The National Health Service

Stephen Hammond Excerpts

Wednesday 23rd October 2019 Commons Chamber

[Stephen Hammond (Wimbledon) (Ind)]

It is an honour, a pleasure and a surprise to be called in this debate, Madam Deputy Speaker. I confess that I had forgotten I put in for it, but I am none the less delighted to speak and to follow the hon. Member for Bishop Auckland (Helen Goodman). She knows how much I oppose no deal, but I say gently to her that I spent more hours of my life than I care to remember between December last year and July ensuring that in the event of a no-deal Brexit the NHS would have the supplies it needs, and I am confident that my successor as the Minister for Health, my hon. Friend the Member for Charnwood (Edward Argar), will be able to reassure her from the Dispatch Box that the NHS is putting in place all the preparations she wants.

For me, the most important line in the Queen’s Speech was that new laws would be introduced to implement the NHS long-term plan. I say that because I think the long-term plan is likely to be one of those documents that define healthcare and the way we deliver it for many years to come. It appears that real thinking has been put into creating a joined-up framework, but as the Chair of the Health Committee, the hon. Member for Totnes (Dr Wollaston), will recognise, it is not just a central diktat document. It is a document that was formulated working upwards with NHS staff and that makes them integral to the whole system.

The Opposition spokesman, the hon. Member for Leicester South (Jonathan Ashworth), was right to identify that there are staffing problems, but he was wrong not to accept the absolute priority the long-term plan attaches to staffing and the work that is being done. The Health Secretary spoke about the number of extra GPs being recruited into training this year; what he did not say was that while recruitment is a problem, retention is even more fundamental. A number of the training places are in new medical schools in areas that are likely to retain the new doctors because they trained in the area. Equally, in nursing, which everyone rightly talks about, retention is as important as recruitment, and efforts are being made through new routes back into nursing. When I visited Great Ormond Street Hospital, I was struck by the introduction of 10 to 2 shifts, enabling mothers who want to return to nursing to continue to practise on child-friendly shifts. It is true that flexible rostering is coming on and we should avail ourselves of such opportunities, because if we cure our retention problem, we halve our recruitment problem.

I am pleased to see the work being done on the NHS infrastructure plan. Inevitably, everybody has said that the 40 hospitals are not there, but anyone who has been in business or in any form of charity work that requires forward planning knows that 40 hospitals or 40 projects are not brought on just like that. They need business plans. We can commit to six hospitals so quickly because the process has been worked through and they are ready to go. It is encouraging that 21 plans are in procedure and are starting now. It is much more likely that those hospitals will come forward more quickly.

It would be remiss of me not to take this opportunity to bring forward one constituency case, which I think highlights a problem that a number of hon. Members have already spoken about today: the use of medical cannabis by people with severe epilepsy. The case concerns my constituent Kayleigh Morris, whose Aunt Dee spends an extraordinary amount of her time and her life ensuring that her niece is able to live. She appreciates that the Health Secretary saw them seven months ago. What she would like, however, is for the Health Secretary to—if I can put it colloquially—put a rocket up the health system. I have spent the past three months writing letters to the chief executive of the hospital just to get him to respond to my constituent on this matter. If the Health Secretary could put that proverbial rocket through the system, it would be greatly appreciated.

I see that I have 18 seconds left, which is probably a relief to the House. I will just say that I am particularly pleased to see that the Government are, along with the long-term plan, going to bring forward reforms to mental health.

Health Infrastructure Plan

Stephen Hammond Excerpts

Monday 30th September 2019 Commons Chamber

[Edward Argar]

While I recognise and pay tribute to the hon. Lady for her championing, as one would expect, of her constituents and local hospital, I am sure she will none the less welcome this Government’s massive investment in our NHS. I hear what she says about her own local hospital, and she is right to highlight the work done by the staff, who do amazing work day in, day out, particularly in the aftermath of some incredibly challenging disasters. I would be very happy to meet and talk to her in more detail about the finances of her hospital and trust since 2011, if she feels that would be useful.

[Stephen Hammond (Wimbledon) (Ind)]

I welcome my hon. Friend to his role and wish him every success. I also welcome this Government’s continuing investment in the NHS, particularly that in the Epsom and St Helier University Hospitals NHS Trust. Does he agree that it will provide high-quality A&E services for my residents, maintain key services at the St Helier site and confound those naysayers who said that this Government were going to shut that hospital?

Oral Answers to Questions

Stephen Hammond Excerpts

Tuesday 23rd July 2019 Commons Chamber

[Anne-Marie Trevelyan (Berwick-upon-Tweed) (Con)]

2. What steps he is taking to increase the level of funding for health services in rural areas.

[The Minister for Health (Stephen Hammond)]

NHS England is responsible for funding allocations to clinical commissioning groups, which already take into account the relative health needs of local areas. NHS England is now introducing a new community services formula, which will better recognise the needs of rural, coastal and remote areas.

[Anne-Marie Trevelyan]

Will the Minister update the House in more detail on how the Department plans to support CCGs such as Northumberland, where managing the extra costs associated with the extreme rurality of communities like the Coquet valley, the most rural in England, means it simply is not possible for community nurses and general practitioners to reach as many patients in a day?

[Stephen Hammond]

Adjustments are already being made in the funding formula for differences in costs related to rurality or location. Northumberland CCG will receive an extra £1.1 million in funding this year to provide emergency ambulance services in sparsely populated areas. By 2023-24, Northumberland CCG will receive £98.5 million more funding.

My hon. Friend has already spoken to me about Rothbury Community Hospital in her constituency, and I would be delighted to speak to her about it again.

[Mr Ivan Lewis (Bury South) (Ind)]

People in rural areas need more investment in social care services. I do not always agree with the Daily Mail, but is it not right when it says that we now need a national dementia fund and an all-party approach to defining the nature and funding of the social care system in this country? Successive Governments have failed in that respect, and older people, disabled people and their families are being let down as a consequence. When will we see some action?

[Stephen Hammond]

The hon. Gentleman is right, which is why the Green Paper will have long-term plans on mental health and, indeed, dementia. I think he will be pleased to see that when the Green Paper is released shortly.

[Sir Desmond Swayne (New Forest West) (Con)]

What can the Minister do to expedite the provision of primary care services in those rural areas where the population is growing fast as a consequence of new housing?

[Stephen Hammond]

My right hon. Friend is right to raise that point, which has been raised with me several times. The new funding formula that the independent advisory committee is setting up will take into account the growth in population. It will look at the growth in the electoral register every year, rather than over a five-year period, as it does now, so it will be able to respond more quickly than is currently the case.

[Mr Dennis Skinner (Bolsover) (Lab)]

Will the Minister bear in mind the fact that dementia comes in many different forms? My mother had one form and she lasted a number of years, but it finally took hold. My sister, on the other hand, went within a short period of time, because she would not eat at all. My best friend at the time in the National Union of Mineworkers, Peter Heathfield, finished his life being violent, struggling with three people who tried to get him to the toilet. Bear that in mind carefully, Minister. Dementia is not a static illness; it is very different for different people.

[Stephen Hammond]

I do not always agree with the hon. Gentleman, but he is right to make that point. I know from very personal experience that dementia affects people in different ways, which is why I am proud to be part of a Government who are committed to delivering in full on the challenge on dementia 2020, to make England the best country in the world for dementia care.

[Tim Farron (Westmorland and Lonsdale) (LD)]

The huge rural area covered by the Morecambe Bay NHS Foundation Trust has and needs three hospitals, but it is funded as if it had only one. As a result, the trust has been fined more than £4 million in debt interest over the past three years. That money could have been spent on nurses, paramedics or doctors. Will the Minister intervene to stop this at once?

[Stephen Hammond]

I met the hon. Gentleman recently to talk about ambulance provision in his constituency and the Morecambe bay area, and I hope he is now satisfied with the progress we are making on that. I will look into the individual case he mentions and respond to him.

[Anne Marie Morris (Newton Abbot) (Con)]

3. What steps his Department is taking to ensure the accessibility of health services for rural populations.

[The Minister for Health (Stephen Hammond)]

The long-term plan that the Department published in January commits to delivering fully integrated community-based healthcare in primary and community hubs. It confirms that the standard model of delivery will be developed for use in smaller acute hospitals that serve rural populations.

[Anne Marie Morris]

I thank the Minister for his answer, but some rural villages, including some in Devon, have no ambulance service at all—a fact masked by high-level statistical reporting. Will the Government work with me and the National Centre for Rural Health and Care to expose the real rural healthcare deficit, which is so masked, and work with us to rectify the situation and provide the appropriate care and medical support necessary by putting in place a robust and accountable rural health and care strategy and plan?

[Stephen Hammond]

I know that my hon. Friend has worked with the National Centre for Rural Health and Care and chairs the all-party group on rural health and social care. She is right to mention the fact that there are particular challenges in the delivery of the best-quality healthcare that we want to see in rural areas. I would be delighted to work with her and the all-party group on the matter.

[Rosie Duffield (Canterbury) (Lab)]

It has now been almost 18 months since health commissioners proposed that the two options for acute medical care in east Kent be put forward for public consultation. My constituents, particularly those in rural areas, are simply fed up with waiting for a new hospital. Will the Minister please confirm for me today just when a full public consultation on the future provision of acute services in east Kent will finally take place?

[Stephen Hammond]

The hon. Lady asks a good question on behalf of her constituents. I cannot confirm today when that will happen, but I will look into the matter and write to her to make sure that she gets the answer.

[Emma Hardy (Kingston upon Hull West and Hessle) (Lab)]

One in 10 women have endometriosis. The average wait for diagnosis is seven and a half years and can be even longer in rural areas, and there is currently no test for it. Researchers at the University of Hull previously developed biomarkers for cancer testing and have recently developed a project to test for biomarkers in urine to help to identify endometriosis. They need £10,000 in seed funding to get the project off the ground; will the Minister please meet me to discuss how we can secure the funding?

[Stephen Hammond]

The hon. Lady has invited me to meet her to discuss that funding. She will be pleased to hear that I will be delighted to do so.

[Ian Austin (Dudley North) (Ind)]

4. What steps he is taking to ensure that people with cystic fibrosis receive the latest treatment for that condition.

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[Jack Brereton (Stoke-on-Trent South) (Con)]

9. What steps he is taking to improve NHS facilities.

[The Minister for Health (Stephen Hammond)]

Modern, fit-for-purpose facilities are better for patients, the NHS staff who work in them and the taxpayer, so the Government have already provided £3.9 billion of new capital investment to deliver new, upgraded facilities across the country.

[Jack Brereton]

I thank the Minister for visiting the site of the proposed new Longton health centre in my constituency recently. Does he agree that we must deliver new primary care facilities such as this to make sure that improvements in health in my local community continue?

[Stephen Hammond]

I very much enjoyed the visit. The new £5 million Longton medical centre will provide general practice service for more than 12,000 patients, and it will be a fantastic community health scheme. My hon. Friend will be pleased to hear that yesterday I wrote to him outlining the capital options that might be available. He is right, and that is why this Government believe in transforming the primary care estate. It is a key enabler for delivering the long-term plan, and it provides better care for patients.

[Rachael Maskell (York Central) (Lab/Co-op)]

A year on, NHS Property Services is now having to remarket the site of Bootham Park Hospital. In the light of this complete failure and the failure to listen to health professionals locally, will the Minister ensure that the One Public Estate bid is seriously considered as the sale moves forward?

[Stephen Hammond]

I met the hon. Lady about this disposal last December, and I have followed the matter carefully. The local health system has not wanted to continue using the site, but I am happy to assure her that I will look at bids from all comers. It is not my decision; it is a decision for local healthcare bodies and NHS Property Services.

[Derek Thomas (St Ives) (Con)]

The Minister will be aware that our general district hospital was closed to new admissions in recent weeks, and the reason given was delayed transfers of care. Ever since I was elected, many others have joined me in looking at how we can provide a step-down, step-up facility—a community healthcare hub—with beds in the St Ives constituency. I wonder what funding is available to achieve that aim.

[Stephen Hammond]

My hon. Friend is right. He will have heard me say in response to my hon. Friend the Member for Stoke-on-Trent South (Jack Brereton) that we are already making available £3.9 billion extra to provide these facilities. We should not be complacent, however, and it is important to recognise that we want world-class facilities for world-class care. One of the benefits of the long-term plan is that we can create a stable environment for capital investment, and we can make the case for more capital investment at the spending review.

[Mrs Emma Lewell-Buck (South Shields) (Lab)]

Government cuts have already resulted in significant downgrading and loss of vital services at South Tyneside District Hospital. Since the Department refused to fund the next phase of downgrading, the trust has approached the local authority to borrow £35 million from the treasury to see it through. Does the Minister agree with me and my incensed constituents that it is wrong that we are now being asked to pay for further cuts to our hospital?

[Stephen Hammond]

The hon. Lady will know that the Government are putting more cash and more money into the NHS than at any other time in its history. There will be £33.9 billion extra going in by 2023-24.

[Karen Lee (Lincoln) (Lab)]

10. What recent estimate he has made of the number of NHS workforce vacancies.

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[Mr Barry Sheerman (Huddersfield) (Lab/Co-op)]

12. What steps he is taking to ensure that (a) adequate resources and (b) highly trained personnel are allocated to health services for vulnerable older people.

[The Minister for Health (Stephen Hammond)]

The NHS is responsible for ensuring adequate resources and a high-quality workforce that can deliver a comprehensive health service for all people, including vulnerable older people. That is clearly happening. We are supporting that through investing an extra £33.9 billion in the NHS.

[Mr Sheerman]

I have also just heard the news that we have a new Prime Minister. I am thinking of the man who stands outside with a sign saying that the end of the world is nigh.

The fact of the matter is that the end of life for many of my constituents is tough, because the people in the care sector who support them are poorly paid, poorly resourced and poorly trained. Surely we should go for well-managed, highly trained, highly skilled people in the NHS for every age?

[Stephen Hammond]

The hon. Gentleman is right, which is why we have ensured that we are putting more money into the NHS and more money into primary care, with £4.5 billion in real terms on primary medical care and community health services. It is why we commissioned Baroness Dido Harding to produce the “Interim NHS People Plan”, which she has done, and why we are working on ensuring that we have the health service workers to provide excellent care for all people in the community.

[Mr Virendra Sharma (Ealing, Southall) (Lab)]

13. What assessment he has made of the effect of public health services on reducing health inequalities.

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[Mike Gapes (Ilford South) (IGC)]

14. Whether his Department’s decision of October 2011 to close the A&E department at King George Hospital, Ilford, has been rescinded; and if he will make a statement on future services at that hospital.

[The Minister for Health (Stephen Hammond)]

The hon. Gentleman will be pleased to hear that I can confirm that there will continue to be an A&E at King George Hospital, Ilford. The NHS has concluded that there is need for such provision now and in future.

[Mike Gapes]

I thank the Minister for that reply. I hope that it will stop some of the more lurid scaremongering and campaigning, which is unfortunately diverting people in my constituency from looking at the most important issue: how we use the King George Hospital site in future. Will he confirm that steps are being taken to integrate North East London NHS Foundation Trust and King George Hospital services to deal with social care and other matters?

[Stephen Hammond]

I am happy to confirm that.

[Kerry McCarthy (Bristol East) (Lab)]

15. What additional funding he plans to allocate to the NHS to reduce the number of people with autism and learning disabilities held in in-patient settings.

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[Kevin Hollinrake (Thirsk and Malton) (Con)]

T7. Has the Secretary of State given further consideration to providing extra funds to meet the challenges of running unavoidably small hospitals, such as Scarborough and the Friarage in Northallerton?

[The Minister for Health (Stephen Hammond)]

My hon. Friend has campaigned on this matter for a while, and I was pleased to meet him to discuss it earlier in the year. We absolutely recognise the challenge that small acute providers face, and over the past two years the Advisory Committee on Resource Allocation has been considering how we might meet that challenge. The committee has endorsed a new community services formula to reflect the pressure in remote areas, which may help the two hospitals mentioned by my hon. Friend.

[Tracy Brabin (Batley and Spen) (Lab/Co-op)]

T3. My constituent Catherine is undergoing post-operative breast cancer treatment. A new drug, Pertuzumab, which has been approved by the National Institute for Health and Care Excellence, has been shown to improve a woman’s life chances. The drug was prescribed for Catherine by her oncologist at the Mid Yorkshire Hospitals NHS Trust, but that was overruled by NHS England, although in the neighbouring trust patients are allowed it. Can the Minister guarantee that women who could extend their lives by taking this drug have access to it, no matter where they live?

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[Mr Barry Sheerman (Huddersfield) (Lab/Co-op)]

T4. I am not going to shout at the Secretary of State this morning, but I will say to him that Huddersfield is a typical town, and a lovely place in which to live and work. Given that it is so attractive, why is it so difficult for us to find doctors and dentists who can give a good service to my constituents under this modern NHS?

[Stephen Hammond]

The hon. Gentleman will know that the Government have produced an interim people plan setting out the course and the trajectory that will mean more doctors and nurses being trained. He will also know that we have opened new medical schools this year, and that more doctors are now being trained.

[Kirstene Hair (Angus) (Con)]

I should declare that I am chair of the all-party group on eating disorders. Despite eating disorders affecting 1.25 million people across the UK and being the most deadly of mental health issues, the average time dedicated to training about eating disorders in a five-year medical degree was found to be only three or four hours; in some cases, there was none at all. Will the Minister agree to look into this and perhaps report back to the all-party group?

Regulation of Physician Associates and Anaesthesia Associates

Stephen Hammond Excerpts

Thursday 18th July 2019 Written Statements

[The Minister for Health (Stephen Hammond)]

Today I am pleased to announce that we have asked the General Medical Council (GMC) to regulate physician associates (PAs) and anaesthesia associates (AAs) across the UK.

On 7 February 2019 the Government published their response to the consultation on the regulation of medical associate professions in the UK.

The response confirmed the decision announced on 12 October 2018 by the Secretary of State for Health and Social Care to introduce statutory regulation for physician associates (PAs) and anaesthesia associates (AAs) (formerly known as physicians’ assistants (anaesthesia)).

However, we set out that further work was required to decide which regulator would take forward regulation of these roles.

Following the completion of this work, we believe that the GMC is best placed to regulate PAs and AAs. Regulation will enable these groups to work to their full potential and provide the very best care to patients as part of a multidisciplinary clinical team, contributing to the development of a safe and flexible workforce. This is an important step towards meeting workforce commitments in each of the four countries including the interim NHS people plan in England.

The UK and devolved Governments will now work together alongside stakeholders to develop and then consult on draft legislation.

[HCWS1741]

NHS Workforce: England

Stephen Hammond Excerpts

Wednesday 17th July 2019 Westminster Hall

[The Minister for Health (Stephen Hammond)]

It is a pleasure to see you in the Chair, Mrs Moon. I look forward to responding to the debate, which has been interesting, and I congratulate the hon. Member for Wolverhampton South West (Eleanor Smith) on securing it.

I listened carefully to my hon. Friend the Member for St Ives (Derek Thomas). He will be pleased to know that I will be happy to write to him about podiatry; there are some interesting issues about new plans that are being put in place. He will recognise that there are more applicants for university nurse training places this year than in the previous year.

I was pleased to hear the contributions from the hon. Members for Lincoln (Karen Lee) and for Westmorland and Lonsdale (Tim Farron). I have responded to the hon. Gentleman about ambulances. He will know that there are eight posted in the Cumbria and Morecambe Bay areas, but I am looking with him at procurement there and will be looking to see where the North West Ambulance Service places those ambulances. He questioned whether promises are being fulfilled. I guide him to the implementation framework. He also talked about planning and investment. That is why there is a long-term plan and a people plan, and why moneys are going in to back them up. I also listened carefully to the hon. Member for Hartlepool (Mike Hill).

I say to the hon. Member for Washington and Sunderland West (Mrs Hodgson), let us start by agreeing with each other. I think both of us, and everybody in the Chamber and across the House, would recognise and praise the work of everybody who works in the NHS—I have been pleased to do that on every occasion I have responded to a debate in Westminster Hall or on the Floor of the House. The hon. Lady rightly mentioned that the interim people plan recognises the pressures that are being put on staff. What she failed to say, of course, is that not only do we recognise that but there is a whole chapter on addressing those issues and making the NHS the best place to work. She talked a little about junior doctors and nurses in training, failing to recognise that we have just done a deal with the junior doctors that includes a four-year pay deal and resolution of the number of issues they had with the contract review. There are now more applicants for nurse training places than there were in the previous year.

Like many other Members, I attended the RCN member-led event yesterday and heard at first hand about the aims of the campaign from many nurses working in the NHS. I met again a number of the people I met at an event for nurses in training back in November. At the heart of the campaign, as everybody recognises, is the RCN’s intention to ensure that the needs and requirements of the NHS workforce are prioritised. I fully support the RCN’s focus on the importance of the NHS workforce—recruitment and retention—but I am not convinced that legislation is always the answer, and I am not convinced that changing legislation will necessarily bring about the changes and focus the RCN seeks.

However, given that the hon. Member for Wolverhampton South West secured the debate in recognition of the Secretary of State’s legislative duties in relation to workforce, it is probably right that I set out exactly what the legal position is. Through the Care Act 2014, the Secretary of State delegated to Health Education England powers to support the delivery of excellent healthcare and health improvement for patients and the public in England by ensuring that the current and future NHS workforce has the right number of staff with the right skills, values and behaviours at the right time and in the right place to meet patients’ needs.

The Care Act 2014 sets out in detail Health Education England’s remit and range of responsibilities, including its duty to ensure an effective system of education and training for the NHS and public health. Beyond the detail of the legislation, HEE provides leadership for the education and training system, and ensures that the workforce have the right skills to be able to deliver excellent healthcare in the right numbers. HEE was established to deliver a better healthcare workforce for England and is already accountable for ensuring that there is a secure workforce supply for the future. It has responsibility for promoting high-quality education and training that is responsive to the changing needs of patients and local communities.

The full range of HEE’s responsibilities, deliverables and accountabilities are described in its annual mandate, which the Secretary of State is required to approve. The most recent edition of that mandate and HEE’s latest annual business plan summarise what it is doing and its achievements. I am pleased to say that, as those who have had the chance to read it will have noted, the mandate for 2019-20 was published last week.

The hon. Member for Washington and Sunderland West made a point about legislation for safe staffing, but there is already a commitment to safe staffing and to ensuring that the NHS aims to be the safest healthcare system in the world, as it should be. Part of that must come from transparency in staffing levels, which is why the care hours per day data were introduced in 2016. The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 require hospitals to have the right staff in the right place at the right time, and appropriate staffing levels are a core element of the Care Quality Commission’s registration regime. As the hon. Lady will know, all providers of regulated activities must be registered with the Care Quality Commission and meet the registration requirements. The safe staffing requirement is therefore already there, and accountability mechanisms are in place.

[Mrs Hodgson]

The Minister says that accountability is already in place. Staffing levels may be required and desirable, but what happens when they cannot be met because the staff are not there? Where is the accountability?

[Stephen Hammond]

The hon. Lady will know that the CQC regime puts directives in place if staffing levels are not there. The local providers are then forced to address those issues. The accountability is there.

Beyond this issue, several hon. Members talked about exactly what we are doing now. There was recognition that the Government have put in place the long-term plan and the people plan. Any reading of those will see that our overarching plan for the health service looking forward recognises explicitly that getting the workforce supply right is key. That is therefore an important part of the long-term plan, which sets out the vital strategic framework to ensure that in the next 10 years the NHS will have the staff it needs. Nurses and doctors will have the time they need to care, work in a supportive culture and allow them to provide the expert, compassionate care to which they are committed.

Hon. Members rightly said that that will not be for this Government; it may well be for the Government beyond. However, the long-term plan rightly recognises by its very nature that what we need to put in place today must continue through the next 10 years to ensure that we have the staffing levels we need.

[Karen Lee]

A number of us mentioned the nursing bursary. The long-term plan talks about extra places for nurses, but if nurses are not being trained—the evidence shows that numbers have dropped by about 25% to 30% —clearly we cannot have them in place. I seek the Minister’s comments on reinstating a nursing bursary so that mature students and other students can afford to train.

[Stephen Hammond]

I will come to the number of nurses in training and related issues in a moment, to address the hon. Lady’s comments.

Associated with the long-term plan is the people plan, which clearly recognises, to reference what I said about Health Education England, the significant role of that organisation in securing the NHS workforce for the future. That is why my right hon. Friend the Secretary of State for Health and Social Care commissioned Baroness Harding, the chair of NHS Improvement, to work alongside and closely with Sir David Behan, the chair of HEE, to develop the workforce implementation plan. The interim people plan published in June set out the actions needed to change positively the culture and leadership of the NHS, making it the best place to work, which addresses the issues rightly raised about recruitment and retention.

The people plan commits to developing a new operating model for the workforce that ensures that activities happen at the optimal level, whether in individual organisations, local healthcare systems, regionally or nationally, with roles and responsibilities being clear.

On NHS workforce supply, hon. Members talked about demand for nursing and midwifery courses. The latest available evidence shows that we are starting to see a substantial rise. Data published only last week showed a 4.5% increase in applicants compared to 2018, with that being the second increase in as many years. To build on that, to ensure that we increase the pipeline of nurses coming into the profession, the Department has worked with NHS England to ensure that funding is available for up to 5,000 additional clinical placements for nursing degrees in England. The chief nursing officer for England has led work to identify and accelerate the availability of such clinical placements. It is vital that universities ensure that they take up offers and provide placements to ensure that places are filled at the end of this year’s recruitment cycle. That can happen.

[Mrs Hodgson]

I acknowledge the 4% increase—it is a small increase—but figures show that the numbers are still down 29% from 51,830 in 2016, when the bursary that covered training was removed. Even with that small increase, we are still 15,000 short of the figure when the bursary was axed.

[Stephen Hammond]

The figures show an increase in applicants this year. The hon. Lady will know that there are 1.4 applications for each place, and she will have heard me say that we are creating additional clinical placements to ensure that more nursing places are available. I recognise that there has been a drop, but I hope that she applauds the 4.5% increase in applicants this year. That is key.

A number of Members rightly talked about additional nursing roles and support. Health Education England is leading a national nursing associates programme with a commitment for 7,500 nursing associate apprentices to enter training this year. That builds on a programme that has already seen thousands start training in 2017 and 2018.

The RCN is leading work focused on the legislative framework for all professional groups. I should set out that work on the people plan also included examining options for growing the medical and allied health work- force, including the possibility of further medical school expansion, increasing part-time study, expanding the number of accelerated degree programmes and greater contestability in allocating the 7,500 medical training places each year to drive improvements in the curriculum.

For allied health professionals, the long-term plan sets out a commitment to completing a programme of actions to develop further the national strategy, focusing on implementation of the plan. There will be a workforce group to support that work and make recommendations, including on professions in short supply, which would address the podiatry point made by my hon. Friend the Member for St Ives. That is essential.

I do not think that anyone should be in any way complacent, and the Government are clearly not complacent. Many hon. Members will have heard me say that, as well as training the workforce for the future, it is important that we support and retain the current workforce. The interim people plan is committed to reviewing how to make increases in a number of factors. One such factor is national and local investment in professional development and workforce development.

There are examples of good practice in this area across the NHS, and I was particularly pleased when I visited Leeds Teaching Hospitals NHS Trust to see how a group of band 6 nurses had created their own in-house training programme, boosting management skills and leading to greater collaborative ways of working. That example of best practice makes the case for national investment in such programmes and for national funding for continuing professional development.

Everyone recognises the need to recruit more staff, but it is also fair to put on the record the fact that the number of staff working in the NHS today is at an all-time high—it is the highest it has been in the NHS’s 70-year history. Since 2010 there has been a significant growth in qualified staff. [Interruption.] I hear a sigh from Opposition Members, but it is worth making the point that there are now 51,900 more professionally qualified staff, including 17,000 more nurses working on wards. That is a simple fact; it is a piece of data, and we cannot get away from it. I do not suggest that one should be complacent in any way, but we should recognise that there are more nurses and doctors, and the Government are committed to delivering on our promise to ensure that the NHS has the right staff with the right skills in the right place at the right time to deliver the hugely valuable, excellent care that patients deserve.

Question put and agreed to.

Resolved,

That this House has considered the legal duties of the Secretary of State for Health and Social Care for NHS workforce planning and supply.

Promoting Professionalism, Reforming Regulation

Stephen Hammond Excerpts

Tuesday 9th July 2019 Written Statements

[The Minister for Health (Stephen Hammond)]

Today I am publishing the Government response to the consultation “Promoting professionalism, reforming regulation”.

“Promoting professionalism, reforming regulation” set out proposals to make professional regulation faster, simpler and more responsive to the needs of patients, professionals, the public and employers.

We will take forward legislative changes to the regulators’ fitness to practise processes and operating framework. We believe that this will realise the greatest benefits for regulatory bodies, registrants and the public.

These changes will deliver:

Modern and efficient fitness to practise processes;

Better supported professionals; and

More responsive and accountable regulation.

We will also make the legislative changes recommended by the Williams review into gross negligence manslaughter in healthcare, including removing the General Medical Council’s right to appeal decisions made by the Medical Practitioners Tribunal Service.

These changes are a real step forward in delivering on our manifesto commitment to reform and rationalise the current outdated system of professional regulation of healthcare professions.

In developing our response, we have reflected on and responded to the findings of a number of recent reports, including the NHS long-term plan and the interim people plan.

The consultation received over 900 responses from individuals, organisations, healthcare professionals and members of the public. I would like to thank all those who took the time to respond to the consultation. Their views will be instrumental in shaping the future of professional regulation in the UK.

The UK and devolved Governments will now work together to develop and then consult on draft legislation.

[HCWS1701]

NHS Procurement and Subcontractor Exclusion

Stephen Hammond Excerpts

Thursday 4th July 2019 Commons Chamber

[The Minister for Health (Stephen Hammond)]

It is a pleasure to respond, and I thank the hon. Member for Bury South (Mr Lewis) for securing this debate to highlight an issue about which he rightly feels very strongly, as it affects a company in his constituency.

The title of this debate highlights the two things the hon. Gentleman wants to raise. The first is the specific issue and, as I have some time, I will talk a little about procurement processes with subcontractors in general, too. He highlights an issue with a specific framework contract that, as he rightly says, is managed by my Department.

The specific issue the hon. Gentleman raises is on the use of subcontractors in the flooring industry under the construction framework ProCure22. The issue was originally raised through the Government public procurement review service, hosted by the Cabinet Office, back in December 2018. A response was provided by officials at the time and is on the Government website.

The hon. Gentleman asked a number of direct questions, which I will tackle later in my speech. I hope to satisfy him but, if not, I will, of course, be very happy to write to him.

The issue, as the hon. Gentleman says, is that one of the suppliers under the P22 framework is using three companies based in the European Union and that a supplier in his constituency is not being used. He is not seeking to suggest that suppliers be excluded for unlawful reasons, but he is suggesting that the supplier in his constituency has been excluded because there was not a fair competition. That is the essence of what he said.

On the competition question, the hon. Gentleman will know that my Department and the Cabinet Office provided a response saying that, although we have some influence over subcontractors under the ProCure22 framework, this only relates to certain tier 1 subcontractors that are primary supply chain members. They are required to pass a certain series of checks with the authority before they can be registered. Those checks are limited to organisations undertaking certain roles and do not extend to the suppliers of flooring products. The principal supply chain partners have been selected through an appropriate procurement process, in line with the Public Contracts Regulations 2015. Those companies are then free to build their own supply chains, which is where the company in the hon. Gentleman’s constituency is at odds. The company leading the supply chain is not always bound by public sector procurement regulations. I am obviously aware of the French authorities imposing a fine on the three companies at the end of 2017, and I want to address some of his remarks on that in a moment.

Officials in my Department have met supply chain partners on a regular basis, and we seek wherever possible to encourage the use of UK-based SME subcontractors. As the hon. Gentleman said, we have a duty to the public sector to deliver value for money. It is for our supply chain partners to demonstrate that that is the case with each of their products.

I think the hon. Gentleman is concerned that my Department has not replied to a letter from Halstead—the aggrieved company in question—of January this year. I can confirm that the Department received the letter from DWF lawyers, acting on Halstead’s behalf. The letter was addressed to me on 16 January, and my Department has a record of a reply being sent on 13 February, referring DWF to the response that had been published on the public procurement review service that I referred to earlier. If the hon. Gentleman does not have a copy of that reply, or if he finds when he speaks to Halstead that it does not have a copy or the lawyers have not passed it on, I will be happy to sort that out.

Officials in my Department have engaged with Halstead directly—that engagement started in March 2018—to explain how the framework operated. I hope that the company will be able to confirm to the hon. Gentleman that officials have responded fairly promptly to any questions that have been raised. I understand that Halstead has used that feedback and is currently bidding to form part of the supply chain.

The hon. Gentleman asked a large number of very specific questions, and given that the House has a little bit of time tonight, I thought I might try to respond to them now rather than writing to him.

[Peter Heaton-Jones (North Devon) (Con)]

I take an interest in this matter because I have a large and very successful district hospital in my constituency. I listened with care to what the hon. Member for Bury South (Mr Lewis) said. It seems to me that what we want in public procurement—not just in the NHS, but across the public service—is for the best contractor to do the best job at the best price for the public purse, but always in a framework, as the hon. Gentleman wisely said, of fair competition. If that has not happened in this case, does the Minister believe that that is because of a structural problem with the P22 framework, or is a local difficulty to blame?

[Stephen Hammond]

I want to speak about the overall process later in my speech. Having been to Nottingham to open the national procurement centre for the NHS last week, I am clear that we should have the best procurement processes in place to ensure that money from the public purse is spent wisely. That is even more important in the health service than it is in almost any other part of the public sector, because money spent wisely means better patient care, and that is key.

I hope that I will be able to prove to my hon. Friend and the hon. Gentleman that the problem with this contract was not with the framework itself, but with how one particular company chose to apply the criteria. I am not saying that the company necessarily applied the criteria inaccurately or wrongly, but it did not do so in a way that we would normally encourage.

[Mr Ivan Lewis]

I thank the Minister for the openness and frankness of his response so far. His last comment was very telling, because he acknowledged that in these circumstances, Kier perhaps did not behave in accordance with best practice or what would usually be expected, even if it did not do anything unlawful. If possible, I want clarity on whether the Minister or his officials have had, or will have, strong words with Kier about what the situation has exposed and the unfairness that has been applied to the company in my constituency. Will he or his officials have that conversation with Kier about what is expected of it, or have they done so already?

[Stephen Hammond]

To be absolutely clear, I was not suggesting that Kier had not necessarily followed best practice, and it certainly had not acted unlawfully. I was suggesting that, as I said a moment ago, we would encourage all the people who use the frameworks to ensure that there are opportunities for UK firms to be on those frameworks.

Let me try to answer directly some of the hon. Gentleman’s questions. He asked what criteria Kier used to draw up the supplier list. As I explained, in respect of how the framework is set up, the Department ensures that the principal supplier on the framework is there correctly, appropriately and legally. It is not for the Department to comment on the criteria that private sector organisations use to draw up their supplier lists. The Department sets out the expectation of the principal supply chain partners, and our expectation on them is to ensure that supply chains provide value-for-money, quality services for the public sector. Understandably, because of the nature of what is being procured, each supply chain partner will have its own processes and prequalification criteria.

The hon. Gentleman asked me directly what processes were used in the absence of competitive tendering. Again, it is not for the Department to comment directly on the specific processes, but I can confirm that each of the supply chain partners needs to follow its own internal policies, and those policies and procedures must align with the requirements of the framework.

The hon. Gentleman asked directly why Halstead and other suppliers that were not included on the list were not necessarily given the opportunity to put their case. The Department does not have visibility of which suppliers were given the opportunity to put their case; however, Halstead is now discussing that with the supply chain partners. As I said, Halstead has spoken to officials at my Department, and that communication goes back as far as March 2018. I understand that Halstead is now using that feedback and is bidding to form part of the supply chain. We give the undertaking that the application will be considered fairly and scored against the set criteria.

The hon. Gentleman asked me directly about what consideration was given to the probity of the three overseas companies, given that sanctions were imposed on them in France.

[Mr Lewis]

The Minister said that the application will be tested against the set criteria, but he cannot tell me what those criteria are. Is that a fair reflection of the situation?

[Stephen Hammond]

As I said earlier in my remarks, each principal supply chain partner must make sure that their internal policies and procedures align with the requirements of the framework, but it is not for the Department to tell each principal supply partner how to set out their criteria, nor the specific processes they should use. The hon. Gentleman rightly made the point that is my Department’s responsibility to ensure that the policy is correct. I hope he is hearing that my Department ensures that the right procedures and processes are in place and that the individual principal supply chain partner must choose the most appropriate one for the right framework it is on. I hope he will accept that.

I was just about to refer to the issue of the three overseas companies that were chosen and the sanctions that were imposed on them. As I said earlier, I am aware that the French authorities imposed the fine on the three companies at the end of 2017, but those convictions were imposed after the preferred supplier list was established. Clearly, the Department does not have sight of the contractual agreements between the supply chain partners and the suppliers. The supply chain partners are not within the scope of the Public Contract Regulations 2015.

The hon. Gentleman asked whether I could assure him that Kier would be instructed to add Halstead to the list as a matter of urgency. He will know, obviously, that it is not within my remit or my ability to instruct private sector organisations to engage with specific companies, but I can reassure him that Halstead is currently bidding as part of the refresh of the Kier supplier list and its application will, I know, be scored on the merit of the criteria set. I hope that that reassures him.

I want to turn briefly to how the Department supports and encourages small and medium-sized enterprises and subcontractors more generally. Clearly, we have been dealing with some very specific issues, and that underlines the complexity of the procurement landscape. The understanding of who exactly subcontractors are, and the work that they undertake, is, by its very nature, not well understood unless it is for a very major significant construction project. NHS organisations would usually expect the Crown Commercial Service or the regional procurement solution to identify and track the supply chain of the suppliers providing the goods, works or services. However, there is currently a limited understanding of the suppliers on locally negotiated contracts.

The Public Contract Regulations 2015 clearly allow public sector organisations to permit subcontracting within supply chains as long as the subcontractors meet the minimum standards set out, and the hon. Gentleman knows that I have just set those out. Where issues in subcontractor performance arise, the regulations also allow for the subcontractor to be excluded.

The Department’s SME action plan for 2019-20 highlights the actions that we are taking to make it easier for SMEs to work with the whole of the health supply system. The Department has a target of 23% of our direct and indirect spend with SMEs by the end of March 2022.

[Peter Heaton-Jones]

Notwithstanding the note that the Minister might just have been passed—[Interruption.] This is an important point. I have mentioned already the fine hospital that I have in my constituency, but I also have many fine SMEs, which need to be on a level playing field when it comes to being able to tender for these sorts of procurement contracts. What I am looking for the Minister to give me and, I am sure, to other hon. Members with fine SMEs in their constituencies is an assurance that they have that level playing field and that they can get these contracts.

[Stephen Hammond]

I am happy to give my hon. Friend that assurance. It is absolutely the commitment of the Government to ensure that small and medium-sized enterprises are not excluded from any form of public sector procurement. I am pleased to say that the Department has published an action plan to that effect. I am actually the Minister in charge of ensuring that that action plan is implemented, and I am pleased to say that the Cabinet Office holds meetings of ministerial champions across Whitehall to ensure that, as a Government, we meet our targets.

[Mr Lewis]

May I ask the Minister about a really important point of clarification? Are Kier or similar organisations fulfilling that function required to publish the basis on which they make these decisions? The Minister has said that it is not for the Department to tell such organisations how to fulfil their responsibilities in drawing up these lists, but are those organisations required to publish, openly and transparently, the basis on which they make decisions about their preferred suppliers?

[Stephen Hammond]

What I can say to the hon. Gentleman—he has heard me say this twice, and I am happy to have a longer discussion with him outside this debate—is that there is a process in place whereby principal supply chain partners are on the framework. If they are on that framework, they have to ensure that their policies, procedures and the criteria they intend to use align with that framework. As private sector organisations that have been contracted by the public sector, they in turn have subcontractors, and they have to ensure that the processes they use to contract those subcontractors are compliant with the framework. I am happy to set that out in writing for the hon. Gentleman, if he would like me to. Clearly, the Department cannot and does not instruct principal supply partners to detail every aspect but, as I have said to him before, we have to be reassured that the processes and procedures they use are compliant with what we have set out in the framework.

This has been a fascinating debate because it gets to the heart of what we want to do. If we want to have a vibrant economy, we must have transparency regarding how companies contract for public sector contracts and the supply thereof. What the hon. Gentleman has rightly done on behalf of his constituents is to ensure that the Department is clear and has investigated that the processes and procedures being used were the correct ones, and that if, as he believes, his constituents were unfairly treated, the Department looks into the case. My officials have been in regular contact with Halstead since 2018 and I am pleased that it is now able to refresh its application for the subcontract list. I am also pleased to have had the chance briefly to set out the Government’s overall ambitions to ensure that all small and medium-sized enterprises are able to bid for Government contracts.

Question put and agreed to.

NHS Pensions

Stephen Hammond Excerpts

Wednesday 26th June 2019 Westminster Hall

[The Minister for Health (Stephen Hammond)]

As ever, Mr Gray, it is a pleasure to see you in the Chair for this important debate, and I congratulate my hon. Friend the Member for Poole (Sir Robert Syms) on securing it. It is a topic that the House has previously considered, when my hon. Friend the Member for East Renfrewshire (Paul Masterton) introduced a debate on the matter.

Colleagues should be reassured that the Government have been listening carefully to senior doctors and their employers. We recognise the actions clinicians are taking in response to their concerns about, and experience of, the annual allowance tax charges and how they are affecting frontline services. My hon. Friend the Member for Poole is right: although we are talking about tax changes for consultants, clinicians and GPs, the reason why this is so serious is that ultimately, if we do not get it right, it impacts on the quality of patient care. We all share that ambition to get it right.

[Mr Sweeney]

The Minister says that the tax changes are likely to have an impact on patient care. They are already having an impact; my constituent has said that he is seeing anaesthetic cancellations on theatre lists at his hospital in Glasgow, which have never been seen before in the NHS. He has had to resign as a foundation programme director, supervising junior doctors, to reduce the number of paid hours he does.

[Stephen Hammond]

Let me make it clear that not only are the changes having an impact, they are likely to continue to have an impact. I recognise that; the hon. Gentleman will hear later in my remarks that we recognise that point.

My hon. Friend the Member for Poole was right to talk about the long-term plan and the cash settlement that goes with it. He was also right, though, to mention that any plan will work only if it works: if we make sure the people delivering it can do so with the numbers and experience required. The hon. Member for Newport West (Ruth Jones), although she said she was not expecting to speak this morning, made a thoughtful speech and raised a number of issues from her direct experience that informed the debate.

My hon. Friend the Member for Winchester (Steve Brine) represents the place where I was born and spent my childhood, so for that and other reasons, I always listen carefully to what he says. He was right to stress at the start of his speech that this is not about tax breaks for particular people, although that is the headline; the reality is that perverse disincentives are being created against providing the care that we need. I listened carefully to the hon. Member for Glasgow North East (Mr Sweeney), who has just intervened on me to reiterate the point he made in his speech about the experiences of some consultants, and I recognise that those experiences are not unique to Glasgow North East.

The hon. Member for Central Ayrshire (Dr Whitford) always makes many informed remarks, given her experience. She made a point that perhaps has not been picked up, but is important in informing the debate: this is not just about losing a number of potential outpatient appointments and clinicians to service them, but about the impact on training. In many of the places that I have had the honour to visit as Health Minister, it is clear that the mentoring and support provided by senior staff to more junior staff is an important contribution, not only to the wellbeing of those junior staff, but to their education and, therefore, to the benefit of patients. That is undoubtedly one of the consequences of what we are talking about today.

[Dr Whitford]

Obviously, senior clinicians are critical to clinical teaching, which is part of the work. However, as other Members have highlighted, consultants are refusing to take on the extra sessions involved in organising that teaching and running rotas for either junior doctors or medical students. Without that, it will just be chaos.

[Stephen Hammond]

The hon. Lady is right to make that point; as I said in my remarks about her speech, I recognise the impact on training. There is clearly concern that unless we address this matter, it will have a number of impacts, of which that is one.

The hon. Member for Oxford East (Anneliese Dodds), speaking for the Opposition, rightly opened her remarks by pointing out the scale of the cost of tax release for pensions to the Treasury. She made valid points about doctors’ knowledge about that liability, and about the interaction of core tax principles with particular schemes. I was rather hoping that she would also welcome the long-term plan and the cash settlement, but I suspect that element of unity was probably a step too far.

As my hon. Friend the Member for Poole may have mentioned at the beginning of his speech, we have fewer Members here and a lower number of contributions. However, those contributions, combined with some of the interventions, have meant that we have had a debate of high quality.

Needless to say, I have heard the representations from everyone in the Chamber. It will not surprise anyone that I have received, as has the Department, representations from NHS employers reporting exactly what we have been discussing—that consultants are increasingly no longer willing to work additional sessions. The lost capacity is clearly difficult to replace, especially in some clinical areas where there are already shortages, and it can be expensive, as employers can pay a premium for locums to fill the gap. It is obvious and right that where there is evidence of an impact on the delivery of services, the Government should be prepared to take action.

At the outset, I reiterate that the Secretary of State and I take seriously the concerns of doctors. That is why we have been involved in a number of discussions with the Treasury, which has resulted in the 50:50 flexibility and the consultation. I will come to that in a moment, but, as Members will hear as I develop my remarks, that will not be the end of our conversation with other Departments.

Looking at the case for pension flexibility, it is true that outside public service, employers in some cases have flexibility to adjust benefit packages to allow high-earning employees to target a lower level of pension saving and so reduce the potential for large regular annual allowance tax charges. That flexibility is not currently present in the NHS. The NHS pension scheme does not allow any flexibility over the level of pension growth. Staff who participate in the scheme must pension all regular earnings from their employment. The Government are right to take the view that it is important to ensure that staff have a good level of pension savings, but senior clinicians, particularly consultants and GPs, have a unique degree of flexibility over their workloads and obviously can reduce their commitments. Consultants can reduce the number of additional sessions undertaken, and many GPs are self-employed. That can create incentives for clinicians to seek to control their income and pension growth by limiting or reducing their NHS work to avoid breaching their annual allowance. As a number of Members have discussed, that clearly has an impact on the delivery of patient care.

It is clear that retaining and maximising the contribution of our highly-skilled clinical workforce is crucial to the NHS and the long-term plan for the NHS. While any pension tax regime should seek to achieve the fiscal ambition of distributing pension saving incentives fairly, it has to be recognised that, in combination with the fixed structure of the NHS pension scheme, that could produce—listening to the evidence today and the evidence I have directly received—unintended consequences for service capacity and the delivery of patient care. The Government are prepared to change the rules to give clinicians more flexibility.

Alongside the publication of the “Interim NHS People Plan” earlier this month, my right hon. Friend the Secretary of State announced our intention to consult on new flexibility for clinicians. The consultation will be published in the coming days—I hope very shortly—and will set out proposals for a 50:50-style option, offering 50% pension accrual and halved contributions. Earlier this year, as part of the new five-year GP contract, the BMA and NHS England asked the Government to consider introducing that option. While I recognise that the BMA has not been unequivocal in its support, it has welcomed the proposal as a step in the right direction.

The Government believe that a 50:50 option balances the benefit of flexibility with the fiscal impact to the Exchequer. The 50:50 option will allow clinicians to build up their pensions more slowly and at a lower cost. Clinicians will still need to make their own personal assessment as to whether their financial interests are best served by taking advantage of the 50:50 model or continuing with full-rate accrual, but I have heard—not necessarily in the debate today, but directly from a number of consultants—that the 50:50 option is not flexible enough and that other measures should be considered.

The new pension flexibility should be viewed as a positive development for clinicians. My hon. Friend the Member for Winchester mentioned that he has asked me about the consultation period on the Floor of the House and that he has spoken to consultants about it. The consultation will be an opportunity to listen to a range of views before any final proposition is agreed. I encourage all Members here today to encourage their local clinicians to take part in that consultation. Equally, I encourage anyone from the health system in its widest context to take note of the debate and take part in the consultation. We want not only to hear any suggestion that there is a generic case for tax changes, but to listen carefully to what clinicians say using their own personal examples to provide evidence for any change they seek.

[Steve Brine]

Is the consultation discussing the merits or otherwise of a 50:50 option, or is it genuinely open to discussion about whether that option in itself is a good idea? As I said in my speech, the initial responses I have seen have not broadly welcomed, to put it politely, the idea of 50:50.

[Stephen Hammond]

The consultation is both. I recognise, as I said a few moments ago, that the 50:50 option has not received unequivocal support from the BMA, but to its great credit, it has asked us to consider that. We have come forward with this proposal. The BMA has welcomed it, but has said that it would want to discuss further options for flexibility and other pension matters. We have said that the consultation will look at the merits of the 50:50 option—or question it—but we will rightly open up that consultation to other suggestions. My hon. Friend will have just heard me say that I hope Members will encourage their local clinicians to use the consultation as a way of expressing their concerns about the 50:50, if they have any, and to express their views on other measures they would like to see introduced in terms of pension contributions. I stress that point again in response to his intervention. He will probably be interested in my next set of remarks, which are on flexibility.

Although the 50:50 option provides a new flexibility, we recognise that it does not provide unlimited flexibility for clinicians to target their own personalised level of pension growth and contributions. The financing model for the scheme means that any flexibility that reduces contribution income has an immediate fiscal impact on the Exchequer. The 50:50 option does not set aside the annual and lifetime allowance tax policies, but will give clinicians a new flexibility to manage their pension growth.

Where 50% accrual reduces pension growth by more than they wish, clinicians can use the contribution savings from the 50:50 model to buy additional pension to customise their own pension growth incrementally. Additional pension can be purchased in units of £250. That clearly adds some flexibility to their ability to manage their own contributions. However, some clinicians may continue to experience annual allowance tax changes, even with accrual rates reduced to 50%. For that group, while 50:50 reduces the charge, it does not eliminate it. We recognise that a number of individuals may wish to target a lower level of pensions growth. We will listen carefully to that suggestion through the consultation.

[Dr Whitford]

Is the Minister suggesting that senior consultants in three pension schemes sit and manage whether they are going to use the 50:50 or add in top-ups? That creates a whole job for people who work often 50 to 60 hours a week doing the thing that they are actually meant to do; it would give them almost a side job to try to manage their pension. Could we not go back to something simpler, whereby they get their payslip with a fair amount of pension tax taken off, but not what is happening at the moment?

[Stephen Hammond]

I have listened carefully to what the hon. Lady has just said, and she will want to listen to my next remarks, but I think she will reflect on the fact that a system of annual and lifetime allowances has been in place for some time. They were first introduced by the previous Government, although there have been some changes. Whether or not she thinks it would be better to have an even simpler system, some people will have recognised over time that it is important to look at their own pension contributions. Although tax relief on pensions is one of the most expensive reliefs, and the NHS pension scheme is rightly one of the better schemes available, I absolutely recognise that annual allowances and negative tax rates have a huge impact on some clinicians and consequently on the services for patients.

Consultants have raised with me the issue of the tapered annual allowance that Members have spoken about. I have been asked why the taper threshold is currently set at £110,000, which cuts across, as many people have pointed out, the typical earnings of an NHS consultant, although some people might perceive £100,000 as a high level of income. Unsurprisingly, tax policy is not something that I can speak to, but I have asked the Treasury and it advises that the threshold income test is designed to ensure that only those on the highest incomes can be affected by the annual taper. In the Treasury’s opinion, the £110,000 threshold balances the desire to restrict the annual allowance taper to those on the highest incomes, while trying to minimise the reduction in the value of the individual’s annual allowance.

I have also been asked why the annual allowance taper calculation takes into account both pensionable and non-pensionable earnings. Again, with the obvious proviso that I cannot design tax policy, the Treasury advises that if non-pensionable pay is excluded from the annual allowance taper calculation, there is the possibility that an unscrupulous employer could reclassify some pay as non-pensionable. To ensure fairness, the Treasury includes all sources of income in the taper calculation. However, hon. Members will not be surprised to hear that I think the concern about unscrupulous employers is not one that applies to the NHS. I recognise the issues raised by hon. Members on behalf of their consultants with regard to the taper threshold, and I am grateful to the Treasury for the discussions we have had, which have resulted in the 50:50 flexibility, but I can assure hon. Members that that discussion has not concluded. We rightly recognise that other pension issues need to be resolved.

I am grateful that the Treasury continues to engage with concerns about the taper threshold and how it impacts upon the workforce. I am happy to assure hon. Members that the Department intends to continue having discussions so that the matter can have a resolution that we hope will sort the matter out in an equitable and fair way, and not only for tax principles. We want to ensure that the dedicated staff working in the NHS feel valued and understand that they will not be penalised through the creation of perverse incentives so that they do not do what we want them to do, which is to provide excellent patient care.

In closing, I again thank my hon. Friend the Member for Poole for raising this important issue. I hope that I have been able to do three things: first, show hon. Members that the Department and I as the Minister responsible for people in the health system recognise the concerns raised by hon. Members on behalf of their consultants. The issues have also been raised with me directly. Secondly, I hope people will recognise that the 50:50 option is an important first step in looking at issues associated with lifetime contributions. I urge hon. Members to encourage their consultants to use the consultation. Thirdly, I recognise there are still issues around the taper threshold and the annual allowance, and I give the Chamber a commitment that the Department will continue to discuss with the Treasury ways in which we might be able to resolve those matters. I conclude by reiterating how important the debate has been this morning.

Oral Answers to Questions

Stephen Hammond Excerpts

Tuesday 18th June 2019 Commons Chamber

[The Minister for Health (Stephen Hammond)]

Our junior doctors work incredibly hard caring for patients around the clock. We introduced exception reporting in 2016 and it has been a major step forward in ensuring safe working. The British Medical Association, NHS Employers and the Department reviewed the effectiveness of exception reporting as part of the junior doctor’s contract agreement, which we announced last week. Revisions will be made to exception reporting subject to the endorsement of the BMA.

[Justin Madders]

Is the Minister aware that research by the Hospital Consultants & Specialists Association shows that, despite thousands of exception reports from junior doctors in unsafe hospital trusts, no changes to shift patterns were made at all. The chief executive of NHS Employers has said that, undoubtedly, there are circumstances where trusts would like to make changes, but because they do not have sufficient staff in place they are unable to do so. What can the Minister do to ensure that, in future, these changes are actually implemented?

[Stephen Hammond]

The hon. Gentleman is right: every exception report has to be addressed. Changing the rota is one possible outcome. He will recognise that there are other possible outcomes as well: the doctor may agree to work extra hours and be given extra time off; timing of the ward rounds in clinics may be adjusted, so that educational opportunities can be taken: and timing of the ward rounds can be adjusted so that support from other senior staff can be there as well. There are many ways around this.

[Anneliese Dodds (Oxford East) (Lab/Co-op)]

7. For what reason he chose not to refer the Thames Valley PET-CT scanning contract to the independent reconfiguration panel.

--- Later in debate ---

[Greg Hands (Chelsea and Fulham) (Con)]

13. What steps he is taking to improve the retention of NHS staff.

[The Minister for Health (Stephen Hammond)]

The interim people plan sets out how the NHS will become a great employer with the culture and leadership needed to retain staff. NHS programmes to retain its highly talented staff are already having an impact. There are now more nurses working in the NHS than at any other time in its 70-year history. In addition, about 1 million NHS workers will benefit from the new Agenda for Change pay and contract deal.

[Mr Dunne]

I welcome the recent announcement of a consultation on NHS pensions arrangements for senior personnel. I hope that that will look at the taper impact, which raises the effective tax rate to an unacceptably high level. Retention of key personnel is critical across the Shropshire health economy, as well as in other parts of the country. Can my hon. Friend reassure me that senior-level changes in Shrewsbury and Telford Hospital NHS Trust’s management will not delay the Secretary of State’s consideration of the Independent Reconfiguration Panel’s report on proposed acute hospital reconfiguration?

[Stephen Hammond]

I thank my right hon. Friend for his welcome for the pensions proposals and the consultation. The Department has received initial advice from the Independent Reconfiguration Panel on the Future Fit hospital reconfiguration. The Secretary of State is currently considering that. He will respond to the IRP’s advice in due course, and I will ensure that he informs my right hon. Friend.

[Greg Hands]

May I thank the Secretary of State again for saving the A&E department at Charing Cross Hospital, which was a very, very popular move? Our brilliant hospital will benefit from the work that the Government are doing to increase the number of nursing associates across the NHS. What more can we do to get more nursing associates at Charing Cross Hospital, Chelsea and Westminster Hospital, and across the whole NHS?

[Stephen Hammond]

I thank my right hon. Friend for his comments on saving the hospital department—that is very important. He is right to raise the important role of the nursing associates, who deliver hands-on care in a range of complex settings. Thousands of nursing associates began training in 2017 and in 2018. Health Education England is leading a programme to recruit more than 7,500 into training in 2019, and I am sure that some of them will benefit his constituency.

[Judith Cummins (Bradford South) (Lab)]

15. Bradford NHS Trust is pressing ahead with plans to set up a wholly-owned subsidiary company. Last week, 97% of Unison members voted for strike action. Given that the trust is currently run by a temporary chair and a temporary chief executive, and is acting on guidance from a now-defunct body, will the Minister, to improve retention, call on the trust to drop these plans and keep the NHS family as one?

[Stephen Hammond]

The hon. Lady knows that a wholly-owned subsidiary is created as a legal entity. It is 100% owned by NHS organisations. It is also the case that local trust board members sit on the boards of those subsidiary entities. It is therefore appropriate that the local organisation takes that decision.

[Chuka Umunna (Streatham) (LD)]

The King’s Fund says that the earnings threshold in the Government’s immigration proposals, which was mentioned earlier, will definitely impact on the ability to retain and attract NHS staff. The proposals for a transition period during which many social care workers would only be allowed to come here for a limited time with no entitlement to bring dependants will, again, negatively impact on the ability to retain staff. When will this Government realise that immigration is good for our public services and good for our country, and that badly thought out policy in this area that impacts on the retention of NHS staff is wrong and nonsensical?

[Stephen Hammond]

The hon. Gentleman is right—immigration has benefited the national health service. This Minister, this Secretary of State and this ministerial team celebrate the fact that global immigration has benefited the NHS. From 2021, the new system will allow people with skills to come to the UK from anywhere in the world. It will remove the cap on skilled migrants, abolish the requirement to undertake the resident labour market test, and should improve the timeliness of being able to apply for a visa.

[Daniel Zeichner (Cambridge) (Lab)]

11. What recent comparative assessment he has made of the adequacy of NHS funding in Cambridgeshire and local population growth.

[The Minister for Health (Stephen Hammond)]

NHS England is responsible for the allocation of resources to clinical commissioning groups. Funding is distributed on the basis of a weighted capitation formula informed by the Advisory Committee on Resource Allocation. Population estimates are provided by the Office for National Statistics. This year, as the hon. Gentleman will know from a debate that we had last week, ACRA recommended and NHS England accepted a wide-ranging set of changes to that formula. Those changes are likely to benefit his constituency.

[Daniel Zeichner]

We had a discussion last week, but the Minister was unable to answer my question so I will try again. Is Cambridgeshire’s clinical commissioning group correct that it will have less money to spend on providing health services next year than it does this year?

[Stephen Hammond]

As I pointed out to the hon. Gentleman last week, we recognise that historically, Cambridgeshire and Peterborough CCG has received less funding per person than neighbouring CCGs, but as I also pointed out to him, the CCG has received an absolute increase of 5.7% in 2019-20, bringing the funding up to £1.1 billion. We had a disagreement about the figures, because I could not agree the figures that he provided. As he knows, I have promised to write to him when I have been able to resolve his figures.

--- Later in debate ---

[Mr Philip Hollobone (Kettering) (Con)]

T7. Will the Secretary of State assure my constituents in Kettering that taking advantage of the local government reorganisation in the county to establish a combined health and social care pilot is one of his Department’s very top priorities?

[The Minister for Health (Stephen Hammond)]

The House will not be surprised to know that the hon. Gentleman has raised this with me and my right hon. Friend the Secretary of State on a number of occasions. I am happy to reconfirm to him that we do consider it a top priority to make sure that all of his constituents get the care they need.

[Diana Johnson (Kingston upon Hull North) (Lab)]

T5. With abortion rates for women over 30 rising, I am sure the Secretary of State will agree with Professor Lesley Regan, the president of the Royal College of Obstetricians and Gynaecologists, who said:“Women must have access to effective contraception and sexual health services to enable them to take control of their health and fertility by preventing unwanted pregnancies and sexually transmitted infections.”Does the Secretary of State also agree with Professor Regan’s comments on the need to end the fragmentation of commissioning, and the underfunding of services that disproportionately affect women?

--- Later in debate ---

[Vicky Ford (Chelmsford) (Con)]

I declare an interest as a doctor’s wife. If the sub-dean at Chelmsford’s brilliant new medical school continues to teach the students and work in the hospital, she faces a 90% tax rate. If she continues to do the weekend hours the hospital needs, she faces having to pay more in tax than she is earning. Will the Minister look again at the taper, which is driving our consultants out of our hospitals?

[Stephen Hammond]

As I said in response to an earlier question, we are putting out a consultation on pensions that will allow for looking at a number of issues, including the taper.

[Several hon. Members rose—]

University Hospital Coventry

Stephen Hammond Excerpts

Thursday 13th June 2019 Commons Chamber

[The Minister for Health (Stephen Hammond)]

I thank the hon. Member for Coventry South (Mr Cunningham) and congratulate him on securing this important debate. I thank the other Members who have contributed. I want to start this debate, as I try to start all debates in the House when talking about the NHS, by congratulating and thanking the staff who work in the NHS—in particular, given the nature of the debate, the staff who work in the hospitals of Coventry and Warwickshire and throughout the west midlands.

The hon. Gentleman made a number of important points that I will try to address. I know that he wrote the Department a letter in May. I will ensure that there is a response to it, but I can tell him now that the response will be that I would be delighted to meet him and the fellow MPs who have signed the letter to discuss its contents and what I am about to say.

The hon. Gentleman raised a number of important concerns regarding the discussions to transfer HPB services from University Hospitals Coventry and Warwickshire NHS Trust to University Hospitals Birmingham NHS Foundation Trust. HPB services treat patients who have disorders of liver, bile ducts and pancreas, including pancreatic and liver cancer. A large volume of HPB services are delivered in local hospitals, but because of their complex nature and the high cost of care, delivery in conjunction with specialist tertiary centres is often necessary.

As the hon. Gentleman indicated, in October last year, NHS England confirmed that no decision had been made to transfer or close the HPB service in Coventry, despite some concerns that national clinical service specifications were not being met. I understand that he is still concerned about that, but I can confirm that there are currently no plans to transfer HPB cancer services away from University Hospitals Coventry and Warwickshire NHS Trust. However, NHS England is actively supporting the trust to work alongside University Hospitals Birmingham NHS Foundation Trust, to ensure that patients have access to safe, high-quality treatment.

University Hospitals Coventry and Warwickshire NHS Trust has said that it is proud—rightly so—of the HPB service, which has excellent outcomes and feedback about the quality of healthcare provided, as the hon. Gentleman mentioned. In 2015, the West Midlands Clinical Senate reviewed the three HPB services across the west midlands and recommended combining them across two sites, because they did not meet national requirements.

The “Improving Outcomes” guideline document specifies that a population base of at least 2 million is required to make a compliant service. Currently, University Hospitals Coventry and Warwickshire NHS Trust treats a population of about 1 million. The guidance also specifies that for a population of around 2 million, around 215 pancreatic and liver resections a year would be expected as a proportion of the population size.

The hon. Gentleman talked about the number of operations and resections done by this unit. Between 2013 and 2018, an average of 80 resections a year were performed in University Hospitals Coventry and Warwickshire NHS Trust. He quoted a rather larger figure, but it was 80 pancreas and liver resections a year. I am happy to discuss with him at the meeting the number he quoted, but it is not one I recognise.

I understand that, over the past two years, teams in both trusts have been discussing how to work together with a view to creating a single point of access and shared multidisciplinary teams for HPB in the local area. Both trusts have agreed that the most complex services should be conducted on University Hospitals Birmingham’s Queen Elizabeth site. However, the trusts are yet to agree on an established definition of the most complex surgery. The clinicians from both hospitals who are currently delivering the service will continue to work together to develop this new combined model of care. NHS England will determine the best way to meet patients’ needs collaboratively, based on specialist surgical skills and the skills that are available at each hospital, as well as on the volume and complexity of clinical cases.

I would like to reassure the hon. Gentleman and, indeed, other Members in the Chamber that I recognise that discussions concerning service change are controversial, and this case is no exception. However, I would also like to reassure hon. Members that all service changes are designed to drive up service quality, meeting the specific requirements of local populations and trying to achieve what is best for specialist service users overall. The hon. Gentleman has set out, with great emphasis, the significant challenges that remain, and it is right that the trusts continue to work together to determine the best method to deliver these highly complex services.

The hon. Gentleman and, I hope, all hon. Members know that cancer is a priority for this Government. Survival rates are at a record high. Since 2010, rates of survival from cancer have increased year on year. However, as we know, there is more to do. That is why, last October, the Prime Minister announced a package of measures that will be rolled out across the country with the aim of detecting three quarters of all cancers at an early stage by 2028.

As part of the NHS long-term plan that we announced in January, the Government have outlined how we will achieve the ambition to see 55,000 more people surviving cancer for five years in England each year from 2028. The Department invests £1 billion a year in health research through the National Institute for Health Research. It spent £136 million of that on cancer research in 2017-18, which is an increase of £35 million on 2010-11. The NIHR is funding and supporting a range of research relevant to liver cancer, including a £1.76 million trial of liver resection surgery versus thermal ablation for colorectal cancer that has spread to the liver and early research on specialised magnetic resonance imaging scanning to detect liver cancer that has spread from colorectal cancer. There is much still to be done, but much is being done.

[Mr Marcus Jones]

I hear clearly what my hon. Friend says about the improvements that are being made in this area and in wider cancer care, but I am still concerned about the potential loss of what is a good service from Coventry. I am also concerned that at the moment, while no decision has been made, discussions and negotiations are clearly going on in that regard. It is quite obvious from the discussions that the hon. Members for Coventry South (Mr Cunningham) and for Warwick and Leamington (Matt Western) and I have had that not everybody in those organisations is in the loop, actually knows what is going on and is satisfied with this situation. Will my hon. Friend look at what more can be done to make sure, in this situation, that information is disseminated widely between clinicians and organisations so that we ensure we do not unnecessarily lose very high-quality people from organisations such as University Hospital Coventry?

[Stephen Hammond]

My hon. Friend makes an important and valuable point, and as a result of this debate I pledge to write to the hospitals to ensure that the ongoing discussions between the various parties are as inclusive as possible. As I said earlier, I will happily meet him, the hon. Member for Coventry South, and other Members.

[Mr Marcus Jones]

My hon. Friend is kind and generous in giving way, and I thank him for the commitment he has made. There has clearly been little public engagement, but that is what we need with regard to any changes that are made, so that the public can understand the rationale behind these changes. I am aware of one person who has been chasing information about this issue, but they have hit a brick wall.

[Stephen Hammond]

My hon. Friend is assiduous in representing his constituents and making his points. As I have said, these discussions have not yet concluded, and it would be hugely inappropriate for me or any politician to try to prejudge the right clinical outcomes. When those clinical outcomes have been worked through and the discussions finalised, I have no doubt that University Hospitals Birmingham and the Coventry and Warwickshire Partnership NHS Trust will wish to publicise the result of those discussions as widely as possible.

[Mr Jim Cunningham]

Following the intervention by the hon. Member for Nuneaton (Mr Jones), the Minister mentioned a wider discussion and involving the public. We met some representatives, including Mr Peter Burns, who is the former chair of the local chamber of commerce and a very influential person. Such organisations, as well as other public bodies, must be brought in and consulted. Will the Minister agree to do that?

[Stephen Hammond]

It would have been inappropriate for me to be involved in clinical discussions, but I hear what the hon. Gentleman says. Before we have that meeting, I will write to him on that point. I hope that we will have a meeting relatively soon, so that we can finalise what should be done.

Service change is often controversial. We should rightly scrutinise any service change, but that should be based on patient safety and the right clinical outcomes. I thank the hon. Gentleman for raising this matter and continuing to hold us to account, and I look forward to meeting him and other hon. Members to discuss the issue further in the near future.

Question put and agreed to.