Oral Answers to Questions

Debate between Philippa Whitford and Steve Barclay

Thursday 24th January 2019 Commons Chamber

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

1. What recent discussions he has had with the devolved Administrations on the UK leaving the EU.

[The Secretary of State for Exiting the European Union (Stephen Barclay)]

The hon. Lady asks about recent discussions. Having been in post for just over two months, all my discussions seem fairly recent. She will be aware that on my first day in post I met the devolved Administrations as a priority. I have had meetings with the Prime Minister and the First Minister of Scotland. Indeed, the Prime Minister met the First Minister again yesterday, and they had a phone conversation last week.

[Dr Whitford]

This week’s report from the Institute for Government suggests that Whitehall Departments are not yet prepared for Brexit, deal or no deal. The UK Government started talking last summer about stockpiling, so why was the list of critical drugs not shared with the Scottish Government until just before Christmas?

[Stephen Barclay]

I think that the assessment in Whitehall is that Whitehall is more prepared than the devolved Administrations. We are looking to work closely with the devolved Administrations. My right hon. Friend the Secretary of State for Health and Social Care has been very clear that medicines and medical products are our No. 1 priority for the supply of goods, and the extra ferry capacity has been purchased with that very much in mind.

Oral Answers to Questions

Debate between Philippa Whitford and Steve Barclay

Thursday 6th December 2018 Commons Chamber

[Stephen Barclay]

My hon. Friend will appreciate that a key focus for me since taking on this role has been to review the work on the state of readiness and to ensure that those discussions are held with Cabinet colleagues. That is exactly what I am doing, and it is supported by the excellent work of the Under-Secretary of State for Exiting the European Union, my hon. Friend the Member for Daventry (Chris Heaton-Harris).

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

T6. As the Secretary of State for stockpiling, can he explain to me how he will maintain a supply of the medical radioisotope technetium, given that its precursor has a half-life of less than three days?

Oral Answers to Questions

Debate between Philippa Whitford and Steve Barclay

Tuesday 23rd October 2018 Commons Chamber

[Stephen Barclay]

I pay tribute to my hon. Friend for the longevity and sincerity of his campaigning on these issues. He draws attention to the wider point of how patients presenting with multiple and complex conditions need to be treated in multiple ways, and what he refers to is a part of that wider discussion.

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

NHS England is being ripped off to the tune of £230 million a year as the price of some off-patent drugs and non-standard preparations, or specials, have been hiked up hundreds of times, for example to over £1,000 for a bottle of pain-relieving mouthwash. In Scotland, specials remain in-house to keep the price down, but a year and a half on from the Health Service Medical Supplies (Costs) Act 2017, why have the Government not used its powers to stop this drug racketeering?

[Stephen Barclay]

The hon. Lady, very astutely and correctly, identifies the issue, which is how we ensure value for money from specials. Indeed, I commend The Times for highlighting a number of these issues. We are looking at this area. As we commit an extra £20 billion in funding to the NHS, our commitment is to ensure that we derive value for money from that investment. That applies to specials, too.

[Dr Whitford]

The healthcare market in NHS England is estimated to cost £5 billion to £10 billion a year and involves 2.5 million nursing hours a week being wasted on non-clinical paperwork. Does the Minister not recognise that this is the biggest inefficiency? Will he commit to reversing the disastrous marketisation of NHS England?

[Stephen Barclay]

Again, the hon. Lady draws attention to my work on driving productivity improvements within the system, which looks at a range of efficiencies such as sending texts and emails, dealing with missed appointments and the use of green energy. We can implement a whole range of initiatives as a part of that agenda.

Dangerous Waste and Body Parts Disposal: NHS

Debate between Philippa Whitford and Steve Barclay

Tuesday 9th October 2018 Commons Chamber

[Stephen Barclay]

The Chair of the Health Committee raises an important point regarding residents in the areas where the sites are located, and I see the right hon. Member for Normanton, Pontefract and Castleford (Yvette Cooper) in her place. The Environment Agency has confirmed that the waste is being stored safely; it is the amount of waste that is the issue. Many of our constituents are waiting for operations on these sites and will want reassurance that those operations can continue in a timely fashion. That has been a key focus of the Department, and I pay tribute to the work of officials in the NHS, the Department of Health, DEFRA and the Environment Agency, who have ensured that that strategic objective has been maintained.

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

This situation does indeed sound graphic and horrific. Equally, I recognise that much of this waste will be cytotoxic, including drugs and syringes. We are talking about materials that are contaminated with faeces, infectious material and blood. We are discussing five sites across England. HES also has two sites in Scotland, both of which have been checked and do not have overstorage.

We hear that HES was served with 13 warning notices and two compliance notices over the past year. If that information was not accelerated up to the Department of Health, should it have been? HES says that it has been reporting its issue with incineration to regulators for quite a long time, yet the Minister says that there is no issue of capacity, so could not the Department have responded by directing HES to all this extra incineration capacity that apparently exists? As more local authorities are going towards zero-waste and incinerating material that would have been in landfill, the pressure will increase. There is probably ageing infrastructure and a need to expand, so do the Government plan a waste incineration strategy?

Integrated Care

Debate between Philippa Whitford and Steve Barclay

Thursday 6th September 2018 Westminster Hall

[Stephen Barclay]

The Chair of the Committee is absolutely right. We have always been clear that integration is about improving patient care, and that the NHS will remain free at the point of delivery.

A number of key points arose from the debate. Remarks were made about ensuring that the service is patient-centred, and concerns were expressed about whether transformation funding may be diluted. I will come to pre-legislative scrutiny, to which the Chair of the Committee referred, and primary legislation.

The hon. Member for Central Ayrshire (Dr Whitford) raised concerns about private firms and the role of GP-led organisations. The hon. Member for Stockton South (Dr Williams) and my hon. Friend the Member for South West Bedfordshire (Andrew Selous) referred to focusing on prevention and taking a wider needs-based approach. A number of Members referred to information sharing, leadership and the lessons from Liverpool Community Health NHS Trust—the hon. Member for West Lancashire (Rosie Cooper) performed a great service by highlighting that. That is reflected in the work I have commissioned from Tom Kark on the fit-and-proper test.

[Ms Karen Buck in the Chair]

Members focused on the need for a patient-centred approach, which the hon. Member for Kingston upon Hull North (Diana Johnson) emphasised in her intervention. In our approach to integrated care, we seek to build a healthcare solution around what is best for the patient and, in the words of the Chair of the Committee, why it matters to patients. That is very much the Government’s intention.

As the Committee Chair said, financial pressure can both incentivise and impede integration. She will be aware that the up to £20 billion a year that will go into the NHS as part of the Prime Minister’s commitment to funding the service will be front-loaded—there is more in the first two years in recognition of the importance of the double-running to which the Chair of the Committee referred. According to past National Audit Office reports, there have been a number of cross-party initiatives under successive Governments. As she and other Committee members set out, sustainability trumps transformation, which is one of the key challenges for the NHS family as it brings forward its 10-year plan. For the first two years, an extra £4.1 billion will go in, with front-loading of 3.6% compared with the average over the five years of 3.4%, which very much reflects the concerns she articulated.

The tone of the debate was one of broad consensus, and we will realise that first by asking the NHS itself to lead on the legislative changes required. The NHS will bring forward its proposals through the 10-year plan. We will not mandate, but let local areas decide what fits their locality best. That will be informed, for example, by health and wellbeing boards. I met the chair of the Lancashire health and wellbeing board yesterday—that speaks to the concern raised about the need for Health Ministers to take a wider approach rather than, as the hon. Member for Stockton South said, looking purely at the NHS element. We are looking much more widely and bringing in local authorities. Indeed, the Department’s name has changed, and the work of the Care Minister reflects the wider integration in our approach.

Although we welcome the Committee’s work on testing the NHS proposals as part of the long-term plan, we will wait for the NHS proposals before confirming the specific pre-legislative scrutiny arrangements. I hope the approach I have taken in discussions with members of the Committee underscores the importance I place on working in a cross-party way. The approach we have set out very much reflects that.

[Dr Whitford]

Can the Minister commit to looking at legislative change? It is fine for designs to come from the NHS, but if those designs are based on existing barriers, they will not reach their full potential.

[Stephen Barclay]

The Prime Minister has set out that it will be for the NHS itself to come forward, rather than for the Government to specify legislative change in a top-down way. As part of the long-term plan, the NHS will determine what can be done within the existing framework and whether change is needed. That will flow from the work that comes forward later in the autumn from Simon Stevens, Ian Dalton and others in the NHS, who are best placed to lead.

--- Later in debate ---

[Stephen Barclay]

Indeed I will, Ms Buck.

I draw the hon. Gentleman’s attention to the Committee report, which states:

“There is also little appetite from within the private sector itself to be the sole provider of…contracts…There are several reasons why the prospect of a private provider holding an ACO contract is unlikely…Integrated care partnerships between NHS bodies looking to use the contract to form a large integrated care provider would have an advantage over non-statutory providers that are less likely to have experience of managing the same scope of services”.

The hon. Gentleman himself referred to the desire not to rule out GP-led organisations, which are independent. He also mentioned GP-led organisations becoming NHS bodies. I am happy to meet him to explore exactly what he means. It is not the Government’s intention for private firms to run ICP contracts.

[Dr Whitford]

The Minister says that that is unlikely and that private firms do not want to run such contracts, but we are talking about a 10-year plan. Does he therefore recognise that it should be ruled out to give surety? We do not want another Hinchingbrooke, where a private company takes a contract on and an entire area faces a private provider walking away from an integrated care partnership.

[Stephen Barclay]

These arguments were explored at the Committee, which addressed that question. The fear of privatisation has been overplayed.

We are taking a people-centred approach and letting the NHS lead on shaping it. We have said we will respond to the points the NHS raises and act on them, but integration will enable services holistically to deliver better care for patients—as the hon. Member for Strangford (Jim Shannon) said, that includes better data sharing—and put the needs of patients front and centre. That is reflected in the report and in the cross-party consensus on how we want to take integration forward.

Oral Answers to Questions

Debate between Philippa Whitford and Steve Barclay

Tuesday 24th July 2018 Commons Chamber

[Stephen Barclay]

My hon. Friend is right to draw the House’s attention to the fact that there are a number of benefits from leaving the EU, not just in terms of the dividend to which he refers, but in terms of flexibility, for example in—[Interruption.] Labour Members do not seem to want to hear about the opportunities: opportunities on life sciences for example, in terms of getting medicines through in shorter timescales; opportunities on immigration; opportunities on professional qualifications; opportunities even on food labelling. It is important that we take those opportunities, as my hon. Friend says.

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

I too welcome the Secretary of State to his place. Membership of the European Medicines Agency has enabled early access to new drugs for UK patients through a single Europe-wide licensing system for a population of 500 million. Can the Minister clarify whether it is still the Government’s intention to remain a member of the EMA, and perhaps explain why on earth they voted against the EMA amendment last Tuesday?

[Stephen Barclay]

As the hon. Lady will be aware, we accepted the amendment, and it is our intention to work as closely as possible on that as part of taking that forward—[Interruption.] To correct the—[Interruption.]

[Stephen Barclay]

This is a near instantaneous correction, Mr Speaker, to recognise that what I should have clarified is that, following the vote in the House, it is our intention to work as closely as possible with that, and we recognise the point the hon. Lady makes.

[Dr Whitford]

It is still rather hard to understand why the Government voted against it in the first place. There is no current associate membership of the EMA for the UK to re-join as a third country, so if it is not possible to stay in the EMA what is the plan to avoid delays of up to a year in the licensing of new drugs for UK patients?

[Stephen Barclay]

There are a number of things that can be taken advantage of. We can use the flexibilities we have in terms of assessments with shorter timescales so that we can prioritise UK drugs that are bespoke to the UK market. There will be opportunities as part of this, as well as our working closely with European colleagues.

Oral Answers to Questions

Debate between Philippa Whitford and Steve Barclay

Tuesday 19th June 2018 Commons Chamber

[Stephen Barclay]

The two do go together because the mental health workforce is a key component of the NHS workforce. I am sure that the hon. Gentleman will welcome the extra £1 billion by 2020 that the Prime Minister announced yesterday, as well as the Government’s prioritisation of mental health, which for too long has been seen as a Cinderella service within the NHS.

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

In 2015, the Secretary of State suggested that junior doctor rotas contributed to avoidable hospital deaths, but research shows that the most important factor is the number of patients under the care of each registered nurse. A 7% increase in mortality for every patient means that 36,000 nursing vacancies in England pose a real threat to patient safety. So with no announcement, and a 33% drop in applications since the removal of the nursing bursary, will the Government follow the Scottish Government’s policy and reintroduce the bursary?

[Stephen Barclay]

The hon. Lady will be well aware that there are 14,000 more nurses in the NHS than five years ago, but she is right to point to the wider issue of long-term workforce planning. That is why she will be aware that Audit Scotland criticised NHS Scotland for its lack of long-term workforce planning.

[Dr Whitford]

rose—

[Dr Whitford]

As the Minister heard, the Scottish Government have just passed a law on staffing. With an ageing population, social care is critical to the function of the NHS, but the charity Independent Age says that we will be short of 700,000 care workers by 2037. With no extra funding for social care announced yesterday, how will the Secretary of State make caring a real profession? Would not it be good to start with a decent wage?

[Stephen Barclay]

The hon. Lady’s supplementary question really reinforces the answer that I gave a moment ago: the essence of why we need a long-term plan is so that we anticipate these issues. We are addressing that through the Green Paper on social care, and that is part of the investment that the Prime Minister announced yesterday.

Infection Prevention and Control

Debate between Philippa Whitford and Steve Barclay

Tuesday 15th May 2018 Westminster Hall

[The Minister for Health (Stephen Barclay)]

As always, Mr Howarth, it is a pleasure to serve under your chairmanship.

I join the shadow Minister, the hon. Member for Ellesmere Port and Neston (Justin Madders), in congratulating the hon. Member for Strangford (Jim Shannon) on securing the debate, which provides an opportunity for the House to emphasise the importance of raising standards of infection prevention and control in the NHS. He was kind to pay tribute to the Secretary of State for his work on patient safety, and on putting that front and centre in his priorities. As the hon. Members for Ellesmere Port and Neston and for Central Ayrshire (Dr Whitford) acknowledged, that is a point on which the House is united in a common cause. How we reduce infections is of real importance to our constituents, as my hon. Friend the Member for North East Derbyshire (Lee Rowley) said, and that is reflected in our surgeries, because it impacts on the lives of those we represent. There is therefore a great deal of common cause.

The debate is timely because it was World Hand Hygiene Day on 5 May, which is an initiative that the World Health Organisation started in 2010 to remind us all, including patients and family members, to practise good hand hygiene, to help reduce the spread of infections. The hon. Member for Strangford was right to challenge the Government to reinvigorate our approach to hand hygiene. A number of initiatives are under way in Government to address exactly the points that he raised. Public Health England has been raising awareness, and NHS Improvement has begun a number of initiatives, such as its NHS provider bulletin and a hand hygiene theme in its executive masterclass. Other ways of raising awareness include the Royal College of Nursing’s glove awareness week. As the hon. Member for Central Ayrshire said, that it is all about taking practice from guidance or files and embedding that into the DNA, the culture and the way people operate, who include visiting relatives and staff at all levels, including doctors as well as nursing staff.

A number of hon. Members, including my hon. Friend the Member for Amber Valley (Nigel Mills), raised technology and what more we can do. One theme of the debate was whether the Government are doing enough to drive forward the use of technology. I recognise the limits of direct observation and how behavioural change may respond to those. That is why the Government are actively looking at the extent to which technology can facilitate this area.

We have carried out an initial assessment; indeed, the NHS Improvement director of infection prevention and control, Dr Ruth May, and her team recently visited the Royal Wolverhampton NHS Trust, which has been trialling an electronic monitoring system to make an initial assessment of that. Their feedback is that the system is reliant on existing technology, and that many IT systems would not be able to support that. A number of practical issues need to be addressed before one would have a roll-out of technology. I reassure the House that Dr May and her team are actively looking at that issue. We all recognise the impact, not just on patient safety, but on the cost of infections and unnecessary deaths. We are actively looking at the issue of technology.

The hon. Member for Strangford also asked if we could publish more. To pick up on the remarks of the hon. Member for Central Ayrshire on the way information is published in NHS Scotland, dialogues are already taking place. I am happy to ask officials to ensure that, as part of the collaboration that is already under way in NHS Improvement with colleagues in the Scotland and England NHS, we look at best practice to ensure that we are working with and maximising the learning from both sets of NHS.

Public Health England has carried out some initial analysis of the available data to determine the suitability of the data available for publishing. Currently, the data is incomplete and will not truly reflect the usage of hand gel. We are exploring how to improve that data. The hon. Member for Central Ayrshire commented that transparency on what is being done and on variance in performance around infection rates is a key driver of prevention.

[Dr Whitford]

The Minister may know that as a breast cancer surgeon, I was involved in developing the breast cancer standards for Scotland. The only action was peer review—putting everyone’s performance up at an annual conference. No one wants to be at the back of the class; in actual fact, seeing genuine performance drives up quality.

[Stephen Barclay]

The hon. Lady is right that peer review is always a powerful motivator. That sort of transparency drives behaviour, so we need to ensure that we do that in an effective way that does not alarm patient families, because of the publication of data that could be misrepresented by those who have different objectives. The need to get more publication of data is an important point, which the hon. Member for Strangford and others raised, on which we need to do further work.

The hon. Member for Upper Bann (David Simpson) asked in his intervention about the specific issue of patients going outside to smoke, and whether there was an associated infection risk, for example through drips. I am advised that there is no additional risk of infection, as long as the drip is well managed. If colleagues have specific issues about the infection risk associated with that, that is the nature of the debate and helpful to know.

My hon. Friend the Member for Moray (Douglas Ross) spoke of the pain and distress to patients caused by infections, and the important link to buildings. Although that is relevant in Scotland, to which he referred, I accept that the point would also apply to the England NHS. The state of the buildings and the maintenance programme have a part to play, not just in the Scottish NHS, but in the England NHS as well.

The hon. Member for Strangford asked whether hand hygiene could be a national marker of care quality. The Department is considering how we could do that effectively. The points he raised were heard and I will ensure that they are addressed. As and when we have any update, I will be very happy to share that with him.

Overall, a great deal of progress has been made. We are committed to reducing the number of infections. Since 2010 we have made excellent progress on MRSA and C. difficile. In the 12 months ending March 2018, MRSA cases were down 54% on the 12 months ending May 2010, and C.diff infections were down 47%. Considerable progress has been made, but as the hon. Member for Central Ayrshire mentioned, although we have made progress in slowing the rate of increase of E. coli infections, there is more to be done to bring that rate down. NHS England has the challenging objective to bring that down by 20% as part of its mandate. As a result of slowing that down, there were 2,400 fewer cases of infections than there would have been with the previous trend.

Clearly, there is more to be done on E. coli and it is an area of considerable focus in the team. Those cases also have a fiscal cost of between £3,000 and £7,000 per infection, but the much more material cost is the patient safety issue and the harm that accrues as a result. NHS Improvement is leading this programme, aimed at a 20% reduction in E. coli bloodstream infections in 2018-19. It is an ambitious but important target. NHS Improvement has begun working with the medical director of NHS England, Steve Powis, on setting up pilots with local health economies across England to engage and assist in the reduction. That may be an issue that my hon. Friend the Member for Morley and Outwood (Andrea Jenkyns) wishes to pick up with me after the debate—how we can work together, given her powerful but extremely sad experience of the events that befell her father.

Colleagues recognised the considerable amount of work on antimicrobial resistance, which is an important factor in treating infections. Our latest estimate is that over five years, there could be an extra 6,000 deaths attributable to pan-antibiotic resistance. Lord O’Neill’s review on AMR said that drug-resistant infections will cost the world 10 million extra deaths a year and $100 trillion by 2050. Those are pretty scary figures, but they underline the importance of preventing infections occurring in the first place.

That brings me on to patient safety. Following the tragic events at Mid Staffordshire and the subsequent public inquiry led by Sir Robert Francis, the NHS embarked on a journey of improvement based upon three strands: better regulation, greater transparency and a culture of learning. Assessing the risk of, and preventing, detecting and controlling the spread of, infections, including those that are healthcare associated, is addressed by the fundamental standards of care, enshrined in regulations, that all Care Quality Commission registered providers are expected to meet. A number of colleagues mentioned the role of the CQC as part of the checks and balances that need to be in place.

In November 2016, the Secretary of State launched new plans to reduce infections in the NHS, including the sepsis commissioning for quality and innovation. Through that, we have incentivised hospitals to improve their sepsis care. Independent CQC inspections have focused on E. coli rates in hospitals and in the community. In addition, we have appointed a national infection prevention lead to ensure a sustained focus at national level, improved training and information sharing, so that NHS staff can cut infection rates and, through the National Institute for Health and Care Excellence’s 2017 guidelines, highlight standard principles and advice on good hygiene.

Considerable progress is being made. Data published in 2017 suggests that four in 10 of all E. coli blood infections cannot be treated with commonly used antibiotics. Infection prevention and control is a key element of tackling antimicrobial resistance, and hand hygiene plays an important part in that. We are working extensively with stakeholders, including the royal colleges, academia and the research community, industry and our expert advisory groups, to inform our next steps.

Several colleagues, including the hon. Member for Ellesmere Port and Neston, mentioned sepsis. We have made significant progress since our focus to improve sepsis practices increased in January 2015. There is new NICE guidance and a new national CQUIN measure to incentivise providers to improve the identification and timely treatment of sepsis. The hon. Member for Central Ayrshire was absolutely right about the time-critical nature of that treatment. That work is already delivering change. The most recent data, which is for the third quarter of 2017-18, shows that emergency department assessment for sepsis has increased from 52% to 92%, and in-patient assessment has increased from 62% to 84% since April 2016.

Considerable progress has been made, which reflects the renewed focus across the NHS, in England and Scotland, on the time-critical nature of sepsis treatment, but we know there is more to do, which is why a new cross-system action plan was launched in September 2017. That plan outlines a range of activities to ensure that the NHS is on the highest possible alert to tackle that devastating condition. Indeed, just recently, on 25 April, NHS Improvement issued a national early warning score 2 patient safety alert to support providers to adopt the revised NEWS2 to detect deterioration in adult patients, including better identification of patients likely to have sepsis.

My colleague the Minister for Care, my hon. Friend the Member for Gosport (Caroline Dinenage), hosted and gave a speech at the launch of Health Education England’s paediatric sepsis e-learning package, which, again, is about raising awareness at an early stage. That training package was informed by clinicians and by parents whose children sadly passed away from sepsis, so we can learn from those tragic events and ensure that warning signs are better picked up at an earlier stage.

As several Members recognised, hand hygiene plays a key role in infection prevention and control, in supporting patient safety and in our efforts to address antimicrobial resistance. Considerable progress has been made—MRSA has more than halved and C. difficile has reduced by just under half since 2010—but, as the hon. Member for Central Ayrshire rightly said, E. coli remains a key area for renewed focus. We have successfully slowed its growth, but we now need to reduce it significantly. Part of the challenge is that a lot of it occurs outside the hospital setting, in the community.

I look forward to working with colleagues from across the House on this shared objective in an area where shared practice, from both England and Scotland, can help. We can learn from each other and from Members’ experiences in their constituencies. We will continue to embed hand hygiene practice and promote awareness of it in the NHS, not just through World Hand Hygiene Day but through debates such as this one.

Education (Student Support)

Debate between Philippa Whitford and Steve Barclay

Wednesday 9th May 2018 Commons Chamber

[Stephen Barclay]

I am happy to confirm that. We now have 13,100 more nurses on wards since 2010 and we have a commitment to expand the numbers—[Interruption.] It is a new programme and we are expanding the number of apprenticeships. We have committed to 5,000 this year, expanding to 7,500.

It is interesting, is it not? Having routes that give people opportunities to progress—having different choices for people and empowering individuals, not all of whom want to go to university—so that people from different backgrounds can go into the profession is the very essence of what our party stands for. It is shame—

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

Does the Minister therefore challenge the figure of only 30 apprentices and does he recognise that with a four-year course they will not be ready until 2022, and there is a need for nurses now?

[Stephen Barclay]

I absolutely recognise that the apprenticeship route will take four years, but the Government have given a clear commitment to that and that is backed up by significant—[Interruption.] The UCAS figures are embargoed, so I do not have the latest figure. The point is that it is a four-year programme and it will take time to roll out, but it is backed by significant funding: the NHS is contributing £200 million to the apprenticeship levy. That is a signal of this Government’s commitment. The Minister for Apprenticeships and Skills is here, championing the apprenticeship route, as are other Members through the Select Committees. It is a shame that some Opposition Members are not reflecting on the benefits offered by apprenticeships as an alternative route into the nursing profession that will deliver more nurses. That should be welcomed.

Oral Answers to Questions

Debate between Philippa Whitford and Steve Barclay

Tuesday 8th May 2018 Commons Chamber

[Stephen Barclay]

I am very happy to do so. We are removing the cap on the number of places covered by the bursaries and increasing the number of student places by 25%, which means that there will be 5,000 more nurses in training as a result of these changes.

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

The Secretary of State’s removal of the nursing bursary and introduction of tuition fees have resulted in a 33% drop in applications in England. In Scotland, we have kept the bursary, a carer’s allowance and free tuition, which means that student nurses are up to £18,000 a year better off, and indeed they also earn more once they graduate. Does the Minister recognise that that is why applications in Scotland have remained stable while in England they have dropped by a third?

[Stephen Barclay]

The hon. Lady speaks with great authority on health matters, but, again, she misses the distinction between the number of applicants and the number of nurses in training. It is about how many places are available, and we are increasing by 25% the number of nurses in training. That is what will address the supply and address some of the vacancies in the profession.

[Dr Whitford]

Workforce is a challenge for all four national health services across the UK, but, according to NHS Improvement, there are 36,000 nursing vacancies in England, more than twice the rate in Scotland. The Minister claims that more nurse students are training, but in fact there were 700 fewer in training in England last year, compared with an 8% increase in Scotland. The key difference is that in Scotland we are supporting the finances of student nurses, so will the Government accept that removing the nursing bursary was a mistake and reintroduce it?

[Stephen Barclay]

The distinction the hon. Lady fails to make is that in England we are increasing the number of nurses in training by 25%; we are ensuring that nurses who have left the profession can return through the return-to-work programme; and we are introducing significant additional pay through “Agenda for Change”. As my right hon. Friend the Member for Harlow (Robert Halfon) said, we are also creating new routes so that those who come into the NHS through other routes, such as by joining as a healthcare assistant, are not trapped in those roles but are able to progress, because the Conservative party backs people who want to progress in their careers. Healthcare assistants who want to progress into nursing should have that opportunity.

Insurance and Genetic Conditions

Debate between Philippa Whitford and Steve Barclay

Monday 8th January 2018 Commons Chamber

[The Economic Secretary to the Treasury (Stephen Barclay)]

Let me begin by thanking the hon. Member for Paisley and Renfrewshire North (Gavin Newlands) for securing this important debate. As he set out so eloquently, rare genetic conditions such as Huntingdon’s disease have a significant impact on the people and families who are affected by them. The Government are focusing on ensuring that the insurance industry functions well for everyone, including those with genetic conditions. Let me deal with the hon. Gentleman’s final point first by saying that I am of course always happy to meet him to discuss more fully the points that he has aired tonight.

I have listened to what the hon. Gentleman has said, and also to wider representations. Broadly speaking, I can identify three key issues. First, people with rare genetic conditions such as Huntington’s disease can find it harder to access some insurance products. Secondly, when they find an insurance product, it is sometimes not affordable. Thirdly, people with rare genetic conditions are often discouraged from having a predictive genetic test for fear that it would make it harder or more expensive for them to obtain insurance in the future.

It is clear that factors such as age, postcode, occupation and health can all have an impact on the availability, pricing and terms of insurance policies. For example, a pre-existing medical condition, such as Huntington’s disease, can be an indicator that someone is more likely to make a claim. For that reason, insurers will use medical history as a rating factor for some products, which may mean that someone with a genetic condition has to pay a higher premium than someone without such a condition. We must acknowledge, however, that the respective capabilities of insurers to assess risk legitimately, and to price their products accordingly, are a key element on which they compete. I think the hon. Gentleman recognised that at the outset when he said that it was often not easy for insurers to strike the right note in this context.

It would not be right for the Government to intervene in individual firms’ pricing decisions in a way that would damage the competition on which the compulsory competitive tendering relies. I am sure the hon. Gentleman agrees that effective competition is the best way to ensure that the insurance market functions well. While, as he has made clear, it can be harder for people to find cover for rare genetic conditions, it is important to note that there is nothing to suggest widespread exclusion from the insurance market. Furthermore, representatives of the insurance industry have given assurances that, as with all pre-existing medical conditions, insurers will try to offer insurance coverage where they can, based on evidence and backed by medical research.

The Government have made it clear that they consider it important for everyone to have access to suitable insurance. To that end, in 2014 a landmark agreement was established by the Government and entered into with the insurance sector, which led to the expansion of the British Insurance Brokers’ Association’s Find a Broker service. The service was set up specifically to help those who were struggling to find insurance, and last year it was used by more than half a million people.

The Financial Conduct Authority, as the organisation responsible for regulating the insurance industry, has rules requiring firms to treat all customers fairly. The FCA also frequently monitors the sector to track and tackle discriminative practices. It recently closed a consultation seeking feedback from people with pre-existing medical conditions, including cancer. As I am sure many Members will know, people with cancer may find it particularly difficult to obtain insurance cover. The FCA plans to announce its next steps early this year.

It is vital that families living with rare genetic conditions, such as Huntington’s disease, are not discouraged from taking predictive genetic tests for fear of subsequently having problems with getting insurance. That was one of the hon. Gentleman’s key concerns. To that end, in 2014 we extended the concordat and moratorium on genetics and insurance, an agreement between the Association of British Insurers, representing more than 90% of the insurance market, and the Government. That agreement gives clarity and confidence to those taking predictive genetic tests on how insurers treat genetic information. Under the rules of that scheme, insurers are not allowed to ask anyone for the result of a predictive genetic test for any condition, including Huntington’s disease, when they apply for life insurance with a value of less than £500,000. It is important to note that more than 95% of life insurance policies sold in the UK would fall within the protection of that £500,000 cap. That gives confidence to those who wish to take a predictive genetic test, because they can be sure that the results will not negatively influence the price or availability of life insurance.

[Dr Whitford]

Does the Minister not recognise the fact that people end up in the same situation that we had with HIV testing, whereby simply by being tested for HIV—not asked for the results—they were classed as high risk? They had exactly the same issues with mortgages and insurance.

[Stephen Barclay]

The hon. Lady’s point would be a legitimate one if that were indeed the case. However, that is not what the evidence shows. As I have just said, 95% of life insurance policies fall within the cap. Also, we should bear it in mind that the genetic test is often prayed in aid because, although there is a 50% chance of a condition materialising, there is also a 50% chance of it not materialising. The genetic test is therefore often prayed in aid to reduce the risk, rather than having a solely negative use. I think the situation is therefore more nuanced than the hon. Lady’s intervention suggests.

The ABI also provided a report to the Department of Health on its members’ compliance with the concordat and moratorium. I understand that in the last year there was only one complaint, which was subsequently resolved. However, if the hon. Gentleman or any other Member has further evidence of concerns, I would be happy to follow up on any evidence that might be forthcoming.

As a final point, I would like to mention that the Government are also committed to a wider financial inclusion agenda. This will ensure that everyone has access to suitable financial services products. As part of this agenda, we will soon be launching the financial inclusion policy forum. This initiative will address the problem of financial exclusion by driving better co-ordination and engagement across Government and the financial services sector. It has received unanimous support, including from the Financial Inclusion Commission and the Money Advice Trust, and it will be chaired by me and the Minister for Pensions and Financial Inclusion, the Under-Secretary of State for Work and Pensions, my hon. Friend the Member for Hexham (Guy Opperman). I hope that the meeting between me and the hon. Member for Paisley and Renfrewshire North following this debate will enable us to—