Department of Health and Social Care and Ministry of Housing, Communities and Local Government

Diana Johnson Excerpts

Monday 2nd July 2018 Commons Chamber

[Dr Wollaston]

Yes, and I am going to say more about that, because Manchester has benefited from transformation funding. I want to talk about not only the benefits of integration, but how we can ring fence transformation funding. I welcome my hon. Friend’s comments.

Returning to the recent announcement, a £20.5 billion a year uplift by 2023-24 for NHS England is welcome and represents a 3.4% average increase over five years. Importantly, it is front loaded, with 3.6% in the first two years, and comes on top of £800 million that has already been promised to fund the Agenda for Change pay rises. However, the announcement should not be the end of the story, because it refers only to NHS England and does not include social care, public health, capital or, importantly, training budgets—staffing is crucial to making all this work.

Of course, the Prime Minister acknowledged that and promised to come forward with a settlement for social care and public health in the autumn. However, we need to be clear right from the outset that we must have a social care settlement that reflects demographic changes, because we will need an increase of 3.9% in funding just to stand still. If we want to do something to address quality and to allow social care to do more, we need to go substantially further. That will be essential if we want to get the most out of the settlement that has already been announced for NHS England.

[Diana Johnson (Kingston upon Hull North) (Lab)]

Returning to the hon. Lady’s point about public health not being part of the recent announcement, has she seen the 2017 review that highlighted that there is a return of over £14 for every pound spent on local and national public health policies? It therefore makes economic sense to invest in public health, not to cut it in any future announcement.

[Dr Wollaston]

I absolutely agree. This is about not just funding for public health, but the policy levers. We do not need lots of talk about the “nanny state” that denigrates important national public policy drivers, because although we need funding for local services, as the hon. Lady says, this is also about the policy environment that is necessary to make important changes. Investing in public health makes a huge difference for people.

One of the problems here is that when the public are asked where they would like the priorities to fall, we often hear, understandably, about the importance of cancer outcomes, mental health and emergency waiting times. Public health is often bottom of the list because nobody necessarily knows when their life has been saved by a public health policy. The reality is that the major changes and achievements relating to life expectancy have arisen largely thanks to public health policy, but we rarely turn on the television and see a programme called “24 Hours in Public Health”, which is a shame.

--- Later in debate ---

[Luciana Berger (Liverpool, Wavertree) (Lab/Co-op)]

It is an honour to take part in this debate in the week we celebrate the NHS’s 70th birthday. I thank the hon. Member for Totnes (Dr Wollaston), the Chair of the Health and Social Care Committee, of which I am proud to be a member, for all the important work she does.

Many of us have been active, particularly in the past week, in doing lots of work on our local health services and in campaigning on national things. Today’s debate is important because it comes in the wake of a number of reports. We have obviously had the report from our Select Committee, which considered the long-term funding of adult social care. In the past few weeks alone, my colleagues on both sides of the Committee and I have attended the presentation of reports on the funding of health and social care from the Institute for Fiscal Studies and the Health Foundation, co-ordinated by the NHS Confederation. We have seen reports from the Institute for Public Policy Research and a number of others.

Collectively, all those reports, including our own, have raised the challenges that our health and social care system faces, and those challenges are not news. We are not sharing a new story, and, in the context of this debate, it is not just about the money that is available for our NHS. Ultimately, we are all here because we want to ensure that we continue to have a national health service that is free at the point of use for all who need it, and that goes hand in hand with the provision of social care.

In my city of Liverpool, we have seen social care devastated in the eight years since 2010. We have seen our Government grant slashed by 60%. Social justice is a real issue, because we know that the north of England has been particularly and disproportionately hit by cuts to local authority budgets. Those cuts have been larger in the most deprived areas. Looking at the figures, we see that the 30 councils with the highest levels of deprivation have made cuts to adult social care of 17% per person, compared with 3% per person in the 30 areas with the lowest levels of deprivation.

That cannot be right, and it pains me, particularly when I speak to constituents on a weekly basis who are affected by this, because they have seen their social care packages taken away, or now cannot access them, or they have seen family members stuck in hospital because there is no social care package for them when they are ready to leave, and/or they are turning up at the doors of A&E because they are not receiving social care in their home.

[Diana Johnson]

Will my hon. Friend comment on the social care precept that local authorities can use to raise additional funding? In the poorest areas, because the council tax base is so low, the precept does not generate sufficient money to fill the gap and provide social care.

[Luciana Berger]

I thank my hon. Friend for that important contribution. To give an idea of what it is like in Liverpool, we do not raise enough in council tax to cover our social care bill alone. That is before we consider all the other services that our local authority has a responsibility to provide in our area. This is a critical issue. The onus has now been transferred to local authorities, with all the costs that come with it, and it is particularly difficult. We have seen a reduction of 7% in the total number of people in receipt of a care package, yet in the same period we have seen demand for support—measured by the number of referrals and requests for help—rise by 40%.

It is important that in this debate we are considering not just the funding that goes to health—we have heard the hon. Member for Totnes speak eloquently about the funding announcement and some of the challenges in what is not included. In particular, we are waiting to see what funding there will be for social care. We cannot divorce social care funding from the NHS. The two go hand in hand, and this is a critical issue—our Select Committee heard evidence on that only today.

The Minister has heard about this on many occasions—one of my hon. Friends will be raising this later, too—but the sleep-in care crisis is a particular issue for social care. Not only do we have this chronic underfunding in the care sector but we are also seeing a complete lack of Government guidance on payments for historical sleep-in care shifts. Social care providers, many of them in the charitable and voluntary sector, are facing a back bill of £400 million, and one provider has already been forced to close. A recent survey found that two thirds of those charities are now at risk of going out of business, and the Government urgently need to address the situation.

I listened closely to what the Minister had to say at Health and Social Care questions, and I hope she might have a new answer for us today, because this situation cannot continue. We had a meeting in Parliament where we heard at first hand from not only providers but people in receipt of care, some of them personal budget holders who will be personally liable to Her Majesty’s Revenue and Customs when they are expected to pay back this historical claim. I hope that the Government and this Minister will share with this House exactly what they are going to do on that, because time is ticking by and by March of next year these providers are expected to pay, as I understand it, £400 million. That could be a serious further detriment to the care sector.

I wish to finish by talking about something a little different, although echoing some of what we have just heard, on the issue of prevention and how we keep people well, which is important in the context of this debate. As I have said, many things have not been included in the Government’s announcement of the funding that is coming to our NHS. We do not know about transformation funding, capital spend or funding for Health Education England for the education of staff. All these elements are very important, but of particular importance is public health spending, which has been decimated over the past few years, to the extent where, as we have heard just today, smoking cessation services have been cut by more than 30% in the past year alone. That is just one example and it is not commensurate with the reduction in people smoking in our country. We need to think actively and urgently about how we have a wholesale reappraisal of how we keep people well in this country.

I want to ensure we have a national health service in 70 years’ time. It is all very well celebrating the anniversary today, but when it is increasingly contending with lifestyle-related disease, we have to be doing everything possible to keep people well, and that starts from conception. We have to address the whole area of what we do for the under-fives, as that is completely ignored at the moment and its funding has been decimated again. I urge the Government to share with the House what they are going to do to keep people well.

Childhood Obesity Strategy: Chapter 2

Diana Johnson Excerpts

Monday 25th June 2018 Commons Chamber

[Steve Brine]

Yes. I am absolutely clear that there are three parts to this particular puzzle: there is Government, and using the power of Government for things like a sugar tax, which clearly only the Government can do; there is business, and the reformulation we are seeing from many, many businesses is impressive and helpful; and there are parents. Parental responsibility is central to this—we cannot do it without them—but we are going to give them information to help them do it.

[Diana Johnson (Kingston upon Hull North) (Lab)]

The Minister’s Conservative Government introduced a tax on sugary drinks, which worked because, as we know, manufacturers have reformulated their drinks. Why does he not accept that the voluntary approach to high-sugar food is not working? Why does he not introduce regulation to cut sugar in the high-sugar foods marketed at families?

[Steve Brine]

The hon. Lady and I went through this at oral questions just last Tuesday. There is a two-part approach: the stick and the carrot. As a carrot, we have a sugar-reduction programme on fizzy drinks, and my colleagues at Public Health England are doing a calorie-reduction programme—working closely with the industry, and with great success, to reduce calories through changes to recipes and portion sizes, for instance. Yes, sometimes the Government need to wave a stick, but there are also times when they need to encourage and to help along the way. We are going to do both.

Gosport Independent Panel: Publication of Report

Diana Johnson Excerpts

Wednesday 20th June 2018 Commons Chamber

[Mr Hunt]

Yes, I will absolutely do that. I ought to say that I know my hon. Friend met many families and relatives during his time as a Minister in my Department, and he always dealt with those cases with a huge amount of compassion. The facts of the matter are, according to the report, that 650-plus people had their lives shortened, but we are in touch with only about 100 families, so we are expecting more people to come forward.

[Diana Johnson (Kingston upon Hull North) (Lab)]

I, too, join in the comments that have made about the remarkable work of Bishop James Jones—not only in this important report, but on Hillsborough and on mediating with the Government last summer about moving the contaminated blood inquiry away from the Department of Health. I seek an assurance from the Secretary of State about the approach that Bishop Jones has put forward, which is the “families first” approach. Is there now a commitment from the Government to making that approach—families first—the hallmark of any inquiry that is ever held in the future?

[Mr Hunt]

I think actions speak louder than words. Such an approach is what Bishop Jones requested on this occasion, and we have done that. We obviously need to think through some process issues, because when a Minister wants to report to the House, they need to be a little bit informed as to what they are talking about. However, I think we have found a way to do that with this report and with the Francis report, so I think it is a good template.

Oral Answers to Questions

Diana Johnson Excerpts

Tuesday 19th June 2018 Commons Chamber

[Steve Brine]

Since we published the plan, progress has been made on sugar reduction. The amount of sugar in soft drinks has been reduced by 11% in response to the industry levy, and Public Health England has published a detailed assessment of progress against delivery of the 5% reduction for the first year. Progress is good, but it is not good enough, which is why we have said that we will produce chapter 2 shortly.

[Diana Johnson (Kingston upon Hull North) (Lab)]

The Minister says that progress is not good enough, so why does he not introduce a levy on high-sugar food as well as the one on sugary drinks? Manufacturers would then reformulate the food that they produce.

[Steve Brine]

Because we believe that there should be a mixture of carrot and stick. We believe that the soft drinks industry levy has been successful, but we are also working with the industry on reformulation across the board. I recently visited Suntory, which makes Lucozade and Ribena. If we work with industry, we see transformative results for companies and for the people who buy their products.

NHS Long-Term Plan

Diana Johnson Excerpts

Monday 18th June 2018 Commons Chamber

[Mr Hunt]

I am happy to do that. My hon. Friend asks the same question as my hon. Friend the Member for Stafford (Jeremy Lefroy). These matters are now decided at arm’s length by NHS England because we think that the fairest way is to take the politics out of it, but I am happy to work with him to engage with NHS England on the Cornish questions.

[Diana Johnson (Kingston upon Hull North) (Lab)]

I listened to what the Secretary of State said earlier about how there can be no transformation of the NHS without a proper emphasis on public health. How will the planned £800 million of cuts to public health help with that transformation, particularly when it comes to tackling the child obesity crisis, the growing sexual health services crisis and the cuts to addiction services, which are causing enormous problems for individuals and the communities now having to deal with them?

[Mr Hunt]

I fully recognise the pressures the hon. Lady is talking about. I said what I said about public health because I do not believe there is a sustainable long-term solution to NHS funding pressures unless we have an equally sustainable solution for public health, and indeed for social care, which she also talks about. She will have to wait for us to negotiate our next spending review settlement to understand how we intend to address those.

Learning Disabilities Mortality Review

Diana Johnson Excerpts

Tuesday 8th May 2018 Commons Chamber

[Caroline Dinenage]

I thank my hon. Friend for raising that important issue. Sepsis is a silent killer. If not identified early, it can lead to life-changing implications or death. She is right that we have made great steps in addressing sepsis. Only a couple of weeks ago, we launched a new e-learning tool to help healthcare professionals better identify the symptoms of sepsis, particularly in children, so they can tackle it early.

[Diana Johnson (Kingston upon Hull North) (Lab)]

The Minister has spoken a lot about being committed to improvements in this area. Does she think it is acceptable that she did not know a report in this important area was to be published on Friday? Why did she not come to make a statement today, rather than waiting to be summoned to the House by my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley)?

[Caroline Dinenage]

What is unacceptable is that people with learning disabilities have poorer health outcomes than the rest of the population, which is why NHS England commissioned this piece of work and why we are determined to address it.

Breast Cancer Screening

Diana Johnson Excerpts

Wednesday 2nd May 2018 Commons Chamber

[Mr Hunt]

My right hon. Friend is absolutely right, and I assure him that the review being done by Lynda Thomas, one of the most senior cancer campaigners in the country, and Professor Gore, one of the most senior oncologists in the country, will look at what lessons can be learned for the entire cancer programme, and not just at the specific issue of why this particular IT problem occurred.

[Diana Johnson (Kingston upon Hull North) (Lab)]

The statement the Secretary of State has made today is truly shocking, and many women and their families will be very worried this afternoon. The Secretary of State said that it is estimated that 309,000 women in this group are still alive and that the first 65,000 letters are going out this week. Why are the letters not going out this afternoon to all 309,000 women? Why are we having to wait until the end of May to put at rest the minds of these women and their families?

[Mr Hunt]

That is a reasonable question, and I assure the hon. Lady that we are sending these letters out as quickly as we possibly can, but we felt that, even though we are not able to send them all out this afternoon—for example, because we have to reconcile with the clinical databases in Scotland, Wales and Northern Ireland for women who have moved to those areas and that is going to take place later this month—it was important to come to the House as soon as possible, without delay, to inform Members that this was happening. There will be a period of a few weeks during which people will have to wait to see if they get one of the letters, and we fully appreciate that that will cause a lot of worry to the women involved.

NHS Staff Pay

Diana Johnson Excerpts

Wednesday 21st March 2018 Commons Chamber

[Mr Hunt]

I am happy to do so. Work-life balance is something that we need to handle a lot better. I think we have been slow to recognise that today’s NHS staff are likely to live in households in which both partners are working and that juggling life and work has therefore become much more complex than it was 30 or 40 years ago. The reform of the increments system means that there will be more focus on training and skills, which will be much more motivating for NHS staff, so I hope that my hon. Friend’s wife is pleased.

[Diana Johnson (Kingston upon Hull North) (Lab)]

I welcome the Government’s change of heart in awarding a pay rise to our hard-working NHS staff. May I pursue the point made by the Chair of the Health Committee, the hon. Member for Totnes (Dr Wollaston)? Our Committee’s report emphasised that continuing professional development was key to the retention of nurses. It was not clear to me from what the Secretary of State said whether money would be ring-fenced—sadly, the amount has been cut—to ensure that nurses can access CPD not only in the NHS, but in social care settings.

[Mr Hunt]

I recognise that there have been pressures on the CPD budget, and that is because we have made increasing the number of nurse training places our main priority. We have increased that by 25%, which has meant that difficult decisions have had to be made about other parts of the budget. I can reassure the hon. Lady, however, that I think that CPD will continue to have a vital role, and we will need to return to the issue.

Mental Health Services: Children and Young People

Diana Johnson Excerpts

Thursday 8th March 2018 Commons Chamber

[Steve Brine]

As I have said, the overall budget is the money we have promised in the Green Paper, but the hon. Gentleman is absolutely right. The Green Paper has at its heart a focus on prevention and significant support—in early years, through schools and, as the hon. Member for Heywood and Middleton (Liz McInnes) mentioned, through higher education—to prevent issues from snowballing in the first place.

[Diana Johnson (Kingston upon Hull North) (Lab)]

With the understaffing of mental health services and the recent Health Select Committee report on the nursing shortage, does the Minister accept that the Government’s decision to remove nursing bursaries, which has particularly affected the number of students training to be mental health nurses, was a mistake?

[Steve Brine]

No, I do not accept that it was a mistake. We need to increase the number of people coming into nursing, and we were turning away far too many who wanted to come into it. The workforce is obviously a huge challenge across the NHS, in primary care—my area—in secondary care and, of course, in mental health, which is why the Secretary of State has said we will create 21,000 new posts by 2021 to support one of the biggest expansions in mental health services in Europe.

Medicines and Medical Devices Safety Review

Diana Johnson Excerpts

Wednesday 21st February 2018 Commons Chamber

[Mr Hunt]

That is the right question to ask. I suggested in the statement that we might need a patients’ champion whose job would be to collect the experiences and views of patients who think that they may have suffered as a result of medicine or medical devices. However, we want Baroness Cumberlege to look at the issue in much more detail. The central point is that if we are to avoid the agonies experienced by my hon. Friend’s constituents, the patient’s voice needs to be as strong as the clinician’s in discussions about the efficacy of medicines or medical devices. That clearly has not been happening to date, but I think that we are moving away from the paternalist system that has operated in the past, and the review will constitute a further step in that direction.

[Diana Johnson (Kingston upon Hull North) (Lab)]

The Secretary of State will know the phrase

“the patronising disposition of unaccountable power”,

which applied in the Hillsborough families’ fight to get justice, and applies, it seems to me, in what has happened to the groups affected by today’s statement. Will the Secretary of State explain why Baroness Cumberlege’s report will not come straight to Parliament, so it can make a decision about how patients can get justice quicker than has happened in many cases such as the ones we are discussing today?

[Mr Hunt]

Those words about the patronising disposition of unaccountable power came from Bishop James Jones, who has made an extraordinary contribution as a voice for people whose voices have been ignored for too long. The House will have every opportunity to debate Baroness Cumberlege’s report. The Government will decide their actions and we will put them to the House, which will have every opportunity to listen, make suggestions for improvements, and to become involved at every stage of the process as we take this forward.