There is a big issue, and my hon. Friend is aware from his time at the Department of Health that its root cause is capacity in the system. These capacity issues taken together are why the Health Foundation says that, in just over a decade, we risk a workforce gap in the NHS of about half a million people. That is why this is such a big issue. I urge the Secretary of State to think about that during the Bill’s passage.
My hon. Friend is absolutely right. These issues are about not just doctors but all associated health professionals, allied health professionals and indeed the social care workforce. It is important to note that they predate the pandemic. That is why, when I was doing the job of my right hon. Friend the Secretary of State, I set up five new medical schools and increased the number of doctor, nurse and midwife training places by a quarter, but we need to go further.
When the number of clinicians we train is decided by haggling between the Department of Health and the Treasury in a spending round, there is always the risk that it will be eclipsed by more short-term considerations. The truth is that we have a short-term emergency with workforce burnout, so I urge my right hon. Friend to look at the simple and sensible solution proposed by the Health Foundation and all the royal colleges in The Times today to legislate for Health Education England to have a statutory responsibility to publish annual independent workforce projections across the health and care system for the next five, 10, 15 and 20 years. That would show how many training places are needed, which would start to tackle this problem and the obscenity of spending £6 billion every year on locum doctors and agency workers. That cannot be the best use of funds.
Frontline health and care workers are exhausted. They know that there is not an instant solution, because they know it takes three years to train a nurse and seven years to train a doctor, but we can at least give them the reassurance that there is a long-term plan in place. That is not in the Bill, but it needs to be. Given the dedication that we have seen from health and care staff over the last year, it is the very least that we owe them.
It is a pleasure to follow the hon. Member for Meriden (Saqib Bhatti) and to congratulate him on the birth of his child.
First, I am going to vote against giving this Bill a Second Reading. I cannot believe that the Government are going ahead with the Bill at this time. It is irresponsible and without any consideration to those who have worked to save our lives and continue to save our lives. The Secretary of State is going to have to assert himself, because he is only just in the job and he seems to have been bounced into this legislation.
Why is this happening now? We have been through this before. I was on the Health Committee from 2010 to 2015. The right hon. Stephen Dorrell was its Chair. On a cross-party basis, we heard evidence that the Bill introduced in 2012 was not the best solution for the NHS. We managed to pause the Bill but the Government continued to press ahead.
Integrated care is Labour party policy. We have seen it. We visited Torbay, where the fictitious Mrs Smith had a single point of entry and everyone was able to track her all the way through the system—through hospital and out—for all her needs. But the 2012 Act stopped that. It stopped the pooling of resources. Integrated care can work only if there are adequate resources for local authorities. Austerity measures since 2010 have starved local authorities and other public services of funding. That is what is making people angry. But the governance of the integrated care system has no clinicians and no patients. People who use it or work in it do not get a say. All sorts of other people can be added on.
My second point is that we do not trust the Government on contracts. Look what happened during the pandemic: £347 million to Randox, the Tory-linked private healthcare company whose testing kits had to be recalled over the summer because of concerns about contamination. We warned them about section 75 and opening this out to tender. The transaction costs associated with that drain the NHS of resources. There is fragmentation and destabilisation. Just ending section 75 is not sufficient; the NHS must become the first and the default option, and private providers cannot be involved in the ICS or in commissioning decisions. We cannot have a select group of fast-tracked friends.
My third point is about the workforce and it has already been raised. They have been magnificent. They have already had a slap in the face with a 1% pay rise and now they are facing further reorganisation. Workforce planning is key to a smart organisation. Clause 33 says who is responsible, but not what must be delivered. Instead of reporting once every five years, how about laying that before Parliament every year? The modelling will have to be done on the workforce assessment, so why can it not be made transparent and available? As the British Medical Association said, we need independently verified projections of future workforce supply so that local and regional decisions can be made on safe staffing levels. That phrase is not even in the Bill, post Francis.
The Secretary of State should think again, as this is the wrong time. The graphs are going up. The BMA and the royal colleges are against this Bill. The main point about healthcare—the right to healthcare—has not been enshrined in the Bill. It must be stopped now, and people and patients should be put first.
With the climate crisis and the reality of an ageing population, there has never been a better time for the Government to centre the wellbeing of people and planet and the way in which public services and the economy are run. Sadly but unsurprisingly, the Bill fails in this context, so I will vote against it, because it does not fundamentally deal with the very real issues facing our healthcare system. It does not address the desert of NHS England providing oral and dental healthcare, which has made it impossible for my constituents to get an appointment. It does not guarantee fair pay and conditions for the key workers who have seen us through the pandemic, and it does not deal with the scandalous state of mental health- care. Patients in my constituency are in crisis, are discharged too early, or not admitted at all, while for a decade, Norfolk and Suffolk NHS Foundation Trust has failed to end the practice of sending patients out of area.
What the Bill does do is transfer yet more centralised power to the Executive—rightly described as a power grab by my right hon. Friend the Member for Leicester South (Jonathan Ashworth)—and, of course, to the private sector. Clause 13, which provides for the establishment of integrated care boards, opens the door to private companies having a say in where funding is allocated and what services are delivered. Clause 3 gives greater political control to the Secretary of State over the NHS England mandate without creating a duty to provide universal, comprehensive and free healthcare to all. Clause 38 empowers the Secretary of State to intervene in the reconfiguration of services, opening the door for politicised interference and gridlocks on decision making.
Where is the democracy, accountability and transparency in the Bill? How will the right of my constituents to healthcare be guaranteed over and above the interests of private companies and the political whims of the Secretary of State? To see what happens when private companies have any role in delivering care, we need only look at the social care crisis. In England, 84% of care home beds are managed by private companies, and three of the five largest care home companies are owned by investment firms whose main priority is economic rent seeking, not the long-term care of our elderly. That model has, unbelievably, led to a cut in the number of care home beds, despite an ageing population, meaning that demand is only growing.
I therefore urge the House to vote against this legislation on what remains of NHS England. It extends the same failed ideology that puts profit before people and which has driven our planet and public services to breakdown.
I remind the hon. Member about the unprecedented support we have given social care during the pandemic: extra funding of £1.8 billion, over 2 billion items of free PPE to providers, a new system of distributing PPE direct to care homes and other care providers across the country, distributing over 120 million covid tests to care providers, and vaccinating hundreds of thousands of care home residents and the care workforce. We have been supporting the social care sector to our utmost during the pandemic, and we will introduce our proposals for reform of social care.
It is really important that discharge is carefully planned and that there is care and support at home for somebody when they are discharged from hospital, but it is also really important that we ensure that people are discharged when they are ready to leave. I saw that with my own grandmother, who ended up spending months in hospital owing to problems with her being discharged. Goodness, I wish that she had been discharged sooner—that would have been so much better for her. It is right that we support people to be discharged when they are ready to go home, and we should press ahead with doing that, although we must also ensure that support is there for people in their home.
Thank you for calling me, Sir Edward. I extend my gratitude to the hon. Member for Bromley and Chislehurst (Sir Robert Neill) and wish his wife well on her stroke journey. I was a physio in the NHS for 20 years and worked in stroke rehabilitation, so I obviously know this issue well from a practitioner’s point of view. I echo much of what I have heard in the debate as the reality of clinical practice. During the course of the debate, about 12 more people in the UK will have had a stroke, which is why urgency in getting things right is so important.
Public health measures are absolutely crucial, because smoking and poor diet and exercise contribute extensively to the risk of having stroke. Above and beyond that, once somebody has entered that journey, we need to make sure that they get the optimum care. In acute care, thrombectomy processes are improving people’s chances of good recovery, which is fantastic, but a significant postcode lottery still loiters around that, which we have to address.
My first question to the Minister is therefore whether, as the NHS goes through significant change over the next couple of years, integrated care systems will be charged to set up their own clinical networks for strokes and to ensure that they have the specialism for that acute phase of stroke placed in each one and also spread through the network. It is really important that we bring this to the fore, and that, as the NHS changes, we make sure that the right services are in place.
All too often, as patients were discharged from my care, I would fret about where they went. If they went to a specialist rehabilitation centre, I knew that all would be well, but if they went to a more generalist step-down facility, or were discharged into the community, without that specialist input—speech and language therapists, occupational therapists, clinical psychology as well as neuro physio—I would worry. It is a specialism in and of itself; indeed, neuro physio diverts into stroke rehab. Making sure that people have the up-to-date specialist skills makes all the difference. They take a long time to train, but they change the way somebody with a stroke is approached.
One challenge I always found was the pressure to get people out the hospital door and discharged quickly. To actually re-educate somebody’s mind and body to synchronise and work together in a new way takes time, and therefore ensuring that there is that investment in time is really important. We also cannot push somebody because they become tired, so we have this really delicate balancing act of timing.
It is different for absolutely every patient, but as they go through that journey, they need that specialist support. I will give an example. They may be discharged home, but we know that so many people, once they go home, will just sit in a chair, as opposed to carrying on their rehabilitation. Or perhaps, even when getting up from the chair, they will take the short cut of pulling themselves up, increasing their muscle tone, which is detrimental, as opposed to, say, using a proper Bobath method of facilitating their muscles. That makes a real difference how this issue is approached, and therefore the paucity of stroke rehab specialists must be addressed, making sure that that skill mix is there, but also with the right level of training. That is crucial.
I ask for more training around stroke rehab for GPs and in the community in particular. A community physio may deal with respiratory patients, musculoskeletal patients, neuro patients. We want neuro physios in the community through an extension of specialist rehab centres moving into the community while keeping that clinical case load. We also want the same clinicians along a patient’s rehab journey. It is not easy for clinicians to relay information about a patient simply, so following them into the community could be a different way of doing that as opposed to the silos of our institutions that we currently see.
One other thing is really important. We know that stroke is for life, and therefore we need to ensure that the services are there for a substantial amount of time. I have raised the issue of the six-month review, which is far too long to wait—an individual may plateau or even regress in their care. Regular intervention is really needed and, if someone has plateaued or regressed when they could have been progressing, they should be brought back into more specialist care, even if that is residential care, to help them take that step forward again and get that continuity that is needed. If we do not put in those interventions, clearly the impairments experienced by someone will deepen, which will create pressures that will show themselves elsewhere in the NHS or the social care system. Therefore, that investment is so important for people as they are recovering from stroke.
There is clearly so much to be done. I really welcome the call for an APPG and would be happy to serve on such a group should it arise, but as we are currently reimagining healthcare, this is a real opportunity to put the patient’s need at the centre of a stroke service and ensure that we sustain that for the rest of their life.
It is a pleasure to see you in the Chair, Sir Edward. I thank the hon. Member for Bromley and Chislehurst (Sir Robert Neill) for securing the debate and for his detailed introduction. He highlighted that there is increased awareness of the symptoms of strokes, and that acute care has certainly been on an upwards trajectory. The point that he made so eloquently and so personally was that there is still a long way to go on aftercare. He spoke of courage, patience and consistent professional care being needed, and that is something that we all want to see. A number of hon. Members added their personal perspectives to the debate. I believe we always do better when we hear those perspectives.
We also heard a professional perspective, from my hon. Friend the Member for York Central (Rachael Maskell), who set out clearly the importance of specialist services. The question she asked about the future of those in the new structures was very important.
As we heard from various Members, strokes are very prevalent in this country—100,000 a year, or one every five minutes. We also know that two-thirds of stroke survivors leave hospital with a disability, and it is the fourth-largest cause of death in the UK. It is perplexing, as the hon. Member for Bromley and Chislehurst said, that it does not get more of our attention. As my hon. Friend the Member for Stockport (Navendu Mishra) said, it is also something of a mystery why the level of research funding is not as high as in other areas, even before the challenges of the pandemic that all voluntary fundraising organisations have faced.
Members will know that the national priority in the NHS long-term plan is the national stroke programme. It is intended to deliver better prevention, treatment and care. It is an ambitious programme, but if it is to succeed, it needs adequate funding. I hope the Minister will be able to set out briefly how that funding is being allocated and what progress is being made to meet the targets and aims set out in the plan. A recent report by the Stroke Association found that thousands of stroke survivors are being let down—in various ways, as we heard in the debate, but particularly in the current provision of post-stroke support and rehabilitation.
The most recent Sentinel Stroke National Audit Programme data for April 2019 to March 2020 shows that only 41% of patients received a recorded six-month post-stroke review, and just over a third of applicable patients received recommended levels of physiotherapy or occupational therapy. Less than a fifth received the recommended levels of speech and language therapy. As hon. Members put it in different ways, those figures are clearly not good enough. It needs to be emphasised that that poor record is from before the pandemic.
There were concerns before the pandemic about the shortage of specialist stroke consultants. Figures from Kings College London showed that almost half of hospitals had a shortage of specialist stroke consultants, with 48% of hospitals in England, Wales and Northern Ireland having at least one consultant vacancy in the previous 12 months or more. To pick up on the comment by the hon. Member for Beaconsfield (Joy Morrissey), the Stroke Association called on the Government and NHS England to make stroke medicine a more attractive proposition for junior doctors to specialise in, as well as the other specialities, and drew attention to the need for nurses and rehabilitation. Can the Minister update us on the number of consultant vacancies and say what steps are in place to introduce a plan to deliver the staffing levels that we so clearly need?
It is clear, from what everyone said, that we need to go further and faster to provide support for stroke survivors. Further investment is vital to ensure equitable access to services, avoid digital exclusion and improve health outcomes, to stop the kind of disparities that we have heard about. We must end the postcode lottery. It is so important that, no matter where you live, you get access to the same quality stroke support services, which are consistent with clinical guidelines. I hope the Minister will address the issues that Members have raised, and will set out what steps the Government intend to take to support more survivors of strokes.
We will need to draw many lessons from the pandemic. For instance, my brilliant team who have done all this procurement of PPE have also built an onshore PPE manufacturing capability. With regard to almost all items of PPE, 70% of it is now made onshore in the UK, up from about 2% before the pandemic—likewise for vaccines, where we did not have large-scale vaccine manufacture and we now do, and for a host of other areas, including some of those that the hon. Gentleman mentioned.
My hon. Friend is absolutely right. The court ruling in question found that we were on average 17 days late with the paperwork, but it did not find against any of the individual contracts. My team worked so hard to deliver the PPE that was needed and so, as the National Audit Office has confirmed and as my hon. Friend set out, there was never a point at which there was a national shortage. There were, of course, localised challenges and we were in the situation of a huge increase in global demand, but I think that we should all thank the civil servants who did such a good job.
During previous debates of this nature, it has not always been possible to draw positives from what has been a difficult, dark year for all of us, but the roll-out of the vaccination programme is providing, in my constituents’ words, a glimmer of light at the end of a long tunnel. On behalf of my constituents, I want to say a huge thank you to all the staff helping to deliver vaccinations at our GP practices and mass vaccination centres, as well as all the staff at the Aneurin Bevan University Health Board and the volunteers working behind the scenes to ensure that this enormous task is undertaken effectively. The Welsh Government also deserve credit for their effective management of the vaccine roll-out. Wales was the first nation to offer the top four priority groups a covid jab, and one in four people in Wales have now received their first dose. Well done, Wales!
While it is right to celebrate the positives, it is also vital that we remember all those who continue to struggle during the lockdown. I want to talk about a few of the issues that have been highlighted in the debate. Young people have had their school and college lives upended by the crisis, and there is still huge uncertainty over the complicated picture around vocational and technical qualifications. It is more complicated in Wales, with some awarding bodies responsible to the Department for Education—that includes BTECs—and some to the Welsh Government. Students and their colleges need clarity on issues such as struggling to get work experience, being assessed and getting their grades awarded. The Welsh Government are doing all they can with colleges such as Coleg Gwent, but UK Education Ministers need to get our national awarding bodies to tell colleges as soon as possible what to do this year.
Mental health is an ongoing concern for people of all generations, and I hope that one positive to emerge from this period will be a renewed focus on the impact of isolation and loneliness in policy making at all levels. There are lots of good groups in my constituency doing good work. I particularly want to thank Newport County AFC, who I met last week, for the work it is doing through its support network for supporters struggling with mental health problems when fans have not been able to meet up at games. The club is a prime example of how sport can act as a force for good in the community, and I encourage other English Football League clubs to learn from its successful model.
I would also like to speak about the plight of asylum seekers in my constituency. Home Office and UK Visas and Immigration processing times are very long, there are lengthy waits for biometric residency permits, and despite a promise to prioritise those who work in the NHS, that does not seem to be happening. There is real hardship out there in that community. There are people with nothing.
I have spoken in previous debates about universal credit. The Chancellor’s decision to scrap the £20 a week uplift from April, amounting to a cut of £1,000 a year, is indefensible, as is the fact that the uplift has never applied to the 2 million on legacy benefits. That needs to be sorted as soon as possible. We also need long overdue action for workers who have been excluded from UK Government support schemes during the pandemic. There is a Labour-led debate on this tomorrow and I hope that Conservative Members will listen and do the right thing.
That is exactly our goal, and we have been working very hard with the carriers and airport operators to put this new scheme in place. There is further work to do in the days ahead, and no doubt after its initial introduction on Monday. What I would say very directly to my hon. Friend, the airline industry and the airports is that I know this is very difficult and tough. It is absolutely vital that we all work together constructively, positively and with the spirit of innovation that she describes to put in place a robust system that uses all possible technology to ensure that we have the basis of a future safe global travel arrangement. It is about both securing the borders now and ensuring that we can get global travel going for the long term.
I understand why the hon. Lady and many others want to know what the speed of the roll-out will be. Because we are reliant on the manufacturing process, which is itself a difficult challenge, we cannot put figures on when the roll-out will be. We hope that we will be able to lift the measures by the spring, and we hope that we will all have a much more normal summer next year, but I do not want to put too much more detail on it than that, and I cannot put more in terms of the numbers, because there are so many contingencies. What we can be sure of, and what we can work and plan for, is the NHS being able to deliver the roll-out at the speed at which the manufacturers can manufacture.
Well, I very much hope so, but there is some time between now and then, so we have got to temper our joy and enthusiasm at today’s announcement with the need to keep on keeping each other safe between now and then. Let us not blow it, since we can see that the answer is on the horizon.
I reiterate the point that my hon. Friend made about the team in the Department, because my civil servants and special advisers have been amazing during this year. They have worked so hard—seven days a week, often 18 hours a day—and they deserve enormous praise, because this is a team effort and nobody can do this sort of thing on their own.
The Minister may be aware that Hull has the highest rate of covid infections in the country; we have 161 patients in Hull Royal Infirmary, 16 of whom are in intensive care, and 265 have died since the pandemic began. The situation in Hull and the East Riding is a public health emergency, so where are these Nightingale hospitals to help? I have been told that they have been mothballed and will not be reopened. Our rate is double that of the average in England, and I am incredibly worried about the situation in schools. Despite the headlines saying that they remain open, year groups are being sent home, not to self-isolate, but because teachers are not available to teach in them. Where is the testing for staff, to keep these schools open? Where is this additional support? Why has Hull not had support from the armed forces as Liverpool has had when its rates became so high? We have been promised 10,000 tests, but that will not be enough. This is not a league table I want my city to top; we need that additional help from Government if we are going to move down it.
Losing someone hurts. On Monday, I lost my nan to covid-19. She did not die in Hull; she died somewhere else. I hope that if my mum is watching, she knows that I am sending her all my love from this place and that as soon as possible I will be round there to give her a hug and we can remember all the wonderful things my nan did. It was only last year when I stood up in this Chamber and told everyone what a remarkable woman she was. I urge people to take this situation seriously.
The northern powerhouse study shows that because we started from an uneven point in the north, covid has had a disproportional impact on the cities we represent. The report today says that we have had an extra 12.4 deaths per 100,000 in the northern powerhouse that in the rest of England put together, and an extra 57.7 deaths per 100,000 due to all causes during this pandemic. Things are not equal; this pandemic has not impacted all of us equally, and it has an economic cost. To all those who make the false divide between health and the economy, I say: think again. All those additional people who have died in the areas in the northern powerhouse have had an economic impact—it is not just the heartbreak of people who have lost loved ones. Some £6.86 billion has been lost in economic growth. There is no divide between health and economy; sort out the problem with health and then deal with the problem with the economy. They are not mutually exclusive.
Compliance is falling in my area, and there is mistrust of the Government. We need transparency, honesty and openness. We need a Government to admit it when they get things wrong. We need to explain why the rules are different for golf and for walking, for private worship and for visiting the supermarket, because people will then understand. The gap from Government in information, clarity and transparency is being filled with misinformation, lies and dangerous fake news on social media telling people that this is not real. Well it is real when you lose people. Some 50,000 lives have already been lost in this pandemic. That is 50,000 families who have been impacted. I do not want a Government who are focused on PR, bluster and incoherent metaphors. What I want is a Government just to give people honest and straightforward advice, so that together we can try to deal with this virus.
I remind hon. Members that there have been some changes to normal practice in order to support the new call list system and to ensure that social distancing can be respected. Members should sanitise their microphones using the cleaning materials provided before they use them, and then place those materials in the bin. They should also respect the one-way system around the room. Members should speak only from the horseshoe, and they can speak only if they are on the call list—that applies even if debates are undersubscribed.
Members cannot join the debate if they are not on the list. Members are not expected to remain for the wind-up speeches. I remind hon. Members that there is less of an expectation that they stay for the next two speeches once they have spoken—that is to help manage attendance in the room. Members may wish to stay beyond their speech, but they should be aware that if there are lots of speakers, doing so might prevent Members in the seats in the Public Gallery from moving to the horseshoe.
I am happy to do that, because I have been looking into that issue as well. The guidance I have been given is that Public Health England and those running the trial want it to take place first in the 30 care homes, which I mentioned. That will enable us to have confidence that those who have had a lateral flow test will be able to visit. There is sequencing to be done, but the issue is at the top of my mind. Lateral flows tests are already being used, and we should make the most of that to enable visiting. I hope to be able to put that more formally in writing in due course.
In the time available, I wish to pick up on a few of the other points that were made in the debate. The hon. Member for St Albans (Daisy Cooper) referred to the 30-minute time limit. I believe that that must be something that the care home in question has chosen to put in place. Our guidance advises that one should book a visit with a care home, but does not stipulate a 30-minute limit.
My hon. Friend the Member for Bexhill and Battle (Huw Merriman) set out an excellent list of things for me to take forward. Many of them are indeed in train, such as testing and work on the vaccine. The Joint Committee on Vaccination and Immunisation has proposed that care home staff and residents should be at the top of the list for that. He mentioned a reporting mechanism, which I am also taking forward.
The hon. Member for Liverpool, Walton (Dan Carden) referred to the lottery of visits. On the one hand, we responded to local authorities and care homes when they asked for more discretion and a local say in how we respond to the pandemic; on the other, we can find that in one area there is far more access than in another, so we need to combine allowing local discretion with being able to investigate whether somewhere is not being so supportive of visits. We need to ask what is going on and how can we bring this about.
My hon. Friend the Member for Beaconsfield focused on the situation of those of working age living in a residential care home. As she said, they have been talked about less during the pandemic than those of an older age, but the people of working age living in residential care are absolutely at the top my mind. As we have seen during the pandemic, those with learning disabilities might be at greater risk if they catch covid, and, like those of an older age with dementia, they need family visits and the support, love and advocacy of a family member.
As my hon. Friend also said, the pandemic has shone a light on some of the problems that existed in our social care system before the pandemic. Yes, the pandemic has been hard for social care, but there were problems before. Although the vast majority of care homes have provided wonderful supportive care—indeed, loving care—for those who live in their buildings, some have sadly let down those they care for. We must continue to identify, intervene and prevent cases where there is neglect or, worse, the abuse of those living in residential care.
We are in the thick of a pandemic that has made life so hard for those living and working in the social care sector. We have to step forward, get on the front foot and really achieve the social care reform that everyone has been crying out for, for so long. This is an, “If not now, when?” moment. We will seize this moment not only to support social care through the pandemic, but to bring about a system of social care where we can hold our heads up high and be happy for the care of our loved ones, our friends and family, or indeed for ourselves, should the time come when we need it.
We want as little impact on the rest of NHS activity as possible. Of course, we are having to take that action in some high-prevalence areas. That decision takes into account local circumstances; it is not a blanket, national decision as it was in March. The most important thing that we can all do to keep our NHS open for non-covid treatment is to abide by the rules and have that lockdown in place.
Absolutely. The armed services of this country have played an amazing role during the pandemic. I have talked about a war against a virus, in which we are all on the same side. The military have done and are doing their bit, and there is a lot more that we will need from them in the future. They are involved in the mass testing and the vaccine roll-out, and I am very grateful for their support.
I have addressed several of those points already in questions. The idea that, instead of the large-scale national system working together with local contact tracers, we should disparage one part and praise the other—this divisive approach proposed by the SNP spokesperson—is wholly wrong and would lead to things getting worse, not better. Instead, we need to work together to improve the system, in the same way the Scottish Government and the UK Government worked together to provide testing capability right across Scotland.
On the arrangements for the future of PHE, we look around the world for the best way to ensure we have systems at a national level that can respond to the virus, in the same way we put in place the Joint Biosecurity Centre, when we worked closely with the Scottish Government, the Welsh Government and the Northern Ireland Administration to ensure the best possible system—for instance, when cases move over a border. Some of the best systems in the world, such as the German system, have an institute dedicated to infectious disease control. I am convinced that the enormous amounts of extra money we are putting into health protection, along with the extra support going in and the clarity and dedication of the new National Institute for Health Protection, will be a step forward. I pay tribute to all those who have worked in PHE and right across the board to keep people safe during this crisis.
I will certainly look into whether the roll-out can start in Buckinghamshire. Thankfully, it has a relatively low rate of the virus, which is good news, and we are working to ensure that the testing system there is as effective as it can be. That will include using this new generation of testing when we can begin to roll it out more broadly than the current pilots.
I pay tribute to the hon. Lady’s campaigning on these issues. We have worked closely together to bring really positive news on the treatments for cystic fibrosis on which she has campaigned so strongly. She also made the case very clearly on Spinraza, which I have since discussed with NHS England. It is, of course, NHS England’s statutory responsibility to take a decision, but I discussed it with NHS England, as I committed to do so to her and her constituent, Jake.
I say to all those in the shielding category that we have recommended that shielding restrictions come to an end at the end of this month because it is clinically advised that the levels of new infections are low enough that it is safe to do so. It is safe to do so. I plead with those who are shielding to listen to this clinical advice, because we also know that staying at home and not seeing other people has downsides to health too. If anyone wants proof that we will not take this step unless we are confident that it is safe, we have paused the end of shielding in Leicester exactly because rates of infection are higher—to keep people safe. People can be assured that it is safe, from the end of this month, for those in the shielding category to go out into the community, taking the precautions that everybody should take.
I am pleased to congratulate all those working in Buckinghamshire—the council, the CCG and the other parts of the NHS—on their work to keep Buckinghamshire safe. The number of infections across Buckinghamshire is very low now, and we want to keep it that way.
I also take this opportunity to answer part of the question from my hon. Friend the Member for South Derbyshire (Mrs Wheeler) that I did not answer. More powers, as well more data, will be available to local areas to take more local action themselves, without having to refer up to the Secretary of State to use my powers. Of course, national Government hold further powers for significant action, which we have had to use just the once, but we will give local areas more powers, as well as more data, to be able to grip this issue locally.
All sides of the House have rightly recognised the immense sacrifice and service to this country made by our health and care workforces, but it is now time to put our money where our mouths are and start to recognise and reward those staff. We on the Liberal Democrat Benches have argued through this crisis for a package of frontline support, including something akin to the deployment allowance given to the military frontline. We should have a frontline service award of a daily allowance during this crisis, but beyond that, this is not the time for a pay freeze. Negotiations on public sector pay must reflect the service and sacrifice that many on the frontline have made for us and our loved ones.
In social care, many do not work in the public sector. Two million people in care jobs are largely on the minimum wage. Half are on zero-hours contracts, yet they are undertaking highly skilled work, taking care of the most vulnerable and providing intimate care. They are often not paid benefits or for travel time, which can be significant in London. It is possible to earn more money stacking shelves in Tesco. It is important to recognise that they have very few career prospects and little training. The pay differential between careworkers with less than a year of experience and those with more than 20 years’ experience has now reduced to just 15p an hour. That is because of the funding crisis in social care, which is keeping those wages down. The case for ensuring that our careworkers are at the very least paid the real living wage is overwhelming and a moral imperative.
In the longer term, to tackle the workforce crisis and put social care on an equal footing with the NHS, pay scales must be reviewed and ideally aligned with the NHS, but that obviously needs to go hand in hand with tackling the long-term funding crisis in social care. Those reforms are well overdue.
We know there is a huge number of migrant workers in social care and in the NHS. The figure is one in seven in the NHS and one in six in the care workforce. We on the Liberal Democrat Benches have argued through the crisis that the cruel policy of no recourse to public funds must be suspended. That is particularly relevant for those on the frontline who may be reticent to take time off or self-isolate because they are only eligible for statutory sick pay, which, frankly, is not enough to live on. A number of other benefits are not available to them, but, most importantly, when people have put their lives on the line for us and our loved ones, we must recognise those workers by granting them indefinite leave to remain. A visa extension is not enough. It is not enough to just take their service and say, “Bye bye. Thank you very much.” We have a moral responsibility to allow them to stay.
I begin by thanking every single health and care worker in my constituency of Coventry South. They have gone over and beyond to keep us safe and healthy. I know that I speak on behalf of all of Coventry when I say thank you. They have faced this crisis with incredible strength, selflessness and determination. At its height, millions of people across the country went out every Thursday to clap for health and care workers. Now it is our responsibility to match that appreciation with meaningful action— with NHS staff and carers getting the real pay rise and recognition that they so richly deserve.
The simple truth is that NHS staff and carers have been failed for far too long. Since 2010, newly qualified nurses have faced an 8% pay cut. Half of frontline carers are paid less than the minimum wage and years of devastating cuts to the NHS and neglect of care work have left us all more vulnerable to a pandemic. We saw that with the PPE shortages in hospitals when the crisis hit. We saw that when doctors and nurses repeatedly —desperately—asked for testing, only to be told that there was not capacity. We saw it again with black and ethnic minority NHS workers killed by coronavirus at a disproportionately higher rate, exposing the inequalities that lie at the heart of our society.
Let me go through some of the experiences that my constituents who work in our health and care system have told me of. There are migrants who work on the frontline, but have been hit by the hostile environment and burdened with visa fees and health surcharges. There are NHS staff who, until recently, were forced to pay obscene parking charges at University Hospital Coventry—in some cases, almost £500 a year. These charges are exploitatively set by private companies that are making profits on the back of our workers.
There are nurses robbed of NHS bursaries, leading to a 32% decrease in nursing applicants nationwide. Now we have an overstretched and overworked workforce, with more than 7,500 nursing vacancies in the midlands alone, which has been called a “full-blown crisis” by the Royal College of Nursing. Then there are the A&E workers, who face a mental health crisis, with one of my constituents describing their work as heart-breaking and soul-destroying, and their work environment as a war zone.
Those are just some of the wrongs done to the NHS and care workers in my constituency. I urge the Government, who clapped for them through this crisis, to match that with action: give our carers, nurses, porters and cleaners a real pay rise; end poverty wages in the NHS and care work; ensure that they are all on good contracts with no more precarious work; give indefinite leave to remain to all migrant workers; and restore the NHS to a truly public service, free from privatisation and run for the public good, not private profit.
Yes, I would like to thank the carers of Beaconsfield for the work they have done through this crisis and before. I tell them that the value and esteem with which we hold them is so high and we are so grateful for what they do. My hon. Friend is right that you simply could not have a localised approach, and therefore the safety of reducing safely and cautiously the overall lockdown measures, without a significant testing capacity. Thanks to the teamwork of the NHS, Public Health England and many, many private companies, we have built the largest coronavirus testing capacity in Europe from almost nothing. It is a testament to so many people, to the team effort and to the way the country has rallied behind that need.
We absolutely did a throw a protective ring around social care, not least with the £3.2 billion-worth of funding we put in right at the start, topped up with £600 million-worth of funding on Friday. Further to that, the hon. Lady does know, I think, that testing has been carried out in care homes throughout. Of course there is always more that we should and will do, but we have been working very hard and closely with the adult social care sector. Towards the start of this crisis, I was meeting the leaders of adult social care in Downing Street with the Prime Minister. We have been working very hard to tie together our response in what is a very diverse sector.
Yes, I would be very happy to meet my hon. Friend, possibly via Zoom—other videoconferencing services are available—to discuss what Makers 4 the NHS and other voluntary organisations and groups of volunteers have come together to deliver with regard to PPE: it is absolutely fantastic. I pay tribute, too, to the Daily Mail’s PPE campaign, which has raised an enormous amount to bring in PPE from China. But those who are making it here in Britain I salute and I thank.
I reiterate the point I made in response to earlier questions. I hope that in his response to all his constituents, the hon. Gentleman will send a link to the NHS website, where the answer to his question was set out extremely clearly right from the start. It is very clear that there are three groups of people. Those who have received a letter from the NHS saying that they must shield for 12 weeks are in that category; those who have not are not. I know that some media reports have stated otherwise, but I implore people to follow the guidance clearly set out on the NHS website, which the hon. Gentleman and any other Member who has questions about that should send to their constituents to inform them. It is a matter of our public duty. It is not a matter of political debate.
Getting new Government guidance to the visually impaired is of course a challenge. It is something we have been working hard on. In the first instance, the first port of call should be primary care—somebody’s GP or 111—if there are any queries. That is where I would point people in the first instance. It has been a challenge, because we have been making policy at speed, and writing and updating guidance at speed, but I would point those who are visually impaired to 111 and their GP if they have any questions.