Oral Answers

James Gray Excerpts

Tuesday 25th April 2023 Commons Chamber

[Maria Caulfield]

I am very happy to contact the hon. Lady’s local commissioners to find out the answer for her. However, I highlight the fact that the £7.6 million health and wellbeing fund is funding 19 projects across England to reduce health disparities in new mothers and babies. Two of those projects are in the south-west: the Trelya in Cornwall, a community-centred whole-family provision that takes a holistic approach to working with children and their families; and the Splitz Support Service in Wiltshire, which aims to improve community knowledge, access to and engagement with pre-conception and perinatal care. We are investing in the hon. Lady’s region, but if she has a local funding issue I am very happy to speak to her local commissioning group on her behalf.

[James Gray (North Wiltshire) (Con)]

I am very glad that the maternity unit at the Royal United Hospital in Bath is rated as outstanding—we actually have very good choices in our local area. Does the Minister agree that choice is an important thing in maternity services? I am very glad that we have a first-class birthing centre in Chippenham and another in Malmesbury. One of the most important things is allowing women the choice to have the birth at home. That requires first-class midwifery support thereafter, which we also have in our area.

[Maria Caulfield]

Absolutely; choice is important. Only last month we published the single delivery plan for maternity and neonatal services, which I am sure Members across the House will already have read. It puts women at the heart of decision making and learns from the Ockenden and East Kent inquiries, to ensure that women have better choice when giving birth.

Oral Answers to Questions

James Gray Excerpts

Tuesday 19th July 2022 Commons Chamber

[Steve Barclay]

I always welcome solutions from colleagues on both sides of the House. From memory, Tim Ferris, who leads on tech within the NHS, is looking at a tech solution—I think it is in beta testing, although I would have to check. Appointments made shortly after a person has been discharged from hospital are often quite complex cases and create additional pressure on GPs.

Another issue I am keen to explore is GP appointments that can be done through either better use of technology or the wider skills mix so that we can better focus GPs’ time on more complex cases where their expertise delivers the best patient outcomes.

[James Gray (North Wiltshire) (Con)]

A much-needed new medical centre at Calne in my constituency was approved by the NHS in 2021, but there have since been a number of blockages to do with covid and the contractors. Will the Secretary of State look into those problems to find out what the blockages are—I think they are largely bureaucratic—and clear them out of the way to give the people of Calne their much-needed new medical centre?

[Steve Barclay]

I am very happy to look into that specific issue, which I know my hon. Friend has raised with the Department. I am happy to have further conversations with him.

Future of the NHS

James Gray Excerpts

Monday 31st January 2022 Westminster Hall

[Matt Vickers]

I will carry on; I am sure that there will be a chance for the hon. Member to contribute. I look forward to hearing the rest of the debate and to listening to the input of Members from across the House.

[James Gray (in the Chair)]

Members will see from a glance around the room how many people intend to speak. I do not intend to impose a formal limit, which seems to sacrifice quality in favour of quantity, but I do suggest that, as a courtesy to one another, speeches are limited to around three minutes.

--- Later in debate ---

[Andy McDonald]

rose—

[James Gray (in the Chair)]

I apologise to the hon. Member for Middlesbrough; I fear we have no time.

--- Later in debate ---

[Andrew Gwynne (Denton and Reddish) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Gray. This has been a spirited and emotional debate, and one that captures the unique place that the NHS holds in the heart of this nation. On behalf of the Labour Front Bench, I want to personally thank the petitioners and the campaigners behind the petition, because the NHS is more than just an institution. It is an example of the difference that politics, society and individuals can make. It gives us hope that Governments can make real differences to people’s lives, so long as there is the requisite willpower and determination to do so.

Over the last 12 years, NHS staff have had to move heaven and earth just to keep the service on its feet. They have faced extraordinary upheaval, underfunding, neglect and Government mismanagement. I would like to place on record my thanks to all NHS staff, at every level, for the work they have done—not just over the last 12 years and before, but particularly in the last two years, when we were hit by the covid pandemic and the NHS was placed under enormous strain. I am in awe of the work that the staff have done, but I am angry that they have had to step up to try to mitigate the failures of this Government.

Even before the pandemic, the scale of the crisis in the NHS was stark. Covid has compounded the problems, but it did not cause them. Any attempt by the Government to blame covid for the state of our national health service is nothing more than an abdication of responsibility.

This debate is about the future of the NHS, but to understand the future, we must understand how we got here in the first place and how the steps we must take are informed by principles that have been too easily forgotten by the Conservative Government. The NHS is Labour’s finest moment: emerging from the tragedy and upheaval of world war two, the British public decided to put their faith in a Labour Government. British people suffered from endemic health inequalities and squalid living conditions, and were bearing the brunt of decades of public health neglect.

The NHS, spearheaded by the great Aneurin Bevan and Clement Attlee, aimed to change all of that. Many said it could not be done, but it was. It was done through courage of conviction and a belief in the necessity of a service based on need rather than income—a simple principle with revolutionary consequences.

We now find ourselves in 2022, almost 74 years on. If the Labour pioneers who built our health service were here today, what would they see? They would see record waiting lists, an acute staffing crisis, morale at its lowest ebb, health inequalities growing, and a Government fundamentally incapable of addressing their own failings. Yet if they twisted the dials of their time machine to 2010, they would see an NHS in a pretty healthy condition. Waiting times had dropped, public satisfaction was at the highest level ever, and hospitals were staffed at record numbers. In 12 years, that progress has been systematically undone.

The first priority of the next Labour Government will therefore be to sort out the immediate mess that the Tories have left our health service in—once more. That means throwing everything at slashing waiting times and reducing the care backlog, and it means recruiting, training and retaining the staff we need across the NHS and social care. The last Labour Government brought average waiting times down from 18 months to 18 weeks. We will have to do the same again as a matter of urgency. That must all come alongside a long-term plan for the care workforce and wider reforms to fix social care.

However, the Government are doing none of that. Instead, they are faffing around with an unnecessary and distracting top-down reorganisation of the NHS, in the form of the Health and Care Bill, while doing precious little to tackle waiting lists or address the staffing crisis. I would be grateful if the Minister recognised those concerns in his response and outlined what steps the Government will take to ensure that any NHS reorganisation comes alongside a proper plan to address soaring waiting times and critical staffing shortages.

However, the future of the NHS is about more than just addressing the immediate crisis; it is also about adapting to the needs of our population and recognising that health is about more than just surgeries and hospitals. Last week, here in Westminster Hall, I spoke about health inequalities and about how health is all too often viewed as an isolated issue, without considering the external factors that influence our wellbeing. Wellbeing is linked to our communities, our access to green spaces, our mental health, our opportunities and much more. If we fail to consider those influencing factors, our health service will always be geared to address the symptom, as opposed to the root cause of the symptom.

That is why the future of our NHS relies on prioritising preventive health measures. One example of that is Labour’s recent announcement that we would recruit more than 8,500 mental health professionals to support 1 million more people every year. That is exactly the kind of progressive, proactive and preventive policy that the Government should be driving. Such an investment in mental health would mean that every community had access to a mental health hub for young people, and every school specialist support. Wellbeing would be addressed beyond the clinical setting, and the health consequences of stress, depression and anxiety addressed before they reached the hospital waiting room.

So far, I have seen little evidence from the Government that they realise the importance of preventive health measures. In fact, I would go as far to say that the withdrawal of funding from community centres, green spaces and sports clubs over the past 12 years shows that the Government are not sensible and are not serious about preventive health policy. In his response, perhaps the Minister will correct me on that and advise how the Government intend to reverse their disastrous cuts to local services, which have had a calamitous impact on health outcomes.

Our NHS was built to provide security. It was built to recognise that our prosperity is innately linked to our health, and that we all deserve to live long, fulfilling lives—all of us, irrespective of our background or where we have come from. It is an issue of basic respect. To be healthy and have access to care is not a privilege; it is a fundamental right of every human being, a right that we expect the Government to protect and defend at all costs. The job of the Government of the day is to pass the national health service on in a better condition than they found it in when they came to office. I am afraid to say that this Government have failed in that obligation massively.

I am hopeful, however, that with the right support, the right investment, the right approach and the right values—values matter when it comes to our health and wellbeing—Labour can undo years of neglect and equip the NHS with the tools it needs to survive and then to thrive. That day cannot come quickly enough.

[James Gray (in the Chair)]

We have a few minutes in hand so, unusually—although I am told it is perfectly in order—I will call the hon. Member for Middlesbrough, Andy McDonald, to make a brief contribution.

Skin Conditions and Mental Health

James Gray Excerpts

Tuesday 25th January 2022 Westminster Hall

[James Gray (in the Chair)]

I remind Members that Mr Speaker has asked us to wear our masks if at all possible and to maintain social distancing where we can.

--- Later in debate ---

[James Sunderland]

I thank the hon. Lady for her intervention; I could not agree more. The simple answer is that doctors cannot see anything on a Zoom call. Also, people need to be able to see a doctor to get a prescription. If someone has a skin condition, they cannot just go to the chemist to get a prescription. They have to get an appointment first in order to get the prescription, and that is where face-to-face appointments come into it.

My third point is that we need to increase the range of psychological support for all those who need it. That is part of the panoply of health support that we need. A 2014 study showed that 94% of the patients who had completed psychodermatology treatment reported reduced stress, 92% reported increased confidence, and 90% reported that their skin condition was better understood. Wow. Those figures are amazing, but if someone asks for that treatment at this point in time, it takes up to a year for a referral, which is worrying.

I want to commend the excellent services locally in my constituency. The Frimley integrated care system is one of the best in the country, if not the best. The treatment that I have had personally has been pretty good, notwithstanding the delay that we are all suffering form. Lastly, I ask the Minister to reinvest accordingly in this very important area so that young people and adults are not suffering.

[James Gray (in the Chair)]

This debate can continue until 6.07 pm. However, the House will know that there is very probably a vote at 6 pm. Coming back for five minutes seems odd, so it would be helpful if we can conclude by 6 pm. We have three further Back-Bench speeches and 15 minutes to conclude them in, so four or five minutes each will be helpful.

Covid-19 Update

James Gray Excerpts

Monday 6th September 2021 Commons Chamber

[Nadhim Zahawi]

I reiterate that the work that the chief medical officers are carrying out is looking at the impact of this—whether it be educational, psychological or relating to the public health impact—on 12 to 15-year-olds. As I say, they will then come back with their advice, having had the JCVI in the room for those deliberations. Parental consent is required in any school-age vaccination programme, but I do not want to pre-empt this decision. No decision has yet been made, but parental consent would be required. On the very rare occasions when there is a difference of opinion, Gillick competence applies.

[James Gray (North Wiltshire) (Con)]

May I take this opportunity—the first one after lockdown, I think—to thank the Minister, his officials and the whole of the national health service for the fantastic job that they have done and for their brilliant roll-out of the vaccine? Will he join me in congratulating the Order of St John, which has done a huge job in carrying out the vaccinations and in training and co-ordinating volunteers? It has done a brilliant job, and it is worthy of our thanks.

[Nadhim Zahawi]

I will absolutely join my hon. Friend in congratulating St John’s volunteers, who have done a phenomenal job. They really rose to the challenge when we contacted them and said that we needed them. They delivered in spades. I thank my hon. Friend for all his words: this has been a massive team effort involving the health service, the public sector and of course the private sector as well.

Reducing Baby Loss

James Gray Excerpts

Tuesday 20th July 2021 Westminster Hall

[James Gray (in the Chair)]

I start with a few parish notices, as it were. First, we do all continue to wear a mask, apart from when we are speaking. Secondly, I am told that we are now allowed to intervene, if we are physically in the room, on one another, although perhaps we want to keep such interventions to a relatively minimal number. Thirdly, let me remind those who are with us virtually—welcome to you all—that you have to remain in the room with your television camera on throughout. You cannot turn the TV camera off and go off for a cup of coffee; you have to be here in the debate throughout—from beginning to end.

[Cherilyn Mackrory (Truro and Falmouth) (Con)]

I beg to move,

That this House has considered progress towards the national ambition to reduce baby loss.

Sir James, it is a pleasure—

[James Gray (in the Chair)]

Order. I regret to say I am not Sir James—perhaps one day. I am just Mr Gray.

[Cherilyn Mackrory]

Thank you, Mr Gray. I had just promoted you. It is a pleasure to serve under your chairmanship.

The ambition is to halve the rate of stillbirths and neonatal deaths by 2025 and to have achieved a 20% reduction in these rates by now. Every day in the UK, about 14 babies die before, during or soon after their birth. Baby deaths need to fall much faster if the Government’s national maternity safety ambition is to meet that important target. The ambition also includes halving maternal deaths and brain injuries in babies that occur during or soon after birth by 2025, and reducing the pre-term birth rate from 8% to 6% by 2025.

Earlier this month, the Health and Social Care Committee published its report about maternity safety. I co-chair the all-party parliamentary group on baby loss with the Chair of the Health and Social Care Committee, my right hon. Friend the Member for South West Surrey (Jeremy Hunt). The Select Committee report echoes much of what we have been hearing from hospital trusts, health professionals, bereavement charities, bereaved families and others throughout our work in the APPG. I pay tribute to everybody who speaks out on this most upsetting of topics. It is a crucial issue on which we must all work together to achieve success.

The Select Committee report notes that progress towards reducing the rate of stillbirths and neonatal deaths has been “impressive”, with its external expert panel rating it as good, although it notes that the baseline for the progress was low in comparison with other countries, such as Sweden, and that there is still a “worrying” level of variation in the quality of care. On stillbirth, the report from the expert panel notes:

“The Department has achieved the interim target of a 20% reduction earlier than the 2020 deadline. However, increased efforts are required to meet the final target”

of a halving in 2025. On neonatal deaths, the report states:

“Good progress has been made towards achieving a 50% reduction…by 2025. However, it has been difficult to determine the full extent of the Government’s progress due to a change in the measure of progress against the National Maternity Ambition on neonatal deaths, with concerns expressed about the validity and unintended consequences of this change. This change in measuring progress has potentially inflated the achievement in the data analysed and may inadvertently exclude extremely pre-term babies from the on-going national efforts to improve neonatal outcomes. We encourage the Department to continue to measure and drive progress towards reducing mortality in both the population of babies born before and after 24-weeks’ gestation.”

On maternal deaths, the report concludes:

“No discernible progress has been made towards reducing the 2010 rate of maternal deaths by 50% by 2025”,

which I find alarming. It continues:

“The factors contributing to maternal deaths are predominantly indirect, such as existing disease, and therefore complex to address. Tackling the causes of maternal death will require concerted efforts, with a focus on pre-conception interventions and improved post-natal support, particularly relating to mental health support…In addition, the worsening disparity in risk of maternal death for women from minority ethnic and socio-economically deprived backgrounds needs to be urgently addressed.”

On pre-term births, the report acknowledges that

“this target was only added to the National Ambition in 2017. Therefore, the window for newly introduced measures to impact on the data is very narrow…While the initiatives currently being implemented by the Department are welcomed, we anticipate that increased efforts will be required to counteract the setbacks to reducing pre-term”

deaths arising from the COVID-19 pandemic.

Great strides have been made in this vitally important space, and it is important to acknowledge that, but there is still more to do. Last week, I had the pleasure of speaking to some members of our excellent midwifery team at the Royal Cornwall Hospital in Treliske, in Truro. Because of continuing covid restrictions, that was conducted remotely, and it was a bittersweet meeting for me, not least because the tech let me down after about 20 minutes. I had a conversation with the fabulous consultant obstetrician, Karen Watkins, who was able to tell me how things were going at Treliske and what further things the team felt needed to be done to accelerate the national ambition.

It was Karen who had delivered the shattering news to my husband and me that our baby could not be saved, that she would have no chance of life. It was Karen who performed the procedure to humanely end Lily’s life—the most frightening point of mine. Last week, I had the privilege of thanking her, as face to face as we could get online, for her kindness, compassion and professionalism in such devastating circumstances. Not everybody gets the chance to do that. The entire bereavement midwifery team at Treliske are outstanding, and I continue to be in awe of our local team, of how they do such a difficult job, are able to support families at their lowest ebb, and continue to take special care of our babies after they have died.

The impact of covid on those issues seems to be a mixed bag, which is against the expectation. There was a peak in stillbirth and neonatal death in March 2020 and another in January 2021. Our team in Cornwall points to a slow and steady decline in the numbers since 2010. This year, there have been two stillbirths so far. In a so-called usual year, there would have been between eight and 12 by now. It is difficult to commend this figure, however, as the team do not yet really know what to attribute it to, apart from natural peaks and troughs. It could be a temporary irregularity; more research will need to be done to see whether we can find a pattern. This is no comfort at all to the two Cornish families who have suffered that unbearable loss.

The APPG has heard evidence from the sector about how covid has exacerbated existing inequalities. Inequality is the biggest issue that needs to be tackled to reduce the number of babies dying and to improve maternity safety. The Health and Social Care Committee report highlights the need to tackle “unacceptable inequalities in outcomes”. The report by the health and social care expert panel report notes that

“improvements in rates of stillbirths and neonatal deaths are good but are not shared equally among all women and babies. Babies from minority ethnic or socioeconomically deprived backgrounds continue to be at significantly greater risk of perinatal death than their white or less deprived peers.”

It is fair to say that mums and babies should not be at an unfair risk just because of their background.

The Select Committee’s recommendation that the Government introduce a target to end the disparity in maternal and neonatal outcomes, with a clear timeline for achieving that target, is exactly right. Work must be done urgently to identify a suitable target and ways to evidence the gap closing nationally, supported by the evidence of progress locally. The target must aim to achieve equity among all groups and ensure that those who currently have the least good outcomes have the best outcomes.

What needs to be done? I have taken it down to five or six points. First, on staffing, action is needed to address staffing shortfalls in maternity services. At a minimum, we need nearly 500 more obstetricians and nearly 2,000 more midwives. I welcome the recent increase in funding for the maternity workforce, but there will need to be further funding commitments to deliver the safe staffing levels that expectant mothers should receive. In Cornwall, when Karen Watkins started 14 years ago, there were eight consultant obstetricians. Today, there are still eight. None of them are dedicated bereavement obstetricians, and staff need to take on this role as part of their existing duties.

Secondly, on training, the 2016 maternity safety training fund has delivered positive outcomes. More funding is required to embed ongoing and sustainable access to training for all maternity staff, given changes in the practice, developments on how to deliver safely and aspects related to covid-19. Funding for backfill cover when training takes place is also desirable.

Thirdly, on parent involvement, after a patient safety incident, too often families are not provided with the appropriate, timely and compassionate support that they deserve. Involving families in a compassionate manner is a crucial part of the investigation process. The Healthcare Safety Investigation Branch has taken considerable steps to improve family engagement but must continue to pursue improvements in that area.

Fourthly, on clinician confidence, this is related to the earlier point about training, but is also about giving clinicians the confidence to report issues without worry. I welcome the Government’s proposal to review clinical negligence in the NHS more broadly. Elements of the rapid resolution and redress scheme have been implemented, but the scheme has not yet been implemented in full. Until it is, there is a high risk that the fundamental changes needed to improve the safety of maternity services may fail to be achieved.

Fifthly, carer continuity is close to my heart. I am a huge advocate for this, and it has been shown to improve the outcomes of those who currently have the worst outcomes. I would like to ensure that those involved in delivering carer continuity have received the appropriate training, and that all professionals are competent and trained in all the work they are able to do, particularly in relation to black mothers, where the disparities are the greatest. Carer continuity helps to point out other issues that might not be specifically or medically looked for such as domestic violence.

Sixthly, we need more research. If a baby dies at term, the parents ask why, and often there is no answer. I would like to see more money put into research and development so that we can understand more about this horrific phenomenon. There is more to say, and I am sure colleagues will add to the discussion today. I thank the Minister for her continued support in this area, and I know she is listening.

Group B strep is the most common cause of life-threatening infection in newborn babies, causing a range of serious infections including pneumonia, meningitis and sepsis.

Screening could save 50 babies a year, and protect a further 70 from life-changing issues. Our Minister has been a force in trying to ensure that all women can ask for the group B strep screening and that all hospital trusts can offer it.

We have just passed the halfway point in this important journey to 2025, and I would like to thank all the healthcare professionals who have contributed to the successes so far. I call on the Government to work with them to achieve the rest and save as many lives as possible in the future.

NHS Dentistry and Oral Health Inequalities

James Gray Excerpts

Wednesday 25th November 2020 Westminster Hall

[Barry Gardiner (Brent North) (Lab)]

My hon. Friend is a student of the Old Testament, and she will know Proverbs 25, verse 19:

“Confidence in an unfaithful man in time of trouble is like a broken tooth”.

We are certainly in a time of trouble. It is not for me to call the Prime Minister an unfaithful man—

[James Gray (in the Chair)]

Certainly not. You must be brief.

[Barry Gardiner]

But the lack of support for dentistry and dental technicians has certainly resulted in a few broken teeth. What does my hon. Friend believe is the single most important thing that the Government can do to support dentistry and the oral health of the nation?

NHS Pensions

James Gray Excerpts

Wednesday 26th June 2019 Westminster Hall

[Sir Robert Syms (Poole) (Con)]

I beg to move,

That this House has considered NHS pensions, annual and lifetime allowances.

I begin by declaring an interest, because anybody who has been in the parliamentary pension scheme is affected by annual allowance and lifetime allowance. Therefore, some of the things I say may reflect on me and maybe other hon. Members, so I suggest they make a declaration as well—

[James Gray (in the Chair)]

Order. The hon. Gentleman may be right to say that all hon. Members may be affected by that matter, but for each individual to have to make that declaration would, I think, be otiose.

[Sir Robert Syms]

Thank you, Mr Gray. This is an important subject, and the more I learn about it, the more I realise its implications for the national health service. I had originally been told that the Treasury would respond to the debate, but I understand that the Department of Health and Social Care has manfully stepped up to the plate—the first example I have seen of a hospital pass to a Department.

The subject has devastating implications for the NHS, dental services and many other services in this country unless it is addressed by the Government. When the coalition Government came into office in 2010-11, they were quite right to reduce the amount of money that could be put into pension funds. At that time, someone could put £255,000 into a pension fund tax free; clearly, if they had such resources, it was unfair on the lower paid. The Government moved to reduce the tax leakage by reducing a number of the allowances.

The problem today is that the Government have drawn the allowances too tight, and in 2015-16 they also introduced a taper to the annual allowance. All that is having a pernicious effect on the NHS and creating what the British Medical Association has called a “perfect storm”. The lifetime allowance, which is just over £1,055,000, is such that most senior doctors and general practitioners get pulled into additional tax, paid at 55%. That raises the question whether they should continue working or retire early; there is a lot of evidence that members of the medical profession are deliberately retiring early because of the implications of working longer.

The annual allowance of £40,000 is creating problems of supplementary tax bills, which are falling at the doors of consultants, doctors and senior nurses. That £40,000 is made up of the increase in the fund and contributions, in a slightly convoluted formula, but the introduction of the taper and the way that it operates cause particular havoc. For higher earners, a strict regime applies to annual contributions, which is known as tapered annual allowance. It applies to people who have both adjusted income over £150,000 per year, which is total taxable income plus the real growth in value of pension rights over the year, and threshold income above £110,000 per year, which is essentially total taxable income, but net the value of any employee pension contributions.

Where an individual ticks both boxes, for every £2 of adjusted income that they receive above the £150,000 level, their annual allowance is reduced by £1. This means that those with an adjusted income of £210,000 have their annual allowance tapered down from £40,000 to £10,000, the lowest level to which tapering can reduce the annual allowance. That tapered allowance was introduced in 2016-17. The ability to carry forward unused allowances for years before the taper was enforced has so far helped to dampen down its impact, but in 2019-20, carry-forward will be from no earlier than 2016-17, when the taper came into force. That will reduce the number of people with significant amounts of underused annual allowance available, and as a result the taper will bite rather more than in earlier years.

If we look at the figures, we see the number of people who exceed annual allowance or hit the taper multiplying each year, pulling many more people into the system. Many senior doctors earn enough money from their core hours plus additional shifts to be potentially affected by the tapered annual allowance. In addition, because of the relative generosity of the NHS pension scheme, pension rights can be built up quite quickly, especially for those who have experienced a step-up in pension rights because of a promotion. Paradoxically, in most cases overtime shifts are not pensionable. That means that a doctor can find that, by working more, he or she has built up no extra pension but, because of the operation of the tapered annual allowance, has reduced the amount of pension that he or she can build up within the tax relief limits.

All that leads to more complexity within the system. It is extremely difficult for someone to work out whether they have an annual allowance issue; that is true for any high earner, but may be particularly true for those in the NHS, because they have rights under different sections of NHS pension schemes—for example, a final salary pension and a career average pension. Those rights are tested against annual allowance, but a negative accrual in one scheme cannot be set against a positive accrual in another scheme.

--- Later in debate ---

[Steve Brine (Winchester) (Con)]

I add my congratulations to my good friend, my hon. Friend the Member for Poole (Sir Robert Syms), on securing the debate, kicking things off and so clearly setting out the challenge that we face. In recent weeks, we have worked as a tag team between Winchester and Poole— earlier this month I raised the issue in the Chamber during an urgent question on the NHS people plan, which is a logical place for the subject to sit, and he, obviously, is leading the debate today—and that is entirely appropriate given that we are relatively near constituency neighbours and that many of our constituents work in Winchester, Bournemouth, Poole and Southampton NHS trusts and do shared work across those trusts.

I must say that the debate should be responded to by a Minister from Her Majesty’s Treasury. That is no criticism of the excellent hospitals and workforce Minister, who until very recently I was honoured to call a ministerial colleague in the Department of Health and Social Care. This is the first debate being responded to by a Minister from the Department of Health and Social Care that I have spoken in since I left office. However, seeing as we have a Health and Social Care Minister here, I will focus my remarks on patient care, which my hon. Friend the Member for Poole has discussed.

Over the past few weeks, I have spoken on a number of occasions to the chief executive of Hampshire Hospitals NHS Trust, Alex Whitfield, and I have spoken either through her or directly to numerous consultants and senior clinicians about this challenge. I am aware how serious it is, both for the individuals adversely affected—as we heard from my hon. Friend the Member for Cheltenham (Alex Chalk) and the hon. Member for Newport West (Ruth Jones)—and for patient care and wellbeing, because the NHS is about its people if it is anything.

When I first spoke to my local trust about this, the chief executive told me that

“the pension situation is having a significant impact on our people”

in Winchester and Basingstoke, and:

“The NHS scheme is particularly affected by changes to the pension tax system relating to the Annual Allowance and the Life Time Allowance.”

She is not wrong when she says:

“These changes are complicated and for individuals in the NHS defined benefit pension scheme the implications are not at all transparent.”

That point was well made by my hon. Friend the Member for Poole. She says:

“As a result, individuals are receiving unexpected tax bills of tens of thousands of pounds. It particularly impacts on consultant doctors, senior nurses and managers. Individuals are making different decisions as a result of these bills.”

I will pause on that point, about the senior NHS staff on whom this is having an impact.

I was privileged to be part of a Department that, under the previous Secretary of State, who is now the Foreign Secretary, and under the current Secretary of State, has delivered a record funding settlement for the NHS—£20.5 billion a year. I saw that play out in Winchester a few weeks ago, when I opened the new emergency department of the Royal Hampshire County Hospital in the heart of the city. That is excellent news. In my opinion, the challenge for the NHS will not be too little money, as a result of the settlement and the excellent long-term plan, but having the right people, who can spend that money in the right way to deliver the patient care outcomes that we want. If we are losing senior people, we have a senior problem.

As well as speaking to the leadership at my local trust, I wanted to find out more from the horse’s mouth, so I asked members of the local clinical community to come forward with their own stories and, if I may, I shall put a few of them on the record. One consultant set the scene very clearly. He told me that the issue is the annual allowance pension tax taper, which I will come back to, and the inflexibility of the NHS pension, which is landing consultants with huge tax bills for doing extra work on top of their contracted hours. The consultant was clear—and I agree, not least as a former Health Minister—that that extra work keeps the NHS running in the face of ever increasing demand.

I was told that, in certain circumstances, the marginal tax rate on earnings for the extra work is greater than 100%, which means that senior doctors working in my local hospital are in effect having to pay to do extra work. They are some of the most committed individuals in public service in our country, and I have had the privilege of working closely with many of them, but that is taking things a bit too far. It is clearly not a sustainable situation and, now that the huge tax bills are landing on doorsteps, it is causing a huge change in the behaviour of consultants at all levels in my local trust.

Another consultant told me that she has been an NHS doctor for 19 years and has worked as a consultant in my local trust for the last seven. She is employed on a full-time contract, with additional out-of-hours cover. Moreover, she regularly covers additional lists and shifts that require cover, sometimes at very short notice. She could not have been clearer with me that she is happy to provide that cover in the interest of safe patient care, which is of course what this is all about, as everyone has said. However, she has now been hit with a £30,000 tax bill, and she tells me that the only way she can avoid regular large tax charges, which may be for tens of thousands of pounds a year and which of course are in addition to her not insignificant income tax payments, is seriously to reduce the hours that she works for the NHS and not to take on any additional duties. As has been said, that goes to the heart of the issue. The consultant fears, as does her MP, that that is the conclusion that many of her colleagues will be forced to accept.

Let me again give some facts from trust level. Hampshire Hospitals NHS Foundation Trust recently ran a survey on the pension issue and received a healthy 2,500 responses. It is the case that 42% of all the respondents have reduced their work commitment; 20% have avoided promotion; and, critically, when the people were asked who might change working practices in the future, the figure goes up to 80%, including 33% considering early retirement and just over a quarter considering leaving the NHS altogether.

I have no doubt that the changes were introduced in good faith. They are aimed at top rate earners, as my hon. Friend the Member for Poole said, but in practice this has had a damaging effect on key people in the NHS, and if it is not sorted quickly, we will see that escalate further, and it will become harder and harder to retrieve the position. The suggestions put to me for fixing it include removing the annual allowance tapering. When I spoke during the urgent question earlier this month, a number of consultants from across my local trust and Poole and Southampton contacted me. They are pleased that the consultation, which I am sure my hon. Friend the Minister will say more about, is imminent, but what they fear from that is that the 50:50 fudge will just not work. We need wholesale reform, and the taper really does need to be scrapped.

In addition, I ask the Minister whether it is worth considering removal of the annual allowance taper for public sector workers. Of course, that is a decision not for him but for the Treasury and for whoever is inhabiting No. 10 in a few weeks’ time—I may be well placed to influence that, or I may be not at all placed. The point is this. If we want to make the NHS a great place to work, why not provide a tax benefit to working for the public sector—one of the biggest employers in the world? That is food for thought.

Let me finish in the same way as I have tried to make the whole of my contribution this morning—with a real-life example from Hampshire Hospitals NHS Foundation Trust of what we are seeing at trust level. In Winchester, like everywhere else and as I have set out, the Royal Hampshire County Hospital, one of the three hospitals in the trust, relies on many doctors and other senior staff doing additional sessions over and above their timetabled work in order to fill gaps in the medical workforce. Locally, we have seen that especially in radiology, where the additional sessions are used for radiologists to review scans and write the reports about what they see. The reporting of scans is clearly required so that patients can be told what the scan shows and clinical staff can work with patients on the most appropriate treatment.

My good friend from the Scottish National party, the hon. Member for Central Ayrshire (Dr Whitford), whom we will hear from shortly, and I spent many hours in this Chamber when I was the Minister with responsibility for cancer, and I was extremely proud to get the 75% stage 1 or 2 diagnosis ambition into the long-term plan, as announced by my right hon. Friend the Prime Minister. That is critical: early diagnosis is cancer’s magic key, as has been said by me and others many times in this Chamber. If we are to get anywhere near realising that ambition, we have to have a functioning, improved and expanded radiology service. Any reduction in radiology and the diagnosis stage will have an adverse impact and make that ambition unattainable, in my opinion. I am reliably told by my local trust that it has seen the backlog of scans waiting to be reported growing each week over the last few months. That concerns me greatly. It is of course just one department—it is an area that I know a little about—but it is a sobering example and one that we simply cannot ignore.

I shall finish by saying that we must act. I have so much respect for this Minister, but we need the Treasury to take this issue seriously and we need the next Prime Minister to act. If we do not, it will only get worse. We need to grip it, and we need to grip it fast.

[James Gray (in the Chair)]

Despite his late arrival to the debate, I call Mr Paul Sweeney.

--- Later in debate ---

[Anneliese Dodds]

Absolutely. I am grateful to the—

[James Gray (in the Chair)]

Obviously, in the context of the debate.

[Anneliese Dodds]

Great. I will keep it within the context of the debate as much as possible, because in fact this debate is around taxation—

[James Gray (in the Chair)]

Order. The hon. Lady will not keep it within the context of the debate “as much as possible”; she will keep it within the context of the debate.

[Anneliese Dodds]

I certainly will, Mr Gray. Thank you.

As I was saying, this debate is broadly around the contours of the taxation system and how they affect high-paid workers in particular. I am sure that the hon. Member for Winchester is aware that Labour has a different approach from that of the current Government around progressive taxation. We set out our proposals at the last general education: we indicated how, by increasing the tax paid by the very best-paid workers, we would free up the resources that are necessary. I am sure that he has seen what Labour produced in that regard—in particular, we would not pay for the boost in spending that the NHS needs only through a short-term windfall, which in practice is what the Chancellor did, because all the commitments that the Government made to the NHS were as a result of lower than projected spending and higher than projected taxation receipts.

That is not a sustainable way to fund our NHS in the long run. Instead, we should look at the longer-term measures that are necessary, which is exactly what we have been doing.

We need to ensure that NHS workers on lower incomes can save properly for retirement, but we also need to look at the situation that has been the focus of today’s debate. We need to focus on the changes that were made in the 2015 pension scheme, and how they interact with the variety of alterations that have been made to tax release. It is especially important to do so in the context of staff retention, and I understand the comments that Members have made about that topic. We have a particular problem with NHS staff leaving their jobs early, which in my experience is not merely because of these issues, although of course they are important. When I talk to senior staff in the NHS, they also mention stress, a general lack of resource, having to deal with short-term changes such as operating theatres being closed because of a lack of staff, and so on. A whole variety of features is driving those retention problems.

Oral Answers to Questions

James Gray Excerpts

Tuesday 19th December 2017 Commons Chamber

[Jackie Doyle-Price]

I thank the hon. Gentleman for his support and for his hard work in this space. Through him, I can perhaps thank the Daily Mirror for its public displays of education through the Max’s law campaign, but we all need to make an effort. There is no doubt that the public are hugely in favour of donation and want to be able to support it as best they can, but the matter has rather fallen from public consciousness. Everyone in the House has an opportunity to raise public awareness, get involved in the consultation and have a real debate, because we need to ensure that people are willing to donate their organs so that we can save more lives.

[James Gray (North Wiltshire) (Con)]

There are already 24 million people on the voluntary organ donation register, which is a significant proportion of Great Britain’s population. None the less, three people a day die because appropriate organs are not available for transplant, and it is vital to do something about that. Is my hon. Friend aware of a particular difficulty with members of black and minority ethnic populations being more reluctant to join the register than others? Is there a way to encourage them to take part in the voluntary scheme?

[Jackie Doyle-Price]

My hon. Friend highlights one of the biggest challenges we face. There is no doubt that the rate of organ donation is much lower among black and minority ethnic populations, and yet they are more likely to suffer from diseases that require a donated organ, so we are keen to work on that. Only this week, I met organisations connected with the black and Asian community to discuss how we can communicate, getting the right messages through the right messengers, to encourage people to join the register.

Operational Productivity in NHS Providers

James Gray Excerpts

Wednesday 1st July 2015 Westminster Hall

[Dr Offord]

It was a pleasure to start the debate under the chairmanship of Mr Pritchard and, indeed, it is a pleasure to finish under you, Mr Gray.

[Mr James Gray (in the Chair)]

Covering all your bases.

[Dr Offord]

The debate was fantastic, but not entirely what I expected. The NHS is often used as a political football. I thank the Members present for their contributions and for highlighting some issues for me to consider, as well as for the Department and the Minister to consider.

The personal NHS experience of the hon. Member for Bristol South (Karin Smyth) is welcome not only in the debate, but in the House as a whole, and I look forward to her contribution to other debates. I thank her for today’s contribution, which was important.

I was surprised at first by the hon. Member for Angus (Mike Weir), because the Carter review looked at England, and I wondered where the hon. Gentleman’s contributions would go, but I am pleased that both he and the hon. Member for Strangford (Jim Shannon) spoke about the devolved institutions and the lessons that can be learned throughout the United Kingdom from Lord Carter’s report. That is a great way for us to work as a one nation country.

I am grateful for the comments of the shadow Minister, who made some points about NHS procurement. Some issues about extraction from European Union procurement programmes still need to be resolved—I understand that the shadow Health Secretary, the right hon. Member for Leigh (Andy Burnham), says that that can happen, but Simon Stevens does not believe that is correct—so there are some good things for the Minister to go away and think about. I will certainly take them away too, and I am grateful for that.

In the short time I have available, I want to say a little about the response to the Carter review. There has been a positive response from the Royal College of Nursing, which not only acknowledged that nursing numbers have not been meeting demand, but stated:

“It is clear that there is waste in the NHS, which is holding it back from directing its resources to frontline patient care. Lord Carter’s review is a welcome illustration of how the NHS and individual hospitals could be much more effective in how they procure equipment, drugs, and above all staff.”

As the Minister said, we as parliamentarians therefore have a great opportunity to engage in the issue. As I said at the start of my speech, it came up at many hustings. It is often said that the Conservatives are not strong on the NHS, but I think we have a good story to tell. If we carry on in the same vein, and if the Minister carries on in the way he spoke today and in the recent debate in the main Chamber, that will please me and other colleagues.

I have been unfortunate enough in the past nine months to have need of the NHS, but I have been fortunate enough that it has been there. I am grateful. I have attended Moorfields, the BMI in east London and the Whittington with fairly serious issues. Indeed, my father-in-law had a hip operation on Friday, so I am grateful to the hospital in Swindon as well for making that happen. The care that he and I received has been second to none and I am grateful. I hope that it may continue to be such and that today’s debate will continue our efforts to make the NHS the best national health system in the world.

Question put and agreed to.

Resolved,

That this House has considered operational productivity in NHS providers.