Health and Care Bill

Nigel Evans Excerpts

2nd reading
Wednesday 14th July 2021 Commons Chamber

[Munira Wilson (Twickenham) (LD)]

I would like to make it clear that the Liberal Democrats have long supported the aim of integration between health and social care, and the far greater involvement of local authorities in the planning, commissioning and delivery of services. We recognise that the pandemic has forced many of these bodies to work closely together in a much more collaborative way, and that is welcome. However, the Bill pays lip service to social care. It is largely a Bill about NHS reform, with yet another acronym-laden reorganisation that seeks to provide the legislative basis to integrate NHS services, currently in crisis mode, with a broken, underfunded and fragmented social care system. It is a massive power grab by the Secretary of State for political interference in operational and local service reconfiguration decisions and in who runs integrated care boards. The Bill is woefully inadequate in ensuring that the plans and resources are in place to ensure that we have sufficient doctors, nurses and other healthcare professionals and carers to deliver care, both now and in the future. This is all against a backdrop of record waiting lists and staff who are burnt out, stressed and struggling to cope with the third wave of the pandemic while dealing with surging A&E visitors and tackling the enormous backlog of care.

Without meaningful social care reform, this Bill cannot realise its aim of providing citizens with better joined-up care. With over 100,000 vacancies in the workforce, 1.5 million people are currently missing out on the care they need, putting additional burdens on the NHS and, importantly, on 9 million unpaid carers. The Government have promised—at the moment I take them at their word, though they have broken it many times—that they will bring forward social care reforms later this year. So why not delay the Bill for a few months and take account of the new model of social care, rather than doing a half-baked job now?

It really beggars belief when we look back over the past 16 months of the pandemic that the right hon. Member for West Suffolk (Matt Hancock), who was the architect of the proposals, seriously thought that granting himself more powers over the day-to-day running of the NHS was a good idea. We only need to look at the PPE fiasco and the failures of test and trace, both of which were run centrally, to see that handing back power to the Secretary of State is the very opposite of what we need. Allowing him or her to meddle in the day-to-day running of our NHS seems to fly in the face of the desire for more local and regional decision making.

I fully support and endorse the proposals of the right hon. Member for South West Surrey (Jeremy Hunt) on the health and care workforce independent planning proposals. They need to be properly resourced and annually reported to Parliament. Without a workforce plan, without wholesale reform of social care and while waiting lists are skyrocketing and the Health Secretary is embarking on a power grab that is his predecessor’s vanity project, this Bill will fail in its fundamental aim, shared by most Members of this House and health and care leaders—

[Mr Deputy Speaker (Mr Nigel Evans)]

Order. The hon. Lady’s time has run out.

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[Debbie Abrahams (Oldham East and Saddleworth) (Lab) [V]]

This is the wrong Bill at the wrong time. To introduce a Bill like this when the covid pandemic is far from over and staff are on their knees shows a lack of understanding of what is needed.

I am concerned that this reorganisation of the NHS is being used as an opportunity to extend the involvement of UK and international private healthcare companies. The Bill proposes that private healthcare companies can become members of the integrated care boards, potentially meaning they will be able to procure health services from their own companies. Under the Bill, ICBs will have only a “core responsibility” for a “group of people”, in accordance with enrolment rules made by NHS England. There are concerns that this evokes the US definition of a health maintenance organisation, which provides

“basic and supplemental health services to its members”.

What is included in the core responsibilities?

Why is there no longer a duty but only a power for ICBs to provide hospital services? What does that mean for the thousands waiting for elective surgery? What about those waiting for cancer and other therapies? For those who say, “What does it matter who provides our healthcare as long as it meets the NHS principles of being universal, comprehensive and free at the point of need?” I say that not only is the Bill a clear risk to those founding NHS principles but there is strong evidence that equity in access to healthcare, equity in health outcomes and healthcare quality are all compromised in health systems that are either privatised or marketised, as the NHS has increasingly become.

That brings me to my third area of concern: health inequalities. It is notable that the Bill places the duties for the reduction of health inequalities with ICBs. The 2012 duty on the Secretary of State and NHS England to reduce inequalities is repealed, showing the clear lack of commitment to levelling up and the reduction of the structural inequalities that have been laid bare by this pandemic and contributed to the UK’s high and unequal covid death toll. With this change, the Secretary of State is ignoring not only decades of overwhelming evidence that clearly shows that health inequalities are driven at national policy level, but the Prime Minister’s commitment to implement the recommendations that Professor Sir Michael Marmot made in his covid review last December to tackle inequalities and build back fairer.

My final point is on social care. As chair of the all-party parliamentary group on dementia, I express my profound disappointment that, 19 months since the Prime Minister pledged to fix the broken care system, it still has not been fixed. The Bill is a missed opportunity to set out the framework for social care reform in the context of an integrated health and social care system. For people with dementia and their family carers, who have suffered disproportionately from covid, this is a real blow. They deserve better. For me, the principle of health and social care—

[Mr Deputy Speaker (Mr Nigel Evans)]

Order. Sorry, but we have to go on.

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[Philip Dunne (Ludlow) (Con) [V]]

I am pleased to support the Bill. It is the first significant reorganisation of healthcare in recent years, and only the second since the Conservatives came into office following 13 years of Labour Administrations who reorganised the health services nine times, so we should not be taking lessons from the Opposition on the timing or the fact of putting things right.

The Bill is very substantial legislation that learns lessons from the way in which the NHS has had to work during the covid pandemic. In particular, the flow-through of patients discharged out of the acute sector as a result of much closer working with social care and local authorities is an integral part of creating the new integrated care boards. I very much welcome the fact that they are being established on a statutory footing and that there will be representation from local authorities and a role for health and wellbeing boards to provide local oversight. That is an essential step to allow the healthcare economy across our communities to collaborate effectively, and to remove some of the artificial barriers.

I will touch briefly on three other points. On the measures proposed for reconfiguration, we in Shropshire have been at the wrong end of a protracted reconfiguration process for our acute hospitals. Streamlining the process by which decisions are made will benefit patients. In Shropshire, it has taken several years to reach the point at which decisions can be made, and at every stage obstacles are put in place that add to delay and uncertainty. As a consequence of that, it is hard to attract staff to a system not working as well as it should, and the system has gone into special measures. The provisions to streamline difficult decisions are therefore very welcome.

Secondly, as my right hon. Friend the Member for South West Surrey (Jeremy Hunt), the Chair of the Health and Social Care Committee, said, the Bill is somewhat light on workforce, but it does include key measures to speed up the ability of physicians trained in other systems to be welcomed into the NHS or to return to the NHS and if they have retired. I urge Ministers in Committee to look carefully at what can be done—

[Mr Deputy Speaker (Mr Nigel Evans)]

Order. I am afraid we are under huge time constraints.

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[Bell Ribeiro-Addy (Streatham) (Lab) [V]]

This month we marked the 73rd birthday of the NHS, and instead of celebrating it and giving it the homage that it deserves—the NHS, one of the very best things about our country—the Government have introduced a Bill that looks set to ramp up their long-standing attempts to continue to privatise it. I was proud to add my name to the reasoned amendment in the name of my hon. Friend the Member for Coventry South (Zarah Sultana) because we do not need private healthcare companies to sit on boards deciding how NHS funding is spent, further outsourcing of contracts without proper scrutiny, transparency and accountability, or the introduction of a model of healthcare that incentivises cuts and the closure of services.

Forcing NHS staff to implement yet another top-down Conservative reorganisation would take people away from the task of tackling growing treatment lists and coping with rapidly rising covid cases. We need to fill our 84,000 vacancies, and we need a 15% pay rise across the board for our NHS staff. It is hard to see how ordering a reorganisation such as this while ignoring calls for increased funding and a plan for social care could be anything other than disastrous.

This corporate takeover Bill—which is exactly what it is—will put private companies at the heart of the NHS and pave the way to sell off our confidential health data to multinational corporations. Nobody wants that. It will normalise the corrupt contracting that we have seen during the pandemic. The money that we spend on our healthcare should go to the services that we need, not to the pockets of Conservative party donors or corporate shareholders. Over the path of the pandemic, we have seen what this outsourcing and privatisation has meant in practice. Contract after contract awarded without competitive process. People being failed. Failing contracts. Delivery failed on again and again. Now the Government want to open up new ways for that to happen, just as they have done throughout the pandemic.

Let us consider what happened with Track and Trace, which was a complete disaster in the hands of Serco. The system has been so ineffective that, recently, MPs concluded that it had ”no clear impact”—a £37 billion system with no clear impact. After a decade of cuts, it was our NHS and its staff and volunteers who led the vaccination roll-out. That was a success, but it was their success, not the Government’s success. That is a lesson that we can learn about exactly what happens when we give the NHS the funding it needs, but the Bill does nothing to do that. We do not need more overpaid consultants involved the NHS; we need to value the staff we already have, and put in the investment that made the vaccination programme a massive success. We must be clear—

[Mr Deputy Speaker (Mr Nigel Evans)]

Order. We must move on to the next speaker.

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[Several hon. Members rose—]

[Mr Deputy Speaker (Mr Nigel Evans)]

The wind-ups begin at 6.44 pm.

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[Edward Argar]

She did.

In response to the hon. Member for Central Ayrshire (Dr Whitford), I am again grateful for her comments and happy to accept her kind invitation to join her on a visit to Scotland.

The right hon. Member for North Durham (Mr Jones) made a very important point. In doing so, he rightly paid tribute to the work in this space done by my hon. Friend the Member for Sevenoaks (Laura Trott) with her recent private Member’s Bill. As the Secretary of State said, either he, I or the relevant Minister will be happy to meet him to discuss it further. My hon. Friend the Member for Meriden (Saqib Bhatti) was right to talk about the need for local flexibility. That is what we are seeking to do.

The hon. Member for Eltham (Clive Efford) asked more broadly about public spending constraints after 2010. He is brave, perhaps, to mention that. I recall the legacy of the previous Labour Government, which the right hon. Member for Birmingham, Hodge Hill (Liam Byrne) summed up pretty effectively in saying,

“I’m afraid there is no money.”

On social care, which a number of hon. and right hon. Members mentioned, we will take no lessons from Labour. In 13 years, after two Green Papers, a royal commission and apparently making it a priority at the spending review of 2007, the net result was absolutely nothing—inaction throughout. We are committed to bringing forward proposals this year. Labour talks; we will act.

The NHS is the finest health service in the world. We knew that before the pandemic, and the last year and a half have only reinforced that. It is our collective duty to strengthen our health and care system for our times. I was shocked, although probably not surprised, that the Opposition recklessly and opportunistically intend to oppose the Bill—a Bill, as we have heard, that the NHS has asked for—once again putting political point scoring ahead of NHS and patient needs. For our part, we are determined to support our NHS, as this Bill does, to create an NHS that is fit for the future and to renew the gift left by generations before us and pass it on stronger to future generations. We are the party of the NHS and we are determined to give it what it needs, what it has asked for and what it deserves. I encourage hon. Members to reject the Opposition amendment, and I commend the Bill to the House.

[Mr Deputy Speaker (Mr Nigel Evans)]

I apologise to the 30 Members who did not get to speak in this important debate, some of whom are currently in the Chamber.

Question put, That the amendment be made.

Health and Care Bill

Nigel Evans Excerpts

Report stage
Monday 22nd November 2021 Commons Chamber

[Geraint Davies]

It is a great pleasure to follow the hon. Member for Harrow East (Bob Blackman), who gave an eloquent speech about smoking. What he did not include, and what the Minister is not considering, is the mass passive smoking from air pollution, which causes 64,000 deaths a year. I know that I am in danger of being outside the scope of the Bill, but I will make this point just briefly, because it is about public health.

Indoor and outdoor air pollution is endemic. It costs £20 billion a year. We could simply ban wood-burning stoves, which 2.5 million people have and which contribute 38% of the PM_2.5 emissions in our atmosphere. That is particularly problematic in poorer areas. I make this point partly as I chair the all-party parliamentary group on air pollution, but this is a critical public health issue, so I feel that the Department of Health and Social Care should look at it centrally, rather than leaving it to the Department for Environment, Food and Rural Affairs as an air quality issue.

I turn to the comments by the hon. Member for North East Bedfordshire (Richard Fuller), who sadly is not in his place, about free choice in advertising. Advertising is not about free choice; one would not need to advertise unless one was trying to convince somebody to do something they would not otherwise do. That is not to say that advertising is always bad—good things and bad things can be advertised—but let us be straightforward.

As it happens, I have a background in multinational marketing; I have been involved with PG Tips and Colgate toothpaste—good products. However, the reality is that if someone wanted to make money from a product such as a potato, which is intrinsically good for people, they could impregnate it with salt, sugar and fat, make it into the shape of a dinosaur, get a jingle and call it “Dennis’s Dinosaurs”, and make a lot of money out of that simple potato. That is the way a lot of processed foods work.

Going back to the point about diabetes and added sugar, it is important to remember that diabetes in Britain costs something like £10 billion a year. There is a compelling case for the Government to do more about added sugar, as opposed to natural sugar; obviously, we could discriminate between the two, though a lot of manufacturers will say, “Are you going to tax an apple?”. Clearly, when a child or adult can find a huge bar of chocolate in a shop for £1, we have problems, in terms of the amount of sugar we are supposed to have. Henry Dimbleby put forward a national food strategy, which is worth a read. He makes the key point that reducing the overall amount of money people have—for instance, through universal credit—has a major impact: we find that when universal credit goes down, consumption of alcohol and smoking go up.

It is important for the Department of Health and Social Care to have an idea of how the nutrition of particular natural foods can be increased through better farming. An app will be available next year that will enable people to test a carrot in their local shop. The carrot will have different levels of antioxidant, depending on how it is grown. If it is organic and not impregnated with all sorts of fertiliser and chemicals, it develops a natural resistance to pesticides and is much better for human health. The Government should, in this post-Brexit world, be actively encouraging local high-value, high-nutrition products for export and local consumption.

A whole range of public health measures that need to be moved forward are not in the strategy; but some are, such as those raised by the hon. Member for Harrow East.

[Mr Deputy Speaker (Mr Nigel Evans)]

I call Christian Wakeford. Do you wish to remain seated?

[Christian Wakeford]

That is greatly appreciated, Mr Deputy Speaker.

I would like to put on record my support for amendments 11, 12 and 13, and new clauses 15 and 16. I also thank the hon. Member for Liverpool, Walton (Dan Carden). We have heard why he cannot be here; I wish him well with what is going on in his family.

These much-needed amendments and new clauses are aimed at reducing alcohol harm by introducing advertising restrictions, transparent alcohol labelling and support for effective alcohol treatment. Alcohol abuse leads to many harmful things, and deserves to be called the silent killer. I am chair of the all-party parliamentary group on alcohol harm, and the group has heard in our evidence sessions the stories of those affected by alcohol. It has the potential to destroy individuals, families and wider society. Alcohol has a very public face, but it harms privately. Hospital admissions and deaths from alcohol are at record levels, and have been exacerbated by the covid-19 pandemic. Some 70 people die every day in the UK due to alcohol. Alcohol harm is a hidden health crisis that needs to be recognised.

The Bill does not go far enough to stem the rising tide of this issue. For instance, the Bill introduces restrictions on advertising for “less healthy” products, such as sugary soft drinks, but the same restrictions do not apply to adverts for alcoholic drinks, despite alcohol being linked to more than 200 health conditions, as well as having very high calorie and sugar content. There is significant evidence that children who are exposed to alcohol marketing will drink more earlier than they otherwise would. Existing laws are failing to protect children and vulnerable people. In fact, four in five 11 to 17-year-olds have seen alcohol advertising in the past month. The advertising they are exposed to builds alcoholic brand awareness and influences their perceptions of alcohol. A forthcoming report by Alcohol Health Alliance found that seven in 10 young people recognise the beer brand Guinness, including more than half of 11 to 12-year-olds. Amendments 11 to 13 would ensure that alcohol was considered a less healthy product and was therefore liable to the same proposed restrictions as sugary soft drinks when it comes to advertising on TV, on demand and online.

Awareness of the risks of alcohol is low: about 80% of people do not know the chief medical officer’s low-risk drinking guidelines of 14 units a week; only 25% are aware that alcohol can cause breast cancer; and only 20% know the calories in a large glass of wine. I need only refer you, Mr Deputy Speaker, to the Six Nations championship earlier this year—you may have a slightly better recollection of it than I do. There was alcohol-related advertising on billboards around the stadiums. There were many billboards advertising alcoholic brands. There were also drink awareness campaigns, but they were not seen, due to where those advertisements were placed. People were seeing adverts for Guinness, but not for Guinness 0.0 or for drink awareness campaigns. This is something that the Government really need to look into.

Health and Care Bill

Nigel Evans Excerpts

Report stage
Tuesday 23rd November 2021 Commons Chamber

[Sarah Olney]

The right hon. Gentleman is absolutely right, and that is the point I want to make: we need to boost the status of our care home staff and improve their terms and conditions. We need to improve their pay. This lady who I spoke to on Saturday was telling me that she gets paid for the hours she spends in people’s homes, but not the time spent travelling in between. It is clear to me that the crisis of staffing we are experiencing in our care sector—I think every one of us as MPs is hearing about it regularly from our constituents, who are at the sharp end of that—is as much about workforce planning and improving terms and conditions. The Government needs to give that the most urgent attention, and amendment 10 would go some way to resolving that, although it will not resolve it entirely.

I know that Ministers will push back against the cost of boosting the workforce in all areas of the NHS, but they must surely realise the cost of failing to do so. The right hon. Member for South West Surrey. along with the hon. Member for Central Ayrshire (Dr Whitford), spoke about the cost of locum resource in the NHS. It is not just about the direct cost of locums or of worsening health outcomes as people wait longer for treatment; it is also about the lost productivity of days off sick, the cost of poor mental health as lives are put on hold and, as has been mentioned many times, the cost of exhausted and demoralised staff who are overwhelmed by the demands on the NHS. We cannot afford to continue to fail to effectively plan our healthcare workforce.

I am also very happy to support the amendments tabled by the hon. Member for North West Durham (Mr Holden) on virginity testing and hymenoplasty. I am delighted that the Government are adopting the provisions on virginity testing. We still have much to do to make this country a safe place for women and girls, but all progress is to be welcomed, and I am very glad that this opportunity to bring to an end the degrading practice of virginity testing has not been lost. I congratulate the hon. Member for North West Durham on all the work he has done and, although they may have left the Chamber, the representatives of the other charities referred to earlier. I hope in due course we will see the provisions for hymenoplasty as well, when the review has concluded.

[Mr Deputy Speaker (Mr Nigel Evans)]

I have three people indicating that they wish to speak. I ask people to make really short contributions, because I want to give the Minister six minutes to wind up and we will then go into the votes at half past.

[Matt Warman (Boston and Skegness) (Con)]

I will be brief, Mr Deputy Speaker. I should declare that I am married to a doctor.

Staff are the No. 1 priority for the health service, and have been historically for this Government, so I will support the Government today, but somewhat through gritted teeth. I implore the Minister to include a few things in his 15-year review. I ask him to engage with the feeling of staff, which we have all heard about: if there are fundamentally not enough staff within the system, it is impossible for them to feel that they can do the job they went into medicine to do as well as they possibly can. I know his plans in this 15-year review will address some of that, but I hope he will also address the fact that there is a huge role to play for technology and for the increasing integration between health and social care. If more patients are stuck in hospitals because they cannot be sent on to the social care system, then we need more doctors to staff those hospitals.

I hope the Minister will consider those multiple facets in the review, and also consider that perhaps more important than anything else is how we retain staff. Even if we are putting more and more people into the beginning of a career pipeline, we will never be able to fill up that pipeline sufficiently if people, whether for pension-related reasons or a whole host of other reasons, are leaving more rapidly than we currently imagine they will in the planning.

That retention aspect has to be a hugely important part of the review. I hope that the possibility of addressing all those multiple factors will be core to what the Minister has been talking about. As others have said, I also hope he will be as transparent as possible within that, and that he or his Department will come to the House to make those plans transparent. Fifteen years is good, and transcends the political horizon that so often derails good intentions for the NHS, but the more transparent we can be, and the more support we can give to recruitment, retention, technology, social care and a host of other issues, the less my teeth will be gritted as I support the Government today.

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This amendment enables regulations under paragraph 23 of Schedule 13 to vary the way VAT would have effect in relation to transfer schemes under paragraph 22 of Schedule 13.

[Mr Deputy Speaker (Mr Nigel Evans)]

We are now coming on to the next group of amendments. As hon. Members can see, we have only an hour left, so can I plead to everyone who is participating, including the Front Benchers: short contributions, please, so we can get as many people in as we possibly can?

New Clause 62

Pharmaceutical services: remuneration in respect of vaccines etc

“(1) In section 164 of the National Health Service Act 2006 (remuneration for persons providing pharmaceutical services)—

(a) in subsection (8A) for ‘special medicinal products’ substitute ‘any of the following—

(a) drugs or medicines used for vaccinating or immunising people against disease,

(b) anything used in connection with the supply or administration of drugs or medicines within paragraph (a),

(c) drugs or medicines, not within paragraph (a), that are used for preventing or treating a disease that, at the time the regulations are made, the Secretary of State considers to be a pandemic disease or at risk of becoming a pandemic disease,

(d) anything used in connection with the supply or administration of drugs or medicines within paragraph (c), or

(e) a product which is a special medicinal product for the purposes of regulation 167 of the Human Medicines Regulations 2012 (S.I. 2012/1916).’;

(b) in subsection (8D)—

(i) for ‘special medicinal products are’ substitute ‘anything within subsection (8A)(a) to (e) is’;

(ii) in paragraph (b), for ‘special medicinal products’ substitute ‘that thing,’;

(c) subsection (8E), omit the definition of ‘special medicinal product’;

(d) after subsection (8E) insert—

‘(8F) Where regulations include provision made in reliance on subsection (8A)(c) or (d) and the Secretary of State considers that the disease to which it relates is no longer a pandemic disease or at risk of becoming a pandemic disease, the Secretary of State must revoke that provision within such period as the Secretary of State considers reasonable (taking into account, in particular, the need for any transitional arrangements).’

(2) In section 88 of the National Health Service (Wales) Act 2006 (remuneration for persons providing pharmaceutical services)—

(a) in subsection (8A) for ‘special medicinal products’ substitute ‘any of the following—

(a) drugs or medicines used for vaccinating or immunising people against disease,

(b) anything used in connection with the supply or administration of drugs or medicines within paragraph (a),

(c) drugs or medicines, not within paragraph (a), that are used for preventing or treating a disease that, at the time the regulations are made, the Welsh Ministers consider to be a pandemic disease or at risk of becoming a pandemic disease,

(d) anything used in connection with the supply or administration of drugs or medicines within paragraph (c), or

(e) a product which is a special medicinal product for the purposes of regulation 167 of the Human Medicines Regulations 2012 (S.I. 2012/1916).’;

(b) in subsection (8D)—

(i) for ‘special medicinal products are’ substitute ‘anything within subsection (8A)(a) to (e) is’;

(ii) in paragraph (b), for ‘special medicinal products’ substitute ‘that thing,’;

(c) in subsection (8E), omit the definition of ‘special medicinal product’;

(d) after subsection (8E) insert—

‘(8F) Where regulations include provision made in reliance on subsection (8A)(c) or (d) and the Welsh Ministers consider that the disease to which it relates is no longer a pandemic disease or at risk of becoming a pandemic disease, the Welsh Ministers must revoke that provision within such period as the Welsh Ministers consider reasonable (taking into account, in particular, the need for any transitional arrangements).’”—(Edward Argar.)

This amendment replicates the amendments currently made by clause 76 and makes corresponding provision for Wales. As a consequence clause 76 is left out by Amendment 115.

Brought up, and read the First time.

[Edward Argar]

I beg to move, That the clause be read a Second time.

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[Several hon. Members rose—]

[Mr Deputy Speaker (Mr Nigel Evans)]

Fantastic. I am grateful to the Minister for his brevity; he can see how many people are trying to catch my eye.

[Justin Madders]

Thank you, Madam Deputy Speaker—[Interruption.] It has been a long day, Mr Deputy Speaker, but we will get there.

I will speak to the amendments tabled in my name and those of my right hon. and hon. Friends. As the Minister said, this group of amendments covers a large range of important areas, so I will be brief.

New clause 27 flags up the issues around waiting times. Passing any amendment requiring a report is, of course, not a total solution, but it might be a source of focus. As Labour has said many times since 2010, winter pressures, waiting times and the flight into private healthcare to get earlier treatment have exacerbated the issues.

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[Mr Baron]

I will not. I do apologise, but time is short.

New clause has been endorsed by the founding chief executive of Cancer Research UK, Professor Sir Alex Markham, who has commented that

“comparable health services abroad continue to outperform the NHS in terms of cancer survival. They all remain focused on cancer outcomes and the UK would be foolish not to do likewise.”

The new clause has also been endorsed by others, including the Teenage Cancer Trust. I assure those who are concerned that it will not detract from process targets; quite the opposite because, by implication, improved outcomes can only be facilitated by improved processes and inputs.

I urge the Minister to adopt the new clause. He will then have more time to assess its impact, and perhaps, following consultation, suggest amendments—if necessary —in the other place. I am confident that sufficient cross-party support could be achieved if acceptable nuances were required. If that is not possible, I intend to press the new clause to a vote, but I sincerely hope that I—we—can work with the Government and other parties to drive up survival rates in the NHS across the United Kingdom.

[Mr Deputy Speaker (Mr Nigel Evans)]

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

[Margaret Greenwood]

Thank you, Mr Deputy Speaker.

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

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

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

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

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

Health and Care Bill

Nigel Evans Excerpts

Consideration of Lords amendments
Wednesday 30th March 2022 Commons Chamber

[Several hon. Members rose—]

[Mr Deputy Speaker (Mr Nigel Evans)]

A lot of people want to contribute to this debate, and this first group must come to an end at 10 minutes past 5. Those who make long contributions really are doing other people out of an opportunity to speak.

[Greg Smith (Buckingham) (Con)]

I will be as quick as I can, Mr Deputy Speaker. The point underlying my amendments to Lords amendments 123 to 127 is relatively straightforward and simple. I heard what the Minister said in his opening remarks, but I feel that if we act in a way that impacts an industry—in this case, UK broadcasters—as severely as the advertising restrictions will, and we are talking about a £200 million a year loss to our great British broadcasters, it is a matter of fairness and equity that we should give them enough of a lead-in time, enough notice and enough ability to adapt, remodel their services and find a way of surviving, to put it bluntly.

I have spoken before in the House about the fact that I do not agree with the nanny state and telling advertisers what they can and cannot advertise. The Lords amendments that we are considering, and my amendments to them, are very much about the implementation of a policy, and about giving British broadcasters—public service and fully commercial ones alike—a fighting chance. It would be much fairer to give broadcasters at least a year to comply from the point at which Ofcom publishes its guidance and puts it in the public domain. Broadcasters and advertisers will have to go through a lot of processes once this Bill receives Royal Assent, and that cuts the time that they have to put in place new policies, compliance checks and mechanisms to comply with the legislation. Two months on from Royal Assent, Ofcom will not even have got its statutory powers in this regard, and so will not even be able to start work with the Advertising Standards Authority and other bodies on the detail, and the ways and means of implementation.

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[Dr Johnson]

No, I am going to continue. The other problem with giving tablets—[Interruption.] The hon. Lady spoke for 16 minutes, which is considerably more than a fair share, given the number of Members who want to speak, so I will keep going.

The other problem is who will take the tablets. If someone is prescribed something of such severity over the telephone, the clinician does not know who will take the tablets. Will they be taken by the woman speaking to the clinician on the telephone? Will they be given to somebody else? Are they going to be sold to somebody else? Is somebody else going to be forced to take them? The reality is that we do not know and we cannot know, and that is another safety issue.

I will summarise my concern by saying, as a woman— I have not had an abortion, but I guess in the future I could become pregnant and not want to be—if I were having an abortion, I would rather have the inconvenience of having to go to a clinic than the worry of knowing that some women are having abortions without going to a clinic. Essentially, for me this is an issue of whether we want to make things more convenient for the majority of women, or we want to protect the women who are the most vulnerable, the most marginalised and the most at risk.

[Mr Deputy Speaker (Mr Nigel Evans)]

I intend to call the Minister at 5 o’clock to give him 10 minutes to wind up. We have not got long, so will Members please keep their contributions as short as they can?

[Jim Shannon (Strangford) (DUP)]

Thank you for calling me, Mr Deputy Speaker, to speak in this debate. I am pleased to follow the hon. Members for Sleaford and North Hykeham (Dr Johnson) and for Congleton (Fiona Bruce). I thank them both for the contributions.

It will be no surprise to the House that I am here because I abide by the absolute view that both lives matter—the unborn child and the mother. I know that many people believe that if someone is anti-abortion, they are anti-woman. I am not—I never have been, never will be and it is not the case. I believe in life and helping people. My career and all my life have been based around that, and I will continue as long as God grants me the strength to do so.

The Minister referred in his introduction to the fact that the regional devolved Administrations will make their own decisions. They can make that decision in Scotland and Wales, but we cannot make that decision in Northern Ireland, because the Government made it here. They took that decision away from us, and I am particularly concerned about that.

I have several concerns about the approach adopted during the pandemic in relation to so-called telemedicine to access abortion, which was recognised at the time as short-term. Without a face-to-face appointment, there is no confirmation of how many weeks pregnant a woman is, which makes a difference to the experience of an abortion at home. As reported in the summary of consultation responses, women who had experienced an abortion said that information should be provided on

“how inaccurate dating of pregnancy may mean increased pain and bleeding”.

A woman whose pregnancy is later than 10 weeks could find herself unexpectedly passing a mature baby at home, which could lead to significantly more complications. I understand that those advocating for the Lords amendment argue that complications have decreased since the pandemic, but I question the evidence, given that the Government and the Minister’s Department say that

“data on complications is incomplete”

and they are working on reviewing the system of recording abortion complications.

I am also persuaded by the concerns about the increased possibility of a woman finding herself pressurised at home to have an abortion that she does not want, as other hon. Members have said. There is a well-known link between abortion and domestic violence. Indeed, the BBC published a survey a few weeks ago reporting that 15% of those surveyed said they had felt pressured into ending a pregnancy. How are we protecting those women? How can doctors know that they are really speaking to a woman who is voluntarily calling about an abortion, or even that they are speaking to the right person at the other end of the phone?

There are many differing and strong views on this subject on both sides of the House, but I question whether the women who find themselves coerced into an abortion from their home, or who have found themselves bleeding unexpectedly at home or having an abortion much later in their pregnancy than they expected, would agree that telemedicine abortion is a positive step in women’s health. I doubt that they would.

I have recently been vocal regarding the need for face-to-face GP appointments. I have been inundated by constituents who simply have no confidence that a diagnosis by picture or telephone call is safe. I have constituents whose cancer has been undiagnosed because the GP was unable to see first hand what would have been clear in a face-to-face appointment. I believe that face-to-face appointments should be available.

I find it difficult to understand how pills to end life—to take away life—in a painful manner for the mother can be given without seeing someone to assess what cannot be seen on the phone. The signs and movements that an experienced GP can see that point to a deeper problem cannot be discussed in the two minutes allocated to such phone calls and I am fearful that the duty of care that we are obliged to discharge will continue to be missed. I am diametrically and honestly opposed to this legislation, because as I said at the outset, both lives matter. Lives could have been saved if abortion had not been available on demand.

I will vote against the permanent extension of this ill-advised scheme today and urge hon. Members on both sides of the Chamber to join me. It is a step backwards rather than forwards in providing adequate support and care for women, and it further normalises the practice of abortion as a phone call away rather than as a counselled decision under medical care, which is what it deserves to be. I, my constituents and my party are clear that this is a massive issue. I fully and absolutely oppose the Government in what they are putting forward today, for the safety of both mothers and the babies, because I am about saving lives, not destroying lives.

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[Several hon. Members rose—]

[Mr Deputy Speaker (Mr Nigel Evans)]

Order. Three Members are standing and I want to get you all in, so we will have a four-minute time limit.

[Sir Edward Leigh (Gainsborough) (Con)]

Obviously, abortion is a deeply emotional issue and we probably all know where we stand, but this is not a debate about abortion. At-home abortions were brought in as a purely temporary measure to defend women’s health. It was always the understanding that the measure would continue just as long as the pandemic continued.

There are many different arguments about this issue. I could go through the statistics that have been given to me that some people might deny, but it is undoubtedly the case that more than 10,000 women who took at least one abortion pill at home provided by the NHS in 2020 needed hospital treatment. There is therefore an issue around safety and women’s health and we need a proper debate. This amendment was brought in in the House of Lords at night-time. Barely a seventh of the Members of the House of Lords actually took part in the Division. We need a proper, evidenced debate on this issue. There is nothing more important when a human life is at risk.

Of course, we all support telemedicine; I chaired a meeting yesterday on atopic eczema and we are making wonderful steps, but as important as curing atopic eczema is, it is nowhere near as important as a situation where a life is at stake. I know that there are different views about coercion, but surely the whole point of the Abortion Act, for those who supported it, was to get abortions into a safe medical location and to get them away from the backstreets. People surely did not want them to be done at home, where there is risk. The hon. Member for Upper Bann (Carla Lockhart) spoke about the case of the 16-year-old girl who delivered a foetus who, apparently, was 20 weeks old. That is why, as my hon. Friend the Member for Congleton (Fiona Bruce) said, the National Network of Designated Healthcare Professionals for Children welcomes the Government’s stance, and why children and young people will be provided with protections.

I urge hon. Members, whatever their view, to think, to consider the evidence and not to rush in. The amendment goes completely against the whole spirit of the Abortion Act. Whatever we think of that Act, the amendment would be a huge new step that I believe would put more women’s health at risk and possibly lead to coercion—we need more evidence on that. I therefore support what the Government are doing today.

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[Edward Argar]

I beg to move, That this House disagrees with Lords amendment 11.

[Mr Deputy Speaker (Mr Nigel Evans)]

With this it will be convenient to discuss the following:

Government amendment (a) in lieu of Lords amendment 11.

Lords amendment 51, Government motion to disagree, and Government amendment (a) in lieu.

Lords amendment 80, Government motion to disagree, and Government amendments (a) to (n) in lieu.

Lords amendment 81, and Government motion to disagree.

Lords amendment 90, Government motion to disagree, and Government amendment (a) in lieu.

Lords amendment 105, Government motion to disagree, and Government amendment (a) in lieu.

Lords amendments 1 to 10, 12 to 28, 31 to 41, 49, 50, 65, 83, 102 to 104, 106 and 107.

[Edward Argar]

Let me repeat, quite legitimately, what I said in opening the debate on the previous group of amendments. It is a pleasure to serve opposite the shadow Minister, the hon. Member for Bristol South. It was also a pleasure to serve opposite her in the Bill Committee. She was not the shadow Minister then, but she brought her expertise and, as I said earlier, her forensic knowledge of these areas of the Bill—occasionally to my slight discomfort—and, overall, a degree of informed deliberation to our proceedings.

The amendments in this group relate to integration, commissioning and adult social care. The Government’s amendments strengthen our expectations of commissioners, especially in relation to mental health, cancer, palliative care, inequalities and children. Lords amendments 1, 25, 27 and 49 strengthen our approach to mental health. Amendment 49 makes it clear that “health” refers to both physical and mental health in the National Health Service Act 2006.