NHS Funding Bill

Patrick Grady Excerpts

2nd reading & 2nd reading: House of Commons
Monday 27th January 2020 Commons Chamber

[Matt Hancock]

I want to finish this section, Madam Deputy Speaker. The crucial thing in this Bill is the certainty: the Bill provides everyone in the NHS with the certainty to work better together to make long-term decisions, get the best possible value for money, increase the productivity of the NHS and improve how the health system is organised and delivered. That is not just tied to what has been done in the past, but is driven by a clear view of what the NHS needs to do in future, exactly as my hon. Friend the Member for South Dorset (Richard Drax) said.

[Patrick Grady (Glasgow North) (SNP)]

If the Secretary of State is so proud that these figures represent a floor and not a maximum, why have the Government tabled such a restrictive money resolution? It means that it will be impossible for Members to table their own suggestions about higher amounts—bringing UK health spending in line with per capita spend in Scotland, for example, despite the fact that the Bill is subject to the English votes procedure.

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[Dr Philippa Whitford (Central Ayrshire) (SNP)]

Having spent 33 years as a surgeon at the very sharp end of the NHS, I welcome the multi-year funding because it should allow better planning, but it does come after a decade of drought. Between 2010 and 2015, the average annual uplift was 1.1%. Between 2015 and 2018, it was only 2%. That means that over that period of eight years—during a time of inflation, and particularly rising demand with an ageing population—the NHS in England faced a real-terms cut, which is why quoting the spend per head is actually more realistic and more accurate. Scotland spends £136 a head more on health, which is why the Secretary of State is forever claiming that Barnett consequentials are not passed on in Scotland. Every penny of resource consequentials are passed on, but here is a little explanation of percentages: if the starting amount is bigger, the same amount will be a smaller percentage. We have explained this before, but we keep hearing this nonsense. In actual fact, if the Scottish Government used the same per capita spend on health as the UK Government does for England, Scotland would be £740 million worse off.

[Patrick Grady]

I have raised with the Minister the concern about the cap that the Government have put on the spending figures through the use of the money resolution, but the whole Bill is going to be committed to the English Legislative Grand Committee, so Members from Scotland are not going to be able to table amendments to pursue exactly such points with the Government. We are not going to be able to inquire, as other Members from the rest of the UK will be able to do, table probing amendments or question the impact of the Government’s spending. Does my hon. Friend agree that that really undermines the point of this being a sovereign UK Parliament?

[Dr Whitford]

The whole issue of English votes for English laws applying to Bills that have direct Barnett consequentials for the three devolved Governments is obviously complete nonsense, and certainly makes all devolved MPs second class.

The Government are committed to £33.9 billion a year in cash terms by 2024. As has already been pointed out, that is actually just the same £20 billion that was promised in 2018. It is not extra, new money. It is not on top of the £20 billion. It is the same amount. It has been described as a 3.4% increase in real terms, but the Health Foundation has already suggested that, due to inflation, it is actually only 3.3%, and the Institute for Fiscal Studies predicts that it will be only 3.1%. The key problem of making a commitment in cash terms is that if inflation rises post Brexit—by which I mean at the end of 2020—as is likely, the commitment would simply wither on the vine. It should be front-loaded because the urgent need is now, and it should be in real terms; otherwise, talking about 2024 in cash terms is actually just pie in the sky. The three main health think-tanks and the British Medical Association think that 4% is required to restore the service to the performance that is expected. More than that would be required for service redesign, to match the shopping list we heard the Secretary of State recite.

I am glad that the Secretary of State has moved away from talking about apps. The idea that people are going to rub a mobile phone over their tummy to diagnose appendicitis is for the birds. People need doctors. Healthcare is delivered by people, and the idea that an app on our phones can replace that is just nonsense. However, I was glad to hear the Secretary of State talking about internal IT in the NHS in England because, frankly, it has fallen behind since the Care.data scandal. There is a lot that could be done IT-wise to utilise the existing workforce in a much better way. In Scotland, radiologists can view any X-ray anywhere in Scotland through the picture archiving and communications system. We have electronic prescribing, which is not only efficient, but a patient safety issue because doctors cannot prescribe a drug to which the patient is allergic. These are things that should be focused on, rather than gimmicky apps on mobile phones. Again, this is just money focused on the NHS revenue funding.

The NHS long-term plan, exactly like the 2015 five-year forward plan—we are seeing a bit of a theme here—was predicated on game-changing investment in both public health and social care. The public health grant for local authorities that is currently proposed is only expected to rise by 1%. That means a significant real-terms cut, on the back of £850 million of cuts that have already happened, resulting in a reduction in smoking cessation, sexual health and addiction services. That does not make sense, as even the Secretary of State admits that prevention is better than cure.

NHS Funding Bill

Patrick Grady Excerpts

Legislative Grand Committee & 3rd reading: House of Commons & Legislative Grand Committee: House of Commons & Programme motion: House of Commons & 3rd reading & Programme motion
Tuesday 4th February 2020 Commons Chamber

The final point I wanted to make is about—

[Patrick Grady (Glasgow North) (SNP)]

The third final point.

[Jeremy Hunt]

It was always the final point, and it is very much the final point.

The other area that is essential for capacity is the social care system. My hon. Friend the Member for Ruislip, Northwood and Pinner (David Simmonds) talked about how money can be wasted. One of the biggest wastes of money is that we pay for people to be in hospital beds, which cost three times as much as care home beds, because we do not have the capacity in the social care system. It is very important that we encourage people to save for the future and protect people against losing their homes, but if we want to see a change in the NHS in the next five years it is fundamental that we increase the ability of local authorities to deliver adult social care to people who cannot afford it. At the moment, they do not have enough to do that, and we must put that right.

[Patrick Grady]

Finally, here we are, in the English Parliament after all these years. Isn’t it great? The Mace is down, the signs are up, and the dream of David Cameron has finally been realised. For the first time since 1707, English Members of Parliament will get to vote on English legislation to the active exclusion of the rest of us. I wonder if the Minister could have even dreamed, when he and I were but lowly Back-Bench members of the Procedure Committee back in 2015 and scrutinising the EVEL processes, that this is where we would end up today.

On 19 September 2014 David Cameron promised, in response to the independence referendum in Scotland, that we would have English votes for English laws. Three general elections, two Prime Ministers and countless Leaders of the House later, here it is in all its glory. I wonder, given the responses and speeches that we have heard today, whether anyone on the Government Benches really understands what is going on. We are debating clauses and amendments to a Bill that has been certified as being only relevant to England, but as the amendment themselves demonstrate, and as we have heard in speeches, it will have implications for health spending policy across the whole of the United Kingdom—and very serious issues, too—for mental health, for the construction of hospitals, and for the difference between capital and revenue spending on the NHS.

[Pete Wishart]

I wonder whether, like me, my hon. Friend feels that this English Parliament is actually pretty similar to the usual Westminster Parliament that we do all our business in. Does he agree that the English votes for English laws procedure has been about the most divisive, disruptive and useless procedure ever put into this House? It makes distinctions between classes of Members of Parliament in this House, and what we are doing today is disallowing us to vote on issues that are vital to the Scottish health service. Does he agree that it is a disgrace, and that it must go?

[Patrick Grady]

Yes; I absolutely agree. My hon. Friend is right: I barely noticed the difference as this place magically transformed itself into the Legislative Grand Committee (England). Incidentally, I do not know whether he remembers, from his time here, whether the Scottish Grand Committee was ever permitted to meet in the Chamber of the House of Commons. I fear it was not, so quite why the English Grand Committee enjoys that privilege and does not have to meet elsewhere in the building or elsewhere in England is kind of beyond me. But my hon. Friend is right that those of us from seats in Scotland and Wales and Northern Ireland are, for the first time, being actively excluded from the opportunity to vote on amendments.

The right hon. Member for Alyn and Deeside (Mark Tami) may also have been a member of the Procedure Committee back in the day; I certainly seem to remember points about the cross-border hospitals being raised. He has constituents in Wales who use hospitals in England that will be affected by this legislation, and he is unable to vote on or amend those provisions.

[Neil Gray (Airdrie and Shotts) (SNP)]

My hon. Friend’s secondment to the English Parliament is going rather well so far, although it is rather similar to the UK one. Does it not distil the ridiculousness of the EVEL procedure that we have before us a Bill that clearly impacts on the funding of the NHS in Scotland, as the former Secretary of State mentioned, and yet the Government have put the Chair in the invidious position of deciding on the issues that we can or cannot vote on, instead of our making that decision about the issues that are important to our constituents?

[Patrick Grady]

My hon. Friend is absolutely right; and we raised those points five years ago, when the EVEL process was being introduced.

[Mark Tami]

I have never been a member of the Procedure Committee. The Countess of Chester, which is a foundation hospital, has trustees who are elected from Wales. They are elected and can take part in decision making, but as an elected representative in this place, I cannot, apparently.

[Patrick Grady]

There we go. We have now had as many Welsh and Scottish Members contributing from the Floor, as Members from elsewhere in the United Kingdom. These points were raised back in the day, on the Procedure Committee, even if it was not the hon. Gentleman who gave that evidence.

This morning, the Prime Minister turned up at the Science Museum in London to launch a conference that is taking place in Glasgow. That probably tells us all we need to know about the Government’s concept of how the United Kingdom works. Four days after the UK leaves the European Union, and the Tory Government choose to display their love for the precious Union on these islands by creating two classes of Member in the House of Commons—those who can amend legislation and those who cannot. Well, as the Chair of the Health Committee asked us to say, “Thank you.” Thank you so much, because the polls are showing that support for independence in Scotland has reached 52% and growing, and that support will not go away. Constituents in Scotland will be watching today’s proceedings, wanting to know why their Members of Parliament are not allowed to vote on amendments that could increase health spending, not just here in England but throughout the United Kingdom.

Labour’s new clause 5 rightly calls for the Government to analyse the effect of inflation on the figures set out in the Bill.

[Dr Whitford]

Does my hon. Friend agree that, as I mentioned earlier, the fact that inflation could make these cash rises meaningless makes it very difficult for the Scottish Government to predict what Barnett consequentials they can count on in 2023 and 2024, so it should be committed to in real terms, not just cash terms?

[Patrick Grady]

Yes; my hon. Friend is absolutely right, and we would be very happy to support new clause 5 if the procedures of the House allowed us to. It is absolutely crucial to what the Bill is trying to achieve.

We know it is a showpiece Bill anyway, but the Government are getting a showpiece English Parliament out of it as well. Of course, the terms of the money resolution are so restrictive that amendments intended to amend the figures in the Bill are completely out of order. The Labour party tried that—that point was raised by more than one Opposition Member at Second Reading, and I am not sure that Ministers could answer it.

Labour’s amendment 3 prevents capital funding from being transferred to revenue streams. That is hugely important as well, because any increases in the revenue funding—the figures on the face of the Bill—have to come from new money. Otherwise, the whole thing is pointless: it is just shuffling things around. It is new money that would give rise to Barnett consequentials, and that is where our interest comes in.

New clause 4, on performance targets, makes exactly the same point, and we support that as well. That is also relevant to us.

[Dr Whitford]

It is often cast up here that the Government in Scotland are not spending all the Barnett consequentials on health, but they do. The problem is that although the Government here keep talking about the rise they are giving to the NHS, there are cuts to public health and social care, and there have been cuts to education and training. In Scotland, we still take the whole responsibility of a health Department seriously.

[Patrick Grady]

My hon. Friend is absolutely right on that. The Scottish National party has always pledged—we have done this throughout our time in government—that any Barnett consequentials that arise from health spending in England get passed to the NHS in Scotland. Any time the figures set out in this Bill increase, those Barnett consequentials would be expected to fall to the Scottish block grant, so it is well within the interests of Members from Scotland, Wales and Northern Ireland to seek to amend this Bill. Our own unselectable suggestions that appear on the amendment paper require analysis of what would happen if health spending per capita in England and Wales was raised to the level in Scotland. That was part of our manifesto commitment; by raising health spending in England, we would also raise spending across the United Kingdom. But here and now, on the Floor of the House of Commons, in the UK Parliament, that idea cannot be tested, voted on or even, technically, discussed.

[Dr Whitford]

Does my hon. Friend agree that “per capita” is a much more informative way of describing spending, because demand is increasingly rapidly, with an ageing population that is not ageing healthily, and just talking about the headline numbers does not show whether the amount provided for each person is sufficient to provide their services?

[Patrick Grady]

I thank my hon. Friend for that. The contributions she is making demonstrate precisely why Members from Scotland should have been allowed to participate fully in this stage of the Bill and the whole process.

If the official Opposition choose to press any of their amendments this afternoon, we will seek to express our views, on behalf of our constituents, by walking through the Lobby. We will walk past the signs that say, “England only” and if the Tellers from the Government Whips team choose not to count us, that will be their decision. Of course they will also have to discount any of their own colleagues from Scotland and Wales who deliberately or accidentally end up in the Lobby; perhaps that is also an argument for getting rid of this ridiculous voting Lobby system, but I appreciate that that is for another day.

The Government could have avoided this situation, by allowing proper time for a Report stage, where Members from Scotland and elsewhere could move amendments. They could have committed the Bill upstairs to a Public Bill Committee, but they chose to convene an English Parliament here in the Chamber of the House of Commons, which is supposed to represent the whole of the UK.

[Pete Wishart]

My hon. Friend has taken over the EVEL mantle with great aplomb. I understand that the “England only” signs are already in the Lobby, and this in the UK Parliament of Great Britain and Northern Ireland! What does that say to people from Scotland? What does it say, given that this Bill determines so much of our health spending in Scotland? Surely the days of EVEL have to come to an end. We cannot go on like this. This is the Parliament for everybody across the United Kingdom; it is not their Parliament to squat in.

[Patrick Grady]

It really does not feel like that at the moment, does it? Hear no EVEL, see no EVEL, speak no EVEL should be the mantra, because my hon. Friend is right; this might not be the last time.

[Drew Hendry (Inverness, Nairn, Badenoch and Strathspey) (SNP)]

I am grateful to my hon. Friend for allowing me to speak in the English Parliament for the first time. Does he agree that one way to get around this whole EVEL conundrum is simply for the English Parliament to be made officially an English Parliament and then we can all have our own national Parliaments in our own countries?

[The First Deputy Chairman of Ways and Means (Dame Rosie Winterton)]

Order. I am sure colleagues will appreciate that it is important that we actually talk about the Bill.

[Patrick Grady]

I wholeheartedly agree, Dame Rosie. I have addressed the amendments that we have an interest in, and I am contextualising why they are relevant to our constituents, but points are being extremely well made by my colleagues. There is a simple solution to this, which we in the SNP have been promoting for 84 years, since 1934: Scotland can become an independent country and England can have the Parliament that it wants. As my hon. Friend the Member for Airdrie and Shotts (Neil Gray) says, with the greatest respect for the Speaker, it should not be for the Chair or for the Government to decide what does and does not apply to Members from different parts of the UK. My job and that of my colleagues is to look at each measure before this House and determine for ourselves whether it is relevant to our constituents and act accordingly. Today, we are being actively prevented from doing that. There are amendments and new clauses on the amendment paper that we deem to be of interest to people in Scotland, which would take forward commitments in our manifesto, but we will not be able to vote for them. That is not a precious Union. That is not a partnership of equals. That is not leading instead of leaving. It is not something that is going to be sustainable for much longer, and 52% of people in Scotland seem inclined to agree.

[Anne Marie Morris (Newton Abbot) (Con)]

I rise to speak to new clause 9, tabled in my name and those of the hon. Member for Central Ayrshire (Dr Whitford) and my hon. Friend the Member for Broxbourne (Sir Charles Walker). I am pleased that Scotland will have its say, at least with regard to this new clause.

Conceptually, the Bill will absolutely do the right thing, because for long-term decision making we need some clarity as to how much money there will be. As I said on Second Reading, my concern is about whether or not the figures are right, and at that point I proposed a formula that would enable the figures to be flexed to properly determine the need and whether the figure would to be sufficient to meet it.

New clause 9 deals specifically with the issue of mental health. There is agreement among all parties that it is crucial that we get mental health right. It is crucial that it is properly respected and properly resourced. Members from all parties have talked about and supported parity of esteem between physical health and mental health. It might be useful—this is not in the new clause, but we are talking about the issue more broadly—if at some point the Government could give some clarity on, if not a formal definition of, what parity of esteem means.

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[Jane Hunt (Loughborough) (Con)]

I am grateful to my east midlands colleague, my hon. Friend the Member for North East Derbyshire (Lee Rowley), for that excellent speech. He made some important points, particularly about outputs, the specific healthcare that is needed and the support required throughout the NHS.

I am grateful for this opportunity to speak to amendments 1, 2 and 3. The funding in the Bill will be administered by NHS England. The Bill guarantees long-term funding to implement the NHS long-term plan. It commits the Government to a £33.9 billion increase for the NHS by 2023-24, bringing the total spend to £148.5 billion. It also provides certainty through a double-lock agreement that places a legal duty on the Secretary of State and the Treasury to uphold this level of funding as a minimum over the next four years.

We are putting our money where our mouth is. Our manifesto clearly stated that

“within the first three months of our new term, we will enshrine in law our fully funded, long-term NHS plan”.

Since our success in December, we have consistently put forward and agreed steps to meet the commitments in our manifesto. We are delivering on the promises that we have made.

One of the most important aspects of the NHS long-term plan is its approach to mental health. It is crucial that people have access to mental health services where and when they need them. I, therefore, welcome the fact that the plan commits to ensuring that mental health receives a growing share of the NHS budget, which will be worth at least a further £2.3 billion a year in real terms by 2023-24. This will enable further service expansion and faster access to community and crisis mental health services for adults and particularly for children and young people.

Given that many people living with mental health issues may need to access health services more often, the NHS long term plan also allows for better and more consistent working between all parts of health care and voluntary elements of the sector. As we have seen in west Leicestershire, for example, primary care networks have formed, grouping GPs and other partners together to the benefit of their patients.

As NHS England sets out, primary care networks build on the core of current primary care services and enable greater provision of proactive, personalised, co-ordinated and more integrated health and social care. Clinicians describe this as a change from reactively providing appointments to proactively caring for the people and the communities that they serve.

Linking this local working together with the benefit and knowledge of vanguard projects from across the country and giving experienced local trust leaders, who have a deep understanding of the physical and mental health needs of their local area, the freedom to make appropriate funding decisions will improve the overall experience of the patient and provide better health and lifestyle outcomes. That is to be welcomed and celebrated, and I ask my fellow colleagues to support the Bill and reject the amendments today.

[Patrick Grady (Glasgow North) (SNP)]

On a point of order, Dame Eleanor. I notice that it is now 5.10 pm and that the Minister is about to get to his feet. If the knife falls at 5.30 pm, while the Minister is still speaking, or a Division is under way, can you confirm that that means there will be no Report stage, and no chance for the SNP amendments to be tabled or voted on?

[The Chairman of Ways and Means (Dame Eleanor Laing)]

The hon. Gentleman is absolutely right in regard to the procedure. If we finish this part of the procedure before 5.29 pm, there will be a very short time for the next part of the procedure. If this part of the consideration of the Bill goes to 5.29 pm, there will indeed be no time for the Report and consideration stage. That is correct, as is normal in any Bill, but I am grateful to him for pointing it out so clearly.

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17:32

Division 28

Ayes: 163

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Labour: 155
Liberal Democrat: 7
Green Party: 1

Noes: 300

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Conservative: 300

[Patrick Grady]

On a point of order, Dame Eleanor. I think that we should mark this moment. This is the busiest that the English Parliament has been since 1707. I have never seen so many people so keen to take part.

I am interested in the numbers that have just been read out, Madam Deputy Speaker, because 163 for the Ayes seems very low to me. Just by means of a headcount, I counted a significant number more than that. In fact, according to my calculations, at least 46 Members from Scotland, Wales and Northern Ireland were in the Lobby just now. Can you tell me whether the number that was read out in the House accurately records the number of Members of Parliament who wished to express their view on the amendment?

[The Chairman of Ways and Means (Dame Eleanor Laing)]

I am grateful to the hon. Gentleman for expressing his concerns in such an articulate fashion, and I note the words that he has used. I can confirm to him that, although his count of the number of Members who wished to express their view might well be correct, the numbers that I have announced to the House and on which I will rely from the Chair constitute the number of Members who have a right to vote on this matter. As the hon. Gentleman knows, under the procedures set out in Standing Order 83W—with which he, if not the rest of the House, must of course be familiar—Members who do not represent constituencies geographically situated in England do not have a right to vote in these particular Divisions.

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[Madam Deputy Speaker (Dame Eleanor Laing)]

There are no amendments on consideration.

[Patrick Grady]

On a point of order, Madam Deputy Speaker. It is great to be back in the United Kingdom Parliament—just like magic! I congratulate you on your skilful chairing of the English Parliament from the lower Chair over the last three hours. You have just announced that there are no amendments to be considered on Report as none had been tabled because the knife fell more than an hour ago. Could you confirm that that is correct? I notice that the selection list says:

“Mr Speaker has provisionally selected…New Clauses…as long as the 3 hour time limit has not expired: NC6 [SNP] + NC7 [SNP].”

For the record, can we confirm that the effect of all this has been that amendments tabled by Members of the Scottish National party have not been debated tonight and could not been divided on because the Government did not provide enough time, or Members took up so much time in the meeting of the English Parliament—the Legislative Grand Committee—that they have effectively denied the rights of SNP Members to table amendments to a Bill that directly affects our constituents?

[Madam Deputy Speaker]

The hon. Gentleman’s analysis is not wrong. The knife has fallen. The House voted some days ago to provide three hours, or four hours in total, for consideration of this Bill, and it is indeed the case that because those four hours have passed, there is no time for debate on consideration and Report—that is absolutely correct. There is also no time for debate on Third Reading.

As to whether the Government did not provide sufficient time, or Members of this House took up all the time in the early part of the proceedings, that is not a matter for me to judge; I have merely facilitated it. Members might have decided not to speak for very long at the beginning. If so, the hon. Gentleman and his colleagues would have had the opportunity to discuss the matters that they had tabled. I thank him for his further points.

Does the Minister intend to move a consent motion in the Legislative Grand Committee?

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[The Chairman of Ways and Means (Dame Eleanor Laing)]

I remind hon. Members, although I do not think there is any need for reminding at this stage, that if there is a Division, only Members representing constituencies in England may vote.

[Patrick Grady]

On a point of order, Dame Eleanor. We are back in the English Parliament again and the absurdity of this procedure is now being laid bare. [Interruption.] I am delighted that Conservative Members are groaning because several of them voted for it when it was introduced way back in 2015. They did not have to—it was a choice. I am not trying to beat the record of my hon. Friend the Member for Perth and North Perthshire (Pete Wishart), who has spoken in the Legislative Grand Committee for England more times than any other Member of this House over the past four years, but can we just confirm again that, as you said, if Scottish Members, for whatever reason, were to object to the consent motion, you would not even be able to hear their voices —it is as if we are invisible?

[The Chairman]

It is not as if any hon. Member of this House is ever invisible or, indeed, inaudible, but merely, once again, following Standing Order No. 83W, which this House resolved to put into the Standing Orders of the House.