European Medicines Agency

Justin Madders Excerpts

Wednesday 12th October 2016 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mr McCabe. I congratulate my hon. Friend the Member for Cambridge (Daniel Zeichner) on securing this important debate and on the powerful and knowledgeable way that he made his case today. I share his disappointment that this matter is not being responded to by the Department for Exiting the European Union, but I understand that there are competing interests today. However, I hope that the Minister will undertake to raise the issues set out today with his colleagues in the Department and will answer some of the questions posed today.

I know that my hon. Friend the Member for Cambridge was and remains a passionate advocate for both the European Union and his constituency, and today he has channelled his disappointment at our impending departure from the EU into a well argued case to support key industries in his constituency. He spoke about the local interest that he has in this issue. The Cambridge biomedical campus is one of the most significant sites for medical research not only in this country, but anywhere in the world. Like him, I represent a constituency with an interest in the science and research sector, which could take on even more significance with the proposed Cheshire science corridor, which has the potential to create more than 15,000 new jobs by 2030, around a third of which could be in my constituency. Of course, I do not have to tell the Minister about that because the science corridor benefits Warrington as well as Ellesmere Port. Even before projects such as the Cheshire science corridor come to fruition, the north-west, as we have heard, is already one of the leading regions in the country for the pharmaceutical industry, employing about 18% of the total national workforce.

As my hon. Friend the Member for Cambridge said, the industry is a massive part of our country’s economy, with a turnover of more than £60 billion a year and exports worth around half of that. In 2014, it invested £4 billion in research and development: more than any other sector. It also employs some 220,000 people. I have set out those facts to paint a clearer picture of what is at stake in today’s debate and why it is so important that we begin to offer some clarity about what our plans are, not only for the future of the European Medicines Agency, but for pharmaceutical research, development and regulation more widely. I believe that the importance of the issue is reflected in the number of Members attending the debate, even though the bigger picture on our exit from the European Union is being debated in the main Chamber now.

I appreciate the tone that the hon. Member for Strangford (Jim Shannon) adopted. I think that he was saying that, wherever we came from pre-referendum, and whatever our views on the European Union, the vast majority of Members now want to ensure that our departure happens on the best possible terms. I regret the mischaracterisation of Members who request greater scrutiny and debate on the terms of exit as being involved in a Machiavellian plot to undo the referendum result. What Members are asking for is scrutiny, transparency and accountability on what is surely the most important issue that the country has faced in a generation.

My hon. Friend the Member for Heywood and Middleton (Liz McInnes) spoke from great personal experience. She was right to use the word “isolation”. We want to avoid becoming separate from the rest of the world in such an important area. She gave specific examples of the benefits of pan-European research on diseases such as cancer. The hon. Member for Linlithgow and East Falkirk (Martyn Day) raised important concerns about delays in approval, and the potential loss, on leaving the EU, of our involvement in pharmaceutical trials. He mentioned the concerns of the Japanese Government about the siting of their European bases in London. That echoes concerns that they have raised about other sectors.

The hon. Member for Central Ayrshire (Dr Whitford) clearly set out the fact that the EMA is not a body that tells us what we should do, which is how much of the European landscape is portrayed. It is part of a collaborative exercise across 28 nations, which have been making real progress. She also set out the financial benefits that this country has received from membership, and highlighted the important point about the difficulty that some smaller British companies may face in exporting their innovations, if we do not get the terms of exit right.

We all remember the famous promise, which several hon. Members have referred to, that the Brexit vote would mean £350 million a week being spent on the NHS. It is fair to say that it is accepted that that figure does not stand up and was misleading, but, as the hon. Member for Central Ayrshire eloquently pointed out, I suspect very few people who voted leave would have appreciated the threat that leaving means to jobs in the science and research sector and to speedy access to new medicines.

No one blames the Department of Health for those misleading claims. Indeed, I know from my own parliamentary questions that Ministers sought legal advice about the use of the NHS logo by the leave campaign. However, we are entitled to ask for more from Ministers on the near total absence of work to prepare for the possibility of a leave vote. For example, on 11 July, I asked the Secretary of State what assessment he had made

“of the potential effect on workforce numbers in the NHS of the UK withdrawing from the EU.”

I was told that no such assessment had taken place. On 6 September I asked what discussions the Secretary of State had had with the Home Secretary

“on the immigration status of NHS employees from other EU countries when the UK leaves the EU.”

I was told only that arrangements were being made for a meeting to take place at some point in the future. A similarly disappointing response from the Government on the issue was pointed out by my hon. Friend the Member for Cambridge, who noted that when asked about the future physical location of the EMA the Minister responded that it was “too early to speculate”.

We are not asking the Government to speculate; speculation is happening whether we like it or not. We are asking them to set out some concrete and substantive detail on what they plan to do. We have heard many times from the Prime Minister the words “Brexit means Brexit”, and that she is not prepared to give a running commentary. But investment decisions are being made right now, and if we cannot begin to provide some certainty we shall quickly find out that the UK and, in particular, places such as Cambridge and Cheshire will miss out on investment. It is about time we got some clarity on the Government’s position.

The first and most obvious point is the location of the EMA. We have already heard that countries from around the world are queueing up to offer it a new home. Having heard the benefits that it brings we can understand why they are forming an orderly queue. I know that the Minister does not want to speculate on what will happen, but will he at least set out whether, as part of the negotiations, he will take steps to try to retain the EMA headquarters in London, if that is possible? Will he also provide clarity about what steps the Government will take, if the EMA does relocate, to safeguard the headquarters of major international pharmaceutical and life sciences companies?

Beyond the future location of the EMA, there are wider issues about how medicines will be regulated in future, which could not only have an impact on investment but affect how quickly new medicines reach UK patients. Various hon. Members have mentioned that. Will we be able to safeguard the UK’s position as one of the leading locations for clinical trials in Europe? Clearly, a lot of Members feel passionately about that. Will the Government guarantee that the UK will continue to adhere to the EU regulatory framework on the authorisation and conduct of clinical trials? What assurances can the Minister give us that retaining access to the centralised marketing authorisation procedure will be a key part of our Brexit negotiations? Will the Government seek to negotiate continued access for UK research institutions to the innovative medicines initiative and other EU-funded research and collaboration programmes?

If the UK is left in the position of developing a separate regulatory framework from the EU, not only will that make it a much less attractive place in which to develop, manufacture and launch new products; it could also signify the end of accelerated access to treatments for patients in the UK, putting us to the back of the queue when new medicines are developed. Patients in Australia and Canada, where medicines are licensed nationally, have a comparative delay of six to 12 months before new medicines come to market. For people with rare conditions that could mean the difference between life and death.

European co-operation also provides some key benefits in terms of patient safety. One example is the European Centre for Disease Prevention and Control, which assists in our response to communicable diseases and pandemics. Another is the co-operation that reduces the risk of falsified medicines reaching UK patients. Can the Minister confirm that we will seek to continue to co-operate with our neighbours on those crucial issues?

What assessment has been made of the impact of the EMA’s leaving on the Medicines and Healthcare Products Regulatory Agency? As the hon. Member for Strangford said, work from the EMA is a substantial source of income for the MHRA, accounting for up to a third of its income. What provision has the Department made for the potential shortfall, particularly if the MHRA will have more responsibilities in future? As the hon. Member for Central Ayrshire said, in any scenario, it is likely that the MHRA will require further investment. What provision has been made for that?

This has been a wide-ranging and well informed debate. While we recognise that the issue does not begin and end with the physical location of the EMA and the 900 staff based there, there are at the heart of it, as my hon. Friend the Member for Heywood and Middleton said, 900 people—highly skilled and able to take their talents probably anywhere in the world—who face a future that is a vacuum. They will all have families and plans, and it is unrealistic to expect them to put their lives on hold for two or three years while things are sorted out.

I appreciate the Government’s reluctance to be drawn into making substantial commitments on the issues, but we run risks with respect to decisions about investment, future co-operation and, indeed, staff retention, if we do not begin to make our position clear. I hope that, when the Minister gets to his feet, we shall begin to get some certainty about the Government’s intentions as to seeking regulatory co-operation and, most importantly, safeguarding future investment in the sectors that we have heard about today.

Oral Answers to Questions

Justin Madders Excerpts

Tuesday 11th October 2016 Commons Chamber

[Mr Dunne]

My right hon. Friend managed to include several questions in his impressive supplementary. I can confirm that much of the waste that took place in the years he cited—2002 to 2007—related to projects of the previous Labour Government that they themselves then cancelled, such as the IT project. I can also confirm that savings generated in the NHS are kept in the NHS. Lord Carter, whose report I referred to earlier, has identified £5 billion of efficiency savings, which we hope to deliver during this Parliament.

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

There is a distinction to be drawn between realistic efficiency targets and systematic underfunding. Only last month, Simon Stevens told the Public Accounts Committee that for three of the next five years

“we did not get what we originally asked for”.

Chris Hopson, chief executive of NHS Providers, also said last month that

“we’ve got a huge gap coming… it’s the chairs and chief executives on the front line…who are saying they cannot make this add up any longer.”

On funding, the Government keep saying that the NHS is getting all that it has asked for; those actually running the NHS say something quite different. Who is right?

NHS Sustainability and Transformation Plans

Justin Madders Excerpts

Wednesday 14th September 2016 Commons Chamber

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

This has been a high-quality and interesting debate. I welcome the Minister of State, Department of Health, the hon. Member for Ludlow (Mr Dunne), to his new role. As he is new to the role, I will forgive him for not knowing precisely how many trusts ended last year in deficit—it is 80%, by the way. As my hon. Friend the Member for Lewisham East (Heidi Alexander) said, that is the context in which we are discussing the plans, which means that the public will rightly be cynical about them, particularly if they are presented with a final plan. The Minister underplayed their development a little when he said that they were simply ideas. If that is all they are, let us see them.

We have heard contributions from the hon. Members for Bosworth (David Tredinnick), for Central Ayrshire (Dr Whitford) and for Totnes (Dr Wollaston); my right hon. Friend the Member for Newcastle upon Tyne East (Mr Brown); my hon. Friend the Member for Dewsbury (Paula Sherriff); the hon. Members for Spelthorne (Kwasi Kwarteng), for Bedford (Richard Fuller) and for Faversham and Mid Kent (Helen Whately); my hon. Friend the Member for Bootle (Peter Dowd); the hon. Member for Lewes (Maria Caulfield); my hon. Friend the Member for Hammersmith (Andy Slaughter); the hon. Member for North Dorset (Simon Hoare); my hon. Friend the Member for Newcastle-under-Lyme (Paul Farrelly); the hon. Member for Eddisbury (Antoinette Sandbach); my hon. Friend the Member for Brentford and Isleworth (Ruth Cadbury); the hon. Member for Stafford (Jeremy Lefroy); my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley); the hon. Member for Bath (Ben Howlett); and my hon. Friends the Members for Wirral West (Margaret Greenwood), for South Shields (Mrs Lewell-Buck) and for Heywood and Middleton (Liz McInnes). I am sorry that I am unable to refer more to hon. Members’ contributions because of the time pressures.

Let us get down to the brass tacks. This is another reorganisation of the NHS, only this time it is being done behind closed doors. It is not just a reorganisation but an admission, as if we did not already know it, that the Government got the last one wrong. The Opposition do not need persuading that there is a benefit to more localised strategic oversight of the NHS and the health sector. We know that because we opposed the Government’s decision to scrap strategic health authorities as part of the 2012 Act.Unlike the strategic health authorities they are now trying to replace, there is no statutory basis for STPs and there is no scrutiny or transparency at all. Despite this, they are being asked to go further than any body has ever had to in the entire history of the NHS in terms of the cuts they are being asked to make. These cuts are being cooked up behind closed doors. This is happening without the involvement of patients, carers, clinicians, trade unions and staff. Consultation with the public does not mean presenting them with a completed plan as a fait accompli and asking them whether they support it. It means involving them from day one. The bigger the change, the better it is to start early with that consultation.

In my area, what has been published about the Cheshire and Merseyside plan states that it

“will require our hospitals to be reconfigured, consolidated with less sites and clinicians and consultants.”

Yes, that means fewer hospitals, fewer doctors and fewer nurses. No wonder the Government do not want to talk about it. Many Members, including the Chair of the Health Committee, have talked about the importance of consultation. We know from history that if an attempt is made significantly to alter local health services without engaging with the public and establishing local support at an early stage, it will fail. That is not just my view. This is what the Secretary of State himself said:

“the success of STPs will depend on having an open, engaging, and iterative process that involves patients, carers, citizens, clinicians, local community partners, parliamentarians, the independent and voluntary sectors, and local government”.

That just has not happened so far.

Not only are the public locked out of contributing to this process, they cannot even find out what is happening. I submitted freedom of information requests to NHS England and the 44 STPs, asking for copies of the plans submitted in June. The deadline for replies is tomorrow and so far not one has been provided to me. Many have simply refused to provide me with the plans, using the exemption that they are “intended for future publication.” When I asked the Minister when the June plans would be made available, I was surprised to read in his response that

“The June submissions were a ‘checkpoint’ and will not be published.”

We have STPs saying one thing and Ministers saying something else about whether the plans will be even published. No wonder people are concerned about what is in them.

Is this not the nub of the matter? Plans about fundamental changes to local health services have been sitting on the Secretary of State’s desk since June, but he will not release them. Surely in the interests of transparency they should be made publicly available now. There is nothing wrong in principle with the idea of local partners working collaboratively to transform health services, but there is everything wrong with doing so without transparency, public involvement or clear lines of accountability.

I welcome the new Minister, the hon. Member for Warrington South (David Mowat), to the Government Front Bench. When he responds to the debate, will he commit to dropping the secrecy and listen to the concerns of clinicians and patients, and ask each area to make their plans publicly available immediately? Will he clarify his role in the plans? When responding to a point made by the right hon. Member for North Norfolk (Norman Lamb), he said that plans will not go ahead if they do not deliver for mental health. However, the Minister of State, in response to a written answer, said:

“The reconfiguration of services…is clinically led and a matter for the local National Health Service.”

So which is it? Who will get the final say? Will it be the Government or will it be the local STPs?

What we have seen so far is a process that has failed to engage with just about every stakeholder imaginable, but even those who have been invited to attend the meetings are beginning to lose faith in the process. Council leaders and officers are queueing up to express their concerns. We heard from my hon. Friend the Member for Bootle about how his council leader’s concerns were dismissed. The Conservative leader of Kent County Council, Paul Carter, said:

“In Kent and Medway, NHS England is doing everything it can to keep local government out of it.”

Izzi Seccombe, Conservative leader of Warwickshire County Council, said that local government was being

“left out in the cold and not involved in the integration agenda.”

If STPs are the answer, can the Minister tell us why even council leaders from his own party are finding themselves totally disengaged from this process?

Many Members, including my hon. Friend the Member for Lewisham East and the hon. Members for Central Ayrshire and for Totnes, made the point that much of the money set aside for transformation has been spent on deficits, so let us not pretend that STPs are a panacea. Do not take my word for it; listen to what NHS providers are warning:

“We must be realistic about what STPs can achieve…and what they can deliver in terms of the £23 billion efficiencies required. It should not be overestimated.”

Nigel Edwards, of the Nuffield Trust think-tank, says:

“I’ve been visiting a lot of STPs and nobody I’ve spoken to is confident they can reduce the financial gap.”

Given the warnings we have already heard, will the Government seriously engage with the health service on the challenges they face, or will they continue to insist on impossible targets and unrealistic timetables?

I am sure the response will be the same one that we hear time and again: that the Government are investing £10 billion more in the NHS. We know, however, that that is an illusion. The Health Committee has confirmed that they are in fact delivering less than half of that, while at the same time chronically underfunding social care. The NHS has just had its biggest deficit in history under the stewardship of this Government, but the Secretary of State is not simply trying to convince us that he will maintain services at their current level, he is telling us that he will somehow do more.

The Government are in denial. It seems that virtually every day somebody is warning us that the NHS is on the brink of collapse. Only this weekend, the chief executive of NHS Providers said that

“we face a stark choice of investing the resources required to keep up with demand or watching the NHS slowly deteriorate”.

The Society for Acute Medicine has warned us that the NHS could experience “pockets of meltdown”. In the real world, not one serious commentator or senior NHS manager—not one—believes the NHS can deliver the services that it currently does, function safely, improve quality, move to 24/7 working and be financially sustainable. Let us end this charade; let us open up the debate and get to the truth about the damage being caused to the NHS by this Government. I commend this motion to the House.

Capsticks Report and NHS Whistleblowing

Justin Madders Excerpts

Wednesday 13th July 2016 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mrs Main. I start by paying tribute to my hon. Friend the Member for West Lancashire (Rosie Cooper), who has ploughed what has at times been a very lonely furrow on this issue. She has shown incredible tenacity in pursuing the matter over a number of years. What makes this all the more remarkable is that, despite all of the inspection regimes and safeguards in place, the only reason we are debating this is because she had the courage and the determination to pursue these issues. She made a powerful and lengthy contribution today; I do not use that adjective in a critical way, but to highlight that there is so much that needs to be considered. The debate is certainly not going to be the end of the story. My contribution will perhaps not be as lengthy as on other occasions as I would like to give the Minister as much time as possible to set out how he intends to take matters forward.

At the heart of this is a random occurrence—my hon. Friend attending the trust in question as a result of her father being a patient there—and one can only wonder whether anything would have been done about the situation had she not attended, and had the brave staff on the ward not approached her after that. We heard from her about a whole catalogue of incidents, any of which in isolation ought to have raised alarm bells. When she spoke of the picture across the board, the number of grievances, some taking years to resolved, the suspensions that seem to be used as a punishment rather than the neutral act they are meant to be and the number of complaints of bullying and harassment it is clear that a wider pattern was there. In the words of the report:

“Non-Executive Directors took reassurance too easily and failed to provide sufficient scrutiny and challenge across a number of key areas. They collectively represented a series of missed opportunities to intervene.”

It should be said that there were also repeated failures by the executive directors to be open and transparent with the wider board, which included them not divulging details of a serious assault carried out on a staff member and keeping from the board the results of a staff survey that said 96% of respondents believed bullying was a problem to some degree within the trust. Will the Minister address whether he considers there needs to be more training or support for non-executive directors, so they at least know when they are not getting the whole picture? I also wonder whether there ought to be a requirement for at least one employee representative on each board so that, if there is a culture like this, there is a greater chance of it being revealed. What steps are being taken to prevent those non-executive directors who were involved in this from serving in a similar capacity in future?

The position of the executive directors deserves much sharper criticism, particularly when, as my hon. Friend pointed out, many of the senior people involved have found themselves in employment elsewhere in the NHS, and she quite rightly asked where the individual accountability is. Staff spending their last few days stood at a shredding machine is the sort of thing that goes on in multinational companies that have been cooking the books. It is not what should be happening in an open, transparent and accountable public body. It seems that the human resources team were used as a tool to enforce management’s will rather than to ensure the rules were applied fairly and consistently across the board. It is little wonder in those circumstances that staff did not feel confident that they could raise concerns freely.

I am sure we will talk about the duty of candour, but will the Minister give us assurances that this sort of situation will not happen again? Policies and good intentions can only take us so far, particularly when a culture develops that positively attacks those that raise concerns so that everyone is too frightened to raise those concerns in the first place. In my experience I have seen far too many times people who have legitimate concerns about a practice at their place of work but who do not have the confidence to raise those issues without fear of reprisal. A policy is only as good as the people entrusted to honour it and that is down to the people at the top. They set the tone and they have a duty to ensure that every person who raises a legitimate concern is protected. It only takes one bad experience or one failure to act in good faith on a concern raised and the entire system falls into disrepute.

I am sure that nobody goes into public service with the intention of creating such a culture of fear but it is clear that good intentions can be diverted by other influences and pressures. In this case, the central conclusion in the report, which needs more careful consideration, is that when the trust made the decision to go for foundation status what happened was an

“accompanying focus to reduce costs, which resulted in enormous pressures on many front line services and the emergence of a culture of bullying and harassment of staff at various levels within the organisation and the delivery to some patients of poor and in some cases sub-standard care.”

The report also said:

“For many of these concerns, it is hard to come to any other conclusion than that they were managed in the way they were in order to ensure the Trust application for NHS foundation trust status remained on track.”

That is pretty damning.

Aside from the financial pressures faced, we know that other pressures on staff are not going away, with significant numbers reporting work-related stress. We know that vacancy rates and rota gaps still remain unacceptably high and there are serious problems with staff morale across a whole range of services. I pay tribute to all NHS staff who are working hard in very trying circumstances, but we should also be realistic about the challenges they face. The staff at the trust have been key to delivering the improvements we have already seen, and the latest CQC report recognises that there have been improvements, which is not only a credit to those staff but also to the new leadership team.

It is fair to say that there is clearly still some way to go. For example, the performance of paediatric speech therapy service was worse than at the last inspection to the extent that the trust had to suspend the waiting list for a year. It was also noted that, despite some improvements, too many patients are developing serious pressure ulcers, which is something that ought to be eradicated altogether. Inspectors also highlighted “significant improvements” in the culture of the organisation and praised the trust for the measures it has introduced to keep staff safe, which is clearly one of the biggest and most important changes that was needed.

Whether that change in culture is permanent can only be tested by events, but we should reinforce at every opportunity the importance of speaking out with confidence. In that regard, it appears the future of the national whistleblowing helpline is still being considered. I would like to see the local guardians as complimentary to, rather than a replacement for, the national helpline. I would be grateful if the Minister will address whether any decision has yet been taken on the future of that national helpline.

In conclusion, I add my voice to the calls made by my hon. Friend the Member for West Lancashire for an independent clinical review into patient harm associated with the leadership failings at the trust. We also need an investigation into the adequacy of the actions taken at the same time by NHS Improvement, NHS England, the clinical commissioning groups and their predecessor organisations. Only then can we move into a position from which we can confidently say this is something that will never happen again.

NHS Spending

Justin Madders Excerpts

Wednesday 6th July 2016 Commons Chamber

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

In what has been a hugely significant day in a monumentally significant fortnight, we have been discussing issues that are also of huge significance, but I fear that the contributions will be lost amid the historic nature of the events are currently engulfing this place and the whole country.

Let me turn now to the contributions to this debate. The hon. Member for Central Ayrshire (Dr Whitford) rightly highlighted the uncertainty now facing our staff who have come from the EU. There is also a very real fear that agency costs will go through the roof as a result of the decision that has been made.

My right hon. Friend the Member for Enfield North (Joan Ryan) spoke with graphic clarity about the problems that a lack of funding has caused the health services in her own constituency. She also pointed to the promises to protect local services that have not been honoured. She talked about the scandal of junior doctors left unsupervised in the North Middlesex hospital A&E. I know that she has a debate in Westminster Hall on that issue next week, and I am sure that some of the matters that have been raised today will get a further examination then.

My hon. Friend the Member for Copeland (Mr Reed), who, as my predecessor in this shadow role, has great knowledge of this area, spoke passionately about the challenges that his community faces in delivering an effective health economy. He is right to be concerned that the success regime could indeed turn out to be a Trojan horse.

My hon. Friend the Member for Burnley (Julie Cooper) gave a personal and troubling story about a recent case involving one of her constituents. I agree with the hon. Member for Aberdeen North (Kirsty Blackman) that all of us as politicians will have to work much harder to restore and retain trust in what we say. My hon. Friend the Member for Bristol South (Karin Smyth) spoke with the benefit of her own great experience of the NHS and her more recent experiences as a member of the Public Accounts Committee and the many critical reports it has written. I assure her that I have already considered many of them, so I trust I have her permission to watch the football later.

Finally, my hon. Friend the Member for Harrow West (Mr Thomas) spoke with great authority about the difficulties of his own local NHS trust. I think every Member who has spoken tonight has mentioned challenges in their own constituency, but more significant is the fact that every Member who has spoken tonight said that at least some of their constituents voted to leave the EU because they thought it would mean more money for the NHS.

Those are the Members who have spoken. Who have we not heard from? Where are the right hon. and hon. Members who have spent the last few months spearheading the campaign up and down the country claiming that there was £350 million a week just sitting there, ready to be spent on the NHS. Could it be that because it was a promise that could never be kept and should never have been made, we have seen a collective abrogation of responsibility by people who, frankly, should know better? Make no mistake: those who have associated themselves with such claims will be expected to account for their actions, but let us not allow those wild statements to distract us from the crisis in the NHS caused by this Government.

The challenges we already face in the finances, quality of care and the workforce put the NHS in a precarious position, but be in no doubt: those challenges were there before we voted to leave the EU. It has been clear for some time that the NHS does not have the resources needed to deliver the services that people expect. Only this week, we have heard where the Government’s priorities appear to be, with the Chancellor talking about reducing corporation tax yet again. Is it not interesting that we only hear such extra-parliamentary statements about tax cuts, and not about the extra investment that the NHS patently needs? Indeed, the Chancellor’s last big spending decision on the NHS was to cut £1.1 billion from this year’s capital budget, which came to light only after a study by the House of Commons Library—an approach about as far removed from parading impossible pledges on the side of a bus as I can imagine, but to my mind just as dishonourable.

As we know, the overall deficit in the NHS last year was a record £2.5 billion—a record deficit despite pledges from the Government that the investment needed would be front-loaded now to ensure that the NHS could implement the service transformation needed before the middle years of this Parliament, when the funding increases already announced for the NHS are microscopic. What will the NHS look like a few years down the line if the money that is supposed to be preparing us for the rocky road ahead will in fact be used to plug the black hole in finances left over from the last year? Surely, whatever the implications of the referendum result, the Government must recognise that their existing financial plan for the NHS needs comprehensive re-evaluation.

Only yesterday, we had a report from the Healthcare Financial Management Association that revealed that 22% of the NHS finance directors in hospitals and CCGs surveyed said that quality of care will worsen during this financial year. It does not end there: one in three finance directors fear that care will deteriorate in the next financial year. They warn that waiting times, access to services and the range of services offered are all likely to suffer because of the inadequate funding settlement. I know the Minister will try to reassure us that plans are in place to put the NHS back on an even keel, but I suggest that he listen to the 67% of CCG finance officers and 48% of trust finance directors who have said that there is a “high degree of risk” associated with achieving their organisation’s financial plans for this year.

In addition, only 16% of finance directors have expressed confidence that NHS organisations in their area will be able to deliver the changes required by their local sustainability and transformation plans. Along with the challenges they anticipate in delivering planned efficiencies, finance directors say that continued high spending on agency staff and inadequate funding of social care are pressures that are not going away. As my hon. Friend the Member for Bristol South mentioned, the Minister will be aware of what the Public Accounts Committee said: that the 4% annual efficiency targets imposed are

“unrealistic and have caused long-term damage”.

None of that will be news to the Minister. It is high time the Government acknowledged that within the current parameters, hard-working NHS staff are being set up to fail.

Across a whole range of indicators, the NHS is experiencing its worst performance since records began, but let me be clear: I do not for a second hold the people who work on the frontline in the NHS responsible for that. Indeed, it is only through their dedication that the health service keeps going, despite the best efforts of the Government to destroy staff morale. Be it the current generation of junior doctors alienated by botched contract discussions, the next generation of nurses deterred from entering the profession by tuition fees, or the thousands of EU nationals working in the NHS who fear for their future in this country, existing staff, who are at breaking point, see nothing from the Government that gives them confidence that the Government have a clue how to fix this mess.

Let us once and for all nail the myth propounded by Government Members that this Government have been generous in their funding for the NHS. The King’s Fund and the Health Foundation looked into this claim. Despite the oft-repeated mantra that this year’s funding increase is the sixth largest in the NHS’s history, they said:

“We find that…this year it is in fact the 28th largest funding increase since 1975”.

That is the truth. That is the cruel deception at the heart of the Government’s NHS plans.

NHS Providers, the organisation that represents NHS trusts, had this to say about the size of the deficit:

“the combination of increasing demand and the longest and deepest financial squeeze in NHS history is maxing out the health service”.

The fact is that the NHS is halfway through its most austere decade ever. It is getting a smaller increase this year than it got in any single year of the last Labour Government. Since the health service’s creation in 1948, NHS demand and costs have risen by 3.5% to 4% a year, and on average funding has kept pace. Now funding will rise, on average, by only 0.9% a year between 2010 and 2020. That is a quarter of the historical average, and well below what is needed to provide the same quality of service to a growing, older population.

I return to my opening remarks. It has been a seismic few weeks for this country. Politicians have been exposed as cavalier with the facts, cynical in their actions and irresponsible about the future of this country. Let us not allow that approach to continue to pollute our politics. Let us have the courage to be honest about the challenges that lie ahead. Let us stop the pretence that the NHS can continue to be the service that most of us want it to be within current Government spending limits.

Let us also be clear that the answer is not to emblazon buses with cheap slogans and then run away from those slogans at the first opportunity. Instead, the challenge for all of us in this place who want the next generation to enjoy the same access to the NHS that my generation has taken for granted is to provide a coherent, credible set of policies and then actually deliver them. On that measure, this Government have fundamentally failed. I therefore commend the motion to the House.

Oral Answers to Questions

Justin Madders Excerpts

Tuesday 5th July 2016 Commons Chamber

[Ben Gummer]

I welcome the hon. Lady to her seat. She fought a courageous campaign, and it is good to see her in the Chamber. She brings expertise to the House, which is also very welcome.

I agree with the first part of the hon. Lady’s question—the deficit at her local hospital is indeed partly caused by the excessive costs of agency nurses, and we are trying to put a cap on those costs—but I am afraid I disagree with the second part. I believe that changes in nurse bursaries will enable us to get more nurses and healthcare professionals into the NHS. There has been a similar development in the rest of the higher education sector, and I want to replicate that success in the NHS so that we can provide it with the workers that it requires.

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

I, too, am delighted to welcome my hon. Friend the Member for Tooting (Dr Allin-Khan) to her seat. Her recent experience on the front line of the NHS will be of great value, and we in the Labour party pride ourselves on listening to NHS staff. Let me also put on record my thanks to my hon. Friend the Member for Lewisham East (Heidi Alexander) for the excellent job that she did as shadow Secretary of State.

I must challenge the Minister again about the impact of this policy on mature students. According to an answer given to me by his colleague the Minister for Universities and Science, in 2010-11 there were 740,000 enrolments in higher education among people aged 21 or over. Let me ask a simple question: in 2014-15, after tuition fees trebled, was the number of enrolments among mature students higher or lower?

[Ben Gummer]

I echo the hon. Gentleman’s remarks about the hon. Member for Lewisham East (Heidi Alexander). She gave the House admirable assistance in challenging the Government, and I regret her loss from the Opposition Front Bench.

The latest figure from UCAS, for 2015, shows that the number of mature student applications has risen since the introduction of £9,000 tuition fees, but the hon. Gentleman is right to identify that factor as a challenge in relation to our new plans. That is why we asked open questions during the consultation, and I hope that, now that it has closed, we shall be able to respond to those questions to ensure that we can give the best possible assistance to mature students who want to become nurses.

[Justin Madders]

According to the universities Minister, the number of mature students enrolling in universities has fallen by 22%. If that were repeated in the health sector, what is already a staffing crisis would become a catastrophe. The Minister has said that an extra 10,000 training places will be created during the current Parliament, but everything I have heard from the Government suggests that that figure was plucked out of thin air. What is the baseline figure for the Minister’s claim—10,000 more places compared to when?

[Ben Gummer]

There will be 10,000 additional places over the five years from when the policy was announced last year, and that will give NHS organisations throughout the country the assistance that will enable them to bring down their agency costs. It is only through such bold initiatives that we can reform the NHS for the betterment of patient care throughout the country.

--- Later in debate ---

[Mr Hunt]

My hon. Friend is right to draw attention to that issue. We, too, are very proud of the progress we have made on mental health, with 1,400 more people accessing mental health services every day than six years ago, but there is a particular job to do with children and young people’s mental health, and we are putting £1.4 billion into that during the course of this Parliament—and there is a specific plan for the Manchester area, which I think will help my hon. Friend’s constituents.

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

It seems that almost every day there is another report about the deteriorating condition of NHS finances. Today we hear of a survey by the Healthcare Financial Management Association that said 67% of clinical commissioning group finance officers reported a high degree of risk in achieving their financial plan for the year, so does the Secretary of State now accept that the Government need to commit more funds to the NHS?

[Mr Hunt]

We have accepted that, which is why in our manifesto at the last election we were committed to putting £5.5 billion more into the NHS than was being promised by the hon. Gentleman’s party, but we have to live within the country’s financial envelope, because we know that without a strong economy we will not have a strong NHS. We will continue to make sure we get that balance right.

Stillbirth

Justin Madders Excerpts

Thursday 9th June 2016 Westminster Hall

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

It is an honour to serve under your chairmanship, Sir David. I congratulate the hon. Member for North Ayrshire and Arran (Patricia Gibson) on securing this extremely important debate and the compelling way that she introduced it. She is right that she is not alone in having gone through such a terrible experience, and she is certainly not alone in wanting to move this issue up the political agenda. I pay tribute to her for the courage that she has shown in retelling her experience. I do not think that any Member could fail to have been moved by her speech, and I am sure that many of those watching her contribution will, sadly, have recognised the personal tragedy, which was made more difficult by the defensive attitude of the health service. Many people have had such experiences—not just in this area but through many other failings in care in the health service. She made a compelling case for the extension of coroners’ powers to holding inquests on stillbirths. As we know from recent high-profile inquests, there is a need for a comprehensive review of that whole system.

Hon. Members from both sides have made excellent and sometimes very moving contributions. I draw particular attention to the contribution of the hon. Member for Henley (John Howell), who rightly raised the impact on parents’ mental health of such experiences and the loss that the whole family feels. Not only the mother and father, but little brothers or sisters and the wider family are impacted by such tragic events.

The hon. Member for East Renfrewshire (Kirsten Oswald) was right to highlight the need for prevention and how many parents experience a stillbirth and never get an adequate explanation of how that happened. I agree that only through continued targeted action will we drive the necessary progress. The hon. Member for Colchester (Will Quince) summed up the challenge very well when he said that we do not like talking about death in this country. I pay tribute to him for the great strength that he showed in talking about his experience. I am sure that he will be able to get many more Members to talk about this subject through his work on the APPG. The hon. Member for Livingston (Hannah Bardell) spoke with great sincerity about her constituents’ experience and the twin to twin transfusion syndrome process, and conveyed the incredible range of emotions that parents must go through in such situations, which are rare but none the less extremely difficult for those involved.

I welcome the debate, which, as we have heard, coincides with Sands awareness month. I add my voice to those of others who have already paid tribute to the enormously important work that that charity does. Sands awareness month gives us the opportunity to increase awareness of stillbirth and neonatal death and the devastating impact experienced when a baby dies before, during or after birth, which hon. Members have conveyed with great sincerity and courage.

In November, I was privileged to have the opportunity to respond for the Opposition in a debate marking World Prematurity Day. That debate was also difficult, and what we heard then from Members about stillbirths and neonatal deaths was equally compelling and challenging. We still face those challenges, and this is an opportunity to explore in further detail some of the issues that were raised in November and have been raised today and to scrutinise the progress that the Government have made in the six months since that debate.

As has been said already, although there has been enormous progress in the past century in tackling stillbirth and infant mortality rates, progress has more or less stalled in the past two decades, and the UK continues to perform significantly worse than many comparable nations on infant mortality rates and remains one of the poorest performing countries in the developed world for stillbirths. That is a clear sign that we are not doing well enough in providing neonatal care or tackling the underlying public health issues that contribute to premature births and stillbirth.

Research into babies stillborn from 28 weeks indicates that the UK has a stillbirth rate of 2.9 per 1,000 births —higher than Germany at 2.4; Poland at 2.3; the Netherlands at 1.8; and Denmark at 1.7. Members have said that this issue is not just about statistics, and it is about far more than that, but those statistics need to be laid out, because it is clear that we are not doing as well as we should be and progress is not as swift as in some other places in Europe. I think that all Members want to see that situation addressed. We welcome the Secretary of State’s ambition to reduce stillbirths and neonatal deaths by 50% by 2030, but 14 years is a long way off, so will the Minister give us some indication of what progress he expects to be made before that date? Will he also set out where he expects us to be by around 2020, by which time the Secretary of State has indicated that he expects there to have been a measurable reduction?

We welcome the announcement from 13 November of a £4 million investment in equipment and training and the establishment of a new system enabling staff to review and learn from every stillbirth and neonatal death. The Government have signalled their intention to review every one of those tragedies, and I would appreciate it if the Minister could update us on how close we are to reaching that target, and when he expects it to be met.

One of the key themes that has emerged today and in the debate we had last year is that we have some of the finest neonatal care in the world in this country, but that there is simply far too much variability between hospitals and regions. In my role as an Opposition spokesperson I have had the pleasure of visiting some excellent facilities, most recently those at Barnsley general hospital, where the commitment and attention to detail of the staff, based on listening to and valuing patients’ views, was particularly impressive. At this point, I think it is worth paying tribute to NHS staff who are tasked with helping families at their most difficult time for the sensitivity, understanding and professionalism that they show.

The hon. Member for Colchester raised the issue of bereavement suites being available in every maternity unit in this country. If we had the same quality of care that I saw in Barnsley throughout the country, that would be a real achievement. We need to see those units that currently offer the very best care spreading their expertise across the country, so that everyone can have the very best throughout their pregnancy. Attempts to achieve that have begun. In March, NHS England published new guidance, building on existing clinical guidance and best practice. It identified four key interventions, with the aim of meeting the Secretary of State’s ambition to halve the rate of stillbirths by 2020. Those key interventions are reducing smoking in pregnancy, enhancing detection of foetal growth restriction, improving awareness of foetal movement and improving foetal monitoring during labour.

It has been estimated that if no women smoked during pregnancy, 7.1% of stillbirths could be avoided, which would equate to around 230 additional babies surviving each year. Smoking and passive smoking increase the risk of infant mortality by an estimated 40%. However, despite those startling statistics, we have seen a significant cut in public health funding, leading to around 40% of local authorities cutting budgets for smoking cessation services. Only last week I saw two pregnant women smoking on the same day. While I appreciate that that is anecdotal, it nevertheless brought home to me that we are certainly not making the inroads that we should be into cutting smoking during pregnancy. As the hon. Member for Colchester said, one in 10 women still smoke during pregnancy, which is startling, given the huge amount of evidence about the risks of doing so. We clearly need to do more to get that message across. If the key interventions are to be effective, cuts to public health budgets will not help in achieving that aim.

I have no doubt that the other suggested interventions will also help us to drive down rates of infant mortality. However, as the Royal College of Nursing has pointed out, England remains 2,600 full-time midwives short of the number it needs. We simply must have the correct level of staffing if we are to successfully implement that guidance. There are also serious issues in the levels of other clinical staff in neonatal units. The report published last year by Bliss, “Hanging in the balance”, argues that neonatal services are “stretched to breaking point”. It also states that two thirds of neonatal intensive care units do not have enough doctors and nurses, with around 2,000 more nurses needed to fill that gap. A report by the Royal College of Midwives also stated that more than 40% of wards became so busy last year that they were forced to close their doors. The average unit closed its doors on five occasions, with some closing more than 20 times.

Worrying reports this week also suggest that staff shortages and increasing demands are impacting on the ability of midwives and maternity staff to provide care. A survey by the Royal College of Midwives found that 62% of midwives and maternity support workers felt dehydrated at work because they did not have time to have a drink; 79% did not take the breaks to which they were entitled; and 52% had witnessed an error, near miss or other incident in the past month. Given the impact of current staff shortages, I question the proposal to replace bursaries for nurses and midwives with student loans, as I believe that is a risk we cannot afford to take at this stage.

The Universities Minister has confirmed that, since the tripling of tuition fees in 2012, the number of student nurses over the age of 25 has plummeted. Given that the average age of nurses and midwives in training is over 25, I have serious concerns that, for all the good intentions we have at the moment, we will not have the resources and staff to deliver the improved outcomes we all want to see. Areas such as neonatal care, which are already stretched, need more support, and I therefore invite the Minister to reconsider the current policy.

I conclude by focusing on the families who experience bereavement when their baby dies during or after birth. It is difficult to contemplate what they go through when what should be a time of joy and celebration becomes a period of tragedy beyond measure. Again, I pay tribute to the compelling way hon. Members have expressed their experiences. They have certainly given us all an awful lot to consider. What has made many people’s experiences even more difficult is that speaking about the loss of a baby has, as many Members have said, traditionally been considered taboo. Families have often felt they have nowhere to turn for help, or even to talk about it. The fact that Members have had the courage to talk about it today will help us challenge that taboo, and along with Sands awareness month, we will be able to make progress in making sure that we can talk about these issues openly and give a voice to those who have experienced the personal tragedy of the death of a baby.

I hope the great sincerity and passion with which Members have spoken will lead to a redoubling of efforts, not only in terms of neonatal care and tackling public health issues but in ensuring that we listen to the experiences of people who have gone through this, so that families get the support they need at the point of such a personal tragedy. They deserve the best possible bereavement support from highly trained professionals, and we should do everything in our power to ensure they are offered nothing less than the very best.

Diabetes-related Complications

Justin Madders Excerpts

Tuesday 7th June 2016 Westminster Hall

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

I congratulate my hon. Friend the Member for Dewsbury (Paula Sherriff) on securing this important debate and on the eloquent and powerful way she set out the issues in her opening speech. Several hon. Members have echoed what she said, and I will no doubt repeat it to an extent. After just a year as an MP she has established herself as one of the most effective campaigners in this place, and she is a passionate advocate on a range of issues—particularly public health matters. She spoke of her visit to King’s College with my hon. Friend the Member for Heywood and Middleton (Liz McInnes), and described the excellent care there, as well as mentioning the fact that, sadly, that experience is not replicated throughout the country. She highlighted the cost of diabetes and described education as a missed opportunity to reduce complications. That is a theme that has come through in several of the contributions today.

I also want to mention the contribution from the hon. Member for St Ives (Derek Thomas), who made a powerful point about what kind of future the next generation is heading towards, if we do not put more focus on the issue now. He gave us constituency-specific figures on amputations. I wonder whether all hon. Members would be interested to find out the specific figures for their constituencies. They really bring the issue home. I agree with the hon. Gentleman that the matter should not just be left to CCGs, and that there is a need for more co-ordinated national support. He was also right to say that we should aim to reach the point where amputation is seen as a failure and an exception.

My hon. Friend the Member for Islwyn (Chris Evans)—I hope that is the right pronunciation of his constituency—

[Chris Evans]

Someone once said it as “insulin”.

[Justin Madders]

We could have been forgiven for making that error today, but we will talk more about pronunciation afterwards. My hon. Friend spoke with great sincerity about the benefits for children of taking part in sport, and about how once they get into it they can enjoy the physical activity. I know from experience that dragging kids off the Xbox can be a difficult challenge, but once they actually get out there they enjoy themselves, and that contributes to a healthier lifestyle. He also made a valuable point about the world of work, in that so many more jobs are now sedentary in their nature. Of course, a healthy workforce is a more productive one, and productivity is a challenge for the whole country.

My hon. Friend the Member for Heywood and Middleton spoke with great experience of health. It was great to hear that she had been inspired by her visit to King’s College. She spoke about the national diabetes audit, and the importance of using the data collected to drive improvements. Again, she highlighted the need for more education. It was interesting to hear that some of her constituents have difficulty attending some education courses because employers are not agreeing to give them the time off. It will be interesting to hear the Minister’s reflections on that and it comes back to the point about a healthy workforce being a more productive one. We really need to get that message across to employers.

The hon. Member for Inverclyde (Ronnie Cowan) spoke about his family’s experience and gave us a useful personal insight into the everyday challenges faced. We can all reel off the figures but hearing from someone who has had a close relationship with the condition for a considerable length of time brings home some of the practical challenges that people face.

There is a consensus, as the hon. Member for Linlithgow and East Falkirk (Martyn Day) said. All hon. Members acknowledge that diabetes is one of the most significant healthcare challenges, given the impact that it has on NHS resources and, more importantly, the impact it has on people. We heard very powerful details of that today.

To put the condition in perspective statistically, 45 people in the UK will have been diagnosed with diabetes in the time it takes to complete today’s debate. In that time, one person will have undergone a diabetes-related amputation and four people will have died prematurely due to diabetes-related complications. According to figures produced by Diabetes UK, there are currently 4 million people living with diabetes in the UK, of whom 549,000 are undiagnosed.

The number of people with diabetes is increasing, as various hon. Members have said, and it has more than doubled since 1996. More than doubling the number of people with any condition in 20 years is bound to lead to serious questions about how our society is operating. Indeed, several hon. Members have given some good examples of the challenges we face. Part of our role is to question and support, where possible, how the Government respond to those challenges, particularly when we are talking about something that can be preventable. The level of interest shown by hon. Members today shows that there is at least recognition and agreement that the issue demands significant attention.

The number of people with a diagnosis is huge, as is the cost to the health service. The NHS now spends about £10 billion on diabetes each year, which is equivalent to about 10% of its budget, and £8 billion of that is estimated to be spent on complications, which, as we have discussed, are largely avoidable. Diabetes is an important issue to tackle at any time but, when we have such financial pressures on the NHS, it becomes even more pressing to really get on top of trying to avoid the complications it can cause.

At the heart of the issue are the people involved. Although many are able to manage their diabetes effectively, it is still a life-changing condition that has an impact on those living with it on a daily basis. We heard from the hon. Member for Inverclyde about how it really has an impact not only on the individual, but on their family. For somebody with type 2 diabetes, managing their condition means learning how to treat it with diet and exercise, and possibility coming to terms with the need to take medication and insulin. For someone with type 1 diabetes, it means constant diet management and carefully working out the correct amount of insulin to take. However, for everyone living with diabetes, it means being aware of the potential complications that can occur, and keeping a careful watch not only on blood glucose levels, but on cholesterol, weight, blood pressure and the conditions of eyes and feet.

Put simply, living with diabetes means becoming an expert on the condition. Despite that, less than 2% of newly diagnosed individuals with type 1 diabetes, and just 5.9% of those newly diagnosed with type 2 diabetes, attend a diabetes education course, which is a theme that has been mentioned by various hon. Members. Those figures alone are disappointing, but they are even more so given that there is clear evidence that the courses reduce the risk of individuals developing complications, and given the fact that a worrying 69% of people say that they do not fully understand their diabetes. The very nature of the condition means that self-management is the only practical way to reduce the risk of complications.

We welcome the publication of the Government’s new improvement and assessment framework for CCGs, which will assess CCGs on the attendance of structured education schemes and on the NICE recommended treatment targets. Will the Minister tell us what steps the Government are taking to improve access to diabetes self-management education, what steps she envisages taking against CCGs that perform poorly in the improvement assessment framework, and what support will be available to those identified as poor performers in order to bring them up to what is considered best practice?

[Mr Jamie Reed]

Does the shadow Minister agree that some consideration ought to be given to the funding allocation for CCGs with particularly large concentrations of people with type 2 diabetes, which is, after all, linked to obesity and lifestyle, especially considering that obesity is increasingly statistically linked—there is a clear correlation—with the incidence of poverty and socioeconomic disadvantage? Does he agree that CCGs with those significant populations should have their funding allocation reviewed?

[Justin Madders]

I agree that that needs due consideration. In some written answers, the percentages of people with diabetes per constituency are shown, and there are some definite peaks and troughs. If we are to get the issue under control, we must think more strategically about where the resources are put.

At the moment, a third of CCGs do not commission specific courses, which is contrary to national guidance. I hope that the Minister will be able to tell us what she will do to try to end the current postcode lottery. One of the most convenient and effective sources of education for many people with diabetes is their local pharmacy. There is a need—possibly, a demand—for expanding the role that pharmacies play in supporting people with diabetes. What are the opportunities and possibilities for thinking again about the Government’s plans to slash the community pharmacy budget, which may lead to the closure of up to 3,000 sites?

More significant than the variation in education is the variation in the levels of care and support offered depending on location, the age of the patient and the type of diabetes. There is evidence of markedly different routine care throughout the country, which has a huge impact on the quality of life of diabetics, as well as being costly to the NHS. One in six people in hospital has diabetes, yet one in three hospitals has no diabetes specialist nurse. The national diabetes in-patient audit paints a worrying picture of the variations in the way in which the condition is managed by hospitals, and the unacceptable number of in-patients suffering avoidable complications.

Some of the most serious diabetes-related complications are avoidable amputations and foot ulcers. We have heard that £1 in every £150 that the NHS spends is in that area, and such action has a dramatic, life-changing impact on individuals and their families. As my hon. Friend the Member for Dewsbury said, in 2013 the Health Secretary committed to reducing the rate of amputations by 50% in five years. Will the Minister tell us what progress has been made towards achieving that goal, particularly given that Diabetes UK has said that no progress has really been made? Will she confirm that she still hopes to meet that target?

NICE recommends that all people with diabetes undergo an annual foot check but, in the worst performing CCGs, one in four people are not receiving a foot check at all. Part of the reason for that is the shortage in the number of podiatrists, particularly following a recent reduction in the number of students from 361 to 326. I am concerned that the plan to scrap bursaries for podiatry students and to push them into about £50,000 of debt will make the situation even worse. I ask the Minister to reconsider the direction of travel on this policy. Will she advise us what assessment has been made of the likely number of podiatrists who will be trained each year under the new funding regime?

I will close by making a few remarks about prevention. As I said at the beginning of my speech, the number of people suffering from diabetes continues to rise. The primary driver of that is, of course, lifestyle. Some 11.9 million people are currently at an increased risk of developing type 2 diabetes as a result of their waist circumference or weight. Two in every three people in the UK are now overweight or obese. As other Members have said, people might not necessarily feel that that relates to them, but we must reflect on those figures. Obesity accounts for 80% to 85% of the risk of developing type 2 diabetes, and therefore we need to focus on education and treating the condition. The main strategy to address the prevalence of type 2 diabetes has to be to address the rise in obesity, particularly at a young age, as the hon. Member for St Ives said.

We welcome the Government’s announcement of a sugar tax in the Budget, but that measure will only be effective as part of a wider strategy to address childhood obesity. I do not know whether the Minister will be able to tell us, but what is holding back the publication of the strategy? Is there disagreement on what will be in it? Is it at all possible for her to give us a date for when it will be published? [Interruption.] I suspect I have my answer from the grin on her face.

Both sides of the House are alert to, and supportive of, the need to get on top of this challenge but, as with all such matters, the Government will be judged by the results, on which we will keep a close eye in the coming years.

Oral Answers to Questions

Justin Madders Excerpts

Tuesday 10th May 2016 Commons Chamber

[Ben Gummer]

It depends of course on the career progression of that particular nurse, but the repayment terms will be precisely those for students of other degrees. Newly qualified nurses will not pay any more than they do currently, and the exact rates at which they will pay back—9% above £21,000—are outlined carefully in the consultation document. I recommend that the hon. Lady looks at it and sees the benefits that will come from the reform that, were it to be adopted in Scotland, would provide an enormous benefit to the service north of the border.

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

I start by congratulating the Secretary of State on becoming the longest serving Health Secretary in history. It is an important-landmark, not least because it is the first target that he has managed to hit.

On NHS bursaries, last week the Minister said that

“more mature students are applying now than in 2010.”—[Official Report, 4 May 2016; Vol. 609, c. 197.]

However, a written answer given to me yesterday by the Minister for Universities and Science appears to contradict this. Indeed, it shows that numbers of mature students have fallen in the past five years by almost 200,000. Given that the average age of a student nurse is 28, and in the light of the clear evidence from his own Government, will the Minister correct the record and commit to looking again at the impact of these proposals on mature students, who form a significant part of the student nurse intake?

[Ben Gummer]

I, too, as I know will all my ministerial colleagues, congratulate my right hon. Friend the Secretary of State on a remarkable tenure in his post.

It is clear that mature student numbers dropped immediately after the higher education reforms, but they then started rising and have now exceeded the rate before the reforms. I am happy to give the hon. Gentleman the details of that. We are also clear that we need to nurture mature students, which is why the consultation asked the specific question that it did. We want to invite answers from the service about how best we can do that because we are clear that the current system is not working as well as it should.

NHS Bursaries

Justin Madders Excerpts

Wednesday 4th May 2016 Commons Chamber

[Ben Gummer]

It is precisely to help my hon. Friend’s hospital that we are introducing these reforms.

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

The Minister said there was no alternative to these proposals. Which of the royal colleges did he consult before coming to that decision?

[Ben Gummer]

Contrary to what the hon. Member for Lewisham East said, I did consult the royal colleges. I have spoken at length with the Royal College of Nursing and with Unison. As I would expect, we differ on key parts—though not every part—of the plan, but the royal college’s initial response accepted that the premise on which we were proceeding was, in significant part, correct. In the consultation, I want to find areas we can agree on and improve the proposals we have put before the public. We were open about the consultation and offered the full 12 weeks—many people said we would not do so, but we did—precisely so that we could listen to the concerns, proposals and exciting challenges from people across the sectors, and thereby improve the proposals we have put before the NHS.

The motion suggests a series of things, but not a proposal from the Opposition to do anything different. They are not offering the NHS any new money—they offered £4.5 billion less than we did at the last election—so I can only presume that the money would have to be found from cuts elsewhere in the service. The hon. Lady will have no credibility unless she tells the House that she will pay for the 10,000 additional training places out of taxpayers’ money, rather than by finding an alternative funding mechanism. I will not offer the House a series of suggestions that might or might not be better, or merely criticise proposals, rather than offering constructive improvements.

--- Later in debate ---

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

This has been a high-quality and comprehensive debate. I have to say that I have a small amount of sympathy for the Minister for Community and Social Care, because, as we all know, this policy was not devised in his Department, but hastily put together on the back of a fag packet somewhere in the Treasury following the Chancellor’s £2 billion raid on the Department of Health budget. It looks very much like a case of “Cut first and ask questions later.” I say that because in just two lines of the autumn statement, with no consultation and no evidence base, the Government have committed themselves to a huge gamble with the future of the NHS workforce and with patient safety.

I pay tribute to my hon. Friend the Member for Ilford North (Wes Streeting) for leading the campaign with his early-day motion. His record in this area is unparalleled. He explained expertly why many student nurses are in a different position from that of other students, and expressed the concern that he and many other Members feel about the deterrent effect that the Government’s proposals will have on future numbers. Other Members spoke in similar vein, including my hon. Friends the Members for Manchester, Withington (Jeff Smith) and for Coventry North East (Colleen Fletcher), as well as my hon. Friend the Member for Scunthorpe (Nic Dakin), who pressed the Minister on what estimate had been made of the number of loans that would be written off. He did not receive a reply; I trust that the Minister for Community and Social Care will be able to fill in the details.

My hon. Friend the Member for Wirral West (Margaret Greenwood), who came to this place with a strong reputation as a health campaigner, spoke with great authority about the pitfalls of the proposals. My hon. Friend the Member for Cambridge (Daniel Zeichner), who also has great experience in this area, asked a very pertinent question about the capacity of the health service to take on the extra students. The Chairman of the Health Committee, the hon. Member for Totnes (Dr Wollaston), made an important contribution, and I hope that the Minister will respond directly to some of the very real concerns that she raised.

The Government are presiding over the worst A&E figures since records began, the biggest financial crisis in the history of the NHS—three quarters of trusts are now in deficit—and a crisis in morale across the workforce, with a Secretary of State too belligerent to listen. They have already alienated a generation of junior doctors, and now they risk doing the same for our future nurses and midwives, as well as many other health professionals. Why are they looking to unsettle a huge section of our NHS workforce at a time when good will is more important than ever?

We have several concerns about this policy, many of which hon. Members have aired today and to which the Government are yet to give any credible answer. First, let us look at the actual problem the proposals are trying to address—not the black hole created by the Chancellor but the shortage of nurses in the NHS. Be in no doubt, the Government are entirely responsible for that shortage, because they decided to reduce the number of nurse training places. Had they maintained the level set by the last Labour Government, 8,000 more nurses would have been trained in the last Parliament alone. When we hear, therefore, about spiralling agency costs and staffing shortages, let us remember the cause—not the nurses, the trusts or the patients, but the Government’s chronic mishandling of the NHS.

The proposal, with all its risk and uncertainty, will, in the Government’s most optimistic scenario, deliver 10,000 more nurses, midwives and other health professionals. When they say the proposal could deliver up to 10,000 more staff, they really are looking at the glass half full. The figure comes with so many caveats that, if it were a used car, I would not even take it for a test drive. The Government’s own equality assessment acknowledges that there could be an adverse impact on parents and carers and that childcare costs could have a significant influence on participation. It is worth picking up a few quotes from their impact analysis and evidence document, to get a flavour of just how flaky the proposal is. It says that the

“precise impact is difficult to estimate with certainty”,

that

“Behavioural change is uncertain”,

that

“there may be some uncertainty over applications in the very short term”

and—my favourite—that there

“is no robust set of information to make this assessment.”

In other words, the Government are saying they have done an assessment but have absolutely no idea what the impact of the policy will be. If that does not amount to a huge gamble, I do not know what does.

If the Government will not take heed of their own assessments, they might listen to the Royal College of Nursing, which has said that

“there is a risk of people being put off from applying to nursing degrees, because of concerns over debt.”

It, like many Members, is particularly concerned about the impact on mature students. As we have heard, the average age of a student nurse is 28. The RCN has said:

“There is a worrying lack of assessment of the potential for the changes to act as a disincentive for some students, such as mature students or those from lower income backgrounds.”

Research by the trade union Unison shows that nine out of 10 student nurses surveyed said they would not have gone into training had the new proposals been in place. That is not a trivial number. If the numbers put off turned out to be even half that, the implications for the NHS would be catastrophic. So where is the evidence to reassure us that it will not happen? There is not any. The Minister prays in aid the experience across the general higher education sector, but he knows that he is not comparing like with like. The evidence from the mature student experience does not support his case. In fact, the Higher Education Statistics Agency says that between 2011 and 2015 the number of mature students fell by 17%.

Let us be clear about what the policy really means for nurses. Owing to the Government’s reprehensible decision to freeze the student loan repayment threshold at £21,000 from 2017, all future nurses are facing a real-terms pay cut. According to Unison, based on current salaries, the average nurse, midwife or allied health professional will lose over £900 a year to meet their debt repayments. Staff retention is a huge issue across the NHS, including in nursing, and as the hon. Member for Morecambe and Lunesdale (David Morris) rightly pointed out, the Government’s record is poor. Saddling nurses with extra debt will only make the matter worse.

[David Morris]

I did not say that the Government’s record was poor; I pointed out that we needed reform, which is what we are here to discuss. I am disappointed in the hon. Gentleman’s approach, because we have had a very constructive debate today.

[Justin Madders]

I thank the hon. Gentleman for his intervention. If he is stating the facts, then I interpret them as being a poor record for the Government; that is more about the facts than about the way in which he presented them.

Let us be clear: we are talking about a debt that nurses are never likely to pay off. They will graduate with debts of between £50,000 and £60,000. Many of the mature students who take nursing as a second degree will find themselves with more than £100,000 of debt. Let me repeat that figure so that it sinks in: our country is looking down the barrel of a policy that will saddle nurses with a six-figure debt. They are not bankers or lawyers; the people who keep the NHS going will be earning just a fraction of what they earn. We already have the highest level of student debt in the English-speaking world, which is not a record we should be proud of, and these proposals will only make matters worse.

It would be an error to put nurses into the same category as other students, but I think that the Government are making that error. Student nurses’ courses take up much more of the year, meaning that they have much less opportunity than other students to work while they study. They are also required to spend 50% of the time working with patients in clinical practice, including on evening and weekend shifts. That requires a real commitment of at least 2,300 hours over the length of their course, during which they do difficult jobs at unsocial times. Now the Government are asking them to pay for the privilege of doing that. This policy is like some kind of perverse extension of workfare. Last year, there were 10,000 unfilled nurse places in London alone. Is getting people to work for free really the answer to that?

The Government really need to raise their game to improve retention among nurses. The situation has been getting steadily worse over the past few years, and nearly 9% of nurses left last year. Some might have gone to work elsewhere in the NHS, but many have left the profession altogether. Surely sorting that out would provide a more effective solution to our problems than taking a punt on an untested plan. There appears to have been no dialogue with providers, who seem unaware of the oncoming rush. Each student nurse has to be clinically assessed by a registered nurse who has done their mentoring and assessing course, but no assessment appears to have been made of the capacity for trusts to take on those extra responsibilities.

It is clear that this policy, with all its flaws, was announced with no consultation, no engagement with the sector and no evidence basis. With such a high degree of uncertainty, surely it would have been sensible to consult on the principle before embarking on the policy. But not this Government; they know best, even though they do not seem to know their own record in this area. When I asked the Minister a simple written question on how many nurses had qualified in the last five years, I received the following response:

“The Department does not hold information on the number of nurses who qualified in the last five years”.

What an absolute shambles!

Anyone would think that with such a gap in the available evidence, the Government would have gone out of their way to undertake a full consultation and to seek out evidence before announcing the policy, but no. The Royal College of Midwives, the Royal College of Nursing, the Royal College of Podiatry and the Royal College of Speech and Language Therapists are all respected institutions with years of experience and a wealth of knowledge in this area, but not one of them was asked to make a formal input into this policy before it was announced, contrary to what the Minister has said today. When he was asked, in a Westminster Hall debate on 11 January, who he had consulted, he said:

“There has been consultation with leading nursing professionals.”—[Official Report, 11 January 2016; Vol. 604, c. 237WH.]

He said nothing about the royal colleges. I hope that we shall be able to clear this up. I ask him to tell us exactly who he did consult, and to place in the Library a copy of the advice that he received following the consultation.

Let us not pretend, now that the consultation has been published, that it is a meaningful consultation on the principle or the detail of the proposals. It simply asks a few technical questions on how to implement the changes. You can have any colour you want as long as it is black. It is frankly an insult to the public, to patients and to the profession. The Government should withdraw this proposal and instead commit to a full consultation on how to improve the support available to student nurses, how to increase the number of nurses in the NHS and how to improve retention. I urge all Members who genuinely care about the future of our health service, who have concerns about the potential deterrent effect of these proposals, and who are not prepared to gamble recklessly with our nurses, to join us in the Lobby today and send a clear message to the Government that it is time to think again. I commend the motion to the House.

[Christian Matheson (City of Chester) (Lab)]

Pick that one out of the back of the net!