Pharmacy First

Bernard Jenkin Excerpts

Wednesday 31st January 2024 Commons Chamber

[Dame Andrea Leadsom]

I am always happy to speak to colleagues on both sides of the House about their ideas for new dental and pharmacy schools. It is an ongoing interest.

England is, in fact, blessed with huge numbers of community pharmacies—well over 10,000—and four in five of us are able to walk to a community pharmacy within 20 minutes. The number of pharmacies in more deprived areas is double the number in more well-off areas. We are very well served by our brilliant pharmacies, and I hope the Pharmacy First programme will improve their footfall and their value in each of our communities.

[Sir Bernard Jenkin (Harwich and North Essex) (Con)]

I very much welcome this initiative to encourage our pharmacies to provide more frontline healthcare. People need to know about this, because they often do not think of going to the pharmacy. What work are the Government doing in larger population centres such as Harwich and Dovercourt, which has over 20,000 people but no out-of-hours pharmacy cover? People have to make a round trip of more than 40 miles to collect a prescription on a Sunday, for example. Are the Government doing any work on 24/7 pharmacy coverage for larger population areas?

[Dame Andrea Leadsom]

My hon. Friend raises an important point. Pharmacists will keep their community pharmacy open for up to 72 hours a week in most cases, and up to 100 hours in some cases, which means there is weekend accessibility. We keep this under review, but the availability is very good.

Recovering Access to Primary Care

Bernard Jenkin Excerpts

Tuesday 9th May 2023 Commons Chamber

[Steve Barclay]

I agree and thank the hon. Member, who is absolutely right to recognise the huge amount of work done by GPs and their staff, including receptionists. That is why the recovery plan is very much targeted at recognising the workload. I flagged in my statement the additional volume of patients that a typical GP surgery is seeing and that reflects the huge amount of work that is done. I think pensions were a factor, certainly in the feedback from the profession. The issue was raised. The changes the Chancellor announced take 9,000 GPs out of the tax changes, but the hon. Gentleman is right—that was not the only factor; the workload was another. The recovery plan looks to cut bureaucracy and, as I say, reduces the targets to five. It also looks at areas where there are appointments that we do not feel are necessary—so it looks at how secondary care can do fit notes, for example, rather than someone needing to go to the GP to get one. There are areas where we can streamline GPs’ workload and that is what the recovery plan does. On the workforce plan, we have said on a number of occasions that, post purdah, we would set that out very shortly. We will have more to say on that in due course.

[Sir Bernard Jenkin (Harwich and North Essex) (Con)]

I join the hon. Member for Sheffield South East (Mr Betts) in inviting the Secretary of State to thank all our GPs for their incredible work. I very much welcome his statement. Will the Pharmacy First plan enable places such as Harwich and Dovercourt in my constituency to increase the out-of-hours cover that pharmacies provide? Otherwise people will have to travel miles just to get a prescription. Also, where are all these new GP staff going to be put? Most GPs have very cramped premises. West Mersea surgery in my constituency has been trying to develop new premises for a long time, unsuccessfully because the GPs’ partners will not take the risk. At the Mayflower surgery in Harwich, there is empty space in the building rented by the NHS from a failed Labour private finance initiative project, but the GPs cannot afford to pay the rent, so the space sits empty, although it is still paid for by the taxpayer. What are we going to do about that?

[Steve Barclay]

First, I join my hon. Friend in paying tribute to the work that GPs do in his constituency, as they do elsewhere. On pharmacies, part of the reason for the investment is to support pharmacy, including in rural settings. The more funding going in, the more they can prescribe. The more things they are able to do, the better the business model. There are more pharmacists and more pharmacy shops than there were in 2010, but it is important we make the business model more viable and that is what the announcement does. On estates planning, that is an issue for each integrated care board to consider. He mentions a specific issue locally with a former PFI and how it is being used. That is not a new issue. I sat on the Public Accounts Committee when it was chaired by the right hon. Member for Barking (Dame Margaret Hodge) and I remember looking at many a Labour PFI. The regional fire control centres were a case in point; the estate could no longer be afforded and the space was empty. If there is an issue like that, I will be happy to look at it in due course.

Covid-19 Update

Bernard Jenkin Excerpts

Wednesday 8th December 2021 Commons Chamber

[Sajid Javid]

We work very closely across the UK, and the positive output from that work has been evident throughout the pandemic, especially on vaccinations and antivirals. We will continue to work together and provide whatever support is needed.

[Sir Bernard Jenkin (Harwich and North Essex) (Con)]

My right hon. Friend obviously understands that these measures will try the patience of the British people. Will he look at the other measures that can suppress the virus, particularly the booster rate? Does he agree that the rate of booster vaccinations is constrained not by supply or demand, but by the capacity of the health service to deliver the vaccines? Will he also, therefore, support integrated care systems that call on military assistance or local authority assistance and want to reopen the mass vaccine sites to accelerate the vaccine programme?

Health and Social Care

Bernard Jenkin Excerpts

Friday 3rd December 2021 Commons Chamber

[Madam Deputy Speaker (Dame Rosie Winterton)]

Order. I thank the Minister for his undertaking about brief answers, and I urge Members to ask brief questions as well. Otherwise we will not get everyone in, because we do need to return to the private Member’s Bills.

[Sir Bernard Jenkin (Harwich and North Essex) (Con)]

I thank my hon. Friend for his statement. Can he confirm that it is the Government’s policy to encourage the reopening of mass vaccination centres to get through the bulge of booster jabs that we need? In that regard, will he congratulate the South Suffolk & North East Essex integrated care system, which has once again secured facilities at Harwich international port, and will he thank the port for offering those facilities again? We are hoping for a mass vaccination session on 19 and 20 December, and further sessions in January. Is that not the way to take the pressure off GPs?

[Edward Argar]

Of course I join my hon. Friend in paying tribute not just to Harwich port but to his local healthcare system, about which he and I have spoken on many occasions. It does an amazing job: its willingness to find innovative solutions to boost our booster rates is exactly what we need to see. I commend everything that his local trusts are doing.

Covid-19 Update

Bernard Jenkin Excerpts

Thursday 21st October 2021 Commons Chamber

[Maggie Throup]

I reassure the hon. Lady that we look regularly at all the data, particularly the covid data. If we feel it is necessary, we put enhanced measures in place. A number of colleagues in the House will have experienced that. It works really well. Obviously, we have the Budget and the spending review coming up shortly, and I am sure she eagerly awaits what will be in them.

[Sir Bernard Jenkin (Harwich and North Essex) (Con)]

On the devolution point, let us remember it is a two-way street. There may well be things that we can learn from the Scottish Government that they have done better and differently from the United Kingdom Government, and we should not be shy about that, but we should also point out that Scotland would not have had many vaccines had they not been part of the United Kingdom.

I just point out to my hon. Friend—I hope she will take this back to the Department—that it is dead easy to get the public engaged on this subject: the Prime Minister holds a press conference with the chief medical officer and the chief scientific adviser and starts to explain in harsh terms what will happen if people do not carry on being vaccinated. That is the way to communicate, and we should do that. Can she also explain why we have given the booster vaccine to the GPs? They have enough to do. My integrated care system area is taking it away from the GPs and reopening the vaccine centres so that the GPs can get on with treating their patients, because there are not enough of them to do that job as it is. The pharmacies and the vaccine centres will take over the booster jabs.

[Maggie Throup]

I reassure my hon. Friend that there are numerous ways in which people can get a jab; it is not just at general practices.

Covid-19 Update

Bernard Jenkin Excerpts

Monday 19th July 2021 Commons Chamber

[Nadhim Zahawi]

I thank the hon. Member for that thoughtful question. He is absolutely right: there are about 5.3 million people waiting for treatment. He is also right that we have to make sure that the NHS has the resources to do it, which is why two things have happened: the Secretary of State has made it a priority to deal with the pandemic, and he has made it an equal priority to deal with the backlog. He has made £1 billion available for the NHS to do that work.

[Sir Bernard Jenkin (Harwich and North Essex) (Con) [V]]

I thank my hon. Friend for his statement, but I confess to some disappointment that the daily vaccination rate is not being sustained at a higher level. What is the constraint? Is it supply, is it logistics or is it that the hard-to-reach groups are slower in coming forward? What consideration are the Government giving to what is happening in other countries such as the United States, where people are being offered some kind of reward for coming forward and accepting a vaccination?

[Nadhim Zahawi]

I am grateful to my hon. Friend for his question. The vaccination rates in the United Kingdom have been incredibly high. We are at 88% with the first dose and 68% with double doses. On double doses, we are actually ahead of the United States of America. That does not mean we become complacent, however. We are doing everything we can to ensure that every cohort, and every ethnicity has the ability to access the vaccine.

Let me give him an example of some great work in the London Borough of Newham. Last week it had 23 different vaccination sites in pop-ups, in mosques, in GPs and in community pharmacies across the borough. Young people were literally tripping over a vaccine site. Part of it is access. Part of it is taking the vaccine to those communities. I am working with a number of colleagues to make sure we get into rural communities, for example with vaccine buses, and in community centres where people feel safe and comfortable to have the vaccine. The work does not end today. We continue to double down on our effort to continue vaccination. Again, I want to place on record my thanks to the metro Mayors for the work they do with us to make sure that happens as well.

Health and Care Bill

Bernard Jenkin Excerpts

2nd reading
Wednesday 14th July 2021 Commons Chamber

[Sajid Javid]

First, my hon. Friend is right to say that it would be great if all or most Members of this House, and certainly the different parties, could agree on a new system. I look forward to speaking to all hon. Members about what a future social care system could look like. In terms of the detail, I am afraid that he is just going to have to wait a moment longer, but I agree that the work by the Select Committees will, of course, inform our decisions.

I turn in a little more detail to the measures and themes that are captured in the Bill. The first is more integration. We know that different parts of the system want to work together to deliver joined-up services, and we know that, when they do that, it works. We have seen that with the non-statutory integrated care systems in the past few years. They have united hospitals and brought together communities, GPs, mental health services, local authority care and public health, and it works. We recognise that there are limits on how far this can go under the current law, so this Bill will build on the progress of integrated care systems by creating integrated care boards and integrated care partnerships as statutory bodies. England’s 42 ICSs will draw on the expertise of people who know their areas best. They will be able to create joint budgets to shape how we care for people and how we promote a healthy lifestyle. With respect to the specific geographies of the ICSs themselves, as I have said elsewhere, I am willing to listen.

[Sir Bernard Jenkin (Harwich and North Essex) (Con)]

In passing, may I congratulate my right hon. Friend on his appointment? I also very much welcome part 4 of the Bill, which introduces the health services safety investigations body. This is a great innovation that was promoted by the Public Administration Committee and scrutinised by the Joint Committee that I chair. Can I just reinforce the points that I know he is now receiving from NHS England with a warning about changing the boundaries of the integrated care systems that are already operating? In Suffolk and north-east Essex, we have a very high-functioning de facto integrated care system operating already. Please will he not change it?

[Sajid Javid]

My hon. Friend has raised an important point, and this may be on the minds of other hon. Members as well. It is important to point out that several factors will be helpful in fostering stronger partnerships between the NHS and local authorities, including the alignment of boundaries. Earlier this year, the former Secretary of State asked NHS England to conduct a boundary review of integrated care systems, to understand the best way forward and the best alignment where local authorities currently have to work with more than one ICS. I have met my hon. Friend and other hon. Members, and I know that hon. Members may have made representations to my predecessor. I have been informed of those, and where the information might not be remembered easily, I am sure we can get hold of some video evidence. [Laughter.] I want to thank all hon. Members for their input into this, and I stress that no final decisions have yet been made on the boundary review.

NHS Integrated Care System Boundaries

Bernard Jenkin Excerpts

Tuesday 29th June 2021 Commons Chamber

[Sir Bernard Jenkin (Harwich and North Essex) (Con)]

I am sorry that this debate is unlikely to be the penalty shoot-out that some people may have been looking for.

We know that the Government are about to publish a new Bill on the NHS, but it is not widely known or understood that the NHS in England is being prepared for a major reorganisation. The clinical commissioning groups established by the Lansley reforms have gradually been subsumed into groups called integrated care systems. These ICSs are not legal entities, but single executive teams that have effectively merged the CCGs. Their boundaries are established according to the local health economies. For example, the North East Essex CCG has been merged with two Suffolk CCGs to form the Suffolk and North East Essex ICS, which commissions all NHS services across the whole area. This enabled Ipswich Hospital NHS Trust and Colchester Hospital University NHS Foundation Trust to be merged. I have to say that this is highly effective. In my nearly 30 years as a Member of Parliament, I can honestly say that the NHS in our area has never been better led.

[Sir David Amess (Southend West) (Con)]

I know that my hon. Friend will agree that we have had a fabulous football result this evening.

Going back to the days when my hon. Friend’s father was a Health Minister, when the noble Lord Fowler was Secretary of State and when the late Lord Moore was Secretary of State, would he agree that we have had far, far too many of these reorganisations, and that we need to halt the process in our area at the moment?

[Sir Bernard Jenkin]

I will come to that point later; I shall not want to repeat myself.

[Mr Tanmanjeet Singh Dhesi (Slough) (Lab)]

I congratulate the hon. Member on having secured the debate on changes to the NHS integrated care system boundaries on the night that England have beaten Germany and qualified for the quarter finals of Euro 2020. Does he agree that although these plans may satisfy the political ambitions of some, they do not deliver the best outcomes for our constituents, including my Slough constituents, who are already well served by the successful Frimley ICS, which should not be broken up? If something is not broke, why needlessly try to fix it?

[Sir Bernard Jenkin]

I was anxious to give way to the hon. Gentleman to show that there is cross-party concern about this matter; I am sure that his point will be enlarged upon by my right hon. Friend the Member for Maidenhead (Mrs May).

All this is being put at risk at a time when the NHS is still reeling from the impact of covid-19. The new Bill will place ICSs on a statutory footing, which is a good thing, but there is also a proposal that the ICS boundaries should be redrawn to be coterminous with upper-tier local authority social care boundaries, and that is what we are questioning.

I am most grateful for the way my right hon. Friend at the Dispatch Box has listened recently to MPs affected by these proposed changes and has consulted us. He therefore already understands why I and others remain so concerned, but I must put it on the record that the rest of the consultation process has been not just inadequate but in defiance of proper transparency and accountability.

[Sir David Amess]

Absolutely outrageous!

[Sir Bernard Jenkin]

My hon. Friend says that is outrageous.

A firm of organisational consultants, Tricordant, was instructed by NHS England and NHS Improvement East of England to host roundtables in recent months with all the stakeholders in and around the NHS in the east of England. For some reason, it was told to exclude the MPs. Tricordant has produced several drafts of its report, which have been shared among existing ICS leaderships, NHS providers and tier 1 local authorities, but not with MPs. A few of us were eventually briefed by NHS England at the Minister’s behest, but I am mystified as to why we were not positively engaged at the outset.

The White Paper produced in February 2020—incidentally, just as we perhaps should have been anticipating the pandemic, instead of planning an upheaval of the NHS—talks about this coterminosity of boundaries, but it also has a whole section on the primacy of place. I will explain this, but those two objectives are fundamentally incompatible. The consultation exercise then appears to have been driven by that dogmatic insistence on coterminosity, and has been further confused by a lack of clarity about the problem that actually needs to be solved.

In Essex and Suffolk, areas larger than single counties were ruled out so Ministers will be presented only with a choice between the boundaries as they are and two county ICS areas—one for Essex and one for Suffolk. Discussions concerning the future of the Suffolk and North East Essex ICS have been strongly weighted towards the county councillors and their officers. Not all relevant NHS stakeholders have been consulted, which is why NHS Providers, which represents NHS leaders across the country, has spoken out on their behalf. Individual NHS leaders are understandably reluctant to criticise proposals in public, but they are known to be against the change, including the leaderships of the acute trusts across the east of England.

I understand why the county councils want this change, and I completely respect their ambition. Essex has made clear to me its frustration at making time for meetings with three different ICSs. I can also see that the new boundaries are superficially attractive, because they align NHS commissioning with the boundaries for the health and wellbeing board and other statutory public services, such as the Essex police and the local resilience forum. Essex County Council acknowledges the extremely successful place-based working implemented by Suffolk and North East Essex ICS, which incidentally has been complimented by the Care Quality Commission, the King’s Fund and the National Audit Office.

The new legislation is intended to extend place-based working to all areas. None the less, the Tricordant report would be misleading if it did not express the clear preference of NHS leaders in Essex to retain the existing ICS boundaries, primarily in recognition of the long history of operating as a single health economy, the significant flow of patients across the county border, the strength of existing relationships in the system, and the progress that has been made locally in integrating health and care services.

There are practical difficulties with the changes for Harwich and North Essex, which are replicated in other parts of England. Enablers of effective place-based working—the leadership, the philosophy and having all the partners sitting around one table—are essential to build effectiveness. A place—I use that term advisedly—that has thrived as part of one system will not necessarily thrive as part of another. Superb progress has been made in north-east Essex in recent years and, more recently, in mid and south Essex. These systems are now working not just because commissioning reflects what is called place but because people have grown into their roles and developed relationships of trust across different organisations. All that will be discarded by the wholesale changes to NHS commissioning by imposing coterminosity.

[James Sunderland (Bracknell) (Con)]

Does my hon. Friend agree that, because Members of Parliament in Nottinghamshire, Berkshire, Hampshire, Suffolk, Essex and beyond have not been adequately consulted on these proposals, we should pause any decision with a view to looking more objectively at what is on the table?

[Sir Bernard Jenkin]

My hon. Friend anticipates what I might say later.

The foundation trust for the Ipswich and Colchester hospitals will have two different commissioners, or Suffolk will have to take over the commissioning role for Colchester Hospital, leaving north-east Essex GPs, mental health services and so on with a different commissioning authority from that of the local hospital. NHS England told the MPs:

“We still do not know how the funds will flow”.

We certainly will not have all the partners sitting around a single table. The constituency of my hon. Friend the Member for Waveney (Peter Aldous) will be reabsorbed into Suffolk, even though it is half of the wider Great Yarmouth and Waveney place.

[Peter Aldous (Waveney) (Con)]

My hon. Friend is making a very good point. The Waveney area of Suffolk has been in a health administrative area with neighbouring Great Yarmouth for a very long time, and with the rest of Norfolk for a reasonable time as well. Any change would be highly disruptive, a distraction and demotivating for hard-working staff. I have written three long letters to the Department of Health and Social Care and have had a meeting with the Minister for Health, my hon. Friend the Member for Charnwood (Edward Argar), but does my hon. Friend the Member for Harwich and North Essex share my concern that there is a perception among those working in health and care in the local area and East Anglia that changing the boundaries is a done deal? Can the Minister confirm in his response that that is not the case?

[Sir Bernard Jenkin]

I very much hope that my right hon. Friend the Minister will confirm the latter; I have been assured that it is not the former, which is why I thought it was worth having this debate. The problem that my hon. Friend the Member for Waveney has is that the local population will continue to have acute services commissioned and provided from Norfolk. The imposition of separate Norfolk and Suffolk ICSs would compromise place-level integration for that population.

The west Essex population, which may be close to your heart, Madam Deputy Speaker, has acute services commissioned and provided predominantly from Hertfordshire, London or Cambridgeshire, and very little from the rest of Essex. That means west Essex will become part of an Essex ICS when it does not even include many of the key partners responsible for delivery of acute services to that population, and of course there is to be a new hospital, which may well be outside the Essex border. The proposed county-based arrangements would fragment NHS commissioning for places in north-east Essex, Waveney and west Essex. There might be different commissioners for acute, community and primary care. These places can only fully realise the benefits of integration if they have the flexibility to align all NHS commissioning. Other parts of the country will be similarly affected.

The idea of coterminosity for the administrative convenience of county councils is, I am afraid, a bit like the tail wagging the dog. In 2018, across the UK as a whole, we spent £149 billion on the NHS, but only £22 billion on social care. How can it make sense to align NHS commissioning with social care boundaries? That is not integration with social care; it is disintegration of NHS commissioning, and why do it now, of all times? We would be destabilising our health and care infrastructure while we are not yet out of the pandemic, let alone free of the aftermath.

The focus needs to be on the recovery of services. Elective treatment waiting lists increased to 5.12 million in April—a record high. There are other options for Essex and Suffolk, and I dare say in other parts of the country as well, such as a two-county proposal, as many Essex and Suffolk MPs set out in our letter to the Secretary of State two weeks ago.

In conclusion—I want to give time for others to contribute—the new legislation could provide the opportunity for ICSs to build on their successes, but that will be impossible with the level of disruption that a change of boundaries would bring about. Conservatives should have learned the lesson that NHS reorganisations usually fail to deliver the benefits promised. That will be especially true if reforms are rushed through again, tearing up what has been so recently established. Boundaries are the contentious part of the reforms. It would be better to allow the current ICSs to implement the new legislation and then look at whether boundary changes are necessary, rather than trying to do both at the same time.

So often I have seen it happen: structural and organisational reform is imposed from above as a substitute for a full understanding of what is really going wrong and why. It is always hard to improve leadership and to promote the right attitudes and behaviours in large and complicated organisations, particularly the NHS, but the slowest way to achieve this is to have another structural organisation. Everyone stops thinking about the job they are doing and thinks only about what new job they are applying for. After the reorganisation everyone has to re-learn how their job works and to re-establish new relationships, but nobody has challenged the attitudes and behaviours, which are still holding the organisation back. So often the problems are about poor leadership, poor employee engagement and lack of stability, which yet more structural change just makes worse. I therefore urge my right hon. Friend to delay the decision concerning future ICS boundaries until after the pandemic, and to consult and explore alternative boundary proposals after the legislation has settled down.

--- Later in debate ---

[The Minister for Health (Edward Argar)]

I congratulate my hon. Friend the Member for Harwich and North Essex (Sir Bernard Jenkin) on securing this timely debate about potential changes to ICS boundaries—and indeed on elevating me to the Privy Council, for which I am grateful. He and I have known each other for a long time and I always listen carefully to what he says. When there was the prospect of extra time, our friendship might have been in doubt had I been in here and unable to see the final result, but we got the result we all wanted just in time, so it is a pleasure to be here today.

The subject is important, not only for my hon. Friend, who works tirelessly for his constituents, but for all hon. Members who have spoken. The provision of healthcare goes to the heart of what many of our constituents care passionately about.

In his remarks, my hon. Friend expressed his concerns about the future of Suffolk and North East Essex ICS as one of the areas included in the NHS England ICS boundary review. I am grateful that he has called the debate, not only to allow fellow parliamentarians to express their views before any decision might be made on the Floor of the House, but to let me listen once again to them. I am equally grateful to my right hon. Friend the Member for Maidenhead (Mrs May). She and I have known each other a very long time and she knows that I have huge respect for her opinions. When she speaks, I always listen carefully.

As has been said, in the recent White Paper, we set out proposals to place integrated care systems in statute. We are working with NHS England and the Local Government Association to deliver and develop those proposals. At the outset, it is important that I highlight a key point. Members alluded in their remarks to the feeling that something here is predetermined. If there is such a feeling, that is a challenge for us to overcome because I want to reassure hon. Members that nothing is predetermined in any of the specific situations that they have outlined.

As has been set out, ICSs aim to strengthen partnerships and joined-up working between the NHS and local authorities. Local authorities therefore have a key role in ICSs. We know that coterminous boundaries can support more joined-up working between the NHS and local government, but I take on board entirely from my time as a local councillor—indeed, as a cabinet member for health and adult social care—the point that my right hon. Friend the Member for Maidenhead made that sometimes natural geographies of place can mean a lot more to our constituents than administrative boundaries to which we as politicians might pay a lot of attention.

For the reasons I have given, earlier this year the former Secretary of State, my right hon. Friend the Member for West Suffolk (Matt Hancock), asked NHS England to conduct a boundary review to understand what the options—I emphasise options—were to achieve alignment in the small number of areas where coterminosity was not already in place. He set out to do that in two stages: NHS England and its regional teams have led on the review at a local level, engaging with local NHS and local authority stakeholders to determine options for alignment, local views and concerns, and to put forward a fair reflection of what they had heard, while in parallel I, as a Minister of the Crown, have held multiple meetings with parliamentary colleagues. I think I have met well over a dozen colleagues in person or virtually—in this day and age—and held almost 10 different meetings.

I thank NHS England for all its engagement and work on the review. As I say, over the past six months its regional teams have worked closely with local NHS and local government stakeholders to consider, with an open mind, the options available for the areas identified in the review.

As right hon. and hon. Members have made clear, it is important to recognise where things are working well irrespective of coterminosity and serving Members’ constituents well. As I say, the review is without prejudgment and I would not wish to pre-empt what may be either recommended or even just set out as options. In that context, keeping the current arrangements would of course be an option to consider. I reassure Members that the Secretary of State and I do have at the forefront of our minds the need primarily to ensure the best health outcomes for local people when any decision is taken. I hope that my hon. Friend the Member for Harwich and North Essex will recognise the sincerity with which I say that.

Before I conclude, let me turn to a couple of specific points that my hon. Friend mentioned. I wish to clarify that were any changes made to ICS boundaries as a result of the review, they would not impact on the patient’s right to choose or use services outside of their ICS or current patient pathway flows.

On funding, I wish to try to reassure my hon. Friend a little more than perhaps he was reassured in the meeting to which he alluded. Once ICSs are placed on a statutory footing, the allocation of resources to each integrated care board will be determined by NHS England based on the long-standing principles of ensuring equal opportunity of access for equal need and reflecting the considerations that currently inform how moneys flow to areas when following the patient.

[Sir Bernard Jenkin]

Will my hon. Friend allow me to intervene on one point?

[Edward Argar]

Briefly, because I want to give my hon. Friend the reassurance that he seeks before the time runs out.

[Sir Bernard Jenkin]

What my hon. Friend has said does not address how Suffolk would be funded to commission services for Essex patients at an Essex hospital, and it does not address what will happen to the distribution of deficits, which is uneven across the existing ICSs.

[Edward Argar]

I would try to address that point briefly, but I think my hon. Friend would rather have the reassurance that I can give him. Perhaps I can pick up that point separately with him, because I do not want to run out of time.

Finally, and most importantly, I reassure my hon. Friend and other Members that no decisions have yet been made regarding the outcome of the ICS boundary review. As he would expect, the newly appointed Secretary of State will want to consider carefully the background to this issue, the options before him and, indeed, the views of right hon. and hon. Members before any decision is made. I have discussed this matter with the new Secretary of State and wish to extend his clear commitment to meet my hon. Friend, my right hon. Friend the Member for Maidenhead and other Members before he makes any decision and decides how to proceed in this matter.

My hon. Friend knows me well, and my preference is generally for evolution, not revolution. I hope that, him knowing me well and in the light of what I have said today, he will recognise the sincerity of what I say. I also hope it is helpful that I have put on record, once again, that no decisions have been made and that Members will be consulted and have the opportunity to speak to the Secretary of State. I hope that commitment reassures my hon. Friend, at least in the short term, that nothing will happen without him and other Members having their say clearly on the record.

Coronavirus

Bernard Jenkin Excerpts

Thursday 25th March 2021 Commons Chamber

[Sir Bernard Jenkin (Harwich and North Essex) (Con)]

I suppose I have an opportunity to reply to my right hon. Friend the Member for New Forest West (Sir Desmond Swayne), who has just spoken. I have a rather different take.

Many people seem to be seized of the idea that the vaccination programme has already freed us and that we are entitled to take back freedoms now. I want to challenge that. The threat of a third wave exists—in fact, there will be a third wave; it is just a question of how large it is going to be. The only thing that will constrain it is the proportion of the population who are resistant.

There is 85% take-up in half the population at the moment and the vaccines are on average 85% effective: that means that only 72% of half the population has immunity. The Secretary of State referred to Public Health England advice—based on very fresh data, I hasten to add—that bears out the most recent Imperial College modelling, which shows that even if all the restrictions are not lifted until July there is still a danger of a third wave. If the restrictions were lifted at the end of April, say, there would be a dramatic rise in the number of hospitalisations.

[Mr Harper]

I read with great care my hon. Friend’s article on ConservativeHome this morning. He refers to the modelling that Imperial and Warwick did. I went through that in some detail, but the problem is that the assumptions they made—I went through every single one—are all overly pessimistic compared with the actuality. That is why I asked the Secretary of State to redo that modelling, because if he did so, I think he would come to a much more optimistic conclusion than my hon. Friend has reached.

[Sir Bernard Jenkin]

I am perfectly prepared to accept that it is a worst-case scenario, but we are dealing with projections that are based on a great deal of speculation, and they do not take account of the possibility of new variants. I rather share the concern expressed by some Members in the debate that we need restrictions on people coming into this country, particularly from the continent, and that there should be more testing of people coming here. I am sure that the Government will want to implement those measures if they can. It is rather easier to call for them to implement them than to do so without causing a great deal of disruption.

I want to briefly touch on the continuation of our vaccination programme. One of the risks that we need to factor in is that the rate of vaccination will slow, and particularly the rate of first doses, because the vaccination programme now has to cope with the large quantity of second doses. The restrictions on vaccine supply mean that the number of first doses will perhaps reduce to as little as 50,000 a week in April. That does not rule out that we should adopt a generous attitude towards our European friends, however much they may be casting around for blame and trying to salvage their reputation from the failure of their own vaccination programmes. We can draw comfort from the fact that they are resorting to possible bans and blockades because they have no contractual obligations to enforce upon AstraZeneca—it is a misunderstanding of the difference between contracts that give rights over stock that exists and contracts that give rights over the flow of production, which is creating stock that does not yet exist.

The fact is that we are at the front of the queue, but I think that the United Kingdom should seek to be generous and to avoid this vaccine nationalism, even if it means giving up some of the flow of our vaccine, although it is understood that there are actually some large quantities of vaccine in the European Union that are not being used. The fact that they have trashed the reputation of the AstraZeneca vaccine is most unfortunate, and while understandable in psychological terms, it is unforgivable in public health terms.

Finally, on the issue of lifting covid restrictions in Parliament, I congratulate my hon. Friend the Member for Hazel Grove (Mr Wragg), the Chair of the Public Administration and Constitutional Affairs Committee, who cobbled together a majority in the Procedure Committee to get what he wanted in the Committee’s report. But I suggest that, in the end, it is a matter for the whole House what the House’s procedures are. There are things to learn, as the Prime Minister said yesterday, that will make the House more equal, fairer to people who are sick and fairer to people who have caring responsibilities and perhaps take the pressure off the shortage of time we have because we do not want too many late nights. Some of our debates have got too short, and speeches have got too short, and if those who had to be away could have proxy votes, we could have longer debates, better debates and better scrutiny of legislation, as well as a House that is more attractive for women to stay in and take part in.

[Madam Deputy Speaker (Dame Rosie Winterton)]

I need to point out that, if Members take interventions, it would be helpful for them to stick to the four-minute time limit, because otherwise we simply will not get everybody in. Colleagues in the Chamber may not be able to get in if Members do not stick to the time limit, which would be a shame.

Public Health

Bernard Jenkin Excerpts

Wednesday 6th January 2021 Commons Chamber

[Matt Hancock]

Of course we are considering who, once we have vaccinated those who are clinically vulnerable, should be the next priority for vaccination. Teachers, of course, have a very strong case, as have those who work in nurseries. Many colleagues on both sides of the House have made that point, and we will consider it.

[Sir Bernard Jenkin (Harwich and North Essex) (Con)]

Just to pick up one point, the Secretary of State cites the certain knowledge that there is a way out. The whole point of the intervention by the right hon. Member for Warley (John Spellar) is that there is uncertainty. What contingency plans are there if a mutation proves resistant to either of the vaccines and we have to be in these measures for longer? In particular, will the Secretary of State consider the fact that we have barely drawn on the numerous people in the armed forces to create extra NHS capacity? We could do so much more of that if necessary. Is that part of the plan?

[Matt Hancock]

Yes, it is very much part of the plan; it is happening right now. On mutations and the link to the vaccine, as with flu, where mutations mean we have to change the vaccine each year, any vaccine might have to be updated in the future, but that is not our understanding of the situation now. Of course that is being double-checked and tested, both with the scientists at Porton Down and, as we roll out the vaccine in areas where there is a high degree of the new variant, and by the pharmacological surveillance of those who have been vaccinated, which will allow us to see for real the impact of the vaccine on the new variant. The goal, as my right hon. Friend the Prime Minister said, is that by the middle of next month we plan to have offered the first dose to everyone in the top four priority groups, and they currently account for four out of five covid fatalities. I am not sure that this point has fully been addressed, but the strong correlation between age and fatality from covid means we will be able to vaccinate those who account for four out of every five fatalities within the top four cohorts. It does then take two to three weeks from the first dose to reach immunity, but the vaccine is therefore the way out of this pandemic and the way to a better year ahead.

--- Later in debate ---

[Jonathan Ashworth]

The right hon. Gentleman makes a reasonable point, like the former Public Health Minister, the hon. Member for Winchester (Steve Brine), but this is not just a simple calculation about the number of deaths that are prevented. The right hon. Gentleman has more clinical experience than I have, obviously, but we know that there are people who suffer long-term, debilitating conditions as a result of this virus, with reports of people developing psychosis, long-term breathing problems, and problems with the rhythm of their heart. It remains an extremely dangerous virus, regardless of whether people end up in hospital and on ventilation. But he is quite right: in the end, this will be a judgment for politicians and a judgment for this House. It is not a judgment for the chief medical officer and the chief scientific adviser, although I would hope that our judgments, in the end, are guided by the chief medical officer and the chief scientific adviser.

[Sir Bernard Jenkin]

I, too, commend the hon. Gentleman for the constructive approach he is adopting. He clearly has a very good relationship with my right hon. Friend the Secretary of State. Will he assent to the proposition that public confidence in this vaccination programme is critical if we want people to comply with these lockdown measures, and we must do nothing that creates false expectations or unrealistic expectations about how the vaccination programme will go? We must be modest in what we promise and hopefully we will overachieve. Can he assist my right hon. Friend in that objective?

[Jonathan Ashworth]

I think that as a rule in politics it is always better to under-promise and over-deliver. Maybe the Whip on the Treasury Bench could send that advice to the Prime Minister, because the Prime Minister tends to have the opposite approach to some of these matters, I would say.

Our big target should be to vaccinate more, particularly among NHS staff. Many NHS staff on the frontline, in the face of danger, are scared. They are exhausted. Many have said to me that they feel they were sent out in the initial weeks of the first wave without the protection of personal protective equipment, and now they are exposed again without the protection of inoculation. Will Ministers move heaven and earth to get all frontline NHS staff vaccinated urgently, and can we have a clear date by which NHS staff on the frontline will receive the vaccine? If manufacturers can increase supply, what more can be done to improve distribution? In addition to GPs, our community pharmacists have tremendous links with hard-to-reach communities. We need to make full use of them.

Vaccination not only saves lives, and is not only the route out of restrictions; it is also urgent, because we are now in a race against time. The B117 strain is fast becoming dominant, and it has done so in just a matter of weeks. The more virus there is circulating, the more opportunities there are for further mutations that could give the virus greater advantage—possibly a variant on which vaccines no longer work, risking another devastating covid wave in winter 2021. Vaccination, both at home and across the globe, is now fiercely urgent, and the race to vaccinate is therefore literally a race against evolution.

We will also support this lockdown tonight because we know we have to reduce transmission. That is why we are asking people to stay at home. But not everyone can work from home on their laptops. There are 10 million key workers in the United Kingdom, of whom only 14% can work from home—key workers, many of whom are low paid and often use public transport to travel to work in jobs that, by necessity, involve greater social mixing, who are more exposed to risk. Often, because of their home circumstances, they end up exposing others to risk as well. We witnessed that in Leicester, where it is suspected that a spike back in the summer was the result of a spillover of infections into the community from those sweatshops that did not adhere to proper health and safety rules.

We need to make sure that our workplaces are covid-secure; otherwise, we will not get on top of transmission. What support are the Government offering to install ventilation systems in workplaces? Will the Government introduce a safety threshold for ventilation of indoor workplaces without outside air? Given that the B117 strain is so much more transmissible, are the Government considering reintroducing the 2-metre rule? Given that fewer than 20% of those who should isolate do so fully, will the Government finally accept that sick workers need proper sick pay and support? Otherwise, those workers will be forced to work, spreading this illness.

The British public have done so much over the last year and have made great sacrifices. We are a great country, and our people can and will rise to the occasion. All anyone asks is that the Government do the right thing at the right time: make all workplaces covid-secure; vaccinate health workers as soon as possible; introduce decent sick pay and support to isolate, and roll out a mass vaccination plan like we have never seen before. This is a race against time—a race against evolution—and we will support this lockdown tonight.