Oral Answers to Questions

Jonathan Ashworth Excerpts

Tuesday 18th June 2019 Commons Chamber

[The Parliamentary Under-Secretary of State for Health and Social Care (Jackie Doyle-Price)]

I thank the Committee for its report, which follows the health ombudsman’s report on the tragic death of Averil Hart. It is clear that we have made significant improvements in eating disorder provision since then, but there is still more to do. We have made considerable progress with regard to treating children, and that progress now needs to be translated to the care of adults with eating disorders. My hon. Friend is right that it is the mental health disorder that has the highest mortality rate. At any one time, 1% of the population will be suffering from an eating disorder, and we need to make this more of a priority to make sure that services are available.

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

rose—

[Mr Speaker]

I know the shadow Secretary of State will be brief, because he will not want to crowd out his colleagues. That would be an uncomradely thing to do—inegalitarian no less—and he would not do that.

[Jonathan Ashworth]

Indeed.

I dare say that this is the Secretary of State’s final outing at Health questions, because we believe he has secured transfer to pastures new. In his time here, he has failed to deliver a social care Green Paper and failed to deliver a prevention Green Paper, while he is privatising Oxford cancer scanning services and we have hospitals charging £7,000 for knee replacements. Does he really think that is a record deserving of Cabinet promotion?

[Matt Hancock]

I am agog—and aghast. Over the last year, we have not only delivered £33.9 billion of increased funding, but we have produced the long-term plan for the future of the NHS. Starting this year, with the money already flowing, we are seeing the biggest increase in funding for community, primary care and mental health services. We have developed our work on the prevention agenda, and we have instituted a new verve and energy into the adoption of new technology in the NHS. I look forward to driving forward all these things in the future.

[Jonathan Ashworth]

Will the Secretary of State tell us about the verve and energy in his own constituency in Suffolk, where 32 health visitors are being cut because of his cuts? He is apparently now supporting a candidate who wants £10 billion-worth of tax cuts for the richest in society. Will that not mean further cuts to public health, further cuts to social care and, ultimately, cuts to the NHS as well?

[Matt Hancock]

For the majority of its 71-year history, the NHS has been run under the stewardship of a Conservative Secretary of State. At this moment, it is getting the biggest funding increase and the longest funding settlement in its history, along with the reforms to make sure that everybody can get the health care that they need.

Listeria: Contaminated Sandwiches

Jonathan Ashworth Excerpts

Monday 17th June 2019 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 on the listeria outbreak related to contaminated sandwiches in hospital trusts.

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

I would like to update the House on the actions the Government are taking to protect the public following cases of listeria in hospitals linked to contaminated food. The NHS has identified nine confirmed cases of listeria in seven different hospitals between 14 April and 28 May this year, all linked to contaminated sandwiches from a single supplier. All the known cases involve in-patients. Very sadly, five people have died. I would like to express my condolences to the families of those who have lost a loved one. I promise that there will be a full and thorough investigation, with severe consequences if there is any evidence of wrongdoing.

Lab testing indicated a link between two cases in Manchester Royal Infirmary and one case in Liverpool. Contaminated sandwiches were identified as the likely cause by Public Health England. The manufacturer—The Good Food Chain—and its supplier, North Country Cooked Meats, have withdrawn the sandwiches, and voluntarily ceased supply of all products on 7 June. They are both complying with the Food Standards Agency on a full product withdrawal. The other cases have been identified at these hospitals: Royal Derby, Worthing, William Harvey in Ashford, Wexham Park, Leicester Royal Infirmary, and St Richards in Chichester.

The risk to the public is very low, but any patients or members of the public with concerns should contact NHS 111 or, of course, 999 if they experience severe symptoms. Listeria infection in healthy people may cause mild illness but is rarely fatal. However, for certain groups it can be much more serious, as we have tragically seen. The NHS, Public Health England and the Food Standards Agency have acted swiftly to identify, contain and investigate the cause of this listeria outbreak. These deaths should never have happened. People rightly expect to be safe and looked after in hospitals, and we must ensure that we take the necessary steps to restore that trust that the public deserve to be able to hold.

This is not just about ensuring that the food we serve in hospitals is safe—the NHS served 140 million main meals to in-patients last year—but, importantly, is also about ensuring that food given to patients is healthy, nutritious, and aids their recovery. So I can inform the House that we are launching a root-and-branch review of all the food in our hospitals—both the food served and the food sold. The Government will work with the NHS to build on progress in three vital areas. First, there is eliminating junk food from hospitals. Since the introduction of the NHS action on sugar scheme, we have halved the sale of high-sugar soft drinks, and trusts are taking action to remove unhealthy food and drink items and replace them with healthier alternatives. After all, hospitals are places for good health. Secondly, on improving nutrition, new national standards for all healthcare food will be published this year. All patient menus will have to ensure that minimum patient nutrition standards are met. Thirdly, on healthier choices, we will work closely with the Hospital Caterers Association and others to ensure that healthier food choices are available across the NHS.

The review will identify where we need to do more, where we need to do better to improve the quality of food in our hospitals, and how we help people to make healthier choices. I know that this is an issue that many colleagues in the House feel strongly about, as do the public. We will do everything we can to ensure that the food we eat in hospitals is both safe and healthy.

[Jonathan Ashworth]

Let me say at the outset that despite our often sharp political differences across the Dispatch Box, the Secretary of State has my commiserations over his entirely noble ambition to want to be the Prime Minister of this country—but perhaps, given Brexit, he has had a lucky escape.

Moving on to the substance of what we have to discuss today, our thoughts really must be with the families of those who have lost their lives. This is, first and foremost, an issue of patient safety and standards of care. Every patient deserves the very safest possible care and absolute confidence about the quality and safety of the food that they are offered. I am pleased that there is an investigation, and I welcome what he said about serious consequences if wrongdoing is found. I am also pleased that he talked about a root-and-branch review, which we have been calling for. As I understand it, NHS Improvement was already reviewing the hospital food plan, which was delayed from April. Is this a new review or an existing review that now has new obligations? Can he explain to the House how the review he has announced interacts with the existing NHS Improvement review?

I know that the investigation will want to get to the bottom of what went wrong and why, and it will no doubt make recommendations for the future, but we would be grateful if the Secretary of State offered some clarification. The first case showing symptoms of listeria was on 25 April, and sandwiches and salads were withdrawn on 25 May. When were Ministers informed, and what action was taken?

I am grateful that the Secretary of State listed the other hospital trusts affected, which include the one in my Leicester constituency. As I understand it, the Good Food Chain was supplying sandwiches to 43 trusts. Can he tell us the status of investigations or what investigations have gone on in the other trusts that he has not listed today? Does he expect cases to emerge in more trusts, and what action is currently under way to contain the spread?

What advice has the Secretary of State received from officials that microbiological controls for listeria need to be improved with respect to pre-packaged sandwiches? Will he consider introducing mandatory testing on all batches of high-risk food? Of course, this is not the first time that there has been a listeria outbreak. There was an outbreak back in 2016, and in response, the Food Standards Agency investigated and issued a report warning Ministers of the dangers posed by pre-packed sandwiches. Can he outline what measures were taken by Ministers in response to that report in 2016?

I have been speaking to hospital catering staff in recent days, and they raised concerns that tight finances and years of capital cuts have left kitchens substandard, which has driven a move to greater outsourcing of catering, with sandwiches and soups steadily replacing hot meals. Recent data show some hospitals spending less than £3 per patient per day. Does the Secretary of State agree that the review he has announced today should be backed up by investment in hospital catering facilities and legally backed, clear minimum-quality standards for hospital food? Healthcare is not just about medicine, surgery, bandages and procedures; it is about nutrition and hydration too. Patients will need urgent reassurance. Can he provide that today?

[Matt Hancock]

The shadow Secretary of State raises important questions, and I will try to address them all. Ultimately, I strongly agree with him that this is about standards of care. People deserve to be able to trust that the food they eat and are given in hospital is safe and, indeed, nutritious and good for their health—that is an important part of this too. Clearly, the most acute aspect of what we are discussing is safety and the lack of listeria in food, but it is part of a much bigger picture, which is why we are having a root-and-branch review.

The hon. Gentleman asked about the hospital food plan, which NHS Improvement has been leading. The review will be wider than, but will encompass, some of the existing work that is ongoing. It is about not only how food is procured by hospitals, but the quality of food. Work on the national standards in hospital food is important. It has been ongoing for several years and will come to fruition very soon. More broadly, dozens of hospital trusts have brought their catering in-house and found that they get better quality food that is more likely to be locally produced and is better value for money. We will be examining that model closely, because I am very attracted to it, and it has the potential to reduce the risk of safety concerns such as this.

The hon. Gentleman asked about timings. The Under-Secretary of State for Health and Social Care, my hon. Friend the Member for South Ribble (Seema Kennedy), was made aware of this outbreak on 4 June. I was informed on 6 June, and we published the details of the outbreak on 7 June.

Before that, Public Health England very swiftly identified that there was a link between these particular listeria outbreaks. It is only because of recent advances in genomic medicine and testing that we could work out—that Public Health England could work out—that the outbreak in Liverpool and the outbreak in Manchester were connected, and therefore identify that the source was outside those hospitals, rather than inside the hospitals, and that is what then identified that this was from the food source. The truth is that there are just over 150 listeria cases a year. It is a notifiable disease, so we are confident that we are properly notified of the various cases. Frankly, it was cutting-edge work by Public Health England that allowed us to connect these different cases and work out that a single source was causing these deaths.

The hon. Gentleman mentioned the 43 trusts that we know bought from the Good Food Chain. We have of course been in contact with all hospital trusts, whether or not they bought from this individual company, to try to make sure that we have confidence in their supplies. The Good Food Chain has confirmed that it has followed advice and has disposed of all products. That is what the Good Food Chain company has said to us, but we are of course reconfirming that with the trusts because we want to get this right.

Finally, the hon. Gentleman asked about investment in food and catering facilities. The truth is that it is important to have the best-quality food in hospitals. I am completely open to upgrading hospital equipment if that is what is necessary, and if it provides value for money. I have been struck by the number of hospital chief executives who have said that from the point of view of patient satisfaction, staff morale, and nutrition and the quality of food, bringing such food supplies in-house is the best thing they have done.

Interim NHS People Plan

Jonathan Ashworth Excerpts

Wednesday 5th June 2019 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 on the interim NHS people plan.

[The Minister for Health (Stephen Hammond)]

The NHS published its interim people plan on Monday, and I laid a written ministerial statement at the earliest opportunity yesterday.

The plan is a first, but critically important, step in ensuring that the NHS has the people, leadership and culture it needs to deliver the NHS long-term plan. The interim people plan has been developed by Baroness Dido Harding, the chair of NHS Improvement, in partnership with frontline staff, NHS employers and a wider range of other representative groups and stakeholders. It takes a tough look at the challenges facing people working across the NHS. It sets out how leaders will be supported to create cultures that empower staff and make sure that every member of staff, regardless of their background, will be able to progress.

Critically, the plan calls for all NHS organisations to set out how they will ensure that the NHS is the best place to work. The recently appointed chief people officer for the NHS will play a vital role in supporting the NHS to do this. The interim people plan sets out a number of practical steps to increase the supply of clinical staff. This includes an extra 5,000 additional clinical placements for nurse training places by September 2019 and a commitment to further expansion of medical school places.

Ultimately, the plan will ensure that the NHS is best able to retain the highly skilled and dedicated staff who choose a career in healthcare, including the most senior clinicians. Therefore, we have listened to their concerns that pension tax changes are discouraging them from doing extra work for patients. That is why Government will consult on how to introduce new flexibilities for this critically important staff group.

But we are not complacent. We know there is more work to do to secure the people, leadership and culture that the NHS needs. My right hon. Friend the Secretary of State has asked Baroness Harding to lead further work over the summer to prepare the final people plan. As has always been intended, the final people plan will be published soon after the conclusion of the spending review, when there will be further clarity on education and training budgets.

I would like to take this opportunity once again to place on record my thanks, and the thanks, I am sure, of everybody across the whole House, to all the NHS staff who do a wonderful job in ensuring that our constituents—their patients—get excellent care.

[Jonathan Ashworth]

It is a pleasure, as always, to see the Minister of State, but the Secretary of State should be doing his day job and be here answering questions about the health service, not playing his Tory leadership games.

Our NHS is struggling with vacancies of 100,000. Our NHS staff are the very best in the world—and none of them wants to be part of a trade deal with the Americans, of course—but they are working under immense pressure because of these chronic shortages. Shortages put patient care at risk, and that means that standards of care are falling. This means that our constituents wait longer to get a GP appointment because we have lost 1,000 GPs. It means that women are turned away from maternity units because we are short of 3,500 midwives. It means that cancer diagnosis is delayed because of shortages in the cancer workforce. As Dido Harding’s report shows, we are short of 40,000 nurses in the workforce, and that is now critical. It means that at a time when mental health problems are increasing—The Lancet reports today on an increase in non-suicidal self-harm—we have actually lost 5,000 mental health nurses since 2010. We have problems in the learning disability sector. Health Education England today warns that because of the shortages in learning disability nursing, we are set to

“hit critical levels in the next five years”,

with vacancies of 30%. We have an ageing population. Adult social care is short of 110,000 staff, and yet district nursing has been cut by 50%. We do not have enough nurses on our children’s wards. Health visitors and school nurses in our communities have been cut.

This NHS workforce crisis is linked to decisions of this Government. As Dido Harding’s report says,

“applications for nursing and midwifery courses have fallen since the education funding reforms”.

Those education funding reforms include the abolition of the bursary. Is not that therefore a damning indictment of the decision by this Government to abolish the bursary, and will the Minister now commit to bringing it back?

The report also references continuing professional development, where budgets have again been cut, by a third. It says:

“Employers have…been investing less in their people, as pressures on NHS finances have grown.”

Is that not an admission that Tory austerity, with nine years of underfunding in the NHS, has contributed to the workforce crisis of today?

The Health Secretary has said that he wants “a new Windrush Generation” of overseas nurses to fill the staffing gap, so can the Minister explain why a commitment to recruit 5,000 extra nurses a year internationally was dropped from the Dido Harding report? Did the Government put pressure on Baroness Harding? On international recruitment, can he guarantee that no one offered a job in the NHS or care sector will be restricted by the £30,000 salary cap, as the chair of Health Education England called for yesterday at the Health and Social Care Committee?

Finally, the Minister referenced the spending review. He will have seen that the Chief Secretary said yesterday at a Select Committee that the spending review is now unlikely to be ready for 2020-21. That means that new funding for training, for Health Education England and for capital investment in public health and social care will not come on stream until 2021—two years away. Does the Minister think that that is an acceptable way to deal with the NHS crisis we are facing? I urge the Minister, for whom I have a lot of respect, to accept that we cannot keep delaying this situation further. The Health Secretary needs to abandon his leadership games, focus on his day job and get a grip.

Clinical Trials and Clinical Research Capability

Jonathan Ashworth Excerpts

Thursday 23rd May 2019 Westminster Hall

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

It is a pleasure to serve under your chairmanship this afternoon, Mr Hanson. I congratulate the hon. Member for Bolton West (Chris Green), my fellow London marathon runner. We have run three London marathons together and we always finish in roughly the same time.

[Chris Green]

Over the past three years, it has been a fantastic experience to be always about two or three minutes behind the hon. Gentleman.

[Jonathan Ashworth]

I think the hon. Gentleman beat me three years ago, although I have just beaten him this year.

[David Hanson (in the Chair)]

I didn’t run.

[Jonathan Ashworth]

I have not yet decided whether to run next year’s marathon, but should we decide to run, it would be great to have you running with us, Mr Hanson—or indeed the Minister.

[Marion Fellows]

As a fellow Front-Bench spokesperson, may I withdraw from any suggestion that I might run the marathon next year?

[Jonathan Ashworth]

That is disappointing, but several SNP colleagues ran it this year. Anyway, today’s debate is not about the London marathon—important though it is.

The hon. Member for Bolton West made an excellent speech. I understand that a reshuffle of junior Ministers is going on; based on the quality of his speech, he is very deserving of elevation to the Government Front Bench. He might not want to join it at the moment, but that is a different issue. He well deserves a call from Downing Street.

The hon. Gentleman made some points that muster consensus across the House, as we heard from the hon. Member for Motherwell and Wishaw (Marion Fellows). We agree with what the hon. Gentleman said about R&D investment and the implications for medical research and trials post Brexit. If I may gently tease him, I think that he and I were on different sides of the debate in the Brexit referendum. I believe that some of the issues that he raised today were not given the prominence that they deserved in the referendum campaign the first time round. He may disagree, but I think that many of the concerns that he rightly raised will come to the fore and prove particularly damaging for our clinical research if we leave the European Union on World Trade Organisation terms. If that is the prospect that the country faces, I believe that we should have another opportunity to ask the British people whether that is what they want—but, again, I digress.

The hon. Gentleman made an interesting observation about the history of clinical trials. I did not know where the term “limey” came from, so I am pleased that he has educated me on that front. He could also have mentioned Edward Jenner, who was born 270 years ago and who discovered a vaccine for smallpox through a clinical trial. Because of Edward Jenner’s work, the world was rid of smallpox; the World Health Organisation declared the world free of smallpox in 1980, its first and only such declaration about any human disease.

That example brings home the importance not only of clinical trials, but of understanding and being guided by the science, especially in an age when more and more anti-vaccination propaganda and disinformation is spreading far too rapidly on social media—typing in “anti-vax” on Facebook or Instagram brings up all kinds of disturbing, poisonous nonsense. Sadly, while more and more measles outbreaks are happening throughout Europe and in parts of the United Kingdom, our measles, mumps and rubella vaccination rates are falling. I put on record the importance of being guided by science and understanding the impact and outcomes of clinical trials, which can make a huge difference to saving lives and improving health.

I entirely endorse the hon. Gentleman’s well-made point about the £30,000 visa cap. It is not just that the cap will affect the country’s science base and our ability to attract the best scientists, research technicians and so on to our shores; at a time when we have 100,000 vacancies across the national health service, including 40,000 for nurses and thousands for midwives and paramedics, and when hospital trusts are struggling to recruit, it is completely counterproductive for the Government to propose a £30,000 visa cap.

This country has a proud history of the national health service attracting people from across the world, including clinicians, nurses and technicians. Of course our international recruitment should always be ethical, but to hinder the NHS in this way will do huge damage to our ability to attract the staff we need in the future. We are told that the Dido Harding review of the workforce will propose that the NHS should recruit 5,000 international nurses a year. I presume that the Government would endorse that, but it suggests that one hand of Government does not know what the other is doing. I appreciate that this is a Home Office matter and not necessarily within the Minister’s remit, but I urge Health Ministers to pressure the Home Office on it, because it is not remotely in the interests of our science community or of our NHS generally.

Throughout the 70-year history of the national health service, scientific research and innovation, of which clinical trials have been a part, has made great advances. Sixty years ago, the first mass immunisation programmes offered polio and diphtheria vaccines to under-15s. I think back to the hospital wards full of iron lungs for people suffering from polio; I was not born then, of course, but we have all seen them in grainy black and white photos. What was once an everyday occurrence for too many children in this country is no longer a feature of our national health service—a striking example of the importance of vaccines, research and clinical trials. An everyday aspect of doctors’ and nurses’ care—tending to people in iron lungs in hospital wards—has been completely transformed because of our research and clinical trials.

There have been all kinds of remarkable innovations in the NHS over the past 70 years. We pioneered the first heart transplants here. Forty years ago, we pioneered in vitro fertilisation. We developed CT scanners, MRI scanners and clinical thermometers. We made great advances with DNA. Seminal trials funded by the British Heart Foundation found that aspirin and clot-busting drugs can save lives after a heart attack. Extraordinary, amazing innovations have taken place in the United Kingdom because of the strength of our science base. We must celebrate that, build on it and give it all the support we can.

As the hon. Member for Bolton West rightly said, the issue has become ever more important in the context of an ageing population. In 1948, at the birth of the NHS, 11% of the UK population were 65 or over. Life expectancy was 71 for women and 66 for men. Today, those figures stand at 82 and 79 respectively, and the so-called “oldest old”—those with a substantial risk of requiring long-term care—are now the fastest-growing age group in the UK. It is projected that by 2040 nearly one person in seven will be over 75; the number of over-85s is set to double over the next 20 years. The changing demographic profile of our society will demand greater investment in science to deliver medical advances.

[Chris Green]

Does the hon. Gentleman agree that, with an ageing population, it is not just about additional support and individual treatments? One of the great challenges with an older population is multiple morbidities, where individuals need a whole series of different treatments. It is quite challenging to deliver, because there are side effects, and drugs and treatments have an impact on each other. The whole environment in which the older population gains that support is far more complicated than it is with younger people.

[Jonathan Ashworth]

The hon. Gentleman makes an excellent point. Partly thanks to 70 years of advances in medical research, life expectancy has generally improved. We have seen huge advances—although there are some problems at the moment, as they appear to be tailing off. We have seen huge advances in tackling mortality rates for heart disease, stroke, chronic obstructive pulmonary disease and so on, although there are still problems in the most deprived areas of the country, which is understandable. Medical research has helped to tackle some of the great killers, and people are living longer. That means we have to tackle a different challenge, which brings me to dementia.

It is Dementia Action Week and I pay tribute to all the volunteers across the country who have organised events for people living with dementia. Every three minutes, someone in the UK develops dementia. Almost all of us know someone who has been affected by dementia. Recent mortality statistics show that dementia and Alzheimer’s disease were the leading causes of death in 2017 for the third consecutive year, accounting for more than one in eight of all deaths.

Some 1 million people in the UK will have dementia by 2025, and that figure will increase to 2 million by 2050. That is the equivalent of a 35% increase in the number of people with dementia by 2025, and a 146% increase by 2050. That large projected increase makes finding a treatment to slow or stop dementia as soon as possible absolutely essential. We will not find a cure or a therapy to slow its progress without real investment, innovation, research and clinical trials. There are no treatments yet that can slow the progression or delay the onset of the diseases that cause dementia, but clinical trials are proving crucial for cures and disease-modifying therapies. For example, the progress in understanding the structure of the relevant proteins, by researchers at the MRC Laboratory of Molecular Biology, could help identify areas of the proteins that could be targets for future treatment.

Finding a cure for dementia would be revolutionary and it would touch the lives of every single person in this country. That in itself is enough to make the case for continuing clinical trials—to convince us that we should do all we can to continue to invest in medical research and to support clinical trials, as the hon. Member for Bolton West has said.

Across many types of different diseases and disease groups, the importance of clinical trials to finding cures is obvious. Let us take cancer. Cancer Research UK is currently supporting the international BEACON clinical trial, the first ever randomised clinical trial to treat children with first relapsed neuroblastoma across Europe. This rare form of cancer, which affects young children, has seen significant improvements in treatment owing to scientific research, meaning global survival rates are higher than ever. We should be proud that the UK is considered the leader in clinical trials, ensuring that the most innovative treatments are available to UK patients. We need to continue to hold that enviable global position.

As the hon. Member for Bolton West said, clinical trials are not just about treatments and cures; they are also good for the UK economy. KPMG has estimated that clinical research in the life sciences supported by the National Institute for Health Research clinical research network has generated £2.4 billion, and supports nearly 40,000 jobs.

Our strength in the UK translates into EU strength, because of our co-operation with the EU. The UK contributed to almost 20% of the total research work carried out in EU health programmes between 2007 and 2016. The UK helps maintain Europe’s key registries and research networks on rare diseases. We co-ordinate the highest number of European registries of all EU member states, including those for childhood lung diseases, Huntington’s disease and familial pancreatic cancer. In 2018, the UK accounted for 28% of all new applications for clinical trial authorisation in the EU.

Given the scale of trade and research between the UK and EU on medicines, and given that disease knows no borders and we share many similar health and demographic challenges, will the Minister reassure us that the effective joint working that we have developed with our EU partners over 40 years will be maintained and not hindered by whatever may be our future relationship with the EU? I appreciate that she may not be able to answer the question—things are moving very rapidly on the Conservative Benches, are they not?—but if she can give us some indication, that would be very welcome.

Developing new medicines depends on the international co-operation that is fundamental for access to clinical trials. At the moment, patients in the UK are able to gain access to 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 so important to improving health outcomes in the UK and EU that the UK can continue to access those networks post Brexit. Again, will the Minister give us the reassurances we are looking for?

The Opposition have called for ruling out no deal, and the House supported that; I appreciate that things are going on in the Tory party and we may well get a new Prime Minister who wants no deal, but if that is where we end up, I remind the Minister that the Association of Medical Research Charities has warned that a no-deal, World Trade Organisation-based arrangement would:

“risk patient safety and jeopardise pioneering medical research in the UK.”

The association adds:

“Collectively, members of the Association of Medical Research Charities fund almost half of all publicly funded medical research nationally as well as over 17,000 researchers. A no-deal Brexit could irreversibly damage our relationship with our most important research partner.”

Will the Minister confirm that it is still her position and the position of the Department of Health and Social Care to rule out a no-deal Brexit?

Will the Minister also tell us about the EU clinical trials directive, which, as she knows, governs clinical trials? From 2020, the new EU clinical trial regulation will come into force. As I understand it, the Government have made a commitment to align with the clinical trial regulation, in response to pressure from campaign and charity groups such as Cancer Research UK, the British Heart Foundation and the Wellcome Foundation, which the hon. Member for Motherwell and Wishaw mentioned, and to which I pay tribute.

Will the Government confirm that clinical research will remain a negotiating priority with the EU? Will the Minister also confirm that agreement will be reached in the negotiations on the UK’s participation in the single assessment procedure and access to the shared central IT portal and database, which underpin the cross-national clinical trials regulation and come into operation in the next year? Not having access to the portal will severely reduce the ease of setting up UK-EU trials, and will hurt our thriving life sciences environment. As things stand, UK researchers will enter the implementation period unsure of what regulatory conditions they will face when they exit it next year. If the Minister can offer us some guidance on that, we would appreciate it.

The hon. Member for Bolton West and the hon. Member for Motherwell and Wishaw also mentioned the EU’s Horizon 2020 scheme, which is due to invest billions in health research across the UK over the next couple of years. It is significant funding and its long-term nature is vital to give security to those medical institutions and universities planning major research projects, but institutions are still waiting for clarity from the Government on where we stand with respect to Horizon 2020 post Brexit. Again, I would welcome some clarification from the Minister.

I wonder whether the Minister can say something about transparency. We must ensure there is transparency in all publicly funded medical research. What efforts is the Department making to ensure that UK Research and Innovation and the Medical Research Council publish the results of publicly funded research in a timely manner? She might be aware that a debate is currently raging at the World Health Assembly on an Italian resolution on the transparency of clinical trials, research and development costs, and medicine prices. I understand that the Minister in the Lords, Baroness Blackwood, represented the UK at the World Health Assembly.

The UK is not supporting the resolution that the Italians propose. It might well be that there are very good reasons—around intellectual property rights and so on—why we would not want to support that resolution. However, I would welcome some clarification or explanation from the Minister on why the UK does not support the resolution on transparency, which lots of EU member states including the Netherlands support—others in the EU are not supporting it, but a significant number of EU member states are supporting it. It would be helpful if we could have that on the record, because there is huge concern about the way the pharmaceutical industry operates. We should celebrate its contributions to the economy, but that does not mean we should not hold it to account.

The Minister will know about the very heated debate that has taken place, both in public and between NHS England and Vertex, on the availability of Orkambi for cystic fibrosis sufferers. Frankly, I think Vertex has behaved shamefully. I now understand that the NHS has made Vertex an offer on a two-year managed access arrangement, and I believe it is offering more for Orkambi. I really hope Vertex takes up the offer.

Time after time, we hear stories of pharmaceutical companies acting quite disgracefully. There was another story today, about four pharmaceutical companies colluding over an anti-nausea drug and causing the NHS to spend 700% more on the drug than it should have done. We need more transparency. It might well be that the Government have good reasons for opposing the resolution at the World Health Assembly, and I would welcome the Minister’s explanation. If we cannot support that resolution because of the implications for our life sciences, what are the Government doing internationally to pursue a transparency agenda on R&D, drug pricing and so on?

I thank the hon. Member for Bolton West for securing the debate for this week—I believe we had Clinical Trials Day on Monday. It might well be that other things are going on elsewhere in our constituencies and in the Commons corridors, which is why only a few of us are present, but that does not mean it has not been a high-quality debate. I thank the hon. Gentleman and look forward to the Minister’s response.

Health

Jonathan Ashworth Excerpts

Tuesday 14th May 2019 Commons Chamber

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

I beg to move,

That an humble Address be presented to Her Majesty, that she will be graciously pleased to give directions that the following papers be laid before Parliament: any briefing papers or analysis provided to the Secretary of State for Health and Social Care or his Ministers since 9 July 2018 including impact assessments of public health spending reductions and any assessments made on falling life expectancy and the minutes of all discussions between the Department of Health and Social Care and NHS England on funding pay risks for Agenda for Change staff working on public health services commissioned by local authorities.

A child born at this very moment in the very poorest of communities—whether in inner cities like Manchester or my own city, Leicester, or in towns such as Blackpool or Burnley—will have a life expectancy that is around nine years lower than that of a child born at this very moment in some of the wealthiest communities, such as Chelsea, Westminster or east Dorset, and they will enjoy 18 fewer healthy years of life. Two babies born today could have years of difference in life expectancy and years of difference in healthy living, due entirely to the circumstances into which they are born. The child born in the very poorest of areas is more likely to leave school obese and almost 70% more likely to be admitted to A&E. That child is less likely to receive measles, mumps and rubella vaccinations, more likely to take up smoking as a teenager, and more likely to need the help of specialist mental health services at some point.

Of course, health inequalities have always existed, throughout the 71-year history of the national health service, but nine years of desperate, grinding austerity have brought us record food bank usage and in-work poverty, and seen child poverty increase to 4 million, with 123,000 children today growing up homeless in temporary accommodation—a 70% increase since 2010. Some 4,700 of our fellow citizens sleep rough on our streets, an increase of 15%, and, tragically, nearly 600 of them die on our streets. There have also been savage cuts to public services, including social care, which have left 600,000 elderly and vulnerable people without support. We have seen nine years of all that, and we should be shocked, because the advances in life expectancy that we all take for granted and that have steadily improved for 100 years are grinding to a halt.

[Diana Johnson (Kingston upon Hull North) (Lab)]

My hon. Friend is setting out clearly why the Opposition called for this important debate. Does he agree that the fact that for the first time since Victorian times we are seeing life expectancy falling for the poorest women in the most disadvantaged communities in our country, where the cuts have been heaviest, is a sad indictment of nine years of Conservative rule?

[Jonathan Ashworth]

Absolutely. Not only are there indications that advances in life expectancy are going backwards, particularly for women, but the Institute for Fiscal Studies has been quite clear today in launching its Deaton review:

“In 2001, women born in the 10% most affluent areas could expect to live 6.1 years longer than women born in the 10% most deprived areas; by 2016, the gap stood at 7.9 years.”

That is why we secured this debate.

[Mr Adrian Bailey (West Bromwich West) (Lab/Co-op)]

My hon. Friend is making an excellent case. In my local authority, Sandwell, life expectancy is in the bottom 15% nationally and the childhood obesity rate is more than three times that of the best local authorities, yet although nationally the Government boast that they are investing money in the health service, public health spending seems to be left out. Does my hon. Friend agree that it is essential that there is a big boost to public health spending, so that local area health budgets do not have devastating long-term obligations in future?

[Jonathan Ashworth]

My hon. Friend is absolutely right and, typically, anticipates the argument I am going to make.

Advances in life expectancy look as though they are going backwards for some of the poorest in our communities, particularly women. Let me take as an example our infant mortality rates, which reflect the survival rates for the very sickest of small babies. Those mortality rates have risen again, for the second year in a row.

[Mr Jim Cunningham (Coventry South) (Lab)]

Two or three weeks ago I visited a food bank, one of the biggest in the west midlands, and what amazed me was that it had to provide clothing for babies, which struck me as very profound. In other words, at least 20,000 people in Coventry are using food banks, and that tells us the consequences on people’s health. When they have to go to these centres for clothing and cots, does that not say something about austerity under this Government?

[Jonathan Ashworth]

It most certainly does. We are seeing a huge rise in the number of children living in poverty and an explosion not just in food bank use but in so-called baby banks, where parents arrive to pick up toys, nappies, and so on—even milk. It really is quite shameful.

We are also seeing an increase in the prevalence of mental health conditions among the poorest. Children and adults in the poorest areas are three times more likely to suffer mental health problems. We are also now seeing an increase in so-called “deaths of despair” for those in middle age, that is, deaths from suicide, drug and alcohol overdose, and alcohol liver disease. They are rising—[Interruption.] The Secretary of State says that that is not true, but it is in the report from the Institute for Fiscal Studies today.

Rates of premature mortality, including deaths linked to heart disease, lung cancers, and chronic obstructive pulmonary disease, are two times higher in the most deprived areas of England compared with the most affluent. Growing up and living in poverty means people get sick quicker and die sooner. It is shameful.

[Matt Rodda (Reading East) (Lab)]

I find the picture that my hon. Friend paints deeply disturbing. In my area in Reading, there is exactly the position that has been described by other colleagues; there is a 10-year gap in life expectancy in one town in the south of England between areas that are only two or three miles apart. Does he agree that it is now time for the Government to listen and take urgent action to address these serious problems that are linked to their own policies?

--- Later in debate ---

[Jonathan Ashworth]

Absolutely. Everybody accepts that advances in life expectancy cannot continue indefinitely, but we need urgent investigation into what is happening here in the United Kingdom. As Michael Marmot, the authority on these matters, says:

“Since 2010, this rate of increase has halved. Indeed, the increase has more or less ground to a halt.”

He goes on to say:

The first thing to say is that we have not reached peak life expectancy. A levelling off is not inevitable. In the Nordic countries, in Japan, in Hong Kong, life expectancy is greater than ours and continues to increase.”

We need to understand what is happening in the United Kingdom. Surely it can be no coincidence that this halt in life expectancy advances has come after nine years of desperate austerity in our society.

Many of us are puzzled by the fact that, although we know that growing up in poverty means that people get sick quicker and die sooner, and we all accept that it is shameful—the Prime Minister accepts that it is shameful and talked on the steps of Downing Street about wanting to tackle these burning injustices—the Government continue to cut public health services by £700 million, including cuts of £85 million in the current financial year.

The stark reality is that these inequalities are costing the NHS £4.8 billion a year, and we are seeing a growing burden of chronic ill health in society. The NHS long-term plan, with its many laudable goals and ambitions, is simply undeliverable without investment in local public health services and a reversal of these deep, swingeing cuts.

[Mary Glindon (North Tyneside) (Lab)]

Does my hon. Friend agree that it is disgraceful that while we are talking about all those cuts to the health service the Government have provided more than £4 billion in tax giveaways to alcohol companies, which is the equivalent of the salaries of 160,000 nurses?

[Jonathan Ashworth]

As my hon. Friend indicates, government is about choices. The Government have chosen to give big tax cuts to some of the richest and most privileged people in society while cutting the public health services on which the most vulnerable rely. That tells us all we need to know about the Tory approach to the national health service.

[Geraint Davies (Swansea West) (Lab/Co-op)]

My hon. Friend has eloquently linked poverty and life expectancy. Does he agree that when we look at statistics such as the 64,000 people who die prematurely as a result of air pollution, that is focused on poorer people who live near busy roads? When we look at people who die from diabetes who have been force-fed processed foods, there is another correlation. The common theme is partly the support that the Government give to manufacturers of sugar, diesel and so on. That disproportionately hits poorer areas and ends up killing more people.

[Jonathan Ashworth]

The House has no greater champion of clean air than my hon. Friend. He is quite right—we have to tackle the wider social determinants of ill health, including pollution. We would introduce a clean air Bill. I am disappointed that the Government do not seem to agree that that is necessary.

I shall run through—[Interruption.] The Secretary of State is chuntering. He will have a chance to respond to the points that I have made. We all accept that smoking is a No. 1 cause of ill health and early death, causing about 115,000 deaths a year. Some 480,000 hospital admissions are attributable to smoking, which is an increase of 6% since 2013. That costs the NHS £2.5 billion a year—it costs primary care £1 billion and social care £760 million—but because of public health cuts, smoking cessation services in communities have faced cuts of £3 million. Over half of local authorities have been forced to cut services. Some local authorities have had to decommission smoking cessation services altogether, and 100,000 smokers no longer have access to any local authority-commissioned support. The number of people using smoking cessation services to help them quit has decreased by 11%—the sixth year in a row that the figure has fallen.

That means that smoking cessation services are, in the words of The BMJ,

“withering on the vine as councils are forced to redeploy funding to other areas”

Those cuts will lead to the risk of more people developing cancer and to higher costs for the NHS. It is a similar story with drug and alcohol services, which have seen cuts of £162 million, with more cuts to come this year.

[Gloria De Piero (Ashfield) (Lab)]

A family came to see me to tell me about their alcoholic son who, in the past year, had been taken to hospital by ambulance 35 times, and had spent four weeks over that year in hospital. All that they wanted was support services to help him get his addiction under control. The urgent care was there, but that was not good enough for them. It is devastating for him, but it makes no financial sense for the NHS.

[Jonathan Ashworth]

My hon. Friend makes an eloquent and powerful point. She is absolutely right. It makes absolutely no sense to cut alcohol addiction services, as that fails a number of vulnerable people in society and only increases pressures on the wider NHS.

The NHS recognises the pressures on alcohol services. It announced in its long-term plan that it wanted to roll out alcohol care teams in hospitals—a proposal that I made at the Labour party conference last year. At the same time, public health budgets are cutting alcohol addiction services in our communities. Years of investment under the Labour Government in drug and alcohol treatment and recovery centres helped to reduce HIV, hepatitis and drug-related deaths, and also helped to reduce drug-related crime and wider social harms. Yet the number of those receiving treatment and in recovery for alcohol problems has fallen by 17% since 2013. When alcohol misuse costs wider society £18 billion a year in crime and lost productivity, and when drug misuse is also a factor in so much crime, surely these cuts represent the very worst type of short-term thinking—cutting proven preventive services for a short-term saving but ignoring the bigger and longer-term human and financial cost.

What about weight management programmes? The Government pride themselves on their obesity strategy, but when the NHS spends £5 billion on obesity, when there are 617,000 hospital admissions because of obesity, when 18% of hospital beds are occupied by a person with diabetes, when 25% of care home residents have diabetes, and when we have one of the worst childhood obesity rates in western Europe, why are weight management programmes being cut in communities? One GP told Pulse magazine:

“This is crazy. It makes conversations between GPs and patients very difficult. They say, “you tell me that I need to lose weight, but the only help you can give me is advice and a diet sheet printed off Google.”

Another GP told Pulse:

“You try to refer someone for bariatric surgery but they can only have it if they’ve undergone 12 months of a weight management programme—but there isn’t one.”

[Nick Smith (Blaenau Gwent) (Lab)]

My hon. Friend is doing very well. Does he agree that movement is medicine and we need far more physical activity strategies in our NHS? For instance, if we had more ParkRun activities, particularly in working class neighbourhoods, that would help a lot in improving health inequalities in many parts of the country.

[Jonathan Ashworth]

Absolutely. I hazard a guess that when the Secretary of State stands up, he will talk about the support for social prescribing that he has given to general practice so that GPs can send people for more of this activity. But, at the same time, public health budgets are cutting these very types of activities. One hand does not know what the other hand is doing.

[Alex Sobel (Leeds North West) (Lab/Co-op)]

I met Professor Paul Gately of Leeds Beckett University, who set up the applied obesity research centre. He also established Europe’s longest-running weight loss camp for young people, although only the better-off families can now afford it. He asked me to ask my hon. Friend and the Secretary of State why the sugar tax cannot be used to fund some of that work.

[Jonathan Ashworth]

That is an entirely sensible proposal, and I look forward to the Secretary of State’s thoughts on it. The sugar tax is supposed to be funding more physical activities for young people across the country.

At a time of rising demand, we have also seen £55 million cut from sexual health services. That has meant that half of councils have reduced the number of sites commissioning contraceptive services, with the result that 6 million women of reproductive age live in an area where one or more services have been closed. Prescriptions of long-acting reversible contraceptives—the most effective form of contraception—have decreased by 8% at the same time as abortion rates for women over 30 have been steadily increasing. We have seen an increase in sexually transmitted infections such as syphilis and gonorrhoea while, because of cuts, the number of sexual health checks has dropped by 245,000. I was particularly shocked to hear the evidence given recently at the Health and Social Care Committee by Dr Olwen Williams from the British Association for Sexual Health and HIV, who said:

“We are seeing neonatal syphilis for the first time in decades and neonatal deaths due to syphilis in the UK…We are seeing an increase in women who are presenting with infectious syphilis in pregnancy, and that has dire outcomes.”

That was the evidence presented to the Committee about the impact of these cuts on sexual health services in communities.

What about the cuts to health visitor numbers? Last week, we heard concerns across the House about falling vaccination rates, which fell for the fourth time in a row. Vaccinations are one of the most important public health interventions we can make, and our health visitor workforce is vital to ensuring their take-up. Yet public health cuts and wider local authority cuts have meant that we have lost 25% of our health visitors. Every 12 hours since October 2015, we have lost one health visitor, and there are no proposals to reverse those cuts in the long-term plan. School nurse numbers have gone down, and the case loads of health visitors and school nurses are increasing. As a consequence, parents and small children are missing out. According to the Government’s own figures, 14.5% of children are not receiving a six to eight-week review on time, and 24% are not receiving a 12-month review on time. With high caseloads, there are increased risks of abuse or poor health of babies not being picked up, of maternal mental health issues not being picked up and of domestic violence and trauma not being picked up.





We need investment in the wider public health workforce and we need to expand training opportunities. The Government should honour their commitment to pay the public health workforce properly, and especially those on “Agenda for Change” terms and conditions. Last year, when the Government announced a pay increase for staff, they said they would honour that for all public health staff working for local authorities or in the voluntary sector. We are now told that the Government and the NHS are refusing to honour a pay rise this year. I hope the Secretary of State will tell us whether all public health staff employed on “Agenda for Change” terms and conditions will get a pay rise this year.

We are pleased that the Secretary of State has joined us today from the leadership campaign trail. We look forward to his response but, whenever he is asked about public health cuts, he says, “Well, prevention is better than cure.” Who would disagree with that? He never tells us that he is going to stand up to the Chancellor and demand that these cuts be reversed. He simply says that individuals’ attitudes have to change. But it is not just about individuals; it is about the services that are available in local communities. He gives the impression that he just wants people to look after themselves. For example, he said that those who present at hospital with ailments related to alcohol abuse will be targeted for a “stern talking to”—that is his answer. He needs to take it up with The Sunday Times if that was not what he said.

We know that the Secretary of State loves an app, and one of his solutions is more targeted advertising on Facebook. Whenever there is a problem in the NHS, he says that we are going to have more apps; that is the solution to everything. I am told that he and his old friend George Osborne are now part of a WhatsApp group called “Make Matt Hancock Great Again”—there are some problems that even an app cannot fix.

This is not leadership. Real leadership would be reversing the cuts to public health services and intervening to stop the health inequalities and the rolling back of life expectancy advances. Only Labour is offering that leadership on health inequalities. We will fully fund public health services. We will not cut public health services. We will adopt a health in all policies approach; this Government will not. We will invest in the health and wellbeing of every child and meet our ambition to have the healthiest children in the world. Longer, healthier, happier lives will be our mission. I commend our motion to the House.

--- Later in debate ---

[Matt Hancock]

The public health grant is of course an important part of this, but it is only one part. The overall funding of the NHS is rising by £33.9 billion, the first £6.2 billion of which came on stream last month. I understand the hon. Lady’s point. That is on the money. On the health inequalities, I entirely agree with her that they should be tackled. Doing so is at the heart of the NHS long-term plan. It is a vital task that we do not shirk. Indeed, we embrace it and are addressing it.

Let me turn to the details of the motion. While I care deeply about making sure that we have the best possible health in this nation and the strongest possible NHS—and we are prepared to put the resources in to see that happen—I also care about good governance of the nation. The way that we are run is one of the reasons this country has been strong over generations, and I believe that using the Humble Address to undermine the ability of experts, clinicians, and civil servants to give me the benefit of their frank and wise advice not only undermines me as Secretary of State, but makes it harder to make good decisions. I know the shadow Secretary of State sits on the Front Bench with revolutionaries, but I thought he was a grown-up. I do not know what his mentor, Lord Mandelson, would make of his posturing today. Of course, we will object to the motion and, if he searched the depths of his heart, he would too.

The hon. Gentleman has obviously had a missive from the Leader of the Opposition’s office—LOTO, as it is called—telling him to present the Humble Address, but it is not his style. I hope that we can get back to debating these issues on a proper motion in the future. I respect and like the hon. Gentleman: he is a really nice guy. If he had asked for the information directly—perhaps he could have sent me a message on the app—

[Jonathan Ashworth]

I’m not on it.

[Matt Hancock]

Now that is an insult! There are only two types of people in the world—the people who are on the Matt Hancock app and the people who are not on the Matt Hancock app yet. I can see that the hon. Gentleman falls into the latter category. I digress.

If the hon. Gentleman had asked for the information directly, I would have been more than happy to provide it. To show willingness, I am happy to provide the House with the information requested in the motion. We will republish the impact assessments on the public health grant. They have already been published, but I am happy to do that. We will republish the Office for National Statistics stats and the Public Health England report on life expectancy. We will publish a statement on the “Agenda for Change” decision that he mentioned. It had been released already this week, as it happens, before we saw the motion.

If the hon. Gentleman wants to know about the “Agenda for Change” pay rises, I am delighted to keep talking about them. Perhaps he should ask the 1 million NHS staff who last month received a pay rise of up to 29%, including £2,000 extra a year for new full-time nurses. That came into force at the start of last month. I will debate with him the “Agenda for Change” pay rises any day of the week. Because the Government are running a strong economy, we can afford to put the money in to make sure that under “Agenda for Change” nurses get the pay rise they deserve.

--- Later in debate ---

[Jonathan Ashworth]

I am delighted that the Secretary of State wants me to join his Make Matt Hancock Great Again WhatsApp group. Please add me to it. Perhaps in the group I can get some style tips from him, because he looked rather Alan Partridge-esque in the photos on Friday. I digress.

On Agenda for Change, it was reported in the Health Service Journal that the Government will not honour the pay rise for public health staff such as health visitors, sexual health staff and school nurses—all the sort of staff we have been talking about this afternoon—and that there was a dispute between NHS England and the sector about who will fund that £50 million pay rise. Is he telling us today that the Government will honour that pay rise for public health staff working in public health services?

[Matt Hancock]

We are honouring the pay rise proposed—of course we are. I love the HSJ, which is an absolutely terrific journal, but it was wide of the mark on that. We are putting in record funding.

Tessa Jowell Brain Cancer Mission

Jonathan Ashworth Excerpts

Monday 13th May 2019 Commons Chamber

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

I thank the Secretary of State for an advance copy of his statement. We warmly welcome today’s announcement. His tribute to our much-missed friend and colleague was moving and powerful. It is an extraordinary testament to Tessa’s bravery that in the final harrowing months of her life, faced with a highly aggressive and very-difficult-to-treat cancer, and in full knowledge of the life expectancy associated with such a devastating cancer, Tessa led from the front to campaign for better brain cancer treatment for others. She spoke with extraordinary courage in the Lords, she brought the then Secretary of State and me together, and she convinced Ministers to shift policy, not by garnering sympathy, understandable though that approach would have been, but by persuasion based on facts and policy argument. It was typical Tessa.

Tessa would have been delighted by the Government’s announcement—some 2,000 brain cancer patients a year will now benefit from the “pink drink” solution—but she would be keen to go further still. Almost 11,000 people are diagnosed each year with a primary brain tumour, including 500 children and young people, which is 30 people every day, and more than 5,000 people lose their lives to a brain tumour each year. Brain tumours reduce life expectancy by around 20 years, which is the highest of any cancer, and are the largest cause of preventable blindness in children.

We live in hope of dramatic improvements, but further research is needed, given that less than 2% of the £500 million spent on cancer research is dedicated to brain tumours. I welcome the Secretary of State’s commitments on research, but does he agree that we also desperately need more involvement in clinical trials? The number of brain cancer patients taking part in clinical trials is less than half the average across all cancers. How will the Government encourage more trials and data sharing?

Finally, we know that the NHS remains under considerable strain generally. The 93% target for a two-week wait from GP urgent referral to first consultant appointment was not met once last year. Neurosurgery is no exception. In March 2019, the 18-week completion target for referral to treatment pathways stood at 81.3% for neurosurgery— 5% lower than the average for all specialties—which made neurosurgery the worst performing specialty. This is a question of both resourcing and staffing. I know the Secretary of State has his answer on revenue resourcing—we disagree, but we will leave our political arguments for another day—but on workforce there are vacancies for more than 400 specialist cancer nurses, chemotherapy nurses and palliative care nurses, and there are diagnostic workforce vacancies too.

Meanwhile, the staff who are there are reliant on outdated equipment, and we have among the lowest numbers of MRI and CT scanners in the world. Failing to diagnose early is worse for the patient and more costly for the NHS, so will the Secretary of State update us on when we can expect Dido Harding’s workforce plan? Can he reassure us that the cancer workforce will be a key part of that plan? On equipment and MRI scanners, can he guarantee that the NHS will see increased capital investment budgets in the spending review so that it can upgrade existing equipment and increase the number of MRI and CT scanners?

Overall, however, we welcome today’s announcement. It is a fitting tribute to our friend Tessa Jowell, and like Tessa herself will touch the lives of so many.

[Matt Hancock]

The cross-party tone of this discussion demonstrates what we can achieve when we work together. This is not just about Baroness Jowell, who did so much and was so brave in how she made her case—in the last few months in particular, but before that as well. It is about the many others who have worked together, including the many who were inspired by her words to work harder on brain cancer.

In truth, the amount of research money going into brain cancer—and therefore the number of clinical trials, which the hon. Member for Leicester South (Jonathan Ashworth) mentioned—was too low. There were so few clinical trials because research overall was too low. That is partly because brain cancer is a very difficult disease to treat. Just because it is difficult, however, does not mean we should not try, so we have increased the amount of research money, and I am determined to see an increase in the number of clinical trials and to make sure that the data from them is properly used and openly disseminated.

The hon. Gentleman asked about the cancer workforce. As I mentioned, of course we will need more people to treat cancer. That is partly what the £33.9 billion extra is all about.

The hon. Gentleman is also right to say that we need more early diagnosis. The truth is that, while the NHS is very good at treating cancer once it has been spotted—indeed, it is one of the best in the world—our cancer survival rates in this country need to improve through early diagnosis. That means giving more support to community services, strengthening primary care and ensuring that we have the diagnostic tools that he mentioned. We have more MRI scanners and more Linux machines for treatment purposes, but of course there is always more that we can do.

Oral Answers to Questions

Jonathan Ashworth Excerpts

Tuesday 7th May 2019 Commons Chamber

[Matt Hancock]

Yes, I entirely understand my hon. Friend’s concerns. We are acting to make sure that there is better access. We have a review of access to primary care. But, more than that, the biggest increase of the £39.9 billion of extra taxpayers’ money that we are putting into the NHS is in GP access, primary care and community care to make sure that we get ahead of the curve and help people to stay healthy rather than just treat them in hospital.

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

Can the Secretary of State explain why 200,000 nurses have left the NHS since 2010 and why today we are short of 40,000 nurses?

[Matt Hancock]

The good news is that we have record numbers of nurses in the NHS. We have more staff in the NHS than at any time in its history. While of course in any very large organisation like the NHS there is always turnover, what matters is having the people we need. We are putting more money in, we are going to need more people, and we are developing a plan to make that happen.

[Jonathan Ashworth]

We have about 90 nurses a day leaving the NHS, so rather than posing for the newspapers by the stables like a character from a Jilly Cooper novel, why does the Secretary of State not show some actual leadership and reverse the cuts to development, reverse the cuts to training places and reverse the abolition of the training bursary so that we can start to recruit the nurses and midwives our NHS needs today?

[Matt Hancock]

What I will not reverse is the increase in the number of people who are helping to improve lives and save lives in our NHS. It is only because of the extra money that we in this Conservative Government have put into the NHS that we can be confident that we are securing its future to deliver better care for every single person whom we represent in this House.

Social Media and Health

Jonathan Ashworth Excerpts

Tuesday 30th April 2019 Commons Chamber

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

I am grateful to the Secretary of State for advance sight of his statement. These social media platforms must be made to take responsibility for the harm caused by the dangerous fake news they host, because they are helping to fuel a public health crisis. He talks about the actions that platforms such as Instagram have taken since February, but I have just searched on Instagram and found images and videos of graphic self-harm; there are 8 million posts with the hashtag #suicide—from a quick glance, many are distressing—226,000 posts with the hashtag #killmyself, and 249,000 posts with the hashtag #selfinjury. I found similar pro-anorexia posts and the normalisation of eating disorders. I am sorry to have to share those examples with the House, but I think that we have to understand the scale of the challenge we face. As the father of two beautiful daughters, aged seven and five, I would be devastated if they saw such posts as they grow up.

Dangerous content should be blocked and taken down. I look forward to the Samaritans’ recommendations, so can the Secretary of State update us on the timescale? He talked about the online harms White Paper, but we need action immediately, so can he tell us when the proposed legislation will come before the House? When will the new regulator and duty of care be enforced? Can he guarantee that there will be criminal sentences for executives for serious breaches? In what circumstances would the maximum fine of 4% of global turnover be applied? If, God forbid, something similar to what happened to Molly Russell—I am sure that the whole House will want to praise her father for his brave campaigning—should happen to another child, what action would be taken against the social media companies?

I have also been able to find dangerous anti-vaccination propaganda on platforms such as Facebook, at a time when measles outbreaks are on the increase across Europe and the United States and in parts of the United Kingdom. Unvaccinated children are being turned away from schools in parts of Italy and banned from public areas in parts of New York. I would hate to see that happen here. UNICEF has warned that more than half a million children have missed their measles vaccination, which means the UK now has the third-worst ranking of all high-income countries. As the Secretary of State said, take-up of the MMR vaccine has now declined for the fourth year in a row, making coverage for the vaccine the lowest it has been since 2011-12.

I know that the Secretary of State said on the radio last week that he was considering banning unvaccinated children from schools in England, but we urgently need a clear vaccination action plan from the Government. This cannot be about penalising families. Yes, we need intervention with social media platforms when the legislation is in place, but while we wait for the legislation will he consider instructing Public Health England to launch an online social media campaign, on the platforms that are currently sharing anti-vaccination propaganda, to challenge those dangerous myths?

Will the Secretary of State also accept that our falling vaccination rates are not just about online activity? Public health services have been cut by £800 million. Our health visitors have been cut by 8% in recent years, and our school nurses by 24%. General practice has faced a funding squeeze, and GP numbers are down by 1,000 since 2015. At the same time, 2018-19 marks the first year that we have seen a reversal in the percentage of children receiving vital health check-ups on time since the measurement of these figures began: 14.5% of children are not receiving a six to eight-week review on time; 24% are not receiving a 12-month review on time; and the number of mothers over 28 weeks pregnant receiving their first face-to-face antenatal contact with a health visitor has fallen for the second year in a row. Will he therefore commit today to reversing public health cuts and restoring health visitor numbers, and will he invest in general practice so that we can meet the 95% national vaccination coverage rate, as recommended by the World Health Organisation? When does he expect us to meet that 95% rate?

Children are 20% of our population but 100% of our future. We must always put their health and wellbeing first. Yes, there has been some progress, but we need further action from the Government today.

[Matt Hancock]

I pay tribute to the hon. Gentleman, who has provided leadership on this agenda from his position as shadow Secretary of State. I am glad, listening to his response, that we agree very broadly on the direction we need to take. The agreement across the House is valuable in demonstrating to social media companies the clear consensus on the need for them to act, and to every parent in the land the importance of vaccination. That cross-party support is very, very valuable.

I join the hon. Gentleman in paying tribute to Ian Russell, the father of Molly Russell, whom the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Thurrock (Jackie Doyle-Price), the Minister for suicide prevention, met this morning. He has been brave and eloquent in bringing these issues to light. I pay tribute to him and thank him for how he has spoken about what needs to be done. I know he is as determined as we are to ensure that action translates into saving more lives.

We agreed, after the meeting yesterday, to reconvene in two months’ time, by which time I expect further action from the social media companies. As I said in my statement, we have already seen some progress. I am glad that some of the global algorithms and global terms and conditions have been changed as a result of action taken by the UK Government. It is very important that we keep the pace up. In two months’ time, we expect to see further action from the social media companies and progress by the Samaritans on being able to define more clearly the boundary between harmful and non-harmful content. In each area of removing harms online, the challenge is to create the right boundary in the appropriate place. It is the challenge when tackling terrorist and child abuse material online, so that social media companies do not have to define what is and is not socially acceptable, but we as society do. I am delighted that the Samaritans will formally play that role on material relating to suicide prevention and self-harm, and that Beat will do so on material relating to eating disorders.

The hon. Gentleman asked about the online harms White Paper. We are currently in the middle of a 12-week consultation. I hope he and everybody listening to this who has an interest will respond to it. We are clear that we will have a regulator, but we also genuinely want to consult widely. This is not really an issue of party politics, but of getting it right so that society decides on how we should govern the internet, rather than the big internet companies making those decisions for themselves. I have to say that the tone from the social media companies has changed in recent months and years, but they still need to do an awful lot. I look forward to working with him and others across the House to ensure we can deliver on this agenda.

Government Mandate for the NHS

Jonathan Ashworth Excerpts

Thursday 25th April 2019 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 make a statement on the Government’s failure to lay before Parliament the NHS mandate for the current financial year.

[The Minister for Health (Stephen Hammond)]

I am grateful to have the opportunity to set out the Government’s approach to setting a mandate for NHS England for 2019-20. The Government’s annual mandate to NHS England for 2019-20 will, for the first time, be a joint document with the annual NHS Improvement remit letter, called an accountability framework. This signals the importance of these two arm’s-length bodies working increasingly closely to maximise their collective impact. It will set one-year transitional objectives to allow the NHS time to implement the long-term plan, and it has been developed to meet the needs of patients, families and staff.

We are committed to the NHS and are funding its long-term plan to ensure that it is fit for the future for patients, their families and NHS staff. The accountability framework sets the expectations that will make that long-term plan a reality. The Government have continued to prioritise funding the NHS, with a five-year budget settlement for the NHS announced in summer 2018 that will see the NHS budget rise by £33.9 billion a year by 2023-24.

The funding settlement and the implementation of the long-term plan are not affected in any way by the short delay in the publication of the accountability framework. We are all engaged to ensure that the accountability framework is published and laid as soon as possible, and I and my ministerial colleagues and officials are working closely with NHS England and Healthwatch England, as statutory consultees, to ensure accountability, improvement and progress to deliver world- class care for patients.

[Jonathan Ashworth]

It is a pleasure to see the Minister of State, as always, but the Secretary of State should be here to defend his failure to produce the NHS mandate. In every previous year, in accordance with section 23 of the Health and Social Care Act 2012—an Act that he supported and voted for despite everyone telling the Government not to support it—the Government have published the NHS mandate before the beginning of the financial year. This mandate outlines the Secretary of State’s priorities for the NHS given the financial settlement, yet this is the first time a Secretary of State has failed to lay before Parliament the Government’s mandate to the NHS for the forthcoming financial year. Is this a failure of leadership or the latest piece of stealth dismantling of the Health and Social Care Act? If it is the latter, why not just take our advice and bin the whole thing and so end the wasteful contracting, tendering and marketisation it ushered in?

The Minister talks of the 10-year long-term plan, but it is no good his telling us he endorses Simon Steven’s vision of the NHS in a decade’s time, when Ministers cannot even tell us what they expect the NHS to achieve in a year’s time. He boasts of the new revenue funding settlement for the NHS but seemingly has not got a clue what he wants the NHS to spend it on in the next 12 months, and at the same time he does not talk about the cuts to public health budgets, training budgets and capital investment.

Will the new accountability framework deliver for patients in the next 12 months? Last year’s mandate pledged that A&E aggregate performance in England would hit 95% in 2018. That pledge was broken, so can the Minister tell us whether, for those A&E departments not trialling the new access standard, the four-hour A&E standard will be met this year, or will the target not be met for the fourth year running?

Or how about the 18-week referral to treatment target? More than half a million people are now waiting more than 18 weeks for treatment. The target that 92% of people on the waiting list should be waiting less than 18 weeks has not been met since 2016. Will that target be met in the next 12 months, or has it also been abandoned? What about cancer waits? Some 28,000 patients are now waiting beyond two months for treatment. The target for 85% of cancer patients to be seen within two months for their first cancer treatment after an urgent referral has been missed in every month but one since April 2014. Will that target be met this year, or will cancer patients be expected to wait longer and longer?

On staffing and pay, will funding be made available in the next 12 months, as it was last year, for a pay rise for health staff employed on agenda for change terms and conditions working in the public health sector for local authorities and social enterprises?

We have no NHS mandate, even though it is mandatory. We have no social care Green Paper, even though it has been promised five times. The big issue has been ducked again. We have no workforce plan, even though we have 100,000 vacancies across the NHS, and the interim plan, which should have been published today, has been delayed again. The Secretary of State parades his leadership credentials around right-wing think-tanks, yet on this record he could not run a whelk stall, never mind the Tory party. It is clearer than ever that only Labour will fully fund our NHS and deliver the quality of care patients deserve.

[Stephen Hammond]

Anyone listening to that will have realised that the hon. Gentleman is more concerned with political points scoring and process than with the substance and funding of the NHS. [Interruption.] The hon. Member for Dewsbury (Paula Sherriff) shouts at me, but she will want to remember that the shadow Secretary of State welcomed the long-term plan—or much of it—back in January.

It is absolutely clear—evidence was provided to the Public Accounts Select Committee yesterday by the permanent secretary and the chief executive of NHS England—that while obviously it would be better to publish by the deadline, it is more important that the mandate be right than published on a particular day. It is more important that we get this document on the long-term strategy of the NHS correct. As Simon Stevens, the chief executive of the NHS, said, there is no problem with this short delay to the mandate. It is an important document, but it is causing him no problems. It is causing no problems.

The hon. Gentleman mentioned access to treatment and treatment times. This winter, more than 7 million patients were seen in under four hours. That is an increase of nearly 6% in attendances. I would have hoped that the Opposition Front Bench might have praised the NHS and its hard-working staff—

[Stephen Hammond]

Rather than shouting political points across the Dispatch Box.

The hon. Gentleman says there are no targets. He is of course wrong.

[Jonathan Ashworth]

I said you were not meeting them.

[Stephen Hammond]

No, the hon. Gentleman said there were no targets likely to be set for the NHS this year. The accountability framework will include detailed and specific annual deliverables and set out in detail a process for delivering future implementation as well as some of the early delivery goals for 2019-20. He is wrong therefore to say that the framework will not have deliverables attached to it. It will. He also mentioned the Green Paper—

[Jonathan Ashworth]

Where is it?

[Stephen Hammond]

I have said, as the hon. Gentleman has heard many times, that we are finalising that. Again, it is more important to get it right. On the long-term plan for workforce implementation, a draft plan is being produced and I expect that plan to be published in the very near future—[Interruption.]

Oral Answers to Questions

Jonathan Ashworth Excerpts

Tuesday 26th March 2019 Commons Chamber

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

May I just take a moment, on behalf of the Opposition Front Bench team, to thank the hon. Member for Winchester (Steve Brine) for all his work? We found him a decent, fair-minded Minister, and I wish to pass on my personal thanks for the work that he did on the children of alcoholics agenda.

We have 100,000 vacancies across the NHS. The Brexit mess means that we have fewer EU nurses and health visitors. Across the NHS, voluntary resignations are up 55% since 2011, and the professional development budgets have been cut by £250 million. Does the Minister agree that for Dido Harding’s review to be taken seriously, those cuts to continuing professional development must be reversed?

[Stephen Hammond]

As the hon. Gentleman heard me say earlier, Baroness Harding is developing the implementation plan, which will then feed into the final implementation plan published after the comprehensive spending review. The cuts, as he describes them, are not cuts. He knows that we are increasing the budget for the NHS in real terms and in cash terms up to 2023-24.

[Jonathan Ashworth]

The Minister is responsible for workforce, but does not seem to understand that training budgets have been cut. Baroness Harding’s review will only be taken seriously if it is backed up by real investment.

Outsourcing and transferring of staff, whether to wholly owned subsidiaries or the privatisation of clinical services, further undermines staff morale and creates a more fragmented workforce. The Secretary of State went to the Health and Social Care Committee and said no more privatisations on his watch, yet cancer scanning services in Oxford are being privatised. Will the Minister reverse those privatisations, or can we simply not believe a word the Secretary of State says?

[Stephen Hammond]

The hon. Gentleman can believe everything my right hon. Friend the Secretary of State says. He has delivered on his promise to work with the NHS to deliver a long-term plan, to deliver the funding that will make it possible, and to deliver the workforce that will ensure the plan is not undermined.