Health and Social Care

Debate between Clive Betts and David Mowat

Monday 27th February 2017 Commons Chamber

[David Mowat]

The money is what we were asked to provide by NHS England’s senior management, and we provided it. At that time, the chief executive said that the Government had listened and acted. That is what we did, and that money is now available. That is not the same as saying that we do not accept that the system is under pressure in certain ways. Again, though, we talk about the money that is being spent in France and Germany. In Munich, 15 of the city’s 19 hospitals stopped taking people in over this winter. Right across the world—this is the point—there are challenges in national health systems, and we need to work to ensure that money is spent as effectively as possible. We know that £120 billion will be in our health system in 2020. What this Government have to do and what this ministerial team is doing is ensure that every penny is spent as effectively as possible.

We have talked about the five year forward view, and I accept that we are two years into it, but we know that the health system must tilt back towards community health, and the STPs are part of making that happen. We know that we need to get better than we are so far in terms of mental health and parity of esteem.

[Mr Betts]

I think the STP approach is capable of being a good one. The problem is that when I go to the chief executive of the Sheffield Teaching Hospitals NHS Trust, Sir Andrew Cash, who is respected in government as well, he tells me that the process of transferring resources to the community will not work unless there is some transitional upfront funding for the whole process. We cannot stop doing what is being done in the hospitals and simply transfer it to the community.

[David Mowat]

He is right about that. NHS England is evaluating the STPs at the moment and during March and April, and it will decide which STPs are high priority, which will be invested in and which will be taken forward at speed. We heard the phrase “accountable care organisations” used earlier, and it is the Government’s intention to ensure that those high-performing STPs that we proceed with—it will not be all of them; frankly, the standards are variable and locally driven—will in time become accountable care organisations.

The shadow Minister asked me to talk about social care, and I will do so. During the present Parliament, accessible funding for social care has risen by 6% in real terms; it fell during the last Parliament. Last year 42% of councils increased their social care budgets in real terms, and in December £900 million was provided in new homes bonus payments.

--- Later in debate ---

[David Mowat]

The Care Act 2014 was introduced by this Government, and it has transformed social care, although we accept that the system is under pressure. The number of delayed transfers of care in Newcastle, St Helens, Bedford and Nottingham is nil. The Chairman of the Public Accounts Committee, the hon. Member for Hackney South and Shoreditch (Meg Hillier), said that she had been told by Simon Stevens that if the top-performing councils—in terms of delayed transfers—were emulated by all the rest, the consequence would be very small. The truth is that there is a 30 times difference between the top 10% of councils and the bottom 10%.

[Mr Betts]

Will the Minister give way?

[David Mowat]

No. I have given way to the hon. Gentleman twice already, and I need to finish my speech in two minutes.

We accept that there are challenges and pressures in social care, but we also know that we need to make progress in mental health care, and we are doing so by working towards parity of esteem. By 2020, there will be 5,000 more doctors in general practice and 2,000 more pharmacists. We have talked about the need for more pharmacists. I visited a pharmacist’s practice in Perivale on Friday, and I know that we can transform the way in which general practices work. There will be 3,500 mental health therapists as well.

Nearly 3 million people work in healthcare, in the NHS and care sectors. Many of them are remarkable people doing remarkable things, and they deserve our support. It is important for us not to weaponise this entire discussion. It is important for us not to produce election leaflets about dead babies, and all that that means. Our healthcare system and the NHS deserve our support, and the Government are committed to ensuring that they receive it. I commend the estimate to the House.

BIS Sheffield/Government Departments outside London

Debate between Clive Betts and David Mowat

Monday 9th May 2016 Commons Chamber

[David Mowat (Warrington South) (Con)]

It is a pleasure to follow the hon. Member for Sheffield Central (Paul Blomfield). He made a coherent speech, and I congratulate him on leading the charge on this whole issue.

Unlike the hon. Gentleman, I do not have a direct constituency interest in the matter. My interest came about because I was involved in the Public Accounts Committee’s questioning of the permanent secretary, and it struck me that the logic and reasons given for the decision were, unlike the speech we just heard, less than coherent and that they raised several potential issues about contradictory Government policy.

I am not against “BIS 2020” at all, but I do not think that we need this Sheffield closure to bring about its benefits. There are, however, potential contradictions between how “BIS 2020” is being rolled out and talked about, and the devolution, northern powerhouse and Government estate strategies. The latter came out most recently, in 2014, as a piece of analysis further to the Lyons strategy and all the rest of it, with the general intention, apparently, of trying to get civil service jobs out of London. Since 2010, we have, unfortunately, found that the civil service has become more concentrated in London than it was previously.

I am addressing my remarks not only to you and the House, Madam Deputy Speaker, but to the BIS board, who have yet to make this decision, to Mr Donnelly, who has a chance to row back from some aspects of this, and to Mr Manzoni and Mr Heywood, both of whom have responsibility for consistency of the design principles of some of these initiatives across the civil service. As we have heard, some elements of what is happening in “BIS 2020” do not make sense vis-à-vis what is happening in the Department for Education, the Ministry of Justice and other Departments. If that is not an issue for Mr Manzoni and Mr Heywood, I am not sure what their jobs are.

On “BIS 2020”, I support the need to rationalise; Ministers have been given a target on saving money and if money can be saved, we should do it, if that does not affect efficiency and effectiveness. I have heard that there are 80 BIS sites across the country and that number is to be rationalised to eight, and I have no difficulty with the principle of that. We will come on to understand whether that figure of eight should be nine or seven, and the logic behind how that decision has been made. There are 45 partnership bodies in BIS, and there is clearly a need to change. As we heard in the previous speech, the permanent secretary often says that BIS is quite a distributed Department, and I accept that. I am sure the Minister will have statistics that allow her to discuss how much of BIS is outside London currently, but that is not a logical reason to bring more of it into London in response.

The permanent secretary used a phrase when he was talking about this, saying that a “hub and spoke” strategy is being implemented in “BIS 2020”. The principle of that strategy is that all policy has to be in one place—the hub—with all the other bits being the spokes. Apparently, we have one hub, in London, where the Ministers are—perhaps that is fair enough—and these seven or eight spokes, which is what the focus is going to be on. When I first heard that, I thought, “Okay, we are going to have all the policy in one place. There could be some logic in that. Does that mean 10 people doing policy and they all have to be in London, working together? That might be reasonable. Even 20 or 50 might be reasonable.” Apparently, the number of people who need to be in one place to do policy is 1,600, and that is not a rational approach, although the question is raised as to what is meant by “policy” and by “strategy”. This is based on the advice that McKinsey has given the Department, apparently based on a relatively small amount of input. I know that you don’t get an awful lot of days out of McKinsey for £200,000, and I accept that this is a BIS strategy and not a McKinsey strategy, and that the accountability for it lies with BIS, although the phrase “hub and spoke” does come from McKinsey. We will come back to that issue and to policy.

We have talked about the northern powerhouse and the need for devolution. There is a need in our country to bring gross value added per head up to the same level—as best as we can—as it is in London. If we were able to do that, it would be great. The difficulty is that no region in the UK has more Government spending per capita than London, apart from Northern Ireland, where historical reasons are involved. We see that in the sort of decision that has been made here, and it is why we end up with a great concentration of civil servants in London and all that goes with that. At other times and in other places, we face the same issue in respect of the concentration of transport spend in London, which is partially due to London-centric thinking, resulting from the fact that so many of the civil service and top policy makers are here.

It is also true to say that cuts have been made right across the civil service since 2010. As I say, I do not oppose that, but 9% of those cuts have occurred in London whereas 20% have occurred in the regions, according to the Institute for Government. The consequence is that 18% of the civil service is now in London whereas the figure was 16% six years ago, according to the IFG, and I do not think that is acceptable. I do not think that is the right answer.

[Mr Clive Betts (Sheffield South East) (Lab)]

The hon. Gentleman is making a very coherent case. When my constituents hear the phrase “northern powerhouse”, they ask what it means. We tell them that it means transferring powers, responsibilities and decision making out of London and to the regions, but they then say, “But why are you taking all these jobs from Sheffield and transferring them to London?” Is that not completely inconsistent with what the Government claim their objectives are?

[David Mowat]

It is not for me to answer that intervention, but I would say that the answer is yes. In all fairness, the northern powerhouse is about more than public sector investment and civil service jobs; it is also about private sector investment. When the time comes to say whether the northern powerhouse has worked, the judge and jury will be whether or not the gap in GVA per head has closed—we will see. Let me make a point in defence of Mr Donnelly’s position: he might well accept the analysis that we just heard from the hon. Member for Sheffield Central about cost, but his point would be that he gets more efficiency from having all these policy makers in one place. If he were here, he would make that point—indeed, that is what he did say to the Public Accounts Committee—but it is not a view shared by other permanent secretaries. The argument runs away when he is talking about 1,600 policy makers being in that one place as opposed to 100 of them—it does not bear thinking about.

We have talked about the estate strategy, which was published quite recently, in 2014. It contained a lot of sexy examples of how the Government are saving money through Departments rationalising and moving things out of the capital. It talks about the Ministry of Justice as a case study and about what is happening at the Ministry of Defence; one startling statistic was that the accommodation costs for somebody in Whitehall were £35,000 per annum whereas if we were talking about Croydon, which is still a relatively busy place, the cost would have been £3,000 per annum—goodness knows what the figure would be for Sheffield. Clearly, what we are talking about today is contradictory to that space strategy, which is another reason why Messrs Heywood, Manzoni and Donnelly need to get their act together on this.

I want to discuss three things in a little more detail. The first is the hub and spoke strategy and the need to have all 1,600 people in one place. Mr Donnelly has said, “Well, that is what Vodafone do.” He said that to the Public Accounts Committee. He has said, “That is what Google do.” I am surprised if that is the case. I accept what he says, but I can give other examples of organisations that do not take that approach—Accenture, Shell and many others. Many of these companies would take the view that having people who are doing strategy in different geographic locations helps formulate that strategy, particularly if it is being applied across those locations. I do not feel that the argument being put forward is coherent. But if that is the policy of the civil service, why does it apply only to BIS? Why does strategy in the Department for Education not all have to be in one place, whereas in BIS it apparently does? Why does strategy in the Ministry of Justice not have to be in one place, whereas it does in BIS? At the very least it would be reasonable if the people charged with running the civil service would address that question and tell us the answer, because I have some difficulty in seeing it.

In addition, a design principle is involved there, because lots and lots of civil service rationalisation is coming up in the next decade. If a considered position of the civil service is that all policy is done in one place, let us make sure that everybody knows that when they are doing this. If that is the position, the Department for Education is doing it wrong and the Ministry of Justice is doing it wrong, and I think Her Majesty’s Revenue and Customs may be doing it wrong, too.

We have heard a great dealing about the costing of this proposal. Let us remember that “BIS 2020” has not been published and is not in the public domain. I am not going to charge, as McKinsey did, a couple of hundred thousand pounds for what I am about to say, but I am going to say that although the hub and spoke strategy may well be worth thinking about, there is a Mowat variation to it—it is the double hub and spoke strategy. It could be a model, in the same way as all these consultants have models. Given that we have a starting point with all these people in another hub, it does seem rather odd that, in the context of reducing the size of everything anyway, we have to impose this single hub strategy on the whole thing. Therefore, if the BIS board do get a chance to go through Hansard, I would like it to think about the double hub and spoke strategy and reflect on the fact that, almost certainly given the analysis that we have just heard from the hon. Member for Sheffield Central, it will save money as well as being equally effective.

Finally, there is a policy point about the civil service and the role of London. We have mentioned the fact that it is the major location of civil servants, especially the more senior ones. It is not an entire coincidence that the consequence of that is that current public spending in London is significantly higher per capita than any other region of the UK. This sort of decision will exacerbate that issue. As I said in the Public Accounts Committee, it just does not smell right.

I say to the BIS board that, before it signs off this proposal, it should ensure that it has asked some of the same questions that have been asked today and that will be asked later on this afternoon. Similarly, I say to Mr Manzoni and Mr Heywood that there are points of coherence in BIS vis–à–vis other Departments here and that they need to satisfy themselves that they are happy that rational decisions are being made across the wider civil service. Mr Donnelly, who is the owner of all of this in terms of the civil service, needs to reflect on whether the hub and spoke system is worth dying in a ditch for, or whether a double hub and spoke strategy, which would save money, would be a much more sensible system. If, in order to achieve design purity, we have to go through a NAO audit of costs and sensibleness, then so be it.

Rebalancing the UK Economy

Debate between Clive Betts and David Mowat

Wednesday 3rd November 2010 Westminster Hall

[David Mowat (Warrington South) (Con)]

The right answer to the question of how to rebalance the economy is not to shrink the financial services sector. However, the fact remains that we have the largest financial services sector in relation to the rest of the economy of any advanced economy; the financial services sector accounts for something like 27% of our economy. The interesting policy question is whether we want that percentage to increase as a percentage of the whole or whether we want everything in the economy to increase together.

I think that you also raised a point about the public relations problems that banks are suffering at the moment. Of course, banks have made a huge contribution to our economy, but during the last two years they have sucked in something like £150 billion-worth of Government money and they are not really answering the question about how they should restructure themselves. That question has been left to the Bank of England and others—whether through the Glass-Steagall Act, or whatever—to answer. Until the banks do that themselves, they will continue to be criticised over bonuses.

[Mr Clive Betts (in the Chair)]

Order. I want to say something to the three hon. Members who have made interventions. It is fine that you made interventions, but on each occasion you have used the word “you” as part of your comments. This is just a small reminder—I did not want to stop you in mid-flow.