Adult Social Care

Jeremy Hunt Excerpts

Wednesday 1st December 2021 Commons Chamber

[Gillian Keegan]

It will take long. It is over 100 pages, so it will take a reasonable time if Members are interested in actually finding the solutions.

The hon. Member for Leicester West also asked about workforce strategy and the NHS compared with social care. Obviously, the people in the NHS are employed by the NHS, which is a public body. Social care is largely a private system. There are 18,000 or more businesses. That is why it is a different sector and why we deal with workforce strategy differently. However, we have £500 million to invest in the social care workforce and to make sure that we invest in the knowledge and skills framework, careers options and so on.

There are 1.54 million workers in the sector and they are hugely valued. The hon. Lady said they are leaving in droves. Actually, what we have in the sector is a continual demographic shift in terms of need, and it grows by 1% to 2% every year, so we are always trying to recruit new workers into the sector. Of course, it is very important that these fundamental reforms take place so that we get more people attracted to the sector, more people staying in the sector, more people progressing in the sector and more people providing excellent care all day, every day, providing a lifeline to people across the country.

[Jeremy Hunt (South West Surrey) (Con)]

I thank the Minister for her work putting the White Paper together in a very short period. I know that she has put a lot of effort into it, but it is hard to see it as more than three steps forward and two steps back. The step forward, which we should acknowledge, is the introduction of a cap. Whatever the arguments about what counts towards the cap, having a cap will make a big difference to many people, and that is welcome.

However, these measures do not really give confidence in two crucial areas. The first is the funding to local authorities for their core responsibilities. The White Paper barely gives them enough to deal with demographic change and national living wage increases, and it is a long way off the £7 billion-a-year increase the Health and Social Care Committee called for by the end of the Parliament. It is also hard to see the NHS and social care systems being fully integrated, as they should be, and an end to the workforce crisis, which sees 40% turnover in many companies.

This is a start. The Minister is a very capable new Minister and I personally have great confidence in her, but will she bring forward further measures to deal with those huge problems? Otherwise, we will see hospital wards continuing to be full of people who should be discharged, and older people not getting the care they need because the carers do not exist.

[Gillian Keegan]

My right hon. Friend is right that this is a start. It is a 10-year vision, and obviously we had a three-year spending review and the spending that we set out was a three-year spending settlement, so of course it is just a start.

On the steps to ensure that local authorities move to a fair rate and a fair cost of care, we are exploring a number of options, and we will set out further detail at the local government finance settlement later this year. Local authorities moving towards a fair rate of care is key to building a solid foundation for the future adult social care system, so we will be working closely with them to shape the best possible approach to implementation across different local markets. We will shortly be engaging with local authorities and providers, and we will publish further guidance in due course.

My right hon. Friend is absolutely right about the workforce. I have never worked in a business where the workforce was not key to anything that needed to be delivered, but in the care sector in particular, it is impossible to deliver anything without the workforce. It is also difficult to look at the workforce structure. As I say, it is the largest workforce in the country, with 1.54 million people working in it, but with 40% churn and very high amounts of zero-hours contracts and of retraining. I have never seen something that has that—[Interruption.] This has been the case for decades, and nobody has done anything to address it. [Interruption.] Nobody has done anything to address it. We do need to address it, and that is what we are here to do today, but—[Interruption.]

Covid-19 Update

Jeremy Hunt Excerpts

Monday 29th November 2021 Commons Chamber

[Sajid Javid]

I, too, extend my best wishes to the shadow Health Secretary and wish him a speedy recovery.

I have to say that I think the hon. Lady has misjudged the tone of the House. This is a very serious matter. The whole country will be looking for all Members of this House to work together and support the nation. Surely she is not blaming the UK Government for the emergence of the new variant. Perhaps she was just auditioning for the reshuffle that is going on in her party right now.

The hon. Lady asked about international donations. The UK is leading the world on international donations—quite rightly. It is absolutely right that that be treated as a priority. We would like to see other countries step up as well. A few months back, the Prime Minister pledged 100 million donations by June 2022, 80% of which will go through COVAX, of which we are a huge supporter; 20% will be made bilaterally. So far, we have donated over 20 million doses—more than many other countries. COVAX, which we helped found, and which we support, has donated, I believe, some 537 million doses to 144 countries.

The hon. Lady asked about the rules on travel and masks, and other rules that I set out. I think I have addressed that. I believe that the measures are proportionate, and that this is a balanced response. We have just set out a huge expansion of the vaccine roll-out programme, and it is a shame that the hon. Lady could not find it in herself to welcome that. As I said, I will set out more details in coming days on exactly how we intend to meet the requirement to vaccinate more.

On antivirals, we are one of few countries in the world to have procured the two leading antivirals. Our independent regulator, the Medicines and Healthcare products Regulatory Agency, was the first in the world to approve one of those antivirals. I am pleased with the over 700,000 courses that we have for citizens across the United Kingdom, but of course, given the emergence of the new variant, we will be reviewing that and seeing if more needs to be done.

[Jeremy Hunt (South West Surrey) (Con)]

The late Donald Rumsfeld coined the phrase, “known unknowns”, and that is what we face with the new omicron virus. The Secretary of State is therefore absolutely right to take sensible and proportionate measures to buy time while we wait to understand how dangerous this new variant can be, but does he not agree that the fact that we face this danger is a symptom of the failure of western countries to make sure that vaccines are distributed adequately around the world? I recognise the enormous contribution that the UK has made through COVAX, the development of the AstraZeneca vaccine and so on, but is it not a moral and practical failure that while richer countries have managed to vaccinate 60% of their populations, for poorer countries the figure is just 3%?

Oral Answers to Questions

Jeremy Hunt Excerpts

Tuesday 23rd November 2021 Commons Chamber

[Mr Speaker]

I call the Chairman of the Health and Social Care Committee, Jeremy Hunt.

[Jeremy Hunt (South West Surrey) (Con)]

Thank you, Mr Speaker.

The Secretary of State knows that some in Government are worried about the extra cost of training additional doctors, but does he agree that every additional doctor we train means one fewer locums that the NHS has to hire, which is cheaper for the NHS and better for patients?

[Sajid Javid]

I agree that we want more and more full-time doctors, which will mean that there is less demand for locums and is, of course, very good for the NHS. I also agree that there should be more focus on the workforce, and I hope that my right hon. Friend welcomes the measure that I took yesterday of merging Health Education England with the NHS, so that we can have a much more joined-up workforce plan.

Health and Care Bill

Jeremy Hunt Excerpts

Report stage
Tuesday 23rd November 2021 Commons Chamber

[Jeremy Hunt (South West Surrey) (Con)]

May I just comment that it feels a lot better this time?

[Justin Madders]

Let us just say that the more I hear of the right hon. Gentleman, the more I like what he has to say—I will leave it there.

We all accept the urgent need to address the workforce crisis, but I cannot find anyone who thinks that what the Government have put forward in clause 34 is the solution.

--- Later in debate ---

[Justin Madders]

I thank the hon. Member for his intervention. I think he is being very modest, but he is absolutely right that these things do not happen by accident. It is often the hard work, over many years, of campaigners and campaign groups who being these issues to the fore and do the diligence and the hard work behind the scenes that leads us to the sort of outcome that we will hopefully get today—an end to this abhorrent practice.

On the hon. Member’s other amendment, new clause 22, we also want to see hymenoplasty ended. It has no medical benefit whatsoever. As the Minister said, there is currently an expert panel looking at the issue, and he is waiting on its recommendations. I think the outcome is in little doubt, to be frank. However, I wonder whether the Minister can give us an assurance that, should those recommendations turn out to be as we would expect, he will be able to act on them quickly and get something down in statute as soon as possible so that we do not miss the boat.

Turning to the amendments on the health services safety investigations body, much of the proposed legislation is the same as that proposed in the other place, and there were extensive debates on this matter in Committee. There are, however, issues that remain, which are covered by amendments we will be debating today. I can imagine the other place having quite a lot to say about some of these issues. In general, we support the move to the new body, but over time attention must be applied to some aspects of the way it will function in practice. Our major reservation is, yet again, with the involvement of the Secretary of State. Our amendment 74 would have the effect of leaving out clause 115, which is another clause that gives the Secretary of State extra powers to interfere.

Our general observation would be that there is far too much extra power going to the Secretary of State in the Bill anyway, but we are particularly concerned at the powers set out in clause 115, which give him what we consider to be wholly unnecessary powers to direct. It is pretty much a blank cheque to enable him to step in and interfere any time he likes as long as he considers that there has been a significant failure. Under subsection (2), the Secretary of State can direct the HSSIB in whatever manner he determines, which I would have said is about as far away from independence as we can get—until we get to subsection (4), which means the Secretary of State can also effectively step into the HSSIB’s shoes and undertake the duties himself. I can do no better than refer to the evidence Keith Conradi gave to the Public Bill Committee, when he said:

“Ultimately, we end up making recommendations to the Department of Health and Social Care, and in the future I would like to ensure that we have that complete freedom to be able to make recommendations wherever we think that they most fit.”––[Official Report, Health and Care Public Bill Committee, 7 September 2021; c. 60.]

We also support the amendments put forward by the spokesperson for the Scottish National party, the hon. Member for Central Ayrshire (Dr Whitford), which are important in preserving the principle and status of protected spaces. We feel it is important that they cannot be nibbled away at, as the Bill currently allows.

The purpose of amendment 57, which we also tabled in Committee, is simply to delete clause 127, which deals with the role of the Secretary of State in professional regulation. So far, we have had no convincing explanation of why the Secretary of State needs these powers. If there are no professions that he wishes to remove, we do not need the clause. If there are, he should say so, so we can have a debate now on whether it is appropriate to hand over those powers to him.

Finally, on new clause 1, I pay tribute to the all-party parliamentary group on beauty, aesthetics and wellbeing, whose work in this area has been influential in producing it. Many of the group’s members have put their name to it. As we know, cosmetic treatments can include a wide range of procedures aimed at enhancing or altering appearance. Many of those procedures are becoming increasingly popular and new clause 1 speaks to the well-articulated concern that non-medically and medically trained practitioners are performing treatments without being able to provide evidence of appropriate training, and without required standards of oversight and supervision.

I hope the Members moving new clause 1 will have the opportunity to speak to it, as there are far too many stories of people suffering horrific, life-changing injuries. There would undoubtedly be a saving to the NHS in reduced visits to accident and emergency and GPs to correct mistakes made by poorly trained and unregulated practitioners. We therefore think the new clause has value. Some of the impacts on the NHS from the lack of regulation include outbreaks of infection at a skin piercing premises, resulting in individuals being hospitalised; disfiguration and partial removal of an ear; second and third-degree burns from lasers and sunbeds; allergic reactions due to failures to carry out patch tests or medical assessments, which led to hospitalisation; and blindness in one eye caused by the incorrect administration of dermal filler.

New clause 1 seeks to put the protection of the public at the forefront by giving the Secretary of State power to bring into force a national licensing scheme for cosmetic procedures. Clearly, given that this is a departure from the wild west we face at the moment, we recognise that significant research and engagement with stakeholders will be needed to develop a scheme, as well as the provision of a practical and efficient system for people to become regulators and practitioners. If that does not make it on to the face of the Bill today, we hope this is an issue the Government will return to shortly.

[Jeremy Hunt]

I rise to speak in support of amendment 10 but, before I do, I also want to express strong support for amendments 40 to 43, tabled by the hon. Member for Central Ayrshire (Dr Whitford), which will make a big difference in making the new health services safety investigation body a success. I strongly encourage the Minister to listen to what she says later not just with the deference due to an experienced surgeon, but with the enthusiasm to follow a doctor’s advice, because what she says is extremely important.

I also thank the hon. Member for Ellesmere Port and Neston (Justin Madders) for his generous comments about me. Having sat opposite him at the Dispatch Box on many an occasion, I realise how difficult they must have been for him to say. He must have wrestled with those thoughts for a long time, and I am delighted that he has been able to unburden himself today.

The hon. Gentleman was absolutely right to focus on burnout in the NHS workforce. All of us would agree that NHS and care staff have done a magnificent job looking after us and our families in the pandemic, but right now they are exhausted and daunted. They can see that A&E departments and GP surgeries are seeing record attendances. They can see nearly 6 million on waiting lists, which is more than one in 10 of the population. They also have the vaccine programme and covid patients.

[Jim Shannon (Strangford) (DUP)]

I commend the right hon. Gentleman for amendment 10. With 2,700 vacant nursing posts in Northern Ireland, and 40,000 in the NHS as a whole, will the amendment offer more nursing bursaries, train nurses up to relieve the pressure, and provide a decent working environment?

[Jeremy Hunt]

I believe it will. I am grateful to the hon. Gentleman for raising that issue, because medical training is relevant to the whole United Kingdom, not just one part of it. I hope the amendment will be beneficial to Northern Ireland as well.

If we put ourselves in the shoes of any frontline doctor, nurse or care worker, we would see that they are all completely realistic that this is not a problem that can be solved by next Monday. It takes a long time to train a doctor or nurse. All they have is one simple request: that they can be confident that we are training enough of them for the future, so that even if no immediate solution is in place, there is a long-term solution. That is the purpose of amendment 10. It simply requires the Government to publish every two years independently verified estimates of the number of people we should be training across health and care.

The Government have recognised the pressures on the NHS by giving generous amounts of extra funding. I commend the Government for doing that, but extra money without extra workforce will not solve the problems that we want to solve. At the moment, the NHS just cannot find the staff.

[Munira Wilson]

I congratulate the right hon. Gentleman on amendment 10 and on how he has built such a coalition of support. Many of the challenges facing those with mental health concerns are because, as he says, there simply is not the workforce—it has hardly grown over the past decade. There are over 16,600 full-time equivalent vacancies and a waiting list of 1.5 million. His amendment, which would require a report every two years, is so important for ministerial accountability because the targets in the five year forward view have not been met, so we have no chance with the 15-year projection.

[Jeremy Hunt]

The hon. Lady gives a good example, because mental health is an area that we have all recently come to realise can be immensely beneficial to ourselves, our families and our constituents. However, while there has been explosive growth in demand, we have not had growth in the supply of people able to look after those with mental health issues. We can only do that with the kind of long-term planning that amendment 10 will make possible.

The royal colleges say that, as of today, there are shortages of 500 obstetricians, 1,400 anaesthetists, 1,900 radiologists, 2,00 A&E consultants, 2,000 GPs, 39,000 nurses and thousands of other allied health professionals. That is why this problem has become so acute.

The Minister has engaged thoughtfully with me on the issue on a number of occasions. He and I both know that there is some concern in the Government about the cost of training additional doctors and nurses. I want to take that concern head on. Yes, the amendment would lead to more doctors, nurses and professionals being trained. Yes, that would cost extra money. Yes, it would save the NHS even more money, because every additional doctor we train is an additional locum we do not need to employ. Locums are not only more expensive for the NHS, but less good for patients. Patients prefer to see the same doctor on every visit if they possibly can, which is much harder with a high number of temporary workers.

[Dr Whitford]

It is not just that patients prefer to see a doctor long term. There are safety issues when locums in acute specialties move from hospital to hospital, particularly if they are dealing with an acute case. They do not know where things are or who to phone; passwords and phone numbers change. There is a real safety issue with having too many locum staff in the very exposed acute services.

[Jeremy Hunt]

I absolutely agree with the hon. Lady, who knows about acute services. I also point to recent evidence from Norway that shows the same for general practice: patients who see the same GP over and over again go to A&E departments less than patients who see different GPs.

[Dr Murrison]

The hon. Member for Central Ayrshire (Dr Whitford) is absolutely right about acute safety; I speak from personal experience. My right hon. Friend is right about general practice, but the issues are different. In general practice, the issue is chronic long-term care: patients need to know that practitioners have a view of their condition that spans a long period—sometimes generations. The issues are very different in acute and primary care, but they come to the same thing.

Does my right hon. Friend agree that part of the problem with the workforce is not recruitment, but retention, particularly the retention of senior doctors in their mid-50s? It pains me to say it in this consensual debate, but the root cause is the GP contract and the consultant contract brought in by the last Labour Government. Those contracts incentivise people—in my demographic, as it happens—to leave, potentially leaving the service short of 10% of their entire career.

[Jeremy Hunt]

My right hon. Friend is right that there are problems with the GP contract. I do not want to get into too many discussions about doctors’ contracts in this very consensual debate, but Conservative Members have to take responsibility for not having remedied the pensions anomaly, which gives people an incentive to retire much earlier than we would want. We have to address that issue.

Lots of people might reasonably ask whether I did enough to address the issues in the nearly six years that I was Health Secretary. The answer is that I set up five new medical schools and increased by 25% the number of doctors, nurses and midwives we train. However, that decision was taken five years ago and it takes seven years to train a doctor, so not a single extra doctor has yet joined the workforce as a result.

That is the nub of the problem: the number of doctors, nurses and other professionals we train depends on the priorities of the current Secretary of State and Chancellor. As a result, we have ended up with a very haphazard system that means that although we spend about the average in western Europe on health, as a proportion of GDP, we have one of the lowest numbers of doctors per head—lower than any European country except Sweden.

[Dr Whitford]

All Governments in the UK are expanding medical school places and trying to train more students, but that has led to a shortage of foundation places. In the first two years after a doctor graduates, they are not allowed to practise outwith a foundation job, and they can never practise if they do not go through a foundation job. In the summer, about 400 young graduates were still struggling to find a place. It took 19 years from my entering medical school to my becoming a consultant surgeon. We need to think not just about medical school, but about the whole pathway.

[Jeremy Hunt]

The hon. Lady is absolutely right. Medical school, the foundation years and, as my right hon. Friend the Member for South West Wiltshire (Dr Murrison) said, the retention of staff—all those things need to be built into long-term planning and baked into the system.

That long-term planning strikes a contrast, if I may say so, with some of the short-termism that we have seen recently. Even in the recent Budget and spending review, the budget for Health Education England, which funds the training of doctors in this country, was not settled. Although I think that the proposed merger with NHS England is probably the right thing to do, I fear it will mean that the budget is not settled for many more months, at precisely the moment when the workforce crisis is the biggest concern for the majority of people in the NHS.

[Greg Clark (Tunbridge Wells) (Con)]

My right hon. Friend is making an excellent speech, and I strongly support his amendment. Will he add to the list of factors that need to be considered in the future the requirement for many research scientists in medical sciences to be trained in medical schools first? If we want to expand and build on the excellence that we have there, it is not just a question of meeting the needs of the NHS workforce; we need to have extra people who can become the brilliant researchers and discoverers of new medicines in the future.

[Jeremy Hunt]

My right hon. Friend speaks about these issues with a great deal of knowledge, given his former ministerial and Select Committee roles, and he is absolutely right. I think that the big lesson from the pandemic, and indeed an issue that emerged in the report that our Committees jointly produced, is the way in which science can add value to clinical practice and clinical practice can add value to science.

[Rachael Maskell]

One of the key workforces is, of course, in public health, where the aim is to shift the balance by increasing prevention so that we do not need all the doctors and nurses and other health professionals further down the road. The health visitor delivery programme led to a heavy stream of new health visitors, but it had other consequences. That is another reason why the right hon. Gentleman’s amendment is so important: we see rapid changes in the workforce which could have other consequences.

[Jeremy Hunt]

I thank the hon. Lady, who before entering this place spent her time campaigning to support NHS and care staff. She speaks with great experience, and I think that the fundamental point she makes is very important. Unless there is long-term strategic planning, when we have a priority such as the one we have at the moment of tackling the backlog, we will often make progress on that priority by sucking in staff from other areas, which then suffer. That is an unintended consequence which happened when I was Health Secretary, and I fear that it will happen again without a long-term strategic framework.

Amendment 10 has wide support. It is supported by 50 NHS organisations, including every royal college and the British Medical Association—an organisation which, to be honest, is not famous for supporting initiatives from me—and by six Select Committee Chairs and all the main political parties in this place. I am sure that the Government will ultimately accept it, because it is the right thing to do, but if they are intending to vote it down today, I would say to them that every month in which we delay putting this structure in place is a month when we are failing to give hope to NHS staff on the front line.

Let me end by quoting the Israeli politician Abba Eban, who said that

“men and nations behave wisely when they have exhausted all other alternatives.”

Let us prove him wrong today by supporting amendment 10.

[Dr Whitford]

I am delighted to follow the Chair of the Health and Social Care Committee, and, in this rather unnerving outbreak of consensus and good humour, to mirror his speech and add my support to his amendment on workforce planning.

It is important to remember that healthcare is not delivered by hospital buildings or fancy machines; it is delivered by people to people, which is why the most important asset in any health service is its workforce. As I pointed out in an earlier exchange with the right hon. Gentleman, we need a long-term view, because it takes a long time to train senor specialists. As I said to him, it took 19 years from my entering medical school to my becoming a consultant breast cancer surgeon. We will struggle to work out what specialties we might need in 20 years’ time, because medicine is evolving, but many aspects and many sectors of staff do not change. If we do not get even those right, we are constantly in a position of drought and thirst, and it is not possible for staff to evolve—to pick up new rules, to use new techniques and to develop new services.

Although this workforce strategy would apply only in England, I would encourage consultation with the Health Secretaries and the workforce bodies in the devolved nations, because junior doctors in particular tend to move around during their training. During the junior doctors’ strike, which the right hon. Member for South West Surrey (Jeremy Hunt) might remember rather painfully, I talked to students on the picket lines whom I had trained. People move around, and it is important that such a strategy does not end up just sucking staff out of the three devolved health services. Also, many aspects of medical training are controlled on a UK basis. Foundation places for new graduates are decided on a UK basis, for example, so it is important to take that wider view.

The workforce shortage is the biggest single challenge facing all four national health services across the UK. It has been exacerbated by the loss of EU staff after Brexit, with an almost 90% drop in EU nurses registering to come and work in the UK. Early retirements are being taken due to the Government’s pension tax changes, which, as has been highlighted, have not been sorted out and are resulting in senior doctors paying to go to work. There is only so long that they will continue to do that. Finally, there is the exhaustion of dealing with a pandemic for the past 18 months. This is why it is really important, when we talk about NHS recovery, to have a greater focus on staff wellbeing and on their recovery. There can be no recovery of the NHS without them. I am really disappointed to see how the clapping of last spring has turned to severe criticism and attacks directly from members of the public, from sectors of the media, and even from some Members in this place and members of the Government.

I shall now speak to my own amendments 40 to 43, which seek to tightly define the materials covered by the safe space protections as part of Health Service Safety Investigations Body investigations. The idea behind HSSIB was to learn from air accident investigations and to provide a confidential and secure safe space in which healthcare staff could be open and candid in discussing any patient safety incidents. I was on the pre-legislative scrutiny Committee, which was chaired by the hon. Member for Harwich and North Essex (Sir Bernard Jenkin), and the recommendations of that cross-party—and indeed cross-House—Committee were very clear: evidence gathered under the safe space protocols should be protected and disclosed to third parties only in the most pressing situations, such as an ongoing risk to patient safety or criminality. Despite that, there are aspects of this Bill that could undermine the principle of the safe space, and that is what I am seeking to amend.

Amendment 40 would define he safe space materials much more tightly, because it seemed as though anything that HSSIB was using would be covered by the safe space protocol and that exemptions would then be made, whereas it makes much more sense to be very clear about the materials that are defined as protected materials. Therefore, all the original clinical information—medical notes, etc—would still be available to all the other bodies to enable them to carry out their investigations as they do now.

Amendment 43 would remove the ability of the Secretary of State to use regulation at a later date to authorise the wider disclosure of protected materials beyond the provision that is finally passed in this Bill. Amendment 42 would remove the provision allowing coroners to require disclosure of protected materials, as this has already led to calls for access by other health bodies and even freedom of information requests, as I highlighted in my earlier intervention. If a coroner uses safe space materials in their report, that report is public. The question is: how are they going to handle that so that the safe space materials are not further disclosed? It is critical to defend this. It is important to stress that HSSIB does not limit anyone else’s access to original materials, but nor should HSSIB be seen as an easy way for other bodies to avoid doing the legwork and carrying out their own investigations.

HSSIB will not apply in Scotland, where the Scottish patient safety programme is focused more on preventing patient safety issues in the first place. My interest is purely personal, as a surgeon. I experienced the impact of the Scottish patient safety programme when it was introduced to operating theatres in 2007. It cut post-operative deaths by 37% within two years. It has subsequently been rolled out to maternity, psychiatry, primary care and all the main sectors. It has not just reduced hospital mortality, but prevented morbidity—such as pressure sores, leg thrombosis or sepsis, which all in their own way cost the NHS a huge fortune.

Health and Care Bill

Jeremy Hunt Excerpts

Report stage
Monday 22nd November 2021 Commons Chamber

[Madam Deputy Speaker (Dame Rosie Winterton)]

Order. It will be obvious to Members that a large number of colleagues want to contribute to the debate. I urge brevity, so that others can participate. I call the Chair of the Health and Social Care Committee, Jeremy Hunt.

[Jeremy Hunt (South West Surrey) (Con)]

Madam Deputy Speaker, I think on this occasion I can oblige you, because I will be very brief. I wish to speak to amendment 114, which may seem a rather technical amendment—as is evidenced by the fact that, out of 650 colleagues, only one has actually signed it, and that is me—but it makes up in quality for what it does not have in quantity. It is about making sure that the new integrated care boards focus their energy on the safety and quality of care of patients. That is very important, because the new integrated care boards will have enormous power. In effect, they will be the local governing bodies of our NHS.

Although the statutory structures matter, what the people running those care boards focus their attention on is incredibly important to all our constituents. The amendment will make sure that when care boards consider their priorities, the things that matter to patients—the safety and quality of care—are put at the very top of their list. We know the way the NHS works. It is the fifth-largest bureaucracy in the world, and there is a plethora of internal NHS—

[Edward Argar]

rose—

[Jeremy Hunt]

I see the Minister wants me to give way. May I make my argument for one moment, and then give way?

There is a plethora of internal NHS targets, there are operational targets and there are financial targets. They often have an excellent purpose, but, as in the case of Mid Staffs and other cases where things went badly wrong, being under a lot of pressure to meet those targets means corners can be cut, and the quality of care experienced by patients can be really damaged. The amendment would make sure that there was discipline in the system, so that whatever pressure NHS managers were under, they were always focused on safety and quality of care.

[John Redwood]

I pay tribute to my right hon. Friend for what he did as Secretary of State to stress the importance of this crucial work, and he is not on his own: I support him.

--- Later in debate ---

[Jeremy Hunt]

Before I come to the Minister, I want to say—and I am very grateful to my right hon. Friend the Member for Wokingham (John Redwood), who gave me consistent support on this agenda when I was Health Secretary—that, in the public sector, the one system that has seemed to make sure we focus public bodies on our constituents’ priorities is the Ofsted system in schools. We have rolled that out, I think reasonably successfully, to hospitals, GP surgeries and care homes, and this amendment makes that possible for the new integrated care boards. I want to give the Minister a chance to intervene to tell us his reflections on whether this system could work.

[Edward Argar]

I am grateful to my right hon. Friend. It is not just my right hon. Friend the Member for Wokingham (John Redwood) who supports him on this; I and the Government do, and we are delighted to accept his amendment.

[Jeremy Hunt]

I am most grateful to my hon. Friend, and I am also grateful to the Opposition, who have indicated that they will not oppose the amendment.

[Kevin Hollinrake]

Now that that one is sorted, would my right hon. Friend offer the House his views on new clause 49?

[Jeremy Hunt]

I am happy to do that, because I know my hon. Friend has a great interest in social care issues. I feel conflicted by new clause 49. I think that what we will end up with after this measure will be a whole lot better for people on low incomes than what we had, because the means-test threshold will be raised from £23,000 to £100,000, and that is a very significant improvement. However, I have to be honest and say that it is nothing like as progressive as we had hoped, but it is a step forward. My concern when it comes to social care is that our entire debate is focusing on what does and does not contribute to the cap, when the fundamental problem in social care is the core funding to local authorities; that, though not a matter for this Bill, has a direct impact on the care received by our constituents.

I conclude by thanking the Government for their support for amendment 114. I will move it formally later, but I am not expecting to divide the House on it.

[Dr Whitford]

I initially want to touch on new clause 49. Like other members of the Bill Committee, I sat through hours and hours from September to November, and the Government have suddenly pounced on us with this at the last minute. It is such a complicated new clause, but it has not been interrogated.

It is quite clear that the Government’s original spin that no one would pay more than £86,000 for social care and no one would have to sell their house is completely misleading. All the accommodation costs are on top of this. As has been highlighted in the media and by Members in the Chamber, those with assets of about £100,000 will not see any real gain from this policy, while those sitting on assets of £500,000 or more will keep a lot of their wealth. That means it exacerbates the differences, and penalises those in the north of England and areas where house values are not so high. Basically, it is feeding the frenzy down here of people sitting on over-inflated house prices. As has been said, this is not levelling up, just doubling down.

The cap applies only to personal care, which means things like washing and dressing. That has been provided free in Scotland both within the care home and in home care since 2002. It was expanded in 2011 to provide more hours so that people with greater need could stay at home longer, and it was extended to those under 65 with care needs in April 2019. Scotland is the only UK nation that provides free personal care, and we see it as an investment. It is an investment that we spend 43% more per head on social care in Scotland, but it is an investment in people’s independence and their inclusion in society. The problem is that we spend far too much time talking about social care just as a burden, instead of actually seeing it from the point of view of the user.

The Scottish Government have already added an extra penny on taxation for medium and high earners to cover things such as our wellbeing policies, health or social care, but this Government’s plan to increase national insurance contributions will disproportionately hit low-paid workers and young workers. I would say that the biggest weakness of all, as we know from the original debate on the national insurance change, is that the funding is not going to go to social care initially; it is going to go to the NHS, yet it is social care that is in crisis. This is what is causing the pressure in accident and emergency, because people who are ready to be discharged simply cannot be, as the care support is not there. I do not think that this fixes the problem. There will actually be very little money, because a lot of it is going to go on capping the overall payment. I do not see social care benefiting from this at all, yet it is social care that needs investment more than anything else.

Turning to the main substance of the Bill, which is meant to some extent to unpick the damage and fragmentation of the Health and Social Care Act less than a decade on, I wish to express support for amendments 9 and 72. Many in the NHS, including me, will be glad to see the back of section 75 enforced tendering. Others in the Chamber know that it was the Health and Social Care Act that brought me into politics, as I just could not believe anybody thought what they were doing was a good idea. It is still clear from the pandemic that this Government are absolutely wedded to outsourcing services to private companies, and to the flawed notion that financial competition somehow drives up clinical quality. I am sorry, but that simply is not the case. As the Chair of the Health and Social Care Committee has highlighted, we have to focus on safety, on clinical audit, and on peer review if we want to drive up care quality for patients, not just on the money in the system.

The Government appear to have conceded that integrated care boards should be statutory bodies, as health boards have always been in Scotland, but partnership boards can include private providers, such as with Virgin Care in Bath. As the partnership boards will be involved in devising the local strategy for health services, that is likely to lead to a blatant conflict of interest, and I do not see a resolution to that. The NHS simply should be the presumed provider of health services. That is not just, as the shadow Health Minister said, because the NHS is in it for the long term, or for a quick contract, but because the NHS provides the training to nurses and doctors who are the vital workforce of the future. Private providers do not do that; private providers largely live off the NHS. As well as not training staff, where there are major problems or complications, patients inevitably end up in the intensive care unit of an NHS hospital.

In conclusion, for all the size of the Bill, and the scale that the reorganisation will involve for staff in the NHS, who we all know are frankly exhausted, the Government have failed to take the opportunity to repair fully the damage of the Health and Social Care Act 2012, and to recreate in England a unified public health system, such as the one we are lucky enough still to have in Scotland.

Covid-19 Update

Jeremy Hunt Excerpts

Monday 15th November 2021 Commons Chamber

[Mr Speaker]

I call the Chair of the Health and Social Care Committee.

[Jeremy Hunt (South West Surrey) (Con)]

I welcome the statement; I absolutely agree with what the Health Secretary has announced.

No one can fault the Government’s political commitment to the vaccine programme, which has had a pretty much unlimited budget and has been a huge priority, but my right hon. Friend will be aware that despite that commitment, we have now fallen behind Spain, Portugal, South Korea, Singapore and other countries in the proportion of adults who have been jabbed twice. I am just worried that our regulators have lost some of their fleetness of foot in decision making. It is great that we are giving boosters to the over-40s, but we must now have the data on the under-40s. It is great that we are giving a second jab to 16 to 17-year-olds, but what about 13 to 15-year-olds?

America has already authorised the Pfizer jab as safe for the over-fives. If we are to have a vaccine-led rather than restrictions-led strategy, we need to be absolutely at the front of the pack with approvals. I fear that we are in the middle of the pack, so what will my right hon. Friend do to turbocharge our regulators and the decisions that they are giving him?

Covid-19 Update

Jeremy Hunt Excerpts

Tuesday 9th November 2021 Commons Chamber

[Sajid Javid]

I thank the right hon. Gentleman for his approach to this matter and to issues around vaccination in general. There is no doubt that the general consensus in this House, across parties, has played a vital role in building confidence in vaccines among our citizens, and, once again, I thank him and his party for their approach to vaccination.

The right hon. Gentleman has raised a number of questions. He suggested caution in this approach and he was right to do so. I hope that, from what I have already shared with the House today and what I will continue to share, he will feel that we are taking that cautious approach. For example, if Parliament supports this move, there will be a grace period so that those in the NHS and social care who have not yet chosen to take any vaccine will have plenty of time to do so.

The right hon. Gentleman asked about meeting healthcare leaders. He will not be surprised to hear that, probably like him, I meet healthcare leaders all the time and will continue to do so. I am more than ready to listen to them. Following the consultation that we have had on this so far, we would like to know what further suggestions they have, especially around implementation and take-up.

The right hon. Gentleman specifically asked me about the NHS take-up. The take-up throughout the NHS in England is 93% for the first dose and 90% for two doses, which leaves, I think, 103,000 people in the NHS who are unvaccinated—in other words, they do not have even one jab. As he will understand, it is hard to know what portion of that number will take up the offer of vaccination. If we look at what has happened in care homes since that policy was announced, we can see that there was a significant fall in the equivalent number, and I think that we can certainly expect that here, but, as he has suggested and as came through very clearly to the consultation, it is about making sure that people are encouraged to take a positive choice. From what I said earlier, I cannot be clearer that no one should scapegoat or single out anyone in the NHS or in social care who has, at this point, for whatever reason, chosen not to get vaccinated. This is all about working with them positively, making sure that they have the information that they need. In answer to his question of what more will be done to help people make that positive choice, I say that, as well as information, one-to-one meetings will be offered to everyone who is unvaccinated, if that is what they want. They will have the opportunity to meet clinicians and others to allay any concerns they may have. That includes, of course, those who are pregnant or thinking of one day becoming pregnant. The right hon. Gentleman was right to raise that, too.

Lastly, on the vaccination programme overall, I think the right hon. Gentleman will agree that, as a country, we have done remarkably well. Almost eight out of 10 people over the age of 12 are double vaccinated. That is one of the best vaccination rates in the world, but, as he and others have said, we still need to be working hard to do better. There are still too many people who have not taken up an original offer of a vaccine. We also need to make sure that, for those who are eligible for a booster shot, it is made as easy as possible for them. Some of the recent changes to the booster booking system have led to a phenomenal increase in booster shots—more than 10 million throughout the UK—and the number is growing all the time.

[Jeremy Hunt (South West Surrey) (Con)]

This is a difficult decision, but it is the right decision, and I congratulate the Health and Social Care Secretary on biting the bullet on this. I congratulate his predecessor, my right hon. Friend the Member for West Suffolk (Matt Hancock), on laying the foundations of the vaccination programme that has made it possible.

When we have a disease that can be transmitted asymptomatically, all of us have a responsibility to protect the most vulnerable people, and no one more so than doctors and nurses. I do not know of a single doctor or nurse who do not want to be double or triple jabbed in order to make sure that they are protecting their own patients. Reducing the number of nosocomial infections is one of the big learning points from this pandemic going forward, so this is the right thing to do.,

Exactly the same arguments for the covid vaccine apply also to the flu vaccine. I note that, today, the Health Secretary has not made an announcement about the flu vaccine. Can I encourage him to do so? I wanted to vaccinate NHS staff for flu much more comprehensively than was happening. I think my successor wanted to do it as well. This needs to happen for exactly the same reasons. There is asymptomatic transmission of flu just as there is asymptomatic transmission of covid. I encourage my right hon. Friend to look at that and I would be interested to hear what his plans are on that front.

[Sajid Javid]

I thank my right hon. Friend for his support for today’s announcement. I know that he speaks with huge experience, that he has rightly focused for years on the importance of patient safety, and that he will also welcome this as a patient-safety measure. On his particular question around flu, we did consider that carefully. As he knows, we did consult on it. We looked at the response to the consultation and, after consideration, we were not convinced that we should go ahead with flu at this stage, but the option remains open.

David Fuller Case

Jeremy Hunt Excerpts

Monday 8th November 2021 Commons Chamber

[Sajid Javid]

Yes, I am very happy to expand on that. The NHS has, first, written directly to all trusts and asked them to look into the issues of mortuary access and other post-mortem activities, and to judge them against current guidance to ensure that it is all being applied. In the first instance, that information will go back to NHS England. It will then be shared with me and I will certainly want to find the best way of sharing it with both the House and everyone who is interested.

[Jeremy Hunt (South West Surrey) (Con)]

I thank my right hon. Friend for the extremely sensitive tone with which he is approaching this incredibly difficult issue. He is absolutely right to put the concerns of families and staff first. He is also right to say that this issue will not be resolved by one evil man facing justice. The big question everyone is concerned about is this: could this happen elsewhere and why did this horrendous series of crimes happen over such a long period of time without being detected? I welcome the call for an independent inquiry and the Secretary of State’s decision to do that. May I ask him to praise the work of the vast majority of morticians throughout the country who do an incredibly difficult job extremely well? I met some of them after the Manchester Arena bombing and I know that he would not want this terrible, terrible series of acts to cast a cloud over their fantastic work.

Covid-19 Vaccinations

Jeremy Hunt Excerpts

Thursday 4th November 2021 Commons Chamber

[Maggie Throup]

Ninety per cent. of the adult population have had their first dose, and 8 million people have taken up the opportunity to have a booster jab. That is a successful vaccination programme, so I will take no lessons from the hon. Lady.

The hon. Lady talks about care homes and, from a personal point of view, I know how important it is to make sure our most vulnerable are vaccinated, which is why I am delighted that nine out of 10 care homes have had their jabs either delivered or booked. That is a great success.

This Government have already recognised that covid has exposed the disparities across the nation, which is why on 1 October we launched the Office for Health Improvement and Disparities to understand what is important and how we can make real change in our communities that need the most help.

The hon. Lady talks about bringing back retired medics and volunteers, but they are already back. They have been playing their part for months, and I take this opportunity to thank them for all their efforts. Just last week, I met a retired medic who had come back to St Thomas’ Hospital, and he was relishing his role in this amazing vaccination programme. The hon. Lady does those volunteers and returners a huge disservice.

I am always grateful to the hon. Lady and the right hon. Member for Leicester South (Jonathan Ashworth), because throughout this pandemic they have usually been co-operative, helpful and in agreement with us, but the hon. Lady’s remarks today give too little credit to the phenomenal role that the NHS and community pharmacies are already playing in the roll-out of our vaccination programme. They are delivering a booster programme of third doses while delivering the largest flu programme ever, with 35 million people now eligible for a flu jab. I call on people to come forward as soon as they can.

[Jeremy Hunt (South West Surrey) (Con)]

My apologies, Mr Speaker, for missing the start of the Minister’s statement because you managed to expedite parliamentary business with commendable briskness this morning.

I thank the Minister for her update. Let me say how welcome it is that we have approved the new antiviral, molnupiravir—a new word for us to memorise—which could be immensely significant. When does she think we will be able to distribute it to people who have caught covid who are at home? She says that there is going to be a national study, which is potentially an important step. However, in a pandemic we sometimes bypass these national studies and go straight to distributing medicines that we know are safe to members of the public. Might this not be one of those occasions where we decide to speed things up? I also commend her efforts on the vaccine programme, but, as the shadow spokesman said, one reason we are behind other European countries on vaccinating teenagers is that the Joint Committee on Vaccination and Immunisation did not give its decision until September, whereas France was able to start vaccinating before the summer holidays. Is she looking at how we could speed up the JCVI processes? I appreciate that her hands are tied.

May I also ask the Minister to look at the booking system, because in parts of my constituency people are not able to book a booster jab until after they have passed the six-month mark? Would it not be better for anyone to be able to book their booster jab after they have passed the five-month mark? Finally, may I ask her when she is planning to tell the House about the very important decision on mandatory jabbing for NHS workers? That is a difficult decision. It is one I would support if the Government brought it to the House. I have read in the press that they are thinking of doing that in the spring, which mi well be the right timing, but this is something that NHS staff want to know about.

[Maggie Throup]

I thank my right hon. Friend for his questions. I reiterate on the antivirals that we are working across government and the NHS to urgently get this treatment to patients. As he rightly says, it is important that we act very quickly. It was only earlier today that the Medicines and Healthcare products Regulatory Agency gave its approval, so we are already taking rapid steps in letting people know about this issue. He talked about the JCVI, for which I have huge respect. I do not think it is my position to intervene in its processes. We need robust processes to make sure that what we have available and the programmes we have are very safe, as the UK population would expect. He also talked about booking the booster. We always need to look at ways of improving accessibility, but we did open up the opportunity for people to go to walk-in centres for their booster, so that they do not need to book online or call 119. We are looking at ways of making this easier all the time. On the mandating of jabs, the Secretary of State will make an announcement in due course.

Health Incentives Scheme

Jeremy Hunt Excerpts

Friday 22nd October 2021 Commons Chamber

[Maggie Throup]

I thank the hon. Gentleman for his comments. We have a common purpose: on both sides of the House, we are determined to tackle obesity. The measures that the Government have already taken—we have allocated £100 million to tackle obesity—show that we are serious about this. That is a huge amount of money. It is important to realise that lots of different measures have already been put in place. This is not tinkering at the edges at all.

We began tackling the issue of obesity a number of years ago with the soft drinks levy. I was delighted that the money raised from that went to school sports. We then tackled inappropriate advertising and promotions, out-of-home calorie labelling and front-of-pack nutrition labelling. We have the weight management programme and numerous other activities. It is important that we look at the population measures that are in place, but now we are also looking, with this new pilot, at individual responsibility—personal responsibility. I am really encouraged by this new approach to tackling obesity.

The hon. Gentleman mentioned other public health issues. Once again, this Government are determined not only to halve childhood obesity by 2030, but to make our nation smoke-free by 2030. We are really committed to tackling the public health issues that, as he quite rightly says, are affecting some of the most deprived parts of our country. The fact that we have launched the new Office for Health Improvement and Disparities shows exactly where our commitment lies, and I will continue to fight for this cause as we move forward.

To address the hon. Gentleman’s question about who we will choose for the pilot, we are going to make sure that we choose the right area so that it can really make a difference. That is so important when we are spending public money.

[Jeremy Hunt (South West Surrey) (Con)]

When we came back from recess, I was hoping to ask the Minister one question this week, so to be able to ask her three questions in two days is an unexpected thrill. I am grateful to her for her statement, and I welcome what she says. No Government can stand by when there is a 10-year difference in life expectancy between the richest and poorest 10% in our society. These measures are important and will make a difference. But could I ask her about something even more worrying than adult obesity? On childhood obesity, we are still the second fattest country in Europe. Has she had any discussions with the Department for Education about one of the root causes of that, which is that for several decades we have not guaranteed daily sport and exercise to every child in every state school?

[Maggie Throup]

My right hon. Friend will be aware that, as the previous chair of the all-party group on obesity, this issue has been close to my heart for many years. Over my years as a Member of Parliament I have been delighted to join some of my local schools and run the daily mile. It is inspiring to do that as an MP and I encourage anyone who has not done it to do so. The kids get so excited by it, and I see the difference it makes to them. More specifically, I am yet to have a meeting with the Department for Education, but it is high on my agenda. Tackling child obesity is a No.1 priority for me, and it has been for a number of years.