Cities and Local Government Devolution Bill [Lords]

Andrew Gwynne Excerpts

Monday 7th December 2015 Commons Chamber

[James Wharton]

First, I should put on the record my gratitude and that of my colleagues for the representations made by hon. Members who were keen to see the new clause included in the Bill, and to support and empower their local national parks authorities to do the best job they can and to continue to contribute to the communities they represent. In particular, I am grateful to my right hon. Friends the Members for New Forest East (Dr Lewis) and for New Forest West (Mr Swayne) and my hon. Friends the Members for Thirsk and Malton (Kevin Hollinrake), for Penrith and The Border (Rory Stewart), for Berwick-upon-Tweed (Mrs Trevelyan) and for Richmond (Yorks) (Rishi Sunak). I would like to add Councillor Gareth Dadd of North Yorkshire County Council, who made strenuous efforts to convince us of the merits of these changes and kindly arranged for me to meet representatives of the North Yorkshire national park authority and National Parks England.

In the light of this weekend’s flooding, I think it important to reiterate the comments of my right hon. Friend the Secretary of State for Environment, Food and Rural Affairs in the statement that we have just heard, and I offer my sympathy to the people of Cumbria and other affected areas in recognition of the significant impact of what has happened there as a result of the unprecedented weather events.

Before speaking expressly to the content of the new clause and amendment, I would like to say a few words about the role of the national park authorities in water management in the context of what has happened this weekend, and about how the changes might assist them in further performing that role. Although national park authorities do not have responsibility for emergency planning, the planning decisions they make and the development control conditions they enforce can make a big difference to the demands placed on those who do have to respond during an emergency.

National parks have an important role to play in managing the water environment and helping with restoration work. For example, the floods of November 2009 caused severe damage to the rights-of-way network in Cumbria and the Lake District national park. Over 250 bridges were damaged or destroyed and 85 paths needed repair. The function-specific general power of competence that we are discussing with these amendments could be used to enhance the national park authorities’ ability to respond to flood emergencies by enabling them to enter into partnerships, to develop skills and capacity within small rural communities and businesses to assist with the responses needed, to develop specific skills to combat future flood management, and to adapt the network to improve flood resilience.

[Andrew Gwynne (Denton and Reddish) (Lab)]

Given that national parks might cover one or more metro mayor areas—for example, the Peak District national park is partly in Greater Manchester and partly in South Yorkshire, two areas that might well have metro mayors quite soon—is there not a case for having some co-ordination for emergency planning to make sure that there is the same resilience and the same emergency planning in the different parts of the national park?

[James Wharton]

The hon. Gentleman makes an important point. We want to see co-ordination, and there are already structures in place to deliver it and to ensure that different bodies work together to respond as efficiently and effectively as possible. From what I have seen happening in Cumbria and other areas over the weekend, a number of those bodies are working very hard to deliver for local communities. The hon. Gentleman puts an important point on the record. We absolutely want to see as much co-operation as possible, and we want to empower these public bodies to carry it out wherever possible. That underlies in many ways the purpose of devolution, so it is an apt time for the hon. Gentleman to put his comments on the record.

Junior Doctors’ Contracts

Andrew Gwynne Excerpts

Wednesday 28th October 2015 Commons Chamber

[Andrew Gwynne (Denton and Reddish) (Lab)]

We have had a comprehensive and powerful debate, with 23 speakers and many more Members who would have liked to contribute if we had had more time. I would particularly like to thank my right hon. Friend the Member for Oxford East (Mr Smith), my hon. Friend the Member for West Ham (Lyn Brown), my right hon. Friend the Member for Enfield North (Joan Ryan), my hon. Friends the Members for Wakefield (Mary Creagh), for St Helens South and Whiston (Marie Rimmer), for Workington (Sue Hayman), for Bolton South East (Yasmin Qureshi), for Easington (Grahame M. Morris) and for Ealing Central and Acton (Dr Huq); the hon. Member for Central Ayrshire (Dr Whitford), the right hon. Member for North Norfolk (Norman Lamb) and the hon. Member for Strangford (Jim Shannon); and the hon. Members for Totnes (Dr Wollaston), for Bristol North West (Charlotte Leslie), for Finchley and Golders Green (Mike Freer), for South West Wiltshire (Dr Murrison), for Blackpool North and Cleveleys (Paul Maynard), for Morecambe and Lunesdale (David Morris), for Vale of Clwyd (Dr Davies), for Sherwood (Mark Spencer), for Erewash (Maggie Throup), for Boston and Skegness (Matt Warman) and for Morley and Outwood (Andrea Jenkyns).

Members of all parties have spoken with great passion and praise for our junior doctors, who work tirelessly to deliver good quality services—despite the challenges they face in an NHS that is increasingly under pressure and under strain.

[Andy Slaughter]

rose—

[Andrew Gwynne]

I do not have time to give way, I am afraid.

I echo those sentiments of sincere thanks, but we have heard of junior doctors who already work weekends, already work nights, already work holidays and give their all for their patients. Despite all this, the junior doctors now face a situation that has left them feeling deflated, demoralised and devalued.

Patient safety has been a key theme of today’s debate. Some Members have valiantly leapt to the Health Secretary’s defence, but those voices have been far outnumbered by Members who are deeply concerned that this contract is unsafe for doctors and unsafe for patients.

Members have argued that the removal of the financial penalties that apply to hospitals that force junior doctors to work unsafe hours risks taking us back to the bad old days of overworked doctors, too exhausted to deliver safe care. The BMA says this safeguard, which is built into the current contract, has played an important role in bringing dangerous working hours down. Removing this financial disincentive to overworked junior doctors is extremely alarming, especially at a time when junior doctors are already coming under an enormous amount of pressure and strain. If the Health Secretary would just listen, he would hear junior doctors shouting loudly and clearly that they cannot give any more.

Many Members highlighted the protests and marches that have taken place throughout the country in recent weeks. We had only to catch a glimpse of the placards that were waved as thousands of junior doctors marched against the contract to understand that those doctors now fear for their own health and well-being. I was struck by one banner which read, “I could be your doctor tomorrow, or I could be the patient”, and those doctors’ concerns have been echoed by many Members today. How can the Secretary of State possibly say that he is acting in the interests of patient safety if the very people who work in the NHS say he is putting safety at risk?

Another argument that has been advanced today is that the contract is necessary to ensure that our NHS works seven days a week. Not only does that argument do a huge disservice to our NHS staff who already provide care seven days a week and 24 hours a day, and reveal just how out of touch some Conservative Members are with the realities of working on the frontline in our NHS, but it is wholly inaccurate. If this junior doctor contract were imposed in its current form, it would have the opposite effect, as many independent clinical voices have warned.

It is a bitter irony that the problems that the new junior doctor contract was supposed to be trying to address when it was originally proposed back in 2012—the need to introduce better pay and work-life balance—are the very problems that will be made worse should the contract go ahead in its current form. In letters to the Secretary of State, the presidents of a number of royal colleges and faculties have made it very clear that they share those concerns, but he presumably thinks that they too have been misled.

The Secretary of State said that he did not intend to cut the pay of any junior doctor, but his sums simply do not add up, and everyone can see through the spin. No one with a GCSE in maths can believe that no doctor will be worse off as a result of the new contract. Let the right hon. Gentleman come to the Dispatch Box in the minute that I have left, and answer this question. To what percentage of junior doctors currently working within the legal limits will what the Secretary of State has said today apply? Is it 50%? Less than a quarter? What is it?

[Mr Jeremy Hunt]

All of them.

[Andrew Gwynne]

In that case, I ask the Secretary of State to explain this. If the pay envelope is not increasing, and if the pay is not being reduced, how can these sums add up? They just do not add up, and I suggest that he go back to night school and learn some basic arithmetic.

We know that the BMA has been conciliatory today: it has offered to speak to the Secretary of State again. I ask him, please, let us take this down a notch. Let us get him talking to junior doctors again. The simple fact is that these are the junior doctors who work in our A & E; these are the junior doctors who work in every department of every hospital on the frontline. They come in early and leave late, they already provide care for seven days a week, 24 hours a day, and they deserve a lot better than this Government.

Cities and Local Government Devolution [Lords] Bill

Andrew Gwynne Excerpts

Wednesday 21st October 2015 Commons Chamber

Amendments 43 and 44 are tabled in the name of my hon. Friends the Members for Altrincham and Sale West, for Hazel Grove and for Bury North. Amendment 43 seeks to enable an individual local authority to leave a mayoral combined authority without the need to dissolve and reform the combined authority and provides that where that occurs, the resource is split according to a fair and proportionate division. Amendment 44 would require the Secretary of State to abolish and reform the combined authority when a constituent council wishes to leave. One of the benefits of establishing a combined authority is the long-term stability it offers for the area it covers and the duties it has. These are statutory bodies and that long-term stability is important, but I understand Members’ concerns about how changing circumstances could lead to changes in how the local area would want to work, the geography over which a combined authority should be formed and the functions it should have. I will listen carefully to the comments they make later in the debate.

[Andrew Gwynne (Denton and Reddish) (Lab)]

On the question of dissolving a combined authority, will not the difficulty always be that pooling and sharing arrangements will have been put in place and borrowing arrangements will have been made that a constituent authority might not easily be able to exit? That would make the long-term stability of the combined authority very uncertain were the amendment to be passed.

[James Wharton]

The hon. Gentleman makes a salient and important point. The Government will not support the amendment for that very reason, but I will listen carefully to the speeches that are made because it is important that we address concerns to the fullest extent to which we are able without attracting from the intention of the Bill and the intention of the Government to deliver on our agenda.

Clause 3 provides flexibility to enable a single local authority to leave, in line with the comments that the hon. Gentleman has just made, if it does not wish to continue to be part of a combined authority. A council can also leave a combined authority once a mayor has been elected for the area of a combined authority without the need for the combined authority to be dissolved and reformed, using exactly the same process as is used to establish such an authority of undertaking a governance review demonstrating that the change would improve the exercise of functions. In addition, a council that wishes to leave a combined authority can do so if it obtains consent from the other constituent councils of the combined authority, and if there is one, the mayor. Again, I will listen carefully to the comments of hon. Members with a view to finding a position that can get broad agreement across the House as the Bill makes progress.

Amendment 39 is tabled by my hon. Friend the Member for Amber Valley (Nigel Mills). It applies to circumstances in which a combined authority is proposed and seeks to require that no order can be made for a combined authority unless local government electors have been consulted on replacing the existing county councils and district councils with unitary authorities. That moves away from the flexibility we want to be to deliver and puts conditions on deals that we might want to make but that we do not necessarily want to impose. Again, I will listen very carefully to my hon. Friend’s comments later on in today’s discussions.

--- Later in debate ---

[Mr Betts]

I would not want to second guess the motives of the Secretary of State, so I will use my own arguments to resist what the Government are trying to do.

Apart from the inconsistency of approach, the proposals are confusing. That takes me back to the point I made in my intervention on the Minister. In the Sheffield city region the economic powers, which are important and cover skills, economic development and the infrastructure associated with it, are to be devolved to the combined authority, which will cover nine districts—four metropolitan and five non-metropolitan districts. But as I understand it from the deal, the mayor will have responsibility for just transport. So the mayor is to run transport, and the combined authority is to run economic development. The public want some consistency of approach on these matters. I do not believe that the combined authority, the district, would naturally have come forward with a proposal that broke up the responsibilities in this way.

[Andrew Gwynne]

My hon. Friend is making a powerful case. The difference between his deal and the Greater Manchester deal is that the Greater Manchester deal is within a single metropolitan county, so functions such as police and eventually fire and rescue can also be devolved to the Mayor’s office.

[Mr Betts]

There is a big difference in the Manchester case. I am not arguing that Manchester should have a mayor imposed on it. If Manchester wants that, that is a matter for it, but it is different. In Sheffield we have hybrid devolution, with transport going to the mayor, but the mayor is not going to cover the nine districts. The mayor will cover only four districts—the old south Yorkshire districts—so how are people to understand the devolution deal, which has one set of governance arrangements for economic powers and skills, and another set of governance arrangements for transport, where one set of governance arrangements covers four authorities, whereas the other set covers nine?

The whole purpose of combined authorities is to bring local authorities together on a voluntary basis to cover a travel to work area—the natural economic entity—yet transport, the mayor and the associated powers will not cover the whole travel to work area of Sheffield. This is a real dog’s dinner. It is not going to work, and it is certainly not going to be understood by the public.

That leads me on to my second point. There is a problem with mayoral imposition, which in Sheffield’s case will not cover all five areas. Other districts can choose to join the arrangements for mayors if they wish. My understanding—I may be wrong—is that the districts of north Derbyshire and north Nottinghamshire, which are part of the Sheffield city region, are going to join the combined authority, which they are part of, for the economic powers. However, for transport powers to be devolved to those areas through a mayor, those districts will not merely have to agree, but they will have to get the county, which is the transport authority, or two counties, to agree as well. Does the county have a veto over what happens to devolution in the Sheffield city region?

This is not workable. At the same time as the Sheffield city region has a mayoral possibility, Derbyshire and Nottinghamshire are looking at having a joint combined authority, which would have a mayor as well. As I understand it, the mayor can exist for the districts of north Derbyshire and north Nottinghamshire only if those districts agree to the county mayor for Derbyshire and Nottinghamshire being created. So they have a veto over that. At some stage, surely, Ministers have to take some responsibility for coming forward with proposals to sort out this mess, or it will stop devolution working effectively in these areas.

--- Later in debate ---

[Ann Coffey]

The hon. Gentleman will appreciate that when I read an explanatory statement that says:

“The intention of this amendment is that elected mayors will be introduced only if that proposal has been endorsed, in a referendum, by 50% of the population”,

I am likely to believe the Clerks.

[Andrew Gwynne]

My hon. Friend will know that the Greater Manchester devolution settlement came from the bottom up, from the 10 councils of Greater Manchester, and the 10 leaders always intended to appoint an 11th member of the combined authority to act as full-time chair. The mayor merely becomes that 11th member.

[Ann Coffey]

I thank my hon. Friend for that intervention—his knowledge in this area is comprehensive.

As I was saying, 50% is a very high bar that is unlikely to be reached, so amendment 51 is, in effect, a wrecking amendment intended to stop the devolution of decision making from Whitehall to Greater Manchester. It is a kick in the teeth for the people of Greater Manchester.

The population of Greater Manchester is 2.7 million, and we have a shared sense of identity, even if, at the very minimum, it is, “We’re different from London.” Surely it is right that services to meet the needs of local people should be designed locally. Local people care about that much more than they do about esoteric arguments about organisational arrangements. Greater Manchester comprises 10 local authorities, 11 police divisions and 12 clinical commissioning groups. We have an opportunity to bring those resources together. Too often there are barriers to working together and sharing information and the delivery of services because of boundaries between councils and, for example, health agencies. The combined authority would bring together the strength, competence and experience of the existing local authorities and other agencies in Greater Manchester under the leadership of an elected mayor, which is supported by the 10 local authorities, so that the public can see the public face of that new devolved authority.

[Andrew Gwynne]

Of course, the point is that the Greater Manchester combined authority already exists in statute; it is a body corporate. The Bill will allow the 11th member, who chairs the combined authority, to be directly accountable to the 2.7 million people who live in Greater Manchester. Surely that is a good thing.

[Ann Coffey]

My hon. Friend is absolutely right; it is a good thing. When people talk to me—and, I am sure, when they talk to him—and ask who they can go to, to them having a mayor makes perfect sense.

Of course, there are outstanding issues with regard to health, but there is nothing in the Bill that will take away from the people of Manchester the right to national health services enjoyed by people elsewhere. The problem in Greater Manchester is the fragmentation of health, so it is good that these proposals will help reduce the number of commissioning organisations and allow providers to work together in a more collaborative way for the benefit of local people. However, we need a funding settlement that gives greater flexibility in developing high-quality health and social care services in the community across Greater Manchester as an alternative to hospital admissions, and at the moment it is difficult for each clinical commissioning group to free up resources in order to do that. Without that investment, the demand for expensive hospital care will continue. The authority cannot simply be a bank that hands out money under the current funding arrangements.

There has been a lot of talk about accountability, but in my experience accountability is at its best when well-informed elected representatives, such as my hon. Friend the Member for Denton and Reddish (Andrew Gwynne), demand answers and are willing to make their case loudly and publicly. No complexity in the arrangements for governance can take the place of that, and that is the accountability that the public expect us to ask for.

Last year I did some work looking into child sexual exploitation across Greater Manchester, at the request of the police and crime commissioner, Tony Lloyd, and following that I published my report “Real Voices” last October. Talking to children at risk of child sexual exploitation, it is absolutely clear that they do not observe local government boundaries, health boundaries or police boundaries, and neither do their predators. The digital age has redefined boundaries. A lot of progress on that has already been made across Greater Manchester. In particular, I want to congratulate Project Phoenix, a cross-boundary, multi-agency response to child sexual exploitation across the whole of Greater Manchester, which is working to ensure that child victims receive the same standard of response regardless of where they live. It has also initiated a very successful “It’s not okay” campaign to build public awareness of child sexual exploitation and help young people recognise when they are being groomed. It is clear that work on this crucial agenda will be enhanced by more devolution powers for Greater Manchester. We must overcome the silos and boundaries that prevent people working together to protect children from abuse.

Amendment 51, if passed, would be a kick in the teeth for the people of Greater Manchester and their children, who have felt for years that their voices have been ignored by Whitehall and Westminster. Devolution and the creation of a mayor offer the opportunity to the people of Greater Manchester to develop services that reflect their priorities and needs. We should take that opportunity and be positive about the opportunities we are being offered.

--- Later in debate ---

[Mr Betts]

I agree with what my hon. Friend the Member for Nottingham North (Mr Allen) said about the need for a wider constitutional settlement. That was apposite, and at some point we will have to address those issues. I agree with his points about subsidiarity and taking that below the level of an individual local authority, and about encouraging the process down.

Fiscal devolution is a challenge, and Members have reflected different perspectives from different parts of the country. It is a challenge, but not one that we should duck. I am Chair of the Communities and Local Government Committee, on which the hon. Member for Carlisle (John Stevenson) sat in the previous Parliament. He made important and valuable contributions to our report. We found a way to take on board proposals from the London Finance Commission about the wider devolution of property taxes, while recognising the need to protect areas that will perhaps struggle to raise business rates and other property taxes easily, or to get back money from areas that simply watch property prices rise and receive enormous windfalls. We must have balance in the system.

The Committee has begun an inquiry into the workings of devolution and the Bill, but since then the Chancellor has made his announcement about the full localisation of business rates. The Committee will want to come back and look at how that will be done. I think most Members would support the principle behind such a move, but how will we implement it to ensure protection for poorer areas? How will we devolve more powers to local government to take account of the extra money made available as part of that process?

[Andrew Gwynne]

My hon. Friend is right to say that the Select Committee must consider business rates retention in detail. One possible solution for devolved city regions might be the pooling and sharing of business rates. For example, parts of Greater Manchester are key drivers of economic growth, and that wealth should be spread across the whole conurbation for the benefit of all.

[Mr Betts]

My hon. Friend is right, and the Committee made that recommendation in the previous Parliament. It is a way that we can devolve the redistribution process to more local areas. That does not work everywhere, but it would probably work well in areas such as Manchester that have a spread of different local authorities

--- Later in debate ---

[Andrew Gwynne]

I apologise for the fact that I have only just come into the Chamber for this part of the debate. I have been on Front Bench duty in Westminster Hall.

I am interested in what the Minister is saying about the Secretary of State’s oversight of devolved health in Greater Manchester, which is clarifying one of the issues about which I know a number of Greater Manchester MPs are concerned. May I ask, however, whether any thought has been given to coterminosity? In the case of most of the functions that have been devolved to Greater Manchester, there are coterminous boundaries with the 10 metropolitan boroughs. The NHS is slightly different, in that one of the CCGs—one of my own CCGs, Tameside and Glossop—extends to Derbyshire as well, because Glossop is not part of Greater Manchester.

[Alistair Burt]

I know the area well, and I know exactly what the hon. Gentleman is referring to. Yes, that is part of the consideration, but it is essentially part of the consideration of the combined authority. Not only will it have to devise the working of its services within the confines of what is commonly known as Greater Manchester, but it will have to recognise that some of the provision of those services is carried out by those with cross-border responsibilities, and work something out with the adjoining areas. Nothing in the Bill speaks to that, because it does not relate to what I am discussing—the control of standards and the like—but the hon. Gentleman is absolutely right. That is part of the process that people will be going through.

--- Later in debate ---

[Alistair Burt]

I have read the report of the debates in the House of Lords on exactly this topic, because there was a lot of confusion. My understanding is that it depends on precisely what the breakdown is. Let us suppose that the breakdown, or failure, is in the way in which services have been put together by the combined authority. This is purely off the top of my head, and does not refer to anything of which I have any current knowledge. Let us suppose that there was a dispute between two constituent areas of Greater Manchester, one of which claimed that there was some inequity between the service that it was receiving and the service being received by the other. It might be claimed, for instance, that the combined authority’s decision was somehow disadvantaging Ramsbottom in favour of Bramhall. In the event of such a dispute, the buck would stop with those who were making the decisions locally, and that is the combined authority. The matter would not go anywhere near the Secretary of State. What the Secretary of State retains responsibility for is the standards and whether or not there has been a breach of NHS duties in relation to anything that falls within his own overall responsibility. So the buck still stops with the constituent authority that is delivering the service. In relation to a CCG that is not performing properly, the buck will stop with the CCG, not the combined authority. If there is a lapse of standards in anything connected with the NHS, ultimately the regulators govern that and the Secretary of State would be responsible. But if it is a decision being taken by those who are responsible for the new combined authority to do with where services go and it is within their remit, it will be a matter for them—the buck will stop with them. The short answer, therefore, is that where ultimately responsibility lies depends on where the breakdown is, but it is clear in relation to each of the services and it does not mean anyone can evade their responsibilities.

[Andrew Gwynne]

I think my right hon. Friend the Member for Leigh (Andy Burnham) had a better definition of what the Minister is trying to say. He said it is the Secretary of State’s responsibility to set out the “what”, and the “how it is delivered locally” is for local commissioners or the combined authority in the case of Greater Manchester. The “what” remains with the Secretary of State; the “how” is devolved to the local area.

[Alistair Burt]

I think between the hon. Gentleman’s right hon. Friend, me and the Secretary of State we have probably got where we need to get to in relation to this. I wanted to make clear that there will not be a confusion of who is responsible for what; someone is ultimately responsible for each bit, but who is responsible in each particular case depends on where the breach is.

Secondary Breast Cancer

Andrew Gwynne Excerpts

Wednesday 21st October 2015 Westminster Hall

[Andrew Gwynne (Denton and Reddish) (Lab)]

I congratulate the hon. Member for North Warwickshire (Craig Tracey) on securing this important debate and the laudable and worthwhile work he is doing as a member of the all-party group on breast cancer.

We have made huge progress on improving cancer services—in the past decade, five-year survival rates for nearly all types of cancer have improved—but we still lag behind other countries, and there is worrying evidence from the past five years that the progress we have been making on cancer care has stalled, or potentially even gone backwards. In government, Labour created 28 cancer networks to drive change and improvement in cancer services. The networks brought together the providers and commissioners of cancer care to work together to plan and deliver high-quality cancer services in their areas. They helped to oversee and drive up the quality of services delivered to cancer patients. By significantly changing their structure and cutting millions from their budgets, as well as by scrapping the highly regarded national cancer action team, the coalition Government disrupted those networks.

Our hard-working clinicians and staff are trying their best within the system; despite the challenges, they continue to deliver quality care, so we should all pay tribute to them. Early diagnosis is critical to improving cancer survival because treatment is more likely to be successful at an earlier stage. Naturally, far too many of those people diagnosed through the emergency route are in the advanced stages, meaning the prognosis is poor compared with that for cancer diagnosed through other routes.

The nature of cancer is changing. Just as with AIDS, rapid advances in technology have meant that for many cancer is no longer the death sentence it once was. Such welcome changes do, however, mean that cancer is increasingly being considered a long-term condition, which has its own requirements in terms of long-term care and support. The chance of recurrence, as in secondary breast cancer, underlines the importance of remaining vigilant. It is possible to reduce considerably the probability that people with cancer will experience long-term poor health following treatment by providing appropriate and co-ordinated support and intervention. That is what we must do.

No breast cancer patient should end up lost in our vast health system, unable to find the treatment to which they are entitled. Cancer survivors have to be properly supported once their treatment stops to help their recovery and minimise the impact of their illness on their overall health and wellbeing. The current formulaic approaches are not meeting the needs of cancer patients, and the current hospital-based follow-up service simply will not cope with the growing cancer population.

If implemented, the strategy developed by the Independent Cancer Taskforce in its report would be a huge leap forward. I am pleased that the Department of Health has already made some commitments, and we look forward to hearing more following the spending review, but we need to ensure that these things actually happen. Equally, the cancer strategy recommendation of a “living with and beyond cancer” programme to ensure that people are fully supported and their needs are met should be followed through. I commend those developing support networks in their local areas, but they deserve more backing from the Government. I welcome the Government’s commitment to ensuring that everybody has a recovery package by 2020. That is crucial, as one in three people experience moderate to severe unmet needs after their treatment.

We owe it to the families battling secondary breast cancer today to continue to have high ambitions. I thank all Members for their contributions. Despite political differences, we do all have the same ambition: to bring forward the day when this terrible disease is beaten.

Cancer Drugs

Andrew Gwynne Excerpts

Tuesday 20th October 2015 Westminster Hall

[Andrew Gwynne (Denton and Reddish) (Lab)]

It is a pleasure to see you in the Chair, Mr Hollobone, and to follow the hon. Member for Motherwell and Wishaw (Marion Fellows).

I commend the hon. Member for Strangford (Jim Shannon) on securing the debate through the Backbench Business Committee and on the way in which he opened it. He has set the correct tone for how we seek the improvements we would like to see in access to cancer drugs for all our constituents. He was absolutely right to say that cancer touches every family. I lost my mother to ovarian cancer 21 years ago, and it is as painful to talk about today as it was then, when I was teenager. Only last week, my aunty passed away from cancer. It was a quick movement from the diagnosis to her passing, and I would like to place on the official record my thanks and tribute to all the staff at Willow Wood hospice in Ashton-under-Lyne, who looked after her so beautifully in her last days and hours. I also express my condolences to Evan, Shana, Sonya, Lal and Connor, who she has left behind.

The hon. Member for Strangford was absolutely right to say that we have made advances, but we still lag behind many comparable countries in cancer treatment. Access really does matter. I represent a cross-borough constituency, so I have to deal with two of everything, from police divisions right through to NHS trusts. Early on in my time as the Member of Parliament for Denton and Reddish, a constituent who had been diagnosed with breast cancer came to my advice surgery. She explained that her specialist had recommended Herceptin for its treatment, but that it was not available in her primary care trust area. If she had lived across the road, across the invisible administrative line—but still in the same constituency, with the same Member of Parliament—she would have had access to the drug. That was one of those moments when it was perfectly acceptable for the Member of Parliament to throw all the toys out of the pram. I did so, and thankfully I managed to get the primary care trust to change its mind.

Several years later the lady came to my surgery again, about something completely different, and it was one of those proud moments when one realises one has made a difference. She said, “Mr Gwynne, you don’t recognise me, do you?” and I replied, “I’m sorry, I don’t. I have met lots of people in my time as an MP. Should I recognise you?” She said, “I’m that lady you got Herceptin for, and I’m still here.” I do not know whether the Herceptin made a difference, but she believed that it did, and she would not have had access to it if I had not thrown all the toys out of the pram. That is why I start by commending the Government on the introduction of the Cancer Drugs Fund. The fund has been of significant benefit to patients, and that is to be welcomed—it would be churlish not to recognise the difference it has made. I am a little concerned, however, that the Government—as we have already heard—are now presiding over a series of reductions, which threaten the progress made.

We have already seen 18 treatments cut, and now NHS England has announced that a further 25 are due to be removed from next month. The Rarer Cancers Foundation has estimated that if all the cuts go ahead, more than 5,500 patients a year could be denied access in the future. My hon. Friend the Member for Scunthorpe (Nic Dakin) and others during the course of the debate have made that point powerfully.

Is the Minister content to stand by as the cuts are made? What will he do to help the patients who will miss out on these treatments if they are removed? At Prime Minister’s Question Time last week, the Prime Minister lauded NHS England’s negotiation process as a means of securing better value for the taxpayer, yet I fear the truth is rather different. I hear reports from charities and drug companies that suggest that NHS England has refused even to discuss discounts on some of the treatments threatened with cuts. Far from wanting to strike a deal that works for the taxpayer and helps patients, NHS England seems intent on leaving deals on the table. It is sad that efforts to save money on a range of drugs have been spurned. The chief executive of NHS England once said that he wanted his organisation to:

“Think like a patient, act like a taxpayer.”

The current position, however, seems to be against the interests of taxpayers and patients. Will the Minister intervene in NHS England to ensure that it considers every single offer that is put to it and that it redoubles efforts to maintain access to these drugs while securing the savings we all want to see?

The Minister cannot wash his hands of the issue when the process is evidently failing patients and delivering poor value for public money. Other countries seem to be able to make the drugs available without spending more money on their health services, which implies that they are better at striking deals, or at least are more flexible in doing so. Why are we not following the same process? Why should our constituents be denied these drugs when patients in other countries have access to them?

In brief response to my hon. Friend the Member for Torfaen (Nick Thomas-Symonds), I place on record that we on the Labour Front Bench support his private Member’s Bill on off-patent drugs, which has the support of the Association of Medical Research Charities and will help to improve access to off-patent drugs. We also need to look at ways of encouraging clinicians to use off-patent drugs.

I will touch briefly on points that my right hon. Friend the Member for Oxford East (Mr Smith) and the hon. Member for Foyle (Mark Durkan) made on radiotherapy and surgery and the benefits that extending access to those treatments can provide. Going into the general election, the Labour party’s position was that we would extend the Cancer Drugs Fund to become a cancer treatment fund that would include radiotherapy and surgery. What consideration have the Government given to ensuring that all the innovations will be available as part of the fund?

On the pharmaceutical price regulation scheme, I fear that there is more bad news to come for cancer patients. In August, the Department of Health snuck out some changes to the PPRS on a Friday afternoon, and I fear that the implications of that news could be bad indeed. The change agreed with the Association of the British Pharmaceutical Industry effectively limits the level of PPRS rebates that drug companies have to make on expenditure through the Cancer Drugs Fund. That creates a financial black hole over the lifetime of the PPRS that the Rarer Cancers Foundation tells me could amount to £567 million. The Government need to find more than half a billion pounds to cover the gap between projected Cancer Drugs Fund spend and PPRS rebates. Will the Minister tell the House how this gap will be filled? Can he reassure patients that the budget for the CDF will not be cut and that patients will not miss out as a result of that secret deal between the Government and the drugs companies?

Finally, I want to cover the consultation on the future. The cuts announced to the Cancer Drugs Fund in September were an inevitable consequence of an abject failure to fix the system. The Government’s record on the reform of drugs pricing and assessment is a sorry tale of promises not kept. First we had value-based pricing, which was meant to be the solution, but went nowhere. Then we had value-based assessment, which was derided by all sides and shelved by NICE, the very organisation that proposed it. The hon. Member for Foyle made some powerful points and interesting suggestions not just on the combined purchasing power of the various NHS systems across the devolved Administrations, but on the wider purchasing power of all the Administrations of the islands on which we reside. I would like the Minister to consider that.

We have the promise of Cancer Drugs Fund reform, but the process is already riddled with confusion and delay. The NHS England working group on reform was shut down as quickly as it was set up. A consultation was promised for July and then September—now it is October and we still have no consultation. In drawing the debate to a conclusion, will the Minister provide an update on when the consultation will finally be published? If he cannot do so, will he intervene with NHS England to ensure that Members are updated so that they can reassure the many of thousands of cancer patients whose treatment depends on satisfactory reform?

Oral Answers to Questions

Andrew Gwynne Excerpts

Tuesday 13th October 2015 Commons Chamber

[The Minister for Community and Social Care (Alistair Burt)]

The north Lincolnshire scheme is designed to try to encourage doctors to make sure that there are no inappropriate referrals to secondary care; it is not designed to prevent appropriate ones. Over the past five years we have seen an increase of 600,000 in urgent referrals for cancer care, for example. We want to see that continue. It will not be helped if there are inappropriate referrals, and that is what the scheme is about.

[Andrew Gwynne (Denton and Reddish) (Lab)]

Last week senior officials at Monitor reported being leaned on by the Department of Health to suppress the publication of financial figures ahead of the Conservative party conference. This week the Health Secretary has been accused of vetoing the release of impartial independent reports on measures that could reduce our consumption of sugar. Does he not understand that leadership on transparency must come from the very top? Will he now commit to practising what he preaches on NHS transparency and release this report immediately?

[Mr Jeremy Hunt]

I will take no lessons on transparency from the Opposition. Professor Sir Brian Jarman said that the Department of Health under Labour was a “denial machine” when it came to the problems of Mid Staffs. We have made the NHS more transparent than ever before, and we will continue to practise transparency.

NHS (Contracts and Conditions)

Andrew Gwynne Excerpts

Monday 14th September 2015 Westminster Hall

[Paul Scully (Sutton and Cheam) (Con)]

It is a pleasure to serve under your stewardship, Ms Vaz. It is also a pleasure to follow two fellow members of the Petitions Committee, including the Chair, the hon. Member for Warrington North (Helen Jones). The Petitions Committee is a new Committee, and we are feeling our way. As hon. Members have heard, we cannot debate no-confidence motions; petitioners cannot seek a vote of no confidence in a Secretary of State or anybody else. None the less, it is important that we reflect the views and concerns of people who raise substantive matters with us, and I am glad that we have the opportunity to do so today.

Confidence and good staff morale in the NHS are important. In my constituency, morale in our local hospital, St Helier, has been comparatively low for several decades, for a number of reasons. A reorganisation has been recommended in the past couple of years, which we have successfully fought off so far. The NHS clinicians wanted to move A&E, maternity services and children’s services to St George’s in Tooting. One of the reasons why they wanted to do so was the shortage of consultants in St Helier. They wanted to concentrate consultants’ time in St George’s, which is too far away for residents.

One of the big driving factors in that, to my mind, is the fact that over 20 or so years, our local hospital has been used as a political football. People have said, “St Helier hospital is due to close. We have got only a short time, and we have to save it. We have to fight for this, because it will close some time soon.” I do not know about you, Ms Vaz, but if I were a consultant looking to work in the NHS, would I want to go and work in a hospital that is always apparently under threat of closure? No, I probably would not. I would probably go to St George’s or one of the hospitals that are being talked up. I have seen at first hand how staff morale in the NHS can be fragile. The same thing has happened nationally as well. How many times have we heard that we have 24 hours to save the NHS? We keep seeing, hearing and reading that, time after time. It is important to build confidence.

We also have a manifesto commitment to deliver. We talked in our manifesto about having a seven-day NHS, and we have been elected as a Conservative Government, so it is important that we deliver our promises. We have to work with the profession to do that, however. Why do we want a 24-hour NHS? We have heard some of the arguments about safety and patient outcomes, and at the end of the day, patient outcomes are what it is all about. There is also an argument—although, as my hon. Friend the Member for Totnes (Dr Wollaston) described, it is a secondary priority, because we do not want to divert too many resources—for convenience and fitting in with people’s lifestyles, which I will come back to in a moment.

The 2003 consultant contract made the seven-day move a lot more expensive to deliver, so we need to change things. Consultants, as we have heard, can refuse to work weekends, but it is quite apparent that a great many do not choose to opt out. We are not saying in a broad-brush way that every consultant opts out of such working. None the less, we need to have a degree of consistency if we are going to move towards a seven-day NHS, because we want to make sure that the healthcare in hospitals around the country is as consistent as possible. Removing the opt-out will leave a new limit of working a maximum of 13 weeks in a year—one in four weekends—which still gives plenty of opportunity for family life and for flexibility in rotas, while delivering better patient outcomes.

The changes also recognise the need for proper reward in areas such as A&E and obstetrics, with higher-performing consultants able to earn a bonus of up to £30,000 a year, and with faster pay progression for new consultants. The hon. Member for Warrington North talked about support services, which are crucial for front-line consultants, doctors and nurses. I am pleased to hear that diagnostic services will be moving in the same direction so that patients can have quicker access to information and advice about their conditions.

I have talked about convenience, and GP services cannot be boiled down to some sort of retail operation such as late-night shopping or Sunday opening. None the less, we need flexibility. The 2004 GP contract led 90% of GPs to stop providing out-of-hours care at night and at the weekend. That contract, in many cases, helped to break the personal link between patients and those responsible for their care, which has been especially hard on elderly people. Caving in to the unions at that point effectively restricted GP services to a five-day service, which created extra pressure on A&E.

I have had the misfortunate of having to use my local hospital’s A&E service four times in the past 18 months with my elderly mum and my wife. My wife stood on a six-inch spike in a park, and when she was writhing around in agony with a spike though her wellington boot, there were a lot of people in A&E who had experienced neither an accident nor an emergency. Those people did not know where to go, they chose not to go to the GP, the appropriate care was not signposted clearly enough, or the GP simply was not open. We need to address those pressures, and a seven-day service will help.

The proposal is part of our wider NHS reforms, which since 2010 have moved to bring patient decisions closer to patients. We need to provide services that patients want, rather than a Henry Ford one-size-fits-all approach—we need greater flexibility. We have largely moved away from that, so we need to continue the move towards a seven-day service and towards greater flexibility. A seven-day service fits in with people’s working practices, childcare and busy lives. There is also greater take-up of digital initiatives such as the NHS national information board, and people are being brought in to help support the greater use of technology.

Members have talked about the statistics on satisfaction with the NHS over the past few years. The Commonwealth Fund’s report in 2014—four years after the Conservative-led Government took over—showed that, according to the fund’s records, the NHS is the best-performing health service in 11 countries.

[Andrew Gwynne (Denton and Reddish) (Lab)]

The hon. Gentleman has surely read the detail of that Commonwealth Fund report. Much of the data that were used data from the previous Labour Government.

[Paul Scully]

The hon. Gentleman will also find that the NHS improved over those years. We were second when the Labour Government were in power, so we have improved, and more data are still coming through. That is backed by public confidence, which has gone up by 5 percentage points to its second-highest level in the period covered by the report. The number of people in England who think that they are treated with dignity and respect increased from 63% in 2010 to 76% last year, according to Ipsos MORI. Record numbers say that their care is safe, and the number who think that the NHS is one of the best systems in the world has increased by 24 percentage points in the seven years since Mid Staffs. That is a great base from which to start, but we need to continue working with healthcare professionals to secure the seven-day NHS that we need and people want to see. Shouting and using the NHS as a political football will not get us very far.

--- Later in debate ---

[Andrew Gwynne (Denton and Reddish) (Lab)]

It is a pleasure to see you in the Chair, Mrs Gillan. We have had a good debate, and it is a pleasure to speak in it, for a number of reasons. This opportunity comes with a number of pressures. I note that this is the first debate relating to an e-petition under the new system. As the shadow teams are still being put together, I am not sure whether this will be my last outing as a shadow Health Minister or as a shadow Minister altogether, but patience is a virtue and time will tell.

It is a particular pleasure to respond to my good friend the Member for Warrington North (Helen Jones), who opened the debate. From my slightly partisan perspective as the shadow Health Minister, I thought she made a devastating critique of the Government’s record on the NHS. She will be an outstanding Chair of the Petitions Committee, which is, again, a parliamentary first. I declare an interest: in my first Parliament, from 2005 to 2010, I was a member of the Procedure Committee, and we looked at the practicalities of having a proper petitions facility and a petitions Committee to back that up in the House of Commons. The wheels of democracy take a long time to turn, but here we are 10 years later with the Petitions Committee, debating the first of the probably great number of petitions already lodged with the House of Commons. I welcome my hon. Friend to her post.

While I am making welcoming remarks, I welcome the promotion of my hon. Friend the Member for Lewisham East (Heidi Alexander) to the role of shadow Health Secretary today. She will be a doughty campaigner for the NHS in that role, as she has been for her constituency, not least because she cut her teeth on the Lewisham hospital issue.

I also pay tribute to my right hon. Friend the Member for Leigh (Andy Burnham), who has served diligently and excellently as the shadow Health Secretary for the past four years. I have been privileged to work under him. He has been committed to the national health service in his time as a Health Minister and as the Health Secretary, and in his time in opposition.

There was a need to adjust the terms of the debate to ensure that we addressed the issues and not the personalities, but we have all alluded to why we are here, what triggered the petition and the reasoning behind it. Government Members might want no challenge to their record and policies, but the fact is that while we agree on a large area of health policy—where we do, it is right that there is consensus—we will not avoid political debate just because it is uncomfortable for some Members. It is right that where the Opposition—whichever parties they may be—have differences of opinion with the Government of the day, we are able to raise them.

When it comes to the seven-day NHS, the Health Secretary has a habit of spinning the data to suit his purpose and to divert attention away from some of the Government’s failures on the NHS. Of all his public pronouncements since the election, the most controversial —indeed, it inspired many people to sign the petition—was his suggestion that NHS staff are avoiding working at the weekend. As we heard from the hon. Member for Central Ayrshire (Dr Whitford), that is just not the case, and she speaks with a vast amount of experience. Let me reiterate: it is not true, and we know it is not true.

I want to place on record my appreciation and thanks to all who work in our NHS: the consultants, the doctors, the nurses, the support staff and the ancillary staff. They do a tremendous, often thankless job under difficult circumstances. The deluge of social media users sharing photos of themselves working at the weekend on wards and in surgeries demonstrated just how absurd the Health Secretary’s claim was. Indeed, according to a series of freedom of information requests, only 1% of consultants in our health service actually opt out of weekend working.

The Health Secretary told consultants they needed to “get real”, but it is the Health Secretary who needs to get real. Rather than picking fights with hard-working NHS staff, he should be consulting them on the best way to deliver seven-day services. If the Government are serious about delivering further weekend care, they have to stop coming out with speculation and conjecture, and must urgently define what they want to deliver and how they plan to pay for it. Demonising doctors who are already working evenings and weekends will get us nowhere.

A seven-day NHS is the aim of all those who want the best health service in the world—I include myself among them—but to achieve one, we have to listen to those on the frontline and address their concerns. Staff are rightly worried about losing their antisocial hours pay, the effect of which could be devastating for huge numbers of assistants and nurses. Working at night is as expensive as shifts get, with transport and childcare being more expensive or totally unavailable, and all the evidence shows that night shifts have a detrimental effect on people’s health. It is only right that such shifts are appropriately compensated. I sincerely hope that the Minister, for whom I have a great deal of respect, will address that point in his reply.

We must not forget that the seven-day NHS pledge has been made many times before. It was in the 2010 Conservative manifesto. The Prime Minister repeated it in October 2013, and in September 2014, and of course it was also in the Conservatives’ 2015 election manifesto. The question I am pondering is: if they promised it before and failed to deliver it, why on earth should anyone believe them this time? We would all welcome a seven-day service, but that must be matched by the funding necessary to recruit, support and, importantly, retain hard-working NHS staff. We have already heard that there is a shortage of nurses; there are fewer nurses per head of the population than in 2009-10. The head of Health Education England, Ian Cumming, said earlier this year that

“GP recruitment is what keeps me awake at night.”

The scale of the recruitment crisis is startling even to those of us who have been following the fortunes of the two Health Secretaries since 2010. The coalition Government were wrong to cut training places as one of their first acts, and immigration policy is not joined up with the need for recruitment from abroad. If adequate numbers of staff are not being trained at home, the two polices do not make any sense together. As we have heard, retention is a big challenge; it is about not only the new staff coming through the system but the staff leaving at the other end.

My message to the Minister and the Health Secretary is this: if they want to deliver a seven-day NHS, we will work with them, but they will not achieve it by picking a fight with staff and, importantly, they will not achieve it unless it is properly funded. The Conservatives made many promises on the NHS before the election, many of which the Government have already dropped, and many more of which have not been funded. If the seven-day NHS promise is to be realised, I implore the Minister to work closely with the health service unions and actually go out and speak to the health professionals that keep our system going.

More broadly, we need a serious debate about how services are organised across the whole week, so that people can stay healthy in their own homes. The Minister and I have debated the concept of whole-person care on numerous occasions—in fact, we debated it at length both before and during the general election. There was a degree of consensus around the plans of my right hon. Friend the Member for Leigh. We desperately need to make sure that all parts of our health and care service work together to ensure that care focuses on the individual.

It is no good Government Back Benchers lauding the ring fence for the NHS budget when, as we heard from my hon. Friend the Member for Warrington North, social care budgets have been ransacked. I should not need to remind Government Members, but the fact is that social care cuts are NHS cuts because of the pressure that they cause throughout the health system. Let us look carefully at the workforce issues that triggered the petition and this debate. Let us work with staff, because without them the NHS will not be transformed into that single health and social care service. For all of us who care about the NHS, ultimately that must be our goal.

Barking, Havering and Redbridge University Hospitals NHS Trust

Andrew Gwynne Excerpts

Wednesday 15th July 2015 Westminster Hall

[Andrew Gwynne (Denton and Reddish) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Davies.

I pay tribute to my hon. Friend the Member for Ilford South (Mike Gapes) for securing this important debate. His speech highlighted the very real danger of closing his local A&E department while the trust is, sadly, in the protracted throes of special measures.

I also pay tribute to my right hon. Friend the Member for Barking (Margaret Hodge) and my hon. Friends the Members for Ilford North (Wes Streeting) and for Dagenham and Rainham (Jon Cruddas) for their contributions. All have been champions for patients at the Barking, Havering and Redbridge University Hospitals NHS Trust for a number of years. Like my right hon. and hon. Friends, I pay tribute to the staff at the trust who, in very difficult circumstances, are working hard to deliver high standards of care to patients.

As we have heard, the trust is facing particularly profound challenges. It is one of the largest in the country, serving a huge and diverse population. There is a lot of churn and movement of people and, as a result, things are even more difficult for GP and primary care services, which, as we know from elsewhere in the country, have been under intense pressure in recent years. My right hon. Friend the Member for Barking made some particularly pertinent points on that: if someone cannot see their GP, the pressure is moved on to local hospital services. When those services are already in difficulty and struggling to cope, they could well do without the added pressure of extra demand.

I hope the Minister will accept that the trust needs real support, because it has been hit hard by certain decisions. The trust itself must bear some responsibility, but I am afraid that some of the previous Government’s policies came at the wrong time. Last winter, as we heard, the trust suffered its worst quarterly A&E performance since records began. In January, more than one in four patients were waiting longer than the recommended four hours in A&E—some were even waiting longer than 12 hours.

In December 2013, the trust was placed in special measures following a Care Quality Commission report that raised serious concerns about patient safety and care, particularly in A&E. The report said that staff at the A&E at King George

“did not have confidence in the trust leadership to make the necessary improvements in A&E.”

Although some of the problems at the trust are deep-seated, the CQC report was clear that many of the problems, such as the difficulty in recruiting staff to the emergency department, have either become worse or emerged in recent years. The report also suggested, for example, that staff were concerned about the wide range of locum doctors turning up to shifts. They felt that there was no problem when they were assigned locums with whom they had worked before, but they were clear that the lack of permanent staff posed a risk to patients.

The trust is in a difficult financial situation. As my right hon. Friend the Member for Barking said, and she was echoed by other Members, that is not helped by its having to spend £27 million on agency staff last year because of a shortage of qualified staff. The trust has also been forced to recruit nurses from overseas because not enough home-grown nurses are being trained. It is well worth remembering that, despite what Ministers claim, the NHS now contains fewer nurses per head than in 2010.

The future of A&E services at King George hospital obviously remains in doubt. I remind the Minister that the 2010 Conservative manifesto promised to

“stop the forced closure of A&E and maternity wards”.

Since then, the maternity ward at King George hospital has closed. The plan to close the A&E unit and relocate it to Queen’s hospital has been delayed, but not abandoned. The Minister can, hopefully, update us on those plans and address the valid concerns not only of local MPs, but of the local communities that they represent on the capacity issues that have been mentioned.

Clearly, many of these challenges cannot be tackled in isolation and require working across London and, indeed, considerable support from the Department of Health, but I hope the Minister has listened carefully to the assessment of the problems laid out by my hon. Friend the Member for Ilford South. I also hope that he is prepared to take on board some of my right hon. and hon. Friends’ suggestions. What they have said is eminently reasonable. With the right support from central Government, I know that their constituents can receive the standard of care that they deserve.

Oral Answers to Questions

Andrew Gwynne Excerpts

Tuesday 7th July 2015 Commons Chamber

[The Parliamentary Under-Secretary of State for Health (Jane Ellison)]

My hon. Friend has been an extremely active champion of healthcare services for her local community, and I congratulate her on continuing to raise this matter. The CQC is due to publish the findings of its latest inspection of the NHS trust shortly, and we expect the trust to work closely with the regulators to deal with the concern that has been expressed. I know that there is concern locally, and I believe that Polegate Town Council will be discussing the matter soon.

[Andrew Gwynne (Denton and Reddish) (Lab)]

We have heard a number of fair questions from Opposition Members, and, I am afraid, nothing but woeful and inadequate answers from Ministers so far. Let me try again by asking the Secretary of State about GPs. As we have already heard, before the election he promised that there would be an additional 5,000 GPs by 2020. However, now that the election is over, he says that that promise requires “some flexibility”, and he was similarly evasive in an earlier answer. Given that there is, in the words of the Government’s own taskforce, a “GP work force crisis”, will the Secretary of State now clear things up? By 2020, will there be 5,000 extra GPs—on today’s figures—as he promised, or is this yet another example of the Conservatives not being straight with people on the NHS?

[Mr Jeremy Hunt]

I think that those were woeful and inadequate questions. What I said after the election was exactly the same as what I said before the election, which was that a number—[Interruption.] Yes, we will have about 5,000 more GPs by the end of the Parliament, which is just what I said before the election. I said that a total of 10,000 more people would be working in primary care. I also said before the election that the woeful problems in general practice would be dealt with only if we unpicked the terrible mistakes made by Labour in the GP contract. That is why this year we are bringing back named GPs for every single NHS patient.

Operational Productivity in NHS Providers

Andrew Gwynne Excerpts

Wednesday 1st July 2015 Westminster Hall

[Mike Weir]

The hon. Gentleman makes a good point. He is right about incentives. A happy workforce will be a much more productive workforce. There is a danger of putting increasing pressure on the workforce, especially in the NHS, where mistakes can be disastrous and can do a lot of damage in the long term, both to the system and patients. We have to be careful about some of these things. I was interested in what the hon. Member for Hendon said about the cost of agency workers. I think we would all agree on that point. It would be preferable to have full-time staff in the NHS, but agency workers are used for a reason: shortages.

The hon. Gentleman also talked about people from outside the EU working in the NHS, but again, this shows that there needs to be a more holistic Government policy. The Government recently announced an earnings threshold of £36,000, under immigration policy, for those who have been working in this country for six years. Many nurses working in the NHS throughout the United Kingdom are not earning that sort of money and have been in the NHS for many years. The Royal College of Nursing stated that if this policy was imposed, thousands of nurses could leave the NHS and could have to leave the UK. That is not in the best interests of the health service at the moment. When considering efficiency savings and how the NHS can better work for all our constituents throughout the UK, we have to think about such things .

[Andrew Gwynne (Denton and Reddish) (Lab)]

The hon. Gentleman is making an important point. Would it not be counterproductive if NHS nurses left to work abroad? That would leave a massive gap in the NHS workforce, probably requiring an increase in agency workers, which would cost the NHS more.

[Mike Weir]

The hon. Gentleman read my mind: that was my next point. Agency nurses are causing a drain on resources, because we have to employ so many already. That will not get any better if nurses cannot work in the NHS because of immigration policy. These people did not come to this country a few months ago; some have been here for many years. Many of these nurses are working in hospitals in all parts of the UK, whether Scotland, Northern Ireland or England. They are also working in the care system.

The Government are making a bad situation worse, perhaps because of other pressures on them to do with immigration, and are not dealing with the realities of the health service. Training new nurses to take the place of those who may leave will not happen overnight. It takes years to train a nurse properly. If these people have to leave suddenly, they will leave a huge hole in the NHS. That raises a question about the sustainability of the system. In summing up, the Minister might like to consider that; and perhaps he will take the matter up with Home Office colleagues and discuss the impact this policy may have on the NHS.

Efficiency savings are fine where they can be made. We are all looking for efficiency savings, and we understand that there can be some. For example, there are some interesting responses in the Carter review on medicines and prescriptions. Savings could be made there. A lot of medicines can be wasted if prescriptions are too large. Such system changes can save money, but it is wrong to look for the silver bullet that is going to change things and produce the £22 billion in efficiency and improvement savings.

--- Later in debate ---

[Andrew Gwynne (Denton and Reddish) (Lab)]

It is a pleasure to see you in the Chair, Mr Pritchard. I congratulate the hon. Member for Hendon (Dr Offord) on securing this important debate. We have had a good debate, although fairly brief, and some important issues have been raised.

I formally welcome the Minister. We have had Health Questions and an Opposition day debate on health since he assumed his role, but this is my first opportunity to welcome him. I trust that his time at the Department of Health will be enjoyable and successful.

I am pleased to respond to the debate on behalf of the Opposition. The hon. Member for Hendon is right: the efficiency challenge for the coming years will dominate the debate about healthcare and shape our NHS in England for decades. As Members know—indeed, several referred to it specifically—the Government are committed to seeing £22 billion of efficiency savings in the NHS by 2020 to meet the £30 billion funding challenge. We have not yet heard any details of where the £8 billion in funding will come from; perhaps I can tease some of the detail out of the Minister. I do not wish to prejudge what may or may not be in the Budget, but it would be nice to have some indication, aside from the usual spin about a growing economy, of where he thinks the £8 billion will come from. Setting aside that question, we need to think carefully about how to meet the £22 billion gap that will remain once that £8 billion is found. To achieve savings on that scale would be a huge ask at any time, but when NHS trusts have huge deficits to tackle and providers say they are experiencing the biggest financial pressures they have ever seen, making these efficiencies will be a huge challenge.

It is probably appropriate at this stage for me to place on record my appreciation of and thanks to those who work in our national health service—at every level. It is not always popular to praise managers, but to meet the challenge the NHS will need a great deal of expert management. We therefore need to praise the work of not just the doctors, nurses, clinicians, porters and support staff, but the good managers, because they will face the real challenge of finding these efficiencies.

It is vital, not just for us but for all those who work in the NHS, that the Minister is as open and honest as he can be today about where the efficiencies will come from. One of the few people who has seen the detail of the planned efficiency savings is the former Care Minister, the right hon. Member for North Norfolk (Norman Lamb). Just last week, he said that the £22 billion efficiency savings in the five-year forward view are “virtually impossible” to achieve—words that will not fill people with confidence.

As the Minister knows, the Opposition have pressed the Government on a number of occasions to publish the assumptions underlying the £22 billion figure. I hope he will take that message back to the Secretary of State today, because we need to have a properly informed debate about the NHS’s long-term funding requirements. That is true not just of England, because the proposals will have knock-on consequences for the NHS in all the constituent parts of the United Kingdom, including Scotland and Northern Ireland, which have been represented in the debate.

We need to be honest about the fact that, whatever the scale of the efficiencies that need to be found, there will be no quick fix—a point eloquently made by my hon. Friend the Member for Bristol South (Karin Smyth). However, when budgets are tight, it is right that we debate how money can be better spent to meet the growing cost of delivering world-class healthcare.

With that in mind, let me cover a couple of pertinent areas. The first is procurement. Any doctor will tell us of sales representatives pushing every bit of kit and course of medicine under the sun—that is just the nature of salespeople, and that is what they do. In the NHS, there are around 500,000 product lines for everyday consumables, with cost variances of sometimes more than 35%, which is massive. The Carter review suggested that a catalogue of 6,000 to 9,000 product lines represents best practice. In part, the huge variety of products is a symptom of a more fragmented NHS. These days, we do not have the opportunity to use the NHS’s national purchasing muscle as much as we did, which is a shame and a wasted opportunity. However, having a reduced range of products—perhaps set out in a national catalogue, but definitely coming through the NHS supply chain—would be good for cost-effectiveness. I hope the Minister can take that point on board.

Part of the problem is the army of sales representatives, who are proliferating at all levels of the NHS. Their very existence represents a large dead-weight cost to providers. They can provide a useful service when it comes to selecting the best product for practitioners’ needs, but it is obviously not in their interests to provide products at the lowest practical cost; nor is it in their interests to promote other products or to give practitioners more information about the choices that may be available to them and their patients. It is, to some extent, an imperfect market, with smaller suppliers pushed out from the very beginning. There will always be a need for companies to provide high-end support and advice, but while representatives have a big influence on buying decisions, we must ensure that that influence is at least partly tracked.

Let me talk briefly about the cost of competition. The Minister is new to his post, but he will have paid close attention to the many debates we had on these issues before the election, so he will be aware of the Opposition’s concerns about the competition rules introduced in the Health and Social Care Act 2012. We know that the new competition framework is causing

“significant cost to the system”—

not my words, but those of the former chief executive of the NHS. Last year, we identified at least £100 million that in trusts and clinical commissioning groups alone was being spent on staff and lawyers to analyse tenders and to administer the tendering process. If the Minister is serious about making substantial savings, may I gently advise him that it would be a good start to look at the waste generated by the Act’s competition provisions?

One crucial area to analyse is the poor workflow in hospitals, and specifically the lack of adequate sub-acute services. At the moment, many discharged patients, particularly elderly ones, have nowhere to go. That is attributable mainly to the drastic cuts to adult social care we have seen in recent years. Sadly, I can only anticipate that those pressures will remain, and perhaps become more acute with coming spending reviews. We all know that if patients are not discharged, hospital beds are wasted and hospital workflow is disrupted, which costs the system an absolute fortune. That is to leave aside the fact that hospital is not the best or most appropriate place for such patients to be or for their care to be delivered.

[Karin Smyth]

The consequences of the 2012 Act included fragmentation of responsibility for the flow of patients through the system. Different commissioning organisations now commission primary care to support the patient outside hospital, there is separate provision of community services, and NHS England has an oversight role as well as a role in commissioning specialised services. In Bristol there are two major acute trusts that are largely commissioned by three different clinical commissioning groups, supported by NHS England and involving the Trust Development Authority and Monitor. A large room is needed for people to get around the table at meetings to consider things such as flow, and it is very complicated.

[Andrew Gwynne]

My hon. Friend hits the nail on the head, describing the complexities of the NHS in England. We have talked for several years in the House of Commons about the need for a properly integrated health and social care system. My hon. Friend has set out a prime example of the reason we need that.

I anticipate that the Minister will argue that some of the inefficiencies we have discussed will be addressed through integration. My problem is that many of the competition rules and requirements in the 2012 Act work against such an integrated health and social care system, even though both sides of the House want it. The Government will have to look carefully at the role of some of the rules and regulations they introduced, when local health economies reach the point of developing integrated care models. It is clear that representatives of a hospital trust, local authority adult social care and children’s care services, and the clinical commissioning group cannot sit around a table to plan an integrated health and social care system while many of the requirements placed on the NHS by the 2012 Act continue to apply.

To return to the issue of transfer and delays in hospitals, we all know that the NHS operates something of a just-in-time system. Such systems are used in industry, particularly for international stock control, and they make sure that nothing is wasted. There is little room for slack: if a patient is admitted for longer than necessary because of avoidable shortfalls elsewhere in the system, that can lead to the atrocious scenes that happen when desperately sick and injured people are left lying in corridors. I think that on one occasion, somewhere near the constituency of my hon. Friend the Member for Bristol South, someone was treated in a tent in a hospital car park. We hoped such images had long gone from the NHS.

I want to say politely but firmly to the Minister that the NHS is affected by what goes on in the social care system. Social care cuts are to all intents and purposes NHS cuts. I hope that he will get that message loudly and clearly and that the Prime Minister will stop insisting otherwise. All that demonstrates, as my hon. Friend the Member for Bristol South eloquently stated in her intervention, the need for a properly joined-up service. Labour Front Benchers have argued for that for some time and the previous Government were moving towards it. I am happy to provide guidance to the Minister on what we think should happen to that end, and to provide stern criticism if Ministers do not deliver.

I also want to talk briefly about the cost of agency workers, which the hon. Member for Angus (Mike Weir) touched on. The Health Secretary has belatedly sought to address that issue, but it has been years in the making. Ministers will know that hospitals have consistently cited recruitment difficulties, particularly for qualified nursing and medical staff and in accident and emergency departments. It is welcome that the number of training places has been increased in recent years, but it was a short-sighted mistake to cut the number of those places early in the previous Parliament. That has led in part to the present recruitment issues.

The Minister will know that the rising number of staff suffering from work-related stress has resulted in even more workforce pressures in the NHS. He will also know that the decision to cut nurse training posts has meant that many hospitals must either recruit from overseas or hire expensive agency workers. Health Ministers must make strong representations to Home Office Ministers, because if there was ever a sign of disjointed Government decisions, it was the recent announcement of changes to immigration policy. As we have already discussed, those changes may cause massive problems to some NHS trusts across the United Kingdom that already face challenges and have recruited from overseas.

The savings that the NHS will need to make in coming years are far more difficult than the low-hanging fruit or quick wins that some may think are available. All of us across the parties and across the constituent parts of the United Kingdom need to acknowledge that there will be no quick fixes to the challenge. There should be no mistaking how difficult things have been for many trusts in the past few years. The coming years will be just as difficult for them, if not more so. I hope that the Minister will agree in that context that we need a proper open debate, with all the facts, figures and information before us about where we can make the savings, and how we can ensure that more of the NHS’s funding is spent on what it does best—delivering high-quality patient care across the United Kingdom.

[Mark Pritchard (in the Chair)]

Order. Before I call the Minister I remind hon. Members of the new standing orders that allow the mover of the motion to wind up if there is time available. I am sure that the Minister will be mindful of that, with 30-plus minutes on the clock.

--- Later in debate ---

[Ben Gummer]

I was going to come on to that, so I shall do so now that the hon. Gentleman has prompted me. There have been long and deep discussions about this. Our estimate is that no more than 700 nurses will be affected by the time the new rules are in place, which is a different number from that given by the Royal College of Nursing, whose number we do not recognise. It is small challenge given the scale of the workforce and one that we will surmount at the time, but we must see it within the broader policy of reducing immigration to this country from the hundreds of thousands to the tens of thousands—a policy that has broad support across the House and certainly in the country at large. It would be wrong for the largest employer in the country—one of the largest employers in the world—to exempt itself from that overall ambition.

In the end, we will achieve a sustainable workforce in this country only if we do all we can to ensure that those who are British and have grown up here and want to work in the NHS have the opportunity to do so. That is why it is important that we widen and open the avenues into working in the NHS, as the hon. Member for Bristol South suggested, over the next few years, in order to meet the challenge to which the hon. Member for Strangford alluded.

I want to quickly run through the other issues raised by my hon. Friend the Member for Hendon. On master vendors, he has a specific issue regarding some constituents with whom he has been dealing, but I understand that master vendors are managed under a series of arrangements with the Crown Commercial Service. Officials will meet with that organisation soon to discuss the overall issues around master vendors. It is for individual trusts to make such purchasing decisions, but I understand the issue he has raised and the terms in which he put it, and I will ensure that it is investigated properly.

My hon. Friend identified two areas involving agencies and fraud. Fraud is of course unacceptable, and the NHS has quite good systems for identifying it. Given the scale of the NHS, I find it surprising—it is entirely to the credit of those who work in the NHS—that fraud makes up such a tiny proportion of the excessive costs in the NHS.

On the revalidation of locum doctors, for which the General Medical Council is responsible, some doctors find it difficult to gather all the required supporting information needed for revalidation due to the peripatetic nature of the work. To help with that, specific guidance is available for both the doctors and their employers via NHS England and NHS Employers. Locum doctors are part of a larger issue about agency spend and foreign workers working in the NHS. I imagine that the three organisations will come together in the next few years to produce a more stable situation.

[Mr James Gray in the Chair]

Let me turn to the remaining points of the hon. Member for Bristol South. On the stability of the system, I hope and anticipate that one product of the general election is that the system will be broadly stable over the next five years. We intend to continue with the current structure of the NHS. There will be some small changes, such as that identified by my right hon. Friend the Secretary of State last week concerning the NHS Trust Development Authority and Monitor, but we are broadly content with how the system is set up. We must now proceed to ensure that it works.

The shadow Minister made a point about structures and fragmentation. There will always be a genuine dilemma here, because one can approach any system and say that change can be achieved by altering structures, but changing structures can lead to the same outcome. That has been the story of the NHS since its inception. It would be a mistake to think—the hon. Member for Bristol South and the shadow Minister were not suggesting this—that a structural change would somehow produce the outcomes that we all want. The priority is to ensure that the system’s wiring works correctly—that everyone’s interests are aligned and that the incentives are correct—so that people want to sit around the table and come to a considered decision, which can too often not be the case when there is an adversarial relationship between providers, producers and purchasers. That is why I hope that the system’s stability over the next five years will allow us to focus on the significant challenges mentioned by the shadow Minister.

[Andrew Gwynne]

When discussing competition rules, we often talk of public versus private, but two public parts of the NHS can also compete. Another NHS trust might have the tender for providing a service in another area and an integrated care organisation might want to bring that back in-house.

[Ben Gummer]

Absolutely. There are examples of that all over the country, but there are also examples of people working together in what might be considered competitive situations, so it is about ensuring that we copy the best and delete the worst.

Before I turn to the shadow Minister’s comments, I want to reflect on the contribution of the hon. Member for Angus (Mike Weir). The SNP spokesperson on health, the hon. Member for Central Ayrshire (Dr Whitford), has used a constructive tone in the Chamber so far, bringing some of her expert experiences as a clinician and also the experiences from Scotland. It is nice to be able to sit here and hear the experiences of people in Northern Ireland and in Scotland, and it would have been nice to have heard from Wales in this debate. Indeed, we do not yet properly learn from the best in Scotland, which would be all to our good, let alone the best in America or India.

The £22 billion in savings is an estimate not from the King’s Fund but from NHS England. It formed part of its plan, devised at the end of last year and some years in the making, which identified £30 billion of additional money that needs to be put into the service over the next five years. It stated that £22 billion could be generated internally—that was Simon Stevens’ estimate—which leaves an £8 billion shortfall. That is what we are pledged to provide. None the less, he, like everyone in the Chamber, has correctly seen that £22 billion is a large number and one that will take a great deal of intellectual and moral work to deliver. I welcome the tone with which everyone has approached this challenge in the debate.