puts local government very much at the heart of NHS decision making. How do you think that that will assist in addressing both health inequalities within the local area and—I note your point about the flexibility of the board and the partnership—what barriers do you think it will help remove, so that we get a truly integrated system and service that the local government level will have a positive influence on?

Cllr James Jamieson: Looking at the current situation with health and wellbeing boards and so forth, that has worked well in some places and not so well in others. That is largely down to local factors, relationships and the willingness of the NHS to participate in a place-based approach. Our hope and expectation is that this formalises it, not in absolute terms, but in emphasising the role of local government and other partners that the NHS has to take account of. In essence, it is strengthening our ability to influence the NHS.

Why is that so important? I come back to the comment that I made earlier about how much health outcomes for an individual are based on non-NHS factors. I have forgotten who raised the question of health inequalities, environment and so forth, but those are all place-based factors. Getting more investment in public health, less pollution, better community health care, a better GP service and better occupational therapists will make huge differences to people.

At the end of the day, nobody wants to go to a hospital; they would far rather be healthy and not need to. Therefore, empowering local councils and partners to have a greater say in how we improve the health outcomes of our whole population has to be a good thing.

Professor Maggie Rae: To add to what Councillor Jamieson has said—he is making some excellent points on that agenda—it is important to get the balance right. In England, we had the legislation on health and wellbeing boards. One of the principles should be not to ride roughshod over legislation we already have just because we like the new bright and shiny legislation. On the commitment to stakeholder engagement, we managed to get the Bill team to understand that we have legislation already.

Some of that legislation is still there—we still have directors of public health and the powers in local government—and those things are important, but we also know that if we do not get this legislation right, we will not be able to get right the ambitions on health inequalities and on improving health either. The detail of this is really important. As I think was indicated in what Councillor Jamieson was saying, we know that legislation alone does not always fix problems. I do not know how we can get good relationships just through legislation. We can enable things to happen, but we need to ensure that the legislation is enabling and that there is some holding to account for the standards that the legislation is trying to set.

We cannot afford for the health of our populations to be affected by unhelpful variations. I am very supportive of place-based—action happens at the local level and it can be effective at the local level. We need good national legislation, but if we want to do justice to the population in this country, we cannot have unhelpful variation, because that is what will undermine this legislation. We have to make sure that everyone is working for the same aims and that at the heart of everything is the commitment to reducing health inequalities and improving health outcomes, regardless of where you are. Whatever your own organisation, whether a hospital, a local authority or a mental health trust, we have to have something that overrides loyalty to the organisation—to put the population first.

[Karin Smyth]

Q Following up on that point, I do not know whether our witnesses heard our earlier session, but I asked them about this very issue of decision making, governance and accountability. Professor, I hear what you are saying and I understand that you had lots of discussions with the Bill team, but I am not entirely clear what your ask is for the legislation. It would be very helpful if you could spell out what could be added into the Bill to achieve the outcome that you are seeking and the assurance that the drive and logic of the Bill around place-based commissioning, which I support, are made reality somehow.

My point to Councillor Jamieson, which I made to earlier witnesses, is about the integrated care boards, which are the decision-making and accountability bodies locally—the ICPs are essentially a committee of these boards. The accountability, responsibility and decision making lie very clearly with the integrated care boards, which are essentially, as I have called them, a cartel of local healthcare providers—largely the acute sector trusts, which are responsible for vast sums of money. Councillor Jamieson, you have gone to the effort of putting your name on a ballot paper and persuading local people to put their cross by your name. Should you fall foul of them, or make decisions that they do not agree with, you will soon no longer be Councillor Jamieson. That is very clear accountability. With that hat on, can you talk us through your understanding of the role of local government status wise—beyond “Let’s all work together in partnership”—when we reach that real decision-making, push-comes-to-shove crunch about where accountability to local people could lie for decisions if we improve this Bill?

Cllr James Jamieson: In the ideal world, one would probably like one board. However, that would mean that all members of that board had equal status and so forth. Obviously, the NHS partnership would have budgetary responsibility for hospitals, and there is a technical issue with, “Can you have a bunch of non-NHS people having budgetary responsibilities for the NHS?” We understood the difficulty, and that is why there is the need for two boards. The clear point here is that this legislation provides us with a framework that enables that to have real traction.

But I come back to my earlier point, which is that this is a framework; this is not a solution in itself. Legislation does not solve all the problems. This is about how budgets are managed; it is about all the guidelines and regulations that come out. One of the big requests that we have as local government—I am sure Maggie will have it as well—is that we are deeply involved in those guidelines to make sure that they work. I have to say that, so far, we have been, but many more bits of guidelines will come out. That is the crucial bit.

There are some changes we would like to the legislation, but they are not that great—I will come to them later, because they do not refer to this point. We want statutory and non-statutory guidance around things such as the implementation of the Bill, a comprehensive list of guidance that will be issued and clarity about the flexibility. We want some statutory guidance on health and wellbeing boards to ensure that they are at the heart of this. So there is a lot going on, and I am pleased to say that we have been involved in some of the guidance that has already been issued, such as “Thriving places”. As Professor Rae said earlier, engagement has been very good so far, and we would like that to continue, because this is our chance to get this right. We will do that through getting the statutory and non-statutory guidance correct and making some changes, no doubt, to the Bill. But I do not think that this Bill can accomplish everything, so the LGA would certainly not be in favour of significant change to the Bill.

[Karin Smyth]

Can I just clarify—

[The Chair]

Actually, in view of the time, I am going to ask you not to, Karin. I am sorry, but if we are going to hear from Professor Rae and give Chris Skidmore a chance, we had better just move on.

Professor Maggie Rae: Again, it is good that you have asked for some specifics and related this to governance, because it is very important that we understand how the legislation will be implemented and that the governance is right.

The concerns that members of the faculty would have are quite broad based. While people might be genuinely pleased that we are moving away from a market economy on health, some are very concerned about opening the door to further privatisation. I want to give you some detail on specific public issues on which you said you would like more information. The legislation includes some public health hooks that will make it easier for us to ensure that we have good public health, but I question whether they are explicit enough.

The issue of taking advice on the needs of your population is a fundamental skill of public health. Whether nationally, regionally or locally, the professional job of directors of public health is to assess the needs of the population and provide organisations with the evidence about what will make the biggest difference—cost-effectively, of course. The idea of “taking advice” is a little vague, but strengthening the need for that advice to come from the statutorily appointed directors of public health—the regional directors of public health have been trained to do that and put the needs of population first—might give some strength to the Bill.

In my day job I do a lot of ICS development for the organisation I work for so I have experience of working with ICSs, and many current ICS leaders—I know there has to be an appointment process—are passionate about health inequalities and public health. We have to make sure, as we said earlier, that we have something substantive that guarantees that public health is not down to individuals and personalities, and that we have a framework. We cannot expect Cornwall to be the same as Newcastle, but we cannot have the population suffering from unwarranted variation. If I had a bit more confidence that the role of directors of public health—and the regional directors of public health—would be instrumental in the legislation, the guidance and the assurance process, I would be able to give you more guarantees that things will be better in the future. At the moment, it is a little vague.

--- Later in debate ---

[The Chair]

I thought Lyn Summers was indicating that she had. Okay—anyone else?

[Karin Smyth]

Q The bulk of the Bill is about us in England looking at integrated care systems. Obviously, you operate according to a unitary provision already. I am not sure who is best placed to answer this question, but could you share with us any evidence, which might help inform our deliberations as we move to a different system, that the unitary integrated system provides better patient outcomes?

Eluned Morgan: We are all very aware that the care system is under incredible pressure at the moment. In Wales, we have been able to introduce new systems through legislation that give our health services the power to co-operate and work, within a legal framework, with the care services and local authorities. That has made a significant difference already. We have a long way to go, and this is only the beginning of the process, but that is an example of where a close working relationship, and providing the framework that allows that to happen, is working well. It needs to go a lot further, though.

[The Chair]

Thank you. Do either of you wish to add anything to that?

Eluned Morgan: Lyn or Mari, do you have anything to add?

Mari Williams: No, thank you.

Elective Surgical Operations: Waiting Lists

Karin Smyth Excerpts

Tuesday 20th April 2021 Westminster Hall

[Peter Dowd (Bootle) (Lab)]

I beg to move,

That this House has considered waiting lists for elective surgical operations.

It is a pleasure to see you in the Chair, Ms McVey. Covid-19 has had a “calamitous impact” on patient access to surgical care. That is the view of the Royal College of Surgeons of England and it is what I want to focus on today. The Government need to receive that a message loud and clear. It is a message that needs to be repeated time and again, that cannot and should not be ignored, and that resonates with millions of people. I look forward to the response from the Minister, who I know takes this matter seriously.

The Government are not responsible for covid, but it is the Government’s responsibility to mitigate its effects through a variety of interventions. The question is whether they have fulfilled that responsibility. I imagine that the independent public inquiry will help us pin down that particular question. Let us hope that, as and when it happens, it is independent and full. The Royal College of Surgeons represents about 30,000 members in the UK and worldwide and, in this respect, it has a pretty good insight into the current calamitous situation facing millions of people, as it puts it.

I am sure it will be helpful if I contextualise the current situation facing patients. The most recent waiting time statistics published by NHS England on 15 April 2021 are worrying, but if taken with the hidden statistics, the position becomes almost overwhelming in magnitude. That is the challenge for the NHS, the Department of Health and Social Care, NHS England and, of course, for the Government’s commitment to ensure that the NHS gets all the resources it needs, as promised by the Prime Minister. I know that trusts and clinical commissioning groups, as well as NHS England, Public Health England, the Department of Health and Social Care and other NHS-related bodies have worked hard over the past year to ensure that services are being delivered as best they can, notwithstanding the unprecedented circumstances. My reason for initiating this debate is to highlight issues of concern. It is a challenge for us all.

What do the statistics say? A record 4.7 million patients were waiting for hospital treatment in February 2021. There were nearly 400,000 patients waiting for more than a year, which compares with just 1,643 people waiting for more than a year in February 2020. That is a significant rise, if ever there was one. Only 64.5% of patients waiting for hospital treatment were treated within 18 weeks in February against the Government’s target of 92%, which was last achieved five years ago. In total, 387,885 people are now waiting for more than 18 weeks. Those patients are our constituents. Each and every one of us will have numerous patients or would-be patients affected by this dire situation.

In my clinical commissioning group area, which covers my constituency and that of my hon. Friend the Member for Sefton Central (Bill Esterson), there were 1,374 people who had been waiting a year or more to be seen in February, compared with eight in April last year. It is a huge increase. All specialities are affected, but notable ones are ophthalmology, trauma and orthopaedics. It is important to note that what is not included is the impact on overdue follow-up activity and routine surveillance outside referral treatment.

We cannot overestimate the strains and stresses that such waiting puts on patients and their families, who do not know whether they will get the operation that is needed, or when it will happen. That point about what the situation means for patients was clearly made by the Royal College of Surgeons. There is a breakdown from NHS England, by specialty, which illustrates the situation that we and, more importantly, millions of our constituents face. In the trauma and orthopaedics surgical specialty that I have mentioned, more than 600,000 people are waiting, including 288,000 who have been waiting for 18 weeks or more and 84,000 who have been waiting a year for treatment. The percentage treated within 18 weeks, compared with the 92% target, is 52%. The figures are much the same for general surgery: 394,000 people waiting, with 60% treated within 18 weeks. I will not go through all the figures—I think hon. Members get the gist.

Such waits affect people in a variety of ways, mentally and physically. There is the obvious issue of pain that can be persistent, draining and debilitating for month after month. Also, of course, there are psychological effects such as distress or worry about deterioration in health, and concerns about the impact on a person’s employment status and the financial costs that might follow from the loss of a job, and subsequent loss of income. Of course, there will be an impact on family members or carers, who in turn have to cope or deal with the impact on the patient. There is the worry that an extended wait for surgery will bring more risks of deterioration in the patient’s condition. In certain situations the patient might need more complex surgery later. Moreover, there is always the concern that in certain circumstances a patient might die while waiting for an operation or other intervention. Those are serious, substantive and worrying issues that we, and particularly patients, must all face.

The parlous state of pre-covid waiting lists has made the covid situation worse, but it is not just a question of the impact of covid on lists. There is also the matter of underlying issues faced by the NHS, which covid has greatly exacerbated. In November 2020, making a comparison with 2019, the Health Foundation estimated that there were 4.7 million “missing patients”, as it calls them, who have not been referred for treatment. In other words, if 75% of those patients were included, the waiting list could grow to 9.7 million in 2023-24. That simply reaffirms the point that I made earlier about the need to plan now.

Many people have not referred themselves during covid to their GP. Getting a slot has often been challenging, to say the least. That element could become a significant factor in relation to cancer surgery: it has been estimated that the number of patients with suspected cancer referrals fell by 350,000 compared with the same period two years ago. That point was made not only by the Royal College of Surgeons but by other health-related organisations. The Royal College of Surgeons is not an outlier, and if the Government do not recognise the calamitous situation that patients now face, they will be ill-equipped to resolve it. I do not suggest that they are in danger of putting their head in the sand; but they are, if they are not careful, in danger of underestimating the scale of the crisis facing the country.

[Karin Smyth (Bristol South) (Lab)]

I take my hon. Friend’s point about the Government not putting their head in the sand, but I think he referred to the need to plan. Is the real issue that while perhaps they are not putting their head in the sand they need to demonstrate that they are starting to plan right now?

[Peter Dowd]

That is a fair point, and I will touch on it later. I know that the Minister is well aware of the situation and has his own challenges in getting the point home to his colleagues in the Treasury, among others. We will give him the support that he needs when he has those conversations.

In terms of support to weather this crisis, the Government cannot put the brakes on this vital area of public expenditure. Given the figures I have outlined, it is better to pre-empt this tsunami, because once it comes, it will be all the more damaging. Putting it right after the fact will be more expensive, more difficult and lives will be in danger, not to mention the ongoing economic impacts for the nation. If we have learnt anything from the covid-19 crisis, it is the point made by my hon. Friend the Member for Bristol South (Karin Smyth) that assessment and planning, followed by focused, comprehensive action, are required.

I have set out the issues as many in the health field have them set out. They are not my figures, they are not made up, they are in the public domain. The Minister knows the organisations concerned, as do hon. Members, so I will not list them.

I have attempted to be as concise and factual as possible and to set the scene, but there is a second element: how the issue can be tackled. The rest of my time will be spent on that. Again, this is not me making this up—is is not the hon. Member for Bootle’s version. It is, in a sense, the health organisations’ view. In this respect, the Royal College of Surgeons has set out a clear way in a comprehensive fashion. Other royal colleges and health organisations have expressed their views too. I have no doubt that the Minister will listen to those voices, which will be helpful and constructive. However, they are also unambiguous in their view of the need for the Government to act now with specific proposals that go beyond a balance-sheet approach. I believe the time for details and proposals is fast approaching.

I want to highlight four recommendations. The first is increasing NHS bed capacity. For many years in the run-up to the pandemic, the NHS was far too close to capacity. It was running hot, to use that phrase. International comparisons, which I acknowledge do not tell the full story, but do give a partial story, show that the UK has 2.5 hospital beds per 1,000 people, which is well below the OECD average of 4.7, and behind countries such as Turkey, Slovenia and Estonia. Remember, beds have been reduced from 108,000 in 2010-11 to 95,000 in 2021.

Secondly, during the pandemic the Royal College of Surgeons of England called for the setting up of green or covid-light sites with a separation of elective surgery from emergency admissions. As the college says, there is, “evidence of the risks to patients if covid-19 is contracted during or after surgery, including a greater risk of mortality and pulmonary complications”. In this regard, covid-light sites are critical to process ongoing planned surgery, given that patients and staff are segregated from situations where those who have the virus are treated. In addition, there is a regime whereby patients self-isolate and test negative before any surgical intervention is in operation. Meanwhile, staff without symptoms are regularly tested.

The third recommendation is for surgical hubs. During the pandemic, professionals have worked in partnership to provide mutual aid during periods of intense pressure, thereby enabling a seamless process of surgical intervention. Because of the multi-agency, multidisciplinary co-operation, trusts have also been able to designate certain hospitals as surgical hubs. As such, a capacity for particular types of elective procedures has been facilitated through skills and resources coming together in one place in covid-secure environments. While this hub model, as it is called, is not a total solution, it is none the less a practical way to enable many geographies and surgical specialities such as orthopaedics and cancer to work together.

The fourth recommendation is support for patients, and I touched on that earlier. Again, the Royal College of Surgeons has welcomed the prioritisation of patients in NHS England’s 2021-22 priorities and operational planning guidance. None the less, I agree that we need to go further and provide more guidance about how to develop and expand the options to address those waiting longest, and to ensure that health inequalities are tackled throughout the plan.

In my view, there should also be cross-departmental work on more comprehensive support for those directly affected by covid isolation requirements and people whose livelihood is threatened by longer waiting lists. Before I go on to summarise the four recommendations I have just put to Members, I emphasise that I am aware, and appreciate, that NHS England and NHS Improvement have been working on an elective recovery frame- work covering workforce logistics, clinical prioritisation, patient focus reviews, waiting list validation and patient communication. I welcome that, as will other hon. Members. I acknowledge that the NHS has completed almost 2 million operations and other elective care in January and February this year, and non-urgent surgery times have begun to recover.

In summary, there are four recommendations arising out of the narrative. Recommendation one: the Government should urgently invest in increasing bed and critical care bed capacity across England. Recommendation two: the Government should consolidate covid-light sites in every integrated care system region, and ensure that at least one NHS hospital acts as a covid-light site in each integrated care system in England. Recommendation three: the Government should widen adoption of the surgical hub model across all English regions for appropriate specialities, such as orthopaedics and cancer. Recommendation four: all integrated care systems should urgently consider what measures can be put in place as soon as it is practical to support patients facing long waits for surgery. I would like to put on record my thanks to the Royal College of Surgeons for its advice, information and support in relation to this matter.

Finally, the whole question of workforce-related issues—numbers, pay, conditions at work—needs a comprehensive, fair, equitable and inclusive review. The Secretary of State can initiate a wholesale review of organisational structures in the NHS in the middle of this crisis, which is causing angst and concern across the NHS—we cannot pretend that is not happening. He can therefore initiate a review of the terms that I have suggested.

Many lessons need to be learned from this crisis. I stress the value, commitment and professionalism of all staff in the NHS. Staff across all professions, disciplines and sectors are feeling drained after a year of hard, unrelenting work and we need to thank them for that. Without them, in particular, this country would be in an even worse social and economic predicament than it already is. We owe it to them to ensure that they get all the support they need to support the rest of us. Who could disagree with that?

--- Later in debate ---

[Karin Smyth (Bristol South) (Lab)]

It is a pleasure to see you in the Chair, Ms McVey. I congratulate my hon. Friend the Member for Bootle (Peter Dowd) on securing this important debate. I agree with much of what has been said. I am particularly happy to follow my hon. Friend the Member for York Central (Rachael Maskell), who has spoken so well about assessment, diagnostics and rehabilitation from a clinical perspective—a crucial factor to bear in mind.

The hon. Member for Strangford (Jim Shannon) talked about Northern Ireland. In my own work in Northern Ireland looking at health visiting services, the unique circumstances of Northern Ireland history and the ability to make difficult decisions about reconfiguration and so on and to move services on, as well as the legacy of the conflict, meant that there were some severe challenges making it more difficult for people working in Northern Ireland health services to catch up, even before the pandemic.

I pay tribute to the remarkable job done by the NHS, particularly my colleagues in Bristol, and the way that new pathways and new ways of working have been adopted so quickly. We must maintain and build on the innovation and flexibility that we have seen. As a former manager, one of my previous tasks was to try to get digital technology into the service some 10 years ago, looking particularly at dermatology. It was a gargantuan task. It was not bureaucracy and it was not people not wanting to do it that stopped it happening—it was the way the money works. The way the money works in the system does not always reward innovation. That is one of the things we need to learn from this particular crisis.

I also worked a lot with primary care to try to improve telephone communications, in the days before we had all heard the name Zoom. There is quite a lot of evidence about primary care telephone consultations and how they could help meet the demand for primary care, and about clinicians being willing to undertake them. Patients are often a bit reluctant to undertake them. The evidence has not always been clear. What a massive amount of research opportunity we have now to enable us to understand when people like telephone conversations, when they are helpful, how they support primary care and how we can have new levels of resource.

I know from older members of my family that, despite receiving a lot of phone calls—I have a lot of respect for GPs who have been making those calls—people still want to see people. They want that reassurance. So much of healthcare is about reassurance and making people feel more in control of their healthcare and that they understand what is happening. We need to bear that in mind as well.

We know that we have a large backlog, but we do not know how large. Others have given some estimates. I met leaders at the Bristol, North Somerset and South Gloucestershire clinical commissioning group last week. They are meeting NHS England this week to talk through the levels of backlog and the size of the recovery. My message to those leaders last week is the same as my message for the Minister: locally, we must have very honest, clear conversations about what that backdrop means. Figures of 5 billion, 7 billion and 10 billion mean nothing to local people. We want to understand the impact on our own healthcare system and what the size of the problem is. That openness and transparency—and involving local people in the difficult decisions that are now with us—is absolutely crucial. It is the only way forward.

I have long advocated open, transparent conversations with the health service, and a more locally accountable NHS. When the Minister is looking at his White Paper in the next few months, he might think about having locally elected leaders on the new integrated care partnerships, to bring some of the local democracy that we need, and the accountability of health services, to local people. Local people understand priorities. They understand what has happened. They understand that there is a huge cost and that difficult decisions have to be made. We need to involve them in those decisions. The answer, unfortunately, for some of this recovery is a huge uplift in staffing, facilities and, of course, money, but that must be offset against what happens if we do not ensure that. I know we are all keen to help the Minister do that.

I was a non-executive director during those days of the Labour Government in the early 2000s, when the effort needed to tackle waiting lists was absolutely phenomenal. There was an enormous effort at both strategic and operational level. The clinical and clerical assessment of the lists required control both from the centre and locally. I am told that regular assessment of the lists is being done in Bristol, but it requires more managerial, administrative and clinical staffing models. When phoning patients to see whether they still require treatment, sometimes people will have died. The people who are making the phone calls and contacting people on those lists need to be hugely sensitive. They need to have experience, and they need to be skilled.

Doing this sort of work is not a basic, low-level, ad hoc and temporary admin job. We need to train people properly to do it. They will be communicating difficult decisions and trying to secure an understanding of the level of need in a community. Sadly, during the covid crisis we have seen poor communications around “do not attempt cardiopulmonary resuscitation” decisions. It is problematic having difficult conversations with people, but we have to trust patients and involve people, so let us learn some of those lessons.

I am old enough to remember the Tory Prime Minister who proudly told us in the late 1990s that we would not have to wait more than 18 months—imagine—for our treatment. We in the Labour party thought that we had banished those days to history. We do not want to go back. Our constituents deserve much better, and I am worried that we will go back to those days and to those terrible lists.

As my hon. Friend the Member for Bootle (Peter Dowd) said, we know that there is a resource issue. We will support the Minister in making those text messages, phone calls and emails—however he decides to communicate with his colleague in an up-front, honest and legal way. We will support him in those discussions with the Treasury. He needs to assure us that he understands the size of the problem, that he will be working with leaders locally, and that when those conversations are happening with NHS England and NHS Improvement, we as local Members of Parliament will have full access and an understanding of the level of need, demand and resource in our communities. That has been my challenge to my local leaders of the Bristol, North Somerset and South Gloucestershire clinical commissioning group. If they turn around and tell me they cannot tell me that because someone at NHS England tells them they cannot do so, I will get straight back to the Minister, whose phone number I have, by text message and email to demand answers.

Oral Answers to Questions

Karin Smyth Excerpts

Tuesday 13th April 2021 Commons Chamber

[Nadhim Zahawi]

I am grateful to my hon. Friend, and I echo his comments about the incredible work that is happening across the London borough of Sutton. I thank him for his work in promoting the vaccine, and according to the latest NHS figures almost 90,000 individuals have had their first dose of covid-19 vaccine in Sutton. To this end we are working closely with faith and community leaders to help to spread information about vaccines through trusted, familiar voices and in a range of different languages and settings. That also means leveraging the influence of celebrity figures such as Sir Lenny Henry and the powerful and incredibly moving “call to action” letter and video to black and Afro-Caribbean communities. This is really important. We are also working to support the vaccine programme over important religious observances such as Ramadan, which begins today. We are working with the Muslim community and reiterating the verdict of Islamic scholars and key Muslim figures within the NHS that the vaccine does not break the fast and is permissible, so come and get your vaccine.

[Karin Smyth (Bristol South) (Lab)]

What assessment he has made of the use of do not attempt cardiopulmonary resuscitation orders during the covid-19 outbreak.

[The Minister for Patient Safety, Suicide Prevention and Mental Health (Ms Nadine Dorries)]

In October 2020, I commissioned the Care Quality Commission to review how do not attempt cardiopulmonary resuscitation decisions were taken throughout the covid-19 pandemic and whether they had been inappropriately applied. We welcome the CQC report, which was published on 18 March, and we are committed to driving forward delivery of the recommendations through a ministerial oversight group, which I will chair, to ultimately ensure that everyone experiences the compassionate care that they deserve.

[Karin Smyth [V]]

I welcome the Minister’s comments. It is over a decade since I worked with clinicians on how to communicate end-of-life care, so I was shocked by some of the reports and by reading the CQC and Compassion in Dying reports. The lessons learned from coronavirus can and should be seen as a catalyst to having more open and honest conversations about this decision making and advanced care planning. Will the Minister commit to a public awareness campaign, including groups such as Compassion in Dying, Marie Curie and Hospice UK, to ensure that patients are fully aware and at the heart of these decisions?

[Ms Dorries]

I thank the hon. Lady for her question. That is exactly what we are trying to do at the moment. We have posted a public-facing message on the nhs.uk website, which informs the public about how DNACPR decisions should be taken and the process involved. There should be no blanket application of DNACPR notices. Every patient should be involved in the decision when a notice is applied, as well as the family, relatives and care workers, and where possible it should be signed by a clinician. This engagement with the NHS, the wider public and the voluntary and care sectors is ongoing, and we continue to monitor it.

Covid-19 Update

Karin Smyth Excerpts

Tuesday 9th February 2021 Commons Chamber

[Matt Hancock]

I am delighted to see that there are some parts of the country where the case rate really has come down a long way—down to 25. It is important for us to make sure we get the levels down across the country. We have seen before that when there are areas that are low, there is spread from elsewhere in the country. The experience of last summer was that tourists travelling to go on holiday within the UK did not contribute to an increase in levels. It was when levels elsewhere got much higher that we saw the transmission to other parts of the country. It is those judgments that will inform the road map proposals that the Prime Minister will set out on 22 February. I wish I could say more in more detail to my hon. Friend, but it is for the Prime Minister to set that out later this month.

[Karin Smyth (Bristol South) (Lab) [V]]

The news of the new mutation is obviously of great concern to the people of Bristol, but local public health officials have rapidly set up new testing centres, including five new collect and drop testing centres today. It is a massive effort locally, and hundreds of people have come forward voluntarily since Sunday to be tested. Will the Secretary of State join me in thanking those local public health officials in Bristol and the people who have come forward? Will he join me in encouraging more people in those postcode areas that have been identified to come forward for surge testing to help us understand this virus better?

Public Health

Karin Smyth Excerpts

Wednesday 6th January 2021 Commons Chamber

[Karin Smyth (Bristol South) (Lab) [V]]

Thank you, Mr Deputy Speaker. Retail, hospitality, care, building and trades are the biggest employers in Bristol South. There have been many job losses, but many people are working in those industries and they are keeping our city going. They have done everything the Government have asked of them and we now need to make sure that they are safe, that we get this vaccine delivered and that we open our economy.

I have worked for many years with local GPs and the NHS in the city, and I know them well. I have worked very closely with the team at Ashton Gate stadium, who are on standby to deliver the vaccine. We have a good standard of general practice in south Bristol and good collaboration. They have already started and the Ashton Gate team have been ready for weeks. However, they are all being kept rather in the dark about the expectations upon them and what is happening nationally with the roll-out.

We therefore have some basic questions that we would like the Minister to answer. They are basic project planning “why” questions. We know why we are doing this, but providers locally need to know what vaccine is coming. They need to know who is going to the GP. They need to know how far down the JCVI list we want GPs to go. They need to know how we want them to be called. I think that it is sensible to do the over-75s, care homes and perhaps the clinically vulnerable, but if GPs are going beyond that list, they need to know because, basically, they need to get back to their day job.

We need to know where people are going to be vaccinated. Are the rest of us going to our GP or to Ashton Gate? We need to know when we are going. I understand the reluctance of Ministers to commit to dates—this is a complex manufacturing, distribution and delivery process—but I agree with the right hon. Member for Forest of Dean (Mr Harper) and my hon. Friend the Member for Sheffield South East (Mr Betts) about transparency. Crucially, those who are delivering the service need to know and we, as MPs on behalf of our constituencies, need to know when it is happening.

I have done a back-of-a-fag-packet estimation. South Bristol has about 16,000 over-65s, and GP practices can do roughly 500 to 600 vaccinations a day, so in roughly 30 days we could vaccinate all those over-65s in south Bristol. However, that depends on knowing when we are going to get the vaccine delivered and what the expectations are on the deliverers.

I will support these draconian measures tonight, but I do not want the Government to again impose on us here in Bristol the disaster of the national one-size-fits-all, crony-backed, whack-a-mole nonsense that we have had from them. Our local CCG is doing a good job. We have good collaboration on the ground in south Bristol with GPs and with the people at Ashton Gate stadium. They know what to do; they need support and clarity to get on with it and to make our city safe so that we can resume our normal working lives.

Covid-19

Karin Smyth Excerpts

Wednesday 18th November 2020 Commons Chamber

[The Parliamentary Under-Secretary of State for Health and Social Care (Jo Churchill)]

I beg to move,

That this House has considered covid-19.

Yesterday, there was an increase of 19,609 cases of coronavirus in the UK, and sadly we recorded 529 deaths. I am sure I speak for everyone when I say that our sympathies and prayers are with each and every family. It is a stark reminder, if we needed one, that we still have a long way to go in beating this disease and seeing our country thrive again.

I know that Members across the House will join me in wishing those who are currently unwell a speedy recovery and thanking all the staff across health and social care and key workers for all they do, but I would also like to mention one or two who do not always get a mention: those working in community health, including our health visitors and our pharmacists, and many of the volunteers who keep many of the shows on the road.

As the Office for National Statistics report on loneliness earlier today showed, these changes are taking a toll on our lives. They are taking a toll on individuals, families and businesses, so the news this week of further successful vaccine trials with Moderna and today’s update from Pfizer have given rise to the very real prospect of an effective vaccine in the near future. While I share that sense of hope with many, we still have some way to go, and we must never lose sight of the challenges that we face at the moment. A vaccine still has to go through a regulatory process, but it is right that the planning of the huge logistical exercise of a vaccine roll-out led by the NHS is now very much under way. Throughout this pandemic we have had to learn, and each week brings further understanding.

As more information continues to emerge on the risks of long covid, for example, we are reminded how this virus can remain a threat. I am sure hon. and right hon. Members will be pleased to hear that the NHS will have a network of 40 long covid clinics in place before the end of this month, bringing together doctors, nurses, therapists and other NHS staff to help those patients suffering from the lasting effects of this virus. That is an example of how our response to the virus has to continue to evolve and strengthen to protect staff, patients and the public, moving with the science as we learn more.

It is hard to overstate how little was known about the virus at the start of the year. We have done many things for the first time, and the learning curve has definitely been a steep one, but looking back, we have come a long way through this difficult year. We have always sought to base decisions on evidence, data and scientific advice, and we have been willing to reflect and adapt as we go. From repatriating individuals from Wuhan in the early days of the pandemic, we have constantly faced and met enormous challenges. In the words of General Sir Nick Carter back in April, distributing personal protective equipment, for example, was

“the single greatest logistical challenge”

in his 40 years of service. However, with others helping, such as the Army, we built those supply chains and responded to demand. In some areas, demand went up by 17,000% for eye protection, for example, and by approximately 4,700% for masks. So far, we have distributed more than 4.9 billion items of personal protective equipment to the frontline, and today we have a four-month stockpile in hand across all nine key lines, with a further 32 billion items of PPE on order. We have regularly delivered to more than 58,000 health and care organisations. I would like to pay tribute to Lord Deighton and his team for their extraordinary efforts in building resilience into the supply chain, to enable us to be as confident as we are today.

I am clear that none of this would have been possible without the incredible collaboration we have seen between industry, social care providers, our NHS, the armed forces and others. Industry and individual businesses stepped up to meet the challenge. At the start of the pandemic, only 1% of PPE was manufactured here in the United Kingdom. By the end of the year, we will be manufacturing 70% of the amount of PPE we expect to use from December to March in all key areas bar gloves. This enormous national effort has put our country on a strong footing today and for years to come. Following the launch of the PPE strategy in September, we are looking at sustainability and initiating a UK production site for gloves.

[Karin Smyth (Bristol South) (Lab)]

I accept that it was an extraordinary time and that extraordinary measures needed to be taken, but as we have heard from the National Audit Office today, tried and tested processes and procedures were not used. Will the Minister say something about that report and why that was the case, why we had 11 ministerial directions by May and whether those lessons have been learnt by her Department and others that fell foul of the procurement procedures?

[Jo Churchill]

The NAO report to which the hon. Member refers highlights that we were acting with “extreme urgency” in a global market where demand exceeded supply. The report states that the situation in responding to the covid-19 pandemic was unprecedented, but that we

“secured unprecedented volumes of essential supplies necessary to protect front-line workers.”

[Karin Smyth]

Will the Minister give way again?

[Jo Churchill]

If the hon. Member will bear with me, I will continue.

The NAO report examined potential conflicts of interests involving Ministers and the awarding of contracts and found none. It states:

“we found that the ministers had properly declared their interests, and we found no evidence of their involvement in procurement decisions or contract management.”

The report recognises that there are robust processes in place for spending public money, to ensure that critical equipment got to where it needed to go as rapidly as possible while ensuring value for money. I welcome the report, because we can all learn.

--- Later in debate ---

[Jo Churchill]

I will come on to the area of cancer, in particular. Strides have been made in different ways of treating virtually, so that fewer people go into the hospital setting, and so on. I take the hon. Gentleman’s point about capacity, but that is why the Government have committed to building 40 new hospitals—because there is a need to ensure that sufficient capacity is available across the country for people.

[Karin Smyth]

Will the Minister give way?

[Jo Churchill]

I am going to push on a little bit and then I will give way again.

This enormous national effort has put our country on a strong footing for today and years to come. We are using the best of British ingenuity to help us to deliver in this area. Progress has also been seen in other areas. As the pandemic unfolded, the UK could not call on a major diagnostic industry. From a standing start of about 2,000 tests a day in March, our capacity is now over half a million tests per day. This matters, because it has often been said in this place that in order to beat the virus we need to draw on different parts of our armoury to help to get us through. Testing works. It helps to deny the virus the connections it needs to spread. Mass testing therefore offers us a chance to achieve that on a much bigger scale. We are making progress in city-wide testing in Liverpool. I thank Joe Anderson for his leadership in helping to deliver not only in testing but in other areas too. We are also rolling out a further localised approach to other areas with the help of directors of public health, among others, who know their local areas. Some 83 local authorities have now signed up to receive regular batches of lateral flow tests, which allow for a result to be seen in 15 minutes.

Further, I know that hon. Members will celebrate Monday’s announcement of two mega-labs coming on stream early next year—very high-throughput laboratories, one in the midlands and one in Scotland, adding a further capacity of some 600,000 tests per day. These are massive gains that we are achieving by embracing cutting-edge technology such as automation and robotics and harnessing the best of British industry and academia, meaning that we will not only be able to process more tests but that they can be processed quicker and at a lower cost. The mega-labs will be another powerful weapon in our defence against this deadly virus in order to get back to a more normal way of life, but more than that, they will form a permanent part of the country’s new diagnostic industry. They can help us to respond in the future and build further resilience.

I am excited at the potential for a new diagnostic industry to help to care and deliver across other disease types, not least cancer. Hon. Members will know that, informed in large part by my own experience, I was an advocate of improved cancer outcomes long before I came to this place or took on this role. Early diagnosis is the key to beating the disease, and with bold steps forward in diagnostics, I would like it to make it my mission—I am sure with many others across the House—that we seize new opportunities in cancer services so that covid-19 is not a derailer but an opportunity for a new phase in smarter, faster diagnostics.

--- Later in debate ---

[Alex Norris]

The hon. Gentleman gives a concerning example that shows how the system is struggling in general. I hope that the Minister will address that issue when she winds up the debate, and I will refer more directly to local authority public health shortly.

I do not want to carp on about what is not working without providing any solutions, so I come armed with three things that Ministers could do at a stroke of their collective pens that would radically improve test and trace in short order. First, we must better use NHS lab capacity to turn tests around. I very much welcome what the Minister said about megalabs, which we have eagerly anticipated for some months. However, there has been a large gap in which we have not had that lab capacity, and we will not have it for some time yet. In the meantime, let us put our NHS lab capacity to use in getting tests turned around.

Secondly, we should give control and resources to local authorities to run the tracing operation. They know our communities and already have a local presence. They are a trusted voice and, crucially, they do this routinely. They do this already. Admittedly, that is on a smaller scale—perhaps related to an outbreak of food poisoning linked to a takeaway—but they do it effectively. Let us support them to do it fully. Thirdly, we must develop a proper package of support for those who need to isolate—that is self-evident. Those three things could be done immediately, and we would all be better off if they were.

We have seen the consequence of failure and of a test and trace system that is struggling, and that is another lockdown. This time last year we were banging on doors in the cold and the rain, and none of us supported the lockdown because we want to keep family members away from each other, or to shut businesses in our community or anybody else’s. However, the failure to break the transmission rate of the virus leads us there.

There are two important things that I wish the Government would communicate more. This is not a choice between lockdown and the economy; it is not a choice between lockdown and non-covid healthcare treatment in the NHS. We must have the lockdown for those purposes, and the longer we delay putting restrictions in place, the worse are the long-term impacts on our economy. If we do not introduce regulations to reduce the transmission of the virus, the greater are the pressures on our hospitals, and the less likely they are to be able do other treatments. Those things are not in tension; they are very much complementary.

The failures of test and trace may have led us to a lockdown, but that lockdown buys us time to sort out problems in the system. We must see progress. Lockdowns alone will not tackle or eradicate the virus, but they buy us time to put in place the things that do. We have now had two weeks of lockdown, but we have not heard about what is improving in the test and trace system, or what will be better, including in the next two weeks. Ministers really need to say this today, so we can be sure and confident that the time is being used wisely. Otherwise, when we leave lockdown, this will all recur again, something that none of us wants.

We are all very wary of Christmas. Depending on which newspaper Members read, they may have woken up yet again to see that the Government’s plans, this time regarding yuletide festivities, had been briefed out to national newspapers. Putting aside the discourtesy to the Speaker and Deputy Speakers, to all of us and to this place in general, that is all well and good, but those plans are only going to be feasible if the right efforts are put in place now and this time is used wisely.

It also ought to be stated that this lockdown is longer and more painful than it needed to be because, once again, the Government acted too slowly. The scientists told them they needed to lock down, as did we, but for two weeks the Prime Minister disregarded reality, which meant that the situation worsened. That has meant that the lockdown will be longer and harder, and also meant that we lost the benefits of the school holidays. These are mistakes that cannot be repeated in the future.

As we exit lockdown, the Government need to be honest with the British people—not in off-the-record briefings to mates in the media, but to the British people—about what will come next, both at Christmas and in the return to a tiered system. I know from our experience in Nottingham that trying to negotiate restrictions was painful, even when we wanted them at the beginning of October as our infection rates increased precipitously. We could not get the initial restrictions we wanted, because the Government were moving to the tiered system and it did not fit their timeline. We then managed to get into the tiered system at tier 2; the next day, the Government said that they wanted us to move into tier 3 and were going to call us, which they did not for a further week. Eventually, we had the painful negotiations about what that actually meant for Nottingham: we brought those restrictions in on the Friday, and by the Saturday, the national lockdown had leaked out. The system has not worked for Nottingham, so we need to know that in any return to a tiered system, the Government are going to work much more quickly and in a more agile manner. Every day wasted is a day when the virus thrives, so we need to be better upon exit.

Turning to the vaccine, we strongly welcome the Government’s efforts in this area: they were right to pre-order doses across a wide portfolio, and they were also right to back British. With our excellent research and our proud record in this area, we should be in the vanguard of it, and patriotic about our efforts to tackle this global issue. Last week, I responded on behalf of the Opposition in an excellent Westminster Hall debate on the covid-19 vaccine, secured by the hon. Member for North Herefordshire (Bill Wiggin), the day after the news broke that the Pfizer-BioNTech vaccine had achieved success in a phase 3 study. Since then, we have heard similarly positive news about the NIH-Moderna vaccine candidate, which is likely to be followed by other candidates, whether that of the University of Oxford and AstraZeneca, the candidate referenced by the Minister, or candidates developed elsewhere. I understand that overnight, there have been further promising developments for a Chinese candidate.

During that debate, colleagues and I raised the challenges and considerations that need to be addressed to make sure that this is handled and executed well. I will not repeat those contributions in the level of detail we went into then—they are on the record in Hansard for people to read. However, the theme was that we cannot repeat the slowness or logistical challenges that we saw early in the pandemic with regard to the procurement of personal protective equipment and testing: no Nottingham people being sent to Llandudno or Inverness for their healthcare this time, please, Minister.

As we have done throughout the pandemic, we on the Opposition Benches will work constructively with the Government to support viable vaccines being secured, ensure the right groups are being prioritised, develop an effective delivery programme, counter vaccine hesitancy—that is critical—and continue to support these efforts globally. A failure on any of those points will undermine the whole process, so it is absolutely crucial that we come together, and I am sure that Ministers will welcome that.

However, I want to briefly reference a point that my hon. Friend the Member for Bristol South (Karin Smyth) made regarding the NAO report. Again, we understand—as that report did—that the Government were having to do things that would normally take 18 months’ worth of planning in hours and days, and that comes with some efficiency trade-offs. However, we did not hear clearly enough in the Minister’s opening statement a sense that that has been reflected upon, and we did not hear what will be different in future to make sure those mistakes are not repeated.

[Karin Smyth]

I appreciate my hon. Friend having picked up on the point I made. The Minister very carefully read out a statement in reply to my question about the Government’s response to the NAO report. I am concerned that she was saying that the Government stand by what they did in that period, and do not think that the way in which those contracts and large procurement processes were handled was a problem. It may be that the Minister wants to correct the record, but if that is the case, does my hon. Friend agree that that is deeply worrying?

[Alex Norris]

I heard the point that the test had been clear that nothing wrong had been done, which, frankly, is a very low bar. I do not think anybody would say that there was nothing that happened in the early procurement phases that we would not perhaps want to change or do better later. I hope that the Paymaster General in winding up might reflect on that.

Perhaps this is the best place to say that the announcement on long covid will be very much welcomed by a lot of people, including my good friend Jo Platt who has been campaigning on this for many months, as well as living with her long covid. This is a story for lots of people up and down the country, across all our constituencies, who are living with the after-effects of this horrible virus over and over again. The act of knowing that they are being heard, as well as the 40 clinics, will be a real tonic to a great number of people, so we very much welcome that.

I turn to inequalities. At the beginning of the pandemic, we talked about the virus being a great leveller, not distinguishing between us depending on our lives, our jobs and our postcodes, but nine months on we know that to be patently untrue. Sixty per cent. of those who died were living with disabilities. Those of Bangladeshi heritage are twice as likely to die as those who are white British. Those of Chinese, Indian, Pakistani and black Caribbean ethnicities are 10% to 15% more likely to die than I am. Mortality rates in the most deprived communities are more than twice those of the least deprived communities. This pandemic has shone a light on our inequalities, whether that means the inequality in work, in housing or in income, and these inequalities have had tragic consequences for some and, in the aggregate, are catastrophic for all of us.

When we beat this virus, which together we will, what comes out of it must be a fair settlement that recognises these inequalities as bad and tackles them head-on. That is why it is already concerning to see again—of course, leaked to national newspapers—that the overseas aid budget is the first on the chopping block. In 2010, the Government chose to target those who had the least to pay for a crisis that they did not cause, and these reports are a sign that maybe this is the plan again. We will not let them repeat this in 2020. It simply would be hugely unjust.

Before I finish, I would like to take this opportunity to thank our incredible NHS and social care staff for all they have done for us. They are truly the best of Britain. Similarly, the pandemic has revealed the key workers all over our communities and all over our economy, so this week, during Respect for Shopworkers Week, I would like to say a special thank you to those working in our shops, keeping us fed, but still facing rising violence and abuse every day. The Government should take better action to protect you—the Government could, of course, adopt my private Member’s Bill and I encourage them to do so—but whether it is that or through another mechanism, we will fight for you until they do.

In conclusion, now more than ever we must stand together as a country, as families and as communities, and show once again that at a moment of national crisis, the British people always rise to the challenge, support those who need it and pull together. That involves not only recognising successes, but assertively tackling the failures that have held us back during the pandemic. If we address these, we will beat this virus.

--- Later in debate ---

[Karin Smyth (Bristol South) (Lab)]

Back in March, when our worst fears were confirmed and the first lockdown hit, I thought that some aspects of the UK Government’s response would be taken as read. I worked in public health and emergency planning before entering this place, and I know at first hand what a response should look like in the most basic terms and what it should feel like. I expected usual processes to function and best practice to kick in, and for muscle memory and accepted norms to initially, at least, shape our response. And I expected all that to happen underpinned by Government support.

I accept that the extraordinary nature of those months, as the Minister said in opening this debate, was unusual, However, as the National Audit Office report states, there were 11 ministerial directions. I do not accept that the virus was unexpected: the scenario planning was based on a threat of this type. I do not accept that the NHS was prepared: the Government were consistently warned that running at 95% capacity was not sustainable. And I do not accept that the way in which the response was led is beyond scrutiny.

What we heard from the Dispatch Box earlier was worrying, and I hope that the Paymaster General will clarify the situation when she winds up the debate. Essentially, the Under-Secretary of State for Health and Social Care, the hon. Member for Bury St Edmunds (Jo Churchill), said, “Nothing we have done was corrupt.” However, issuing a ministerial direction is serious. It is about regularity, propriety, value for money and feasibility —and these contracts do not stand that test. One of the contracts for free school meals, for example, was with Edenred, a French company. There was no formal tender process under the emergency regulations, despite existing processes and companies being able to provide those critical school meal vouchers back in early spring. That took so much time and energy from schools in my constituency. It affected vulnerable children and that is totally unacceptable.

We may not be able to scrutinise the Government as we should because we passed the Coronavirus Act 2020, but the Select Committee on Public Administration and Constitutional Affairs, of which I am a member, will continue to do its job. I hope the Government will consider a more open and transparent way of operating in the coming months and that they will look at our report—the Minister gave evidence to the inquiry—in order to learn some of the lessons of what we should have used from the Civil Contingencies 2004. I am afraid time precludes me from talking about that in more detail, but we should return to that in this place.

I said in July that I hoped that we had turned a corner and that there would be more local work and a more local response. I genuinely thought that we might, but we have not, have we? As my hon. Friend the Member for Nottingham North (Alex Norris) has outlined, we will continue to try to make positive suggestions, but it remains the case that people in Bristol South are being disproportionately hammered by covid compared with other parts of the country. For the young and the very old, those on low incomes or in insecure work, those living in houses in multiple occupation, those from black and minority ethnic communities, those from multi-generational households, the cooks, cleaners and retail and hospitality workers, and those who rely on the Government, their inequalities are being exacerbated. This is made worse by the fact that the Government have lost time and wasted valuable knowledge that they could have used locally to manage the system better.

On the Select Committee on Public Administration and Constitutional Affairs, our inquiry has shown that the disconnect between the local and the national has been deeply problematic. In early May, we heard evidence from Sir Ian Diamond of the Office for National Statistics about how we could have utilised much of the data that is available much better, but again the Government have been too slow, and we need them to try to be much better. I think lessons are being learned, but I do not think they are being learned by Ministers and the Cabinet; the political direction and leadership are desperately worrying. We want the Government to do much better, and it is not too late to reset—it really is not. Our lives and our families depend on it, but it is crucial that the Government build back trust and admit where they have got things wrong. People will understand that. We need to empower local capacity and knowledge to lead the work, shape local solutions to the challenge, and deliver on the ground so that we can all have our lives back.

Coronavirus Regulations: Assisted Deaths Abroad

Karin Smyth Excerpts

Thursday 5th November 2020 Commons Chamber

[Matt Hancock]

I respect my hon. Friend’s views, which are deeply and sincerely held, and I respect the fact that the House will debate all views. It is right that that debate is taken forward and led by Parliament, rather than by Government, as my hon. Friend just demonstrated.

[Karin Smyth (Bristol South) (Lab)]

I congratulate my co-chair of the all-party parliamentary group on choice at the end of life, the right hon. Member for Sutton Coldfield (Mr Mitchell), on securing this urgent question, and I thank you for granting it, Mr Speaker. I have sought to change the law since entering the House. In the last five years, I have learned that many colleagues are worried about safeguards. There is an assumption that the law is currently safe, but it is not. In June, here in London, a man threw himself in front of a heavy goods vehicle on the North Circular. He was suffering from throat cancer and knew his tumour would continue to strangle him. He could not bear it. He took his own life because this country denied him the option of choosing the timing and manner of his death. I appreciate that this is a sensitive and difficult issue, but is it not time that we recognise that the law is not compassionate or safe and leaves behind bereaved families and members of the public because of the absence of a safeguarded choice at the end of life?

[Matt Hancock]

The hon. Lady draws a distinction between those who have a terminal illness and the broader issue of suicide, which is an important part of this debate. I respect her sincerely held views. The exchange between my hon. Friend the Member for Congleton (Fiona Bruce) and the hon. Lady exemplifies why it is right that Parliament debates and decides on these matters.

Public Health: Coronavirus Regulations

Karin Smyth Excerpts

Tuesday 13th October 2020 Commons Chamber

[Karin Smyth (Bristol South) (Lab)]

Bristol, in tier 1, has fortunately been able to maintain low transmissions, and hence admissions to hospital and, so far, deaths. We want it to stay that way. My experience of working in the local health system is that this is in large part due to good relationships that have been hard developed over many years, particularly through local resilience forums. There are good relationships with Public Health England and directors of public health. Working together is sustaining some very good work locally, but there is no room for complacency. We recognise that the economy—wealth creation—is crucial to good local health, and we need support from the Government for both those things.

In the short time available, I want to highlight issues around isolating, shielding, and test and trace. As well as reducing social contact, which the Secretary of State talked a lot about, the key to transmission reduction is isolating, but isolation support is woeful and for communities with little money, which face higher unemployment, the situation is worsened. We have to be much more honest about the incentives and the way they work to support people who are isolating. It is hard and the knock-on effects on families are substantial and disruptive. Again, we need local public health people who know their communities to help support those who are isolating. We need much more support for people who are shielding. People do not understand why it is now different from how it was back in March.

Across the House, we all know that the test and trace system is not working. It is causing chaos for the frontline, particularly care home managers and school leaders. There is a balancing act to be done here. Again, we need local support to inform those school leaders and care home managers about how to interpret the guidance. That cannot just be done through the algorithm. It is a disgrace that the test and trace system is not led by a civil servant whom we can hold to account. I do not know how we can hold the Baroness—I do not know whether the courtesies of the House allow me to name her—to account for the system. That must be changed. It is crucial that we can hold people to account.

I accept that the legislation was rushed through in March, and perhaps there was a reason for not using the Civil Contingencies Act 2004 or the public health legislation we are debating today. The Public Administration and Constitutional Affairs Committee has scrutinised this, produced our report and we now need to move to a better way forward. We cannot keep dragging the Government here week after week to do our job, which is to agree to disagree, to scrutinise and to hold to account, based on our experience, the work we do in Committees and our work locally. It would improve the legislation. It would improve local trust, and ultimately that supports the front line and saves lives.

Coronavirus Act 2020 (Review of Temporary Provisions)

Karin Smyth Excerpts

Wednesday 30th September 2020 Commons Chamber

[Nick Thomas-Symonds]

Moving swiftly on.

In England, the number of tests, the availability of tests and the turnaround time simply are not good enough. So dire is the situation that the Prime Minister is arguing with the Health Secretary over whether testing even matters. The Health Secretary has said that

“finding where the people are who test positive is the single most important thing that we must do to stop the spread of the virus”,

and I agree with him. I agree with the Health Secretary. The shame is that the Prime Minister does not appear to, because he has said the complete opposite. The Prime Minister has said:

“Testing and tracing has very little or nothing to do with the spread or the transmission of the disease.”—[Official Report, 22 September 2020; Vol. 680, c. 822.]

Yet again, the Prime Minister refuses to take responsibility for his own actions and his own failings.

The testing of care home residents and staff is critical to saving lives, yet in England there have been repeated delays to the roll-out of testing, and people have waited days for their results. We are also witnessing chaotic scenes at our universities as students are locked down for the want of testing. The Prime Minister has been talking about a “moonshot”, but it is time he stopped looking up at the sky in vain hope and focused instead on what is happening in the everyday lives of families and businesses up and down the country. The failure to show that grip and strategic leadership has severely hampered the way in which the UK Government work with other Governments, as my right hon. Friend the Member for North Durham (Mr Jones) said. Some have not even been properly informed of lockdown plans for their own areas. Let us take yesterday as an example, when we had the chaos of the Prime Minister himself unable to outline what additional restrictions his own Government were implementing for the north-east of England. It is, frankly, an embarrassment, and people deserve better. If the Prime Minister actually bothered to communicate with some of the devolved Governments, he might learn something. In Wales, the tracing system is significantly better. The percentage of contacts that has been reached has been consistently higher than in England, and the Prime Minister ought to follow that best practice.

Let me turn to some of those most at risk in our society. The Health Secretary claimed to have thrown a “protective ring” around care homes in England. If that is what the Government call the shambles they presided over, I would hate to see what they consider a mess to be. Again, the Prime Minister tried to shift the blame, insultingly suggesting that

“too many care homes didn’t really follow the procedures”,

and that was when the Government’s own advice at the start of the pandemic said that people in care homes were “very unlikely” to be infected. The truth is that too many care homes were left high and dry. There was not enough support, insufficient personal protective equipment and a lack of testing. I am sorry to say that some of the most vulnerable paid the price and, sadly, paid the ultimate price. Yet again, care workers, who should be lauded by the Government, were denigrated.

That failure on care homes is particularly relevant as we discuss and debate this legislation and its renewal, because the Act contains provisions that allow for the so-called “easement” of legal safeguards. The Health Secretary said that he thinks those are still necessary, but why are they still necessary? I read carefully the analysis that he published, which did not answer the question. He tried in his speech to make a positive case for it on the basis of prioritisation, but he must realise that that does not deal with the deep concern there is about the situation in our care homes, and he must surely understand that every vulnerable person, throughout this pandemic, must have the standard of care that they need.

We also have significant concerns about the curtailment of the use of GPs to sign death certificates. Again, the Health Secretary said that he wanted to continue with that provision. What assessment has been made about the use of this power? Why does it need to continue? Will he also tell us what its impact has been? Ministers have no excuse for being caught unawares, as they have had months to get to grips with this. We cannot afford for action to protect our care homes and other services to be as slow and chaotic as it was at the start of this pandemic.

On a more positive note, I welcome what the Health Secretary said about the easements under the Mental Health Act; they have not been used and I welcome his assurance that they will not now be used. But what about the easements under the Children and Families Act 2014? He did not mention that Act, and I assume from the silence that they will be continuing. He must bear in mind those with special educational needs and vulnerable children, whose rights should not be rolled back as a consequence of this pandemic. Some of the most vulnerable people have borne the brunt of this virus and this Government’s failings.

We have also seen, across our communities, that the impact has not been evenly felt. Black, Asian and minority ethnic communities have been some of the worst-hit by the virus itself and by the economic fallout, Disabled people and those with underlying health conditions have made up 59% of the covid deaths to date. Despite that, the Government have not done enough work on equality impact assessments on measures or made the necessary evidence available so that we can openly debate and vote to address these deep inequalities. Today, we are faced with an all-or-nothing motion, but let me put the Government on notice that we will not tolerate any discrimination in our society as a consequence of the implementation of these measures. That is why I say to the Government today that they should not be waiting another six months; they should be publishing a monthly review of the impact of this virus on individuals and groups, together with those detailed impact assessments. If the Government continue with the easements under the Care Act 2014, as they say they will, or under the Children and Families Act 2014, they must report regularly to this House about the impact of what they are doing,

[Karin Smyth (Bristol South) (Lab)]

I hope my hon. Friend agrees that the way the Secretary of State has approached this matter today is disappointing. Many of us sit on Select Committees and have scrutinised the way in which this Act has come forward, and are willing to spend more time doing that properly. That is our job as legislators. The approach has been most unsatisfactory, so I completely support my hon. Friend when he says that we need it to be better. There are recommendations in many Select Committee reports, and my hon. Friend should press the Secretary of State to take note of them.

[Nick Thomas-Symonds]

My hon. Friend is absolutely right. She saves me from coming to another part of my speech. Quality scrutiny is available across the House on a cross-party basis, and we have had no credible explanation for why this debate is limited to 90 minutes.

The rights that I have referred to, relating to the easements that the Government are pushing forward, protect vulnerable people—those who need care, those with mental illness and children with special educational needs across the country. We cannot simply put their rights to one side.

On rights, there is a real issue with schedule 21. My right hon. Friend the Member for Leeds Central (Hilary Benn) put his finger on it: the power to detain “potentially infectious persons”, which, as far as I can make out, could include virtually anybody. So far, it has been used for 141 prosecutions, each and every one of which was found to be unlawful when it was reviewed. I cannot think of any other piece of legislation in parliamentary history that that could be said about. All the Health Secretary said was that the guidance had changed and he would keep it under review. With a provision like that, he needs to speak to the Home Secretary and the Justice Secretary and do so much better. A provision that has resulted in 141 unlawful prosecutions cannot be right.

I say to the Health Secretary that the Government have to be transparent and accountable. They must come back not in six months’ time, as set out in Act, but every month to answer for the use of these powers.