Health and Care Bill

Debate between Iain Duncan Smith and Wes Streeting

Consideration of Lords amendments
Wednesday 30th March 2022 Commons Chamber

[Wes Streeting]

I really do understand the hon. Member’s point. She would like to be able to save her services and lobby her colleagues in Government to make those decisions, but—speaking from experience—saving our accident and emergency department was not about using politics or political pressure to change the decision. Public support was really important and we did our fair share of parliamentary petitions, marches and everything we could to keep the pressure up, but in the end it was about the evidence base that we put together to save the department.

When it comes to matters of clinical provision and of providing the best services for patients, clinical factors have to be paramount. I worry about how decisions turn into a political football either side of a general election and become a party political knockabout, when the primary consideration should be patients’ safety and concerns. Although I have cited an example in which saving our A&E was the right decision, I can think of cases right across the country in which communities feel very strongly, and we understand why, but passion, emotion and sentimental attachment to particular services do not always align with the clinical interests of local populations. Patient safety and evidence must come first. I really worry about the introduction of a party political knockabout in that context.

Ministers have argued that the new powers are necessary to ensure democratic oversight of health service decisions, but the existing system allows appropriate democratic oversight and allows contentious service change decisions to be resolved. I do not believe that the wholesale upheaval of the system and the introduction of sweeping new powers for the Secretary of State are justified.

Let me now deal with some of the other amendments— very briefly, as I am conscious of time. We support Lords amendment 48, which requires the Secretary of State to ensure that health service procurement does not violate the UK’s international genocide obligations. The amendment is consistent with the UK’s obligations under the convention on the prevention and punishment of the crime of genocide.

Lords amendment 89 deals with a related issue, prohibiting organ tourism involving both forced organ harvesting and black market organ trafficking. We welcome this change in the Bill, which amends the Human Tissue Act 2004 to prohibit UK citizens from travelling to countries such as China—although the wording of the amendment is not country-specific—for the purpose of organ transplantation. The restrictions are based on ensuring that there is appropriate consent, no coercion, and no financial gain. In some parts of the world, organs are not given freely but are taken by force, and we must bear that in mind in the drafting our legislation.

Lords amendment 57 is intended to retain the current safe haven for patient data

within NHS Digital, and to prevent NHS England from taking on responsibility for it. Keeping patient data safe is important. It can be powerful when it is used well, and has enormous potential for better population health and better clinical outcomes in individual cases, if data is used wisely, safely and ethically. The amendment will keep statutory protections in place for a patient data “safe haven” across health and social care, required for national statistics and for commissioning, regulatory and research purposes. It also ensures that NHS England does not take on this responsibility, because of a potential conflict of interest in its role.

Lords amendments 42 to 46 deal with procurement. We welcome these changes. The years of the pandemic have also been years of crony contracting. After the scandal of billions in taxpayers’ money being handed out to mates for duff PPE and testing contracts, and PPE literally going up in smoke—along with taxpayers’ money—we hope that this is the start of Ministers’ looking again at where they went wrong during the pandemic.

This afternoon the House faces a simple choice. We must decide whether we are going to be honest with ourselves, with the NHS and with the country about the genuine staffing challenge in health and social care—and whether we are going to have a more responsible and grown-up political debate about how we meet that challenge—or whether we prefer to be the ostriches of the Treasury, with our head in the sand, pretending that these issues will go away, hoping for the best, hoping to squeeze a bit more efficiency out of the NHS through new efficiency targets. That really will not cut it. The recruitment of staff already announced by the Government really will not cut it.

For as long as we allow this situation to continue, patients will wait longer. They wait in agony. Their health outcomes are worse, and they lose confidence in the national health service. It is the greatest institution that this country has ever built, and it is going through the greatest crisis in our history. Let us be honest about that—with ourselves, with the NHS, and with the country—and support their lordships in their amendment.

[Sir Iain Duncan Smith]

I shall try to be brief. I rise to speak to amendments (a) and (b) in lieu of Lords amendment 48, which refers to genocide. Along with 19 colleagues, some of whom are present, I tabled amendment (b) to recognise first a problem for the Government, and secondly an absolute imperative for all of us here.

The problem for the Government with Lords amendment 48 is, I understand, the inclusion of genocide. There is a reason for that. I disagree with the Government about this, but that is where they are. The Government talk of a “competent court” having to decide questions of genocide. We have been through this again and again recently, but the fact is that we will never get a decision from a competent court when it comes to countries of the scale and dimension of China, either because they veto it in the Permanent Assembly or because they are not members of the International Criminal Court, so we cannot get them that way.

I recognise that the purpose of this is really more to do—quite rightly—with slave labour, so the title of my amendment alludes to slave labour. That is much more focused, and makes clear what I should like to think we are all after. I abhor the genocide that I absolutely believe to be taking place in Xinjiang, and I think we need to take much greater action on that, but in the context of the Bill, the purpose of the amendment was to make clear to the Government that a significant number of Members—and more would have signed it had I bothered to ask them—are very keen to see such a measure included. I say those words carefully, because I have read what the Government have written down and I have discussed this at length with the Minister and the Secretary of State, and I fully accept what they are trying to do here with this amendment on review, but that amendment on review cannot tighten up the time because it can only be post hoc, as it were, after the Bill goes through. My determination is that, by the time this Bill comes back from the Lords, we will have an amendment specific to modern slavery in it.

The reason I say that is that this is clear, with a reference even in the last two days to the use of equipment made by slave labour in Xinjiang in at least one of our hospitals. That equipment has been tested, so there is no excuse for not knowing. There is a company called Oritain—there are others—that now has the digital and genetic fingerprints of all the products from these areas. It has spent 10 years getting this information, and it can test a product and tell us not only where in rough terms it comes from but even which factory made it. There is no excuse now. This is being used in the United States, which has declared genocide, for testing these products.

The NHS is a phenomenal purchaser and has huge capability to change people’s direction. I say to the Minister that I understand that behind closed doors—if any closed doors exist in Government generally, but these ones—some members of the Government have asked the Secretary of State to do an impact assessment. We love impact assessments in Government. Most times they mean absolutely nothing because they tell us what happened before, but not what will happen in the future. That is because almost every time the Government try to forecast the future, we get it wrong. Even the Office for Budget Responsibility manages that quite regularly.

What difference would an impact assessment make to this amendment in my name and that of 19 other Members? For example, an impact assessment might tell us that we should no longer buy from a particular area because we are certain it provides through slave labour, but that the procurement would be, say, £20 million more expensive as a result. Does that impact assessment then mean we cannot do that because we do not want to lose £20 million—or £20 billion or whatever it happens to be—because that is too expensive, and that we will on balance therefore purchase from a known slave labour provider? Is that what we are saying? Is that what the impact assessment will say to us? I say to those who call for an impact assessment: be careful what you call for. There is a simple impact here: are we to purchase equipment made by slave labour?

I have also heard that someone else in the Government has said that the balance is between provision for those who need it here in the UK and our use of a product that comes from a place using slave labour. I say: be careful of that comment. It is not a choice we have to make. Our choice is to care for those here in the UK, but also to care for those who are being brutalised and beaten into product production and often losing their lives; we have to have a care for them as well. There is no choice here. It is simple: do we or do we not wish to have products in circulation in our NHS, of which we are all very proud, that were made by slave labour? This is the single point.

I understand the problem with Lords amendment 48; it is that the Government will never recognise genocide, so that amendment would never have a bearing or an effect because they would simply say, “We do not recognise that genocide has taken place in that area and therefore we are let out.” It is let-out for them. This amendment of ours is very specific. It deals with slave labour, and we can prove slave labour. So I say to my hon. and right hon. Friends: this unites the whole House. If this comes back amended either by the Government or by somebody in the House of Lords, I give a little warning—not a threat—to my Government that the choice when this comes back will be: do you support the use of slave labour or do you not support the use of slave labour? There is no other choice. It is not a moderated choice. It is very simple for us. I will vote against slave labour for an amendment coming back from House of Lords, and I believe that many of my colleagues here—all of them, I hope—will do the same. I am certain that that will be the case for those on the Opposition Benches.

I have huge regard for my hon. Friend the Minister, and very much so for the Secretary of State. I have spoken to them at length, and I believe them to be completely onside with my argument. I ask a wider group in the Government to stop it. This is more important than moderated impact assessments, which mean nothing; this is about human lives. When it comes to human lives, the best impact we can have is ending brutality, intolerance and slave labour. If we can bring that to an end, it would be the biggest impact we ever have, and we could be proud of it.

South Woodford Post Office

Debate between Iain Duncan Smith and Wes Streeting

Tuesday 31st October 2017 Westminster Hall

[Mr Duncan Smith]

The hon. Gentleman is correct. Such figures are often used to justify things, but they are never returned to after the event and it is never recognised that they did not stack up. I know for a fact that many elderly people will not use a post office in a store—I think the Post Office wants to use an electrical retail store—because they feel intimidated and pressured to buy goods. It is unfair to do that, and it will only create further problems for those who have grown used to the services.

Following the announcement, I met Clive Tickner and Peter Meech—local representatives of the Communication Workers Union, whom I congratulate on their steadfast determination to work with anyone, regardless of their political party, to try to save the post office. They explained that the staff at the George Lane branch are worried about their jobs, and there is good evidence why they should be. Despite the Post Office’s assurances, until an agreement is made with a franchise partner, the staff will not know whether they have a future with the Post Office. They also informed me last year that when branches are moved, most staff—many of whom have years of knowledge about post office service provision—leave the service altogether. They explained to me that, in 2014-15, only 10 out of 400 staff from the Crown offices that were closed were TUPE-ed over to a new retailer, and only six staff out of more than 200 were TUPE-ed over in 2006. There is a genuine concern. In fact, when I talked to the Post Office management, it became clear that the Crown post office is being shut for that very reason: they will employ people on lower rates with less understanding of the service. I found that peculiar for anybody who wants to provide a good service.

[Wes Streeting (Ilford North) (Lab)]

rose—

[Mr Duncan Smith]

I give way to my constituency neighbour.

[Wes Streeting]

I am grateful to the right hon. Gentleman for securing this really important debate. I join him in congratulating the Communication Workers Union on its campaign to save Crown post offices. He correctly described the impact on staff, but I warn him, from our experience of the closure of the Crown post office on Barkingside High Street, that the Post Office often closes Crown post offices with no care or consideration for what will follow. That premise remains vacant and is an eyesore on Barkingside High Street. Many of my Barkingside residents are concerned, and my constituents who use the post office on George Lane are also concerned about what the future holds for that part of the high street.

[Mr Duncan Smith]

I have been looking at that issue, and the hon. Gentleman is absolutely right. He backs up everything I have been saying about the likely consequences for the Crown post office we are debating.

As previously suggested by my hon. Friend the Member for East Worthing and Shoreham (Tim Loughton) in his debate on the Post Office, which many people took part in, the Post Office should use its premises better. I know of no business that goes around reducing its outlets solely as a way of lowering its costs to the point at which it somehow breaks even. Why is it in business at all if its sole purpose is to make sure it has as few premises to do business from so that it can say it has managed to meet the challenge?

As an illustration of the point that the Post Office does not use its outlets properly, its financial services, which should be a key generator of revenue for the business, are diminishing. Earlier this year, 150 financial specialists were made redundant. The Post Office is locked into its partnership for financial services provision with the Bank of Ireland until 2023, which prevents it from creating a more profitable arrangement. The Cass business school at City, University of London produced a report for the Communication Workers Union entitled “Making the Case for a Post Bank”. I want to share some of the points it raises, because I think it is relevant to the reason why the Post Office is embarked on the wrong route.

If the Post Office were to establish a post bank, it could ensure its long-term profitability by expanding its services and increasing its revenues. In addition, a post bank would probably offer other benefits to users, such as better access to finance for small and medium-sized enterprises, and improved financial inclusion for those who struggle to access services with the traditional banks. It would also align the Post Office with the successful strategy of other postal operators around the world. We seem to be almost unique in not using that concept to drive revenue and not having qualified staff. The Cass business school states that the amount of initial capital needed to create a post bank is equal to the investment that the Government have put into the Post Office in the past seven years. Interestingly, it also estimates that the profits that a post bank would generate would eliminate the need for an ongoing annual subsidy, putting the Post Office on a sustainable footing for the future.

It is worth reminding the Minister, who I know will respond to this point, of the figures for the Metro Bank. The way it has succeeded is really quite startling. The banking authorisation process to set up that challenger bank began in 2009, and in 2010 it launched its first branch. What is interesting is that its asset growth is 64% year on year and its revenues are up 62% year on year. It has strong common equity tier 1 capital ratio of 18.1%, and has seen a record 260,000 increase in customer accounts to a total of 915,000. While that is going on, it is also increasing its representation in the community and has opened about 41 stores in the past six years. On the one hand we have an organisation opening up in and serving the community, and on the other we have a well-established organisation retreating from the community and determined not to serve it in the way it could and should.

The Cass business school report also points out that the Post Office is currently suffering from a weak financial performance and lacks a clear plan to ensure long-term sustainability, which is true. The partnership with the Bank of Ireland has not delivered the expected results—I think it is a bad deal. One of the main drawbacks of the current partnership model, in terms of revenue generation, is the strong dependence on the partner’s will and ability to expand the business. As we know, the Bank of Ireland has struggled since the crash of 2007 and is not really interested in expanding its business. Being locked to it is a bad deal for the Post Office, and yet it shows no determination to try to change that.

The Post Office’s overall commercial revenue has therefore been virtually stagnant for the past few years. Compared with what overseas post offices are doing, it is really poor and verging on the pathetic. Even in places such as Italy, revenues in the postal area are predominantly driven by the financial sector, which secures post offices in high streets. Other countries do the same, but here in the UK the proportion of revenues that the financial sector is likely to drive is next to nil.

The Post Office possesses a positive public perception, compared with traditional financial institutions. Creating a post bank is one way of helping it to increase its revenues. My question to the Minister, therefore, is, why is the Post Office not making more of banking, financial services and other areas—particularly given that it is a trusted presence on the high street while most conventional banks have sunk in the public’s estimation?

It is also worth reminding the Minister, the Post Office and the Government that post offices are not just meant to sit there; they are an integral element of high streets, which, bit by bit, are being removed. The banks have disappeared, and in many areas, including my own, there is real pressure to get rid of small industrial estates and start building on them. Those industrial estates, however, are vital to the life of communities, because people who work on the high street during the day or use it to shop for food and so on and so forth would otherwise be out of work and not in that area. That post office is like that, an integral element.

The absence of any sense of innovation in the Post Office is remarkable, given that it owns prime sites that could be used flexibly. When I was at the Department for Work and Pensions, I wanted to persuade the Government to allow post offices to be used for outreach, for identification. The Post Office was utterly negative about the idea and made no effort to entertain it, but I hope that the Government will press it again. Post offices with terminals where people, the elderly in particular, could receive good, reasonable advice about benefit claims might easily be utilised for further Government activity, beyond all the other existing work, especially with identity checks becoming more necessary and vital for the Home Office, and with the roll-out of universal credit. People might feel more comfortable going to a post office than to a jobcentre, so that is a perfect role for post offices and one that would enhance Government programmes. The Post Office has a unique and highly identifiable position as a high street brand, and I cannot understand why it is insisting on backing away from it, as with my Crown post office on the corner of the very road that leads 300 yards down to the tube station, which daily has big footfall because many people are going to the station and coming back past the post office.

In summary, local residents want the Crown branch in South Woodford to remain open. I ask the Post Office, through the Minister, to think again. We have spoken to a number of residents and local businesses and none of them, not one single one, wanted the post office to move. The complete unanimity was interesting. The response that we gave to the Post Office’s public consultation consisted of just under 2,000 signatures, which took us no time at all to gather—people were queuing up to sign our petition to keep the post office where it should be.

I have my concerns about the Post Office consultation process, however, because when we handed in the petition I realised that it was not in the slightest bit interested in consulting us on whether the branch should close. The consultation was solely about where the post office should move to, which in itself was a breach of trust of the local community. After all, the post office is a community asset; the Post Office management at least needs to put forward proposals and ask the community whether they agree that it needs to move. It was not until I badgered the Post Office again, writing twice to ask, “I hope this petition is being taken into consideration and that you are prepared to look at whether this post office should move again”, that it said that it had not at that point closed the door to further considerations. I therefore urge the Post Office to use this opportunity to ensure that the branch does not close.

I hope that the Minister will recognise that, as a political party and a Government, we have a responsibility beyond just letting organisations be run by people who have the sole idea that they need to break even. In reality, we have an investment and a vested interest in a post office system that works. More importantly, it should work not only as a stand-alone financial organisation but in support of the community. That is the most important part. We bleat a lot about high streets, but we do nothing when things such as local post offices disappear.

I have to say that this is the one thing that unites political parties on the Back Benches, the absence of that asset on the high street. It is high time for—I hope—the Minister to be very hard on the Post Office management. I do not understand why it has been so hopeless at finding ways to use post offices so that other services can be delivered at the same time, which would bring the Post Office extra revenue. Instead of being an organisation that seems to think that its job is to get rid of all its main customer-facing areas on the high street, it would turn into an organisation that was flexible, sensible and highly profitable. Furthermore, we have seen post offices in other countries do that. I therefore urge the Minister to do her level best to drive the Post Office management to common sense and allow us at least to retain our excellent Crown post office, which has served my community incredibly well for all these years.

Oral Answers to Questions

Debate between Iain Duncan Smith and Wes Streeting

Monday 7th September 2015 Commons Chamber

[Mr Duncan Smith]

Absolutely. I recognise the huge and vital contribution made by firms such as GO4 Enterprises, delivering huge change in Essex. My Department is instrumental in growing social investment via the £30 million innovation fund I set up, and we will continue to chase and improve those targets.

[Wes Streeting (Ilford North) (Lab)]

T4. How can the Secretary of State claim, as he did this afternoon, that no one has lost out from the roll-out of universal credit, when the taxpayer has lost out to the tune of £140 million because of the botched roll-out of the IT systems?

[Mr Duncan Smith]

Actually, that has not happened. Taxpayers have not lost money. What we have done is to go on rolling out a system, and unlike what happened when tax credits were rolled out under the last Labour Government and hundreds of thousands of people lost money, nobody is losing money as universal credit rolls out.

Child Poverty

Debate between Iain Duncan Smith and Wes Streeting

Wednesday 1st July 2015 Commons Chamber

[Mr Duncan Smith]

We have brought forward these particular measures because they allow us to identify families better. We now have to do the work to identify families who are stuck on low trajectories and are unlikely to break free of such a position on the measure by which we have always measured poverty in the past. I would simply say that that is the best way to give workless families more opportunities now. In the longer term, educational attainment will help to ensure that their children do not repeat what has happened in the past. I believe that the reforms we are making and those we will bring forward will help children more and will help parents to get back into work faster.

[Wes Streeting (Ilford North) (Lab)]

The Secretary of State has not actually addressed the questions asked about tax credits by my constituency neighbour. If I may say so, his statement skirted around the issue of children living in households where the parents work but are still in poverty. How can it possibly be fair, in next week’s Budget or at some point in the future, to cut the tax credits for those families? All he has said today about these measures and everything else will not help the parents of those households to pay the bills when he cuts their tax credits overnight.

[Mr Duncan Smith]

I wonder whether the hon. Gentleman ever reflects on the fact that people can best get out of poverty by progressing through work. In discussions with Labour Members, I tend to find that they are still wedded to the idea that only through constant and high Government spending can anyone move beyond the status of being in poverty. That is the difference between us: Conservative Members believe that helping, encouraging and getting people back to work and reducing the tax burden on them is likely to get them out of poverty; Labour Members think that only Government spending succeeds.

Child Poverty

Debate between Iain Duncan Smith and Wes Streeting

Thursday 25th June 2015 Commons Chamber

[Wes Streeting (Ilford North) (Lab)]

The Secretary of State will find support on the Labour Benches if he champions a higher minimum wage and asks employers to pay the living wage. Is it not the case, however, that getting every employer to pay the living wage will take considerable time, whereas his Government are looking to cut tax credits for people who are in work and on poverty pay overnight?

[Mr Duncan Smith]

It is interesting that the hon. Gentleman says that, because I genuinely believe that we should expect British employers to pay a decent wage to the people they employ, and I am engaged in that process. I do not think that he is right, as I think it will take a much shorter time to get employers to face up to their responsibilities, but as he has offered his support I am very happy to talk about it.