Gaza Border Violence

Debate between Alistair Burt and Julie Cooper

Tuesday 15th May 2018 Commons Chamber

[Alistair Burt]

I am grateful for the hon. Lady’s comments, which I appreciate very much. The statement she quotes is not one with which I agree. I think there have been other statements from Israeli Ministers that everyone in Gaza is a terrorist or that there is no such thing as a peaceful march. The truth is that a lot of people were taking part in the march for perfectly proper reasons: to express their concern about the despair and the hopelessness that we talked about earlier. Equally, it is true to say that there were those who knew that they could exploit it and did so. But the blanket condemnation of everyone in these circumstances does not help a proper understanding of those circumstances, and the hon. Lady is right to draw attention to such comments.

[Julie Cooper (Burnley) (Lab)]

In the festering hellhole that is Gaza, everyday life is extremely difficult. The World Health Organisation has long raised concerns about access to adequate medical care on a routine basis for Palestinians living in Gaza. What assurances can the Minister give to the 3,000 victims injured yesterday that they will be supported with proper medical care?

[Alistair Burt]

As I indicated earlier, we take such concerns extremely seriously, and they are one of the issues we raise. If we want a normalisation of relations, and if we want to decrease the sense of bitterness and upset, ordinary humanitarian considerations have to be a prime concern. We will continue to raise these issues and work very closely with UNRWA and the WHO. We recognise that there are particular pressures at the moment, but joint and combined work between Israel and those in Gaza might help to break down some barriers. We will do all that we can to support it.

Junior Doctors Contract

Debate between Alistair Burt and Julie Cooper

Friday 20th November 2015 Commons Chamber

[Alistair Burt]

Medical studies have demonstrated that there are a number of extra deaths at weekends. The disputes about that are intense, but the medical profession recognises that the absence of facilities, the absence of consultant cover on the level it ought to be at, and the absence of diagnostic tests and other things, make entry into the health service at the weekend less secure than it would be at other times of the week. It is very important to change that. That is what the public voted for at the general election and that is what they expect the Secretary of State to deliver. That that should be held up by an industrial dispute, essentially by a union digging its feet in and not taking the opportunity to negotiate, is unfortunate and bad news for the patients my hon. Friend referred to.

[Julie Cooper (Burnley) (Lab)]

Does the Minister accept that his insistence that junior doctors do not understand the conditions is deeply insulting to some of the most intelligent people in the country? Does he accept that this shabby and patronising treatment has led to a total breakdown in confidence in the Secretary of State, and that the only way forward is through ACAS, an independent body?

[Alistair Burt]

The Secretary of State has gone out of his way to seek to explain to doctors the basis of the contract, partly to deflect what was said about it originally by the BMA during the course of the industrial dispute. He will continue to do that. There is no doubt that we all value the work of junior doctors enormously and fully appreciate that they will be looking very hard at their conditions and everything else. Proper union representation is not delivered by a union that refuses to negotiate after three and a half years and after independent recommendations have been made. I urge the hon. Lady, who also has a valuable role in the NHS in relation to pharmacy and a deep interest in carers, to recognise what will happen for those 50,000 or 60,000 elective admissions that will not be able to take place, to think about those who will be involved and to continue to stress, as I know she will, that negotiations are the answer and that conciliation is available if they are not successful.

Hospital Parking Charges (Exemption for Carers) Bill

Debate between Alistair Burt and Julie Cooper

Friday 30th October 2015 Commons Chamber

[Alistair Burt]

As I have said, the opportunities for discretion exist, but perhaps the way in which discretion is exercised is something that the carers strategy can look at.

It was this Government who passed the Care Act 2014. For the first time, carers—as well as those they were caring for—were given the right to be assessed by a local authority. We gave an extra £400 million for respite care, to be used by those who needed it during the last Parliament. It is therefore reasonable, given the availability of the carer’s allowance and the other measures I have mentioned, for the Government to indicate that carers are valued in ways that they have not been in the past. There has been an incremental increase in support for and recognition of the carer’s role over the years.

I stand four-square behind what my colleagues have done. The Secretary of State’s determination to devise a new carer strategy, on top of what is already there, is a recognition of the fact that more might well need to be done, but it also recognises the value of carers. Nothing we have heard today on either side of the House, including some graphic examples, has suggested that we do not value carers.

Before I respond to the points on car parking charges, I should like to mention the speeches that have been made today. The hon. Member for Burnley set out her case extremely well, and I shall come back to that in a moment. My hon. Friend the Member for Shipley (Philip Davies) is a necessary piece of grit in the oyster of the workings of Parliament. Mrs Thatcher said that every Government needed a Willy, but in addition, every Parliament needs either an Eric Forth or a Philip Davies. They remind us that, at the end of the day, this is not a game. If we pass a piece of legislation, it has consequences and, accordingly, it has to be right. Occasionally, my hon. Friend will say things that people find uncomfortable, but he is just doing his job.

The process of a private Member’s Bill is not easy. Indeed, as I go on talking for a while this afternoon, there will be plenty who say that these processes should be handled differently, but they are not. This is the way in which some things are examined. My hon. Friend made a good speech. Above all, he talked about the problems of economics that I referred to earlier. There are many things that we would all love to do, but often we cannot. We have to make choices. When the Government of the hon. Member for Worsley and Eccles South were in office, they had to make choices, and so do we.

The hon. Member for Birmingham, Perry Barr (Mr Mahmood) made a strong personal plea for the Bill. He mentioned patients on dialysis, and I would like to reassure him that those patients are already covered in our principles as frequent out-patient attenders. The amendment that we have just made to our provisions will ensure that carers of patients on dialysis will be covered by the guidance.

My hon. Friend the Member for Bury North—God bless it!—(Mr Nuttall) went into forensic detail about the Bill. I ask him to convey my good wishes to all at Fairfield hospital, which I remember very well. Both my children were born there, and my wife still has a plaque up on the wall from when she opened a piece of equipment there. My hon. Friend also went into forensic detail when he described the difficulties that would be created by the Bill. He gave it a necessary examination.

The hon. Member for Heywood and Middleton (Liz McInnes), whom we should thank for her services to the NHS over many years, made it clear how passionate she felt about this issue. In a perfect world, everything would be wonderful, and she finished by saying that it would be great if everyone could park for free at hospitals. They cannot do so, however, because the money would have to be found from somewhere. I will come back to that point in a little while.

My hon. Friend the Member for Solihull (Julian Knight) detailed his own personal campaigning for fairer charges in his constituency. He is a perfect example of how an MP of any party can take up an issue and how, when something is wrong that can be worked through, it can be done in a local capacity. He provided a series of perfect examples of what to do as a local Member.

The hon. Member for Ealing Central and Acton (Dr Huq) made a passionate plea for change. My hon. Friend the Member for Christchurch (Mr Chope) examined the Bill in depth, especially in relation to clause 1. He gave examples of where the present discretionary arrangements could work to people’s advantage, and we will come back to those later. If there was no example anywhere of guidance and of opportunity for discretion being used, then the strictures of the hon. Member for Burnley would be much stronger. The fact is that discretion is used in some areas. Various figures were quoted: some 63% of hospitals do not charge, and some 86% or 87% offer discretion. That allows local areas to take notice of the principles and make their own decisions about what is necessary.

May I just add a word about the phrase “postcode lottery”, which is a favourite of mine? A postcode lottery implies a situation in which there is no chance to do anything about it. Many of the things in modern political life that we term postcode lotteries are not postcode lotteries at all, because they all contain the opportunity for people to make a difference, or to change things. The point of local discretion and of transparency in the delivery of services is precisely that it enables people who represent an area to say, “Why isn’t it as good here as it is next door? What is it they are doing that we are not?” They can then apply pressure locally to get something done. They should not always run to Government to say, “It is your fault. You must standardise everything.” Neither should they throw their hands up in the air and say that there is nothing they can do about it. Therefore, I reject the term postcode lottery on most of the times that it is used. This is an example of where, if discretion is used in some areas, why is it not used in others, and what will people do locally to encourage it? Clearly, it happens in some, but not all, places, and it is not always the responsibility of Government.

My hon. Friend the Member for Shipley said that he longed for the day when Ministers could stand up at the Dispatch Box and say, “It is nothing to do with me.” Actually, local discretion is nothing to do with me. All too often people come running towards Government and demand that something is done, when, actually, the answer lies in their own hands, their own constituents’ hands, their own local decision-makers’ hands and, in this particular case, the hands of those who are making decisions about hospital charges. It is fair that responsibility is very widely spread.

Let me move on and say a little bit about the car parking matter. I will do my best to be quick. Everything that the NHS does is on an epic scale, and that is true even in relation to car parking. At hospitals alone, there are around half a million car parking spaces to finance, manage and maintain, and every day, millions of users need to be seen safely on and off the sites. Parking is an amenity that the NHS has to provide if the service is to function properly—or indeed to function at all. Problems are particularly thorny in large acute hospitals, but they also exist in others. Our aim is always to see that parking provision is sufficient, efficient and fair.

The level of car parking provision required is a reflection of massively increased car ownership. When I was a boy and used to go with my father, a GP, to visit our local hospital, there were no car parking charges and the car park was half empty. I was born and brought up in the late ‘50s and early ‘60s, and life was very different. The more people who use our hospitals, the more car parking spaces we will need. Very recently, I went to the Lister hospital, a local hospital used by my constituents, and saw its new car parking facilities, which make a huge difference, but they have to be paid for.

Car parking, like any other service, is provided at a cost. Owning land costs money, so hospitals have to meet finance costs as well as maintenance, lighting, security and so on. Across the NHS, we now see better and better facilities. It is inevitable that some form of charge needs to be levied to cover those very real costs. From this perspective, it is perhaps remarkable that the average cost of parking across the NHS is only £1.15 an hour—and has fallen slightly this year. Once we accept that there is a real and unavoidable cost associated with parking we have to ask ourselves, “If hospital parking costs are not paid for by drivers, who are they paid by?” Again, that was a hard question asked by Members on the Government Benches.

[Julie Cooper]

I just want to clarify that the Bill is not asking for free car parking for all; it is asking to protect a vulnerable group who suffer great financial hardship from car parking charges. Despite the figure he has just mentioned, I am sure that the Minister will agree that the average car parking cost is £39 a week and significantly higher in some areas. Should the most vulnerable—those on the lowest incomes, who are already providing invaluable support to the NHS—be made to carry that burden?

[Alistair Burt]

As the hon. Lady knows, we have adjusted our principles to ask trusts to consider carers as a particularly special category. I do not think the Bill will work because of the technical issues that colleagues have mentioned and the difficulty of defining carers. I know how the hon. Lady wants to do it, but others would want to stretch it further. There is also the question of whether it is right to pick out particular groups in legislation and not others, a case that has been made very strongly. I entirely accept that she is not asking for free car parking for everyone, although some are, but the question remains that if this group is advantaged in this way, what might others work towards?

The principle remains the same. I do not think that anyone disagrees that if local hospital authorities can provide carers with free car parking within their budget without affecting any of their other costs, that is good and we would like to see it. However, that is not the view that we believe is held by all and, accordingly, we think that it is a matter for local discretion.

Let me briefly mention a couple of issues relating to the provision of car parking. I said that we had changed the principles. The principles, which my hon. Friend the Member for Shipley also mentioned, are delivered by the Government to the NHS and used to read:

“Concessions, including free or reduced charges or caps, should be available for the following groups…disabled people…frequent outpatient attendees…visitors with relatives who are gravely ill…visitors to relatives who have an extended stay in hospital…staff working shifts that mean public transport cannot be used”.

The “Julie Cooper amendments” mean that the reference to visitors with relatives who are gravely ill will now include the words

“or carers of such people”.

Where the principles refer to visitors who have an extended stay in hospital, the words

“or carers of such people”

will be added, and a new line has been inserted reading

“carers of people in the above groups where appropriate”.

The word “carers” has been inserted in the principles for the first time, and that is due to the hon. Member for Burnley. I hope that the examples we have heard of where discretion has been exercised might be used by others.

It is reasonable to suggest that if the NHS as a whole had to find costs upwards of £180 million, perhaps even towards £250 million, they would have to come from somewhere. It is therefore reasonable to ask who else would pay for them and whether that would be done through higher charges for others or at the expense of other parts of the NHS. I think that that is a matter for local discretion.

We heard about Scotland and Wales, and the devolved Administrations have decided what works for them. I also understand, however, that their free car parking policy has brought its own problems. Since charges were abolished at Edinburgh’s Western general hospital, the car park has been constantly full and staff have resorted to parking in nearby residential streets. In the first three months of free car parking on the Western general site, 70 complaints were received whereas before there were no complaints at all. In some areas, residents were complaining that people were parked in front of their driveways and Lothian health board has already had to employ wardens to police the overcrowded car park and is now paying for new car parks to be built.

The question of where car parks are sited was also raised, and the majority of hospital car parks where there are charges are in city centres. It is fanciful to believe that if free car parking was available in a city centre near a station or shopping centre, it would not be used by people who were not going to the hospital. There would have to be another method of policing it. Although the free car parking in Scotland and Wales sounds wonderful, it has its problems and we need to be clear about that. It is not an option for many hospitals in city centres.

The Bill was examined in relation to who might be eligible and who might not. Carers and those with underlying access to carer’s allowance include nearly 1 million people, which raises salient questions about where the costs would be diverted to.

I want to talk a little about the availability of car parking and access to it. A sensible, measured approach to car park charges can dramatically increase the availability of spaces. This matters to people who are looking for a car park space in a busy place at a busy time. It is in no one’s interest for a very small number of people to be able to park for free if everyone else, including, potentially, large numbers of carers, are then denied the chance to park at all. Quite reasonably, people who have cars expect to be able to use them to carry out their daily routine, but the available land for parking is limited and we cannot make it grow at the rate we wish. More people driving means more people competing for space, and hospitals have to find a way to make sure that as many people as possible can have access.

Without fair charges, car parks become congested and there is no turnover of spaces. Patients who arrive at 8.30 am may find that they can park, but those whose appointments are for later in the day are likely to be faced with a long and ultimately fruitless search for somewhere to leave their car. This cannot be fair. The Government take the view that it is not sensible to impose central requirements in relation to car parking. We cannot possibly know what each local situation requires. In city centres the cost of the land may be too high, if land is available at all. We are all familiar with St Thomas’ just across the bridge. It has 900 beds, yet has only 380 parking spaces. Those spaces have to work hard, and to do that they need to be in constant turnover. The situation is repeated again and again across the country. I am sure there is not one of us in the House who has not heard of a friend, colleague or loved one who has struggled to find a place to park at a city-centre hospital.

Hospitals outside the cities might well have more space for parking, but they have increased demand from people who have no viable alternative to driving. My hon. Friend the Member for Solihull, speaking about the importance of local transport provision, again made an important point which will benefit carers, patients and others alike. Some will never be able to travel by public transport—it will not be suitable—but others will, and the car will not always be the most convenient option. NHS organisations must have the autonomy to make their own decisions.

These challenges are not an excuse to ignore the principles which, as I mentioned to the hon. Member for Burnley, now include her amendments. Patients, carers and visitors deserve to have consistent concessions across the NHS. The charges may vary, but we can all agree on the groups of people who should benefit. As I indicated, we have identified five groups for whom we believe concessions can enhance access. By adding carers to those principles, we will have made a valuable contribution, very much as a result of what the hon. Lady has done.

A further area of concern for me is the way that car parks are managed and charges set. One aspect that concerns me is when patients, carers and visitors report unfair charges when appointments overrun, through no fault of their own. A number of colleagues have mentioned the problem faced by people trying to decide how much time they are going to spend at hospital, and the need to make sure that people are not worried about making that decision when they are under stress. That is why our principles support pay-on-exit schemes where drivers pay only for the time that they have used. Too often, patients are forced to guess how long their appointment will take, with the consequence that some of them put too much money in, just to be on the safe side. Others run back and forth between clinic and car park, adding money as their time runs out. How much more reassuring it would be for them to know that the amount to be paid will exactly reflect the time spent at the hospital. Over half of our hospitals currently have pay-on-exit systems and we expect that to increase.

In the time allowed to me, I have tried to indicate our support for the principle of what the hon. Lady has said. That is why we have changed our principles. However, we consider that a national decision is not right. The reason why I am carrying on speaking is that I am not going to leave it to any of my colleagues to do the procedural business of talking the Bill out; that must fall to me. What we have done by changing the principles is to recognise what the hon. Lady has done. I hope that authorities have listened to the examples given by colleagues, showing what their authorities have been able to do, and I hope we see more.

I am sure that the shadow Minister will play a keen part and take a great interest as we work through the carers strategy. I am sure that we will find a strategy that recognises some of the other issues that she mentioned. I hope that in doing so we will be able to keep a cross-party, cross-House sense of the importance and value that we associate with carers, while recognising that the hard economics of the world mean that we cannot provide everything and so must provide the things that are of most advantage.