Eye Health: National Strategy

Matthew Offord Excerpts

Wednesday 17th May 2023 Westminster Hall

[Dr Matthew Offord (Hendon) (Con)]

It is a pleasure to serve under your chairmanship for the first time, Mrs Harris. I congratulate the hon. Member for Battersea (Marsha De Cordova) on securing today’s debate. She knows that I feel strongly about eye health and sight-related issues. On one hand, I am pleased to come along to support her. On the other hand, I am disappointed to be having to speak in this debate, because it was not long ago—in fact, it was 11 January last year—that we had the previous debate.

That debate, introduced by the hon. Member for Strangford (Jim Shannon), was on eye health and macular disease. As well as the hon. Gentleman, we heard from the hon. Member for Rutherglen and Hamilton West (Margaret Ferrier), my hon. Friend the Member for Sedgefield (Paul Howell), the hon. Member for East Londonderry (Mr Campbell), my hon. Friend the Member for Darlington (Peter Gibson), the hon. Member for West Ham (Ms Brown), the right hon. Member for Hayes and Harlington (John McDonnell), my hon. Friend the Member for Great Grimsby (Lia Nici), the hon. Member for Coatbridge, Chryston and Bellshill (Steven Bonnar), my hon. Friend the Member for Gillingham and Rainham (Rehman Chishti) and the hon. Member for Denton and Reddish (Andrew Gwynne)—and we all came to the same conclusion.

There were a lot of kind words from the Minister in that debate, and a lot of sympathy for our enthusiasm for a national eye strategy. However, I never actually heard the Minister say that she would agree to an eye strategy. That was surprising considering that, during the debate, we learned that over 2 million people currently live with sight loss, and 350,000 people are registered blind or partially sighted. We also learned that age-related macular degradation is a leading cause of blindless. That can be averted with more accessible healthcare provision. We also learned that more people suffer from macular degradation than dementia. Considering the political priority we give dementia, that seems quite shocking.

During that debate, people took the opportunity to talk about sight loss. I do not use the Chamber as a confessional, but I admit that when I first had macular degradation, I had a conversation with my wife to ask whether life would really be worth living if I lost my eyesight. That has always stayed with me. It is an important issue, and not only to me. When I first experienced the problem, I was amazed at how many constituents told me that either they or their families also had sight loss problems. It is a big issue for many people.

During the previous debate, the Minister was keen to stress the additional £2 billion provided through the elective recovery fund. She also mentioned the additional £5.9 billion of capital funding to support elective recovery diagnosis and technology. I was left mystified about how many people would actually be treated for issues relating to their sight, be it cataracts, macular degradation or anything else. A week later, on 18 January last year, I asked the Department how many cataract operations would be performed as a result of the £2 billion allocated to the NHS through the elective recovery fund. The response was:

“This information is not held centrally, as this funding will not be distributed through set allocations.”

So the answer is none.

I have asked several other questions of the Department. I was most disappointed when I realised that the Minister had no intention to introduce a national eye strategy—something that I called for in last year’s debate—so I asked the Secretary of State, straightforwardly,

“if he will introduce a national eye care strategy.”

The response was:

“There are currently no plans to introduce a national eye health strategy. However, NHS England and NHS Improvement are recruiting a National Clinical Director for Eye Care to lead improvements in eye care services.”

That came on 17 January 2022, a week after last year’s debate. If there is a national clinical director for eye care, what are their achievements so far? Will the Minister provide an update on that?

I went back to the Department on 3 March to ask why its policy is that a national eye care strategy is unnecessary. The answer was:

“Regionally based National Health Service commissioners are responsible for commissioning secondary care ophthalmology services, out of hospital services from primary eye care providers and the NHS sight testing service. These services are put in place to meet local identified needs, which vary across the country. It is therefore important to allow local areas to set their own priorities.”

I have to ask the Minister: is it the case that we will not get a national eye strategy following today’s debate?

I attended an event with the hon. Member for Battersea where the person who I thought was the eye Minister, my hon. Friend the Member for Colchester (Will Quince), said that he would think again about a national eye strategy. I thought that this issue was probably important to him, and I asked him some questions in Parliament. I asked him for his assessment of the impact of ophthalmology waiting times on patient outcomes. I did so to try to understand whether he felt that this was an important issue and that we needed to establish a national eye strategy. His response was:

“No formal assessment has been made.”

I asked the Secretary of State yet another question:

“what assessment his Department has made of the potential economic benefits of additional funding in sight loss research.”

For Conservatives, that would be good fiscal policy, because we could ensure that people are not dependent on the state and are not a burden through increased taxation on others, but the answer came back:

“No specific assessment has been made.”

So the answer is that we simply do not know, and we are not going to get any answers by asking the Department.

I ask the Minister to say today that this is an important issue. It is important, especially for people who have gone through the process of thinking that they may lose their sight—they may even question whether it is worth living. As I said, I have certainly been through that. I would like to see greater provision, because the impact of eyesight loss and partial sightedness is huge.

[Janet Daby]

I thank the hon. Gentleman for talking about his personal experience. Among children who have special educational needs and disabilities, sight loss often goes undetected, which is why it is so important to have ophthalmology treatment within SEND schools. Does he agree that if the Government are going to introduce a national eye health strategy, that issue should be one of their priorities?

[Dr Offord]

I certainly do, as the hon. Lady would expect. The implications of having problems at an early age are much longer term, so we will find people without access to education and, ultimately, to employment, and their quality of life will certainly be much reduced if that provision is not implemented. I believe that it should be a major component of a national eye strategy.

In conclusion, I simply say to the Minister that he should make a national eye strategy his legacy, before it is too late.

[Siobhain McDonagh (Mitcham and Morden) (Lab)]

It is a pleasure to serve under your chairmanship, Mrs Harris. I thank my hon. Friend the Member for Battersea (Marsha De Cordova) for securing this debate, which is about such an important issue. I know that the debate is about a national eye health strategy, and I agree with all the important points raised by my hon. Friend, who continues to be an inspirational campaigner on disability rights. I would go so far as to agree with all hon. Members who have contributed to the debate so far. But I want to focus on something more specific.

In April 2021, the NHS started a scheme that provided sight tests and dispensed glasses to children in special schools in the familiar surroundings of their own schools. The NHS special school eye care service was created after a shocking statistic came out: children with learning disabilities are 28 times more likely to have a sight problem than other children. Four out of five children with a severe learning disability attend a special school, and decades’ worth of studies and reports have all identified higher levels of sight problems in children who attend special schools. We found out that 40% of children in such schools need glasses, but because children have complex needs, they are often unable to get a check-up. Their behaviour makes it hard, and families are hard pressed to attend all the appointments.

[Dr Offord]

The hon. Lady is entirely correct that children with special educational needs often have sight problems, but such problems affect not just those children but children with behavioural problems. They often have behavioural problems simply because they cannot see, and so learn, in the classroom.

[Siobhain McDonagh]

The hon. Member is absolutely correct, and we know from the special school eye care service that so many pupils’ behaviour improves as a result of having glasses.

As I have already said, many people with severe learning difficulties find it very challenging to go to appointments or have their eyes examined. We have learned that attending an eye care appointment has been such a stress that 55% of children with special needs miss the appointments that they have had booked. That is not just an extra and unnecessary stress on the NHS, which certainly does not need that at the moment; it also means that the children are not getting the eye care that they need.

That is where the NHS special school eye care service comes in. It was just common sense: bringing eye care into special schools solves the problem of missed appointments and ensures that thousands of children who would have had their eyesight disability ignored get the healthcare that they deserve. That value cannot be overstated. Children with special needs have enough on their plate; if they also suffer from eyesight problems, but cannot explain what is wrong and can never get the problem checked out by a doctor, it must be awful.

Parents and special schools have praised the scheme, because school is a familiar place for children and the service is also cost effective for the NHS. It is one solution to many of the problems in eye care: it helps to get children out of hospital services, and it addresses health inequalities for this patient group for just tens of pounds. In 2015, I visited my local school for children with severe special needs, Perseid School in Morden—an all-through school for three to 18-year-olds led by the inspirational headteacher Tina Harvey, who retires after 20 years in July. I thank her on behalf of all her pupils and families and our entire community for her tireless and brilliant work in her school, which is rated outstanding by Ofsted.

At the school, I met Alyson, a mum, who told me that her daughter Ellie was getting used to eye care in the familiar environment of her school, and not having to take time out for hospital eye clinic appointments. That gave Alyson one less thing to worry about as a parent, and had greatly reduced Ellie’s anxiety. I invite the Minister to come to the school to see the work being done there; his predecessor has visited. It is important that I can show him how the scheme looks on the ground.

After the scheme was extended to 83 special schools, giving 9,000 children eye care that they might not otherwise have had, the further roll-out of the scheme was halted in August 2022 for an evaluation, which has not yet been published. The NHS now says that the scheme is just proof of concept, and that the proof-of-concept service will end in July—in two months’ time.

Parents, schools and eye care providers are absolutely gutted. More than anything, they are confused about what will happen next. There is still no sign of the evaluation, so there is a very real prospect that there will be no eye care services at all in schools after September 2023. I hope that will not be the case. I know that the Minister recently met charities and eye care bodies to hear about the service, but it still is not clear what NHS England will do.

I do not have many huge asks of the Minister today. I just want a very simple fix that will give certainty to parents. Will he publish the evaluation as a matter of urgency? If he can make sure that the evaluation is published, I have no doubt that it will provide evidence of the clinical need for such a service. Once we have the evaluation, we can start to look to the future of the scheme. I am convinced that NHS England should continue the day school service after July; I hope that he can see why that is absolutely common sense.

I conclude with a quote from a new special school, Kingsley High School, which has used the service. Reshma Hirani, assistant head, says:

“This service should be part of the NHS core offer so that it never stops. My pupils have struggled to access eye care in the community and now they have, quite rightly, something that is going to transform their lives. Well done NHS England for thinking about schools like Kingsley and our children. As a Qualified Teacher of Children and Young People with Vision Impairment I can now put in the support that children need, with the confidence that I have all the right information to hand. It really is the gift of sight.”

I reiterate that NHS England’s evaluation still has not been published. Given that there are only a few weeks before the service will have to start making staff redundant, I urge the Minister to publish the evaluation as soon as possible, so that parents, children and everyone involved has the certainty that they absolutely deserve.

Eye Health and Macular Disease

Matthew Offord Excerpts

Tuesday 11th January 2022 Westminster Hall

[Dr Matthew Offord (Hendon) (Con)]

It is a pleasure to serve under your chairmanship, Ms Nokes. I also pay tribute to the hon. Member for Strangford (Jim Shannon) for securing the debate.

I first became interested in eye health as a child when I wore glasses and had extreme myopia. That manifested itself in 2011 when I had my first detached retina and experienced the possibility of losing my eyesight. I had a second detached retina that necessitated an operation at Moorfields. That was two detached retinas, and I subsequently required cataract operations on both eyes.

My clinical experience at Moorfields was very good and I had no problem with that. However, when I had subsequent check-ups for glaucoma, there was an excessive number of people per session. On occasion, my consultant was treating up to 100 people in under three hours, which greatly concerned me. This is an issue about which I have always been passionate, more so when constituents came to me and said that they had experienced problems, not only with glaucoma and age-related macular degeneration but with cataracts. I realised that this was a problem across the whole of society.

In 2019, the hon. Member for Enfield, Southgate (Bambos Charalambous) called for a national strategy for eye health, which I support. More recently, in response to a written question, the Government stated that there were no plans to develop a national strategy for eye health and that, given the size and variety of health needs in England, the approach should be managed locally.

That is not a view that I share. As the hon. Member for Strangford said, the number of people waiting for treatment on the NHS for eye-related conditions has increased during the pandemic. We are certainly aware of that, but what is most troubling is that clinical commissioning groups ration the number of operations for conditions, including cataracts. A survey in 2017 of ophthalmic leads shows that some CCGs apply even stricter access to patients needing surgery on a second eye. That means, as has been said, that people are unable to drive and, certainly, unable to read, and have great difficulty accessing normal sight due to the need to wear a single glass lens in a pair of glasses, rather than glasses for one eye.

I have struggled with the possibility of losing my sight, both as a Member of Parliament and as an individual. May I tell the Minister that it is a difficult diagnosis to receive when someone says, “If you do not have this operation, you will lose your sight. If you have it, you will probably save your sight. We have to tell you that, if you do not have it, you will definitely lose your sight”?

I have been keen to campaign for more eye clinic liaison officers. I have repeatedly asked Ministers about the number of eye clinic liaison officers and how we could have more. The response has always been that they are funded by CCGs based on assessment of need. In dealing with the impact of sight loss, the actions of ECLOs in helping people through their support and rehabilitation has always been judged to be of great value. In September 2021, a response that I received to a written question said:

“Eye clinics and their staff, including Eye Clinic Liaison Officers, are commissioned, and funded by individual Clinical Commissioning Groups on the basis of local assessments of need, details of which are not routinely collected centrally.”

Once again, we go back to the point of having the issues decided at local level, with the Department of Health and Social Care not knowing how many officers are in attendance.

The Department is keen to highlight the additional £2 billion that is going into the NHS this year—£8 billion over three years—to increase activity on the elective care backlog caused by the pandemic and other factors. We welcome that, but I have a problem with Ministers never identifying where any of the money will be awarded. Eye health is never identified, so we do not know how many elective operations will occur in the next year or the next three years. The Department also says:

“NHS England and NHS Improvement’s National Eye Care Recovery and Transformation programme aims to transform secondary care ophthalmology services by using existing funding more effectively to improve service quality and patient outcomes.”

That seems to counteract an assertion that any of the £2 billion this year, or the £8 billion over three years, will be allocated directly to eye care.

I have two asks of the Minister. The first is to establish, promote and publish a national eye health strategy for England. The second is to identify and allocate resources to ophthalmology so that we can say to our constituents that, when they need the NHS at a moment that could effectively end their productive life through the loss of their sight, we will be there for them.

Eurotunnel: Payment

Matthew Offord Excerpts

Monday 4th March 2019 Commons Chamber

[Matt Hancock]

No, the decision to settle this case in order to provide for the unhindered supply of medicines, which I am sure that, like me, the hon. Gentleman, agrees is important, was the correct judgment and the correct decision, because we need to make sure that we keep people safe.

[Dr Matthew Offord (Hendon) (Con)]

Although it can never be comfortable to give a settlement to any organisation, I have to agree with the Father of the House, my right hon. and learned Friend the Member for Rushcliffe (Mr Clarke), that it is better to draw a line under this and move on. [Interruption.] The hon. and learned Member for Edinburgh South West (Joanna Cherry) is chuntering. I shall have to defer to her knowledge of losing cases in the legal courts. Can the Secretary of State tell me whether it is correct that Eurotunnel has said it will use this money to provide increased resilience at the Dover port?

[Matt Hancock]

Yes, my hon. Friend is correct. He makes a broader point: people watching these proceedings, people who have serious illnesses, and people who rely on medicines every day to keep them alive will be amazed by those Members who will not vote for the deal and therefore make a no-deal exit more likely, and by those Members who just cause political noise rather than admitting that, in the circumstances, they too would have settled this case. We are hearing a lot of that from those on the Opposition Benches. On the Government Benches, however, we are hearing from Members who care deeply about making sure that people get the medicines that they need.

Appropriate ME Treatment

Matthew Offord Excerpts

Thursday 24th January 2019 Commons Chamber

[Carol Monaghan]

Actually, NICE has taken a very positive step in reviewing the guidelines—it is listening to the community—but until they are published in 2020, we need NICE to make a public statement about the potential harm of graded exercise; patients must be made aware of the risk. It is a big ask to request that the Minister talks to NICE and encourages it to make that statement, so that this information can be added to the current guidelines while we are waiting for updated guidelines in 2020.

Care programmes for people vary greatly. Some with ME describe medical professionals who are sympathetic, but others talk of being disbelieved and forced down treatment paths to which they have not consented. Coverage of ME in many medical textbooks remains potentially misleading and inadequate, even non-existent. Health professionals must be equipped with clear guidance on diagnosing ME early and accurately, and with appropriate basic management advice.

At the end of last June’s debate, the Minister for public health resolved that

“as a result of the debate I will redouble my efforts to”

raise awareness among medical professionals concerning ME, and said that

“as part of my role as Minister for primary care, all GPs certainly should be aware of ME”.—[Official Report, 21 June 2018; Vol. 643, c. 229WH.]

That was a welcome statement; I would now like to understand what concrete steps have been taken since that promise was made. Furthermore, I would ask the Minister to ensure that ME clinics and treatment centres are aware of the risks of graded exercise and are not forcing this on patients.

Some of the worst cases we hear about are children with ME. ME affects an estimated 25,000 children in the UK. Many experience significant distress when disbelieved by medical and teaching staff, often when these professionals do not understand how ME affects the child’s ability to attend school.

[Dr Matthew Offord (Hendon) (Con)]

Is the hon. Lady aware that one in five families looking after children with ME have been referred to child protection services?

[Carol Monaghan]

Yes. The statistics are terrible, but I want to describe one such case, which is really quite harrowing. It involves a girl, B, whose name cannot be disclosed. B became ill at the age of eight. A diagnosis of probable ME was made, but it was suggested that the underlying issues were psychological. To show willing, her parents took her to a child psychiatrist, who then involved social services. B’s parents were warned that if they did not fully comply, child protection proceedings would be initiated. Social services specified graded exercise, despite being warned of the dangers. As a result, B deteriorated rapidly until she became wheelchair-bound. Under threat of court action, B’s parents were then forced to take her to a children’s hospital, having been warned that they were “not under arrest just yet.”

B’s parents found what they presumed to be a safer option in an ME unit run by a consultant who appeared to view ME as an organic illness, but this was disastrous. B arrived wheelchair-bound but still able to sit upright and read and write, but under the activity programme, she deteriorated. Her mother was banned from visiting, but other parents in the unit observed B unattended in the wheelchair, in constant pain, unable to sit upright, with her head hanging down the side and crying in distress. This treatment continued for five months. Her parents were threatened that if B did not progress, she would be transferred to a psychiatric unit or placed in foster care. Desperate, they turned to Dr Nigel Speight and the Young ME Sufferers Trust. B was finally allowed home, and her name was eventually removed from the at-risk register. However, by the age of 15, she was bedridden, paralysed, unable to feed or wash herself and utterly dependent on carers. Doctors, psychiatrists and social services all failed her when she was eight. As the hon. Member for Hendon (Dr Offord) suggested, this is the case for one in five families living with a child with ME.

A firm diagnosis of ME protects the child from these proceedings, but unfortunately, paediatricians are often reluctant to give this, simply because they do not understand the condition. This leaves the child open to social service intervention. Often, paediatricians phone a so-called expert on ME, who immediately prescribes graded exercise, without even seeing the child in person. I say to the Minister that this is a national disgrace and it needs urgent action. Children who are already blighted by ME must not be subjected to this trauma. I ask him to consider this issue with the utmost seriousness, and to give the House an assurance that parents will not be prosecuted simply for caring for a sick child.

ME has been disregarded for far too long, and it can be fatal. In the UK, there have been two patients, Sophia Mirza and Merryn Crofts, whose deaths have been attributed by coroners to ME. However, the actual number of deaths due to ME may be much higher, and we cannot wait for more. The ME community have waited decades for their voices to be not only heard but believed. The Government have the power to make radical changes, and I invite the Minister to meet groups of patients who would welcome the opportunity to describe their experience. Little progress has been made in the 20 years since the 1999 debate. Surely, Minister, in the 21st century we can do better for those suffering from this devastating illness.

NHS Long-term Plan

Matthew Offord Excerpts

Monday 7th January 2019 Commons Chamber

[Matt Hancock]

As I have said, after I became Secretary of State, we put £240 million extra into social care, and there will be £650 million next year.

[Dr Matthew Offord (Hendon) (Con)]

I congratulate the Secretary of State on this announcement and particularly on the increase in spending, which is more than the Labour party promised at the last general election. The vital point of today’s announcement is the publication of the plan, which has been decided by clinicians, so that they can tell politicians what is right for the NHS. Will he thank the clinicians for that work? We want to take party politics out of the NHS.

[Matt Hancock]

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

Organ Donation (Deemed Consent) Bill

Matthew Offord Excerpts

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

[Nigel Huddleston]

My hon. Friend makes a perfectly valid point that I am sure will be raised again in this debate, but we are talking about a matter of life and death. All the surveys show the large number of people willing to support organ donation in principle, so it is alarming that the number who are actually on the organ donation list is relatively low, despite the fact that it takes literally two minutes. In an ideal world, everybody would be completely educated and would voluntarily make their own choice, but that is not happening. Many such issues will be raised in Committee; I hope we will be able to find a reasonable alternative.

[Dr Matthew Offord (Hendon) (Con)]

Is my hon. Friend aware that in the past 10 years the number of organ donors has increased by 75% and the number of transplants by 56%? Is there really a need for the Bill?

[Nigel Huddleston]

There is indeed, because there is still a long way to go and people are still dying because they are not getting the donations or transplants that they need. There absolutely is a need to move forward with the Bill.

Let us look at the alternative systems around the world. The example of Spain is often mentioned. We are looking at the system there as some kind of model, although perhaps not an exact one. Spain leads the world with 43.4 deceased donors per million. It is joined at the top of the statistical league table by other opt-out systems in countries such as Croatia, Portugal, France and Italy. All these countries have better donor rates than England and all have opt-out rather than opt-in systems. Another advantage of such “soft” opt-out systems is that they do not deny or restrict the role of bereaved families, and they allow families to be consulted on the wishes of their loved ones. That is important.

One thing that surprised me about that 43.4 per million figure was how incredibly low it is. Half a million people die in the UK every year, yet just 1% of them die in circumstances or conditions that allow them even to be potential donors. It is important to note that just because someone is on the donor list, that does not mean that they will end up donating their organs, but we need to get the figure as high as possible to help as many people as we can.

We also need the supporting infrastructure to enable those who wish to donate actually to do so. We have all heard about people who have been willing to donate their organs but have, for example, passed away at the weekend in a hospital in which there is no capability to take the organs out of their bodies and transplant them. We need to look carefully at the supporting mechanisms for any changes that are introduced.

Quite a few colleagues have mentioned the need to raise overall awareness, which is linked to the need to encourage family consent. It is telling that in cases where a specialist nurse is involved, donation consent rates are 68.6%, whereas if a specialist nurse is not involved, consent rates plummet to 27.5%. That is clear statistical evidence that when people are provided with impartial but expert information about the possibility of donating, they are more likely to consent to donating their organs.

One problem is that there is still an awkwardness or queasiness about the idea of one’s body being examined and operated on post-death. We are often comfortable about that ourselves, but, in the horrible circumstances of someone passing away, particularly if the circumstances are tragic or the death unexpected, our families are particularly queasy about the idea. It is therefore vital that we continue to have these dialogues—that we all go home and have these conversations with our families, including our children, because of course children can also become donors. We must have informed conversations.

It is simply not right that 80% of people say that they would be willing to donate their organs, but only 36% actually register to do so. The number is increasing, but we need it to be much higher. In a well-publicised opt-out system, those figures could converge, and the 20% who are unwilling to donate would have a simple mechanism for making sure that they do not have to do so.

Many years ago, I was asked if I had a private Member’s Bill—I think it was during one of the selection processes—what would it be. It would be exactly this one. The hon. Member for Coventry North West should be in no doubt that I fully support this Bill, and I hope that many of, if not all, our colleagues will do so too.

--- Later in debate ---

[Dr Matthew Offord (Hendon) (Con)]

I congratulate the hon. Member for Coventry North West (Mr Robinson) on promoting the Bill, and I know that it will make progress today. As many people have said, 80% of British society support organ donation, but 20% do not. I want to speak on behalf of that 20% to ensure that they are carried along with the debate, rather than left behind.

A gentleman in my constituency, Vijay Patel, was recently unnecessarily killed, and his family took great comfort from the fact that his organs were used to help other people. For me, that is such a gift, and I commend anyone who donates, and their families, for allowing the donation to take place. Many people prepare themselves to be organ donors after they die, and their families are an integral part of that process. Within that wider framework, the crucial role of the donor’s family must be understood, because their role regarding the ownership of the body after a person dies, and their duties towards it, is a central aspect of the grieving process.

There has recently been a lot of concern about a north London coroner who refused to release bodies, which is causing a great deal of concern to my constituents. It therefore follows logically that the family must be involved in organ donation, and I believe that their consent is paramount at the crucial time. Those families need reassurance along their pathway towards consent.

It has been said that there are religious differences on donation, but that is incorrect. Both Islam and Judaism allow organ transplants from live and deceased patients in order to continue and save lives. One factor that perhaps some are not aware of, and that might influence the decision-making process of some families, is how the point of death is decided. Some people regard death as defined by cardiovascular criteria, which is when the heart ceases to function. Others use cessation of brain function—brain stem death—as their criterion. Those two distinctions sometimes make people uncomfortable with donation.

The National Institute for Health and Care Excellence recognised both definitions of death when it formulated the NICE guidelines that explain how healthcare professionals should support a bereaved family when discussing organ donation. There is one pathway for those who accept only cardiovascular death, and another for those who accept brain stem death. As a result, families are helped to understand how they might be able to combine deceased organ donation in a way that does not interfere with some religious traditions.

Enabling someone accessible to guide a family through the donation process is a humane, sensible and constructive proposal. A properly trained and resourced transplant co-ordinator should be able to do that, as it is the most important way in which families can be supported at a terrible time in their lives. In practice, however, under the system proposed, there would be less institutional incentive for health services to employ such people.

The Government are aware of the issues around transplantation, and they cannot plead ignorance in that our religious communities are being unresponsive to human need. In 2013, leading Muslim and Jewish groups wrote jointly to the Government suggesting a way forward in which an enhanced and improved opt-in system could be introduced that would alleviate their concerns. Improvements would include a Government-backed statement that Jews and Muslims could sign, which would enable them to donate organs in a manner compatible with their beliefs. If that approach were to be adopted, it would enable the two communities to be even more supportive of an opt-in system than they have been in the past. That proposal has been raised on several occasions, but I am afraid it has been ignored. The hon. Member for Coventry North West mentioned former Chief Rabbi Lord Sacks, who he said opposed such measures. As I understand it, however, the current Chief Rabbi, Rabbi Mirvis, is in favour of the proposal I have just outlined.

Life, and indeed death, has changed for many people. More people want, understandably, to spend their final months at home. If they die at home, organ donation is much less likely. Healthcare professionals who need to secure consent for donation must have a conversation with organ donors, and their loved ones, about why they are best placed to give the gift of life if they remain in hospital. That conversation is a natural feature of an opt-in service. Under an opt-out service, there will be little incentive to have that complex discussion with potential donors and their families. The result could be that patients might drift to spend their last months in hospital.

[Bob Stewart (Beckenham) (Con)]

May I ask my hon. Friend, as a doctor, how quickly the medical profession can assess whether someone who has died is the right sort of person for a donation? So few people are the right fit for a donation—1%, as I understand.

[Dr Offord]

I cannot mislead the House, because unfortunately I am not a medical doctor and I am not able to answer that question. I am certainly content to talk about socio-economic deprivation in places such as Cornwall, which was part of my PhD thesis, but I will leave the issue raised by my hon. Friend alone. He mentioned the 1%, but other potential donors and their families could be intimidated by clinical settings, have problems with language skills or be too emotionally distraught actively to engage with a system that lacked incentives to ensure professional support throughout their decision-making process. Such potential donors and families could find their rights eroded in that practice.

My hon. Friend the Member for Shipley (Philip Davies) made a point that I wish to echo. The underlying question raised by some considerations is whether public services should treat patients and their families as citizens whose active consent must be sought as a legal duty, or as subjects whose ability to choose whether to donate or not depends on the goodwill of well-meaning but overstretched professionals. Ultimately, an opt-in system that harnesses the role of both religious and civil society to increase organ donation from deceased donors is, for me, the best way forward to maximise organ donation while defending not only religious freedoms, but the rights of all potential donors and families.

Oral Answers to Questions

Matthew Offord Excerpts

Tuesday 19th December 2017 Commons Chamber

[Steve Brine]

EPP has a devastating impact on a person’s health and quality of life, and is something that the hon. Lady has discussed with me before. We will of course take the matter seriously, and I am very happy to talk to her more about it.

[Dr Matthew Offord (Hendon) (Con)]

Given that my own brother’s funeral will be held later today, may I ask the Secretary of State what help and support he is giving to the families of drug and alcohol abusers?

[Mr Hunt]

The whole House will want to express its condolences to my hon. Friend on what is happening this afternoon. He, alongside many people on both sides of the House, including the shadow Health Secretary, has raised this issue, and we are looking closely at what more support we can give to children in one of the most vulnerable situations imaginable. I thank him for raising the issue.

Adult Social Care Funding

Matthew Offord Excerpts

Thursday 6th July 2017 Commons Chamber

[Steve Brine]

I am sorry, but I did not see that programme. I shall look out for it on “watch again”. What we can do is put in place the toughest, most rigorous assessment and inspection regime, and that is what we have. That has come from this Secretary of State, not from the previous Government, who ducked the issue. What we can do is ensure that there is rigorous inspection to root out poorly performing services. That is the same in the hon. Gentleman’s constituency as it is in mine.

[Dr Matthew Offord (Hendon) (Con)]

With an increasingly ageing population, does the Minister agree that it is deeply cynical to pretend that there is some financial solution to this issue that does not involve very difficult decisions both within and across generations?

[Steve Brine]

Yes, I do. There were many disappointing things for me about the recent general election—[Laughter.] To be serious, one of the more disappointing things was that the debate around the future of adult social care was reduced to the use of the words “dementia tax”, which did the sector, our constituents, our public life and this Parliament an enormous disservice. We do need to have a grown-up debate in this country about this issue, and that is why we will bring forward proposals for consultation.

Land Registry

Matthew Offord Excerpts

Thursday 30th June 2016 Commons Chamber

[Mr Lammy]

My hon. Friend makes a very serious point. Even if there were a case for these proposals—I suspect all of us agree that there is no case—now cannot be the time to continue with them. There is no doubt that a private company would seek a profit and become a compulsory monopoly business, driving up the fees charged to users—the point raised by my hon. Friend the Member for Harrow West (Mr Thomas). A sale price of about £100 billion has been mooted in the press. A private company would therefore look to recoup this investment through the fees it charges and then turn a profit for its shareholders.

The argument we often hear in favour of privatisation is that competition will drive prices down, but this completely disregards the fact that the Land Registry is a unique asset in our lives. It is one of a kind, and users are compelled to pay the fees during any transaction involving land or property. There is only one Land Registry; it is a compulsory monopoly and we need to reflect on what would happen if this public monopoly became a private monopoly. We would have profiteering—pure and simple—by ripping off the public with inflated fees.

The Minister refused to answer my written question of 6 June about what steps would be taken to ensure that Land Registry service fees did not increase in the event of privatisation, so I hope we will hear something from him today. We are left to assume that the “protections” and safeguards that the Secretary State mentioned in the foreword to the consultation document do not include any protection from vastly inflated service fees. In time, whatever sum the Government might secure from a sale today will ultimately be paid for by the people and businesses who use and depend on the Land Registry’s services.

[Dr Matthew Offord (Hendon) (Con)]

rose—

[Mr Lammy]

I must make some progress.

We therefore reach the crux of the issue: the Government are looking to sell off the family silver to turn a short-term profit to try to make their sums add up. As the most recent Budget showed, the Government’s plan to close the deficit is dead in the water, so now they are looking around for assets to cash in. This privatisation is purely political, with absolutely no regard for what is right for the Land Registry or indeed the people of this country. The short-term profit derived from any sale will be dwarfed by the increased costs that are ultimately paid by all of us in the form of increased fees, and it will be dwarfed by the lost revenue to the public purse in the medium to long term.

There is no economic rationale for this privatisation. If the Land Registry were making a loss and being subsidised by the taxpayer, I could understand the Government’s enthusiasm for privatisation, but it has made a surplus in 19 of the last 20 years, and it returned over £100 million to the Treasury last year alone. The Land Registry pays rich dividends to the public purse, and there is absolutely no reason why it should pay dividends only to wealthy investors and shareholders in the future.

Satisfaction with the Land Registry is currently running at 96%. Far from being a basket case of public sector inefficiency, it is a shining example of a successful public service being run efficiently and effectively. I must state in the clearest possible terms that privatising it would be daylight robbery and a national scandal. Sadly, we know that this Government have previous: just look at what they did to Royal Mail.

Let me deal briefly with the conclusions of earlier studies. In particular, the Government’s quinquennial review of 2001 found that the privatisation of the Land Registry

“should be firmly rejected”,

and would

“be an act of…considerable folly”.

It is clear from the responses to the consultation on proposals to transfer the Land Registry to a service delivery company in 2014 that the proposed privatisation was decisively rejected by most of the respondents. We are told that

“91% of respondents did not agree that creating a more delivery-focused organisation at arm’s length from Government would enable Land Registry to carry out its operations more efficiently and effectively”,

and that

“89%...not be comfortable with non-civil servants processing land registration information”.

However, although the overwhelming majority of respondents made it clear that the Land Registry must remain publicly owned, the Government are back, disregarding what was said just two years ago and making their case again.

A further issue of vital significance is the impact that a privatised Land Registry would have on the transparency of our property market. The Panama papers leak earlier this year brought to light the industrial use of tax haven shell companies by tax evaders, oligarchs, corrupt crooks, drug traffickers and arms dealers seeking to conceal their wealth. More than half the 214,000 companies whose details were leaked were incorporated in the British Virgin Islands, and many channel their money into the UK property market. A total of 100,000 properties worth £170 billion have been registered by shady and opaque overseas entities in the UK to hide their true owners.

Meanwhile, the Prime Minister and Members of his Government have consistently spoken of a crackdown on offshore tax evasion and dirty money. Indeed, the Prime Minister himself declared last year:

"There is no place for dirty money in Britain... London is not a place to stash your dodgy cash.”

How, then, can we be in this situation? I noted with interest the Prime Minister's article in The Guardian, in which he said:

“We know that some high-value properties—particularly in London—are being bought by people overseas through anonymous shell companies”

using

“plundered or laundered cash.”

The Department for Business, Innovation and Skills has also said that it is aware of the problem. Perhaps the team who wrote its consultation document could let the Minister know.

I listened with interest to this year’s Queen's Speech, which promised that

“legislation will be introduced to tackle corruption, money laundering and tax evasion.”

I say this is in the strongest possible terms, and I say it as a warning to the Government.

We are faced with a severe housing crisis and institutional tax avoidance on a huge scale. First, we need serious steps that will make it harder for shady offshore entities to buy up property in this country, and secondly, we need to make it harder for opaque shell companies to shield themselves from scrutiny and investigation. Privatising the Land Registry would achieve the complete opposite. Surely the most basic common sense tells us that the first step in any crackdown on tax evasion, money laundering and corruption should be to ensure that data about who owns what are made public and are not privately held. As recently as last month, the Minister for the Cabinet Office told the Open Government Partnership in South Africa:

“The UK is a leader on transparency...Increasing openness and tackling corruption are 2 sides of the same coin.”

A public Land Registry could open up its data to support efforts to tackle the endemic corruption and abuse of the property market.

Currently, the average fee for the searching and provision of Land Registry data is £3. Journalists and campaigners have made use of that function to lay bare the true scale of offshore ownership of UK property, much of it derived from shell companies set up to avoid tax or to launder dirty money. A private organisation would have no obligation to open its data and would be able to charge whatever it liked for providing such data. Crucially a private company would not necessarily be subject to the Freedom of Information Act, so would have no duty to supply such data when asked.

Confidence in land and property in our society depends on a land registration system that is administered with integrity, neutrality and absolutely no conflict of interest.

It is a nonsense that a private company should be given an adjudicatory role on the land rights of citizens, other companies and the Government. It is a nonsense that a publicly owned Land Registry that is performing well and returning healthy dividends to the public purse should be turned over to a private owner. And it is a nonsense that this is being forced through by a Government apparently committed to tackling offshore tax evasion and corruption in this country.

This privatisation is not only woefully misguided, but plain wrong and should be abandoned before the public interest is sacrificed in favour of a short-term profit. I look forward to what the Minister has to say and the many contributions from Members in this House this morning.

--- Later in debate ---

[John Stevenson (Carlisle) (Con)]

I am pleased to make a contribution to this very important debate about a significant national organisation. Of course I am aware that the consultation has concluded and acknowledge that the Government have not yet come forward with any proposals for the actual privatisation of the Land Registry. I also bring to the House’s attention my entry in the Register of Members’ Financial Interests: I am a practising solicitor.

There are plenty of arguments for retaining the Land Registry in state hands, and we have already heard a number of them. Some of those arguments may be valid and some undoubtedly have merit, but quite a few are, to be honest, bordering on irrelevant. Similarly, there are very sound arguments to suggest it would be far more beneficial for the Land Registry to move out of state ownership into more commercially minded ownership.

[Dr Offord]

I wanted to say this to the right hon. Member for Tottenham (Mr Lammy) as well: while I certainly am a privatisation believer, I do not understand why the Government are seeking to take a public monopoly and make it a private monopoly. I cannot see the benefit that the market will be able to bring to that.

[John Stevenson]

My hon. Friend makes an interesting point, and unsurprisingly I could support many of the arguments for privatisation, but I will come to that in due course.

I want to make two specific contributions to this debate. First, I shall comment as a practitioner—as someone who actually uses the services of the Land Registry and whose firm works with the Land Registry on a daily basis. Secondly, I shall comment as a Conservative politician.

Speaking as a practitioner, the Land Registry is an extremely important aspect of the conveyancing and land ownership process. Indeed, it is central to the whole system as over 75% of land is already registered and ultimately all land will be registered, at which point no physical deeds will be required. Therefore, the accuracy and integrity of the register is absolutely vital. Each day thousands of transactions are logged through the Land Registry portal, queries are raised, and in some cases disputes are resolved. It is part of the everyday work of the conveyancer.

However, we have to accept that the Land Registry is not in any way perfect. Most practitioners would confirm this and I suspect the Land Registry itself would also acknowledge it. The Land Registry does make mistakes, it has backlogs, it needs investment, and it needs to modernise—it is in many respects just like many other organisations that have similar issues.

Operational Productivity in NHS Providers

Matthew Offord Excerpts

Wednesday 1st July 2015 Westminster Hall

[Mark Pritchard (in the Chair)]

Given the temperature today, colleagues may remove their jackets if they so choose.

[Dr Matthew Offord (Hendon) (Con)]

I beg to move,

That this House has considered operational productivity in NHS providers.

It is a pleasure to serve under your chairmanship, Mr Pritchard, and I welcome the Minister to his role. I believe this may be his first Westminster Hall debate, and I am greatly pleased that I am the Member who secured the debate.

The national health service featured heavily in the recent general election campaign. I recall speaking at several hustings and telling my constituents that I recognised that this Parliament would witness an increasing demand for NHS services. On occasion I was challenged on how the additional £8 billion highlighted by the Stevens review would be found. My response, then and now, is that the greatest efficiencies can be identified within current services without undermining patient care. Such a view is shared by Simon Stevens, but most interestingly it is a view shared by others, including my constituents Philip Braham and David Green, who established a medical recruitment company called Remedium Partners. I am pleased that both gentlemen are here today in the Public Gallery.

Having met Mr Braham and Mr Green before the election, I was eager to re-establish contact with them earlier this month to discuss their ideas about NHS efficiency in employment. It is possible that more cynical Members will say that this is more evidence of the Conservative party seeking to introduce greater private sector involvement in the NHS for others to make a profit, but that would be an incorrect assertion to make. In fact, I found our discussion focusing on opportunities to save the NHS more money and prevent its resources being plundered by unscrupulous individuals.

The publication of Lord Carter of Coles’s interim report, “Review of Operational Productivity in NHS providers”—hence the title of this debate—two days before our meeting could not have been more fortuitous. The report outlined four areas where Lord Carter believes greater efficiencies could be achieved to allow additional moneys to be spent on front-line care. One objective in seeking today’s debate was to air the issues and to place them on the public record. Lord Carter’s efficiencies within the NHS include saving £1 billion from improved hospital pharmacy and medicines optimisation, £1 billion from the NHS estate, £1 billion from improvements to procurement management, and £2 billion from improvements in workflow and encompassing workforce costs.

Workforce costs is the area that I intend to focus on in this debate, as I have discussed it directly with my constituents and because just a 1% increase in workforce productivity could achieve as much as £400 million of savings. This is a significant and important area of the work of the NHS. Lord Carter believes that the £2 billion figure would be achieved without making anyone redundant and without seeking to increase the responsibilities of staff, nor would it mean decreased levels of remuneration for future employees. What it does mean is a greater command of management control on non-productive time, which are the periods when staff emphasis is not on direct patient care—days and shifts of annual leave, sickness and training. It also includes better management of rosters, improved guidance on appropriate staffing levels and skill ranges for certain types of wards.

The NHS is one of the largest employers in this country, employing more than 1.3 million staff in more than 300 different types of roles. In the last year that figures were available, the cost to the NHS budget was £45.3 billion, the largest proportion of the £118 billion budget. The cost of nurses alone totals £19 billion, and with the increased number required for safer staffing and a third increase in the number of nurses leaving the profession in the past two years, the reliance on agency nurses will see this figure rising.

[Mr Jim Cunningham (Coventry South) (Lab)]

When the hon. Gentleman talks about increasing the productivity of staff, can he itemise which staff he is referring to and say how much would actually be saved?

[Dr Offord]

We are talking about all the different staff. There are 300 different employment roles in the NHS, so we are talking about everyone across the NHS, but I hope later in my speech to come to the specifics of clinicians and the use of agency staff for that sort of role.

[John Stevenson (Carlisle) (Con)]

I congratulate my hon. Friend on securing this important debate. In my constituency in north Cumbria there is a hospital with a large number of agency staff, which has been a problem for some considerable time. I understand the need to employ agency staff, but does he agree that it would be far better to have staff employed directly by the hospital, as that would improve patient care and staff morale and also—to echo his point—improve the costs and productivity of that hospital?

[Dr Offord]

I certainly do agree with that point, and I hope to elaborate further on that. I also wish to touch on the use of bank nurses, or bank employees, who periodically work for parts of the NHS. I agree that for patient care it would be best to have full-time permanent staff who not only know the patients and the hospitals, but know the other employees they work with on a day-to-day basis.

Most worryingly, Lord Carter identified the fact that, in some of the 22 hospitals he surveyed, bank nurses are remunerated at a level that does not discourage them from remaining with, or moving to, agencies. I looked at the website of one of the trusts that took part in the review by Lord Carter and was surprised to see the range and number of bank employees—including, ironically, the position of the e-roster co-ordinator. I will not name that particular trust, as this debate is not a “name and shame” exercise, but I raise it to illustrate the point, because if such a role is vacant, what hope can there be to ensure that other clinical positions are staffed suitably?

The e-roster co-ordinator is in the best position to monitor employment and identify irregularities in work patterns to prevent fraudulent practices. The majority of people who work for the NHS are honest, but there are a minority who seek to defraud its resources. I want to highlight the types of fraud that occur. Such fraud involves staff and professionals who claim money for services not provided or more money than they are entitled to, or who divert funds to themselves. It can also involve external organisations that provide false or misleading information, including invoices, to claim money they are not entitled to. Some of these frauds can be fairly low value, but they can often cost the NHS hundreds of thousands of pounds.

One example is Michael Botham, a hospital worker in Stoke-on-Trent who claimed nearly £20,000 for shifts he did not work. He applied for work via a recruitment agency, AMG Nursing and Care Services, in October 2007. He was then assigned as an unqualified healthcare worker to Bucknall hospital in Stoke-on-Trent, where he worked in the complex needs ward. Most worryingly, it took a ward manager to identify an overspend and to report their suspicions about Botham to the trust’s local counter-fraud specialist team. When the team analysed his timesheets, they revealed that he had submitted false claims for work from 1 January to 26 July 2009, complete with forged authorisation. In fact, he had worked only one shift during that period.

Botham also claimed payment for four shifts at Bradwell hospital, part of the same trust, in January 2009. Again, he had not worked those shifts and the authorising signatures were also false. In total, the trust overpaid £19,362 as a result of his false claims to the agency, which invoiced the trust in good faith on a weekly basis, but subsequently, to its credit, offered to pay back its fees of £3,956.50. This is a clear case of an individual deciding to defraud the NHS, but what is concerning is that the problem emerged only as a result of the scrutiny of another member of staff whose role was not to look for fraud.

[Karin Smyth (Bristol South) (Lab)]

I worked for a clinical commissioning group in Bristol. Does the hon. Gentleman accept that one reason why that would have happened is that all members of NHS staff have to undergo mandatory and statutory training to recognise and counter fraud?

[Dr Offord]

I do, but I am saying that this should have been picked up by an individual with a strategic, holistic approach to staffing and staffing budgets, rather than leaving it to one individual on the ward who realised there was a problem with the budgets. There are processes in place to ensure that fraud does not happen, and I would like all hospital trusts to introduce such processes. In his report, Lord Carter highlights a case where one provider identified 20 cases of counter-fraud when they reviewed and strengthened their sickness and annual reporting leave. That prompts the question of why such abuses continue to be left unchecked.

There is another case of fraud that I want to highlight, which has been judged more harshly, although it can be argued that it is certainly not as deceptive because the individual actually undertook the work. Simon Olufemi Ajani was sentenced to 12 months’ imprisonment following a fraud investigation by NHS Protect after he had produced a false passport and certificate of entitlement to the right of abode in the UK. That enabled him to obtain work with patients at East London NHS Foundation Trust, South London and Maudsley NHS Foundation Trust, and other London trusts through NHS Professionals, the agency that supplies temporary staff to the NHS. His fraud was first uncovered through a data-matching exercise that highlighted inconsistencies between UK Border Agency records and NHS payroll records.

The difference between those two cases is that Ajani worked the hours that he was paid for, even though he was not entitled to be employed in this country, while Botham was just a crook stealing money directly from the NHS and patient care. These examples lead me to ask the Minister about the employment of those from outside the EU, an issue I have discussed recently with my constituents, as I mentioned. There is some criticism about the use of foreign doctors in the NHS, and some people consider that these jobs have been taken out of the reach of British people. However, we all know that the NHS does not have the numbers of doctors and nurses that it needs and there is not the capacity within the population of the United Kingdom to provide them. That is why some agency staff are required.

For some medical practitioners, however, remaining a locum is an alternative to having a permanent position. Some doctors are able to earn between £1,400 and £1,500 for a 12-hour shift, while the on-costs payable to agencies mean that hundreds of thousands of pounds a year are being charged to health trusts around the country for employment of temporary staff. One alternative to the costly system of locums could be the employment of a permanent doctor from overseas who could earn a salary of between £75,000 and £120,000. I need not ask the Minister whether he feels that this is better value for money than having a locum.

The NHS is an employer of those considered to have skills that are needed in this country, and a tier 2 visa allows “skilled workers” from outside the European economic area with a job offer to enter the UK. However, it has been established that the immigration health surcharge is levied against non-EU citizens. This requires every applicant and their dependents to pay not only their visa fees but a further £200 each year for up to three years. It strikes me as perverse that the very people needed to work in the NHS are being penalised by paying an additional amount that should perhaps be part of their terms and conditions of employment. Can the Minister explain in his summing up how the figure of £200 was reached and whether he feels that levying this tithe against NHS employees is counterproductive?

Lord Carter’s report goes on to identify opportunities in managing annual leave—what he terms the largest part of non-productive time. There are many ways in which NHS employers can ensure they manage staff leave. I am not going to stand here and say that the Minister should micro-manage the NHS in England, but even simple practices do not appear to be implemented in some NHS trusts. We all agree that, while the needs of patients must be considered when managing annual leave, people do need time off. Introducing a notice period of a month for leave requests of, say, more than three or four days would allow NHS managers the time to plan ahead, but that is not happening uniformly, thereby ensuring that agency staff are needed as an emergency measure.

Can the Minister therefore confirm that measures introduced by the Secretary of State to reduce agency locum spend will include a requirement for trusts to ensure that their employment practices and policies include such conditions as notice periods to book leave, that trusts consider employing e-roster co-ordinators and that trusts examine their employment policies so that they can compare themselves with their peers and undertake a skill mix review, the combination of which would reduce the need for spending on agency staff?

A fear raised with me by my constituents concerns the revalidation of full-time locum doctors. It is well known that locum doctors can experience a variety of challenges with revalidation, largely due to the peripatetic nature of their work, but annual appraisals are the backbone of revalidation and fundamental to demonstrating the fitness of medical professionals to practise. Revalidation should be carried out by the framework suppliers—the agencies that supply staff—but I have heard anecdotal reports that agencies do not revalidate, and it has been alleged that some health professionals are even practising outside their qualifications and skill range. Can the Minister tell us how the Department will ensure that the revalidation of all full-time locum medical professionals is carried out by the framework suppliers?

The final issue about the use of agency staff I want to raise is the use of master vendor contracts between health trusts and employment agencies. The use of this practice creates an opportunity for collusion within the employment industry to seek maximum financial gain through the use of exclusive contracts. While such contracts may be an easy option for the employer—in this case, the health trust—the agency can ask premium prices for a service that could be provided more cheaply if it were opened up to competition. Such a practice effectively introduces a closed shop and prevents smaller employment agencies from being able to enter the health market. Can the Minister advise us how the Department can ensure that the use of master vendors does not result in tacit collusion in the employment industry for exclusive contracts that cost the NHS more than it might pay for the services elsewhere?

In conclusion, this debate is not a negative criticism of employment agencies or the work of people in the NHS; in fact, it is the opposite. I congratulate the people who work in the NHS and I want to ensure that more people are employed in the NHS. I am framing this debate as an opportunity to assist the Government in ensuring that the resources needed by the NHS and identified by the Stevens review are made available. It is an opportunity to start the process by recognising where we can work smarter to ensure a better NHS for all and identify opportunities to achieve economies that do not undermine patient care, but in fact achieve the opposite, by ensuring the correct number of appropriately qualified staff in the NHS, working confidently, diligently and at a pace that ensures the best care for patients.

--- Later in debate ---

[Dr Offord]

It was a pleasure to start the debate under the chairmanship of Mr Pritchard and, indeed, it is a pleasure to finish under you, Mr Gray.

[Mr James Gray (in the Chair)]

Covering all your bases.

[Dr Offord]

The debate was fantastic, but not entirely what I expected. The NHS is often used as a political football. I thank the Members present for their contributions and for highlighting some issues for me to consider, as well as for the Department and the Minister to consider.

The personal NHS experience of the hon. Member for Bristol South (Karin Smyth) is welcome not only in the debate, but in the House as a whole, and I look forward to her contribution to other debates. I thank her for today’s contribution, which was important.

I was surprised at first by the hon. Member for Angus (Mike Weir), because the Carter review looked at England, and I wondered where the hon. Gentleman’s contributions would go, but I am pleased that both he and the hon. Member for Strangford (Jim Shannon) spoke about the devolved institutions and the lessons that can be learned throughout the United Kingdom from Lord Carter’s report. That is a great way for us to work as a one nation country.

I am grateful for the comments of the shadow Minister, who made some points about NHS procurement. Some issues about extraction from European Union procurement programmes still need to be resolved—I understand that the shadow Health Secretary, the right hon. Member for Leigh (Andy Burnham), says that that can happen, but Simon Stevens does not believe that is correct—so there are some good things for the Minister to go away and think about. I will certainly take them away too, and I am grateful for that.

In the short time I have available, I want to say a little about the response to the Carter review. There has been a positive response from the Royal College of Nursing, which not only acknowledged that nursing numbers have not been meeting demand, but stated:

“It is clear that there is waste in the NHS, which is holding it back from directing its resources to frontline patient care. Lord Carter’s review is a welcome illustration of how the NHS and individual hospitals could be much more effective in how they procure equipment, drugs, and above all staff.”

As the Minister said, we as parliamentarians therefore have a great opportunity to engage in the issue. As I said at the start of my speech, it came up at many hustings. It is often said that the Conservatives are not strong on the NHS, but I think we have a good story to tell. If we carry on in the same vein, and if the Minister carries on in the way he spoke today and in the recent debate in the main Chamber, that will please me and other colleagues.

I have been unfortunate enough in the past nine months to have need of the NHS, but I have been fortunate enough that it has been there. I am grateful. I have attended Moorfields, the BMI in east London and the Whittington with fairly serious issues. Indeed, my father-in-law had a hip operation on Friday, so I am grateful to the hospital in Swindon as well for making that happen. The care that he and I received has been second to none and I am grateful. I hope that it may continue to be such and that today’s debate will continue our efforts to make the NHS the best national health system in the world.

Question put and agreed to.

Resolved,

That this House has considered operational productivity in NHS providers.