(5 years, 9 months ago)
Commons ChamberOnly with his gel. He is absolutely right that, as the Secretary of State just said, community pharmacies are experts in so many minor health matters, and Pharmacy First can absolutely be used when it comes to head lice as well.
Is the hon. Gentleman feeling jumpy or does he wish to contribute?
My hon. Friend makes an excellent point. Clearly the more we can do to educate people to make informed choices to improve their diet, the better. He is absolutely right: poor health among children used to be indicated by being underweight, but now being overweight is very much an indicator. I congratulate any food manufacturer that is taking action to address the problem.
The Minister and the ministerial team know that many working class people do not have good access to GPs, and that GPs treat them differently from more middle class people, as demonstrated by the number of people from poorer backgrounds with atrial fibrillation who are wrongly diagnosed. If they are diagnosed with an irregular heartbeat or pulse, they are given the wrong drugs. That happens to many ordinary people in this country: there are still all these wonderful GPs prescribing aspirin that will do no good at all. What is going on with GPs and poorer people?
Our NHS is full of people who are doing their best to deliver the best possible care for all their patients. It is important that GPs and any health practitioners consider the holistic needs of all their patients—
The hon. Gentleman says they are killing people; that is not the debate I want on the NHS.
(5 years, 9 months ago)
Commons ChamberUrgent Questions are proposed each morning by backbench MPs, and up to two may be selected each day by the Speaker. Chosen Urgent Questions are announced 30 minutes before Parliament sits each day.
Each Urgent Question requires a Government Minister to give a response on the debate topic.
This information is provided by Parallel Parliament and does not comprise part of the offical record
My hon. Friend is absolutely right to recognise that the cases in which people end up in a long-term residential setting often reveal a failure of joint working—of the wraparound services that people need to keep them in the community. We are looking at working-age adults as part of the social care Green Paper, and it will be published before Christmas.
The Minister will know that I chair the autism commission, which has been looking at health and fake medicine—some serious reports. Will she expand her vision? There is obviously something seriously wrong in the justice system and the fact that police are not trained to recognise and understand someone on the autism spectrum. We need Health and Justice to look into the issue thoroughly, because something is going wrong. We need to train people, and to train them now.
The hon. Gentleman makes a good point: training is fundamental. We have already accepted the LeDeR review’s recommendation that all health and social care staff should have mandatory training on how to care for people with learning disabilities and autism. I would very much like to see that sort of training spread more widely out into society.
(5 years, 9 months ago)
Commons ChamberI respect my hon. Friend’s understanding of these issues, not least because I am married to an osteopath, so my back is feeling okay and I hope that other people can access such services, too.
I very much welcome what the Secretary of State said about people on the autism and special educational needs spectrum. I also welcome his enthusiasm for the use of new technology, big data, data analytics and all that. Across party lines many of us see some real opportunities for delivering real public education in the health sector. When the Secretary of State makes good decisions and puts in the resources, he will have our support.
(5 years, 9 months ago)
Commons ChamberThe House of Commons Library tells me that I have listened to Budgets in the House 44 times, so I hope I am an experienced Budget evaluator. I always come to the Chamber to listen to the Budget, and I base my evaluation of its quality on two criteria. The first is the great global issues that we face, which for me are always the fragile planet, the environment, climate change and global warming, and the fact that the planet’s burgeoning population has to be fed, and fed sustainably. We also face the challenge of keeping the peace. Many of us thought that that could be taken for granted, but in the current global circumstances, keeping the peace has become a great concern for us all.
My second criterion for evaluating a Budget is what it will do for my constituents. I believe that I have a sacred duty to come here and represent my constituents, and to make sure that everything that I do—the contribution that my colleagues and I make in the House—adds to the welfare, health and prosperity of my constituents. Those are the twin criteria, and on both I believe that this is an uninspiring little Budget. It is lacking in passion, leadership and values. That is my sincere criticism of the Budget.
Let me go into a little more detail. I have been in the House at times when the country has been in great crisis. At a time of crisis, I have seen people whom one would have thought were pretty ordinary politicians suddenly stepping up to the Dispatch Box and showing the world that they had leadership quality, that they understood what was going on in the wider world, and that they could stand up to do the right thing. I take umbrage at the fact that a Chancellor of the Exchequer could stand in the Chamber yesterday and call the cataclysm of 2009 and the global meltdown of the world economy “Labour’s great recession.” I have to say that it must have been a very powerful Labour party and Labour Government who caused the world recession. What rubbish that the man who is supposed to be our Chancellor of the Exchequer could say such a thing—shame on him!
I saw Gordon Brown and Alistair Darling at that Dispatch Box, calm in the face of a hurricane in the world economy. They stood there and made the right decisions. They bailed out the selfish banks. They did what was necessary to save our country. This bunch over on the Government Benches should not tell us how to rise to our responsibilities. We showed leadership. We showed that we had the values. We worked incessantly to get this country back on track.
We understand that there was a global banking crisis, but is it not right that the Labour Government did not prepare the country for problems that might occur, given their chronic overspending of money that we just did not have, which left us in a great deal of debt when the recession happened?
I hear what the hon. Lady says, but let us be serious. I recommend that she goes away and looks at a rather good book that I have recently read called “Reckless Endangerment: How Outsized Ambition, Greed, and Corruption Led to Economic Armageddon” by Gretchen Morgenson. Read it and learn it, because that was what we came through.
The Chancellor’s remarks yesterday did not really touch on many of the issues that affect my community. The fact is that we have a hospital in danger that suffers due to a private finance initiative scheme. All the Chancellor said was that Labour was responsible for PFI. I have been here long enough to know that the great charm offensive on PFIs was led by John Major. PFIs were the fashion among Members on all Benches. As Chairman of the Education Committee, I saw good PFIs and bad PFIs, but I also saw a lot of smart City types who danced rings around local authorities and local health authorities and gave them a rotten deal. That is the truth of PFIs—there were good ones and bad ones, but a lot of City spivs made a lot of money out of them. Nothing that the Chancellor said yesterday will rescue my local hospital and health trust from that burden.
Is the hon. Gentleman aware that 90% of all PFIs were signed under a Labour Government? Yesterday the Chancellor took steps to make sure that there will be no more.
The Chancellor took no steps to help those parts of the country that are in trouble due to PFIs.
Watching the television and reading the papers, my constituents are not fooled: they know that what was left out yesterday was that whatever Brexit deal is struck, it will not be as good as staying in the European Union—that is the truth of it. I come here to represent my constituents, and I know that we are moving towards a disaster for their living standards, their health standards and everything else that will touch their lives over the coming years. This is a year of crisis. Just as we had the crisis of the great depression and the crisis in 2009, this will be the next crisis, and we need people at the Dispatch Box who will take on their role as leaders. I do not mean people such as the former Prime Minister and Chancellor who, when they lost the referendum, ran away from their responsibilities and from leadership. Where are they now? Writing for the Evening Standard I suppose, or writing their memoirs in their man caves.
Being in this House and representing our constituents is a grave responsibility. The job does not come and go—we do not want people who try a bit of time as Chancellor of the Exchequer and a bit of time as Prime Minister but then disappear. The great people who have been at that Dispatch Box are the people who have had values, showed leadership, and led this country in good time and in bad times. The fact of the matter is that we are heading for a very bad time indeed if we leave the European Union on bad terms, but that was not mentioned. The Chancellor of the Exchequer, at this time of crisis and impending disaster for our country, did not have the courage to mention Brexit more than once—that is the truth, and my constituents want me to say that today.
At this time of the year, I am, like many in the Chamber, wearing my poppy. I have just been reading a lovely new history about the first world war. The fact is that right in the middle of that war, everybody knew that it was unwinnable and that more and more young men were going to die. Of course, the real responsibility for the first world war lies with us—the politicians. Politicians failed the people of this country. German politicians failed their people, as did French politicians. It was politicians who did it, and they went on killing more and more young people. That was a failure of leadership, a failure of values, a failure of responsibility and a failure to make courageous decisions at the Dispatch Box. We are heading in that direction—not particularly into war, but into the most troubled times when our people will come out impoverished, miserable and unhappy. That will hurt their health, their education and their chance of a good life. For my part, I will do everything that I can to stop the disaster that those on the Government Benches have wished on our people.
(5 years, 10 months ago)
Commons ChamberI pay tribute to my hon. Friend for making that case so powerfully. We work very closely with NICE, which is rightly the objective decision maker that makes recommendations for Ministers to follow about what drugs should and should not be accessed through the NHS. He makes the case very strongly.
This question is about innovative technology in the health service. What is the Secretary of State saying today to scientists? For example, 97% of people from the Francis Crick Institute say that our science and our bioscience are in danger because of Brexit. What is he going to do about technology that is suitable for the health service?
The scientists, like me, want a Brexit that is based on a good deal for the UK, and that is what we are seeking to deliver. In any case, we have put more money into the science budget than ever before, so no matter what the outcome of the negotiations, there will be more support for science in Britain.
(6 years, 1 month ago)
Commons ChamberMy hon. Friend is absolutely right that obesity, especially in children, is one of the underlying conditions that often leads to much worse long-term health conditions. Some 22% of children aged four and five in reception are overweight or obese; that number is too high and we have to act.
I welcome the Secretary of State to his new post, which is one of the toughest jobs in Parliament. Having worked with him on other things in the past, I am sure that his energy will come through in the Department.
I have a vested interest in the welfare of young children as we are expecting our 11th grandchild in October. Will the Secretary of State look closely at the relationship between obesity in later childhood and the diet of mothers during pregnancy? Early research shows that there is a link, so will he look at it carefully?
(6 years, 1 month ago)
Commons ChamberI am very grateful to the Minister for that positive intervention, and we look forward to seeing that guidance when it is brought forward.
On clause 5, I am also supportive of the focus on involving
“patients in the planning, development and delivery of care and treatment”.
I would have preferred to see that extended to the patient’s family, as was proposed by my hon. Friend the Member for Christchurch, because, as we know, mental illness does not affect just the patient; it can affect those near and dear to them, too. Again, the Minister stated on Report that she would seek to put this into statutory guidance and I hope she intends to follow through with that, because many family members would think it is very important.
As chair of the Westminster Commission on Autism, may I tell the hon. Gentleman that many people in the commission have a great interest in this Bill and support it? He has started off very reasonably in his remarks and I hope he will continue in that reasonable way, because the autism community want to see this Bill become law.
Absolutely. The hon. Gentleman is not alone in that, and nor is the autism community—I want the Bill to become law, too. If he had not intervened on me, we could have completed this a bit sooner. I assure him that this Third Reading will complete very soon. I certainly do not intend to go on for long today and I do not think anyone else does. We want to complete this as quickly as possible and see the Bill on the statute book. I want to see that just as much as he does.
Clause 6 deals with recording the use of force and I am very supportive of having this in the Bill. It is right to record the carrying out of such practices on patients. The police have a system in place when using restraint as part of their role, so it is only right that medical staff should follow suit. I am advised by my local care trust that it does have some measures in place to record restraint of a patient, but this Bill will of course make it a legal requirement to do so, which is important and absolutely right. Again, I was disappointed that my amendment proposing that these records be added to the patient’s medical records was not accepted. As I have stated, restraint is considered to be a form of medical care and therefore should be documented in the patient’s medical notes. That would help people to know what reaction the patient had had when restraint had happened in the past. I hope the Minister will make sure that the statutory guidance can be used and updated to make sure that these things are added to people’s medical records at the same time. I hope she will be able to confirm that in the fullness of time, too.
On clause 6(5), the information listed to be included in the report is largely constructive. Where I feel it falls short is in insisting on adding what are referred to as “relevant characteristics”. As the hon. Member for Croydon North knows too well, I do not agree that that is necessary. I am of the opinion that including these “relevant characteristics” detailing race, sexuality, religion, marital status and so on is purely a politically correct gesture in order to be seen to be doing something to combat discrimination, when instead it causes the illusion of discrimination. There is a notion that this creates a more transparent mental health service, but that is not the case. For instance, the detailing of these “relevant characteristics” will extend only to the patient and not the staff. My amendment to say that staff members should be included in this was also supported by the hon. Gentleman, for which I am grateful. I hope that the Minister takes on board those points and will ensure that the statutory guidance she produces in conjunction with the Bill will set out that staff members’ “relevant characteristics” will be included alongside those of the patient.
(6 years, 2 months ago)
General CommitteesI beg to move,
That the Committee has considered the draft Nursing and Midwifery (Amendment) Order 2018.
It is always a pleasure to serve under your chairmanship, Mr Evans. Health Education England’s “Shape of Caring” review made a series of recommendations to strengthen the capacity and skills of the nursing and caring workforce. A key recommendation was to explore the need for a defined carer role to act as a bridge between the unregulated healthcare assistant workforce and the registered nursing workforce. The amendments that we are proposing to the Nursing and Midwifery Order 2001 put in place provisions to regulate a nursing associate role that satisfies that recommendation.
In short, the proposed amendments to the 2001 order give the Nursing and Midwifery Council statutory responsibility for regulating the nursing associate profession in England and extend its powers and duties under the order to nursing associates in respect of the key functions of registering nursing associates in England and setting the standards of proficiency, education and training, and continuing professional development and the conduct of nursing associates in England.
During my time as Chair of the Select Committee on Education there was great controversy about teaching assistants and whether they diluted the profession. I can see that nursing associates need to be registered, to have that recognition of being regulated, but will nursing associates mean a watering down of the profession? Will we have a large number of them as substitutes for highly qualified nurses?
I am grateful to the hon. Gentleman for raising that point. I think we can all see the value for children in school that teaching assistants offer alongside teachers. They are a good example of how, in education, the need for a diverse workforce has developed, and that is exactly what today’s order addresses. It is a response to what employers have said they want, which is more flexibility in their workforce, to ensure progression for staff who want to progress into nursing, but who in the past might have felt trapped in a healthcare assistant role by having young children or otherwise been constrained from going to university. Our proposal gives them a ladder between the two roles, as part of a flexible workforce that responds to employers in the way that happens in education, as the hon. Gentleman correctly said.
Is the plan to expand the nursing profession by enabling people to join as nursing associates before becoming better qualified and ending up as fully qualified nurses?
The hon. Gentleman is right to probe on this, because that is the essence of the Government’s proposal. The nursing associate role is a stepping stone. Some people will progress to nursing associate and stay in that role, but some, having done the foundation year of their degree, might want to do the following two years and become a nurse. We want to respond constructively to that aspiration, which his constituents will have, as do mine. Some will start as healthcare assistants, gaining valuable experience in that role, but some will want to progress to nursing associate and some will want to become a registered nurse. The draft order is about ensuring flexibility in the workforce to enable that.
I have checked, and the starting qualification for a nursing associate is GCSEs grades 4 to 9 in English and maths. The lower end of that range is very low indeed, is it not? Indeed, it is the same starting qualification for teaching assistants. Is the Minister happy with that?
Yes, I am, and it is helpful of the hon. Gentleman to raise this issue. The qualifications that nursing associates will undertake are to be set by the NMC, so people will need to go on courses that satisfy the NMC. However, they will also gain valuable hands-on experience alongside their foundation training. Our proposals are about creating a ladder from the nursing associate role. Some will stay at that level, because they feel that, educationally, that is the level they have attained, and they want to continue as a nursing associate—
I will just finish my point and will then happily take one further intervention, after which I will make some progress.
Quite rightly, some people will want to continue as a nursing associate, playing a valuable role on a ward and freeing up those who have done three years at university level to focus more on skilled roles. That is part of the flexibility that employers have asked for. Others, having had a taste in the foundation year, will want to do a further two years. The system allows that progression, which I am sure the hon. Gentleman’s constituents will want.
The Minister said that he would allow me one last intervention, and this will be my last. The great criticism of nursing has been that it became an academic and university qualification. Everybody said that something had gone wrong. If we tie this change to graduate apprenticeships, which nursing is moving towards, it could mark the beginning of a return to a much more hands-on, experience-driven qualification. That is most interesting, so I thank the Minister for his responses.
I am grateful to the hon. Gentleman. I see exactly what he is driving at, and I have a great deal of sympathy with that point. It is slightly beyond the scope of this legislation, which covers those who satisfy the foundation-course level after their first year. If they want to become a registered nurse, they will need to satisfy, as now, the three-year-degree level. The legislation does not say that people do not have to reach the educational attainment of a registered nurse. Rather, it allows them to continue to earn, to gain hands-on experience and to do that in stages, which may provide flexibility to, for example, those with young children or other caring responsibilities. It allows that stepping stone.
The hon. Gentleman touches on a point slightly beyond the scope of today’s order, which is whether someone could gain a nursing qualification without a degree—I think that was within his question. That is not what this legislation does. It requires—
On a tiny point of information, it is fascinating to think that we could get back to the days when people had much more hands-on training and went right through to a degree, but with no debt.
The hon. Gentleman absolutely sees my enthusiasm for this order, and that is why I hope that colleagues on both sides of the Committee will support it. Alongside the apprenticeship levy, it offers an alternative to a student loan and what we might see as a more conventional degree. That is not to say that we will not continue with that route, because obviously it will remain a main pathway into nursing, but it is good to give flexibility to employers and to school leavers and others who see the opportunity to go into nursing. We are conscious that, currently, many people who want to do nursing are rejected when they apply, so having different pathways is a key part of the system.
It is a pleasure to serve under your chairmanship, Mr Evans. As the Minister said, the draft order amends the Nursing and Midwifery Order 2001 to provide the Nursing and Midwifery Council with the necessary legal powers to regulate the nursing associate profession. Committee members will be relieved to hear that the Opposition do not oppose the draft order. We understand the importance of bringing nursing associates under the auspices of the NMC as soon as possible.
As we heard, the nursing associate role was create in response to the “Shape of Caring” review in 2015 as a defined care role to act as a bridge between unregulated healthcare assistants and the registered nursing workforce. Now that the role has been created, we agree with the Royal College of Nursing, which stated in its response to the Government’s consultation on these provisions that
“there must be absolute clarity that the nursing associate…is not a separate profession, but a new role within the nursing family that works under the delegation of the Registered Nurse”.
It went on to ask for “urgent guidance” to be published on “the precise relationship between” nurse associates and registered nurses
“in terms of delegation and accountability”.
Although bringing both roles under the same regulatory umbrella is a step in the right direction, will the Minister confirm whether we can expect such guidance to be issued? It is particularly important to try to achieve clarity and consistency given the varied roles that associates are taking during the implementation phase, not least for their benefit and for patient safety.
Let me turn to the amendments to the 2001 order, in particular the appointment of nursing associates to relevant panels. It is worth noting that the discretion afforded to the NMC for practitioners is slightly wider than it is currently for nurses and midwives. I presume that is to take account of the initial paucity of nursing associates with relevant experience to sit on panels. The NMC hopes that sufficient associates will emerge in due course to take a more active role in the process. Does the Minister intend to keep an eye on that, to ensure that in time these roles will always be judged by relevant peers?
The Opposition support the proposed approach to education and training for nursing associates. However, as my hon. Friend the Member for Easington said, there are concerns about continuing professional development across the board. As we heard, Health Education England’s budget for workforce development has been slashed by 60% over the last two years, from £205 million to £83.49 million in 2017-18. We had an announcement about increased spending in the NHS this week, but I understand that there was nothing specifically for training. I know this is slightly outside the scope of the order, but I would be grateful for some clarity from the Minister on that.
There is also a worrying shortage of qualified registered nurses to supervise the training of nursing associates. We are certainly in favour of the approach but urge the Minister to step up the availability of continuing professional development to ensure adequate supervision and training.
My hon. Friend pushed the Minister early in his remarks on whether the Royal College of Nursing was fully consulted and on board. What is his interpretation—is it on board and in favour of all this?
It is fair to say it is on board the train. On whether it is fully behind this, it is a question of ensuring that it is done in the right way. I will go on to outline where its main concerns lie.
As the Minister will know, there is a question about substitution. I commend his ingenuity in claiming that the vacancy rate in the nursing profession is only 1%, which must be a record for the public sector. I am sure he will be talking to his ministerial colleagues about how he has managed to achieve that. There is clearly an issue with the level of money spent on agency and bank nurses in the NHS, so we must remind ourselves that the real figure is much higher.
As my hon. Friend the Member for Huddersfield said, there is anxiety about substitution, particularly in the context of the high vacancy rate we believe there is. The fact is, more nurses are leaving the profession than joining it, and there is also a demographic challenge in that one in three nurses are due to retire in the next decade. In that context, there is well-founded anxiety that nursing associates could be used as a substitute for registered nurses.
I appreciate what the Minister said about providing a bridge or a ladder between particular roles, but there may be concerns, as some trusts have acted in, shall we say, a quite remarkable or coincidental way. The Warrington hospital trust agreed to reduce the number of full-time equivalent nurses on its wards by 23.58, and at the same time created 24 new nursing associate roles. That seems quite a remarkable coincidence and shows why there will be legitimate questions about whether the order will continue to be fit for purpose if it turns out that nursing associates are taking on more of the nursing role.
My hon. Friend is absolutely right. We need to keep a close eye on that. It is not fair on the professionals involved, and it is certainly not fair on patients, if people are asked to do things beyond their capacity or competence. The order would be a fool’s errand if we found that that became commonplace.
Was the Minister aware of the issue in Warrington, and has he made inquiries about any risks or trends in substitution? Does he intend to put safeguards in place to prevent it from becoming commonplace?
Today of all days, with the vote that we will all be involved in shortly, someone should put on record the question of how far the order, which I have read carefully, applies to nursing associates coming from Spain. My chief executive at the Calderdale and Huddersfield trust said that at one stage, the hospital could not have been run without young Spanish nurses, although they are much diminished in quantity now. Under the present visa regulations, could those Spanish nurses come in as nursing associates to train here?
I think my hon. Friend’s question is directed at the Minister, rather than me.
I repeat the question that my hon. Friend has posed. There is provision in the order to take account of European economic area nursing associates, I think, but my understanding is that there is not a uniform description or role that fits the narrative across the board. We are still developing that, so comparisons are not necessarily easy to make. I urge the Minister to look carefully at the guidance on delegation and accountability for both roles, so that the scope of practice reduces any risk that staff are carrying out activities and duties beyond their professional remit.
We do not oppose the order or what it seeks to achieve, but I would welcome some reassurance from the Minister on the issues that have been ventilated. The nursing associate role has the potential to make an important contribution to the NHS, but—this needs to be reinforced—it can never be a substitute for the role of a registered nurse. I appreciate what my hon. Friend the Member for Huddersfield has said, because the role will allow people to enter the profession or the nursing world without being saddled with the debts that the Government’s current policy commits them to. Of course, the Opposition are committed to reinstating the nursing bursary, which I hope will reverse the trend we have seen in the past couple of years of a downward trajectory in the number of applications and a narrowing of the groups that have applied, but I do not see that as inconsistent with what the Government are trying to achieve today.
(6 years, 2 months ago)
Commons ChamberThat is exactly what we have been doing, but we need Vertex to be reasonable regarding the price that it offers the NHS. We need to pay fair prices. We have heard that it will be coming back with a new offer next week—we hope it is a reasonable one—but we urge Vertex to waive commercial confidentiality so that we can all see, in the interests of transparency, the kind of prices it is trying to charge the NHS.
Will the Secretary of State consider West Yorkshire in particular? We have the universities, the science, the technology and the life sciences; all we need is a new teaching hospital in Huddersfield.
(6 years, 3 months ago)
Commons ChamberThe centre has already engaged with stakeholders to identify the issues and responses to the challenge of providing health and care in rural settings. The centre will focus on four areas—data; research; technology; and workforce and learning—and will work with partners to identify, scale up and promote the adoption of its activities across the public and private health sector to reduce health inequalities and improve the quality of life for all rural people.
If the ministerial team want to learn about the comparison of health outcomes in urban and rural communities, they should come to Huddersfield, as we have both there. But what we want in Huddersfield is a great hospital, great GPs and a supportive community pharmacy network. When are we going to get them?
I will address the point the hon. Gentleman makes about urban and rural health, as my constituency has the same situation. Obviously, there are specific challenges with regard to sparsity of population, which have to be tackled through the funding formula. The new national centre for rural health and care will address that.