Oral Answers to Questions
Edward Argar Excerpts(2 years, 5 months ago)
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Ian Levy (Blyth Valley) (Con)
The Minister for Health (Edward Argar)
This Government committed to growing the NHS workforce, including our pledge of 50,000 more nurses by 2024, and we are delivering on that, as we are delivering across Government, with almost 31,000 more nurses so far as of March 2022—the latest data point we have.
Ian Levy
I commend the Government on their target to train 50,000 new nurses. I know first-hand how hard the nursing staff work in the NHS as I worked as a mental health support worker for almost 30 years. With that in mind, I welcome the new school of nursing to be built at the Cramlington A&E Hospital. Will my hon. Friend do me the honour of visiting Cramlington to see for himself the construction of this amazing new facility?
Edward Argar
I pay tribute to my hon. Friend for his work supporting the NHS and healthcare in this country both prior to and subsequent to his election to this House. I would be delighted to visit Cramlington with him—indeed, on the same visit perhaps I could visit his local health facilities to see modular construction in action. I should also say that his ever-efficient office has already invited me.
Gareth Thomas (Harrow West) (Lab/Co-op)
More nurses across the country, and particularly in Harrow, would make a real difference in helping those who suffer from diabetes. Given that this is Diabetes Week and that diabetes has a disproportionate impact on those from a south Asian background—particularly, for example, among my Gujarati constituents—when will the Minister put extra resources into tackling this terrible health condition?
Edward Argar
I am grateful to the hon. Gentleman for his important question. As he highlights, we are investing more in more nurses, but there is also a large piece of work to do on health education and improving access to those services for people with diabetes. I urge him to look forward with eager anticipation to the health disparities White Paper.
Jonathan Gullis (Stoke-on-Trent North) (Con)
Mr Speaker, you will be aware that I am proud to support the “no time to wait” cross-party campaign to ensure that we have a mental health nurse in every GP surgery across the country. I am delighted to see the hon. Member for York Central (Rachael Maskell), who supports the campaign, in her place.
I was delighted to read that the Secretary of State has said that we will recruit 2,000 mental health nurses into GP practices. Can I have more detail on how that will work? Can we look at Norfolk, which is using primary care networks, and third sector organisations such as Mind to help with that recruitment?
Edward Argar
I am grateful to my hon. Friend for drawing attention to this important issue as well as for highlighting what is going on in Norfolk and the opportunities to learn from that. The Government have put record funding into mental health, and I understand that my right hon. Friend the Secretary of State is due to meet him and supporters of the campaign soon.
Dr Rosena Allin-Khan (Tooting) (Lab)
Working a shift in A&E just two days ago, I could not have felt prouder of the teams of nurses who form the foundation of our NHS. As the Minister is so gushing about the Government’s track record, will he explain why specialist food banks are being opened up in hospitals? Will he explain why, in a report by the Royal College of Nursing, 83% said that staffing levels on their last shift were not sufficient to meet patients’ needs safely and effectively? These lifesavers need a Government who are on their side. Only Labour will deliver for the NHS workforce and ensure that nurses and patients get what they rightly deserve.
Edward Argar
I think that I detected the hint of a question in there. On a serious point, I pay tribute to the hon. Lady, as I often do on such occasions, notwithstanding the challenges that she throws at us, for the work that she does in the NHS and the work that she did before she was elected to the House. Through her, I also pay tribute to NHS workers up and down the country for their work.
The Government have put in place record support for our NHS, including nurses, which is about supporting those already on the frontline in the profession—that is absolutely right—and about growing that workforce to ensure that the work that needs to be done is spread among more people. That is exactly what we have done. We have record numbers in our NHS workforce, and we are well on target to meet our manifesto commitment on more nurses.
Suzanne Webb (Stourbridge) (Con)
Rosie Cooper (West Lancashire) (Lab)
The Minister for Health (Edward Argar)
NHS trusts have an integral role in the local health and care system. We expect appropriate engagement between integrated care boards, integrated care providers and the respective NHS providers in an area. An NHS trust is a formal partner of an ICB if it provides any services in the ICB area and has the function of participating in the nomination of members to the board. Regulations give details as to how to determine which trusts that provide services in an ICB area should participate in the nomination process.
Rosie Cooper
Notwithstanding the Minister’s comments, Cheshire and Merseyside integrated care system has recently made the decision to stop my West Lancashire constituents accessing routine dermatology at St Helens Hospital, which is the only nearby provider. Due to geography, my constituents are in the Lancashire ICS, and are therefore not represented in Cheshire-Mersey—in place or local authorities.
My question, which I have asked several times, is: what is the Department doing to ensure that there is a mechanism for my constituents in Lancashire ICS to be represented in Cheshire-Merseyside’s decision-making process, which directly affects the care they are given? I have raised this point about cross-border difficulties so many times that I must question whether we any longer have a national health service, or whether we have a series of protected ICS kingdoms.
Edward Argar
The hon. Lady and I speak regularly about different aspects of her local health system, and I am happy to do so again on this matter. I do not know the exact details behind the specific example, but I do not think it relates directly to how ICSs are configured in statute and guidance. I would be happy to meet her to understand the local factors that may have contributed to the situation.
Jacob Young (Redcar) (Con)
Luke Hall (Thornbury and Yate) (Con)
A new hospital at Thornbury would provide greater primary care and outpatient services, more GP appointments and a proactive frailty hub to support the elderly to stay in their own home longer. Our bid was submitted against the sustainability and transformation plan wave 4 capital pot, and I thank the Minister for all his work and effort in speaking to me, South Gloucestershire Council and our clinical commissioning group about this bid. Will he update the House on the timescales for its outcome?
The Minister for Health (Edward Argar)
I am grateful to my hon. Friend; he rightly alludes to the fact that he is a strong champion of his constituents and has met me on a number of occasions to argue the merits of the Thornberry health centre. As he will be aware, we now have a multi-year capital settlement for our NHS, which will allow us the opportunity, through local systems, to consider the most appropriate projects for investment.
Edward Argar
It was a great pleasure to visit my hon. Friend before the jubilee weekend and to meet the staff who do such an amazing job at his local hospital. As ever, his puts his case clearly and firmly for a new hospital to replace the QE in King’s Lynn, and we hope to be able to announce the longlist of those expressions of interest in due course.
Hospital of St Cross: Accident and Emergency
Edward Argar Excerpts(2 years, 5 months ago)
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The Minister for Health (Edward Argar)
I congratulate my hon. Friend the Member for Rugby (Mark Pawsey) on securing this important debate. He is right to highlight that it is the responsibility of Members of Parliament to highlight and champion their constituents’ concerns, and he is doing exactly that today, just as his illustrious predecessor and father did over a combined total of about 18 years in this House, representing that area with distinction just as he does. My hon. Friend has been a regular campaigner for the NHS in his constituency. Indeed, as I recall from oral questions some time ago, I think I am right in saying that he volunteered at the Locke House vaccination centre during the pandemic to assist his local NHS. Not only does he talk the talk; he walks the walk in supporting his local NHS, and his constituents in Rugby are incredibly lucky to have such a passionate local champion for their cause in this House.
My hon. Friend’s engagement with his constituents, and his being in tune with their concerns, is reflected by the survey he mentioned. He said he had received around 3,000 responses, which is a phenomenal response rate for such a survey. I think I read that it was reported on the excellent CoventryLive site, which highlighted exactly what he had done. He asked me to acknowledge, and of course I do, the virtual uniformity of the concerns raised in his constituents’ responses. That is a powerful message that his constituents are sending to us.
I understand that the Hospital of St Cross has operated an urgent care centre since the closure of the full A&E in 2011, transitioning to become an urgent treatment centre in line with national changes in 2019. That service is available 24 hours a day, seven days a week, allowing patients to access the urgent care services that it is able to provide at any time. Trained nursing staff are on hand and patients can have X-rays and blood tests and access a pharmacy. As my hon. Friend said, patients with more complex medical conditions requiring advanced tests or investigations will be referred or taken by ambulance to be cared for by specialists at the University Hospital in Coventry. This, to a degree, reflects the staffing availability and specialist staff required for different services, and which services are available in a particular setting.
My hon. Friend highlighted an important point, which applies not only to his local hospital but more broadly across the country. There is more we can do to help our constituents, and those who may need services, to understand what services each different NHS destination —be it an A&E or a UTC—can provide, and hopefully reduce the number of people who see the H sign on the motorway and think, “I’ll go there because I need assistance,” only to end up being transferred to another hospital to receive the services they need for their condition. There is more we can do to make that clear.
I appreciate my hon. Friend’s call for a restored full A&E service in Rugby, on the basis of demographic change since the decision was taken in 2010 and implemented in 2011. He is right to highlight the pace of change, including in population. I know his patch a little; it is a relatively short hop down the M69 and back across the M6 from my patch to his. He is right to highlight all that Rugby and the area is doing to help support the objectives of providing affordable housing for people who need it; but that of course comes with additional pressures on local public services and local infrastructure, as he rightly emphasised.
As my hon. Friend knows, the original decision to alter local service provision was made following a full public consultation to address concerns raised at the time that the unit was not able to sustain full A&E services, with serious cases, even then, being sent to Coventry for treatment. I can assure my hon. Friend that this decision will rightly be taken by the local clinical commissioning group, as it was in 2010—although it was possibly a primary care trust at the time. Shortly, it will be a decision for the local integrated care boards, which are due to come into force very soon, following the passage of the Health and Social Care Act 2022. It would not be right for the inception of such decisions to come from Ministers in Whitehall. I would note, however, that for any future changes we will see slightly altered powers for Ministers, with the power of direction and intervention introduced in that legislation.
I can assure my hon. Friend that the funding available to his local health system has risen in line with demographic change since 2010—as determined by the formula set by the Advisory Committee on Resource Allocation—and that ensuring that resources are allocated to deliver the best care for patients is a key duty of both the CCG and, subsequently, the ICB. The local health system is best placed to consider sustainability, location, and demand for services across its area. Any such assessment of whether to reduce services, move services or open new services should include consideration of the mix of accident and emergency services, UTCs and other treatment services, such as GP access.
Without wishing to pre-empt any particular course of action that my hon. Friend’s local system might be persuaded by his forceful advocacy to consider, I would also comment that it is for the ICBs and trusts to plan for reconfigurations of NHS services. Judging by what my hon. Friend said, he is already lobbying them pretty firmly. Where services are reconfigured, we are clear that these are subject to four stringent Government tests, which are strong public and patient engagement, consistency with current and prospective need for patient choice; a clear clinical evidence base, and support for proposals from clinical commissioners.
Decisions on any reconfiguration are rarely easy or straightforward; they are effectively about balancing different needs and benefits, including patient transport and inequalities, and it is important to hear from as many local people as possible about the practical impacts and concerns. As I alluded to, I encourage my hon. Friend to continue his conversations with his local NHS system.
Before turning to pressures on A&Es more broadly and the ambulance service locally, I should say that there is already significant investment to improve services in Rugby. The University Hospitals Coventry and Warwickshire Trust remains committed to expanding services at the Hospital of St Cross, and in recent times that has included the opening of a £1 million purpose-built haematology and oncology unit, and new modular theatres to help treat more patients on elective waiting lists. It is probably fair to say that a degree of credit goes to my hon. Friend for fighting the corner for his local hospital, as he always does.
I shall now mention pressures on emergency departments. The emergency department at the University Hospital in Coventry has also been granted £15 million by the Government to increase its capacity and further enhance patient care. This investment will expand the department, including with a new minor illness and injuries unit. The funding will also be used to install additional treatment cubicles, to expand the waiting room in the children’s ED, to increase the level of same-day emergency care and to support diagnostic capacity with an additional CT scanner.
It is right that we take a whole-system approach to these challenges, and all this work is designed to complement existing services provided at both the Rugby and Coventry urgent treatment centres. My hon. Friend is right to highlight the pressures we are seeing in EDs across the country, which is often manifested in ambulance delays and ambulance queues. That is a symptom of the patient flow challenge in hospitals. Space is needed to offload patients safely into EDs, for which EDs have to be able to discharge patients safely or admit them into the hospital. To do that, hospitals have to be able to discharge patients to free up the bed space to enable that patient flow. In recent months we have seen sustained pressure in hospitals across the country in that respect, and he rightly highlights his local hospital.
My hon. Friend talked about the ambulance service and highlighted the tragic case of Jamie Rees, which has been reported on extensively by CoventryLive. Jamie sadly passed away on new year’s day following a cardiac arrest. Through my hon. Friend, I extend my sympathies and condolences to Jamie’s family and friends.
I understand the West Midlands ambulance service believes that, sadly, an ambulance station, had there been one in Rugby, would not have altered the outcome in Jamie’s case. In the 90 minutes before it received the first 999 call, I understand there had been five other emergency calls in the Rugby area. That means any ambulances based in the town would have already been dispatched to deal with those emergency cases, so the ambulances would not have been available wherever the station were based. I fear that reflects the pressures at the time. None of that will be any consolation to Jamie’s family, but I wanted to highlight the context.
My hon. Friend also rightly highlighted the “Our Jay” campaign and the number of externally mounted defibrillators, which is a hugely important topic. It is sad that there is sometimes an unwillingness to fund externally mounted defibrillators due to the despicable behaviour of utterly heartless individuals who, for some reason, think they have the right to vandalise or steal this life-saving kit. It is a sad reflection on them, and I sincerely hope they never find themselves in a situation where they need such kit to be available. I pay tribute to the “Our Jay” campaign.
More broadly, we have put a number of measures in place to try to ease the pressure on A&E and ambulance services. The discharge taskforce is helping to free up patient beds by ensuring that patients who are fit to be discharged are discharged more rapidly. In recent years, £450 million has been spent on expanding A&E departments, and there has been a £55 million investment in strengthening ambulance trusts and keeping an extra 156 ambulances in service and on the road to bolster capacity and resilience during the winter period.
I hear the passionate case my hon. Friend makes. There is significant support in place, both locally and nationally, to help ensure constituents in Rugby can access the care they need when they need it, but I also wish to make a number of points. First, I am happy to meet him to discuss this matter. I was going to offer to make the short hop down the M69 and the M6, but from what he has says I have been pipped to the post by my boss arranging to do that visit; he has perhaps upgraded the offer, with the Secretary of State rather than a mere Minister of State. I hope my hon. Friend will feel free to share the detail of his survey and the responses with me. I am also conscious that I have some outstanding correspondence from him—I checked that this morning—and I will ensure that I respond to it in the next few days. I will pull it out of the system and ensure that he gets answers to the specific points he raised.
I thank my hon. Friend, once again, for rightly raising this important issue, securing an important debate on the Floor of the House today and doing what he does so well: championing his constituents’ best interests, and making sure that Ministers have no opportunity to forget them and to forget the people of Rugby. Indeed, he ensures that they are impressed upon our minds. I look forward to meeting him to discuss this further, and I hope that will happen shortly.
Question put and agreed.
Correction to PQ62745
Edward Argar Excerpts(2 years, 7 months ago)
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The Minister for Health (Edward Argar)
I would like to inform the House that I wish to correct the formal record in relation to written answer 62745 to the hon. Member for Aberavon (Stephen Kinnock) on 28 October 2021.
The reply stated that neither the Department nor the former Public Health England has any collaborative, commercial or contractual links to the Beijing Genomics Institute or its subsidiaries.
The correct answer is that BGI Genomics UK Limited was awarded a call-off contract from a framework contract held by Public Health England in August 2021 following a mini competition. This call-off contract lapsed on 14 November 2021 and no further contract with BGI has been let.
[HCWS793]
National Strategy for Self-Care
Edward Argar Excerpts(2 years, 7 months ago)
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Westminster Hall is an alternative Chamber for MPs to hold debates, named after the adjoining Westminster Hall.
Each debate is chaired by an MP from the Panel of Chairs, rather than the Speaker or Deputy Speaker. A Government Minister will give the final speech, and no votes may be called on the debate topic.
This information is provided by Parallel Parliament and does not comprise part of the offical record
Sir Charles Walker (in the Chair)
I will call the shadow Minister shortly. There is usually a five-minute limit for the Opposition spokesperson, but as we have quite a long time left, if the hon. Lady would like to speak for longer, she can do so, although she is under no obligation to do that. I am sure the Minister would not mind either.
The Minister for Health (Edward Argar)
It is always a pleasure to serve under your chairmanship, Sir Charles, and a particular pleasure to serve opposite the hon. Member for Bristol South (Karin Smyth), the shadow Minister. We spent many happy days in Committee on the Health and Care Bill, even if we were not in full agreement. The Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Lewes (Maria Caulfield), within whose portfolio this would normally sit, has just been answering a debate in the Chamber, which is why I am responding to this debate.
I will endeavour to do justice to the very important points that the right hon. Member for Knowsley (Sir George Howarth) raised in his speech. I will do something, which, even within my own portfolio, would cause my officials to wince—and I suspect that the same may happen given that this falls within somebody else’s portfolio—which is that, notwithstanding the wonderfully well written notes that my officials have provided me with, I may well say what I think on this subject and respond to the specific points that have been raised in the course of this debate. This could be career limiting, but we will see.
The right hon. Member made a powerful speech. Essentially, the way in which he illustrated through the prism of a particular condition of diabetes a number of the points that could be applied more broadly across the spectrum of self-care was particularly helpful to hon. Members. Although we may not have a huge quantity of hon. Members in this Chamber today, what we do have is quality, judging by the contributions that we have heard.
The right hon. Member is absolutely right, as is the shadow Minister, that, in talking about self-care, we must be very clear that we do not see it as an alternative—an either/or—to medically qualified support or other forms of support. The two parts of the system should work hand in hand. Indeed, I see it as a continuum. I have seen the work done by PAGB, the Self-Care Forum and others on that self-care continuum. We start at one end with education, which I will turn to in a moment. The pure end of self-care is around diet, daily calorie intake, and the simple lifestyle changes that can make a big difference to our own health and the risk of our contracting illnesses or diseases. Those lifestyle and dietary factors may not be for everyone given the nature of particular conditions, but, by and large, are within the control of the vast majority of us.
At the other end of that continuum, we have things such as major trauma, or treatment for illnesses such as cancer or cardiac conditions where medical care, and often hospital-based care is essential. Then there is that space in the middle around self-treatable conditions. There are the minor ailments where people might be able to self-care, but where, as the hon. Member for Bristol South put it very well, some might need some confidence or advice to be able to do so.
There is also the management of acute conditions and long-term conditions, which, I suspect, will entail a degree of professionally qualified medical care, but, equally, a degree of self-care based on that advice as well. We have that spectrum—that continuum—and it is important that we view it in that way. The ability to turn to the right type of support at the right time is crucial to maximising the benefits and opportunities for individuals in self-care.
Through the pandemic, we have seen the opportunities to innovate. They were opportunities forced on us by the circumstances in a dreadful situation, but, none the less, there have been ideas and innovations that have come out of that pandemic. We have seen also the consequences of demand within our healthcare system, particularly at GP practices, at accident and emergency, and at urgent treatment centres. Notwithstanding the record investment by this Government in our NHS, and notwithstanding the record numbers of staff in the NHS, we do see pressures. An effective and proportionate self-care approach that people feel confident in can play a key part in helping to manage the pressures, where people go to the most appropriate point to be treated.
Empowerment is key—people understanding and being educated in their choices and the implications of their choices, through public health messaging. There is a telling statistic, although it may be a little out of date—I was discussing this with some officials earlier this week: 43% of the population do not feel fully confident in understanding health information conveyed in words. The figure leaps to 61% of people who do not feel fully confident in understanding information about their own health and their choices when the information contains words and numbers. That signifies that there is a lot more work for us to do.
Sir George Howarth
I am encouraged by the first part of the Minister’s speech that he gets this, as I was by the response of my hon. Friend the Member for Bristol South (Karin Smyth) on the Front Bench. The Minister is right that people who have long-term conditions—or, for that matter, the general population—need to understand better what they can do for themselves. It is not always obvious to people what they can do. It is also important—I referred to the recommendations—that medical practitioners understand these issues in their initial training and that they are kept up to date on the potential. Otherwise, people are operating in a fog, without understanding the potential. I am sure the Minister will agree that those things are important.
Edward Argar
I entirely agree that for health professionals, having up-to-date and refreshed knowledge is hugely important. In my current role and my previous role at the Ministry of Justice, I have looked at this point when considering domestic abuse and domestic violence. GP practice staff are often the first people to get an indication that something is wrong—not necessarily because a patient presents saying so, but because of the nature of their injuries or what they present with. Up-to-date knowledge across a range of areas is hugely important.
The hon. Member for Bristol South is right that education cannot start too early for forming good habits, and that, through school and beyond, it is important to educate people about the choices they make and the impact of those choices. That is not the so-called nanny state; it is about people being given the information to make an informed and educated choice for themselves and the benefit of their health. Another key element is confidence. People need information, but they also need to be confident to take a decision on that basis and to know where to go if they are not sure. I will turn to community pharmacies in a moment.
There are two other broad points to highlight—mental and emotional health—which the hon. Member for Bootle (Peter Dowd) quite rightly highlighted. I hope that all of us in this place agree, and that it is understood more broadly in society, that we cannot look at physical health in isolation. All elements interact with and impact on each other. We need to be fully cognisant of that and of the broader determinants of health and health inequalities, be they social, economic or health factors. There are a whole range of impacts on individuals and their overall health.
We need to ensure that people have access not only to information, but to the technology and kit to be able to manage their condition. During the pandemic, virtual wards have become more prevalent. For example, there are pieces of kit that monitor oxygen levels in blood and report back to the GP to give an early indication. That is just one example of how technology can assist, and it expanded rapidly of necessity.
I will turn to the recommendations in the report, speak a little about community pharmacies, which have quite rightly been highlighted, and then turn to the request of the right hon. Member for Knowsley for a meeting—always an easy point to respond to when one is not the Minister responsible. It is always nice to be able to commit other colleagues to meetings, but I will also address the issues in my own right.
I hear what the right hon. Member for Knowsley says about the need for a specific strategy, but I would sound a slight note of caution. It is often the case that the first call in a particular area of policy is, “We need a strategy around this”, and I am slightly cautious about having a multiplicity of strategies without bringing together a whole range of actions. That may be a point that the right hon. Gentleman wishes to raise with my hon. Friend the Member for Lewes, who I will commit to meeting him in a moment.
On that specific recommendation, self-care is an integral part of the NHS long-term plan, which we are looking at at the moment in the light of the experiences and impacts of covid, and the community pharmacy contractual framework—the five-year deal running to 2024. For that reason, I merely sound a note of caution about an additional national strategy, because over the past two and a half—almost three—years, what I have often seen in the Department of Health is a strategy for a particular issue or area of care that does not always interact with other elements of the system or take into account just how complex that landscape is. The right hon. Member for Knowsley is aware of that point from his many years in this House, but I merely sound a slight note of caution.
Peter Dowd
The Minister is making an important point. However, I am sure he also recognises that there are already lots of things out there in the care continuum he spoke about: the health literacy toolkit, the e-learning programme on health literacy from Health Education England, the health literacy support hub, guidance on physical health and mental wellbeing in schools, the community pharmacy contractual framework to which he referred, modules on self-care for minor ailments and successful self-care, and so on. Part of a strategy, if that is what we want to call it, is trying to bring all those things together. On top of that, does the Minister agree that in the plan, so to speak—the “Realising the Potential” document—there is a reference to how
“There should be a cultural shift among healthcare professionals, towards wellbeing and away from the biomedical model of care”?
It is about trying to fit those things together in a coherent strategy, if that is what we want to call it.
Edward Argar
The hon. Gentleman is seeking to find a way through some of these points in his typically dexterous way. Suggesting “a strategy, if that is what we want to call it”, leaves open the option for my hon. Friend the Member for Lewes to consider other ways in which the same thing might be achieved. I do not want to prejudge the conclusion that she will come to, but I will ensure that she receives a transcript of this debate.
Sir George Howarth
I hear what the Minister says. To be honest, I am not overly fussed about what we call it. My concern is that the Government—and, for that matter, the rest of us—are able to draw on the experience of patients, clinicians, and all those in the healthcare system to examine how we can do things better. If the Minister wants to call it something else, I am not here to have a row with him about that; I am here to try to make some progress.
Edward Argar
I am grateful to the right hon. Gentleman for that typically courteous intervention. A lot of what we are seeking to do in this area comes back to the refresh of the NHS long-term plan, which will have to happen in the context of what we have seen during the pandemic. The hon. Member for Bristol South highlighted the health inequalities White Paper, which will come forward in due course. There is a genuine opportunity to use that White Paper to draw a number of these elements together.
I am conscious that the right hon. Member for Knowsley had six other key recommendations, which I will address briefly. I will say a little bit about community pharmacy before I turn to meetings. He raised the issue of building on the successful community pharmacist consultation service, and exploring additional pathways to access that service through the implementation of self-care recommendation prescriptions to support GPs and other professionals to appropriately refer patients to self-care. Rather than taking the issue of community pharmacy separately, I will address it in response to this point, because that is probably the neatest way to do so.
I fully recognise the value of community pharmacy, and the hon. Member for Bristol South also rightly highlighted its importance. My first official engagement when I took on this job in 2019 was to attend, in lieu of the Pharmacy Minister at the time, my hon. Friend the Member for Bury St Edmunds (Jo Churchill), the Pharmacy Business Awards ceremony, which recognised community pharmacies that had done amazing work in their communities, such as the one the hon. Member for Bristol South highlighted.
As constituency Members of Parliament, we all know the depth of expertise and local knowledge that our community pharmacies bring to the communities they serve, and we know just how well regarded they are by our constituents as friendly, accessible sources of advice. Constituents do not have to be there first thing in the morning, and they do not have to make an appointment. They can stroll in and talk to a pharmacist who can give them genuinely helpful advice, without having to wait. I put on record my gratitude, and I suspect that of all hon. Members, to community pharmacies.
We are increasing our potential to expand the Community Pharmacist Consultation Service to urgent treatment centres and A&E departments. It has already taken just shy of 184,000 referrals from GPs, which, as hon. Members have suggested, is of benefit to our general practitioners, who can better manage their workload, given that some people do not need to see a GP. We are promoting the uptake of that service and incentivising its use through the GP contractual arrangements. Negotiations with the PSNC on what community pharmacy will deliver in 2022-23 as part of the five-year deal are ongoing, and hon. Members would not expect me to prejudge those negotiations. As soon as they conclude, we will announce the arrangements so that Members can consider and scrutinise them as they see fit.
The right hon. Member for Knowsley talked about primary care networks. I know the value of primary care networks. My own GP in Leicestershire is actively involved in the PCN. We saw their potential to do amazing things during the pandemic when they supported our communities with the vaccination programme and in a whole range of ways. He is right to highlight their potential to consider ways to improve self-care in their local populations as part of their network development. I hope that the soon-to-be-statutorily-constituted ICSs and ICBs will also take that very seriously, obviously subject to the other place and their deliberations later this evening.
I know from my own GP, who I regularly speak to, that many local health systems are proactively exploring upstream prevention initiatives across the health and care system and looking for further partnership opportunities to support people to improve their overall health and care outcomes. Clinical commissioning groups—soon to be ICSs—and NHSEI regionally also have the option to commission a local minor ailments service in addition to CPCSs. I hope they will explore those options as they go forward—particularly ICSs.
The fourth recommendation was that NHSEI should enable community pharmacists to refer people directly to other healthcare professionals where self-care is not appropriate, enhancing the role of pharmacists as a first port of call for healthcare advice. I entirely agree with that. There is an educational point as well in making people aware that they can go to their pharmacists. Equally, all community pharmacists are required under the terms of service to signpost people to other health and social care providers and support organisations as appropriate. There is, I suspect, more we can do in that space, but I think we have an extraordinary resource there at our disposal. NHSEI is accelerating efforts to enable community pharmacists to populate medical records and give them full integration into operability of IT systems as part of LHCR partnerships and national support for data sharing.
Data and the sharing of data in this space is, as all hon. Members know, a vexed and complicated subject, but when got right, it holds incredible potential for improving health outcomes and care. NHSX is leading the Government’s plans that will see the development of interoperable NHS IT systems that integrate health and care records, while of course considering issues that the hon. Member for Bristol South brought up in Committee when we were discussing similar matters—issues such as patient consent and data security.
We are very clear in our view that community pharmacy must play an enhanced role in the healthcare of our country, and it is our responsibility and NHS England’s responsibility to help support that. The right hon. Member for Knowsley made two final recommendations about meetings. The Government should promote a system-wide approach to improving health literacy, including working with royal colleges to include self-care modules in healthcare professionals’ training curricula and continuous professional development. I touched on that point in my response to his intervention. I have had many helpful and positive meetings with the royal colleges. I seek to meet them regularly—perhaps not as regularly as I would like, given the pressure of business in this place at times—because they have a depth of knowledge that is incomparable and incredibly useful.
Public Health England, when it was around, undertook a programme of work to improve health literacy across the country, and the Office for Health Improvement and Disparities will continue to work on that issue. The pharmacy integration programme will deliver a further almost £16 million-worth of post-registration training. That investment will equip pharmacy teams across primary care so that they are better prepared to support wider integrated healthcare delivery and expand their role in providing clinical care to patients. A pharmacist independent prescriber can provide autonomously for any condition within their clinical competence, with the exception of certain controlled drugs, particularly for the treatment of addiction. To become an independent prescriber, pharmacists must complete additional qualifications, which last typically six months, before they can prescribe.
In 2021, the General Pharmaceutical Council introduced new professional standards for initial education and training to ensure that the next generation of pharmacists is equipped with essential clinical skills. A key theme running through all the contributions today is that, when a resource is used, there can still be an untapped element of it that can be better utilised to provide support, alongside education, self-care and all the things we can do as individuals, to provide confidence and professional expertise.
NHSX should evaluate the use of technologies that have been developed during the covid-19 pandemic, and develop them to cover a wider range of minor ailments to promote self-care and manage demand on the NHS. I alluded to one example that we are working on. The Department is working with NHS Digital and NHS England and Improvement to encourage innovation and enable new approaches and organisations to support services and collaborate effectively.
I hope that, as someone whose policy area this is not, I have addressed at least in outline some of the right hon. Gentleman’s key recommendations. He made specific requests about meetings. I am always wary about that, because I have discovered that when I have meetings with my right hon. Friend the Member for Maidenhead (Mrs May) and you, Sir Charles, I come out having agreed to something or changed the direction of a policy, after being persuaded by both of you. I know that the right hon. Member for Knowsley is equally persuasive. With that in mind, I am happy to ask the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Lewes, to arrange to meet the right hon. Gentleman, my right hon. Friend the Member for Maidenhead and you, Sir Charles, to discuss this issue more broadly.
The right hon. Member for Knowsley also asked for a meeting with Diabetes UK and the relevant Minister. I will certainly pass that on to the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Lewes. In the context of the elective recovery work and my work with the NHS more broadly, I have met a number of charities in the course of developing the elective recovery plan and since we published it. I am always happy to meet charities and other organisations that do so much not only to educate people and campaign on issues, but sometimes to press us in particular directions. They always do so with good intentions and to support people. In that context, I have also met trade unions and other bodies, because I believe that a collaborative approach in this space is useful. I will pass the request on to the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Lewes, but if the right hon. Member for Knowsley feels that this could also fall within the ambit of elective recovery or of my role as Minister sponsoring the NHS long-term plan, I will of course, framed in that way, also be happy to meet Diabetes UK—I have met many charities in recent months.
If that does not provide the right hon. Gentleman with immediate agreement on what he called on the Government to do, I hope it provides him with some reassurance of just how seriously we take this issue and the recognition of just how important self-care is for each of us as individuals, for our constituents, for our healthcare system and indeed for this country. And I am very grateful to him for bringing the matter before the House today.
Sir Charles Walker (in the Chair)
I call Sir George to sum up, for no more than two minutes.
Health and Care Bill
Edward Argar ExcerptsMonday 25th April 2022
(2 years, 7 months ago)
Commons ChamberRead Full debate Health and Care Act 2022 View all Health and Care Act 2022 Debates Read Hansard Text Watch Debate Read Debate Ministerial Extracts Amendment Paper: Commons Consideration of Lords Message as at 25 April 2022 - (25 Apr 2022)
The Minister for Health (Edward Argar)
I beg to move, That this House disagrees with Lords amendment 29B in lieu.
Madam Deputy Speaker
With this it will be convenient to consider the following:
Lords amendments 30B and 108B to words restored to the Bill, Government motion to disagree, and Government amendments (a) to (i) in lieu.
Lords amendment 48B in lieu, Government motion to disagree and Government amendment (a) in lieu.
Government motion to insist on disagreement with Lords amendment 80, insist on Commons amendments 80A to 80N in lieu, and disagree with Lords amendments 80P and 80Q.
Edward Argar
The Lords amendments before the House today relate to the NHS workforce, reconfigurations, modern slavery and the adult social care cap. In respect of amendments 30B and 108B on reconfigurations, I am grateful for the constructive debate on these issue across both Houses. This House has twice voted strongly in favour of the ability for the Secretary of State to call in reconfiguration proposals when needed, and it remains a key principle that decisions on how services are delivered should be subject to ministerial oversight. However, my right hon. Friend the Secretary of State and I have listened carefully to the debates throughout the Bill’s passage, and as a result we have proposed a series of amendments to minimise bureaucracy and ensure transparency.
The first set of changes would mean that the NHS had to notify the Secretary of State only about those reconfiguration proposals that were deemed notifiable, which we will define through regulations. We intend to align that definition with the existing duty on NHS commissioners to consult local authorities where there is a substantial development of variation in the health service. We also propose to remove the requirement for commissioners and providers to inform Ministers of
“circumstances that are likely to result in the need for the reconfiguration of NHS services”.
Taken together, these changes will mean that the NHS will need to notify the Secretary of State only about proposals that are substantive and of great importance to people.
Secondly, we will give local authorities, NHS commissioners and anyone else the Secretary of State considers appropriate a right to make representations to the Secretary of State when he has called in a proposal for reconsideration. We expect this to include any relevant provider. The Secretary of State will be required to publish a summary of the representations he receives, and we will set out in statutory guidance further detail on how local bodies, including providers, will be engaged.
Thirdly, transparency is vital to ensure that these powers are always used by Ministers in the clear interest of the people we all serve. We will therefore require the Secretary of State to provide the reasons for his decisions and directions when he makes them. Finally, we have heard throughout these debates that it is vital that decisions are made expeditiously and expediently in order to give certainty to local bodies so that reconfigurations can be made quickly to improve the quality of services received by patients. We are therefore introducing a requirement that, once a reconfiguration proposal has been called in, the Secretary of State must make any decisions within six months. We believe that this set of changes addresses the key concerns raised in this House and the other place, and I commend it to the House.
I turn to Lords amendment 48B, and the Government’s amendment in lieu, on modern slavery. We share the strength of feeling expressed in both Houses on ensuring that the NHS is in no way inadvertently linked with modern slavery and human trafficking through its supply chain. That is why the Government brought forward an amendment in the first round of ping-pong to create a duty on the Secretary of State to undertake a thorough review of NHS supply chains. I am pleased to announce today that we are going further. The Government’s amendment in lieu of Lords amendment 48B will require the Secretary of State to make regulations with a view to eradicating the use by the NHS in England of goods or services tainted by slavery or human trafficking. The regulations can set out steps the NHS should be taking to assess the level of risk associated with individual suppliers, and the basis on which the NHS should exclude them from a tendering process.
I particularly commend my right hon. Friend the Member for Chingford and Woodford Green (Sir Iain Duncan Smith) for his consistent and vocal campaigning on this issue. I am delighted that he has confirmed his support for the amendment in lieu. I look forward to working further with him and his supporters to bring these measures forward.
Ms Nusrat Ghani (Wealden) (Con)
I congratulate the Minister and the Department on taking this extraordinary step. The public may believe that we already do not use slave-made goods, but unfortunately we do. It is remarkable that the Department has taken this step, and it is incredibly important that we look at Xinjiang in particular, where Sir Geoffrey Nice QC determined there has been a genocide, as there was in Bosnia. The sanctioned MPs and all our colleagues in the inter-parliamentary alliance on China will work with the Department to ensure we have no Uyghur slave-made products in our NHS.
Edward Argar
I paid tribute to my right hon. Friend the Member for Chingford and Woodford Green, but my hon. Friend the Member for Wealden (Ms Ghani) has also taken a keen interest in this issue. The Secretary of State and I will continue to work closely with others across Government to ensure that our measures to eradicate modern slavery in NHS supply chains are effective and targeted, and reflect best practice.
On Lords amendment 29B, the Government are committed to improving workforce planning and are already taking the steps needed to ensure that we have record numbers of staff working in the NHS. In July 2021, the Department commissioned Health Education England to work with partners on reviewing the long-term strategic trends for the health and regulated social care workforce over the next 15 years. We anticipate the publication of that work in the coming weeks.
Jim Shannon
If the right hon. Member for South West Surrey (Jeremy Hunt) were to pursue the matter, my party and I would be minded to support him. Although I understand from the figures in the press today that there are significant numbers of new nurses coming into the NHS, there is still a large shortfall. Will the Minister confirm for Hansard in the Chamber today that every step is being taken to recruit the nurses needed to address the issue of workforce safety?
Edward Argar
The hon. Gentleman is right to highlight the work we are already doing, which I will address in a moment, and the number of nurses we have recruited. I believe we have now recruited 29,000 or so en route to our target of 50,000 more nurses by the end of this Parliament.
Sir Robert Neill (Bromley and Chislehurst) (Con)
Will my hon. Friend give way?
Edward Argar
I will make a little progress, if I may—a few more paragraphs—as I am very conscious of allowing time for Back-Bench colleagues to speak.
Building on this work, we recently commissioned NHS England to develop a workforce strategy. We will set out the key conclusions of that work in due course. In addition, we have committed ourselves to merging Health Education England with NHS England to bring together responsibility for service, financial and workforce planning in one organisation. We will continue to grow and invest in the workforce. There are record numbers of staff, including nurses, working in the NHS.
Sir Robert Neill
I am grateful to the Minister for giving way. He will know of my interest as chair of the all-party parliamentary group on stroke, and he will be aware of the particular concern of the Stroke Association and others about the number of qualified therapists to provide the therapy people need after a stroke. Will he commit himself to that being part of the workforce strategy and to moving swiftly? This is already a pressing problem for stroke survivors who are not getting the care they need.
Edward Argar
I reassure my hon. Friend that my right hon. Friend the Secretary of State has made it clear that he wishes the whole health and care workforce landscape to be considered by Health Education England.
The growth in our workforce comes on the back of our record investment in the NHS, which is helping to deliver our manifesto commitments, as I said to the hon. Member for Strangford (Jim Shannon), including our commitment to 50,000 more nurses by the end of the Parliament. The spending review settlement will also underpin funding for the biggest ever intake of undergraduate medical students and nurses.
Although I might not be able to say anything sufficient to fully convince my right hon. Friend the Member for South West Surrey (Jeremy Hunt), I put on record my gratitude to him not only for the insight, expertise and knowledge he has brought to our debates on this issue but for the typical courtesy he has displayed throughout our interactions and conversations. I do not know what he will say in a moment, but I have tried to pre-empt him. I hope that he may be tempted to stick with it.
I hope that the House will recognise that the Government are already doing substantial work to improve workforce planning, and that placing a requirement such as Lords amendment 29B on the statute book is therefore unnecessary.
Edward Argar
Very briefly, but I am sensitive to Madam Deputy Speaker’s instruction to be brief.
Kim Leadbeater
I thank the Minister for giving way. More than 100 organisations, including the Royal College of General Practitioners and the British Medical Association, have expressed their support for Lords amendment 29B. Does he agree that the only way to ensure that we recruit and retain the talented staff that our NHS and social care sector desperately need is through a long-term workforce plan in consultation with the experts in the field, such as health and care employers, unions and integrated care boards?
Edward Argar
That is exactly what we are doing through the work commissioned by my right hon. Friend the Secretary of State, which is why Lords amendment 29B is unnecessary.
Edward Argar
I fear that I cannot, but my hon. Friend may catch me during my winding-up speech. I want to make progress, as about 10 Back-Bench colleagues wish to speak.
Finally, on the adult social care cap, the Government have announced our plan for a sustainable social care system. It is fair, affordable and designed to end the pain of unpredictable care costs by capping the amount anyone needs to pay at £86,000. Without clause 140 there would be a fundamental unfairness: two people living in different parts of the country, contributing the same amount, would progress towards the cap at different rates based on differences in the amount their local authority is paying. We are committed to levelling up and must ensure that people in different parts of the country are benefiting to the same extent, and our provisions support this. Amendments 80A to 80N also make crucial changes to support the operation of charging reform, as these changes were lost by the removal of clause 140 in the other place.
Lords amendments 80P and 80Q insert a regulation-making power to amend how
“costs accrued in meeting eligible needs”
is determined in section 15 of the Care Act 2014. However, if regulations were made using this power, they would result in anyone entering the care system under the age of 40 receiving free personal care up to that age. As local authority contributions would count towards the cap under these changes, a 35-year-old with average care costs would reach the cap and not have to pay anything towards the cost of their care, yet a person who enters care the day after their 40th birthday would need to contribute towards the £86,000 cap over their lifetime. We believe this is unfair. Our plan already includes a more generous means test that means more people will be eligible for state support towards the cost of care earlier, enabling them to keep more of their income.
The changes introduced in the other place also threaten the affordability of our reforms. Lords amendments 80, 80P and 80Q would clearly affect financial arrangements to be made by this House and, as such, have financial privilege. These new Lords amendments would cost the taxpayer more than £1 billion a year by 2027-28. Ultimately, this would mean we need to make the same level of savings elsewhere, making the system less generous for other users. I hope I have been able to provide some reassurance that we believe our approach is still the right one, and I ask the House to disagree with the other place’s amendments.
Finally, I put on record my gratitude to my hon. Friend the Member for Aberconwy (Robin Millar) and the noble Baroness Morgan of Cotes for their constructive and positive engagement during the Bill’s passage on ways to strengthen co-operation between the UK Government, the UK Statistics Authority, the Office for National Statistics and the devolved Administrations, and for their passion for strengthening the Union. I am pleased we are taking forward that work, albeit outside this Bill. I am stimulated by their important work.
We have sought throughout the passage of the Bill to be pragmatic and to listen to this House and the other place in either accepting their amendments or addressing them in lieu. I hope the House recognises that this approach continues to characterise our work, save where we sadly cannot agree with the other place in respect of its amendments on both the workforce and social care caps.
Several hon. Members rose—
Matt Warman
I agree that the Government need to continue to address that issue in the way I have described, through more extensive engagement to try to demonstrate some of what is happening.
That brings me to my second point—I will try to stick to the original time limit—which is that these issues are about trust. We need trust with the NHS workforce. As my right hon. Friend the Member for West Suffolk (Matt Hancock) said, with reconfiguration it is very often the case, as it is in my constituency, that even though the data says we will save lives by moving a service from Boston to Lincoln or vice versa, we need to engage with local communities, because right now they simply do not believe that a service that is further away may yet save lives. That does not ring true, and often the data is not yet there.
I simply appeal to my hon. Friend the Minister to deliver on what he said at the Dispatch Box about engaging with the profession, because that is essential to try to improve the morale that the pandemic has damaged so much. I also appeal to him to ensure that local NHS organisations engage with local people, because only that will win public support for the reconfiguration that is so essential for our NHS both locally and nationally.
Edward Argar
With the leave of the House, I would like to thank right hon. and hon. Members who have spoken in this debate. I am grateful to the shadow Minister, the hon. Member for Bristol South (Karin Smyth), and indeed to the hon. Member for Ellesmere Port and Neston (Justin Madders), with whom we spent many happy hours over many weeks in Bill Committee.
I also put on record my gratitude to the amazing Bill team in the Department, with whom it has been a pleasure and a privilege to work on this piece of legislation. They have done an amazing job.
I thank my right hon. Friend the Member for West Suffolk (Matt Hancock), under whose leadership we saw the genesis of this Bill, and whom it was a pleasure to work with and work for over a long period of time.
On reconfigurations, and on tackling modern slavery and supply chains, I hope and believe that these measures attract support across the House, and therefore will not reprise the case for them here.
In respect of workforce planning, I join my hon. Friend the Member for Boston and Skegness (Matt Warman) and many others who have spoken in highlighting our gratitude to the NHS workforce and our recognition of the pressures they have faced, particularly over the past two to two and a half years, but also more broadly. That is why we have not only put in place the measures I outlined to deliver an assessment through Health Education England of the needs of the workforce and the framework for growing it, but rather than waiting for that, already put in place measures to continue to significantly increase the workforce.
Edward Argar
Yes—it is the only intervention I will take, but I promised my hon. Friend.
Steve Brine
When I visit the elective orthopaedics team at Royal Hampshire County Hospital in Winchester later this week, I suspect that they will not tell me that the workforce is not one of the things on their worry list, so it is regrettable that the Government cannot accept amendment 29B. They are obviously going to get their way and win the vote, but will the Minister and his team reflect on the argument that has been had between the two Houses over the past year and, in that spirit, take this issue forward? It is not going away, I need to have an answer for the team on Friday, and what I am hearing right now is not going to satisfy them.
Edward Argar
I hope I can reassure my hon. Friend that I always reflect carefully not just on what he says and what my right hon. Friend the Member for South West Surrey (Jeremy Hunt) says, but on what the other place, and other hon. and right hon. Members on either side of this House, say.
I hope I have provided the majority of colleagues with sufficient reassurance about the steps the Government are already taking and our commitment to ensuring that we have the right number of people working in the NHS, coupled with the increases in staffing that we have already delivered and continue to deliver. I hope that the House will again agree that the substantial work already being undertaken by the Government to improve workforce planning is leading to the improvements we all seek, and I therefore urge hon. Members to reject their lordships’ amendment.
We also ask that amendments 80, 80P and 80Q are rejected and amendments 80A to 80N are accepted in lieu. The cap on care costs clause is key to this Government ending unpredictable care costs for everyone by introducing a universal £86,000 cap. That must stand part of the Bill, alongside the necessary further amendments 80A to 80N, and we encourage hon. Members to back us on this.
This Bill is an important step forward in evolving our health and care system to meet future needs, and it comes from a Government who are clear in both their record and their future plans in their support for our NHS. I hope that the other place will heed the large majorities with which this House has already sent these measures back to it, and I hope that we will do so again this evening. We always listen to the other place, but we believe that this House has, on multiple occasions and hopefully again this evening, expressed a clear view of our position on these matters.
Question put, That this House disagrees with Lords amendment 29B in lieu.
Oral Answers to Questions
Edward Argar Excerpts(2 years, 7 months ago)
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Dr Alan Whitehead (Southampton, Test) (Lab)
The Minister for Health (Edward Argar)
Reducing waiting lists and waiting times, exacerbated of course by the impact of the pandemic, is a key priority for this Government. Southampton, like the rest of the country, will benefit from the detailed actions set out in the elective recovery plan published by my right hon. Friend the Secretary of State a few months ago. In addition, as part of Solent Acute Alliance hospital upgrade programme, University Hospital Southampton NHS Foundation Trust has received £12.1 million to increase capacity at Southampton General Hospital.
Dr Whitehead
The hospital trust in Southampton, which is an excellent provider, is desperate to get back to elective surgery and non-life-threatening procedures, but finds that it cannot because it cannot integrate covid treatment into general ward activities, and has a continuing high level of staff sickness, which means that procedures are often undertaken very inefficiently in terms of resources. What assistance can the Minister provide for the trust to enable it to get on the front foot as regards elective procedures and non-life-threatening treatments in the near future?
Edward Argar
The hon. Gentleman rightly pays tribute to the staff at his hospital trust, and I join him in doing so. The number of those in his area waiting for an elective procedure or routine operation has reduced slightly. There is more to do, but the trust is making inroads, as he says, and I know that it wants to do more. As we set out in the elective recovery plan, some innovations, such as surgical hubs, allow a greater separation between covid areas, or areas where covid may be present, and elective activity is a key part of that. If it is helpful, I am always happy to meet him to discuss the specifics of his local hospital.
Kirsty Blackman (Aberdeen North) (SNP)
The Minister for Health (Edward Argar)
The workforce are the heart of our NHS, and I join the Minister for Care and Mental Health, my hon. Friend the Member for Chichester (Gillian Keegan), and Opposition Members in paying tribute and putting on record our thanks to those who work in the NHS. In the short term, the NHS has well-established processes to ensure that the health service has the right number of staff with the right skills, and that is alongside our investment in workforce expansion, including delivering 50,000 more nurses over the course of this Parliament. For the longer term, we have commissioned Health Education England to set out the key drivers of workforce supply and demand. It is due to report this spring. Building on that, my right hon. Friend the Secretary of State has commissioned NHS England to develop a long-term workforce framework. We will share the conclusions in due course.
Kirsty Blackman
The anti-immigration, “hostile environment” rhetoric and actions of this Government are having a significant impact on our NHS workforce, both by not encouraging people to come here to work in our NHS and by discouraging current staff from staying here. The Health and Social Care Committee recommended the introduction of a national policy framework on migration to support national and local workforce planning. When will the Government implement that recommendation?
Edward Argar
I am very grateful to the hon. Lady for her question. We are clear, and always have been clear, about how much we value the huge contribution that overseas workers in our NHS make towards keeping our health service up and running, and delivering first-class care every day. There are three strands to our approach to building and increasing our workforce. The first is increasing the numbers of people training in this country and the second is increasing retention. The third focuses on the workforce who come from overseas and who are incredibly welcome here. Indeed, the number of people coming from countries outside the EU into our NHS workforce has increased.
Anne Marie Morris (Newton Abbot) (Ind)
The Minister will be aware that I have highlighted the challenge for rural areas in developing a workforce plan on a number of occasions. Indeed, the last report from the all-party parliamentary group on rural health and social care made 10 recommendations, including for how we might address workforce planning in rural areas. Will the Minister advise me of what steps he has taken to put in place any of those recommendations to improve the plight of those living in rural areas?
Edward Argar
I am grateful to my hon. Friend, who takes a close interest in this issue, which she and I have discussed on a number of occasions. She is right to highlight the challenges that some more remote or rural communities can face in securing the workforce they need to meet their communities’ needs. The HEE work and the subsequent workforce framework will be looking at that across the whole range of different geographies and the challenges they face.
Martyn Day (Linlithgow and East Falkirk) (SNP)
The Scottish Government have recently bought Carrick Glen, a private healthcare hospital, in order for it to become part of the national network of treatment centres, which once fully operational will have capacity for over 40,000 additional surgeries and procedures each year. In contrast, the UK Government have taken the path of further privatisation of the NHS, so what recent assessment has the Minister made of the impact on the workforce of further privatisation of NHS England?
Edward Argar
I am grateful to the hon. Gentleman, and had we been going further down the route of privatisation, his question might have had a little more resonance. What we are doing in the NHS in England is investing in our workforce and investing in our national health service, while of course working closely with the independent sector to maximise the use of its capacity in parallel to make sure we bring down waiting lists and waiting times.
Mr Laurence Robertson (Tewkesbury) (Con)
Mr Peter Bone (Wellingborough) (Con)
The Minister for Health (Edward Argar)
No one, with the possible exception of my hon. Friend the Member for Kettering (Mr Hollobone), is more passionate than my hon. Friend the Member for Wellingborough (Mr Bone) about seeing improvements delivered in their local hospital, and I had the pleasure of visiting. As my hon. Friend will know, the £46 million was allocated originally for an urgent treatment centre; the hospital asked that that be changed and it folded in with the overall programme. It has yet to submit a business case for the enabling works; when it does, I will make sure that it is expedited.
Tony Lloyd (Rochdale) (Lab)
Dehenna Davison (Bishop Auckland) (Con)
Thank you, Mr Speaker. I will try not to make this one a waste. I was grateful to the Minister for meeting me to discuss my ongoing campaign to restore the A&E to Bishop Auckland Hospital. Many of my constituents face a long drive to get to Darlington or Durham, and given that swift treatment can be a significant factor in outcomes for conditions such as strokes and heart attacks, does he agree that having A&E services spread geographically rather than just in strong population centres is an essential part of keeping our community safe?
Edward Argar
I did indeed have a positive and constructive meeting with my hon. Friend. It is right that we have access geographically spread to A&E services, but the decisions are rightly taken by clinical commissioners on the basis of clinical evidence. I know that she will continue fighting the corner for the reopening of her local A&E with tenacity and passion.
Mrs Sharon Hodgson (Washington and Sunderland West) (Lab)
Health and Social Care: 2022-23 Mandate for NHS England
Edward Argar Excerpts(2 years, 7 months ago)
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The Minister for Health (Edward Argar)
As we are learning to live with covid, we must now return our focus to delivering the Government’s important strategic goals for health and care, including—subject to the agreement of Parliament—by taking forward the further reforms set out in the Health and Care Bill, which is nearing its final stages.
We can define our goals in terms of four key priorities. First, we must prioritise prevention, supporting people to live healthier lives with reduced risk of future health problems. This is crucial if we are to ensure that health and care services can focus resources on those who most need them. It is a central theme of the Government’s command paper “Build Back Better: Our Plan for Health and Social Care” and also supports our action plan on levelling up the United Kingdom.
Secondly, we must create more personalisation—empowering people by putting them in control of their own care. Thirdly we must prioritise performance—driving up the quality of care by working smarter. And in achieving our goals, we must support our people, without whom health and care services could not provide high quality and safe care to all who need it.
I am today laying before Parliament the Government’s 2022-23 mandate for NHS England. This sets out the action that the Government expect the NHS to take in the year ahead in support of these four priorities. There is a firm focus on recovering important NHS-led services that have been impacted by the pandemic. Beyond that, there will be further progress on the NHS long term plan, which will be updated in summer 2022 to ensure it remains aligned to the Government’s post-pandemic priorities. It then paves the way for more resilient and integrated health and care services in future, with excellent leadership, a culture of transparency and openness, and a strong commitment to support and develop the NHS workforce. Key work remains on covid-19. High rates of infection will still need to be managed as we shift from pandemic to endemic.
The revenue and capital resource limits for NHS England in 2022-23 set out in the mandate reflect the updated NHS financial settlement and also take account of the additional support provided through the 2021 spending review to fund the biggest catch-up programme in NHS history.
Also as required by the Act, I am today laying a revised 2021-22 mandate. This revision is to update NHS England’s capital and revenue resource limits for 2021-22 in light of in-year funding decisions.
[HCWS764]
Ambulance Response Times: Shropshire
Edward Argar Excerpts(2 years, 7 months ago)
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The Minister for Health (Edward Argar)
Just as I had the pleasure of giving the final speech in the final debate before the House went into recess before the last half-term, I have the same privilege today. To that end, I congratulate the hon. Member for North Shropshire (Helen Morgan) on securing this important debate. In the short time in which she has been a Member of this House, she has taken an extremely close interest in the issues of ambulances and healthcare for her constituents more broadly. She has been assiduous in raising them in the House, as she has today, or through other means with Ministers and the Department. I pay tribute to her for that.
The hon. Lady will be aware, as she has genuinely and openly said, that there are complex causes behind the challenges faced by her constituents, and also by people around the country, with the ambulance service and ambulance response times. Ambulance services have faced extraordinary pressures, which have been particularly exacerbated during the pandemic. I am sure the House will join me in expressing gratitude, as she did, to all the ambulance service staff in the NHS for their outstanding work and dedication during this time. I recognise the very powerful individual cases that the hon. Lady cited, suitably anonymised, to illustrate her arguments and her case.
As I have mentioned, the pandemic has placed very significant demands on the service. In February this year, the service answered over 760,000 calls to 999—this is nationally, and I will turn to the hon. Lady’s local situation in due course—which is an increase of 13% on February 2020. That places very significant pressures on the ambulance service and the wider NHS, and I will turn to the broader causes shortly. She was absolutely right to highlight that the issue is often not with the ambulance service itself—the number of ambulances or the number of staff—but about handovers and the ability to do turnarounds having safely deposited a patient at an acute setting in a hospital, but I will turn to that in a minute.
A range of other issues, as well of course as demand, impact on performance, including the need for infection prevention and control measures, which remain in place in hospitals. They may not be as acute or as severe as they were at the height of the pandemic, but they are still there, and that does have an impact. There are the handover delays the hon. Lady spoke about, which are linked to capacity with those infection prevention and control measures, but also to the ability either to treat and discharge or to admit patients to a hospital. In recent months, we have also had high workforce sickness absence rates, often down to covid and covid self-isolation, with staff quite rightly taking the view that when they test positive for covid they should stay at home until they do not.
In spite of these pressures—and this is in no way to diminish the point the hon. Lady made about the impact on her constituents, but is by way of context—the average response time in the west midlands to category 1 calls, the most serious calls classified as life threatening, was maintained at eight minutes and 11 seconds in February 2022. That was despite of a 40% increase in that category of calls on the previous year and a 16% increase locally in 999 calls overall. At a national level, the category 1 response time has been largely maintained at about nine minutes on average over the last several months—so not quite as good as the performance in the West Midlands—despite a 23.5% increase in those incidents compared with before the pandemic. However, we are clear that there have been significant increases in response times in the other categories, which of course we must improve.
Helen Morgan
I just want to make the point that in Shropshire we are not seeing the same level of service that we see across the west midlands as a whole. I am calling for more granular data because I think some excellent service provided elsewhere in the West Midlands Ambulance Service area is overshadowing some of the specific problems we are seeing in Shropshire. In addition, the number of hospital admissions to the Shrewsbury and Telford Hospital NHS Trust is running roughly at the same level as in prior years, so although the covid pandemic has provided challenges in separating out such patients when they arrive through infection control measures, it is not actually leading to a higher level of admissions.
Edward Argar
I am grateful to the hon. Lady, and I will turn to her specific asks in a moment.
However, I will turn now to the Bill introduced by the hon. Member for St Albans (Daisy Cooper), which I am aware of. I have to be honest and say that we do not consider that the Bill would necessarily be the most appropriate way of achieving what she wants. The challenge with that legislation is that, at a time when we wish trusts to be focused on the delivery of frontline services, it is another administrative process of data collection. I would add that trusts of course operate at trust level, not at an individual station or county level, and trusts may cover a number of counties. So while I am aware of her legislation, it is not something that I believe would achieve the outcomes or be practical in the way she wishes, and she and I regularly have a to and fro across the Dispatch Box about a number of issues when she speaks for her party on health and care matters.
There is strong support in place to improve performance. At the national level, as the hon. Member for North Shropshire generously recognised, there was £55 million of investment last summer, in advance of the winter, to help increase ambulance staffing capacity to manage pressures. All trusts received a portion of that funding to expand capacity through additional crews on the road and additional clinical support in control rooms as well as extending hospital ambulance liaison officer cover at the most challenged acute trusts.
On overall staffing, which includes frontline clinical staff and the clinical support staff who work with them, our ambulance service has seen about a 38% increase since 2010—the Liberal Democrats can quite rightly take some credit for that from their five years in government—and, indeed, in the last year we have seen an increase of about 500 frontline staff. So we have increased staff and continue to increase available staff.
The £55 million was supported by an additional £4.4 million in capital investment—these are still national figures, but I will turn to her specific local circumstances—which helped to keep an additional 154 ambulances on the road during winter over and above normal levels. Call handler numbers, which are equally important, are being boosted with more than 2,400 on target to be in place by the end of March—the end of today. That is about 500 more FTE—full-time equivalent—staff compared with September 2021, with potential for services to increase in capacity further during the coming financial year.
NHS England and Improvement is also providing targeted support to the hospitals facing the greatest issues with delays in the handover of ambulance patients, helping them to identify short and longer-term interventions to reduce delays and get ambulances swiftly back out on the road. She is right that that is hugely important, and even more so in areas with large rural populations because of the distances involved. Trusts also receive supportive continuous central monitoring and support by NHSEI’s national ambulance co-ordination centre.
With clinical support in control rooms, the ambulance service is closing just over 11% of 999 calls with clinical advice over the phone, which is an increase of three quarters since before the pandemic. That helps to save valuable ambulance resources to respond to more urgent calls, with that clinical input ensuring that the advice and decisions are right.
The hon. Lady will be pleased to hear that significant local support is in place to improve response times in her county. The West Midlands Ambulance Service is working with community partners to help avoid conveying patients to hospital where there is no clinical necessity, providing alternate treatment and care at home or in the community and helping to avoid unnecessary trips to hospital, thereby freeing up resources and hopefully providing a more pleasant experience for those patients.
In raw numbers, the West Midlands Ambulance Service conveyed over 600 fewer patients to hospital in February based on the clinical advice this year compared with two years ago. It has also introduced a clinical validation team of advanced paramedics who work in control rooms and clinically triage lower urgency cases and, where appropriate, signpost patients to other services, as I alluded to. In February, that team reviewed 967 cases in Shropshire, of which 61% of were not sent an ambulance, 14% were treated on the scene and just 25% were conveyed to hospital. That was based on the clinical triage, which I am sure the hon. Lady agrees should be central to any decisions made. That has played a significant part in helping the service to tackle the pressures.
Other practical solutions include hospital ambulance liaison officers—HALOs—who are paramedics who work with bed managers to smooth out the flow of patients coming to an A&E department. They can provide a constant flow of information about capacity to the strategic command cell at the ambulance service headquarters, escalating any issues and avoiding queueing where possible. There is also joint work to cohort ambulance patients at A&E sites, where a single ambulance crew takes responsibility for three or four patients. That releases crews to respond to outstanding calls in the community more quickly.
A new same-day emergency centre—SDEC—has been opened at the Royal Shrewsbury to divert patients, as clinically appropriate, away from A&E, improving handover times. In the two and a half years that I have been a health Minister, I have discovered that there are probably almost as many acronyms in health as in the Ministry of Defence. Surgical SDEC capacity at the Royal Shrewsbury has also been expanded and all SDEC units receive ambulances directly for suitable patients.
The hon. Lady rightly mentioned hospitals, and I am grateful that my hon. Friend the Member for Telford (Lucy Allan) is here and made an intervention. During her seven years in the House, she has been a regular and vocal advocate for her local hospital in Telford. I pay tribute to her, because it was due to her campaigning and tenacity that there is an A&E locally at Telford. That is still seeing patients and helping to alleviate the pressure in Shropshire. She should rightly be proud of that, having successfully campaigned for it.
Action is being taken locally to improve the patient flow through hospitals by discharging patients more quickly to create bed space. The aim is not only to increase the number of discharges a day, but to bring more discharges forward to earlier in the day, when it is clinically safe to do so, to allow the effective discharge and transition back to care at home or in a care home. Health and care system partners locally are looking to create additional community and social care capacity to support timely discharge, create bed space to take patients from A&E and reduce ambulance handover times.
At a national level, we have set up a national discharge taskforce. As a Minister, I get almost daily statistics about where we are on delayed discharges across the country. It is a complex picture, with a variety of reasons behind delayed discharges. The hon. Member for North Shropshire is correct that some are about delays in getting into care homes or getting domiciliary care packages or rehabilitation packages at home. Some are also down to delays in the hospital in sign-offs and procedures, and there is more that we continue to do to drive those delays down.
Construction is also under way on a new modular ward at the Royal Shrewsbury site, with 32 additional beds in service by spring 2022. That is alongside a £9.3 million upgrade of the emergency department at the Royal Shrewsbury, delivering additional cubicles, a new and improved majors department, a new designated emergency zone for children and young people and a new clinical decisions unit. The first phase of that work is complete and all areas will be finished by spring 2022.
The hon. Lady raised a number of other issues, including the Future Fit model. We have been clear that funding of £312 million was allocated for that project, and that remains allocated. The challenge we face is that, thus far, the trust has not proposed a solution that meets that budget. We continue to work with the trust and to encourage it to do so. I hope that it will so that we can continue to drive that important project forward.
I will very gently push back on what the hon. Lady said about there being £10 billion of PPE that is not fit for purpose. She will know that that is not correct. In the statement that was made about write-downs, not write-offs, the amount was about £8.7 billion, and it was not all PPE, by any means, that was not fit for purpose. Only a tiny proportion of that was the case. A significant element of that was essentially due to over-ordering at the height of the pandemic to make sure that the frontline had the PPE that it needed. We were buying at the height of the market, and there is currently a glut of PPE, so its value has inevitably declined. Not all of it will be used, because we got more than we needed to make sure that clinicians and others on the frontline were not exposed.
The hon. Lady touched on local ambulance Make Ready stations and the changes to them. Decisions on reconfigurations and changes to that are made locally by the trust; it consults, but it makes those decisions. The Government do not have any power over those matters. The Health and Care Bill, which we debated yesterday, would give the Secretary of State greater power over such reconfigurations in the way that she asked, but her hon. Friend the Member for St Albans argued against that. I gently say that that is a matter for the local trust and the usual NHS processes on reconfigurations.
The hon. Lady touched on, I think—forgive me if I am wrong—asking the CQC to look into this issue. It is entirely open for her or others to raise it with the CQC, and the CQC will make a decision or a judgment on whether it believes that it is appropriate or otherwise to look into the matter.
In the few seconds that I have left, before Mr Deputy Speaker calls me to order, I say that I recognise and do not in any way diminish the significance of the issues that the hon. Lady raised. I hope that I have given her some reassurance that we are working through these issues and that we continue to put the support in place to help her constituents in Shropshire and more broadly.
Finally, the hon. Lady requested a meeting, and I am conscious that she has raised the issue of correspondence. I have asked for that; I believe that that has happened since Christmas, as the Department works through the backlog. There is still a delay in correspondence, but I have pulled that out and asked for it, and I am happy to meet her and her fellow Shropshire MPs, together with the ambulance trust, to discuss their collective concerns or reflections that they would like to put to me as a Minister.
I conclude by wishing the hon. Lady a very happy Easter and by thanking her for bringing this to my attention and the attention of the House.
Mr Deputy Speaker (Mr Nigel Evans)
On behalf of Mr Speaker and the entire Deputy Speaker team, I wish a happy Easter and a good recess to all who work here.
Question put and agreed to.
PPE Stock Management
Edward Argar Excerpts(2 years, 7 months ago)
Written StatementsRead Full debate Read Hansard Text Read Debate Ministerial Extracts
The Minister for Health (Edward Argar)
The Government rightly prioritised saving lives throughout this pandemic. The scale of the challenge we faced should not be underestimated. We have worked tirelessly to source lifesaving PPE, delivering more than 19.1 billion items to protect frontline health and care staff.
Global demand for PPE reached unparalleled levels at the outset of the pandemic, which resulted in huge disruption across the market for PPE.
Our fight was against a new infection and at the outset, the data to determine what PPE the health and care sectors needed did not exist. Requirement for supplies was initially forecast on reasonable worst-case scenario modelling, and we now know less PPE was needed in practice.
However, in a fast-moving world of tough choices too much was preferable to too little given this was about saving lives. We had to plan for the worst. As the orders were being placed during the height of the crisis, when the market was extremely volatile, we had to factor in the likely non-performance of contracts.
We are now in a position where we have high confidence that we have sufficient stock to cover all future covid-19 related demands, even in the face of new variants of concern such as we have seen with omicron and with cases of the BA.2 lineage rising.
Not only this, but we now have the capability to produce most of what we need here in the UK across all categories except for gloves.
Where we have surplus stock, including stock that has turned out not to be suitable for use in the NHS, we have employed a range of measures to reduce it including selling, re-using and donating both in this country and internationally, recycling, and by pursuing return or recovery of costs through the original supplier.
Where products have failed quality assurance, or if products were ordered that have not arrived, the Department is taking action to determine whether a breach of contract has occurred. The investigations into contracts where we have some degree of dissatisfaction due to our high standards of quality control, or due to clear contractual breach, relate to 176 contracts.
We are working through the dispute resolution process and we are aiming to recoup significant amounts. The Department has already reduced the supply of PPE by varying and curtailing contracts. As at 18 December, the Department had negotiated the cancellation or variation of contracts to reduce the original supply of PPE by 1.21 billion items that would have cost £572 million.
Sales
To date we have achieved the sale of 330 million masks to two private companies, and we have other deals in the pipeline.
We are also about to launch an online auction to sell PPE, so individuals and companies may bid for our excess stock. Details are available on Gov.UK.
Repurposing
There are a number of items that meet all technical requirements and are suitable for use in the NHS, but they are not the preferred option. For example, self-construct visors which take four to six minutes to build were not overly appropriate for clinical settings with high usage.
However, the items were high quality and have been used in settings which allow for less time-pressured set up, such as by dentists.
Similarly, flatpack aprons have been able to be distributed for use in social care settings.
Shelf-life extension
We are exploring shelf-life extension for items that are in demand.
The Department has appointed a third-party medical laboratory to provide testing of certain categories of PPE products to see how viable it is to extend their shelf life without the products being compromised where this fits with our overall plans.
Donations
We have donated a large number of products domestically to support this country’s road to recovery underpinned by the fantastic success of our vaccination rollout. This includes 207 million masks being supplied to our schools so that pupils could get back to learning in classrooms with their peers and 38 million to transport operators to help get Britain moving once again as we begin to live with the virus. Masks have also been distributed to charities and polling stations.
Having this stock has also allowed us to provide items across the world to support the global fight against the virus.
So far, working with the Foreign, Commonwealth and Development Office, we have donated 500,000 items to Lebanon, Nepal and Overseas Territories and are in discussions with other countries and multilateral organisations, working to finalise agreements and logistics with over 30 countries. We have also donated to Ukraine, as part of a wider package of UK Government support.
Recycling
After successful trials, we have now recycled 23 million visors into plastic food trays. We are also in the process of recycling 53 thousand pallets of aprons and eye protectors; aprons are being made into bin bags, “Bags for Life" and other high-demand products.
Disposals
Our priorities are to sell, donate, repurpose or recycle wherever we can. Nevertheless, there are some PPE products that we cannot reuse or recycle. The majority of PPE items are designed to be single use and disposed of as medical waste and so are often made up of complex chains of polymers. These items cannot be broken down for recycling. As a result, many of the products we hold are not able to be fully recycled and around half are completely non-recyclable.
We have awarded contracts to two expert waste service providers. These lead waste providers will review the feasibility of recycling each item across our excess and provide detailed options.
To reduce storage costs, we must accelerate the speed of our programme, particularly for stock that is likely to become out-of-date before it is ever used and is unsuitable for recycling. For every pallet of PPE we sell, repurpose, donate and recycle, taxpayers save on average £2.75 a week for years to come.
The amount taxpayers will save from taking this decisive action would, for example, be enough to employ around 1,850 nurses for a year.
We will work with our lead waste providers to examine wider disposal options including through “energy from waste” processes. Environmental concerns will be key, and we will be taking into consideration the Government’s waste hierarchy, prioritising recycling, and then energy from waste for that proportion of stock which we hold that cannot be recycled.
Our priorities are to keep selling, repurposing and donating the stock that we can but at the same time taking a realistic, pragmatic approach to managing stock and putting in place solutions that make sense economically and environmentally.
[HCWS762]
Health and Care Bill
Edward Argar ExcerptsWednesday 30th March 2022
(2 years, 8 months ago)
Commons ChamberRead Full debate Health and Care Act 2022 View all Health and Care Act 2022 Debates Read Hansard Text Watch Debate Read Debate Ministerial Extracts Amendment Paper: Commons Consideration of Lords Amendments as at 30 March 2022 - (30 Mar 2022)
The Minister for Health (Edward Argar)
I beg to move Government amendment (a) to Lords amendment 91.
Madam Deputy Speaker
With this it will be convenient to discuss the following:
Lords amendment 91.
Lords amendment 85, and Government motion to disagree.
Lords amendment 86, and Government motion to disagree.
Lords amendment 87, and Government motion to disagree.
Lords amendment 88, and Government motion to disagree.
Lords amendment 92, Government motion to disagree, and Government amendment (a) in lieu.
Lords amendment 95, Government motion to disagree, and Government amendment (a) in lieu.
Lords amendments 52 to 54, 66 to 79, 82, 84, 93, 94, 96 to 101 and 109 to 122.
Lords amendment 123, and amendment (a) thereto.
Lords amendment 124, and amendment (a) thereto.
Lords amendment 125, and amendment (a) thereto.
Lords amendment 126, and amendment (a) thereto.
Lords amendment 127, and amendment (a) thereto.
Lords amendments 128 and 129.
Edward Argar
It is a pleasure to debate their lordships’ amendments and to serve opposite the hon. Member for Tooting (Dr Allin-Khan) for our consideration of this group of amendments—I do not usually do so as our portfolios do not always overlap. The amendments in the group all relate to questions of patient safety, patient engagement, public health and building a learning culture in the NHS.
First, may I put on record how proud I am that the Government are protecting the safety of women and girls through the hymenoplasty amendment, which I know has cross-party agreement? I will run through the amendments and concessions that the Government have made on a number of aspects of the Bill before turning to the perhaps more contentious areas in the group. We have tabled amendments to ban the carrying out, offering and aiding and abetting of hymenoplasty in the United Kingdom. We have accepted all the recommendations of the expert panel on hymenoplasty and agree that the procedure is inextricably linked to virginity testing and violence and that it has no place in our society. I offer my gratitude to all the members of that expert panel, to those who have campaigned so long and so hard on the issue and to my hon. Friend the Member for North West Durham (Mr Holden) for his continued hard work to protect vulnerable women and girls.
I urge the House to support amendments 84, 96 and 129, which create a licensing regime for non-surgical cosmetic procedures.
Mr John Baron (Basildon and Billericay) (Con)
In the spirit of accepting amendments and suggestions, may I thank the Minister, his officials and his special advisers for accepting the amendment in this place on prioritising cancer outcomes as a means of encouraging earlier diagnosis? That really will drive survival rates up. I also thank the nearly 100 colleagues here and in the other place who helped and supported the campaign. In that spirit, I assure the Minister that we will do what we can to help the Government in ensuring that the legislation prioritising cancer outcomes will have its desired effect at the frontline.
Edward Argar
I am grateful to my hon. Friend. Again, I think that I speak for both sides of the House on a cross-party basis in saying that we were pleased to be able to accept his amendment, on which he campaigned hard, in this place. I think that will lead to further improvements in cancer treatment and cancer care outcomes for many people in our country.
I return to the amendments relating to cosmetic regulation. I thank the hon. Members for Member for Swansea East (Carolyn Harris) and for Bradford South (Judith Cummins) and the right hon. Member for North Durham (Mr Jones) on the Opposition Benches as well as my right hon. Friend the Member for Romsey and Southampton North (Caroline Nokes) and my hon. Friends the Members for Sevenoaks (Laura Trott) and for Thurrock (Jackie Doyle-Price) for their hugely important work in driving forward the agenda. While the amendment is broad, the Government will of course work with stakeholders, including Members of this House, to develop regulations to set out the specific cosmetic treatments that will be subject to licensing and the detailed conditions and training requirements that individuals will have to meet.
Mr Richard Holden (North West Durham) (Con)
I thank the Minister for his comments about virginity testing and hymenoplasty and the work done by other hon. Members on parts of the legislation that affect women and girls. One issue with virginity testing and hymenoplasty relates to the family procedure rules—I know that they fall outside his Department—which still permit spouses to apply for a so-called virginity test on the grounds that a marriage is not consummated. Will he speak to his colleagues and perhaps suggest a meeting with me and other campaigners in the area to see if we can remove from legislation some of those issues affecting women and girls?
Edward Argar
My hon. Friend makes an important and highly relevant point. I will certainly pass his request on to colleagues in the Ministry of Justice and the Attorney General’s Office to look at that and, hopefully, meet him to discuss it further.
We are accepting amendments in a number of other areas to improve the quality of services that the NHS provides. First, we are tabling amendments to ensure the full operability of the noble Baroness Hollins’s amendment—Lords amendment 91—on mandatory training on learning disabilities and autism. We have discussed and agreed the changes with her and are content that her amendment, along with our Government amendment, will legislate that all health and social care providers who carry out regulated activities ensure that their staff receive specific training on learning disabilities and autism.
Dame Caroline Dinenage (Gosport) (Con)
On that amendment, will my hon. Friend join me in paying tribute to the many people who have campaigned for learning disability and autism training for health and care professionals? I think specifically of Paula McGowan—the training will be named after her son, Oliver McGowan. Training frontline health and care professionals to have a better understanding of learning disability and autism will certainly improve people’s interactions with our health and care services, and it will save lives.
Edward Argar
I am happy to join my hon. Friend in paying tribute to Paula McGowan and all those who have campaigned for this and other amendments that the Government have been able to accept to the Bill. It is often easier to pay tribute to right hon. and hon. Members who have championed issues in this House, but often they are merely mouthpieces for those campaigners who have done so much to raise the profile of such issues.
The Government have also taken steps to extend the storage limits for embryos and gametes, removing an existing unfairness. Currently, legislation discriminates between those who have a medical need to freeze their materials and those who do not. Amendments 82, 98, 100 and 122 remove that distinction by introducing a new scheme consisting of 10-year renewable storage periods up to a maximum of 55 years for everyone regardless of medical need. Our proposals were welcomed unreservedly in the other place, and I hope that they will receive a similar reception in this House.
The Government have also tabled a number of amendments in the other place on transparency of payments made and other benefits given to the healthcare sector. Lords amendments 52 to 54, 93, 94 and 97 all deliver on a recommendation from Baroness Cumberlege’s independent medicines and medical devices safety review. They will enable the Secretary of State to make regulations requiring companies to report information about payments or other benefits that they have provided to the healthcare sector.
Alec Shelbrooke (Elmet and Rothwell) (Con)
I thank my hon. Friend for what he said, which, with the Cumberlege review, is very important. I urge him again to go further on that review.
Edward Argar
I hear my right hon. Friend’s gentle but firm urgings, and I hope that he will welcome the progress that we have made.
Sir Mike Penning (Hemel Hempstead) (Con)
The Cumberlege report was fantastic. The Minister accepted some of what it said but not in relation to Primodos, especially in the area of compensation. Can we look at that again?
Edward Argar
I am always happy—or the relevant Minister is always happy—to meet my right hon. Friend on any matter relating to the Department’s work.
Turning to the Health Services Safety Investigations Body—HSSIB—and patient safety, we intend to support the development of a learning culture across the NHS. With that in mind, I would like to turn to Lords amendments 66 and 109. The related clauses concern how we balance the need for those who speak to the HSSIB to feel safe to speak openly and candidly to HSSIB staff, while ensuring that coroners can fulfil their judicial functions. This has been, throughout the passage of the Bill, a difficult balancing act with no perfect answer, which has been given much thought and attention, and on which reasonable people can come to equally valid but different views. However, I have concluded that there is significant strength of feeling in both this House and the other place on whether coroners should have access to protected material held by the HSSIB.
I am grateful to my colleagues in the Ministry of Justice, in particular the Under-Secretary of State for Justice, my hon. Friend the Member for Corby (Tom Pursglove), and to the Chief Coroner for considering the different views judiciously. Recognising that, the Government have decided to accept their lordships’ amendment, which removes the ability of senior coroners to access protected material held by HSSIB through relying on certain powers under the Coroners and Justice Act 2009. We hope that will give reassurance and strengthen the ability of the HSSIB to deliver what we all want across this House, which is to support an open learning culture across the NHS.
This group of amendments also includes a substantial number of amendments to improve public health. In the other place, we brought forward amendments to enable the smooth and effective implementation of restrictions on the advertising of less healthy food and drink. I urge the House to accept Lords amendments 101, and 123 to 128, which allow the necessary preparatory work to take place before the restrictions are due to come into force on 1 January 2023. They also introduce the ability to delay that implementation date via secondary legislation, should that be deemed necessary.
John Redwood (Wokingham) (Con)
I welcome very much what the Minister said on the previous Lords amendment concerning safety culture. Can he tell us a little more about what other actions will be taken in lieu of legislation, which is not always the best answer, to encourage the learning, safety and quality culture which is so vital to a great service?
Edward Argar
I am grateful to my right hon. Friend, who is absolutely right. We heard in this House, a little earlier this afternoon, the Secretary of State for Health and Social Care present a statement on the Ockenden review. The review has a number of—not recommendations specifically, but urgent action points. Donna Ockenden was very clear on that and my right hon. Friend accepted all of them. One of the themes that came out in that context is people’s fear of speaking up. We believe that the HSSIB will play an important part in stimulating that culture of openness and transparency, and people coming forward without fear. That is why we reflected very carefully and accepted their lordships’ amendment.
Sir Peter Bottomley (Worthing West) (Con)
I want to re-emphasise to the Minister and to others the injustice when Dr Hadiza Bawa-Garba, at an inquest three years after an event, led the police to get her prosecuted for gross negligent manslaughter and then the other actions, which I will not rehearse now. If we are going to have doctors as good as Dr Bawa-Garba and others learning from events, we will do better than the previous system. I am glad the Government are accepting the Lords amendment.
Edward Argar
I am grateful to the Father of the House, who I believe, in the course of our discussions about whether to accept the Lords amendment, wrote to me, along with other right hon. and hon. Members highlighting that particular case in the context of an open and transparent learning culture.
Dr Philippa Whitford (Central Ayrshire) (SNP)
I thank the Government for accepting the amendment. I raised the issue on Second Reading and I can see the Minister smiling at how many times we have talked about it in Committee and in the prelegislative Committee. It is critical that the safe space is safe. Systems make errors or do not prevent errors, so we need people to be candid. I pay tribute to the Government for accepting that, because it allows HSSIB to have a decent start and a decent chance.
Edward Argar
I am grateful to the hon. Lady not only for her comments just now, but for her work on this agenda and on HSSIB over many years on various incarnations of this legislation. She has a right to gently tweak my tail that I could have listened to her in Committee and got here faster, but as she will know, occasionally it takes a little time in Government to be able to move to the compromise that often we all seek.
Turning back to the advertising restrictions, the overall policy direction has been set out effectively through last year’s Government consultation response, this proposed legislation and the debate that has taken place in both Houses.
Edward Argar
If I may just finish this point. I suspect my right hon. Friend may speak later on the amendments tabled by my hon. Friend the Member for Buckingham (Greg Smith).
A consultation on secondary legislation will be launched shortly and consultations on the wider guidance to the restrictions, which will support industry and provide further clarity on what to expect, are anticipated later in the year. Therefore, we do not believe there is a need to incorporate a requirement in primary legislation to specify a gap between the date of publication of guidance and implementation of the restrictions, as proposed by my hon. Friend, but I look forward to hearing his speech later. I reassure him that the Government will of course continue to work closely with industry and with him to ensure that the transition is as smooth as possible.
Alun Cairns
I am grateful to my hon. Friend for giving way and he pre-empts some of my comments. Does he recognise the significance of the change to the broadcasting and advertising industries? It seems to me that the amendment tabled by my hon. Friend the Member for Buckingham (Greg Smith) is very reasonable in giving 12 months minimum for the industry to prepare for such significant changes.
Edward Argar
I am grateful to my right hon. Friend. I know him well but I was not sure if would be able to predict exactly what he was going to say, so I am pleased that I have managed, to a degree, to pre-empt him. I recognise the impact, and that is why we believe we have struck the appropriate balance, both in terms of the time for preparation and implementation, but I will of course listen to what my hon. Friend the Member for Buckingham says when he speaks to his amendments.
Finally, amendment 79 relates to the international healthcare arrangements clause, which amends the Healthcare (European Economic Area and Switzerland Arrangements) Act 2019 to enable the Government to implement comprehensive reciprocal healthcare agreements with countries outside the EEA and Switzerland. The clause will give the devolved Governments a power to make regulations giving effect to such agreements in devolved areas of competence. This minor and technical amendment to the definition of devolved competence and the consent requirement in new section 2B(2) reflects the fact that the consent of the Secretary of State under section 8 of the Northern Ireland Act 1998 is given in relation to an Assembly Bill, rather than an Assembly Act. It has no impact on the policy intention of the clause and I hope that hon. Members on both sides of the House will be content to pass the amendment.
On Report in the other place, the Government committed to accept in principle Lords amendment 95 to change the process for regulations that give effect to healthcare agreements, so they are subject to the affirmative resolution procedure. While we continue to support the intention of the amendment, I move that this House disagrees with Lords amendment 95 and moves an amendment in lieu, Government amendment (a). This amendment achieves the same objectives, but amends the international healthcare agreements clause rather than the regulations clause for the Bill to ensure that all regulations made under the soon-to-be-named healthcare international arrangements legislation are subject to the affirmative procedure. This includes any regulations made by the devolved Governments and achieves the objectives of the Lords amendment. This conclusion has been reached following constructive engagement with noble Lords for which the Government are extremely grateful.
In addition, to make parliamentary scrutiny of our healthcare agreements even more robust, we will set out a forward look in annual reports produced under section 6 of the 2019 Act, highlighting any agreements with other countries that are under consideration. We will publish all non-legally binding agreements and their associated impact assessments. I urge the House to accept all those Lords amendments as beneficial to the public and the NHS.
Although I have sought to compromise and reach agreement on many areas, I am afraid that there are a number of Lords amendments that we urge the House to reject. First, let me deal with Lords amendments 85 to 88. I pay tribute to the work of my hon. Friend the Member for Harrow East (Bob Blackman), the chair of the all-party group on smoking and health, for its proposals to help the Government to achieve a smoke-free country by 2030. However, the Government cannot accept these Lords amendments, because the proposals would be very complex to implement, take several years to materialise and risk directing a lot of Government resource into something that we do not see as a sustainable or workable way to fund public health. This would also rightly be a matter for Her Majesty’s Treasury.
The Javed Khan review is under way and I encourage colleagues to wait patiently for that and to be guided by what emerges from it.
Edward Argar
If I can just finish this point, I will give way to my hon. Friend. Our preference is to continue with a proven and effective model of encouraging tobacco cessation. Ultimately, given the review that is under way and the forthcoming tobacco control plan, which will be published later this year, we do not believe that this Bill is the right place for the proposals.
I will give way to my hon. Friend, but then I wish to turn to the final, important set of Lords amendments on abortion.
Bob Blackman
I thank my hon. Friend for giving way and for what he is saying about tobacco control. The recommendations are due to come out next month and most of those—indeed, most of these Lords amendments—refer to carrying out consultations without decisions actually being made. Does he not accept the point about having a consultation, taking people’s views and then deciding what to do?
Edward Argar
To a degree, that is why I mentioned the Javed Khan review. We are undertaking a lot of work and let us see what emerges from that, as well as from consultations and other pieces of work, and draw it all together. I can see where my hon. Friend is coming from, but I think that the Government have set out the right approach, so I encourage right hon. and hon. Members to reject their lordships’ amendments.
Edward Argar
I will if my hon. Friend is brief, but I know that a lot of colleagues wish to speak on the abortion amendment and I want to give them enough time to do so.
Steve Brine
Further to the intervention from my hon. Friend the Member for Harrow East, when I published the tobacco control plan in 2019, with the smoke-free ambition for 2030, we in the Government promised to consider the “polluter pays” approach to raising funds for tobacco control and smoking cessation services. The Lords amendments just require the Government to fulfil that commitment, which was barely three years ago, and to consult. I press the Minister on that again because we as a Government committed to doing this less than three years ago.
Edward Argar
My understanding—although my recollection may fail me, so I caveat my comment with that—is that this was initially looked at that stage, but was not proceeded with. I know that my hon. Friend will continue to press that point and I pay tribute to him for being the policy Minister at the time and for making huge progress on this agenda. I suspect that we will return to this matter subsequently, and I look forward to the comments of the shadow Minister, the hon. Member for Tooting, in due course.
Edward Argar
I will not now, but I may during my wind-up speech, if I have time. I want to conclude my remarks so that colleagues can make their contributions on the matters that I have referred to, but if there is time, I commit to taking an intervention from the hon. Lady at the end of our consideration of this set of Lords amendments.
We come, finally, to Lords amendment 92 and the amendment offered in lieu relating to abortion. I am aware of strong and sincerely and genuinely held views from Members on all sides of this debate and this issue, and I respect the integrity of their views. Although I will set out why the Government took the action that they did and the procedure that is in place, I emphasise at the outset that, given that this matter is before the House because of an amendment by their lordships, it is right that this is properly considered and that this will be—in line with how we normally treat these matters—a free vote, in which how individual Members vote will be a matter of conscience.
In response to the covid pandemic, an approval was issued in accordance with the Abortion Act 1967 that allowed women to take both pills for early medical abortion at home. That temporary measure addressed a specific and acute medical need, reducing the risk of covid-19 transmission and ensuring continued access to abortion services. My right hon. Friend the Secretary of State announced last month that the approval will end at midnight on 29 August 2022.
Tonia Antoniazzi (Gower) (Lab)
Does the Minister acknowledge that, in Wales—[Interruption.]—and in Scotland, telemedical abortion will continue to be available to all women after the covid-19 pandemic has finished? To be honest with the Minister, that needs to follow suit in England.
Edward Argar
I would not suggest for a moment that Wales or Scotland should follow England or that England should follow Scotland and Wales. They are devolved competences. Each devolved Administration will rightly form their own view of the balance of benefits, the pros and cons, and that is right. That is what our devolution settlement is for. This House is considering the amendment that was brought here from the Lords and this is an opportunity for Members to express their view on what should happen in this country.
The Government remain of the view that the provision of early medical abortion should return to pre-covid arrangements, and face-to-face services should resume, given that the temporary change was based on a specific set of emergency circumstances. However, we recognise that their lordships have made an amendment in that respect and it is therefore right that this House considers it.
In normal times, we prefer and believe that decisions about the provision of health services are more appropriately dealt with through the usual processes, rather than through primary legislation. We have a number of concerns about the approach taken in the amendment. Parliament has already given the Secretary of State a power to issue approvals under the Abortion Act. That allows the Secretary of State flexibility to make decisions about how healthcare in this area is provided, which can be adapted quickly and easily to respond to changes in service provision or other external circumstances, as was the case with the temporary approval in response to concern about the risk to services from covid-19.
From a process perspective, it is not appropriate, in our view, to insert into primary legislation the intended detail regarding home use of both pills. That would mean that should any issues arise, there would no longer be scope to react quickly, as the Secretary of State did during the pandemic. However, we recognise that that is now a matter for debate and decision by this House.
In addition, Lords amendment 92, as drafted by my noble Friend Baroness Sugg, would not have the intended effect. If agreed to, it would create legal uncertainty for women and medical professionals by including wording on the statute book that does not, in fact, change the law in the way it appears to. On a procedural point, we therefore urge all right hon. and hon. Members to disagree with the Lords in their amendment.
All Members have the opportunity, however, to vote on our amendment (a) in lieu, which we have drafted to ensure, irrespective of colleagues’ views, that the provision does the job it was intended to do. We all agree that it is crucial that the law is clear in this area and does not create any uncertainty for those who rely on it. That is why we have tabled our legally robust amendment in lieu, which stands in my name and which would achieve the intended purpose of Baroness Sugg’s amendment.
It is for right hon. and hon. Members, in a free vote, to judge how they wish to vote on the amendment in lieu. I encourage them to reflect and make their decision when the amendment is pressed to a Division.
Dr Rosena Allin-Khan (Tooting) (Lab)
The Opposition congratulate the Lords on their hard work on the Bill, which is much improved from when it left the Commons. We support the Lords amendments, which are sensible and proportionate and will go some way to tackling health inequalities that are still sadly far too prevalent.
Over the past two years, we have seen the very best of our NHS. Publicly owned and free at the point of use, it is the best of us and has protected our families for generations; I hope it will continue to do so for many years to come. Unfortunately, the Government are set on a power grab, and refuse to act to tackle workforce shortages and ever-growing waiting lists. Waiting times for cancer care are now the longest on record, patients with serious mental illnesses are being sent hundreds of miles away for treatment, and one in four mental health beds have been cut since 2010. We deserve better. Our NHS deserves better.
We can all agree that the amendments in this group are wide-ranging, so I will be covering a range of subjects. A number of amendments in the group speak to women’s health. We have seen time and again that the Government are dismissive of women’s health and have ignored the needs of half the population. In its original form, the Bill was far too scant on tackling health inequalities; it is only because of colleagues in the other place and Labour votes that we are making ground on tackling them at all.
Along with the rest of our health team, I am proud to support the continued provision of telemedical abortion services in England. Maintaining the existing provision of at-home early medical abortion following a telephone or video consultation with a clinician is crucial for women’s healthcare. Not only did that preserve access to a vital service during the pandemic; it enabled thousands of women to gain access to urgently needed care more quickly, more safely and more effectively. Women’s healthcare must reflect the needs of those whom it serves. Scrapping telemedical abortion services would drastically reduce access to that vital service, and would simply serve to increase the number of later-term abortions. Everyone should have access to safe and timely healthcare. I say to Ministers: please do not ignore clinical best practice and the expert opinions of organisations and royal colleges.
We welcome provisions to ban hymenoplasty, and the power to create a licensing regime for non-surgical cosmetic procedures. Those too were a result of Labour votes, because the original Bill did not even mention them. Ministers must stop treating women as an afterthought in healthcare provision. However, we are glad to see that the Government have accepted the Lords amendment to remove coroners’ access to material held by the Health Service Safety Investigations Body.
On the NHS frontlines, I see at first hand the pressure placed on staff. Staff must feel protected, and must be encouraged to come forward. It is crucial for the Bill to promote a learning culture, so that any investigation can establish what training and procedures need to change in order to prevent any future mistakes. Only by enshrining that culture can we ensure that staff will feel comfortable about coming forward.
We welcome Baroness Hollins’s amendment to introduce mandatory training on learning disabilities and autism for all regulated health and care staff, and we are pleased to see that the Government support it. Everyone deserves access to safe, informed, individual care, and hopefully the amendment will go some way towards reducing health inequalities that are faced all too regularly by people with learning disabilities and autism.
Edward Argar
Given that I spoke at length in my opening remarks, I will endeavour to use the few minutes remaining to me to cover some of the key points made in the debate. First, I should have said in my opening remarks, and say now to the hon. Member for Linlithgow and East Falkirk (Martyn Day), that I am grateful to the devolved Administrations for the constructive manner in which they have engaged with me and with my Department. I hope that that process has been collegiate and satisfactory from their perspective as well.
Let me clarify my response to a point made by the hon. Member for Gower (Tonia Antoniazzi). Health is, of course, devolved in Wales and Scotland. Were the Government’s amendment in lieu in respect of abortion to be passed, it would apply to England and Wales, but it would simply do what the Welsh Government are already doing.
We have called for Members to reject Lords amendments 85 to 88, in respect of tobacco. We heard from the hon. Member for Stockton North (Alex Cunningham), who rightly cited the hon. Member for City of Durham (Mary Kelly Foy). I am sorry that she could not be here today, but in Committee she took a close and well-informed interest in these issues. We have also just heard from my hon. Friend the Member for Harrow East (Bob Blackman).
Edward Argar
I did promise not to take interventions, given the time, but I will take one from the hon. Lady, because I was not able to do so during my opening remarks.
Edward Argar
Before responding to the hon. Lady, I must correct myself. I should have said “With the leave of the House” before starting my wind-up remarks.
I am grateful to the hon. Lady for her work on this issue. Although this does not normally fall within my ministerial portfolio, she and I have debated this issue across the Floor of the House, and I know her interest and her passion for this issue, and the hard work that she has done on it. While I recognise that, I believe that the Government’s approach of resisting the Lords amendments in this space is the correct one, and I therefore fear I may disappoint her. We will see whether the House divides on this matter; I suspect it will, but that will be up to shadow Ministers and other Members. I welcome the debate, and I suspect it is a debate we will continue to have.
I have listened extremely carefully to my hon. Friend the Member for Buckingham (Greg Smith), as he would expect. I would encourage him not to press the point further at this stage, and I will of course continue to reflect carefully on the points he has made. They are important points about the impact on industry and on the broadcasting industry, and I will consider carefully what he said, but we believe that we have struck the appropriate balance in the legislation as it stands. I am grateful to him for his intervention in this debate and his comments.
It was perhaps predictable when looking at the nature of the amendments in this group that Lords amendment 92 and amendment (a) in lieu would inform the bulk of the contributions across the House. This is an issue that Members quite rightly hold strong views on, and there are sincerely held and informed views on both sides of the debate. It is important that this debate is well informed. We heard from my hon. Friends the Members for Runnymede and Weybridge (Dr Spencer), for Congleton (Fiona Bruce) and for Sleaford and North Hykeham (Dr Johnson), and the hon. Member for Strangford (Jim Shannon), the right hon. Member for Kingston upon Hull North (Dame Diana Johnson) and the hon. Member for Birmingham, Yardley (Jess Phillips). May I offer my condolences to the hon. Member for Birmingham, Yardley and her family on the loss of her mother-in-law, Diana, on Friday?
We also heard from my right hon. Friend the Member for Basingstoke (Mrs Miller), my hon. Friend the Member for Sevenoaks (Laura Trott) and my right hon. Friend the Member for Gainsborough (Sir Edward Leigh), as well as from my hon. Friend the Member for Boston and Skegness (Matt Warman), who gave a typically powerful speech on the subject. We also heard from the hon. Member for Upper Bann (Carla Lockhart).
I have made it clear throughout the debate that this is a free vote, but I would urge Members, in reaching their decisions, to be cautious about some of the figures that have been used in support of some of the arguments today. We do not have all the detailed figures, and I understand that some of them may be based upon extrapolations from freedom of information requests conducted in this respect. I am not drawing any conclusions beyond that, but I would urge caution among Members in how they use those figures.
It is absolutely right that this issue, having been inserted into the Bill by the noble Baroness Sugg, should have been carefully considered by this House. The volume of contributions reflects the importance attached to it by Members. The Government have been clear that these were temporary provisions put in place to reflect an extraordinary set of circumstances, and my right hon. Friend the Secretary of State has been clear that, as we move out of the pandemic, such temporary pandemic-related measures should cease. However, the House has had the opportunity to debate this matter today, and the views expressed on both sides are important for the House to hear.
As I have said, I hope that Members will be clear about the process that we will follow. We hope that, on the voices, the House will reject the Lords amendment tabled in Baroness Sugg’s name purely on the basis that it is legally defective and will not do the job that was intended for it in policy terms by the noble Baroness. We have therefore tabled what we believe is a legally effective amendment in lieu of that amendment. Uncertainty in this area of policy and of law does no one any favours, and we would not wish uncertainty for anyone in this space. That is why we were unable to accept the noble Baroness’s amendment and why we are asking the House to reject it, but we have come up with something that we believe provides clarity and is legally effective in what it does. As I say, it is for hon. Members to consider their own position on this matter of conscience, which is of import to our constituents up and down the country, and I suspect they, too, will have strong views either in favour or against. It is right that the House brings such matters to a debate and a vote.
Madam Deputy Speaker (Dame Eleanor Laing)
With this it will be convenient to discuss the following:
Lords amendment 30, and Government motion to disagree.
Lords amendment 48, Government motion to disagree, Government amendment (a) in lieu, and amendment (b) in lieu.
Lords amendment 57, and Government motion to disagree.
Lords amendment 89, Government motion to disagree, and Government amendment (a) in lieu.
Lords amendment 108, and Government motion to disagree.
Lords amendments 42 to 47, 55, 56 and 58 to 64.
Edward Argar
It is a pleasure in discussing this set of amendments to be facing the shadow Secretary of State, the hon. Member for Ilford North (Wes Streeting), although I might not say that after he has made his contribution or challenged me. I am grateful for the opportunity to speak to this important set of amendments, and I again put on record my gratitude to their lordships for the work they have done in scrutinising this Bill. This group is about accountability and makes it clearer that the Government are committed to ensuring that the NHS is transparent, accountable and effective.
Lords amendments 42 to 47 ensure that the procurement regulations will have to include provision for procurement processes and objectives; for steps to be taken when competitively tendering; and for transparency, fairness, the verification of compliance and the management of conflicts of interest. They also require NHS England to issue guidance on the regulations. It behoves me to pay tribute to the shadow Minister, the hon. Member for Bristol South (Karin Smyth), who served on the Bill Committee throughout. Although we did not always agree, she brought her expertise and forensic skills with issues such as this to that Committee. Even if she did not always agree with the conclusions, she made sure we were well informed in the conclusions we reached.
We recognise those key aspects as vital. While it was always our intention to include them in the new provider selection regime, the amendments add clarity and clearly signal our intentions. Furthermore, Lords amendment 47 makes the regulations subject to the affirmative procedure. We are grateful for the input of the Delegated Powers and Regulatory Reform Committee in advising that, and we have listened.
Lords amendment 55, supported by the Scottish Government, makes it clear that any powers or duties conferred on Scottish Ministers in relation to their role in collecting information for medicine information systems can be treated in the same way as other NHS powers or duties in Scotland and be delegated to health boards in Scotland.
Lords amendments 56 and 58 to 64 relate to the power to transfer the functions of arm’s length bodies. Following constructive engagement with the devolved Governments, these amendments enable us to proceed on a UK-wide basis. Lords amendment 56 clarifies that the powers in part 3 of the Bill in respect of special health authorities apply in relation only to England and cross-border special health authorities, and not Wales-only special health authorities. Lords amendments 58 and 59 remove devolved Ministers and Welsh NHS trusts from the list of appropriate persons to whom property, rights and liabilities can be transferred through a transfer scheme following a transfer of functions.
Lords amendment 60 creates a requirement for the Government to obtain the consent of the devolved Governments for any transfer of functions within the competence of their legislatures or which modify functions exercised by the Welsh Ministers, Scottish Ministers or a Northern Ireland Department. Finally, Lords amendments 61 to 64 are consequential upon the changes made by Lords amendment 60.
I am also asking the House to disagree with several amendments made in the other place. First, Lords amendment 29 relates to the workforce, and I reassure the House that the Government are committed to improving workforce planning. We recognise the importance of having a properly trained workforce in sufficient numbers and in the right places. We are already taking the steps we need to ensure we have record numbers of staff working in the NHS. While we recognise the strength of feeling behind the amendment, we simply do not think it is necessary in its current form, and we urge the House to reject it.
Peter Aldous (Waveney) (Con)
I am aware that the Government have put in place their own plans for NHS workforce planning, but can my hon. Friend address the concerns that framework 15 has inadequacies in terms of data collection, does not provide an assessment of workforce numbers and is not responsive to societal shifts?
Edward Argar
My hon. Friend puts his finger on a key issue, which is the dynamic nature of workforce trends, whether in terms of demand or supply, which is one of the challenges of a long-term projection—it would need to be a dynamic process. That is why we believe that the right approach is the one set out by my right hon. Friend the Secretary of State. His predecessor commissioned that framework review from Health Education England in July last year, and the Secretary of State has subsequently asked for further work to be done in a further commission that looks at a workforce framework over 15 years. That is the first time that has been done, as I heard him say at the Dispatch Box earlier today when talking about the Ockenden review, and it will be a hugely valuable tool for the NHS and for us when we make decisions in this place about priorities and prioritisation in healthcare. As always, I am grateful to my hon. Friend the Member for Waveney (Peter Aldous).
Before I go into more detail, I will make a point on which I suspect the shadow Secretary of State and I are in complete agreement. Although there may not be many things in this group of amendments that we agree on, I am sure that he will join me in recognising the amazing work done by our health and care workforce over the past two years, and not just in the past two years, which were exceptional circumstances, but every day of the year—day in, day out—whichever year it is. I put that on record because it is important.
Edward Argar
The hon. Gentleman nods; as I say, I suspect that may be a rare moment of agreement on this group of amendments.
We continue to be committed to growing and investing in the workforce. This year we have seen record numbers of staff working in NHS trusts and clinical commissioning groups, including record numbers of doctors and nurses. The monthly workforce statistics for December 2021 show that there are more than 1.2 million full-time equivalent staff. Those workforce numbers come on the back of our record investment in the NHS, which is helping to deliver our manifesto commitments, including to have 50,000 more nurses by the end of the Parliament. We are currently on target to meet that manifesto commitment, as the number of nurses was a little over 27,000 higher in December 2021 than in September 2019.
The spending review settlement will also underpin funding the training of some of the biggest undergraduate intakes of medical students and nurses ever. In that context, I highlight the decision made, I believe, under one of my predecessors to expand the number of medical school places from 6,000 to 7,500, which has come on stream. Of course there is a lead time before those going through medical schools will be active in the workforce, but it is an important step forward.
Janet Daby (Lewisham East) (Lab)
I draw the Minister’s attention to the 2 million Uyghurs who have been detained in concentration camps. They are making slave-made goods that have infiltrated our NHS, which puts health workers at risk of wearing products made by modern slavery. Will he recognise the importance of accepting Lords amendment 48 so that the NHS is not dependent on slave-made goods?
Edward Argar
I hope the hon. Lady will forgive me, because I will finish discussing the workforce amendments before I turn to the so-called genocide amendments and the organ sales amendments. I will come to her point, but I hope she will allow me to do it in that way; I have heard what she has said.
Edward Argar
I will make a little progress, then I will give way to the hon. Lady, as I tend to do. She is a regular participant in health debates.
We are already committed to improving workforce planning. In July 2021, as I said, we commissioned that important work with partners to review long-term strategic trends. It is also important to note in that context that my right hon. Friend the Secretary of State announced that we are merging NHS England and Health Education England, which is a hugely important move that brings together the workforce planning and the provision of places and of new members of the workforce with the funding available for that and the understanding of what is needed in the workforce. It brings supply and demand considerations together.
Debbie Abrahams (Oldham East and Saddleworth) (Lab)
Will the Minister give way?
Edward Argar
I will make a little more progress, then I will give way to the hon. Member for York Central (Rachael Maskell) and then, if I have time, I will give way to her. I want to address the points of the hon. Member for Lewisham East (Janet Daby) in good time and I am conscious that the votes took up a chunk of the time allowed for this group of amendments.
We are also committed to increasing transparency and accountability. The unamended clause already increases transparency and accountability on the roles of the various actors within the NHS workforce planning system.
Rachael Maskell
When looking at workforce planning, it is really important not only that the Government depend on NHS professionals trained overseas, but that they look at commissioning more training places here. In particular, I would point to the dentistry profession, as the Government are currently waiting for 700 dentists to pass their exams. It really does highlight the shortage of training for our own dentists when one in three dentists practising has trained overseas. Will the Government look at the commissioning of more training places so that we can grow our own workforce?
Edward Argar
The hon. Lady will be pleased to know, or will I hope be reassured to a degree to know, that underpinning our strategy to grow the workforce—for example, the nursing workforce or other specialisms—is the fact that we have multiple strands to the strategy. Those coming from overseas who wish to work in the NHS are always going to be an important and valued part of our NHS workforce, but of course we are also committed to growing the number, for want of a better way of putting it, that we grow at home through training places and medical schools. Crucially, however, a key element here is retention of our existing staff, so that we are not simply recruiting and training lots more staff to replace those who are leaving. All of those factors are important.
Debbie Abrahams
Does the Minister want to comment on the fact that 100-plus organisations—and not just those 100 organisations, including the BMA, but former chief executives of NHS England—are still very concerned that the Government’s measures on workforce planning do not go far enough?
Edward Argar
I am grateful to the hon. Lady, and she and I have worked together on a number of issues in the past. We always engage—and the since the inception of the Bill and throughout its passage, we have engaged collaboratively—with a whole range of organisations, such as professional bodies and trade unions, including some of those she mentioned. We believe that the approach we have adopted in the commissions from the Secretary of State, coupled with the merger with Health Education England, will be a significant step forward, and we believe it is the right approach to take. I suspect that the hon. Lady may disagree, and I always respect her opinion, although I may not always agree with it.
Jeremy Hunt (South West Surrey) (Con)
Will the Minister give way?
Edward Argar
I wanted to make a little progress, but I will give way to the Chair of the Select Committee.
Jeremy Hunt
Could the Minister possibly just tell me whether there is a single NHS organisation that is not supporting Lords amendment 29, which the Government are planning to reject?
Edward Argar
I may regret giving way to my right hon. Friend. I do not often say that, but perhaps I do now. I believe that this is about striking an appropriate balance in workforce planning and understanding supply and demand. I believe that the approach we have adopted as a Government, with the commission and the subsequent commission from the Secretary of State, is the right one. We are working closely with all NHS organisations from NHS England down, and I am sure that we will continue that collaborative work and that they will recognise the value being added by these commissions.
Tim Farron (Westmorland and Lonsdale) (LD)
Will the Minister give way?
Edward Argar
I will make a little progress if I may, but if the hon. Gentleman can shoehorn his way in a little later, I will, assuming I am making good progress, try to find a way to come back to that point for him.
On Lords amendments 30 and 108, while we recognise the concerns of the other place, we think it is important to enable the Secretary of State to intervene in reconfigurations with greater flexibility where such an intervention is warranted. While the Secretary of State already has powers over reconfigurations, our proposals will allow them to better support effective change and respond in a more timely way to the views of the public, health oversight and scrutiny committees and, indeed, parliamentarians in this House. It will reduce wasted time and effort, and it will allow Ministers to become involved at the right stage, not simply at the end stage of the process. For that reason, we urge the House to reinstate clause 40 and schedule 6.
Edward Argar
I think the hon. Gentleman is seeking to intervene. I find it difficult to say no to him, so I will give way.
Tim Farron
The Minister is a thoroughly good man, and I am very grateful. He will be aware of the National Audit Office’s projection that there are probably 100,000 undiagnosed cancer cases since the pandemic. Tragically, clinicians reckon that probably 20,000 of those people have already passed away. Will he agree and commit to a specific workforce strand when it comes to cancer? We desperately need cancer specialists, nurses, oncologists, radiotherapists and so on if we are going to be able to tackle this problem, but also make sure that we are not overburdened in the future, so that we can save lives?
Edward Argar
I am pleased I took the hon. Gentleman’s intervention on an issue that I know he has long taken an interest in. As well as the overall macro-trends of supply and demand, I expect the work being undertaken to look at the specialisms sitting beneath. He and I have discussed the significant increase in percentage terms in the number of radiographers, radiologists and others since 2010, but I acknowledge his underlying point that there is more to do if we are to achieve the ambitions set out in our consultation on the 10-year cancer plan and our broader ambitions for cancer care and treatment. We continue to look at that, and those specialisms will form a part of that work.
The hon. Member for Lewisham East raised a subject that I suspect will come up in contributions to the debate, including from my right hon. Friend the Member for South West Surrey (Jeremy Hunt). Regarding Lords amendment 48, we have heard the strength of feeling in the other place about the gravity of this issue, and I know that no one in this House would support the use of forced labour in creating NHS goods or their coming from areas where genocide may be taking place. We are fully committed to ensuring that that does not happen and we are now proposing further measures to tackle the use of forced labour, but we do not believe that this is the right legislative vehicle for introducing those changes, especially those made in the other place relating to genocide.
The Government will bring forward new rules for transforming public procurement in the forthcoming procurement Bill, which will cover all Government procurement and further strengthen the ability of public sector bodies to exclude from bidding for contracts suppliers that have a history of misconduct, including forced labour. We believe that that is the right vehicle for such provisions. The review of the 2014 modern slavery strategy will be published in spring this year, and will provide an opportunity to build on the progress we have made and to adapt our approach to take account of the evolving nature of these terrible crimes. We know that the NHS is one of the biggest procurers in this country, and it is for that reason that we are introducing measures in this Bill to ensure that NHS procurement works for the good of all.
NHS England and NHS Improvement agreed a new slavery and human trafficking statement for 2022-23 on 24 March, with new modern slavery countermeasures in the NHS supplier road map, updates to the NHS standard contracts to strengthen our position on modern slavery, and the development of a new strategy to eradicate modern slavery across the NHS supply chain. We are going to go further than that, though. In amendment (a) in lieu of amendment 48, we propose to introduce a duty on the Secretary of State to carry out a review into the risk of slavery and human trafficking taking place in NHS supply chains, and to lay before Parliament a report on its outcomes. That review will focus on Supply Chain Coordination Ltd, which manages the sourcing, delivery and supply of healthcare products, service and food for NHS trusts and healthcare organisations across England. As well as supporting the NHS to identify and mitigate risk with a view to resolving issues, the review will send a signal to suppliers that the NHS will not tolerate human rights abuses in its supply chains and will create a significant incentive for suppliers to revise their practices. I will listen to my right hon. Friend the Member for South West Surrey when he makes his contribution and endeavour to respond when I wind up this debate. I know he has strong views on this subject, as do other hon. Members
Janet Daby
I thank the Minister for his response. My concern is the level of urgency. If the Government allow the problem to continue in the NHS, they are inadvertently allowing slavery to continue, which is not helpful.
Edward Argar
As ever, the hon. Lady makes her point courteously but clearly. As I said, depending on the time available at the end of the debate, I will endeavour to respond more fully to the points that she and my right hon. Friend make.
Sir Iain Duncan Smith (Chingford and Woodford Green) (Con)
I hope to speak on this subject if I catch your eye, Madam Deputy Speaker, but I want to make the point that right now, even though it is not meant to be allowed, the NHS is using products made by slave labour. Only two days ago, The Spectator demonstrated that products being used in King’s College Hospital actually came from providers in Xinjiang, so it is happening now. Like the hon. Member for Lewisham East, I want to emphasise the urgency of this issue, so I intend to bring it up with my hon. Friend the Minister during the debate.
Edward Argar
I should say at this point that I was grateful for the opportunity to talk to my right hon. Friend about this subject a week or two ago, and I suspect that our conversations will continue.
I want to cover the rest of this group of amendments. Lords amendment 57 would exclude statutory functions of NHS Digital from the transfer of powers in the Bill. I urge the House to reject that amendment. I have assured Members of this House and in the other place that the proposed transfer of functions of NHS Digital to NHS England would not in any way weaken the safeguards we have in place for the safe and appropriate use of patient data. NHS Digital’s current obligations in terms of its data functions, and particularly the safeguards that apply to patient data, will become obligations on NHS England. The merger, which has been announced as Government policy, is in response to the recommendation of the Wade-Gery review. It is essential to simplify a complex picture of national responsibilities for digital and data services in the NHS, bringing them together in a single organisation that leads on delivery and the data needed to support it.
Edward Argar
As ever, I thank hon. and right hon. Members from all parts of the House for all their contributions to this important debate on an important set of amendments. Even if I do not always agree with everything he says, I welcome in particular the contribution from the hon. Member for Ellesmere Port and Neston (Justin Madders). He and I spent a productive period—I was going to say happy—sitting opposite one another for two days a week over many weeks in Bill Committee, taking this legislation through. While I miss him from his previous role as effectively my shadow, I wish him well in his current shadow ministerial role. I also put on record my gratitude, although he cannot be here today, to the hon. Member for Nottingham North (Alex Norris) for his work on the Bill.
I gently tease, and this is no reflection on the current shadow Minister, that in Committee it took two shadow Ministers to try to keep me on my toes. It appears today that it takes three, but in saying that I cast no aspersions on the shadow Secretary of State, the hon. Member for Ilford North (Wes Streeting), who I am fond of, even when he is gently or less so gently pushing me on certain issues.
I turn first to the organ tourism amendment, and I am grateful to the shadow Secretary of State for his approach on this issue. We have a shared objective here, and I assure Members that our approach would target not only transplant tourists, but anyone involved in making the arrangements for the purchase of the organ who may be a British national. The Government amendment, paired with our commitment to work with NHS Blood and Transplant to make more patients aware of the legal, health, and ethical ramifications of purchasing an organ, will send an unambiguous signal that complicity in the abuses associated with the overseas organ trade will not be tolerated.
Turning to reconfigurations, I strongly believe that the public rightly expect Ministers to be accountable for the health service, which includes the reconfigurations of NHS services. This House rightly voted to retain these clauses on Report. The reconfiguration power will ensure that decisions made in the NHS that affect all our constituents are subject to democratic oversight. Without it, the Secretary of State’s ability to intervene and take decisions will remain limited, and usually be at a very late stage in the process. Although I hear what hon. Members have said, I note that many hon. Members from both sides of the House none the less seek to persuade the Secretary of State and seek to raise issues relating to their local services with the Secretary of State with a particular outcome in mind.
As now, the Secretary of State would not be alerted to a potential change in services until the change had become a relevant issue and would not be able to intervene without that formal referral. We have retained the independent reconfiguration panel. The shadow Secretary of State raised the issue of the clinical appropriateness of the changes. Nothing that is proposed here alters the fact that clinical appropriateness and clinical and patient safety remain central to any decisions and remain an obligation on the Secretary of State in any decisions that he or she makes in that context.
Briefly, on the remarks of the shadow Secretary of State about waiting lists, he will be aware that we published a comprehensive and ambitious but realistic elective recovery plan that is backed by record funding and resources for the NHS to tackle those waiting lists, which have grown as a result of the pandemic. I am straight enough with him to recognise that there were waiting lists before the pandemic. He always makes that point and I highlight that we have a plan to fix that, which is exactly what we are doing.
The shadow Secretary of State also highlighted several other factors relating to the workforce and the workforce clause, as did my right hon. Friend the Member for South West Surrey (Jeremy Hunt), the shadow Secretary of State—sorry, the Chair of the Health and Social Care Committee; I do not think we will be fielding shadow Secretaries of State from the Conservative Benches for some time yet. I entirely understand where my right hon. Friend is coming from on this issue, but I believe the approach that the Government have adopted, with the framework 15 commission and review and the broader commission that the Secretary of State has set out to look at drivers of workforce supply and demand, absolutely reflects our recognition of the centrality and importance of the workforce, and the right workforce, to the delivery of all our ambitions for constituents and for recovering waiting lists and waiting times.
We have not waited for any projections to get on with that; we are already investing in increasing our workforce and we are seeing record numbers of people working in our NHS. I have already highlighted that we are well on target to meet the commitment of 50,000 more nurses, with a current increase in the number of nurses of 27,000. The hon. Member for St Albans (Daisy Cooper) highlighted the same issues in her remarks.
I am particularly grateful to my right hon. Friend the Member for Chingford and Woodford Green (Sir Iain Duncan Smith) for his contribution on a challenging issue. There is a considerable degree of consensus on both sides of the House about the abhorrence of modern slavery, slavery or anything linked to it. We remain of the view that this is not the right legislation for the proposed changes.
As I set out in my previous remarks, new rules for transforming public procurement will further strengthen the ability of public sector bodies to exclude suppliers from bidding for contracts where they have a history of misconduct—or extreme misconduct in the case of slavery, forced labour or similar. In developing the modern slavery strategy review, it will continue to be important to engage across Government and civil society, nationally and internationally, to collect the necessary evidence to agree an ambitious set of objectives. It is right that the Government take action on the crime of modern slavery and it is right that the NHS is in step with all public bodies in doing so.
From listening to my right hon. Friend, I expect the issue to reappear when their lordships consider our amendments. In that context, I hope that he and other hon. Members are willing to continue to engage with the Government and my Department on this hugely important issue. As he rightly said, it is important not just in this House but outside this House to those we represent. I look forward to continued engagement with him.
Edward Argar
I have literally 30 seconds left, so if my right hon. Friend’s intervention can be in five seconds, I will give way.
Sir Iain Duncan Smith
Can the Minister tell his colleagues in the Government that there is never a good time? Now is the right time, and let us get on with it.
Edward Argar
I think that was exactly five seconds, and I am grateful to my right hon. Friend. I suspect that colleagues across Government will have heard what he said and will pay very careful attention to it, as I know Ministers across Government do to all that my right hon. Friend says in this House.
With that in mind, I ask the House to accept the motions in my name on the amendment paper.
Madam Deputy Speaker (Dame Eleanor Laing)
I congratulate the Minister on his perfect timing. That is very rarely done with such precision.
Question put, That this House disagrees with Lords amendment 29.
Edward Argar
I beg to move, That this House disagrees with Lords amendment 11.
Mr Deputy Speaker (Mr Nigel Evans)
With this it will be convenient to discuss the following:
Government amendment (a) in lieu of Lords amendment 11.
Lords amendment 51, Government motion to disagree, and Government amendment (a) in lieu.
Lords amendment 80, Government motion to disagree, and Government amendments (a) to (n) in lieu.
Lords amendment 81, and Government motion to disagree.
Lords amendment 90, Government motion to disagree, and Government amendment (a) in lieu.
Lords amendment 105, Government motion to disagree, and Government amendment (a) in lieu.
Lords amendments 1 to 10, 12 to 28, 31 to 41, 49, 50, 65, 83, 102 to 104, 106 and 107.
Edward Argar
Let me repeat, quite legitimately, what I said in opening the debate on the previous group of amendments. It is a pleasure to serve opposite the shadow Minister, the hon. Member for Bristol South. It was also a pleasure to serve opposite her in the Bill Committee. She was not the shadow Minister then, but she brought her expertise and, as I said earlier, her forensic knowledge of these areas of the Bill—occasionally to my slight discomfort—and, overall, a degree of informed deliberation to our proceedings.
The amendments in this group relate to integration, commissioning and adult social care. The Government’s amendments strengthen our expectations of commissioners, especially in relation to mental health, cancer, palliative care, inequalities and children. Lords amendments 1, 25, 27 and 49 strengthen our approach to mental health. Amendment 49 makes it clear that “health” refers to both physical and mental health in the National Health Service Act 2006.
Sir Charles Walker
I want to thank my hon. Friend for making that clear, because there was some concern that the Bill broke with parity of esteem by not recognising that mental health was as important as physical health. A number of Members raised concerns about that, and I want to thank my hon. Friend and his team for getting it right. They should be congratulated.
Edward Argar
I am very grateful to my hon. Friend. He has come in at just the right time, because I was about to thank and pay tribute to him and, indeed, to my right hon. Friend the Member for Maidenhead (Mrs May). Both of them have, in their typically determined and persistent but very courteous way, pressed this issue and highlighted the need for it to be explicit in the legislation. I think we have made the Bill stronger and clearer through Lords amendment 49, and I pay tribute to my hon. Friend for that.
Lords amendments 1, 25 and 27 also require the Secretary of State to publish, and lay before Parliament, a document setting out the Government’s expectations for mental health spending for the financial year ahead. Lords amendment 105 requires a member with experience of mental health to sit on each integrated care board. Although we have adopted a permissive rather than a prescriptive approach throughout, we are persuaded of the need and the benefits—given the parity of esteem—of having that experience on the ICBs, and, while we are proposing some changes in the drafting, we agree with the principle. I hope that the shadow Minister shares that view.
I pay tribute to my hon. Friend the Member for Basildon and Billericay (Mr Baron), and to Members of the other place, for their engagement and continued support in relation to Lords amendments 2, 3 and 4, which relate to cancer objectives in the NHS mandate. The amendments change the focus of the cancer outcomes objectives so that they capture all cancer interventions. Those objectives will have priority over any other objectives relating to cancer, not just those relating specifically to “treatment”. I also pay tribute to Baroness Finlay, who has long campaigned to add explicit reference to palliative care services to the list of services that an integrated care board must commission. That is why we are accepting Lords amendment 12.
Lords amendments 22, 83, 102, 103 focus on addressing the needs of babies, children and young people. Lords amendment 22 would require the ICB to set out any steps it proposed to take to address the particular needs of children and young people, while Lords amendments 83, 102 and 103 specify that the Government must publish a report describing the Government’s policy on information sharing by or with public authorities in relation to children’s health and social care and the safeguarding of children. I pay tribute in that context to my right hon. Friend the Member for South Northamptonshire (Dame Andrea Leadsom), who has long taken a keen interest in these issues.
Alicia Kearns (Rutland and Melton) (Con)
I thank my hon. Friend and neighbour for giving way. On the duties of integrated care boards, he knows that one of my grave concerns about health inequalities relates to rural settings. In Rutland, our citizens receive care in Peterborough, Stamford, Kettering, Corby, Leicester and sometimes even beyond. The big problem at the moment is that their health records are not shared across those different clinical commissioning groups, leading to big problems with them getting the care and support they need. Will ICBs be able to help us to overcome these issues? I have been lobbying the Department of Health and Social Care for months to help us sort out this problem.
Edward Argar
I can reassure my hon. Friend that under the changes we are putting in place through the integrated care systems, ICBs will continue to be able to commission services and to send patients to hospitals outside the ICS area. They will also be obliged to co-operate and work with other organisations in the patient’s best interests. We are setting this alongside the broader work that we are doing in the Department on the interoperability of data. I hope that that has reassured her to a degree.
We are also committed to supporting research, and I ask the House to agree to Lords amendments 6, 15, 26 and 28, which further embed research and provide increased clarity, transparency and oversight in respect of ICBs, NHS England and the Secretary of State’s research duties.
Debbie Abrahams
I want to ask the Minister about two matters. First, why are health inequalities not explicitly mentioned among the triple aims of the Bill? Secondly, on the membership of ICBs, I am sorry if I misheard, but I did not hear him discuss the amendment on how to avoid any conflict of interest involving private providers on those boards.
Edward Argar
The reason for that is that an amendment was brought forward on Report, and the matter was settled at that stage; things have not changed since. In lieu of what had been tabled, we tabled our own amendment on Report, which—even though in our view it was unnecessary—we felt further clarified how to avoid conflicts of interest. In the previous group of amendments, we tabled an amendment to extend that conflict of interest policy and approach to the sub-committees of the boards, in order to ensure that it is explicit that the policy applies to both. It is essentially the same principle, but widened out to the sub-committees to avoid them being inadvertently left out of the legislation.
Craig Tracey (North Warwickshire) (Con)
I really welcome Lords amendment 12 on palliative care. Can the Minister give us any more information about whether statutory guidance will be given to the ICBs? It is important that they get proper guidance on what is expected of them. Can he also reassure us that palliative care will be a priority objective for the trusts?
Edward Argar
I can give my hon. Friend an assurance that we expect that to be the case. I will turn to palliative care in the context of other amendments shortly, and I might address some of his points then.
We are also committed to tackling climate change. Lords amendments 9, 18, 33 and 40 place duties on NHS trusts, foundation trusts, ICBs and NHS England to have regard to the Government’s key ambitions on climate change and the natural environment in everything they do. The amendments include a guidance-making power for NHS England that will assist in the discharge of these duties by different bodies.
There are also a number of amendments relating to how integrated care boards should operate as statutory bodies. Amendments 19 to 21 and 23 require an ICB to consider the skills, knowledge and experience it needs to discharge its functions and, where there are gaps, to consider what steps it can take to mitigate them. The amendments also require the forward plan to include detail on how the ICB intends to arrange for the provision of health services, as well as its duties under sections 14Z34 to 14Z45. The annual report must also include an explanation of how it has discharged these duties.
The hon. Member for Oldham East and Saddleworth (Debbie Abrahams) mentioned conflicts of interest. We amended the Bill in this place, and the Lords amended it further with Lords amendment 11. We understand the motivation, but the drafting does not fulfil the stated aim, which is why we tabled an alternative amendment in lieu of that amendment.
Edward Argar
I want to make a little progress. If I make good time, I may be able to give way, but I am conscious of the need to give the shadow Minister and other colleagues plenty of time to speak—about, I suspect, one aspect of this group of amendments in particular, but we will see.
We commend a number of additional amendments to the House. Lords amendments 34 to 37 limit the powers to set capital expenditure limits for NHS foundation trusts, so that they cannot apply for periods longer than a financial year. I reaffirm my commitment to ensuring that these powers on expenditure limits are used only as a last resort, as NHS England agreed with NHS Providers. I also ask the House to accept Lords amendments 50, 65, 104, 106 and 107, which are minor and technical changes required to ensure that the Bill functions as intended.
Although we have made progress on a number of amendments, we urge the House to disagree with the other place on others. First, we ask the House to disagree with amendment 90 on dispute resolution in children’s palliative care, and instead support the amendment we tabled in lieu. Our approach will require the Secretary of State to commission a full independent review of the causes of disagreements between the providers of care and persons with parental responsibility on the care of critically ill children, how these disagreements can be avoided, and how we can sensitively handle their resolution.
We also seek to reject Lords amendment 81. Although we agree on the need to make good progress on the Care Act 2014, it is not in the interests of good government to be forced to implement reform of this complexity and scale through a deadline set in primary legislation. We are getting on with implementing social care reform, and operational guidance is out for consultation. We have announced a small number of local authorities that will act as trailblazers to test the reforms from January 2023, but we must take time to engage with local authorities as they build the necessary infrastructure, and use these trials to refine delivery systems and guidance ahead of the national roll-out. We encourage the House to reject Lords amendment 81, which we believe affects the financial arrangements to be made by this House and, as such, is subject to financial privilege.
Debbie Abrahams
I would be grateful if the Minister answered my question about the triple aims, and the impact of not including in them an explicit reference to health inequalities. The Bill refers to health and wellbeing, but not to health inequalities. My main point is on the care cap. More than one in six of my constituents with dementia will not reach the cap, as it stands. The Lords amendments mean it would be one in five, so I would be grateful if the Minister could say exactly why he is prepared to let one in six of my constituents not reach the care cap.
Edward Argar
I will address the care cap, because there is a fair bit to say. I was just addressing the noble Lord Lansley’s amendment. I apologise for missing the hon. Lady’s first point. We do not think it is necessary to have health inequalities explicitly among the triple aims, as we believe that the issue runs through everything that ICBs do and everything the Bill sets out. We therefore feel that the Bill is effective, and that each ICB’s ICS will have regard to health inequalities and will see them as central to its objectives.
Before I turn to Lords amendment 80, I will briefly address Lords amendment 51, which relates to consultation with carers during hospital discharge planning. We have heard about the strength of feeling in the other place on that issue. We wholly agree that we must ensure that, where appropriate, unpaid carers are involved in planning around discharge. Although the Government appreciate the intention behind the amendment and want to address the concerns raised, we want to do so in the most effective way, and in a way that does not create unintended delays to discharge. I ask Members to support our amendment in lieu, which would achieve much of what Lords amendment 51 sought to achieve. It will introduce a new duty on trusts and foundation trusts to involve carers during adult discharge planning. Unlike schedule 3 to the Care Act 2014, this duty applies to all carers where the patient has care and support needs following discharge; and it applies to young carers as well as adults. Our amendment in lieu and the new statutory guidance will ensure that patients and carers are involved in discussions about post-discharge care as soon as they start.
Liz Twist
I am pleased that that concession has been made. However, a number of points of clarification would be really helpful to carers. One is about being given a choice about caring, carers having the right information, and carers being able to express their needs properly. The second is about disabled children, who are not referred to here, and the third is about ensuring that young carers are clearly covered by any guidance issued. Will the Minister say how those issues will be addressed?
Edward Argar
I hope that I can give the hon. Lady reassurance. When we refer to “carers”, we intend that to be a broad term, rather than a narrowly drawn one. She is absolutely right to highlight young carers; they are carers. They also face particular challenges, because they often juggle school and similar things with caring. It is our intention that all carers will be covered by this duty on trusts and foundation trusts to involve carers during adult discharge planning. That would apply to all adults who are being discharged, where a carer is involved. I hope that that gives the hon. Lady some reassurance. We would look to ensure that these points were suitably emphasised in guidance and in the advice we give to ICBs and ICSs. As she will know, the Department works with NHS trusts and NHS England, and has various mechanisms for guiding and informing trusts. I recognise the importance of the issue.
We ask that this House rejects Lords amendment 80, and that it reintroduces the clause that the Government originally inserted on Report in this House, alongside further amendments to support the operation of charging reform that were originally tabled in the other place. The Government have set out their plan for a sustainable social care system. We want to end unpredictable care costs for everyone by introducing a universal £86,000 cap on an individual’s personal care costs. I pay tribute to the Minister for Care and Mental Health, who, since taking up her post last September, has made driving this agenda forward a personal priority. I should also pay tribute to her predecessor, my hon. Friend the Member for Faversham and Mid Kent (Helen Whately), for her work in this area.
We entirely recognise and respect that there are strong views on this issue across the House, and it is vital that our approach is fair. The Government believe that the fairest version of the cap would be based on what people contribute towards their care, rather than our counting local authority contributions as well. It simply cannot be fair that two people living in different parts of the country, contributing the same amount, progress towards the cap at different rates because of the differences in the amount that their local authority is paying.
Peter Aldous
The Government’s plans are regressive when compared with the proposals under the 2014 Act. They are less equitable to those with moderate assets, including those living with dementia and working-age adults with disabilities. It would be fairer to keep to the original Dilnot proposals, but can the Minister outline how the £900 million saving that, it is estimated, will result from the Government’s proposals and the use of means-testing will better protect those with lower-value properties?
Edward Argar
I am grateful to my hon. Friend, who has been open and consistent in expressing his concerns about this issue. He cites the 2014 Act, but it is important to note that those proposals were never implemented and were not deemed to be financially sustainable or deliverable. There were other proposals, including in 2015, but although no proposal is perfect, the proposals before us are a dramatic improvement, in terms of the protections offered and the crippling care costs that many face under the existing regime. This is an important step forward. Let me make a little more progress, after which I may touch on some of my hon. Friend’s other comments.
Edward Argar
I have given way to the hon. Lady already in this debate, as I did in the debate on the previous group of amendments, so I shall make a little progress. She knows that I am always tempted to give way, but I do want to make some progress.
Kevin Hollinrake (Thirsk and Malton) (Con)
It is a pleasure to speak after my hon. Friend the Member for Darlington (Peter Gibson). He made some very strong points in his speech with which I absolutely concur. I want to speak to Lords amendment 80, and his constituency—I know it pretty well, having been there and spent a bit of time there prior to the last election—is the kind that will be affected by it. The Government’s decision is to resist that Lords amendment, which I cannot support. In my view, this is a classic policy for levelling down, not levelling up.
The Minister is absolutely right—both Ministers involved in this Bill are good friends of mine, and I do not want to make their lives more difficult in any shape or form—when he says that the policy across the board is a significant improvement on anything we have had before. That is absolutely right. He said that in his speech, and I agree with it, but I do not agree with him when he says that it is fair. I do not believe it is fair, and that must be the basic criterion on which we judge any proposals, not least these.
I think everybody, including the Minister, accepts that it is quite clear that a £900 million transfer is happening here, which was introduced just as the Bill went on to Report stage. That is a direct transfer of £900 million from household wealth to somewhere else. That is what it is: a transfer of assets—household wealth—to healthcare, the Treasury or wherever else it is going, because that is the way that council contributions are used when it comes to the speed at which somebody reaches the cap.
I could live with that, if we were trying to make the system more affordable, as the Minister says—if the burden was going to fall equally on everyone’s shoulders in different parts of the country. It also true to say that most people will not be affected, because only people on very long care journeys tend to be affected badly, but there are quite a few of them: according to the Department’s own figures, about 6,000 a year—10 people per constituency—would be affected in this way, and most of them have dementia. We know that there are 900,000 people with dementia in the UK today; according to the Alzheimer’s Society, there will be 1.6 million by 2040; and 70% of care home residents are dementia sufferers, and they are the sort of people who will suffer because of the changes. They have very long care journeys, and they move out of their house so it becomes one of the assets that we take into account when assessing how much people contribute to the care cap.
The Minister says we are making these changes to make the system sustainable. Well, okay, make it sustainable, but make it fair too. I do not believe that this is fair. I know I am comparing this with a system that never existed—my hon. Friend is right to say that—but one was proposed in which the council contributions would count in calculations of people’s contribution to the care cap. That is the change we have made—the specific measure to make the system more sustainable is that change, and that affects people with limited assets and wealth. We are balancing this on the shoulders of people with fewer assets and less wealth, and on certain areas as well, as people in some of the regions in the north that we represent tend to have fewer assets and less wealth.
Particularly affected are people who have wealth or assets worth between £75,000 and £150,000. The research provided by the Alzheimer’s Society is clear: under the Dilnot proposals, about 50% of people living with dementia benefited fully from the care cap—they reached the care cap. That was true across all the wealth quintiles—it was very fair. This is not. Only 13% of people in the least wealthy quintile will reach the cap, whereas 28% of the most wealthy will. Such huge disparity cannot be right, yet that is the change that we have made. That £900 million has been found from people with less wealth. That cannot be right, nor is it consistent with levelling up. Look at how different regions are affected: only 13% of people in the north-east reach the cap whereas 29% of people in the south-east do so. Previously, in almost every part of the country, about 50% of people did so. The cap was not as generous, but it was very fair across different wealth quintiles and different regions of the country. I cannot see how this is fair.
Instead of each of us having 10 people in our constituency affected, some will have more and those representing wealthy constituencies will have fewer. I and other Members representing the north-east will have more constituents affected by this change and less generously treated because of it. For that reason, and because in my view it levels down, I cannot support the Government and will vote against them this evening on Lords amendment 80.
Edward Argar
I am grateful to all colleagues who have spoken this evening. A number of the arguments were made on Report, and rightly, right hon. and hon. Members have reiterated some of those points where they felt it was appropriate. I will address a number of the points raised relatively briefly.
What we are legislating for in this Bill represents an evolution of our health and care system, and improved integration. My hon. Friends the Members for Gosport (Dame Caroline Dinenage) and for Winchester (Steve Brine) both spoke about carers. Young carers are included, which I hope reassures my hon. Friend the Member for Gosport. In respect of the statutory guidance, I hope that it will provide reassurance if I can set out that we will develop that guidance in partnership with Carers UK to ensure its input and so that it captures exactly the things that hon. Members have alluded to. Again, in statutory guidance, we will look at how to ensure that the duty to give people the information that they need is properly and effectively discharged.
I am grateful to my hon. Friend the Member for Broxbourne (Sir Charles Walker) and my right hon. Friend the Member for Maidenhead—she is now in the Chamber—for the work that they have done on the Bill to ensure that parity of esteem for mental and physical health is not forgotten and is explicit.
On a point made by the hon. Member for Oldham East and Saddleworth (Debbie Abrahams), I will clarify what I said earlier on the triple aim, which may give her a little reassurance, even if not necessarily sufficient reassurance. We have not created a quadruple aim or a fourth limb, but we have included a reference to health inequalities under the existing triple aim in the other place. It is not forgotten. I hope that gives her a degree of reassurance on that specific point.
Lords amendment 80 was the crux of much of the debate. I fear that many are comparing our proposals with something that was never done. We are significantly improving provision around the sustainability and affordability of social care. The Prime Minister was clear that he would grapple with the issue and resolve it. When the Opposition were in power, they had two Green Papers, one royal commission and one spending review priority on the issue and they utterly failed to address it. We are a Government who have made huge strides in creating a better system.
I listened, as always, with great care to my hon. Friend the Member for Thirsk and Malton (Kevin Hollinrake). I am sorry that he will not be joining me in the Lobby tonight. While I respectfully disagree with him, I know that he has thought long and hard about this matter and has strong and sincerely held views. With that in mind, I regret that we will have to ask the House to disagree with the Lords amendment on care metering.
Lords amendment 11 disagreed to.
Government amendment (a) made in lieu of Lords amendment 11.
Lords amendment 51 disagreed to.
Government amendment (a) made in lieu of Lords amendment 51.
Clause 140
Cap on care costs for charging purposes
Motion made, and Question put, that this House disagrees with Lords amendment 80.—(Edward Argar.)