Health and Care Professions Council: Registration Fees

Liz McInnes Excerpts

Thursday 14th March 2019 Westminster Hall

[Liz McInnes (Heywood and Middleton) (Lab)]

It is a pleasure to serve under your chairmanship, Mr McCabe. I am grateful to my hon. Friend the Member for Coventry South (Mr Cunningham) for securing this important debate. I, too, had requested a debate on this subject but was unsuccessful, so I am pleased that he has been able to bring this important issue to the attention of the House.

Before I was elected to this place, I was registered with the Health and Care Professions Council, because I worked as a clinical scientist in the NHS. As we have heard, registration with the HCPC is an essential part of the job: without professional registration, scientists and allied health professionals in the NHS are not allowed to practise. I am no longer registered with the HCPC. Having worked for the NHS for 33 years and had a career change late in my working life, I have called time on my NHS career, so there is no conflict of interest.

The HCPC charging above-inflation fee increases is nothing new, but it is scandalous that its latest proposal is to raise fees for already hard-pressed healthcare professionals by an enormous inflating-busting 18%. If that increase is imposed, HCPC fees will have risen by 40% since 2014, outstripping inflation and going hugely above any pay rises that NHS staff have had.

I remember from my days in the NHS that the HCPC used to impose above-inflation fee increases during the years of the George Osborne 1% public sector pay cap. Any representations that the staff and trade unions made to the HCPC, at a time when many staff had had no pay rise at all, fell on deaf ears and were simply ignored. It appears that that has emboldened the HCPC to ask for more and more from its members, with no discernible improvement in the performance of the HCPC or an increase in the services that it provides to its registrants.

NHS staff are already struggling, their pay having been suppressed for many years since 2010, but more and more financial demands are made on them in order to stay in work. NHS staff in England have to pay to park at their workplace; NHS staff are paying more towards their pensions; any member of staff with any sense will be paying trade union subscriptions; many are repaying student loans; and now, they appear to be expected to finance the HCPC’s excessive, unreasonable and unjustified fee demands.

The staff are just not being listened to. My trade union, Unite, submitted a 38,000-signature petition against the fee increase to the chief executive of the HCPC before the decision was made on 14 February this year to increase its mandatory fees by 18%. It appears that the HCPC is quite happy to blithely ignore the voices of 38,000 of its members. Additionally, the HCPC consulted on increasing its fees from £90 to £106 a year and 90% of those who responded disagreed, yet that seems to have had no impact on the decision made on 14 February.

[Dr David Drew (Stroud) (Lab/Co-op)]

Does my hon. Friend agree with me—she is making this case anyway—about how unaccountable this body is? I have dealt with individuals who have fallen foul of it and I have written to it on their behalf, but it appears to take no notice at all of what an individual MP or constituent has to say.

[Liz McInnes]

I do agree, and I thank my hon. Friend for that intervention. I should add that while I worked for the NHS, I was a trade union rep for Unite the union and had many encounters with the HCPC. I found it to be opaque in its dealings and difficult to deal with.

I want to mention the effect of the fee increase on part-time workers, because scandalously there is no difference in fees between full-time and part-time workers, so it will have a disproportionate effect on part-time workers, who in the NHS are predominantly female.

If we look at what the HCPC actually does, we find, from its 2018 annual report, that it dealt with complaints against only 0.64% of registrants and that it sanctioned only 0.09%. Many members comment that they receive no benefit or professional services at all from their registration. As we have just discussed, the HCPC operates in a very opaque manner. Trade unions are not recognised within its own workforce, so there is no collective pay bargaining for its own employees, and so we do not even know what the HCPC pays its staff.

The HCPC says that it needs this increase so that it can deliver smarter regulation, improve services and mitigate the impact of the transfer of the regulation of social workers to Social Work England. However, I have already talked about how few fitness-to-practise cases the HCPC deals with as a proportion of the total membership. When social worker regulation moves to a new regulator later this year, that should lead to a reduction in fitness-to-practise expenditure, given that 59% of that expenditure currently goes on social work cases. The HCPC’s costs should decrease, not increase, which makes this demand on registrants even more unjustified.

This is Healthcare Science Week and I pay tribute to all the scientists working across our NHS. Their work quite often goes unrecognised, but is an essential component of the diagnosis and treatment of disease. Healthcare scientists and allied health professionals are a vital part of our NHS team.

In conclusion, I call on the HCPC to pause, to delay any decision to increase fees, and instead to explore alternative ways to reduce costs and to fully assess the impact of the transfer of social workers.

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[Stephen Hammond]

I listened to the hon. Gentleman, and I will make a promise to him. As I pointed out at the beginning of my speech, it is not the Government’s role to tell the regulator how to set its fees or what to set them for. However, I see no reason why the Professional Standards Authority should not ask the HCPC to give that reassurance and to publish that information. I will write to the hon. Gentleman when I have spoken to the PSA to ensure that it can do that within its remit. Given that it has oversight, I am sure that that will be possible.

[Liz McInnes]

It is my understanding that the changes to the HCPC rules will be subject to parliamentary approval. The Minister says that the Government will not be able to have any influence, so by what mechanism will the rule change be approved by Parliament?

[Stephen Hammond]

On oversight of the fee change, there is effectively accountability to Parliament through an order of the Privy Council. The Government will need to introduce an order of the Privy Council, which will be subject to the negative resolution procedure. The financial oversight is done by the PSA. The Government have to lay the order, but the oversight is done via the Privy Council.

As I said, there has rightly been much discussion this afternoon about the reason for the proposed fee rise. The HCPC makes the point that it has not raised its fees since 2015. It also rightly makes the point that the vast bulk of the fee rise is for the services that its registrants want. I promised to write to the hon. Member for Stroud (Dr Drew) about that.

I thank the hon. Member for Coventry South for raising this issue. The debate has highlighted his campaign. I have no doubt that the HCPC and the PSA will have listened, and will take regard of this afternoon’s debate. I hope that my remarks, the promise I made to the hon. Member for Stroud, and my commitment to write to the HCPC will help the campaign of the hon. Member for Coventry South. I am clear that registrants should continue to benefit from a regulator that provides value for money and services to its registrants; I know that the PSA will ensure that they do so.

Non-surgical Cosmetic Procedures: Regulation

Liz McInnes Excerpts

Tuesday 12th February 2019 Westminster Hall

[Alberto Costa]

I thank the hon. Lady for her intervention. She is right to use the word “professional”, but the mark of a professional is somebody who is regulated, and in the private sector it is somebody who has professional indemnity insurance behind them. It is easy for someone to call themselves a professional, but a real professional is someone who is regulated. I am a solicitor and I am regulated by the Solicitors Regulation Authority, and behind me there is professional indemnity insurance. If I give advice negligently, a consumer has redress against the insurance product. We want a healthy, thriving industry in non-surgical cosmetics, where people can freely choose these procedures, but we have a duty as MPs to protect the health and safety of consumers, enabling them to make informed choices when seeking treatment from professional beauticians.

[Liz McInnes (Heywood and Middleton) (Lab)]

I thank the hon. Gentleman for giving way again. Regarding the training that those administering these sorts of treatments need, I recently spoke to a father whose 19-year-old daughter had received Botox injections, to which she had suffered a severe allergic reaction. This is the realm of medical practice. Anyone administering Botox should be aware of the possibility of those receiving it having an allergic reaction and should know what to do if they do. That is an area that regulation needs to address.

[Alberto Costa]

The hon. Lady is exactly spot-on. It is beyond belief that somebody can inject someone else with a foreign substance and have no medical expertise whatsoever. That is the nub of the problem.

We see more and more young people seeking these types of procedures, and at younger ages. It is incumbent on the Government to act swiftly and decisively to ensure that proper regulation and protection are in place for our constituents, of all ages, before the situation spirals out of control.

According to data from Save Face, a Government-approved voluntary register of accredited practitioners, there has been an alarming rise in reports of botched cosmetic procedures in the UK. The number of complaints about unregistered practitioners of treatments such as lip fillers and Botox reached almost 1,000 last year, showing that there is a large gap in safety and proper process that must be bridged.

Further, there is a separate but inextricable link between the rise of non-surgical cosmetic procedures and the pressures that young people in our society feel. Members may have seen Sky News this morning about social media, selfies and changing one’s image. That is clearly a major issue, particularly among the younger generation. Social media also has a responsibility regarding advertisements for non-surgical cosmetic procedures that are particularly targeted at minors. Although it is a person’s prerogative to undertake any treatment they wish, they should be able to do so through the prism of an informed decision, and with the peace of mind that the treatment they receive has been tried, tested and regulated by a professional body.

Colleagues might have seen the news about Superdrug a week or so ago, in which NHS England’s medical director strongly criticised the trusted high street retailer for not conducting “medically responsible” checks before customers receive their treatment. Similarly, NHS England’s chief executive sternly warned ITV about screening advertisements for these types of treatment in breaks during programmes such as “Love Island”, which is hugely popular with young people. Many colleagues will be shocked, as I was, to find that anyone can carry out non-surgical cosmetic procedures, with no regulation or expertise whatsoever.

A multitude of small businesses, and even individuals, spread across Facebook and, especially, Instagram, offer their services to impressionable young people. Many of them have no corporate responsibility or regulation and there are therefore absolutely no safeguards for consumers. Although I appreciate that many colleagues may have never seen an episode of “Love Island”—I confess to being in that category; I do not even have an Instagram account—

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[Jackie Doyle-Price]

I could not agree more with my hon. Friend. He is absolutely right: the priority for us in the Department of Health and Social Care has to be the safety of people undergoing these procedures. Aligned with that, I was pleased to see in the challenge to Superdrug a recognition of the fact that people’s seeking these sorts of treatments can be an indication of dysmorphia and an underlying problem. We need to make sure that all practitioners in this field have the ability to recognise those problems.

[Liz McInnes]

I also wanted to raise the issue of dysmorphia, which strays into the area of mental health. I am concerned that we seem to be accepting that it is okay for people to want to change their appearance. The issue of body dysmorphia illustrates that people may be asking for these procedures for the wrong reasons, and I question whether somebody on the high street who is not a qualified mental health practitioner is able to determine whether somebody is suffering from body dysmorphia.

Orkambi

Liz McInnes Excerpts

Monday 4th February 2019 Commons Chamber

[Bill Wiggin]

I am not quite sure I follow. I would have been much more sympathetic to Vertex if it had not been doing share buybacks. If a company expects to make $13 billion of profit, it will have factored into its calculations a reasonable profit margin. I believe that Vertex has an unreasonable profit margin. I support the private sector, and I like the idea of that R&D going on to benefit the shareholders, but I also recognise that we have a responsibility. As people who want to see patients cured, we want to see this deal done ideally by Vertex and NICE. This is a £500 million gamble for Vertex, because it will not get the money if it does not do the deal.

[Liz McInnes (Heywood and Middleton) (Lab)]

I am grateful to the hon. Gentleman for giving way. He mentioned the R&D that is going on. That R&D does not exist in a vacuum; it is done on patients, with input from doctors. Does he agree that the company, no matter how much profit it might want to make, has a moral obligation to cystic fibrosis patients?

[Bill Wiggin]

I absolutely agree, which is why I am suggesting that the Crown use licence ought to be used and taken seriously. I imagine that people working for Vertex are listening closely to this debate. They will have heard the hon. Lady’s point, and I think they need to move on from this attention to profit margin.

As a Conservative, I understand the importance of managing the expectations of private companies. We in Parliament have a responsibility to people with cystic fibrosis to stand up to the greed. That is what we are doing now, and it is lovely to see so many Members here. I urge the Government to consider enacting a Crown use licence, to break the deadlock on this patented drug and reduce the price of Orkambi and the suite of medicines that go with it, which are so desperately needed not only by our constituents, but by their children.

Cervical Cancer Smear Tests

Liz McInnes Excerpts

Monday 28th January 2019 Westminster Hall

[Steve Brine]

I cannot tell the hon. Lady that, but I will find out and write to her and other Members who in the debate. It is not my policy area—obviously I am not the Minister of State for School Standards—but it is a good point and it would seem logical that that is done in consultation with the Department of Health and Social Care and with Health Education England.

To go to the heart of where I want to start, the hon. Member for City of Chester talked about a constituent being refused a smear test. He said that it would be simple for a Minister to change the regulations and said that this was an example of the system not doing what we direct it to do. As the shadow Minster said, the system should already do that. It would not be appropriate to go into individual instances, but it is important to understand that cervical screening is a screening test and not a diagnostic test. It aims to detect abnormalities of the cervix that if left undetected may develop into cancer, so it is preventative. Cervical screening is not appropriate for women with symptoms, but if women of any age, including under-25s, have unusual symptoms or abnormal bleeding, they should consult their GP immediately and they should be treated under the NHS and initially offered a speculum examination in accordance with the National Institute for Health and Care Excellence guidance for primary care. If that is not happening and if that were one of my constituents, I would be taking that up through the procedures that the hon. Gentleman will know about as an experienced constituency MP. I think that is clear.

The hon. Gentleman also touched on the petition. To be clear, the petition is entitled:

“Lower the age for smear tests from 25 to 18 to prevent cervical cancer.”

He is right to raise the point about women requesting that. We do not often hear about “Liberating the NHS: No decision about me, without me” in the House these days, but it is still very much alive. I would encourage him to take that case up, as I would encourage any other Member who runs into that issue to do.

[Liz McInnes (Heywood and Middleton) (Lab)]

Will the Minister address the issue of self-screening kits for HPV in his remarks? I am sure he will go on to talk about them. My interest is at the other end of the spectrum, with women aged over 64, but it is pertinent to young women, aged 18 to 25, as well.

Appropriate ME Treatment

Liz McInnes Excerpts

Thursday 24th January 2019 Commons Chamber

[Liz McInnes (Heywood and Middleton) (Lab)]

I thank the hon. Member for Glasgow North West (Carol Monaghan) for securing this important debate. I spoke in the debate last year about Merryn Crofts, who is one of just two people in the UK to have myalgic encephalomyelitis recorded as the cause of death. She was my constituent and lived in Norden, in the Rochdale area of my constituency.

Merryn suffered so badly from pain that she could not get out of bed. Her GP had worked in a hospice for 10 years, looking after cancer patients, and said that in that job, she could not always take away pain but could manage it. The GP said that Merryn’s pain was unmanageable. Although Merryn was on diamorphine and ketamine, she was still in pain. Any kind of stimulus—even just a nurse walking into the room—was an exertion for Merryn.

Merryn’s mother was very critical of the PACE guidance given by NICE and attributes the worsening of Merryn’s condition to it. She tells me that Merryn thought she could push through the condition and keep going, although her family wanted her to slow down. Sadly, it was only when the family contacted a private medical practitioner that Merryn was given the advice to slow down and rest. The specific advice given was, “Whatever you feel you can do, only do 50% of it.” Merryn’s mother feels strongly that, had Merryn been given that advice when her condition started, she might not have gone on to develop severe ME, and she strongly urges that the NICE guidelines be reviewed. Merryn’s mother told me:

“If the PACE trial were a drug, it would have been banned by now.”

I have also been contacted by other constituents who have urged me to take part in this debate. One of them is Rebecca Pritchard, who points out that it would not be difficult to increase funding for research, given that very little funding for ME has been given so far. She highlights the work done by Invest in ME Research, based in Norwich, and points out the huge funds that have been crowdfunded by patients and their families.

NHS Long-term Plan

Liz McInnes Excerpts

Monday 7th January 2019 Commons Chamber

[Matt Hancock]

My hon. Friend is quite right: we must focus on the substance of what is needed to deliver an NHS that will be there for us all in our hour of greatest need. That is what we should be concentrating on. I have heard some Members say, “Whatever the Government promise, we will just promise more.” That is no way to have a discussion about the future of the country and our most valued institution. Instead, we should back the NHS’s plan, deliver on it and keep the economy strong so that we can keep putting in the money that the NHS needs.

[Liz McInnes (Heywood and Middleton) (Lab)]

Paragraph 4.17 of the plan states:

“Mature students are more likely to have family and other commitments that make it harder to retrain without financial support.”

Will the Secretary of State therefore now admit that his Government made a huge mistake when they abolished bursaries for nurses and allied health professionals?

[Matt Hancock]

No; we are proposing to have more targeted support for those who need it, to ensure that we get support to the areas of nursing with the most acute shortages, such as community nursing and mental health services. That is where support is best targeted.

Diabetes: Artificial Pancreas

Liz McInnes Excerpts

Wednesday 12th December 2018 Commons Chamber

[Mr Howarth]

I am grateful to the hon. Gentleman, who must be psychic, because that is the very next point I was going to make.

There have been, as the hon. Gentleman says, postcode lottery-style problems with accessing the technology. For example, with FreeStyle Libre, a flash glucose monitoring device, patients in Liverpool are able to get it on prescription if they meet the criteria. That is very welcome, but many patients from outside the area cannot get one, as up to 30% of CCGs do not fund them. There needs to be more work done on that and I know the Government have made an announcement, which I will refer to in a moment.

Thanks to Diabetes UK’s campaign on 14 November, World Diabetes Day, NHS England announced that from April 2019 the FreeStyle Libre will be made available to all who meet the clinical criteria regardless of where they live. That is a very welcome development. I do not think it will apply to Northern Ireland, but I hope a similar policy is adopted in Northern Ireland. Innovation in diabetes technology is evolving rapidly in exciting ways.

[Liz McInnes (Heywood and Middleton) (Lab)]

I thank my right hon. Friend for giving way. To go back to the postcode lottery of funding, I wonder whether the Minister will talk in her winding-up speech about the work of the Scottish diabetes technology improvement plan, which was supported by £12 million of funding and has resulted in increased insulin pump usage in Scotland. I wonder whether we might emulate that scheme.

[Mr Howarth]

The common-sense approach is to look at what is going on elsewhere—in Scotland and in other parts of the world—to get the best of what is available and use it in the most effective way. My hon. Friend is quite right about that.

It is pointless giving type 1 diabetics the latest technologies, such as an artificial pancreas system, if they are not given structured education to support them to use the technology that is available. The limited uptake of educational programmes is a matter of great concern, and I hope the Minister shares that concern. Despite guidance from the National Institute for Health and Care Excellence, in 2014-15 only 2% of people newly diagnosed with type 1 diabetes were recorded as having attended structured education courses. For some, that lack of knowledge of the key principles of self-management is a major barrier to the use of technology, because without sufficient education, type 1 diabetics are not equipped to get the best results from the technology available.

--- Later in debate ---

[Mr Howarth]

My hon. Friend is right. This is not just about technology, important though that is. Anyone with diabetes who manages it well—and technology will help to do that—will have fewer hospital emergency admittances. I do not have the statistics to hand—I am not even sure they exist—but those people will clearly have fewer hospital admittances and fewer complications with their diabetes, and therefore cost the NHS less. As I am sure the Minister will acknowledge, however, the NHS is not very good at doing cost-benefit analysis. It needs to get smarter at it, because the point that my hon. Friend makes is right, not only as regards the support we give to people with type 1 diabetes, but about the cost to the NHS of dealing with the consequences.

[Liz McInnes]

I want to echo the point about cost-benefit analyses and how bad the NHS is at joining up different departments’ budgets. It really needs to get better at being able to identify that spend in one area leads to a huge reduction in spending in another.

[Mr Howarth]

My hon. Friend makes the point more clearly and eloquently than I did.

A new device that takes us closer to the artificial pancreas has been developed by Medtronic: the MiniMed 670G. A number of people with type 1 diabetes have started using the system in the UK in a pilot phase before it is rolled out more widely across the country. However, only 15.6% of those with type 1 diabetes are using insulin pumps, and it is potentially a concern that healthcare professionals would be unlikely to recommend an artificial pancreas if someone was not already using a pump and continuous glucose monitoring. If the issues to do with NHS access to today’s type 1 diabetes technology can be addressed, a path can be cleared towards adoption of the artificial pancreas.

We need to ensure that people living with diabetes are equipped with the skills to self-manage. That would support patients in using current technologies effectively, and ultimately in using artificial pancreas systems. Structured education is central to enabling people living with type 1 diabetes to best manage their condition through effective use of monitors and insulin pumps. The NHS can support type 1 diabetics to do that by increasing the provision and uptake of diabetes education. To do that, it needs to make diabetes education courses more accessible and convenient, possibly through digital solutions.

A recent survey by Dexcom revealed that more than three quarters of people with diabetes suffer from stress, anxiety attacks or bouts of deep depression. While healthcare teams help, and teach people how to manage their blood glucose levels, type 1 diabetes is largely a self-managed condition. The NHS needs to ensure that the resources and community support that people with type 1 diabetes require are well advertised, well recognised, well understood and well invested in. I believe we are on the threshold of being able to make type 1 diabetes not a thing of the past, but a thing that can be well and easily managed, and I hope the Minister will take these words seriously and do everything she can to advance that day.

[Keith Vaz (Leicester East) (Lab)]

It is an honour to follow my right hon. Friend the Member for Knowsley (Mr Howarth), who has been an hon. Friend for almost 30 years and is a great champion for those with diabetes, in particular type 1 diabetes.

I declare an interest, as a type 2 bordering on type 1 diabetic. The usual suspects are here, including my hon. Friend the Member for Heywood and Middleton (Liz McInnes) and the hon. Member for Strangford (Jim Shannon), who has popped out but I know will be back. The Government Benches are empty, apart from the Minister and the Lord Commissioner of Her Majesty’s Treasury, the hon. Member for Finchley and Golders Green (Mike Freer), because Conservative Members are listening to the most famous type 1 diabetic in the world, if we discount Halle Berry and Mary Tyler Moore. I admire so much the way in which the Prime Minister does her job, with all the demands on her, as a type 1 diabetic—we do not even notice, and that is because of the technology that has been developed and the way in which she conducts herself.

[Liz McInnes]

Among the most famous type 1 diabetics, we must not forget Sir Steven Redgrave, the Olympic rower.

[Keith Vaz]

Indeed. Before anyone else jumps up with another name, I include all diabetics in what I am saying.

The Prime Minister and others such as myself talk about diabetes, and we are not cowering in corners; we are debating it openly. Because of technological advances, we are able to do our jobs and continue with our lives in a way that was not possible when diabetes was first discovered 100 years or so ago.

The first artificial pancreas, which was developed by Sir George Alberti through funding from Diabetes UK, was the size of a filing cabinet. Madam Deputy Speaker, can you imagine walking around with an artificial pancreas of that size? We should always acknowledge the research and innovation of which my right hon. Friend the Member for Knowsley spoke and the power of science to change people’s lives.

I want to give a few examples from my own city of Leicester of the work that has been done on diabetes. There is the work done by Professor Kamlesh Khunti and Melanie Davies of the University of Leicester; my own general practitioner, Professor Azhar Farooqi, who diagnosed me with diabetes—had I not been diagnosed, I might not be standing here today, because I did not know what the symptoms were—and Professor Joan Taylor from De Montfort University, who began developing her own version of the artificial pancreas.

It was very interesting to learn from my right hon. Friend’s speech about all the other clever people—probably much cleverer than all of us here—who have been able to develop their own artificial pancreas. Not all of them will be able to fly, so to speak, but it is amazing that people are putting their minds to it, and Professor Joan Taylor at De Montfort has done the same. There is also Professor Hovorka of Cambridge University who, like George Alberti, was funded by Diabetes UK in developing the artificial pancreas. These people deserve our respect and admiration for what they do, because they spend day after day trying to make the medical breakthrough that will help people and save so many lives. I want to thank them for what they have done, because their work has enabled us to get to the position we are in today.

There are also the private companies. Members do of course criticise, as we are entitled to do, the profits made by drugs companies. The Minister will know because she has to sign the cheques—perhaps she does not sign the cheques, but she sends them to the Treasury to get them signed—when the bills come through for the artificial pancreases and the metformins or Glucophages and all the other things that we take. The cost has gone up and there is no doubt that the drugs companies do make very big profits, but they should be commended for putting back so much of their profits into research and development. That is something that the Government cannot do, but it is something that those companies do every single day.

In acknowledging the huge cost of drugs, we also have to acknowledge what companies such as Novo Nordisk do. I declare an interest in relation to Novo Nordisk, because it has worked with the all-party group on diabetes, which I chair, for a number of years. Roche Diabetes Care is another such company, and there are many more. There are so many of them that I cannot name them all, but they have all been involved, and they will all invest and research until the breakthrough comes.

We know from FreeStyle Libre what Abbott has done. I remember the former Prime Minister—it is of course based in David Cameron’s old constituency—telling me five years ago about Abbott and the work it was doing on FreeStyle Libre. Now, thanks to the decision of Ministers, FreeStyle Libre is available, as my right hon. Friend the Member for Knowsley has said. That is why, when we have that breakthrough, it is vital that such a facility and such equipment is available to all, irrespective of where they live.

We did not have access to FreeStyle Libre in Leicester, even though we have so many experts at Leicester University and De Montfort, until the decision taken by the Government. Actually, we will not get access to it until next April, so my hon. Friend the Member for Birmingham, Selly Oak (Steve McCabe) and others will have constituents who still want to get FreeStyle Libre, but cannot do so. We do not want that to happen for those who need pumps and artificial pancreases, because it is vital that they get such equipment straightaway. If they do not, it will affect their lives.

What my right hon. Friend the Member for Knowsley said about wellbeing or mental health and diabetes was interesting. That is something that people very rarely recognise, and I have only myself recognised it, having been a sufferer, in for the past two years or so. They do not actually know it because they think it is part of their condition. For type 1 diabetics, it is even worse. We can just have our pills—I take six in the morning and three at night; some people take more—but the fact is that they live with the injection of insulin for this condition for the rest of their lives.

The deputy leader of the Labour party, my hon. Friend the Member for West Bromwich East (Tom Watson)—obviously, he is not in his place today, because he has other things to do—has reversed his type 2 diabetes. Anyone who sees him in the Division Lobbies will know that he looks a completely different man from the person I knew when I voted for him to be the deputy leader, because he has adopted the Pioppi diet and changed his lifestyle. He does all the things that I do not, because I do not manage my diabetes particularly well. However, people cannot do that with type 1—it is with them forever. The right hon. Member for Hemel Hempstead (Sir Mike Penning), who obviously has gone to Committee Room 14, mentioned that there is that fundamental difference. Sometimes when we talk about the thousands —or the millions, now—who have type 2 diabetes as opposed to type 1, we talk about people changing their lifestyle, their diet or their wellbeing, but that does not apply to the type 1s.

Assessment and Treatment Units: Vulnerable People

Liz McInnes Excerpts

Tuesday 6th November 2018 Commons Chamber

[Caroline Dinenage]

I thank my hon. Friend for that question, which gets to the root of the issue. It is not enough to ask people what they think and set up commissions and reviews; we have to listen to what people are saying but then we have to act. The thematic review the CQC is starting straight away is reporting back in two phases. That is important as it means that, as soon as the first phase comes back, we can start action straight away.

[Liz McInnes (Heywood and Middleton) (Lab)]

Can the Minister say what resources will be made available to local councils to enable people with learning disabilities and autism to move out of the units as a matter of urgency and into community placements?

[Caroline Dinenage]

NHS England transferred over £50 million up front to CCGs that are closing beds over the course of the financial year, so that they can invest in community alternatives. In addition, between 2015 and March 2019 it will invest another £50 million in transforming funding to put in place things such as the much needed crisis prevention teams, which are focused on supporting children in the community.

Hospice Funding and the NHS Pay Award

Liz McInnes Excerpts

Wednesday 31st October 2018 Westminster Hall

[Liz McInnes (Heywood and Middleton) (Lab)]

I beg to move,

That this House has considered hospice funding and the NHS pay award.

It is a pleasure to serve under your chairmanship, Mr Davies. I welcome everyone to the debate. It is half-past nine in the morning, and the good number of people attending highlights the importance of, and interest in, this subject. I am pleased to have been able to secure the debate.

When the Government announced that they would give our hardworking national health service staff a pay award that freed them from the constraints of the 1% public sector pay cap and was definitely higher than the pay freeze that many NHS staff have endured since 2010, I—like many MPs, I am sure—was very pleased for those staff, especially as I used to be one of them. When I worked as a clinical scientist in the NHS, I saw my take-home pay reduce year on year from 2010 to 2014, at which time I was elected to this place.

My message is certainly not that our hard-working NHS staff do not deserve this pay award; they deserve it, and more. The question is how the pay award will be funded by the charitable sector that is commissioned to provide NHS services. In April this year, I was contacted by the chief executive of my local hospice, Springhill, which provides end of life care to my constituents in Heywood and Middleton and to the wider borough of Rochdale. I am pleased to see my hon. Friend the Member for Rochdale (Tony Lloyd) in his place; while the hospice serves the whole borough, it is in his constituency, and I am sure he will have a useful contribution to make.

The chief executive of my local hospice raised three issues with me. The first was whether the Government have considered the impact of the increases in NHS pay on the hospice sector.

[Chris Green (Bolton West) (Con)]

This is an incredibly important topic for debate, not least for Bolton Hospice, which is just outside my constituency. Does the hon. Lady agree that the pay increase causes problems not only in staff retention, but in the recruitment of new staff? We need very dedicated and skilled nurses to work in our hospices.

[Liz McInnes]

Of course I agree with the hon. Gentleman, and I will go on to talk about recruitment and retention and the problems that this issue is causing to our hospices in Bolton, in Rochdale and, I am sure, up and down the country.

The chief executive raised three issues with me; I have outlined the first, but the second was whether the effect of the pay increase on voluntary sector hospices had been calculated. The third point was whether voluntary hospices would be able to access additional Government funding to be able to afford the NHS pay increase.

[Thelma Walker (Colne Valley) (Lab)]

Does my hon. Friend share my concern that these changes will only reinforce existing recruitment and retention pressures, and agree that the Government should ensure that they take steps to address staffing issues as well as pay changes?

[Liz McInnes]

There is a theme developing on recruitment and retention. We have shortages of particular groups of staff, and a two-tier pay arrangement for different NHS providers will only exacerbate those problems.

[Melanie Onn (Great Grimsby) (Lab)]

The points that colleagues have made seem to reflect the situation around the country. The hospice in my constituency, St Andrew’s, provides end of life and respite care for adults and children. The chief executive spoke to me when I went to the opening of its new garden, and expressed exactly the same concerns and fears about future staffing arrangements. The hospice has an incredibly dedicated team of staff, but fears losing them if they can get better pay elsewhere in the NHS.

[Liz McInnes]

My hon. Friend highlights the problems that hospices up and down the country are experiencing with the recruitment and retention of staff. I will explore those issues further in my speech.

[John Howell (Henley) (Con)]

Maybe the hon. Lady will come on to this in her speech, but has she looked at the different effects that the pay rise has on hospices for adults and hospices for children, and whether there is effectively a two-tier system in the way that those services are delivered?

[Liz McInnes]

That is an interesting question. In terms of hospice funding, children’s palliative care tends to receive less NHS funding, so I would imagine the problem is exacerbated for children’s hospices, because they will have to find proportionally more money to fund the pay award than adult hospices. It is an important point, and I hope the Minister will be able to shed some light on those issues when she sums up at the end.

[Tony Lloyd (Rochdale) (Lab)]

As my hon. Friend says, we share a hospice. She said—I am not picking up on the phrase she used—that the hospice will need to raise more money. Raising money is the crux of this issue, because something like 70% of the funding for Springhill Hospice comes from charitable giving and less than 30% from public funds. Raising more money, unless the Government are prepared to put their hand into the taxpayer’s pocket, is nearly impossible. If the hospice cannot raise more money, the truth is that it will be a smaller service, and both those who are dying and their families will be unable to obtain this amazingly well-appreciated service.

[Liz McInnes]

My hon. Friend is absolutely right. This is the crux of the debate: a pay award has been decided on and agreed with the trade unions, but the Government do not seem able or willing to fund that pay award for non-NHS organisations.

[Ellie Reeves (Lewisham West and Penge) (Lab)]

I am lucky enough to have the renowned St Christopher’s Hospice in my constituency, and Demelza, which provides children’s hospice care, is also nearby and serves my community. Those hospices will have to find £200,000 a year each to fund the pay rise. Does my hon. Friend agree that the pay rise must be matched by central Government funds in order for our hospices to carry on providing their excellent services to our communities?

[Liz McInnes]

St Christopher’s Hospice got in touch with me about this debate, so I have had some communication with it about the problems it is experiencing. Sadly, those problems are replicated in hospices up and down the country, and it is important that we find a pot of funding to finance the NHS pay award.

[Bill Esterson (Sefton Central) (Lab)]

Queenscourt Hospice serves my constituents and their families and carers. Like all hospices, it plays an incredibly important part in delivering NHS services, but it can only play a full part if it is fully funded. It faces a £250,000 increase in its wage bill in order to do just that. Is it not the point of this debate, which the Government have so far refused to engage with, that unless that money comes from central Government, those hospices, including Queenscourt, will not be able to continue to provide the vital services they provide now?

[Liz McInnes]

My hon. Friend makes an important point: hospices seem to be facing a choice of asking the community to give them extra money, or reducing the service they provide.

[Sir Desmond Swayne (New Forest West) (Con)]

Am I incorrect in my understanding that hospices adopting the full Agenda for Change will receive Government assistance? Perhaps the Minister will clarify that. The difficulty for hospices in adopting it is that they lose control of their salary budget. The difficulty is in getting that balance right, and I hope that the Government will be able to help.

[Liz McInnes]

The right hon. Gentleman is absolutely right. I will explore the Agenda for Change later, because adopting it presents huge difficulties for non-NHS organisations.

The three points from the chief executive of Springhill Hospice were tabled as parliamentary questions. Sadly they received identical answers that included:

“We are considering carefully the impact of any agreement on non-NHS organisations such as hospices that may be affected by the proposed pay deal; however no decisions have been made. Staff in hospices do a fantastic job in delivering world-class care and the Department remains fully committed to improving palliative and end of life care.”

In July, I wrote to the Secretary of State for Health and Social Care, asking for an update on the issue. The response stated that he “understood concerns” that

“hospices may find recruitment and retention challenging if some of their staff choose to leave in favour of organisations that employ staff on the Agenda for Change contract”.

In summary, the Government will finance the pay award for non-statutory, non-NHS organisations only for organisations employing staff on the Agenda for Change contract, which is the nationally agreed set of terms and conditions for most NHS staff. The rationale for that was that:

“Additional funding relies on organisations employing staff on the Agenda for Change contract, because it is the Agenda for Change pay and non-pay reforms that together will help deliver the productivity improvements the Chancellor asked for in return for additional pay investment”.

What are the reforms that can only be made under Agenda for Change? On examination, it seems to be an emphasis on training and apprenticeships and a programme of appraisal and personal development. There is also a slightly vague statement on the improvement of the health and wellbeing of NHS staff, to improve levels of attendance, with a reference to

“positive management of sickness absence”,

whatever that may mean.

The response from Springhill Hospice was grim. The chief executive wrote to me:

“Very few charitable hospices employ their staff on Agenda for Change contracts, and as a result, Springhill Hospice, along with many other hospices, will miss out on the funding being set aside by the Government. This will place us at a considerable disadvantage in recruiting and retaining essential staff to deliver the services that we offer to people with life-limiting illness in this community, and will leave us with a significant additional cost.

Recruiting and retaining skilled staff is a critical challenge for us, and in order to remain competitive, we will have little choice but to increase pay for clinical staff. Over the course of the three-year NHS pay deal, we estimate that this will bring an additional cost to the hospice of in excess of £250,000. Without support from the Government, this extra cost can only be met by asking our communities to give more, or by reducing the services that we provide.

We are already asking our community for in excess of £2 million contribution each and every year, and in an area of high deprivation, I can only envisage that any additional ‘ask’ will not be able to be met by our community, so sadly we may have to look at service reduction, which in turn will place additional burden on an already stretched NHS.

NHS staff will start to see the pay increase reflected in their pay packets from this month onwards. Without government support, Springhill Hospice will see a significant additional cost fall to the charity as a consequence.”

[Dr David Drew (Stroud) (Lab/Co-op)]

My hon. Friend is being very generous with her time. Does she agree that one problem, shared by Longfield Hospice in my constituency, is the opaqueness about the money that the NHS puts into the hospice movement? It does not put much in, and it is unclear why it comes and what it should be used for.

[Liz McInnes]

I certainly agree with my hon. Friend. While preparing for the debate, I tried and failed to get clarity on how NHS funding is allocated to hospice services. I hope that the Minister will provide some clarity on that.

The chief executive of Springhill said that the Department’s response was unhelpful, and that if the hospice were to utilise Agenda for Change terms and conditions in full, it would have to go through a massive consultation with staff and would need to change everyone’s terms and conditions of employment, assuming that there was buy-in through the consultation process. In addition, it would have to employ a very bureaucratic appraisal system—it already has robust appraisal processes in place—while adopting the Agenda for Change process would necessitate a massive investment in staff training, which would again add to the cost burden.

[Melanie Onn]

The chief executive of a social enterprise that provides social care in my constituency under the Care Plus Group TUPE-ed out several staff in order to continue to provide those services. Those staff are on Agenda for Change contracts, but they will not receive the Government uplift in pay, because as the chief executive says:

“The plan is to fund only NHS trusts and foundation trusts, to pay the uplift directly to them.”

The issue goes much wider in the healthcare sector than hospices. It will affect providers of health and social care in our communities, as well as those staff contracted out from the NHS, including porters, orderlies and caterers. I know that Unison is campaigning for those staff who have been privatised within the NHS. Does my hon. Friend think that all those staff are integral to providing healthcare for all of us, and should be included in the uplift?

[Liz McInnes]

My hon. Friend is absolutely right: this goes wider than hospices. It applies to non-statutory, non-NHS organisations that provide essential services to the NHS. Staff being TUPE-ed out is difficult, and I hope the Minister will consider it in her remarks. The pay award has to be funded from somewhere, and it is extremely unfair if NHS staff are TUPE-ed out to a non-NHS provider and lose out on the pay award as a result.

The chief executive of Springhill talked to me about the role of the clinical commissioning group, saying she hoped that

“the CCG will recognise this significant additional burden when agreeing our annual contract”,

and that it will

“not be expecting us to reduce our costs this next financial year.”

I know, and the interventions I have taken show, that the problems experienced by Springhill Hospice are replicated up and down the country, and I am grateful to hon. Members for sharing their experiences from their own communities.

Hospice UK estimates that, over the course of the three-year NHS pay deal, charitable hospices will face an additional bill of between £60 million and £100 million. It says that the Department of Health and Social Care’s criteria for non-NHS providers to access the additional funding set aside to support the implementation of the NHS pay award exclude the majority of the country’s charitable hospices from that essential support. The Department itself has acknowledged that most charitable hospices do not employ staff on NHS terms and conditions, as the staff working in hospices are not NHS employees. However, as hospices recruit their staff from the same local pool as the NHS, they have little option but to mirror the pay award made to NHS staff in order to recruit and retain the staff they need. As a consequence, hospices face a difficult choice: they must either ask their local communities to donate more to fund the pay award or look at options to reduce services proportionately to cover the cost. Neither is a palatable option for the hospices or for the communities that they serve.

The Department maintains that hospices should look to their clinical commissioning groups for additional support, yet research by Hospice UK shows that in recent years two thirds of hospices in England have seen their NHS funding cut or frozen—in many instances, for several consecutive years. In the absence of tariffs reflecting the costs of care, the NHS currently makes a contribution towards the costs of providing hospice care. It is on average just 30% of the costs of providing adult hospice care services and just 15% for children’s hospice services, although that funding varies widely around the country.

Hospice UK has suggested a solution to the problem, which is to follow the precedent set in 2004, when the employer contribution to the NHS pension scheme was doubled from 7% to 14%. At the time, the Labour Government acknowledged that charitable hospices would face an additional cost that they could not recover from elsewhere, so they set aside a national pot of funding to be distributed centrally to mitigate the impact. That worked very well and is a model that would work well in relation to the NHS pay increase by recognising the unintended consequences for charitable hospices while maintaining the integrity of the deal negotiated and agreed with the NHS trade unions.

Additionally, I have been contacted by my hon. Friend the Member for Plymouth, Sutton and Devonport (Luke Pollard), who tells me that he has secured an agreement for 3,000 healthcare workers in his constituency who work for a social enterprise to receive Government funding to finance the pay rise, so clearly a precedent has already been set. I would be interested to hear the Minister’s comments on that.

The pay deal that has been agreed is a pay deal for NHS staff and is welcomed. Since this debate was announced, I have also been contacted by the Chartered Society of Physiotherapy.

[Melanie Onn]

It has taken me a little while to catch up, but did my hon. Friend just say that a colleague has managed to secure an independent agreement that the pay deal will be honoured for some workers in a hospice setting? If so, how is it possible that one person can get such an agreement from Government but everyone in this Chamber who is raising issues cannot?

[Liz McInnes]

I thank my hon. Friend: that is exactly the point that I wanted to make. A deal has been done in Plymouth for a social enterprise provider that is not a hospice but a provider of mental health services. Obviously, smaller deals are being done. My hon. Friend the Member for Plymouth, Sutton and Devonport is not able to be with us today, but I was very interested in the evidence that he sent me. The Department of Health and Social Care needs to look at the smaller deals that have been done and ask itself what on earth is going on.

To return to the issue of physiotherapists, they are clinical staff whose role in hospice care is sometimes forgotten. The CSP told me that its members overwhelmingly backed the pay changes when consulted earlier this year. It pointed out to me the importance of the physiotherapist’s role in enabling people with a terminal illness to stay active as long as possible—a really important role—and went on to say that with the current shortage of physiotherapists, it is relatively easy for staff to change roles if they wish to do so, and that employers who cannot broadly match NHS pay rates will find it increasingly difficult to recruit staff.

There is clearly real concern that the NHS pay award will have an unforeseen but damaging impact on charitable hospices and other organisations that are already at a significant disadvantage compared with other non-NHS providers in not receiving reimbursement for the costs of the care that they provide to NHS patients. A sustainable hospice movement is an essential component of delivering the improvements in end of life care that the Government have rightly sought. The Government must look again at the conditions imposed on non-NHS providers and consider how funding may be made available to prevent a diminution of the end of life care service.

[Sir Desmond Swayne]

May I therefore, through the offices of the hon. Lady, put in my bid to the Minister for just such a local agreement for Naomi House and the Oakhaven Hospice in Hampshire?

[Liz McInnes]

I thank the right hon. Gentleman for that intervention, but we want a national agreement rather than a piecemeal set of local agreements. I hope that that will be addressed today.

I shall conclude by quoting NHS Employers:

“Patients are at the heart of everything the NHS does.”

How does that square with the Department of Health and Social Care’s refusal to finance the pay award for hospices, and how is that refusal putting terminally ill patients, at the time when they are most in need of care, at the heart of our NHS?

--- Later in debate ---

[Caroline Dinenage]

Sadly, I cannot comment on individual cases. I am not aware of any individual deals being done with the Government, but of course, this could be a local arrangement. For 2019-20 and the remaining two years of the deal, funding will follow the usual route. It goes through CCGs, so I imagine that the instance that the hon. Lady mentioned is due to that, but I am keen to hear more.

[Liz McInnes]

Maybe the Minister would like to take the issue up with my hon. Friend the Member for Plymouth, Sutton and Devonport (Luke Pollard), who has informed me of an agreement that has been made in Plymouth regarding a social enterprise, with the support of the trade unions. That is an interesting example that we potentially should extend to the whole country.

[Caroline Dinenage]

I can only applaud the hon. Lady’s tenacity in continuing to make that case, and we will certainly look into the matter. As I say, I have no knowledge of that individual case, but I share the desire of my right hon. Friend the Member for New Forest West to ensure that hospices such as Naomi House and Jacksplace have the funding that is necessary to do their incredible work. My mum got the whole family involved in all manner of quite humiliating fundraising exercises back in the 1990s to build Naomi House children’s hospice, and I was delighted that my role as Minister took me back to Naomi House and, indeed, Jacksplace, which caters for young adults. I went there over the summer, and Mark Smith, its director of care, was kind enough to give me a tour of the facilities. We discussed some of the issues that have been raised today, as well as others, and my team has been looking carefully at what more we can do about some of those issues.

Since I was appointed Minister for Care in January, I have met with a range of charitable stakeholders from the end of life and palliative care sector, as well as the national clinical director for end of life care, Professor Bee Wee, who is quite incredible. Having met both system representatives and representatives of charities, I have been impressed by not only their incredible passion and commitment to see Government aims for end of life care delivered, but the shared consensus on what changes are needed to drive through the improvements that we would all like to see. Hospices are an incredibly important feature of end of life care provision, but we have to see them in the wider context of our ambitions in that area. In 2016, the Government published our end of life care choice commitment, which encompasses the whole system approach to transforming end of life care, placing patients and their choices, needs and preferences at the heart of planning. The NHS gets it right when choice is meaningful, personalised, and matched by healthcare services that can respond in an effective way that places patients, families and carers at the centre of the decision-making process. I know that parts of the country are delivering excellent palliative and end of life care for both adults and children.

--- Later in debate ---

[Liz McInnes]

I thank everyone who has contributed, and I thank the Minister for her response, but I am disappointed that there was no commitment to provide funding for hospices to afford this pay award. The case has clearly been made on the disastrous effects of not funding the pay award. I had hoped that the Minister might have been able to commit to more than a report that is coming out in November.

We need to deal with the issue as a matter of urgency. I suggest the Minister looks at equivalence and whether appraisals, staff health and wellbeing and the systems that hospices already operate can be classed as equivalent to the agreement set out under Agenda for Change. That would help get over the hurdle of the productivity demands that the Chancellor has made.

Question put and agreed to.

Resolved,

That this House has considered hospice funding and the NHS pay award.

Oral Answers to Questions

Liz McInnes Excerpts

Tuesday 23rd October 2018 Commons Chamber

[The Minister for Health (Stephen Barclay)]

My hon. Friend is right to highlight this. The Secretary of State was at the trust last week, and I visited earlier in the year. There is a specific range of actions, including partnership with Sherwood Forest Hospitals NHS Foundation Trust; advanced clinical practitioner courses, which started in June; £1.8 million of capital to support improvements to patient flow; and a frailty pilot at Lincoln. There is an intensive programme of work with this trust, because we recognise my hon. Friend’s concerns.

[Liz McInnes (Heywood and Middleton) (Lab)]

T8. North West Ambulance Service NHS Trust spent £30 million in the past three years on private ambulances. Does the Minister agree that that money would have been far better spent on the recruitment and retention of NHS ambulance staff?

[Stephen Barclay]

As the hon. Lady will know, since 2010, the number of paramedics has increased by more than 30% and the pay band has been increased from band 5 to band 6. She will also know from the excellent work of Lord Carter that there was significant variation between ambulance services and a significant opportunity to make savings that can be reinvested in ambulances by addressing differences in sickness rates, “hear and treat” and “see and treat” rates and other variables. We have also committed additional funding for new ambulances, including in the north-west, which will be in place by this winter.