Checks on Goods: Northern Ireland and Great Britain

Debate between Nigel Mills and Steve Barclay

Thursday 24th October 2019 Commons Chamber

[Stephen Barclay]

I think that what has shaped these arrangements is something on which I hope the right hon. Gentleman and I can agree. There are unique circumstances in Northern Ireland. That does require a unique solution. There are already unique circumstances pertaining to the Belfast/Good Friday agreement. That is what the solution has put in place. He would, I think, be the first to criticise the Government if we proposed a solution that in any way compromised or involved infrastructure on the border between north and south. Therefore, that does require a degree of flexibility and creativity on all sides; that is part of a negotiation. It is to the credit of Taskforce 50 that, having for a long time said that the backstop was all-weather and all-insurance—having said that it could not be changed, that not a word could be amended—the taskforce did apply creativity and flexibility, and perhaps he should do so as well.

[Nigel Mills (Amber Valley) (Con)]

The Secretary of State has referred to electronic declarations for goods going from west to east. Is he planning to build a new system in the next 14 months, or is he planning to use an existing system such as CHIEF, the customs handling of import and export freight?

[Stephen Barclay]

My hon. Friend is right that this is a straightforward process. In terms of documentation, hauliers and the transportation of goods, often, a firm will be making the same journey to their supplier, which is why any impact of the administrative procedures will be mitigated over time and the systems will ease them. However, we will work with the Joint Committee to reduce the impact of those. That is exactly what the implementation period is for.

Derbyshire CCGs’ Finances

Debate between Nigel Mills and Steve Barclay

Tuesday 4th September 2018 Westminster Hall

[Stephen Barclay]

My hon. Friend is absolutely right. I was coming on to address the allocations for the four CCGs, which I am told by NHS England are above where NHS England independently sets the target. To be precise, according to NHS England, in the case of the Derbyshire CCGs, North Derbyshire is 6.2% above its target allocation, while Erewash is 2.31%, Hardwick 1.92% and Southern Derbyshire 0.25% above the target.

My hon. Friend is absolutely right that it is about how effectively the money is spent. He is also right that, within that search for efficiencies, alongside the additional £20 billion of funding that the Government have allocated, we need to address the point that the hon. Lady correctly raised about the value for money of many of the voluntary services. He correctly identified that there is a cross-party consensus and indeed concern that the value for money of those services should not be the first line of call when seeking efficiencies.

As part of that discussion, the CCG has confirmed that, having looked into this, three of the voluntary services will be protected. The south Derbyshire, Chesterfield and north Derbyshire Cruse Bereavement Care and the Stroke Association support services will be protected. The hon. Lady made a point about the value for money of night services costing £34,000, which within a £51 million target is a very small sum, and the New Mills where she cited the £2.26 per hour. That is exactly the discussion that the CCG is having. It is unhelpful to scare local people ahead of those consultations, because those decisions have not been taken. One of the benefits of the hon. Lady calling this debate is that it allows Members from across the House to put on record their support for voluntary services as part of looking at the legitimate question of where the efficiencies from economies of scale can be identified across the CCGs.

The Government are allocating more funding to the NHS, but they are looking at areas that are above their target allocation to ask, “Where are the inefficiencies and how do we spend that?” As part of asking taxpayers to contribute £20 billion more a year to the NHS, it is right that we ask how effectively that money is spent and that we ensure that we drive efficiencies.

The hon. Lady did not mention this, but it is pertinent that there is funding to Derbyshire in other forms: for example, the £12.5 million that has recently been provided for the four CCGs to spend on increasing theatre capacity at the Royal Derby Hospital. Again, that is part of enabling the CCGs to drive efficiencies. Some £40 million of sustainability and transformation partnership capital bids are yet to be approved. There are additional funding bids in the Department, NHS Improvement and NHS England as part of driving those efficiencies that the CCGs are being asked to deliver.

Alongside that is the vanguard programme—the CCGs agreed a business case in January 2018 to spend £1.1 million to continue to fund significant elements of the Wellbeing Erewash programme. My hon. Friend the Member for Erewash (Maggie Throup) has been an extremely strong champion of the benefits and importance of the programme in Erewash in her interactions with ministerial colleagues. The CCGs have introduced a range of financial measures to improve their financial position, including development of an efficiency strategy and a move to joint leadership arrangements, to which the hon. Member for High Peak referred. Closer functional working across the four CCGs in Derbyshire will help, but so will the additional capital that is being sought and innovation to work more efficiently through programmes such as vanguard.

On the voluntary sector, which was the meat of the hon. Lady’s remarks, it is important to stress that decisions have not been taken and that a consultation process is under way. The CCGs will have those discussions with local stakeholders. It is important to be clear that before taking any final funding decisions on services through the voluntary and communities sector, that further round of engagement and consultation with the local communities, local authorities, patients, GPs and other stakeholders will take place.

[Nigel Mills]

What we desperately do not want is a short-term saving made to fix a short-term problem. Bringing those services back in 18 months’ time when the much-welcome increased funding is available will not happen, because the volunteers and the organisations will have gone. Can there be any kind of downpayment on that future funding, or some slight relaxing of the annual deficit calculations, just to get us through the gap so that we do not do something now that we regret in 18 months’ time?

[Stephen Barclay]

To some extent, that is already happening in the form of the £45 million of the deficit that is being absorbed by NHS England, but part of the NHS England consultation is assessing where the CCGs are against their target allocation—it is part of the consideration of the £40 million of capital bids for Derbyshire and part of the £12.5 million that was secured for the improvements at Derby county. It is also part of other issues in the NHS such as length of stay—43% of patients in acute hospitals do not clinically need to be there and would be better served in the community, which is where those value for money assessments need to play a part.

Oral Answers to Questions

Debate between Nigel Mills and Steve Barclay

Tuesday 19th June 2018 Commons Chamber

[Stephen Barclay]

I am grateful for my hon. Friend’s support on tier 2 visas. She will be aware that clinicians who reach the £1 million lifetime allowance limit can expect a pension of about £44,000, payable at age 60, increasing with inflation, plus a tax-free lump sum of about £132,000. Although these are ultimately issues for the Treasury, it is important that we ensure that tax allowances, two thirds of which go to higher-rate taxpayers, are fair to other taxpayers.

[Nigel Mills (Amber Valley) (Con)]

16. What steps his Department is taking to support the use of innovative drugs and devices in the NHS.

East Midlands Ambulance Service

Debate between Nigel Mills and Steve Barclay

Wednesday 21st February 2018 Westminster Hall

[Stephen Barclay]

My right hon. Friend makes a pertinent point. As he mentioned, he is my constituency neighbour and I am very aware of the specific challenges posed by the geography and the road network in Lincolnshire. I am happy to take that specific point forward. It will not surprise him that I have already zeroed in on some of the challenges in Lincolnshire, particularly around United Lincolnshire and Northern Lincolnshire and Goole, how that interplays across the spectrum of primary care, how the patient pathway goes through, the various blockages in the system and how we look at that in a more systemic way.

That issue interplays with a much wider debate, outside the scope of this one, but to give my right hon. Friend one statistic, 43% of beds are occupied by 5% of patients. If we take the average length of stay from 40 to 35, that is the equivalent of 5,000 hospital beds, each at £100,000 per year. We can see how there is an interplay between what we are debating with the ambulance services and the wider Lincolnshire health economy, which is a specific point. I am happy to have further discussions with him on that.

The hon. Member for Bassetlaw (John Mann) raised three points about the report on the disproportionate calls, which were pertinent to a conversation I had just this morning about spikes in care homes and what action might be taken. For example, to what extent can we improve GP access into specific care homes in Lincolnshire through Skype, as one of the mitigations of ambulance demand? We are looking at how we assess the return on investment between the cost of ambulances and emergency admissions and what that investment might do if it were put into a more preventative role—care homes, for example.

On the specific matter of Sports Direct, which I was not aware of, the hon. Gentleman makes a valid point, which I will be keen to look at with officials—where there are peaks of demand, what is driving those peaks and how to mitigate them. He also mentioned the issue of privatisation from 2009. We are looking at how we take a more holistic view across a landscape and how mutual support from different parts of the system can provide assistance to that. It will not surprise the hon. Gentleman, knowing my views on Brexit, that for all the talk of some of the challenges of Brexit, the opportunities of Brexit should not be missed. I share his desire on that.

There is also the geography point—whether it is the way services elsewhere have been reconfigured or the extent to which there are, for example, centres of excellence to which his constituents are being taken. Is the issue the formal geography or how the operating protocols within that geography have evolved? That, again, is a perfectly valid point and one we can look at on a case-by-case basis.

I know my hon. Friend the Member for Boston and Skegness has championed a number of these issues over a period of time. He raised how we can get the ambulance service working together with the other emergency services. I know that is an issue that many police and crime commissioners have also identified, and many within the fire service are keen to ensure that we have a better join-up between the blue-light services.

The hon. Member for Lincoln (Karen Lee) raised the issue of hospital handovers. I assure her that daily reviews are currently being undertaken by NHS England and NHS Improvement. Greater transparency and targeted assistance are being provided, and there are also specific initiatives linked to individual hospitals, particularly including the hospital-ambulance liaison officers.

The hon. Lady also mentioned pay. It is worth reminding the House that the pay band that applies to paramedic staff has been increased from band 5 to band 6, so there has been a recognition in the system of the importance of paramedics, alongside an increase—around 30% since 2010—in the number of paramedics. However, we recognise that there is also an increasing demand, and that this service has been under considerable pressure.

[Nigel Mills (Amber Valley) (Con)]

The Minister has skirted around the issue of breaking up EMAS, which I think some areas might quite like. Does he agree that our priority should be having more paramedics and ambulances, not more chief executives and office buildings?

[Stephen Barclay]

I think most people who observed my questioning during my four years on the Public Accounts Committee will know that organograms and looking at where investment is and how streamlined structures are is extremely important to me.

At the same time, it is important that one does not make a false saving in driving down some of the management costs, so that procurement, IT investment and consultancy spend, for example—some of the big ticket expenditure—is not effectively managed and escalates. There is a balance to be struck between having good leadership of trusts and, as my hon. Friend alludes to, not drifting into areas where additional hires are created in the back office as opposed to services on the frontline, where I think Members from across the House want to see them.

In terms of the service nationally, a number of actions have been taken. Under Sir Bruce Keogh’s review of the NHS urgent and emergency care system, ambulance services are being transformed into mobile treatment centres, making much greater use of “hear and treat”, which is treating patients over the phone, and “see and treat”, which is treating and discharging patients on the scene. While we have heard of some of the challenges faced by the trust, it is also worth placing on the record that it is one of the best-performing trusts for “hear and treat”, and treats and discharges more than three in 10 patients either on the phone or on scene. There are areas of good practice that, for balance, it is only fair to recognise.

I will conclude, to allow the hon. Member for High Peak time to speak. We recognise that the trust has challenges, and I am very happy to work with the hon. Lady and other colleagues as we move forward to address those. In addition to the increase in pay bands and the increase in numbers, an active plan is under way to tackle some of the challenges we have heard about today, which I hope gives some comfort to the hon. Lady.