Integration White Paper

Margaret Greenwood Excerpts

Wednesday 9th February 2022 Commons Chamber

[Edward Argar]

My hon. Friend is absolutely right. He is, I think, alluding to the fact that quite considerable inputs in the form of taxpayers’ money and resources go into the system. Members sometimes fall into the trap of talking about inputs as the ultimate result, whereas my hon. Friend quite rightly talks about outcomes for patients and ensuring that money is well spent and delivers reform and improved outcomes. That is exactly what this paper is determined to achieve.

On my hon. Friend’s final two points, I will certainly consider taskforces. We have used one on tackling delayed discharge, so I know their value. I also take his point about data, and underpinning that is something that underpins all our work: co-design and doing things with patients, not to them. We must recognise that it is their data and that they should have control of it.

[Margaret Greenwood (Wirral West) (Lab)]

The Minister talks about ICBs, but he knows full well that they are able, under his Bill, to delegate functions and budgets to private providers, which represents a clear Government privatisation agenda.

The Minister talks about transferring skills and knowledge across the NHS, public health and social care, but how will that work in practice? Will the NHS be running training courses for private sector care organisations? If so, why should the NHS hand over valuable intellectual property and spend time gifting it to big business? Will he explain what that will mean for NHS staff?

[Edward Argar]

We have had these debates before. The hon. Lady knows that the pace of privatisation was fastest under the last Labour Government, when the increase in spend on the private sector was much steeper. We have always been clear in our belief in the founding principles of our NHS, which is free at the point of need, but we have also been clear, as have every other Government since the foundation of the NHS, that there continues to be a role for voluntary sector organisations and private sector providers in that context.

On the hon. Lady’s final point, it is important, as in this White Paper, that we bring out the opportunity to help increase knowledge and share skills across the NHS, local authorities and the voluntary sector.

Future of the NHS

Margaret Greenwood Excerpts

Monday 31st January 2022 Westminster Hall

[Margaret Greenwood (Wirral West) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Gray. It is a truly extraordinary achievement that we have the national health service. We are so indebted to Nye Bevan and all those people who have fought for it. I pay tribute to everyone who signed the petition, which refers to the Health and Care Bill

“locking in privatisation and dividing the English NHS into Integrated Care Systems.”

If the Bill is enacted, we can expect to see the NHS split up into 42 locally managed health systems, which will be required to balance the books each year, rather than a national health service responding to patient need. Following intense pressure from the Labour party, campaign groups and other stakeholders, the Government have conceded that anyone who

“could reasonably be regarded as undermining the independence of the NHS because of their involvement in the private healthcare sector”

will not be able to sit on integrated care boards. Such individuals will still be able to have significant influence through a complex array of sub-committees, however, including place-based partnerships and provider collaboratives. It is there in black and white in NHS guidance:

“The Health and Care Bill, if enacted, will enable ICBs to delegate functions to providers including, for example, devolving budgets to provider collaboratives.”

That exposes the Government’s real intentions of increasing the involvement of private companies in the running of the NHS.

The Bill also includes measures to revoke the national tariff and replace it with an NHS payments scheme. As private providers would be consulted on the NHS payment scheme, it would effectively give the them the opportunity to undercut NHS providers. I am concerned that as a result, we will see more and more healthcare delivered by the private sector rather than by the NHS, with money going into shareholders’ pockets rather than being spent on patient care. If that happens, NHS staff could be forced out of jobs that are currently on the agenda for changed rates of pay and the NHS payments scheme, with only private sector jobs available—potentially with far worse pay and conditions.

I am also concerned that the Bill will lead to an increased rationing of services because ICBs would have strict financial limits each year. Once that money has been spent, patients would have to wait longer or go without treatment. Some may be tempted by the adverts for private healthcare, of which we are seeing more and more, but it is worth looking at where that path leads. According to Will Russell, a provider of international health, life and income-protection insurance, the average annual cost of health insurance in the US is an eye-watering $7,470 for an individual and $21,342 for a family. Employers typically fund roughly three quarters of those bills, so they also create a massive burden on businesses. The average cost for an individual of purchasing their own health insurance is $456 per month, according to a 2020 survey by eHealth.

In this country, we can only imagine just how devastating such costs would be to individuals, businesses and the economy. We cannot afford to let such a system take hold here. We must defend the NHS as a universal comprehensive national service that is there to treat us when we need it. Time is running out. I urge MPs across the House to appreciate just how fortunate we are to have the national health service, to join the campaign against NHS privatisation, and to oppose the Health and Care Bill.

--- Later in debate ---

[The Minister for Health (Edward Argar)]

It is a pleasure to serve under your chairmanship, Mr Gray. I pay tribute to my hon. Friend the Member for Stockton South (Matt Vickers) for leading this debate on behalf of the Petitions Committee. I am pleased we were able to find time to hear from the hon. Member for Middlesbrough (Andy McDonald); I offered to take an intervention from him, which I suspect was a brave offer on my part given the intervention that might have come my way. I am pleased he got to give his speech.

I am grateful to the shadow Minister, the hon. Member for Denton and Reddish (Andrew Gwynne). I think this is the first time we have properly been opposite one another since his appointment to this role on the Opposition Front Bench. Although I did not agree with everything he said, he made a typically well-informed and well-argued speech. He is right to pay tribute to all hon. Members who have spoken today, regardless of whether one agrees with the positions advanced. This has been a passionate debate. At its heart is, perhaps, the most precious of our country’s institutions; understandably, right hon. and hon. Members and our constituents have very strong views on the subject.

Before turning to the substance of the debate, and although I may not agree with their position, I pay tribute in a broader context to the work of Unite, Unison and other trade unions. I do not always agree with the stance they adopt, but they play a hugely important role in our democracy and society. It is right to put that on the record. As always in these debates, and as the shadow Minister has done very clearly, I also put on the record our gratitude—from both sides of the Chamber equally—to all NHS staff and those working in social care, local government and other key workers across the country for what they have done across the past two years and, indeed, what they do every year, day in, day out.

As I have said before, the Health and Care Bill reflects evolution, not revolution. It supports improvements already under way in the NHS and, crucially, builds on what the NHS recommended and consulted on back in 2019.

[Margaret Greenwood]

Will the Minister give way?

[Edward Argar]

I will make a little progress before giving way; I will always give way to the hon. Lady. The Bill is backed by not only the NHS but many others working across health and social care. In a joint statement, the NHS Confederation, NHS providers and the Local Government Association state that they

“believe that the direction of travel set by the bill is the right one”,

noting that local level partnership is the only way we can address the challenges of our time.

[Margaret Greenwood]

The Minister is talking about a consultation that, as I recall, took place over the Christmas period, when NHS staff are absolutely exhausted. He talks about these changes being requested by the NHS, but what percentage of NHS staff does he actually think took part in the consultation?

[Edward Argar]

As the hon. Lady will know, the former chief executive of the NHS, Lord Stephens, was clearing in saying that the

“overwhelming majority of these proposals are changes that the health service has asked for.”

We should do the right thing by them and by patients. It is the right time for the Bill: it is the right prescription at the right time.

The substance of the petition, which has framed many speeches by hon. Members today, calls for the Government to renationalise the NHS. I have to say that it has never been denationalised. The NHS is and always will be free at the point of use. The Government are committed to safeguarding the principles on which the NHS was created. The hon. Member for Denton and Reddish set that out very clearly. We have no plans for privatisation.

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[Edward Argar]

I am grateful to the hon. Gentleman. Although we occasionally cross swords in the main Chamber or here, he knows I have a great deal of respect for him. All I would say gently on the point about the 2004 changes is that they came seven years into a Labour Government, so I do not know the reason why they had not been able to make progress before then.

We continue to work closely with the NHS to implement the changes that it has asked for, so that we can build back better and secure our NHS for future generations. As the shadow Minister, the hon. Member for Denton and Reddish, rightly said, the covid-19 pandemic has tested our NHS like never before, and all our NHS staff have risen to meet these tests in extraordinary new ways.

Hon. Members on both sides have rightly raised the point about the pressure that NHS staff have been under. Those who have been under pressure dealing with this pandemic are the people who will also be working flat out to deal with waiting lists and backlogs. We need to ensure that we are honest with the British people and that those staff have the time and space to recover, emotionally and physically, from the pressures they have been under. That is hugely important and we acknowledge the workforce.

[Margaret Greenwood]

Will the Minister give way?

[Edward Argar]

I will not give way to the hon. Lady now. I have given way to her before. I will try to make progress, but if there is time I will try to give way to her.

We have seen innovative new ways of working: new teams forged, new technologies adopted and new approaches found to some old problems. There is no greater example of that than the phenomenal success of our vaccine roll-out. That would not have been possible without the staff, who are the golden thread that runs through our NHS. As we look to the future and a post-pandemic world, we know that, as the shadow Minister said, there is no shortage of challenges ahead of us: an ageing population, an increase in people with multiple health conditions and, as he rightly says, the challenge of deep-rooted inequalities in health outcomes and the need to look at the broader context. I do not know the shadow Minister as well as I knew his predecessor, but both his predecessor and I had a career in local government as councillors. I suspect that the shadow Minister may have had one too, so he may well know that I understand his point about the broader context.

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[Edward Argar]

As the hon. Gentleman will know, there are 1.2 million full-time equivalents in the NHS—a record number of staff. Take one example: our pledge for 50,000 more nurses by the time of the next scheduled general election in 2024. Last year alone, we saw the number of nurses in our NHS increase by 10,900. We have a plan in place, and we are recruiting and training more staff through increased numbers of places—at medical schools, for example.

[Margaret Greenwood]

Will the Minister give way?

[Edward Argar]

I will not, because I have only two or three minutes left. If I make sufficient progress, I will try to give way, but I cannot promise the hon. Lady.

We know that different parts of the system want to work together and deliver joined-up services, and we know that when they do, it works; we have seen that with non-statutory integrated care systems over the past few years. The petition calls for the Government to “scrap integrated care systems”, but to do so would be to let down our NHS. The reforms have been developed by the NHS, and integrated care systems are already in place. The Health and Care Bill places them on a statutory footing to allow for that integration and joined-up working to continue.

In the minute or two I have left before I hand back to my hon. Friend the Member for Stockton South, I will touch on PFI contracts, which is an issue that he and other hon. Members have raised. In 2018, the Government announced that PFI and PF2 will not be used for any future public sector projects, including those in the NHS. The Government will honour existing PFI contracts, as wholesale termination would not necessarily represent good value for money. We need to look at each on its merits; many have clauses for early termination, which would cost a lot more than the life of the contract.

However, we have committed to undo the worst of the contracts inherited from the previous Government. The hon. Member for City of Chester (Christian Matheson)—I hope he will let me tweak his tail a little on this—chided my hon. Friend the Member for Stockton South by saying he should be careful about references to PFIs. Of the 124 significant PFIs currently in place, 122 were signed between 1997 and 2010.

Mr Gray, I think you want me to give my hon. Friend the Member for Stockton South some time to sum up, so I will conclude. We believe that this Government are doing everything necessary to ensure that the NHS remains free at the point of use. We are working with the NHS to deliver what it has asked for through the Health and Care Bill. There is huge support from those working in the system for the direction of travel. The Bill will create a more efficient and integrated healthcare system that is less bureaucratic, and allegations that this is privatisation by the back door are simply misleading. Through the legislation, we will ensure better and more joined-up services, improving health and care outcomes for all.

Adult Social Care

Margaret Greenwood Excerpts

Wednesday 1st December 2021 Commons Chamber

[Madam Deputy Speaker (Dame Eleanor Laing)]

I gently suggest to the Minister that the rule about facing the Chair when addressing the House is not just about courtesy and politeness—I know that she is the most courteous and polite person on the planet. It is also because if she is looking at someone who has asked a question, the microphone does not pick up her voice. I say this to everyone. That is why it is important to face this way; if she does so, she can be properly heard.

[Margaret Greenwood (Wirral West) (Lab)]

The Minister said that there was a lottery in how people paid for their care. There certainly is, and this is raised with me on a regular basis by my constituents. A quarter of Wirral adults with ongoing health needs were denied continuing healthcare over the summer, according to figures from NHS England. I think the Minister would agree that the CHC—continuing healthcare—system is unfair. Just at the very time when families need support, they often find themselves facing huge bills for care and having to consider selling the home of the person who needs care. Can she tell us what action she will take to ensure that no person has to sell their home to pay for their care, or was that just another hollow promise from the Prime Minister?

[Gillian Keegan]

I thank the hon. Lady for her question, because this is something that bothers me. It happened to my grandmother. We had to sell her council house, which she had bought under the right to buy that was introduced by a Conservative Government. It is very important that we start to fix this, because under today’s system, everybody out there can go down to their last £14,250. That is all that is protected. It is therefore a very unfair system today. That is why we are making these changes and introducing this cap, to ensure that nobody will ever have to pay more than £86,000. In addition to that, we are putting the means test up to £100,000, so that the cost of care is shared as a person’s assets get below £100,000. That will also slow down the depletion of assets. It will be a much fairer and better system than the one in place today.

Health and Care Bill

Margaret Greenwood Excerpts

Report stage
Tuesday 23rd November 2021 Commons Chamber

[Laura Trott (Sevenoaks) (Con)]

I will speak mainly to new clause 1, but I cannot start without paying tribute to my hon. Friend the Member for North West Durham (Mr Holden) for his work to ban virginity testing. It is an abhorrent practice and high time it was made illegal.

I speak to new clause 1 in the names of my right hon. Friend the Member for Romsey and Southampton North (Caroline Nokes) and the right hon. Member for North Durham (Mr Jones), among others. The existing situation, absurdly, is that someone may walk into a clinic and easily and legally get a treatment that could blind them, and there is absolutely no regulation whatever. For some time, we have talked about fixing the issue, and my private Member’s Bill—now the Botulinum Toxin and Cosmetic Fillers (Children) Act 2021—which was passed with the support of many Members of the House, has been able to bring some regulation to this space. Under-18s are now able to get only non-cosmetic interventions, and that by legal practitioners alone.

For those over the age of 18, however, there is no protection. Save Face, a campaigning organisation, last year received 2,000 complaints from people. Those are complaints not about the clinics people were in being dirty, but practitioners being uninsured or unable to fix the problems created when patients were given injections or fillers. People had necrotic or rotting tissue, which individuals would have to pay for themselves to get fixed. It is unacceptable that we are in a situation where that can take place with no regulation by Government.

I am afraid that is a pattern over time, across many Governments, of issues that primarily affect women not having the attention that they deserve. I am hopeful that we make some progress today. I pay tribute to my right hon. Friend the Member for Romsey and Southampton North on tabling her amendment.

[Margaret Greenwood (Wirral West) (Lab)]

The Health and Care Bill allows for

“a profession currently regulated to be removed from statutory regulation when the profession no longer requires regulation for the purpose of the protection of the public.”

Labour voted against the relevant clause in Committee, but we were defeated by the Government. I therefore tabled amendment 57, which would remove clause 127 from the Bill and ensure that a profession currently regulated cannot be removed from statutory regulation, and that statutory regulatory bodies cannot be abolished. I am grateful that the amendment received cross-party support.

The removal of a profession from regulation is deeply concerning because, once a profession is deregulated, we can expect the level of expertise in that field to decline over time, and along with that the status and pay of those carrying out those important roles. It also brings with it serious long-term implications for the health and safety of patients. In the White Paper that preceded the Bill, the Government stated:

“This is not about deregulation—we expect the vast majority of professionals such as doctors, nurses, dentists and paramedics will always be subject to statutory regulation. But this recognises that over time and with changing technology the risk profile of a given profession may change and while regulation may be necessary now to protect the public, this may not be the case in the future.”

It is notable that the Government only “expect” that the vast majority of professionals will be subject to statutory regulation, but they give no guarantee. The fact is, if the Bill passes, Ministers will be able change their mind at any point and make changes through secondary legislation.

The Government appear to be arguing that technological advances may change roles to such a degree that the high level of professional expertise that currently serves the NHS will no longer be needed. I will make two points about that. First, if the work of an NHS profession has changed to such a degree that regulation is no longer needed, I would argue that it is a different profession and needs a new job title. Secondly, when deploying new technology, there is always a need for professional staff with a high level of expertise and understanding of not only the functionality of that new technology, but its shortcomings. Technology has the power to improve productivity, but it should not be used as an excuse to deregulate professions.

It is important to consider where the impetus for that proposal may be coming from. The recent lobbying scandal certainly gives us a clue when we consider the number of MPs on the Government Benches with private interests in medical technology—I do not want to elaborate on that today, but to make the point. Certainly, big business is keen on deregulation, because it allows them to pay lower salaries to staff.

During a seminar on wellbeing, development, retention, and delivering the NHS people plan and a workforce fit for the future, a representative of Virgin Care said:

“We should have flexible working for all. We should consider what that means. We should embrace what that means. Both of those things really push what has been quite a traditional work model across the NHS. We need to be more modern. We need to have a think about how we rip up the old rule book. But change in an area that is very risk averse because the nature of the work we do is really tricky, so we need our leaders and our workforce to embrace trying things”.

That was an alarming statement for her to make. I think we would all agree that healthcare professionals’ understanding of risk and the importance of mitigating risk is incredibly important. It is always a matter of concern when business says that it wants to “rip up” the rule book on employment rights and pay.

Yesterday, in the Minister’s summing up, he said that

“the Bill does not privatise the NHS.”—[Official Report, 22 November 2021; Vol. 704, c. 151.]

I have to say, however, that I disagree. ICBs—integrated care boards—will be able to delegate functions, including commissioning functions, down to provider collaboratives, and provider collaboratives can be made up of private companies. I do not understand what it is that the Minister does not understand about that.

Add to that the fact that the abolition of the national tariff will open up the opportunity for big business to undercut the NHS, this is a potent situation indeed, and one that will be exploited by big business if the Bill goes through. The late Kailash Chand, former honorary vice-president of the British Medical Association said:

“The core thrust of the new reforms is to deprofessionalise and down skill the practice of medicine in this country, so as to make staff more interchangeable, easier to fire, and services more biddable, and, above all, cheaper”.

The removal of professions from regulation is a part of that scenario he described.

I turn now to workforce planning. There is a workforce crisis in the NHS. In fact, that is probably an understatement. Earlier this year, I met members of the Royal College of Nursing in the north-west, who told me of the sheer exhaustion that they are experiencing because of staff shortages. I was struck by how, even at this point when they were describing how they are on their knees with exhaustion, their primary concern was patient safety. We owe it to them to address the matter. The British Medical Association highlighted:

“Burnout has led to significant numbers of medical professionals considering leaving the profession or reducing their working commitments”.

According to the latest figures, there are well over 90,000 full-time equivalent vacancies in England’s NHS providers. The best the Government can come up with is in this Bill is to require the Secretary of State to publish a report, at least once every five years, describing the system in place for assessing and meeting the workforce needs of the health service in England. That is woefully inadequate. The Royal College of Physicians says that this duty on the Secretary of State

“falls short of what is needed given the scale of the challenge facing the health and care system”.

The Royal College of Paediatrics and Child Health is among those who have called for this duty to be strengthened in the Bill. I ask the Government to listen to the expertise of those bodies.

The Government’s plans to remove NHS professions from regulations is wholly unacceptable and it is particularly alarming at a time when there are such acute shortages of staff, right across NHS professions. We all value the NHS highly and respect the high level of professionalism in the service. Instead of looking to deregulate professions, the Government should be investing in the training of the next generation of professionals.

[Mr Andrew Mitchell (Sutton Coldfield) (Con)]

I draw the House’s attention to my interests, which are set out in the Register of Members’ Financial Interests, and to the fact that my wife is an NHS GP and has been for the past 30 years.

I rise to support amendment 10, tabled by my right hon. Friend the Member for South West Surrey (Jeremy Hunt), as it seems to be absolutely right. I cannot understand why the Minister, an extremely good Minister, is not obliging the Government to accept it in full. It is clear from what is being said across the House that my right hon. Friend has achieved an unexpected unity. Even brilliant junior hospital doctors who in the past have marched against some of his policies are four-square behind what he is saying today and the work his Committee is carrying out so brilliantly.

I wish to make three points about why the House and indeed the Government would be wise to support my right hon. Friend’s amendment today. The first is that, for reasons he has set out eloquently, as has the hon. Member for Central Ayrshire (Dr Whitford), who speaks on these matters for the Scottish National party, burnout in the NHS is an incredibly serious issue. The need for us to project how many people we are going to need in all the different disciplines in the health service has never been greater, and the workforce requirements have never been more uncertain. As has been so eloquently set out, the cost of that uncertainty is paid in locums, with all the difficulties and downsides that have been mentioned.

I wish to quote a note I have had from Dr Rahul Dubb, the lead doctor in Royal Sutton Coldfield. He successfully led the roll-out of the vaccinations in our town hall and he is extremely experienced. He says, “A greater understanding is needed as to why doctors are leaving the profession. It is clearly multi-factorial across the generations. One of the reasons includes pension rules. These penalise staff wanting to work more hours due to capped taxation rules, deterring senior staff from staying, and may lead to a significant exodus from the profession. In these circumstances, it is essential that far more effort is put into projecting future workforce numbers and how many are required to meet future need.” In my judgment, Dr Rahul Dubb is absolutely right in what he is saying.

The second reason is that the Government should listen carefully to what my right hon. Friend has said. During his time as Health Secretary—no one in the House has been so long at the crease and has as much experience as him—he significantly increased the number of doctors who will be trained. We were particularly pleased in Birmingham to see the additional work that Aston University has been able to do to bring those who might have felt themselves excluded from the medical profession into contention, so that they could go to university and achieve their ambition of qualifying as medics. Having that sort of analysis—the analysis that is behind his amendment—is right in securing value for money. I have been dismayed that when we had the measures to increase national insurance earlier this year—this was greatly to the credit of the Government for grasping a nettle that so many have not grasped before—those on the Treasury Bench were extraordinarily disinterested in checking that value for money for this additional taxpayer spend was achieved. When I suggested that we should account to our constituents through the Treasury, making certain that we understood where this £1.2 billion was going, the answer from those on the Treasury Bench was extremely lacklustre. Ensuring value for money and that we get these judgments right will save money and, for the reasons that have been set out, will make medicine and the treatment of our constituents that much safer. As my right hon. Friend set out, the whole sector is united behind this amendment, and the Government should hear that loud and clear.

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[Mr Deputy Speaker (Mr Nigel Evans)]

I must ask for brief contributions from now on. I call Margaret Greenwood.

[Margaret Greenwood]

Thank you, Mr Deputy Speaker.

The proposed NHS payment scheme in the Bill will, in effect, give private healthcare companies the opportunity to undercut NHS providers, and I believe we will then see healthcare that should be provided by the NHS increasingly being delivered by the private sector, with money going into the pockets of shareholders rather than being spent on patient care. If that happens, NHS staff may well find themselves forced out of jobs that currently provide Agenda for Change rates of pay, NHS pensions and other terms and conditions, and find that only private sector jobs with potentially lesser pay and conditions are available for them to apply for if they wish to continue working in the health service.

My amendments 54, 55 and 56, which are supported by the Royal College of Nursing, are intended to ensure that the pay rates of Agenda for Change, pensions, and other terms and conditions of all eligible NHS staff are not undermined as a result of the adoption of the NHS payment scheme, and that all relevant trade unions and other organisations representing staff who work in the health and care sectors are consulted by NHS England on the likely impact of the proposed scheme.

On hospital discharge, I have tabled amendment 60, which would remove clause 80 from the Bill. The hospital discharge proposals pose risks to patients and staff. In its written evidence given to the Bill Committee, the RCS said:

“In the context of current high vacancy rates across district and community nursing, and poor understanding of workforce shortages across the health service, public health and social care, along with chronic underfunding due to failure of the current service payment model to recognise community nursing, this legislation should not seek to demand a service delivery approach which transfers such disproportionate risk to nursing staff and patients.”

As of May this year, 4 million patients had been discharged since 2020 under discharge to assess and the temporary measures of the Coronavirus Act 2020. I asked the Government how many of those patients had been readmitted within 30 days but they told me that they did not hold the data. In effect, they did not know; they do not have that information. Back in June of this year, the Government told me that the national health service had commissioned an independent evaluation of the implementation of hospital discharge policy, and that the evaluation was under way. It was due to report in autumn 2021—that is, now. Yet the NHS told me last week that the report containing the evaluation had not yet been finalised. It is therefore a matter of extreme concern that the Government are pushing ahead with a policy that is risky to both patients and staff without properly understanding its clinical outcomes, and that they know they are doing so. I ask the Minister to withdraw clause 80 from the Bill.

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[The Secretary of State for Health and Social Care (Sajid Javid)]

I beg to move, That the Bill be now read the Third time.

For years, colleagues in health and social care have worked hard and as one to deliver for the benefit of their patients, but their ambition has not always been matched by the structures they have had to work with. This Bill provides the framework in legislation to help them to achieve just that.

We are not only recovering from the pandemic but learning from it, and the principles that underpin the Bill—embedding integration, cutting bureaucracy, boosting accountability—have never been more important. I am hugely encouraged by the support that the Bill has received from so many quarters, from the NHS Confederation to the King’s Fund, the Health Committee and even those on the Opposition Front Bench.

[Margaret Greenwood]

rose—

[Sajid Javid]

Talking of the Opposition, I give way to the hon. Lady.

[Margaret Greenwood]

Will the Secretary of State comment on the discharge-to-assess proposals? I am concerned, because his Department told me that a report about how the process goes was meant to be published in autumn. His Department told me back in May that 4 million people have been discharged under discharge to assess—that is, having their care needs assessed after they have left hospital rather than before—but the same Department did not know what the clinical outcomes were and it did not know how many people had been readmitted to hospital within 30 days. I would have thought that it was essential that MPs were provided with that information and with a full outline of the clinical outcomes of that policy. Will he comment on that and tell us what he can do about it, so that we really understand what is happening?

[Sajid Javid]

I listened carefully to the hon. Lady and I will look into the specifics of what she said, but it is clear—I hope she agrees—that if people are clinically ready to be discharged, it is better that they are discharged rather than staying in hospital a moment longer.

I take this opportunity to thank everyone who has helped us to shape this important legislation, including hon. Members across the House and colleagues in Wales, Scotland and Northern Ireland, whose engagement will help us ensure that the Bill delivers for the four nations of the United Kingdom. I also thank members of the Public Bill Committee for their constructive scrutiny. The Bill is a lot better for it.

Let me draw the House’s attention to some of the changes that we have considered since Second Reading.

Health and Care Bill

Margaret Greenwood Excerpts

Report stage
Monday 22nd November 2021 Commons Chamber

[Margaret Greenwood (Wirral West) (Lab)]

The Bill opens the NHS up to big business, allowing private companies a say in the care that patients receive. The Government’s amendment to the make-up of integrated care boards is weak and it fails to rule out the possibility of people with an interest in private health sitting on them. For that reason I tabled amendment 101, which seeks to ensure that ICBs are made up wholly of representatives from public sector organisations and that private companies, their employees and representatives, and those with financial interests in them, are not represented on them. Surely, that is what the public expect from a body that will be responsible for spending huge amounts of public money?

However, the influence of private companies is not just an issue with ICBs. The Bill allows for private companies to play parts in other ways, for example at sub-system level via place-based partnerships and provider collaboratives—they are not actually stated in the Bill, but that is what it means. Guidance by NHS England states very clearly that the Health and Care Bill will enable ICBs to delegate functions to providers, including, for example, devolving budgets to provider collaboratives. There is nothing to stop such partnerships from being open to big business, so the Government’s rhetoric around protecting the independence of ICBs is, frankly, quite meaningless. For all their talk of recognising

“that the involvement of the private sector, in all its forms, in ICBs is a matter of significant concern to Members in the House,”

they have not taken the action needed to stop private companies from influencing decision making. That is why I have put forward amendment 58, which is designed to ensure that any organisation carrying out the functions of an ICB on its behalf is a statutory NHS body.

Although the Government have made some noise about private membership of integrated care boards, they have said with respect to integrated care partnerships that they

“want local areas to be able to appoint members as they think appropriate.”––[Official Report, Health and Care Public Bill Committee, 14 September 2021; c. 258-259.]

That is a matter of great concern. ICPs are required to

“prepare a strategy…setting out how the assessed needs in relation to its area are to be met”.

Integrated care boards must have regard to a strategy drawn up by the ICP, which may well be influenced by private companies that do not have the same objectives as the NHS. I have therefore tabled amendment 100, which would do for ICPs what my amendment 101 would do for ICBs: seek to ensure that they are made up wholly of representatives from public sector organisations, and that private companies are not represented on them.

--- Later in debate ---

[Ms Diane Abbott (Hackney North and Stoke Newington) (Lab)]

Does my hon. Friend agree that the Bill has the sense of being an NHS corporate takeover Bill? We have already seen £5 billion in contracts being awarded to private companies through the VIP lane. The Bill opens the door to private corporations sitting on 42 local health boards. That is wrong.

[Margaret Greenwood]

I thank my right hon. Friend for putting the case so clearly. She hits the nail absolutely on the head: as a result of the Bill, contracts could be handed out to the private sector without the stringent arrangements that one would expect in the awarding of public money. That is a recipe for the kind of cronyism that has become all too familiar, as she says.

I turn to the cap on care costs. I was proud to stand on a manifesto in 2019 that pledged to

“build a comprehensive National Care Service for England”,

to include

“free personal care, beginning with investments to ensure that older people have their personal care needs met, with the ambition to extend this provision to all working-age adults.”

The Conservative manifesto in 2019 did not go that far, but it at least made the guarantee that

“nobody needing care should be forced to sell their home to pay for it.”

We now know that that was a sham—another broken promise by this Government.

Last week, Ministers sneaked out changes to social care plans that would mean that poorer pensioners will not after all be able to count means-tested payments by the state for their care towards a total cap of £86,000 for any individual. The Chair of the Health and Social Care Committee, the right hon. Member for South West Surrey (Jeremy Hunt), described it as “deeply disappointing” that the new plans were “not as progressive” as those put forward by Andrew Dilnot, the economist who drew up the original plans for a cap on individual contributions. Mr Dilnot has said that the Government’s plan is

“a big change that…finds savings exclusively from the less well-off group.”

A former Conservative Cabinet Minister has urged the Government

“to adopt a different approach”,

while another Conservative MP, a former Under-Secretary of State for Health, has said that

“it will be poorer pensioners who have relatively modest assets that will be most affected by these changes.”

I hope that Members on the Government Benches are listening to those points from Government as well as Opposition Members and will do the right thing. Elderly people deserve better. All Members, including Government Members, have a responsibility to vote these measures down.

When the Prime Minister was discharged from hospital in April 2020, having spent seven nights there, of which three were in intensive care, he said that

“the NHS has saved my life, no question.”

Now he and his Government should save the NHS by withdrawing the Bill. The national health service is this country’s greatest social achievement. It is devastating that this Conservative Government are intent on taking it off us.

[Matt Hancock (West Suffolk) (Con)]

I support new clause 49 because I support the action that is needed to make reforms to social care that are long overdue. I have listened carefully to the debate, and it is vital that we understand that the new clause would deliver one part, but not the whole, of the package that was set out by the Government in September. There is no doubt whatever that that package, as a whole, improves the provision of social care, makes the way it is paid for fairer, and removes some injustices that have existed in the system for far too long.

First, the proposal that has been put forward—and I think it is the right proposal—is for a cap on the costs that individuals face in paying for their care. The contributions from the state, even if they are from another part of the state such as local government, are not individuals’ care costs, and it is therefore wrong that they should be contributions towards the cap. The cap has the stated goal of being a cap on the cost of care to an individual, not a cap on the cost that accrues to both the individual and a local authority.

Let us look at what would happen if the new clause were not passed. The provision of care by local authorities is different in different areas, largely according to how well off those local authorities are. A richer council that pays more costs than the statutory minimum as set out in the Care Act 2014 would help local residents to meet the cap sooner than a poorer council that pays only the statutory minimum of care costs, and therefore people who live in poorer areas would take longer to reach the cap, so we would end up, in effect, with a postcode lottery cap meaning that people from poorer areas would tend to have to contribute more. That is wrong, and I am very glad that it is put right by the proposals that are before us today.

Secondly, for those with lower asset values, the rise in the floor in the means test is more important. It is the rise in that floor that makes this system fair. When the shadow Minister, the hon. Member for Ellesmere Port and Neston (Justin Madders), read out a long list of places with low asset values on average—places where house prices tend to be lower—he listed exactly the areas that will benefit most from the rise in the floor. [Interruption.] We can see what Labour Members are doing. [Interruption.] They are taking a narrow area, and they are taking a specific detail, and they are ignoring all the parts of the package that benefit the people who will benefit from this package as a whole. [Interruption.]

Medical Cannabis: Alleviation of Health Conditions

Margaret Greenwood Excerpts

Thursday 4th November 2021 Commons Chamber

[Ronnie Cowan]

It is great to see that research has now been undertaken, and I have a list of five or six projects looking at medical cannabis across a range of different medical conditions, but there is still the issue that many academic organisations cannot get access to the cannabis or hemp plants they require because they are graded as category 2, which keeps the plants out of their hands. The paperwork and processes they have to go through to access the raw product are prohibitive, and recategorisation from category 2 to category 4 would aid the research of a host of academic establishments.

Why are we not making it easier for people to access medical cannabis? Why are people who would benefit from medicine derived from the hemp plant being denied that opportunity? Why can some medicines be purchased on private prescription only? Why are we not making medicines that are widely available in other countries available in the United Kingdom?

[Margaret Greenwood (Wirral West) (Lab)]

I congratulate the hon. Gentleman on securing this debate. He is making some important points. One of my constituents lives with progressive myelopathy of uncertain cause that affects his mobility and causes him to suffer brain fog, exhaustion and almost constant pain, which he has described as feeling like “hot wires” being pulled through muscles and skin. Does the hon. Gentleman agree there is real urgency to this issue because of people like my constituent who are suffering on a daily basis?

[Ronnie Cowan]

Of course I agree, and I understand the difficulty in which the Government find themselves, particularly the Under-Secretary of State for Health and Social Care, the hon. Member for Lewes (Maria Caulfield), who is new in post. We need solid research that proves the efficacy of medicines, but behind that we have people who are living with these extreme conditions, day in, day out, for an awfully long time. We have been slow to get to this stage, so there is every reason why the Government should accelerate the research in such cases.

Over the last week or so I have met representatives from the Multiple Sclerosis Society and End Our Pain, and over the years I have heard representations from a much wider range of organisations and individuals that see medical cannabis as at least part of the solution to their or other people’s health issues. There are two licensed cannabis medicines, Epidiolex and Sativex, which are both made by GW Pharmaceuticals. There is nothing wrong with these medicines, but they are isolates, or very nearly, and isolates simply do not work as well as full spectrum products, and they have more side effects.

A full spectrum cannabis product contains all the different cannabinoids and terpenes found in that strain, whereas an isolate product contains only one chemical, such as cannabidiol in Epidiolex. There is published evidence that the full spectrum products are twice as good as the licensed Epidiolex in the treatment of seizures.

Then there are the unlicensed cannabis products that account for virtually all privately prescribed products. Unlicensed products are not routinely prescribed by NHS clinicians, but they can be prescribed by a specialist doctor on the General Medical Council’s specialist register. There are now about 10,000 private prescriptions, 60% for pain, 30% for anxiety and similar conditions such as post-traumatic stress disorder, and 10% for other conditions including neurological conditions, such as epilepsy and MS, and some cancer and gastrointestinal disorders such as Crohn’s. It is clear that medical cannabis can aid a wide range of conditions.

All imported products are imported because the Home Office has been slow in granting cultivation licences for high-THC plants in the United Kingdom, and matters are made worse by the cumbersome import process. Three years and three months after the current Secretary of State for Health and Social Care, while he was Home Secretary, changed the law to allow prescriptions for medical cannabis, we still have only three NHS prescriptions.

As I mentioned in yesterday’s Westminster Hall debate, and it is worth repeating, Hannah Deacon, whose son Alfie is in receipt of one of those NHS prescriptions, has written to the Health Secretary three times to ask him to help, as he promised her he would in writing when he was Home Secretary, but all three letters have been ignored. Why, three years and three months later, are there so few NHS prescriptions?

Basically, doctors are not trained in cannabis medicine, although several teaching programmes are now available. However, the main barrier is the rather unhelpful guidance produced by the National Institute for Health and Care Excellence, which has looked at cannabis as if it were a pharmaceutical product, but it is not. We need better guidance written by people who understand the plant, not by those who understand only pharmaceutical medicine.

We also need acceptance of the validity of real-world evidence. The British Paediatric Neurology Association recently reviewed its guidance on prescribing medical cannabis in cases of intractable epilepsy, about which I have a number of serious concerns. If a family go ahead with a private prescription for medical cannabis, the guidance appears to say that the NHS paediatric consultant should insist that the private paediatric consultant takes on 24/7 care.

I am extremely concerned that this is a further attempt to make private prescribing so burdensome as to deter private prescribers. No private prescriber will have the infrastructure to provide this level of wraparound care. My concerns are further increased as this appears to have happened to one family already, and I have a letter supporting my concerns. I am pretty sure that washing their hands of patients in this way is not legal. Will the Minister immediately examine this issue and seek clarification from the BPNA that this is not the interpretation, and will she insist that the guidance is removed or changed?

Many barriers would be broken if general practitioners were allowed to prescribe, and a recent survey shows that a quarter of GPs would be happy to do so. That would require a simple change of the necessary statutory instrument under the Misuse of Drugs Regulations 2001 and would not require parliamentary time. I notice that, as of today, a leading UK insurer is now offering insurance cover at rates not dissimilar to normal cover for doctors prescribing medical cannabis.

To make this easier, there should be a focus on where the evidence lies for prescribing indication-specific, medicalised, pharmaceutical-grade cannabis. We must build on the legitimacy and efficacy of these medicines through the implementation of structured approaches to prescribing, which would help the UK healthcare system to be more inclined to prescribe cannabis sensibly.

In our debates in this place on refusing access to immigrants, health and safety in the workplace, poverty and welfare, I have heard the question many times: “Does somebody have to die before we take action?” Well, people are dying and people are living in unnecessary pain and discomfort.

I have four questions for the Minister. Will the Government recognise the value of real-world evidence, such as the research of Drug Science—including Project Twenty21—as proof of the efficacy of medical cannabis and stop insisting on randomised controlled trials, which are particularly unsuitable for rare forms of epilepsy in children? Do the Government have any plans to conduct a health economics analysis to investigate the cost-effectiveness of medical cannabis? Will the Government meet the costs of prescriptions for children requiring Bedrocan’s Bedrolite or similar products? And if a child was suffering from an epileptic seizure and the Minister had the medicine in her hands, would she administer it? I am sure the answer to the last question is yes, so will she please help to put that medicine into the hands of those who care for these children?

Finally, access to medical cannabis will someday be the norm. We need to confront the obstacles that exist today and clear the path for better access tomorrow.

GP Appointment Availability

Margaret Greenwood Excerpts

Tuesday 26th October 2021 Westminster Hall

[Joy Morrissey (Beaconsfield) (Con)]

I beg to move,

That this House has considered GP appointment availability.

It is a pleasure to serve under your chairmanship for the first time, Mr Robertson. The chances of misdiagnosis can increase dramatically if GPs rely on emails or telephone calls exclusively. I speak from experience: for days, my mother-in-law was misdiagnosed as having a urinary tract infection, when she had actually suffered a severe stroke. Precious time was lost, and terrible damage done, because she was not seen by a GP. For every 100 ailments that can be diagnosed safely without seeing a GP, there will be one that cannot—one that could prove to be fatal, which is not a price worth paying.

I thank NHS workers and GPs for working tirelessly throughout the pandemic. I was encouraged to apply for this debate by my constituents, who came to see me again and again about this issue. I wanted to make sure that their voice was heard. I will read out some of their actual cases, because it is important to hear from them about what they have been experiencing. I would say that they are divided into two categories. The first is those who are disabled and perhaps suffer from dementia or other cognitive impairments, who find talking on the phone very difficult, and who really need to see a GP in person. The second is those who are happy to speak over the phone when they need a GP appointment, but find that the IT systems in place in certain GP surgeries cause issues with access to GPs.

The first example is from Marlow. A lady wrote to me and asked for an appointment to see me. She said:

“When I got through to the surgery, we were told that we should have a telephone appointment first. The GPs have my daughter’s number, as she cares for her grandmother. I explained that we do not live with her and cannot sit at her house and wait for a call. Also, there was a phone for her to sit around all day, and no one answers. She isn’t good with IT and has trouble explaining and expressing herself and telling someone what is wrong over the phone. I understand we are in extremely unusual circumstances, but there has to be exceptions, and there must be a way for elderly, and in some cases disabled, people to be able to get an appointment. Many do not have the capability to use the internet, and even phones in some cases.”

That was particularly true in the case of my mother-in-law, who had had a stroke. Luckily, we had power of attorney, but many people do not. I appreciate that the Government have made great strides in this regard, but we need to look at how we can protect those who are disabled, who perhaps have cognitive impairments and who need to have a carer come with them to a GP surgery in order to express what is wrong and explain what condition they have. Greater attention should be paid to this in the future.

We also have the issue of general IT and phone challenges. A resident in Farnham Common wrote to me and said:

“We have difficulty making the initial contact with GP surgeries. Most GPs operate a system which requires the patient to telephone when the surgery opens at 7 am to seek a consultation for that day. In our collective experience, it is often extremely difficult to get through. It takes a very long period of repeated calling. One friend recorded 140 unsuccessful attempts to reach the GP surgery.”

Some of the GP surgeries in my constituency are excellent. They were excellent during the vaccine roll-out and through covid, but we have certain GP surgeries that have had challenges meeting residents, challenges with the vaccine roll-out, and challenges in general throughout the covid period. Quite a number of residents have written to me and spoken to me about Burnham Health Centre, so I want to share specifically the IT challenges that it seems to face consistently.

One resident, Colin, said that if you are lucky enough to be 29th in the queue that morning at 7 am, you may get a message that says no appointments are left for the day. You can hang on in silence, or you may get to speak to a person—you may get through to a human being. You are told that there are no appointments and that you need to use Patient Access. When you try to book an appointment via Patient Access, it gives you possible ways to book, but only for things like contraceptive appointments, and nothing else. When Colin tried to access Patient Access, he was given an electronic form which he completed several times. It kept coming back saying that it could not be processed. He tried dozens of times and finally gave up and decided that Patient Access was not working.

He was not the only resident in Burnham who complained about Burnham Health Centre and Patient Access; several more wrote to me about the same issue. One said:

“I do think it’s ridiculous that you cannot get an appointment when you call, I am happy to wait a day or two, if it is urgent, there is always 111. The practice of releasing a limited amount of appointments at a certain time is not fair and just causes a bun fight. I do think the staff would benefit from customer service training”—

for everyone’s benefit.

A set amount of appointments are on a first-come, first-served basis. This seems to be unique to this GP surgery, but it has become a very agitating issue for people in the area who already suffer from some health inequality. They perhaps do not have the financial ability to go privately. Many are older and vulnerable, and it is demoralising that they often cannot get hold of a GP for even a phone call and consultation. Just getting a phone call would be a positive step in certain cases in my patch.

[Margaret Greenwood (Wirral West) (Lab)]

The hon. Lady is making really good points on this massively important issue. She just remarked that it was unique to where she is. Not at all; I have similar issues and I am sure other Members will talk about their issues. It is so important. Does she agree that the difficulty people have in accessing GPs has a knock-on effect on the National Health Service in other areas? We see people going to A&E out of frustration, because they cannot see their GP. This is really a problem that needs to be tackled head on. I congratulate the hon. Lady on introducing the debate to put pressure on exactly that.

[Joy Morrissey]

I thank the hon. Lady for her contribution. I agree that the problem has a trickle-down effect throughout the NHS. We will see more people presenting at A&E and perhaps with more advanced stages of disease, because they have not been seen in person. Encouraging GPs or creating a covid incentive programme for them to see people in person will decrease the amount of hospital admissions and lead to earlier diagnosis for cancer and heart disease. These things can really only be done in person. If someone is healthy and just needs a phone appointment, that is fine, but certain things cannot be seen unless a person’s vitals—their heart pressure—can be physically checked. Only a GP can do that and really only in person. If we want to reduce the overall burden on the NHS this winter, finding a safe and secure way for more residents to see their GP will reduce the overall pressure long term on the NHS. I know we have an aging population, and that GPs are under huge amounts of pressure and strain, but I believe there is a way we can work together to find a solution.

[Joy Morrissey]

The hon. Lady is stealing my thunder, but I agree with that comment. With the multi-disciplinary approach, even nurse practitioners and others could be recruited into a GP surgery structure, to help with many of the ailments that people are presenting at A&E with or asking for an appointment about. There is a wide range of healthcare professionals who could help and support GPs, and I think this is an important issue that needs to be further discussed and debated.

When this matter came before the House in July, several relevant questions were raised. One of them was about NHS England and NHS Improvement, or NHSEI, which leads the programme of work support practices, using digital and online tools to widen access. I would just love to hear what progress has been made since this topic was debated in July. Also, what is the progress of NHSEI’s independent evaluation of GP appointments? Again, I would like to see whether we have had any progress on that independent evaluation. Finally, what is being done by the NHSEI access improvement programme to support practices where patients are experiencing the greatest access challenges, such as drops in appointment provision, long waiting times, poor patient experiences or difficulties in embedding new ways of working related to covid-19, such as remote consultations as part of triage? I would really welcome any updates on those questions.

We could perhaps discuss today how we can provide GPs and their surgeries with some kind of in-person patient incentive during covid. Perhaps that could come from existing regional funding streams. Perhaps each time a GP sees a patient in person, they could receive an extra payment, or they could receive an additional payment for visiting someone in their home. That would mitigate the additional cost of PPE and also the additional risk posed to the GP themselves by having to see people in person during covid or high levels of winter flu.

Some GP surgeries are already receiving additional funding for cervical cancer and diabetes screening, and we have seen uptake increased in those areas very successfully, so this type of programme has been modelled in the past. It would help to mitigate the risk and burden for GPs, while still getting as many of our constituents as possible into in-person appointments if they need them.

The NHS claims that it would like more patients treated at home rather than having to stay in hospital for extended periods of time. This model could be enhanced if GPs were given the financial incentive to carry out in-home treatments for patients who traditionally would have remained in hospital. Obviously, this allocation would have to be set by the integrated care system in each region and it would be decided on within regional NHS structures, but it is worth considering.

In my own personal experience with my mother-in-law, she has been at home all the time 24/7. She is now completely disabled and needs 24-hour care, but the most difficult challenge was the out-of-hospital care provision—getting the GP, the hospital and the council to co-ordinate the care effectively. It is a full-time job for someone to co-ordinate that care. If we can make those pathways of care and co-ordination easier for everyone, then, as was said earlier in the debate, it would reduce the overall pressure on the NHS.

[Margaret Greenwood]

Does the hon. Lady share my concerns about the provision in the Health and Care Bill for the assessment of patients to take place after they have been discharged from hospital instead of before, as happens at the moment? I have very serious concerns about that issue. I tabled a couple of parliamentary questions, which were answered by a different Minister to the one who is here in Westminster Hall today. One question was about the fact that this discharge-to-assess approach has been going on under the Coronavirus Act; I asked how many patients had been discharged that way. The reply came back that 4 million patients had been discharged from hospital without having their assessment. I asked how many of those had been readmitted within 30 days; the Minister replied that the Government did not know because the information was not held nationally.

This is a very serious concern, because we are talking about vulnerable people. I know the hon. Member for Beaconsfield is talking about a particular relative. The idea that somebody with dementia, or early-stage dementia that has not been fully diagnosed yet, should be discharged before their needs are fully understood is very alarming. An independent review of this is going on at the moment, and I would be grateful if the Minister could give us an idea when that is going to be published. It is meant to be this autumn. I would like to raise this with the Minister as a very serious issue and wondered if she would like to comment on it.

[Mr Laurence Robertson (in the Chair)]

Order. I remind hon. Members that interventions need to be brief.

--- Later in debate ---

[Rachael Maskell]

My hon. Friend hits the nail on the head. We cannot look at part of the health service without looking at the entire health service, and the pressures that are brought to bear. As we have heard, many people do go to their A&E or urgent care centre, because that is the only way that they know they can confidently access the service, which puts more pressure on those parts of the service. We must look at the whole.

However, when it comes to trying to engage with our community practitioners—that is what primary care is all about: people who would traditionally have known the patient and the family—medicine has changed so much, yet we have not caught up with where it is. I saw both the call handlers and the GPs facing burnout. They are reducing the number of sessions that they are working because, we must remember, a session then extends right through into the night, as they are catching up with paperwork, ordering tests and following things through. Individuals are just saying “If I don’t step back, it will have a serious impact on my own wellbeing.” We have got to protect the wellbeing of GPs. They are a precious resource in delivering our healthcare services.

[Margaret Greenwood]

My hon. Friend is making an excellent speech. Does she share my concern about the shortage of GPs? The Government have committed to having an extra 6,000 GPs by 2024 or 2025, I think. The pressures GPs are under is a direct consequence of the failure to address the issue.

[Rachael Maskell]

My hon. Friend raises the next point in my speech. We are in this mess because for over a decade we have had failed workforce planning across the system. We have seen that most acutely in primary care. The pandemic continues to be mismanaged, which I want to stress. The Government may be looking at the numbers when it comes to intensive care and hospital admissions, but as people are less sick they instead go to see their primary care physician. That puts more pressure on them. We need to see more measurements and data on the pressure that has been put on primary care during the pandemic. In addition, we have long covid as well. In York there are around 3,000 cases. It is not coded, so can the Minister get that sorted urgently? We need to look at the support that people with long covid require.

--- Later in debate ---

[Chris Green (Bolton West) (Con)]

It is a pleasure to serve under your chairmanship, Mr Robertson. It is a pleasure to follow the hon. Member for York Central (Rachael Maskell), who makes important points in her speech. I congratulate my hon. Friend the Member for Beaconsfield (Joy Morrissey) on securing the debate and making many compelling arguments. I congratulate my hon. Friend the Minister on taking her position on the Front Bench. She is one of a small number of individuals in Parliament who has recent frontline experience and I am sure she will bring that to bear in her role.

GP appointments are an important issue about which there have been concerns for many years. The principal concern at the moment relates to coronavirus and the lockdown. We cannot avoid that or simply touch on the subject, then concentrate on a wealth of other concerns. We have to focus on that issue as the prime driver of the current problems in the sector.

The Chancellor has put forward substantial resources, but more are always needed to make sure that resources are available for the national health service and for general practitioners. More needs to be done, and I am sure that, in the coming months and year or so, more resources will come forward.

I am here to raise the concerns of my constituents who are increasingly worried. At the beginning of the coronavirus lockdown, many people chose not to take up available GP or hospital appointments, but many of those conditions that have not been investigated or checked in the last 19 months are now far worse. The pressure and demand on hospitals and GPs are more severe. People are increasingly less frightened of coronavirus but more frightened about when they will get to see their family doctor, who is now difficult to see.

People are told by their GP receptionist to call at 8 o’clock, or earlier in some areas, but they have to make call after call after call for half an hour or 45 minutes. They cannot get through until it is too late and they are told to do the same tomorrow. That is happening day in, day out. Many people are now going to accident and emergency. For a long period at the beginning of the pandemic, A&Es were quiet because people were worried about going and getting coronavirus, but the situation has changed radically. People cannot access their GP surgeries and they are going to A&E, but it is far more difficult to get the service there too.

The system is coming under significant and increasing pressure, which is piling up as we head into winter. It is not just coronavirus. There is an expectation that the pressure from other respiratory viruses will mount up along with, as I mentioned, conditions that have not been checked or investigated for all those months such as cancer and other life-threatening conditions.

We have heard about elective care for issues such as cataracts and hip replacements. In the scheme of things, when we are thinking about life and death, they may seem relatively minor but they have a dramatic impact on people’s standard of living. The situation has negatively affected all those discretionary care items, but they have to be addressed too.

[Margaret Greenwood]

The hon. Gentleman is talking about rationing and what is happening in the wider system. With the Health and Care Bill, we are moving away from a national health service to 42 integrated care systems that will all have to balance their books every year under tight financial controls and will all have different strategies. Does he share my concern that that will embed the postcode lottery and increase the rationing of care? Have his constituents commented on that and do they share those concerns?

[Chris Green]

The hon. Lady makes some important points about the Bill, but the postcode lottery is already there. Most people view the national health service as a one-size-fits-all service that provides the same service wherever they are in the land, but that is not true and perhaps never has been. Access to medicines is very variable and IVF is a good example of something for which different areas have different agendas, policies and accessibilities. We all know that there is already a postcode lottery.

I do think that NHS England is too large an organisation. I was not intending to talk about this, but I was hopeful about health and social care devolution in Greater Manchester. The Mayor could have taken that up and championed it, but he has not made a single speech on the subject—he has not touched it. Having seen the failure of that devolution, the Government are now looking at other mechanisms to champion the cause of better accountability—

[Margaret Greenwood]

rose—

[Chris Green]

I am sorry, I have very little time—where local leaders may be able to champion the cause of better delivery, with organisations in a sufficiently large area in which they can make a difference, but which are close enough to people that local needs can be respected and identified. Different areas are often so very different.

About 5.5 million people are on hospital waiting lists. That is an extraordinary figure. However, there have been about 7 million fewer GP to hospital referrals during the pandemic. If we extrapolate from those figures, we have roughly 13 million people on the hospital waiting list. We need to get the GP service sorted out as soon as possible. It is appalling. I am disappointed in the British Medical Association for threatening strikes. The health system, the unions and the Government need to get together and deal with those problems as soon as possible.

I was concerned about the renewal of the Coronavirus Act 2020 because I know what that will symbolise to the civil service, the health system, the education system and wider society: that we have not and should not yet return to normal. As long as the Coronavirus Act is in place, I can see that the wider system of state, including GPs’ surgeries, will not return to normal. That has to be changed and normal service must resume as soon as possible.

--- Later in debate ---

[Peter Aldous (Waveney) (Con)]

It is a pleasure to serve with you in the Chair, Mr Robertson. I congratulate my hon. Friend the Member for Beaconsfield (Joy Morrissey) on securing this debate and on her graphic and very personal assessment of the current position.

Over the past two to three months, I have received a great deal of correspondence on this issue, with constituents very upset that they have not been able to secure face-to-face appointments with their GPs. Late last month, I had a virtual meeting with GPs practising across the Waveney area, who themselves are very upset at the abuse that they have been receiving—something that they and their staff should not have to put up with.

There is clearly a major problem, and, at a time when the pressures on the NHS are growing at an exponential rate, there is a need to work together to find a solution. In the Norfolk and Waveney clinical commissioning group area, notwithstanding the enormous demand for GP services, the position with regard to appointments is positive, although it is recognised that more needs to be done. In August 2019, there were 478,160 GP appointments, and this August that figure increased to 482,993. The proportion of patients being seen face to face is increasing. This August it was 69%, compared to 67% in July and 66% in June. More patients are being seen face to face in Norfolk and Waveney than in other parts of the country: the August figure of 69% compares with a national average of 58%.

That said, it is recognised that a lot of people are very distressed, and in many cases very worried, that they have not been able to see their GP. The pandemic has meant that there is now an enormous increase in demand for GP services, with people on growing waiting lists needing support, and with those who were unable to see their GP during the pandemic wanting an appointment in order to highlight something that is causing them a lot of worry and distress.

The increase in demand for GP services has been happening for some time, but there are severe capacity constraints on the number of patients who can be seen face to face. The current infection, prevention and control measures that are needed to keep patients and staff safe mean that in-person appointments take much longer. Social distancing means that, at practices with smaller waiting rooms, people have to wait in their cars and staff have to go and get them when it is time for their appointment. Additional cleaning arrangements are also required between patients. There is a need to improve and standardise the way that remote appointments are operated and to adopt a whole-team approach, as there are many cases where a patient does not always need to see their GP and can often be cared for better by a physio or pharmacist.

[Margaret Greenwood]

The hon. Member is making some very interesting points. Does he agree that it is important that the Government review the outcomes of patients who have been consulted remotely? I have heard harrowing stories from my constituents. One woman thought she had a very minor ailment—she did not get seen by a GP, and she ended up with life-changing surgery. She will never be the same again. It is important that there is a national review of what has happened to such patients, rather than assuming that everything is all right because a patient does not come back.

--- Later in debate ---

[Maria Caulfield]

My hon. Friend is certainly persistent in his questioning on that issue. It is a decision for the Secretary of State, who is looking at such factors. The vast majority of NHS staff have been vaccinated, for their own protection as much as anything else. I want to highlight that we are increasing the number of primary healthcare professionals across the board, aiming to replicate the model used in hospitals, where a consultant leads a team of multi-disciplinary professionals who will help see a patient and are, sometimes, more expert in dealing with certain clinical situation than GPs themselves.

[Margaret Greenwood]

I have had GPs talk to me, somewhat frustratedly, about not having sufficient GPs in their surgery and having physician associates who do not have the same level of training. There is a concern that this is a backing-away from the Government’s commitment of 6,000 extra GPs. Could the Minister confirm whether the Government are still committed to 6,000 extra fully qualified, trained GPs?

[Maria Caulfield]

We are committed to increasing GP numbers, as in our manifesto commitment. However, that does not stop us increasing the numbers of other healthcare professionals. We need to get the message out to patients that seeing a nurse, physio or paramedic at the GP surgery is not second best. These are highly qualified, experienced and educated professionals who often are better placed—though I do not want to upset the shadow Minister—to see a patient than a doctor. They can make a considerable difference, but very often patients feel they are being fobbed off or seeing the second best. We need to do a lot of work to reassure patients on that.

We have already recruited 10,000 of the additional 26,000 staff we stated in our manifesto would be working in general practice by the end of 2023-24. We are strengthening our plans to increase the number of doctors in general practice. To reassure Members, so far we have filled a record number of GP speciality training places this year, with the latest data showing that there are already 1,200 more full-time equivalent doctors in general practice than two years ago. It is a challenge; I am not going to say it is not, but we are making progress.

I feel particularly passionate about the use of community pharmacists. In many other countries, the pharmacist is the first port of call for minor ailments. They are highly qualified professionals with over five years of clinical training who are able to assist patients. Over 800 practices have already signed up to participate in the community pharmacist consultation service, which enables patients to see a pharmacist, on the same day in many cases, to deal with minor conditions. That will not only help patients, but it will free GPs up to see the patients that really need to see them for clinical conditions.

Future of the National Health Service

Margaret Greenwood Excerpts

Wednesday 22nd September 2021 Westminster Hall

[Margaret Greenwood (Wirral West) (Lab)]

It is a pleasure to serve under your chairmanship, Ms Bardell. I congratulate my hon. Friend the Member for Leeds East (Richard Burgon) on securing this important and extremely timely debate.

The NHS is under great strain. Nurses I met over the summer told me how over-stretched the service is, not just because of covid but because of staff shortages, which my hon. Friend the Member for Rhondda (Chris Bryant) spoke so eloquently about. In June, there were almost 94,000 full-time equivalent vacancies in the NHS, and then of course we have the backlog of patients waiting for hospital treatment in England, which is getting worse. In July, 5.6 million people were waiting. Sadly, that is not just because of the impact of covid; the upward trend was in progress before the pandemic. In February 2020, there were about 4.4 million people waiting for hospital treatment, up from 3.7 million in February 2017.

Yet instead of addressing those extremely serious issues, the Government are pressing ahead with a major reorganisation of the NHS in the form of the Health and Care Bill, through which they will establish statutory integrated care boards and statutory integrated care partnerships, thus breaking the NHS up into 42 local integrated care systems. Each will set out which services to prioritise and which to reduce in their area, embedding a postcode lottery into the NHS in England. It is clear that that variation in the offer, depending on where people live, coupled with strict local financial limits, would lead to increased rationing of healthcare. If that is allowed to happen, I am concerned that people will have to wait longer for care or go without. That is contrary to the founding principles of the NHS.

It is important that we understand just how fortunate we are to have the NHS and why we must defend it. Looking across to America makes very clear our good fortune. Over there, typical costs for health treatment, as advertised by insurance companies looking for business, are as follows. People can expect to pay anything between $400 and $1,200 for an ambulance; between $9,000 and $17,000 for a baby to be delivered; and between $7,000 and $10,000 to have surgery for a broken wrist. Typical annual insurance costs for an individual are around $1,440 and for families around $5,700. That covers only part of the cost because, in America, employers pay the bulk of insurance costs for the individual, with all the cost that that adds to the business communities. Clearly, we do not want an American-style insurance-based system here.

As it stands, the Government’s Bill would put big business at the heart of our NHS. The Government have indicated that they would ensure that individuals with significant interests in private healthcare are prevented from sitting on ICBs, but that is simply not good enough. Private companies should have absolutely no say in how public money should be spent in the NHS. There should be no place whatsoever for private companies on ICBs or integrated care partnerships.

The Government intend to revoke the national tariff and replace it with an NHS payment scheme, with NHS England consulting with ICBs, NHS and independent sector providers. There are real concerns that this will give big business the opportunity to undercut NHS providers. We will see healthcare that should be provided by the NHS increasingly being delivered by big business, with all the implications that that has for patients, for all those working in the service, “Agenda for Change”, and the future of national collective bargaining.

The Government’s reforms would also create a power to deregulate NHS professions, and would have serious implications for the quality of care as well as the employment status, pay, terms and conditions of workers in the service. The NHS is our finest social institution and it has served us well since 1948 but now its future is in peril.

During the campaign against the Conservative-Lib Dem privatisation Bill, which became the Health and Social Care Act 2012, a man told me of his experience of life before the NHS. When he was about eight years old, his baby brother was seriously ill. Everyone in the street was worried for the child. One of the neighbours called for the doctor but, on hearing that, the mother said to the boy, “Run up the street and tell the doctor he is fine and there is no need to call.” The boy ran to the doctor, who had just turned into their street, and sent him away, just as his mother had told him to. Shortly after, the baby died, as the mother knew he would. She had told him to send the doctor away because she knew she could not afford to pay him.

We cannot begin to know the agony that that woman went through. The man who told the story had carried the burden of that action with him through life. That was life and death before the foundation of the NHS, when that family and countless others could not afford medical treatment. It is sobering to think that, after 73 years, the Government’s Bill undermines the principles of the NHS as a comprehensive and universal service.

History will not be kind to those who support such changes. I believe we all have a responsibility to protect the NHS and fight for it as a universal, comprehensive, public service for this generation and those to come. I ask Government Members to reflect on the importance of the decisions that they face in the coming weeks and months, and I urge them to consider the needs of their constituents and oppose the Health and Care Bill.

--- Later in debate ---

[The Minister for Health (Edward Argar)]

It is a pleasure to serve under your chairmanship, Ms Bardell; I think that I do so for the first time.

Although I suspect that it is fair to say that the hon. Member for Leeds East (Richard Burgon) and I are not fellow travellers in the same direction on many things politically, I congratulate him on securing this debate on a very important subject. Although his speech was long on opinion and perhaps short on fact, I do not think that anyone could doubt the passion or the sincerity with which he spoke, whether one agrees with everything he says or not. I pay tribute to him in that respect.

I think it is clear to everyone in this Chamber, as I hope it will be to people watching on Parliament TV and those who read the transcript of our debate, the genuine affection and respect that every Member of this House has for our NHS and those who work in it. It is right that I join the shadow Minister, the hon. Member for Tooting (Dr Allin-Khan), and others—I often do so on these occasions, because this cannot be said too often—in paying tribute to those who work in our NHS, including the shadow Minister herself. On the occasions when she and I see each other across the Dispatch Box, I always try to make that point.

A number of key themes have emerged today. The legislation is currently in Committee, and I know that a number of Opposition Members have argued that it should be paused or even scrapped. I have to say that the former chief executive of the NHS, Lord Stevens, said that about 85% of the Bill is exactly what the NHS asked for, wanted and wanted done now—ideally, the NHS wanted it done two years ago, before the pandemic.

In the evidence sessions of our Bill Committee, which continues to meet, we heard NHS Providers, the NHS Confederation and the Local Government Association all saying, “This is the right Bill at the right time.” I should acknowledge that some of those witnesses said there were certain elements that they would question or challenge, but they said it was the right time to pass this legislation. In fact, in a joint statement the NHS Confederation, NHS Providers and the LGA said,

“we believe that the direction of travel set by the bill is the right one.”

At the heart of this legislation is the principle of integration underpinned by evolution. Colleagues across the House who have served with me since 2015 will know that I am not by nature revolutionary, so the legislation is evolutionary in what it seeks to achieve, but it seeks to achieve greater integration. I think it was the hon. Member for Liverpool, Wavertree (Paula Barker) who spoke about accountability needing to be upwards, downwards and sideways. With these proposals we seek to do exactly that: to achieve greater integration at a local level within the NHS and, at the ICP level, to achieve greater integration with local authorities.

[Margaret Greenwood]

What would the Minister say to the British Medical Association council, which passed a resolution overwhelmingly

“calling for the Health and Care Bill to be rejected, arguing that it is the wrong time to be reorganising the NHS, fails to address chronic workforce shortages or to protect the NHS from further outsourcing and encroachment of large corporate companies in healthcare, and significantly dilutes public accountability”?

[Edward Argar]

I will turn to those key points in a moment, but first I will address the specifics. The point I made to the Chair of the BMA council in Committee was that, if I recall rightly, every single piece of legislation on the NHS, including the National Health Service Act 1946 that brought it into place, has been opposed by the BMA. I challenged him to tell me which pieces of legislation the BMA had supported, and he said he would write to us. I have yet to get that letter; I am sure, knowing Dr Chaand Nagpaul as I do, that he will write to us, but in the Committee he was unable to say which piece of legislation—including Labour legislation in 1999, 2001, 2003 and 2006—the BMA had supported.

[Margaret Greenwood]

Will the Minister give way?

[Edward Argar]

I will make a little bit of progress, because I want to address the hon. Lady’s allegations about privatisation and workforce. If we have time at the end, I will of course seek to let her come back in.

On allegations or suggestions of furthering privatisation, I know it is tempting for some, even when they know better—and they do—to claim that this is the beginning of the end for public provision. It is not, and Opposition Members know it. There have always been key elements of the NHS that have involved private providers, voluntary sector providers and so on.

What is instructive is the extent to which that was accelerated when the Labour party were in power. The shadow Minister talked about the 2012 legislation and any qualified provider, but that was not brought in by the 2012 legislation; it was brought in by the Gordon Brown Government in 2009-10 under the term “any willing provider”. The name was changed, but nothing substantive changed from what the Labour Government had introduced in terms of the ability to compete for contracts.

The other point I would make is that one of the key changes allowing private sector organisations to compete for and run frontline health services came in 2004, under the Labour Government, when the tendering for provision of out-of-hours services by private companies was allowed.

--- Later in debate ---

[Edward Argar]

My hon. Friend makes a fair point about the need for us to create the conditions—the physical spaces with the technology—in which the workforce, which is the heart of our NHS, can work. He makes a subtle—or not so subtle—plea for his own local hospital. He will not be surprised that I will not comment on the detail of that.

To finish my response to the hon. Member for Strangford, the Command Paper recognises the challenges posed by the current arrangements in the Northern Ireland protocol around the supply of medicines and other goods, for example. The approach that the hon. Member set out, of removing medicines and medical devices from the orbit of the protocol, is reasonable. I hope that discussions between the European Commission and Lord Frost are productive, and that a consensus can be reached on the way forward.

I have to take issue slightly with the hon. Members who raised the role of Sam Jones, one of the Prime Minister’s advisers. They focused on one particular aspect—that for a brief period she worked for an independent provider. What they did not do, which is extremely unfair to a dedicated public servant, is highlight that she worked for NHS England, running new care models; that she has been an NHS paediatric and general nurse; that she was the chief executive of Epsom and St Helier University Hospitals NHS Trust; that she was the chief executive of West Hertfordshire Hospitals NHS Trust; and that she was the Health Service Journal chief executive of the year for 2014 and was highly commended for her work in driving forward patient safety. I gently say that it ill behoves Members of the House to attack public servants, who cannot answer for themselves in this Chamber, with partial references to their careers rather than recognising that they have contributed a huge amount in the past.

The hon. Member for York Central was absolutely right to highlight health inequalities as one of the greatest challenges—not the only challenge—that we face as a society and as a health system. The measures on integration and change in the Bill will help us tackle those health inequalities. I suspect that on Report and Third Reading she may test and challenge me on those assertions and assumptions, but she is absolutely right to highlight the centrality of health inequalities.

The hon. Member for Liverpool, Wavertree (Paula Barker) spoke about residential care and the link to social care. While I am not the social care Minister, everything that I do in my role as Health Minister must have an eye to social care. I was a cabinet member for adult social care in the dim and distant past, when I had rather more hair, and I also sat on the primary care trust, as it then was, at that time. I recognise the need for those two parts of the system to work together to achieve the best outcomes for our constituents. She makes a valid and important point.

I found what the hon. Member for Wirral West (Margaret Greenwood) said about the US experience of great interest and instructive, but it is utterly divorced from what the Bill and the Government are doing in respect of our NHS. It was an interesting reflection on what is going on in America, but it certainly does not bear any resemblance to what is happening or will happen in this country.

[Margaret Greenwood]

Does the Minister not recognise that, where we have a postcode lottery and the increased rationing of care—my constituents are very aware of the rationing of care, and a number of Members have spoken about what happens when people cannot get the treatment that they need on the NHS—there is the spectre of an individual, private insurance-based system? Members of his own party have in fact argued for such a system. People need to be mindful of just how dangerous for us all it would be to introduce a private insurance-based system.

[Edward Argar]

Will the hon. Lady forgive me? I was not questioning the integrity of what she said, but I was suggesting that there was no risk of that system as she described it developing in this country.

I will sum up, because I want to give the hon. Member for Leeds East a little more than two minutes, if I can. We are determined to continue supporting our NHS; this Bill, this legislation, the funding announcements we have made and the reforms we are putting in place do just that. We want to create an NHS that is fit for the future, renewing the gift left to us by previous generations, building on that gift and strengthening our NHS as it evolves to meet the challenges of the future. We remain the party of our NHS; we will give it the support it needs—as we always have done.

NHS Update

Margaret Greenwood Excerpts

Wednesday 21st July 2021 Commons Chamber

[Helen Whately]

My hon. Friend is absolutely right about the importance of people being able to access GPs and to get healthcare close to home. NHS England has been clear to GPs that they must ensure that they are offering face-to-face appointments as well as remote appointments. In general, practices are taking this approach, and we will continue to support GPs to provide that access over the months ahead.

[Margaret Greenwood (Wirral West) (Lab) [V]]

Last week, the Minister for Health, the hon. Member for Charnwood (Edward Argar), said in response to a question from my hon. Friend the Member for York Central (Rachael Maskell) that

“it is not the intention that ICBs”—

integrated care boards—

“depart from “Agenda for Change”.—[Official Report, 14 July 2021; Vol. 699, c. 474.]

However, given that the Health and Care Bill will revoke the national tariff and places a clear emphasis on a move to tariffs varying by area and other factors, coupled with strict financial controls for ICBs, is it not inevitable that it will undermine “Agenda for Change” and the pay and terms of conditions of over 1 million NHS workers in England?

[Helen Whately]

No, I do not think that is the case.

Social Care Reform

Margaret Greenwood Excerpts

Wednesday 23rd June 2021 Commons Chamber

[Helen Whately]

My hon. Friend is absolutely right; reform has been talked about by many Governments. One of the challenges is that people say, “Social care is broken and we must fix it”, but different people mean different things. Some are particularly concerned about what are called catastrophic costs, including the problem of people selling their home to pay for their care. Others are much more concerned about care—and rightly so—for working-age adults and the increasing costs for those of working age with disabilities. For other people, it is about questions of housing or technology. We are hugely ambitious about our social care reforms and want to bring this all together into a long-term plan for social care.

[Margaret Greenwood (Wirral West) (Lab) [V]]

Instead of bringing forward plans to fix the social care crisis as the Prime Minister has promised, the Government intend to put in place a legal framework for a discharge to assess model, whereby NHS continuing healthcare and NHS-funded nursing care assessments can take place after an individual has been discharged from acute care, instead of before. The Government have told me that an independent evaluation of the implementation of the hospital discharge policy is currently under way, and that it is due to report this autumn. Will the Minister tell us why the Government are pressing ahead with this policy, despite not yet fully understanding the impact that it is having on patients and unpaid carers?

[Helen Whately]

I would not see this as either/or. We have said that we will bring forward proposals for social care reform. To the hon. Lady’s point about discharge, it is well known at that, particularly for an older person, spending a long time in hospital can be harmful to their prospects of recovering and living a good quality of life. I have seen that in my own family as well as knowing that it is a long-standing challenge across our health and social care system. It is absolutely right that we should take steps to support people to be discharged from hospital to home when they are clinically ready.