Healthcare (International Arrangements) Bill

Lindsay Hoyle Excerpts

3rd reading: House of Commons & Report stage: House of Commons
Monday 21st January 2019 Commons Chamber

Consideration of Bill, not amended in the Public Bill Committee.

[Mr Deputy Speaker (Sir Lindsay Hoyle)]

I should inform the House that notification has been received that the Scottish Parliament has agreed to the legislative consent motion in respect of this Bill. Copies will be available in the Vote Office.

New Clause 1

Annual report on the cost of healthcare arrangements

‘(1) The Secretary of State must lay before Parliament an annual report setting out all expenditure and income arising from each healthcare arrangement made under this Act.

(2) The annual report laid under subsection (1) must include, but is not limited to—

(a) all payments made by the government of the United Kingdom in respect of healthcare arrangements for healthcare provided outside the United Kingdom to British citizens;

(b) all payments received by the government of the United Kingdom in reimbursement of healthcare provided by the United Kingdom to all non-British citizens;

(c) the number of British citizens treated under healthcare arrangements outside of the United Kingdom;

(d) the number of non-British citizens treated under healthcare arrangements within the United Kingdom;

(e) any and all outstanding payments owed to or by the government of the United Kingdom in respect of healthcare arrangements made before this Act receives Royal Assent; and

(f) any and all administrative costs faced by NHS Trusts in respect of healthcare arrangements.

(3) The information required under section 2(a) and 2(b) above must be listed by individual country in every annual report.”—(Justin Madders.)

Brought up, and read the First time.

[Justin Madders (Ellesmere Port and Neston) (Lab)]

I beg to move, That the clause be read a Second time.

[Mr Deputy Speaker (Sir Lindsay Hoyle)]

With this it will be convenient to discuss amendment 1, in clause 5, page 3, line 44, leave out subsections (5) and (6) and insert—

‘(5) Any statutory instrument which contains regulations issued under this Act may not be made unless a draft of the instrument has been laid before Parliament and approved by a resolution of each House.”

This amendment would make all regulations issued under this Act subject to the affirmative procedure and require approval from Parliament before they become law.

[Justin Madders]

We want to ensure that there are appropriate safeguards with regard to costs, not least because the Bill currently gives the Secretary of State authority not only to facilitate a continuation of existing arrangements, but to enter into any number of bilateral agreements with individual member states, with very little opportunity for parliamentary scrutiny. It also provides the authority to strengthen existing reciprocal healthcare agreements with countries outside the EU, or to implement new ones across the globe, in line with the Government’s aspiration to develop trading arrangements with countries beyond the EU. There is therefore a potential for the establishment of multiple complex agreements.

New clause 1 addresses the important point that the Bill before us is rightly intended to provide for all reciprocal healthcare arrangements in the future, and to provide for all eventualities. As we know, a no-deal Brexit could lead to a multitude of new bilateral agreements within the EU27, let alone the rest of the world. At this stage, none of us can be clear about how many of those agreements will come into being. We cannot assess their likely cost or impact, and, indeed, the Government’s own impact assessment is inadequate in that regard. It suggests that the cost will be similar to, or lower than, the current £630 million per year.

Mental Capacity (Amendment) Bill [Lords]

Lindsay Hoyle Excerpts

2nd reading: House of Commons & Money resolution: House of Commons & Programme motion: House of Commons & Ways and Means resolution: House of Commons
Tuesday 18th December 2018 Commons Chamber

[Paul Blomfield]

Does the Secretary of State accept that that access to an advocate should not be necessarily subject to a best interest test, as is being proposed, but should be a right?

[Mr Deputy Speaker (Sir Lindsay Hoyle)]

Order. Just to help everybody, let me say that we have 11 speakers, we still have to hear from the Opposition shadow Minister and we have the wind-ups. So I hope we can take that into account, although I recognise that the Minister is being very generous.

[Matt Hancock]

Thank you, Mr Deputy Speaker. These are very important points—

[Mr Deputy Speaker]

Order. Perhaps I will have to set it out differently. What I am trying to say is that we have 11 Members to speak and we could try to give them some time. Important as this and giving way all the time is, it is very important that we hear from other people.

[Matt Hancock]

Noted. Returning to the point made in the intervention, of course if there is an objection, there is a right in this case. So there is an escalation process in the event of an objection.

Before I end, I want briefly to deal with the Opposition’s reasoned amendment, because I hope we are able to show in this debate that all the points they raise have been considered. I hope the House will not mind my taking a moment to address each one briefly. First, they make the claim that somehow the Bill has been rushed through and insufficient pre-legislative scrutiny has been carried out. The Bill follows the Law Commission spending three years developing the new model, consulting extensively. The Joint Committee on Human Rights then conducted an inquiry and pre-legislative scrutiny. The Local Government Association, Age UK and Sir Simon Wessely have all backed the new legislation now. The LGA says:

“The Bill provides a vital opportunity for long-awaited reform”

and it needs to be passed. So we need to get this Bill on the statute book, because every extra delay risks depriving someone of their liberty and their right to freedom unnecessarily, and I do not want to see that happen.

Secondly, the amendment claims that the Bill

“enshrines a conflict of interest in relation to independent providers of health and care services”.

Again, that is not the case. Every authorisation must be reviewed by somebody who does not deliver day-to-day care and treatment for the person in question. We plan to go further by tabling Government amendments that will require authorisations in independent hospitals to be reviewed by an external approved mental capacity professional. Finally, the reasoned amendment claims that it is concerned about clearing the backlog in the current system. Well, so are we, and that is what this Bill does. Anyone concerned about the backlog and the current system should back the Bill with enthusiasm.

The claims that this Bill does not put the interests of the cared for person first or address the interface with the Mental Health Act have been addressed already. The very reason we need this legislation is so that we can put their interests first, because they cannot afford to wait for the recommendations of the Mental Health Act review to come into effect, in a Bill that will inevitably take time to develop, because of the need to do this on a consultative and broad basis. While welcoming the probing, I very much hope that the Opposition and every Member of this House will support this Bill, because it strikes a careful balance between liberty and protection. It offers vulnerable people a brighter and better future. We have listened to concerns and we continue to be open to ideas. We have sought to amend and improve the Bill as it has progressed through the other place, and we will make further amendments in this House. I therefore hope that this opportunity to change the system for the better is one that the House recognises. I also hope it will recognise that doing nothing is not an option. That is why I am proud to commend the Bill to the House.

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[Several hon. Members rose—]

[Mr Deputy Speaker (Sir Lindsay Hoyle)]

I must now introduce a six-minute limit on speeches.

HIV and World AIDS Day

Lindsay Hoyle Excerpts

Thursday 29th November 2018 Commons Chamber

[Lloyd Russell-Moyle]

I thank my right hon. Friend for his intervention, and I totally agree with him. There are some countries in the world I may now struggle to travel to because of this announcement. It is important that we continue to make international efforts. I do not have time to talk about all the international aspects here. I commend the work of the HIV/AIDS Alliance and plan to come back to this House in future months to talk about its ENDAIDS 2030 Festival, which is really important.

Turning back to the UK, it is the case not just that HIV is treatable, but that it is preventable with one tablet a day. A person can prevent themselves from contracting HIV with pre-exposure prophylaxis. PrEP is revolutionising the fight against HIV transmissions. It has an almost 100% success rate, a higher rate than condoms, in the prevention of HIV, and it is just one pill. We expect this pill to be soon available as a generic drug and, according to the NHS’s own analysis, it could save the health service £1 billion in preventing HIV transmissions for future generations. Astoundingly, however, the only way to access PrEP in England is through a limited trial. This is not a medical trial—those have been done and approved. This is not about financing—we know the cost. This trial, as far as I can see, is about delaying the roll-out of PrEP in England because someone meddling in the Ministry thinks that they know better than doctors when it comes to people’s health. It seems to me that this trial is more concerned about what a person does between the sheets than the health of the nation. Despite being just one year into this three-year trial, 3,000 additional places have already had to be added, and it looks like the 13,000 places will run out early next year. England now lags behind all the other nations in the UK as the only country with capped PrEP access on the NHS. There are two years to go until this trial ends, yet people cannot get immediate access to PrEP, with many clinics now having long waiting lists, and some completely full.

We know that there are cases of young men who have sought out this prevention pill and have been turned away because the clinics cannot accommodate them, and they have subsequently become HIV-positive. Those men now have to live with HIV and everything associated with it because of the misguided morality of this decision. Let us make no mistake: these are not isolated cases. The longer this Government wait to roll out PrEP properly, the more people will be diagnosed.

Will the Minister intervene to ensure that PrEP is made routinely available on the NHS in England—just like his Government have already done with Northern Ireland with direct rule, just like the Scottish Government have done, and just like a Labour Government have done in Wales? Failing that, will he at least uncap the trial to ensure that those trying to access the drug can do so? Will he reverse public health cuts, including those in sexual health, so that the Government meet demand, including that of people affected by HIV, otherwise we seriously risk undoing the really good progress that we have all made?

Just today, the latest Public Health England statistics show that the UK has met its UN AIDS target of 90-90-90, ahead of 2020, which was the date. This is amazing progress, with 92% of people living with HIV diagnosed, 98% on treatment and 97% with undetectable viral load, meaning that they cannot pass it on.

At the Terrence Higgins Trust World AIDS Day reception earlier this week, I am told that the Minister hinted that the Government were considering bolstering their ambition on HIV to committing to reaching zero new HIV transmissions by 2030. In the light of today’s statistics, now is the time to seize that opportunity of reaching zero new HIV infections and be a true global leader. Can the Minister provide details of how the UK Government plan to end HIV infections and what timescale they will commit to?

At present, one young person every day is still diagnosed with HIV and young people continue to suffer some of the worst sexual health outcomes. We cannot be complicit on this. Will the Minister agree to work with the Department for Education to ensure that relationship and sex education guidance has a strong focus on not only HIV prevention, but anti-HIV stigma? Will the Minister also liaise with Department for International Development colleagues to ensure that research funding is increased so that we can make huge gains in scientific breakthroughs to eradicate this disease globally?

In two days’ time, on World AIDS Day, I will stand with my community to mourn the losses of those who have died of AIDS. I will do so at the Brighton AIDS memorial—the only such dedicated public memorial in the country. I will stand there in the knowledge that I will live a life that so many could not. I am able to do that because of the people who have come before me: the people who have fought and lost their lives, and the people who stood up and had their lives changed. We owe it to these people to beat the disease—something we have the power to do. I hope that future generations will look at HIV in the same way that we look at smallpox and polio, as diseases that were once killers but can now be eradicated.

LGBT people often talk about coming out as something that you constantly have to do to new neighbours, friends and work colleagues. You could say the same about your HIV status. I have spent many nervous moments deciding whether to tell new friends and acquaintances about my status. The lump forms in your throat and your heart flutters, and you finally kind of blurt it out and hopefully move on. Well, Mr Deputy Speaker, I would like to thank you for giving me this platform to do just that. I thank my friends, family and colleagues for supporting me. I also thank the Terrence Higgins Trust for all its work and the support it has given me in preparing for this debate.

We have the ability to end new HIV transmissions, as well as to end stigma and discrimination—not only here, but globally. I hope we can all make that our mission. [Applause.]

[Mr Deputy Speaker (Sir Lindsay Hoyle)]

We should not clap in the House, but I understand why people have. That was a very brave and moving speech, which will give hope to a lot of people around the world. I should also say that I broke with convention today by allowing an Opposition Front-Bench Member to speak in the Adjournment debate. Please be reassured that this is not the norm; it is a one-off.

Budget Resolutions

Lindsay Hoyle Excerpts

Tuesday 30th October 2018 Commons Chamber

[Several hon. Members rose—]

[Mr Deputy Speaker (Sir Lindsay Hoyle)]

Order. We now have a seven-minute limit on speeches.

Tobacco Control Plan

Lindsay Hoyle Excerpts

Thursday 19th July 2018 Commons Chamber

[Alex Cunningham]

Will the Minister give way?

[Mr Deputy Speaker (Sir Lindsay Hoyle)]

It is up to the Minister. He said that he wanted to speak for only one minute.

[Steve Brine]

I will give way.

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[Mr Deputy Speaker]

It was the Minister who suggested that he wanted only one minute in which to sum up. The fact that we are late does not matter to me.

[Alex Cunningham]

Let me tease the Minister on three matters. One, what are we going to do about the “tab houses”? Two, what is his position on cigarette pack inserts? Three, what is he doing to do about the fact that mass media campaign funding has been cut by 90% in the last 10 years? We need that funding in order to be effective.

Health and Social Care (National Data Guardian) Bill

Lindsay Hoyle Excerpts

3rd reading: House of Commons & Report stage: House of Commons
Friday 6th July 2018 Commons Chamber

[Mr Bone]

With the leave of the House, I thank the parliamentary counsel, the Clerks of the House and officials at the Department of Health and Social Care for their assistance in preparing the Bill. I also thank, from my office, Jordan Ayres for the research and Helen Harrison for the drafting of the Bill. I also thank the eight Back-Bench MPs who have taken the opportunity to participate, particularly my hon. Friends the Members for Corby (Tom Pursglove) and for Torbay (Kevin Foster), both of whom sat on the Public Bill Committee.

The last thing to say on the Bill before, hopefully, it is read for the Third time is that, if it makes it all the way through and becomes an Act of Parliament, let us hope it is referred to as the Churchill Act.

[Mr Deputy Speaker (Sir Lindsay Hoyle)]

There might already be one or two Acts with that name.

Question put and agreed to.

Bill accordingly read the Third time and passed.

Department of Health and Social Care and Ministry of Housing, Communities and Local Government

Lindsay Hoyle Excerpts

Monday 2nd July 2018 Commons Chamber

[Several hon. Members rose—]

[Mr Deputy Speaker (Sir Lindsay Hoyle)]

Order. I just say to Members that they have six minutes each.

Mental Health Units (Use of Force) Bill

Lindsay Hoyle Excerpts

Report stage: House of Commons
Friday 15th June 2018 Commons Chamber

[Sir Christopher Chope]

Some people looking at today’s proceedings may say that my hon. Friend has been speaking for a long time, but we need to remember that when Bills are considered, the amendments are often grouped so that we do not consider all amendments in one discussion. Today, we are considering all the amendments to the Bill in one group, which I think explains why he has spoken for a bit longer than he might sometimes do.

[Mr Deputy Speaker (Sir Lindsay Hoyle)]

Order. May I just say that we do not need to be reminded of how long the hon. Member for Shipley (Philip Davies) has spoken? All that does is use up precious time, and I know you would not want to do that, Sir Christopher.

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[Richard Benyon (Newbury) (Con)]

On a point of order, Mr Deputy Speaker. I seek your advice, because I have heard conflicting views. It is quite clear that we are not going to get to my Armed Forces (Statute of Limitations) Bill today. Would I be right that, if I were to not move it today and were to go to the Public Bill Office to seek another date, we would then have a better chance of having a debate? Many Members on both sides of the House want to debate the Bill, and there are 250 veterans in Parliament Square who particularly want the matter aired on the Floor of the House. I seek your advice on the best way to make that happen.

[Mr Deputy Speaker (Sir Lindsay Hoyle)]

If it goes wrong, it is obviously going to come back on me. In the end the right hon. Gentleman must make the decision, but overall I would say yes; my view is that the actions he mentioned would lead to more time for a better debate.

If there are no further points of order, I call Sir Christopher Chope to speak—briefly, I presume, because I know that he wants to get on with the amendments.

[Sir Christopher Chope]

There is only a bare hour left, Mr Deputy Speaker.

[Mr Deputy Speaker]

Twenty-five minutes will do you, then. Come on, Sir Christopher!

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The House proceeded to a Division.

[Mr Deputy Speaker (Sir Lindsay Hoyle)]

I ask the Serjeant at Arms to investigate the delay in the Aye Lobby.

NHS Outsourcing and Privatisation

Lindsay Hoyle Excerpts

Wednesday 23rd May 2018 Commons Chamber

[Anna Soubry]

Would the hon. Gentleman like to speak to Nottingham City Council, which is run by Labour? It has repeatedly refused to unblock beds at NUHT, unlike Conservative-run Nottinghamshire County Council, which always ensures that it has social care available so that there is no bed-blocking in Nottinghamshire. The problem is Labour in the city—

[Mr Deputy Speaker (Sir Lindsay Hoyle)]

Order.

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[Anna Soubry]

On a point of order, Mr Deputy Speaker. Could the record please record that indeed the leader of Nottingham City Council does not run NUHT, but he is responsible for social care in the city? That was the point I was making.

[Mr Deputy Speaker]

I think that is clarification.

[Jonathan Ashworth]

I am grateful to the right hon. Lady for that. I invite her to make another point of order, because Nottinghamshire County Council is closing five care homes.

[Anna Soubry]

I am happy to take that up. My understanding is that Nottinghamshire County Council is looking responsibly at the provision of—[Interruption.] Well, the hon. Gentleman invites me to give him information; I am trying to assist him. In my constituency, the county council is making sure that the money that it spends on social care goes to the very many care homes in my constituency that are rated as good or outstanding—

[Mr Deputy Speaker]

Order. May I just help a little? We have 25 speakers to come in after the Front Benchers, so I appeal to the Front Benchers to leave time for Back Benchers to contribute.

[Jonathan Ashworth]

I shall take your guidance, Mr Deputy Speaker. It is always a pleasure to indulge the right hon. Lady, but I have to point out to her that Councillor Cutts of Nottinghamshire County Council is cutting care homes across Nottinghamshire. The record will show that.

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[Helen Whately (Faversham and Mid Kent) (Con)]

I thank the hon. Gentleman for giving way. I remember well when I worked in the NHS under a Labour Government, before I was a Member of Parliament. All around me was talk of independent sector treatment centres, offering more choice through bringing in more private sector provision to the NHS, and PFI contracts. That was under the previous Labour Government, who I believe were trying to make the NHS give better patient care, but Labour has changed its tune. I am concerned that this seems to be all about ideology. I care—

[Mr Deputy Speaker (Sir Lindsay Hoyle)]

Order. Members cannot make speeches in interventions.

[Jonathan Ashworth]

I greatly respect the hon. Lady, and I greatly enjoyed her Red Box blog on mental health provision last week. I know she thinks carefully about these matters, but this is not about ideology. It is about what works. Let us take the example of the East Kent contract for integrated NHS 111 and GP out-of-hours services, which began in January 2017. After only seven months of Primecare running it, the service was placed in special measures after it was rated inadequate. That is happening in her own backyard. This is not working, and that is the point we are making.

The history of PFI is that when we came into government, a third of hospitals were more than 50 years old. That is why we carried on with the John Major PFI scheme, which was the creation of that Government. Current Cabinet Ministers such as the shadow Health Secretary at the time, now the Secretary of State for International Trade, stood at the Dispatch Box and congratulated the Labour Government on taking up the private finance initiative developed under the previous Government. He said he would not object to the use of PFI

“exclusively to fund private capital projects”—[Official Report, 8 January 2003; Vol. 397, c. 181.]

In this House, the current Chancellor of the Duchy of Lancaster gave a “warm welcome” to a PFI in his own constituency. The Brexit Secretary said in this House:

“The PFI has many virtues—after all, it was a Conservative policy in the first instance.”—[Official Report, 10 March 1999; Vol. 327, c. 429.]

The Business Secretary said:

“PFI was initiated by the previous Conservative Government”—[Official Report, 12 February 2013; Vol. 558, c. 787.]

The Scottish Secretary has said that PFI is a “successful basis for funding”. The Welsh Secretary said:

“I am a fan of PFI in general.”—[Official Report, 4 November 2010; Vol. 517, c. 1124.]

We will take no lessons from the Tories when it comes to PFI.

We have not only seen facilities management contracts having to be brought back in-house in Leicestershire and Nottingham; we have also seen them deliver a poor quality of service across Lewisham and Greenwich. Those contracts at Lewisham Hospital should come back in-house. I know that the Labour candidate in Lewisham East will be campaigning to bring them back in-house, and I hope the Tory candidate will do the same.

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[Jonathan Ashworth]

My hon. Friend, who is an authority on these matters and campaigned on them for many years before entering this place, speaks well and she is absolutely right.

I will take an intervention from the hon. Lady from Wales, but then I will not take any more because I fear I am really testing your patience, Mr Deputy Speaker.

[Mr Deputy Speaker (Sir Lindsay Hoyle)]

It is not about my patience, but about Back Benchers.

[Liz Saville Roberts]

I have only one question: will the hon. Gentleman explain why the Welsh Labour Government have outsourced dialysis services at Wrexham?

[Jonathan Ashworth]

We have always said that there is a small role for the private sector. This is what I said earlier—[Interruption.]

[Mr Deputy Speaker]

Order. I want to hear Members on both sides, and I certainly want to hear the answer, but I cannot do so if everybody is shouting.

[Jonathan Ashworth]

We have always said that, and I do not know why Government Members are so surprised about it. Indeed, the Prime Minister, thinking she had a humdinger, quoted me at Prime Minister’s questions, but I was decidedly nonplussed by her response to my right hon. Friend the Leader of the Opposition.

Perhaps the biggest area in which private contracts have gone out is in community services, where the private sector has taken over 39% of contracts compared with the 21% in the NHS. NHS Providers said last week:

“The fragmentation of the community sector is…due to the private provider share of the community…service market being much larger than in other sectors”.

It also said:

“it is almost always a legal requirement for commissioners to go out to tender competitively for community services. Tendering for contracts is therefore much more competitive in the community sector than in the acute sector, and contracts are sometimes won on cost savings, rather than improvements in the quality of care.”

We have seen this time and again. For example, Serco was awarded a £140 million contract in Suffolk, but could not meet key response times, such as the four-hour response time for nurses and therapists to reach patients at home 95% of the time. Before Serco took over the contract, the target was achieved 97% of the time.

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[Several hon. Members rose—]

[Mr Deputy Speaker (Sir Lindsay Hoyle)]

Hopefully we will get some Back Benchers in, but I warn them that they will get no more than four minutes each. That may have to come down and some Members may not get in.

Health and Social Care (National Data Guardian) Bill (Money)

Lindsay Hoyle Excerpts

Money resolution: House of Commons
Monday 21st May 2018 Commons Chamber

[Mr Peter Bone (Wellingborough) (Con)]

rose—

[Mr Deputy Speaker (Sir Lindsay Hoyle)]

I was going to let the shadow Minister come in first, Mr Bone.

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[Sir Christopher Chope (Christchurch) (Con)]

We have just allowed a money resolution to go through on the nod in relation to the Tenant Fees Bill and I think the sums involved are much higher than £700,000, yet under Standing Orders we were not allowed any separate debate on that. Can my hon. Friend explain why his Bill for £700,000 has 45 minutes but a much more expensive Bill has nothing?

[Mr Deputy Speaker (Sir Lindsay Hoyle)]

I do not think we need to consider that.

[Mr Bone]

Mr Deputy Speaker, I wanted to get credit for the fact that some years ago I got the House to accept that in Second Reading debates we can deal with the money resolution; that is perhaps my only achievement in Parliament. But it is right that if the money resolution does not follow Second Reading immediately there has to be a 45-minute debate, and the Department of Health and Social Care estimate of the cost is £700,000.

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[Mr Bone]

Absolutely. There was much discussion with the Clerks of the House on that point. As my hon. Friend knows, that money has already been expended on the system that we have. My Bill is actually not going to cost the public purse any more money than at present. I argued strongly that my Bill should not have a money resolution, but the Clerks persuaded me that it was the proper thing to do. I think they felt that, on balance, it was safer to do it like this.

I did not think I would be speaking about a money resolution for my Bill. I did not think that anyone would spend any time on this matter. What normally happens—[Interruption.] No, I think we need to scrutinise this properly—

[Mr Deputy Speaker (Sir Lindsay Hoyle)]

Order. There is someone else who wishes to speak as well.

[Mr Bone]

I do apologise, Mr Deputy Speaker, but I think that we have 45 minutes, whatever happens.

I have lost my thread a bit, but the fact is—