Covid-19
Karin Smyth Excerpts(5 years, 7 months ago)
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The Parliamentary Under-Secretary of State for Health and Social Care (Jo Churchill)
I beg to move,
That this House has considered covid-19.
Yesterday, there was an increase of 19,609 cases of coronavirus in the UK, and sadly we recorded 529 deaths. I am sure I speak for everyone when I say that our sympathies and prayers are with each and every family. It is a stark reminder, if we needed one, that we still have a long way to go in beating this disease and seeing our country thrive again.
I know that Members across the House will join me in wishing those who are currently unwell a speedy recovery and thanking all the staff across health and social care and key workers for all they do, but I would also like to mention one or two who do not always get a mention: those working in community health, including our health visitors and our pharmacists, and many of the volunteers who keep many of the shows on the road.
As the Office for National Statistics report on loneliness earlier today showed, these changes are taking a toll on our lives. They are taking a toll on individuals, families and businesses, so the news this week of further successful vaccine trials with Moderna and today’s update from Pfizer have given rise to the very real prospect of an effective vaccine in the near future. While I share that sense of hope with many, we still have some way to go, and we must never lose sight of the challenges that we face at the moment. A vaccine still has to go through a regulatory process, but it is right that the planning of the huge logistical exercise of a vaccine roll-out led by the NHS is now very much under way. Throughout this pandemic we have had to learn, and each week brings further understanding.
As more information continues to emerge on the risks of long covid, for example, we are reminded how this virus can remain a threat. I am sure hon. and right hon. Members will be pleased to hear that the NHS will have a network of 40 long covid clinics in place before the end of this month, bringing together doctors, nurses, therapists and other NHS staff to help those patients suffering from the lasting effects of this virus. That is an example of how our response to the virus has to continue to evolve and strengthen to protect staff, patients and the public, moving with the science as we learn more.
It is hard to overstate how little was known about the virus at the start of the year. We have done many things for the first time, and the learning curve has definitely been a steep one, but looking back, we have come a long way through this difficult year. We have always sought to base decisions on evidence, data and scientific advice, and we have been willing to reflect and adapt as we go. From repatriating individuals from Wuhan in the early days of the pandemic, we have constantly faced and met enormous challenges. In the words of General Sir Nick Carter back in April, distributing personal protective equipment, for example, was
“the single greatest logistical challenge”
in his 40 years of service. However, with others helping, such as the Army, we built those supply chains and responded to demand. In some areas, demand went up by 17,000% for eye protection, for example, and by approximately 4,700% for masks. So far, we have distributed more than 4.9 billion items of personal protective equipment to the frontline, and today we have a four-month stockpile in hand across all nine key lines, with a further 32 billion items of PPE on order. We have regularly delivered to more than 58,000 health and care organisations. I would like to pay tribute to Lord Deighton and his team for their extraordinary efforts in building resilience into the supply chain, to enable us to be as confident as we are today.
I am clear that none of this would have been possible without the incredible collaboration we have seen between industry, social care providers, our NHS, the armed forces and others. Industry and individual businesses stepped up to meet the challenge. At the start of the pandemic, only 1% of PPE was manufactured here in the United Kingdom. By the end of the year, we will be manufacturing 70% of the amount of PPE we expect to use from December to March in all key areas bar gloves. This enormous national effort has put our country on a strong footing today and for years to come. Following the launch of the PPE strategy in September, we are looking at sustainability and initiating a UK production site for gloves.
Karin Smyth (Bristol South) (Lab)
I accept that it was an extraordinary time and that extraordinary measures needed to be taken, but as we have heard from the National Audit Office today, tried and tested processes and procedures were not used. Will the Minister say something about that report and why that was the case, why we had 11 ministerial directions by May and whether those lessons have been learnt by her Department and others that fell foul of the procurement procedures?
Jo Churchill
The NAO report to which the hon. Member refers highlights that we were acting with “extreme urgency” in a global market where demand exceeded supply. The report states that the situation in responding to the covid-19 pandemic was unprecedented, but that we
“secured unprecedented volumes of essential supplies necessary to protect front-line workers.”
Jo Churchill
If the hon. Member will bear with me, I will continue.
The NAO report examined potential conflicts of interests involving Ministers and the awarding of contracts and found none. It states:
“we found that the ministers had properly declared their interests, and we found no evidence of their involvement in procurement decisions or contract management.”
The report recognises that there are robust processes in place for spending public money, to ensure that critical equipment got to where it needed to go as rapidly as possible while ensuring value for money. I welcome the report, because we can all learn.
Jo Churchill
I will come on to the area of cancer, in particular. Strides have been made in different ways of treating virtually, so that fewer people go into the hospital setting, and so on. I take the hon. Gentleman’s point about capacity, but that is why the Government have committed to building 40 new hospitals—because there is a need to ensure that sufficient capacity is available across the country for people.
Jo Churchill
I am going to push on a little bit and then I will give way again.
This enormous national effort has put our country on a strong footing for today and years to come. We are using the best of British ingenuity to help us to deliver in this area. Progress has also been seen in other areas. As the pandemic unfolded, the UK could not call on a major diagnostic industry. From a standing start of about 2,000 tests a day in March, our capacity is now over half a million tests per day. This matters, because it has often been said in this place that in order to beat the virus we need to draw on different parts of our armoury to help to get us through. Testing works. It helps to deny the virus the connections it needs to spread. Mass testing therefore offers us a chance to achieve that on a much bigger scale. We are making progress in city-wide testing in Liverpool. I thank Joe Anderson for his leadership in helping to deliver not only in testing but in other areas too. We are also rolling out a further localised approach to other areas with the help of directors of public health, among others, who know their local areas. Some 83 local authorities have now signed up to receive regular batches of lateral flow tests, which allow for a result to be seen in 15 minutes.
Further, I know that hon. Members will celebrate Monday’s announcement of two mega-labs coming on stream early next year—very high-throughput laboratories, one in the midlands and one in Scotland, adding a further capacity of some 600,000 tests per day. These are massive gains that we are achieving by embracing cutting-edge technology such as automation and robotics and harnessing the best of British industry and academia, meaning that we will not only be able to process more tests but that they can be processed quicker and at a lower cost. The mega-labs will be another powerful weapon in our defence against this deadly virus in order to get back to a more normal way of life, but more than that, they will form a permanent part of the country’s new diagnostic industry. They can help us to respond in the future and build further resilience.
I am excited at the potential for a new diagnostic industry to help to care and deliver across other disease types, not least cancer. Hon. Members will know that, informed in large part by my own experience, I was an advocate of improved cancer outcomes long before I came to this place or took on this role. Early diagnosis is the key to beating the disease, and with bold steps forward in diagnostics, I would like it to make it my mission—I am sure with many others across the House—that we seize new opportunities in cancer services so that covid-19 is not a derailer but an opportunity for a new phase in smarter, faster diagnostics.
Alex Norris
The hon. Gentleman gives a concerning example that shows how the system is struggling in general. I hope that the Minister will address that issue when she winds up the debate, and I will refer more directly to local authority public health shortly.
I do not want to carp on about what is not working without providing any solutions, so I come armed with three things that Ministers could do at a stroke of their collective pens that would radically improve test and trace in short order. First, we must better use NHS lab capacity to turn tests around. I very much welcome what the Minister said about megalabs, which we have eagerly anticipated for some months. However, there has been a large gap in which we have not had that lab capacity, and we will not have it for some time yet. In the meantime, let us put our NHS lab capacity to use in getting tests turned around.
Secondly, we should give control and resources to local authorities to run the tracing operation. They know our communities and already have a local presence. They are a trusted voice and, crucially, they do this routinely. They do this already. Admittedly, that is on a smaller scale—perhaps related to an outbreak of food poisoning linked to a takeaway—but they do it effectively. Let us support them to do it fully. Thirdly, we must develop a proper package of support for those who need to isolate—that is self-evident. Those three things could be done immediately, and we would all be better off if they were.
We have seen the consequence of failure and of a test and trace system that is struggling, and that is another lockdown. This time last year we were banging on doors in the cold and the rain, and none of us supported the lockdown because we want to keep family members away from each other, or to shut businesses in our community or anybody else’s. However, the failure to break the transmission rate of the virus leads us there.
There are two important things that I wish the Government would communicate more. This is not a choice between lockdown and the economy; it is not a choice between lockdown and non-covid healthcare treatment in the NHS. We must have the lockdown for those purposes, and the longer we delay putting restrictions in place, the worse are the long-term impacts on our economy. If we do not introduce regulations to reduce the transmission of the virus, the greater are the pressures on our hospitals, and the less likely they are to be able do other treatments. Those things are not in tension; they are very much complementary.
The failures of test and trace may have led us to a lockdown, but that lockdown buys us time to sort out problems in the system. We must see progress. Lockdowns alone will not tackle or eradicate the virus, but they buy us time to put in place the things that do. We have now had two weeks of lockdown, but we have not heard about what is improving in the test and trace system, or what will be better, including in the next two weeks. Ministers really need to say this today, so we can be sure and confident that the time is being used wisely. Otherwise, when we leave lockdown, this will all recur again, something that none of us wants.
We are all very wary of Christmas. Depending on which newspaper Members read, they may have woken up yet again to see that the Government’s plans, this time regarding yuletide festivities, had been briefed out to national newspapers. Putting aside the discourtesy to the Speaker and Deputy Speakers, to all of us and to this place in general, that is all well and good, but those plans are only going to be feasible if the right efforts are put in place now and this time is used wisely.
It also ought to be stated that this lockdown is longer and more painful than it needed to be because, once again, the Government acted too slowly. The scientists told them they needed to lock down, as did we, but for two weeks the Prime Minister disregarded reality, which meant that the situation worsened. That has meant that the lockdown will be longer and harder, and also meant that we lost the benefits of the school holidays. These are mistakes that cannot be repeated in the future.
As we exit lockdown, the Government need to be honest with the British people—not in off-the-record briefings to mates in the media, but to the British people—about what will come next, both at Christmas and in the return to a tiered system. I know from our experience in Nottingham that trying to negotiate restrictions was painful, even when we wanted them at the beginning of October as our infection rates increased precipitously. We could not get the initial restrictions we wanted, because the Government were moving to the tiered system and it did not fit their timeline. We then managed to get into the tiered system at tier 2; the next day, the Government said that they wanted us to move into tier 3 and were going to call us, which they did not for a further week. Eventually, we had the painful negotiations about what that actually meant for Nottingham: we brought those restrictions in on the Friday, and by the Saturday, the national lockdown had leaked out. The system has not worked for Nottingham, so we need to know that in any return to a tiered system, the Government are going to work much more quickly and in a more agile manner. Every day wasted is a day when the virus thrives, so we need to be better upon exit.
Turning to the vaccine, we strongly welcome the Government’s efforts in this area: they were right to pre-order doses across a wide portfolio, and they were also right to back British. With our excellent research and our proud record in this area, we should be in the vanguard of it, and patriotic about our efforts to tackle this global issue. Last week, I responded on behalf of the Opposition in an excellent Westminster Hall debate on the covid-19 vaccine, secured by the hon. Member for North Herefordshire (Bill Wiggin), the day after the news broke that the Pfizer-BioNTech vaccine had achieved success in a phase 3 study. Since then, we have heard similarly positive news about the NIH-Moderna vaccine candidate, which is likely to be followed by other candidates, whether that of the University of Oxford and AstraZeneca, the candidate referenced by the Minister, or candidates developed elsewhere. I understand that overnight, there have been further promising developments for a Chinese candidate.
During that debate, colleagues and I raised the challenges and considerations that need to be addressed to make sure that this is handled and executed well. I will not repeat those contributions in the level of detail we went into then—they are on the record in Hansard for people to read. However, the theme was that we cannot repeat the slowness or logistical challenges that we saw early in the pandemic with regard to the procurement of personal protective equipment and testing: no Nottingham people being sent to Llandudno or Inverness for their healthcare this time, please, Minister.
As we have done throughout the pandemic, we on the Opposition Benches will work constructively with the Government to support viable vaccines being secured, ensure the right groups are being prioritised, develop an effective delivery programme, counter vaccine hesitancy—that is critical—and continue to support these efforts globally. A failure on any of those points will undermine the whole process, so it is absolutely crucial that we come together, and I am sure that Ministers will welcome that.
However, I want to briefly reference a point that my hon. Friend the Member for Bristol South (Karin Smyth) made regarding the NAO report. Again, we understand—as that report did—that the Government were having to do things that would normally take 18 months’ worth of planning in hours and days, and that comes with some efficiency trade-offs. However, we did not hear clearly enough in the Minister’s opening statement a sense that that has been reflected upon, and we did not hear what will be different in future to make sure those mistakes are not repeated.
Karin Smyth
I appreciate my hon. Friend having picked up on the point I made. The Minister very carefully read out a statement in reply to my question about the Government’s response to the NAO report. I am concerned that she was saying that the Government stand by what they did in that period, and do not think that the way in which those contracts and large procurement processes were handled was a problem. It may be that the Minister wants to correct the record, but if that is the case, does my hon. Friend agree that that is deeply worrying?
Alex Norris
I heard the point that the test had been clear that nothing wrong had been done, which, frankly, is a very low bar. I do not think anybody would say that there was nothing that happened in the early procurement phases that we would not perhaps want to change or do better later. I hope that the Paymaster General in winding up might reflect on that.
Perhaps this is the best place to say that the announcement on long covid will be very much welcomed by a lot of people, including my good friend Jo Platt who has been campaigning on this for many months, as well as living with her long covid. This is a story for lots of people up and down the country, across all our constituencies, who are living with the after-effects of this horrible virus over and over again. The act of knowing that they are being heard, as well as the 40 clinics, will be a real tonic to a great number of people, so we very much welcome that.
I turn to inequalities. At the beginning of the pandemic, we talked about the virus being a great leveller, not distinguishing between us depending on our lives, our jobs and our postcodes, but nine months on we know that to be patently untrue. Sixty per cent. of those who died were living with disabilities. Those of Bangladeshi heritage are twice as likely to die as those who are white British. Those of Chinese, Indian, Pakistani and black Caribbean ethnicities are 10% to 15% more likely to die than I am. Mortality rates in the most deprived communities are more than twice those of the least deprived communities. This pandemic has shone a light on our inequalities, whether that means the inequality in work, in housing or in income, and these inequalities have had tragic consequences for some and, in the aggregate, are catastrophic for all of us.
When we beat this virus, which together we will, what comes out of it must be a fair settlement that recognises these inequalities as bad and tackles them head-on. That is why it is already concerning to see again—of course, leaked to national newspapers—that the overseas aid budget is the first on the chopping block. In 2010, the Government chose to target those who had the least to pay for a crisis that they did not cause, and these reports are a sign that maybe this is the plan again. We will not let them repeat this in 2020. It simply would be hugely unjust.
Before I finish, I would like to take this opportunity to thank our incredible NHS and social care staff for all they have done for us. They are truly the best of Britain. Similarly, the pandemic has revealed the key workers all over our communities and all over our economy, so this week, during Respect for Shopworkers Week, I would like to say a special thank you to those working in our shops, keeping us fed, but still facing rising violence and abuse every day. The Government should take better action to protect you—the Government could, of course, adopt my private Member’s Bill and I encourage them to do so—but whether it is that or through another mechanism, we will fight for you until they do.
In conclusion, now more than ever we must stand together as a country, as families and as communities, and show once again that at a moment of national crisis, the British people always rise to the challenge, support those who need it and pull together. That involves not only recognising successes, but assertively tackling the failures that have held us back during the pandemic. If we address these, we will beat this virus.
Karin Smyth (Bristol South) (Lab)
Back in March, when our worst fears were confirmed and the first lockdown hit, I thought that some aspects of the UK Government’s response would be taken as read. I worked in public health and emergency planning before entering this place, and I know at first hand what a response should look like in the most basic terms and what it should feel like. I expected usual processes to function and best practice to kick in, and for muscle memory and accepted norms to initially, at least, shape our response. And I expected all that to happen underpinned by Government support.
I accept that the extraordinary nature of those months, as the Minister said in opening this debate, was unusual, However, as the National Audit Office report states, there were 11 ministerial directions. I do not accept that the virus was unexpected: the scenario planning was based on a threat of this type. I do not accept that the NHS was prepared: the Government were consistently warned that running at 95% capacity was not sustainable. And I do not accept that the way in which the response was led is beyond scrutiny.
What we heard from the Dispatch Box earlier was worrying, and I hope that the Paymaster General will clarify the situation when she winds up the debate. Essentially, the Under-Secretary of State for Health and Social Care, the hon. Member for Bury St Edmunds (Jo Churchill), said, “Nothing we have done was corrupt.” However, issuing a ministerial direction is serious. It is about regularity, propriety, value for money and feasibility —and these contracts do not stand that test. One of the contracts for free school meals, for example, was with Edenred, a French company. There was no formal tender process under the emergency regulations, despite existing processes and companies being able to provide those critical school meal vouchers back in early spring. That took so much time and energy from schools in my constituency. It affected vulnerable children and that is totally unacceptable.
We may not be able to scrutinise the Government as we should because we passed the Coronavirus Act 2020, but the Select Committee on Public Administration and Constitutional Affairs, of which I am a member, will continue to do its job. I hope the Government will consider a more open and transparent way of operating in the coming months and that they will look at our report—the Minister gave evidence to the inquiry—in order to learn some of the lessons of what we should have used from the Civil Contingencies 2004. I am afraid time precludes me from talking about that in more detail, but we should return to that in this place.
I said in July that I hoped that we had turned a corner and that there would be more local work and a more local response. I genuinely thought that we might, but we have not, have we? As my hon. Friend the Member for Nottingham North (Alex Norris) has outlined, we will continue to try to make positive suggestions, but it remains the case that people in Bristol South are being disproportionately hammered by covid compared with other parts of the country. For the young and the very old, those on low incomes or in insecure work, those living in houses in multiple occupation, those from black and minority ethnic communities, those from multi-generational households, the cooks, cleaners and retail and hospitality workers, and those who rely on the Government, their inequalities are being exacerbated. This is made worse by the fact that the Government have lost time and wasted valuable knowledge that they could have used locally to manage the system better.
On the Select Committee on Public Administration and Constitutional Affairs, our inquiry has shown that the disconnect between the local and the national has been deeply problematic. In early May, we heard evidence from Sir Ian Diamond of the Office for National Statistics about how we could have utilised much of the data that is available much better, but again the Government have been too slow, and we need them to try to be much better. I think lessons are being learned, but I do not think they are being learned by Ministers and the Cabinet; the political direction and leadership are desperately worrying. We want the Government to do much better, and it is not too late to reset—it really is not. Our lives and our families depend on it, but it is crucial that the Government build back trust and admit where they have got things wrong. People will understand that. We need to empower local capacity and knowledge to lead the work, shape local solutions to the challenge, and deliver on the ground so that we can all have our lives back.
Coronavirus Regulations: Assisted Deaths Abroad
Karin Smyth Excerpts(5 years, 7 months ago)
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Matt Hancock
I respect my hon. Friend’s views, which are deeply and sincerely held, and I respect the fact that the House will debate all views. It is right that that debate is taken forward and led by Parliament, rather than by Government, as my hon. Friend just demonstrated.
Karin Smyth (Bristol South) (Lab)
I congratulate my co-chair of the all-party parliamentary group on choice at the end of life, the right hon. Member for Sutton Coldfield (Mr Mitchell), on securing this urgent question, and I thank you for granting it, Mr Speaker. I have sought to change the law since entering the House. In the last five years, I have learned that many colleagues are worried about safeguards. There is an assumption that the law is currently safe, but it is not. In June, here in London, a man threw himself in front of a heavy goods vehicle on the North Circular. He was suffering from throat cancer and knew his tumour would continue to strangle him. He could not bear it. He took his own life because this country denied him the option of choosing the timing and manner of his death. I appreciate that this is a sensitive and difficult issue, but is it not time that we recognise that the law is not compassionate or safe and leaves behind bereaved families and members of the public because of the absence of a safeguarded choice at the end of life?
Matt Hancock
The hon. Lady draws a distinction between those who have a terminal illness and the broader issue of suicide, which is an important part of this debate. I respect her sincerely held views. The exchange between my hon. Friend the Member for Congleton (Fiona Bruce) and the hon. Lady exemplifies why it is right that Parliament debates and decides on these matters.
Public Health: Coronavirus Regulations
Karin Smyth Excerpts(5 years, 8 months ago)
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Karin Smyth (Bristol South) (Lab)
Bristol, in tier 1, has fortunately been able to maintain low transmissions, and hence admissions to hospital and, so far, deaths. We want it to stay that way. My experience of working in the local health system is that this is in large part due to good relationships that have been hard developed over many years, particularly through local resilience forums. There are good relationships with Public Health England and directors of public health. Working together is sustaining some very good work locally, but there is no room for complacency. We recognise that the economy—wealth creation—is crucial to good local health, and we need support from the Government for both those things.
In the short time available, I want to highlight issues around isolating, shielding, and test and trace. As well as reducing social contact, which the Secretary of State talked a lot about, the key to transmission reduction is isolating, but isolation support is woeful and for communities with little money, which face higher unemployment, the situation is worsened. We have to be much more honest about the incentives and the way they work to support people who are isolating. It is hard and the knock-on effects on families are substantial and disruptive. Again, we need local public health people who know their communities to help support those who are isolating. We need much more support for people who are shielding. People do not understand why it is now different from how it was back in March.
Across the House, we all know that the test and trace system is not working. It is causing chaos for the frontline, particularly care home managers and school leaders. There is a balancing act to be done here. Again, we need local support to inform those school leaders and care home managers about how to interpret the guidance. That cannot just be done through the algorithm. It is a disgrace that the test and trace system is not led by a civil servant whom we can hold to account. I do not know how we can hold the Baroness—I do not know whether the courtesies of the House allow me to name her—to account for the system. That must be changed. It is crucial that we can hold people to account.
I accept that the legislation was rushed through in March, and perhaps there was a reason for not using the Civil Contingencies Act 2004 or the public health legislation we are debating today. The Public Administration and Constitutional Affairs Committee has scrutinised this, produced our report and we now need to move to a better way forward. We cannot keep dragging the Government here week after week to do our job, which is to agree to disagree, to scrutinise and to hold to account, based on our experience, the work we do in Committees and our work locally. It would improve the legislation. It would improve local trust, and ultimately that supports the front line and saves lives.
Coronavirus Act 2020 (Review of Temporary Provisions)
Karin Smyth Excerpts(5 years, 9 months ago)
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Nick Thomas-Symonds
Moving swiftly on.
In England, the number of tests, the availability of tests and the turnaround time simply are not good enough. So dire is the situation that the Prime Minister is arguing with the Health Secretary over whether testing even matters. The Health Secretary has said that
“finding where the people are who test positive is the single most important thing that we must do to stop the spread of the virus”,
and I agree with him. I agree with the Health Secretary. The shame is that the Prime Minister does not appear to, because he has said the complete opposite. The Prime Minister has said:
“Testing and tracing has very little or nothing to do with the spread or the transmission of the disease.”—[Official Report, 22 September 2020; Vol. 680, c. 822.]
Yet again, the Prime Minister refuses to take responsibility for his own actions and his own failings.
The testing of care home residents and staff is critical to saving lives, yet in England there have been repeated delays to the roll-out of testing, and people have waited days for their results. We are also witnessing chaotic scenes at our universities as students are locked down for the want of testing. The Prime Minister has been talking about a “moonshot”, but it is time he stopped looking up at the sky in vain hope and focused instead on what is happening in the everyday lives of families and businesses up and down the country. The failure to show that grip and strategic leadership has severely hampered the way in which the UK Government work with other Governments, as my right hon. Friend the Member for North Durham (Mr Jones) said. Some have not even been properly informed of lockdown plans for their own areas. Let us take yesterday as an example, when we had the chaos of the Prime Minister himself unable to outline what additional restrictions his own Government were implementing for the north-east of England. It is, frankly, an embarrassment, and people deserve better. If the Prime Minister actually bothered to communicate with some of the devolved Governments, he might learn something. In Wales, the tracing system is significantly better. The percentage of contacts that has been reached has been consistently higher than in England, and the Prime Minister ought to follow that best practice.
Let me turn to some of those most at risk in our society. The Health Secretary claimed to have thrown a “protective ring” around care homes in England. If that is what the Government call the shambles they presided over, I would hate to see what they consider a mess to be. Again, the Prime Minister tried to shift the blame, insultingly suggesting that
“too many care homes didn’t really follow the procedures”,
and that was when the Government’s own advice at the start of the pandemic said that people in care homes were “very unlikely” to be infected. The truth is that too many care homes were left high and dry. There was not enough support, insufficient personal protective equipment and a lack of testing. I am sorry to say that some of the most vulnerable paid the price and, sadly, paid the ultimate price. Yet again, care workers, who should be lauded by the Government, were denigrated.
That failure on care homes is particularly relevant as we discuss and debate this legislation and its renewal, because the Act contains provisions that allow for the so-called “easement” of legal safeguards. The Health Secretary said that he thinks those are still necessary, but why are they still necessary? I read carefully the analysis that he published, which did not answer the question. He tried in his speech to make a positive case for it on the basis of prioritisation, but he must realise that that does not deal with the deep concern there is about the situation in our care homes, and he must surely understand that every vulnerable person, throughout this pandemic, must have the standard of care that they need.
We also have significant concerns about the curtailment of the use of GPs to sign death certificates. Again, the Health Secretary said that he wanted to continue with that provision. What assessment has been made about the use of this power? Why does it need to continue? Will he also tell us what its impact has been? Ministers have no excuse for being caught unawares, as they have had months to get to grips with this. We cannot afford for action to protect our care homes and other services to be as slow and chaotic as it was at the start of this pandemic.
On a more positive note, I welcome what the Health Secretary said about the easements under the Mental Health Act; they have not been used and I welcome his assurance that they will not now be used. But what about the easements under the Children and Families Act 2014? He did not mention that Act, and I assume from the silence that they will be continuing. He must bear in mind those with special educational needs and vulnerable children, whose rights should not be rolled back as a consequence of this pandemic. Some of the most vulnerable people have borne the brunt of this virus and this Government’s failings.
We have also seen, across our communities, that the impact has not been evenly felt. Black, Asian and minority ethnic communities have been some of the worst-hit by the virus itself and by the economic fallout, Disabled people and those with underlying health conditions have made up 59% of the covid deaths to date. Despite that, the Government have not done enough work on equality impact assessments on measures or made the necessary evidence available so that we can openly debate and vote to address these deep inequalities. Today, we are faced with an all-or-nothing motion, but let me put the Government on notice that we will not tolerate any discrimination in our society as a consequence of the implementation of these measures. That is why I say to the Government today that they should not be waiting another six months; they should be publishing a monthly review of the impact of this virus on individuals and groups, together with those detailed impact assessments. If the Government continue with the easements under the Care Act 2014, as they say they will, or under the Children and Families Act 2014, they must report regularly to this House about the impact of what they are doing,
Karin Smyth (Bristol South) (Lab)
I hope my hon. Friend agrees that the way the Secretary of State has approached this matter today is disappointing. Many of us sit on Select Committees and have scrutinised the way in which this Act has come forward, and are willing to spend more time doing that properly. That is our job as legislators. The approach has been most unsatisfactory, so I completely support my hon. Friend when he says that we need it to be better. There are recommendations in many Select Committee reports, and my hon. Friend should press the Secretary of State to take note of them.
Nick Thomas-Symonds
My hon. Friend is absolutely right. She saves me from coming to another part of my speech. Quality scrutiny is available across the House on a cross-party basis, and we have had no credible explanation for why this debate is limited to 90 minutes.
The rights that I have referred to, relating to the easements that the Government are pushing forward, protect vulnerable people—those who need care, those with mental illness and children with special educational needs across the country. We cannot simply put their rights to one side.
On rights, there is a real issue with schedule 21. My right hon. Friend the Member for Leeds Central (Hilary Benn) put his finger on it: the power to detain “potentially infectious persons”, which, as far as I can make out, could include virtually anybody. So far, it has been used for 141 prosecutions, each and every one of which was found to be unlawful when it was reviewed. I cannot think of any other piece of legislation in parliamentary history that that could be said about. All the Health Secretary said was that the guidance had changed and he would keep it under review. With a provision like that, he needs to speak to the Home Secretary and the Justice Secretary and do so much better. A provision that has resulted in 141 unlawful prosecutions cannot be right.
I say to the Health Secretary that the Government have to be transparent and accountable. They must come back not in six months’ time, as set out in Act, but every month to answer for the use of these powers.
Testing of NHS and Social Care Staff
Karin Smyth Excerpts(6 years ago)
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Jo Churchill
I am sorry. I put Worcestershire, but I knew that it had a bit of the compass before it.
My hon. Friend the Member for West Worcestershire (Harriett Baldwin) spoke of innovation. She said that the appointment of Lord Deighton had led to a revolution in the UK manufacturing of PPE to support all our NHS workers as we drive forward. Some 2 billion items have been ordered to be made in this country. She also mentioned innovations by our GPs, pointing to the fact that the number of surgeries delivering video consultations has risen from 3% to 99%. She talked about innovations in medicines and treatment, and about the first effective treatment to save lives. On testing, she said how proud she is of everything that is going on there.
My hon. Friend the Member for Crewe and Nantwich (Dr Mullan) talked about managers and workloads as normal services return. He, like many hon. Members, brings to the House his experience from the NHS. One thing struck me in particular—that we target messages at the right groups. We know that health inequalities are persistent and stubborn, so we must get the messaging right as we go forward.
My hon. Friend the Member for Meon Valley (Mrs Drummond) spoke about the importance of preparedness, including assisting staff. This afternoon, mental health came up repeatedly and ensuring that helplines are in place to assist all our NHS recover and gain resilience throughout the next phase.
Jo Churchill
I am sorry, I will not give way, as I have only a minute left.
On testing, we are continuing to prioritise our frontline NHS staff with symptoms for testing and testing asymptomatic NHS staff where appropriate, where there is an incident. We are surveying the health and care settings in Public Health England’s SIREN study and monitoring prevalence. Although the CMO has recommended that testing happens fortnightly at the moment, all these issues are currently under review.
At the start of this crisis, we made sure that NHS capacity was always there at the time of need. The goal was clear that, however tough things got, the NHS would never fall short of that founding promise to be there for somebody who needs it. It meant taking difficult decisions and, as we rebuild and refocus on delivering for all those on the waiting list, I want to put on record my thanks to those on the frontline for their heroic efforts.
At the same time, the NHS has been instrumental in carrying out the world’s first successful clinical trial and, in just a few months, it has achieved much. The NHS is also playing a crucial role to help to operate one of the largest and most comprehensive test and trace systems in the world, with capacity for 280,000 tests today. I have gone on the record many times to say that our colleagues in the NHS and across the public services are always there for us. If you are concerned about anything, you should seek help. The NHS will always be there for you. But what we have discovered from the speech by the shadow Secretary of State—
Oral Answers to Questions
Karin Smyth Excerpts(6 years ago)
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Matt Hancock
Absolutely. When we set up the loneliness strategy in 2018, when I was the Culture Secretary, I had no idea that covid-19 would make it so vital. I very much hope that, in England at least, the measures the Prime Minister is due to set out very shortly might help in that regard. Covid has underlined the importance of loneliness as an issue that we must directly and actively tackle.
Karin Smyth (Bristol South) (Lab)
Matt Hancock
Because this is a big team effort by a combination of public and private sector partners. I pay tribute to Deloitte, without which the testing programme would not be possible. I pay tribute to all the pharmaceutical companies and I pay tribute to Amazon, which has delivered the home testing with remarkable success. Instead of trying to divide, we should unite and bring people together.
Coronavirus
Karin Smyth Excerpts(6 years, 3 months ago)
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Each Urgent Question requires a Government Minister to give a response on the debate topic.
This information is provided by Parallel Parliament and does not comprise part of the offical record
Matt Hancock
This is a very important point. One thing we will be doing during this period is encouraging people who need to see their GP or to have an out-patient appointment for something that is not to do with coronavirus to do so via Telemedicine if it is both clinically and practically possible. That is even more important in rural areas, and absolutely critical for reducing the amount of infection through GPs.
Karin Smyth (Bristol South) (Lab)
Before I entered this place, I worked as an emergency planner for the NHS. I would like to pay tribute to my former colleagues and to say that I am pleased that the Secretary of State is following their expert advice. Most people will not go into hospital or go to their GPs; they will be supported in the community. Critically, they will be supported by the wider services of local government and the voluntary sector. Will the Secretary of State expand on what conversations he is having with his counterpart in the Ministry of Housing, Communities and Local Government to support the wider public health and social care provision of local government?
Matt Hancock
We have extensive work under way to provide exactly that support. It is also available through the Office for Civil Society, and through volunteers as well. It is very important that we offer the opportunity for people to volunteer in these difficult circumstances, but we have to do so in a way that the voluntary efforts can then plug in and add to the professional efforts that are, as the hon. Lady says, providing a great service to this country.
Health Inequalities
Karin Smyth Excerpts(6 years, 3 months ago)
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Karin Smyth (Bristol South) (Lab)
I agree with the hon. Member about the social determinants of health. Does she agree that, going back 10 or 15 years, to before 2010, the Labour Government appreciated those determinants and directed public policy to that end?
Dr Whitford
I do. I respect the work that Labour did, and child poverty was falling. Interestingly, the upturn in child poverty we have seen did not happen with the crash in 2008; it happened after the 2012 welfare changes. That is striking. The impact of Government policy has been austerity in every way and in every approach to individuals, families and communities. We have seen slow income growth for the vast majority of people over the last decade. There has been absolute inequality. The majority of the growth that there has been, has been at the top. The national living wage simply is not a living wage. More people are in insecure work—zero-hours contracts, the gig economy—and do not have protections. As the shadow Health Secretary mentioned, in all the discussion about covid-19, we have been trying to highlight that people on low pay and insecure contracts do not get sick pay, yet we will be asking them to stay at home for two weeks and self-isolate. In the meantime, the wealthiest people have actually trebled their wealth. So categorically we have not all been in it together over the last 10 years.
In addition, we have seen a restriction on public expenditure. The regressive welfare cuts of 2012 and 2016 have reduced support for families by 40%: the benefit cap, the benefits freeze, the two-child limit, the five-week wait for universal credit, which puts people in rent arrears and debt, personal independence payments, the bedroom tax. Eighty per cent. or more of these cuts have affected women directly because they tend to be lower paid, to be carers and to rely more on services. In the main, they are responsible for children. The disabled have also been particularly hard hit. We have not seen a cumulative impact assessment of female lone parents who are disabled and have three or more children. Some of them have had their income slashed.
There have been cuts to local government and services. Interestingly, the least deprived areas face 16% of cuts, while the most deprived on average had 31% cut from their local government budget. I have heard Labour Members talk about between 40% and 60% cuts in their local government budgets. There are changes in the pipeline to move £300 million from local authorities in the north to the south. I wonder if that will be reversed now that the Conservative party has won some seats in the north.
Karin Smyth (Bristol South) (Lab)
In 1980, the Black report told us that the
“causes of health inequalities are so deep rooted that only a major and wide-ranging programme of public expenditure is capable of altering the pattern.”
The report was, famously, whisked out on a bank holiday. It was massively rejected by the then new Thatcher Government as being unrealistic in its expenditure levels— typically short-sighted and we have borne the cost of that since.
The findings of the report and the consequent discussions about health inequalities, I discussed when I was at university, as quite a young person at that point. My lecturer, Professor Albert Weale, taught me a lot about health inequalities, which served me to want to seek a career in the NHS to make a difference. But the NHS contributes little if anything to reducing health inequalities, and many would argue that it in fact increases them: it makes them worse, with better-off patients finding access easier and being better able to navigate the systems—the sharp elbows. The inverse care law also applies: the best services are in the better-off areas. So I am always passionate about my career in and commitment to the NHS, but I have never deified it.
Progress was made in the last 40 years. In 1997 we, as the new Government, tried to tackle the social determinants of health, with healthy living centres, such as the one in my constituency in Knowle West, the new deal for communities, a focus on early years and families, smoking cessation, teenage pregnancies and sexual health services. We made a massive difference, but in 2011 the health inequality targets were removed. It is heartbreaking for me to see in my constituency the evidence-based work that we led in that Government destroyed by this Government, the shocking waste of human potential that has resulted, the huge personal and family and community loss, and the huge financial problem that that causes the Government in lost income and increased benefit payments.
The Treasury should be deeply concerned about the Marmot findings. The figures are stark; they continue to be stark. In report after report that I have read in my 30-odd years in the NHS and as an MP, we hear much about the north, but Bristol has neighbourhoods that are among the most deprived in the country, and the 10 most deprived neighbourhoods in Bristol are all in my constituency of Bristol South. Personal independence payment claims stand at 5,500, and those for carer’s allowance and live employment and support allowance at 4,907—all the highest in Bristol. One in 10 people of working age in Bristol South are not able to work because of health and disability reasons, and the joint strategic needs assessment also tells us that it is women who are bearing the brunt of this. Women in Bristol on average live in poor health for 22 years, which is higher than the England average. The health burden and the mortality and morbidity figures are equally stark, as Professor Marmot has highlighted.
In 40 years, we have learnt a lot, and if the Government are willing to use the learning we could have much better policy, but local government is key. Public health rooted in local authorities and using independent advice ought to be far more influential in issues around prioritising and resource allocation, overcoming the vested interests that are in the NHS.
Early intervention is key. The NHS does maternity and there is then a big gap until care of the elderly; local government has the interaction with children. The NHS focuses on individuals; local authorities focus on families and communities. NHS bodies are not co-terminus with local authorities. They have no grounding in community, but local authorities do. Resource allocation in the NHS is driven by payment by results. Local authorities are much better at aligning resources with local needs. The NHS is not directly accountable to electors, which would make it better understand communities and social care. Unless the Government support local government, everything else is platitudes.
Hospital Improvement Plans: VAT Rules
Karin Smyth Excerpts(6 years, 5 months ago)
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Karin Smyth (Bristol South) (Lab)
It is a pleasure to see you in the Chair for this debate, Madam Deputy Speaker.
I am pleased to have been granted this debate at a significant time in Parliament, following this evening’s votes. I hope to shed some light on how complicated VAT rules, which have evolved over time in the NHS, are now creating incentives for trusts to behave contrary to the Government’s objectives, in particular those relating to capital investment and the implementation of the long-term plan.
I am pleased to see the Minister for Health here to answer the debate. My expertise in the finer aspects of taxation policy and its operation is fairly limited, and I do not believe that he is a tax expert either, but before I came to this place I spent most of my professional life as an NHS manager so I know a lot about planning and delivering health services, including new hospitals. The Minister has clear policy objectives as the Government work to implement the NHS plan, which is predicated on place-based commissioning and improved capital infrastructure. I believe that, as the Minister for Health, he has an obligation to support NHS leaders by providing greater clarity on how the rules operate. Indeed, the Office of Tax Simplification agrees with me that this is a problem, with its 2017 report recording frustration
“about a number of cases where the VAT position was unclear…with HMRC and government tendering departments having differing interpretations.”
It noted that
“VAT liabilities should be clearly outlined during the tendering process for public services and contracts.”
The Government also appear to agree, and the spring statement announced a policy paper, although it was vague on details. The announcement was for:
“A policy paper exploring a potential reform to VAT refund rules for central government, with the aim of reducing administrative burdens and improving public sector productivity.”
The 2019 OTS update noted that that spring statement had involved a commitment to
“a policy paper on VAT Simplification and the public sector”.
It is essential to raise this issue now, because as we move towards implementing the NHS plan we all need to understand exactly how the Government will allocate the necessary funding for hospital improvements and other infrastructure projects. The potential of VAT savings will increasingly become a major consideration for trusts up and down the country. Capital investment is always to be welcomed and it is long overdue. Whether we think we will have 40 or six new hospitals, my sympathies are with the finance directors and managers in trusts who are faced with the task of maximising these investments, and managing the competing interests of recruiting and retaining staff, developing integrated local health systems and securing local public trust in their plans. It is my belief that the underlying problem here is that the priorities of Her Majesty’s Revenue and Customs and the Department of Health and Social Care are not in alignment.
The problem manifests itself in a number of ways. First, a decade of underinvestment in our health service has led to NHS trusts desperately trying to recover whatever finances might be possible. Some of the VAT rules and debates go back decades. I hope the Minister does not rise to say that the last Labour Government used rules to involve the private sector and are responsible for some of this, and I respond by saying that it all started under Margaret Thatcher’s outsourcing, and we simply do not help anyone. I hope we can be more helpful than that. That was the last comment I had back, so I am just stemming that off at the pass.
The real explosion in this issue came from the direction of the coalition Government and the creation of contracted-out services regulations. The HMRC manual “VAT Government and Public Bodies”, from 2012, states:
“Government departments and health authorities have been encouraged to contract out services to the private sector which would have traditionally been performed in-house”—
over many decades.—
“It is recognised that many of these services would be subject to VAT and where they were acquired for 'non-business' purposes, the non-reclaimable VAT could act as a disincentive to contracting-out.”
That was then the policy of the Government. The manual continues:
“It was therefore decided to compensate government departments and health authorities by a direct refund mechanism, which is provided for in section 41(3) of the VAT Act 1994. Under this provision, the Treasury issues a Direction, commonly known as the 'Contracting Out Direction' which lists both the government departments and health authorities that are eligible to claim refunds of VAT, and the services on which VAT can be refunded.”
For lay people, myself included, that in essence means that under these regulations full VAT could be recovered on the cost of a managed service which provided premises that could be used for delivering healthcare. Of course, the private sector was pleased, as it meant it could now, as it saw it, compete on a level playing field with the public sector. But really we should view any tax breaks or loopholes with extreme suspicion, as they lead to reduced revenue for the Exchequer. There should always be a compelling public interest for any tax breaks or loopholes. After this direction and as austerity has bitten, more and more complex arrangements have been set up.
Following the OTS 2017 report, I am sure many in the accounting departments across the public sector were relieved to hear last year's spring statement, when the then Chancellor announced a consultation on VAT in the public sector. This could mean a potential reform to VAT refund rules to reduce administration and improve public sector productivity. However, concerningly, the language of the spring statement, and the background to it, appear to suggest a widening of VAT refunds for those engaged in services—that, again, is reducing the amount of VAT paid by public sector contractors back to the Treasury. I am worried that the Treasury are going to make the situation worse.
My good colleague in the other place, Lord Hunt, followed up on the whereabouts of the review in October, when he asked for an update on the review’s progress. He was told by the Earl of Courtown to expect a policy paper for public consultation “in the coming months”. I know we have all been busy, but the world awaits and it would be helpful if the Minister provided the House with an update on that review, either tonight or in writing afterwards.
The area of VAT avoidance that has attracted a great deal of attention, and that myself and many colleagues—including my hon. Friend the Member for Blaydon (Liz Twist)—visited the Treasury to talk about last year, is the establishment of wholly owned companies in NHS trusts. Such companies can be seen up and down the country, from Northumberland to Yeovil. They vary greatly between those that try to remain part of the NHS and those that position themselves as separate corporate businesses only loosely connected to patients and the public. Most are set up to deliver a full range of facilities management services—including cleaning, catering, porters and security—and then charge the parent trust for this managed service on a private finance initiative-style unitary fee basis.
We have heard that, to avoid charges of tax avoidance, which created a degree of media discussion, the new arrangements are supposed to be better from a service-delivery point of view. Ostensibly, they are solving problems with estates and facilities management and how staff are managed, but there is no evidence of that. In every case, almost all the benefits, some of which are considerable financial benefits for the trust, appear to come from tax changes, not service improvements. Many of the schemes have resulted in thousands of NHS staff being taken out of the NHS and transferred against their will into wholly owned subsidiaries. This increases fragmentation, and there are examples of companies falling out with their parent trust. There are also arguments about which organisation is responsible for what and who pays.
Far worse is that in some cases the use of a separate company is used to undermine national agreements on terms and conditions. Around 50 such proposals have been progressed or are in the pipeline, and it is highly worrying that they were advanced in secret, without consultation with patients or the workforce involved. When freedom of information requests were made for access to the business cases that sought to justify the changes, trade unions and others were denied access, with claims that the information was commercial and confidential.
Just this week, The Pharmaceutical Journal reported that 34% of trusts had outsourced their pharmacy service to a commercial firm and 16% have created wholly owned subsidiaries. The practice is now widespread. Despite that, the recent examples at the Bradford Trust and the Frimley Health Trust have been vigorously opposed, particularly by Unison, and it appears that both proposed schemes have been stopped. That is good news for thousands of low-paid staff who wish to remain NHS employees.
Thanks to the considerable pressure put on NHS Improvement, trusts must now in effect ask for permission before they create a subsidiary company, although far from being a device to prevent the practice, the seeking of permission appears more like a scheme to embellish some badly written business cases so that the changes can go ahead with a veneer of justification. Under some pressure, that process is being reviewed.
Although in the short term it appears that individual trusts will gain through tax advantages offered by the wholly owned companies, other trusts will not, and it means less VAT for the Treasury. But the Treasury seems unconcerned about the lost income. The practice is not a strategic, collaborative or positive solution to the problems that trusts face, and it is not about better employment. The NHS has agreed national terms and conditions for a good reason: because overall it works. All these schemes try to undermine the national agreements and offer staff less favourable terms to save money.
Having two-tier workforces is not a good way to progress. A few years ago, I made that point successfully in my own area of Bristol. The North Bristol NHS Trust, which was at the time under considerable financial pressure, was considering adopting a wholly owned company but, following local discussions, including with Unison, it recognised that in the local, highly competitive market for staff, at a time when the trust needed to start to collaborate on service development, it needed not to outsource. The creation of a second and third-tier workforce made no sense operationally and gave the wrong messages to staff and the public about valuing the all-important workforce across the entire Bristol health economy, so the trust did not do it.
As I touched on in my opening remarks, the controversy over VAT and how it applies in the NHS is relevant to infrastructure investment, because the temptation for the trusts set to benefit from the new capital—I accept that there is new capital, and that is good—will be to avoid paying VAT to reduce significantly the direct ongoing costs. That is why it is so important that the Government give careful consideration to how the investment is going to be made.
I believe the choices made by the Government on this issue will reflect how well they understand both the importance of the NHS estate itself, as part of the health ecosystem, and the direction of the long-term plan. I cannot emphasise enough—and I do think hon. Members understand this—that capital is not a technical, dry subject, but is crucial to the delivery of quality healthcare. It is not a burden on the system. It is time for us all to show we understand that we need a joined-up strategy and proper investment.
The thing I kept at the forefront of my mind as an NHS manager, and do so now as a local representative, is that the health service is wholly funded by the taxpayer, and the public have a great attachment to people and place when engaging with healthcare. Buildings are so much more than a pile of bricks of which to sweat the assets, or empty vessels to lease for maximum return. Buildings really are a physical manifestation of local people’s love for and connection to their local health service. Local people are not over-concerned with how services are developed, but they do not expect their health service to behave in such a way as to constantly try to exploit tax loopholes or penalise staff.
For 15 years or so I have been a supporter of the concept of place-based commissioning, by which I mean local collaboration across the public sector, making good use of the publicly owned estate to deliver quality health services and maximising the value of the taxpayer’s pound. Place-based commissioning has been the direction of travel for some time. It was knocked off course by the Health and Social Care Act 2012, but there is hope of getting it back on track once the long-term plan is in place.
I understand that the setting up of a subsidiary might make sense in the short term for individual trusts, but it makes no sense for the wider health economy or the whole NHS. We must move from a competitive, short-term, market-driven approach at a micro level to a collaborative approach focused on overall gains. The logic of the VAT exploitation and WOCs practice is based on the old idea of trusts having autonomy, behaving like businesses and competing, but this is out of date and directly at odds with the NHS plan, which is built around place-based solutions like sustainability and transformation partnerships and integrated care schemes. On the contrary, the fundamental principle underpinning these initiatives and the Government’s own strategy is much greater collaboration across the system, which absolutely includes the use of buildings and any capital investment.
Another example of what those running the health service are trying to grapple with is GP commissioning and the new primary care networks. One of my last jobs before coming to this place was running a GP commissioning group, so I understand how difficult it is to get practices to work together and align their businesses. Last summer the NHS published a document called “The Primary Care Network Contract DES and VAT”, referring to the way in which the health service funds these proposals. The document sought to give guidance about VAT in the new primary care networks. The author goes to some pains to set out over several pages what NHS England “expects” will be the best approach—and then comes the following caveat:
“Although we anticipate the VAT treatment to follow the above analysis it is not straightforward. Practices should note that HM Revenue & Customs has not agreed the position described in this document and that they are the authority responsible for agreeing, administering and collecting VAT.”
If the Government and NHS England are publishing guidance on how to set up these new organisations without really knowing how HMRC is going to treat them, how on earth can we expect people in the frontline to develop good services?
Let me mention another issue, which is local to my constituents and which I have been working on for some time: GP employment status. For the last five years, HMRC has been reviewing the employment status of GPs who provide NHS out-of-hours services, which are now called integrated urgent care services. During this period, demand for GP services has risen and the need identified by NHS England for a substantial—that is, 5,000-plus—increase in the number of GPs has not yet been met with wholetime equivalent resourcing. Based on arrangements in place since the formation of the NHS, GPs have continued to work on a self-employed basis, and this remains the desired option for many of them. This has been the subject of some political debate over a number of years, but it is the position as people understand it.
BrisDoc is a local GP organisation based in my constituency that provides urgent care services to the NHS. It has been faced with five years of uncertainty regarding its workforce because HMRC does not accept the legitimacy of independent GPs working on a self-employed basis, even though this correctly reflects the way services are contracted based on professional and legal advice. How they are funded is a separate debate, but if HMRC changed GPs’ status, it would increase the risk that GPs would not be willing to work and would increase the cost to the NHS. Both of these have a negative impact on NHS services, reducing GP capacity at a time when we need more, and costing more, which will ultimately lead to a greater cost for the Treasury.
The priority has to be on patient safety and care, and the provider, BrisDoc, has continued to fight for this focus in order to maintain the best possible level of GP availability. However, HMRC states that its focus is simply on “employment status” and not any wider implications of any change, whereas NHS England indicates that it cannot get involved with determining employment status for GPs, who are an essential part of the NHS workforce. This leaves BrisDoc vulnerable to financial and workforce loss while doing everything possible to maintain the service. Its plea, and my plea on behalf of my constituents, is this: can the overall strategy for the GP workforce be reviewed to ensure that the key priorities and objectives are aligned with regard to any change in employment status? It is unacceptable nonsense for it to spend five years between the two Government Departments. Will the Minister be willing to meet me and BrisDoc to better understand the problem?
I hope that I have impressed on the Minister not only the preposterous nature of this VAT problem but how critical it is that we sort this loophole out now through proper consultation with the NHS and an urgent publication of the VAT review. Finance directors in particular need the support to make decisions that align with the strategic vision of the long-term plan, not that are at odds with it. To do this, the guidance from HMRC and the policies of the Department of Health and Social Care must be joined up. If the Government are, as they have indicated, supportive of the strategic direction of the NHS plan, then this must mean supporting local health economies to flourish through the collaborative partnerships integral to STPs and integrated care systems. They simply cannot work if trusts, and other delivery partners, are in competition with each other.
After a decade of fairly imprudent underinvestment and failing policy, we really are at a crossroads, and we need to get this right. If we can level the playing field for all trusts through proper funding, and consistent, sensible VAT rules that do not divert time and effort from the objectives of the trusts to serve their local patient population, we could have every reason to be positive about the potential of local place-based commissioning for success.
Health Infrastructure Plan
Karin Smyth Excerpts(6 years, 9 months ago)
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Edward Argar
My right hon. Friend makes an important point. This money will be hugely important to doing exactly what she says: investing in our NHS buildings for the long term, so reducing the reliance on expensive capital repairs.
With this plan, we are also looking to deliver a step change in how we deal with capital in the NHS, which is also hugely important. Instead of stop-start investment, we are looking for a rolling programme of investment to make sure we get those facilities up to standard in order to reduce the day-to-day spend on repairs. I will happily talk to my right hon. Friend about what we can do to ensure that we go through due process as swiftly as possible so that her hospital trust can get on with it.
Karin Smyth (Bristol South) (Lab)
I worked on many business cases for capital projects during my long NHS career. These projects are important to local people, but local people across the country were misled over the weekend. This is a proposal to give permission to think about building a hospital; they are not new hospitals. The Government’s own response to the Naylor report said that sustainability and transformation partnerships are the chosen means of planning and delivering capital projects, so how were STPs consulted about which projects to progress?
Edward Argar
The hon. Lady, as she says, comes to this with a wealth of experience. The bids were put forward by individual trusts working with their STPs, and in the context of the STPs that have been developed. There is a synthesis and a read across to ensure that, in this announcement, we have picked the trusts that put together the most compelling bids in order to deliver value for money and improvements where they are needed.