NHS Workforce Expansion

Ben Bradley Excerpts

Tuesday 28th February 2023 Commons Chamber

[Ben Bradley (Mansfield) (Con)]

It is a pleasure to speak in this debate. I will try to skip the partisan rhetoric and get to the crux of some of the issues.

I start by thanking my hon. Friend the Member for Newcastle-under-Lyme (Aaron Bell) for mentioning PFI, because I also represent a hospital that, the last time I checked, spends 14% of its annual budget on repaying Labour’s PFI deal. That is incredible and a detriment to all my constituents, although it is a lovely building.

The workforce question is important, and we all want happy, healthy staff in our NHS and our wider health services. We all understand that they are under untold pressure from covid, the cost of living challenge and short staffing, but my message to the shadow Minister is that saying that, and saying that we want things to be better, is not a plan. It is nice to talk about, but it does not fix anything.

The motion is a little misleading, because it does not mention that we have 37,000 more doctors, 45,000 more nurses, record levels of recruitment and record staff numbers in our NHS. Truth be told, we have shortages in everything in our economy. We will debate the economy a little later, and we could discuss many of these things in that debate because we have a wider challenge of economic inactivity and getting people into work. This is a much bigger systems and process question than just chucking in more resources and adding more training courses. That will not fix this issue.

We have record funding and record staffing in our NHS, and this Government have taken a lot of action to try to increase them. People often talk about a reduction in the number of applications, but they miss or neglect to mention that Government action, including the nursing bursaries, has led to an increase in the number of actual people doing actual nursing courses because it removed the targets, enabled more funding to flow into the system and created more spaces on nursing courses, which has led, in part, to a 25% increase in the number of people studying nursing. We can all talk rhetoric and point fingers, but the Government action was, in many ways, effective. The truth is that the issue is more fundamental than just staffing, and the shadow Minister, probably deliberately, misses that point.

I want to raise two things. First, we should not forget care. I do not understand how we can discuss this issue without talking about care. The Government’s proposal on integration is essential. The NHS, even in one county, is not one organisation—it is all sorts of different organisations trying to work together, including a care system that does not share the same data or the same processes. So much of the burden and the pressure on staff comes down to the fact that these things do not work together properly.

Ambulances are taking elderly patients with care issues to A&E. Hospitals are discharging to care homes and increasing the likelihood of people ending up back in hospital, which is also a care issue for the most part. These things are interconnected, so I am aghast that the Opposition neglected to talk about care in their motion.

Where I agree with the Opposition is that we need a joint workforce plan across health and care, not least to try to overcome some of the stereotypes of working in care, so that, when people consider a career in care, they can clearly and overtly see the pathways through the system into a health service that provides a wide range and scale of opportunities. It would be a huge step forward if we could jointly recruit across health and care into a wide-ranging and exciting set of careers.

Discharge funding has been helpful, and the Government have improved care capacity in Nottinghamshire and the ability to get people out of hospital into care. However, there is still a whole-system issue: data and process need reform, as much as anything else. I agree with the shadow Minister on community-based care but, again, saying we would like more of it is not, in itself, a plan.

Secondly, no amount of money or reform will fix the system. Demand, and public expectations of our health service, have gone through the roof. Capacity has increased, but it is never enough because we expect our health service to provide, for free, everything we want in an increasing range of services. That is not possible or feasible when we have increasingly complex and expensive needs, an older population, more working-age disabled people, more lifelong and chronic illness and more mental ill health. The NHS was never set up to deal with that or the range and complexity of services, which were never envisaged.

Most of us agree that basic healthcare, free at the point of use on and through our NHS, is absolutely right and is fundamental to what many of us feel and believe about Britain, but it cannot grow forever at the expense of services, education and infrastructure. At some point we will need to have a conversation—it will be a brave Government who have that conversation—that draws a line around a basic set of services and expectations that people can access for free, and we will need to have a proper conversation about how we do the rest, because it is not sustainable to keep chucking more money into a pot and to keep expecting hard-pressed NHS staff to offer and deliver more and more when we know they will never catch up with increasing public demands and expectations. Staffing and funding are at record highs, yet the gap grows and waiting times grow. At some stage, we will need to have a proper discussion about what the NHS is for and whether our expectations are realistic, because the NHS does many things that are perhaps not what it is for.

I know you are keen for us to wrap up quickly, Mr Deputy Speaker, so I will finish with a few points. I have touched on some big, long-term questions, but we could quite quickly change some smaller things that seem like simple common sense to most people. We still deliver paracetamol on prescription, but it costs 30p at Boots. It costs £35 to go through all the different appointments and all the different systems to get paracetamol on prescription from the NHS, at the cost of tens of millions of pounds a year. Why do we do that? Why do we add that burden to our health system?

The 111 service was set up as an advice service to help people to figure out where in the system they needed to go, but now it calls ambulances. A few weeks ago, an ambulance technician told me a story about ambulance staff being sent out on a category 2 “stroke-level emergency” because a 111 call handler had ticked the wrong box on the decision tree—the caller had actually rung to say they had been picking up ice and had cold fingers. And we wonder why there is not the capacity and the space in the system! We need to reform the 111 service so that it follows the same decision tree as the 999 service or directs people back into 999. We need to give ambulance staff the ability to say no to people who call every day and to people who are not having emergency, critical conditions or problems and live near a hospital and are sat next to somebody who has a car and could drive them there. People have this impression that they can jump the queue. All those things would relieve pressure on A&E and on NHS staff, and they seem like simple and obvious things to do.

My final point is on the need to have an honest conversation. I agree that staffing and the need for more capacity and support to tackle waiting lists are huge priorities, and the Government are working on them, but we cannot continue to grow the health service forever. Everybody knows that—my constituents certainly do. This is a much more wide-ranging systems and process issue and a much more wide-ranging issue about our expectation of what a health service can realistically deliver. That is not something we are going to tackle today, but it is a conversation I have no doubt we will have to return to in the very near future.

[Several hon. Members rose—]

NHS Winter Pressures

Ben Bradley Excerpts

Monday 9th January 2023 Commons Chamber

[Steve Barclay]

The hon. Gentleman seems to be quoting Onay Kasab, the lead national officer of Unite, who spoke to Sky News outside the Department of Health and Social Care just a few minutes after my discussions with the trade unions. The slightly odd thing was that Mr Kasab was not actually in the meeting on which he was commenting.

[Ben Bradley (Mansfield) (Con)]

It is pleasing to hear from across the House a focus on capacity in domiciliary care, which is a huge priority. Ultimately, that is where we want people to end up: independent in their own homes, as far as possible. I wonder if the Secretary of State could reassure me about some elements of the plan for the NHS to procure care beds. Where does he envisage staff coming from? If it is from the NHS, how will we ensure that more people do not leave domiciliary care for what are often better-paid roles in the NHS? In the same vein, on capacity, how will we ensure that people are able to move on from residential care beds into domiciliary care when there is that shortage of capacity?

[Steve Barclay]

As befits the leader of his own county council, my hon. Friend rightly recognises the importance of the integration of health and care. I have pointed to examples where that is already being done extremely effectively in an integrated way. As I recognised in my remarks, the medical director of NHS England has said that helping people to leave hospital with the right support when they are ready to do so is not just clinically the best option for those individuals, but one of the safest options for expanding capacity for everyone who needs care. It is the right thing to do clinically, but his point—one that we are extremely focused on—is about how we then ensure that wraparound service for patients who are released into residential care so that they can move into domiciliary care.

Oral Answers to Questions

Ben Bradley Excerpts

Tuesday 19th April 2022 Commons Chamber

[Sajid Javid]

The hon. Gentleman has long been a campaigner on this issue and I commend him for that. He is right to continue pushing. I do not want to pre-empt the outcome of the independent review because it is just that, a review fully independent of Government. However, once it is complete—I hope to publish it in May—we can set out our plans.

[Ben Bradley (Mansfield) (Con)]

2. What steps he is taking to help ensure that health and care services are well integrated.

[Andrew Lewer (Northampton South) (Con)]

19. What steps he is taking to help ensure that health and care services are well integrated.

[The Secretary of State for Health and Social Care (Sajid Javid)]

The past few years have shown that we are strongest when we work together. Earlier this year we published the integration White Paper, drawing on our experience of the pandemic to develop a plan that will bring together the NHS and local government to deliver jointly for local communities. We have also created integrated care partnerships, such as the programmes in mid-Nottinghamshire and Northamptonshire, through which we are already showing how we can bring together health and local social care services.

[Ben Bradley]

As covid regulations come to an end, I understand that the discharge fund is also set to end. This could leave local government vulnerable where there are no formal procedures locally to pass funding from the NHS to local government services and local authorities. Particularly as we seek to reduce hospital backlogs, it is vital that we get people out of hospital and into appropriate care settings. Will my right hon. Friend assure me that, where local authorities seek to tackle such backlogs, they will have access to appropriate funding?

[Sajid Javid]

I can give my hon. Friend that assurance. Of course, we are already putting in record funding for local authorities and the NHS to deal with backlogs. I believe the plan we set out earlier this month for the integration of NHS and local authority care services will make a real difference.

Smoke-free England

Ben Bradley Excerpts

Tuesday 29th March 2022 Westminster Hall

[Ben Bradley (Mansfield) (Con)]

The Minister talks about the range of alternative products, such as vapes, “heat not burn” and other things that already exist, and about the statistics on people’s perceptions of the health impacts of those products. We know that those products are less harmful, so does she agree with what my hon. Friend the Member for Windsor (Adam Afriyie) said about the importance of getting that information our to people—even if it is as simple as a slip of paper in a cigarette packet? I like to think that a Conservative Government, rather than seeking to ban things, could empower people to make that choice through information. We could certainly do more to get that information out there.

[Maggie Throup]

My hon. Friend is quite right. It is important that we communicate the other ways people can stop smoking and, as the hon. Member for North Tyneside said, do so in such a powerful way. As Members of Parliament, we all have a role in getting those messages out, and I am sure that everybody in this room will be doing their bit in VApril to get that message through to the public. It is about messaging and about people understanding the impact smoking has, not just on their lives but on other people’s lives as well.

I am also aware of the desire to bring snus to the UK market to give smokers further choice of less harmful alternatives. Considering the range of alternative nicotine products that can be accessed by smokers, the Government are not currently minded to introduce a new tobacco product to the UK market. Current alternative products such as nicotine pouches deliver nicotine in an identical way to snus but do not contain any tobacco. We will continue to consider the evidence around snus and we welcome additional non-tobacco reduced-risk products to the UK market.

I thank my hon. Friend the Member for Broxbourne again for calling this important debate and for hon. Members’ interesting contributions to the discussion. We have packed a lot into 30 minutes. I hope to be able to tell the House more in the coming months about the specific policies that will deliver our ambitious agenda for a smoke-free England. The end is in sight through a sustained and multi-pronged approach. I hope we can look forward to a future for our children without the death and misery that is caused by smoking.

Question put and agreed to.

Social Care: Nottinghamshire

Ben Bradley Excerpts

Monday 21st February 2022 Commons Chamber

[Ben Bradley (Mansfield) (Con)]

It is great to have the opportunity to raise the issue of social care in the Chamber, and I am grateful for the time from the Minister and from colleagues to engage with this really important issue. I would also like to thank the Government for finally taking the issue of social care reform seriously and coming forward with plans, which are long overdue.

Social care is absolutely key, not just in itself, but to the success of our wider health services. NHS backlogs could be prevented or reduced by investment in care, with hospital admissions prevented or timely discharges achieved by better integration between the two. For example, an emergency care package could be put in place in a timely way rather than having someone need an ambulance to accident and emergency. It is important therefore to ensure that the funds described as being “for social care”, from the national insurance increase, do make their way to care provision—to local authorities and providers—to improve support and capacity. I know that the Government have prioritised tackling hospital backlogs with the first year or so of that money, but care has backlogs too—in Nottinghamshire we have gone from a waiting list of zero to one of 400 over the course of the covid pandemic. As I have described, care services play a key part in tackling those backlogs in the health service. As ever, we often focus on hospitals, but I have always felt that primary care, community-based services and, of course, social care are by far and away the best and most cost-effective ways to tackle these issues and improve our wider health service provision.

That said, this White Paper and talk of improved integration between the two services is very welcome. I have already described how this is key to reducing pressure on hospitals, but the same applies for our ambulance services and GPs too, if people are able to be cared for effectively without calling on acute or emergency services. As the White Paper says, the current system can be complex and disjointed. The focus on community-based provision and improving healthy life expectancy is a good one, and I welcome the fact that it explicitly talks about support for working-age adults with disabilities, who are so often forgotten. The debate about social care in the public domain and in the media always seems to focus on elderly people, and of course that aspect is vital and really important to us all, but half of the provision of social care is actually for disabled, working-age adults with increasingly long-term and complex support needs, which are also increasingly expensive and unsustainable. That area certainly needs more focus, so I welcome the fact that it is included—

[Darren Henry (Broxtowe) (Con)]

An integrated approach is needed for social care. Nottinghamshire’s social care needs are not the same as those of any other county, so does my hon. Friend agree that a communities-based approach is needed, as is precisely laid out in the social care White Paper?

[Ben Bradley]

My hon. Friend knows the challenges in Nottinghamshire social care as well as anybody—I am sure they come across his desk in Broxtowe all the time—and he is right that this work has to be locally led. I welcome the opportunity in the White Paper to build from the community upwards through our integrated care strategy and to work together with health partners around the county. In the long term, locally led and community-based provision will help us to tackle the challenges we face.

This debate is on social care in Notts. As the Minister knows, among those in this place I am unique in being responsible for the direct delivery of social care services in my county and in my Mansfield constituency, so this is a unique opportunity for me to raise the key issues that affect those services with her and with the Government—from the coalface, so to speak. That is part of why I have argued that my dual role can benefit my constituents and the Government. I hope that proves to be true.

The Minister will not be surprised to hear that workforce capacity is far and away the biggest challenge that we face in Nottinghamshire. We have seen a further 5% decline in staffing levels in a sector that was already understaffed. I am grateful that a crisis was averted by the revocation of the mandatory vaccination plans, because they would have seen thousands more leave the sector in Notts. That change of policy was absolutely the right decision.

We estimate that the turnover of staff in home care is around 26%, which is a massive and ridiculous proportion. That reflects the fact that there is significant competition for pay; that people can earn more in other sectors locally; that we are struggling to recruit; and that staff who have been through the ringer in recent years in incredibly tough circumstances are increasingly deciding to retire early or take a break because of the pressures.

We are doing a lot locally to try to combat the amount of turnover, including through new apprenticeships and big recruitment campaigns with market providers, and by incentivising collaboration between providers and offering incentives for them to invest in staff wellbeing or training, but more is needed. We need a national workforce strategy and recovery plan with sustainable funding that recognises the disparities in pay and conditions in the sector, and that needs to be part of the “fair price for care” reforms, which is not currently the case.

We need to understand what more can be done to increase the stature and status of care workers and the care profession. The workforce plan needs to include clear and defined pathways into health services, so that people see social care as an entry pathway to wider health and NHS careers, where the range and scale of opportunities for different jobs and long-term careers is massive. Care is often perceived to be a low-skilled, low-paid job with little scope for progress or promotion, but that is absolutely mad when we consider the fact that the skills and qualifications are directly transferable into one of the world’s biggest employers, the NHS, which covers every health role under the sun.

The pathways should be obvious and we need to make them obvious and overtly available to care workers and young people in schools and colleges. I hope we can plan some of this work locally, perhaps through the devolution of skills funding in the coming years. We are already working on some of that with West Nottinghamshire College and Nottingham Trent University, which are trying to build the pathways from school directly into the health services in my Mansfield constituency. A national pathway for integrated health and care careers would be fantastic.

The shortage in home care has meant that an additional 10 people a day are waiting to be discharged from my local hospital and much higher proportions of people end up being discharged to care homes when they could and should have gone to their own home. That is not good for long-term outcomes or those people’s wellbeing and also means that our reablement services—those that support people to get back on their feet and be independent in their own home—are overwhelmed. These are observations from Notts, but the trend is regional and national, not just ours. In fact, we have fared better than many other areas.

I thank the incredibly hard-working and dedicated staff in Nottinghamshire’s social care services for everything they have done to manage incredibly difficult circumstances. I include among them our council’s service director, Melanie Brooks, who directly delivered care packages and was on call over Christmas to try to mitigate the pressure. A huge thank you to her and her teams.

We have a lack of housing stock for care provision, and investment in things such as supported accommodation has slowed down, obstructed by covid, construction and supply chain issues and other factors. It often seems like the link between health and housing is not made clear, and it does not seem to feature much in some of the recent proposed legislation, but good housing can reduce social care needs, prevent hospital admissions and support people to remain active and sociable in their own homes and communities.

Homes England funding could be devolved to support local areas to meet their needs. Housing needs to be a key part of care reform. In our two-tier area we are working hard on collaboration among councils and providers to ensure that housing and health services talk to each other, but that is an option rather than something that is automatically built into the system. That needs to change. Similarly, if we have accountable local leaders—the Government have made clear through the Department for Levelling Up, Housing and Communities their intention to devolve significant powers—could we not have more local control over how powers are managed and delivered? That would help us to integrate our local services. Children’s services are also key to this. I question whether all this needs to be linked to the children’s care work that seems to be in the pipeline, through the Josh MacAlister review and the special educational needs and disability review that is happening in the Department for Education. Children’s care services and adult care services are linked, quite clearly, and they need to be integrated just as health and care do. I know that this is complex as it spans multiple departments, but it is also sensible and it needs to happen.

Our local integrated care systems will seek to draw all these things together to offer the best start in life and the right preventive interventions, just as Nottinghamshire County Council is doing with a significant investment in the transformation of our children’s services. More proactive and preventive services will be announced in our budget on Thursday. That is something of which I am incredibly proud and it will, I think, change lives. If local plans across the country seek to integrate adult care services and children’s care services then, clearly, national ones must do so, too.

Financially, Nottinghamshire has some capacity to use adult social care precepts this year, but continued rises in council tax without major reform are also unsustainable, especially when we consider that some London boroughs pay half the council tax that many people do elsewhere, including in my own constituency. That is not fair, but, as an authority, it means that we do have some funds to draw on this year. Our social care budget for 2022-23 will rise by around £12 million compared with last year. That extra funding is very welcome, but, again, we need to understand that that is not sustainable in the current system. Fairer funding for local government needs to be a priority to make sure that we have that level playing field across the country.

There will be a significant challenge in terms of resources and staffing capacity as we try to tackle both the day-to-day care issues that I have touched on—pressures of services and staffing—as well as delivering the significant reform that we are being asked to deliver. Although it is welcome and right, it will present its own challenges and pressures. The Government must ensure that sufficient capacity exists if they want us to do both at the same time.

[Tom Randall (Gedling) (Con)]

I congratulate my hon. Friend on securing this Adjournment debate; it is on a very important subject. I am sure that most Nottinghamshire MPs have spoken to people such as Terry Galloway who has some very interesting ideas on this subject. I am talking in particular about people who are of working age but who are leaving the care system—reintegrating into life as it were. They face particular challenges that are almost akin to a benefits trap in terms of leaving care and then having to meet certain costs. Does he agree that, when we talk about resources, it is important that we give these people the resources that they need to bridge that gap? In the longer term, that will benefit both them and the wider system as it will help them to get back to a normal life.

[Ben Bradley]

I thank my hon. Friend for that intervention. Terry Galloway is fantastic. He is a real advocate for some of our children’s services—our care leavers’ services in particular—in Nottinghamshire. I am pleased that my hon. Friend has raised his case here today. This is a prime example of where children’s services and adult care services need to talk to each other, and where we need to have those clear pathways into additional support. Some of those children will get support until they are 25 under the current system, but that is not all funded. Equally, we need to do more at a county level to plan for the lifetime of these children. We know that they are there. We know that when they are in children’s services, they are likely to come into adult services, and we need to make sure that we are planning for that in the long term. The same applies to SEND and other local challenges—my hon. Friend is absolutely right about that. We know that the outcomes for care leavers are not great, which is partly why we are investing £14 million over the next three years at County Hall in transforming those proactive and preventive services, starting with our children’s services, making sure that we are delivering the best possible support and offer to them.

I am pleased that the Government are finally grasping the nettle of social care reform and integration, because, just like the never-ending increases in the NHS budget, it is neither right nor affordable for spending to go up and up every year and for that to be accepted by Government or by anyone else. That is not a solution. We must do it differently. If we cannot tackle the growth in cost and demand under the current systems, then those systems need to change—whether they be care services, health services, children’s services, or all of it. In some ways, covid provides us with that opportunity to draw a line, to think again and to reform. I hope Government will take that opportunity, and I look forward to hearing from my hon. Friend the Minister.

Vaccination: Condition of Deployment

Ben Bradley Excerpts

Monday 31st January 2022 Commons Chamber

[Sajid Javid]

Where the hon. Lady and I will absolutely agree is on the service that we have seen as a country from care home workers and domiciliary care workers over the pandemic. It has been the test of a lifetime for anyone working in that sector and each and every one of those people has risen to that challenge and provided the best care that they could in the most difficult circumstances. As the hon. Lady will know, there is an inquiry into the pandemic, where I am sure that many of the issues will be looked at, such as whether better support could have been provided under the circumstances. Looking ahead, however, it is important that we continue to do everything we can to continue to support that vital sector.

[Ben Bradley (Mansfield) (Con)]

I welcome the Secretary of State’s decision, which is important for the continuity and delivery of our local services. We were faced with losing more than 3,000 health and care staff in Nottinghamshire alone in a few weeks’ time, so this will massively take the pressure off come March and April. I urge him to go further if possible: I do not think it is fair to present the decision that care home workers made in November as leaving by choice. The truth is that we need those staff and more if we are to implement the reforms that the Government are asking the care sector to deliver on at a local level in the coming months, rather than having to focus all our energy on everyday firefighting. Will he change the view that he has stated so far, reach out to those staff and try to help them back into the sector?

[Sajid Javid]

Yes, I agree with my hon. Friend. As I said, we need more people in care and in the NHS. We have a waiting list in both sectors. There are many people out there who will have experience and will want to do that. He asked whether we can work with the sector to reach out and to support and help people to re-enter it where they wish to do so. Of course we can. At the same time, we can continue to give any information that may be helpful and necessary to help to persuade those who remain unvaccinated to make that positive choice and get vaccinated.

Oral Answers to Questions

Ben Bradley Excerpts

Tuesday 13th July 2021 Commons Chamber

[Ben Bradley (Mansfield) (Con)]

What steps his Department is taking to improve collaboration between health and social care.

[The Secretary of State for Health and Social Care (Sajid Javid)]

We can no longer just think of a health system; we have to think about the health and social care system. We want people’s experiences of care to be seamless, which is why we have introduced the Health and Care Bill and will debate its Second Reading today.

[Ben Bradley]

In order to better integrate and support local services in Nottinghamshire, we would benefit greatly from working with a single integrated care footprint for a simpler and fairer service. A boundary congruous with our county boundary would allow us to offer more equitable care across the whole area. I understand that the decision on the integrated care system boundaries is imminent, so will my right hon. Friend meet me to discuss the potential benefits?

[Sajid Javid]

I am aware that several factors are helpful in fostering stronger partnerships between the NHS and local authorities, including alignment of boundaries. My hon. Friend will know that the former Secretary of State, my right hon. Friend the Member for West Suffolk (Matt Hancock), asked NHS England to conduct a boundary review for integrated care systems. That review, which is just being completed, will certainly look at and give advice on the best ICS footprint for alignment. No final decision has yet been made, but it is a priority for me. I would be happy to arrange a meeting for my hon. Friend with Ministers to discuss the matter further.

A Plan for the NHS and Social Care

Ben Bradley Excerpts

Wednesday 19th May 2021 Commons Chamber

[Ben Bradley (Mansfield) (Con)]

I rise to welcome the measures in the Queen’s Speech, particularly on skills—legislation to back up our White Paper on adult learning; retraining to help people move across sectors; funding for that learning; and better career paths for people into work. Those are particularly important in the wake of covid and vital to our levelling-up agenda. If we are going to make a long-term impact, capital investment is all well and good, but education is the key to long-term levelling up.

There is a strong expectation among my constituents that we will deliver on immigration, and I welcome that commitment in the Queen’s Speech. There is a strong theme on levelling up and what it means throughout the Queen’s Speech. The east midlands is consistently at the bottom of the charts when it comes to Government and private sector investment, so I would argue that it is most clearly in need of levelling up. I would welcome conversations with any and all Ministers about setting out a clear vision for that.

It is my belief that there is a handful of key decisions—about HS2, devolution, our freeport and our development corporation—that are fundamental to our long-term progress in the east midlands. We cannot afford to let our region down. Given his Leicestershire constituency, the Minister will appreciate the importance of support for the east midlands.

The theme today is health and social care. I have a number of points to make in a short time. First, I am pleased to see Government plans to make progress on social care reform in this Session. I welcome the elements of that in the Queen’s Speech—we know that such reform is long overdue. Although ad hoc grants to support local authorities in the delivery of social care have been welcome, they are not a long-term solution. We need certainty on this issue. Will the Minister give us some time scales, if he has them, for ideas and proposals coming forward?

Secondly, I would welcome some clarity on prevention in the health and care Bill. Perhaps, in truth, we could look again at some of these priorities. I have raised concerns about the obesity strategy a number of times and there are proposals that, in my view, verge on meddling in people’s freedom and choice. Over the past 18 months, we have seen that our public health functions have a huge amount to do to ensure their preparedness for major health issues. We should focus on that, rather than limiting people’s choices in shops, pricing people out of items or banning adverts, which has dubious impacts, if any. Let us support people with information and facilities to encourage healthy lifestyles and exercise; banning two-for-one Mars bars will not have the impact that we would hope for.

The Bill is set to look at a more integrated system of care between the NHS and local authorities. I make a plea to the Minister—I have spoken to him about this already—to start on the right foot by confirming our county’s integrated care boundaries and fixing those to the county boundary in Nottinghamshire. That will allow us to deliver more efficient and effective primary care, and I know that that is in line with Government priorities. Unblocking the gateway in primary care is absolutely vital to offering a better experience to residents. We can make a big impact with an early and good Government decision.

The Government can be proud of the record levels of support and investment in our health service. We need to use this opportunity now to ensure that funding is put to good use, with the most efficient and effective service delivery to residents. Let us not waste it on meddlesome interventions into eating habits; instead, let us look at direct support to improve healthy lifestyles for those who need it. Let us encourage activity, educate and improve access to community-based services, which are key to tackling our health inequalities and are therefore a big part of levelling up life chances.

There is a huge amount to welcome in the Queen’s Speech, and I have not even touched the surface in just four minutes, but I very much welcome the proposals and look forward to supporting the Government in delivering them during this Session.

Future of Health and Care

Ben Bradley Excerpts

Thursday 11th February 2021 Commons Chamber

[Matt Hancock]

The devolution of decision making to integrated care systems will help to join up care and deliver it more effectively. That is one reason why these proposals have been received so enthusiastically by the NHS itself and by NHS colleagues, including from local government, not least because the proposals originated from proposals from the NHS. I look forward to working with the hon. Gentleman and suggest that he works with his local NHS to make sure that this legislation goes through in the most high-quality way possible and that we have a high-quality debate on it, so that it can serve his constituents in exactly the way he sets out.

[Ben Bradley (Mansfield) (Con) [V]]

I know from conversations I have had with the Health Secretary in Mansfield that much of this change will be widely welcomed, and joining up our services is vital if we are to have the best possible healthcare system. I just have one concern: the announcement also talks about new public health measures, and there is an obesity strategy that I fear risks increasing inequality by raising the cost of the weekly shop. Surely education is the key to public health, by, for example, teaching people to cook fresh meals, as people need the skills to make healthier choices or they just end up paying more. So will the Health Secretary ensure that the public health elements of these reforms focus on that education and do not just end up hitting people in their pockets?

[Matt Hancock]

Yes, of course I am alive to that concern, and I look forward to further discussing these measures with my hon. Friend. The crisis has demonstrated how helping people achieve a healthy weight is important, and the Prime Minister has shown personal leadership on that in policy terms. Of course more information and education is an incredibly important part of this because it is about shared responsibility, including personal responsibility, to improve public health. I look forward to working with my hon. Friend on the details of it and making sure that we can get this into such a shape that it genuinely supports the tackling of obesity in a way that supports people, as he sets out.

Public Health

Ben Bradley Excerpts

Wednesday 7th October 2020 Commons Chamber

[Helen Whately]

I thank my hon. Friend for his comment. We are trying to get the balance right between wanting to target restrictions and not impose them on areas where they might not be needed, while being mindful that if every area has its own local variant specifically, it does get more and more confusing, so there is a clear balance to strike in being targeted but also trying to keep things simple.

[Ben Bradley (Mansfield) (Con)]

Will the Minister give way?

[Helen Whately]

Let me just come to Bolton. I was saying that we had consulted local leaders in Bolton and we used the emergency procedure to make the present set of regulations as soon as we could. Recognising the concern about the time that it can take for Parliament to debate these statutory instruments and given the pace of the pandemic, I hope that hon. Members acknowledge that we are debating today measures that came into force just this Saturday.

As I mentioned, for the implementation of these measures, existing legislation was amended rather than bringing in new Acts. We reviewed the impact of existing regulations and considered where they needed to be more robust or could be eased. We took into account the existing measures in place elsewhere and assessments of the impact that those measures were having. The complexity of local restrictions has been highlighted recently, so the decision was made to impose regulations already in place rather than to develop new ones.

There is extremely serious concern about the outbreak in the north of England, the north-east and the north-west, both at the point the decisions were made to introduce further restrictions and ongoing. Engagement with local public health teams and local leaders has been extensive. I would like to thank the local council leaders, local authorities more broadly and the local resilience forums, as well as Public Health England, the Joint Biosecurity Centre, and the local and regional directors of public health for all their engagement and all the work they are doing. All the local councils involved have engaged sensibly at chief executive and other levels, and I know they have also been doing a huge amount locally—for instance, working to increase compliance, supporting increased access to testing, working with care homes and supporting the most vulnerable. We will only succeed in suppressing this virus by working together at every level.

--- Later in debate ---

[Alex Norris (Nottingham North) (Lab/Co-op)]

In recent weeks, Ministers and Opposition Front Benchers have met upstairs in Committee to discuss such covid-related statutory instruments. It is welcome that we are debating this in the main Chamber because it means that local Members of Parliament can scrutinise them also. With that in mind, I do not intend to speak for long and I will probably limit the interventions I take—one thing I know is not to disappoint a roomful of colleagues who want to talk about their community.

I will start with the good news. I have been critical throughout the pandemic about the time that it has taken between a statutory instrument being brought into effect, and it being debated. In one case there was a lag of nine and a half weeks. It makes a nonsense of parliamentary scrutiny if we rubber stamp measures months after they have come into effect. We must have a timely say, so that the British public can have confidence, and as the Minister said, this statutory instrument is just four days old—that is the good news.

The bad news is that SI 2020/1074 amends SI 2020/1010, which came into force on 18 September, although it is not to be debated until Monday. We are discussing amendments to secondary legislation, even though we are yet to discuss that secondary legislation. I am keen to hear from the Minister why things have happened in that order. Is it possible that the other SI is more controversial and is to be hidden upstairs and discussed after the fact? We have followed events over the past hour or so on the controversial SI on the curfew. That seems to have been pulled from upstairs entirely because it is coming downstairs. What on earth is going on? I hope the Minister can tell us so that we do not have to find out through anonymous briefings yet again. This is a reflection of rather chaotic, rather than competent, leadership.

I suspect that the Government are doing this to head off division in their own ranks, once again putting the interests of the Conservative party ahead of the interests of the country. I say gently to would-be rebels—I say this at every opportunity—that if they do not like the delegated powers in the Coronavirus Act 2020, they should wait to see the ones in the Brexit-related legislation. For example, as drafted, the Medicines and Medical Devices Bill will hand to the same Secretary of State virtually unfettered powers over our entire medicines regime in this country. I hope that when the time comes, Members will be as keen and proactive to ensure that those powers are used in an appropriate way as they have been with these secondary powers.

The Opposition do not oppose the substance of SI 2020/1074. We know that as infection rates increase, so will restrictions. In this case, Liverpool city region, Warrington, Hartlepool and Middlesbrough are being added to those areas where mixing indoors is barred, which is an inevitable part of rising infection rates. We in Nottingham are awaiting that same call this week.

[Ben Bradley]

The hon. Gentleman mentioned Nottingham and as a fellow Nottinghamshire MP I am interested in his views. A few minutes ago, my hon. Friend the Member for Redcar (Jacob Young) mentioned the granular and localised nature of those lockdown areas and being able to pick the areas where this is most effective. My constituents in Mansfield, with one seventh of the rate of transmission in Nottinghamshire, are faced with lockdown measures linked to that outbreak. Does the hon. Gentleman agree that it is important in those areas to consider local data, and not to impose additional restrictions on people where that might not be appropriate?

[Alex Norris]

I am grateful for that intervention and I share that view. I have seen the hon. Gentleman’s tweet this afternoon in which he is very clear about that. Like me, he will have followed local Nottinghamshire data closely, and there should be close consultation with hon. Members, and with leaders such as the Mayor of Mansfield, and the leader of Nottinghamshire County Council. A one-size-fits-all approach is not the best route scientifically, and it will also breed local discontent and mean that people might be less inclined to follow it. So I support the hon. Gentleman in that venture.

Although rising restrictions are an inevitable part of rising infection rates, there is nothing inevitable about the loss of control of this virus. The Government promised us a world-class test and trace system, but rather than building on tried and tested local options in local government, they pursued a big national private contract. It was a triumph for dogma at a time when we need evidence-based leadership, and of course it has been a debacle.

The Government had a chance to fix this at a time when infection rates were relatively low, but they failed to do so. They have now lost control of the virus entirely, and our people will lose freedoms as a result. Yesterday, I saw a Minister blame the British people for rising infection rates. I thought that was extraordinary. Our constituents have made incredible sacrifices over the last several months; they do not deserve to have the Government thumb their nose at them for it.

Frankly, the Government can deflect as much as they want, but it will not wash. I would like to hear from the Minister today what they are doing to get this right and when it is going to happen. No more being sent hundreds of miles for tests, no more delayed results, no more lost spreadsheets. Drop the ludicrous defence of the indefensible. Let us stop pretending it is all okay when it is obviously not.

I have debated a number of these statutory instruments, and it is striking that every one of them has related to the north or the midlands. Rather than levelling up, we risk entrenching the north-south divide in this country. It is no longer reasonable to say, either, that these are going to be short, sharp interventions.