Capita Contract (Coventry)

Karin Smyth Excerpts

Tuesday 8th November 2016 Commons Chamber

[Mr Geoffrey Robinson (Coventry North West) (Lab)]

I thank the Speaker for granting this debate. It is timely, because while the issue has been raised by local GP practices and their senior managers in Coventry, I am well aware, following a gracious call from the Minister’s office and given the presence of other hon. Friends, that the problem has a wider significance and that it has echoes in many other parts of England, at least. I thank Jane Moxon and others who came to see me—all very senior practice managers in Coventry. They alerted me what is evidently a growing problem throughout the country.

The Minister, who is aware of the situation emerging across the country, kindly asked whether she should address the wider issue, or concentrate on Coventry. The topic of the debate is the impact on patient care and the health service in Coventry of the privatisation of the thoroughly well-executed existing service for GPs in our area. The same thing is happening in other areas, however, and I will be very happy to give way to my hon. Friends. Sufficient time is available—not that I want to detain you unnecessarily, Madam Deputy Speaker, or the Minister or other Members, but if there is interest, I am sure that we can accommodate others, such as my hon. Friends the Members for Coventry South (Mr Cunningham) and for Coventry North East (Colleen Fletcher); all three Coventry Members are properly on parade this evening to take part in the debate.

The position was very simply summarised by the senior practice manager from Broomfield Park, Jane Moxon, when she came to see me. She acted as chair for the group, and still does. Warwick University is in the same position: students from the EU face the loss, absence or lateness of their patient records. Allesley Park hosted our meeting; Kevin Arnold is the practice manager there. They have all alerted me to the fact that GPs are simply unable to do their job without having their patients’ records to hand.

An excellent manual service was provided under the national health service, but the Government were taken in by the lure of apparent savings and the prospect of cutting 40% from a £1 billion bill, and they contracted the work out to Capita, of all people. Only last week, we saw what could happen in the absence of a properly thought-through privatisation programme. These contracts are gaily handed out to companies that do not have the skills, preparation or sheer commitment necessary to provide the service.

[Karin Smyth (Bristol South) (Lab)]

I am grateful to my hon. Friend for initiating this debate. I have been contacted by my GP practices in Bristol South about this issue. In a previous role, I worked in a commissioning group and I have employed GPs. The arrangements for doing that are very complex, requiring specialist local knowledge and a lot of experience. Does he agree that the decision to put the entire service out to a national tender was driven by a desire to make massive wholesale savings, and that the savings target completely ignored the service need locally? Does he also agree that we are in a very poor situation across the country? I hope that the Minister can address that point.

--- Later in debate ---

[Mr Robinson]

I entirely agree with every single word my hon. Friend says. I would add, by way of a warning, that it is not a question of trying to punish the private sector by making it pay for this. Capita has to put the necessary resources into trying to correct the problem, and that must be its first priority. Something must give in the drive for profit, the drive to cut the costs of the services and the drive to improve the services. Those are irreconcilable objectives to start with, and in rectifying them the first thing that has to go is the drive for profit. Capita must realise that when it comes to put this right, it has to put the resources behind that. Compensation for GPs is important—I do not disagree with my hon. Friend for a minute on that—but I put it secondary to the provision of resources to get the contract right. I am sure that she would agree.

One other aspect of this shows an unacceptable, unpleasant and displeasing aspect of the privatisation process. It appears—I do not know this first hand—that Capita has turned to CitySprint to deliver these things. The effect of that is that we are employing drivers with no contracts, no sickness benefits and no breaks. This continual turning of the screw downwards is leading to a low-wage, low-productivity, low-output and impoverished economy. The workforce is suffering from that and it seems to be characteristic in many areas. For the public service to be involved in that process and almost to accelerate it, tightening that screw, is unacceptable.

This is another aspect of the commitment to negotiation and to the evaluation and validation process. The Government must learn to consider the quality of the service being provided and the quality of the means by which they intend to provide that service. CitySprint does not measure up to the standards we would expect from a good public sector contractor or employer.

To return to the main theme of tonight’s debate, what do we learn from this? The Government—principally the civil service, but Ministers, too—must learn to evaluate and validate the process of contracting out services. They cannot be driven by short-term savings, which are invariably illusory, but must consider the quality of the underlying contract. That is an art that must be learned, but I think it can be.

[Karin Smyth]

My hon. Friend is being generous with his time. I do not know whether he is aware that the Public Accounts Committee recently held an evidence session on the contract awarded to UnitingCare in Cambridgeshire. Many of the issues he has rightly outlined about the scoping of such contracts and expertise within the NHS were highlighted, particularly as regards whether the expertise was there to do the sort of detailed and specialist work he mentions. Should that expertise be built back into the NHS, so that it can conduct those contracts in the spirit of good public service as opposed to yet more taxpayers’ money being spent on expensive external consultants?

[Mr Robinson]

We are ranging wide of the debate, but again I have to say that I entirely agree with my hon. Friend, and I saw something about that Public Accounts Committee hearing. That is absolutely right; the problem is getting these lessons learned by the Government. I do not know what it is; it is as if there is an institutional or cultural inhibition leading to resistance to doing the technical job properly. People can be brought in to do it, but—I think that this was my hon. Friend’s point—there is a wealth of knowledge and expertise about the health service in the NHS that needs to be released and employed. Being able to do that is the art of management.

That is my plea. Yes, we want to bash Capita tonight, but more than bashing Capita and hitting out at incompetence and inexperience in the civil service, the real point of tonight is to tell Capita it is in disgrace and needs to get this right. It is obviously a nationwide—an England-wide—problem and it is not just restricted to Coventry. Capita’s overriding No. 1 objective is to put it right. That is our message tonight: “Get your finger out, put it right. Put the resources into putting this whole problem right and do not go for the short-term solution.”

--- Later in debate ---

[Nicola Blackwood]

The hon. Lady is absolutely right to raise the impact on GP services in recent weeks and months, and I will move on to that point later.

Capita has piloted a new way to move medical records. I think that is the pilot in west Yorkshire to which the hon. Member for Stretford and Urmston referred, but it was not a pilot for the overall Capita project. Capita assures me that ultimately it will be more reliable and secure by tracking the end-to-end movement of every record. It is piloting that approach in west Yorkshire and plans to be ready to roll it out nationally in March 2017. I am aware that some GPs were left short of basic supplies as a result, including syringes, and that they have had to source those from other suppliers at their own expense. NHS England tells me that it has reimbursed practices for any costs incurred from having to buy local supplies of needles and syringes.

I know that many of the hon. Members’ GP constituents have experienced frustration with Capita’s contact centre. I share those frustrations. Capita assures me that the contact centre has improved the way it responds to urgent queries by investing in more staff, improved processes and enhanced training. Capita is confident that these measures will deliver a quality service to customers. We will monitor its progress closely, including through meetings.

[Karin Smyth]

I am listening carefully to the Minister, and it is obviously reassuring to know that Capita, NHS England and the Minister are having these conversations at a national level. In those discussions, has any consideration been given to my point about the loss of local, specialist knowledge and expertise? Is any consideration being given to putting back some of those local arrangements, given the importance of primary care to the entire system?

[Nicola Blackwood]

I shall come a little later to the problems with the existing system that meant it needed to be replaced. However, the hon. Lady’s point about the value of institutional knowledge, especially among NHS workers and personnel in other roles, is very important. They have been engaged in a lot of consultation processes as we try to put this issue right with NHS England and Capita. If the hon. Lady writes to me, I will be happy to give her more detail.

I also expect Capita to address issues with the courier service. I am aware of several steps that have been taken to ensure that all practices receive regular collections and deliveries. Both NHS England and Capita have taken steps to demonstrate that they are committed to restoring their reputation and re-establishing a quality service, and I am encouraged to see them working in partnership to do so. That said, I recognise that GPs, and ophthalmologists in particular, have suffered financial detriment as a result of late processing of payments. NHS England is working with Capita to explore what can be done to support affected stakeholders, and I have made it clear to Capita that I expect it to consider compensation as an option.

Some have suggested that the old model for provision of primary care support should be reinstated, but we must remember that it relied on localised services that did not connect with one another, with much duplication across processes. The quality of these services varied greatly—in some areas, it was outstanding; in others, it was quite poor. That was simply unsustainable. Furthermore, the system was unable to generate useful management information and so, honestly, issues such as the ones that we now face would be very unlikely to have surfaced. They would have gone unreported.

A new model, with efficient and modernised processes, is the right approach to deliver to our primary care providers the service that they deserve. The Department and I will continue to closely scrutinise Capita and NHS England as they work to resolve current problems and build a quality service that is sustainable. I acknowledge fully that there is a long way to go before the service can be considered acceptable and that Capita has much to do to earn the trust of practitioners and patients.

This is clearly a live issue. I want to be clear today: I am listening. The issue is at the top of my priority list and will remain there until I am satisfied that an efficient and effective service is being delivered that meets the needs of patients and providers.

Question put and agreed to.

SELECT COMMITTEE ON HEALTH

Karin Smyth Excerpts

Thursday 3rd November 2016 Commons Chamber

Dr Wollaston

- Hansard - - Excerpts

I thank my hon. Friend, and I welcome him to the Health Committee. Yes, he is absolutely right that one of the initiatives that has been put forward is to look at streaming at the front door, but what we heard is that this is quite nuanced. If very senior staff are tied up seeing every single person at the front door, that can be a waste of resources. However, if the patients who are most at risk of needing admission—the sickest individuals —are identified early on and seen by the most senior doctors available, then yes, absolutely, that makes a difference.

Karin Smyth (Bristol South) (Lab)

- Hansard -

I had a little smile to myself at the Minister’s response. When I was a commissioner, we often said to each other, “It’s another A&E plan—it must be winter again.” On Monday, I asked the Secretary of State about the £2.4 billion protection for general practice, and I am afraid that there was not a satisfactory answer and the money will not plug the hospital deficits. There are very severe general practice problems in south Bristol and very worrying reports about sustainability. I am looking forward to the report, but will the hon. Lady say something about the role of general practice in the winter pressures issue?

Dr Wollaston

- Hansard - - Excerpts

We have to think of A&E winter pressures as a marker for the whole system. The hon. Lady is absolutely right and I welcome her reference to primary care, because if people cannot get an appointment in primary care, they are more likely to end up in A&E. Luton and Dunstable is now co-locating primary care so that people arriving at the front door who are more appropriately seen there can be seen directly in that setting. There is, however, another viewpoint: co-locating can sometimes end up creating demand, meaning that more people go there directly, so our report calls for better evaluation of the different models. One of the things that Luton and Dunstable does particularly well is apply evaluation at every stage to the changes it makes. The answer is complex, in that co-location may be absolutely the right thing for some systems, but not necessarily the right thing across the board. I absolutely agree with the hon. Lady that people need to have decent, timely access to primary care.

A&E Departments: Winter Pressure

Karin Smyth Excerpts

Thursday 3rd November 2016 Commons Chamber

[Dr Wollaston]

I thank my hon. Friend, and I welcome him to the Health Committee. Yes, he is absolutely right that one of the initiatives that has been put forward is to look at streaming at the front door, but what we heard is that this is quite nuanced. If very senior staff are tied up seeing every single person at the front door, that can be a waste of resources. However, if the patients who are most at risk of needing admission—the sickest individuals —are identified early on and seen by the most senior doctors available, then yes, absolutely, that makes a difference.

[Karin Smyth (Bristol South) (Lab)]

I had a little smile to myself at the Minister’s response. When I was a commissioner, we often said to each other, “It’s another A&E plan—it must be winter again.” On Monday, I asked the Secretary of State about the £2.4 billion protection for general practice, and I am afraid that there was not a satisfactory answer and the money will not plug the hospital deficits. There are very severe general practice problems in south Bristol and very worrying reports about sustainability. I am looking forward to the report, but will the hon. Lady say something about the role of general practice in the winter pressures issue?

[Dr Wollaston]

We have to think of A&E winter pressures as a marker for the whole system. The hon. Lady is absolutely right and I welcome her reference to primary care, because if people cannot get an appointment in primary care, they are more likely to end up in A&E. Luton and Dunstable is now co-locating primary care so that people arriving at the front door who are more appropriately seen there can be seen directly in that setting. There is, however, another viewpoint: co-locating can sometimes end up creating demand, meaning that more people go there directly, so our report calls for better evaluation of the different models. One of the things that Luton and Dunstable does particularly well is apply evaluation at every stage to the changes it makes. The answer is complex, in that co-location may be absolutely the right thing for some systems, but not necessarily the right thing across the board. I absolutely agree with the hon. Lady that people need to have decent, timely access to primary care.

Community Pharmacies

Karin Smyth Excerpts

Wednesday 2nd November 2016 Commons Chamber

[Dr Whitford]

I agree with the Government about looking for more services, but this is not the way to work with the profession, given that they want those in it to do more work and to work differently. Sadly, during my time in the House, we have repeatedly seen the Government not sitting down with a profession and saying, “Why not look for where savings can be made?”, but simply making a cut.

[Karin Smyth (Bristol South) (Lab)]

I was going to intervene on the Minister to follow up the point made by the Chair of the Health Committee. We are looking at bottom-up planning in England for the first time for a number of years with the sustainability and transformation plan process, so this is completely the wrong time to be making these irrational and random cuts.

[Dr Whitford]

We recently debated STPs and the potential they provide. The danger is that at the moment we are seeing finance-centred care, instead of patient-centred care. Going back to place-based planning, which is what we have kept in Scotland, where we still have health boards, means that we can look at integrating services, and pharmacies definitely need to be part of that. They have the potential to be a significant front-line player.

--- Later in debate ---

[Karin Smyth (Bristol South) (Lab)]

Madam Deputy Speaker, if you were to walk along a busy shopping street in Bedminster in my Bristol South constituency today, you would pass seven pharmacies within a mile or so. However, if you were to walk through the Knowle West estate or Hartcliffe, which are two of the most deprived wards in the country, you would see many fewer pharmacies.

I have spent time in pharmacies in Filwood Broadway and Bedminster, and like most hon. Members, I have been contacted by pharmacists and constituents who are worried about the plans. The greatest fear in my constituency, which has a relatively high density of pharmacies, is its severe problem with GP recruitment and with the sustainability of primary care. We stand to lose disproportionately from those twin concerns. As hon. Members have said, we all know the valuable role that pharmacies play in our communities. This is not just about the damage to healthcare as a result of some of the cuts, but about the impact on our wider economy in some of our most deprived areas.

Madam Deputy Speaker, if you were to wander around my constituency in two years’ time, how many pharmacies—and, crucially, which ones—would still exist? As hon. Members are aware, the NHS-wide process of sustainability and transformation planning is currently being undertaken with the aim, finally, of taking a strategic overview of the whole system. This is the first bottom-up, system-wide planning that has taken place since the disastrous Health and Social Care Act 2012. We are bringing back planning to the system, which is long overdue. This is also about saving a lot of money.

In that context, the delayed Government funding announcements on pharmacies, followed by rushed ones, are the opposite of the STP process. It shows an absence of planning, and a failure to include the vital role that the community pharmacy can play. Where is the sense, when communities need stability, in forcing through a cut of this magnitude at this time? The Chair of the Health Committee, the hon. Member for Totnes (Dr Wollaston), said that earlier.

In my area, the local pharmacy committee is represented on the STP board. All the local players are working hard, collaboratively, in the best interests of patients, to find a solution to our local healthcare needs. However, as has been said by the chair of the LPC, Lisa Fisher, who runs a pharmacy at Whitchurch in my constituency, this measure is a “devastating blow”. It runs totally counter to the process that Ministers want to succeed.

The Bristol CCG reported earlier this year on the root cause of the waste of medicines, and made recommendations to address the problems in the system. The figures are eye-watering. It estimates that medicine waste amounts to £5.7 million a year in Bristol, and that we can save £2.8 million a year. It made 15 recommendations for such work, but none covers having fewer pharmacies in our community.

The Minister may stand in front of pharmacies and lament the way in which the market has produced clusters in some areas, but will a large supermarket chain housing a pharmacy decide the floor space is better utilised for a café, and will the pharmacy that does the most deliveries in areas of greatest health need and that offers the most self-care advice close? How does he know? He does not. Crucially, how will my constituents know, and how can they influence the service provided to them?

In Ministers’ minds, is any consideration being given to starting from community need, not from market forces at such a time? If they were putting forward a new model that was genuinely built on pharmacies being at the forefront of Government thinking in addressing the challenges of our healthcare system, that would be good, but they are not doing so. This is not a modernisation package, but a fig leaf. It is a missed opportunity, and that is a great shame at this time.

NHS Funding

Karin Smyth Excerpts

Monday 31st October 2016 Commons Chamber

[Mr Hunt]

My hon. Friend is absolutely right. Although I was not personally responsible for the decision in Corby, I am very happy to take credit for it.

[Karin Smyth (Bristol South) (Lab)]

Representatives of the Department of Health and NHS England have appeared before the Public Accounts Committee eight times so far this year. We have taken a detailed look at the Department’s accounts, following the Comptroller and Auditor General’s unprecedented explanatory note, and I am glad that the Health Committee has said that it will examine the issue further.

The Secretary of State said that prevention was better than cure. The “General Practice Forward View” refers to a £2.4 billion increase in investment by 2020. Can the Secretary of State assure us that that crucial investment in primary care will be protected and not used to plug hospital deficits?

[Mr Hunt]

It is a vitally important investment. The first speech that I made as Health Secretary after the last election was made to GPs, and I said then that we wanted to deliver an extra 5,000 doctors working in general practice. It is vital that we eliminate hospital deficits, but we are making good progress in doing so.

Community Pharmacies

Karin Smyth Excerpts

Monday 17th October 2016 Commons Chamber

[David Mowat]

The hon. Gentleman makes a good point: I should not just reach out to pharmacists at posh dinners. In the past three weeks, I have visited a number of pharmacists. I have even opened a new pharmacy. I bow to no one in my view of the value that they can add, but they agree, and I think most Members in the House agree, that the community pharmacy network must move from a model based on dispensing to a model based more on services. We are going to help pharmacies to do that, and these proposals in the round will achieve that.

[Karin Smyth (Bristol South) (Lab)]

As we have said, primary care is the cornerstone, indeed the foundation, of the NHS, and pharmacies represent a successful public-private model. This proposal does seem to be a totally counter-intuitive one. When I, on the Public Accounts Committee, questioned the chief executive of the NHS last month about the Department of Health accounts, he expressed surprise that there may be a reprieve for pharmacies, because the reality is that this is an in-year cut that is already happening; it is part of NHS England’s delivery of savings this year. Can the Minister clarify the reports over the weekend—what are the figures we are talking about? The reports were that the cuts would be £113 million in 2016-17 and £208 million in 2017-18. Are those the correct figures?

[David Mowat]

The figures to which the hon. Lady refers were announced in the consultation in December 2015. The only change since those figures were announced in that consultation in 2015 is that, because of the delay in looking at this again, the in-year saving this year is likely to be lower.

Oral Answers to Questions

Karin Smyth Excerpts

Tuesday 11th October 2016 Commons Chamber

[Mr Hunt]

I am happy to look at that particular funding issue for my hon. Friend. I know that Kettering hospital is under a great deal of pressure. The one thing that it could do to relieve its financial pressures is to look at the number of agency and locum staff that it employs. As with many hospitals, there are big savings to be made in that respect in ways that improve rather than decrease the quality of clinical care.

[Karin Smyth (Bristol South) (Lab)]

The Secretary of State will be aware that the Public Accounts Committee has questioned both the Department of Health and NHS England on the parlous state of NHS accounts this year, following the comments by the Comptroller and Auditor General. It is clear that STPs are the only plan on the table. Will the Secretary of State make clear his support to the NHS to deliver the STPs in the teeth of opposition from his own Back Benchers? If he will not, what is plan B?

[Mr Hunt]

I do not recognise the picture the hon. Lady paints about opposition to STPs. We need to ensure we have good plans that will deliver better care for NHS patients by bringing together and integrating the health and social care system, and improving the quality of out-of-hospital plans. While we are in a period where those plans have not been published there will obviously be a degree of uncertainty, which we will do everything we can to alleviate, but she is right to say that these plans are very important for the future of the NHS. The process has our full support.

NHS Sustainability and Transformation Plans

Karin Smyth Excerpts

Wednesday 14th September 2016 Commons Chamber

[David Mowat]

I shall not take interventions; I now have only five minutes left.

When it comes to funding, we have put in an extra £10 billion, and it is real money. If that money had been available in Wales, some of the points raised in the debate about the interface between us and Wales would have been quite different. This year, the increase in health funding is 4% in real terms—three times the rate of inflation. The real point, however, is not to do with money—however much the Conservatives put in and however much Labour says it might put in, although we have not heard that yet. But however much is put in, it does not detract from the need for the health service to be managed effectively and properly so that it can improve and innovate.

There is a prize from these STPs. At the end of the process, we will have a health service that is more oriented towards primary and community care where people live. The health service will provide better access to GPs, emphasise prevention more than ad hoc responses, properly address long-term conditions such as diabetes and begin to address more quickly our mental health and dementia commitments. I say again that if STPs do not address those things, they will not go forward. Perhaps the most important of all the advantages is that the unacceptable gap that currently exists between healthcare and social care will be breached. That is at the centre of the whole process.

[Karin Smyth (Bristol South) (Lab)]

Will the Minister give way?

[David Mowat]

No, I will not. I have only four minutes left, but the hon. Lady, who worked with me on the Public Accounts Committee, can come and see me.

It is also true to say that if we achieve all those things, there will be lower hospital admissions and more humane and timely discharges. That might save money, but it is not being driven by the need to save money. It is driven by care needs because that is the right thing to do.

Let me deal quickly with the STP process. We have been told that it is a secret process and a Trojan horse for privatisation, and we have heard that we are not going to consult. Well, let us talk about consultation first. The right hon. Member for North Norfolk (Norman Lamb) made some good points about the difficulties involved in change programmes on which proper consultation does not take place. However, we must have something on which to consult that is reasonably agreed and reasonably stable, because if we do not, we shall give rise to expectations that cannot necessarily be fulfilled—in both directions, positive and negative.

When the STPs come back in October after being signed off, they will be consulted on. A document that will be in the House of Commons Library by the end of the week will describe in detail how all the stakeholders will be consulted and what we will do, but in any event—this point was made by my right hon. Friend the Member for Chelmsford (Sir Simon Burns)—no consultation and no engagement will take away the statutory commitments, the need for configurations to be looked at properly, and the requirement for nothing to proceed that has not been locally agreed.

We were told that the plans were secret. In fact, they were so secret that they were announced in December 2015, in the NHS planning guidelines. They were so secret that 38 Degrees, which was responsible for the principal leak, obtained its information from the websites of the organisations that were keeping it all secret. If we ever do something in secret in future, it really will be done better than this.

The STP process is complex. It will not work equally well in all the locations, and there will be issues to resolve. Some plans, if they are not adequate, will not be proceeded with in the same way as others. I say this to Members, however: we need you to engage with the process—

NHS Spending

Karin Smyth Excerpts

Wednesday 6th July 2016 Commons Chamber

[Karin Smyth (Bristol South) (Lab)]

Does my right hon. Friend accept that as well as the £350 million promise, the issue of access to GP primary care appointments caused a lot of anxiety in many communities? That is the fault not only of the funding situation but of the way in which primary care has been run down in the past six years.

[Joan Ryan]

The lack of primary care—particularly in London but also elsewhere—is a key factor behind the huge pressures on our accident and emergency departments and urgent care. No wonder people go there when they cannot get an appointment.

--- Later in debate ---

[Kirsty Blackman (Aberdeen North) (SNP)]

Throughout this referendum campaign, there were numerous times when the campaigns were deceitful. There were numerous times when things that could not be promised were promised. Today, the Vote Leave official Twitter page still has a headline that says:

“We send the EU £350 million a week. Let’s fund our NHS instead.”

That is still on the Vote Leave Twitter page. In fact, they have not posted since the 23rd; I think they have screwed things up and run away.

I was a bit surprised that the Labour party’s motion did not mention the right hon. Member for Birmingham, Edgbaston (Ms Stuart), because when I looked up the £350 million claim, the first quote that came up was:

“Every week we send £350 million to Brussels. I’d rather that we control how to spend that money, and if I had that control I would spend it on the NHS.”

That was said by the right hon. Lady, and it was patently untrue.

BBC Radio 4’s “More or Less” looked at the statistics. For anyone who does not listen to the programme, I should say that it is rather excellent and tends to debunk what politicians say on a regular basis. It does not usually say something is actually false, however; it will say “It’s not quite right.” But with this claim, it said that it was false.

[Karin Smyth (Bristol South) (Lab)]

I hear what the hon. Lady says about my right hon. Friend the Member for Birmingham, Edgbaston (Ms Stuart), but she is not in the Government so does not have the power to transfer that money to the NHS budget, unlike those on the Conservative Benches. Does the hon. Lady agree?

[Kirsty Blackman]

I agree that the right hon. Member for Birmingham, Edgbaston is not in the Government, but she was in the Vote Leave campaign and made those promises.

Going back to “More or Less”, Tim Harford said:

“If we left the EU we wouldn’t have an extra £350 million to spend on the NHS.”

He also talked about the amount of money that we pay to the EU in comparison with the amount that comes back and said that the

“rebate is about £85 million a week. Unless you think we’d continue to get the EU rebate after we left the EU, it’s impossible to make the claim that there would be £350 million a week to spend on the NHS.”

He went on to say:

“We reckon that in the year 2014 the UK paid £280 million a week to the EU and received back £90 million a week in contributions to farmers and poorer regions and another £50 million in spending on British companies.”

Therefore, the most that could possibly have been available is £140 million, and there was no way that anybody in the leave campaign was ever going to spend all that money on the NHS.

It is not unusual, however, for people to be disingenuous. The people of Scotland are actually quite used to people telling untruths during referendums. The article below the now-famous headline, “The Vow”, stated:

“People want to see change.”

Well, they certainly delivered that. The article also said:

“We will honour those principles and values not only before the referendum but after.”

Ruth Davidson, leader of the Conservative party in Scotland, said on 2 September 2014:

“No means we stay in”

the EU. The Conservatives have completely failed to deliver on the promise they made to the people of Scotland. They are trying to drag Scotland out of the EU against our will.

This Conservative Government have a terrible record of making disastrous pledges, mostly because I think they did not expect to have a majority. They thought that they could write anything they wanted into their manifesto and then backslide on it because they were not going to have a majority. They had the fiscal charter, which was disastrous and condemned us to austerity. They had the removal of the subsidy for onshore wind, which was also disastrous. They had the pledge to have an EU referendum and they thought that they could avoid that one because they would not get a majority, but now look at what has happened.

There was also the disastrous, awful, horrendous migration cap. I am faced with constituents most weeks who sit in my office and explain to me what they do for their community and the work that they do in local government or the NHS. They talk about their volunteering and say to me, “Why does this Government want to send me back to another country?” The only answer that I can possibly give them is that this Government signed up to a migration cap and are therefore trying to reduce the number of people here based not on how hard they work, how much they give to their community or how much they put into NHS services, for example, but on trying to reduce the headcount. The Government’s behaviour is absolutely ridiculous.

What does that mean for the future of political campaigning? People across the UK are looking at the pledges, such as the one that is still on the Vote Leave Twitter page saying that £350 million should be spent on the NHS, and their trust in politics and politicians is being eroded further than ever before. If we want to try to bring things back, we are going to have to work incredibly hard and be incredibly truthful. Our campaigning is going to have to be incredibly positive. The fear factor inspires nobody, and we are losing the trust of so much of the population. They do not believe what we say because we constantly present them with fear, which is not good.

The Health Secretary spoke earlier about having to be careful in what he said in case he further damaged the British economy. He did not want to talk down the economy, which I understand, but I hope that that does not mean that the Conservative Government will refuse to be positive about the benefits of migration. The people who come to this country to work in our NHS and in other services provide a huge economic benefit to the UK as a whole and Scotland in particular. It is important to our country’s economy that people are willing to come here. If the Government are scared about damaging the economy and their ability to use people as bargaining chips and are unwilling to talk about the benefits to the British economy of migration, that is a major issue. Things are bad enough already; we do not want to make them any worse.

I want to mention a few other things that people have said. The hon. Member for Uxbridge and South Ruislip (Boris Johnson) said that people would value NHS services more if they had to pay for them. He then said that the £350 million should go to the NHS. Those two things are mutually incompatible. It is a shame that such points were not highlighted a bit more during the campaign.

So many Westminster Governments over so many years, and indeed decades, have been unwilling to do anything other than take part in short-term politics, focusing on what will be of benefit in the next five years in order to try to win elections. The NHS is a prime example, because some of the health measures put in place by the Conservative Government avoid touching on some of the thorniest issues. For example, breast feeding counselling and support, access to which is being reduced, costs money now but will result in a financial benefit—a return to the Treasury—many years later. It would be good if the Government were willing to take such decisions, which may mean they have a smaller budget now, in order to give people health benefits in 20 years’ time.

Earlier this week we had the main debate on the estimates. NHS and health budgets regularly go against HM Treasury guidance by transferring capital to revenue spend, which other Departments are not allowed to do. What I want to know is why that money is not being spent on capital projects. What capital projects on which the money should be spent are being avoided? Why are the Government not funding the NHS revenue spend to the levels they should be? Why does the NHS have to make these transfers between capital and revenue, rather than being adequately funded?

Madam Deputy Speaker, thank you for your indulgence in allowing me to speak in this debate. I really appreciate it.

--- Later in debate ---

[Karin Smyth (Bristol South) (Lab)]

The Public Accounts Committee, of which I am a member, has published seven reports since January on the workings of the Department of Health, including on diabetes, the cancer drugs fund, services for people with neurological conditions, access to GP services, acute hospital trusts, NHS clinical staff and personal budgets in social care. We have had two further hearings, for reports yet to be published, on discharging older people from hospital and specialised services.

I recommend those reports to those on the Government Front Bench—I have a few copies with me, just in case they do not wish to watch the football tonight. Taken together, they paint a bleak picture of a system under immense pressure, with commitments undelivered, a massive increase in complexity as a result of the Health and Social Care Act 2012 and, above all for the Public Accounts Committee, continuing poor data upon which to make decisions and manage performance, as well as a complete lack of clarity about accountability for delivery on the areas we have investigated.

The concerns outlined in our reports include: on staffing, that trusts have been set unrealistic efficiency targets, and that the shortage of nurses is expected to continue for the next three years; on funding, that the financial performance of trusts has deteriorated sharply, and that this trend is not sustainable; and that the data used to estimate trusts’ potential cost savings targets are seriously flawed.

[Melanie Onn (Great Grimsby) (Lab)]

Northern Lincolnshire and Goole NHS Foundation Trust has only just been taken out of special measures, but last week’s Care Quality Commission report highlights a concerning dip in standards at Diana, Princess of Wales hospital. The bosses have said that that is because they struggled to recruit quality staff. Does my hon. Friend agree that removing the NHS nursing bursary is long-term pain for short-term gain?

[Karin Smyth]

I agree with my hon. Friend. In fact, one of the reports I have with me is the one we published in December about the work of the Care Quality Commission and some of the concerns that have already been issued about the work it does to uncover issues such as the ones she has highlighted in her constituency.

[Catherine West (Hornsey and Wood Green) (Lab)]

Does my hon. Friend agree that a worrying number of trusts are now in deficit, whereas 10 years ago they were simply bubbling along well—in fact, they were getting more money for their budgets? Even for North Middlesex hospital, which we have heard about extensively tonight, the situation is increasingly worrying, as it is now in deficit for the first time in 10 years.

[Karin Smyth]

I agree and I will talk about some of the issues with trusts.

Hon. Members have provided examples that highlight our concerns about how the Department is managing to do what Parliament intended with the funds voted to it. They highlight the importance of giving the Public Accounts Committee and Parliament the opportunity to review the departmental accounts properly.

The Department of Health annual accounts cover more than 20 arm’s-length bodies and delivery partners, not only NHS England, but the Care Quality Commission, NHS Improvement, the National Institute for Health and Care Excellence, the Human Tissue Authority, Health Education England, the NHS Litigation Authority and—one of my and, I am sure, many hon. Members’ favourite organisations—NHS Property Services Ltd.

Within NHS England, NHS trusts reported a record deficit of £2.45 billion in 2015-16—almost £500 million worse than planned, and triple the size of the 2014-15 deficit. As my hon. Friend the Member for Hornsey and Wood Green (Catherine West) said, a record 121 out of 138 acute trusts ended 2015-16 in deficit. Analysis by the King’s Fund and the Health Foundation has challenged the Secretary of State’s claim that, in the 2016-17 Budget, the NHS will receive the sixth biggest funding increase in its history. The chief economist at the King’s Fund concluded that this year’s total real spend increase of 1.6% is the 28th largest increase since 1975-76.

The Health Foundation noted:

“The health budget has been protected from cuts but spending growth is substantially below the growing pressures on the service…In exchange for this protection, the NHS has been asked to absorb these pressures through improved efficiency. There are opportunities to improve the efficiency and effectiveness of the NHS but realising these savings is proving to be a huge challenge—particularly against a backdrop of staffing shortage.”

Given the size of the trust deficit and the implications for the budget of NHS England, which takes up by far the greatest part of the Department’s budget, there are widespread concerns about how the Department might stay within its departmental expenditure limit. Failure to do so would be an exceptional breach of control. As my friend, the hon. Member for Aberdeen North (Kirsty Blackman) said, there are issues about the way in which capital has been transferred to revenue and so on.

The Public Accounts Committee understands that the accounts will be available before the recess—perhaps next week, which would be very welcome. We need to look at not only NHS England’s spend, but that of the other 20 or so bodies that make up the Department of Health. I know that you, Madam Deputy Speaker, and Parliament will take a dim view if the Department’s accounts are not subject to proper scrutiny when the Committee, which had some additional training this year to review the accounts, is ready to undertake such scrutiny.

In addition to my concerns about last year’s accounts and this year’s departmental budget, I believe that Brexit now poses huge risks. My major concerns are about staffing, procurement and medicines, but there are many others. In my NHS career as a non-executive director on a trust board and as a manager, I read and indeed compiled many a risk register. It is truly a joyful task. The Department requires all its bodies to identify, assess and mitigate risks. As anyone in any business knows, risk registers are an essential part of the planning process. Few if any risks to business could be greater than Brexit. I would expect the Department to have a robust Department-wide risk assessment process, and I would expect it to include Brexit.

Yesterday at Health questions, I asked what was being done across the Department, including the NHS, to assess and mitigate the risks to its current year budget of Brexit’s huge impact on staffing, procurement and medicines. I received a far from satisfactory reply—although he tried to be helpful—from the Under-Secretary of State for Life Sciences. I therefore pose three key questions to Ministers: what are the risks of Brexit that the Department must surely have already identified through its risk register or by other means? How are they to be mitigated? When will they be debated and discussed in Parliament?

Oral Answers to Questions

Karin Smyth Excerpts

Tuesday 5th July 2016 Commons Chamber

[Mr Speaker]

Order. Progress has been rather slow today, but I want to accommodate one further inquiry. I call Karin Smyth.

[Karin Smyth (Bristol South) (Lab)]

14. What steps he is taking to ensure that forward budget planning in his Department is robust.

[The Parliamentary Under-Secretary of State for Life Sciences (George Freeman)]

In the autumn statement and the Budget the Government fully funded NHS England’s five year forward view. We have committed to an extra £10 billion in-year by the end of this Parliament. Furthermore, we have frontloaded it, as we were asked to do by NHS England, with £6 billion extra by the end of 2016-17 with an extra £4 billion for technology funding.

[Karin Smyth]

I thank the Minister for his answer. Having published reports on seven areas of the Department’s work since January, members of the Public Accounts Committee, of whom I am one, were looking forward to the publication of the annual accounts with some anticipation. It is becoming clear that Brexit’s impact on staffing, procurement and medicines will be huge, so what is the Minister doing to assess and mitigate the risk to the 2016-17 budget and will this be made clear in this year’s published accounts?

[George Freeman]

May I first make it clear, as the Prime Minister has done, that nothing immediately changes? We are still full voting-right members of the European Union, and nobody in the system needs to worry about any immediate changes. The Government are putting together a plan for handling the negotiations that now need to be taken forward, and for my own part I as a Minister in the Department have convened a workforce to look at the issues around medicines access. There are three things we need to do: first, to reassure people that this country has a very strong life science and healthcare research system and economy; secondly, to make sure that we negotiate our new relationship with the EU in a way that works; and thirdly, to take advantage of the regulatory freedoms that we now have to make sure that this country is the very best country in the world in which to develop those innovations.