Oral Answers to Questions
Stephen Hammond Excerpts(5 years, 3 months ago)
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Gavin Newlands (Paisley and Renfrewshire North) (SNP)
The Minister for Health (Stephen Hammond)
The long-term plan explicitly recognises the importance of the workforce, and my right hon. Friend the Secretary of State has commissioned the chair of NHS Improvement to work closely with the chair of Health Education England in leading detailed work programmes to deliver an implementation plan. Social care plays a vital role in the forthcoming adult social care Green Paper, in which we will set out our plans to recruit, train and retain good people.
Gavin Newlands
The Minister is right about the workforce challenge for all four health services in the UK, but the number of students in England taking nursing degree courses in the past two years has dropped by 900; and at over 11%, NHS England’s nursing vacancy rate is more than twice that in Scotland. With a 90% drop in the number of EU nurses coming to the UK because of Brexit and fewer students starting degree courses because of the cost, is it not time to follow Scotland by reintroducing the nursing bursary and ending tuition fees?
Stephen Hammond
I am sure the hon. Gentleman will want to recognise the latest UCAS data for this year’s application cycle, which shows that, compared to the same time last year, there has been a 4.5% increase in the number of applicants for undergraduate nursing and midwifery courses. This is a significant improvement. He will also want to recognise that the loans system provides an extra £1,000. [Interruption.]
Mr Speaker
Order. Mr Luke Graham, calm yourself. You aspire to statesmanship, and I wish to cultivate and hone that legitimate aspiration—calm, Zen, statesmanship!
Derek Thomas (St Ives) (Con)
On Friday, I was privileged to take part in the launch of the health and social care academy in Cornwall. Cornwall NHS and social care providers have come together to train local students, including mature students, within the local health and social care provision without student tuition fees so that they can secure a job in Cornwall. May I invite the Minister to come and see the work we are doing and welcome this local innovation that is helping to address the NHS workforce challenge?
Stephen Hammond
My hon. Friend rightly points out that there are several routes into healthcare professions, and I am delighted by what is happening in Cornwall. I understand that my right hon. Friend the Secretary of State will be visiting him in the very near future.
Justin Madders (Ellesmere Port and Neston) (Lab)
We are in the midst of the worst-ever NHS workforce crisis, with more than 100,000 vacancies. The situation is unsustainable. Well-respected think-tanks say the figure could rise to 350,000 vacancies within a decade. What does the Minister consider a sustainable vacancy level both now and in a decade’s time?
Stephen Hammond
The hon. Gentleman will recognise that the £20.5 billion in real terms that we are investing in the NHS under the long-term plan will make a significant difference. He will also want to recognise the roll-out of medical places, the fact that more people are applying for nursing places now than they were last year and the detailed implementation plans that my right hon. Friend the Secretary of State has commissioned. These will deliver a sustainable workforce.
Robert Halfon (Harlow) (Con)
The Minister for Health (Stephen Hammond)
My right hon. Friend is aware of—and, indeed, welcomes— the Government’s commitment to providing an extra £20.5 billion in real terms for patient care over the next five years. Car parking charges are a matter for local NHS organisations, but most hospitals give concessions to some groups of users, such as patients who need extended or frequent access to hospitals.
Robert Halfon
Last year, the brain injury charity Headway said that it had paid a family £374 for hospital car parking charges. These charges are unacceptable. They are a stealth tax on patients, a stealth tax on the vulnerable and a stealth tax on staff. Will my hon. Friend scrap them once and for all?
Stephen Hammond
I commend my right hon. Friend for being a tireless campaigner on this matter. We have always made clear that staff, patients and their families should not have to deal with the stress of complex and unfair charges, and we introduced tougher guidelines in 2014, but I must stress that this is a local matter.
Tommy Sheppard (Edinburgh East) (SNP)
Tom Tugendhat (Tonbridge and Malling) (Con)
The Minister for Health (Stephen Hammond)
My hon. Friend has been absolutely passionate about securing the best possible outcome for his constituents. As he knows, the Edenbridge War Memorial Hospital is held by NHS Property Services on behalf of my right hon. Friend the Secretary of State. Local NHS bodies in Kent are considering the future of services in the Sevenoaks area, including their nature and possible funding. I am sure that my hon. Friend will recognise that I cannot intervene directly, but I would be happy to meet him to discuss this further.
Stephen Timms (East Ham) (Lab)
Stephen Hammond
I pay tribute to the hon. Lady for her courageous campaigning on this issue. There have been several reports looking into the events at the trust, and we understand that further detail would be helpful to realising her wish that those in senior positions be held accountable. I hope she agrees that the Kirkup report has provided the basis for that, and I am happy to meet her to discuss how the matter may be advanced.
Ben Bradley (Mansfield) (Con)
We all want a pipeline of talented staff entering our NHS. In many areas, the health service is a key local employer. Would the Minister welcome proposals for a specialist school in Mansfield, run in conjunction with our hospital trust, to ensure that we equip young people with skills and an aspiration to join our health service? May I meet him to discuss the matter further?
Stephen Hammond
My hon. Friend will have heard the answer that my right hon. Friend the Secretary of State gave about missed appointments, and I would be happy to meet my hon. Friend to discuss the situation in Mansfield. We encourage everybody to use technology to ensure that cancelled appointments are used for the benefit of others.
Stephen Morgan (Portsmouth South) (Lab)
Mental health services need proper staffing, but 2,000 mental health staff are leaving the NHS every month. How do the Government expect to achieve any ambitions in the long-term plan without adequate staff?
NHS 10-Year Plan
Stephen Hammond Excerpts(5 years, 3 months ago)
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The Minister for Health (Stephen Hammond)
I beg to move,
That this House has considered the NHS Ten Year Plan.
Thank you, Madam Deputy Speaker. You will understand that I am pleased not to have to follow my predecessor’s responsibilities.
As last year’s 70th anniversary celebrations proved, the NHS is one of this country’s proudest achievements. That is clear from the number of people who want to contribute to the debate this evening, so I shall be as brief as I possibly can. The Government’s top funding priority is the NHS. By 2023-24, the NHS budget will increase by £33.9 billion in cash terms, which is the equivalent of £20.5 billion in real terms. This means that in five years’ time the total NHS budget will be £148.5 billion.
In January this year, the NHS published the long-term plan, which sets out the priorities for the next 10 years of the service. The additional funding has given the NHS the stability and certainty it needs to make that plan for the decade ahead. The plan represents a historic moment for patients across the country. It was developed by NHS leaders and clinicians, in consultation with patients and the public, and Members can be assured that it focuses on the biggest priorities for patients in the next decade.
John Redwood (Wokingham) (Con)
Will the plan ensure that areas such as mine, which has fast growth and lots of new housing, will receive adequate resources to put in new surgeries and additional capacity, which has not happened in the past?
Stephen Hammond
My right hon. Friend will note that the plan includes the transformation that we will bring to primary care, which will look not only at how primary care will be developed and delivered, but at ensuring that there is enough money to deliver the changes.
The plan sets out a scheme that will provide the best support for patients throughout their lives—from getting the best start in life to being supported into old age. The plan sets out the transformation needed at every level of the health system to ensure that it can continue to provide world-class care. Part of that, as I have just said to my right hon. Friend, is a fundamental shift towards primary care and prevention. The plan will keep people healthy and out of hospital by boosting services closer to home.
Stephen Hammond
I am sure that there will be a number of excellent questions and interventions, but it was a good question. The plan sets out that all local health systems will be expected to outline this year how they will reduce health inequalities by 2023-24, and the intention is that that process will consider exactly the health inequalities that the hon. Member for Sheffield, Heeley (Louise Haigh) mentions.
Additional money for the primary sector will ensure that funding for primary medical and community health services, such as GPs, nurses and physiotherapists, increases by £4.5 billion in real terms in the next five years. That will mean up to 20,000 extra health professionals working in GP practices, with more trained social prescribing link workers within primary care networks. By 2021, all patients will be offered a digital-first option when accessing primary care. The plan also considers the future of the health system, and the new proposals for integration are the deepest and most sophisticated ever proposed by the NHS.
Dr Dan Poulter (Central Suffolk and North Ipswich) (Con)
The plan recognises that some proposals in the Health and Social Care Act 2012 were made in error when it comes to the transference of powers to public health bodies and local authorities. However, based on my reading of the plan, the omission from that list relates to addiction services. If we are serious about mental health and about improving care and reducing health inequalities in areas such as Sheffield, which was just mentioned, we need to get the commissioning of addiction services right and transfer that back to the NHS. Such services deal with some of the most vulnerable patients, but they are underfunded and failing to treat people, and the taxpayer is paying the price. Patients badly need those services, so will my hon. Friend take the matter up and give it a push?
Stephen Hammond
My hon. Friend makes a good point and urges me to take up the issue, which I will. He is obviously an expert in this field and will know that the Government have asked the NHS to come forward with proposals for legislative reform to support the long-term plan’s ambitions, and I will reflect on his comments in my thinking.
By 2021, every part of the country will be covered by integrated care systems, which will bring together local organisations, including local authorities, to redesign care and improve population health. They will become the driving force for co-ordination and integration across primary and secondary care. Any claim that such reforms might lead to privatisation are misleading. In fact, the Chair of the Health and Social Care Committee said that the proposals
“will not extend the scope of NHS privatisation and may effectively do the opposite”.
The NHS will invest more in preventing ill health and stopping health problems getting worse. That includes offering tobacco treatment services to all in-patients and pregnant women who smoke, establishing new alcohol care teams, and offering preventive treatments to more people with high blood pressure and other risk factors for heart disease.
Sir Paul Beresford (Mole Valley) (Con)
As my hon. Friend is probably aware, I have a part-time job in which I deal with a preventable disease: caries. In dentistry we spend £34 million to £38 million on this preventable disease. Will he consider looking seriously at how we could persuade local authorities to put fluoride in the water supply to prevent caries?
Stephen Hammond
My hon. Friend will know that the plan has much on prevention in primary care and public health. I offer to meet him, and I will listen carefully. He tempts me down a line that I would rather not go down tonight.
The long-term plan marks a huge step towards parity of esteem between mental and physical health. In the next five years, the budget for mental health services will increase by at least £2.3 billion in real terms. This additional funding will be used to fund a major expansion of mental health services for both children and adults. In addition to piloting four-week waits for children and young people, we will test waiting times for adult and older adult community mental health teams, and clear standards will then be set. Specific waiting times for emergency mental health services will take effect for the first time from 2020 and will be set to align with the equivalent targets for emergency physical health services.
Layla Moran (Oxford West and Abingdon) (LD)
The mental health budget is 10.2% of the current NHS budget. If the overall budget increases, will there be an equivalent rise in the mental health budget? The mental health budget has risen because the overall budget has increased, but the proportion allocated to mental health has not risen. If we are serious about tackling mental health in this country, why is the proportion allocated to mental health not higher?
Stephen Hammond
The hon. Lady will know that, as I said a moment ago, the long-term plan, for the first time, sets a parity between mental health and physical health. The mental health budget will increase by £2.3 billion by 2023-24.
Of course, everything we have been talking about here needs to be supported by new innovations and new technology. Patients can expect a radical reshaping of how the NHS delivers its healthcare using technology, so that services and users can benefit from the opportunities of advances in digital technologies. That includes making care safer, enabling earlier diagnosis and giving more independence to those managing different health conditions.
Additionally, it is vital that we build a more innovative NHS, which will help patients to be among the first in the world to benefit from life-changing new technologies. Last year, the Secretary of State announced his ambition to sequence 5 million genomes in the next five years, making the NHS the first national healthcare system to offer whole genome sequencing as part of routine care.
Most importantly, none of that will be possible without dedicated staff who are properly trained and supported throughout their career. The long-term plan sets out a strategic framework to ensure that, over the next 10 years, the NHS will have the staff it needs to ensure that the detailed plan can be implemented. Baroness Harding is leading an inclusive programme of work to set out a detailed workforce implementation plan, which will be published in the spring, but the plan is not about numbers.
Vicky Ford (Chelmsford) (Con)
On the future workforce, I thank the Government for investing in our new medical schools. We are enormously proud of the new medical school in Chelmsford, which is training 100 doctors a year—I understand it is 12 times oversubscribed for next year. I am also pleased to hear that nursing numbers are up, but what will the Government do to target support at areas such as mental health nursing and adult nursing, where we have seen numbers drop?
Stephen Hammond
My hon. Friend is right that we need targeted support, which is why we have looked not only at increasing the recruitment of nurses but at the retention packages that might be offered, particularly for certain specialties—she mentioned mental health nurses. We have looked at the possibility of issuing golden hellos, and we have looked at targeted support for childcare and travel.
Mr Philip Dunne (Ludlow) (Con)
My hon. Friend has been generous in giving way. I welcome the workforce implementation plan, and I welcome the fact that Baroness Harding, the chair of NHS Improvement, will be taking this work forward. Will my hon. Friend ensure that Baroness Harding looks at the retention of senior, experienced general practitioners under the general practice forward view? That issue has been raised in a number of areas. We are losing too many of them too early in their career, and the situation is similar with experienced consultants in our hospitals. A contributing factor is the annual allowance for pension contributions, where tax payments take away the extra gross income staff receive as they progress through their later years. Will my hon. Friend pick that up with the Treasury?
Stephen Hammond
I have listened carefully to my right hon. Friend’s intervention, and he will be pleased to know that discussions with the Treasury are ongoing about certain potential incentives to senior serving staff.
The plan is not just about numbers; it focuses on getting the right people with the right skills in the right place, ensuring that our dedicated staff are supported, valued and empowered to do their best. It has clear commitments to tackle bullying, discrimination and violence, and a programme of work to sustain the physical and mental health of staff who work under pressure every day and every night.
Grahame Morris (Easington) (Lab)
All good policies should be evidence-based, so let me ask the Minister about the national cancer advisory group, which prepares an annual report detailing the progress of the cancer strategy each year. That report was expected in October/November but it has been delayed. When will it be published? It may well inform the work of the 10-year plan.
Stephen Hammond
The publication date has not yet been finalised. I understand that it will be soon, but I will write to the hon. Gentleman to confirm the date of publication.
Through the long-term plan, we will ensure that the NHS continues to strive to be a world leader. It will continue to push the boundaries between health and social care, and between prevention and cure. It will be at the cutting edge of technology and innovation, while providing high-quality service for all patients. More importantly, it will always be there in our hour of need, free at the point of use and based on clinical need, not on the ability to pay. I commend the long-term plan to the House.
NHS Funding: Essex
Stephen Hammond Excerpts(5 years, 3 months ago)
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The Minister for Health (Stephen Hammond)
Sir Christopher, it is good to see you in your place and to take part in this important debate. I start, as I should, by congratulating my right hon. Friend the Member for Harlow (Robert Halfon) on securing another debate—his fourth—on this matter. He is well known for his tireless work on matters of healthcare in Harlow and across the whole of Essex. My right hon. Friend the Member for Witham (Priti Patel) described him a moment ago as a “warrior for Harlow”; I think that was in response to the compliment he paid her of being a “champion for Essex”. I listened to her speech and her earlier intervention, and I will say that, should she wish to, I would be delighted if she joined me in a debate next Tuesday on the 10-year plan.
My right hon. Friend the Member for Witham is of course right that this is an opportunity. We have set out a comprehensive plan, full of ambitions to link up healthcare, backed up by an implementation plan. I am hopeful, because this is the first time that has been seen. Layer on to that the integration of health and social care in the Green Paper, and I hope she will agree that those are steps forward.
My right hon. Friend the Member for Harlow has not only secured debates, but has had a number of meetings with my predecessor on a number of issues relating to the Princess Alexandra Hospital NHS Trust. I notice that today he welcomed the visit of my right hon. Friend the Secretary of State, who visited the trust two weeks ago. I know the Secretary of State was hugely impressed by the outstanding staff and the good work they do, and I have noted the kind invitation extended by my right hon. Friend the Member for Harlow to come to Harlow, which I accept; I look forward to coming later in the year.
On a number of occasions, my right hon. Friend has raised the proposal to build a new hospital, which demonstrates his commitment to what he and I both recognise as the most important issue in his constituency. The Government recognise that a number of trusts face estates challenges; that is why there is a commitment to upgrade the NHS estate, with £3.9 billion in capital investment for buildings and facilities by 2022-23. I will come on to the comprehensive spending review in a second.
I noted, of course, the interventions from other hon. Members. My hon. Friend the Member for Hertford and Stortford (Mr Prisk) made the point about Harlow’s importance to the wider health economy in Hertford and Stortford, and my hon. Friend the Member for Clacton (Giles Watling) reminded me that we must have the staff in the hospitals. The workforce section of the 10-year plan sets that out.
My right hon. Friend the Member for Harlow knows that the NHS’s buildings and services are being modernised and transformed through the sustainability and transformation fund investment. That money is going toward a range of programmes. I recognise that in July 2018 the trust put forward a revised bid for around £330 million, with potential for that to be funded through sustainability and transformation partnerships funding, private finance contributions and some land disposals.
I know that the bid was well supported and attracted a lot of careful attention but, as my right hon. Friend will recognise, there was strong competition from a range of schemes across the country; the fund was heavily over-subscribed and there was some rigorous prioritisation. I hope he will recognise that officials from both NHS England and NHS Improvement are working closely with the trust. They are supportive of the capital bid that has been put forward and are working with the trust on the programme to look at that bid for the future. They continue to develop the options to tackle the challenges that the people of Harlow and the wider economy face, and to secure that best outcome. I guarantee him that that work will continue, and that I will ensure that I take an interest in his scheme.
I know that my right hon. Friend will have recognised and welcomed a number of tranche 4 bids that did secure some money for the trust for additional bed capacity, improving emergency department performance and patient flow and reducing bed occupancy. That scheme represents a key part of the NHS trust’s plan to dramatically improve and transform the emergency care pathways. I acknowledge that that was not the scheme he wanted, but I hope he will recognise that it has been extremely helpful, and that the trust has made excellent use of that capital.
I know that my right hon. Friend will wish to acknowledge that there has also been wider recognition of bids from across Essex; there was money for Hertfordshire and West Essex in Luton, in the Hertfordshire and West Essex vascular surgery network and in West Hertfordshire hospitals. I hope he will agree that there is continued commitment from the Government to the NHS and to the patients in the wider region.
I will directly address the point that my right hon. Friend raised with the Chancellor of the Duchy of Lancaster. There will be further opportunities to access capital. As my right hon. Friend the Member for Witham pointed out, there will be a comprehensive spending review this year, in which we clearly have the chance to link up those things she mentioned; I entirely take her point on board. My right hon. Friend the Member for Harlow will recognise that the CSR will be when decisions on future capital allocations will be made for the next five years. The 2015 CSR first did that, and that has continued, and we expect it to happen in the next CSR. I assure my right hon. Friend that I have no doubt that the Chancellor of the Exchequer and the Chief Secretary to the Treasury will listen to his financial appeals for his constituents.
I hope that my right hon. Friend recognises the wave 1 and 2 capital funding secured during 2017-18 to support the redesign of the emergency department at the hospital. That was targeted very much at improving those facilities. I hope that he also recognises that that was on top of what I referred to earlier. I am sure he will support, as I do, the fact that that has gone into championing excellence in the paediatric emergency department.
My right hon. Friend mentioned the Harlow science hub and campus programme. Partly owing to his campaigning, there will be a new public health campus in Harlow, and I pay tribute to his efforts. I am pleased to say to him—as I am sure he knows—that that is still on schedule. A phased opening from 2021 will ultimately see approximately 2,700 people based there from 2024. Public Health England and the Princess Alexandra Hospital have discussed what other opportunities for Harlow’s wider health economy might arise from basing the campus there. I hope to be able to share with him more details on that in the near future.
I commend my right hon. Friend’s work in raising support for the Princess Alexandra Hospital NHS Trust’s bigger capital bid. I reassure him that there will be opportunities to access that capital in the spending review process in the latter part of this year. He challenged me on the timeline of that. As someone once closely associated with the former Chancellor, he will know that the Treasury does not easily give out its timelines. “Soon” or “this autumn” are probably appropriate answers to his inquiry.
On numerous occasions, my right hon. Friend has raised the estate issues facing the trust, in the House, in meetings with my predecessors and with the current Secretary of State. I look forward to accepting his invitation to continue working with him on this issue for the people of Harlow and for the NHS in Essex.
Question put and agreed to.
Leaving the EU: Reciprocal Healthcare Legislation
Stephen Hammond Excerpts(5 years, 3 months ago)
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The Minister for Health (Stephen Hammond)
Current European Union (EU) reciprocal healthcare arrangements enable UK nationals1 to access healthcare when they live, study, work, or travel in the EU and vice versa for EU citizens2 when in the UK. They give people retiring abroad more security; they support tourism and businesses and facilitate healthcare co-operation.
These arrangements ensure that UK nationals living and working in the EU, European Economic Area (EEA) and Switzerland can access healthcare in exchange for paying taxes and social security contributions. The UK also funds healthcare abroad for a number of current or former UK residents. This includes healthcare for UK state pensioners who spend their retirement in the EU and needs arising healthcare when UK residents visit the EU for holiday or study through the European healthcare insurance card (EHIC) scheme.
The Government’s priority is to secure a withdrawal agreement with the EU. However, as a responsible Government, we are preparing for all eventualities, including the possibility the UK leaves the EU without a deal. If necessary, the UK would like to make arrangements with individual EU member states to ensure that there are no immediate changes to people’s access to healthcare after exit day and that there is a strong basis for ongoing co-operation on health issues. The UK is therefore seeking to maintain reciprocal healthcare rights for pensioners, workers, students, tourists and other visitors in line with the current EU arrangements, including reimbursement of healthcare costs, for a transitional period lasting until 31 December 2020. This is only possible with agreement from other member states and we have commenced discussions on this issue.
The Healthcare (International Arrangements) Bill (the Bill) is being brought forward as a result of the UK’s exit from the EU; however, it is forward-facing and not intended to deal only with EU exit. The Bill is intended to support the implementation of comprehensive reciprocal healthcare arrangements with countries both within and outside the EU to enable possible future partnerships.
The Bill can be used to implement complex bilateral arrangements with a member state that may differ to current EU arrangements, or to make unilateral arrangements to assist UK nationals to access healthcare abroad in exceptional circumstances and in the interests of patient safety. The Bill also provides the legal basis to fund and process data relating to healthcare outside of the United Kingdom.
The European Union (Withdrawal) Act 2018 will convert EU law as it stands on exit day into UK domestic law and preserve the laws made in the UK to implement EU obligations. This means that EU regulations providing for EU reciprocal healthcare arrangements will become part of the UK’s statute book on exit day. Without further legislation, in a no-deal scenario the regulations would not be coherent or workable without reciprocity from member states. Therefore, on 7 February, the Government will bring forward two statutory instruments under section 8 of the European Union (Withdrawal) Act 2018, to prevent, remedy or mitigate deficiencies in retained EU law relating to reciprocal healthcare.
These instruments also afford the UK an additional mechanism for ensuring there is no interruption to healthcare arrangements for UK nationals3 after exit day in those member states who agree to maintain the current arrangements for a transitional period. Through these instruments, the UK can transitionally maintain current EU reciprocal healthcare arrangements for countries where we have established reciprocity during an interim period lasting until 31 December 2020 and no later. The arrangements would not apply to member states who do not agree to maintain the current reciprocal arrangements with us.
Together with the Bill, these instruments are focused on supporting a smooth transition as we exit the EU. Both of these legislative vehicles are necessary to ensure the UK Government are ready to deal with reciprocal and cross-border healthcare in any scenario. They afford the UK Government flexibility of action and ensure the UK is able to respond quickly to protect people’s healthcare.
The Bill and the forthcoming statutory instruments are intended to support further preparations the UK Government are making with regard to reciprocal healthcare arrangements. The Government have issued advice via the Government and NHS websites to UK nationals living in the EU, to UK residents travelling to the EU and to EU nationals living in the UK. This advice explains how the UK is working to maintain reciprocal healthcare arrangements, but that their continuation depends on decisions by member states. It sets out what options people might have to access healthcare under local laws in the member state they live in if we do not have bilateral arrangements in place, and what people can do to prepare. Our advice to people travelling abroad after exit day is to purchase travel insurance, as we already recommend now. These webpages will be updated as more information becomes available.
The Bill and the statutory instruments feed into a broader body of work by the Department of Health and Social Care and across the UK Government, to ensure health and social care systems are well prepared as we exit the EU.
1 This is a short-hand term for persons who are the responsibility of the UK. They may or may not be UK nationals.
2 This is a short-hand term for EU27/EEA/Swiss-insured individuals i.e. persons who are the responsibility of an EU or EEA member state or Switzerland.
3 Please see footnote 1.
[HCWS1304]
Kark Review
Stephen Hammond Excerpts(5 years, 3 months ago)
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The Minister for Health (Stephen Hammond)
On 23 May 2018, the House was informed that the Government had asked Tom Kark QC to carry out a review of the scope, operation and purpose of the fit and proper person requirement. Tom Kark has now completed his review having engaged on these issues with a range of interested parties, including the Care Quality Commission, NHS improvement, NHS England, and parliamentarians who had expressed an interest. We are today publishing his report on the review of the fit and proper person test as it applies to directors within the health services in England.
Our senior leaders are critical to the delivery of high quality and safe care in the NHS. We owe them our thanks and respect and we need to support them and ensure that they have the right skills and competencies to do these most challenging roles. The review underlines the importance of supporting the vast majority of NHS directors to do a good job and what more could be done in strengthening the leadership in the NHS.
Tom Kark has made seven recommendations and the Government accept in principle the recommendations to develop specified standards of competence that all directors who sit on the board of any health providing organisation should meet, and to create a central database of directors. We will consider all other recommendations including a mandatory reference requirement and a recommendation to introduce a power to disbar directors for serious misconduct. Tom Kark has also recommended that the fit and proper person test should be extended to clinical commissioning groups and appropriate arm’s length bodies.
It is important we consider this review alongside other proposals on leadership and development for NHS managers. I have therefore asked Baroness Harding to look at how best to implement these recommendations through the system wide workforce implementation process which she is chairing and which is set out in the NHS long term plan. We have asked Baroness Harding to consider a range of options and to ensure that she draws on the views of key partners.
I am keen to see the NHS open up to a diverse range of talented individuals from outside the NHS, beyond the traditional NHS background, and more with clinical backgrounds. Excellent NHS directors are vital to delivering a high standard of care and are committed to serving the needs of patients and service users. It is important that we focus on leadership and enhancing the strength of NHS managers as a profession, while dealing appropriately with the small minority of directors whose conduct raises concerns about their suitability for their post.
I would like to thank Tom Kark and his team for their work in delivering this important report.
A copy of the report has been deposited in the Library of both Houses.
[HCWS1301]
Draft European Qualifications (Health and Social Care Professions) (Amendment etc.) (EU Exit) Regulations 2018
Draft European Qualifications (Pharmacists) (Amendment etc.) (EU Exit) Regulations (Northern Ireland) 2018
Stephen Hammond Excerpts(5 years, 3 months ago)
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The Minister for Health (Stephen Hammond)
I beg to move,
That the Committee has considered the draft European Qualifications (Health and Social Care Professions) (Amendment etc.) (EU Exit) Regulations 2018.
The Chair
With this it will be convenient to consider the draft European Qualifications (Pharmacists) (Amendment etc.) (EU Exit) Regulations (Northern Ireland) 2018.
Stephen Hammond
It is a great pleasure to see you in the Chair, Mr Howarth.
The draft regulations aim to ensure continuity in the recognition of European economic area and Swiss health and care professional qualifications in the United Kingdom in a no-deal European exit scenario. The statutory instrument relating to Northern Ireland, which has been introduced here because the Northern Ireland Assembly is suspended, ensures that the approach to recognising health and care professional qualifications is consistent throughout the United Kingdom.
European health and care professionals make a major contribution to the national health service and the wider health and care system. Since 1997, more than 100,000 EEA and Swiss-qualified health and care professionals have applied to have their qualifications recognised in the United Kingdom, and more than 77,000 of them have been dentists, doctors, midwives, nurses and pharmacists. The Government have been clear that European health and care professionals will continue to be welcome after the UK leaves the EU, and the statutory instruments are part of ensuring that.
Arrangements for the recognition of professional qualifications within the EU is provided for by the directive on the recognition of professional qualifications, which will cease to apply if the UK leaves the EU without a deal. Changes to the domestic legislation that implements the directive are therefore needed to ensure that recognition of those EEA and Swiss qualifications can continue after EU exit, in the case of no deal. The directive provides for mutual recognition of EEA and Swiss professional qualifications within the EU and makes provision for harmonised education and training standards in seven professions, five of which are in health—doctors, dentists, nurses, midwives and pharmacists. The directive allows for recognition of listed qualifications that meet the harmonised education and training standards and provides for recognition under a general system for qualifications that do not meet those harmonised requirements. The directive also covers Switzerland and EEA nations.
It is worth noting, as I have said, that the UK has been a major beneficiary of the arrangements under the directive. Since 1997, the UK has recognised 77,000 EU qualifications in the automatically recognised professions. In contrast, fewer than 7,000 UK qualifications have been recognised in other EU states. The directive has helped with the recruitment of skilled professionals to the UK’s health and care sector and it is important that the arrangements that allow for continued recognition of health and care professional qualifications are in place if the UK leaves the EU in a no-deal scenario.
The two instruments that we are debating have three main effects. First, they put in place arrangements for the recognition of those EEA and Swiss professional qualifications that are currently recognised and provide for the continuation of recognition arrangements for those qualifications that are covered by the general system. Secondly, they ensure that applications for recognition that are ongoing at exit day can be completed under the current legal arrangements and, finally, they remove a number of provisions that would not be appropriate to maintain in the event of a no-deal Brexit.
I will set out the changes in a little more detail. The instruments put in place new arrangements for the recognition of professional qualifications that are currently automatically recognised. Such qualifications will become recognised overseas qualifications, or “relevant European qualifications” in the case of pharmacist qualifications in Northern Ireland. As such, they will continue to be recognised without additional testing, other than the checks for an applicant’s language skills and on whether there are concerns about their fitness to practise.
The regulations give UK regulators a new power to designate a qualification that is currently recognised automatically.
Vernon Coaker (Gedling) (Lab)
The Minister has just announced a major change, in that a UK regulator would determine whether qualifications were acceptable. Who sets the criteria for the regulator to determine that?
Stephen Hammond
I have said two things: that there will be new arrangements, so that professional qualifications that are currently automatically recognised will continue to be recognised without additional testing, other than checks for language; and that the regulations give powers to designate a qualification that is currently recognised. As yet, I have not said that there will be a new designation system.
Vernon Coaker
My understanding is that the regulator will determine whether a qualification is regarded as comparable. Is that the case? If so, who determines the criteria on which the regulator will make that decision?
Stephen Hammond
I will come to that a little later, if I may. The hon. Gentleman is right that we need to come on to that point, because some qualifications will be comparable and we need to ensure that the right regulatory system is in place.
As I was saying, designating a qualification will allow UK regulators to stop the automatic qualification, which is not possible under the directive. That is an important additional measure, which will enhance public protection. Such designation will be subject to Privy Council consent, or the agreement of the Department of Health in Northern Ireland in relation to pharmacists’ qualifications there.
The Secretary of State for Health and Social Care will review the arrangement for the continued recognition of automatic qualifications no later than two years after the regulations come into force. The review clause is important because it means that the arrangements put in place by the regulations will not remain indefinitely. It would be reasonable for hon. Members to ask what the review will cover. In short, it will cover whether it is appropriate for the near-automatic recognition of European qualifications to continue. It would not be right for me to predict what key factors there might be at that point in two years’ time, but I guess that hon. Members will make a judgement about which factors ought to be included in the review.
Vernon Coaker
The point I am trying to make is about the difference between automatic acceptance and the regulator determining that certain qualifications are not acceptable. I am trying to tease out from the Minister how that difference will be determined, between automatically accepted qualifications and those that are regarded as non-comparable. Who sets those criteria? That is the question for the Minister.
Stephen Hammond
It is the question. There is a system currently in place, as the hon. Gentleman knows, in which the regulator has powers to automatically accept qualifications. There is also a system in place for professionals from outside the EU and the EEA, which looks at regulatory qualifications and ensures that they comply with UK standards, which, at the moment, is the EU directive. Therefore, there is already a regulatory system for non-EU/EEA/Swiss citizens that sets those standards. If we were considering different standards to the current automatic recognition, it would be appropriate to use that process of regulation to give the regulator his authority to decide whether a qualification was acceptable. I hope that answers the hon. Gentleman’s question.
What I can say about the two-year review period is that it is important to have a widespread and encompassing review of the arrangements for recognition of all international healthcare. That will ensure that the process of recognising all the qualifications is effective and proportionate. If and when the arrangements for the recognition of relevant EEA and Swiss qualifications come to an end, a parliamentary review to determine the time when that happens will be appropriate.
The regulations, as I hope I explained in more detail in answer to the hon. Gentleman’s question, enable qualifications that are not covered by the automatic system to be considered by the relevant UK regulator and compared with the equivalent UK qualifications standard, as currently happens. They allow applications made before exit date to be concluded under the current arrangements, as far as practically possible. They allow individuals practising under temporary and occasional status, or under the EU professional card, to continue to do so until such registration expires.
The regulations also remove obligations and administrative arrangements that will no longer apply to UK domestic regulators when the UK leaves the EU. Those changes include the removal of provisions relating to cross-border temporary provision of services, which currently allow professionals in a member state to practise in another member state on a temporary and occasional basis without having to register fully; the removal of the requirement to share information through the European Commission’s internal market information system, to which UK regulators will no longer have access; and the ending of arrangements that allow professionals to practise in the EU using the European professional card. That card is underpinned by European Commission systems that will no longer be available to UK regulators.
Finally, the regulations remove the requirement on UK regulators to set professional education and training standards that comply with the standards set out in the directive. That will provide UK regulators with greater flexibility to set education and training standards that meet the needs of the UK’s health and care professions.
In conclusion, the regulations put in place a system for the recognition of EEA and Swiss health and care professionals if the UK exits the EU without a deal. They also ensure that applications that are in progress at exit day will be concluded under current arrangements as far as practically possible.
As I said at the outset, the UK places enormous value on the contribution of the EEA and Swiss-qualified professionals who work in the UK health and care sector. The regulations will facilitate the continued recognition of EEA and Swiss professional qualifications after the UK leaves the EU. I look forward to hearing the contributions of other hon. Members. The effect of the regulations is to ensure continuity of recognition of qualifications in the event of a non-deal EU exit.
Vernon Coaker
It is a pleasure to serve under your chairmanship, Mr Howarth. I wish to reinforce a couple of important points made by my hon. Friend the Member for Ellesmere Port and Neston from the Front Bench in his excellent contribution.
The hon. Member for Linlithgow and East Falkirk, who speaks for the SNP, talked about this, but these SIs are incredibly important. Tucked away in these regulations are all sorts of policy changes that will have huge implications for our constituents and our country. I want to mention a couple. Hon. Members might not have read all these regulations—I have not read all of the pages, but I have read some—but if, in a few weeks’ or a few months’ time, a no deal happens, we will have people coming to our constituency offices asking what has happened to change their working arrangements in this country. We will have to say, “We’re not quite sure; we’ll go back and have a look and see where that happened.” And it will have happened in Committees such as this.
I say this as an aside—I know that we have all said it—but one of the problems with SIs is that we cannot amend them. Let me give one example. My hon. Friend the Member for Ellesmere Port and Neston mentioned this, but one really significant change tucked away in these regulations is the removal of the right of EU and Swiss nationals who are working here on a temporary or occasional basis to do so. My hon. Friend set out how many people that covers. What will we say when a Swiss or EEA national turns up at our surgeries and says, “I am working here on an occasional or temporary basis”—or says that they wish to do so—“and my local hospital needs me”? The figures are there: 42 General Medical Council registrants, 88 other professionals, and so on. If one of those people comes to us and says, “I am no longer able to work here,” it will be this Committee that agreed that regulation.
I agree with my hon. Friend that we will not vote this measure, but why on earth is the Minister doing this? Why on earth are we saying to EEA and Swiss nationals who are working here on an occasional or temporary basis that they cannot do so?
Vernon Coaker
I will of course give way to the Minister, but the House of Lords Select Committee raised that point, so is he going to tell me that that has been changed?
Stephen Hammond
The hon. Gentleman is raising a number of serious and important points, as did the Opposition Front-Bench spokesperson—he was right to do so, and I will answer those points. However, the hon. Gentleman will be aware that at the moment the number of social and healthcare professionals working under the regime that he is describing is fewer than 160. Does he not agree that if people wish to work, or to continue to work, on a temporary or occasional basis, it might be more sensible, in the interests of public safety, for them to seek full registration? We are talking about a very small number. Surely full registration is the way forward.
Vernon Coaker
The implication of what the Minister has just said is that those people have been working in the NHS at the present time with sub-standard qualifications.
Vernon Coaker
That is exactly the implication of what the Minister has just said.
Stephen Hammond
It is not. The hon. Gentleman was citing the example of someone who wanted to work here on a more permanent basis and to use that regime to achieve that. If someone wishes to work under that regime, would it not be sensible to have full UK regulatory recognition?
Vernon Coaker
The Minister will give his answer, but this question has been raised by NHS professionals and by the cross-party House of Lords Select Committee that looks into these matters. Indeed, that Committee specifically said that the Minister should be questioned about the change, because it has serious concerns about the detriment to the NHS from removing the right of those people to work in this country under the occasional and temporary arrangements. The Minister may say it is only a small number, but if there is a no-deal scenario, let us see whether that small number start appearing at our surgeries and whether we have to explain why the current arrangements no longer apply.
I think the change is unnecessary. The system works very well now and allows people to move backwards and forwards. As my hon. Friend the Member for Ellesmere Port and Neston pointed out, this is a reciprocal arrangement. People from this country benefit from exactly the same arrangements when they go to other countries across Europe. It will be interesting to hear the Minister’s answer to my hon. Friend’s question about what he expects the reciprocal arrangements to be and how other European countries will respond to our doctors, nurses and other healthcare professionals seeking to broaden and extend their experience by working in other countries in Europe.
The Minister started to answer my earlier questions about qualifications that are not regarded as comparable. In his response to the House of Lords Committee, he said it would be a matter to be determined by the regulator. My hon. Friend has already raised this point, but given that different regulators will determine which qualifications are not comparable, will they all have different criteria? How on earth will there be any consistency? The bureaucracy will be enormous. What are the costs of that? What will the staffing arrangements be? Again, the House of Lords Committee, in response to what the Minister said, raised serious concerns about how that will be done. My hon. Friend is right: the Minister needs to lay out more clearly how he believes the NHS will not be detrimentally affected by the changes introduced by these regulations, should that be necessary in a no-deal scenario, given the numbers he pointed to—3,200 people being automatically registered and 1,500 being registered under the general system. Will the Minister also confirm, as I think he said earlier, that the language tests will remain exactly the same?
My final point refers to Northern Ireland. It is a general point for the Minister to take away and one that he should perhaps ask the Secretary of State to discuss in Cabinet. There is no Assembly in Northern Ireland. The explanatory memorandum says that, under the legislation passed by this House, the Government talk with officials in Northern Ireland to determine whether these or other regulations are acceptable. Without getting into the arguments about why that is occurring or not, the democratic deficit is quite significant. I wonder whether there might be a better, more informative way of proceeding than just to include a few lines saying, “We’ve consulted with Northern Ireland officials about whether these regulations will apply appropriately in Northern Ireland,” given the responsibility on us all, in the absence of a Northern Ireland legislature, to consider the impact of regulations on that part of the United Kingdom in a more appropriate way.
These are significant changes. The Minister says that a small number of people will be affected, but those receiving treatment from someone who will no longer be able to register under the temporary or occasional scheme will be asking how this Parliament passed legislation that is potentially detrimental to their healthcare. That is not the Minister’s intention, but these are appropriate questions for this Committee and the House to ask the Minister as we move into the unknown.
Stephen Hammond
I would like to reassure hon. Members that, while it is essential to the public’s protection that we put in place this legislation, I recognise that a number of important and significant issues have been raised. I also recognise the potential impact on patients and citizens of the whole of the United Kingdom of not getting this right. There have been a lot of questions, which I shall try to address in some sort of order, perhaps lumping together some of the points put to me.
Initially there was a lot of talk about the impact on the numbers. From the overall number of EU, EEA and Swiss health and care professionals practising in the United Kingdom, the number working in NHS trusts in England increased by over 3,500 in the 12 months following the referendum. That includes an extra 600 doctors. As of June 2017, over 21,000 EEA doctors were registered with a licence to practise with the GMC. The number of joiners from the EEA has remained steady since 2016; therefore, these regulations would allow that to continue. The hon. Members for Ellesmere Port and Neston and for Gedling might like to point out that there has clearly been a decline in registered nurses. That is a significant concern to the Department, and we have looked not only at the number of current vacancies resulting from EU nationals not coming forward but, as importantly, at the need to train, recruit and retain UK nurses, which is why there are a number of routes into nursing.
There are language issues. One reason for the nursing staff shortage in respect of EEA applications is down to the language controls introduced by the NMC, which took full effect in July 2016. Although some people might concentrate on the referendum as the contributory factor, the language testing is also judged to have had an impact. Therefore, since November 2017 the NMC has introduced a number of changes to the language requirements for nurses and midwives trained outside the UK, which has increased the options available to such applicants to demonstrate their language ability. The changes appear to be having a positive effect on international recruitment, with 2,500 more overseas joiners to the register between January and December 2018.
The hon. Member for Gedling asked about a slightly different language issue. I will confirm this in writing, but it is my understanding that we do not intend to change the language tests.
The temporary permissions argument is clearly of concern, and I have tried to address the hon. Gentleman’s questions about that. The numbers currently working under the regime are relatively small; however, that does not mean that they do not have a positive impact. It is right that under a new regulatory system people should seek full registration. However, over the EU exit day period and the period post that, the regime will continue. As temporary and occasional permissions last for up to 18 months, there will be plenty of time for those working under the regime to decide to apply for full registration.
The hon. Member for Ellesmere Port and Neston asked about the impact on UK professionals wishing to practise in the EU after exit day. I said in my opening remarks that it is the UK that is the main beneficiary of mutual recognitions. After exit day, professional qualifications awarded in the UK will no longer be covered by the directive, and the EU has agreed that holders of UK qualifications who have been registered in EEA countries and Switzerland will continue to be registered. However, in the absence of an agreement with the EU, recognition of UK qualifications after exit day will be determined by the national policy of the individual member state.
The hon. Gentleman and I have discussed reciprocal international healthcare arrangements on several occasions, both on the Floor of the House and in Committee, and he will recognise that the Government hope that a widespread and encompassing international healthcare reciprocal agreement will be in place with the whole EU after exit day—that is our ambition. In the event of a deal, during the implementation period the current arrangements will pertain and we can look to put in place such a treaty.
Stephen Hammond
One moment, and then I will. As the hon. Gentleman rightly knows, in the event of a no-deal EU exit—which is a lot of what we are talking about this morning—it is the Government’s ambition first to put memorandums of understanding in place and then hopefully to have a widespread agreement with the whole EU or, if not, individual arrangements with member states.
Justin Madders
We all hope that arrangements will be in place, but my question was: have any discussions been entered into yet with individual member states about the arrangements in a no-deal scenario?
Stephen Hammond
There are ongoing and widespread discussions with the Commission and with member states. A number of member states are of high priority because the numbers of UK nationals currently living there make reciprocal international healthcare arrangements particularly important. A number of issues are being discussed. Given the nature of the discussions, I hope the hon. Gentleman will accept that reassurance.
Dr Paul Williams (Stockton South) (Lab)
Is it not the case that the guidance issued yesterday says that in some cases the European health insurance card may not be valid or guarantee access to healthcare after 29 March and that it is the responsibility of individuals to check the healthcare arrangements with the countries they are visiting?
Stephen Hammond
The hon. Gentleman is correct. That is why we discussed in depth the reciprocal healthcare arrangements under the Healthcare (International Arrangements) Bill. Although it is absolutely the Government’s intention, in either a deal or no-deal scenario, to ensure continuity of international arrangements, at the moment that cannot be absolutely guaranteed. I hope the hon. Gentleman heard me say to the hon. Member for Ellesmere Port and Neston that it is the Government’s intention to ensure that, in the event of a no-deal scenario, memorandums of understanding will be put in place. We have already stated that anyone seeking emergency medical care, from wherever they come, will be treated by the NHS. We hope to ensure the continuity of current arrangements in a deal or a no-deal scenario.
To give Members a bit more flavour and depth, let me say, in response to both the initial inquiry, from the hon. Member for Ellesmere Port and Neston, and the inquiry from the hon. Member for Stockton South, that there is understandably a widespread agreement in this area that the current arrangements are to the mutual benefit of the healthcare systems of both the UK and the whole EU and should continue. In that light, very positive discussions are taking place, particularly with the countries where most UK nationals currently reside.
I do not need to write to the hon. Member for Gedling; I can confirm that the regulators will continue to apply the language tests as currently set out.
The hon. Member for Ellesmere Port and Neston talked about the loss of the internal market information system. If the UK exits the EU without a deal, it will no longer have automatic access to the EU systems, including the internal market information system, which regulators across the EU use to exchange information. We hope that the discussion about international healthcare arrangements will continue, but it may well be the case that UK regulators have to seek information from their European counterparts directly, rather than from the Commission. UK regulators are aware of that and are preparing for it, although, as I have said, that may well be part of the discussions about international arrangements and encompassed in a future bilateral or EU-wide international healthcare arrangements agreement. However, the regulations mean that UK regulators will not be required to carry out more assessments of European qualifications than they do now and they will allow bilateral applications for information.
Justin Madders
The Minister has been very generous in giving way. We should be clear that, as things stand, the early warning system will not be in operation. It is important to express our concern about that and our sincere wish to put in place an arrangement to avoid it.
Stephen Hammond
The hon. Gentleman is absolutely right to raise that concern, but as I have sought to reassure him, it will be perfectly possible for UK regulators and EU regulators, either in whole or individually, to exchange information. It will be possible under this arrangement for UK regulators to seek that information from their individual European counterparts, should they need to do so.
The hon. Gentleman asked about the capacity of regulators to check qualifications. Although it is not the Government’s intention or desire to have a no-deal outcome, regulators have been preparing for that possible scenario. These regulations will ensure that there will be little additional work for regulators in recognising EEA and Swiss qualifications at exit date. Under the regulations, the regulator can choose to review automatic qualifications that it was previously obliged to accept and to designate those qualifications where there are patient and public safety concerns. An applicant will be obliged to supply the regulator with the relevant documents, and if the regulator is not satisfied, it can reject the application. My point is that there is no extra administrative burden on regulators.
On the potential for an additional financial burden, the UK and the regulators have been preparing for a possible no-deal outcome. As the regulations seek to maintain the current systems as far as possible, for at least two years from their coming into force after the expected exit day until the review, there should be little extra cost or impact. There is, as the hon. Gentleman pointed out, the potential for regulators to recover those costs through additional fees, and that is true of current regulatory systems, in many cases.
The hon. Members for Ellesmere Port and Neston and for Linlithgow and East Falkirk asked whether the regulations reduce the ability to safeguard public and patient safety, making the health service less safe. At the heart of these instruments is the recognition that public protection and patient safety must be the foremost ambition; therefore, public protection is the key purpose of regulating health and care professionals. The instruments provide the regulators with the necessary powers to protect the public by introducing the power to designate EEA and Swiss professionals, who they are currently obliged to accept automatically. In addition, they will still be able to check applicants’ language skills and, as I confirmed to the hon. Member for Gedling a moment ago, the language tests will not change.
I was asked about the review process. It is appropriate that a two-year review of the regulations is put in place, which will potentially be wide-ranging and encompassing. The regulations are intended to be subject to review two years after they come into force. As I said earlier, it would be wrong of me either to limit the scope of the review or to predict the factors that may be in place at the time. I am often asked by the hon. Member for Ellesmere Port and Neston and others to commit to reviews of regulations and other legislation, and, as we are committing to a review after two years, I hope that he will accept my assurance on that.
Several hon. Members, including the hon. Member for Linlithgow and East Falkirk, asked me about the impact assessment. There is no significant impact. The impact for the instrument falls below the £5 million threshold of the annual net direct cost to business, as detailed by the business impact target. There is no significant impact on business, and no significant direct impacts have been identified as a result of the changes. Hon. Members have asked about the potential impact regarding allowing recognition so that EEA and Swiss professionals who are valued in the health service can continue to practise in the UK post-EU exit day in a no-deal scenario. That is the impact, and the regulations seek to minimise it. They put in place sensible measures to ensure that that recognition can happen.
Finally, I was asked about whether the regulations support cross-border co-operation between Northern Ireland and the Republic of Ireland. The regulations ensure the continued recognition of Irish professional qualifications in the UK for at least two years after exit day. They allow professionals practising under an existing and temporary or occasional status to continue until the end of that—
Vernon Coaker
Will the Minister give way? I think he misunderstood what I asked.
Vernon Coaker
To clarify, I was not talking about the cross-border arrangements. I was making the point about whether, in the absence of the legislative Assembly in Northern Ireland, instead of having two or three lines saying, “We’ve discussed this with Northern Ireland officials and that’s fine,” we need to give more detail to our discussions about that.
Stephen Hammond
Not at all. The hon. Gentleman is right to ask whether, in the absence of an Assembly in Northern Ireland, the Pharmaceutical Society of Northern Ireland can assess EEA and Swiss pharmacist qualifications that are not covered by automatic recognition—he recognises, of course, that the automatic recognition system is there. These regulations will ensure there should be little change in those. The PSNI will continue to recognise pharmacist qualifications that are within the scope of the automatic system at exit day. Those who do not hold a qualification currently within that scope will be registered with the General Pharmaceutical Council before registering with the PSNI. That is a continuation of the current practice. I am happy to keep this issue under review and to make it part of the discussion with Northern Ireland officials.
With those remarks, I hope that I have managed to satisfy hon. Members’ inquiries, and I commend both sets of regulations to the Committee.
Question put.
Healthcare (International Arrangements) Bill
Stephen Hammond ExcerptsMonday 21st January 2019
(5 years, 3 months ago)
Commons ChamberRead Full debate Healthcare (European Economic Area and Switzerland Arrangements) Act 2019 View all Healthcare (European Economic Area and Switzerland Arrangements) Act 2019 Debates Read Hansard Text Read Debate Ministerial Extracts Amendment Paper: Consideration of Bill Amendments as at 21 January 2019 - (21 Jan 2019)
The Minister for Health (Stephen Hammond)
It is a great pleasure to bring the Bill to its Report stage tonight. Before I address new clause 1 and amendment 1, it might help the House if I set out with clarity what the Bill actually does. It provides the powers to fund and arrange payments for healthcare for UK residents, or indeed former residents, outside the UK as well as to share the necessary data to facilitate this. In a deal scenario, the Bill’s powers would support the Government’s attempts and motivation to implement a future relationship with the EU from 2021 and bilateral arrangements with individual member states, should the EU agreement fall short. In a no-deal scenario, the powers would ensure that the UK was prepared for any outcome. This could include implementing any negotiated reciprocal healthcare arrangements, which might differ from the current EU arrangements, or making unilateral arrangements for UK nationals in order to assist with accessing healthcare abroad in exceptional circumstances.
I am grateful to the hon. Member for Ellesmere Port and Neston (Justin Madders) for tabling new clause 1, because it gives me the opportunity to reiterate what I said in Committee about the important issue of financial reporting and facilitating parliamentary scrutiny. I note that, in Committee, the hon. Member for Burnley (Julie Cooper) tabled exactly the same provision as new clause 1, and that it was defeated. I said at the time that I recognised the new clause as a device that Oppositions always used. That does not make it any less relevant, but I explained that the Government were committed to openness when it came to the managing of public money. Expenditure by the Department of Health and Social Care relating to EU reciprocal healthcare arrangements is currently published in this place in the form of annual resource accounts, and will continue to be so. However, given that we do not know the provisions and administrative processes of future reciprocal agreements, the Government are once again unable to accept the proposal. As now, the Department’s future expenditure on reciprocal healthcare would be subject to the existing Government reporting requirements.
However, the hon. Gentleman’s new clause asks the Government to place a statutory duty on future Administrations to collect and report on data, which we have not yet agreed to exchange with other countries. This cannot be appropriate. The frequency and detailed content of a financial report should and could be determined only when reciprocal healthcare agreements have been reached. Currently, the UK and other EU member states are able to collect data and report both nationally and at EU level, as provided for in the relevant EU regulations. Spending on EU healthcare is reported as part of the Department of Health and Social Care annual report and accounts laid before this place.
My Department is currently working to ensure that UK nationals can continue to access healthcare in the EU in exactly the same way as they do now, either through an agreement at EU level or through agreements with the relevant member states. In either case, we will have to agree how eligibility is evidenced, the way in which and frequency with which that information is exchanged and, of course, the reimbursement mechanisms that will govern the new agreements.
Lady Hermon (North Down) (Ind)
I have listened closely to what the Minister has said. It would be helpful if he could offer some reassurance to Irish citizens living in Northern Ireland who, under the terms of the Good Friday/Belfast agreement, are entitled to regard themselves as Irish citizens, British citizens or indeed both. I presume that their rights will continue unchanged in Northern Ireland after Brexit. Am I right?
Stephen Hammond
The hon. Lady is completely correct. We explored that in Committee, and discussed the purposes of the common travel area. Indeed, there was an explicit debate in Committee on the arrangements for Northern Ireland. I am happy to confirm that to her.
Each of the agreements that we are seeking to strike could differ from country to country. Such agreements will have to take into account the operational possibilities and limitations of each contracting party, to ensure the smooth operation of reciprocal healthcare arrangements. This should include how NHS trusts in the UK can evidence eligibility for the treatment of non-UK citizens in the most efficient and least burdensome manner. Only when these technical details are known will the Government be able to speak confidently to the specific measures that we can report on for each country. Regardless of the specifics of any arrangements entered into, and as with all departmental expenditure, reciprocal healthcare costs are and will continue to be authorised by the Treasury supply process and to be included in the Department’s annual estimates, as well as being included in the annual resource accounts, which are audited by the Comptroller and Auditor General. I said in Committee that I hoped that the hon. Member for Ellesmere Port and Neston would be satisfied by that commitment to transparency, and I give that commitment again tonight. With that, I hope that he will feel able to withdraw new clause 1.
Turning to amendment 1, the hon. Member for Ellesmere Port and Neston again raised the important issue of appropriate levels of parliamentary scrutiny. The Government clearly recognise the importance of such scrutiny for this Bill and for secondary legislation made under it. The hallmarks of an effective and responsible parliamentary system are the processes by which we draft, consider and test legislation, and the appropriate parliamentary procedure for the scrutiny of regulations made under this Bill is the negative resolution procedure. The exception to that is where provision within regulations is needed to make consequential changes to amend, repeal or revoke primary legislation. Consequently, the Government are once again resisting that amendment.
As I have said previously, the powers in this Bill provide the Government with both the flexibility and the capacity to implement detailed and complex arrangements concerning healthcare access abroad. The remit of our regulation-making powers is tightly focused. They can be used only to give effect to healthcare agreements or arrange, provide for or fund healthcare abroad. Therefore, the subject matter to which the regulations relate is narrow. I say again that when regulations amend, repeal or revoke primary legislation, they will of course be subject to the affirmative resolution procedure, which is the appropriate level of scrutiny for such powers. However, where statutory instruments do not make changes to primary legislation, and deal with procedural, administrative or technical provisions, they should be subject to the negative resolution procedure, and that is reflected in our approach to this Bill.
We have been clear about our intentions for reciprocal healthcare in the context of exiting the EU. In the short term, our policy is to maintain the current system of reciprocal healthcare with the EU on a transitional basis until the end of 2020. That would happen automatically if there is an implementation period, and it is something that we are seeking to agree individually with member states in the event of no deal.
Kevin Foster (Torbay) (Con)
I welcome the Minister’s confirmation of the Government’s intentions behind this Bill. Will he confirm that the nonsense we heard from the shadow Minister about funding hip operations in Arizona is absolute tosh? While the shadow Minister may be enthusiastic about the healthcare system in the United States, will the Minister confirm that we are not?
Stephen Hammond
My hon. Friend is right. I said continually in Committee and I say it again now that this Bill is tightly focused in terms of the regulations that can be made under it. We want long-term reciprocal healthcare arrangements with the EU or relevant member states, and that is the Bill’s focus.
When the UK negotiates an international healthcare agreement in the future, the most important elements setting out the terms of that agreement would, as Members should expect, be included in the agreement itself. Such agreements are likely to contain all the detail of which Parliament should have due consideration, such as who is covered under the terms of that agreement. In contrast, the regulations implementing the agreement would not include anything fundamentally new. They would contain the procedural, administrative and technical details, such as the types of documents or forms to be used. It is therefore right that regulations issued under this Bill be subject to the negative procedure. That is an appropriate use of parliamentary time. Were we to accept amendment 1, it is likely that this Parliament would find itself debating whether the forms required to process reciprocal healthcare arrangements should be changed. That would clearly be a misuse of Parliamentary time.
I once again reassure the House that Parliament will have the opportunity to undertake appropriate scrutiny of future binding healthcare arrangements. Where we strike a comprehensive healthcare agreement with the EU or with individual member states, that agreement would be subject to the appropriate parliamentary scrutiny. Part 2 of the Constitutional Reform and Governance Act 2010 sets out the process under which Parliament can review what are intended to be legally binding healthcare agreements. That provides an opportunity for parliamentary scrutiny in respect of the substance of healthcare agreements. Implementation of such an agreement, if that is by way of regulations under the Bill, will then be subject to its own scrutiny before ratification of the healthcare agreement.
Everyone in this House wants reciprocal healthcare arrangements. Overwhelming support for reciprocal healthcare has been shown throughout the passage of this Bill, including in Committee during the evidence sessions with the expert witnesses. We heard directly from several Members and evidence was presented, and there is a clear desire for current arrangements to continue.
Stephen Hammond
I beg to move, That the Bill be now read the Third time.
We have had a productive debate on the Bill, and I am grateful to all Members, including those who recently contributed, who have engaged so constructively with the passage of the Bill and demonstrated a shared commitment to protecting the healthcare-access options of UK nationals in the EU. The support shown to the Bill throughout its passage shows the value of reciprocal healthcare. I wish to put on record my appreciation for the consensual approach shown by all parties in the House, and particularly to note the contributions from the hon. Members for Burnley (Julie Cooper) and for Ellesmere Port and Neston (Justin Madders). Not only in Committee but on Report, they raised objections but were very helpful in respect of the passage of the Bill.
Although the Bill is short, it is nevertheless important. The powers it contains will ensure that we are prepared, whatever the outcomes of exiting the EU are, and also that we are able better to implement complex reciprocal healthcare agreements with members and non-member states. Powers under the Bill will enable the UK to fund and give effect to our future relationship with the EU on reciprocal healthcare. The Bill allows us to look to the future. The powers it contains will allow us to implement strengthened reciprocal healthcare arrangements, or new ones with countries outside the EU. It is necessary to provide the Government with the powers to ensure a smooth transition from our current relationship with the EU to the future one.
Let me take this opportunity to thank those Members who served on the Public Bill Committee, in particular my hon. Friend the Member for South West Devon (Sir Gary Streeter) and the hon. Member for Blackley and Broughton (Graham Stringer), who ably chaired the Committee. I reiterate my thanks to those who gave oral evidence to the Committee and to those who provided written evidence, including Mr Alastair Henderson, Mr Raj Jethwa, Ms Alisa Dolgova and Ms Fiona Loud. Their expertise and perspectives were vital in understanding the importance and impact of reciprocal healthcare arrangements to medical professionals, insurers and, most importantly, the patients. I also put on record my thanks to my officials, who have guided me through this process.
As a responsible Government, it is important that we plan not only for every eventuality currently before us but for the future. The Bill is intended to provide reassurance to UK nationals living in the EU or those planning to travel to the EU. Again, I thank Members for their support. I commend the Bill to the House.
Oral Answers to Questions
Stephen Hammond Excerpts(5 years, 4 months ago)
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Jim McMahon (Oldham West and Royton) (Lab/Co-op)
The Minister for Health (Stephen Hammond)
Good morning, Mr Speaker. The NHS employs more staff now than at any time in its 70-year history, with a significant growth in newly qualified staff since 2012. We have increased the number of available training places for doctors, nurses and midwives, and taken further actions to boost the supply of nurses, including offering new routes into the profession and encouraging those who have left nursing to return. The long-term plan, which was announced last week, sets out the framework to ensure that the NHS has the staff it needs.
Neil Coyle
Guy’s and St Thomas’s, which is based in my constituency, offers globally renowned, first-class healthcare, but the trust has seen a massive drop in applications from other EU member states, including of almost 90% in midwives alone. All vacant posts across the NHS present the risk of longer waiting times and risk patient safety, so why did the Government not publish the workforce strategy in the so-called long-term plan? When will it appear? Will the Government reinstate nursing bursaries to address the shocking staff shortfall across the NHS?
Stephen Hammond
As I said a moment ago, the long-term plan sets out a framework to ensure that, over the next 10 years, the NHS will have the staff it needs. To ensure that we have the detailed plan the hon. Gentleman wants, my right hon. Friend the Secretary of State has commissioned Baroness Harding to lead a rapid and inclusive programme of work to set out a detailed workforce implementation plan, which will be published in the spring.
Helen Jones
Fifty per cent. of the staff the NHS will need in 15 years’ time are working there now, yet one in 10 nurses is leaving, 80% of junior doctors report excessive stress and six out of 10 consultants want to retire at 60 or before. Does the Minister not accept that this Government have presided over a disastrous decline in morale in the NHS, and will he say what the workforce plan will do to address it?
Stephen Hammond
Nurses are at the absolute heart of our NHS. There are 13,400 more nurses since May 2010. We have announced the biggest expansion of nurse training places, with 5,000 more available from 2018. Alongside that, we are opening up new routes. As the hon. Lady will know, the workforce is at the heart of the long-term plan and, as I have just said, a detailed workforce implementation plan will be published in the spring.
Stella Creasy
Last week, a 14-year-old boy lost his life in my local community, yet in September, when the Department wrote to my local community asking for ideas about mental health provision, I wrote back to Ministers asking for an urgent meeting to talk about how we could get mental health workers into our schools to work with young people who might be at risk of being involved in gang violence and youth violence. With the shortage of mental health workers at a rate of one in 10, can I finally have that meeting with Ministers so that we can talk urgently about how to support such young people and save not only money, but lives?
Stephen Hammond
The answer to that question is yes. The Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Thurrock (Jackie Doyle-Price), will be delighted to meet the hon. Lady.
Jim McMahon
The most recent Care Quality Commission inspection of the Royal Oldham Hospital said that it failed to meet safe staffing numbers in maternity and it only had 85% of the required staffing contingent in surgery. There is a human cost to that. We see list after list where people have died, including children, because of unsafe staffing numbers in that hospital. Where is the urgency that is required to address that? Will the Minister meet me about this particular hospital to see what more can be done?
Stephen Hammond
The hon. Gentleman is right. I recognise that the overall CQC rating was that the hospital requires improvement. I understand that the funding that has gone into it has been more than adequate and that it is improving. However, I recognise the concerns he raises and I would be delighted to meet him to discuss them.
David Tredinnick (Bosworth) (Con)
Will my hon. Friend congratulate Conservative-controlled Hinckley and Bosworth Borough Council’s health and wellbeing board, and its approach to NHS workforce shortages? It has, for several years, been working on collaboration between GPs and community services, which is in line with the 10-year plan. Will he look at the registers of the Professional Standards Authority, which are not mentioned in the long-term plan, and see if he can make better use of the 80,000 properly regulated practitioners on those registers?
Stephen Hammond
My hon. Friend is right to recognise that community provision lies at the heart of the long-term plan, and that a number of health service professionals make up that community provision. If he wishes to write to me about registers, I will be delighted to respond.
Victoria Prentis (Banbury) (Con)
The Minister knows about our difficulties in recruiting obstetricians, which has led to what we very much hope is the temporary closure of the full obstetrics service at Horton General Hospital in Banbury. We are doing everything we can locally to rectify that situation. What more can the Minister do to help us nationally?
Stephen Hammond
I pay tribute to my hon. Friend’s campaign and her tireless work on behalf of her constituents. Figures from the Royal College of Midwives show that there are over 2,000 more midwives on our wards since 2010. The NHS plans to train 3,000 more midwives over the next four years, and as of last September there are over 5,000 more doctors in obstetrics and gynaecology than there were in May 2010. The NHS is hoping to fulfil what my hon. Friend wants to see.
Mr Philip Hollobone (Kettering) (Con)
Will the Minister confirm that since the Brexit referendum in June 2016 there has been an increase of 4,000 EU nationals working in our NHS?
Stephen Hammond
My hon. Friend and I do not always agree on everything about the EU, but numbers and statistics show that he is correct on that matter.
Bob Blackman (Harrow East) (Con)
Clearly, it is important as we move forward with the NHS to train more doctors and nurses. What is the Minister doing to encourage young people to start training to become nurses, doctors, and for other positions in the health service?
Stephen Hammond
My hon. Friend is right, and we are ensuring more routes into the nursing profession, such as nursing apprenticeships and nursing associates. We are training more GPs, and we are determined to get 5,000 extra GPs into general practice. A record 3,400 doctors have been recruited into GP training and, as part of the long-term plan, newly qualified doctors and nurses entering general practice will be offered a two-year fellowship to support them to stay there.
Justin Madders (Ellesmere Port and Neston) (Lab)
The long-term plan admits that staffing shortfalls are “unsustainable”, yet incredibly there is no mention anywhere in the document of the damage done by the abolition of the nursing bursary. The plan contains an ambition to double the number of volunteers within three years, and although we should rightly celebrate the fantastic contribution made by volunteers, is it not damning that, with a record 100,000 vacancies in the NHS, the main plank of the Government’s strategy to tackle the workforce crisis is to rely on volunteers?
Stephen Hammond
The hon. Gentleman is right to say that volunteers in the NHS provide an invaluable service, but he is completely wrong to suggest that any part of the long-term plan relies on volunteers. There is an expansion in numbers of nursing associates to deal with those vacancies and, as I have said to other hon. Members, we have seen an increase in the number of doctors in GP training. Obviously, he will welcome the £20.5 billion a year that is going into the national health service. That will inevitably mean more doctors and nurses, which is why we are making more training places available.
Wes Streeting (Ilford North) (Lab)
Karen Lee (Lincoln) (Lab)
The Minister for Health (Stephen Hammond)
Our policies have allowed the NHS to recruit over 13,400 more nurses into all wards since 2010. Additionally, we have increased the number of available nurse training places, offering new routes into the profession and encouraging those who have left nursing to return to practice, alongside retaining more of the staff that we have now.
With your permission, Mr Speaker, I was so enthusiastic about the number of extra staff in the national health service, I might have inadvertently misled my hon. Friend the Member for Banbury (Victoria Prentis): it is 500 obs and gynae doctors since 2010.
Mr Speaker
In calling the hon. Member for Lincoln, I congratulate her on her birthday.
Karen Lee
You are very kind, Mr Speaker. The latest Care Quality Commission report on Lincoln County Hospital found sufficient nursing staff on only four of the 28 days reviewed and a heavy reliance on agency staff. As people know, I was a cardiac nurse for 12 years, and I can tell the House that agency nurses are expensive and create extra work—often they cannot do IVs and they are not familiar with paperwork, so the regular nurses end up doing half their jobs for them. Will the Secretary of State explain to the House why the NHS long-term plan has no policy on effectively tackling understaffing and no mention of reinstating the nursing bursary, which enabled nurses like me to train?
Stephen Hammond
The hon. Lady is right: we want to see more nurses in the NHS. That is why we have provided funding to increase nurse training places by 25% and why the long-term plan will have a detailed workforce implementation plan. She talked about the bursary, but since that was replaced nurses on current training schemes are typically 25% better off. Alongside that, additional funds support learning.
Rachel Maclean (Redditch) (Con)
I welcome the fact that my local trust has 94 more nurses than in 2010. What is the Minister doing to ensure greater retention of nurses at my local hospitals, so that they have their own nurses instead of relying so much on agency nurses?
Stephen Hammond
As I said earlier, nurses are absolutely the heart of our NHS, and my hon. Friend is right about the extra number of nurses at her hospitals. She is also right that retention is one of our big issues. That is why the Agenda for Change pay award was put through last year, why we are working with Health Education England to look at other retention methods and why we are increasing the number of training places to ensure that we not only retain nurses but recruit more into the national health service.
Julie Cooper (Burnley) (Lab)
I join you, Mr Speaker, in wishing my colleague a happy birthday. I acknowledge that no one knows better than she does about the crisis in nursing staff levels. At the same time, the shortfall in GPs has risen to 6,000, and a third of all practices have been unable to fill vacancies for over three months. Unsurprisingly, waiting times for GP appointments are at an all-time high. As ever under this Government, it is patients who suffer. The situation is set to get worse, with more practices destined to close this year. Why are the Government not taking urgent action to tackle that? When will we finally see the workforce implementation plan that has been promised?
Stephen Hammond
The hon. Lady asks about GPs. As she would want to acknowledge, a record number of doctors are being recruited into GP training. We are determined to deliver an extra 5,000 doctors into general practice. NHS England and Health Education England have a number of schemes in place to recruit more GPs and to boost retention—the GP retention scheme and the GP retention fund—and she will know, as I have said it twice this morning, that the workforce implementation plan, which is part of the long-term plan, will be published in the spring.
Andrew Selous (South West Bedfordshire) (Con)
Mr Robert Goodwill (Scarborough and Whitby) (Con)
The Minister for Health (Stephen Hammond)
My right hon. Friend is right to welcome the announcement for Scarborough Hospital, and I understand that the full business case for the redevelopment of Whitby Hospital is going through the Hambleton, Richmondshire and Whitby governing body for approval on 24 January. I am assured that the clinical commissioning group remains supportive of the redevelopment of Whitby Hospital and, if it is helpful, I would obviously be delighted to meet him after 24 January.
Barbara Keeley (Worsley and Eccles South) (Lab)
This Government’s cuts to council budgets have meant that 100,000 fewer people received publicly funded social care over the past three years, and 90 people a day died while waiting for social care last year. What does the Secretary of State think it says to their families that the social care Green Paper and the meaningful funding settlement have been delayed again?
Andrew Lewer (Northampton South) (Con)
Stephen Hammond
Departmental officials have worked alongside the council to engage with Shaw Healthcare to identify the causes and explore the solutions to minimise the number of empty beds under the PFI. Through improved contract management and regular meetings with Shaw, significant improvements are being made, and contract changes are under discussion to further improve performance. This aligns with the Department’s best practice centre for PFI contracts, as the Chancellor announced in the Budget—
Mr Speaker
Order. I appreciate the natural courtesy of the Minister in looking in the direction of the person questioning him, but the House wants the benefit of his mellifluous tones, so he should face the House. We are grateful to him.
Helen Goodman (Bishop Auckland) (Lab)
Stephen Hammond
The hon. Lady will know that in the long-term plan we have committed to ensuring that more people are treated and that more money is spent in hospitals. The decision on closure is for local organisations, as she will know, but, as I have said to other hon. Members, my door remains open and I would be delighted to meet her.
Gordon Henderson (Sittingbourne and Sheppey) (Con)
Mohammad Yasin (Bedford) (Lab)
Stephen Hammond
A number of MPs, including the hon. Gentleman, have raised issues about the trust’s performance, and a range of actions have been put in place. He will be pleased to know that I met the performance director in December. I have been discussing several support mechanisms involving both the NHS and the Department, and I continue to receive reports. He will also be pleased to hear that the trust’s performance improved over December.
Maria Caulfield (Lewes) (Con)
Children’s hospices provide vital support for children with life-limiting conditions and their families at the most difficult of times. I welcome the £25 million of extra investment in these services, but what more can be done to support children’s hospices across the UK?
Winter Preparedness
Stephen Hammond Excerpts(5 years, 4 months ago)
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The Minister for Health (Stephen Hammond)
This Government recognise that winter, with demand placed on services with colder weather and seasonal flu, is a challenging time for the NHS as it is for health services around the world. DHSC Ministers meet weekly with our systems leaders in the NHS to ensure that our services are equipped for winter to support those who need them.
We have been busier than ever, but our NHS has been rising to the challenge over the festive period.
The latest data to November shows that compared to last year, we have seen 3.6% more attendances per day at A&E, and that over 1,600 more patients per day were seen within four hours so far this year. Despite that, the published NHS winter operational updates show that in December there have been fewer ambulance handover delays and diverts to other A&Es compared to last year. This means ambulances spend less time at hospitals and more time on the roads reaching patients.
Ahead of winter
We started the run up to the winter period with over 2,200 more doctors and 1,600 more nurses on our wards than just a year ago, bringing the total increase since 2010 to 16,500 more doctors and 13,400 more ward nurses
We also increased NHS funding by £1.6 billion at the start of this year, to support and improve A&E and elective care performance.
On top of this, in advance of winter, more than £420 million has been provided to help the NHS this winter:
£240 million for adult social care—allowing councils to plan to provide care for 40,000 more people.
£145 million capital funding to hospitals for winter improvements—to upgrade wards and redevelop A&Es—the benefits of which the NHS expects will bring the equivalent of an additional 900 beds.
£36.3 million has been invested into the ambulance services for new vehicles and ‘make-ready hubs’. This will pay for more than 250 new ambulances, with 100 delivered by Christmas Eve.
The NHS has continued to work to improve services in advance of winter, to help people avoid a hospital visit or admission, and get them home quickly if they do have to stay. This has included:
Increased access to GP appointments at the evening and weekends. The latest figures (August 2018) show that full extended access was available for 40 million people, which is an increase of over 4 million from March 2018.
Fully embedded clinical streaming in A&Es following our investment ahead of last winter of £100 million, which means patients are directed to the most appropriate service.
Improved NHS 111. Half of calls to NHS111 now receive clinical input and ahead of this winter we have rolled out 111 online across the country so that the public can access care advice and services through digital channels and reduce additional pressures on A&E. 91% of the population have access to NHS Digital’s 111 online service.
Work to standardise services provided by urgent treatment centres and increasing public awareness of this as an alternative to A&E for minor illness and minor injury.
Increased implementation of ‘hear and treat’ and ‘see and treat’ by ambulances—reducing unnecessary conveyance to hospitals.
Joint working between hospitals, councils and other local partners to reduce long lengths of stays in hospital and helping improve transfers to community and social care. The published NHS winter operational updates show that the number of beds occupied by patients staying more than 21 days in hospital on average per day is down by more than 2,000 (12.5%) this winter so far, when compared to the equivalent period last year.
Extending the flu vaccination programme—already the most comprehensive in Europe—even further. Vaccination remains the best line of defence against flu and this year, we have more effective vaccines available than ever before.
This winter we have also encouraged all healthcare workers to be vaccinated, are funding the vaccination again for frontline social care workers, and have extended the offer to staff giving direct care in the voluntary managed hospice sector. Free vaccine eligibility has also been extended to include children up to nine years old (Year 5) so that all two to nine year olds are now offered the vaccine.
Performance over the next few weeks
The NHS continues to make some progress in rising to the seasonal challenges, but we also know that there is no room for complacency at this early stage of winter.
There are clearly a number of hospital trusts where the situation has been challenging. The most recent statistics showed that 75% of all 12-hour trolley waits occurred in just 10 trusts.
In addition, NHS England and NHS Improvement continue to monitor NHS performance daily. They are supporting hospitals nationally and, working with regional teams, will maintain a close grip and oversight during winter of their performance.
The Care Quality Commission will be continuing to monitor hospital services over the winter months with over 30 visits to hospital emergency departments planned. The CQC is able to undertake further visits in response to any emerging risks identified.
And we will go further to support this through our long-term plan to guarantee the future of the health service—backed by an extra £20.5 billion a year in real terms by 2023-24.
[HCWS1232]
NHS Reorganisation
Stephen Hammond Excerpts(5 years, 5 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.
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The Minister for Health (Stephen Hammond)
It is a pleasure to serve under your chairmanship, Mr Gapes. It is a pleasure to respond to the hon. Member for Warrington South (Faisal Rashid). I am pleased that he secured this debate, and I agree with him that the NHS is a great credit to our country. I know that the Opposition spokesman will have heard me say yesterday—I will repeat it—that the Government and I, as Minister for Health, greatly value the staff who work in the NHS. It is our absolute intention to ensure that they recognise that and that we continue to show that.
I want to start with a few facts, because having listened to what the hon. Member for Warrington South described, I think there are other things that are worth pointing out. There are 11,000 more nurses in the NHS than there were in 2010. There are 18,200 more doctors than in 2010. Almost nine out of 10 patients are seen within four hours in an emergency department. We are committed to 5,000 training places for doctors in general practice—this year saw 10% more than we aimed to achieve. Of course, this is the highest level of funding that the NHS has had in its 70 years. The hon. Gentleman raised a number of other issues, as did the Opposition spokesman, and I will try to respond to those in my speech.
The hon. Member for Mitcham and Morden (Siobhain McDonagh) made a contribution. I have immense respect for her. Anyone who knows her knows that she always argues her case passionately and stands up for her constituents, and she did that again today. She and I have occasionally shared joint endeavours on St Helier Hospital. I think we both agree that there is a substantial case for keeping the acute services there. I think we would both agree—I say this in a constituency capacity—that the infrastructure needs upgrading, and I think we have had that discussion. She rightly points that we have had another consultation this year. As a Minister, I say that we expect any significant service changes to be subject to exactly the full public consultation she has described, if it is going to happen, and that the proposals must meet the Government’s four reconfiguration tests, which are support from GP commissioners; strengthened engagement with the public; clarity on the clinical evidence; and clarity and consistency with patients’ choice. She says that there have been rounds of consultations, as I certainly saw when I was on the council—I think she was already a Member of Parliament then—under Governments of all colours over the past 20 years.
It is the same with the hon. Member for Strangford (Jim Shannon). I have had the pleasure of taking interventions from him in several debates. He is always a powerful advocate for his constituents. I listened carefully to his point about out-of-hours care, which may have been slightly out of the scope of the debate. Yesterday, I had the chance to visit the North Middlesex University Hospital. Some of its work on the integration of out-of-hours care and triaging in A&E moves along the lines that he discussed. I have seen that several times.
To address the crux of the debate, between 2016 and 2036, the UK population is expected to increase from 65.6 million to 71.8 million, which is a growth rate of about 10% in 20 years. In the same period, the number of people aged 75 and over is expected to grow by 64% from 5.3 million to 9 million. Those figures are clearly something to celebrate, showing that the NHS is doing exactly what we want it to, but they mean that more will need to be done to make sure that those years are quality years.
For the NHS to continue to deliver high-quality care in the next 20 years, as it has done for the last 70 years, we need to look at new models of care that promote more joined-up care across the NHS and social care. In the past few years, the Government have supported a number of pilots at local and national levels to test new models of care that bring together the NHS, local authorities and wider public services to develop new ways of ensuring that services are delivered in a more joined-up way. Those areas have seen some improvements in access to services, patient experience and moderating demand for acute services.
It is time for the NHS to move beyond those pilots and embrace wholesale transformational changes across the whole system in every part of the country. It is therefore developing a 10-year plan for its future, which is underpinned by a five-year funding offer. To support the NHS in delivering for patients across the country, the Government announced a new five-year budget settlement for the NHS, in which funding will grow on average by 3.4% each year to 2023-24. The hon. Member for Strangford, who has just left the Chamber, welcomed the fact that that means the NHS budget will increase by more than £20 billion compared with today, underpinning the 10-year plan to guarantee the future of the NHS.
The hon. Member for Warrington South remarked on sustainability and transformation partnerships, and commented on his own local STP. The Government are fully committed to NHS England’s vision of STPs transforming how care is delivered and putting the system on a sustainable footing for the future. We will back STPs where they are clinically led and locally supported.
The hon. Gentleman questioned some aspects of local democracy. Each partnership has to set out agreed priorities and say how they are going to be delivered, and have a strategic priority to work with partners in local authorities. The Cheshire and Merseyside STP is making some progress in building those relationships, but he is right to acknowledge—I acknowledge it as well—that it is an extremely large and diverse area.
Clearly, the hon. Gentleman and the hon. Member for Ellesmere Port and Neston (Justin Madders) will recognise that there are now nine local footprints, including Warrington Together. The idea is that they will develop some of the integration suggestions and plans, and the consultation with local authorities to which the hon. Member for Warrington South referred. The STP brings local areas together to tackle the challenges, and I think he would acknowledge that it makes sense to do that across a bigger area, so the smaller areas build into the larger area.
Last week, the Government announced that they were supporting the Cheshire and Merseyside STP with £11 million in capital spending for improving emergency department capacity at the St Helens and Knowsley Teaching Hospitals and for a 12-bed, tier-4 child and adolescent mental health services unit at Alder Hey Children’s Hospital. The hon. Member for Ellesmere Port and Neston challenged me on STPs, so I will say that, in their more mature form, they are integrated care systems that promote collaboration between NHS bodies, local government and local communities. The 10-year plan will set out how they will spread the integrated care models that have been developed and tested through the whole vanguard programme.
There was also a challenge about what were formerly known as accountable care organisations and are now called integrated care providers, with several questions about that. At a small number of sites, commissioners are looking at how contractual models can support more integrated care. To support that, NHS England has developed the draft integrated care provider contract which, if introduced, will give the NHS the option of having a single lead provider that is responsible for primary, community and hospital services, with the aim of integrating services across traditional silos.
If NHS England chooses to introduce a contract for the ICPs, Parliament will have a chance to debate the regulations. I recognise that the regulations are subject to the negative procedure, so there is not an automatic debate, but as the hon. Member for Warrington South will have spotted, in those circumstances, if Parliament decides, there will be an opportunity to have that debate. NHS England has recently concluded the public consultation on the draft ICP contract and we expect a response in due course.
I want to touch on the premise that the ICP contract is privatisation. It is completely misleading to suggest that an integrated provider model is a step towards privatising the health service. The NHS will always offer free healthcare at the point of use—that is not just the Government’s view. I am sure that the Library briefing that the hon. Member for Strangford challenged me to read notes the evidence from the Health and Social Care Committee, whose Chair, my hon. Friend the Member for Totnes (Dr Wollaston), said that the evidence received by the inquiry into integrated care—the report was published in July 2018—was that ICPs
“and other efforts to integrate health…and social care, will not extend the scope of NHS privatisation and may effectively do the opposite.”
That is quite powerful and I hope that the hon. Members for Ellesmere Port and Neston and for Warrington South take note.
Justin Madders
I know what the Select Committee said; I am interested in what the Government are saying. Is the Minister ruling out any private provision from ICPs?
Stephen Hammond
I am not ruling out private providers from bidding, but it has been made clear, and I say again, that we expect any ICP contract to be won by NHS bodies. As I said, the evidence to the Select Committee inquiry tends to support that that is our view and that is what is likely to happen.
The Government have made it clear that the change is not about reorganising the NHS from the centre or adding more layers to an already complex system. As the Prime Minister reiterated in her speech in June, the Government should learn the lessons of the past and not try to impose change on the NHS. To achieve that, we firmly believe that any changes to the model of care for patients need to be locally led, informed by knowledge of the population and the population need, and supported by clinicians on ground.
That is why we have asked local leaders in STPs and integrated care systems to create five-year plans detailing how they will improve local services for patients and achieve financial sustainability. Of course, this is something that we may want, but it cannot just be wished into being, which is why the Government are supporting the NHS with £20 billion of additional funding.
Local plans will build on the work of the last three years to develop new ways of delivering services and enhance collective efforts to use that additional funding to improve people’s health and wellbeing. It is essential that that process proceeds in a spirit of genuine partnership and that all local partners, including local government, are fully involved from the outset.
For any significant system reconfiguration, we expect all parts of the system to be talking to the public regularly; it is vital that the public shape the future of their local services. That relates directly to the point that the hon. Member for Mitcham and Morden made earlier. To make it absolutely clear, no changes will take place without public consultation and engagement.
After all, the aim of integrating services is not an end in itself; it is to improve the patient experience and quality of care, so it is essential that the views of the public should be at the heart of local plans. Integrated care means a health and care system built around people’s needs, whereby physical, mental and social care needs can be addressed together, and patients should feel as if their care is being provided by one organisation.
Integration also gives us the means to avert ill health, preventing unnecessary hospital visits and supporting patients to have happier, healthier lives into old age, and taking the pressure off NHS staff. For example, in Thanet, the Margate Task Force is an integrated service that brings staff from 16 different agencies together in a single “street-level” team.
In conclusion, integrated care provides the best opportunity to ensure that the NHS continues to deliver the highest level of quality services to people and to meet the demands of the 21st century. The Government have supported the NHS to implement the five-year forward view and to develop new integrated ways of working to meet those demands. It is now time to drive those initiatives and spread them across the whole country. That is why we are committed to those plans and it is why we have committed to increase the NHS budget, to support the national move towards integrating care.