Tobacco and Vapes Bill

Lord Clarke of Nottingham Excerpts

Report stage
Tuesday 24th February 2026 Lords Chamber

[Lord Pannick (CB)]

My Lords, I have listened very carefully to the speeches from the noble Lords, Lord Murray and Lord Naseby. However, what they cannot avoid is that their amendment, by maintaining the legal sale of tobacco products to persons over the age of 21, will continue the enormous damage to public health and the enormous cost to the National Health Service that is caused by the consumption of this product.

I am not persuaded by the freedom arguments. We ban heroin. We require that people wear seat belts, even if they are over the age of 21 and they may take a different view. If Sir Walter Raleigh were to bring tobacco into this country today for the first time, there is surely no doubt whatever that it would be banned because of its noxious, dangerous character. The Bill contains such detailed provisions relating to legality precisely because this has been a lawful product for so long. I think the Government are quite right in the way they seek to deal with it.

The only other argument of substance presented was from the noble Lord, Lord Murray, relating to illicit tobacco products. But that is an unfortunate consequence of banning any product. We ban cannabis. There is an illicit trade in cannabis, but I do not think the noble Lord, Lord Murray, is a supporter of legalising the sale of cannabis. The enactment of the Bill will do an enormous amount to educate the public of the dangers that this product causes and of the need to ensure that we move forward now to promote public health.

[Lord Clarke of Nottingham (Con)]

My Lords, I want to speak to my interest. About 30 years ago, I was a director of British American Tobacco. I started smoking when I was at school, and I have now been smoking for about 70 years. At the moment, the thought has not crossed my mind that I am going to abandon my enjoyable smoking of small cigars.

Leaving that aside, I recall that when I was at BAT, just as my noble friend’s experience of Gallaher has confirmed, we were desperately anxious to keep our reputation as a company and make sure the dangers of our product were brought to people’s attention and we could protect our reputation. I will not reminisce for too long, but I recall that we lobbied the then Government to make it illegal to sell our products to under-18s. They rejected that idea because of counterlobbying from retailers. We certainly offered no resistance whatever to the widespread publication of the health risks of smoking, which are considerable.

We were often accused of doing dreadful things. People who campaigned against our product decided they had to campaign against the evil organisation that was involved in it. But this was a complete misunderstanding of our attempt to maintain a good reputation. It was, in fact, an extremely well-run company. My opinion is that smoking should not be banned and made illegal if the sale is to adults who are fully informed that they are adding to the risk to their health that motoring and other things already pose to them and decide that the pleasure of smoking involves them taking it on.

I will not repeat all the excellent arguments of the noble Lord, Lord Murray, who put the case perfectly clearly and well—I agree with every word he said. I find the proposition, which was first put forward by my own party towards the end of our last period of office, a quite extraordinary one. It is going to be found that shopkeepers are making an illegal sale if their customer is a day older than the legal limit imposed by Parliament. I assume that in 60 years, somebody like me will be required to go into a shop taking my birth certificate, saying that I am 85 so can legally buy a cigarette, whereas if I was 84 years of age it would be an illegal act to engage in this transaction. I cannot see how shopkeepers are going to comply with the law except by demanding some proof of date of birth and continuing to demand that proof as the legally entitled purchasers steadily grow older and older. I am sure it is well intentioned. It is another attempt to reinforce the already very successful efforts we have made in this country to reduce the incidence of smoking. But it is faintly ridiculous and slightly preposterous, and, given the history of the decline of smoking in this country, it is quite unnecessary.

The most important point that the noble Lord, Lord Murray, makes to those who might be faintly neutral in this debate is that it will stimulate organised illegality. It most undoubtedly will. He made the arguments for that, but I remind the House of the best example in my lifetime. Until about 30 years ago, betting on racehorses was legal only on the course, and there was a firm law saying that you could not place a bet on a horse—it was strictly illegal—unless you were actually at the course.

--- Later in debate ---

[Lord Rennard (Non-Afl)]

My Lords, I oppose Amendment 1 and the associated amendments tabled by the noble Lord, Lord Murray of Blidworth, because I believe wholeheartedly that a country free from the harms of tobacco would transform the public health of this nation and prevent huge amounts of human suffering. We heard from the noble Lord about the reversal of the planned policy in New Zealand, but we did not hear an explanation for that. The explanation is quite simple: there was a change of coalition parties following a general election. One of the new coalition parties feared the drop in revenue to the Government as a result of the policy being introduced and a reduction in the prevalence of tobacco smoking, which surely proves the point that that party accepted that such policies as this would be effective.

We have heard about the wonderful, kind-spirited nature of the tobacco industry in caring for young people, but not enough about the many decades of deceit, in which that industry knew full well the links between its products and lung cancer, and covered up what it knew and lied about them, as it lied about tobacco smoking of a second-hand nature. This is not an industry which we can trust for a remote second.

[Lord Clarke of Nottingham (Con)]

May I ask what evidence the noble Lord has for that? I well remember, when I was on the board of BAT, that we acknowledged the health risks. We were accused of somehow denying it, but the people with this bizarre conspiracy theory were never able to produce any examples of our denying it, because we did not, and we did not oppose warnings and labels on packages. It is just part of the mythology of the more extreme fringe of well-intentioned anti-tobacco lobbyists.

[Lord Rennard (Non-Afl)]

My Lords, with respect, I am not part of any extreme fringe, and the views I have enunciated are shared almost entirely by the medical profession in this country. For decades, the tobacco companies had evidence that tobacco was linked to lung cancer, yet they kept denying until it was proven by showing the number of people with lung cancer who smoked and the number of people with lung cancer who did not. The industry hid that as it fought tooth and nail against such things as plain packaging with many bogus arguments. This is the most deceitful industry in the world.

We have heard about the cliff edge problem, but it is one that we have now. At 17 years and 364 days, you may not buy tobacco, but you can on your 18th birthday. With these amendments, that would change to being able to buy tobacco on your 21st birthday, but not after 20 years and 364 days on this planet.

My experience of being orphaned at 16, and finding my mother, a heavy smoker, dead in her bed as a result of hypertensive heart disease, with smoking obviously a key factor in her death, has driven me, ever since then, to support people trying to quit—that is most smokers, in my experience—and to prevent the tobacco industry promoting addiction to its lethal products. The Bill proposes a world-leading policy of which we should be proud, and we should not make it less effective, as proposed by many amendments in this group.

Raising the age at which someone can legally be sold a cigarette works in terms of reducing tobacco consumption. It may not be 100% effective, but that is not a reason to try to make it less effective. We know that raising the age of sale in England from 16 to 18 in 2007 reduced smoking rates among 16 and 17 year-olds by 30%. In the US, when the age of sale was increased from 18 to 21, the chance of a person in that age group taking up smoking fell by 39%.

The tobacco industry employs the most deceitful and dangerous lobbyists in the world. Their role is to try to protect its enormous profits and persuade more people—in particular young people—to take up the deadly habit in order to replace the 50% of its consumers whose lives are shortened by smoking tobacco.

One argument we hear from opponents of tobacco control legislation is that it represents a so-called nanny state. This is a term that I feel is really used only in the media. The phrase does not resonate with the public, who are highly supportive of tobacco control legislation. I hear laughter, but polling shows that 68% of the public support the smoke-free generation. The Chief Medical Officer has been clear that there is no freedom in addiction. Many people start smoking as children and become addicted almost immediately. Two out of three people who try just one cigarette go on to become daily smokers, and three-quarters of smokers say that they would never have started if they had the choice again.

It is also important to be clear what this policy does and does not do. The rising age of sale does not remove any current adult’s ability to buy tobacco; it simply phases in a high minimum age of purchase for future generations. That is a proportionate approach. By contrast, accepting these amendments would mean that those aged 18 to 20 who already smoke would suddenly be unable to buy tobacco legally—a far more intrusive step.

Smoking remains one of the greatest preventable burdens on our public services and our economy. It is responsible for up to 75,000 GP appointments every year. It costs the country approximately £27.6 billion in lost economic productivity. It costs the NHS almost £2 billion annually and local authorities nearly £4 billion a year in social care costs. That is money we do not have, and which could and should be spent on improving health, not managing preventable harm. The number of people—

--- Later in debate ---

[Earl Russell (LD)]

My Lords, I will briefly sum up for the Front Bench on this interesting group of amendments. Our position is that we support this generational change and welcome the Government bringing it forward. This is not party-political; these ideas come from across the House, and we welcome them.

From our point of view, changing the age of sale to 21 would be tinkering at the edges and would not bring about the change that we all know we need. Nobody who has ever smoked a cigarette or been a smoker would wish otherwise. Imagine for a moment that, today, we were not considering this ban but contemplating introducing cigarettes for the first time. Nobody with a modicum of common sense would ever contemplate introducing cigarettes and allowing corporate companies to sell products that kill half their users. We all need to change this. My own father died of emphysema, and I am sure there is hardly anyone in this House who has not been impacted by tobacco.

This might be one of the most important things that any of us in the House do in our lifetime. It is hard to see another piece of legislation having such a beneficial impact on preventing harm and misery for people in society and helping them to lead healthier and better lives.

We see no insurmountable problem in this legislation. Yes, it is new and novel, and there will be teething problems—I cannot say there will not be—but they are all surmountable. Age verification and ID are commonly used, we need to look after our small retailers and look at how this change will be implemented, and there are other views on the EU question, but this is essential and it needs to be done. We have had conversations about freedom of choice, but we would not allow any young person to pick up a loaded revolver with two chambers and one bullet and give them the freedom of choice to spin it, put it against their head and pull the trigger.

[Lord Clarke of Nottingham (Con)]

Does the noble Earl not agree that we would save many lives if we passed a law saying that nobody should be allowed to drive a motor car unless there is a man waving a stick walking in advance of them? Similarly, if we banned electric bicycles, we would prevent a great deal of injuries and possible deaths. We all have to face these kinds of judgments as part of the human condition and living in a society.

[Earl Russell (LD)]

With the greatest of respect, there are degrees of risk. There is no electric bike or motor vehicle that we have allowed that kills 50% of people who get on a bike or in a car. The noble Lord is comparing apples with pears. The dangers of smoking are known and proven, and are far greater than anything else.

To conclude, we welcome this generational ban. There are particular issues that need to be looked at and the Bill will need to be regularly reviewed, but we will come to amendments on that. This is the most important thing that we must do. It is essential that we make progress to improve the public health of people in this country.

National Insurance Contributions: Healthcare

Lord Clarke of Nottingham Excerpts

Tuesday 19th November 2024 Lords Chamber

[Baroness Merron (Lab)]

Under previous Governments, including her own, this was exactly what happened, and it will continue to happen. There are established processes on NHS guidance and the national tariff system, and there will be consultations on primary care contracts, which will play out in the normal—and what I regard as a fair and open—way. I make that point in respect of all Governments, not just this one.

[Lord Clarke of Nottingham (Con)]

My Lords, the root of this problem is that, in an election that the Labour Party was bound to win, it made a promise that it would not raise income tax, national insurance or corporation tax. The taxes it promised not to raise provide 70% of the Government’s income and are the basic toolbox of any Chancellor in any Budget. They sometimes go up or down according to the economic needs of the nation, and they are the broadest-based and fairest taxes. Now that the Government have imposed these rather damaging taxes to raise revenue in this last Budget and have gone for the choices they have, can I have the Minister’s assurance that this promise is not good for the next five years? It will confine the Government’s ability to raise revenue when they need to, so they will go into more areas and will do unintended damage to employment or particular sectors of the economy.

[Baroness Merron (Lab)]

I appreciate hearing the view of the noble Lord, with his considerable experience, but this is a place where I know the current Chancellor would beg to differ. I gently point out that I believe the root cause is something rather different: this Government inherited a £22 billion black hole.

Coronavirus Act 2020: Temporary Provisions

Lord Clarke of Nottingham Excerpts

Monday 28th September 2020 Lords Chamber

[Lord Clarke of Nottingham (Con) (Maiden Speech)]

My Lords, for about 50 years now, I have been in the habit of making parliamentary speeches quite regularly. I retired from that when I left the other place in November last year. So I am particularly honoured to find that I can now resume this practice in this most illustrious setting with such distinguished colleagues on all sides, including many old friends. I trust I will not abuse the privilege of being back in parliamentary debate, but my maiden speech will be the first time I have ever attempted to make a speech subject to a four-minute time limit. Many of my noble friends will be, at this moment, doubting my ability to manage that.

I echo what my former Commons colleague the noble Baroness, Lady Clark, said about the welcome new Peers receive here. This is, in every way, a remarkable institution. Fellow Peers—not just old friends—are especially welcoming, and I share her gratitude to all the staff here, who go out of their way to help people utterly baffled by the rabbit warren of corridors and the somewhat strange new practices we have to take on.

The major change I am having to face is that I find that this historic Chamber has all its logistics based on the use of IT of various kinds which I have previously scorned. It is most surprising that, in this particular House, a 20th-century man is being forced to get into the 21st century. Trying to open and switch on a laptop and an iPad, then contemplate how to use them, is my biggest problem at the moment, because of the generosity of all those who are helping me in every other way.

On this subject I can only say that I have every sympathy with the Government, as a former Secretary of State for Health and a former Chancellor of the Exchequer. This is the worst health crisis to have hit this country and the worst depression—no, recession, so far—and economic crisis that has occurred in my lifetime. The difficulty of dealing with it is that it is shrouded in total uncertainty. All forecasts on all fronts are quite useless because the disease is new, its behaviour is unknown and therefore the range of scientific and medical opinion about the way in which it can be controlled and what is going to happen is not a unanimous science: it is immensely varied. Quite unprecedented choices have to be made on the tensions between the life-saving prospects of doing one thing and the damaging economic consequences that step will have. Everybody is going to second-guess every decision that Ministers come to as they go along. As we are now in the days of public inquiries, with the wisdom of hindsight everybody will be able to see what should have been done in the light of what we know has happened, and everybody will say how obvious it was that steps should have been taken.

Yes, the Government have made mistakes; every western Government have made mistakes. The mistake at the beginning was not being tough enough. It is quite obvious that we should have gone into lockdown probably about three weeks before we did. It is quite obvious that we should have quarantined flights in from places such as Spain and Italy almost instantly. We should obviously have been more aware of the dangers to the residents of care homes and ended the practice of discharging patients from hospitals to care homes without testing before doing so. But, if the Government had done those things at the beginning of March, they would have faced all the protests about civil liberties, excess infringements, controls and so on that we are hearing now. We must not repeat that. The policy succeeded after that because we had only about 60,000 excess deaths and, although we are as bad as almost any other country in the world, people have now got used to the small level of deaths—each of them tragic—and disaster we are having. The demand now is: let us have more liberty and protect our freedom and let us not step things up.

The Government should subject themselves to more parliamentary scrutiny of the next steps. I totally agree with all who have voiced that. It would strengthen them and give them more authority. It would give them a better defence when they make an obvious mistake—and they will make more. The position now is that they would also be strengthened by the support they would get. The majority of the public support the measures that the Government are now taking. The rule of six is not particularly severe, while closing pubs at 10 pm takes us back to the days of my teens but is not actually a tremendous infringement of civil liberties. Opinion polls show that the public would accept tougher measures from the Government and I think that, after proper debate and scrutiny, the majority in Parliament would allow most of them. That would, however, save us from the occasional strange dilemmas and slips that we know have occurred. The Government, the public and the nation will be held together better if we scrutinise more firmly, but not on the basis that we second guess every decision that any Minister makes and start politicising it in this extremely dangerous world.

Interim NHS People Plan

Lord Clarke of Nottingham Excerpts

Wednesday 5th June 2019 Commons Chamber

[Stephen Hammond]

Perhaps that is the soundbite that the hon. Gentleman and his colleagues—including the hon. Member for Dewsbury, who is shouting across the Chamber yet again—should remember.

[Mr Kenneth Clarke (Rushcliffe) (Con)]

I welcome the Minister’s announcement that the Government are giving higher priority still to the recruitment and retention of staff in the NHS. It is an undeniable fact that there are acute shortages, particularly of nurses, in practically every part of the NHS, and we urgently need to improve our recruitment and retention. With that in mind, will he confirm that in finalising the people plan, serious consideration will be given to the immigration rules that will apply to recruitment after we leave the European Union? About one in 20 of the whole staff of the NHS at the moment are citizens of the European Union, and it would make no sense at all to put new restrictions of any kind on people coming from the European Union who want to make a valuable contribution to our health service. In Nottingham, we used to run recruitment campaigns for nurses in Romania. We are a long way away from being able to in any way put restrictions on staff coming from any part of the continent.

[Stephen Hammond]

My right hon. and learned Friend the Father of the House is completely correct. We want to make sure it is clear that the EU nationals who work in the national health service—there are more than 63,000 of them—are valued and make a huge contribution to our NHS. He will probably be aware that my right hon. Friends the Secretary of State and the Home Secretary are in continuing negotiations, to ensure that there is no change to that position. I guarantee that we want to see EU nationals continue to work in and contribute to our great health service.

Eurotunnel: Payment

Lord Clarke of Nottingham Excerpts

Monday 4th March 2019 Commons Chamber

[Matt Hancock]

Unlike in the question from my hon. Friend the Member for Berwickshire, Roxburgh and Selkirk (John Lamont), what I did not hear in the hon. Gentleman’s long question was a statement about whether he supports the decision or not. I think that is because he does support the decision to ensure we have what we need to get the unhindered supply of medicines. More than that, he and his Scottish National party friends complain endlessly about a no-deal Brexit, yet they do not do what is needed to avoid a no-deal Brexit, which is to vote for the deal.

[Mr Kenneth Clarke (Rushcliffe) (Con)]

It is always a pleasure to see my right hon. Friend the Secretary of State for Health and Social Care, although rather a surprising one on this occasion. The usual reason for settling an action is to minimise your losses when you are obviously on a loser in defending it, but I am relieved to hear that this was done in order to ensure the safety of medicines. As we are on that subject, can he give me some reassurance about the long-term future for the regulation and approval of medicines in this country? If and when we leave the EU—we look as though we are bound to do so—we of course leave the European Medicines Agency, which is leaving this country, and I am not clear what our long-term arrangements will be. Are we going to seek some association with the EMA system, or will we be setting up a totally new British system to replace it? Can he guarantee continuity of the proper regulation of medicines while that process is under way?

[Matt Hancock]

The short answer to that is yes. The medium length answer is that we will ensure that medicines can be licensed in this country with no further burdens than under the EMA system by matching some of the EMA processes, but in a no-deal scenario we would also be looking to introduce our own processes so that some medicines could be brought and licensed here before they could be licensed in Europe. Indeed, changes to this area is one of the examples of advantages from Brexit, which I am sure my right hon. and learned Friend will be delighted to hear about, because they mean that we can grasp some of the opportunities that the future of medicines presents. The long answer is so long that I will be happy to write to him with full details and place a copy of the letter in the Library of the House.

NHS Long-term Plan

Lord Clarke of Nottingham Excerpts

Monday 7th January 2019 Commons Chamber

[Matt Hancock]

Well, I think we discovered from that that Labour has absolutely nothing to say about the future health of the nation. The hon. Gentleman did not even deign to thank the people who work in the NHS for their incredible work. Did we hear any acknowledgement of the million more people who are seen by the NHS, of the record levels of activity going on in the NHS and of the fact that we have more nurses and doctors in the NHS than we had in 2010? He had nothing to say. He talked about the workforce. Chapter 4 of the document is all about the workforce plan. He gives me the impression that, like his leader on Brexit, he has not even read the document he is talking about.

The hon. Gentleman asked about targets and legislation. On legislation, when clinicians make proposals on what legislation needs to change to improve the NHS, we listen. We do not then come forward with further ideological ideas. We listen. So we will listen to what they have said. The clinicians have come forward with legislative proposals and we will listen and study them closely.

On the money that the hon. Gentleman talked about, it was a bit like a broken record. He asked about a £1 billion shortfall in the NHS budget. I will tell him what we are doing with NHS budgets: we are putting them up by £20.5 billion. There is an error in the analysis by the Nuffield Trust, because it does not take into account an improvement in the efficiency of the NHS. Is it true that every year we can improve the way the NHS delivers value for taxpayers’ money? Absolutely. We can and we must, because we on the Government Benches care about the NHS and about getting the right amount of money into the NHS, but we also care about making sure that that money is spent wisely. The hon. Gentleman would do well to heed the views of the NHS itself, which says that yes, the NHS is probably the most efficient health service in the world, but there is always more to do.

The hon. Gentleman argued about various budgets. The budgets in the NHS are going up because we care about the future of the NHS. The Labour party called for an increase of 2.2% a year; we are delivering an increase of 3.4% a year. Labour has nothing to say on health, as it has nothing to say on any other area of domestic business. We will make sure that we are the party of the NHS for the long term.

[Mr Kenneth Clarke (Rushcliffe) (Con)]

First, I congratulate my right hon. Friend on his paying tribute to the work of the late Sir Henry Willink, who served in Churchill’s Conservative Government. I met him once or twice when he became master of a Cambridge college. The Conservatives have shown respect for the NHS ever since, as he foreshadowed.

I also congratulate my right hon. Friend on the large increases in funding that are almost as big as some of the funding increases that I received when I was a Health Minister and then Secretary of State. Ever since it was founded, all Governments have increased spending on the NHS—they are bound to—and whichever party is in opposition we always have these knockabout exchanges about whether it is enough. As my right hon. Friend rightly says, what matters is how effectively the money is spent to produce the right patient outcomes. The plan appears to reflect that very well.

Does my right hon. Friend agree that the biggest pressure facing the health service is the extraordinary growth in demand, and the change in the nature of that demand, which is being caused by the ageing population, with chronic conditions playing such a large part? Does he also accept that his most urgent priority is to build further links between the hospital service, the GPs, the community services and local authority social services, so that we have people working no longer in silos, but together to produce the best package for the patient? We have achieved something, but not very much. I hope that when we produce our adult social care policy, which I hope is soon, my right hon. Friend will begin to think about some reforms to make sure that all elements of the service work together properly to produce the proper and most cost-effective personalised treatment for each individual patient.

[Matt Hancock]

I pay tribute to my right hon. and learned Friend, who of course did so much to set in train the modern health service that we know and whose reforms were kept and, indeed, enhanced during the period when Labour was in government. He is right about the need to run the NHS so that it can be the best that it possibly can be. Yes, we need the money, but we also need to run it well. It is no good just to argue about the money. On that he may have a surprising ally, because the shadow Secretary of State, who is currently looking at his mobile phone—well, he is not any more—said a couple of months ago:

“we need to augment the debate beyond the current mantra of ‘we can spend the most’”.

However, it appears that the Labour party only has a mantra of “We can spend the most.” We care about the money, but we care about the NHS being the best that it possibly can be, too.

NHS Winter Crisis

Lord Clarke of Nottingham Excerpts

Monday 8th January 2018 Commons Chamber

[Mr Dunne]

I am glad that the hon. Gentleman mentioned the Secretary of State. I want to put on record my tribute to my right hon. Friend, who has served in that position for almost as long as Aneurin Bevan, who was the first Secretary of State for the NHS.

I am delighted to be here to respond to the hon. Gentleman, who, as usual, listed a cacophony of allegations, very few of which are directly related to the challenges that our hospitals face today—the increase in demand and pressure on our NHS as a result of a combination of the increase in population and challenges posed by demographics, as well as the weather and the presence of flu in many parts of the country, adding to the pressure on staff at this time of the year.

The hon. Gentleman asked several questions. On the funding issue, he is well aware that the £337 million announced in the Budget was allocated in December. His own local trust, which includes the Leicester Royal Infirmary, received £4.2 million. It is a great shame that he chose not to welcome that extra money for his local trust. The money announced in the Budget has been allocated, but we have kept £50 million in reserve to allocate this month if particular pressures that become apparent during the course of the month need addressing.

The hon. Gentleman asked about the impact of the cancelled operations. We do not know that operations are cancelled. There have been a few thus far; procedures and treatments are being deferred. It will not become apparent until after this period has finished how many actually do end up being cancelled, so it is not possible to calculate the financial impact on any of the trusts where deferral is taking place.

The hon. Gentleman referred to the situation as unprecedented. I gently remind him that we have a winter crisis of some kind or another every year. He will have been in Downing Street in 2009-10, when, as it happens, the then Conservative shadow Health Secretary chose not to try to take advantage of the near flu pandemic at the time because he recognised that there were operational pressures on the NHS and it was not down to him to score party political points. The hon. Gentleman has unfortunately chosen to do that. At that time, tens of thousands of elective procedures were cancelled to provide capacity to cope with the emergency at the front doors of our hospitals. So this is a routine way to deal with pressure coming through hospital front doors.

What distinguishes this year from previous years is that in the past elective procedures were cancelled within hours of operations being due to take place. Sometimes it was the day before and sometimes it was on the day. That caused patients considerable distress and gave rise to considerable problems for staff. We have set up the national emergency pressures panel to anticipate problems when we see the signals, and we can then give notice to patients that their procedures are going to be deferred. That is a much more humane and sensible way to do things and it provides much more opportunity for hospitals to cope with the pressures that are coming through the door.

[Mr Kenneth Clarke (Rushcliffe) (Con)]

NHS acute services have never been better and are among the best in the world. As the Minister just said, every year we have this slightly ritual exchange about winter pressures, but does he accept that the problems are changing because of the increased number of elderly people in the population and the increased urgency of the need to solve the problem of how to admit them promptly to the right part of the service and then discharge them properly and safely as soon as they are recovered? Will he advertise further to the many people who are not aware of it the availability of emergency GP services? Will he concentrate on the reform and integration of the community care system, the social care system and the primary care services and make sure that co-operation among them is steadily improved so that they can cope better in future years, because this problem is undoubtedly going to develop?

[Mr Dunne]

I am grateful to my right hon. and learned Friend for making those points. He brings to the House considerable experience of what it is like to be responsible for the NHS. He is absolutely right: the number of over-80s who are presenting to hospital A&Es is going up exponentially each year. Hospitals need to adapt the way that they treat such patients to try to keep them as healthy as possible so that they can live independently for as long as possible. That is why many hospitals are now introducing frail elderly units close to or at the front door of A&E departments so that they can turn around patients and avoid admissions. My right hon. and learned Friend is also right to point to the increasing integration between the NHS and social care that is necessary to encourage more people to live independently out of hospital and leave emergency departments for those people who are urgently ill.

NHS and Social Care Funding

Lord Clarke of Nottingham Excerpts

Wednesday 11th January 2017 Commons Chamber

[Jonathan Ashworth]

My hon. Friend makes a powerful point about Wales. As a Member for Cardiff, he understands what is happening in the Welsh health service. I wish Conservative Members understood that better.

[Mr Kenneth Clarke (Rushcliffe) (Con)]

Will the hon. Gentleman give way?

[Jonathan Ashworth]

I will give way to the right hon. and learned Gentleman, but I will then make some progress.

[Mr Clarke]

Does the hon. Gentleman accept that every winter, for as long as I can recall, we have had a winter crisis in the NHS? It usually happens after Christmas. In winter the demands on the service become unpredictable, infections spread and the NHS starts losing staff. There are bound to be parts of the system that come under very real strain, and no one is trying to minimise the fact that they do. Apart from just producing this year’s crop of stories of very unfortunate incidents in various places, does he have any policy proposal at all, apart from simply spending more money wherever the reports are coming from?

[Jonathan Ashworth]

I am very grateful to the right hon. and learned Gentleman, who is a very experienced parliamentarian, for his intervention, but he will know that this is one of the worst winters for probably 20 years. He casually suggests that this happens every year, but I remember the years of a Labour Government when it did not happen. I remember the years of a Labour Government when we went further than the financial settlements he delivered as Chancellor of the Exchequer and were more than doubling the money going into the NHS—and tripling it in cash terms.

Junior Doctors: Industrial Action

Lord Clarke of Nottingham Excerpts

Monday 5th September 2016 Commons Chamber

[Mr Hunt]

Thank you, Mr Speaker.

The shadow Health Secretary needs to recognise that working people, the people her party claims to represent, need a seven-day NHS. The vulnerable people that Labour claims to represent get admitted to hospital at the weekends, and in industrial disputes patients should always matter more than politics. The next time she meets a constituent who has suffered because of not having a seven-day service or because their operation has been cancelled because of a strike, she and her colleagues should hang their heads in shame.

The hon. Lady has used some very strong words. She used words such as “vilifying” and “demonising” in relation to the junior doctor workforce, and that is a very serious thing to say. I challenge her to find a single piece of evidence that has come from me or anyone in the Government, and if she cannot do so, she needs to withdraw those comments and apologise to the House. The fact is that the single most demoralising thing for the NHS workforce is strikes, because they entrench and harden positions, which results in people getting very angry, and it becomes much harder to find consensus.

The hon. Lady also talked about the use of statistics. She does not have to listen to what I say—and I understand, given the sparring that goes on between us, that she might not want to—but we have had eight academic studies in the past five years that describe increased mortality rates for people admitted to hospitals at weekends. Her response to this, in a phrase she used in another context, was that there was “zero empirical evidence” for a weekend effect. I would caution her on this, because taking that approach to hard data is exactly what happened at Mid Staffs, where hard evidence was swept under the carpet year after year because it was politically inconvenient. This Government will not make that mistake.

Finally, the hon. Lady said that my civil servants had apparently advised me that this policy would not work. Not at all. What happens with every Government policy, as you would expect, is that smart civil servants kick the tyres of every aspect of the policy to enable us to understand the risks involved. She did not mention the fact that the same document to which she referred actually says that we are on track to deliver the four clinical seven-day standards to 20% of the country by next April. I think that her constituents will welcome that, even if she does not. These strikes are going to harm patients, damage the NHS and make it harder, not easier, to resolve the challenges facing junior doctors. Labour has chosen political opportunity today, but we will do the right thing for patients.

[Mr Kenneth Clarke (Rushcliffe) (Con)]

Does my right hon. Friend agree that it has been an indefensible anomaly for many years that the national health service so reduces its services at weekends when the patients it serves are vulnerable to urgent or emergency conditions and need the highest standards of care for chronic conditions on a seven-day basis? Will he continue to make what he has described as careful progress? Will he also make it clear that the seven-day service will not simply do routine work and that it will be introduced as resources and staffing allow in line with civilised conditions? Further, on the strange politics of the dispute that keeps coming back to haunt him, does he agree that while the BMA has always been one of our most militant trade unions and while the Labour party has been very left wing in its leadership before—most notably in the 1980s—it is almost inconceivable that at any time in the past such extreme militant action that threatens patients would have been supported by the BMA or the Labour party? They are now opposing a contract that union leaders praised as a sensible settlement, given the improvements that it offered, only two or three months ago.

[Mr Hunt]

As ever, my right hon. and learned Friend speaks incredibly wisely. Actually, his last comment goes to the nub of why this is totally extraordinary, unprecedented and completely unacceptable. It is true that the junior doctors have rejected the agreement that was reached in May in a ballot, and we have to accept that. There are all sorts of reasons why that might have happened, but the choice to escalate the industrial action and to call the worst strike in NHS history was made not by those junior doctors but by the BMA leaders. They made that decision about a contract that they themselves had described as being good and safer for doctors and patients only in May. How can they justify that? Is there not perhaps a desire to pick a very big fight?

We were making good progress over the summer in a whole series of dialogues in different areas to try to resolve some of the non-contractual issues that the junior doctors are worried about, but this action makes it virtually impossible to continue that progress, although we will try very hard to do so. My right hon. and learned Friend is absolutely right to say that this is completely unacceptable and damaging for patients. I am afraid that I am having to go through some of the very same battles that he had to go through when he was Health Secretary.

Junior Doctors Contract

Lord Clarke of Nottingham Excerpts

Wednesday 6th July 2016 Commons Chamber

[Mr Hunt]

I thank the hon. Lady for her constructive comments, which are born of her NHS experience. She is right: we are phasing in the contract carefully to make sure that we learn lessons. She is absolutely right to talk about rota gaps. Unfortunately, the problem of rota gaps cannot be solved at a stroke on signing a contract; it has to do with making sure that we have a big enough supply of doctors in the NHS to fill those rota gaps. We now have much greater transparency about the safety levels that are appropriate in different hospitals; that is one of the lessons that we learned post Mid Staffs. We are investing more in the NHS in this Parliament. We recruited an extra 9,300 doctors in the last Parliament and we are increasing our investment in the NHS in this Parliament, so that we can continue to boost the doctor workforce in the NHS. In the long run, that is how we will deal with the rota gap issue; but unfortunately, that cannot be done overnight.

[Mr Kenneth Clarke (Rushcliffe) (Con)]

I congratulate the Secretary of State on taking the only responsible decision that he could take, in the interests of the service and patients, to bring this sad, extraordinarily long episode to an end. I also congratulate him on being conciliatory, because he made concessions in May to produce the final contract, and now he is phasing it in, in its negotiated form. I hope that we get back to a peaceful settlement. Does he agree that the surprising fact that so many dedicated junior doctors were prepared to take industrial action over rather ill-defined problems with the contract shows that there is a problem with morale in the service? Will he give an undertaking that the very welcome steps that he has announced today to try to address the wider issues will last not just a few months, until the dust settles on this dispute, but will be part of a continuous process to make sure that we restore to the service the morale and dedication on which we all know the NHS relies?

[Mr Hunt]

As ever, my right hon. and learned Friend speaks with great wisdom and experience. He is absolutely right to say that tackling the morale deficit in the NHS has to be a key priority. That is why we have to recognise that for doctors—particularly junior doctors starting out on their medical careers—the most depressing and dispiriting thing of all is when they cannot give the patients in front of them the care that they want to. That is why we are looking at a number of things to make it easier for doctors to improve the quality of care. One of the things that is particularly challenging and that we in this House have to think about and discuss a lot more is how difficult doctors and nurses find it to speak out if they see poor care, or if they or a colleague make a mistake, because they are frightened of litigation, a General Medical Council referral, or disciplinary action by their trust. The problem is that people then do not go through the learning processes necessary to prevent those mistakes from happening again. The key is creating a supportive environment, in which learning can really happen, in hospitals.