Defending Public Services
Lindsay Hoyle Excerpts(9 years, 8 months ago)
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Bob Blackman (Harrow East) (Con)
It is a pleasure to follow the hon. Member for Washington and Sunderland West (Mrs Hodgson). I also place on the record my appreciation of the memorable maiden speech of the hon. Member for Sheffield, Brightside and Hillsborough (Gill Furniss). The connection between those two hon. Members is that I look forward to visiting their football teams next season and not having to suffer attending St James’ Park.
The Queen’s Speech contained some 21 Bills. I do not intend to refer to all of them in the time available to me, but I want to mention some and to express my views about some that appear to be missing. It is almost de rigueur to discuss the EU referendum in our speeches, and I look forward to the Government needing to bring forward legislation to disentangle us from the European Union once we, the British people, have set ourselves on to the path of freedom and democracy.
As for today’s debate, I particularly want to talk about the national health service and not only some of the key issues contained in the Queen’s Speech, but some things that do not require legislation. The Bill to ensure that people who do not pay taxes in this country have to pay their way when using the NHS should be welcomed across the House. We all recognise that the NHS requires additional funding and needs resources, but it is a national health service that the people who live, work and play in this country rely on for their health; it is not an international health service to treat the rest of the world. I hope that that Bill will receive support right across the House, including from the Opposition.
I congratulate the Health Secretary on achieving an end to the negotiations with junior doctors that paves the way for a proper seven-day NHS. I went looking around my constituency at the weekend on behalf of constituents who want a weekend GP service, but no GP surgeries were open at all. That is the reality. GPs widely advertise as being open Monday to Friday, but no GP service is available in my constituency on a Saturday or a Sunday. If someone is ill or needs medical treatment, there is no choice but to attend A&E, leading to increased pressure on the emergency services. Equally, it is important that the Health Secretary negotiates terms with GPs that ensure that a service is available for people needing routine medical procedures at the times of day and on the days of the week when people want the service to be provided and not just when it is convenient for GPs.
The NHS’s cumbersome investment decision-making process must also be disentangled. The Royal National Orthopaedic hospital, which I am proud to champion, has been making a case for its rebuilding for some 30 years. Six years ago, we received confirmation from the coalition Government that money was available to do exactly that. However, despite draft outline business case after draft outline business case and so on, we are still waiting, six years on, for the business case to be signed off. It is ridiculous in this day and age that our NHS is spending more money on management consultants to make decisions than on consultants to deliver medical treatment. I hope that our health team can resolve the problem without the need for legislation by ensuring that we cut through red tape and enable decisions to be made—a business-like approach to running the NHS without introducing any form of privatisation whatsoever.
I warmly welcome the proposed sugar tax, because it is a great means of driving behaviour. For most people, the sugar content of many drinks is masked, which is clearly unhealthy for people of all ages, young people in particular. The change is a sign of the way things are going. Something that seemed to pass without too much celebration last week was that we finally got clearance to introduce standardised packaging of tobacco products when the court case brought by the tobacco companies collapsed in the High Court. That is good news. I was also pleased by Axa’s decision to remove the £1.7 billion of its policyholders’ money that was invested in the tobacco industry. It quite rightly said that investing in tobacco products was destroying its customers’ health and it then had to pay out on insurance claims to support those customers. That shows the way things are going. I hope that the Chancellor will consider not only the sugar tax, but a levy on tobacco companies through increasing the cost of a packet of 20 and then ensuring that all the money raised goes directly to funding local health initiatives to stop people smoking and to prevent them from starting.
I also welcome the digital economy Bill. For the unaware, I had the honour of working for BT for 19 years before being elected to this House. Back then, I promoted the idea of BT having a universal service obligation to provide superfast broadband. In fact, broadband full stop would be a start, and speed could be increased thereafter. My constituency is on the edge of London, yet it has a series of housing estates, built more than 20 years ago, in which it is impossible to get broadband—that is outrageous. We have people who work in the City of London, in very responsible jobs, who would like to work from home but are unable to do so because BT fails to provide broadband of a reasonable speed. In this day and age, it is outrageous that they should be deprived of that fundamental service, on which we all rely. As we ask more and more people to work from home, so that they do not congest the roads and do not have to travel to an office to do their work, they should have the facilities to be able to work from home, if they so wish. I look forward to that becoming more and more a focus of attention for the Government.
I also welcome the neighbourhood planning Bill. As hon. Members on both sides of the House have said, we need to build more houses in this country for people to live in. I strongly supported the Bill that became the Housing and Planning Act 2016, which creates the environment in which houses can be built. The neighbourhood planning Bill clears up the issue and prevents the process whereby plans are clogged up and development is prevented from taking place. We should set out our plan, and I support the Government’s plan to generate more and more housing for younger people to be able to purchase and so get their foot on the ladder of property ownership.
One of the most fundamental local services is refuse collection. Although localism is welcome, it cannot be appropriate that, right across London, and probably across the country, people who move, probably every six months, because of private rental arrangements suddenly find that the refuse collection systems and the colours of the bins are totally different depending on the borough. They are therefore totally confused as to what should happen. As a fundamental service to people, we should seek to ensure that we have a sensible waste-collection service in this country; we should sort out who pays for it and how it is collected. At the moment, it is one area where local decisions can be made but clearly there are vast differences in the quality of services being provided.
I am also pleased that the education Bill will be coming forward, and I am glad that the Government have wisely dropped their decision to force schools to become academies. I welcome academies being created, but forcing schools to do that would be the wrong thing to do. Finally, I will just mention the counter-extremism and safeguarding Bill, in the short time I have left. I have—
Contaminated Blood
Lindsay Hoyle Excerpts(9 years, 10 months ago)
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Mr Deputy Speaker (Mr Lindsay Hoyle)
Order. I believe that there was an informal time limit of seven minutes, and the hon. Gentleman has a minute to go. If we cannot get it down to six minutes, I will have to impose a formal time limit, which I do not want to do.
Peter Heaton-Jones
I understand, Mr Deputy Speaker; thank you.
My hon. Friend the Member for Taunton Deane (Rebecca Pow) makes the perfectly reasonable point that time is running out, and that these people find themselves in an impossible position. I do not seek to extend this process unnecessarily, but the 15 April deadline cannot and must not be the end of the story. It cannot be a deadline after which a decision is simply handed down. Let us give a proper, respectful hearing to those who believe that an injustice is about to be done, and let us try to put this right.
I also said that we needed understanding. These events have devastated the lives of many people, including my constituent, Sue Threakall. I shall end as I began, by quoting her words in an email. She says:
“At the moment I haven’t the slightest idea how I will be able to manage and am in complete despair. Over the last week it has occurred to me several times that after fighting this for over three decades…I really don’t want to carry on.”
I say to my constituent and to the other campaigners who are with us today: do carry on, and do keep telling us what we need to know. As my hon. Friend the Member for Norwich North (Chloe Smith), who has just left her place, said, it is by hearing the true life stories of those who have been affected that my hon. Friend the Minister, who I know is listening, will be able to take very careful note. Let us do all we can to deliver what my constituent and many thousands of others want and deserve: truth, fairness and justice.
End of Life Care
Lindsay Hoyle Excerpts(9 years, 11 months ago)
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Pete Wishart (Perth and North Perthshire) (SNP)
On a point of order, Mr Deputy Speaker. We have just concluded two days of debate on the Government’s estimates, but the estimated expenditure itself has not been debated. At 7 o’clock, we will be asked to authorise the Government’s spending plans for Departments of State—some £600 billion of public money—without there having been any debate whatsoever about them. How can that possibly be right, and what should Scottish Members of Parliament do now that we are effectively banned from voting on English-only legislation that may have a Barnett consequential? We were told that that would be considered in the estimates process, but we are not getting the chance—
Mr Deputy Speaker (Mr Lindsay Hoyle)
Order. Mr Wishart, you have made your point very well time and again, and I understand why you are frustrated. As you know, it has been agreed by the House and that is what the Standing Orders say. We all know that it is not the Chair who is responsible.
Access To Medical Treatments (Innovation) Bill
Lindsay Hoyle Excerpts(10 years ago)
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Nick Thomas-Symonds
I am grateful to Members across the House for their contributions and to the Life Sciences Minister for his clear response to the six probing new clauses. I am pleased to hear that the Government will accept amendments 10 and 13. As I said in my opening speech, having off-label treatments in the Bill and the database will make a significant difference and help move things forward. I was also pleased with his reassurance to the hon. Member for Central Ayrshire (Dr Whitford) that we will continue to review the system, as, I hope, the number of off-label treatments and prescriptions increases.
In view of the Minister’s commitments and acceptance of amendments 10 and 13, I do not propose to press new clauses 1, 2 and 3. New clauses 4, 5 and 6 are in the names of the hon. Members for Bury St Edmunds (Jo Churchill) and for Central Ayrshire (Dr Whitford). I beg to ask leave to withdraw the motion.
Clause, by leave, withdrawn.
Clause 1
Access to innovative medical treatments
Amendment made: 10, page 1, line 3, after “treatments” insert
“(including treatments consisting in the off-label use of medicines or the use of unlicensed medicines)”—(Chris Heaton-Harris.).
Chris Heaton-Harris
On a point of order, Mr Deputy Speaker. I am unsure of the process. What happened to amendment 13?
Mr Deputy Speaker
It comes later. It is about three pages further on in the dossier. It has not been lost, and we will be coming to it, so the hon. Gentleman can rest assured. It is there.
Chris Heaton-Harris
I beg to move amendment 1, page 1, leave out lines 7 to 9.
Mr Deputy Speaker
With this it will be convenient to discuss the following:
Amendment 11, page 1, line 18, in clause 2, leave out from beginning to “involves” in line 19 and insert
“In this section, “innovative medical treatment” means medical treatment for a condition that”.
Amendment 2, page 2, line 26, leave out clause 3
Amendment 3, page 3, line 19, leave out clause 4
Amendment 4, page 3, line 40, in clause 5, leave out “this Act” and insert “section 2”
Amendment 12, page 3, line 42, in clause 5, leave out paragraph (b)
Amendment 5, page 4, line 1, in clause 5, leave out “this Act” and insert “section 2”
Amendment 6, page 4, line 3, in clause 5, leave out “this Act” and insert “section 2”
Amendment 14, page 4, line 8, in clause 6, leave out “Sections 1 to 5” and insert “Sections 1, 2 and 5”
Chris Heaton-Harris
I just thought I would check about amendment 13, Mr Deputy Speaker. This whole experience has been a steep learning curve when it comes to procedure in the House. Perhaps we have invented a few things on the side as well, given how we have gone about our business here. I do not want to speak too soon, but if we could conduct all our health debates in the positive and constructive tone that has characterised these debates and the process behind the Bill, we might improve our heath service in leaps and bounds, rather than getting caught up in unnecessary politics. But that is where we are.
My amendments 1, 2 and 3 would remove, among other provisions, two clauses on clinical negligence. I want to talk about the reasons for their removal and the original idea behind the clauses. As right. hon. and hon. Members who have been following the progress of my Bill will know, many of the ideas in it came from Lord Saatchi’s Medical Innovation Bill in another place. Those ideas have not had the smoothest of journeys in this place. I have been regularly reminded by hon. Members—I thank those here today—and others outside this place that these clauses have not enjoyed the support of stakeholders.
Such concerns have been around since before the Bill was even drafted. Unfortunately, the echoes of those concerns haunted the first mention of the word “innovation” in the clause, and I decided from conversations I have had that those concerns could not be quelled in time. Throughout the process, I was clear that I wanted to listen to everybody with something to say on this matter. I have met and read the briefings of everyone who has contacted me wishing to share their views, and I hope it has been evident that I have been up front, honest and very clear about my intentions. I tried to solve the concerns of Members and the medical community who believed the clause would have negative and unintended consequences. That is why I tabled these amendments.
I hope that this process reflects favourably on Parliament and shows how a piece of possible legislation can evolve with a huge amount of stakeholder engagement and with parliamentary opinion taken on board. Since the beginning, I have focused on the sharing of good practice and transparency—and, indeed, on the failures of treatments through a database. Those ideas are reflected in clause 2 and have received much support.
I wanted to maintain the camaraderie built up around the Bill and have been unable to find the support I needed for the more controversial clauses, 3 and 4. Clause 3 sets out the steps that a doctor would need to take to show that he or she had acted responsibly using the Bill. They were intended to reflect the steps that a responsible doctor could be expected to take under common law when innovating. In relation to a proposed treatment, clause 3 would require the innovating doctor to
“obtain the views of…appropriately qualified doctors”
with
“appropriate expertise and experience in dealing with patients with the condition in question.”
Clause 4 expressly preserves the common-law Bolam test, the key precedent for judging whether a doctor has acted negligently.
The two clauses received strong opposition, which I will not go into too much. However, I worked closely with many officials from the Department of Health, and I want to thank them, because I had read the briefings that were so adamant in saying how dangerous parts of the Bill would be, so it was nice to have some of the best and brightest legal and parliamentary counsel remind me again and again that they viewed them as perfectly safe and did not see them as a danger to patients.
Access to Medical Treatments (Innovation) Bill
Lindsay Hoyle Excerpts(10 years ago)
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Mr Deputy Speaker (Mr Lindsay Hoyle)
With this it will be convenient to discuss the following: amendment 9, page 2, line 20, at end insert—
“(6A) Regulations under subsection (1) may not be made unless the Secretary of State is satisfied that the regulations have the approval in principle of—
(a) the HSCIC,
(b) the General Medical Council,
(c) the British Medical Association,
(d) the Association of Medical Research Charities,
(e) the Royal Colleges,
(f) the Academy of Medical Sciences,
(g) the Medical Research Council,
(h) the National Institute for Health and Care Excellence,
(i) the Medicines and Health Products Regulatory Agency, and
(j) any other body or individual that the Secretary of State considers it appropriate.”
Amendment 15, in clause 5, page 4, line 1, leave out subsection (2) and insert—
“( ) References in section 2 to medical treatment include references to treatment carried out for the purposes of medical research (but nothing in section 2 is to be read as affecting the regulation of medical research).”
This amendment makes it clear that the database for which clause 2 provides may contain information about treatments carried out for the purposes of medical research (including, for example, in the context of a clinical trial).
Heidi Alexander
Setting aside the fact that I question whether what is left of the Bill is necessary, if the database is to be created, it is important that we get its design right. The Association of Medical Research Charities has expressed concern that the database might adversely impact patients and medical research. For such a database to be effective, it will need to be appropriately regulated and quality controlled. I believe that it can command the confidence of the medical profession only if it is developed in consultation with it. With that in mind, amendments 8 and 9 deal with the bodies that the Secretary of State must consult and get approval from before introducing regulations establishing a database of innovative treatments.
As the Bill stands—this is set out in clause 2(1)—to make those regulations the Secretary of State need only consult the Health and Social Care Information Centre. Restricting the statutory consultees to only one organisation seems highly restrictive and is inconsistent with the Bill’s explanatory notes, which state:
“The detailed design of the database would be consulted upon with professional bodies and organisations.”
Amendments 8 and 9 would make the legislation clearer on which bodies should be consulted.
I note that the Minister was unable to support similar amendments tabled in Committee because he felt that the list was “not exhaustive”. Indeed, he went on to say:
“Although it represents a helpful list of consultees, such a provision would need to include many more organisations. While I understand the intention behind the amendment, restricting the process would not be helpful”.
The hon. Member for Daventry (Chris Heaton-Harris) then said:
“I know from my consultation on the Bill with stakeholders that we would need longer lists than those in the amendments.”––[Official Report, Access to Medical Treatments (Innovation) Public Bill Committee, 16 December 2015; c. 22-23.]
With those constructive comments in mind, I have included in the list a provision allowing the Secretary of State to consult
“any other body or individual that the Secretary of State considers it appropriate to consult.”
I know that there were concerns that the list of specified organisations could become out of date. However, given that these regulation-making powers would likely be used only once—to create the database—I do not believe that concern is wholly justified. Indeed, if the Minister, or any hon. Member, believes that an inappropriate organisation is on the list set out in my amendments, I would be keen to know which organisation they feel should not have a say in the creation of the database.
I hope that these important amendments will address the concerns raised in Committee and that hon. Members will now be able to support them, because they will ensure that we get the design of the database right.
Mr Deputy Speaker (Mr Lindsay Hoyle)
The hon. Member for Daventry (Chris Heaton-Harris) may have to shake his watch a little longer. I call Jo Churchill.
Jo Churchill
I spoke earlier about the new clauses we tabled, but I did not emphasise my own need for us not to paralyse the database. It is vastly important, given the wider horizon of genomics and informatics, and we have not even touched on how it could accelerate the whole system and improve patient outcomes significantly. We need to put patients at the front and centre of the process, and allow enough flex for the system to be the best and the database to be the finest in the world. We have the finest scientists, the greatest charities and some of the best academic minds at our disposal.
The database may also revolutionise the life sciences industry, to which my hon. Friend the Member for Newton Abbot (Anne Marie Morris) has just referred. That industry generates 1% of our export market from one drug. The power for this billion-pound industry to grow and to improve health—not only in our own country, but across the world—has to be seen to be believed. It costs upwards of £1 million to take a drug to market. What on earth would incentivise a company to do that if it could not get some sort of payback? We must not tie the hands of the people who can find the answers. Many such companies start as micro-companies, spun off from the great universities of our country, but many of them fail in what they call “death valley”. Our health system needs to modernise, digitise and reform to collect, collate and use our health data in the right way.
I believe that clinical trials are vital. I would take part in one, as a dear friend of mine recently did, to give other people a better chance of beating their disease. That is why we must not constrain the database in a way that, like a straitjacket, would completely constrict the industry and academia. At the same time, we must maintain the rigour in dealing with science for which our country is so famed. I believe that the power behind that science is patient data, and every patient holds an answer. With the support of clinicians and charities, and with a strong sense of purpose from the Government, I want data to be used for the benefit of patients. I will stand here and make my point over and again for these five years if we wreck the ability for a database to be a power for good in this Chamber today.
NHS and Social Care Commission
Lindsay Hoyle Excerpts(10 years ago)
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Debbie Abrahams
I hope the hon. Lady will not mind if I do not. I have spoken for some time, and I am being pressed by you, Mr Deputy Speaker—[Interruption.]
Several hon. Members rose—
Mr Deputy Speaker (Mr Lindsay Hoyle)
Order. The winding-up speeches will begin in 15 minutes. I call Dr Philippa Whitford.
Dr Philippa Whitford
Just on the Commonwealth Fund analysis, the standard that the UK did badly on was actually healthy life expectancy. That is not the same as an outcome in hospital. We may have successful operations, but we have underlying deprivation and ill health.
Mr Deputy Speaker (Mr Lindsay Hoyle)
I just say to the Minister that I did give him the nod. I have been very generous. When we say that he has “up to 15 minutes”, he is meant to take 15 minutes. As he can see from the clock, he has taken a lot longer.
Alistair Burt
I beg your pardon, Mr Deputy Speaker. I have tried to accommodate interventions but I entirely take your point. I am just about to finish and am grateful for your generosity.
I take the hon. Lady’s point, but in conclusion, the Government take advice from a lot of sources on everything connected with health. If the right hon. Member for North Norfolk wants to do exactly what he suggested, he can do it, and we will listen very carefully to him, as we do to others. However, I am afraid that, at the moment, I cannot see a Government-sponsored commission. If we have more debates such as this one, the public will be better served and the House will have done its job.
Mary Creagh (Wakefield) (Lab)
On a point of order, Mr Deputy Speaker. In the past hour, we have had the news that the Lord Chancellor has scrapped the Government’s proposed legal aid reforms, which had drawn such huge protests from criminal solicitors across the country, including in my constituency. We had a debate on prison and justice issues for three hours yesterday, which would have given him ample opportunity to tell the House of the news. May I use your good offices, Mr Deputy Speaker, to ask whether it would be appropriate for the Lord Chancellor to come and make a statement to the House tomorrow, which is a sitting Friday?
Mr Deputy Speaker (Mr Lindsay Hoyle)
I have been given no notice today of any statement, and it is very late in the evening and we are about to finish. What I can say is that it is certainly on the record and the Government are certainly able, if they wish, to make a statement tomorrow. The hon. Lady is able to put in for an urgent question if she feels it is appropriate. I cannot promise anything, but those avenues are open to the Government and to the hon. Lady.
Childhood Obesity Strategy
Lindsay Hoyle Excerpts(10 years ago)
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Mr Deputy Speaker (Mr Lindsay Hoyle)
Order. It is meant to be a 15-minute opening speech. Mr Davies will want to speak and he will not want me to take any minutes off him, so I am sure this will be a very quick intervention.
Geraint Davies
The debate is often between reformulation and tax. I agree with the tax on fizzy drinks, but if we had a tax on overall sugar input—for the sake of argument, let us suppose that sugar makes up half a Hobnob and the tax is at 10%—that would give an incentive to the manufacturers to reformulate without the price going up and we could get the sugar content down.
Several hon. Members rose—
Cities and Local Government Devolution Bill [Lords]
Lindsay Hoyle Excerpts(10 years, 2 months ago)
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Mr Brady
The Minister has to understand that this is endemic in the nature of the process. It will become more and more commonplace as we see more powers being transferred from the local authorities to combined authority level, and the new arrangements will become entrenched. That is why it is so important that we ensure that the safeguards are in place at this point—
Mr Deputy Speaker
Unfortunately it is me that makes the decisions—we could do this over two days—but I would have thought the Minister had at least some indication.
Alistair Burt
I rest my case with my hon. Friend: I believe that legislation currently provides the reassurance that he seeks. However, I undertake that, before the matter is concluded in the House of Lords, we will ensure that that assurance is there so that he is covered. He is absolutely right to make sure that his local authority has the opportunity to make representations when it needs to. I am sure that the legislation does that, but we will make doubly certain that it does.
Mr Allen
That is exactly the difference between decentralisation and devolution. This proposal is the Secretary of State pushing some power to the locality, purely on the basis that he can suck it back; it is not giving power and, as of right, allowing the local authority to exercise that. There is no way in which the local authority can intervene in this process. It is a bystander, as an agent of central Government.
Mr Deputy Speaker (Mr Lindsay Hoyle)
The interventions must be shorter, as I still have to get the Front Bencher in.
Alistair Burt
The hon. Gentleman is coming at this from the wrong point of view. He is coming at it from the point of view that the Secretary of State is deliberately pushing something towards an authority, but he is not—the authorities are asking him for something. He would not be doing that unless authorities came to him and said, “We want to do this.” The Secretary of State would not agree unless he thought it was in the best interests of healthcare, because it is not his personal judgment but his duty. If those functions are not performed properly, his ultimate duty, which the House has already agreed, must be to take the powers back. The hon. Gentleman is approaching it from the point of view that there is something malevolent about the Secretary of State which means he wants to challenge the authority. The duties he has, which are contained in statute and which the House says he must retain when NHS powers are devolved, are what impels the amendment, nothing else.
Hospital Parking Charges (Exemption for Carers) Bill
Lindsay Hoyle Excerpts(10 years, 3 months ago)
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Philip Davies
I suspect it means that people are parking in places where they should not be parking within the car park because there are not enough spaces, so they park somewhere where there is not a space.
Mr Deputy Speaker (Mr Lindsay Hoyle)
Order. I do not think we need to worry too much about going over the capacity of 100%. We need to concentrate on the Bill and worry about carers’ parking.
Philip Davies
I very much agree, Mr Deputy Speaker. I will move on. I will discuss how it might work with my hon. Friend in the Tea Room afterwards.
Philip Davies
Whether it is or not, Mr Deputy Speaker, I will move on.
I asked my local hospital how many carers already use its car parking spaces, which very much is our concern today. It replied:
“The Foundation Trust is currently unable to determine how many carers use the designated hospital car parks. It would therefore be difficult to assess the potential impact on car parking revenue”.
That goes some way towards answering the question my hon. Friend the Member for Christchurch asked. The honest answer is that we do not know what the impact will be on any particular hospital. My local hospital certainly does not know.
Julian Knight
My hon. Friend is making the important point that his foundation trust does not know how many carers park at the hospital. I have asked similar questions and have not received any answers. That shows that we do not know how much the Bill would cost the country if it were put in statute.
Mr Deputy Speaker
In fairness, we have had an hour of explaining that we do not know the cost. I am sure that we do not want to rerun that.
Philip Davies
Absolutely, Mr Deputy Speaker.
Although there are no official statistics on this matter, in the NHS car parking impact assessment for 2009, the Department of Health provided an estimate of the revenue raised from hospital car parking charges as a whole, which was in the range of £140 million to £180 million. University Hospitals Birmingham NHS Foundation Trust raised £1.5 million from car parking in 2004-05. This measure would clearly leave a substantial hole in NHS hospital budgets.
As I have made clear, one consequence of the Bill would be increased car parking charges for people who do not apply for the free parking. One of my concerns is that we have already seen considerable increases in car parking charges at hospitals. Wye Valley NHS Trust has increased its average hourly rate from 33p in 2013-14 to £3.50 in 2014-15. I would be loth to put any additional cost on people who are using that car park. The Whittington health trust in London doubled its average hourly rate from £1.50 to £3, and Medway Maritime hospital in Gillingham increased its price for a five-hour stay from £5 to £8. Given that we are already seeing such huge increases in parking fees, I would not want to pass a Bill that would see people paying even more.
That point was highlighted by the British Parking Association in 2009, following the scrapping of hospital car parking charges in Scotland. It said:
“Car parks need to be physically maintained, somebody somewhere has to pay. Charges were not introduced to generate income but rather to ensure that key staff, bona fide patients and visitors are able to park at the hospital. Without income to support car park maintenance…funds which should be dedicated to healthcare have to be used instead.”
Barbara Keeley
On a point of order, Mr Deputy Speaker. The hon. Gentleman has been speaking for an hour and nine minutes, and we are now getting a lot of repetition. Many other people want to speak.
Mr Deputy Speaker (Mr Lindsay Hoyle)
In fairness, it is for me to decide whether there is repetition. I certainly do not need any advice. You should not be questioning the Chair’s ability to hold the speaker to account. I am sure that Mr Davies is well aware that many people wish to speak and that he wants to hear those other voices. He is in order, but I am worried that we will get into repetition. I certainly do not want to get bogged down in the maintenance of Scottish car parks. I am sure that he will move on quickly.
Philip Davies
I am grateful for that guidance, Mr Deputy Speaker. The hon. Lady has intervened on me more often than anybody else, which has held me up in making my remarks. My advice is that if she wants me to crack on, she should not keep intervening on me so that I have the opportunity to do so.
A big geographical inequality would result from the Bill because car parking charges vary wildly from one part of the country to another—from £4.26 in the north-east to £11.85—
Mr Deputy Speaker
Order. The hon. Gentleman has given a great number of examples. I do welcome examples, but there is a limit to how many we need. I think that people can get a flavour of the arguments from the examples he has used. Hopefully he will bring something new to the Chamber. If not, I am sure that he would like to hear somebody else. I am sure that some of his colleagues are desperate to speak.
Philip Davies
I am very grateful, Mr Deputy Speaker.
I will turn to the example that the hon. Member for Burnley used in her remarks, which she encouraged me to reflect on. As she said, at the end of last year, Torbay and South Devon NHS Foundation Trust announced that it would offer free parking to registered carers at Torbay hospital. I should point out that that scheme, unlike the Bill, is offered specifically to unpaid carers, rather than people who receive carer’s allowance. That is not what the Bill proposes, despite the impression the hon. Lady wanted to give. The interim chief executive of Torbay hospital, Dr John Lowes, said in December 2014:
“Family members and friends who provide unpaid care to our patients at home are invaluable, so we wanted to do something to make their hospital visits a little less stressful, and to demonstrate that we really do value what they do.”
He explained that the system was being implemented with the involvement of the established local care providers and that
“if someone is registered with either Devon or Torbay Carers Services, they just need to display their Carers Card on the car dashboard whilst they are parked in the public pay and display areas, and they will not be charged for parking.”
There are two points to make about that. First, the hon. Lady argued that what happens in Torbay shows why we can happily roll out the scheme across the country, but my view is that it is a perfect illustration of why we do not need legislation. Torbay has managed to do it without any legislation in a way that suits its local requirements, which is what I want to see.
Secondly, I know from my own experience that there is a problem with having a card displayed on a dashboard in a pay and display area, which is effectively what happens with blue badges. Anybody who has been involved in that area knows that people hand their badge to someone else to use—a member of their family, or whoever. It is not right—it is a terrible thing—but it happens, and we cannot ignore the fact that it would happen under the system proposed in the Bill.
Mr Rees-Mogg
I just want to say that I am sure things like that do not happen in Somerset.
Mr Deputy Speaker (Mr Lindsay Hoyle)
Order. And I am sure that it is not part of the debate for today.
Philip Davies
Thank you, Mr Deputy Speaker. Again, I will move on.
As the Torbay scheme is the nearest to the one that the hon. Member for Burnley proposes, I asked some questions through freedom of information requests about the impact and take-up of the scheme. I asked how many people had used the scheme since it was introduced, and the reply from Torbay was:
“We are unable to provide you with the information requested as it is not held electronically or in a central location. We do not record the details of carers, only a verification that they are on the register.”
We do not even know how many people take up the scheme that has been introduced.
Philip Davies
That is my reading of the situation. Because the definition of carers in the Bill is different from that used by Torbay—
Mr Deputy Speaker
Order. May I just say that we have covered Torbay? The hon. Gentleman has moved on, but unfortunately the hon. Member for North East Somerset (Mr Rees-Mogg) keeps wanting to drag him back to what he has already covered. I know that he does not want to go back to that.
Philip Davies
I am pleased that you have acknowledged that I am being led astray, Mr Deputy Speaker.
Philip Davies
In which case we must look at the Bill itself, Mr Deputy Speaker, if that is what you are urging me to do.
The Bill is called the Hospital Parking Charges (Exemptions for Carers) Bill, but it would actually apply to all health service providers, both public and private, and not just hospitals. I do not think many people appreciate its true scope. Clause 1 states that bodies that provide healthcare must
“make arrangements to exempt qualifying carers”
from car parking charges. That applies to
“any National Health Service hospital, walk-in centre, GP practice or other health care facility to which patients are admitted, or which they attend, for diagnosis, testing, treatment or other appointment relating to their health”,
so we are not just talking about hospital car parking charges. It also extends to private hospitals, so not only are we dictating what should happen in the NHS, but we are telling private hospitals what they should do. Many people might argue that those who can afford private healthcare treatment can also pay for car parking. Whether that is a legitimate use of resources is a different matter.
Mr Rees-Mogg
Can my hon. Friend explain whether under clauses 2 and 5 somebody can quality for this allowance but not be eligible, or be eligible but not qualify?
Mr Deputy Speaker
If the Bill goes to Committee, such points can be teased out and straightened out there, rather than on the Floor of the House today.
Philip Davies
My hon. Friend makes an interesting suggestion. I contend that the Bill is so flawed that it cannot be rescued in Committee, or that rescuing it would involve filleting it to such an extent that it would come out barely recognisable, which would be a pointless exercise. I appreciate that such issues could be considered in Committee—as ever, Mr Deputy Speaker, you are perfectly right.
Clause 7 says that the Act must come into force
“12 months after the day on which this Act receives Royal Assent.”
There are two pertinent points about that. If it is so unjust for carers to pay hospital car parking charges, how can the hon. Lady justify requiring them to pay charges for another year? Why not introduce the change much sooner? I think I know the answer to that question, and it reinforces my argument. I think the hon. Lady realises that the provisions in the Bill would be a logistical nightmare to implement, for some of the reasons that I have already mentioned—I am sure there are also many others. She probably realises that to make anything of the Bill it would require at least a year to come up with anything that makes any sense. It is interesting that such a measure is part of the Bill, and it justifies my concerns. The hon. Lady said that she would like the measures in her Bill to be extended in future to cover other people. She made the point that this is a good start—
Mr Deputy Speaker
Order. That is speculation for another day. We are dealing with the Bill before the House, not what might be before us in future. I know that the hon. Gentleman is desperate to hear the views of other hon. Members, and I am sure his colleagues are desperate to speak.
Philip Davies
I agree. This is hard work, Mr Deputy Speaker, and you are right—I am anxious to press on.
Mr Deputy Speaker
I reassure the hon. Gentleman that we are not going to open that can of worms today. Philip Davies, I know that you want to get beyond clause 7 and to your conclusion.
Philip Davies
I knew it was a mistake giving way to my hon. Friend, and that he would try to lead me astray once again. I will leave him to consider Barnett consequentials in his remarks—I am desperately trying to reach a conclusion.
I appreciate that the hon. Lady genuinely wants to help carers, and if the principle behind her Bill is to support carers, I will happily support that principle. However, of all the worthwhile issues and campaigns championed by different carers organisations and charities, it seems that she has picked the one dud. I would have been happy to support many other campaigns for carers had she raised them. For example, parent carers could be offered an assessment rather than having to request one for their children, and we could introduce measures such as:
“Clear recognition in law that parent carer assessments and services must have the promotion of their well-being at the heart of what they do.
Consolidation of legislation on parent carers from three different Acts”.
I would have been prepared to support such worthwhile campaigns to help carers, but I fear that the hon. Lady has picked the wrong campaign. For future reference I urge her to consider some of the other campaigns that carers organisations would like to be raised. I think she would get a lot of support from across the House and—I hope—from the Government.
In conclusion, the Bill is ill-thought through and many areas are far too vague. It will be a logistical nightmare to enforce and implement, and it would cost NHS trusts up and down the country millions of pounds, forcing higher charges on other visitors, or risking patient services. It would exempt a lot of people who are just as worthy recipients of parking concessions—I think that the Government’s guidance on hospital car parking is far more sensible than the provisions in the Bill, and they encompass more people who deserve to be considered. Hospitals already have power to implement the policy suggested by the hon. Lady if they wish, and perhaps on reflection she should go away and come back at some point in future with a different Bill. I have not mentioned the money resolution consequences of this Bill, but I hope that others will consider that issue. I have not seen any money resolution proposals.
Finally—very finally—I have people visiting Parliament today, so I apologise in advance if I cannot be here for the entire debate. I will try to stay for as much as possible because it is an interesting discussion.
Philip Davies
Perhaps they are, perhaps they are not—I do not know. I genuinely wish the hon. Lady well in her time in the House, and I do not doubt the worthy sentiment in this Bill. We all support what carers do in this country, but I think the Bill is misguided.
Mr David Nuttall (Bury North) (Con)
It is a pleasure to follow the hon. Member for Birmingham, Perry Barr (Mr Mahmood), who gave us his take on the Bill, although I feel the matter is a little more complicated than he would have the House believe.
I congratulate the hon. Member for Burnley (Julie Cooper) on coming fourth in the ballot for the right to bring in a private Member’s Bill—as a new Member entering the ballot for the first time, she has done very well indeed—and on choosing such an important topic. I do not know if she does the national lottery, but if she does—
Mr Deputy Speaker (Mr Lindsay Hoyle)
Order. Obviously, congratulating the hon. Lady is a good way of taking up time, but actually I did the draw, so if the hon. Gentleman is going to congratulate anybody, I think it should be me. However, I do not want us to get bogged down in that, because I know he wants to get straight into the Bill, on which I would welcome his comments. I know he would rather talk about the Bill.
Mr Nuttall
Of course, you were there, too, Mr Deputy Speaker, doing the draw, and very well you did it as well. As you know, however, because it is done in reverse, coming first actually means coming 20th.
Mr Nuttall
I will move on.
This is the first Bill to come before the House for its Second Reading since the new Standing Orders were introduced last week on what generally is referred to as “English votes for English laws” but what I prefer to call, more accurately, “English vetoes for English laws”. The new Standing Orders make it clear that the new procedures do not apply to private Member’s Bills, but it is worth noting—
Mr Deputy Speaker
Order. They do not apply to private Members’ Bills, so we do not need to discuss them. Seriously, a lot of Members still wish to speak, and I do not want any filibustering. I know that people are interested in the Bill and want to concentrate on it.
Mr Nuttall
I am grateful for the work carers do in my own constituency, particularly at the carers centre I visited recently, which provides a wide range of activities and support for those who undertake the often unsung job of caring for a loved on. I also pay tribute to the work that Carers UK does, as the principal national charity for carers. Of course, it very much supports the Bill, in this its golden jubilee year.
The aim of the hon. Lady’s Park the Charge campaign, which has resulted in the Bill, is to improve the financial position of carers who have to use hospital car parks by exempting them from car parking charges. Without doubt, the Bill is well intentioned, and no one from across the House would disagree with the proposition that helping those who selflessly care for others is a worthy aim. The first difficulty, however, facing anyone determining the size and nature of a group is that of definition, and that applies to carers as much as to any other. Carers UK says there are 6.5 million carers in the UK, with 5.4 million of them living in England. As I tried to mention earlier, the Bill only applies to England so that is the relevant figure.
Carers UK goes on to state that these people are providing unpaid care for their loved ones, saving the economy an enormous £119 billion each year, yet its research found that 48% of carers were struggling to make ends meet, and 45% said that financial worries were affecting their own health. It is no surprise, therefore, that Carers UK and the Bill seek to alleviate one of the financial pressures on carers—hospital car parking charges. However, I have several concerns, ranging from the Bill’s drafting to its financial implications and potential impact on other groups.
It is not clear to me how we can objectively determine who should and should not be expected to pay for car parking, as we would be doing if we started centrally exempting one particular group as being more deserving than another group. It would seem preferable to allow individual NHS trusts to continue making such decisions locally. Otherwise, on the face of it, we seem to have here a fair and reasonable proposal. Indeed, my initial thought was that it sounded like a good thing to do, and I suspect that most people’s instinct would be to support the Bill simply because of the title.
I know that the hon. Lady has campaigned on this issue with the best intentions, but I want to deal precisely with the exemptions she seeks to introduce. The Bill would exempt two groups of carers. The first is defined in clauses 1 to 3. Clause 2 states that beneficiaries of an exemption would either be in receipt of carer’s allowance or have an underlying entitlement to it. Carer’s allowance is a taxable benefit currently set at £62.10 a week to help a carer look after someone with substantial caring needs, and it is paid to the carer, not the recipient of the care. To qualify, the applicant must be over 16, spend at least 35 hours a week caring for someone, have been in England, Scotland or Wales for at least two of the last three years and not be in full-time education or studying for 21 hours a week or more. The person in receipt of care must receive qualifying benefits, such as the daily living component of the personal independence payment, the middle or highest care rate of the disability living allowance, attendance allowance or the armed forces independence payment.
That is the first group to which we can start to put a number. According to Department for Work and Pensions figures, as of February, 721,000 people were receiving carer’s allowance, so these people would be the first group that would clearly qualify under the criteria. However, the Bill would go further, by also including within the first group all those who have what is referred to as an underlying entitlement to carer’s allowance. The term “underlying entitlement” refers to the fact that a claimant cannot usually receive two income-replacement benefits together—for example, carer’s allowance and the state pension. This is called the overlapping benefit rule. If a person is not entitled to be paid carer’s allowance because of this rule, they are said to have an underlying entitlement to carer’s allowance instead. This might mean they could get the carer’s premium in jobseeker’s allowance and income support, the extra amount for carers in pension credit or the carer’s allowance element of universal credit. The importance of including those people is that the Bill would otherwise exclude carers in receipt of other benefits, such as the state pension, bereavement allowance, contribution-based employment and support allowance, contribution-based jobseeker’s allowance, incapacity benefit, industrial death benefit, maternity allowance, severe disablement allowance, universal credit, war widow’s or widower’s pension or widow’s pension.
Not surprisingly, the inclusion of these people significantly increases the number of those eligible under the Bill. DWP figures, as of February, estimate this group to number 409,000. Taken together, therefore, clauses 1 to 3 could exempt approximately 1.13 million people. These people are either receiving carer’s allowance or have an underlying entitlement to it. As the hon. Lady will be aware, in the north-west, where both our constituencies are located, there are 163,000 such people. To give some idea of the massive increase in the number of carers in recent years, I should add that the figure of 1.13 million is up from 451,000 in February 2000.
If, however, the definition of entitlement is applied in strict accordance with clause 2, the Bill would exclude, a university student caring for a disabled parent, for example. I suspect that the second group of potential beneficiaries was defined for people in such a position. The Bill therefore draws a distinction between a “qualifying carer”—someone caught by clause 2—and an “eligible carer”, as defined in clauses 4 to 6. My hon. Friend the Member for Shipley (Philip Davies) touched on this, and I pointed out in an intervention that the figure of 1.13 million—the figure quoted by Opposition Members as being the total number involved—seemed to ignore completely those included under clauses 4 to 6.
Clause 5(1)(a) defines the eligible carer as someone who
“has been assessed for free hospital parking”
by virtue of an amendment to the Care Act 2014, which this Bill would insert. The Bill proposes to amend section 10 of the 2014 Act, which deals with carer’s assessments. A carer’s assessment is made by a trained person either from the council or another organisation that the council works with. The Bill will make it a mandatory requirement for the assessor to assess
“whether the carer should be eligible for free hospital…parking”.
This is in addition to assessing, as outlined in the rest of section 10—
“(a) whether the carer is able, and is likely to continue to be able, to provide care for the adult needing care,
(b) whether the carer is willing, and is likely to continue to be willing, to do so,
(c) the impact of the carer’s needs for support on the matters specified in section 1(2),
(d) the outcomes that the carer wishes to achieve in day-to-day life, and
(e) whether, and if so to what extent, the provision of support could contribute to the achievement of those outcomes.”
It is not clear at all on what basis the assessor is expected to make this decision. If only eligibility or underlying eligibility to carer’s allowance is going to be checked, this provision is superfluous, as such people would be covered in the first group. If some other criteria are to be applied, there is nothing in the Bill or in any guidance notes—no such notes have been issued—to suggest what that might be.
Returning to my example of the student who is caring for a parent but cannot get carer’s allowance because of their studies, clause 5(1)(b) perhaps comes to the rescue. It says an “eligible carer” is a person who
“provides or intends to provide substantial care on a regular basis, other than by virtue of a contract or as voluntary work and has been certified as such by an appropriate clinician.”
I believe that the meaning is ambiguous. What does “intend to provide” mean? How far into the future is it expected that the care will be delivered—within the next week, the next month, the next year, or what? The Bill does not say. Or is a fixed timescale not required; is consideration of caring enough? What constitutes “substantial care” in this provision? Is it the 35 hours a week required to be eligible for the carer’s allowance, or is it fewer than 35 hours a week? We need to know, because the Bill is asking an assessor to be the ultimate arbiter of whether someone is entitled to free hospital parking charges.
Suddenly, the number of people who might benefit from free hospital parking becomes a lot less certain. The first group gave us 1.13 million people. How many more of the 5.4 million carers estimated by Carers UK to be living in England would be included in the second group? We simply do not know.
Julian Knight
My hon. Friend is providing a forensic discussion of the Bill and all its parts. Does he agree that we could end up with hospital trusts seeing staff members taken off the front line in order to administer these schemes, or even with administration staff, who would be better deployed in the hospital, being brought in to ensure that the right people get the free hospital parking?
Mr Deputy Speaker (Mr Lindsay Hoyle)
Order. I think we have heard this question before. Mr Davies was asked whether staff would be taken from the front line. We are going over ground that has already been covered. This is about a Bill, about car parking, and about the benefit of carers. What I do not want to do is become involved in speculation. We are not here to speculate about the future.
Mr Nuttall
I was about to say exactly the same thing, Mr Deputy Speaker, but I do not think that my hon. Friend the Member for Solihull (Julian Knight) was in the Chamber when someone made what I agree was a very similar point. I will merely say that, undoubtedly—I think that Members in all parts of the House will agree with this—the scheme will have to be administered somehow. It is not going to run itself. Someone, somewhere, will be required to run it, either someone new who has been brought in or someone who is currently doing another job in the hospital.
I do not know whether, as part of her preparation for the Bill, the hon. Member for Burnley ascertained how many national health service trusts in England might have to alter their price structures—that is, increase their parking charges to avoid falling foul of the income- generation principle—if the number of exempted carers were to be as significant as it appears. I do not know whether she proposes to scrap the principle of not running a scheme at a loss, as required by the 2006 guidance from the Department of Health. The NHS Confederation, which is the membership body for some 500 organisations that plan, commission and provide NHS services, says:
“NHS principles and Government policy are clear that healthcare is funded through taxation, not through patient charges. Surpluses from parking charges should only be a by-product of covering costs and managing space fairly.”
Most trusts make it clear that the income they receive from car parking charges goes towards covering the maintenance of the car park: for instance, the security, facilities and staff. To be specific, we are talking about the ongoing costs of anything from lighting to CCTV, footpath and cycle path maintenance, car park surfacing, and the employment of enforcement and security staff. If there is any money left over—and some trusts have no surplus from their car parking—it must, in accordance with the guidance, be used to improve local health services.
The Government have already been active in ensuring that information about parking is made very clear to members of the public, and I think it perfectly fair and reasonable to require trusts to ensure that that information is clearly visible on websites and in patient information in, for instance, letters. Patients are entitled to the reassurance of knowing that the purpose of the car park charge is not to provide the NHS with an additional, excessive income stream, but to provide for the car park in the first place. Charges, therefore, are used primarily to cover the running costs of the car park, and if there is a surplus, it cannot be used for other pet projects.
I referred earlier to the 2009 NHS car parking impact assessment. The then Labour Government commissioned the detailed, 61-page assessment of the costs of introducing free car parking. It concluded:
“On the available evidence there is scope for this policy to have both a positive and negative impact, both for older people and the disabled.”
Despite that rather mixed finding, Labour’s 2010 manifesto pledged to scrap hospital car parking charges. Five years later, however, at the time of this year’s May general election, Labour appeared to reverse its view, and to decide that the policy was unworkable. I look forward to hearing from the shadow Minister later whether that is still the position of the official Opposition. In fact, the Bill runs contrary to the principle that individual trusts feel that it is right to set parking charges according to their own financial situations. Only yesterday it was reported that the Oxford Health NHS Foundation Trust was consulting on the introduction of parking charges at its community hospitals.
What are hospital car parking charges actually paying for? That is a perfectly legitimate question for people to ask. It is reasonable to say that visitors and patients do not generally have a great deal of choice when it comes to parking at a hospital. There is usually just one car park operator, and patients, staff and visitors are therefore a captive audience. In some town centres, one might be fortunate enough to have the choice of a cheaper place in which to park, but for hospitals there is no market incentive to keep costs under control.
In December 2010, the British Parking Association, which is the largest professional association in Europe representing parking and traffic management organisations, released a charter of best practice for parking in hospital car parks. Understandably, given the large number of disabled users, it set high standards. The Charter for Hospital Parking stated that hospital parking operators should provide
“good lighting, high standards of maintenance for structures and surfaces, payment systems and equipment that are easy to use and understand, signs that are clear and easy to understand”
and
“clearly marked parking bays.”
Patients and visitors will understandably want a safe and secure environment in which to park when they go to their local hospital, or, potentially, a hospital that is out of their immediate area if they are receiving specialist treatment. As Carers UK points out, attending hospital can be a stressful experience for patients and visitors. The last thing they want is to have their car broken into, or to spend 20 minutes driving round in circles because entrances and exits are not marked properly, or to be stuck facing a ticket machine that does not work with the threat of an unfair penalty charge looming. Patients, and their carers, visitors and staff, will quite reasonably expect a properly maintained car park with proper lighting and adequate security, along the lines of what is set out in the charter, whether the purpose is to guide a daytime visitor with proper and effective signage or to protect the doctor or nurse who gets into the car at 3 am in the dark after a long shift.
The charter also states:
“Parking charges can help to pay for maintenance and management services, and prevent these from becoming a drain on healthcare budgets. Therefore, we encourage NHS Trusts and car park operators who manage hospital car parks to sign up to this charter and to abide by its letter and spirit.”
So far, 24 hospital trusts have signed up to the charter.
Mr Deputy Speaker (Mr Lindsay Hoyle)
Order. This is very worthy, and it is great to acquire this extra knowledge, but it is not really anything to do with carers. The hon. Gentleman has got on to nurses and lighting, and I understand all that, but, worthy as it is, it is not in the spirit of what we are meant to be discussing.
Mr Nuttall
Parking places are finite, Mr Deputy Speaker. If the Bill encouraged more carers to visit hospitals, which is what I think would happen, it would make it easier for them to gain access to car parks, and one consequence of that might be a knock-on effect on the income that would—
Mr Deputy Speaker
Order. I understand the point that the hon. Gentleman is trying to make, but it has already been well thumbed. As the hon. Gentleman knows, it was covered very thoroughly by Mr Davies, and I do not want him to repeat everything that Mr Davies covered. I think that, in his hour and a half, Mr Davies did not leave a lot of scope, but this is one point that he made sure we were well aware of.
Mr Nuttall
The problem with selecting a group to exempt from parking charges is the necessity of considering other groups, and deciding which groups it is fair to charge and which groups should be exempt. Is it fair to exempt a particular visitor, albeit a carer, but to charge a clinical support worker who parks at the hospital every day? It could be someone with children or other dependants, working and acting as a carer but not in receipt of carer’s allowance.
Fairfield general hospital in my constituency comes under the Pennine Acute Hospitals NHS Trust. According to figures from the northern commissioning region for the latest available year, I understand it is one of the trusts that charges on average 11p per hour for staff to park. I have to say that the trust sets out very clearly what its charges are for hospital car parking, and it provides a range of concessions. I take note of your stricture, Mr Deputy Speaker, so I will not read them out, but it is fair to say that it has obviously looked at this question and considered the various groups that should be entitled to a concession. For example, it has picked out blue badge holders, patients and visitors who need to attend on a frequent or regular basis and those who need to visit because they have suffered the bereavement of a loved one.
Such a scheme would be put in danger, and the trust would have to revisit it, which would undoubtedly have an effect on the viability of that scheme. Is it fair to charge a spouse or partner of a cancer patient who is still working and does not get carer’s allowance if they are too busy to get certified as eligible for hospital parking charge exemption, as required under clause 5 of this Bill? The Bill would require them to be approved in advance, and there will be many other deserving cases not covered by the Bill. The Bill does not seek to exempt people because of their low incomes, which is one a weakness. Some of the carers may well be in straitened circumstances, but there may be others who would be able to pay the charge, whereas some members of other groups would not be in that position.
The conclusion may well be that the fairest answer is not to exempt any groups but to make car parking free for everyone, as has happened in Scotland and Wales. Aligning us with those countries would be a popular idea with many people, but we must not forget that it would mean taking hundreds of millions of pounds out of the healthcare budget. The 2009 impact assessment suggested that the cost then would be between £140 million and £180 million. In six years’ time, it is reasonable to assume that cost would have increased enough to pay for 13,000 band 1 clinical support workers or 9,000 band 5 nurses. We have to ask what we think it is right to spend the healthcare budget on: patient care or free or reduced car parking.
Mr Nuttall
My hon. Friend is right. The fact is that in September 2014 the then Health Minister, my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter), noted in a debate that 40% of hospitals now do not charge for hospital car parking. They are likely to be in rural areas where there is less demand for parking—where it is easier to provide parking and there is less pressure on it. I suspect the reality is that a hospital with a car park in a central location in a busy town or a major city centre has no choice but to have a car parking charge. That is the reality of life. If it were be free, there would just be chaos; essentially, it would mean that those who really needed to get close to the hospital would not be able to do so. There has to be some system in place to protect the spaces that are close to the hospital for those who need them. Whatever system we have, there is no simple answer to that.
What we do know is that the present system of having local decision making is working. Fairfield hospital allows 30 minutes of free parking for everyone; then it costs just £1 for up to one hour. In the constituency of the hon. Member for Burnley, by contrast, people would pay £1.90 for up to three hours’ parking. There is a huge disparity across the country. We heard earlier—in an intervention from the hon. Member for Streatham (Mr Umunna), I think—about the costs in central London, which are understandably very much higher than in the provinces.
While the Bill does explain the generality of what is required, it does not explain how the system would work in practice. In the opening remarks of the hon. Member for Burnley, she mentioned that the system would work by way of having a badge in the car window. I am happy to be corrected if I misheard. That is the first time I had heard that. It would perhaps have helped all of us if that had been in an explanatory note saying this was how the scheme would work. She also mentioned that in some hospitals people have to pay on entry—I think the hon. Lady is nodding. That is all very well, but I am not quite sure how simply having a voucher in the car window would help in that scenario. It must be more complex than that, and some sort of token would be needed in order to get through the barrier.
Mr Deputy Speaker (Mr Lindsay Hoyle)
Order. The question is not how people get into a car park; it is whether there is free concessionary parking for carers. We are dealing with that, not the detail of how we get there. Obviously if the Bill were to go into Committee, these would be the areas that Members would want to cover there. I want to concentrate on where we are now and how we keep to where we want to be within the Bill.
Mr Nuttall
I will move on from that detail. I accept it is a detail, but it is an important detail.
Mr Deputy Speaker
Order. I agree, but we have heard about all the different scenarios previously and in detail. That is what worries me. We can get bogged down in repeating details, and I know the hon. Gentleman does not want to do that.
Mr Nuttall
I want to move on to the devolution of healthcare. It was only very briefly touched on earlier, but it is of particular significance to my constituency, because, as Members will be aware, it is proposed to devolve healthcare to Greater Manchester. From April next year, it will be the first English region to get full control of its health spending. The situation in this regard is not at all clear. The Bill states that it will apply to the whole of England, but if healthcare is devolved, will Greater Manchester be exempt on the same basis that Scotland and Wales are exempt? Healthcare spending has been devolved to those countries and they are then excluded from this Bill.
Junior Doctors’ Contracts
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Lucy Frazer (South East Cambridgeshire) (Con)
I do not think that any of us dispute the fantastic work that doctors do day in, day out, but we need to debate the motion that the hon. Lady has proposed. She said there were three points that she wants to put to the Secretary of State, but she failed to mention the one in the last line of the motion, which is that she wants proposals to be put forward that are “safe for patients”. Given that there was an article just last month on 5 September in the BMJ, put together by seven experts, including three professionals, that said that there was a clear association between weekend admission and worse outcomes for patients—
Mr Deputy Speaker (Mr Lindsay Hoyle)
Order. I am sorry, but hon. Members should know that interventions should be short. You cannot make a speech in an intervention, and that should be a lesson for us all. Many Members want to speak and I want to get everybody in.
Heidi Alexander
The problem with how the Government have handled the negotiations is that they have provided absolutely no clarity to junior doctors about what the proposals would mean for them individually. Everyone thinks that they are going to lose out.
The Government say that they want to reduce the number of hours defined as “unsocial” and thereby decrease the number of hours that attract a higher rate of pay. They say that they will put the rate of pay for plain time up to compensate, but there is no guarantee that the amount by which basic pay goes up will offset the loss of pay associated with fewer hours being defined as unsocial. Does the Secretary of State understand that those who work the most unsociable hours, the junior doctors who sacrifice more of their weekends and nights, feel that they have the most to lose?
Mr Hunt
I am happy to deal with that. We went into the election in May saying that on the back of a strong economy we were prepared to commit £10 billion extra to the NHS in real terms over the course of this Parliament. That was £5.5 billion more than the hon. Lady’s party was prepared to commit. In the last Parliament, when the increase in NHS spend was half that amount, we increased the number of doctors by 9,000, so we are increasing the number of doctors, but as we do so we need to ensure that we give the right care to patients.
I want to give a word of caution to the shadow Secretary of State. The tragedy of John Moore-Robinson, the gentleman I have mentioned, happened not only on a Saturday, but at Mid Staffs. The last time the House discussed the difference between excess and avoidable deaths was under a Labour Government, when they tried to brush the problems at Mid Staffs under the carpet, saying that we should not take the figures on excess deaths too seriously because they were a statistical construct and different from avoidable deaths. I would have hoped that the Labour party learned the lessons of Mid Staffs and would not make the same mistakes again. [Interruption.]
Mr Deputy Speaker (Mr Lindsay Hoyle)
Order. The hon. Member for Islington South and Finsbury (Emily Thornberry) may shake her head, but I expect voices in the Chamber to be a little quieter. I want to hear the Secretary of State, and I think all our constituents do. I understand that you might not agree.
Mr Hunt
Let us look at some of the facts. What is the most important thing for people admitted to hospital at the weekend? It is that they are seen quickly by a consultant. Currently, across all key specialties, in only 10% of our hospitals are patients seen by a consultant within 14 hours of being admitted at the weekend. Only 10% of hospitals provide vital diagnostic services seven days a week. Clinical standards provide that patients should be reviewed twice a day by consultants in high-dependency areas but, at weekends, that happens in only one in 20 of our hospitals across all key services.
Mr Hunt
I thank my hon. Friend for his consistent support for his local hospital. It has had many troubles, but it is beginning to show signs of turning a corner. If we want to turn things around, we must first be honest about the problem.
I welcome the shadow Health Secretary to her place. Her predecessor tried to minimise the care problems that took place under a previous Labour Government, and he described our attempts to put them right as trying to “run down the NHS”. I hope that she does not do the same. Labour used to be the party that stood up for ordinary men and women; it cared enough about them to set up the NHS, so that no one had to worry about getting good medical care, whatever their circumstances. People need to know that they can depend on our NHS seven days a week. Instead of making mischief about a flawed doctors contract that was introduced by a Labour Government in 2000, the hon. Lady should stand with us as we sort out this problem. Be the party not of the unions but of the patients who depend on high quality care, day in, day out. Professor Bruce Keogh talked about the moral and professional case for concerted action. Surely in that context, she might reconsider this rather ill-judged attempt to make party political capital out of a very real problem.
Everyone who cares about the NHS should want the same thing. The hon. Lady should tell the BMA to get around the negotiating table, something she conspicuously failed to do. In doing so she would stand alongside the many independent voices calling on the BMA to return to the table and discuss a solution with the Government—the Royal College of Surgeons, the Royal College of Physicians, NHS providers and the Academy of Medical Royal Colleges. If she does not do that, the British people will draw their own conclusion about which party is backing the NHS with the resources it needs, which party is supporting hospitals to become safer at the weekends, and which party is standing four-square behind doctors and nurses in their ambition to deliver high quality standards of care for patients. There is only one party that can be trusted, one true party of the NHS, and that is the Conservative party.
Mr Deputy Speaker (Mr Lindsay Hoyle)
There will be a four-minute limit on Back Bench speeches.