Oral Answers to Questions

Layla Moran Excerpts

Tuesday 18th June 2019 Commons Chamber

[Seema Kennedy]

I thank my right hon. Friend for his question. I am looking forward to the meeting this afternoon. As I have said, I am assured that the decision will maintain services in Oxford and that there will be improved patient access, with new scanners in Milton Keynes and Swindon for people living there as well.

[Layla Moran (Oxford West and Abingdon) (LD)]

Surely the reason we have got to this point is that the clinical commissioning group was never actually consulted on what was right for the local population. How can the Minister ensure that, in future, centralised procurement services and local CCGs are always consulted as a matter of course?

[Seema Kennedy]

As I have said, there has been engagement with local people, Members of Parliament and the local health community. I think that the outcome that we are all looking for is good PET-CT scanners for the people in Oxfordshire and for the whole of Thames Valley.

Eurotunnel: Payment

Layla Moran Excerpts

Monday 4th March 2019 Commons Chamber

[Matt Hancock]

There is a notable difference in tone, is there not, between those who care about ensuring that people get the supply of medicines in future, and those who want to make political points out of it but do not oppose the decision we are discussing.

[Layla Moran (Oxford West and Abingdon) (LD)]

I find this utterly extraordinary, because in the Public Accounts Committee hearing on this matter, the permanent secretary said:

“I am confident that our process was lawful, and obviously the Department and I acted on legal advice in determining how to take that process forward”.

If we were so confident in that legal advice, why was this settlement reached at all? Actually, is this not an admission of a catastrophic failure in stakeholder management?

[Matt Hancock]

No. It is clear that we needed to ensure that there were no risks around the two contracts for the capacity that we need to bring in an unhindered supply of medicines, whatever the Brexit scenario. I do not know whether the hon. Lady thinks it would have been worth bearing the risk of a court case, which may well have struck down the capacity to make sure that people who have serious and life-threatening conditions can get the medicines that they want. She implied that she was against such assurances, and I think that would have been a mistake.

--- Later in debate ---

[Mr Speaker]

I am grateful to the shadow Secretary of State for his point of order. As he will know, the choice of Minister to respond to an urgent question is exclusively a matter for the Government. For example, it is commonplace for somebody other than the Secretary of State to appear. It is not altogether uncommon for a Department other than that at which the question was tabled to field a representative to respond. I recognise that it is relatively unusual for the Secretary of State in the Department questioned not to appear, and for someone who rejoices in the seniority of Secretary of State in another Department to appear instead, but we should never underestimate the enthusiasm, stoicism and commitment to regular performance in the Chamber of the Secretary of State for Health and Social Care, and he has demonstrated that again this afternoon. Colleagues will form their own assessment of how he has batted at the wicket of the governmental team.

As to what the Secretary of State said about the question not being about Seaborne Freight, I think I will say that he has placed his own interpretation on the matter, and colleagues will form their own assessment. I thought that most of the inquiries were about legal action flowing from the cancellation of the contract, but the Secretary of State does have a legitimate public policy interest in the matter, both as a member of the Government and because of his regard for the safe delivery of medicines. Some people will think that he was absolutely right, and others will think that his interpretation of matters was a tad quirky, but nevertheless he has offered us his own assessment and colleagues can now assess it at leisure, possibly over their tea.

[Layla Moran]

On a point of order, Mr Speaker. In reply to my question, the Secretary of State said:

“I do not know whether she thinks it would have been worth bearing the risk of a court case, which may well have struck down the capacity to make sure that people who have serious and life-threatening conditions can get the medicines that they want. She implied that she was against such assurances”.

I did no such thing, and you were here to hear it, Mr Speaker. I asked very specifically why we no longer have confidence in the legal advice that the permanent secretary herself told the Public Accounts Committee she did have confidence in. I do not take particularly kindly to men putting words in my mouth, so I wonder what recourse I have to get a retraction.

[Mr Speaker]

The hon. Lady has made her point with considerable force and alacrity, and I have no doubt whatever that she is totally sincere, because she came up to the Chair to register her displeasure. I think that the Secretary of State was mildly carried away with the theatricality of the occasion, and he is very accustomed to jousting from the Dispatch Box. Ordinarily I have found him a most good-natured individual, so I think it unlikely—very unlikely indeed—that he would willingly impugn the integrity of a very committed and conscientious Member of Parliament in the hon. Lady, because at heart he is a very gracious chap. He may well wish to proffer an apology to her—[Interruption.]

NHS 10-Year Plan

Layla Moran Excerpts

Tuesday 19th February 2019 Commons Chamber

[Stephen Hammond]

My hon. Friend will know that the plan has much on prevention in primary care and public health. I offer to meet him, and I will listen carefully. He tempts me down a line that I would rather not go down tonight.

The long-term plan marks a huge step towards parity of esteem between mental and physical health. In the next five years, the budget for mental health services will increase by at least £2.3 billion in real terms. This additional funding will be used to fund a major expansion of mental health services for both children and adults. In addition to piloting four-week waits for children and young people, we will test waiting times for adult and older adult community mental health teams, and clear standards will then be set. Specific waiting times for emergency mental health services will take effect for the first time from 2020 and will be set to align with the equivalent targets for emergency physical health services.

[Layla Moran (Oxford West and Abingdon) (LD)]

The mental health budget is 10.2% of the current NHS budget. If the overall budget increases, will there be an equivalent rise in the mental health budget? The mental health budget has risen because the overall budget has increased, but the proportion allocated to mental health has not risen. If we are serious about tackling mental health in this country, why is the proportion allocated to mental health not higher?

[Stephen Hammond]

The hon. Lady will know that, as I said a moment ago, the long-term plan, for the first time, sets a parity between mental health and physical health. The mental health budget will increase by £2.3 billion by 2023-24.

Of course, everything we have been talking about here needs to be supported by new innovations and new technology. Patients can expect a radical reshaping of how the NHS delivers its healthcare using technology, so that services and users can benefit from the opportunities of advances in digital technologies. That includes making care safer, enabling earlier diagnosis and giving more independence to those managing different health conditions.

Additionally, it is vital that we build a more innovative NHS, which will help patients to be among the first in the world to benefit from life-changing new technologies. Last year, the Secretary of State announced his ambition to sequence 5 million genomes in the next five years, making the NHS the first national healthcare system to offer whole genome sequencing as part of routine care.

Most importantly, none of that will be possible without dedicated staff who are properly trained and supported throughout their career. The long-term plan sets out a strategic framework to ensure that, over the next 10 years, the NHS will have the staff it needs to ensure that the detailed plan can be implemented. Baroness Harding is leading an inclusive programme of work to set out a detailed workforce implementation plan, which will be published in the spring, but the plan is not about numbers.

Social Care Funding

Layla Moran Excerpts

Wednesday 17th October 2018 Commons Chamber

[Barbara Keeley]

I very much agree. In recent months, I have met carers of people with MND and one becomes aware of how much time presses on them.

Our motion deals with social care funding, but this debate is really about people, such as the people my hon. Friend just referred to. It is about how society treats older and younger adults, how we should enable them to live independently and with dignity, and how this Government are badly letting them down. I will look today at the damage caused by Government inaction—damage to vulnerable people who rely on social care to live with dignity, damage to the lives of unpaid family carers who have had to step in to care for their friends and relatives, and damage to 1.4 million hard-working care staff, many of whom are so badly paid and so overworked that they cannot deliver the care that people need.

[Layla Moran (Oxford West and Abingdon) (LD)]

I am not sure whether the hon. Lady knows that in Oxford this is now starting to affect the local NHS. The John Radcliffe Hospital had to suspend non-urgent operations on two separate occasions in March because 170 beds were being bed-blocked. Does she not agree that it is time to see the promised Green Paper on social care, before this winter?

[Barbara Keeley]

Indeed. As I said, it is now coming up to a year since that was promised and it is about time that we started to see some plans. However, we have to bear in mind that a Green Paper is only the first stage of change—and a very early stage at that, really.

I want to pay tribute to the care staff I just mentioned. There has been a lot of talk recently about low-paid staff and how they will fare in terms of migration policies. Being low-paid does not mean that caring roles are low-skilled. Caring staff are highly skilled. They are a credit to this country, and without their dedication the problems facing social care would be immeasurably worse. Unfortunately, their efforts cannot paper over the cracks that have emerged because of this Government’s hammer blows to council budgets. I will come on to talk about the impacts that social care cuts have on people.

Oral Answers to Questions

Layla Moran Excerpts

Tuesday 19th June 2018 Commons Chamber

[Jackie Doyle-Price]

No, it is not. Labour Members like to draw attention to north-south divides and so on, but the issues about health inequalities are much more complex than how money is spent and where. Within my constituency, for example, there are differences of 10 years in life expectancy depending on the particular locality. We need a much more multi-layered approach to tackling inequality, and that is what this Government will have.

[Layla Moran (Oxford West and Abingdon) (LD)]

3. What discussions he has had with the Home Secretary on the effect of the tier 2 visa cap on recruitment in the NHS and social care sector.

[The Secretary of State for Health and Social Care (Mr Jeremy Hunt)]

Last week the Home Secretary removed doctors and nurses from the tier 2 visa cap.

[Layla Moran]

In Oxfordshire, the situation with social care workers is at least as bad a problem. Of course we all very much welcome the removal of doctors and nurses from the cap, but what about social care workers? Why are we focusing on only half the problem?

[Mr Hunt]

Perhaps I can help the hon. Lady by pointing out that tier 2 visa cap is specifically for higher-paid workers. We do need to think about social care workers, but a lot of them are lower paid. That is why we are putting together a 10-year workforce plan for the health and social care sectors, both of which are very important. We will make sure that that goes hand in glove with the NHS plan that we announced yesterday.

Helen and Douglas House Hospice

Layla Moran Excerpts

Friday 11th May 2018 Commons Chamber

[Layla Moran (Oxford West and Abingdon) (LD)]

I am so grateful that the House has allowed me to speak about funding for the Helen and Douglas House Hospice in Oxford. It is an incredibly important matter, not least because Helen House was the world’s first children’s hospice, starting the children’s hospice movement that spread around the world. It opened in 1982 to provide a home for terminally ill babies, children, young adults and their families. In 2004, Douglas House was opened by Her Majesty the Queen to provide care for 16 to 35-year-olds, not just in Oxfordshire but throughout the whole south-east. It provides specialist services for young adults, bridging that crucial gap between children’s and adult hospices.

I am sorry to say that we have to be here today because those services are under threat. Indeed, 48,000 people signed a local petition—that is extraordinary for a local petition—calling on the Prime Minister to intervene to stop the closure of Douglas House and to make sure that those services are properly funded. That is a staggering amount of public support and I hope that the Minister takes that to heart today.

Let me start by outlining the value and importance of Helen and Douglas House. I think that it is best summed up by my constituent Alison, who is a volunteer in the hospice. She said:

“Helen and Douglas House really is one of a kind, providing a lifeline both to those needing end of life care, and their families—from befriending and home support services, to The Elephant Club for bereaved siblings; to the annual remembrance service. Helen and Douglas House brings these families together, providing a support network to help them enjoy the time they have left together, and to face the future afterwards.”

Families rely on the work of Helen and Douglas House and they are indebted, as we all are, to the dedicated army of staff, volunteers and fundraisers who go above and beyond, and also to the nurses and the medical team.

[Robert Courts (Witney) (Con)]

The hon. Lady is making a very powerful and moving speech. Helen and Douglas House is not far from my constituency—it borders my constituency. I have visited it, and I am sure that she has, too. Perhaps she will agree with me that it is an oasis in the centre of Oxford. I wish to pay tribute—as I am sure that she does too—to everybody who works there, to all the volunteers, to the extraordinary therapy provided for the patients and to the support network that is provided for the family.

[Layla Moran]

I very much thank the hon. Gentleman for his intervention, and completely endorse what he says. The care that the hospice provides is world class and one of a kind. With the closure of Douglas House—I will get to this later—we will see hospices across the area having to deal with the extra need. Helen House is truly unique. I wish to pay tribute to some amazing fundraising efforts. Paul Townsend of Abingdon and Stuart Ryan of Farringdon are looking to raise £92,000 for Helen and Douglas House, and also for Sobell House in Oxford, with a tour of 92 football grounds in the 2018-19 football season—I suspect that there may also be an ulterior motive to their fundraising efforts, but I wish them well. Golfer Eddie Pepperell from Abingdon will wear a Helen and Douglas House cap for the televised BMW PGA championship in Wentworth later this month. He has also raised £7,500 via JustGiving.

Local businesses, including Stagecoach, radio station Jack FM—of which I am a huge fan—and Reed recruitment are just a few examples of the local businesses that have taken Helen and Douglas House into their hearts. The strength of feeling in the community across the whole of Oxfordshire is palpable.

[Bambos Charalambous (Enfield, Southgate) (Lab)]

Does the hon. Lady agree that it is a real shame that many hospices, such as the North London Hospice in my constituency, have to resort to fundraising to provide palliative care, which is so massively under-resourced with the NHS?

[Layla Moran]

I absolutely agree with the hon. Gentleman. There is a more systemic issue that I will get to later in my speech.

I now wish to tell the story of Sienna, who very much exemplifies one of the children and many of the families who we know use Helen and Douglas House. She is six years old and lives in Wootton with her mum, Kay, and dad, Andy. Her brother, Jamie, is 13 and sister, Ella, is 12. Sienna was born with Dravet syndrome, a rare and catastrophic form of epilepsy. Kay said:

“Being Mum for Sienna is like having a new-born baby for life. She cannot do anything for herself and therefore requires 24-hour care and monitoring. Her health is fragile and she is constantly dealing with illness and seizures, which are worse when she gets a temperature. Looking after a child like Sienna can consume much of my time, so having help is essential so that I can also be Mum to my other two children.”

She goes on to say:

“When Andy and I need a few days to spend time as a couple, or do something active with Jamie and Ella, Helen and Douglas House provides Sienna with a welcoming and safe place to go. Helen House is sensitive to the needs of our family and in that way it feels a lot like coming home; a safe haven. It makes me feel normal again and able to carry on.”

That very much exemplifies what hospices across the country do.

Let us get to the crux of the issue, however. The hospice is now facing the closure of Douglas House. Why is this happening? First, we have a situation where more babies are being born earlier and therefore many of them have more severe issues, and also medical advances mean that they are living longer. That is fantastic, but there is a knock-on effect in the wider system because demand is increasing. This is a third-sector organisation that, when it was first set up, never wanted or asked for money from the NHS but now finds itself providing services that the NHS itself should be providing, and facing a shortfall of £3.6 million. It brings in a huge amount—£52.3 million a year—but its expenditure is £55.9 million.

That is why we are now facing the closure of Douglas House, with a loss of care for 90 patients and 60 job losses. These are specialist nurse and medical teams that I fear would disappear from our ecosystem in Oxfordshire and have to end up going elsewhere. The hospice is also considering a review of its 37 excellent shops, which I often shop in. It currently receives zero funding from the local clinical commissioning group. That is the crux of the issue. Some beds are brought in by the NHS—roughly 12%—but zero per cent. of its funding comes from the CCG. I would argue that that is partly why the deficit has built up over time. In a way, the NHS is abdicating some of its responsibility towards an organisation that has been very strong at fundraising in the past but is now struggling and still being asked by the NHS to provide this service.

It is worth noting with cautious optimism that in more recent times—literally the past couple of weeks—the CCG has told the hospice that it might be able to give it some money, in the order of £100,000. However, hospices in nearby areas such as Buckinghamshire and even Birmingham that are doing similar things are being funded in the order of 30% to 37% rather than the 12% that Helen and Douglas House gets from the NHS.

I would like the Minister to address some of the bigger systemic issues. Of course, if there were a magic pot somewhere that she wanted to announce, that would be lovely, because we desperately need the money, and if we could in any way avoid the closure of Douglas House that would obviously be the best option. Will she explain why children’s hospices are funded less than adults’ hospices? That is the top ask. We need to ask ourselves whether that is fair. Together for Short Lives, the fantastic charity that does work in this area, is calling on the Government to grant £25 million a year to bring in funding parity. I think that is a fair ask given the amount of work that the hospice does. I should point out that the Scottish Government have already earmarked £30 million over the next five years to do just that. I know that nobody in this place ever wants to fall behind the Scots, so let us make sure that we get this right.

In 2016, the Government’s response to the review of choice in end-of-life care stated that to support high quality personalised care for children and young people, commissioners and providers of services must prioritise children’s palliative care in their strategic planning. If that is true, then why did we get to the point where Oxfordshire’s Helen and Douglas House received nothing from the CCG? While I appreciate that the Government are making the right noises on this, I am asking for some clarity on oversight. Are they checking and challenging the CCG, because I am not convinced that that has happened so far? It really should not take a petition of 48,000 people to get to the point where the CCG is finally starting to listen. That is ridiculous. Where else in the country is this happening? We have amazing organisations falling by the wayside.

There are some more specific things about Helen and Douglas House that I would like the Minister to address. The first is communication. The Government need to take some ownership of this. On 14 February, I wrote to the chief executive of Oxfordshire clinical commissioning group about the future of Helen and Douglas House. I was met with quite a lengthy waiting time and got a response—clearly a “cut and paste”—from the community and engagement team on 27 March. Their main argument was that Helen and Douglas House has the capacity to bid for contracts. Helen and Douglas House told me that the contract it was being asked to bid for was so vast, and the sort of care it was being asked to provide was so huge, that it did not feel it was the right fit for that pot of money.

It is a proactive organisation, so it reached out to the CCG and said, “We can’t bid for this”—in fact, Barnardo’s now has that contract—“but what we can do is this, that and the other. Can you help us? We’re providing a great service,” but it received radio silence from the CCG, with delay after delay. It had some meetings where it felt things were going forward, and then nothing happened. That lack of communication and lack of accountability for what the CCG does is the crux of what I would like answered today. If excellent organisations like Helen and Douglas House, which has a long-standing and illustrious history, are not able to engage with the CCG, where else is that going wrong, and what handle do the Government have on that? I welcome what the CCG has now done, but are we sure there are not hospices elsewhere where that is happening?

The last point I would like to make is about the false economy of not providing this care. This is critical. The intensive care nurses in the John Radcliffe, when speaking to the chief executive, said, “These are the children on the wards who we worry about the most.” These are the sickest children in our society, and if they are not being given that care before, and if the families are not properly equipped to do what they need to do to prevent these children from going into intensive care, we all know how much that costs. There is a cost argument. The children obviously would much rather not have to go into intensive care; they would rather have the care at home, or if their parents have respite, they can give that care properly. If we end up not spending the money, further down the line, all we will end up with is NHS trusts having to provide the intensive care for these children.

There is a disincentive in the system, because the money for NHS intensive care comes from the trusts, but the money for hospices comes from the CCG. It is clear to me that that is where the bottleneck lies. That communication is not working freely. The overall picture is not working well. We saw a move from Government, with the name change to the Department of Health and Social Care, earlier this year, towards more joined-up thinking in this area. However, I want to know what the Minister has been doing to unblock this specific issue. I was a little disappointed that, when I asked a written question on this matter, the Minister wrote back saying that there had been no discussions at all with Helen and Douglas House, despite the fact that it has been raised in this place and the other place.

We are now getting some traction, but £100,000 is not enough. Helen and Douglas House has asked for £215,000, which would bring parity with neighbouring counties. What can the Minister do to unblock this? What can she do to ensure that in future, other hospices like Helen and Douglas House do not have to make a massive media ruckus and go to their MP to get an Adjournment debate, and that they can provide the care that we desperately want the most poorly and vulnerable children in our society to receive?

Education (Student Support)

Layla Moran Excerpts

Wednesday 9th May 2018 Commons Chamber

[Angela Rayner]

I respect the hon. Lady and I pay tribute to her for her work in the NHS as a nurse, but the figures show that not only is this change making it difficult for trainee nurses, who do an excellent job on our wards, it is contrary to what we need. Applications fell by 33%, with a 42% drop in mature students. In contrast, an undergraduate nursing course can take three years and postgraduate courses, referred to in the regulations, can take two years, making them some of the quickest ways to tackle the shortfall in numbers.

The same is true with the nursing associates suggested by the Government as another solution. The Government’s policy is not only unfair, it is failing completely on their own terms. They have pushed ahead with a policy that has reduced the number of people training to work in our NHS and now they are trying to do it again. I should add that trainee nurses in any of these routes have to do the day job as well. I pay tribute to our nurses for the fantastic job they do every single day in our NHS. Trainee nurses do not get paid the going rate. Those affected by the regulations actually have to borrow money for the privilege.

I hope the Government are clear that simply having more trainees on wards is not a solution to staff shortages. They are there to learn their job, not to do someone else’s. There is clear evidence that using support workers or trainees as replacements for qualified nurses has potentially disastrous consequences for care. I hope the Minister will confirm that that is not the Government’s intention.

This measure does not make any financial sense. Tuition and a bursary for a postgraduate or diploma student could cost less than the average premium the NHS pays for an agency nurse for a single year. Providers have suggested that they could expand their courses by up to 50% if funding was available. This comes at a time when there are 40,000 nursing vacancies in the NHS. The Government’s failure to fill vacancies is so severe that the Migration Advisory Committee has placed nursing on the shortage occupation list, even as potential recruits in our constituencies are denied the support that they need to serve in the NHS.

[Layla Moran (Oxford West and Abingdon) (LD)]

Does the hon. Lady agree that in the end, the only people we must care about are the patients? In Oxfordshire, in the John Radcliffe Hospital, 170 beds were closed primarily because there was a staff nursing shortage. These measures are not going to fix the immediate problem. Why are the Government continuing to do something that is not evidence-based and will not work?

[Angela Rayner]

I absolutely agree with the hon. Lady. She is absolutely right to point out that all our focus has to be on making sure that the jewel in Britain’s crown—the national health service—has the qualified staff to do the job and keep our patients and loved ones safe.

I have talked about the failure to fill the vacancies in the NHS at the moment, and that is even before we consider the impact of Brexit on the 21,000 brilliant nurses who have come from EU countries to serve in our national health service. Only two months ago, the Health Secretary said that the winter crisis in our NHS was “probably…the worst ever”, but if he carries on like this, there will be worse to come.

It is one thing for Ministers to push ahead with policies against the warning of the Opposition. It is quite another for them to ignore their Departments’ impact assessments, yet that is precisely what Ministers have done. The Department for Education’s assessment of the changes to the bursary said that it would disproportionately affect women and ethnic minority students, yet Ministers have wilfully pressed ahead. Then the Department of Health and Social Care found that the change could make women, older students and students with lower incomes less likely to participate in postgraduate nursing courses. Again, Ministers pressed ahead, and we have seen the consequences not just in the number of applications, but in who has applied. Just as they were warned, the profile of our future nurses has become less representative. In particular, there has been a 42% fall in applications from mature students.

This is not simply a matter of fairness or even just about the benefit of a diverse workforce providing frontline care to a diverse population. Older nursing graduates are more likely to stay longer in the NHS and are more likely to choose areas such as mental health or learning disability nursing, which are facing severe staff shortages. Just yesterday, campaigners warned of the impact that the abolition of the bursary has had on those areas.

--- Later in debate ---

[Stephen Barclay]

I do agree with my hon. Friend. Indeed we have three Ministers from the Department for Education here, which again shows the Government’s joined-up approach. The NHS, as the employer of 1.5 million people, is a standard setter that can provide leadership in the apprenticeships market and looks at doing so not just for nursing apprenticeships, but across a range of apprenticeship routes. The Minister for Apprenticeships and Skills, who is a former Minister in the Department of Health, understands that issue extremely well.

[Layla Moran]

Does the Minister really think that this needs to be an either/or? Could we not do the very good work that is going on with apprenticeships and also maintain this important bursary? Does he have something to say to the chief executive of the Royal College of Nursing, who says these changes are short-sighted? Has the RCN’s position changed?

[Stephen Barclay]

I agree with the hon. Lady that we can do both: we can have the apprenticeship route, but we can also increase the number who do postgraduate training as an entry point into the profession. It is also why we are looking to expand the number of undergraduates. This is also empowering for students because it means that, while they are undertaking their course, they will receive more funding than they would under the existing system. Under the move to the loan system, depending on the circumstances of the course, health students will typically receive up to 25% more in the financial resources available to them for living costs during the time they are at university. For example, a student without dependants living away from home could access £9,256 under the loans system, compared with £6,975 under the NHS bursary system.

Organ Donation (Deemed Consent) Bill

Layla Moran Excerpts

2nd reading: House of Commons
Friday 23rd February 2018 Commons Chamber

[Jackie Doyle-Price]

I would like to make progress, so I will take no more interventions.

As I have made clear, we support the Bill and are determined to secure more organs for transplant, because we are concerned that we are losing lives unnecessarily. People have referred to the experience in Wales and whether the learning from that will achieve a material difference. At this stage, it is too early to draw any conclusions about the number of organs that the change in Wales has secured, but we have seen an increase in consent and opting on to the register. Our best estimates are that the change will secure an additional 100 donors a year, which could lead to the saving of 200 extra lives.

[Layla Moran (Oxford West and Abingdon) (LD)]

Will the Minister give way?

[Jackie Doyle-Price]

I will take no more interventions.

On the basis that we could save 200 lives, we wholeheartedly support the Bill. I look forward to working with all Members to secure Royal Assent.

NHS Staff: Oxfordshire

Layla Moran Excerpts

Tuesday 20th February 2018 Westminster Hall

[Layla Moran (Oxford West and Abingdon) (LD)]

I beg to move,

That this House has considered recruitment and retention of NHS staff in Oxfordshire.

It is a pleasure to serve under your chairmanship, Mr Hollobone. I am delighted to have secured this important debate on the retention and recruitment of NHS staff in Oxfordshire. It is a pleasure to see fellow Oxfordshire MPs in the Chamber.

Since my election last summer, the state of the NHS in our county has been one of the issues that my constituents have raised with me most frequently. I pay tribute to all those who work in the NHS in Oxfordshire at every level for their outstanding dedication and commitment to delivering first-class care. We owe it to them, and to patients and their families, to ensure we are providing the best possible service across Oxfordshire and, indeed, the country. I am sure all hon. Members will agree that the staff do an incredible job, but they are under increasing pressure. Some have described the situation as a crisis. Although politicians are prone to hyperbole, I fear that that word is increasingly apt.

Last month, our local NHS hit the headlines nationally, as a leaked memo suggested that Oxford University Hospitals NHS Foundation Trust is considering rationing rounds of chemotherapy at the Churchill Hospital for terminally ill cancer patients because of a 40% shortfall in the number of specialist nurses needed to deliver care. I spoke with the trust bosses, as I am sure many other hon. Members did, and they assured me that the leaked suggestion is not their policy—it is important to reaffirm that point—but they confirmed that it is one option among many being considered by senior staff in the privacy of internal conversations. It is alarming that they are having such conversations at all. That points to a wider issue that needs to be addressed urgently.

The problem, of course, goes beyond cancer services at the Churchill. I am sure Oxfordshire colleagues have their own experiences. In my advice surgery, junior doctors, who prefer to remain nameless, have told me in confidence that staff shortages at the John Radcliffe Hospital and high workloads are leaving some departments dependent on less experienced doctors. They tell me that that would not have happened in years past, and that they are now anxious about patient safety. They work far more than their allocated hours to catch up with paperwork, and they are especially concerned about the night shift, when the problem is most prevalent.

In recent years, the NHS in our area has been propped up by the good will of staff at all levels—doctors, nurses and ambulance workers alike—who put patients first, but the stress of the job is affecting them and their families, and I am afraid that some are voting with their feet. In nursing, the shortage is most acute. In Oxford, we had 560 unfilled vacancies at the end of last June. The vacancy rate increased from 6% to 10% at OUH trust between October 2016 and October 2017.

Mental health is another area of concern. The child and adolescent mental health services in Abingdon provide outstanding care and support to young people with mental health issues and their families, but I have been contacted by residents who are worried that experienced staff are leaving the profession and the NHS altogether due to the pressure on the service and their workloads. According to the Royal College of Psychiatrists, in the Thames valley area, we have a below average number of consultant psychiatrists per 100,000 people, below average numbers of junior doctor psychiatrists, and below average numbers of psychiatric nurses.

The Department of Health’s pledge to expand the mental health workforce to the tune of 570 extra consultant psychiatrists by 2021 is welcome, but the number of medical students specialising in psychiatry has flatlined. The Government must do more to ensure Oxfordshire has sufficient mental health specialists to make parity of esteem between mental and physical health a reality. I am interested to hear from the Minister what they are doing about that.

On the mental health of NHS workers themselves, there is a huge if perhaps unsurprising problem relating to stress and sick leave. A freedom of information request by the Liberal Democrats found that nurses took 5,869 days off for stress and mental health-related illnesses in Oxfordshire in 2016-17—up 11% on the previous year.

Why are we having all these issues? There are several strands to the problem, some of which are specific to Oxfordshire and some of which are represented more widely in the country. I will take each in turn. My Oxfordshire colleagues on the Conservative Benches, in particular, would be disappointed if I did not take the opportunity to speak about Brexit, so let me do that first. To put it bluntly, the Government need to do more to reassure the EU citizens working in the NHS that they are not just welcome in the UK but valued. They face uncertainty about their future status, whether they will be settled and the cost and bureaucracy of it all, and they do not have faith in the Home Office to manage the gargantuan administrative burden. More than 2,700 EU nurses left the NHS in 2016—a 68% increase since two years ago. Separate figures from the Royal College of Nursing show that the number of EU nationals registering as nurses in England has dropped by 92%. I am told by local EU nurses that one of the main sticking points is uncertainty about whether their time spent in the UK will count towards career progression in their country when they go back home, so people are making the decision not to come to the UK lest they risk being at a disadvantage in their career. Is the Minister aware of that problem? If so, what is the Department doing to tackle it? I would also like to see the introduction of an NHS passport, or an equivalent with a different name, to secure the rights of EU citizens who have made their home here and to encourage others to come now, because we cannot wait to address this crisis.

Coming back to our home-grown population, the Royal College of Nursing suggests that the next generation of British nurses is deterred by pressure, a lack of funding and poor pay. It also says that the cuts to training places are exacerbating the problem. Just a fortnight ago, we learned of a 13% reduction in the number of UCAS applications for nursing, compared with the year before. This is the second year in a row that applications for nursing courses have fallen, and 700 fewer nurses are even starting. NHS Digital figures show that one in 10 nurses is leaving the NHS every year, and that those leaving now outnumber those joining.

I recently visited Abingdon Community Hospital, and the staff there told me that the shortages mean that they are increasingly using agency staff to fill the gap. Although those staff are well trained, there is strain associated with bringing them up to speed while managing everything else. It is not a sustainable situation.

The RCN is clear that the Government’s attempts to increase the number of trainee nurses are not working, and that care failings are becoming more likely. The Government must address this situation urgently so the public can have confidence in safe staffing levels in our NHS. The Department has pledged an extra 5,000 places for student nurses in 2017. Again, that is welcome, but how does it square with the collapse in applications? I would like to hear what the Minister and the Department are doing about that.

I think we can lift the 1% pay cap for NHS staff, who deserve a decent, fair and long overdue pay rise. The Minister must be aware of what the cap is doing to morale across the NHS—especially in areas such as Oxfordshire, where the cost of living is high.

[Robert Courts (Witney) (Con)]

I congratulate the hon. Lady on securing this important debate. She may be about to address this point—I apologise if I am foreshadowing her speech—but she mentioned the cost of living, and of course the cost of housing is a big issue for all of us in Oxfordshire, no matter where we live. Does she agree that one of the most helpful things we can do is to follow the example of schemes such as the partnership in my constituency between Blenheim Estates and West Oxfordshire District Council, which is looking at providing substantially reduced market-rent housing for all key workers—not just those in the health sector? There is a great deal to be done there. Furthermore, institutions such as hospitals may be able to look at similar practices. The clinical commissioning group might take up the long-standing invitation for it to attend growth board meetings, in which it will be able to have some input into the housing provided for key workers, what it costs and where it is located. I am sorry that there are so many points there, but perhaps the hon. Lady can consider them.

[Layla Moran]

Not at all; I thank the hon. Gentleman for his helpful intervention. He is right to foreshadow what is coming later. The more times we make the point, the better, because it is the crux of the issue in Oxfordshire. On the pay cap, when will we see the timetable for the pay review? We need to ensure that the basic cost of living at least is covered. I will come on to housing later.

I am glad about the renewed focus on social care in the Department since the reshuffle, but I sincerely hope that it extends beyond just a name change. Staffing levels for the sector are even worse than in nursing in Oxfordshire. One of the more surprising facts I have learned in recent months has been about how many social care staff are leaving the service locally to fill positions in the retail sector created by the opening of the shiny new Westgate centre in Oxford. Pay is at a similar level, but the work is less stressful, so the people doing those vital social care jobs are deciding that they would rather do something else and take the easier path.

It is not just pay that we are talking about; Oxfordshire pays well for such jobs in comparison with other parts of the country. Our area still struggles to recruit and keep people. The recently published Care Quality Commission report for Oxfordshire found that

“The system in Oxfordshire was particularly challenged by the issues of workforce retention and recruitment across all professions and staff grades”,

and that “countless” concerns had been expressed about recruitment and retention, and their impact on developing a skilled and sustainable workforce.

The report goes on to highlight the need to do more to increase professional development. We must ensure that budgets are available for continuous professional development within the NHS, allowing existing staff to train, develop and build their career over time. Without such opportunities, it is little wonder that they move on. That has been raised vociferously by nursing leads as another key factor in the retention crisis. I will be interested to hear what the Minister has to say about CPD and whether the budget for that will be increased.

Then there is overall funding. At the election, all political parties pledged more, but it was not enough. Rather than just talking about how much, I want to talk about how we can be honest with the public about how to pay for more funding, if we are all agreed that that is needed. In the short term, my party would like to see a ring-fenced penny in the pound on income tax, providing a £6 billion cash injection. In the longer term, and as a replacement for national insurance, on the basis of wide consultation, we advocate a dedicated health and social care tax. The advantage of that would be that people could see in their pay packets exactly what we were paying for.

We also want an NHS and care convention to bring together all political parties and stakeholders, so we stop using the NHS and social care as the political football it was during the election. Recently a letter on the issue backed by nearly 100 MPs was sent to the Prime Minister, but I was saddened to see that it was not taken up. I therefore urge the Minister not only to continue to ask the Prime Minister and the Treasury for more money for the NHS but, critically, to back something along the lines of a cross-party NHS and care convention, so that we can take the NHS out of the hands of political pundits and put it back into the hands of patients, where it belongs.

I have talked about what I would like to see from the Government: an open and generous offer to EU citizens; a decent pay rise; better funding, which is not kicked about as much; improved working conditions; and action on bursaries and training for nurses. But, to come to the point made so eloquently earlier, that will not cut the mustard for Oxfordshire, because our biggest issue by far is the prohibitive cost of housing in the county.

I will share an email I received from one of my constituents in Kidlington who works for the NHS. She contacted me to say that she feels as though she will never be able to afford a house of her own:

“I work for the NHS and although it comes with fantastic benefits and, I hope, great security it doesn’t pay like those who would be doing the same job as me as an office manager, in the private sector.

My situation is that I have been working for NHS nearly 9 years now. I want to move out and I live in Kidlington. To have a slight chance I would have to do shared ownership. Although not ideal it is a great stepping stone, and you have to start somewhere. However, if I was to look outside Kidlington, the Bicester area where there is up and coming new builds, the prices are still out of my range. It is disheartening to be rejected, especially when you are literally outside the affordability, yet you have worked, paid taxes and generally contributed to society.”

That is a damning indictment, and the despair is shared by so many public sector workers across Oxfordshire. A 2017 study by Lloyds bank listed Oxford as the most expensive city in which to live in the UK, with the average house price now 11 times average earnings. The recent CQC report on Oxfordshire found that staff at every level cited cost of living and housing as barriers to staff recruitment and retention.

There have been some steps in the right direction. As the Minster will know, in March 2016 the OUH trust launched a scheme in which new nursing recruits were offered a cash incentive equivalent to their first month’s rent and a deposit. I have no doubt that the council, the NHS and other organisations in other parts of the county, as we have heard, are doing everything they can—I am not here to bash them—but the fact is that the new houses to be built will not fix the problem. At best, the models show that house prices may flatline over time, but the definition of affordable as 80% of the value of incredibly expensive houses is still nowhere near enough to tackle the problem for public sector workers.

I can propose a solution. I would like to see some kind of Oxfordshire housing allowance for public sector workers given to local NHS staff to help them meet the extremely high cost of living and to tackle our recruitment crisis. Unison’s Oxfordshire health branch has called for the reintroduction of an Oxford weighting to help staff with living costs in the area, in line with the NHS weighting already paid to staff in London. I prefer not to do that, simply because “more pay” can be seen as “more valued”, which is not what that is meant to be. I would prefer to see the introduction of a specific payment for housing—a specific payment for a specific problem.

I am open to exploring all options, and I am very keen to hear what fellow Oxfordshire MPs and others think. Without an Oxfordshire housing allowance in some form, we will always struggle to recruit the NHS staff we require. Moreover, we need to start doing something now.

To conclude, the Government can and must take a role collaboratively with stakeholders to recognise the unique situations and challenges that we face in Oxfordshire. If we do nothing, we risk the rationing of care and treatments and, rightly, a backlash from our constituents. God forbid that anything should happen to a single patient as a result of any of the issues I have described today. It is our duty to tackle the problems head on and to ensure that we recruit and retain the staff whom patients deserve and our local NHS desperately needs.

[Mr Philip Hollobone (in the Chair)]

The debate can last until 1 o’clock. I will call the Front-Bench spokespeople at 12.30 pm, so other Members have 10 or so minutes each. I call Victoria Prentis.

--- Later in debate ---

[Layla Moran]

I end the debate by thanking all my fellow Oxfordshire MPs for their fantastic contributions. I am pleased to see that we are in violent agreement on most of the issues that we face. We also agree that the staff, above all, must be thanked for the work that they do; we cannot say that enough. I thank the shadow Minister, the hon. Member for Ellesmere Port and Neston (Justin Madders), for his remarks, and the Minister. I hope that he can see how passionate we all are about this matter and that we hunt as a pack, so this will not be the last time that he is contacted by us. I look forward to his note and to any answered questions that come back to us on this issue.

[Mr Nigel Evans (in the Chair)]

Order.

[Layla Moran]

Finally, I would like to thank you, Mr Evans.

[Mr Nigel Evans (in the Chair)]

I should not have stopped you there, should I?

Motion lapsed (Standing Order No. 10(6)).

PACE Trial: People with ME

Layla Moran Excerpts

Tuesday 20th February 2018 Westminster Hall

[Carol Monaghan]

I will make some progress. The PACE trial was used to inform NICE guidelines, which has meant that symptoms have been disregarded, and sufferers are considered to be attention-seeking hypochondriacs or even, in the case of some female patients, hysterical. Although in some ways the lack of belief has been the most difficult thing for sufferers and their families, the impact of the PACE trial and the resulting NICE guidelines is far further reaching. Many sufferers have reported major difficulties in accessing financial support. Employment and support allowance assessments do not consider the impact of exertion on a person’s ability to function on subsequent days, and personal independence payment assessments, which consider ME to be psychological following the PACE report, mean that sufferers struggle to access that entitlement and simply rely on family members.

Conflicts of interest in the trial are also deeply worrying. The former chief medical adviser to the DWP sat on the trial’s steering committee, and ultimately the results of the trial have been used to penalise those with ME. When we consider the relationship between key PACE investigators and major health insurance companies such as Unum, the trial takes on a far more sinister slant. Sufferers have reported that their health insurance company would pay out only if they undertook a programme of GET—an impossible task, as the insurance giants knew.

It is not only adults who are affected. Children with the disease have been subject to care proceedings because of widespread misunderstanding among health workers. ME has been mistaken for school phobia, neglect or even abuse.

[Layla Moran (Oxford West and Abingdon) (LD)]

Will the hon. Lady give way?

[Carol Monaghan]

I will in a moment. One mother contacted me, saying:

“Our 12 year old son was seen at specialist ME centre by a consultant who prescribed GET. In one year this ‘programme’ caused our youngster’s body to develop higher and higher levels of inflammation, he began limping, was in continual pain from not only the ME headaches but joint and foot pain. The comments were ‘well he managed to limp into my office’, ‘you were very active, now since the virus you are very inactive, so you will have this pain due to lack of exercise’.

GET caused his body’s immune system to go into overdrive. My son developed Juvenile Idiopathic Arthritis. This was treated by a paediatric Rheumatology Consultant who was shocked it had been left so long and told my son that his toes would be permanently swollen even after treatment as the bones had grown abnormally during the inflammation”.

[Layla Moran]

I, too, have been contacted by parents in my constituency. In the case of one constituent, her daughter took a year to be diagnosed and missed an entire year of school as a result. The effect on children’s lives at a very young age is palpable.