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.

Covid-19 Update

Bernard Jenkin Excerpts

Wednesday 30th December 2020 Commons Chamber

[Matt Hancock]

I am not sure that the hon. Lady was listening when I said in my statement that the NHS is under very significant pressure. Of course we are working hard to ensure that that pressure is alleviated as much as possible. Over the summer, we built significant extra capacity into the critical care facilities of the NHS, including across London. The Nightingale hospitals are there, as she puts it, as an insurance policy—as back-up. The London Nightingale hospital is there on standby as back-up. I have seen some stories circulating saying that it has been decommissioned. Those stories are wrong. It is better for people if they are treated inside a hospital, but the Nightingales are there for extra support should it be needed. It will require changes to the working patterns of staff if we do need to have patients in the Nightingales once more, but it is crucial, in my view, that we have those Nightingales there ready in case we need them.

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

I can confirm to my right hon. Friend that Essex has declared a major incident. It is also, at this very moment, submitting a MACA—military aid to the civil authorities—request to assist with the construction of community hospitals for additional hospital capacity, supported and partly staffed by the armed forces. It would also like armed forces help with the roll-out of the vaccine to accelerate that in Essex and to assist with testing in schools. Will he look into the German BioNTech test as an alternative to the lateral flow test, as it is as reliable as the PCR—polymerase chain reaction test—and turns around in one hour?

[Matt Hancock]

I will absolutely look into, and get back to my hon. Friend about, the BioNTech test. Of course, BioNTech is an absolutely fabulous pharmaceutical company, as the whole House knows. What he says about the pressures in Essex is very significant, and it is important. Of course, I will look favourably on any request for military assistance, working closely with my right hon. Friend the Defence Secretary, who has been incredibly supportive, as have the whole armed forces, during this whole year. They have done so much. They are already involved in the roll-out of testing, as my hon. Friend knows, and we draw on the ingenuity, reserve and sheer manpower of the armed forces when we need them. I am very grateful for my hon. Friend’s support for the work that we all need to do in Essex to support the NHS there and to try to get the number of cases down.

Covid-19 Update

Bernard Jenkin Excerpts

Thursday 17th December 2020 Commons Chamber

[Matt Hancock]

This has been an incredibly difficult year for so many people and so many families. The fixed numerical limits place a particular burden on very large families. We have taken, I think, a balanced and right approach, but while I understand the urge for caution—of course I understand that, from my NHS colleagues and others—I also understand that people want to see their children and their loved ones. Christmas is an important time of year, and we have to find a balance.

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

I join my right hon. Friend in wishing NHS staff and everyone in this crisis a happy Christmas. Will he join me in wishing Essex County Council and local authorities in Essex a happy Christmas for what they have contributed to the test, track and trace operation since NHS Test and Trace started to share data much more quickly with local authorities? I can report to him that most districts have started door-knocking to follow up the contacts of cases, and the complete case contact rates are now around 87% and 90% respectively. Will he join me in congratulating the local authorities of Essex on this tremendous effort?

[Matt Hancock]

My hon. Friend is absolutely right, and I am grinning because I think this is the first time in the dozens and dozens of statements I have made this year when the hon. Member for Leicester South (Jonathan Ashworth) has not mentioned track and trace. I will tell you why, Madam Deputy Speaker: the latest statistics show that where communications were available, 96.6% of people were reached and told to self-isolate. That is because of the huge improvements in contact tracing and testing that have been delivered this year—[Hon. Members: “By local authorities.”] Including, of course, by local authority partners, but also by the brilliant national NHS Test and Trace system, which we should all congratulate. Getting those contact rates—[Interruption.]

Covid-19 Update

Bernard Jenkin Excerpts

Monday 14th December 2020 Commons Chamber

[Matt Hancock]

We are trying to support the economy as much as possible throughout all these difficult decisions. The extraordinary levels of financial support are a part of that, including the furlough scheme, which has now been extended to the end of March. I, of course, talk to my right hon. Friend the Work and Pensions Secretary regularly to make sure we take the action that is necessary in a way that supports people as much as possible.

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

I thank my right hon. Friend for his statement, albeit that it contains a lot of very grim news about the virus itself and its effect on many areas. It will be greeted with considerable relief in Harwich, Clacton, Colchester and Uttlesford, where the virus rates are much lower and we will stay in tier 2. Is the message now not that we stay in tier 2 or go down a tier much more by our own efforts—by the efforts of local authorities, with the support of NHS Test and Trace—to make sure we support those who have to isolate and track down and trace those who are spreading the virus? By doing that, and by compliance and forbearance, we can reduce the spread of the virus and help to defeat it so we can get down the tiers.

[Matt Hancock]

Yes. My hon. Friend is absolutely right. Trying to keep the virus under control is in the hands of local authorities and local communities. I would say to everybody in Harwich, and people across the south-east and east of England who have not gone into tier 3 today, that we all still need to work together, be vigilant and effectively do everything we can to stop the spread of the disease, because so many people are asymptomatic—about a third—and never have any symptoms but can nevertheless spread the disease. I am very grateful to my hon. Friend for the work he has done in giving me ideas to support colleagues to help in that effort. The links between the national system and local authorities are getting stronger all the time, and I want colleagues to be able to play our part—especially as, through our campaigning, we know our communities well—by getting into communities to spread the message that if we all stick by the rules and we get the testing and contact tracing in, we will be able to keep this under control.

Coronavirus Vaccine

Bernard Jenkin Excerpts

Wednesday 2nd December 2020 Commons Chamber

[Matt Hancock]

The hon. Gentleman has worked supportively and constructively with the Government throughout this pandemic. I pay tribute to the approach that he has taken, and that he took again today.

I stand with the hon. Gentleman in saying that vaccinations save lives. If we can encourage anybody who might be hesitant to take a vaccine by appearing together to be vaccinated together, of course I would be happy to do that. I recommend that we have a professional vaccinate us, of course—I do not think that he would trust me to do it.

The hon. Gentleman asked for a public information campaign, and there will of course be one. He asked about health inequalities, which are a very important consideration. The best thing to support tackling health inequalities is the fact that we have a vaccine, but we absolutely need to reach all parts and all communities across the whole country.

The hon. Gentleman asked how many will be vaccinated by January. While today brings more certainty, it does not end all uncertainties. We have 800,000 doses that have now passed the batch testing, but the total number to be manufactured over this timeframe is not yet known, because it is all dependent on the manufacturing process, which is itself complicated. After all, this is not a chemical but a biological product, so I cannot answer that question—that is as yet unknowable.

The hon. Gentleman asked when the PCNs and the centres will open. The answer is very soon. We have 50 hospital hubs ready to go from next week. The PCNs are also being stood up, and the centres outside hospitals. They are all coming very soon.

The hon. Gentleman then asked when we will get to lift restrictions. Of course, I understand why not only he but almost everybody in the country wants to know the answer to this question: how many people do we have to vaccinate before we can start lifting the restrictions? The answer to that is that, while we know that the vaccine protects an individual with a 95% efficacy, we do not know the impact of the vaccine on reducing transmission, because of the problem of asymptomatic transmission, which has so bedevilled our response to this virus and made it so hard to tackle.

We do not know the answer to that question, but what we will do is to follow the same five indicators that we were discussing at length yesterday, which are the indicators of the spread of the disease. We will look at the cases, the hospitalisations and of course the number of people who die with covid, and we will hope very much that, as we vaccinate more and more vulnerable people, we will see those rates come down and therefore be able to lift the restrictions. We will have to see how the vaccination programme impacts directly on the epidemic, and then move as swiftly as we safely can to lift the restrictions, which we all want to see gone.

The hon. Gentleman asked about community testing being licensed from door to door. I have not heard about that problem—I will ensure that I get back not only to him, but to those who raised it with him, if he will work with me. I am a bit surprised to hear that. Administering the lateral flow test currently requires a professional, although we hope to move on from that, but as far as I know it can take place in any setting, hence my surprise. However, as the comment was made by a public health professional, I shall dig into it further.

Finally, the hon. Gentleman talked about the testing prospectus we launched on Monday. We hope to be able to use testing to do more things that we would not be able to do without testing. In a way, visits to care homes are an example of that, as something we can now safely recommend that we could not recommend before; so too is testing to release from quarantine people coming into this country. If there are further examples of that sort of enablement of normal life through the use of testing that can be safely done and can be approved by a director of public health and by the chief medical officer and his team, we are enthusiastic about working with local areas to deliver it on the ground.

There are lots of ideas out there, and I urge people to be creative about how we can we can use testing to enable some of the things we love to get going again in a way that keeps people safe. That is what that part of the testing prospectus was about. I am very enthusiastic about it and look forward to working with directors of public health and with colleagues in this House. Yesterday, the Prime Minister said that with the roll-out of mass testing and the availability of these tests, we all, as leaders in our local communities, have a role in promoting mass testing. I am sure that there are communities across the country represented in this House that can benefit from the roll-out.

Looking around the Chamber right now, I see many people who have already approached me—not just from Lancashire. I look forward to working with colleagues in all parts of the House to promote this public health message, along with all the other important public health messages we have to promote, not least that if the NHS phones you up or sends you a letter saying that there is a vaccination slot open to you, just say yes.

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

I congratulate my right hon. Friend on this moment and the Government on the news about the Pfizer vaccine, but please can we continue to have increased honesty about what we still do not know? We do not know how long the immunity will last, we do not even know whether people who have been vaccinated can still transmit the disease, and of course we do not know whether tier 2 restrictions will succeed in bringing the R rate down. Until we can answer those questions, we will continue to need maximum effort behind contact tracing and isolation of virus spreaders.

Councils including Essex County Council need daily access to all the positive cases recorded by NHS Test and Trace immediately and without delay, so that they can make their own operations effective, so why are they having to wait 48 to 72 hours before they get the data? Also, what are the Government going to do to engage districts and their community volunteer hubs to help to persuade people to support those who must still isolate even if they have been vaccinated?

[Matt Hancock]

Dealing with the pandemic has been a case of dealing with uncertainty in large degree. Today we have more certainty because we know this vaccine is safe and effective, but just as I said to the hon. Member for Leicester South (Jonathan Ashworth) that we do not know the effect of the vaccine on transmission, so, as my hon. Friend says, we do not know the longevity of its effectiveness.

My hon. Friend is right about another part of public health advice that all of us as local representatives can play a part in promoting: that is, engagement with contact tracing. I will write to him about access to daily data in Essex. Of course we have to wait until the test result comes in, which can sometimes lead to delay, even though the results of the majority of tests done in person now come back within 24 hours, but I agree with him in principle, so let us make it a reality in practice.

Covid-19 Update

Bernard Jenkin Excerpts

Tuesday 10th November 2020 Commons Chamber

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

My right hon. Friend’s strategy is, as he keeps reporting to the House, to “suppress the virus” until a vaccine can be deployed, but this is still beset by so many uncertainties. Who would have thought that mink in Denmark could throw a spanner into this situation? Is the tracing capability and the ability to get people to isolate not absolutely crucial? Who should we hold accountable for whether that is operationally effective as we come out of lockdown? I say that because this is the only time we have got to make this work, otherwise we will be in another lockdown.

[Matt Hancock]

Of course it is important that we continue to build and strengthen the contact tracing system, as we are doing. My hon. Friend mentions the uncertainties, and the issue of the virus that has spread back from mink to humans is one example of that. Of course managing a pandemic is beset by uncertainty. We still have uncertainty, for instance, over whether even the Pfizer vaccine will pass the safety hurdles that we very much hope it will in the coming weeks, but managing through that uncertainty is a critical part of getting this right.

Covid-19

Bernard Jenkin Excerpts

Monday 2nd November 2020 Commons Chamber

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

If I may just respond to the hon. Member for Paisley and Renfrewshire North (Gavin Newlands), I do not feel that this House is ignoring Scotland; I feel that this House has voted for very large sums of extra money to be devoted to Scotland. But perhaps my Government need to be more mindful of the fact that these things can be so easily misconstrued in the heat of Scottish politics, and it is the responsibility of the Government to make sure that they are not so misconstrued.

This crisis was incredibly unexpected, even though it took months to arrive, and almost every western Government was extraordinarily ill-prepared for it. There have been unprecedented challenges, inevitable mistakes, much experimentation, much learning and much wasted, but much achieved. However, the politics of this country inevitably tends to revert to type, and we have seen a bit more of that in the House of Commons today with what we do best in here, which is to disagree with each other for the sake of disagreement. Somehow we have to try to rise above that in this crisis.

The opposition to these measures on the Government Benches reflects declining public confidence in the Government’s covid response, and it is public confidence that the Government should, above all else, strive to address. So what needs to be done to strengthen public confidence? We heard quite a lot about that in the speech by my right hon. Friend the Member for South West Surrey (Jeremy Hunt). A lot of it is about having a plan, explaining a plan, and giving people hope that there is a plan. The measures announced on Saturday are another reaction that has set the course for the next four weeks, but beyond that, the Government have not published any plan. I have been asking for some time for a plan called “Living with coronavirus”. There may be a single vaccine that gets us out in one go, but that is most unlikely to happen, so we will go on needing to manage the spread of the virus for many months and possibly even years. How are the Government going to do that? The Royal Society certainly does not expect an instant vaccine.

There are basically three choices facing this House. The first is to control the virus with more of these economically ruinous lockdowns. We all agree that that is not going to be acceptable, and we have heard frustration being expressed by some of my colleagues. The second is to expand the NHS to gargantuan proportions so that we can deal with as many people who get infected. We cannot afford to do that and we do not have the capacity to do it. The only solution is to try to manage the virus, perhaps with vaccines but certainly with Test and Trace. We have had six months to get Test and Trace to where it is. Let us celebrate the 500,000 tests a day and the huge organisation that has been established, but we should ask ourselves what needs to be done in order for us to have as effective testing and tracing as people have in Japan and in Korea. They had years practising in the aftermath of SARS—severe acute respiratory syndrome. We have had to achieve this very much more quickly, but that does not mean that we cannot adapt those experiences of very different societies to our own immediate future to make sure that we do a much better job.

We need to carry on improving the data. The fact that Test and Trace is divided among four different directorates in four different locations, and that the data directorate has had three directors general in the past five or six months, does not suggest that there is much continuity or co-ordination across Test and Trace.

We need to deliver a campaign to change behaviour on the street. This cannot be done from a spreadsheet in Whitehall. It cannot be done from remote call centres with unfamiliar telephone numbers. It can only be done with person-to-person human contact. Go and ask the Japanese how they are doing it. It is very analogue. It is very old-fashioned. There is an app— every country has an app—but an app is a tiny proportion of what people can achieve. People are not going to use an app if they think it just results in them being rung up by some stranger and told what to do. That is not working.

Above all, NHS Test and Trace needs a single command structure and a single plan. However localised the delivery is, and I am very much in favour of using local authorities—the local authority pilots that have been carried out already have proved very much more successful in contacting a much higher proportion of people—every local authority should be so funded. However, we need a central headquarters, preferably run by a military capability that can bring this together and win this together.

[Madam Deputy Speaker (Dame Rosie Winterton)]

Order. In order to get everybody in, after the next speaker I will need to reduce the time limit to four minutes, which is what was in place in the debate before the recess. Perhaps colleagues might like to tell the hon. Member for Wycombe (Mr Baker) when he returns that it will be four minutes for his speech.

Covid-19 Update

Bernard Jenkin Excerpts

Programme motion
Monday 19th October 2020 Commons Chamber

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

Most of the MPs in Essex have reluctantly felt the need to support the tier 2 measures that are now being applied, but we are very concerned about the effect of this on the hospitality sector, in particular. Is it not very important that we align the economic interests of our constituents with the public health interests instead of polarising the debate such that one is either in favour of the economy or in favour of controlling the virus? May I also emphasise that one of the reasons why public confidence in the Government’s strategy is somewhat in decline is that we have yet to see the transformation of the leadership of test and trace, which I have discussed with the Secretary of State many times?

[Matt Hancock]

Where I agree with my hon. Friend is that there is no trade-off between health and economic measures, because if the virus gets out of hand, then we will end up with a worse economic hit as well. I know he agrees with that because we have discussed it many times. He, like other Essex MPs, may not like the fact that we have to collectively put in place these measures in Essex, but it is the right course of action.