Homeopathy and the NHS

Andrew Smith Excerpts

Wednesday 29th March 2017 Westminster Hall

[David Tredinnick (Bosworth) (Con)]

I beg to move,

That this House has considered homeopathy and the NHS.

Mr Hanson, it is always a pleasure to serve under your chairmanship, particularly when before we have even started the match, you have given us extra time. It is not often that we are able to start a debate earlier than expected.

This debate has come about for two reasons. The first is the attacks on the long-established national health service homeopathic service. Secondly, we are approaching a very happy moment, Homeopathy Awareness Week, when the homeopathic community comes together to tell people about what it can offer in providing support to doctors and alternatives where other treatments have not worked.

Homeopathy Awareness Week takes place from 10 to 16 April in a celebration of homeopathy: a safe, gentle, natural system of medicine that I have used for 30 years to great effect. In the UK, it might surprise people to hear that 15% of our population already use homeopathy and a further 80% have heard about it. Many people are not sure what makes it different from other medical systems. The week aims to get people to have a better understanding. A lot of events have been organised, including the film première of “Just One Drop”.

To put things in a global perspective, some 450 million people use homeopathy each year. If homeopathy did not work, why would so many people choose to use it and carry on using it? It is a global medical system, the second largest medical system in the world, and is used particularly in very poor communities, which I will come on to.

On British practitioners, a survey recently showed that 72% of homeopathic patients rated their practitioners either very good or excellent. The 4Homeopathy group recent study showed that practitioners are treating all kinds of things, from irritable bowel syndrome—30%—to depression—20%. More than three quarters of teenagers and 41% of adults receive homeopathic treatments for skin disorders. About a third of adults and 40% of teenagers go to homeopaths for anxiety and stress. It is a service that delivers both in and out.

[Mr Andrew Smith (Oxford East) (Lab)]

I congratulate the hon. Gentleman on securing this debate. I certainly would not dispute the testimony of those who have benefited from homeopathic treatment, but does he not agree that scientific evidence of its effectiveness would help in a decision on whether to use it?

[David Tredinnick]

The right hon. Gentleman, who has been in the House as long as I have, has made a good point. There is scientific evidence out there, although we could use more. One of the problems is that, when scientific evidence is produced, it is pooh-poohed. However, that does not stop people using, for example, arnica cream when they get wounds. It is a standard preparation and it is a homeopathic medicine. So there is a degree of need for more studies, but there are studies out there that are ignored.

I have said homeopathy is the second biggest medical system in the world. Some would say it is the most prestigious. It has always been held in very high regard by people who are widely respected. It is no secret that the royal family and many celebrities have used homeopathic medicine over the years. It has become increasingly important in an age when drug dependency is epidemic and when there are serious worries about the effectiveness of antibiotics.

The homeopathic private sector is growing fast not only in this country, Europe and America, but everywhere. However, in the NHS, we are under attack from people in the medical establishment. This goes back to 2005, when a letter was put out attacking homeopathic services in the health service. It was actually a bogus letter on NHS letterhead. The Countess of Mar and Lord Palmer asked a question about it and the reply acknowledged that

“this document was not issued with the knowledge or approval of the Department of Health and that the use of the National Health Service logo was inappropriate in this instance. The document does not represent any central policy on the commissioning of homoeopathy”.

Anti-homeopathy groups such as the so-called Good Thinking Society, which is a front for one individual, a sceptic called Simon Singh, are threatening clinical commissioning groups with legal action for commissioning homeopathy. People such as Simon Singh are anti-patient, anti-choice and closed-minded individuals who have never studied or used homeopathy. In the UK, we have a robust system of homeopathic regulation. We have the Faculty of Homeopathy, which was formed in the 1950s for doctors. Doctors are, of course, regulated by the General Medical Council as well. In 2015, the Professional Standards Authority took on oversight of the regulation of the 2,000 members of the Society of Homeopaths. Such enhanced regulation is important and is a good reason why homeopathy should be more greatly available in the health service.

O’Neill Review

Andrew Smith Excerpts

Tuesday 7th March 2017 Westminster Hall

[Kevin Hollinrake]

My hon. Friend makes a very good point. We need to take action now because of the delays in producing new drugs.

[Mr Andrew Smith (Oxford East) (Lab)]

I congratulate the hon. Gentleman on securing this important debate. Is it not self-evident that the prevention of the occurrence and spread of infection must be in the first line of the battle against this problem, and screening people on admission to hospital to determine who might be resistant and carrying infections would be very useful?

[Kevin Hollinrake]

The right hon. Gentleman is right. Some 50% of prescriptions are needless, and diagnostics would mean that a lot of drugs were no longer prescribed.

We talk glibly about tens of thousands of deaths—Stalin once said, “One death is a tragedy; a million is a statistic” —but the reality is that these are our partners, our brothers, our sisters and our children, so we must act.

Agenda for Change: NHS Pay Restraint

Andrew Smith Excerpts

Monday 30th January 2017 Westminster Hall

[Catherine McKinnell]

My right hon. Friend is absolutely right. It is also a false economy to lose professionals, given all the money that has been invested to make them a well-trained, well-performing workforce.

As hon. Members will be aware, Agenda for Change was introduced in 2004 as a system of pay, terms and conditions, and it applies to more than 1 million directly employed clinical and non-clinical NHS staff, with the exception of doctors, dentists and some very senior managers. It was designed with the intention of delivering fair, transparent pay that is better linked to career progression, skills and competencies. Agenda for Change is based on the principle of equal pay for work of equal value. According to NHS Employers, the system allows NHS organisations to

“design jobs around the needs of patients rather than around grading definitions”

and individual NHS employers are better able to define the skills and knowledge that they want the staff in those jobs to develop.

Importantly, in relation to this debate, Agenda for Change was also designed to enable employers to address more local recruitment and retention difficulties. However, as with hundreds of thousands of people who work in the public sector, all Agenda for Change staff have been affected by the previous and current Governments’ imposition of pay restraint.

[Mr Andrew Smith (Oxford East) (Lab)]

My hon. Friend is making an excellent speech. Is it not perverse that the Conservative party seems to favour the introduction of all sorts of markets in the NHS apart from a labour market? The devolution of responsibility to trusts that it often heralds is completely inconsistent with a centralised, state-imposed pay freeze.

[Catherine McKinnell]

My right hon. Friend makes an important point. There was a two-year pay freeze from 2011-12 and a 1% increase in 2013-14 and 2014-15, followed by confirmation in the Budget of summer 2015 that the Government would fund an average public sector pay award of only 1% for the four years from 2016-17. As has been pointed out, the Government decided to reject the independent NHS Pay Review Body’s recommendation of a further 1% uplift to all pay scales from 2014-15, stating that there would be an annual increase of at least 1% for Agenda for Change staff in England through either contractual incremental pay or a non-consolidated payment.

Southern Health NHS Foundation Trust

Andrew Smith Excerpts

Wednesday 8th June 2016 Westminster Hall

[Suella Fernandes]

I thank my hon. Friend for highlighting the problems communicated to her by families, which echo and reflect the precise concerns about which the families sitting in the Public Gallery feel strongly. They emphasise that this is not an isolated issue. This is something that we all need to take seriously.

The Mazars report is the next chapter in this story. At the request of Connor’s family, NHS England commissioned an independent report into the deaths of people with learning disabilities or mental health problems while under Southern Health’s care. The report reviewed the deaths of people in receipt of care from mental health and learning disability services in the trust between April 2011 and March 2015. The report sought to establish the extent of unexpected deaths in those services and to identify issues that needed further investigation.

The report was published in December 2015, and its main findings included, first, that many investigations into deaths were of “poor quality” and took too long to complete. Secondly:

“There was a lack of leadership, focus and sufficient time spent in the Trust on carefully reporting and investigating…deaths”.

Thirdly, there was a lack of family involvement in investigations after a death and, fourthly, opportunities for the trust to learn and improve were missed.

Of the 1,454 deaths recorded at the trust during the period under investigation, 722 were categorised by the trust as unexpected. Of those, the review looked at 540 and found that only 272 unexpected deaths received a significant investigation. The report did not specify how many investigations there should have been, but it drew attention to the limited number of deaths that were investigated in different categories. The trust has questioned the use of some of those figures, but the picture painted overall was one of inconsistent standards for investigations, raising the worrying prospect that an unspecified number of deaths may not have been investigated properly. The question of whether there may have been other preventable deaths like that of Connor Sparrowhawk could not be definitively answered, which has led to a great deal of concern among the trust’s patients and something of a breakdown in confidence. Understandably, people want to know that they or their loved ones will be safe in the care of Southern Health. Those whose relatives have died while under the trust’s care need reassurance that the investigations were properly conducted and that the deaths were not also the result of avoidable errors.

My constituent Richard West is one of those relatives. His son, David, died in 2013, and he has been seeking answers from the trust ever since. At times, the handling of his case has been very poor indeed. Mr West, a former detective and policeman, says that he was ignored and was even told by a representative of the trust that the deaths of patients in its care were “like an airline losing baggage.” I know from speaking to other families that others have experienced similarly insensitive treatment.

The Mazars report contained serious and specific criticisms of the trust and its management. In particular, it levelled criticism at the board itself for the failures. It found that

“there has been a lack of leadership, focus and sufficient time spent on reporting and investigating unexpected deaths of Mental Health and Learning Disability service users at all levels of the Trust including at the Trust Board.”

[Mr Andrew Smith (Oxford East) (Lab)]

I applaud the hon. Lady on securing this debate and on her excellent speech. In just about any other organisation, such a searing indictment of the board and, by implication, its executives would have resulted in their resigning. Is she surprised that they did not simply stand down and accept responsibility, as they should have?

[Suella Fernandes]

There is a lot of pressure from the public, patients and families for people to step down, and the resignation of the chairman of the board is a reflection of the seriousness with which Southern Health takes this issue.

The report continued:

“Due to a lack of strategic focus relating to mortality and to the relatively small numbers of deaths in comparison with total reported safety incidents this has resulted in deaths having little prominence at Board level… There are a number of facets to this poor leadership…: a failure to consistently improve the quality of investigations and of the subsequent reports; a lack of Board challenge to the systems and processes around the investigation of deaths…; a lack of a consistent corporate focus on death reflected in Board reports which are inconsistent over time and which centre only on a small part of the available data; an ad hoc and inadequate approach to involving families and carers in investigations; a lack of focus on deaths amongst the health and social care services caring for people with a Learning Disability; limited information presented at Board and sub-committee level relating to deaths in these groups…; and a lack of attention to key performance indicators…indicating considerable delays in completing…investigations.”

The report also found:

“There was no effective systematic management and oversight in reporting deaths and the investigations that follow… The Trust could not demonstrate a comprehensive, systematic approach to learning from deaths”.

In what I consider one of its most damning findings, the Mazars report also found evidence of repeated warnings being ignored:

“Despite the Board being informed on a number of occasions, including in representation from Coroners, that the quality of the…reporting…and standard of investigation was inadequate no effective action was taken to improve investigations”.

The report also stated:

“Despite the Trust having comprehensive data relating to deaths of its service users it has failed to use it effectively to understand mortality and issues relating to deaths of its Mental Health or Learning Disability service users.”

By any measure, those criticisms were immensely serious and required a robust response.

Following the report’s publication, my right hon. Friend the Secretary of State for Health expressed his determination to learn the lessons of the report and set out a number of measures to address the issues raised, including a focused inspection by the Care Quality Commission looking in particular at the trust’s approach to the investigation of deaths. As part of that inspection, the CQC was asked to assess the trust’s progress on implementing the action plan required by NHS Improvement and on making the improvements required by its last inspection, published in February 2015. Separately, the CQC was also asked to undertake a wider review of the investigation of deaths in a sample of all types of NHS trusts in different parts of the country. That is particularly important because we need to know whether the problems and failings at Southern Health are exceptional outliers or whether there is a similar problem in other parts of the country.

The trust accepted the findings of the Mazars report and apologised unreservedly for the failings identified. NHS Improvement set out in January 2016 its plans to provide assistance to the trust to ensure that it delivers on plans to implement the agreed improvements, which include the appointment of a new improvement director and the taking of advice from independent experts. All those measures were agreed by the trust’s management, and in January we had a letter from the chief executive officer setting that out.

--- Later in debate ---

[Mr Andrew Smith (Oxford East) (Lab)]

I congratulate the hon. Member for Fareham (Suella Fernandes) on securing this vital debate and on her work with the all-party group on Hampshire and Isle of Wight. Everything that has come out or been dragged out since the tragically avoidable death of Connor Sparrowhawk, “Laughing Boy”, has highlighted the severe failings of Southern Health and the wider questions they raise about the treatment of learning-disabled people in the NHS. The facts that have emerged are awful beyond belief and are a shocking indictment of the leadership of the Southern Health trust and the appalling neglect of the most basic care needs and human rights of learning-disabled people.

As the hon. Lady said, we all owe enormous thanks to the courage and determination of Connor’s mother, Sara Ryan, and her family, as well as the other families of those who have died and suffered. Without them, there was a real risk that the hideous truth of neglect at Southern Health might not have been fully exposed. Connor’s family and other families have been let down so badly and shamefully by Southern Health, which did not share information that the family had a right to. The family were treated as the enemy at Connor’s inquest and did not even receive an apology until Southern Health was directly pressed to give one. Even today, as Sara went for mediation with Southern Health on her human rights case, it had not released background papers, as it was supposed to have done.

The Mazars report happened only because of the determination and persistence of Connor’s family. As we have heard, the failings it exposed were shocking beyond belief and have been confirmed by the CQC reports. It is important to remember some of the hideous statistics that the hon. Lady quoted; we should remember that each one is a human life. Of 10,306 deaths, 722 were categorised as unexpected, of which only 272, or 37%, were investigated as a critical incident. A lower proportion—30%—of deaths in adult mental services were investigated. Appallingly, less than 1% of deaths in learning disability services were investigated. Liaison with families was appalling, with 64% of investigations not involving the family.

I will quote what the My Life, My Choice charity from my constituency said in a letter yesterday to the new chair of Southern Health. It is a charity of learning-disabled people, for learning-disabled people. This is how things look from the perspective of people with learning disabilities. It said:

“You suggested that the Mazars report was not very important, or not true. We think it is a very important report. Our members are very worried about people with learning disabilities dying, and their deaths not being properly looked into. We know from Connor’s case that the truth is not always told, so investigations need to happen. Our members are scared because people with learning disabilities do not get the same standard of healthcare as everybody else. The Mazars report told us that if we die, our deaths will not be taken seriously.”

Someone has to take responsibility for what happened. To the families and to the public, it is unbelievable that the chief executive and medical director of Southern Health are still in post. We all understand that due process has to be followed, but nearly three years on from Connor’s death, we must ask: how long will it take before those responsible are properly held to account? That is important not just to atone for a wrong; it is crucial because of the signal it sends to others responsible for the care of learning-disabled and other vulnerable patients. It is crucial in re-establishing public confidence that those leading the provision of care are responsible and are held responsible for their actions.

I look forward to the Minister’s response to this debate. With Sara Ryan I met the Secretary of State, and I have talked and corresponded with the Minister. I know that they too are both concerned to see matters put right at the trust, and to apply the lessons more generally in the healthcare system.

[Nicola Blackwood (Oxford West and Abingdon) (Con)]

The right hon. Gentleman is making a powerful speech. His point that no one, no matter how vulnerable, should feel fear when they go into our health services is something that should give us all pause for thought in this Chamber. But it is not only about accountability in this case; it is also about making sure that those who are watching us as we go through the process know that an independent, verifiable process will be put in place so that nothing like this can ever happen again, not only at Southern Health but throughout our mental health services.

[Mr Smith]

I very much agree with the hon. Lady, my neighbour and friend, on that important point. I look forward to the Minister’s response as to what the independent oversight will be to ensure security in future.

It will be helpful if the Minister can update us on progress in relation both to the Southern Health trust and to wider concerns in the NHS, and if he can say when he expects the CQC to publish its opinion on the trust’s response to its warning notice, with the possibility of enforcement action being taken. Will he also say when he expects the Government to be in a position to make a definitive statement on the action they will take on the conclusion of the Care Quality Commission’s wider investigation into deaths throughout the NHS? It is an enormously important issue to get right.

We all have to learn from these appalling events. We have to apply the lessons and put in place procedures and the culture so that learning-disabled people and others receive the care, treatment and respect that they deserve, and so that they can be confident that they will get that. An NHS that truly fulfils its duty of care, in which Southern Health so lamentably failed, is the only thing that can come close to a fitting memorial for Connor Sparrowhawk.

[Mr David Hanson (in the Chair)]

We can be more relaxed about the two remaining speakers because a Member who indicated that they wished to speak has now left.

--- Later in debate ---

[Alistair Burt]

My hon. Friend makes her own point about a conversation I was not part of. I am sure people will read what she has to say.

As I have already set out, a clear and robust process is being taken forward by the interim chair to review the capability of the board and to take any necessary action. My hon. Friend the Member for Fareham has called for far-reaching changes. I ask that we await the conclusions of the review and look for the right balance to be struck between continuity and stability to ensure that the trust is able to deliver what it has promised. Wholesale change could introduce further delays to making progress on such work.

Recent media reports have suggested that the trust might be split up. I repeat that the priority now is to ensure safe and effective care in the present and in the future for the population served by Southern Health. NHS Improvement is working with the trust to explore all available options.

Members have also asked why the trust has not been prosecuted for historic safety breaches. I am aware of the allegations of historic health and safety breaches made by a former health and safety advisor to the trust, who has also briefed CQC about such concerns. I share the concerns of all those who are asking why it has taken so long to get a grip on the issues. CQC did indeed identify safety concerns back in October 2014 and has provided an assessment of safety in its most recent report. However, it is unforgivable that patients have continued to be exposed to unnecessary risk while the trust has dragged its feet in resolving the problems.

I understand that CQC has now reviewed evidence gathered during the most recent inspections and additional information obtained from the trust and other public bodies, including the Health and Safety Executive. CQC’s review has identified further lines of inquiry, which it plans to complete as quickly as possible in order to inform a decision on prosecution one way or the other.

[Mr Andrew Smith]

Is it not the case that following the gathering of that further evidence and, indeed, of other leaked reports of what Southern Health knew at an earlier stage, which had not previously been apparent, the police are now reviewing the case for prosecution?

[Alistair Burt]

Genuinely, I am unaware of that. The police may review evidence at any time. If CQC has certain evidence that it wishes to take to the police for prosecution, that is a matter for it. I understand the processes that people would want to go through. It is important for me to offer reassurance that those processes are in place, and that things that for too long have been swept under the carpet are open for examination, which I understand to be the case.

Let me deal with the question of a public inquiry. Ministers face many calls for inquiries, and it is important for public inquiries to be considered only where other available investigatory mechanisms would not be sufficient. Public inquiries are rare events. I argue that the processes now being followed by NHS Improvement and CQC are the best way to put right the safety and governance issues at Southern Health. That does not rule out the dissemination of wider learning from this case through NHS Improvement or, where appropriate, the holding to account of individuals via professional regulation or normal performance management routes.

It is right and proper that we should ask such questions. We can perhaps examine whether the system would have responded in the same way had the trust been an acute trust, as I mentioned earlier. I am passionate about improving the care and outcomes for people with mental illness or learning disabilities by ensuring that all aspects of healthcare for people, whatever the issue that has brought them into the care of the NHS and others, are given equal priority with physical health. That must include regulation.

Let me now deal with the point made by my hon. Friend the Member for Oxford West and Abingdon (Nicola Blackwood). As I have indicated, what I have observed over the past year has worried me. That is to say, there seems to be greater tolerance of when things go wrong in mental health than in acute services. We need to ask ourselves why it has taken so long to resolve those difficulties and to reach the regulatory decisions that are now starting to take effect.

I will therefore be looking at the matter with NHS Improvement, to consider both the effectiveness and the timeliness of regulatory interventions in mental health and learning disability services. I am keen to bring independent leadership into that work, alongside NHS Improvement. A task-and-report group will do a piece of work specifically on that.

Let me name the other places that have upset me during the course of the year. In Hull, there has been a problem with in-patient beds and an inability on the part of the NHS to make decisions about it for more than three years. There was the case of Matthew Garnett, the young man with autism in the wrong place; I could not get information on him for weeks, because of the failure of the NHS to provide what I needed. There are the problems in Tottenham with new mental health facilities, similar to what happened in York, at Bootham Park—how that was closed, and the inability of people to handle it correctly. That is a whole series of cases in which I think things could have been done better. The response has not been good enough. An inquiry into one thing is not sufficient, and the processes are in place to deal with that. Looking at the whole range of why such things happen is really important, and that work is now underway.

Ambulatory Care

Andrew Smith Excerpts

Wednesday 27th April 2016 Westminster Hall

[Mr Andrew Smith (Oxford East) (Lab)]

I am sorry to come in at the end of the debate, but I was delayed by traffic. I congratulate my colleague from Oxfordshire, the hon. Member for Henley (John Howell), on securing this important debate. Does the Minister agree that in the roll-out it is important that the ability, training and qualification of home careworkers is raised, so that they can complement the changes in services?

[Ben Gummer]

The right hon. Gentleman makes an interesting and subtle point. That is absolutely the case, and that is partly why, as part of the workforce review that I instigated, we are looking at apprenticeship and nursing associate models that will help to upskill nurses and care practitioners in not just acute but community settings. The result will be an ability to provide a far better, more holistic service to patients when they turn up at an ambulatory care setting, or indeed at the John Radcliffe, or, hopefully, when they are looked after at home before that happens, and when they return from either of those places. All that taken together provides a far better service to constituents.

I welcome the approach that Members have taken in this little but important debate. If we are positive about these changes and have a will to explain them to constituents, they will quickly understand why this system is better for them. Those Members who wish to pursue a cruder campaigning method that looks purely at the number of beds provided in any one setting, based on the model inherited from 1948 rather than one relevant to 2018, will be doing their constituents a disservice. In being brave and direct with his constituents and in explaining clearly the benefits that he has endeavoured to get, my hon. Friend the Member for Henley has delivered a far better service for the people of Henley than the one they had last year. It will continue to improve throughout the course of the Parliament.

Question put and agreed to.

Brain Tumours

Andrew Smith Excerpts

Monday 18th April 2016 Westminster Hall

[Nicola Blackwood (Oxford West and Abingdon) (Con)]

I am humbled to speak after hearing so many moving personal stories. I am here because of Skye. Skye was five when he tragically died in August 2014, not from the medulloblastoma that he was diagnosed with but from the severe side effects of his treatment—the Milan protocol. We now know that a number of other children also developed similar side effects, and the Milan protocol has now been withdrawn. Skye’s mother, Sally, is here in the Gallery today and since his death his family have shown extraordinary courage, raising awareness of, and funding for, childhood brain tumours and setting up the charity Blue Skye Thinking to support research so that all children diagnosed with brain tumours have a better chance of survival. However, Skye’s story illustrates that, although much is working in childhood cancer treatment, some key areas are in need of urgent improvement.

[Mr Andrew Smith (Oxford East) (Lab)]

As the hon. Lady knows, I lost my dear wife, Val, to secondary tumours and it is a year to the day since she started to have palliative care. I very much share what the hon. Lady said about Skye’s case. Does she agree that, more generally, there is a cruel paradox? Progress is being made in treating other cancers but, because of the blood-brain barrier, that increases the number of people who survive to get a brain tumour. That is a further compelling argument for more research.

[Nicola Blackwood]

The right hon. Gentleman, and friend, has made an important point and I hope the Minister will respond to it. However, we should note at this stage that the overall story of childhood cancer over the last 30 years is positive. Eight in 10 children with cancer survive five years or more, compared with just three in 10 during the 1960s. We should congratulate the Government on that because it is clear that the work and funding we put into fighting cancer is money well spent. As we have heard, unlike most cancers, brain tumours are on the rise and research is underfunded, and because the money spent on cancer is effective, we must put that right.

I want to focus on childhood cancers, for obvious reasons. Despite causing more than a third of childhood cancer deaths, brain tumours receive only 6% of childhood cancer funding. Childhood cancers account for less than 1% of cancer diagnoses in the UK and of that 700 children are diagnosed with a brain tumour every year. It is the most common form of cancer affecting children and the most lethal, killing 160 children every year.

We must consider childhood cancer funding in its own right because children’s cancers are biologically very different from adult cancers and to treat them effectively requires specifically tailored research and treatment. The effect of the funding shortage, ethical challenges and small cohorts mean that 50% of childhood cancers are part of a clinical trial and the remainder are treated using standard treatment guidelines such as the Milan protocol. There are risks with that approach.

As we have heard, cancer treatment is a brutal regime and can cause long-term disability. That is particularly true of childhood brain tumour survivors, 60% of whom are left with life-altering disability. In a few cases like Skye’s, these effects can be fatal.

National Minimum Wage: Care Sector

Andrew Smith Excerpts

Wednesday 23rd March 2016 Westminster Hall

[Mr Andrew Smith (Oxford East) (Lab)]

I will try to be as quick and as brief as I can, Mr Rosindell. I congratulate my hon. Friend the Member for Sheffield Central (Paul Blomfield) on securing this debate and on his powerful speech, which compellingly made the case for urgent Government action in this vital area. I fully support the case being made by Unison and the Low Pay Commission to use section 12 of the National Minimum Wage Act to require employers to provide workers with a statement showing compliance with the national minimum wage.

As my hon. Friend said, the present situation is scandalous. There has been some improvement in some places since we, the unions and those with a concern for the social care sector mobilised pressure, but it has been not nearly enough and a lot more needs to be done. The example of Oxfordshire County Council shows that we are not making an unreasonable demand. The council, which is Conservative-independent controlled, has recently commissioned a new home care service that will come into effect on 1 May. As part of that, the council will require providers to give a breakdown of their prices; to demonstrate the hourly rate that will be paid for care workers at or above the national living wage from 1 April; to include travel time and the hourly rate paid to care workers; to pay care workers for travel expenses, as they should; and to adopt an open-book accounting method. That will enable the council to understand whether the national living wage is being paid to care workers. If the provider does not comply, it can be suspended. That is the sort of practice we need to see everywhere.

As my hon. Friend said, it is vital that that practice goes along with other measures to raise the status, training and overall remuneration of this vital group of workers. I will give a local example of just how important it is that we get it right across the country. Because of the problems of delayed discharge from hospitals, which are as bad if not worse in Oxfordshire than just about anywhere else, the local hospital trust commissioned 150 places in intermediate care and private care homes so that people could be moved on from hospitals, which are not the best place for those people to be. It is also the most expensive place for them to be. Initially, that reduced the problem of delayed discharge, but then it got worse again because the intermediate care providers could not discharge those people to their homes because of the insufficiency of domiciliary care support. As a result, the hospital trust will shortly be recruiting 50 domiciliary care workers to try to address that problem. They will be paid for out of the hospital’s budget, rather than from the local authority social care budget, which is stressed and under pressure.

We are talking about workers who are vital to crucial health and social care services. I do not believe that Government Members—it is a pity that there are not more Members on the Government Benches taking an interest in this vital issue—want social care workers to be exploited or treated badly. Instead, because of their rhetoric against red tape and regulation and their antipathy sometimes towards trade union campaigns, I think they do not understand how vulnerable these workers are, or the pressure under which they work.

I appeal to the Government to think again and to see how the measure is essential for the dignity and proper reward of vital workers and for recruitment and retention in this vital sector, as well as how essential it is in ensuring that the people whom they are caring for receive the standards of care to which they are entitled. The Government must act now and, using section 12 of the 1998 Act, bring some consistently higher standards to this vital sector.

--- Later in debate ---

[Yvonne Fovargue (Makerfield) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Rosindell. I too congratulate my hon. Friend the Member for Sheffield Central (Paul Blomfield) on securing this debate. I am pleased that so many of my colleagues have come to put forward cases; it is just a pity that there were so few on the Government Benches to listen to the human stories put forward by the hon. Member for Dudley South (Mike Wood).

I would like to start by paying tribute to care workers. They allowed my mum to live in her home at the end of her life, and that gave me the confidence to work here and her the confidence to stay at home. I have to say that in many instances they have the patience of saints. We rely on these people to look after our loved ones, and yet, as we have heard, so many are routinely and illegally still paid less than the minimum wage. I too would like to thank Unison for its briefing and its long campaign to support workers through all means, including legal action.

As the hon. Member for Motherwell and Wishaw (Marion Fellows) said, we all have an interest in this debate, either sooner or later. We heard from my hon. Friend the Member for Heywood and Middleton (Liz McInnes) that investigations by HMRC of care providers found that 41% were guilty of non-compliance between 2011 and 2015. The Resolution Foundation calculated that care workers are collectively cheated out of £130 million per year due to below-minimum-wage payments. The effect on care workers and those they care for is immeasurable. It plunges care workers into poverty, as was highlighted by my hon. Friend the Member for Neath (Christina Rees). It leads to high staff turnover and therefore a lack of continuity of care, which is so valued by the person being cared for. The care worker is not just a paid employee or a carer; they become a friend.

So how do providers get away with that? It is by not paying for travel time, which encourages call-clipping—leaving a few minutes early to minimise time spent working for free. However, as we heard from my hon. Friend the Member for Greenwich and Woolwich (Matthew Pennycook), many care workers do not do that because they care about the people they are working for. Effectively, they are subsidising our care system.

We heard about how the combination of cuts to council funding and the rise in the minimum wage will increase the problem. The funding is simply insufficient for social care, both now and in the future, as was so eloquently put by my hon. Friends the Members for Worsley and Eccles South (Barbara Keeley) and for Edmonton (Kate Osamor), who have long campaigned on the issue, and I pay tribute to my hon. Friend the Member for Sheffield Central and my right hon. Friend the Member for Oxford East (Mr Smith) for their work on it.

Pressure from my colleagues led to the Government ordering HMRC to carry out an investigation into the six largest care providers. Care providers are businesses, as we heard from my hon. Friend the Member for Great Grimsby (Melanie Onn), who spoke passionately about the large corporations and some of their actions, which are less than compassionate. Despite the Government ordering HMRC to carry out that investigation in February 2015, it has still not been completed. Why is that? When will it be complete?

Just a handful of small care providers—13—have been named and shamed since BIS commenced this policy in 2014. Of those 13 providers, eight were identified as owing arrears to just one care worker. How can that be if care workers are working under the same terms and conditions? Is HMRC extending its investigation to other care workers within the companies? If not, why not? We have heard that that is partly due to the process; HMRC recovers arrears only for the worker who contacted it, and employers are allowed to self-correct and pay back the other workers with minimal oversight. Effectively, they are shamed as bad employers that are not to be trusted, but are then trusted to do the right thing by the employees who they cheated in the first place.

The assurance process on this is minimal. It relies on workers knowing how much they are owed, but, as my hon. Friend the Member for Bradford South (Judith Cummins) rightly highlighted, many care workers are not currently provided with a proper breakdown of all their working time. HMRC also consistently identified a very low level of arrears, with an average of £201 per worker. Should HMRC not be made to carry out assurance checks, publish the results and talk to a wider range of people about this, including the trade unions?

Some may ask why people do not report these abuses. As we have heard, there are low levels of awareness among workers that they should be paid for travel time, as well as a fear of losing jobs, of cuts in hours and of tribunal fees, as my hon. Friend the Member for Ashton-under-Lyne (Angela Rayner) highlighted.

[Mr Andrew Smith]

My hon. Friend is making an excellent speech. As was pointed out earlier in the debate, a high proportion of these workers are migrant workers. With the awful rhetoric directed at them from some sections of our society and political parties, do not those workers feel additionally vulnerable and scared about reporting such things?

[Yvonne Fovargue]

I agree with my right hon. Friend. Many workers in this sector are already exploited, as we heard from my hon. Friend the Member for Great Grimsby. They are women. They are migrant workers. They are people who do not traditionally complain. Another issue is the length of time before the judgment in tribunal cases. In 2014-15, it was on average 74 weeks before a judgment was reached.

Does the Minister feel that a voluntary statement of a national minimum wage is sufficient? In view of the widespread non-compliance, should the national minimum wage not be compulsory in this sector? As we have heard, many care workers do not know the hours they are paid for. Does he agree that we must go beyond the Low Pay Commission’s suggestion of simply having a review, and that there should be a requirement for payslips of hourly paid staff to clearly state the hours for which they are paid?

Details on the number of care workers who contact the pay and work rights helpline should be collected, as they were previously. That is vital, because it gives a sense of the levels of awareness about non-payment and the willingness to complain.

Councils’ commissioning processes should be monitored as to whether they are insisting that providers pay the minimum wage. Councils also need support to carry out spot inspections of providers’ payroll records, which should be clear, and they should carry out regular, anonymous staff surveys, in conjunction with trade unions, to identify any risks of non-payment.

We rely on care workers to look after the most vulnerable, and yet we are allowing them to be exploited and underpaid. They work in one of the most demanding sectors, caring for our loved ones, and they deserve to be looked after by all available means without further delay.

--- Later in debate ---

[George Freeman]

I will continue, if I may—I am under a tight time limit. The enforcement of the minimum wage is therefore essential to its success and we are committed to cracking down in every sector across the economy on employers who break the minimum wage law. Our approach is simple: through effective national minimum wage enforcement, we are able to support workers and businesses by deterring employers from underpaying their workers and removing the unfair competitive advantage that underpayment could bring.

[Mr Andrew Smith]

Will the Minister give way?

[George Freeman]

I will very briefly, but I am going to run out of time if Members keep intervening.

[Mr Andrew Smith]

Does the Minister not agree that those efforts would be very strongly buttressed if the power were taken under section 12 of the National Minimum Wage Act for mandatory statements showing compliance?

[George Freeman]

I will deal with the right hon. Gentleman’s points, with which I have a lot of sympathy, if I am given time to crack on.

Hon. Members have rightly raised the issue of non-compliance with the minimum wage in this sector. I want first to set out the measures that we are putting in place now and that we have put in place already, before touching on some things that we may go on to do in due course. HMRC responds to every complaint made by workers through the ACAS helpline. When a third party reports suspected non-compliance, HMRC evaluates the report and investigates the employer when there are grounds to do so.

Since HMRC began enforcing the minimum wage in ’99, it has identified more than £65 million in arrears. Between April and November 2015, HMRC took action against 557 businesses, clawing back over £8 million for 46,000 workers who had been illegally underpaid. That is already the largest amount of arrears identified in any single year since the national minimum wage was introduced and is possible as a result of the increased investment and extra measures we have put in place to support enforcement.

We are going further. The Prime Minister has committed to a package of measures that are currently being implemented that will build on Government action to date and strengthen the enforcement of the national minimum and living wage. First, we are increasing the enforcement budget from April 2016, demonstrating our ongoing commitment to ensuring that the hardest-working and lowest-paid people receive the pay that they are entitled to. HMRC will also continue to promote compliance with the law and respond when employers have got things wrong.

Secondly, the Government are further increasing the penalties that employers will have to pay when they break the law. From 1 April, the calculation will increase further, to 200% of the arrears that an employer owes. By increasing the penalties for underpayment of the national minimum wage, we intend that employers who would otherwise be tempted to underpay comply with the law and that working people receive the money they are legally due.

Furthermore, under changes being implemented through the Immigration Bill, we are creating a statutory director of labour market enforcement, who will set out a single set of priorities for the enforcement bodies across the spectrum of non-compliance. That should ensure a targeted approach that addresses problems and best helps victims.

Under the Immigration Bill, we are also creating a new type of enforcement order. That labour market enforcement undertaking will be supported by a criminal offence for non-compliance. We want to tackle employers who deliberately, persistently and brazenly commit breaches of labour law and fail to take remedial action. That cannot always be done satisfactorily through the repeated use of existing penalties or offences, which may lead to the continued exploitation of workers.

BMA (Contract Negotiations)

Andrew Smith Excerpts

Monday 21st March 2016 Westminster Hall

[Helen Jones]

My hon. Friend makes a fair point. First, the research has its critics, and various bits of research done on deaths following weekend admissions have reached different numbers: 3,000; 4,400; 6,000. The problem is that it is difficult to ascertain cause and effect. If the research is adjusted for the fact that we admit different kinds of patient at the weekend—people are sicker and there are more emergencies, and not many elective patients in most trusts—there remains a slight increase in the death rate. The problem is that ascertaining the cause is difficult. As the hon. Member for Totnes (Dr Wollaston) pointed out in a previous debate on this issue, when hospitals look back at such deaths, it is difficult for them to find out what could have been done differently in those 30 days.

When a complaint was made to the UK Statistics Authority about the use of those data, it said:

“We are speaking with Department of Health officials to ask that future references to this article are clear about the difference between implying a causality that the article does not demonstrate, and describing the conclusions reached by the authors.”

The reason is that although the research shows us that something is going on that we need to investigate, it does not show exactly what is causing it. I do not know whether the Secretary of State understands that. If he does not, I must say that Oxford is probably not what it was. However, I suspect that he understands it very well.

[Mr Andrew Smith (Oxford East) (Lab)]

I assure my hon. Friend that Oxford is certainly not only what it was, but better than it was. Therefore, the Secretary of State really ought to understand what is going on.

[Helen Jones]

I am grateful to my right hon. Friend for defending the university in his town. I am sure that he is right.

Any experienced negotiator will say that beginning negotiations by insulting the staff is never a good tactic. That is part of what the Government have attempted in muddying the waters: first, by drawing conclusions from the research that are not there, and secondly, by not being clear what they mean by a seven-day NHS. They have constantly said, “We need a seven-day NHS”. What they fail to tell us is whether they want a seven-day emergency service, which we already have but everybody accepts that it could be improved, or a seven-day elective service, which will require a huge investment not only in doctors and nurses but in diagnostics, support staff, lab technicians and so on. That failure to be clear has made doctors very wary of what the Secretary of State is trying to achieve.

[Helen Jones]

My hon. Friend makes a very good point, and she is right.

The Government need to make clear what they are trying to do, then they need to negotiate with the staff in good faith. Unfortunately, there is not much good faith around at the moment. That is why 90% of junior doctors have said they would consider leaving the NHS if the new contract is imposed on them. I do not think for one minute that 90% of junior doctors will go, but the Government have proceeded—as they do in a lot of cases—as if those junior doctors had nowhere else to go. Unfortunately, in this case they do: they can go to Scotland, or to Wales; or they can go and work abroad, where their skills are in high demand and where they will find, in many cases, they are paid more and work fewer hours than they do here. If even a small percentage of junior doctors go, what will the Government do to fill the gaps? We already have gaps in certain specialities, such as A&E, and paediatrics. What is the Government’s plan?

[Mr Andrew Smith]

I congratulate my hon. Friend on securing this debate—she is making a powerful argument—and I congratulate all the people who petitioned for it. Does not the threat—and decision—by the Government to impose the contract amount to an admission on their part that they were incapable of persuading the critical backbone of NHS clinical staff that their plans made sense? If so, is that an abject failure or an act of malevolence?

--- Later in debate ---

[Andy Slaughter (Hammersmith) (Lab)]

It is a pleasure to be here under your chairmanship this afternoon, Sir David. I congratulate my hon. Friend the Member for Warrington North (Helen Jones) on her speech. In introducing the petition, which a large number of members of the public feel strongly about, she managed to explain in just a few minutes how the Government have put forward an entirely false perspective on the dispute from the beginning and continue to do so. I am sure that many more Members would be here for this debate this afternoon were it not for events in the main Chamber. I know that many people want to be present as witnesses or contributors to the dissolution of the Conservative party—not least members of the Conservative party—so perhaps the timing of the debate is unfortunate.

[Mr Andrew Smith]

I understand what my hon. Friend says about what is going on in the main Chamber, but is it not striking that only one Conservative Back Bencher has turned up to defend the Government’s handling of the dispute?

[Andy Slaughter]

I agree with my right hon. Friend, but I think that what the hon. Member for Morley and Outwood (Andrea Jenkyns) said was even more striking in its own way. I felt I could forgo the entertainment in the main Chamber because I feel so strongly about this issue, not least because my constituency hosts two of the main teaching hospitals in the Imperial College Healthcare NHS Trust, and because many thousands of junior doctors from that trust and other trusts live in my constituency. I have therefore followed the dispute with increasing anxiety and depression. I have met not only individual junior doctors but groups of them at Charing Cross hospital, and I have spoken to them at the BMA. The image of them put forward by the Secretary of State, and what we have heard from the governing party today, does no credit to that party. The slurs on junior doctors are extraordinary, and it is perhaps time to pause and consider matters again.

Are we seriously being asked to accept that junior doctors are some sort of militant clique looking to undermine the Government? That is pure fantasy. Anybody who has spent time with junior doctors will have seen exactly what is going on. The speech by the hon. Member for Morley and Outwood was tragic in many ways, but in some ways it was quite brave, because I suspect that any of her constituents who read it will begin to think, “What have I done in electing her last year?”

Bowel Cancer Screening Age

Andrew Smith Excerpts

Tuesday 8th March 2016 Westminster Hall

[Caroline Ansell]

My hon. Friend makes a very worthy point. He brings glad tidings, too, that bowel cancer can be beaten and that those who have suffered from this terrible condition can go on to lead rich and fulfilling lives—which, in some cases, bring them to Parliament.

[Mr Andrew Smith (Oxford East) (Lab)]

The hon. Lady is being very generous in giving way. I commend her excellent speech, the petitioners and her remarks about her brave constituent. With the national rate of screening at 58%—it is only slightly higher in Oxfordshire—does she agree that, as well as raising awareness and pushing for an earlier age of screening, which I fully endorse, still more needs to be done to increase take-up, notwithstanding the adverts and the reminder letters that are already sent?

[Caroline Ansell]

The right hon. Gentleman is right in identifying that as a key way to move forward. In fact, screening uptake has not really moved in more than a decade, so we do need to be in the business of raising awareness of the condition, its symptoms and the opportunities for screening, at whatever age it is set.

NHS Bursary

Andrew Smith Excerpts

Monday 11th January 2016 Westminster Hall

[Liz McInnes (Heywood and Middleton) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Pritchard. I am grateful to be able to make a contribution to this important debate. I congratulate the 154,000 people who have signed the petition and brought this issue to the House for discussion.

I declare an interest: I am a Unite member and an ex-Unite workplace rep in the NHS. I used to work as a healthcare scientist in the NHS. I did not receive a bursary for my training; I was employed in a supernumerary position. I was privileged to be able to do that. In my day, it was recognised that I was making a contribution to the NHS while being trained. The Government should perhaps go back a few decades and have a look at how NHS staff were treated in the 1980s, when I trained.

Members have quoted various figures about the proposed changes. From the reading I have done, I believe that under the proposed changes, students could be burdened with up to a staggering £65,000 of debt by the time they finish their training. Under the current system, the bursary allows those without financial means to study as nurses, midwives and, importantly, allied health professionals—I am grateful that a lot of Members have mentioned AHPs, because it is important that we do not forget them and their contribution to our NHS. Many trainees already struggle to make ends meet, even under the bursary system. As Members have said, the system is not perfect, and we need to look at it, but let us do it properly and put in place a system that actually works, rather than one that appears not to have been tested or consulted upon.

[Mr Nigel Evans in the Chair]

Many Members referred to the difficulty of getting part-time jobs. It was a pleasure to listen to the hon. Member for Lewes (Maria Caulfield) talk about her own experience. Given the number of hours that NHS trainees—nurses, midwives or AHPs—are expected to work during clinical placements or at university, plus all the extra hours on assignments, exams, practicals and study, there are not enough hours in the day for them to take on a part-time job.

I was interested to hear the hon. Member for Sutton and Cheam (Paul Scully) refer to Martin Lewis’s MoneySavingExpert.com website. I had a look at it during the debate to see the advice that he gives about NHS bursaries. I could not find anything particularly relevant, but I noticed that, to help students financially, he advises them to get a part-time job. That is obviously not suitable in this situation. The hon. Member for Lewes highlighted the relatively low pay that nurses on band 5 or 6 can expect to earn. Under a loan system, those people, once qualified, will be paying back that debt for their whole career. I urge the Government to consider those points, which have been well made.

[Mr Andrew Smith (Oxford East) (Lab)]

My hon. Friend is making an excellent speech. Does she agree that the pressures will be all the more acute in high-cost housing areas such as Oxford, where nurses are already struggling, which will be a further disincentive to recruitment and retention in services that are already under enormous pressure?

[Liz McInnes]

I thank my right hon. Friend for his important intervention. Housing costs must be borne in mind in any discussions about changes to NHS bursaries. The days when cheap accommodation was available to NHS trainees are long gone. I can remember staying in a tower block in Greenwich at a reasonable rate during my training, but those tower blocks were sold years ago and are now privately owned.

Replacing bursaries with loans will reduce the diversity of those able to access a career in healthcare. I noted with interest that the hon. Member for Sutton and Cheam claimed when challenged that that would not be the case, but was then unable to quote any equality impact assessments. I would be interested to hear from the Minister what assessments have actually been performed. The NHS bursary is not a cost but an investment in the health and wellbeing of our society. To lose the bursary would affect not only prospective students but each and every citizen of this country, by which I mean England, because the proposals apply to England only.

In the Budget debate of July last year, I spoke against the change from maintenance grants to loans for young people hoping to go to university. The withdrawal of NHS bursaries, as announced in the comprehensive spending review, directly mirrors that change. As a result of the Budget proposals, our students will be saddled with even more debt. I said at the time that there was a real risk that the Government were experimenting with the future of the current generation of secondary school students, but it now appears that they are also experimenting with the future of current and potential nursing and health trainees. In short, it is an experiment on the future staffing of our NHS that has the potential to go badly wrong.

I put out a simple statement on Twitter regarding the views of the Royal College of Midwives, which opposes the proposals to remove NHS bursaries, and received this response:

“My daughter a single parent budgeted carefully b4 becoming a student nurse, may not be able to complete studies.”

That is an appalling situation into which the Government have put that student nurse. Again, that gives the lie to their oft-repeated claim to be the party of working people. Simply repeating the same line over and over again does not make it true, although that does seem to be this Government’s modus operandi on so many issues.

As with the Government’s conversion of maintenance grants to student loans, I would be interested to read an equality impact assessment, should such a thing exist, of the removal of NHS bursaries. The Government’s claim that cutting the bursary will encourage more prospective students into nursing is ludicrous, and even some Government MPs are saying so publicly. I was pleased to hear the hon. Member for Lewes on Radio 5 live yesterday stating that she would have not been able to train as a nurse without an NHS bursary. Today she hinted at alternatives, including apprenticeships and maybe even a return to the days of state-enrolled and state-registered nurses, and I hope that the Minister will be able to elaborate on them.

The Royal College of Midwives believes that the NHS workforce deserves a better future and says, interestingly, that the Government have

“taken money away from other parts of the health system, including student education, to be able to give ‘the NHS’ more money. According to the King’s Fund, spending on health activity that falls outside NHS England’s budget will decrease by more than £3 billion in real terms by 2020/21—a reduction of more than 20%.”

The RCM then quotes the King’s Fund, which states that

“it is clear that a large amount of the additional increase in NHS England’s budget has come at the expense of other areas of health spending.”

The Royal College of Nursing is similarly opposed to the plans and refers to them as “ill thought out”. As the RCN celebrates its centenary, it calls upon the Government to listen to its knowledge and expertise, stating:

“The future of nursing must be protected. Our patients deserve nothing less.”

Unite the union also opposes the plans, highlighting the other health professions covered by the NHS bursary, including occupational therapists, physiotherapists, radiographers and speech and language therapists, to which other hon. Members have referred. Those professions are the backbone of our NHS, and we cannot allow entrants to them to train at their own expense while racking up debt. To do so would be disastrous for our NHS and for future patient care. I urge the Government to reconsider the proposals and, more importantly, to take advice from the professional bodies.