Oral Answers

Paul Bristow Excerpts

Tuesday 25th April 2023 Commons Chamber

[Will Quince]

The hon. Gentleman is right to raise this issue. Better communication with patients was one of the five principles at the heart of our elective recovery plan, which was published in February. We recommend that all providers use appointment reminders, often through text messages. As he suggests, in some cases that has been shown to reduce “did not attends” by up to 80%. Providers have told us that they see better results when communication is two-way, for example, where patients can reply to cancel their own appointments. Alongside that, we also launched the My Planned Care website, so that patients can access information ahead of their planned appointment, and of course we are doing a lot more with the NHS app. This is just one of the ways in which we are putting patients in control of their own care.

[Paul Bristow (Peterborough) (Con)]

I am the father to two beautiful daughters, Becky and Eris, one of whom was conceived through in vitro fertilisation. Being a father is one of the best things that has ever happened to me, and I was very proud to see IVF services reinstated in Peterborough and Cambridgeshire, following a campaign that I supported and helped to lead. What plans does the Minister have to ensure that IVF services and appointments are routinely offered across the NHS, in line with National Institute for Health and Care Excellence guidance?

[Will Quince]

I, too, have two daughters, so I recognise much of what my hon. Friend said—

NHS Strikes

Paul Bristow Excerpts

Monday 17th April 2023 Commons Chamber

[Steve Barclay]

One of the concerns at the moment is the BMA rate card, which is significantly increasing the cost of providing the required cover for the strikes, and in turn taking money away from things NHS staff have raised with me, such as improving our tech offer, improving the NHS estate and the many other priorities on which money could be spent. I am keen, as I am sure the hon. Gentleman is, to bring down the cost of agency workers. That is why we have the commitment to the NHS workforce plan and why I am keen to sit down constructively with the junior doctors committee, in the same way that I did with the NHS Staff Council. After we reached our deal, the leader of those negotiations for the trade unions commented on the meaningful and constructive approach that we took with the Agenda for Change negotiations. We are keen to do the same with the junior doctors, but that has to be based on a reasonable opening position from them.

[Paul Bristow (Peterborough) (Con)]

When union bosses open their pay demands at 19% for nurses and 35% for junior doctors, is it any wonder that some ordinary members feel let down when they have been asked to settle for a generous and fair 5%? Would it not be far better if the BMA junior doctors committee revised its ludicrous demand for 35%, got around the table and did its members some service by negotiating for a fair and reasonable pay offer?

[Steve Barclay]

I agree with my hon. Friend. The fact that even the Labour party does not support 35%—the Leader of the Opposition himself says that is not affordable —indicates how out of step the junior doctors committee co-chairs are on what is realistic to get the balance right in bringing down inflation and on the wider economic pressures we face. We stand ready to engage constructively with the junior doctors committee but, as my hon. Friend says, that has to be on the basis of a meaningful opening position.

Oral Answers to Questions

Paul Bristow Excerpts

Tuesday 24th January 2023 Commons Chamber

[Helen Whately]

Yet again, an hon. Member from the SNP thinks it is all to do with Brexit, when the facts show that that is simply not the case. As I said a moment ago, 12,000 more staff from EU and EEA countries are working in the NHS in England since the referendum. However, I point the hon. Gentleman yet again towards his own party’s record in government in Scotland and the problem of the NHS in Scotland haemorrhaging staff.

[Paul Bristow (Peterborough) (Con)]

10. What recent progress he has made on tackling the covid-19 backlog in elective care.

[The Minister of State, Department of Health and Social Care (Will Quince)]

Since the publication of the elective recovery delivery plan, the NHS has virtually eliminated two-year waits for treatments and is making progress on tackling the next ambition of ending waits of over 18 months by April. To support those efforts, NHS England recently wrote to providers mandating action on 18-month waits. We agreed that appointments must be scheduled as soon as possible to enable that target to be met.

[Paul Bristow]

The people of Peterborough are looking forward to their new NHS community diagnostic centre supplying an extra 67,000 tests, scans and checks each and every year, but that will shine a light on the need to power through our covid elective backlog. At the Royal Free Hospital, many cases that were previously treated as elective overnight stays are now treated as day cases, improving patient experience and increasing capacity. How will the Minister ensure that such innovation is spread across the NHS?

NHS: Long-term Strategy

Paul Bristow Excerpts

Wednesday 11th January 2023 Commons Chamber

[Paul Bristow (Peterborough) (Con)]

When I heard the big announcement recently that Peterborough would have a new NHS community diagnostic centre, I described it in my local newspaper as a great Christmas present for our city. This is a good NHS news story. The new centre will include MRI, CT and ultrasound scanning, as well as phlebotomy and cardiology testing. I am so pleased about the benefits that the centre will bring: it will mean that more than 67,000 extra scans and tests can be conducted in Peterborough every year. Along with many other centres opening across the country, it will do just what the Prime Minister has pledged to do: cut NHS waiting times and detect conditions earlier. I am talking about it today because this is precisely what we need to do: we need to get on with the job and have a long-term plan for our NHS. I am delighted that Peterborough is getting this state-of-the-art facility, because it is fantastic news for my city.

Like the Prime Minister, I have huge admiration for NHS workers. Both my parents worked for the NHS as nurses for most of their lives, and I understand the sacrifice and the long hours that are involved. Let me tell a story about something that happened in my constituency only recently, which is an example of the amazing work of NHS staff. I was told this story by my constituent Ivelina Banyalieva.

On 31 December, at 8 pm, a new year’s eve Bulgarian party was taking place in a local restaurant. A guest at one of the tables started sweating and was asking for napkins to wipe his face. The next second, he was lying unconscious. Some of the guests picked him up and took him outside the restaurant. Some tried to help, but of course they did not know what to do. Using her first aid training, Ivelina was able to determine that the guest had swallowed his tongue, was not breathing and did not have a pulse. She was able to take his tongue back out and, along with one of the guests standing outside, she started cardiopulmonary resuscitation while restaurant staff rang 999.

After five minutes of CPR the first ambulance arrived, and its staff confirmed that the man was still not breathing and had no pulse. They immediately started defibrillation, and within two or three minutes two more ambulances arrived. For an hour and half, those staff fought for the man’s life. They took it in turns to give CPR as they became exhausted, but did not stop for a second. After those one and a half hours, they were able to detect a very weak pulse. They transferred the man to one of the ambulances, where they spent another hour putting him into an artificial coma, and then successfully transferred him to a Cambridge hospital. He was given surgery with the placing of three stents, and 12 hours later he woke up.

That story shows that amazing things are happening in our NHS in places such as Peterborough. Saving someone’s life—essentially, bringing someone back to life—is one of the most amazing things that anyone can do. Such stories give me great pride in our national health service. Getting a new diagnostic centre makes me incredibly excited for the future. Yes, the NHS is facing challenges—no one will deny that—but I look forward with confidence, given my experience as the son of two nurses and experiences such as the one I have described. I am confident that this Government’s long-term plan for the NHS will succeed. I am confident that it is the right plan for the people of Peterborough.

NHS Workforce

Paul Bristow Excerpts

Tuesday 6th December 2022 Commons Chamber

[Wes Streeting]

I would say two things. As I have already said, I accept that the pandemic made the challenge right across the United Kingdom worse. I also accept that, in every part of the United Kingdom, the NHS is under severe pressure. I would say two things in response. First, even if some of our friends on the SNP Benches do not want to acknowledge it, there is no doubt that every part of the United Kingdom would be better off with a Labour Government and every part of the NHS in every part of the United Kingdom would be better off if there were a Labour Government, because the investment that we are proposing in NHS staff today would benefit countries right across the United Kingdom. [Interruption.] In response to the outgoing hon. Member for Peterborough (Paul Bristow), do not say that politics does not make a difference. Do not expect the people to believe that somehow there was an inevitable sense of decline in the NHS. I am sure people remember that, when Labour was last in government, we delivered the shortest waiting times and the highest patient satisfaction in history.

[Paul Bristow (Peterborough) (Con)]

rose—

[Wes Streeting]

Is the hon. Member planning to cross the Floor? I look forward to hearing from him.

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[Paul Bristow]

Certainly not. The hon. Member’s plan seems to be simply vote Labour—there is no detail to it and nothing else to it. I suggest that he looks at the good people of Wales, who suffer under a socialist healthcare system. They are certainly not very happy, are they?

[Wes Streeting]

I do not pretend that our plan is not vote Labour, but of course those are the means by which we get to better ends. What we propose today is the biggest expansion of the NHS workforce in history. I will explain how that will benefit patients across the country and how we will pay for it. I think that people in Peterborough, 2,788 of whom are waiting more than a month to see a GP, will welcome Labour’s plan for investment. That is why, after the next general election, Peterborough will have a Labour MP.

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[Steve Barclay]

As the hon. Gentleman knows, I have been at pains to point to the huge pressure the pandemic has generated, which he seems unwilling to accept.

In Wales, 60,000 people have been on a waiting list for more than two years, which is a huge example of what a Labour Government deliver in practice. Everyone recognises the huge demand for GP appointments, and there is no single solution, but GPs are seeing more people. Forty per cent. of appointments are booked for the same day, and almost 40% of patients have continuity of care.

[Paul Bristow]

Does my right hon. Friend agree that the £45.6 billion invested in health and social care is a phenomenal investment? The key to addressing the challenge is to make sure the money is spent wisely. If a Labour Government were in charge of making sure the money is spent wisely, with their record of wasting public money, it would be like putting Dracula in charge of the blood bank.

[Steve Barclay]

My hon. Friend raises an important point. The Government have increased the funding, which will be used in new, innovative ways to deal with the huge challenge we face as a consequence of the pandemic. That is why we have the elective recovery plan, on which we hit our first milestone over the summer in terms of two-year waits. We have rolled out 91 community diagnostic centres, which have delivered more than 2 million tests and scans.

The workforce is, of course, a vital component of this mission, which is why the ambulance workforce has increased by more than 40% since 2010, but we recognise there are significant pressures, particularly as a consequence of delayed discharges, which are having such an impact on the wards and in A&E. That reads across into the challenge of ambulance handover delays.

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[Paul Bristow (Peterborough) (Con)]

I refer Members to my entry in the Register of Members’ Financial Interests. It is a great honour to follow the hon. Member for West Ham (Ms Brown), who I thought spoke very movingly about the challenges faced by communities in her constituency. West Ham is not a million miles away from Peterborough, and I recognise some of the challenges that she identified, especially the horrible disparity between black women giving birth and their white counterparts—that is a stark statistic. She spoke passionately about that, and I think we would all recognise it—especially me, as a father of two young daughters.

In one of my first speeches as a Member of this House, I stood here and spoke about our NHS as someone who had worked in healthcare and public policy on and off for 20 years. I said that every two or three years, politicians stand up and say that the NHS needs more money, more capacity and a plan. When I made that speech—about three years ago now—I said that we cannot have another situation whereby we stand in the House asking again for more money, more capacity and a plan. Ultimately, that is exactly what we are doing. And so it goes on.

I understand that we have had a covid pandemic in the meantime; I understand that we have to recover from something that was extraordinary. But we have to make sure that the NHS is able to make the most of the budgets that it has. We have listened to quite a few contributions from the Labour party, including that of the shadow Secretary of State, the hon. Member for Ilford North (Wes Streeting). I cannot quite be sure whether he was asking for more money or saying that the investment in our NHS was not enough. As a result of the covid pandemic, the Government are putting an extra £45.6 billion of investment into healthcare. That is an extraordinary amount of money.

Indeed, the Institute for Fiscal Studies says that by 2024, healthcare will account for 44% of day-to-day Government spending. I understand that that does not include capital funding, but that 44% of day-to-day Government spending leaves just 56% for everything else—that is an extraordinary statistic. We have to make sure that we get value for money out of the money going in. Yes, we have the £44.6 billion that is going in, but another £3.7 billion is also being spent on capacity. What does that say to us? It says that we need to increase productivity in our NHS and get the most out of the money that we are putting in.

The King’s Fund has found relatively recently that the annual average growth in productivity in our NHS increased from 0.7% in the 1980s to only 1.2% by 2012-13, and we need to do much better. When I say “we”, I am talking not about the individuals working for our NHS—doctors, nurses, allied health professionals; people on the ground—I am talking about the system as a whole. We need to do much better, and I want to suggest a few things that may help.

The first is ensuring that clinicians and those working in our NHS operate and practise at the top of their licences, and that we make better use of other healthcare professionals, such as nurse practitioners, and of things that have been around for a long time, such as nurse-led prescribing. Why does my wife, if she does not want another child and she wants to take contraception seriously and go back on the pill, need to have that prescribed by a GP? That does not need to be done by a doctor; it could easily be done by a pharmacist or at least a nurse in a practice. That does not require a face-to-face GP appointment, especially when we have shortages of GP appointments.

Some GP practices are doing fantastic work. I refer to the Thistlemoor surgery, which I have mentioned in this House on a number of occasions. I think that Dr Neil Modha and everyone who works there would be embarrassed by the number of occasions I talk about them in this place. That GP surgery serves up to 35,000 people in my constituency, of whom 80% do not have English as a first language. Those there pride themselves that if someone turns up who was unable to get a face-to-face appointment by ringing up, they will do everything they can to see that person on the day, and in the vast majority of cases that happens. How do they do it, with such a huge demographic challenge with the number of people who do not have English as a first language? They do it through effective use of admin staff. They have a number of people who work in the admin department in triaging who speak a variety of different languages from the communities that the surgery represents. By the time the patient is with the GP or relevant healthcare professional, they already know pretty much everything about the patient, what symptoms they are presenting with and what might be done to help them. It is an excellent surgery doing excellent things in my city.

I also want to talk about surgical and cath lab capacity. Perhaps I am naive, but we seem to spend lots of money to create that capacity in our NHS, yet for a significant period of time, it is just not being used. We are increasing the productivity of those places by making sure that they operate throughout the day, and in certain cases throughout the night, but a consultant I spoke to relatively recently said that it was still very common for consultants to operate only one day a week in cath labs. I understand that they have lots of important things they need to be doing with their time, including training the people of tomorrow, and that being a surgical consultant is not just about surgery time, but goodness me we need to be doing a lot better than one day a week. We need them to be treating patients, powering through lists and doing what they need to do.

A lot of this is about investing in innovation, too. Lots of procedures, such as nurse-led endoscopy, do not necessarily need to be done by a consultant at the top of their game. We need to be investing in systems and technologies that allow us to have more day cases, rather than more expensive in-patient services. This all seems like common sense, but the same debate about increasing productivity has been going on for about 20 years in the NHS, and these are some of the arguments I have been making for a number of years, not just inside this House, but outside it.

I also want to talk about pharmacy. During the pandemic, pharmacy was often the only visible sign of the NHS on our high street. It is right that we make more effective use of pharmacy and pharmacists. I speak to pharmacists in my constituency, and they want to do more. They did so much during the pandemic, particularly with vaccinations, and they can do so much more. My plea is to use our pharmacies as much as we possibly can.

Another issue I want to raise while I have the House’s attention is that we spend a lot of money on organisations such as the National Institute for Health and Care Excellence and Getting It Right First Time. We put a lot of responsibility in the hands of doctors, clinicians, patient organisations and all those involved in creating policies, commissioning policies, service specification and all the rest of it, but often we then go away and ignore them. I do not understand why we do that. GIRFT identifies sensible ways that the NHS can save money and get better outcomes for patients, but most of the time that is not replicated across the system, and I just do not understand why. Of course local decision making is important, but if something works in Peterborough, it will work in Torquay. We can certainly increase productivity, patient outcomes and save money by doing the things that those organisations tell us to do.

Similarly, we do not quite have the 24/7, seven days a week NHS system that many of us would want. There are far too many elements of our NHS that only seem to operate between 9 and 5 on weekdays. Unfortunately, when someone presents with a serious episode, such as myocardial infarction, stroke or whatever, they will not wait until 9 o’clock on a Monday morning to get the most appropriate treatment. We need a system that is truly 24/7, 365 days a year.

I pay tribute to what my hon. Friend the Member for Winchester (Steve Brine) said about prevention, which was spot on. A lot of the things I have talked about on increasing productivity relate to treatment within the NHS itself, whether in an acute or primary care setting, but if we are to make significant productivity or value for money savings in the NHS, we need to stop people presenting at hospital when they do not need to. A lot of that will be achieved by people looking after themselves and having the information available to them, through investment in public health. I asked today in the Health and Social Care Committee whether these integrated care systems looked like a true partnership among public health, primary care, acute care and social care. The jury is still out on that one, but we definitely need significant investment in prevention, and I am looking forward to taking part in that inquiry.

I end with this. I have talked a little about what I think needs to happen, and I have done it rather constructively, I hope Members from all parts of the House agree. Despite the fact that there are probably severe differences between both sides of this House, all of us want a national health service and systems in place that are working as they should be, and all of us want to see a fully funded, appropriately funded and appropriately staffed national health service. Significant progress has been made: the Chancellor of the Exchequer, my right hon. Friend the Member for South West Surrey (Jeremy Hunt), who was previously Chair of the Health and Social Care Committee, has said that he will accept the idea of an official workforce target being put in place. That is a huge step forward.

Some significant gains, and investment, have been made in our NHS. The number of people working in our NHS is going up. With a little consensus about the solutions we need for our national health service, such as those that I have suggested, we can ensure that it goes on and prospers.

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[Taiwo Owatemi (Coventry North West) (Lab)]

Many Members will remember that the Health and Social Care Committee recently published a report on the NHS workforce—a report that the Government frustratingly chose to ignore. As workforce shortages stand at unprecedented levels right across the NHS, with the latest figures revealing that there are more than 133,000 vacancies in England alone, I thought it might be useful to remind the Government of some of the report’s key recommendations.

First, the Government are failing to provide our NHS nurses with the essentials that anyone would need to do their job properly. In short, they are serving up poor working conditions, year in, year out. At the bare minimum, all nurses across the NHS should have easy access to hot food and drink, free parking or easy access to work and spaces to rest, shower and change, but the Government cannot even get that right.

I have repeatedly raised with the Department of Health and Social Care and the Prime Minister the fact that NHS staff at Coventry’s University Hospital are paying an astronomical £600 per year simply to park at work. In the middle of a cost of living crisis, it is outrageous that Coventry’s NHS heroes are out of pocket because the Government choose to do vanishingly little to improve their situation. I again call upon the Department of Health and Social Care to look closely at this situation and scrap these unfair parking charges for good.

Is it really any surprise that the Government’s current target of recruiting 50,000 nurses has been woefully missed when they are treated so poorly? It is unacceptable that many NHS nurses are struggling to feed their families, pay their rent and heat their homes. Some nurses are even resorting to using food banks this winter. I urge the Government to look closely at how they can better pay and treat NHS staff this year and next, so that we can finally reverse this worrying trend.

Our beloved NHS, which I had the honour of working for as a senior cancer pharmacist before being elected, is on its knees as a result of 12 years of Conservative neglect and mismanagement. Many services are crumbling. Pay has failed to keep up for years, and morale among nurses is in a truly terrible place. That is exactly why the Royal College of Nursing has been pushed into taking industrial action this month and why the Government must stop the mud-slinging and instead work with nurses to resolve this crisis.

Secondly, the Government must take urgent action to improve maternity care. For over a decade, the Conservatives have failed midwives across my community, and now we are all paying the price. We need a robust, fully funded maternity workforce plan, and the Government must commit to recruiting and retaining the workforce at the level set out in the forthcoming report by the Royal College of Obstetricians and Gynaecologists. Labour has made it crystal clear that we would train at least 10,000 additional nurses and midwives each year to tackle the crisis that currently exists in maternity care. Labour has also committed to a historic expansion of the NHS workforce, to plug the gaps created by this Government.

The Government must also improve diversity in the recruitment of midwives, to improve the standard of care that black, Asian, mixed-race and minority ethnic women receive throughout pregnancy, birth and the post-natal period. By increasing diversity across the NHS, we can guarantee better standards of care for everyone, regardless of their background or ethnicity. Labour’s women and equalities team has routinely pushed for reforms that would improve how everyone experiences healthcare in this country, so when will the Government catch up?

Lastly, as the newly elected chair of the all-party parliamentary pharmacy group, I want to highlight an opportunity that the Government have failed to grasp: better use of community pharmacists. As a trained pharmacist, I know that the sector is crying out for more responsibilities to become the first port of call for patients who need advice and treatment. That would help to rebalance the workload across primary care, bring healthcare back into the community, reduce the pressures on GPs and hospitals and deliver healthcare that is much more prevention focused.

Any plan for the future of pharmacy must ensure that all pharmacists have adequate access to supervision and training, along with clear structures for professional career development into advanced and consultant-level practice to help to deliver this. That way, community pharmacists can play a much larger and more effective role in delivering healthcare. Until this Government properly mobilise pharmacies, we will struggle to reduce waiting times, clear NHS backlogs or improve patient access to GPs, so I desperately want to see action here. Every Member here today understands that our NHS workforce faces a range of big challenges. Whether it is nurses, midwives or pharmacists, our NHS workforce are at breaking point.

[Paul Bristow]

I completely share the hon. Lady’s sentiments about making better use of community pharmacists. She talked about better support and resources being available for pharmacists to do just that, but what specific things does she think need to happen to get the ball rolling?

[Taiwo Owatemi]

That is an excellent question. I could be here for hours explaining what I would like to see, but essentially, what I and many in the profession would like to see is an understanding and full use of the various skills that pharmacists have. We talked about this in the Health and Social Care Committee today: I would like pharmacists to be involved in providing clinical care—for example, a diabetes workshop or a cardio blood pressure workshop. We have seen other countries do that. In Alberta, Canada, community pharmacists are involved in the whole of the hypertension management; it is taken away from GPs and brought into the community, because it is more accessible in a community pharmacy.

Whether it is nurses, midwives or pharmacists, our NHS workforce are at breaking point, but the Government are seemingly ignoring that. I hope that the Government urgently sit up, take note and look at how they plan to address our workforce needs, to ensure that our beloved NHS staff are no longer ignored.

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[Sam Tarry]

Absolutely. My little sister is a nurse who works in palliative care in Southend, Essex. During the pandemic, her job was to help lots of people to experience the least suffering as they met the end of their life. The mental health of nurses has been broken, there is increased stress, and bank staff are being used—all as a result of nurses being so devalued that the Government have taken away their bursaries. We have a huge crisis, but one obvious fix would be to sort that out. Of course I agree that we have to listen and value our nurses.

[Paul Bristow]

Will the hon. Gentleman give way?

[Sam Tarry]

I will make some headway, because plenty of other hon. Members want to speak.

It is not just about pay: workforce shortages are at unprecedented levels across the NHS. The latest figures reveal that there are now more than 133,000 vacancies in England alone—more than a third of which are in nursing—which is an all-time high and a record for this country under the Government. The vacancy rate in registered nursing is running at nearly 12%, which is an increase from 10.5% in the same period of the previous year. A key factor in the failure to attract and retain enough staff is the Government’s inability to provide workers with a decent pay rise. Some 68% of trusts report that staff are leaving for better terms and conditions elsewhere.

[Paul Bristow]

The hon. Gentleman spoke about nurses’ pay and how they deserve more. We would all like to give nurses more money, but how does he account for the fact that the Welsh Labour Government are giving exactly the same pay award as proposed by this Government?

[Sam Tarry]

I cannot speak for the Welsh Government, but if we look at their record—the times that they have been returned to office with a stonking majority, and the fact that there are no strikes on their railways, which they had the guts to take into public ownership; they called it what it was—I would much rather be living under them than the appalling Government we have.

The impact of those shortages on existing staff is enormous. Reports by Unison have repeatedly highlighted the acute strain that understaffing has put on the workforce, with stress and burnout rife among NHS staff. That predates covid, which demonstrates the immense damage done by a decade or more of Conservative Governments and the failure of successive Governments and Prime Ministers to invest in the workforce or take workforce planning seriously. As the RCN has said, the dispute is about not just pay, but patient safety, which is key for all of us. Staffing levels are so low that patient care is being compromised; only paying nursing staff fairly will bring the NHS to a point where it can recruit and retain people to address those issues.

I have visited my local hospital, King George Hospital, on many occasions and I have heard about the impact of staff shortages and pay cuts on staff and patients alike. Recently, for once, I went to open some new services in paediatric emergency and radiology—something positive after 20 years of campaigning for our local NHS in Ilford—yet the staff were still overstretched, run ragged and demoralised. They just want the support that they need to care for their patients, which means pay recognition and ensuring fair practices at work without undermining their working conditions.

I spoke to staff who, during the worst of the pandemic, received food donations from the local community just to get by. That should never, ever be allowed to happen and makes it even more sickening to hear about the outright corruption on the other side of this House and the despicable corrupt PPE deals with people like Baroness Mone. People in Ilford are sick and tired of that because of the attacks on our local services. We even had to stand up and campaign for our local ambulance station not to be shut down under the Government’s measures.

Conservative Members seek to present nurses’ demands as unreasonable and undeliverable, and have asked nurses to tighten their belts even further, while they have allowed the pay of the wealthy to explode. This year, FTSE 100 CEOs collected an average of 109 times the pay of ordinary workers—that is part of the answer to where we get the money to pay the people who actually keep our country off its knees. Where is the Government’s commitment to pay restraint when it comes to high pay and those sorts of people? How many Conservative Members have fat cat salaries and executive directorships, and coin it in left, right and centre?

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[James Murray]

All the pledges that the Opposition make are fully costed and fully funded. [Interruption.] If the hon. Gentleman waits one second, I will address that point. Today is about political choices. It is not just a political choice of whether we invest in the NHS; it is a political choice of how we pay for it. That is why we have made it clear that, to pay for our NHS workforce expansion plan, Labour would abolish the unfair, outdated non-dom tax status. Non-dom tax status is passed down through people’s fathers and it costs the public purse £3.2 billion a year, while failing to support economic growth in the UK. Under the current arrangements, a small group of high-income people who live in the UK are able to avoid paying tax on their overseas income for up to 15 years. We would abolish that 200-year-old tax loophole and introduce a modern scheme for people who are genuinely living in the UK for short periods. We believe that if a person makes Britain their home, they should pay their taxes here.

[Paul Bristow]

My hon. Friend the Member for Winchester (Steve Brine) asked the hon. Gentleman a very specific question about the exact cost of doubling the number of places at medical school. Is the hon. Gentleman able to confirm the exact cost of that—not the non-dom cost, but the exact cost of doubling the number of medical places?

[James Murray]

I thank the hon. Gentleman for his intervention. I have set out that scrapping the non-dom status would raise £3.2 billion, and that our workforce expansion plan would cost £1.6 billion, so we would be well able to afford that measure from the amount of money that we have raised from scrapping this outdated, unfair tax loophole.

Non-dom status should have no place in our modern tax system. It is unfair. When the Government are making working people pay more tax, it is simply wrong to allow wealthy people with overseas income to continue to benefit from an outdated tax break. It is also bad for UK business: the loophole prevents non-doms from being able to invest their foreign income in the UK, as bringing it here means it becomes liable for UK tax. Abolishing non-dom status would end that barrier to UK investment—and, as I have said, raise £3.2 billion, money we would use to put towards priorities including expanding the NHS workforce.

To be honest, we would have thought abolishing non-dom status, replacing it with a modern system and using the money to strengthen the NHS and economy would be a no-brainer. What is it about this Conservative Government, led by the right hon. Member for Richmond (Yorks) (Rishi Sunak), that makes them so reluctant to close that loophole? Last week, during the rushed debates on the Government’s autumn Finance Bill, I asked Treasury Ministers to confirm whether the Prime Minister had been consulted on the option of abolishing non-dom status and whether it was ever considered as an option for last week’s Finance bill. I also asked whether, when the current Prime Minister was Chancellor, he had ever recused himself from discussions on the matter, for obvious reasons.

I put these questions to Treasury Ministers on three separate occasions last week, but they refused each time even to acknowledge the questions, never mind answer them. For a Minister to overlook a set of questions once might be an oversight, but to ignore them three times looks like something else. Perhaps the Minister will today show that they have nothing to hide by answering the questions I have raised.

In the autumn statement and last week’s Finance Bill, the Chancellor chose to leave non-dom status untouched, while picking the pockets of working people, including nurses, with stealth taxes such as freezing income tax thresholds and pushing up council tax. Today, the Secretary of State for Health only mounted a brief defence of non-dom status; I wonder whether his colleague from the Treasury will, in her closing remarks, repeat some of the defences that Treasury Ministers tried to set out last week.

Last week, Ministers tied themselves in knots trying to find a justification for the £3.2 billion tax break for non-doms. They tried to pretend that the Government's investment relief is working, when only 1% of non-doms invest their overseas income in the UK in any given year, and last week they tried to win praise for ending permanent non-dom status, while keeping quiet about the new loophole they created, which allows people to use trusts to retain non-dom benefits permanently.

The truth is that, unless the Conservatives vote with us today to abolish non-dom status once and for all, the British people will be clear that no amount of reason or common sense will get this Government to come round. The British people need a fresh start and a new Labour Government that would take those fairer choices on tax to support the stronger NHS we so desperately need.

The NHS is an achievement we share together as a country and one that we all have a personal relationship with. We all want to know that when we have medical symptoms, concerns or needs, the NHS will be there for us. We want to know it will be there as a publicly funded service, free at the point of use, able to provide us with the high-quality help we need. That is what I wanted to know in my early 20s, when I started to notice symptoms of what would later be diagnosed as myasthenia gravis, a rare neurological condition that caused muscle weakness throughout my body.

After the best care I could have hoped for from my brilliant consultant and his team and colleagues at the National Hospital for Neurology and Neurosurgery in Queen Square, I have been symptom-free for many years now, but the memory of first feeling those symptoms and then finding my way towards the right treatment sticks with me. I would never want anyone to feel symptoms like mine and not be sure whether the NHS would be there to help.

We all know stories like that. We all need the NHS to diagnose and treat us when we are worried. We all need to be able to turn to the NHS so that we get that treatment in good time. We all connect with the NHS through our own lives and the lives of our family and friends. That is why the NHS matters so much to us all and why we are so determined to deal with the crisis the NHS is facing and to make sure it is ready for the modern challenges we face.

At the heart of our vision for the country are stronger public services and stronger economic growth. We know that getting public services back on track will support a growing economy, which will in turn support modern, sustainable public services. Before us today we have a chance to end the unfair 200-year-old tax loophole, which lets a small number of people avoid tax on overseas income, and use the money saved to fund one of the biggest workforce expansion plans in the history of the NHS. That is the choice in front of us today, and I urge all MPs to do the right thing by backing our plan.

Royal Assent

Access to GP Services and NHS Dentistry

Paul Bristow Excerpts

Tuesday 21st June 2022 Commons Chamber

[Sajid Javid]

The hon. Lady raises an important issue. That is why the Government commissioned an independent report. We have responded to that report. We are still listening to what hon. Members such as herself and others are saying on this important issue, and then we will do a follow-up of the report within a year, so that will be later this year. I know that she will take an interest in that.

[Paul Bristow (Peterborough) (Con)]

Does my right hon. Friend agree that a lot of the issues with primary care services are about leadership? In my constituency, we have the brilliant Thistlemoor surgery with Dr Neil Modha and Dr Azhar Chaudhry, who serve 29,500 patients, 80% of whom do not have English as a first language. Same-day, face-to-face GP appointments are the norm in that practice. In contrast, a Thorney surgery has just temporarily closed a surgery in my constituency due to a lack of admin staff, which is not the fault of the admin staff themselves. Will he back my campaign to make sure that that GP surgery is open again serving local people as soon as possible?

[Sajid Javid]

My hon. Friend is campaigning passionately for primary care services in his constituency, and he points to some fantastic practices. I congratulate all the people involved in delivering that and support him in his work with his local commissioners to make sure that they are getting even better local primary care.

Elective Treatment

Paul Bristow Excerpts

Tuesday 8th February 2022 Commons Chamber

[Sajid Javid]

I thank the hon. Lady for her work on the Committee. She is right to raise the importance of mental health. Although today’s plan is focused on elective surgical procedures and diagnostics, she is right to talk about other types of care, especially mental health care. I know that she supports the huge amount of record investment going into the NHS for mental health care. Under the NHS long-term plan, it is an additional £2 billion a year. She is also right to raise the importance of patient care. I believe that there is a lot in this plan on patient care that she will support.

[Paul Bristow (Peterborough) (Con)]

I welcome the statement and the national mission. I must say that for the Labour party to try to play party politics with it is a serious misjudgment. Surgical hubs have been successfully piloted in London by the Getting It Right First Time programme. As they are rolled out across the country, will the Secretary of State ensure that GIRFT continues to be properly resourced and is given a key role in leading the programme in future?

Adult Social Care

Paul Bristow Excerpts

Wednesday 1st December 2021 Commons Chamber

[Gillian Keegan]

I thank the hon. Lady for her question, because this is something that bothers me. It happened to my grandmother. We had to sell her council house, which she had bought under the right to buy that was introduced by a Conservative Government. It is very important that we start to fix this, because under today’s system, everybody out there can go down to their last £14,250. That is all that is protected. It is therefore a very unfair system today. That is why we are making these changes and introducing this cap, to ensure that nobody will ever have to pay more than £86,000. In addition to that, we are putting the means test up to £100,000, so that the cost of care is shared as a person’s assets get below £100,000. That will also slow down the depletion of assets. It will be a much fairer and better system than the one in place today.

[Paul Bristow (Peterborough) (Con)]

I draw the House’s attention to my entry in the Register of Members’ Financial Interests.

A few months ago, I spoke with a social care service user who told me that living in supported housing made him feel like a king, because he had access to his own private shower. These small, incredibly significant, humanising differences between long-term hospital care and being supported to live independently are striking. Can my hon. Friend confirm that one of the drivers behind this White Paper is to ensure that people can live as independently as possible for as long as possible, and does she recognise that this can be achieved through the integration of social care, mental health and supported housing?

[Gillian Keegan]

My hon. Friend is absolutely right. Half of the social care budget today is spent on working-age adults. It is not just spent on elderly people. Of course, many people with disabilities or learning disabilities want to continue to work and they want to be supported in that. A supported house and the right mental health support are obviously the right approach, and that is something that we will be working on in this White Paper.

Health and Care Bill

Paul Bristow Excerpts

Report stage
Tuesday 23rd November 2021 Commons Chamber

There are two aims on the non-surgical side, because we have to beef up the regulation as well. I say to the Minister that if we do not get that in this Bill, I am not sure where we are going to get it. If the amendment is not accepted for technical reasons, I and, I am sure, the right hon. Member for Romsey and Southampton North and others, would like to work with him to draft an amendment before the conclusion of the Bill that brings in the regulation that was promised. The evidence is behind it, as is the Keogh review. It will not only give people confidence that procedures have been carried out safely, but drive the cowboys out of the sector, so that they will not be able to practise and harm vulnerable people.

[Paul Bristow (Peterborough) (Con)]

I rise to speak to amendment 10 in the name of my right hon. Friend the Member for South West Surrey (Jeremy Hunt). I refer Members to my entry in the Register of Members’ Financial Interests.

I have spoken in the House before about being involved in health policy for about 20 years. The same thing tends to happen every three or four years: the NHS says it needs more money, it needs more capacity and it needs a plan, and that is what we are doing again in the Bill. When we talk about more capacity, we mean not just more hospitals, more theatres and more diagnostics, but a bigger workforce. Thanks to this Government and the investment that has been made, I do not think anyone with any credibility can now say that the NHS does not have enough money. NHS England’s resource budget will rise to £162.6 billion in 2024-25—a 3.8% average annual real-terms increase. The Government also plan to spend a further £8 billion to tackle the elective backlog. This is the biggest ever catch-up programme in our NHS for elective surgery. Department of Health and Social Care capital spending will rise to £11.2 billion by 2024-25. I repeat: I do not think that anyone can say with any credibility that our NHS is now underfunded. We have the new diagnostic centres. We have the new pathways that should be adopted to increase NHS productivity. A long-term deal with the independent sector can ensure that we have the capacity to power through the elective backlogs—the hip and knee, hernia and cataract procedures that make up the vast majority of cases.

Of course, we need the nurses, the doctors and the consultants—the workforce—to carry out those procedures. This is a historical problem; it did not just happen overnight. All past Governments and, I dare say, past Secretaries of State for Health and Social Care have a degree of responsibility for this. As my right hon. Friend the Member for South West Surrey said, there are an estimated 93,000 vacancies in our NHS—consultants, GPs, nurses and allied health professionals. I was proud to stand on a manifesto at the last election that pledged to increase the number of healthcare workers in our NHS, and I know that considerable progress has been made, but just as the Government are doing with social care by putting in place a plan that focuses, laser-like, on resolving some of the long-term issues we face in that sector, we need the same laser-like focus to deal with some of the challenges with our NHS workforce. Any changes we make to our NHS workforce, or any long-term plans, need to reflect the real needs of our NHS. That is incredibly important. Some sort of duty to report independent figures about how we will make up the workforce is a very sensible measure.

Many years ago, I worked with the British Society of Interventional Radiology. The proposals we made and the work that we called for then were about workforce. Some argued that a lot of people were reaching the end of their professional career and retiring and there was a lack of new people coming through, so ultimately this would have an impact on patient care—on the number of procedures that could be carried out. The same arguments are now being made across a number of disciplines. Since I became an MP, I have met the Royal College of Surgeons and the Royal College of Physicians, and the same arguments are being made there. It is sobering to think about these challenges, and that is why this laser-like focus has to be considered very carefully.

We have talked about overseas recruitment. I heard what my right hon. Friend the Member for Sutton Coldfield (Mr Mitchell), who is no longer in his place, said about that, and he made a very powerful argument. In some ways, we are going to have to use overseas recruitment to plug the gaps in our NHS, but there are other solutions. We have heard hon. Members talk about retention. I was alarmed and shocked by the number of healthcare professionals who—understandably—wish to work part-time because they are parents and they have childcare responsibilities. I understand that, but it is going to leave our NHS with recruitment challenges.

When I speak to clinicians—members of the Royal College of Surgeons and others—they talk to me about the ability to work independently and autonomously. Many clinicians want that ability, but do not feel that they have it. There is also the idea that they want to be part of something bigger than their own small team. It is not that they want to be part of this thing called the NHS and that they are all working towards that goal; it is more that, once we have come through the challenge of the pandemic—once we have got ourselves over that mountain—there is an even bigger mountain ahead of them, which is dealing with the elective backlog, where they feel that things never change. That is what I have been told, and those are very powerful things.

What are the solutions to this problem? Ministers need to think about how we can encourage our consultants, our GPs and our medical professionals to practise at the top of their licence. Speaking to medical professionals, I have been told alarming things. About 40% of a GP’s time is spent on sickness notes or providing medical records to insurance companies and other people. That is admin staff work. As valuable as those admin staff are, that is not what GPs and medical professionals went into their professions, and went to medical school for all that time, to do. It is absolutely right that that burden be lifted from our medical staff and placed elsewhere. Nurse-led prescribing has existed for quite some time, but we have not really had the push and the drive there that we should have. GPs should not be spending their time prescribing very simple things such as the pill. We can certainly be doing a lot better and working a lot more productively, as my hon. Friend the Member for North East Bedfordshire (Richard Fuller) said. This is not about working harder; it is about working smarter.

[Clive Lewis (Norwich South) (Lab)]

Listening to the hon. Member’s speech, I think he is giving the game away in some ways, because what I am hearing, if I understand him correctly, is that he wants to see a core of healthcare provided by the NHS and then the more lucrative parts of the NHS—administration and other parts—siphoned off to the private sector, which is a model we have seen in the US and which this Bill makes so much easier.

[Paul Bristow]

I would ask the hon. Member to listen a bit more carefully, because nowhere have I said admin should be carried out by the private sector. I said that it should not be carried out by medical professionals. They did not go to medical school to work in admin; they went to medical school to treat the sick. That is what we want our medical professionals doing—operating at the very top of their licence.

I also do not want to see situations where untold numbers of consultants are spending just one day a week in the operating theatre. I understand that consultants need the opportunity to train junior colleagues and to continue their own professional development, but they should be operating in our theatres a lot more frequently than that.

[Dr Whitford]

I gently point out that surgeons do not just operate—we run clinics; we run endoscopy lists and colonoscopy lists—so it is not that they are only working one day a week. They investigate the patient before they operate, and that is one of the strengths of the system in the UK in comparison to other countries, where surgeons only operate and someone else has done the diagnostics.

[Paul Bristow]

I agree with the hon. Lady that surgeons work incredibly hard. What I am talking about is operating at the top of the licence and for our consultants to be able to do the things that we want them to do. She is absolutely right; they are doing vital work in other areas running clinics and so on, but ultimately what we have is an elective challenge, and we need to ensure that we spend as much time addressing that elective challenge.

[Dr Ben Spencer (Runnymede and Weybridge) (Con)]

Does my hon. Friend agree that one of the challenges for primary care is that general practitioners have absorbed a great deal of the role of social advocacy in our society? People are trying to get a face-to-face GP appointment, and it is sometimes being suggested to them that such things as getting a fitness note or a letter to go to a school might be better served by someone else in the wider multi-disciplinary team. People are getting frustrated, because our messaging about how to use the health service and the different range of roles and responsibilities offered is sometimes getting a bit diluted.

[Paul Bristow]

My hon. Friend speaks with much experience and makes a powerful point. I think he would agree that that core admin function is not what he went into medicine to do. He went into medicine to treat patients. I am grateful that the Minister laid out some of the plans that the Government have to deal with this issue. It is right that we should be looking to the long term, and the 15-year framework for future workforce is to be welcomed, but there also needs to be a much more regular reporting mechanism attached to that to ensure that we as Members are informed, but more importantly the NHS is informed, about how that challenge is going. The integration between NHS England and Health Education England—aligning the delivery arm and the workforce capacity arm—is probably also the right thing to do.

I end with this point: the challenges around workforce will be addressed not only by employing and training more NHS staff, although that is crucial—that is why I have some sympathy for amendment 10—but by ensuring that we work more productively by asking clinicians to operate at the top of their licence. It is also about ensuring that the NHS works smarter. We have created organisations such as Getting It Right First Time and NICE and asked them to go away and do the hard work of coming up with the most cost-effective and efficient ways of delivering care. If we ask those organisations to come up with the pathways and the ways of doing these things, surely it is only right that the NHS then adopts them instead of sitting there and saying, “These things will not necessarily work here.” We ask experts to come up with the right way of performing procedures; I suggest we go ahead and adopt them.

[Sarah Olney (Richmond Park) (LD)]

I rise to speak in support of amendment 10, tabled by the right hon. Member for South West Surrey (Jeremy Hunt), the Chair of the Health and Social Care Committee, because the amendment reflects the key issue facing the NHS and all our health and care services at this time: the workforce. Access to healthcare services is the No. 1 issue raised with me by constituents at the moment, and I know that concern is being echoed in other constituencies across the country.

People are experiencing the issue in many different ways. Some are struggling to get a GP appointment. I regularly speak to parents in great distress because of the lack of available help for their children’s mental health needs. The accident and emergency department at Kingston Hospital in my constituency has regularly had to ask patients to consider whether there are more appropriate sources of help for their needs. Patients waiting in the backlog of elective procedures are regularly having appointments rescheduled or cancelled. Ambulances do not always arrive when called.

The impacts are many and various, but when I speak to health service leaders in my local area, the answer is pretty much the same: there is a lack of available staff. Even in cases where lack of funds is not in itself a limiting factor, the lack of people with the relevant skills makes it impossible to fill all the vacancies they are able to pay for.

Many of these problems are covid-related. The current NHS waiting list is estimated to be over 6 million, and it is clear that much of that is because so many elective treatments were delayed during lockdown. Demand for mental health services has accelerated because of the impact of the lockdown, particularly on young people. Covid is still with us, of course, and workforces in every part of the economy are being impacted by the need for individuals to isolate when they have symptoms or test positive. Healthcare staff need to be more vigilant than the rest of us.

Many of these problems are also Brexit related. A lot of young Europeans decided to return to their home countries at the start of lockdown and have not since returned. Brexit has stymied our ability to recruit from the EU, shutting off an extremely important supply for all parts of the labour market, but the effect is being felt most markedly in health and social care, since it is having to manage the extraordinary demand of a global pandemic at the same time.

Many of these problems are also the result of a long-term failure to correctly predict or prepare for workforce demand. One of the huge advantages of a national health service is that it is possible to get clear data from right across the sector and to make appropriate plans and decisions. For some reason, that has not been done, and it is absolutely right that the Government should adopt amendment 10 to start to put that right.

I want to amplify a Backbench Business debate that I was able to bring to this Chamber a few weeks ago, in partnership with the right hon. Member for South Northamptonshire (Dame Andrea Leadsom) and the hon. Member for Newcastle upon Tyne North (Catherine McKinnell). It was on the subject of giving every baby the best start in life, and it was the firm view of all who attended that debate that the health visiting workforce needs to be substantially boosted to enable all new parents to receive a home visit from a trained healthcare professional. During the course of that debate, we heard of the many ways in which a health visiting workforce can support new families and the critical role they play in supporting babies and their families. One estimate is that the cost of poor parental mental health in the first year of life is more than £8 billion. It is clear that the cost of boosting our health visiting workforce would more than pay for itself in a very short time.

I also want to reflect briefly on a conversation I had with a constituent in the street in Richmond town centre on Saturday. Despite having two degrees, she was working in the care sector, and she was talking to me about her terms and conditions of work. She is employed by an agency and is not allowed to engage with any other agency. She is on a zero-hours contract, so she has to sit at home and wait to hear how many hours she might be required to work the following week. For various reasons that suits her, but I feel that it underpins the recruitment crisis we are experiencing in our social care sector, because that is no way to retain skilled and committed staff.

Health and Care Bill

Paul Bristow Excerpts

Report stage
Monday 22nd November 2021 Commons Chamber

[Edward Argar]

I will not give way. I want to make some more progress.

[Paul Bristow (Peterborough) (Con)]

Will my hon. Friend give way?

[Edward Argar]

I want to make a little more progress. I will not give way to one of my hon. Friends or to the hon. Lady at this moment.

This will be done by amending the provisions to clearly describe the information that must be included in a personal budget so that individual contributions count towards the cap at the local authority determined rate, and to ensure that personal budgets and independent personal budgets work as they were originally intended when being used in conjunction with the cap.

Before turning to integrated care boards, let me put it on record that, once again, this must be regarded as part of a package of measures that improves significantly on the current provision in place for those funding care.

--- Later in debate ---

[Edward Argar]

I did wonder whether I would regret that intervention. It was typically courteous, although I have to say that when a Member of the Opposition says that, “We’re here to help you”, I am not always sure. [Interruption.] Of course, when the hon. Lady does it, I know that she is sincere about it. The point I make is that this important change is necessary to deliver on the pledge we have made. It is being introduced on Report. While ICBs and integrated care systems, which we will speak about shortly, are hugely important, I suspect that this matter will dominate the debate in this group on Report. Equally, I suspect that it will be fully debated and scrutinised in the other place.

[Paul Bristow]

Does the Minister agree that we have been on a journey? The context of this needs to be considered. We are starting a conversation, but other things will come. There will be bumps in the road, but the context that we need to consider is that this is the first Government to tackle the issue of social care in decades. That is the right way to look at this piece of legislation. It should not be looked at in a short-term way.

[Edward Argar]

I am grateful to my hon. Friend, a member of the Health and Social Care Committee, for his intervention. He makes the point well that this is another step on the journey, but it is a journey that only this Government have actually got round to starting. Previous Governments have failed to make that progress. The previous Labour Government produced two Green Papers, one Royal Commission, and one spending review and nothing was done, so this Government are making significant progress.