Unavoidably Small Hospitals

Kevin Hollinrake Excerpts

Tuesday 6th September 2022 Westminster Hall

[Bob Seely (Isle of Wight) (Con)]

I beg to move,

That this House has considered unavoidably small hospitals.

Thank you very much, Mr Hollobone; as ever, it is a pleasure to serve under your chairmanship. I thank the Minister for being here, and I wish her luck in any coming reshuffle. I also thank colleagues from Yorkshire, Devon, Cornwall and other parts of the United Kingdom for being here. Indeed, we have two Members from Yorkshire—my hon. Friend the Member for Thirsk and Malton (Kevin Hollinrake) and my right hon. Friend the Member for Richmond (Yorks) (Rishi Sunak). It is a delight to see them both. I saw one quite recently on the Isle of Wight, but sadly not both.

The debate was originally granted prior to the covid pandemic. Clearly, much has changed since then, but I also wonder whether the fundamentals of unavoidably small hospitals have changed. The reason why I called the debate back then, and why I want it now, is that I fear they are still the poorer cousins of larger district general hospitals.

I will make two points. Clearly, I am going to talk specifically about St Mary’s Hospital on the Island, because it is in my constituency, but there are broader points to be made about unavoidably small hospitals throughout the United Kingdom. I want specifically to ask the Minister to put as much information as possible about the funding processes for unavoidably small hospitals in the public domain. We were talking prior to the debate, and she said that some of that information rests with the new integrated care boards. That may well be the case, and that is fair enough, but they are not elected bodies. We know that the NHS can be rather top down and bureaucratic in some of its behaviours, and the more information she can put in the public domain to help Members with unavoidably small hospitals understand the situation, the better.

Before I address that further, let me put on record my thanks not only to staff at St Mary’s but to GPs on the Isle of Wight and their staff, and to the pharmacists, the dentists and all the staff in care homes, who do a no less valuable job. Some of the problems we are facing are because of a lack of integration with our adult social care system; the inability to find a home for the elderly and vulnerable that that system looks after puts additional pressure on hospitals.

Let me also put on record my thanks to the Government for the £48 million additional capital spending on the Island. Indeed, I suspect that the former Chancellor, my right hon. Friend the Member for Richmond (Yorks), deserves thanks for that, as well as for the fair funding formula reference for the Isle of Wight. I am delighted and very grateful that he did both those things. That £48 million was part of getting a better deal for the Island, which is clearly an ongoing project.

In England and Wales, there are 12 unavoidably small hospitals, which are defined as hospitals that, due to their location and the population they serve, and their distance from alternative hospitals, are unavoidably smaller than the “normal” size of a district general hospital. In the Isle of Wight’s case, we are about half the size—about 55% to 60%—of the population needed for a district general hospital.

I would argue that the pressures on these small hospitals are greater than elsewhere. They are smaller, so they are more easily overwhelmed due to their size, and they are under greater economic pressure, because the NHS funding model—we recognise that there has to be a funding model—is designed for an average-sized, “normal” district general hospital, rather than an undersized one. You cannot give birth on a helicopter or a ferry; on the Island, we need to run our maternity services and our A&E 24 hours a day, seven days a week. However, our income is based on national tariffs that do not equate to the size of our population. As the Island’s trust says,

“the Island’s population is around half of that normally needed to sustain a traditional district general hospital.”

The third pressure on unavoidably small hospitals is because they exist outside of major population centres. Without a shadow of a doubt, they are in some of the loveliest parts of England and Wales, but because they are outside of those major population centres, recruitment and retention of staff becomes more difficult, which adds pressure on the staff who are there and adds costs in terms of locums and agency staff, which can have a highly significant effect on budgets. Ferries aside—with the partial exception of the Scilly Isles—the pressures at St Mary’s on the Isle of Wight are shared by other unavoidably small hospitals. I think that helps to explain why, in the last decade, a number of unavoidably small hospitals have been put in special measures or have sadly failed, despite the best efforts of those people who work there.

Our hospital, St Mary’s, is classed as 100% remote, which is unique even by unavoidably small hospital standards, because it is accessible only by ferry—although, as far as I can see, accessibility by sea is not a factor in the definition of an unavoidably small hospital. On the Island, our need for healthcare is arguably higher than elsewhere in the United Kingdom. We struggle to get the national standard, but our need for that national standard is greater because over a quarter of our resident population is aged over 65 and, by 2028, over-65s will be one third of the population. Indeed, we have a particularly large cohort of 80 to 84-year-olds.

All the evidence and common sense suggests that that has a disproportionate effect on healthcare: older people, and especially the very old and frail, need healthcare more than young people. We on the Island are struggling—as, potentially, are other USH areas—to provide quality for that ageing population. In addition, the Island’s population doubles over the summer, because we have lots of lovely visitors. That impacts demand, which means that our A&E can be close to overflowing at times, even as efficiently run as it is.

I suggest that there is an additional factor: the impact of high levels of social isolation. People retire to the Island as a couple and one sadly dies, leaving the other isolated from family and social networks because they lived most of their life in other parts of the United Kingdom. That leads to increased reliance on statutory services.

All this has been noted. The former Health Secretary, my right hon. Friend the Member for West Suffolk (Matt Hancock), confirmed his concerns to me in July 2019, telling the House:

“As for Island healthcare costs, my hon. Friend is right to say that the Isle of Wight is unique in its health geography, and that there are places in this country—almost certainly including the Isle of Wight—where healthcare costs are”—[Official Report, 1 July 2019; Vol. 662, c. 943.]

increased.

I am not saying that we are the only place like that. There is isolation in other parts of the country, including Yorkshire, Cornwall, Devon and Cumbria, but in the Island’s case the situation is cut and dried because of our separation by sea from the mainland. In its January 2019 sustainability plan, the Isle of Wight NHS Trust estimated that the annual cost of providing a similar—I stress to the Minister that this is the critical element—standard of healthcare and provision of 24/7 acute services, including maternity and A&E, on the Island to that enjoyed by mainland residents would be an additional £9 million. These are 2019 figures.

The estimated cost of providing additional ambulance services, including coastguard helicopter ambulance services, was about £1.5 million. In the Scilly Isles, patient travel is funded out of the clinical commissioning group—now the ICB—budget. Ours is not. Our patient travel budget comes from ferry discounts and council contributions, and it was estimated to be £560,000. In total, one is looking at between £10 million and £12 million at 2019 figures.

Either because they were going to do so anyway or, hopefully, because of representations from myself and others, the Government have recognised since then that unavoidably small hospitals need a funding model that serves them, because there is no alternative but to keep those hospitals open to serve those populations in a way that is ethical and, frankly, legal nowadays.

I am proud of our efforts to highlight the plight of unavoidably small hospitals to the Government, and I thank them for listening and for trying to put in place a package of support for them. I say to the Minister that this is where I would welcome more facts being put in the public domain. I have trawled through NHS documents for the last couple of days, and the last figure I can see for the unavoidably small hospital uplift for St Mary’s on the Isle of Wight is that from 2019, when we received £5.3 million. That is roughly half of what we think we need to run a national level service, so we are grateful that the Government have recognised the need for an uplift for unavoidably small hospitals. Will the Minister please update me on how much money St Mary’s has had as an unavoidably small hospital since 2019, given that we have clearly had issues with covid?

According to page 13 of the NHS “Technical Guide to Allocation Formulae and Pace of Change” for 2019-20 to 2023-24, that money was given in 2019 due to

“higher costs over and above those covered by the”

market forces factor. I cannot see other figures in the public domain. I do not quite understand how the Government could calculate that figure in 2019 when the advisory committee said in January 2019 that it was

“unable to find evidence of unavoidable costs faced in remote areas that are quantifiable and nationally consistent such that they could be factored into allocations”.

That is from the NHS England document “Note on CCG allocations 2019/20-2023/24”.

The Government say that they cannot work out how much extra to give unavoidably small hospitals, while at the same time a different NHS document says, “We are going to do some calculations, and here is the rough calculation.” Can the Government work out the additional costs or can they not? They are basically saying the same thing in two separate documents.

[Kevin Hollinrake (Thirsk and Malton) (Con)]

I congratulate my hon. Friend on securing this important debate. May I give an example of how the Government might calculate the figure? A hospital in my constituency in Scarborough is run by the York and Scarborough Teaching Hospitals NHS Foundation Trust, which tells me that it has to pay extra to get consultants to travel to Scarborough and stay overnight, as well as paying their hotel bills. However we factor this stuff in, we have to be able to make a calculation that allows those trusts properly to fund these hospitals.

[Bob Seely]

I thank my hon. Friend for that valuable intervention. We have exactly the same problem. I will come on to how we are trying to solve it, but we have the same issue getting consultants over from Portsmouth, although we are very close to Portsmouth and Southampton. It is difficult for a consultant with a speciality to work in a small NHS trust, because there is no opportunity to practise that speciality effectively enough to keep their ticket to do their very valuable and worthwhile job.

Although I am delighted that the previous Conservative Government recognised the additional costs and gave the Isle of Wight nearly £50 million in additional capital expenditure, my trust assesses that the funds given are roughly half what is needed. I stress that we are not just sitting on the Island saying, “We want money.” We understand that we need to sort out these problems for ourselves. Our trust was in special measures and is now rated good, due to some fantastic hard work by Maggie Oldham and other health leaders, who have come in and turned our hospital around, really helping to make a difference. I thank everybody, from the cleaning staff to the most junior nurse and the most junior doctor, for the great work they have done.

We are now rated good and have been looking at ways to provide better services on the Island, without just waiting for the Government to provide funding. We are integrating. We have deepened our relationship with Portsmouth general hospital, our university hospital, the idea being that when it hires a consultant, we share that consultant for 10% or 25% of their time. A world-leading consultant in an area of medical expertise will therefore spend some of their time looking after folks on the Isle of Wight.

We have reformed our mental health services, and we are reforming our ambulance service too, to ensure that we have more ambulances out there to treat more people, more quickly. Along with everywhere else, we are integrating adult social care as part of the Government’s plans. We want to be pioneers in that. Because of our age demographic, we want to be at the front of the queue. I have sadly learned that, if the Island is not first, it tends to be last, because it comes as an afterthought. I always want to ensure that the Island gets to the front of the queue, so that when the Government look to test pilot schemes, they come to us first.

We are looking at chances to pilot new schemes. We did it with Test and Trace, and we are adopting telemedicine as fast as we can. We are working with the University of Southampton to pilot using drones to deliver cancer care. The drone testing started during covid and, as of a couple of months ago, it is now a regular service that brings just-in-time cancer medicine to the Isle of Wight. That is a really good way to see that advanced technology is helping folks on the Island and, indeed, helping the NHS to provide a better-quality service.

I will round up, as I am mindful that other people want to speak on this issue and it is important that the Minister hears other voices. In January 2019, the NHS long-term plan set out a 10-year strategy for the NHS in England. For smaller acute hospitals such as St Mary’s, the plan stated that the NHS will

“develop a standard model of delivery”.

It would be great to hear from the Minister what has happened to that plan for a standard model of delivery. Is that now the funding formula that is included in the new integrated care boards? If so, will the Minister please outline how that funding formula works and is calculated, as my hon. Friend the Member for Thirsk and Malton and I have asked? It is in the public interest that the formula is as transparent as possible.

Will the Minister please explain why, if someone travels from the Scilly Isles to the mainland for care, it is paid for out of a central budget? If someone has prostate cancer or another form of cancer, they often need to be treated in Portsmouth or, occasionally, Southampton. That funding does not come from the Government. Why is that? Why is there a double standard that affects the Isle of Wight negatively?

Finally, the Minister mentioned before the debate that the funding formula details are held by the new integrated care boards. For the 20 Members of Parliament in England and Wales who are within the remit of an unavoidably small hospital, those figures should not be held at ICB level but should be shared between Ministers and interested Members, so that we can all see how these very important institutions in our communities are funded. By doing so, I hope that we can increase the funding for them or at least increase the Government’s understanding that just because such hospitals are the smaller cousins of larger district general hospitals, they should not be treated worse but should be given extra care and attention to make sure that folks in our communities can have the same standard of care as other people throughout the rest of England and Wales.

--- Later in debate ---

[Kevin Hollinrake (Thirsk and Malton) (Con)]

It is a pleasure to speak in this debate with you in the Chair, Mr Hollobone. I thank my hon. Friend the Member for Isle of Wight (Bob Seely) for tenaciously following up on this very important issue, which I and my right hon. Friends the Members for Scarborough and Whitby (Sir Robert Goodwill) and for Richmond (Yorks) (Rishi Sunak) have been following closely over the years.

My hon. Friend concluded in exactly the right place. The issue is not hard numbers in terms of cash, deficits or whatever; this is about patients and patient care. We have experienced two challenges in respect of Scarborough Hospital and the Friarage Hospital in Northallerton in particular. Yes, as my hon. Friend set out, there is the issue of funding and the extra costs of delivering services in places such as Scarborough, but there is also the fact that these hospitals are run by trusts that run a number of hospitals, and the small hospitals are, of course, not necessarily their largest hospitals. Because the trusts are faced with the extra costs of running the smaller hospitals, there is a natural tendency for them to try to centralise care in one of the other hospitals. When they talk to the public—they tend to talk to their customer base before they make changes—they ask them, “Would you be prepared to travel for better health outcomes?” Who would not say yes to that? Of course! But it is a leading question.

I have a couple of examples of how it works in practice. A number of my constituents have written to me. One of them had to go to York Hospital from Scarborough. They did not have transport—they did not have a car—and they had to go for an appointment at 7.30 in the morning for treatment for a brain tumour, and were then discharged at 11 o’clock that night, without transport. It is not just that people have to travel for extra care and that they are deprived of local care for treatment that would have been available at Scarborough at one point; it is the fact that there is no real consideration of some of the challenges of living in a rural area. Some of my constituents have had to travel to York from Scarborough on the east coast—from Filey in my patch—to stay in a hotel overnight because there is no public transport to get to early morning appointments in York Hospital. Those are direct consequences of centralisation.

[Bob Seely]

The problem is clearly significant in my hon. Friend’s patch, but does he understand that when people are separated by sea from the mainland it becomes an even greater problem? There are even greater logistics if people need a car and then a ferry to the bus and so on.

[Kevin Hollinrake]

My hon. Friend is absolutely right. His challenge may be even greater than ours in rural parts of North Yorkshire.

Centralisation is a natural tendency for any organisation, of course. A person sat in a larger hospital in York will think, “Let’s have all the services over here. It is easier and cheaper to employ consultants over here.” Centralisation is easier, but it is much worse for patients. It is not fair on them, given the complexity of travel and the effect on local communities.

The principal trust that runs the hospitals in my area is the York and Scarborough Teaching Hospitals NHS Foundation Trust, which runs Malton Community Hospital, Scarborough General Hospital and St Monica’s Easingwold, which is a small cottage hospital. It is easier for the management to centralise things, and it is cheaper, given that it is more expensive to provide healthcare in more remote locations. I said earlier that because remote hospitals have difficulty recruiting people, they tend either to close services down or provide additional remuneration for the consultants who work there, so there is a double whammy of cost.

The other issue in my constituency is that it is 40 miles from Scarborough Hospital to York, and on a good day it takes an hour to travel on the A64 all the way to York as it is a single carriageway for most of its stretch and is often logjammed with traffic. The dualling of that carriageway has been the subject of many pleas to the former Chancellor, my right hon. Friend the Member for Richmond (Yorks), and many others, and hopefully we will get that in the not-too-distant future. This is serious stuff, of course, for anyone who needs emergency treatment.

The stroke unit at Scarborough was relocated to York some time ago, so if someone has a stroke in Scarborough, they have to get to York, and they might be in an ambulance for two hours on that road. It is unfair. I understand that they may get better treatment at the hyper-acute stroke unit at York, but nevertheless there are potentially direct impacts on people’s healthcare when services are centralised in distant locations.

It is not just stroke care that has been centralised in other hospitals, but outpatient physiotherapy, dermatology and pain clinics. Breast cancer oncology was moved away from Scarborough some time ago owing to the difficulties of recruitment. It is easier to employ consultants in a hospital that has more money than to incentivise them to go to more remote locations. The A&E unit at the Friarage Hospital in Northallerton, in the patch of my right hon. Friend the Member for Richmond (Yorks)—he will talk more about it—was downgraded to urgent care treatment, and we were told that one of the reasons was that it was difficult to recruit anaesthetists.

Services are being closed down. The Lambert Hospital in Thirsk in my constituency, which provided respite and elderly care, was completely closed down because it could not recruit in that location. Our suspicion was that the trust did not really try all that hard to recruit people because it is more difficult to run services in remote locations.

On costs, I can give my hon. Friend the Member for Isle of Wight a direct comparison. When the York and Scarborough Teaching Hospitals NHS Foundation Trust took over Scarborough back in 2012, it was given £10 million a year for the extra costs of providing services in that location. That ended in 2018. A small amount has been provided to make up for the loss of £10 million—£2.6 million of funding through the clinical commissioning group—but, as a consequence, services are diminishing.

There is some good news: my right hon. Friend the Member for Scarborough and Whitby and I campaigned, and the Health Ministers were very supportive. There has been £40 million of extra investment in the A&E at Scarborough, but nevertheless there are some real concerns about the services, which are reduced as a consequence of underfunding. I would like to hear from the Minister exactly what we are doing about it now and what we will do in the future to improve the situation.

--- Later in debate ---

[The Minister for Health (Maria Caulfield)]

It is a pleasure to serve under your chairmanship, Mr Hollobone. I thank my hon. Friend the Member for Isle of Wight (Bob Seely) for securing this really important debate. Small hospitals are often the Cinderella service of the NHS, and their value is not always recognised. We have heard cross-party support from Scotland and Northern Ireland, and if Welsh Members had been present I am sure that they too would have recognised the challenges that unavoidably small hospitals face.

I reassure colleagues that the ministerial team recognises the worth of small hospitals. As my hon. Friend the Member for St Ives (Derek Thomas) said, it is not just about the value they bring to their local communities, but the pressure they take off the wider health service in their regions, which we have seen particularly clearly in recent months and years. When we had covid hot and cold sites in the NHS, smaller hospitals were able to work and function and take some of the pressure off larger hospitals that had large outbreaks of covid. While I acknowledge that small hospitals are more expensive to run, their added value cannot be underestimated. My constituency does not have a hospital, so my constituents have to travel. We do, however, have the Lewes Victoria Hospital—it is a small community hospital, not an unavoidably small hospital—and my constituents really value its work. If they did not have it, they would have to go to the big hospitals in Brighton, Eastbourne or even Hastings, so I am on the same page as many of the Members here.

My hon. Friend the Member for Thirsk and Malton (Kevin Hollinrake) and my right hon. Friend the Member for Richmond (Yorks) (Rishi Sunak) touched on this. When trusts run a portfolio of hospitals, it is often tempting for them to move services to a much more cost-efficient, bigger site, but what then tends to happen is that, once the consultant-led maternity service goes, it becomes difficult for the anaesthetists to keep up their skills, and all of a sudden the hospitals become unsustainable. That is a risk. As my right hon. Friend highlighted, and as I saw when I visited the constituency of my hon. Friend the Member for North Devon (Selaine Saxby), there has been a resurgence in interest in small hospitals and their values. We are putting in surgical hubs and investment because we recognise that they can do specialist work, sometimes more easily than big trusts that have the pressures of big A&E departments, trauma centres and wards that are struggling with capacity.

Smaller hospitals can deliver in different ways, but there are no doubts that they face unique challenges. My hon. Friend the Member for Isle of Wight touched on the significant issue of funding. I will come back to that, but I will first touch on some of the other issues they face. On the Isle of Wight, for example, having a smaller hospital can sometimes produce better quality of care for patients. The ambulance handover delays on the Isle of Wight are minimal. The average handover for emergency conveyancing is less than 15 minutes, and their record on 60-minute breaches is often better than that of some of the larger centres.

The quality of care can also be a significant factor, but that also takes intervention and support. It is not just about the funding and the staffing, which we have also touched on, but the system itself. The recovery support programme that has evolved from the special measures programme is working with small hospitals to provide a systems-focused approach to support them and address some of those challenges. As my hon. Friend the Member for Isle of Wight has said, the hospital there went into special measures in 2017 and it is now rated as good. That resulted from a lot of support from the national systems, but also from the hard work of local clinicians and managers. It is a testament to their hard work.

Retaining workforce is difficult. We know that GPs, dentists and nurses are more likely to stay where they trained. That is difficult for smaller hospitals, because traditionally they do not have their own training programmes. People train in large teaching hospitals and often stay there and develop their practice further.

Health Education England is working on changing the traditional nature of training. Blended learning programmes use a combination of technology, online learning and the apprenticeship model to make it easier for small hospitals to train their own staff of nurses, healthcare workers and doctors. There is also the apprenticeship model, with apprenticeships now available in a number of healthcare organisations. Existing staff can take apprenticeship routes, stay in their workplaces and not have to travel long distances to universities miles away. That is important, whether it is for the registered nurse degree apprenticeship, healthcare assistant practitioners or the new medical doctor degree apprenticeship. That will make it easier for smaller hospitals to train and develop their own workforce and, crucially, to upskill the existing workforce. Traditionally, if someone wanted to take on an advanced nurse practitioner role or was an anaesthetist wanting more training, they would often have to leave their small hospital and go to a bigger teaching hospital to take such courses. The blended learning programme will make recruitment and retention easier for smaller hospitals, and will be a lot more rewarding for staff.

My hon. Friend the Member for Isle of Wight talked of funding. I am the first to acknowledge that smaller, more rural and coastal hospitals have greater expenses because they cannot get the scale of efficiency of a larger teaching hospital. A lot of work is going in to supporting the funding mechanism. NHS England is responsible for allocating funding. It goes down to the new integrated care boards, which were established in July. Funding allocations for this financial year were published earlier this year. If my hon. Friend cannot find that information, I am happy to provide him with the figures and the algorithm used to achieve them. The formula seeks to acknowledge geographic and demographic distribution, which can vary, as a number of hon. Members have said. Some areas can have an older population, and it is important that the funding formula reflects that. The discussion is between NHS England and the integrated care boards. There has been a change in the formula to take account of the higher costs of providing emergency services in particular in sparsely populated areas, with an adjustment for costs that are unavoidable due to the small nature of the hospital.

If my hon. Friend and other hon. Members feel that the changes to that formula and the relationship between NHS England and the local integrated care boards are not delivering some of the funding measures we had hoped for, I am happy to discuss that further and to sit down with colleagues so that they are clear about the funding formula and allocation. It should not require trawling through pages of documents to find that out. I am happy to help my hon. Friends with that, because it is important to recognise.

I want to touch on urgent and emergency care. It is important for emergency care to be available locally, but that can be a challenge for unavoidably small hospitals, because they see a much smaller number of trauma cases or cardiac arrests. Highly skilled staff, such as anaesthetists, with the support of their royal colleges, need a number of such cases to keep their skills in place, and we need to support them.

I want to reassure colleagues that we are committed to keeping smaller hospitals. The investment in the Friarage surgical hub is a case in point. We have also recently seen investment in North Devon. I also hear the call for the 40 hospitals programme. We are committed to that, and it is important that staff have that reassurance and patience, because it is about not just the services that are technically on a site, but the quality of care. As smaller hospitals often know their patients well, they get a quality of care that they sometimes do not get in larger hospitals with hundreds of patients coming through a department.

[Kevin Hollinrake]

One of the Minister’s predecessors wrote to me on 28 October 2019 and said that a new community services formula was being used for hospitals such as Scarborough Hospital in my constituency, and others that have been mentioned. Will the Minister write to tell us exactly what impact that has had on funding since 2019 so that we can understand what extra resources have been made available?

[Maria Caulfield]

I am happy to write to all colleagues on that. It is important to understand the difference that that formula will make and to assess whether it is working in practice, and Members of Parliament will be able to pick up quickly on whether it is making a difference locally. I also encourage colleagues to meet their integrated care boards—if they have not already done so—which will have a relationship with NHS England and will supply the information on the demographics and geographical variations that make the formula work. The integrated care boards came into force in July, and now is a good opportunity to have those conversations so that ICBs are clear that Members of Parliament and their local communities value smaller hospitals and that that must be considered when decisions on funding and services are made.

We have had a good debate. I want to reassure colleagues that small hospitals are a vital part of the NHS family: they take pressure off some of the larger services and provide good quality service for local residents, who really value them.

Health and Care Bill

Kevin Hollinrake Excerpts

Consideration of Lords amendments
Wednesday 30th March 2022 Commons Chamber

[Peter Gibson (Darlington) (Con)]

I believe that everyone should have high-quality, personalised palliative care, and that is why I am speaking in favour of Lords amendment 12 on palliative care. I wholeheartedly welcome the benefits that this Bill can bring to those in need of that care. I must mention the tireless campaigning of Baroness Finlay, as referenced by the Minister in his opening statement, and Hospice UK, which acts as the secretariat for the all-party parliamentary group on hospice and end of life care, of which I am a co-chair along with Baroness Finlay. Without their campaigning, we would not have been able to welcome this step forward. I should also declare my interest as a trustee of a hospice, and I draw the House’s attention to my entry in the Register of Members’ Financial Interests.

On the day of the publication of the Ockenden report and our discussion of good births, it is time that we started to talk about good deaths, too. There is far more that we need to do to ensure that hospices and palliative care providers have the tools they need to achieve this, and Lords amendment 12 certainly moves us forward. We need to ensure that the impact of the measures in this Bill are maximised. The Bill specifies appropriate palliative care, but we should expand on this to ensure that a fair minimum standard of care is provided. We should be providing statutory guidance to integrated care boards on the commissioning of palliative care, ensuring that the new requirements are clear. That point was ably raised by my hon. Friend the Member for North Warwickshire (Craig Tracey).

Funding certainty for hospices is essential. Certainty can enable them to better plan, support the needs of their local community and give commissioning boards confidence in relying on them as an integral part of local services. Certainty of funding will allow hospices to invest, innovate and integrate with the NHS and care system. Before the pandemic, adult hospices on average received 34% of their funding from Government, with some receiving little or none. Hospice funding came primarily from charitable donations, with the sector needing to raise £3.1 million every day. The pandemic saw donations, retail sales and fundraising activities fall dramatically, at the same time as an increase in service delivery. I want to put on record my thanks to the Government for the support that was given to all our hospices during the pandemic—and, in particular, to St Teresa’s in Darlington—but we need to see some certainty of funding for our hospices to deliver on this promise.

I am pleased that the Government accept Lords amendment 12. It is an important step forward for hospices and palliative care, and I welcome it.

[Kevin Hollinrake (Thirsk and Malton) (Con)]

It is a pleasure to speak after my hon. Friend the Member for Darlington (Peter Gibson). He made some very strong points in his speech with which I absolutely concur. I want to speak to Lords amendment 80, and his constituency—I know it pretty well, having been there and spent a bit of time there prior to the last election—is the kind that will be affected by it. The Government’s decision is to resist that Lords amendment, which I cannot support. In my view, this is a classic policy for levelling down, not levelling up.

The Minister is absolutely right—both Ministers involved in this Bill are good friends of mine, and I do not want to make their lives more difficult in any shape or form—when he says that the policy across the board is a significant improvement on anything we have had before. That is absolutely right. He said that in his speech, and I agree with it, but I do not agree with him when he says that it is fair. I do not believe it is fair, and that must be the basic criterion on which we judge any proposals, not least these.

I think everybody, including the Minister, accepts that it is quite clear that a £900 million transfer is happening here, which was introduced just as the Bill went on to Report stage. That is a direct transfer of £900 million from household wealth to somewhere else. That is what it is: a transfer of assets—household wealth—to healthcare, the Treasury or wherever else it is going, because that is the way that council contributions are used when it comes to the speed at which somebody reaches the cap.

I could live with that, if we were trying to make the system more affordable, as the Minister says—if the burden was going to fall equally on everyone’s shoulders in different parts of the country. It also true to say that most people will not be affected, because only people on very long care journeys tend to be affected badly, but there are quite a few of them: according to the Department’s own figures, about 6,000 a year—10 people per constituency—would be affected in this way, and most of them have dementia. We know that there are 900,000 people with dementia in the UK today; according to the Alzheimer’s Society, there will be 1.6 million by 2040; and 70% of care home residents are dementia sufferers, and they are the sort of people who will suffer because of the changes. They have very long care journeys, and they move out of their house so it becomes one of the assets that we take into account when assessing how much people contribute to the care cap.

The Minister says we are making these changes to make the system sustainable. Well, okay, make it sustainable, but make it fair too. I do not believe that this is fair. I know I am comparing this with a system that never existed—my hon. Friend is right to say that—but one was proposed in which the council contributions would count in calculations of people’s contribution to the care cap. That is the change we have made—the specific measure to make the system more sustainable is that change, and that affects people with limited assets and wealth. We are balancing this on the shoulders of people with fewer assets and less wealth, and on certain areas as well, as people in some of the regions in the north that we represent tend to have fewer assets and less wealth.

Particularly affected are people who have wealth or assets worth between £75,000 and £150,000. The research provided by the Alzheimer’s Society is clear: under the Dilnot proposals, about 50% of people living with dementia benefited fully from the care cap—they reached the care cap. That was true across all the wealth quintiles—it was very fair. This is not. Only 13% of people in the least wealthy quintile will reach the cap, whereas 28% of the most wealthy will. Such huge disparity cannot be right, yet that is the change that we have made. That £900 million has been found from people with less wealth. That cannot be right, nor is it consistent with levelling up. Look at how different regions are affected: only 13% of people in the north-east reach the cap whereas 29% of people in the south-east do so. Previously, in almost every part of the country, about 50% of people did so. The cap was not as generous, but it was very fair across different wealth quintiles and different regions of the country. I cannot see how this is fair.

Instead of each of us having 10 people in our constituency affected, some will have more and those representing wealthy constituencies will have fewer. I and other Members representing the north-east will have more constituents affected by this change and less generously treated because of it. For that reason, and because in my view it levels down, I cannot support the Government and will vote against them this evening on Lords amendment 80.

[Edward Argar]

I am grateful to all colleagues who have spoken this evening. A number of the arguments were made on Report, and rightly, right hon. and hon. Members have reiterated some of those points where they felt it was appropriate. I will address a number of the points raised relatively briefly.

What we are legislating for in this Bill represents an evolution of our health and care system, and improved integration. My hon. Friends the Members for Gosport (Dame Caroline Dinenage) and for Winchester (Steve Brine) both spoke about carers. Young carers are included, which I hope reassures my hon. Friend the Member for Gosport. In respect of the statutory guidance, I hope that it will provide reassurance if I can set out that we will develop that guidance in partnership with Carers UK to ensure its input and so that it captures exactly the things that hon. Members have alluded to. Again, in statutory guidance, we will look at how to ensure that the duty to give people the information that they need is properly and effectively discharged.

I am grateful to my hon. Friend the Member for Broxbourne (Sir Charles Walker) and my right hon. Friend the Member for Maidenhead—she is now in the Chamber—for the work that they have done on the Bill to ensure that parity of esteem for mental and physical health is not forgotten and is explicit.

On a point made by the hon. Member for Oldham East and Saddleworth (Debbie Abrahams), I will clarify what I said earlier on the triple aim, which may give her a little reassurance, even if not necessarily sufficient reassurance. We have not created a quadruple aim or a fourth limb, but we have included a reference to health inequalities under the existing triple aim in the other place. It is not forgotten. I hope that gives her a degree of reassurance on that specific point.

Lords amendment 80 was the crux of much of the debate. I fear that many are comparing our proposals with something that was never done. We are significantly improving provision around the sustainability and affordability of social care. The Prime Minister was clear that he would grapple with the issue and resolve it. When the Opposition were in power, they had two Green Papers, one royal commission and one spending review priority on the issue and they utterly failed to address it. We are a Government who have made huge strides in creating a better system.

I listened, as always, with great care to my hon. Friend the Member for Thirsk and Malton (Kevin Hollinrake). I am sorry that he will not be joining me in the Lobby tonight. While I respectfully disagree with him, I know that he has thought long and hard about this matter and has strong and sincerely held views. With that in mind, I regret that we will have to ask the House to disagree with the Lords amendment on care metering.

Lords amendment 11 disagreed to.

Government amendment (a) made in lieu of Lords amendment 11.

Lords amendment 51 disagreed to.

Government amendment (a) made in lieu of Lords amendment 51.

Clause 140

Cap on care costs for charging purposes

Motion made, and Question put, that this House disagrees with Lords amendment 80.—(Edward Argar.)

Access to NHS Dentistry

Kevin Hollinrake Excerpts

Thursday 10th February 2022 Westminster Hall

[Peter Aldous]

While there are particular problems in rural, coastal and more peripheral locations, which it is difficult to get dentists to move to, it is clear from looking around the Chamber today that the problem is not confined to such areas and is an issue in metropolitan areas as well. Sir Robert Francis, chair of Healthwatch England, has commented:

“Every part of the country is facing a dental care crisis, with NHS dentistry at risk of vanishing into the void.”

I believe there are five issues that need to be tackled to address the problem. First, a secure, long-term funding stream must be provided. Secondly, we need to step up the recruitment and retention of dental professionals. Thirdly, it is vital that work on the new NHS dental contract, which has been being developed for more than a decade, is completed as soon as practically possible. Fourthly, it is important to highlight the role that water fluoridation can play. Finally, there is a need for greater accountability and for dentistry to have a voice in the emerging integrated care boards and partnerships.

[Kevin Hollinrake (Thirsk and Malton) (Con)]

I congratulate my hon. Friend on securing this important debate. Another point that needs developing is that in Helmsley, in my constituency, the commissioners have still not recommissioned services after 20 months. The commissioning of dental services by the NHS is simply too slow and too bureaucratic. It is a real deterrent for new dentists to take these contracts.

[Peter Aldous]

I thank my hon. Friend for that intervention, and he is right. There has been a recent procurement process in East Anglia, but it has been only half successful. There are places that have not been able to get dentists to fill those voids.

Figures published in March 2020, before the pandemic, show that 25% of patients new to practices in England could not get an appointment. The situation has got worse: the most recent figures, from 2021, show that that number has increased to 44%; in my area, it is 56%. Dentistry was locked down from March to June 2020 and the ongoing restrictions on dentists—fallow time between appointments—are still limiting the ability to see more patients.

The latest figures on workforce, published in August 2021, show that 951 fewer dentists performed NHS dental activity than 12 months earlier, with 174 of those losses in the east of England. Those figures confirm that parts of England are becoming dental deserts; beyond Suffolk and Norfolk, that includes the east Yorkshire coastline, Cornwall, Portsmouth and the Isle of Wight.

The lack of access to NHS dentistry has a fivefold impact on patients. First, millions are missing appointments. Secondly, there has been a significant increase in DIY tooth extraction. Thirdly, the poor are hit hardest. Fourthly, mouth cancers are going undiagnosed. Finally, children are suffering. This very serious situation has been confirmed by the “Great British Oral Health Report” carried out by mydentist.

I apologise for going on at length, Mr Efford, but it is important to emphasis the crisis we are facing. I will now briefly outline some of the solutions. The first issue that must be tackled is getting more dentists and dental practitioners working in the NHS. The Association of Dental Groups has put forward its “six to fix” proposals for solving the workforce crisis, which I will summarise. First, we need to increase the number of training places in the UK. That is a long-term measure. Secondly, in the short term, the Government should continue to recognise EU-trained dentists. Thirdly, there needs to be a recognition of other overseas qualifications. We have an opportunity to make more of our links with Commonwealth countries such as India, which has a surplus of highly skilled English-speaking trained dentists.

Fourthly, the process for overseas dentists to complete the performers list validation by experience—or PLVE—so that they can practise in the NHS must be simplified and sped up. Fifthly, whole teams in dental practices should be allowed to initiate treatments. The largest barrier to better use of the skills mix under the current NHS contractual arrangements is that allied dental professionals are unable to open a course of treatment, which means they cannot raise a claim for payment for work delivered.

Finally, the Government must create a new strategy for NHS workforce retention. The current contract through which NHS dentistry is provided was introduced in 2006 and for some time it has been widely recognised as not being fit for purpose. It is a major driver of dentists leaving NHS dentistry. Reforming the NHS contract is needed to deliver better access and preventive care so as to improve the nation’s oral health. Flexible commissioning, aimed at increasing access to vulnerable groups such as those in care homes should be an important part of the reform. The current dental contract is target-based, and it was accepted before the pandemic that it needed to be reformed. We must complete that reform as soon as possible. I would welcome an update from the Minister as to progress on that and when we might see a new contract.

It is important that NHS dentistry receives a sustainable long-term financial settlement and not a short-term fix. Additional funding is vital if long-term and sustainable improvements to NHS dentistry are to be secured. The pledge of £50 million on 25 January for a dentistry treatment blitz is welcome, and £5.73 million is available to the east of England. However, that is a time-limited one-off injection of funding that is available only until the end of March, and there is a concern that it will barely make a dent in the unprecedented backlogs that NHS dentistry now faces. The British Dental Association estimates that it would take £880 million per annum to restore dental budgets to 2010 levels.

Since my Adjournment debate on NHS dentistry in Waveney last May, there have been improvements to the local service, which it is important to acknowledge. A temporary contract was awarded to a Lowestoft-based NHS dentist to see additional patients, which has definitely helped prevent the situation from getting any worse. Tomorrow I shall be with Community Dental Services, which along with Leading Lives, a Suffolk-based not-for-profit social enterprise, is launching its toolkit to help improve the oral health of people with learning difficulties. It is also good news that from 1 July a contract has been awarded to Apps Smiles for the delivery of NHS dentistry in Lowestoft, but it is concerning that it was not possible to do that in nearby Leiston and across the border in Norfolk, in Fakenham and Thetford. It will be interesting to receive further details as to why that happened, but one can speculate dentists might not have been interested in those opportunities and might have been put off by the existing, unattractive contract.

I have concerns about the procurement process that go back a long time. I am concerned that it does not encourage traditional partnerships to put forward proposals. I urge the Minister to carry out a whole review of the procurement process.

A vital strand of NHS dentistry should be the prevention of oral health challenges—prevention rather treatment. Fluoridation of water supplies can play a vital role in that, so it is welcome that the Health and Care Bill allows for it. There is also a need for greater accountability.

--- Later in debate ---

[Peter Dowd (Bootle) (Lab)]

I thank the hon. Member for Waveney (Peter Aldous) and my hon. Friend the Member for Bradford South (Judith Cummins) for raising this issue and for their tenacity. It is a pleasure to see you in the Chair, Ms Ali.

As many hon. Members have said, dentistry is not just about teeth; it is a vital component of our health. The hon. Member for North Devon (Selaine Saxby) shared a Shakespearian quote, and there is another one worth mentioning. In Shakespeare’s “As You Like It”, Jaques says:

“Sans teeth, sans eyes, sans taste, sans everything.”

If the Government carry on the way they are, it will be “sans dentists” as well. They need to get a grip of the situation.

The hon. Member for North East Bedfordshire (Richard Fuller) talked about the cash and the expenditure. I am happy to have a debate with him on this issue, and if he wants to secure a Westminster Hall debate on public expenditure, I will join him. I will give him an example of what he was talking about: the £10 billion-worth of covid-related fraud. That is equivalent to £153 for every person in his constituency—the best part of £50 million, which would be better spent on dental services in his constituency.

[Kevin Hollinrake]

Will the hon. Gentleman give way?

[Peter Dowd]

I am more than happy to come back to the hon. Gentleman in a moment.

Last week, I took part in a debate on the energy crisis. This week, I took part in debates on the crisis in children’s mental health services, the food insecurity crisis and the cost of living crisis. Today, it is about the access to dental services crisis. There is a bit of a theme beginning to develop here—it is about crisis, and all these crises are not isolated.

It is not as though the Government are having a run of bad luck through no fault of their own and have an otherwise impeccable record; there is something systemic and even endemic going on. I get a bit tired of the Government’s default approach to any deficit in policy application, and we have heard it a bit here: it is the CCGs, the NHS, the officials—it is everybody else’s fault bar the Government’s. They have to take responsibility.

--- Later in debate ---

[Peter Dowd]

In a moment.

Any denial by the Minister that there is a problem is itself a part of the problem. I really do not want to hear any denials.

[Kevin Hollinrake]

The hon. Gentleman is not making a particularly collegiate speech, but never mind. I have a lot of time for him. I do not know where the £10 billion fraud figure he throws out has come from. If it is about PPE, he should look at the facts behind that: £4.6 billion of that was write-down of current value versus value at the time of the pandemic. If we are going to debate in this place, it should at least represent the facts.

[Peter Dowd]

I am pleased that the hon. Gentleman raises that. The bottom line is this: look at the Public Accounts Committee documents. There are more to come out. If the hon. Gentleman wants to have a debate on fraud, I am more than happy to have one. Perhaps he can put in the application and I will come and speak to him about it.

--- Later in debate ---

[Kevin Hollinrake (Thirsk and Malton) (Con)]

I thank the hon. Member for Bradford South (Judith Cummins) and my hon. Friend the Member for Waveney (Peter Aldous) for securing this important debate. It is clearly a huge, topical, cross-party issue that has largely been discussed in a collegiate fashion.

On the rare occasions that I get any press coverage for my work as a Member of Parliament, I am often referred to as “senior” or “veteran”, which I think says more about my age than my experience. When I got here in 2015, this was one of the first things I raised with the then Minister for dentistry, Alistair Burt. To be fair, things have changed since then; they have actually got a lot worse. The reality is that it is impossible for most people in my constituency to get on an NHS waiting list. We must be honest with the public: either we open the gates so that more people can access treatment, or we tell them that dentistry is for some people and not for others.

The Father of the House said that it would be helpful to be able to search for availability in each of our constituencies. I agree, but I know exactly what it would say for my constituency, because this morning I checked across North Yorkshire—which is larger than my constituency—and there is simply no availability on NHS waiting lists. It has been like that for most of the seven years I have been in Parliament. The pity is that I have dentists who will accept NHS patients, but they just cannot get the units of dental activity. There is a real impasse between the issues and our honesty in saying whether NHS dentistry treatment is available in our constituencies.

Of course, that has real-world effects, and I will read from a couple of emails. A Mrs Weston wrote to me this morning:

“My son, an adult with special needs… is on universal credit and PIP, and he has to pay for private treatment as we cannot get on an NHS list… He has had to have a tooth removed because of an abscess, something that could well have been avoided if he had had regular check-ups.”

Even worse than that, a lady from Rillington wrote:

“My daughter has a toothache and needs to see a dentist… Our dentist ceased providing NHS services and there is nowhere else we can get into… They advised us to ring 111… and we were told a dentist would get back to us within 7 days. No one did. Tonight we rang again. We were on hold for 2 hours before we got through to the Yorkshire and Humber Dental Services, who told us they have no capacity to help.”

This is simply unacceptable.

Somewhat different from most of today’s speeches, the key thing that I want to talk about is commissioning. In my constituency—my hon. Friend the Minister knows this, and she has been very responsive on it—the NHS dentist on Bondgate in Helmsley closed totally in September 2020. It will not reopen until April ’22 at the earliest—that is the predicted date of opening—so it will have taken 20 months for the NHS people who commission services to reopen the service, despite the fact that we had someone who was willing to take the contract right from the start. On Kirkgate in Thirsk, it will have taken six months, so that is slightly quicker—apparently, that will open in March this year.

The contract is wrong. This “five plus two” contract, rather than a general dental services contract, deters investment and is very bureaucratic, having to be revisited consistently. We must simplify the commissioning process. We must put a rocket up the people commissioning this—20 months is simply not acceptable. I agree with others who suggest devolving this stuff back to local areas: we can look after it and commission the treatment, rather than having it all done centrally by super-regional managers.

--- Later in debate ---

[The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)]

It is a pleasure to serve under your chairmanship, Ms Ali. I congratulate my hon. Friend the Member for Waveney (Peter Aldous) on securing the debate and I am pleased that he is seeing a local improvement after we met recently. I also thank the hon. Member for Bradford South (Judith Cummins) for securing the debate.

I agree with my hon. Friend the Member for Stroud (Siobhan Baillie) that we have seen a level of interest in and concern about the matter across the Chamber, and that we need to ensure that we take some of the politics out of it because there are some difficult steps to take to improve dental services across the board. I welcome the contribution from my hon. Friend the Member for Mole Valley (Sir Paul Beresford), whose clinical experience is so helpful in the debate. I reassure colleagues on both sides of the House that since I came into post in September, dentistry has absolutely been a priority for me. I have been working night and day to try to make some short and long-term improvements, because I am live to all the concerns that have been raised.

We have set up some joint working, which was not happening before, between NHS England, the chief dental officer and the Department, and I meet the BDA regularly because we are serious about reform. I say to any dentists watching the debate that I absolutely understand the problems that make delivering an NHS contract unbelievably difficult. The contract is the No. 1 long-term issue that we have to deal with, and we are starting progress on that as soon as possible. I will come to some specifics shortly, but first let me mention covid.

I know that there has been some concern that covid is a lame excuse but, as my hon. Friend the Member for Mole Valley said, it has had a significant impact on access to dental services in the past 18 months. When lockdown happened, services were immediately reduced; only urgent services were allowed. That continued for a significant period. It was not until 8 June 2020 that practices were allowed to open for up to 20% of normal activity and it was not until last year that that went up to 60% and, towards the end of the year, to 65%. Although dentists were compensated for their loss of income during that period, the backlog that that generated is shown in all our postbags right now.

I place on record my thanks to dental teams up and down the country. Urgent appointments went back to pre-pandemic levels in December 2020, but with only 85% of activity allowed the backlogs will only grow. We need to be honest about that; the impact is significant. I completely understand the pressures that that is putting on dentists. We are keen to support dentistry where we can to get it up to 85%. It has been difficult during omicron with staff sicknesses and patients having to cancel when they become covid positive, and I absolutely recognise the stress and strain that covid has put on the system, but we have to be honest. I think it was the hon. Member for Bootle (Peter Dowd) who mentioned this, and I am happy to accept the difficulties we face. There were problems before covid and there are those same problems post covid, and we are absolutely focused on starting to tackle them.

Let me make a couple of points. There is no patient registration system for dentistry—that is one of the myths. It is not like GP practices, where someone signs up and is then on the list. Patients can go from dentist to dentist if there is one available, and we are making sure that we open up capacity where it exists.

We have written to all dentists to ask them to update their capacity so that we can put it on the website mentioned by the Father of the House, my hon. Friend the Member for Worthing West (Sir Peter Bottomley), and we have also asked them to run a cancellation list. If someone cancels, the practice will be able actively to contact the next person on the list. Capacity is being generated by that, but I am aware of the problems with capacity across the board. We have talked about many parts of the country, such as Norfolk and Devon, that are experiencing capacity issues, but all parts of the country have experienced a squeeze in the number of appointments available.

A couple of weeks ago, we announced £50 million to help with some of those issues. I know that some Members have been quite dismissive of that this afternoon, but we know that it will cover the period to the end of this financial year to buy some urgent capacity for the system and to help deliver more than 300,000 appointments that currently cannot happen. There has been good uptake, even in the few weeks since the money was announced. Regions across the country are signing up and because the payments to dentists are much better than under the current contract, there is an appetite among dentists. That shows that if we remunerate dentists adequately they have an interest in taking on NHS work.

I encourage Members from all parties to contact their local commissioners, because we want to ensure that that money is used. If there is no interest, or if they are struggling to spend the money, they should let us know. NHS England has been in contact with local commissioners to get that feedback so that we can make the best use of the money and buy as much capacity as possible.

[Kevin Hollinrake]

Does the Minister think that it is acceptable for commissioners to take 20 months commissioning a service when we have dentists who want to take that work and take on that surgery?

[Maria Caulfield]

Absolutely. I will come on to that point, which is valid. We want to increase capacity and there are dentists who want to take on NHS work. When contracts are handed back, we have to do the whole procurement process, and when there is an interested party, even when they are ready to sign on the dotted line, that takes a considerable amount of time. In the Department, we are looking at how we can change the procurement process. It often falls in the lap of local commissioners, but they are stuck with the procedures they have to follow. I am keen to see how, when someone is willing to take up a contract, we can enable that to happen as quickly as possible.

We have also relaxed the upper tolerance threshold and increased activity from 104% to 110% of dental activity. The current contract penalises dentists if they go over their contracted work, which is a perverse disincentive when dentists have capacity and want to take on extra work.

Before I touch on the nub of the problem, I will mention prevention. I am pleased that prevention is being considered and that the Government’s proposals on water fluoridation are part of the Health and Care Bill. I hope Opposition Members will support us when the Bill comes back from the Lords. We are also looking at options for how to introduce supervised tooth brushing in parts of the country where there is the greatest need. I reassure hon. Members that the prevention and oral health element is as key as getting dental procedures done.

The dental contract is the crux of the matter, and we are absolutely committed to reform. I met the BDA this week to start negotiations. We are looking at some quick wins over the next 12 months and some long-term contractual reform to the UDAs. We have started informal negotiations, and the formal negotiations will start in April. We all—the BDA, patients, MPs and the Department —know the urgency. It cannot be a long, protracted negotiation. However, we are working well with the BDA. We are keen to get negotiations under way and to reach a resolution as quickly as possible. We have to make the NHS a better and more attractive place to work, because dentists have other options; I cannot remember which Member said it, but dentists are voting with their feet when it comes to where they want to practice.

On the recruitment, retention and training of dentists, Health Education England published its “Advancing Dental Care Review” in September. It is working through how we can train not just more dentists but the whole dental team, and on how we can upskill dental technicians and dental nurses. We will bring forward legislative changes to enable other members of the dental team to take on more roles. We are setting up centres of dental development in those areas of the country with the biggest shortages, which tend to be coastal and rural. I take the point made by my hon. Friend the Member for Broadland (Jerome Mayhew) about Norfolk—I think I heard that several times. We are looking at where in the country those dental deserts are and whether we can match them to centres of dental development.

Members may not realise that this week the Department announced a consultation with the General Dental Council on the registration of international dentists and whether we can put in place a process to recognise the qualifications of dentists from around the world, as my hon. Friend the Member for Mole Valley mentioned. The overseas registration exam, which they have to take, was suspended throughout the whole of covid, so we have a backlog of around 700 dentists waiting to take it. The first exams started a couple of weeks ago, and there are exams in place for the rest of the year to try to get through that backlog. We are confident that we can do that.

We need to work on how we recognise existing qualifications to remove the barrier of having to do an exam. Again, I encourage colleagues to respond positively to the consultation on the GDC website and to the developments it is making. My hon. Friend the Father of the House has written to me about international dentists having to take the exams within five years of their first attempt, and whether those rules can be relaxed. That is also part of the consultation. We very much recognise that covid has had an impact on those rules too.

I reassure colleagues that I am working on bringing NHS England, dentists and the BDA together so that we can make a difference as quickly as possible. The changes in the Health and Care Bill on integrated care systems and having accountable people for commissioning locally are crucial. Integrated care boards will be statutory from 1 July, and will have accountable officers. I strongly urge colleagues to speak to their ICBs or CCGs, because there are differences in practice across the country. Some commission dentistry really well, some not so well. Very often, if the money allocated to dentistry is not ringfenced, and if it is not spent locally, it goes into other healthcare provision and is lost from dentistry. I encourage Members to hold the feet of their local commissioning bodies to the fire on what they are doing with the money given to them. We are here to support them, and work will be done on dentistry commissioning going forward.

In the short time I have had, I hope I have been able to provide assurances that dealing with the situation is not without its challenges. There is no silver bullet that will resolve all the problems. There is not a quick-fix solution, but I am working at pace, as is the Department, to reform the contract. Work is starting in April on the formal negotiations, and I hope that will improve recruitment and retention in dentistry. We value the work that dentists do, which for too long has gone unrecognised and has been a Cinderella part of the service. The people who have suffered are not just the dentists, but the patients.

Antimicrobial Resistance

Kevin Hollinrake Excerpts

Tuesday 7th December 2021 Westminster Hall

[Sir Gary Streeter (in the Chair)]

Before we begin our next debate, I remind Members that they are expected to wear face coverings when they are not speaking in the debate. That is in line with current Government guidance and that of the House of Commons Commission. I remind Members that they are asked by the House to have a covid lateral flow test twice a week if coming on to the parliamentary estate. That can be done either at the testing centre in the House or at home. Please also give each other and members of staff space when seated, and when entering and leaving the room.

[Kevin Hollinrake (Thirsk and Malton) (Con)]

I beg to move,

That this House has considered the health impacts of increasing levels of antimicrobial resistance.

It is a pleasure to serve under your chairmanship again, Sir Gary. Mark Twain once said:

“I am an old man and have known a great many troubles, but most of them never happened.”

This is not a trouble that will not happen. This trouble is happening now; this trouble will get much worse. The UK Health Security Agency chief medical adviser, Dr Susan Hopkins, said that antimicrobial resistance, or AMR, was “a hidden pandemic” and that it was important that

“we do not come out of COVID-19 and enter into another crisis.”

What I fear most is that, as Warren Buffet once said:

“What we learn from history is that people don’t learn from history.”

There can be no excuse this time if we do not prepare well for a future pandemic of AMR.

This is not the first time I have raised the issue in the House, and it will not be the last, because AMR is simply too important to ignore. Antibiotics are one of the most powerful tools in healthcare, underpinning every aspect of modern medicine. We need them not just when we are poorly at home with an infection but when we are going through significant life-changing procedures such as chemotherapy and hip replacements. Antibiotics work by killing bacteria but, in the same way that the covid-19 virus can mutate and evolve, so can bacteria, developing resistance to antibiotics.

Right now, this year, about 700,000 people will die from antibiotic resistance infections across the world. It is estimated that by 2050, AMR could claim as many as 10 million lives a year. It is not a hypothetical or vague threat that is happening elsewhere; it is happening in the UK, is getting worse and will get much more so. Professor Jennifer Rohn of University College London has said:

“AMR has very much not gone away, and in the long term the consequences of AMR will be far more destructive.”

The latest report from the English surveillance programme for antimicrobial utilisation and resistance found that antibiotic resistance increased by 4.9% between 2016 and 2020. That means that one in five people with a bloodstream infection in 2020 had one that was antibiotic resistant—a serious, potentially life-threatening situation.

I want to tell you about a mother named Helen. Helen experienced resistant infections in 2013 and 2018, which caused her a great deal of anxiety and pain. She was to experience a third resistant infection shortly after giving birth. When her baby was just six weeks old, Helen developed mastitis, an infection of the breast tissue. She soon developed flu-like symptoms, and a GP prescribed her an oral antibiotic. The infection was resistant and two days later it was getting worse, and she could barely hold her baby. She started vomiting and was sent to A&E, where she was kept on heavy-duty intravenous antibiotics for two nights. Luckily, the sepsis was caught early and she recovered, but it could have been a very different story. Sepsis causes 48,000 deaths in the UK every year, many of them due to resistant infections.

AMR is the next pandemic. It is a hidden pandemic, but that does not mean that we can treat it any less seriously than covid-19. We must have the right plan in place. First, we need a strong system for monitoring the impact of rising AMR here in the UK. I welcome the fact that the Government have been looking into recording AMR or antibiotic resistance as a cause of death on death certificates and I had a welcome update from the Minister on where we are with those proposals. However, it is surprising that not many parliamentarians are focused on the problem, given its context and scale. It is good to see my fellow parliamentarians here today who are taking an interest, but until we have a proper register and until more parliamentarians are made aware of the issue through their constituents, I do not think the levels will be sufficiently high to raise awareness as often as we need in Parliament to make sure we take the matter forward and take action against it. Secondly, we need to support only the appropriate use and prescription of existing antibiotics. Thirdly, we need to ensure that we incentivise the development and research of new antimicrobials and antibiotics.

We need to take a one-health approach across all three issues that recognises the link between resistance and use in humans, animals, agriculture and the environment. The Government’s five-year national action plan on AMR set out the steps we need to take, but we are now just about halfway through and have yet to see any clear update on progress. The UK has been a trailblazer on AMR, but that lack of reporting is not where we need to be. We must be at the forefront of taking domestic action, not least because we are trying to maintain our leadership position as an example for other countries.

It was pleasing to see that the UK made AMR a centrepiece of our G7 presidency. We are long-standing global leaders in AMR and this is hugely important work, but we cannot afford to let our attention drop from what we can also do here and at home. The Minister and I shared many conversations on this matter as Back Benchers and I know she is very focused on and aware of the context, particularly in diagnostics, which I will talk about shortly. Will she consider introducing annual reports for all the partners on the actions in both this plan and in the next five-year action plan?

As has already been mentioned, one of the biggest issues facing us is the fact that there is not enough research and development of new antimicrobials. I would be interested to see what metrics of success we can use to judge the outcomes of the National Institute for Health and Care Excellence’s AMR project, formerly called the pilot, which is trialling a new model for valuing and paying for antibiotics. This is a world-leading, first-of-its-kind subscription-style payment model that will help incentivise companies to develop new drugs needed to tackle resistant infections and is supported by NICE.

The reasons we need a new model are complex. Bacteria naturally evolve to become resistant to certain drugs, but that evolution is happening faster than new medicines are reaching healthcare systems. That is partly because developing antibiotics is a long, complex and risky process, with many products failing along the way. At the end of that process, we do not have a viable commercial market for the new products. That is the key problem and that is because antibiotics are not like other medicines. Often, we want to reserve the new antibiotics for the patients who really need them, meaning the new products could just sit unused on the shelf. In that scenario, the cost of development could way exceed the return, undermining future research. The commercial model for developing antibiotics is broken.

I pay tribute to the UK’s leadership in introducing the AMR project in the first place. I know it is the result of many years of work by the Government, NHS, NICE and the industry sector, but we cannot afford that leadership and drive to slacken off now, because the price is simply too high if we do not succeed. As the Minister knows, the pilot looks at only two antibiotics and, as yet, there are no concrete plans to evolve into a new permanent model for all new antibiotics that come after them. Even though we are world leaders, we must urgently start thinking about the next steps and that must be built into the next action plan. The next steps must consider how we evolve the pilot and implement its learnings at scale and pace. Will the Minister comment on what conversations she has had with NHS England and NICE about how best to do this and what the timeframe might be?

We must also remember that the world is watching the world-leading AMR pilot. NICE has always been regarded as the gold standard and its actions have always carried weight, but now it is running one of only two pilots in the world considering this issue. It is therefore important not only that we get the project right, but that we also get right how we talk about what happened, the results and, indeed, what went wrong. Given that the goal is to incentivise private research and development, I urge the Minister to work with industry on that communication to ensure we are all aligned on the successes and learnings.

In 2019, in their five-year national action plan, the Government committed to reducing hospital-acquired infections by 2024 and halving gram-negative bloodstream infections in the NHS long-term plan. However, there is increasing concern that the covid-19 pandemic will have pushed those targets into the background. I would welcome the Minister’s comment on that issue, too.

As a final action point, in his landmark report, Lord O’Neill describes diagnostics as the most important of his 10 commandments to tackle AMR. The launch of the community diagnostic hubs represents an important opportunity to combat an increased incidence of AMR through accurate and targeted prescription. However, we need to tackle the false economy of simply prescribing antibiotics because they are cheaper than a diagnostic test.

I know other Members want to come in, so I will close by recognising those who do tireless work on this issue and with whom I work closely. First, Antibiotic Research UK or ANTRUK, which is in my constituency, is the world’s first charity specialising in antimicrobial research and education. It provides vital research and support services for patients impacted by resistant infection. Secondly, the British Society of Antimicrobial Chemotherapy provides the secretariat to the all-party parliamentary group on antibiotics, of which I am a member. Without its efforts, the efforts of the Minister and her team and the work of many others, we would not have achieved so much in our fight to stop the next pandemic, but that must be our challenge, to make sure that this time we prepare properly for a pandemic that absolutely will happen if we do not put the right steps in place.

[Sir Gary Streeter (in the Chair)]

Before I call Theresa Villiers, we are expecting three Divisions in the House in a moment. When we get to that point, Members should perhaps think about adjusting their diaries, because it will be 25 to 35 minutes before we come back.

--- Later in debate ---

[Jim Shannon (Strangford) (DUP)]

You are most kind, Sir Gary; thank you very much. I am not sure about the pure gold, but I will certainly do my best to make my contribution to the debate. I congratulate and thank the hon. Member for Thirsk and Malton (Kevin Hollinrake). He is not only an hon. Member but my friend, and has been for all the time we have been together in the House. We have spoken on many issues together, so I am pleased that he has brought this subject forward.

I have an interest in this issue, probably because of my constituency. I will start with a comment from back home. This is not only a UK-wide issue but a global issue. As Northern Ireland’s chief medical officer, Dr Michael McBride, said:

“As certain antibiotics lose their ability to kill particular strains of microbe, and if we cannot develop new drugs that can beat those bugs, then by the year 2050 we can expect about 10 million deaths per year, worldwide, from drug-resistant infections.”

If that does not shock hon. Members or sound horrific, it should. If hon. Members thought the covid-19 pandemic was their worst nightmare, with all its repercussions and problems and horribleness, I suggest that this debate has the potential to be their even worse nightmare. Will I be here in 2050? It is highly unlikely, but many others will be, so we should ensure that what we do today will be sufficient to protect those of tomorrow—my children, my grandchildren and, whenever they come, my great-grandchildren.

The rise in antibiotic-resistant infections is of real concern: England saw 90,000 hospital admissions because of such infections in 2019-20 alone. There is a real problem, and we need to act now, as right hon. and hon. Members have said. There is a rising tide of antibiotic-resistant infections. We have to do something.

I declare an interest as a member of the Ulster Farmers’ Union. I have acknowledged on the record the need for investment in agriculture in the effort to tackle antimicrobial resistance from every angle. The Ulster Famers’ Union said:

“As a farming industry, we are committed to playing our part in reducing antibiotic usage and resistance. Significant progress has already been made in the pig and poultry sectors, which have seen their usage fall by over 50% and 80% respectively. Historically, those working with cattle are smaller users of antibiotics but there are improvements that can be made.”

I welcome that commitment from not only the Ulster Farmers’ Union but the National Farmers Union here on the mainland; it is a joint operation. We should support the clear commitment by the farmers unions to do these things and take this action.

[Kevin Hollinrake]

The hon. Gentleman is making a very good speech, and he makes a good point about the pig sector. I am sure he will be aware that the reduction in antibiotic use in the pig sector has not affected yields at all, which demonstrates that things can be done more sustainably, and can be better for the environment, without affecting the economics of farming.

[Jim Shannon]

The hon. Gentleman is absolutely right. The farmers unions welcome these things because, first, they are the right things to do, and secondly, because they do not affect the profitability of the sector or the industry. We need to try to reinforce that.

My constituency has only two or three pig units—one is fairly big, by the way—but a big poultry sector, which has made significant moves towards those things. I live right in the middle of a farm. All my neighbours are dairymen or have beef cattle or some sheep, and they told me that they are careful about what antibiotics they give their animals because that is the right thing to do. Who led the way on net zero targets from the farming sector? The National Farmers Union. It did not have to be coaxed to do that; it was happy to do it. Those are some good things.

It is clear that the farming community is stepping up to the mark and that we in this House need to do more. We need to get the message out that antibiotics are a last line of defence. We must allow our bodies to do their work against viral infections, which antibiotics cannot hope to address. I do not take antibiotics often, but I had to in 2019 because I got a bad infection, and those worked well to clear up my chest infection. Researchers at the University of Limerick found that GPs often felt pressurised into prescribing antibiotics, particularly for fee-paying patients in both in and out-of-hours situations, despite being aware that antibiotics were inappropriate for treating non-bacterial infections. Can the Minister provide an idea of what GPs and consultants do in relation to that and why it is important to get that right and not to be pressurised into giving those out?

GPs need our support and a clear message needs to be sent. We need to ensure that the message is simple: that it is a matter of life and death. Antibiotics are the last of our steps to take and only if we hold them as sacred will we ensure they can still work effectively and save lives. At the end of the day, that is all we want.

--- Later in debate ---

[Kevin Hollinrake]

I thank my hon. Friend the Minister. As I said earlier, she has always been a passionate champion of this subject, long before she was an excellent Health Minister. AMR is quite an esoteric issue. Most hon. Members, as we can tell from the attendance, are not particularly concerned about or aware of the problem. I was only made aware of the issue because a charity in my constituency, Antibiotic Research UK, or ANTRUK, drew my attention to it. It acted as an adviser to a Radio 4 programme called “Resistance”, which is well worth listening to. There are about four or five series, and it is a dramatisation where an antibiotic-resistant bug wipes out over 99% of the planet’s population.

That is the potential for how devastating AMR could be, so it is absolutely critical that we get this right. For me, it is down to the three D’s—drugs, diagnostics and data. I wonder how concerned we all would have been about covid, particularly early on in the crisis, had we not seen the data behind it. For most of us, it did not really directly affect us, so the data is crucial. I know that it can be challenging to determine exactly what somebody has died from in the case of a resistant infection, but it is critical that we establish a framework so that there is more concern among parliamentarians, the media and constituents, which leads to parliamentary concern, and constituents can come to our surgeries and say, “We are very concerned about this, because we have had a catastrophic personal incident ourselves.”

I thank hon. Members for their contributions. There were few of them, but this is a hugely important issue, and I really am grateful to hon. Members for coming here and speaking about it today.

Question put and agreed to.

Resolved,

That this House has considered health impacts of increasing antimicrobial resistance.

Adult Social Care

Kevin Hollinrake Excerpts

Wednesday 1st December 2021 Commons Chamber

[Gillian Keegan]

I want to pay tribute to the 1.54 million people who work in this sector, because they offer the most incredible care, and also to unpaid carers. The hon. Gentleman mentioned young carers, and it is important that we support them. We will work with the Department for Education, which will amend the schools census at the earliest opportunity to include young carers so that we can identify them and put in the support around them. I do not agree with what the hon. Gentleman said about today’s statement. In 13 years, the Labour Government produced two Green Papers, a royal commission and a spending review, but absolutely nothing that has made a difference to anybody. Of course, none of the Opposition Members have yet had the pleasure of reading the plan, but I can assure them that it is a plan that will deliver on a 10-year vision and start the changes that, as my right hon. Friend the Member for South West Wiltshire (Dr Murrison) said, have been ducked since 1940.

[Kevin Hollinrake (Thirsk and Malton) (Con)]

I thank my hon. Friend for all her work on this, as a Back Bencher and as a Minister. As she will know from our many conversations, I am a fan of the German system, not least because of its greater focus on domiciliary care and on personal budgets, which allow people, instead of relying on the professional workforce, to pay a loved one or a neighbour to provide their care. In many cases, that is much more beneficial for that individual. Is that going to be a feature of the White Paper, which I have obviously not yet had a chance to read?

[Gillian Keegan]

I know my hon. Friend’s views on that system, because we have discussed it many times. There are two things that I think he will welcome in the White Paper. The first is the focus on people being supported to stay in their own home or in supported housing for as long as possible. The second is personal budgets, which we will be exploring for people after they have been metered towards the cap. There is some use of personal budgets today, but we will be exploring what greater use of them we can put in place.

Health and Care Bill

Kevin Hollinrake Excerpts

Report stage
Monday 22nd November 2021 Commons Chamber

[Kevin Hollinrake (Thirsk and Malton) (Con)]

May I take the Minister back to new clause 49, very briefly? He is right to point out that some measures that he has brought forward are more generous than previously proposed, but there is no doubt that the way that the cap works means that it is less generous for those with more modest assets. Does he not agree? How can that be fair?

[Edward Argar]

I simply take my hon. Friend back to my previous point: when compared to the current system, this is a significant improvement and step forward, particularly when taken in the round with the overall package of measures that see the floors go from £23,250 up to £100,000 and from £14,250 up to £20,000. We have to look at this issue in the round, considering all those aspects rather than purely one element alone.

--- Later in debate ---

[Jeremy Hunt]

I am most grateful to my hon. Friend, and I am also grateful to the Opposition, who have indicated that they will not oppose the amendment.

[Kevin Hollinrake]

Now that that one is sorted, would my right hon. Friend offer the House his views on new clause 49?

[Jeremy Hunt]

I am happy to do that, because I know my hon. Friend has a great interest in social care issues. I feel conflicted by new clause 49. I think that what we will end up with after this measure will be a whole lot better for people on low incomes than what we had, because the means-test threshold will be raised from £23,000 to £100,000, and that is a very significant improvement. However, I have to be honest and say that it is nothing like as progressive as we had hoped, but it is a step forward. My concern when it comes to social care is that our entire debate is focusing on what does and does not contribute to the cap, when the fundamental problem in social care is the core funding to local authorities; that, though not a matter for this Bill, has a direct impact on the care received by our constituents.

I conclude by thanking the Government for their support for amendment 114. I will move it formally later, but I am not expecting to divide the House on it.

--- Later in debate ---

[Edward Argar]

I am conscious of time, Madam Deputy Speaker, so I will try to cover some of the main themes that have emerged from today’s debate. I am grateful for the debate we have had today. The vast majority of what is contained in the Bill is exactly what the NHS said that it wanted and needed, and it is the right legislation being brought forward at the right time, to drive forward those priorities highlighted by the NHS in its 2019 consultation. The Bill drives forward integration not only within the local NHS within a region, but also greater integration with a local authority. It provides the foundations on which we can continue to build, as we move forward with greater integration of health and social care services that are designed to work around the individual, rather than in institutional silos.

Despite misleading claims by campaigners—and, indeed, by some Opposition Members—the Bill does not privatise the NHS. The NHS will always be free at the point of delivery. It has been in the hands of the Conservative party longer than it has been in the hands of any other party, and the Conservative party has put in place record investment in terms of resources in our NHS. What we propose in the Bill continues to build on that. Government Amendment 25 on ICBs is clear: ICBs are NHS bodies. They have always been NHS bodies in our proposals, and we have put in place provisions regarding conflicts of interest. Just to make sure, and given the misleading claims about private involvement, new clause 25 puts beyond doubt that ICBs are NHS bodies and must act in the best interests of the NHS. It is an amendment that is much stronger and much more effectively drafted than the alternatives put forward by the Opposition, because we believe in putting this question beyond doubt.

On the ICBs and ICPs, we have sought to be permissive rather than prescriptive, giving those local systems, within a national framework, the flexibility to deliver what they need to deliver for their local areas, which they know best.

I have been happy to accept amendments 102 and 114. I will continue to reflect on the points made by my hon. Friend the Member for Broxbourne (Sir Charles Walker); in the nicest possible way, I suspect that—rightly—he will not go away. The former Secretary of State, my right hon. Friend the Member for South West Surrey (Jeremy Hunt), set out very clearly the case for his amendment 114, which I was happy to accept, and the importance it places on patient safety.

My right hon. Friend the Member for South Northamptonshire (Dame Andrea Leadsom) has done a huge amount of work in this space—I pay tribute to her—and she is right: we will look very carefully in the statutory guidance at how we can emphasise that. I fear that my hon. Friend the Member for Newton Abbot (Anne Marie Morris) was not in her seat when I paid tribute to the work that she had done previously, but I put that on the record too.

On new clause 49, my hon. Friend the Member for Gosport (Caroline Dinenage), a distinguished former Care Minister, made the point extremely well that this is a significant improvement and step forward on where we currently are in respect of tackling the social care challenge.

[Kevin Hollinrake]

Will the Minister give way?

[Matt Western (Warwick and Leamington) (Lab)]

Will the Minister give way?

Health Incentives Scheme

Kevin Hollinrake Excerpts

Friday 22nd October 2021 Commons Chamber

[Maggie Throup]

I am delighted to congratulate King’s Lynn park run on its achievements, as well as park runs across the whole country. I am not a great runner—I am more of a sprinter—so I tend to avoid them, but I know the enjoyment that can be achieved by going along and improving one’s fitness, as well as the sense of community they bring with them.

[Kevin Hollinrake (Thirsk and Malton) (Con)]

As somebody who is carrying a Westminster stone, I could definitely do with losing a few pounds myself. More than three decades ago, I was more than six stone heavier than I am today. I lost that weight without the need for airmiles and Nectar points. Does my hon. Friend agree that the most important factors in good health are personal discipline and personal responsibility?

[Maggie Throup]

I completely agree with my hon. Friend, who obviously has great motivation. We want to help everybody to have great motivation. If we can do that through an app, we will be able to find out what really helps people to make such changes to their lives.

Oral Answers to Questions

Kevin Hollinrake Excerpts

Tuesday 19th October 2021 Commons Chamber

[Sajid Javid]

First, may I take this opportunity to congratulate all the health and care workers across Devon on the fantastic work they are doing? The right hon. Gentleman will know that the Government have set out clearly their approach to dealing with the pandemic and that we are very much focused on vaccinations, which are working, building a wall of defence, treatments and testing.

[Kevin Hollinrake (Thirsk and Malton) (Con)]

Further to the last question on NHS dentistry from the right hon. Member for Normanton, Pontefract and Castleford (Yvette Cooper), we are in a difficult situation across North Yorkshire, where there is no NHS dentist availability across the whole of Thirsk and Malton. It will take the NHS two years to recommission the service in Helmsley—the closed practice in Helmsley—and the Thirsk practice has just closed its doors with its current list of patients. Will my right hon. Friend set out exactly what we can do to increase the availability of NHS dentistry?

[Sajid Javid]

Again, my hon. Friend is right to raise this issue. As we have just heard from other hon. Members, there is a real issue with dentistry across England, including in North Yorkshire, and we know how the pandemic has had an impact on that. Dentists have tried to do the best they can in those circumstances. The changes we are making to infection prevention and control will help. We are looking at further measures, and I understand that my hon. Friend will be meeting the Minister shortly to discuss his issues in North Yorkshire carefully.

Health and Care Bill

Kevin Hollinrake Excerpts

2nd reading
Wednesday 14th July 2021 Commons Chamber

[Sajid Javid]

There have been wide-ranging consultations on the Bill, as I mentioned, which have taken place over the past two years. While I cannot say specifically which trade union or which particular organisation has been spoken to, as I was not in the Department at the time, I know that the conversations have been wide ranging.

The Bill is not the limit of our ambitions on the nation’s health. We are also transforming public health; we are bringing the Mental Health Act into the 21st century; and, by the end of this year, we will set out plans putting adult social care on a sustainable footing for the future.

We are also ambitious for our workforce. I have commissioned Health Education England to refresh its strategic framework for health and social care workforce planning. HEE will work in partnership across the sector and gather views from the widest possible range of stakeholders to help us to shape a workforce with the right skills, the right knowledge and the right values for the year ahead.

[Kevin Hollinrake (Thirsk and Malton) (Con)]

My right hon. Friend has set out his plans to introduce a plan for social care by the end of the year, and I know that he is looking for a cross-party solution. In a joint inquiry by two Select Committees—the Housing, Communities and Local Government Committee and the Health and Social Care Committee—one of the recommendations was a system with a German-style social care premium. Would that potentially feature in his recommendations, and does he agree that that is a much fairer system than a Dilnot-style system that incentivises people to spend their assets or move them somewhere where they cannot be touched?

[Sajid Javid]

First, my hon. Friend is right to say that it would be great if all or most Members of this House, and certainly the different parties, could agree on a new system. I look forward to speaking to all hon. Members about what a future social care system could look like. In terms of the detail, I am afraid that he is just going to have to wait a moment longer, but I agree that the work by the Select Committees will, of course, inform our decisions.

I turn in a little more detail to the measures and themes that are captured in the Bill. The first is more integration. We know that different parts of the system want to work together to deliver joined-up services, and we know that, when they do that, it works. We have seen that with the non-statutory integrated care systems in the past few years. They have united hospitals and brought together communities, GPs, mental health services, local authority care and public health, and it works. We recognise that there are limits on how far this can go under the current law, so this Bill will build on the progress of integrated care systems by creating integrated care boards and integrated care partnerships as statutory bodies. England’s 42 ICSs will draw on the expertise of people who know their areas best. They will be able to create joint budgets to shape how we care for people and how we promote a healthy lifestyle. With respect to the specific geographies of the ICSs themselves, as I have said elsewhere, I am willing to listen.

--- Later in debate ---

[Jonathan Ashworth]

My right hon. Friend is absolutely right. I will come to the financial flows in a few moments. But how on earth can we have a triple aim of trying to improve health outcomes for a population and not even give public health a voice and a seat on the decision-making body that decides health plans for an area?

The Secretary of State talks about integrating health and social care. There is no seat for directors of adult social services on these committees, either. And what about patients? Patients were not mentioned very often by the Secretary of State in his speech. Patients will always come first for the Opposition. They have no mandated institutional representation, either—no guaranteed patient voice—so we have yet another reorganisation of the NHS whereby patients are treated like ghosts in the machine. It is utterly unacceptable. This is fragmentation, not integration, with a continued sidelining of social care.

There is a loss of local accountability as well, because there is no explicit requirement that the boards meet in public or publish their board papers. Although NHS England has stated that that is its preference, it is not required; nor is there any commitment, despite the wide geographical spread of some ICSs, for meetings to be made accessible online. But, of course, the White Paper did indicate that the independent sector could have a seat on an ICS, and the explanatory notes to the Bill state that

“local areas will have the flexibility to determine any further representation.”

[Kevin Hollinrake]

The right hon. Gentleman talks about solutions to social care. Will he come on to his own solutions to social care? Will they potentially include the recommendations of the Select Committees about that German-style social care premium—recommendations made by members of his own party who were elected by his party to serve on those Committees? Is that something that he is now willing to explore? He has ruled it out time and again on the Floor of the House.

[Jonathan Ashworth]

I have. The hon. Gentleman is a dogged advocate for that proposal for social care, and he is quite right: he always raises it with me. I am unpersuaded but I am more than happy to sit down with the Secretary of State and with my hon. Friend the Member for Leicester West to discuss a solution to social care. We keep being told that there are going to be cross-party talks, but I think I missed the Zoom link, because they have not happened so far.

As I was saying, these committees do permit a seat, if the committees want it, for the independent sector. In Bath, in Somerset, we have seen Virgin Care get a seat on the shadow ICS. The Opposition think that is unacceptable and we shall table amendments to prohibit it.

I welcome the removal of the section 75 competition and procurement rules, finally scraping the remnants of the Lansley competition rules off the boots of the NHS. We did warn him and others that this compulsory competitive tendering would lead to billions going to the private sector, would be wasteful and bureaucratic, and would be distracting—and it even led to the NHS getting sued by Virgin Care when it did not win a contract. But this is not the end of contracting with the private sector. Without clauses to make the NHS the default provider, it would be possible for ICBs to award and extend contracts for healthcare services of unlimited value without advertising, including to private companies. Given the past year, when huge multibillion-pound contracts have been handed out for duff personal protective equipment and testing, we naturally have concerns about that and will seek safeguards in Committee. We are worried about further cronyism.

We are particularly concerned about the Bill because of the power grab clauses for the Secretary of State. He is creating 138 new powers, including seven allowing him in effect to rewrite the law through secondary legislation, to transfer functions between arm’s length bodies without any proper scrutiny. He has not explained why he needs these powers or given any guidance on how he expects to use them. These powers also include a requirement that Ministers be informed of every single service change, every single reconfiguration, and the Secretary of State will then decide whether or not to call them in for ministerial decision. Are you sure you want that power, Secretary of State?

The Government have gone from wanting to liberate the NHS under Lansley to now listening out for the clang of every dropped bedpan echoing through Whitehall. This is not a plan for service modernisation; it is a “Back to the Future” plan and it will mean more inertia. Instead of powers to interfere at every level, resetting the mandate for the NHS within years, we instead would want the duties on the Health Secretary, and therefore on the 42 ICSs to which he delegates those responsibilities, to continue the promotion in England of a comprehensive health service, as per the National Health Service Act 2006, to be fully reinstated and made explicit.

Social Care Reform

Kevin Hollinrake Excerpts

Wednesday 23rd June 2021 Commons Chamber

[Helen Whately]

I pay tribute to the hon. Member for the hours, the love and the effort that she has put into caring herself. She knows, from her own experience, the experience of carers across the country and what it takes in time, physical effort and emotional effort.

Carer’s allowance is not intended to be somebody’s income; it is intended to support people with some of the costs of caring. It is primarily led by the Department for Work and Pensions, but I can say that I am committed to ensuring that there is support for unpaid carers and family carers, and, as I said earlier, ensuring that, as well as caring for and looking after others, those individuals should be able to have time for themselves to lead their own lives.

[Kevin Hollinrake (Thirsk and Malton) (Con)]

Does my hon. Friend agree that a Dilnot-style proposal would reward and incentivise people who had not saved or used financial planning to pass their assets and savings on to relatives or to trusts? A German-style social care premium would be a much fairer system. We would all pay a small amount to cover those who were hit by the catastrophic costs to which she has referred. When she makes proposals, will she include perhaps two or three, including a social care premium, so that we can have a proper debate on this important issue and try to achieve cross-party consensus?

[Helen Whately]

I do not on this occasion agree with my hon. Friend, but I do very much appreciate his consistency and his commitment to ensuring that we have an informed conversation about the funding options for social care, as well as his well-informed drawing on international examples.