NHS Funding Bill

Edward Argar Excerpts

2nd reading & 2nd reading: House of Commons
Monday 27th January 2020 Commons Chamber

[The Minister for Health (Edward Argar)]

As ever, this has been an excellent and wide-ranging debate, with constructive speeches from both sides of the House. As my right hon. Friend the Secretary of State has said, the NHS is the people’s priority and it is our priority. Today, we take another important step towards delivering on our manifesto commitment: our pledge to the people to enshrine in law the record funding for our NHS.

The NHS has a long-term plan to build a sustainable health and social care system that can rise to the challenges of the future. The NHS has told us how much funding it needs to deliver that plan and the Government are providing it. By 2023-24, the NHS will have an additional £33.9 billion to spend each year. I welcome the Opposition’s willingness to support the Bill, as indeed they should; it provides an iron-clad guarantee to deliver the NHS funding. In doing so, we are giving the NHS the certainty it needs to invest now for the long term.

[Mr Steve Baker (Wycombe) (Con)]

As the Opposition Front Benchers are engaged in a conversation and not listening to my hon. Friend, will he repeat the point he made about the Government giving NHS England the money that it has asked for?

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[Edward Argar]

I have already stated that at the Dispatch Box and my hon. Friend makes the point even more forcefully.

Let me turn to the shadow Secretary of State, the hon. Member for Leicester South (Jonathan Ashworth). Like the shadow Minister, the hon. Member for Ellesmere Port and Neston (Justin Madders), he is a good man and genuinely believes passionately in our NHS, and he campaigned passionately for his party. I have to say, though, that I was a little surprised by his comments suggesting that the Bill caps spending. Had he read the Bill, he would have found that, only four lines in, it states clearly:

“an amount that is at least the amount specified”.

That is a floor, not a cap.

More broadly, I suggest to the Opposition that they may want to be a little cautious when talking about the financial situation that we inherited. Labour’s legacy, as so wonderfully encapsulated in a letter by the former Chief Secretary to the Treasury, the right hon. Member for Birmingham, Hodge Hill (Liam Byrne), is that “there is no money”. It is this Government who have invested in supporting and rebuilding our nation’s finances to give us the strong economy that allows us to invest in our NHS.

[Jonathan Ashworth]

I am grateful to the Minister for his comments about me. He is a fellow Leicestershire MP and I know that he is passionate about the NHS as well.

If the Bill is not a capped-expenditure Bill, why are the numbers in it in cash terms and not the real-terms percentage increases that the previous Secretary of State, the right hon. Member for South West Surrey (Jeremy Hunt), set out to the House in June 2018?

[Edward Argar]

Because the cash set out in the Bill is the money that the NHS is going to be getting as a floor.

The shadow Minister rightly raised the issue of mental health. My right hon. Friend the Secretary of State was rightly clear that spending on mental health provision will increase the fastest under the proposals in the Bill, with spending on children’s mental health increasing the fastest of all. I am sure the Opposition will welcome that.

My right hon. Friend the Member for South West Surrey (Jeremy Hunt) rightly highlighted the quantum of spending and how that compares to other countries around Europe and, indeed, in the OECD. I pay tribute to him, because a lot of what we are talking about today is based on the foundations that he built when he did such a fantastic job as Secretary of State.

The hon. Member for Central Ayrshire (Dr Whitford) and my hon. Friend the Member for West Aberdeenshire and Kincardine (Andrew Bowie) rightly alluded to the Bill’s impact on Barnett consequentials and spending in Scotland. As the hon. Lady will know, the Barnett consequentials will apply. My hon. Friend highlighted the fact that not only the NHS in England but the NHS in Scotland faces challenges that we must all step up to meet.

My hon. Friend the Member for Newton Abbot (Anne Marie Morris) highlighted the need for us to focus not just on inputs but on outcomes and what we achieve with the money that we invest. That is exactly what the Secretary of State is determined to do.

The hon. Member for Nottingham South (Lilian Greenwood), a fellow east midlands Member, highlighted the need for capital investment in her local hospitals in Nottingham. I am happy to meet her to discuss that further, if that would be helpful to her.

Let me turn to maiden speeches. My hon. Friend the Member for Darlington (Peter Gibson) made an excellent maiden speech. As Members have said, his predecessor Jenny Chapman was respected and well liked in the House. I suspect that, given his speech, he will achieve exactly the same distinction. He spoke forcefully and powerfully on behalf of his constituents. I am sure that they will find him a doughty local campaigner in their interest.

My hon. Friend the Member for Ashfield (Lee Anderson) paid tribute to his predecessor, Gloria De Piero, who was my shadow when I was a Justice Minister. He was right to pay tribute to her, because she was a fantastic colleague to have in this House. None the less, he achieved a fantastic result. As a fellow east midlands MP, I know his constituency well. It is a fantastic place and his constituents are very lucky to be represented by him. He is a local man standing up for his community. He also spoke movingly of his journey—if I may put it this way—from pit to Parliament, and the power of social mobility, of aspiration and of opportunity. He reminded me of a former colleague of ours and a good friend of mine, Sir Patrick McLoughlin, who made the same journey. He ended up in the Cabinet, so I will be watching my hon. Friend’s inevitable ascent carefully.

The hon. Member for Feltham and Heston (Seema Malhotra) touched on, among other things, Heston health centre. Again, as ever—as in my previous role—I am happy to meet her to discuss that. The hon. Member for Kirkcaldy and Cowdenbeath (Neale Hanvey), in an eloquent but forceful maiden speech, clearly put this House on notice that he will always speak up for his principles and his beliefs, and, while we may on occasion disagree on policy, I doubt we will disagree on his passion and determination to champion his constituents’ interests.

My hon. Friend the Member for Dover (Mrs Elphicke) also focused on achieving outcomes. She touched on the tragic death of Tallulah-Rai Edwards. I extend my condolences to the family, but may I also say that my hon. Friend the Parliamentary Under-Secretary of State for patient safety will be happy to meet her to discuss that in more detail.

It is always a pleasure to meet the hon. Member for Easington (Grahame Morris) and to hear from him. We have met previously, and he and the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Bury St Edmunds (Jo Churchill), are due to meet again to discuss this matter in a few weeks’ time when we will pick it up further.

Let me turn now to my hon. Friend the Member for Birmingham, Northfield (Gary Sambrook). May I pass on my congratulations to his sister on the birth of Freddie and pay tribute to all staff, as he did, working in our amazing NHS for the work that they do. Many hon. Members paid tribute to them, including the hon. Member for Rhondda (Chris Bryant), and my hon. Friend the Member for Banbury (Victoria Prentis)—I have no doubt that I will be hearing from her about the Horton on many occasions in the future. My hon. Friends the Members for North Dorset (Simon Hoare) and for South Dorset (Richard Drax) made powerful pleas for investment in their community hospitals and in their local health infrastructure. I am a regular visitor to the constituency of my hon. Friend the Member for North Dorset, so I look forward to visiting both colleagues in due course.

As well as talking about Crawley Hospital, my hon. Friend the Member for Crawley (Henry Smith) highlighted the need for Gatwick airport to be included in the conversations on the coronavirus, and I know that my right hon. Friend the Secretary of State will have heard what he said, and is already factoring that in.

Before concluding, I will touch very briefly on two other contributions: my hon. Friends the Members for Stoke-on-Trent Central (Jo Gideon) and for Stoke-on-Trent North (Jonathan Gullis)—and indeed my hon. Friend the Member for Stoke-on-Trent South (Jack Brereton), who was not in his place. They have all highlighted the issue of the private finance initiative. I am happy to meet them to discuss it further.

Let me turn now to my hon. Friend the Member for Carshalton and Wallington (Elliot Colburn) and the hon. Member for Mitcham and Morden (Siobhain McDonagh). I have to say that my hon. Friend made a very strong case for the benefits that this investment will bring for all those who are served by his local trust. I encourage the hon. Lady to engage with this process and engage with the benefits that this investment will bring.

[Siobhain McDonagh]

Will the Minister give way?

[Edward Argar]

I am afraid that, with one minute to go, I will not give way.

The nation’s health and social care is the people’s priority and it is also our priority. Key to delivering on our long-term plan, and the NHS’s long-term plan, is giving the NHS the investment that it needs. This Bill does exactly that. We are delivering on the people’s priorities and on our pledges to the NHS, and I commend the Bill to the House.

Question put and agreed to.

Bill accordingly read a Second time.

NHS Funding Bill

Edward Argar Excerpts

Legislative Grand Committee & 3rd reading: House of Commons & Legislative Grand Committee: House of Commons & Programme motion: House of Commons & 3rd reading & Programme motion
Tuesday 4th February 2020 Commons Chamber

[Alex Cunningham]

I am very grateful, Madam Deputy Speaker.

Amendment 2 concerns spending on mental health services and the Secretary of State’s plans to achieve parity of esteem. Mental illness is often not viewed as a risk to human life, but it is exactly that. In 2018, according to the Samaritans, 6,507 deaths in the United Kingdom were registered as suicides—an increase of 10.9% on the previous year. That means that nearly 7,000 people did not believe that there was help, or another way out of what they were going through.

It can be hard for adults to talk about the feelings that come from being mentally unwell. The words are in their vocabulary, and it may be simple enough to string them together into a sentence, but it is incredibly difficult to say them out loud. I can only imagine how hard it must be for children to express how they are feeling when something is not right. Perhaps they do say the words that are in their heads, but they are not taken seriously. It is a scandal that there are suicidal children as young as 12 who are having to wait more than two weeks for a mental health bed. By not viewing mental illness as life-threatening, we are letting generations down.

There is much debate about what causes mental illness and what is the best form of treatment, but it can take several visits to a GP for people to be taken seriously about not being OK—although many GPs, of course, respond immediately. When parents are fighting for their unwell children to be taken seriously and receive the urgent care and treatment they need, it is horrifying for that to be delayed.

At this stage I should pay tribute to my former colleague Paul Williams, who was the Member of Parliament for Stockton South. He is a GP, and as a member of the Health Committee he spoke extensively about health matters, but locally he took on the child and adolescent mental health services. He knew, as I did because we shared the same area, that it was taking well over two years for young people to be seen by CAMHS. As a direct result of his work, that ended, up to a point, because some children who were due to be seen quickly were actually seen when they should have been. However, those long waits still exist in our area. As we heard earlier from the right hon. Member for South West Surrey (Jeremy Hunt), the former Health Secretary, sometimes children are just not taken seriously.

It is right for the Secretary of State to answer to the House on exactly what the Department is doing, because this is a matter of life and death. Not only the House but the country needs assurance and answers. The state of mental health services will only get worse unless we take action to deliver what is required. The additional money is more than welcome, but I see the amendment as the first, necessary step to provide the funds that are so desperately needed. Equally important is the ability to monitor what those funds are being spent on, and how.

There are many other services on which people depend heavily, including some that we may take for granted, such as smoking cessation services. There is widespread concern about existing funding for services to help people stop smoking. Nearly a third of local authorities no longer provide specialist “stop smoking” services. Stopping smoking is not just a matter of nicotine patches or vaping; people need behavioural support as well, particularly pregnant women, children, and people who are already unwell. One ward in my constituency has some of the highest incidences of smoking in families—whole families smoking—but we also have some of the highest incidences of smoking during pregnancy, and that is not good for the unborn child.

We cannot afford to lose the progress that we have made. We have made tremendous progress over the years, but we need local services that are effective and properly funded. The Government also need to return to funding the multi-media approach to smoking cessation services. I was particularly pleased to learn last week that research has shown that the ban on smoking in cars when a child is present has produced a 75% drop in children being exposed to cigarette smoke in a car. I led on that issue during my first few years as an MP, through private Members’ Bills and a ten-minute rule Bill. The Bills were unsuccessful, but I was delighted when the Government adopted my clause a few years later. We still need to be ambitious and bold about helping people to quit smoking, but services need the resources. I hope the Minister will commit to ensuring that such services are provided, whether for mental health or for smoking cessation, and that they are fully funded so that we can continue to make real progress in that area.

Finally, I shall turn to the matter of capital. The Minister has already heard me talk about the needs in my own constituency. In one ward—the same one I referred to earlier: the Town Centre ward in Stockton—men live 14 years less than those in the Prime Minister’s constituency. His constituency is getting a new hospital, but there are no plans yet for us. However, I have good news for the Minister, because the plan for our hospital is still sitting there. I met the chief executive of North Tees and Hartlepool NHS Foundation Trust just two weeks ago, and she told me that they were ready to dust off the plans again and see how we could provide a hospital. At the time we asked for £100 million from the Government as a guarantor in order to make the project work. The numbers do work, and the health inequalities need to be addressed.

We need to be able to attract the best doctors and clinicians that we can to address the problems in our society. The heart problems are higher on average than anywhere else in the country. We have smoking problems, as I have mentioned, with their related lung and respiratory problems. We also have the legacy of our heavy industry on Teesside, where men who have now retired are in extremely ill health but sometimes cannot get the support they need because we do not have the experts locally to provide it.

In my final sentences, I appeal to the Minister to meet me and the trust members so that we can sit down and talk about this project.

[The Minister for Health (Edward Argar)]

indicated assent.

[Alex Cunningham]

I am glad that he is nodding his head. Ten years ago, the Tory-Lib Dem Government cancelled the project, despite the fact that it was a priority for the country and for the national health service, so I hope that we can now have a meeting and actually start to motor on this. I am pleased to see the Minister smiling, and I hope that he can leave me smiling as well.

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[The Chairman of Ways and Means (Dame Eleanor Laing)]

The hon. Gentleman is absolutely right in regard to the procedure. If we finish this part of the procedure before 5.29 pm, there will be a very short time for the next part of the procedure. If this part of the consideration of the Bill goes to 5.29 pm, there will indeed be no time for the Report and consideration stage. That is correct, as is normal in any Bill, but I am grateful to him for pointing it out so clearly.

[Edward Argar]

In the 15 or so minutes remaining to me, I will endeavour to address all the points that have been raised. First, I thank Members on both sides of the House for their contributions and for the amendments that have been tabled. I particularly thank the shadow Minister for his typically reasonable tone in making his case forcefully. This Committee debate has been a wide-ranging and important one.

I will turn in detail to the amendments shortly, but, in the interests of time, I will swiftly address the requests for meetings or visits. The hon. Member for Stockton North (Alex Cunningham) was right when he said that he saw me nodding. I will be very happy to meet him, my hon. Friend the Member for Stockton South (Matt Vickers) and the chief executive of his hospital trust to discuss the issues that he raised. I will also be very happy to meet the hon. Member for Harrow West (Gareth Thomas) separately to discuss the issues that he raised.

[Pete Wishart]

rose—

[Edward Argar]

I will give way very briefly, because the hon. Gentleman is eating into his own time.

[Pete Wishart]

The Minister is in a very accommodating mood. Does he accept that this Bill has funding implications and consequences for health spending in Scotland?

[Edward Argar]

As has been very clear throughout the progression of this Bill so far, there are Barnett consequentials, which will be dealt with in the usual and appropriate manner.

I will turn to the detail of the amendments in a moment, but before I do, let me say that my hon. Friend the Member for Telford (Lucy Allan) addressed the debate in Westminster Hall just before the general election. In that, I said that if her constituents wanted a strong voice in this place, they should vote for her. I am very pleased that they did exactly that. Her speech shows exactly why.

This legislation is a simple Bill of two clauses. The substantive clause—clause 1—puts a double-lock duty on the Secretary of State and Her Majesty’s Treasury to ensure that NHS England will receive, as a minimum, £33.9 billion extra a year by 2024, enshrining in law the NHS England revenue budget rise in line with the Government’s manifesto commitment. The Bill has deliberately been drawn narrowly to focus on that core commitment.

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[Theo Clarke (Stafford) (Con)]

This Bill is about funding, but buildings and services are key to delivering on our national health service priorities, so may I highlight the importance of the A&E at the County Hospital in Stafford and ensuring that we are supporting NHS services in my constituency?

[Edward Argar]

My hon. Friend is a sound and vocal champion for her constituents in Stafford. I am sure that she will continue to champion their cause, and I am happy to meet her to discuss the specific issue she raised.

I turn to amendment 3, in respect of capital-to-revenue transfers. Clause 1(2) ensures that the funding specified in the Bill can only be used for NHSE revenue spending, meaning that day-to-day spending for the NHS is protected. As we have highlighted in the House previously, the Government have made a range of capital commitments to the NHS, including the commitment to 40 new hospitals. Nevertheless, going to the point in the amendment itself, we have been clear that the transfers from capital revenue should have only been seen as short-term measures that were rightly being phased out, and we are doing so. My right hon. Friend the Member for South West Surrey (Jeremy Hunt), the former Secretary of State, did, however, set out why a degree of flexibility is required, and we would not believe that a blanket ban set in legislation was the right approach.

[Gareth Thomas]

Will the Minister give way?

[Edward Argar]

I will not, if the hon. Gentleman will forgive me, as I only have 10 minutes or so left.

There are sometimes very good and logical reasons why adjustments between capital and revenue are needed. As the former Secretary of State highlighted, in some cases, for perfectly good reasons a capital pot may not be spent fully within a year and there is an opportunity to achieve patient good from transferring it. While I take his point and believe it is right that we should continue to move away from such transfers, I would not wish to see that rigidly set in legislation.

Amendments 2 and 1, and new clauses 1, 2, 3 and 9, relate to mental health services both for children and adults, and accountability to Parliament and reporting mechanisms. We have rightly seen considerable interest in mental health in this debate, so I will seek to address both those points together. I begin by paying tribute to Paul Farmer of Mind, Sir Simon Wessely, Professor Louis Appleby, the Mental Health Foundation, Rethink Mental Illness, YoungMinds, the Royal College of Psychiatrists, and a host of other individuals and organisations up and down the country, for their fantastic work in making mental health such a feature in our debates and in the public consciousness. It is absolutely right that they have done so.

I pay tribute to the Under-Secretary of State, my hon. Friend the Member for Mid Bedfordshire (Ms Dorries), and her predecessor, my hon. Friend the Member for Thurrock (Jackie Doyle-Price), who brought to the role of mental health Minister passion, dedication and a determination to make a difference. I should also reference some former Members of this House: Norman Lamb, who did so much in this area; the former Prime Minister, David Cameron; and of course my right hon. Friends the Members for South West Surrey and for Maidenhead (Mrs May), who ensured that it was front and centre of this Government’s commitment.

I want to be totally clear that the Government are fully committed to transforming mental health services. That is why we enshrined in law our commitment to achieving parity of esteem for mental health in the Health and Social Care Act 2012. As my right hon. Friend the Member for South West Surrey said, that is driving real change on the ground. We have also committed to reforming the Mental Health Act 1983 to provide modernised legislation. I would also highlight that at £12.5 billion in 2018-19, spending on mental health services is at its highest ever level.

We have made huge strides in moving towards parity, but there is still so much more to do. We are ensuring, through the NHS long-term plan, that spending on mental health services will increase by an additional £2.3 billion by 2023-24. This historic level of investment in mental health is ensuring that we can drive forward one of the most ambitious reform programmes in Europe. It will ensure that hundreds of thousands of additional people get access to the services they need in the lifetime of the plan. I flag that up because we can and will always strive to do more, and it is right that we are always pressed by this House to do so. While proposals for a ring fence in mental health spending are understandable, the approach that this Government have already set out, with long-term commitments to funding, is already driving the results we wish to see.

I now turn to new clause 9, tabled by my hon. Friend the Member for Newton Abbot (Anne Marie Morris). If I may, I will also address new clause 2 in this context because there is a degree of overlap. I welcome my hon. Friend’s new clause. Although I hope that, as she indicated, she will not press it to a vote—and I heard what the hon. Member for Twickenham (Munira Wilson) said in respect of hers—the sentiment behind it is a good one, particularly the focus on outcomes and outputs rather than simply inputs and the amount of money going in, and on adopting a holistic approach. I know that my hon. Friend the Member for Newton Abbot recently met the Secretary of State to discuss the matter, and I am happy to meet both her and the hon. Member for Twickenham. While we do not believe it is the right approach to set additional reporting mechanisms in legislation over and above the different reports that NHS England and the Secretary of State already make to Parliament, which offer opportunities for debate, we are happy to consider whether, within the existing reporting mechanisms, there is a way to better convey to the House and the public more widely the progress we are making against those targets.

The NHS long-term plan represents the largest expansion of mental health services in a generation, renewing our commitment to increase investment faster than the overall NHS budget in each of the next five years. Not only will spending on mental health services increase faster than the overall NHS budget as a proportion, but spending on CAMHS will increase at an even faster rate. The hon. Member for Twickenham was right to highlight the importance of CAMHS. In our surgeries, we have all had constituents come to see us who are deeply worried and concerned about the mental health and welfare of their children, be that in relation to eating disorders, which I focused on when I came to this place, or a range of other factors. We are committed to delivering the NHS long-term plan to transform children and young people’s mental health services, with an additional 345,000 children and young people being able to access those services.

While we are deeply sympathetic to the spirit behind the amendments on mental health spending, we do not believe that putting a ring fence into the Bill is the appropriate way forward, given the work already being done, the money already being spent and the outcomes already being delivered. We believe that the reporting requirements are already extensive and varied. They already give the public and Parliament the opportunity to scrutinise the work of the Department and NHS England. We are happy to look at ways in which those reports might be more accessible and include different metrics, but we believe it would be wrong to legislate on them at this point.

As I said on Second Reading, this is a simple Bill. It has two clauses, of which one is substantive. It has a single, simple aim: to enshrine the funding settlement behind the NHS long-term plan in law. It delivers the funding that the NHS said it needed and wanted, and it delivers on this Government’s pledge to do so within three months of the election. In the light of that, while the amendments are clearly well intentioned and we appreciate the spirit behind them, they are unnecessary additions to the Bill, and I urge their proposers not to press them to a vote. I appreciate that Members have indicated their intention to press some amendments to a vote, I urge them, in the short period remaining before Committee ends, to reflect a little longer on whether they might reconsider and not move their amendments to a vote.

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[Madam Deputy Speaker]

The hon. Gentleman’s analysis is not wrong. The knife has fallen. The House voted some days ago to provide three hours, or four hours in total, for consideration of this Bill, and it is indeed the case that because those four hours have passed, there is no time for debate on consideration and Report—that is absolutely correct. There is also no time for debate on Third Reading.

As to whether the Government did not provide sufficient time, or Members of this House took up all the time in the early part of the proceedings, that is not a matter for me to judge; I have merely facilitated it. Members might have decided not to speak for very long at the beginning. If so, the hon. Gentleman and his colleagues would have had the opportunity to discuss the matters that they had tabled. I thank him for his further points.

Does the Minister intend to move a consent motion in the Legislative Grand Committee?

[Edward Argar]

indicated assent.

The House forthwith resolved itself into the Legislative Grand Committee (England) (Standing Order No. 83M(3)).

[Dame Eleanor Laing in the Chair]