Privatisation of NHS Services

Richard Graham Excerpts

Monday 23rd April 2018 Westminster Hall

[Richard Graham (Gloucester) (Con)]

Perhaps we should start with what we agree on, which seems to me fundamental for all of us in Parliament: the NHS is more precious than perhaps any institution except our monarchy and democracy. We all agree that it is and should remain a public institution available to everyone, no matter what they earn, and free at the point of delivery. We absolutely agree on those tenets of the NHS and the health services that our constituents benefit from. However, there are also things that we disagree on.

I suggest that the debate has frankly more to do with imminent local elections in London and elsewhere than with the health of the national health service. It is at least the fourth time in my short eight years in Parliament that the left, or some of the left, have tried to weaponise the NHS. When I hear Labour MPs talking as the hon. Member for Colne Valley (Thelma Walker) did about the “dismantling” of the NHS, I say to them that if the Conservatives had ever intended to privatise the NHS it would have been done by now, for the Conservatives have been the party of government for much longer than Labour since 1948. Secondly, privatisation of the NHS has never been in a Conservative manifesto. I defy any Opposition Member to find a single Conservative Member of Parliament who would want it, although it is normally possible to find one MP to sign up to most things. There is a challenge to Labour MPs, and particularly to those new ones who have known only the right hon. Member for Islington North (Jeremy Corbyn) as their leader. If anyone really believes that real privatisation is anything more than a fantasy threat, I ask them please to go and find a single Member of Parliament from the Conservative party Back Benches who would support it.

[Stephen Pound (Ealing North) (Lab)]

I have huge respect for the hon. Gentleman and have come to admire him over the years, but clearly he has not visited a hospital lately and seen privatised portering services, privatised catering services, privatised nurses being provided by privatised banks, privatised doctors being provided by privatised agencies, and patients being delivered by privatised hospital car services. I suggest he should pop down to Ealing Hospital while it is still standing. I will show him the true horror of privatisation. It is prevalent, endemic and everywhere.

[Richard Graham]

That is an interesting point, but the hon. Gentleman may not be aware that I volunteer in my local hospital, and have done for the past eight years. I have not only seen porters in action; I have worked alongside them—and ditto for a variety of wards. The situation he paints about what goes on in Ealing is completely different from what happens at the Gloucestershire Royal Hospital in my constituency, where those services are carried out by employees of the NHS—and will continue to be, whether they are in a subsidiary company or not—effectively and well. I pay tribute to all four of the NHS trusts in my constituency, one of which, Gloucestershire Care Services, received a good rating, alongside the already highly rated ²gether mental health trust. I shall put that issue to one side, but the hon. Gentleman is a distinguished Member of the House and knows better than to scaremonger about privatisation. Real privatisation is what happens in America, as he knows. It does not exist here in the United Kingdom.

The narrative today is, I am afraid, about scaremongering, with the favourite Labour bogeyman, privatisation, to the fore. There is one sentence from the petition that in a sense gives it away:

“Companies should not be profiteering from NHS contracts”.

The logic of that is that every single provider of equipment or services to the NHS, from pencils to EpiPens to imaging machinery to software, should do so at a loss. They should not. It is crucial that businesses make profits, invest and innovate for the future, reduce paperwork, increase scientific solutions to all sorts of difficult health issues and improve the life chances of our constituents. The opposite logic, of businesses making no money at all and going bankrupt, and the state trying to do everything, has been tested to death—literally—in both Russia and China. If Opposition Members, as socialists, want to understand why China has been so successful, I commend to them joining my all-party parliamentary China group, to visit China and understand what socialism with Chinese characteristics looks like and means.

[Graham P. Jones]

I hope the hon. Gentleman takes up the opportunity to visit Ealing Hospital. He argues that this is not the USA, but that is not the point being made. Of course the current NHS is not the US healthcare model. Does he accept that we are not privatising purchasers with insurance policies, as in America, but that what is happening in the United Kingdom is the fragmentation and privatisation of providers? That is the issue we are discussing. Does he agree?

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[Richard Graham]

I thank the hon. Gentleman for his comments. That is part of an issue that he is certainly keen to discuss, and part of what is in the petition.

The point I was going to make, which is relevant to that, is that there is a difference between sensible, profitable and innovative businesses and profiteering. There has been, in my view, one clear example of profiteering taking place in the NHS since 1948. It came with the private finance initiative policy during the new Labour period of Blair and Brown, which brought capital into the NHS that was off balance sheet and not recorded in the public finances, at exorbitant cost. It saddled hospitals around our country with interest rates that they could not afford to pay back, and it was the Conservative-led coalition Government who did what was legally possible, although not as much as any of us in this House would wish, to dismantle those contracts.

I think I am right in saying that we took out about £2 billion of costs a year by renegotiating the PFI contracts that could be renegotiated—somebody may know the precise figure. Opposition Members, some of whom were here at that time, should be ashamed of their complete responsibility for introducing the only obvious example of profiteering that has happened in the NHS since it was created.

[Paula Sherriff]

I wonder whether the hon. Gentleman is attempting to remove the architect of privatisation within the NHS, who I understand was Sir John Major. I agree with the hon. Gentleman about PFI; there have been some arrangements where it is difficult to argue that value for money is being achieved. But we must remember history, and it was Sir John Major who introduced the PFI scheme.

[Richard Graham]

I am happy for the hon. Lady to correct the record on John Major’s introducing PFI, but the point about PFI and all private financing is that the devil is in the detail. The principle of bringing private finance into the public sector is fundamentally a good one and approved of by, I think, all major parties. I am afraid that what went wrong during the 13 years of new Labour, as she knows and has implicitly agreed, was rampant exploitation of the NHS, with public servants signing agreements that frankly should never have been signed.

That is in the past—the fairly recent past, but the past. We have moved on since then. Since the petition was written, other things have also moved on. The most important is the issue of pay, with the Government committing several billion pounds from taxpayers to give 1.1 million NHS staff significantly higher pay over the next three years. I think we all strongly applaud what has happened—we know what an enormous job the NHS does in all our constituencies.

I will briefly raise what matters more in the longer term about the NHS, a subject that this petition could have tackled. The real issue is the long-term funding of the NHS. As a nation, we cannot lurch from year to year with the Secretary of State for Health and Social Care effectively going cap in hand to the Chancellor of the Exchequer for more cash to bail out the NHS. We need a longer-term, agreed basis on which to fund the NHS; I suggest at least five and ideally 10 years, so that everyone can plan ahead on what is needed to fund our NHS, with cross-party consensus. That way, never again can we face a situation in a general election of leaflets saying, “24 hours to save the NHS”. It is an old bogeyman that we must do away with.

I believe that the only effective way to do that is by bringing in equal contributions from the self-employed as well as the employed, and from those still generating income over a certain limit in retirement, through a dedicated source of funds or a hypothecated fund. The most obvious of those is national insurance, which does not really insure anybody for anything. It should be renamed the NHS fund. I put that proposal to our party before the last general election; understandably, there was not really enough time for it to be seriously considered. It would be a major change of direction and one not entered into lightly. There would be huge challenges with it. For example, what would we do in times of high unemployment, such as 2008 to 2010? Could the Budget effectively top up the NHS fund in such times?

That is why I am so pleased that the King’s Fund is researching that very issue now—would it be possible to have a hypothecated fund to fund the NHS? Would national insurance be a good starting point? What sorts of hazards and potential would that throw up? The King’s Fund report will be an important guide to hon. Members on both sides of the House about whether we can look at having a serious, long-term source of funding for the NHS around which we can have consensus, so that some of the endless debates and arguments, particularly around the word “privatisation”, can be dealt with and we can know that we have a source of long-term public funding for our NHS.

That is where I wish to finish. I regret attempts by some Opposition Members to try to create differences between political parties on something as precious as the NHS. All of us—all our families and all our constituents, wherever we were educated, whatever sport we like, whatever job we have and whatever sort of retirement we have—depend on the NHS for our health and, I contend, for our care as well. That is the other reason we need to find a hypothecated source of funds for the NHS—so that it can deal with care as well. That is a subject that the Health Secretary is wrestling with in his Green Paper as we debate. That is why in today’s debate we should leave the partisan efforts at point-scoring on privatisation and focus on what we can all contribute to the bigger debate about a long-term source of funding for a fully publicly owned NHS.

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[Kevin Hollinrake]

I agree with that point entirely. We all love the NHS and respect so much the work of the people who work in that service, so congratulations on the fact that Labour introduced the NHS, but that is not the point. This debate should not be about ideology; it should be about what works.

[Richard Graham]

Just on a point of fact, about two weeks ago it was the anniversary of the first White Paper on a national health service, which was presented to Parliament by the wartime Conservative Health Minister, Willink. The thinking behind much of that came of course from civil servants, of whom Beveridge was undoubtedly one of the more important, and he was a well known Liberal. I therefore suggest to my hon. Friend that before conceding the historical point, which we should accept absolutely, that bringing the national health service into being was a Labour achievement, we should point out that there was in fact a huge amount of cross-party consensus, particularly during the war years, in the lead-up to the birth of the NHS. It is important that we all recognise the contribution of all parties in its origins.

[Kevin Hollinrake]

I am very grateful for that historical clarification. One thing I used to say in my business to any people who came to me with new ideas was that ideas are 10 a penny. What matters is how we implement things. What matters is how we implemented things then and how we implement things today. That is what makes the critical difference in whether something will succeed or fail.

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[Martin Vickers]

The hon. Lady is obviously very knowledgeable, as we heard earlier. I cannot compete with 33 years’ experience, although I recognise those faults and I can recall the stories of dirty hospitals, which may have had something to do with poor procurement and bad management.

However, the reality is that the private sector has a role to play. Are we seriously suggesting that we should inconvenience people by forbidding Boots, Superdrug or a supermarket from administering prescriptions? Obviously not. Should we preclude social enterprise operations from taking part in NHS services? Surely not, because they can be extremely valuable and improve patient care.

[Richard Graham]

My hon. Friend makes some good points. Does he agree that the hon. Member for Ealing North (Stephen Pound) makes a different argument from that of his colleagues, who argue against companies that are subsidiaries of the NHS by definition? There is a considerable difference between someone who works for an agency that works for the NHS and someone who works for an NHS subsidiary company.

[Martin Vickers]

I thank my hon. Friend for that timely and helpful intervention.

The King’s Fund report, “Is the NHS being privatised?”, determined that the gradual increase in the use of private providers has improved the choice and service for patients. That must be for the good of everyone. It is the patients who are important; scaremongering does not help them. A focus on process rather than patient outcomes is unwise and a distraction from the real issues. The best interests of the patient are what matters. We must ensure that as much as possible of the resources that are made available goes into patient care.

The Leader of the Opposition has made repeated pledges to “save the NHS”. Frequently, those on the left whip up hysteria about how the Government of the day are doing something that will fundamentally alter healthcare in this country and bring the NHS to an end, but when exactly have these warnings been accurate? Were they accurate in April 1997, when Tony Blair famously declared that we only had

“24 hours to save the NHS”,

or when union leaders have spoken out about the NHS? Such reports have always proved false. As was said earlier, the reality is that the Conservative party has led government for 43 of the 70 years that the NHS has been in existence, so if the aim was to destroy the NHS, we have done a pretty poor job. The reality is that the Conservative party is as committed as any other party in this House to the continuation of the NHS.

What we see is outrageous hyperbole that is designed to prey on the worries of those who rely on the NHS, which—let us face it—is virtually all of us. That is irresponsible and in some cases cruel. Furthermore, it adds to a climate in which we cannot have a sensible discussion about the future of healthcare in this country. Within our politics, there is a paranoid conspiracy theory surrounding the motives of the Conservatives in relation to the NHS. It goes something like this: “Conservatives hate the NHS for ideological reasons, but given the toxicity of the subject and the reverence with which the public quite rightly regard the NHS, they realise the only way to implement privatisation is by stealth.” That is absolute and complete nonsense.

Let us face it, there have been changes to the NHS throughout its existence. We have had mention of fragmentation; I suggest that some of the fragmentation took place during the Blair and Brown Administrations. We spend around 8% of our GDP on healthcare, which is in line with countries such as Belgium and more than is spent by the likes of Australia and Canada, which have large private sector involvement. If, as we are told, we are underfunding healthcare to undermine support for the public system, what would be the motive for the apparent underfunding of healthcare systems elsewhere? The NHS turns 70 this year and, as I have said, the Conservatives have been in power for the majority of that time. There is no masterplan to replace the NHS with a privatised alternative.

There is also the question of what we mean by “privatisation”, which I mentioned earlier. “Privatisation” is a buzzword for ideologues to spread fear and embed an inefficient system that fails patients. Is Germany a private system, or is Switzerland? The answer is no. However, Germany and Switzerland embrace the market, while ensuring that no one slips through the net.

The German system shows that a healthcare system can be fully funded in the style of a pension system. The situation in Switzerland proves that even considerable levels of out-of-pocket patient charges need not be regressive. We can trust people to choose from a range of health insurance plans and identify the best option for them. Throughout Europe, healthcare systems offer universal high-quality care that is free at the point of use. In many cases, they make use of a greater number of private providers than our own NHS.

Social health insurance does not have to clash with the principles of the NHS that are so greatly entrenched in our society. We can still have a universal system of healthcare that is free at the point of use. We may have been the first country to establish a healthcare system based on those principles, but we are no longer unique in that respect. Virtually every developed country has some form of coverage.

The United States is an outlier in this regard. Canada offers universal healthcare that is free at the point of use. Germany offers universal healthcare, and while patients there may have to pay a small amount to see a doctor—around £10—the poorest in society are often reimbursed.

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[Justin Madders (Ellesmere Port and Neston) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Hosie. I congratulate my hon. Friend the Member for Hartlepool (Mike Hill) on the eloquent and knowledgeable way in which he introduced the debate on behalf of the Petitions Committee. He took us through a brief history of the health service and private sector involvement in it, and talked about the fears that have been expressed about the future of private involvement, particularly through the tendering process and the potential trade deals with other countries. I was very sorry to hear about his constituent, Connor McDade, and I would like to send my condolences to his family. I join my hon. Friend in paying tribute to the staff who looked after Connor and to all staff in the NHS, who make it the institution we feel passionately about.

That passion is demonstrated by the fact that, by the time we finish the debate, more than 20 Members will have spoken. Unfortunately, because of the number who have spoken, I am not able to go through every single contribution, but I want to draw attention to some of them.

My hon. Friend the Member for Hyndburn (Graham P. Jones) made an excellent speech in which he told us in detail how Lancashire has fragmented under the Health and Social Care Act 2012, and said that a High Court judge has blocked a £4 million Virgin Care contract. Later, I will talk about some of the adverse consequences of the 2012 Act in terms of litigation.

My hon. Friend the Member for Warrington South (Faisal Rashid) rightly raised concerns about the fact that the pursuit of profit can put patient care at risk. He gave a number of examples of the litigation that has been forthcoming, and he was ably assisted by my hon. Friend the Member for Dewsbury (Paula Sherriff) in that regard.

My hon. Friend the Member for Stroud (Dr Drew) talked about the wholly owned subsidiary that is proposed for his area. He is right that such a major change should not be proposed without being referred to hon. Members or members of the public. He asked a number of pertinent questions, and I look forward to hearing the Minister’s replies.

Similarly, my hon. Friend the Member for Leeds North West (Alex Sobel) talked about the wholly owned subsidiary company in his constituency. I was pleased to hear that his trust has at least responded to hon. Members’ concerns and is taking stock before moving on. I agree that there needs to be equality across all trusts in respect of the funding base upon which they make such decisions. He was absolutely right to say that it is not only clinical staff who make the NHS what it is today. Sometimes we do not recognise the valuable contribution that those who work behind the scenes make to the smooth running of our services.

My hon. Friend the Member for West Lancashire (Rosie Cooper) gave a tour de force of a speech. She is a greatly experienced health campaigner and described three fundamental problems with how the health service is run at the moment: transparency, accountability and the prioritisation of shareholder gain. How can it be right for a publicly funded service to refuse to answer questions from an hon. Member on the basis of “commercial confidentiality”, a phrase that can cover a multitude of sins? My hon. Friend is absolutely right to continue pursuing such matters, as she has done in many areas.

My hon. Friend the Member for York Central (Rachael Maskell), as always, gave a formidable speech about the issues affecting our national health service. She set out clearly how the cherry-picking of some services by the private sector damages the NHS as a whole and loads risk on the public sector.

[Richard Graham]

I was struck by how the hon. Member for York Central (Rachael Maskell), while talking about the need to find cross-party consensus on these issues, took no interventions from anyone on the Government Benches—[Interruption.]

[Stewart Hosie (in the Chair)]

Order.

[Richard Graham]

Furthermore, she made no recognition of the fact that issues such as subsidiary companies and so on are separate from the points she was making and absolutely not about privatisation.

[Justin Madders]

Members are indicating that my hon. Friend the Member for York Central did take interventions. It is not for me to comment on that, but I thought her speech was superb, and it came from many years of experience in the health service. However, on the contribution of the hon. Gentleman himself, I have to say that I disagree with him—this debate is about not a local election or weaponising the NHS, but about the 240,000 members of the public who signed the petition, which was launched some five months ago.

The hon. Gentleman also challenged us to find Conservative Members in support of privatisation—they may not express that support publicly, but we need only look at what has happened to the health service under a Conservative Government to see that privatisation has accelerated since 2010. There is also the famous 2005 pamphlet that advocated privatisation of the NHS. The Health Secretary has, I know, disowned his comments as one of the co-authors, saying that the pamphlet no longer represents his views, but at least five other current Conservative Members were co-authors, so there are questions to be asked about it of those on the Government Benches.

As other Members have said, private sector involvement has of course always been an element of the NHS, but since the Health and Social Care Act came into force there has been a step change in that involvement. After the Act became law, the amount of cash going to private sector partners went up by a staggering 25% in the first year alone. That is part of a broader trend identified by House of Commons Library research—the equivalent of £9 billion a year of NHS funds now goes into the private sector, which is double the figure under the previous Labour Government.

As we have heard, there are also huge problems with litigation arising from the 2012 Act. Money should not be spent on lawyers, procurement processes, tendering and court cases; it should be spent on patients. Given the longest and most sustained financial squeeze in the history of the NHS, we can ill afford money to be used in that way. The financial squeeze has also had consequences for how NHS hospitals are forced to use the private sector. Elective procedures in the private sector have gone up by 58% in the past year alone.

Oral Answers to Questions

Richard Graham Excerpts

Tuesday 20th March 2018 Commons Chamber

[Caroline Dinenage]

My hon. Friend speaks about this with great knowledge. He was an outstanding Defence Minister and understands this subject better than almost anybody. He will be pleased to learn that, following the incredible progress that we have seen with adult prostheses through places such as Headley Court, we are now seeing the same technology in the development of children’s sports and activity prostheses, using the same manufacturers. The research collaboration will also enable us to invest in future studies, including in the development of some exciting technologies, such as myoelectrical bionic upper-limb prostheses for children.

[Richard Graham (Gloucester) (Con)]

3. What steps his Department is taking to ensure that NHS primary care infrastructure meets the demands of an ageing population.

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

By 2020, investment in general practice will have risen by £2.4 billion, which is 14% in real terms, including an additional £680 million in infrastructure and premises in the last two years.

[Richard Graham]

The Health Secretary knows how hard staff have worked at the Gloucestershire Royal Hospital to ensure that this year—in fact, in January—it was rated 15th out of 137 hospitals for its A&E performance, despite the intensities of the winter. He knows from his recent visit that all staff, and their co-operation with health services, as well as within the A&E, have led to this, but will he also recognise and do all he can to let Public Health England know how important it is that new capital expenditure is available in order to increase beds and to serve the demographics of an ageing population?

[Mr Hunt]

I was pleased and privileged to see the brilliant work that staff are doing in Gloucester when I went on that visit. Deborah Lee and her team deserve enormous credit for getting a 10% improvement in performance year on year to February. A capital bid has been put in by my hon. Friend’s sustainability and transformation partnership. It is a promising bid and I hope to be able to give him news on that soon. If it is successful, it will be in no small part thanks to lobbying by him and our colleague, my hon. Friend the Member for Cheltenham (Alex Chalk).

Oral Answers to Questions

Richard Graham Excerpts

Tuesday 10th October 2017 Commons Chamber

[Mr Hunt]

Let me just remind the hon. Lady that there are 11,300 more nurses on our wards than there were just four years ago, so we are increasing the number of nurses in the NHS. She mentions what is happening in Scotland. I gently remind her that nearly double the proportion of patients are waiting too long for their operations in Scotland as in England.

[Richard Graham (Gloucester) (Con)]

17. The Secretary of State will know that the University of Gloucestershire recently introduced courses for both the higher apprenticeships scheme as a pilot project and for nursing degrees. These have been incredibly popular in my constituency and around the county of Gloucestershire. Does he support our bid to have a university technical college that will provide pathways for people into health and care, working closely with all NHS organisations?

[Mr Hunt]

I support all universities that are trying to move into offering more courses that can help me to ensure that we have enough staff for the NHS. I am sure that the University of Gloucestershire’s bid will be powerful, but I am aware that other hon. Members are supporting bids from their own constituency—including, I have to say, that of the University of Surrey, which puts me in a somewhat difficult position.

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[Mr Hunt]

What I accept is that we have 30,000 more professionals working in mental health than when my Government came into office. There has been a decline in the number of mental health nurses, but we have in place plans to train 8,000 more mental health nurses, and that will make a big difference.[Official Report, 17 October 2017, Vol. 629, c. 6MC.]

[Richard Graham (Gloucester) (Con)]

The Gloucestershire Hospitals NHS Foundation Trust capital expenditure bid would fund a 24-hour urgent care service, and it would also increase bed capacity and improve hospital performance in Gloucester and Cheltenham, to the benefit of patients throughout the county. When do Ministers expect to announce the results of the bid? Will they take this particular bid into careful consideration?

[Mr Dunne]

I am aware that, under the Gloucestershire STP, a proposal has been submitted for capital funding to support plans to improve the clinical environment for patients and staff at the Gloucestershire Royal Hospital. I am afraid that my hon. Friend will have to join me in awaiting the Chancellor’s announcement in the Budget as to whether there will be a second phase of capital funding for STPs. If there is any funding, it will be allocated thereafter.

NHS Bursaries

Richard Graham Excerpts

Wednesday 4th May 2016 Commons Chamber

[Heidi Alexander]

I do not agree with the hon. Gentleman, and later in my speech I shall explain why in some detail.

I would like to return to the Migration Advisory Committee report, because it does not make happy reading for Ministers. It goes on to say:

“It seems self-evident to us that the reduction in the number of commissioned training places between 2010 and 2013 across England, Scotland, Wales and Northern Ireland, was a significant contributing factor towards the current national shortage of nurses.”

Finally, there is the crucial sentence that sums up why we are experiencing across-the-board nursing shortages:

“Almost all of these issues relate to, and are caused by, a desire to save money. But this is a choice, not a fixed fact. The Government could invest more resource if it wanted to.”

Those are the words of the Migration Advisory Committee. Hospitals are short of nurses; mental health services are short of nurses—so, too, are care homes, hospices and primary care. We therefore have a big problem. No one in this House disputes that, but no one in this House should be under any illusion as to the cause. The question, when faced with this problem, is this: what is the right thing to do? How best can the Government work with experts to ensure that we are training enough staff and supporting those staff so that they stay motivated and stay working in the NHS?

[Richard Graham (Gloucester) (Con)]

Of course we all agree that there is a significant shortage of nurses, and the hon. Lady is absolutely right to ask what should be done. Does she therefore support the Government’s concept of associate nurses, which I believe will make a huge difference in places like my constituency where we need new nurses of this kind to increase the numbers of home-trained nursing staff?

[Heidi Alexander]

I am grateful to the hon. Gentleman for his intervention. The key question we need answered with regard to nursing associates is whether the Government intend them to replace registered nurses. If that is the case, I fear the proposals would be bad for patient care.

Madam Deputy Speaker, you might think a sensible approach to trying to resolve this problem would be to sit down with the Royal College of Nursing, other trade unions, universities and healthcare providers to work out a way forward. But no, this Government seem incapable of that. Instead, in just two lines in the Chancellor’s autumn statement, they announced that they would be scrapping NHS bursaries and asking student nurses to pay tuition fees. The Minister will argue that this will allow universities to train more students, but his problem is this.

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[Ben Gummer]

It is an assertion that is backed up by the evidence of the past five years, and which has received the recommendation of Professor Dame Jessica Corner, the chancellor of the Council of Deans of Health. I can tell the hon. Member for Lewisham East, in answer to her barracking, that Professor Dame Jessica Corner said:

“We recognise that this has been a difficult decision for the government but are pleased that the government has found a way forward. Carefully implemented, this should allow universities in partnership with the NHS to increase the number of training places and also improve day to day financial support for students while they are studying. The plan means that students will have access to more day to day maintenance support through the loans system and recognises that these disciplines are higher cost, science-based subjects.”

Likewise, Universities UK has said:

“We support increasing health professional student numbers and will work with Government and the NHS to secure the sustainable funding system”

that the Government have provided. It is particularly pleased about the impact that this will have on placement training. These are the people who are providing training in our NHS, and they support our proposals because they will release the same kind of innovation that we have seen elsewhere in the university sector.

[Richard Graham]

I want to reinforce a point that the Minister has made. I think—he will know this—the evidence shows that far more people from deprived backgrounds have gone to university since the changes we made five years ago, at a time when Opposition Members were saying that they would have precisely the opposite effect. So the evidence is even more conclusive than my hon. Friend suggests. Can he confirm that the maintenance grants will go up by about 25%, which will help in regard to the specific point being made by Universities UK and the other lady?

[Ben Gummer]

I thank my hon. Friend for that intervention. It brings me neatly on to my next point, which is that the great virtue of these reforms to student finance is that we will be able to increase student finance support—maintenance support—by 25%.

The hon. Member for Lewisham East made some clear and sensible points. She suggested that training as a student nurse was different from being a history undergraduate, because student nurses have less time to take on a second job. There is therefore even more reason to provide better maintenance support for them. However, she has not come to tell the House that she will provide 25% additional maintenance support for students who do not have time to do a second job. She has not made that commitment, yet she has criticised our efforts to increase maintenance support by 25% precisely to help those people who would not otherwise be able to take time out to take on a university course. She cannot have it both ways. She cannot criticise us for the reforms we are undertaking while at the same time saying that students need greater support. It is precisely through these reforms that we are producing the support that so many students require.

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[Ben Gummer]

I will make some progress now, if the hon. Lady does not mind.

We are introducing a new nursing associate grade. This will present an extraordinary opportunity to eradicate one of the great unfairnesses in the NHS, which is that there are brilliant people working as healthcare assistants who are unable to become registered nurses because they were let down by the schools they went to. I am afraid that this is a consequence of the failure of school reform under the previous Government. Under previous Governments, people were failed to the extent that they have not been given the opportunities that they deserve.

We are going to reverse that situation by providing an apprenticeship ladder to a nursing associate role, and from there to a registered nursing position. A degree apprenticeship will be available to those who are able and competent to reach that grade. That will provide a route of opportunity that was not available under the previous Labour Government. It is being brought in by this Conservative Government—a one nation party for all.

By bringing in these reforms, creating a nursing associate role and creating 100,000 apprentices in the NHS, many of whom will be healthcare assistants working their way towards a nursing associate position and from there to a registered nursing grade, we will give people multiple opportunities to become nurses. That will include those who are already in the service and who want to earn while they are learning. It will take them between four and a half and six years to get to a registered nursing position from a healthcare assistant role. It will also include those who are able to take time out and do a degree to become a registered nurse, for whom we will provide additional support in the form of increased maintenance grants. Opposition Members are shaking their heads, but at what, I do not know. Are they shaking their heads at the 100,000 NHS apprentices that we are creating? Are they shaking their heads at the nursing associate roles? Are they shaking their heads at the increased maintenance support? None of those issues was addressed in the speech of the hon. Member for Lewisham East.

[Richard Graham]

Will the Minister give way?

[Ben Gummer]

I hope that my hon. Friend will not mind if I just conclude my remarks, because I know that Members from across the House want to contribute to the debate.

In my remaining minutes, I want to state why the reform is important not only for the individuals who want to become nurses, and not just for social equality and opportunity, but for the NHS. The NHS is unable to innovate like other parts of our public sector and our private sector because of the long lead times for training people. We do not have the instruments within the NHS to reflect the dramatic changes in demography and technology that change the NHS not year by year, but month by month. The great benefit of bringing in apprenticeship routes and nursing associate roles, of diversifying the skill mix and of creating quicker, more numerous routes into the nursing profession is that we can create a more diverse, flexible and agile trained workforce.

All that will be possible as a result of the changes, of which this bursary reform is part. None of it would have been possible with the reduction in funding promised by the Labour party, or a failure to wish reform upon the system. That is why I hope the House will reject the motion, which is full of suggestions and implications rather than firm plans. It says nothing about the future of the people on whom the NHS depends, and does nothing to suggest how we will increase numbers, provide additional maintenance support or, most importantly, provide opportunities for those who have not yet had any. We will do that by reforming the system, just as we did in 2010. We will ensure that we do not listen to the well-intentioned but erroneous voices of the Labour party. Had we listened to them back in 2010, tens of thousands of people would have been denied an opportunity. We are determined not to do that. We will be the party of opportunity, presenting it to people who want to be nurses or hold any other position in the NHS. This NHS will be truly national only if it provides opportunity to the many, not the few.

[Dr Lisa Cameron (East Kilbride, Strathaven and Lesmahagow) (SNP)]

I must declare an interest due to my work in the NHS and having had the privilege of a grant when training to be a doctor.

The NHS is one of our most esteemed public services, but there is a long-standing shortage of qualified healthcare professionals. While the current bursary system for nursing and allied healthcare students in England may not be without issue, the UK Government’s proposed changes are concerning, as is the manner in which they have been presented, with detailed consideration of the impact somewhat lacking.

As we have heard, the UK Government have proposed changes to the current NHS bursary system. Instead, healthcare students will be required to pay tuition fees and will be subject to the same standard loans-based system to which other students in England are subjected. The UK Government have indicated that they expect the reforms to create up to 10,000 additional nursing and health professional training places over the course of the current parliament. However, that appears to be narrow-sighted. The proposed move to a system that relies on students funding themselves by taking on significant debts has raised substantial concerns among unions, professional bodies and students. One of the key fears is that such a move could be a barrier that deters prospective students from entering the profession. I stand here as the first doctor in my family, and I have to say that I would not have considered applying if it had meant racking up debt. I am particularly concerned about access to doctorate courses and postgraduate requirements. Will we create an elite workforce based not on ability, but on means?

Unison estimates that a student undertaking a three-year, 30-week course outside London under the new scheme will graduate with a debt of at least £51,600, plus interest and any overdraft and commercial debt.

[Richard Graham]

The hon. Lady’s achievement as the first doctor in her family is to be applauded by us all, but does she recognise that there are many people who do not think that university is for them? The two-year apprenticeship course offered by the new nursing associate route will provide them with a real opportunity to get into the NHS and maybe to go on to become a full nurse later on.

[Dr Cameron]

I want to see a widening of access to training schemes in the NHS, and I would hope that that would be properly funded and that we do not rely on NHS staff doing other jobs while dealing with the stress of training. We should invest in and fund them properly, letting them know that NHS staff are invaluable.

For many, loans may be higher due to the additional costs of longer courses or of courses within London. As I said, I am particularly concerned about postgraduate courses and doctorate trainees, who may not be able to afford further loans that will add to their debt. It is likely that debt could be considerably higher for the majority of healthcare students. It is naive to think that larger loans will not be a psychological deterrent, especially to those from poorer or non-university backgrounds or to mature students and career changers, who may have additional financial responsibilities or debts from first degrees or family life.

The demographic of students on nursing, midwifery and allied health professions courses tends to be different from other student populations, as we have heard. They are more likely to be women, from black and minority ethnic backgrounds, parents or mature students. It is therefore likely, and a real concern, that abolishing bursaries will reduce diversity, foster inequalities and discourage potentially high-quality applicants.

--- Later in debate ---

[Jeff Smith (Manchester, Withington) (Lab)]

It is a great pleasure to follow the hon. Member for Totnes (Dr Wollaston), as I have a lot of respect for her. Indeed, she commands respect across the House, and it is important that we listen to her views. It is also important that we listen to the views of others, including those of her colleague the hon. Member for Lewes (Maria Caulfield), who said:

“Speaking as a nurse, I would struggle to undertake my nurse training given the proposed changes to the bursary scheme.”—[Official Report, 5 January 2016; Vol. 604, c. 15.]

Clearly, the changes have not been thought through.

As a south Manchester MP, I am very proud to represent a large number of Manchester University students, including many of our nurses and midwives of the future. Indeed, the School of Nursing, Midwifery and Social Work at the university was the first institution in England to offer a nursing course, and it remains one of the top 10 universities in the world to study that same degree today. For the 2,000 students currently studying there, as well as for those weighing up their future with healthcare education in mind, the proposals on student bursaries will do nothing to instil any confidence that the Government understand the perspective of student nurses or potential student nurses.

I want to use my brief remarks to raise two main points. The first is the disappointing lack of consultation with organisations such as the Royal College of Nursing, and the second is the effect that this policy will have on potential students and patient care. Ensuring that access to these professions remains fair, that their funding is sustainable and that the Government consult experts from the sector are vital factors in securing the interests and the confidence of future healthcare professionals. Those roles are the lifeblood of our national health service, and we all have a stake in their future.

One big concern that we have consistently raised is the Government’s reluctance to engage with stakeholders. We have heard from charities, representative organisations, and think-tanks that the evidence base for these proposals is at best uncertain, and at worst non-existent. The very real fear is that the proposals will reduce the numbers of people entering nursing studies. Even the 12-week consultation that the Minister was lauding earlier takes the form of a technical questionnaire on the implementation of the proposals rather than a real consultation on the substantive policy.

[Richard Graham]

On consultation with stakeholders and so on, does the hon. Gentleman agree that when a hospital such as the Gloucestershire Royal shows strong support for the concept of nursing associates and wants to run a pilot project for them, we have to assume that it sees real value in those associates in terms of providing good nursing for its patients and my constituents, and that that must be as telling as anything in a formal consultation?

[Jeff Smith]

I thank the hon. Gentleman for his intervention. Parliamentary questions have shown that the Department of Health failed to consult the Royal College of Midwives, the Royal College of Nursing and Unison before the policy was announced in the autumn statement last year. It is not just the Labour party that is worried about this, but the Royal College of Midwives, the Royal College of Nursing, the College of Podiatry, the Royal College of Speech and Language Therapists and the NHS Pay Review Body, as well as Members across the House. It is little surprise, then, that the result fails to understand the unique characteristics of the sector and the hard-working professionals that work in it. This is a process that has been driven by short-term financial savings at the cost of tackling the big questions of how we adequately fund our NHS for the decades to come.

What about the effect of this policy on the nurses and midwives of the future? At the centre of any policy on healthcare education must be the students themselves. In this case, they are diverse: older than most—the average age is 28—and overwhelmingly female. There are greater numbers from black and minority ethnic backgrounds. We should not forget that completing a degree necessitates 2,300 hours of clinical practice over three years. Any legislation that we need to design to encourage students in the future and to guarantee high-quality care for patients must recognise those types of people. They are people like Katie, a nurse in my constituency, who wrote to me about her concerns about the prospect of debt. She said:

“It is particularly worrying for mature students, many of whom have dependants, and it could deter them from joining the profession altogether. I can relate to this as three of my close colleagues are mature students and have stated on multiple occasions that, without the bursary, nursing school would not have been an option. Student nurses are not like other students: 50% of their time is spent on unpaid clinical placements in hospitals and in the community and there are simply not the same opportunities for part-time work as other students. I could not have completed this course without the bursary. Studying nursing requires participation in extra-curricular activities. This is in line with a recent national initiative: revalidation…Therefore, finding time for part-time work becomes very difficult, and many of my friends have been turned away from part-time jobs as our weekly schedules, working shifts and time for completing university work are often sporadic. The bursary covers my rent and without that I would not be able to support myself and nor would my family.”

We need to take such views on board when looking at a new policy.

Cities and Local Government Devolution Bill [Lords]

Richard Graham Excerpts

Monday 7th December 2015 Commons Chamber

[Robert Neill]

My hon. Friend is absolutely right. The troubling thing is this: applications for fracking, licensing matters and all that regime are not governed by a power of general competence in the slightest. The new clause has no effect on fracking of any kind whatever, and I regret to have to say to the hon. Lady that to suggest otherwise is either wilful ignorance or a serious piece of misleading the public.

The new clause gives local authorities that are national parks the same powers to deal with things as their district councils and county councils have. The point has also been well made that it enables them to enter into devolution deals, which again I believe the Opposition supported. So far, they are against a power of general competence, which they supported when we brought it in, they are against devolution deals in national parks, which they have supported, and they have set up an Aunt Sally that has nothing to do with the case.

I appreciate that the Opposition Front Benchers have been shuffled so many times that they probably do not have time to read an Order Paper nowadays, but the most cursory reading of the amendment might have given them some idea that their approach is totally off the case, it is against the views expressed by the Select Committee rightly and properly and it is against devolution. I am sorry to say that we heard a bizarre speech from the Opposition and they are taking a bizarre approach. If they divide the House on this, they are simply—

[Richard Graham (Gloucester) (Con)]

Is my hon. Friend aware that quite a campaign has been whipped up across the country about the possibility of fracking springing up in national parks as part of some dastardly plot by the Conservative Government to introduce fracking wherever they can find a national park? Does he think that perhaps the response from the Opposition is influenced in some way by that campaign?

[Robert Neill]

I have always taken the view in politics that the further left you go, the greater the conspiracy theories get; I suspect that may have happened, perhaps with one or two honourable exceptions, to the Opposition Front-Bench team. But that has nothing whatever to do with what we are about. It has nothing to do with their ludicrous scare campaign. A simple amendment, whose principle was not objected to when the Localism Bill was brought through, is suddenly being seized upon for the most bizarre bit of political grandstanding by a bankrupt Opposition. The best thing they can do is find something to agree upon. Their approach would prevent a national park authority from entering into a joint venture with its district and county councils, although that is a perfectly sensible and reasonable thing to do. Anyone who speaks to people who have represented areas in national parks will know that one of their concerns was the inability to join up the service delivery between the national parks authority, the district council and the county council. That sort of thing was a regular issue upon the desk of any Minister.

The new clause enables that to be done through a simple, legal structure. It has nothing whatever to do with applications for planning permission for fracking and with the licensing regime for fracking. It is a sad and sorry day when an important and useful technical amendment is hijacked by one of the more bizarre bits of political boulevardiering that I have ever seen in my time in the Commons.

GP Services

Richard Graham Excerpts

Thursday 5th February 2015 Commons Chamber

[John Howell]

I will talk a bit about funding later. I say to the hon. Member for Heywood and Middleton that we are trying to put together a picture on the basis of individual constituencies. It is no use taking an overall, theoretical picture and then trying to work out what is happening in individual constituencies; it has to be done the other way around, by individual constituencies saying what is happening with them. I am setting out precisely the situation in my constituency.

[Richard Graham (Gloucester) (Con)]

On that point, in Gloucester we had exactly the same problem that Members have referred to, so our clinical commissioning group managed to arrange funding for 300 additional hours in GP surgeries a week, which is proving very effective. That is the sort of thing that can be done locally by using the budget creatively. Does my hon. Friend agree that others might be able to explore that?

[John Howell]

I agree that that is a very good local initiative that could be spread across general practice.

Let me give the House an example. I happened to be visiting a surgery one afternoon, so I asked the staff what the problem with access was. I was told that a good example was a lady who had come in that morning to have her plaster changed. I imaged plaster being removed from a suppurating wound, but it was actually a small plaster on her hand. She was told to go away. I think that is an abuse of a GP practice by a patient.

A and E (Major Incidents)

Richard Graham Excerpts

Wednesday 7th January 2015 Commons Chamber

[Mr Speaker]

Order. I really am keen to accommodate remaining colleagues, because I understand the interest in this subject. May I appeal to colleagues to put single, short supplementary questions without preamble? Now, who might be a master of the genre—Mr Richard Graham?

[Richard Graham (Gloucester) (Con)]

Thank you, Mr Speaker—I will seize the moment.

Part of the long-term solution is attracting and retaining more nurses. Will my right hon. Friend encourage the National Health Executive to allow the university of Gloucestershire to run pre-registration training courses for nurses so that we can attract and retain more local nurses?

[Mr Hunt]

I am happy to do that, and also to welcome the 80 new nurses in my hon. Friend’s local area over the past four years.

Atrial Fibrillation

Richard Graham Excerpts

Wednesday 12th March 2014 Westminster Hall

[Glyn Davies (Montgomeryshire) (Con)]

I am grateful to have the opportunity to speak in a debate that is hugely important to me on a personal level. I agree with every word of the speech by the hon. Member for Huddersfield (Mr Sheerman).

Soon after I was elected as a Member of Parliament in 2010, I was selected for Question 1 at Prime Minister’s questions. I immediately thought that that was going to be my great occasion. One knows that one is on national television and everyone is watching. It is a chance to support the thrust of the Prime Minister’s argument and I was really looking forward to it, but on the Monday morning I called my GP, because I had been suffering a bit of breathlessness, and I was rushed into hospital because he thought that I was having a heart attack. This is what influenced me greatly. I then spent three days in the assessment unit of the Royal Shrewsbury hospital, and it was probably the most expensive bed in the hospital.

As I said, I was there for three days with a supposed heart attack. No one was telling me what was happening. It was only because I became so angry that I almost had a heart attack that I had some reasonable treatment, and I was told that I was probably suffering from atrial fibrillation. I had never heard of this; I did not know what it was, but as I got to know a little more about it, I learned how, in many cases, it is very easy to put right. I was given electric shock treatment—cardioversion—which reversed the fibrillation on the first attempt, and I made a full recovery, but I learned quite a lot about the condition and I realised the sheer lack of awareness that there is of it. Then I understood what the hon. Member for Huddersfield has been telling us. The issue is not so much the atrial fibrillation itself—although it can be quite difficult for many people—but what it causes. It multiplies the chance of a stroke by about five times. That is a massive cost to the NHS, but it also completely destroys people’s lives in a way that AF does not necessarily do. There are several other diseases associated with it, but the key issue is the implications of the cost of a stroke.

[Richard Graham (Gloucester) (Con)]

My hon. Friend is making a powerful point on an important issue. Those of us who work right next door to him are delighted that he made a full recovery at that time. Does he agree with me that part of making people more aware of atrial fibrillation and what can be done to help sufferers is providing defibrillators? Some very good work has been done across the country, but particularly in my constituency of Gloucester by the Rotary club, which has funded and installed a defibrillator in Gloucester cathedral; and I pay tribute especially to the Hickman family, who have raised huge amounts of money for the Cystic Fibrosis Trust, which is also doing good work in this area.

[Glyn Davies]

I certainly do agree with that. Defibrillators are being installed, through voluntary efforts and fundraising, in many parts of the country. That is not only a good thing in itself, but the way it leads the community to work together is also a very good thing.

I want to return to today’s issue, because I am aware of the time. Today’s issue is the uptake of novel oral anti-coagulants. Warfarin was my treatment and it was fine; it worked very well. However, there is a problem because of the number of occasions I have to visit a hospital. It was once or twice a week in the early stages. That is very difficult. In London, I happen to live next door to St Thomas’s and I could pop in as I was going to work in the morning, so it worked out quite well.

However, there is an issue with warfarin, for two reasons. One is that it is not as effective as the new anti-coagulants that have been approved by NICE and come on stream. Also, there is a negativity about warfarin because it is, in many people’s minds, a rat poison. I remember seeing a headline in a national newspaper, which could have been the Daily Mail, with a huge picture of rat poison—warfarin. The standard way of dealing with atrial fibrillation is still to ask people to take warfarin regularly, and there it was, being promoted as a rat poison. Nothing could be more damaging to the health of the nation than that campaign. I thought it was a disgrace.

I can understand in a way, because of short-termism—the way in which things are often done in Britain today—that there are financial reasons for the use of warfarin. Clearly, there is an extra cost associated with the new products. Warfarin is as cheap as chips. I dismiss aspirin because it does not have any effect anyway, and it is a bit of a disgrace that aspirin is still being recommended. As I said, warfarin is as cheap as chips, but of course it is not as effective. There may be a short-term gain, but there is a long-term cost. I understand the financial pressures. There are financial pressures on every organisation and service. I understand those, but I think that what is happening is wrong. However, the lack of understanding and knowledge of the new products—the lack of awareness—is what we really have to challenge.

There is a risk element. We know that there is a risk. There is a small risk, if one s thinning the blood, of an internal bleed, but there is a very large risk, in not doing it, of causing some heart-related illness. The balance of risk is just not clearly understood. We need a genuine campaign, with Government support and the NHS organisations’ full support, to move towards use of the novel oral anti-coagulants. There would be a long-term saving from that; I accept that it is not short term. It would remove the element of suspicion and of risk that is associated with the standard use of warfarin.

We have to deal with AF, because the numbers of people suffering from it and the implications of it are huge. I hope that my hon. Friend the Minister will take from today’s debate, which is part of a campaign, the message that we need to move forward as quickly as possible on the best treatments for atrial fibrillation.

Oral Answers to Questions

Richard Graham Excerpts

Tuesday 14th January 2014 Commons Chamber

[Mr Hunt]

I recognise the real concern over the previous advice given by the JCVI. I hope that the hon. Gentleman agrees that, on something as important as this, it is helpful to have an independent body coming to these decisions and making a ruling. When a ruling is made, we are legally bound to accept the advice, which means that there is a measure of independence. I have met families campaigning for the MenB vaccine. We are waiting to hear what the JCVI says in February. We should let it come to its conclusion after re-reviewing all the advice and the literature.

[Richard Graham (Gloucester) (Con)]

T8. The Government’s decision to increase our dementia research budget was welcome news, and the G8 conference agreement to share research among all G8 members was an important development too. Does my right hon. Friend agree that there is a role for MPs in helping to keep constituents informed about scientific developments that may lead to significant progress?

[Mr Hunt]

I do agree, and I congratulate my hon. Friend on his work. I know that he is meeting Alzheimer’s Research UK next month in his own constituency. This matter is something in which we can all be involved in our own constituencies. There is a lack of willingness to talk about dementia. Many people are frightened of it, and the more we can do to raise the profile of this condition, the more we can give people hope that something can be done about it.

Care Bill [Lords]

Richard Graham Excerpts

Monday 16th December 2013 Commons Chamber

[Andy Burnham]

I would like to say that I would have been shocked, but I know that the system just gets worse and worse each year as the pressure builds and corners have to be cut, and it is older people and their families who are paying the price. How can any “care” be given in five minutes? Of course it cannot. It does not make financial sense in the long run, because we have a care system that does not provide people with support in their own homes, buts leaves them to drift towards hospital, leaving our acute hospitals increasingly and unsustainably full of frail older people.

[Richard Graham (Gloucester) (Con)]

I am slightly confused, because we have been called to the House today to debate the amendment tabled by the right hon. Gentleman, which states that this House

“declines to give a Second Reading to the Care Bill”,

but I thought I heard him tell the Secretary of State for Health earlier that he is not opposing the Bill’s Second Reading. Will he please clarify that?

[Andy Burnham]

I would have thought that the hon. Gentleman had been here long enough to know the difference by now. We will not oppose the Bill, in the sense that we will not vote against it on Second Reading, but it contains measures to which we simply cannot give a clear endorsement, as I will go on to explain. That is the purpose of our reasoned amendment. We will not oppose the Bill’s passage on Second Reading, which is why I objected to the Secretary of State misrepresenting my position.