Mental Capacity (Amendment) Bill [Lords]

Maria Caulfield Excerpts

2nd reading: House of Commons & Money resolution: House of Commons & Programme motion: House of Commons & Ways and Means resolution: House of Commons
Tuesday 18th December 2018 Commons Chamber

[Barbara Keeley]

Absolutely, we do, and that is a real concern. The Opposition’s concern is that we do not want to end up with a flawed piece of legislation replacing another flawed piece of legislation, and then to have to change it again.

It is worth noting that until yesterday the Government had not even published an equality impact assessment, more than five months after the draft Bill was first presented. Before that, the Government’s only published impact assessment was concerned solely with the cost savings that the new system would bring. That initial impact assessment is now woefully out of date, given the number of amendments made to the Bill in the House of Lords—I understand that more than 300 amendment were tabled. I pay tribute to the work of many peers in the House of Lords, including my colleagues on the Labour Front Bench, who worked to try to improve the Bill, despite the hurdles placed in front of them by the Government. Nevertheless, fundamental problems with the Bill remain that simply cannot be rectified by amendments.

We cannot support the Bill in its current form because, quite simply, it proposes to replace one deeply flawed system with another. I will come onto the flaws in the Bill in due course, but, first, I wish to address the need for substantial reform of the Mental Capacity Act, which we accept. We recognise that the deprivation of liberty safeguards system is deeply complex and bureaucratic, as the Law Commission identified in its report last year. Concerns about the deprivation of liberty safeguards predated even the Law Commission’s report, and we know that a House of Lords Committee declared the DoLS not fit for purpose in 2014.

The scope of DoLS is too narrow, applying only in care homes and hospitals. Authorisations outside care homes and hospitals have to be done through the Court of Protection, which is costly and cumbersome. It is clear, as we have already heard in this debate, that the explosion in the number of DoLS applications after the Cheshire West judgment left the system struggling to cope. The latest figures, as the Secretary of State has said, show a backlog of 125,000 applications. That, of course, leaves the person subject to the application potentially unlawfully deprived of their liberty. If the Government want to resolve that backlog, as they profess to, then the way to do it is to provide local authorities with the resources they need to process all the applications they receive. The Government should not be trying to hide their failure to fund local government behind a streamlined process that does not protect vulnerable people.

Although the deprivation of liberty safeguards need reform, and I agree that they do, the Bill deals with none of the challenges that have been outlined and creates some new problems that cannot be solved simply with further amendments. I am afraid we feel that the Government cannot be relied on to make the necessary changes during the remaining legislative stages given the resistance that they showed to making important changes in the House of Lords. On the contrary, the transformative spirit of the Law Commission’s draft Bill has been squashed, and the measures that would place the best interests of the cared-for person at the heart of the new system have been reduced.

The Government should have enacted the Law Commission’s proposals in full through the 15-clause Bill that was drafted, but instead we have this five-clause Bill. Why did they not simply bring forward the Law Commission’s proposals? The inescapable conclusion that we have come to from reading the Bill is that the Government are more interested in cost saving than in the best interests of cared-for people. This is a crucial point, because there can be disastrous consequences when the best interests of cared-for people are not taken into consideration.

[Maria Caulfield (Lewes) (Con)]

I say this in a spirit of co-operation on such an important issue. The Labour party amendment is to decline to give the Bill a Second Reading. Instead of trying to change the Bill and bring in some of the Law Commission’s recommendations, why, with nearly 200,000 people waiting to have a DoLS assessment, have the Opposition proposed an amendment to reject the Bill out of hand?

[Barbara Keeley]

That is a question that the hon. Lady needs to put to her own party. What has happened up to this point is that the Government have been asked repeatedly to pause, to carry out more consultation, and to consider redrafting the Bill. There is a list of 40 organisations that have asked for a pause and a redrafting of the Bill. This is a familiar situation from health and social care legislation—it has happened before in this House. The Government could have considered a pause, and the Minister for Care, the hon. Member for Gosport (Caroline Dinenage), knows that I have discussed that with her. The whole question really falls back on the Government.

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[Maria Caulfield (Lewes) (Con)]

Let me start by welcoming the Second Reading of the Bill and by declaring an interest as a registered nurse who has used the current legislation in clinical practice. I therefore welcome the provisions in the Bill, which amend and reform the current legislation.

The Mental Capacity Act 2005 was a groundbreaking piece of legislation, which, for the first time, provided safeguards not just for those without capacity, to enable decisions to be made about their care, but for healthcare professionals, families and friends who were having to make the most difficult decisions in the most difficult circumstances.

In terms of the deprivation of liberty aspects of the legislation, there is no doubt that, after 10 years, reform is urgently needed. The DoL system has become too cumbersome and too bureaucratic, and it is not responsive enough to patients’ changing needs. I therefore fully support the Law Commission’s report last year, which recommended that DoL be repealed and replaced. The Bill delivers those reforms.

There was a huge amount of debate in the House of Lords, and many amendments were tabled. The Government were in listening mode and accepted many of those amendments. Therefore, it is disappointing to see the Opposition amendment before us today, which simply states that we should decline to give the Bill a Second Reading. There will be plenty of opportunities in Committee and on Report for Members to lay down amendments about the concerns they have. This is such a serious issue, and there is such a backlog of cases; we are talking about the most vulnerable people in our society, and to leave them waiting for assessment or languishing with a DoL system in place that is clearly not working—we have a huge body of evidence that shows that—is irresponsible. If Opposition Members have concerns—many of them have raised genuine concerns today—I urge them to table amendments to address them, and not simply to reject Second Reading out of hand.

At the Lord’s Committee stage, concerns were raised, and the Bill has been amended accordingly. There are four measures, in particular, that I welcome. First, the scope of the Bill was extended to 16 and 17-year-olds. That is a welcome move, which will ensure that they are covered by the new legislation. In addition, I welcome the fact that family and friends will be able to trigger a review if there is an objection. That possibility does not exist in the current legislation. I also welcome the fact that the person we are discussing will be part of the consultation. Although they cannot make an informed choice, because they lack capacity, it is important to continue that dialogue with them, because they are the most important people in the whole process. I welcome the introduction of safeguards in relation to conflicts of interest and care home providers undertaking assessments. That was recognised as a genuine concern and the Bill has been amended as a result.

I still have a concern about independent hospitals. It would have been helpful if Opposition Members had tabled an amendment to reflect that concern. We want to ensure that the proposed legislation covers patients who move between various sectors—independent hospitals, care homes or NHS hospitals—in all scenarios. There is a feeling that there is a gap that still needs to be bridged and perhaps that could be considered in Committee.

I want to make a final point, Madam Deputy Speaker, on what I know is not the responsibility of UK Government Ministers. I sit on the Northern Ireland Affairs Committee. Only last week, the Committee heard evidence from mental health professionals about people who lack capacity in Northern Ireland. There is actually no legislation in Northern Ireland, compared to the rest of the UK, on mental capacity. While there is no Northern Ireland Assembly and no Northern Ireland health Minister, that will remain the case. It is a huge concern that while UK Ministers are amending current legislation to make it more adaptable and responsive to patients’ needs, vulnerable patients in Northern Ireland have no legislation to cover them. There are healthcare professionals working in Northern Ireland who do not have safeguards to protect them. I urge Ministers to have discussions with the Northern Ireland Office and Northern Ireland Ministers to see whether something can be done until the Northern Ireland Assembly is up and running.

As a healthcare professional who has used the existing legislation, I am encouraged by the changes proposed in the Bill. I welcome the reform of the legislation to protect the most vulnerable, to protect healthcare workers in that setting, and to protect family and friends. I welcome further debate in Committee.

NHS: Staffing Levels

Maria Caulfield Excerpts

Tuesday 11th December 2018 Westminster Hall

[Maria Caulfield (Lewes) (Con)]

I declare my interest as a nurse who is still on the Nursing and Midwifery Council, or NMC, register. I speak, therefore, with first- hand experience about having to deal with staffing shortages during more than 20 years of working in the NHS. Staffing problems have always been there, but I welcome the debate that the hon. Member for Batley and Spen (Tracy Brabin) has secured because we must recognise the issues that many hospital trusts and community services are experiencing.

I welcome last month’s NMC figures, which show an increase of more than 4,000 nurses joining the register in the past 12 months, a significant percentage of whom were UK-trained nurses. There was also an increase of 3,000 UK nurses compared with this time last year. I welcome those figures, but that is not to say that there is not a staffing problem across the NHS.

I want to focus on some of the solutions from my experience that would make a real difference out there in the workforce. I understand the sentiments of the hon. Members for Batley and Spen and for York Central (Rachael Maskell) about the bursary scheme, but I trained on that scheme myself and it is far from the panacea that has been portrayed in recent years. We were paid a pittance—£400 a month—for the three years of our training. Yes, it paid for travel and expenses, but not for much else.

Someone training as a nurse has to do the minimum hours to get on to the register, so it is very difficult for them to have an additional job, as other students would. Often times they are mature students and have other commitments, such as children and family responsibilities, and an additional part-time job is almost impossible to hold down. Life on a bursary was tough, and it often explained the high drop-out rate during the three years.

The system I would prefer, and have always advocated, is the degree apprenticeship route. During my time in this place, I have been doing bank shifts at my old hospital with student nurses who are now on the degree apprenticeship route: it is a far better system, and we need to upscale it as a matter of course. Not only are student nurses earning while they are learning; they are part of the workforce, which is a point that the bursary scheme missed completely. Student nurses were university students, but not necessarily part of the working environment, and often found it tough to move into that environment, because they were not seen as key members of the workforce.

The degree apprenticeship route also means that when students work for hospitals or community trusts during their degree apprenticeship, they are often being paid by those trusts, which are then able to accurately predict the number of students coming through the system. That was different under the bursary system: trusts just had to wait and see which newly qualified nurses applied for their vacant posts. For long-term workforce planning, having those student nurses as part of the team means that trusts have an idea of who is likely to come forward when they qualify. There are a number of positives, and I push for the Government to roll out that degree apprenticeship system—maybe not just in nursing, but in other healthcare professional specialities.

I will briefly touch on flexible working. We are under the misapprehension that internal rotation and a shift-based system means there is flexible working for staff in the NHS, which there absolutely is not. In most areas, people are forced to do internal rotation, whether in the community or in the hospital-based system, and that is increasing as we move towards a seven-day-a-week service. If young parents with children are all of a sudden put on a week of nights with a week’s notice, and have no childcare provision, that makes it almost impossible for them to hold down their job.

In the good old days when I first started, people were able to do a permanent nights system, to do permanent weekends, or to choose to work evening shifts. That is all gone now: they are forced to do internal rotation. I say to the Minister that the NHS needs to look at a flexible working system for its staff, because if it does, it is more likely to hold on to the excellent staff who keep the NHS going.

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[The Minister for Health (Stephen Hammond)]

It is a pleasure to serve under your chairmanship, Mr Hollobone. I thank the hon. Member for Batley and Spen (Tracy Brabin) for securing this debate. As she and hon. Members who have contributed to other such debates will know, the issues she raises are very similar to those that we discussed on 21 November in the debate that the hon. Member for Ellesmere Port and Neston (Justin Madders) has just referred to. However, it is welcome to have the opportunity to discuss them again, because such debates reflect the importance that we all place on the NHS workforce. The one thing that the hon. Gentleman and I agree on is that it is right to begin by reiterating our thanks to the NHS professional staff for their work treating patients day in, day out.

I also thank other hon. Members for their contributions. I note in particular the comment rightly made by my hon. Friend the Member for Lewes (Maria Caulfield) that we need to upscale nurse degree apprenticeship routes. I will speak about that in more detail if I have time. My hon. Friend the Member for Redditch (Rachel Maclean) spoke about the capital announcement made last week, which I was pleased to see come through. My hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter) made some points about mental health—may I offer him a meeting at the Department to discuss those matters directly, because today I want to concentrate on other matters? The hon. Member for York Central (Rachael Maskell) made a contribution based on her valuable experience.

I should say right at the outset, as I did in our debate two weeks ago, that the Government greatly value the staff who contribute to and support the NHS. We understand its importance and are committed to ensuring that it is supported and funded appropriately, which is clearly reflected in the extra £20.5 billion a year that the NHS will get by 2023-24.

As the hon. Member for Ellesmere Port and Neston quoted me saying in our last debate, we expect NHS England to set out clearly its commitment to the workforce in the long-term plan. The plan will address how to open up the profession to more people from all backgrounds and ensure that they get the right support throughout their training. To answer his question: yes, when the long-term plan is published, he will see the workforce embedded in it and in our strategy. We also expect NHS England to deliver a clear implementation plan to guarantee the future of the workforce. The NHS employs a record number of staff—more than 1.2 million in 2018, which is more than at any other time in its 70-year history—with significant growth in newly qualified staff since 2010.

Let me repeat what I said two weeks ago:

“the Government, and I as the new Minister for Health, should never be complacent”.—[Official Report, 21 November 2018; Vol. 649, c. 372WH.]

We are not. We are absolutely committed to ensuring that nursing remains an attractive career so that the NHS can build on the record numbers of nurses on our wards. Actions already taken to boost the supply of nurses range from training more nurses and offering new routes into the profession to enhancing rewards and pay packages, and there are now 11,000 more nurses on our wards than in May 2010.

NHS England, NHS Improvement and Health Education England are working with trusts on a range of recruitment, retention and return to practice programmes to ensure that the required workforce is in place to deliver safe and effective services. We should note that NHS Improvement has had some real success with its retention programme. Retention seems to me one of the key issues for the Government to focus on, and that will be reflected in the long-term plan. NHS Improvement’s programme continues its direct work with trusts to support improvements in retention, with a focus on the nursing workforce and the mental health clinical workforce. So far, 35 trusts have been involved and the initial evidence is positive and encouraging, with more flexible working programmes and greater support for older workers. It is therefore right that that programme be expanded further to all remaining NHS trusts in England.

[Maria Caulfield]

Revalidation is a new system for nurses to retain their registration, but it is a very difficult and stressful process for nurses who may be part-time or part of a hospital bank. I was lucky because my NHS trust, the Royal Marsden, is extremely supportive to its bank workers, but will the Minister ensure that bank nurses are supported through the revalidation process to keep them registered?

[Stephen Hammond]

I am listening carefully to my hon. Friend, and I will ensure that that work is undertaken.

As I have said today and on previous occasions, the priority is to get more nurses on our wards. There are currently 52,000 nurses in training, and we have announced a policy change that will result in additional clinical placement funding to make 5,000 more training places available each year. My hon. Friend made the point that nursing bursaries were not always the panacea that everyone suggests; students on the loans system are at least 25% better off than under the previous system. However, we recognise that students incur additional costs as a result of attending clinical placements, so we have introduced a learning support fund with a child dependants allowance, reimbursement of travel costs and an exceptional hardship fund. When I spoke to nurses at Barts last week, I listened carefully to the points they made about the need for help with travel in particular, and I am looking carefully at that issue.

The hon. Member for Batley and Spen raised the RCN proposal. Yesterday, as I had promised I would, I responded to the RCN in a formal letter to Dame Donna, and I look forward to meeting her to discuss her proposals in the near future—hopefully the very near future.

We are increasing the number of midwifery training places by more than 3,000 over the next four years. There continues to be strong demand for nursing places, with more applicants than places, but I am under no illusions, nor am I complacent. We need more people applying and we need to increase that route. A number of routes are open. HEE’s programme covers all fields of nursing; its RePAIR—reducing pre-registration attrition and improving retention—programme explores effective interventions to ensure that people are supported through their whole student journey from pre-enrolment to post-qualification.

The hon. Member for Batley and Spen was right to mention the number of new routes into nursing. In particular, she will have noted the report published last week by the Select Committee on Education on the nurse degree apprenticeship. We are working with the Department for Education to carefully consider the Committee’s recommendations and I will respond in due course.

I want to turn to the story of doctors. In the NHS today, it is true that there are 18,200 more doctors in trusts and CCGs than there were in 2010. My hon. Friend the Member for Central Suffolk and North Ipswich raised the matter of the additional 5,000 doctors. This year, we have recruited 3,473 GP trainees, against the target of 3,250. That is an increase on last year, but we are determined to meet the commitment of 5,000. To ensure that that is possible, we have rolled out an extra 1,500 medical school places. By 2020, as he knows, five new medical schools will be open to deliver that expansion.

In the whole of this discussion, it is only right that I recognise that the Government value the professionals. It is key that we ensure that NHS staff are well remunerated. It is absolutely right that we have given NHS staff a well-deserved pay rise. All staff will receive a 3% pay rise by the end of 2018-19.

There is a lot more I might have said. The hon. Member for Batley and Spen raised a number of local issues, including ambulatory care. If she cares to write to me or to catch me, I would be happy to have a longer discussion with her. I thank her and all hon. Members for the points they have made in the debate. I also stress, as I have done today to staff at North Middlesex, and last week, that making sure that we have an NHS long-term plan that sets out a strategy for the NHS and ensures a sustainable supply of clinical workforce—doctors, workers and others—is key, and it is key to delivering our ambitions for the NHS. I thank the staff for all that they do.

Gosport Independent Panel

Maria Caulfield Excerpts

Wednesday 21st November 2018 Commons Chamber

[Matt Hancock]

Yes, of course that is the Government’s position, and I am very happy to reiterate it today. The police need to be able to follow the evidence without fear or favour.

[Maria Caulfield (Lewes) (Con)]

I declare an interest as a registered nurse and someone who has worked in areas using syringe drivers and controlled drugs. I welcome the measures announced today, but may I make two further suggestions? First, there are very strict guidelines for nurses on controlling the stock of controlled drugs, and wrongdoing is picked up very quickly. There is not, however, enough training in the use, the dosage, the method and the route of controlled drugs that would give nurses confidence to speak up. Secondly, this situation could have been picked up much sooner if we had a proper IT system that shares medical notes between hospitals and doctors.

[Matt Hancock]

My hon. Friend is right on both points, and I am very happy to work with her on them. On the latter point, there is still much more work to do to have a system that is fully interoperable between secondary and primary care. As she says, many patients’ GPs might have picked up on the unusual patterns if they had had access to hospital notes. That now does happen in a small number of hospitals, but it is central to improving the technological capability of the NHS.

NHS Outsourcing and Privatisation

Maria Caulfield Excerpts

Wednesday 23rd May 2018 Commons Chamber

[Jonathan Ashworth]

If Members will forgive me, I will make a little bit of progress, and then hopefully we will get a chance for more to come in later.

Labour has been calling for a long-term economic plan for the NHS. We are led to believe that the Secretary of State agrees with us, because according to The Guardian, in an article headed “Hammond and Hunt in battle over NHS funding boost”, the Secretary of State and Chancellor are reported to be “at loggerheads”, with the Secretary of State calling for £5.3 billion extra, but the Chancellor only wanting to offer £3.25 billion. Of course, neither is quite as generous as the extra £45 billion for the NHS and social care across the Parliament that Labour was offering, but we will watch carefully.

Our plans would have been funded from increasing taxation on the top 5% of the wealthiest in society. Perhaps the Secretary of State can tell us how he proposes to fund his extra £5 billion. Will it be an increase in national insurance for pensioners, as has been floated? Or will other Departments be cut? Will the defence budget be cut to fund the extra £5 billion increase in the NHS? Will it be a move towards co-payment and charges? Or will it be another conjuring trick from the Secretary of State, whereby he claims to be increasing the funds going into the health service, only for us to subsequently find out that public health budgets, training budgets and infrastructure budgets have been cut and the settlement is not quite as generous as we have been led to believe? According to tomorrow’s Spectator, there will be a Tory splurge on the NHS, so he should honour the House today with his confidence and tell us where he thinks this splurge will come from—tax rises, cuts elsewhere, or charges and co-payments.

I remind the right hon. Gentleman: it was a Labour Government with Gordon Brown who increased taxation to pay for the NHS and helped us treble funding in cash terms, and it will be the next Labour Government who will increase taxation for the very wealthiest in society to fund a long-term, sustainable plan for the NHS. When we face the demographic challenges of an ageing population, with people living longer, the disease burden shifting and people living with co-morbidities, and when we are on the cusp of great advances and innovations from artificial intelligence and genomics, is it not clear that the current fragmented structures of the NHS are wasting energy, wasting time and wasting resources?

We are now led to believe that, according to the BBC, the Prime Minister and the Secretary of State, despite both having sat in a Cabinet that agreed the Health and Social Care Act 2012, have realised that the structures produced by that Act have been a dismal failure. I do not like to say, “We told you so,” but we did actually tell you so. The Act has created a fragmented mess, with healthcare leaders trying to work around it. I say to the Secretary of State that it does not need amending—it simply needs consigning to the dustbin of history to be included in the next edition of “The Blunders of Our Governments”.

We will test any new legislation that the Secretary of State brings forward to see if it moves towards greater collaboration—away from a purchaser-provider split model in favour of partnership and planning. Any new legislation should bring an end to the creeping, toxic privatisation of the NHS and instead restore and reinstate a public universal national health service. The Health and Social Care Act has contributed to the reality today where, according to the Department of Health’s own figures, £9 billion is spent on private providers—a doubling in cash terms since 2010. Indeed, we have seen about £25 billion of contracts awarded through the market since the Act came into force.

Of course, there has always been a role for the private sector in providing services, as I said to the hon. Member for East Worthing and Shoreham (Tim Loughton), who is no longer in his place, as indeed there has always been a role for the voluntary and co-operative sector. But the combination of years of underfunding alongside the constant tendering of contracts via the any qualified provider arrangements has led to creeping privatisation. Before Government Members tell us that this is just 8% of the total budget—in fact, the Secretary of State told the House in January that it is “not huge”—let me point out that the problem is that that 8% is located almost exclusively in areas like elective care, community services and patient transport, meaning that the private sector is disproportionately influential in those areas. Moreover, the way in which the funding mechanism works restricts NHS income from those areas and leaves NHS providers picking up the more complex, costly cases—emergencies and the chronic sick. In other words, outsourcing and privatisation is increasingly a false economy where supposed savings are easily outweighed by the costs.

But more importantly than that, privatisation has first and foremost a detrimental impact on patient care.

[Maria Caulfield (Lewes) (Con)]

rose—

[Jonathan Ashworth]

I will give way to the hon. Lady because she is a nurse.

[Maria Caulfield]

Does the hon. Gentleman not agree that the any qualified provider system was brought in under the previous Labour Government in 2009?

[Jonathan Ashworth]

I remind the hon. Lady, whom I greatly respect in this House because of her work in the NHS, that we moved away from that system to a preferred provider mechanism because we knew that the any qualified provider mechanism did not work and was not in the interests of patient care or the interests of the taxpayer.

Let me give some examples. On support services, GPs have warned repeatedly of the dangers of NHS England outsourcing primary care services to Capita, in a contract designed to save £40 million. Those fears proved well founded, as the National Audit Office found that there was a real risk of “serious patient harm” stemming from Capita’s handling of the contract, with major problems around the secure transfer of patient notes, with notes going missing or delivered to the wrong surgery. Capita’s work in providing back-office services such as payment administration, cervical screening tests, medical records and supplies orders had fallen

“well below an acceptable standard.”

On patient transport contracts, I mentioned to the right hon. Member for Mid Sussex (Sir Nicholas Soames) what happened with Coperforma. This was a contract worth £63.5 million.

[Maria Caulfield]

rose—

[Jonathan Ashworth]

And the CCGs are still paying out to Coperforma—is that not correct?

[Maria Caulfield]

With regard to Sussex—I am sure that my right hon. Friend the Member for Mid Sussex (Sir Nicholas Soames) would agree with me—the last time Labour was in government it proposed to close the Princess Royal Hospital in Haywards Heath.

[Jonathan Ashworth]

I am sure that the hon. Lady accepts that it is a scandal that the CCGs—her local health economy—are still paying out to Coperforma. She should be getting up and complaining about that.

What about support services? Interserve was brought in to provide facilities management across 550 NHS buildings across Leicestershire, with a seven-year, £300 million contract. The contract was scrapped four years early because of reports of patients receiving meals up to three hours late, bloodstains in the corridors and bins not emptied. How about Carillion, which won a £200 million, five-year estates and facilities management contract with Nottingham University Hospitals NHS Trust? It failed to clean the hospitals properly, with reports that infectious waste was seen overflowing in the children’s ward.

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[Maria Caulfield (Lewes) (Con)]

I, too, want to use this opportunity to debunk the myth that the Conservative party wants to, or ever has wanted to, privatise the NHS. That is an image that the Labour party wants to portray, but the facts tell a different story. In the 70 years of the NHS, 43 of those years have been under a Conservative Government, so if privatising the NHS were the sole aim of the Conservative party, it would have been done by now. The NHS remains based on the three founding principles of meeting the needs of everyone, being free at the point of use, and being based on clinical need, not ability to pay. However, facts do not often matter to the Labour party.

I was at a meeting at the weekend of more than 200 GPs who were desperate for the politics to be taken out of the NHS. They welcome the Government’s talk of a long-term settlement and of taking the NHS out of the political cycle. That puts fear into the heart of Labour because it would mean that the NHS would come first, not the motives of the Labour party.

If Labour Members were honest with themselves, they would recall the history of the last Labour Government, who did more for privatisation in the NHS than anyone before or since. In 1999, within two years of coming to power, the Labour Government set up market structures in the NHS to create choice and competition, with hospitals starting to charge by price per episode to compete with the private sector. That is Labour’s record on privatisation in the NHS. In 2003, they set up foundation trusts so that hospitals could be free from the constraints of the NHS and run like a business. That is Labour’s record of privatisation in the NHS. Also in 2003, they introduced independent sector treatment centres—private companies set up to provide wholly NHS elective procedures. That is Labour’s record of privatisation in the NHS.

Some 84% of PFI projects were started under Labour. Although they built £11.8 billion-worth of hospitals, the cost to the NHS is £79 billion over 31 years. In 2009, the Labour Government introduced “any qualified provider”, which we have heard about this afternoon, allowing the private sector to undertake NHS work. That is Labour’s true record of privatising the NHS. The King’s Fund analysis on the Labour Government found that by the time they left office, the NHS in England was operating more like a market, with half of elective patients being offered a choice of the private sector. The culture of the NHS had changed from one of collaboration to one of competition.

I am not against the involvement of the private sector in the NHS. As a research nurse, I worked with many multinational pharma companies setting up joint research studies that gave NHS patients access to drugs long before they were available on the NHS and access to equipment that was paid for by pharma companies and left in perpetuity to the NHS.

Labour Members lecture us on privatisation in the NHS, but the last time they were in government, they wanted to close the Princess Royal in Haywards Heath to patients in my constituency. When we were missing Government targets and breast cancer patients were not getting their treatment under the last Labour Government, did they listen to the breast surgeons in my unit who said, “Give us an extra theatre and we can deliver it.”? No, they spent hundreds of thousands of pounds on performance management consultants, time and motion studies, brainstorming sessions and patient pathway mapping. At the end of that six-month process, they told us that the solution was to have more theatre sessions, which the surgeons had told them in the first place.

This is not just my experience; the British public know that the NHS is safe in Conservative hands. That is why, for 43 of the last 70 years, they have put the Conservative party in charge of the NHS, and long may that continue.

Education (Student Support)

Maria Caulfield Excerpts

Wednesday 9th May 2018 Commons Chamber

[Angela Rayner]

My hon. Friend is absolutely right and I congratulate her on her outstanding dedication to nursing.

The Government said that they can fill the gap with nursing apprentices. They promised 1,000 of them, yet it has now been revealed that just 30 apprentice nurses have started the course. To miss a target may be unfortunate, but to miss it by 97% and carry on regardless just seems reckless. The shortfall is not the only problem with relying entirely on apprenticeships. A nursing apprentice will take four years to become a registered nurse. Even if there is a miraculous surge in apprentices starting this summer, we would not see any new qualified nurses on our wards until 2022.

[Maria Caulfield (Lewes) (Con)]

I am not sure the hon. Lady understands what life is like on a bursary as a student nurse. There is just £400 a month to live on. Apprentice nurses are paid. They are a member of a team and they have a guaranteed job at the end of it. That is a very different system, which is a step forward in progress towards getting more nurses into the profession.

[Angela Rayner]

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

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

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

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

--- Later in debate ---

[Stephen Barclay]

The hon. Gentleman is quoting selectively. He is right to point to 2016, because the number of nurses in training was at a record high—an achievement by this Government for which little credit was given by the Opposition. The new system will take time to bed in, but it is important to ensure that more places are available and that there are more applicants, and that is our approach.

[Maria Caulfield]

Opposition Members seem to be portraying the bursary system as a panacea, but it was not a well-functioning system. There were more applicants than available places, and it was a real struggle for students from poorer backgrounds, such as myself, to live on £400 a month with no alternative income. The system also only catered for students with an academic background. The new apprenticeship system allows degree-entry nursing, but not necessarily through the academic route.

[Stephen Barclay]

As a nurse, my hon. Friend speaks with great authority and she is right. This is about empowering those who want to be a nurse, not all of whom want to go to university. She is also right to remind the House that many people’s ambitions are choked off by the existing system. Under the bursary system, over 30,000 people who applied to be a nurse were rejected. Too many people were being rejected, and we need more nurses, so we have a package of measures to increase the number of nursing places. Nothing has been said about those who were thwarted in that ambition. Universities, too, have consistently argued that healthcare postgraduate courses were an area prime for growth if we offered suitable loan products.

--- Later in debate ---

[Maria Caulfield (Lewes) (Con)]

May I start by declaring that I still work as a nurse on the bank shift, mainly at the Royal Marsden Hospital in London? It is a pleasure to do so.

I have previously been very outspoken against the removal of bursaries and the move to a tuition fee-based system, for practical reasons: student nurses are different from most students. The course requires them to do a set number of practical hours, and the fact that those are often unsocial and irregular means that it is almost impossible for student nurses to get other part-time work to supplement their time on their courses. We have heard today that student nurses are often mature students who have come from other professions and so already have financial commitments, such as mortgages and loans, that they have to bear in mind when they start a nursing course. Postgraduates who have existing debt are often reluctant to take on more to become a student nurse.

However, since the changes were introduced a couple of years ago, the background has changed. We have seen the rise of the apprenticeship route for nursing and of the associate nurse. My difference with Opposition Members is that I have actually worked with some associate nurses who are in training, and with apprenticeship nurses in training, and the difference is phenomenal. They are enjoying their courses a huge amount more because they are working in a practical setting. It is not just about what they are learning on their nursing course; they are back to being part of the team. They are not students who just come to their placement from university; they are learning about being part of a hospital team and a clinical community.

Associate nurses and apprentice nurses are more than just students; they bring experience with them. Many have backgrounds as healthcare assistants. The experience that they bring from a variety of settings is phenomenal. I know about the support that they have given me on shifts as a bank nurse, and that would not have been available with student nurses previously. We are underestimating their power.

I echo some of the comments in the debate: we do need to ramp up the apprentice and associate routes, because that is the way forward. The bursary system was far from ideal. I lived on a bursary of £400 a month for the three years that it took me to train as a nurse, with little or no additional income. As the hon. Member for Lincoln (Karen Lee) said, student nurses rack up significant debt during those three years. That shows that the bursary system was far from ideal. The statutory instrument took some of those points into account, establishing a hardship fund for struggling students and grants for childcare, travel and accommodation—none of which were available under the bursary system. They are there to support students who have financial pressures.

The bursary system has failed to achieve the number of students that we need. There was a cap on the number of places. Each and every year there were more applicants, but there were not more students coming through the system, because the cap did not allow those applying to secure the places. We need to embrace change, and use this as an opportunity to increase the number of nurses. We should also make student nurses feel valued, and give them a variety of routes into nursing. They have the associate nurse role, which means that they are healthcare assistants who want to do their associate training. They can then top up their training in the future to become registered nurses, or they can go down the apprenticeship route to qualify.

I see Opposition Members laughing. They seem to find it difficult to understand how a Conservative Member of Parliament can be a nurse—I am talking about someone who came from a deprived background and who took the route into nursing because she could not get into university. I will not apologise. I am not afraid to speak out for student nurses and for nurses. I worked with the RCN in the “Scrap the cap” campaign. I spoke out when there was a move away from the bursary system, but, with my hand on my heart, I can say that the associate and apprenticeship routes into nursing are the way forward. It is misleading to pretend that the bursary system was a panacea, that student nurses were happy and that we were fulfilling the numbers that we needed.

I am a member of the RCN and I fully respect everything that it does to support nurses, but its briefing has been slightly misleading. It lists only two routes into nursing: the two-year postgraduate route, and the three-year route into nursing. It does not even mention the associate route or the apprenticeship route, which we need to take into account. It also highlights the fact that applications into nursing have fallen, but it has not mentioned that 2017 saw the second-highest number of students ever accepted on to nursing courses—26,620 students—and that was despite an overall fall in the total number of applications.

[Karen Lee]

I have the briefing here, and it does mention it.

[Maria Caulfield]

I thank the hon. Lady for her intervention. As a member of the RCN, I, too, have had the briefing, and it does not mention the associate and apprenticeship routes into nursing.

The bursary system was not the panacea that Opposition Members claim it to be. I am happy to stand up to fight for nurses when I think that Labour Members may have a point, but I think they are now moving into the realm of scoring political points, which is their usual tactic. There is a better way to get nurses into training, and I urge Ministers to continue both the associate route and the apprenticeship route, to give student nurses alternative routes into nursing, to boost nursing numbers and to develop nursing into a degree-entry healthcare profession.

[Vernon Coaker (Gedling) (Lab)]

May I just say to the hon. Member for Lewes (Maria Caulfield) that this is not about scoring political points? It is about debating in this House of Commons something that is of immense importance to our country. I agree with her that no one has a monopoly on these things, but it is only right and proper that we have an open and frank debate about the matter. That means that there will be a clash of views and a clash of opinions, but out of that will come better policy, and I hope that the Government, as they move forward, will listen to some of the concerns that have been raised, even if they do not change their policy. There is nothing wrong with that. That is not political point scoring; that is holding the Government to account for the policies they are pursuing.

Let me also say this: the only reason why the Government are being held to account is that my hon. Friends on the Opposition Front Bench have obtained this debate. They deserve a great deal of credit for that, because the Government were not going to debate these regulations. Indeed, the House of Lords Committee, that scrutinises these secondary legislation reports said that it was unprecedented for the Government to be forced to hold a debate in this place when revoking one set of regulations and replacing them with another. So, it is quite right that we are actually saying this to the Government. We would not be able to get the Government to put forward their views as to why removing bursaries is a good thing, and we would not be able to explain why we are holding them to account, were it not for the fact that we raised this matter in the way that we have.

The hon. Member for Lewes criticised the Royal College of Nursing’s figures, but the RCN—a highly respected body in this country—has laid out the statistics, including for many of the routes that she says it has not, regarding the fall in the number of applications since NHS bursaries were got rid of two years ago. There has been a 33% fall in the number of applications for nursing degrees. It may be that that does not matter, but the Government still need to address and defend it and explain why the RCN is wrong to highlight that as a figure that should cause us concern.

[Maria Caulfield]

That is the point: despite the fall in the number of applications, the number of placements has actually increased to its second-highest level ever. If the bursary system was so great, why were the nursing student numbers not coming through it, and how come we had such a high drop-out rate of student nurses?

[Vernon Coaker]

Let us see where this goes. The hon. Lady’s point is that it does not matter that there has been a 33% fall in applications, because other things will happen, but that is not the view of the Royal College of Nursing. Applications from mature students have been disproportionately affected by the funding reform; the number of applicants aged over 25 has fallen by 42%. I do not know whether the Minister intends to respond—it would be a shame if he did not—but perhaps he can explain why that figure does not matter. That point needs to be addressed in debate. The hon. Lady disagrees, but I say that it does matter, and that it will cause problems for future nursing recruitment.

Breast Cancer Screening

Maria Caulfield Excerpts

Wednesday 2nd May 2018 Commons Chamber

[Mr Hunt]

We have not had conversations at ministerial level, but we have had conversations at official level. The Welsh Administration do not believe this problem has affected them, even though Wales was using the same IT system we were using in England. Our concern is about people living in England who are registered with a Welsh GP or people living in Wales registered with an English GP. That is why we are having constructive discussions to share IT information and make sure everyone in England or Wales registered with a GP will get that letter.

To respond to the earlier question about what people should do now, anyone is free to call the helpline number, which will be made public today, but we are hoping to get the letters out as quickly as possible over the next four weeks, during the month of May, so that everyone can be pretty confident that they are okay if they have not received one of those letters.

[Maria Caulfield (Lewes) (Con)]

I welcome the Secretary of State’s announcement today that there will be an independent review; it is important that women have confidence in the screening programme. As someone who worked in breast cancer for over 10 years before being elected, I gently say to women that the screening mammogram is just one tool in the early detection of breast cancer and that if they notice a change in the interval of three years between mammograms they must seek medical advice. Also, not all mammograms pick up breast cancers, so they must not just rely on screening mammograms.

[Mr Hunt]

I thank my hon. Friend for her excellent advice, which gives me the opportunity to repeat that the advice for women about looking after their breasts and making sure they are alert to potential breast cancer remains unchanged. All women should take great care over this and should always come forward to see their GP or local cancer service if they have any concerns or doubts.

Social Care

Maria Caulfield Excerpts

Wednesday 25th April 2018 Commons Chamber

[Barbara Keeley]

I will indeed, because given the cuts that many councils have been facing—I am sure Bristol is the same—these efforts to protect care services are really excellent.

I was talking about those London boroughs that have committed to pay care staff the London living wage, which, at £10.20 an hour, is way above the Government’s so-called living wage of £7.83—a commitment that is no small undertaking. That is a further example of the good that Labour-run councils are doing for the most vulnerable people in their communities. We on this side of the House—this ties in very much with the point that my hon. Friend has just made—see the need for social care to be valued as a career. At last year’s general election, Labour pledged to implement the real living wage for all care staff and to ensure that care staff were paid for travel time, that 15-minute care visits were scrapped and that zero-hours contracts were ended for care staff. Those are important steps, but we know that we have to go much further if we are to improve care quality.

It is clear from the reports of the Care Quality Commission that staffing levels are still a major issue in those care services rated as inadequate or requiring improvement. Much of the care workforce are underpaid, undervalued and overworked, which leads to high turnover and vacancy rates in the sector among care staff and, more importantly, the registered managers who are responsible for overseeing care quality. Improving pay for care staff will help with that, but we also need to commit to improving care staffing levels to reduce the workload pressure and offer better training and career paths.

The National Audit Office has criticised the Government for failing to have an up-to-date workforce strategy for the care sector and for their lack of oversight of workforce planning in local areas. Indeed, the Government have no major workforce strategy for social care. It was the Labour Government who produced the last strategy, in 2009. The head of the National Audit Office has said:

“Social care cannot continue as a Cinderella service—without a valued and rewarded workforce, adult social care cannot fulfil its crucial role of supporting elderly and vulnerable people in society.”

Skills for Care has a budget of only £21 million for care staff training, whereas Health Education England has a budget of £4.7 billion. That disparity in budgets between health and social care says it all about the Government’s lack of priority for improving the quality of social care.

At the 2017 election, Labour pledged an extra £8 billion for social care across this Parliament, with an extra £1 billion to ease the crisis in social care this year. That aimed to relieve the pressure on the social care system. It would have been enough to begin paying care staff the real living wage and would have sought to offer more publicly funded care packages for people with different levels of need. Today’s debate is not primarily about the long-term funding of social care, but Labour has made it clear that maintaining the current funding system is not an option in the long term. Recently, polling by the Alzheimer’s Society has shown that paying for social care is a growing public concern and that there is overwhelming public support for a cap on care costs. The next Labour Government will implement a lower cap on care costs than the cap set under the Care Act 2014. We will also raise the asset threshold to a higher level than under the current system.

[Maria Caulfield (Lewes) (Con)]

I am listening with interest to the hon. Lady’s opening remarks. I am obviously interested in the cap, in paying care workers more and in raising the threshold, but how would a Labour Government pay for that?

--- Later in debate ---

[Caroline Dinenage]

I am happy to answer the hon. Lady’s questions, which she is right to ask. Although we are very hopeful that this procedure will have a positive result, we are taking steps to ensure we are prepared for all eventualities. The Care Quality Commission and my Department are monitoring the situation, and the CQC will notify local authorities in the event it considers it likely that services will be disrupted as a result of business failure. The law means that local authorities will step in to meet individuals’ care and support needs if a care provider business fails and its services are disrupted. The relevant local authorities are working up contingency plans to ensure individuals’ care and support needs continue to be met.

While the long-term options are being resolved, it is right that funding for social care comes from a variety of sources, including business rates, general taxation and the social care precept. Delayed transfers of care is one area where that money is clearly making a difference. This Government are clear that no one should stay in a hospital bed for longer than is necessary; doing this removes people’s dignity, reduces their quality of life and leads to poorer health and care outcomes.

[Maria Caulfield]

My local East Sussex County Council is a rural authority, so for decades it has had 49% less funding per head of population, yet it has had the same pressures as the areas represented by Opposition Members. By working together with health services, my council has reduced delayed discharges by 38%. Will the Minister welcome the hard work of East Sussex County Council?

[Caroline Dinenage]

I do welcome it. I recognise the very hard work of local councils that have managed to reduce delayed transfers of care. Indeed, I also recognise the very hard-working NHS staff, such as my hon. Friend, who have also helped to make that a reality.

We know that the NHS is busier than ever before, with hospital admissions rising by 33% since 2007, yet we have set clear expectations for reducing delayed discharges. Despite these challenging circumstances, both the NHS and social care have been working hard to free up beds. Since February 2017, more than 1,600 beds per day have been freed up nationally. I need slightly to take exception to the way the hon. Member for Worsley and Eccles South described people being discharged before they are medically fit. If someone is experiencing a transfer of care that has been delayed, it is because a multi-agency team have already assessed them as being medically fit for discharge.

NHS Staff Pay

Maria Caulfield Excerpts

Wednesday 21st March 2018 Commons Chamber

[Mr Hunt]

What led to the mushrooming agency fee was the realisation, post Mid Staffs, that we needed a lot more nurses. Nursing staff numbers were going down until the Francis report was published, but the report created huge demand among hospitals, which realised they needed to improve patient safety by recruiting more staff. The hon. Gentleman will be pleased to know, however, that we are bringing down the agency bill, and I expect it to be significantly lower this year.

[Maria Caulfield (Lewes) (Con)]

It is disappointing to see the lack of welcome from Labour Members for this pay rise for NHS staff in England—one day after the announcement of five new medical schools across the country. Has the Secretary of State had discussions with the Labour Government in Wales to see if they will be replicating this pay rise for NHS staff in Wales?

Oral Answers to Questions

Maria Caulfield Excerpts

Tuesday 20th March 2018 Commons Chamber

[Steve Brine]

Obviously, everybody in the House is aware of this case, and our thoughts are with Alfie and his family. The policing Minister has met Alfie’s family and discussed options that may assist him. No decisions have been made, and any proposal would need to be led by Alfie’s clinicians using sufficient and rigorous evidence.

[Maria Caulfield (Lewes) (Con)]

Despite not hearing it from Opposition Members, I am sure that all Members in this House welcome the five new medical schools announced today. Will the Minister also welcome the extra medical school places in Brighton and Sussex Universities, supporting my constituents, and the launch last week of the new nursing apprenticeship scheme by the University of Brighton, which will enable more nurses to enter the profession?

NHS Winter Crisis

Maria Caulfield Excerpts

Wednesday 10th January 2018 Commons Chamber

[Maria Caulfield (Lewes) (Con)]

I regret that Opposition Members have continued to politicise this issue. I speak as someone who has worked in the health service for more than 20 years. I worked in A&E under the previous Labour Government and coped with the winter pressures—when there were ambulances queuing round the block, when major incidents were declared because we could not take in any more patients, and when patients were cared for in corridors, including cupboards, and left lying on floors on makeshift mattresses. To continue to blame one Government or the other does nothing for patients or staff. If we continue down that route, we will be here not just next year or the year after, but in five, 10 or 15 years’ time.

This is not just about throwing money at the problem. We have heard today that Wales gets 8% more funding per person than the rest of the UK, yet it is also facing pressures this winter. Hospitals there are also cancelling operations and appointments, so this is clearly about not just funding, but what is done with the money.

I pay tribute to my local health service. In a debate at this time last year, I asked why the two trusts in my constituency were not coping when a neighbouring trust in Worthing was able to cope with virtually all its patients. A year later, after the imposition of special measures, after the CQC put in extra resources, and after a new management team were put in place, I am proud that both my local hospitals have coped with not just a 6% increase during non-winter periods, but an 11% increase in the number of patients not just visiting A&E but being admitted to A&E. They have not had to cancel hospital appointments, they have not had patients waiting in corridors and they have not had ambulances queueing round the block.

That tells me that this is not just about how much money people put into the service; it is about what they do with that money. Let us look briefly at what my local trust has done to stop the crisis which seems to have happened in other parts of the country. NHS staff, including doctors, nurses, porters and ambulance staff, have worked tirelessly throughout, and I pay tribute to them. It is also about the management, and the new management teams in Eastbourne and Brighton have done tremendously well to turn those services around.

It is also about better planning. My local community health trust has seen a 38% reduction in delayed discharges, so going into the winter period, it had an occupancy rate of about 84% in acute hospitals. That was achieved by working together with community services. A major Government or departmental reorganisation is not needed; change can be achieved by working locally, which is what the trust is doing.

This is also about working with social services on social care. Opening up 40 community beds in Newhaven has taken a huge amount of pressure off local hospitals, and both my trusts say that the emergency money provided this winter—nearly £2 million to each hospital trust—has enabled them to keep those beds open. It has enabled patients to be admitted to the acute centre for treatment, and then moved to the community hospital and be discharged safely and securely.

We need to look at capacity. If there is going to be an 11% increase year on year in the number of patients coming through the door, the solution is not just providing more money; it is about looking at the service and how it is delivered. My local trusts have done it, and there is no reason why that cannot happen in the rest of the country. Once again, I pay huge tribute to Brighton and Eastbourne Hospitals.