Brexit, Science and Innovation
Debate between Norman Lamb and Jeremy Lefroy(6 years, 2 months ago)
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Norman Lamb
The right hon. Gentleman pre-empts what I was going to say. That was the subject of our second report, and he is right that, whenever we go to a research lab in a university or a research institute, we find a global community—a community not just of Europeans but of people from around the world.
If our pre-eminent position is to be maintained and indeed strengthened, we need to make sure we can continue to attract people to our country.
I have one other point to make about the danger of this uncertainty. Why would anyone risk their bid, which might involve other universities from across the EU, by listing the UK as a lead partner if there are question marks as to whether we can receive funds on behalf of others? The danger of this continuing uncertainty is also that the UK, which has been very good at leading research collaborations, will lose out on the opportunity to do that during this period of uncertainty.
The Committee also argued that it was important to try to separate out science and innovation from the rest of the process so that it does not become collateral damage. The no deal technical note shows why that is a pressing issue; science could suffer as a result of a no deal scenario, and it is in no one’s interests to let that happen. I would like to hear the Minister’s views on the possibility of creating an accord on science and innovation that could withstand a no deal scenario. I hope he will address that during the debate.
Access to funding has clearly been a big issue in this report, but we are also clear that a science and innovation pact—this relates to the point made by the right hon. Member for Leeds Central (Hilary Benn)—has also fully to cover the people element. We were told that a pact that did not address the need to attract and retain the people needed to support science and innovation would be of limited value. We were given the clear message that access to the best people is the most important priority; beyond the collaboration and the funding issues, we have to be able to bring in the best people for research in this country.
At the time, the Migration Advisory Committee’s report on immigration and the UK economy was many months away. We were told it was due in September, so, presumably, it is due any day now. We recommended in March that the MAC should be asked to bring forward its conclusions relating to the migration of scientists and researchers so that the comprehensive pact could be agreed early on. The Government rejected that recommendation in their response. We were told that agreeing a pact—now described as one of the “accords” in the most recent Brexit White Paper—remained an ambition but that we would have to wait until September for the MAC to produce its report before anything relating to immigration could be considered. We are in September now and this becomes a pressing issue.
Jeremy Lefroy (Stafford) (Con)
I thank the right hon. Gentleman for what he has said. I declare an interest: I am a member of the board of the Liverpool School of Tropical Medicine and the Innovative Vector Control Consortium. Does he agree that in attracting the highest calibre scientists and researchers from around the world, any legislation needs to look at the qualifications and experience of those people, not just a purely salary-based criterion? So often, science does not pay enough; the salaries are not high enough. We might find that if an arbitrary limit of £30,000, £35,000 or £40,000 a year were set, we would be excluding the best and the brightest, simply because scientists do not work for lots of money—they work for other, higher ideals.
Norman Lamb
Was I right in hearing that the hon. Gentleman was referring to the Liverpool School of Tropical Medicine, an amazing place, which I visited in my role as Chair? It undertakes incredible work in a previously deprived part of Liverpool and demonstrates that investment in science in some of the poorer regions of our country is vital. He makes an important point and, like the right hon. Member for Leeds Central, he pre-empts what I will say on this subject.
As a result of issues such as the one the hon. Gentleman raises, we decided specifically to explore the issue of immigration rules and what will be needed to ensure that the UK can maintain its pre-eminent position. Again, I do not think that this should be in any way controversial, for either Brexiteers or remainers; those who favoured Brexit were simply arguing that they wanted control of immigration rules, not that we should exclude the brightest and best people from our country. So for our report “An immigration system that works for science and innovation”, the second cited in today’s motion, the Committee asked the science community to work quickly to set out what it wanted to see in an immigration system. We are particularly grateful to the Wellcome Trust for hosting a workshop so that we could develop some concrete proposals. I hope that they will be of use to the Government as they seek to navigate their way through to their future position for this country.
Our proposals were designed to tackle the rapidly approaching problem of what to do about European economic area immigration when the transition period ends. We were warned that the worst thing to do after Brexit would be to roll EEA countries into our existing rest-of-the- world system, as that was seen as too restrictive and so would not facilitate the free flow of people to carry out research in our country. But in the future, if our proposals relating to EEA countries are accepted, we saw that there would be advantages to rolling out our proposals beyond the EEA, so that there is a single immigration system that works for science and innovation, and that attracts great people from wherever they are around the world to come to work in this country.
Our proposals for a new immigration system that works for science and innovation are based on several principles. We must bear in mind that this is important not just for academia, but for industry, and it is therefore crucial for our economy, too. Let me set out those principles. The first is that we need to be able to attract individuals who have different types and levels of skill, and who are at different career stages, as well as their dependants. That means going beyond the “brightest and the best” whom the Government refer to so that we can attract and retain people such as the technicians, who are so crucial to undertaking research; they may be part of a team we are seeking to recruit from overseas. Secondly, we need to be able to attract and recruit highly skilled people, wherever they are from, without being subject to an annual limit.
Regulatory Reform
Debate between Norman Lamb and Jeremy Lefroy(10 years, 2 months ago)
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Norman Lamb
I fully understand that we should always be arguing the case for greater openness and for greater legitimacy and accountability. All I am saying is that the system that we inherited had no local legitimacy at all, and that this is a significant improvement.
The shadow Minister talked about alignment with health and wellbeing boards. I think that that will almost always be the case. In my county of Norfolk, there are several CCGs, but all are operating within a health and wellbeing area and a local health economy. There may be circumstances in which more than one health and wellbeing board area is being considered, and I think that that is the case within the Manchester area and the discussions that are going on there. But in most circumstances, the sort of collaboration that we are talking about will be consistent with the health and wellbeing board area.
The shadow Minister also asked how CCGs will be held to account for joint decisions. When they act in joint committee, they will be subject to the same duties as when they act on their own and the accountability they face will be exactly the same. It is very important to reiterate that point.
The hon. Lady also raised concerns about the issues that Healthwatch England has raised, and I stress that the Department, NHS England and Healthwatch England are working together to ensure that CCGs have the materials and resources they need to support their effective and accountable collaboration and that local healthwatch organisations and others are supported to hold the system effectively to account. Everything on our side is about facilitating accountability at a local level, not undermining it.
My hon. Friend the Member for Stafford (Jeremy Lefroy) raised concerns about the issues in his area. I think that it is fair to say that they are not directly related to the proposals under the order, in that his concerns are about issues under the current arrangements rather than any potential impact of the proposed change. I want to reassure him that nothing in the order in any way undermines effective accountability for changes. I think it would be dangerous for me to go down the route of responding to the points he raises about his local circumstances, and I suspect that you, Mr Deputy Speaker, would rule me out of order if I tried to do so.
Jeremy Lefroy
The point I wish to make is that in our case the group of CCGs that is seeking to put out to tender the commissioning of end-of-life and cancer services appears to be abrogating its responsibilities for commissioning. These are clinical commissioning groups, yet they seek to put out to tender the commissioning of vital services for our constituents for 10 years. One might be concerned that the groupings would seek to do more like that.
Norman Lamb
My hon. Friend expresses a concern about what is happening at present and he is absolutely right as a local Member to challenge, question and hold to account the clinical commissioning groups in his area, but I do not think that there is anything in the order that changes the arrangements about which he is concerned. Indeed, I think that streamlining the system so that there is more effective accountability and less opaque decision making is better for local people.
Concerns were raised that joint committees might not meet in public. Joint working does not need to mean that it will take place behind closed doors and exactly the same responsibilities will apply to CCGs when they work jointly as when they work on their own or through committees in common. Indeed, I understand that committees in common have already on occasion met in public and I would always encourage accountable organisations to operate in public wherever possible. That is the approach that I seek to advocate.
In response to concerns raised by my hon. Friend the Member for Stafford, let me make the point that the requirements for service change that apply to a CCG regarding any major proposal for change will still apply, including that for appropriate consultation. Joint committees might want to consult jointly to co-ordinate their communications to patients and the public where appropriate, but the duty remains on the clinical commissioning group and it must demonstrate that it is meeting it.
The hon. Member for Blackley and Broughton (Graham Stringer) again raised concerns about the process going on in Manchester and he and I debated the matter in the debate to which he referred. I stress that his concerns are about actions taken under the existing regime, with a committee in common, rather than under the proposals in the order.
The hon. Gentleman expressed worry about the appropriateness of the order under the Legislative and Regulatory Reform Act 2006, but both the Regulatory Reform Committee and the Delegated Powers and Regulatory Reform Committee judged that a satisfactory case had been made for the LRO and that the order met the tests under the 2006 Act, so his concerns are misplaced. Although he has legitimate and genuine concerns about the process in Manchester and whether it is right for local people, I suggest to him that accountability will be encouraged and improved if the new system is less opaque and more clearly set out in legislation than the existing one. All the things about which he worries are happening under the existing arrangements.
It is up to CCGs to set out terms of reference for any joint committee arrangement, such as the scope for decision taking, and arrangements for membership or voting. They may also determine situations in which a CCG would wish to withdraw from a joint committee arrangement. The hon. Gentleman was worried that one CCG might feel oppressed or bullied by others, but it could set the terms of reference so that it could withdraw in defined circumstances, so his concern is misplaced.
My right hon. Friend the Member for South Cambridgeshire spoke about important improvements in democratic accountability and clinical leadership in commissioning, and the benefits that that secures. He asked about collaboration on commissioning not only between CCGs, or between CCGs and NHS England, but, critically, with local authorities and public health bodies. Such collaboration is facilitated, and he and I share the view that we should try to promote a more permissive NHS health and care system within which local arrangements may be put in place to ensure that the resources available throughout the health and care system are used as efficiently as possible. We should encourage such joint commissioning, rather than putting blocks in its way.
My hon. Friend the Member for Bedford (Richard Fuller) rightly talked about the tension that exists between local decision making and clinical best practice. This approach is all about managing that tension, rather than trying to pretend that it does not exist. He made the vital point, with which I agree, that people want health decisions to be taken locally, and we should try to facilitate open discussion and debate about the difficult choices that we sometimes have to make, rather than taking power away from people, which just undermines confidence in the system.
My hon. Friend asked about unanimity, so I repeat that if a CCG wants to enter into a joint committee arrangement, and protect its position on behalf of its local community, it can insist that unanimity is the basis on which decisions are taken. That is entirely a matter for the participating CCGs.
My hon. Friend asked about the cost and burden of the existing arrangements. We all understand the possibility of legal challenge, and there can be complex arrangements that involve organisations going through hoops to ensure that they meet their legal duties, perhaps by going back to their CCGs so that a decision taken in a committee in common may be endorsed. The more complicated those arrangements, however, the greater the risk of legal challenge, and therefore the cost, so simplifying in law the basis by which CCGs and NHS England can come together to make joint decisions, should they want to, improves accountability, makes the system less opaque and reduces the risk of unnecessary costs. I totally agree with my hon. Friend that this is not about the burden of localism. Localism is a burden worth carrying; it is not to be avoided. The burden is bureaucratic complexity and the involvement of lawyers—I speak as an ex-lawyer. The more we can keep lawyers out of it, the better, and I am sure many hon. Members would agree.
My hon. Friend made the point that not all consequences may be known at the outset and that things may change, but CCGs can set the terms of reference to provide for that if they choose to. The measure is absolutely permissive; it does not impose anything on anyone.
My right hon. Friend—sorry, my hon. Friend the Member for Totnes (Dr Wollaston). I thought something might have happened as a result of her election to the Chair of the Select Committee, but it will happen in time, I am sure. I am delighted that she supports the measure. She made the perfectly legitimate point that we ought to be encouraging and facilitating working across boundaries, both of CCGs and of the different organisations involved in health and care, to get the best possible use of the resource available for any local area.
Finally, I repeat that we take on board the concerns of Healthwatch England. We intend to work with that body to ensure maximum accountability for the decisions taken as part of these joint committees.
Question put.
Oral Answers to Questions
Debate between Norman Lamb and Jeremy Lefroy(10 years, 9 months ago)
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Norman Lamb
The review being undertaken by NHS England will report in March. I agree that that situation is intolerable, but I have made it very clear on many occasions that there is an institutional bias against mental health in the NHS. Interestingly, the Health Committee report on deficits in 2006-07 specifically made the point that mental health was particularly targeted, so that always happens when NHS finances are tight. However, it cannot happen, because there has to be parity of esteem, including in the way in which money is distributed in the NHS.
Jeremy Lefroy (Stafford) (Con)
In Stafford hospital, many young people with mental health problems are extremely well treated in normal in-patient wards. That should not be the case, but no other facility is available. What will happen if those in-patient beds are no longer there?
Norman Lamb
As far as possible, we should be trying to ensure that children with mental health crises can remain at home; it does not make sense, in very many cases, to put them into in-patient care. However, we have made it clear, as has NHS England and as was confirmed in the crisis care concordat last week, that beds should be locally available whenever they are needed.