NHS: Treatment of Children from Other Countries

Lord Beamish Excerpts

Thursday 21st November 2024 Lords Chamber

[Baroness Merron (Lab)]

The agreements that the UK has in place which contain referral arrangements whereby the funding is discussed and agreed as part of the process of the referral are with the member states of the EU, Switzerland, the EFTA-EEA bloc of countries, the British Crown dependencies and some overseas territories. As the noble Lord rightly acknowledges, it is only fair that those using the NHS are those contributing to it, and we therefore have to ensure that we stick to those agreements. If trusts seek to undertake work outside of that area, that will be a matter for individual trusts, which will have to make decisions about their funding and their requirements to serve the NHS.

[Lord Beamish (Lab)]

Will my noble friend the Minister join me in congratulating the heart transplant unit at the Freeman Hospital in Newcastle, particularly the unit which conducts children’s heart transplants, providing a great service not just for this country but for children from across the world? One of the issues, though, is trying to encourage donors to come forward. What more can be done to encourage donors, specifically children, to come forward?

[Baroness Merron (Lab)]

I am very happy to add my congratulations to the hospital, which my noble friend knows very well. There are several approaches that we take on donors. One is the increased use of technology to ensure that organs donated can be used when and where needed. We tend to lose a lot of organs because that is not possible to do, depending on the technology. Another approach is to ensure that organ donation is a route that people are assured they can take, feel confident in, and are willing to participate in, including where somebody has died and we must deal very delicately, of course, with their loved ones.

Building an NHS Fit for the Future

Lord Beamish Excerpts

Monday 13th November 2023 Commons Chamber

[Helen Whately]

I understand what the hon. Gentleman is saying, and I know how strongly families and patients feel about this. It is not for me, as a Minister, to step on the independence of NICE, which has a remit to take those decisions. I am sure that the new Secretary of State for Health and Social Care, my hon. Friend the Member for Louth and Horncastle (Victoria Atkins), and other Ministers in the Department will continue to listen to the concerns of families about access to those treatments.

If we want to fully embrace preventive care, we must tackle the single biggest preventable cause of ill health, disability and death, which is smoking. Unlike drinking alcohol or eating fatty, salty or sugary foods, there is no safe level of smoking. It causes almost one hospital admission every minute, one in four cancer deaths and 64,000 deaths a year.

Four in five smokers start by the time they are 20, so the best thing we can do is to stop young people smoking in the first place. That is why this Government will automatically raise the smoking age by one year every year, so anyone who is 14 or younger today will never be able to buy tobacco legally. Increasing the smoking age works. When it rose to 18, smoking rates dropped by almost a third in that age group. Restricting choice is never easy, but this time it is the right thing to do. Existing smokers will not be affected, but the next generation will be smoke-free, saving thousands of lives, reducing pressure on the NHS and building a brighter future for our children.

[Mr Kevan Jones (North Durham) (Lab)]

I hear what the Minister says about the Government’s commitment to this policy, but can she explain why the Government are allowing a free vote rather than whipping Back Benchers to vote for Government policy?

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[Mr Kevan Jones (North Durham) (Lab)]

First, I congratulate the hon. Member for Uxbridge and South Ruislip (Steve Tuckwell) on making his maiden speech. Having mentioned his local boozer, he will no doubt be forever welcomed there with open arms. I welcome him to his place and thank him for his speech.

I note the historic event last week of the King making his first Gracious Address as sovereign. It is just a pity that the speech written for him by the Government was so thin, with little content and little vision. It was a clear demonstration that the Government not only are running out of steam, but have none left at all.

People know that I have campaigned on mental health for many years. It is 11 years since the hon. Member for Broxbourne (Sir Charles Walker) and I spoke, in a mental health debate, about our own mental health. I think attitudes have changed for the better over that period, and it has clearly moved up the political agenda. I was therefore, like a lot of campaigners and professionals, very disappointed that the reform of the Mental Health Act 1983 was dropped from the King’s Speech. The Act is outdated and archaic in parts, and its language is more fitting to the Victorian era. As my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley) said, in some cases it is leading to people with learning difficulties and autism being locked in the system for many years, without any voice to raise their plight.

The Minister, in her address, seemed to dismiss that as though it was somehow not important, but depriving people of their liberty is a very serious thing. To deprive somebody of their liberty, you have to ensure that they not only have rights, but care. My concerns about the Mental Health Act relate to those with autism and learning disabilities, some of whom have been locked in the system for years without a strong advocate. There are people in the criminal justice system locked into a Kafkaesque system that we have created. The Minister more or less threw that aside. I am sorry, but if you are a black teenager in the criminal justice system or an adult with learning difficulties, the system needs reforming and it needs reforming now.

It is not as though the Government started with a blank sheet of paper. We had Sir Simon Wessely’s excellent review in 2018. The Government made a manifesto commitment in 2019 to bring forward legislation. There was a draft Bill last year and a Joint Committee to scrutinise it. One would have thought it was a clear priority for the Government to move the issue up the political agenda, but what we have had from the Department of Health and Social Care is not just no Bill, but inaction. The Joint Committee spent a great deal of time looking at the Bill and put forward 36 recommendations. Ten months later and they have not yet even been answered by the Government. This is not just the Government abandoning the Bill and a broken Conservative party manifesto promise; it is a dereliction of duties. Politics is about priorities and, for me, this is a priority. Some 50,000 people a year are sectioned under the Mental Health Act. For some, I accept, it is life changing. For others, however, it leads to a system that they get into and cannot get out of. It is right to reform the Act and it is absolutely shocking that that is not in the King’s Speech. It will certainly be a commitment for the next Labour Government. I and many on the Labour Benches will make sure it is a commitment.

The Minister, in her Gatling gun approach to her speech, was more or less saying that it does not matter because everything else is okay in mental health. I am sorry, but it is not. In April 2022 we had, with much fanfare, the 10-year mental health and wellbeing plan. Over 5,200 individuals and mental health charities responded to a consultation, only to find out in January this year that it had been completely scrapped. The Minister talks about mental health being a priority, but the facts do not support that. Unless we have a proper joined-up approach to mental health, we will not get on top of the issue of individuals who need help, or have a system fit for a modern country such as the UK.

[Jim Shannon (Strangford) (DUP)]

I congratulate the right hon. Gentleman on raising this matter. Throughout my time in the House he has spoken up significantly for those with mental health issues, and he understands the subject very well. One group who seem to fall below the radar are veterans. In Northern Ireland, a large number of people who have served in the forces suffer from post-traumatic stress disorder. Does the right hon. Gentleman agree that those veterans who are suffering greatly must be a priority in addressing mental health?

[Mr Jones]

I agree with the hon. Gentleman. As a former veterans Minister, I did a lot about veterans mental health. We now have a disjointed system with a veterans Minister who, in Trumpian style, says that everything is perfect and everything is working, when it is clearly not. We need to ensure that veterans receive the best mental health care in their local areas, and that means adopting a joint approach.

If we are to get on top of the nation’s mental health, that must be done through a public health approach. It must be done at local level, and it must ensure that public health takes a lead. Less than 2% of the mental health budget is spent on preventive work, which needs to be done not just in schools but in communities generally. Fortunately for my constituency, a new initiative has been launched in Chester-le-Street where GPs and local community groups divert people from mental health services by securing them the help they need, and I congratulate those who are involved.

Tobacco affects mental health, with 50% higher smoking rates among those with a mental illness and two-thirds higher death rates, so I support the movement for a smoke-free generation, although I note that the Government will not ask their Back Benchers to support the policy because they know they will not receive it. Action also needs to be taken on illegal sales of counterfeit tobacco, but that cannot be done in the present circumstances, because the number of local trading standards officers has been cut by 52% since 2009. We need to ensure that more money is put into trading standards and policing. The Government keep saying how wonderful it is that we have extra policing, but in fact County Durham has 140 fewer police officers than it had in 2010. It is important for us to have the enforcement side, because without that some people will be driven into the illegal tobacco market, but we cannot see it as a silver bullet that will justify cuts in public health budgets. We need continued, dedicated local smoking cessation programmes, because without them we will not make the strides that we want to make.

I shall say something on two other issues. First, on leasehold reform, let us look at the facts, as opposed to what the Government are saying. The Government have given the impression that this reform will affect every leaseholder, but it will not; it will apply only to new buildings. There is no roll-out of the commonhold for new flats, which constitute the majority of leasehold properties. This outdated feudal system needs to change. There will be a great many disappointed people who, having assumed they would suddenly be given more rights, then find otherwise. Let us be honest: this has been fuelled by the Government’s right to buy scheme, which is being used by Persimmon and other big house builders as a way of making extra cash, mainly at the expense of the taxpayer and those poor individuals.

Secondly, on transport, I have heard the references to the Network North plan. I will not dwell on it too much, because I do not believe anything in it. We know that 85% of it has already been announced, but some of those announcements have been withdrawn very quickly. In the north-east, for example, the Government argued that the Leamside line, which would help my constituency of North Durham, would be reopened, only for that announcement to be withdrawn within 24 hours. I doubt that many of these projects will see fruition.

With my role on the Intelligence and Security Committee, I welcome the investigatory powers reforms, which will be important in ensuring that the right safeguards are in place for the way our security services collect bulk data, and in bringing some of the oversight up to date. It is also important that the Government work closely with the ISC—something they did not do on the National Security Bill that went through in the last Parliament. We are still waiting for a response to some of our arguments around how the ISC is run. This legislation will be important to ensure that we give our security services the necessary powers to protect us all, and to ensure that we get the proper oversight.

This will be the last King’s Speech before the general election. It was half-hearted and full of gimmicks that were designed to be eye-catching, but it has no long-term plan for the future of our country. That is the disappointing thing, and that will only change when we get a change of Government at the next general election.

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[The Secretary of State for Work and Pensions (Mel Stride)]

May I begin by welcoming the new Secretary of State for Health and Social Care, my hon. Friend the Member for Louth and Horncastle (Victoria Atkins), to her place? This has been a good and full debate. It has, in large part, been fairly well-informed, although I thought the quality of the offerings from behind me was a little ahead of that from in front. None the less, it has been a good and passionate debate.

No effort today was in any way better than that of my hon. Friend the Member for Uxbridge and South Ruislip (Steve Tuckwell), who gave us a virtuoso example of a maiden speech. He referred to the fact that it was in his constituency that Winston Churchill first uttered the immortal words,

“Never in the field of human conflict was so much owed by so many to so few.”

Of course, Churchill then repeated that in this Chamber, but not with the same eloquence as my hon. Friend, and he certainly did not manage to squeeze in a tribute to the Middlesex Arms, my hon. Friend’s local pub, where I am sure a free beer awaits him—that is probably where he is at this very moment. Now that I too, in addition to him, have mentioned his local pub, I hope that a second pint awaits him.

There are certain things that the shadow Secretary of State, the hon. Member for Leicester West (Liz Kendall), and I can agree on, and smoking is one of them. I was interested to learn that she is a former smoker. They always say that former smokers have a passionate desire to stop other people smoking, and she certainly demonstrated that. We know that one in four cancers is caused by smoking. As a father of three young daughters, vaping is of great concern to me personally, and I was pleased to see the reference in the King’s Speech to getting on top of those kinds of products and the way in which they are retailed.

The hon. Lady also mentioned mental health, as did many of this afternoon’s speakers. We have said that we will come forward with a mental health Bill if parliamentary time allows, and of course that does not mean we have not already done a very great deal in exactly that space, or will not do a great deal further. Some £2 billion of extra funding is already going into mental healthcare compared with four years ago, with a 20% increase in staffing since 2010. It does not stop there: we will also be bringing forward mental health hospitals and 100 specialist ambulances.

[Mr Kevan Jones]

We have now been waiting six years for a change to the Mental Health Act 1983. The Minister says that the Government are committed to mental health, but earlier this year we saw the 10-year mental health and wellbeing plan scrapped. I am sorry, but I have to say to the Minister that words are pretty hollow; when it comes to action, the Government are doing very little.

[Mel Stride]

I have just set out for the right hon. Gentleman two very significant actions that this Government have taken: £2 billion of additional funding compared with just four years ago, and a staff increase of some 20% since 2010.

I have to pick up on the non-doms point, because we hear it so often from the Opposition. Those poor old non-doms are going to be paying for the entire British economy over and over again. They pay UK taxes on their UK income, and it is just not realistic to expect to be gaining more tax in the longer term as a result of taxing them.

We have heard much about waits for NHS services. We have been working very hard on that issue, and it has to be recognised that we have had a pandemic, as well as a considerable amount of industrial action. Frankly, if the Opposition had done more with their trade union paymasters to encourage them to go back to work, we would have had smaller backlogs than we do at the moment. We have already largely eradicated the 18-month waits; the two-year waits have already been abolished; and we are rolling out all sorts of approaches to make sure we have more provision going forward, including 140 new surgical hubs. When Labour tells us about their plans, we need only to look at Wales, where we can see the results of Labour’s stewardship of the health service: on average, waiting times in Wales are five weeks longer than in England.

The hon. Member for Leicester West spent some time discussing employment, an area in which we have a first-class record. Economic inactivity, which she raised, is almost 300,000 lower than it was at its peak during the pandemic: it is below the average level of the OECD and the average level across the European Union. Unemployment is at a near-historic low, the number of those in payroll employment is at a near-historic high, and youth unemployment is down 44% on 2010. What happened under the Labour party? As Opposition Members know, it went up by almost exactly the same amount—another 44%. Labour is the party of unemployment; it has never left office with unemployment anything other than higher than when it came in. Under Labour’s stewardship, 1.4 million people were languishing on long-term benefits for over a decade, and that is a disgrace.

Dental Care: Durham

Lord Beamish Excerpts

Wednesday 24th May 2023 Commons Chamber

[Mary Kelly Foy]

I could not agree more with my hon. Friend. The dentists that I have spoken to recently all want to help NHS patients, but the way the contracts are designed, it is not worth their while, and of course they have to make a living.

I mentioned that I made a point of order yesterday regarding the Prime Minister, who has repeatedly claimed that there are “500 more dentists” in the NHS. However, following a freedom of information request, we now know that the number of dentists in the NHS fell by nearly 700 last year. The number of dentists has also fallen since the pandemic and is at its lowest level in a decade.

Diagnosing the causes of the problem is not complicated. As I mentioned at the beginning, Britain has poorer oral health than any other developed economy. The system is also dysfunctional, and practices have handed back a record £400 million-worth of funding back to the Government because they do not have the capacity to meet the required targets.

[Mr Kevan Jones (North Durham) (Lab)]

Does my hon. Friend and neighbour agree that we have to see what the need is in each area? I contrast the current approach with when Labour were in power in Durham: we brought in new capacity where we knew that areas did not have access to NHS dentistry.

[Mary Kelly Foy]

I thank my right hon. Friend for the intervention. We all know that there is huge demand and such a lack of NHS dentists out there that it is, I guess, a question of political will whether this problem is solved or not.

The absence of oral healthcare from our national debate about the future of the NHS is alarming. Dentistry is integral to our national health and therefore must be key to the NHS. Without proper investment in preventive healthcare such as dental check-ups, we cannot quickly treat oral cancers, nor can we stem the flow of people with dental problems into our already overcrowded accident and emergency departments.

I would be grateful if the Minister responded to the following questions. First, will he ensure that dentistry is properly represented in the governance structures of the NHS? Dentistry must be at the centre of the policy-making process, not an afterthought. Secondly, will the Government publish a comprehensive national dental strategy, one that is focused on prevention and tackling health inequalities? Thirdly, will he undertake meaningful reform of the NHS dental contract, which would stem the flow of dentists out of the system? Fourthly, will he work with the BDA on the previous points?

Finally, as I have said, I raised a point of order yesterday on the Prime Minister’s claim that there are 500 extra dentists in the NHS. There are in fact 700 fewer dentists, not more. Unless I have missed something today, the Prime Minister has not corrected the record, as he is obliged to. Will the Minister finally correct the record on behalf of the Prime Minister?

I could have spoken for hours this evening, reading out the correspondence I have received from constituents. Each constituent’s experience reflects a serious failure by this Government, so I implore the Minister not to insult the intelligence of the people of Durham, but to take this opportunity to accept that there is a crisis in NHS dentistry and to commit finally to meaningful reform.

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[Neil O’Brien]

I have already read out the statistics. I will not read them out again, and I do not think there is a need to correct the record. The statistics that the hon. Lady is drawing on are incomplete, because there is effectively a two-month lag between activity and the need to report that activity. Drawing on such incomplete information does not give the full picture, so I caution her against doing so.

First, I encourage the hon. Lady to wait for the official data in the usual way. Secondly, we are looking to improve that official data by, indeed, working with and responding to concerns raised by the BDA. I do not think that headcount is a sensible measure with the workforce. There are more people doing NHS work than there were in 2010. What we are really interested in is the total amount of activity, which is best measured by the total number of UDAs being delivered. As I have said, that total amount of activity is going up. In the last month for which we have data, it had gone up from 85% in March 2022 to about 101% in March 2023, but it is still not high enough. Although the trend is positive and dentists are doing more NHS work, the point of agreement here is that that needs to improve further.

[Mr Kevan Jones]

I am sorry, but the Minister cannot have it both ways. First, the population of this country has increased since 2010 and we need to measure the number of dentists against the size of the population. The other thing is that he can talk about UDAs, but if people are in an NHS dentist desert, as is the case in Durham, it does not matter if the number has gone up elsewhere. If people do not have access to a dentist, they do not have access to a dentist and therefore cannot be treated.

[Neil O’Brien]

That point is clearly correct, but that is not to disagree with anything that I have just said.

Rather than getting into the weeds—I have already read out the official statistics—let me try to end on a note of agreement. We absolutely want to take further steps to ensure that we increase access to NHS dentistry where it is lowest and, as well as improving the service for patients right across the country and improving preventive activity, we want to see particularly rapid improvement in those areas, perhaps including that of the hon. Member for City of Durham, that have not had the level of access that we would want over recent times.

Question put and agreed to.

Health and Care Bill

Lord Beamish Excerpts

Report stage
Tuesday 23rd November 2021 Commons Chamber

[Richard Graham (Gloucester) (Con)]

I rise to speak on amendment 10. I want to start by relaying a conversation that I had soon after being elected 11 years ago in Gloucester. I talked to the chief executive of a hospital trust—he has subsequently moved on—and asked him how many nurses a year we needed to replace those who have retired and resigned, and to cope with increasing demand, not just in the hospital trust but including district nurses and nurses to cover the whole panoply of our needs in the county of Gloucestershire. He explained that we needed roughly 400 a year at that time. I asked him how many we were training. He said that the University of the West of England trains around 120 graduates a year from its nursing outlet in Gloucester. How do we meet the gap, I asked, and he said, “Well, we advertise. We try to encourage people from London to look for a change in their lifestyle and we recruit from abroad.” I asked him where that got us to. He said, “Well, it increases the numbers, but it never gets us enough. We struggle with a permanent shortfall of recruitment.”

Over the next few years, I worked on three things. The first was to support the Government push to create nursing associates. The second was to encourage the University of Gloucestershire to become a nursing teaching university and to submit an application to get pilot project status for the nursing associates’ training. Both of those came to pass. They were a credit to the Government, a credit to the university and a credit to the Nursing and Midwifery Council that supported them. None the less, we were, and are, still short; that gap has not been closed.

One other thing that I have done recently is to support the close engagement with the Government of the Philippines, who have kindly allowed us to carry on recruiting nurses from the Philippines to the United Kingdom during the pandemic. I ask everyone here to join me in paying tribute to the roughly 35,000 nurses from the Philippines who have made such a difference to our NHS. All those things have helped, but anyone who has played the role that all of us in this House have over the past two years will know that the people problem is the greatest problem that we have.

I chaired, first every week and now every two or three weeks, a meeting between all the MPs in Gloucestershire, the heads of the NHS trusts, public health and the county council. Time and again, the same issue comes up in a slightly different way: it is about people. Yes, we could build extra wards. Yes, we could convert offices into wards. Yes, we could build bed capacity, but we do not have more people to look after the patients in them. Yes, we have plenty of spaces in care homes, but we need to be able to send people back to their home from hospital, because that is how they recover best, and we do not have enough domiciliary care workers.

We have gone round and round for the past 10 or 11 years on this issue of staff—doctors in primary care surgeries, nurses everywhere and domiciliary care workers. I do not believe that we can resolve this problem until we start planning for the needs in different parts of the country and then working out how we can provide the training, the skills and the recruitment of individuals to make that happen. Of course it will not be perfect. Of course disasters such as the pandemic will make a bad situation much worse. We recognise that, but until we start that process, I do not believe that things will change. For as long as I am MP for Gloucester, I am absolutely certain that I will be having the same conversations about human resources—the people who deliver the care and health that all the people in my constituency and across the county and country need and deserve. It is not the best use of MPs’ time to constantly have to sit down with our health professionals in local NHS trusts to work out how we are going to mind the gap. That whole process has to be started from higher up, in the Department of Health and Social Care.

Today, we have an amendment that has enormous support not just from the Select Committee that my right hon. Friend the Member for South West Surrey (Jeremy Hunt) chairs, but from outside this House from the royal colleges, the NHS trusts and many others beside. I am frustrated that the Government have so far not indicated whether they will accept the amendment. In their hearts, the Minister and his colleagues, all good people trying to do their best, recognise that this problem will have to be tackled. Perhaps part of the solution will be in the White Paper that we are all so eagerly waiting for and that we wish that we had been able to have a few days ago, before the votes last night, on which I supported the Government on the basis of trust. None the less, there comes a time when we have to say and vote for what we believe in. I do believe that we need this change and that the Government can and should do it, and I will vote for it.

[Mr Kevan Jones (North Durham) (Lab)]

I rise to support new clause 1, which stands in the name of the right hon. Member for Romsey and Southampton North (Caroline Nokes), myself and 18 other right hon. and hon. Members from across the House. I first took an interest in this subject through a constituent, Dawn Knight, from Tanfield in my constituency. Dawn raised issues around the cosmetic surgery industry having been a victim of a particular hospital group. She has been a tireless campaigner in ensuring not only that victims get a voice, but that we press for more regulation.

I join others in paying tribute to the all-party group on beauty, aesthetics and wellbeing for its recent report and to my hon. Friends the Members for Swansea East (Carolyn Harris) and for Bradford South (Judith Cummins) for their work on that report, which highlights what my hon. Friend the Member for Ellesmere Port and Neston (Justin Madders) called the “wild west”. That is exactly what it is: it is a wild west without any regulation. It is a multibillion-pound industry, which is not only putting people at risk, but costing the NHS money.

In April 2013, the Health Secretary at the time—Andrew Lansley, now Lord Lansley—commissioned Sir Bruce Keogh to carry out a review of the regulation of cosmetic surgery. The review came out not only when we were having problems in the sector itself, but when interest was heightened around Poly Implant Prothèse breast implants, which people will well remember. When the review concluded, it explicitly advised the Government to increase regulation of the cosmetic surgery industry to prevent unlicensed treatments and increase patient safety. The review stated that a person having a non-surgical procedure

“has no more protection and redress than someone buying a ballpoint pen or a toothbrush”,

and

“dermal fillers are a crisis waiting to happen.”

As the right hon. Member for Romsey and Southampton North said, that crisis has actually happened already.

I have been campaigning on this issue for a number of years, during which time I have gone through a succession of Health Ministers, all of whom have come back with two points. The first is, “We are going to implement the Keogh recommendations”. But because Ministers were too terrified previously to make any health legislation, they were reluctant to bring those recommendations forward in that way.

The only good news in the area has been private Member’s Bill of the hon. Member for Sevenoaks (Laura Trott), the Botulinum Toxin and Cosmetic Fillers (Children) Act 2021. That legislation was tightly focused—as all private Member’s Bill have to be—and banned botox injections for under-18s. I congratulate the hon. Member on that work. However, any other regulations have been left unfinished. I have sheaves of letters from former Health Ministers saying, “The Keogh recommendations will be implemented”, but they have not been to date. If we do not do that in this Bill, when will it be done? I doubt that the Department will come forward with a Bill just to implement those recommendations; that is wishful thinking.

There is clearly no regulatory framework in the UK at present for those performing aesthetic non-surgical cosmetic treatments. The area is completely unregulated and lacks any national standards. There is no consumer protection, education, training or qualifications for those administering such treatments. As my hon. Friend the Member for Brent Central (Dawn Butler) said, some people call themselves nurses with no qualifications whatever. There is a huge discrepancy between the standards and qualifications of the training of these people. The other side of the issue, to which I will turn in a minute, is the regulated system, which, frankly, is failing as well.

The right hon. Member for Romsey and Southampton North raised the issue of training. If hon. Members visit any website tonight, they will see huge adverts saying, “Become a dermal filler specialist: training and qualification online within half an hour”—even less time in some cases. The people offering such services have no qualifications whatever, because the qualifications are not worth the paper that they are written on, but these people start carrying out invasive procedures without anybody stopping them. They can do it in a kitchen, or in any area that has not been clinically cleaned and is not of a standard that we would expect for medical procedures. It is a multimillion-pound racket that includes both the people offering the training and those carrying out procedures. It is an increasing issue, which needs to be addressed.

We also need to address the issue of advertising. As I have said before in the House, the Advertising Standards Authority is frankly a complete waste of time. If hon. Members go on any website tonight, or even open the national newspapers, they will see people advertising these services—potentially dangerous procedures—without any qualifications. We might ask, “Why would people have these procedures?” Well, I suggest that everyone reads the Mental Health Foundation’s 2019 report on body image, which shows the increasing pressure on young people.

The right hon. Member for Romsey and Southampton North is correct that this issue mainly affects young women, but it is increasingly an issue for some young men. The pressure of factors such as advertising and photo enhancements lead people to think that there is the perfect individual, but—apart from you, Mr Deputy Speaker—I am not sure that there is. The foundation’s reports highlights the pressure that is put on young people, but particularly young women. If they look at prices for procedures, they end up going to people who are completely unqualified. It is a scandal that there is no legislation to prevent this.

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[Sarah Olney (Richmond Park) (LD)]

I rise to speak in support of amendment 10, tabled by the right hon. Member for South West Surrey (Jeremy Hunt), the Chair of the Health and Social Care Committee, because the amendment reflects the key issue facing the NHS and all our health and care services at this time: the workforce. Access to healthcare services is the No. 1 issue raised with me by constituents at the moment, and I know that concern is being echoed in other constituencies across the country.

People are experiencing the issue in many different ways. Some are struggling to get a GP appointment. I regularly speak to parents in great distress because of the lack of available help for their children’s mental health needs. The accident and emergency department at Kingston Hospital in my constituency has regularly had to ask patients to consider whether there are more appropriate sources of help for their needs. Patients waiting in the backlog of elective procedures are regularly having appointments rescheduled or cancelled. Ambulances do not always arrive when called.

The impacts are many and various, but when I speak to health service leaders in my local area, the answer is pretty much the same: there is a lack of available staff. Even in cases where lack of funds is not in itself a limiting factor, the lack of people with the relevant skills makes it impossible to fill all the vacancies they are able to pay for.

Many of these problems are covid-related. The current NHS waiting list is estimated to be over 6 million, and it is clear that much of that is because so many elective treatments were delayed during lockdown. Demand for mental health services has accelerated because of the impact of the lockdown, particularly on young people. Covid is still with us, of course, and workforces in every part of the economy are being impacted by the need for individuals to isolate when they have symptoms or test positive. Healthcare staff need to be more vigilant than the rest of us.

Many of these problems are also Brexit related. A lot of young Europeans decided to return to their home countries at the start of lockdown and have not since returned. Brexit has stymied our ability to recruit from the EU, shutting off an extremely important supply for all parts of the labour market, but the effect is being felt most markedly in health and social care, since it is having to manage the extraordinary demand of a global pandemic at the same time.

Many of these problems are also the result of a long-term failure to correctly predict or prepare for workforce demand. One of the huge advantages of a national health service is that it is possible to get clear data from right across the sector and to make appropriate plans and decisions. For some reason, that has not been done, and it is absolutely right that the Government should adopt amendment 10 to start to put that right.

I want to amplify a Backbench Business debate that I was able to bring to this Chamber a few weeks ago, in partnership with the right hon. Member for South Northamptonshire (Dame Andrea Leadsom) and the hon. Member for Newcastle upon Tyne North (Catherine McKinnell). It was on the subject of giving every baby the best start in life, and it was the firm view of all who attended that debate that the health visiting workforce needs to be substantially boosted to enable all new parents to receive a home visit from a trained healthcare professional. During the course of that debate, we heard of the many ways in which a health visiting workforce can support new families and the critical role they play in supporting babies and their families. One estimate is that the cost of poor parental mental health in the first year of life is more than £8 billion. It is clear that the cost of boosting our health visiting workforce would more than pay for itself in a very short time.

I also want to reflect briefly on a conversation I had with a constituent in the street in Richmond town centre on Saturday. Despite having two degrees, she was working in the care sector, and she was talking to me about her terms and conditions of work. She is employed by an agency and is not allowed to engage with any other agency. She is on a zero-hours contract, so she has to sit at home and wait to hear how many hours she might be required to work the following week. For various reasons that suits her, but I feel that it underpins the recruitment crisis we are experiencing in our social care sector, because that is no way to retain skilled and committed staff.

[Mr Kevan Jones]

Does the hon. Lady agree that it is not just about levels of pay and uncertainty for those individuals, but ensuring that we nationally accredit the qualifications of those individuals and address the career paths that do not exist in those sectors at the moment?

[Sarah Olney]

The right hon. Gentleman is absolutely right, and that is the point I want to make: we need to boost the status of our care home staff and improve their terms and conditions. We need to improve their pay. This lady who I spoke to on Saturday was telling me that she gets paid for the hours she spends in people’s homes, but not the time spent travelling in between. It is clear to me that the crisis of staffing we are experiencing in our care sector—I think every one of us as MPs is hearing about it regularly from our constituents, who are at the sharp end of that—is as much about workforce planning and improving terms and conditions. The Government needs to give that the most urgent attention, and amendment 10 would go some way to resolving that, although it will not resolve it entirely.

I know that Ministers will push back against the cost of boosting the workforce in all areas of the NHS, but they must surely realise the cost of failing to do so. The right hon. Member for South West Surrey. along with the hon. Member for Central Ayrshire (Dr Whitford), spoke about the cost of locum resource in the NHS. It is not just about the direct cost of locums or of worsening health outcomes as people wait longer for treatment; it is also about the lost productivity of days off sick, the cost of poor mental health as lives are put on hold and, as has been mentioned many times, the cost of exhausted and demoralised staff who are overwhelmed by the demands on the NHS. We cannot afford to continue to fail to effectively plan our healthcare workforce.

I am also very happy to support the amendments tabled by the hon. Member for North West Durham (Mr Holden) on virginity testing and hymenoplasty. I am delighted that the Government are adopting the provisions on virginity testing. We still have much to do to make this country a safe place for women and girls, but all progress is to be welcomed, and I am very glad that this opportunity to bring to an end the degrading practice of virginity testing has not been lost. I congratulate the hon. Member for North West Durham on all the work he has done and, although they may have left the Chamber, the representatives of the other charities referred to earlier. I hope in due course we will see the provisions for hymenoplasty as well, when the review has concluded.

Giving Every Baby the Best Start in Life

Lord Beamish Excerpts

Tuesday 9th November 2021 Commons Chamber

[David Simmonds (Ruislip, Northwood and Pinner) (Con)]

All of us in this House who are parents or have young children among our family and friends will know that there is an abundance of advice available on the topic of today’s debate and many of us take that advice: we talk to our babies in the womb; we play games with them before they are born; we study baby-led weaning; and we invest in stain-proof covers that never seem to extend quite far enough. But wherever on the nurturing scale we sit as mums and dads, babies thrive when they are surrounded by adults taking an active interest.

The focus of my contribution is the babies and young children who need extra help to thrive—those whose interests are at the heart of the decision by the Government to invest in family hubs in the recent Budget, as championed by my right hon. Friend the Member for South Northamptonshire (Dame Andrea Leadsom). As many Members have said, it is welcome that this agenda is taking a higher profile in the context of levelling up, because we all recognise the need to build on sound foundations.

Twenty years’ experience in children’s services has taught me a lot about the strengths and weaknesses of the child support system in our country. Like our NHS, we are very good at emergency services, and studies by academics at the University of Bristol and the University of Warwick show that the UK has a world-leading child protection system. But today’s debate goes beyond protection from harm, and into how we help children to thrive and flourish—something that is a matter not just of social responsibility but, as my right hon. Friend the Member for South Northamptonshire highlighted, of long-term economic benefit to our country.

Thriving children live lives that cost the taxpayer less and contribute more to everyone’s benefit. To that end, I am going to offer three points, which are focused on how we turn the widely-shared aspiration that we hear in the Chamber—I grew up in the village of the hon. Member for Pontypridd (Alex Davies-Jones) and am glad to hear of the progress it is making—into a change that children and their families can see and feel in their lives.

First, we need to follow the flow of money. The funding for early years, which is a key statutory responsibility for all local authorities, remains mired in bureaucratic processes that are dominated by those whose focus, for good reasons, is elsewhere. Schools forums, which determine the distribution of the dedicated schools grant, in which much of this funding sits, are dominated by the interests of our secondary schools. A fragmented early years sector of small private, voluntary, charitable providers often struggles to be heard. There is a structure around the money that inhibits innovation and flexibility, and stands in the way of creating the joined-up local offer that my hon. Friend the Member for East Worthing and Shoreham (Tim Loughton) highlighted. Although I can see that there is a perceived political benefit to lumping that early years funding in with schools, in reality the needs of the sectors are different.

[Mr Kevan Jones (North Durham) (Lab)]

I have listened carefully to what the hon. Gentleman says about ringfencing and I do not disagree, but that is why Sure Start funding was directed through local authorities and ringfenced at a local level for local authorities to draw up their local strategies. He talks about levelling up, but this process did not start in 2019. We have seen the devastation of Sure Start centres, certainly in County Durham, as a result of cuts to that funding by his Government—although I know that he perhaps was not in the House then.

[David Simmonds]

It is good to hear the right hon. Member’s contribution. I was in a local authority throughout Sure Start’s implementation period, and although it was welcome to see a Government giving a high degree of priority to children in the earliest years of their lives, there were a number of failings with that programme. One was that the pace at which Government sought to deliver it—for understandable reasons, it was a political priority—meant that poor decisions were often made about the location of services and exactly what was delivered. At a time when many activities outside Sure Start were a high priority for local areas, Sure Start was generously funded to meet the Government’s aspiration while other activities, such as child protection, were starved of cash. Although all Governments want to deliver their priorities, we need to achieve a longer-term consensus about what is in the interests of children in the earliest years of their lives.

I call on Ministers to consider how we free the early years sector from the shackles imposed by the dedicated schools grant and bring it together with other local authority and NHS budgets, so that investment can be aligned with the needs of local families and built on the strengths of the early years sector. We must not forget that the sector is not just about nurseries; it provides an opportunity to join up with a range of local statutory and non-statutory services, which include health visiting, child minding, family hubs, child protection, public health, vaccination services, libraries, play and informal learning. When I was a new parent, the services provided by the libraries of the London borough of Hillingdon, including story time for young children, were an outstanding example of that early support. They were a chance to meet other parents whose children were at the same stage, to get informal advice and tips. That may sit outside what Government mandate, but it is exactly the sort of thing that parents of young children treasure.

Having touched on the funding challenge, we need to ensure that every area has the scope to develop a strategy for thriving that suits local circumstances. Many of our councils—the 152 top-tier authorities—are in partnership arrangements of one kind or another. Some are council to council, and others reflect outsourced services. That all reflects issues of local need and capacity. Along with the statutory lead member for children’s services and the director of children’s services, the health and wellbeing board has the most scope to join up the offer to get babies the best start in life. Those boards—statutory committees of the local authority—still struggle to assert their role, especially with the NHS, which in my experience is strategically disengaged, despite their role as key partners.

The rearguard action fought by the NHS against making public health a local and accountable service has also inhibited innovation and tied up resources in rolled-over NHS contracts rather than stimulating the reshaping of local services around children. I have seen some outstanding examples of such reshaping, however. I pay tribute to my constituent Dr Jide Menakaya, a leading paediatrician who has led work across the sector in his field of neonatal care in the London borough of Hillingdon to join up children’s services and Sure Start so mums and dads have a seamless experience. However, the system still tends to stand in the way of creativity rather than promoting it.

My suggestion to the Front-Bench team is that, in line with previous asks of our health and wellbeing boards—for example, to produce joint strategies on child mental health—we look at setting a clear expectation for them on a strategy for helping children to thrive in line with the first 1,001 days ambitions. Much of this already exists in different forms at a local level, but for a new parent or an expectant family, it can feel hard to access and fragmented, because it is driven by the disparate duties and funding regimes imposed by Government. In line with the local offer for children with special educational needs and disabilities, a strategic approach to the local offer for the earliest years will deliver greater value for money and, vitally, greater coherence for parents who access it.

The final area that I would like to put forward for consideration is accountability. Successive Governments have adjusted the regulatory environment for the early years, but broadly speaking the two priorities today are school readiness—seen in the regulation of settings such as child minding and nurseries—and the avoidance of harm to children, which is seen in the regulation of child protection and the NHS. We are in a context where resources are extremely stretched—not just money, but, as we have heard from a number of Members, the workforce too—which tends to drive a risk-averse approach in the early years, prioritising the absence of failure, rather than the promotion of innovation. We need to consider how we line up the accountability that we have all talked about with what we are seeking to achieve for our children. My suggestion to Ministers is that we need to look beyond the current inspection regimes and datasets used for performance management, many strengths though they have, and think about how we measure the things involved in a child thriving—the positive health and social outcomes that we want for babies in our country and how we incentivise the behaviour that will deliver them. Time is tight, so I will simply say that we have so many statutory duties in place that will help us deliver that, but so often the holders of those duties lack the autonomy needed to fulfil the aspirations we have. We need a permissive approach from Government.

In conclusion, we need to recognise that much of what we do is world class and of the highest quality, as many parents of young children, including me, can attest, but the regulatory regime still too often expects low standards. Rather than contributing to success, we have a complex funding system that stands in the way of local communities and their leaders delivering value for money and good outcomes for every child. We all want to give our babies the very best start in life. By enabling local leadership, setting high standards and setting people free to innovate, we give ourselves the best chance of levelling up life chances for all our children.

Covid-19 Vaccinations: 12 to 15-year-olds

Lord Beamish Excerpts

Monday 13th September 2021 Commons Chamber

[Nadhim Zahawi]

The important thing to remember is that the JCVI’s advice was very much predicated on what it was clinically qualified to look at. It was its recommendation to the chief medical officers to then take a further look. My hon. Friend will recall that JCVI’s advice was that, on balance, it is beneficial for children to have the vaccine rather than not have the vaccine, but not enough to recommend a universal programme, hence its advice to CMOs to go further on that. The work the CMOs have done in recommending a single dose is very much predicated on the data they have seen. JCVI, by the way, were in the room during the deliberations from America and elsewhere on the myocarditis on the second dose.

[Mr Kevan Jones (North Durham) (Lab)]

I welcome the statement from the Minister tonight. I agree with my right hon. Friend the Member for Leicester South (Jonathan Ashworth) when he says that clear information will be key. I would just suggest that social media might be more effective with young people rather than leaflets. May I raise an issue around children with special educational needs? Some may already have been vaccinated because of vulnerabilities. Will the Minister outline what arrangements have been put in place for schools and cohorts of individual children with special educational needs? It will need a lot more effort and time to ensure we get them vaccinated.

[Nadhim Zahawi]

The right hon. Gentleman is quite right. A number of children with special educational needs would have been vaccinated already, because they would have come under the earlier JCVI recommendation. The school-age vaccination programme does pay particular and careful consideration to those schools, working with school leaders and making sure that parents are able to get all the information. I mentioned leaflets earlier, but of course there will be a digital information programme as well.

Health and Care Bill

Lord Beamish Excerpts

2nd reading
Wednesday 14th July 2021 Commons Chamber

[Sajid Javid]

I listened carefully to what the hon. Gentleman said. As I have said, no final decisions have been made, but if he would like a meeting with a Health Minister, we can arrange that so that the matter can be discussed further.

I am also very grateful to another of my predecessors, my right hon. Friend the Member for South West Surrey (Jeremy Hunt), first for his leadership of the Health Committee, whose valuable report and recommendations we have taken on board, and secondly for his tireless dedication to the cause of patient safety, which sees its culmination in the Bill’s creation of the Health Services Safety Investigations Body. We must continue, in his words, that quiet revolution in patient safety. I have asked my officials to consider whether the Care Quality Commission could look broadly across the integrated care systems in reviewing the way in which local authorities and providers of health, public health and social care services are working together to deliver safe, high-quality integrated care to the public.

[Mr Kevan Jones (North Durham) (Lab)]

The Secretary of State talks of patient safety. May I ask him why the Bill contains none of Sir Bruce Keogh‘s recommendations on the cosmetic surgery industry, which are now 10 years old? In response to questions that I have asked, Ministers keep saying that the recommendations are going to be implemented. Could this not be an opportunity to improve patient safety in that area?

[Sajid Javid]

The right hon. Gentleman has raised an important matter. There are issues surrounding the cosmetic surgery industry, and I know that he has spoken eloquently about them in the House before. I do not necessarily agree that this Bill has to be the vehicle for any change, but if he wishes to discuss the matter further, I should be happy to meet him in due course, because it is important and it does require a fresh look.

Whenever the NHS is subject to change, it is tempting for some, who should actually know better, to claim that it is the beginning of the end of public provision. We know that that is complete nonsense, and they know it is nonsense, but they say it anyway. So let me very clear: our integrated care boards will be made up of public sector bodies and those with a social purpose. They will not be driven by any private interests, and will constantly make use of the most innovative potential of non-NHS bodies.

The spirit of this Bill is about holding on to what is best about the NHS and removing what is holding it back. That is something that we all want, and I am looking forward to a mature debate—[Laughter.] Perhaps that is too much to ask in this Chamber with this Opposition Front Bench, but I hope for, and I think the public expect, a mature debate on the Bill and on how we can achieve these sensible changes together.

In that spirit, the second theme of the Bill is cutting bureaucracy. As we have been tested during these past months, we have looked at the rules and regulations through new eyes. It has become increasingly clear which of them are the cornerstone of safe, high-quality care, and which are stifling innovation and damaging morale. It is that second group of rules and regulations that the Bill strips away, removing the existing procurement regime and improving the way in which healthcare services are arranged. Yes, this is about how we deliver better value for the taxpayer, but fundamentally it is about how we can free up NHS colleagues to deliver better care. We know that patients are better served when experts are free to innovate unencumbered by unnecessary bureaucratic processes. That is why the Bill will repeal section 75 of the Health and Social Care Act 2012, giving the NHS the flexibility for which it has been asking. I know that this is a point of agreement with the Labour party—

--- Later in debate ---

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

I beg to move an amendment, to leave out from “That” to the end of the Question and add:

“this House declines to give a Second Reading to the Health and Care Bill, notwithstanding the need for a plan for greater integration between health services and social care services and for restrictions on junk food advertising to improve population health outcomes, because the Bill represents a top down reorganisation in a pandemic leading to a loss of local accountability, fails to reform social care, allows further outsourcing permitting the private sector to sit on local boards and fails to reinstate the NHS as the default provider, fails to introduce a plan to bring down waiting lists for routine NHS treatment or tackle the growing backlog of care, fails to put forward plans to increase the size of the NHS workforce and see them better supported, and fails to put forward a plan that would give the NHS the resources it needs to invest in modern equipment, repair the crumbling NHS estate or ensure comprehensive, quality healthcare.”

Well, the Secretary of State talked a lot, but he did not say very much. Look at the context of where we are. Yesterday, we recorded 36,000 covid infections. Hospital admissions have increased to over 500 a day, up 50% in a week. Waiting lists are at the highest level on record, currently at 5.3 million. Some 336,733 people have been waiting over a year for treatment, over 76,583 people are waiting over 18 months, and over 7,000 people are waiting over two years. Some 25,889 people are waiting more than two weeks from urgent referral to a first consultant appointment for cancer. Emergency care is grappling with some of the highest summer demands ever seen. Two hundred and fifty thousand people are waiting for social care. NHS staff are exhausted, facing burnout. We went into this pandemic with 100,000 vacancies across the NHS and a further 112,000 vacancies across social care.

The answer from the Secretary of State is to embark on a top-down reorganisation when we are not even through the pandemic—a reorganisation that will not deliver the integration needed, because reforms to social care are delayed again; a reorganisation that will not deliver more care but in fact, in periods of stretched health funding, could well deliver less care; and a reorganisation that is, in effect, a Trojan horse to hide a power grab by the Secretary of State.

Let us be clear why this reorganisation is taking place. The Government have come forward with this Bill because of the mess of the last reorganisation—the mess that the Secretary of State supported and voted for, and the mess that he spoke out for in this House, saying that it would modernise the NHS and that the

“concept of GP commissioning has been widely supported by politicians from all parties for many years. May I urge my right hon. Friend to keep putting patients first by increasing GP involvement in the NHS?”—[Official Report, 4 April 2011; Vol. 526, c. 773.]

Why, if he believed that then, has he U-turned now? And it was a mess that we warned of. My hon. Friend the Member for Leicester West (Liz Kendall), who opposed that Bill in this House, warned the Government that it would increase bureaucracy and increase the fragmentation that the Secretary of State has just complained about from the Dispatch Box.

Ministers said that that reorganisation under Lord Lansley would reduce bureaucracy, and Back Benchers told us that it would reduce bureaucracy, but what ended up happening? Billions were wasted and thousands of NHS staff were made redundant. That was the Government’s priority then, and now they are asking us to clean up their mess today. They also told us that that reorganisation would improve cancer survival rates, and where are we today? We are still lagging behind other countries on cancer survival rates. Perhaps the Secretary of State could have come to the Dispatch Box and apologised for that Lansley reorganisation and 10 wasted years.

The Secretary of State talked about NHS leaders, but the truth is that NHS leaders asked for a simple Bill to get rid of the worst of the Lansley restructuring and instead re-embed a sense of equity, collaboration and social justice in our NHS structures. That is not what this Bill is. Of course, the Secretary of State secretly agrees with me. According to The Times, he wrote to the Prime Minister saying that there were “significant areas of contention” that were yet to be resolved with the Bill, and that he wanted to delay it. The Secretary of State was only back five minutes and already Downing Street was overruling him. When it overrules him on his choice of spin doctors, he walks; when it overrules him on the future of the NHS, he puts his career first and stays in the Cabinet.

I listened carefully to the case made by the Secretary of State. He talked of the need for greater integration between health and social care and the need to provide better co-ordinated care, and he referred to an ageing population.

To be frank, that was a speech that Health Secretaries and their predecessor Social Services Secretaries have been making more or less since 1968, when Richard Crossman proposed the first set of NHS reorganisations. Indeed, there were echoes of the Secretary of State’s speech in that made by his predecessor Keith Joseph, when he came to this House in 1972 to set up the area health authorities, bringing together hospitals and community care and working more closely with local authorities because we needed seamless care. Those authorities were of such a size that, within a year, they were rearranged again into district health authorities. Given the size of some of the integrated care systems that the Secretary of State is proposing, I suspect that the seeds of the next reorganisation are being sown today.

Yesterday, the Secretary of State told the House that his

“three pressing priorities for these critical…months”

were

“getting us…out of this pandemic…busting the backlog”

of non-covid care, and

“putting social care on a sustainable footing for the future.”—[Official Report, 13 July 2021; Vol. 699, c. 163.]

But absent from his speech was any credible explanation of how this reorganisation will meet his objectives that he outlined to the House yesterday. In fact, in the last 30 years, we have seen around 20 reorganisations of the NHS. Have any of them delivered the outcomes that Health Secretaries have promised from the Dispatch Box? Well, not according to analysis in The BMJ, which observes:

“Past reorganisations have delivered little benefit”.

Why should this one be any different?

The question for me is: how will the 85-year-old with multiple care needs experience better whole-person care as a result of the restructuring that the Secretary of State is embarking upon? How will waiting times for elective surgery for cancer and mental health be improved by this reorganisation? How will health inequalities that have widened and life expectancy advances that have stalled be corrected by this reorganisation? To those questions, the Secretary of State had no answer today: the Bill fails those tests because it is a badly drafted Bill and could in fact even worsen health outcomes.

Let me outline our specific concerns. On the proposed integrated care boards, the Bill collapses the remaining 100 or so clinical commissioning groups into 32 integrated care systems differing in geographical size and with some covering populations up to 3 million or 4 million. In some parts of the country, the ICSs are not based on the NHS agreed boundaries, but currently on centrally drawn-up boundaries for political reasons. We know that Cheshire will be combined with Merseyside. Glossop is cut off from Greater Manchester and allocated to Derbyshire. Frimley is split up, leading the former Prime Minister, the right hon. Member for Maidenhead (Mrs May), to complain in an Adjournment debate recently:

“Do not break up Frimley ICS. Just for once, let common sense prevail.”—[Official Report, 29 June 2021; Vol. 698, c. 238.]

These boundaries and the way in which they were proposed by the previous Secretary of State, the right hon. Member for West Suffolk (Matt Hancock), prompted NHS Providers to warn that the disruption could lead to

“a worsening of patient care”.

And then, of course, we have the design of the integrated care system, split across two committees—a partnership board containing people from local authorities, the third sector and others, and then an NHS board responsible for spending the money, for commissioning. The Secretary of State has moved away from GP commissioning, of course; he wants the NHS board to commission now. Those two boards will probably have different chairs, but the NHS board only has to have “regard” to the partnership board strategy. Nor is it clear how local authority seats—the one local authority seat—will be decided when they cover more than one council and possibly even councils of different political persuasions, so we will see how a consensus can be built then.

Other important voices are left out. Mental illness accounts for roughly a quarter of the total burden of illness, yet there is no guarantee that mental health providers will get the seats on these boards, when we know that mental health services are under pressure and the Secretary of State tells us that the mental health backlog is one of his personal priorities. The pandemic has also reminded us that the health and wellbeing of our community is not just in the hands of large hospitals or general practice. It is also in the hands of our directors of public health, who have shown exceptional local leadership throughout this crisis, standing on the shoulders of their forebears, who in the past confronted diseases such as cholera, smallpox and diphtheria. Test and Trace would have been far safer in their hands from the outset, by the way, and what is their reward? They are sidelined. Public health, again, should be properly represented on the NHS boards and we will table amendments to that effect.

[Mr Kevan Jones]

Does my right hon. Friend agree that it is not just about their being sidelined; it is actually about the budgets for public health, which have been pushed off into the autumn? If the consultation paper that went out last year is anything to go by, County Durham would lose 19% of its budget. How can we effect these changes without its being divorced from what will be provided in terms of cash?

[Jonathan Ashworth]

My right hon. Friend is absolutely right. I will come to the financial flows in a few moments. But how on earth can we have a triple aim of trying to improve health outcomes for a population and not even give public health a voice and a seat on the decision-making body that decides health plans for an area?

The Secretary of State talks about integrating health and social care. There is no seat for directors of adult social services on these committees, either. And what about patients? Patients were not mentioned very often by the Secretary of State in his speech. Patients will always come first for the Opposition. They have no mandated institutional representation, either—no guaranteed patient voice—so we have yet another reorganisation of the NHS whereby patients are treated like ghosts in the machine. It is utterly unacceptable. This is fragmentation, not integration, with a continued sidelining of social care.

There is a loss of local accountability as well, because there is no explicit requirement that the boards meet in public or publish their board papers. Although NHS England has stated that that is its preference, it is not required; nor is there any commitment, despite the wide geographical spread of some ICSs, for meetings to be made accessible online. But, of course, the White Paper did indicate that the independent sector could have a seat on an ICS, and the explanatory notes to the Bill state that

“local areas will have the flexibility to determine any further representation.”

--- Later in debate ---

[Mr Kevan Jones (North Durham) (Lab)]

In opening this debate, the Secretary of State said that the Bill would improve patient safety. One area in which it does not do that is the area of cosmetic surgery. In April 2013, the Government commissioned Sir Bruce Keogh to do a review of this industry following the PIP—Poly Implant Prothèse—implants scandal. He came forward with some very sensible and clear recommendations to improve safety in the cosmetic surgery industry and to make sure that patients were protected. The review highlighted the fact that those buying a ballpoint pen have more protection than people having non-surgical procedures in this sector. These recommendations have sat on the shelf in the Department of Health since then. I have asked numerous times when they are going to be implemented, only to be told tomorrow, but tomorrow never seems to come.

We did see some change with the private Member’s Bill of the hon. Member for Sevenoaks (Laura Trott)—the Botulinum Toxin and Cosmetic Fillers (Children) Act 2021 —which, for example, limited botox for under-18s, but this business is a wild west when it comes to regulation. There is a missed opportunity in this Bill not only to get proper patient safety, but to implement Sir Bruce Keogh’s recommendations, which the Government say they support but somehow do not want to implement. This is a multibillion-pound industry, and patients are being put at risk. It is mainly women who, in this sector, need protection. I hope that the Government will implement the Keogh recommendations in this Bill, and I put the Minister on warning now that I will be tabling amendments for that. This is important, and I do not yet understand the reason why the Government are not doing it, because the royal colleges support this and a large number of Members of Parliament have backed these reforms. They do need to be implemented, and we are missing an opportunity to do so.

May I touch on one last thing about public health? I agree with my right hon. Friend the Member for Leicester South (Jonathan Ashworth) that public health, strangely enough, has been forgotten about in this crisis. If we had actually concentrated on putting the main focus on public health and supporting directors, I think we would have had a better outcome. This is not just about this Bill forgetting about public health; it is about the money that goes with it. Under the fair funding formula being touted last year, County Durham would have lost £19 million in public health funding, while Surrey would actually have increased its budget by £14 million a year. That cannot be right. Public health now needs to be at the centre of our healthcare locally, and the Government have to ensure not just that it gets a voice in this Bill, but that local directors of public health get the finance and support they desperately need.

Covid-19 Update

Lord Beamish Excerpts

Monday 12th July 2021 Commons Chamber

[Sajid Javid]

On the app and the so-called pinging—my hon. Friend referred to an individual in his constituency who has perhaps been pinged too many times—it is right, as I have said, that we take a fresh look at any changes that we can make in the light of the success of the mass vaccination campaign. If my hon. Friend will bear with me, I think he will be pleased with our course of action.

[Mr Kevan Jones (North Durham) (Lab)]

In response to my hon. Friend the Member for City of Chester (Christian Matheson), the Secretary of State said that the Government speak with one voice. Well, clearly on masks they change in response to whatever the latest YouGov poll says. He has been very clear today that people should wear a mask in confined spaces, so I ask him a direct question: what is his advice to retailers? Should they insist on their customers wearing masks when they enter their shops?

[Sajid Javid]

The guidance that we will publish today will be very clear on that.

Point of Order

Lord Beamish Excerpts

Tuesday 8th June 2021 Commons Chamber

[Mr Kevan Jones (North Durham) (Lab)]

On a point of order, Madam Deputy Speaker. Last month, I received from a constituent some serious allegations about the conduct of individuals in the cosmetic surgery industry. The allegations involved a surgeon who had been struck off the General Medical Council register in this country, but who was conducting consultations with UK patients via Zoom, from a private clinic overseas. A separate allegation was that a doctor in the UK continued to refer patients to the struck-off surgeon, and that his services were being advertised on UK-based websites.

On 20 May, I wrote to the Minister for Patient Safety, Suicide Prevention and Mental Health, the hon. Member for Mid Bedfordshire (Ms Dorries). On 3 June, I received a direct response to my letter. Lo and behold, it was not from the Minister, but from the CEO of Transform Hospital Group, a private company. I know that it was a direct response because the CEO actually states that he had received my letter directly from the Care Quality Commission.

I take an extremely dim view of my correspondence with the Minister being passed on to a private company without my knowledge or consent. I consider that a major breach not only of confidentiality, but of my trust and that of my constituent who made the complaint in the first place. I do not think a Minister’s correspondence should ever be shared with a private company, breaking the bond of trust that we have with our constituents. I seek your advice, Madam Deputy Speaker, on how I can rectify this and ensure that it does not happen again.

[Madam Deputy Speaker (Dame Eleanor Laing)]

I am grateful to the right hon. Gentleman for having given me notice of his intention to raise this point of order. Mr Speaker shares his concern that sensitive correspondence appears to have been passed from the Department to a private company for a response, and Mr Speaker will be drawing this matter to the attention of the Leader of the House to ensure that these important issues are understood across Government and not only by the people who are paying attention to this particular point of order this afternoon.

The 2016 guidance produced by the Cabinet Office on the handling of parliamentarians’ correspondence goes into some detail, which I will not quote in full now, but the right hon. Gentleman is right in pointing out that that guidance says that

“departments should treat correspondence with great care to ensure that confidentiality is not broken.”

It also states that

“official replies to letters from MPs should only be authorised in exceptional circumstances”.

It would appear that guidance has possibly not been followed in this case.

I would have said to the right hon. Gentleman that I would make sure that the Minister gives an answer, but I am delighted to say that the Minister in question is here in the Chamber, so I shall call her to respond to the point made by the right hon. Gentleman.

Covid-19 Update

Lord Beamish Excerpts

Monday 19th April 2021 Commons Chamber

[Matt Hancock]

My right hon. Friend has asked about this many times, and he is quite right to, because it is not just about cleaning. We have learned a lot during the pandemic about the importance of good ventilation, and that is now embedded in infection prevention and control. As cases in hospitals come down, hospitals across the country are separating, as much as is possible, those who might or do have covid from people who are coming to hospital having been tested and knowing that they do not have covid. That is incredibly important to reassure people that if they are asked to come to hospital by a clinician, it is the best place for them.

[Mr Kevan Jones (North Durham) (Lab)]

In response to my right hon. Friend the Member for Leicester South (Jonathan Ashworth), the Secretary of State said that it was up to local NHS trusts to decide whether to take up the Greensill payday loan app, but The Sunday Times yesterday published an email between David Cameron and Matthew Gould, the head of NHSX, on 23 April. It reads:

“As you can imagine, Matt Hancock, David Prior [NHS England chairman], Simon Stevens [NHS chief executive], as well as the many trust CEOs, are extremely positive about this innovative offer.”

Is that email correct? Was the Secretary of State “extremely positive” about the Greensill app? Does he not think there is something morally wrong with using poorly paid and struggling NHS staff to allow a private company to construct a financial bond to be traded on the international money markets?

[Matt Hancock]

As I said to the right hon. Member for Leicester South (Jonathan Ashworth), my approach was and is that local NHS employers are best placed to decide.