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.

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[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.

A&E Services

Andrew Gwynne Excerpts

Wednesday 24th June 2015 Commons Chamber

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

We have had a good debate. I pay tribute to hon. Members who made their maiden speeches. I particularly congratulate my hon. Friends the Members for Dewsbury (Paula Sherriff) and for Salford and Eccles (Rebecca Long Bailey). Having been a student at the University of Salford, I had not realised until now that I followed in the footsteps of Marx and Engels by supping in The Crescent; you learn something new every day. The hon. Member for Dumfries and Galloway (Richard Arkless) also made his maiden speech. I congratulate them on their contributions. It is clear that all three will make their presence felt in the House of Commons in the coming years.

I thank the other Members who have contributed, particularly my hon. Friends the Members for Birmingham, Edgbaston (Ms Stuart), for Hartlepool (Mr Wright), for Hammersmith (Andy Slaughter) and for Ealing Central and Acton (Dr Huq), and the hon. Member for Central Ayrshire (Dr Whitford), who leads on health issues for the SNP. On the Government Benches, we heard from the hon. Members for Totnes (Dr Wollaston), for Sittingbourne and Sheppey (Gordon Henderson), for Lewes (Maria Caulfield), for Crawley (Henry Smith), for Braintree (James Cleverly), for Bath (Ben Howlett), and for Morley and Outwood (Andrea Jenkyns). Many Conservative Members stuck very closely to their party’s policy research unit paper, a copy of which I was conveniently sent earlier today. I congratulate them on being so loyal to their Whips Office.

It would be very remiss of me not to place on record my own tribute to the doctors, nurses, healthcare assistants and other dedicated NHS staff who provide such extraordinary and professional care. Many Members of this House who have been here for a number of years will know that I had a run of bad health about five years ago. As a result, I became far more familiar with my own local hospitals, Tameside general and Stepping Hill, than I had hoped to, even given my position as a constituency Member of Parliament and a shadow Health Minister. I have experienced the very best of NHS care. If I am honest, I also experienced some care that did not meet the standards that we perhaps expect of our NHS. I know, however, that we have a workforce who are completely dedicated and caring.

The House should be in absolutely no doubt, though, that those staff are under a great deal of pressure—sustained pressure that has been building over the past five years. The facts need to be laid out in the open, and Ministers need to be challenged on their fictions. They made all sorts of desperate promises to get them through an election campaign, and now they need to show where the money is going to come from to pay for those promises and to set out exactly how they are going to deliver them. Yet what have Ministers been doing since the general election? I do not disagree with Professor Sir Bruce Keogh’s decision to improve the publication of data for mental health and for cancer—that is welcome—but I do disagree with what this Government intend to do in relation to A&E data. Instead of dealing with the pressure facing the NHS in England, they have decided to stop publishing weekly data about those pressures.

[Helen Whately]

Will the hon. Gentleman acknowledge that the NHS leads the world in transparency, and that an excessive focus on one data point—the four-hour target for A&E—is detrimental overall to patients?

[Andrew Gwynne]

We should remember, of course, that the last Labour Government started that transparency with heart and stroke data.

I think we all know what is going on here. There can be no clearer sign of the Tories’ failure on the NHS than the fact that hospital accident and emergency departments have now missed their own four-hour target for 100 weeks in a row. This is a landmark failure, to which the Prime Minister promised he would not return. The reality is that this Government caused the crisis by making it harder to see a GP and by stripping back social care services.

Let us be under no illusions—[Interruption.] The Secretary of State can chunter, but social care cuts are NHS cuts. The Government made damaging mistakes that have seen the number of people going into hospital soar. The best thing that they could do is to admit it and explain what they are going to do to fix the problem. It is stunning that their only solution is to spin their mistakes and to make the NHS less transparent.

Let me briefly come on to nurse staffing problems. Only this week, we have seen yet another example of poor policy coming out of the Department of Health. If it insists, along with the Home Office, that migrants not earning £35,000 after six years must go home, that will cut a hole right through the middle of our NHS. The Royal College of Nursing estimates that 6,620 nurses will have to leave the country by 2020. Because of the Government’s failure to train adequate numbers of nurses in the UK, those nurses will have cost almost £40 million to recruit from overseas. People coming from other countries to work in the NHS make a huge contribution and our health service would not be able to cope without them, but this is now a mess entirely of Ministers’ own making.

The short-sighted cuts to nurse training in the early years of the last Parliament left NHS hospitals with no option but to recruit from overseas or hire expensive agency nurses. That is also one of the main reasons why many hospital trusts are now in deficit. It was an absolutely profound error and I hope that the Minister will acknowledge that. As ever with this Government, patients and taxpayers will pay the price for the Prime Minister’s mismanagement of the health services.

There have been further mistakes. On GP access, it stands to reason that if it is made harder to see a GP, people will be more likely to end up in hospital. As we have heard, the reasons for the crisis are many, but the lack of access to GP services appears to account for much of the problem. No amount of obfuscation and massaging of figures can hide the fact that this Government have made it harder to get a GP appointment. All Members will know of constituents who have had to phone their doctors only to be told that no appointments are available and that they should ring back the next day—which they do, only to experience the same problem again. That they end up in frustration in A&E should not come as any shock.

The Prime Minister has now repeated his 2010 promise to provide access to GPs seven days a week, but he cannot even provide access to them five days a week. When patients want up-to-date information on how their local hospital is performing, this Government plan to publish the data less frequently. I hope that the Government will now see sense, and I commend our motion to the House.

Oral Answers to Questions

Andrew Gwynne Excerpts

Tuesday 2nd June 2015 Commons Chamber

[Mr Hunt]

I welcome my hon. Friend warmly to his place; he hits the nail on the head. We had a big problem with diagnosis—less than half of the people who had dementia were getting a diagnosis—and we have made progress on that. It is still the case that in some parts of the country, although I hope not in Mid Dorset, when someone gets a diagnosis not a great deal happens. We need to change that, because getting that support is how we will avoid tragedies such as that in Weaver Vale, which we heard about earlier.

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

The Secretary of State knows that the availability of social care for vulnerable older people has a big impact on the NHS, especially for people with dementia, yet 300,000 fewer older people are getting help compared with 2010. Given that the Secretary of State has said that he wants to make improving out-of-hospital care his personal priority, can he confirm that there will be no further cuts to adult social care during this Parliament, which would only put the NHS under even more pressure?

[Mr Hunt]

I can confirm that we agree with the hon. Gentleman and the Opposition that we must consider adult social care provision alongside NHS provision. The two are very closely linked and have a big impact on each other. I obviously cannot give him the details of the spending settlement now, but we will take full account of that interrelationship and recognise the importance of the integration of health and social care that needs to happen at pace in this Parliament.

Health and Social Care

Andrew Gwynne Excerpts

Tuesday 2nd June 2015 Commons Chamber

[Jane Ellison]

No, I cannot give way at this moment.

The coalition Government had an excellent record on cancer. Yes, there is further to go, and that is why we have made it central to our plans. We want to see the NHS go further and faster on diagnostics. That is why NHS England has an independent taskforce looking at this issue. We got its interim report in March. We will get its final report in the summer and we will act on it.

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

It is bluster.

[Jane Ellison]

The hon. Gentleman says it is bluster. Is it bluster to talk about the £1 billion invested in the cancer drugs fund?

Nurses and Midwives: Fees

Andrew Gwynne Excerpts

Monday 23rd March 2015 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mr Havard. It is also a pleasure to follow my hon. Friend the Member for Foyle (Mark Durkan). We recently had the pleasure of serving for 13 hours that we will never get back on the Committee for the National Health Service (Amended Duties and Powers) Bill, which my hon. Friend the Member for Eltham (Clive Efford) promoted. It is quite a novelty to speak in a health debate in which hon. Members have actually spoken about health. It feels quite unique after the debates in that Committee.

As is customary, I place on the record my appreciation of and congratulations to the petitioners, who managed to achieve the number of signatures necessary for the debate, and my hon. Friend the Member for Blaydon (Mr Anderson) and the Backbench Business Committee on getting it on the Floor of Westminster Hall today. I also pay tribute to all who work in our national health service, not only the nurses and midwives in particular, but everyone who helps make the NHS the service that it is. We are now only five and a half weeks from the next general election and we are in the last full week of the 2010 to 2015 Parliament. Issues such as the one that we are debating show the direction in which our health service has been heading.

It is totally wrong to impose further charges on nurses and midwives, especially when many are facing a cost of living crisis caused by the Government. Wages are falling and prices rising; this is now set to be the first time in living memory when people will be worse off at the end of a Parliament than they were at the beginning. Yet the Nursing and Midwifery Council wants to increase the burden on the shoulders of registrants. What message does that send to the nurses, midwives and patients whose interests it is there to protect? I think a pretty poor one.

We have all had similar cases, but the hon. Member for Congleton (Fiona Bruce) put her constituent’s very eloquently. I am sure that other Members have such cases to pursue with Ministers, which highlight the issues surrounding the debate. We are talking about not only numbers, but real people, and it is right for such matters to be raised. Taken together with the 1% pay rise—for which, to put it bluntly, nurses had to fight tooth and nail after the Government initially indicated that they would not honour their pledge—the move we are discussing today shows what the Government think of public sector workers. When Labour gets into power, clearly we will have to look carefully at the books, but we absolutely will not do what this Government have done: break every single promise made to NHS staff.

As we have heard throughout the debate, in particular from my hon. Friends the Members for Blaydon, for Easington (Grahame M. Morris) and for Foyle, the Government should have introduced the Law Commission’s draft Bill on the regulation of health and social care professionals, which included some good measures. Had the Government introduced it, it would have enabled the NMC to increase efficiencies and decrease costs. Instead, the Government have been introducing a swathe of delegated legislation to form something of a patchwork quilt of reform. Indeed, I seem to remember, Mr Havard, that you chaired two statutory instrument Committees only last week—

[Mr Dai Havard (in the Chair)]

At the same time.

--- Later in debate ---

[Andrew Gwynne]

At the same time!

I do not understand why the Government could not have found time to introduce the measures in the draft Bill. Even the head of the NMC, Jackie Smith, thinks that the Government have not gone far enough. She has complained that she is fully aware her organisation is not resolving cases quickly enough, but that the legislation as it stands does not allow the NMC to do things any quicker. Likewise, the Royal College of Nursing, the Royal College of Midwives, the Patients Association, the Parliamentary and Health Service Ombudsman, the Care Quality Commission, Unison, Unite and others have voiced their strong support for the draft Law Commission Bill.

In response to the Francis report, the Prime Minister hailed the draft Bill, but then promptly forgot about it. It is simply not a priority for the Government. In response to the draft Bill, they said that they would be

“committed to legislating on this important matter when parliamentary time allows”,

but we have already heard how, towards the end of this Parliament, it has been dubbed the “zombie Parliament”: we have one-line Whip after one-line Whip and we have finished business earlier than the normal moment of interruption on many days. There has been plenty of time to introduce the measures had the Government seen fit to do so. Certainly given the supposed cross-party consensus on the measures, they could have reached the statute book by Dissolution. Judging by the lack of any sort of activity in the House in recent months, the Government have had their chance many times over. Sadly, only a few days of the Parliament now remain.

It looks to me as if the only people opposed to the draft Bill were Ministers. To be fair to the Minister present, whom I like, I do not think that that is through any malice, but that it is rather a result of inertia, or perhaps a lack of attention—I do not know. Let me place clearly on the record, however, that Labour supports reform and simplification of the legal framework for regulation. The draft Bill would enable the regulators to work better together and to share functions and, crucially, to make savings and to keep their costs down. The Government’s failure means that they are now leaving the NMC to force nurses and midwives literally to pay the price.

We went through the same procedure three years ago: the NMC announced that it had to put its fees up; it held the consultation that it is obliged to do; and it promptly increased the fees by one third. In that instance, the consultation showed an overwhelming majority of respondents opposed to the plans. This time it has put the fees up by another fifth, which means, as we have heard from other Members, that the fees will have gone up by £44 in three years, an increase of more than 50% on 2011.

The e-petition has shown the strength of feeling. As my hon. Friend the Member for Blaydon stated, 114,000 signatures is some doing—not many e-petitions make the 100,000 threshold necessary to be considered for a debate in Westminster Hall or in the main Chamber. This e-petition is one of the most modest and reasonable of the ones to meet the criteria, so I genuinely hope that the Minister will consider it in the few days left to him to be accountable to Members of this House of Commons—after Dissolution there will, of course, be no Members of the House of Commons, although the Minister will remain in his post until the formation of a new Government. I want his commitment to give the e-petition the full consideration that it deserves.

I will say a little about the other duties of nurses. Later this year, the NMC will introduce a new process of revalidation for registrants that will place additional requirements on those wishing to stay on the register. It will require significant efforts from registrants. Together with pay restraint lagging well behind increases in the cost of living and an environment of demand, unrest and difficult decisions, it is difficult to see how further increases in the registration fee would not simply demonstrate to nurses that they are not valued. Encouraging staff to leave the NHS is the last thing that we should be doing given the UK’s shortfall in nurses and midwives.

Furthermore, why would new students decide to go into nursing and midwifery when the Government are making life even more difficult for graduates? Nurses have been subjected to an effective cut in their pay of between 8% and 10% since 2010, and the latest move is unacceptable. The Labour party seeks to reverse some of the trends: we are fully committed to a time to care fund, which will pay for 20,000 additional nurses and 3,000 extra midwives, along with 8,000 new doctors and 5,000 extra home care workers over the period of the next Parliament.

I am sympathetic towards the NMC’s complaint that it has no room for manoeuvre when it comes to cutting costs. The real shame here is the lack of reform, but the NMC has £10 million in its reserves. Now that reform is clearly not that far away, perhaps it will consider holding off the fee rise. I understand why it has proposed and gone ahead with that rise, as under current law the fee is almost its sole source of income, and it has a statutory duty of public protection. However, the increase is not reasonable under the circumstances, especially when looked at in the light of the fee bump in 2012.

As far as I am concerned, the blame for this situation lies at the door of the Ministers who could have made changes. The Minister had his chance to introduce the draft Bill in this Parliament, but it will be left to the next Labour Government to make the changes that are so desperately needed.

--- Later in debate ---

[George Freeman]

The Government take recommendations from the Health Committee very seriously—we have done so on a number of issues. It is interesting to quote what the Committee has said on this matter:

“We would urge the NMC to avoid further fee rises and to consider fee reductions for new entrants to the register.”

My point is that it is the NMC’s responsibility to deal with the issue. It is accountable to Parliament, and the Under-Secretary of State for Health, my hon. Friend the Member for Central Suffolk and North Ipswich, observes its recommendations closely. However, its internal organisation is a matter for itself.

[Mr Philip Hollobone in the Chair]

[Andrew Gwynne]

The Minister is correct that the NMC is accountable to Parliament, but it has asked for legislative changes, and the legislative programme is largely under the control of Ministers, so why have the Government not acted?

[George Freeman]

It is a fair question, which I will come to, but it has nothing to do with the importance of getting this right; it is merely a matter of the regrettable constraints of parliamentary time. One reason why I very much hope my colleagues and I will be returned in May, Mr Hollobone—I was about to call you Mr Havard; I welcome you to the Chair—is that we will be able to get on with that important reform.

For the benefit of the House, let me finish summarising some of the important information about the NMC. The NMC’s total income for 2013-14 was £65 million. Its fee income was £62 million, which is quite a substantial sum. It received a grant of £1.4 million from the Department of Health and investment income of £1 million. Its expenditure totals £70 million, with £24.18 million, or 34%, going on staff. Its permanent headcount has been going up year on year. The average for the year 2014-15 was 496. The NMC had 521 permanent staff on the payroll in March 2014 and 577 in March 2015. The permanent headcount for March 2016 is projected to be 606. I merely point that out to highlight that the NMC faces some important considerations in driving productivity and efficiency internally to deliver the service it is statutorily required to deliver to its members, who fund it through subscription.

Let me turn now to the relationship between the PSA and the regulations we have introduced. The proposed change will be introduced in the Professional Standards Authority for Health and Social Care (Fees) Regulations 2015—or S.I., 2015, No. 400, with which you will be intimately familiar, Mr Hollobone, as an assiduous observer of these things—which have already been laid in Parliament. The NMC’s council meets this week to decide its policy towards them, so this debate is, again, extremely timely.

The NMC has decided to increase its fees for nurses and midwives from £100 to £120. The rise was effected through the Nursing and Midwifery Council (Fees) (Amendment) Rules Order of Council 2014, which came into force on 1 February. Although the NMC is an independent statutory agency, the Government have made it clear that they expect the NMC council to have clear justification for, and to consider nurses’ and midwives’ financial constraints when making, decisions on fees. I will say a little more in a moment about that and about the importance of the Bill to modernise the NMC’s constitution.

The NMC has consulted its registrants on the proposed fee rise, but I am aware of the strong body of opinion among those who opposed it, and that has been expressed in the debate and in the number of people who have signed the petition. The NMC says that it has not taken its decision lightly and that it has considered the responses to the consultation in detail and carefully listened to the issues raised, and I have no reason to doubt that. However, I remind hon. Members that the NMC’s first duty must be to deliver its core regulatory functions and to fulfil its statutory duties to ensure public protection, and the fee rise must be justified against its core duty.

Let me touch now on the Government grant, which is important. I appreciate that, since the NMC was established in April 2002, there have been a number of increases in its annual registration fee, and I appreciate the impact that that has had on dedicated nurses and midwives working long hours in difficult roles to provide excellent care. That is why, in February 2013—more than 10 years after the increases started in 2002—the Government awarded the NMC a substantial, £20 million grant to ease the pressure.

One purpose of that grant was to allow the NMC to protect nurses and midwives—particularly lower-paid nurses and midwives—from the full impact of a proposed annual registration fee rise. The grant meant that, in 2013, the NMC was able to raise its fee from £76 to £100 and not to £120, as originally intended. With a week before Parliament dissolves, the Government have no plans to give the NMC a further grant to subsidise the 2015 registration fee increase. Given that we continue to have to make tough decisions to put the economy back on track, and that we have given the NMC £20 million, it now needs to work out internally how best to allocate the fee increase, which I should remind hon. Members is equivalent to £3 per member if it is spread equally among them.

I am pleased to say that, as part of the broader package of measures the Government are putting in place to support the lowest-paid workers in the NHS, all the major NHS trade unions accepted the Government’s pay offer on 9 March. It will be implemented from 1 April, giving more than 1 million NHS staff, including most nurses and midwives, a 1% pay rise, without risking front-line jobs or costing the taxpayer more money. That means our lowest paid staff will receive the biggest rise.

I want to update hon. Members on the changes, because they are an important wider consideration against which to view the impact of the fees. For the lowest- paid, the 1% rise will mean an increase of up to 5.6%, or an extra £800 in their pay packets. I have looked at the salary figures, and the average, ending March 2014, for nurses, midwives and health visitors—the people we are talking about—is £31,000. They will get the 1% rise, which is an extra £800.[Official Report, 25 March 2015, Vol. 594, c. 3MC.] Importantly, staff earning between £15,000 and £17,000 will get an extra £200, which is equivalent to 2.3%. Nursing staff earning up to £40,558 who are not at the top of their pay band are still eligible to receive an incremental increase.

Let me take issue with the point that the Government are not looking after the lowest-paid. The pay offer specifically makes sure that the increases the system can afford are targeted at the lowest-paid. Those earning more than £56,000 are more able to cope with the challenges of pay restraint. We are supporting the poorest in the system most, and we are making the highest-paid bear more of the burden. Finally, the bottom pay point will be abolished, seeing the lowest pay rise from £14,300 to £15,000, with about 45,000 on the lowest two pay points benefiting.

--- Later in debate ---

[George Freeman]

I am glad, again, that the hon. Gentleman raises that, because fortunately the Chancellor was able to confirm that the Office for Budget Responsibility has confirmed that finally people in this country are better off, after a very difficult period. I am not going to pretend that it has not been difficult. The reason was that we inherited a chronic legacy of debt, deficit and structural deficit, which was tackled by the previous Government nowhere less than in health care. That created a situation in which, despite a growing economy, we face a huge structural challenge, exacerbated by demographics.

This year there are 1 million more pensioners in the system—1 million more people needing and generating high health demand. I do not hold the Opposition responsible for that. However, the lack of reform and the structural issues at the heart of the health service, which mean that the health structural deficit is growing faster than the general economy, have left us with a challenge. We need to tackle that.

As the hon. Member for Blaydon pointed out, the NMC has stated that there has been a significant rise in its costs, because of fitness-to-practise referrals, which are up more than 100% since 2008-09. Since 2008-09 it has raised its fee by only 63%, making up the bulk of the difference in cost through a programme of efficiencies. Without those it would have had to scale back its fitness-to-practise activity, or generate additional costs earlier. The NMC has provided assurances that it is committed to continuous improvement in carrying out its regulatory functions and will continue to deliver more efficient ways of working to maximise the value of registration fees and to keep them at the lowest level possible while enabling it to fulfil its statutory duty. The NMC is a £70 million-a-year organisation with substantial opportunities to put efficiencies in place, to reduce the cost of the £3 extra cost on its members.

As to the need to update the NMC constitution, the Government have worked with it to make changes to its legislation. We have made good progress with legislative change to reform the way it operates. On 11 December 2014 an order made under section 60 of the Health Act 1999, amending the Nursing and Midwifery Order 2001, came into force. Those changes to the NMC’s governing legislation will enable it to introduce more effective fitness-to-practise processes, while not lessening the public protection it provides.

A key amendment to the NMC’s governing legislation enables it, through its rules, to delegate the decision-making functions currently exercised by its investigating committee to its officers known as case examiners. The intended effect is to speed up and therefore reduce the cost of early-stage fitness-to-practise proceedings, as it will not be necessary to convene the full investigating committee to consider every allegation of impairment of fitness to practise. That should result in financial savings to the NMC as well as greater consistency in decision making. I think we would all welcome that. The rules that bring those changes into effect come into force on 9 March.

The section 60 order has helped the NMC by providing a degree of modernisation of its legislation. However, there is still much to do and that is why we asked the Law Commission in 2011 to review the whole framework of legislation underpinning professional regulation. The report was published last year and we published the Government response in January. I am aware that the decision not to progress a professional regulation Bill to take forward the thinking in the report in the current parliamentary Session was a disappointment to the NMC, as it was to us. We want to move on, but parliamentary time, as you know, Mr Hollobone, is an eternal constraint on Government’s ability to implement. However, that decision provided an opportunity to invest time in getting that important legislative change right, for the benefit of those who will be affected by it. Of course, it will not restrict the NMC’s ability to implement its own internal modernisation and efficiency programme, or to decide how to deal with the internal allocation of its fee obligations to the PSA. It is free to do that.

[Andrew Gwynne]

The Minister will know that a number of the changes and efficiencies that the NMC would like to implement require further legislative change. With those changes, it could free up some of its £10 million reserves, to offset some fee charges. Could we give the NMC some certainty, on a cross-party basis, that, whoever forms the next Government, we will bring in those changes? That would give it the certainty that it could use the reserves to offset the fee increases.

[George Freeman]

I am delighted to confirm that the Government remain committed to introducing primary legislation to address those wider reforms to the system of professional regulation; and it sounds as though, if the hon. Gentleman and I are in our posts then, that may well have cross-party support. That would be an important measure, and our inability to pass it before the end of this Parliament is not a sign of its importance; it is merely a function of the challenge of the availability of parliamentary time.

It is worth pointing out that the performance of the NMC has been challenged and highlighted by a number of bodies, including the Select Committee, but also by some of its members—nurses and midwives. It has had a troubled past with its performance, which is why Ministers commissioned the predecessor body of the Professional Standards Authority, the Council for Healthcare Regulatory Excellence, to undertake a full strategic review in 2012. That review put forward 15 high- level recommendations for improvement in the delivery of the NMC’s regulatory functions, and set an expectation that demonstrable improvements should happen within two years.

In 2014, the NMC commissioned KPMG to undertake an independent review to assess its progress, and KPMG concluded that the NMC had made a substantial number of improvements, which cumulatively placed it in a much stronger position than in 2012. That improvement was recently recognised by the Secretary of State for Health in his oral statement to the House about the Morecambe bay investigation. However, the NMC itself recognises that there is still much more to be done, and so the processes of improvement continue. Ministers have made it clear that we expect the NMC to work towards and ensure compliance with the standards of good regulation, and to continue looking for more efficient ways to work.

Hon. Members on both sides have raised points that I want to deal with. Several mentioned how the fees of part-time nurses are dealt with by the NMC, which is an interesting point. It is not for me to tell the NMC how to deal with it. That is for the NMC to decide, as an independent body, but I should have thought that, on the basis of pure justice and equity, members who do not work full time and therefore do not earn the same as those who do, and who do not generate, even on a pari passu basis, the same level of exposure to the costs or their organisation, would not have to pay the same costs. However, that is of course a matter for the NMC.

The hon. Member for Blaydon raised several questions, including whether the NMC will review its guidelines on fitness to practise, and provide guidance on fitness to practise cases. Those are all matters for the NMC as an independent body, but new legislation means that nurses can pay fees in instalments, and that fees can reflect part-time work.[Official Report, 25 March 2015, Vol. 594, c. 4MC.] The hon. Gentleman made an important point in his speech about part-time nurses.

The hon. Gentleman also spoke about revalidation. The truth is that the majority of the cost of nurse revalidation will fall on the employers that will be responsible for supporting their staff through revalidation. The revalidation drive is an important means of raising professional standards, and it will ensure that the public have faith and confidence that we are raising standards for nurses and midwives.