NHS Staff Pay

Ben Spencer Excerpts

Monday 8th March 2021 Commons Chamber

[Dr Ben Spencer (Runnymede and Weybridge) (Con)]

I draw the attention of the House to my entry in the Register of Members’ Financial Interests and to the fact that my wife works in the NHS. NHS staff pay is and always will be a highly contentious issue—it was contentious during the junior doctor contract debate and we do not need the back end of a pandemic for it to be so at the moment—because of the mere existence of national pay contracts, pay awards and review bodies. As part of the implementation of the changes proposed in the future of health and care White Paper, will my hon. Friend view alternative models that allow decisions on individual staff pay to be set by local employers, such as NHS trusts themselves, so that they can be best suited to the employees and the services they work for?

[Helen Whately]

I thank my hon. Friend, who makes a really important point. The balance between nationally set pay and local pay has been a point of much debate over the years. There are pros and cons to both ways. We do not want to have trusts competing directly all the time for workforce, but on the other hand there are higher costs of living, for instance, in some areas. That is why there is some flexibility in the system for different levels of pay according to different areas, as he will well know, and some extra support in areas where it is hard to retain staff. I always to listen to his expertise, which I really value.

Covid-19

Ben Spencer Excerpts

Monday 22nd February 2021 Commons Chamber

[Dr Ben Spencer (Runnymede and Weybridge) (Con)]

I welcome the road map announced today, particularly the return to school on 8 March, the clear vision, the refutation of a zero-covid strategy, and the commitment to a steady and irreversible lifting of restrictions. This will bring added certainty and hope to many of my constituents.

Our local roll-out of vaccinations in Runnymede and Weybridge has been fantastic. Vaccination hubs have opened at Chertsey Hall, Egham Hythe and St Peter’s Hospital. Each and every one of our volunteers and staff at these sites are saving lives and getting us all one step closer to the lifting of restrictions. I thank everyone who has worked and continues to work so hard in our vaccination hubs and everyone who helped out or volunteered in the recent surge testing in Egham.

The road map charts a course to lifting the restrictions on the back of the vaccination programme, and it promises that the process will be irreversible, but I hope that the Minister will not think me churlish in asking for another plan—a long-term plan to enable us to live with the virus and support the NHS as it faces the major challenges on the horizon, in particular the coming winter pressures.

It is increasingly clear that covid is a seasonal disease, like other coronaviruses. Winter pressures have plagued the NHS for pretty much every year that I have worked as a doctor, but this autumn and winter will be different. The NHS has reduced hospital capacity as a consequence of social distancing in hospitals, the increased need for infection control measures such as testing and the burden of cleaning and PPE on throughput. Even if the number of patients needing to be hospitalised with covid this winter is radically reduced—and we all hope it will be— the NHS will still face normal winter pressures from diseases such as flu and pneumonia, but with reduced capacity as a result of its covid infection control measures.

I asked my local hospital, St Peter’s, what it needs to increase NHS surge capacity—is it more money, real estate or oxygen? It says that the limiting factor is more trained staff, which I am sure is the case in many of our hospitals. The NHS and our staffing plans were not designed for surge capacity in a pandemic or when recovering from one; why would they be? While the road map focuses on what we need to do to reduce the number of patients who need to be hospitalised, we also need to think of the other side of the equation: how to increase overall NHS hospital capacity—not just surge capacity for covid, but capacity for all care in a post-covid world. While I welcome the announcement of increased nursing applications over the weekend, we need these nurses now. We know that winter pressures are coming later this year. What do we need to do now to prepare us, so that we can live with this virus for the long term, as the road map charts, and prevent any prospect of future restrictions?

Public Health

Ben Spencer Excerpts

Wednesday 30th December 2020 Commons Chamber

[Dr Ben Spencer (Runnymede and Weybridge) (Con)]

Naturally, my constituents and I are disappointed that we were placed in tier 4 and at the short notice of the changes. Of course it is right that in the face of changing facts the Government respond quickly and decisively, and while I regret that we have not been able to debate the tier 4 restrictions sooner, I am glad that Parliament is here now and that we are debating the changes today.

There have been two huge developments in the last fortnight in terms of the pandemic and our response to it. One is the emergence of a new strain of covid that is more infective and that is thwarting some of our measures to contain it, and the other is the development of safe and effective vaccines that can be deployed at pace. I am sure that everyone in the House will celebrate the success of the British science and research that led to the development of the Oxford/AstraZeneca vaccine and of the genomics surveillance that made possible the early discovery of the new variant of covid. It is the Government’s long-term planning that led to our procuring the vaccine in advance, so that we are now best placed to deliver it at pace to our population, and it is science that led to the reduction of the self-isolation time, reducing the impact of infection control measures and making it easier for people to follow them.

However, amidst this positive news, the evidence that the new variant is much more infectious is concerning indeed. It raises serious concerns about the effectiveness of our previous tiers and the individual restrictions in reducing rates of infection and ensuring that they do not spiral out of control and overwhelm NHS capacity—and this is all about NHS capacity. We therefore need to take stock in the context of a rapidly changing situation, with rates increasing in front of us, and urgently research this new variant and the impact of the measures needed to control the rate of infection.

While I am disappointed that my constituency has gone into tier 4, we can all see the pressure that the NHS faces at the moment, we can see the impact of the new variant and we can see our rapidly expanding vaccination programme, which, after today, will really take off. As a doctor, I was always taught to look at every intervention in terms of the risks and the benefits, the costs and the harms. I have been calling for a cost-benefit analysis of the suite of individual restrictions that we and all our constituents have to face. Clearly, the facts that I have just laid out radically shift the cost-benefit ratio faced by our constituents and our country, which we have discussed in this place at length. A change in the facts can, and in his case I believe must, force a change in response.

I support the restrictions that are coming into force, but they will not be without their own harms, which need to be mitigated until the restrictions can be lifted. I wish to talk in particular about uncertainty. I have had many meetings with constituents who work in a range of sectors that are directly impacted by the restrictions. I have spoken to Runnymede and Weybridge’s businesses, publicans and gym owners and to people who work in events, corporate events and weddings—the list goes on—and the message from each is clear: the uncertainty around the restrictions and all the opening and closing is one of the most difficult challenges that they face. My local school leaders tell me that they can prepare and handle anything for the good of their pupils and students; they just need time to put in the contingency planning so that they know where they stand.

Uncertainty is not just harmful for business but detrimental to us all. We need to know, and see, how and how soon we can get out of this situation and when we will be able to see our friends and family again and to reopen those businesses that have shut down. A vaccine is here and about to be scaled up, so as we start to plan for a future when the pandemic is behind us, will my hon. Friend the Minister chart and publish the plan out, detailing in granular detail how many need to be vaccinated and what impact that will have on lifting the restrictions, and show my constituents in Runnymede and Weybridge the road map through the pandemic to the other side and the end of the restrictions that we have brought in to mitigate it?

Covid-19 Update

Ben Spencer Excerpts

Thursday 26th November 2020 Commons Chamber

[Matt Hancock]

Of course we have been engaging with the team who work across London. There is a lot of work to do in London. There are parts of London where cases continue to rise, and we need to get that under control, but there are also parts where they are falling and things are very much going in the right direction. Likewise, there is pressure in some parts of the NHS, but there is a lot of mutual aid within the NHS across London. There is a lot of work to do in London to keep it in tier 2, and I look forward to working with the hon. Lady and other London colleagues on that.

[Dr Ben Spencer (Runnymede and Weybridge) (Con)]

People living in Runnymede and Weybridge often ask me on what basis we are subject to local tiers and to restrictions, and it is clear that, alongside the data, other factors are taken into account in the two decisions. I thank my right hon. Friend for his response to the question from my hon. Friend the Member for York Outer (Julian Sturdy) that the reasons and the data will be published. Will local hospital bed utilisation be part of the reasons published?

[Matt Hancock]

Yes. There are five indicators that we take into account in deciding on which tier. One is pressure and anticipated pressure on the local NHS, and bed occupancy rates are of course a critical part of that assessment. I know that people are looking for a clear numerical boundary between the different tiers, but because we are looking at five different indicators rather than a single one, there is no automatic figure at which a different tier is triggered. We have to look at all the circumstances, including, for instance, outbreaks. Some cities, on their pure numbers, would be in tier 3, but because an outbreak is specific—for instance, in a school or care home—it is appropriate that they are in tier 2. We have to look at these very localised issues as well, and that is why the engagement with local directors of public health is so important.

Covid-19

Ben Spencer Excerpts

Wednesday 18th November 2020 Commons Chamber

[Dr Ben Spencer (Runnymede and Weybridge) (Con)]

The announcement of the preliminary results of the effectiveness of the Pfizer and Moderna covid vaccines is great news, a ray of hope at a time when we are tired, weary and going through a second lockdown. There are still many questions, but the direction of travel is a good one.

I will talk in a moment about the many challenges ahead, but before then I want to point out that this Government are unrivalled in their support of research and innovation. They have led the world in funding and promoting efforts to find treatments and vaccines, and it is this Government who are already laying down plans to deploy a vaccine. After further analysis and the results from the vaccine trials come good, it will still take some time until we are on the other side of this. Depending who you listen to, life can be back to normal by spring, by summer, by winter, by next year. We simply cannot yet know, and while now we have reason to be optimistic, none of this helps those struggling now.

Lockdowns are incredibly damaging and the lockdown itself will have a cost in lives in the future. We need to think where we will be after six months more of this. The Scientific Advisory Group for Emergencies does not consider the economic impact of its recommendations, which is a substantial limitation. The economic impact will cost lives through diseases generated through poverty. Our public services are built on the back of a strong economy.  Economic damage means less money to invest in medical care and treatment, in community services and in education, again with a cost in lives and quality of life.

Decisions are being made on epidemiological scientific information alone. Although we have been able to see interpreted data—I thank the Government for making experts available—we have been unable to interrogate SAGE and the modellers directly or to see economic impact assessments. The Government’s decision making is rightly based on the science. As any scientist knows, scientists disagree all the time. We need to be able to hold Ministers to account and to interrogate the scientists advising them.

I therefore support calls for a covid commission to take an overall view of all the features of the covid response, but again, that does not help those affected now. We will need to make more difficult decisions over the next few weeks. Lockdowns and restrictions, like all interventions, are a tool—one that has great side effects but, deployed cautiously when necessary, can prevent the NHS from being overwhelmed. Just like in any discussion about a potential treatment with a doctor, before someone consents, they need to know the risks and benefits. That is why we must see clearly the projected harms and benefits before we make any decision.

We are told that there is no alternative, but with potential vaccines around the corner, we will be living with covid and its impact for some time. We cannot simply ask those who are struggling to wait just a bit more, just a bit more, just a bit more, so we need to have now an enduring plan to live with the virus.

Covid-19

Ben Spencer Excerpts

Thursday 22nd October 2020 Commons Chamber

[Dr Ben Spencer (Runnymede and Weybridge) (Con)]

We face a difficult winter. Many areas of England are under heightened restrictions, including Elmbridge, part of which forms part of my constituency. We face the national challenge of a new disease, with a population that is largely unexposed to it and has built no immunity to it through either prior infection or other means, such as vaccination. It spreads easily and quickly, and can make people in high-risk groups, particularly the elderly, seriously ill. It can spiral out of control and overwhelm our health service.

I supported the first lockdown and I support the current restrictions. As an NHS doctor, I say with all my body and soul that we cannot let the NHS be overwhelmed. But lockdowns and restrictions are deeply harmful in themselves. The long-term effects will be profound—a higher burden of disease from poverty, with associated costs in lives; loss of livelihoods; misery and damage from isolation, and reduction in liberties. We need a way out.

My constituents are feeling it—especially those who are now in tier 2 restrictions in Elmbridge—and I pay tribute to them for their resolve. They rightly ask me, “What’s the way out? How does this end? How do we escape the cycle of lockdown?” The current strategy is to suppress until there is a vaccine, but what if there is never a vaccine? As people start to tire of lockdown, increasing coercion and punitive measures are being put in place. On my commute from Runnymede and Weybridge, I travel to Waterloo station, and I have seen the signs there change—from a £100 fine for not wearing a face mask, to £3,000, to £6,000—in the course of a few months. It is inevitable that greater coercion will be needed. When does that stop?

Coercion is illusory. It works briefly, but after a while it fails, unless we take people with us and they own the decision. Of course, in a public health response to an infectious disease, we cannot have a free-for-all, but at the same time, in my constituency, I see people at low risk from covid who ignore the guidance because it will not directly affect them and all they see is harm from restrictions. I see people at high risk ignoring guidance because life is short and they want to see their grandkids. I see people terrified of covid hiding away from the world. Day in, day out, people make decisions about their health risks, such as to smoke or not to smoke—indeed, given that 76,000 people die every year from smoking, probably more people have already died this year from smoking than from covid. People decide whether to put salt on their chips, or not to eat chips. We all make compromises and trade-offs, but rather than the state deciding those trade-offs, we must find a way to let people decide their own.

[Chris Bryant]

Is not the problem that whether I choose to have salt on my chips is a matter for my health, but when I take risks with covid, I take them not just for myself but for everybody else with whom I interact, and for the whole of society?

[Dr Spencer]

I thank the hon. Gentleman for his intervention, and I will come to precisely that point in due course.

I supported the first lockdown, and I support the current restrictions, but we need a way out that works, irrespective of the invention of a vaccine. We need a way out that supports people to take their own decisions and respects free choice but, as the hon. Gentleman said, we must also protect society from an infectious disease. Such a system needs to be sustained for a long time, and those measures will need to be in place for a long time.

It is easy to criticise, but it is more difficult to put forward other options. We therefore need a debate about what a plan B could look like. We started with a national lockdown, but that was too blunt. We rightly moved to targeted measures, which are better, but still not great. The geographical area is too large, and people do not live their lives by local authority boundaries. The next logical step is to shrink the geography further—to the household or individual—and to have a system that allows people to make decisions for themselves regarding their own risks and the people they come across socially or at work.

We must use our testing capabilities in a targeted, risk-based manner, so that those at high risk, should they choose to, can shield and have support to do that. Those at low risk would be able to live their lives more freely, should they choose to do so. At the same time, we must ensure that things do not spiral out of control, with broader measures and restrictions available in reserve if needed. We must invest in our NHS surge capacity, and carry out research into vaccines and treatments.

The challenge, of course, is how we support those at medium risk, or those who live or work with high-risk individuals, and we need to have that debate. Lockdowns are not a cure for covid. They only regulate the pressure on the health service and, important as that is, in time they can, and will, be worse than the disease itself. We need to have that difficult debate and there is no easy solution. While I suggest that we wait for the phase 3 trials of vaccines, which come out imminently, we must start putting flesh on the bones of a plan B, based on individual choice, and consider a pilot in the UK. To get through this pandemic, whatever we do will be difficult. Difficult decisions have to be made, and more difficult decisions remain to be made.

Covid-19 Update

Ben Spencer Excerpts

Thursday 15th October 2020 Commons Chamber

[Dr Ben Spencer (Runnymede and Weybridge) (Con)]

I thank my right hon. Friend for his statement today. It is absolutely right that we take measures to support the NHS and ensure that it is not overwhelmed with a high rate of covid and non-covid-related deaths. With increasing rates in Elmbridge, part of which is in my constituency, it is right to bring in these measures, and I pay tribute to the resolve of my constituents in Elmbridge—of all my constituents in fact—in dealing with this and getting us through this crisis. Local measures, though, are only part of the solution. Ensuring that we have sufficient NHS surge capacity to deal with high rates of cases for non-covid and covid care is also important. With regard to the Nightingale hospitals and NHS care, what does he anticipate the bottlenecks will be for surge capacity? Is it beds, is it staff, or is it ventilators and other kit, and what is he doing to tackle those bottlenecks?

[Matt Hancock]

I welcome my hon. Friend’s thoughtful approach to the action that is needed in Elmbridge. Of course Elmbridge’s connection to Greater London is very intense, and the travel to work patterns mean that, like him, a huge number of people who live in his constituency work in the centre of London. His council has worked closely with the national team to make this decision.

The expansion of NHS capacity is, of course, critical, as is controlling the virus—both of them. In London, we have not yet had to stand up the NHS Nightingale again, which is at the ExCeL centre. We stand ready to do so if necessary. We now have a huge quantity of ventilators; we have the Nightingale hospitals for bed capacity; we have brought more people back into the NHS over the past six months; and we have retired NHS staff on standby. It is the combination of the three—the kit, the physical space and the staff—that we need in order to expand capacity. Unlike in Manchester, where we are having to stand up the Nightingale hospital again already, we are not yet at the point where we need to that in London. I really hope that, in pulling together and following the level 2 rules, the people of London and Elmbridge can avoid that in the future.

Covid-19

Ben Spencer Excerpts

Monday 28th September 2020 Commons Chamber

[Dr Ben Spencer (Runnymede and Weybridge) (Con)]

I would like to talk about our long-term covid strategy. In doing so, I want to touch on the past, the present and the future. The past: in response to covid arriving in our country, the lockdown in spring saved lives, and the incredible financial and business support brought in by the Government saved many jobs and businesses. In my constituency, 40% of working-age adults have been supported by the coronavirus job retention scheme and the self-employment income support scheme. The economic and financial support continues. The community response to support the NHS has been incredible. The lockdown gave us time to learn, to research, to understand the virus better and to find possible treatments, to set up track and trace and the covid app and to pivot the NHS. We also started from scratch a monumental testing service. Yes, there have been challenges and setbacks, but we are coming through them.

I turn to the present. We are seeing a rise in measured infections, and new measures and restrictions are being brought in. There are three hard truths that we need to consider, and cannot shy away from them. First, covid is here to stay. Rather than talk about a second wave, we need to talk about a seasonal resurgence of endemic covid infection. I am sorry that I cannot reference the columnist from The Daily Telegraph who first mentioned that as a term, but she is absolutely correct in how we should look at it. Covid is here to stay.

Secondly, there is no vaccine and there may never be one. There are many diseases for which we do not have vaccines, despite a monumental investment of time and effort over the decades, such as other coronaviruses, malaria and HIV. Sure, those are different pathogens with different challenges around vaccine development, but they illustrate my point that it is not a given that a vaccine will be invented. I hope to God that we can invent one. We have some of the best scientists in the world working on it, but we must be realistic about the prospect of success. Furthermore, even if one is invented, it may not be a game changer; it may simply reduce the impact and burden of disease, with other measures remaining necessary.

Thirdly, every action has an equal and opposite reaction. Every measure we have brought in to tackle coronavirus has its consequences elsewhere. Pivoting the NHS will have an impact on cancer detection and treatment, and increases in socio-economic deprivation and poverty will have their cost in lives and disease in years to come. Let me emphasise that point: we should be in no doubt that the economic contractions we are seeing will have a long-term cost in lives.

Turning to the future, the Secretary of State has put forward two options: to “let rip”, or to suppress until a vaccine is available. I suggest to the Government that there is a third option that we could and should pursue, in which we continue to invest and research a vaccine, but acknowledge that until we have invented one, the default position we adopt must be to expect that one will not arrive and that, if it does, it may not be a game changer. That option is not to let rip nor to totally suppress, but to adapt, pivot and evolve to living and thriving in a post-covid world.

Covid-19 Update

Ben Spencer Excerpts

Thursday 17th September 2020 Commons Chamber

[Matt Hancock]

First up, we absolutely support the pillar 2 testing, as it is called, which in Sheffield has delivered more than 10,000 tests in the past week. The hon. Gentleman, who is normally such a reasonable man, should welcome that and thank all those who work on that project. I absolutely support his proposal to further expand the NHS testing in Sheffield, and I look forward to working with the NHS in Sheffield to do just that.

[Dr Ben Spencer (Runnymede and Weybridge) (Con)]

It is absolutely right that we now put in provisions to prepare for winter, so will my right hon. Friend join me in welcoming the announcement of £6 million for expanding St Peter’s Hospital’s accident and emergency and urgent care centre, which will make a huge difference to patients and to staff working in our hospital?

[Matt Hancock]

Absolutely. This is one of the 25 projects that we are announcing today that are all about preparing for winter. There is nobody who stands up for Runnymede in this House more than my hon. Friend, and he has made a great case for his local hospital. I am very glad to be able to support it today.

Coronavirus Update

Ben Spencer Excerpts

Tuesday 14th July 2020 Commons Chamber

[Matt Hancock]

I am incredibly proud to have supported the introduction of the living wage. We brought that in, and it has had a bigger impact on care workers’ salaries than on pay in almost any other sector. The introduction of the living wage is a real testament to the fact that the Government support the lowest paid workers to get the support they need. That is true in social care across the board. The hon. Member says it is not mandatory. It absolutely is mandatory, it is in force, and we are putting the living wage up.

[Dr Ben Spencer (Runnymede and Weybridge) (Con)]

I, like many colleagues across the House, pay tribute to my right hon. Friend and his team for driving down infections across the country. One of the lessons we have learned in the pandemic is that, while it is easy to impose restrictions, it is much more difficult to lift them. Could he therefore explain the criteria that will be used for lifting mandatory face masks while people go shopping?

[Matt Hancock]

In the same way that these are judgments on the way in, they are judgments on their way out. We will have to make that judgment according to the spread of the virus and, in particular, the risk level imposed by people catching the virus. We will keep all these things under review.