Flu Vaccination and Blood Test Cancellations
Lord Coaker Excerpts(3 years, 2 months ago)
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Lord Coaker (Lab)
Does the Minister not understand the frustration across the Chamber? Every one of us knows that there are problems with routine blood tests and cancellations of flu vaccinations. Everyone would expect the Minister to explain what he is going to do about it—so what is he going to do about it?
Lord Bethell (Con)
My Lords, I hear the frustration in the House, particularly on flu vaccinations. Quite clearly the personal experience of those in this Chamber is different from what is being reported to me. I have undertaken to look into it more closely, to write to the noble Baroness and to put that letter into the Library. I think that is an entirely fair and reasonable response and, if I may say so, demonstrates the effectiveness of this Chamber at holding Ministers to account.
Draft European Qualifications (Health and Social Care Professions) (Amendment etc.) (EU Exit) Regulations 2018
Draft European Qualifications (Pharmacists) (Amendment etc.) (EU Exit) Regulations (Northern Ireland) 2018
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Stephen Hammond
It is a great pleasure to see you in the Chair, Mr Howarth.
The draft regulations aim to ensure continuity in the recognition of European economic area and Swiss health and care professional qualifications in the United Kingdom in a no-deal European exit scenario. The statutory instrument relating to Northern Ireland, which has been introduced here because the Northern Ireland Assembly is suspended, ensures that the approach to recognising health and care professional qualifications is consistent throughout the United Kingdom.
European health and care professionals make a major contribution to the national health service and the wider health and care system. Since 1997, more than 100,000 EEA and Swiss-qualified health and care professionals have applied to have their qualifications recognised in the United Kingdom, and more than 77,000 of them have been dentists, doctors, midwives, nurses and pharmacists. The Government have been clear that European health and care professionals will continue to be welcome after the UK leaves the EU, and the statutory instruments are part of ensuring that.
Arrangements for the recognition of professional qualifications within the EU is provided for by the directive on the recognition of professional qualifications, which will cease to apply if the UK leaves the EU without a deal. Changes to the domestic legislation that implements the directive are therefore needed to ensure that recognition of those EEA and Swiss qualifications can continue after EU exit, in the case of no deal. The directive provides for mutual recognition of EEA and Swiss professional qualifications within the EU and makes provision for harmonised education and training standards in seven professions, five of which are in health—doctors, dentists, nurses, midwives and pharmacists. The directive allows for recognition of listed qualifications that meet the harmonised education and training standards and provides for recognition under a general system for qualifications that do not meet those harmonised requirements. The directive also covers Switzerland and EEA nations.
It is worth noting, as I have said, that the UK has been a major beneficiary of the arrangements under the directive. Since 1997, the UK has recognised 77,000 EU qualifications in the automatically recognised professions. In contrast, fewer than 7,000 UK qualifications have been recognised in other EU states. The directive has helped with the recruitment of skilled professionals to the UK’s health and care sector and it is important that the arrangements that allow for continued recognition of health and care professional qualifications are in place if the UK leaves the EU in a no-deal scenario.
The two instruments that we are debating have three main effects. First, they put in place arrangements for the recognition of those EEA and Swiss professional qualifications that are currently recognised and provide for the continuation of recognition arrangements for those qualifications that are covered by the general system. Secondly, they ensure that applications for recognition that are ongoing at exit day can be completed under the current legal arrangements and, finally, they remove a number of provisions that would not be appropriate to maintain in the event of a no-deal Brexit.
I will set out the changes in a little more detail. The instruments put in place new arrangements for the recognition of professional qualifications that are currently automatically recognised. Such qualifications will become recognised overseas qualifications, or “relevant European qualifications” in the case of pharmacist qualifications in Northern Ireland. As such, they will continue to be recognised without additional testing, other than the checks for an applicant’s language skills and on whether there are concerns about their fitness to practise.
The regulations give UK regulators a new power to designate a qualification that is currently recognised automatically.
Vernon Coaker (Gedling) (Lab)
The Minister has just announced a major change, in that a UK regulator would determine whether qualifications were acceptable. Who sets the criteria for the regulator to determine that?
Stephen Hammond
I have said two things: that there will be new arrangements, so that professional qualifications that are currently automatically recognised will continue to be recognised without additional testing, other than checks for language; and that the regulations give powers to designate a qualification that is currently recognised. As yet, I have not said that there will be a new designation system.
Vernon Coaker
My understanding is that the regulator will determine whether a qualification is regarded as comparable. Is that the case? If so, who determines the criteria on which the regulator will make that decision?
Stephen Hammond
I will come to that a little later, if I may. The hon. Gentleman is right that we need to come on to that point, because some qualifications will be comparable and we need to ensure that the right regulatory system is in place.
As I was saying, designating a qualification will allow UK regulators to stop the automatic qualification, which is not possible under the directive. That is an important additional measure, which will enhance public protection. Such designation will be subject to Privy Council consent, or the agreement of the Department of Health in Northern Ireland in relation to pharmacists’ qualifications there.
The Secretary of State for Health and Social Care will review the arrangement for the continued recognition of automatic qualifications no later than two years after the regulations come into force. The review clause is important because it means that the arrangements put in place by the regulations will not remain indefinitely. It would be reasonable for hon. Members to ask what the review will cover. In short, it will cover whether it is appropriate for the near-automatic recognition of European qualifications to continue. It would not be right for me to predict what key factors there might be at that point in two years’ time, but I guess that hon. Members will make a judgement about which factors ought to be included in the review.
Vernon Coaker
The point I am trying to make is about the difference between automatic acceptance and the regulator determining that certain qualifications are not acceptable. I am trying to tease out from the Minister how that difference will be determined, between automatically accepted qualifications and those that are regarded as non-comparable. Who sets those criteria? That is the question for the Minister.
Stephen Hammond
It is the question. There is a system currently in place, as the hon. Gentleman knows, in which the regulator has powers to automatically accept qualifications. There is also a system in place for professionals from outside the EU and the EEA, which looks at regulatory qualifications and ensures that they comply with UK standards, which, at the moment, is the EU directive. Therefore, there is already a regulatory system for non-EU/EEA/Swiss citizens that sets those standards. If we were considering different standards to the current automatic recognition, it would be appropriate to use that process of regulation to give the regulator his authority to decide whether a qualification was acceptable. I hope that answers the hon. Gentleman’s question.
What I can say about the two-year review period is that it is important to have a widespread and encompassing review of the arrangements for recognition of all international healthcare. That will ensure that the process of recognising all the qualifications is effective and proportionate. If and when the arrangements for the recognition of relevant EEA and Swiss qualifications come to an end, a parliamentary review to determine the time when that happens will be appropriate.
The regulations, as I hope I explained in more detail in answer to the hon. Gentleman’s question, enable qualifications that are not covered by the automatic system to be considered by the relevant UK regulator and compared with the equivalent UK qualifications standard, as currently happens. They allow applications made before exit date to be concluded under the current arrangements, as far as practically possible. They allow individuals practising under temporary and occasional status, or under the EU professional card, to continue to do so until such registration expires.
The regulations also remove obligations and administrative arrangements that will no longer apply to UK domestic regulators when the UK leaves the EU. Those changes include the removal of provisions relating to cross-border temporary provision of services, which currently allow professionals in a member state to practise in another member state on a temporary and occasional basis without having to register fully; the removal of the requirement to share information through the European Commission’s internal market information system, to which UK regulators will no longer have access; and the ending of arrangements that allow professionals to practise in the EU using the European professional card. That card is underpinned by European Commission systems that will no longer be available to UK regulators.
Finally, the regulations remove the requirement on UK regulators to set professional education and training standards that comply with the standards set out in the directive. That will provide UK regulators with greater flexibility to set education and training standards that meet the needs of the UK’s health and care professions.
In conclusion, the regulations put in place a system for the recognition of EEA and Swiss health and care professionals if the UK exits the EU without a deal. They also ensure that applications that are in progress at exit day will be concluded under current arrangements as far as practically possible.
As I said at the outset, the UK places enormous value on the contribution of the EEA and Swiss-qualified professionals who work in the UK health and care sector. The regulations will facilitate the continued recognition of EEA and Swiss professional qualifications after the UK leaves the EU. I look forward to hearing the contributions of other hon. Members. The effect of the regulations is to ensure continuity of recognition of qualifications in the event of a non-deal EU exit.
Vernon Coaker
It is a pleasure to serve under your chairmanship, Mr Howarth. I wish to reinforce a couple of important points made by my hon. Friend the Member for Ellesmere Port and Neston from the Front Bench in his excellent contribution.
The hon. Member for Linlithgow and East Falkirk, who speaks for the SNP, talked about this, but these SIs are incredibly important. Tucked away in these regulations are all sorts of policy changes that will have huge implications for our constituents and our country. I want to mention a couple. Hon. Members might not have read all these regulations—I have not read all of the pages, but I have read some—but if, in a few weeks’ or a few months’ time, a no deal happens, we will have people coming to our constituency offices asking what has happened to change their working arrangements in this country. We will have to say, “We’re not quite sure; we’ll go back and have a look and see where that happened.” And it will have happened in Committees such as this.
I say this as an aside—I know that we have all said it—but one of the problems with SIs is that we cannot amend them. Let me give one example. My hon. Friend the Member for Ellesmere Port and Neston mentioned this, but one really significant change tucked away in these regulations is the removal of the right of EU and Swiss nationals who are working here on a temporary or occasional basis to do so. My hon. Friend set out how many people that covers. What will we say when a Swiss or EEA national turns up at our surgeries and says, “I am working here on an occasional or temporary basis”—or says that they wish to do so—“and my local hospital needs me”? The figures are there: 42 General Medical Council registrants, 88 other professionals, and so on. If one of those people comes to us and says, “I am no longer able to work here,” it will be this Committee that agreed that regulation.
I agree with my hon. Friend that we will not vote this measure, but why on earth is the Minister doing this? Why on earth are we saying to EEA and Swiss nationals who are working here on an occasional or temporary basis that they cannot do so?
Vernon Coaker
I will of course give way to the Minister, but the House of Lords Select Committee raised that point, so is he going to tell me that that has been changed?
Stephen Hammond
The hon. Gentleman is raising a number of serious and important points, as did the Opposition Front-Bench spokesperson—he was right to do so, and I will answer those points. However, the hon. Gentleman will be aware that at the moment the number of social and healthcare professionals working under the regime that he is describing is fewer than 160. Does he not agree that if people wish to work, or to continue to work, on a temporary or occasional basis, it might be more sensible, in the interests of public safety, for them to seek full registration? We are talking about a very small number. Surely full registration is the way forward.
Vernon Coaker
The implication of what the Minister has just said is that those people have been working in the NHS at the present time with sub-standard qualifications.
Stephen Hammond
It is not. The hon. Gentleman was citing the example of someone who wanted to work here on a more permanent basis and to use that regime to achieve that. If someone wishes to work under that regime, would it not be sensible to have full UK regulatory recognition?
Vernon Coaker
The Minister will give his answer, but this question has been raised by NHS professionals and by the cross-party House of Lords Select Committee that looks into these matters. Indeed, that Committee specifically said that the Minister should be questioned about the change, because it has serious concerns about the detriment to the NHS from removing the right of those people to work in this country under the occasional and temporary arrangements. The Minister may say it is only a small number, but if there is a no-deal scenario, let us see whether that small number start appearing at our surgeries and whether we have to explain why the current arrangements no longer apply.
I think the change is unnecessary. The system works very well now and allows people to move backwards and forwards. As my hon. Friend the Member for Ellesmere Port and Neston pointed out, this is a reciprocal arrangement. People from this country benefit from exactly the same arrangements when they go to other countries across Europe. It will be interesting to hear the Minister’s answer to my hon. Friend’s question about what he expects the reciprocal arrangements to be and how other European countries will respond to our doctors, nurses and other healthcare professionals seeking to broaden and extend their experience by working in other countries in Europe.
The Minister started to answer my earlier questions about qualifications that are not regarded as comparable. In his response to the House of Lords Committee, he said it would be a matter to be determined by the regulator. My hon. Friend has already raised this point, but given that different regulators will determine which qualifications are not comparable, will they all have different criteria? How on earth will there be any consistency? The bureaucracy will be enormous. What are the costs of that? What will the staffing arrangements be? Again, the House of Lords Committee, in response to what the Minister said, raised serious concerns about how that will be done. My hon. Friend is right: the Minister needs to lay out more clearly how he believes the NHS will not be detrimentally affected by the changes introduced by these regulations, should that be necessary in a no-deal scenario, given the numbers he pointed to—3,200 people being automatically registered and 1,500 being registered under the general system. Will the Minister also confirm, as I think he said earlier, that the language tests will remain exactly the same?
My final point refers to Northern Ireland. It is a general point for the Minister to take away and one that he should perhaps ask the Secretary of State to discuss in Cabinet. There is no Assembly in Northern Ireland. The explanatory memorandum says that, under the legislation passed by this House, the Government talk with officials in Northern Ireland to determine whether these or other regulations are acceptable. Without getting into the arguments about why that is occurring or not, the democratic deficit is quite significant. I wonder whether there might be a better, more informative way of proceeding than just to include a few lines saying, “We’ve consulted with Northern Ireland officials about whether these regulations will apply appropriately in Northern Ireland,” given the responsibility on us all, in the absence of a Northern Ireland legislature, to consider the impact of regulations on that part of the United Kingdom in a more appropriate way.
These are significant changes. The Minister says that a small number of people will be affected, but those receiving treatment from someone who will no longer be able to register under the temporary or occasional scheme will be asking how this Parliament passed legislation that is potentially detrimental to their healthcare. That is not the Minister’s intention, but these are appropriate questions for this Committee and the House to ask the Minister as we move into the unknown.
Stephen Hammond
The hon. Gentleman is absolutely right to raise that concern, but as I have sought to reassure him, it will be perfectly possible for UK regulators and EU regulators, either in whole or individually, to exchange information. It will be possible under this arrangement for UK regulators to seek that information from their individual European counterparts, should they need to do so.
The hon. Gentleman asked about the capacity of regulators to check qualifications. Although it is not the Government’s intention or desire to have a no-deal outcome, regulators have been preparing for that possible scenario. These regulations will ensure that there will be little additional work for regulators in recognising EEA and Swiss qualifications at exit date. Under the regulations, the regulator can choose to review automatic qualifications that it was previously obliged to accept and to designate those qualifications where there are patient and public safety concerns. An applicant will be obliged to supply the regulator with the relevant documents, and if the regulator is not satisfied, it can reject the application. My point is that there is no extra administrative burden on regulators.
On the potential for an additional financial burden, the UK and the regulators have been preparing for a possible no-deal outcome. As the regulations seek to maintain the current systems as far as possible, for at least two years from their coming into force after the expected exit day until the review, there should be little extra cost or impact. There is, as the hon. Gentleman pointed out, the potential for regulators to recover those costs through additional fees, and that is true of current regulatory systems, in many cases.
The hon. Members for Ellesmere Port and Neston and for Linlithgow and East Falkirk asked whether the regulations reduce the ability to safeguard public and patient safety, making the health service less safe. At the heart of these instruments is the recognition that public protection and patient safety must be the foremost ambition; therefore, public protection is the key purpose of regulating health and care professionals. The instruments provide the regulators with the necessary powers to protect the public by introducing the power to designate EEA and Swiss professionals, who they are currently obliged to accept automatically. In addition, they will still be able to check applicants’ language skills and, as I confirmed to the hon. Member for Gedling a moment ago, the language tests will not change.
I was asked about the review process. It is appropriate that a two-year review of the regulations is put in place, which will potentially be wide-ranging and encompassing. The regulations are intended to be subject to review two years after they come into force. As I said earlier, it would be wrong of me either to limit the scope of the review or to predict the factors that may be in place at the time. I am often asked by the hon. Member for Ellesmere Port and Neston and others to commit to reviews of regulations and other legislation, and, as we are committing to a review after two years, I hope that he will accept my assurance on that.
Several hon. Members, including the hon. Member for Linlithgow and East Falkirk, asked me about the impact assessment. There is no significant impact. The impact for the instrument falls below the £5 million threshold of the annual net direct cost to business, as detailed by the business impact target. There is no significant impact on business, and no significant direct impacts have been identified as a result of the changes. Hon. Members have asked about the potential impact regarding allowing recognition so that EEA and Swiss professionals who are valued in the health service can continue to practise in the UK post-EU exit day in a no-deal scenario. That is the impact, and the regulations seek to minimise it. They put in place sensible measures to ensure that that recognition can happen.
Finally, I was asked about whether the regulations support cross-border co-operation between Northern Ireland and the Republic of Ireland. The regulations ensure the continued recognition of Irish professional qualifications in the UK for at least two years after exit day. They allow professionals practising under an existing and temporary or occasional status to continue until the end of that—
Stephen Hammond
I will give way but I think I might be about to predict that as well.
Vernon Coaker
To clarify, I was not talking about the cross-border arrangements. I was making the point about whether, in the absence of the legislative Assembly in Northern Ireland, instead of having two or three lines saying, “We’ve discussed this with Northern Ireland officials and that’s fine,” we need to give more detail to our discussions about that.
Stephen Hammond
Not at all. The hon. Gentleman is right to ask whether, in the absence of an Assembly in Northern Ireland, the Pharmaceutical Society of Northern Ireland can assess EEA and Swiss pharmacist qualifications that are not covered by automatic recognition—he recognises, of course, that the automatic recognition system is there. These regulations will ensure there should be little change in those. The PSNI will continue to recognise pharmacist qualifications that are within the scope of the automatic system at exit day. Those who do not hold a qualification currently within that scope will be registered with the General Pharmaceutical Council before registering with the PSNI. That is a continuation of the current practice. I am happy to keep this issue under review and to make it part of the discussion with Northern Ireland officials.
With those remarks, I hope that I have managed to satisfy hon. Members’ inquiries, and I commend both sets of regulations to the Committee.
Question put.
Oral Answers to Questions
Lord Coaker Excerpts(5 years, 10 months ago)
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Matt Hancock
The use of new technologies is drilled through the new NHS long-term plan. Genome sequencing holds great opportunities to improve the health of the nation, and my hon. Friend is a great advocate for it.
Vernon Coaker (Gedling) (Lab)
Draft Human Fertilisation and Embryology (Amendment) (EU Exit) Regulations 2019
Draft Quality and Safety of Organs Intended for Transplantation (Amendment) (EU Exit) Regulations 2019
Draft Human Tissue (Quality and Safety for Human Application) (Amendment) (EU Exit) Regulations 2019
Lord Coaker Excerpts(5 years, 11 months ago)
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Vernon Coaker (Gedling) (Lab)
It is a pleasure to serve under your chairmanship, Mr Stringer. I agree with the comments made by everyone. We are all disappointed that we are where we are and that we have to come forward with these measures, although it is only right, given where we are, that we make contingency plans. In line with my hon. Friend the Member for Garston and Halewood, I believe it would be helpful for the Committee to have a bit more detail.
As the Minister said, only a small number of organisations are involved, but if someone needs an organ, cornea or cell, that is a critical matter. Without the support of masses of civil servants, it is difficult to understand the situation. Will the Minister confirm that there is no change in anything here—it is just a simple transposition of law? Will she also confirm that the Secretary of State has gained no additional powers? A huge number of regulatory powers are given to the Secretary of State.
There is sensitivity around these issues and the Acts referred to; we know about the debates on embryology, reproduction and research. Has anything changed in that area? References to a subsection of a subsection of a subsection sometimes mean that there is a change somewhere. The Minister’s confirmation would be helpful. My hon. Friend mentioned the transition arrangements of six months. What happens at the end of that if nothing has changed?
I had to look for the technical note. That was not referred to, yet it includes important information that relates to the SI. For example, it says:
“Further information on the agreement process will be published in November.”
I cannot find that further information. Has it been published? What are the written agreements? Who is supposed to be making them? Again, I am not opposed to what the Minister is saying, but if it says on her own website that further information will be published, where is it? My hon. Friend has obviously been looking for it, too.
The website also says:
“We’ll be publishing more information and instructions on putting written agreements in place in November 2018.”
Presumably, individual companies are supposed to be producing these written agreements, not the Government. So what has happened with those companies? Do they know? What discussions have taken place with them?
I have been reading in the media today that business is expressing a lot of concern—whatever the rights and wrongs of where we are—about what they are, or are not, supposed to be doing. Given the importance of this matter, who is producing these written agreements?
The website goes on to say:
“The aim is to give organisations, businesses and individuals as much certainty as possible, as soon as possible, and to ensure that any new requirements are not unduly burdensome.”
To be honest, Minister, the Committee could have done with seeing what the information is—given that it was supposed to have been published last month, and given its importance. Some clarity on that would be really helpful.
The technical note also says that
“This notice is meant for guidance only”,
but then goes on to say:
“You should consider whether you need separate professional advice before making specific preparations.”
I do not know what that means. Why would anyone need separate professional advice if everything was carrying on exactly the same as before? The situation has just moved on and people should just carry on. I would be grateful if the Minister clarified what the separate professional advice is. As my hon. Friend has just asked, who is paying for that?
I come to my last point. Yesterday, the Department published a note on funding for different health organisations, entitled:
“EU Third Health Programme funding if there’s no Brexit deal”.
Are all the organisations affected by this SI going to receive funding under that health programme funding arrangement, so that they can address some of the issues that will arise if there is no deal, which we all hope will not be the case?
Clearly, this is an important SI. As my hon. Friend has said, these SIs are all hugely important, because down the road we will suddenly find that something has changed or that there should have been a written agreement—even though it is on the website, nobody has asked what those written agreements actually are or what they are supposed to contain. Again, I would be grateful if the Minister clarified some of that.
Jackie Doyle-Price
It is a pleasure to follow the right hon. Member for Don Valley. I do not think I disagreed with a word she said. I recognise that, for some Members, it is a matter of regret that we are leaving the European Union. None the less, we are committed to delivering the instruction given by the British people in the referendum. I think I speak for most people in the room when I say we would prefer to do that on the basis of an agreed deal with our European allies, but we need to be ready for the eventuality that we are not able to secure such a deal. That is why we introduced these SIs. I am grateful to Committee members for their pertinent questions. They are evidence—if only the public could see it—of how seriously we are taking the challenges of a no-deal Brexit, which of course we all wish to avoid as best we can.
A number of Members expressed concerns about whether affected establishments had been properly communicated with and were ready for the changes in these regulations, and about costs. We issued a technical notice to all affected parties in August to give them due notice to be able to prepare for the regulations. As was referred to, there is a six-month implementation period, but we expect that preparation to have been undertaken now. Given that it effectively will be business as usual, we expect that preparation to be relatively straightforward. Some of the things we have put in, such as the six-month transition period, are really just a sort of legal process to set deadlines, but we expect all those affected to be compliant almost immediately.
On the issue referred to in the technical notice of whether establishments might need to seek separate advice, we expect establishments just to engage with the regulators. Again, this will be business as usual, but the regulators stand ready to give all those affected as much advice as they need to be able to comply.
The hon. Member for Gedling is quite right that the updated information was not published in November, but it has now been published. It was published on 7 December, so it was slightly delayed—that is not unusual when it comes to things associated with Brexit—but it can be found online, and I will draw his attention to it.
Jackie Doyle-Price
Google has its limitations, it has to be said.
On whether costs need to be reimbursed, it is worth noting that we expect the costs incurred by establishments to be extremely low. The main impact of the draft regulations relates to agreements that establishments have to put in place with whomever they trade with, but most establishments already hold import licences and are well used to making and applying such agreements. We expect them simply to roll over their existing written agreements. Again, however, NHSBT and the Human Tissue Authority will work with and support establishments to put those agreements in place. There will be no impact on organ transplant centres, and in the case of non-reproductive cells we think all the establishments concerned will already have such agreements in place. On that basis, we do not expect any establishment to incur significant costs, so there will be no need for any reimbursement.
The right hon. Member for Don Valley and the hon. Member for Washington and Sunderland West mentioned organ donation. Clearly, the 30 organs that come in and out of the country every year are a matter of life and death. It is of considerable concern to me that we have sufficient provision in place to ensure that that can continue. Much of that movement is between the Republic of Ireland and the north, and at this stage we do not anticipate significant problems there, but there is good reason to worry about Dover-Calais.
We have all heard the concerns about whether things will be able to get into the UK through that entry point. We are working with the Department for Transport to ensure that things such as medical supplies, including organs, can get through if there is traffic congestion. We are making such provisions—contingency plans will be in place. I hope we do not get to the point of having no deal, but we are determined to ensure as best we can that, if we do, it will be business as usual and that, for example, couriers are escorted so they can navigate traffic more quickly. It is very much on our agenda to ensure that we can enable that to happen.
Question put and agreed to.
draft Quality and Safety of Organs Intended for Transplantation (Amendment) (EU Exit) Regulations 2019
Resolved,
That the Committee has considered the draft Quality and Safety of Organs Intended for Transplantation (Amendment) (EU Exit) Regulations 2019.—(Jackie Doyle-Price.)
draft Human Tissue (Quality and Safety for Human Application) (Amendment) (EU Exit) Regulations 2019
Resolved,
That the Committee has considered the draft Human Tissue (Quality and Safety for Human Application) (Amendment) (EU Exit) Regulations 2019.—(Jackie Doyle-Price.)
Social Care Funding
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Vernon Coaker (Gedling) (Lab)
I want to make a brief contribution, picking up on the excellent contribution by my hon. Friend the Member for Leicester West (Liz Kendall). The Minister said earlier that he sent money out to various local authorities, which is welcome, but frankly it is a sticking plaster. It would have been great if he had come and said, “I have heard the outrage and frustration across the country about the number of people who have to stay in hospital because there is no social care for them, people who have inadequate care and people who cannot get the care their deserve, and I am bringing a Green Paper to Parliament today. I will ensure that it is looked at and dealt with as a matter of urgency, and then I will bring a White Paper. We will actually grasp the nettle and sort this out.” The hon. Member for Solihull (Julian Knight), unless I misheard him, rightly agreed. Unless we get a hold of this issue, this debate will happen again in six months, a year, two years and three years.
The Secretary of State challenged my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley) on parties working together. If he has read our manifesto, he will have seen that, before it says how we are going to spend the money, it says that we commit to working on a cross-party basis to sort this out—it says it in the manifesto. But people have to mean what they say. It is no good all of us in the Chamber saying that we agree if, the first time a shadow spokesperson or a Minister gets up and says something, people decry it. That will not work and we will, in the end, let the people of this country down.
That is what I wanted to say, Madam Deputy Speaker. People are raging about this; Parliament should be raging. The Secretary of State and Ministers—they are Ministers of the Crown—have it within their power to get it sorted. That is what this debate and this Parliament is saying to the ministerial team today: let’s get this sorted. The people out there deserve it.
Several hon. Members rose—
NHS Outsourcing and Privatisation
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Jonathan Ashworth
I am sure that the hon. Lady accepts that it is a scandal that the CCGs—her local health economy—are still paying out to Coperforma. She should be getting up and complaining about that.
What about support services? Interserve was brought in to provide facilities management across 550 NHS buildings across Leicestershire, with a seven-year, £300 million contract. The contract was scrapped four years early because of reports of patients receiving meals up to three hours late, bloodstains in the corridors and bins not emptied. How about Carillion, which won a £200 million, five-year estates and facilities management contract with Nottingham University Hospitals NHS Trust? It failed to clean the hospitals properly, with reports that infectious waste was seen overflowing in the children’s ward.
Vernon Coaker (Gedling) (Lab)
The concerns that my hon. Friend is raising are the same as those raised by the Chair of the Health Committee in a letter to Sir Simon Stevens, chief executive of NHS England, in which she said:
“My central concern is that contracted services can seemingly fail to meet the basic clinical requirements without being held to account or compelled to acknowledge and remedy their failings. This risks undermining the effective commissioning of services and could, ultimately, compromise patient care and safety.”
Jonathan Ashworth
My hon. Friend, who is extremely experienced, shows with great eloquence the dangers of this relentless outsourcing of services. It damages patient care and is not in the interests of the taxpayer.
Education (Student Support)
Lord Coaker Excerpts(6 years, 6 months ago)
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Vernon Coaker (Gedling) (Lab)
May I just say to the hon. Member for Lewes (Maria Caulfield) that this is not about scoring political points? It is about debating in this House of Commons something that is of immense importance to our country. I agree with her that no one has a monopoly on these things, but it is only right and proper that we have an open and frank debate about the matter. That means that there will be a clash of views and a clash of opinions, but out of that will come better policy, and I hope that the Government, as they move forward, will listen to some of the concerns that have been raised, even if they do not change their policy. There is nothing wrong with that. That is not political point scoring; that is holding the Government to account for the policies they are pursuing.
Let me also say this: the only reason why the Government are being held to account is that my hon. Friends on the Opposition Front Bench have obtained this debate. They deserve a great deal of credit for that, because the Government were not going to debate these regulations. Indeed, the House of Lords Committee, that scrutinises these secondary legislation reports said that it was unprecedented for the Government to be forced to hold a debate in this place when revoking one set of regulations and replacing them with another. So, it is quite right that we are actually saying this to the Government. We would not be able to get the Government to put forward their views as to why removing bursaries is a good thing, and we would not be able to explain why we are holding them to account, were it not for the fact that we raised this matter in the way that we have.
The hon. Member for Lewes criticised the Royal College of Nursing’s figures, but the RCN—a highly respected body in this country—has laid out the statistics, including for many of the routes that she says it has not, regarding the fall in the number of applications since NHS bursaries were got rid of two years ago. There has been a 33% fall in the number of applications for nursing degrees. It may be that that does not matter, but the Government still need to address and defend it and explain why the RCN is wrong to highlight that as a figure that should cause us concern.
Maria Caulfield
That is the point: despite the fall in the number of applications, the number of placements has actually increased to its second-highest level ever. If the bursary system was so great, why were the nursing student numbers not coming through it, and how come we had such a high drop-out rate of student nurses?
Vernon Coaker
Let us see where this goes. The hon. Lady’s point is that it does not matter that there has been a 33% fall in applications, because other things will happen, but that is not the view of the Royal College of Nursing. Applications from mature students have been disproportionately affected by the funding reform; the number of applicants aged over 25 has fallen by 42%. I do not know whether the Minister intends to respond—it would be a shame if he did not—but perhaps he can explain why that figure does not matter. That point needs to be addressed in debate. The hon. Lady disagrees, but I say that it does matter, and that it will cause problems for future nursing recruitment.
Dr Whitford
The hon. Member for Lewes (Maria Caulfield) asks why not enough nurses were coming through. Is that not simply because there was a cap on places? The Government keep linking the bursary with the cap. The issue was not the bursary; it was the cap. If the Government want to invest in nurses, they should lift the cap but not remove the bursary, because that will shrink the number of applications.
Vernon Coaker
I thank the hon. Lady for her intervention. I say to the Minister that there is hard evidence from the Government’s own equality analysis that the reforms will
“increase the amount of student loan borrowing for postgraduate students and could lead to a fall in student numbers. The government has acknowledged that, due to the student intake, the impact will fall largely on women, older students and, to a lesser extent, students from ethnic minorities.”
Where is the Government’s defence of that, and what are they doing to mitigate it? I have no doubt that the Government would say, “We have done x, y and z.” Indeed, that is what the hon. Member for Lewes has said, but where is the Minister’s explanation?
It is not just the Government equality analysis that says we should be concerned about the changes. A House of Lords Secondary Legislation Scrutiny Committee report, published just a few days ago, also raised concerns. First it criticised the process and then it said:
“Our second, no less strongly felt concern is with the wider impact on recruitment to post-graduate nursing courses which may result from the switch from bursary to loan support”.
That is why this debate is so important. There is evidence from a highly respected Select Committees of this House, and from the Government’s own equality analysis, and were it not for the actions of my Front-Bench colleagues, we would not even be debating the issue and the House of Commons would not even be reflecting on a major change to the way in which we fund the postgraduate training of our nurses.
We all agree that the nurses of this country deserve our respect, and that they do a wonderful job, but the point of this debate is to ask whether we are going to address the shortage of nurses following the removal of nursing bursaries. As my hon. Friend the Member for Ashton-under-Lyne (Angela Rayner) said, we have serious concerns and doubts about that, and it is quite right that those are debated.
Let us see whether the hon. Member for Lewes is right, or whether the Royal College of Nursing is right that the huge fall in applications we have seen at undergraduate level will be reflected at postgraduate level, and that down the track the Government will regret ignoring the professional bodies and their own equality analysis. The Government need to reflect on that and see what more can be done. Rhetoric about our nurses being brilliant is fine, and we all share that admiration, but at the end of the day, what this country needs is hard-nosed policy that works.
Southern Cross Care Homes
Lord Coaker Excerpts(13 years, 4 months ago)
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Paul Burstow
I understand entirely the point that my hon. Friend and other hon. Members are making on behalf of their constituents. The nature of the reporting of the announcement yesterday, and other announcements before it, is a source of worry for residents, staff and families. I hope that today’s statement will go some way towards giving them some reassurance. Equally, it will not help the successful, solvent restructuring of the business, which will provide that continuity of care, if we have an endless commentary on it. What is important is that the necessary actions are taken, and they are being taken.
Vernon Coaker (Gedling) (Lab)
Does not the Minister understand that it is not endless commentary that we want from him but some reassurance for residents in these homes? Also, it is not continuity of care that they want, but continuity of the place in which they live. These are not just residential homes; they are places where people live, and they form a valuable part of the community. What reassurance can the Minister give us that this is not only about continuity of care for those people but about their having continuity of residence in the home they live in?
Paul Burstow
The hon. Gentleman is absolutely right; this is about people’s homes and their futures. That is why the Government have been working to make it abundantly clear to all those involved in the process what their responsibilities are, and what the local authorities’ responsibilities are. We have also made it abundantly clear that in no circumstances will the Government do anything other than ensure the future continuity of care for people. No one will be made homeless, and no one will wind up without the care and support they need.
Oral Answers to Questions
Lord Coaker Excerpts(14 years, 4 months ago)
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Anne Milton
The hon. Gentleman is right to raise the impact that smoking still has on the health of children in particular—I believe that 200,000 take up smoking each year. We still have 80,000 smoking-related deaths in this country. It is important to watch what happens in Australia and see where the evidence points for the future.
Vernon Coaker (Gedling) (Lab)
14. What his policy is on provision of healthcare services to those with autism.
The Minister of State, Department of Health (Mr Paul Burstow)
We are committed to addressing the health care needs of people with autism and are fully supportive of “Fulfilling and rewarding lives: the strategy for adults with autism in England”. Consultation on statutory guidance for health and social care bodies to support the strategy will begin shortly.
Vernon Coaker
May I thank the Minister for that reply? We have all been inspired by the parents of children with autism. One thing that they depend on perhaps more than anything is respite care. That provision has improved in the past few years, but with the pressure on budgets, will the Minister do all he can to ensure that respite care does not become an easy target for cuts, given the importance of the service to parents of children with autism?
Mr Burstow
I am very grateful to the hon. Gentleman for that question. He is right; carers are a valuable and valued resource. They make an incredible difference to the quality of life of the people for whom they care. The Government are determined, as we have outlined in the coalition programme for government, to develop respite services further and make them available through direct payments for those people.
Mr Burns
I am a bit confused as to where to look. [Interruption.] Right, I will look forward.
My right hon. Friend the Secretary of State well remembers his visit in April to meet the York and District pain management support group. He made it plain at the time that it should be for GPs and their patients to decide what treatment should be given, as opposed to a decision by the PCT to veto spinal injections for all sufferers of long-term chronic back pain. We will, in due course, set out our proposals to put more power in the hands of patients and GPs.
Vernon Coaker (Gedling) (Lab)
T3. Does the Minister agree that it is crucial for patients to have information if we are to make a reality of choice within the NHS? In that respect, does he agree that if we are to give people a real choice as regards the choose and book system that GPs operate, there is a need to ensure that patients have the information about the success rates of different hospitals, and different surgeons, as regards operations?
Mr Lansley
I agree with the hon. Gentleman—it is just that that did not happen under a Labour Government in the way that it should have done. For example, the national quality registers in Sweden have 69 areas of clinical practice for which such comparative data are published. I have made it clear that one of our priorities is that we focus on outcomes and on giving patients real empowerment. To do that, information for patients on outcomes will be absolutely critical.