Income tax (charge)

Justin Madders Excerpts

Monday 16th March 2020 Commons Chamber

[Justin Madders (Ellesmere Port and Neston) (Lab)]

First, I welcome the Minister back to his place after his period of self-isolation. I am sure that all parts of the House will agree that the current coronavirus crisis has demonstrated beyond all doubt just how important our public services are. We all know that this is a very serious time and that our constituents will be concerned. I know many are frightened by the way the crisis has escalated over the past week or so, so I start by sending our condolences to all those who have already lost a loved one including, sadly, one gentleman in my constituency. I also send our gratitude to those who are already working flat out to do their best to limit the impact of coronavirus, whether they are in the NHS, the rest of the public sector or the private and voluntary sectors, which are making a vital contribution as well.

As the Minister will know, we are supportive of the national effort to contain and delay the spread of the virus, and it would be irresponsible of us as an Opposition to make any attempt to exploit the pandemic for party political gain. I thank the Minister for his kind words in that respect. Equally, it would be irresponsible of us to ignore the concerns being raised by the public, the scientific community and the sector more widely. It is critical that we ask important questions on their behalf, especially when the limits of public service will be tested like they have never been tested before.

We know that many aspects of life will have to change or stop altogether, albeit temporarily, but it is hoped that accountability, transparency and the ability of Opposition parties to scrutinise Government decisions will continue. We are under no illusions that, at this time, our ability to do that comes with a particular responsibility, so I hope the House will understand that I will focus mainly on the challenges of the immediate crisis facing us and ask some of the many important questions that have been raised. I appreciate that there will be a statement later, and I will understand if the Minister refers some responses to that, but we will have slightly more time in this debate to discuss important concerns that have been raised with us by many in the country.

Let me turn to the Budget, as this is a financial debate. We have previously acknowledged the extra funding announced in the Budget for the NHS and social care as part of the covid-19 response. That is something we have long called for, but there remain unanswered questions about how that funding will be precisely allocated. Can the Minister tell us exactly how the extra funding will be allocated and what will happen once the money is depleted? The NHS said last week that it needs to scale up intensive care beds sevenfold. That new pot of money is going to run out at some point, and it will need topping up. Will another Budget be necessary then, and what will the process be for determining resources at that point?

While we welcome the extra funding, we are aware that it is in the context of the NHS already facing extreme pressure, as usually happens over a busy winter period. We know from the last NHS winter report two weeks ago that 80% of critical care beds were occupied and that 93% of general and acute beds were also occupied. We know that the proportion of people being seen within four hours at A&E is the lowest on record, and the target has not been met since July 2015—the best part of five years. We know that the number of people on waiting lists in England is the highest it has ever been—nearly 4.5 million people are on a waiting list for treatment—and the waiting list target has not been met for nearly four years. Sadly, some cancer targets have not been met for over six years.

Those figures should tell us that the NHS is already stretched to capacity and that we are not starting from the optimum position. But it also tells us why the Government’s strategy of delay is one that has to be supported. Even if we take at face value the Government’s insistence that they have provided enough NHS resources to deliver the commitments in the long-term plan, we must surely all accept that the covid-19 outbreak will lead to an increased demand on trusts, meaning that resources in the system will have to be reallocated. Should trusts be expending time and resources on working on control totals and end-of-year accounts at this precise moment?

Will beds from the private sector be made available to covid-19 patients, and at what cost? What will the process be for trusts that have particularly large outbreaks and increased demand? Is any audit being undertaken of disused hospitals or other public sector facilities that may be required at some point? For example, is there any way that the brand new Royal Liverpool Hospital building could be brought on stream more quickly? Are the Government sourcing more ventilators, and when can we expect to see those available? Many manufacturers export all around the world. Will steps be taken to ensure that the NHS is at the front of the queue when those goods are produced?

I want to say a few words about the workforce. We know that, before we entered the crisis, the NHS was already short of over 100,000 staff, including 43,000 nurses and 10,000 doctors. The impact of staffing shortfalls manifests itself across the whole spectrum of NHS performance, as I have just outlined. It is therefore more critical than ever that those people who work in the NHS and whose good will we rely on already get adequate protection. It is evident that, in order for patients to have the best care possible, the NHS must support its staff to ensure that they stay well and can provide that vital care. That means a continuous supply of the right equipment and facilities. Personal protective equipment is vital in that respect. I hope we will hear, either in the Minister’s response or the statement later today, about what is being done to secure supplies of equipment and whether there is enough capacity in the system to ensure continued supply.

We would also be grateful for more information on the plans mooted to get retired staff back into the health service. Will some of the money announced in the Budget be used to deal with the anticipated increase in the wage bill that that would mean? Can we have an explanation as to how those people would be protected given that, by definition, the majority of them are likely to be over 70? What oversight will be put in place to ensure that they are delivering safe care if the revalidation process is to be suspended for retired returnees? Those on the frontline who I have spoken to are concerned about identifying the point at which an individual has been away from practice so long that it becomes impractical to reintegrate them in a safe and effective way. Will guidance be issued on what that point might be? What consideration has been given to those in the existing workforce who might be in a more vulnerable category because of their age or an underlying health condition?

A major concern is the lack of clarity about when people should be tested. We are hearing of many frontline NHS staff displaying symptoms but not being tested. What does that do for morale, if nothing else? The World Health Organisation has said that we should be continuing to test and contact-trace those suspected of having the virus. As a matter of importance, we should have a full explanation of exactly why we are currently diverging from WHO advice. It has been reported that labs are overwhelmed and tests are now taking several days to come back with results. Is the current ambiguity on testing policy a question of capacity rather than anything else? Will the Government be putting more resources into those labs, and if so, when will this materialise? It seems to us that continued testing is vital not only to stop the spread of the disease, but to understand when its peak has been reached. It may also be that efficient and accurate testing means fewer people having to self-isolate unnecessarily, which of course has an unnecessary economic knock-on effect.

[Mike Amesbury]

A GP has been in touch with me today to say that they were in close proximity to a patient who is likely to have coronavirus and have been sent home to self-isolate, but they have not been tested. How on earth will they know, when they do return to work, that they are not a risk to others? Surely testing should be extended to such vital GPs.

[Justin Madders]

My hon. Friend makes very well the point that I was making. It is evident that if that particular GP does not have the virus, it would be better for us all if they know that sooner rather than later, so they can get back in and treat patients. It is also worth restating at this point that people who have suspected symptoms should not be turning up at their GP practice because that is one of the ways, unfortunately, that we will spread the virus.

[Jim McMahon]

The case that has been outlined is very important, but we also need to remember that social careworkers, who will be visiting all the people in their care in their homes, are also placing their patients at high risk, but at the moment there are no plans I have heard about to test those social careworkers. I should say, by the way, that many of them are paid just over the minimum wage, and there is a real question here. We say that we value the NHS and that we value these community workers, but I am not sure a lot of them feel that way at the moment.

[Justin Madders]

I will be dealing with the concerns about the social care sector in a little while, but the points my hon. Friend makes are absolutely valid and they certainly require a Government response.

We should think about protecting NHS staff not just in terms of the doctors, nurses and other frontline staff, but in terms of the cleaners, porters and all the other essential staff who are needed to keep a hospital running and who also play a vital part in infection control. We often hear about the importance of data, and it seems to me that this is a particularly clear example of where data have a huge role to play. If the data are not collected on a regular and consistent basis, surely we will not be in the best position to take the right action.

Yesterday, it was announced that UK medical schools have been urged to fast-track final year students to help fight coronavirus. Can we have an explanation of how this will work, and how will we ensure that graduates still face rigorous testing to make sure they provide the best quality care for patients? There is certainly a role for them to play, but trusts need clarity about its limits so that they can plan ahead. Are staff on maternity and paternity leave being encouraged to return to work early, and would they be able to do so without losing any untaken leave?

[Stephen Doughty]

Does my hon. Friend agree with me—I asked Defence Ministers this question—that we should be calling up full-time reserve service members of the Royal Army Medical Corps and the medical corps of the other armed services, if they are not already NHS workers in their civilian lives? There are people with excellent training and excellent skills, and they and their facilities should be brought into use as soon as possible.

[Justin Madders]

My hon. Friend makes a very important point. I think it shows the spirit of this place at the moment that we are all coming up with very important suggestions. No stone should be left unturned in using all the resources at our disposal to tackle this virus.

As we move to the later stages of the Government’s plan, do we expect to see the cancellation of elective surgery, which will only make those record waiting lists grow further? It is fair to say that that would not be a surprise, but a reduction in elective surgery will have a knock-on impact on trust finances in the longer term. I would be grateful for some clarity about what contingencies will be put in place to help trusts financially in these difficult times, especially when they are collectively in deficit to the tune of almost £1 billion already. Is there also a case to defer loan repayments that are currently made by trusts back to the Department for a period of time?

There was a great deal of surprise and disappointment at seeing no mention of public health in the Budget. Public health directors are currently preparing local responses to covid-19. They need to expend significant sums of money on that, yet they do not know what the public health allocation will be for the next financial year, which starts in just over two weeks. I am sure the Government understand what an invidious position that puts them in, and we urgently need those allocations to be published. Will the Minister say when that will happen? Will he assure the House that the funds will be sufficient to help local authorities deal with these issues?

Has any assessment been made of the extra demands placed on public health budgets regarding preparatory work? It is likely that the knock-on economic effect will severely impact on council finances. Fewer people will use services that they currently pay for, such as leisure facilities, and it is likely that council tax collection rates will drop. There will almost certainly be unanticipated expenditure from covering staff sickness, and that is before we get to social care.

[Geraint Davies]

Is my hon. Friend aware of whether the Government are continuing to pursue the idea of herd immunity—namely letting the virus transmit almost unchecked through the population, which would put overwhelming strain on beds, social services, and so on, or are they trying to minimise transmission by asking people to move and assemble less, and then get resources and testing in place? I am worried that they are still attached to the social services model, rather than to evidence-based experience from China, and elsewhere, regarding ways to control this virus.

[Justin Madders]

That is a perfect question to put to the Secretary of State—he will be here shortly—and my hon. Friend raises an important point about the messages being put out. All sorts of stories are coming out in the press, not all of which are necessarily accurate, and it is important that we do our utmost to ensure a clear and consistent message across the board. I am not sure whether or not herd immunity is a Government policy, but I am sure the Secretary of State will take the opportunity, if he is so minded, to put that matter straight once and for all.

[Emma Hardy]

On confusing messages coming from Government, will my hon. Friend help me seek clarity on advice for people who self-isolate? Can they still go for walks outside? Can they go outside to walk family pets if they go on their own, or are they to be contained within their property? There seems to be a mixed message about what constitutes self-isolation.

--- Later in debate ---

[Justin Madders]

Again, we need a definitive answer on that from the Secretary of State. I appreciate that things are evolving rapidly, and sometimes what was considered best practice a few weeks ago might have changed in light of the evidence. It is incumbent on us to hear the advice directly from the Secretary of State, and then we can send the same message to our constituents, so that there is no more confusion and ambiguity.

[Ruth Cadbury]

My hon. Friend was excellently covering council income, but one area I am concerned about, and have heard nothing about, is council rents. Many council tenants are at risk of losing work or being forced into self-isolation, and they might not get paid. I appreciate the Government’s work on statutory sick pay, but that will not be enough to pay council or housing association rents. Does my hon. Friend share my concern that many people could be at risk of arrears unless the Government support councils in addressing that issue?

[Justin Madders]

My hon. Friend is right: a whole raft of issues will have an effect over the coming months, and although housing revenue accounts are separate to main council budgets, we still need to have that balance. Over the past decade, as a consequence of welfare reform, we have seen how councils and housing associations have adopted policies to deal with that loss of income from a number of changes to the welfare and benefits system, and we must keep that dialogue open over the next few months. We certainly could not expect full collection rates at this time, and we must work with people to understand the limitations of that. We will talk to the Government regarding any legislation that comes forward in due course.

[Jim McMahon]

I thank my hon. Friend for giving way; he is being extremely generous. Does he share my concern that, beyond rent, many households are just a payday away from poverty, so people will be sent into debt that they may never get out of in their adult lives? Surely, the Government need to do far more to help households that are really on the edge.

[Justin Madders]

That is a very fair point. We are only beginning to understand just how precarious a lot of people’s household incomes are in this economy. It is going to take concerted Government effort to support people, but it is also going to take everyone in the private sector who has a debt with an individual holding off enforcing that debt while this crisis comes through. Again, that is something we need to work on. I am afraid I will not be able to take any more interventions.

Social care has been mentioned a couple of times already. Unfortunately, once again, we have a Budget in which social care is not addressed. Local authorities have had £8 billion cut from their adult social care budgets over the past decade, leaving people struggling without any care at all. Our social care system is already at breaking point, and it is likely that the spread of coronavirus will test it even further. Without proper measures to protect people in care homes and those who receive care in their own home, there could be tragic consequences. It is crucial that social care receives the same attention from the Department as the NHS. We expect to see a plan to advise people in social care along the lines we have discussed.

As my hon. Friend the Member for Cardiff South and Penarth (Stephen Doughty) mentioned, those in the social care sector have raised particular concerns about the availability of personal protective equipment. That equipment, which is crucial to protect staff and patients, is just as necessary in social care settings as in the NHS. I have heard from local care companies about difficulties sourcing hand sanitiser, to name but one example. As equipment runs low, how will care staff, including those who are self-employed, have the equipment they need to continue to keep patients safe?

However, the biggest concern for the social care sector is whether it will have the staff it needs to deal with this crisis. As we know, there are already 122,000 vacancies across the sector, leaving staff feeling under immense pressure. We know they already feel pressure, due to staff shortages, to come into work when they feel unwell, but in this case it is vital that they stay at home if they feel unwell. How will the Government ensure that there are enough staff to care for patients when we have far more people in the care sector who are unwell and self-isolating?

A quarter of social care staff and almost half of all home carers are on zero-hours contracts. For some care staff, there is no guarantee that they will be entitled to sick pay, despite today’s announcement. That is particularly true of those who work for multiple agencies or work irregular hours. It is vital that those staff, as a key part of the workforce, feel fully supported if they become unwell. We need a guarantee that all social care staff will receive statutory sick pay. All workers need reassurance from the Government that they will receive sick pay if they are unable to work.

Over the past few days, a number of nursing homes and care homes have made the difficult decision to close their doors to visitors. They made that decision themselves, in the absence of clear guidance. Families are now unable to see their loved ones, and they will want reassurance from the Government that that is the safest call. Will there be guidance on that issue for the care sector?

Inevitably, social care providers will face difficult choices over the next few months. Many will face higher costs. Last year, more than half of social care providers handed contracts back to local authorities because of financial pressures. That causes immense pressure on councils and, of course, worries for the families of people receiving care. It seems inevitable that we will face that situation again soon. Will local authorities and care providers get the financial support they need if cost pressures become too much to deliver safe care? At this difficult time, we must ensure that care services continue to provide the vital support that people need.

What about those who provide care for a loved one outside the system? Inevitably, there will be people who are not able to provide care for a period. The state has no official role to play in that situation, but those people will still need help and support. How will that be addressed?

In conclusion, providing well-resourced and well-funded public services is vital to tackle the spread of this disease, but of course that is not the whole picture. Every member of society will have to play their part. We will all have to recognise that the impact could be felt for many years to come, but we should take heart from the fact that we have a truly national health service and the capacity to rise to whatever challenges we face, so we are better positioned than many to take on this challenge. That will only be true, however, if we can be confident that the services people will rely on in the coming months are robust enough to deal with the storms ahead.

A decade of underfunding has not left us in as strong a position as we would like, but it seems that in the hour of need that may change. We will support the Government in any attempt to boost funding across the board, but we will not be afraid to point out when we believe measures are not enough. Beyond funding, we want messages from the Government about the action they are taking to be clear, consistent and quick. We all have a responsibility in this place to get that message across. Her Majesty’s official Opposition stand ready to give that message as well.

[Several hon. Members rose—]