Cambridgeshire and Peterborough CCG: Funding Pressures

Stephen Hammond Excerpts

Tuesday 11th June 2019 Westminster Hall

[The Minister for Health (Stephen Hammond)]

It is a pleasure, as ever, to serve under your chairmanship, Mr Hollobone. I thank the hon. Member for South Cambridgeshire (Heidi Allen) for bringing forward this debate. I know there are not many Members in the Chamber, but that should not in any way undermine or take away from the importance of this debate, which is clearly of great interest to her. She spoke powerfully about the problems that the CCG has had.

I recognise right at the outset that Cambridgeshire and Peterborough CCG has faced a number of difficult, interlocking and historical factors. The historically low funding settlement is obviously taking time to rise to target—there is a commitment to rise to target over time, which I will come on to in greater depth in a moment—and that has combined, as she rightly points out, with the fast rate of population growth across the area, which has put additional demands on the CCG.

I and the Government recognise that the CCG receives less per person than its neighbouring CCGs. As the hon. Lady rightly pointed out, it gets £119 per person less than its neighbouring CCG in Bedfordshire. Although it is moving towards target—as she rightly points out, it is 3.7% below target this year—that figure reflects some of the historical funding patterns. It does not reflect the allocation formula change that the NHS is working to resolve.

The hon. Lady and the hon. Member for Cambridge (Daniel Zeichner) pointed out the growth levels. She is right that Cambridge and Peterborough have seen substantial population growth in recent years, and that growth has been 0.6% above the England average over the past four years. Inevitably, that growth—plus the potential growth from the Oxford-to-Cambridge expressway, which will put more housing along the corridor—will clearly cause additional pressures.

The hon. Lady asked for a commitment from me. I can say that NHS England is committed to bringing all CCGs up to target as soon as possible, while also ensuring that all CCGs receive some additional funding this year. As a result, the CCG has received an additional 2.5% per capita growth in 2018-19, and will receive a further 5% per capita growth in 2019-20. That will bring the CCG funding up to £1.1 billion for 2019, which is below target but moving up. As I think the hon. Lady said, it was previously some 5% away from the target; it is now 3.7% away from the target. Our commitment is to bring all CCGs up to the target as soon as possible.

The hon. Lady will not be surprised to hear me say that it is, of course, a matter for NHS England to allocate funding to CCGs, and that process has been evolving. It might be helpful if I briefly set out how that happens. NHS England must ensure that funding is equitable and fair, taking into account the three main drivers of healthcare demand: population growth, deprivation and an ageing population. As a point of principle, CCG allocations are based on equal access for equal need and reducing health inequalities.

As the hon. Lady pointed out, a complex national formula supports the allocation of resources, and historically that has caused some distortions. That formula is developed by the Advisory Committee on Resource Allocation, known as ACRA, which is an independent body of experts, supported by the population projections of the Office for National Statistics.

The hon. Lady cited some population predictions, which I think come from the Cambridge Research Group as opposed to the Office for National Statistics. She will therefore understand that, although I accept that those numbers are shared locally, Ministers and the NHS have to rely on the independent and academically rigorous body. Otherwise, it could easily be perceived that we were using a local think-tank’s population growth estimates to privilege one group over another.

[Heidi Allen]

Am I allowed to intervene?

[Heidi Allen]

Thank you, Mr Hollobone. Forgive me—I have not led a Westminster Hall debate before. I accept all that the Minister has said, and it is a difficult matter, but the statistics are flawed. The Minister said that he accepts that the growth is 0.6% above the England average; the Office for National Statistics is working on its being 0.1% below. Something is therefore going a little astray.

[Stephen Hammond]

I am sorry—either I did not make myself clear, or the hon. Lady misheard me. I said that the population growth was 0.6% above the England average over the last four years. The number that she cited of the growth being below the average is from ONS predictions for the next two or three years.

[Heidi Allen]

Forgive me if I am mistaken, but I thought I heard the Minister agree that the growth was in fact 0.6% above the England average. If it is, why on earth are we working on the ONS figures that it is 0.1% below the England average?

[Stephen Hammond]

This is prejudging the tennis season, in that we can go backwards and forwards, but let me say for the record that if I misled the hon. Lady I apologise wholeheartedly. I agreed that the population growth of the Cambridge and Peterborough CCG area has been 0.6% above the England average over the last four years; I did not intend to suggest that it is expected to be 0.6% above the England average for the next one, two or three years. I think the ONS number that she cited is one that we recognise; however, as I said, the numbers that she produced from the Cambridge Research Group are different from those of the ONS.

This year, ACRA has recommended a wide-ranging set of changes to the formula, to ensure fairness across the country. In the case of Cambridgeshire and Peterborough CCG, that has led to an increase in NHS England’s estimate of what the fair share of resources should be. That is mainly due to the mental health and learning disability service estimate and the market forces factor.

Changes have also been made to the way population data is used. ACRA now uses the annual average registered list for the most recent year, rather than the size of the list at the time of allocations, to allocate resources on a per capita basis. That change will inevitably benefit Cambridgeshire and Peterborough CCG because it will reflect more recent population growth. The change is obviously also intended better to reflect cyclical patterns in areas with large numbers of seasonal workers or large student populations.

ACRA also now uses specific data regarding age and gender population projections produced by the ONS, so that if population growth in an area is disproportionately in a younger or older population, which will obviously affect the relative need, that will now be reflected in the new way that NHS England calculates the allocations. As I said earlier, the formula changes will more accurately reflect population growth, deprivation and the structure of the population over the next few years.

[Heidi Allen]

I appreciate the sincerity, and my CCG knows that NHS England intends to improve the formula to make it more representative. However, a question remains, and it is the same question that the hon. Member for Cambridge (Daniel Zeichner) referred to regarding education: what happens in the meantime? Our CCG is talking about significantly cutting community services. That will affect elderly care in the community. That will stop vasectomies. It may take IVF treatment away altogether, as we are at just one round at the moment. Although I appreciate that NHS England is an enormous machine and improving the health formula will take some time, what do I say to my constituents whose health services are being cut while we wait?

[Stephen Hammond]

I will say two things to the hon. Lady. First, the reflection of the formula and the increase in the money is coming through this year and next year. We have spoken about the additional per capita funding that is coming through.

[Daniel Zeichner]

There is a complicated set of issues surrounding national health service funding, but the CCG is telling us that it will have less money to spend in 2019-20 than in 2018-19. I really just want confirmation from the Minister that that is his understanding too.

[Stephen Hammond]

All I have are the percentage increases in additional per capita funding for 2018-19 and 2019-20. I will seek inspiration to confirm the absolute totals, and if that inspiration reaches me while I am still on my feet, obviously I will relay it to the hon. Gentleman. If not, I am happy to confirm that I will write to him.

My point is that the NHS England allocation is based on the ACRA assessment and on the change in the funding formula. The hon. Member for South Cambridgeshire and the hon. Member for Cambridge rightly point out that, historically, the funding of their CCG has not been equivalent to that of local areas. That historical funding disparity is being improved, and is moving back towards the target of funding for CCGs over the next two or three years. I pointed out that last year there was a funding increase of 2.7%, and there will be one of more than 5% this year.

[Heidi Allen]

While the Minister’s inspiration is working diligently on the back row behind him, may I ask to be included in that? If we do not have time now, perhaps the Minister could come back to us. He is right that some additional funding has been provided to the CCG, but more than that amount is in mandated national programmes over which it has no control, so how much extra will the CCG receive for core services—not for something that has been put on it from a national point of view?

[Stephen Hammond]

The hon. Lady will know that some of those core mandated services are providing core services as well. I am happy for the hon. Member for Cambridge to correct me, but my understanding is that an additional £8.5 million will go into the CCG. If he wishes to write to me with his figures, I will happily source those numbers for him. However, I have just received inspiration from somewhere, for which I am very grateful, and I can confirm that that is the number.

[Daniel Zeichner]

We could probably swap numbers for the remaining 11 minutes of the debate, but I am told that the CCG has additional nationally mandated commitments that exceed the extra money that it is getting, which is the nub of the problem. The overall problem, however, is that the Prime Minister has been going around telling people that a huge amount of money is coming into the national health service, but locally it appears that we have less. That is obviously difficult for local people to understand.

[Stephen Hammond]

The Prime Minister has rightly been telling people that there is a huge commitment to put more money into the NHS. Throughout the debate, I have recognised that the moneys that the CCG historically received were below the target for CCGs. I have stated that more money is now coming into the CCG and that NHS England is committed to moving all CCGs to target. Although he may say that is a historical issue, I hope he would also recognise the fact that the Government are putting more money into the national health service and that that money is coming to his area.

That brings me to the point I wanted to make about wider funding. The Government are making a commitment and backing the NHS with an extra £20 billion a year by 2023, which will be reflected in the resources available to CCGs.

[Daniel Zeichner]

I note, however, that my reading of what is happening to the CCG is that it has already spent a lot of the money that is coming through, so it will mean not more money, but dealing with past debt. Again, could the Minister confirm that that is in fact the case?

--- Later in debate ---

[Stephen Hammond]

That will partially be a decision for the CCG. I do not recognise exactly what the hon. Gentleman has said; I have said that an additional amount of money is going in. I accept that there are nationally mandated core services that need to be provided by the CCG. I stress again, as I have throughout the debate, that I accept that the CCG has historically been underfunded against population growth and against other local CCGs, as he and the hon. Member for South Cambridgeshire have pointed out.

I have reflected in my remarks that the change in the formula will allow the population growth that has happened in the previous four years to be more accurately reflected. If the hon. Lady’s growth projections prove more accurate than those of the ONS, I have indicated how, through the formula change, that will come through more quickly in the funding that is received by the CCG. Those are the key points. I am happy to write to her and the hon. Member for Cambridge to confirm the financial position as I and the Department understand it, so we are clear. We could spend another joyous eight minutes swapping numbers, but perhaps we will not do that now.

Suffice it to say that the long-term plan also sets out how the NHS will use those resources more effectively. It is clear that there is a huge increase in the commitment to primary care and that the formula change will reflect that more accurately for CCGs. I have no doubt that, if the formula increase does not come through in the way that the hon. Gentleman and the hon. Member for South Cambridgeshire expect, or that I expect, they will continue to make the case to me and will bring me back for another debate. I thank the hon. Lady for securing the debate and I hope she agrees that we have discussed the funding formula.

Question put and agreed to.

Historic Patient Safety Incidents: Liverpool Community Health NHS Trust

Stephen Hammond Excerpts

Thursday 6th June 2019 Written Statements

[The Minister for Health (Stephen Hammond)]

The report of an independent review conducted by Dr Bill Kirkup into the widespread failings by Liverpool Community Health Trust was published on 8 February 2018. The report described how over-ambitious cost improvement programmes as part of a bid for foundation trust status placed patient safety at risk, leading to serious lapses in care and widespread harm to patients. A culture of bullying meant that staff were afraid to speak up and safety incidents were ignored or went unrecognised.

Today, I am Informing the House that NHS England and NHS Improvement will establish an independent investigation of previous serious incidents at Liverpool Community Health. This second review will again be led by Dr Bill Kirkup supported by an independent expert oversight panel and will be conducted over three stages. Stages 1 and 2 will identify individual serious patient safety incidents that had not been reported or adequately investigated by Liverpool Community Health and undertake a series of historic, mortality reviews. Stage 3 will fully investigate those individual serious patient safety incidents identified from the previous stages to determine the scale of deaths and patient harm and identify local and national learning.

The independent investigation will also advise regulators where, in the opinion of the panel, the systems, processes and senior leadership within the former Liverpool Health Community Trust may have adversely contributed to the safe delivery of patient care. It will identify any themes, trends or issues that may require further investigation.

This will not be a re-run of the previous independent review, but it will draw upon its findings as well as the new evidence identified by Mersey Care NHS Foundation Trust in its response to the recommendations of the original report. The independent investigation will engage with families of former patients and affected staff to understand their concerns to inform the work of Stage 3.

Local stakeholders will be briefed and the investigation will publish its terms of reference once these have been finalised with the Chair.

NHS England and NHS Improvement expect work on Stages 1 and 2 will commence immediately and the independent investigation will report towards the end of 2020.

I am confident that Dr Bill Kirkup will oversee a thorough and independent investigation of these outstanding issues and deliver his recommendations swiftly.

[HCWS1601]

Interim NHS People Plan

Stephen Hammond Excerpts

Wednesday 5th June 2019 Commons Chamber

[Jonathan Ashworth (Leicester South) (Lab/Co-op) (Urgent Question)]

To ask the Secretary of State for Health and Social Care to make a statement on the interim NHS people plan.

[The Minister for Health (Stephen Hammond)]

The NHS published its interim people plan on Monday, and I laid a written ministerial statement at the earliest opportunity yesterday.

The plan is a first, but critically important, step in ensuring that the NHS has the people, leadership and culture it needs to deliver the NHS long-term plan. The interim people plan has been developed by Baroness Dido Harding, the chair of NHS Improvement, in partnership with frontline staff, NHS employers and a wider range of other representative groups and stakeholders. It takes a tough look at the challenges facing people working across the NHS. It sets out how leaders will be supported to create cultures that empower staff and make sure that every member of staff, regardless of their background, will be able to progress.

Critically, the plan calls for all NHS organisations to set out how they will ensure that the NHS is the best place to work. The recently appointed chief people officer for the NHS will play a vital role in supporting the NHS to do this. The interim people plan sets out a number of practical steps to increase the supply of clinical staff. This includes an extra 5,000 additional clinical placements for nurse training places by September 2019 and a commitment to further expansion of medical school places.

Ultimately, the plan will ensure that the NHS is best able to retain the highly skilled and dedicated staff who choose a career in healthcare, including the most senior clinicians. Therefore, we have listened to their concerns that pension tax changes are discouraging them from doing extra work for patients. That is why Government will consult on how to introduce new flexibilities for this critically important staff group.

But we are not complacent. We know there is more work to do to secure the people, leadership and culture that the NHS needs. My right hon. Friend the Secretary of State has asked Baroness Harding to lead further work over the summer to prepare the final people plan. As has always been intended, the final people plan will be published soon after the conclusion of the spending review, when there will be further clarity on education and training budgets.

I would like to take this opportunity once again to place on record my thanks, and the thanks, I am sure, of everybody across the whole House, to all the NHS staff who do a wonderful job in ensuring that our constituents—their patients—get excellent care.

[Jonathan Ashworth]

It is a pleasure, as always, to see the Minister of State, but the Secretary of State should be doing his day job and be here answering questions about the health service, not playing his Tory leadership games.

Our NHS is struggling with vacancies of 100,000. Our NHS staff are the very best in the world—and none of them wants to be part of a trade deal with the Americans, of course—but they are working under immense pressure because of these chronic shortages. Shortages put patient care at risk, and that means that standards of care are falling. This means that our constituents wait longer to get a GP appointment because we have lost 1,000 GPs. It means that women are turned away from maternity units because we are short of 3,500 midwives. It means that cancer diagnosis is delayed because of shortages in the cancer workforce. As Dido Harding’s report shows, we are short of 40,000 nurses in the workforce, and that is now critical. It means that at a time when mental health problems are increasing—The Lancet reports today on an increase in non-suicidal self-harm—we have actually lost 5,000 mental health nurses since 2010. We have problems in the learning disability sector. Health Education England today warns that because of the shortages in learning disability nursing, we are set to

“hit critical levels in the next five years”,

with vacancies of 30%. We have an ageing population. Adult social care is short of 110,000 staff, and yet district nursing has been cut by 50%. We do not have enough nurses on our children’s wards. Health visitors and school nurses in our communities have been cut.

This NHS workforce crisis is linked to decisions of this Government. As Dido Harding’s report says,

“applications for nursing and midwifery courses have fallen since the education funding reforms”.

Those education funding reforms include the abolition of the bursary. Is not that therefore a damning indictment of the decision by this Government to abolish the bursary, and will the Minister now commit to bringing it back?

The report also references continuing professional development, where budgets have again been cut, by a third. It says:

“Employers have…been investing less in their people, as pressures on NHS finances have grown.”

Is that not an admission that Tory austerity, with nine years of underfunding in the NHS, has contributed to the workforce crisis of today?

The Health Secretary has said that he wants “a new Windrush Generation” of overseas nurses to fill the staffing gap, so can the Minister explain why a commitment to recruit 5,000 extra nurses a year internationally was dropped from the Dido Harding report? Did the Government put pressure on Baroness Harding? On international recruitment, can he guarantee that no one offered a job in the NHS or care sector will be restricted by the £30,000 salary cap, as the chair of Health Education England called for yesterday at the Health and Social Care Committee?

Finally, the Minister referenced the spending review. He will have seen that the Chief Secretary said yesterday at a Select Committee that the spending review is now unlikely to be ready for 2020-21. That means that new funding for training, for Health Education England and for capital investment in public health and social care will not come on stream until 2021—two years away. Does the Minister think that that is an acceptable way to deal with the NHS crisis we are facing? I urge the Minister, for whom I have a lot of respect, to accept that we cannot keep delaying this situation further. The Health Secretary needs to abandon his leadership games, focus on his day job and get a grip.

--- Later in debate ---

[Stephen Hammond]

The House will have listened to the hon. Gentleman. It is important to put out some facts, which were missing from his fact-free analysis. For example, we have had 52,000 more professionally qualified clinical staff in the last nine years, almost 16,500 more doctors and over 17,000 more nurses on our wards. He set out a list of promises, but with little detail and no means to pay for them. He asked a number of questions, which I will respond to.

The hon. Gentleman talked about the number of nurses and said that there was no plan. There clearly is. Increasing nursing is a priority, and this plan sets out—[Interruption.] If the hon. Member for Dewsbury (Paula Sherriff) would like to listen, this plan sets out a focus to ensure that we can recruit nurses. The hon. Gentleman talked about applications, but he will know that applications for nursing places are up 4% on the previous year. He will also know that the plan sets out 5,000 more clinical placements available in September this year, which is a 25% increase on the previous year. He will know that the plan sets out 7,500 more nursing associates. The plan also quite clearly sets out measures that will ensure that the NHS is the best place to work, and therefore more nurses will want to stay in it.

The hon. Gentleman spoke about a number of other issues. The Migration Advisory Committee has made recommendations, which he will have seen. He will know that the Secretary of State has made a firm commitment that we intend to continue to recruit internationally, as well as increasing domestic recruitment. He mentioned continuing professional development. It would be useful if he had read the plan, which sets out commitments to ensure continuing education and opportunities for education for all staff in the NHS. He will have seen that there will be a final level of commitment.

The hon. Gentleman speculates about the spending review. He speculates about a number of things, but it would be better not to speculate. It would also be better not to make allegations about my right hon. Friend the Secretary of State, who was doing his day job yesterday. I know that the hon. Gentleman is always interested in soundbites, and one soundbite he should have taken notice of was when my right hon. Friend said yesterday:

“the NHS is not on the table in any trade talks. The NHS is not a bargaining chip in negotiations, with the US or otherwise.”

[Paula Sherriff (Dewsbury) (Lab)]

We’ll see.

[Stephen Hammond]

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

[Mr Kenneth Clarke (Rushcliffe) (Con)]

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

[Stephen Hammond]

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

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

I welcome the interim NHS people plan. Workforce is the greatest challenge across all four health services, but the 41,000 nursing vacancies in NHS England are simply a patient safety issue and cannot be parked on some shelf or kicked into the long grass. The plan identifies the removal of the nursing bursary and the imposition of student fees leading to a drop of over 30% in new student nurses. Will the Minister commit to re-establishing the bursary? Scotland preserved the bursary and free tuition, and our nursing vacancy rate is less than half that. The plan also calls for 5,000 new GPs. I remember the former Secretary of State promising 5,000 new GPs by next year, and rather than being close to delivering that, there are 1,000 fewer. How will the Minister deliver 5,000 extra GPs? Will he increase funding to Health Education England to deliver it?

There is no question but that the NHS across the UK will need non-UK staff. How will the Minister attract both EU and non-EU staff when there has been a 90% drop in European nurses coming here, and non-EU doctors are leaving because of visa charges and the £400 a year they pay per member of their family to access NHS services? What is he going to do about the pension tax allowance rules that are driving young consultants out of the NHS?

[Stephen Hammond]

I thank the hon. Lady for welcoming the plan. I think she will accept that this is a good interim plan; it is a stepping stone. She asks what we are doing to fill nursing places. I point out yet again that we are increasing applications and ensuring that there are 5,000 extra clinical placements available, which is a 25% increase on last year. Far from being complacent about the number of nursing applicants, we are looking to ensure that more nurses can be trained in this country, beyond the 35,000 who are being trained at the moment.

The hon. Lady asked about doctors. The Royal College of Physicians has made it clear that we need more medical school students. We are committed to increasing the number of undergraduate medical school places for domestic students by 1,500, with the first 630 being taken up last year. By 2020, there will be five new medical schools across England, helping to deliver—[Interruption.] Of course it takes time, but if we do not take that step now, we will never make the end of that journey. That has been a consistent problem for many years. There are still more doctors coming through now, but we need to do more, which is why this plan is being put in place.

The hon. Lady will have heard me say to my right hon. and learned Friend the Father of the House that there are more than 63,000 EU nationals working in the health service. That is more than there were in December 2017, and over 5,000 more than there were in June 2016. She is right to point out that we want those skills in the right clinical areas. I reiterate what I said a moment ago: we wish to make it absolutely clear that the contribution of EU nationals working in the health service is extraordinary and valued and will continue to be so.

The hon. Lady briefly mentioned pensions. She will have noted that we launched a consultation yesterday, setting out some ideas. I am pleased to say that the British Medical Association has welcomed them but asked us to look at other flexibility within the pension rules. I encourage the hon. Lady and all consultants to take part in that consultation.

[Steve Brine (Winchester) (Con)]

The Minister knows from our time together in the Department how much I welcome the interim people plan. It simply is the turnkey without which our long-term plan just cannot work. He is aware of how important retention is, and that is at the heart of the plan. I know he has mentioned this several times already—and consultations are great, and I will encourage my constituents to take part—but may I ask him to look urgently at the changes to the NHS pension scheme in relation to the annual allowance and the lifetime allowance? My trust has contacted me to say that senior consultant doctors and senior nurses are receiving unexpected tax bills of tens of thousands of pounds—up to £50,000—which is starting to have an impact on decisions about their future and the additional sessional work they are prepared to take up. This is impacting on patient care now, so on behalf of my constituents, I urge him—I know he will take this seriously—to look urgently at the NHS pension scheme issue.

[Stephen Hammond]

Again, my hon. Friend was absolutely right at the start of his question to point out that this is a key stepping stone to making sure that the long-term plan works. He is also absolutely right to point out that we recognise and have taken extraordinarily seriously the difficulties that a number of clinicians have had with the pension tax changes. He will know from his time in the Department that we have been in continuous discussions with the Treasury about what options may be available. I have set out today that the consultation will propose a new 50:50 option for higher-earning clinicians to halve the rate of pension growth in exchange for halving contributions. I accept that that is only one part of the solution, but it is a step forward. I welcome contributions to the consultation, and I urge him and his consultants to take part.

[Yvette Cooper (Normanton, Pontefract and Castleford) (Lab)]

In our area, GP practices have had serious problems recruiting, and one constituent has contacted me about surgeries being cancelled and having been told that the next routine appointment, for what is actually a serious condition, will be in August. My constituents cannot wait that long for GP appointments. Frankly, Ministers have had nine years to anticipate this crisis, and instead of making things better, they have in fact made things worse, with the King’s Fund warning that GP shortages could treble in the next five years. Frankly, the warm words the Minister has said are not urgent enough and not substantial enough to turn this around, so what is he going to do in the next six months to make a difference to my constituents, who are waiting far too long for important appointments?

[Stephen Hammond]

The right hon. Lady is right to be angry because her constituents should not be waiting that long. If she wishes to speak to me afterwards, I will take that up directly, with her, on behalf of her constituents.

The right hon. Lady says that we are not taking this seriously and not acting urgently enough. She will know that this interim people plan makes sure we will have not only more people recruited to the NHS, but more people wishing to stay working within the NHS. One of the key issues the NHS has faced is that a lot of people have decided not to work within it, and the key part of the people plan—this being the interim before the final is published later—is actually about ensuring we have more staff there. I reject what the right hon. Lady says. We are taking this seriously, and we are acting on it now.

[Henry Smith (Crawley) (Con)]

I welcome the record amounts of investment going into the NHS, but may I seek assurances from the Minister that we will be using those resources to ensure that specialist clinicians in areas such as blood cancer and heart disease are properly supported so that we have the training for those personnel to tackle those conditions in particular? I say that as the chairman of the all-party groups on both conditions.

[Stephen Hammond]

My hon. Friend will know, because I have been in debates with him before, that I recognise the exceptional work that those two all-party groups do. He will know from the long-term plan that we have set out new commitments on diagnosis for all cancers and for cardiac. He will know that the reason why we have set out an interim people plan and will then set out a final people plan is that a long-term plan cannot work unless we have the people to back it up and are training the right number of people. This plan sets out how to recruit more people, how to train more people, how to give people the skills to deal with what will face the clinicians and the physicians of the 21st century, and that is key to delivering what he has asked for.

[Mr Ben Bradshaw (Exeter) (Lab)]

Baroness Harding, who is a Conservative peer, and Sir David Behan, the head of Health Education England, told the Health Committee yesterday in absolutely clear terms that both the abolition of nursing bursaries and Brexit are seriously exacerbating the staffing crisis in the NHS. Are they wrong?

[Stephen Hammond]

I am sure they will also have said that one of the things Health Education England has explicitly set out is that one of the biggest barriers to more nurses was that there was not the placement capacity. I am sure Sir David Behan will also have set out that he therefore welcomes entirely the 5,000 extra clinical placements that are being made available, which is a 25% increase on last year.

The right hon. Gentleman will also know, as I have set out, that there are more EU nationals working in the NHS now than there were at the time of the referendum. However, one of the reasons why we are having an interim people plan is that we are not complacent. There are huge challenges, as I set out not only in my written ministerial statement, but in my opening remarks. That is why this plan is addressing the shortages in nursing, and it is right that we do so.

[Lucy Allan (Telford) (Con)]

I welcome very much this initiative, and I am delighted by all that has been said. The chief executive officer of Shrewsbury and Telford Hospital announced his departure on Monday, following a catalogue of failings. Despite these failings, formal complaints to Dido Harding and others and a series of calls for his dismissal, the CEO has apparently resigned of his own volition to take up another highly paid job within the NHS and is not going to work his notice because he has too much holiday to take. Does the Minister agree that senior management in any organisation, including the NHS, must be held to account for their performance, and will the people plan deliver this?

[Stephen Hammond]

My hon. Friend makes a very powerful statement on behalf of her constituents about the change of leadership. I am obviously aware of the change of leadership, including the departure of the chief executive, and I am aware that it raises a number of issues, which she and I may wish to have a meeting to discuss. She is right to ask whether we are tackling the culture to make sure that we have the best leaders in the NHS, whether we are ensuring that they are properly trained for the challenges of the 21st century and whether we are making sure that they are not only held accountable but supported to make sure they are doing the best they can. That is why Sir David Behan led a chapter in the whole draft people plan, which will lead into the final people plan, on leadership. The right leadership for the NHS will make sure that our constituents get better care.

[Ellie Reeves (Lewisham West and Penge) (Lab)]

It has been reported this week that there has been a dramatic rise in self-harm, with one in five girls cutting, burning or poisoning themselves. Despite this, the NHS trust in my constituency has cut the Lewisham child and adolescent mental health services budget, due to central Government cuts. We desperately need more funding and more staff. Given that the Government are not on track to meet their mental health workforce target for 2020-21, is the Minister really confident that we can meet these new, larger recruitment targets?

[Stephen Hammond]

I am confident that we are putting in place the measures that will allow those targets to be met. There is a comprehensive expansion of mental health services, with an additional £2.3 billion being invested over the next four years, which will make sure we resolve the problems the hon. Lady has highlighted. In particular, 350,000 more children will get the support they need, which I am sure will translate into dealing with the issues at local level that she has raised.

[James Cartlidge (South Suffolk) (Con)]

GP retention is a significant challenge in my constituency, and GPs do often raise the impact of the current pension system. May I say to my hon. Friend that I very much welcome the consultation on pension arrangements for clinicians, but can he set out the potential timing of when those changes may come into force? He will be aware that GPs are making decisions right now about things such as early retirement, and we need this as a matter of urgency.

[Stephen Hammond]

I thank my hon. Friend for that question. The Department will launch the consultation at the end of this month. It will set out the proposals, which we spoke about yesterday, to introduce greater pension flexibility. They are designed to take away the disincentives not only for senior clinicians but clearly for GPs. That consultation will last for the normal length of time, and I hope we will be able to proceed quickly thereafter.

[Ann Clwyd (Cynon Valley) (Lab)]

When I came to Parliament 35 years ago, I had served for three years on the royal commission on the NHS. We made many recommendations. When I hear the Minister talk about things that will be done and say that notice has been taken of reports, I am reminded that that report landed on Margaret Thatcher’s desk. The recommendations that we made were never carried out. One was about the shortage of doctors. Thirty-five years ago, we knew that there would be a shortage of doctors. We made many other important points, which should have been acted on. What assurances can the Minister give so that on this occasion the recommendations in the report will be acted on? What is the point of all these words and all this work done by people on things such as royal commissions unless the Government take action?

[Stephen Hammond]

The Government are taking action specifically on the points that the right hon. Lady made. We committed to increase the number of undergraduate medical school places by 1,500, and 630 are already in place.

[Paul Masterton (East Renfrewshire) (Con)]

I thank the Minister for grappling with the NHS pension scheme issue. I am not convinced that the 50:50 option is a long-term, sustainable option, so will he confirm, as the Secretary of State said yesterday, that the consultation will be open to exploring other mechanisms? In particular, will he keep banging at the Treasury’s door, because the ultimate solution is in its power? The way in which it has tried to dodge this and pass it to the Department of Health and Social Care is a bit of disgrace.

[Stephen Hammond]

My right hon. Friend—I am sorry, my hon. Friend; I am only presaging something that will happen in future—will know that when my right hon. Friend the Secretary of State speaks he says what he means. The consultation will be open to looking at other schemes and other potential flexibility. My hon. Friend will know that the British Medical Association has welcomed the 50:50 option but would like to see other options. He will also know, much as the Department might like to make tax policy, we do not do so, so it would be injudicious of me to commit, but I am happy to continue our long-standing conversations with the Treasury on this matter.

[Dr Rosena Allin-Khan (Tooting) (Lab)]

There will be no people plan if Donald Trump gets his hands on our NHS. Unlike Donald Trump, the NHS does not discriminate, and staff value everyone who walks through the door as equal. Does the Minister agree that the NHS was not for sale yesterday, it is not for sale today, and it must not be for sale tomorrow?

[Stephen Hammond]

The good news is that I think the hon. Lady was agreeing with my right hon. Friend the Secretary of State, who set that out yesterday. I welcome the fact that she supports him.

[Steve Double (St Austell and Newquay) (Con)]

The fishing village of Mevagissey risks losing its GP surgery because the last remaining doctor there has handed the contract back to the NHS. The people of Mevagissey have launched an incredible campaign to find a new GP for their village. Does the Minister support their campaign, and will he spread the message far and wide that there is an amazing community waiting for a new GP and that all expressions of interest are welcome? Can he reassure me that the new people plan contains measures not only to recruit more doctors but to ensure that rural and coastal communities can find the GPs they desperately need?

[Stephen Hammond]

My hon. Friend is right, and I am happy to support the campaign by the people of Mevagissey, which is a wonderful part of the country to live in. I am happy, too, to assist him in that campaign if he wishes to come and speak to me about it. He is right that the plan sets out ways to recruit and retain more doctors, including GPs in rural and coastal locations, as well as those in urban locations.

[Tom Brake (Carshalton and Wallington) (LD)]

Would the Minister join me, first, in congratulating the Royal College of Nursing on backing a people’s vote? Does he accept that one reason for that was doubtless that the number of nurses and midwives from the EU has dropped by 5,000 in the past two years? Will he set out what extra cost and complexity will be associated with the recruitment of nurses and midwives from the European Union, if indeed we leave the EU, in future?

[Stephen Hammond]

I join the hon. Lady in congratulating the RCN—

[Tom Brake]

The hon. Lady?

[Stephen Hammond]

I am sorry, I wholeheartedly apologise to the right hon. Gentleman. I certainly join him in welcoming the RCN’s welcome for a people plan. It is a great and sensible step forward, without being complacent about what needs to be done in the next phase, which will be published later in the year. He will know that we have been working with other EU members to ensure that, after what I hope is an orderly Brexit, there is continued recognition of medical qualifications. He will know that the European Commission has already set out its desire for a wide-ranging, extensive reciprocal healthcare agreement, and the Government continue to work to achieve that ambition.

[Dr Paul Williams (Stockton South) (Lab)]

I do not think that the Minister is taking this seriously. In the past two years, 5,000 nurses and midwives from EU countries have left the NHS, at a time when we are 40,000 nurses short. Does he agree with David Behan, the chair of Health Education England, who agreed yesterday that Brexit was exacerbating the NHS staffing crisis?

[Stephen Hammond]

I have already set out the fact that the Department, the whole NHS management, the whole NHS, and we as a country welcome and recognise the huge contribution of EU nationals in the NHS. I have set out our desire to continue to ensure that EU nationals work in the NHS. Alongside that, I know that Sir David Behan will have also said to the hon. Gentleman that it is important that we have more routes into nursing to ensure that those 40,000 vacancies that he discussed do not continue, which is why we have set out in the plan more nursing apprenticeships, more nursing associates and more clinical placements. It is important to have both international and domestic recruitment.

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

The Minister has talked a lot about leadership. He said in his opening statement that there was a need to create in the NHS leaders who could create cultures that empowered staff. What is he going to do about the bullying at the top of the NHS, including in NHS England and NHS Improvement, which Dido Harding admitted yesterday at the Health Committee?

[Stephen Hammond]

The hon. Lady is right: that culture is not acceptable and must be driven out. She will have read the interim people plan, which talks explicitly about ensuring that we create leadership that stops that culture. There is a chapter on making the NHS the best place to work. She will know that we have been working across the country to ensure that all staff know that they are valued, that they have the right to speak up and that the culture of bullying must be driven out. I shall speak with Baroness Harding, as I do regularly, to ensure that that message is spread throughout the NHS and that staff know that they are valued.

[Jamie Stone (Caithness, Sutherland and Easter Ross) (LD)]

I realise that health is devolved to the Scottish Government. Nevertheless it has to be said that the Scottish Government are having enormous trouble with their workforce planning, which means that doctors and nurses have to pick up the slack and that we are wasting good money on employing agency staff, which need not happen. May I make a plea to Her Majesty’s Government to share workforce planning and best practice with the Scottish Government so that they can get that right?

[Stephen Hammond]

As the hon. Gentleman rightly pointed out, health matters in Scotland are devolved, but I am delighted to share any of the excellent initiatives that are set out in the draft people plan with the Scottish Government.

[Liz McInnes (Heywood and Middleton) (Lab)]

Despite the vital role played by carers in society, they merit just a paragraph in the plan. Will the Minister ensure that his Department matches Labour’s commitment to publish a full strategy for carers and to increase carer’s allowance to the same rate as jobseeker’s allowance?

[Stephen Hammond]

I welcome Labour’s commitment to publish a paper, but the hon. Lady will know that the Department is going to publish a Green Paper on adult social care. We are finalising that. [Interruption.] The hon. Member for Leicester South (Jonathan Ashworth) shouts at me. I know he makes a lot of promises without detail. We want to make promises that have detail and can work.

[Grahame Morris (Easington) (Lab)]

This is an important report into NHS people planning. It is an interim report, so there is an opportunity to identify any deficiencies. My particular concern is about the cancer workforce, in particular the point made by my hon. Friend the Member for Leicester South about the loss of bursaries not just for nurses but for therapeutic radiographers. May I draw the attention of the Minister, with due respect, to the fact that the radiotherapy and oncology course at Portsmouth University recently closed? Concerns are being expressed and not just by politicians on the Opposition Benches. Mr Richard Evans, chief executive of the Society of Radiographers, said that he has concerns about whether our hospitals and specialist cancer centres will be able to recruit enough skilled and trained personnel. This could even threaten the delivery of cancer treatment and the ambitious plans that the Minister has in the new cancer strategy.

[Stephen Hammond]

The hon. Gentleman is right: this is a serious plan. As he rightly points out, it is an interim plan. It sets out a number of specific actions for this year. It also sets out a number of clear action paths and trajectories to ensure that the people plan is achieved. I would be delighted to meet him and other officers of the all-party group to ensure that we get the skills in the right places to ensure that the ambitious and deliverable plans in the long-term plan can happen.

[Andy Slaughter (Hammersmith) (Lab)]

I raised the cost of the Babylon GP at Hand app and the cuts in the number of conventional GPs at Prime Minister’s questions but, with respect to the Minister for the Cabinet Office, he missed the point, astonishingly. Even if NHS England funds £21 million of the shortfall for this year, that is still money from the public purse and it does not address the past cost to Hammersmith and Fulham of at least £12 million or any future costs. Will the Government suspend the Babylon contract while there is a proper investigation into this privatisation of the NHS?

[Stephen Hammond]

It is not a privatisation of the NHS; it is a scheme allowing greater access to GP services. The hon. Gentleman will know that it is delivering healthcare to a number of his constituents as well.

Interim NHS People Plan

Stephen Hammond Excerpts

Tuesday 4th June 2019 Written Statements

[The Minister for Health (Stephen Hammond)]

Today I am depositing in the Libraries of both Houses a copy of the interim people plan, which sets out the steps the NHS will take to ensure the health system has the people, culture and leadership it needs to deliver the long term plan.

The interim people plan has been developed by Baroness Harding, the Chair of NHS Improvement, in partnership with front-line staff, NHS employers and representative organisations including trades unions and royal colleges. The plan takes an unflinching look at the challenges facing people working across the NHS and, importantly, for the first time considers what action employers and NHS leaders need to take to make the NHS a great place to work. In future, careers in the NHS will better reflect the different lives, aspirations and expectations of those who choose to work in it.

In addition to the action the NHS will take to ensure the NHS is a great place to work, the interim people plan also sets out a number of practical steps the NHS will take now to increase the supply of clinical staff. A consultation is planned exploring proposals to introduce greater pension flexibility, which are designed to address disincentives that may encourage senior clinicians to limit or reduce their workloads whilst participating in the NHS pension scheme. A final people plan will be published soon after the conclusion of the spending review.

[HCWS1587]

NHS Accountability Framework

Stephen Hammond Excerpts

Tuesday 21st May 2019 Written Statements

[The Minister for Health (Stephen Hammond)]

I will today lay before Parliament the Government’s 2019-20 accountability framework with NHS England and NHS Improvement. For the first time, this combines the Government’s annual statutory mandate to NHS England with the annual remit set for NHS Improvement.

NHS England oversees the commissioning of health services in England and NHS Improvement oversees and holds to account NHS foundation trusts, NHS trusts, and independent providers of NHS-funded care. Working together they will play a vital role in leading the NHS as it takes forward its long term plan, which has been created in partnership with doctors, nurses, other clinicians and builds on the views and insights of patients and the public. They have come together under a joint senior leadership team to do this effectively and the Government are supporting them with a funding settlement that will see the NHS’s annual budget increase by £33.9 billion by 2023-24, the largest cash settlement in the history of the NHS.

This is an important year for the NHS as it transitions into full implementation of the NHS long term plan while at the same time ensuring that every patient in England will continue to receive vital services as the country leaves the EU. To put it beyond doubt that these are the most important things that the NHS has to deliver this year, the accountability framework sets NHS England and NHS Improvement two objectives for 2019-20: to ensure the effective delivery of the long term plan, and to support the Government in managing the effects of EU Exit on health and care.

The framework clearly demonstrates the Government’s commitment to NHS staff, to the public, to patients and to taxpayers, that the long term plan will be delivered and that the safety and quality of NHS services will be safeguarded through a period of change. As required by the Act, NHS England and Healthwatch England have been consulted on the objectives set in it, along with NHS Improvement.

NHS England and NHS Improvement are co-ordinating a system-wide process of implementation planning, at both local and national level. This will culminate in a national implementation programme for the long term plan to 2023-24, and an NHS workforce implementation plan, by the end of 2019. My intention is then to set a further accountability framework from 2020-21 to 2023-24 taking account of these, the outcome of our spending review, the needs of patients and the public, and the views of Government.

As in previous years, I will also today re-lay the mandate for 2018-19. This is to take account of in-year revisions to NHS England’s budget for 2018-19. There are no other changes.

[HCWS1570]

Oral Answers to Questions

Stephen Hammond Excerpts

Tuesday 7th May 2019 Commons Chamber

[Lilian Greenwood (Nottingham South) (Lab)]

3. What recent assessment he has made of trends in the level of workforce vacancies throughout the NHS.

[The Minister for Health (Stephen Hammond)]

The NHS employs more staff than at any time in its 70-year history. Posts may be vacant for a variety of reasons, including maternity and career breaks. The latest data shows that as of December 2018 about 80% of nursing vacancies and 85% of medical vacancies are filled by a combination of bank and agency staff.

[Lilian Greenwood]

Recent data from NHS Digital shows that there are 720 fewer GPs in the east midlands than just two years ago. According to NHS England, each month thousands of people wait more than four weeks for a face-to-face GP appointment in Nottingham. In January, 3,206 people had to wait more than 28 days between making the appointment and seeing their doctor. Ultimately, that is leaving the GPs we do have overwhelmed and overworked. I know myself that it is creating huge pressures on the emergency department at Queen’s Medical Centre. What is the Minister going to do to change that system?

[Stephen Hammond]

The NHS long-term plan will set out vital strategic frameworks to ensure that the needs for the next 10 years are met. The hon. Lady will know that we are training an extra 5,000 GPs to work in primary care and general practice. If she writes to me about the specifics of the numbers she mentioned in respect of Nottingham, I will be happy to respond.

[Victoria Prentis (Banbury) (Con)]

Those of us who are campaigning to reopen a full obstetric unit at Horton General Hospital know how important the workforce are to safety in our NHS. At an excellent meeting today, Baroness Harding set out some of the things we can do to increase our workforce, one of which was much better leadership and career planning for the staff we are already retaining in the NHS so that they want to stay longer. What is the Department doing about that?

[Stephen Hammond]

As my hon. Friend has heard, the Secretary of State commissioned Baroness Harding to bring forward the interim workforce plan. One of the workstreams was looking at retention and the staff we currently have. More than 52,000 nurses are in undergraduate training, and it is essential that they stay in the NHS after training. What Baroness Harding outlined today will ensure that that happens.

[Mr Ben Bradshaw (Exeter) (Lab)]

Can the Minister confirm today’s Daily Mail report that the NHS plans to recruit thousands of overseas nurses over the next five years? How much of that shortage has been caused by the exodus of EU nationals from the NHS, and how much of it by the Government’s disastrous decision to abolish nursing bursaries?

[Stephen Hammond]

I will not comment on the specifics of a leak from an outdated version of the plan. The NHS has always recruited nurses internationally and there are no plans to change that. The workforce plan will set out how more nurses, doctors and nursing associates will be recruited and retained inside the NHS.

[James Heappey (Wells) (Con)]

Many surgeries in my constituency augment the work of GPs with nurse practitioners. Will the Minister join me in praising the work of nurse practitioners and say what more the Government could do to grow their number so that they can continue their excellent work in surgeries around the country?

[Stephen Hammond]

I absolutely agree with my hon. Friend. Nurse practitioners do an extraordinarily valuable job across the country. The Government are committed to training more nurses and more nursing practitioners. As I said in an earlier answer, that will be set out in the workforce plan.

[Dr Sarah Wollaston (Totnes) (Change UK)]

The workforce shortfall is not evenly distributed across the NHS either geographically or by specialty. The Minister will know that there are particularly serious nursing shortfalls in learning disability and community services. He will also know of the implications of shortfalls—for example, for the ambition to deliver 75% of cancer diagnoses at stages 1 and 2. Will he look again at the evidence on mature students and the impact of losing bursaries on that section of the workforce? Will he meet me to discuss that?

[Stephen Hammond]

The Chair of the Select Committee is right: the vacancies are not evenly spread and are of particular concern in learning difficulties and a number of other areas. Of course we want to ensure that mature students come back to and stay within the health service. That is why a number of incentives are being put in place to encourage, recruit and retain mature students. I would, of course, be happy to meet her to discuss this matter in more depth.

[Nigel Huddleston (Mid Worcestershire) (Con)]

I appreciate the Minister’s comments about the need for retention and morale-boosting in the NHS. Does he agree that constantly going around fabricating threats of closures when no such threats exist, or talking down the NHS—as some politicians do—does not exactly help recruitment and retention either?

[Stephen Hammond]

My hon. Friend is completely right. One would have hoped that all Members on both sides of the House celebrate the fact that the number of nurses and the number of doctors in the NHS are now higher than they have ever been in its 70-year history, and that the Government are backing that up with a commitment to invest £33.9 billion.

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

Cuts in lifetime and annual pension tax allowances are causing senior doctors to retire earlier and younger consultants to avoid working extra hours, as they can end up paying more in tax than they earn from the extra hours of work. What discussions has the Secretary of State had with the Chancellor about the fact that these recent changes are driving doctors from the profession and increasing workforce shortages?

[Stephen Hammond]

The hon. Lady raises a very important matter. The Government recognise the concerns that have been expressed by NHS doctors, and my right hon. Friend the Secretary of State is engaging in numerous conversations with the Chancellor. I am reluctant to give a running commentary on the nature of those internal discussions, but I can say that we hope to resolve the matter soon.

[Daniel Zeichner (Cambridge) (Lab)]

4. What discussions he has had with the Secretary of State for Education on the provision of NHS mental health services for university and college students.

--- Later in debate ---

[Mr Philip Hollobone (Kettering) (Con)]

6. If he will make provision for (a) a new urgent care hub at Kettering General Hospital and (b) a health and social care pilot in Northamptonshire with the Ministry of Housing, Communities and Local Government. [R]

[The Minister for Health (Stephen Hammond)]

The Government are committed to transforming the NHS estate. I discussed the urgent care hub with my hon. Friend and other colleagues in January, and, as he knows, I enjoyed my visit to Kettering General. He also knows that future levels of capital will be determined at the next spending review, after which our prioritisation process will be determined, to identify the strongest transformation schemes. We welcome initiatives from local leaders to strengthen and better integrate the local health and care landscape in Northamptonshire.

[Mr Hollobone]

When Kettering’s present A&E was built 25 years ago, it was designed to cope with 45,000 patients a year. It is now coping with 91,000, and it is estimated that in 10 years’ time, 120,000 will use the facility. The whole NHS in Northamptonshire recognises that an urgent care hub at Kettering General Hospital is urgently required. Will the Government get on and fund it?

[Stephen Hammond]

My hon. Friend is a diligent and consistent representative of his constituents on this matter. He will know that I have heard his request and that, as I have said to him before, the spending review will take place later in the year. Priorities will be decided at that stage.

[George Freeman (Mid Norfolk) (Con)]

7. What steps he is taking to improve the patient experience through the use of digital technology.

--- Later in debate ---

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

12. What steps he is taking to increase the number of nursing associates in the NHS.

[The Minister for Health (Stephen Hammond)]

Health Education England is leading a national nursing associate programme with a commitment for 7,500 nursing associate apprentices to enter training in 2019. It is also working with health and care providers to develop a talent pipeline of future nursing associates, as well as sharing how providers are deploying currently qualified nursing associates.

[Greg Hands]

I thank my hon. Friend for that answer, and I thank the Secretary of State for his welcome announcement last month on “Shaping a Healthier Future” in London, which has gone down very well locally. How many more nurses does the Minister for Health think London will need over the spending review period? What specific measures is he taking to improve London’s offer to would-be nurses?

[Stephen Hammond]

My right hon. Friend is absolutely correct that the Secretary of State’s announcement has gone down extremely well. He will know that there are now more nurses in training than ever before—over 50,000—and he will know that London, in particular, will get its share of those nurses. He should be reassured that we are creating routes into nursing via nurse training, nursing recruitment and, indeed, nursing associates, and their recruitment into valuable roles across the health service will benefit his constituents.

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

Does the Minister know that when I went to a restaurant the other night with my wife there was a hum and a buzz coming mainly from the young women there? I asked, “Who are all these young women?” The maître d’ said, “They are all young Spanish nurses who are going home. This is their last evening in Britain.” Nursing associates will not fill that gap; these are young people coming in at the classroom assistant level of qualification. We need more nurses now, and we want to stop this haemorrhaging of nurses who are going back to the rest of Europe.

[Stephen Hammond]

The hon. Gentleman will know that nursing and nursing associate training places are being increased; that more funding is going in to increase nurse training places by 25% every year, from last September; and that we are announcing an expansion of nursing associates. He will see tomorrow, when new figures are announced, that more nurses are working in the NHS than this time last year.

[Patricia Gibson (North Ayrshire and Arran) (SNP)]

13. What recent discussions he has had with Cabinet colleagues on recognising 17 May as diffuse intrinsic pontine glioma awareness day.

--- Later in debate ---

[The Minister for Health (Stephen Hammond)]

My hon. Friend will have heard me say in answer to the earlier question that my right hon. Friend the Secretary of State and the Chancellor are in discussions about that matter. It would be unfair of me to comment on the progress of those discussions, but we hope to resolve them soon.

[Kate Green (Stretford and Urmston) (Lab)]

T3. Maternity Action reports that migrant women requiring maternity care from NHS hospitals are being deterred from receiving treatment by charges and fear of immigration sanctions. Will the Secretary of State meet me and campaigners to discuss what we can do to address that worrying situation?

--- Later in debate ---

[Nigel Mills (Amber Valley) (Con)]

T10. Does the Secretary of State agree that nursing associates are an excellent new role on the frontline of the NHS, delivering hands-on care for patients? If so, what more can be done to get more of them across the country?

[Stephen Hammond]

My hon. Friend is absolutely right. That role has been introduced to help build the capacity of the nursing workforce and support nurses and wider multidisciplinary teams. As he will have heard me say earlier, I am delighted that Health Education England is leading the national nursing associate training programme, with a commitment to train 7,500 nursing associates this year.

[Bill Esterson (Sefton Central) (Lab)]

T8. Tens of thousands of children are born every year with brain damage as a result of pre-natal exposure to alcohol, yet most clinical commissioning groups are not providing support for those with foetal alcohol spectrum disorders, despite Government guidance telling them to do so. Will the Government take the action needed and provide support for those suffering with this life-limiting and lifelong condition?

--- Later in debate ---

[Stephen Hammond]

My hon. Friend raises an important issue. The NHS faced the loss of a contract last year, which was then safely put back into place. The point he makes about guidance is absolutely right, and if he wants to come and talk to me about it, I will be happy to discuss it.

[Ellie Reeves (Lewisham West and Penge) (Lab)]

It is deeply concerning that in the past 10 years the number of prescriptions for opioid drugs has risen by 9 million. In this time, codeine-related deaths have more than doubled to over 150 a year. While I welcome moves to label opioid medicines, what further measures will the Secretary of State take to protect people from the dangers of opioid addiction?

Healthcare: East Midlands

Stephen Hammond Excerpts

Tuesday 30th April 2019 Westminster Hall

[Mrs Sharon Hodgson (Washington and Sunderland West) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Hollobone. I thank my hon. Friend the Member for Lincoln (Karen Lee) for securing this important debate. She is a passionate advocate for the NHS in her area and made a passionate speech. I also thank the other hon. Members who spoke—the hon. Members for Bosworth (David Tredinnick) and for Sleaford and North Hykeham (Dr Johnson), my hon. Friend the Member for High Peak (Ruth George) and, of course, the hon. Member for Strangford (Jim Shannon), who has just left the Chamber—for their excellent speeches and interventions.

Although I am pleased to respond on behalf of Labour, it is with sadness that Members come here time and again to explain the impact on their constituents of the crisis in the NHS. Sadly, as we have heard, standards are slipping across the board. It was a mild winter, but despite the thankfully lower levels of flu and vomiting virus, we saw the worst performance against the four-hour A&E target since records began. [Interruption.] If the Minister cares to—

[The Minister for Health (Stephen Hammond)]

It was an improvement on last year, so it was not the worst.

[Mrs Hodgson]

Oh, right—it was the second-worst, then. Anyway, bed occupancy also rose to 95.2% this winter, well above the 85% deemed to be safe, and patients are waiting almost 4% longer in A&Es than they were two years ago. In Nottingham they are waiting 14% longer than in 2017, and in Leicester they are waiting almost 4% longer than two years ago. East Midlands Ambulance Service NHS Trust has missed its targets for responding to patients in life-threatening situations. We have heard countless stories today that demonstrate how the crisis happening in our NHS both locally and nationally is real.

It is clear that the Tories’ plans for NHS funding fall short of what is needed. The autumn Budget announcement of a cash injection for health services excluded public health budgets, training and capital, which means an increase of just 3% for health services when we have a childhood obesity crisis, cuts to sexual health and addiction services, workforce shortages and a backlog of nearly £6 billion in repairs. It is not even enough to wipe out hospital deficits.

Nottingham University Hospitals NHS Trust alone predicted a deficit of more than £40 million by the end of the financial year, and it has declared 15 black alerts since December. How will the Government’s settlement help trusts like that become more sustainable? Where is the funding to guarantee sustainable health services in the face of ever-increasing demand from a complex and changing demographic? For example, in the east midlands, the number of preventable deaths from liver disease has increased by 37%. Obesity is also a growing problem, 66% of the population being overweight. People in the east midlands are more likely to have had a depressive episode than those in the rest of the country—3.9% compared with 2.2%. In 2013-15, the average life expectancy at birth across the east midlands was 79.3 years for males and 82.9 years for females, both of which are significantly below the national average. There is also considerable variation in preventable mortality from the major causes of death across the east midlands local authorities, with an urban-rural divide. The urban areas of Nottingham, Leicester and Derby have significantly lower life expectancy than the average for England.

Money is, of course, only one of the issues surrounding the crisis in the NHS. There is a staff recruitment and retention issue, too. NHS figures show that there are 100,000 vacancies across the health service, including 31,000 across the midlands and the east of England. Therefore, 9.3% of posts in the midlands and the east—about one in 11—are unfilled.

Constituents will also be worried about the integration of services in the east midlands. In recent years, councils have distanced themselves from sustainability and transformation plans and the integrated care systems in some areas, due to a lack of democratic accountability and scrutiny from stakeholders, including concerns over cuts and privatisation. Nottinghamshire’s ICS is an interesting case: the city council suspended its membership for six months last year for those very reasons, rejoining only in April 2019 after assurances were given to improve accountability and shared decision-making processes. I am sure that Members will be keen to hear from the Minister how democratic accountability and transparency is being improved in such cases.

Residents will also be concerned about the number of community hospitals that have closed or are under threat of closure. Residents of Bakewell and Bolsover have to travel to Chesterfield or Derby for their appointments, after their hospitals closed. The loss of those community hospitals impacts on rural areas of the east midlands, isolating people further because not only will they have to travel further to appointments, but so will any visitors, so patients are suffering.

The Government have spent nine years running down the NHS, imposing the biggest funding squeeze in its history, with swingeing cuts to public health services, and social care has been slashed by £7 billion since 2010. As we have heard, the NHS is clearly buckling under the pressure as a result, and standards of care continue to plummet. I would appreciate assurances from the Minister about how the Government will get a grip on the situation in the east midlands and across the country as a whole, to reverse the extremely worrying statistics and tackle the issues we have heard about.

[The Minister for Health (Stephen Hammond)]

It is a pleasure to serve under your chairmanship, Mr Hollobone. As you know, I have met the chief executive of the team from Kettering, I have visited Kettering and I have responded to you on the Floor of the House about Kettering. Kettering and its requirements for the A&E are therefore not far from the forefront of my mind.

I congratulate the hon. Member for Lincoln (Karen Lee) on securing the debate and I thank all hon. Members for their contributions. I intend to spend some time going through a number of the areas raised this morning. I am bound to say that the long-term plan, which a number of Members welcomed, is a substantial step forward, and the funding commitment—the biggest ever in peacetime—is a key to ensuring that that can be delivered. The number 100,000 has been trotted out, but clearly that does not represent posts unfilled, nor does it take any account of the actions that the Government are undertaking. More than that, the simple fact is that, compared with eight years ago, there are 14,700—over 15%—more doctors, 10,300 more nurses, midwives and health visitors and, in addition, over 15,900 more nurses on our wards.

I also point out that of those vacancies that several hon. Members mentioned, well over 80% are being filled by a combination of bank and agency nurses. Of course no one wants that situation to persist, but there has been a consistent decline in the number of agency staff, and since the transfer from the bursary to the loan system, much has been done working with nurses to ensure that courses are filled. We are seeing more applications than previously: this time around UCAS reported over 4,000 more applicants. Last year, my predecessor announced a fund to provide an increased package for postgraduate nursing students starting courses in 2018-19 in terms of employment in learning disability, mental health and district nursing roles, which are the key vacancies that need to be filled.

I will try to answer a couple of specific points raised by the hon. Member for Lincoln. She rightly voiced concerns about the closure of Skellingthorpe health centre in her constituency. As she pointed out, were there to be a closure, the CCG would be required to conduct a proper consultation. I spoke to the CCG yesterday and I understand that as yet—she may wish to correct me—there has been no formal request for closure. Equally, the CCG tells me—I hope this is right—that it will meet the hon. Lady later in May to discuss this matter, and that, were there to be a request, it would immediately inform her and offer her a meeting with it and the lead GP at Skellingthorpe to see what action could be undertaken. The CCG has also confirmed —she will understand this—that it appreciates that this is a rural community, and that there are additional challenges for local residents, so it is working not only with Skellingthorpe to understand the challenges and how they may be met, but to ensure that the rural network of GPs might work together.

The hon. Lady rightly expressed concern about CQC inspections, and I will go on to speak about those if I have time. She mentioned the recent inspection that took place on 25 February at Pilgrim Hospital, with a report published on 3 April. Although “requires improvement” remains the rating, there were marked improvements in certain areas, including in the standard of care, numbers of staff and nursing provision for children, and a real improvement in the triage time. She will appreciate that the trust is receiving substantial support from NHS England, including to help the hospital get out of special measures.

My hon. Friend the Member for Bosworth (David Tredinnick), chair of the all-party parliamentary group for integrated healthcare, spoke passionately about the health and wellbeing partnership. He is absolutely right, and the Government support the integration of healthcare services and recognise the good work being done by that partnership in Hinckley and Bosworth. The Secretary of State enjoyed his visit to Hinckley, and was particularly pleased to get a real impression on the ground of the improvement in services that will come from the £8 million investment. My hon. Friend reminded me of his Christmas present to me, and I was pleased to read some—although not all—of his report over the Christmas period. You will not be surprised to hear, Mr Hollobone, that I was also intrigued to hear his comments about India. I sometimes think that the “Ministry of Calm” in India could benefit many people in this place.

The hon. Member for High Peak (Ruth George) spoke about “Better Care Closer to Home”. That reminded me of when I was a councillor 18 years ago and a different Government wanted to do to local services in my area the things that she described. The issue was only resolved some years later, in 2015, when a new medical centre was built. She rightly mentioned the East Midlands ambulance service and—most importantly —its paramedics. I visited that service earlier this year, and spoke not only to the management but to the medics who deliver those services. There are clearly challenges regarding location, and not all the standards have been met. It is also true, however, that there are 67 new ambulances—an increase of 27—and response times have improved, which is to be welcomed. I recognise the problems with CAMHS that the hon. Lady raised. That is clearly an issue nationally as well as in the east midlands, and it is right for the long-term plan to recognise that. The commitment to mental health diagnosis and treatment times is a significant change from the previous situation.

[Ruth George]

Mental health services were allocated £1.2 billion, but that money was not ring-fenced. That is the problem that CAMHS has had with the cuts. Will the Minister commit that any additional funding for mental health services will be ring-fenced, so that it goes where it is needed?

[Stephen Hammond]

There is a commitment to treatment and the funding that backs it in the long-term plan, and that money is dedicated to that commitment. That is pretty clear.

[Ruth George]

indicated dissent.

[Stephen Hammond]

The hon. Lady is asking me to use the word “ring-fenced”, but if I say that the money is there and allocated for that matter, then it is specifically ring-fenced for it.

My hon. Friend the Member for Sleaford and North Hykeham (Dr Johnson) gave us a valuable insight into the NHS, given her experience as a consultant. She is right to say that we must tackle a number of workforce issues, and morale is undoubtedly key to that. I was pleased to see that set out in the initial workforce plan; and Baroness Harding, chair of NHS Improvement, has been asked to consider a stream of work about making the NHS the best employer. That work will consider a number of issues about retention and the culture and morale of staff. I look forward to the publication of that report, and I hope my hon. Friend will join me in welcoming the new ideas it contains.

My hon. Friend was right to mention the pensions of a number of GPs and other NHS staff. She will not be surprised to hear that I am continuing to persuade Treasury colleagues to accept the Department’s proposed solution for that issue, and I hope we can make progress and make an announcement on that soon, which will be reassuring to many. I encourage my hon. Friend to write to me about the dispensing service she mentioned, and I will consider what issues we can take up. Finally, she was right to talk about the orthopaedic services at Grantham. “Getting It Right First Time”—GIRFT—is led nationally by Professor Tim Briggs, who was lead clinician at the Royal National Orthopaedic Hospital. That is making a huge difference, not only to the concentration, specialisation and number of operations being undertaken, but—equally importantly—the great improvement in safety and reduction in infections is leading to hugely better care for patients.

The hon. Member for Washington and Sunderland West (Mrs Hodgson) mentioned A&E performance, and she is right to say that it fails to meet the target. However, she is wrong to say that this year has seen the worst performance ever, as there has been an improvement on last year. Over the past months, United Lincolnshire Hospitals NHS Trust has seen a huge increase in attendances compared with the previous year. That reflects the wider NHS, where demand is up by 6%, yet more than 4,700 patients per day are treated within the four-hour waiting limit. The hon. Lady mentioned Public Health England and Health Education England, but funding for those bodies was designed to be dealt with in the comprehensive spending review that will take place in the autumn. It was never intended to be tackled inside the long-term plan and spending commitment.

The hon. Lady mentioned money, but this is a transitional year for funding. The funding provided is enough to work on the deficit, and given the analysis being done, the Government’s commitments, and the work on efficiency in the health service, it is surprising that Labour Members who recognise the benefits of much of the long-term plan are not prepared to welcome the financial settlement that backs it up and will deliver it.

Briefly, let me mention another east midlands MP, my hon. Friend the Member for Erewash (Maggie Throup). She was not able to speak today as she is my Parliamentary Private Secretary, but she has done great work in pointing out the benefits of Ilkestone Community Hospital, which I intend to visit in the near future. May I just say that—

[Mr Philip Hollobone (in the Chair)]

Order. I do not think the Minister can just say it. He must allow time for Karen Lee to sum up the debate, so perhaps he will bring his remarks to a close.

[Stephen Hammond]

Thank you Mr Hollobone. I will not just say anything other than that I wanted to address a number of issues about east midlands care, so I will put them in a letter and write to Members who have participated in this debate. It is important to address the huge number of issues raised by colleagues and ensure that the context is clearly understood. This Government wish to thank all hard-working professionals in the NHS for their work. We will do everything we can to continue that support, with a plan and the money to back it up, so that, both nationally and locally, the NHS can deliver for patients.

Government Mandate for the NHS

Stephen Hammond Excerpts

Thursday 25th April 2019 Commons Chamber

[Jonathan Ashworth (Leicester South) (Lab/Co-op)]

(Urgent Question): To ask the Secretary of State for Health and Social Care if he will make a statement on the Government’s failure to lay before Parliament the NHS mandate for the current financial year.

[The Minister for Health (Stephen Hammond)]

I am grateful to have the opportunity to set out the Government’s approach to setting a mandate for NHS England for 2019-20. The Government’s annual mandate to NHS England for 2019-20 will, for the first time, be a joint document with the annual NHS Improvement remit letter, called an accountability framework. This signals the importance of these two arm’s-length bodies working increasingly closely to maximise their collective impact. It will set one-year transitional objectives to allow the NHS time to implement the long-term plan, and it has been developed to meet the needs of patients, families and staff.

We are committed to the NHS and are funding its long-term plan to ensure that it is fit for the future for patients, their families and NHS staff. The accountability framework sets the expectations that will make that long-term plan a reality. The Government have continued to prioritise funding the NHS, with a five-year budget settlement for the NHS announced in summer 2018 that will see the NHS budget rise by £33.9 billion a year by 2023-24.

The funding settlement and the implementation of the long-term plan are not affected in any way by the short delay in the publication of the accountability framework. We are all engaged to ensure that the accountability framework is published and laid as soon as possible, and I and my ministerial colleagues and officials are working closely with NHS England and Healthwatch England, as statutory consultees, to ensure accountability, improvement and progress to deliver world- class care for patients.

[Jonathan Ashworth]

It is a pleasure to see the Minister of State, as always, but the Secretary of State should be here to defend his failure to produce the NHS mandate. In every previous year, in accordance with section 23 of the Health and Social Care Act 2012—an Act that he supported and voted for despite everyone telling the Government not to support it—the Government have published the NHS mandate before the beginning of the financial year. This mandate outlines the Secretary of State’s priorities for the NHS given the financial settlement, yet this is the first time a Secretary of State has failed to lay before Parliament the Government’s mandate to the NHS for the forthcoming financial year. Is this a failure of leadership or the latest piece of stealth dismantling of the Health and Social Care Act? If it is the latter, why not just take our advice and bin the whole thing and so end the wasteful contracting, tendering and marketisation it ushered in?

The Minister talks of the 10-year long-term plan, but it is no good his telling us he endorses Simon Steven’s vision of the NHS in a decade’s time, when Ministers cannot even tell us what they expect the NHS to achieve in a year’s time. He boasts of the new revenue funding settlement for the NHS but seemingly has not got a clue what he wants the NHS to spend it on in the next 12 months, and at the same time he does not talk about the cuts to public health budgets, training budgets and capital investment.

Will the new accountability framework deliver for patients in the next 12 months? Last year’s mandate pledged that A&E aggregate performance in England would hit 95% in 2018. That pledge was broken, so can the Minister tell us whether, for those A&E departments not trialling the new access standard, the four-hour A&E standard will be met this year, or will the target not be met for the fourth year running?

Or how about the 18-week referral to treatment target? More than half a million people are now waiting more than 18 weeks for treatment. The target that 92% of people on the waiting list should be waiting less than 18 weeks has not been met since 2016. Will that target be met in the next 12 months, or has it also been abandoned? What about cancer waits? Some 28,000 patients are now waiting beyond two months for treatment. The target for 85% of cancer patients to be seen within two months for their first cancer treatment after an urgent referral has been missed in every month but one since April 2014. Will that target be met this year, or will cancer patients be expected to wait longer and longer?

On staffing and pay, will funding be made available in the next 12 months, as it was last year, for a pay rise for health staff employed on agenda for change terms and conditions working in the public health sector for local authorities and social enterprises?

We have no NHS mandate, even though it is mandatory. We have no social care Green Paper, even though it has been promised five times. The big issue has been ducked again. We have no workforce plan, even though we have 100,000 vacancies across the NHS, and the interim plan, which should have been published today, has been delayed again. The Secretary of State parades his leadership credentials around right-wing think-tanks, yet on this record he could not run a whelk stall, never mind the Tory party. It is clearer than ever that only Labour will fully fund our NHS and deliver the quality of care patients deserve.

[Stephen Hammond]

Anyone listening to that will have realised that the hon. Gentleman is more concerned with political points scoring and process than with the substance and funding of the NHS. [Interruption.] The hon. Member for Dewsbury (Paula Sherriff) shouts at me, but she will want to remember that the shadow Secretary of State welcomed the long-term plan—or much of it—back in January.

It is absolutely clear—evidence was provided to the Public Accounts Select Committee yesterday by the permanent secretary and the chief executive of NHS England—that while obviously it would be better to publish by the deadline, it is more important that the mandate be right than published on a particular day. It is more important that we get this document on the long-term strategy of the NHS correct. As Simon Stevens, the chief executive of the NHS, said, there is no problem with this short delay to the mandate. It is an important document, but it is causing him no problems. It is causing no problems.

The hon. Gentleman mentioned access to treatment and treatment times. This winter, more than 7 million patients were seen in under four hours. That is an increase of nearly 6% in attendances. I would have hoped that the Opposition Front Bench might have praised the NHS and its hard-working staff—

[Paula Sherriff (Dewsbury) (Lab)]

Always do. I worked in it for 17 years.

[Stephen Hammond]

Rather than shouting political points across the Dispatch Box.

The hon. Gentleman says there are no targets. He is of course wrong.

[Jonathan Ashworth]

I said you were not meeting them.

[Stephen Hammond]

No, the hon. Gentleman said there were no targets likely to be set for the NHS this year. The accountability framework will include detailed and specific annual deliverables and set out in detail a process for delivering future implementation as well as some of the early delivery goals for 2019-20. He is wrong therefore to say that the framework will not have deliverables attached to it. It will. He also mentioned the Green Paper—

[Jonathan Ashworth]

Where is it?

[Stephen Hammond]

I have said, as the hon. Gentleman has heard many times, that we are finalising that. Again, it is more important to get it right. On the long-term plan for workforce implementation, a draft plan is being produced and I expect that plan to be published in the very near future—[Interruption.]

[Mr Speaker]

Order. The shadow Secretary of State exceeded his time on his feet. He must not now chunter in borderline delinquent fashion from his seat.

[Mr Speaker]

No one is ever too old to behave in a delinquent fashion.

[Stephen Hammond]

There are all sorts of lines I could follow that with, Mr Speaker.

It is clear that it is this side of the House that is putting in the funding to make sure that the NHS can deliver for the patients, staff and families.

[Sir Peter Bottomley (Worthing West) (Con)]

Most of us will remember that the NHS Confederation said four years ago that it wanted

“a manageable number of objectives, which…focus on long-term outcomes for patients and populations rather than measures of how services are delivered”—

and—

“encourage collective responsibility for patient outcomes rather than silo working – particularly the expected outcomes from integrated care”.

Most people in the NHS will welcome the short delay if the result is that it makes it more possible for them to achieve the objective of the NHS, which is serving patients together.

--- Later in debate ---

[Stephen Hammond]

My hon. Friend will have noted, as I said in my opening remarks, that this is an accountability framework because it brings together both the mandate for NHS England and the remit letter to NHS Improvement. It is a sign of more collaborative working which, as he says, almost everybody in the NHS and the healthcare arena would welcome.

[Ms Eagle]

The Minister will know the funding pressures that the NHS has been under, despite the 10-year plan: we still await the actual money being delivered, even though it has been announced. In the Wirral, a great deal of inefficiency is caused by the chronic underfunding of social care, for which the Government are responsible, which puts enormous pressure on health services. When it finally arrives, will the plan for the next year offer some proper relief in that area?

[Stephen Hammond]

The hon. Lady will know that the Government have committed £33.9 billion up to 2023-24, and the first element of that has arrived this year. There will be, as I said earlier, publication of a Green Paper on social care and, combined with the comprehensive spending review, that will ensure that the Government will provide for the social care funding that is necessary.

[John Howell (Henley) (Con)]

Will the Minister recognise that the commitment under the long-term plan to ambulatory care, which is supported by the Royal College of Physicians, is helping patients receive the best form of care service in their own homes?

[Stephen Hammond]

My hon. Friend is right. At the heart of the long-term plan is the emphasis on primary care and prevention. Providing care for people in their own homes undoubtedly achieves better outcomes for patients and he is right to welcome it.

[Dr Paul Williams (Stockton South) (Lab)]

The Minister will know that NHS England is currently consulting on proposals to change the law to remove mandatory competition, but billions of pounds’-worth of NHS services are currently out to tender. Has he considered, as part of the mandate, issuing clear guidance to CCGs that while the consultation is taking place they do not need to put many services out to the market? Or is he happy for that privatisation to continue on his watch?

[Stephen Hammond]

The hon. Gentleman is right to point out that a consultation is being undertaken on various aspects of the long-term plan and the legal framework that needs to be put in place. It is entirely up to local CCGs to make decisions on their procurement policy.

[Mr Philip Hollobone (Kettering) (Con)]

Record investment is going into Kettering General Hospital and a record number of patients are being treated, but the best way that the Minister can deliver the NHS mandate and long-term plan for the people of Kettering is by providing the funding for a new urgent care hub, the site of which he has visited at Kettering General Hospital, and by working with the Ministry of Housing, Communities and Local Government to take advantage of local government reorganisation in Northamptonshire to create a health and social care pilot. Will he commit to both?

--- Later in debate ---

[Stephen Hammond]

My hon. Friend and I have sometimes disagreed on certain things, but one thing we agree on is his advocacy for his constituents, and he is right that I have been to see for myself the issues in Kettering in terms of the current configuration of the accident and emergency department. He is right to press for that urgent care centre, and he knows that he has impressed the case on my mind.

[Mr Speaker]

Everybody in Kettering must be aware of the hon. Member for Kettering (Mr Hollobone). It is beyond my vivid imagination to suppose that there is any resident of the area who is not aware of him.

[Dr Sarah Wollaston (Totnes) (Change UK)]

The truth is that it is very difficult for the NHS to make plans without knowing what the Government’s plans are for social care. We know, following a response to a question in yesterday’s debate, that the Green Paper has actually been written. There is simply no excuse for the continued delay in its publication which would allow the House to scrutinise it and the NHS to be able to provide a truly integrated approach to health and social care. Just saying that it will be published soon is no longer acceptable. Will the Minister set out when we can expect to see this vital document, so that we can scrutinise the Government’s plans?

[Stephen Hammond]

The hon. Lady knows that the House and her Committee will have the fullest opportunity to scrutinise the document as and when it is published. She also knows that there is a commitment to publish it soon. She also rightly points out that it will deliver on the need to ensure that health and social care are integrated.

[Karin Smyth (Bristol South) (Lab)]

For most of my professional life, I was an NHS planner. I assure the Minister that the great expectation and anticipation of NHS planners for planning guidance in the mandate is very real. They are public servants who expect to be held accountable and do what the Government ask them to do. It is unacceptable to leave them in the dark. It is an insult to patients—taxpayers who pay for services and expect to know what they can receive locally. The delay is inexcusable.

The Minister says he has a plan and the Government say they have the money, so why cannot they publish it? What are they trying to hide?

[Stephen Hammond]

The Government are not trying to hide anything. The hon. Lady is right that it is an important document, and it is important therefore that we get it absolutely correct. I refer her to what the chief executive of NHS England said yesterday. He said:

“We have an agreed direction in the long-term plan…We have the budget set for the next year, and we have the NHS annual planning process…wrapped up…2019-20 is…a transition year…stepping into the new five-year long-term plan.”

The chief executive of the NHS thinks that the process is working acceptably.

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

I am really not following the Minister on why this mandate has not been published. I wonder whether it is because of the paralysis in Government caused by the Brexit shambles or because, as the Health Service Journal reports, the Secretary of State is focused on an anticipated leadership race and his thoughts are elsewhere.

[Stephen Hammond]

The hon. Lady does a great injustice to my right hon. Friend. He is today—

[Paula Sherriff]

Writing his speech for the leadership!

[Stephen Hammond]

In the hon. Lady’s fantasy world, that may be true, but my right hon. Friend is in fact addressing a conference in Manchester, talking about the gender pay gap and how this side will close it in the NHS. I would have thought she would welcome that, rather than shouting at me.

[Dr Wollaston]

On a point of order, Mr Speaker. When the Secretary of State comes to the Dispatch Box and makes a clear commitment that the publication date of the Green Paper will be before Christmas, and we know that the document has been written, what are the consequences of an absolute failure to honour such a commitment made at the Dispatch Box by a Secretary of State?

Draft Food Additives, Flavourings, Enzymes and Extraction Solvents (amendment etc.) (EU Exit) Regulations 2019

Stephen Hammond Excerpts

Monday 1st April 2019 General Committees

[The Minister for Health (Stephen Hammond)]

I beg to move,

That the Committee has considered the draft Food Additives, Flavourings, Enzymes and Extraction Solvents (Amendment etc.) (EU Exit) Regulations 2019.

I think I can say on behalf of the whole Committee without reservation that it is a pleasure to see you in the Chair, Sir Roger.

The Government’s priority is to ensure that the high standards of food safety and consumer protection that we enjoy in this country are maintained when the UK leaves the European Union. This instrument is crucial to meeting our objective of a functioning statute book after exit day. Food additives, flavouring enzymes and extraction solvents are important substances referred to collectively as food improvement agents.

--- Later in debate ---

On resuming—

[Stephen Hammond]

These substances perform technological functions in or on food during its production or storage. Examples include preservatives, which are highly effective in protecting consumers from dangerous pathogens. They are used to improve the taste, texture and appearance of food. Common examples are artificial sweeteners and flavourings. In general, they are not sold to the final consumer but are traded between businesses.

As all hon. Members know, the Government’s top priority is to secure a deal, but at the same time it is the responsibility of a responsible Government to prepare for all possible scenarios. An extension to article 50 does not rule out no deal as a possible scenario. It is therefore absolutely right that the Government continue to prepare for no deal, and this instrument is part of that preparation. We are committed to ensuring that the UK’s legislation and policies function effectively in a no-deal scenario. It is for that scenario that these draft regulations have been laid before Parliament.

The instrument is to be made under the powers in the European Union (Withdrawal) Act 2018. It makes the minimum necessary amendments to retained legislation that governs the use of food improvement agents. It was due to be debated on Tuesday 19 March, alongside four other instruments on regulated products in food. Minor drafting errors were identified and have now been rectified.

The Government remain committed to ensuring high standards of food and feed safety and consumer protection. We will ensure that what we enjoy now is maintained in any deal or no-deal scenario. The instrument will ensure that the controls contained in the 11 retained regulations that govern food improvement agents continue to function effectively after exit day.

There will be no change in how food businesses are regulated or run. All existing food improvement agents permitted for use in the UK prior to exit day will continue to be permitted immediately after exit, and conditions and requirements attached to their use will be preserved. That will ensure continuity and clarity for UK food businesses and for those exporting their food products to the UK, and will maintain existing levels of public health protection and food safety.

I wish to make it clear to the Committee that, as with previous statutory instruments presented to the House by the former Minister, my hon. Friend the Member for Winchester (Steve Brine), the instrument makes no policy changes. It makes only essential changes that are necessary to ensure that we have an effective and fully operative statute book on exit day. The instrument’s primary purpose is to ensure that legislation continues to function effectively after exit day. The amendments are critical to ensure minimal disruption to food controls in the event that we leave the EU without a deal. The changes also ensure that a robust system of controls will underpin the ability of domestic businesses to trade, both in the UK and internationally.

I stress that food safety will not be affected by the short delay caused by the instrument’s withdrawal and re-laying before Parliament. The existing list of permitted substances, along with their specifications and conditions of use, will be retained by virtue of the European Union (Withdrawal) Act 2018. The Food Additives, Flavourings, Enzymes and Extraction Solvents (England) Regulations 2013, which provide for the enforcement of provisions relating to those products, remain operable.

In the unlikely event that urgent action is required on unsafe foods in any short interim period between exit and the coming into force of the instrument, the Food Safety Act 1990 and retained EU food law will continue to provide food safety protections for consumers. That legislation, which has already been corrected, allows for enforcement action to be taken against placing any unsafe food on the market.

The instrument makes no changes to policy, beyond the minor and technical amendments to correct deficiencies arising as a consequence of the UK leaving the EU. Those deficiencies concern the assignment of functions to EU institutions on processes to which the UK will no longer have access and on which it can no longer rely. The instrument assigns powers and responsibilities that are currently incumbent on EU entities to the appropriate UK entities.

Under EU legislation, the European Commission currently holds a range of powers and functions to enable new substances to come on to the market, to amend the current conditions of use and purity criteria, and to remove substances from the permitted lists. The instrument transfers those powers from the Commission to Ministers in England, Scotland and Wales, and to the devolved authority in Northern Ireland. It also transfers responsibility for risk assessment from the European Food Safety Authority to UK risk assessors. The Committee should note that all powers in that category relate to technical, scientific and administrative adjustments that may be necessary to respond to changing circumstances.

Risk assessment and the oversight of food controls will be essential to ensure that food remains safe, whether it is imported or produced in the UK. The Food Standards Agency and Food Standards Scotland are responsible for protecting public health in relation to food, and will continue to be independent science and evidence-based Government departments. Those functions will be delivered through an increased risk assessment capacity that has already been put in place.

The instrument will revoke EU regulation 257/2010, which places no obligations on the UK. That regulation established a programme for the European Food Safety Authority to re-evaluate the authorised food additives that were assessed for safety prior to 2009, which ensured that those substances remained safe for the general population in the light of the latest scientific data and technological developments. To date, re-evaluations for all colours, preservatives, antioxidants and aspartame have been completed, while re-evaluations for remaining food additives are ongoing. The official deadline for the completion of the re-evaluation programme is the end of 2020. All the EFSA’s re-evaluations are published online and will remain accessible to the UK after it exits the EU. Through the Foods Standards Agency and Food Standards Scotland, the UK will continue to scrutinise the European Food Safety Authority reports as we do now, alongside other robust scientific evidence, and will consider if action on the UK authorised list is necessary.

By way of further assistance, the Committee may wish to know that article 26 of regulation (EC) 1333/2008 will be retained on exit day. It preserves the duty placed on producers or users of a food additive to immediately notify the UK of any new scientific or technological information that may affect the safety assessment of a food additive. The UK has sufficient safeguards and expertise in the Food Standards Agency and Food Standards Scotland to ensure that food additives on the UK authorised list are actively kept under review on an ongoing basis. Consequently, there is no need to establish a UK re-evaluation programme and replicate work already far advanced by the EFSA.

This instrument will have no impact on the food industry, as there are no changes to the controls on the use of substances. There are also no changes to the authorisation process for any new substances, except that the roles of the European Commission and the European Food Safety Authority will be replaced by relevant UK entities. To support the changes, the Food Standards Agency intends to publish detailed guidance on the UK authorisation processes. Scientific data requirements in support of applications will remain the same, and the same package of data can be submitted to the UK and the EU, avoiding any unnecessary additional burden.

This instrument is a necessary measure to ensure that the high standard of food safety and consumer protection we enjoy in this country is maintained, and that the relevant regulations continue to function effectively after exit day. Due to the instrument being laid under the European Union (Withdrawal) Act 2018, the scope of its amendments is limited to achieving that objective. At an appropriate point in future, the Department will review whether the UK’s exit from the EU offers us opportunities to re-appraise current regulations while continuing to ensure that we protect the nation’s health and food safety standards. I urge hon. Members to support the instrument, which I commend to the Committee.

--- Later in debate ---

[Stephen Hammond]

Let me try to address hon. Members’ questions and comments. The hon. Member for Washington and Sunderland West asked what errors were identified in the SI and what has been done to rectify them. As I said in my opening remarks, they were relatively minor drafting errors, mainly due to style rather than content. For instance, there was a drafting error in regulation 16(b), where an obligation to inform the Food Standards Agency and Food Standards Scotland of the receipt of an application for a product to be included on a list was not included for smoke flavourings. That has been corrected.

There was a comment about the failure to comply with proper legislative practice, which related to whether some text should have been prepared and presented as a footnote instead. Although it was considered that we did not have to follow that practice, we have followed it. I hope the hon. Lady will be satisfied that they were relatively minor drafting errors. She was right to make the supposition that the original explanatory memorandum still applies to this, as it did to the other three regulations that were introduced in this batch.

The hon. Lady asked about the impact on industry. As I hope she took from my words, the instrument will have no impact on the food industry. There are no changes to the controls on the use of substances or to the authorisation process for new substances, except, as we have said and as I tried to explain—I hope she took the point—that the roles of the European Commission and the European Food Safety Authority will be replaced by the relevant UK entities. I have also made the point that scientific data requirements in support of applications remain the same, so the package of data that must be submitted remains the same. Therefore, there should be no unnecessary additional burdens.

The consultation that took place with industry was open for six weeks between 4 September and 14 October, but, because it is so important that food safety and standards are maintained, it was left open for another week so that any latecomers could be included in the analysis. In total, 50 responses were received, of which some 82% supported the Government’s approach. I hope the hon. Lady is reassured that industry has been consulted, that it understands the impact on it—that is, that there is very little impact—and that it is satisfied.

The hon. Lady asked about aspartame and the PKU impact. No changes are being made to labelling. Therefore, PKU sufferers will continue to see labelling as they do now.

Both the hon. Lady and the hon. Member for Argyll and Bute raised the subject of the European Food Safety Authority. As I said at the beginning, the instrument will not change the FSA’s top priority in the UK, which is to ensure that UK food remains safe. The FSA has strengthened its risk analysis. The hon. Gentleman asked whether capacity has been strengthened, and I can tell him that capacity and resource for risk assessment and risk management have been strengthened. The FSA is also expanding its access to scientific experts who can provide the necessary scientific advice and other scientific services to meet any potential increased need for risk assessments.

[Brendan O'Hara]

On a point of clarification, are the Food Standards Agency and Food Standards Scotland expected to take over all the existing functions of the EFSA?

[Stephen Hammond]

As I pointed out, the UK will still have access to the re-evaluation programme until the end of 2020. All those re-evaluations will be undertaken through the Food Standards Agency and Food Standards Scotland. The draft regulations, along with other instruments, will transfer the functions of the EFSA to those bodies—[Interruption.] Inspiration has reached me to confirm that point.

The hon. Gentleman asked how we will ensure that we have the required expertise and resource to maintain standards in the UK. As I said, we have already put in place extra capacity and access to extra scientific advice. We are also looking at expanding the role of scientific advisory committees, to help us to uphold the principles of protecting public health and maintaining consumer confidence through openness and transparency.

Question put and agreed to.

Resolved,

That the Committee has considered the draft Food Additives, Flavourings, Enzymes and Extraction Solvents (Amendment etc.) (EU Exit) Regulations 2019.

Healthcare (International Arrangements) Bill (Changed to Healthcare (European Economic Area and Switzerland Arrangements) Bill)

Stephen Hammond Excerpts

Ping Pong: House of Commons
Tuesday 26th March 2019 Commons Chamber

[The Minister for Health (Stephen Hammond)]

I beg to move, That this House agrees with Lords amendment 1.

[Mr Deputy Speaker (Sir Lindsay Hoyle)]

With this it will be convenient to discuss Lords amendments 2, 8 to 10, 18 to 20, 3 to 7 and 11 to 17.

[Stephen Hammond]

It is a pleasure to be in the Chamber this afternoon. We now have the opportunity to turn our attention to an issue of great importance which, I know, commands the support of the House: the issue of reciprocal healthcare. As Members know, our ability to fund healthcare abroad brings invaluable benefits to people, and it is our responsibility to ensure that we continue to make them available to the public. I thank Members on both sides of the House for their work in considering the Bill so far, including those who have spoken to me about it outside the Chamber.

The amendments deal with the global scope of the Bill. It was intended to provide the Secretary of State with powers to fund healthcare outside the UK, to give effect to healthcare arrangements and healthcare agreements between the United Kingdom and other countries or international organisations—such as the European Union—and to make provision in relation to data processing, which is necessary to underpin these arrangements and agreements. Although it was introduced as a result of the UK’s exit from the EU, it was intended to be forward-facing and not to deal only with EU exit. It offered an opportunity to implement new comprehensive reciprocal healthcare agreements with countries outside the EU.

[Tom Brake (Carshalton and Wallington) (LD)]

I am sorry that the Minister was not able to join us at St Helier Hospital yesterday. I understand the reasons for that perfectly, but I hope that he will back the plan for the hospital.

The Minister mentioned the international scope of the Bill. Does he accept that that was a mistake in view of the concerns that people have expressed about, for instance, the opening up of the NHS in future international trade deals with countries such as the United States?

[Stephen Hammond]

I thank the right hon. Gentleman for his words about why I was unable to go to St Helier Hospital. He knows that, as a Minister, it would have been inappropriate, but as a constituency Member of Parliament, I have no doubt that I will be visiting there again soon. I do not accept his criticism. That was never the point of the Bill. We made that argument consistently both in this House and in the Lords. But we have listened carefully to what has been said about the scope of the Bill and I am about to address that now.

As we prepare for our imminent exit from the EU, the global scope of this Bill has been the source of much discussion in here, outside this House and in the other place. I am pleased that the noble lords did not fundamentally disagree with the idea of reciprocal healthcare arrangements outside the EU. However, it was strongly felt that this was not the time to provide for it. Although the Government would have welcomed that opportunity to provide for it, they have recognised that through this group of amendments their lordships voted to restrict the scope of the Bill to making provision only for EU/EEA countries and Switzerland.

The Government believe it is disappointing to lose at this particular time the opportunity to be able to help UK nationals to obtain healthcare when they visit countries outside the EU, such as when they are travelling, studying or working abroad, or if they want to give birth or obtain treatment. It remains the Government’s view that international arrangements on these issues could promote more life options for our citizens outside the EU, offer greater personalisation of care and assist further in the fostering of international healthcare co-operation. However, it must be our foremost priority to ensure that the Bill receives Royal Assent and is in place so we can respond to the different scenarios without delay and assist, as appropriate, the people who rely on these vital healthcare arrangements.

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

The Minister and I have form on this, in that we were in a Statutory Instrument Committee only yesterday when I was trying to get over to him the need to be very clear to our constituents that, when we leave the EU, the EHIC—the European health insurance card—will disappear and when our constituents go to anywhere in Europe the full bank of healthcare will disappear. Yesterday, the Minister suggested people should take out private insurance instead. Is it not his job as a Minister to tell his constituents and my constituents the truth about this?

[Stephen Hammond]

It absolutely is my job to tell my constituents and the whole of the country the truth, and I did that yesterday in Committee and will do it again now. If the hon. Gentleman votes for the withdrawal agreement and it passes, the EHIC will remain in place, as I said yesterday. As I also said yesterday it has always been the Government’s advice that people should purchase travel insurance. None of that has changed and that is exactly what I said yesterday and it is exactly what I am saying today.

[Kevin Foster (Torbay) (Con)]

Does my hon. Friend agree that we need to be very clear that, with the EHIC, people will get treated as if they are a local; it is not the NHS on tour, so to speak, so we can still face some charges? Particular note should be taken of repatriation costs. If going abroad on something like a skiing holiday, people would be foolish not to take out full travel insurance.

[Stephen Hammond]

My hon. Friend is right. I made that point yesterday; I made it when I was speaking at the Dispatch Box on Report; and I am happy to make that commitment again today.

It must be our foremost priority to ensure that the Bill receives Royal Assent and is in place so that we can respond to different scenarios. We take this decision with regard for the people who currently rely on the EU reciprocal healthcare arrangements and, only with that in mind, we are choosing not to disagree with the Lords amendments.

[Mr Sheerman]

Will the Minister give way?

[Stephen Hammond]

One last time because the hon. Gentleman and I had form on this yesterday.

[Mr Sheerman]

This is an important issue. If the Minister wants me to make a series of points of order, I will because this is so important. Yesterday in a Committee Room, none of us could understand this. At one point, the Minister said, “This is transitional. This will only cover the transition until we are out of the EU. After we have left the EU, EHIC won’t apply.” That is what he said yesterday. I am still not sure whether EHIC will apply only in the transition period, or will go on forever. He has not been clear about this.

[Stephen Hammond]

I have been clear. One can say these things as many times as one likes, but if someone won’t hear, they won’t hear. I will say one more time to the hon. Gentleman—I am happy to take his interventions if he is going to move on to other points—that, as I made clear yesterday, if the withdrawal Bill passes, the current arrangements for reciprocal healthcare will continue throughout the implementation period. During that implementation period, it is the express intention of the Government and the EU to secure continuing reciprocal healthcare arrangements.

[Mr Sheerman]

There is no guarantee.

[Stephen Hammond]

The hon. Gentleman chunters that there is no guarantee. I have given him the guarantee that it is the express intention of both the UK and the EU to ensure reciprocal healthcare arrangements for our citizens post EU exit. I have set out clearly that, in the event of the withdrawal Bill passing and the implementation period starting, EHIC will continue and I think—

[Mr Sheerman]

On a point of order, Mr Deputy Speaker. The Minister and I were in an SI Committee yesterday and you will know how pressurised they are. Four SIs were all blended together, so it was very difficult to separate them and do our job of scrutinising the legislation going through this place, which is our prime responsibility. What we could not get from the Minister was absolute clarity, speaking out to the public and saying that actually the likelihood of keeping EHIC after we leave the EU is on a wing and a prayer—there is no certainty at all.

--- Later in debate ---

[Stephen Hammond]

The hon. Gentleman put that on the record yesterday. I answered the question yesterday. I did so with clarity, in a way that I think almost any member of the public could have understood, and I hope that with that we can move on.

The next amendment I wish to discuss is Lords amendment 3. Their lordships have amended clause 2 to limit the regulation-making powers at clause 2(1). Clause 2(2) was intended to be an illustrative list setting out examples of the type of provision that may be included in regulations made under clause 2(1). It is not, on its own, a delegated power. The effect of amendment 3 is to make the list at clause 2(2) exhaustive. Regulations made under clause 2(1) can now only provide for those things on the list at clause 2(2). The intention of the Government has always been to be prudent and transparent in the use of the Bill’s delegated powers and the list was included to be helpful by demonstrating the types of provision that the regulation-making powers at clause 2(1) could include.

[Mr Sheerman]

On a point of order, Mr Deputy Speaker. I like the Minister—he is a nice man—but he is reading a brief that for most of my constituents and his is absolute gobbledegook—brackets, references here and sub-clauses there. Surely his job as a Minister is to tell this House in plain English what the dangers are to their future travel—their holidays and business in Europe?

--- Later in debate ---

[Mr Deputy Speaker]

The hon. Gentleman not making another point of order might be helpful as well. Let’s just get on and move forward because it is in everybody’s best interests to hear what the Minister has to say.

[Stephen Hammond]

Much of what we discuss in this House is clearly of a technical nature, and sometimes its language is impenetrable to others who are watching. However, as the hon. Members for Burnley (Julie Cooper) and for Ellesmere Port and Neston (Justin Madders) will know, the House has had a chance to look at this in a fairly exhaustive way. They will know exactly what I am referring to, and I am sure that they will wish to refer to it in their speeches.

Using “for example” to introduce an illustrative list of things that can be done under a regulation-making power can be found in a number of other pieces of legislation. Section 11(2) of the Automated and Electric Vehicles Act 2018 states:

“Regulations under subsection (1) may, for example”.

Section 48G(2) of the Banking Act 2009 says:

“An order may, for example”.

Using “for example” is not unknown. However, we acknowledge the concerns raised about the breadth of the delegated powers in the Bill, and the Government have taken considerable steps to address those concerns via a number of Government amendments that were accepted in the other place, which I will come to shortly. In addition, we are choosing not to disagree to this amendment, to give further reassurance that the delegated powers in the Bill are no wider than necessary.

[Mr Sheerman]

The Minister knows that I have also been on another, similar Statutory Instrument Committee, which looked at the use of the green card that gives our constituents the assurance when they travel to Europe that if they are hit by an uninsured driver they will be covered by the insurance industry. That will be lost when we leave the European Union. I used that example yesterday, but the Minister did not come back on it. That is a right and privilege that our constituents expect, and now they are going to lose a similar one relating to healthcare. Is it not clear that these are both examples of the real damage that leaving the European Union will do to us?

[Stephen Hammond]

The hon. Gentleman has confused various clauses of the Bill, but I will not trouble to explain that. I simply say that the green card is clearly an issue for another Department. I also say again, as I said to him yesterday, that citizens are not going to lose the benefits they enjoy under the EHIC if the withdrawal agreement is passed and the implementation period starts. I would guide him by saying that the easiest way to ensure that all the good burghers of Huddersfield whom he so ably represents can continue to enjoy those rights is to vote for the withdrawal agreement.

As I was saying, the Government have taken considerable steps to address these concerns via a series of Government amendments that were accepted in the other place. In addition, we are choosing not to disagree to this amendment, to give further reassurance that the delegated powers in the Bill are no wider than necessary. Our primary concern, as I have said, is to ensure that the Bill is in place so we have the legal mechanism to support people who rely on these vital healthcare arrangements, as may be necessary.

I would now like to turn to the Government amendments in this group. The Government have also sought to restrict the regulation-making powers in clause 2(1). Amendments 4, 5, and 6 will ensure that, if we confer or delegate functions, this will only be to public authorities. The Government have listened closely to the concerns that the regulations could be used to confer functions on “anyone, anywhere”. The hon. Member for Ellesmere Port and Neston argued in Committee that this wide-ranging scope was unacceptable. As I said to him, there has never been an intention to confer functions on private bodies in order to implement reciprocal healthcare arrangements, but, given the concerns that have been raised, we were prepared to make this restriction clear through these amendments to clause 2.

The Government have also brought forward amendment 7. Arguably the most persistent criticism in both Houses has concerned the Bill’s delegated powers. The Delegated Powers and Regulatory Reform Committee and the Constitution Committee both raised particular concerns about the breadth of the powers. The powers in the Bill were sought to provide options in the event of no deal to mitigate the detrimental effects of a sudden change in healthcare overseas for UK nationals living in the EU. In particular, the regulation-making powers in clause 2 (1)(a) and 2(1)(b) provide a means for dealing with situations where there is no bilateral or multilateral agreement in place.

The Government listened carefully to the concerns raised by parliamentarians across both Houses about the scope of the Bill’s regulation-making powers and concluded that the powers used to establish unilateral healthcare arrangements outside of reciprocal healthcare agreements should be sunset for a period of five years following the UK’s exit from the EU. During the five years before the sunset, we will have the ability to use regulations under clause 2(1) as appropriate. These powers can be used to support UK nationals in the EU in different EU exit scenarios. After the sunset, making use of the regulation-making powers under clause 2(1) would be limited to clause 2(1)(c) only. This provides the Government with a mechanism to give effect to future complex healthcare agreements with the EU, individual EEA member states and/or Switzerland.

[Mr Sheerman]

Will the Minister give a crystal clear guarantee to all those people who are related to our constituents and who live across Europe and have perhaps retired there that, if they have a long-term health need, the benefits they enjoy under the EHIC at the moment will continue? I do not want to hear anything about the difference between transitional and long term; can he assure those people that they will continue to get those health benefits in the long term?

[Stephen Hammond]

If the hon. Gentleman votes for the withdrawal agreement, he will be able to give them that reassurance.

I want to turn now to Government amendment 11. The matter of financial reporting and parliamentary scrutiny has also been a matter of legitimate concern to this House and the other place, and amendment 11 speaks to this concern. As I explained in Committee, the Government are firmly committed to transparency in the use of public money. We have made this commitment plain in the Bill with a duty on the Secretary of State to lay a report before Parliament each year. This report will outline all payments made during the preceding financial year in respect of healthcare arrangements implemented by the Bill. I believe that this amendment directly addresses the concerns raised by hon. Members in Committee, particularly those raised by the hon. Member for Burnley. The nature and implementation of future reciprocal healthcare agreements is a matter for future negotiations. However, we envisage that through this reporting mechanism we would also be able to provide Parliament with further information on the operation of future agreements. For example, we anticipate that this report would include details of both expenditure and income to reflect the reciprocal nature of the agreements.

Before I speak to Government amendment 12, I am pleased to report that we have secured legislative consent motions from both the Scottish and Welsh Governments, in addition to having positive and productive engagement with colleagues in the Northern Ireland Department of Health and the Northern Ireland Office. I want to put on record my thanks to all of them. We have amended the Bill to reflect the outcome of our productive discussions, and the Secretary of State must now consult the relevant devolved authority before making regulations under clause 2(1) that contain any provision that is within the legislative competence of a devolved legislature. To underpin and facilitate this consultation, we have developed and agreed a memorandum of understanding with the devolved Administrations. The MOU sets out a practical and mutually beneficial working relationship that will ensure that the devolved Administrations continue to play a vital role in delivering reciprocal healthcare for the benefit of all UK nationals. We believe that this practical and pragmatic agreement allows us to move forward in a collaborative way with all our colleagues in the devolved Administrations.

[Mr Sheerman]

The Minister will remember that, in our previous encounter on this matter in Committee, we asked him how far he had spread his discussions about the impact of this Bill in Northern Ireland. He was very honest and said that he had spoken mainly to officials and civil servants, and not to the politicians who represent the constituents there. Has he changed his mind about that, because that seems like a strangely narrow sort of consultation?

[Stephen Hammond]

I do not think that it was narrow in the slightest. We have discussed matters with the Welsh and Scottish Governments and, given the situation in Northern Ireland, which the hon. Gentleman well knows, with the Northern Ireland civil service, the Northern Ireland Department of Health and the Northern Ireland Office here. I think that that is exactly what I said yesterday, and I am happy to repeat it.

Turning to amendment 15 and transparency, we have also amended the Bill to allow for further parliamentary scrutiny of the list of persons who can lawfully process data as a part of implementing new reciprocal healthcare arrangements under the Bill.

--- Later in debate ---

[Mr Sheerman]

The Minister is being generous in giving way. He will be aware that even Henry VIII in his full pomp would not have got away with stealing the right to health cover of British citizens travelling on holiday to Europe or visiting on business without full democratic scrutiny of the decision. Henry VIII would have been pleased to have had that privilege. This Government have been smuggling the decision through, both in Committee and here in this empty Chamber, and they are stealing the rights of British people.

[Stephen Hammond]

Given that I just said that we have accepted the amendment that would remove the powers, that argument is hardly powerful. I also suspect that the Opposition spokesperson and the other members of the Committee will be surprised to hear that they had not fulfilled their role when they sat through the hours of scrutiny in Committee.

In conclusion, I offer my thanks to hon. Members from across the House and to the Lords for its constructive work in scrutinising and improving this Bill. We share a common goal in wanting to ensure that we can continue to benefit from the current reciprocal healthcare schemes and benefit from similar arrangements in the future. This Bill is an important and necessary piece of legislation that seeks to ensure that the Government are ready and able to respond to different EU-exit scenarios and that we are in a position to support, as appropriate, people who rely on current EU reciprocal healthcare arrangements. For that reason, it is critical that we take those steps and that the Bill can become law.

[Julie Cooper (Burnley) (Lab)]

I rise to support the Lords amendments before us. I thank all the Members who have worked on the Bill at various stages and the staff of the House, who have provided invaluable support. I also put on record my particular thanks to my hon. Friend the Member for Ellesmere Port and Neston (Justin Madders) for his great work during the Bill’s earlier stages. I also thank those in the lords for their exceptional work on this Bill. Thanks to their endeavours, we now have a Bill that is fit for purpose. I am pleased that the Government have decided to listen to our noble friends and give full support to the amended Bill, which marks a welcome, if rather belated, climbdown by the Government.

As we prepare to leave the European Union, it is vital that the Government are able to respond to the widest range of possible EU-exit outcomes in relation to reciprocal healthcare. So many people are reliant on the continuation of reciprocal arrangements and the Government are quite right to seek to secure such arrangements as we leave the EU. The Opposition have supported the principle of this Bill from the outset. but our concerns have been around the scope and the wide-ranging powers that were originally proposed. We were not happy to give the Government a blank cheque to enter into any number of health agreements, with anyone anywhere in world, with no requirement to report back to Parliament, and with little or no opportunity for parliamentary scrutiny. These amendments have addressed our concerns, and I again thank those in the lords for their work.

Turning to amendments 1, 2, 8, 10 and 18 to 20, I want to stress to the House the scale of the issue before us, as pointed out by my hon. Friend the Member for Huddersfield (Mr Sheerman), who is no longer in his seat. Under the existing arrangements, 190,000 UK state pensioners and their dependants who live abroad, principally in Ireland, Spain, France and Cyprus, enjoy the benefits of reciprocal health agreements. The current arrangements also provide full access through the EHIC to healthcare and emergency treatment for UK residents who visit the EU on holiday, to study or to work. The same protections are extended on a reciprocal basis to EU nationals who reside in the UK or who seek to visit. For the sake of those people, I am glad that the Government have come to their senses. These arrangements, which give full peace of mind for healthcare, must be protected.

I remind the House of the evidence given by representatives of Kidney Care UK. We heard that 29,000 people in the UK are dependent on dialysis, which involves three five-hour sessions per week to ensure survival. Under the current arrangements, if those people choose to holiday in the EU, they can easily pre-book slots for dialysis, with Kidney Care UK saying that that

“means that people are able to go away with the confidence that they will be able to be supported and receive the treatment they need.”––[Official Report, Healthcare (International Arrangements) Public Bill Committee, 27 November 2018; c. 12, Q39.]

That also means that they and their families are able to get a much-needed break. Kidney Care UK also made the point that

“it is easier to go away for two weeks in Europe and take a break in that way than it is to get two weeks in a UK unit”––[Official Report, Healthcare (International Arrangements) Public Bill Committee, 27 November 2018; c. 14, Q43.]

Perhaps there is a learning point for us there.

Based on that evidence, the Minister concluded at the time that without a continuation of these arrangements it would be more or less impossible for sufferers of kidney disease to travel. I totally agree, and I am delighted that the Government appreciate the urgency of the situation in which we find ourselves and are giving their full support to this amended Bill. That is important because we may yet leave the EU with no deal, and there will be many British citizens listening nervously to this debate because they have already booked holidays—some of them will be departing at the weekend or in the coming weeks. However, they can now be reassured that the legislation will pass without further delay.

I reassure Baroness Chisholm that the main Opposition priority is always to ensure that those who need care get it. Further to that, we are right in the first instance to protect the rights that UK citizens already enjoy. In short, we must protect our rights to reciprocal healthcare in Europe before we seek to acquire global healthcare provision. Similarly, those UK citizens who have retired to the EU will be relieved to know that treatment for chronic health conditions and ongoing health support will continue to be provided for them, as it is now, without interruption.

If that was not the case because the Bill was unable to receive Royal Assent in a timely fashion, there would have been much understandable consternation and anger among UK citizens currently residing in the EU. A significant proportion of these citizens are pensioners, and they would have been personally liable for healthcare costs after exit day unless a new agreement with the EU or new bilateral agreements with member states were in place. We must also consider the fact that if there is an interruption in provision, many British expats would have no alternative but to return to the UK, which would of course add to the pressures on our already overstretched NHS.

At every stage, both here and in the other place, concerns have been raised about what those in the lords described as the breathtaking powers sought in this Bill. Lords amendments 3 to 7 serve in part to restrict the powers to those that are clearly defined and to those that are necessary for the purpose of protecting reciprocal health arrangements. In amendment 3, just removing the words “for example” assists in terms of essential accountability issues by restricting the powers of the Secretary of State to those regulations specifically listed. The powers listed remain extensive, and the lords was assured that they give the Government everything they need to take forward the negotiations on reciprocal healthcare. We welcome amendments 5 and 6, which ensure that the power to deliver functions is conferred only to a public authority. We are happy that the powers conferred by clause 2 should also be subject to a five-year sunset clause.

We support amendment 11, which provides an important and necessary requirement to consult with the devolved authorities, namely the Scottish Parliament, the Welsh Assembly and the Northern Ireland Assembly. We fully support the vital role that the devolved Administrations play in delivering reciprocal healthcare arrangements, and we welcome the memorandum of understanding that has already been achieved.

Amendment 12, which requires the Secretary of State to report on repayments made under this Bill, is also welcome. This amendment reasonably calls for annual reports to be published after the end of each financial year as soon as is reasonably practicable. It is anticipated that these reports will include details of both expenditure and income. This will facilitate transparency on the Government’s use of public money. I am especially pleased that the Minister has withdrawn his former opposition to that procedure.

On a wider point, in connection with repayments, it is important that we do not overlook the fact that many hospital trusts are struggling to recoup moneys owed under current EU arrangements. Indeed, some costs are never recovered. The UK recovers less than £50 million a year for the cost of treating European patients, while paying £675 million for the care of Britons in Europe.