UK’s Withdrawal from the European Union

Debate between Philippa Whitford and Sarah Wollaston

Thursday 14th March 2019 Commons Chamber

[Dr Sarah Wollaston (Totnes) (Ind)]

I rise to speak to amendment (h) in my name and that of the hon. Member for Central Ayrshire (Dr Whitford). It seeks an extension to allow us to obtain the consent of the British people to whatever deal is approved by this House, with an option to remain.

Many of us believe that consent is at the heart of this argument. We are repeatedly told that the Prime Minister’s deal is the will of the people. The truth of the matter is that it is not the will of Parliament. It has been voted down by this place by 230 at the first time of asking, and by 149 at the second time of asking. However, I would say that there is no evidence that it is the will of the public either. It is certainly not the will of the 48%, nor is it the will of a very significant number of those who voted to leave—both in this place and outside—because they write to tell me so very vigorously that they do not think that this is the Brexit they voted for.

The truth is that the great Brexit charlatans have been exposed for the lies they perpetrated during the campaign. This Brexit is nothing like the sunlit uplands that they were promised, and I would ask people how many of them would have voted for this dog’s Brexit if it had been presented to them at that time.

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

My hon. Friend is talking about consent, and there has been discussion about that. As a surgeon, I have always had to have explicit, signed, informed consent, and such a discussion is always based on risks and benefits. We did not have that debate before the referendum, and we have had it only now, so it is only now that people have had the chance to learn how this Brexit deal will affect them.

[Dr Wollaston]

I thank my hon. Friend for that, and she is absolutely right. For someone to be able to consent to something, they need to know what they are consenting to. Let us face it: the risks and benefits of the various versions of Brexit are very different. The risks and benefits of no deal, WTO, the Prime Minister’s deal, Norway and Norway plus the customs union are very different procedures, if we talk about this in strictly clinical terms.

The other thing about consent is that nobody would seriously proceed on the basis of a consent form that was signed nearly three years ago. Furthermore, young people in this country face being wheeled into the operating theatre for major constitutional, social and economic surgery based on a consent form that was signed by their grandparents nearly three years ago. This is the point: given the sheer weight, significance and implications for all of their futures, what is the constitutional outrage or the democratic outrage about pausing to check that we have their consent?

I say to those on the Government Front Bench that they will never be forgiven for the consequences of Brexit, unless they have taken the time to pause and ask for explicit consent for their version of it. Even if the House were to approve a Norway-style Brexit, with or without a customs union, that will still not represent what many people out there thought Brexit should be. There is therefore a compelling case for all hon. Members to be honest about the way people feel about this issue, and to pause to ask for explicit consent. If the Prime Minister were a surgeon, she would be struck off if she proceeded without consent.

Integrated Care

Debate between Philippa Whitford and Sarah Wollaston

Thursday 6th September 2018 Westminster Hall

[Dr Wollaston]

Coming back to why integrated care does not happen, there are many deeply ingrained structural divides. Since the inception of the NHS 70 years ago, we have had a system that is free at the point of use for the NHS, but means-tested for social care. That presents an extraordinary hurdle when systems are trying to join up. It is not just that; it is different contractual arrangements and working practices. Good integration comes down to individuals and teams being prepared to work together, but it often feels like they are working together to achieve integration despite the systems around them, not because of them.

We need a system where everybody is focused on helping the right kind of integration to take place, and we need to go back and look at that fundamental structural divide between the systems. I ask the Minister to look again at the joint report, “Long-term funding of adult social care”, because that is an important issue that goes to the heart of the barriers to joining up services. It is about contractual differences, different legal accountabilities and payment systems that work against the pooling of budgets, and financial pressures within the NHS.

A certain amount of financial pressure can encourage systems to come together to pool their arrangements and provide a more efficient service, but as the Minister will know, when the elastic is stretched too tight and the financial strain becomes critical, we see the opposite—systems are forced apart. I have seen that happen in my area, where people suddenly feel that they have to retreat to their organisational silos to fulfil their legal obligations. There is no doubt that, for the process to work effectively, we need the right amount of funding—and sufficient funding—and tweaks to the legislative arrangements to allow people to come together, so it does not feel as if they are working together despite the system.

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

I am grateful to the Chair of the Committee for giving way. Does she agree that when there is an attempt to elicit change through turning off the financial tap, what happens in fact is that people cut what they think is easiest to cut, which is often the most innovative solution, rather than step back with a clear head to consider where they want to get to in the end? Does she also agree that we often find that the result of that kind of cost-cutting is a backward step rather than a forward one?

[Dr Wollaston]

I thank the hon. Member for that intervention and for her own service to the Committee previously—she is very much missed. Her remarks are typical of the constructive input that she has always made to the health debate in emphasising the need to take the long view. Financial pressures so often force us into short-term solutions, not only in the way she set out but through the salami-slicing of services.

One of the points that our Committee feels strongly about and that I was going to make to the Minister is the need to ring-fence transformation funding, because it is so easy for that funding to get lost. I welcome the uplift in funding—a 3.4% increase will be very helpful—alongside a 10-year plan. However, we have to be realistic about what that uplift can achieve, because there are very many demands on that budget, as the Minister will know and as we have seen in the past. We saw it with the sustainability and transformation fund, which tended to get sucked into sustainability and not into transformation. That has been the pattern of recent decades. There is good intention to ring-fence money for transformation, but that money disappears because of other priorities around deficits and, as I have said, the many other calls on the funds available.

That is why we feel that, in order to prevent the continuation of that cycle of past mistakes, it is important that the pattern is recognised and that funding is earmarked for transformation—not only for capital projects but for things such as double-running.

I will give an example from my area. There will be a complete destruction of public trust in new models of care if money is not set aside for double-running. The community was prepared to accept that there would be a new facility—nobody wanted the closure of the local community hospital in Dartmouth, but there was an assurance that there would be a new facility. Unfortunately, despite many of us opposing the closure of the old facility, what happened was that it was closed and then there was a breakdown in the arrangements for the new facility. The community was left with nothing and there has been a huge destruction of public trust in the process, which unfortunately will have ripple effects across other communities. Had we received the money to keep the existing service while the new service was built and got up and running, it would have left us in an entirely different situation. I am afraid that we see that too often across health and social care. There is good intention, but without double-running, which is part of having a ring-fenced transformation fund, I am afraid that the system has broken down too often in the past. I would like the Minister to focus on that when he makes his remarks.

The Committee is also looking forward to the 10-year plan—we look forward to working alongside both NHS England and the Department of Health and Social Care to examine how that plan emerges—but is important to draw attention to legislative changes. Our Committee made a recommendation that legislative proposals should come from the service itself rather top-down from the Department, which would immediately run into difficulties. However, as a Committee we also offered to subject such proposals from the service to pre-legislative scrutiny.

As the hon. Member for Kingston upon Hull North (Diana Johnson) pointed out in her intervention, we need to build cross-party consensus at every point. As it has not been covered in the formal response to the Committee’s report, will the Minister say in his closing marks whether the Government would support the Committee conducting pre-legislative scrutiny?

I am pleased to have had a conversation with Simon Stevens, the chief executive of NHS England, who has confirmed that, as it emerges, the NHS assembly will consider that within its remit—NHS England hopes to produce proposals in draft form before Easter 2019. Nevertheless, as I have said, it would be helpful to receive the Minister’s assurance that proposals will come to our Committee for pre-legislative scrutiny as part of the process of building consensus.

Department of Health and Social Care and Ministry of Housing, Communities and Local Government

Debate between Philippa Whitford and Sarah Wollaston

Monday 2nd July 2018 Commons Chamber

[Dr Wollaston]

I absolutely agree. This is about not just funding for public health, but the policy levers. We do not need lots of talk about the “nanny state” that denigrates important national public policy drivers, because although we need funding for local services, as the hon. Lady says, this is also about the policy environment that is necessary to make important changes. Investing in public health makes a huge difference for people.

One of the problems here is that when the public are asked where they would like the priorities to fall, we often hear, understandably, about the importance of cancer outcomes, mental health and emergency waiting times. Public health is often bottom of the list because nobody necessarily knows when their life has been saved by a public health policy. The reality is that the major changes and achievements relating to life expectancy have arisen largely thanks to public health policy, but we rarely turn on the television and see a programme called “24 Hours in Public Health”, which is a shame.

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

In the air quality debate last Thursday, I touched on the need for health in all policies. From active transport to quality of housing, is that not where we need to drive public health?

[Dr Wollaston]

The hon. Lady is absolutely right. Health in all policies means using every opportunity to maximise public health. When Departments work together, such as on the childhood obesity strategy, we need maximum engagement across the whole of Government to make that effective. The way it was put to us when the Committee visited Amsterdam was that it should be viewed as a sandbag wall, and if any part of it is missing, we are not going to achieve what we want. That applies to all of public health.

European Union (Withdrawal) Bill

Debate between Philippa Whitford and Sarah Wollaston

Committee: 7th sitting: House of Commons
Wednesday 13th December 2017 Commons Chamber

[Dr Whitford]

I absolutely agree. As I said, we have lost 10,000 EU nationals from our health services. We have seen a greater than 90% drop in the number of EU national nurses registering to come here. It is not just about protecting the people already here. For the four NHSs across the UK, the workforce is one of their biggest issues, yet we are sending out such an unwelcoming signal that we will struggle to attract anyone else.

[Dr Sarah Wollaston (Totnes) (Con)]

I agree with many of the hon. Lady’s points, but is it not vital that we send out the clear reassurance, which the Prime Minister gave at the Dispatch Box to all our NHS and care staff, that they and their families are welcome to stay, that we want them to stay and that their rights are now guaranteed?

[Dr Whitford]

I absolutely agree with the hon. Lady, but unfortunately it is not enough to come to the Dispatch Box every couple of months with warm words of welcome to EU staff, when in between women who are raising families here, with British partners or partners of EU origin, are being turned down for permanent residency because they have not taken out private comprehensive health insurance. We have had 100 EU nationals sent “prepare to leave” letters. Friends of ours tried to get citizenship for their three children, who were born and grew up in Scotland: the eldest and youngest were given passports; the middle child was refused. I am sorry but the experience of EU nationals on the ground over the past year and a half has been horrendous. If the phase 1 agreement last week is to mean anything, we must incorporate it into the immigration Bill to give them certainty now, instead of telling them they might have to wait another year before they find out what their future will be.

To exercise the right to live anywhere, access to healthcare and social security is crucial. It has made such a difference, not just to EU nationals here, but to our pensioners who have settled in the sunny uplands of the northern Mediterranean. What position will they be in if they cannot access healthcare? We must recognise that freedom of movement was not a one-way street; our young people and professionals have been able to take advantage of it for the past 40 years. We are taking that away from the next generation, which is something that I find terrible.

The Government say, and it is in the phase 1 agreement, that they accept keeping regulations 883 and 987, so let us bring that in. Let us get that down on paper and get it passed, because saying to EU nationals, “You’re welcome to stay, but there might be no deal, which means you’ll have no legal standing and you won’t be able to use the NHS,” is no use to anyone.

NHS Sustainability and Transformation Plans

Debate between Philippa Whitford and Sarah Wollaston

Wednesday 14th September 2016 Commons Chamber

[Dr Wollaston]

I thank the hon. Gentleman for his intervention. As I said, the plans that are produced at the end of the day will be better if we involve those who are using the services and those providing them, as well as those commissioning them, as we go along, rather than present a plan, even if it is a draft, as a fait accompli, because then it becomes a binary choice rather than one where people can make suggestions to improve the plans as they develop.

[Dr Philippa Whitford]

I know that Scotland is a lot easier to get around in population terms, although size and transport are not always that easy, but one of the mechanisms that the Scottish Government use when developing strategies is what they call the national conversation, whereby the ministerial team literally go walkabout and have meetings to hear from people directly before anything goes on paper.

[Dr Wollaston]

If we get too caught up in the process of consultation, we will not address the other serious hurdles in the way of STPs achieving their aims, chief among which is the issue of finance. The NHS is now in its seventh year of a historic level of austerity, and the average of a 1.1% annual uplift in funding for the NHS over the past six years represents an extraordinary challenge in the context of increasing demand. It is good that we are living longer, but we are doing so with much more complex conditions, and the treatments available to tackle them are more expensive. We need to be clear that, because of that, and even though the settlement for health has undoubtedly been generous in relation to other Departments, a significant gap is opening up in health, and the situation is even worse in social care.

Figures from the Association of Directors of Adult Social Services show that 400,000 fewer people are in receipt of social care packages in 2015-16 than there were in 2009-10, and not only are fewer people receiving social care packages, but those packages are smaller. Many STPs are about transferring care into the community. We need to make sure not only that the funding is available to provide those social care packages, but that we have the workforce to deliver them. The proposal in the area that I represent is to close two community hospitals that are used by my constituents. As a former rural general practitioner, I know just how important those facilities are to local people. They are special to them not only because of the step-up, step-down care that they provide and to which the hon. Lady has referred, but because these are the places that more people like to be at the end of their lives. They provide personal care and allow people, particularly those in rural areas who are doubly disadvantaged by not being able to travel to larger local centres, the opportunity to be treated closer to home.

NHS and Social Care Commission

Debate between Philippa Whitford and Sarah Wollaston

Thursday 28th January 2016 Commons Chamber

[Dr Wollaston]

I thank my hon. Friend for mentioning the “Five Year Forward View”, but I would respond by saying that Simon Stevens has referred to prevention and social care as “unfinished business” from the spending review. If we are to deliver the plan, we need to listen to his views and be mindful of the fact that spending on social care actually saves the NHS money. We cannot separate social care from the NHS, and we should not ignore his wise words on the importance of prevention in delivering the “Five Year Forward View”.

[Dr Philippa Whitford]

Is it not the case that when Simon Stevens was before the Health Committee, he said that a quarter of the £22 billion of savings that were hoped for would have to come from prevention and public health, yet that is being cut?

[Dr Wollaston]

Indeed; I remember that too. I agree that unless we up our game and redouble our efforts on prevention, we will not achieve the savings that are required to close the gap in the “Five Year Forward View”. That is why I wanted to touch on prevention first.

There is another area that we need to do much more on here and now. We need to have a relentless focus on variation across the NHS. We hear examples of local systems that are making things work, but the NHS has a long history of failing to roll out best practice. The “Growing old together” report, which was published today by a commission set up by the NHS Confederation, gives examples of good practice across the NHS and social care in which integrated practice is not only delivering better care for individuals, but saving money. The only depressing aspect of that is that one has to ask why it is not happening everywhere. Rather than endlessly focusing on the negatives in the NHS, let us focus more on the positives and on facilitating their roll-out.