Hospital Building Programme

Debate between Justin Madders and Mike Penning

Wednesday 3rd November 2021 Westminster Hall

[Justin Madders]

My hon. Friend probably needs to direct his pleas to the Minister more than me—at this stage, of course—but I would be delighted to visit the facility with him. I am sure that he will make a strong case for investment, as other Members have done. There is an issue with how the interplay works between some of the competing bids for what is obviously a very competitive process, which I will return to later. Like the hon. Member for Eddisbury (Edward Timpson), my hon. Friend the Member for Weaver Vale (Mike Amesbury) has shown that there is cross-party support for the case for a new hospital that was made by the hon. Member for Crewe and Nantwich, who also set out why this is good for patients. He talked about some of the issues around privacy, dignity and infection control, and he said that a new build gives us an opportunity to invest in modern digital infrastructure. Of course, he also mentioned important stuff to do with COP26 and the energy efficiency of a new build. Those were all well-made points.

We also heard from the right hon. Member for Hemel Hempstead (Sir Mike Penning), who made a persuasive and passionate case as to why the current plans need to be reconsidered. He made a very interesting point about the accountability of trusts. He is probably not aware that the Minister and I have been debating this issue in Committee for a number of weeks, and it is fair to say that we have differing views as to how accountable the current system is and whether it will actually change at all when the Health and Care Bill receives Royal Assent. There is an issue with how large trusts have their own priorities, which are not necessarily in tune with the rest of the wider population and healthcare system.

The hon. Member for North West Norfolk (James Wild) made a very strong case for the Queen Elizabeth Hospital in King’s Lynn; he highlighted the critical nature of the maintenance issues there, which are clearly having an effect on patient care now. The Minister will not be surprised to know that I will be referring to the maintenance backlog during my comments today. The hon. Member also set out very well how new builds can not only improve infection control, but enhance the patient experience. We should always remember that the patient journey is central to these things. A new hospital always has to have the interests of patients, and their perspective, at the heart of its plans.

The hon. Member for Keighley (Robbie Moore) made a strong case for why a new hospital is needed in Airedale. Again, it is a building that is past its original lifespan; it has critical infrastructure issues. Describing it as the “leakiest hospital is the UK” is not something the hon. Member will want to repeat for much longer. It shows again that many of these issues have been building up for some time.

I was very interested in what the hon. Member for Hartlepool (Jill Mortimer) said about health inequalities; it was an important point, and perhaps a broader one than some of the others that have been made. She is absolutely right that the pandemic has shone a light on the existing health inequalities in this country. I agree that if we are serious about levelling up, reducing health inequalities has to be central to any policy.

The right hon. Member for Basingstoke (Mrs Miller) made a compelling case about how investment is needed for her new hospital, and how the change and growth in local population has created additional demand. It is an important point that, because of the way that her town has built up, there is more demand from an increasingly ageing population.

All the Members have made very good cases today; if it was based on the commitment and passion of individual Members, the Minister’s job would be quite straightforward. However, I know there will be many other demands on the departmental budget. There is a serious point here. We need to have transparency on the criteria that will be applied when the decisions are made. It would be fair to say, if we look at levelling-up bids, there has been some consternation that the decisions are not always made on the merits of the case. It is important that the Department is crystal clear on why particular projects are getting the go-ahead, and why others may have to wait a little longer.

I am sure that the Minister would be disappointed if I did not make a reference to whether the Prime Minister’s claim to be building 48 new hospitals is in fact an accurate one. We take with a large pinch of salt the definitions from the Department’s playbook that the following count as a new hospital: they say this includes

“a new wing of an existing hospital (provided it contains a whole clinical service, such as maternity or children’s services).”

They also say this includes

“A major refurbishment and alteration of all but the building frame or main structure, delivering a significant extension to useful life which includes major or visible changes to the external structure.”

That may well be investment in buildings—which is of course welcome—but it stretches credibility to say that those are new hospitals. I will not repeat the whole debate again on whether those descriptions can be classed as new hospitals, except to say that the Minister will no doubt rely on his VAT notices to reach that figure of 48: we will rely on the good sense of the British public to judge whether a new hospital is indeed a new hospital. When we get to 2030, we will see how many new hospitals we actually have—although it is possible that both the Minister and I will have moved on by that point.

Let us return to the present day, move away from the headlines and the spin, and ask some specific questions about the programme. I will start with the cost issue. It is my understanding that the projects identified in phase 1 have been promised a total of £2.7 billion, although some reports suggest that a £400 million price cap is being applied to each scheme, even though some of the published plans for those schemes have exceeded that limit already. Could the Minister comment on whether there is in fact an upper cash limit on particular projects, and whether it is indeed £400 million?

Almost exactly a month ago, the Prime Minister made an announcement on round 2 of the health infrastructure plan, in which, incidentally, only three out of the 25 hospitals are in the whole of the north of England. I think that says something about the Government’s commitment to levelling up and bolsters the case made by the hon. Member for Crewe and Nantwich to push forward for a new building in Crewe. Could the Minister advise what period and how much of the total programme the £3.7 billion mentioned in that announcement covers? Could the Minister also advise if the £4.2 billion, announced in the spending review last week in relation to new hospitals, is the same money as the Prime Minister announced on 2 October or is in addition to that? If it is additional, what period does that £4.2 billion cover? We want a little clarity on how much has actually been allocated and the period that it covers. I am sure the Minister realises that, even if we add up all those figures, it would not be the total cost of all those projects moving forward to 2030.

We have had three separate announcements over the last year. I make that point because the foreword to the health infrastructure plan talks about ending the “piecemeal and uncoordinated approach”. We have an investment plan spanning a decade, but the necessary investment has been announced for only the first half of that decade, at best, to come out in dribs and drabs. I suggest that the Minister might need to read the foreword to the plan again to see whether the ambitions set out there are being met.

NHS Providers has said that the actual cost of the planned building projects would be around £20 billion, most of which will need to be found in the next few years. Even building an average-sized new hospital costs around £500 million, which rather puts the spotlight on the supposed £400 million cost limit I referred to earlier. I wonder if the Minister could put a total cost—

[Sir Mike Penning]

I think we have to be slightly careful when referring to costs such as that £500 million. Built into that is inflation, because of the way the Green Book works, because of the risk. I had to deal with this on the roads programme as roads Minister: what happens is that a figure is set out, but it is not the same as the actual cost of the build project. That is probably where some of that cost anomaly comes from. The Treasury Green Book insists on inflation of that price when the build price is much lower; in my case, £500 million was £420 million in the Birmingham build. We have to be careful of trusts that do not want to do that; for example, my trust—the West Hertfordshire Hospitals trust—inflates the cost into £600 million because it does not want to do it.

[Justin Madders]

I will reflect on the right hon. Gentleman’s comments. That leads on to another point I wanted to raise with the Minister: we are aware that the economy is currently in something of a flux in a whole range of sectors, in terms of finding the right people and the right skills, and construction is not immune to that. Do the plans include any wiggle room to take account of the fact that the cost of labour and materials is unfortunately going up quite rapidly at the moment?

NHS Providers said that

“there are still significant questions on whether the NHS will be able to meet the government's manifesto pledge to upgrade 70 hospitals and build 40 new ones given the lack of clear, long term, funding commitments beyond 2024/25.”

It also said that it awaits

“confirmation of the money that will be available to providers to tackle the £9.2bn maintenance backlog that has built up.”

The Minister will know that that has shot up in recent years, leading to cancelled operations and a 23% increase in treatments being delayed or cancelled in the last year because of infrastructure failures, and yet we are hearing very little on what is being done about that. I think the hon. Member for Eddisbury mentioned something in the region of £400 million being identified as the maintenance backlog costs at Leighton Hospital alone. We have also heard from other Members on infrastructure issues causing difficulties in their own trusts.

These problems are not new; they are the result of a decade of underfunding on both capital and revenue, with the Health Foundation reporting that

“the UK is investing significantly less in health care capital as a share of GDP compared with most other similar European countries.”

Of course, we have also seen frequent revenue raids on capital in the last few years. If these plans are to be successful, those raids must stop. I hope the Minister will be able to guarantee that there will be no revenue raids on capital for this programme in the next decade. I would also be grateful if he could set out the Department’s plan to tackle the maintenance backlog.

A few moments ago, I mentioned the interplay between large infrastructure projects and other capital requirements at a system level, particularly around how we get capital investment into primary and community care. Taking my own patch, Ellesmere Port, which I know best, we have several GP premises in the town centre that are past their best—past their useful life, perhaps—they are not really suitable in these covid-conscious times. We are not short of more modern, available premises in the town centre, where there might even be greater potential for integration with other services

However, these projects take time and money, and some decision must be taken at a system level to prioritise them. I think that would be an important step forward for improving access in my community and dealing with some of the health inequalities we have talked about. I recognise that sometimes it is a fact of life that the bigger players—the acute trusts—will always be higher profile than individual practices for attracting funds and investment. In many ways, this is an echo of the debate that the Minister and I have had in recent weeks on the Health and Care Bill Committee. I mention it again because, particularly with capital investment, there is a danger that primary and community services will struggle to have their voices heard against some of the bigger players in an extremely large integrated care system.

I will end with a few comments from stakeholders regarding the Chancellor’s statement last week. The King’s Fund said that

“the real game changer would have been clear funding for a workforce plan. Chronic workforce shortages across the health and care system heap further pressure on overstretched staff who are exhausted from the pandemic. Yet despite pledges, promises and manifesto commitments, the government has failed to use this Spending Review to answer the question of how it will chart a path out of the staffing crisis by setting out the funding for a multi-year workforce strategy.”

The Health Foundation said that

“new money for technology and buildings, although vital, is of limited value without additional staff. A workforce plan backed by investment in training are critical and we await details of both so that the NHS’s recovery can be secured.”

The Nuffield Trust said:

“It is striking that there is a lack of strategic workforce investment alongside this boost in funding for facilities. Staffing is recognised as the number one issue for the sustainability of the health service. Recovery from the pandemic not only rests on investment but on hard-working staff as well.”

Finally, the NHS Confederation said that

“to ensure the extra money delivers for the public, a strong and supported NHS workforce is needed. This is why training and increasing the supply of doctors, nurses and other health and care professionals is so important at a time when public polling recognizes that staffing is the biggest problem facing the NHS.”

While we welcome the investment in new buildings, we hope that none end up being a white elephant, because the elephant in the room is that we could find ourselves in the remarkable position by 2030 that brand new hospitals, extensions, or refurbishments are delivered, but are not fully operational because of a failure over the preceding decade to tackle the workforce crisis. That is here and now, and it needs to be tackled in the short, medium and long term. That is the final plea I make to the Minister: these investments are welcome, but we must ensure that we have a plan so that these buildings are fully staffed when they are up and running.

Police Procurement (Motor Vehicles)

Debate between Justin Madders and Mike Penning

Thursday 16th July 2015 Westminster Hall

[The Minister for Policing, Crime and Criminal Justice (Mike Penning)]

Mr Brady, it is a pleasure, as usual, to serve under your chairmanship in my first Westminster Hall debate in the same role as I had in the previous Government, but doing more. The Prime Minister kindly inserted the word “Crime” into my portfolio—a short five-letter word that means I have apparently taken over most of the rest of the Home Office.

I congratulate the hon. Member for City of Chester (Christian Matheson). It is a beautiful city; I know it well. It is a long time since I was there, so perhaps I need to go back soon and go out on patrol. The hon. Member for Ellesmere Port and Neston (Justin Madders) also spoke in the debate. As a young fireman I did a bit of moonlighting in the Port Sunlight area, delivering quite a lot, and I used to drive through that part of the world regularly—well, I tried to drive, but it was like a car park on the motorway most of the time.

Anybody who knows me will know that I am ever so slightly Eurosceptic, so I have a great deal of sympathy with what has been said in this Chamber this afternoon. As a Minister with experience in five Departments now, I assure colleagues that I have pushed the parameters as far as I can when it comes to what I perceive—and what I am sure the Government perceive—as incorrect interpretation of EU regulations. My advice is that many of the things that Members have been asking be done—I will ensure that I check this when I write to them—are illegal under the EU procurement directive. Even looking at the matter again in 2015, as Members have mentioned, that would have made no difference to the geographical part of the procurement process. If I am wrong, I will certainly write to colleagues to correct it, but that is the advice I stand here with as a Minister.

[Justin Madders]

On the lawfulness of the process, is the Minister aware of any judicial testing of how the system operates in other European countries compared with our own?

[Mike Penning]

As a Minister in the Home Office and the Ministry of Justice, I would not want to take on other responsibilities, but I promise to made sure that we look into that and get the facts on how other countries do it. Other countries interpret their membership of the European Union differently. I have committed infractions on more than one occasion in more than one Department, because my interpretation was different both from what my officials were pushing me to do and from the interpretations of courts in Europe.

If I was sitting on the Opposition Benches—I have sat there—I would be arguing for similar things. Whether we can physically do those things and how we get to the position where we can do them are important. To be honest, a Select Committee could look at this in procurement terms, so that we can be open and honest about what we can and cannot do. I thank the shadow Minister for his comments; we have come a long way in the past couple of months. We disagree that there should be a centralised purchasing system. We have freed up the police authorities to police their areas in the way that they feel they should. The police are doing fantastic work in Cheshire: crime has dropped with fewer police officers and less money, and the situation is exactly the same with West Midlands police.

One point that the shadow Minister and I agree on is that there is money to be saved in procurement. There is no argument about that; I was banging on about that long before I came into the House. As a fireman, I used to complain bitterly about the money that we spent. There were cupboards full of stuff bought 15 years before; it was sitting there and would never be used. I am desperately trying to push that spending down. To be fair to the PCCs and the chiefs, they are coming to the table. We created the PCCs to be independent and to be able to do what they want, and all I have said to them all along is that there has to be value for money. Some of them have clearly said to me, as Members have in this debate, that if they can buy locally, that should outweigh a little of the cost that they could have saved if they had got it cheaper elsewhere, and I understand that point. There are, however, huge differentials in what forces are paying, not only for cars, but for batons, shirts, fleeces and trousers. They are so huge that I have decided in the next couple of weeks to publish by police force the main things that they buy, so that the public can see what their force is spending in their area. We will make that information available, including for Cheshire, West Midlands and Leicestershire.

I was a tad cheeky in saying that Leicestershire was not part of the consortium of 22 police forces that has done the recent review. The West Midlands force, sadly, is not part of it either. I am sure there are reasons for that, and I am sure they will come to the party. We can get that 22 up, but it is not just about having all 43 forces. As we have heard, Police Scotland is part of the consortium, which is welcome as it helps us to get more bang for our buck, as are the British Transport police.

I will touch on the points raised on it being only Peugeot that won a contract, because it was not only Peugeot. BMW, Ford, Vauxhall and Peugeot were successful in the e-bid process that we have just come through. An interesting point was made about whether, when manufacturers have brought something else to the UK, that balances things out. That is similar to what the shadow Minister said about Italy buying 4,000 SEAT vehicles from Spain that were manufactured in Spain—some of the parts might have been produced here in the UK. We are a major exporter of car parts, and we should not underestimate that part of the system. BMW makes the Mini in this country, and that very successful product employs lots of people in Swindon. Sadly, Ford does not manufacture vehicles here any more. As a young fireman in Essex, I used to go to the Dagenham plant all too often—it was technically over the boundary, but we were often needed when there was an incident. The TCDI engine is a world-leading diesel engine that is exported all over the world. Some 80% of the vehicles manufactured in this country are exported, and Members have alluded to that great success story.

I must declare an interest: many of my constituents in the great constituency of Hemel Hempstead work in Vauxhall’s Luton van manufacturing plant, which is part of the consortium. Vauxhall vans will be with police forces, based on the process that took place, and Peugeot has also won a contract.

A new bidding process will take place this autumn. I am sure that Vauxhall, like many other manufacturers, will want to bid. Nearly every time I have visited a police force, I have been squeezed into the back of an Astra. The Astra is a bit of a Marmite subject for police forces. I love the Astra, and we have had Astras in our family, but colleagues who have been out on patrol will know that if there are two burly bobbies with all their kit and a burly Minister in the back, it can be interesting—but it does the job. Peugeot has won this contract, and I am sure that Vauxhall will be bidding for the other one.

What has happened here for the first time is economies of scale. I was a little bit cheeky by naming two forces that just happen to cover the constituencies of two of the most senior Members in Westminster Hall this afternoon. I am sure that there are contractual reasons for those forces not being in the consortium, because nearly all the chiefs I have met have said, “We’re going to be part of this. It’s very important.” I hope that forces join together at that level in other types of procurement. We see a lot of joint practice across different forces at the moment on HR and procurement in the IT sector. We have just announced a new IT company that will run the IT purchases for all 43 forces. I hope that Scotland will join us on that, because it would be brilliant to have an operable IT system. We need to work together on that with the National Crime Agency and organised crime units, and I will be working on it with Ministers in Scotland and Northern Ireland.

The key is having the right vehicles for the right people doing the right jobs. I first became a Minister back in 2010. I never dreamt that would happen to me, but it did. Having been a shadow Health Minister for four and a half years, the Department for Transport was really interesting on the first day. One thing I worked on was the Government car service. I am sure that colleagues remember the Mondeos outside Parliament over the years, then the Priuses and the Honda hybrids, but they have probably noticed that we do not see those vehicles out there any more—certainly not the Honda hybrids and the Toyotas. I made an absolutely conscious decision to buy the Avensis for junior Ministers, because they were assembled and manufactured in this country. There was not another compatible vehicle that could do the job—we tried lots of other vehicles: we had a Qashqai on loan for a considerable time, but it did not work; Hyundai sent us some vehicles, and I think one of them is still hanging around. I took a little bit of flack, but I wanted that pressure.

There are exemptions. For instance, the Metropolitan police wanted to use BMW armoured vehicles because they come off the production line armoured, whereas all other vehicles, such as the Jaguar, are retrofitted. I think we will find that the Prime Minister is in a Jaguar. It took a little while, but we got there in the end. I do not criticise the Metropolitan police for taking that time, because they wanted to keep people as safe as possible, but I want to ensure we have vehicles that create as many jobs as possible in this country, and I have a track record of trying to do that.