Social Care

John Redwood Excerpts

Wednesday 25th April 2018 Commons Chamber

[Barbara Keeley]

Yes, indeed. My hon. Friend takes me ahead in what I was going to say, but I know she has been involved with Age UK in understanding the state of care in her own local area, and I applaud her for that. Cuts have resulted in providers giving poor-quality care, and that is having a serious impact on the lives of people who need care. It means people not being washed or going hours without receiving a meal or being given a drink; it means people being left without help to go to the toilet; and in some cases, as she just said, it means people not being given crucial medication.

Care quality has become so bad that Age UK’s recent report was entitled, “Why call it care when nobody cares?” Many Members went to the launch of the report and listened to the older carers who were there. The anger of those older carers who spoke at or attended the event was palpable. Some told me that they and their families were often at breaking point, that they felt betrayed by a system of care that left them with little or no affordable support, and that they faced rising care costs which they described as crippling, although the care for which they paid was often not good enough.

I know that the Minister was present at that event. She may have talked to one carer there, Elaine from Northamptonshire, whose council is battling insolvency. Elaine gave up her job to care and has cared full-time for her husband ever since, but rather than giving her any extra help, the council recently tried to increase the weekly cost of care support at home from £88 to £178 per week. That was another battle for a carer to fight to obtain the care support that she needed at a price that she and her husband could afford.

Labour Members recognise that unpaid family carers need more support. We understand how much families are doing to look after their family members, and how hard that is for many carers but the Government have not even developed an updated national strategy for carers, having scrapped the planned strategy back in October. Since then, they have even failed to publish the action plan that was promised for January. What does that say about their attitude to carers?

[John Redwood (Wokingham) (Con)]

The motion states that

“there is an unacceptable variation in the quality and availability of social care”.

Where in the country does the hon. Lady think it is really good at the moment?

[Barbara Keeley]

It tends to be outstanding in the independent sector. Charities in particular can be outstanding, although they are not always so.

The care sector’s funding crisis also has an impact on the growing number of people who need care but are given none at all. More than 1.2 million people are now living with unmet care needs, many of them isolated and lonely, and that number rises to 1.5 million with the addition of people who need assistance with taking medication. Unmet needs can lead to people being forced to wear incontinence pads overnight because there is no one to help them to get to the toilet, which takes away their dignity. The number of older people living with unmet care needs will inevitably rise without an injection of new funding, because of the growing demand for care in our ageing population.

It is clear that the social care system needs sustainable funding from central Government, but the Government’s response to the crisis so far has been to push the funding problem on to hard-pressed councils and council tax payers through the social care levy. The only increase in Government funding has been the paltry £150 million extra for social care in the local government finance settlement. That is nowhere near enough to avert the crisis that the Government have created in social care. Moreover, it was not the new money that councils desperately needed. The Government admitted that the increase would be funded through an expected underspend in existing departmental budgets.

It is clear that local authorities are now facing some of their greatest challenges just to make ends meet. I want to highlight the heroic efforts of Labour councils to protect adult social care in the face of swingeing budget cuts from the Government.

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[Caroline Dinenage]

I do welcome it. I recognise the very hard work of local councils that have managed to reduce delayed transfers of care. Indeed, I also recognise the very hard-working NHS staff, such as my hon. Friend, who have also helped to make that a reality.

We know that the NHS is busier than ever before, with hospital admissions rising by 33% since 2007, yet we have set clear expectations for reducing delayed discharges. Despite these challenging circumstances, both the NHS and social care have been working hard to free up beds. Since February 2017, more than 1,600 beds per day have been freed up nationally. I need slightly to take exception to the way the hon. Member for Worsley and Eccles South described people being discharged before they are medically fit. If someone is experiencing a transfer of care that has been delayed, it is because a multi-agency team have already assessed them as being medically fit for discharge.

[John Redwood]

Following on from the point about the big variations in how much per head councils get, may I point out that some time ago West Berkshire and Wokingham were cut back because they were very efficient and doing a good job? Will the Minister make sure that in the new formula good conduct is taken into account and does not lead to penalties?

[Caroline Dinenage]

I will certainly take that into consideration.

NHS Winter Crisis

John Redwood Excerpts

Wednesday 10th January 2018 Commons Chamber

[Mr Hunt]

That is completely unacceptable, but it is disappointing that the hon. Lady stands up and runs down the NHS when her own trust, which received £3.4 million before Christmas to help with winter, has managed to improve its performance: last November’s figure was 91.8% compared with 77.7% a year earlier. That is a huge achievement for Mid Yorkshire Hospitals NHS Trust. Why will she not praise what is happening, rather than running the NHS down?

[John Redwood (Wokingham) (Con)]

I support the leadership that the Secretary of State has offered during this winter crisis and the tone he has adopted in this debate. As a result, there is not the kind of crisis we have had in past years. Now that he has widened responsibilities for social care, will he help West Berkshire and Wokingham, which have had problems with past formulas and do not have enough money to take pressure off the hospital in the way he would like?

[Mr Hunt]

I will certainly revisit the issues in my right hon. Friend’s local authorities because I have looked at them before and know that there are particular pressures there. He alights on something else that the Opposition have not wanted to talk about, but which is very significant: the Prime Minister’s commitment to the integration of health and social care, which eluded the previous Labour Government over 13 years, despite their talking about it a lot. We are starting to see that happen in this country. Monday’s decision means that policy leadership will come back to the Department of Health, which will help us to make even faster progress.

NHS Shared Business Services

John Redwood Excerpts

Tuesday 27th June 2017 Commons Chamber

[Mr Hunt]

I gently say to the hon. Gentleman that it is totally inappropriate to try to make political capital from this incident. The facts of the case are that the NAO today published a report saying that patient safety was the primary concern of both the Department of Health and NHS England throughout. There were some problems with the assurance of that contract, but the contract and the relationship with SBS in particular dates back to 2008. Both sides of the House need to learn the lessons of properly assuring NHS contracts, and I dare say the same is true in Scotland.

[John Redwood (Wokingham) (Con)]

I fully support the Secretary of State’s actions, which were quite right in the difficult circumstances in which he found himself, but what action will be taken against the executives who presided over this shambles? Is there any enforcement mechanism under the contract against the other owner of the company?

[Mr Hunt]

The company has been stripped of that contract; it was relieved of the contract back in 2015. We are very clear that it will have to fulfil all its contractual requirements, including paying its fair share of the costs that have been incurred as a result of this wholly regrettable incident.

Health Service Medical Supplies (Costs) Bill

John Redwood Excerpts

Ping Pong: House of Commons
Wednesday 15th March 2017 Commons Chamber

[Mr Dunne]

The short answer is yes, it is. That is set out in the NHS constitution. The measures considered by the NICE board today provide some additional flexibility for NHS England in its handling of negotiations with the drugs companies over the introduction of new technology.

Let me conclude on amendment 3 by saying that the Government strongly believe that it would have a negative impact on the Government’s ability to operate price controls, so I ask Members to disagree with it.

I will deal briefly with the other amendments. Lords amendments 1 and 2 and amendments 4 to 24 were made in the other place. They are all amendments that the Government brought forward, having worked constructively with parliamentarians on improving the Bill.

Amendments 1 and 2 relate to the remuneration for persons providing pharmaceutical services in England and Wales respectively. The amendments provide for new regulation-making powers in respect of special medicinal products. These are unlicensed medicines that can be manufactured or imported to meet a patient’s individual needs when no licensed product is available.

The unique nature of specials—the hon. Member for Central Ayrshire (Dr Whitford) mentioned them during our consideration in this place—and their manufacturing arrangements mean that we need to do more to ensure that the prices paid by the NHS represent value for money for all these products. These amendments would enable England and Wales to develop options that will secure improved value for money—for example, by using a quotes system that has been trialled in Scotland, but there are also other options. We will consult the community pharmacy representative body on how best to take this forward.

Amendments 4 to 7 introduce a consultation requirement on the Government with regards to medical supplies. Again, the hon. Member for Central Ayrshire helpfully pointed out that such a requirement was in place for medicines, but not for medical supplies. I thank her for engaging with me and my officials, which has helped to improve the Bill.

The Government have listened to concerns in the House of Lords and in this House about the Government’s power to control the prices of medical supplies. These amendments would ensure that the first order to control the price of any medical supply would be subject to the affirmative procedure, giving both Houses an opportunity to discuss that order.

Amendments 8 and 9 and 15 to 17 are amendments to the information powers in the Bill. Responding to concerns from industry about the potential burdens of the proposed information power, they introduce an additional hurdle for the Government to obtain information by requiring them to issue an information notice whenever they require companies to provide cost information related to individual products, which can be appealed by the company concerned.

[John Redwood (Wokingham) (Con)]

One problem in coming to a fair price for a new drug—we want to reward the company for its innovation, but without being ripped off—is knowing what kind of production run or demand there might be for it. Is there any way that the NHS could get better at forecasting what its volume might be, as that might drive the price down?

[Mr Dunne]

As ever, my right hon. Friend, who is a champion of market solutions to some of these tricky problems, lights on an important point. We need to be better at trying to predict the take-up of medicines. Of course, until a new medicine has been introduced, it is very difficult to assess that, because it requires clinicians to get behind the product and to choose to prescribe it. He is absolutely right that we need to look at the way in which we model in order to have a negotiation with the pharmaceutical company that ensures that we build in as good a volume as we are expecting to maximise our prospects of getting the best price.

Let me return to Lords amendments 8, 9 and 15 to 17. When the Government ask a company to provide straightforward information about prices and other transaction costs or overall costs, there is no need for an information notice. The rationale is that there could be a significant burden on companies to provide product-level cost information. Any such request should be made only in exceptional circumstances—for example, in order to set the price of an unbranded generic medicine, when the Government would need insight into the costs and profits associated with the specific product.

Health and Social Care

John Redwood Excerpts

Monday 27th February 2017 Commons Chamber

[Dr Wollaston]

I absolutely agree with the hon. Lady. It is undermining public confidence in sustainability and transformation plans. I shall discuss that in more detail later.

The financial position is starting to create a perfect storm of delayed discharges, rising waiting times in A&E, and rising so-called trolley waits for patients waiting to be transferred to the wards, which has quite serious implications for their safety. There are unsustainable levels of bed occupancy, and increasingly we are hearing stories of not only routine but urgent surgery being cancelled. Worryingly, there have been two cases in which urgent neurological procedures did not take place, resulting in the deaths of two patients. That is extremely serious.

[John Redwood (Wokingham) (Con)]

Does my hon. Friend agree that when we look at the formulae for the distribution of money via councils, we cannot look only at deprivation, which tends to be highly weighted? It is an important issue, but in more affluent areas such as mine we have an even bigger problem with people living a very long time; although that is good news, there is far more demand for services because they live for so much longer.

[Dr Wollaston]

My right hon. Friend makes an extremely important point: it is about not only the overall budget but the distribution. I think we would all agree, on both sides of the House, that deprivation must be properly weighted, but he is absolutely right that age and the resulting need for services is one of the key drivers of need. That is probably not adequately reflected in the way resources are currently distributed.

There is undoubted evidence of the impact of the financial position on patient care. Unfortunately, this whirl of hospitals having to cancel routine procedures has a further impact on their ability to meet their financial targets, because of the reduction in their income. I hope Ministers will not simply consider this as a short-term issue; more importantly, they must look at how we can fund these things sustainably in future. They must not look at health and social care in their separate siloes but see them as a single system and genuinely look at how we are going to take things forward.

If we do not address this problem, we need to be honest with our constituents about the consequences. People talk about a collapse in the NHS. I do not believe that that will happen, but what we will see is a continuing deterioration in performance, with a real impact on the quality of care, which will put lives at risk. The safety, which is essential to our patients and which the Department of Health has prioritised, is increasingly in danger of slipping.

A number of Members have commented on sustainability and transformation plans. In principle, they are extremely important as a way not only of acting as a road map for the Five Year Forward View, but of enabling us to return to a much more logical way of planning for integrated health and care. Hopefully, they will enable us to get away from endless contracting rounds in the NHS and move towards genuine planning. I am afraid that what has undermined them has been inadequate local consultation, inadequate working with local authorities, and, crucially, inadequate funding. If we do not have the funding to put in place the transformation of services, we will see these plans fail. Increasingly, those plans are being seen as a vehicle for cuts—

Defending Public Services

John Redwood Excerpts

Monday 23rd May 2016 Commons Chamber

[Mr Hunt]

The hon. Lady shakes her head, but let us consider what the King’s Fund said in the run-up to the election:

“Labour’s funding commitment falls short of the £8 billion a year called for in the NHS five year forward view.”

It was there in black and white: Labour was committing to a £2.5 billion increase in the NHS budget, not the £8 billion that this Government committed to. The hon. Lady cannot have it both ways. If this figure was £5.5 billion, the efficiency savings needed would be not £22 billion, but £27.5 billion, which is a 25% increase. That would be the equivalent of laying off 56,000 doctors, losing 129,000 nurses or closing down about 15 entire hospitals.

[John Redwood (Wokingham) (Con)]

I welcome the Secretary of State’s policy that foreign visitors should be asked to pay for non-urgent treatment that they get when they are here and that European visitors should have to recoup this through their national systems. Why do we need extra legislation, and how much money does he think we can get from that?

[Mr Hunt]

We need extra legislation to expedite the process. I point out to my right hon. Friend that that is another policy which has been opposed by the Labour party. All the time it says we should be doing more to get a grip on NHS finances and yet it opposes every policy we put forward in order to do precisely that. The answer to his question is that the issue with the NHS is primarily that we are not very good at collecting the money to which we are entitled from other European countries, because we are not very good at measuring when European citizens are using the NHS. This legislation will help us to put those measurement systems in place so that we can get back what we hope will be about half a billion pounds a year by the end of this Parliament.

We will no doubt hear later this afternoon the charge that the Government have lost control of NHS finances, but we strongly reject that charge. The House may want to ask about the credibility of that accusation from a party that is at the same time proposing a funding cut for the NHS and criticising the difficult decisions we need to take to sort out NHS finances.

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[Heidi Alexander]

I am not going to be drawn into giving figures here at the Dispatch Box today. Yesterday the Life Sciences Minister was tweeting that we need a big public debate about funding of the NHS.

Three days ago, the scale of this crisis was laid bare. NHS Improvement, the body responsible for overseeing hospitals, published figures showing that NHS trusts ended 2015-16 with a record £2.45 billion deficit—I repeat, £2.45 billion. To give hon. Members some context, that is treble the deficit from last year. What is the key cause? It is the spiralling agency spend because of staff shortages. When this Government talk about more money going in, let us remember that, before that money gets to the frontline, the bulk of it will be spent on paying off the bills from last year.

[John Redwood]

Will the hon. Lady give us an idea of how much extra money and how many more personnel she thinks we need to deal with current levels of migration?

[Heidi Alexander]

I am grateful to the right hon. Gentleman for that intervention. I actually think that the health service benefits more from migrants than the amount migrants cost it.

I want to tell all Conservative Members that Labour Members are not going to take any lessons about NHS spending from the party that has created the biggest black hole in NHS finances in history. It has got so bad that the Health Secretary cannot even guarantee his Department will not blow its budget. It is chaos: Ministers blame hospital bosses, hospital bosses blame Ministers and all the while patients are paying the price.

Faced with this crisis, we might have thought that the NHS would get more than a passing reference in the Queen’s Speech, but that was not the case. What is the Government’s answer when it comes to the NHS? Fear not: they will introduce a Bill to crack down on health tourism. With all the problems the NHS is facing, this Government want to focus Parliament’s time on debating a Bill that risks turning NHS staff into border guards.

Let me be clear: if such measures are about getting the taxpayer a better deal and ensuring fairness in the system, we will not oppose them. However, I must ask, given everything that is happening in the NHS right now, whether Ministers’ No. 1 priority is really to introduce legislation to charge migrants and their children for going to A&E. If so, my fear is that we will see the kind of dog-whistle politics that was so rejected by the people of London earlier this month, and which I hope will be rejected again on 23 June. The truth is that the cash crisis in the NHS is not the fault of migrants; it is the fault of Ministers.

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[Ian Blackford]

I am saddened at the depths to which the hon. Gentleman stoops. I am delighted to have friends and colleagues representing my party here and in government in Edinburgh, and they will continue to have our full support.

The Queen’s Speech demonstrates that the Tories are a threat to high-quality, well-funded public services. Having listened to the Leader of the Opposition last week on the Queen’s Speech, we are none the wiser as to what the Labour party is offering. We could have asked him, of course, had he been taking interventions, rather than forcing us to sit and listen to a monologue that lost the attention of his own party, never mind that of the House.

Some measures are to be welcomed, such as the likely delivery of the universal service obligation on broadband, as mentioned by the right hon. Member for Basingstoke, but the Queen’s Speech delivers nothing on pension reform for the WASPI women, on tax simplification or on social security, and no major action on the economy to boost exports and productivity.

The Conservatives have orchestrated some truly devastating cuts that have destroyed the safety net that social security should provide. We see through their rhetoric on life chances. The scrapping of legal commitments to tackle child poverty, the four-year freeze on working-age benefits, including child tax credit, working tax credit and jobseeker’s allowance, will see families losing up to 12% of the real value of their benefits and tax credits by 2020. We have seen the butchering of the very aspect of universal credit that might have created work incentives and the hammering of low-paid workers, to name just a few of the regressive cuts that will decrease the life chances of children across these islands.

[John Redwood]

Why do the SNP Government not put up taxes in Scotland if they feel that they need to spend more money?

[Ian Blackford]

One of the things we want to do in Scotland is to deliver economic prosperity and a fairer society. We want to invest in our economy in order to grow the economy. Let me remind the right hon. Gentleman that we fought the general election in Scotland on a progressive manifesto that would have seen us investing over the lifetime of this Parliament, throughout the UK, £140 billion by increasing Government spending by 0.5%—investing in innovation and in our productive potential with a view to delivering confidence and growth in the economy. This was a sensible programme that would still have seen both the debt and the deficit reduced. It was a sensible way of dealing with the problems we face both in Scotland and in the rest of the UK.

It does not matter how many times the Government use the soundbite of “life chances” because in reality the so-called assault on poverty is a crusade to refine what poverty is and a shift towards blaming individuals rather than the Government, so that their austerity agenda can continue to attack the most disadvantaged in our society.

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[Ian Blackford]

One of the things we have done since being in government in Edinburgh since 2007 is to protect local government. What we face is the consequence of the cuts that have come from Westminster. I am delighted that an SNP Government have, through the council tax freeze, saved individuals in a typical band D house £1,500—protecting the individuals, while at the same time protecting the budgets of councils. That is what the SNP Government have done in Edinburgh.

In Scotland, the SNP Government have protected public services, despite the cuts to the Scottish budget. With cuts to Scottish public services handed down from the Chancellor of the Exchequer, lacking in compassion and empathy, the poorest and the weakest in our society are paying the price for Tory austerity.

The SNP has put forward a credible, progressive alternative to the Queen’s Speech, proving once again that it is the only real opposition to the Government in the House of Commons. [Interruption.] In our dreams? Well, let us see what the Labour party is offering. We got nothing from the Leader of the Opposition last week, and we certainly got nothing from the Labour Front Bench. It is little wonder that Labour has fallen in the polls, and fallen to become the third party in Scotland. That is the reality: no hope, no vision, and no agenda from today’s Labour party.

Although the debate could be characterised as focusing specifically on defending public services, to my mind, and those of my colleagues, it should be seen in a much wider context. The SNP has published its own Queen’s Speech, which offers hope to the people of Scotland. It says that we should aspire to do better, and that we need to create the circumstances that will allow us to deliver sustainable economic growth, thus enhancing life chances for all, while at the same time recognising the necessity of investing in and enhancing our vital public services.

Our manifesto, like our Queen’s Speech, recognised the necessity of driving down debt and the deficit, but we would not do that on the backs of the poor and at the cost of our public services. We recognise not only that austerity is a political choice, but that its implementation is, in itself, holding back not just growth in the economy, but the potential of so many people throughout the United Kingdom. Cuts in public services withdraw spending from the economy, and that undermines our moral responsibility to deliver public services that support people and give them opportunities to return to work, as well as the vital support network that allows communities to function effectively.

The attacks on services for the disabled, women and young people are a result of the Government’s programme, which holds people back from making a full contribution to society. What we in the SNP have, by contrast, is a strategy that will enhance life chances for people in Scotland and throughout the United Kingdom. It is a progressive agenda, which recognises the responsibility of Governments to show leadership in creating the architecture that will deliver sustainable economic growth. That means investing for growth, delivering stronger public services, driving up tax receipts, and cutting the deficit. Our strategy is an appropriate response to the circumstances in which we find ourselves, but it also acknowledges the circumstances in which many Governments in the western world find themselves.

We in the SNP are ambitious for Scotland. That can, perhaps, best be evidenced by the programme of Nicola Sturgeon’s Government. That programme will tackle the attainment gap, while also focusing clearly on using what powers we have to influence innovation, recognising that there is a twin track: tackling attainment must go hand in hand with improving skills, enhancing capability, and creating competitive opportunities in the global marketplace.

We have focused specifically on export capabilities in key sectors. The manufacture of food and drink continues to be our top export sector, accounting for £4.8 billion in revenues. The value of our food and beverage exports, excluding whisky, rose from £755 million in 2013 to £815 million in 2014, an increase of 8%. In 2014, Scotch whisky exports reached £3.95 billion, accounting for 21% of the food and drink exports of the whole United Kingdom. Scotland has shown the way in increasing its export capability, and driving investment and jobs into our economy. That plays to our key strengths, and our reputation as a provider of high-quality food and drink. It is also based on segments of the market that offer long-term growth opportunities.

We need to tackle the relative decline of manufacturing in our overall economy that hampers our ability to meet the challenge of delivering prosperity. Growth sectors in the economy, such as biotechnology, can deliver opportunities for jobs and growth. We need a strategy which focuses on manufacturing growth that outstrips the service sector in terms of value added to our economy. That is not to downplay the desire to achieve growth in services, but to recognise that we have an imbalance in our economy that hampers our ability to maximise opportunities for all our people.

We cannot decouple a debate about defending public services from the wider economic agenda, because they are so completely intertwined. We need a well educated, healthy population who can rely not only on our education and health services but on our ability to deliver effective childcare, for example. When Conservative Members talk about small government, they reject the vital role of the state in providing much of the support that allows all of us to achieve our potential.

This Queen’s Speech is a missed opportunity to deliver a programme that could offer so much more to those who aspire to a healthier, wealthier and fairer society. We need to tackle inequality, to improve living standards for ordinary workers, to create a fairer society and to strike an effective balance between prosperity and investment in the public services that underpin a successful society. Today, we are moving away from that.

There is an increasing disparity between executive pay and rates of pay in the mainstream, leading to increased calls for action by shareholders and ultimately to stronger action if moderation cannot be achieved. With wage growth outpacing productivity growth, there are legitimate concerns about the sustainability of real wage growth and, as a consequence, taxation receipts and the ability of the Government to meet their targets, with all that that would entail for the public finances and, no doubt, for investment in our public services.

In short, to secure our public services, we need to tackle the shortcomings of the Government’s economic strategy. Of course we would invest for growth and create opportunities for investment by the private and public sectors, resulting in greater confidence and growth outcomes. Confidence and growth, on the back of modest investment in our public sector, would see the debt and deficit come down, by contrast with policies driven by this Government’s ideological desire to achieve a budget surplus at any cost. The logic behind that desire to achieve a budget surplus almost irrespective of economic circumstances beggars belief. If the Chancellor misses his growth forecasts, as has been the case on numerous occasions, his office can make the strategy work only through tax rises or, more predictably, cuts to public spending.

The trouble with this strategy is that we are now six years into it and it is not working. The squeeze on public spending is hurting and damaging services. Those of us who are old enough to remember the Thatcher Government elected in 1979 will recall the line from the Government that “if it’s not hurting, it’s not working”. Patently, it is hurting and it is not working—[Interruption.] It might have been John Major, but it is the same old Tories. The strategy is harming the life chances of people in Scotland and the rest of the UK.

Let me return to the Queen’s Speech and the future of the NHS. We strongly disagree with the UK Government’s moves to charge visitors to this country to use the NHS. NHS Scotland will not charge overseas visitors if they need to visit A&E or a casualty department if it involves a sexually transmitted disease or HIV or if they are sectioned under the Mental Health Act. That is the right thing for anyone to do in a civilised society.

[John Redwood]

Does the hon. Gentleman not understand that the Government are not proposing to charge for emergency treatment in A&E? Surely it is right, however, that if someone comes here and has elective surgery, they should pay the bill and get the money back from their own country.

[Ian Blackford]

In many cases, we are talking about the Government wanting to charge people who have come here to work and who are already paying their taxes. What a disgraceful way for any Government to behave! That measure is the latest indication that the Tories represent a real and present danger to the NHS.

The Conservatives have mismanaged the junior doctors’ contracts in England and shamefully filibustered the recent debate on a Bill introduced by the hon. Member for Brighton, Pavilion (Caroline Lucas) that would have restated the principle of the NHS being public and free. In the Scottish election, the Scottish Tory leader, Ruth Davidson, stood on a platform of reintroducing prescription charges. Such a measure would be a regressive tax on the ill. It is estimated that the SNP’s abolition of prescription charges has benefited around 600,000 adults living in families with an annual income of less than £16,000.

In England, the Health Secretary—who is no longer in his place—seems to favour confrontation with the health service, but we in Scotland favour a more consensual approach that delivers results. The SNP Scottish Government have delivered record funding for Scotland’s NHS despite Westminster cutting the Scottish budget. They will ensure that the NHS revenue budget rises by £500 million more than inflation by the end of this Parliament, meaning that it will have increased by some £2 billion in total. Health spending in Scotland is already at a record level of £12.4 billion. Under the SNP, the number of employees in the Scottish NHS is at a record high—up by nearly 9% since 2006.

Patient satisfaction with the NHS in Scotland is high, with 86% of people being fairly or very satisfied with local health services, which is up five percentage points under the SNP. That is the result of a popular SNP Government working together with our health professionals to deliver results. Unlike the UK Government, the SNP values and respects the work of all our medical professionals. Were we to move towards a new contract for junior doctors in Scotland, it would only ever be done on the basis of an agreed negotiated settlement. Thank goodness that we are still wedded to the principles of Beveridge in Scotland and will protect the ethos of the health service as a public asset for the common good.

Turning to further and higher education, one of our driving principles is that access should be based on ability, not ability to pay. Tuition fees of £9,000 and potentially more remain a heavy burden on the working families and students of England, and the UK Government must rule out the Higher Education and Research Bill raising the cap. The SNP has guaranteed free university education for all in Scotland, but Ruth Davidson and the Tories would have tuition fees north of the border if they ever got near Bute House.

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[John Redwood (Wokingham) (Con)]

The Queen’s Speech contains an important measure, the Bill of Rights, but we are told that we need to wait and get it correct. I have no problem with that. If there is to be a Bill of Rights, it needs to reflect the liberties and freedoms that have been hard won over many centuries by people and Parliaments in our country.

I welcome the principle behind the Bill of Rights—the simple principle that our ancient and modern liberties should rest on the decisions of this Parliament, to be upheld by MPs, as custodians of those liberties, or to be amended and improved as the British people see fit and as they express their will through general elections. It is extremely difficult to root our liberties and freedoms in inflexible international treaties, or to rely on the judgments of far-away foreign judges, who may not understand the mood, the temper, the history or the culture of our country, rooted in liberty and rooted in a titanic struggle to establish parliamentary control.

There is one obvious omission in the Queen’s Speech, for the reason that we do not yet know the will of the British people on the fundamental issue that overhangs the debates that we will have today and over the next few weeks. Do the British people wish to take back control? Do they wish this Parliament to find within itself the wit, the wisdom and the skill to wrestle back control of our laws, our taxes and our decision-making powers so that we can be freer, more prosperous, more independent and more democratic; or do they not wish us to do that? I earnestly hope that they will want to be on the side of freedom and liberty.

At the moment, we are but a puppet Parliament—a Parliament that struts upon the stage and pretends to be in charge and in control, but is not in charge or in control. Let us take the mighty issue of paying for our public services, which is at the heart of this debate. I am on the side of prosperity, not austerity. I think that we do need to spend more on health and education, and I welcome the extra money that the Government have managed to find. But how much easier it would be if the £7 billion of revenue that we collected from big businesses in the last Parliament but had to give back to those companies, because the European Court of Justice said that we were not allowed to raise it, were available for our public services. [Interruption.] How much easier and better it would be to banish austerity—and the chuntering of some Opposition Members, who rightly do not like austerity—if we had back the £10 billion of net contributions that we make to the EU every year, which we cannot spend on our own priorities because it is spent elsewhere.

I want us to take back control of our money so that we can banish austerity. I want us to take back control of that money so that we have it for our priorities of health and education. While we are taking back control, as a free people, we should empower people in an elected Assembly to decide how to raise revenue and which taxes to impose. I want us to restore that power on behalf of the British people. I would like us to abolish the tampon tax. I would like us to say to the European Court of Justice, “We do not accept your verdict that we have to put up taxes on green products to 20% from 5%.” However, that is its judgment, and that is what this Parliament will have to do after the referendum should we decide to stay in and not to leave.

The Government say that they have made progress in their renegotiation, that there will be some relaxation of the requirements, and that we will get a little bit more power back over the imposition of VAT. However, I have now read the document issued by the European Union after those negotiations and I am afraid to tell the House that that document makes absolutely no mention whatsoever of any deal or settlement between the United Kingdom Government and the European Union. It makes no mention of our need to abolish the tampon tax, and it makes no mention of our wish to keep our green taxes down at the 5% level because we want to encourage people to have more draught excluders and insulation so that they can keep warm in the winter at lower cost. It is not an unreasonable request, so why is there nothing in the European Union document on that reform that makes it clear that we could do that? There are only two things in that document: one is more centralisation of our future VAT system so that it can collect more and ensure that we are collecting all that it wishes; and the other is some general statement that perhaps at some point in the future, if the European Parliament and all the member states so agree, there could conceivably be some greater flexibility, but it is extremely unlikely.

The sadness of the document is that it shows that there is no political agreement whatsoever in the European Union to give back to us the right to impose the taxes that people should pay and that they might accept. There is absolutely no right for this Parliament to do what it clearly wishes to do by overwhelming majority on the issue of the tampon tax and the green tax.

We see before us the parting of the ways with those who believe that it is fine to belong to a subsidiary Parliament that pretends to be able to make choices on the part of the British people, but that has to give away a lot of its money to the European Union, has to accept a series of judgments on things such as trade union law, which it does not like, and has to accept that we are no longer free to make the laws that we need to make to reflect the will of the British people.

Is there nowhere in this Parliament on the Front Benches where we can find the Hampdens, the Miltons and the Cromwells not guilty of our country’s blood, who will rise up and say, “Surely now is the time to take back control, to make sure that we can choose our own laws, to make sure that we can impose our own taxes, to make sure that we can redress the wrongs before we ask people to pay those taxes, to go back to the fundamentals of United Kingdom democracy fought for over many centuries, and to go back to the foundations of democracy as so brilliantly chronicled in the founding documentation of the United States of America”? We can only say that we have a proper Parliament and not a puppet Parliament if we do those things. More Members need to urge their constituents that now is the time and now is the moment to seize control and to banish the puppet Parliament.

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[John Redwood]

Is the TTIP draft treaty not just another example of what I was trying to say, which is that more and more things are no longer under the control of British law makers and electors, but under the control of unelected people in Brussels, and that such things are not amendable once they have been agreed?

[Mr Lilley]

My right hon. Friend is absolutely right. If we let TTIP through, it will be a further transfer of law-making power away from this country to international bureaucrats and multinational companies.

There is a referendum dimension to the TTIP treaty issue. First, the only absolutely certain way of preventing it is of course not to be part of it—by leaving the EU on 23 June. We might be able to exempt ourselves or to prevent the treaty from going ahead if we remain in, but that is far from certain. Secondly, as my right hon. Friend has said, there is a certain similarity between such courts of a supranational nature—run by bureaucrats to enforce laws negotiated by bureaucrats, which have never been endorsed by this House and are not open to rejection by it—and it is natural that those courts should sympathise with each other and carry the treaty forward. If we were outside, we could negotiate our own deal with the United States, which I hope would not need any such system of courts. Why should America need such courts to invest in this country or for us to invest in the United States? That deal would require a stripped-down and far simpler Bill, and it would be far quicker and easier to negotiate.

Some people have said, “But President Obama has said we won’t be allowed to negotiate a deal and we’ll have to go to the back of the queue”, but the House of Commons Library has revealed that there is no queue. After the negotiation of TTIP, there are no countries with outstanding negotiations with the US. Not only was President Obama trying to bully us, but he was doing it on the basis of a bluff. We will be not at the end of the queue but at the front of it, and we will no doubt be able to negotiate with his successor.

I hope that hon. Members will consider the EU dimensions of TTIP seriously. I accept that people who are very optimistic about what we can achieve within the EU, and about what the EU might be able to achieve in negotiating TTIP with the Americans, might want to take the risk. It is not a risk that I want to take. It is not a risk that those who give high priority to the NHS, or those who are worried about environmental standards, health protection standards and potential threats to our education and other public services, will want to take. In the light of the topic of today’s debate, I hope that we will give priority to protecting public services rather than going along with something that none of us has ever seen—we are not allowed to see it, and it is being negotiated in secret—and that has aspects that most of us ought to find offensive to the House and dangerous to the people of this country.

--- Later in debate ---

[Maria Eagle (Garston and Halewood) (Lab)]

I welcome the Minister for Culture and the Digital Economy to his place and look forward to hearing what he has to say, but it is extraordinary that the Secretary of State for Culture, Media and Sport could not be bothered to turn up to wind up his part of the debate on the Gracious Speech at the very beginning of this new parliamentary Session. What a dereliction of duty. Who knows whether he is otherwise engaged—no doubt on the vote leave battle bus—or whether the Prime Minister simply does not trust him enough to let him out of the Cabinet dog house to which he has no doubt been confined on the shortest of leashes because of his support for the leave campaign.

We have had a broad-ranging and excellent debate. We have heard from 31 Back-Bench colleagues, one of whom, my hon. Friend the Member for Sheffield, Brightside and Hillsborough (Gill Furniss), made an excellent and well received maiden speech. It showed quite clearly what a great MP she is going to be, rooted as she is in the community that she now represents. Sad though the circumstances are that have brought her to this place, it is quite clear from her remarks that she will do an excellent job.

This was the Queen’s Speech that was not supposed to happen ahead of the EU referendum, and it showed. As my right hon. Friend the Member for Leicester East (Keith Vaz) and my hon. Friend the Member for Stoke-on-Trent Central (Tristram Hunt) said, we were told in Government briefings in March that the Queen’s Speech was to be postponed until after the EU referendum, but the Prime Minister then changed his mind. Perhaps that explains the ill thought out programme, with a small number of Bills, many of which seek to do things that everyone agrees with, being cobbled together to give an impression that all is well with this relatively newly elected Government—except that it is not.

We can see clearly that the Prime Minister is not focused on this legislative programme because he is otherwise engaged. It is no wonder, given that his fractious, warring Cabinet members seem to have lost all mutual respect, denouncing each other in language more suited to bitter political enemies. I will give two examples. The erstwhile Welfare Secretary thinks that the Chancellor tells fibs—he has said today that Pinocchio,

“with his nose just getting longer and longer and longer”,

is

“very similar to the Chancellor. With every fib you tell, it gets longer. Who am I to judge how many there have been?”

Meanwhile, the Employment Minister has accused the Prime Minister of “concocting Armageddon scenarios”, calling some of his claims about what will happen if we leave the EU “fantastical”, “hysterical” and “incredible”. It was clear from the context that she did not mean it in a positive sense.

We have heard an echo of those debates on the Government Back Benches today, with the right hon. Members for Hitchin and Harpenden (Mr Lilley) and for Wokingham (John Redwood) being opposed by the right hon. Member for Arundel and South Downs (Nick Herbert) on EU issues. My hon. Friend the Member for West Ham (Lyn Brown) called it a Tory “Game of Thrones”, and the hon. Member for Glasgow South West (Chris Stephens) even went so far as to offer parallels with individual characters from that drama. It makes for an interesting spectacle, but not for good governance or an ambitious legislative programme.

[John Redwood]

Could the hon. Lady give us an up-to-date view on how the Labour party is getting on with the arguments on unilateralism and the nuclear deterrent?

[Maria Eagle]

Certainly not in 10 minutes.

The Government’s extraordinary decision to announce that they will accept an amendment to the Humble Address if necessary, clarifying that the NHS will be exempt from arrangements in the Transatlantic Trade and Investment Partnership, is highly unusual, not to say humiliating for them. That major concession before we have even got to the end of the debate on the Gracious Speech shows how desperate the Prime Minister is to avoid being defeated on the Floor of the House by his own Brexit-driven rebel Back Benchers, at least 25 of whom have signed the amendment—enough, along with all the rest of us, to defeat the Government. Without that retreat, this would have been the first vote on a Gracious Speech lost by a Government since 1924.

That also shows how willing Tory Brexit rebels are to inflict such a defeat on their own Prime Minister. Indeed, some reports over the weekend suggested that it would be followed by the rebels going on strike to block Government legislation after the referendum unless some of their number were promoted—an extraordinary state of affairs. Meanwhile, one pro-remain Minister is reported to be demanding that the rebels should all be kicked out of the Tory party; a Tory “Game of Thrones” indeed. No wonder this legislative programme is so slim. The Prime Minister will be spending all his time after 23 June on party management. I can only congratulate the right hon. Member for Hitchin and Harpenden, who spoke to his amendment with great cogency, and my hon. Friend the Member for Dewsbury (Paula Sherriff) on causing such Government turmoil. My hon. Friend has now secured Government concessions on both the Budget and the Queen’s Speech—she is really getting the hang of how this place operates.

I am sure the hon. Member for Blackpool North and Cleveleys (Paul Maynard) will be glad to hear that the Opposition agree with the aims behind some of the legislation that has been announced. In the case of the Department for Culture, Media and Sport, how could one object to the Cultural Property (Armed Conflicts) Bill, which will implement The Hague convention to which the UK has been a signatory for many years? We support it wholeheartedly. We also welcome the aims behind the digital economy Bill, as did the right hon. Member for Arundel and South Downs, the right hon. Member for Basingstoke (Mrs Miller) and the hon. Members for Harrow East (Bob Blackman), for High Peak (Andrew Bingham), for Mid Worcestershire (Nigel Huddleston) and for Rossendale and Darwen (Jake Berry).

We particularly welcome the proposed introduction of the universal service obligation for broadband, automatic compensation for customers deprived of good service, and enhanced transparency for consumers to make an informed choice. We will look carefully at proposals to introduce a new electronic communications code, protect intellectual property rights online, and introduce age verification for pornographic websites. It is extremely disappointing that the Government will break their promise to automatically roll-out broadband to all households, so perhaps the Minister will spell out the additional costs that many households and businesses will need to bear to get connected, and give us the total number that he expects will be adversely affected.

Despite their desperate efforts to appear uncontroversial in this legislative programme, the Government pose an underlying threat to all our public services—many of my hon. Friends referred to that during the debate. The Government seem to know the price of everything and the value of nothing, and their obsession with marketisation as a prelude to privatisation leaves them with a tin ear to the value of the public service ethos. As my hon. Friend the Member for Huddersfield (Mr Sheerman) said, they seem to believe that the public sector is automatically bad, and the private sector automatically good.

Unfortunately, the Government are developing that theme across Departments. As my hon. Friends the Members for Washington and Sunderland West (Mrs Hodgson), for Manchester, Withington (Jeff Smith), for Sheffield Central (Paul Blomfield), for West Ham (Lyn Brown), and for Merthyr Tydfil and Rhymney (Gerald Jones) said, the Government seem unable to accept the fact that public service broadcasting and the public service ethos—as exemplified by the BBC—makes a hugely positive contribution to our society, boosts the UK creative industries and creative economy, and is successful and massively popular, providing great value for money for licence fee payers and high-quality broadcasting for us all. Channel 4 fulfils its remit without any input from the taxpayer or licence fee payer.

However, the Secretary of State for Culture, Media and Sport has shown himself to be utterly committed to denigrating and diminishing the BBC, which he recently described as no more than

“a market intervention of around £4 billion by Government”.

He wants to privatise Channel 4—he said so just last month, although I notice that there is no Bill for that in this legislative programme.

The constant assumption that the private sector is better, and that the public sector should be diminished or sold off, is based on ideology, not evidence, and is out of step with public opinion. Just last week the BBC announced that it would start to do what the Secretary of State said he wants, which is to cease activity that duplicates what can be done in the private sector—something he calls “distinctiveness”. The BBC announced that it would remove its online recipes. The huge public outcry was instructive, and the Government should take note. So far 195,000 people have signed the petition asking the BBC to keep that trusted resource. The Secretary of State immediately said that the plan was nothing to do with him, but we all know that it was.

Some of our debate has been about the national health service—our most loved public service—and I tell this House and the Government that the Labour party will not stand by and watch the health service be denigrated, reduced or cut. This legislative programme will do nothing to deal with the real challenges facing our public services, whether our NHS or the BBC. We know the value of our public services, and we will make it our business to speak up for and defend them.

Junior Doctors Contracts

John Redwood Excerpts

Monday 25th April 2016 Commons Chamber

[Mr Hunt]

I agree with the hon. Lady on one point: it is a total tragedy when the Health Secretary ends up with no other choice but to impose. Had we had sensible negotiations, that would have not have been necessary. She talked about the royal colleges. They say that the withdrawal of emergency care should not happen. Clare Marx, the president of the Royal College of Surgeons, has said that she personally would not and could not strike. I have tried to be very clear this afternoon about exactly what we are trying to do, and we have been clear on many occasions that this does not apply to elective care.

If the hon. Lady is concerned about the statistics, I would encourage her to read some of the 15 international studies covering stroke, cancer, emergency surgery and paediatric care, including the very thorough Fremantle study published last September. She is right to suggest that many of them talk about senior decision-makers being present. That could be a consultant, but it could also be an experienced junior doctor. As she knows, the term “junior doctor” is something of a misnomer because someone could have been a doctor for seven years and still be a junior doctor.

The hon. Lady also asked about the link with the junior doctor contract. The single outstanding issue is Saturday pay rates, as the BMA has confirmed in private emails that it has sent out. We need to make it possible for doctors to roster more people at weekends, and Saturday pay rates are obviously connected to that. What I have tried to do today is to show that the supply of trained doctors into the NHS will be going up during this Parliament, so we will not be depending on the current workforce to supply the additional Saturday cover in its entirety. There will be more doctors going into the NHS, which will spread the burden, and that is the way that we will get the safe NHS that we want.

[John Redwood (Wokingham) (Con)]

I support the vision of a seven-day NHS and a safer NHS that my right hon. Friend is so energetic about. However, for the benefit of all those uncommitted people listening to our debate who just want the NHS to work, will he tell us how big the gap is over that remaining issue, and how he sees it being resolved as quickly as possible?

[Mr Hunt]

My right hon. Friend is right to draw attention to the difficult paradox that we face. Earlier this year, we came close to an agreement and, had there been a willingness to negotiate rather than what I fear was the BMA’s desire to settle for nothing less than a full Government climb-down, we could have had a deal. The outstanding issues were about pay for antisocial hours and particularly about Saturday hours pay. That is where the main difference lay. We proposed a sensible compromise on that but, as Sir David Dalton, the chief executive at Salford Royal, said, we had to decide quickly what we were going to do because the contracts are coming in this August and there is a process we have to go through. So that will be in the new contracts from this August, but we are very willing to talk to all parties, including the BMA, about the implementation of these contracts, about the contents of future contracts and about anything to ensure that this contract works, because we would much rather have a negotiated agreed solution and it is a great tragedy that we were not able to do that this time.

End of Life Care

John Redwood Excerpts

Wednesday 2nd March 2016 Commons Chamber

[Dr Wollaston]

I agree entirely with the hon. Gentleman that this care should apply irrespective of someone’s age or the setting in which they are treated. Social care will be integral to that, and I will expand further on that issue later on.

Another report the Minister will be aware of—it was commissioned by the previous Government from the Choice in End of Life Care Programme board—is “What’s Important to Me. A Review of Choice in End of Life Care”. It is now exactly a year since that report was launched. When can we see a timetable and a response to that long-awaited report?

I know other Members want to speak, so I will just touch on four key themes today: variation, communication, choice and control, and funding—including funding for social care. On variation, dying does not make equals of us. People with cancer are currently accessing about 75% of specialist palliative care. We are making great progress in that regard, but we need to make such palliative care available to people with other diagnoses. Our report touched on poor access for elderly people, particularly those with a diagnosis of dementia. The Minister will be aware of the “National Care of the Dying Audit for Hospitals,” which showed that 21% of hospital trusts are meeting National Institute for Health and Care Excellence guidance for providing seven-day-a-week, face-to-face specialist palliative care between the hours of nine and five. In fact, only 2% of trusts are making that care available around the clock, seven days a week. We have a long way to go.

Tackling variation means understanding where the gaps exist. The VOICES survey, which collects the views of informal carers and evaluates the services available to them, has been invaluable in setting out the issues important to those who have been bereaved and the experience of their loved ones after a bereavement. A point that has been made to me very forcefully is that we could do so much better in addressing the gaps in provision if the VOICES survey was expanded. Currently, it does not have enough power to be able to identify where there is variation around the country. Will the Minister address that point when he sums up?

[John Redwood (Wokingham) (Con)]

I wonder whether my hon. Friend could give me some guidance. Ideally, when should end-of-life care begin? What sort of time period are we talking about and how much uncertainty is there over the diagnosis? There are all sorts of complications: we cannot be sure whether someone is terminally ill and is going to die within a limited number of days.

[Dr Wollaston]

My right hon. Friend raises a very important point. It should start as soon as possible—as soon as someone receives a life-limiting diagnosis. We need to start those conversations much earlier on. We need to get better at identifying, towards the very end of life, when people are in the final stages of an illness. I will touch on that point in greater depth in a minute.

We should recognise some successes and welcome the changes made by the Care Quality Commission, in one of its thematic reviews, to prioritise end-of-life care. Does the Minister have any plans to roll out that rather successful approach in prioritising end-of-life care to out-of-hospital settings? The CQC has highlighted successfully the critical importance of leadership in improving end-of-life care, examining how having a named individual—not as a tick in a box—translates into their leading change within the hospital and identifying other individuals there who can improve the quality of care at the end of life. Recognising it as a thematic review would be very helpful in other fields.

The critical importance of training has been raised by all those who have commented. We need to provide adequate training for medical, nursing and caring staff across the board. Has the Minister had any conversations with Health Education England about what progress can be made in rolling out further training?

On communication, which my right hon. Friend the Member for Wokingham (John Redwood) touched on, early identification will be crucial to rolling out end-of-life care to other groups beyond the traditional groups who access specialist end-of-life care. That means health professionals having the confidence and training to raise these issues at a much earlier stage and to start those difficult conversations that are too often put off.

We know that having an end-of-life care plan enables people to exercise much greater choice and control. We could go further in looking at explaining to people the differences between, for example, advance statements of wishes and advance decisions to refuse treatment. We could help people to put in place lasting powers of attorney, and nowhere is that more important than when people have been diagnosed with dementia. These conversations need, critically, to start at a much earlier point.

The sharing of communication between professionals is another issue. I know that the Minister has taken an interest in electronic care planning. When people have a life-limiting diagnosis, how can we ensure that at whatever point in the system they access care, they will not have to keep repeating their story? People’s wishes need to be understood at the earliest possible stage. We know that electronic care planning can help to reduce unnecessary hospital admissions. It is crucial for ambulance staff, for example, to have access to people’s records—with the patients’ consent, of course—so that they can be shared widely. Will the Minister update us in his summing up on what progress he has made with respect to electronic care planning and recording people’s wishes?

We can also improve communication by putting in place care co-ordinators. This point has been made to me repeatedly by people who are suffering from life-limiting illnesses. The system can sometimes appear to be terribly confusing, so allowing families to have a single point of contact to advocate on their behalf at a time when they are in distress can make a huge difference, as can having a named clinician who is taking overall responsibility for the care.

On care for people at the very end of life, the Minister will know that over the years we have much debated the Liverpool care pathway and its success. Other Members may wish to talk in greater detail about that, but emergency care treatment plans are important so that people can clearly document their wishes well in advance—not as a tick-box exercise, but as a considered exercise of having discussions with individuals and their loved ones about what their wishes are and then ensuring that they are respected. Will the Minister tell us where we are now with emergency care treatment planning?

At a time when people so often feel that they are losing control towards the end of their lives, it is vital to give people more choice and more control. That was the key theme of the so-called “Choice” review, on which I hope the Minister will update us. Where are we now with all who need it having a “national choice offer”, as it was termed? We know that about a half of the 470,000 people who died in 2014 died in hospital, yet we know from the VOICES survey that of those who expressed a preference, only 3% wanted to be in hospital. We are a long way from allowing people the kind of choice and control they want about where to be at the end of their lives. Most people would prefer to be at home, surrounded by their loved ones. We can do far better.

Many practical issues need to be addressed. One that I have seen first hand in my clinical experience is where families are exhausted and overwhelmed by caring responsibilities. Sometimes the individual at the heart of this will opt to go into hospital because they feel bad about the burden they feel, often wrongly, they are placing on their families. One key theme of our Health Committee report was that nobody should have to end their life in hospital for want of a social care package. That will mean being much more generous about providing free social care at the end of life, or much more rapid access to the assessments needed to allow people to continue in care, as they are sometimes very delayed. I hope the Minister will update us on that, too.

The Minister will be familiar with the work of the Nuffield Trust. Its report on the use of Marie Curie nurses, for example, pointed out that the service could save total care costs of £500 per patient and also allow many more people to be where they wanted to be at the end of their lives. Not only is the service good value for the overall health and care system, but it provides the choice and control that people desperately need and deserve at the end of their lives.

Funding lies at the heart of this issue, and it is not just a question of social care packages. I know the whole House agrees that we owe an enormous debt of gratitude to the hospice movement. Hospices play a pivotal role in outreach, providing specialist support not just for hospitals but, critically, throughout the community. Rowcroft hospice, in my constituency, is hugely valued in the community. It provides extraordinary levels of care and supplies many specialist services to the NHS to deal with—cases of lymphoedema, for instance. This week, however, it informed me that it faces a funding shortfall of £1 million next year. While about a third of its funding comes from the NHS, about 60% comes from charitable giving.

Hospices do not want to lose their link with the voluntary sector, because it is deeply embedded in the way in which they work in communities. However, it makes them rather vulnerable, because the level of charitable giving and legacies can vary greatly. What they need is a higher percentage of stable core funding to allow them to expand the important work that they do. The Minister will probably want to comment on the so-called currencies that are being developed to replace funding for palliative care. The feedback that I am receiving suggests that there is a risk that that will become a rather bureaucratic process, and there is also a worry that its implementation by clinical commissioning groups will not be compulsory. An update from the Minister would be helpful.

Will the Minister also assure us that, if the Government intend to implement all the recommendations of the “Choice” review—which I hope they do—he is satisfied that, across NHS England, the business plans that have been established will allow sufficient funding for a full implementation?

I know that other Members wish to speak. There are many other issues that I could raise, including bereavement support and research, but let me end by asking the Minister to be truly ambitious. I think that we can achieve seven-day, 24-hour access to specialist palliative care in all settings, and that we can address variation and give people choice and control at the end of their lives. It would be an extraordinary achievement for the Government to go further. We should not rest on our laurels because we are leading the world; we should say that we lead the world not just for some people, but for everyone.

--- Later in debate ---

[John Redwood (Wokingham) (Con)]

I will draw on conversations that I have had with people around the country who have experienced a relative dying fairly recently, as well as on my own observations. I will not mention a particular case, because if I did have a difficult case, I would take it up privately in the usual way.

The first conclusion that I have formed, which I think the Secretary of State has wisely come to, is that a patient undergoing the last stages of their life and their family need a named doctor who is in charge. The family and the patient, when the patient has capacity, need to have access at reasonable times to that doctor to find out where they have got to and what the next stage is likely to be.

I believe that Ministers have put in place a requirement for there to be a named general practitioner for every patient when they are at home or in a care home. That is very welcome and let us hope that it works, so that there is someone people can turn to, whom they trust and know. However, when, as so often happens, people enter hospital and may not come out again, because of the way in which rosters and rotas work, it means that every day or every other day there is a different group of doctors and nurses in charge of them.

That can mean one of two things. Sometimes, the family and/or the patient are constantly retold very bad news because the new team feels that they have a duty to tell them. It may not be helpful for people to keep getting the same bad news. Alternatively, the family or the patient with capacity may want information at a particular time, but no one is up to speed because they have only recently taken over and have not had time to read the notes. Indeed, reading the notes is not necessarily as good as being continuously in charge of the patient and talking to them over the days or weeks in which the treatment is undertaken or as their last days draw near. I therefore urge Ministers to get behind the idea that it is best if there is a named senior doctor—perhaps a consultant or registrar.

Often, people in their last few weeks or months of life have complex and multiple medical conditions, so a series of different consultants are involved, but no one consultant feels as if they are ultimately in charge. I am told that in some hospitals patients are moved from ward to ward at very short notice, with different specialties in mind. The family then turn up and do not even know where the patient is, because they think that they will be where they last saw them. That can be very disruptive for the family. More care and attention is needed in some cases to deal with that issue.

The second issue, which has been mentioned by other colleagues, is the interface between social care and hospitals. All of us who visit hospitals as Members of Parliament and sometimes as family members will have observed that a very large number of patients in a lot of our wards are extremely elderly and very frail, with lots of complex medical conditions. Some of them may not be easy to treat. Others might be better off in a care home or at home, but there has been a failure to put together the set of services that they need.

I do not really believe that that is a money issue, because in many cases one could buy an awful lot of social care for the cost of the hospital bed that the person is occupying. Social care might even be cheaper. I am not recommending that we take people out of hospital because somewhere else is cheaper, but if they would be better off somewhere else, if they want to be somewhere else and if there are no longer any medical interventions that the hospital can make, it is sensible to take advantage of social care if it is also cheaper.

[Kelvin Hopkins]

I hear what the right hon. Gentleman says, but when local authorities know that they have to pay for care when somebody comes out of hospital, they will try to persuade them to stay in hospital for as long as possible. Different budgets put different pressures on different institutions.

[John Redwood]

The hon. Gentleman is right. Throughout the time he and I have been in the House, under Governments of different persuasions, we have all known about the problem, we have all said that we need to solve it and still we have not managed to do that. I hope that our current talented Ministers can do something that no previous groups of Ministers have been able to achieve. There is an experiment because, with the devolution models that Ministers are considering, if the health and social care budgets are put together under the same authority, the excuse that there is a budget row goes. One would hope that the best interests of the patient were dominant and that authorities would realise that, in some cases, the best interests of the patient also enabled them to save money through switching from an expensive hospital bed to a decent care package. That could be helpful, and I hope that Ministers will do that.

For the families of those who die, the need for care does not end at the moment of death. That is generally understood by the public sector, but there are serious problems with delivering the support and administrative back-up that families need when a loved one dies. Several people who have been through this recently told me that the first thing that happens is a delay in getting a death certificate. Without a death certificate, nothing can be done to settle things. People cannot even hold a funeral because they cannot instruct a funeral director until they have a death certificate.

Not only is there a delay in getting the death certificate from the medical staff at the hospital, but people cannot register the death because of the insistence on a face-to-face meeting with the registrar, which can mean a further delay of many days before a slot becomes available. Quite a lot of families therefore end up with one, two, three and four weeks of delay before they get the death certificate, which is necessary to trigger the funeral and any financial changes consequent on a person’s death.

The Government have introduced a sensible “Tell Us Once” system so that when a person dies, the family can fill in quite a complicated electronic form, which is meant to tell all Departments with which the dead person may have been involved what the Government need to know. There are two problems with that. First, families often do not have all the knowledge that they need. Unless they have that knowledge, the Government seem unable to cross-refer and discover that, for example, the person had a benefit as well as a pension. It would be helpful if Government computers talked to each other more adequately so that the Government could do more of the work and families just had to notify them of the death and did not have to know every detail of the dead person’s financial affairs.

Secondly, because the delays with the death certificate and registrar appointments often mean that registration of the death is delayed, the Government make payments to the deceased person, and the families, having used “Tell Us Once”, get a set of not terribly friendly letters—I appreciate that they have been dressed up a bit—saying, “Your dead relative owes us this much money”. The families cannot necessarily get their hands on that money, but they are none the less obliged to pay the Government back, at an unsettling time when they are mourning and grieving and were not expecting a tax or benefit bill.

In the interests of handling the families better, the Government should speed up their side of the administration so that the death can be registered promptly, the Government do not make wrong payments and the families are not faced with letters demanding money back when they have other things on their mind and are trying to deal with the hurt. It does not make it better when the Government say, “We’re very sorry you’ve had a loss” if they go on to say, “but you owe us this much money. The usual rules apply. See you in prison if you don’t pay”.

We need to improve greatly on dealing with the first few weeks for the poor grieving families, who do not necessarily know the process, are very lost because they have lost their loved one, and are not helped by delays and sometimes the incompetence of the regulatory authorities.

--- Later in debate ---

[The Parliamentary Under-Secretary of State for Health (Ben Gummer)]

What a fantastic debate this has been on a most important subject, with many Members bringing their personal experiences to the attention of the House, and with such agreement on both sides about what constitutes good end-of-life care and what we need to do to improve the situation.

As Members on both sides have acknowledged, the situation is already very good. As my hon. Friend the Member for Totnes (Dr Wollaston) pointed out, The Economist recently rated end-of-life care in this country the finest in the world. The hon. Member for Burnley (Julie Cooper) said that that fact made her proud to be British, and I am sure many others share that sentiment. My hon. Friends the Members for Henley (John Howell) and for Poole (Mr Syms) said that our end-of-life care was a sign of Britain at its best, not just because we are doing well compared with other countries, but because that care exemplifies many of the qualities we cherish in our communities—community work, giving and generosity, especially in our hospice movement, which is unique to this country, and of which we are proud. There is, therefore, much to be proud about.

Our end-of-life care comes from a deep tradition, which, in its current incarnation, goes back to Dame Cicely Saunders, as the hon. Member for Central Ayrshire (Dr Whitford) pointed out, but far further back too, into our medieval history. It is about care for the dying and an understanding, as many Members have pointed out, that the special time at the end of life should be cherished and that we should respect care at that time as much as we would other parts of people’s care.

However, as hon. Members also pointed out, there is much too much variation. The hon. Member for Burnley said that that in itself is something of which we should be ashamed, and I agree with her about that too. There is exceptional care in this country for people approaching the end of life, but there is also, I am afraid, care that is not good enough. Constituents have put that to hon. Members across the House, and we need to change that in this Parliament.

We need to eradicate the variation I mentioned; to quote Bevan, we need to universalise the best—that is one of the foundation stones of our NHS. Indeed, that was a promise made during the assisted dying debate. As the hon. Members for Heywood and Middleton (Liz McInnes) and for Central Ayrshire pointed out, exceptional palliative care is the foundation of all care in the NHS, and it should be the expectation of everyone reaching the end of their life. That is where I would like to start in replying to hon. Members’ remarks.

The quality of care we provide for people in hospitals and at home is a mark of how we think about the national health service and the care services we provide. We should not think of them purely as curative services; they work as curative services only if that cure is on a foundation of care, and that is why getting this issue right is so important.

My hon. Friend the Member for Faversham and Mid Kent (Helen Whately) said this issue should be a priority, not just because of its importance in and of itself, but because it points to many of the efficiencies we can make in the health service and the care sector, which will free up money for care elsewhere in the sector.

The hon. Member for Luton North (Kelvin Hopkins) said end-of-life care embodied compassion in the service, and that is why we should place especial importance on it. My hon. Friend the Member for Poole said that respect at the end of life was something all clinicians and all others involved in care should show. Again, if we are able to achieve that for people for whom there is no cure, we can also do something remarkable for those elsewhere in the service, for whom there is, happily, the prospect of a cure.

My hon. Friend the Member for Vale of Clwyd (Dr Davies) said we needed to make particular changes in different settings, whether that was improving privacy in hospitals, improving discharge to home or improving the ability to look after people in their permanent residence, be that at home or in a care home. We need to take a range of different approaches in order to eradicate the variation that so many hon. Members have talked about. People can be expected to achieve choice only if a consistent quality of care is offered in all settings.

Hon. Members have pointed out the need to address funding, and NHS England is looking at the different currencies of care. We need also to look at the measurement of how care is provided. I have taken note of the points made by my hon. Friends the Members for Totnes and for Faversham and Mid Kent about the need to produce consistent measurements for quality of care at a local level. I hope to be able to deal with that in the not too distant future.

We need to look at the accountability of clinicians. I point Members in the direction of the “gold line” offered by Airedale NHS Foundation Trust. I take very seriously the remarks of my right hon. Friend the Member for Wokingham (John Redwood), who talked about named doctors, and refer him to the Secretary of State’s comments of 29 October where he expressly said that there should be a named consultant for patients in hospital. I hope that we will be able to extend that principle further afield, as we already have done in the course of the previous Parliament.

This matter should be addressed in a holistic manner. The hon. Member for Alyn and Deeside (Mark Tami) mentioned the need for the care of young people to be accommodated within these plans, and I intend to take that forward. We also need to consider those who are very young.

The hon. Member for Strangford (Jim Shannon) and my hon. Friends the Members for Lewes (Maria Caulfield) and for Erewash (Maggie Throup) referred to people who do not have cancer, especially those suffering from Parkinson’s disease and Alzheimer’s disease, falling out of the safety net in some areas. All those points were well made and will be taken into account.

I want to reflect on the comments of many Members about the importance of having a conversation. Professionals need to be brave, as my hon. Friend the Member for Erewash said. My hon. Friend the Member for Vale of Clwyd mentioned the need for confidence from professionals and for education.

[John Redwood]

Will my hon. Friend take up my point about relatives handling the death and the lack of a medical certificate or a death certificate?

[Ben Gummer]

I will. I take my right hon. Friend’s comments on that very seriously. We are looking at the whole system of death certification, and I hope to be able to come to the House in that regard in the not too distant future. His points were very well made.

My hon. Friend the Member for Salisbury (John Glen) talked about the duty that we all have to ensure that there is a better conversation between patients and clinicians; we should all be able to have that conversation so that we can break what my hon. Friend the Member for Faversham and Mid Kent described as a taboo. At this point, not just as a Government or as Ministers but as a society, we need to grasp the nettle. We will all need to be involved so that we can give people the confidence to talk about such matters.

Draft Pharmacy (Premises Standards, Information Obligations, etc.) Order 2016

John Redwood Excerpts

Tuesday 1st March 2016 General Committees

[The Minister for Community and Social Care (Alistair Burt)]

I beg to move,

That the Committee has considered the draft Pharmacy (Premises Standards, Information Obligations, etc.) Order 2016.

It is a pleasure to serve under your chairmanship, Ms Dorries. The draft order makes changes to the pharmacy regulators’ powers to regulate pharmacy premises. In broad terms, the intention is to remove the General Pharmaceutical Council’s duty to set standards in rules; it will instead set them as code of practice-style obligations that are enforced through disciplinary committee procedures. The Northern Ireland regulator, the Pharmaceutical Society of Northern Ireland, will have a statutory duty to set standards for registered pharmacies, and the draft order will clarify what those standards can cover.

The draft order will make changes to the regulators’ ability to issue interim suspensions from the premises register. The General Pharmaceutical Council’s powers relating to improvement notices will be amended. It will be enabled to publish reports of pharmacy premises inspections. Its powers to obtain information from pharmacy owners will be changed. A correction will be made to the Pharmacy Order 2010 in respect of the notification of the General Pharmaceutical Council of the death of a pharmacy professional. All the changes have been developed with the agreement of the regulators, the Government and the devolved Administrations. The General Pharmaceutical Council’s pharmacy premises standards may relate to the regulation of pharmacy technicians, which is a devolved matter, so the draft order has also been laid in the Scottish Parliament. The draft order was debated in another place on Monday 22 February.

I will give the Committee some background. All pharmacists and pharmacy technicians who practise in Great Britain must be registered by the General Pharmaceutical Council. Pharmacists who practise in Northern Ireland are registered with the Pharmaceutical Society of Northern Ireland. Pharmacy technicians are not a registered healthcare profession in Northern Ireland. Unlike most other healthcare regulators, the pharmacy regulators are also responsible for the regulation of registered premises. The regulation of retail pharmacy premises is the subject of the draft order.

The key change for the General Pharmaceutical Council, and one of the Law Commission’s recommendations, is that it should no longer be required to set standards for registered pharmacies in rules. Instead, the standards should be aligned with other regulatory standards and be code of practice style-obligations, enforced through disciplinary procedures. This supports the General Pharmaceutical Council’s approach, since its inception in 2010, to move to an outcomes-based approach to pharmacy premises regulation. Overall, the draft order will align the legal status of registered pharmacies standards with the status of standards for individual registrants.

As a consequence of moving the standards out of rules, they will no longer be included in a statutory instrument that is subject to Privy Council approval. Increasing the autonomy of the General Pharmaceutical Council in this way is in line with Government policy. However, the draft order includes an explicit requirement for the General Pharmaceutical Council to consult Scottish Ministers, as well as English and Welsh Ministers, on changes to pharmacy premises standards.

The General Pharmaceutical Council’s standard setting powers are being extended to include associated premises; that is, premises at which activities are carried out which are integral to the provision of pharmacy services. This reflects the fact that, in some respects, the traditional model of pharmacy premises being entirely self-contained operations at which all aspects of the retail pharmacy business are carried out is outdated for some businesses. Integral parts of their business operations—for example, electronic data storage—may be elsewhere. Very similar changes are being made in relation to Northern Ireland.

The disqualification procedures for pharmacy owners and the procedures for removing premises from the premises register will be amended for both regulators: first, so the disqualification procedures apply to retail pharmacy businesses owned by a pharmacist or a partnership, as well as bodies corporate; and, secondly, to clarify that the test to apply sanctions, where premises standards are not met, is whether the pharmacy owner is unfit to carry on the retail pharmacy business safely and effectively. The General Pharmaceutical Council already has powers to issue improvement notices where a pharmacy owner breaches the standards for pharmacy premises.

The draft order will make two amendments to the sanctions provisions relating to breaches of improvement notices. The two changes mean that the General Pharmaceutical Council will deal with all breaches of premises standards as disciplinary matters. Both regulators are being enabled to make suspension orders, pending a full hearing of the case against the owners of pharmacy premises, and to make interim suspensions from the register prior to a disqualification decision or a removal decision taking effect. These changes reflect the move to better align the disciplinary provisions for pharmacy owners, in respect of breaches of pharmacy premises standards, with those for individual registrants.

[John Redwood (Wokingham) (Con)]

The power in article 18, which the Minister has already referred to, is that Ministers have to be consulted before a change is made to the rules. What is the point of that? It does not seem that Ministers have any right of veto, or to insist on anything different, so why do they not just trust the regulator?

[Alistair Burt]

Bearing in mind Ministers’ overall responsibilities to duties under the NHS, legislation about what pharmacies do and the general mandate of the NHS in relation to pharmacies, a consultation procedure is still required so that Ministers are made aware of the sort of changes that are being included, to ensure that those changes fit with other aspects of the NHS mandate for which Ministers are responsible. In no sense is that anything other than permissive. If there was disagreement and Ministers did not want to continue, that would be an important part of the discussion. But I do not think that a general duty to consult is necessarily a bad thing and it conforms with other responsibilities that Ministers may have.

The remaining changes are for the General Pharmaceutical Council. It is currently required to make rules in relation not just to premises standards but to the information obligation of pharmacy owners. The latter duty is permissive. The draft order will also clarify when the General Pharmaceutical Council can require pharmacy owners to provide such information and the type of information covered. Currently, there is no provision about how these information-gathering rules are to be enforced, and this gap is being filled by making use of the existing enforcement regime via the General Pharmaceutical Council’s improvement notice system. The General Pharmaceutical Council is also being enabled to publish reports and outcomes from pharmacy premises inspections.

The opportunity is being taken to correct an error in the Pharmacy Order 2010 to require notification of the death of a registered pharmacist or registered pharmacy technician by a registrar of births and deaths, or in Scotland a district registrar, rather than by the Registrar General, as the legislation currently states.

A full public consultation on the draft order was conducted across the United Kingdom from 12 February 2015 to 14 May 2015. There were 159 responses and the overwhelming majority supported the proposals, with many welcoming them. However, the need for guidance—whether from regulatory professional bodies or others—was raised in response to a number of the proposals, to help understand the proposed changes and their impact in practice. To supplement the consultation, a number of events were arranged across the UK for patients and the public. Participants at the events gave unanimous support to the proposals for an outcomes-based approach to standards for registered pharmacy premises. The emphasis on patient safety was welcomed and it was recommended that pharmacy users should have a voice in whether good outcomes for patients are being achieved by pharmacies. Publication of inspection reports in Great Britain was also welcomed.

In summary, the key proposals concerning the continuing development of an outcomes-based approach to standards for registered pharmacy premises build on best practice. The proposal that the standards should not be placed in legislative rules follows as a consequence of this approach and will enable the General Pharmaceutical Council, and eventually the Pharmaceutical Society of Northern Ireland, to respond quickly when reviewing and updating the standards to keep pace with the increasingly rapid changes in pharmacy service provision. I commend the draft order to the House.

Cities and Local Government Devolution Bill [Lords]

John Redwood Excerpts

Monday 7th December 2015 Commons Chamber

[John Redwood (Wokingham) (Con)]

The hon. Gentleman is making a very thoughtful speech. Does he not agree that the fact that devolution is being driven at pace by the Scottish agenda means that there is no time to have such a convention on the big devolution to Scotland, and is it not time for England to have matching devolution if Scotland is going to get so much?

[Mr Allen]

The right hon. Gentleman talks about moving at pace and then immediately suggests that England should have what Scotland has. I would go with the latter of his contradictory points: in such devolution Bills, England should have everything that has been obtained by the Scottish people. To round out the package, England should in particular have not just the powers but the financial capability to make the powers real.

I will talk later about new clause 5, which says that we can have income tax assignment to England, in just the way it pertains to Scotland, without civilisation as we know it falling apart. I would add that that would renew and strengthen the Union, which will need to happen in future decades, as a federal entity in which the nations of the Union work together very closely as a family, but all retain a degree of income tax in their areas to make their own country work effectively.

--- Later in debate ---

[James Wharton]

I begin with new clauses 1 to 4, which propose the establishment of a local government constitutional convention. We had the opportunity to discuss these provisions on our first day in Committee, and as the hon. Member for Nottingham North (Mr Allen) said then, they include the nuts and bolts of this body, as proposed by the Political and Constitutional Reform Committee, which the hon. Gentleman chaired in the previous Parliament. He now draws on the wealth of the knowledge that he acquired from his chairmanship during that time. His intention has been, in part at least, to ensure that some of his observations and experience could be read by anyone who feels that the concept of a constitutional convention is something that could be recommended to the House. I hope he feels that he has been successful in that aim. I have certainly enjoyed the debates we have had on the issue, and I recognise his tenacity and consistency in putting his case before us.

I do not consider it necessary to go through in detail every stage of the possible effects that new clause 1 could have, but it is important to recognise that the hon. Member for Nottingham North has made a number of points that draw on his experience and that inform the debate on devolution. However, as has been the case in previous debates and in Committee, I am not yet persuaded to go as far as to include new clause 1 in the Bill at this time.

[John Redwood]

Will the Minister confirm that as the talks on Scotland’s money versus that of the rest of the United Kingdom make rapid progress, it will be the Government’s aim to ensure that England has a block grant that it may choose how to spend?

[James Wharton]

My right hon. Friend tempts me to go further than I can in the specific context of the Bill, but I think he has been above averagely consistent on that point and very clear about his position. He has put it clearly on the record today, as he has before, and the fact that he has done so is welcome.

I look to the Chair, Madam Deputy Speaker, for advice on whether you would like me to comment on the other amendments in the group, which I would be happy to do, although I have not yet heard the comments of hon. Members on them.