Support for Carers

Peter Dowd Excerpts

Thursday 22nd July 2021 Westminster Hall

[Peter Dowd (Bootle) (Lab) [V]]

It is a real pleasure to take part in the debate under your stewardship, Mr Hollobone. I thank the right hon. Member for Kingston and Surbiton (Ed Davey) for enabling us to tease out the issues relating to unpaid carers. I concur with much of what he said.

I am disappointed to see only Labour and Liberal Democrat Back Benchers taking part in the debate. I genuinely would have liked to listen to Tory MPs’ views on the matter, given that it affects so many people in our constituencies. It is worth reiterating a few figures. In 2019-20, around 7% of the UK population were providing unpaid care. That is just under 5 million people, or an average of more than 7,500 people in each constituency, providing unpaid care.

In my own local authority in Sefton, around 5,000 people aged over 65 have dementia. In my constituency alone, that is around 1,700 people. I expect that figure could be higher if we take into account non-diagnosed dementia and people who are below the radar. By 2030, that number is set to rise to almost 6,500 people and over 4,000 of them will have severe dementia, meaning they are most likely to need support and social care. As many as 700,000 informal carers support people with dementia in the UK. They are asking to be helped out—not to be given a free ride. Of course, a significant number of carers themselves will be older and have their own physical and/or mental health issues. The real human impact on the lives of so many people and individuals can be clouded by the figures, but the figures cannot be ignored.

When I use the word “clouded”, it actually brings to mind the Alzheimer's Society report, “The Fog of Support”, which I exhort Members to read. In short, it sets out the challenges faced by both informal and/or unpaid carers, and formal carers. Some of the examples are heartbreaking. One carer says:

“Because I’ve got to be back within a certain time…you’re clockwatching. You can’t relax.”

Another quotation reads:

“He doesn’t want to go and if he goes in for respite he packs his case every night, ready to come home.”

Covid has thrown a cloak over the needs of many, and those two examples are not just reflective of reality; they are reality. For those who have no family and are the only carer, the strain and pressure are intolerable. In the first wave of covid, family and friends spent an additional 92 million hours caring for people with dementia—unpaid care. Since the pandemic began, unpaid carers have provided £135 billion-worth of care. It has been a long 16 months, and many relationships are under strain.

Members will have seen the Alzheimer’s Society briefing for the debate, and I thank it for that information. I am afraid that the Government’s policy on support for carers is in complete disarray. The Commons Library report is, as ever, a measured assessment of the current state of affairs. It says:

“The Government has said that it intends to publish a final evaluation of the Carers Action Plan in 2021…When the Government decided not to proceed with the publication of a Carers Strategy it stated that carers would instead be included in a then expected Green Paper on the reform of adult social care. However, the expected Green Paper had not been published by the time of the 2019 general election and the current Government no longer specifically refers to plans for a Green Paper.”

There is delay after delay, with more delay for good measure in case there was insufficient delay in the first place. A meeting between the Prime Minister, the Chancellor and the former Health Secretary—a so-called “do or die” meeting—was postponed in June. Asked about the postponement on Radio 4, the Business Secretary said he did not know that it was happening, and that it had been called off. If three senior members of the Government cannot even co-ordinate their diaries on one of the most important social issues affecting millions of people, what confidence can we have in their getting to grips with the substantive issue?

The Prime Minister, the Chancellor, the Health Secretary and every single member of the Government and their supporters are letting down not just older people but younger people, children and working-age disabled people. The Disabled Children’s Partnership produced an excellent briefing for the debate. Time does not allow me to go into its findings in any detail, but I hope it will be a salutary and informative read for the Minister. How much more evidence do the Government need to prove that the care system in general is in disarray, as is the informal, or unpaid, care system?

The Prime Minister likes things to be oven ready. He claims to like to get things done. He has promised action on this time after time, so perhaps he could use his isolation in Chequers productively and get to grips with this issue. It is time to deliver. Actions speak louder than words.

Elective Surgical Operations: Waiting Lists

Peter Dowd Excerpts

Tuesday 20th April 2021 Westminster Hall

[Peter Dowd (Bootle) (Lab)]

I beg to move,

That this House has considered waiting lists for elective surgical operations.

It is a pleasure to see you in the Chair, Ms McVey. Covid-19 has had a “calamitous impact” on patient access to surgical care. That is the view of the Royal College of Surgeons of England and it is what I want to focus on today. The Government need to receive that a message loud and clear. It is a message that needs to be repeated time and again, that cannot and should not be ignored, and that resonates with millions of people. I look forward to the response from the Minister, who I know takes this matter seriously.

The Government are not responsible for covid, but it is the Government’s responsibility to mitigate its effects through a variety of interventions. The question is whether they have fulfilled that responsibility. I imagine that the independent public inquiry will help us pin down that particular question. Let us hope that, as and when it happens, it is independent and full. The Royal College of Surgeons represents about 30,000 members in the UK and worldwide and, in this respect, it has a pretty good insight into the current calamitous situation facing millions of people, as it puts it.

I am sure it will be helpful if I contextualise the current situation facing patients. The most recent waiting time statistics published by NHS England on 15 April 2021 are worrying, but if taken with the hidden statistics, the position becomes almost overwhelming in magnitude. That is the challenge for the NHS, the Department of Health and Social Care, NHS England and, of course, for the Government’s commitment to ensure that the NHS gets all the resources it needs, as promised by the Prime Minister. I know that trusts and clinical commissioning groups, as well as NHS England, Public Health England, the Department of Health and Social Care and other NHS-related bodies have worked hard over the past year to ensure that services are being delivered as best they can, notwithstanding the unprecedented circumstances. My reason for initiating this debate is to highlight issues of concern. It is a challenge for us all.

What do the statistics say? A record 4.7 million patients were waiting for hospital treatment in February 2021. There were nearly 400,000 patients waiting for more than a year, which compares with just 1,643 people waiting for more than a year in February 2020. That is a significant rise, if ever there was one. Only 64.5% of patients waiting for hospital treatment were treated within 18 weeks in February against the Government’s target of 92%, which was last achieved five years ago. In total, 387,885 people are now waiting for more than 18 weeks. Those patients are our constituents. Each and every one of us will have numerous patients or would-be patients affected by this dire situation.

In my clinical commissioning group area, which covers my constituency and that of my hon. Friend the Member for Sefton Central (Bill Esterson), there were 1,374 people who had been waiting a year or more to be seen in February, compared with eight in April last year. It is a huge increase. All specialities are affected, but notable ones are ophthalmology, trauma and orthopaedics. It is important to note that what is not included is the impact on overdue follow-up activity and routine surveillance outside referral treatment.

We cannot overestimate the strains and stresses that such waiting puts on patients and their families, who do not know whether they will get the operation that is needed, or when it will happen. That point about what the situation means for patients was clearly made by the Royal College of Surgeons. There is a breakdown from NHS England, by specialty, which illustrates the situation that we and, more importantly, millions of our constituents face. In the trauma and orthopaedics surgical specialty that I have mentioned, more than 600,000 people are waiting, including 288,000 who have been waiting for 18 weeks or more and 84,000 who have been waiting a year for treatment. The percentage treated within 18 weeks, compared with the 92% target, is 52%. The figures are much the same for general surgery: 394,000 people waiting, with 60% treated within 18 weeks. I will not go through all the figures—I think hon. Members get the gist.

Such waits affect people in a variety of ways, mentally and physically. There is the obvious issue of pain that can be persistent, draining and debilitating for month after month. Also, of course, there are psychological effects such as distress or worry about deterioration in health, and concerns about the impact on a person’s employment status and the financial costs that might follow from the loss of a job, and subsequent loss of income. Of course, there will be an impact on family members or carers, who in turn have to cope or deal with the impact on the patient. There is the worry that an extended wait for surgery will bring more risks of deterioration in the patient’s condition. In certain situations the patient might need more complex surgery later. Moreover, there is always the concern that in certain circumstances a patient might die while waiting for an operation or other intervention. Those are serious, substantive and worrying issues that we, and particularly patients, must all face.

The parlous state of pre-covid waiting lists has made the covid situation worse, but it is not just a question of the impact of covid on lists. There is also the matter of underlying issues faced by the NHS, which covid has greatly exacerbated. In November 2020, making a comparison with 2019, the Health Foundation estimated that there were 4.7 million “missing patients”, as it calls them, who have not been referred for treatment. In other words, if 75% of those patients were included, the waiting list could grow to 9.7 million in 2023-24. That simply reaffirms the point that I made earlier about the need to plan now.

Many people have not referred themselves during covid to their GP. Getting a slot has often been challenging, to say the least. That element could become a significant factor in relation to cancer surgery: it has been estimated that the number of patients with suspected cancer referrals fell by 350,000 compared with the same period two years ago. That point was made not only by the Royal College of Surgeons but by other health-related organisations. The Royal College of Surgeons is not an outlier, and if the Government do not recognise the calamitous situation that patients now face, they will be ill-equipped to resolve it. I do not suggest that they are in danger of putting their head in the sand; but they are, if they are not careful, in danger of underestimating the scale of the crisis facing the country.

[Karin Smyth (Bristol South) (Lab)]

I take my hon. Friend’s point about the Government not putting their head in the sand, but I think he referred to the need to plan. Is the real issue that while perhaps they are not putting their head in the sand they need to demonstrate that they are starting to plan right now?

[Peter Dowd]

That is a fair point, and I will touch on it later. I know that the Minister is well aware of the situation and has his own challenges in getting the point home to his colleagues in the Treasury, among others. We will give him the support that he needs when he has those conversations.

In terms of support to weather this crisis, the Government cannot put the brakes on this vital area of public expenditure. Given the figures I have outlined, it is better to pre-empt this tsunami, because once it comes, it will be all the more damaging. Putting it right after the fact will be more expensive, more difficult and lives will be in danger, not to mention the ongoing economic impacts for the nation. If we have learnt anything from the covid-19 crisis, it is the point made by my hon. Friend the Member for Bristol South (Karin Smyth) that assessment and planning, followed by focused, comprehensive action, are required.

I have set out the issues as many in the health field have them set out. They are not my figures, they are not made up, they are in the public domain. The Minister knows the organisations concerned, as do hon. Members, so I will not list them.

I have attempted to be as concise and factual as possible and to set the scene, but there is a second element: how the issue can be tackled. The rest of my time will be spent on that. Again, this is not me making this up—is is not the hon. Member for Bootle’s version. It is, in a sense, the health organisations’ view. In this respect, the Royal College of Surgeons has set out a clear way in a comprehensive fashion. Other royal colleges and health organisations have expressed their views too. I have no doubt that the Minister will listen to those voices, which will be helpful and constructive. However, they are also unambiguous in their view of the need for the Government to act now with specific proposals that go beyond a balance-sheet approach. I believe the time for details and proposals is fast approaching.

I want to highlight four recommendations. The first is increasing NHS bed capacity. For many years in the run-up to the pandemic, the NHS was far too close to capacity. It was running hot, to use that phrase. International comparisons, which I acknowledge do not tell the full story, but do give a partial story, show that the UK has 2.5 hospital beds per 1,000 people, which is well below the OECD average of 4.7, and behind countries such as Turkey, Slovenia and Estonia. Remember, beds have been reduced from 108,000 in 2010-11 to 95,000 in 2021.

Secondly, during the pandemic the Royal College of Surgeons of England called for the setting up of green or covid-light sites with a separation of elective surgery from emergency admissions. As the college says, there is, “evidence of the risks to patients if covid-19 is contracted during or after surgery, including a greater risk of mortality and pulmonary complications”. In this regard, covid-light sites are critical to process ongoing planned surgery, given that patients and staff are segregated from situations where those who have the virus are treated. In addition, there is a regime whereby patients self-isolate and test negative before any surgical intervention is in operation. Meanwhile, staff without symptoms are regularly tested.

The third recommendation is for surgical hubs. During the pandemic, professionals have worked in partnership to provide mutual aid during periods of intense pressure, thereby enabling a seamless process of surgical intervention. Because of the multi-agency, multidisciplinary co-operation, trusts have also been able to designate certain hospitals as surgical hubs. As such, a capacity for particular types of elective procedures has been facilitated through skills and resources coming together in one place in covid-secure environments. While this hub model, as it is called, is not a total solution, it is none the less a practical way to enable many geographies and surgical specialities such as orthopaedics and cancer to work together.

The fourth recommendation is support for patients, and I touched on that earlier. Again, the Royal College of Surgeons has welcomed the prioritisation of patients in NHS England’s 2021-22 priorities and operational planning guidance. None the less, I agree that we need to go further and provide more guidance about how to develop and expand the options to address those waiting longest, and to ensure that health inequalities are tackled throughout the plan.

In my view, there should also be cross-departmental work on more comprehensive support for those directly affected by covid isolation requirements and people whose livelihood is threatened by longer waiting lists. Before I go on to summarise the four recommendations I have just put to Members, I emphasise that I am aware, and appreciate, that NHS England and NHS Improvement have been working on an elective recovery frame- work covering workforce logistics, clinical prioritisation, patient focus reviews, waiting list validation and patient communication. I welcome that, as will other hon. Members. I acknowledge that the NHS has completed almost 2 million operations and other elective care in January and February this year, and non-urgent surgery times have begun to recover.

In summary, there are four recommendations arising out of the narrative. Recommendation one: the Government should urgently invest in increasing bed and critical care bed capacity across England. Recommendation two: the Government should consolidate covid-light sites in every integrated care system region, and ensure that at least one NHS hospital acts as a covid-light site in each integrated care system in England. Recommendation three: the Government should widen adoption of the surgical hub model across all English regions for appropriate specialities, such as orthopaedics and cancer. Recommendation four: all integrated care systems should urgently consider what measures can be put in place as soon as it is practical to support patients facing long waits for surgery. I would like to put on record my thanks to the Royal College of Surgeons for its advice, information and support in relation to this matter.

Finally, the whole question of workforce-related issues—numbers, pay, conditions at work—needs a comprehensive, fair, equitable and inclusive review. The Secretary of State can initiate a wholesale review of organisational structures in the NHS in the middle of this crisis, which is causing angst and concern across the NHS—we cannot pretend that is not happening. He can therefore initiate a review of the terms that I have suggested.

Many lessons need to be learned from this crisis. I stress the value, commitment and professionalism of all staff in the NHS. Staff across all professions, disciplines and sectors are feeling drained after a year of hard, unrelenting work and we need to thank them for that. Without them, in particular, this country would be in an even worse social and economic predicament than it already is. We owe it to them to ensure that they get all the support they need to support the rest of us. Who could disagree with that?

[Esther McVey (in the Chair)]

Before I call Back Benchers to speak, I remind Members that in this 90-minute debate we will be calling the Front Benchers no later than 3.40 pm, and obviously Peter Dowd will be winding up again after the Minister.

--- Later in debate ---

[Peter Dowd]

This excellent debate has brought out so many things. I thank the hon. Members for Twickenham (Munira Wilson) and for Strangford (Jim Shannon) and my hon. Friends the Members for Bristol South and for York Central (Rachael Maskell) for contributing, and I thank the Minister for his replies. He has a pretty good feel for the strategic and organisational issues, and the hon. Member for Strangford and my hon. Friends set the scene for particular areas. This has been a qualitative debate—it has been about the quality rather than quantity of Members, and we have had a rich tapestry.

Finally, I want to say to the Minister that if he wants to include us in his ministerial WhatsApp group, he can do so. If he wants to give us the Prime Minister’s mobile number and the number for the Treasury team, we would be happy to take them. We will give him all the backing he needs in continuing to make the case for the resources we all want the NHS to have. Thank you very much, Ms McVey, for the opportunity to speak today.

Motion lapsed (Standing Order No. 10(6)).

Covid-19: Community Pharmacies

Peter Dowd Excerpts

Thursday 11th March 2021 Westminster Hall

[Peter Dowd (Bootle) (Lab) [V]]

It is a pleasure to see you in the Chair, Sir Graham. I thank the hon. Member for Thurrock (Jackie Doyle-Price) for bringing this issue before us today. She is right to say that pharmacies need our support now. They have played a crucial role as an integral part of our health service, which is under stress and strain at the best of times, and that is all the more the case during the covid pandemic. Pharmacies continue to play an even more important role, if that is possible, during this crisis. They have been there to support our communities when people could not access GP services. We have heard so many times during the crisis that people did not seek advice from their GP, local walk-in centre or hospital because they did not want to put even more of a strain on those services. Of course, many of them got the help and support that they requested, and it was from pharmacies. On behalf of my constituency, I would like to thank all the pharmacies that have helped during this crisis.

As the hon. Lady says, all the warm words we express count for nothing if that is all we do. Words are meaningless without action to back them up. Pharmacists have had enough words to last them a lifetime, so I will cut to the chase. First, the Government should review the response from pharmacies during the pandemic and re-evaluate a clear vision of what we need from these undervalued and vital frontline healthcare workers. It is not good enough to take pharmacies for granted. If this pandemic has shown us anything, it is how hard-pressed yet responsive our pharmacies have been during the crisis.

Secondly, the NHS and the Government should enable pharmacists to do more, as the hon. Lady said, by giving additional resources for training and support for this vital sector. The Test and Trace system has been given £22 billion, with another £15 billion in the pipeline. That is almost £600 per person to run a system that, at best, has been mediocre in terms of its returns. Frankly, a fraction of that resource could be put back to pharmacies. That would have a higher rate of return, be more productive and have a better outcome for our constituents.

Thirdly, a reassessment of the value of pharmacies, especially by finance teams in the Department of Health and Social Care and the NHS, would be welcome. When was the last time any real assessment of the value of pharmacies was undertaken by the Department or NHS finance teams in a comprehensive fashion that has led to any real support for the sector?

Fourthly, the Government should write off the advance payments as an immediate way of providing relief. Additionally, they should re-evaluate the financial implications of asking pharmacies to pay back the £370 million advance. This is crucial, given that pressures are pushing many community pharmacies to the edge. Quite simply, payments have not been enough to cover the financial pressures brought on by covid-19.

Fifthly, and linked the points above, the sustainability of pharmacies is crucial. That is why the all-party parliamentary group on pharmacy is giving them its support.

I urge the Government, before it is too late, to consider that current funding levels may already be causing irreversible damage. It is time for us to give our local pharmacists—for example, Dr Lisa Manning, the CEO of my local pharmaceutical committee—and their colleagues a shot in the arm. It is time to support them, and the time is now.

Covid-19 Vaccine

Peter Dowd Excerpts

Tuesday 10th November 2020 Westminster Hall

[Neale Hanvey]

I thank the hon. Member for that helpful clarification. I certainly hope that there would be a concordance of agreement to ensure not only that similar standards are followed, but that research can be worked on across all countries that have the capacity to do so.

I will make some progress. In our collective hope that there is indeed light at the end of the tunnel, the darkness of our shared journey through this pandemic must not be allowed to obscure our important public duty to act in good faith and with financial probity. That responsibility is not only of value in and of itself; we must do that out of respect for the many who did not make it through and who succumbed to covid-19, and in memory of those key workers who did so for the most selfless of reasons.

I want to refer to comments made by the hon. Member for Strangford (Jim Shannon). I agree with him that this has been a long, dark six months; it has been incredibly difficult. There is a need to feel optimistic, but it almost feels too good to be true. We hope that we will see this through, but again, I urge patience so that we can move forward collectively.

We must not emerge from this dark period with an “at any cost” attitude. We must ensure that the burden was shared equally and we acted together. In the spirit of co-operation alluded to by the hon. Member for Henley (John Howell), during Prime Minister’s questions on 18 March I asked a question about scientific support and I concluded:

“Does he agree that the prize on this occasion must be the victory and not patents and profits?”

In response the Prime Minister stated:

“I endorse completely the sentiment that the hon. Gentleman has just expressed about the need to do this collectively.”

And he concluded that

“everybody is working together on the very issues that the hon. Gentleman raised.”—[Official Report, 18 March 2020; Vol. 673, c. 1001.]

With regard to the spirit of togetherness, it is deeply concerning that we repeatedly hear of cronyism at the heart of this Government, particularly in relation to their less than rigorous approach to appointments and procurement. This morning on the BBC’s “Today” programme, the Secretary of State was challenged about the costs surrounding the vaccine taskforce’s work and its processes. Rightly or wrongly, the appointment of Kate Bingham has proven controversial, and there are no doubt questions to be asked about the absence of any clear recruitment process. However, when she appeared before the Health and Social Care Committee last week, I was very impressed by her performance. She has a very real command of the work that she has been leading, and the relevance and depth of her skillset were clearly in tune with the demands of such a position. However, that does not negate the Government’s or, indeed, any appointee’s responsibility to act ethically and in good faith and, most importantly, to transparently account for their actions.

Concerns about passing on company names that the Government favoured in the pursuit of a vaccine is not a matter for me to pass any judgment on, but they do need to be scrutinised fully. The most recent concerns, set out in The Guardian this morning, are also significant. In simple terms, how can a job be considered unpaid when the postholder holds a position of influence or control in the process of awarding a £49 million investment in a company that they remain a managing partner of? That Ms Bingham is married to a Treasury Minister should have set off the ethical alarm bells well in advance of the matter appearing in the media.

[Peter Dowd (in the Chair)]

Order. Mr Hanvey, can you wind up your remarks, please?

[Neale Hanvey]

I am just about to finish, Mr Dowd; sorry.

Whether the sign-off of the £49 million award came from Nick Elliott or, as the Secretary of State claimed this morning, some civil servant, this matters. These allegations of cronyism, if investigated and found to be true, are sure to make the expenses scandal, the cash-for-honours scandal or the cash-for-influence scandal seem like child’s play. This is a day for cautious optimism indeed, but not at any price.

[Alex Norris (Nottingham North) (Lab/Co-op)]

It is a pleasure to serve under your chairship for the first time, Mr Dowd. I am grateful to the hon. Member for North Herefordshire (Bill Wiggin) for initiating today’s debate on this topic. Timing is everything in politics, and his is clearly spot-on. Similarly, a rare political skill is the ability to make the complex comprehendible, and he really did that in his setting out of the debate. I do not know who is watching, but I did plug this debate when I was on Sky News at lunchtime, so I hope a few people are, because that was the best explanation that I have heard, and certainly the best one that can be distilled into about 15 minutes, of just how rigorous the process is. I hope people will take from that explanation the reassurance that although we are keen for the vaccine to succeed, there is a rigorous process. It has not been retrofitted to fit the vaccination’s journey, so we should have some confidence in that.

To reflect on the two Back-Bench contributions, when the hon. Member for Strangford (Jim Shannon) referred to it being bit of good news, = he was speaking for all of us. He mentioned the groups that will be prioritised, and I think there will be a high level of consensus on that. Hopefully, it is something that we will settle on very quickly. I was cheered by the hon. Member for Henley (John Howell), who talked about the Council of Europe and the World Health Organisation, because those are exactly the sorts of fora that we need to engage with to get an equitable distribution around the world. It is hard for all of us; this is why political consensus is so important. It is hard for us to tell our constituents why we feel there needs to be a global distribution when people are so desperate to get their lives back to normal, but we know there is both a moral and a pragmatic obligation to do that. The organisations that the hon. Gentleman talked about are exactly the places for those conversations.

On the politics of this, it is really important that we do not mess around or be mischievous with the idea of the vaccine. There is a big public conversation about this. Any look of doubt from us would be magnified significantly. As community leaders, we have a responsibility to say that we trust the process. The outcome is whatever the outcome is, but the process itself is a proper one that we trust. That is certainly what hon. Members will see from the Opposition.

Yesterday’s news on the progress and the efficacy of the vaccine will have cheered all of us. I know that the Government are on record with regard to doses from that particular provider, but when we add in the AstraZeneca-University of Oxford one and the Moderna one, might the Minister be able to tell us how many pre-orders have been put in place for the vaccinations? That would help us to gauge the scale. I know the Government have laid the pitch for the roll-out through the changes to the human medicines regulations, and significant changes were made, including giving the Medicines and Healthcare Products Regulatory Agency the powers to grant temporary authorisation pending the granting of a licence.

I was grateful for the time that the Minister gave me with her and the deputy chief medical officer to talk about those changes, but when will there be a parliamentary opportunity to do so? We need to demonstrate that we have scrutinised this properly because the public want to know that we are talking about these things to the fullest extent. That would also allow us to address the point about immunity from civil liberty that the manufacturers and healthcare professionals are seeking, which is not surprising, but there are important and significant qualifiers around that not extending to sufficiently serious breaches. Will the Minister explain what a sufficiently serious breach would look like, or when we might have an occasion to talk about that further?

On vaccine hesitancy, it seems there are distinct phases. We have the anti-vax movement, which is about the substance of vaccinations to an extent, but it also about a broad range of other things. As our constituency mailbags will reflect, there is also a group of people who are hesitant, which is entirely understandable. They want to know that any vaccination, whichever one it is, is a safe one, but it is telling that last year the WHO had vaccine hesitancy in its top 10 threats to global health—up there with a future pandemic. That is something that we need to be aware of. We know that such speculation and the stuff that moves online at an incredible pace can really damage the process. For example, in Denmark in 2013 there were false claims from a documentary about the HPV vaccine, which led to a decline in uptake among some of the cohorts from levels of around 90%. Similarly, between 2014 and 2017 in Ireland, vocal attacks on the HPV vaccine from the anti-vaccine lobby led to a drop in take-up from 70% to 50%. These things matter. One thing that best counters them is proactive, positive health promotion campaigns. I am keen to hear whether the Government plan to talk about these things to educate the population ahead of time, but, again, it something that we all need to buy into, share and push out on a cross-party basis.

An area where I think there might be a little more room for divergence is delivery. We do not know what the future holds for the vaccine or when things will pop up, but it is reasonable to say that we expect one, and we know the scale of our population, so we have no reason not to have significant plans. When the Health Secretary was pushed on it this afternoon, he said that there were plans, but he was less forthcoming on what they were. I am keen for more detail. Whether it was PPE at the early stage of the pandemic or test and trace, frankly, throughout it, such big-scale planning and logistical exercises have not gone flawlessly. Qualifications could be made when they were being done for the first time, but we cannot repeat those mistakes now that we are, I hope, learning from what has happened.

Again, the Health Secretary has talked quite a bit today in the media and the Chamber about the importance of general practice. As I understand it, the BMA’s GP committee, NHS Improvement and NHS England have agreed an enhanced service for general practice to lead this process. That is good. People will want to see this delivered through the NHS rather than a private company, whether because they believe in its efficiency, as I certainly do, or whether in general they think that will reflect best in the population. That is a wise thing to do.

I understand that it is optional for practices to sign up, so may I get more detail from the Minister on that? If take-up is not good enough, will an alteration be considered? I also want to understand what assessment has been made about GPs’ capacity and workload. As I understand it, the programme requires participants to deliver at least 975 vaccinations over a seven-day period from each designated site—that will require 12-hour days seven days a week, including bank holidays. GPs are already busy, so I am keen to know about what assessments have been made about prioritisation.

I do not have enough time to talk about this properly, but I turn finally to the point made clearly by the hon. Members for Henley and for North Herefordshire: we have to come to an equitable settlement globally, too, and to play a leading role in global organisations as we do so.

[Peter Dowd (in the Chair)]

There will be multiple votes in the Chamber shortly. I call the Minister to speak.

Covid-19 Update

Peter Dowd Excerpts

Tuesday 8th September 2020 Commons Chamber

[Peter Dowd (Bootle) (Lab)]

Given covid, the Health Secretary said it was “mission critical” to prepare the NHS for the winter, as he unveiled the biggest flu vaccination programme in history; that is very Trumpian, I have to say. In the light of the lockdown delay, the PPE debacle, testing and tracing chaos—we could not get tested yesterday in my borough, with 300,000 people in it—not to mention, I will remind the Secretary of State, the 40,000 people already dead from covid on his watch and that of the Prime Minister against, and he is quite happy to compare internationally, 9,400 in Germany, why should we have any confidence in this bungling Government’s ability to get the flu vaccination programme in shape for this winter?

[Matt Hancock]

We are going to have the biggest flu vaccination programme in history. I think the hon. Gentleman simply has not taken into account the action that was taken to protect the NHS in the crisis, building a capacity for testing that is bigger per head of population than any other major European country. This country is the only country in the world that has discovered treatments that reduce people’s likelihood of dying from coronavirus. I think he should get onside with what this country is doing, not keep squabbling from the sidelines.

NHS Pay

Peter Dowd Excerpts

Wednesday 13th September 2017 Commons Chamber

[Peter Dowd (Bootle) (Lab)]

Regrettably, I do not have much time to go through Members’ speeches, but I want to draw attention to the maiden speech by my hon. Friend the Member for Portsmouth South (Stephen Morgan)—a Pompey boy. There are two victories in Portsmouth: HMS Victory and my hon. Friend’s victory, for which I thank him. He mentioned Arthur Conan Doyle’s time as a doctor in Southsea; if the Tories had their way, this country would be going back to Victorian times.

Some 5.4 million people work in the public sector—including members of my family; my wife and daughter work in the NHS, as I did for many years—and they provide services that are crucial to the good running and, literally, the order of the country. They provide the armed services that protect our country and the protection that this House enjoys day in, day out; they provide the services that educate and look after our children; and they provide the services that care for our disabled citizens and senior citizens. They provide services that we barely notice until things go wrong, such as traffic problems, floods, weather damage, public health emergencies and much more. Some 1.6 million of those people work in the NHS, providing the services that look after the physical and mental health of our—yes, our—constituents.

[Lucy Frazer]

Will the hon. Gentleman give way?

[Peter Dowd]

I will come back to the hon. Lady in a moment.

NHS workers are the subject of today’s debate, but we must not forget workers in the rest of the public sector. In fact, I believe that NHS workers would be dismayed if we focused only on their pay situation. Why would they be? Because they spend their professional lives looking after others. I take NHS workers’ commitment incredibly seriously, unlike that hon. Member on the Government Benches who laughs at nurses, doctors and allied professionals. That is the sort of thing we get from the Tories.

[Simon Hoare]

Will the hon. Gentleman give way?

[Anna Soubry]

Will the hon. Gentleman give way?

[Peter Dowd]

No, I will not.

I know that NHS workers take that view because I have spoken to them.

[Anna Soubry]

On a point of order, Mr Deputy Speaker. Is it in order for an hon. Member to point randomly across the Chamber and insult another Member, without even having the courtesy to name them and thereby give them the right of reply?

--- Later in debate ---

[Mr Deputy Speaker (Mr Lindsay Hoyle)]

If we were to take that as an example, I could give many other examples of people on both sides pointing and certainly not being courteous to Members in the way one would expect. The right hon. Lady has a good track record of being able to give a bit out; she ought to be able to take it.

[Peter Dowd]

I say again that I know for a fact that NHS workers take the view that this debate is not just about them but about the public sector generally.In proxy terms, this debate is about all public sector workers. Many of the arguments about the health sector apply to other parts of the public sector as well.

[Anna Soubry]

Will the hon. Gentleman give way?

[Peter Dowd]

No, I will not.

This debate has come at a stark time for our public sector workers. We have had the hardest summer that many of us can remember—our emergency workers and other public sector workers have faced the horror of terror attacks and the outrage of Grenfell.

[Anna Soubry]

Will the hon. Gentleman give way?

[Peter Dowd]

No, I will not.

As the country suffered, those workers stepped forward. Will we step forward for them? Labour says, yes, it will. We know what those workers provide for our communities and for our country. What do we provide for them—or, rather, what do the Tories provide for them? First, they provide huge amounts of patronising claptrap—we have seen loads of that today—backslapping and warm words. Those workers do not need our tributes; they need our action. The Tories tell them how much they are valued and what a great job they do. The Prime Minister tells us virtually on a daily basis how wonderful our public services are—it usually happens after a national emergency in which people are murdered, maimed or, in the case of Grenfell, asphyxiated or burned to death. Yes, in the week of the Grenfell public inquiry, it is as stark as that, so let us not shilly-shally around this issue.

Those public sector workers are the people we turn to when no one else is available. They are the people who save lives, help to bring life into the world and are there when we leave the world. While they gave their all for us over these hard months, they knew that the Conservative Government remained committed to capping their pay and to continuing with the real-terms pay cut they have faced since 2010. Ever since the election, they have faced mixed messages about their pay from the Conservatives.

[Rachael Maskell (York Central) (Lab/Co-op)]

The problem is not just about pay, but about the funding of the NHS. York’s hospitals are in this capped expenditure process due to the debts they have accrued because of massive underfunding. Can we ensure that this money comes from the Treasury and not out of the coffers of the NHS?

[Peter Dowd]

I will come to that point in a minute.

In the election, Labour promised to end the public sector pay cap and to free the pay review bodies to do their work properly without the artificial encumbrance of a 1% cap. Meanwhile, the Tories have spent the period since the election putting the heads of public sector workers in a spin—will they or won’t they. Yesterday, No. 10 was briefing that the pay cap was over. The Chief Secretary to the Treasury was on the radio announcing derisory offers to police and prison staff, rather than coming to this House to explain what was going on. We had to have this debate today to get the Government here to explain their actions. Members on the Government Front Bench would do well to remember these words of wisdom:

“It is better that you should not vow than that you should vow and not pay.”

We will hold them to that. When the reality of this supposed U-turn emerged, there was nothing tangible. In the case of the police, it was just an unconsolidated 1% bonus on top of what they were due to get. Prison officers were offered just 1.7%. In effect, less than 4% of public sector workers were covered by the proposals announced yesterday. In the meantime, the other 96% can whistle. The nasty party simply cannot help itself. What is its tactic? It is the same old one, regurgitated time and again, of divide and rule. As ever, it tries to pit one group of workers against the other—the public sector against the private sector, doctor against manager, admin against manual workers, British workers against foreign workers, and the north against the south. Yes, it is the same old hackneyed tactic, but this time it has not worked. If the Government had focused on dealing with this matter and on sorting out the tax dodgers, we might not have been in this situation in the first place.

This is over. Even as the Government conceded the need for a thaw in the pay cap, Tory Front-Bench Members were briefing the media to raise the issue of wonderful contracts and pensions in the public sector. The Prime Minister attacked our public servants for having progression pay as they gain experience. The Government just could not accept that fairness required a change in direction. They still had to have that streak of resentment when they were announcing the policy change. As Anne Bronte said:

“There is always a ‘but’ in this imperfect world”.

With the Tories, it is always an industrial-sized ‘but’, visible from space.

The police and prison officers will have to pay for their pay rise themselves. There is no new money and no new resource. It is an announcement without substance. If and when the public sector pay cap is lifted across the rest of the public sector—namely the other 96% I referred to earlier and, in particular, the NHS—will the Minister be asking them to pay for their own pay rise by sacking more NHS staff? Will she provide new resources? Does she expect waiting times to get longer, and operations to be delayed or deferred? Who will be first on the sacking list—the porter, the radiographer, the medical secretary, the nurse, the doctor or an allied professional? Perhaps none of these redundancies will be needed because jobs in nursing, medicine and other allied health professions cannot be filled in large parts of the country.

This is a betrayal of public sector workers and it has to end. The Tories do have something in common with nurses and doctors, but for wholly different reasons. Nurses and doctors in the medical profession stitch people up for the benefit of the patient. The Tories stitch people up for their own benefit.

Accelerated Access Review

Peter Dowd Excerpts

Tuesday 13th December 2016 Westminster Hall

[Ian Austin]

The hon. Lady is completely correct. It is good that she is here in the Chamber, making these important points.

Vertex is also keen to explore flexible reimbursement schemes, which would allow the NHS to manage the overall budget impact of the treatment. However, the inflexible current system insists that any offer has to be made public, rejects the trust’s solutions and offers no scope for flexible reimbursement schemes. That brings me to the accelerated access review, which was commissioned to speed up access to innovative new drugs and treatments such as Orkambi. The review was finally published in October, after a long delay, and recommends that NICE reviews its processes. It calls directly for the current system to change, to include more emphasis on the confidential commercial arrangements, flexible reimbursement arrangements and collection of real-world data that I and other Members have referred to. Those recommendations could be the key to reaching a deal that delivers Orkambi to those desperate to receive it.

When the review was commissioned last year by the Minister’s predecessor, the hon. Member for Mid Norfolk (George Freeman), he spoke of how accelerating the uptake of transformational technologies in the 21st century would attract investment in research and innovation to help us earn the prosperity we need as an advanced economy. When the review was published in October, NHS England’s chief executive, Simon Stevens, said that creating headroom for faster and wider uptake of important new patient treatments would create opportunities for the UK’s globally successful life sciences sector. The failure to deliver Orkambi undermines that vision.

We have a rigid and inflexible system, and warnings that it is not fit for purpose have been ignored throughout the process. Instead of embracing the opportunity for an innovative solution, we have been offered further negotiations based on criteria that have already failed once. That is a waste of time and taxpayers’ money and sends completely the wrong signal to a global life sciences industry currently questioning future investments here in the UK. Hugh Taylor, the review’s chair, set out the need for commitment and collaboration across Government, the NHS and the life sciences industry to make the review’s proposals a reality.

The review sets out criteria for transformational treatments that should be fast-tracked for access. Orkambi meets those criteria. It presents the perfect opportunity to put many of the review’s proposals to the test, to illustrate the commitment and collaboration needed and to demonstrate how we can come together and adapt in the light of new information. It is predicted that 95% of people with cystic fibrosis could benefit from a personalised medicine within five years. Coming up with a solution for Orkambi—one that makes sense to the NHS as well as reflecting the investment that goes into these treatments—will give us a genuine opportunity to beat this condition.

I am sure people will benefit from the review’s proposals in the years to come, but that must not be at the cost of Orkambi, which is available now. Many people with cystic fibrosis, as well as their families and carers, such as my constituents Carly Jeavons and Samantha Carrier, are watching this debate. Many of them are forced to spend weeks and months of each year in hospital, and most of all they want a chance to be able to do the everyday things we all take for granted, such as raising a family, planning a holiday or breathing without struggling. They have already endured needless delays, and as time goes on those delays present an obstacle to investment in future treatments to beat cystic fibrosis. That is not the vision set out by the accelerated access review.

[Peter Dowd (Bootle) (Lab)]

Muscular Dystrophy UK is calling, among other things, for ring-fenced, protected funding for rare diseases. That was not included in the review to which my hon. Friend refers. Does he feel that that possibility should at least be considered as a way forward at some point?

[Ian Austin]

That is a really good point, and I am pleased that my hon. Friend raised it. I am sure the Minister will want to respond to that.

Tragically, we have to face the fact that many people are dying now. They do not have time to wait for the Government to respond to the review or for NICE to enter a lengthy consultation on its processes. They want to see the Government get on with exploring how Orkambi can reach those who need it without delay. If the Government create the conditions for constructive negotiations, the manufacturers will play their part, just as the Government themselves need to be flexible in order to deliver transformational treatments such as Orkambi.

I would like to ask the Minister the following questions. Does he think it is right that people in this country are considering moving to France or Germany in order to save their children’s lives by giving them Orkambi, which is now proven to halt the progression of their children’s decline? What does that say about a Britain trying to project its place as being at the cutting edge of the life sciences sector? Will the Minister provide assurances to people watching today that the Government are listening, and that everything possible will be done to explore progressing the negotiations on Orkambi in 2017? Will he reassure them that we are capable of finding a solution next year that will bring an end to this cruel and unnecessary wait?

Will the Minister seek guidance from Government, NICE and NHS England on how the recommendations in the accelerated access review can be used to break the deadlock in negotiations? Will he meet Vertex and the Cystic Fibrosis Trust to discuss that? Samantha Carrier points out that in the 1970s, the life expectancy of cystic fibrosis sufferers was only five years old. Thankfully, that has increased greatly, but the rules for free prescriptions have not moved. When people become 18, they have to pay for their medication, despite the fact that they need these drugs to stay alive. Will the Minister look at that issue?

This is exactly how Parliament and politics in our country should work. It is our job to listen to our constituents and come here to stand up and speak out on their behalf. People like Carly Jeavons struggle to work or spend time with their family and do other things that the rest of us take for granted because they have to undergo hours and hours of treatment. New treatments have helped Carly, but others are missing out on these new drugs at the moment. People like Sam and Rob are having to come to terms with what this condition means for their newborn child, at the same time as having to care for her. All three of them—Sam, Rob and Carly—are devoting hours to raising funds or campaigning for better treatments for people with cystic fibrosis. They are an inspiration to us all; will the Minister meet Carly Jeavons, Samantha Carrier and Rob Evans and listen to them directly?

Oral Answers to Questions

Peter Dowd Excerpts

Tuesday 15th November 2016 Commons Chamber

[Mr Hunt]

The right hon. Gentleman understands health extremely well, both from his ministerial position and from being on the Select Committee. If he looks at the hospitals going into special measures, he will see that we are beginning to succeed in moving hospitals out of special measures, but because we have an independent inspection regime, sometimes other ones go in. That is how it should be. That is what works very well in the education sector and is beginning to work well in driving up standards in health care as well.

To go back to my answer to the hon. Member for Lewisham East (Heidi Alexander), £1.3 billion more in the NHS this year compared with what would have been put into the NHS if Labour had won the last election means 30,000 nurses, 13,000 doctors or 200,000 hip replacements that we are able to do because of this Government’s funding of the NHS.

[Peter Dowd (Bootle) (Lab)]

3. How much his Department spent on healthcare as a proportion of GDP in (a) 2009-10 and (b) 2015-16; and what estimate he has made of the amount that will be spent on healthcare as a proportion of GDP in 2020-21.

[The Secretary of State for Health (Mr Jeremy Hunt)]

Because of the 2008 financial crisis, all political parties committed to reducing the proportion of GDP spent on health in 2010, but because this Government chose to protect the NHS, the proportion fell from 6.4% to 6.2%, a drop of just 0.2% of GDP.

[Peter Dowd]

While welcome, that creative response does not answer the question. The fall in GDP spent on health is worrying. To mitigate that fall, when can my constituency expect its share of the Brexit NHS bonus to be injected into its health economy, which would bring in £30 million a year?

[Mr Hunt]

No one would be more delighted than the Health Secretary if we had a Brexit bonus for the NHS, which is why we are getting on with negotiating the best possible Brexit deal for this country, including by invoking article 50 as soon as possible.

Hormone Pregnancy Tests

Peter Dowd Excerpts

Thursday 13th October 2016 Commons Chamber

[Peter Dowd (Bootle) (Lab)]

It was fantastic to hear that compelling speech by my hon. Friend the Member for Garston and Halewood (Maria Eagle). A theme is developing. One thing we have learned in this country time and again from many public inquiries into various issues is the need to ensure that the victims of injustice, the survivors and their families have an opportunity to have their say, in whatever format, in as transparent and open a way as possible, with no regulatory or industry cosying-up.

The second thing we have learned is that we need to bend over backwards and go the extra mile to ensure that the victims, or those speaking on their behalf, have full confidence in the mechanism set up to seek out the truth behind what has occurred. How many times have we in this country failed to investigate such matters properly, only to have to revisit them and reach the conclusion that those seeking justice were right in the first place? It often seems as though a blanket is deliberately drawn over difficult and challenging issues, to prevaricate and procrastinate until those affected are worn out, worn down or die. Institutions live on; people do not. It is a cynical game of cat and mouse. The victim is the mouse, but often it is the mouse that roars. In this case, it roars “No cover-up!”

After all the miscarriages of justice that have occurred in this country over the years, do we really have to drag institutions and organisations kicking into the light of an examination? How has it come to this? Have we learned no lessons from the history of all those inquiries? Are our institutions so arrogant that they feel immune to the democratic process, to scrutiny and to accountability? What has it come to when this House has to consider such a motion from my hon. Friend the Member for Bolton South East (Yasmin Qureshi)? We should not have to be here doing this today.

My hon. Friend has done a remarkable job on behalf of the people affected by this scandal. That is what it is—a scandal, pure and simple. She has been tenacious in pursuing the matter on behalf of the families affected by this sorry tale of incompetence and deficiency and a lack of will to put it to the test. In her, those families have a doughty champion. She and my hon. Friends the Members for Garston and Halewood, for Makerfield (Yvonne Fovargue) and for Stalybridge and Hyde (Jonathan Reynolds), and the hon. Member for Livingston (Hannah Bardell), have today laid out the inadequacies of the process so far. I do not want to repeat what they have said. They could not have been any clearer, any more forensic or any more passionate. However, I will make just two brief points.

First, I want to express my continued support for my hon. Friend the Member for Bolton South East and for the families affected, some of whom are my constituents. I am grateful for the work that she has done on their behalf so far. There is no time for subtlety in this regard, so secondly, I want to say that if the people in the institutions who have been given the task of getting to the bottom of this issue, paid for by the taxpayer—and, yes, by the families who are here today—are not prepared to carry out that task to the full satisfaction of the thousands of people affected, namely the victims, they should move aside and let others, who want to expose the inadequacies of a system that has left those people adrift for decades, get on with the job.

Enough is enough. I hope and trust that the Minister will hear the just and reasonable pleas of our constituents, and that he will take this motion and away and put it into effect, to the letter and in spirit. This injustice has gone on for 40 years, and it is time to draw a line under it. It is time to give closure and peace to the victims and their families. Anything less would be a betrayal of our duty and of our constituents.

NHS Sustainability and Transformation Plans

Peter Dowd Excerpts

Wednesday 14th September 2016 Commons Chamber

[Peter Dowd (Bootle) (Lab)]

A recent report to my local health and wellbeing board on STPs stated:

“There is a growing consensus that one of the most powerful ways to achieve change is through local services working together—across entire communities and pathways of care—to find ways to close the gaps between where we are now, and where we need to be in the future.”

That was the hope of the many people who have written to me on this matter. I really appreciate the time they have taken to share their concerns with me, but I can give them little comfort as things stand. Regrettably, in my area the “footprint” is an area in Cheshire and Merseyside, not in the Liverpool city region. That was determined unilaterally by the governance structure and it is regrettable, getting the process off to the wrong start, with the suggestions of local political leaders dismissed. That act has compounded the problem, in that they are the very people the NHS should be consulting: local communities, the leaders of councils and local councillors. These are the democratically elected representatives in those areas.

This move is all the more disappointing given that there is a council leader who has responsibility for the health and social care brief across the city region. It is more than disappointing—it is bizarre, especially as local government is supposed to be a significant partner of the NHS. The Government have pushed the issues of health and social care integration no end, but it seems more in theory than in practice. NHS England can hardly put out a press release without mentioning it, yet I suspect that many health footprints are in the same situation as those in my constituency. There is no doubt that people are being excluded. I have emphasised this issue because it goes to the heart of the willingness of the NHS to step out of its self-imposed bureaucratic mindset. Worryingly, though, it appears to have an almost pathological inability to break out of it.

In my area, it is a case of going back to the past. The default position of my local NHS is to reinstate the old Cheshire and Merseyside health authority areas. My message is to stop and think. We are in the 21st century, not the 20th century. The reality is that the democratic lack of accountability in the NHS, certainly at a local level, leads to an inability to recognise that, in setting the terms of engagement with local community partners, it must do so before decisions are made, not after.

As far as I am concerned, the Government are telling us that all is well, that they have poured loads of money into the NHS and that there is enough in the system, so it is just a question of making better use of it. Yet the Germans spend 40% more per head than we do, and across the European Union the figure is 25%. People take the Government’s claims with a big pinch of salt, as all they see are waiting lists growing longer; ready access to their GPs becoming increasingly difficult; waiting times in A&E growing by the day; ongoing industrial disputes with junior doctors; and GP-led clinical commissioning groups beginning to start the process of rationing. And so it goes on. We need an NHS that has the consent of our community and an NHS that links in with communities. In this respect, I fear that the plans will turn out to be neither sustainable nor transformational, which will send the message that the NHS is not safe in Tory hands.