(3 years, 3 months ago)
Commons ChamberUrgent Questions are proposed each morning by backbench MPs, and up to two may be selected each day by the Speaker. Chosen Urgent Questions are announced 30 minutes before Parliament sits each day.
Each Urgent Question requires a Government Minister to give a response on the debate topic.
This information is provided by Parallel Parliament and does not comprise part of the offical record
(Urgent Question): To ask the Secretary of State for Health and Social Care if he will make a statement on covid-19.
Our race between the vaccine and the virus continues. As a nation, we have taken some huge strides forward: there are now 908 people in hospital with coronavirus, a fall of 9% in the past week, and the average number of daily deaths is now six, the lowest number since the middle of March. On top of this positive news, our vaccination programme is accelerating at pace. Over 72% of all adults have now been given their first dose, and 43% of all adults have the protection of two doses.
This weekend, we reached the milestone of 60 million vaccines administered across the United Kingdom, and Public Health England also published new research showing that the effectiveness of vaccination against symptomatic disease from the variant first discovered in India is similar after two doses when compared to the B117 variant dominant in our country. As with other variants, even higher levels of effectiveness are expected against hospitalisation and death. This is encouraging data, and it reinforces once again the importance of our vaccination programme in giving us a path out of this pandemic, as well as showing just how important it is that everyone comes forward for both jabs when the call comes through. It is the progress made by the British people in following the rules, and in taking up the protection offered through our vaccination programme, that means we were able to take step 3 in our road map last week.
However, we take these steps with vigilance and caution, staying alert to new variants that can jeopardise the advances we have made. We have come down really hard on the variant first identified in India wherever we have found it, surging in testing capacity and vaccines for those who are eligible. Over the past few days, we have extended this rapid approach to even more areas: as well as Bolton and Blackburn with Darwen, which the Prime Minister spoke about at his press conference on the 14th of this month, we are taking rapid action in Bedford, Hounslow, Burnley, Leicester, Kirklees and North Tyneside. As the Prime Minister set out two weeks ago, we are urging people in these areas to take extra caution when meeting anyone outside their household or support bubble, including meeting outside rather than inside where possible; keeping 2 metres apart from people they do not live with; and trying to avoid travelling in and out of the affected areas unless it is essential, for example for work—if a person cannot work from home—or for education.
As the Prime Minister said, we want the whole country to move out of these restrictions together. We are trusting people to be responsible and to act with caution and common sense, as they have done throughout this pandemic, and to make decisions about how best to protect themselves and their loved ones that are informed by the risks. That is exactly what we should be doing. We are always looking to see how we can communicate more effectively with local authorities, and we will of course take on board the views expressed by the House over the course of this debate. By acting quickly whenever the virus flares up and protecting people through our vaccination programme, we can guard the incredible gains we have all made, and get ourselves on the road to recovery.
Does the Minister appreciate that cities such as mine, Leicester, or towns and boroughs such as Burnley, Bolton, Batley and Blackburn, have borne the brunt of this crisis over these past 15 months? We have often been in lockdown for longer than elsewhere. At times, we have felt abandoned. We did not have adequate financial support: families did their best, but they struggled. Can the Minister understand how upsetting, how insulting, it is to have new restrictions imposed on us—local lockdowns by stealth, by the back door—without the Secretary of State even having the courtesy to come and tell us?
Why was the guidance plonked on a website on Friday night and not communicated to everyone? Why were local directors of public health and local authority leaders not consulted? Why were MPs not informed? What does it now mean for our constituents? What does it mean for the family in Leicester who have booked a few days next week by the coast for the school half-term? Do they have to cancel that break? What does it mean for university students in Leicester when they have finished their exams? Do they have to go home—or can they go home? Can prospective students come and look at the campuses?
What does the guidance mean for the parents in Bolton who are planning to take their children to see grandparents on the other side of Greater Manchester this bank holiday Monday? Should they rearrange their plans? What does it mean for the young couple in Burnley, Blackburn or Batley, who have postponed their wedding for over a year and invited friends and family from across the country to come and celebrate their special day with them? Is the message to them that they have to delay their wedding again?
Can the Minister answer these questions today? Can he take a message from me, as the Member of Parliament for Leicester South, back to the Secretary of State—“Withdraw this guidance now and convene a meeting this afternoon of the relevant directors of public health to produce a plan involving isolation support and enhanced contact tracing”? As the hon. Gentleman knows from his work as vaccines Minister, a single dose of the vaccine is less effective against this particular variant. Will he produce a plan with local directors of public health to roll out vaccinations to everybody and consider including bringing forward a second dose for a larger cohort of people?
A year ago, Ministers such as the hon. Gentleman were defending Dominic Cummings on Twitter. Now, Mr Cummings tweets about the lack of competent people in charge. Many of our constituents, looking at this latest lockdown fiasco, will think that Mr Cummings has a point.
I thank the right hon. Gentleman for, I hope, his equally supportive comments when it comes to supporting his constituents and others around the country—in Bedford, Blackburn, Bolton, Burnley, Kirklees and Leicester, his own patch, as well as Hounslow and north Tyneside.
I spoke to the M10 metro Mayors this morning, and the one thing I would urge is that we all work together and take the politics out of this. Our constituents deserve that. Essentially, as I said in my opening statement, we are asking people in the affected areas to be cautious and careful. The right hon. Gentleman asked about visiting family: people should meet outside rather than inside, where possible. Meeting indoors is still allowed, in a group of six or as two households, but meeting outdoors is safer. People should meet 2 metres apart from those they do not live with unless they have formed a support bubble; that obviously includes friends and family they do not live with. So yes, people can visit family in half-term if they follow social distancing guidelines. The guidelines include specific sections on meeting friends and family. Avoid travelling in and out of the affected areas, as the Prime Minister said on 14 May, unless it is essential—for work purposes, for example.
The whole principle is that we need to work together. The right hon. Gentleman has a responsibility, as do I and the metro Mayors, to communicate to our residents and constituents that this is a time to be vigilant and careful. We are putting more surge testing and turbocharging vaccinations in those areas, to make sure that we do the work with local directors of public health. I hope he will agree that we have had that plan in place and seen it operate in Bolton and Blackburn; we will see it operate in his constituency and other parts of the country as well.
My hon. Friend will recall that the Prime Minister addressed this issue on 14 May.
Yes, he did address this issue in his press conference. I can read the right hon. Member for Leicester South (Jonathan Ashworth) the words from that press conference, because he says from a sedentary position, “He did not.” The Prime Minister said, speaking about Bolton:
“given the caution that I think we have to exercise with this new variant, the risk of extra transmissibility, I would urge people just to think twice about that. That’s what we’re saying. I think that we want people in those areas to recognise that there is extra risk, an extra disruption, a threat of disruption to progress caused by this new variant and just to exercise their discretion and judgment, in a way I’m sure that they have been throughout this pandemic and will continue to do so, I hope very much.”
Those were his words, and the guidance was in place.
(3 years, 3 months ago)
Commons ChamberI beg to move an amendment, at the end of the Question to add:
“but respectfully regret that the Government has provided insufficient information for its proposals properly to be scrutinised; and therefore beg leave that she will be graciously pleased to give directions that the following papers be laid before Parliament: the DHSC internal review of their operation during the pandemic as referenced by the Prime Minister’s official spokesman on 12 May.”
May I take this opportunity to note that although amendment (e) in the name of my hon. Friend the Member for Rhondda (Chris Bryant) has not been selected, its contents, which relate to brain injury, are important and welcome? I hope that Ministers take on board its recommendations.
It is all too tempting to intervene; I have never objected to temptation. On brain injury, I just want to say that I really want us to think about legislation now. The United States of America has made dramatic changes—it has introduced legislation four times now—and I think it is time we went down that route.
I completely agree. I hope that Ministers on the Treasury Bench have listened carefully. If they are prepared to bring forward legislation, we would work constructively across the House to ensure its speedy passage. May I thank my hon. Friend for the reference in his amendment to the impact of alcohol abuse on children? He knows that it is a subject very close to my heart; on behalf of the children of alcoholics community, I am grateful that he referred to it in his amendment.
Although we have often said this in the House, I still think that the whole House will want to remember today the 127,691 people so far who have lost their lives to covid-19, this awful disease, including the 850 health and care workers. Although repeating the numbers has become almost routine in this House, that does not make the scale or gravity of the loss any less shocking. We grieve as a nation and we all pay tribute to our healthcare workers, our social care workers and our public sector workers.
I am sure that the whole House will want to dedicate itself in good faith to learning lessons for the future. Sadly, we are in an era when, according to the experts, pandemics are becoming more predictable and will become more regular because of climate change and biodiversity loss, so learning lessons is about preparing better for the future rather than settling scores.
We know that the B1617.2 variant is spreading. From the data that I have seen, it appears to have a growth rate advantage of about 13% over the B1117 variant. It could well become the dominant strain in the United Kingdom. Although vaccination should mean that many are much safer and ought to avoid hospitalisation, the Government still have a responsibility to do all they can to contain its spread, minimise sickness and ensure that the 21 June target is not disrupted, if at all possible.
That is why I said on Monday that we need more surge vaccination in hotspot areas. We know that with vaccination there are always pockets where rates are lower than necessary, and we need to drive those rates that up. We have seen that throughout history—with measles, for example. So we urge the Government again to do all they can to drive up vaccination rates in Bolton, Bedford, Blackburn and other areas where we know there is an issue. We also need the Government to do more to contain the virus through test, trace and isolate. We need more surge testing. We need more enhanced contact tracing locally, with local authorities given the resources to carry it out. We need sick pay and isolation support fixed as well.
For those who are going in to work, or for those who are now socialising in premises, those buildings and premises need proper air filtration systems. There are experts now who can easily fix filtration systems in buildings to make them much more covid secure, and we should be inspecting workplaces in all these areas to ensure that every workplace is covid secure.
We need transparency in decision making as well. For the first time in my life, I think, I find myself agreeing with Mr Dominic Cummings. I know the Secretary of State does not often agree with Mr Dominic Cummings, but I find myself agreeing with Mr Dominic Cummings, who tweeted yesterday:
“With something as critical as variants escaping vaccines, there is *no* justification for secrecy, public interest unarguably is *open scrutiny of the plans*”.
Mr Cummings, on this occasion, is correct. [Interruption.] A wry laugh from the Secretary of State. Mr Cummings may well have been saying something different when he was in government; I do not know, but at least his public statement yesterday is correct. That is why our amendment calls for the publication of a Government lessons-learned review; not so that we can try to undermine the Government or find some hole to use across the Dispatch Box, but so that we can learn the lessons in our efforts to contain variants, and ensure that we are better prepared for the future. I hope the Secretary of State looks sympathetically upon that request, and perhaps joins us in the Division Lobby this evening.
I now turn to the contents of the Gracious Speech more generally. This should have been the Queen’s Speech that unveiled a new NHS plan to bring down the elective waiting list, which now stands at 5 million. This should have been a Queen’s Speech that outlined proposals to tackle the backlog of 436,000 people waiting over 12 months for treatment—many of them waiting in pain and anxiety, many of them facing permanent disability as a consequence of those waits.
Will the hon. Gentleman give way?
The shadow Minister and I, and many others in this House, shared that wonderful victory on Saturday. After 139 years of Leicester City, we won the FA cup; it is great news.
I chair the all-party parliamentary group for respiratory health. This morning, we were given some very worrying figures. They indicated that the halting of the lung cancer screening pilots restricted access to diagnostic tests, contributing to a 75% drop in urgent lung cancer referrals. Does the shadow Minister agree with me, and share my concern, that the outcomes for patients with the fastest-progressing cancers, such as lung cancer, are indeed very worrying?
The hon. Gentleman is spot-on. I will come on to cancer in a few moments. He is a great champion for improving cancer care, and I thank him for reminding the House that Leicester City won the FA cup on Saturday. It is a reminder that even when the odds are stacked against them, a small team can still beat a well-funded, complacent opposition.
I will now move on to elective waiting lists. Where is the plan in this Queen’s Speech to bring down the rocketing waiting lists for treatment and surgery? Where is the plan to roll out technology such as in ophthalmology, for the thousands in our constituencies awaiting cataract operations? There are already 81,762 of our constituents waiting over 12 months for orthopaedic surgery. Where is the plan to get on with the hip replacements and knee replacements that many of our constituents will be raising with us in our surgeries, and how much longer will they have to wait? Where is the plan for the 24,407 of our constituents who are now waiting over 12 months for gynaecological surgery? How much longer will they have to wait?
Everyone understands that there has been a pandemic and that that has meant a disruption in care pathways, but the NHS was forced into this unprecedented position because we went into the crisis on the back of 10 years of Tory underfunding and cutbacks. We went into this crisis on the back of a 6% reduction in bed numbers between 2010 and 2019. That is why, at the beginning of 2020 when we debated the last Gracious Speech, 4.5 million people were on the waiting list for treatment. The target of 92% of patients beginning treatment within 18 weeks of referral from their GP had not been met for five years. We need a resourced plan now because the queues are set to lengthen further, as those who may have delayed seeking treatment for fear of covid infection will begin to emerge once again. Even though the NHS is dealing with significantly fewer covid patients, it is still operating at a much-reduced capacity and is unable to treat everyone in need of care.
Infection control measures meant that the number of beds fell by 9% in the first quarter of last year. It has only partially recovered in the past three months, but the number is still 6% lower than the previous year. What that means when we look at the most recent figures is that, on average, there are almost 4,000 fewer patients in NHS general and acute beds than the equivalent pre-covid period.
The Prime Minister has delayed the review of social distancing for entirely understandable reasons, but we must have a plan to drive up this capacity in the NHS. The solution to these capacity issues in the NHS cannot be a multi-billion pound deal with the private sector. The loss of capacity in terms of beds in the NHS is actually far larger than the whole capacity offered by the private sector. In order to reopen those closed and empty general and acute beds in the NHS, we need more capital investment. This investment needs to be built up now, so that the NHS can get on with the routine surgery that it will clearly have to confront in the coming years. I am afraid that, both the Queen’s Speech and, indeed, the Budget from a few weeks ago, failed to deliver that.
Is the hon. Gentleman saying that under no circumstances would he use the independent sector to reduce the pressure on elective surgery waiting lists?
If the hon. Gentleman thinks that the answer to driving up capacity is just a four-year £10 billion deal with the private sector, then we will not be in a position to reopen the beds over the coming years in the NHS. That is the issue. It undermines capacity in the NHS. We need capital investment in the NHS, so that we can drive up capacity.
Let me repeat the question: is the hon. Gentleman explicitly ruling out using the independent sector at all to drive down that backlog?
The independent sector is not the answer to this. The answer is investing in capital in the NHS. In the hon. Gentleman’s local area, there are 8,485 patients waiting for diagnostic tests—that is 25% when the operational standard is supposed to be 1% or less. He should be arguing for capital investment in the NHS, but he is not, and he is not sticking up for his constituents.
I want to make a bit of progress. If the hon. Gentleman wanted more beds in the NHS and greater diagnostic capacity, he would have been arguing for capital investment in the NHS, which we did not get in the Budget and we did not get in the Queen’s Speech.
That brings me to diagnostic capacity—I have just given the hon. Gentleman his local diagnostic figures. [Interruption.] This is not about new hospitals; this is about diagnostic capacity. The Secretary of State knows that we still have some of the lowest numbers of computerised tomography scanners and magnetic resonance imaging scanners per capita in the OECD. We still have only average amounts of RTE radiotherapy machines. We need investment in this technology, which we are not getting in sufficient amounts. That is why, in the past year or so, we have seen 4.6 million fewer diagnostic tests for cancer. Some 46,000 fewer people are starting cancer treatment. We should not have to choose between covid care and cancer care, but, for too many, that has been the reality of the past year, and it means that 4,500 additional avoidable cancer deaths are expected in the next 12 months. It means that progress in survival rates for colorectal cancer, breast cancer and lung cancer is expected to be undone. The proportion of cancers diagnosed while still highly curable has dropped from 44% to 41%.
The long-term plan, on which the Secretary of State fought the election, promised rapid action on cardiovascular disease. Experts now predict the highest cardiovascular mortality in a decade, and they predict 12,000 additional heart attacks and strokes over the next five years. The Queen’s Speech needed to include proposals to expand access to the appropriate cardiovascular healthcare facilities, but it also needed to include real interventions to tackle smoking and alcohol rates, and to reduce salt intake. Yes, there is a commitment to a tobacco control plan, but will there be a reversal of the 17% cuts to smoking cessation services? Given that 7,400 people died last year from alcohol abuse—a record number—will the Secretary of State reverse the cuts to drug and alcohol addiction services, with budgets being cut by 15% over the past three years?
We have been promised action, again, on banning junk food advertising, but when? I have heard the Secretary of State—and, to be fair, his predecessor—make that promise at the Dispatch Box many, many times, but when will we have the ban? When will he reverse the cuts to public health weight-management services?
Narrowing health inequalities should be at the heart of every Government policy, but there can be no levelling up while life expectancy advances stall for the poorest in society. Levelling up and tackling inequalities apply to mental health outcomes as well. More people suffer from depression in the poorest areas of the country than the richest. We know that the mental health problems are prevalent among certain minority ethnic communities —black men, in particular, are more likely to be detained under the Mental Health Act 1983, more likely to be subjected to seclusion or restraint, and less likely to access psychological therapies. We therefore welcome the commitment to reform the Mental Health Act, as we welcomed it last year, and I look forward to working constructively with the Secretary of State on reforming the Act. I would like to put on record my thanks to Sir Simon Wessely for his pioneering work on this front. Simon is a committed Chelsea fan, so I dare say that he will be more responsive to my felicitations this morning than he might have been on Saturday evening.
We face a crisis in mental health now, and we need action now. Two hundred and thirty five thousand fewer people have been referred for psychological therapies; eating disorder referrals for children have doubled; and the pandemic—again, because of infection control measures —has meant a reduction of almost 11% in beds occupied, which is equivalent to 1,700 fewer patients over the past three months compared with a year earlier. When will the Government implement their promise of significant increases in staff and resources for mental health, to ensure that mental healthcare is genuinely given parity of esteem with acute services?
That brings me to staffing more generally. Given that we are short of 200,000 staff across the health and social care sector, why was there nothing new in the Queen’s Speech to recruit more doctors, nurses and social care staff? Why was there no plan to give our NHS staff the pay rise that they deserve? NHS staff, including nurses who have cared for those with covid on wards, and district nurses who, in the first wave, cared for those who were discharged from hospital earlier than planned so that they could stay at home safely, have gone above and beyond, yet they feel that the 1% pay rise, which could well turn out to be a real-terms cut because of inflation, is a kick in the teeth. Is it any wonder that nurses are leaving the profession, including the nurse who cared for the Prime Minister, blasting Ministers for treating NHS workers with a total lack of respect? It is simply not fair. Our NHS staff deserve better.
The gaping hole in the Queen’s Speech is the plan for social care. Two years ago, the Prime Minister stood on the steps of Downing Street and said he had a plan to fix social care. He said:
“we will fix the crisis in social care once and for all with a clear plan we have prepared to give every older person the dignity and security they deserve.”
It was not a plan to be developed, or work in progress; no, this was a plan that was already done—oven-ready, you might say, Madam Deputy Speaker. But two years on, where is it? Has the Health Secretary seen it? What do we need to do to see it—perhaps we could pay for some cushions in the Downing Street flat? The Government promised us cross-party talks. They now brief that cross-party talks have taken place, but when—did they forget to send the Zoom link?
However, there is a consensus on social care, isn’t there? Care workers should be paid the living wage and proper sick pay. There should be a cap on costs, as this House legislated for. When the Institute for Public Policy Research, social care and older people’s charities and a House of Lords Committee, which, at the time, consisted of true-blue Thatcherites such as the noble Lords Lamont and Forsyth, have all called for reform of free personal care, why is the Secretary of State not engaging in that debate with us? To be frank, though, lack of cross-party talks is not an excuse for not getting on with reform. A Prime Minister with an 80-seat majority should be able to show some leadership and get on and fix social care.
If the Health Secretary wants to talk social care reform, I am free this afternoon. He knows where I am. I am happy to sit down with him at any time and discuss it. I think we would have very constructive conversations on this one, because it is true to say, as Members have detected, that we have developed something of a bond these past 12 months. The Health Secretary has been so friendly to me across the Dispatch Box that I am half expecting to win a lucrative PPE contract by the end of the day.
Because we have this new friendship, I have, as we say on the Labour Benches, some comradely advice for the Health Secretary. I know he is bringing forward a Bill to neuter the independence of the NHS chief executive and bring powers back to the Secretary of State. I have been around a long time and I remember when Tory MPs used to complain that the NHS needed independence, but we will leave that to one side. I just suggest that he ought to be careful what he wishes for, because I have been reading the Evening Standard, where Mr Tom Newton Dunn reveals not only that Simon Stevens, whom the Secretary of State is trying to neuter, was best man at the Prime Minister’s wedding, but that the Prime Minister is said to be about to appoint Simon Stevens—I beg your pardon, Lord Simon Stevens—to, yes, you guessed it, the newly empowered post of Secretary of State for Health and Social Care. It brings a whole new meaning to the phrase, “the best man for the job”, doesn’t it? But this is a Secretary of State who set up Test and Trace, who was responsible for PPE procurement and who failed to protect care homes. Dominic Cummings said the Department under his leadership was a “smoking ruin”—and now he wants more control.
The Queen’s Speech was remarkably unspecific in its description of the contents of the coming health and social care Bill, so perhaps the Secretary of State can reassure us today. Can he commit to ensuring that neither the NHS nor the partnership force to be set up in each integrated care system will permit the inclusion of private sector participants? Will he rule that out? Can he guarantee that as statutory bodies ICSs will meet in public, publish board papers and be subject to the Freedom of Information Act 2000? What guarantees can he give this House that the establishment of integrated care systems will not lead to more private corporations taking over GP practices, as has happened recently with Centene, or services currently delivered by NHS providers? I hope he can give us those very simple reassurances today.
With nearly 5 million people on the waiting lists and rising, ever-lengthening queues in our constituencies waiting for hip replacements and cataract removals, cancer survival rates worsening, mental healthcare in crisis, social care reform kicked into the long grass, and a costly, morale-sapping reorganisation on the way, we needed a fully resourced 10-year rescue plan for our NHS. I commend our amendment to the House.
Order. At the beginning of this debate, I fear it was not quite clear which other amendments had been selected by Mr Speaker. I have now had an opportunity to look at my notes on my Order Paper. For the sake of clarity, let me tell the House that Mr Speaker has not selected amendment (e) in the name of Mr Bryant, as I predicted earlier. He has selected amendment (g) in the name of the hon. Member for Walthamstow (Stella Creasy), the right hon. Member for Haltemprice and Howden (Mr Davis) and others. He has also selected amendment (i) in the name of the leader of the Scottish National party.
I remind hon. Members that, although their contributions should address the terms of these amendments, it is in order for them also to refer to other matters relevant to the Gracious Speech.
Yes, my hon. Friend is absolutely right. I thought that his exchanges with the right hon. Member for Leicester South were disappointing, because we know that the Opposition spokesman supports the use of the private sector in the NHS, because he was the guy behind the private finance initiative projects of the last Labour Government. Mr PFI there is a huge fan of the use of the private sector in the NHS, but he cannot admit it, because of the people sitting behind him, and the right hon. Member for Ashton-under-Lyne (Angela Rayner) sitting next to him, keeping watch over him from the hard left of the party.
For goodness’ sake, I was not responsible for a single PFI contract. Actually, I remember that it was for the previous Chancellor of the Exchequer, George Osborne, that the right hon. Member was the chief lickspittle and bag carrier in signing off PFI contracts when he was first appointed to the Treasury. He can go through all the Treasury documents and he can FOI it until the cows come home, and he will find that I was not involved in any PFI contracts when I worked in the Labour Government, but I was responsible for helping invest in the NHS, which brought waiting lists down to their lowest level ever.
Well, it did not actually, because after 2010 we then had to bring waiting lists down, and we brought them down. The 52-week waits came down to just 1,600 before the pandemic, and it is our task and our mission to make sure that we get them down once again. However, this will take time and it will take all the resources that are possible—yes, extra staff, and that is happening; yes, extra capital investment, and that is happening; and yes, extra diagnostics, and that is happening. We have to use all the capacity of everything that we can—north and south, revenue and capital, public and private. What people care about and what our constituents care about is whether they can get the problem fixed, and last year has demonstrated that without doubt. So on the Government side we will use everything in our power to support the NHS. It is only those on the other side of the House who have the ideological divisions, and that just demonstrates once again that we are the party of the NHS.
In March, we committed £7 billion for further funding for healthcare services, including £1 billion to address backlogs from the pandemic, and that has taken our additional funding for covid-19 to £92 billion. We are also helping the NHS to recover medical training, and today I can confirm to the House an additional £30 million for postgraduate medical training. The formula for beating this backlog is looking closely at the demand as we emerge from the pandemic, putting in the right resources to meet this demand and putting in place an ambitious programme of improvement in the NHS.
That brings me to the third thing I want to talk about, which is how we are going to build back better. The Queen’s Speech outlines improvement in almost every area of healthcare, applying vital lessons that we have learned from the pandemic, including from the successful vaccination programme, when the whole health and care system has worked as one in the face of challenge and adversity. The vaccination programme brought a jigsaw of academics, the private sector, volunteers, the NHS, civil servants and many more, and put this together, revealing a bold picture of what is possible in this country when we pull together. That is the spirit and the energy that will underpin our reforms, and all of them have a common thread, which is to improve the health of the nation, based on the principle that prevention is better than cure.
Turning to our health and care Bill, as outlined in Her Majesty’s most Gracious Speech, one of the lessons of the crisis is the importance of integrated working. We knew this before, but it has come right to the front of mind. For years, people in the NHS at all levels have called for stronger integration within the NHS, and between the NHS and others they work so closely with, such as local authorities. The Bill will allow for a more preventive, population health-based approach to how we spend NHS money, helping people to stay healthy in the first place, and that is at the core of our Bill.
The right hon. Member for Leicester South asked about the new integrated care systems. They will bring together decision making at a local level between the NHS and local authorities to ensure that decisions about local health can be taken as locally as possible. The Bill will tackle much of the bureaucracy that makes it harder to do the right thing and free up the system to innovate and embrace technology as a better platform to support staff and patient care.
Her Majesty also set out our commitment to reform adult social care, and we will bring forward proposals this year to give everyone who needs care the dignity and security they deserve. Throughout the pandemic, we have sought to protect the elderly and the most vulnerable, and this will remain our priority as we look to end the care lottery and ensure that people receive high-quality, joined-up care.
This country understands the importance of the NHS and social care, but I also think that there has never been a greater appreciation of the importance of public health. Never have the public been more engaged, and never have we learned quite so much in such a short space of time. We must capture the lessons of the pandemic on how we do public health in this country and put that together with the innovations of the last decade—in data, genomics, population health, science and research.
One of the lessons that we have had to learn quickly is that health security and health promotion each need a single-minded focus. The people who get up in the morning and think about how we increase healthy life expectancy must be different from the people focused on fighting novel pandemic threats. Each is important and each needs dedicated focus. We have split these functions into two purpose-built organisations so that we are better at both.
The new UK Health Security Agency will have a dedicated focus on responding to the current threats, planning for the next pandemic and scanning the horizon for new threats in good times as well as bad. Of course, pandemics do not respect administrative boundaries. The UKHSA’s role is specifically to promote and protect the security of the United Kingdom as a whole.
Next, the job of our new Office for Health Promotion will be to lead national efforts to improve and level up our health—addressing the causes of ill health, not just the symptoms, such as through our plans to tackle obesity and make healthier choices easier and more accessible, and through supporting our colleagues in primary and community care. General practice, after all, is at the forefront of all population health measures and GPs are the bedrock of the NHS. General practice will be central to our levelling up the health of the nation because we know, and they know, that prevention is better than cure. A greater proportion of our efforts will now be directed at preventing people from becoming patients in the first place.
All of that brings me to mental health reforms. To truly level up health and reduce health inequalities, we must level up every part of our health, including mental health. I am determined to see mental ill health treated on a par with physical ill health, and to ensure that support is in place for those struggling with their mental wellbeing. We have provided record levels of funding for mental health services, especially to meet the additional burdens of the pandemic, but we need a better legislative basis—a mental health Act fit for the 21st century.
We are modernising the Mental Health Act to improve services for the most serious mental illnesses and support people so that they can manage their own mental health. The new Act will tackle the disparities and iniquities of our system and improve how people with learning difficulties and autism are supported. Ultimately, it is going to be there for every single one of us if we need it.
(3 years, 3 months ago)
Commons ChamberI thank the Secretary of State for advance sight of his statement. May I start by congratulating the Leicester City football team on winning the FA cup on Saturday? The winning goal from Tielemans was one of dreams. Leicester City fans boast that Foxes never give up and nor do I, so let me turn to the matters before us.
Yesterday, the Secretary of State warned on the television that the B.1617.2 variant could “spread like wildfire” among the unvaccinated, but does he accept that we could have avoided this? Our borders have been about as secure as a sieve, and the delay in adding India to the red list surely now stands as a catastrophic mis-step. One month ago in this House, I urged him to act quickly in response to this variant. The Wellcome Sanger Institute data today shows a rapid increase in this variant, to 30% of all sequenced cases in the UK, and that excludes cases from travel and surge testing. Alarm bells should be ringing, because although the Secretary of State offers reassurance that vaccines are effective, we have also heard Professor Anthony Harnden of the JCVI recently warn us that vaccines are “almost certainly less effective” at reducing the transmission of this variant.
I entirely appreciate that when questioned I suspect that the Secretary of State will not be able to give a cast-iron assurance about opening up on 21 June, and I am not going to try to push him into a corner; we all understand that we are dealing with uncertainties and we have to be grown up about these things. But we do need a plan now to contain this variant urgently. He is said to be considering local lockdowns. As he knows, I speak as a resident of long locked-down Leicester. Before he takes out his mallet to try to whack moles again, may I suggest a number of things for him to try first?
First, will he consider surge vaccination in all hotspot areas and go hell for leather to roll out vaccinations to everyone? I listened very carefully to what he said about vaccination increases in Bolton, and I hope that also includes Blackburn. Is he saying that everyone over 18 in those areas will now be eligible for vaccination? As he knows, that is something that public health directors on the ground have been calling for, and I hope we listen to them.
We have had these debates in the House before, and the Secretary of State knows that even if we drive up vaccination as high as it can possibly go among adults, there are still about 20% of the wider population—children —who remain unvaccinated, which means the virus can still spread. The Centers for Disease Control and Prevention in the US are moving to vaccinate children. Will he update us on what progress he is making on that front here? On children, the Secretary of State knows that in many secondary schools, mask wearing is no longer necessary. Will he assure us that he thinks that is the right response in the light of the data he unveiled today?
Secondly, the Secretary of State has announced extra surge testing, but he knows by now that surge testing must be backed up by proper sick pay and decent isolation support. That should have been fixed in the Queen’s Speech last week.
Thirdly, more venues are opening up today. Many will be spending a lot of time disinfecting surfaces, like we do in here, which is good and important, but we know so much more about this virus now. We know about airborne spread of the virus, so why are we not supporting venues more with ventilation? What are we doing to help supermarkets, shopping centres and larger venues where air circulates around the building to put in place covid-secure air filtration systems?
Fourthly, what the Secretary of State said about the NHS and the uptake of beds is welcome, but NHS staff, as he knows, are exhausted and fear another surge. What modelling has been shared with NHS leaders, and what are they doing to prepare for any surge in admissions?
Finally, the surge in this variant reminds us that we are not safe until everyone is safe. That is not a slogan; it is a fact. Some 3.3 million lives have been lost globally to this virus, and Dr Tedros Adhanom Ghebreyesus from the World Health Organisation warns that we are on track for the second year of this pandemic to be far more deadly than the first. Only 0.3% of vaccine supply is going to low-income countries. Trickle-down vaccination is not an effective strategy for fighting this deadly virus. Not only do we have a moral responsibility to play our part internationally, but that also reduces the risk of new variants bouncing back at us and setting us back.
At this critical time, when we need to work internationally to defeat this virus, why are we the only G7 nation cutting its aid budget? How can the Secretary of State defend cutting our contribution to vital science and research projects? Given the total silence from the Government on President Biden’s support for the temporary lifting of patent protections to increase vaccine production, should we assume that the Government do not agree with President Biden?
Let me address the hon. Gentleman’s substantive questions. The first was about the surging of vaccines and testing into hotspots. We saw in south London earlier in the month and last month that that sort of surge testing can work. We had an outbreak of the South African variant in south London. We put in more than 200,000 tests, and we effectively managed to contain that outbreak. That is the approach that we are taking in Bolton and Blackburn, and we will also take that approach if we see a further spread in other areas of the country. We have been working very hard on that to ensure we have that capacity and can do that effectively. We do that, of course, hand in glove with the local authorities in question, which know the communities on the ground.
We are also making sure we have the vaccines available, but I want to be absolutely crystal clear about the approach to vaccination. The hon. Gentleman asked about vaccinating all over-18s in Bolton and Blackburn, but that is not our approach. I have looked into it in great detail, and we have taken clinical advice. The approach is to make sure that we get done as many second vaccinations as possible, as many first vaccinations as possible among the vulnerable groups, and then as many vaccinations as possible among those aged under 50 in the eligible groups. We have taken that approach because that is what is likely to save most lives. That second jab is vital. The first jab for anybody over 50 could mean the difference between life and death. The very strong focus is to get the vaccine to all those over 50 who have not yet taken the first jab. I am glad to say that reports from both Bolton and Blackburn suggest that uptake among people who are eligible, but who have not yet taken the jab, has increased since we saw the rise of the B1617.2 variant in those areas. It is effective in proving to people that the jab really does work to protect them. That is what the data shows.
The hon. Gentleman asked about children. I have been closely following the results of the clinical studies from Pfizer that show that the vaccine is safe and effective among children between the ages of 12 and 18. We have procured enough Pfizer to be able to offer that jab to children should that be clinically approved here, but given that we are at the stage of opening tomorrow to people aged 37, there is some time to go before we get to 18-year-olds. We are on track to meet the target of offering the vaccine to all those aged 18 and above by the end of July, so we have a couple of months before we need to make and operationalise a decision. We want to be very, very careful and sensitive about whether and how we offer the vaccine to children.
The hon. Gentleman asked about important wider measures. He mentioned ventilation. We have put in place guidance for businesses in terms of strengthening the rules around ventilation, and that, too, is important. He did a bit of a Captain Hindsight act on the Indian variant. He did not seem to mention that we put India on the red list before this variant was even deemed a variant under investigation, let alone a variant of concern. Indeed, we put India on the red list before countries such as Germany and Canada stopped flights from India. We have a strong policy of restrictions at the border and we will remain vigilant.
The final point to which I wanted to respond was on the global moral responsibility to vaccinate everybody in the world. The hon. Gentleman is absolutely right that we have a global moral responsibility. I argue that, thus far, the United Kingdom has done, and will continue to do, more than any other nation. It is about not just the huge sums that we have put into COVAX, but the way that we delivered the Oxford-AstraZeneca vaccine around the world. As of this morning, 1.47 billion vaccines have been delivered globally, 400 million of which have been the Oxford-AstraZeneca vaccine. AstraZeneca has charged a profit margin and a margin for intellectual property of zero—no charge for intellectual property, no profit for AstraZeneca. Costs, of course, need to be met, but we have taken nothing for the money that we put into the vaccine’s development. This is the biggest gift that this country could give to the world. A total of 65% of those 400 million doses have been delivered into the arms of people in low and middle-income countries, including more than 150 million in India. On the COVAX facility, which is the biggest global effort to vaccinate in low and middle-income countries, it has delivered 54 million vaccines so far, 53 million of which have been done with the Oxford-AstraZeneca vaccine.
This country can be hugely proud of the contribution it has made. It is far bigger so far than that of any other country. We took the view from the start that we do not need to change our IP rules, we do not need to change the law, we just need to get on and get the vaccine out to as many people around the world as possible, at cost. Everybody in this House should be very, very proud of what AstraZeneca and Oxford University have done with the support of the UK Government. That is how we save lives around the world.
(3 years, 4 months ago)
Commons ChamberI thank the Secretary of State for advance sight of his statement. Let me start by saying that I have no doubt that Downing Street was reluctant to cancel the Prime Minister’s trip to India. As a Member of Parliament for Leicester, I am immensely proud of our deep ties and bonds with India, but it was the correct thing to do in the circumstances, because we must always be vigilant and driven by the data, and variants are the biggest threat to our progress.
Tackling the variants demands that vaccination continues to be rolled out successfully; I again pay tribute to all involved. Uptake levels are improving, as the Secretary of State said, but they are still too low in some minority ethnic communities. Will he provide extra resources to the local communities that need them to drive up vaccination rates?
We will look carefully at the details for vaccinating social care staff, but the Secretary of State will know that every attempt throughout history to force mandatory vaccination has proved counterproductive. Why does he think this attempt will be any different?
Even with high levels of vaccination across the population, there will be significant groups who are unvaccinated—children, for example. The virus will be endemic, as the chief medical officer has recently confirmed. Papers from the Scientific Advisory Group for Emergencies model a third wave this summer. How do we avoid that? May I suggest to the Secretary of State that one way that we could do that would be to pay higher sick pay and expand its scope? Some of the poorest and the lowest paid will continue to suffer and be left exposed to the virus unless we fix that. We should not just glibly accept these health inequities; it could mean that urban areas are left behind, remaining under restrictions with higher infection rates. For the millionth time of asking, will he please fix sick pay?
Let me turn to India, which has the most cases in the world at the moment—more than 250,000 confirmed cases a day, I think, and going up. That is one of the world’s steepest surges, right now. Uploads of Indian sequencing to the global open access database show that the new double mutant B1617 variant has become dominant in India in the past few weeks, out-competing our home-grown Kent strain. As of today, COVID-19 Genomics UK reports 135 cases of B1617 in the UK and 115 in the last 28 days. It has been the fastest growing variant in the UK in the last three weeks. Most of those variants are imported, so we welcome the Secretary of State’s announcement about adding India to the red list, although I hope that there will be support and help in place for constituents such as mine who are legally in India and want to return.
We also now have cases in the community that are not linked to international travel. I understand that the Secretary of State is carrying out analysis of those samples, but surely we now need to start surge testing and designate B1617 as a variant of concern. How long will it take before we have more definitive evidence that it is more infectious or immune-escape? We already know that this variant carries mutations of concern in other variants. If we have learnt anything in the past 12 months, it is that this virus ruthlessly exploits ambiguity and that we must act fast when the situation is controllable, because in a few weeks’ time, it might not be.
The Secretary of State did not mention vaccine passports in his statement. Does he anticipate that vaccine passports will soon be needed for football games or concerts? As he said, Leicester City have made it to the FA cup final, and they are a team challenging for Europe on merit who always put fans first. Many who are anticipating going to a football match later this year will be wondering this: if they need a vaccine passport, will it be based on one dose or two? He may have seen data from Israel or the Centres for Disease Control and Prevention in the US which suggests that people are still infectious after one vaccine dose, so can he update us on that front?
Finally, I turn to the latest Sunday Times revelations about the lobbying by Greensill and Cameron of the Secretary of State and the very highest NHS officials about the payday financing scheme. This was not an act of altruism to staff in a pandemic but an investment plan to package up loans to sell to investors, with the former Prime Minister, not nurses, in line for a payday windfall. Cameron wrote in one of his emails:
“As you can imagine, Matt Hancock”
is
“extremely positive about this innovative offer.”
They sought a partnership with NHS Shared Business Services, which is jointly owned by the Department. They sought access to the personal and financial data of thousands of NHS staff. They wanted their electronic records for their own commercial gain. Their plan was to expand into the social care sector, where staff are on low pay or zero-hours contracts, and because the market is fragmented and made up of private providers, the supposed non-profit offer would presumably not apply.
There were meetings and communications with a parade of the most senior NHS officials, including former Health Minister Lord Prior and Baroness Harding. At least 30 trusts may have spent valuable time considering the adoption of this untested payday lending scheme, and it is all because the Secretary of State succumbed to the lobbying of his old boss Cameron. So again I ask him, will he publish all the text messages, all the emails and all the correspondence with David Cameron? Can he tell us how many NHS leaders and officials Cameron and Greensill lobbied and met? How many NHS trusts in total were approached about this expensive, unneeded scheme?
While we are on the issue of NHS Shared Business Services, can the Secretary of State also tell us why he never declared his own links to Topwood, the confidential document shredding firm which was still on Friday night, until it was curiously taken down, using the NHS logo on its website to promote itself? With so many accusations and allegations of sleaze and cronyism, these are basic questions that deserve clear answers. NHS staff deserve a pay rise and support, not these payday loan apps forced on the NHS by speculators trying to make money out of the pandemic. How can he possibly defend it?
Let me address the final point first. As I said to the House last week, my approach was and is that local NHS employers are best placed to decide whether to take up offers of pay flexibilities, and Ministers are not involved in decision taking in NHS Shared Business Services. When it comes to the other matter that the right hon. Gentleman raised in terms of my declarations—which are known to him and to everybody else only because I have followed the rules in letter and spirit and made that declaration—I agree with the Leader of the Opposition, rather than him, who said that he was not suggesting that any rules were broken.
I turn to the covid-related matters. I welcome the right hon. Gentleman’s support of the decision to put India on the red list, which is not one that we take lightly. He is right to ask about surge testing, to make sure that we limit the spread as much as possible of the variant first found in India, and I can confirm that we will be doing that.
I welcome the right hon. Gentleman’s support for vaccinations, which he has demonstrated at all turns. It is partly because of the unanimity across the House among all parties on the importance of vaccination that we have this absolutely spectacular level of uptake. He says that every attempt at mandatory vaccination is counterproductive. I gently point him to the fact that surgeons needs to have a vaccine against hepatitis B. Vaccination that is tied to work in fact has a longstanding precedent in this country.
The right hon. Gentleman asks many questions about certification, but he knows that a review of it is under way at the moment, being led by my right hon. Friend the Chancellor of the Duchy of Lancaster, who I am sure will have heard his representations and questions, and will be able to address them in the review.
Finally, the right hon. Gentleman says that we must avoid a third wave by sticking to the rules, and he is right. We should avoid a third wave if we can, and the way that we can do it is by sticking to the rules and getting the jab. That is why the vaccination programme is so important. It is why the road map is cautious and, we hope, irreversible. That is the plan, and with the 10 million second vaccines and the progress in the vaccination programme that we have seen in the last few days, weeks and months, I am very pleased to say that we are on track.
(3 years, 4 months ago)
Commons ChamberI warmly welcome my right hon. Friend’s enthusiasm and support for that project, which the Prime Minister set out at a high level to the Liaison Committee. We are working hard, including with stakeholders, and the Minister for Care has held a number of roundtables on the subject. We want this to be an open and broad programme, to ensure that we get the right answers to these long-standing questions.
Will the Secretary of State explain why, following a private drink he had with Lex Greensill and David Cameron, Greensill was handed an NHS payroll financing contract that sought to convert income from NHS staff pay packets into bonds to sell internationally, and effectively to make money on the back of NHS staff in a pandemic? Why was that contract given without tender? Why was that meeting not declared? What pressure did the Secretary of State put on officials to hand that contract to Greensill?
Ministers were not involved in the decision by NHS Shared Business Services to facilitate the provision of salary advances in pilot schemes. I attended a social meeting organised by the former Prime Minister, and given that departmental business came up, I reported to officials in the normal way.
This is part of a wider pattern of behaviour. We see PPE contracts going to Tory donors, and a pub landlord WhatsApping the Secretary of State and receiving a testing contract. We see a US insurance firm taking over GP contracts, and one of its bosses gets a job in Downing Street. It is cronyism and it stinks. If the Secretary of State thinks he has done nothing wrong and has nothing to hide, will he publish all the minutes, emails, correspondence and directions that he gave to civil servants, and all his text messages with David Cameron, so that we can see exactly what went on with the awarding of this contract?
Yesterday the Government announced a review into this matter, and I will of course participate in that in full. It is important that Governments engage with external stakeholders and businesses and, as was raised in the previous question, it is important that that happens, and happens in an appropriate way within the rules, which is what happened in this case.
(3 years, 5 months ago)
Commons ChamberI will just make a little more progress.
We are also suspending three further provisions, although they may need to be restored and called on if required. As well as that, we have completed the six-month statutory review on covid-secure regulations for businesses, the collection of contact details and self-isolation, and concluded that they remain necessary at this time. The Coronavirus Act is temporary, time-limited and proportionate to the threat we face, and we are keeping measures only where they are necessary as we exit this pandemic, and then we can do away with this Act for good.
Throughout the pandemic, this House has also found a way to meet. I cannot wait for the time when this Chamber will be full and rowdy once again as the cockpit of our democracy, where we can almost literally take the temperature of the nation. I may pay for that when I say something particularly unfortunate, but I prefer it, and I think everybody in this House does. After widespread consultation and on the basis of detailed public health advice, my right hon. Friend the Leader of the House has tabled a motion to extend virtual participation and the current proxy voting arrangements until 21 June, the proposed date for the removal of all legal restrictions on social contact. We thank you, Madam Deputy Speaker, and through you the other Deputy Speakers, Mr Speaker and the House authorities for the work that has been done in these unprecedented times to keep people safe here.
The measures before the House today show how we will put the pandemic behind us and restore life to normal. We are on the road to recovery, but we are not at the finish line yet, and by passing these measures, we can keep protecting lives and livelihoods while we get our nation back on its feet once more.
On a specific point, which I rather hoped the Secretary of State would cover but I anticipate will not, we are obviously very concerned about variants in Europe and the surge that we are seeing there. Is it the Government’s intention to impose restrictions on those coming in from France or Germany—to add either France or other European countries to the red list—or to impose testing on hauliers coming into the country?
All these questions will be answered as part of the work of the global travel taskforce, which the Prime Minister has announced will be published on 5 April, so I recommend that the right hon. Gentleman waits until then. In answering that final question, I commend the motions to the House.
I appreciate the Secretary of State allowing me to intervene on him at the end of his speech.
It is right that this week we remember all those who have lost their lives to this horrific virus, and that we reflect on the grief of all those who have lost loved ones. Across the House we pay tribute to those who put themselves in the face of danger—our NHS, care workers, and all our public servants and key workers who have kept our society functioning.
More than 126,000 people have died. In social care, the impact has been devastating, with more than 30,000 deaths. Residents have been left isolated and frightened, deprived of visits from their loved ones for months on end. Across the NHS, cancer patients have had surgery cancelled and screenings postponed, and more than 300,000 people have been waiting for more than a year for treatment. A study today from the University of Leicester suggested that 71% of those patients who were hospitalised and discharged have not fully recovered after five months, and 20% have been left with a new disability. The long-term impact of covid is likely to be severe for many people.
Our NHS staff face burn-out, and children have lost months of education and social interaction. They risk being among the biggest victims of the pandemic. Families are worried and anxious. Our NHS has suffered. Public health funding has been cut for many years, which left our public health services without the capacity they needed when the pandemic hit. The poorest communities saw more than double the death rate in the first wave of the virus, and in ethnic minority communities the death rate has been up to 50% higher. It did not have to be like that. A healthier more equal society would have weathered the storms better. We could have planned better, acted more quickly, and responded more comprehensively.
Our vaccination programme has been successful, and again I thank everybody who has been involved in that. But the reality is that we are not yet out of the woods. The pandemic still has some way to go, and it is right that we proceed with caution and do not become complacent. Vaccination alone does not make us bullet-proof. It makes us safer, but we are not safe until we build population immunity and roll out vaccinations everywhere across the world.
Last week I asked the Secretary of State about the vaccination of children, and he rightly said that we had to wait for the research and clinical trials. Yesterday it was suggested that the vaccination of children could start as soon as August, if safety requirements are met. I hope Ministers are commissioning the Joint Committee on Vaccination and Immunisation to produce a plan for how children’s vaccinations could roll out. That will be an important way to drag down transmission.
A third wave is surging across Europe, much of which is due to the B117 Kent variant. Increasingly, we are seeing higher prevalence of other variants, and as the Secretary of State rightly said, we are uncertain about whether they will evade the vaccines. We therefore have to be careful and proceed with caution. Although we are making extraordinary progress in this country with our vaccination rates and in bringing infection rates down, we know that the virus mutates and that it could come back and hit us even harder, particularly at a time when a considerable amount of virus is circulating.
Infections are still running at more than 5,000 day, and last week the Office for National Statistics estimated that 160,000 people in England had the infection in the past week. We must still work hard to break transmission chains and shut down opportunities for the virus to replicate. Given the loss of life we have suffered, and the risk of mutations that could set us back, we must have zero tolerance of letting the virus rage unchecked. For that reason, Labour accepts that restrictions must stay in place, and we will support the renewal of the Coronavirus Act 2020 and the public health regulations.
We do not support that renewal with any enthusiasm or relish—quite the opposite. Neither the Secretary of State nor I came into politics to put powers such as these on the statute book. These powers curtail so many basic freedoms and deregulate so many basic standards for which our forebears fought so hard and that so many people have taken for granted.
I am also acutely conscious that this deadly virus spreads rapidly, exploits ambiguity and thrives on inequality. Suppressing the virus does depend on social distancing measures, which is why we need them on the statute book, but it depends on other measures as well, such as properly isolating the sick and paying them fully to isolate. It depends on having proper community-led contact tracing, both retrospective and looking forward. It depends on investing in science, so that we have not just the vaccines but the therapeutics that will lead us out of this crisis.
Restrictions in themselves are a blunt tool, but sadly they will be needed, given that the virus is still surging across the world. That is why we supported the measures 12 months ago and will support them again today. Indeed, it was 12 months ago that I met regularly with the Secretary of State. It was just over 12 months ago that I sat round a very small table in the Prime Minister’s office in Downing Street with the Prime Minister and the then Leader of the Opposition, my right hon. Friend the Member for Islington North (Jeremy Corbyn), alongside advisers such as Dominic Cummings and others, to negotiate the content of the Act.
We pressed for statutory sick pay from day one, and that is in the Act. We think that the Government should go further—it is not enough, but at least we have statutory sick pay from day one. We pressed for a ban on evictions for those in rent arrears, and again, the Prime Minister gave us that concession. We pressed for furlough as well in that meeting. On each of those, I want the Government to go much, much further, and it is a monstrous failure that decent sick pay and financial support have not been provided over the past 12 months, but it would be churlish of me not to recognise that we had that meeting and that concessions were offered as a result of it.
Even though we supported the Act 12 months ago, I raised at the Dispatch Box a number of concerns about its content and said that, in different circumstances, with a proper process whereby Members could table amendments in good time, we would have hoped for better scrutiny of it. We raised concerns about the easements of the Care Act 2014, and I am pleased that those clauses will be removed. We raised objections to the Coronavirus Act giving the Secretary of State powers to change section 42 of the Children and Families Act 2014. I understand that those powers have not been used since July last year, but we remain concerned that they appear still to be in the Act. I ask the Secretary of State and Ministers to reflect on that and to take those clauses out of the Act.
We also raised concerns about the more draconian elements of the Act. Indeed, I said at the Dispatch Box a year ago:
“The Bill contains the most draconian powers ever seen in peacetime Britain—powers to detain and test potentially infectious members of the public…powers to shut down gatherings, which could impede the ability to protest against the overall handling of the crisis or against the abuse of the powers themselves. It needs no explanation and very little imagination to understand the huge potential for abuse that such powers and others in the Bill, however well intended and needed, still give rise.”—[Official Report, 23 March 2020; Vol. 674, c. 59.]
Sadly, we have seen such abuses. Schedule 21, which gives the power to detain potentially infectious persons, has been used for a number of prosecutions, every one of which was found to be unlawful when reviewed by the Crown Prosecution Service. The Joint Committee on Human Rights advised in its report of September last year that
“In the absence of any clear evidence to support the retention of these powers”—
the schedule 21 powers—
“they ought to be repealed.”
We have huge sympathy with that, as do Members who have contributed to the debate so far, and we urge the Government to look again at that schedule.
I am grateful for what the hon. Gentleman just said. I am very sorry—although I completely understand it—that my amendment on schedules 21 and 22 was not selected, because we probably would have gone through the Lobby together on it. Could he advise the Secretary of State on whether he would vote to call upon Ministers to remove those schedules, should such a question come before the House?
I understand why we should want to deal with somebody who is infectious and refusing to isolate, but I do not think the schedule and the way it has been applied is needed. That needs to be looked at again.
I make a broader point. Although I understand why the Government have to put, or maintain, these restrictions on the statute book, and I am a strong believer in doing all we can to suppress the virus, drive down infections, cut transmission chains and prevent opportunities for it to replicate—I am a strong believer in putting public health and prevention first—I also think that the Government could have found time for this debate to take place in the House over a couple of days, so that Members could table amendments and we could properly scrutinise the legislation. The Government have a rather handsome majority; I am sure they would have got their way on most things, but who knows? Perhaps through proper scrutiny we might have improved the legislation.
The hon. Gentleman invites me to offer endorsement before I have read the details—he is a canny operator in this place—but in principle his suggestion sounds reasonable. I look forward to no doubt receiving an email from him later today, which I will be able to read when I am on the train back to Leicester.
My hon. Friend is giving us an interesting insight into the history of the epidemic in this country and the discussions that took place. Would he care to put it on record that we should immediately start an independent public inquiry into what has gone on so that we can get a full picture? It is a feeble excuse to say that people cannot attend a public inquiry when virtually every Select Committee in this House is having witnesses every day.
My hon. Friend is absolutely right: we need a public inquiry. Mistakes have been made. There have been examples of poor decision making. When we went into the crisis, our health and social care capacity was less than it should have been, and our public health capacity, after cutbacks over many years, was lacking. We were late going into lockdown a year ago; maybe that was not unreasonable, but we were also late going into lockdown the second and third time. Of course we need a public inquiry to get to the bottom of all these matters.
The Secretary of State is embarking on a reorganisation of the national health service. Yesterday, he made an interesting speech about the future of public health, which he opened by saying that one lesson of this crisis is that we need to set up a national institute of health security. I agree with him on health security, as it happens, but the Government cannot, on the one hand, say that they have learned lessons from this crisis and they need to do X, Y and Z while, on the other hand, the Prime Minister says it is too early to learn lessons and we cannot have an inquiry. My hon. Friend the Member for Blackley and Broughton (Graham Stringer) is absolutely right and I totally agree with him.
We have concerns about schedule 21 of the 2020 Act, but we are where we are, and the procedures of the House leave us little room for manoeuvre, so we will support the Government in the Division Lobby, should it come to that, albeit that we would rather not be in this situation.
Schedule 22 is another schedule that is open to abuse, and I hope the Government will review it and come forward with alternatives; given recent events, the power it contains on gatherings has caused understandable concern. However, some progress is offered by the public health regulations, which expressly include—I think for the first time, and in relation to each step of lockdown relaxation—the right to gather for purposes of protest. That is welcome but, to be frank, it should have been there all along. I have some concerns that, to comply, organisers must take into account, in the words of the regulations,
“any guidance issued by the government relevant to the gathering”,
which means that the Government, through guidance, which could be general or specific to a particular protest, can determine what is allowed by way of protest. I hope the Minister, who is a decent man and a fellow Leicestershire MP, can offer us some guidance on that in his response.
Notwithstanding our concerns, we understand why the 2020 Act must stay on the statute book and why the public health regulations must receive the support of the House today. The pandemic is not over. The virus is surging again. Deaths are increasing across the world after going down for some weeks. Mutations could emerge, which could bounce back at us and set us back considerably. Although they would probably not put us back to square one, they could evade the success of our vaccination programme. A year ago, I concluded my remarks by observing:
“The crisis has exposed the vulnerability of a society in which insecure work is rife, deregulation is king and public services are underfunded. When we come out on the other side, as we will, we have to build a society that puts people first.”—[Official Report, 23 March 2020; Vol. 674, c. 61.]
Rebuilding that society becomes ever more urgent every day.
The four-minute limit will now be on for Back-Bench speeches.
(3 years, 5 months ago)
Commons ChamberAs always, I thank the Secretary of State for advance sight of his statement.
Our constituents will be worried, anxious and disappointed at the news on vaccination last night. It has been an unspeakably horrific year. We have one of the worst death rates in the world and our economy has taken a massive hit. Many key workers under the age of 50, such as teachers and police officers, who through the nature of their work are not at home, are going out and are more exposed to risk, had been hoping that vaccination for them was not far away. Of course, we understand why there will be delays in supply, but this is not fantastic news and nor, frankly, is it expected news.
On Saturday, the Government, or Government sources at least, were briefing The Daily Telegraph about a “bumper boost” and that everyone over 40 would be offered their first vaccine by Easter. Last week, the Business Secretary was hinting that all adults could be vaccinated by June, saying:
“There is no reason why we can’t be optimistic.”
On Monday, Nottingham and Nottinghamshire clinical commissioning group began inviting those in their 40s for vaccination, and a similar invitation went out from Bury CCG. We are grateful for the Secretary of State’s update today, but it will be a surprise to many.
The Secretary of State did not mention Moderna supplies today. I understand that supplies from Moderna will start in April. Is there any prospect that, if Moderna supplies come on stream, new appointments can be offered in the light of that?
About 11 million people received their first dose between January and February. I listened carefully to what the Secretary of State said. Can he clarify for the House and our constituents: is he offering them an absolute guarantee that all those will get their second dose within the 12 weeks throughout April? Our constituents will be keen to get that absolutely clarified.
The vaccination programme will need to ramp up to about 3.5 million doses a week from May to ensure that everyone under 50 is vaccinated by mid-July. Is the Secretary of State confident that these supply issues will be fixed by May? Is there any prospect of doing more than 3.5 million jabs a week from May? We heard today from Adam Finn of the Joint Committee on Vaccination and Immunisation that infection rates may rise as a result of the delays. Does the Secretary of State anticipate that any of the stages, any of the dates, in the road map for easing out of lockdown will be pushed back, given that we are rightly judging the road map by data, not dates?
On behalf of the official Opposition, I take this opportunity to support the AstraZeneca vaccine. Of course, where people are worried and have concerns, those worries and concerns must be addressed, not dismissed. But this is a concern at the moment. Yesterday, for example, I was told that hundreds of people failed to show for appointments at the ExCeL centre and we think that is because of concerns and misinformation circulating online.
There are parts of the country where infection rates remain relatively high and vaccination rates are relatively low. I see that in my Leicester South constituency. Will the Secretary of State pull together a cross-party taskforce of community and local leaders to look at tackling these vaccine hesitancy issues? I again offer to work with him on that on a cross-party basis.
Children make up about 21% of the population. That is a large segment of the population that will be lacking immunity. Obviously, research and trials are ongoing, but does the Secretary of State have a timeline for when he hopes to vaccinate children? Does he anticipate, for example, being able to vaccinate children this autumn, as Anthony Fauci in the US has suggested could well happen over there? Even as vaccination rolls out, the virus continues to circulate, and new vaccine-evading variants could emerge. We may need booster jabs in the autumn, and the winter will be challenging, which is why driving up vaccinations across the whole of the population is so important.
On the Budget allocations that the Secretary of State has announced for the next six months, I welcome the extra funding, of course, but can he guarantee that the NHS will continue to get additional funding after the six months if it is needed for covid care? As he has said, people are waiting longer for treatment, with more than 300,000 people waiting over a year, risking permanent disability or loss of livelihood, and with thousands waiting too long for cancer treatment, risking loss of life. We should not have to choose between cancer care and covid care. We are also facing a mental health epidemic as a consequence of this crisis. Crucially, because of years of underfunding, bed cuts and understaffing, when we entered the pandemic we already had growing waiting lists, our A&Es were in crisis and we were missing cancer targets. Can he tell us when he expects to bring down those waiting lists and meet the various cancer targets again?
Finally, the Secretary of State did not mention NHS pay today. He claps NHS workers and nurses, but he is introducing a real-terms pay cut for our NHS staff. Can he tell us whether he will implement any recommendations of the independent pay review body? If it recommends an increase above 1%, can he assure us that the funding will be additional to what he has announced today? In truth, if he really wants to value NHS staff, he should withdraw that pay cut now.
I welcome the right hon. Gentleman’s support for the vaccines, the vaccine roll-out and the clinically-led approach that we have taken in this country, and I mean that as more than simply a polite gesture. It is vital in this country that we have such a strong cross-party consensus, which includes all parties represented in this House, behind the vaccine programme and behind the science. The science means, of course, that we should and we do publish any side-effects, and we are open and transparent about that, but also that we make an assessment as to the benefits and how those benefits weigh against any side-effects. It is absolutely clear from the data we have seen so far that the vaccines are safe and that they make us safer than not getting vaccinated. That is an absolutely critical fact, and the MHRA will shortly set out more details; it is properly for the independent regulator to set out those details.
The right hon. Gentleman asked about supplies from Moderna. We expect supplies from Moderna in the coming weeks, and I am grateful to Moderna for the work that it has done. Of course, we have always been cautious about setting out future supply details, and the experience of the last 24 hours makes me even clearer that it is far better for us to set out clear commitments to the public in terms of when people can be vaccinated. This means that all over-50s now can come forward and that we are committed to and on target to offer to all over-50s and groups 1 to 9 by 15 April.
However, we know that supply figures move up and down. We have seen that throughout the roll-out, and it is part of the normal management of this roll-out. The commitment I can give the right hon. Gentleman is that, for those who are coming forward for second doses, those appointments will not be delayed because of these supply issues. Also, appointments that are already made will not be cancelled because of supply issues. I therefore say clearly to any member of the public who is watching: the vaccination programme is on track to meet the targets we have set out, and if you get the call from the NHS—whether you get it through a letter, a text, a telephone call or even, these days, an email—take up the offer and get the jab.
The right hon. Gentleman rightly asked about the road map. We are on track for the dates in the road map, and there is no impact on the road map from the changes to vaccine supply that we have been detailing in the last 24 hours.
The right hon. Gentleman asks about the vaccination of children and the autumn vaccination programme. Neither of these is certain. The vaccination of children is currently being assessed in a number of different clinical trials and it is very important that we consider the results of those before making any decision. It is likely that we will need a vaccination booster programme in the autumn, not least to deal with new variants, but that is again not yet certain.
Finally, I am very glad that the right hon. Gentleman welcomed the extra funding that we are putting into the NHS. He asks whether, after six months, there will be more funding if needed for covid purposes. The Chancellor has been absolutely clear from the start of this crisis that the NHS will get what it needs to deal with covid. That is very important, as is the work to restart the NHS in areas where it has had to be paused and, critically, the work that colleagues across the NHS will be doing to recover the backlog of elective work and make sure that everybody can get their appointments and operations in a timely way on the NHS once more. That is the work of the months ahead and I look forward to supporting NHS colleagues in delivering on it.
(3 years, 5 months ago)
Commons ChamberUrgent Questions are proposed each morning by backbench MPs, and up to two may be selected each day by the Speaker. Chosen Urgent Questions are announced 30 minutes before Parliament sits each day.
Each Urgent Question requires a Government Minister to give a response on the debate topic.
This information is provided by Parallel Parliament and does not comprise part of the offical record
(Urgent Question): To ask the Secretary of State for Health and Social Care if he will make a statement on the Department of Health and Social Care’s recommendations on NHS staff pay.
This pandemic has asked so much of our health and care system. The whole country recognises how our NHS workforce have performed with distinction and gone the extra mile throughout this crisis, which has also had a huge impact on our economy. It has been and still is a tough time for businesses and all those who work in them.
As hon. Members will be aware, most of the public sector is having a pay freeze. However, even against that backdrop, we will continue to provide pay rises for NHS workers, as the Chancellor set out at the spending review. This follows a multi-year pay deal, which over a million NHS staff have benefited from and which includes a pay rise of over 12% for newly qualified nurses. We are also ramping up our investment in our NHS, with a £6.2 billion increase for 2021-22, as part of our £34 billion commitment by 2024-25, and £3 billion for supporting recovery and reducing waiting lists. As part of that, we are increasing the number of staff in the NHS, with over 6,500 more doctors, almost 10,600 more nurses, and over 18,700 more health support workers in the NHS now than a year ago. We are also on track to have 50,000 more nurses in the NHS by the end of the Parliament.
Last week, we submitted our evidence to the NHS pay review bodies, which are independent advisory bodies made up of industry experts. Their recommendations are based on an assessment of evidence from a range of stakeholders, including trade unions. They will report their recommendations in late spring, and we will carefully consider their recommendations when we receive them.
I can assure the House that we are committed to the NHS and to the amazing people who work in it. Just as they have been so vital throughout this pandemic, they will continue to be the very essence of our health service, together with all those who work in social care, as we come through this pandemic and build a health and care system for the future.
I am grateful to the Minister, but where is the Secretary of State? Why is the Secretary of State not here to defend a Budget that puts up tax for hard-working families and cuts pay for hard-working nurses? The Secretary of State has stood at that Dispatch Box repeatedly, waxing lyrical, describing NHS staff as heroes, saying they are the very best of us, and now he is cutting nurses’ pay.
Last summer, when asked by Andrew Marr if nurses deserved a real-terms pay rise, the Secretary of State replied:
“Well, of course I want to see people properly rewarded, absolutely.”
Yet now he is cutting nurses’ pay.
Last year, the Secretary of State brought to this House legislation to put into law the NHS long-term plan. He said from that Dispatch Box that his legislation represented
“certainty for the NHS about a minimum funding level over the next four years and certainty for the 1.4 million colleagues who work in our health service”.—[Official Report, 27 January 2020; Vol. 670, c. 571.]
That long-term plan was based on a 2.1% pay increase for all NHS staff. Every Tory MP voted for it, the Minister voted for it, and now every Tory MP is cutting nurses’ pay.
The Minister talked about the Budget. Where is the Chancellor? Where are his glossy tweets? Where is his video? Why did he not mention in the Budget that he was cutting nurses’ pay? Why did he sneak it out the day before in the small print?
This is happening at a time when our NHS staff are more pressured than ever before. In the midst of the biggest health crisis for a century, when there are 100,000 shortages, what does the Minister think cutting the pay of NHS staff will do the vacancy rates? Perhaps she can tell us.
The Minister talked about the pay review body, but she did not guarantee that the Government will implement any real-terms pay rise that the pay review body recommends. Why is that? It is because Ministers have already made up their minds to cut, in real terms, NHS pay in a pandemic. Our NHS staff deserve so much better. If this Government do not deliver a pay rise, it shows once again that you simply can’t trust the Tories with the NHS.
I thank the shadow Secretary of State for his welcome. As it is International Women’s Day, it is a shame that he does not have a female colleague by his side at the Dispatch Box.
(3 years, 5 months ago)
Commons ChamberAs always, I thank the Secretary of State for advance sight of his statement. On the Brazilian variant, in January and February cases here were running at tens of thousands a day and we were in lockdown—we are still in lockdown—because of our own home-grown new infectious variant, yet people were allowed to fly in from abroad, bringing the P1 Brazilian mutation with them. Throughout history, epidemic after epidemic has exploited international travel. Surely it is obvious that tougher border controls should have been in place sooner.
I welcome the progress that the Secretary of State has made on identifying the batch, but how on earth can a test be processed that does not collect the contact details? What mechanisms will be put in place to fix that in the future? Twenty-two billion pounds has been allocated to this system, and it feels as though someone has vanished into thin air. Can he assure us that it will not happen again?
I note that the Secretary of State said that there is no information to suggest wider spread of this variant, but he will recall that John Edmunds from SAGE told the Home Affairs Committee in January that for every identified South African variant, there were probably another 30 unidentified. Can the Secretary of State tell us whether he has received any estimates of the number of unidentified cases in the wider community?
I welcome the tremendous progress that has been made on vaccination and driving infection rates down. It is a testament to the NHS and everybody involved in the vaccination programme, and to everybody who is playing their part in this lockdown. We also know that the virus can quickly rebound and that mutations could evade vaccination. We are in a race against evolution, so we have a long way to go. To be frank, nowhere is covid-safe until everywhere is covid-safe. None of us wants to yo-yo in and out of lockdowns, so will the Secretary of State guarantee that the lockdown easing will, as promised, absolutely be based on data, not dates, and that the assessment time between each step is not compromised? I welcome the extra surge testing, but what is the current timeframe for genetic sequencing? How can it be sped up?
Overall trends are coming down, and that is welcome, but infections in some areas remain stubbornly high. The national average is 100 cases per 100,000, but in Leicester, my city, the infection rate is one of the highest in the country at 222 per 100,000. In Ashfield, the infection rate is 246 per 100,000. In Hyndburn, the infection rate has increased to 162 per 100,000. In Oadby and Wigston, it has gone up. In Watford, it has gone up. In Worthing, it has gone up. What steps will be taken to ensure that areas such as Ashfield, Leicester, Watford, Worthing, Hyndburn and so on are not left behind when the national lockdown restrictions begin to lift, or will those places remain in localised lockdowns? Will the local authorities be given extra resources to do more door-to-door testing and retrospective tracing? Will workplaces in those areas be inspected by the Health and Safety Executive to ensure they are covid-secure? And of course, will people finally be given decent sick pay and isolation support?
Many areas such as Leicester are facing a double whammy of relatively high infection rates and relatively low vaccination rates. What further action will now be taken to drive up vaccination rates among hesitant communities? Will the Secretary of State fund faith groups, community groups and local public health teams to develop more targeted and tailored local vaccination campaigns?
Tomorrow’s Budget cannot be about the Chancellor’s Instagram account; it has to be about the NHS and social care accounts. Can the Secretary of State guarantee that tomorrow we will get an increase in public health allocations to help public health teams plan their local covid response over the next year? Will our NHS heroes get the pay rise they deserve? With 224,000 patients waiting more than 12 months for treatment, will our NHS get the resources it needs to deliver the patient care that patients and our constituents deserve?
The right hon. Gentleman is quite right to thank all those who are responsible for the vaccine roll-out. It has been an absolutely remarkable effort. He is right to say that the NHS has played its part—it has played a central part—but it has been more than the NHS. It has been the brilliance of the logistics, in particular, of our armed services. It has been the volunteers who have come forward in their droves. It has been the regulator and the partnership with private industry, and I think that this model of a combination of academic excellence and partnership between Government, regulator and private industry is one on which we can build. I know it is a model that they do not like much on the Opposition side of the House—
The right hon. Gentleman says he likes it. We always knew that he was misplaced over there. His problem is that sometimes his rhetoric is aimed more at his Back Benchers than what he thinks is right. I urge him to listen to his conscience and to back us and the businesses that are making this vaccination roll-out happen, and to put that support into practice.
The right hon. Gentleman asked about sequencing—again, done by a brilliant combination of academics, Government and private businesses. We are now sequencing a third of the positive tests in this country. That is not yet a full survey of all the positives, although we are working towards that, but it does mean that we are able to spot the variants much more than anywhere else in the world. We currently provide around 40% of the total global sequences of this disease—this virus—and we are driving up that sequencing capacity.
The right hon. Gentleman asked about increasing the uptake of vaccination. He was quite right to, and we are working with faith groups and local directors of public health and others. Councils have a very important role to play alongside pharmacists and, of course, GPs in increasing the vaccination uptake. However, the vaccination uptake has been very, very high—higher than I expected—and I am really thrilled about that.
Finally, the right hon. Gentleman asked about making sure that the road map follows data, not dates. We have rigorously set out the gap between the steps to ensure that we can see the effect of one step before we take the other. That is with the goal of having this road map as a one-way route out of restrictions so that we can all get back to the freedom that we crave.
(3 years, 6 months ago)
Commons ChamberThe good news is that, thanks in part to the work that my right hon. Friend did when he was in my shoes, we now have a record number of doctors in the NHS and he will have been as pleased as I was to see the record number of applicants to nursing places as well, because we need both more doctors and more nurses. I am delighted that, during the pandemic, we have increased numbers very substantially. On nurses, we are on track to meet our manifesto commitment to 50,000 more nurses, and we have seen a significant increase—just under 10,000—in the number of doctors too, so there is significant progress. Of course there is more to be done, and of course we will need to set out the route to that, as he suggests. The time is not quite right now, because right now there are still very urgent needs and pressures, thanks to the pandemic—I am sure that he and the Select Committee understand that—but this is undoubtedly a question that we will return to.
Everybody knows—apart from the Secretary of State, it seems, from this morning’s media—that there were PPE shortages. The National Audit Office reported on it, we saw nurses resorting to bin bags and curtains for makeshift PPE, hundreds of NHS staff died, and his response was to pay a pest control firm £59 million for 25 million masks that could not be used, to pay a hedge fund based in Mauritius £252 million, again for facemasks that were inadequate and to pay a jeweller in Florida £70 million for gowns that could not be used. So will he take this opportunity to apologise, and will he commit to recovering every penny piece of taxpayers’ money from those companies that provided us with duff PPE?
Well, I am going to start by congratulating the hon. Gentleman—the right hon. Gentleman—on his appointment to the Privy Council. I appreciate the work that he has done in support of the Government and in support of the nation during this pandemic. Although occasionally he turns to rhetoric and narrow questions that he knows there are perfectly adequate answers to, he has generally during this pandemic, in the face of temptation—I mean this very genuinely—done the right thing and supported the right messages to people where they need to be made across party lines. So I congratulate him and thank him for that.
On the specifics of the question the right hon. Gentleman raised, of course, where a contract is not delivered against, we do not intend to pay taxpayers’ money, but of course, also, we wanted to make sure that we got as much PPE as we could into the country. While of course there were individual instances that we all know about and that highlight how important it was to buy PPE, there was, as the National Audit Office has confirmed, no national level shortage, and that was because of the incredible work of my team and the amount of effort they put into securing the PPE and doing the right thing.
I dare say the Secretary of State has just finished off my political career with that fulsome praise but, on the substance of the point, I think he confirmed that he will—[Interruption.] When did it start? [Laughter.] I think he was saying in that answer that he will not be trying to recover money that he has paid out for duff PPE, but can I ask him about a different issue, which again comes down to public scrutiny and accountability? In London, a week or a week and a half ago, GP services with 375,000 patients were taken over by the US health insurance corporation Centene. There was no patient consultation; there was no public scrutiny. This is arguably a stealth privatisation, with huge implications for patient care. Will he step in, halt the transfer, ensure it is fully scrutinised and prevent takeovers like this happening in the future?
On the right hon. Gentleman’s first point, such a reasonable and sensible man is, of course, always welcome on these Benches, and I might ask, since his wife is taking the Labour party to court: why doesn’t the whole Ashworth family come and join us on this side?
On the substantive point the right hon. Gentleman raises, of course what matters for patients is the quality of patient care. We have seen again and again, especially throughout the pandemic, that what matters to people is the quality of care. That is what we should look out for, and that is, I know, what doctors, nurses and other staff, in primary care and right across the board, are working so hard to deliver on.