Eurotunnel: Payment
Matt Hancock Excerpts(5 years, 9 months ago)
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Andy McDonald (Middlesbrough) (Lab)
(Urgent Question): To ask the Secretary of State for Transport to make a statement on the payment of £33 million to Eurotunnel over no-deal ferry contracts.
The Secretary of State for Health and Social Care (Matt Hancock)
I would like to update the House on the settlement that the Government have reached with Eurotunnel, which will help to deliver the unhindered supply of vital medicines and medical devices in the case of a no-deal Brexit.
The best way to ensure a smooth and orderly exit from the EU, both for the NHS and for the wider economy, is to support the deal that the Attorney General is currently finalising. Anyone in this House who cares about the unhindered supply of medicines should vote for that deal, but leaving the EU without a deal remains the default position under the law, and it is incumbent on us to keep people safe. It is therefore vital that adequate contingency measures are in place for any Brexit scenario.
Preparing for a no-deal exit has required significant effort from the NHS, the pharmaceutical industry and the whole medical supply chain, and I pay tribute to their work and thank them for their efforts on these contingency measures. The settlement struck between the Government and Eurotunnel last week is an important part of these measures. Because of the legal action taken by Eurotunnel and the legal risks of the court case, it became clear that, without this settlement, we could no longer be confident of the unhindered supply of medicines. Without this settlement, the ferry capacity needed to be confident of supply was at risk. As a Government, we could not take that risk, and I doubt anyone in this House would have accepted that risk, either. With this settlement we can be confident, as long as everyone does what they need to do, that supply will continue unhindered. Under the settlement, Eurotunnel has to spend the money on improving resilience, security and traffic flow at the border, benefiting both passengers and business.
The Department for Transport, on behalf of the whole Government, entered into these contracts in good faith. Our duty is to keep people safe, whatever complications are thrown up. Although we continue to plan for all eventualities, it is clear that the best way to reduce all these risks is to vote for the deal in the days to come.
Andy McDonald
Once again, the Transport Secretary is not in his place to answer a question directed to him. His disregard for taxpayers and this House is clear. On Friday he reached a £33 million out-of-court settlement with Eurotunnel to provide services in the event of a no-deal Brexit because the Government were going to lose the case.
The Transport Secretary’s decision to bypass procurement processes in awarding a contract to Seaborne Freight, a ferry company without any ships, breached public procurement rules, and Eurotunnel had the Government over a barrel. Will the Minister now detail the total cost to taxpayers of this decision, including legal costs? How much money will be paid up front?
Eurotunnel will seemingly make Brexit-related improvements at Folkestone. Can the Minister say exactly what sort of agreement the Government have with Eurotunnel? What makes him think that this contract with Eurotunnel will not be challenged on anti-competition grounds? A former Department for Transport adviser said:
“there is a risk it could be construed as another piece of public procurement without open and transparent competition.”
That would risk further legal action and yet more public money being squandered.
Even in this golden age of ministerial incompetence, the Transport Secretary stands out from the crowd. He leaves a trail of destruction in his wake, causing chaos and wasting billions of pounds, yet he shows no contrition, no acknowledgment of his mistakes and no resolve to learn and improve. He is now ridiculed in The New York Times. The mayor of Calais has banned him from his town. The Transport Secretary has become an international embarrassment. The Prime Minister is the only person in the country who retains confidence in this failing Transport Secretary, and she does so only because of her own political weakness. The public deserve to know: how many more calamities is the Prime Minister prepared to tolerate? How many more billions of pounds will she allow him to waste before saying, “Enough is enough”? This country cannot afford this Transport Secretary. He should be sacked without delay.
Matt Hancock
In listening to that, I notice that the hon. Gentleman did not disagree with the decision we made on Friday. That decision was to ensure that we have the ferry capacity in place so that whatever happens in the Brexit scenario we can have the unhindered supply of medicines. That is the duty of this Government and that is why the whole Government came to this decision. He asked some specific questions, which I answered in my statement. However, let me reiterate: this is a legal settlement with Eurotunnel; the maximum cost is £33 million, as was set out clearly on Friday; and the purpose of the decision is to ensure that unhindered flow of medicines. So, as I said in my statement, the purpose of this is to make sure that whatever happens in Brexit people can be safe. I was happy to support that decision, which everybody in this House would have made in the same circumstances.
John Lamont (Berwickshire, Roxburgh and Selkirk) (Con)
Many of my constituents are concerned about the supply of medicines after Brexit. What reassurance can the Secretary of State give me that the supply of medicines to harder-to-reach places such as Scotland will continue after we leave the European Union?
Matt Hancock
My hon. Friend is absolutely right to ask about the unhindered supply of medicines. The first thing he can do to ensure that that supply continues, with no risks to it, is to support the deal in the meaningful vote, as he has done before. Secondly, we are working with all parts of the country and with the devolved authorities on this. Although ensuring that we have these supply chains in place in any Brexit scenario is a UK Government matter, we are working with the devolved Administrations, especially to ensure that the flow reaches all parts of the country.
Alan Brown (Kilmarnock and Loudoun) (SNP)
I wish to echo the question: where is the £2.7 billion man? I have asked him to step aside several times, I have challenged the Prime Minister to sack him and now he has his own social media hashtag—FailingGrayling. Surely now is the time he has to go.
Apparently, we hear that this is not compensation for Eurotunnel but a contract for vital services. If they were so vital, why did it take Eurotunnel going to court to get a contract? Why was Eurotunnel overlooked in the first place? The secrecy on this is a real concern. How much documentation is still hidden away from public view? If the no-deal contract is not invoked, how much money will still be paid to Eurotunnel? Why on earth would the Health Secretary entrust the transportation of life-saving medicines to the Transport Secretary?
Bechtel is set to sue the Government over the HS2 tender process. What other departmental procurement risks still exist? After his efforts at the Ministry of Justice cost us £600 million, the Transport Secretary has allowed Virgin Trains East Coast to walk away owing £2 billion; he has blamed Network Rail for mishaps when he is in charge of the organisation; and he has culpability for Southern rail, for the £38 million Northern rail timetable fiasco and for the £800,000 ferry due diligence contract, where due diligence was not carried out on the company with no ships. He has tried to argue that the Seaborne fiasco has not cost the taxpayer any money. Only for this Transport Secretary can this £33 million be just the tip of a financial iceberg. What does it take for him to be sacked—or to do the decent thing and walk away?
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.
Mr Barry Sheerman (Huddersfield) (Lab/Co-op)
There is something quite wrong here. I have been in the House for quite a few years—usually people say, “Too long,” but I have been here a long time. This almost seems to be an abuse of the House. The fact is that the Opposition asked for an urgent question on the Eurotunnel payment of £33 million. I do not know what £33 million means in Suffolk, but in Huddersfield it would make a hell of a difference in regenerating our local economy. I am not calling for the Transport Secretary’s resignation because he is a symptom of something deeply wrong with this Government. They are totally incapable of arranging their policies ready for Brexit. That is the truth of the matter. There is total chaos on the Government Benches because they had not predicted what was going to happen with Brexit, and they are showing no ability to cope with post-Brexit conditions, what is happening in the Eurotunnel and so on.
Matt Hancock
The hon. Gentleman is normally a sensible man, but I could not disagree with him more on this one. The point of this settlement is to ensure that we have the unhindered supply of medicines, so that, whatever the Brexit scenario, people can get their medicines. This was a cross-Government decision and I am here, as the Health Secretary, because it is medicines that will be carried on these ferries. If the court case had gone against the Government and the court had struck down these contracts, we would not have been able to be confident about the supply of those medicines. I think it is incumbent on any Government to ensure that they can deliver that. There is something else we can do to deliver the unhindered supply of medicines and he can do it too; it is within his gift—he can vote for the deal.
Mr Marcus Fysh (Yeovil) (Con)
I welcome my right hon. Friend’s sensible contingency planning for any eventuality, but may I highlight that it is important to focus on all the routes across the channel and everything related to that? Although it is good that Eurotunnel is being focused on, it is worth looking at the transit system as a way to smooth the procedures on the main ferry routes across the channel also.
Matt Hancock
Yes, and that is exactly what these contracts, with which we can now proceed because of the settlement, do. Essentially, they provide for more capacity away from Dover-Calais so that medicines can be routed into the UK and, indeed, onwards to Ireland through other routes. They allow for that. I am glad of my hon. Friend’s interest in this matter and hope he will vote for the deal.
Lilian Greenwood (Nottingham South) (Lab)
The Secretary of State for Transport may have ducked today’s questions, but I am pretty sure that my Committee will still require his answers. If there is a Brexit deal or, indeed, if there is no Brexit, how much of our taxpayers’ £33 million do the Government expect to recover from Eurotunnel?
Matt Hancock
Of course, the medicines are going on these boats that we are procuring and that makes this a serious health matter. The hon. Lady is perfectly within her rights to ask these sorts of questions. The truth is that the £33 million is the maximum figure. It may not be as high as that, but we have been clear about the full exposure.
Damian Green (Ashford) (Con)
If we can essay a transport-related question, could my right hon. Friend give me some assurance that the extremely important cross-channel rail link will continue as it is now, under any circumstances, after 29 March? On the medical front, can he say what steps his Department has taken on radioactive isotopes and particularly important medicines? I have constituents who are very concerned about that.
Matt Hancock
Of course, we very much hope that the train will also continue to operate as now and we have received such assurances. When it comes to radioisotopes, we have also procured flights and aircraft capacity to ensure that those goods and those parts of the medical supply chain that need to be brought in faster and cannot be stockpiled can also be brought through.
Tracy Brabin (Batley and Spen) (Lab/Co-op)
Can the Secretary of State tell us precisely how much of the £33 million being paid to Eurotunnel is being contributed by the Department of Health and Social Care?
Matt Hancock
This was a cross-Government decision. It is all taxpayers’ money, at the end of the day.
Mr Marcus Jones (Nuneaton) (Con)
It is important that people with long-term health conditions are reassured that they will have access to the right medicines, so my right hon. Friend is right to make sure that there is proper access across the channel. What are the pharmaceutical companies doing to keep a greater stock of reserves over and above those that they usually hold?
Matt Hancock
We have a multifaceted approach to making sure that we have an unhindered supply of medicines, and stockpiling is of course another important part of that. The vast majority of the 12,300 medicines that are commonly used in England can be stockpiled. For those that can be stockpiled, we asked for a six-week stockpile to be put in place, and we have plans in place for almost all of those. For the very small number remaining, we are putting plans in place right now. We are doing all that with the confidence that by the time we get to 29 March, so long as everybody does what they need to do between now and then, we will be able to have confidence in that unhindered supply.
Joanna Cherry (Edinburgh South West) (SNP)
The Secretary of State is making the mistake of insulting the intelligence of those of us who have been pursuing this issue for the past two months. What happened on Friday was nothing to do with the unhindered supply of medicines: it was an out-of-court settlement to avoid the British Government’s being found in breach of the law of competitive tendering. Will the Secretary of State confirm that even in the event of a deal, not a penny of that £33 million will be recoverable, because it is not for a contract but for an out-of-court settlement to avoid a finding that his Government were in breach of the law?
Matt Hancock
On the contrary: this is all about the unhindered supply of medicines, because that is what we will be doing with the boats.
Vicky Ford (Chelmsford) (Con)
I do not know when you last travelled through the channel tunnel, Mr Speaker, but when I came back on Saturday 5 January there was complete chaos at Calais, with miles of queues and hours of delays, so I am glad that Eurotunnel is going to improve its investment in our borders and security. Will the Secretary of State confirm that if the money is not spent on improving our borders and security, it will be paid back to the taxpayer?
Matt Hancock
I can go even further than that: it will not be paid over unless it is being spent on security, resilience and other measures, so we will get some of the improvements that my hon. Friend seeks.
Steve McCabe (Birmingham, Selly Oak) (Lab)
With all due respect to the Secretary of State for Health and Social Care, surely the House and the taxpayer are entitled to hear today what the main mistake made by the Secretary of State for Transport was that has resulted in this unnecessary pay-out of £33 million. Where does this latest shambles rate in the Secretary of State for Transport’s top 10 catalogue of ministerial mishaps?
Matt Hancock
Frankly, I do not think we should really pay much heed to such a statement, rather than a question, unless the hon. Gentleman is going to vote for the deal as well.
Kevin Foster (Torbay) (Con)
It is always a bonus to see my right hon. Friend the Secretary of State for Health and Social Care at the Dispatch Box answering questions, particularly today. On the deal and making sure that we have a secure supply of medicine, will he reassure me that he will continue to ignore some of the noise and party political point scoring and focus on making sure that the NHS can function in whatever circumstances it faces after 29 March?
Matt Hancock
There is a notable difference in tone, is there not, between those who care about ensuring that people get the supply of medicines in future, and those who want to make political points out of it but do not oppose the decision we are discussing.
Layla Moran (Oxford West and Abingdon) (LD)
I find this utterly extraordinary, because in the Public Accounts Committee hearing on this matter, the permanent secretary said:
“I am confident that our process was lawful, and obviously the Department and I acted on legal advice in determining how to take that process forward”.
If we were so confident in that legal advice, why was this settlement reached at all? Actually, is this not an admission of a catastrophic failure in stakeholder management?
Matt Hancock
No. It is clear that we needed to ensure that there were no risks around the two contracts for the capacity that we need to bring in an unhindered supply of medicines, whatever the Brexit scenario. I do not know whether the hon. Lady thinks it would have been worth bearing the risk of a court case, which may well have struck down the capacity to make sure that people who have serious and life-threatening conditions can get the medicines that they want. She implied that she was against such assurances, and I think that would have been a mistake.
Neil O’Brien (Harborough) (Con)
I support the withdrawal agreement—it is a good deal—but I also support our being ready for no-deal eventualities. I was reassured by the Secretary of State’s answer to the question from my hon. Friend the Member for Nuneaton (Mr Jones) about stockpiling medicines that can be stockpiled, but for those that cannot be stockpiled, what action is the Secretary of State taking to be sure that they can be air-freighted rather than have to come through the tunnel?
Matt Hancock
My hon. Friend is quite right to support a deal and the action that we have taken in case there is no deal. That is the position that anybody who cares about the unhindered supply of medicines should take. When it comes to those medicines that cannot be stockpiled, we have contracts for flights to ensure that those medicines can be flown in. We have in place a flight from Birmingham to Maastricht, and the return journey, obviously, to ensure that we can get those short-term medicines in.
Diana Johnson (Kingston upon Hull North) (Lab)
This must be making parliamentary history this afternoon. We have two urgent questions about the same incompetent Minister causing mayhem and chaos in two different Departments and he does not even have the face to come here and front it out—and we are left with Hancock’s half hour! Let me ask the Secretary of State for Health and Social Care: is any of the £33 million going to be reimbursed from his budget to the Department for Transport?
Matt Hancock
This was, of course, a cross-Government decision, which is why I am here. It is the medicines that will be using that capacity. In the Hancock family, we are very proud of “Hancock’s Half Hour”, and we thought that Tony was a very funny man.
Mr Speaker
It is worth pointing out that that Hancock was deliberately funny.
John Howell (Henley) (Con)
The Secretary of State has talked about medicines, but there are also prescribed foods—for example, the gluten-free food on which some people depend. What will the situation be for those foods?
Matt Hancock
Of course that matters enormously, too. Although medicines are the category 1 prioritised goods that will be using the extra procured capacity safeguarded by this settlement, there are other measures being undertaken by the Department for Environment, Food and Rural Affairs to protect the supply of foods.
Paula Sherriff (Dewsbury) (Lab)
That £33 million would pay the annual salary of 118,000 nurses, and God knows we need them. The NHS has 40,000 nursing vacancies in the NHS in England. Does the Secretary of State for Health think that the cost of the latest blunder of the elusive Secretary of State for Transport is money well spent?
Matt Hancock
Well, I do think that it is very important that we spend what is necessary in order to have the unhindered supply of medicines. [Interruption.] The hon. Lady shakes her head, but would she, in these shoes, put at risk the unhindered supply of medicines? Of course she would not, so she must agree with me that this was the right decision to take.
Tom Pursglove (Corby) (Con)
My right hon. Friend has dealt with the channel aspect, but one of my constituents, Jeff Screeton, has a small business that specialises in small-scale freight on domestic passenger rail services. That includes medical items, particularly items that need to move quickly. Might he be interested in this work, particularly from the domestic transportation side of this contingency planning?
Matt Hancock
Yes, I would be very happy to talk to my hon. Friend about that business.
Graham Stringer (Blackley and Broughton) (Lab)
This expenditure is only necessary because of the sheer incompetence of the Secretary of State for Transport. I have sat and listened to him in this Chamber and listened to him in the Transport Committee, and after every fiasco his defence is that it has not cost the Exchequer any money. The fact is that this has cost the Exchequer £33 million. Has he not run out of runway and should he not resign?
Matt Hancock
No, the decision to settle this case in order to provide for the unhindered supply of medicines, which I am sure that, like me, the hon. Gentleman, agrees is important, was the correct judgment and the correct decision, because we need to make sure that we keep people safe.
Dr Matthew Offord (Hendon) (Con)
Although it can never be comfortable to give a settlement to any organisation, I have to agree with the Father of the House, my right hon. and learned Friend the Member for Rushcliffe (Mr Clarke), that it is better to draw a line under this and move on. [Interruption.] The hon. and learned Member for Edinburgh South West (Joanna Cherry) is chuntering. I shall have to defer to her knowledge of losing cases in the legal courts. Can the Secretary of State tell me whether it is correct that Eurotunnel has said it will use this money to provide increased resilience at the Dover port?
Matt Hancock
Yes, my hon. Friend is correct. He makes a broader point: people watching these proceedings, people who have serious illnesses, and people who rely on medicines every day to keep them alive will be amazed by those Members who will not vote for the deal and therefore make a no-deal exit more likely, and by those Members who just cause political noise rather than admitting that, in the circumstances, they too would have settled this case. We are hearing a lot of that from those on the Opposition Benches. On the Government Benches, however, we are hearing from Members who care deeply about making sure that people get the medicines that they need.
Justin Madders (Ellesmere Port and Neston) (Lab)
Does the £33 million include all the possible expenditure under this agreement, or are there any additional costs, such as legal fees, that need to be added on top? If there are, how much are they?
Matt Hancock
The settlement is £33 million. Of course, there are lawyers, and legal time was also needed inside the Department. That happens all the time in order to try to make sure that we can keep people safe, which is the whole purpose of this exercise.
Alison Thewliss (Glasgow Central) (SNP)
The reality is that the Secretary of State is engaged in deflection. We are now in a situation where this country risks running out of vital medicines for each and every one of our constituents because of this Government’s relentless pursuit of a no-deal hard Brexit that will ruin this country. Is it not the case that this money that we are having to pay out is emblematic of the chaos in this Government and the incompetence of this Government and that our constituents will go without medicine because they cannot get their act together?
Matt Hancock
If the hon. Lady really, really believes what she just said, it is incumbent on her to vote for the deal.
Jo Stevens (Cardiff Central) (Lab)
The Health Secretary really is taking one for the team in this urgent transport question. Incidentally, where is the Transport Secretary?
Matt Hancock
The Transport Secretary is working hard on making sure that we can improve the transport system.
Nic Dakin (Scunthorpe) (Lab)
And the Secretary of State almost said that with a straight face. What went wrong and who is taking responsibility for it?
Matt Hancock
This is a cross-Government decision. The purpose of this settlement was to ensure the unhindered supply of medicines. I am the Health Secretary and it is my job to do everything that I can, in all circumstances, to ensure that there is that availability of medicines. I am sure that, whatever the Brexit scenario, the hon. Gentleman’s constituents who need medicines would rather that we made this settlement to ensure that we have the confidence that we can deliver that.
Dr Roberta Blackman-Woods (City of Durham) (Lab)
I have recently been to see the Secretary of State for Education to lobby him for desperately needed resources to rebuild schools in my constituency and I was told that there is no money. Can the Secretary of State tell me how incompetent I need to be to walk away with £33 million for my constituents?
Matt Hancock
I am sure that the hon. Lady’s constituents will need to be confident that there is medicine for them, whatever the scenario is under Brexit, and that is what this settlement is all about.
Ronnie Cowan (Inverclyde) (SNP)
Is the Minister aware of the number of healthcare companies that are reluctantly extending their bank credit so that they can stockpile goods and components because of the lack of forward planning by this Government? What can he do to help those companies and also to help the banks that have to lend on longer terms than they normally would have an appetite for?
Matt Hancock
I mentioned in my statement that the pharmaceutical industry has stepped up to the plate and acted extremely responsibly in order to put in place the stockpiling that is necessary for a contingency in the event of a no-deal Brexit. All of us in this House can do something about the potential of a no-deal Brexit: we can vote for the deal.
Luke Pollard (Plymouth, Sutton and Devonport) (Lab/Co-op)
I know that the Health Secretary dreams of being Prime Minister, but to his great surprise, and to ours, he woke up as the Transport Secretary’s fall guy this morning. Trying to explain to constituents what is happening in this place is really hard. Trying to explain why a Transport Secretary has not been fired or has not resigned for effectively taking a decision that has lost the taxpayer £33 million is really difficult. Why is it that the Health Secretary cannot get up and simply apologise for the Transport Secretary’s error here? It would go such a long way to restoring confidence in politics. At the moment, this shows Parliament and the Government at their very, very worst.
Matt Hancock
I think I have mentioned that the point of this settlement was to ensure the unhindered supply of medicines, which is very much a matter for me as Health Secretary. People watching these proceedings will also be astonished that the Labour party can argue against a settlement such as this when it is refusing to vote for the deal that could ensure that we have a smooth and orderly exit and that the plans and the contingency plans for a no-deal Brexit are not necessary. Mr Speaker, the hon. Gentleman should vote for the deal, too.
Carol Monaghan (Glasgow North West) (SNP)
I do not know what is more embarrassing: that the Secretary of State has the brass neck to sit there this afternoon, or that his entire Front-Bench team are nodding along with his “Jackanory” stories.
Since the Secretary of State insists that this is about the supply of medicines, I am going to ask him, for the second time in a fortnight, about radioisotopes. Last time he said that there was no problem because we could fly them in. Can he now tell us how we can get radioisotopes supplied to us if we are not a member of Euratom?
Matt Hancock
Access to radioisotopes is precisely through the aviation route—that is exactly what I said to the hon. Lady last time, and I say it to her again today.
David Hanson (Delyn) (Lab)
Was the Secretary of State for Transport advised by any officials that his decision to award a contract to Seaborne Freight would result in a challenge in the courts by Eurotunnel?
Matt Hancock
This is not linked to the Seaborne Freight contract; this is about ensuring that the contracts that are in place are able to deliver the unhindered supply of medicines in whatever Brexit scenario.
Martin Docherty-Hughes (West Dunbartonshire) (SNP)
I do not know about you, Mr Speaker, but I think this is the worst “Hancock’s Half Hour” I have ever seen—and it is in colour for the first time. The Secretary of State, in response to the hon. Member for Middlesbrough (Andy McDonald)—I am grateful to him for securing the urgent question—advised the House that he has been speaking to the devolved Administrations. When did it come to pass that the Government of the United Kingdom of Great Britain and Northern Ireland have to discuss out-of-court settlements to get medicines with the devolved Administrations?
Matt Hancock
I am not sure that the hon. Gentleman had a question in there, but all I will say is that of course discussing the supply of medicines with the devolved Administrations is important, to ensure that those supplies reach all parts of the UK. The devolved Administrations support the wish to ensure that we have in place the capacity to deliver that unhindered supply, and I think that he should support that too.
Drew Hendry
The streak continues, Mr Speaker.
I am going to be more charitable to the Government, because I think they blatantly realise that having no Secretary of State for Transport is infinitely better than having the one they have got. We have listened to the Secretary of State for Health and Social Care’s fairy tale about medicines today, but will he at least have the decency to admit that £33 million is a lot of money, especially to people facing hardship on universal credit, the disabled and the low-waged?
Matt Hancock
It is very important that we always remember that this is taxpayers’ money. One of the duties of Government is to use taxpayers’ money to keep people safe, and that means having an unhindered supply of medicines, which is what we on the Government Benches are working so hard to deliver.
Douglas Chapman
This is not about the deal; this is all about incompetence at Government level, with £50 million for the original no-ships contract and a further £33 million in legal compensation to clear up the Eurotunnel mess. Now that the Government have found the magic money tree, how much is coming to Scotland, since we actually have ferries that we want to run?
Matt Hancock
I find it astonishing that Members on the Opposition Benches continue to make the case that this is not about medicines; it is all about medicines, because that is what we are going to be putting on this capacity in the event of a no-deal Brexit. It is about ensuring that, whatever happens on Brexit, people can still be safe. That is why this cross-Government decision was the right one to take. I think it is the same decision that anybody in the House would have taken were they in this place.
Several hon. Members rose—
Mr Speaker
The hon. Lady has made her point with considerable force and alacrity, and I have no doubt whatever that she is totally sincere, because she came up to the Chair to register her displeasure. I think that the Secretary of State was mildly carried away with the theatricality of the occasion, and he is very accustomed to jousting from the Dispatch Box. Ordinarily I have found him a most good-natured individual, so I think it unlikely—very unlikely indeed—that he would willingly impugn the integrity of a very committed and conscientious Member of Parliament in the hon. Lady, because at heart he is a very gracious chap. He may well wish to proffer an apology to her—[Interruption.]
Matt Hancock
Come on then. Further to that point of order, Mr Speaker. The first thing to note following these points of order is that—
Mr Speaker
Order. I am not inviting the Secretary of State to give a sort of general response, in the style of a Second Reading debate, to everything that has been said. If he wants to respond in relation to personal offence being taken, he can. That would be appreciated.
Matt Hancock
The point I was making, Mr Speaker, which I think I made a few times, is that those who care about having unhindered supply of medicines should vote for the deal, because that is the best way to ensure that people can be kept safe. That is all that I was implying by my comments.
Mr Speaker
Well, the Secretary of State has said what he has said, and colleagues will make their own assessment of it. I thank him for coming to the Dispatch Box.
Mr Speaker
I think that the right hon. Gentleman’s question was more rhetorical than not, and there was not really a question mark at the end of it. I can only say, for my own part, that when discharging my duties to the best of my ability this morning, I was rather under the impression that the urgent question was about the cancellation of the contract on account of legal action and that it was to do with Seaborne Freight. It may be that my interpretation was notably eccentric, but I do not think so. I think I was pretty clear what it was about, and that my assessment was shared by the team that accompanies me at the 12 o’clock meeting on a Monday morning.
Matt Hancock
On a point of order, Mr Speaker. You are an esteemed and eloquent Member of this House, as you often say to us, and you have just made a comment about what this case was about. Can I be very clear? The reason we settled this case, as I said to the hon. Member for Middlesbrough (Andy McDonald), was to ensure that the freight capacity purchased from DFDS and Brittany Ferries continues, in order to have the unhindered supply of medicines. That is what the settlement was a about.
Mr Speaker
No, no—I am not arguing the toss with the Secretary of State. I said earlier that he placed his own interpretation on what he judged to be the gravamen of the matter. That the question was about the cancellation of the contract and that it was about Seaborne Freight is, I think, so manifestly clear as to brook no contradiction by any sensible person. That it also related to the delivery of medicines is a perfectly arguable point. The Secretary of State has made his own point in his own way, and if he is satisfied with his own efforts and goes about his business with an additional glint in his eye and spring in his step, then I am very happy for him.
Oral Answers to Questions
Matt Hancock Excerpts(5 years, 9 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Peter Kyle (Hove) (Lab)
The Secretary of State for Health and Social Care (Matt Hancock)
On 30 January, we announced that we will increase access to PrEP, doubling the number of people who can receive this potentially life-saving HIV prevention drug.
Peter Kyle
Funding for HIV prevention has become quite complex, with a complex mix of central funding and local authority funding. Cities such as Brighton and Hove still have the highest contraction rates outside London. Will the Secretary of State meet me and the Terrence Higgins Trust to understand how that is impacting us on the frontline and tell us what more can be done?
Matt Hancock
Of course I would be delighted to meet the hon. Gentleman to discuss this matter. In the long-term plan, we made it clear that we are looking at commissioning arrangements for sexual health services. I am delighted that the number of new cases of HIV has been falling and that we have been able to declare that by 2030 we want the UK to have zero AIDS. That is an achievable, but hard, goal, and I will work with anybody to make it happen.
Dr Sarah Wollaston (Totnes) (Con)
Does the Secretary of State share the widespread concern about the variation in availability of PrEP treatment, which is surely an unacceptable situation?
Matt Hancock
There is a variability in availability. Of course the current model of delivery is a trial—we have doubled the size of that trial but it is still a trial that runs until 2021. I am very happy to work with my hon. Friend as well as with the hon. Member for Hove (Peter Kyle) to try to make sure that it is as available as possible.
Andy Slaughter (Hammersmith) (Lab)
Hammersmith is one of the sites that is now closed. When will PrEP be made freely available? Here we have a drug that has almost 100% effectiveness and that will save money for the NHS through HIV protection. When will we see it available to anyone who needs it?
Matt Hancock
As I have said, last month we doubled the availability of PrEP, which is an important step in the right direction.
Will Quince (Colchester) (Con)
Colchester is one of the sites that is now closed to men who have sex with men who want to access the HIV prevention drug PrEP. When will the Government’s commitment, made almost three weeks ago, to double the number of places on the PrEP trial be implemented across all trial sites?
Matt Hancock
It is being implemented as we speak. I am very happy to talk to my hon. Friend about when it will be rolled out in Colchester.
Mrs Sharon Hodgson (Washington and Sunderland West) (Lab)
I welcome the Government’s commitment to end the transmission of HIV in England by 2030. However, HIV reduction was not mentioned in either the prevention plan or the long-term plan. How will the Government reach that ambitious goal without a concerted and fully costed strategy?
Matt Hancock
We do have a concerted and fully costed strategy. Indeed, I have given the commitment of ending new AIDS cases by 2030 with a plan around that. The long-term plan goes into detail about new ways of commissioning sexual health services. This is a very important area, and, as the hon. Lady says, it is an important part of the prevention agenda, and we will make sure that we get it right.
Several hon. Members rose—
Jeremy Lefroy (Stafford) (Con)
The Secretary of State for Health and Social Care (Matt Hancock)
We are increasing the NHS budget by £20 billion, or £33 billion in cash terms, over the next five years. This major investment will support the NHS to continue to deliver world-class care. The long-term plan set out a vision for the NHS, ensuring that every penny will be well spent.
Jeremy Lefroy
I thank the Secretary of State very much for his answer. Local accident and emergency departments, such as at County Hospital in Stafford, are absolutely vital for the long-term plan of the NHS. What can he do to ensure that funding is there for these departments because they need an awful lot of block funding and not so much payment by procedure—or payment as you go?
Matt Hancock
My hon. Friend, who is an advocate for Stafford beyond compare and an advocate for its A&E—he has personally put much effort into saving it and ensuring that it is in good shape—rightly makes the point that paying per person who comes through the door does not accurately reflect the costs of providing A&E, so we are moving to a much greater proportion of block funding for A&Es, with a smaller element that varies according to the costs of serving everybody, to ensure that the finances follow the need.
Laura Smith (Crewe and Nantwich) (Lab)
The latest figures show that more than one in five patients visiting Leighton Hospital A&E in Crewe has had to wait for more than four hours, yet instead of receiving support, the trust has been financially penalised, unable to access capital support to fund improvements to its A&E, while at the same time losing out on the performance element of the provider sustainability fund. Can the Minister explain how the Government are supporting Leighton Hospital?
Matt Hancock
We are supporting Leighton Hospital through the delivery of the long-term plan and the extra £20 billion—£33 billion in cash terms—the first £6 billion of which comes on stream in April, in two months’ time. It is true that a record number of people are going to A&E. We have to make sure that the record numbers being treated within the four-hour target are supported, but that we also support hospitals to do yet more.
Lucy Allan (Telford) (Con)
In Telford, we have been waiting five years for the chance to ask the Secretary of State to call in for review a highly controversial plan called Future Fit. We now have that chance, and the Secretary of State has been really generous with his time in listening to MPs’ concerns. The local council, however, has still not yet made any submission to the Secretary of State. Can he confirm that without that submission he cannot call in that scheme for review?
Matt Hancock
My hon. Friend has made the case very powerfully for the future of Telford Hospital, and I have enjoyed working with her, but it is true that the call-in powers that I have as Secretary of State can be exercised only when a scheme is referred to me by a local council. Should that happen, I will consider it very carefully.
Ms Angela Eagle (Wallasey) (Lab)
Will the Secretary of State now come clean with the House and admit that the Lansley Act, which fragmented the NHS into tiny pieces, caused huge inefficiencies; and that successive Governments, including the one of whom he is a member, have starved the NHS of resources, which has caused a lot of the problems that our constituents face in increased waiting times and increased pressure on staff?
Matt Hancock
We care about securing the future of the NHS. That is why we are putting £20 billion extra into it over the next five years—£33 billion extra in cash terms. Yes, we will consider proposals being made for legislative changes, but what we care about is making sure that the NHS gets all the support it needs, and not just political nonsense.
Richard Drax (South Dorset) (Con)
Does my right hon. Friend agree that one of the vital components to ensure the long-term future of the NHS is community hospitals? Will he meet me to discuss what can be done to recruit more qualified staff, so that beds at the Portland Community Hospital can be reopened?
Matt Hancock
I would be very happy to meet my hon. Friend to discuss that, because community hospitals have a vital role to play in the future of the NHS as more care is delivered close to home.
Mr Dennis Skinner (Bolsover) (Lab)
It was not insignificant, what happened between ’97 and 2010 under a Labour Government. They trebled the amount of money going to the national health service. It was a system of hypothecation, whereby a 1% increase in national insurance went directly to the national health service, and nobody else fiddled with it.
Matt Hancock
It is unusual, but I am delighted to be able to agree with the thrust of the hon. Gentleman’s question. As he knows, we both come from Nottinghamshire mining stock, and it is surprising that we do not agree on more, but we do agree on the importance of having a properly funded NHS. That is why we have put the largest ever, longest ever cash injection into the NHS, because we care that it should be fit for the future.
Christine Jardine (Edinburgh West) (LD)
Ian Murray (Edinburgh South) (Lab)
The Secretary of State for Health and Social Care (Matt Hancock)
Leaving the EU with a deal remains the Government’s top priority, but we are preparing for every eventuality. I am confident that if everyone does what they need to do, the supply of medicines will continue unhindered.
Nick Smith
Will the Secretary of State say how much has already been spent since the NHS no-deal contingency plans were active, and what the overall bill will be?
Matt Hancock
Yes. About £11 million has been spent already. The NHS is not generally buying the extra medicines that are going into the elongated stockpiles, but the pharmaceutical industry is. We will of course eventually buy most of those medicines for the NHS. There have been costs to the pharmaceutical industry as well, but the cost so far to the taxpayer is £11 million. I expect it will remain at about that level, or a little higher.
Vicky Ford (Chelmsford) (Con)
Some of my constituents with diabetes have contacted me about supplies of insulin. Will the Secretary of State give us an insulin-specific answer?
Matt Hancock
Yes. Whereas across all medicines we have requested that the pharmaceutical industry has an extra six weeks of supplies in case of a no-deal Brexit, in the case of insulin the two major providers have already made stockpiles of at least double that. That shows that those with concerns about access to insulin can know that the plans we have in place for insulin are being enacted even more strongly than elsewhere.
Ian Murray
But the Secretary of State is refusing to provide any reassurance to constituents up and down the country, and particularly to my constituents. I got an email yesterday from a constituent—I have no shame in quoting this—who said:
“I have type 1 diabetes, as does Theresa May, and the supplies of insulin, needles and blood testing equipment all come from Europe. Insulin is perishable. Without it, so am I.”
Will the Secretary of State come to the Dispatch Box and say to my constituents that, whichever disease they have and whichever medical supplies they require, they will get them even if we leave the European Union with no deal? Would not the best thing to do be just to rule out no deal?
Matt Hancock
I have already given the assurance that if everybody does what they need to do, I am confident that supplies will be unhindered. In the case of insulin, the stockpiles are already double what we requested. However, on the point about the deal, the hon. Gentleman has a really important point about ruling out no deal being the best thing for people’s supply of medicines. He knows as well as I do that if we want to rule out no deal, we need to vote for a deal, so he and everybody in this House should vote for the deal.
Dr Philippa Whitford (Central Ayrshire) (SNP)
The serious shortage protocol statutory instrument would allow pharmacists to dispense alternative drugs when there is short supply, but, crucially, without consulting a GP. The problem is that they cannot access patients’ records and might dispense a drug that has previously caused serious side effects. Is the Secretary of State really expecting such extensive shortages that phoning a GP will be impractical?
Matt Hancock
This change is to respond to the shortages that happen from time to time regularly in the NHS. Given that the supply of 12,300 drugs is typical across the NHS, there are always some logistical challenges. This protocol is to try to ensure that we can respond to those challenges as well as possible. Pharmacists are highly trained in what they do and perfectly able to carry this out as proposed.
Dr Whitford
The problem is that the key issue is not consulting the GP. The medical legal responsibility for any problems normally lies with the prescriber, yet the General Medical Council was not even consulted on this SI. Does the Secretary of State really think that such a significant change should be pushed through with a negative resolution and no scrutiny and debate?
Matt Hancock
Well, it is getting scrutiny and debate now. The change that is being proposed is about making sure we can get people the drugs they need. Of course the responsibility is on the pharmacist to ensure that it is the appropriate drug and, if necessary, that the GP is involved. However, it is absolutely right that we make changes to ensure that we have an unhindered supply of medicines whenever there are shortages—whether that is to do with Brexit or not.
Jonathan Ashworth (Leicester South) (Lab/Co-op)
The Secretary of the State spoke with his characteristic self-confidence about the supply of insulin, but at the end of last week Diabetes UK said that
“despite reaching out directly to the Department of Health…we still have not seen the concrete detail needed to reassure us…we cannot say with confidence that people will be able to get the insulin and other medical supplies they need in the event of a no-deal Brexit.”
Why is Diabetes UK wrong and the Secretary of State right?
Matt Hancock
Diabetes UK is not a supplier of insulin. Of course, it plays an important role in representing those who have diabetes. We have given Diabetes UK reassurances, including, for instance, that the stockpiles we have for insulin are more than twice as long as we proposed and as required. That is an important assurance.
Jonathan Ashworth
I hope the Secretary of State will contact Diabetes UK to give it those reassurances directly.
On the various no-deal medicines statutory instruments that the House will debate today and on other occasions, the Government’s own impact assessments say that, in a no-deal scenario, the NHS will pay more for drugs, UK firms will face more red tape, and NHS patients will go to the back of the queue when it comes to international innovation. Given that the consequences of no deal would be so devastating for the NHS, will the Secretary of State—as, apparently, the Justice Secretary will—resign from the Government if it means blocking no deal?
Matt Hancock
If the hon. Gentleman really cared about stopping no deal, he would vote for the deal. There is something else that is worth saying about this shadow Secretary of State. He is a reasonable man—he is a sensible man—and I like him. My politics are probably closer to his than his are to those of the leader of his party, so why does he not have the gumption to join his friends over there on the Back Benches in the Independent Group, instead of backing a hard-left proto-communist as leader of the Labour party?
Bim Afolami (Hitchin and Harpenden) (Con)
Tommy Sheppard (Edinburgh East) (SNP)
The Secretary of State for Health and Social Care (Matt Hancock)
To provide the best care, the NHS needs the best technology, and we are therefore bringing together leaders of the digital agenda across the NHS under a new organisation called NHSX. We are also publishing a new code of conduct for the use of artificial intelligence in the NHS. NHSX will report jointly to the NHS and to me, and it will lead this vital agenda so that the NHS can be a world leader in emerging technologies that help to cut costs and save lives.
Tommy Sheppard
Meanwhile, in the real world, Scottish Care reports that 30% of social care staff in the highlands are nationals from other European countries. They are paid the real living wage of £9 an hour as a matter of public policy, but that is well short of the Government’s proposed limit of £30,000 for new immigrants in the future. Will the Secretary of State fight in the Cabinet to change that policy, or is he content to let these new immigration policies choke off the supply of labour to our social care sector?
Matt Hancock
We welcome people working in social care from the EU and from the rest of the world, and we need to ensure that that can continue, but we also need to ensure that we can train people locally to work in social care. That is incredibly important.
James Heappey (Wells) (Con)
Matt Hancock
My hon. Friend makes an incredibly important point. As important as new technology is and new ways of working and nurse practitioners are, we still need more GPs, and we need more GPs especially in rural and coastal areas. The targeted enhanced recruitment scheme offers a £20,000 salary supplement to attract GPs to parts of the country where there are serious shortages, including in Somerset.
Neil Coyle (Bermondsey and Old Southwark) (Lab)
Matt Hancock
I want to see this being implemented as soon as possible. It has already started, but we need commitment from local authorities as well as the NHS to deliver. I am very happy to work with the hon. Gentleman and all other interested Members to see it happen.
Dr Sarah Wollaston (Totnes) (Con)
Peter Kyle (Hove) (Lab)
Matt Hancock
Thankfully, the recruitment both of nurses and doctors is going up, which demonstrates that people do want to work in the NHS, and so they should because it is an amazing place to work and it has a great mission, which is to improve the lives of everyone.
Giles Watling (Clacton) (Con)
Matt Hancock
My hon. Friend is absolutely right: the £20,000 bonus is an important part of the solution, but so is having more GPs, and the fact that we have a record number of people going into GP training at the moment is great news that Members in all parts of this House should welcome.
Toby Perkins (Chesterfield) (Lab)
Matt Hancock
Of course the nature of being in a GP practice is changing. For a long time practices, which are essentially private businesses, also had the benefit of rising property prices that brought additional income on top of their income from the NHS. That is no longer the case because property is so expensive, so many people are changing the way that GPs are employed, so they are directly employed rather than through practices. That move is happening, but it is just one of the many changes we are seeing to try to make sure that being a GP is sustainable, and clearly things are starting to improve because a record number of people are choosing to become GPs.
Tom Tugendhat (Tonbridge and Malling) (Con)
Paul Masterton (East Renfrewshire) (Con)
The internet and social media have provided huge opportunities and positives for our young people, but we have been far too slow to react to the negatives, including cyber-bullying and issues around body image. Will the Minister responsible for suicide prevention, or my right hon. Friend the Secretary of State, confirm that they are taking a truly cross-Government approach to this issue and that they will seriously tackle the role of the tech companies?
Matt Hancock
Yes; my hon. Friend is dead right to bring up this subject. The rise in material promoting self-harm and suicide online is dangerous, and it needs to be stopped. I am delighted that, under pressure from this House, Instagram has now decided to take down that material, but there is much more to do. In this country, it is this House that makes the rules, not the global companies.
Bill Esterson (Sefton Central) (Lab)
The greatest damage from prenatal exposure to alcohol is often done in the first few weeks of pregnancy, yet three quarters of women in the recent Bristol University study said that they drank alcohol while pregnant. Will the Minister commit to ensuring that the chief medical officer’s advice is given loud and clear by all health professionals: do not drink alcohol if pregnant or trying to conceive?
Royston Smith (Southampton, Itchen) (Con)
Southampton is above the English average with nearly 6% of GP appointments being missed. Nationally, missed appointments cost the NHS more than £200 million a year. Does my right hon. Friend agree that a standardised online booking system featuring a reminder function with the option of cancelling or rescheduling an appointment would save money and reduce waiting times? Does he have any plans for such a system?
Matt Hancock
Yes, I do. This is one of the sorts of things that NHSX will drive forward. A decent IT system can reduce missed appointments in GP practices by a third—[Interruption.] So, while Opposition Members snigger about using modern technology and want to go back to the past, over here we are providing the best technology for the NHS for the benefit of patients.
Louise Haigh (Sheffield, Heeley) (Lab)
A recent answer to a parliamentary question from my hon. Friend the shadow Minister confirmed that in nearly half of cases of mental health crisis, it is not NHS staff but the police who are conveying people hospitals. Will the Department conduct a review into the impact that this is having on people in mental health crisis?
David Tredinnick (Bosworth) (Con)
A report in The Lancet in March 2018 found that most drugs and injections are useless for lower back pain. What will my right hon. Friend do to find alternative treatments?
Matt Hancock
I pay tribute to my hon. Friend, who recently announced that he will be standing down at the next election, for the amount of attention he has given to broadening people’s minds and to looking at what works and what the evidence shows works. We know, for instance, that social prescribing can help people and ensure that they get the support they need, and he has made a great contribution to that debate.
Rosie Cooper (West Lancashire) (Lab)
After reviews by ACAS, Capsticks and Dr Bill Kirkup, will the Minister outline how he intends to deliver justice for both staff and patients of the Liverpool Community Health NHS Trust? How will he ensure that the board members who disgracefully refused to give evidence to Kirkup will be held to account and made to give evidence in future investigations?
Stephen Morgan (Portsmouth South) (Lab)
Mental health services need proper staffing, but 2,000 mental health staff are leaving the NHS every month. How do the Government expect to achieve any ambitions in the long-term plan without adequate staff?
Matt Hancock
The hon. Gentleman is right. When we put a large amount of money into a service, we of course need more people to deliver it. That is most acute in mental health, which is getting the biggest increase in funding—£2.3 billion of the £20.5 billion overall. I assure him that the Minister responsible for mental health and suicide prevention, my hon. Friend the Member for Thurrock (Jackie Doyle-Price), is working night and day to ensure that we attract the people we need to deliver the services that our people deserve.
Mr Mark Francois (Rayleigh and Wickford) (Con)
May I ask a question in memory of my late friend Stephen Horgan, who died a few years ago from a rare form of blood cancer with just a few months’ notice? In his memory, I am a now a supporter of Bloodwise, an excellent charity that raises awareness of rare cancers. Asking on the charity’s behalf, will the new workforce plan for the NHS include clinical psychologists, particularly those with cancer knowledge, to make the absolute best use of the welcome new resources, which I am sure Stephen’s family also welcome?
Matt Hancock
Yes, my right hon. Friend puts it extremely well, because he reminds us of who we are here to serve when discussing questions of health and of cancer. He is right to raise this matter, and I can absolutely confirm what he asks for: we will deliver in Stephen’s memory and in the memory of others who have died. That is what gives us the strength to carry on and try to deliver and improve services for everybody.
Carol Monaghan (Glasgow North West) (SNP)
The Secretary of State talked earlier about a six-week stockpile of medicines, but radioisotopes for cancer diagnosis and treatment cannot be stockpiled. I have asked many times about the future arrangements for radioisotopes post-Brexit, so will the Secretary of State detail them now?
Matt Hancock
In the event of a problem at the Dover-Calais strait, we will bring in radioisotopes by air, and we have already contracted an aircraft to ensure that that happens. That part of the planning is well advanced.
Mark Pawsey (Rugby) (Con)
On Thursday, with Rugby’s mayor, I had the great pleasure to open the new Brownsover surgery, which came about because of the hard work of the patient action group. Will the Secretary of State welcome the work of patient groups in delivering NHS services?
Matt Hancock
I am absolutely delighted to welcome the work of the group, which has raised so much money, and of my hon. Friend, who stands up and makes the case for Rugby. More broadly, we should welcome all those who want to make a contribution to our hospitals and hospices. We take a broad-minded and open approach to welcoming people who volunteer hours or raise money to improve our great NHS.
Oral Answers to Questions
Matt Hancock Excerpts(5 years, 11 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Tommy Sheppard (Edinburgh East) (SNP)
The Secretary of State for Health and Social Care (Matt Hancock)
We do not want a no-deal scenario in our exit from the European Union, but it is incumbent on us to prepare in case. We asked medical suppliers to stockpile a further six-week supply over and above normal levels, and that work is going well. We will continue to work to ensure the unhindered supply of medicines in all Brexit scenarios.
Wes Streeting
The Prime Minister’s threatening of this Parliament and the country with no deal is entirely reckless, irresponsible and unnecessary. It is also causing unnecessary fear and anxiety among a range of clinicians and patients who rely on the consistent supply of life-saving drugs. The Secretary of State says that the Government are stockpiling medicines for up to six weeks. Will he do the right thing and commission an independent assessment of those plans so that patients can be reassured? Better still, will he go back to the Cabinet and say that no responsible Health Secretary would allow no deal to take place, no responsible Prime Minister would allow no deal to take place, and this House will not allow no deal to take place?
Matt Hancock
It is incumbent on me as Health Secretary and on my team to ensure that we prepare for all potential scenarios. Of course, because of the overwhelming vote of the House in favour of the withdrawal Bill, no deal is the law of the land unless the House does anything else. If the hon. Gentleman is so worried, the best thing that he and all his friends can do is vote for the deal tonight.
Ian Murray
Would it not have been a better use of taxpayers’ money to have spent hundreds of millions of pounds on frontline patient care rather than on no-deal planning? The Secretary of State has just said to my hon. Friend the Member for Ilford North (Wes Streeting) that the Government have to prepare for all possible scenarios. A responsible Secretary of State would rule out one of those scenarios, which is no deal.
Matt Hancock
As I said, thanks to the votes of Members in all parts of the House, no deal is a matter of the law of the land. They can’t get away from it: if they don’t like no deal, they need to join me in the Lobby tonight, and vote for the Prime Minister’s deal.
Tommy Sheppard
In Scotland, 6% of all social care staff are nationals of European countries. In England the figure is 8%. In Scotland, despite the Scottish Government paying the real living wage of £9 an hour, that comes nowhere near the £30,000 threshold proposed for a tier 2 visa. Can the Minister tell us here today what action he will take to avert a staffing crisis in social care?
Matt Hancock
We have brought into place already the EU settlement scheme to ensure that those EU workers who are working in social care and in the NHS can and should remain here and continue to contribute, as they do so valuably.
Vicky Ford (Chelmsford) (Con)
I know the Secretary of State wants to avoid a no-deal scenario, but can he look at the case of prescription foods, which my constituent Cait, who has PKU, relies on for keeping her life, and make sure they are also covered by no-deal planning?
Matt Hancock
We are working to ensure that the prioritisation of not just medicines, but medical products and other things needed for the health of the nation, is taken into consideration. There is detailed work under way that is clinically led; the medical director of the NHS is heavily engaged in that work and works very closely with the Department on it. I am very happy to go through the details of my hon. Friend’s constituency case to make sure that that is also being dealt with appropriately. I am glad that, because she does not want no deal, she will be voting with the Government tonight.
Dr Philippa Whitford (Central Ayrshire) (SNP)
Legislation was passed two years ago so that the Secretary of State could end profiteering by some drug companies. Now drug shortages after a no-deal Brexit could mean soaring costs across UK health services, so why have the Government not set the regulations from this legislation so that we can use the powers and avoid a black market in medication?
Matt Hancock
We have already taken action to ensure that the cost of drugs is reduced. I am very happy to write to the hon. Lady with the extensive details of the agreements that have been made. The legislation is indeed important; so, too, is working with the drugs companies to make sure that we keep those costs down and yet also get the drugs that people need.
Dr Whitford
As the precursors of medical radioisotopes have a half-life of less than three days, they cannot be stockpiled. I have frequently asked the Government how they will maintain a steady supply if there is a no-deal Brexit. Can the Secretary of State answer—and please don’t say “Seaborne Freight”?
Matt Hancock
No, absolutely, we have ensured that there will be aircraft available, and air freight, to make sure that we can get those isotopes that have a short shelf life and cannot be stockpiled, and that there is unhindered supply. I make the following point to the hon. Lady and her colleagues, with an open mind and in a spirit of collaboration: if she is worried about no deal, which she seems to be, she and her party should support the Government tonight.
Jonathan Ashworth (Leicester South) (Lab/Co-op)
The Secretary of State boasts of being the world’s biggest buyer of fridges to stockpile medicines, but if sterling drops because of the Government’s mishandling of Brexit, the parallel trade in medicines could mean that stockpiles rapidly deplete as medicines are quickly exported back into the EU. Will he impose restrictions and suspend the necessary export licences that he is responsible for? Otherwise, he risks his fridges standing empty.
Matt Hancock
Of course, we have the legislative tools and powers the hon. Gentleman describes at our disposal; we know that. Nevertheless, stockpiling is going according to plan—it is going well—and the pharmaceutical industry has responded very well, with great responsibility. But I say, rather like a broken record—[Hon. Members: “You are.”] Yes, and it is important that I say it again and again and again. There is one route open to the House to avoid no deal, which Opposition Members purport to be worried about. They cannot complain about no deal unless they are prepared to do something about no deal, and to do something about no deal, they need to vote with the Government tonight.
Jonathan Ashworth
If the Secretary of State has those powers, he should use them now. This is going to be the biggest disruption to patient safety we have ever seen. He is also proposing emergency legislation that means patients might not get access to the medicines their GPs prescribe. Can he tell us whether an insulin patient will be able to get their prescription within a day of presenting at a pharmacy? He is the Secretary of State for Health; why will he not do the responsible thing and rule out no deal, which will do so much damage to the NHS and patients?
Matt Hancock
Because of the votes of most of us in the House, including the hon. Gentleman, no deal of course is the law of the land unless the House passes something else. He is a reasonable man. He is a mentor of the old Blairite moderate wing of his party. He is absolutely a centrist. I do not believe that, privately, he believes in the hard-left guff that comes from other Opposition Front Benchers. He is a very sensible man and I like him an awful lot, so after this session and before 7 o’clock tonight, why does he not take a look in the mirror and ask himself, “In the national interest, is it best to vote for the deal and avoid no deal, or is it best to play politics?”
Mr Speaker
Order. Let me say very gently to the Secretary of State, who is renowned for his charm in all parts of the House, that his likes and dislikes are a matter of immense fascination to colleagues, including the Chair, but what is of greater interest is his brevity.
Rebecca Pow (Taunton Deane) (Con)
The Secretary of State for Health and Social Care (Matt Hancock)
In September, we announced £145 million to upgrade NHS facilities for winter and, last month, £1 billion as part of the NHS long-term plan. Future capital spending decisions will be for the spending review.
Mr Wragg
I am grateful to my right hon. Friend for his answer. He will know the importance of Stepping Hill Hospital to my constituents. Will he work with me and others to ensure that the hospital can secure additional capital investment to expand accident and emergency, improve outpatient facilities and provide additional car parking?
Matt Hancock
I look forward to working with my hon. Friend and his local colleagues on what we can do to support Stepping Hill Hospital further. He is an assiduous representative for Hazel Grove who makes the argument very clearly, both to me and to the NHS Minister, who has already heard from him on several occasions. We did manage to provide £1 million for upgrades to Stepping Hill Hospital ahead of this winter and we understand the case that they make.
Colin Clark
Since 1980, Aberdeen University has been at the forefront of MRI development. May I invite the Secretary of State to visit Aberdeen medical facilities to see the fast field-cycling scanner, a development of national importance to stroke diagnosis?
Matt Hancock
Yes, I love going to Aberdeen and look forward to another reason for going to the north-east. Of course, Aberdeen University and the UK have been at the cutting edge of this innovation for years and must be for years to come.
Rebecca Pow
I first thank the Department for supporting me in my case for upgrading the theatres at Musgrove Park Hospital.
Having skilled staff to work in these places is really important and the University Centre Somerset is one of just two places piloting the nursing associates programme. It is growing really well and it is a vital stepping stone between healthcare assistant and nurse. Will the Secretary of State join me in congratulating the college on how well the programme is going and meet me to discuss the option of a degree course?
Matt Hancock
Yes, absolutely. We support nursing associates and I am delighted to see the rapid expansion that is taking place. We want more universities and higher education institutes to come to the fore to provide that sort of education. I cannot wait to meet my hon. Friend.
Mr Speaker
Including, of course, as the right hon. Gentleman knows from his recent meeting with me, the University of Buckingham in my constituency.
Seema Malhotra (Feltham and Heston) (Lab/Co-op)
One of my constituents, who is 17, seriously ill with breathing difficulties and in need of urgent specialist care, is waiting for a room to be available at the Royal Brompton. Is the Secretary of State aware of any delays and whether these have been caused by not having sufficient NHS facilities at the Royal Brompton to meet such urgent demand?
Matt Hancock
I have not heard any of the details of that case before now. If the hon. Lady will write to me, I will be very happy to talk to her and engage with her on what we can do for her constituent.
Tim Farron (Westmorland and Lonsdale) (LD)
It is 12 long months since the Government closed their consultation on whether to upgrade NHS radiotherapy facilities. Meanwhile, in south Cumbria, cancer patients have to make daily round trips of up to four hours for weeks on end to receive treatment. When will the Government respond to the consultation and when will they invest in satellite radiotherapy provision in places such as Westmorland General Hospital?
Matt Hancock
We will respond to the consultation very soon. We wanted to get the NHS long-term plan published first, because clearly the two are strongly linked. I pay tribute to the hon. Gentleman’s work chairing the all-party group on radiotherapy and I look forward to working with him.
Luke Pollard (Plymouth, Sutton and Devonport) (Lab/Co-op)
Plymouth is pioneering health and wellbeing hubs—a new type of NHS facility. I am most excited about the new one in Plymouth city centre, which will include directly employed GPs and mental health, sexual health and dentistry services. We have submitted a funding application to the Minister. When will he be able to fund and support that pioneering project, a new type of NHS facility delivering in some of our poorest communities?
Matt Hancock
The hon. Gentleman’s neighbour in Plymouth has already brought this to my attention and made the case very strongly for it. I am still waiting for the “Thank you” for the new facilities at Derriford Hospital, but I am a massive supporter of the work that is going on in the local area and the NHS in Plymouth will go from strength to strength under this Government.
Dr Sarah Wollaston (Totnes) (Con)
The maintenance backlog across the NHS is deeply worrying. It affects equipment as well as buildings. Two of the 10 operating theatres at Torbay Hospital remain out of action. Would the Secretary of State meet me to discuss the impact that that is having on patient care? It is increasing waiting lists and leading to very short-notice cancellations to make way for emergency cases. Torbay Hospital has a £34 million maintenance backlog. It is deeply worrying.
Matt Hancock
I am very happy to meet my hon. Friend, who makes a very important point. Of course, future allocations of capital are for the spending review. I look forward to working with her to try to sort out the problems in Torbay and across the board.
Diana Johnson (Kingston upon Hull North) (Lab)
A consultation is taking place about the closure of Faith House GP practice on Beverley Road in Hull. It is partly about the premises being less suitable for delivering modern healthcare, but also about how difficult it is to recruit GPs. What will the Secretary of State do about GP services being removed from communities? How will he support the development of GP services in those areas?
Matt Hancock
The £4.5 billion extra in the long-term plan that is going to primary and community care is absolutely targeted at solving problems like that. As it happens, I know Beverley Road in Hull quite well; I had family who lived there. It is very important that the services in primary care and in the community are there and are available to people to ensure that that crucial element of our prevention agenda is strengthened to keep the pressure off hospitals, too.
Suella Braverman (Fareham) (Con)
Matt Hancock
Yes, I would love to do that. I will raise it with Mike Richards, who is running a review of the future of screening services. I am sure that the whole House will want to join me in congratulating my hon. Friend on her forthcoming use of maternity services in the NHS.
Karen Lee (Lincoln) (Lab)
Mr Clive Betts (Sheffield South East) (Lab)
The Secretary of State for Health and Social Care (Matt Hancock)
Last week we launched the NHS long-term plan, which delivers on the vision for how the extra £20.5 billion that we are putting into the health service will be spent to get the best return for the taxpayer. The long-term plan is built on the principle that prevention is better than cure, and there will be a new focus on personal responsibility that reflects and complements the responsibility that the NHS has to us all.
Mr Betts
Looking to the last financial year, I am sure that the Secretary of State has seen a National Audit Office report that says that auditors gave a qualified opinion on 38% of local NHS bodies, expressing concerns about overspending and value for money. The Comptroller and Auditor General said:
“A qualification is a judgment that something is seriously wrong”.
Does the Secretary of State accept that many of these problems are down to local bodies struggling with the effects of austerity and real-terms cuts to their funding? Does he also accept that he is ultimately responsible for spending in the NHS, and does he accept responsibility for the totally unsatisfactory state of affairs that the NAO has identified?
Matt Hancock
That is a very big question, and the very big answer comes in the form of the £20.5 billion that is going in, but it is not just about the money. We also need to ensure that, at all levels, we strengthen the leadership capacity in the NHS, because the best hospitals that deliver the best services, that hit their targets and that are the best clinically are also the ones that have the best financial results. Strengthening leadership, making sure that the money is available, as appropriate, and ensuring that we deliver for patients are at the core of the long-term plan.
Mr Robert Goodwill (Scarborough and Whitby) (Con)
Yvonne Fovargue (Makerfield) (Lab)
Matt Hancock
The hon. Lady is absolutely right that these waiting time targets need to be improved upon, which is one reason why we are putting so much extra taxpayers’ money into the NHS. Of course, waiting times also need to follow clinical need, and we are taking advice on that.
Alan Mak (Havant) (Con)
Genome sequencing and other fourth industrial revolution techniques play a key role in the detection and treatment of cancer and other diseases. How is the NHS adopting those new techniques?
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)
Matt Hancock
The biggest proportional increase in spending in the NHS—it has taken place faster than the average rate, over a five-year period—is in mental health services, alongside the increase in primary care and community care. That money will come on stream with a £6 billion cash injection for the NHS overall in April, in just over two months’ time. So we are getting on with it, but there is a lot of work to be done.
Julia Lopez (Hornchurch and Upminster) (Con)
NHS Property realised £43 million when it sold St George’s Hospital in my constituency, yet a £17 million bid for a new health centre there has not been successful. Will my right hon. Friend commit himself to looking at that again in order to convince communities that they benefit when local NHS assets are sold?
Matt Hancock
Absolutely. I look forward to working on that with my hon. Friend and local commissioners, and also to working with my hon. Friend before the spending review, when the next round of the capital allocations will be set.
Ms Marie Rimmer (St Helens South and Whiston) (Lab)
Matt Hancock
Yes, 100%. That is exactly what is in the plan, and I am delighted to have such support. This is precisely the direction in which we need to go in integrating care to ensure that patients are served better, whoever is the ultimate funder of the service.
Tracey Crouch (Chatham and Aylesford) (Con)
In the event of an out-of-hospital cardiac arrest, access to a defibrillator can make the difference between life and death. Although there are tens of thousands of defibs across the United Kingdom, the majority are not known to the ambulance service, so will the Minister join me in welcoming the British Heart Foundation’s efforts to map the location of all defibs so that ambulance services can direct people to their nearest heart restarter in an emergency and, hopefully, we can save more lives?
Mrs Pauline Latham (Mid Derbyshire) (Con)
What advice can the Minister give to elderly and vulnerable people who missed out on the first wave of flu jabs? Are they still available?
Dr Rosena Allin-Khan (Tooting) (Lab)
While working a night shift in A&E this weekend, I was struck by the fact that I was working alongside so many members of staff from our EU—Italian, Irish and Spanish. I am proud that St George’s Hospital is paying for the visas of those vital staff post Brexit, but can the Secretary of State tell me why the financial burden of retaining them and improving their morale is falling on NHS trusts and not the Government?
Matt Hancock
I welcome what St George’s is doing, and I welcome all the people from the EU who are working in our NHS—in greater numbers than on the day of the referendum. They are welcome here, and I look forward to their working here long into the future.
Andrea Jenkyns (Morley and Outwood) (Con)
Each month I hold my memory cafés for those suffering with memory loss, dementia and Alzheimer’s, and their carers, families and friends. What support are the Government providing for those suffering with such memory loss conditions?
Mr Skinner
The Secretary of State has been very fond today of talking about the long-term plan. I am 86 years of age, and the reason I am able to ask this question is because under Labour—is he listening?—the money that went in was trebled from £33 billion to £100 billion, an increase of £67 billion. That is why I am still here: I had my operation for cancer, and it was successful; I had an operation for a bypass, and it was successful; and I had a hip replacement, and I can still walk backwards. That is the Labour story—just remember it!
Mr Speaker
Order. Before the Secretary of State responds, let me say that the ferocity and eloquence of the hon. Member for Bolsover (Mr Skinner) are legendary, but all he is really telling us is what the Chair already knew, namely that the hon. Gentleman is indestructible.
Matt Hancock
The hon. Member for Bolsover (Mr Skinner) and I both come from Nottinghamshire mining stock, and we both support the NHS, which was first proposed from this Dispatch Box by a Conservative Minister under a Conservative Prime Minister, and has been presided over by a Conservative Secretary of State for most of its life. I am delighted that those operations, including under a Conservative-led Administration, kept the hon. Gentleman ticking, because what an adornment he is—I look forward to voting with him this evening.
Several hon. Members rose—
NHS Long-term Plan
Matt Hancock Excerpts(5 years, 11 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
The Secretary of State for Health and Social Care (Matt Hancock)
With permission, I would like to make a statement about the NHS long-term plan. The plan sets out how we will guarantee the NHS for the future. It describes how we will use the largest and longest funding settlement in the history of the NHS to strengthen it over the next decade, rising to the challenges of today and seizing the opportunities of the future.
It is worth taking a moment to reflect on the time when the NHS was first proposed from this Dispatch Box, under the Churchill Government in 1944. Even after the perils of war, infant mortality was nearly 10 times what it is now, two thirds of men smoked and life expectancy was just 66. It came 10 years before we knew the structure of DNA and four decades before the first MRI. The NHS has led the world throughout its history, but one constant has been the core principle set out by the Conservatives in that national Government: the NHS should be available to all and free at the point of use according to need, not ability to pay.
As last year’s 70th anniversary celebrations proved, the NHS is one of our proudest achievements as a nation. We all have an emotional connection to it—our own family story—and we all owe an enormous debt of gratitude to the people who make the NHS what it is and work so hard, especially during the winter months when the pressures are greatest.
Because we value the NHS so much, the new £20.5 billion funding settlement announced by the Prime Minister in June provides the NHS with funding growth of 3.4% a year in real terms over the next five years. That means that the NHS’s budget will increase in cash terms by £33.9 billion, rising from £115 billion this year to £121 billion next year, £127 billion in 2020-21, £133 billion in 2021-22, £140 billion in 2022-23 and then £148 billion in 2023-24.
That rise of £33.9 billion, which is actually over £1 billion more in cash terms than was proposed in June, delivers on our commitment to the NHS and will safeguard the NHS for the long term and help to address today’s challenges. The NHS is facing unprecedented levels of demand. Every day, it treats over 1 million people. Compared with 2010, the NHS carried out 2 million more operations and saw 11.5 million more out-patients last year. Despite record demand, performance was better this December than last December. So we will address today’s challenges, not least with the £6 billion extra coming on stream in under three months.
As well as addressing current challenges, the NHS long-term plan sets up the NHS to seize the opportunities of the future. At the heart of the plan is the principle that prevention is better than cure. In the future, the NHS will do much more to support people to stay healthy, rather than just treating them when they are ill, so the biggest increase to any part of the NHS—at least £4.5 billion—will go to primary and community care, because GPs are the bedrock of the NHS. That means that patients will have improved access to their GPs and greater flexibility about how they contact them, as well as better use of community pharmacists and better access to physiotherapists. Improving the availability of fast and appropriate care will help communities to keep people out of hospital altogether.
The next principle is that organisations across the NHS, local councils, innovators and the voluntary sector will all work more closely together so that they can focus on what patients need. There will also be a renewed clampdown on waste so that we can ensure that every penny of the extra money goes towards improving services and giving taxpayers the best possible return.
Ultimately, staff—the people who work in the NHS—are at the heart of the NHS. The long-term plan commits to major reforms to improve working conditions for NHS staff, because morale matters. Staff will receive better training and more help with career progression. They will have greater flexibility in their work, be supported by the latest technology that works for them and be helped more with their own mental health and wellbeing. That already happens in the best parts of the NHS, and there has been a huge amount of work to support the people who work in the NHS, but I want to see it happen everywhere. We will bring in better training, mentoring and support to develop better leadership in the NHS at all levels. We will build on the work that is already going on to recruit, train and retain more staff so that we can address critical staff shortages.
The plan published today is the next step in our mission to make the NHS a world-class employer and deliver the workforce it needs. To deliver on the workforce commitments, I have asked Baroness Dido Harding to chair a rapid programme of work, which will engage with staff, employers, professional organisations, trade unions, think-tanks and others to build a workforce implementation plan that puts NHS people at the heart of NHS policy and delivery. Baroness Harding will provide interim recommendations to me by the end of March on how the challenges of supply, culture and leadership can be met. She will make her final recommendations later in the year as part of the broader implementation plan that will be developed at all levels to make the NHS long-term plan a reality.
That is the approach that we will be taking to support the NHS over the next decade, but what does it mean for patients and the wider public? It means patients receiving high-quality care closer to home. It means supporting our growing elderly population to stay healthy and independent for longer. It means more personalised care and more social prescribing. It means empowering people to take greater control of, and responsibility for, their own health through prevention and personal health budgets. It means accessing new digital services to bring the NHS into the 21st century. It means more support for mothers by improving maternity services. It means providing more support for parents and carers in the early years of a child’s life so that this country can be the best place in the world in which to be born, in every sense.
We will improve how the NHS cares for children and young people with learning disabilities and autism by ending inappropriate hospitalisation, reducing over- medicalisation and providing high-quality care in the community. The NHS will tackle unacceptable health inequalities by targeting support towards the most vulnerable in areas of high deprivation. To help to make a reality of the goal of parity between mental and physical health, we are going to increase mental health service budgets not by £2 billion, but by £2.3 billion a year. For the first time ever, we will introduce waiting time targets for community mental health so people get the treatment they need when they need it. We will also expand services for young people to include those up to the age of 25—something that never happened under the previous Labour Government.
The long-term plan focuses on the most common causes of mortality, including cancer, heart disease, stroke and lung disease. The health service will take a more active role in helping people to cut their risk factors by stopping smoking, losing weight and reducing alcohol intake. The NHS will improve the quality and speed of diagnosis and improve treatment and recovery, so that we can help people to live well and manage their conditions. We will upgrade urgent care so people can get the right care more quickly.
All in all, the NHS long-term plan has been drawn up by the NHS—by more than 2,500 doctors, clinicians, staff and patients. It will continue to be shaped and refined by staff and patients as it is implemented, with events and activities across the country to help people to understand what it means for them and their local NHS services. The experts who wrote the plan say that it will lead to the prevention of 150,000 heart attacks, strokes and dementia cases, and to 55,000 more people surviving cancer each year—in all, half a million lives saved over the next 10 years. It is funded by taxpayers, designed by doctors and delivered by this Government.
This is an important moment in the history of the NHS. Our long-term plan will ensure that the NHS continues to be there, free at the point of use, based on clinical need, not ability to pay, but better resourced with more staff, newer technology and new priorities. It will be fit for the future, so that it is always there for us in our hour of need. I am proud to commend this statement to the House.
Jonathan Ashworth (Leicester South) (Lab/Co-op)
I welcome the advance copy of the Secretary of State’s statement, but may I quickly say at the outset that Churchill’s Tory party voted against Labour’s NHS 22 times?
We welcome many of the ambitions outlined today by NHS England. We welcome the greater use of genomics in developing care pathways. We welcome the commitment to early cancer diagnosis; after all, it was a Labour policy announced at the general election. We welcome the commitment to new CT and MRI scanners; it is a Labour policy. We welcome the greater focus on child and maternal health, including the expansion of perinatal mental health services; again, it is a Labour policy. We welcome the roll-out of alcohol teams in hospitals, because, yes, it is another Labour policy.
The Secretary of State did not mention this, but we will study carefully the details of any new proposed legislation, because we welcome the recognition that the Health and Social Care Act 2012 has created a wasteful, fragmented mess, hindering the delivery of quality healthcare. Healthcare should never be left to market forces, which is why scrapping the competition regime and scrapping the Act’s section 75 procurement regulations, as proposed today by NHS England, are long-standing Labour policies. The Government should be apologising for the Health and Social Care Act. But why stop halfway? Why not commit to fully ending the purchaser-provider split? Why not commit to democratic accountability when planning care? Why not commit to consigning the whole Lansley Act to the dustbin of history?
What about the other holes in today’s announcement? Waiting lists are at 4.3 million, with 540,000 waiting beyond 18 weeks for treatment. A&Es are in crisis, with 618,000 trolley waits and 2.5 million waiting beyond four hours in A&E. So why is there no credible road map today to restoring the statutory standards of care that patients are entitled to, as outlined in the NHS constitution? They were routinely delivered under a Labour Government. Is it not a damning indictment of nearly nine years of desperate underfunding, cuts and failure to recruit the staff we need that those constitutional standards will not be met as part of this 10-year plan?
The Secretary of State boasts of the new budget for the NHS. Will he confirm that once inflation is taken into account, once the pay rise is factored in and once the standard NHS England assumption about activity is applied, there is actually a £1 billion shortfall in the NHS England revenue budget for this coming financial year? When he answers, will he tell the House—I will be listening carefully to what he says—whether he has seen or is aware of any internal analysis from the Department, NHS England or NHS Improvement that confirms that £1 billion shortfall figure?
Can the Secretary of State also confirm that despite his rhetoric about prevention, the public health budget is set to be cut again in the next financial year as part of a wider £1 billion of cuts to broader health spending, and that when those cuts are taken into account, spending will rise not by 3.4%, as he says, but by 2.7%? That will mean deeper cuts again to smoking cessation services, deeper cuts again to drug and alcohol addiction services and deeper cuts again to sexual health services when infections such as gonorrhoea and syphilis are on the rise. By the way, why is HIV/AIDS not even mentioned in the long-term plan? What was the Secretary of State’s answer when asked about public health cuts in his weekend interviews? Targeted Facebook advertising. Given that life expectancy is going backwards, health inequalities are widening and infant mortality is increasing, the public health cuts should have been reversed today, not endorsed.
The NHS long-term plan admits that
“the extra costs to the NHS of socioeconomic inequality have been calculated as £4.8 billion a year in greater hospitalisations alone.”
Does that not confirm that, for all the rhetoric on prevention, the reality is that the Government’s austerity and cuts are making people sicker and increasing the burden on the NHS? Nowhere have we seen greater austerity than in the deep cuts to social care, but where are the Government’s proposals today? They still do not have any.
With respect to social care, surely the Secretary of State agrees that:
“It is not possible to have a plan for one sector without having a plan for the other.”—[Official Report, 18 June 2018; Vol. 643, c. 53.]
Those are not my words, but the words of the Foreign Secretary when he stood at the Dispatch Box last June as the Secretary of State for Health and Social Care. I agree with him; it is a shame that the current Secretary of State does not.
By the way, the Foreign Secretary also promised that:
“Alongside the 10-year plan, we will also publish a long-term workforce plan”.—[Official Report, 18 June 2018; Vol. 643, c. 52.]
Where is it? The Secretary of State has not done it. We all want to know where the staff are coming from to deliver the ambitions that have been outlined today. We are short of 100,000 staff. We are short of 40,000 nurses. The Secretary of State talks of doing more for mental health services; we are down 5,000 nurses in mental health. He talks of doing more for primary and community care; GP numbers are down by 1,000 and district nursing numbers are down by 50%. Now, the Home Secretary wants to impose a £30,000 salary cap on those coming from abroad to work in our NHS, ruling out nurses, care assistants and paramedics. The Secretary of State should do his job and tell the Home Secretary to put the future sustainability of the NHS first, instead of his Tory leadership ambitions, and ditch that salary cap for the NHS.
There are certainly many welcome ambitions from NHS England today, but the reality is that those ambitions will be hindered by a Government who have no plan to recruit the staff we need, who have no plan for social care and who are pushing forward with deep cuts to public health services. Patients have been let down as the Government have run down the NHS for nearly nine years. We do not need 10 more years of the Tories. The NHS needs a Labour Government.
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.
Dr Philippa Whitford (Central Ayrshire) (SNP)
I note that the Secretary of State referred to the Churchill Government in 1944, but had he looked at Hansard he might have seen that Churchill cited the Highlands and Islands Medical Service, which was the first national health service in 1913.
I welcome the long-term plan, but the integration to which it aspires is going to be frustrated if there is no reform of the internal market and the fragmentation continues. The Secretary of State cites the funding, which he describes as 3.4% per year. That is actually just back to what the NHS received prior to 2010. He talks about a million extra patients. With this enormous increased demand, does he not think that it would be more honest to describe funding per head, rather than just a total? Scotland spends £163 more per head. Perhaps he should aspire to spend the money on the patients and then perhaps the NHS would keep up.
Again, like the previous funding agreement, the funding is focused only on the NHS, with cuts to public health, no extra money for health education and still no Green Paper on social care. I totally agree that prevention is better than cure, so will the Secretary of State reverse the cuts to public health? In his own letter, which was circulated, he emphasised reducing cancer deaths, yet there was no mention of prevention at all. That is the best way to reduce cancer deaths. Public health is crucial, smoking cessation is crucial and tackling childhood obesity is crucial, so will he liaise with his colleagues in the Department for Digital, Culture, Media and Sport and set a nine o’clock watershed on advertising rubbish foods?
I agree with the aim of improving screening. Last year, the Government agreed that they would reduce the bowel cancer screening age from 60 to 50. Can the Secretary of State tell us when that will actually happen? Does he recognise that it will mean a bigger need for endoscopists and radiologists? So will he fund Health Education England to provide them and to provide the other doctors, nurses and staff that the NHS will need to deliver this long-term plan?
Matt Hancock
My response is yes on the cancer screening—it is in paragraph 3.53. I want to return to the point that was made by the hon. Lady and by my right hon. and learned Friend the Member for Rushcliffe (Mr Clarke) about the link to social care. Of course that is critical. The plan has a section on the link to social care and the social care Green Paper will then tie into the plan. Of course, the two come together and the Green Paper on social care will be provided soon.
Dr Sarah Wollaston (Totnes) (Con)
I warmly welcome this ambitious and wide-ranging long-term plan for the NHS. I agree with the hon. Member for Central Ayrshire (Dr Whitford) that so much is dependent on social care, on public health and on the workforce through Health Education England budgets, but may I add to that the situation for capital budgets within the forthcoming spending review? So much of the success of transforming services depends on the upfront funding to get things going and sometimes double running so that we can get a new service up and running before an existing service closes down. Will the Secretary of State go further in talking about the role and importance of capital budgets?
I also really welcome the triple integration—not only between health and social care, but between mental and physical health and between primary and hospital services. Could the Secretary of State confirm and support the proposal in the long-term plan that the legislative tweaks that will support that much needed integration will come from the NHS itself? I confirm that the Health and Social Care Committee remains committed to subjecting those proposals to pre-legislative scrutiny. Will he meet me to see how we can take that forward?
Matt Hancock
Yes, I would be very happy to meet my hon. Friend to discuss the legislative changes. These changes have been proposed by the NHS. The NHS wants the changes set out at a high level in the plan. Of course there is a lot of consequential work to do to turn them into a full legislative proposal. The NHS is working on that. If it does that alongside and working with the Select Committee, I would be very happy to meet with her to discuss how that might happen. This is very much the NHS’s proposed legislation and I look forward to discussing it with her.
Liz Kendall (Leicester West) (Lab)
I am glad that the Secretary of State says that he will listen to clinicians if they want to change primary legislation. I just think that many of those clinicians and many Labour Members wish that he and his colleagues had listened to us when we warned about the problems with the Lansley legislation six years ago. But let us put that to one side. The biggest challenge facing the NHS is indeed the increase in the number of older people with two, three or more long-term chronic conditions. They need more joined-up services in the community and at home. The local NHS has been asked to put forward its plans for these new services by April. It cannot do so without proper long-term funding for social care. So will we hear about that in the Green Paper before April—yes or no?
Matt Hancock
When I answered a previous question on the timing of the social care Green Paper, I said it would be provided “soon.” I certainly intend that to happen before April. My previous commitment was to do it before Christmas, so it is well advanced. But the hon. Lady is right on the legislative proposals. There is a broad consensus on the need for more integration, as my hon. Friend the Chair of the Select Committee said. The proposals that are made by the NHS in the paper are what it thinks is needed in order to deliver this integration, which I very strongly support.
Sir Nicholas Soames (Mid Sussex) (Con)
No doubt my right hon. Friend is gratified, as would be the Churchill-led National Government of 1944, by how truly remarkable and amazing the national health service, the baby of that Government, has turned out to be. Will he assure me that this money does not come without strings and that he will enforce a much better system of lessons learned and, in particular, of disseminating best practice more widely through the NHS? Finally, will he please kick the work of the sustainability and transformation partnerships into some form of prompt result?
Matt Hancock
When I referenced Churchill, I did not realise that it would be in front of his family. My right hon. Friend is quite right about the need for a just culture—a need for understanding the lessons that are learned when things go wrong—in what is a high-risk business of providing medicine and medical care. Those lessons should be properly learned and there should be transparency and openness and a culture of constantly improving the way that things are done, whether that is medically, logistically or organisationally in hospitals. That is a critical part of the review that Baroness Dido Harding will take forward. It is something that she cares deeply about, making sure that we get the culture right within the workforce not only to tackle the high levels of bullying and harassment, which are completely unacceptable in the national health service, but to make sure that there is a spirit and a culture of continuous improvement and of learning from errors that everyone makes. All of us make errors, and we should learn from them and that culture should be inculcated right across the NHS.
Norman Lamb (North Norfolk) (LD)
The Secretary of State was absolutely right to commit in his statement to ending the inappropriate hospitalisation of people with learning disability and autism, but the long-term plan itself postpones for five years the ambition of reducing by 50% the number of people who are in institutions. Mencap has described that as disgraceful. It amounts to abandoning the current plan to reduce the number by 50% by this March and it effectively tells the system to take its foot off the brake and will result in people continuing to be treated as second-class citizens, and continuing to have their human rights abused. I urge him to rethink this outrageous long postponement of an absolute imperative to get people out of institutions and to give them a better life.
Matt Hancock
I have a lot of sympathy with the right hon. Gentleman’s argument. The target for this March, which I inherited, was for a reduction of a third to a half. We are at a reduction of over 20%. The challenge has been that, while the number of people who are being moved into community settings has proceeded as per the plan, more people have been put into secure settings. This is an area that I care deeply about getting right, and I very much take on board the response of Mencap and the right hon. Gentleman to the proposals.
Anna Soubry (Broxtowe) (Con)
I congratulate the Secretary of State on his plan. As a former Minister of public health, let me say how delighted I am and how much I agree with him that prevention is better than cure. As Governments of all shades have said for a long time, the reality is that people must take more responsibility for their own health—notably to keep their weight down and to take more exercise. This is all good messaging, but the problem is that obesity and being over-weight is an increasing problem, especially among the young. What new messages—what new approach—will we have to public health if he is really going to make the sort of progress that we need to make?
Matt Hancock
My right hon. Friend is absolutely right. Throughout this statement, Opposition Members have been murmuring from a sedentary position about the public health budget. Let me address that directly. The public health budget, which was devolved five years ago with widespread acclamation across the House, has been set and will be set in the spending review. We are putting an extra £20 billion into the NHS—the scale far dwarfs individual budgets—and the whole long-term plan is about prevention being better than cure. The public health budget is important, and it is being delivered well because it is being delivered by councils in concert and tied to other subjects. The truth is that we are having the whole NHS focus on the prevention strategy, not just one individual budget; those who concentrate on just one budget are missing the point.
Several hon. Members rose—
Meg Hillier (Hackney South and Shoreditch) (Lab/Co-op)
I am heartened that Baroness Harding is looking at the staffing side of things, but she does have a mountain to climb. Let me remind the Secretary of State that the last time the NHS went out to recruit GPs, it ended up with fewer GPs at the end of the year than it had had before. That is not to mention the pension cap put in place by his former mentor—or maybe his current mentor—the former Chancellor, which now means that there is a problem with the retention of senior clinical staff. We can add to that list the immigration rules and pay ceiling. Is the Secretary of State lobbying the Home Office and the Treasury, particularly to deal with the £30,000 cap and the pension cap?
Matt Hancock
I welcome much of the tone of the hon. Lady’s remarks. The truth is that it is critical to ensure that we have the workforce and the people to deliver the plan. There is a whole section of this plan, as well as ongoing work, to deliver that. I want to clear up this point: in the immigration White Paper published by the Home Secretary before Christmas, as now, there is no cap on recruitment numbers for nurses and doctors. The proposal is that the cap will not necessarily apply within a shortage occupation. We will be recruiting people from around the world to work in our NHS.
Dr Andrew Murrison (South West Wiltshire) (Con)
I very much congratulate my right hon. Friend on the 10-year plan and on his announcement of the Harding review. Will Baroness Harding look particularly at the way in which pay and pensions are structured for general practitioners and pinch-point specialists within the NHS, since they are retiring or going part time at the moment—a full 10 years before the time they had anticipated when they went to medical school?
Matt Hancock
We are already looking at that subject. It is very complicated because of the nature of assets owned by GPs—their value having risen sharply over the last generation. However, we have record numbers of GPs in training. Although we need to ensure that we retain more GPs and encourage as many as possible to be full time, we have successfully breached our target; we are training more GPs than we had planned to, and that is a good thing.
Diana Johnson (Kingston upon Hull North) (Lab)
I welcome the focus in the long-term plan on the most common causes of mortality—cancer, heart disease, stroke and lung disease—and on cutting the risk factors. However, will the Secretary of State just explain to me how cuts to public health budgets and the fact that the comprehensive spending review is much later in determining the money that will be made available for public health can be part of a joined-up plan to start dealing with some of these diseases?
Matt Hancock
There is £16 billion ring-fenced for public health in this spending review. Crucially, we want the whole NHS to be focused on keeping people healthy as well as curing them when they are ill. Yes, of course it is a matter for that one budget in the spending review process, but it is also a matter of the whole £148 billion a year that will be going into the NHS.
Martin Vickers (Cleethorpes) (Con)
I welcome the Secretary of State’s plan. He will be aware that our constituents value receiving treatment as locally as possible. Will he give an assurance that he will do all he can to ensure that district general hospitals are there to provide most of these crucial services?
Matt Hancock
Yes. I am a strong supporter of district general hospitals and community hospitals. So often, local matters because it matters to patients and their families. If someone is having a highly complicated procedure, they will want to be in the very best place in the country—or, indeed, in the world—but often they will want to be close to home as well. That matters for small hospitals and district general hospitals such as the one on which my hon. Friend’s constituents rely so much.
Ms Angela Eagle (Wallasey) (Lab)
The Secretary of State has waxed lyrical today about the NHS becoming a learning organisation, being transparent and admitting its mistakes. Will he therefore set the trend and lead by getting up at the Dispatch Box and apologising to this House for the fragmentation and chaos caused by the Lansley Act?
Matt Hancock
We will listen to and learn from what clinicians say about what legislative changes are needed now. This document is all about concentrating on what is the right thing for the future, rather than the blame culture that we are trying to get rid of in the NHS.
Sir Patrick McLoughlin (Derbyshire Dales) (Con)
I very much welcome my right hon. Friend’s statement and the fact that he has been able to announce future spending so that hopefully the planning for how those resources are spent can be done properly. Will he also bear in mind that, during the period of the national health service, some 60% of the time there has been a Conservative Secretary of State, which shows very much the support and commitment of the Conservative party to the health service? Regarding the money that he is talking about, what will he do to ensure that people see and understand what is being spent locally?
Matt Hancock
As my right hon. Friend says, from its inception and the first White Paper throughout most of its history, the NHS has been supported and nurtured by a Conservative Secretary of State, and long may that continue.
Grahame Morris (Easington) (Lab)
I want to concentrate on cancer services. I have tried to be very positive and to engage with Ministers through the all-party parliamentary group on cancer, but I must express my disappointment at chapter 3. The Secretary of State referred to paragraph 3.51 on cancer, particularly in relation to some of the new investments. Practicalities and resources must be linked to the ambition to improve outcomes, so we need early diagnosis and cost-effective treatment. For example, this country has the second worst survival rate in Europe for lung cancer; only Bulgaria is any worse. The “Manifesto for Radiography” by professionals, oncologists and so on set out some specific asks, including a one-off investment of £250 million in advanced radiotherapy and an additional £100 million a year to support that investment with trained staff. I am afraid that the Government’s plans set out in the 10-year plan fall far short of that, so I do hope that the Secretary of State will look at that again.
Matt Hancock
We very much agree with the thrust and purpose of the hon. Gentleman’s remarks. In fact, paragraph 3.56 sets out how we are learning from what has happened in Liverpool and elsewhere in the country to make sure that we get early diagnosis right because, as he says, early diagnosis is absolutely critical. I will take away his specific points, but the whole thrust of the plan with regards to cancer is about increasing early diagnosis.
Justine Greening (Putney) (Con)
In a local community survey that I am doing right now, mental health is particularly flagged up by people as a priority for them, as well, so I very much welcome the Secretary of State’s continued focus on that in this 10-year plan. I also very much welcome the fact that as part of the work with the Department for Education, the trailblazer area in south-west London will enable us to really see some of the more joined-up working that he talked about. Will he set out what the additional services available for young people up to the age of 25 will mean practically? I represent a very young constituency, and that will be a key change that could benefit us.
Matt Hancock
At the moment, as somebody transitions from children’s mental health services to adult mental health services, there is often a gap in provision as they register for the adult services. The purpose of having the new care plans up to the age of 25—similar to those, for instance, for care leavers that we have brought in in other legislation—is to make sure that there is a seamless transition from children’s mental health services to adult mental health services and not a gap that many, many people fall through.
Mr Clive Betts (Sheffield South East) (Lab)
Let me bring the Secretary of State back to the issue of public health. He seems to be saying that this is only a small grant and therefore not really very important compared with spending on the NHS as a whole. May I draw his attention to the wording in the long-term plan where it says that action by the NHS
“is a complement to, but cannot be a substitute for, the important role of local government”?
That role has been undermined by £700 million of cuts to public health grants in the past five years. Will he now recognise that if we are going to get a proper joined-up approach to ill-health prevention, he needs to give a commitment that in future the public health grant will increase, in real terms, at least by the same amount as NHS funding as a whole?
Matt Hancock
I certainly did not say that the public health grant was small—I said that it was £16 billion over the last spending review period. But NHS spending as a whole, by the end of this five-year funding settlement, will be £148 billion every year. Therefore, turning the firepower of the whole NHS to keeping people healthy in the first place will play a huge role in this. Of course, the public health grant has to be settled as part of the spending review, but the idea that that is the whole of everything with regard to preventing ill-health is missing the point.
Vicky Ford (Chelmsford) (Con)
In the week before Christmas, when we mere mortals were just looking forward to a holiday, the Secretary of State did an all-night shift in Milton Keynes University Hospital and then travelled to Chelmsford, where he visited my brand new medical school and did a “Dragons’ Den” with medical entrepreneurs who are finding new ways to use technology to treat their patients. May I thank him for his super-energy, and does he agree that supporting staff and embracing innovation is also key to our NHS?
Matt Hancock
Yes, it was a joy to make that visit. We found ourselves in a new medical school in a room where the students were enjoying a dissection—my goodness, after a night without sleep it was quite a thing. It was a joy to go there with my hon. Friend and I agree with both the points she made.
Jim Shannon (Strangford) (DUP)
I, too, congratulate the Secretary of State on the NHS 10-year long-term plan. There are between 6,000 and 8,000 rare diseases. One in 17 people, or 6% of the population, will be affected by a rare disease in their lifetime—that is 3.5 million people in the United Kingdom. Will he confirm a commitment to assisting those with rare diseases, and can the NICE process for new life-saving drugs be urgently speeded up so that more lives can be lightened and saved?
Matt Hancock
I strongly agree with the hon. Gentleman. For those who have rare diseases, diagnosis takes seven years, on average, and genomics can bring that down to a matter of seven days, in the best cases. We are the world leaders in genomics and we are going to stay that way. We have reached the 100,000 genome sequence and we are going to take it to 1 million, with 500,000 from the NHS and 500,000 from the UK Biobank. He is absolutely right. This is one of the bright shining stars of the future of healthcare, and Britain is going to lead the way.
George Freeman (Mid Norfolk) (Con)
As a former Health Minister, I congratulate the Secretary of State and the Government on this statement. I particularly pay tribute to his work on mental health—I am proud that under this Government it looks as though we are finally beginning to close the gap and stop mental health being the Cinderella service—and on early diagnosis of cancer. I also welcome his espousal of the work on genomics, which I, as a former Minister for life sciences and health technology, and others were involved in setting up. Does he agree that if we are really going to drive the revolution of accountability, productivity and local engagement, the accountable care pilots offer us the chance to really measure and drive digital communities of healthcare where we reward communities that promote health and wellbeing?
Matt Hancock
Yes, I do. I pay tribute to the work that my hon. Friend did in putting together the areas of the NHS where this is already working. We want to spread that success more broadly across the NHS to make sure that we seize these very exciting opportunities as well as deal with the important day-to-day challenges that the NHS faces.
Emma Hardy (Kingston upon Hull West and Hessle) (Lab)
On 29 December, two young people, one of them aged only 24, committed suicide by jumping from the Humber bridge in my constituency. Since I first commented on this, I have been inundated with comments from local residents detailing the inadequate mental health support that they have. Unfortunately, the Humber bridge is becoming a place that people choose to visit when they are feeling desperate and as though there are no other options. Partly for this reason, can I ask the Secretary of State to commit—not in 10 years, or even in one year or six months, but right now—to providing more money for the Humber NHS Foundation Trust so that we can help to support people when they are feeling so very desperate?
Matt Hancock
I will absolutely look into the request that the hon. Lady makes. The example that she gives locally in Hull is actually reflected across the country in terms of the need for greater access. For the first time, we are going to have access targets for community mental health, because it is critical to make sure that we have accountability and understand what is happening in mental health trusts in terms of access so that we can then drive policy to meet it. But I appreciate that that is a medium-term goal: in the short term, she has made a specific request for a specific organisation, and I will absolutely look into it and write to her.
Mr Marcus Jones (Nuneaton) (Con)
Mental health issues are often part of the very complex causes of rough sleeping. They are also a barrier to getting rough sleepers off the streets. Will my right hon. Friend say more about how his plan fits in with the Government’s plan to eradicate rough sleeping?
Matt Hancock
Yes, my hon. Friend is absolutely right about this. I pay tribute to the work that he did as a Minister in this area. We have put forward £30 million to support mental health services for rough sleepers. It is about so much more than just the money, though—it is about co-ordinating care and co-ordinating different agencies. There is a lot of work going on on this inside Government that he was very much involved with.
Andy Slaughter (Hammersmith) (Lab)
My clinical commissioning group has to make more than £40 million of cuts in the next 15 months and is proposing to cut GP and urgent care centre opening hours. It also has an £11 million risk thanks to the predatory private “GP at hand” scheme, of which the Secretary of State is a member. We have had GP practices suspended, palliative care beds closed, and our major hospital under threat of demolition for seven years. Will he accept that the self-regarding statement he has just made will be unrecognisable to people who work in and use the NHS, which is reeling from the crisis that his Government have caused?
Matt Hancock
I will take advice and consideration from many people, but not from the hon. Gentleman, who for seven years has run a frankly outrageous campaign based on scare stories about hospital closures that are totally unreasonable, unrealistic and wrong. He will never be somebody I listen to, because I care about improving the future, not political point-scoring.
Kevin Foster (Torbay) (Con)
Last Friday, it was a pleasure to meet the chief executive and chair of my local hospital trust to discuss the new A&E department and the new mental health ward that will be built on the site of Torbay Hospital over the next year. Does the Secretary of State agree that it also vital that we have the local services around mental health, in particular, because in the past we have seen far too many people from Devon being sent elsewhere, across the country, and that this investment will now bring that to an end?
Matt Hancock
Yes, absolutely. My hon. Friend is a brilliant advocate for Torbay and for the English Riviera, and has made the case so strongly for his local hospital. I was delighted that we could recently find the funding to support the case that he and local clinicians have made, and I look forward to working with him to make it a reality.
Karin Smyth (Bristol South) (Lab)
Before coming to this place, I was a senior manager in Bristol’s primary care trust and then the CCG. I want to pay tribute to the NHS managers who have kept the ship afloat since the Lansley reforms. Today’s plan is clear in its commitment to triple integration and seeking to free commissioners from the barriers to integration in the 2012 procurement rules, but tomorrow the CCG in Bristol will embark on a huge re-procurement process for some community services for the next 10 years based on those old rules. In the light of his plan, will the Secretary of State intervene locally and support my call to pause that divisive community services re-procurement?
Matt Hancock
I will raise the hon. Lady’s point with NHS Improvement, which considers these things. Local provision of services should, rightly, be decided by local clinical priorities, but she makes a cogent point that I will raise with NHSI, and I will ask its chief executive, Ian Dalton, to write to her.
Henry Smith (Crawley) (Con)
I declare an interest, as chair of the all-party parliamentary group on blood cancer and the APPG on heart and circulatory diseases. I very much welcome this plan’s focus on those areas. In tribute to my caseworker, Susan Lester, who sadly passed away last week from pancreatic cancer, can I have an assurance from the Secretary of State that he will continue to work with voluntary sector organisations such as Bloodwise, the British Heart Foundation and Pancreatic Cancer UK?
Matt Hancock
Yes, of course. I am sure the whole House will join me in passing on our condolences to the family, friends and colleagues of my hon. Friend’s caseworker. He is doing right by her in raising that issue in the House. Of course we will keep working with those organisations, which do brilliant work. In fact, there is an event in the Commons tomorrow with Bloodwise, which the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Winchester (Steve Brine), will attend.
Seema Malhotra (Feltham and Heston) (Lab/Co-op)
Before Christmas, I attended the inaugural event of the Addie Brady Foundation, in memory of 16-year-old Addie, who died a year ago from a brain tumour—her second primary cancer. She was affected by a rare genetic condition called Li-Fraumeni syndrome, a feature of which is a high risk of cancer and repeat cancers. Her family, other families and an international panel of experts have been campaigning for a national screening programme for people suffering from Li-Fraumeni syndrome. Can the Secretary of State confirm whether his announcement today includes much needed Li-Fraumeni syndrome screening on the NHS, particularly for children, which would extend and save lives?
Matt Hancock
I will certainly take up the hon. Lady’s suggestion with Mike Richards, who is running a review of our screening programmes to ensure that they are all fit for purpose, run as effectively as possible and targeted at the right people.
Tom Pursglove (Corby) (Con)
I am delighted to hear my right hon. Friend talk at length about prevention. In that vein, what role does he see for initiatives such as the daily mile in schools, which allows young people to get into the thrust of getting involved in sporting activity and sets them up for life?
Matt Hancock
My hon. Friend makes an important point. Things like the daily mile, which I have participated in, are an incredibly important part of this. Prevention is about public health and the whole NHS, but it is also about more than that. We talk a lot in the House about the rights that the NHS gives us—the right to care that is free at the point of use, according to need—but we also need to talk about the responsibilities that we have, including the responsibility to use the service wisely and the responsibility to ourselves and our communities to keep ourselves healthy. That part of the debate needs to continue and be strengthened, at the same time as ensuring that the NHS is always there for us.
Mr Kevan Jones (North Durham) (Lab)
Under the Government’s public health proposals, County Durham will lose 38% of its budget—or £19 million. The Secretary of State said that we should be listening to clinicians. Clinicians in County Durham are clear that they want that budget protected. Can he tell me what those clinicians are missing? Is it not a fact that this Government are quite clearly going to remove money from deprived areas such as County Durham, while more leafy areas, including Surrey, have an increase in their budgets?
Matt Hancock
That is obviously not right. Indeed, there is a whole section of the plan on reducing health inequalities, which is extremely important.
Rebecca Pow (Taunton Deane) (Con)
I very much welcome this plan, its ambitions and the Government’s commitment to it. Does my right hon. Friend agree that one of the biggest obstacles to a fully functioning health service is the fact that information cannot be easily shared between many centres? There are myriad systems, which means that data cannot be accessed from one centre to another. When it comes to care, the professionals are brilliant and must be praised, but this situation is causing distress, and it slows diagnosis and wastes patients’ time. I speak from a great deal of personal experience, unfortunately, having spent too long in the NHS with family members. Can he give an assurance that that will be addressed by the plan?
Matt Hancock
Yes. I feel strongly about this. Chapter 5 of the plan is all about digitally enabled care. The interoperability of data between systems in different parts of the NHS is mission-critical. Over Christmas we published proposals for the interoperability of primary care systems, and we will roll that out in the hospital sector as well, so that people can access their own patient record and the clinicians who need to see it can access the whole record. Instead of having to phone each other up to find out what is going on with a patient they once had, they should be able to look at the record.
Nic Dakin (Scunthorpe) (Lab)
I welcome the Secretary of State’s recognition that the staff are at the heart of the NHS and join him in thanking them for their excellent work, but there are 40,000 nursing vacancies today. How many nursing vacancies will there be at the end of 2019, and how many will there be at the end of 2020?
Matt Hancock
I know that the hon. Gentleman takes a close interest in that, as chair of the all-party group. Obviously we need more nurses. The vacancies are, in many cases, filled by temporary staff, but that is not the best way to manage things. We need more nurses and more doctors. I am glad that we have a record number of GPs in training. In the plan, we have made provision for a 50% increase in the number of clinical placements. We have a whole programme, including the Harding review, to take this forward and ensure that it happens, because the NHS is, at its heart, delivered by its people.
James Morris (Halesowen and Rowley Regis) (Con)
I welcome the Secretary of State’s statement and in particular the continued commitment to increase funding for mental health and build on the work already done through the five year forward view. Does he agree that one of the challenges in implementing those changes is ensuring that funding gets to the frontline through commissioning decisions? That has been one of the obstacles to generating real change on the ground and achieving the goal of parity of esteem between mental and physical health.
Matt Hancock
My hon. Friend is absolutely right. We need not only more funding for mental health, which is in the plan, but more joined-up delivery of mental health services. Since the birth of the NHS, mental health services have been separate from physical health services, but treatment needs to be for the whole person—their physical, mental and social health. We need not only the money but the join-up, and my hon. Friend the Member for Thurrock (Jackie Doyle-Price), the Mental Health, Inequalities and Suicide Prevention Minister, is working closely on that.
Laura Smith (Crewe and Nantwich) (Lab)
I agree with the shadow Secretary of State completely. I do not feel satisfied that the Secretary of State recognises the urgent need to reverse cuts to social care budgets alongside this plan. Does he see that savings made by reducing avoidable admissions and delayed transfers of care could go towards delivering a more ambitious 10-year plan for our NHS?
Matt Hancock
As I have said, after I became Secretary of State, we put £240 million extra into social care, and there will be £650 million next year.
Dr Matthew Offord (Hendon) (Con)
I congratulate the Secretary of State on this announcement and particularly on the increase in spending, which is more than the Labour party promised at the last general election. The vital point of today’s announcement is the publication of the plan, which has been decided by clinicians, so that they can tell politicians what is right for the NHS. Will he thank the clinicians for that work? We want to take party politics out of the NHS.
Matt Hancock
My hon. Friend is quite right: we must focus on the substance of what is needed to deliver an NHS that will be there for us all in our hour of greatest need. That is what we should be concentrating on. I have heard some Members say, “Whatever the Government promise, we will just promise more.” That is no way to have a discussion about the future of the country and our most valued institution. Instead, we should back the NHS’s plan, deliver on it and keep the economy strong so that we can keep putting in the money that the NHS needs.
Liz McInnes (Heywood and Middleton) (Lab)
Paragraph 4.17 of the plan states:
“Mature students are more likely to have family and other commitments that make it harder to retrain without financial support.”
Will the Secretary of State therefore now admit that his Government made a huge mistake when they abolished bursaries for nurses and allied health professionals?
Matt Hancock
No; we are proposing to have more targeted support for those who need it, to ensure that we get support to the areas of nursing with the most acute shortages, such as community nursing and mental health services. That is where support is best targeted.
Bim Afolami (Hitchin and Harpenden) (Con)
My constituency is one of the 25 trailblazer areas that will have new mental health support teams working in and around schools. Will the Secretary of State give further details on what this plan will do to deliver improved mental health services on the ground, particularly for young people in schools?
Matt Hancock
Supporting children with mental ill health is an incredibly important part of the plan, from early intervention on anxiety and depression through to support for those with more serious mental health conditions. It means that there will be dedicated support that can link with schools’ mental health services and help signpost in what is often a complicated system. The Mental Health Minister, my hon. Friend the Member for Thurrock, has already agreed to meet my hon. Friend to discuss this further. It is an important and welcome intervention.
Paul Farrelly (Newcastle-under-Lyme) (Lab)
When our local sustainability and transformation plan was submitted in October 2017, it projected an annual deficit in health and social care in Staffordshire and Stoke-on-Trent of £542 million by 2020-21, which is more than double the £250 million projected at the time of the 2015 general election. That shows the scale of the problem, because there are more than 40 STPs across England. Will the Secretary of State write to me with some numbers to show how this long-term plan will help our local STP with the extra revenue and investment needed to transform services so that we do not face a litany of unsustainable cuts, notwithstanding those in the years immediately to come?
Matt Hancock
Of course we are putting more money in, and in the coming days we will announce the local provision increases for the first year—there is a £6 billion cash uplift in year 1. We will be working with local areas in the months ahead on the plans for years 2 to 5.
Robert Courts (Witney) (Con)
In the past few weeks I have visited Witney Community Hospital, the Windrush surgery, the Nuffield health centre and the associated nearby pharmacies, and I have seen not only their brilliant winter preparedness but how they form a hub for care close to home. Does my right hon. Friend agree that ensuring that people are treated in the community and improving public health is the way to ensure that we have free, high-quality care for everybody?
Matt Hancock
My hon. Friend is absolutely right. The community hubs being developed in many different parts of the country are critical in bringing together support and enabling early intervention. The adage that a stitch in time saves nine is almost as old as “prevention is better than cure,” but both are equal in their wisdom.
Ms Karen Buck (Westminster North) (Lab)
Money might not be everything, but transforming a service against a background of real-terms cuts is almost impossible. The Central London clinical commissioning group is in the middle of a 13% real-terms cut, the West London clinical commissioning group is having an 8% real-terms cut, real-terms cuts are being made in mental health services, and Westminster City Council has cut 31% of its funding for social care. Can the Secretary of State indicate whether inner-London residents will see any benefit as a result of this plan?
Matt Hancock
As I said a moment ago, local allocations will be published in the coming days.
Bob Blackman (Harrow East) (Con)
One of the most effective ways of reducing avoidable deaths is to stop people smoking in the first place, and to encourage those who do smoke to give up as fast as possible. How will this plan encourage pregnant mothers, 11% of whom still smoke, to give up smoking and get their partners to give up, and how will it encourage young people not to start in the first place?
Matt Hancock
My hon. Friend is absolutely right. When people are in hospital, there will now be much more aggressive provision of counselling and support to stop them smoking. It is also about targeting support, rather than treating everyone the same and giving them the same messages. It is absolutely right to include micro-targeting and to use social media to communicate with people. There are luddites who say that we should not use these modern approaches, but we on the Government Benches believe in the future.
Debbie Abrahams (Oldham East and Saddleworth) (Lab)
I am pleased that the Secretary of State is keen to improve public health and reduce health inequalities, and I assume that he will therefore support my new clause 5 to the Finance (No. 3) Bill, which is specifically about ensuring that the Government’s economic policies reduce health inequalities. On social care, is he aware that in 2017 alone 50,000 people with dementia had an emergency hospital admission because there was not adequate social care? What will he do to ensure that his plan, which we are still waiting for, will avoid such emergency admissions in 2019? Please do not say that more has been given in the Budget, because that is a sticking plaster compared with all the cuts that the Government have made in social care.
Matt Hancock
Page 32 of the document sets out details on the integration with social care that the hon. Lady rightly calls for. Clearly, ensuring better integration in cases of dementia is absolutely vital. Some parts of the country are doing that brilliantly with integrated commissioning, but we need to ensure that is spread across the whole country.
Matt Warman (Boston and Skegness) (Con)
I welcome this plan and the Secretary of State’s energy. When he visited Pilgrim Hospital in my constituency, he saw that this is not solely about money, because a huge chunk of the challenge that the NHS faces is about the workforce. Within the workforce plans in this 10-year plan, will he pay particular attention to under-doctored areas such as Lincolnshire, where it is a huge challenge to produce the same outcomes that we see in other parts of the country?
Matt Hancock
My hon. Friend is dead right. It was a real pleasure to visit Pilgrim Hospital in Boston, where my grandmother worked as a nurse for 30 years, and to meet the staff. He is absolutely right about the recruitment challenges that they face, which is why a whole chapter of the report, and ongoing work, is dedicated to improving recruitment. When we put £20 billion into a public service, of course we will need more people to deliver it.
Luke Pollard (Plymouth, Sutton and Devonport) (Lab/Co-op)
At this very moment, Derriford Hospital in Plymouth is on OPEL 4 alert—the new name for black alert. The real shame is that that is now so commonplace that it no longer always makes the news. Will the Secretary of State, who I know visited the hospital recently, explain whether the new NHS plan will address the structural inequalities in funding for the regions, especially the far south-west? Those inequalities often contribute to the underfunding of services, which is why our hospital is on OPEL 4.
Matt Hancock
I enjoyed my visit to Derriford Hospital’s night shift and learned an awful lot from it. One of the consequences of seeing what is happening on the ground is that we are providing it with a new A&E facility. We are putting tens of millions of pounds into the hospital, so it would be a bit better if the hon. Gentleman mentioned that as well as rightly raising concerns about performance. That funding was the result of the campaigning of the hon. Member for Plymouth, Devonport, who is an absolutely brilliant campaigner for his local community—[Interruption.] Yes, the Members for Devonport and for Moor View. I am a big supporter of Derriford Hospital and think it does a brilliant job, and in challenging conditions, but it is going to get a better A&E because we have provided the funding to allow it to do that.
Helen Whately (Faversham and Mid Kent) (Con)
I welcome the commitment to mental health in the NHS long-term plan, particularly the badly needed new care model for young adults, the commitment to more care for people with severe mental illnesses and the further expansion of mental health liaison services in A&E. I also welcome the commitment to more performance standards for adults with mental illnesses. Will my right hon. Friend make sure that those mental health standards are introduced sooner rather than later, so that we do not have to wait too long for the waiting time standards? Transparency is so important for the parity of esteem between mental health and physical health.
Matt Hancock
My hon. Friend is absolutely right. Those standards are being trialled at the moment. Of course we want to get them right, but we will look at the results of those trials as soon as we can.
Mohammad Yasin (Bedford) (Lab)
The Bedfordshire mental health trust told me today that the need for in-patient beds for men has increased. Will the Secretary of State urgently reinstate the in-patient mental health facilities in Bedford, which his Government removed, so that my constituents no longer have to travel at least 20 miles to access care?
Matt Hancock
Of course the provision of services locally is a matter for local clinicians, and it must be led by local clinicians. I am always happy to look at individual cases and, as with the other example, I will ask the NHS to write back to the hon. Gentleman with an explanation.
Alan Mak (Havant) (Con)
Upgrading the NHS’s technology is key to its productivity and its future, and it should include rolling out a new NHS app; phasing out outdated technologies such as fax machines; and adopting new fourth industrial revolution technologies. What progress has the Department made in those areas?
Matt Hancock
My hon. Friend is dead right. There is a whole chapter in the plan on using new technologies not only to improve care but to make care more convenient. He has been a doughty campaigner for the use of technology in health services. His trip to my local hospital to understand these issues went down incredibly well locally, and I hope he keeps pushing us to do the best we can.
Lilian Greenwood (Nottingham South) (Lab)
How can it possibly make sense that, when the Health Secretary is targeting much needed support towards areas of high deprivation, the Secretary of State for Housing, Communities and Local Government is cutting funding for social care and public health, and cutting deepest in cities such as Nottingham with high levels of poverty? Is that not actively undermining the Health Secretary’s stated ambition to improve health and reduce inequality?
Matt Hancock
In debates on the future of our nation’s healthcare, we should always start with the facts, and the fact is that social care funding is going up. It went up by £240 million this year, and it is going up next year, too.
Mr Philip Hollobone (Kettering) (Con)
Adult social care is not working properly in Northamptonshire, with far too many delayed transfers of care for elderly people. With the root-and-branch reform of local government in Northamptonshire, there is a wonderful, unique opportunity to create successful integrated health and social care pilots. Will the Secretary of State seize this opportunity and get the 10-year NHS long-term plan off to a wonderful start in Northamptonshire?
Matt Hancock
Yes. I have discussed the proposals made by my hon. Friend and his Northamptonshire colleagues with the Secretary of State for Housing, Communities and Local Government. We are both enthusiastic to see what can be done, and I invite my hon. Friend into the Department to speak to my officials about how this could be done. His proposals are, by design, entirely consistent with the proposals in paragraph 1.58 of the long-term plan, and I very much look forward to working with him and his Northamptonshire colleagues on making it happen.
Rachael Maskell (York Central) (Lab/Co-op)
Health visitors are vital to delivering early intervention and prevention, yet their numbers are in freefall—falling by 23.5%, or 2,425 health visitors, since October 2015. Health visitors are now working with dangerous caseloads, so when will the Secretary of State ensure that we have safe delivery of health visiting services?
Matt Hancock
The hon. Lady is dead right. Of course, health visitor numbers went up very sharply between 2010 and 2015. In fact there is a proposal in the plan, and the NHS will be discussing with Government the best way to commission health visitors. Health visitors are clearly a health service but, at the moment, they are commissioned by local authorities. We look forward to working with the NHS and with the Ministry of Housing, Communities and Local Government on how best we can commission health visitors in future, because they are a critical part of maternity services.
Christian Matheson (City of Chester) (Lab)
Over the holiday period, another young woman tragically died of cervical cancer, which she contracted before the age of 25; therefore, she was not able to have a smear test. Will the Secretary of State, as part of this review, remove that ridiculous and utterly arbitrary age limit so that, where a GP believes a female patient needs a cervical smear, they can have one irrespective of their age?
Matt Hancock
I entirely understand the hon. Gentleman’s argument. He is a reasonable man who makes reasonable arguments, and I will take it up with Mike Richards, who is running the screening review. I will ask Mike to write to him specifically on that point and to take it into account.
Alison Thewliss (Glasgow Central) (SNP)
As the chair of the all-party parliamentary group on infant feeding and inequalities, I am glad that the long-term plan has a commitment to improving maternity services in England. The announcement on 30 December said that the UK Government are
“asking all maternity services to deliver an accredited, evidence-based infant feeding programme in 2019 to 2020, such as the UNICEF Baby Friendly initiative”.
What does the Secretary of State mean by “such as”? UNICEF Baby Friendly is the gold standard, as recognised by Scotland and Northern Ireland, which have 100% accreditation, but England has only 60% accreditation. Does he also acknowledge the need for community-based infant feeding support, such as peer supporters and health visitors, because it cannot just stop at the hospital door?
Matt Hancock
I pay tribute to the hon. Lady’s work as chair of the all-party parliamentary group on infant feeding and inequalities. She makes a strong and passionate case for breast feeding. I do not want to let the best be the enemy of the good. The proposal she cites is a proposal from the NHS. Of course, if other such services come forward, why should we be against it? I want to be clinically led in this area, but I very much support the thrust of her argument.
Mike Hill (Hartlepool) (Lab)
The people of Hartlepool lost their A&E several years ago, and there is a powerful argument for the return of those services. On the subject of urgent care, what measures does the Secretary of State intend to take to help our overstretched ambulance services?
Matt Hancock
There is extra support for ambulance services in the plan, which is incredibly important. The targets and accountability measures for ambulances were reviewed this time last year, and we now need to make sure that the whole ambulance service gets the support it needs.
Matthew Pennycook (Greenwich and Woolwich) (Lab)
Will the Secretary of State update the House on the review of the tariff process in relation to his statement? Specifically, what will be the impact on NHS trusts in London of changes to the market forces factor? I am concerned that those changes will mean that London loses out when it comes to the funding to be allocated in his plan.
Matt Hancock
Of course we want to make sure that the funding is allocated fairly, and we want to make sure that all the different factors that count towards and cause different costs in different parts of the country are properly taken into account, whether it is rurality or the market forces factor, so called because of the differences in relative costs. I will write to the hon. Gentleman with the full details in the coming days, but what matters here is to make sure that we are clearly led by the evidence.
Mental Capacity (Amendment) Bill [Lords]
Matt Hancock ExcerptsTuesday 18th December 2018
(6 years ago)
Commons ChamberRead Full debate Mental Capacity (Amendment) Act 2019 View all Mental Capacity (Amendment) Act 2019 Debates Read Hansard Text Read Debate Ministerial Extracts Amendment Paper: HL Bill 147(a) Amendment for Third Reading (PDF) - (5 Dec 2018)
The Secretary of State for Health and Social Care (Matt Hancock)
I beg to move, That the Bill be now read a Second time.
Every Member of this House will agree that we have a duty of care to the most vulnerable in our society, and that everybody deserves to be treated with dignity and respect, no matter what their physical or mental condition. I hope that the House will also agree that liberty is a fundamental right, and that no decision on the deprivation of liberty can ever be taken lightly. Such decisions can be taken only to protect society or individuals. There are currently 2 million people in this country who have impaired mental capacity. Care homes and hospitals often have to take decisions to restrict people’s movements in order to protect them. That could involve preventing elderly people with dementia from moving, or stopping vulnerable people getting access to things that they could use to self-harm. The present deprivation of liberty safeguards are meant to ensure that people who lack the capacity to make decisions for themselves are not deprived of their liberty unfairly or unnecessarily, but the current system is broken and needs to change.
Mr Tanmanjeet Singh Dhesi (Slough) (Lab)
What assurances can the Secretary of State give us that local authorities will be given sufficient resources to allow them to process all deprivation of liberty cases?
Matt Hancock
The resource question is an important one, and so too is the process. The question of resources and the question of what the process is go hand in hand. There has been an increase in the amount of resources given to local authorities to enable them to deliver in this area, but the question will undoubtedly arise again as we run up to the spending review.
Mr Jim Cunningham (Coventry South) (Lab)
I visited a police station a couple of weeks ago, and I found that the police lacked adequate training to deal with some of the cases that they were coming across. Has the Minister had any discussions with the Home Secretary about that?
Matt Hancock
Yes, I have. This is an incredibly important point. The deprivation of people’s liberty in a police cell when there is a lack of mental capacity—or, in certain circumstances, when there is a serious mental illness—happens far too often. The purpose of police cells is to detain criminals. Providing a system in which such people do not have to be held in police cells is absolutely critical and part of our plan.
Several hon. Members rose—
Matt Hancock
I want to make a little bit of progress.
For many reasons, the current system is broken. Too many people do not have the protections they need because of a bureaucratic backlog. There are currently more than 125,000 people waiting to be processed, and nearly 50,000 people have been waiting for over a year.
Matt Hancock
I will give way to the right hon. Gentleman, who did a huge amount of work on this as a Minister in the Department.
Norman Lamb
I thank the Secretary of State for giving way. I share his view on the extent to which the current system is broken. He will be aware that the Bill came under substantial criticism in the House of Lords, and that substantial improvements were made to it there. There is a recognition, however, that there is still a long way to go. Will he commit to working with the Opposition parties and to meeting us and interested parties beyond Parliament to ensure that by the end of this process we have an agreed Bill that will actually improve people’s safety?
Matt Hancock
Yes, absolutely I will. I know that the right hon. Gentleman met the Minister for Care, my hon. Friend the Member for Gosport (Caroline Dinenage), yesterday to discuss this question. Of course this ought to be a collaborative process. Improvements were made to the Bill in the other place—I shall talk about those in a moment—but we recognise that further improvements could still be made. Ultimately, there is a careful balance to be struck between the need to protect people who do not have the full mental capacity to take care of themselves and the need to ensure that we do not deprive people of their liberty unnecessarily. That is a careful balance, and we should take this forward on the basis of open discussion and deliberation, rather than of a party political ding-dong.
Paul Blomfield (Sheffield Central) (Lab)
The Secretary of State is clearly right about the system being broken, and one aspect of that is the shockingly low rate of appeals under deprivation of liberty orders, which currently stands at about 1%. Although the case law has become clearer, in most situations there is a positive obligation on advocates to progress cases to court where somebody is objecting to their deprivation of liberty, either directly or even through their behaviour. In contrast, 47% of detention decisions under the Mental Health Act 1983 are appealed. The Bill’s impact assessment predicts that the number of appeals will halve under the new procedure. Given the amendments that were made to the Bill in the Lords, does the Secretary of State think that the Government should now review that figure?
Matt Hancock
All such considerations should be taken into account and looked at in Committee. We made changes to that area in the Lords, and we are determined to reach the right balance, but I take the hon. Gentleman’s important point seriously. Like anyone who has read the Bill, he will know that it makes a significant improvement in this area. Rather than cases being immediately passed on to the courts, there is a process in place both before the deprivation of liberty where that is possible, which is a big improvement, and then later on when the deprivation is questioned. I accept the thrust of the hon. Gentleman’s intervention, but the Bill makes significant progress, and if he has suggestions for how the details may be nuanced still further, we are all ears because this is very much a collaborative process.
Lyn Brown (West Ham) (Lab)
I am surprised that this Bill and the reforms to the Mental Health Act are not being considered at the same time. As I understand it, this Bill would allow clinicians and managers to detain somebody for up to three years without a renewal decision, which is much longer than is recommended for community treatment orders by the Wessely review. If both reforms are implemented, patients detained under the Mental Health Act could have the security of a shorter review period than those detained under this Bill. Will the Secretary of State tell me whether that is the Government’s intention or simply a mistake?
Matt Hancock
The hon. Lady is not quite right about the three-year period, because there are review points, meaning that it involves a twice-possible one-year extension, so she is not quite right about the relationship between that and what happens under the Mental Health Act. However, she makes an important point about the links between the Mental Capacity Act 2005, this Mental Capacity (Amendment) Bill and the mental health Bill that we propose to bring forward.
We considered putting the two Bills together, but we did not do that for two reasons. First, it would simply be a big Bill that included two separate regimes, and we would not want the full Mental Health Act powers to be applied across the board, and I think there is a broad consensus behind that. Secondly, the view of Sir Simon Wessely, who ran the review into the Mental Health Act, is that we need to get on with this while taking the time to get the Mental Health Act update right. Combining the two was seriously considered, and I considered it again when I became Health and Social Care Secretary and asked for further advice, but we came to this conclusion, which I hope the hon. Lady will support.
Mr Kevan Jones (North Durham) (Lab)
I do not disagree with Sir Simon Wessely’s conclusions about that, but the review does contain suggestions that could be transferred into this Bill. For example, the use of tribunals instead of the Court of Protection in some cases would make them a lot simpler, cheaper and better for the person involved.
Matt Hancock
The right hon. Gentleman is quite right. To start to deal with the serious number of cases that we need to make progress with, the interface between this Bill—hopefully on the statute book by then—and the Mental Health Act provisions will be considered as we develop the draft mental health Bill. The truth is that the current system causes unnecessary suffering, and the case for reform could not be more urgent. That is why we are bringing forward this Bill now. Age UK, the UK’s largest charity working with older people, says we have a crisis in the current system that is
“leaving many older people with no protection at all… If we lose this opportunity we’re unlikely to get another one in this Parliament and it is profoundly unfair on the older people and their families…to have to wait any longer…doing nothing is not an option.”
Melanie Onn (Great Grimsby) (Lab)
Has the Secretary of State had any discussions with the Justice Secretary about the application of the measures in this Bill upon those who are serving prison sentences, particularly indeterminate sentences?
Matt Hancock
I have had some discussions on that subject, and I am happy for the hon. Lady to take up that point in more detail either directly with me or with the Minister for Care, or in Committee, because there are significant interlinkages between the two areas.
The Bill builds on the extensive work and recommendations of the Law Commission. It has been fully scrutinised by the Joint Committee on Human Rights and then improved by the other place, as has been discussed. I am grateful for all that work. Ultimately, it is about striking a balance between liberty and protection.
John Howell (Henley) (Con)
My right hon. Friend mentions the Law Commission and its suggestions. What he proposes does not quite tally with all the Law Commission’s recommendations. Where are the differences?
Matt Hancock
We built the Bill on the basis of the Law Commission report, but we have put some differences into the Bill. For instance, we think the principle of prioritising people over process is important, and we have strengthened that compared with the Law Commission’s recommendations. The Law Commission improves the law but does not make policy decisions. On top of the Law Commission’s work, which is incredibly helpful, we have made further policy decisions to ensure that people are put more foursquare at the heart of the process. It is true that the Bill and the Law Commission’s recommendations are not exactly aligned, but I would strongly defend our further improvements.
Geraint Davies (Swansea West) (Lab/Co-op)
I have the privilege of chairing the all-party parliamentary group on speech and language difficulties. The Royal College of Speech and Language Therapists is concerned about the conflation of mental capacity with speech and language difficulties. It is important we have provision so that people with speech and language difficulties are appropriately assessed and are not banged up because they are thought to be dangerous. There should be enough training in light of the fact that 60% of people in the criminal justice system have speech and language difficulties.
Matt Hancock
The hon. Gentleman is absolutely right about the importance of getting highly trained social workers to make these judgments and about the importance of making sure such training is provided for and embedded in the Bill. He speaks powerfully, and I agree with how he puts it.
The Bill introduces a new liberty protection safeguards system, and it makes the authorisation simpler and more straightforward. It removes some bureaucracy and duplication, and it makes the system easier to navigate for individuals and their family. People will get their rights protections sooner, there will be greater independence when decisions are taken to restrict liberty, and the NHS and social care providers will be given a bigger role in the decision-making process so that people under their care receive the right care and their rights will be protected. It will introduce an explicit duty to consult the person being cared for and to consider their wishes and feelings.
Bob Stewart (Beckenham) (Con)
An appropriate person will be appointed when dealing with vulnerable people. Who are these appropriate people, and what will be their role?
Matt Hancock
An appropriate person will have greater involvement in any decision to restrict liberty, so their role is essentially to speak for those whose liberty is potentially being restricted. We have framed this in terms of an “appropriate person” because in large part this will be a family member or a carer, but that cannot always be the case.
Matt Hancock
It could easily be a carer, yes. Some people have no family and in others cases the family are not the appropriate people to be the spokesperson for those who are mentally incapacitated. The appropriate person—the families and carers—will have greater powers to intervene or to object. Crucially, where there is no family or an appropriate person to advocate for the individual, the person has the right to an independent mental capacity advocate. So in all cases there should be a person whose role in the system is to advocate on behalf of the person whose liberty is being restricted.
Paul Blomfield
Does the Secretary of State accept that that access to an advocate should not be necessarily subject to a best interest test, as is being proposed, but should be a right?
Mr Deputy Speaker (Sir Lindsay Hoyle)
Order. Just to help everybody, let me say that we have 11 speakers, we still have to hear from the Opposition shadow Minister and we have the wind-ups. So I hope we can take that into account, although I recognise that the Minister is being very generous.
Mr Deputy Speaker
Order. Perhaps I will have to set it out differently. What I am trying to say is that we have 11 Members to speak and we could try to give them some time. Important as this and giving way all the time is, it is very important that we hear from other people.
Matt Hancock
Noted. Returning to the point made in the intervention, of course if there is an objection, there is a right in this case. So there is an escalation process in the event of an objection.
Before I end, I want briefly to deal with the Opposition’s reasoned amendment, because I hope we are able to show in this debate that all the points they raise have been considered. I hope the House will not mind my taking a moment to address each one briefly. First, they make the claim that somehow the Bill has been rushed through and insufficient pre-legislative scrutiny has been carried out. The Bill follows the Law Commission spending three years developing the new model, consulting extensively. The Joint Committee on Human Rights then conducted an inquiry and pre-legislative scrutiny. The Local Government Association, Age UK and Sir Simon Wessely have all backed the new legislation now. The LGA says:
“The Bill provides a vital opportunity for long-awaited reform”
and it needs to be passed. So we need to get this Bill on the statute book, because every extra delay risks depriving someone of their liberty and their right to freedom unnecessarily, and I do not want to see that happen.
Secondly, the amendment claims that the Bill
“enshrines a conflict of interest in relation to independent providers of health and care services”.
Again, that is not the case. Every authorisation must be reviewed by somebody who does not deliver day-to-day care and treatment for the person in question. We plan to go further by tabling Government amendments that will require authorisations in independent hospitals to be reviewed by an external approved mental capacity professional. Finally, the reasoned amendment claims that it is concerned about clearing the backlog in the current system. Well, so are we, and that is what this Bill does. Anyone concerned about the backlog and the current system should back the Bill with enthusiasm.
The claims that this Bill does not put the interests of the cared for person first or address the interface with the Mental Health Act have been addressed already. The very reason we need this legislation is so that we can put their interests first, because they cannot afford to wait for the recommendations of the Mental Health Act review to come into effect, in a Bill that will inevitably take time to develop, because of the need to do this on a consultative and broad basis. While welcoming the probing, I very much hope that the Opposition and every Member of this House will support this Bill, because it strikes a careful balance between liberty and protection. It offers vulnerable people a brighter and better future. We have listened to concerns and we continue to be open to ideas. We have sought to amend and improve the Bill as it has progressed through the other place, and we will make further amendments in this House. I therefore hope that this opportunity to change the system for the better is one that the House recognises. I also hope it will recognise that doing nothing is not an option. That is why I am proud to commend the Bill to the House.
Barbara Keeley
I thank my hon. Friend for saying that, and it is the case.
Let me give an example. Just last week, the BBC’s “Victoria Derbyshire” programme exposed the horrific case of Rachel Johnston, a woman with learning disabilities who died after having an operation to remove all of her teeth. Rachel had a long-standing and extensive dental problem, but, clearly, could not consent to the dental work. Rather than doing the surgery in several treatments, the dentist opted to remove all her teeth in one operation, using the Mental Capacity Act to authorise the use of a general anaesthetic because he deemed it to be in her best interest. After being discharged, Rachel bled profusely from her gums, developed breathing difficulties and later died. How on earth can that treatment have been in her best interest? That case shows a need for greater safeguards, not fewer safeguards. We should not allow medical professionals to make decisions without considering the best interests or wishes of people who lack the capacity to consent to treatment.
I recognise that, as the Secretary of State mentioned, the Government conceded in the House of Lords that the cared-for person must be consulted, but there are still worrying aspects of the Bill that undermine that principle. We should ensure that individuals have access to an independent advocate. That is a vital safeguard that allows people to challenge authorisations, and it should be the default. The manner in which the independent mental capacity advocates can and should be appointed remains ill-defined and even contradictory.
The Minister in the House of Lords, Lord O’Shaughnessy, seems to have dismissed concerns raised about the application of a best interest test before the appointment of an advocate. The role of an advocate is essential to allowing individuals to access appeals and review their rights. Access to support from advocates should not depend on best interest tests, and the provisions in the Bill are far weaker than those proposed by the Law Commission. Yet despite that being pointed out in the debate in the House of Lords, the Minister there seemed unwilling to listen to advice, merely saying that it would work “in practice”. That is simply not good enough. These factors amount to a severe undermining of the concept of the individual’s best interests, which should be at the heart of the Bill but is sorely lacking.
I will now address the backlog of deprivation of liberty safeguard applications, because at the outset the Government presented the Bill as a cost-effective way of reducing it. On Second Reading in the House of Lords, the Minister claimed that the Bill would relieve
“local authorities of the…legal liability burden of more than £408 million by removing the backlog of…applications.”—[Official Report, House of Lords, 16 July 2018; Vol. 792, c. 1060.]
But he made no mention of how that would happen. Our conclusion is that by attempting to place the onus for assessments on care home managers, the Bill would remove the responsibility from cash-strapped local authorities.
The Government initially tried to pass responsibility for assessments on to care home managers, and that was clearly intended as a cost-cutting measure. That was amended in the House of Lords, but care home managers will still decide whether an assessment needs to take place and will also identify whether the person being cared for objects to a liberty protection safeguard for their own care and treatment. The British Association of Social Workers has said that this presents a potential conflict of interest for care homes, as they need to maintain occupancy and may not readily identify an objection by the cared-for person.
The BASW has a further concern about the grounds on which the responsible body would decide whether it or the care home manager would make the necessary arrangements for an LPS authorisation. There is a significant risk of a two-tier system, whereby local authorities under financial or waiting list pressures would default to care home managers completing the new duties, and other local authorities under less strain would do the assessments themselves. I think we have enough of a postcode lottery in care without adding to it through the Bill.
Care England, which represents the network of care providers, says:
“There is a lack of clarity about the role of the Care Home Manager...the separation of roles between care homes and community care provision seems designed to increase rather than reduce confusion and complexity.”
Indeed, the body is so concerned by this Bill that is has also said:
“This ill-considered Bill risks storing up a range of problems of a kind that we do not want and should be slowed or returned for redrafting.”
There remains a further dangerous conflict of interest at the heart of the Bill because of the role that independent hospitals are given in the assessment process. Despite debate in the House of Lords regarding the role of independent hospitals, under the Bill they would still be allowed to appoint their own approved mental capacity professionals. That would allow independent hospitals the responsibility to authorise deprivation of liberty for people in that same hospital for the assessment and treatment of mental disorders. That is plainly wrong.
Barbara Keeley
The Minister says no, but Lord O’Shaughnessy in the House of Lords would not consider amendments tabled by two parties to deal with that issue. It is plainly wrong and represents a very clear conflict of interest.
Moreover, the Bill currently allows for the deprivation of someone’s liberty to be authorised for up to three years without review after two initial periods of 12 months, as the Secretary of State said earlier. It cannot be right to have that period of three years without renewal. The Bill is reducing the protections afforded by the current DoLS system, which operates a maximum period of 12 months before renewal.
Barbara Keeley
Very much so. I will come on to that shortly, but I will not leave the point about independent hospitals, because it is important.
We know only too well from media reports, and the Secretary of State does too, of the torrid situation in independent hospitals that detain people with autism and learning disabilities under the Mental Health Act, and the measures in this Bill could have disastrous and far-reaching consequences. I have raised at the Dispatch Box on several occasions the appalling treatment of people with autism and learning disabilities in assessment and treatment units. I have described the situation as amounting to a national scandal, and I believe that it is still so. As many as 20% of people in these units have been there for more than 10 years. The average stay is five and a half years. The average cost of a placement in an assessment and treatment unit for people with a learning disability is £3,500 a week, but the costs can be as high as £13,000 a week or more.
As the journalist Ian Birrell has exposed in The Mail on Sunday, private sector companies are making enormous profits from admitting people to those units and keeping them there for long periods. Two giant US healthcare companies, a global private equity group, a Guernsey-based hedge fund, two British firms and a major charity are among the beneficiaries of what campaigners have seen as patients being seen as cash cows to be milked by a flawed system at the expense of taxpayers. According to a written answer I obtained from the Department of Health and Social Care, in the past year alone the NHS has paid out over £100 million to private companies for these placements. Shamefully, the Government cannot reveal how much they have spent since they came to power, because they claim that they did not record the expenditure before 2017. It cannot be right that the Bill potentially gives private companies the power to lock up vulnerable people for years at a time to feed a lucrative and expanding private health sector.
I would like to draw attention to one more issue that the Bill does not address—we have already discussed it—and that cannot be papered over by amendments. The Government commissioned Professor Sir Simon Wessely to lead a review of the Mental Health Act, which is of course long overdue for reform. However, as the hon. Member for Central Suffolk and North Ipswich (Dr Poulter) said, there is clearly a complex interface between the Mental Capacity Act and the Mental Health Act. Professor Sir Simon Wessely has made the point that there is now a worrying trend of people, particularly with dementia, being detained under the Mental Health Act when their deprivation of liberty should be dealt with under the Mental Capacity Act. His review recommended imposing a new line of objection to determine who should be treated under which legislation, but, as the hon. Gentleman said, there has been no engagement with these recommendations, which were finalised as this Bill was going through the House of Lords.
In our view, the Government must commit to a review of the interface between the two Acts, with full consultation, which has, to date, been sorely lacking. It is one thing to say that Sir Simon had a conversation with the Secretary of State about this, but that is not full consultation. The consultation must look at both hospital and community settings and provide clear and accessible rights of appeal.
Matt Hancock
Of course the interface between the Mental Capacity Act and the Mental Health Act will be considered, but Sir Simon himself favours bringing forth the Mental Capacity Act renewal now and then dealing with the Mental Health Act later. As with all of the hon. Lady’s other considerations, that has been taken into account, and this is the best way forward.
Barbara Keeley
Well, clearly we do not agree.
The reform of the Mental Capacity Act began as an attempt in good faith to reform a flawed piece of legislation that fails to protect the human rights of some of the most vulnerable people in this country, but it now threatens to infringe those rights further through this Bill. We simply cannot afford to rush an issue of this magnitude where individual liberties and human rights are at stake. Indeed, the Minister in the House of Lords himself admitted:
“We cannot introduce another Bill or piece of legislation that just creates a problem three years down the line.”—[Official Report, House of Lords, 16 July 2018; Vol. 792, c. 1110.]
But that is exactly what this Government are trying to do today. We will fail some of the most vulnerable people in society if we allow the creation of flawed legislation that needs to be replaced in just a few years. We must get this right. That is why the Government must pause the Bill, and why I urge hon. Members to vote for our reasoned amendment and ensure that Ministers get the message loud and clear.
Mental Health Act: Independent Review (Final Report)
Matt Hancock Excerpts(6 years ago)
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The Secretary of State for Health and Social Care (Matt Hancock)
“Modernising the Mental Health Act: Increasing choice, reducing compulsion”, the final report of the independent review of the Mental Health Act, has been published today.
The Government committed in their manifesto to reform mental health legislation. As a first step towards this, the Prime Minister asked Professor Sir Simon Wessely to chair a full and independent review of the Mental Health Act 1983. We welcome this report, and would like to thank Sir Simon and his vice chairs for their achievement in setting out a set of recommendations that have the overall purpose of increasing patient rights and improving the way the Act works for people.
I can confirm that the Government will consider the report and its recommendations in detail, and will respond in due course. Our intention remains to reform mental health law and so the Government will develop and bring forward legislation when parliamentary time allows.
I can today accept two of the report’s recommendations, which both highlight the review’s focus on increasing the rights and autonomy of patients:
the establishment of new statutory advance choice documents (ACDs), so that people’s wishes and preferences can carry far more legal weight. These would enable people to express preferences on their care and treatment, to help ensure that these preferences are considered by clinicians, even when the person may be too ill to express themselves.
ensuring that people have a say in which relative has power to act for them, through the creation of a new role of nominated person, to be chosen by the patient, rather than allocated to them from a list of relatives. This person would have enhanced powers in their role; both to be informed about the person’s detention in hospital and to be involved in decisions made about their care.
The report is available at:
https://www.gov.uk/government/groups/independent-review-of-the-mental-health-act.
I have deposited a copy of the report in the Libraries of both Houses.
[HCWS1149]
Oral Answers to Questions
Matt Hancock Excerpts(6 years ago)
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Michael Tomlinson (Mid Dorset and North Poole) (Con)
The Secretary of State for Health and Social Care (Matt Hancock)
Community pharmacies play a vital role in our health service, but we know they can do more, and we are determined to see them do more, to keep people healthy.
Michael Tomlinson
I am grateful to the Secretary of State for that answer, because he is absolutely right in what he says. The Dorset Local Pharmaceutical Committee is very active and is promoting the policy of Pharmacy First, which should help to relieve pressure on our general practitioners, and even on our accident and emergency facilities. What is he doing to support that policy?
Matt Hancock
I agree very much with my hon. Friend that pharmacies can play an increasing role in helping to make sure that people get their healthcare where they need it, and in keeping the pressure off GPs and off secondary care by making sure that people can help themselves to stay healthy. We are piloting 111 directing people to pharmacies as well as to GPs and, where appropriate, to secondary care, and encouraging people to use pharmacies for minor ailments, but there is much more we can do together on this.
Julie Cooper (Burnley) (Lab)
The NHS Confederation has warned that, following Brexit, the supply of some medicines and medical technologies may be delayed in reaching patients, and some may not be available at all. The chief executive officer of the Association of the British Pharmaceutical Industry has been clear that we cannot stockpile the amounts we are going to need, because we do not have sufficient cold warehouse storage. The Medicines and Healthcare Products Regulatory Agency is worried therefore that diabetics will not be able to access insulin. What steps is the Minister taking to ensure that community pharmacies are able to supply vital medical supplies post Brexit, particularly in the event of no deal?
Matt Hancock
Community pharmacies, like everybody else, should support the Prime Minister’s deal, which will make sure that that eventuality does not occur.
Emma Hardy (Kingston upon Hull West and Hessle) (Lab)
The Secretary of State for Health and Social Care (Matt Hancock)
Prevention is indeed better than cure. As well as having a right to expect NHS services to be free at the point of use, we all have responsibility for our own health, and to use the NHS responsibly.
Jim Shannon
I recently met Breast Cancer Now—the Secretary of State will be aware of it. It has 10 priorities for the NHS long-term plan. Has he made an assessment of the impact of the real-terms 5% cut in public health budgets on reducing the incidence of cancer?
Matt Hancock
There are many things we need to do to diagnose cancer early, and of course public health is part of that, but there is a much bigger agenda, and that includes more screening. We have seen an increase in the number of people invited to screening, but we need to get the screening right, so I have instituted a review of all our screening processes for cancer and other diseases.
Robert Neill
Will my right hon. Friend look at the work done by Connect Well Bromley, a partnership funded by the local clinical commissioning group but delivered by Bromley Third Sector Enterprise and Community Links Bromley? That partnership sets out what is in effect a social prescribing programme of activities and services to deal with wellbeing issues at an early stage. Is that a model for elsewhere in the country?
Matt Hancock
Yes, it is. I have been briefed on the example that Bromley is setting, which has been brought to my attention by its brilliant local representative, my hon. Friend. Social prescribing systems such as this one are on the rise, because the evidence shows that social prescribing helps to keep people healthy and out of hospital.
Luciana Berger (Liverpool, Wavertree) (Lab/Co-op)
A fortnight ago, during his statement to the House on prevention and how the Government intend to keep our nation well, the Secretary of State told me that he would look at my Health Impacts (Public Sector Duty) Bill, which had its Second Reading on Friday. Unfortunately, on Friday, the Government objected to my Bill. Which elements of the Bill did the Secretary of State object to?
Matt Hancock
I know the hon. Lady has done an awful lot of work on this, and I respect that work. We did look at the Bill, but we thought it was, unfortunately, technically deficient. I know she cares a lot about this, however, as do I, and I want to work with her to see what we can do.
Dan Jarvis (Barnsley Central) (Lab)
According to Office for National Statistics figures, over the past five years, there have been 150,000 excess winter deaths—a mortality rate twice that in Germany and Norway. What specific work is the Secretary of State doing to reduce the number of deaths this coming winter?
Matt Hancock
This year, since I became Secretary of State, we have put an extra £420 million in to make sure we are as well prepared as possible. The NHS is of course under pressure, although it is performing exceptionally well, in terms of how much it does for the money going in, and from next year, we will put in the extra £20 billion. I want part of the long-term plan to be about how we can plan for the long term, instead of having this annual cycle of winter pressures.
Tracey Crouch (Chatham and Aylesford) (Con)
Earlier this year, I had the pleasure of joining volunteer leader John Goodwin and others on a health walk around Capstone park in my constituency—one of a number of health walks supported by Medway Council. Will the Secretary of State join me in encouraging more GPs to prescribe walking as a gentle, low-impact form of exercise that is suitable for all ages and abilities?
Matt Hancock
With enthusiasm, I endorse the call from my hon. Friend, who did so much work on this at the Department for Digital, Culture, Media and Sport, both before I was in that Department and when I was Secretary of State there. She made the case brilliantly, and she continues to do so. She is absolutely right.
Stephen Gethins (North East Fife) (SNP)
Matt Hancock
Every EU worker across our health and social care system—whether in the NHS, or working in public health, in local authorities or in social care—is welcome here, and is supported to be welcome here, and we look forward to the settled status scheme rolling out. We are grateful for their service.
Theresa Villiers (Chipping Barnet) (Con)
GP appointments are vital for many to lead healthy lives, so will the Secretary of State give his strong personal support to the work of our fantastic GPs, and encourage the NHS to put general practice at the heart of the £20 billion future plan?
Matt Hancock
Yes. General practice will be at the heart of the long-term plan. GPs are the bedrock of the NHS. We will put an extra £3.5 billion, at least, into primary and community services to help keep people healthy and prevent them from going to hospital.
Jonathan Ashworth (Leicester South) (Lab/Co-op)
The Secretary of State got into a muddle last week with his GP figures, so may I suggest that he download an exciting new app to his phone? It is called a calculator. He has said that there will be more for community and primary care by 2024. Can he guarantee that there will be the extra GPs and district nurses to provide the services that he is promising?
Matt Hancock
Yes, I can; given that we have the money coming into the NHS, we are doing everything possible to ensure that we have the people to do the work. I am delighted to say that we have a record number of GPs in training right now.
Jonathan Ashworth
But GP numbers have gone down by 700 in the last year, have they not? There are 107,000 vacancies across the NHS, acute trusts are closing accident and emergency departments overnight, the closure of chemotherapy departments is being considered, and Health Education England’s training budget is the lowest that it has been for five years, with more cuts to come next year. Does the Secretary of State agree that if the long-term plan that he will publish next week is to be credible, he must reverse those training cuts and deliver the staff that our NHS needs?
Matt Hancock
That was a bit of a surprise, because the hon. Gentleman is normally such a reasonable fellow. I thought that he would welcome the record number of GPs in training, and the record number of nurses in the NHS. Because we love the NHS, of course we want to do more, and we will.
Marsha De Cordova (Battersea) (Lab)
Jack Brereton (Stoke-on-Trent South) (Con)
The Secretary of State for Health and Social Care (Matt Hancock)
We are increasing the NHS budget by £20.5 billion in real terms over the next five years. It is a major investment to make sure that the NHS is there for us all.
Jack Brereton
Royal Stoke University Hospital continues to be in financial special measures, and local clinical commissioning groups are now projecting significant overspends in their budgets. How will the Secretary of State ensure that stressed health economies such as those in Stoke-on-Trent and Staffordshire get a significant share of the additional £20.5 billion?
Matt Hancock
Clearly, part of the £20.5 billion of extra funding that taxpayers are putting into the NHS over the next five years is for ensuring that services can be put on a sustainable footing, and that includes some of the highly stressed services such as those in Stoke.
Dr Paul Williams (Stockton South) (Lab)
How do the Government plan to use funds to better identify perinatal mental health problems? Half of all women with perinatal mental health problems say that the current system does not identify their need.
Matt Hancock
I very much agree with the premise of the hon. Gentleman’s question. We need to do much more on this subject. It is incredibly important, and there will be more to hear in the long-term plan.
Mr Adrian Bailey (West Bromwich West) (Lab/Co-op)
Emma Reynolds (Wolverhampton North East) (Lab)
The Secretary of State for Health and Social Care (Matt Hancock)
The deal that the Prime Minister struck to leave the EU will ensure access to medicines and medical equipment, so it is another good reason to vote for the deal.
Matt Hancock
Well, of course, while voting for the deal is the best way to ensure the unhindered supply of medicines and medical devices, as a responsible Government we are also planning for the unlikely event of no deal, and that planning includes ensuring that we can continue to get unhindered access after the six weeks for which we are making sure that supplies are available.
Emma Reynolds
We are currently an influential member of the European Medicines Agency, which gives patients access to new medicines six months sooner than non-members. Given that the political declaration reduces us to exploring the possibility of co-operation with the EMA, will the Secretary of State admit that there are no guarantees for patients and that it is very likely that they will have to wait longer?
Matt Hancock
No, because in the event, under any circumstances, we will make sure that there are no further burdens on ensuring that medicines can get licensed here so that patients can use them, but it is another reason why the hon. Lady should vote for the deal.
Anna Soubry
Many people say that the much-heralded £20 billion extra for the NHS is some sort of Brexit dividend. In the event that our country remains in the European Union, will the Secretary of State confirm that that extra 3.4% a year will continue and that £20 billion will be made available to our NHS?
Matt Hancock
I am afraid that I will have to let my right hon. Friend know that we are leaving the European Union on 29 March.
David Tredinnick (Bosworth) (Con)
Luke Hall (Thornbury and Yate) (Con)
The Secretary of State for Health and Social Care (Matt Hancock)
This month, we launched our vision for the prevention of ill health that sets out measures to help increase life expectancy by at least five years because prevention is better than cure. We need to give people responsibility for their own health, while empowering them to make the right decisions in the right way. We are also saving more than £1 billion on the NHS drugs budget and committing more than £3.5 billion to primary and community care. Next month, we will publish the long-term plan for how we spend the extra £20 billion committed to the future of the NHS.
Luke Hall
19 November marked the three-year licence of the cystic fibrosis drug, Orkambi, in the UK, which is still not available on the NHS. Will the Secretary of State confirm whether there has been any further consideration to provide interim access to this treatment for patients, such as my constituents Annabelle Brennan and Cameron Jameson, while these negotiations continue?
Matt Hancock
The NHS and the National Institute for Health and Care Excellence have written to Vertex, the company involved. I am determined to see progress. We have made the largest ever proposal to Vertex, at half a billion pounds. It needs to engage with this very generous offer, which will mean that everyone wins, most of all those suffering from this awful condition. The ball is in Vertex’s court.
Barbara Keeley (Worsley and Eccles South) (Lab)
The learning disabilities mortality review—the LeDeR—investigated 1,000 early deaths of people with learning disabilities in hospital settings, but today major concerns have been raised by the parents of Oliver McGowan about the way in which some deaths have been investigated. The Secretary of State knows that 40 autistic people and people with learning disabilities died in assessment and treatment units, and he has called for a year-long review of the use of seclusion in ATUs. But that is not urgent action. Will he commit to stopping the use of ATUs immediately and to looking urgently at how early deaths are being investigated, particularly that of Oliver McGowan?
Matt Hancock
I can recommend to anybody spending the night with my hon. Friend in Derriford Hospital, where we learnt a huge amount. The team there were absolutely amazing and it was a brilliant experience. I also learnt a lot about the capital bid, which I have been keeping my eye on very closely. My hon. Friend should hear shortly.
Kerry McCarthy (Bristol East) (Lab)
Matt Hancock
I have a huge amount of sympathy for the hon. Lady’s point. We did act to ensure that the parties came together. The offer has been made and the response from the company has frankly not been good enough. It needs to come to the table; the ball is in its court.
Mr Philip Dunne (Ludlow) (Con)
Mr Ben Bradshaw (Exeter) (Lab)
Matt Hancock
I join the right hon. Gentleman in celebrating World Aids Day and ensuring that we redouble our commitment to making sure that we do everything we can. I will certainly look into the precise commitment that he asks for to make sure not only that it is deliverable but that we work not just here but around the world to end this scourge.
Kevin Hollinrake (Thirsk and Malton) (Con)
Everyone in this place has lost someone close to them to the terrible and terrifying disease that is cancer. How will the NHS 10-year plan help to improve detection rates?
Mrs Emma Lewell-Buck (South Shields) (Lab)
South Tyneside District Hospital recently surpassed targets for waiting times, yet this Government’s forced cuts under the guise of sustainability and transformation plans have left my constituents fundraising to fight the downgrading of key services in court next month. Why is the Secretary of State presiding over this destruction by stealth of our high-performing hospital and the NHS?
Matt Hancock
Of course, the STP proposals have to be clinically led and consulted on and discussed with local people. It is right that the allocation of services and exactly how they are configured locally is led locally, so that we can get the best services to people in Tyneside and across the country.
Tom Pursglove (Corby) (Con)
In England, over 80,000 people have a stroke each year and about 20% of them die within a year. Can my right hon. Friend reassure me, the House and my constituents in Corby and East Northamptonshire that he not only wants to drive down that figure but has a plan to do so?
Stephanie Peacock (Barnsley East) (Lab)
Despite the Government’s reassurances on the new NHS pay deal, it has left one of my constituents actually taking less money home at the end of the month and being required to pay money back. When I wrote to the Department, the Minister had the audacity to simply respond with a generic factsheet. Does he think this acceptable, and if not, will he give a meaningful reply to my constituent, who has done 30 years in the NHS?
Matt Hancock
Yes, of course. We value everybody who works in the NHS. I would love the hon. Lady to take up this individual case with me directly, and I am very happy to look into it.
Andrea Jenkyns (Morley and Outwood) (Con)
I have recently been contacted by a constituent who works as a paediatrician in a nearby hospital. Last Friday, tragically, a baby died in their ward. The cause of death is unknown. Owing to the lack of a coroner service at the weekend, the baby had to stay for three nights with breathing tubes fixed in. For the parents, these are the last memories of their child. What steps will the Minister be taking to guarantee that the seven days NHS requirement also applies to coroners and histopathologists?
Matt Hancock
My heart goes out to the parents of this child, my hon. Friend’s constituents, as I am sure it does from everybody in this House. Of course I will happily take up this individual case. But she raises the broader point, too. I am meeting the Justice Secretary on this topic to discuss what further we can do. It is technically a matter for the Ministry of Justice, but I understand entirely why we need to work together to make progress.
John Woodcock (Barrow and Furness) (Ind)
Is not the Secretary of State alarmed that fake psychiatrist Zholia Alemi was revalidated in 2013 under the supposedly strengthened revalidation process? Why did the Government not act on the findings of the Sir Keith Pearson report in January last year, which pointed out this exact weakness in the system?
Gosport Independent Panel
Matt Hancock Excerpts(6 years ago)
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The Secretary of State for Health and Social Care (Matt Hancock)
In June this year, the Gosport Independent Panel published its report into what happened at Gosport War Memorial Hospital between 1987 and 2001. It found that 456 patients died sooner than they would have done after being given powerful opioid painkillers. As many as 200 other people may have had their lives shortened, but this could not be proved because medical records were missing.
The findings in the Gosport report are truly shocking, and we must not forget that every one of those people was a son or daughter, a mother or father, a sister or brother. I reiterate the profound and unambiguous apology on behalf of the Government and the NHS for the hurt and anguish that the families who lost loved ones have endured. These were not just preventable deaths, but deaths directly caused by the actions of others. The report is a deeply troubling account of people dying at the hands of those who were trusted to care for them. I pay tribute to the courage of the victims’ families and their local MP, my hon. Friend the Member for Gosport (Caroline Dinenage), in their work for and commitment to the truth. Without their persistence, the catalogue of failures may never have come to light.
Along with the Prime Minister, I have met Bishop James Jones, who chaired the panel. He made it absolutely clear that what happened at Gosport continues to have an impact and places a terrible burden on relatives to this day. The failures were made worse because whistleblowers were not listened to, investigations fell short and lessons failed to be learnt. We must all learn the right lessons from the panel’s report and apply them across the entire system.
As Bishop Jones writes in the report, relatives felt betrayed by those in authority and were made to feel like “troublemakers” for asking legitimate questions. The report states that
“when relatives complained about the safety of patients…they were consistently let down by those in authority—both individuals and institutions. These included the senior management of the hospital, healthcare organisations, Hampshire Constabulary, local politicians, the coronial system, the Crown Prosecution Service, the General Medical Council and the Nursing and Midwifery Council.”
The panel heard how nurses raised concerns as far back as 1988, but were ignored and sidelined. More than 100 families raised concerns over more than two decades, but they were ignored and patronised. Frail, elderly people were seen as problems to be managed, rather than patients to be helped. Perhaps the most harrowing part of the report is when it makes clear that if action had been taken when problems were first raised, hundreds fewer would have died at Gosport. People want to see that justice is done, policies are changed and that we learn the right lessons across the NHS. I will take each of those in turn.
First, on justice, between 1998 and 2010, Hampshire constabulary conducted three separate investigations. None of the investigations led to a prosecution. The panel criticised the police for their failings in the investigations and their failure to get to the truth. Families said that they felt police had not taken their concerns seriously enough or investigated fully. Because of Hampshire police’s failures, a different police force has been brought in. A new, external police team is now independently assessing the evidence and will decide whether to launch a full investigation. They must be allowed to complete that process and follow the evidence, so that justice is done. Much has improved in the NHS since the period covered by the panel’s report, but we cannot afford to be complacent. What happened at Gosport is both a warning and a challenge.
Let me turn to the reforms that have been made and the reforms that we plan to make. The Care Quality Commission has been established as an independent body that inspects all hospitals, GP surgeries and care homes to detect failings and identify what needs to be improved. We have set up the National Guardian’s Office to ensure that staff concerns are heard and addressed. Every NHS trust in England now has someone in place whom whistleblowers can speak to in confidence and without fear of being penalised. We have established NHS Improvement—a separate, dedicated organisation—to respond to failings and put things right, and the Healthcare Safety Investigation Branch now investigates safety breaches and uses them to learn lessons and spread best practice throughout the NHS.
Those are the reforms that the Government have already made, but we must go further, so motivated by this report we will bring forward new legislation that will compel NHS trusts to report annually on how concerns raised by staff have been addressed; and, we are working with our colleagues in the Department for Business, Energy and Industrial Strategy to see how we can strengthen protections for NHS whistleblowers, including changing the law and other options.
Next is the question of drug prescription. Central to the deaths at Gosport was the prescribing, dispensing and monitoring of controlled drugs. Since the period covered by the report, there have been significant changes in the way that controlled drugs are used and managed and these syringe drivers are no longer in use in the NHS. However, in the light of the panel’s findings, we are further reviewing how we can improve safety.
Further, from April next year, medical examiners will be introduced across England to ensure that every death is scrutinised by either a coroner or a medical examiner. Medical examiners are people bereaved families can talk to about their concerns to ensure that investigations take place when necessary, to help to detect and deter criminal activity and to promote good practice. The new system will be overseen by a new independent national medical examiner and training will take place to ensure a consistency of approach and a record of scrutiny.
The reforms that we have made since Gosport mean that staff can speak up with more confidence and that failings are identified earlier and responded to quicker. The reforms that we are making will mean greater transparency, stricter control of drugs and a full and thorough investigation of every hospital death. Taken together, they mean that warning signs about untypical patterns of death are more likely to be examined at the time, not 25 years later.
However, as well as these policy changes, there is a bigger change, too, which I turn to now. Just as with the reports into Mid Staffs and Morecambe Bay, the Gosport report will echo for years to come, and the culture change that these reports call for is as deep-rooted as it is vital. There has been a culture change within the NHS since Gosport, but the culture must change further still. One of the most important things that we learnt from the report is that we must create a culture where complaints are listened to and errors are learnt from, and that this must be embedded at every level in the NHS.
What happened at Gosport was not one individual error; it was a systemic failure to respond appropriately to terrible behaviour. To prevent that from happening again, we need to ensure that we respond appropriately to error—openly, honestly, taking concerns and complaints seriously and seeing them as an opportunity to learn and improve, not a need for cover-up and denial. I want to see a culture that starts by listening to patients and their relatives and by empowering staff to speak up. That starts with leaders creating a culture that is focused on learning not blaming—a culture that is less top-down and less hierarchical, with more autonomy for staff, and that is more open to challenge and change. We need to see better leadership at every level in the NHS to create that culture across the NHS.
Today marks an important moment. Lessons have been learned, will be learned and must be applied. The voices of the vulnerable will be heard. Those with the courage to speak up will be celebrated. Leaders must change the culture to learn from errors, and we must redouble our resolve to create a health service that will be a fitting testament to the Gosport patients and their families. I commend this statement to the House.
Jonathan Ashworth (Leicester South) (Lab/Co-op)
I thank the Secretary of State for an advance copy of his statement. I welcome the statement and the tone of his remarks, and I thank him for repeating the unambiguous and clear apology that the previous Secretary of State, the right hon. Member for South West Surrey (Mr Hunt), offered at the Dispatch Box before the summer—it is good to see the previous Secretary of State sitting on the Treasury Bench today.
We welcome the Secretary of State’s apology today. The whole House was shocked when the previous Secretary of State reported the findings of the Gosport inquiry to the House. This Secretary of State is right to remind us that everyone who lost a life was a son or daughter, a mother or father, a sister or brother. As he said, our thoughts are with the families of the 456 patients whose lives were shortened because of what happened at Gosport, and the families of the 200 others who may have suffered—whose lives may have been shortened; because of missing medical records, we will never know for sure. That lingering doubt—never knowing whether they were victims of what happened at Gosport—must be a particularly intolerable burden for those families affected.
Like the Secretary of State, I pay tribute to the victims’ families, who, as he says, have in the face of grief shown immense courage, fortitude and commitment to demand the truth. I think the whole House will pay tribute to them today. I also reiterate our gratitude to the former Bishop of Liverpool, James Jones, for his extraordinary dedication, persistence, compassion and leadership in uncovering this injustice. Finally, I applaud those hon. Members who played a central role in establishing this inquiry, not just the previous Secretary of State, but the right hon. Member for North Norfolk (Norman Lamb) and the Minister for Care, the hon. Member for Gosport (Caroline Dinenage), who in recent years has played an important role in her capacity as a constituency MP.
The Secretary of State is correct to say that lessons must be learned and applied across the whole system. We all understand that in the delivery of healthcare and the practice of medicine, sadly, tragically, things can and do sometimes go wrong, but we also understand, as Bishop Jones said in his report, that
“the handing over of a loved one to a hospital, to doctors and nurses is an act of trust”,
but that that trust was
“betrayed.”
I still believe that that betrayal was unforgivable. Patient safety must always be the priority, so when there are systemic failures, it is our duty to act, learn lessons and change policies.
I wish to respond to the Secretary of State’s announcements today. We welcome his commitment to legislation placing more transparency duties on trusts, and we will engage constructively with that legislation. Is it his intention to bring forward amendments to the Health Service Safety Investigations Bill, and if so when, or should we expect a new bill altogether? We look forward to his proposals on strengthening protection for whistleblowers, but he will know that the NHS has just spent £700,000 contesting the case of whistleblower Dr Chris Day, a junior doctor who raised safety concerns. He will also be aware of the British Medical Association survey showing that not even half of doctors feel they would have the confidence to raise concerns about safety. Moreover, he will be aware of how Dr Bawa-Garba’s case played out, with her personal reflections effectively used in evidence against her. Can he offer more details on how he will change the climate in the NHS so that clinicians feel they can speak out without being penalised?
I welcome the thrust of the Secretary of State’s remarks on medical examiners, and I agree they are a crucial reform, but can he offer us some more details? Is it still the Government’s intention that they will be employed directly by acute trusts? He will be aware that this has provoked questions about their independence. We would urge him to go further and base them in local authorities and extend their remit to primary care, nursing homes and mental health and community health trusts. If legislation is needed, we would work constructively with him.
We welcome the review into improving safety when prescribing and dispensing medicine. Clearly, one of the first questions that comes to mind when reading the Gosport report is: how were these prescriptions monitored? The Government’s own research indicates that more than 230 million medication errors take place a year, and it has been estimated that these errors and mix-ups could contribute to as many as 22,000 deaths a year, so this review is clearly urgent. Can the Secretary of State tell us whether it will be an independent review, who will lead it and when we can expect it to report?
Finally, patient safety is compromised when staff are overworked and overburdened with pressures. He will know that we have over 100,000 staff vacancies across the NHS. Some trusts are proposing closing A&E departments overnight because they do not have the staff, and some are even proposing closing chemotherapy wards because they believe that the lack of staffing means services are unsafe. How does the Secretary of State plan to recruit the staff our NHS desperately needs to provide the level of safe care patients deserve?
In conclusion, I offer to work constructively with the Secretary of State to improve patient safety across the NHS, and we support his statement today.
Matt Hancock
I appreciate the tone of the hon. Gentleman, who rightly focuses on the need to ensure that this never happens again, and I join him in thanking Bishop James Jones for his work on this and other inquiries. It was quite brilliant empathetic work. I also thank the right hon. Member for North Norfolk (Norman Lamb), for whom I have an awful lot of respect.
The core of the questions the hon. Gentleman raised, about the need to ensure that whistleblowers are listened to and that people are heard in the NHS, comes down to culture change. A whole series of policies underpins that culture change, and I will come to them, but ultimately it comes down to this: errors happen in medicine—it is a high-risk business—but what matters is behaviour, that everything is done to minimise errors and, when they are made, to learn from them, rather than try to cover them up. The culture change needs to be driven across the NHS. It has changed and improved in many areas, but there is still much more to do.
The hon. Gentleman asked whether amendments would be tabled to the Health Service Safety Investigations Bill or in separate legislation on whistleblowers. We are looking at both options. Partly it comes down to the technicalities of scope and the exact distinction and definition of the amendments, but I look forward to working with him on that legislation.
The hon. Gentleman asked why gagging clauses are still in use. I may well ask the very same question. They were deemed unacceptable by my predecessor—I join in the tributes to him—who did so much on this agenda. Gagging clauses have been unacceptable in the NHS since 2013. Trusts, which are independent, can legally use them, but I find them unacceptable, and I will do what it takes to stamp them out.
The hon. Gentleman said that too many people in the NHS feel unable to speak up. To ensure a route for this, we now have, in every single NHS trust, an individual separate from line management to whom staff can go to raise concerns. This is part of the culture change, but it is not the whole. Line management itself in every hospital should welcome challenge and concerns, because that is the way to improve practice. Challenges and concerns that are raised with managers should be deemed an opportunity to improve the service offered to patients, rather than a problem to be managed.
The hon. Gentleman also mentioned medication errors. Of course, this was not a case of medication error—it would have been far less bad had it been; it was a case of active mis-medication that led to deaths. Medication errors are an important issue, however, and we are bringing in e-prescribing across the board to allow much more accurate measurement, audit and analysis of medication.
Finally, the hon. Gentleman said that pressures often come from staff shortages. Again, that was emphatically not the concern here, and we absolutely must not muddle up the behaviour here with the issue of staff shortages. Nevertheless, I acknowledge the need for more staff in the NHS. Indeed, we are putting £20 billion into it over the next five years to make sure we have the people we need to deliver the NHS that everyone wants.
Dr Sarah Wollaston (Totnes) (Con)
I welcome the Secretary of State’s statement and commitment to introduce legislation to compel trusts to report on how they handle staff complaints and concerns, but will he assure the House that trusts will not be penalised if they have more staff concerns raised, because it might be an indicator that they have introduced the culture change necessary for staff to feel able to come forward? Will he also clarify how rapidly we will be rolling out the very welcome introduction of medical examiners?
Matt Hancock
My hon. Friend is absolutely right that the number of complaints and concerns raised is not the material factor. A complaint that is actively welcomed and then acted on by management is merely part of the improvement process of any organisation. We should be open to them, welcome them and see them as an important part of the continuous improvement of NHS trusts, which is how many successful organisations see them. As I set out in the statement, medical examiners will be introduced from next April, but I am happy to give her more details of that whole policy.
Dr Philippa Whitford (Central Ayrshire) (SNP)
I, too, welcome the Secretary of State’s statement and the proposals in it. As he says, these 450—possibly even 650— deaths were not accidental, but deliberate.
I welcomed the Secretary of State’s attendance at our event yesterday, when we discussed the need for a just and learning culture in the NHS. Obviously, he heard the stories that were related during the event: stories of patients who had lost their lives, and families who have ended up spending their entire lives fighting for justice or change, so they have suffered over and above their bereavement. Staff were obviously not listened to. One witness compared a whistleblower with someone reporting to the police, or a state witness, and pointed out how shocked we would be if the police tried to shut that case up. Whistleblowers should be welcomed as people giving evidence against wrongdoing or failure.
I particularly welcomed the Secretary of State’s comment about reform of the Public Interest Disclosure Act 1998, which I think needs to be replaced. I think we need legislation that gives definite protection to people who come forward. As one who has been a clinician for more than 30 years, I can tell the Secretary of State that the long trail of clinicians who have reported concerns and then had their careers ended lies there like a threat to every whistleblower who thinks of speaking up.
If patient safety and the ability of people to speak up in safety are not enshrined in the NHS, we are all under threat. I am sure that not just the hon. Member for Leicester South (Jonathan Ashworth) but Members in all parts of the House would work with the Secretary of State to reform the legislation here and inspire the culture change that is needed in the NHS itself. I certainly would.
Matt Hancock
I agree with an awful lot of what the hon. Lady has said, and I appreciate the wisdom that she brings to this issue with her clinical experience.
The need for a just culture in the NHS is very clear, and the Gosport report makes it clearer still. A just culture means that, yes, there is accountability, but the accountability is established with the intent that the system will improve and people will learn; that people can come forward with concerns rather than covering them up; and that when concerns are expressed, they are welcomed.
I am also pleased about the hon. Lady’s attitude to potential legislation. I look forward to working with her, and, indeed, learning from some of the improvements that have been made in Scotland, to try to ensure that we can get this right.
Alan Mak (Havant) (Con)
The events at Gosport are of substantial interest to my constituents in Havant and across the Solent region. I agree with the Secretary of State that lessons must be not only learned but applied. Will he confirm that ensuring patients’ safety will remain at the heart of all that the NHS does, including the development of its new 10-year plan, and will he confirm in particular that better medical records can be produced through, for instance, the use of new technologies?
Matt Hancock
Absolutely, and I pay tribute to my hon. Friend’s work. People from across the country, and certainly from across the region, were affected by this. The need for better medical records is underlined in the report. In the case of several hundred people, we do not know whether their lives were shortened or not. Of course technology has a huge part to play in this. From about 15 years ago onwards it is highly unlikely that medical records would have been lost or misplaced in this way, and therefore new technology has a role to play, but it needs to be improved so that access to those records can be made available to the right people at the right time.
Norman Lamb (North Norfolk) (LD)
I welcome the ambition in the statement for the culture change that is clearly still needed in the NHS. This is the most extraordinary scandal. The Secretary of State is right to highlight the extent to which loved ones were patronised and ignored and staff were often crushed, and how that facilitated the ongoing scandal at Gosport War Memorial Hospital. Clearly, the pursuit of justice is the most pressing priority for the relatives, given how long delayed that is, but may I specifically highlight the Secretary of State’s reference to working with the Business Secretary to establish whether reforms to the legislation are necessary? Does he agree that reformed legislation that allows staff to feel able to speak out—not just in the NHS, but in any occupation—can facilitate the very culture change that he needs so much?
Matt Hancock
Yes. I pay tribute to the right hon. Gentleman’s work, especially as a Minister in the Department, to make sure that people got to the bottom of this and that the truth was published and brought out in the way that it has been. He is right about the question of justice, but it is currently—rightly—a matter for the police, so I will go no further than that.
I strongly agree with the right hon. Gentleman that the legislative framework that we set here in Parliament leads to and underpins the culture that is critical. That is, of course, a matter for the whistleblowing legislation. There are also questions of legal liability. As the right hon. Gentleman well knows, often what patients who have been wronged—or the families of patients who have been wronged—want most of all is an apology, an explanation and a commitment that others will not be affected because the lessons will be learnt. Too often what has been offered instead is the phone number of a no-win, no-fee lawyer, and that is not the way to solve this problem.
Suella Braverman (Fareham) (Con)
I welcome the Secretary of State’s announcement and his plain and self-evident commitment to learning from this episode and righting the wrongs. The findings of the report are shocking and heartbreaking, and they affect some of my constituents whose families have suffered so much grief because of the life-shortening policy employed at Gosport War Memorial Hospital. Many of them still have questions many years on, about such matters as criminal investigations. I welcome the Secretary of State’s announcement that an external police team will be carrying out an investigation on whether to press charges, but can he provide some guidance on the timeline and whether the police can realistically expect justice to be done, and seen to be done, through the criminal courts?
Matt Hancock
My hon. Friend is right. The grief over the loss of a loved one whose life has been foreshortened is compounded if that is not acknowledged by the authorities, and we therefore acknowledge it once again today. As for the police investigation, the timings are of course a matter for the police themselves, who are rightly independent. The process currently under way is the reviewing of all the evidence to establish what and whether prosecutions should be brought forward. That will continue into the new year, and the police will then make a statement on the next stages of their investigation.
Ruth Cadbury (Brentford and Isleworth) (Lab)
On 10 October, my constituent Bridget Reeves submitted a petition with more than 100,000 signatures to the Government to trigger a parliamentary debate. Today is the anniversary of her grandmother Elsie Devine’s death at Gosport War Memorial Hospital. She died after concerns had emerged from staff at the hospital.
I thank the Secretary of State for his statement and for his commitment to addressing many of the problems that have already been identified and are emerging from the various inquiries. The families want justice, among other things, but they will not get it until the outcome of the fourth police investigation—and I welcome the fact that it is being carried out by a different police authority.
I have two questions. First, will the Secretary of State meet the families face to face? Secondly, while I acknowledge his points about concerns of culture in the NHS, I am concerned about the culture in the coroner service, in relation to not just this case but others, including one that I met constituents to discuss this morning. There is a governance issue relating to when the coroner service needs investigating in the case of some inquests. Will the Secretary of State work with the Attorney General and pick up the concerns that Members expressed about a number of inquests?
Matt Hancock
The point about coroners is a matter for the Ministry of Justice, but I am pleased to see that the Under-Secretary of State for Justice, my hon. Friend the Member for Charnwood (Edward Argar) is present. He would delighted to meet the hon. Lady to take up that point—
The Parliamentary Under-Secretary of State for Justice (Edward Argar)
indicated assent.
Matt Hancock
Yes: good.
I will, of course, be happy to meet the families, but the advice of Bishop James Jones is that that will be appropriate after this stage of the police investigation. I wrote to the families to explain the position before making my statement. It is important that we go through the process properly during the police investigation to ensure that justice can be done, but I shall be more than happy to meet the families at the appropriate moment.
Several hon. Members rose—
Mr Philip Dunne (Ludlow) (Con)
I join the cross-party support for my right hon. Friend’s statement and add my voice in commending the dedication and commitment of Bishop James Jones, who, I am pleased to say, is I think in the Chamber listening to the Government response to his report.
I am a great supporter of the National Guardian’s Office and the “freedom to speak up” guardians; in fact I am such a strong supporter that I wear its lanyard around my neck and have done ever since I was in the Health Department. But a number of people who make complaints either do not yet have sufficient confidence in these guardians or feel that their complaints are not properly addressed. There are however good examples of best practice, where some chief executives of trusts have a regular, routine meeting with guardians to make sure that complaints are brought directly to their attention. Will my right hon. Friend work with the senior leaders across the NHS and the National Guardian’s Office to ensure that best practice is used so we can give the most possible confidence to people with concerns about safety?
Matt Hancock
Yes, absolutely I am happy to do that, and I am happy to commend my hon. Friend’s lanyard, too. Ultimately culture change and having a good culture comes down to the leadership within the NHS and individual trusts. It has struck me in the four months that I have been doing this job that the trusts that have the best results in terms of outcomes for patients, waiting times and waiting lists and finances are also those that are hot on this subject; they listen to complaints and act on them, because they know that that is the way to improve their organisation. I want to see that sort of best practice right across the board.
Stephen Lloyd (Eastbourne) (LD)
Like colleagues, I welcome the Secretary of State’s statement. It was my constituent Gillian Mackenzie 21 years ago who was the first relative to raise concerns, and she has been battling ever since. She came to me 11 years ago and it was with pleasure that I introduced her and the other families to my colleague, my right hon. Friend the Member for North Norfolk (Norman Lamb). I am grateful for the changes in the health service that will hopefully prevent any such dreadful and shocking episode from happening again.
I must bring the Secretary of State back to the justice issue, however, as it is very important. I appreciate that it concerns a different Department, but the Secretary of State said in his statement that the police
“must be allowed to complete that process and follow the evidence, so that justice is done.”
A few weeks ago I had a constructive meeting with Assistant Chief Constable Downing, who is in charge of that. I would like a commitment from the Government that there will be sufficient funding for the full assessment, and, if it goes to investigation, sufficient funding in the budget for a proper investigation to be done so that relatives can get the justice they have been denied for so long.
Matt Hancock
Yes, of course that is the Government’s position, and I am very happy to reiterate it today. The police need to be able to follow the evidence without fear or favour.
Maria Caulfield (Lewes) (Con)
I declare an interest as a registered nurse and someone who has worked in areas using syringe drivers and controlled drugs. I welcome the measures announced today, but may I make two further suggestions? First, there are very strict guidelines for nurses on controlling the stock of controlled drugs, and wrongdoing is picked up very quickly. There is not, however, enough training in the use, the dosage, the method and the route of controlled drugs that would give nurses confidence to speak up. Secondly, this situation could have been picked up much sooner if we had a proper IT system that shares medical notes between hospitals and doctors.
Matt Hancock
My hon. Friend is right on both points, and I am very happy to work with her on them. On the latter point, there is still much more work to do to have a system that is fully interoperable between secondary and primary care. As she says, many patients’ GPs might have picked up on the unusual patterns if they had had access to hospital notes. That now does happen in a small number of hospitals, but it is central to improving the technological capability of the NHS.
Nigel Huddleston (Mid Worcestershire) (Con)
I welcome the Secretary of State’s statement and his overall approach on patient safety. We have talked a lot about the need to change the culture from one of blame to one of accountability and transparency. That is easy to say, but difficult to implement so, as well as the changes to the annual report and procedures and process changes, will there be additional training and practical support that can help embed this new culture?
Matt Hancock
Training has improved over the last couple of decades. The training programmes are independently devised for doctors by the royal colleges and are developed and implemented with the General Medical Council and the Nursing and Midwifery Council. There is still much to do to drive through the modern culture of inclusivity and bringing in ideas from all places and to remove some of the unnecessary hierarchies in the world of medicine, both within the NHS and without. I look forward to working with my hon. Friend on that.
Finally, may I end by saying that there is still work to do, not least on the judicial element, and all of us should thank Bishop James Jones for how he has handled this process and made sure that people feel that justice can be done and that the learnings can be taken?
Bill Presented
Palestinian Statehood (Recognition) Bill
Presentation and First Reading (Standing Order No. 57)
Layla Moran, supported by Richard Burden, Sir Vince Cable, Mr Alistair Carmichael, Tim Farron, Wera Hobhouse, Ben Lake, Norman Lamb, Stephen Lloyd, Caroline Lucas, Jess Phillips and Dr Philippa Whitford, presented a Bill to make provision in connection with the recognition of the State of Palestine.
Bill read the First time; to be read a Second time on Friday 8 February 2019, and to be printed (Bill 295).
Government Vision on Prevention
Matt Hancock Excerpts(6 years, 1 month ago)
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The Secretary of State for Health and Social Care (Matt Hancock)
Today I am placing before the House the Government’s prevention vision, “Prevention is Better than Cure”.
This document sets out a cross-Government vision for stopping health problems from arising in the first place and, when they do, supporting people to manage them as effectively as possible. Our mission is to improve healthy life expectancy, so that, by 2035, we are enjoying at least five extra years of healthy, independent life, while closing the gap between the richest and poorest. When it comes to prevention, we all have a role to play: individuals, families, communities, employers, charities, the NHS, social care, and local and national Government. Only by working together can we make this vision a reality.
I am placing a copy of the prevention vision in the Libraries of both Houses.
[HCWS1063]
Points of Order
Matt Hancock Excerpts(6 years, 1 month ago)
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Barbara Keeley (Worsley and Eccles South) (Lab)
On a point of order, Madam Deputy Speaker. The treatment of autistic people and people with learning disabilities in assessment and treatment units is nothing short of a national scandal. Seven years after the Winterbourne View scandal, the Government still have not got rid of these units or substantially cut their use. Now we get, with no notice, the whole issue rolled into another oral statement on public health. The shameful treatment of 2,300 people in Bedlam-like conditions is too important to be dealt with in this way. Can you advise on how to get the Secretary of State for Health and Social Care to take this issue more seriously in the way that he communicates to the House?
The Secretary of State for Health and Social Care (Matt Hancock)
Further to that point of order, Madam Deputy Speaker. I have come to the House at the first available opportunity to explain very clearly, and with some force, I hope, how strongly I feel about people with learning difficulties and autism being held in seclusion units. It is unacceptable morally and unacceptable medically. It has to stop, and it is going to stop.
Barbara Keeley
Further to that point of order, Madam Deputy Speaker. What I was complaining about was that this was done with no notice—no notice to the shadow Secretary of State, no notice to me or the team, and no notice to Members of this House who were not here to ask questions. We should have had notice that this important issue was being dealt with.