Oral Answers to Questions

Debate between Karin Smyth and Steve Barclay

Tuesday 17th October 2023 Commons Chamber

[Karin Smyth (Bristol South) (Lab)]

Not only are the hospital buildings crumbling after 13 years of neglect, creating huge capacity challenges; it seems that those still standing do not have enough beds. As we heard from The Times this morning, the number of

“hospital beds…has fallen by almost 3,000 since ministers promised 5,000 before winter”.

It feels pretty much like winter to me. Is that just another broken promise?

[Steve Barclay]

First, we have got more than £1 billion of investment in an additional 5,000 permanent beds going into the NHS estate as part of our urgent and emergency care recovery programme. More widely, the Government are committed to the biggest ever investment in the NHS estate, backed with more than £20 billion—the biggest of any Government. Of course, we will not take lectures from Labour, which bequeathed the NHS the consequence of expensive private finance initiative deals that many trusts are still paying for to this day.

Urgent and Emergency Care Recovery Plan

Debate between Karin Smyth and Steve Barclay

Monday 30th January 2023 Commons Chamber

[Steve Barclay]

My right hon. Friend hits the nail on the head. He is right: it is about how we better manage demand in the community before people get to the emergency department. That is where, for example, action targeted at the frail elderly is so important. It is also about how we enable people to discharge sooner, where they are fit to do so, so that they can recover, whether in a community setting or, ideally, at home, with the right wraparound support.

[Karin Smyth (Bristol South) (Lab)]

The people of Bristol South will be ever so grateful to have data that they are waiting 12 hours, rather than perhaps ringing me up to tell me they have been waiting 12 hours. The Secretary of State is a Treasury man, so he must know we are now paying more for less. In the interest of transparency, can he be assured that in his own ICB, demand and capacity are matched, and will he know that? How will I know that demand and capacity are matched in my own ICB?

[Steve Barclay]

I think the hon. Lady was welcoming the transparency on 12 hours—I certainly hope so. The ICBs became operational in July, and we are working with them as to how, by taking a system-wide view, they can baseline the gaps in data, and one key area of that is on the community side. When she talks about matching capacity, part of that is about understanding virtual ward capacity, what conditions that applies to, what the physio wraparound services are, what is available within residential care versus community care and other domiciliary care packages, as the right hon. Member for Islington North (Jeremy Corbyn) touched on in terms of local authorities. We need to look at the data package across the piece on a system-wide basis. That is why we are setting up control centres. I am keen to make that much more transparent, because to be blunt, as a Secretary of State, I get the transparency anyway when things go wrong. Like the hon. Lady, I would rather have much more transparent data so that ICBs themselves can be better held to account, and indeed that is what the Hewitt review is looking at in terms of that wider transparency piece.

NHS: Long-term Strategy

Debate between Karin Smyth and Steve Barclay

Wednesday 11th January 2023 Commons Chamber

[The Secretary of State for Health and Social Care (Steve Barclay)]

I beg to move an amendment, to leave out from “House” to end and add:

“pays tribute to the work done by the National Health Service and recognises that there are pressures on health systems around the world; recognises that all parts of the UK are facing pressures; welcomes that the Government has committed to reduce waiting times in England as part of its strategy to strengthen the NHS and care system with up to £14.1 billion additional funding being made available by government over the next two years to improve urgent and emergency care and tackle the backlog—the highest spend on health and care in any government’s history; and regrets that the Scottish and Welsh governments have refused to make similar such commitments.”

I am grateful for the opportunity to update the House further to my statement on Monday, in which I recognised the very real pressures faced by the NHS, particularly in emergency departments and with ambulance handovers, and the fact that the experience had not been acceptable for some patients and staff in recent weeks. I set out a range of actions that we are taking in response to those pressures—pressures that are being experienced by healthcare systems throughout the United Kingdom, and in Europe and beyond.

Before I turn to the honourable Opposition’s flawed motion, I want to reflect on a few points that the hon. Member for Ilford North (Wes Streeting) did not cover. For a start, he hardly mentioned social care, although that was an issue raised on his own Benches. We have made £2.8 billion and £4.7 billion available for social care in each of the next two years, recognising that what happens in one part of the system impacts the other. He also failed to mention any of our life sciences success stories, such as our 10-year partnership with Moderna, our deal with BioNTech to give 10,000 people early access to cancer therapies, and how we were the first country in the world to have the bivalent vaccines. That kind of work will shift the dial on prevention.

[Karin Smyth (Bristol South) (Lab)]

Will the Secretary of State give way?

[Steve Barclay]

I will, and perhaps the hon. Lady will explain why none of her Welsh colleagues is here for the debate.

[Karin Smyth]

I speak for the people of Bristol South. Let me talk about social care: can the Secretary of State explain why he will not publish information about the trailblazers on social care? The Government made a huge commitment to people in this country that they would fix social care, but they have reneged on that promise. They spent £2.9 million on trailblazers. I have asked written parliamentary questions of the Secretary of State and have been told that they are not publishing information. We do not know what has happened to that money. We do not know the outcome of that trailblazers report. If we are to learn from the disaster of the last year in which the Government marched us up the hill and back down again, we need to understand the outcomes. Will he commit to publish the evidence that we have had thus far?

[Steve Barclay]

I support transparency, so I will take away the issue of trailblazers that she raises. [Interruption.] The hon. Member for Wallasey (Dame Angela Eagle) chunters from a sedentary position, but I am agreeing to look at the point that the hon. Member for Bristol South (Karin Smyth) raises. She and I have debated in the past, not least when I was a Minister of State and she raised the issue of NHS property. She knows that I was a supporter then of transparency. She raises an interesting point that has not been raised with me previously.

I am very happy to take that away and look at how we get some transparency on that, because it is important that the House is able to see the evaluation of innovation and where pilots are done. Secondly, one of the challenges that the NHS faces is that it does not adopt that innovation at scale. The substance of the hon. Lady’s point is fair and I will happily take it away. On why I mentioned Welsh MPs, given Bristol’s proximity I thought she may be able to shine a light on the strange absence of any Welsh MPs, unlike the Secretary of State for Wales who is taking a keen interest in this debate.

I turn to the motion moved by the shadow Secretary of State, which seems, incidentally, to have been written before my statement on Monday. I might have thought that he would change it. We set out a further £250 million to support emergency departments and to get those patients out of hospital who are medically fit to be discharged. Across the House, people recognise that the pandemic has had a significant impact on that. It effects flow in hospitals and it is an area of common ground between the shadow Secretary of State and me: the issue of delayed discharge is a big factor in the compression in emergency departments.

NHS Workforce

Debate between Karin Smyth and Steve Barclay

Tuesday 6th December 2022 Commons Chamber

[Steve Barclay]

I very much agree. In fact, in the spirit of co-operation, I would be happy to write to Sir Ian Diamond at the Office for National Statistics to encourage that, if the Welsh Government were willing to make that commitment. I do not know whether the Opposition would be willing to sign up to encouraging the Welsh Government to have that level of transparency. They seem reticent about having that transparency.

[Karin Smyth (Bristol South) (Lab)]

Going beyond the party knockabout, I think that the issue of statistics across the Union is a really important one, and I have raised it in the House many times. Can the Secretary of State tell us what the vacancy rate is in North East Cambridgeshire?

[Steve Barclay]

Well, it depends on what we are talking about. Are we talking about doctors or nurses? Are we talking about locums? Are we talking about the churn within care? There is a range of factors. The reality is that we do not have a major hospital in North East Cambridgeshire. We are served by four different hospitals, at King’s Lynn, Peterborough, Hinchingbrooke and Addenbrooke’s. Someone particularly interested in data would need to look across those ranges.

[Karin Smyth]

rose—

[Steve Barclay]

Let me make some progress.

There is a fair list of omissions in the motion. It did not talk about how the Government are on track to deliver their manifesto commitment of 50,000 nurses by 2024, with nursing numbers over 32,000 greater than they were in September 2019, and the fact that there are over 9,300 more nurses and almost 4,000 more doctors than there were a year ago. There has also been a 47% increase in the number of consultants since 2010.

[Steve Barclay]

I agree that it is not simply about statistics, but I think it is remiss not to point to the increase in doctor numbers, with 2,300 more in primary care—

[Karin Smyth]

Will the Secretary of State give way?

[Steve Barclay]

Can I just answer the hon. Member for Bath (Wera Hobhouse)? I have taken a number of interventions. The hon. Lady is intervening on an intervention.

We must look at the increase in doctors in primary care of over 2,300, and we currently have over 9,000 GP trainees, but the hon. Member for Bath’s wider point is correct. It is not simply about the number of GPs; it is about ensuring that the wider primary care force operate at the top of their licence. It is also about access for patients, and avoiding the 8 am Monday crunch when lots of people make calls at the same time. That is why we are looking at the better use of telephony in the cloud and the latest that technology offers. It is also why we have the opportunity, through Pharmacy First, to make better use of what the pharmacists throughout our pharmacy network can do. It is about increasing the number of GPs, yes, but it is about the wider workforce, the use of technology and the use of different patient pathways, too.

Another omission from the motion is that there are around 90,000 more GP appointments every working day, excluding covid vaccinations, than there were last year. When I hear people say that they cannot see their GP, it is worth putting it in context—[Interruption.] The shadow Secretary of State is chuntering again. Does he want to have another go?

--- Later in debate ---

[Steve Barclay]

The hon. Lady raises a fair point. Nurses are under huge pressure, and I want to say how much we respect and value the work they do. The pandemic has placed huge strain on the NHS, which manifests in the pressures staff face. I am ready to speak further to trade unions about many of these issues and their impact on staff—there are sometimes concerns about safety and staffing levels—and about how we can have better investment in tech and the NHS estate.

I was up in Liverpool the week before last, and £800 million has gone into the Royal Liverpool Hospital. What a difference that is making to working conditions. We need to see more of that investment elsewhere. A range of things are contributing to the very real pressures staff face, which is why we have committed to investment in capital, both on the estate and in areas such as tech, which can make such a difference to working conditions.

[Karin Smyth]

Will the Secretary of State give way?

[Steve Barclay]

The hon. Lady has had a go, so I will make some progress.

The hon. Member for Ilford North says that Labour would free up £3.2 billion by making changes in respect of non-doms—that was raised both at Question Time and in this debate. It will not surprise the House that the Opposition have now spent that money several times on their various pledges. His proposal ignores the fact that we need a tax system that is internationally competitive. His Majesty’s Revenue and Customs figures show that non-dom UK residents are liable to pay more than £6 billion in UK income tax, capital gains tax and national insurance contributions, so the proposal would leave us as a less attractive destination to people who, by their nature, are mobile and can go elsewhere. If they did, we would lose the tax they currently pay into the UK Exchequer.

The hon. Gentleman criticises the Government’s track record on medical training places, but it is worth reminding the House that it was this Government who, in 2018, funded a record 25% increase in medical school places and, in doing so, opened five new medical colleges. Of course, it will take time for that to bear fruit, and the first of those students will shortly enter the foundation programme training. This is an important investment for the long term, and it is why we now have a record number of medical students in training.

The motion covers nursing and midwifery placements. Here, too, we have seen progress, with more than 30,000 students accepting places on courses in England in the last year, a 28% increase compared with 2019. All eligible nursing and midwifery students will receive a non-repayable grant of at least £5,000 per academic year. NHS England has invested £127 million in the NHS maternity workforce and in improving neonatal care, on top of last year’s £95 million investment to fund 1,200 midwife posts and 100 consultant obstetrician posts.

As well as developing talent at home, we must also look to attract talent from abroad. In a motion focused on workforce, it is interesting that there seems to be no mention of recruiting from overseas. People hired from overseas make a fantastic contribution to our NHS, as I hope the House would agree. Unlike the Labour party, the Conservative party recognises the talent that international doctors, nurses and care workers offer, which is why we have been doing more international recruitment. It is interesting that the motion does not seem to welcome that fact, and does not seem keen on more international recruitment.

Oral Answers to Questions

Debate between Karin Smyth and Steve Barclay

Tuesday 1st November 2022 Commons Chamber

[Karin Smyth (Bristol South) (Lab)]

This month a care provider in my constituency is closing, citing the workforce crisis. I have listened carefully to the Ministers’ answers, and the current Chancellor spent the last year telling us about the critical need for a workforce strategy. The door is open. Has the Secretary of State had a conversation with the new Chancellor to ask for a workforce plan on which we can all rely?

[Steve Barclay]

As I said, I am meeting the Chancellor later today.

The Economy

Debate between Karin Smyth and Steve Barclay

Wednesday 8th July 2020 Commons Chamber

[Steve Barclay]

Again, we have taken measures with specific support, as my right hon. Friend the Chancellor set out. That is why we are cutting VAT for campsites and the tourism sector from 20% to 5%. That is part of it, but as the Chancellor also said, if we extended as the hon. Lady suggests, others would say, “Another month, another month, another month”, and people would be away from the labour market for a long period, which would not be in their interests.

[Karin Smyth (Bristol South) (Lab)]

Bailey of Bristol in my constituency is a world-class manufacturer, and I totally echo the point made by my hon. Friend the Member for Kingston upon Hull West and Hessle (Emma Hardy) that these businesses are not talking about forever. They are clearly talking about getting through to the spring. That is not that long, and it is a big investment. Please will the right hon. Gentleman reconsider?

[Steve Barclay]

Again, this was covered extensively in the earlier debate. First, the furlough is already in place for an extremely long period, until October. That is eight months, and we are only halfway through it. Secondly, other measures are being put in place, including measures to incentivise employers to bring those on furlough back. It is not right that people should stay on furlough for an extended period of time—[Interruption.] Nor have the Opposition set out exactly which sectors they want it extended for, or how that would apply in areas such as the supply chain. We would simply get an indefinite period in which that scheme would be —[Interruption.]

Oral Answers to Questions

Debate between Karin Smyth and Steve Barclay

Monday 18th May 2020 Commons Chamber

[Steve Barclay]

My right hon. Friend is absolutely right. That is why £7 billion has been allocated through the Barnett consequentials, including £2.1 billion of additional funding to the Welsh Government. That, of course, sits alongside the UK-wide measures, such as the furlough scheme or the self-employed income support scheme that the Chancellor has announced.

[Karin Smyth [V]]

In Bristol, that current funding gap is £82.4 million as a result of the current crisis. Will the Treasury consider allowing local authorities to retain all surpluses against the business support grants so that they can be reinvested into local short-term interventions to get us through this crisis?

[Steve Barclay]

What we have seen through this crisis is an unprecedented level of support, including the £3.2 billion that has been announced and the further £600 million of support specifically targeted at the care home sector. That sits alongside earlier funding, including the estimated 4.3% real-terms increase that councils received this year.

European Union (Withdrawal Agreement) Bill

Debate between Karin Smyth and Steve Barclay

Committee stage & Committee: 1st sitting: House of Commons & Committee: 1st sitting
Tuesday 7th January 2020 Commons Chamber

[Steve Barclay]

I am pleased that my hon. Friend signals from a sedentary position that he is content with that.

Ultimately, clause 1 will ensure that there is continuity in our laws during the implementation period and that our law continues to operate properly. It is therefore essential and must stand part of the Bill.

[Karin Smyth (Bristol South) (Lab)]

The Secretary of State has commented about the sovereignty of this United Kingdom Parliament across the whole United Kingdom. At all stages in the future, as marked out by the Northern Ireland protocol and the exceptions to this Bill, the people of Northern Ireland will be subject to European Union law for a long time into the future, as far as we can see, so it is not correct, is it, to say that the sovereignty of the entire United Kingdom will be placed in this place?

Leaving the EU: Business of the House

Debate between Karin Smyth and Steve Barclay

Wednesday 12th June 2019 Commons Chamber

[The Secretary of State for Exiting the European Union (Stephen Barclay)]

May I be the first to congratulate my hon. Friend the Member for North Dorset (Simon Hoare) on his election to that important Select Committee, at an important time for it?

I want to begin by picking up on a few of the points that the right hon. and learned Member for Holborn and St Pancras (Keir Starmer) made in his opening remarks. The first passage of his speech covered what the motion does not do. He set out that it does not cover the legislation that it would unlock—it does not cover the substance, and it does not cover the form. So often in our exchanges at the Dispatch Box, he tells me how much he does not like a blind Brexit, and yet what we have before the House is, in essence, a blind motion. He devoted his opening remarks to the extent to which this is a blind motion, for it does not contain the detail on the basis of which the House will decide.

Interestingly, in the context of the Conservative leadership election, the right hon. and learned Gentleman went on to point out that a new Prime Minister would be limited—they would be unable to go to Brussels to secure a change of substance to the backstop—and yet his position is that a Labour Prime Minister would be able to go to Brussels to secure that. Within his remarks, one can see the contradictions inherent in the motion.

Let me deal with the substance of the motion. Section 1(b) gives precedence to any motion from any individual MP over Government business, and section 1(c) states that it is for you, Mr Speaker, to decide whether that motion is brought before the House over other motions. In essence, sections 1(b) and 1(c) say that an individual MP and the Speaker—two Members of the House—can override Government business. That is the effect of the motion. It puts in the hands of just two Members of Parliament the decision on which business takes precedence. That is what the text of 1(b) and 1(c) says.

[Karin Smyth (Bristol South) (Lab)]

The current Prime Minister has got stuck in a triangle composed of the Brexit that the Conservative party wants, the constitutional make-up of the United Kingdom, and the successor to the Good Friday/Belfast agreement and all it contains. She has not been able to sort out that triangle. What will be most important to the new Prime Minister when he goes to Brussels: the Brexit he is promising the Tory party, the constitutional make-up of the United Kingdom, or the legacy of the Good Friday/Belfast agreement?

[Stephen Barclay]

First, the hon. Lady says “he”, but there are a number of female candidates in the leadership election and one should not pre-empt the outcome. Secondly, we do not know who the Prime Minister will be. Thirdly, first let me deal with the text. [Hon. Members: “Answer the question.”] I will happily come on to it, but I thought we were here, as per the direction of Mr Speaker and as the hon. Member for Stoke-on-Trent Central (Gareth Snell) said in an intervention, to debate the motion. [Interruption.] The hon. Member for Heywood and Middleton (Liz McInnes) may chunter, but I am not surprised that she does not want to debate the motion, because it is a flawed motion, for reasons I will come on to. Labour Members do not want to debate the text that is before the House.

Oral Answers to Questions

Debate between Karin Smyth and Steve Barclay

Thursday 4th April 2019 Commons Chamber

[Stephen Barclay]

I think the hon. Lady mischaracterises the position. The number of staff recorded as EU27 nationals working in the NHS trusts and clinical commissioning groups in England increased by more than 5,200 between June 2016 and December 2018—there has actually been an increase in EU nationals. She also omits to mention the record investment—£20.5 billion a year extra—that this Government are making in the NHS, the NHS apprenticeships we are bringing through, and the change in tier 2 visas for talent around the world in order to attract more doctors and nurses to the NHS.

[Karin Smyth]

In my former job, before I came to this place, I was an emergency planner for the NHS locally in Bristol. The NHS has had to put in contingency plans and major incident plans to cope with a no-deal scenario and the future. What compensation will the Government give local NHS bodies for the time and money they have spent and wasted on incident planning that probably will not come into effect because of the Government’s incompetence?

[Stephen Barclay]

I know from my time as a Health Minister that the hon. Lady always asks very pertinent questions in respect of health matters. She will be well aware of the statement issued by the Royal College of Paediatrics and Child Health, which said how well prepared the NHS was. It has been our priority to ensure that we maintain the supply of medicines and to ensure that the NHS is a priority in our contingency planning. That is the responsible thing for a Government to do.

Management of NHS Property

Debate between Karin Smyth and Steve Barclay

Wednesday 4th July 2018 Westminster Hall

[The Minister for Health (Stephen Barclay)]

It is a pleasure to serve under your chairmanship once again, Ms Dorries. I pay tribute to the hon. Member for Bristol South (Karin Smyth) for bringing such an important issue before the House.

The hon. Lady opened by saying that property may not be the most exciting of topics but, as her speech set out, it is integral to the healthcare service offered in local settings. The substance of her remarks was whether we can better align the property estate with a place-based approach to healthcare. As we move to a more integrated and place-based approach to health, I think there is cross-party consensus that property has an important role to play as an enabler of that. The hon. Member for York Central (Rachael Maskell) kindly recognised that that is very much the approach that I have taken in my post, and my hon. Friend the Member for York Outer (Julian Sturdy) recognised it in expressing his frustration with one or two meetings and asking whether decisions on property are aligned with the place-based approach.

The first point I will make to the hon. Member for Bristol South is that the long-term plan and the future discussions about the NHS give us the opportunity to look at wider system changes around integration and place-based healthcare, and how property aligns with that—for example in York, which has been discussed—as an enabler of change in a more holistic approach. As such, her remarks are timely as part of that wider debate.

The hon. Lady mentioned Knowle West health park, which, if I am honest, I looked at for the first time when preparing for the debate; I was not as sighted on that as I might have been. The issue is that, if NHS England provided that service, the additional market rent costs would have been reimbursed, but because it is provided by the county council they are not. However, as she recognised, there has been progress in recent weeks, thanks in part to her work. I am happy to take forward a discussion on that offline if that would be helpful, because I recognise that it is an important service and that we need to ensure that, where market rents are applied, it is not counterproductive to those services.

However, that should not get in the way of the wider point. The hon. Lady suggested that the new approach is a backwards step. I simply point out that there has actually been significant progress by NHS Property Services. The previous model had the inherent conflict that the primary care trusts were both the landlord and commissioner of the property, and therefore the use of the estate was quite opaque. As a result, we did not get transparency on the true cost of the estate, meaning that inefficiencies were not being flushed out and estates were not being utilised in the most effective way.

One driver of NHS Property Services applying market rents has been the need to encourage better utilisation of the estate by being more transparent on the actual costs. I point out to the hon. Lady that there has been significant progress as a consequence. Some £200 million in capital receipts has been unlocked, 500 capital investment construction projects are being launched each year and running costs have been reduced by £120 million. On balance, as we look forward to the long-term plan and pick up on some issues that the hon. Lady quite rightly highlighted, it is also important to recognise that the old system often allowed estates to be utilised inefficiently. Having truer market rents has actually enabled more transparency and driven efficiencies, with savings then able to be reinvested into the service.

The hon. Lady also mentioned salaries and bonuses, which again are part of a wider question. On the one hand, these are big businesses and their leaderships compete in a competitive market. There is a wider debate within Parliament on the right value to assign to senior salaries in the public sector in order to attract talent. These are big budgets, so we need to attract people of the right ability; it is a false economy to save a relatively small sum on lower salaries for people who then make incorrect decisions that waste much larger sums. At the same time, salaries should reflect the values of the NHS and should not be out of step with others in the NHS. There is a cross-party debate on that, and I am interested in the hon. Lady’s points about it.

The hon. Lady also raised NHS Property Services’ new offices. My understanding is that the previous model was highly inefficient. It had five different properties, so the move to Gresham Street was a consolidation of those five properties into one. That drives productivity, which is a key issue that we need to unlock within the workforce. Two thirds of NHS costs are in the workforce, so driving workforce productivity is a key objective. I am sure the hon. Lady will agree that the workforce being consolidated in one office enables a degree of productivity and efficiency that would be harder to achieve if they were disparate across five areas.

The hon. Lady mentioned the impact of the rent adjustment on Bristol. Some 15 GP practices in and around the city of Bristol occupy NHS Property Services sites. NHS England has been working with the Avon local medical committee, practices, NHS Property Services and the Bristol, North Somerset and South Gloucestershire clinical commissioning group and has facilitated negotiations between GP practices and NHS Property Services on reviewing the levels of rent and service charges invoiced to GP practices, to ensure that there is transparency on them.

However, as the hon. Lady will be aware, rent and business costs incurred by practices are reimbursed to GPs under the premises cost directions, and GPs should be compensated for any rent changes through that route. The Department has provided an additional £127 million to the NHS England mandate, with effect from the 2016-17 financial year, to fund the increased costs in the NHS of this policy change.

[Karin Smyth]

I am grateful for the Minister’s comments about, and work on, Bristol. I agree that the estate was not always particularly well managed in the local health system previously, and that the correct incentives are needed. However, does he agree that he has outlined a merry-go-round of money keeping the entire system afloat? NHS Property Services exists on a large and continuing Department of Health loan, so it is not, in any sense—as the Minister described—a successfully run property business.

[Stephen Barclay]

I was trying to make the point that greater transparency on the true cost of the estate drives behaviour to use the estate more effectively. Part of the difficulty has been that, because the estate was not adequately charged market rents in some areas, moving to a fairer and more transparent assessment of market rents—these things are independently assessed, I hasten to add—is a difficult adjustment. However, a consequence of correctly assessing the value of the estate is the unlocking of efficiencies where the estate is not being utilised, and that money can then be reinvested into the system.

I absolutely agree with the hon. Lady’s wider point, which I took as the substance of her remarks, that property is the enabler of system change. That also came out in the points raised by my hon. Friend the Member for York Outer, and has been inherent in points made by the hon. Member for York Central in our previous discussions. Property does not sit in a silo but is inherent in the wider service offering, and it also plays into reconfigurations. A key part of clinically led reconfigurations of estates to drive productivity will be what property there is to enable that and how to utilise it.

The point on which there is a degree of cross-party consensus, as my hon. Friend the Member for Henley (John Howell) recognised, is that decisions need to be accountable. Likewise, I am happy to pick up on the point he raised on behalf of his constituents about there being no accountability. That is an absolutely fair challenge to the Department and one that I am very happy to look at. However, I am mindful, as I know he will appreciate, that these are often independent bodies making independent decisions, and we need to look at how they fit into the system.

A further point raised by the hon. Member for Bristol South, although it is slightly outside of the scope of the debate, was about wholly owned subsidiaries, which she also raised in more detail in the estimates debate. I make two points. First, as she knows, subsidiary companies actually give greater flexibility to trusts that want to compete in a local market and perhaps offer higher salaries offset by changes to pensions. That is one way in which trusts are empowered and enabled to hire in a competitive market, for instance in the case of maintenance staff. It is an enabler, and it often results in people getting paid more for a role, although there may be other, less favourable terms and conditions to offset that. I merely point out that those were exactly the arrangements reached for Members, and I do not remember too many press headlines suggesting that Members were being exploited by that change.

Secondly, I remind the hon. Lady that, as I am sure she is well aware, legislation introduced by the last Labour Government enabled wholly owned subsidiaries. Again, I do not recall Labour Ministers, when taking that legislation through the House, suggesting that it would provide a way of exploiting NHS workers or privatising the NHS.

I commend the hon. Lady for the points she raised. This is a timely debate given our discussions with the NHS leadership on the long-term plan. She is absolutely right—Government Members and other Opposition Members also recognised this—about the centrality of property to the place-based approach that we seek to take. I am happy to have a separate discussion with her on Knowle Park to check whether that is now in the right place or whether further work is needed. I look forward to further discussions with her on how we should utilise the property estate in the most effective way.

Question put and agreed to.

NHS Wholly Owned Subsidiary Companies

Debate between Karin Smyth and Steve Barclay

Tuesday 6th March 2018 Westminster Hall

[Stephen Barclay]

I will happily take interventions, but first I will finish this point, addressing the previous issue. The recent staff survey was extremely positive: 86% felt part of the Gateshead Health NHS Foundation Trust group. Furthermore, the figure for those with a positive response to the level of pay was 15% higher than the NHS comparator. The idea that the arrangement is exploiting people when the staff survey shows them to be 15% more approving than in other areas is again not a fair representation of the case.

[Karin Smyth (Bristol South) (Lab)]

In the short time remaining, I would like to move the Minister on to the issue of accountability for public money. Following a freedom of information request, in the case of Yeovil we understand that the benefit to the trust is several million pounds-worth of income, which is a lack of income from the Treasury—I have written to the Minister about this and I will be grateful for an answer. Is the Government’s position that they would be happy to forgo the expected income to the Treasury so that those companies can be set up to undercut wages?

[Stephen Barclay]

As I set out in my reply to the hon. Lady, the Department has been clear that setting up a subsidiary is not a vehicle to avoid VAT—that is not acceptable. In the autumn, we sent out guidance to make that clear. As a former Treasury Minister myself, I assure her that Treasury Ministers would take a very close interest if they felt that an abuse of VAT was taking place.

The reality is that commissioners and regulators are responsible for ensuring that NHS providers act in the best interests of patients and taxpayers. We would expect providers to work closely with their employees in any developments.

Oral Answers to Questions

Debate between Karin Smyth and Steve Barclay

Tuesday 6th February 2018 Commons Chamber

[Karin Smyth (Bristol South) (Lab)]

9. If he will hold discussions with the Chancellor of the Exchequer on the VAT status of NHS trusts.

[The Minister of State, Department of Health and Social Care (Stephen Barclay)]

There are no plans to hold discussions with the Chancellor of the Exchequer on the VAT status of NHS trusts.

[Karin Smyth]

I am grateful for that reply, although I suggest it ought to be reconsidered. NHS trusts desperate to avoid financial difficulties appear to have found a new magic money tree: setting up wholly owned subsidiaries to avoid paying substantial amounts of tax to the Treasury. Rather than encouraging this tax dodging and further fragmenting the NHS, why do the Secretary of State and his friend the Chancellor not either ban this practice or agree to let them all have the VAT exemptions?

[Stephen Barclay]

The Department wrote to all NHS and foundation trusts in September 2017 to remind them that tax avoidance schemes should not be entered into in any circumstances, but the hon. Lady makes a slightly strange point. She seems to be arguing that NHS hospitals are, in essence, paying too much tax to the Treasury, rather than having that money within the NHS. These subsidiaries are 100% owned by trusts themselves.