Oral Answers to Questions

Liz McInnes Excerpts

Tuesday 22nd March 2016 Commons Chamber

[Ben Gummer]

My hon. Friend is right, and the returns from the friends and family tests across the country show increasing patient satisfaction with the NHS.

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

22. How does the Minister think that staff morale is affected when people hear the Government’s constant refrain of “implementing seven-day working”, particularly among pathology staff and others who have for decades provided a 24/7 service?

[Ben Gummer]

Despite the best efforts of Labour Members, staff morale has gone up over the past few years. The situation is not helped when the nature of the junior doctors contract is misrepresented, as it continually is by Labour Members. If they were to give a fair account of the contract to their constituents, I am sure we would see further improvements in staff morale in years to come.

End of Life Care

Liz McInnes Excerpts

Wednesday 2nd March 2016 Commons Chamber

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

It is a pleasure to take part in this debate and to follow the hon. Member for Henley (John Howell). When the House debated assisted dying last year, the point was made very strongly that good quality palliative care should be available to all; that at the end of life people deserve a good death, with access to palliative care and support; and that, rather than being subject to a postcode lottery, consistent, high quality end-of-life care should be available to all. Yet the quality of care and support that people and their families experience still varies significantly depending on where they live. Sadly, many people who would benefit from palliative care do not receive any at all. It is estimated that over 100,000 people a year in the UK—almost one in five of all deaths—would benefit from palliative care but do not receive it.

I want to talk about hospice care, as many Members have done. Hospice care forms a vital part of palliative care, supporting people through illness, the end of life, bereavement and into remembrance. It provides for the medical, emotional, social, practical, psychological and spiritual needs of individuals, as well as the needs of their family and carers. Although many might think of hospice care as in-patient care, in fact 90% of it is provided through day care and at-home services, enabling patients to stay in their own homes—many Members have mentioned how important that is—and giving much-needed respite for carers.

Hospice care relies heavily on the support of local communities; it is estimated that 125,000 volunteers donate their time and expertise to UK hospices. On average, Government funding covers only a third of the expenditure of hospices. My constituency is served by an excellent local hospice, Springhill, which works closely with the community and is well known and well respected. The cost of running the hospice exceeds £3 million a year, and 70% of the running costs comes from fundraising in the local community. Year on year, Springhill hospice has to attract 70% of its income through fundraising events, charity shops, lottery, legacies and donations. Like many local people, I am doing my bit to help this year by running the Manchester 10k in aid of the hospice.

Springhill, like most hospices, provides a wide range of services in addition to in-patient and out-patient services, all of which improve the end-of-life experience for both patients and their carers and families. As part of its education programme, the hospice has developed a palliative care education passport for staff in care and nursing homes, and it has just celebrated the first group of 34 staff who have completed the passport. To complete the passport, health and care staff must demonstrate kindness, as well as the skills, confidence and the application of knowledge in the care of those with palliative care needs; transferable skills that, once part of everyday practice, will enhance the care of all service users. That is just one example of a hospice working in partnership with other healthcare providers to deliver better care to more people and to help reduce pressure on the NHS. Such partnerships are vital to deliver the improved end- of-life care we all want to see.

Although we would all agree that our hospices are doing great work, I would like to take this opportunity to talk about statutory funding and commissioning arrangements for our local hospices. NHS and local authority funding for hospice care varies considerably between localities, and a variety of commissioning and contracting practices exists. More than two thirds of hospices had their funding from local CCGs frozen or cut in 2014-15, and more than eight in 10 hospices do not think they are funded fairly and sustainably by the NHS and local authorities. If the Government invested more in hospice care, they could reduce the number of people in hospital at the end of their life who had no clinical need, and no wish, to be there. That would help to relieve the pressure on the NHS and the strain on A&E and acute wards, and it would improve the end-of -life experience for the patient and their family.

I cannot talk about end-of -life care without paying tribute to the work of Marie Curie and Macmillan nurses, without whom patients are more likely to use A&E services and to spend longer in hospital. Although a small number of people would prefer to die in hospital, that is the least preferred option for the majority. As the Chair of the Select Committee mentioned, the Nuffield Trust has shown that using the Marie Curie nursing service results in a £500 reduction in total care costs per person. That cost saving can be replicated by other palliative care providers, meaning that investing in community-based palliative care can save the NHS money and reduce pressure on hospitals.

Changing demographics mean that the situation around end of life care will get worse. By 2040, an extra 100,000 people will die each year. The number of people with long-term conditions will have grown from 1.9 million in 2008 to 2.9 million in 2018. Unless the Government take action now to improve access to palliative care, the situation can only get worse, not better.

Junior Doctors Contracts

Liz McInnes Excerpts

Thursday 11th February 2016 Commons Chamber

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

Can the Secretary of State clarify something in his statement for me? He says that “those working one in four Saturdays or more will receive a pay premium of 30%. That is higher on average than that available to nurses, midwives, paramedics and most other clinical staff”. The staff he cites will be employed on bands 4 to 9 under “Agenda for Change” terms and conditions. If they work Saturdays, they receive plain time plus 30% for working then, so can the Secretary of State tell me how he has calculated an average? I do not understand his mathematics.

[Mr Hunt]

I am happy to do that. The contract that we are going to implement gives junior doctors who work more than one in four Saturdays—so one in three Saturdays —a higher premium of 50%, so when taken on average, it is a higher premium for working on a Saturday.

Oral Answers to Questions

Liz McInnes Excerpts

Tuesday 9th February 2016 Commons Chamber

[Mr Jeremy Hunt]

The Government have made a huge and significant assessment of the cost of overseas people using the NHS, and we think that there are £500 million of recoverable costs that we do not currently recover. When it comes to the EU, the biggest problem that we have is that we are able to reclaim the costs of people temporarily visiting the UK, but we do not do so as much as we should because the systems in hospitals are not as efficient as they need to be. We are sorting that out.

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

T5. Despite the prevalence of pancakes in Parliament today, I am pleased to be asking a food-related question. A recent opinion poll performed by Diabetes UK showed that three quarters of British adults think food and drink manufacturers should reduce the amount of saturated fat, salt and sugar in their products. Does the Minister support introducing mandatory targets for industry to reformulate food and drink products to help people to eat more healthily, and will that form part of the Government’s childhood obesity strategy?

[Jane Ellison]

We made considerable progress in this area in the last Parliament, under the responsibility deal, but we have always said that there is more to do and the challenge to industry remains. We will say more about that when we publish the childhood obesity strategy in due course.

Junior Doctors’ Contract Negotiations

Liz McInnes Excerpts

Monday 8th February 2016 Commons Chamber

[Ben Gummer]

I cannot possibly add to the comment made by my hon. Friend, and I just hope the shadow Secretary of State takes note.

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

Strike action is always a last resort, and I can say categorically, as an ex-NHS worker, that no NHS worker wants to go on strike. We have here a complete failure of negotiation. The Secretary of State’s door may be open, but the inflammatory and insulting comments he made in the media this weekend do not exactly invite people to cross that threshold and talk to him. Given that he has manifestly failed as a negotiator, is it not about time he stood aside and let a trained negotiator deal with the BMA and come to an agreement, before it is too late?

[Ben Gummer]

I am not sure the hon. Lady has been listening to the statements made in this House and elsewhere.

[Liz McInnes]

I have been listening—

[Ben Gummer]

I am not sure the hon. Lady has been listening because otherwise she would have heard that the negotiations have already been taken on by leading negotiators from NHS Employers and, latterly, by Sir David Dalton, one of the leading chief executives in the country. Significant progress has been made, contrary to what she has just suggested. Negotiations have worked. We have managed to nail down—[Interruption.] The hon. Lady shakes her head, but the fact is that Sir David Dalton has managed to secure agreement on every single point of contention other than pay rates for plain time, unsocial hours and Saturdays. This dispute on Saturday and the kind of results we are going to see across the country on Wednesday will, in essence, be about pay rates on a Saturday, with the BMA wanting preferential rates over nurses, porters, cleaners and other workers in the NHS.

NHS Trusts: Finances

Liz McInnes Excerpts

Monday 1st February 2016 Commons Chamber

[Ben Gummer]

The hon. Gentleman is an experienced Member of Parliament and, as he will know, there was a time when reorganisations and changes in the structure of the NHS, and the way that hospitals were disposed, was very much decided in Whitehall. That changed as a result of the Health and Social Care Act 2012, and such changes are now led by clinicians. The changes to which he alludes—which we will discuss tomorrow in Westminster Hall—are led by local clinicians, and ultimately the Secretary of State must defer to their opinion. An independent reconfiguration panel judges those changes, and so far the Secretary of State has always concluded that the panel and local clinicians have been correct. That is the right thing to do. In this case I hope and expect that we will do the same, but I will look carefully at the hon. Gentleman’s concerns, and ensure that I take them on board and relay them back to the CCG.

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

At Pennine Acute Hospitals NHS Trust, which serves my constituency, A& E attendances are at a record high, and this weekend the local paper carried the headline “Stay away from A&E unless it’s life or death.” The trust is predicting a deficit of £29 million by the end of the financial year, and although staff work hard in difficult circumstances, does the Minister truly believe that that is an example of a successfully run NHS?

[Ben Gummer]

There are many examples of success in the NHS, and hospitals, CCGs and community health organisations are delivering exceptional care within existing budgets. We must ensure that we spread that practice and approach to care across the NHS. Some parts of the NHS are not doing that, but with our ability to level up and “universalise the best”, as Bevan coined it, we will ensure that everyone gets the level of care that those in the best areas of the NHS already receive.

NHS Bursary

Liz McInnes Excerpts

Monday 11th January 2016 Westminster Hall

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

I thank the hon. Gentleman for his comments about Martin Lewis. May I just ask whether Martin Lewis advised the Government when they proposed the plans for the NHS bursary scheme?

[Paul Scully]

I am a new Back-Bench MP so I was not around then, but I know that Martin Lewis was on a Committee at some point afterwards to determine relationships, but I will take advice on that.

--- Later in debate ---

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

It is a pleasure to serve under your chairmanship, Mr Pritchard. I am grateful to be able to make a contribution to this important debate. I congratulate the 154,000 people who have signed the petition and brought this issue to the House for discussion.

I declare an interest: I am a Unite member and an ex-Unite workplace rep in the NHS. I used to work as a healthcare scientist in the NHS. I did not receive a bursary for my training; I was employed in a supernumerary position. I was privileged to be able to do that. In my day, it was recognised that I was making a contribution to the NHS while being trained. The Government should perhaps go back a few decades and have a look at how NHS staff were treated in the 1980s, when I trained.

Members have quoted various figures about the proposed changes. From the reading I have done, I believe that under the proposed changes, students could be burdened with up to a staggering £65,000 of debt by the time they finish their training. Under the current system, the bursary allows those without financial means to study as nurses, midwives and, importantly, allied health professionals—I am grateful that a lot of Members have mentioned AHPs, because it is important that we do not forget them and their contribution to our NHS. Many trainees already struggle to make ends meet, even under the bursary system. As Members have said, the system is not perfect, and we need to look at it, but let us do it properly and put in place a system that actually works, rather than one that appears not to have been tested or consulted upon.

[Mr Nigel Evans in the Chair]

Many Members referred to the difficulty of getting part-time jobs. It was a pleasure to listen to the hon. Member for Lewes (Maria Caulfield) talk about her own experience. Given the number of hours that NHS trainees—nurses, midwives or AHPs—are expected to work during clinical placements or at university, plus all the extra hours on assignments, exams, practicals and study, there are not enough hours in the day for them to take on a part-time job.

I was interested to hear the hon. Member for Sutton and Cheam (Paul Scully) refer to Martin Lewis’s MoneySavingExpert.com website. I had a look at it during the debate to see the advice that he gives about NHS bursaries. I could not find anything particularly relevant, but I noticed that, to help students financially, he advises them to get a part-time job. That is obviously not suitable in this situation. The hon. Member for Lewes highlighted the relatively low pay that nurses on band 5 or 6 can expect to earn. Under a loan system, those people, once qualified, will be paying back that debt for their whole career. I urge the Government to consider those points, which have been well made.

[Mr Andrew Smith (Oxford East) (Lab)]

My hon. Friend is making an excellent speech. Does she agree that the pressures will be all the more acute in high-cost housing areas such as Oxford, where nurses are already struggling, which will be a further disincentive to recruitment and retention in services that are already under enormous pressure?

[Liz McInnes]

I thank my right hon. Friend for his important intervention. Housing costs must be borne in mind in any discussions about changes to NHS bursaries. The days when cheap accommodation was available to NHS trainees are long gone. I can remember staying in a tower block in Greenwich at a reasonable rate during my training, but those tower blocks were sold years ago and are now privately owned.

Replacing bursaries with loans will reduce the diversity of those able to access a career in healthcare. I noted with interest that the hon. Member for Sutton and Cheam claimed when challenged that that would not be the case, but was then unable to quote any equality impact assessments. I would be interested to hear from the Minister what assessments have actually been performed. The NHS bursary is not a cost but an investment in the health and wellbeing of our society. To lose the bursary would affect not only prospective students but each and every citizen of this country, by which I mean England, because the proposals apply to England only.

In the Budget debate of July last year, I spoke against the change from maintenance grants to loans for young people hoping to go to university. The withdrawal of NHS bursaries, as announced in the comprehensive spending review, directly mirrors that change. As a result of the Budget proposals, our students will be saddled with even more debt. I said at the time that there was a real risk that the Government were experimenting with the future of the current generation of secondary school students, but it now appears that they are also experimenting with the future of current and potential nursing and health trainees. In short, it is an experiment on the future staffing of our NHS that has the potential to go badly wrong.

I put out a simple statement on Twitter regarding the views of the Royal College of Midwives, which opposes the proposals to remove NHS bursaries, and received this response:

“My daughter a single parent budgeted carefully b4 becoming a student nurse, may not be able to complete studies.”

That is an appalling situation into which the Government have put that student nurse. Again, that gives the lie to their oft-repeated claim to be the party of working people. Simply repeating the same line over and over again does not make it true, although that does seem to be this Government’s modus operandi on so many issues.

As with the Government’s conversion of maintenance grants to student loans, I would be interested to read an equality impact assessment, should such a thing exist, of the removal of NHS bursaries. The Government’s claim that cutting the bursary will encourage more prospective students into nursing is ludicrous, and even some Government MPs are saying so publicly. I was pleased to hear the hon. Member for Lewes on Radio 5 live yesterday stating that she would have not been able to train as a nurse without an NHS bursary. Today she hinted at alternatives, including apprenticeships and maybe even a return to the days of state-enrolled and state-registered nurses, and I hope that the Minister will be able to elaborate on them.

The Royal College of Midwives believes that the NHS workforce deserves a better future and says, interestingly, that the Government have

“taken money away from other parts of the health system, including student education, to be able to give ‘the NHS’ more money. According to the King’s Fund, spending on health activity that falls outside NHS England’s budget will decrease by more than £3 billion in real terms by 2020/21—a reduction of more than 20%.”

The RCM then quotes the King’s Fund, which states that

“it is clear that a large amount of the additional increase in NHS England’s budget has come at the expense of other areas of health spending.”

The Royal College of Nursing is similarly opposed to the plans and refers to them as “ill thought out”. As the RCN celebrates its centenary, it calls upon the Government to listen to its knowledge and expertise, stating:

“The future of nursing must be protected. Our patients deserve nothing less.”

Unite the union also opposes the plans, highlighting the other health professions covered by the NHS bursary, including occupational therapists, physiotherapists, radiographers and speech and language therapists, to which other hon. Members have referred. Those professions are the backbone of our NHS, and we cannot allow entrants to them to train at their own expense while racking up debt. To do so would be disastrous for our NHS and for future patient care. I urge the Government to reconsider the proposals and, more importantly, to take advice from the professional bodies.

--- Later in debate ---

[Ben Gummer]

The hon. Gentleman knows that I cannot commit other Ministers to debates, but I will certainly represent his concerns to the Minister for Universities and Science, my hon. Friend the hon. Member for Orpington (Joseph Johnson). He makes a strong point. It seems that I am the only person in this Chamber not to have a close acquaintance with Martin Lewis, but I will ensure that the hon. Gentleman’s points, including the one about the Delegated Legislation Committee—I sat on such Committees for a few years and never received anything nearly as exciting as student grants—are represented to the Universities Minister, so that he can answer him directly.

I wish also to address the points raised by the hon. Member for Heywood and Middleton (Liz McInnes), who talked about equality impact assessments. We have worked up an assessment of the impact that the changes will have on recruitment into nursing—of course we have—as part of our policy generation. That will culminate in a full equality impact assessment and a business case, which will be published at the time of the consultation, not long from now. I hope that that will inform the discussions that take place, so that we can have a robust and evidence-based debate.

The hon. Lady talked about housing costs, which was reflected in an intervention by the right hon. Member for Oxford East (Mr Smith). Housing costs are a considerable pressure for many students—not only those applying for nursing courses, but those in high-cost parts of the country. That is partly why we want to increase the amount of maintenance we can provide. To return to my central point, within the current spending envelope we can do that by such a considerable amount—25%—only through a reformed system. To do it in other ways would be prohibitively expensive, and I do not believe the Opposition have proposed that.

The hon. Lady asked about NMC registration fees. At the moment, they are incurred at the point of registration when the university course has finished and are tax-deductible. They have risen in the last year, which I know has caused disquiet among nurses. I have spoken to the regulators, including the NMC, and implored them to keep their fees at a sensible level and to avoid rises whenever possible. The NMC has had to deal with a considerable increase in fitness-to-practise cases, but I hope that with internal cost savings it will be able to mitigate further rises. I have certainly asked it to do that, although it is an independent body.

The hon. Lady cited someone she had spoken to who was, if I understood her correctly, halfway through a degree. It is important to state that the change is for new students only, so those on existing courses will not be affected.

[Liz McInnes]

The Minister has said that the equality impact assessment will be published at the time of the consultation, but what assessment has been made to ascertain the effect of the proposed changes?

[Ben Gummer]

The hon. Lady probes like an expert, but she should know that there has been a detailed assessment of the impact of the changes as part of the policy development, which is still taking place. When we launch the consultation, the full details of the assessment will be made public as part of the process, so she will be able to see very soon what the changes will mean.

My hon. Friend the Member for Lewes spoke with great eloquence about her own nursing experience. Other hon. Members may not know that she has a master’s degree connected with her nursing work. She certainly knows about the full gamut of the academic discipline of nursing, and I take her views with considerable seriousness. She was right to point out that the change is part of a wider package of reform.

Several hon. Members spoke clearly and, in one case, movingly, about people who want to become nurses but cannot, either because they did not achieve the necessary grades earlier in life to go to university—that was a failing of their education rather than because of an innate inability to be a nurse or to pass the exams—or because they have caring responsibilities. We want both sorts of people to be in nursing, because they care and because of their vocational call to be nurses. At the moment, a significant number of them are working as healthcare assistants and cannot progress to being nurses. They are prevented from doing so unless they leave the workforce, go to university and then come back into the system. Even under the existing arrangements, that makes it impossible for many of them, which is profoundly wrong.

That is why it is a priority for me, as I announced a few weeks ago, to open up an apprenticeship route to enable healthcare assistants to move from a band 3 position in the NHS to an intermediate new position—nursing associate—that is part of a vocational route to full nursing registration. The exciting thing about that is that it will provide a dual training route into nursing. There is the traditional nursing undergraduate route, which will still take three years, and there will be the new route—an apprenticeship—which will open up nursing to a whole new group of applicants who are currently precluded from achieving their dream of going into nursing and who do not even count in the statistics of those refused a place.

In the round, we are doing what I hope many Opposition Members want. I share their wish to see the diversity of the workforce, which is already one of the most diverse in the country, improve still further, and to see opportunity expanded, the quality of training improved and support given to people at university. Conservative Members also want all those things.

I appreciate the sensitive way in which hon. Members on both sides of the Chamber have spoken. I also appreciate that they may disagree with how the Government want to proceed to try to improve nurse training. In the absence of alternative ideas, I believe that our proposals really are the way to expand places, improve diversity, increase opportunity, especially for those from disadvantaged backgrounds, improve quality and provide support for those at university.

[Ben Gummer]

I would be delighted to hear alternatives, and not just via the medium of the consultation. I would very much like them to be offered within the current spending envelope, but if people wish to offer alternatives outside that envelope, they must explain how much they will cost and how they will be funded. Within that spending envelope, the reforms will allow us to expand the number of places and improve quality, support and opportunity.

[Liz McInnes]

The Minister mentioned introducing apprenticeships to enable healthcare assistants to move on and train as nurses. Before I left the NHS, a similar scheme was being implemented. It was called “Modernising Scientific Careers” and applied to healthcare scientists. There was a long and arduous consultation process, which to my knowledge has still not been completed. How long does the Minister envisage it will take to implement the process for nurses and healthcare assistants?

[Ben Gummer]

We have a commitment to have 100,000 apprenticeships across the NHS in this Parliament, a significant proportion of which will be for nurses. I am approaching this at the utmost speed, and I and the Government will be judged on whether we deliver in five years’ time. I know that the hon. Lady will hold us to account. I will happily pick up on where the consultation to which she contributed has gone—I hope there is not still someone in the basement of the Department of Health working on it—and give her an answer as to what happened as a result of it.

I want to address one final result of the reforms that we are bringing in. It was raised by my hon. Friend the Member for Isle of Wight (Mr Turner) and by the hon. Member for Scunthorpe (Nic Dakin), both of whom talked about the rurality of their areas and the impact that isolation has on recruitment. I hope that, especially through the introduction of nursing associates—an apprenticeship route through to nursing—we can help address problems of recruitment and retention in specific parts of the country. I recently floated that not far from the hon. Gentleman’s constituency, in Hull, where people were receptive of the idea of a different route into nursing that complemented the university route.

This is potentially an exciting moment for nursing. We will be able to expand the number of places and improve support, diversity, opportunity and quality—all things that have been achieved in the rest of the university sector. We will do so quickly, and we will do it even better if we have a good and robust consultation on the details. I will of course write to hon. Members who feel that their points have not been answered, and I once again thank the Petitions Committee for bringing the matter to the notice of the House.

Southern Health NHS Foundation Trust

Liz McInnes Excerpts

Thursday 10th December 2015 Commons Chamber

[Mr Hunt]

My hon. Friend is absolutely right. It seems wrong to draw any crumbs of comfort from the awful things in the draft report, but we can draw some comfort from the fact that the NHS itself is commissioning hard-hitting reports that do not pull any punches—the new CQC inspection regime does exactly that. I commend all the staff at Medway hospital who have worked so hard to raise the standard of care over the last few years. I know it has not been easy for them.

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

The Secretary of State has not yet mentioned the role of the medical examiner. Does this latest tragedy not illustrate that the introduction of a national system of medical examiners, as recommended by the Shipman, Mid Staffs and Morecambe Bay public inquiries and supported by the Royal College of Pathologists, is now long overdue?

[Mr Hunt]

I agree with the hon. Lady. It was also a recommendation of the Francis report that the coalition Government committed to implementing. We will tell the House shortly what our plans are on this front.

Cities and Local Government Devolution Bill [Lords]

Liz McInnes Excerpts

Monday 7th December 2015 Commons Chamber

[James Wharton]

Devolution is a bottom-up process; it is done by consensus. I know that the hon. Gentleman will have a significant opportunity further to discuss some of the relevant provisions today, but where we see bodies that have the capacity to co-operate, we want to empower them to do so. We want to give them the levers they need to deliver such things as better public services and economic development. The first step towards that is to confer the powers that the bodies will need to achieve it. What the amendments do is to start the process of empowering our national parks authorities so that they can not only contribute on flooding and resilience, but better the offer that they can make to the public to improve the work they already do so well.

New clause 7 confers new general powers on national park authorities in England, along similar lines to those conferred on, among others, fire and rescue authorities and integrated transport authorities in chapters 2 and 3 of part 1 of the Localism Act 2011. I should make it clear to Opposition Front Benchers that those general powers are intended to enable a national park to do more and to do it better; they are not a back door to fracking or shale gas development, and will not affect the approach that we intend to take in that regard.

In England, our nine national parks include some of the country’s finest landscapes, beautiful vistas and exciting wildlife. They are part of our national identity. National parks protect those landscapes for future generations so that we can all enjoy them. They are the cornerstone of many rural businesses. The new powers for national park authorities will allow an authority to act as an individual could—with certain limitations—in relation to its functions. For example, a functionally specific power of competence will allow a national park authority to act through a company, and will allow authorities to trade in a broader way than they currently can.

National park authorities have themselves asked for that power, because they consider that it will enable them to act in a more entrepreneurial and innovative way. For example, they consider that they will be in a better position to enter into partnerships to support growth across our rural economy. Jim Bailey, the chair of National Parks England, has said:

“We are pleased to see the Government introduce this amendment. This will help National Park authorities to maximise opportunities to fulfil our statutory purposes”.

The measure will allow national park authorities to participate fully in devolution deals—an example is Northumberland national park authority's request as part of the north-east devolution deal—and to seek additional sources of funding to assist further their work in supporting rural economies.

It is important to note that a power of competence does not override existing legislation. National park authorities will therefore be bound by their statutory purposes: conserving and enhancing the natural beauty, wildlife and cultural heritage of an area, and promoting opportunities for the understanding and enjoyment of the special qualities of the area. It is also important to note that the power will not be used by national park authorities as an opportunity to start charging for entry. As all but a very small percentage of land in national parks is owned privately rather than by the national park authorities, they could have no legal basis for charging.

Let me also make it clear that the new powers will not be used to encourage or permit too much, or inappropriate, development. National parks are designated under the National Parks and Access to the Countryside Act 1949 for their natural beauty and opportunities for open-air recreation. Under the Act, they have the two statutory purposes to which I have just referred. The statutory framework of protection and consents will remain unchanged, and, in using their new powers, the park authorities will not be able to promote or permit activities that are incompatible with those statutory purposes.

The powers given to the Secretary of State, by regulation, to restrict the use of powers by national park authorities in a particular way relate solely to the new clause, and not to their existing powers. Other than those concerning the furtherance of national park purposes, which are retained, the new powers replace the existing general powers of national park authorities under the Environment Act 1995. The new powers are considered more extensive, but the old ones are being repealed to avoid overlap.

Amendment 51 is a minor and technical amendment to schedule 5. It contains consequential amendments to section 65 of the Environment Act.

We are making these changes in response to effective representations that we have received from a number of Members, and from National Parks England and national park authorities. I hope that they will be broadly supported by Members on both sides of the House.

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

Our national parks are precious national assets. Millions of people use and enjoy them every year. They are areas of protected countryside that everyone can visit, and where people live, work, and shape the landscape. We have 15 national parks: 10 in England, three in Wales and two in Scotland.

In his autumn statement, the Chancellor included devolution to national park authorities in England, allowing them to lend, invest, trade, and set up co-operatives with businesses. That is legally known as the general power of competence. However, we know what is driving this change: cuts made by this Government. Since 2010, national park authorities in England have suffered cuts of up to 40% in their Government funding. Indeed, Northumberland national park is already renting out its spare office space—vacated by staff who have lost their jobs—where an enterprise hub has been set up.

New clause 7 would amend the Environment Act 1995 to provide English national park authorities with general powers to do anything they consider appropriate in carrying out their functional purposes. The new general powers in proposed new section 65A are similar to those conferred on other authorities by chapter 1 of part 1 of the Localism Act 2011. The new clause only applies to English national park authorities.

Proposed new section 65B limits the scope of the general power of competence in several respects. It does not allow English national parks to borrow money or charge a person for anything they do other than for a commercial purpose. That immediately raises concerns. The coalition Government’s attempt to privatise our forests was met with a public outcry. That plan was rightly defeated. This Government have attempted to open up our national parks to fracking, again causing a great deal of concern among the public, who value our precious national assets and have no wish to see them opened up to commercial ventures in that manner. We need strong assurances that the character of our national parks will be protected and that such important national institutions are maintained for the benefit of the public. We need a cast-iron assurance from the Government that fracking is not going to be allowed in our national parks.

We need more details on Government funding of national parks. We need more details on what the national parks are actually planning to do with the new powers. We cannot allow the commercialisation of our national parks by the back door. The future governance and accountability of our English national parks is an absolutely massive issue, which deserves proper debate. It does not belong here, in the Cities and Local Government Devolution Bill, inserted at the eleventh hour with no time for the weighty issues raised to have a proper discussion.

[Robert Neill (Bromley and Chislehurst) (Con)]

Given that national parks are local authorities for these purposes, will the hon. Lady reflect upon the complete and deeply misleading red herring that she raises? After all, the fracking matter has nothing to do with the role of local authorities of any kind—national parks or otherwise —in relation to a general power of competence. Should she not welcome the ability of national parks to enter into joint agreements, for example with their district and county councils, which is precisely what this provision is aimed at? She is actually setting up a complete Aunt Sally in this matter.

[Liz McInnes]

Red herrings, Aunt Sallies: I am merely expressing the unsuitability of the new clause in application to this Bill. It has been brought in at the eleventh hour with the minimum of notice. It raises huge issues. I do not think the general public would agree with the hon. Gentleman that the worry about fracking in our national parks is a red herring. I certainly got a lot of correspondence about it when the Government were talking about it a few weeks ago, and I think we need a proper debate.

[James Wharton]

I do not know whether I could be clearer on this: the debate around fracking is perhaps for another day, but let me be absolutely clear that these clauses will not be a back door to fracking. They do not affect the issue of fracking with regard to national parks. I would also add very clearly that this is something that has been asked for by national parks. I would be interested if the hon. Lady could tell the House how many national park authorities she has spoken to before coming to oppose the new clause and amendment.

[Liz McInnes]

The Minister makes an important point. The Government have not given us time to respond correctly. I have not spoken to any national park authorities because the Government have not given us time to consult properly on this matter. No reference had been made to the new clause before now. Today the Bill’s Third Reading debate will take place, and the new clause has been slipped in at the eleventh hour. The Minister is being disingenuous if he seriously expects us to have been able to do a thorough consultation with all the national park authorities in England. If that is his approach, he is trying to set us up to fail. We value our national parks, and we want to ensure that we have a proper debate on their future. That is what we are asking for here.

[Mrs Anne-Marie Trevelyan (Berwick-upon-Tweed) (Con)]

As the MP for the Northumberland national park, may I say to the hon. Lady that this issue has been ongoing for many months? The powers of competence that are dealt with more widely elsewhere in the Bill have been the cause of enormous concern to the national parks as they have tried to get themselves into the arena of discussion. It is a huge credit to the Minister that he has come up to the north-east and spoken to those in North Yorkshire and to some of my colleagues at the national park in Northumberland to ascertain just how important the new clause—which is just an extension of those general powers of competence—will be. I hope that the hon. Lady will talk to the national parks, because they are absolutely passionate about having this freedom to get on and expand what they do.

[Liz McInnes]

I am sure that, like me, the hon. Lady does not agree with the cuts that have been made to the Northumberland national park authority. I am sure, too, that she would rather we had a proper debate on this matter instead of discussing a new clause that has been snuck in at the eleventh hour.

[Steve Brine (Winchester) (Con)]

I understand that the hon. Lady has not spoken to the national park authorities, but that is not necessarily a reason to oppose the proposal. I have spoken to members of the board of the South Downs national park authority—Margaret Paren, who leads it, and Councillor Barry Lipscomb, who is a Winchester City councillor—and they very much welcome it. They think that this general power of competence will allow them to be full players at the table in the devolution bids that are so important in my area. I do not know what “Aunt Sally” means, although I remember her on the television, but this is nonsense. It is opposition for opposition’s sake. The Government should get with the plan here. Just because the Opposition have not talked to the national park authorities does not mean that they should vote against the proposal. I have spoken to the national parks, and they want this.

[Liz McInnes]

I am sure the hon. Gentleman believes that the Government should get with the plan. However, we are the Opposition. I am not opposing the proposal for opposition’s sake; I am opposing it because I think we need a proper debate on it. It could have a far-reaching effect on our national parks, which are loved and valued by the general public.

[Several hon. Members rose—]

[Liz McInnes]

I will not take any more interventions. I have already given way to hon. Members.

The national park authorities are one part of the equation, and, as I have already said, we have not had time to consult them properly because this proposal was brought in at the eleventh hour. Surely any reasonable person would want—[Interruption.] Conservative Members had prior knowledge of it. I am sure that every reasonable person would agree that we need a proper debate on such an important issue. The national park authorities are not the only stakeholders involved. The public are the real stakeholders. Millions of people use and enjoy our national parks every year, and they should have their say. They would not thank us if we allowed this measure in through the back door.

Neither I nor any of my team are opposing the new clause for opposition’s sake; we are opposing it because we have serious concerns about the way in which it has been introduced. We will not agree to such a huge change in the governance and accountability of our national parks at only a few days’ notice and without a proper debate. If the Minister thinks that we are going to let this go through without a proper discussion, he is very much mistaken.

It is totally inappropriate that the new clause, which could bring about major and irreversible changes to our national parks, should be slipped into the Bill in this manner. The national park authorities are there to protect the environment for the good of the nation and its people. I call on the Secretary of State to withdraw the new clause. It does not belong in the Bill. If a discussion is needed about the future funding of our national park authorities, so be it, but let us have a proper debate. Let us give our stakeholders, the people, a chance to have their say, and let us not try to introduce damaging changes to our national parks by the back door.

[Robert Neill]

rose—

--- Later in debate ---

[Alistair Burt]

It is not about the centre not liking the decision. The Secretary of State has statutory duties that Parliament has given him. He has to exercise his power both to grant and revoke power based on those duties, not because he likes or does not like a decision. It is that statutory duty for which he is responsible that is so important. The House of Lords pressed that matter, but the House of Commons has accepted it. It is the maintenance of those duties that is so important. Liking or disliking a decision does not come into it.

Let me make further progress on the other amendments that the Government wish to push through. Amendment 35 is a further amendment to clause 18, which applies valuable safeguards to local devolution of health functions, including where certain functions and duties should continue to be held nationally. The clause was inserted in the Bill by an amendment tabled by Lord Warner in the other place and was amended in Committee in the Commons to give further definition and clarity to support its valuable principles. Clause 18 provides that regulatory functions of national bodies held in respect of health services will not be available for transfer to a combined or local authority.

Amendment 35 makes it clear that, in addition to NHS England’s responsibilities for assurance and review of clinical commissioning groups, all its supervisory and oversight functions set out in chapter A2 of part 2 of the National Health Service Act 2006 are out of scope of a transfer order. These include functions relating to CCGs’ institutional and constitutional arrangements, including their establishment.

Briefly, amendments 46, 47, 48 and 49 amend schedule 4, which makes amendments to the 2006 Act to provide a wider menu of flexible, voluntary options for local bodies, including combined authorities, to work with each other and with NHS England in respect of health functions.

One of the amendments introduced by schedule 4 includes provision under proposed new section 13ZA of the 2006 Act for new “devolved arrangements”, whereby NHS England is able to delegate its functions to a group of local commissioners exercising them together, or to make arrangements to exercise its functions jointly with that group. The group of local partners must consist of at least one clinical commissioning group and at least one combined authority or local authority, and the delegates or partners must exercise the function jointly.

Amendments 46, 47 and 48 are minor and technical amendments, which make it clear that “devolved arrangements” may relate to one or more of NHS England’s functions.

New clause 12, which was tabled by the hon. Member for Hemsworth, says:

“The Secretary of State must, within 15 months of this Act being passed, publish a review of health services devolved under the provisions of this Act.”

The review must include an assessment of how standards have been maintained, particularly of the quality and outcomes delivered by the devolved health service.

Maintaining the integrity of the NHS standards and ensuring that there is clear accountability for quality of outcomes is a key objective, as reflected by a number of vital safeguards provided for by the Bill. An order to confer health functions on a combined authority can only be made if a proposal to do so satisfies the Secretary of State that such a transfer will lead to the improvement of statutory functions.

As the House has debated a number of times, the requirements to monitor and regulate the functions that have been devolved remain exactly the same as if they had been with the NHS. It is the Secretary of State’s responsibility to ensure that the quality of services devolved is of NHS quality. For that reason, a full formal review is not necessary. There will be constant review of the quality of work done locally, and putting a formal review in the legislation is therefore not necessary. It is inconceivable that the authority delivering the functions on behalf of the NHS would not keep up a full review and the quality of regulatory work and monitoring work ensures that a full review is carried out in any case.

I hope that the new clauses will not be pressed to a vote and that I have been able to satisfy the House about the functions that need to be retained by the Secretary of State. I hope that the technical amendments will also be agreed to.

[Liz McInnes]

I want to support new clause 12, although the Minister has made his case for turning it down. I think it is important that we build a review stage into the devolution of health simply because the implications of the Bill for the English NHS and social care system are not clear. The Bill regulates for important new powers to remove functions from NHS hospitals, commissioners and other bodies and to transfer them to the local regional authority. Depending on the implementation, interpretation and limits of the powers, such transfers might fundamentally reshape the health service in the years to come. We must ensure that the national health service stays national. We do not want a postcode lottery for healthcare.

Accountability and scrutiny remain crucial for a well-run national health service, delivering the best care it can for everyone no matter where they live. The Bill’s light-touch nature and the pace with which the agenda is moving leave a number of crucial and unresolved questions, some of which I would now like to ask. Will central and regional government argue over the responsibility for meeting population needs and making difficult decisions, such as those on whether to close hospitals or prop up overspending healthcare providers? What will happen to neighbouring areas?

Deals permissible under the Bill create the possibility of NHS funding melting into wider regional authority budgets, making ring-fencing or protecting impossible. Given the importance of healthcare spending as an issue, it needs clarity and scrutiny. Devolution to combined authorities under the Bill might actually have a centralising effect for many health and social care functions, taking power away from councils that represent smaller communities and the clinical commissioning groups that represent clinicians. Although that might be desirable in some cases, it is also important to consider how the positive developments brought to health and social care by these bodies can be preserved.

Clauses 7, 16 and 17 allowed the piecemeal transfer of health care commissioning responsibilities from clinical commissioning groups and NHS England to local government. I am concerned about the impact that will have on the NHS, especially as regards local variation in service levels, further allocation of resources and the cross-border impact of decisions. The Opposition believe that there should be a statutory duty on the Secretary of State for Health to secure and provide universal health care and that core national NHS standards should remain in place.

[Mr Brady]

I want to make it very clear, and this might be helpful to the hon. Lady, that after the Minister’s assurances to me I will seek the leave of the House to withdraw new clause 9. She might, of course, wish to do other things with her new clause.

[Liz McInnes]

I thank the hon. Gentleman for that intervention.

Although I see a range of possible potential benefits arising from the devolution agenda, particularly the opportunity for greater integration of services between health and social care and bringing public health and other areas under local government control, a number of outstanding questions will need to be resolved, largely focused on resolving the tension between local and national arrangements and the extent to which the “national” in the national health service will be preserved. What we are witnessing is not devolution. The models adopted in the deal so far appear to be closer to delegation than the formal devolution outlined in the Bill.

As the Opposition understand it, there are no plans to use the order-making power created through the Bill to transfer additional health functions to local authorities. Any health-related orders will be used only to enable combined authorities to share the health duty that already sits with local authorities. I seek the Minister’s assurance that the devolution of health service will be reviewed in a year to ensure that standards and quality of services and outcomes have not declined. That is what new clause 12 outlines—it seems an eminently reasonable request given an issue as important as our nation’s health.

[Mr Brady]

I beg to ask leave to withdraw the motion.

Clause, by leave, withdrawn.

Sugary Drinks Tax

Liz McInnes Excerpts

Monday 30th November 2015 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mr McCabe. I thank my hon. Friend the Member for Warrington North (Helen Jones) for securing this debate. I strongly identify with her comments about being brought up in the north and the change we have seen in children’s diets. When I was growing up in Oldham, fizzy drinks were a rarity for our family—the pop van did not come to our house. If we were thirsty, my mother’s response was always, “There’s plenty of corporation pop,” corporation pop being the stuff that comes out of the taps. That was normal in my family, and many people of a certain age will be able to relate to that, but our children’s diets have really changed. While I am talking about my mum, it is her 85th birthday tomorrow. She is a living testament to the benefits of a strict diet and lots of corporation pop, and I want to pay tribute to her.

I thank the Select Committee on Health for its report on childhood obesity. I was briefly a member of the Health Committee and enjoyed my time on it; I wish that I could have stayed there. I am looking forward to reading the report properly, and I applaud the Committee for its brave and bold moves.

I respect the opinions of several health bodies that support a sugar tax. I am far more persuaded by the views of the British Medical Association, Diabetes UK and the British Heart Foundation than those of the Food and Drink Federation. There has been some debate as to whether health research has been influenced by such bodies. I am unaware that any money has changed hands, but I am sure that, ethically, health researchers must declare it if they have worked in partnership with charities.

The BMA totally approves of the Government imposing a tax on sugary drinks, specifically to reduce the amount of drinks that people consume. It produced a report called “Food for thought: promoting healthy diets among children and young people”, which justifies the tax, noting that

“the strongest evidence of effectiveness of taxation approaches is for sugar-sweetened beverages; that these products are typically high in calories and low in essential vitamins and minerals (often referred to as ‘empty calories’); that the intake of added sugars by many children and adults in the UK far exceeds recommended levels; and that a high intake of added sugars is a risk factor for a range of health conditions.”

That neatly sums up the argument for considering a sugary drinks tax. As the hon. Member for Totnes (Dr Wollaston) pointed out, most manufacturers will produce a low-sugar alternative to their high-sugar drinks, which shows that they are aware of the problem. Most hon. Members have had access to the same data, so I will not repeat the things that everyone else has said.

The British Heart Foundation fully recognises that we cannot reduce obesity simply through a sugar tax—a point that many Members made—and says:

“a sugar tax alone will not solve the problem of obesity. It needs to be combined with other measures”.

I support that. The measures that it suggests include

“a reduction in the amount of sugar added to the foods”

that we buy. That sugar is often hidden. As other hon. Members have suggested, we need to look at convenience foods, because they contain an awful lot of hidden sugar. Someone’s first thought when choosing a savoury dish might not be that it is laced with sugar, but they often are, so we need to be careful when buying convenience and microwaveable food. The BHF also wants to restrict

“the marketing of unhealthy food and drink products to children and young people both online and on TV.”

Tracy Parker, a BHF heart health dietician, says:

“Cutting down on sugary drinks and replacing them with sugar-free options is a simple swap”.

That is why I am supporting the e-petition. It is a simple thing that we can do. We would end up not collecting any tax at all if everyone switched to a low-sugar alternative, and I believe that that, rather than penalising poor families through their food bills, is the tax’s intention.

We have already heard the statistic that poor diets cause 70,000 premature deaths each year, but it is worth bearing that in mind when discussing our nation’s health. Reference has been made to the sugary drinks tax introduced in Mexico, which has been shown to have cut consumption. Following the introduction of the tax on sugar-sweetened drinks, purchases were reduced by 6% in 2014. We need to be aware of the evidence showing that a tax will actually reduce the purchases of sugary drinks.

Diabetes UK also supports a sugar tax for the avoidance of type 2 diabetes, while stating that it needs to be part of a larger package of interventions, including marketing restrictions on unhealthy food, restricting advertising to children, supporting clear labelling and, interestingly, investing more heavily in active travel by dedicating a budget to walking and cycling nationally. My right hon. Friend the Member for Leicester East (Keith Vaz) is no longer present, but I am unsure whether that proposal includes electric bikes. I imagine that the intention is that people put in a little more physical effort—but hey, we have to start somewhere.

Today’s e-petition was initiated by Jamie Oliver, and many people have paid tribute to his activities in raising awareness of the campaign, which has really caught people’s attention. Many Members mentioned the teaspoons-of-sugar labelling system, which has drawn particular attention and which everyone can understand. When someone picks up a bottle and reads, “This half-litre bottle of Coke contains 13 teaspoons of sugar,” they can relate more to that than to grams per millilitre. Jamie Oliver has recommended that that labelling system be taken up, and we should really consider it as a simple way of getting people to visualise what they are about to drink or give their children.

Many hon. Members mentioned tooth decay. Unfortunately, tooth decay caused by sugar is the most common reason why children aged five to nine are admitted to hospital. We really need to do something about that. If we do not encourage good dental hygiene in our children’s younger years, we are just storing up a load of problems for their teenage and adult years.

I want to wind up by saying that I recently saw a film called “That Sugar Film”, which explores the problem of hidden sugars in our food. Among other things, the film highlighted a drink that I had previously never heard of called Mountain Dew, a half-litre bottle of which contains an astounding 17 teaspoons of sugar. The film referred to a condition in America known as “Mountain Dew teeth” and showed a young man of about 20 whose teeth were completely rotten as a result of his Mountain Dew habit. Sadly, now that I am aware of the drink and its lurid green bottle, I have actually seen it for sale in my local supermarkets. We really should be imposing some kind of tax on these high-sugar drinks to hopefully make them far less desirable and affordable. We need a clear, effective, easy-to-understand labelling system, and the teaspoons-of-sugar measurement is the right way to go. As many Members have said, there is no silver bullet for reducing childhood obesity, but the sugar tax would be a start, and I heartily recommend it.