Healthcare (International Arrangements) Bill

Julie Cooper Excerpts

3rd reading: House of Commons & Report stage: House of Commons
Monday 21st January 2019 Commons Chamber

[Julie Cooper (Burnley) (Lab)]

First, as the Bill is given its Third Reading, may I thank all Members who have contributed?

We will not oppose the Bill at this stage, as we acknowledge the importance of safeguarding healthcare for the estimated 190,000 UK expats living in the EU and the 50 million nationals who travel abroad to EEA countries each year. That is not to say that the Bill is perfect—far from it. There are issues that for us remain unresolved, and we are anxious about the implications of the sweeping powers that the Bill will give the Secretary of State. We hope that Members in the other place will pick up on some of these concerns.

We are now only 67 days away from formally leaving the EU. On Second Reading—which, coincidentally, was 67 days ago—there was a clear assumption on the Government’s part that an agreement with the EU would be reached and that arrangements would carry on as now. I do not think it is an understatement to say that that is now looking rather less certain.

I said at the time that the Government’s own impact assessment seemed seriously to underestimate the consequences of a no-deal scenario. As my hon. Friend the Member for Ellesmere Port and Neston (Justin Madders) said earlier, the impact assessment set out how the costs of establishing future reciprocal healthcare arrangements on the same basis as now would be £630 million per year. It then went on to estimate that, in the event of a no-deal scenario, the costs would be expected to be similar or less, depending on the number of schemes that were established. It has never been made clear why the costs might be less, unless we stop reciprocating with other countries, and I do not believe anyone expects that.

The British Medical Association and the Royal College of Paediatrics and Child Health have expressed concern that, should no EU-wide reciprocal agreement be achievable, the significant costs of establishing bilateral reciprocal arrangements with the EU and EEA countries would in future fall on the NHS. Perhaps in the scenario we now face, we will be able to replicate exactly what is in place now, but that is not certain, and the implications are potentially significant. I therefore ask the Minister whether he would mind keeping us updated on the progress in bilateral discussions.

UK state pensioners living abroad account for 75% of the total amount that we spend on reciprocal healthcare, and they will be anxious to know that they will be able to enjoy the same access as they do now. If not, those with chronic conditions or complex healthcare needs may need insurance that is prohibitively expensive—if it can be found at all. The potential implications of that cannot be underestimated. For those travelling abroad, the BMA and others have said that, without a reciprocal healthcare agreement, patients with disabilities would also be among the most affected. Again, for those groups, as much information on progress as possible would be appreciated.

Associated with that is a lack of clarity over how dispute resolution will work in the event of bilateral agreements being necessary. We know from what the Minister has told us that, if we manage to reach full agreement with the EU27, there will still be a limited role for the European Court of Justice, but we do not know what the dispute resolution procedure will be if we do not. Can he confirm whether it is still the Government’s position that the ECJ will have no jurisdiction in the event of bilateral agreements being necessary? I am not sure what incentive there will for other countries to agree to a brand new dispute resolution architecture, and I doubt very much that they would want to pay for one. It seems to me that, sooner or later, the Government will have to come clean with their own Back Benchers that, in this area at least, the ECJ will still have a role to play, even in the event of a no-deal scenario.

Even under the current arrangements, cost recovery is something that we do not appear to have handled satisfactorily and the fault for that lies with the Government alone. In 2012-13, the NHS charged only around 65% of what it could have done to visitors from outside the EEA and Switzerland, and only 16% to visitors from within that area. Although I accept that things have improved since then, they are still far from perfect. Indeed, as my hon. Friend the Member for Ellesmere Port and Neston mentioned, the Public Accounts Committee said that it was chaotic.

The Law Society of Scotland was clear on the importance of this issue when it gave evidence to the Lords Committee. It said that

“as the NHS has never been very effective in reclaiming the fees owed to it by overseas visitors to the UK, the UK may find itself substantially worse off financially when new arrangements for funding cross-national use of health services are put in place.”

So the Government need to raise their game in terms of cost recovery. If there is an additional administrative burden on the NHS in setting up new systems of cost recovery because of agreements reached, will the Minister give a commitment that NHS providers will be adequately compensated?

Perhaps the issue of reciprocal healthcare matters most on the island of Ireland where the border area has a dispersed population of around 2 million people, with an integrated healthcare system that has to survive whatever the future arrangements end up being. They cannot be failed by this Bill, which is why we believe that there needs to be maximum parliamentary oversight.

This Bill is necessary, but it does seem that the Government have used the opportunity to give themselves powers far beyond those that are necessary to achieve the objective set out under this legislation. They are using every trick in the book to avoid proper scrutiny of their actions. That is part of a disturbing trend that we are seeing across much of the Brexit legislation. It is a trend that does the Government no credit and it is a trend that I believe Members from across the House will come to regret.

Mental Health First Aid in the Workplace

Julie Cooper Excerpts

Thursday 17th January 2019 Commons Chamber

[Julie Cooper (Burnley) (Lab)]

I congratulate my hon. Friend the Member for Liverpool, Wavertree (Luciana Berger) on securing this debate and pay tribute to her for the excellent work she does in this area. I also thank the right hon. Member for North Norfolk (Norman Lamb) and the hon. Member for Plymouth, Moor View (Johnny Mercer) for helping to secure this important debate, and particularly pay tribute to the hon. Gentleman for sharing his personal experiences, which are very powerful. My mother suffered with OCD all her life and regularly said to me, “If I had a damaged leg I would have got help and sympathy, and there would have been no stigma attached.” So I thank the hon. Gentleman for raising this issue.

Debates such as this with a particular end in sight—to raise awareness and end stigma—are important. I join with Members, in this wonderful spirit of co-operation in all corners of the House, in saying to anyone out there suffering with mental ill health and to their family members that many of us in this place are sincerely dedicated to effecting good change.

We have heard powerful contributions from all sides of the House on the impact that mental health issues can have on people’s lives, and indeed on our economy. For the one in four people who will experience mental health issues, there are serious consequences in all areas of their lives, including at work. It is estimated that 5 million workers, nearly one in seven, are experiencing a mental health condition. Women in full-time employment are twice as likely to have a common mental health problem as full-time employed men, and 300,000 people with a long-term mental health condition lose their job every year. The human cost of this is hard to calculate; these are people who have lost their livelihoods because they cannot get the support they need.

While the human cost is difficult to quantify, we do know that there is an enormous economic cost overall. For the whole of the UK it costs up to £99 billion a year. The Mental Health Foundation found that over 12% of sick days in the UK can be attributed to mental health conditions. The Health and Safety Executive reported that 15.4 million working days are lost each year to work-related stress, anxiety and depression—more than are lost to physical ill health. Mental ill health hits smaller businesses hard, and research from the insurance sector found that it costs small and medium-sized enterprises £30,000 in recruitment costs, training time and lost productivity to replace a staff member. There is another side to presenteeism. As the TUC points out, UK workers with mental health problems also contribute to the economy, adding £226 billion to the UK’s GDP in 2016 alone. They are contributing despite living with mental ill health, so it is only right, at the very least, that society gives something back to them. Despite them often suffering illness, their work supports our economy, so our society must support them.

Mental health does not exist in isolation. It is fundamentally bound up with how we live our lives, and the stresses and strains of modern life take their toll. In my constituency of Burnley, one in five people report feeling anxious or depressed, which is higher than the national average. As many Members have said, incidents of suicidal thoughts and outright acts of suicide have risen worryingly since 2000, with the number of people who self-harm more than doubling over the intervening period. Workplace conditions can be responsible for such strains. Indeed, three quarters of adults say that they are stressed about work. As a former employer, I say to employers out there that the best thing that they can do to improve productivity and profitability is to invest in the health and wellbeing of their workforce, including mental health, which is paramount. Sadly, mental health support is severely lacking for many workers and access to services that prevent mental health problems is getting worse.

Mental health services are still a long way from reaching the promised parity of esteem. Mental health trusts have less money to spend on patient care in real terms than they did in 2012. That underfunding is leading to delays for people who are trying to access services. In some areas of the country, people are waiting four months to access basic talking therapies—four months without the support that they need to stay in work. When it comes to mental health in the workplace, as research from MIND and others has shown, we can actually put a number on the cost of failing to fund mental health services adequately. Poor mental health at work is estimated to cost the taxpayer between £24 billion and £27 billion a year, which is made up of NHS costs, benefit costs and lost tax revenue. Those costs can be avoided if our mental health services are properly funded to give people the support they need.

Just as work can be the cause of stress and, ultimately, mental ill health, work is also where mental ill health can manifest itself. Today’s discussion has shown us one way that support at work could be provided. Mental health first aid, much like physical first aid, can provide a first port of call when mental health problems arise. We have heard already today about the value of early intervention. My hon. Friends the Members for Dagenham and Rainham (Jon Cruddas) and for Liverpool, Wavertree raised specific examples of where companies have invested proactively in employing and training mental first aid workers, and we heard that Thames Water has seen a three quarters reduction in sickness absence related to mental health issues.

It is clear that mental health first aid can work, but there is no duty on employers to provide it. Labour’s view is that there should be. In 2012, the Government encouraged employers to offer mental health first aid, but we still have not seen it taken up as widely as it should have been. The amount of Government resources for mental health first aid training is clearly not enough to embed mental health first aid. Last year, the review of workplace mental health by Paul Farmer and Lord Stevenson recommended that all employers put in place systems to support workers with mental health conditions. As we have heard today, mental health first aid can play a key role in that. At the time, the Government accepted the recommendations of the Farmer and Stevenson review, including those about the role of employers. Will the Minister tell us what action the Government are taking to put the recommendations into practice?

The debate today has called for a change in the law, and Labour joins that call. The Government must come forward with proposals to support employers to ensure that mental health first aid is provided. This matter is too important to be left to the good will of employers. Legislation is required.

Mental health first aid alone will not be enough, however. Its role will also be to refer people on to professional mental health services when that is appropriate. Mental health first aid is not a solution when the wait for professional mental health services could be months. It must be part of a wider network of support, alongside clinical services that give people appropriate and timely support. If this Government are serious about tackling the burning injustice of mental ill health, there must be less tinkering around the edges, and a comprehensive new system of support that can intervene as soon as possible when problems emerge. The human cost and economic impact of what is becoming a mental health epidemic can no longer be ignored, and the Government must demonstrate that they take this seriously and act now.

Oral Answers to Questions

Julie Cooper Excerpts

Tuesday 15th January 2019 Commons Chamber

[Stephen Hammond]

As I said earlier, nurses are absolutely the heart of our NHS, and my hon. Friend is right about the extra number of nurses at her hospitals. She is also right that retention is one of our big issues. That is why the Agenda for Change pay award was put through last year, why we are working with Health Education England to look at other retention methods and why we are increasing the number of training places to ensure that we not only retain nurses but recruit more into the national health service.

[Julie Cooper (Burnley) (Lab)]

I join you, Mr Speaker, in wishing my colleague a happy birthday. I acknowledge that no one knows better than she does about the crisis in nursing staff levels. At the same time, the shortfall in GPs has risen to 6,000, and a third of all practices have been unable to fill vacancies for over three months. Unsurprisingly, waiting times for GP appointments are at an all-time high. As ever under this Government, it is patients who suffer. The situation is set to get worse, with more practices destined to close this year. Why are the Government not taking urgent action to tackle that? When will we finally see the workforce implementation plan that has been promised?

[Stephen Hammond]

The hon. Lady asks about GPs. As she would want to acknowledge, a record number of doctors are being recruited into GP training. We are determined to deliver an extra 5,000 doctors into general practice. NHS England and Health Education England have a number of schemes in place to recruit more GPs and to boost retention—the GP retention scheme and the GP retention fund—and she will know, as I have said it twice this morning, that the workforce implementation plan, which is part of the long-term plan, will be published in the spring.

Healthcare (International Arrangements) Bill (Second sitting)

Julie Cooper Excerpts

Committee Debate: 2nd sitting: House of Commons
Thursday 29th November 2018 Public Bill Committees

[Julie Cooper (Burnley) (Lab)]

I beg to move amendment 1, in clause 4, page 3, line 17, leave out paragraph (d).

It is a pleasure to serve under your chairmanship, Mr Stringer, and I am pleased to have the opportunity to speak to clause 4. At this time of great uncertainty, when the nature of our future relationship with the European Union is still unknown, we welcome the intention outlined in the Bill to give some confidence to those who currently rely on the reciprocal health arrangements between the UK and the nations of the EU and EEA. We are only surprised that the Bill has taken so long to come before us.

The scope of the Bill is designed to cater for all possible outcomes of the UK and EU negotiations. The intention is that, deal or no deal, the Bill will empower the Secretary of State to negotiate future reciprocal healthcare arrangements between the nations of the UK and the EU, and any other such nation as is desired. Providing for pensioners, visitors, students and workers to live, work, study and travel in EU member states with complete peace of mind regarding the provision of healthcare is a priority for Labour. We therefore recognise the need for the Bill.

While understanding that any future agreement must allow for the smooth transference of data for the achievement of the best possible outcomes for patients, we believe it is also crucial that the Bill provides robust powers to protect personal data. Health records contain both personal and sensitive data, and access to such information must be allowed sparingly and only for medical purposes. Access to personal data should be available to health professionals who are bound by a duty of confidentiality on the basis of need to know. The Data Protection Act 2018 outlines the key principles relating to the protection of data; compliance with the spirit of those principles is fundamental to good data protection practice, and embodies the spirit of lawful, fair and transparent use of data.

Currently, the General Data Protection Regulation places restrictions on the transfer of personal data to countries outside the EU and EEA. As the UK leaves the EU, we will not automatically enjoy existing protections; indeed, this Bill provides powers for negotiations to take place with nation states across the world, to reach agreement on a bilateral basis. That makes it imperative, in our view, that the Bill protects against potential misuse of personal data.

Clause 4 outlines the detail of how data will be processed for the purposes of the Bill. We have noted the wide-ranging powers to be given to authorised persons, who may

“process personal data held by the person in connection with any of the person’s functions where that person considers it necessary for the purposes of implementing, operating or facilitating the doing of anything under or by virtue of this Act.”

We are not satisfied that sufficient safeguards are in place when defining an authorised person for the purposes of the Bill. We have listened carefully to the concerns of the British Medical Association, and share that organisation’s concerns about the lack of detail in the definition of “authorised person” in subsection (6). Mr Jethwa, representing the BMA, said in his evidence to this Committee that data

“has to be accessed on a need-to-know basis, and only when it is in line with patients’ expectations. Data sharing has to be transparent. We would be absolutely concerned that any safeguards meet those criteria and principles. I do not think the details in the Bill make that clear at the moment. We would like to see more clarity and detail about that in future.”––[Official Report, Healthcare (International Arrangements) Public Bill Committee, 27 November 2018; c. 5, Q14.]

Mr Henderson, from the Academy of Medical Royal Colleges, said that although he recognises that there must be a “free flow” of data,

“individual patients’ data must be protected”,

and that

“it is slightly hard to say whether there is sufficient protection there or not”.––[Official Report, Healthcare (International Arrangements) Public Bill Committee, 27 November 2018; c. 5, Q13.]

He is correct: it is hard to see that there are sufficient protections in the Bill. This is a hugely important issue that needs to be fully addressed.

With that in mind, we are of the view that subsection (6)(d) should be deleted, principally because it gives the Secretary of State a power—to authorise private health companies to access patient data—that is far too wide ranging. We believe that removing that paragraph protects personal data and achieves a balance, giving more confidence to patients while allowing the smooth transfer of data to designated qualified personnel.

The right to privacy and access to healthcare are rights that we value, and the one should not be conditional on the other. We wish to ensure that the Bill gives UK patients, and patients from the EU, full confidence that their personal information will not be shared inappropriately. That remains the case whether healthcare is received in the UK or overseas as part of a reciprocal healthcare agreement. As we leave the European Union, citizens accessing medical care as part of a reciprocal health agreement need to be sure that their personal data will not be shared inappropriately. Without that assurance, citizens may be discouraged from seeking medical assistance.

[Stephen Hammond]

I thank the hon. Member for Burnley for moving this amendment, because it gives me the opportunity to set out clearly and in some depth why we have chosen to include clause 4(6)(d) in the Bill. I want to lay out the reasoning for our concerns about this amendment. I hope that I will be able to reassure her of the vital importance of paragraph (d), and that it is necessary and appropriate, because we will be unable to accept the amendment.

Reciprocal healthcare agreements are made possible by close, consensual co-operation of different parties and bodies, such as the Department of Health and Social Care, the Commissioners for Her Majesty’s Revenue and Customs, Ministers of devolved Administrations, healthcare providers and all their opposite numbers in EU and EEA countries. Since the Bill is about the provision of healthcare, it would be remiss of Her Majesty’s Government to exclude healthcare providers, either those in the United Kingdom or those in other countries, from the list with authority and sanction to process and share data. Given that it is the Government’s position that in the agreement with the EU, future arrangements for the provision of healthcare abroad will reflect existing ones, it is worth reflecting on the place of healthcare providers in these processes, to illustrate the role they play in the commission and delivery of healthcare abroad.

Under the S2 route, a UK resident may decide to seek planned treatment abroad. As part of the ordinary procedure, the UK resident must visit a healthcare provider in the UK. The clinician would then provide written evidence that the person has had a full clinical assessment, which must clearly state why the treatment is needed in their circumstances and what the clinician considers to be a medically justifiable time period within which they should be treated again, based on their circumstances. As is clear under existing arrangements, this function can only be served by a medically trained healthcare provider. This paperwork is then passed on to NHS England or the comparable authority in the devolved Administrations for further processing. Many of those organisations are provided for by subsection (6)(c). Members will, I hope, understand that the lack of qualification around the term “provider of healthcare” is appropriate and necessary at this stage, given that future arrangements are not yet clear.

If the Government are adequately to fulfil the purposes outlined in clause 1, they need to be able to facilitate and fund healthcare for UK persons, for whom they feel responsible, whether the provider is based in the UK or overseas. In that connection, I think it is worth pointing out that the current reciprocal healthcare arrangements allow UK persons to access treatment from providers of healthcare in another country that are not NHS bodies or comparable state providers in another country, as defined by UK healthcare legislation. That might include an optometrist or a dentist, many of whom fall outside the state healthcare system.

Subsection 6(d) proposes to ensure that other types of healthcare providers are authorised to process personal data under the Bill, but most importantly that NHS bodies are able, where necessary, to share personal data for the purposes of the Bill with healthcare providers based outside the UK. Simply, if such providers were not also considered authorised, it would be impossible for healthcare commissioned, implemented, facilitated or funded by the UK to be authorised to be rendered abroad.

The hon. Lady is concerned that the clause will allow private providers access to patient data and the powers to process it. She should be reassured that that is already legal and proper under existing arrangements governed by EU regulations. Under existing reciprocal healthcare arrangements, UK persons are able to receive treatment in another country on the same basis as a local resident of that country. That includes healthcare or other treatments given by healthcare providers other than those that fall within the scope of domestic UK healthcare legislation.

After the fact and on return to the UK, the person would be able to seek reimbursement, where appropriate, from the relevant UK authorities. It is worth noting that the person who sought treatment abroad would typically only be reimbursed up to the amount it would have cost under the NHS. It would be for the person, not the Department of Health and Social Care, to bear the financial risk of any additional cost.

Since our desire to continue existing arrangements is shared by those on both sides of the House, I do not feel that the clause has inappropriate powers. To further allay any other fears, I remind members of the Committee that the clause contains safeguards to guard against any misuse of data. The Bill gives powers to providers, either in state healthcare systems or private ones, to process solely where it is necessary for the limited purpose of funding or arranging healthcare abroad—nothing more.

All processing of the data by all parties must also comply with existing data protection legislation. That is a crucial safeguard under UK data legislation. Data concerning healthcare is personal or specific category data. That can only be processed where specific conditions are met, namely that processing is necessary for the purpose of healthcare and in the public interest. Members will recognise that clause 4(6)(d) does not represent a deviation or new departure from existing arrangements and simply allows for the Government to maintain or improve those arrangements in whatever circumstances we find ourselves in after exit.

In closing, were the amendment agreed, it could risk patient outcomes by excluding providers of healthcare from the list of authorised persons. The hon. Lady expressed some concerns, and I hope that my response has allayed them. I offer to make my officials available to provide a briefing on this matter to her and any other member of the Committee who should so wish, so that they can be completely reassured that the normal data protection legislation will apply to the Bill. The exchange of data may happen only for a limited and focused purpose. The hon. Lady was right to express her concerns, and I hope she will be reassured by my words and that she will not feel the need to press her amendment to a Division.

[Julie Cooper]

I am grateful to the Minister for those explanations, and I welcome him saying it is a very limited and focused use of the data. I would be happy to take a briefing from his officials, but further to that, to give assurance to our side, I would be grateful if he will undertake to go further on Report and outline the scope of the subsection. If he will do that, we will not press the amendment to a Division.

[Stephen Hammond]

We will carefully consider what the hon. Lady has said and her request for further details on Report. I have listened and have offered that briefing, and I hope that is sufficient for her to decide not to press the amendment to a Division now.

[Julie Cooper]

I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Question proposed, That the clause stand part of the Bill.

--- Later in debate ---

[Stephen Hammond]

I wish to introduce this short clause, which I suspect will be somewhat less contentious than the previous one. Subsection (1) provides that the Bill extends to England and Wales, Scotland and Northern Ireland. Subsection (2) provides that the Bill will come into force on Royal Assent, which reflects the need to respond to the range of possible EU exit scenarios in a timely manner. Subsection (3) establishes that the short title of the Act will be Healthcare (International Arrangements) Act 2018. With that short explanation, I recommend that the clause stand part of the Bill.

Clause 6 accordingly ordered to stand part of the Bill.

New Clause 1

Annual report on the cost of healthcare arrangements

‘(1) The Secretary of State must lay before Parliament an annual report setting out all expenditure and income arising from each healthcare arrangement made under this Act.

(2) The annual report laid under subsection 1 must include, but is not limited to—

(a) all payments made by the government of the United Kingdom in respect of healthcare arrangements for healthcare provided outside the United Kingdom to British citizens;

(b) all payments received by the government of the United Kingdom in reimbursement of healthcare provided by the United Kingdom to all non-British citizens;

(c) the number of British citizens treated under healthcare arrangements outside the United Kingdom;

(d) the number of non-British citizens treated under healthcare arrangements within the United Kingdom;

(e) any and all outstanding payments owed to or by the government of the United Kingdom in respect of healthcare arrangements made before this Act receives Royal Assent; and

(f) any and all administrative costs faced by NHS Trusts in respect of healthcare arrangements.

(3) The information required under section 2(a) and 2(b) above must be listed by individual country in every annual report.’—(Julie Cooper.)

Brought up, and read the First time.

[Julie Cooper]

I beg to move, That the clause be read a Second time.

I should stress that we support the intention of the Bill. Providing that UK citizens can live, work, study and travel in EU member states with complete peace of mind with regard to the provision of healthcare is a priority for us. We are aware that, under existing arrangements, the healthcare of 190,000 UK state pensioners living abroad, principally in Ireland, Spain, France and Cyprus, and of their dependent relatives, is protected.

In addition, we seek to ensure that the health benefits currently enjoyed by UK residents who visit the EU on holiday or to study continue, so that they may use the European health insurance card to access healthcare and emergency treatment for healthcare needs that arise during their stay. We also seek to continue the arrangement under which EU nationals receive reciprocal provision when they visit the UK post Brexit.

We note, however, that the Bill is intended to provide for all reciprocal healthcare arrangements in the future, even though we still do not know—even at this late stage, two and a half years after the referendum—whether a satisfactory Brexit deal will be approved by the UK Parliament. Given the possibility of a no deal scenario, where the UK crashes out of the EU and potentially enters a period of unprecedented uncertainty, we are extremely concerned.

We understand and support the Government’s preferred policy position with regard to future reciprocal healthcare agreements, where the intention is to seek a wider agreement with the EU that covers state pensioners retiring to the EU or UK and allows for continued participation in the European health insurance card scheme, together with planned medical treatment. We want to ensure, however, that appropriate safeguards are in place with regard to costs, not least because the Bill provides the authority for the Secretary of State not only to facilitate a continuation of existing arrangements, but to enter into any number of bilateral agreements with individual member states, with no provision for parliamentary scrutiny.

We also note that the Bill provides the authority to strengthen existing reciprocal healthcare agreements with countries outside the EU, or to implement new ones with countries across the globe, in line with the Government’s aspiration to develop trading arrangements with countries beyond the EU. There is, therefore, the potential for the establishment of multiple complex agreements.

As it is not possible to know the detail of those agreements in advance, we cannot assess their likely cost implications. We therefore believe that the Government’s impact assessment is woefully inadequate in that regard. The assessment suggests that the cost of establishing a future reciprocal healthcare arrangement would be £630 million per year, which is the same as the current agreement and takes no account of inflation or future medical developments. The impact assessment’s suggestion that costs might actually be less than those we already incur is not credible.

We will be in uncharted waters, facing the prospect of the necessity to negotiate multiple agreements, some of which may be complex. As the former Secretary of State said,

“It is perfectly possible to agree the continuation of reciprocal healthcare rights as they currently exist, but it is not possible to predict the outcome of the negotiations.”

We agree that it is impossible to provide reliable estimations of likely costs in advance. We are therefore not prepared to give the Government carte blanche.

New clause 1 would provide a sensible requirement for the Government to report back to Parliament on an annual basis. Subsection 2(a) would require the Government to provide details of all payments made by the UK Government for healthcare provided outside the UK to British citizens. Subsection 2(b) would stipulate a requirement to provide details of all payments received by the UK Government in reimbursement of healthcare provided by the UK to all non-British citizens. Subsections (c) and (d) are straightforward and would require details of the numbers of citizens treated under reciprocal arrangements. Subsection 2(e) would write into law a requirement to report on all outstanding payments owed to or by the UK Government.

The Bill provides an opportunity to monitor efficiency in this area and may provide an incentive to address the concerns raised by the Public Accounts Committee in its 2017 report, “NHS treatment for overseas patients”. It stated,

“the NHS has been recovering much less than it should”,

and,

“The systems for cost recovery appear chaotic.”

That is not good enough and we would not want to see that poor level of performance replicated as a result of any new reciprocal agreements.

Currently, the Public Accounts Committee reports that there is no evidence that EU reciprocal health arrangements are being abused. However, there is an increased risk of poor performance on collection targets if there are multiple future arrangements with differential terms. Subsection 2(e) will enable ongoing parliamentary scrutiny of performance levels. While respecting that urgent medical care is provided to any patient who needs it, the NHS and the Department of Health and Social Care must always ensure that money due to the NHS is recovered. We need a system that is fair to taxpayers and to patients who are entitled to free care either by virtue of being a British citizen or under a reciprocal agreement.

It is clear that, even under current arrangements, the collection of moneys owed for healthcare provided to foreign nationals, together with the administration of existing reciprocal healthcare agreements, is an onerous task for hospital trusts. As we leave the EU, it might be necessary for the UK to enter into multiple complex arrangements on a bilateral basis. Indeed, the Bill gives powers to the Secretary of State to enter into any number of agreements, which would introduce additional considerable financial burdens on hospital trusts whose duty it will be to administer the collection of charges for NHS services provided to foreign nationals who retire to the UK or who visit the UK under future reciprocal arrangements. It is likely to be a more onerous process as a series of differential arrangements might be required. The BMA and the Royal College of Paediatrics both agree that, should it be necessary to establish bilateral reciprocal arrangements with EU nations, significant additional costs would fall on the NHS.

Subsection 2(f) would introduce a requirement for the Government to report the detail of all costs incurred by hospital trusts in the pursuance of that duty. Cuts to real-terms NHS funding since 2010, together with increased demand, have pushed many NHS hospital trusts into deficit positions. The NHS is underfunded and understaffed, and hospitals face all-year-round crises. It is therefore imperative that hospital trusts are not required to shoulder additional financial burdens because of the costs of administering the collection of charges. It is absolutely essential that all agreements reached within the remit of the Bill do not direct funds for the treatment of patients to administration.

Ordered, That the debate be now adjourned.—(Wendy Morton.)

Healthcare (International Arrangements) Bill (Third sitting)

Julie Cooper Excerpts

Committee Debate: 3rd sitting: House of Commons
Thursday 29th November 2018 Public Bill Committees

[The Minister for Health (Stephen Hammond)]

Mr Streeter, it is a pleasure to see you in the Chair this afternoon and to serve under your chairmanship. The hon. Member for Burnley has moved the motion, and in responding, I will take the opportunity to deal with the important issues of financial reporting and facilitating parliamentary scrutiny.

I will say at the outset that there can be no suggestion, nor is it the Government’s intention, that we should have anything other than a commitment to transparency and transparent use of public money. We are also committed to appropriate parliamentary scrutiny: we have taken several significant steps to ensure that central Government data is published in a transparent way, including spending control. However, that needs to be done in an efficient and effective manner, and we need to know what data is available and is not available. I have problems with the hon. Lady’s new clause because such a detailed reporting requirement is premature, and risks the very thing that she seeks to avoid. She seeks to avoid placing an administrative burden on the public bodies, but that is exactly what the new clause might do.

We believe that the frequency and detailed content of a financial report should be determined once the reciprocal healthcare arrangements have been made and the technical and operational details of those agreements are known. At the moment, the collection of administrative data is facilitated by the registration and exchange of e-forms through the processes provided for in the relevant EU regulations. As a result, the UK and other EU member states are able to collect data and report both nationally and at an EU level, based on known processes. Current spending on EEA healthcare is reported as part of the Department of Health and Social Care’s annual report—which the hon. Member for Burnley may wish to look at, or may well already know about—as well as the accounts that are presented to this place. The Department also provides information to the European Commission for its triennial report on cross-border healthcare, as well as providing an annual statement of financial accounts to the Commission.

The Department is currently negotiating with the EU and individual states therein with a view to providing UK citizens with continued access to healthcare in the EEA, either through an agreement or through bilaterals. In that case, we will have to agree how eligibility is evidenced; how, and how often, that information is exchanged; and, of course, the reimbursement mechanisms that will govern the new arrangements. Those agreements will have to take into account the operational possibilities and limitations of each contracting party. That should include how NHS trusts in the UK can evidence eligibility for treatment, and how that can be done in the most efficient and least burdensome manner. I therefore say to the hon. Lady that much of the data she requests is already published. There is no suggestion that the new healthcare reciprocal arrangements will change the administrative burden; in certain cases, it is a simple matter of looking at coding within systems. However, only once the technical details are known will the Government be able to formally commit to any additional reporting, if necessary.

I am bound to say to the hon. Member for Burnley that when I saw that the new clause had been tabled, I remembered that 10 years ago, I was in the place she is in now. It is the traditional role of Oppositions to table these new clauses for almost every Bill; it is also the traditional role of Governments to reject them when they see them, as I remember only too clearly from when I was sat in the hon. Lady’s place. I therefore hope I have gone some way towards making clear to her that we are not trying to avoid any reporting requirement, or to shy away from any parliamentary scrutiny. There are already a number of reporting processes in place, and we want to make sure that any future reporting processes operate in a proportionate and considered manner. I hope that the hon. Lady will accept the spirit of my remarks, and that she will therefore choose not to press the new clause to a Division.

[Julie Cooper (Burnley) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Streeter, and to respond to the Minister’s points. I appreciate some of his arguments, but we are in unprecedented times. As the Bill will facilitate the arrangement of a diverse range of agreements, it must cover every eventuality. It is therefore perfectly reasonable to expect the technical agreements, once they have been reached, to be reported back to Parliament annually. Parliament cannot be expected to grant a blank cheque. I accept that I do not have the Minister’s experience in this place, but large amounts of money will be spent on as yet unknown agreements, so it seems reasonable to request that, when the negotiations result in an agreement, it is reported back to Parliament once a year. That is the first thing that concerns me.

I should have thought that the Government would want to take the opportunity to report on the improved performance and collection of charges due to the UK in respect of all non-UK citizens seeking to access care in the UK.

[Stephen Hammond]

Indeed, and of course we are doing so. We have made that clear. As the hon. Lady knows, over the past four years we have quadrupled the amount of income we are recovering.

[Julie Cooper]

I am grateful to the Minister for that clarification, but my understanding is, as the Public Accounts Committee reported, that the Government have still not met their own targets on improved collection, and there will potentially be greater barriers to protection if several agreements are negotiated. I therefore want Parliament to have the opportunity to scrutinise the Government’s delivery on collection.

I am concerned that the Minister does not think it fitting for Parliament to have sight of an impact assessment of the additional burdens that the collection resulting from the as yet unknown agreements would have on NHS hospital trusts’ general financial wellbeing. I will press this new clause to a Division. I think it is sensible and reasonable, so there can be no cause to object to it.

Question put, That the clause be read a Second time.

Oral Answers to Questions

Julie Cooper Excerpts

Tuesday 27th November 2018 Commons Chamber

[Matt Hancock]

I agree very much with my hon. Friend that pharmacies can play an increasing role in helping to make sure that people get their healthcare where they need it, and in keeping the pressure off GPs and off secondary care by making sure that people can help themselves to stay healthy. We are piloting 111 directing people to pharmacies as well as to GPs and, where appropriate, to secondary care, and encouraging people to use pharmacies for minor ailments, but there is much more we can do together on this.

[Julie Cooper (Burnley) (Lab)]

The NHS Confederation has warned that, following Brexit, the supply of some medicines and medical technologies may be delayed in reaching patients, and some may not be available at all. The chief executive officer of the Association of the British Pharmaceutical Industry has been clear that we cannot stockpile the amounts we are going to need, because we do not have sufficient cold warehouse storage. The Medicines and Healthcare Products Regulatory Agency is worried therefore that diabetics will not be able to access insulin. What steps is the Minister taking to ensure that community pharmacies are able to supply vital medical supplies post Brexit, particularly in the event of no deal?

[Matt Hancock]

Community pharmacies, like everybody else, should support the Prime Minister’s deal, which will make sure that that eventuality does not occur.

Healthcare (International Arrangements) Bill (First sitting)

Julie Cooper Excerpts

Committee Debate: 1st sitting: House of Commons
Tuesday 27th November 2018 Public Bill Committees

[Justin Madders]

Q Have you looked at what the possible impact might be of a no-deal scenario on increased demand on services if, for example, pensioners currently living abroad came back?

Raj Jethwa: We are familiar with the research that the Nuffield Trust has done on this, as most people are. Our members are very cognisant of this. I know the Committee will be familiar with the figure of approximately 190,000 UK pensioners who may require access to healthcare facilities in the future if the S1 arrangements do not remain in place. We have concerns about that. In particular, if the arrangements do not remain in place in the future, those people may need to access healthcare facilities back in the United Kingdom. That would be a concern in terms of doctor and clinician numbers and beds, and the tight financial resources that the NHS has to work under at the moment.

[Julie Cooper (Burnley) (Lab)]

Q Good morning. Mr Henderson, you mentioned the protections around personal data in the Bill. Do you feel that the Bill gives enough protection? Are there enough controls in the Bill?

Mr Henderson: As Raj says, this is an enabling Bill, so it is slightly hard to say whether there is sufficient protection there or not. Clearly, it is a hugely important issue that needs to be fully addressed. Equally, we would say very strongly that, while individual patients’ data must be protected, the free flow of data and exchange of information are absolutely crucial. We should never forget that side of the equation: properly and safely sharing anonymised data for research purposes, clinical trials and so on is crucial. While it is absolutely essential that we ensure that personal data is protected, I would put more emphasis on that other side, which is ensuring that we continue to share and benefit from the exchange of anonymised data for purposes that benefit the health service and research.

[Julie Cooper]

Q Thank you. Mr Jethwa, would you like to comment on the same issue?

Raj Jethwa: It is important that an agreement can allow a seamless operation, but there are some well-established ethical principles and safeguards in relation to this. First, it has to be relevant data and it has to be accessed on a need-to-know basis, and only when it is in line with patients’ expectations. Data sharing has to be transparent. We would be absolutely concerned that any safeguards meet those criteria and principles. I do not think the details in the Bill make that clear at the moment. We would like to see more clarity and detail about that in future.

[Maggie Throup (Erewash) (Con)]

Q Mr Jethwa, when you look at the current regulations, do you think the powers in the proposed legislation are proportionate?

Raj Jethwa: We would like to see much more emphasis on scrutiny of all the discussions in the arrangements going forward. There are some negative procedures—I think that is the term. Given the weight of the issue and the number of people that could be affected by it—I have mentioned the 190,000 UK pensioners who live abroad at the moment, but there are close to 3 million people from the European Union who access healthcare in this country, and there are many more than that who travel across the European Union at the moment—there probably needs to be greater scrutiny of any arrangements going forward.

--- Later in debate ---

[Justin Madders]

Q Obviously, we hope that we do not need to get into that situation. Do your members plan things quite far in advance because of the need to get the right treatment?

Fiona Loud: That is what many people would do, for the very reasons we have given. We have people who are sometimes thinking about two years in advance. If you have kidney failure, it may well be that your income is quite limited. If you are spending three days a week in hospital and you are not particularly well, you would be likely to plan a long way in advance, because it is so important. As a charity, we give grants to kidney patients to be able to go away and have that break, so we hear quite a lot about it from various patients. Some can be up to two years in advance; others will be at shorter notice.

[Julie Cooper]

Q Good morning and thank you for coming along to help us. I want to ask about a couple of things. The aim of the Bill is to provide the confidence that we have talked about, to mirror as far as possible the reciprocal arrangements that we already enjoy. However, it does give the Secretary of State the authority to enter into any number of differential agreements with individual EU states. Do you have concerns about that? If we were in this situation—I hope we are not—the Bill empowers the Secretary of State to do that. What would be your view be on the arrangement with Spain being one thing and that with Italy another, and so on?

Fiona Loud: Although we completely understand the need to be able to have the latitude to make bilateral arrangements for everyone’s benefit, from a patient point of view we would like to see a simple arrangement that is the same across all countries. People will not be sitting in these Committees or reading these Bills in great detail. They simply want to be able to go away. They know how a system works at the moment: they will perhaps turn to somebody in their own NHS unit, or they will turn to us or to other specialists, and ask, “How do I go ahead and book my holiday?” and they will assume that, because they have that card, that is how it will be. That would be our wish and our preference, but we understand that that is not always possible.

If I may make a separate comment about Northern Ireland, there are potential issues there that are nothing to do with holiday but are simply about residents who are used to going across the border day to day for their care and treatments. There are pre-existing arrangements and protocols there. For example, somebody might be on dialysis in Northern Ireland but, because the rest of their family live in Ireland—it is only 10 or 15 miles away—they might be planning to retire there in a year or two and assume that they can just carry on having their dialysis there.

The provision exists for people who live in Northern Ireland to be listed on the Irish organ donor register—you can only be on one—and vice versa. They will need to look at where they are registered. Does that change immediately? There are also other arrangements for organ sharing. If an organ is donated in one of those two jurisdictions and the weather is too bad to take it to the mainland, it can be taken across by road. That is not used very often, but those are just a couple of examples of some of the detail that might affect people. That is to do with healthcare but it is also separate. There may, therefore, need to be some other bilateral arrangement for Northern Ireland, which is separate from the more general one that we have just discussed.

[Julie Cooper]

Q Thank you, that is very helpful. Could I just ask you one more question about costs? You rightly made the point that, if somebody is attending for dialysis three days a week, they are likely to have lower income than average. If it is not possible to continue something similar to the EHIC card, are you concerned that transferring extra costs to insurance premiums is going to make travel virtually impossible?

Fiona Loud: We are. A dialysis session in the EU would cost between €250 and €350, so that is about €1,000 a week. We have had correspondence with Sabine Weyand, who is the deputy chief negotiator for exiting the EU. She confirmed to us that British nationals would be treated as third-country nationals, in the case of no negotiation being in place. Therefore, our conclusion is that for third-country nationals, those costs that I have just referred to would be applied. Therefore, only people who were able to afford that, alongside a higher insurance policy—which would not cover the dialysis, though it would cover other things—would be able to travel, effectively making it out of reach for most patients, unfortunately.

[The Chair]

Are there any more questions from the Committee? If not, I thank you very much for helping us with our deliberations today. That concludes our oral evidence-gathering for the Bill. The Committee will meet again on Thursday 29 November at 11.30 am in Room 12, when we will commence line-by-line consideration of the Bill.

Ordered, That further consideration be now adjourned. —(Wendy Morton.)

Healthcare (International Arrangements) Bill

Julie Cooper Excerpts

Wednesday 14th November 2018 Commons Chamber

[Julie Cooper (Burnley) (Lab)]

I am grateful for this opportunity to close the debate on behalf of Labour. It is clear that Members on both sides of the House understand the importance of the Bill. The UK currently enjoys reciprocal agreements for the provision of healthcare with all the nations of the European Union. Under existing arrangements, the healthcare of 190,000 UK state pensioners living abroad—principally in Ireland, Spain, France and Cyprus—and their dependent relatives is protected. In addition, UK residents who visit the EU or the European economic area on holiday or to study may use the European health insurance card to access healthcare for emergency treatment and healthcare needs that arise during their stay. Anyone who is ordinarily resident in the UK qualifies for an EHIC and 250,000 claims for medical treatment are made each year under this scheme. By the same token, EU nationals visiting the UK can use their EHIC to receive free care from the NHS for any emergency healthcare needs and for healthcare needs that arise during their stay. I am grateful to the hon. Member for Chelmsford (Vicky Ford) for reminding the House that the card does not cover repatriation and other associated expenses, but visitors to the EU can currently be reassured that their immediate emergency costs will be met. That is something that we would seek to protect.

By means of the S1 form and the EHIC, current arrangements also provide for the healthcare of employees of UK companies and organisations working in the EU and the EEA, as well as for that of frontier workers living there, and vice versa. Importantly, the agreement also provides funding for UK residents to travel overseas to receive planned treatment in other countries—for example, for procedures unavailable in the UK within a medically justifiable timescale, or to return home to give birth.

Providing for pensioners, visitors, students and workers to live, work, study and travel in EU member states with complete peace of mind with regard to the provision of healthcare is a priority for Labour. We therefore support this Bill in principle, although we are quite shocked that we have had to wait so long for it, given that there are only 135 days left until the UK exits the EU. It is essential that we seek to safeguard, through agreement with EU member states, the healthcare of the 190,000 expats and the 50 million who travel abroad every year. I do not for one moment think that anyone here would want to contemplate the consequences if an agreement were not possible when the UK exits the European Union. We therefore welcome the Government’s intention, as outlined in the White Paper on the future relationship with the EU, to continue a reciprocal healthcare arrangement by means of an agreement with the EU, the EEA and Switzerland.

We are concerned, though, about the scope of the Bill. It includes no detail of specific reciprocal arrangements, although at this stage we understand why it is not possible, in the absence of any certainty, to outline such details. We will not seek to block the Bill, because we want to ensure the seamless continuation of reciprocal healthcare arrangements, but we are not prepared to give the Government carte blanche to secure any agreement at any price. We are not prepared to hand them a blank cheque.

We are concerned that the Bill includes no requirement for the Secretary of State to report back to Parliament. Nor does it incorporate any facility for parliamentary scrutiny, even in the event that a member state decides not to reciprocate. The British Medical Association shares our concerns on this point. It rightly maintains that the discretionary powers granted to the Secretary of State in the Bill should be proportionate and subject to thorough scrutiny, and that all regulations should be subject to the affirmative procedure in Parliament. We also have concerns about the protection of patient data, and we wish to ensure that appropriate safeguards are in place in the Bill. We will look to address those concerns in Committee.

The Health Secretary is on record as saying with confidence that this is one part of the Brexit deal that is resolved. I welcome his confidence and that of the hon. Member for Walsall North (Eddie Hughes) on this—I wish I had their confidence. However, the Secretary of State does offer the proviso that that is

“so long as we land a good deal.”

That is surely the crux of the issue, given the current uncertainty about whether we will get a deal at all.

I hope the Minister is able to give some reassurances on this issue, because the failure to facilitate a reciprocal arrangement for healthcare would be catastrophic for UK citizens seeking healthcare routinely within the nations of the EU. The thought of 190,000 expats losing their right to free healthcare is unthinkable. As the Minister rightly said, UK citizens have paid their taxes all their lives, and they need and deserve the certainty of the right to free healthcare and of knowing that it is protected. That is something the hon. Member for North Thanet (Sir Roger Gale) was keen to support, and we agree with him. It is unthinkable that expats living in the EU should be reduced to the status of third country nationals in a queue for healthcare. Similarly, the 50 million visitors to the EU each year will need certainty, as the hon. Member for East Renfrewshire (Paul Masterton) pointed out—I am sure the whole House is interested to hear more about his stag trip. Without a reciprocal agreement in place, costs for citizens overseas may well be prohibitive, and there are obvious implications for health insurance premiums.

We are also concerned about the impact on our NHS in the UK if expats need to return here for treatment. Our system is already having to cope with unprecedented demand, and the thought of adding to that is something we are concerned about. I reiterate the concerns of my hon. Friend the Member for Ellesmere Port and Neston (Justin Madders) that the issue is not covered in the impact assessment. We also know that no assessment has been made of the impact on disabled citizens and those with pre-existing medical conditions.

Importantly, neither is there any mention, as the hon. Member for Totnes (Dr Wollaston) said, of how any future disputes will be adjudicated. The Prime Minister has ruled out the future involvement of the European Court of Justice, so we are concerned about this issue going forward. Perhaps the Minister can advise us today which body he envisages being used to adjudicate in any such event. We also hope that the Bill can be used to outline processes for the efficient collection of moneys owed to the UK under any future arrangements for reciprocal healthcare.

We look forward to addressing these concerns in Committee. We want to see this Bill go further and be used as an opportunity to strengthen reciprocal arrangements further and to provide for enhanced arrangements with other nations worldwide, in line with the UK’s ambition to extend its range of trading partners.

Hospice Funding and the NHS Pay Award

Julie Cooper Excerpts

Wednesday 31st October 2018 Westminster Hall

[Julie Cooper (Burnley) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Davies.

I am grateful for the contributions by Members from both sides of the Chamber; they obviously all value the hospices in their constituencies. I pay particular tribute to my hon. Friend the Member for Heywood and Middleton (Liz McInnes) for securing this important debate and for outlining so clearly the dilemma facing hospices, citing the example of her own excellent hospice, Springhill. The dilemma is that the delivery of excellent services, by an excellent and qualified workforce, must be balanced against the funding to deliver those services continually.

We are all aware that the NHS is facing massive workforce issues and that recruitment of skilled people is an issue right across the NHS; there is a shortage of such people. We are also very much aware that if hospices are to compete for staff and to recruit and—crucially—retain staff, they must be able to make this pay award, which is extremely welcome. That is the essence of this debate.

Hon. Members made some really important points about the wider issues of funding, which are important, and about the lack of funding. I am grateful to the hon. Member for St Ives (Derek Thomas) for sharing a very personal family experience from his local hospice and for making the important point that hospices allow people to live and die well, which is absolutely crucial.

It is important to set this debate, which is essentially about funding, in a wider context, looking in the first instance at the vast array of services provided by hospices. The majority of hospices are charitable organisations, and provide absolutely tremendous support to the NHS but are not directly part of it. There are in the region of 3,000 in-patient hospice beds in the UK, where patients are helped to manage pain and other symptoms. Hospices also provide respite for carers; it is important not to overlook that.

However, hospices offer far more than an in-patient bed for those reaching the end of their life. In fact, the majority of hospice care is provided in people’s own homes. Hospice UK reports that, in 2016, 51,000 people accessed in-patient hospice care, while 179,000 people received the support of trained hospice staff at home. Many hospices also offer daycare, which gives people the chance to spend time in a hospice and use the majority of the services it offers, while still living at home. In 2017, 37,000 people used day hospice services.

The majority of hospices also offer bereavement counselling. Hospices help to mitigate negative outcomes of loss, helping people to manage what can be a hugely painful and isolating experience. One gentleman in my constituency told me that he did not know how he and his daughters would have coped without the excellent Pendleside Hospice when he lost his wife, and his daughters lost their mother.

It is clear that our hospices are doing a fantastic job supporting people when they need it most. It is difficult to measure the level of demand, but it is a fact that, in 2016, 597,000 people died in the UK, and Hospice UK estimates that 450,000 of them could potentially have benefited from hospice services. It is also clear that there is much unmet demand and that provision varies widely from town to town. Given the changing demographics, though, it is very likely that demand for hospice services will continue to rise.

Consequently, it is imperative that, at the very least, we protect the provision that already exists. As I have said, the majority of hospice services are provided by charitable hospices, which rely on donations from, and fundraising in, their local community to meet the majority of their costs. It is a fact that hospices have a combined revenue of £1.4 billion, and yet the NHS pays only £350 million towards hospices. The average NHS contribution to hospices equates to 30%, and that proportion is falling because there has not been an uplift in funding to hospices for many years. Ten years ago, my own hospice received 32% of its funding from the NHS. That has now fallen to 22%, and in common with other charitable hospices it is reliant on the generosity of local people and businesses. Each year, hospices must raise millions of pounds to run their services and pay their staff.

I will briefly mention children’s hospices. Last week, I met staff from Derian House, and I was shocked to learn that although this excellent hospice supports children and young people from 38 constituencies, only 10% of its funding comes from the NHS. There are 49,000 babies, children and young people in the UK with life-limiting or life-threatening conditions. That number is growing as a result of advances in medical technology, and it is vital that these children and their families have access to palliative care that meets their needs.

Austerity has made fundraising more challenging, as many new and worthy charities now compete for funds. It is a fact that in this economic environment the financial stability and sustainability of many hospices is at risk, and implementing the NHS pay award will add to the financial pressures they face. It is unthinkable that, in the face of increasing demand, they may be forced to reduce services or even close.

At this point, I want to join colleagues in paying tribute to the dedicated staff who are the lifeblood of our hospices. The majority of charitable hospices, although outside the NHS Agenda for Change, attempt to match NHS pay and conditions, ensuring that staff who do that amazing work are properly remunerated. It is essential that those hospices are able to match NHS levels of pay if they are to continue to recruit and retain the staff they need.

I welcome the recently negotiated NHS pay award. That award, which has been hard won and is long overdue, will be hugely welcomed by clinical and non-clinical staff throughout the NHS. Crucially, though, it will not be funded for the charitable sector, and hospices will need to raise additional funds. Coming on top of existing funding pressures, that is going to push our hospices to breaking point. Pendleside Hospice, which serves my constituency, will need to raise an additional £500,000 to fully fund that award. I am sure that the Department of Health and Social Care did not intend to disadvantage hospices in this way, and that this was an unintended consequence. I hope that, in the first instance, the Minister will take the opportunity to announce that the Government will fund the staff pay award in all hospices.

In conclusion, I hope that the Minister will go further to ensure that NHS England resumes its work on developing a specialist palliative care currency, to inform future CCG commissioning of hospice care. It is an inescapable fact that a mechanism to increase the proportion of NHS funding paid to hospices is urgently needed. In a world without hospices, that clinical care would have to be entirely provided directly by the NHS, and would add significantly to NHS costs.

--- Later in debate ---

[Caroline Dinenage]

The hon. Lady makes an excellent point. She is right: there are services up and down the country delivering first-class care, but there are also areas where we know we need to do more. NHS England is firmly focused on providing both the support and the challenge to achieve that, and the hon. Lady is right to mention the incredible efforts of the imaginative and resourceful volunteers who do incredible work to raise much-needed funds for those vital hospices.

A key objective in delivering our commitment to strengthening the provision of end of life services out of hospital and in the community is that people should have that level of choice, and a quality choice, up and down the country. Work is ongoing nationally to provide sustainability and transformation partnerships with tailored information to assess and enhance end of life care services in their areas. We talked earlier about commissioning; NHS England has commissioned Hospice UK to undertake an evaluation of the cost-effectiveness of hospice-led interventions in the community. Historically, hospices have struggled to demonstrate strong evidence of the services they provide and the fabulous care that we all know they offer.

The hon. Member for Burnley (Julie Cooper) mentioned currency. NHS England is working to support local use of the specialist palliative care currency, which can help local areas to plan and deliver services, including hospice services. The currency can help local services better understand the complexity of palliative care and the investment needed to deliver it properly. It is also essential that we can assess how effectively commissioners are working to improve end of life care services. My hon. Friend the Member for St Ives hit the nail on the head when he spoke about that. This year we have a new indicator in place designed to help measure how well patients needing end of life care are supported in the community. Going forward, we are planning to do more work to develop indicators that will enable NHS England to further scrutinise the effectiveness of local health economies in delivering choice in end of life care and securing the progress we all want to see.

[Julie Cooper]

Can the Minister give some idea of the timescales? The point has been made that not only are these organisations at risk of closing, but the people who need the care have not got time. Timescales that indicate the urgency with which the Government are treating the matter would be welcome.

[Caroline Dinenage]

That is a very good point. NHS England will bring forward its report on hospice care very shortly, in November.

I want to talk about staff funding. In common with much of the sector, I know hospices have faced financial challenges. I recognise the concerns of hospices that the recently announced NHS pay rise is putting them under pressure to match the uplift awarded to staff employed on the Agenda for Change contract not only to retain the incredible staff they already have, but to attract the staff they need. We have agreed that for 2018-19, non-NHS organisations that employ existing and new staff on the Agenda for Change contract will be eligible to receive additional funding. Most hospices do not employ their staff on the Agenda for Change contract because of the cost that would entail and so are ineligible.

Budget Resolutions

Julie Cooper Excerpts

Tuesday 30th October 2018 Commons Chamber

[Julie Cooper (Burnley) (Lab)]

I note the Prime Minister’s recent announcement that austerity is over, although the message does not seem to have reached the Chancellor. There was nothing in yesterday’s Budget to end austerity and there is no doubt that austerity is alive and kicking viciously in my constituency. As with so many things, the Prime Minister seems to think that just by saying something she can make it happen. Her first announcement as Prime Minister was that she was going to help those just about managing. Well, the just about managing are still waiting, and the just about managing in Burnley are managing just a bit less well than they were two years ago.

When we confront the Conservative party with the dire consequences that its budget cuts have wrought on our constituents—from the rise in NHS waiting lists to the lack of care available to the elderly and disabled and headteachers struggling to manage underfunded schools—we are told that record amounts are being spent. It does not take an economist to see that the Chancellor cannot, on the one hand, take credit for reducing the deficit and, on the other, brag about increased spending, without having a better record on growth than this Government’s miserable effort.

Yesterday’s Budget failed to address the crisis in the NHS and social care—one mention of carers, but not a single penny of support; not even a mention of the WASPI women or women’s refuges; no attempt to right the wrongs of universal credit; no extra funding for the police and fire services; no attempt to provide additional funding for nursery schools, in spite of the Education Secretary’s recent warm words. The extra spending on repairing potholes is welcome, but I find it shocking that the Chancellor provided more for potholes than he did for schools, even though every school in Burnley and Padiham is facing damaging cuts.

The Government like to mislead with figures. There is a pattern of swingeing cuts, followed by the reinstatement of modest amounts amid a fanfare of celebration. However, the recent revelation from the Office for National Statistics about the Department for Education’s dubious figures really was something else. Most ridiculously, spending on private schools was counted as Government spending on education. Next, I would not be surprised to see the use of luxury spas included in public health spending.

For me, the most damning statistic to emerge over the summer was the one on life expectancy, which has fallen in parts of my constituency for the first time in over 30 years. That is a true reflection of the Government’s record in office and the price my constituents are paying for austerity. Members will not be surprised to learn that the last time there was a fall in life expectancy was the 1980s, during the tenure of another Tory Government committed to policies that resulted in the decimation of our public services. Members may recall that we were told at the time, “There is no alternative.” Well, there is an alternative: it is a Labour Government.

The Government consistently remind us of the need to be fair to taxpayers. Let us consider that with regard to taxpayers in my constituency. Consider the low-paid essential worker who earns £12,500 per annum. Every extra pound they earn is taxed at a marginal rate of 32%. Compare that with the tax paid by the multimillionaire who, barely lifting a finger, reaps the benefits of stock market wheeling and dealing, and pays capital gains tax at a mere 20%. There is nothing fair about that.

Let us consider fairness for council tax payers. The owner of a band A property in my constituency, worth as little as £50,000, has to pay a council tax bill of £1,220, while the owner of a band G property in Westminster worth £2 million gets a council tax bill £36 lower. There is nothing fair about that.

[Faisal Rashid (Warrington South) (Lab)]

Does my hon. Friend agree that eight years of austerity have failed completely and that only a Labour Government will provide the investment our country desperately needs?

[Julie Cooper]

My hon. Friend makes a good point; I agree with him absolutely.

Some 36% of the children in my constituency are growing up in poverty, and the changes to universal credit will make that much worse. Can it be fair to punish children whose only crime is to have two siblings? Five and a half thousand children growing up in Burnley and Padiham will be affected by those draconian measures. There is nothing fair about that either.

The people in my constituency know who is responsible for the growing queue at the food bank; they know who to blame when they cannot get a GP appointment; they know who to hold to account when the old and disabled are left to struggle on without adequate social care; and, perhaps most importantly, they will not forget that it was this Conservative Government who, most shamefully of all, forced record numbers of our children to grow up in poverty, short of food, warmth and hope. They will not forget.