Health and Care Bill

Jonathan Ashworth Excerpts

Report stage
Tuesday 23rd November 2021 Commons Chamber

[Jonathan Ashworth (Leicester South) (Lab/Co-op)]

I start by thanking all those who served on the Bill team and the Clerks, the Library and all the staff of the House who supported them. I also thank the hon. Member for Wellingborough (Mr Bone), my hon. Friends the Members for Sunderland Central (Julie Elliott) and for Birmingham, Selly Oak (Steve McCabe) and the hon. Member for South East Cornwall (Mrs Murray) who chaired the Committee deftly. I put on the record Labour’s thanks to the Minister for Health, the hon. Member for Charnwood (Edward Argar)—my constituency neighbour in Leicestershire—who both in Committee and over the past two days in the House has been courteous and patient in responding to the various amendments and in how he conducted himself across the Dispatch Box. We are grateful for that.

Equally, I thank my hon. Friends the Members for Nottingham North (Alex Norris) and for Ellesmere Port and Neston (Justin Madders) for working so hard on this Bill and making the case for our amendments. My hon. Friend the Member for Ellesmere Port and Neston had his birthday yesterday—there is no greater place to celebrate one’s birthday than at the Dispatch Box—and I am told that he may well be putting in an appearance at the Strangers’ Bar after tonight’s vote. I am sure that hon. Members from both sides of the House may want to join him in his celebrations.

Of course, Labour welcomed parts of this Bill. It did indeed scrape some of the worst remaining vestiges of the Lansley reorganisation off the boots of the NHS. The compulsory competitive tendering of contracts, which we warned against nearly 10 years ago, are finally put in the dustbin. Of course, it was this Secretary of State, as an enthusiastic and loyal Back Bencher, who spoke in those debates supporting that reorganisation, but we welcome the ending of section 75.

We also welcome some of the provisions around public health, particularly those on childhood obesity and advertising, but we wish the Bill had gone further on smoking cessation and alcohol. Madam Deputy Speaker, I know it is not the convention to praise Members on Third Reading as one does on Second Reading, but I praise the hon. Member for Bury South (Christian Wakeford)—the constituency in which I grew up and went to school—who spoke with great eloquence, emotion and very personally about the impact of alcohol addiction on his family. It has also had an impact on my own family, as some hon. Members know. Although the Secretary of State did not accept either the hon. Gentleman’s amendments or ours, perhaps he will be prepared to meet us on a cross-party basis to discuss how we can take that agenda forward.

In saying all that, however, we are not minded to support the Bill in the Lobby tonight. We remain unconvinced by the arguments put forward by the Minister for Health in the past 48 hours. We still believe that this is the wrong Bill at the wrong time. As the right hon. Member for Wokingham (John Redwood) said in his intervention on the Secretary of State, this is an extensive reorganisation of the national health service at a time when we are still in a pandemic and when NHS staff are exhausted and facing burnout. We should be prioritising the monumental waiting lists, the huge referrals for mental health treatment, the crisis in A&E, and the huge pressures on ambulance services and general practice. This Bill is not only a distraction, but it contains provisions that Labour thinks are deeply damaging.

Yesterday, the House focused on the care cap amendment. It represents a change to existing policy and differs from the position outlined in the “Build Back Better” document, under which the House was asked to endorse a national insurance rise. The change means that those with wealthier estates and more expensive houses will see a greater proportion of their assets protected. Somebody with a £1 million house will have 90% of that asset protected, but somebody with an £80,000 house in Barrow, Mansfield or Hartlepool will lose nearly everything. That cannot be fair.

The Secretary of State, who was working the phones yesterday, may have won the battle, but I dare say that there are further skirmishes ahead. I suspect that Members in the other place—certainly those on the Labour Benches —will return to the matter, and I hope that they send the Bill back to us so that we can look at it again.

There are other provisions in the Bill with which we are uncomfortable. We are not convinced about the prohibitions on the private sector’s role in sitting on integrated care boards; we do not think that the Government’s amendment is strong enough. We will return to that point at a future opportunity.

Although the Bill gets rid of the Lansley competitive tendering requirements, it still allows the Secretary of State to hand contracts out to the private sector without proper scrutiny. We have seen a £10 billion contract going to the private sector to use 8,000 beds. That money would have been better spent on elective treatment in the national health service.

In conclusion, the Opposition cannot support the Bill, so we will divide the House tonight. On the care issue, I know that the Secretary of State thinks that he got his policy through the House yesterday and that it is all over, but I am afraid that it most certainly is not.

Oral Answers to Questions

Jonathan Ashworth Excerpts

Tuesday 23rd November 2021 Commons Chamber

[Sajid Javid]

First, I am sorry to hear about my hon. Friend’s constituent Chris and wish him all the very best. She will know that clinical commissioning groups are responsible for commissioning local healthcare services. If the aim of a cosmetic procedure is health rated, such as the need to repair or reconstruct missing or damaged tissue or skin that might come through illness, birth defect or accident, it will be commissioned and seen to by commissioners. She refers to a particular case. If she would like to provide me with more details, I would be happy to take a look.

[Jonathan Ashworth (Leicester South) (Lab/Co-op)]

At the weekend, the Secretary of State effectively ditched his promise to deliver 6,000 extra GPs. Last week, the Infrastructure and Projects Authority said his promise to deliver 40 new hospitals is “unachievable”. Last night, he whipped a vote that sees poorer pensioners lose their homes to pay for care, while the homes of the richer are protected. Can he tell us which promise is he going to break next?

[Sajid Javid]

I have to say that the right hon. Gentleman is wrong on all three counts. The Government are absolutely committed to hiring more GPs, with over 1,800 full-time equivalent GPs entering primary care in the two years to September 2021. We are seeing success after success in the hospital building programme, with the biggest capital investment programme in hospitals that this country has ever seen. As for our social care programme, this Government are the first in decades to have the guts to deliver, and that is exactly what we are getting on with.

[Jonathan Ashworth]

The Secretary of State’s social care programme is not levelling up when the promise in his manifesto that no one should have to lose their home to pay for care is broken and in tatters after last night.

The Secretary of State’s next promise was to give the NHS “everything” to get through the backlog. With waiting lists growing at pace, ambulances backed up outside hospitals, and cancer operations getting cancelled, what will he do to recruit the staff we need? He is apparently not going to support the cross-party amendment in the name of the former Health Secretary, the right hon. Member for South West Surrey (Jeremy Hunt), tonight, and he failed to win the funding needed for recruitment and training in the Budget, so how will he deliver on his promise to give the NHS “everything” when it does not have the staff to deliver the care to bring waiting lists down?

[Sajid Javid]

Once again, the right hon. Gentleman proves he still does not understand the social care programme that this Government have set out. I think that is deliberate; he chooses not to understand it. For the first time, catastrophic costs are being capped for everyone in the country, regardless of where they live, and the generous means-testing system will ensure that the vast majority of people will benefit and that no one will lose out.

The right hon. Gentleman asks me what I am doing about the workforce. We are making the biggest investment in the workforce that this country has ever seen. Yesterday I announced the merger of Health Education England into the NHS, so that we can have a better joined-up strategy, and we have already set out a 15-year framework to consider the long-term needs of the workforce.

Health and Care Bill

Jonathan Ashworth Excerpts

Report stage
Monday 22nd November 2021 Commons Chamber

[Barbara Keeley]

rose—

[Jonathan Ashworth (Leicester South) (Lab/Co-op)]

rose—

[Edward Argar]

If the shadow Secretary of State will forgive me, the hon. Lady has attempted on a number of occasions to get in, so it is only fair that I give way to her.

--- Later in debate ---

[Edward Argar]

If I may make a little progress, I will then give way to my former boss, the former Secretary of State, and then, if I have time, to my hon. Friend.

To reiterate, as my right hon. Friend, the Prime Minister, said on 7 September, nobody—nobody—will be “worse off” than under the current system. Currently, around half of all older adults in care receive some state support for their care costs. This will rise to roughly two thirds under these reforms. This clause would also make a number of minor technical amendments to other sections of the Care Act 2014.

[Jonathan Ashworth]

Will the Minister give way?

[Edward Argar]

Before I give way to the right hon. Gentleman, I will give way to the former Secretary of State.

--- Later in debate ---

[Edward Argar]

Yes, of course, as we move through this reform process, it is absolutely right and vital that we work with our partners in the Local Government Association and local authorities of all political complexions. In respect of the impact assessment, I do believe that it is important that we have an impact assessment before this legislation completes its passage through both Houses.

[Jonathan Ashworth]

I am extremely grateful to the Minister. He is showing his typical courtesy in giving way. Many across the House are puzzled because we recall this document that the Government placed before the House when they asked the House to endorse the national insurance increase. Indeed, many Members did endorse that national insurance increase, even though they were breaking a manifesto commitment. This document actually says that it will introduce a care cap and

“deliver a core recommendation of the independent Dilnot Commission. It will be implemented using legislation already in place under the 2014 Care Act, which introduces the independent Dilnot Commission’s social care charging reform.”

It goes on to describe that as the “new cap”. Why have the Government moved away from the position of just a few months ago that they published ahead of a vote on increasing national insurance and moved to a policy now that disproportionately benefits those with greater assets, which surely cannot be fair?

[Edward Argar]

I am grateful to the shadow Secretary of State who, while I do not necessarily agree with what he says, as ever puts it courteously. We hold true to what we put in that “Build Back Better” document. It is necessary for this one particular element to see further primary legislation, hence the amendment today.

--- Later in debate ---

[Edward Argar]

I am afraid that I will not give way now.

[Jonathan Ashworth]

For Leicestershire!

[Edward Argar]

I did give way to the right hon. Gentleman, the shadow Secretary of State, and he is my other constituency neighbour in Leicestershire.

Let me turn to integrated care boards and integrated care partnerships. I remind the House of what my right hon. Friend the Secretary of State said on Second Reading. These bodies are critical for delivering the key aims of the legislation: reducing bureaucracy; supporting integration and collaboration; and improving accountability. At the heart of the legislation for these bodies is flexibility—giving systems the scope to shape structures according to their needs. This principle is widely supported across the NHS and local government, and we would not want to imperil that, which is why we will be resisting attempts this evening to constrain more tightly how ICBs and ICPs operate. However, we recognise that there are a number of points of clarification that would be helpful to include, and we have tabled a number of amendments to do just that.

Before we reach the meat of this section, there are a number of minor amendments to deal with. First, minor and technical Government amendment 29 will update a reference in the Health and Social Care (Community Health and Standards) Act 2003 to reflect the changes made to section 99 of the National Health Service Act 2006. Secondly, Government amendment 30 will designate integrated care boards as operators of essential services under the Network and Information Systems Regulations 2018. This will place requirements on ICBs to protect their network and information systems by managing risks to ensure service availability and prevent patient harm.

We expect ICBs to take decisions on IT investment, including on cyber-security, and owning systems—and the associated cyber-risk—that are critical to the provision of healthcare. This includes holding the shared care record. The loss or corruption of data from the shared care record could have clear implications for the delivery of care, and for wider public trust in the digitisation and data-sharing agenda. We must take this risk seriously, and assure ourselves that ICBs are doing so as well.

--- Later in debate ---

[Anne Marie Morris (Newton Abbot) (Con)]

I thank the Minister for the time he gave me to consider my amendments, which we discussed in some detail, and I thank Her Majesty’s Opposition who, very kindly, took some of my amendments through Committee, sadly unsuccessfully. Tonight I hope to have the opportunity myself to explain why these amendments are so important. Before the House thinks, “Oh my goodness, how can we possibly deal with that many clauses and amendments?” let me say that I will endeavour to be brief. I rise to speak to new clause 33, and amendments 21, 22, 19, 16, 17, 20, 18 and 23—but I will be brief.

Let me divide my remarks into four topic areas: domestic abuse, mental health, access to medicines, and research. New clause 33 deals with domestic abuse. That is a horrific crime. It is insidious, it is hidden, and it is on the rise, and during the pandemic it has, sadly, grown from strength to strength. I say, pointedly, that this is a hidden crime, and at the moment, all the teeth are with the police. However, the police can deal only with very evident crime.

Where does domestic abuse first appear? It is in a doctor’s surgery, or at accident and emergency. To date, however, there is no obligation on clinical commissioning groups, integrated care boards or hospitals to come up with a strategy to address that horrific ill. New clause 33 would place a new obligation on ICBs to put in place a proactive strategy to properly manage that issue, and to introduce the education and training that GPs and those in hospitals and A&E need. We must ensure that we no longer find, as in the Safelives report, that those experiencing domestic abuse will have experienced it for three years before it is picked up, despite having already been to visit their GPs almost five times. I do not believe that that is acceptable in a civilised society such as the one we have today.

Five and a half per cent. of adults between 16 and 74 experience such abuse, and the Home Office has determined that the cost of that was £66 billion in 2016-17. Of that, £2.3 billion was the cost to the health service. We know that 23% of those who are at risk attend A&E, and yet nothing happens. I am fortunate that in Devon we have a pilot. My CCG is the only one in the country to have a dedicated individual on the board who specifically oversees and sets a dedicated strategy on this issue. The estimate from the pilot so far reckons that if we spent £450,000 a year on our GPs in Devon, we would get a return of £7 million. But this is not about money; this is about what is the right thing to do. Until this measure is on the statute book, and until there is an obligation to put in place a strategy, this will not change, and I cannot sit here and accept that.

Let me turn to mental health. For many years and in many documents, we have seen a commitment to parity of esteem, but I have been through every statute on the book and at no point is there any reference to the words “parity of esteem for mental health”. If parity of esteem for mental health is not on the statute book, how can we say we believe in it? If it is not on the statute book, how can we possibly measure it? Currently, there are very few measures of inputs or outputs—or, worse, of outcomes —for those going through the mental health system. There are some, but they are minuscule compared with what we have for physical health.

Amendment 23 to clause 19 would require each ICB to compare the inputs and outputs on physical health and mental health. Each ICB would be required to set out: the number of patients presenting with physical symptoms and with mental symptoms; the waiting times for initial assessment in physical health and in mental health; the waiting times for treatment in physical health and in mental health; the number of patients actually receiving treatment in physical health and in mental health; and, finally, reports on readmissions. I know that Ministers do not like that level of detail, but how important is this? Without some very specific measures, it will not happen. What gets measured generally gets done.

Amendment 23 would also require the ICBs to report against the very few national standards that there are. At least then we would see what they were; we would shine a bright light on the fact that there are so few for mental health while there are numerous for physical health. The Secretary of State would be required to consolidate those reports into a national report, which would have to be presented to Parliament—to both the Commons and the Lords. What is there for Ministers not to like about that amendment? What is there for those on the Opposition Benches not to like about it?

[Jonathan Ashworth]

We like it!

[Anne Marie Morris]

Then I would like to see you wishing to press it to a vote and putting your vote—and your feet—where your mouth is. [Interruption.] I apologise, Madam Deputy Speaker; it is not your mouth. I was carried away by an overwhelming desire to get my point across, and I apologise most profoundly.

I turn to access to medicines. Most Members believe, do they not, that medicines that have been approved by the National Institute for Health and Care Excellence are available to all our constituents? The reality is that they are not. A medicine may have gone through the Medicines and Healthcare products Regulatory Agency and been proved to be safe, and through NICE and been said to be cost-effective, but each CCG—each ICB, as they will be—and hospital trust, and every other NHS body responsible for prescribing, sets its own formulary, and those formularies do not include all NICE drugs. If a medicine is not on the formulary, then no consultant or GP will be able to get reimbursement, so they will not be allowed to prescribe it.

In my constituency, a number of individuals have come to me because they cannot get access to a particular medicine, yet people in another constituency can. I do not believe that a postcode lottery is right. We all talk about the NHS, and health and care, being free at the point of delivery, and we all assume that we can get access, whether to GPs or to hospitals, but I do not think it occurs to most of us—it had not occurred to me—that we cannot necessarily get access to medicines.

My amendment 21 to clause 15 would effectively oblige every ICB, where any individual patient has the advice of their clinician that they should have a particular medicine and it has been approved by NICE, to make provision to ensure that that medicine is provided—perhaps from a neighbouring ICB, taking advantage of the duty to collaborate across ICBs. That would ensure that even if a medicine was not on the formulary in the area of an individual ICB, it could be obtained from another area. Bear in mind that there is no financial loss in doing that, because all NICE-approved drugs are subject to a voluntary pricing agreement between the pharmaceutical companies and NHS England. Under that agreement, x number of drugs will be provided at an agreed cost. Anything above that will be reimbursed by the drug company, so the Government and the NHS will not be out of pocket. Why would that not be a good clause? To provide belt and braces, under amendments 20 and 22, all NICE treatments would automatically be added to all formularies within 28 days of market authorisation and every ICB would be obligated to report.

My last area—I will be very brief, Madam Deputy Speaker—is research, which is so important, as we discovered during the pandemic. I would like to draw the attention of the House to some of the challenges. Some of the anti-viral solutions to coronavirus were late to market because we could not get the clinical trials. Why? Because we could not get access to the records of the patients who had had covid or been diagnosed with covid so that we then had the appropriate cohort to be able to test the anti-virals. It therefore seems very clear that research must be taken on board across every hospital trust and across every ICB. If every ICB and hospital trust had in place a system to ensure research was part of their DNA—that they had to report on what research they were undertaking and had an obligation, if they were asked and had the appropriate cohort, to recruit the patient base so that particular clinical trials could take place—we would get more medicines faster to market. I think most people would say that that was a win.

Randox Covid Contracts

Jonathan Ashworth Excerpts

Wednesday 17th November 2021 Commons Chamber

[Gillian Keegan]

I will not give way until I get some facts out, so can hon. Members please bear with me?

Moreover, working with Randox made sense with respect to our cross-UK efforts against covid-19, giving us the ability to use the existing facilities in Northern Ireland for the benefit of the whole United Kingdom. Initial contracts with Randox were procured under regulations that allow us to marshal goods and services with extreme urgency in exceptional circumstances, and these were extremely exceptional circumstances, Mr Speaker. There is no question but that Randox played its part. The initial challenge that it faced was the challenge facing Governments the world over: a shortage of machinery and transport. None the less, it quickly overcame them to play a critical role in our pandemic response.

An independent assessment in June 2020, which the hon. Member for Brent Central (Dawn Butler) might like to read, found that Randox was ahead of all other labs in terms of its process, its plans and its reporting, so a six-month extension was agreed in September 2020. By March this year, Randox was actually exceeding its contract target—

[Jonathan Ashworth (Leicester South) (Lab/Co-op)]

Will the Minister give way?

[Gillian Keegan]

I will get the target out and then I shall let the right hon. Gentleman intervene.

The target that Randox exceeded, which was its contract target, was processing more than 120,000 tests in a single day.

[Jonathan Ashworth]

I am grateful to the Minister for running through the dates. She may recall that the Secretary of State for Health and Social Care came to this House in, I believe, July of last year to announce that 750,000 Randox tests that were being used in care homes had to be withdrawn because they were faulty. Subsequent to that announcement, the Government awarded a £350 million contract to Randox. Why?

[Gillian Keegan]

Why? It was because the Government were trying to get out as many tests as possible. As I said, Randox processed—[Interruption.] Just to put it into context, Randox has, to date, carried out more than 15 million tests for covid-19, and identified more than 700,000 positive cases. That is 700,000 people who might otherwise have gone on to spread the disease. As a result of this testing capacity, they received the right advice to isolate, thereby protecting their friends, their family and society at large.

Covid-19 Update

Jonathan Ashworth Excerpts

Monday 15th November 2021 Commons Chamber

[Jonathan Ashworth (Leicester South) (Lab/Co-op)]

I thank the Secretary of State for advance sight of his statement. Like him, I express my sympathies and thoughts to all those affected by the terrorist incident outside Liverpool Women’s Hospital, and to put on record my thanks to the emergency services who responded so professionally.

The Secretary of State is right to warn of covid rates up-ticking. The Prime Minister, at his press conference a few moments ago, has just refused to rule out a Christmas lockdown. Only last week, when he was asked about the over-65s being banned from public places if they had not had a booster, the Secretary of State said:

“I can’t rule that out”.

I have to say that that is quite a remarkable statement from Parliament’s biggest fan of Ayn Rand. The Prime Minister himself has warned of storm clouds over Europe.

Nobody wants to see further restrictions and they need not be inevitable. If the Secretary of State wants to avoid plan B—we understand why—will he at least consider introducing better sick pay and widening isolation support, so that those who are low paid can isolate themselves should they catch the virus? Will he consider better support for public buildings by putting in place high efficiency particulate air—HEPA—filter systems, because we know the virus is airborne and we need to reduce opportunities for us all to be breathing polluted air?

Will the Secretary of State go further to fix the stalling vaccination programme? I have put it to him for a number of weeks now that there are pockets of the country where the level of vaccination at second dose is nowhere near where it ought to be. For example, here in the Borough of Westminster only 52% of residents have had their second dose. In areas where the Prime Minister imposed a local lockdown last year as part of his whack- a-mole strategy, the second dose rate is: 61% in my own area of Leicester, 67% in Burnley, 64% in Sandwell and 69% in Bolton. There is a similar pattern in other areas. What is he doing to drive up vaccination rates in those areas, because nobody wants to see localised lockdowns?

The Secretary of State talks about children’s vaccination rates, but the Government promised that every child would be offered a jab by half-term. Two weeks or so on from that half-term, only about a third of children have been vaccinated. Why are we so far behind on children’s vaccination coverage? Pfizer has been given the sign-off for younger children. Can he update the House on where we are on younger children and vaccination?

The Secretary of State will know that the levels of infection in society continue to put immense pressure on the NHS. With intensive care unit beds filling up, staff are exhausted. Chris Whitty, the chief medical officer, just said at the press conference that a number of the women in ICUs are unvaccinated pregnant women, so again, what is the Government’s plan to promote the safety of the vaccine for women who have concerns about fertility?

Some hospitals with the most covid patients, such as those in Birmingham, Leicester and Manchester, are those with the most pressured A&Es. We heard from ambulance chiefs today that 160,000 patients come to harm every year because ambulances are backed up outside hospitals. Thousands of patients will suffer serious harm, with some at risk of permanent disability, and others will die because of the pressures on hospitals. Last week, we heard that patients are waiting, on average, close to an hour for an ambulance when suffering a suspected heart attack or stroke, and all 10 ambulance trusts are on high alert. At what point does the Secretary of State accept that the pressures on the NHS are unsustainable?

After years of flat funding, bed closures, understaffing and deep cuts to social care, does the Secretary of State not accept that the NHS across the piece is in crisis? What is he going to do about it? I know that he will get up and tell us about the extra expenditure and the tax rise that he is imposing on working people, but he failed to secure a new funding settlement in the Budget for the long-term recruitment and training of the staff we need. He failed to secure a funding settlement to fix social care now, when we know that one in five beds is occupied by an older person who could be discharged into social care. As we go into the winter—the “brighter” winter than last year’s, as he described it—can he tell us what his plan actually is to get the NHS through this winter without compromising patient care?

[Sajid Javid]

The right hon. Gentleman stated that no one wants to see any further restrictions, and that is absolutely true. As I set out in my statement, one of the best ways that we can all work towards preventing any kind of further restrictions is by making sure that we keep the vaccine wall strong. Although I did not quite hear him say so in his comments, I assume that he welcomes today’s extension of the booster programme, the second doses for 16 and 17-year-olds and the continuing relentless focus on the vaccination programme.

The right hon. Gentleman mentioned other things that can help, such as sick pay. That is why we are still offering sick pay from day one; we also have the hardship payments. He is right to point to the importance of ventilation, and there is very clear guidance on other measures, whether that means ventilation or mask wearing in certain circumstances. All of that can help, and guidance is out there to help people and organisations to make sure that they have the very best advice.

The right hon. Gentleman is right to emphasise the importance of second doses. I think he would welcome the fact that we as a country have got to a place where almost 88% of people who are eligible have had at least one dose and almost 80% have had their second dose. Clearly, there is a gap there, and a huge amount of work by the NHS and others is going into filling that gap. Also, people who have still not even had a single dose remain eligible; our offer of vaccination is evergreen. We are offering the vaccination in vaccination centres, walk-in centres and the temporary vaccination vans, and that is all part of making sure that the vaccines are as accessible as possible. He may well also have noticed the huge communications programme. All the latest data is showing that that is having a huge effect in allowing more people to come forward to access the vaccines if they are eligible.

Vaccination of 12 to 15-year-olds, which he mentioned, is hugely important, and that is why I referred to it in my statement. One million 12 to 15-year-olds out of a total cohort of around 2.3 million, if I remember correctly, have received the vaccine, as have almost 60% of 16 and 17-year-olds, and we have today’s offer of second doses.

The right hon. Gentleman also mentioned the importance of pregnant women in particular coming forward. The MHRA, our independent regulator, could not be clearer about the safety and efficacy of the vaccine for pregnant women. It clearly helps to protect them. We could not make that message clearer but I am glad that he raised it, because it gives us another opportunity to say so in the House.

Lastly, the right hon. Gentleman mentioned winter pressures. We can all see that there is significant pressure on the NHS at the moment, especially on A&E and other emergency treatment. Many of the challenges of the winter are still to come. I emphasise the importance of the flu vaccine programme—the largest that this country has ever seen, which is hugely important for getting through the winter—and the extra funding in the second half of this year. There is £5.4 billion in extra funding both for the NHS and for social care, because they are inextricably linked, especially in terms of their funding; for example, hundreds of millions are going into the discharge programme. That is all part of giving the NHS the support that it needs this winter.

Covid-19 Update

Jonathan Ashworth Excerpts

Tuesday 9th November 2021 Commons Chamber

[Jonathan Ashworth (Leicester South) (Lab/Co-op)]

I thank the Secretary of State for, as always, timely advance sight of the statement.

Vaccination saves lives—it is the best protection against this deadly disease and helps to cut transmission—and we of course want to see NHS staff vaccinated. As has been pointed out many times before, there are already categories of staff for whom a hepatitis vaccination is expected. We will look carefully at the regulations and the equality impact assessment, but I urge the Secretary of State to proceed with caution, because the NHS is already under the most intense pressure this winter; waiting lists are close to 6 million; there are more than 90,000 vacancies across the NHS; and the Chancellor failed to allocate in his Budget funding for training budgets to train the medics we need for the future. There will be anxiety at trust level that a policy, however laudable in principle, could exacerbate some of these chronic understaffing problems. We simply cannot afford to lose thousands of NHS staff overnight.

We do welcome the fact that the Secretary of State has listened to representations from organisations such as NHS Providers and others about delaying the implementation of this until after the winter; we welcome that. None the less, there are still organisations, such as the British Medical Association, that have raised concerns about the practicalities of implementing this policy. Helen Stokes-Lampard of the Academy of Medical Royal Colleges has said that mandatory vaccination is neither “necessary” nor “proportionate”. Will he agree to meet the royal colleges, the BMA, and the relevant trade unions to agree a framework for how this policy will be implemented? Will he outline to the House what success looks like for this policy? Some of the 10% of NHS staff who are not vaccinated include those with medical exemptions, those who are on long-term sick, and those who could not get the vaccine first time round because they were ill with covid. Will he tell the House: what is the actual number of NHS staff who should be vaccinated, but who have not had the vaccine? What is the actual number? In other words, what then does he consider a success? What does full vaccination across the NHS look like for him? Is it 94%, 95%, or 96%? What are we aiming for here? What is his target?

The aim of this policy is presumably to limit those with covid coming into contact with patients, but one can still catch and transmit covid post vaccine, so will the testing regime that is in place for NHS staff—I think it is twice a week at the moment—increase in frequency? Furthermore, thousands of visitors go onto the NHS estate every week, so will visitors to hospitals be asked whether they have had the vaccine or have proof of a negative test?

What analysis has the Secretary of State done of those who are vaccine hesitant in the NHS workforce? What targeted support has he put in place to persuade take-up among those groups? He refers to trusts where take-up is around 80%, so what specific support has he put in place to help those trusts drive up vaccination rates? We know from society more generally that there has been hesitancy, for example, among women who are pregnant and who want to have a baby. That has meant that a significant proportion of those in hospital with covid are unvaccinated pregnant women. A large proportion of the NHS staff workforce are women of a similar age, so is this one of the issues as to why there is hesitancy in certain pockets across the NHS? Will he therefore look at a large-scale campaign to reassure pregnant women of the safety of the vaccine and look at launching an information hub, perhaps a dedicated phoneline, to offer clear advice to women and their partners who might have concerns?

Finally, on vaccination more generally, I do not want to see—I do not think that anyone across this House wants to see—anymore lockdowns imposed on cities such as my own in Leicester, or across Greater Manchester, or Bradford, but in many of these areas, vaccination rates are not good enough. Leicester has a vaccination rate of just around 61%, Bradford 63%, Bolton 69%, and Bury 71%. Generally, on children’s vaccinations, we are only at 28%. On the boosters, there are still around 6 million people eligible for a booster who have not yet had one. The Government’s own analysis shows that people over 70 who are dying from covid or hospitalised should have had a booster, but have had only two jabs.

With Christmas coming, which will mean more mixing indoors at a time when infection rates are still high—one in 50—we are facing six crucial weeks. What more support will the Secretary of State offer now to local communities, such as Leicester, Bolton, Bury and Bradford, to drive up vaccination rates, because nobody wants to see those local lockdowns again.

[Sajid Javid]

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

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

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

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

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

David Fuller Case

Jonathan Ashworth Excerpts

Monday 8th November 2021 Commons Chamber

[Jonathan Ashworth (Leicester South) (Lab/Co-op)]

I thank the Secretary of State for advance sight of his statement and for its content, and I welcome what he has announced today.

This is an unspeakably vile and horrific crime, and across the House our thoughts and hearts go out to the families of Wendy Knell and Caroline Pierce, and to the families of those with deceased loved ones. Those 100 victims—we are talking about the corpses of 100 women —were, as has been reported in the press, violated in the most monstrous, vile and sickening way. Will the Secretary of State confirm that all the families impacted will have immediate access to the psychological counselling and support that they need? Will NHS staff at the hospital, many of whom will themselves be devastated, also have access to appropriate counselling and support?

I welcome the announcement of an inquiry, and I pay tribute to local Members of Parliament across Kent and Sussex who have spoken up on behalf of their communities in recent days. In particular, the right hon. Member for Tunbridge Wells (Greg Clark) said over the weekend that authorities and politicians must

“ask serious questions as to how this could have happened and…establish that it can never happen again.”

I agree, and that is why an inquiry is so important.

Will the Secretary of State offer some precision as to when the terms of reference will be published? Fuller was caught because of a murder investigation, which in itself prompts a number of questions about the regulation of mortuaries. The Human Tissue Authority, which regulates hospital mortuaries, reviewed one of the mortuaries in question as part of its regulatory procedures. It raised no security concerns, but found a lack of full audits, examples of lone working, and issues with CCTV coverage in another hospital in the trust. Will the inquiry consider—or perhaps this is the remit of the Secretary of State—the Human Tissue Authority’s standards, the way it reviews hospital mortuaries, and how those standards are enforced? Will the inquiry recommend new processes that the Secretary of State will put in place if it is found that a mortuary fails to meet the high standards for lone workers, for security and for care?

The NHS has asked trusts to review their procedures; I welcome that. Will the Secretary of State ensure that all mortuaries document and record the access of all staff entering a mortuary, and will he ensure that standards for CCTV are enforced and that CCTV is in place comprehensively across all mortuaries? There are, of course, other premises where dead bodies are stored, such as funeral directors, that do not fall under the regulatory remit of the Human Tissue Authority, so will its remit be expanded, or will the inquiry look at regulation for other premises where bodies are stored?

When our loved ones are admitted into the hands of medical care, that is done on the basis of a bond of trust—that our loved ones will be cared for when sick and accorded dignity in death. That bond of trust was callously ripped apart here. I offer to work with the Secretary of State to ensure that something so sickening never happens again.

[Sajid Javid]

I very much welcome the right hon. Gentleman’s words and his offer to work together on this. I most certainly would like to take him up on that. I think the whole House would want to see us all working together on this.

I reassure the right hon. Gentleman that there is comprehensive support rightly available to all families and friends that have been affected. As I said a moment ago, every family of the known victims has been contacted directly by family liaison officers. They are in touch, and that support will continue for as long as necessary, including dedicated caseworker support, a 24/7 telephone support line and whatever counselling and support of that nature is needed. That includes support for staff in the NHS and elsewhere, where staff will also be affected.

On the terms of reference, that is something that I and my Department will work on with Sir Jonathan. I have already started discussions with him on that, and I am sure that he will want to have discussions with others, including families, their representatives and the Members of Parliament who represent those families.

The work that Sir Jonathan will do will be broad in its nature. I think it has to be, because, as the right hon. Gentleman rightly alluded to, it has to go beyond just hospitals. There are a number of settings that rightly need to be looked at, including, for example, local authority mortuaries, private mortuaries and other settings, such as undertakers. I think the inquiry should be open to all of that, and I think we would want to see that reflected in the terms of reference.

Lastly, the right hon. Gentleman referred to recommendations around access, documentation and CCTV. He is right to raise all those issues. I want to be careful not to pre-empt the final outcome of what is an independent inquiry, but I am sure all those issues will rightly be looked at.

Smoking Cessation: Prescription of E-cigarettes

Jonathan Ashworth Excerpts

Monday 1st November 2021 Commons Chamber

[Jonathan Ashworth (Leicester South) (Lab/Co-op)]

(Urgent Question): To ask the Secretary of State for Health and Social Care to make a statement to the House on the Government’s announcement that e-cigarettes will be available on prescription.

[The Parliamentary Under-Secretary of State for Health and Social Care (Maggie Throup)]

I am grateful to the right hon. Gentleman for his question. Covid has been a stark reminder that our underlying health and lifestyle determine how resilient we are to new risks and diseases. Covid did not strike evenly. People who smoked, were overweight, or struggled with chronic conditions fared worse. We are determined to level up health for a society that is not just healthier but fairer.

Smoking rates are down to 13.9%—the lowest on record—but tobacco continues to account for the biggest share of avoidable premature death in this country. It contributes half the difference in life expectancy between richest and poorest. Action against smoking is therefore at the heart of our mission to level up. Our goal is for England to be smoke free by 2030. To support this goal, we have an ambitious tobacco control plan, and will soon publish a new plan with an even sharper focus on tackling health disparities. Our new Office for Health Improvement and Disparities will support this vital mission nationally and locally.

Ministers from my Department have long been clear, including in this place, that we support e-cigarettes as part of a gateway process for stopping smoking. Last week, the Medicines and Healthcare Products Regulatory Agency updated its guidance on licensing as medicines e-cigarettes and other inhaled nicotine-containing products. The updated guidance sets out the steps needed to license an e-cigarette as a medicinal product, as well as quality, safety and efficacy standards.

Having e-cigarettes as a licensed product will enable them to be available on prescription, which I know will give health professionals greater confidence in their use. I am happy to update the House further when we are closer to having a licensed product. We will continue to consider e-cigarettes, and indeed any other innovative ways of improving the health of our nation, so that we can end disparities and level up to a healthier and fairer country.

[Jonathan Ashworth]

We welcome the announcement that e-cigarettes will be available on prescription. It should be a really significant step in helping 7 million smokers to quit. As the Minister says, smoking kills; it leads to 90,000 deaths and 500,000 hospital admissions every year across the UK. I think she will find broad support for what she has announced, but the House would have preferred to have heard this first, rather than via a press release issued by the Secretary of State on Thursday evening.

The Minister says that she will return to the House when she has more detail. What is the timeframe for that, and when does she expect the first prescriptions for e-cigarettes to be issued? She will know that to those who find it hardest to quit, the offer of e-cigarettes will be important, but it would be much better if it were backed up with access to specialist support services. However, smoking cessation services have been cut by over £22 million in the last five years. Indeed, areas with high levels of heart disease, cancer and stroke are among those hit hardest by the cuts. For example, Dudley has had a 17% cut. Derbyshire, which is where her constituency is, has had a 20% cut. Hartlepool and Wolverhampton have had cuts of 81% to their smoking cessation services.

To be frank, there will be no levelling up unless health inequalities are tackled, and unless we prevent cancer, heart disease, stroke, chronic obstructive pulmonary disease and diabetes where we can, but that demands fully funded local public health services, whereas in recent years, the public health grant has been cut by £1 billion in real terms, and in the Budget last week, it was just maintained at present levels. As the Association of Directors of Public Health has warned, this will mean further

“significant… reductions in public health services and capacity across the country.”

Will the Minister guarantee no further cuts to smoking cessation services? She mentioned the tobacco control plan, which is supposed to be published this year. Can she tell us at what point in the next two months that will happen?

[Maggie Throup]

I welcome the right hon. Gentleman’s support on the issue we are talking about and on our ambitions to make this country smoke free by 2030.

On the MHRA, the updated guidance provided further details on the steps required to license an e-cigarette as a medicinal product. To achieve a licence, a product would need to meet the standards of quality, safety and efficacy expected of a medicinal product. If successful, that would potentially allow safe and effective products to be made available for prescription for tobacco smokers who wish to quit. The update provides clarification and gives more guidance to potential providers on that issue.

The right hon. Gentleman asked about timescales. We anticipate that if a product was put to the MHRA today, for example, there could be an 18 to 24-month process for that product to be licensed. At this stage, we could not say anything further than that, so we are quite a long way from any e-cigarette being licensed and provided as a prescription medicine.

The public health grant increased by £135 million in 2020-21 and by £55 million in 2021-22. With regard specifically to the public health grant for smoking services, it is up to the local authority to decide how it spends its allocation of funding, but in addition, in our long-term plan, we have committed to helping to drive smoking cessation for a number of different groups. We want to provide help with cessation plans for in-patients and pregnant women, and to provide support for those with mental health and learning disabilities to tackle their smoking addictions. All in all, a lot of money is being spent both at the public health level and at the NHS level. We will continue to make sure that we do whatever we can in our power to make England smoke free by 2030.

Dame Carol Black’s Independent Review of Drugs Report

Jonathan Ashworth Excerpts

Wednesday 27th October 2021 Westminster Hall

[Jonathan Ashworth (Leicester South) (Lab/Co-op)]

It is a pleasure to see you in the Chair, Ms Fovargue. I commend all hon. Members who have spoken, with great insight and authority. They made many serious points, which I hope the Minister will respond to.

I pay particular tribute to my hon. Friend the Member for Liverpool, Walton (Dan Carden), for not only his superb presentation of the issues in the Black report but for the way in which he spoke with great eloquence and bravery about his personal story of addiction. I am not ashamed to say that it moved me to tears. I, too, have spoken about how addiction has affected my family and what it meant for me as a child growing up with a father who had a serious drink problem. I know that thousands of people who are, struggling with addiction, or see a loved one doing so, will have heard my hon. Friend’s speech. Although they may never get in touch with or meet him, his speech will have been a tremendous comfort to them, and we should all thank him for his bravery.

I will focus on the addiction crisis that we face as a country. I commend Dame Carol on her excellent report. Her 32 recommendations should be taken forward by the Government, and we need to hear from the Minister exactly what their attitude is to them. I offer to work with her on a cross-party basis on this public health crisis. In the last year, more than 7,000 people in England and Wales have died from alcohol-related causes. Alcohol-related liver disease is increasing. More and more people are dying from drug poisoning across England and Wales. There are, of course, particular issues in Scotland, which Members who represent Scottish constituencies rightly raised.

We are at risk of our society falling into a situation where deaths among those in their 40s and 50s are increasingly either the result of suicide or are drug or alcohol-related. They are called deaths of despair. For quite some time, this been a well known and tragic phenomenon in the United States, and we are at risk of seeing it become a feature here in the United Kingdom. My hon. Friend the Member for Liverpool, Walton is right that addiction is a national crisis, and spot on when he says that it is everywhere but well hidden.

We are having this debate on the day the Chancellor has presented his Budget, but even though this is a public health crisis, and we are still experiencing another public health crisis, public health did not feature in the Budget. As a number of Members have quoted, Dame Carol says:

“Government faces an unavoidable choice: invest in tackling the problem or keep paying for the consequences.”

The Chancellor ducked that choice today, and public health did not get the substantial increase in funding that it needs. As my hon. Friend the Member for Luton South (Rachel Hopkins) said, the Budget comes after real-terms cuts in recent years of £800 million to £1 billion, depending on how we calculate the figures. Those real-term cuts mean that drug and alcohol addiction services have lost £122 million in recent years—a 15% cut.

The Health Secretary likes to use Blackpool as an example of why we need to level up, pointing out the stalling life expectancy there. Blackpool, which has the highest mortality rate in the country for alcohol-related deaths and has the thirteenth highest number of deaths from drug poisoning, has had a £43 per person cut to public health funding in recent years. Manchester, which had the fifth highest number of deaths from drug poisoning in 2020, has had a £33 cut per person in public health funding in recent years. In 2020, Liverpool had the joint highest number of deaths from drug poisoning, with 89 people losing their lives, yet the city has had a £34 per person real-terms cut in public health funding. We look forward to the Minister telling us how local authority drug and alcohol addiction services are expected to cope if the cuts are not reversed—

[Yvonne Fovargue (in the Chair)]

Order. I am afraid I have to call the Minister.

[Jonathan Ashworth]

Will the Minister respond on the public health cuts? When will we see the investment in drug and alcohol addiction services that Dame Carol Black’s report calls for?

NHS England Funding: Announcement to Media

Jonathan Ashworth Excerpts

Monday 25th October 2021 Commons Chamber

[Edward Argar]

I am grateful to my hon. Friend, indeed my friend, and I understand and entirely appreciate where he is coming from. He is an assiduous parliamentarian and quite rightly, as Mr Speaker alluded to, he takes the role of this House extremely seriously, as do I. I suspect that what he says, just as what Mr Speaker said, has been heard loud and clear both in the Department of Health and Social Care and across the Government, including in the Treasury.

[Jonathan Ashworth (Leicester South) (Lab/Co-op)]

Thank you for granting this urgent question, Mr Speaker. I remember a time when Chancellors went into purdah before a Budget. Perhaps that tradition needs to return.

Fortunately, I received the press release on Sunday. I should not have, but I was sent it, and obviously Members should have received it, too. Of course the NHS is in a desperate state and is under crushing, unsustainable pressure, partly because of a decade of under-investment in infrastructure, the cutting of thousands of beds and raids on the capital budget. It means that today, hospitals are facing a repair bill of £9 billion, and we have sewerage pipes bursting, ceilings collapsing and equipment breaking down. The number of safety incidents in hospitals as a result of these problems has increased by 15% in the last year alone. Not only is the equipment old and outdated but, on a head-for-head basis, we have some of the lowest numbers of computed tomography and magnetic resonance imaging scanners in Europe and the highest numbers of fax machines. Capital budgets have been raided throughout the last 10 years. Will the Minister confirm that, in what he is announcing, the total capital budget will be ring-fenced and not raided in the coming years?

The Minister has not mentioned mental health, but we have thousands of unsafe and undignified dormitory wards. Will there be extra capital investment to get rid of them? If so, by when? Will the diagnostics centres that he mentioned be provided and run by the NHS or run and supplied by private sector contractors? He said that we will clear the 1.3 million backlog in diagnostic tests by the end of the Parliament, but nobody wants to see ghost surgical hubs or new equipment standing idle. Who will staff the diagnostics centres? Who will staff the surgical theatres? Who will operate the new equipment?

The Minister mentioned diagnostics staff, but we are short of one in 10 of them. We are also short of 55% of consultant oncologists, short of radiologists and short of 2,500 specialist cancer nurses. Will he guarantee that the Health Education England budget will be not frozen or cut but properly funded to recruit the thousands of extra doctors, nurses and NHS staff needed to provide safe care and bring waiting times down?

[Edward Argar]

I am grateful to the right hon. Gentleman—my constituency neighbour—for his sensible and reasonable questions. I will endeavour to answer each of them in turn. On capital, he will know, not least because his local hospital—mine as well—is in that list to receive capital investment as part of the overall 40 new hospitals programme, that an initial £3.7 billion has been already allocated to the 40 hospitals that we are committed to delivering by 2030. That is investment not just in maintenance but in replacing old or outdated stock with new hospitals to minimise those longer-term maintenance bills. He is right that we must continue to support ongoing maintenance, as we have done. To take one example, we did exactly that by making an extra £110 million available to help support the maintenance of RAAC—reinforced autoclaved aerated concrete—plank hospitals around the country.

On mental health, the right hon. Gentleman is right to talk about capital investment. In the context of those new hospitals, mental health facilities and hospitals are included. They have not been left out; they have got their share.

The right hon. Gentleman also rightly talked about staff, which, as I said to the hon. Member for St Albans (Daisy Cooper), is a key point. We have seen significant increases in the number of doctors and nurses. He is right to highlight the need for continued increases in specialisms such as radiographers and radiologists. I highlighted the increases that we have seen, but we know just how valuable they are. I alluded to the £12 billion that the Secretary of State announced back in September, a significant part of which will go to support the workforce in the delivery of elective recovery.

On how community diagnostic centres and community diagnostic hubs will both be selected and operate, we are working closely with the NHS on exactly how to do that to ensure that the workforce are sufficient and that we do not impose burdens over and above those already imposed on them. I think that I have answered the right hon. Gentleman’s questions, but I am sure that his hon. Friends will come back if I have missed anything.