Coronavirus

Jonathan Ashworth Excerpts

Wednesday 11th March 2020 Commons Chamber

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

I thank the Secretary of State for advance sight of his statement and, as is entirely appropriate, for making arrangements to come to the House at this relatively late hour in these unusual circumstances. I thank you, Mr Speaker, for your constructive engagement with the Opposition on these matters. I know that you will continue that, and we welcome it.

I put on the record my sorrow that two more people have died, and I express our deepest condolences to their loved ones and family. Again, we thank the NHS and Public Health England staff for all they are doing. Will the Secretary of State convey our very best wishes to the Under-Secretary of State for Health and Social Care, the hon. Member for Mid Bedfordshire (Ms Dorries), who is in all our thoughts, as well as to her staff in both her departmental private office and her parliamentary office? I am sure they are all very worried, and I want them to know that they are in our thoughts as well at this time.

We welcome what the Secretary of State has said about Parliament and his advice to keep Parliament open. It is crucial that Members should be able to continue to raise issues on behalf of their constituents and hold Ministers to account. I note that he said that procedures or arrangements may need to be modified, and we look forward to continued engagement on that front.

I also welcome the advice that the right hon. Gentleman has given to people who have come into contact with the hon. Member for Mid Bedfordshire, but can he offer us some extra advice? I have heard about cases of this today. What is the advice for those who work on the estate who feel ill and appear to have symptoms but have not, as far as they are aware, been in contact with the hon. Lady? Should they now be tested as well as a matter of routine? The advice for them is just to self-isolate, but what is the latest guidance on that front?

We welcome the opportunity to discuss emergency legislation. The Secretary of State knows that we have concerns about statutory sick pay and other issues, but we will engage constructively on that front and seek to pass emergency legislation in a timely manner. He also knows that we support the action of the chief medical officer and we very strongly agree that we must at all times be guided by the science. However, may I press him a little further on the epidemiology, the latest medical advice and the appropriate moment when we should move into the so-called delay stage and start adopting some of the more stringent social distancing strategies?

The right hon. Gentleman will have seen that some in the science community—the editor-in-chief of The Lancet, for example—are suggesting that we are not following the epidemiology in the correct way and that we are perhaps placing too much emphasis on behavioural science. Other countries are taking different approaches. Tonight, for example, 3,000 Atlético Madrid fans are arriving in Liverpool to watch the champions league game. If that game was in Madrid, they would not be able to go to the stadium because of the Spanish social distancing measures. Will the Secretary of State explain the thinking in the United Kingdom and why it appears to differ from that of some of the other nations in Europe? Our constituents would welcome that.

I have just a couple of final points, Mr Speaker. On the Budget, it would be churlish of me not to recognise that extra funding was announced for the NHS and social care as part of the covid-19 response. It is something that we have long been calling for. Will the Secretary of State tell us how that money will be allocated, and what happens when that money is depleted? The NHS has said today that it is seeking to scale up intensive care beds sevenfold. That fund will run out at some point and it will need topping up. Do we have to wait for the spending review process in the summer, or will it be topped up over the coming weeks and months?

I am sorry to ask the Secretary of State this again, but when will we get the public health allocations? I would have thought that we would have had them today. Please, let us know when we are getting them. We must do all we can to support NHS staff at this time. The NHS has suggested suspending Care Quality Commission inspections for now. What is his view on that? As he says, this is now designated a pandemic by the World Health Organisation. We agree that we all have to do our bit. The Government have our continued co-operation, because public health and public safety must always come first.

Oral Answers to Questions

Jonathan Ashworth Excerpts

Tuesday 10th March 2020 Commons Chamber

[Jo Churchill]

The closure of any GP practice stirs up understandably strong emotions in the local community. The Care Quality Commission inspection last May highlighted safety concerns at Sandiway surgery, and significant investment is required to bring the premises up to standard. I believe Danebridge medical centre has consulted on and looked into the difficult decision to close the practice and increase appointments and services at the other two local practices. As ever, I am happy to meet my hon. Friend to discuss how we can ensure that Sandiway residents have access.

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

I note what the Minister said about GPs and their role in responding to covid-19, and I entirely agree with her. GPs want to do their very best for their patients. They need quicker access to protective equipment and they need clear guidance. Will the Minister lift all the bureaucracy that GPs currently face? I am talking about appraisals and the quality and outcomes framework end-of-year requirements. Will she suspend those requirements so that GPs can focus entirely on responding to coronavirus?

[Jo Churchill]

I am currently having discussions to make sure that, within the bounds of making sure that patients stay safe, we can lift all bureaucracy where appropriate. We now have more than two thirds of personal protective equipment rolled out into GP surgeries, with the rest arriving imminently.

[Jonathan Ashworth]

Many of our constituents, especially those with underlying conditions—from emphysema to chronic obstructive pulmonary disease, diabetes and asthma—will look to GPs for guidance. When they see what is happening today in Italy, they will be extremely frightened. What is the Government’s advice to those with underlying conditions? Will the Minister tell the House, for the benefit of our constituents, what lessons the Government have learned from the Italians about their handling of coronavirus to date, and why we are taking a different approach?

[Jo Churchill]

As we have laid out from the beginning, our approach will be science-led and about the safety of everybody. That is why at some point in future doctors will make decisions and clinical judgments, and those with existing co-morbidities or at the more serious end of an illness will be triaged up into an appointment first. That may mean that some people have to wait a little longer during this period, but it will always be done on clinical advice and with the safety of the patient at the heart of things.

Coronavirus

Jonathan Ashworth Excerpts

Monday 9th March 2020 Commons Chamber

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

(Urgent Question): To ask the Secretary of State for Health and Social Care if he will update the House on the coronavirus outbreak.

[The Secretary of State for Health and Social Care (Matt Hancock)]

The coronavirus outbreak continues to advance around the world. The number of cases in China and South Korea keeps rising but at a slowing rate, but the outbreak in Iran, Italy, Switzerland and now France and Germany is growing. In Italy alone, we have seen 1,492 more cases overnight and 102 more deaths. Here in the UK, as of this morning, there were 319 confirmed cases. Very sadly, this now includes four confirmed deaths. I entirely understand why people are worried and concerned, and we send our condolences to the families.

The UK response is guided by our four-point action plan: we continue to work to contain the virus, but we are also taking action to delay its impact, to fund research and to mitigate its consequences. Throughout, our approach is guided by the science; that is the bedrock on which we base all our decisions. Our plan sets out what we are prepared to do, and we will make the right choice of which action to pursue at the right moment. The scientific advice is clear that acting too early creates its own risks, so we will do what is right to keep people safe. Guided by science, we will act at the right time, and we will be clear and open about our actions and the reasons for them. These are the principles that underpin the very best response to an epidemic such as this.

On research, I can report to the House that we have made available a further £46 million to find a vaccine and develop more rapid diagnostic tests, and we will continue to support the international effort. Here at home, the NHS is well prepared, with record numbers of staff, including nurses and doctors. I thank all those involved for their work so far. The number of calls to NHS 111 has increased—we have now added an extra 700 people to support that effort—and 111 online is now dealing with more inquiries than the voice calls.

To date, Public Health England has tested nearly 25,000 people, and the time taken to test is being reduced, as we are bringing in a new system for faster results, but of course responding to coronavirus will take a national effort; everyone must play their part. Of course, that means Government, and it also means everyone washing their hands more often and following public health advice, but there is much more we can all do, through both volunteering and supporting the most vulnerable. We will shortly introduce legislative options to help people and services to tackle the outbreak. The Bill will be temporary and proportionate, with measures that will last only as long as necessary in line with clinical advice. I can also report that over the weekend, we initiated action to help 120 passengers on the Grand Princess cruise ship off the coast of California to return home.

We will stop at nothing to get our response right.

[Jonathan Ashworth]

Our thoughts are naturally with the loved ones who have sadly died of covid-19. Let me also record, again, our thanks and gratitude to our hard-working NHS and Public Health England staff.

May I press the Secretary of State a little further? He will know that we have called repeatedly for an emergency funding package for our NHS, he will know that the NHS is short of 100,000 staff, and he will know that critical care beds were at 81% capacity during the week for which the latest figures are available. The Chancellor has said that the NHS will receive whatever it needs. Does the Secretary of State agree that in this Wednesday’s Budget we need to see significantly more resources for the NHS, not just rhetoric?

Scaling up and freeing up capacity in the NHS is now urgent. What is being done to scale up intensive care beds in the NHS, what is being done to expand access to the oxygen and ventilation machines that will be needed, and what is the current capacity of extra corporeal membrane oxygenation beds? We welcome the distribution of personal protective equipment to NHS staff, but does the Secretary of State agree that GPs and social care staff also need access to that equipment?

Those in receipt of social care are some of the most vulnerable, and could be affected extremely badly by this virus. Indeed, many who work in social care are low paid, and if they have to go on sick leave there are huge implications for the delivery of social care. What advice has been given to social care providers and, indeed, local authorities to ensure that the most vulnerable are protected, and what plans are in place to protect staff and increase the number in the social care sector?

Public health directors are expected to play a leading role in local preparations. They need to make decisions about deploying staff—Public Health England, for example, has asked for staff to be seconded—yet they still do not know their public health allocations for the next financial year, which will start in three weeks’ time. We are begging the Secretary of State: please tell local directors of public health what their Budget is for this coming April.

We are still officially in the containment stage. At some point, we presume, we will need to move into the delay stage, when we understand that social distancing measures will be necessary. Many of our constituents are now asking—and I think it would benefit the House if the Secretary of State could explain to them—why we are not yet considering more home working, whether we should be asking those over 65 to isolate themselves, whether we should be cancelling larger events, and whether those returning from northern Italy, for instance, should be quarantined. I think it would help our constituents if the Secretary of State ran through the medical advice, although I understand why he has made the decisions that he has made.

Can the Secretary of State also confirm that once we move into the phase in which measures of this magnitude are proposed, he will come to the House, explain why that has happened, and allow Members to question him? He has hinted, or suggested, that we will need emergency legislation for the mitigation stage. As a responsible Opposition, we would like to sit down with him in order to understand the content of that legislation, because we want to work on a cross-party basis; but let me leave him in no doubt that we also want statutory sick pay for all from day one. Asking people to wait five weeks for universal credit is not a serious solution.

Will the Secretary of State update the House on food supplies and the conversations that he has had with supermarkets? Can he reassure us that our constituents do not need to be panic-buying, as we saw people doing on social media in some parts of the country over the weekend? Finally, does he agree that whatever happens, we must find a way for Parliament to continue to hold Ministers to account so that we can ask questions on behalf of our constituents? However, we continue to offer to work constructively with the Government, because the public health interest and the safety of our constituents must always come first.

[Matt Hancock]

Let me start by concurring with what the hon. Gentleman said about the legislation. It should be taken through on a cross-party basis. I should of course be happy to talk to him about the proposals in that legislation, and also to ensure that the clinicians are able to explain why they are necessary and proportionate. I am grateful for the tone that he has taken throughout, recognising that our responses are led and guided by the science.

The hon. Gentleman asked about the NHS and its preparedness. There are record numbers of nurses and doctors, as I said. The 8,700 increase in the number of nurses over the past year is welcome in this context. We are, as he said, scaling up intensive care beds, and making sure that we have as much availability of ventilation equipment and, crucially, the skilled and trained people to use it, because ventilation equipment, without trained people, is dangerous. On that subject, we are making sure that we have the oxygen needed to go into those ventilation kits, working with oxygen suppliers to make sure that that is available.

The hon. Gentleman also asked whether GPs would have access to the protective equipment that they need, and the answer is yes. We have stockpiles of protective equipment and, again, we will release it at the right time. I am working closely with NHS England to make sure that that happens.

The hon. Gentleman asked about social care. He is absolutely right to draw attention to the importance of making sure that the staff in social care are well enough supported, including if they are sick and, critically, because many people in residential social care are some of the most vulnerable. Those living in the community in receipt of social care are likely to be vulnerable, whether because of prior health conditions or because they are elderly, or both. That is an area of significant attention, and we will update the existing guidance this week with further information for social care providers.

The hon. Gentleman asked about public health budgets which, of course, are going up. He also asked about home working and the cancellation of large events. We are not at this stage proposing the cancellation of mass events, because we are following the scientific advice that that is not what is proposed at this stage. Home working and flexible working are things that, in many cases, are advocated anyway. People will make their own decisions as to when that is appropriate. What we are saying from the Government point of view is that people should follow the public health advice so that, for instance, if they are returning from an affected area and they have symptoms they should stay at home, and that means home working. Over the weekend we added northern Italy to the list of places to which the Foreign Office does not recommend travel except in exceptional circumstances. We recommend that people returning from northern Italy self-isolate if they are symptomatic.

The hon. Gentleman asked about the food supply. We are confident that food supply will continue, even in our reasonable worst-case scenario. We have been talking to the supermarkets for some time about this scenario. I appreciate that on Friday there was discussion about whether every single supermarket executive had been involved in those talks. If any further supermarket executive wants to be involved in those conversations they should get in contact, but those conversations have been ongoing, and it is important, especially as we ask more people to self-isolate and stay at home, that we can ensure that we get supplies that are needed to the people we are asking to stay at home.

The hon. Gentleman asked about statutory sick pay, and I can confirm that we are proposing to put changes to statutory sick pay in the legislation, and I am happy to go through the details with him in the talks that I mentioned at the beginning of my response.

Finally, on Parliament, of course, this is a matter for the whole House. I know that the Commission met this morning, and I think that parliamentary scrutiny of decisions of the magnitude that we are having to take in response to coronavirus and their novel nature is incredibly important, and I will do all that I can to ensure that Parliament remains open.

Health Inequalities

Jonathan Ashworth Excerpts

Wednesday 4th March 2020 Commons Chamber

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

I beg to move,

That this House notes the publication of Health Equity in England: The Marmot Review 10 Years On; is concerned by its findings that since 2010 improvements to life expectancy have stalled for the first time in more than 100 years and declined for the poorest women in society, that the health gap between wealthy and deprived areas has grown, and that the amount of time people spend in poor health has increased across England; agrees with the review that these avoidable health inequalities have been exacerbated by cuts to public spending and can be reduced with the right policies; and calls on the Government to end austerity, invest in public health, implement the recommendations of the review, publish public health allocations for this April as a matter of urgency, and bring forward a world-leading health inequalities strategy to take action on the social determinants of health.

A former Health Secretary, Frank Dobson, whom we sadly lost towards the end of last year, said:

“Inequality in health is the worst inequality of all. There is no more serious inequality than knowing that you’ll die sooner because you’re badly off.”

He was absolutely right. Poverty and deprivation mean that people become ill quicker and die sooner. The current Health Secretary—I understand why he cannot be here for this debate; I do not criticise him for that, given what is going on, and we welcome the Under-Secretary of State, the hon. Member for Bury St Edmunds (Jo Churchill), to the Chamber—said, when we last debated health inequalities, that

“extending healthy life expectancies is a central goal of the Government, and we will move heaven and earth to make it happen.”—[Official Report, 14 May 2019; Vol. 660, c. 153.]

Well, last week the respected academic, Sir Michael Marmot, gave us his assessment of the Government’s attempts to move heaven and earth to narrow those inequalities and extend healthy life expectancy.

[Mr Toby Perkins (Chesterfield) (Lab)]

I absolutely congratulate my hon. Friend on bringing this crucial issue to the Chamber. The health inequalities that we have seen in our communities are bad enough, and the additional inequalities regarding access to GP appointments are even worse, but we are also seeing cuts in local government funding hitting the most deprived areas and adding to those inequalities we are already aware of.

[Jonathan Ashworth]

My hon. Friend makes that point very well. Not only are there inequalities in health outcomes, but inequalities are opening up in access to health services.

I said that I understood why the Secretary of State cannot be here, but he has now joined his colleagues on the Front Bench. I will state, just for the record so that he can be reassured, that I did not criticise him for not being here—I said that I entirely understood why he could not be here. But he is always welcome to listen to my pearls of wisdom, of course.

Michael Marmot’s analysis was shocking, and his conclusions devastating. Let me remind the House of what Professor Marmot found: for the first time in more than 100 years, life expectancy has essentially flattened overall since 2010, and has actually declined for women in the poorest areas of England. In last week’s Opposition day debate, the Health Secretary told Opposition Members that we must debate these issues based on the facts. In fairness, he said that there were life expectancy differences between, for example, Blackpool and Buckingham. [Interruption.] Indeed—gulfs. The Secretary of State made that point. If I may say so, however, I do not believe that he was as clear as he could have been in presenting the full picture for the benefit of Members. When we look at the figures, we see that for more than 100 years, life expectancy has been increasing by about one year every four years. More recently, from 2001 to 2010, the increase was 0.3 years for each calendar year for men and 0.23 years for women. Between 2011 and 2018, the average rate of increase was 0.07 years for males and 0.04 years for women. By any standards, that is a truly dramatic lowering in the rate of improvement in life expectancy between 2011 and 2018.

[Olivia Blake (Sheffield, Hallam) (Lab)]

The latest figures for my city of Sheffield show that life expectancy is nearly nine years more for women from the least deprived decile than the most deprived, and that gap has widened significantly since 2010. Does my hon. Friend agree that, as we approach International Women’s Day and the Budget, we must be mindful of the toll that austerity has taken on our cities and across the country, especially in relation to life expectancy and quality of life?

[Jonathan Ashworth]

I welcome my hon. Friend to her place. She is already an eloquent and passionate fighter for her constituents in Sheffield, and the point she makes is spot on: the reality is that 10 years of austerity has hit women hardest.

[Zarah Sultana (Coventry South) (Lab)]

Will my hon. Friend give way?

[Several hon. Members rose—]

[Jonathan Ashworth]

I will give way to my hon. Friend, but then I must make some progress because, as I understand it, some Members want to make maiden speeches in the debate.

[Zarah Sultana]

I thank my hon. Friend for giving way. Health inequalities between regions are stark, but there are also huge disparities across short distances. In my constituency, the life expectancy of men in St Michael’s is 13 years shorter than it is of men just 2.5 miles away in Stoneleigh, just south of Coventry. Does he agree that to reduce those shocking health differences, the Government need to tackle underlying economic inequality and systemic poverty, and reverse 10 years of Tory cuts?

[Madam Deputy Speaker (Dame Eleanor Laing)]

Order. The hon. Lady’s intervention might not have seemed very long to her, and I appreciate that she is new to the House, but it was very long. I thank the hon. Member for Leicester South (Jonathan Ashworth) for what he said before he took that intervention. It would be much appreciated if the Front-Bench spokespeople took only a few interventions. This is a debate—we can have some interventions—but if Members who intend to intervene and then leave take up all the time at the beginning of the debate, those who sit here all afternoon will not get to speak at the end. We are talking about unfairness here, and that is unfair. The hon. Gentleman has been most courteous, and I know that the Minister has also been courteous in saying that she intends to take only a few interventions.

[Jonathan Ashworth]

I am grateful, Madam Deputy Speaker, but the point made by my hon. Friend the Member for Coventry South (Zarah Sultana) was an excellent one. She is right: this variance in life expectancy and these widening health inequalities are surely intolerable, and we have been sent here by our constituents to do something about it.

Taking your guidance, Madam Deputy Speaker, I will try not to take any further interventions, because I am aware that Members want to make maiden speeches. I am sure that Members who have been in the House a bit longer will testify that I am usually very generous in taking interventions. I hope Members will understand.

I dare say that the Minister will pray in aid the Office for National Statistics data that came out last night, but that is just a single data point. The ONS data also shows that regional inequalities in health have widened since 2010 and confirms that life expectancy for women in the most deprived decile outside London and the north-west has fallen. The rate of increase in life expectancy slowed markedly after 2010, which just happens to coincide with the swingeing cuts to public services and working-age benefits that the Tory Government imposed upon our society.

When life expectancy stops improving, inequalities widen and health deteriorates. That is why Sir Michael Marmot found that time spent in poor health is increasing for men and women in the most deprived areas of England. He found that there is a north-south gap opening up, with some of the largest decreases seen in the most deprived 10% of neighbourhoods in the north-east. He found that the mortality rate among those aged 45 to 49 is increasing. So-called deaths of despair—the combined effect of increasing death rates from suicide, drug abuse and alcohol-related illness—are a phenomenon we have seen for many years in the United States, and they are now making their morbid presence felt here. Perhaps most shamefully of all, the most deprived 10% of children are now twice as likely to die as the most advantaged 10% of children, with children in more deprived areas more likely to face a serious illness during childhood and to have a long-term disability. Surely this stands as a devastating and shameful verdict on 10 years of Tory austerity and cuts. Of course, we have always had health inequalities since the NHS was created 70-odd years ago, but the point is that the Government should be trying to narrow them, not widen them, because as Professor Marmot says,

“if health has stopped improving it is a sign that society has stopped improving.”

Perhaps some will quibble with Marmot’s findings, but they coincide with what others have found. For example, the all-party group on longevity found a few weeks ago that men and women in our poorest areas are diagnosed with significant long-term conditions when they are, on average, only 49 and 47 years old respectively. The Institute for Fiscal Studies’ Deaton review has also warned about deaths of despair, pointing out that rates of long-standing illness and disability among people aged 25 to 54 have been increasing since 2013. The Royal College of Paediatrics and Child Health has today warned of stalling infant mortality rates and how a generation of children is being failed.

I am afraid that this does not suggest that the Government are “moving heaven and earth”, in the words of the Secretary of State, to tackle widening health inequalities, and it does not fill us with much confidence that the Secretary of State is on target to meet his goal of five years’ longer healthy life expectancy by 2035. Will the Minister update us on how we are getting on in meeting that target?

I hope that the Minister, who has responsibility for public health, will also give us some reassurance about the Government’s plans to mitigate the health inequality implications of the covid-19 outbreak. May I press her to explain exactly what the Prime Minister meant at Question Time earlier? Is the Prime Minister saying that statutory sick pay will kick in from day one? If so, we welcome that, but because of low pay, the earnings threshold, precarious work, the gig economy and zero-hours contracts, about 2 million people are not eligible for statuary sick pay. The Prime Minister seemed to suggest at Question Time that such people would be eligible for universal credit, but the Government’s own guidance—I checked the website just before the debate—makes the position crystal clear. The Government’s website says:

“It usually takes around 5 weeks to get your first payment”

in respect of universal credit. The public health implications of that should be blindingly obvious: some of the lowest-paid workers who need to self-isolate will be forced to make a choice between their health and financial hardship. Surely it would be far simpler and smoother just to guarantee statutory sick pay for everyone from day one.

There are also practical problems with sick notes. People are being asked to self-isolate for a fortnight, but as the Secretary of State himself said yesterday, self-certification lasts for only seven days. Will this now be extended from one week to two weeks? I put it to the Minister, as I put it to the Secretary of State yesterday, that we will co-operate and help the Government with emergency legislation to ensure that statutory sick pay for all from day one is on the statue book as quickly as possible. Will Ministers take up our offer?

I dare say that the Minister will want to remind us of the funding settlement for the NHS for the next four years, but she will not be able to remind us of the public health funding settlement for local authorities for the next month because Ministers have not told local authorities what their public health allocations are for the next financial year, which starts next month. It is not good enough to say that the grant overall will increase. These are services that prevent ill health and promote health and wellbeing, as she knows, and those services have been left teetering after years of real-terms cuts of about £1 billion. Smoking cessation services have been cut, obesity services have been cut and drug and alcohol services have been cut, while health visitor numbers are falling, school nurse numbers are falling and mandated health visits are abandoned, yet directors of public health are expected to plan for the next 12 months when they have not even been given their local public health allocations. When will they be published? We are expecting directors of public health to put in place plans to deal with the covid-19 outbreak, and they do not even know their budget lines. That is clearly irresponsible and unsustainable.

It is not just about health funding, however, because that does not tell the full story, as the Secretary of State, in fairness to him, has recognised. He has said before that

“only around a quarter of what leads to longer, healthier lives is…what happens in hospitals.”

We need the Government to focus on the wider social determinants of ill health, too: the childhood experiences we are all exposed to; the neighbourhoods we grow up in; the schools we are nurtured in; the conditions of the work that we do, especially in today’s gig economy; the food we eat; the quality of air we breathe; and the support we rely on in our older years.

Whether it is air pollution, the toxic stress of precarious work or how the benefits system operates, it is those in poverty whose health suffers as a result. Just last week, a longitudinal study in The Lancet found that universal credit is exacerbating mental health issues among claimants, causing tens of thousands to experience depression and mental distress. The Government cannot deny the links between poverty and ill health, because poverty, as Sir Michael Marmot says, “has a grip” on our nation. Some 14 million adults live below the poverty line. We have record food bank usage. More than 4,000 of our fellow citizens sleep rough on our streets, a huge increase since 2010, and over 700 die on our streets.

The poverty a child experiences harms their health at that time and through the rest of their life. Child poverty impairs cognitive development and creates an environment in which mental health and emotional disorders fester. Children in poverty are more likely to be obese, less likely to be up to date with immunisations, and more likely to be admitted to hospital, yet under this Government, the number of children living in poverty has already risen to 4 million, and we have reports of children scavenging in bins. We have 120,000 children pushed from pillar to post in temporary accommodation—a huge increase under the Tories. The working-age benefit cuts that are set to come in will push child poverty levels to the highest since records began in 1961—higher than even in the Thatcher years. That is not levelling up; that is condemning future generations to ill health and shorter lives.

But poverty need not be inevitable and life expectancy does not have to stall. This House should not let health inequality leave an indelible stain on our society. There is a better way, and I commend our motion to the House.

[Several hon. Members rose—]

--- Later in debate ---

[Jo Churchill]

The problems we are dealing with are complex across the piece, which is why we have held the public health budget at the same level this year so that we can start to deliver on them. It is important that local people have local ownership over the issues and challenges in their area, because one size will not fit all.

[Jonathan Ashworth]

rose—

[Jo Churchill]

If the hon. Gentleman will bear with me for just a few minutes, I want to push on rather than incur the wrath of Madam Deputy Speaker.

I am clear that there must be integration across Departments, because dealing with these issues is about having a warm home that is suitable for you and those you love, and about having an environment that sustains your health. It is about good education, so that people are equipped with the skills to look after their health. It is about having jobs that are purposeful and rewarding.

The health inequalities challenge is stubborn, persistent and difficult to change, and I recognise the enthusiasm, energy and frustration that those who will speak in this debate will bring. The Government have firmly signalled their intention to take bold action on these issues. We are committed to reducing inequalities and levelling up. To be effective in reducing health inequalities, we need a long-term sustainable approach across all Departments. Early onset diseases, disability and avoidable mortality are concentrated in poor areas, so this is where we must act if we are going to make the system fairer.

--- Later in debate ---

[Jo Churchill]

I thank the hon. Member—he has just got himself a job as an ambassador. I congratulate him on quitting smoking, because it is hard.

The specialist centre showed me that with the right holistic support and encouragement, the health of both mum and baby can be improved. Such services will be crucial in achieving the ambition of becoming a smoke-free society by 2030.

Similarly, we must tackle the health harms caused by alcohol, and support those who are most vulnerable and at risk from alcohol misuse. Through the NHS plan, up to 50 hospitals with the highest rates of alcohol dependency-related admissions will have alcohol care teams. That could prevent more than 50,000 admissions every five years. Currently, eight of those teams are in operation, providing seven-day services focused on those areas with the highest levels of admissions related to alcohol dependency.

Alcohol addiction has a devastating impact on individuals and their families, and it is unfair that children bear the brunt of their children’s condition. I know that this topic is dear to the heart of the hon. Member for Leicester South (Jonathan Ashworth), who has spoken about it movingly. I pay tribute to the way he has influenced this agenda in this place. I am pleased so say that we are investing another £6 million over three years to help fund support for this vulnerable group.

As is often the case with addiction, there is a toxic mixture of several items. On substance misuse, last Thursday I attended the UK-wide drug summit in Glasgow, along with Home Office Ministers and Ministers from the devolved Administrations. We discussed the challenges associated with drug misuse and listened to Dame Carol Black present her findings from the first phase of her review. I am pleased that my Department will fund and commission the second phase of the review, which will make policy recommendations on treatment, prevention and recovery. Only through the combined efforts of different Departments working together can we hope holistically to improve the health and other outcomes of people with substance misuse problems. Many of us know from our constituency work that they often bounce between various parts of the system. Local authority leadership and action on public health prevention is vital as it will help to focus local measures to decrease health inequalities. As a condition of receiving long term plan funding, every local area across England must set out specific and measurable goals, and ways by which they will narrow health inequalities over the next five and 10 years. Local areas know their localities best.

[Jonathan Ashworth]

I thank the Minister for her kind words about me a few moments ago. It is an issue dear to my heart and, as she knows, I have run three London marathons to raise funds for alcohol charities—although that is not how I am proposing to fund services in the future.

The Minister has to recognise that whether it is smoking cessation services—I am sure the right hon. Member for South West Wiltshire (Dr Murrison) was not implying that I do not think that smoking cessation is important—or drug and alcohol services, they have suffered from a number of cuts. Directors of public health are desperate to know what their funding grant will be for the next financial year, starting in four weeks’ time. Can she tell us when they will know what their allocations will be, so they can fund all the work that she is talking about?

[Jo Churchill]

I appreciate that they need to know those figures, and they will know them extremely shortly.

I strongly believe that high-quality primary care is also crucial to early and preventive treatment, and key to reducing the health inequalities we are discussing. We are improving access to primary care by creating an extra 50 million appointments in general practice within the next five years, growing the workforce by 6,000 more doctors and 26,000 more wider primary care professionals. Within that, we want to target NHS resources, so that they can help their localities to level up. Through the targeted enhanced recruitment scheme, we are recruiting trainees to work in the areas of the country where we have had vacancies for years, particularly rural and coastal areas, such as Plymouth, and the coastal area of County Durham and North Yorkshire. It has already proved highly successful, with a fill rate of close to 100% last year, and over-subscription in many parts of the country. For that reason, we will increase the places on the TERS from 276 to 500 in 2021, and then up to 800 in 2020, to make sure that we get the skilled staff in the areas where they can do most good.

Practices, working together within primary care networks, will be asked to take action on health inequalities, to be agreed as part of the next 2021-22 GP contract. What happens in one’s early years, even before one pops out into the world, has an impact well into later life. Pregnancy and early years are therefore a key time to have an impact on inequalities. In particular, the fact that women’s life expectancy is so challenged is of acute importance to me. We have many challenges as we travel through life, and making sure that we are equipped to make the best of our lives, particularly as we often act as primary carers, is hugely important.

Pregnancy and early years are a key time to have an impact on inequalities. Many babies do get a fantastic start, but sadly it is not the case for everyone. Children in more deprived areas are more likely to be exposed to avoidable risks and have poorer outcomes by the time they start school. It is right that all universal support has a focus on reducing inequalities, and that it is targeting investment to meet higher needs. Many children are benefiting from investment in childcare and early years education. Fifteen hours of free early years education for disadvantaged two-year-olds and 15 hours of free early years education for all three and four-year-olds is key. We have also announced our commitment to modernise the healthy child programme to reflect the latest evidence to support families.

--- Later in debate ---

[Dr Dan Poulter (Central Suffolk and North Ipswich) (Con)]

Thank you for calling me, Madam Deputy Speaker, and I draw your attention to my declaration in the Register of Members’ Financial Interests as a practising NHS psychiatrist.

It is a pleasure to follow the hon. Member for Central Ayrshire (Dr Whitford), who is absolutely right to highlight the fact that health inequalities and their determinants go much wider than the NHS. We are talking about issues to do with housing, poverty and employment. We know that poverty and deprivation are associated with poor health outcomes, both physical and mental, and health inequalities.

In that respect, some of what I am going to say will ask the Government to revisit legislation that we passed as part of the Health and Social Care Act 2012 in relation to addiction services. That is where I shall concentrate my remarks, because we are all aware that addiction services treat some of the most vulnerable people in society, but face particular challenges and treat people often with some of the lowest life expectancies. In that respect, we must recognise that the changing commissioning arrangements, the move towards commissioning of addiction services by local government and some of the funding restraints that are present in the system have impacted on the quality of service delivery.

I shall touch on Dame Carol Black’s report later, but we have seen that, in some areas, there is now minimal provision in many addiction services, and local authorities often look towards the lowest bidder to provide their services. I hope Members on both sides of the House think that is not necessarily a good thing, because we want to see effective addiction services that make a difference for patients and for the people who need them. What we see, though, is that services have deteriorated over the past few years. Services have become increasingly fragmented, and the numbers of dependent opioid users and opioid deaths are rising. That may well be because there are greater medical comorbidities in that particular group, and the age profile may be associated with a higher mortality rate.

Dame Carol Black’s report makes some important points about the challenges. She includes a timeline that indicates how addiction services have been delivered, and she highlights that in 2005, under the previous Labour Government, a ring-fenced, pooled treatment budget was created, centrally funded and allocated on need. Additional funding contributions were made by local authorities, the police and the NHS. Funding increased from £50 million to nearly £500 million during the 2000s, which saw a step change in the ability of addiction services to respond to the needs of local populations.

The biggest change in the delivery of addiction services came with the Health and Social Care Act, in which responsibility for the commissioning of drug and alcohol services moved to local authorities. I do not need to rehearse many of the arguments, but it is worth highlighting some of the challenges we now face. A number of those challenges are a direct consequence of that change in commissioning arrangements.

Overall funding for treatment has fallen by 17%. It is not possible to disaggregate alcohol and drug treatment spend, but many local authorities will have reduced expenditure on drug and alcohol treatment by far larger amounts, with residential services—that is in-patient facilities—being particularly hard hit. The report says:

“Likely many areas are now offering the bare minimum service with large increases in worker caseloads an inevitability. The overall numbers in treatment have fallen at a similar rate as funding with the largest decreases seen in opiate users (and those in treatment for alcohol only).”

At the same time, we are aware from Home Office data that the prevalence of opiate and crack use is increasing and that the number of opiate users in treatment is falling, so there is a challenge for the Government to address in how those services are delivered and commissioned.

We should also recognise that many people who are in need of addiction services have two or more other complex needs. From Dame Carol Black’s report, we see that over 70% are unemployed, close to 40% also need mental health treatment, over 15% are homeless and over 25% have been referred from the criminal justice system. She states:

“Over 60% of opiate clients have two or more complex needs alongside their drug use”.

In the brief time I have left, it is worth reflecting that reduced funding is available to treat those people, but the commissioning arrangements mean that drug and alcohol services are commissioned by local authorities and are no longer integrated or joined up with the NHS, which makes it much harder to treat people with co-existent mental health problems; to find housing solutions, as the NHS does on a daily basis, for patients with a housing need; and to address some of the challenges we face in joining up and integrating care with the criminal justice system.

I hope the Minister will take away those challenges.

[Jonathan Ashworth]

Will the hon. Gentleman give way?

[Dr Poulter]

I will give way very briefly.

[Jonathan Ashworth]

I am grateful to the hon. Gentleman —I am sorry, Madam Deputy Speaker, but I will be very brief.

The hon. Gentleman is making an excellent speech, and I agree with every word—I hope I have not ruined his career prospects by saying that. Does he agree that the way in which services are commissioned, and the lack of integration with wider mental health services, is leading to a problem in recruiting addiction psychiatrists into the sector?

Coronavirus

Jonathan Ashworth Excerpts

Tuesday 3rd March 2020 Commons Chamber

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

May I apologise to you, Mr Speaker, and to the House for being a few minutes late? I had a problem with my printer when I was trying to print the Secretary of State’s statement. I thank him for advance sight of the statement, and, indeed, for advance sight of the action plan this morning. Let me also record my thanks for the briefing that the Leader of the Opposition and I received yesterday from departmental officials, the chief medical officer and the Government Chief Scientific Adviser. I believe that the chief medical officer will brief parliamentarians later today, and I think that that is a very welcome initiative.

The Government’s strategy to contain then delay, research and then mitigate has our endorsement, but may I ask the Secretary of State for some specific clarifications? The first relates to containment and self-isolation. The Prime Minister said today—as, indeed, the Secretary of State has said before—that workers who self-isolate are considered to be on sick leave. Can the Secretary of State confirm that those who need to self-isolate will not need to visit a GP to obtain a sick note, given that the Government’s advice is not to visit a GP? As he will know, 2 million workers on low pay or insecure contracts in the gig economy do not even qualify for statutory sick pay. He will also know that those who are receiving benefits are often asked to physically attend appointments. Can he guarantee that no financial sanction will be imposed if they are asked to self-isolate?

Does the Secretary of State accept that people should not be forced to make a choice between their health and avoiding financial hardship? We are told that he is considering emergency legislation. Will he introduce legislation to remove the barriers to self-isolation so that all workers can receive the sick pay that they deserve? That is in the interests of public health. If he introduces such legislation, we will help him to get it on to the statute book quickly. He could do it this week or he could do it next week, and we will support him. Let us give all workers the security that they deserve, so that they do not have to put their health ahead of their financial interests or vice versa.

More broadly on the NHS and social care, I want to look at the response of the NHS and the support that it will be given through the containment and mitigation phases. We know that around 80% of critical care beds were occupied last week. We know that the NHS is short of 100,000 staff, and we also know that staff working in the NHS, particularly those on the frontline such as GPs, need to be protected as well. Even if we take at face value the Government’s insistence that they have provided the NHS with the resources to deliver the commitments of the long-term plan—we obviously disagree on this, but that is a debate for another time—we can surely all accept that covid-19 is going to lead to increased demand on trusts and the wider NHS. Every trust that sends a sample for testing has to pay for it to be couriered. Trusts are likely to take on more agency staff. If retired staff are encouraged to return to practice, the wage bill will increase. By the way, on retired staff, can the Secretary of State reassure us that protections and oversight will be in place, particularly around returning staff who, as we understand it, will not need to go through a revalidation process for their licence?

The Government have recognised that, as we move into the mitigation phase, non-urgent care may be delayed. I assume that means that trusts will be looking at cancelling elective surgery, which will result in waiting lists growing. Again, this will impact on trusts’ finances. Will the Government provide an emergency funding increase for the NHS resource budget to support the NHS through this next challenging period? Directors of public health still do not know their public health allocations for the next financial year, which starts next month. This means that directors of public health could be cutting the nurse workloads they are responsible for commissioning at a time when those very nurses will be needed to deal with covid-19 cases. Will the right hon. Gentleman announce the public health allocations as a matter of urgency?

On social care, we know that many who are at risk from the virus are the elderly and those with chronic conditions. Social care is responsible for and has a duty of care to many of the people who are most vulnerable to the outbreak. What advice does the Secretary of State have for social care providers, and will extra resources be announced for social care services? On the emergency powers that he has briefed about, will he sit down with us and other Opposition parties to discuss the contents of that legislation?

On the global efforts to contain the virus, we know that disease knows no borders. We cannot build a wall or an iron curtain around these islands. Why, then, are the Government apparently walking away from the EU early warning and response system, which plays such a vital role in pandemic preparations? We have been led to believe that No. 10 has overruled the Secretary of State on this. Also, to contain the virus internationally, countries with weaker health systems need to be supported as well, otherwise, we will not contain the virus. Can the Secretary of State update us on what help he is offering to the World Health Organisation on that front?

This is a serious time. Our constituents will be concerned, and many will be frightened. We will raise our concerns responsibly, but we offer to work constructively with the Government, because the public health interest and the safety of our constituents must always come first.

[Matt Hancock]

I am grateful to the hon. Gentleman for the constructive approach he has taken from the start, and I will seek to address all the questions that he has raised. His first point was about statutory sick pay. For those who need to self-isolate for medical reasons to protect others, that counts as being off sick. They do not need to go to a GP, because there is a seven-day allowance for self-declaration. I hope that that addresses that point directly—[Interruption.] We keep all matters on this under review because, broadly, I agree with him on the principle that he has set out. On the NHS, he asked about resources. We have already increased resources to the NHS and we stand ready to do so if that is necessary.

The hon. Gentleman asked about doctors and revalidation. In legislation, we are proposing to make revalidation simpler. We will bring forward those measures, and of course we will engage with the Opposition on the potential measures as and when that is necessary.

On public health allocations, we have already been clear that the public health grant is going up in aggregate. As my right hon. Friend the Communities Secretary set out last week, we have seen a 4.4% real-terms increase in local authority budgets this year, and the social care budget is going up by £1 billion. I think that that takes into account the issues that the hon. Gentleman raised.

The hon. Gentleman also raised engagement with the World Health Organisation We have supported the WHO with extra funding. On engaging with the EU, I have regular engagement with colleagues from across Europe, and some of the reports I have seen in the newspapers are not accurate, because the questions of engagement with the EU on matters of health security are a matter for the negotiations, as set out on Thursday in the negotiations document.

Medicines and Medical Devices Bill

Jonathan Ashworth Excerpts

2nd reading & 2nd reading: House of Commons & Money resolution & Money resolution: House of Commons & Programme motion & Programme motion: House of Commons & Ways and Means resolution & Ways and Means resolution: House of Commons
Monday 2nd March 2020 Commons Chamber

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

We do not intend to divide the House on the Bill this evening. We understand the need for the Bill because its purpose is for the UK Government to take the powers they need as a result of Brexit. In that respect, we broadly support the principles of the Bill, and we offer to work constructively with the Government on strengthening and improving aspects of it. I have a couple of remarks to make that are related to this, but not to the exact contents of the Bill.

May I start by saying that we all know, not least because of the coronavirus outbreak, that disease knows no borders and defeating disease cannot be done in isolation? International co-operation and research and development are vital and must be accelerated, not hindered. Will the Secretary of State—or indeed the Under-Secretary of State for Health and Social Care, the hon. Member for Bury St Edmunds (Jo Churchill), in her winding-up speech—explain or comment on the press reports today suggesting that the UK is not seeking to participate in the EU pandemic preparedness measures, which may obviously help in relation to coronavirus and other future outbreaks?

I am of course talking about the early warning and response system. It was suggested in The Daily Telegraph today that No. 10 had overruled the Secretary of State. Since then, a former Minister, Baroness Blackwood, has told Sky News:

“My advice while I was in there was that I thought it was absolutely appropriate that we should stay engaged with that system… I think this is something that the EU would want to maintain and we as Britain should seek to maintain.”

I agree with her. I believe it would be foolhardy to pull out of something like this at the best of times, but to do so at the time of an outbreak such as this is surely putting narrow dogma before the public health of the country. I would be grateful if the Minister responded on that.

Secondly, we also learned at the weekend that the UK will not participate in the unified patent court, which will make developing medicines here in the UK more expensive, not cheaper and easier, and it may make doing clinical trials here less attractive. The Government have done lots of briefing on this Bill, but over the weekend they slipped it out while briefing trade magazines that the UK will not be seeking involvement in the unitary patent system. Again, that is disappointing, and I would welcome some remarks from the Minister on that front when she sums up.

However, this Bill is important, and we do not want to see anything that undermines what has been built up over many years in the United Kingdom. We do have much to be proud of in the field of medical innovation. We have long history of taking a leading role in scientific advance and novel trial design. Indeed, the recent deal to give NHS patients early access to a new cholesterol treatment demonstrates that the UK is already a world-leading destination in which to develop cutting-edge treatments. We want to build on that, not undermine it.

Members across the House will be aware that our pharmaceutical industry is the single largest private sector investor in UK R&D and provides many jobs across the country for many of our constituents. We should be proud of that sector and of the contribution that life sciences make in providing access to the most cutting-edge treatments. We should be proud that they are vital to economic growth, enhance UK productivity and ensure prosperity for the future.

Yet while the opportunities before us to develop medicines and medical devices are transformative—both saving lives and radically improving the quality of life for those with the most debilitating of conditions—we also know that things can go wrong. There must never be any compromise on patient safety. Patients put their trust in practitioners, literally trusting them with their lives, and they rightly expect medicine and medical devices to be safe, yet too often in recent years the system has failed patients.

For many years, long before I acquired the health brief in my party, I worked closely with a constituent, Emma Friedmann, who has campaigned for justice for women whose children were impacted by sodium valproate. Members from across this House have spoken with passion and eloquence on behalf of women affected by Primodos. Equally, we have heard heartbreaking stories in this House about the surgical mesh scandal. My hon. Friend the Member for Washington and Sunderland West (Mrs Hodgson), the shadow Minister, has been one the leading campaigners on this issue, along with colleagues across the House. We eagerly anticipate the Cumberlege independent medicines and medical devices review, but there have been other scandals too—breast implants, hip replacements—that are not necessarily covered. We would welcome an update from the Minister about that review and some remarks on whether the Government expect to implement its findings.

My point is that a robust regulatory framework for medical devices to protect patients and users is paramount. We will be testing this Bill to ensure that it provides the safety standards that our constituents deserve, while at the same time ensuring it is forward looking enough to be the correct framework to capture the fast pace of innovation in this field, which the Secretary of State mentioned. However, I believe that the existing regulatory framework has become complex and, arguably, unwieldy.

The House will be aware that much of the regulatory landscape derives from EU directives that have been implemented in domestic legislation. At the end of the transition period, these frameworks will be preserved as retained EU law, but as I understand the Bill, the Secretary of State is proposing to take delegated powers to allow these existing regulatory frameworks to be updated without the need for primary legislation. The Bill requires the Secretary of State, as he said, to have regard to the safety and availability of medicines and medical devices, as well as to the attractiveness of the relevant part of the UK with respect to the life sciences sector. We argue that that attractiveness clause could benefit from some definition, and it would allay concerns if the Government accepted an amendment in Committee to indicate that the Secretary of State, or some other appropriate authority, would always prioritise safety.

The overall effect of the provisions is to confer on the Secretary of State an extensive range of delegated powers to make regulations that span the manufacture of medicines, marketing and supply, falsified medicines, clinical trials, fees, information and offences, and emergencies. That extensive range of powers risks inadequate scrutiny of what will become major policy decisions, and in Committee Labour will press Ministers to support time-limiting those delegated powers.

[Matt Hancock]

I am sure that this debate will continue in Committee, but for clarity, those delegated powers existed under the European Communities Act 1972. The Bill proposes to replace existing delegated powers from the 1972 Act with new powers to make such regulations under the new Act. This is not a new set of delegated powers; it replaces one set with another—indeed, the Bill replaces those powers with clearer safeguards on those matters to which the Secretary of State must have regard.

[Jonathan Ashworth]

That is a welcome clarification, but I am sure the Secretary of State will agree that it is important that decisions made in this field are properly scrutinised through the usual procedures. We are keen to ensure that by tabling an appropriate amendment in Committee.

We are leaving the EU, but Labour Members consider it essential that we stay closely aligned with it on medicine regulation. With that in mind, the Government should clarify their attitude to new EU regulations such as the in vitro diagnostic medical devices regulation, which is due to be implemented in 2022. As I understand it, that regulation will not automatically apply to the UK. Is it the Government’s intention to align with it? The EU tissue and cells directive is being reviewed. Do the Government intend us to align with it? To ensure that the UK remains a world leader in scientific research and discovery, it is vital that we align with guidelines on clinical trials. Otherwise, patients could miss out on participating in trials and the UK could find it harder to access funding.

Effective joint working with our European partners has been vital for the NHS over recent years on everything from infectious disease control to the licensing, sale and regulation of medicines. Patients in the UK can access EU-wide trials for new treatments and the UK has the highest number of phase 1 clinical trials across the EU, as well as the highest number of trials for rare and childhood diseases. It is vital for improving health outcomes in the UK and EU that the UK continues to access those networks. Otherwise, we run the high risk of patients with rare diseases being adversely impacted.

The Bill contains provisions to extend the range of professions that can prescribe medicines, thereby allowing additional health care practitioners such as paramedics and midwives to be given restricted prescribing rights. We welcome those provisions and, assuming that their competencies have been assessed in the same way as those of other prescribers and that equal safeguards are in place, we support that sensible and timely reform. Will there also be plans for a consultation on the future prescribing rights of physician associates and surgical care practitioners?

I will not say too much about part 2 of the Bill, other than to confirm that any measures that help in the battle against anti-microbial resistance have Labour’s support. Part 3 is about medical devices. I have already commented on the use of delegated powers, and as I said at the outset, patient safety must be the priority and we will look to strengthen regulation in that area. Unlike medicines and drugs, many surgical innovations can be introduced without clinical trial data or centrally held evidence. That is a clear risk to patient safety, and it undermines public confidence. Manufacturers are often in charge of testing their own products after faults have developed and they can shop around for approval to market their products without declaring any refusals.

Two years ago, freedom of information requests to the Medicines and Healthcare Products Regulatory Agency revealed 62,000 adverse incident reports that were linked to medical devices between 2015 and 2018, and more than 1,000 had resulted in death. Most devices are cleared through a pathway that allows new products to inherit the approval status of “substantially equivalent” products already on the market. In some cases, after lengthy chains of equivalence-based approvals, the new devices scarcely resemble the original version. Indeed, a study in The BMJ in 2017 found that the family tree of 61 surgical mesh products related to two original devices that were approved in 1985 and 1996. Unless we fix that and put patient safety at the heart of the regulatory framework, patients will suffer and lack confidence.

We know the Secretary of State is a great champion of and has promoted many health-based apps. We need a robust and sophisticated mechanism to evaluate app-based healthcare for use in the NHS, and in Committee we will look to strengthen the regulation of that. We welcome what appear to be plans for a devices register, and I took note of what the Secretary of State said in his interaction with my hon. Friend the Member for Birmingham, Selly Oak (Steve McCabe). We believe, however, that such a register must provide comprehensive data on who, where, how and why devices were implanted, and by whom, so that any recall could be quickly enacted.

To achieve that, we encourage Ministers to strengthen the Bill by reflecting provisions in existing EU regulation and to ensure there are unique device identifiers, such as serial numbers on medical devices that are labelled with tracking information, as well as the power to track the use of those devices, so that the NHS can find and notify affected patients if and when problems arise. By the same token, the Government must reassure us that with such a register it is practically possible to cover all devices, including everything from implants to bone screws, software, apps, mesh, medical cannulas, pacemakers and so on. That is an extensive list of different devices, and I would be keen to hear how such a register could be implemented practically.

[Dr Luke Evans (Bosworth) (Con)]

The hon. Gentleman’s point about “why?” is important. As a doctor, I know that things move on, and when someone leaves medical school 50% of what they have learned is out of date. With devices that are likely to exist for 10, 20, 30 or 40 years, looking back it can be difficult to work out exactly why something was implanted. I would like the Bill to request an explanation from the clinician at the time to say what the thinking was. In the future, that would inform people who needed to deal with someone who had something implanted in their heart 20 years ago, for example, by which time the history might be exactly that—history.

[Jonathan Ashworth]

It has taken me some time, but let me welcome the hon. Gentleman to his place, particularly as a fellow Leicestershire MP. His contribution is well made, and I look forward to working constructively with him on health matters, as well as on various Leicestershire matters. I hope the Minister will reflect on his contribution and answer it when responding to the debate.

The Opposition will not seek to divide the House. We want the Bill to proceed to Committee, and we will work constructively with the Government to improve and strengthen it. It is up to Ministers to allay concerns about patient safety and about the UK’s ability to develop medicines rapidly for NHS patients in the future, and we look forward to a constructive debate on the Bill.

Coronavirus

Jonathan Ashworth Excerpts

Wednesday 26th February 2020 Commons Chamber

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

I thank the Secretary of State for advance notice of his announcement and for sight of his statement. Again, all our thoughts must be with those who have been diagnosed with coronavirus—covid-19—in the UK and across Europe, and again we reiterate our support and put on record our thanks to all NHS staff and public health staff, as well as to the chief medical officer for the leadership he is showing.

The World Health Organisation has warned that countries are “simply not ready” for a pandemic. There has now been significant spread of the virus across the European continent—in Italy in particular, but other cases have been identified in Austria, Croatia and Switzerland. This is clearly now very serious. Yesterday there did appear to be a little bit of a discrepancy, if I may say so, between the travel advice from the CMO and the Secretary of State. Can the Secretary of State clarify for the House what exactly the travel advice is for those travelling or seeking to travel to northern Italy? I think that would be welcome.

We welcome the Secretary of State’s plans for Heathrow. Could he explain to the House why that facility is proposed only for Heathrow, and why similar facilities will not be in place at other major airports, particularly the bigger airports such as Manchester and so on. The Secretary of State mentioned the situation in Tenerife. We are all obviously very concerned about the situation there. Could he offer a little more detail about what advice and support are being offered to British nationals at this hotel?

I note what the Secretary of State says about schools, and I entirely understand it, but we do have several schools in England and Northern Ireland shut completely at the moment for a deep clean, after students and teachers returned from skiing trips. I understand that schools should check relevant websites and get local advice, but does the Secretary of State expect advice to be sent to schools from the Department for Education? If schools have to start shutting, will the Government consider arrangements for alternative schooling provision for those affected?

Will the Secretary of State update the House on how many specialist and extracorporeal membrane oxygenation beds are available across the NHS? We know that the NHS is under intense pressure at this time of year—indeed, today the BBC is running a story about people waiting on trolleys in hospital corridors and so on. The Nuffield Trust has warned that there is “little in the tank” to cope with coronavirus, and Public Health England has announced that tests for the condition are being increased to include people displaying flu-like symptoms at 11 hospitals and 100 GP surgeries across the UK.

Will community trusts and clinical commissioning groups fund the extra work related to coronavirus from their existing baselines, and is the Secretary of State making representations to the Treasury for additional emergency NHS revenue resource in the coming weeks? Will he update the House on how much has been drawn from the capital facility for hospitals to develop specialist pods to quarantine patients, which he announced in his previous statement?

I reiterate that the Opposition want to work constructively with the Government on this issue. We are broadly supportive of the steps taken by the Secretary of State, and I hope he understands that we are trying to be constructive in our questions. We continue to thank all NHS staff for their work at this difficult time.

[Matt Hancock]

I join the hon. Gentleman in reiterating our thanks to all NHS and Public Health England staff, and others, who have been working so hard on this issue. I also express my thanks to the hon. Gentleman, and to every Member of the House with whom my Ministers and I have had dealings. In each and every case, everyone has taken a responsible and proportionate approach. This is not a political matter; this is a matter of keeping the public safe, and everybody in this House has played their part.

Plans are in place in case of the virus becoming a pandemic, but it is not yet certain that that will happen. The plan is still in the phase of “contain”: we aim to contain the virus both abroad and here at home, and prevent it from becoming a pandemic, while of course ensuring that plans are in place should that happen. On travel to Italy, our advice is that all but essential travel is not recommended to the quarantined areas of northern Italy. The advice for people returning from northern Italy is clear: those returning from the quarantined areas should self-isolate, and those returning from the rest of northern Italy should self-isolate if they have symptoms. I hope that advice is clear, and it is available on the Government website.

The hon. Gentleman asked about Heathrow, and we have expanded the availability of supported isolation facilities. Just having Arrowe Park and the facility at Milton Keynes is not appropriate for individual travellers whom we think need to be quarantined, but at the moment those numbers are low, which is why we need only one facility. We chose a facility near Heathrow because that is the point of biggest throughput, but we do not rule out rolling that out more broadly if we think it necessary.

The Department for Education has repeatedly issued advice to schools—I am glad to see the Minister for School Standards in his place—and we issued revised advice this morning. Our goal is to keep schools open wherever we can, as long as that protects the public. Our wider goal is to have minimum social and economic disruption, or disruption to the NHS, subject to keeping the public safe. The message that we do not have a policy of blanket school closures is important. Unless there is specific professional advice, or until there is a positive test, schools should stay open and follow the advice on the GOV.UK website. If they have queries they should contact their regional schools commissioner.

The hon. Gentleman asked about the availability of testing, and as far as we know, we now have testing sites at all A and E facilities across England. We are also planning to introduce home testing, some of which has started already, so that people do not have to go to the pod in front of A and E—that pod has been placed there to ensure that people do not go into A and E, where they might infect others. Home testing is the safest place to be tested because people do not have to go anywhere, and that will allow us to roll out testing to a larger number of people. The hon. Gentleman asked about the available funding. Funding is available from the Treasury. So far we have used it for capital funding, but we will obviously keep this issue under review.

Social Care

Jonathan Ashworth Excerpts

Tuesday 25th February 2020 Commons Chamber

[Matt Hancock]

As I said, life expectancy is rising, Madam Deputy Speaker.

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

The Secretary of State will have seen Sir Michael Marmot’s report, launched today. Indeed, one of his own departmental officials spoke at the launch, because he could not make it, and said that no one could disagree with the analysis. Sir Michael Marmot says that life expectancy advances are flattening and even going backwards—they are decreasing—for the poorest 10% of women. Is Sir Michael Marmot wrong? Is that what the Secretary of State is saying?

[Matt Hancock]

No. What I am saying is that life expectancy, as I have repeated, is going up, but there are areas where it is not, and we will and we must tackle that. The challenge for us as a country is not to try to pretend that things are different to the facts. The challenge here, which Opposition Members will not accept, is that there are parts of the country where life expectancy is advancing rapidly and there are parts where it is not, and we must tackle that. We cannot have a decent policy conversation if half of the debate will not accept the facts on the ground.

The Marmot report was published this morning. It is absolutely critical that we level up life expectancy. The fact that in Blackpool a healthy life expectancy for men is 53 years yet in Buckingham it is 68 years is a disgrace, and we will put that right, but you cannot put things right if you ignore the facts when you are starting.

Wuhan Coronavirus

Jonathan Ashworth Excerpts

Tuesday 11th February 2020 Commons Chamber

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

I thank the Secretary of State for advance sight of the statement and advance notice of the regulations and steps he was going to invoke yesterday.

Our thoughts must be with all those diagnosed with novel coronavirus and those in quarantine, and I place on record again our thanks to NHS and Public Health England staff and all other staff involved in responding to the outbreak.

On the specific issue of the quarantine arrangements, I understand the approach the Government have taken, and the Secretary of State will recall that in response to last week’s statement I asked him what would happen should an evacuee wish to leave Arrowe Park. In response he understandably reminded the House that evacuees had signed contracts that effectively offered passage back to the UK in return for compliance with the Government’s quarantine arrangements. However, given that questions were raised around how practically enforceable those contracts were, and indeed wider questions about what was allowed under human rights legislation, I understand why the Secretary of State has invoked the regulations that he is entitled to do under the Public Health Acts. He has our support.

Quarantine arrangements must be seen to be necessary, proportionate and in accordance with the law, and enforcement of those quarantine arrangements, including with powers of restraint where necessary, must be fully transparent, and the rights and freedoms of the quarantined evacuees must be fully understood so as to ensure they are treated with dignity and respect. We agree that a legislative framework for this is far preferable to the ad hoc contracts that were the original basis for the quarantines.

In order to maintain public confidence in these arrangements, that framework must be understood and scrutinised by Parliament. With that in mind, on the instrument the Secretary of State laid before the House yesterday, at what point will the House get an opportunity to consider the regulations and will that be on the Floor of the House? I appreciate that the Secretary of State is not one of the business managers—although there is going to be a Government reshuffle so who knows by the end of the week—but if he can give us some clarity at this point on that, we will appreciate it.

Turning to the UK response more generally, can the Secretary of State tell the House if he is asking clinical commissioning groups and trusts to make plans should this outbreak turn into a pandemic in the coming months? What work is he doing to ensure that the local plans are robust, and can he guarantee they will be fully resourced? What communications have directors of public health in local authorities received and how will they continue to be kept informed?

Is the Secretary of State confident that NHS 111 has sufficient capacity to deal with increased numbers of calls? Will community health trusts, which I understand will be tasked with visiting suspected patients in their homes to carry our swab tests, be given extra resources to scale up capacity, or will they be expected to fund this extra work from their existing baselines?

With respect to the capital facility the Secretary of State has announced, I understand that hospitals are being given specialist pods to quarantine patients and access to this facility. Can he tell us whether GPs have the necessary equipment and resources to cope with patients who may present with novel coronavirus? Will they be able to apply for this capital facility?

I welcome the Secretary of State’s advice on travel arrangements, not least with school holidays coming up next week. Many people will want clarification. Can he assure us that Foreign Office advice is fully aligned with Public Health England advice, and tell us what monitoring arrangements are in place at airports for flights returning not just from China but other places across the world where there has been a coronavirus outbreak?

Finally, can the Secretary of State update the House on international efforts to share research and intelligence, as well as attempts to find a vaccine, and a timescale? He will know that there is a World Health Organisation summit today, for example.

On behalf of the official Opposition, we again thank all our hardworking NHS staff, particularly those on the frontline, some of whom have been diagnosed with coronavirus. We thank the Secretary of State for coming to the House, and reiterate our hope that he will continue to keep the House updated in the weeks ahead.

[Matt Hancock]

I am grateful for the support of the Opposition for the measures we have taken. The best way to deal with an outbreak like this is on a bipartisan basis. The approach the House has taken has thus far helped to enable as efficient and capable a response as possible to what is obviously a very difficult situation. I entirely agree with the hon. Gentleman that the use of the powers we brought into force yesterday must be proportionate. Enforcement, too, needs to be reasonable. That is a very important consideration.

The hon. Gentleman is right to ask about NHS 111. We will ensure that NHS 111 services have support available. We have plans in place to expand support for those taking the calls on 111 if necessary. Thus far, we have not had to do that. Compared with the huge scale of the millions of calls to NHS 111 that are made, the number concerning those who think they may have coronavirus is still relatively small, but of course we stand ready to do that if necessary.

On timing, as far as I understand it business managers have not yet scheduled the debate on the affirmative procedure for the statutory instruments I presented yesterday. They are made affirmative—as in, they become law—the moment they are signed and thus are law now. They remain in force, with the requirement for Parliament to debate and pass them within 28 days. We will ensure that that happens. They then stay in force for two years, or until the end of the public health emergency is declared.

The hon. Gentleman asked about links with the local authority in Brighton. That is an incredibly important question. I understand that the links have been very close and that the public health officers in Brighton have been working very closely with Public Health England. I thank them, as well.

The hon. Gentleman asked about access to capital for GPs. If GP facilities or other parts of the NHS need capital upgrades, we will of course look at that. In the first instance, though, it is very important that people do not go immediately to their GP, but rather call NHS 111. If they do go to A&E, we will ensure that pods are available so that people are separated from the vast majority of those going to A&E, as we do not want them to be contaminated.

The advice remains absolutely clear: if you suspect that you may have coronavirus, call 111 and do not leave home until you have spoken to a clinician.

Paterson Inquiry

Jonathan Ashworth Excerpts

Tuesday 4th February 2020 Commons Chamber

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

I thank the Minister for advance sight of her statement. I welcome her apology on behalf of the Government and the national health service. I agree that the issues raised in this report are, as she says, shocking, serious and harrowing. Our thoughts are naturally with all the innocent victims of Ian Paterson. As the Minister rightly acknowledged, today is indeed World Cancer Day. We all know that a cancer diagnosis is frightening. When we hand ourselves, or a loved one, over to the care of a medical professional, we are literally trusting them with our lives. For that trust to be callously betrayed for financial gain is unforgivable, and indeed, as it has been found, criminal. I associate myself with the Minister’s remarks in paying tribute to all the patients—all the victims—for their bravery in speaking out. I thank all those who have represented them, including the various legal firms such as Thompsons, and thank Bishop Graham for putting together this report.

The findings from the inquiry were published at 12 noon today, so the House will want time to fully digest and reflect on the recommendations. However, I think we all agree that while we cannot undo the awful harm that Paterson’s criminal action has caused to so many, lessons must be learned and changes made so that something so heinous does not happen again. This report must not remain on a shelf to be forgotten, because it is clear that this was not just the action of one rogue lone surgeon; systemic organisational failures were at fault as well.

Fundamentally, it is time that we addressed the question of safety in private healthcare providers and the way in which clinicians are able to operate in private providers with little oversight. Paterson worked under the so-called practising privileges model, effectively as a self-employed contractor whereby people get a fee on top of their NHS salary for each funded NHS operation carried out in the private sector. Moreover, private hospitals would often, and still often, incentivise referrals from consultants by giving them, for example, shares in those private hospitals. This model creates financial incentives to distort clinical decision making and can lead to over-treatment, as we saw in the Paterson case. Indeed, as the Minister said, earlier this month something similar happened at Spire Healthcare when it was forced to recall hundreds of patients amid concerns over operations carried out by another surgeon.

The inquiry makes a number of recommendations and it is right that we reflect on them, but what is clear is that we need full transparency and accountability. I hope the Government mandate health bodies to quickly implement many of these recommendations. The fight that patients had to go through for compensation is, quite frankly, shameful. Surely it is time that private hospitals employed surgeons directly and required them to be fully liable for their actions. In that way, we would resolve the liability loophole.

About a third of all private hospital income now comes from the NHS for hip replacements, hernia procedures, cataract procedures and so on. Yet safety standards in the private sector leave much to be desired. Unlike in an NHS hospital where there are multi-disciplinary teams on standby to deal with potential complications post-op, in the private sector, post-operative care for patients is often left in the hands of a single junior doctor—a resident medical officer often working many hours, 24/7. In private hospitals there are few critical care facilities available if something goes wrong. Indeed, many patients are often referred back to an NHS hospital when complications occur. In 2018, the previous Secretary of State, the right hon. Member for South West Surrey (Jeremy Hunt), wrote to the private hospital sector telling it to get its house in order on patient safety.

Patient safety must always be a priority. If this demands legislation to change the regulation of private hospitals, I hope the Minister can bring such legislation forward. We would work with her constructively to ensure that it finds its way on to the statute book. It is time to take these issues in the private sector seriously, and we will be happy to work with the Government on that front.

[Ms Dorries]

The hon. Gentleman raises many issues that we can agree on. I am not here to defend the private sector, but I would like to reiterate that women were affected both in the national health service and in the private sector. It does not take into consideration the suffering of those women in the NHS if we just focus on one particular area.

The CQC has had a duty with regard to the private sector since 2015. These cases took place between 1997 and 2011. In 2012, the CQC introduced the revalidation system for doctors, with responsible officers attached to each organisation and an appraisal process that consultants and doctors go through to assess their performance. That happened in 2012 and was introduced by the General Medical Council.

In 2014, we instructed the CQC to appraise the private sector in the same way and hold the private sector to the same standards as the NHS. As I said, I am not here to defend the private sector, but in the CQC examination it came out as good, and I believe that Spire scored 85%.

The hon. Gentleman is right—this is about patient safety and all providers raising their game. As I said, healthcare providers and healthcare professionals have a responsibility to speak out. The time that it took from complaints being made about Paterson to action being taken was too long. We need people in the NHS and the private sector to speak up, to listen and to act more quickly. That is one issue we want to take forward. I will take all his points on board. There is much we agree on. As I said, I am not here to defend the private sector, but women in the NHS suffered as well.