Oral Answers to Questions
Chuka Umunna Excerpts(5 years, 6 months ago)
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Stephen Hammond
The hon. Lady knows that a wholly-owned subsidiary is created as a legal entity. It is 100% owned by NHS organisations. It is also the case that local trust board members sit on the boards of those subsidiary entities. It is therefore appropriate that the local organisation takes that decision.
Chuka Umunna (Streatham) (LD)
The King’s Fund says that the earnings threshold in the Government’s immigration proposals, which was mentioned earlier, will definitely impact on the ability to retain and attract NHS staff. The proposals for a transition period during which many social care workers would only be allowed to come here for a limited time with no entitlement to bring dependants will, again, negatively impact on the ability to retain staff. When will this Government realise that immigration is good for our public services and good for our country, and that badly thought out policy in this area that impacts on the retention of NHS staff is wrong and nonsensical?
Stephen Hammond
The hon. Gentleman is right—immigration has benefited the national health service. This Minister, this Secretary of State and this ministerial team celebrate the fact that global immigration has benefited the NHS. From 2021, the new system will allow people with skills to come to the UK from anywhere in the world. It will remove the cap on skilled migrants, abolish the requirement to undertake the resident labour market test, and should improve the timeliness of being able to apply for a visa.
King’s College Hospital Foundation Trust
Chuka Umunna Excerpts(7 years ago)
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Mr Dunne
The right hon. and learned Lady said on the radio yesterday,
“just because they’re the regulator, when these judgments have to be made, doesn’t mean that they are actually right”.
I have to ask her about that, in the light of the comments made by NHSI, the regulator. I will give her a couple of quotes. Jim Mackey, who was until recently the chief executive of NHSI, has said:
“Honestly, I don’t think they have in my time hit a single set of their re-forecasted numbers”.
The current chief executive, Ian Dalton, has said that no other trust in the country
“has shown the sheer scale and pace of the deterioration at King’s”.
This is not just about the numbers; it is about the way in which the trust is managed.
Mr Dunne
As I have indicated, the chief executive of NHS Improvement said yesterday that no other trust
“has shown the sheer scale and pace of the deterioration at King’s. It is not acceptable for individual organisations to run up such significant deficits when the majority of the sector is working extremely hard to hit their financial plans, and in many cases have made real progress.”
That is from the regulator responsible for putting the trust into special measures for now.
Chuka Umunna
The “brutal reality”—to use the Minister’s words—is that the staff at King’s, which also serves my constituency, are doing all they can in impossible circumstances. If we are honest about this, we on both sides of the House have perpetuated the fiction for too long—over decades—that we can have Scandinavian levels of public services on American levels of taxation. That is why I ask him to heed the call of the hon. Member for Totnes (Dr Wollaston), and many others across the House, and set up a proper convention to look at what is a sustainable model, not just for King’s but for the whole NHS, so that our constituents can continue to get the services they deserve.
Mr Dunne
I share the hon. Gentleman’s support for the staff, and I have already paid tribute to the hard work and commitment that they are showing to their local population. His question regarding a royal commission is rather beyond the scope of this urgent question and rather above my paygrade.
Leaving the EU: NHS Funding
Chuka Umunna Excerpts(8 years, 1 month ago)
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Mr Chuka Umunna (Streatham) (Lab)
On 23 June, our country voted to leave the European Union. The result was not a landslide: 48% voted to remain; 52% voted to leave. London, Scotland and Northern Ireland voted to remain; the majority of England and Wales voted to leave. The young overwhelmingly voted to stay; older voters opted to go. Socioeconomic classes and ethnic groups also voted in different ways.
I was immensely proud to play a leading role in the “Labour In for Britain” and “Britain Stronger in Europe” campaigns during the EU referendum. To my core, I still believe that by the strength of our common endeavour we achieve more together than we do alone, not only as individuals but as a nation state, as we seek to amplify Britain’s role in the world and achieve as much for our community of nations around the world as possible. However, I accept the result. Before the vote, remain campaigners accepted the rules under which the referendum was fought. I do not think that, having had a referendum conducted under those rules, which we debated in the House, we can now reject them because we do not like the outcome. Either you are a democrat or you are not, Mr Speaker, and I am a democrat.
Various promises were made by each side in that referendum campaign. Now it is over, it is important that we hold to account the winning side for the policies and claims that were made and upon which people voted. I say “hold to account” deliberately. We on the remain side would not want all of Vote Leave’s promises to be delivered, but it is right and proper, for the sake of our shared values of democracy, accountability and transparency—the foundations upon which this House is built—that Vote Leave campaigners who are Members of the House should be tested on whether they deliver what they pledged to the people. If they do not, they should explain why not to their constituents and the nation in this House. Thousands of people agree—they have joined the Vote Leave Watch campaign because they care about this, too. I chair that campaign, and I draw the attention of the House to my entry in the Register of Members’ Financial Interests.
One promise that the overwhelming majority of people—both the 16 million who voted remain and the 17 million who voted leave—want to see kept is the Vote Leave campaign’s pledge to put £350 million extra per week into the NHS. That was the key pledge of the Vote Leave campaign. Prominent members of the current Cabinet—the Foreign, Environment, International Development, International Trade, and Transport Secretaries—went around the country in a big red bus that said, “We send the EU £350 million a week. Let’s fund our NHS instead”. They gave speeches in front of a sign saying, “Let’s give our NHS the £350 million the EU takes every week”. None of them disowned that pledge during the campaign—not a single one. The clear message they sought to give to the people was that if we leave the EU, £350 million a week extra will be put into our national health service. No qualification was given to that pledge.
Stella Creasy (Walthamstow) (Lab/Co-op)
My hon. Friend is making a powerful case. This is such an important point for our economy, as we know in my part of London, where the Barts trust has the largest predicted overspend in NHS history. Does he agree that it is vital that those who campaigned on the pledge that this money would be provided are held to account, because communities such as mine are suffering without investment in the NHS?
Wes Streeting (Ilford North) (Lab)
My hon. Friend is absolutely right that the claim of £350 million a week for the NHS was at the centre of Vote Leave’s campaign. Leave campaigners were given a number of opportunities to review, qualify or disown the claim, including following strident criticism from all members—remainers and leavers—of the Treasury Committee. The fact they chose not to distance themselves from the claim surely demonstrates that this is a promise that ought to be delivered. If it is not delivered, they will have some explaining to do.
Mr Umunna
I completely agree with my hon. Friend. As he said, it was significant that the Treasury Committee came to its conclusion, since it is a cross-party Committee whose members include leavers and remainers.
As my hon. Friend the Member for Walthamstow (Stella Creasy) said, we know that the NHS needs extra cash. The Minister also knows this. As members of the Health Committee pointed out last month, the deficit in NHS trusts and foundation trusts in 2015-16 was more than £3.5 billion.
Lilian Greenwood (Nottingham South) (Lab)
My hon. Friend makes a powerful argument for extra NHS funding, but does he share my concern that our NHS could actually be worse off as a result of the decision to leave the EU, given that the reduction in our exchange rate will make it more expensive to purchase products from abroad? Does he also share my concern that, when I asked the Secretary of State for Health how much and what proportion of the total NHS budget was spent on imports, the Department was unaware and therefore unable to give me that information?
Mr Umunna
It is outrageous that Ministers were unable to give my hon. Friend those figures. Ministers themselves exacerbated the knock-on impact on the economy of the depreciation of the pound. It depreciated in value by 6% before October, and then by a further 15% because of uncertainty around our trading arrangements that was triggered by comments made by the International Trade Secretary that differed from those of the Chancellor to the Treasury Committee and in other forums. The knock-on effect is not, however, just on household budgets. As the cost of things increases, of course the NHS will take a big hit. Public services in general will be affected if growth reduces and Exchequer receipts fall.
Ministers’ claimed increases in NHS funding, which the Under-Secretary of State for Health, the hon. Member for Warrington South (David Mowat), might mention, are actually being funded by reductions in other areas of health spending that fall outside NHS England’s budget. Reductions in spending on social care are having a serious impact on the NHS, and that is translating into increased accident and emergency attendances, emergency admissions and delays to people leaving hospital. I have talked about what Select Committees, Ministers and Members of Parliament are saying, but we have also heard from third parties. The King’s Fund, the Nuffield Trust and the Health Foundation are clear that current Government spending plans through to 2019-20 will not be enough to maintain standards of care, to meet rising demand from patients and to deliver the transformation in services outlined in the NHS five year forward view.
I and more than 40 Members from different parties, including all my hon. Friends in the Chamber for the debate, have written to the Chancellor asking that when he presents his first autumn statement on 23 November, he sets out how he will put the Government on a path to increasing national NHS spending by that promised £350 million extra a week once we have left the EU. To be clear, that additional funding must be over and above the amount currently planned to be spent on the NHS. The British Medical Association has made the same demand.
Anna Soubry (Broxtowe) (Con)
Is the hon. Gentleman saying that the Government have to honour a promise made by others to the tune of £350 million a week extra for the NHS? My hon. Friend the Member for North East Somerset (Mr Rees-Mogg) and other notable leavers have now conceded that the actual figure was £120 million. Would it not be unfair to say that the Government have to deliver that pledge, given that they never made any such promise to the British people?
Mr Umunna
I am grateful for the right hon. Lady’s intervention; I shall come on to those precise points shortly. I note, however, the public statements she herself made when she was a member of the Government. She criticised the way in which her fellow Ministers were going around making these big promises, perhaps on her behalf.
Anna Soubry
We must be very clear about this. During the referendum, we campaigned individually, not as Ministers on behalf of the Government. The hon. Gentleman is right that some Ministers campaigned for leave and made this promise—and indeed many other promises that I do not think they will be able to deliver—but there is a distinction to be made between the promises of the Government and those of people who now happen to be in government. It is really the leave campaign that must be held to account, not the Government.
Mr Umunna
The right hon. Lady pre-empts what I am about to say; I shall come on to that precise point.
To be clear, I want the Minister, on behalf of his Department, to give the same commitment that we are asking the Treasury to make, and to outline how his Department will make good on this pledge. I shall explain why this is a pledge that the Government should deliver. The Minister might give a number of reasons, perhaps echoing the right hon. Member for Broxtowe (Anna Soubry), to explain why the promise given by his ministerial colleagues during the referendum should not be treated as such. I will deal with each of the main possible reasons in turn.
First, there are those who claim that this was not a pledge at all. Nigel Farage, the interim leader of the UK Independence party, said that it was one of the mistakes that he thought the leave campaign made. The current Transport Secretary, who was also a member of the Government at the time of the referendum, has said that Vote Leave’s specific proposal was, in fact, to spend £100 million a week of the £350 million for the NHS that was originally hoped for, commenting that that would be an “aspiration” to be met. Let me tell the Transport Secretary that the poster that the Vote Leave supporters all stood next to did not say that this was an “aspiration”; it was a pledge—pure and simple. There was no qualification on the poster or on the big red bus. This statement was made, and the people who made it should be held to account for it.
Secondly, many leave campaigners deny ever using the £350 million figure. One of them said:
“I always referred to Britain’s net contribution of nearly £10 billion—some £200 million a week…rather than £350 million.”—[Official Report, 5 September 2016; Vol. 614, c. 20WH.]
It is true—my hon. Friend the Member for Ilford North (Wes Streeting) touched on this—that the Office for National Statistics said that the £350 million figure was misleading, but the head of the Vote Leave campaign said:
“the £350 million figure is correct and we stand by it.”
Vote Leave, whose banner Government Ministers campaigned under, carried on citing the figure, as my hon. Friend said, and those Ministers must now be held to account.
Stella Creasy
I take my lead from the right hon. Member for Uxbridge and South Ruislip (Boris Johnson), who sadly does not appear to be in this Chamber. He was one of the most prominent members of the Vote Leave campaign and said that Brexit must give the NHS a boost. In my part of town, a boost to the NHS is the vital funding that we need to get our NHS back on track. Does my hon. Friend agree that we should listen to the right hon. Member for Uxbridge and South Ruislip about that point?
Mr Umunna
I shall come on to him shortly.
A further thing that is said—again, I think this has been touched on—is that not all the people who made these pledges were members of the then Conservative Government. Perhaps that could be said of the right hon. Member for Uxbridge and South Ruislip (Boris Johnson). Well, of the five current members of the Cabinet whom I mentioned, three were members of the then Government and one—the right hon. Member for Uxbridge and South Ruislip—attended the political Cabinet at the time. Yes, the Secretary of State for International Trade was sitting on the Back Benches, but countless other Ministers from outside the Cabinet at the time who are now serving more than make up for that—for instance, the hon. Members for Portsmouth North (Penny Mordaunt), for Camborne and Redruth (George Eustice) and for Stockton South (James Wharton). I could go on. Those are just a few of the people who posed by those posters and next to that big red bus, and they must be held to account.
Finally, it is said—this is the crux of the argument advanced by the right hon. Member for Broxtowe—that the commitment was given by one side in a referendum campaign, not by a Government. I am sorry but that simply will not wash. Many of those people were put up to appear in the media and to campaign on Vote Leave’s behalf precisely because they carried the authority that attaches to Government Ministers. That was why they were used. That was why they were asked to stand by that red bus, and to stand by those posters.
All those key Vote Leave campaigners, whether they were Ministers or not, were Members of this House. If our democracy is to mean anything, it must mean that Members are answerable to the electorate for their policies, and held to account in the House for the things that they say. People cannot go around the country casually promising the world and betraying people by failing to deliver, but then expect to get away with it. We will not forget; we will not let up. It was in the name of parliamentary sovereignty that those Ministers campaigned, and it is time that the House, on behalf of the people whom we are elected to represent, took back control, if we want to use that phrase, and made those Ministers answer.
Lilian Greenwood
I thank my hon. Friend for giving way again. He is being very generous with his time.
Is this not dangerous and damaging not only to parliamentary democracy, but to the morale of workers in our national health service? I was told by the chair and chief executive of my local NHS trust, Nottingham University Hospitals NHS Trust, that they are frequently stopped by members of staff who ask, “When are we going to get the extra money?” Those people will surely be not just incredibly disappointed but doubly disappointed, given the difficulties that they are facing because the trust has a huge deficit and is struggling to provide the services that they know that patients require.
Mr Umunna
My hon. Friend is absolutely right. I am very grateful for all the interventions that Members have made today.
Either those Ministers made this pledge to the people in the expectation of delivering on it, in which case they must now show us the money, or they made it in the sure knowledge that their promise would never be fulfilled, in which case they will never be forgiven for their betrayal of those who, in good faith, relied on them. Perhaps the Minister can tell us which it will be.
David Mowat
Nobody in this House would be more pleased than me if we did not have the PFI millstone around our neck. The hon. Lady talks of renegotiation; this is real money, and these are real contracts that were signed more or less entirely by the last Labour Government. There is no magic wand that enables us just to set those PFI contracts aside, although I wish there was; that is not how the commercial world works.
Mr Umunna
I am sure the Minister will be aware that the £10 billion figure for increased funding he has just cited is rejected by the cross-party Select Committee on Health. It is also very well him referring to what he alleges are increases in NHS funding, but the other cuts his Government have made over the last five to six years, in particular to local authority budgets, have put huge pressure on social care, which has led to a knock-on impact on the NHS and its funding.
David Mowat
The hon. Gentleman mentions social care, and that is fair. It is funded separately to the NHS, and the budgets are separate. During the course of this Parliament the social care budget will increase in real terms. I do accept that the social care system is under pressure, but there is a massive disparity in performance in social care between councils. The top 10% of councils are about 20 to 25 times better in terms of outcomes for delayed transfers of care and so forth than the bottom 10%. There are many facets to this, therefore, but I accept the basic point. I think that, all other things being equal, Members on both sides of the House would like the NHS to have more money; let us agree on that and see how we make progress on it.
Brexit introduced a number of variables that may not have been there before. What will be the impact of Brexit on our economy? Our GDP in three or four years could be higher, but also could be lower, because of Brexit. The truth is that neither the hon. Gentleman nor I knows the answer to that. There are different views on that in this House, too, although some with other views may not be here today. This is important and relevant because if the economy were to have a significant difficulty, that could impact on spending commitments.
The second variable is a very substantive one and was mentioned earlier: the exchange rate. Our exchange rate went down about 15%, principally, it would seem reasonable to say, as a consequence of Brexit. That is a good and a bad thing for the economy. Many countries in the world are trying to get their exchange rate down. I represent a constituency in the north of our country where we have a more manufacturing-based economy. Frankly, a lower exchange rate will help the economy there. That may not be the case in other parts of the country and in the City.
The exchange rate has an impact on the NHS. In fact, it has two impacts. As the hon. Member for Nottingham South (Lilian Greenwood) mentioned, it will be more expensive to import products such as scanners and, potentially, to import drugs. She asked what the figure was, but I cannot give her an exact figure. My understanding is that it is considerably less than 5% of the total NHS expenditure of about £100 billion. Nevertheless, this is a relevant factor and it makes a difference.
The other impact of the exchange rate, which the hon. Lady did not mention, is that it will affect the attractiveness to overseas workers of the UK economy in general and the NHS in particular. If someone comes in from the EU to work in our economy and the value of the pound is 15% lower than it was a year ago, they will be earning 15% less in their home currency. That will have an impact on the margin in relation to staffing, and that is an issue that we need to manage.
The third variable is the one that we have spent so much time talking about—namely, the payment that we make to the EU. I am not going to get bogged down in the numbers, but I believe that we pay the EU about £20 billion a year, of which we get roughly £10 billion back. Leaving the EU would therefore create a bonus. The hon. Member for Streatham mentioned a letter. Even if that bonus were to materialise, as I expect it to, it will not happen until after we have left the EU, so his writing a letter to the Chancellor now strikes me as somewhat symbolic.
Mr Umunna
To be absolutely clear to the Minister, the ask was that the Chancellor should set out the path for achieving this payment after we have left. I want to ask the Minister two questions. First, given his view that the pledge to make a payment to the NHS was made not by the Government but by the campaign, would he say that it was wrong for people to go around giving the impression that the Government would dish out that money? Secondly, for the record, is he saying that this Government will not meet that pledge?
David Mowat
Just for the record, I am not saying that this Government will not meet it. All I can say is that this Government have yet to decide how they will spend any bonus that comes from any rebate we get. This will all depend on the precise negotiations that take place and the precise type of exit that we make from the EU. Nobody in this Chamber knows the answers to those questions. For example, we could get a Norwegian-type deal that could entail paying money to the EU. I am not a member of the Department for Exiting the European Union and I do not know where the current thinking is on that, but this is of course a variable.
David Mowat
Had I been writing something on the side of the bus, and had I been campaigning on that cause in the referendum, I might have been more circumspect. I might have said that £350 million could become available and could be spent on whatever the Government’s priorities were, one of which was very likely to be the NHS. I hope that that satisfies the hon. Gentleman.
Mr Stewart Jackson (Peterborough) (Con)
I regret that I seem to have stumbled into a sort of elongated primal scream therapy session involving refighting last June’s referendum. The hon. Member for Streatham (Mr Umunna) would have a more persuasive and cogent argument if he saw the other side of the equation. Yes, EU workers have a massive impact on and are committed to the NHS, but unrestricted EU migration over a number of years has put massive strains on the delivery of our health services. He has never conceded that point.
David Mowat
I want to make some progress in the debate, although I understand that I have until 7.30.
We have mentioned the payments to the EU, and there is also the point about staff. Another point that has not been mentioned—I shall mention it for completeness—is that there will be an impact on EU institutions. For example, the European Medicines Agency is located in London, which is of benefit to our pharmaceuticals industry. Where it ends up should be an issue for the people negotiating this deal, because of the potential impact involved. From my point of view, we talk too often about the conditions in relation to the EU for the City of London and passporting and all that goes with it, but not enough about other world-class industries, one of which is pharmaceuticals. I hope that those responsible will listen to that.
We have talked about the economy, which is a big variable. To be frank, neither I nor the hon. Member for Streatham knows whether the economy will be better or worse as consequence of leaving the EU, but it is true that the 15% fall in the value of the pound is helping manufacturing firms in the north and will have an effect on GDP, but it will also have some effect on imports of, for example, scanners, accelerators and drugs.
The NHS is hugely reliant on staff from the EU. Some 58,000 people from EU countries work in the NHS, and another 90,000 work in social care. I want to take this opportunity to reiterate the Government’s position that we understand that massive contribution and know that it is important to our NHS that it continues. The Secretary of State said exactly that to the Health Committee and the Prime Minister has said that she hopes and expects citizens from the EU to stay in our vital services. I would like—perhaps the hon. Gentleman and the group he is speaking for today can help with this—some of our EU colleagues and friends to make a similar commitment about people from this country who are working in EU countries, because that has not yet happened.
Mr Umunna
I speak for my constituents above all others whenever I speak on such issues in this House. On that specific point, will the Minister explain why the Government do not simply guarantee the right to stay of EU citizens working in our health service? I understand the demand for the reciprocal right to be given to UK citizens living in other EU countries, but they should not be used as a bargaining chip. When the Immigration Minister appeared before the Home Affairs Committee, he admitted that we do not know where most of the EU citizens are in this country or who they are, so if we were not to deliver on the promise to guarantee them the right to stay we would have no way of removing them.
David Mowat
It is not for me to make that specific guarantee. The Prime Minister clearly said that she hopes and expects them to remain. It is disappointing that a similarly strong statement has not been made by any Head of State in any other European country.
It is also right that we do more to train more of our own nurses and doctors—not because we need to replace people from the EU, but because it is the right thing to do. We should try to become self-sufficient in these matters, and that will happen.
We have knocked around this point quite a lot during the debate and have talked about variables such as the exchange rate, GDP and the EU bonus or payment that we will get, but there is one thing that is not a variable and it is probably the single most important constant: the extent to which this Government give priority to the health service in their spending commitments. That constant is absolutely clear. The previous Prime Minister treated the NHS as his No. 1 commitment, as does the current Prime Minister. Many of the points we have discussed this evening are things that should properly form part of the negotiation that we are going to have after we trigger article 50, as we hope to do by the end of March, and I am certain that that will be the case. What is not negotiable is that our commitments to NHS funding and social care funding are unmoved by any of these things; this is the No. 1 priority for this Government.
Hospital Parking Charges (Exemption for Carers) Bill
Chuka Umunna Excerpts(9 years, 1 month ago)
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Julie Cooper
I am grateful to the hon. Gentleman for raising that point, and I will come to it later in my comments, if he will bear with me.
Mr Chuka Umunna (Streatham) (Lab)
I congratulate my hon. Friend on bringing forward the Bill. To answer the point made by the hon. Member for Christchurch (Mr Chope), for a carer visiting one of my local hospitals for a couple of hours twice a week to take a relative for treatment, parking costs about £40 a month at St George’s hospital, about £20 a month at King’s hospital and about £48 at Guy’s and St Thomas’s. That is the reality of the situation, and that illustrates how discretion is not being used to help people in the situation we are discussing.
Julie Cooper
I am grateful to my hon. Friend for making that important point.
We all need to understand that carer’s allowance is not dished out willy-nilly. To qualify, a person has to devote at least 35 hours a week to caring for a person with substantial care needs, and many carers provide far more hours than that. To fulfil their caring role, they often have no option but to work reduced hours, and some are forced to give up work altogether. They often face a steep drop in income if they have to leave work or reduce their hours in order to care, and there is sometimes a double loss of salary if they are caring for a partner who also has to give up work as a result of their illness or disability. Some 2.3 million people have given up work to care, and that loss of income is often coupled with a steep rise in expenditure as a result of the additional costs of caring and disability, including travel and parking costs as they support the person they care for to attend medical appointments or continue to provide care during stays in hospital.
One carer, Jackie, shared her story with me. She cares full time for her husband David, who has secondary progressive multiple sclerosis and hairy cell leukaemia. She said:
“As David’s wife and sole carer, I was at the hospital every day from 9.30 am until 7 pm. We live 22 miles from the hospital and rely on benefits as our sole income—so the expense of travelling to and from hospital every day and paying the parking charges was huge. We exhausted the little savings we had. Weekly parking tickets were available and cheaper than daily charges, but I never knew how long my husband would be in hospital for. The last thing I needed was to be worrying about car parking charges when I was anxious about whether my husband was going to make it or not. Carers are at such a disadvantage already, car parking charges are one extra penalty they do not need.”
For carers, fulfilling their caring role often involves parking at hospitals for hours on end day after day, week after week. Hospital parking charges place an unfair financial burden on those caring for disabled, seriously ill or older friends or family members. NHS hospital trusts and foundation trusts are responsible for setting their own charging policies and are not currently required under law to provide any exemptions. Some hospitals in England already provide free car parking, and others offer some concessions, although these are few and far between and invariably poorly advertised.
Health and Social Care (Re-committed) Bill
Chuka Umunna Excerpts(13 years, 3 months ago)
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Nadine Dorries
I should like to make this point before I take any more interventions, because I also want to defend BPAS. I do not want it to look as if I am attacking the organisation, because it and, probably more so, Marie Stopes, do what they do—the clinical procedure of carrying out abortion—incredibly well. The service that they provide for the NHS is absolutely vital, and I do not want to see Marie Stopes or BPAS disappear or to diminish their roles. They have a job to do, and they do it well. Their job is the provision of clinical abortions, and I want that to continue.
Mr Speaker
Order. It is important that the hon. Lady makes it clear to whom she is giving way.
Mr Umunna
The central point of disagreement for many people is the implication in the amendment that the abortion providers—BPAS has a presence in my constituency—are incapable of providing impartial independent counselling to those who come to them. The manager and staff at the centre in my constituency have said that they find insulting the idea that when they are giving counselling they are somehow seeking to persuade those who come to them to have an abortion, when that is not the case. In fact, when I visited BPAS recently a couple of young ladies had come to the centre intending to go through with an abortion but subsequently decided not to because of the counselling that they received.
Nadine Dorries
All I can say is that we will look at the freedom of information figures that have come from the clinic in the hon. Gentleman’s constituency. If what he says is the case, that must have been the year’s allocation for that clinic, because the FOI request information that we have received does not show that.
Nadine Dorries
Because, unfortunately, abortion provision and counselling is never scrutinised thoroughly or legislated on. No legislation happens in this place to deal with abortion. It is an issue that can never be debated. People shy away from debating abortion because of the uproar that results so things do not happen that perhaps should happen. If one is to have cosmetic surgery and it is deemed that it might have a psychological effect, one would be offered independent counselling. That does not happen with abortion.
Nadine Dorries
No, I would like to continue on the financial incentives.
BPAS and other organisations would say that they do not have to meet targets and that they have no financial concerns. However, BPAS has advertised for business development managers, whose primary function is to increase its market share—those are its own words in the advert. If an organisation advertises that it wants to increase the number of abortions, can we trust it to provide vulnerable women who walk through the door with the counselling that they need? On pensions mis-selling, this place has separated by law the people who provide and sell pensions from the people who advise on pensions.
Future of the NHS
Chuka Umunna Excerpts(13 years, 7 months ago)
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Grahame M. Morris
I am grateful, Madam Deputy Speaker.
Indeed, that was the point that I wanted to make when the right hon. Member for Charnwood was speaking about the level of the challenge faced by the NHS. Sir David Nicholson rightly pointed out that major efficiency savings have to be made and he identified the figure. However, he did not advocate massive organisational change on top of the drive for efficiencies in the system.
During the 28 sittings of the Public Bill Committee, I raised countless issues and made numerous interventions against the health reforms. Unfortunately, the Secretary of State was unwilling to take them earlier in this debate. I have followed this matter very closely. The hon. Member for Banbury (Tony Baldry) asked if I had read the Bill. As a matter of fact, I have read it inside out and could probably give some lessons to a few Members who are in the Chamber. My conclusion is that the policy has remained basically the same, and that only the public relations strategy and the spin has changed.
Mr Umunna
My hon. Friend said that he sat on the Public Bill Committee and he is also a member of the Health Committee. Has any clarification been given during this reorganisation on the operation of the Transfer of Undertakings (Protection of Employment) Regulations 1981 and 2006 with regard to employees in the NHS?
Grahame M. Morris
That is a key point, and I know that whether TUPE will apply under the terms of the Bill is a legitimate concern of trade unions. However, I will leave it to the Minister to give a definitive response.
My argument is that we need an end to the gesture politics and a radical shift in policy. The Conservatives’ rhetoric and that of their coalition partners must match the reality on the ground. If the opportunity to
“pause, listen, reflect and improve”
is the Health Secretary’s chance to engage with NHS staff, the 98% vote of no confidence against him by the Royal College of Nursing must have been a major hiccup.
It seems to me that this week’s strategy is to let the Deputy Prime Minister flex his muscles. He said yesterday:
“Protecting the NHS, rather than undermining it, is now my number-one priority.”
Perhaps he can tell us what has changed since the White Paper was published in July last year. So far, we have heard that as a result of the listening exercise there may be tweaks to GP-led commissioning consortia to make them more inclusive and accountable, that scrutiny arrangements may be strengthened and that the pace of change from PCTs to GP consortia may be slowed. If that is all the Deputy Prime Minister can negotiate as No. 2 in the Government, it demonstrates, particularly to his own supporters, that he has prostituted his party and the NHS for a position in power.
The Deputy Prime Minister must take heed of the lesson from the Royal College of General Practitioners:
“Intensifying competition in the NHS will lead to the service breaking up, drive up costs, damage patient care, and mean less integration of services.”
The future of the NHS requires him to put aside gesture politics and use his clout to force out the central privatising elements of the Bill; drop Monitor, the economic regulator of the health service; protect national pay terms and conditions for NHS staff; and limit the ability of private health care companies to enter the NHS at every level. He must ensure that the Government do not privatise the health budget, but bring GPs and other health professionals into PCTs to achieve clinical excellence in commissioning, without there being ulterior motives for private profit.
I know that time is short and that many Members wish to speak. My final point is that if the Deputy Prime Minister is serious about protecting the NHS and achieving substantial and significant changes to the reforms, he must force his coalition partners to drop the Bill and start again.
Dr Sarah Wollaston (Totnes) (Con)
I have no doubt that one of the main reasons I was elected to the House was that I promised to bring my clinical experience to bear on the health debate and to stand up for our NHS. I would therefore like to set aside party politics for a moment and give my personal take on the direction that I hope the proposed reforms will take and where we should go from here.
At the heart of the Bill lie issues of choice, competition and clinical commissioning. My right hon. Friend the Member for Charnwood (Mr Dorrell) set out clearly the huge funding challenges that face the NHS. We have always had rationing in the NHS, but we are squeamish about discussing it. In an ideal world with unlimited resources, unrestricted choice would of course be a good thing, but it is not deliverable. Because of the limited budget, we need to focus on getting the very best value while openly and honestly involving communities in how we do that fairly. If that happens locally, one person’s local commissioning becomes another person’s postcode lottery.
The central problem with unrestricted choice in the form of the “any willing provider” model is that it forces commissioners to act as bill payers and has the potential to undermine good commissioning. What is the point of commissioners designing high-quality, locally responsive clinical pathways that deliver good value for money for the whole community if patients have a free choice of any willing provider and commissioners have no choice but to write the cheques?
Mr Umunna
The hon. Lady has long experience of working in the sector. One of my concerns about the “any willing provider” model is how it will potentially disadvantage teaching hospitals. [Interruption.] The Minister of State, the right hon. Member for Chelmsford (Mr Burns), might want to listen to this, because one of the hospitals involved is St Thomas’s, which serves the House, and if he fell ill here he would probably go over there. One of my concerns is about how teaching hospitals will be able to compete with other providers given the extra burdens of training and supervising those who are learning to work in the NHS. Does the hon. Lady share that concern?
Dr Wollaston
Of course, one of the greatest burdens on many hospitals is that of the private finance initiative, and I will come to the issue of training later. I am not opposed to competition in the NHS, but it should not be an end in itself. It can have a role in improving some services—take, for example, the provision of mental health services and talking therapies, on which I am repeatedly told that the voluntary sector delivers better results. If I were facing a long wait for an MRI scan, for example, I would not mind if it was provided by the private sector as long as it was free to me at the point of use as part of the NHS.
The point is that competition should be used only where there is evidence that it can deliver real benefits for patients and value for money for the whole patient community. If competition becomes an end in itself, that can actually increase costs and risk fragmentation. For that reason, I hope that as the Bill moves forward, there will be fundamental changes to the role of Monitor. The NHS cannot operate like a regulated industry, and I believe that concern about the proposed role of Monitor is the impassable barrier to co-operation from the professions, without which we will not achieve the great success that we need from these reforms.
We must return to the original promise of the reforms, which was about clinical commissioning and a focus on outcomes rather than targets. For years, commissioning has failed because decision making in primary care trusts has not been clinically led. The NHS has been dogged by illogical care pathways, top-heavy management and a target-driven mentality, often completely divorced from any evidence base. The idea that clinicians should be put at the heart of decision making is still very sound, and it has become divisive only because of the stipulation that GPs should hold all the cards and be the sole commissioners.
Where clinical commissioning is already successful, that is achieved through a collaborative process with multi-disciplinary input. I hope that as a result of the Government’s welcome listening exercise, the call to broaden the membership of commissioning consortia will be heeded, along with the need for a more graduated and phased introduction so that consortia are authorised only when they are ready. The same should apply to foundation trusts. They should take on functions only when it is right for that to happen.
If commissioning consortia are to achieve the best results for their patients, they will need to focus on the integration of health and social care, as my right hon. Friend the Member for Charnwood said. I pay tribute to Torbay, which was at the forefront of moves that were widely applauded nationally and internationally, including by the King’s Fund, and that achieved real results for patients, driving down unnecessary admissions and improving outcomes. The integration of health and social care is complicated to achieve, so perhaps Monitor could have a relevant role in it—not arbitrating in disputes about competition law, but driving down costs and facilitating integration. We know that splitting tariffs, for example, could benefit community hospitals. Again, that is complex to achieve, so perhaps Monitor could also help in that regard.
For consortia to succeed, not only do we need to focus on the make-up of their boards, but they must be geographically logical and, I am afraid, cater for geographically defined populations. Giving a free choice to register with any consortium risks encouraging consortia to cherry-pick their patients. One striking feature of the Bill is its sheer scope. All junior doctors will remember the fiasco of MTAS—the medical training application service. We currently have a successful model of deaneries in this country. I hope that we can retain them as the Bill goes forward, because they have a vital role to play in encouraging quality. Of course they are not perfect, and they need to look at regional variants, but we should keep our deaneries.
Speaking of quality, at present, PCTs play a vital role in maintaining what is called the performers list, on which all GPs have to be registered in order to practise in an area. As we move forward, we need to clarify who will take over that role. That is particularly important because we have a crisis with many doctors coming here, particularly from the European Union, who do not speak adequate English, as we saw in the case of Dr Ubani. We need to ensure that the person responsible for the performers list can get rid of this nonsense, so that all doctors not only have the necessary qualifications, clinical skills and experience, but have good spoken English.
I welcome this listening exercise, which I believe is genuine, and I hope that the Opposition will engage with it constructively. The public’s affection for the NHS is well justified. At its best, the NHS is outstanding. Where that is the case, it is not competition that has delivered those good results, but a relentless focus on what is right for patients. We need to do the same in this House.