NHS (Charitable Trusts Etc) Bill
Kevin Foster Excerpts(8 years, 3 months ago)
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Michael Tomlinson
I envisage the consultation being as wide as possible. My hon. Friend mentions everyone who has been to see “Peter Pan”, and that would be a pretty wide consultation—perhaps not everyone has seen “Peter Pan” and I highly recommend that those who have not, do so. I envisage that the principle is that it is as wide a consultation as possible.
The Bill, which has wide support on both sides of the House, is the product of a public consultation, so I fail to see how Members can disagree with this proposal.
Kevin Foster (Torbay) (Con)
I thank my hon. Friend for giving way; he is being incredibly generous in taking interventions. Every charity has a group of people it benefits. Does my hon. Friend agree that for this consultation to have any meaning, it would have to be with the entire area of benefit, which could in some cases involve literally millions of people? Does he also agree that most of them would probably feel their charitable funds would be better spent getting on with the job, rather than having a very large consultation about who appoints a director of the trustees?
Michael Tomlinson
I understand that point, which is similar to other points questioning the benefit and the cost, but I respectfully suggest that the benefit outweighs the cost in this case and that the public, seeing that they are consulted, would once again be re-engaged with the political process, which I think my hon. Friend should support.
Michael Tomlinson
In which case, let me turn to that very point. As my hon. Friend rightly says, my amendment 4 contains the word “appropriate”. We can all envisage inappropriate public consultations. I again contend that this term should be relatively uncontroversial, because we all know what it means. An inappropriate consultation would be too short or would take place over a festive period such as Christmas, when either people would not have the opportunity to respond or an insufficient number would have the opportunity to do so. Although I welcome the opportunity to expand on the word “appropriate”, I believe it is pretty obvious what it means.
Kevin Foster
The word “appropriate” also relates to the level of the thing to be consulted upon. We have a tradition in this country: certain things—for example, Britain’s membership of the European Union—are decided by consulting every member of the public in a referendum. Other issues such as school funding also affect the wider public, but on issues such as who is a director of something we do not usually go to the length of a full public consultation to decide the process. This is about what is appropriate given the nature of the issue, as well as what is appropriate in terms of the time of year the consultation is held and how long we give people to respond.
Michael Tomlinson
I am very grateful for that helpful intervention. I would wish to expand on the issue of an EU referendum, but I suspect that Mr Speaker would encourage me to move on, so I will not be tempted down that line. I understand the point my hon. Friend makes and will merely respectfully suggest that the word “appropriate” speaks for itself and requires no further elaboration.
Given your encouragement, Mr Speaker, I will now move on to amendments 5 and 6, which also stand in my name and that of my hon. Friend the Member for Erewash. They seek to remove the requirement that the regulations may make provision consequential to the removal of the Secretary of State’s powers; in effect, they would remove the affirmative resolution procedure and insert the negative one. They are simple amendments, so I will not take up your time in debating them at length, Mr Speaker. In effect, the debate is being held now, as is perfectly appropriate, and it would therefore be unnecessary in this case to bring it back.
Mr Rees-Mogg
I raised the question of what the word “appropriate” meant earlier and I was indeed intending to come back to it. Appropriate, inappropriate, unacceptable and disappointing are those new Labour words that get dropped into conversations and they mean remarkably little or what, in a Humpty Dumptyish way, what the person hearing them wishes to think that they mean. What is an appropriate consultation? There is no qualification or clarification in the amendment, so what is it intended to achieve? Does “appropriate” mean that signs should be put on noticeboards, as with planning issues? Does it mean that letters should be written to local residents? Does it mean that something should be squirrelled away on the internet? Does it mean that a paper should be laid before this House, or put in the Library, where, no doubt, many people would follow its contents closely? Or does “appropriate” mean that the Secretary of State has a word in his office with the permanent secretary, saying, “Do you think this would be a good idea, Sir Humphrey?”, then Sir Humphrey replies, “Well, you would be very brave, Minister,” and then the idea is dropped on the basis of that consultation? Does it mean the Secretary of State can have a word at home with his family—with his kitchen cabinet—telling them that he is minded to appoint or not appoint a few trustees? I could tell all sorts of anecdotes about how that used to happen in the good old days, but I think it might be wandering slightly from the point. “Appropriate” is a very imprecise word and legislation ought to be precise.
Kevin Foster
My hon. Friend is giving us the benefit of his usual style of speech—[Interruption.] Of fashionable speech, yes. It is certainly in fashion on a Friday to hear my hon. Friend the Member for North East Somerset (Mr Rees-Mogg) speak so well. Does he agree that the problem is that “appropriate” can mean anything under the sun and that various people have different views? For example, with the recent pension changes, some have said that the information should appear in adverts in the press and others that it should be provided in individual hand-delivered letters. This term is so vague and really would have to be defined. I think it is strange to say that we want to consult if we are handing out something that is unlikely to get more than a handful of responses given its detailed and technical nature. That will merely build up in the public’s mind the idea that yet again people have decided what they will do and are now consulting on it.
Mr Rees-Mogg
I agree with my hon. Friend. I want to finish on this set of amendments by saying that this House should be jealous of its role as the major focus of consultation in the nation. We were elected to represent our constituents and therefore to express views on these issues. That is why we are here, and what is done with consultation so often is a pretence. It is not about the Government wanting the wisdom of the millions before making up their mind but about the Government wanting the comfort of having been through a rigmarole to get what they wanted in the first place. We should not give up our authority lightly or increase the power of the Executive.
I know want to turn briefly to the amendments tabled by my hon. Friend the Member for North West Hampshire, which are absolutely glorious in their conception. They basically reverse what the Bill is trying to do in the first place, which is a great thing for him to have slipped past our ever-attentive Clerks. That does not often happen on Report. Perhaps the amendments—and this is why our Clerks in their wisdom let them go through—would ensure that there is a safeguard. Safeguards may be sensible. There have been occasions where charities have got into trouble when public money is being spent. Although it is broadly considered a good idea to remove the power from the Secretary of State to appoint trustees so that a decision is made more locally and so that the construction of the charities may be more suitable for the local organisations—that has a great deal of support —we know that something will go wrong at some point.
That is not a particularly Cassandra-like view to take; it is just the experience that we have. We know that there will be a small charitable hospital that puts all its money into an Icelandic bank, for example, and suddenly loses it. The trustees get criticised and attacked, or they write 3,000 letters a year to elderly ladies asking them for money and are seen to have behaved badly. Then somebody will come forward, probably a Member of this House, who will ask the Secretary of State at Question Time, “Why is it that you, Secretary of State, are not doing anything to stop this problem arising? Why have you not kept those residual powers? Why did you not ensure that when the Bill went through Parliament, there was a safeguard, something to protect—”
Mr Rees-Mogg
My hon. Friend makes an interesting and important point. NHS charities are different because of the structure of the national health service and the conception of the national health service in people’s minds. There is much less of an immediate governmental interest, or concern with, ordinary private charities that were founded sometimes centuries ago with grants from generous benefactors that through the mists of time have evolved and developed. NHS charities work side by side with the state in all that they do, so they are a marginal extension of the state rather than something completely different from it. If we draw a Venn diagram of the third sector, we have a part that is very private and another part that is very much state. NHS charities are very much in the state part of the Venn diagram.
Kevin Foster
I thank my hon. Friend for giving way. He is generous with his time, as always. He talks about NHS charities being close to the state and therefore needing particular provision, but many other charities work closely with our national health service. I think of Rowcroft hospice in my constituency which provides palliative care across south Devon. Why, then, safeguard only certain charities? Why not expand it to all? The amendments do not strike me as worth while.
Mr Rees-Mogg
My hon. Friend ignores the starting point, which is that the Secretary of State makes the appointments, whereas that has never been the case for other charities. They have evolved differently, whereas NHS charities are evolving out of the NHS, more towards the private sector. To put in place a safeguard which one hopes would not be used seems to me quite a prudent thing to do. It says, “This is our hope, this is our intention. We expect it to work and we think it will work in the vast majority of cases and make NHS charities more like other private sector charities.”
Mr Rees-Mogg
I quibble about the word “rescue”. It is not so much rescue as fire. If the trustees do things badly, the Secretary of State may fire them and put other people in their place. That would not encourage slackness, idleness or malpractice. It would encourage probity, forthrightness and good management. The logic of my hon. Friend’s argument supports what I am saying, rather than what he thought he was promoting.
My hon. Friend the Member for North West Hampshire has proposed extremely sensible, prudent measures that will keep a broad eye on what is going on.
Kevin Foster
I am listening to the points being made, but I am still struggling to understand why a handful of NHS charities performing wrongly would be any different from any other charity performing wrongly. I see the hon. Member for Bristol South (Karin Smyth) in her place. We remember the recent discussions in the Public Accounts Committee about the Kids Company collapse. Why should we not have a good system of charity regulation, rather than a specific power, as suggested in the amendments?
Mr Rees-Mogg
I reiterate—I am sorry, Mr Speaker, to reiterate. I may be becoming repetitive, but I hope not yet tediously repetitive; that may come at a later stage. We need to look at the starting point. These charities are coming out of the control of the Secretary of State. To move them completely away from his control in one fell swoop may be relatively imprudent, whereas to do it more cautiously and keep a safeguard is perfectly sensible. By contrast, in the case of charities that have never been under the Secretary of State and have never had their trustees appointed by the Government, it is perfectly sensible to leave them with their existing regulatory system.
Mr Rees-Mogg
I go back to what I said earlier about where NHS charities sit. By virtue of the money being given to a charity that supports the NHS, that money comes into the public purview and is subject to the way in which the public sector ought to ensure the good management of money. That is why I think it is appropriate—“appropriate”; I am using that awful word—rather, suitable and proper that it should be audited thoroughly to make sure that assets are not handed over that should not be handed over or misappropriated, and to give confidence to this House, and indeed to the other place, that moneys are being sensibly protected. These are very modest amendments.
Kevin Foster
Does my hon. Friend agree that some of his comments strike against the heart of this Bill, which says that these charities should be independent so that people feel encouraged to donate to them rather than feeling that by doing so they are replacing what could be, or they might believe should be, funded by the Government. Saying that it becomes public money when donated hits at the whole point of the Bill.
Mr Rees-Mogg
What a pleasure it is to see you taking the Chair, Madam Deputy Speaker. We have been waiting for this happy hour to arrive to help us carry our debates forward.
No, I do not think my hon. Friend is right. When people give money to a charity that is linked to the Government, they are even more concerned that it will be spent well, and they therefore want extra protections to assure them of that.
Mr Rees-Mogg
My hon. Friend’s kindness towards the Comptroller and Auditor General is, I am sure, noted in many other places beyond this one, and I expect that his office would be delighted not to have the extra work. However, my hon. Friend is missing a point that I may already have laboured, so I will labour it only once more. This is a transition phase. This money is very close to public money. It is in a Neverland, one might say, in that it is not quite separate from charitable money and not quite ordinary public expenditure. Therefore, keeping an eye on how it is used in the most formal and protected way, at least in an initial stage, is a prudent way of ensuring that the assets are not used or transferred unsuitably.
Amendment 9 is different in nature and arises from a constituency issue. A constituent of mine, with the support of the NHS, established a charity that put defibrillator boxes around the country. These are very admirable boxes that operate in conjunction with the ambulance service and have been shown to save lives by ensuring that defibrillation equipment is available throughout small villages across the country. It has been a most successful charitable endeavour.
While my constituent was working with the ambulance trusts, they wrote to him to say that it was perfectly all right—indeed, they wanted him to do this—to put the ambulance service logo on the boxes, so that people would know that they were formally connected to the NHS. He then received a letter out of the blue from some little-known bureaucracy that protects the NHS logo. I understand the reasons for that: we do not necessarily want random private companies to call themselves the NHS or for unrelated businesses to use the logo. Some protection is needed, but the letter struck me as a heavy-handed way of going about things. It was an excessive response to something that was linked to the NHS and that was, at its core, a health issue operating with and through the support of the NHS.
The amendment would merely make it straightforward for the Secretary of State to overrule the whole procedure. When there is an issue of this kind, the Secretary of State would have the power to say, “Well, there may be this bureaucracy that safeguards the NHS logo, but I am overruling it and giving permission for the logo to be used, because I think it is a sensible thing to do.”
The reason I like the amendment is that, in a strange way, it relates to what this place is about. It is about seeking redress of grievance for our constituents when they are badly treated by bureaucracy. The best way of doing that is not through independent, unaccountable and unelected bodies that have been separated off from Government, but by a Minister being held accountable at the Dispatch Box. That is how we get things put right for our constituents.
This very small amendment would simply allow the Secretary of State to short-circuit the system when it is behaving badly. It provides that the permission given by the Secretary of State can be cancelled with six months’ notice, which is a reasonable amount of time for people to change any boxes, stationery or anything else they may have with the NHS logo on it, if they are found to have been abusing the permission or for some other reason. The principle that power should be with democratically elected people, and that it should be there to override offshoots of bureaucracy that nobody previously knew about or cared for, is a very good and sound one. As I understand it, the issue that my constituent has had has been mainly sorted out, but the amendment would be a better and clearer way of dealing with such things.
Of the amendments that I have tabled, amendment 9 is of the greatest importance to me. As is the case with so much of what I have been saying, it is about the fundamental principle of what we are trying to do when we legislate. We are trying to ensure democratic accountability and the rights of our constituents, and not to be constantly handing things over to ever-growing bureaucracies.
Kevin Foster
The primary aim of this Bill is to make very clear that the charities are independent of the Government. The NHS logo relates to an organisation that is the epitome of what many people see the public sector as being about—that is, the Government. My hon. Friend’s amendment would, therefore, strike at the very heart of the Bill and make it less worthy.
Mr Rees-Mogg
My hon. Friend is absolutely wrong. He has misunderstood, misconstrued and possibly even misread the amendment, which uses the word “may”. I am not compelling the Secretary of State to go out and chuck the logo on to every box he sees all over the country or to spray the NHS logo on every shopping centre he passes. I do not see him as a vandal going around with a spray can and a little cut-out stencil, spraying “NHS” on everything or engraving it on our foreheads when we come into the Chamber. That is not what the amendment proposes—it uses the word “may”. It says that when those charities that work immeasurably closely—hand in glove, on some occasions—with the national health service find it useful to use the logo and the Secretary of State thinks it is a good idea, he may give them the authority to do so.
Kit Malthouse
I do not, and the reason is that the Secretary of State currently has control of the appointment of trustees. That is exactly why. If I were Secretary of State—I assume that the same is true of the current Secretary of State and past Secretaries of State—I would be very careful about who I appointed, so that I was sure that I was handing that fiduciary duty to people whom I trusted and who had an element of accountability to me.
Kevin Foster
My hon. Friend is being very generous in taking interventions. I want to get to the nub of his amendments. The examples that he has cited of corporate governance, and Alan Yentob’s emotional blackmail in respect of the Kids Company charity, relate to general issues of regulation. Why should NHS charities be different? We are trying to make them independent. Why should the Bill be amended in this way? I do not think that my hon. Friend would argue that any time a business or charity goes wrong, the solution is for the Government to appoint a director, so why is he making that argument in respect of this Bill?
Kit Malthouse
My hon. Friend is right. Proposed subsection (2B) in amendment 1 provides that the Secretary of State would be allowed to use the powers only by permission of the House. I am with my hon. Friend in his desire to protect the House’s privileges and powers. I did not get elected to give the Government a free run. When the good people of North West Hampshire elected me, they placed two votes: one for a Government and the other for somebody to hold them account. I will try to do that job. Should the Secretary of State wish to step in, he would have to lay a statutory instrument before both Houses of Parliament and seek their support. It could not be done easily, on a whim or through a signature on a piece of paper. It would require debate and examination, and need all of us to do our job of scrutiny and reach a settled decision to allow him to step in. I recognise that it is a fundamental step and that an element of separation should be maintained.
Kevin Foster
My hon. Friend is generous with his time. In my constituency, Torbay Hospital League of Friends has operated successfully for 60 years, raising millions of pounds for the benefit of local people. A picture is being painted of needing a step-in power, but the whole process that must be gone through to achieve it, which my hon. Friend has just outlined, probably makes the amendment meaningless. Why do these charities need such a provision when other successful charities that are linked to hospitals do not?
Kit Malthouse
My hon. Friend is a dog with a bone. As I have explained—I think five times—I believe that the charities that we are considering are different because of the inextricable link with the institution that they serve. In the public’s mind, they are just a vehicle to give the money to the hospital and the national health service. Indeed, many boast about the percentage of money given to them that will be spent on the wards of a hospital. Those charities are seen co-funding, along with the Government, the NHS. I can see that not everybody is convinced, but I hope that others will speak in support of my amendments.
As I have said, the provision would be in the House’s control through a statutory instrument. It is not as though the Secretary of State could act unilaterally. We would all have control.
Kit Malthouse
My hon. Friend will make a great diplomat when the time comes. I agree there is the possibility of misbehaviour by politicians, but we politicians come with a great advantage. We have had a few thousand people vote for us and those few thousand people can vote us out if they think we have behaved badly. There are not many other people in public life who come with that brake on their behaviour.
Kevin Foster
I will make this my last intervention. My hon. Friend has been very generous. With the provisions in the Bill I was expecting today to go off on a trip to Neverland. Instead, with all the death, doom and disaster in this speech I feel we are in an episode of “EastEnders.” Does he not agree that there is a very large area of charity regulation to deal with things going wrong and difficulties emerging? Charities will still be subject to that. Merely allowing the Secretary of State to appoint the odd trustee will not deal with any systemic problems. That is what the wider area of regulation is there for.
Kit Malthouse
Many years ago, my mother and father went on a camping trip in Europe. On their first night, they pulled in, in their Thames van, to what they thought was a campsite. In the dark, my father attempted to pitch the tent. Every time he tried to hammer a tent peg into the ground it went “Ping!” and disappeared off into the darkness. Only in the morning did he realise he had been trying to hammer the tent pegs into a concrete tennis court. That is how I feel this morning.
I have tried to explain many times now that these charities are different. They come with a badge upon them that says to the public they are partially in the public sector. Secretaries of State will always have an eye to their conduct, because what they do will impact politically and financially on the national health service and on whichever party happens to be running it at the time. I realise that, in the eyes of the sponsors, I might be pushing water uphill. Most people know I am a relatively optimistic person and I am hesitant to put these pessimistic circumstances to the House; nevertheless, someone has to do it.
I will move on now, finally, to other amendments. Amendment 9, in the name of my hon. Friend the Member for North East Somerset, seems eminently sensible and reflects exactly the point I have been making about the special connection. In these days of the internet, it is quite easy to download the NHS logo from any hospital website, affix it to a piece of paper and fire it off to raise money. I am sure it has, on occasion, been used fraudulently to raise money. I therefore completely support his wish to have some kind of control over the use of the logo, the name and the brand.
Giving that power to the Secretary of State seems eminently sensible to me, not least because these charities maintain most of their fundraising ability through their connection with the NHS. The leverage is extremely powerful and very useful. Many will raise millions and millions of pounds off the back of their connection with the NHS and they should be encouraged to do so. The judicious use of the brand, the logo and the name is absolutely to be supported, but it needs to be done in a relatively nimble way. The only way I can think to do that is via the permission of the Secretary of State, so I support the amendment.
Unfortunate amendment 4 deals with consultation. As I said in my intervention earlier, during my career in local and city politics consultation became the bane of my life, and of my residents’ lives. We all knew, when we participated in a consultation, that the decision had broadly been taken already and that the politician or Department in question was largely going through the motions to make sure they were not judicially reviewed or challenged.
Of course, the notion of consultation was promulgated by the Blair Government. It is a characteristic of our managerial, technocratic politics. Where we have a House filled with conviction politicians who know what they believe, and that what they believe is right for the country, they do not need to go out and consult. They consult once every four or five years through general elections and display the philosophical sheet-anchor that sits underneath every decision they make. However, when politicians drift from their basic principles into unknown waters, they feel a bit uncertain. They feel a need to consult, to be told what to do and to get a feel. That is what politicians do these days: they have focus groups and polls. They consult constantly about their image and what they should and should not do.
I would therefore like to play a small part in doing our bit to rein back the amount of consultation. We could get to a situation where this House becomes redundant. With the advent of technology, the thing that naturally follows consultation is permanent referendums where everybody can vote from their desks, and we do not need to have a House that discusses and debates from points of experience and different aspects. I therefore firmly oppose the amendment.
Wendy Morton
Absolutely. As I am explaining, the amendments, worthy of consideration though they be, are not necessary in the light of the research I have done, and they would fundamentally change the objectives of the Bill.
The amendment to make
“provision for one trustee to be appointed by the NHS institution…for whose benefit the charitable trust exists”
is an interesting one, but again I do not believe it necessary. Under the new independent charity model there can be a “blend of trustees”, meaning there can be a link to the hospital—on the proviso that the NHS members remain in the minority. That is important. When we are seeking to move away from Secretary of State appointments to a more independence model for special charities, it is the word “independence” that is crucial. These charities are seeking to be independent of Government for fundraising and many other purposes.
Kevin Foster
My hon. Friend may be aware that the Public Accounts Committee recently considered a report on the sustainability of NHS trusts, many of which are in deficit. Does she agree that if they had a right to appoint a trustee, it could reinforce in the public’s mind that these charities are about back-filling money into the NHS that could or should be provided by the Government rather than being independent charities providing extra money to what is provided by the Government and the public sector?
Wendy Morton
My hon. Friend raises an interesting point. The key point of my private Member’s Bill is to enable this group of charities to achieve what they said they wanted in the consultation, which is a shift away from the Secretary of State’s powers to appoint so that they can demonstrate independence. The charity world has moved on so much since charities were first created, and the model of governance needs to change in the same way.
What makes this particularly interesting is that previous rules surrounding the appointment of individual trustees were restricted to one linked person only. In any case, I believe that the new arrangements in the Bill—not the amendments—are far better and far more beneficial because this “blend of trustees” helps further to help and enhance communications and understanding by both the charity and the trust. Surely that can only be a good thing.
If I may, as the Member in charge of the Bill, I would like to touch on amendment 9, which deals with the use of the NHS logo and was tabled by my hon. Friend the Member for North East Somerset (Mr Rees-Mogg). I shall not make too many references to fashion. Although I could make many a link between logos—and, indeed, brands—and fashion, I shall leave Members to draw their own conclusions about the fashion, style or otherwise of my hon. Friend. To be fair, he raised the issue of the NHS logo on Second Reading, so it is only right for him to bring it forward today as an amendment for consideration. I bow, if not to his fashion sense, to the grace and eloquence of his style in speaking to his amendment today. Perhaps we could share some lessons.
The term “logo” can be defined as a symbol or other small design adopted by an organisation to identify its products, uniforms, vehicles or perhaps a company or organisation. It is often uniquely designed for ready recognition, and I think the NHS logo fits that definition. It is instantly recognisable, and the public know exactly what it is all about. However, I cannot support the amendment because I believe it is a matter best explored through the Department of Health or perhaps through the memorandum of understanding, which is part of the move to independent charity status. It should not become part of this Bill.
At risk of sounding—hopefully not appearing—more like Hook than Wendy Darling, I will bring my comments to a conclusion by simply saying that although we have explored worthwhile amendments this morning and raised some important points, I shall not support any of those amendments.
Kevin Foster
I am conscious of the time, so I shall be careful not to be either repetitive or irrelevant, and to confine my remarks to the amendments. I should make it clear at the outset that, while I respect the points of passion—and fashion—that have been made in support of them, I do not think that any of them would enhance the Bill.
Amendment 4 deals with public consultation. We surely do not want to ask people to comment on a matter that has already been decided, or in circumstances in which a response to a consultation will not make any real difference to the outcome—other than, as was pointed out by my hon. Friend the Member for South East Cornwall (Mrs Murray), potentially helping to take funds away from either the charity and its objectives or the Department of Health, which is paying for the consultation.
As several Members said, nothing is more likely to build public cynicism about politics than the idea that people have been asked to comment on something and their comments will then be virtually ignored. I can think of an example in local government. A council wanted to reduce free weekend parking, because that had been a manifesto commitment and the council had been returned with a majority. However, it then had to engage in a legal public consultation to find out whether motorists objected to the idea of free parking at the weekend, as opposed to the idea of paying for it. That was absolute nonsense. Several thousand pounds were wasted on advertising in the local press with public notices, and, funnily enough, no motorist wrote in saying, “Do you know what, I would actually like to pay two quid next time I park.”
We should not introduce measures that will engender cynicism. We should not say that a measure has been decided on and announced, but will be subject to a consultation; nor should we provide for a consultation on a matter that is highly technical, and with which very few people will be able to engage. When I was preparing for the Second Reading debate and for today’s Report stage, I found myself burrowing into a huge amount of detail. I do not see how a consultation would be effective.
Mrs Sheryll Murray
With individual consultations as well, there is no guarantee we are going to reach everyone. I remember when a consultation was entered into on whether Cornwall should have a unitary council, and the company used admitted in the end that it had not reached all the households concerned, so a lot of people were missed. This is one of the downsides of consulting on individual things.
Kevin Foster
My hon. Friend makes excellent points about the difficulties in reaching everyone. In the consultation that created Cornwall Council, there was a major discussion to be had on, I believe, six district councils and one county council being merged into one. There was significant media coverage on, for instance, BBC “Spotlight” and BBC Radio Cornwall, but still, even after all that, some people will have said, “I didn’t know the consultation was going on,” or “I didn’t know exactly what the nature of the consultation was.”
I sat through discussions about future local government structures, including referendums on an elected mayor, during my time in the midlands. People could, I think, engage with some things—for example, planning decisions or social services decisions—but in terms of how a local charity board is structured at the local hospital, and who can make appointments, how they are structured and the process gone through to make them, I cannot see many people saying, “I want to go out to talk about that on a Tuesday night in mid-February.”
If we are having consultations, they should be meaningful. On the question of what is “appropriate”, we should be asking what the appropriate stage is of decision making for each item. As I have argued in the Chamber before, on major constitutional change—the voting system for this House, for instance, or whether we abolish, or significantly change, the other place—we would probably at least need a manifesto commitment, and without that people should be directly asked for their consent to make that change. In terms of the fundamental constitution, it should have the direct consent of the people, therefore. At the other end of the spectrum, however, none of us would argue that the things that this House deals with through secondary legislation would be appropriate subjects for public referendums.
We should ask what the appropriate process is, and in this case the appropriate level of consultation would more be along these lines: “Yes, the charities should talk to each other and, yes, they should go through the normal process to appoint trustees by speaking to their members, but they do not necessarily have to host a public meeting to discuss that.” If this amendment were passed, there would be the nonsense that these particular charities would be required to go through a public consultation, yet the vast majority of charities in this country, who are regulated under the normal method for charities, would not have to do so. I recognise the intention of my hon. Friends the Members for Erewash (Maggie Throup) and for Mid Dorset and North Poole (Michael Tomlinson) in wanting people to be able to engage with the NHS and its services, but this amendment is not the right way of going about it.
On amendments 1, 3 and 2, tabled by my hon. Friend the Member for North West Hampshire (Kit Malthouse), I found the level of doom and disaster that was presented as possibly affecting these particular NHS charities quite interesting. If anyone listening is thinking of becoming a trustee, they might be slightly put off from doing so when they hear all the things that could possibly happen to them as a member of the board of trustees of one of these charities. I am not at all convinced that we need special provision in this Bill for these charities, rather than the wealth of charitable legislation that we already have, including a Bill currently before this House to change that legislation.
I do not think these amendments would tackle the issues, and worst of all they still give the idea that the Secretary of State is in control of a charity. As I said on Second Reading, at the heart of this Bill is independence. It is about these charities not being seen as an arm’s length part of the Department of Health—not being seen as government by the back door.
Wendy Morton
Does my hon. Friend therefore agree that these amendments on trustees, which seek to re-establish the powers that my Bill wishes to remove, represent a regressive step, rather than the progressive step the Bill seeks to deliver?
Kevin Foster
My hon. Friend is right. The whole point of the Bill is to free these charities from being, in effect, arm’s length parts of the Government. If we say, “We want to free you, but now we want to pop back in the Secretary of State having specific powers that do not apply to any other charities”, that is not a coherent argument and it would not produce coherent legislation. Hon. Members may have concerns about how charities are regulated and whether someone can go off to the Seychelles with the money, but that is a debate about the wider system of charity regulation in this country. They should not seek to put something specific into this Bill that adds another layer of bureaucracy for the charities involved, given that the whole point of the Bill is to get shot of such bureaucracy. I am not persuaded by those amendments.
Amendment 9 deals with the NHS logo. It was put forward eloquently by my hon. Friend the Member for North East Somerset (Mr Rees-Mogg), but, sadly, I will not be joining in the fashion of supporting it. I appreciate that the bodies it deals with are working closely with the NHS, but so, too, do other charities. For example, the Torbay Hospital League of Friends has its own logo and it successfully raises money for Torbay hospital. The name makes it obvious what it is linked with.
Mrs Sheryll Murray
We could extend that point even further. A lot of the surgeries in my constituency have “friends of the surgery” organisations. Are we saying that they should be allowed to use the NHS logo, too? Where does this end?
Kevin Foster
I thank my hon. Friend for that good point. Once we start on the principle of these changes, where do we stop? Karing, a charity in my constituency—it is in Preston, in Paignton—is very closely linked with a local doctor’s surgery, and it was lucky enough recently to have had its new base opened by Esther Rantzen. It is not, however, part of that surgery. Clearly, the two work together, with Karing supporting and providing great services, giving real benefits to local people, but, crucially, it is not part of the business that is the surgery, nor is it part of the business that is the NHS. That is where the logo point comes in.
Tom Tugendhat
My hon. Friend is making a strong, clear point. In my constituency, Edenbridge hospital has a league of friends, which is there not only to support the hospital—it does that incredibly impressively—but to support the needs of the community and to advocate when the hospital gets it wrong, which, occasionally, it may have done. Keeping that independence is essential so that the charity can actually do its job and not merely be an adjunct to the hospital.
Kevin Foster
My hon. Friend makes the excellent point that many people will see a league of friends at a local hospital as not just having a function of holding some money in an account, but as also being a stakeholder in the process, able to speak independently and fearlessly about the local hospital and the charities. It needs to be seen as neutral and independent. As we have mentioned, the Public Accounts Committee looked in depth this week at the financial sustainability of NHS trusts. There are concerns about that, and we have seen examples where NHS trusts have gone badly wrong. Thankfully, this Government have been far more prepared to talk about that and deal with it than previous Governments have been. If the charity is seen to be part of the trust, we go back to the idea that the charity is not bringing in additionality. People will think, “I am not donating money so that there is something extra; I am donating money that could or should have been provided by the Government or by the trust.”
If we start spreading the logo around, we open up other debates that are not particularly helpful, as we set a precedent. That was touched on briefly in the intervention by my hon. Friend the Member for South East Cornwall. People are very precious about the NHS—it is a symbol of the public sector, delivered by the public sector. That is a very important point. If we start extending use of the logo to charities, what do we do about other bodies that might wish to start using it? For example, we regularly see the NHS logo used alongside “in partnership”, for example with a foundation trust or the Department of Health, but we do not see groups such as my local league of friends abandoning their long-established and very well-recognised brand within the local area to say that they are collecting for the NHS. The Torbay Hospital League of Friends is doing a great job with its “This is Critical” campaign to get money to help equip the new critical care unit of the hospital, but it is not the NHS, and the essence of that approach is that what it provides is additional and that it is independent. That is why, for me, the amendment would go against the whole spirit of the Bill, which is about independent charities and independent trusts. For me, amendment 9 does not make sense and I will not be supporting it. I hope that my hon. Friend the Member for North East Somerset will not press it to a vote.
Jeremy Quin
I am grateful to my hon. Friend for clarifying his views. I have no problem with paying for consultations when they are necessary and appropriate, but I do not believe that the circumstances likely to pertain to the Bill will be in that category. Issues worthy of consultation are those described by my hon. Friends the Members for Torbay and for North West Hampshire, and the local issues to which I referred.
On amendment 2 tabled by my hon. Friend the Member for North West Hampshire, I hope he will not be upset if I refer to it as the magic circle amendment—now you see it in the Bill, now you don’t—hey presto. With one stroke, his amendment would remove a power that is at the core of the Bill, as it creates clarity for the charities concerned. I know that every hon. Member who has tabled an amendment today is a passionate supporter of those charities, as are we all. The benefit of the Bill is that it provides clarity to the charities. Under the Bill, trustees will become fully independent. They are left in no doubt about who is responsible for the conduct of the charity and about their own corporate governance. That is a good thing, which empowers them and encourages responsibility.
Kevin Foster
My hon. Friend has made some excellent points. Does he agree that the point of the Bill is to make these charities independent and regulated like others? This is the Peter Pan Bill, but the tale of disaster behind the amendments will make them the Tinker Bell amendments.
Jeremy Quin
I am grateful for my hon. Friend’s knowledge of pantomimes. No doubt Captain Hook is in there somewhere. I certainly accept the pith of his remarks. By making the charities fully independent, we provide clarity not only to the trustees by empowering them, but to donors, who will know that their generous gifts to the charities will be looked after by independent trustees.
My hon. Friend the Member for South Ribble (Seema Kennedy) referred to the sad state of current polling on Government Ministers. I think we would all agree in this House that those who fulfil the functions of charity trustees are good people doing a good task, and are recognised as such. They are the people whom the generous donors to these charities want to be in command of the assets that they transfer, rather than any other body. That is why I oppose the amendment.
Amendment 7, which stands in the name of my hon. and fashionable Friend the Member for North East Somerset, would merely add to complexity and cost, neither of which is required. In particular, a report from the Comptroller and Auditor General is an unnecessarily bureaucratic step.
Jane Ellison
My hon. Friend is absolutely right. Several hon. Members have mentioned charities in their area that are doing great work to increase the public availability of defibrillators. Perhaps I may take a moment to update the House on that matter. The Government were delighted, in partnership with the British Heart Foundation, to provide £1 million for defibrillators, meaning that this life-saving equipment will be given to communities right across the country—we have heard about several examples this morning, and my hon. Friend has mentioned another great example in Derbyshire—and that more people can be trained in cardiopulmonary resuscitation. That will make it easier for people to act in an emergency, and ultimately it will of course save lives.
I can update the House by saying that applications opened last October and interest was very high. The British Heart Foundation allocated funding to applicants who could demonstrate that the criteria had been met, and the application process has now closed. We look forward to hearing more about all the places around the country—I am sure that some of them will be in constituencies of hon. Members in the Chamber—where such life-saving work will be enabled.
Kevin Foster
I am interested to hear the Minister’s remarks. Given the slightly negative perceptions of charitable work and the descriptions of things that could go wrong that we heard earlier, would she like to comment on the things that are going very well? Will she put on the record her thanks, on behalf of Her Majesty’s Government, to the Torbay Hospital League of Friends? Over 62 years, it has raised millions of pounds to support local people and it is currently running its “This Is Critical” campaign to provide equipment for the new critical care unit that is under construction at Torbay hospital.
Jane Ellison
My hon. Friend is exactly right. At times, the debate has moved into rather gloomy territory. He used the “EastEnders” analogy. During the contribution of my hon. Friend the Member for North West Hampshire (Kit Malthouse), I began to think he was speaking to the Private Frazer amendment—the “We’re doomed!” amendment.
My hon. Friend the Member for Torbay (Kevin Foster) is right to bring us back to the great work that is being done. My experience of a local league of friends is similarly positive. Often, in the cut and thrust of our debates on legislation from Monday to Thursday we do not have time to put on the record the thanks of Parliament and the Government for the efforts of groups like his league of friends. It is welcome that this morning, when we have a little more time, we are able to put on the record our thanks to people who are not in the spotlight, but who are doing wonderful work in all our constituencies. I congratulate him on doing that and join him in praising the Torbay Hospital League of Friends.
Kevin Foster
It is a delight to be called to speak in this Third Reading debate. I will keep my remarks relatively short, given the time.
It is a delight to speak again about the “Peter Pan” Bill promoted by Wendy. Although it is amusing to allude to “Peter Pan”, this debate is backed up by the serious work done by the charities affected. Securing the royalties for the future will ensure that one of the world’s best places for treating sick children—a place that does groundbreaking work and allows people who would otherwise not have survived to see their adult years, not to mention to have a full chance in life—will be able to continue. That is so important, which is why I am pleased to support the Bill.
The Bill also sends a powerful message about the independence of charities. The charities affected will not be seen as arm’s length parts of Government, but as independent organisations that offer something additional to what the NHS provides. I opposed a number of amendments because they were not in keeping with the Bill’s golden thread: the idea that NHS charities are independent organisations that add extra to the NHS, not arm’s length Government bodies trying to collect donations to do what many people feel the NHS should either be doing already or looking to be doing in the future.
I know from my experience of working with charities that work closely with the NHS—I touched on that earlier—that some of the fears associated with the independent status of the charities are false. Many charities work very well in collaboration with local authorities, the NHS and other public sector bodies to deliver services and make a difference in their communities. That is what this Bill will fundamentally allow such charities to do.
It has absolutely been worth while giving the Bill the level of scrutiny it has received today, given that the Committee was truncated by the Syria debate. It is important to send to the other place a very strong message about our support for the Bill, the fact that it makes sense to enact it, and the fact that it should not head off into the Neverland of endless debate, but should in due course receive Royal Assent.
The Bill is the right step to take with regard to monitoring NHS charities. It frees them from being part of the Government, but not from the overall provisions regulating charities, or from the overall duties of trustees under laws passed in Parliament. The charities will still have to follow those laws and are not free to do anything they want, but they can say to someone who is honestly thinking of making a donation, “We are not part of the Government or an arm’s length part of an NHS organisation; we are an independent charity that provides extra services to support the work of the NHS and the local hospital to which we are affiliated.” What the Torbay Hospital League of Friends does in my constituency should be done across the whole country.
It has been a pleasure to be in the Chamber today, and to speak on Third Reading. I hope that it will not be necessary to have a Division, but that the Bill will receive unanimous support from all parts of the House.
Oral Answers to Questions
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Alistair Burt
Absolutely, and a number of the pilots and pioneer programmes are doing just that. Early results from the living well programme in Penwith in Cornwall show a 49% reduction in non-elective admissions to hospital and a 36% reduction in emergency admissions to hospital. So the hon. Gentleman is right: better social care and better integration may have, and should have, an impact on hospital admissions and make sure people are receiving the most appropriate care in the most appropriate place.
Kevin Foster (Torbay) (Con)
I was pleased to hear the Minister’s reference to the integrated care organisation that is being created in my constituency. Given the increasing challenge of providing social care to those in the later stages of life, does he agree that this is a model that needs to be looked at, and will he give it as much support as he can?
Alistair Burt
Indeed; the ability to see how these pilot projects respond to the different demographics in different areas enables one area to learn from another. Torbay has come up frequently in this context, and I am pleased to be able to praise it again. While I am on my feet, I should also like to point out that many of those involved in adult social care were greatly affected by the recent flooding in the north of England and that they were looking after vulnerable people and working beyond the front line. That work was very important, and I am grateful to Ray James of the Association of Directors of Adult Social Services and to all those working in local authorities in the affected areas who contributed so well to looking after vulnerable people during that period.
Victims of Contaminated Blood: Support
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Jane Ellison
My officials are working closely with their opposite numbers in all the devolved Administrations. As we move towards publication of the consultation, I will look to communicate directly with my opposite numbers in the devolved Administrations and pick up all these points.
Kevin Foster (Torbay) (Con)
I know from her statement that the Minister will appreciate the frustration that my constituents, some of whom have been waiting for an outcome for some decades, will feel at another delay. Given her comments on the carrying over of transitional funding, will she give me a clear idea of when she expects the new system to be in place?
Jane Ellison
We aim to consult, and we want to make sure that the final shape of the reformed scheme is informed by that consultation. As I have said, we look to start transitioning to a reformed scheme in the spring. At this stage, however, it is a little difficult to be more precise. We are working hard to ensure that aspects of the transition are being planned and thought about, and this will be informed by the final outcome of the consultation.
Mental Health: Out-of-Area Placements
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Norman Lamb
That is a shocking practice. I applaud my hon. Friend for the work that he has done on it in his area. The idea of putting someone who is suffering an acute mental illness into a police cell, which is defined in the legislation, unbelievably, as “a place of safety”, is bizarre and ought not to be tolerated. I am pleased that the Government have indicated an intention to legislate, in effect to eradicate the problem completely for under-18s and to make it an exception for adults. We managed to reduce the numbers in England by 50% in the past two years, which was considerable progress, but we need to go much further and bring an end to an unacceptable practice.
It is interesting that where local passion and drive exist, amazing things are possible. In our capital city, London, last year around 20 people in total ended up in a police cell, whereas in Sussex the number was over 400. That demonstrates that with real drive from both police and mental health services, practices can be changed and people’s lives can be made better. My hon. Friend is right to persist with the issue in Wales, just as I have tried to do in England.
Kevin Foster (Torbay) (Con)
I congratulate the right hon. Gentleman on securing the debate and on the work that he has done to bring the issue to the fore. A police cell should be for someone charged with a crime, not for someone who is unwell. Does he agree that to some extent the problem could be overcome with better co-ordination? I had a case in my constituency where a local treatment unit was full so a person was placed in Maidenhead. We then discovered that there was someone from Maidenhead in the local treatment unit in Torbay and arranged a swap.
Norman Lamb
Such a story makes one weep and leaves one feeling that there is a degree of incompetence somewhere. I will come to that point. Much of what I want to see happen can be done by better organisation, rather than by providing more money. I strongly believe that we need more investment in mental health services, but a lot can be done just by organising things much better.
Norman Lamb
We do not have that information—the data are very basic—but that matter is crucial. I imagine that communications often fall down when urgent referrals to another location take place.
I would raise another issue about families. If they have to visit a loved one 50 km or 100 km from home, just imagine the cost involved. Members in the Chamber— any of us could be in this situation—can afford to visit a loved one, but many people cannot do so. That is another reason why the situation is intolerable.
Kevin Foster
It is very interesting to hear the right hon. Gentleman’s statistics on my own area of Devon. It is important to get to grips with the issue for the reasons he has mentioned. He raised the point about communications in the example of the expensive round trip from Devon to Maidenhead. In many cases, families may know where their loved one will go, but the reality is they are presented with a choice: “Your loved one needs treatment—this is where it’s going to be. There is not much you can do, other than trying to mitigate all the impacts in the best way you can.”
Norman Lamb
Such a situation leaves the family feeling desperate, guilty that they can do nothing to help their child or loved one, and powerless to do anything. That is similar to the case of Josh Wills, a little boy with autism, who lives in Cornwall. He was placed in a specialist unit in Birmingham, so we can imagine the journey his parents had to make every week. He was there for more than three years, and when I was the Minister, I had to intervene personally to get the commissioners to London to try to sort out the case. Josh is now back in Cornwall, but it took far too long for that to happen. Such cases must put families under intolerable pressure and strain.
I should mention the areas where the problem is at its worst. In the Lancashire Care NHS Foundation Trust, there were 30 cases in August. Again, that is one a day. In the Kent and Medway NHS and Social Care Partnership Trust the figure was 30, in West London Mental Health NHS Trust it was 25 and in Birmingham and Solihull Mental Health NHS Foundation Trust it was 25. Again, there is the caveat that we do not know where the responsibility lies, but we should all accept that the practice is not acceptable and has to be brought to an end.
The data focus on non-specialist beds. There will be cases, just as with physical health problems, where a patient needs specialist input and where a referral to a specialist hospital, such as Papworth in the case of a heart condition, is appropriate. However, non-specialist beds and services should surely be provided closer to home. So we got these data together and they now allow us to hold the system to account. As well as establishing the dataset, we got Monitor and the Trust Development Authority to do, to use the jargon, deep dives into a number of organisations, both good organisations and those with a bad record of out-of-area placements, to get a better understanding of what was going on. When they reported back to me, their conclusion was that this problem ought to be solvable.
That is the important point for the Minister. It is not that this problem is something we would all love to solve but find it impossible to do. It is achievable, but it requires drive, ambition and determination to see it through. If I may, as an ex-Minister, I will offer a bit of advice to the incumbent. It is no good saying that we need to make incremental progress to reduce the numbers. We need to establish the principle that this practice is not acceptable. Someone in a mental health crisis who does not require specialist care should not be sent away from home, full stop. This is not a difficult issue. It should become what in the NHS is known as a “never event”—it should never happen. If we know that there is a link between this practice and an increased risk of suicide, how can we tolerate it?
The Minister has to set the objective of ending this practice. I understand that it will take time. Back in March, I wanted to see it end by the end of this calendar year. I recognise that that is now not achievable, but I set the objective of ending it within 12 months. That is achievable, provided that there is drive, ambition and purpose to make it happen.
A related issue is that of money. I have made it clear that I totally sign up to the importance of doing things differently and making better use of resources to achieve good results for people. However, investment is needed in mental health. In the negotiations in the run-up to the March Budget, my right hon. Friend the Member for Sheffield, Hallam (Mr Clegg) secured £1.25 billion of extra investment in children and young people’s mental health services for the five-year period of this Parliament. In year 1, the amount that ought to have arrived on an equitable division of that £1.25 billion was £250 million. The amount that was made available was £143 million, which means there is a shortfall.
We were told that that was because we were part way through the year, we had had the general election and we needed to make sure that the money was spent effectively. I sort of accepted that explanation, but I have since heard from reliable sources that there was a land grab going on and that money was taken away from children and young people’s mental health services to prop up the finances of acute hospitals, for example. I urge the Government to make good the shortfall in future years.
On 13 October, the Minister helpfully reconfirmed that the full £1.25 billion would be spent in this Parliament. I call on him to repeat that commitment today. It is critical that the extra investment that was confirmed in the Budget in March is stuck to. It is a matter of good faith by the Government and I would like to hear that confirmation. I also think, incidentally, that we should make good the shortfall in year 2 because, just as with the rest of the NHS, frontloading the money to invest in change is the best way to use the resources that are available.
I will move towards the end of my contribution, which has been rather elongated owing to the additional time that is available. I will end by asking specific questions of the Minister. I would be grateful if he addressed each of them directly this afternoon. If he is unable answer any of those questions directly, I would be grateful if he wrote to me as soon as possible and responded to them directly.
First is the issue of principle. Does the Minister accept that this practice is intolerable? I am not talking about specialist beds; I am talking about non-specialist beds where someone at a moment of mental health crisis, or in other circumstances, is shunted around the country—a practice that would never be tolerated in physical health. Secondly, will he commit to ending that practice completely within 12 months, and effectively to make it a “never event”? Thirdly, will he personally drive that change, because I know from experience that that is necessary? He needs to be on the case constantly to ensure that the system responds to that moral imperative.
Fourthly, will he ensure that all providers provide the data that their contracts oblige them to provide to the information centre? Anything short of that is completely unacceptable. The data are still in experimental form, and information centre notes state that they provide a “reference point” for a more accurate measurement in the future. There must therefore be an evolution to get to a point where data around the country are completely accurate, so that providers and commissioners can be held to account. Will the Minister commit to ensuring that the experimental data are turned into final-form data that we can all rely on?
Finally, will the Minister reconfirm his total and absolute commitment to ensuring that £1.25 billion of additional investment is spent on children and young people’s mental health services this Parliament? Will he commit to sticking with the vision that we published in October last year and to introduce comprehensive maximum waiting time standards? I did that work—which led to the publication of that document—in collaboration with the Secretary of State, and he was incredibly helpful in supporting me to get that published. The vision was clear, and it recognised that until we have comprehensive waiting time standards for mental health, just as exist for physical health, we will not get equality of access to treatment. An essential principle in a publicly funded service is that all people must have the same right to receive evidence-based treatment on a timely basis. As I have said, will the Minister write to confirm any specific point that he feels unable to deal with this afternoon?
Norman Lamb
One of the recommendations from the taskforce that NHS England established to look at tier 4 services, at the number of beds required across the system and at the variability of the services was that treatment should always be contained within a region —in other words, that no child who lives in the south-west should ever go out of the south-west for treatment. I cannot remember where the child from Torbay had to go—
Norman Lamb
Indeed. Is the Minister going to stick to that? Is he going to ensure that that is the objective, and will he monitor it to ensure that he meets it?
Antibiotics (Primary Care)
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Maggie Throup
I completely agree with the hon. Gentleman. It is not just a UK-wide issue; it affects the whole world. That is one of my concerns. We need to play our part to set the trend for the whole world, because this is a global issue.
As I said, antibiotic prescriptions in 2013-14 cost the NHS £192 million. What is more worrying is that many of the 41.6 million prescriptions were unnecessary and will undoubtedly have contributed to the growing issue of antimicrobial resistance. More than half the antibiotics used in primary care are for respiratory tract infections, most of which are viral or self-limiting.
So what can be done to halt the ticking timebomb? Just last Wednesday, Public Health England called for NHS patients to become “antibiotic guardians” by thinking carefully before asking for drugs and taking more care to prevent the spread of infections by washing their hands and accepting the flu jab. I believe that we can go even further in reducing the use of antibiotics in ways that are better for the patient and that save the NHS money.
Kevin Foster (Torbay) (Con)
I congratulate my hon. Friend on bringing this issue before the House. Does she agree that the big problem, which she has touched on, is that a lot of people put pressure on their doctors to give them antibiotics, falsely thinking that they will cure a cold, which is a virus, when antibiotics are only useful against bacterial infections?
Maggie Throup
My hon. Friend is right. That is what we need to make clear. People often do not understand that the causes of those illnesses are quite different.
My local clinical commissioning group, Erewash CCG, is working hard to empower patients to take responsibility for their health, very much along the lines of the antibiotic guardians idea. As part of the initiative, it wants patients to learn to recognise when it is right to visit the GP and when it is right to seek alternative advice, such as that of a pharmacist.
I want to come back to where I began: the little device that performs the C-reactive protein point-of-care test. I can tell that hon. Members are wondering what C-reactive point-of-care testing is. A point-of-care test is a diagnostic test that is quick and easy to perform. It can be used during a patient consultation or completed while the patient waits. It allows for immediate diagnosis and treatment choice. Such point-of-care tests are designed to be used by people who are not laboratory scientists.
A C-reactive protein point-of-care test is a blood test that measures the amount of protein called C-reactive protein in a person’s blood, using just a drop of blood from the finger. Evidence shows that the test can deliver significant benefits when used in the primary care setting. It is used in the primary care setting in several European countries and has been shown to reduce unnecessary antibiotic prescribing by empowering GPs to make informed decisions.
NHS (Charitable Trusts Etc.) Bill
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Wendy Morton
My hon. Friend makes a useful point. The important point is that whereas the NHS charity can benefit from this new independent model, there will always be accountability. This is not public money but money that comes from benefactors and donors, so it is right and proper that the trust instilled in the process of giving is maintained at all times.
Kevin Foster (Torbay) (Con)
My hon. Friend is making a great speech in support of her Bill. Does she agree that that very independence gives beneficiaries the confidence that their money is spent as intended and that the wealth of charity law is there to ensure that funds are put to the right purpose?
Wendy Morton
My hon. Friend makes a valid point. I shall explain that a little more later, but the Bill is about creating independence while maintaining accountability. I believe that we are looking for a route to enable these charities to move forward and to be on a more level playing field with some of the big charities operating across the country. Let us not forget that this is something that they have been asking for.
Collectively, across the country, about 260 charities exist to receive and manage charitable funds on behalf of NHS bodies. I am sure that everyone in the House would agree that they do fantastic work and that many Members are aware of local hospital charities in their constituencies. My preparation for this Bill made me think back to when my sister, who was five or six at the time, spent six weeks in the local NHS hospital and my mum was able to stay near the hospital thanks to accommodation that was provided either by a “friends of” organisation or a local charity that provided that sort of sheltered accommodation. Without that, she would have had to make the long journey to and fro every day. I am sure it made a huge difference, not only to her, but to the whole family.
Hon. Members will be interested to learn that just over £345 million was raised by these charities in the past financial year, supporting patients and staff right across the country. I am sure everyone in this House would agree that they make an outstanding contribution and are deserving of our support. Members may be asking why it is necessary to legislate, and that is a perfectly good question. It is one that I have asked, and I now wish to answer it. In simple terms, the Bill is good housekeeping; it is a matter of follow through. The charitable environment has moved on and there is a need to provide certainty in an already complex world and a complex structure. The Bill seeks to remove the Secretary of State for Health’s powers to appoint trustees, so it will draw that process to a conclusion. The Bill is overdue and it makes sense.
Currently, 16 NHS charities have trustees appointed by the Secretary of State for Health and are directly affected by the Bill. They are bound by charity law and NHS legislation. They are currently unincorporated and their trustees have unlimited liability. This means that the 16 NHS charities will choose either to revert to a corporate trustee model, meaning that the board of the NHS body for which the trustees were appointed acts as trustee of the charitable funds, which is how many NHS charities already successfully operate today, or, as many of the 16 have indicated they would like to do, they can convert to become independent charities without Secretary of State-appointed trustees.
Wendy Morton
I will come on to deal with some of those benefits later. Anyone would think my hon. Friend had read my speech, because the next words on it are “six charities”. I can assure you, Mr Speaker, that no one has seen it. Six charities have already completed the transition to independence. They include Barts Charity, which raises money for Barts Health NHS Trust, including St Bart’s hospital. That was the first to convert to an independent model. The others are Alder Hey in Liverpool; Birmingham Children’s Hospital Charity, which is close to my constituency; and Guy’s and St Thomas’. The Royal Brompton & Harefield Hospital Charitable Fund has also become an independent charity. They are all able to benefit from greater independence and less bureaucracy.
Kevin Foster
Why was it necessary to bring a Bill before Parliament to deal with these issues and make these changes? Why could a legislative reform order not have been used?
Wendy Morton
An LRO was mentioned to me early on when I was doing my research on the Bill, but this Bill covers two parts; one is the Great Ormond Street part and the other is about the trustees, so an LRO was not appropriate as it was not the right vehicle to enable those things to be brought together and taken through Parliament. There was a streamlining of the process, with no duplication and less bureaucracy.
The other charity to have converted to independence is Great Ormond Street Hospital Children’s Charity. It has started the process of moving to independence. I have made specific reference to it because of its unique status and the need for specific legislative change, and I will come back to that point later. A further six have now notified the Department of Health of their intention to convert to the independent model. Another is in the process of reverting to a corporate trustee model, which will be completed by 1 April. Of the remaining nine, about half have agreed to independence, but have not yet formally informed the Department of Health, while the others are in discussion with their trustees and hospital boards. Clearly, many have made the decision, and many others are in the process of doing so.
Earlier in the summer, I met the hon. and learned Member for Holborn and St Pancras (Keir Starmer), and I have written to Members whose constituencies have an NHS body with trustees appointed by the Secretary of State, which would be affected by my Bill, to keep them fully informed. The Bill is supported by Great Ormond Street Hospital charity and NHS charities more generally. It also has the support of the Association of NHS Charities, with which I have met. Recently, I attended a forum where I spoke to some of the association members. I was reassured by their support for the Bill and by their feedback about how it would affect them in a positive way.
The parts of the Bill that would effect the change are intended to be brought into force on 1 April 2018, which gives this group of 16 hospital charities time to consider and to finalise their positions. Lines of accountability would also be simpler, as the new independent charities would be accountable to the Charity Commission, with the additional management bureaucracy no longer being needed.
I am grateful for the support of the hon. and learned Member for Holborn and St Pancras, who is in his place and in whose constituency Great Ormond Street Hospital Children’s Charity is based. During the summer, I was very fortunate to go to Great Ormond Street hospital and to meet some of the charitable trusts. I met the staff and learned at first hand about the tremendous work that they do in support of the hospital, staff, patients and families. I was lucky enough to be taken on a tour of parts of the hospital; it is the most amazing place in the world. I visited the Peter Pan ward and the chapel—I do not think that there is a Wendy ward, but who knows?
Wendy Morton
In a nutshell, the figure is significant, and I will come on to that shortly.
The charity funds vital support services that care for the child and often the whole family: financial advice, parental accommodation, as well as spiritual support and helping families to stay together and manage their lives during what can be very difficult and trying times.
The Great Ormond Street hospital charity has a large number of donors, individual companies and, I am told, celebrities who support their work. On fundraising, Members will be interested to know that the charity raised £80,981,000 in the financial year 2014-15—an increase on the previous financial year—so the figure is indeed significant.
One of the most generous donors in its history is, of course, J.M. Barrie. As the Great Ormond Street Hospital Children’s Charity is keen to take advantage of the opportunity to move to independent status, specific legislation is required to provide for the rights to the “Peter Pan” royalties to be given to the new charity. The idea of royalties being paid to a charity is not unusual in itself. As we approach the run-up to Christmas, I am reminded of songs recorded for charity where royalties go into charitable trusts, but the relationship between Great Ormond Street hospital and “Peter Pan” is different. It is already a unique situation, and a unique solution is required to enable the rights to the crucial royalties to be given to the Great Ormond Street Hospital Children’s Charity, so that Great Ormond Street hospital can continue to benefit from the generous J.M. Barrie bequest.
Kevin Foster
My hon. Friend is being incredibly generous with her time in allowing interventions. Will she clarify something? Does Great Ormond Street receive royalties from only the original book featuring Peter Pan and Wendy, or does it receive them from subsequent publications and performances?
Wendy Morton
The charity continues to receive royalties. In fact, there are many productions of “Peter Pan” around the country in the run-up to Christmas, and the charity continues to receive royalties or agreed donations when such productions are performed. We must ensure that the charity continues to get those royalties, which makes the Bill even more important.
J.M. Barrie donated all rights in “Peter Pan” to Great Ormond Street hospital in 1929. He died in 1937, but the hospital enjoyed a further 50 years of royalties. On the eve of the copyright expiring, the J.M. Barrie bequest acquired its unique legal status, as a direct result of Lord Callaghan’s amendments to the Copyright, Designs and Patents Act 1988, which ensured that, despite the copyright in the work expiring on 31 December 1987, the special trustees for Great Ormond Street hospital would have the rights to royalties in respect of all commercial publications or public performances of “Peter Pan” and would hold them on trust for the purposes of Great Ormond Street hospital. The relevant provisions are found in section 301 of and schedule 6 to that Act.
The royalties are now held in perpetuity, so J.M. Barrie’s generous gift will continue to benefit very sick children and their families for as long as the hospital exists. My Bill seeks to support the continued legacy of this great children’s author from Kirriemuir in Scotland. I do not know whether any Member present in the House today has heritage or roots in Scotland, but there is certainly a link back to north of the border.
Anne Marie Morris
I am appropriately reprimanded, Mr Speaker. I shall ensure that, in particular, I give you the focus and attention you clearly deserve, and indeed Members on the Opposition Benches.
I will continue with the history behind this valuable Bill. The Bill addresses concerns about the Secretary of State’s powers to appoint trustees of NHS foundations and trusts. In 2012, Barts and The London Charity and the Royal Brompton & Harefield Hospitals Charity said that it was
“unclear as to why the Department seems at pains to preserve the Secretary of State’s…ultimate control over the appointment and removal of trustees”.
They added:
“We broadly agree with the stated aims of the review and would welcome the outcomes listed in”
the report,
“particularly those that would result in NHS charities being able to deliver improved services to NHS patients as their beneficiaries.”
In “Review of the regulation and governance of NHS charities”, the Government’s response to the consultation, the Secretary of State said that he was
“willing to seek to remove those specific legislative provisions as soon as possible.”
The Bill allows him to fulfil that promise.
The Bill refers not only to past consultation, but to past legislation. Following the expiry of the copyright on “Peter Pan” in 1987—50 years after the death of J. M. Barrie—it was concluded that Great Ormond Street hospital should continue to benefit from Mr Barrie’s gesture, and legislation was enacted to do so under the Copyright, Designs and Patents Act 1988. Sections 301, 304 and schedule 6 briefly became redundant, due to a European Union directive on copyright, which meant that copyright law was
“harmonised at 70 years after the death of the author or 70 years after the work is lawfully made available to the public”.
The directive was implemented on 1 July 1995, giving Great Ormond Street hospital extra copyright until 2007. The 1988 Act then came into force and that unique Act remains in place to this day.
The Bill builds on this House’s commitment to Great Ormond Street hospital to benefit from the royalties from “Peter Pan”—as laid out in the 1988 Act—by effecting a change in the identity of the person on whom the right is conferred. That is because, under charity law, the trustees have converted from being special trustees appointed by the Secretary of State to being an independent charity.
There is much more to the relationship between Barrie and Great Ormond Street hospital than a benevolent gesture. Barrie’s brother was the inspiration for the play after his tragic death just before his 14th birthday. His mother was said to take comfort from the fact that her son would remain a child forever, and thus the seed was planted for “Peter Pan”.
“Peter Pan” is the story of how a young family travel to a magical land—Neverland—with the help of a little bit of fairy dust. They learn that family is a very important concept, and I have no doubt that many of the visitors to Great Ormond Street hospital and many hon. Members can relate to that. They encounter numerous perils in the shape of a hook-handed pirate, a crocodile that has swallowed an alarm clock and a jealous fairy named Tinker Bell. The story concludes with Peter Pan, the boy who did not want to grow up—I know many other boys who do not want to grow up, many of them quite old—being unable to connect with his friends as they grow older and he remains a child.
Great Ormond Street hospital works to make sure that children do get that opportunity to grow up, but without losing the comfort and experiences of being a child and enjoying their young lives. Sadly, some visitors to Great Ormond Street do not grow up, much like Barrie’s younger brother David, and the connection to Peter Pan is therefore strong ever more.
Since its completion in 1904, “Peter Pan” has formed the basis of nine films, including a spin-off series on Tinker Bell, one radio adaptation and nine TV shows since 1955, the first of which was a stage adaption aired on NBC. Seven video games contain characters from the “Peter Pan” universe. Not only that, but “Peter Pan” has continued to be reproduced in countless plays, books and comics. According to the Great Ormond Street website, between now and next March, 23 runs of “Peter Pan” will be performed across the country—north, south, east and west—including in the northern powerhouse, which is a testament to the fantastic work and its legacy.
Barrie was a great supporter of the work Great Ormond Street hospital did then; it continues to do such work to this day. In 1929, he was approached to sit on a committee to buy some land so that the hospital could build a much needed new wing. Barrie declined to serve on the committee, but said that he hoped to find another way to help. Two months later, the hospital board was stunned to learn that Barrie had handed over all his rights to “Peter Pan”. At a Guildhall dinner later that year, Barrie, as host, claimed that Peter Pan had been a patient in Great Ormond Street hospital and
“it was he who put me up to the little thing I did for the hospital.”
It therefore seems fitting that such a gesture was made to the hospital to continue its great work.
As my hon. Friend the Member for Aldridge-Brownhills said, Great Ormond Street Hospital Children’s Charity raises money to enable the hospital to provide world-class care and to pioneer treatments and cures for childhood illnesses, with an estimated 255,000 patients coming through its doors every year. The hospital originally had just 10 beds and two doctors.
Kevin Foster
My hon. Friend is making a long and strong speech about the benefits of Great Ormond Street hospital. Does she agree that although the hospital is based in London, it actually provides specialist care across the UK, including for some of our constituents in Devon?
Anne Marie Morris
My hon. Friend makes an entirely correct comment. He is absolutely right that Great Ormond Street hospital makes a fantastic contribution across the country, and those of us representing the south-west have constituents who have directly benefited from the fantastic services that the hospital offers. He was quite right to make that point.
Marcus Fysh (Yeovil) (Con)
I am grateful for the opportunity to speak in this debate. I congratulate my hon. Friend the Member for Aldridge-Brownhills (Wendy Morton) on bringing forward the Bill, which would allow this massively important charity to move forward.
My father is a consultant paediatrician, a neonatal intensive care specialist and a former president of the paediatric assocation of the Royal College of Medicine. As a child, I spent many Christmases visiting wards and seeing very sick children. That made an indelible impression on me, and now that I have my own children I remember the many faces that I saw. I therefore have some understanding of what goes on at Great Ormond Street hospital, with which my father worked closely on many occasions. It is truly leading the way on treatment and on research.
There are good facilities for sick children at the hospital in my constituency, and I pay tribute to all the incredibly committed doctors and nurses who work there. As we have heard, more difficult cases are often referred from other parts of the country to the London trusts, and particularly to Great Ormond Street because of its cutting-edge work.
I was involved in helping one family in my constituency, the Bennett family, to go to Great Ormond Street. They were incredibly grateful for the benefits that the Great Ormond Street charity provided, and particularly for the help they received with accommodation at what was an extremely difficult time.
Yeovil has its own hospital charity, Flying Colours. I pay tribute to its manager Sarah Cherry and all the other people at the district hospital, who have managed to raise more than £500,000 for better facilities and an expansion of the hospital’s special baby unit. That is intended to support, in particular, children who are born with addictions, which I know can be one of the most distressing conditions to witness. There are other great charities in Yeovil, including St Margaret’s hospice, which, because of the way in which it was set up, already has the flexibility that allows it to raise money in different ways. It would be great if charities such as Flying Colours had the same ability.
“Peter Pan”, by J.M. Barrie, is a perfect story to associate with the Great Ormond Street charity, and we should thank Barrie for the foresight that he showed in helping those who are indeed forever young in some cases. I should add that I know something else about his relationship with the hospital: his family used to live in Bloomsbury, which was, of course, a great centre of the London literary world, and it is nice that it retains that association with the hospital to this day.
However, the fundraising of the Great Ormond Street Hospital trust goes much wider than the bequest of J.M. Barrie, and I think it needs the flexibility that would allow it, too, to raise money in a number of different ways. J.M. Barrie’s copyright is sometimes disputed, particularly in America. The Bill’s proposal to reduce the liability that the trustees can face is a positive step, because no one wants to be sued by the Americans.
Kevin Foster
I entirely agree with what my hon. Friend is saying. It is not just a question of the tactics that the trust can use to raise funds. The Bill will enable those who donate, and who participate in fundraising, to feel confident that the charity, and those who are independent of the Government, will spend the money and decide how it will be spent.
Marcus Fysh
My hon. Friend has made a very good point.
The Bill will provide the flexibility, the independence, the reduced liability and the reduced operation costs that will allow the charity to maximise its innovation, the help that it gives to other people, and the great work that is done in the hospital, and I commend it to the House.
Kevin Foster (Torbay) (Con)
It is a pleasure to speak in the debate and to support the Second Reading of the Bill. Discussing a Bill about Peter Pan proposed by Wendy was not one of the subjects I expected to debate in this Chamber when I was elected, but the Bill has a serious purpose as it makes clear the independence of the charitable trusts it covers.
It is right that we should have oversight when public money is being spent, and the NHS is subject to plenty of oversight, including through this Parliament, but this is not about taxpayers’ cash but about the additional money that people freely donate. People donating should have confidence that the trustees, who are completely independent and whose goals are solely those of the charity, will decide exactly how the funds will be used. A trustee or director appointed by the Secretary of State will clearly be cognisant of their duties under charity law to put the charity’s interests first, but being appointed by the Secretary of State creates the idea that such trustees are there to represent someone else: even though those who are familiar with the law will understand the role of a trustee, that is not the impression given. It makes sense that the charities referred to in the Bill are in a similar position to most other charities in the country and may, through their members and supporters, find trustees and appoint them to the board to exercise their duties rather than having someone appointed for them by the Government.
Charities in the NHS bring additionality to NHS services; they are not about replacing them or replacing funding from the taxpayer, but about doing extra things. I think particularly of the Torbay Hospital League of Friends, an independent charity that raises money to support services at Torbay hospital and uses its flexibility and independence to get people to donate. Its “This is critical” campaign aims to equip the critical care unit that is being built. Public money provides the basic service, whereas charitable bequests and donations enhance the service.
Anne Marie Morris
Does my hon. Friend agree that one of the benefits of this independence is that it encourages not only donations but people to give their time? Charities need not just money but volunteers to give their precious time not only for fundraising but to work with families, patients and young children. Does he have any thoughts on that?
Kevin Foster
My hon. Friend is absolutely right. Charities depend on the money and time donated. That might mean time donated to raise funds for the charity or, as she mentions, for other work. Everyone can take part, rich or poor. An hour donated is an hour donated. As she will know, Torbay hospital’s cafeteria is staffed by volunteers. It not only raises money for the charity in the hospital but provides a service. People might have come in and heard not great news, or they might be anxious and stressed with a relative in hospital, and they get a valuable pastoral service over a cup of tea and a cake from volunteers who, in some cases, have been involved for many years. They provide an excellent service.
Today, we are naturally talking about the structures and finances of a charity. As my hon. Friend the Member for North Dorset (Simon Hoare) said, we should ensure that the money cannot go on Lucky Lad in the 3.10, but we should also not forget that volunteers are at the heart of charities and how they operate and work. If the charities are truly independent, that will only enhance their ability to attract volunteers, get donations and make a difference.
Wendy Morton
Does my hon. Friend agree that, under this new model, charities will be able to bring in a new blend of skills and expertise, enabling them to increase capacity and build on their strengths?
Kevin Foster
My hon. Friend is absolutely right. In my constituency, for example, we have many people over the age of 60 who have retired from professional careers. They reach the point in life where they wish to retire from full-time work, but they still have skills and abilities that they want to offer, and might be thinking about a social rather than a financial reward. Having more flexibility in the charities’ structures means that they can bring in more of those people. People who might be slightly reticent about being appointed by the Secretary of State, perhaps because of their previous job, might be delighted to be involved in an independent charity that is committed solely to its objects.
Antoinette Sandbach
The risk attached to the appointment by the Secretary of State is the perception that it might be a political appointment when it is actually an independent appointment. That is what the Bill removes.
Kevin Foster
I could not have put it better myself. My hon. Friend is right that although the Secretary of State might appoint someone independent with skills and abilities such that they become a trustee by another route, the fact that they are appointed by the Secretary of State makes it appear that they are the Government’s person, even if they are diametrically politically opposed to the Government of the day. I am sure that the Minister will be able to think of examples of Government appointments who are not the most supportive of the current Administration.
Kevin Foster
Indeed. This is a bit like the reforms to school governors, where we have reduced the number of local authority appointments. Although some were very independent minded and focused solely on the school and its interests, in other areas it was almost a tradition to have a certain number from Labour, a certain number from the Conservatives and a certain number from the Lib Dems.
Kevin Foster
I accept that at the moment a Lib Dem and an endangered species have something in common. I will return to the subject of the Bill, despite the generous opportunity offered by my hon. and gallant Friend to make a remark about the political situation west of Bristol.
Why, as a Devon MP, am I keen to see the Bill make progress, given that it relates particularly to Great Ormond Street? As I said in my intervention on my hon. Friend the Member for Newton Abbot (Anne Marie Morris), the hospital provides specialist services that benefit the whole of the UK. The provisions on the “Peter Pan” copyright apply to all four nations in the United Kingdom, not just to England and Wales, as some of the other provisions in the Bill do. This hospital provides services that it clearly would not be practical to provide in individual areas and individual hospitals, because that pure specialty is needed. At least one person who has been in my surgery recently has benefited from Great Ormond Street’s work even though they are a resident of Torquay, because of the specialties that the hospital brings.
It is therefore right that we should make this provision that the J. M. Barrie bequest and copyrights can be properly applied, to the benefit of the hospital. It is nonsense to have two charities in place purely because of law that made sense at the time but which now looks like a legal accident, whereby the money has to go into one pot and cannot go into another pot, even though almost any other bequest in this country would be going into the one charity. As has been said, that means that money for patients—money for services—is going to lawyers and accountants. That is not right, which is why the Bill is so timely. It seeks to resolve that anomaly and give that certainty, particularly to Great Ormond Street, and to all the other trusts.
I am very pleased to be here to support this Bill, which will make a real difference. It may sound very technical—it sounded exceptionally technical when I first read it—but it will make a real impact on the ground in providing better services and better outcomes, and helping some of the sickest and most vulnerable people in our society. That is why it is right that the Bill receives its Second Reading. I am delighted that my hon. Friend the Member for Aldridge-Brownhills decided that this subject was the right choice for her private Member’s Bill slot, given the number of choices that would have been available to her, and it is good to see so much support here this morning from hon. Members.
I look forward to hearing what the Minister will say in response to today’s debate—[Interruption.] I am glad he is looking forward to it, too. We are anticipating every moment of his speech, which I am sure will be a tour de force, given his knowledge of this area. We hope it will confirm that giving the Bill its Second Reading makes eminent sense and that it will move into Committee, so that we can turn it from a worthwhile Bill into a worthwhile Act of Parliament. I am delighted to endorse the Bill and I hope the whole House will support it.
Mr Rees-Mogg
I know. The Minister in his seat is looking appalled at that suggestion, but it is true. Many people think that if there is any possibility of the Government getting their grubby paws on a little bit of money, those grubby paws will dart out and the money will be raked in. There is of course a history of Government doing that. For example, hypothecated taxes have been introduced for particular purposes. When the Government run a bit short of money, or find that too much is being paid in the hypothecated taxes, they dehypothecate them—they put them to another purpose. I am thinking of national insurance, which was introduced as an insurance scheme, and of the road fund licence, which was introduced to build our roads. Both of those were syphoned off by Governments, arguably for very good reasons, which I will not go into because they are too broad for this Bill. I merely wish to illustrate the point that charities need to be robust in spending the money on what it has been given for, and not on any other thing, and if they cannot spend it on that which it has been given for, they should give it back to the people who gave it in the first place. The reason that that is important is partly that we believe in the rights of property—this is a Tory Bill. If property belongs to a specific designated purpose then that is what it is there for; it is not there to be used for any random purpose that someone thinks is a good idea at some later stage. There are many good purposes, and there are many charities that some people think do less good things than the good purpose that they have thought up, so there is always pressure to reallocate resources in the way that a Government, or some authority, think is preferable.
Kevin Foster
My hon. Friend is bringing his usual fairy dust to this debate. Does he agree that this is about people having confidence in the independence of the trustees, and believing that donations will be used exactly for the purpose of the charity? Furthermore, it is about removing any sense that those donations might be filling in for taxpayer funds.
Mr Rees-Mogg
I am extremely grateful for that intervention, because that is exactly the point. It is one of those occasions where rigour really helps. If donors feel that their money will be used properly, they are more willing to give. It is fascinating how charity law has developed in this direction in recent years. Historically, if people gave money to charities, they gave it to the charity for its general purposes. Then they discovered that the general purposes of charities included all sorts of jolly things, such as lunch at the Ritz, so increasingly they have given money for limited purposes, and the funds can then only be spent on those purposes, even within a single charity. For example, if people viewing this debate wish to make donations for the renewal and restoration of this Palace, that money could only be spent on the renewal and restoration of this Palace; it could not be used for other purposes. Charity law has gone that way because it encourages people to give, as they have confidence in how the money will be spent. That is crucial for NHS charities, because there is this large pool of Government money, but it is never quite enough. We hear of deficits, and hospitals and doctors wanting more money, and all of that is a constant pressure on the health service.
Antoinette Sandbach (Eddisbury) (Con)
I am grateful for the opportunity to take part in the debate. I am pleased to follow my hon. Friend the Member for North East Somerset (Mr Rees-Mogg), who spoke with characteristic authority, certainly educating the newer Members, among whom I count myself.
I support the Bill introduced by my hon. Friend the Member for Aldridge-Brownhills (Wendy Morton). She cited the hospital that serves my constituency in Eddisbury, the Alder Hey hospital, as an example of successful independence from the NHS trust. To show how valuable that is, the hospital moved in October to new premises and became Alder Hey in the Park, a brand new £237 million hospital with 270 beds and 16 brand new operating theatres equipped with state-of-the-art technology. It treats 275,000 children across the north-west and north Wales, and is as important a centre for children’s health, medicine and research as Great Ormond Street in London.
The charitable part of Alder Hey became independent in the way proposed by the Bill in April. The charity has contributed £20 million for equipment in Alder Hey hospital, and because it is independent it is separate from the hospital board. In my previous role, I had experience of cases in which the hospital board and the NHS charity were integrated, and in which the charity did not have the independent thinking that is clearly demonstrated by the Alder Hey charity and the other six charities referred to by my hon. Friend in her eloquent explanation of the Bill. It is clearly a vital step for those bigger charities to achieve perceived independence.
Kevin Foster
It will be not just independence but the flexibility to bring in different skills and talents that will benefit the charity, its objectives and, ultimately, patients.
Antoinette Sandbach
I entirely agree with my hon. Friend. One important step being taken by Alder Hey is in ground-breaking research, and the charity allows it to get funding that will help in those aims.
The new facilities at Alder Hey are extraordinary, designed in part by former child patients. A group of children aged 10 to 22 who had stayed in the hospital contributed towards the design of the new Alder Hey in the Park. I invite Members from across the House to consider visiting the hospital to see the invaluable work that it does. As my hon. Friend the Member for Aldridge-Brownhills said, funding from NHS charities contributes to innovation and research.
Antoinette Sandbach
I am so grateful to the hon. Gentleman for making that point, because health services that my constituents access are affected by decisions taken in Wales. The threat to maternity services in north Wales will have a direct impact on the resources of the county of Cheshire and Leighton hospital, yet they have no say in those decisions—even the hon. Gentleman has no say—because they are taken in Cardiff.
Kevin Foster
It is very tempting to go down that path and discuss various issues relating to devolution, but I am conscious, Madam Deputy Speaker, that to do so would not be in order. Does my hon. Friend agree that the benefit of the Bill is that it would make the charities independent so that they can select who is best to be on their board of trustees from the whole area, regardless of politics or boundaries?
Antoinette Sandbach
That is precisely why I support the Bill, and it is no doubt why my hon. Friend the Member for Aldridge-Brownhills has attracted support from so many Members today. The crucial matter is independence. Unfortunately, in my previous role I had experiences that went the other way when independence was lacking, and that had a negative impact on outcomes for my constituents.
The Minister for Community and Social Care (Alistair Burt)
I congratulate my hon. Friend the Member for Aldridge-Brownhills (Wendy Morton) on securing her place in the ballot and on her speech. This is the NHS (Charitable Trusts Etc) Bill, but it will forever be known as the “Peter Pan and Wendy Bill”, and we shall all do our best to refer to it in that way as we proceed.
I thank colleagues for what they have said during the course of the debate. I welcome the hon. Member for Ellesmere Port and Neston (Justin Madders) to his place and thank him for his brief support for the Bill, which is appreciated.
Those of us who have known my hon. Friend the Member for Aldridge-Brownhills for some years—I think we first knew each other when we were working in Rwanda together—will appreciate that there is a lot of her personality in this Bill: a determination to support the right causes, a fierce and deep commitment to the charitable objectives represented by the NHS, and her usual diligence in introducing the Bill and working very hard to secure support for it and to discuss the issues involved. I thank her very much for the way in which she has done this.
A number of J. M. Barrie quotes are appropriate, and we may hear them during the debates in Committee, if the House wishes to progress the Bill. The one that caught my eye was,
“one girl is worth more than twenty boys.”
I am not sure whether it is currently acceptable to make such a comment from the Dispatch Box, but I use it in its historical context as a sentence from the book, “Peter Pan”. I think that my hon. Friend has well demonstrated her worth in relation to what she has brought forward today.
The hon. and learned Member for Holborn and St Pancras (Keir Starmer), in whose constituency lies Great Ormond Street hospital, made a very decent and correct response to the Bill in which he proudly supported his hospital, as of course he, and we, would wish to do.
Kevin Foster
The Minister says “his hospital”. He is obviously right that it is based in the constituency of the hon. and learned Member for Holborn and St Pancras (Keir Starmer), who sadly is not in his place, but it is actually the whole UK’s hospital given the services it provides.
Alistair Burt
My hon. Friend makes a point that I would have gone on to make and was emphasised by him and several others. Of course, Great Ormond Street hospital covers not only the areas of London but the rest of the country and, indeed, the world. That is one of the reasons we are so proud to support what my hon. Friend the Member for Aldridge-Brownhills proposes.
My hon. Friend the Member for Newton Abbot (Anne Marie Morris), in supporting the Bill, commented on the history of Barrie, not least making the link with the childhood tragedy of the death of his brother leading to the chain of thought about a young boy living forever, which was certainly in his mother’s mind. My hon. Friend brought us that little bit of tragedy to remind us of the origin of the story.
My hon. Friend the Member for Cheadle (Mary Robinson) concentrated on the technical aspects of the Bill, to which I will turn later in my remarks.
My hon. Friend the Member for Telford (Lucy Allan) raised some of the work done by the local charitable trusts in her area. She spoke of the Friends of the Princess Royal Hospital, Telford and the substantial sums that that charity has contributed to the work of the hospital.
My hon. Friend the Member for Erewash (Maggie Throup) spoke of the League of Friends of Ilkeston Community Hospital and Treetops Hospice Care. She reiterated the point that although we have an almost uniquely taxation-based system of support for the health service in this country, that does not completely absolve people from the desire to make their own contribution to hospitals in a charitable manner, as they do in extraordinary ways.
Kevin Foster
The Minister is making an excellent speech, as predicted during my own speech. Does he agree that the core issue is that charitable funds are not just giving extra to patients in the NHS, but going beyond what would be funded by the NHS? This is not about replacing taxpayers’ money; it is about giving that extra boost and extra bonus.
Alistair Burt
It is about exactly that. In a world of never-ending resources, there would be no need to look for charitable funding. As I have said, charitable funding covers not just finance but the instinct to give and support. Even if it was not about finance, plenty of people are able to support their local communities and local hospitals, not because they contribute financially, but because they give their time. Leagues of friends and others are perfect examples of that instinct.
My hon. Friend the Member for Stafford (Jeremy Lefroy) spoke characteristically succinctly about charities making a real difference in his hospital and health community. My hon. Friend the Member for North East Somerset (Mr Rees-Mogg) made a vigorous defence of the private Member’s Bill as an example of Conservative principles and values. I am not sure whether he wanted to convey that a vigorous defence of fundamental Conservative principles is best and appropriately summed up in a Bill about Peter Pan and Neverland. Perhaps he recognised that those principles are reflected in the fact that the most successful example of the genre is everlastingly popular. I am sure that is exactly what my hon. Friend meant to convey.
Members can imagine my shock at my hon. Friend’s suggestion that an anonymised, bureaucratic element in the NHS might be pursuing a seemingly puzzling and unnecessary course of action to add to bureaucratic difficulties. Although I do not necessarily recognise the exact unit of which he speaks, I will look into his concerns, just in case it can be identified.
My hon. Friend the Member for Eddisbury (Antoinette Sandbach) spoke of the contribution of Alder Hey hospital, which was also welcomed and supported by the right hon. Member for Knowsley (Mr Howarth). My hon. Friend spoke of the new hospital and the charity work being done there. I am sure that most Members present would wish to recognise her contribution to a debate earlier this week in very different circumstances. She was immensely brave and her remarks will no doubt lead to much good. In today’s debate, she pointed out that charities can make a contribution to the running of even the best known hospitals.
Finally, my hon. Friend the Member for Bury St Edmunds (Jo Churchill), who had a personal reason for her particular interest in the Bill, referred to this country’s extraordinary pioneering work in medicine. That was exemplified by the news just this morning of genetic editing and the happy outcome for one little girl in particular. That reminds us of this country’s extraordinary reputation in medicine and medical research, and of the work of medical academics and all other health professionals. Every day we are appreciative of everything they have done for and contributed to this country’s reputation.
Alistair Burt
My hon. Friend makes a very important point about the community’s engagement and the way in which it can work with existing health services. The renewed attention paid to mental health will provide many further such opportunities.
Kevin Foster
The Minister is being exceptionally generous in giving way to colleagues. Given the rapidly ageing population, which means that there are likely to be more demands on services because of age-related illnesses, does he agree that the Bill is very timely? That is particularly true in a ward in my constituency where 9% of the entire population is aged over 85.
Alistair Burt
My hon. Friend makes a significant point about the use of the health service and the relationship of charities to its work. I am sure that many of us have similar contributions in mind. I appreciate how the Bill brings those two things very closely together.
I think it would help the House if I made some progress on the technicalities of the Bill. As I have mentioned, the Bill delivers commitments announced by the Government in response to the consultation on the “Review of the regulation and governance of NHS charities”, published in March 2014. Charities were given the opportunity to seek greater independence under the sole regulation of the Charity Commission, so removing themselves from dual regulation under NHS legislation and charity law. Six NHS charities have converted to become independent and others are progressing towards independence.
The Government response to the consultation made it clear that, given the new freedom for NHS charities to become independent, the Secretary of State’s powers to appoint trustees were no longer necessary and that they would be revoked as soon as possible once a legislative vehicle became available. This Bill is that legislative vehicle. It completes the reform of the regulation and governance of NHS charities, and it delivers the Government’s commitment to repeal the Secretary of State’s powers to appoint trustees to NHS bodies that hold charitable property.
The Department of Health has stated that it will not appoint trustees to any further bodies that are not already named in existing trustee appointment orders. It will, however, continue to enable the replacement of trustees for NHS bodies that currently have Secretary of State-appointed trustees until the appointment powers are repealed. The Department has said that the provisions removing the Secretary of State’s powers, if the Bill passes into law, would be brought into force in April 2018. That will allow charities with trustees appointed by the Secretary of State a generous period of grace in which to decide whether to become independent or to revert to corporate trustee status with the board of the NHS trust or NHS foundation trust as the trustee.
The Bill confers powers on the Secretary of State to make regulations to transfer charitable property from the trustees of an NHS trust or NHS foundation trust to the trust itself. This power will enable the Secretary of State to ensure that, prior to the repeal of his powers to appoint trustees, any trust property held by trustees can be transferred back to the trust to which the trustees were appointed. It is hoped that all charities with trustees will have resolved their future status, either by becoming independent or by reverting to corporate trustee status, before the Secretary of State’s powers are revoked so that the powers will not be needed.
The Bill amends the provisions of the Copyright, Designs and Patents Act 1988, which conferred in perpetuity the rights to royalties, and other remuneration as agreed, from the play “Peter Pan” on the special trustees appointed by the Secretary of State for Great Ormond Street hospital. J. M. Barrie’s gift of the rights to “Peter Pan” has provided a significant source of income for the charity. I do not want to linger for too long on “Peter Pan” because we have said quite a bit about it, but in deference to my granddaughter, who may be watching this debate, I wanted to mention that I am proud to be able to take this Bill through its initial stages and, hopefully, beyond.
The quality of the gift provided by J. M. Barrie has been mentioned by others. It was an almost unique charitable gift. I hope that through our talking about it, others will be encouraged to do the same. There are many generous benefactors from show business and the business and economic community, but to provide an endowment to a hospital in the manner that J. M. Barrie did was remarkable. He was a remarkable individual. I think that colleagues in the House know a little more about him now than they did before the debate. One of the quotations that is worth leaving with colleagues is:
“When a new baby laughs for the first time a new fairy is born”.
I suspect many of us have had the pleasure of saying that to our own children and grandchildren. This is an appropriate opportunity to discuss such issues.
Great Ormond Street Hospital Children’s Charity was eager to take the opportunity to become independent. It became partially independent on 1 April 2015. It is, however, unable to complete its conversion to an independent charity because the original NHS charity has to be kept in existence until the Copyright, Designs and Patents Act 1988 is amended, so as to avoid its statutory rights to the “Peter Pan” royalties being lost. The Bill will confer those rights on the new independent charity for Great Ormond Street hospital.
Retaining the original NHS charity causes a number of complications for Great Ormond Street Hospital Children’s Charity. Most significantly, running the two charities side by side creates a risk that legacies to the charities may fail. It also duplicates the governance arrangements, requires the production of separate accounts and may require the submission of duplicate returns to the Charity Commission.
Transferring the rights to “Peter Pan” also clears the way for removing the Secretary of State’s powers to appoint trustees to NHS charities. The Government will not remove those powers until such time as Great Ormond Street Hospital Children’s Charity no longer needs its Secretary of State-appointed trustees to receive royalties from “Peter Pan”.
In considering this Bill, the House needs to reflect briefly on the evolution of NHS charity legislation. Charities played a key role in the provision of healthcare before the NHS was created. In the years before 1948, people relied on a mixture of charitable provision and some limited national and voluntary insurance schemes. Prior to the NHS, many hospitals and other healthcare services were organised on a charitable basis, with their property and assets held in charitable trusts.
On the appointed day, 5 July 1948, the NHS took control of 480,000 hospital beds in England and Wales. The National Health Service Act 1946 transferred virtually all existing voluntary hospitals to the Minister of Health. The effect was that property previously held in clear charitable trusts for a hospital ceased to be charitable property. The 1946 Act also gave hospital boards the power to accept on trust further charitable property, such as donations. It gave the Minister of Health the power to appoint a hospital board as the trustee to hold charitable property for charitable purposes. The structure of the NHS has changed many times since the 1946 Act, but NHS legislation has always ensured that NHS bodies have the power to receive, hold and deal with charitable property.
NHS charities are characterised by the fact that they are bound both by charity law and their statutory objectives set out in NHS legislation, as well as by the fact that the Secretary of State has the power to appoint and remove trustees. NHS charities are linked directly to NHS bodies. In addition to raising funds, they have a special role as the charities that automatically receive money donated by members of the public to the NHS or to their linked NHS bodies. The NHS bodies that can hold charitable property are NHS trusts, special health authorities, foundation trusts, clinical commissioning groups and NHS England.
The statutory objectives of NHS bodies are derived from NHS legislation. They can hold property on trust both for the purposes of their linked NHS body or for any purposes relating to the health service. In reality, the vast majority of funds are held by charities linked to an NHS trust or foundation trust. They therefore hold property both for the purpose of their linked trust and for the purposes of the health service more generally.
As my hon. Friend the Member for Aldridge-Brownhills said, as at March 2015, there were about 260 NHS charities with a combined income of about £320 million and assets with a value of £2 billion. There is considerable disparity in size across the sector, with income heavily skewed towards charities linked to large, high-profile hospital trusts. At the time of the consultation in 2012, the top five NHS charities accounted for a third of the total income and the top 30 for over two thirds. That is why a concentration on smaller charities, such as those that have been mentioned by colleagues today, is so important.
The default position for an NHS charity is the corporate trustee model, whereby property held on trust is held by the NHS body itself, acting as a corporate trustee. The directors of the NHS body act collectively as a trustee for charitable property. The members of the board of the NHS body are not, individually, the trustees of the charity. NHS bodies acting as a corporate trustee are required, under charity law, to act exactly as an independent trustee would—that is, solely in the interests of the charity and its beneficiaries. The vast majority of NHS charities use the corporate trustee model. As at March 2015, of around 260 NHS charities, more than 90% had corporate trustees.
NHS legislation makes provision for the Secretary of State to appoint trustees for NHS bodies, and those appointed trustees carry out the trustee function in respect of that body’s charitable property. Trustees appointed by the Secretary of State have powers to hold trust property on the same terms as NHS bodies. Once in post, the trustees are answerable to the Charity Commission and not their linked NHS body.
The right hon. Member for Knowsley raised a potential issue in respect of the independence of charities and asked whether this provision would in any way deflect them from their other responsibilities. I assure him that that is not the case. Charitable law will still apply. They will still be regulated, but solely under charity law by the Charity Commission. That reduces the administrative burden and cost, and the calls on the time of the charity’s staff, but it does not weaken the essential controls. I hope that I have reassured him.
NHS legislation does not stipulate the circumstances in which such trustees should be appointed. The Department’s policy has been to establish bodies of trustees only where the charity holds such significant assets that it justifies the engagement of people with relevant expertise. The most recent Department of Health guidance, which was issued in 2011, said that assets of more than £10 million and an annual income or expenditure of £l million would provide a clear case for the appointment of separate trustees.
As hon. Members have mentioned, issues of charitable control are very much in the minds of the House at the moment and, I suspect, will continue to be so as we look into the background of Kids Company. It is important that when trustees are appointed, the importance of their role and the duties they have to perform is recognised. There should be extreme caution about appointing people to boards just for the sake of it, now more than ever.
Kevin Foster
There has been a National Audit Office report on Kids Company and I believe that the Public Administration and Constitutional Affairs Committee is looking into it. This Bill is about ensuring that the charities affected have the freedoms and benefits that all other charities have. There is a wider discussion to be had, perhaps at another time, about how charities should be structured to ensure that they operate appropriately and have good corporate governance.
Alistair Burt
That is absolutely right. The House will be pleased to know that I do not intend to go further down that road. In the context of recent discussions, it is important to ensure that the misuse of charitable funds is the exception to the rule. It is important that people retain confidence and faith in what charities do. That is why it is important to have a rigorous examination whenever allegations are made about things being wrong. In the NHS, such confidence is vital.
In practice, the Secretary of State has delegated his responsibility for making trustee appointments to NHS bodies to the Trust Development Authority, which is a special health authority. In addition to having powers to appoint trustees to an NHS body, the Secretary of State retains powers under NHS legislation to appoint special trustees for certain university hospitals or teaching hospitals. Those special trustees have narrower objectives than other NHS trustees. The special trustees’ objectives are limited to holding property on trust mainly or wholly for the hospital for which they are appointed, or for any other part of the NHS associated with hospitals. In contrast, all other NHS trustees may hold property for any purposes relating to the health service, as well as for the purposes of their linked NHS body.
As the House has heard, following the Government’s response to the consultation, there is now a process for NHS charities to convert to independent status. NHS charity trustees need to assess how they see the NHS charity’s future in order to decide whether or not to convert. There are a number of advantages to conversion. An independent charity’s liability can be limited. One main issue with the current position is that trustees appointed by the Secretary of State risk unlimited personal liability, and that can impact negatively on moves to attract new trustees with the relevant experience and expertise. Moving to independence allows trustees to form structures, such as limited liability companies that provide them with limited liability, thereby enabling them to tackle more significant and innovative projects.
Furthermore, in the eyes of a potential donor, an NHS charity can be seen as too close to Government. Experience has shown that donors—especially major donors—can be reluctant to give if they think the charity is simply seeking money that could or should be provided by the Exchequer. Some grant-giving charitable foundations will not entertain applications from NHS charities simply because of their connection to Government. An independent charity is able to adopt wider charitable purposes in respect of funds raised after it has become independent, and enter into more innovative fundraising initiatives, collaborations and mergers.
Independence removes the need for the charity to comply with NHS legislation, and enables it to be regulated solely under charity law by the Charity Commission. That reduces the administrative burden, costs and calls on charity staff time. It also removes the need to be tied to the “Agenda for Change” pay structure. “Agenda for Change” was not designed for charities and for some it hampers their recruitment of suitable staff at an appropriate salary.
There are, however, some drawbacks to converting to independence and some costs to conversion. There may be additional costs to being an independent entity, some minor VAT disadvantages, and the NHS body may fear a loss of influence over its charity. Each set of trustees has to decide what is best—whether to convert to independence or have corporate trustee model arrangements. Conversion involves the creation of an independent charity outside the NHS. As my hon. Friend said, conversion to independent status involves the creation of a new charity, usually in corporate form, either as a company limited by guarantee or a charitable incorporated organisation in relation to which Secretary of State has no powers. Alternatively it could involve the transfer to the new charity of all the charitable property of the NHS charity, or the winding up of the NHS charity.
The relationship between the NHS body and the independent charity is important. The conversion process requires a formal agreement, or memorandum of understanding, to be in place. The content of that is to be decided between the parties, but there must be a binding obligation on the NHS body to transfer all charitable donations it receives to the independent charity. The Department is also of the view that the NHS body should have some involvement in the new charity’s governance arrangements, for example by having a specific place on the board. That is because of the commitment for all future donations to be transferred to the independent charity, and because the independent charity’s objectives will continue to relate to the NHS.
The independent charity’s governing instrument—such as articles of association or its constitution—must ensure that the existing objects of the independent NHS charity are the same as those applying to the funds transferred from the former NHS charity. It will, however, be possible for the independent charity to have wider objects for new funds raised after independence. Prior to completion of the conversion, the Department must be satisfied with the final memorandum of understanding, and see evidence that the NHS body’s board has considered and approved the conversion.
As the House has already heard, five NHS charities with appointed trustees have converted to independent status: Barts Charity, Alder Hey Children’s Charity, Guy’s and St Thomas’ Charity, Birmingham Children’s Hospital Charity and Great Ormond Street Hospital Children’s Charity. Of the 16 remaining charities with appointed trustees, six have formally notified the Department that they are converting to become independent, one has formally decided to revert to corporate trustee status, and the other nine are at various stages of deciding the best way forward. One NHS charity with corporate trustee arrangements, Royal Brompton & Harefield Hospitals Charity, has already converted to independence, and Yeovil District Hospital NHS Foundation Trust charitable fund has notified the Department that it has decided to convert to independence—my hon. Friend the Member for Yeovil will know it well. The Department is aware of other charities with corporate trustees that are actively considering conversion to independence.
In summary, the Government have listened to the NHS charities and given them what they asked for. NHS charities can, if they so choose, do away with dual regulation, and gain greater independence under the sole regulation of the Charity Commission. Alternatively, they can have corporate trustee arrangements that provide a tried and tested means of managing charitable funds. This Bill makes good on the Government’s decision to repeal the Secretary of State’s powers to appoint trustees to NHS bodies. They are no longer needed. It also provides powers for the Secretary of State to transfer, by regulations, property from the appointed trustees to their linked trust, if any Secretary of State-appointed trustees are still in place when those powers are repealed.
The Department of Health has told the NHS that the powers to appoint trustees would not be revoked before April 2018, to provide a period of grace for trustees appointed by the Secretary of State to decide the most appropriate legal form for their charity in future. As we have extensively discussed, the Bill amends the Copyright, Designs and Patents Act 1988 to provide for the right in perpetuity for royalties from the play “Peter Pan” to be conferred on Great Ormond Street Hospital Children’s Charity. This Bill will enable the charity to complete its conversion to full independence.
I appreciate the points that have been made today and the way that the House has handled the Bill, and many colleagues have contributed. The Government are supportive of the Bill’s intentions, not because it delivers what we want, but because it helps to deliver the model and freedom that charities themselves have asked for.
I will conclude with one final quote from J. M. Barrie—[Interruption.] It is a final quote:
“Those who bring sunshine into the lives of others cannot keep it from themselves”.
Those of us who know my hon. Friend the Member for Aldridge-Brownhills, will know that that is certainly true about her, and I commend her Bill to the House.
Junior Doctors’ Contracts
Kevin Foster Excerpts(8 years, 6 months ago)
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Dr Sarah Wollaston (Totnes) (Con)
I start by declaring a relevant personal interest in that my daughter is a junior doctor, and one of many hundreds who have moved to Australia to work. Because of that very clear conflict of personal interests, I shall abstain in this evening’s vote. I want to speak, however, because I have relevant personal experience, as before I came to this place I taught junior doctors and medical students for 11 years.
I can tell the House that this dispute is about far more than pay. It is about junior doctors feeling valued. The junior doctors I used to teach, including F2 foundation year doctors, felt that they were not being supported at the weekends, disliked the inability sometimes to work in the same county as their partner and disliked obstructive attitudes about rostering. That presents us with an opportunity to bring all those issues into the negotiations in this current dispute.
One thing I do know is that young people do not go into medicine because they are motivated by pay. I hope that the House sends a very clear message to junior doctors that we value what they do and are grateful for what they do on behalf of patients. What we must do is avoid a strike at all costs. A strike would be immensely damaging for patients. I would say to junior doctors that there is no meaningful industrial action that they can take that would not harm their patients. I urge them to step back from such a move. A strike would be damaging not only for patients, but for the professional reputation of doctors, and of course politically. That should not be the consideration. Our main consideration should be how we encourage junior doctors to walk back through the door of the Secretary of State’s office, as he has stated. The best way to do that would be to start again.
Many elements of the dispute feel similar to the one we had in 2007, when I was teaching junior doctors, over the medical training application service—or MTAS, as it was known. It was a very unloved, unlovely scheme that collapsed, after a much-needed apology, in 2007. The Government of the day went back to the drawing board and started again. I think it would be right to do so on this occasion. We need to remove the barricades that are preventing junior doctors from walking back through the door. It would be right to take away the preconditions, the red lines and the threat to impose—and start again, looking at all the issues in the round.
Junior doctors share many of the Government’s objectives. They want to improve care for patients; they recognise that shortage specialties in the NHS are a real issue and that if we are going to put patients first, we need to incentivise entry to specialties such as accident and emergency, general practice, psychiatry and so forth. We need mechanisms to make that happen. They recognise, too, the need to address variation across the NHS, including with respect to weekends, but we need to look at that in the round. It is not just about senior and junior doctors either; it is about nursing, access to diagnostics, being an outlier on a ward that someone should not be in because the hospital is over-full.
Kevin Foster (Torbay) (Con)
I am sure that my hon. Friend would agree that one thing about which junior doctors want certainty is no longer having whole weeks of nights or having to work beyond 72 hours. The Government need to be clear about how they will achieve that.
Dr Wollaston
I thank my hon. Friend for his intervention. There is much to be welcomed in the new contract, but we need honesty about some of this. I am very pleased that the Secretary of State has given an assurance today that no junior doctor will be worse off, but I hope that when he sums up the debate, he will tell us what will happen to a junior doctor working 70 hours a week, perhaps in a specialty such as accident and emergency or anaesthetics. If the pay envelope is the same and some junior doctors will be better off, the maths indicates that some will be worse off and we need to clarify which ones. We need much more clarity, not just about whether an individual will be no worse off as a result of changing from one job to the next over the transition period, but about what will happen to the pay for that post over the coming years.
While I welcome many of the elements of the junior contract, I feel that, because the debate has become rather toxic, we should take the opportunity to begin again to examine all the issues in the round, and ask junior doctors themselves to work with the Secretary of State in establishing how we can achieve our common aims on behalf of patients. We should also take the opportunity once more to welcome junior doctors and value everything that they do.
Contaminated Blood
Kevin Foster Excerpts(8 years, 9 months ago)
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Ben Gummer
I know that my hon. Friend has spoken about that issue to my hon. Friend the Member for Battersea, the Minister with responsibility for public health, and she will write to him shortly with an answer to his question.
Kevin Foster (Torbay) (Con)
My hon. Friend will be aware of the frustration of those waiting for a result, including some of my constituents. I heard what he said about consultation, but can he assure victims that a final decision will be made as soon as possible, given the decades that they have spent waiting for justice?
NHS Reform
Kevin Foster Excerpts(8 years, 9 months ago)
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Mr Hunt
I recognise that the hon. Lady has legitimate concerns about the way that the whistleblower, who I think is one of her constituents or is near to her constituency, was treated. I have, as she requested, looked into that very carefully. She will understand that it would not be right or proper for me to comment on an individual case. She knows that, as a result of requests by her and fellow MPs, I looked into whether due process was followed in the case that she mentioned. All I will say is that bullying behaviour should not happen anywhere in the NHS. That is a very important part of the culture change that I want to see.
Kevin Foster (Torbay) (Con)
In Torbay, there are a number of concerns about access to primary care, due to issues of recruitment and retention of GPs. Recognising the comment that the Secretary of State made earlier in response to my hon. Friend the Member for Totnes (Dr Wollaston), how does the Secretary of State see his statement today helping to improve this situation?
Mr Hunt
We have some fantastic primary care in Torbay. I remember visiting my hon. Friend during the election campaign and going to a hospice run by an absolutely inspirational lady. We need to build on those traditions, and modern technology offers us an opportunity to go even further. In the end, this is about having a less hospital-centric system and prevention rather than cure, and our great tradition of general practice will be our strongest asset in that change.