Health and Social Care Budgets

Kevin Foster Excerpts

Tuesday 14th March 2017 Westminster Hall

[Kevin Foster (Torbay) (Con)]

It is a pleasure to serve under your chairmanship, Mr Bailey. I congratulate my friend from the Public Accounts Committee, the hon. Member for Hackney South and Shoreditch (Meg Hillier), on securing this debate, which is welcome. To start on a positive note, we are having this debate because the NHS has been a great success. Life expectancy in England is now approaching 81, which would have been unimaginable when the service first started. Treatments in today’s hospitals would have been seen only in “Star Trek” in the late 1980s. So, to be positive, the story is about how we deal with a challenge created by the greatest success.

I remember my time in local government. Other former councillors in the room may have seen the same graph showing that emptying bins and disposing of rubbish and social care would be the only thing left that councils would be able to afford to provide owing to the predicted rise in the cost of social care as demand increased. We have heard a lot today about the possibility of integrating services. I can certainly reflect on the challenges that my hon. Friend the Member for Northampton South (David Mackintosh) faced in terms of different budgets and different organisations.

In Torbay we have an integrated care organisation that is fairly successful in removing barriers. It has certainly helped contribute to one of the lowest levels, if not the lowest level, of delayed discharges over winter, yet now we are having to discuss how the risk-share agreement is structured, because the NHS organisations still need to comply with budgetary rules for them as individual organisations. It is not about the amount of money in the system overall; it is not about the spending of taxpayer pounds; it is about how that is divvied up in terms of a risk-share agreement. That is the exact opposite of what we want to see when we look at integrated care.

The issue is also the pace of some of the changes. Paignton Hospital will stop taking inpatients on 3 April after a consultation that many of us felt was a bit of a done deal and a waste of time. I was shut out of the first meeting because a small venue had been booked for a large meeting. There was a feeling that the measure was going to happen anyway. On top of that, we have 32 beds being closed at Torbay hospital in the same period. For me the issue is how the pace of change is being forced.

There is a long-term debate. We have touched on pensions and—let us be blunt—there was an element of cross-party agreement when the pension age for my generation was increased to 68. It can be tempting to talk about the amnesia of opposition. We need to discuss long-term solutions. The Budget was welcome, but it has to be seen as a short-term measure. We need a long-term schedule that will last for more than one Parliament and more than one Government.

Health and Social Care

Kevin Foster Excerpts

Monday 27th February 2017 Commons Chamber

[Kevin Hollinrake]

My hon. Friend makes a very strong point. I do feel that we need more money now. I am sure the question of whether more money might be available is taking up some of the Chancellor’s time as he works on his Budget calculations for 8 March. In the short term, we need more money to plug the gap. In the longer term, we need a cross-party conversation on how we solve this problem.

The Select Committee has been an excellent forum through which to explore this issue and many others. As the hon. Member for Sheffield South East (Mr Betts), the Committee Chair, mentioned in his remarks, we went to Germany to examine its system. It was very enlightening. In 1995, Germany moved from one system to another: from a local government-funded system that just did not work—they clearly saw this coming before we did—to a social insurance system. They are more used to that system in Germany, which has similar systems in place for health, pensions, unemployment and accident insurance. It works very well. It is cross-party, seems to be apolitical and takes a salary contribution of about 1.175%. It is a bit like auto-enrolment, but it is compulsory—it is a mandatory scheme. It means that when people need care they have a pot to call on. Needs are independently assessed, so they receive the level of provision that suits them. It can also be used to provide domiciliary care. Money coming back out of the system at the right time can go to help family members look after the person who is ill, so it has a social benefit as well as being a sustainable system that works in the longer term. We should look at that model. It is not the only one, but I reiterate—I know Members on both sides of the House feel the same way—that we should look at this issue in a cross-party way to ensure long-term sustainability.

[Kevin Foster (Torbay) (Con)]

I am very much enjoying my hon. Friend’s speech. Does he agree that the current method of local government funding does not help? There is a ward in my constituency where 9% of the population are aged over 85. Demographics are not properly reflected and the challenges faced by coastal communities in particular, as opposed to some of the more traditional challenges here in London, are not reflected in funding schemes.

[Kevin Hollinrake]

My hon. Friend makes a very good point. The evidence clearly shows that the current methods of funding adult social care do not correlate with the needs in those areas. We need to take a strategic look at that. The Government are moving toward a different way of funding local authorities by 2020. A key part of business rates retention is the consideration of the allocation of funding. It is critical to put need first and foremost, so that need and the cost of delivering services are the cost drivers. Having a fair and transparent system is fundamental.

On adult social care and learning disabilities, one of the most heartening examples of how to deliver them in a different way, rather than looking at them from a single viewpoint, is the Botton Village “shared lives” concept, where people look after each other—co-workers and people in need of care alike. It is a fantastic and inspirational scheme.

Finally, I will touch on a couple of very small points. We should look at how people are charged for domiciliary care. Financial assessment for domiciliary care is different from that for residential care. I think money could be taken out of the system—it does not make much sense to me that the Government fund one thing one way and another thing another way—or people could contribute, if their houses are taken into account in their domiciliary care assessment.

My final point relates to co-terminosity. There are so many different services provided by so many different agencies working in different geographical boundaries. Co-terminosity works well in Sheffield, where all the agencies work together very effectively. In my area, it is completely different. There is a real mish-mash of different providers and geographical areas, which makes it difficult to provide a joined-up service.

[Steve McCabe (Birmingham, Selly Oak) (Lab)]

Often, the NHS estimates day debate is a rather perfunctory affair, but this year, five years into the reign of the present Secretary of State, we are entitled to ask what on earth is happening to our NHS and social care system. Can we any longer afford the extraordinary complacency of this Government? As an Opposition MP, I sometimes worry that, either by design or simple neglect, they will finally fulfil our worst fears that the Tory party is destined to destroy the NHS.

[Kevin Foster]

So much for cross-party dialogue.

[Steve McCabe]

I don’t think I need any lectures on cross-party dialogue from the party of the death tax and the £8 billion financial fib.

In Birmingham, we have seen £28 million cuts to the social care budget, bringing the service to its knees. Elderly people are being treated like cattle, lying around on trolleys, waiting in corridors and dispatched from hospital in the middle of the night. Everywhere we look, we see our hospitals, GPs and social care services collapsing under the strain.

This Secretary of State is quite happy to flex his muscles when it comes to bullying junior doctors, but it is always someone else’s fault when it comes to resources, management and administration of the NHS. There was a time when the deal was simple: in return for the red box and a ministerial salary, Ministers took responsibility —the buck stopped with them. But no more. I have lost track of how many parliamentary answers begin with the words, “The Department does not collect that data centrally,” or “It would not be cost-effective to provide information in that format”. Basically, Ministers do not know, do not want to know and do not want us to know what is really happening. They no longer preside over a genuinely national health service. Whether it is the postcode lottery that characterises the provision of IVF, with clinical commissioning groups ignoring NICE guidelines and making up their own criteria as they go along, or children’s dentistry, where there is a growing crisis and a heavy reliance on hospital emergency surgery because of the lack of provision and monitoring of proper dental services for children, all this Government want to do is hide behind and blame others for their shambolic decisions.

The latest disaster is the business rates revaluation, which in Birmingham is estimated to see a rise for University Hospitals Birmingham’s Queen Elizabeth hospital from £2.8 million to £6.9 million per year—talk about robbing Peter to pay Paul! And yet Ministers from the Department for Communities and Local Government and the Department of Health have not even met to discuss the problem—although I note that private hospitals get an 80% reduction because they are registered as charities.

In my constituency, we have been fighting a battle to save our Katie Road walk-in centre for several years: we have had stop-go consultations, money wasted, explanations and excuses that vary from month to month, consultations announced and then scrapped, and now we have a sustainability and transformation plan that sadly, as acknowledged, has turned into a secret strategy drawn up by non-elected bureaucrats from which the public and their elected representatives have been largely excluded. It seems that Katie Road is now caught up in this fiasco. With its contract scheduled to finish on the 31st of next month, we still do not know what is happening, although if rumours are true, even more money that ought to be spent on healthcare in Birmingham is about to be siphoned off to rescue bankrupt neighbours.

Only the other week, I discovered that the contract for South Maypole GP services was to be cancelled. It is apparently no longer cost-effective—not cost effective to provide GP services to the sick and elderly! Only under this Secretary of State could the NHS have come to this.

Mental Health and NHS Performance

Kevin Foster Excerpts

Monday 9th January 2017 Commons Chamber

[Mr Hunt]

In the hon. Gentleman’s long list of statistics, what he was not prepared to say is that people wait twice as long for a hip replacement in Wales, more than double the proportion of the population is on a waiting list for NHS care—that is one in seven people in Wales, compared with one in 15 in England—and those in Wales are 40 times more likely than those in England to be waiting too long for a diagnostic test result.

[Kevin Foster (Torbay) (Con)]

Torbay, like many other places, has been under pressure owing to the demographics of an ageing population in the bay area, but does the Secretary of State agree that it is encouraging to hear of work being done in places such as the Chelston Hall practice, which I visited on Friday, to make sure doctors can be available on the day for those who need them and people are sent on to specialists who can help them better, such as a physiotherapist, rather than just taking up vital GP appointments?

[Mr Hunt]

Yes, indeed, and I congratulate all the NHS and social care staff in Torbay on doing a fantastic job. I also congratulate them on the pioneering work they have done on health and social care integration, which has made a huge difference to my hon. Friend’s constituents.

CQC: NHS Deaths Review

Kevin Foster Excerpts

Tuesday 13th December 2016 Commons Chamber

[Mr Hunt]

There are a number of barriers, one of which is time. Staff feel very pressured for time. I strongly argue that it is a false economy not to allow time for lessons to be learned, because tragedies, when they happen, take up a huge amount of time. From a management and leadership point of view, we have to make sure that doctors and nurses are given the time for reflective learning as part of what they do.

Another thing is the management culture. If people feel that the management of their trust are open and listening, they are more likely to be open and listening themselves. If they feel that there is a hire-and-fire culture, they are less likely to take that approach. There are a number of lessons.

[Kevin Foster (Torbay) (Con)]

Given the case of three-year-old Sam Morrish, who died at Torbay hospital in 2010, and the conclusions of the Parliamentary and Health Service Ombudsman that many investigations into avoidable deaths were not fit for purpose, I welcome the statement. I also welcome the spirit of openness that will follow in relation to these extremely difficult issues. We are, ultimately, all mortal. Although I think it is absolutely right that we will not be setting targets, will the Secretary of State reassure me about the ongoing monitoring we will undertake and the proactive work we will do with trusts to reduce the number of such incidents?

[Mr Hunt]

As my hon. Friend knows, I have met the parents of Sam Morrish—Scott and Sue Morrish—on a number of occasions. They described how when their son died, all the shutters came down. I met them only a few months after I became Health Secretary, and that engraved itself on my memory because it was so awful to hear about what they were doing.

My hon. Friend raises a rather sensitive issue, which I tried to talk about in my statement. I expect, as a result of the changes, the number of reported avoidable deaths to increase. If that happens, I do not think that it will necessarily mean that patient care is suffering. We have to be very careful, in this House and with our local newspapers, to say that if trusts start to report an increased number of avoidable deaths, it might mean that they have a more transparent culture and are being more open. Their standards about what is expected and what is unexpected may start to change as they realise that things could have been done to prevent a death that they might previously have described as expected. We have a duty, as Members, to encourage responsible reporting of this new openness, and that, in turn, will help staff.

Oral Answers to Questions

Kevin Foster Excerpts

Tuesday 15th November 2016 Commons Chamber

[Mr Dunne]

I thank the hon. Gentleman for making that point. We do of course have the cold weather payment system in force across the UK, and later this week I will attend a meeting with other Government Ministers to look at winter preparedness across the board.

[Kevin Foster (Torbay) (Con)]

The Minister will be aware of the concerns in Torbay about the impact on accident and emergency services from the potential loss of the minor injuries unit at Paignton hospital. Does he agree that it is vital that MIU services are kept within Paignton given that it is the second biggest town in Devon?

[Mr Dunne]

My hon. Friend is aware that a consultation is going on regarding services in south Devon. The point he makes has been well made and I am sure it will be taken into account by the clinical commissioning group and the local community hospital trust.

Coeliac Disease and Prescriptions

Kevin Foster Excerpts

Tuesday 1st November 2016 Westminster Hall

[Mr Jones]

The hon. Gentleman raises an interesting point, especially in terms of families with children. There is also a question of availability in some rural areas. Larger supermarkets stock some of these products at the prices he mentioned and higher, but in other areas the products are not available.

[Kevin Foster (Torbay) (Con)]

Will the hon. Gentleman give way?

[Mr Jones]

I will make a bit more progress.

We have a situation where, in places such as east Essex, the needs of patients are being discounted despite a complete lack of any type of research. I am concerned that more CCGs across the country will begin to use inadequate justifications as a precedent and follow a similar path. That leads me back to my earlier point about the big problem of under-diagnosis. I am afraid we will see a bigger problem if gluten-free prescriptions are not made available to those on low incomes.

--- Later in debate ---

[Kevin Foster]

The Minister is making valid point about supermarkets. Will he suggest to CCGs such as Torbay in south Devon that there is a halfway house and that instead of scrapping the prescription of gluten-free products they could provide vouchers that could be taken to a local supermarket?

[David Mowat]

That is an interesting idea, which I will consider, but I am not briefed to talk about it. The position of most Members on this issue is very clear from the tone of this debate and the points being made, and we will respond to that.

Health Service Medical Supplies (Costs) Bill

Kevin Foster Excerpts

2nd reading: House of Commons & Programme motion: House of Commons
Monday 24th October 2016 Commons Chamber

[Mr Hunt]

I am happy to give that reassurance. As I said, this industry contributes £56 billion to the UK economy, with tens of thousands of jobs. When the Prime Minister talks about where she sees our competitive advantage, she talks, first, about financial services, and life sciences is the very next industry she mentions. I completely agree with right my hon. Friend about its incredible importance, not just to this country but to the future of humanity. That is why we seek in this Bill to establish a fair relationship between the NHS, which we have to represent as we are funding it through the tax system, and the pharmaceutical industry. It is also fair to say that there have been times when some pharmaceutical companies’ practices have been disappointing, and because we want to make sure that that does not happen and that we can continue with a harmonious and productive relationship we are proposing this Bill to the House.

[Kevin Foster (Torbay) (Con)]

We agree that this is not about profit controls—about having a fair return for investment made—but about tackling an emerging business model that could almost be seen as profiteering.

[Mr Hunt]

My hon. Friend is right about that. The nice way of putting it is that we are closing a loophole. If one were being less polite, one might say that it is a shame we are having to do that. None the less, it is important to do what we are proposing to the House.

We recognise that it has been some time since the Government consulted on the options, and I wish to reassure hon. Members and those companies in the statutory scheme that we will consult further on the implementation of a payment mechanism in the statutory scheme, including the level of the payment mechanism, before the regulations come into force. We estimate that 17 companies would be affected by the introduction of a payment mechanism, with the 166 companies that are currently members of the PPRS not being affected. Our proposals would save health services across the UK an estimated £90 million per year.

The second key element of this Bill amends the 2006 Act to strengthen the Government’s powers to set prices of medicines where companies charge unreasonably high prices for unbranded generic medicines. We rely on competition in the market to keep the prices of these drugs down. That generally works well and has, in combination with high levels of generic prescribing, led to significant savings. However, we are aware of some instances where there is no competition to keep prices down, and companies have raised their prices to what looks like an unreasonable and unjustifiable level. As highlighted by the investigation conducted by The Times earlier this year, there are companies that appear to have made it their business model to purchase off-patent medicines for which there are no competitor products. They then exploit a monopoly position to raise prices. We cannot allow this practice to continue unchallenged. My Department has been working closely with the Competition and Markets Authority to alert it to any cases where there may be market abuse and provide evidence to support this, but we also need to tackle it within our framework for controlling the cost of medicines and close the loophole of de-branding medicines. Although the Government’s existing powers allow us to control the price of any health service medicine, they do not allow controls to be placed on unbranded generic medicines where companies are members of the voluntary PPRS scheme. Today, most companies have a mixed portfolio of branded medicines and unbranded generic medicines. For that reason, all the manufacturers of the unbranded generic medicines mentioned in the investigation by The Times are able to use their PPRS membership to avoid government control of their prices.

It should be said that that practice is not widespread, but a handful of companies appear to be exploiting our freedom of pricing for unbranded generic medicines where there is no competition in the market, leaving the NHS with no choice but to purchase the medicine at grossly inflated prices or to transfer patients to other medicines that are not always suitable. Alongside the Government, many in the industry would also like to see this inappropriate behaviour stamped out.

--- Later in debate ---

[Kevin Foster (Torbay) (Con)]

It is a pleasure to follow my hon. Friend the Member for Vale of Clwyd (Dr Davies) and to hear many of the points he made. He spoke of the NHS spending £262 million a year on 50 drugs; that is actually £262 million extra that we are spending on those drugs courtesy of the greatly increased prices. That really brings home the problems here and why the Bill needs its Second Reading.

As many hon. Members have already focused on a range of issues, I will focus in particular on generic drugs and some of the huge price increases we have seen. It is right to say—and this was perhaps touched on by the Secretary of State in response to the intervention by the hon. Member for Wolverhampton South West (Rob Marris)—that it is not unreasonable for a pharmaceutical company to make a profit in exchange for investment in developing a new drug and bringing it to market. But that is what our patent system is for. The patent is there to protect for a period of time the ability of the company to charge a reasonable price to reflect the risk it took in its investment.

The key point is that the drugs we are considering are now out of patent. The company has had a reasonable period of time to make its investment back. The issue is that there is only a very limited supply of them. It is only right that we deal with what is an emerging business model. There can be no two ways about it. Some of the names on the list of companies, such as AMCo and Atnahs, seem consistently to have unusually high increases in prices, in the thousands of per cent. It is clear that a business model is developing to take advantage of a loophole in the legislation and ultimately not to make a profit but to profiteer, at the expense of the NHS and people who need those treatments. I am sure we can all think of instances where drug company lobbying points to patients who are unable to get treatment; this is exactly the sort of thing that means people cannot get treatment.

It was highlighted earlier that it is slightly ironic that here we are, as Conservatives and under a Conservative Government, arguing for price controls. But this is not about intervening in a market but about intervening to deal with market failure, where the normal procedures of competition are not producing a fair or reasonable outcome either for the NHS or for the patients on whose behalf we are providing products.

I went to see the amazing work being done on brain tumour research at Plymouth University recently—the skills and the groundbreaking research that will bring real benefits. But that is not the business model of the companies the Bill deals with. Their model is to look for a drug that needs to be prescribed and has only one supply, then buy it, get hold of the supply and jack the price up. That is nothing to do with delivering new and innovative products. The Bill is therefore very welcome, as it looks to intervene in that situation.

It is also right that to be able to tackle the problem we need information. Let us be blunt; if a company is looking to put its product price up by 12,000% it is not going to be particularly co-operative with an inquiry into whether that is fair, so it is right that the Secretary of State will have powers to require that more information be supplied.

[Rob Marris]

I am grateful to my new friend, another socialist, for giving way. May I tempt him to suggest some other areas of the economy where he and what I must now call his Christian Democrat fellows would be prepared to address the issue of profiteering, as we on the Opposition Benches would?

[Kevin Foster]

The hon. Gentleman tempts me, but I see you are now in the Chair, Mr Deputy Speaker, and you are very tough on any irrelevant points or points off subject, so that could be very dangerous territory.

[Mr Deputy Speaker (Mr Lindsay Hoyle)]

And you shall not be tempted.

[Kevin Foster]

That is good to know.

We have seen work the Government have done in other sectors, for example, on information in the energy sector. The Bill deals with a particularly unique practice, where there is, in effect, only one customer, the NHS, and only one supplier. I am struggling to think of many other industries where that is replicated. That is why these price rises are so disgraceful. This industry is about profiteering from illness and pain. There is nothing else like that.

[Rob Marris]

May I suggest another industry it might be worth looking at, where this situation obtains, namely the defence supply industry—not all of it, but parts of it?

[Kevin Foster]

I thank the hon. Gentleman for that intervention. As a member of the Public Accounts Committee I have spent plenty of time looking through examples of defence procurement that went wrong. The Minister might be new to the Department of Health but he certainly is not new to defence procurement. It is noticeable that much of what now makes its way to the PAC for a review of what went wrong concerns legacy issues—for example, the military flying contract—rather than modern procurement. But I am conscious that with Mr Deputy Speaker in the Chair I need to get back to the price of drugs for the NHS.

Looking through the evidence it is clear that the current system of regulation is not effective. Companies can, in effect, put their branded products into the voluntary scheme and use that as a way of jacking up costs for their generic products. That is just not right. As other Members have touched on, we are facing demands and pressures on the NHS. I have no problem with companies that give a good service charging a fair price and making a fair return on their investment.

That is clearly not what is going on with this business model. We can see numerous examples, in particular in the chart put together by the House of Commons Library, which shows increases of thousands of per cent. across a number of products. It is impossible to believe that such increases are going on for any of the input materials for those products. As we have said, this is flagrant racketeering and profiteering at the expense of patients and of people in pain. Even if the drug is still provided, that money should have been spent on other NHS services.

I am therefore pleased at the almost unanimity breaking out in the House on the proposals. They will clearly need to be discussed in more detail in Committee. But it is the right time for the Bill. It is not about tackling fair and legitimate profits but about getting rid of profiteering, which is why it has my full support.

--- Later in debate ---

[Barbara Keeley]

No, but I think the hon. Member for Torbay was talking about companies that are not doing any research, but just buying up generic products and profiteering from them. There has been general condemnation of those sort of companies on all sides.

[Kevin Foster]

I want to be clear about this point. I think the shadow Minister would probably agree that certain names keep on popping up, particularly in The Times investigation, of companies that seem to be regularly involved in some of the most eye-watering price increases and involved in the mixed model. This Bill is about tackling anyone else who might be thinking of following that kind of business model as a way of exploiting the NHS for money.

[Barbara Keeley]

Very much so.

The hon. Member for Bury St Edmunds (Jo Churchill) welcomed the Bill and talked about the fact that individual CCGs could save £1 million on unused repeat prescriptions. A number of different forms of savings could clearly be made. She talked about the pressure on social care, and I join her in my concern about that. The right hon. Member for Chelmsford spoke earlier about an ageing population and the need for drugs, but older people also do not want to be isolated. It is worrying that 16,000 cases of malnutrition were found last year with an average age of 64 among those cases. People need social care, and I hope that the new Chancellor will listen and bring forward funding for social care in the autumn statement, because people need more than drugs.

As my hon. Friend the Member for Ellesmere Port and Neston (Justin Madders) made clear earlier, Labour supports the broad aims of the Bill and what the Government are seeking to achieve—better control of the cost of medicines. However, as my hon. Friend also outlined, we have a number of concerns, and I hope that the Minister will address them in his closing speech.

As well as taking the understandable measures to collect pharmaceutical data and manage costs, the Bill also introduces provisions to manage the purchase of other medical supplies. I was glad to hear the Secretary of State raise in his opening speech the issue of the impact on the medical supply sector, but I have heard concerns expressed that the medical technology sector sees the new information measures as “onerous”. The hon. Member for Erewash (Maggie Throup) mentioned that, too. There is a concern that measures in the Bill fail to take into account the unique characteristics of medical devices and the medical device industry. I hope that they will start to be taken into account as the Bill progresses. There is seen to be a danger that the measures will put additional burdens on that sector and the NHS, and lead to higher costs. I hope that that is not the Government’s intention; it would be ludicrous if costs were increased by a Bill that is designed to manage them.

We need to bear it in mind that the medical technology industry employs around 89,000 people in the UK, has an annual turnover of over £17 billion and has seen employment growth of around 11% in recent years. Some 99% of the UK’s 3,310 medical technology firms are SMEs, with 85% of them having a turnover of less than £5 million. The cap levels at which data could be collected were mentioned earlier. We should bear it in mind that we are talking about an awful lot of small companies.

The Bill imposes a regulatory burden on all companies in the supply chain. The reporting requirements will affect all firms producing medical supplies, including the very small organisations. The issues we have extensively discussed on pharmaceutical pricing bear no relation to the price of other medical supplies. The example of a particular type of product was mentioned earlier, but they are or seem to be treated the same way in the Bill.

On the scale of the burden being imposed, the Government’s impact assessment is not much help. It says:

“The main costs will be on manufacturers, wholesalers and dispensers. These costs have not been quantified, as their magnitude will not be known until after consultation on subsequent regulations.”

Measures seem to have been bolted on to this Bill, as Members have mentioned, at the last minute, but because they could have a negative impact on the medical technology sector, we need to be very aware of them. The new information powers proposed by the Government are being put forward at a time when manufacturing firms are going through the uncertainty surrounding this country’s leaving the EU. These measures can only add to that uncertainty. As I said, 99% of the medical technology firms are SMEs, with 85% of them having a turnover of less than £5 million.

Notes on the financial implications of the Bill put forward a curious position that

“no policies will be directly implemented as a result of these changes. Their implementation would require additional future changes to secondary legislation and additional Impact Assessments to assess their cost effectiveness.”

Ministers are asking us to change primary legislation to give the Government new information powers, but the details and impact of those new powers on the supply chain will emerge only in future. That level of uncertainty is unacceptable, and we will seek to amend the relevant clauses in Committee if we feel that this still needs to be resolved.

Importantly, the information powers will also impact on dispensing GPs and pharmacists. I note that the BMA was not represented at the workshop held by the Department of Health on the information powers. We wait to hear, but I would find it unusual if our hard-pressed dispensing GPs would welcome the additional work required of them to provide and disclose information to the Government.

The other part of the supply chain affected by the new information powers will be pharmacists. The Government have just imposed punitive cuts on pharmacists, which we discussed in the House last week. I am still deeply concerned about those cuts. Ministers do not seem to understand what they are doing to the sector. On Friday, an independent community pharmacist in my constituency told me that he estimated that the Government cuts would cost him £86,000 a year, and that he envisaged an average cut of £60,000 for many pharmacies. That will certainly mean staff cuts, but it also means potential bankruptcies for the pharmacies that will be hardest hit.

In relation to that, and the new information powers that the Bill imposes, Pharmacy Voice told me that

“small volume pharmacies are the hardest hit by the proposals and many face a funding cut of around 20% in 2017/18 from the imposition of cuts announced…They do not have teams of administrative staff who can respond to demands for information, and the likelihood is that the NHS would insist on information being provided in a specific format.

It could be information that they do not currently analyse. For example, when a pharmacy buys stock for dispensing, it may also include purchases of medicines for sale over the counter. The overall discount the pharmacy gets on the order is not allocated to each item, and pharmacies could not provide the actual price paid per item.”

On behalf of the pharmacists that it represents, Pharmacy Voice wants to ensure that the cost of meeting the Government’s information requirements is fully funded by the NHS. It feels that the imposition of cuts has already jeopardised the future of the pharmacy sector, and that of small pharmacy businesses in particular. Can the Minister assure me that the cost of the information that must be gathered under the new information powers will not impose an additional burden on pharmacists?

The Labour Opposition support the broad aims of the Bill and the measures to control the costs of medicines, but, as I said earlier, we are concerned about the information powers that the Government want to take, which are considered to be “onerous” by the medical supplies sector. We want to be reassured that they are not. The work and the costs involved could deal yet another blow to the pharmacy sector, which, as I have said, is still counting the costs of the Government’s imposition of funding cuts amounting to 12% for the rest of this year and over 7% next year. We will table amendments in Committee relating to the work and the costs involved in information-gathering.

We also ask Ministers to give serious consideration to using all future rebates from the pharmaceutical sector to improve access to treatments for patients. A number of Members have referred to the need to examine that much bigger issue of access to drugs and treatments, and I hope that Ministers will take the opportunity to do so as the Bill progresses.

Healthcare (Devon)

Kevin Foster Excerpts

Tuesday 18th October 2016 Westminster Hall

[Kevin Foster (Torbay) (Con)]

It is a pleasure to serve under your chairmanship, Mrs Main. I congratulate my right hon. Friend the Member for East Devon (Sir Hugo Swire) on securing the debate. I will be mindful of your comments about the time. I presume that a maximum of eight minutes will be appropriate.

[Mr Geoffrey Cox (Torridge and West Devon) (Con)]

Seven minutes.

[Kevin Foster]

I am reminded that it is seven minutes. [Interruption.] The more heckling there is, the longer I might get.

For me, this debate is prompted by what is one of the greatest successes of the NHS: the fact that life expectancies are rising. In parts of my constituency, life expectancy has reached 90, and in one ward that I represent, Wellswood, 9% of the entire population are aged over 85. That brings challenges not only in health and social care, but in relation to the wider selection of services that those who have reached that age will need in order to have a whole life and not just have their healthcare needs taken into account.

Today, however, the focus is on the health service. Clearly, the proposals announced by South Devon and Torbay clinical commissioning group have created a lot of concern across Torquay, Paignton and the rest of the bay and south Devon. In fact, public concern was so great that the first three consultation meetings that it arranged in Paignton did not go particularly well. It arranged what were obviously going to be very large meetings in rather small venues, so when I attended the first one, at 9 am, I found myself, with about 40 residents, my predecessor, the former mayor and a number of councillors, plus trade union representatives, being told that the room was full and we could not go in. Things got worse at the 4 o’clock meeting. I ended up addressing more people at an impromptu meeting on the steps of the venue than had actually got into the official meeting. Then finally, in the evening, although there was a reserved seat for me, that meant that another resident was turned away because I was there speaking. It was a shambolic start to a serious consultation, but thankfully I notice the trust has now arranged further meetings.

Local concern about Paignton hospital is so great because of the breadth and importance of the services that it provides, not least the beds that many people are discharged to from Torbay hospital. When the Public Accounts Committee did its recent report on delayed discharges, Torbay had one of the best records. I am sure that my right hon. Friend the Member for East Devon would reflect that, sadly, the Royal Devon and Exeter did not. That is not so much about the hospital’s own services as about its ability to discharge to a social care setting.

We have already seen the impact that the consultation has had in terms of beds. Qualified staff have decided to seek jobs elsewhere, seeing the numbers of beds already reduced. During the consultation, the fact that there are hundreds of beds in residential and nursing care homes in Paignton was cited. I took the time to ask the obvious question: how many of those are actually vacant at the moment? The answer that I got back—this was a snapshot taken two weeks ago—was that 12 of the beds are vacant, yet two are in places that are accepting no new placements at the moment and four are in a place that specialises in caring for children. That causes real concern that we will see more delayed discharges at our local hospital if the proposals for Paignton go ahead.

Many residents of Paignton are concerned about the wider clinical services provided there, not least the minor injuries unit. The suggestion made in the consultation is that if a minor injuries unit closes at Paignton, residents will travel to either Totnes or Newton Abbot. I am sure that we will hear from my hon. Friend the Member for Newton Abbot (Anne Marie Morris) that the facility there is in excellent condition, but the reality is that that involves travelling past the acute hospital at Torbay, with its A&E department. I think it is far more likely that there will be more pressure as a result of people who would have been at the minor injuries unit in Paignton ending up at A&E in Torbay—the very place that we want to discourage people from going to unless they need to be there. There are also services such as X-rays and other clinics that many local residents find convenient and that support local GPs in delivering excellent healthcare.

My other concern about the consultation document is that although it is very detailed about what will be taken away from the south Devon area, it is not detailed at all about what will replace it. For example, there is talk of a clinical hub in Paignton, but no location. There is talk of doing more through GP surgeries, yet many of the practices are in buildings that predate 1948 and are in effect converted houses—not places that would be able to provide extended facilities for healthcare.

I find it very concerning when I speak with local people about what engagement there will genuinely be as part of the consultation, not least given the meetings arranged for small venues and the way that much of the questioning really produces only one logical answer. No one is going to say, “Yes, I’d like to spend the night in hospital,” but we would spend the night in hospital if we felt that we needed to be there. This is about ensuring that people have genuinely been able to express their views. That is why I hope that my hon. Friend the Minister will take a close look at the consultation being undertaken.

In closing, I emphasise the point that has been made about recruitment. The movement of qualified staff out of Paignton the moment the proposals to close the hospital were mooted speaks to a wider problem of recruitment across health and social care in south Devon. Although seeing the Torbay and South Devon trust receive Fair Train’s gold standard work experience accreditation last Friday was welcome, more still needs to be done to convince people that careers in health and social care are just that: careers. Many male jobseekers in particular see a job in that field as an entry-level job that they would not progress from, yet there are so many opportunities there. This is another concern for me, as it is for colleagues. We can put things down on paper, but if, in the social care market locally, there are not the providers, there is not the quality of provider and, bluntly, the vacancies that we already have for GPs are spreading across other health professions, then whatever position we come up with in the consultation will not be able to be implemented unless we address those long-term challenges in our economy.

[Sir Hugo Swire]

Does my hon. Friend share my concern about recruitment in social care and care homes: that a lot of staff are, of course, from the Philippines and other countries around the world? We must all hope that that is taken into account when the UK comes up with a new immigration policy.

[Kevin Foster]

I thank my right hon. Friend for his intervention. It is worth saying that the outcome of the EU referendum and Brexit is probably not going to affect those from the Philippines, given that the Philippines is not a member, but I fully accept the point that we have for too long relied on importing healthcare professionals—doctors and others. We have to have a debate about whether it is ethical for us basically to be depopulating parts of the third world of much-needed doctors, nurses and other trained medical professionals and to be relying on other countries’ training schemes to provide the numbers of healthcare professionals we need. The key point is that we want our own young people to be taking up those opportunities, as well as having the services provided.

I can see you indicating that my time is coming to an end, Mrs Main, or has come to an end. I will finish with one plea: I want to see Paignton hospital and Paignton people’s services continuing into the future.

Oral Answers to Questions

Kevin Foster Excerpts

Tuesday 11th October 2016 Commons Chamber

[Mr Hunt]

I do not recognise the picture the hon. Lady paints about opposition to STPs. We need to ensure we have good plans that will deliver better care for NHS patients by bringing together and integrating the health and social care system, and improving the quality of out-of-hospital plans. While we are in a period where those plans have not been published there will obviously be a degree of uncertainty, which we will do everything we can to alleviate, but she is right to say that these plans are very important for the future of the NHS. The process has our full support.

[Kevin Foster (Torbay) (Con)]

The Secretary of State will be aware of the concern in my constituency about the future of Paignton hospital, which prompted hundreds to turn up to a recent meeting. Does he agree with me that it is vital the clinical commissioning group, in publishing its plans, does not just publish what it will remove but the details of what it will replace them with?

[Mr Dunne]

Considerable efforts are going into sorting out some of the historical challenges in the provision of both acute and community care in Devon. I hosted a meeting for a number of colleagues who are concerned about this and I am happy to continue to engage with colleagues across the county.

Junior Doctors: Industrial Action

Kevin Foster Excerpts

Monday 5th September 2016 Commons Chamber

[Mr Hunt]

I was nervous mentioning the fact that the Government have made 107 concessions when I saw that my hon. Friend might be in the Chamber because I knew that, for him, that would be 107 too many. His broader point is absolutely spot on. The working terms and conditions for Saturdays for junior doctors in this new contract are better than they are for nurses, police officers, fire officers and for those in many other parts of the economy. That is why I think it is a fair deal that everyone should recognise and welcome.

[Kevin Foster (Torbay) (Con)]

I know that the Secretary of State will agree that what sums up this dispute is that, under the existing contract unless the new one is brought in, we could be treated by a doctor working their 91st hour in a week. Does he agree that it is absolutely bizarre to see this level of strike action called when even the BMA’s own council was so divided over whether to support it?

[Mr Hunt]

That is absolutely right. What my hon. Friend is alluding to is the fact that, in the new contract, we are reducing the maximum hours that any doctor can be asked to work in any one week from 91 hours to 72 hours. There are all sorts of other safeguards that benefit safety. He is right. This should not be happening, and I urge the BMA to reconsider.