Oral Answers to Questions
Stephen Hammond Excerpts(5 years, 1 month ago)
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Derek Thomas (St Ives) (Con)
The Minister for Health (Stephen Hammond)
The long-term plan sets out how we will make the NHS a world-class employer and ensure that the NHS has the people that it needs. The NHS, led by Baroness Harding, is engaging with people across the sector to develop a people plan. That plan will set out how the challenges of supply and demand reform can be met, and it will be published in the spring.
Derek Thomas
I thank the Minister for that response. In Cornwall, we have set up the Health and Social Care Academy, and we use the apprenticeship levy to enable local people to train within the NHS service or social care wherever they want to. However, there are many restrictions around the levy, and I wonder if the Minister will meet me and others to discuss how the levy can actually be about training and supporting people into the NHS, rather than just restrictions about paying fees.
Stephen Hammond
The apprenticeship levy was obviously introduced to cover the training and assessment costs of apprenticeships at a rate that would meet employee demand. I recognise some of the challenges that there are, and I would be delighted to meet my hon. Friend to discuss the issues that he has raised.
Luke Pollard (Plymouth, Sutton and Devonport) (Lab/Co-op)
Stephen Hammond
The hon. Gentleman knows that I wrote to him on 20 March on this issue, and I outlined that officials from DHSC had contacted the scheme administrator about the issues with Livewell. I can confirm that the members there would still be dealt with in the way set out prior to the implementation date, and I am happy to meet him.
Mr Philip Hollobone (Kettering) (Con)
The best way that Kettering General Hospital could deliver the NHS’s 10-year plan would be to have the funding for an urgent care hub. I thank the Hospitals Minister for visiting recently. What can he do to ensure that that project is delivered?
Stephen Hammond
I was delighted to visit Kettering and to meet the chief executive and the chairman of the trust again. They made very strong representations. The representations by my hon. Friend and the trust have been heard, and he knows that they are at the forefront of my mind.
Carol Monaghan (Glasgow North West) (SNP)
Changes to the pensions allowance are particularly impacting consultants in their willingness to do additional shifts, or indeed stay in their roles, so what discussions has the Minister had with the Chancellor about the effect of the changes to pension allowances on the retention of consultants in the NHS?
Stephen Hammond
My right hon. Friend the Secretary of State and I have both had conversations with the Treasury and the Chancellor, and there are ongoing discussions.
Andrew Selous (South West Bedfordshire) (Con)
The Government have done well to get more medical students into general practice, but we are not doing quite so well at retaining GPs later on. What more can we do to make sure that GPs stay in general practice, so that more of our constituents can go and see a doctor more easily?
Stephen Hammond
NHS Improvement has a number of retention schemes in place, for GPs and for nurses, to look at why some people are leaving. The interim plan being developed by Baroness Harding has an employer of excellence work stream, which will report on a number of potential issues.
Jonathan Ashworth (Leicester South) (Lab/Co-op)
May I just take a moment, on behalf of the Opposition Front Bench team, to thank the hon. Member for Winchester (Steve Brine) for all his work? We found him a decent, fair-minded Minister, and I wish to pass on my personal thanks for the work that he did on the children of alcoholics agenda.
We have 100,000 vacancies across the NHS. The Brexit mess means that we have fewer EU nurses and health visitors. Across the NHS, voluntary resignations are up 55% since 2011, and the professional development budgets have been cut by £250 million. Does the Minister agree that for Dido Harding’s review to be taken seriously, those cuts to continuing professional development must be reversed?
Stephen Hammond
As the hon. Gentleman heard me say earlier, Baroness Harding is developing the implementation plan, which will then feed into the final implementation plan published after the comprehensive spending review. The cuts, as he describes them, are not cuts. He knows that we are increasing the budget for the NHS in real terms and in cash terms up to 2023-24.
Jonathan Ashworth
The Minister is responsible for workforce, but does not seem to understand that training budgets have been cut. Baroness Harding’s review will only be taken seriously if it is backed up by real investment.
Outsourcing and transferring of staff, whether to wholly owned subsidiaries or the privatisation of clinical services, further undermines staff morale and creates a more fragmented workforce. The Secretary of State went to the Health and Social Care Committee and said no more privatisations on his watch, yet cancer scanning services in Oxford are being privatised. Will the Minister reverse those privatisations, or can we simply not believe a word the Secretary of State says?
Stephen Hammond
The hon. Gentleman can believe everything my right hon. Friend the Secretary of State says. He has delivered on his promise to work with the NHS to deliver a long-term plan, to deliver the funding that will make it possible, and to deliver the workforce that will ensure the plan is not undermined.
Liz Twist (Blaydon) (Lab)
Andrew Lewer (Northampton South) (Con)
The Minister for Health (Stephen Hammond)
Health Education England is leading a national nursing associate expansion plan to train 7,500 apprentice associates in 2019, building on the 5,000 who were trained in 2018.
Andrew Lewer
The University of Northampton successfully carried out its partnership with Northampton General Hospital in training the first wave of nursing associates in the United Kingdom, as the Secretary of State saw when he visited the hospital recently. What can he and his team do to encourage other universities and local hospitals to form partnerships to deliver similar results?
Stephen Hammond
I know that the Secretary of State enjoyed his visit and was very impressed by what he saw. Health Education England has led the establishment of test site partnerships across England. There were 11 test sites in the first wave and a further 24 in April 2017, and the programme is now being rolled out all over the country.
Mr Jim Cunningham (Coventry South) (Lab)
What discussions has the Minister had with nursing associations and the Home Secretary about the recruitment of nurses and social care workers from the European Union after we leave and about how it can be made easier?
Stephen Hammond
I know that my hon. Friend the Minister for Care met the Home Secretary last week and that there are ongoing discussions.
Sir Hugo Swire (East Devon) (Con)
Jeff Smith (Manchester, Withington) (Lab)
The Minister for Health (Stephen Hammond)
Workforce is a key priority for the Government, which is why my right hon. Friend the Secretary of State asked Baroness Dido Harding to develop an interim workforce implementation plan for the spring, including a 2019-20 action plan. It is right that local leaders and clinicians should be empowered to shape the services they need, which is why NHS Improvement has written to all system leaders in England to ask for their views on the vision that is coming forward.
Jeff Smith
The all-party parliamentary group on mental health’s recent report found that workforce is the biggest challenge to delivering improvements to mental health care. Given that there are 4,000 fewer mental health nurses than there were in 2010, what additional guidance and funding will the Government provide to ensure that local partnerships can recruit mental health nurses, and what are they doing to expand medical school places so that we can train more doctors, particularly in psychiatric specialties?
Stephen Hammond
The hon. Gentleman asked a number of questions there. It is true that the NHS has recently asked all sustainability and transformation partnerships and integrated care systems to create new five-year plans by autumn 2019 setting out how they are going to transform services. He will know that mental health is a priority in the long-term plan and that we are expanding the number of places for clinicians.
Jeremy Lefroy (Stafford) (Con)
Will my hon. Friend meet me to discuss the severe shortage of pathologists to carry out post mortems? Professor Peter Hutton’s report referenced some ideas that we could take forward.
Stephen Hammond
My hon. Friend has already mentioned several such ideas and I would be happy to meet him to discuss them.
Christian Matheson (City of Chester) (Lab)
Stephen Hammond
The hon. Gentleman is right: early diagnosis of cancer is vital for successful outcomes. The Government are absolutely committed to a cancer workforce with the skills and expertise to ensure that 75% of all cancers are diagnosed early, not just the top 10. As I have said several times, that is why we asked Baroness Dido Harding to develop a detailed workforce plan to ensure that that can be delivered.
Henry Smith (Crawley) (Con)
Blood cancer is the fifth most common and the third biggest killer in the UK. What assurances can I get that the workforce in that area will be increased?
Stephen Hammond
My hon. Friend has been a champion of this cause for a long time, raising the matter on the Floor of the House several times. He can be assured that, as I said to the hon. Member for City of Chester (Christian Matheson), Baroness Harding has been asked to bring forward detailed plans for the cancer workforce in her implementation plan.
Paula Sherriff (Dewsbury) (Lab)
Mental health nurse numbers have fallen for the second month running, and learning disability nurse numbers have fallen by 40% since this Government came to power. Nearly 13,000 mental health staff left their roles between May and October 2018, and the vacancy rate is now almost 10%. The King’s Fund, the Nuffield Trust and the Health Foundation say that
“Urgent action is now required to avoid a vicious cycle of growing shortages and declining quality.”
Is it not time for Ministers to start taking such advice, rather than giving it?
Stephen Hammond
The Department of course takes such things seriously. My hon. Friend the Minister of State for Care met Baroness Harding last week to discuss how to ensure that there are nurses and carers to help people with learning disabilities. The money that has been promised to make that possible comes in the new financial year, which starts next week.
Vicky Foxcroft (Lewisham, Deptford) (Lab)
Kevin Hollinrake (Thirsk and Malton) (Con)
The Minister for Health (Stephen Hammond)
I commend my hon. Friend for his commitment to raising the local priorities of his constituents and for the campaigning he does on behalf of the local NHS. I think that these plans are best worked through by the local NHS. However, if he would like, I would be happy to meet him to discuss the concerns that he has on behalf of his constituents.
Lloyd Russell-Moyle (Brighton, Kemptown) (Lab/Co-op)
Tim Farron (Westmorland and Lonsdale) (LD)
The north-west of England has only half the number of ambulances per head of population as London. In rural Cumbria, the situation is far worse. Will the Secretary of State agree to our proposal for an additional two ambulances for Westmorland so that we can keep our communities safe?
Stephen Hammond
The hon. Gentleman will know that, in the winter funding round, extra ambulances were provided across the whole country. I am happy to meet him and discuss his proposals, which I will then consider carefully.
Nicky Morgan (Loughborough) (Con)
ADHD Solutions is a community interest company based in the constituency of the shadow Health Secretary that serves children and young people with ADHD across Leicester and Leicestershire. Fifty per cent. of its referrals come from the NHS, yet it does not get funding for those referrals; however, those NHS services are able to meet NICE guidelines because ADHD Solutions is doing the job. Will the Health Secretary meet me and the shadow Health Secretary to discuss that?
Draft Social Security Coordination (Reciprocal Healthcare) (Amendment etc) (EU Exit) Regulations 2019
Draft National Health Service (Cross-Border Healthcare and Miscellaneous Amendments etc.) (EU Exit) Regulations 2019
Draft Health Services (Cross-Border Health Care and Miscellaneous Amendments) (Northern Ireland) (EU Exit) Regulations 2019
Stephen Hammond Excerpts(5 years, 1 month ago)
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The Minister for Health (Stephen Hammond)
I beg to move,
That the Committee has considered the draft Social Security Coordination (Reciprocal Healthcare) (Amendment etc) (EU Exit) Regulations 2019.
The Chair
With this it will be convenient to consider the draft National Health Service (Cross-Border Healthcare and Miscellaneous Amendments etc.) (EU Exit) Regulations 2019 and the draft Health Services (Cross-Border Health Care and Miscellaneous Amendments) (Northern Ireland) (EU Exit) Regulations 2019.
Stephen Hammond
It is a great pleasure to serve under your chairmanship, Sir David. I am grateful to the Committee for agreeing to discuss these regulations together, which seems logical to me. I welcome the hon. Member for Dewsbury, who is debating with me. I want to put on record at the start that the hon. Member for Ellesmere Port and Neston (Justin Madders), who is no longer on the Labour Front Bench, conducted himself in a helpful and constructive way in this particular part of our discussions about EU exit, which is about reciprocal healthcare and the good of all our constituents.
I would also like to put on record my thanks to the Scottish Government and the Welsh Assembly, and the Labour Government there, for their help with the Healthcare (International Arrangements) Bill, on which we have had legislative consent motions. That is a record, because it is the only piece of EU exit legislation to which we have a legislative consent motion. It will mean, hopefully, that some of the things that we are discussing tonight will be easier to implement when that Bill comes through, either tomorrow or some other time.
Mr Sheerman
Before the Minister gets into full flow, I would like to say that I have been to lots of these Committees—I do not know if someone up there loves me or the Whips have a grudge—but I have never come across one that is such a rag-bag of things. As a Member of Parliament, I am supposed to give parliamentary scrutiny to this whole rag-bag of very important pieces of delegated legislation. Is that just because the Minister is in a hurry? This disaster of Brexit is coming and we are throwing everything at it. Up until now, we have had one statutory instrument, debated it in some detail and, by and large, felt that we have led some accountability. This looks like a total mess. How can we do our job properly with this large number of documents in front of us?
Stephen Hammond
The hon. Gentleman has been in the House much longer than I have. He will know that it is not unusual to have statutory instruments grouped together. In fact, last week a number of SIs from the Department for Environment, Food and Rural Affairs were grouped together and discussed on the Floor of the House, and then voted on individually.
The rationale for this evening’s grouping is simple: they are all to do with reciprocal healthcare, ensuring that our citizens—in either a deal or, particularly, a no-deal situation—have the potential to have the rights that they currently enjoy, which is the Government’s aim. That is why I have asked for them to be grouped together. I am grateful to the Committee for allowing that. Had the hon. Gentleman chosen to do so, we could have discussed them individually. If he allows me the time to progress with my speech, I hope he will see the logic of why we have grouped them this evening.
Stella Creasy (Walthamstow) (Lab/Co-op)
I have a slightly different question for the Minister. He just spoke about his gratitude to the Scottish Parliament and the Welsh Assembly Government for their work on the legislative consent motions that these statutory instruments require. I note that in the explanatory memorandum it says that consent has also been sought from Northern Ireland. For the record, I would like the process by which consent has been sought from Northern Ireland on the measures to be set out.
Stephen Hammond
If the hon. Lady will allow me, I will tackle that in my speech. I will set out the arrangements that are in place with the Northern Ireland Executive, and if she is then not happy I will try to answer any questions at the end.
Mr Sheerman
I have to explain this accountability and scrutiny work I am doing to my constituents, so before the Minister sets sail—I wish him a really nice journey, with no problems—will he be putting the SIs into layman’s language, carefully going through them and saying what they really mean in the sort of language his constituents, along with mine and yours, Sir David, could understand?
Stephen Hammond
The hon. Gentleman can only test that and prove whether he has done his work on accountability after he has heard what I have to say, so I hope he will allow me to say it. I read this speech last week and it went back for re-writing, so I hope that it is now in the sort of language that both he and I and, importantly, our constituents will be able to understand.
Stephen Hammond
Here we go.
The Government are introducing these three statutory instruments under section 8 of the European Union (Withdrawal) Act 2018, to correct deficiencies in retained EU law relating to reciprocal and cross-border healthcare, and to ensure that the law is operable on exit day. When the UK leaves the EU, that Act will automatically retain the relevant EU legislation and the domestic implementing legislation in UK law. In a no-deal scenario, however, if we did not legislate further, the regulations would be incoherent and unworkable without reciprocity from member states. There would be a lack of clarity about patients’ rights to UK-funded healthcare in EU and European Free Trade Association countries.
Current EU reciprocal healthcare arrangements enable people to access healthcare when they live, study, work or travel in EU and EFTA countries, and in the UK. They give people retiring abroad more security, they support tourism and business, and they facilitate healthcare co-operation. The Government intend to continue those reciprocal and cross-border healthcare arrangements, as they are now, in any exit scenario until at least December 2020.
In a deal scenario, the in principle agreement we have reached with the EU under the withdrawal agreement is that during the implementation period—until 31 December 2020—all reciprocal and cross-border healthcare entitlements will continue. There will be no changes to healthcare for UK pensioners, workers, students, tourists and other visitors, and the European health insurance card scheme and planned treatment will continue. That would all be legislated for in the European Union (Withdrawal Agreement) Bill. The Government want to secure a wider reciprocal healthcare agreement with EU and EFTA states following the end of the implementation period, which will support a broad range of people. We will negotiate that with our European partners during phase 2 of the talks on our future relationship.
In a no-deal scenario, our proposal to all EU and EFTA countries is to maintain the current reciprocal healthcare arrangements for at least a transitional period lasting until December 2020, to ensure that UK nationals can continue to access affordable healthcare when in the EU.
Mr Sheerman
When we get our EHIC card and go across to anywhere in Europe, we are sure that if we need medical attention it is covered by those reciprocal agreements. Is the Minister saying that for a short transitional period the continuity of that process will be maintained but that it will all end when we leave the European Union?
Stephen Hammond
No, that is not at all what I am saying. I am sure that the hon. Gentleman was listening carefully. I was saying that in a deal scenario all current arrangements will continue and in a no-deal scenario we are seeking to put in place interim arrangements. In both scenarios we seek to have an arrangement that will continue reciprocal healthcare after the implementation period. Were he to vote for the withdrawal agreement, the EHIC card he was talking about would continue to be used, certainly until December 2020 and possibly much later depending upon what we negotiate. These regulations seek to ensure that UK law is consistent, so that the arrangements that are in place in a potential no-deal scenario can allow reciprocal healthcare arrangements to continue.
Mr Sheerman
When I discussed the subject with a junior Transport Minister, who is a good colleague of the Minister’s, he said that the green card—which ensures that UK drivers who are hit by an uninsured driver when driving in Europe, whether they are in their own car which they have taken to the EU or one they have hired there, are insured—will disappear as we leave the European Union and it will no longer work. He was very final about that. The hon. Gentleman is now saying that he is not sure if that is final. It is the end of a reciprocal relationship and after 2020 everyone will be uninsured when they travel abroad.
Stephen Hammond
The hon. Gentleman is putting words into my mouth that I did not say. What I said was that in a deal scenario all reciprocal arrangements will continue as per now until 31 December 2020. As I have pointed out, during that period clearly the Government will seek to negotiate an EU and EFTA states-wide continuing reciprocal arrangement. Everything we have now will immediately go into that transitional period when we negotiate. If there were a no-deal scenario, we would have to put in place interim arrangements to ensure that the current arrangements pertain. Again, during the transitional period it is the Government’s intention to seek to negotiate an EU and EFTA states-wide continuing reciprocal healthcare arrangement. However, we might also have to do that on a bilateral basis with individual states. There is no intention or expectation from the Government—or from the EU or EFTA states—that 31 December 2020 is a break point. I hope that I have satisfied the hon. Gentleman on that point.
Stephen Hammond
I am not going to respond to the chuntering from the floor, other than to note very clearly what—
Stephen Hammond
The Government want to secure a wider reciprocal healthcare agreement with EU and EFTA states following the end of the implementation period, which supports a broad range of people. That is what I have just explained. In a no-deal scenario, our proposal to all EU and EFTA countries is to maintain the current reciprocal healthcare arrangements for at least a transitional period to ensure that UK nationals can continue to access affordable healthcare when they are in the EU.
The statutory instruments we consider today will support us to do that with the countries we are able to negotiate those agreements with. However, our proposal depends on reciprocity from other European countries and we are in advanced discussions with member states to ensure continuity. In the event that an agreement cannot be reached, healthcare cover for those nationals may change.
We have approached and are in discussion with other member states and are prioritising those that are the major pensioner, worker and tourist destinations. The UK and Irish Governments are committed to continuing access to healthcare arrangements within the common travel area and both Governments are taking legislative steps to ensure we can implement the arrangements in time for exit day.
The Government welcome the action by EU member states who have prepared their own legislation for a no-deal scenario, including, but not limited to, Spain, France, Portugal, and Belgium. Depending on the decisions by other member states, it is important to acknowledge that access to healthcare could change.
Mr Sheerman
Did I hear the Minister right? Forgive me for another intervention, Sir David. Did the Minister say that he thanks those other European states, because they are negotiating this? It is not final, is it? As I said earlier, this is a “coming home on a wing and a prayer” policy. Our constituents should know the position, surely. We are Members of Parliament; we are paid to come here and represent our constituents. The Minister is telling me that this legislation will mean that after 2020 they will not be insured for their healthcare when they travel abroad. That is what he is saying, because there is no certainty in what he says.
Stephen Hammond
The hon. Gentleman is completely wrong: that is not what I am saying. I will say this once again for him. If the withdrawal agreement is signed—I urge him to vote for it, because that would provide certainty for his constituents—the current arrangements will continue, and it is the Government’s intention, during the transitional period, the implementation period, to negotiate an EU and EFTA states continuing arrangement. In a no-deal scenario, we will have to put in place interim arrangements, and that is what we are discussing now. It would still be the intention—it is a very clear expectation of the Government and is very clear from the stated ambitions and comments of the EU—that reciprocal healthcare would be the subject of a negotiation, either on an EU-wide basis or by individual member states.
I accept that there is some element of uncertainty, but I hope that I can now reassure the hon. Gentleman. Each of the 27 EU member states is a country with universal healthcare, and in general people have good options for obtaining healthcare, provided that they take the appropriate steps. Depending on the country, it will be possible to access healthcare through legal residency, current or previous employment, or by joining a social insurance scheme. Less frequently, people may need to purchase private insurance. It is always the advice when people travel overseas, including to Europe, that they should purchase appropriate travel insurance. People have always been encouraged to do that. However, I appreciate that it can be difficult for some people with long-term conditions, and it is important that people make the best decisions for their circumstances when choosing to travel.
As is the case now, UK nationals who return to live permanently in the UK will be able to access NHS care. UK nationals who currently have their healthcare funded by the UK and are resident in the EU on exit day can use NHS services in England without charge when they temporarily visit England. We recognise that that might mean change, and in some circumstances additional expense, for UK nationals living abroad. It is to avoid that that we are bringing forward these statutory instruments.
I would like to reassure the Committee that the Government have issued advice, via Government and NHS websites, to UK nationals living in and travelling to EU and EFTA states and to EU citizens living in the UK. The advice to UK nationals explains how the UK is working to maintain reciprocal healthcare arrangements, but that their continuation depends on decisions by member states. It also sets out what options people might have to access healthcare under local laws in the country that they live in if we do not have bilateral arrangements in place, and what people can do to prepare.
Mr Sheerman
The Minister has lifted the lid on this. It is horrific news for our constituents—for people who live in Huddersfield and Dewsbury and all the constituents we represent. It is, in stark terms, the end of the assurance that people can travel around Europe. We all had our little card and we knew that we did not have to go out and get private health insurance; we would be covered. We had that peace of mind. What the Minister is saying today, in plain language, is that that peace of mind will end. He has just read that out. It will end unless by luck, some wing and a prayer policy that arrives from this incompetent Government actually delivers something that they cannot promise and cannot deliver.
Stephen Hammond
The hon. Gentleman is a noble exponent of the art of opposition, but he is sensationalising and misunderstanding what I say. I have not said that the arrangements are not going to continue; what I have said is that in a no-deal scenario there may be some circumstances where people have to consider different arrangements from what they have already. It is the Government’s intention, in both a deal and a no-deal scenario, that these arrangements should continue, and that is what we will put in place this afternoon, if we ever get there.
Mr Marcus Jones (Nuneaton) (Con)
The hon. Member for Huddersfield seems to be trying to imply that if someone goes on holiday in the EU area at the moment, they do not need to have travel insurance. Now, from my experience of travelling to the EU area, it has always been advisable to have travel insurance, because in my experience, when I have had to access services, the first thing that the hospital in an EU country has asked is, “Where is your health insurance? Where is your credit card?” So it is not necessarily just a given that the card that people can obtain covers them in all eventualities.
Stephen Hammond
Where my hon. Friend is absolutely right is that, of course, it has always been the advice that people should purchase travel insurance when they travel, wherever they travel, including within the EU. The EHIC card is clearly in place. If the withdrawal agreement is signed, that arrangement will continue, but it has always been the Government’s advice that people should take out the appropriate travel insurance when travelling abroad, and he is absolutely right to make that point.
Neil Coyle (Bermondsey and Old Southwark) (Lab)
I thank the Minister for giving way; he is being very generous in doing so. There are particular British expatriates living in other countries. As he said, some people have long-term conditions, including skin conditions that are temperature-sensitive and lung issues, for example. Just to be absolutely clear, he has said that there may be circumstances in which some of those people with long-term conditions may have to make other arrangements. So there is a direct disadvantage for disabled British people who are supported under the current framework who may not be supported, even under the Government’s plan. Is that correct?
Stephen Hammond
It is correct only in the unlikely circumstance of a no-deal scenario, and only in that there may not be interim arrangements put in place immediately after exit in a no-deal scenario. That is why I am setting out what the possibility might be, but I stressed that this is not what the Government hope for. Neither is it something that the Government expect or that is the Government’s ambition. What I have said is that, in the unlikely circumstance of a no-deal scenario, there may be some changes that some people need to make.
Mr Sheerman
On a point of order, Sir David. I know this Minister to be a very honest man, but I think he is in danger of misleading the Committee, only in this sense—that he keeps saying “only if we crash out without a deal”. I am sorry, but as I read the documents and listen to him when he reads from them, that does not appear to be the case. It seems to me that, whatever happens when we leave the EU, the security of being insured as people travel around Europe will disappear, whether we crash out or whether we achieve a deal.
The Chair
As a Member of 40 years’ standing, the hon. Gentleman knows perfectly well that no one can be accused of misleading anyone, so I am sure that he did not mean to say that. And as far as the point of order is concerned, it was not a point of order; it was a point of exasperation.
Stephen Hammond
Exasperation is something that many of us feel, Sir David. However, in some circumstances these instruments enable the Government to protect individuals irrespective of reciprocity with other countries. The issue was raised during the Lords’ consideration of the Healthcare (International Arrangements) Bill and has been misreported in the press.
I want to be absolutely clear, or at least I will try to be absolutely clear, and hopefully the hon. Member for Huddersfield will accept what I say. Through these instruments, we can finish funding healthcare for people in a transitional situation. That would cover those who are in the middle of a treatment on exit day, those who have already had treatment and are receiving post-treatment care, and those who have applied for or been given authorisation for the treatment before exit day. That will apply for a year, or for the period of authorisation, whichever is later. That, of course, assumes that the member state is willing to provide the treatment and accept reimbursement from the United Kingdom. The offer that the Government are making through these instruments is to continue to fund healthcare through the current reciprocal and cross-border healthcare arrangements until 31 December 2020 in those member states that agree to reciprocate. It is not feasible to directly fund healthcare for hundreds of thousands of people living in, or visiting, the EU without the cooperation of the member states.
Many hon. Members will know that the Government have also brought forward a Bill focused on reciprocal healthcare arrangements, the Healthcare (International Arrangements) Bill. That Bill will ensure that the UK can respond to all exit scenarios, and complements the approach we are taking in these instruments. It provides powers to give effect to comprehensive healthcare arrangements that are bespoke, or are different in any way from the current arrangements provided by the EU regulations. That Bill will also provide the legislative framework to implement long-term, complex reciprocal healthcare arrangements with the EU or bilateral agreements with individual member states.
We are also exploring whether there is a need to further fund healthcare for limited numbers of people in exceptional circumstances in which there would otherwise be a very serious risk to their health. The Healthcare (International Arrangements) Bill will give us the powers to do that, and to respond to an unpredictable situation. Clearly, we need to prioritise support for those individuals who most need it, and those in countries where there are actual challenges in obtaining healthcare. It is our hope that that will not be necessary at all. I recognise the difficulty of the current situation, and assure the Committee that we are doing all we can to minimise changes in the way that care is accessed. Of course, if the withdrawal agreement is passed, there will be certainty.
I will try to pre-empt a number of questions about why these instruments are subject to the affirmative procedure and regulations under the Healthcare (International Arrangements) Bill are subject to the negative procedure, although I am sure there will be other questions. As has been explained during the course of debates on that Bill, regulations that are made under it will give effect to healthcare agreements and are most likely to focus on procedural, administrative and technical details, such as the types of documents or forms used to administer the reciprocal healthcare arrangements. The Government therefore believe that the negative procedure offers parliamentary scrutiny and proper checks on the use of delegated powers, and balances those against the appropriate use of parliamentary time. The withdrawal Act statutory instruments that we are debating prevent, remedy or mitigate deficiencies in the retained EU law relating to reciprocal healthcare, and in doing so amend powers to legislate, which is one of the triggers for the affirmative procedure under that Act.
I clarify that the instruments we are considering do not make any changes to welfare benefits policy; the Department for Work and Pensions is bringing forward separate legislation on welfare benefits. I also reassure hon. Members that, as I said at the outset, we have been working closely with our colleagues in the devolved Administrations, who have provided consent for these instruments. I am pleased to acknowledge those Administrations’ co-operation on securing the legislative consent motions, and thank them for it. I also thank colleagues in the Northern Ireland Department of Health and in the Northern Ireland Office for the productive engagement we have had with them. We have amended the Bill to reflect the outcome of those discussions: the Secretary of State must now consult the relevant devolved Authority before making regulations under clause 2(1) containing provisions that are within the legislative competence of a devolved legislature.
Stella Creasy
For the avoidance of doubt, could the Minister set out what he believes to be the relevant devolved Authority for giving consent? He has said that in addition to the legislative consent motion, the Northern Ireland Department of Health and the Northern Ireland Office had been consulted, and had given consent. I do not want to get this wrong, so could the Minister clarify which bits which Departments have given consent to, and which relevant devolved Authority he believes will give consent to this motion at this point in time?
Stephen Hammond
What I actually said was that we have had productive and positive engagement with colleagues in the Northern Ireland Department of Health and the Northern Ireland Office, and Northern Ireland officials have agreed that they are content for the Department of Health and Social Care to lay the draft Health Services (Cross-Border Health Care and Miscellaneous Amendments) (Northern Ireland) (EU Exit) Regulations 2019. That follows a decision by UK Ministers that, in the interest of securing legal certainty in Northern Ireland, the UK Government will progress the necessary secondary legislation for Northern Ireland at Westminster, in close consultation with Northern Ireland officials and the relevant Northern Ireland Departments. I hope that satisfies the hon. Lady.
Stella Creasy
I beg the Minister’s indulgence. For the avoidance of doubt, is he saying that consent to the orders will be given in Westminster for the specific Northern Ireland elements of the statutory instrument? Can he confirm that that is what he is telling us about the legislation?
Stephen Hammond
What I am telling the hon. Lady about the specific statutory instrument, the Health Services (Cross-Border Health Care and Miscellaneous Amendments) (Northern Ireland) (EU Exit) Regulations 2019, is that consent was sought from the Northern Ireland civil service, and was provided by the permanent secretary for the Department of Health for Northern Ireland. The Northern Ireland civil service may make decisions in the public interest under the Northern Ireland (Executive Formation and Exercise of Functions) Act 2018. Again, following decisions by UK Government Ministers, in the interest of securing legal certainty in Northern Ireland, the UK Government will progress the necessary secondary legislation in close consultation. As I have said, consent was sought from the Northern Ireland civil service, and was granted.
Stephen Hammond
It is not a constitutional point. I will not take the hon. Gentleman’s intervention.
The Chair
Order. We can have only one person on their feet at a time. Is it the case that the Minister is not giving way?
Stephen Hammond
I have given way on a number of occasions. I am bound to say to the hon. Member for Huddersfield that I have been clear about the legal position and the legal certainty. I have given clarity that the Northern Ireland civil service and the Northern Ireland Department of Health are clear and are consenting to what we are doing.
Stephen Hammond
Then the hon. Gentleman does not need to ask me, because I have just answered his question.
In addition, I am pleased to report that we have the legislative consent motions for our Healthcare (International Arrangements) Bill. To underpin and facilitate the consultation, we have developed and agreed a memorandum of understanding with the devolved Administrations, which sets out a practical and mutually beneficial working relationship. That will ensure that the devolved Administrations will continue to play a vital role in delivering reciprocal healthcare for the benefit of all United Kingdom nationals.
Mr Sheerman
The Minister is a little grudging, but it is an important issue. He has gone through all the people whom he has consulted in Northern Ireland, and they all sounded like bureaucrats and civil servants to me. I did not hear him once say that he had confronted the facts of what is happening, through the statutory instruments, to our parliamentary colleagues or that he had put it to them. For all these years, their constituents have felt that they could go all over Europe and carry with them an extension or a bubble of the national health service that delivered the NHS promise, even though they were travelling. Did they get the picture? Were they told in blunt terms that that will no longer exist for their constituents? For people who are travelling, it is the old Tory dream of privatising the health service.
Stephen Hammond
I was going to say that I can see why the Speaker regards the hon. Gentleman as a national treasure, but after his final remarks, it is difficult to agree.
In closing, I make it clear that the instruments make miscellaneous amendments to EU references in retained EU law—for example, by removing references to EU concepts. Moreover, together with the Healthcare (International Arrangements) Bill, the instruments are necessary to ensure that the UK Government are ready to deal with reciprocal and cross-border healthcare in any EU exit scenario. They provide us with an efficient and effective mechanism to ensure that there will be no interruption to people’s healthcare in a no-deal scenario.
I thank members of the Committee for their valuable contributions.
Mr Sheerman
I do not want to speak for more than half an hour, but I must make the point about this bundling. I have been on many Delegated Legislation Committees and have become quite an expert on statutory instruments.
Stephen Hammond
If the hon. Gentleman and the hon. Member for Walthamstow did not want the statutory instruments to be bundled, they could have said so at the beginning of the Committee. The Government did nothing other than seek the permission of the Committee to bundle them. Should the Committee have wished, I would have been perfectly happy to unbundle them.
The Chair
Order. We cannot have interventions on interventions. The Minister is intervening on Mr Sheerman.
Stephen Hammond
I recognise the concerns of the hon. Gentleman and the hon. Lady and I will address their points, but the Government asked the Committee to agree, and the Committee agreed to the bundling of the statutory instruments.
Mr Sheerman
I take that point. There has been honest confusion, because when the Minister introduced the statutory instruments, I did not realise that, because they had all been bundled, I could not have a responsible view and single out the statutory instrument relating to Northern Ireland. I would not want to vote against that, but I want to vote against the others. I did not realise that was what would happen; I thought we would vote on each one.
Stephen Hammond
Of course I do not take umbrage at the hon. Gentleman’s criticism or scrutiny. After all, that is what he is here to do. I would just say to him, though, that his characterisation of what the Government are putting in place is wrong. He can say to his constituents that if the withdrawal agreement is passed, there will be no interruption to their healthcare. In a no-deal situation, these instruments will allow—
Stephen Hammond
I made it very clear that it is the intention—the expectation—of both the UK Government and the EU and EFTA states that there will be an agreement about reciprocal healthcare.
The hon. Member for Walthamstow raised a number issues about Northern Ireland. As she rightly pointed out, healthcare is fully devolved to Northern Ireland. These statutory instruments would normally be dealt with by the Northern Ireland Assembly. In the absence of the Northern Ireland Assembly, and in the absence of a Northern Ireland Executive, statutory instruments under the European Union (Withdrawal) Act 2018 have to be laid in Westminster to allow for debate and scrutiny. She has heard that that Act was consented to by the Secretary of State for Northern Ireland. The Northern Ireland consent for social security regulations was provided by the permanent secretary for the Northern Ireland Department of Health, which is the appropriate place in the absence of the Northern Ireland Assembly. Her characterisation of direct rule is incorrect.
Stella Creasy
The Northern Ireland (Executive Formation and Exercise of Functions) Act 2018 explicitly sets out that Ministers must also have regard to representations made by Members of the Northern Ireland Assembly. What efforts has the Minister made to seek the views of Members of the Northern Ireland Assembly on these particular statutory instruments? Even if the Assembly is not sitting, it is written into that Act that its Members should be able to make representations. Can he clarify what he has done in that respect, please?
Stephen Hammond
I can clarify that the permanent secretary for the Northern Ireland Department of Health was consulted, as I said.
The hon. Member for Dewsbury asked about arrangements for cancer and paediatric heart surgery. The north-south arrangements provide that services such as paediatric heart surgery on the island of Ireland are not impacted by the UK’s withdrawal from the EU or these statutory instruments. Those arrangements operate under memorandums of understanding and service level agreements between the Irish and Northern Irish health authorities, which will continue to operate after exit day. The UK and Irish Governments are committed to continuing access to healthcare services within the common travel area, and both Governments are taking steps to enable us to implement these arrangements in time for exit day.
The hon. Member for Southwark and Old Bermondsey asked me about—sorry, Old Bermondsey and Southwark—
Stephen Hammond
I’ll get there in the end. The hon. Gentleman asked about a number of chronic conditions. The statutory instruments allow the Government to fund the treatment of UK nationals who are in the middle of treatment on exit day or who have pre-authorised treatment in another member state. That could include the chronic conditions he mentioned.
Finally, I am not sure which part of the website the hon. Member for Dewsbury was looking at, but I am happy to ensure that we guide her to the right place. There is advice on www.gov.uk and www.nhs.uk to UK nationals living in the EU, to UK residents travelling to the EU and to EU nationals living in the UK. That advice explains how the UK is working to maintain reciprocal healthcare arrangements and sets out the options people might have to access healthcare under local laws in member states that they live in. I am happy to ensure that the hon. Member for Dewsbury can see that guidance.
Richard Graham (Gloucester) (Con)
The Minister has done an outstanding job in explaining a complex matter fairly concisely and taking innumerable interventions, mostly the same ones. Could we now move to a vote?
Stephen Hammond
I understand my hon. Friend’s entreaty.
These three instruments, together with the Healthcare (International Arrangements) Bill, give us the best possible opportunity to ensure that there is no loss of reciprocal healthcare arrangements for UK nationals in the EU and EFTA states. I commend the regulations to the Committee.
Question put.
Valproate Pregnancy Prevention Programme
Stephen Hammond Excerpts(5 years, 2 months ago)
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The Minister for Health (Stephen Hammond)
It is a pleasure to respond to this debate on behalf of the Government, and it is an honour to follow the hon. Member for Lancaster and Fleetwood (Cat Smith), who has secured an important debate. I wish to pay tribute to her and her constituents from INFACT, whom she mentioned.
The hon. Lady has rightly set out that, as Members of this House will be aware, valproate is a very effective treatment for epilepsy and bipolar disorder. For a few women with epilepsy, it may be the only effective treatment, and she rightly recognised that in her speech. However, its use is associated with serious side effects in children exposed to it during pregnancy; there is a 40% risk of persistent developmental disorders and a 10% risk of physical birth defects. Valproate should therefore be used to treat women of childbearing age only if alternative drugs are ineffective or not tolerated.
In April 2018, strengthened regulatory measures for valproate were introduced. They include a pregnancy prevention programme that aims to rapidly reduce and eventually eliminate pregnancies exposed to valproate. The hon. Lady asked a number of questions about the PPP. The challenge is to ensure that valproate is used by only those who need it, that they are fully informed about the risks in pregnancy and that treatment is closely monitored. Let me emphasise that it is vital that no woman stops taking valproate or any other antiepileptic without discussing it with her doctor.
Valproate has always been known, since the time it was first licensed, to carry serious risks if taken during pregnancy. However, important questions have been raised about the extent to which women have been informed about the nature and magnitude of those risks over the decades. At the time valproate was first marketed in 1974, animal studies had shown that there may be a risk of birth defects. Health professionals were made aware of that and were expected to weigh the benefits against the risks. They were expected to prescribe valproate only in severe cases or those where there was resistance to other treatments. Difficult prescribing decisions sometimes had to be made.
Campaigners have highlighted minutes of a meeting of the Committee on Safety of Medicines in 1973—the hon. Lady referred to that—where it concluded that it would be best not to mention the risk of birth defects following the use of anticonvulsants in the information supplied with the medicine, but that doctors should be informed. At that time, it would have been the doctor’s responsibility to pass on information on side effects. Today, patients and doctors are expected to make decisions jointly, based on open communication about all the risks and benefits of a treatment.
Over the years, warnings have been issued to prescribers by the regulator when new evidence on risks in pregnancy has become available. In 1983 and 1993, communications went out to update prescribers on the growing evidence of the risks in pregnancy. In 2003 prescribers were warned about a possible risk of developmental delay in children exposed to valproate during pregnancy. Warnings were extended to include a risk of autism in 2010, and a further bulletin was issued in 2013. It was around that time that the full magnitude and nature of the risks of valproate in pregnancy first became known, following the long-term follow-up of cases of affected children.
Given the seriousness of the accumulating evidence, the Medicines and Healthcare Products Regulatory Agency initiated a major Europe-wide safety review of valproate in pregnancy, which was completed in November 2014. The conclusion was that the balance of the benefits and risks of valproate in epilepsy and bipolar disorder remained favourable in women of childbearing potential only when other drugs were ineffective. The MHRA went further than updating the statutory information, as required by the EU review, and developed the valproate toolkit for healthcare professionals and women, which consists of a set of clear and informative materials. More than 100,000 healthcare professionals have received the toolkit.
As the hon. Lady referred to in her speech, in the autumn of 2015, given the importance of the issue, the then Life Sciences Minister, my hon. Friend the Member for Mid Norfolk (George Freeman), brought together all the relevant healthcare bodies to support the promotion of the toolkit and ensure that co-ordinated messaging was given out to health professionals and patients. The MHRA further developed this group into a 39-strong stakeholder network of health system organisations, health professional bodies, charities and campaign groups, which has been convened 11 times to date, to raise awareness and to help to embed the new measures in practice.
Despite extensive work to communicate the risks of valproate, concerns about the limited impact of the action in the UK and other member states led to a further EU review, which in 2018 resulted in a strengthened regulatory position stating that valproate must not be used in women of childbearing age unless they comply with the requirements of a pregnancy prevention programme. All healthcare professionals who prescribe valproate to female patients must ensure that they are enrolled in the pregnancy prevention programme. That ensures that women must use effective contraception throughout their valproate treatment and have an annual review with a specialist, which includes the consideration of alternative treatments, and must sign an annual risk acknowledgement form.
I am sure the hon. Lady will know that in February 2018 the then Secretary of State, my right hon. Friend the Member for South West Surrey (Mr Hunt), announced that he had asked Baroness Cumberlege to lead the independent medicines and medical devices safety review, which is exploring what happened in the cases of valproate, Primodos and mesh and considering the robustness of processes, the quality of engagement with and response to patients’ concerns, and any wider lessons. As I am sure the hon. Lady does, I welcome that important work and look forward to seeing the recommendations from the review. It is vital, though, not to wait for the outcome of the review. Much work is being done, and will continue to be done, to ensure compliance with the valproate pregnancy prevention programme. We expect the review to report later this year. It has been consulting in a detailed and patient-orientated manner throughout the UK, with patients and relevant patient and healthcare organisations.
The hon. Lady raised a number of issues with the pregnancy prevention programme. The MHRA has monitored the impact of the programme closely since its introduction last year. Monitoring is being done via data from the clinical practice research datalink and national databases, which link data from community drug dispensing and maternity services. The MHRA is also accessing data from clinical audits run by healthcare professional organisations and information on patient experience via surveys.
Patient input and engagement with the patient group INFACT, to which the hon. Lady referred and which was started by her two constituents, has been invaluable throughout the process, as a source of both evidence and feedback on the implementation of action. The data shows a decline in the use of valproate in women of childbearing age, but we recognise that there is local variability. I am also aware of evidence of non-compliance by some healthcare professionals, which is of great concern. Non-compliance with the pregnancy prevention programme is not acceptable, and those concerns are being investigated to ensure that people are brought back into compliance. I can inform the hon. Lady that enforcement action will be taken as and when necessary.
The concerns that were raised in the survey that the hon. Lady referred to have led the UK chief pharmaceutical officers to contact all pharmacists to stress their responsibilities when dispensing valproate. This was reinforced by messages from professional regulators to their members and by articles in the MHRA’s electronic bulletin “Drug Safety Update” in September and again in December, making sure that all healthcare professionals recognise that they need to examine whether they are prescribing in compliance with the new measures.
Achieving full compliance with the valproate pregnancy prevention programme will require concerted action across the healthcare system. I recognise that there is more to do, but I stress again that healthcare professionals who prescribe the drug must make sure that their female patients are enrolled in the pregnancy prevention programme. As I have said, non-compliance is not acceptable.
The hon. Lady asked a number of other questions, some of which I hope I have answered during my speech. My noble Friend Baroness Blackwood specialises in this area and will take the lead in it. I know that she would be delighted to meet the hon. Lady and members from INFACT.
I thank the hon. Lady for highlighting this issue and pay tribute not only to her constituents, but to many other women who have spoken powerfully about the effects that valproate has had on their lives and the lives of their children. Their tireless campaigning has been vital in highlighting the further action that is needed to ensure that women know the risks and are helped to make an appropriate judgment about their treatment. It is vital, therefore, that all healthcare professionals work together rapidly to reduce and eliminate the exposure of pregnancies to valproate.
I hope that the action I have outlined today shows that steps are being taken to ensure that the necessary assessment, monitoring and, where necessary, enforcement action will be taken. In commending the hon. Lady, I hope that she, like me, will look forward to Baroness Cumberlege’s review, which, as I said, should be published later this year. I thank her once again for raising this important matter this afternoon.
Question put and agreed to.
Health and Social Care
Stephen Hammond Excerpts(5 years, 2 months ago)
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Stephen Hammond
It is important to recognise that NHS England has taken measures to build a clearer narrative around integrated care. The long-term plan, which will be backed by £20.5 billion extra by 2023-24, will introduce integrated care for patients in England over the next decade.
[Official Report, 18 March 2019, Vol. 656, c. 878.]
Letter of correction from the Minister for Health:
An error has been identified in my contribution to the debate.
The correct information should have been:
Stephen Hammond
It is important to recognise that NHS England has taken measures to build a clearer narrative around integrated care. The long-term plan, which will be backed by an extra £33.9 billion in cash terms by 2023-24, will introduce integrated care for patients in England over the next decade.
Leaving the EU: Health and Social Care
Stephen Hammond Excerpts(5 years, 2 months ago)
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Westminster Hall is an alternative Chamber for MPs to hold debates, named after the adjoining Westminster Hall.
Each debate is chaired by an MP from the Panel of Chairs, rather than the Speaker or Deputy Speaker. A Government Minister will give the final speech, and no votes may be called on the debate topic.
This information is provided by Parallel Parliament and does not comprise part of the offical record
The Minister for Health (Stephen Hammond)
The hon. Gentleman ought to be absolutely clear: we are not advising people to stockpile medicines. That is alarmist, and he should not be saying it. That is not what the Government are doing.
Brendan O'Hara
I will rephrase that. The Government are advising the stockpiling of medicines—perhaps not by individuals, but the Minister and the Government have advised the stockpiling of medicines.
The Minister for Health (Stephen Hammond)
It is a pleasure to see you in the Chair this morning, Mr Bone. I will start by addressing the remark by the hon. Member for Burnley (Julie Cooper). She should know that the whole of the Department of Health and Social Care, and indeed the whole of the Government, are absolutely committed to ensuring that there are in place detailed plans, which I hope I will be able to outline and reassure hon. Members about, to ensure that in any post-Brexit scenario the health and social care of our country’s citizens is our top priority.
I thank the hon. Member for Argyll and Bute (Brendan O'Hara) for securing the debate and commend him for his private Member’s Bill. He will know that the Government do not support his Bill—although we support the spirit of it—in part because, as the contribution from the SNP Front Bench showed, it is unnecessary. He is arguing for an independent evaluation and careful analysis of Brexit, but I thought the contribution from the hon. Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron), frequently citing the Health and Social Care Committee, proved that there is a huge amount of independent evaluation, accountability and scrutiny of the plans.
The hon. Member for Argyll and Bute raised a number of questions. I have with me a prepared speech, but I am not sure I will get on to it, because I want to address as fully as I can some of the concerns that hon. Members have raised. He raised a number of concerns about the social care sector, and he is right to do so. Brexit or no Brexit, it is a fragile sector and any event could hinder care provision. That is why, in the light of Brexit, we are working with the sector and local authorities to ensure that we have contingency plans in place.
I will speak more, if I have time, about what we have done regarding EU nationals in the short term, but I want to stress, as the hon. Member for Burnley did, my thanks to all EU nationals who work in either the healthcare system or the social care system. They play a crucial role in delivering high-quality health and social care, and we all recognise that. It is a fact, of course, that the number of EU nationals in adult social care has increased each year, from about 5% in 2012-13 to 8% in 2017-18, but that is no reason to be complacent. That is why we have put in mitigations regarding the EU settlement scheme and are implementing long-term policies to deliver the workforce and address the supply-demand gap that exists.
The hon. Member for Argyll and Bute will of course have noticed the recent recruitment plan, Every Day is Different, which started only last month. As he challenged me directly on this, I can say that we are currently in discussions with the Home Office about the salary threshold for social care.
My hon. Friend the Member for Henley (John Howell) spoke eloquently, as he always does—I have heard him speak in several of these debates—about Henley and other matters. He challenged me to visit Henley, which I would be delighted to do—perhaps on a Friday in July, when other events are on as well.
The hon. Member for North Ayrshire and Arran (Patricia Gibson) asked a number of questions. I made this clear at the start of my speech, and I will make it clear again directly to her: we value all the professionals who work in the national health service and the social care sector. We are putting plans in place, both short term and long term, to ensure that our words are followed by actions and there is practical support, and to ensure that people know how much they are valued. I heard her charge of arrogance, but she might like to reflect on the fact that some might consider it arrogant to suggest in any way that this Government are not putting in place all the necessary preparations to protect the NHS.
Stephen Hammond
I will not take an intervention. If the hon. Lady listens carefully to my remarks, she will understand why some of us feel that her charge was unfair.
Stephen Hammond
I am about to, if the hon. Lady will give me time, which is why I will not take her intervention.
The hon. Member for Strangford (Jim Shannon) asked about NHS investment. He knows, of course, about the increase in cash terms of £33.9 billion by 2023-24, which reflects, as I said at the outset, our top priority. He also challenged me about the cancer workforce. Baroness Dido Harding, the chair of NHS Improvement, is carrying out a rapid programme of work for the Secretary of State, engaging with relevant stakeholders across the system to build a workforce implementation plan, which the hon. Gentleman mentioned. We have charged her with making sure that her plan matches the long-term plan’s ambitions. The hon. Gentleman will know that the long-term plan superseded previous plans to establish a larger cancer workforce, and Health Education England is now working with Baroness Harding to make sure that is in place.
I listened carefully to the hon. Member for Glasgow East (David Linden), who asked important questions about insulin and the financial impact of leaving the EU on cancer patients. My officials spoke this morning to insulin suppliers, who have increased their buffer stocks so that they will hold 16 weeks of additional stocks over and above their normal supply. [Interruption.] Yes, it is stockpiling, but it is stockpiling that we have asked the whole pharmaceutical industry to undertake. As the hon. Member for Burnley rightly pointed out, there should be no stockpiling by individuals or pharmacists. I will explain the whole stockpiling issue and why we are rightly putting in place buffer stocks to ensure continuity of supply. The hon. Gentleman asked me whether buffer stocks of insulin are in place, and I can confirm that they are.
The hon. Gentleman also asked me what assessment has been made of the financial impact of EU exit on cancer patients, and what measures are in place to protect services. He will know that the long-term plan contains clear proposals for improving cancer diagnoses. That plan is fully costed. As I just said in response to the hon. Member for Strangford, the workforce implementation plan is putting in place the cancer workforce.
I also listened carefully to the hon. Member for East Kilbride, Strathaven and Lesmahagow, who asked whether my door was open to chairs of all-party parliamentary groups. The answer is yes, of course. If she wishes to contact me, I would be delighted to engage with her, and with chairs of other all-party parliamentary groups.
It is also worth putting on the record the relationship that we are likely to have with the European Medicines Agency post Brexit. The Government are clearly striving for a deal, and in the light of the withdrawal agreement being signed, the political declaration sets out that it is the UK’s intention to explore the possibility of EMA co-operation during negotiations on the future framework. In the event of no deal, we would clearly no longer be any part of the EMA, and the Medicines and Healthcare products Regulatory Agency is ready to carry out EMA functions as a sovereign regulator.
To ensure the continuity of supply, the UK will continue to accept batch testing of human medicines carried out in countries named on a list by the MHRA, including EU, European economic area and European Free Trade Agreement countries, and most third countries with which the EU already has in place a mutual recognition agreement.
Patricia Gibson
I thank the Minister for giving way; I know there is a lot that he wants to say. As he is talking about ensuring the supply of medicines, can he reassure the House that that includes medical isotopes?
Stephen Hammond
I reassure the hon. Lady that we have been working since last August to ensure that companies understand the routes available to maintain continuity of supply, including air freight routes. We will ensure the potential use of those alternative shipping or air freight routes because, as she rightly points out, these are short-life products. The worst-case scenario—no deal—has been looked at, and routes will be available to ensure that medical isotopes can continue to come into this country.
The hon. Lady referred in her speech to the operationalisation of those plans, which is relevant. Normally, if sea routes are used, it can be ensured that medical isotopes or short-life products are at hospitals by 9 am. She referred to the likelihood that, if air freight routes are used, those products would not arrive until midday, which the NHS advises us would mean that some clinics would be likely to be rescheduled to later in the day. People’s opportunities to undergo treatment will not be interrupted.
Julie Cooper
I hear what the Minister says about making his best efforts to ensure that there is no interruption of supply. However, does he accept that, as of yesterday, health professionals who deal with this were not reassured? We could be in a no-deal situation in just over a week’s time. Will these arrangements hold good in a no-deal situation? Will he assure us that those vital isotopes will be in the places where they need to be?
Stephen Hammond
Had the hon. Lady joined me in walking through the Lobby to vote for the withdrawal agreement—so that Brexit would happen on 29 March and leaving without a deal would be impossible—she would know that all the arrangements currently in place would pertain. We are talking about arrangements for a no-deal situation, which I and the Government certainly hope will not happen. These arrangements are specifically designed to ensure that arrangements are in place for no deal.
In the short time I have left, I will stress the continuity of supply. It is essential that any responsible Government, even if they wish for a different outcome, should prepare for the outcome that they do not want, which in this case is no deal.
Brendan O'Hara
I want to give the Minister the opportunity to answer the question I asked about the long-term plan to fill those hundreds of thousands of vacancies now and in future, and to reassure supporters of my Bill that health and social care will not be adversely affected by the UK leaving the EU. I would be hugely grateful if he did so in the next three minutes.
Stephen Hammond
There are so many issues that I could tackle in the next three minutes. However, as the hon. Gentleman will have seen, the long-term plan has ambitions to ensure that there are new routes into nursing and that there are extra doctor training places. I said in response to the hon. Member for Strangford that we have commissioned Baroness Harding to start a workforce implementation plan. I assure the hon. Member for Argyll and Bute that driving down the number of vacancies is a priority for the Government. However, he will recognise that several of those vacancies are not necessarily unfilled posts, because they are usually filled by staff from the temporary staff bank. We need to be clear about what we are talking about. Recruitment into our national health service and our social care system is absolutely a key priority.
My Department has overall responsibility, on behalf of the devolved Administrations, for ensuring the continuity of supply of medicines and medical products. All supply arrangements take into account the whole of the United Kingdom. We have had significant support from, have given reassurance to and are constantly working with the pharmaceutical industry, the whole of the medical supply industry, clinicians and patients, and I am delighted to say that last week we held a roundtable with the devolved Administrations, so that their concerns could be listened to and directly addressed.
Several Members commented on stockpiling. We recognise that if we leave the EU without a deal, the medical supply chain will come under a lot of pressure. Around three quarters of the medicines and more than half the clinical consumables that we use come from the EU. Since last August we have been working with the industry to ensure that, before 29 March, there is at least an additional six weeks of stock over and above the usual buffer stocks in the UK.
We have also advised companies that if they are likely to face difficulties in their supply routes, there are ways of bringing in supplies outside the normal short straits route, either by using existing services or by making use of the additional capacity that the Government have procured. We are reliant on transport and freight being re-routed, but I am confident that, if everyone—including suppliers, freight companies, the health and care system and international partners, all of whom we have worked with since last August—does what they need to do and have committed to doing, the supply of medicines and other medical products will be uninterrupted.
I had intended to deliver a rather longer speech this morning, but I thought it was important to try to answer directly the questions put to me by hon. Members. There is no doubt that many areas of the health and care system will be directly affected by EU exit. We do not have time to address those today. However, it is important that the country knows that the Government are committed to ensuring that, whether we leave with or without a deal, we have in place the contingency plans needed to meet those challenges.
Health and Social Care Update
Stephen Hammond Excerpts(5 years, 2 months ago)
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The Minister for Health (Stephen Hammond)
Today, I am updating the House on the Department for Health and Social Care’s plans for the continuity of reciprocal healthcare arrangements in the event we exit the EU without a deal.
Under current EU-based entitlements, the UK pays for the healthcare costs of 180,000 UK nationals, mostly pensioners, in health systems across the EU. There are around 50 million UK tourist visits to the EU annually; the European healthcare insurance card (EHIC) is used in around 0.5% of these visits. Moreover, approximately 50,000 posted workers are protected through the current arrangements.
The current EU healthcare arrangements operate on a reciprocal basis. The UK, EU member states and EFTA states (Iceland, Norway, Liechtenstein and Switzerland) reimburse each other for the healthcare of those who remain covered by their respective social security schemes when living in, working in or visiting each other’s country. These arrangements are a function of EU membership that also applies to the EFTA countries, and are an exception to the arrangements that apply to the rest of the world. As a result, extending these functions in the event of the UK leaving the EU without a deal is subject to agreement and cannot be done by the UK alone.
Separately, the UK and Irish Governments are committed to continuing to facilitate access to healthcare services within the common travel area (CTA). Discussions to continue reciprocal healthcare arrangements are under way between the UK and Ireland and both Governments are taking legislative steps to enable us to implement these arrangements by exit day. Additional guidance for those living and working in the CTA has been published on the gov.uk website.
While EU reciprocal healthcare is funded and administered on a UK-wide basis, the devolved Administrations have responsibility for healthcare provision in Scotland, Wales and Northern Ireland. We are working closely with all parts of the UK on our approach.
My Department has published country specific guidance on gov.uk and nhs.uk about healthcare arrangements if the UK leaves the EU without a deal and has been working closely with EU member states and EFTA states to protect existing healthcare arrangements for these and other groups.
The UK Government’s proposal
Subject to Parliament ratifying the withdrawal agreement, in a deal scenario current reciprocal healthcare rights will continue during the implementation period until 31 December 2020. The withdrawal agreement and EFTA agreements also give longer term reciprocal healthcare rights to those who are living in or previously worked in the other country on exit day.
We have proposed to EU member states and EFTA states that we should maintain the existing healthcare arrangements in a no-deal scenario until 31 December 2020, with the aim of minimising disruption to UK nationals and EU and EFTA state citizens’ healthcare provision.
This would mean that we will continue to pay for healthcare costs for current or former UK residents for whom the UK has responsibility who are living or working in or visiting the EU and EFTA states, where individuals are not covered by the EFTA citizens’ rights agreements. We are hopeful that we will reach such agreements.
We have brought forward legislation to enable us to implement new reciprocal healthcare arrangements. The Healthcare (International Arrangements) Bill was introduced in Parliament on 26 October 2018 and passed Report stage in the House of Lords on 12 March 2019. It will provide us with the power to fund and implement comprehensive reciprocal healthcare arrangements after we leave the EU. We have also laid three statutory instruments which will give us the specific legal basis to implement our proposal.
Minimising disruption in the event of no deal
As outlined above, we want to work with EU partners to protect existing healthcare arrangements beyond exit day. If that is not possible, healthcare arrangements in many EU member states would revert to those which apply to the rest of the world. Whenever travelling abroad, individuals are always responsible for ensuring they have travel insurance. It is already the case that we advise people to obtain comprehensive travel insurance when working, studying or travelling to the EU and the rest of the world. This will remain our advice in all circumstances.
Many people rely on EHICs. In a no-deal scenario, these may no longer be valid in EU member states (and in EFTA states for those visitors not in scope of the EFTA citizens’ rights agreements and travelling after exit day). UK nationals living in or travelling to EU member states should check up to date information gov.uk and nhs.uk and ensure they have taken the necessary steps to prepare.
Although we are hopeful that we can agree reciprocal healthcare arrangements, as a responsible Government we have developed a multi-layered approach to minimise disruption to healthcare provision to UK nationals currently in or travelling to the EU member states and to those UK nationals not covered by the EFTA citizens’ rights agreements:
1. We welcome action from those EU member states who have prepared their own legislation for a no-deal scenario. EU member states such as Spain have made public commitments that they will enable resident UK nationals and visitors to access healthcare in the same way they do now.
2. As noted above, the UK and Irish Governments are committed to continuing to facilitate access to healthcare services within the common travel area (CTA). Discussions to continue reciprocal healthcare arrangements are underway between the UK and Ireland and both Governments are taking legislative steps to enable us to implement these arrangements by exit day. Additional guidance for those living and working in the CTA has been published on the gov.uk website.
3. The UK Government have already agreed with Iceland, Norway, Liechtenstein, Switzerland (EFTA) to protect citizens’ rights. This means that UK nationals already living in EFTA states and vice versa will be able to access healthcare as they do now. However, in line with the arrangements we are seeking with EU member states, we would like to protect the healthcare cover of visitors not in scope of the citizens’ rights agreements travelling between the EFTA states and the UK after exit day to enable them to continue to be covered for needs-arising healthcare (currently facilitated under the EHIC system).
4. The UK Government have committed to fund healthcare for UK nationals (and others for whom the UK is responsible) who have applied for, or are undergoing, treatments in the EU prior to and on exit day, for up to one year, to protect the most vulnerable. The statutory instruments introduced on 11 February would also enable some UK residents to recover costs if they are charged. For UK nationals who are visitors, we will refund costs directly. For UK nationals who are resident in another member state, this commitment requires us to reach an arrangement with individual EU member states. We are hopeful that they will remain willing to treat patients and accept reimbursement and are in discussions to seek such an agreement.
5. We have published guidance profiles on gov.uk and nhs.uk and will update the guidance with further developments.
6. Should UK nationals face changes in how they can access healthcare, they may use NHS services if they return to live in the UK. As is currently the case, UK nationals living in the EU will have an entitlement to NHS services as soon as they take up ordinary residence in England. We will continue to work closely with the NHS in England and across the devolved Administrations in the UK to ensure returners can appropriately access NHS services. A British citizen who moves to the UK can be considered ordinarily resident upon arrival if it is clear that they are here to reside on a properly settled basis for the time being. British citizens who return to live in the UK part way through their treatment will be able to access NHS services.
7. Those who have their healthcare funded by the UK under current EU arrangements and are resident in EU member states on exit day can use NHS services in England without charge when on a temporary visit to England.
8. The Association of British Insurers (ABI) has advised that travel insurance policies will cover emergency medical treatment costs as standard that could have been reclaimed through the EHIC, although some routine treatments would not be covered. People should be aware that there are a small number of policies in the market that state they will only provide cover if you have and use an EHIC. The ABI have advised that all individuals should check their current travel insurance thoroughly to ensure they have the correct amount of cover for their requirements. Additional guidance has been published on the ABI website here.
Advice for citizens of EU member states and EFTA states
We have confirmed that, in a no-deal scenario, we will protect the healthcare rights of citizens from EU member states and EFTA states, who are living lawfully in the UK on exit day, and this includes their entitlements to NHS cover.
Advice for UK nationals
In the event that we cannot reach an agreement with EU member states and EFTA states for those nationals not in scope of the EFTA citizens’ rights agreements, it is not possible for the UK Government to guarantee access unilaterally to healthcare abroad, beyond the situations set out above. We will be employing a small number of overseas healthcare advisers in UK missions across Europe who will be able to provide advice where individuals have particular need for support. However, it is vital that all UK nationals who are currently or planning to reside in, travel to, work or study in EU member states and EFTA states take the following actions now:
Residents: The UK Government have published advice setting out options to access healthcare under local laws in EU member states and EFTA states and what people can do to prepare. We have analysed 31 countries and strongly advise that all affected UK nationals check the latest country specific guidance on gov.uk and nhs.uk.
Substantial numbers of UK nationals will already be eligible for or enrolled in the relevant health authorities locally, either because of their residency, benefits or employment status. There is no reason to think that a no-deal scenario will affect these arrangements where EU countries offer equal access to healthcare.
For some people it may be advisable to register their healthcare entitlement with their relevant health authority locally. This may mean that they will need to join a social insurance scheme and contribute as other residents do. Others will need to buy private healthcare insurance.
Visitors: The Government always advise UK nationals to take out travel insurance when going overseas, both to EU and non-EU destinations. UK nationals, including those with pre-existing conditions, planning to visit an EU member state or EFTA states on or after exit day should continue to buy travel insurance.
As with any policy, UK nationals are advised to make sure they understand the terms and conditions of any travel insurance policy and that the policy is sufficient to cover healthcare needs. Most travel insurance policies will cover emergency treatment as standard but we advise all travellers to check their policies as some treatments may not be covered in the countries they are visiting.
Any questions regarding individual travel insurance policies should be directed to the relevant insurance companies or refer to guidance published on the ABI website here.
If we do not reach an agreement with EU member states and EFTA states for those nationals not in scope of the EFTA citizens’ rights agreements, EHIC may no longer be valid after exit day. ABI advice is that, while almost all insurance policies will remain valid, some insurance policies may be affected. There are a small number of insurance policies which are dependent on having an EHIC, so if you have purchased one of these policies it is recommended you speak to your provider to ensure you are fully protected before you leave the UK.
Workers: We have published country specific guidance on gov.uk and nhs.uk to help UK workers make the necessary preparations for a no-deal scenario. We strongly advise that workers ensure they have comprehensive healthcare insurance for the full period of their stay.
Students: Currently, students residing in the UK who are going on a placement abroad are entitled to a UK-issued EHIC to cover healthcare costs for the duration of their placement.
We cannot guarantee that this will continue for all EU member states in the event of a no-deal scenario where the existing arrangements are not extended. We strongly advise that students check the country specific guidance that we have published on gov.uk and nhs.uk and make the necessary preparations for a no-deal scenario.
The EFTA citizens’ rights agreements protect the rights of UK nationals who are studying in an EFTA state over exit day, and who are entitled to a UK EHIC, to continue to benefit from the EHIC scheme for the duration of their course.
Returners: As is currently the case, UK nationals who return to live in the UK and meet the ordinarily resident test will be able to access NHS care on the same basis as other UK residents. If these people return to live in the UK partway through their treatment, they will be treated by the NHS in a fair and equitable way.
UK nationals who have their healthcare funded by the UK under current EU arrangements and are resident in the EU on exit day can use NHS services in England without charge when on a temporary visit to England.
UK nationals who are resident in an EU country, who do not have their healthcare funded by the UK under current EU arrangements and who do not wish to return to the UK, should seek to formalise their current residency status if they are eligible. Guidance has been made available on gov.uk and nhs.uk.
The UK is taking steps to protect individuals whose healthcare it is responsible for under current EU arrangements, but who are not UK nationals. Where this paper refers to UK nationals, it includes non-nationals for whom the UK is responsible.
[HCWS1429]
Integrated Care Regulations
Stephen Hammond Excerpts(5 years, 2 months ago)
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The Minister for Health (Stephen Hammond)
Although we oppose the motion, I welcome the opportunity to debate the regulations. The NHS long-term plan, which was published in January, set out a clear blueprint for fully integrated community health in the NHS for the first time in its history. The plan highlighted the intention to dissolve the historical distinction between primary and community health services and to break down the traditional barriers between care institutions, teams and funding streams, so as to support the increasing number of people with long-term health conditions, rather than viewing each encounter with the health service as a single unconnected episode of care.
NHS organisations will increasingly focus on population health by delivering the so-called triple integration of primary and specialist care, physical and mental health services, and health with social care, which is consistent with what doctors have consistently reported they need. I obviously welcome the commitment from the shadow Secretary of State, the hon. Member for Leicester South (Jonathan Ashworth), to integration. Today, the integration of services can take place through collaboration and co-operation, including some local alliance arrangements. However, in some areas, people working on the ground have told us that it would be better to have a lead provider to take responsibility for the integration of services for a population through an integrated care provider contract.
It is worth making the distinction between integrated care providers, which we are discussing tonight, and integrated care systems. An integrated care system growing out of the current network of sustainability and transformation partnerships will provide a platform on which commissioners can make shared decisions with providers about how to use resources, design services and improve population health. The long-term plan has set out an ambition for all STPs to evolve into ICSs. Integrated care providers, or ICPs, will be a new way of integrating health and care services so that people’s care is co-ordinated around them.
NHS England has developed the ICP contract to enable local areas to commission local health and care services, including primary medical services through a single contract. The intention is to establish the right organisational and financial incentives for providers to collaborate in order to deliver preventive, proactive and co-ordinated care. It is important to underline that ICPs are not new types of legal entity, but provider organisations that have been awarded ICP contracts. In the long-term plan, NHS England underlined that, when the contract is made available for use, it expects ICP contracts to be held by public statutory providers, and I want to discuss that a bit more in my remarks later.
Turning to the particular statutory instrument we are discussing tonight, we have identified a number of regulations that need to be amended to allow the first ICP contract to be awarded.
Thelma Walker (Colne Valley) (Lab)
In the last year, I have been on numerous Delegated Legislation Committees, and I have been shocked by the complex and far-reaching changes the Government have forced through without appropriate scrutiny. Can the Minister justify why substantive change to existing regulations should not be part of a Bill and subject to parliamentary scrutiny?
Stephen Hammond
As the hon. Lady knows, this has been subject to considerable scrutiny. It has been scrutinised by the Health and Social Care Committee, as she has already heard from its Chairman. She will also have heard that it has been subject to a number of other scrutiny processes, including judicial reviews.
Dr Paul Williams (Stockton South) (Lab)
The Minister is correct in saying that there has been some analysis of integrated care partnerships by the Health and Social Care Committee, but it has not scrutinised this statutory instrument. The Select Committee actually recommended very clearly that ACOs or ICPs should be NHS organisations. Will the Minister say why he should not accept the Committee’s recommendation?
Stephen Hammond
As the hon. Gentleman knows, the long-term plan has set out that the ICP contracts will be held by public statutory providers. That point has been made and reiterated several times not only in the Select Committee’s scrutiny, but in the remarks that the Committee and a number of people have made about privatisation. The Chairman of the Health and Social Care Committee has already intervened on the shadow Secretary of State, but she has said:
“The evidence to our inquiry was that ACOs, and other efforts to integrate health systems and social care, will not extend the scope of NHS privatisation and may effectively do the opposite.”
Dr Wollaston
Will the Minister assure the House that only public statutory providers will hold these contracts? That would be reassuring, as the language on this is not completely clear. Will he also give some assurance regarding the Select Committee’s other proposal, which is that the policy should be carefully piloted and evaluated? If it is done first in Dudley, followed by careful evaluation, I would be prepared to support it. If he cannot give reassurance on those points, it would be difficult for me to support the regulations.
Stephen Hammond
I can give the Chair of the Select Committee the assurance that the ICP contract will be made available in a controlled and incremental way, conditional on the successful completion of NHS England and NHS Improvement assurance through the integrated support and assurance process. That incremental process is, I think, in line with what she and her Committee recommended.
Jonathan Ashworth
Will the Minister confirm that, because of the competition and procurement rules and the regime brought in by the Andrew Lansley Act, he cannot rule out the possibility of an independent provider winning a contract? He might say it is unlikely, but he cannot rule out the possibility, so why does he not introduce a measure—a simple one-clause Bill, perhaps—to give the assurances that many campaigners want?
Stephen Hammond
The hon. Gentleman is right: it is highly unlikely. More than that, it is stated and restated in the long-term plan that NHS England has the clear expectation that the ICP contracts will be held by public statutory providers. He knows that, and others who have discussed this point have made it clear.
Justin Madders
I have a simple question and we would like a simple answer. Yes or no: do the Government intend to repeal section 75 of the Health and Social Care Act 2012?
Stephen Hammond
As the hon. Gentleman knows, the NHS has proposed in a recent legislative document that it looks at a number of issues. It is important that that round of engagements takes place, and the Government will consider what is said.
The majority of the amendments we propose simply ensure that the regulatory framework that applies to contractual arrangements for the provision of healthcare services continues to apply where services are provided under the new ICP contract and to those organisations that hold a contract. That is an important safeguard that, in simple terms, helps to ensure that care provided under an ICP contract is subject to all the same rules as care provided under existing and other NHS contracts, such as those governing the handling of complaints and the reimbursement of travel expenses.
The shadow Secretary of State has asked me to comment on the substantive change being proposed, underpinning the existing contractual arrangements for the provision of NHS GP services. The regulations will allow GPs who are currently providing services under existing contractual general medical services or personal medical services arrangements to suspend, rather than terminate, those arrangements in order to provide services under an ICP in what is known as a fully integrated arrangement. The British Medical Association has underlined that GPs should not be pressured into joining an ICP arrangement, and we want to make it clear to the House tonight that the participation of any individual GP practice is entirely voluntary. Any role in any ICP will be for them to decide. Allowing the suspension of GP contracts allows GPs to take part in an ICP arrangement but keeps the option available to them of returning to their previous contract.
The hon. Gentleman expressed a number of concerns about the ICPs. He implied that they had been brought in by stealth. In fact, the proposals have been subject to significant scrutiny by Parliament and the public, particularly in the past year. We have already discussed the examination of the evidence by the Health and Social Care Committee, which published a report last summer, which is, I believe, largely supportive of ICPs, recognises potential benefits and sets out helpful recommendations on introducing them in England. I have described the consultation processes previous iterations of the ICP contract and the regulations have gone through.
Moreover, as the Health and Social Care Committee was promised, NHS England has completed a full public consultation on the ICP contract and announced through the long-term plan that the ICP contract will be available for use. NHS England’s full response to the consultation was published on 15 March.
Various people have made points tonight about the privatisation of the NHS and said that ICPs are a route to privatising the NHS. They are clearly not.
Stephen Hammond
The NHS has stated clearly that NHS England’s expectation is that these contracts will be held by public statutory providers. The hon. Lady, who is making a number of points—[Interruption.] She says she is not making them, but shouting at me. Indeed, she is shouting at me.
Stephen Hammond
Oh, she is chuntering at me. While she is chuntering at me, she might like to consider what the King’s Fund has said about the claims of mass privatisation, which is that they are “hugely overstated”. I have already quoted the Chair of the Select Committee, who said that the evidence to its inquiry was that ICPs and
“other efforts to integrate health systems and social care, will not extend the scope of NHS privatisation and may effectively do the opposite.”
It is important to recognise that NHS England has taken measures to build a clearer narrative around integrated care. The long-term plan, which will be backed by £20.5 billion extra by 2023-24, will introduce integrated care for patients in England over the next decade.[Official Report, 19 March 2019, Vol. 656, c. 6MC.] Where local commissioners propose to use ICP contracts, they will have to ensure that it is an effective and beneficial option for the local area. The regulations will ensure that the healthcare of this country is improved by integrated care providers. I commend them to the House.
Health and Care Professions Council: Registration Fees
Stephen Hammond Excerpts(5 years, 2 months ago)
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The Minister for Health (Stephen Hammond)
It is a pleasure to serve under your chairmanship, Mr McCabe. Like everyone else, I congratulate the hon. Member for Coventry South (Mr Cunningham) on securing this debate. He made an impassioned speech that aired his campaign, which he has led with style and impact. The Health and Care Professions Council is one of nine UK-wide regulators. It performs an important role in the health and care sectors across all four countries of the UK, acting in patients’ and service users’ interest to ensure the professional standards we need to guarantee safety and quality.
Right at the start of my speech, I pay tribute to all the dedicated professionals who work in the professions governed by the HCPC. It is also right to respond to the Opposition spokesman, the hon. Member for Ellesmere Port and Neston (Justin Madders). He said, if I heard him correctly, that it was irresponsible of the Government not to intervene. There is an important point of principle here: the HCPC is independent of the Government. It is funded by registrants’ fees on a cost-recovery basis. It is therefore not the Government’s role to tell the HCPC what its fees should be. It is not a question of hiding or a lack of political will; it is a matter of law. As the hon. Gentleman knows, there is a mechanism for oversight of the HCPC, which is the Professional Standards Authority. It oversees the HCPC and its setting of fees.
It has been an excellent debate with lots of useful and informed contributions. I have been in a number of debates with the hon. Member for Strangford (Jim Shannon), and he spoke with his usual passion not only on behalf of the people of Strangford, but in the wider context as well. I want to pick up on what the hon. Member for Heywood and Middleton (Liz McInnes) said; I was listening carefully to her contribution. She is right that the vast majority of registrants have very little contact with the regulator between renewals of their registration. That may be a frustration and not seen as value for money, but from the other point of view, the HCPC’s largest expenditure is on delivering the fitness-to-practise function. It is therefore inevitable that it concentrates on the very small number of registrants whose performance or conduct has fallen below the expected level.
The key thing is the need for regulatory reform, which the hon. Member for Ellesmere Port and Neston was challenging me on a moment ago. We have recognised that regulators have inherited a complex and restrictive registration practice that is often bureaucratic and administratively burdensome. As he rightly pointed out, the four UK Governments consulted on proposals for reforming the legislative structure of professional regulation. That consultation finished last year.
The reforms that we are looking to make, and are still committed to, will shift the balance in professional regulation, freeing up the regulators to concentrate more on prevention and to work directly with registrants, rather than just on fitness to practise. I assure the hon. Gentleman that it is not our intention to hide that. We intend to bring it forward, and we will do so in the near future.
I was listening carefully to the hon. Member for York Central (Rachael Maskell). She made a point about the need for registration and also for the system to be updated. The Government are committed to that. I also listened carefully to the hon. Member for Blaydon (Liz Twist). She spoke with knowledge and mentioned a number of the fitness-to-practise cases she has been involved with. She was right to point out that the vast majority of those have been social care cases over a number of years. That brings me to a key point. A number of Members raised the issue of the HCPC’s costs potentially going down as a result of social workers moving out of that regulatory process. I have not looked at that in great depth, but it is highly likely that variable costs will decline for the HCPC. As a number of Members have pointed out, social workers make up the vast majority of the professions that are regulated—more than 25%—so there is an element of fixed costs. They are being helped by the establishment of Social Care England, and the costs are being met by the Government.
The HCPC currently regulates 16 professions. The hon. Members for Coventry South and for Ellesmere Port and Neston read out the list of professions, so I will not rehearse them all over again, but I reiterate my point: these valued professionals are performing crucial roles across the NHS and the wider health and care system. It is important that the public have assurance that those professionals are regulated. If they are regulated by the HCPC, the public knows that they are appropriately trained and hold the relevant qualifications, and that they meet the expected standards of conduct, performance and ethics. Where a professional falls below these standards, it is important that the HCPC is able to protect the interests of patients.
I take the point made by a number of hon. Members that the HCPC currently has the lowest registration fees of any UK-wide regulator in the health and care professions. It is clearly not right to look at that in comparison with some of the more highly paid professions, but it is true that the current annual registration is lower than that for a number of others, such as nurses and midwives. I also take the point that the proposal is for a large, one-off increase, but there has not been an increase for two years, and the registration fees are tax-deductible, so the increase will amount to about £1 a month.
A number of Members mentioned the disparity between the fees that are payable by part-time and full-time staff. I have listened carefully to that argument, and I will write to the HCPC to ask it to look at that more carefully. That seems to me to be a fair point.
A number of Members raised points about the consultation. The legislation that founded the HCPC required it to consult on any fee increase. Accordingly, it ran a public consultation, to which it received 2,396 responses. Some 95% of those responses were from professionals whom it regulates. It also engaged extensively with professional bodies, trade unions and other bodies ahead of and during its consultation. The draft response to the fees consultation was published with the HCPC’s council papers of 14 February. It is right that 90% of the respondents did not support a proposed fee rise.
However, it is fair to note that the majority of respondents also wanted HCPC to invest more in prevention and improved services, in increasing capacity, and in improving the quality and timeliness of the fitness-to-practise services that it delivers. Everybody accepts that no fee rise is popular, but the HCPC has been clear that the principal reason for this one is to allow it to deliver the services identified by registrants in the consultation.
Stephen Hammond
I listened to the hon. Gentleman, and I will make a promise to him. As I pointed out at the beginning of my speech, it is not the Government’s role to tell the regulator how to set its fees or what to set them for. However, I see no reason why the Professional Standards Authority should not ask the HCPC to give that reassurance and to publish that information. I will write to the hon. Gentleman when I have spoken to the PSA to ensure that it can do that within its remit. Given that it has oversight, I am sure that that will be possible.
Liz McInnes
It is my understanding that the changes to the HCPC rules will be subject to parliamentary approval. The Minister says that the Government will not be able to have any influence, so by what mechanism will the rule change be approved by Parliament?
Stephen Hammond
On oversight of the fee change, there is effectively accountability to Parliament through an order of the Privy Council. The Government will need to introduce an order of the Privy Council, which will be subject to the negative resolution procedure. The financial oversight is done by the PSA. The Government have to lay the order, but the oversight is done via the Privy Council.
As I said, there has rightly been much discussion this afternoon about the reason for the proposed fee rise. The HCPC makes the point that it has not raised its fees since 2015. It also rightly makes the point that the vast bulk of the fee rise is for the services that its registrants want. I promised to write to the hon. Member for Stroud (Dr Drew) about that.
I thank the hon. Member for Coventry South for raising this issue. The debate has highlighted his campaign. I have no doubt that the HCPC and the PSA will have listened, and will take regard of this afternoon’s debate. I hope that my remarks, the promise I made to the hon. Member for Stroud, and my commitment to write to the HCPC will help the campaign of the hon. Member for Coventry South. I am clear that registrants should continue to benefit from a regulator that provides value for money and services to its registrants; I know that the PSA will ensure that they do so.
Acute NHS Care: South-west Hertfordshire
Stephen Hammond Excerpts(5 years, 2 months ago)
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This information is provided by Parallel Parliament and does not comprise part of the offical record
The Minister for Health (Stephen Hammond)
It is a pleasure to serve under your chairmanship, Sir David, and to respond to my right hon. Friend. I want to say at the outset that one thing we absolutely agree on is what he said in his opening remarks. He expressed, in bringing forward this important matter for debate on behalf of his constituents, recognition of and admiration for the frontline staff. Even though I do not know the frontline staff in his area, I know from my visits in my short time as Minister and from my constituency experience that the professional care they deliver is admirable and extraordinary. We should never forget the effort they put in, and my right hon. Friend is right to acknowledge that.
Before I address specifics, and before what I suspect will be an iterative debate, I want to deal with two fundamental points, which I know my right hon. Friend knows, but are worth putting on the record. First, any service change in the NHS must clearly be based on clear evidence. Secondly, before any substantive change is made, patients and the public should be consulted. My right hon. Friend raised two interesting subjects on which we could have a debate of an hour and a half, or probably even three hours. One was local accountability in the NHS, in its wider sense and form, and how he is accountable as the Member of Parliament. The other was funding criteria.
My right hon. Friend has, I think, addressed two other Ministers on his passion for the longstanding need to improve the quality of hospital infrastructure in west Hertfordshire. That has been a stated aim of the Hertfordshire and West Essex sustainability and transformation plan since its inception. I know it is engaging in the process of looking at how a redevelopment and redesign of the hospital provision in west Hertfordshire can be achieved, working alongside NHS England and NHS Improvement.
I recognise that my right hon. Friend has real concerns and real scepticism about the work of the CCG. I hope he will recognise the work that the sustainability and transformation partnership is involved in in the hospital development process, and the fact that the director of strategy took part in a process and evaluation meeting in February 2019, at which a shortlist of our options was discussed. The STP is also due to take part in the next evaluation event.
I understand what my right hon. Friend says about the capital. I hear his criticism and scepticism of the West Hertfordshire hospitals trust, but it has been taking the lead in developing the strategic outline case for change. I understand that it and NHS Improvement had dialogue, and feedback was provided on the strategic outline case for the acute hospital redesign submitted by the trust. I also understand, as he will, that the feedback made two key points: it was clear, first, about the need for funding, and secondly, that the overall public money for hospital redevelopment is relatively limited.
My right hon. Friend has raised the issue of the £350 million; he knows that the turnover figure is a key criterion and a key threshold for capital investment, and that any options that significantly exceed the £350 million capital cost have been excluded from the current shortlist. He is obviously aware of a £750 million figure being used locally, but I must confess I am not aware of that figure. I would be delighted to offer him a chance to sit down and try to work out with me where that figure came in—recognising, as he rightly points out, that it will not be a Minister who makes any decision. If it is helpful to him, I am happy to have that discussion.
Sir Mike Penning
I had that discussion with the Secretary of State, a couple of days after he was appointed. It is not just Ministers that I pick on—Secretaries of State get it in the ear as well. There are two points I would like to touch on. First, how can it be fair to a community that, if it is just based on the turnover of a trust and that trust happens to be a very small one, the provision we get locally is second class? We cannot even go to that territory. Secondly, on the £750 million, I will ask the Minister to step in, because that is the figure being used locally to rule out the greenfield site. There was an evaluation panel, and members of the panel asked for the greenfield site to be put in, and fundamentally, it appears to me, they have been completely ignored.
Stephen Hammond
I made the point a moment ago that, because the cost of that greenfield site exceeds the £350 million threshold, it has currently been dropped from the shortlist of options. My right hon. Friend repeats a point that he made during his speech, questioning the criteria; he will know that I have heard what he has said. As he has just informed me, he has made a representation to the Secretary of State about that figure, and I have offered to have a meeting with him so that we can both explore it.
I do not think that, in the relatively short time available, I should get into the debate about the loan criteria, as I said at the beginning. We can have that debate at some other stage if my right hon. Friend wishes to put it forward, but he knows that at the moment the key threshold for capital investment would be the turnover, and therefore options that significantly exceed a £350 million capital cost have been excluded. As part of the option appraisal process, senior leaders and clinicians, as well as expert analysts, were involved in information gathering to put together the option evaluation. He will know that that included demand and capacity analysis based on population, hospital activity and operational planning.
With regard to reviewing that process, my right hon. Friend, as he said, wrote to both NHS England and NHS Improvement concerning the approval process. As he referenced in his speech, he forwarded to them an email from Professor Ron Glatter of the New Hospital Campaign. I understand that in that email, the professor requested a full statement of the outcomes of NHS Improvement’s review of the trust’s acute transformation strategic outline case.
In its answer, NHS Improvement has so far said that it has not started its formal review because the Treasury and the Department have not yet decided whether the proposal represents a scheme that can in principle be supported by central Government. I recognise the strength and effort of the campaigning for the new hospital option and I acknowledge the expert views that have been sought. While it is obviously not right for me to prejudge the answer from NHS Improvement, I know my right hon. Friend will recognise that I and the Department must take a wider view and that decisions made on capital funding must be the same for everyone across the country.
There has clearly been a huge amount of public engagement throughout the process, and I understand that further public engagement is planned for this month. Notwithstanding my right hon. Friend’s scepticism, I understand that the results of those consultations, in terms of the preferred way forward, will be taken to the trust board and the CCG in June 2019.
I recognise my right hon. Friend’s commitment to improving services; I assure him that the information provided by the New Hospital Campaign is being considered and will be considered as part of the review. As I said, it is not appropriate for Ministers to comment on specific decisions but, as he knows, the Government are determined to encourage innovation and to ensure that all patients have access to high-quality services. The updated proposal will clearly help to inform both the Department and the Treasury about capital allocations in the next spending review. I will not rehearse the arguments about the extra £33.9 billion of cash to support the NHS, or the additional capital and the bid we are putting forward in the comprehensive spending review.
Sir Mike Penning
If we accept that the rules at the moment are that any bid cannot be over the revenue income, which is the £350 million, can the Minister explain to me why, in Birmingham, the new build for 750,000 people cost between £300 million and £350 million, which we know because of the Carillion contract that collapsed, and the Royal Liverpool cost £335 million, yet we have been ruled out of having any new build on land that is actually owned by us—one of the sites is on Crown Estate land, public land—because it would exceed £350 million? I know he probably will not have the ability to answer that this second, but a letter in the next few weeks would be very helpful.
Stephen Hammond
As my right hon. Friend knows, all Ministers can make an attempt at an answer, but I am sure he would prefer a detailed answer. Therefore, I will make that detailed response to him, as he has asked, in a letter. I also know that he would like me to commit to the spending now, but he will know that I am unable to do so at this stage. I have listened carefully to his points about what might be the cost of the redevelopment that he believes should happen, and he will know that I have heard that. He will also know that I have heard the differences that he has pointed out between the supposed or quoted cost and the cost of build in other areas. He knows that I will have taken that on board.
At this stage, with just 30 seconds to go, I thank my right hon. Friend for bringing this matter to the Chamber and for making the case yet again for his constituents. He should know that the Minister and the Department have listened, and I will respond to him and have that meeting with him.
No-deal EU Exit: Medicines and Medical Products
Stephen Hammond Excerpts(5 years, 2 months ago)
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The Minister for Health (Stephen Hammond)
Today, I am updating the House on the Department for Health and Social Care’s plans for the continuity of medicines and medical products in the event we exit the EU without a deal.
My Department has been working closely with trade bodies, product suppliers, the health and care system in England, the Devolved Administrations (DAs) and the Crown Dependencies, to ensure the continuation of the supply of medicines and medical products to the whole of the UK in the event of a no deal EU Exit. This includes the NHS, social care and the independent sector and covers medicines (prescription, pharmacy and general sales list medicines); medical devices and clinical consumables (such as needles and syringes); supplies for clinical trials; vaccines and countermeasures; and blood, tissue and transplant materials.
Together with industry and the health and care system, my Department has analysed the supply chains of 12,300 medicines, close to half a million product lines of medical devices and clinical consumables, vaccines used in national and local programmes, and essential non-clinical goods on which the health and care system relies, such as linen, scrubs and food.
We have also assessed contract risks associated with potential no-deal EU exit in the broader NHS and social care sector in England and within the DAs and are working with suppliers to ensure adequate mitigations are in place for non-clinical goods and services (e.g. hospital food, laundry, IT contracts, etc.).
This has been a very large undertaking but we are grateful for the excellent engagement from all parties—our plans are well advanced as a result.
While we never give guarantees, we are confident that, if everyone—including suppliers, freight companies, international partners and the health and care system—does what they need to do, the supply of medicines and medical products should be uninterrupted in the event of exiting the EU without a deal.
My Department has well established routine procedures to deal with medicine shortages, from whatever cause, and works closely with the MHRA, the pharmaceutical industry, NHS England and others operating in the supply chain to help prevent shortages and to ensure that the risks to patients are minimised when they do arise.
There is no hard evidence to date to suggest current issues are increasing as a result of EU exit.
My Department has overall responsibility on behalf of the Devolved Administrations for ensuring the continuity of supply of medicines, and they have opted to utilise our contingency arrangements so we can work together to ensure the supply of medical devices and clinical consumables. Therefore, all supply arrangements take into account the whole of the UK, reflecting the engagement and co-operation of our colleagues in the DAs.
Around three quarters of the registered medicines and over half the clinical consumables the UK uses come from (or via) the EU. Government estimate that the key risk to supply is reduced traffic flow at the short straits crossing (ie between Calais and Dover or Folkestone).
My Department has put in place a multi-layered approach to minimise any supply disruption:
Building up buffer stocks and stockpiling before 29 March in the following areas:
Medicines: We have analysed 12,300 licensed medicines products. Around 1,800 of these were determined to not be relevant as no longer marketed in the UK.
For the remaining approximately 7,000 ‘POM’ (prescription-only medicines) and ‘P’ (pharmacy only medicines, that can be purchased only from a pharmacy without a prescription) with an EU/EEA touchpoint, we have been working with suppliers to ensure they increase their buffer stocks to hold at least an additional six weeks of stock (over and above usual buffer stock) in the UK before 29 March. The vast majority of companies have confirmed stockpiling plans are in place. For those medicines that cannot be stockpiled because, for example, they have short shelf-lives, such as medical radioisotopes, we have asked suppliers to make alternative routes using airfreight, which some suppliers already do now.
For general sales list (GSL medicines—also known as over-the-counter or OTC products), 500 of which have a EU touchpoint, we have worked with NHS England to identify those which are important for the management of specific health conditions, and are working with suppliers to assure contingency plans for those products.
Medical devices and clinical consumables: My Department has placed extra orders for the medical devices and clinical consumables which NHS supply chain routinely stocks. Although the NHS supply chain organisation normally only covers England, we have worked closely with the national procurement and logistics services in Scotland, Wales and Northern Ireland, to ensure their demand levels for the UK are covered. Not all suppliers have the capability to hold stock of their full product range in the UK and routinely supply product directly from EU distribution centres to care providers or patients. These suppliers are working on their own contingency measures; however, we have also put in place national contingency measures to provide a reliable and responsive means of moving product into the UK, including additional daily air freight capacity from Maastricht to Birmingham.
Blood, tissues and transplants: NHSBT manages the blood supply in England and is working to ensure there is no disruption to this. We are largely self-sufficient in blood and blood components and do not export or import these products in large quantities. In exceptional cases we export or import very rare blood for urgent clinical need, usually in single unit quantities. NHSBT has put in place stockpiles and other contingency arrangements to ensure a continuous supply of blood (including frozen plasma) and transplant materials. NHSBT has been collaborating with the other UK blood services and is working with its EU counterparts to ensure that the current organ exchange arrangements can continue post exit. The regulators are working with licensed establishments so the import of tissues and cells from EU countries can continue.
Vaccines and countermeasures: My Department is taking the same approach to the supply of vaccines and countermeasures as we are for the supply of medicines (in terms of stockpiling, warehousing and replenishment). Public Health England (PHE) manages significant stockpiles of vaccines for the national immunisation programme across the whole of the UK, as part of their business as usual planning. PHE is working with vaccine suppliers to ensure replenishment of these existing stockpiles continues in the event of supply disruption in the UK.
Supplies for clinical trials: We are working with organisations running clinical trials and have requested these organisations to consider their supply chains for clinical trials ahead of 29 March. We have requested that they ensure contingency arrangements are in place for their supplies. Supplies of clinical trials are transported in small quantities and usually via airfreight.
Non-clinical goods and services: We have been working closely with a range of NHS and social care providers and suppliers to ensure mitigations are in place for non-clinical goods and services (e.g. hospital food, laundry, IT contracts).
Buying extra warehouse space: To ensure sufficient space to store these products, we have agreed contracts for additional warehouse space, including ambient, refrigerated and controlled drug storage. Last week we updated industry on how they can access this additional storage.
Securing, via the Department of Transport (DfT), additional roll on, roll off freight capacity (away from the short straits) from 29 March.
Contracts have been signed by DfT with two ferry companies for the next six months. These routes are away from the Dover Straits where most goods flow from the EU and will run from the following routes: Cherbourg—Poole, Le Havre—Portsmouth, Roscoff—Plymouth, Caen—Portsmouth, Vlaardingen—Immingham, Cuxhaven—Immingham and Vlaardingen—Felixstowe. The Government have purchased the tickets from the shipping freight operators, and these will be sold on at market rate.
There is cross-Government agreement that all medicines and medical products will be prioritised on these alternative routes to ensure the flow of all these products may continue unimpeded.
Companies which supply medicines or medical goods will be offered the option of buying tickets on these routes and my Department is currently engaging with industry to ascertain the likely uptake levels.
We have worked with the pharmaceutical industry to ensure that planes are contracted to bring in medical radioisotopes under the appropriate specialist conditions.
Making changes to, or clarifications of, certain regulatory requirements so that companies can continue to sell their products in the UK even if we have no deal. The MHRA has for this scenario consulted on, and published, further guidance on how medicines, medical devices and clinical trials will be regulated. This guidance can be found at: https://www.gov.uk/government/publications/further-guidance-note-on-the-regulation-of-medicines-medical-devices-and-clinical-trials-if-theres-no-brexit-deal.
In August, the Government also published a dedicated technical notice on the unilateral recognition of batch testing of medicines, if there is no deal. This can be found at:
https://www.gov.uk/government/publications/batch-testing-medicines-if-theres-no-brexit-deal.
Strengthening the processes and resources used to deal with shortages. My Department has put in place legislation to enable Ministers to issue serious shortage protocols that, where appropriate, enable community pharmacies to supply against a protocol instead of a prescription without going back to the prescriber first. We are working closely with the DAs to ensure a common approach across the UK.
This multi-layered approach is essential: A combination of securing freight, buffer stocks, stockpiling and warehousing, and regulatory requirements, will be needed to help ensure the continuation of medicines and medical supplies in the event of a no-deal exit.
Local stockpiling is unnecessary and could cause shortages in other areas, which could put patient care at risk. It is important that patients order their repeat prescriptions as normal and keep taking their medicines as normal.
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