A&E Provision: Shropshire and Mid-Wales

Debate between Daniel Kawczynski and David Mowat

Wednesday 11th January 2017 Commons Chamber

[The Parliamentary Under-Secretary of State for Health (David Mowat)]

In the few minutes available I shall give the House a recap, describing the process that we have undergone, the impasse that we have reached, and what it has been suggested we do to bring about a decision. I agree with my hon. Friend the Member for Shrewsbury and Atcham (Daniel Kawczynski) that it is important for us to make that decision and to get it right. The provision of better A&E services for the whole county in a way that works for everyone should not be the divisive issue that it has become.

First, however, I think it appropriate to reflect on the 2.7 million people who work in the NHS and the care system and to acknowledge and congratulate them on the work that they do. Today, as every day, some 2 million people have used A&E services across the country. Let me also say that my hon. Friend the Member for Shrewsbury and Atcham has worked diligently on this issue, as have other Members, including my hon. Friend the Member for Telford (Lucy Allan). I know that it is difficult for them to get this right for their constituents.

At the beginning of his speech, my hon. Friend the Member for Shrewsbury and Atcham made the important point that, ultimately, this must be a local decision. It is not a decision for Ministers, and it will not be imposed. It will be made by the local governance bodies that have been established, notwithstanding the present impasse.

Let me summarise what has been happening. This is a tale of two CCGs and a hospital trust providing services across Shropshire—in Ludlow, Bridgnorth, Oswestry and Shrewsbury—and, indeed, in mid-Wales, including Powys. I agree with my hon. Friend the Member for Montgomeryshire (Glyn Davies) that we need to get this right for the people of Wales as well. The process has been going on for a long time, but the driver for change is not financial. We are finding it increasingly difficult to staff the two A&E centres in Telford and Shrewsbury. Rotas are not being filled, and it is feared that unless we find a robust solution, there will be safety issues and it will not be possible to keep the centres open for as long as we want.

My hon. Friend the Member for Shrewsbury and Atcham observed that this was not a new issue, and that is certainly true. I understand that it is being discussed locally and that projects have been reviewing it since about 2005 without a solution being found. The Future Fit project was set up in 2013. As has been said, the process ended at the end of last year with a preferred option, which was, in broad terms, that emergency care should be centralised in Shrewsbury, with urgent care continuing to be in both locations. I heard it said in the debate earlier that that would mean most patients would continue to be served closer to where they are, either at Telford or Shrewsbury.

On the governance issue, the report of the Future Fit process was voted on by members of the two CCGs, who have broadly a 50% share in that decision, and the result was a tie. Indeed, Telford CCG raised concerns about the methodology of the process and the appraisal techniques used and whether it was robust and fair. As a consequence, there has been no agreement and we have reached our current impasse.

I understand that at the end of December an editorial in the Shrewsbury Star—

[Daniel Kawczynski]

Shropshire Star.

[David Mowat]

Sorry, an editorial in the Shropshire Star—it is not a newspaper I read—made the point that we now need to get this right; we need to make a decision and to stick by it. I think everybody in the Chamber would agree with that, with the caveat that in the end it has to be a local decision. There are very real battle lines here; I think my hon. Friend the Member for Telford met the Secretary of State yesterday on this with other Members and council leaders.

What is the proposed way forward? My briefing from the CCGs is that a week today there will be a meeting at which the intention is that two things happen. The joint committee will be reconstituted and an independent chair appointed who will have a casting vote. In parallel with that, there will be an appraisal, or review of the appraisal process, that Future Fit takes, with the intent to address the concerns raised by Telford about whether it was robust. At the end of the review—depending on the outcome, I guess—there will be a new vote with a view to potentially having a majority on one side or the other and therefore there will be a local direction. That is my understanding of the way forward.

[David Mowat]

I have been advised that the timescale is in the order of eight to 12 weeks, but it remains a local decision. That is what we hope and expect to be the case.

In finalising my comments, I want to make a couple of observations.

[Daniel Kawczynski]

I am pleased with the Minister’s announcement; hopefully we will see a conclusion to this. May I appeal to him to take an active interest in the process in these eight to 12 weeks because the integrity of this devolution of power is at stake unless we empower the clinicians to take the decisions we have ultimately empowered them to take?

[David Mowat]

I am happy to agree to that, although I should have said at the start of my remarks that in the normal course of events this debate would have been answered by my ministerial colleague, my hon. Friend the Member for Ludlow (Mr Dunne), as he is the Minister with this responsibility, although he is not independent on this, so it is appropriate that I answer for the Government.

Once the decision has been taken and a consultation occurs, a component of the proposal will require capital. Various numbers have been floated around, one of which is £300 million. I do not believe that NHS England has yet confirmed that that capital is available, so there is a hurdle to be overcome once a local decision has been taken. I do not want to raise expectations that the process will necessarily be straightforward. This is the way in which the process will occur, as I am sure colleagues would expect. If, as a result of that stage, capital is awarded, there is the potential for those on either side of this discussion to take the configuration proposal to the independent reconfiguration panel. That is always the case in such processes, and the panel can accept or not accept what has been suggested. That is the normal process in the NHS.

I want to make one final point to all my colleagues, who are so keen to get this right for their constituents in Telford and in Shrewsbury. I ask them to remember that the NHS is not just about bricks and mortar. We often have discussions about the bricks and mortar, but I want gently to point out to right hon. and hon. Members that there are other things that they should be holding their clinical commissioning groups to account for. They should be looking at cancer performance, cancer survival rates and maternity performance, for example. There are many aspects of the NHS that are not about bricks and mortar, and it is important that Members should recognise that when we debate these matters.

Question put and agreed to.

Home Affairs

Debate between Daniel Kawczynski and David Mowat

Tuesday 10th June 2014 Commons Chamber

[David Mowat (Warrington South) (Con)]

It is always a pleasure to follow the hon. Member for Perth and North Perthshire (Pete Wishart). I have been desperately trying to think of something that I could agree with him on at the start of my remarks, but we will just have to let that pass.

I support the provisions in the Queen’s Speech. There is a great deal in it about modern slavery, about child protection, on which we heard from my hon. Friend the Member for Erewash (Jessica Lee), and about trafficking. In particular, there is a great deal about cybercrime and strengthening the legislation around disabling IT systems. We need a reorientation in the criminal justice system to address that issue, which is a massive and growing problem that threatens not only financial loss but organisations’ economic stability.

Of the 11 Bills in the Queen’s Speech, I want principally to address my remarks to those on pensions tax and private pensions, and the Bill on infrastructure and what it means for our energy security and for fracking. The pensions legislation was described by the Prime Minister as the centrepiece of the Queen’s Speech, which in many ways it is. It is hard to think of an issue that affects so many people so much as what they will have to spend in retirement. We have systematic under-provision of retirement income throughout the country. There is a rule of thumb that says that pensioners are divided into three slugs of a third each. One third broadly has some kind of public sector pension, possibly not enough, but nearly always more generous than the next third, who are broadly in some kind of private sector scheme. Increasingly, the gold-plated private sector schemes have been closed, but even those people are better off than the final third who have no provision at all. The pension reforms in the Queen’s Speech, and lately in Parliament, have addressed those last two-thirds.

In the comparison between public and private pensions—this is not a dig at public pension provision; we need good and generous provision—it is worth reflecting on the fact that a pension that is inflation-proofed at around £15,000 per annum would cost £400,000 to purchase in the private sector. Virtually no one can do that. The average pension pot in the private sector is about £35,000. A problem is about to hit us.

The structural issue in the UK comes of a policy point versus the EU. We have chosen to pay relatively low pensions to people on the assumption that they will be topped up by the private sector. Nearly every other country in Europe has chosen not to go down that route but has higher provision. The Pensions Minister has made some progress in addressing that. We have paid £40 billion per annum tax relief into the pension system to mitigate this problem, but it has not worked and it is not working. There is a massive distrust of the pension system among the punters out there. I have lost count of the number of people who have told me that they would rather bite off their right arm than invest in a pension. Typically, that is because there is a view that so much goes in charges. There has been a market failure. For a pension pot, about 30% or 40% can go on charges, and the provisions need to address that.

The same is true of annuities. Until quite recently, pensioners have been buying annuities without going on the open market. There have been inconsistent and inappropriate products. In my constituency, about 1,200 people per annum are buying an annuity, of whom more than a half are buying the wrong product. That is just wrong. This is compounded by the auto-enrolment initiative and its success, making the need for action even stronger.

The Government have introduced legislation to allow small pots to be combined; they have provided a cap on pension charges at 0.75%, half the amount the Opposition had in terms of stakeholder provisions; they have dramatically and structurally changed the annuity rules so that annuities no longer need to be taken out, which has burst the whole market wide open; and they have removed many of the abusive features of pension funds, such as active market discounts whereby pensioners who remain in a pension fund having left the company pay more in charges. Most interestingly, in this Queen’s Speech they have brought forward a collective defined contribution idea, which is a paraphrase of the Dutch solution, to try to make progress on costs. Broadly, the assumption there is that there is a collectivisation of risk with pension schemes coming together with the idea that costs will be reduced, which I very much hope happens. There is evidence that in Holland the average pension is 20% to 25% higher than in the UK. The collective schemes may be one reason for that, and another is a much higher propensity to use passive investments. I very much welcome what is going on in that area.

It is worth pointing out that in Holland these collective schemes, which are brought forward in the Queen’s Speech, tend to be industry-specific. Pensioners share the risk, but there is also an element by which pensioners can be penalised, even after they have retired, something which is not currently allowed in UK law. There is therefore an intergenerational issue to be fixed there, but it is an important first step, which I support.

In summary, the Government have addressed some of the issues in the pensions industry, including under-provision in the private sector, but there will remain a massive problem, which I have not talked about at length. The £40 billion of tax relief that we have put into the pension system is to a large extent misdirected, and at some point some Government will have to address that and make progress on it.

The Infrastructure Bill, and the encouragement it gives to the exploitation of unconventional gas, either coal gas or shale gas, is important in relation to the three tenets of our energy policy—decarbonisation, lower cost and security of supply. We hear a lot about whether we should frack. Is it important that we do so? We talk as though it is an option, as though no one else is fracking.

The world has changed when it comes to fracking. It changed about five years ago when the United States went into the industry at great velocity. That changed our entire energy supply market. It is now a net exporter of energy and gas, as opposed to an importer. That has implications for its foreign policy—what it does in the gulf of Arabia and all that goes with that—but even more important in terms of how it relates to us is the fact that now its chemical feedstock and electricity costs are one-third of what ours are in the UK. That is a massive competitive change; it is a game-changer. The consequence of that is not necessarily whole businesses immediately moving from here or from Germany to America; it is rather that a new unit or distillation plant in Teesside or the north west will now be built by global companies in America to take advantage of costs that are one-third—not 10%—cheaper than ours. We have to address this situation.

[Daniel Kawczynski]

I do not know about my hon. Friend’s constituents, but this week alone I have received more than 100 letters from mine who are concerned about fracking. Does he accept that the Government need to do more to convince British people of the need for fracking, and what is his constituents’ perception of fracking?

[David Mowat]

I thank my hon. Friend for his intervention. I accept that we need to do more to convince people that we need fracking; that is one of the reasons I am making a speech about it. It is a little bit about leadership—if we think something is the right answer, we go with it.

I do not want to say that there are no environmental issues associated with fracking, and of course it is important that we frack in the right areas; there will be some places where we should not frack and some places where we should. All that is true, but it is not a reason to turn our backs on this industry. The case that I am putting to my hon. Friend and to other Members is that the world is already fracking. This week, Germany gave the go-ahead for fracking; it had been reluctant to do that, but did so under pressure from its industry. We need to decide as a country how competitive we wish to be, but one of the vehicles of being competitive is cheap prices for energy and chemical feedstock, and fracking is one of the ways in which those cheap prices will be delivered.

There are three tenets of energy policy, the first of which is decarbonisation. Fracking—or gas, I should say—is an element of any decarbonisation strategy that we seriously wish to pursue. In this country, something like 50% of electricity comes from coal and oil. Replacing that coal and oil with gas is the single quickest and most effective way of reducing our carbon footprint. Indeed, of all the countries in the OECD, the one that reduced its carbon by the most in the last five years is the USA. It has done that because it has reduced its coal expenditure and usage, and instead used gas.

The UK—perhaps slightly counter-culturally—already has one of the lowest amounts of carbon per capita and per unit of GDP in the EU. A strategy based on replacing our coal with gas, and doing so more quickly, would lead to even more progress in that regard.

I have talked a little bit about cost, but it is self-evident that there is a correlation between GDP and energy usage. We cannot rebalance our economy on differentially high energy prices, particularly if we are rebalancing it towards manufacturing, and part of the solution is cheaper gas prices.

It has been said that our having unconventional shale gas in the UK does not necessarily reduce prices, and to an extent that is true. However, it is rather like saying we should not have exploited North sea gas or oil 30 years ago because there is a world market for North sea oil and we cannot guarantee that lower prices would—