Health Inequalities

Andrew Murrison Excerpts

Wednesday 4th March 2020 Commons Chamber

[Jo Churchill]

If the hon. Gentleman will just bear with me and let me make a little more progress, I will come back to him.

Going forward, I am clear that we must integrate good health into decisions on housing, transport, education, welfare and the economy, because we know that preventing ill health, both physical and mental, is about more than just access to our health services.

[Dr Andrew Murrison (South West Wiltshire) (Con)]

In his opening remarks, the Opposition spokesman mentioned smoking cessation just once, yet we know that over half the excess mortality between social classes is directly attributable to smoking. Does the Minister agree that we will not make progress on this important subject unless we get real about this vile poison that has, unfortunately, picked off the poorest for decades and decades? It must stop.

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[Dr Whitford]

I thank the hon. Member for that recognition. The Scottish Government are spending more than £100 million every year in mitigating some of these cuts—they pay the bedroom tax and they have set up the Scottish welfare crisis fund—but that is money that should be going into devolved areas, not patching up austerity decisions here; it is not the role of the Scottish Parliament just to mitigate.

Public health in England has been cut by £850 million—again, the greatest cuts to the poorest areas—and it is exactly the same with future planned cuts. This has led to cuts in smoking cessation projects. There is no point standing up and talking about the importance of stopping smoking—we all know that. People who have smoked for decades need help to stop and those services are critical. We have also seen cuts to drugs and alcohol projects and to sexual health projects, and all those have an impact on the poorest people.

The Minister, who is no longer in her place, might have listened to Dame Carol at the drugs summit in Glasgow but, sadly, the Minister for Crime and Policing, the hon. Member for North West Hampshire (Kit Malthouse), did not. He came to Glasgow, made his speech and then left before all the expert evidence was given. We also hear of a social care gap across England of over £6 billion. Again, that affects women if they have to give up work to look after elderly relatives or disabled children. This rolling back of the state has affected the social determinants and increased health inequalities. Child poverty has increased, as we have heard, with 4 million children affected, and 1,000 Sure Start centres have been closed. Education funding is down. There is a housing crisis and therefore a rise in homelessness. People with insufficient funds to afford a healthy life are depending on food banks, and deprived communities are simply losing hope.

Poverty is simply the biggest driver of ill health and has the biggest individual impact on life expectancy. The increase in life expectancy in England has stalled for the first time in 120 years—the first time since 1900. The gap between the most and least deprived has widened: the gap is now almost 10 years for women and the life expectancy of some women in areas of the north-east of England has dropped by almost a year.

[Dr Murrison]

I always listen with great respect to what the hon. Member has to say, but given that the SNP has its hands on many of the levers relating to the things she has discussed this afternoon, I am assuming from what she has said that Scotland is in the wonderful position of having narrowed health inequalities. Could she perhaps compare and contrast what has happened in Scotland with what has happened in the rest of the United Kingdom? I rather think that the two are very similar.

[Dr Whitford]

If the right hon. Gentleman waits to hear the rest of my speech, I will highlight some of the differences in child poverty.

We have seen life expectancy for those women falling, but when we look at healthy life expectancy, the gaps are even bigger. Time spent in poor health is increasing, and that of course puts pressure on the NHS and care services. We in this Chamber are always discussing the pressure that the NHS is under. Emergency admissions in areas with low life expectancy are double the numbers in wealthier areas. Women in deprived areas will now spend two decades or more of their life in poor health. Improving the healthy life expectancy by at least five years was actually a policy in the industrial strategy, so that people could be active and engaged in the economy, but what we have seen is an adverse effect both on health and health equality.

We know that someone’s health for most of their life is determined in the early years, even starting when their mother is pregnant. Child poverty is central to this and it is rising. It is defined as children in households with less than 60% of median income. England had child poverty down to 27%, but it is now 31%. Scotland had it down to 21%, and it is now 24%. That is because welfare changes are taking place right across the UK. Poverty is decided in this Chamber; it is not decided anywhere else, and the Scottish Parliament, as we have heard, spends a lot of energy on trying to mitigate it.

As we know, housing costs are a major contributor because of the shortage of housing. This is a rising issue among the poorest: 38% of the poorest will spend 30% or more of their income on rent or housing. That figure was 28% 10 years ago. The Scottish Government have built 87,000 affordable houses, and that is part of why our child poverty level is lower. It is the housing impact. In the 2015 general election, the Conservatives promised 200,000 starter homes. They built precisely zero.

Some 4 million children are growing up in poverty, and that will affect their whole lives. Whenever the issue is raised at the Dispatch Box, we are told that unemployment is down and that people must work their way out of poverty. We are told that that is how we change things, yet two thirds of those children already have a working parent. The problem is that all of this drives ill health.

Coronavirus

Andrew Murrison Excerpts

Wednesday 26th February 2020 Commons Chamber

[Matt Hancock]

The hon. Lady is right with regard to concerns about under-reporting, especially in some countries. I am afraid I do not recognise some of her clinical observations, and I do not recognise the idea that we should change travel advice between China and Italy. We should base travel advice on expert clinical evidence. I am very happy to ensure that she receives a full briefing from medical experts, so that she can get the clinical points right.

On thermal detection, rather like stopping flights this is against clinical advice. The clinical advice is not to undertake thermal detection, because we get a lot of false positives. Indeed, the only country I know of in Europe that undertook thermal detection at the border was Italy and that is now the scene of the largest outbreak.

Finally, the hon. Lady made a very important point about people in work and self-isolation. Self-isolation on medical advice is considered sickness for employment purposes. That is a very important message for employers and those who can go home and self-isolate as if they were sick, because it is for medical reasons.

[Dr Andrew Murrison (South West Wiltshire) (Con)]

Mercifully, nobody in this country has yet died of coronavirus, but every year 600 people die of seasonal flu. In the phase to which my right hon. Friend refers, is he redoubling our efforts to ensure that the elderly and the vulnerable in particular are vaccinated against seasonal flu, therefore perhaps mitigating pressures on our national health service in the event that coronavirus becomes more of a problem here and makes demands particularly on intensive care beds?

[Matt Hancock]

My right hon. Friend is absolutely right. The vaccination rate was, I think, at a record level this year, and it is very important. The simple measures that everybody can take, such as washing hands and using tissues, protect us against flu as well as coronavirus.

NHS Long-term Plan

Andrew Murrison Excerpts

Monday 7th January 2019 Commons Chamber

[Matt Hancock]

I welcome much of the tone of the hon. Lady’s remarks. The truth is that it is critical to ensure that we have the workforce and the people to deliver the plan. There is a whole section of this plan, as well as ongoing work, to deliver that. I want to clear up this point: in the immigration White Paper published by the Home Secretary before Christmas, as now, there is no cap on recruitment numbers for nurses and doctors. The proposal is that the cap will not necessarily apply within a shortage occupation. We will be recruiting people from around the world to work in our NHS.

[Dr Andrew Murrison (South West Wiltshire) (Con)]

I very much congratulate my right hon. Friend on the 10-year plan and on his announcement of the Harding review. Will Baroness Harding look particularly at the way in which pay and pensions are structured for general practitioners and pinch-point specialists within the NHS, since they are retiring or going part time at the moment—a full 10 years before the time they had anticipated when they went to medical school?

[Matt Hancock]

We are already looking at that subject. It is very complicated because of the nature of assets owned by GPs—their value having risen sharply over the last generation. However, we have record numbers of GPs in training. Although we need to ensure that we retain more GPs and encourage as many as possible to be full time, we have successfully breached our target; we are training more GPs than we had planned to, and that is a good thing.

Gosport Independent Panel: Publication of Report

Andrew Murrison Excerpts

Wednesday 20th June 2018 Commons Chamber

[Mr Hunt]

The hon. Lady is absolutely right to raise that matter. The nurse concerned, Anita Tubbritt, talks in the report about her concerns and the pressure that she was put under, and it was a brave thing to do. When the hon. Lady reads the report, she will see that nurse auxiliaries and others who were not professionally trained clinicians also came forward with concerns and were also worried about the impact that doing so would have on their own career. That is what we have got to stop because, in whatever part of the UK, getting a culture in which people can speak openly about patient safety issues is absolutely essential.

[Dr Andrew Murrison (South West Wiltshire) (Con)]

I was a junior doctor at the Royal Hospital Haslar in Gosport, which is just around the corner from the Gosport War Memorial Hospital, so I know that hospital fairly well, and I also know that the people of Gosport will be disappointed and distressed by this, since they very much value their community hospital.

Does the Secretary of State agree with me that there is an issue about the governance of smaller institutions, as we have seen in the past? I in no way wish to disparage the excellent work done by community hospitals, of which I have been a champion for many years, but will he look specifically at the pages in the report that touch on this? There is an issue about governing and ensuring safety in small institutions—whether in general practice or in hospitals?

[Mr Hunt]

I think that that is actually an excellent point, and we should definitely look at it. Big hospitals have clear lines of accountability—boards, chief executives—but those often do not exist in community hospitals and there is no one who can say they are the boss of that trust, so we should look at that.

NHS Long-Term Plan

Andrew Murrison Excerpts

Monday 18th June 2018 Commons Chamber

[Mr Hunt]

I always listen to the hon. Lady very carefully when she talks about the social care sector. I would say to her that while we are not announcing a new long-term plan for social care today, we are making some very important commitments to the NHS and the social care system, including the commitment that we will not allow the pressure from the social care system on the NHS to increase further. That means that, even before the date she mentioned, we are going to have to look very carefully at the settlement for social care.

[Dr Andrew Murrison (South West Wiltshire) (Con)]

I congratulate my right hon. Friend, whose commitment to our NHS is very clear. Does he agree with me, however, that the Commonwealth Fund indicator that really matters concerns clinical outcomes, some of which he referred to in his statement, and on that the news is not good? Will he do everything he can to make sure that the increased funding he has announced today is absolutely dedicated to improving outcomes for stroke, cancer and heart attack, on all of which we still lag well behind countries with which we can reasonably be compared?

[Mr Hunt]

I absolutely agree 100% with my hon. Friend, and we really must look at outcomes. The Commonwealth Fund was kind enough to say that that was actually one of the areas in which we are one of the fastest improving Commonwealth Fund countries. However, it has to be said that that was from a very low base, and we need to sort that out.

Education (Student Support)

Andrew Murrison Excerpts

Wednesday 9th May 2018 Commons Chamber

[Stephen Barclay]

As a nurse, my hon. Friend speaks with great authority and she is right. This is about empowering those who want to be a nurse, not all of whom want to go to university. She is also right to remind the House that many people’s ambitions are choked off by the existing system. Under the bursary system, over 30,000 people who applied to be a nurse were rejected. Too many people were being rejected, and we need more nurses, so we have a package of measures to increase the number of nursing places. Nothing has been said about those who were thwarted in that ambition. Universities, too, have consistently argued that healthcare postgraduate courses were an area prime for growth if we offered suitable loan products.

[Dr Andrew Murrison (South West Wiltshire) (Con)]

The Minister is right to highlight the university sector but has he, like me, recently visited his local further education college? If he has, I am sure that staff will have expressed the same view that I heard in Trowbridge recently: the new apprenticeship route into nursing is good for FE colleges that want to offer nurse training. Some colleges currently feel constrained because they are frozen out by universities but, in setting up such courses, colleges will be able to offer nursing to a much greater range of people than is currently the case.

[Stephen Barclay]

As a medic, my hon. Friend alights on an important point that I am happy to pick up. A number of the professions are degree entry, which precludes the further education college sector, so I will be happy to discuss that with him.

It is worth drawing to the House’s attention that it is not just universities that have been pushing for a change. Professor Dame Jessica Corner, the chair of the Council of Deans of Health, said:

“Our members report receiving a high number of good quality applications for most courses and they will continue to recruit through to the summer. Where courses have historically had a large number of applicants, fewer applicants might well not affect eventual student numbers”.

The key issue is not just how many people apply; it is ensuring that there are sufficient applicants for the places and then increasing the number of places on offer.

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[Robert Halfon (Harlow) (Con)]

To achieve social justice and deal with the skills deficit, we need a skills revolution. In many sectors, we have a real skills shortage, particularly at level 4 and above. Young people are pushed towards traditional degrees, but only 52% are getting jobs after graduation that require a degree, according to the Chartered Institute of Personnel and Development. On the flipside, degree apprenticeships are just not growing fast enough, and we need to invest more in further education and skills provision.

I welcome what the Minister has said today, and I thank him for meeting me to discuss this issue. We must go further on nursing apprenticeships, which I believe are the answer to this whole problem. We can square the circle and support nurses by rapidly expanding the apprenticeship programme. Hon. Members will know that I am a passionate advocate of apprenticeships, and I therefore support the introduction of new routes into nursing, through degree apprenticeships and the creation of the nursing associate role.

Nursing degree apprentices will not have to pay anything themselves, as my hon. Friend the Member for Lewes (Maria Caulfield), a brilliant former nurse, explained. They will be able to become degree-registered nurses in four years. Similarly, the new nursing associate role will provide extra capacity in the workforce, and many of those who train as nursing associates may decide to continue to degree-level nursing.

The twin themes of the Education Committee in this Parliament are social justice and productivity. Nursing degree apprenticeships are key to both. They offer an attractive route both for mature students and for those with children, ensuring that all those who wish to train as nurses have the opportunity to do so. I am not suggesting that people should not have the choice of a three-year undergraduate course, but we must maximise the opportunities provided by degree apprenticeships. Doing so would mean that we have a sufficient nursing workforce and that aspiring nurses have options for training.

I have real worries about the fact only 30 people began training as a nurse through the nursing apprenticeship schemes this year, and we need to rapidly improve the number of people doing degree apprenticeships. There needs to be a taskforce involving the Minister for Apprenticeships and Skills, the Minister for Universities, Science, Research and Innovation, Health Ministers, the Institute for Apprenticeships and others to drive this forward and to encourage people with a proper advertising campaign, using the £200 million levy. Thirty is just not enough; we need many thousands of people. If people in my constituency and across the country knew about the schemes, they would want to take them up.

[Dr Murrison]

Does my right hon. Friend agree that part of the way we might expand the numbers taking the apprenticeship route is to unleash the power of the further education sector? The sector now has degree-awarding powers and would be very attractive to a large number of people not just in the big urban centres but in the smaller regions, too.

[Robert Halfon]

Like me, my hon. Friend is a big champion of further education and understands it completely. This could be an incredible moment for our further education colleges because, along with some very good private providers, they could be leading the way in providing degree apprenticeships.

Breast Cancer Screening

Andrew Murrison Excerpts

Wednesday 2nd May 2018 Commons Chamber

[Mr Hunt]

We are indeed talking to the charities operating in this sector about how we can best provide all kinds of support, including mental health support, as well as clinical guidance. We often talk in the House about the challenges facing the NHS, but it is important to note that breast cancer is an area in which survival rates have been improving, and have actually been catching up with those in other European countries. The NHS deserves great credit for that, despite today’s very serious failing.

[Dr Andrew Murrison (South West Wiltshire) (Con)]

I commend my right hon. Friend for the way in which he brought this very bad news to the House, and the hon. Member for Leicester South (Jonathan Ashworth) for the way in which he responded to it.

As my right hon. Friend will know, breast cancer is not just about survival nowadays; it is also about quality of life after treatment. Will his contact with those who have been affected extend to those who have been treated, but who may have had to be treated in a more radical way than might have been the case had their cancers been picked up earlier?

[Mr Hunt]

Absolutely. As my hon. Friend will know from his own medical background, it is impossible to know that until there is a detailed case note review, but we will certainly undertake that review for anyone who thinks they may have been affected.

NHS Staff Pay

Andrew Murrison Excerpts

Wednesday 21st March 2018 Commons Chamber

[Mr Hunt]

This constitutes an investment by the Treasury of £4.2 billion, and the normal Barnett consequentials will apply, so it is perfectly possible for the Labour Government in Wales to replicate this deal if they choose to, but we know, of course, that had they replicated the increases in funding to the NHS in England, the NHS in Wales would have had an additional £1 billion spent on it over the past five years.

[Dr Andrew Murrison (South West Wiltshire) (Con)]

rose—

[Dr Julian Lewis (New Forest East) (Con)]

rose—

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[Mr Speaker]

I see that two doctors are standing on the Government Back Benches. I am sure that the House will understand if I call the medic rather than the military strategist.

[Dr Murrison]

I warmly welcome this announcement and congratulate my right hon. Friend, the trade unions and NHS Employers on reaching this deal. One problem facing our NHS is that of people not returning to work after they have had caring responsibilities. What elements of the deal will encourage more people to consider coming back into the workforce? I am thinking, in particular, of the non-pay elements and the reform of pay structures that he has mentioned.

[Mr Hunt]

The most important thing about the deal is that it will discourage people who might be reaching breaking point, because of personal circumstances, from packing it all in and leaving the NHS family. There is a particular proposal to allow much greater flexibility in the buying and selling of annual leave, so that people who need to work less because of things that happen at home, and perhaps people who want to work more, find it much easier to do so. This is therefore part of a much bigger shift towards the flexible working that we know everyone wants these days.

NHS Winter Crisis

Andrew Murrison Excerpts

Wednesday 10th January 2018 Commons Chamber

[Jonathan Ashworth]

Yes, I will. I of course thank the NHS staff. Of course, if the hon. Lady wanted to thank the NHS staff, she could have supported us when we brought in motions to give them a fair pay rise, but I do not think she did so.

[Dr Andrew Murrison (South West Wiltshire) (Con)]

rose—

[Jonathan Ashworth]

I give way to the hon. Gentleman, who I know always wants to contribute to such debates, but then I will make some progress.

[Dr Murrison]

The hon. Gentleman is extremely generous, and I always follow his remarks with a great deal of interest. Any cancellation is appallingly bad, but does he understand that the worst possible cancellation is one on the day of surgery, which is clinically unacceptable? Will he give the system credit for at least trying to introduce some sort of planning this year, for the first time that I can remember since 1984?

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[Dr Andrew Murrison (South West Wiltshire) (Con)]

It is a great pleasure to follow the hon. Member for Stockton South (Dr Williams), who qualified in 1996. I have about 10 years on him, and since 1984 I cannot recall a winter when there was not talk of pressure. We have to understand that this is not a new phenomenon. I particularly recall the bad winter of 2009, and the very positive way in which the then Opposition approached it and helped the then Government, in the interests of not politicising and not weaponising this issue. It is pity we have not seen the same thing repeated.

We need to give due credit to managers in the NHS. They come in for a lot of flak all the time, but we have seen a managed process this year and it has taken a great deal of input to make sure we do the best we can to disadvantage patients the least; I pay tribute to that much-maligned group. The only way in which I can see we can make this better is by running a lower bed occupancy rate, which is okay, but has opportunity costs attendant upon it. The reality of doing such a thing, which would avoid the sort of cancellations we have seen this winter, as in any winter, is severe, and I do not think many right hon. or hon. Members would wish to see those things.

That brings me on to the Commonwealth Fund, which was rightly cited by the Prime Minister earlier in response to my question in Prime Minister’s questions. She was right to say that on access, equity, the care process and administrative efficiency—four of the five points the Commonwealth Fund looks at—the NHS does very well. The problem is with the last one, which is clinical outcomes, where we run 10th out of 11, with the 11th being the United States of America, which nobody here wishes to emulate. We do not do well on clinical outcomes—we do not do well on cancer, on stroke or on heart attack—and we need to do something about it. It is no good citing OECD averages. We need to be comparing ourselves with Denmark, Germany, France and the Netherlands, not with the basket of countries included in the OECD.

Where does all that lead us? It leads us to a debate about resources. Having talked about management, which is vital, we need to address long-term resources. I entirely support those who wish planning to be done on a 10-year rather than five-year basis. That is vital, and we must also ensure that we have the necessary funding for the improvements we need to achieve to get outcomes up to the level enjoyed by our peer-group nations in western Europe, not the basket of nations with which we are often erroneously compared. How do we do that? We have to take the public with us and work across party boundaries. None of the decisions that will ultimately be made about the future of our national health service in this, its 70th anniversary year, are necessarily going to be easy. It is important that we at least try to get some level of cross-party consensus. We can do that by establishing a body that is above politics. The route to which I am drawn is the establishment of a royal commission, with all its problems.

The Merrison commission was the last big royal commission that considered matters to do with the health service. It came in for a lot of criticism, but most of its recommendations, made 40 years ago, were ultimately rolled out into Government policy. With the right terms of reference, such a body would be effective. That seems to me to be the right and proper way to deal with the future, particularly the sustainable funding future of our most treasured of national institutions. I very much hope that my Front-Bench colleagues will listen to those of us from all parties—particularly the recommendation from the Centre for Policy Studies this week—who think we should set up a royal commission in this 70th anniversary year to consider the future of our national health service.

Oral Answers to Questions

Andrew Murrison Excerpts

Tuesday 4th July 2017 Commons Chamber

[Mr Hunt]

The hon. Lady may have noticed a little thing called Brexit that happened last year, which is the cause of understandable concern. If she looks at the facts about how many doctors came from the EU to the NHS in the year ending this March, in other words, post-Brexit, she will see that 2,200—[Interruption.] Someone asked about nurses. I happen to have that information here: 4,000 nurses joined the NHS from the EU in the year ending in March.

[Dr Andrew Murrison (South West Wiltshire) (Con)]

One of the consequences of free movement in the European Union is that proportionately we take in rather fewer doctors, in particular, and fewer nurses from the Indian subcontinent and other places. What assessment has the Secretary of State made of the capacity to revisit the strong relationship we had with those workforces in the immediate post-war years?

[Mr Hunt]

My hon. Friend makes an important point. We want to attract the brightest and best into the NHS from all over the world, wherever they come from, if there is a need. The only caveat I would make is that we have imported a number of doctors from very, very poor countries that actually need those skills back home. We have to recognise that we have international responsibilities to make sure that we train the number of doctors and nurses we need ourselves.