Leaving the EU: Business of the House

Debate between Karin Smyth and Steve Barclay

Wednesday 12th June 2019 Commons Chamber

[The Secretary of State for Exiting the European Union (Stephen Barclay)]

May I be the first to congratulate my hon. Friend the Member for North Dorset (Simon Hoare) on his election to that important Select Committee, at an important time for it?

I want to begin by picking up on a few of the points that the right hon. and learned Member for Holborn and St Pancras (Keir Starmer) made in his opening remarks. The first passage of his speech covered what the motion does not do. He set out that it does not cover the legislation that it would unlock—it does not cover the substance, and it does not cover the form. So often in our exchanges at the Dispatch Box, he tells me how much he does not like a blind Brexit, and yet what we have before the House is, in essence, a blind motion. He devoted his opening remarks to the extent to which this is a blind motion, for it does not contain the detail on the basis of which the House will decide.

Interestingly, in the context of the Conservative leadership election, the right hon. and learned Gentleman went on to point out that a new Prime Minister would be limited—they would be unable to go to Brussels to secure a change of substance to the backstop—and yet his position is that a Labour Prime Minister would be able to go to Brussels to secure that. Within his remarks, one can see the contradictions inherent in the motion.

Let me deal with the substance of the motion. Section 1(b) gives precedence to any motion from any individual MP over Government business, and section 1(c) states that it is for you, Mr Speaker, to decide whether that motion is brought before the House over other motions. In essence, sections 1(b) and 1(c) say that an individual MP and the Speaker—two Members of the House—can override Government business. That is the effect of the motion. It puts in the hands of just two Members of Parliament the decision on which business takes precedence. That is what the text of 1(b) and 1(c) says.

[Karin Smyth (Bristol South) (Lab)]

The current Prime Minister has got stuck in a triangle composed of the Brexit that the Conservative party wants, the constitutional make-up of the United Kingdom, and the successor to the Good Friday/Belfast agreement and all it contains. She has not been able to sort out that triangle. What will be most important to the new Prime Minister when he goes to Brussels: the Brexit he is promising the Tory party, the constitutional make-up of the United Kingdom, or the legacy of the Good Friday/Belfast agreement?

[Stephen Barclay]

First, the hon. Lady says “he”, but there are a number of female candidates in the leadership election and one should not pre-empt the outcome. Secondly, we do not know who the Prime Minister will be. Thirdly, first let me deal with the text. [Hon. Members: “Answer the question.”] I will happily come on to it, but I thought we were here, as per the direction of Mr Speaker and as the hon. Member for Stoke-on-Trent Central (Gareth Snell) said in an intervention, to debate the motion. [Interruption.] The hon. Member for Heywood and Middleton (Liz McInnes) may chunter, but I am not surprised that she does not want to debate the motion, because it is a flawed motion, for reasons I will come on to. Labour Members do not want to debate the text that is before the House.

Oral Answers to Questions

Debate between Karin Smyth and Steve Barclay

Thursday 4th April 2019 Commons Chamber

[Stephen Barclay]

I think the hon. Lady mischaracterises the position. The number of staff recorded as EU27 nationals working in the NHS trusts and clinical commissioning groups in England increased by more than 5,200 between June 2016 and December 2018—there has actually been an increase in EU nationals. She also omits to mention the record investment—£20.5 billion a year extra—that this Government are making in the NHS, the NHS apprenticeships we are bringing through, and the change in tier 2 visas for talent around the world in order to attract more doctors and nurses to the NHS.

[Karin Smyth]

In my former job, before I came to this place, I was an emergency planner for the NHS locally in Bristol. The NHS has had to put in contingency plans and major incident plans to cope with a no-deal scenario and the future. What compensation will the Government give local NHS bodies for the time and money they have spent and wasted on incident planning that probably will not come into effect because of the Government’s incompetence?

[Stephen Barclay]

I know from my time as a Health Minister that the hon. Lady always asks very pertinent questions in respect of health matters. She will be well aware of the statement issued by the Royal College of Paediatrics and Child Health, which said how well prepared the NHS was. It has been our priority to ensure that we maintain the supply of medicines and to ensure that the NHS is a priority in our contingency planning. That is the responsible thing for a Government to do.

Management of NHS Property

Debate between Karin Smyth and Steve Barclay

Wednesday 4th July 2018 Westminster Hall

[The Minister for Health (Stephen Barclay)]

It is a pleasure to serve under your chairmanship once again, Ms Dorries. I pay tribute to the hon. Member for Bristol South (Karin Smyth) for bringing such an important issue before the House.

The hon. Lady opened by saying that property may not be the most exciting of topics but, as her speech set out, it is integral to the healthcare service offered in local settings. The substance of her remarks was whether we can better align the property estate with a place-based approach to healthcare. As we move to a more integrated and place-based approach to health, I think there is cross-party consensus that property has an important role to play as an enabler of that. The hon. Member for York Central (Rachael Maskell) kindly recognised that that is very much the approach that I have taken in my post, and my hon. Friend the Member for York Outer (Julian Sturdy) recognised it in expressing his frustration with one or two meetings and asking whether decisions on property are aligned with the place-based approach.

The first point I will make to the hon. Member for Bristol South is that the long-term plan and the future discussions about the NHS give us the opportunity to look at wider system changes around integration and place-based healthcare, and how property aligns with that—for example in York, which has been discussed—as an enabler of change in a more holistic approach. As such, her remarks are timely as part of that wider debate.

The hon. Lady mentioned Knowle West health park, which, if I am honest, I looked at for the first time when preparing for the debate; I was not as sighted on that as I might have been. The issue is that, if NHS England provided that service, the additional market rent costs would have been reimbursed, but because it is provided by the county council they are not. However, as she recognised, there has been progress in recent weeks, thanks in part to her work. I am happy to take forward a discussion on that offline if that would be helpful, because I recognise that it is an important service and that we need to ensure that, where market rents are applied, it is not counterproductive to those services.

However, that should not get in the way of the wider point. The hon. Lady suggested that the new approach is a backwards step. I simply point out that there has actually been significant progress by NHS Property Services. The previous model had the inherent conflict that the primary care trusts were both the landlord and commissioner of the property, and therefore the use of the estate was quite opaque. As a result, we did not get transparency on the true cost of the estate, meaning that inefficiencies were not being flushed out and estates were not being utilised in the most effective way.

One driver of NHS Property Services applying market rents has been the need to encourage better utilisation of the estate by being more transparent on the actual costs. I point out to the hon. Lady that there has been significant progress as a consequence. Some £200 million in capital receipts has been unlocked, 500 capital investment construction projects are being launched each year and running costs have been reduced by £120 million. On balance, as we look forward to the long-term plan and pick up on some issues that the hon. Lady quite rightly highlighted, it is also important to recognise that the old system often allowed estates to be utilised inefficiently. Having truer market rents has actually enabled more transparency and driven efficiencies, with savings then able to be reinvested into the service.

The hon. Lady also mentioned salaries and bonuses, which again are part of a wider question. On the one hand, these are big businesses and their leaderships compete in a competitive market. There is a wider debate within Parliament on the right value to assign to senior salaries in the public sector in order to attract talent. These are big budgets, so we need to attract people of the right ability; it is a false economy to save a relatively small sum on lower salaries for people who then make incorrect decisions that waste much larger sums. At the same time, salaries should reflect the values of the NHS and should not be out of step with others in the NHS. There is a cross-party debate on that, and I am interested in the hon. Lady’s points about it.

The hon. Lady also raised NHS Property Services’ new offices. My understanding is that the previous model was highly inefficient. It had five different properties, so the move to Gresham Street was a consolidation of those five properties into one. That drives productivity, which is a key issue that we need to unlock within the workforce. Two thirds of NHS costs are in the workforce, so driving workforce productivity is a key objective. I am sure the hon. Lady will agree that the workforce being consolidated in one office enables a degree of productivity and efficiency that would be harder to achieve if they were disparate across five areas.

The hon. Lady mentioned the impact of the rent adjustment on Bristol. Some 15 GP practices in and around the city of Bristol occupy NHS Property Services sites. NHS England has been working with the Avon local medical committee, practices, NHS Property Services and the Bristol, North Somerset and South Gloucestershire clinical commissioning group and has facilitated negotiations between GP practices and NHS Property Services on reviewing the levels of rent and service charges invoiced to GP practices, to ensure that there is transparency on them.

However, as the hon. Lady will be aware, rent and business costs incurred by practices are reimbursed to GPs under the premises cost directions, and GPs should be compensated for any rent changes through that route. The Department has provided an additional £127 million to the NHS England mandate, with effect from the 2016-17 financial year, to fund the increased costs in the NHS of this policy change.

[Karin Smyth]

I am grateful for the Minister’s comments about, and work on, Bristol. I agree that the estate was not always particularly well managed in the local health system previously, and that the correct incentives are needed. However, does he agree that he has outlined a merry-go-round of money keeping the entire system afloat? NHS Property Services exists on a large and continuing Department of Health loan, so it is not, in any sense—as the Minister described—a successfully run property business.

[Stephen Barclay]

I was trying to make the point that greater transparency on the true cost of the estate drives behaviour to use the estate more effectively. Part of the difficulty has been that, because the estate was not adequately charged market rents in some areas, moving to a fairer and more transparent assessment of market rents—these things are independently assessed, I hasten to add—is a difficult adjustment. However, a consequence of correctly assessing the value of the estate is the unlocking of efficiencies where the estate is not being utilised, and that money can then be reinvested into the system.

I absolutely agree with the hon. Lady’s wider point, which I took as the substance of her remarks, that property is the enabler of system change. That also came out in the points raised by my hon. Friend the Member for York Outer, and has been inherent in points made by the hon. Member for York Central in our previous discussions. Property does not sit in a silo but is inherent in the wider service offering, and it also plays into reconfigurations. A key part of clinically led reconfigurations of estates to drive productivity will be what property there is to enable that and how to utilise it.

The point on which there is a degree of cross-party consensus, as my hon. Friend the Member for Henley (John Howell) recognised, is that decisions need to be accountable. Likewise, I am happy to pick up on the point he raised on behalf of his constituents about there being no accountability. That is an absolutely fair challenge to the Department and one that I am very happy to look at. However, I am mindful, as I know he will appreciate, that these are often independent bodies making independent decisions, and we need to look at how they fit into the system.

A further point raised by the hon. Member for Bristol South, although it is slightly outside of the scope of the debate, was about wholly owned subsidiaries, which she also raised in more detail in the estimates debate. I make two points. First, as she knows, subsidiary companies actually give greater flexibility to trusts that want to compete in a local market and perhaps offer higher salaries offset by changes to pensions. That is one way in which trusts are empowered and enabled to hire in a competitive market, for instance in the case of maintenance staff. It is an enabler, and it often results in people getting paid more for a role, although there may be other, less favourable terms and conditions to offset that. I merely point out that those were exactly the arrangements reached for Members, and I do not remember too many press headlines suggesting that Members were being exploited by that change.

Secondly, I remind the hon. Lady that, as I am sure she is well aware, legislation introduced by the last Labour Government enabled wholly owned subsidiaries. Again, I do not recall Labour Ministers, when taking that legislation through the House, suggesting that it would provide a way of exploiting NHS workers or privatising the NHS.

I commend the hon. Lady for the points she raised. This is a timely debate given our discussions with the NHS leadership on the long-term plan. She is absolutely right—Government Members and other Opposition Members also recognised this—about the centrality of property to the place-based approach that we seek to take. I am happy to have a separate discussion with her on Knowle Park to check whether that is now in the right place or whether further work is needed. I look forward to further discussions with her on how we should utilise the property estate in the most effective way.

Question put and agreed to.

NHS Wholly Owned Subsidiary Companies

Debate between Karin Smyth and Steve Barclay

Tuesday 6th March 2018 Westminster Hall

[Stephen Barclay]

I will happily take interventions, but first I will finish this point, addressing the previous issue. The recent staff survey was extremely positive: 86% felt part of the Gateshead Health NHS Foundation Trust group. Furthermore, the figure for those with a positive response to the level of pay was 15% higher than the NHS comparator. The idea that the arrangement is exploiting people when the staff survey shows them to be 15% more approving than in other areas is again not a fair representation of the case.

[Karin Smyth (Bristol South) (Lab)]

In the short time remaining, I would like to move the Minister on to the issue of accountability for public money. Following a freedom of information request, in the case of Yeovil we understand that the benefit to the trust is several million pounds-worth of income, which is a lack of income from the Treasury—I have written to the Minister about this and I will be grateful for an answer. Is the Government’s position that they would be happy to forgo the expected income to the Treasury so that those companies can be set up to undercut wages?

[Stephen Barclay]

As I set out in my reply to the hon. Lady, the Department has been clear that setting up a subsidiary is not a vehicle to avoid VAT—that is not acceptable. In the autumn, we sent out guidance to make that clear. As a former Treasury Minister myself, I assure her that Treasury Ministers would take a very close interest if they felt that an abuse of VAT was taking place.

The reality is that commissioners and regulators are responsible for ensuring that NHS providers act in the best interests of patients and taxpayers. We would expect providers to work closely with their employees in any developments.

Oral Answers to Questions

Debate between Karin Smyth and Steve Barclay

Tuesday 6th February 2018 Commons Chamber

[Karin Smyth (Bristol South) (Lab)]

9. If he will hold discussions with the Chancellor of the Exchequer on the VAT status of NHS trusts.

[The Minister of State, Department of Health and Social Care (Stephen Barclay)]

There are no plans to hold discussions with the Chancellor of the Exchequer on the VAT status of NHS trusts.

[Karin Smyth]

I am grateful for that reply, although I suggest it ought to be reconsidered. NHS trusts desperate to avoid financial difficulties appear to have found a new magic money tree: setting up wholly owned subsidiaries to avoid paying substantial amounts of tax to the Treasury. Rather than encouraging this tax dodging and further fragmenting the NHS, why do the Secretary of State and his friend the Chancellor not either ban this practice or agree to let them all have the VAT exemptions?

[Stephen Barclay]

The Department wrote to all NHS and foundation trusts in September 2017 to remind them that tax avoidance schemes should not be entered into in any circumstances, but the hon. Lady makes a slightly strange point. She seems to be arguing that NHS hospitals are, in essence, paying too much tax to the Treasury, rather than having that money within the NHS. These subsidiaries are 100% owned by trusts themselves.