NHS Dentists: South-West England

Robert Syms Excerpts

Wednesday 24th May 2023 Westminster Hall

[Sir Robert Syms (Poole) (Con)]

I congratulate my hon. Friend the Member for West Dorset (Chris Loder), who set out not only the problems but some of the solutions to the crisis in NHS dentistry, and my hon. Friend the Member for South Dorset (Richard Drax) reinforced his arguments.

If one is honest, there has never been an ideal NHS system. Before covid, people still needed a degree of luck and persistence to find an NHS dentist, but one of the main impacts of covid was to create a crisis in dentistry that was not there before. There is a massive backlog and a lot of people are leaving the profession. It is certainly one of those issues that needs to be higher on the political agenda.

The Government have already done one or two things to help. The changes to the annual allowance and lifetime allowance for professionals, particularly those in dentistry, will keep more people in the profession. We need a short-term and a longer-term plan to increase the number of people in the profession. Most of my hon. Friends have come up with solutions. My hon. Friend the Member for Torbay (Kevin Foster) said that we need to train more people, not just generally in the national health service but in dentistry.

We have a common problem. Parents find it difficult to find NHS dentists for their children. I get a lot of emails from pregnant women in Poole and those with special care needs who tell me that, because a number of NHS practices have packed up, they are shuttling around trying to find treatment that is not there.

Like my colleagues, I think the Government need to speed up the dental recovery plan to give those who at the moment are not getting treatment some hope of better times ahead. That is the short-term solution. In the long term, we will simply have to spend more to train people in the dental profession and raise the cap on dental schools. About 20 years ago—not too long after I was first elected—there was a proposal for Southampton to have a dental school, and the rationale for that was that dentists tend to stay in the area they train. That did not go through because the Blair Government decided not to go ahead, but I am interested in the proposals for a dental school in Dorset. We need more in the south-west of England so that people come in, train, like the communities they are living in and stay.

In our inboxes, we get a sense of our constituents’ urgency. There are people in need of treatment, so we need fundamental reforms and possibly some additional money from the Government. I know the Government and local health authorities are looking at this issue seriously. There is no magic bullet, but the sooner we get proposals from the Government to start to recover the situation, the better it will be for my constituents who are struggling to get the services they thought they would be provided with.

NHS Winter Pressures

Robert Syms Excerpts

Monday 9th January 2023 Commons Chamber

[Steve Barclay]

The hon. Lady makes a good point about the risk of introducing infections into care homes, as happened in the past. It is worth the House reflecting on the fact that we are in a very different position from the start of the pandemic. First, we now have vaccines in place for care home residents and staff. Secondly, we now have antivirals. Thirdly, we now have huge knowledge about covid. From an infection point of view, the risk of releasing people into care homes is now in a very different place.

On the wider workforce, part of the reason for the £500 million announced in the autumn statement is to support measures for the workforce, but we are also looking to boost numbers through international recruitment.

[Sir Robert Syms (Poole) (Con)]

I welcome what the Secretary of State says about community pharmacists, who have always wanted to do more. They can take a lot of the burden off GPs and, if access to GPs were improved, fewer people would turn up at A&E. It seems to be a win-win-win situation, so let’s do it.

[Steve Barclay]

I could not agree more. There is a huge opportunity for pharmacists to do more, and I have asked the Department and NHS England to explore that at pace. I expect to say more on that when I announce our recovery plan at the end of the month.

I think we can go even further because, alongside pharmacists, there is much more scope to work with employers. Staff absences due to cardiovascular conditions are a significant cost to employers, so it is in their interest to work with us on prevention measures.

Much more can also be done through home testing. One of the lessons from covid is that the public will test at home. In looking at the challenge of excess deaths, there is a significant opportunity to do more home testing, employer testing and work in the community, particularly through pharmacists.

Covid-19 Update

Robert Syms Excerpts

Monday 6th December 2021 Commons Chamber

[Sajid Javid]

On vaccine donations, I refer the hon. Lady to the answer I gave to a similar question. In terms of transport, I also refer her to an answer I gave previously.

[Sir Robert Syms (Poole) (Con)]

My constituents Mike and Carol Parkin are paying £2,700 for the privilege of being imprisoned in a Delta hotel in Milton Keynes and my constituent David Brayshaw £3,700 for being in a 3-star hotel in downtown Hounslow. The highlight of the day is meals in boxes, with plastic cutlery, that are inedible, cold or both. Can we go back to a proper quarantine where people can go home? What they are getting is very poor value indeed.

[Sajid Javid]

I think my hon. Friend will understand the difference in terms of public health between a managed quarantine facility and home quarantine, but he is right to point to an important issue. Of course no one is going to enjoy being quarantined in this way—why would anyone? I think everyone understands the issues, but it is really important that the quality of care provided there is equally decent and of good quality. If my hon. Friend can share with me some of the information he has about his constituents, I would like to look into that.

Coronavirus

Robert Syms Excerpts

Wednesday 16th June 2021 Commons Chamber

[Matt Hancock]

Up to a point, and the point is that, should that be taken as an absolute principle, there is a challenge should there be an overwhelming demand on the NHS that would impact on others. Of course, with a communicable disease, there is an impact on others in terms of spreading the disease, so we do have to have an eye to that. That is why I phrased it as I did, but in terms of my right hon. Friend’s argument, I think she and I concur on the broad thrust of the case being made.

[Sir Robert Syms (Poole) (Con)]

My point is slightly niche. The reason why we developed all the vaccines was that thousands of Brits volunteered to trial them. There are now a number who trialled vaccines that are not yet approved, such as the Valneva vaccine, and who therefore cannot use the NHS app and some other things. Should they go for two shots of another vaccine, or will the Health Department take that into account?

[Matt Hancock]

Being certified as having had a vaccine includes being on a vaccine clinical trial. The deputy chief medical officer, Professor Jonathan Van-Tam, has written to participants in vaccine clinical trials, who are doing, as my right hon Friend says, a great service to their country and indeed to the world by offering themselves to have an unlicensed vaccine in order to check that it works. I am very grateful to all of them. We will not put them in a more difficult position because of that.

We will make sure that when it comes to someone proving that they have been certified as vaccinated, being on a clinical trial counts as certified and continues to count as certified during a grace period after they are unblinded, so that if they are in the placebo arm, they can get both jabs and will not be disadvantaged for being on the clinical trial. That is a very important point. I am very glad that right hon. Friend raises it. If anybody from any part of the House gets that question from a constituent, please point them to the comprehensive letter by Professor Jonathan Van-Tam that explains and reassures.

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[Sir Robert Syms (Poole) (Con)]

The pandemic has been a massive challenge to the British Government. I happen to think that, given the uncertainties that they have faced, the Prime Minister and senior Ministers have done a pretty good job. In terms of the vaccination programme, they have certainly proved to the world that Britain can go alone and do a lot to safeguard its population when it uses its science and its ability to get things done.

When the road map was unveiled, I thought to myself, “At least that stops me voting against the Government again”— until we get to the point when the Government have delayed opening up. I do think that this is a matter of balance and judgment. My view is that most of the senior Ministers who took this decision need a damn good holiday. If we look at the data and at what is happening in the country, the restrictions are totally out of kilter with the sense of the problem.

Let me take the south-west of England. There are 5.6 million people in the south-west of England.

[Mr Deputy Speaker (Mr Nigel Evans)]

Order. Sir Robert, can you please face the Chair? Your voice is not being picked up by the microphone and Hansard cannot hear you.

[Sir Robert Syms]

There are 5.6 million people in the south-west of England. There are 23 people in hospital. There are two in ICU. In Dorset, where there are nearly 1 million people, we have one person in hospital. Yet there are hundreds of couples who want to get married, businesses that want to be viable, and people who want to get their lives back in order. I just think that the balance is wrong. Most of the population have now been vaccinated. We may not totally break the link with people going into hospital, but there are more than 100,000 beds in the NHS. One per cent. are taken by covid patients. Now it might go up to 2%. We already have experts on TV saying, “In order for the NHS to catch up, we may well have to keep restrictions for longer.” I think that is unacceptable to the British people. As a Conservative, I am perfectly willing to accept restrictions when hundreds and thousands of people are dying and we are dealing with a virus that we do not understand, but we have sort of got to the point where we have won the battle. There will be variants. There will be challenges, but we have to get on with normal life.

The points made by my right hon. Friend the Member for North Somerset (Dr Fox) are perfectly right. If it is simply that we need to get second doses in—if that had been explained—we might be a little more relaxed. If we look at the explanatory notes, though, we will see that we have a review of data in two or four weeks’ time, and not necessarily a release date. We need to get people’s freedoms back. We cannot save everybody, but what we have done is save thousands and thousands of lives. Now we need to safeguard employment, safeguard businesses and safeguard people’s personal relationships.

I began by saying that the Government have done a pretty good job and that the vaccine programme is outstanding, but we have to now take the dividend from that to get people back to normal life. When they queued up with their enthusiasm to get that jab in their arm, they thought that that meant that things would get back to normal. They did not expect that they would be in further restrictions which would go on and on and on. I think we should have lifted all restrictions on 21 June. I hope and I pray that, in two weeks’ time, the Government will look at the data again and set people free.

Public Health

Robert Syms Excerpts

Wednesday 6th January 2021 Commons Chamber

[Matt Hancock]

I am a man after my hon. Friend’s heart. I can tell the House that we have removed a series of unnecessary training modules that had been put in place, including fire safety, terrorism and others. I will write to him with the full panoply of training that is not required and that we have been able to remove. We made this change as of this morning, and I am glad to say that it is now in force. I am a fan of busting bureaucracy, and in this case I agree that it is not necessary to undertake anti-terrorism training in order to inject a vaccine.

[Sir Robert Syms (Poole) (Con)]

I notice also a story about not delivering vaccines on Sunday. As I understand it, it is thought that there will be sufficient vaccines to be able to do seven-day inoculations. If somebody runs short, they will get topped up, which is a little different from what The Daily Telegraph said today.

[Matt Hancock]

My hon. Friend is quite right. The supply of vaccines can take place on all seven days of the week, but, in a regular way, we do it on six days of the week and then, on the seventh day, people can either rest or deliver further vaccine if that is what is necessary. As a result of this delivery schedule, there has been no point at which any area has been short of vaccine. We have a challenge, which is to increase the amount of vaccine available. The current rate-limiting factor on the vaccine roll-out is the supply of approved, tested, safe vaccine, and we are working with both AstraZeneca and Pfizer to increase that supply as fast as possible. They are doing a brilliant job, but that is the current rate-limiting step. As that supply increases, we will need more people to give vaccinations. We will need to get pharmacists involved in the vaccination. I very much hope to get my right hon. Friend the Member for South West Wiltshire (Dr Murrison), a former doctor, and others involved in vaccinations. We will need more people, but the current rate-limiting factor is the supply of vaccines.

That is not to say that the companies are not supplying on the schedule that was agreed; they are, and they are doing their bit, but we do need to increase that supply and then the NHS will increase its delivery. I hope to make that point crystal clear, because Public Health England work to get the vaccine out is not a rate-limiting factor, the current discussion with pharmacists is not a rate-limiting factor, and the fill and finish is not a rate-limiting factor. What is a rate-limiting factor is the amount of the actual juice—the actual vaccine—that is available, which is not manufactured like a chemical. It is a biological product. I do not know whether you bake your own bread, Madam Deputy Speaker, but I sometimes do and it is a bit like the creation and the growth of yeast. That is probably the best way to think of it. It is a complicated and difficult task and that is the rate-limiting factor. I pay tribute to those who are engaged in the manufacturing process of this critical product.

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[Sir Robert Syms (Poole) (Con)]

This is a difficult crisis for the Government, and no doubt the Prime Minister and the Secretary of State for Health must each have the constitution of an ox to deal with the very difficult decisions they have to deal with every day, but I am afraid that I cannot support this legislation today. The principal reason is that, at the end of last year, I thought we had got to the point where Parliament would be consulted on a regular basis. We have regulations today set out to 31 March, which is a full three months. Although we have had warm words—“Of course, we’re going to review and we’ll come back to discuss with Parliament”—as of right we do not have any ability to influence this once it is passed. It is essentially a blank cheque for three months to Public Health England to do what it wishes, and that is why I worry about the legislation today.

If the legislation said there would be a month and then a review or two months and then a review, I might even be tempted to vote for it, but the three-month nature of the regulations seems to me too long, and I do not think it is proportionate to where we are. Parliament is sitting—the reality is that we are here—so we need to be involved in these decisions. I notice that regulations have been passed saying that if someone sits by a river with a fishing rod, they are breaking the law under the current lockdown regulations. People will follow sensible regulations if they feel it saves lives, but the bureaucratic nature of this essential lockdown is such that I think people will get frustrated and they may well actually break the regulations because they cannot understand why they are there. So we need this reviewed, we need Parliament involved and we need the Government to listen.

I was somewhat concerned earlier when the Secretary of State was talking about when this would be lifted. We need a programme, and we need the criteria for lifting it. Is it hospitals, is it infection rates or is it deaths? Is it all the vulnerable people actually being inoculated, because we heard earlier that, once they are inoculated, the Government will think about it?

I have businesses in my constituency, I have people who work and I have people trying to pay a mortgage. People have worked for generations sometimes, and certainly for decades, building up businesses, and they are being closed down and they may not survive. Taking away the freedom of people to trade is a very substantial thing to do, and there are some people who will not survive the regulations and the way in which we are locking them down. That is one reason why I will call a vote tonight. If we are going to take away people’s liberties and freedom, let us do it with our eyes open and a vote of this Chamber, because I feel very queasy about destroying people’s livings in my constituency when people work so hard. The people who make these decisions are superannuated, pensioned and public sector: they are safe and they can retire. In my constituency, there are people who do not have these advantages.

Covid-19 Update

Robert Syms Excerpts

Thursday 26th November 2020 Commons Chamber

[Matt Hancock]

Yes. There are five indicators that we take into account in deciding on which tier. One is pressure and anticipated pressure on the local NHS, and bed occupancy rates are of course a critical part of that assessment. I know that people are looking for a clear numerical boundary between the different tiers, but because we are looking at five different indicators rather than a single one, there is no automatic figure at which a different tier is triggered. We have to look at all the circumstances, including, for instance, outbreaks. Some cities, on their pure numbers, would be in tier 3, but because an outbreak is specific—for instance, in a school or care home—it is appropriate that they are in tier 2. We have to look at these very localised issues as well, and that is why the engagement with local directors of public health is so important.

[Sir Robert Syms (Poole) (Con)]

There will be bitter disappointment in Dorset, in both the urban and rural areas, that we are in tier 2 even though our infection rates are now falling quite rapidly. My main interest today is finding out how we get out of tier 2 and into tier 1. If we are going to have regular—that is, weekly—reviews, that is great and fine, but if we are not, and we are stuck in that tier for two or three weeks, would the Secretary consider some kind of appeals process, and might his admirable Minister for Health be the appeals process?

[Matt Hancock]

We work as a very cohesive team of Ministers in the Department, and we all work on covid-related issues. I take my hon. Friend’s gentle chiding that he would rather my No. 2 took these decisions, but I am afraid he is stuck with me for the time being.

On the serious point that my hon. Friend raises, we will review the tiers in a fortnight and then regularly, which he can reasonably take to be weekly. We have a weekly cycle of meetings, with the chief medical officer chairing a meeting, typically on a Tuesday. I then chair a meeting on a Wednesday for an announcement on Thursday of any change to the tiers.

NHS Pensions

Robert Syms Excerpts

Wednesday 26th June 2019 Westminster Hall

[Sir Robert Syms (Poole) (Con)]

I beg to move,

That this House has considered NHS pensions, annual and lifetime allowances.

I begin by declaring an interest, because anybody who has been in the parliamentary pension scheme is affected by annual allowance and lifetime allowance. Therefore, some of the things I say may reflect on me and maybe other hon. Members, so I suggest they make a declaration as well—

[James Gray (in the Chair)]

Order. The hon. Gentleman may be right to say that all hon. Members may be affected by that matter, but for each individual to have to make that declaration would, I think, be otiose.

[Sir Robert Syms]

Thank you, Mr Gray. This is an important subject, and the more I learn about it, the more I realise its implications for the national health service. I had originally been told that the Treasury would respond to the debate, but I understand that the Department of Health and Social Care has manfully stepped up to the plate—the first example I have seen of a hospital pass to a Department.

The subject has devastating implications for the NHS, dental services and many other services in this country unless it is addressed by the Government. When the coalition Government came into office in 2010-11, they were quite right to reduce the amount of money that could be put into pension funds. At that time, someone could put £255,000 into a pension fund tax free; clearly, if they had such resources, it was unfair on the lower paid. The Government moved to reduce the tax leakage by reducing a number of the allowances.

The problem today is that the Government have drawn the allowances too tight, and in 2015-16 they also introduced a taper to the annual allowance. All that is having a pernicious effect on the NHS and creating what the British Medical Association has called a “perfect storm”. The lifetime allowance, which is just over £1,055,000, is such that most senior doctors and general practitioners get pulled into additional tax, paid at 55%. That raises the question whether they should continue working or retire early; there is a lot of evidence that members of the medical profession are deliberately retiring early because of the implications of working longer.

The annual allowance of £40,000 is creating problems of supplementary tax bills, which are falling at the doors of consultants, doctors and senior nurses. That £40,000 is made up of the increase in the fund and contributions, in a slightly convoluted formula, but the introduction of the taper and the way that it operates cause particular havoc. For higher earners, a strict regime applies to annual contributions, which is known as tapered annual allowance. It applies to people who have both adjusted income over £150,000 per year, which is total taxable income plus the real growth in value of pension rights over the year, and threshold income above £110,000 per year, which is essentially total taxable income, but net the value of any employee pension contributions.

Where an individual ticks both boxes, for every £2 of adjusted income that they receive above the £150,000 level, their annual allowance is reduced by £1. This means that those with an adjusted income of £210,000 have their annual allowance tapered down from £40,000 to £10,000, the lowest level to which tapering can reduce the annual allowance. That tapered allowance was introduced in 2016-17. The ability to carry forward unused allowances for years before the taper was enforced has so far helped to dampen down its impact, but in 2019-20, carry-forward will be from no earlier than 2016-17, when the taper came into force. That will reduce the number of people with significant amounts of underused annual allowance available, and as a result the taper will bite rather more than in earlier years.

If we look at the figures, we see the number of people who exceed annual allowance or hit the taper multiplying each year, pulling many more people into the system. Many senior doctors earn enough money from their core hours plus additional shifts to be potentially affected by the tapered annual allowance. In addition, because of the relative generosity of the NHS pension scheme, pension rights can be built up quite quickly, especially for those who have experienced a step-up in pension rights because of a promotion. Paradoxically, in most cases overtime shifts are not pensionable. That means that a doctor can find that, by working more, he or she has built up no extra pension but, because of the operation of the tapered annual allowance, has reduced the amount of pension that he or she can build up within the tax relief limits.

All that leads to more complexity within the system. It is extremely difficult for someone to work out whether they have an annual allowance issue; that is true for any high earner, but may be particularly true for those in the NHS, because they have rights under different sections of NHS pension schemes—for example, a final salary pension and a career average pension. Those rights are tested against annual allowance, but a negative accrual in one scheme cannot be set against a positive accrual in another scheme.

[Alex Chalk (Cheltenham) (Con)]

My hon. Friend is making an excellent speech on an area that is technical, but has enormous implications. I have been contacted by a consultant in emergency medicine at Gloucestershire Hospitals NHS Foundation Trust, who has indicated that because of the perverse incentives of this scheme, he will not be taking on an extra shift and out-of-hours work, which reduces that vital expertise. Does my hon. Friend agree that we must turn this around so that we have frontline medics doing what they should be doing—caring for our patients?

[Sir Robert Syms]

Almost anybody I talk to in any hospital anywhere has an example of the impact of this additional taxation biting, and its impact on working methods. I know my hon. Friend has tried to get a debate on a similar subject, because we are ultimately talking not about consultants, but about the patients and the impact this has on delivering services.

For defined benefit pension rights, the test against annual allowance is complex. The growth in rights over the year must be adjusted to strip out any increase that simply keeps pace with inflation, and is then multiplied by 16 added to any additional lump sum accrual before being tested. Whether the tapered annual allowance applies depends not just on whether someone’s adjusted income is over £150,000, but on whether their threshold income is over £110,000. These two measures are quite different, and adjusted income in particular is calculated in a very complicated way.

That creates unpredictability. A tapered allowance works by using income from the current year to determine the size of the annual allowance for the current year. Many NHS doctors work extra NHS shifts and many do private work; they may have little idea what their income for the year will be until very late in the year. Sometimes, NHS trusts get additional money released at the end of the year, leading to more operations. Sometimes, NHS trusts pay at a rather slow rate, and they may pay in a different year from that in which an operation was undertaken. As a result, doctors who take on a lot of extra work late in the year can suddenly find they have an annual allowance issue.

There is also a cliff edge issue. Although the tapered annual allowance result is a gradual reduction in annual allowance for each £1 of adjusted income over £150,000 per year, the fact that the whole system switches on abruptly for threshold income above £110,000 can create a violent cliff edge effect. For example, those with threshold income that is 1p below £110,000 can effectively ignore the tapered annual allowance, but those with income that is 1p above it can find themselves caught with a rather large tax bill. For the latter group, not only does each extra £1 attract income tax at 40p and a loss of personal allowance equivalent to another 20p in the pound, but they can suddenly face a big drop in their annual allowance.

Some people can be worse off overall by working an extra shift. I have heard testimony to that effect from many doctors who say they have done additional work and ended up worse off.

[Paul Masterton (East Renfrewshire) (Con)]

I congratulate my hon. Friend on securing this debate. I hope he will not mind my taking the opportunity to plug the event I am hosting with the BMA next Wednesday between 4 pm and 6 pm, which will be a great opportunity for MPs to meet many consultants with stories such as this, and to find out more information about the problem. Does he agree that, because this matter is so complex, it is important for MPs to come along and speak to the BMA, and speak to their local senior consultants, to really understand the impact this is having on the ground?

[Sir Robert Syms]

I thank my hon. Friend for his contribution. This is an area that people start to get interested in only when they start thinking about retirement. Then they realise how complicated the retirement rules are. This issue is upsetting many people who work in the NHS because of the impact it is having.

A survey of GPs to which 46% replied—354—found that their average tax bill owing to the tapered allowance was £18,500, so we really are talking about considerable sums of money being levied on doctors, many of whom do not expect it and suddenly get into arrears. Dr George McInnes, radiologist at Poole Hospital, said to me that most of his radiologists are contracted for 10 sessions, with most working 11 or 12 as a matter of norm to keep the throughput going. However, as is the case in most hospitals, he now finds it terribly difficult to get them to do more than 10, and when people come to review their contracts, they ask to do less work, rather than more, because of the impact of the pension arrangements.

The real problem is that most of the people affected have done years of training and have years of experience—they are the super strikers of the NHS; the team leaders—and despite tax bills have a loyalty to their hospitals and teams and continue working. However, year on year, they find themselves penalised for working. As rational people, they decide to play golf or to spend more time with their families or with Netflix. That is logical, and the Treasury is deterring many people from doing what they have trained for their whole lives to do. The letters, emails and phone calls I get from doctors do not say that they want to work less. They actually want to work more, but they do not really feel that they should work more and be worse off as a result.

The Government have put additional resources into the NHS, and we can argue about whether it is enough or not. However, the key point from the Treasury and the Department of Health and Social Care was the importance of productivity in the NHS, which we can get only if the people within the service are actually able to deal with patients and the issues before them. If, because of the tax issue, people work less, the only way around that—apart from locums, if they can be recruited —is to recruit more people to do fewer operations. That is not increased productivity; that is reduced productivity. If we want to use these people, we have to set a tax system that is proportionate and sensible.

It is not only the NHS. The British Dental Association says the same thing: people are retiring early and are more averse to taking on NHS patients. The consequence is the problem that we are now starting to see, which will get worse and worse. I know that the Department of Health and Social Care understands the issue; I have talked to the Secretary of State. I think the Treasury sort of understands that there is a problem, which is why I think it indicated that it might give additional resources to the NHS. However, the problem is that the only way out of this is to get rid of the taper, because its impact on the way people work is so detrimental to the NHS. Even if we take into account wider issues and other areas, I cannot see how any scheme can be brought in to ameliorate its impact.

We in this House want patients to get the best service, and sometimes we have to pay people to get the best service in the national health service. Most consultants or senior nurses have trained for years and are dedicated to their patients, and all they want to do is to turn up and work. The Government have put money into the NHS to allow operations to take place, but perversely our system of taxation on pensions, which was probably drawn up to stop city slickers avoiding tax, is impacting on a major, important public service and will lead to longer waiting lists, meaning people—who, if not in pain, will be very uncomfortable—waiting to be dealt with.

We all want people to be dealt with, doctors to be happy and the NHS to work properly. We need the Treasury to get out of the way on this one, because it is causing problems.

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

I declare an interest: I spent more than 30 years as a consultant in the NHS and am married to a GP, so naturally the issue affects us. However, it also affects many of our colleagues.

The first thing to hit was the lifetime tax allowance changes. In my husband’s practice, I saw GPs being driven out at the age of about 57 or 58. They had had no intention of retiring early, but they had been warned in their annual meeting with their accountant that, because of the taper, they would suddenly reach a high marginal tax rate of well over 50%, which naturally is not very attractive. The result, exactly as other hon. Members have laid out, is that we are losing the people with the most expertise—the people who train the new people.

It is important that we do not get carried away into thinking that the NHS is about machinery, buildings or gizmos and gadgets. Every one of those gizmos and gadgets is used by a person. It is people in the NHS who care for, treat and diagnose people. If we do not have the workforce, all the waiting times that we like to stand up and talk about will be completely shot. The workforce issues that all four UK nations face are being made worse by these problems.

Many people may think, “A £1 million pension pot allowance? What a great problem to have!” It is a great problem, but the difficulty is that in general practice, GPs reach a high salary quite early, unlike in a hospital where becoming a consultant takes 15 or 16 years, so people have taken out added years and bought extra service. Because we graduate late, it ends up being very difficult to work for 40 years and have a half-salary pension. We thought about buying added years—we looked at it twice, but we could never afford it.

It is the same issue that arose with the Women Against State Pension Inequality Campaign and with Hewlett Packard, Magnox and all the others: people are expected to commit to a pension in their early 20s, but when they get to the other end, the goalposts have moved. It hits them when they can do nothing about it but bail out—and that is what they are doing.

The lifetime tax allowance limit has already driven out consultants and GPs before the age of 60, but what makes the problem much more acute is the tapering annual tax allowance. As we have heard, it was introduced in 2010 at more than £250,000 to avert tax avoidance and gaming of the system. Senior medics in the NHS are probably the highest-paid people who do not run a business. They are on pay-as-you-earn, so they cannot play the game of writing off this, that and the other or paying themselves in weird ways; they just get their payslip, and the tax is taken. They are not in the tax avoidance game that was perhaps thought of when the taper was introduced. The commercial sector is defined contribution, not defined benefit; it is how the limits interact with the NHS, and probably other public service schemes, that causes the problem.

The annual allowance was reduced to £50,000 in 2011 and then to £40,000 in 2014. For those caught by the taper, the allowance can go right down to £10,000. The threshold is £110,000—not £150,000, which was the impression that the Chancellor gave at Treasury questions on 21 May. People hit a cliff edge, as hon. Members have highlighted: all of a sudden, they are caught in a system where they are taxed over and over on the same income. It particularly affects consultants, who are paid about £110,000 or more, and full-time GPs.

Those who have been caught out and hit by these bills are now talking to their colleagues. The result is that people are refusing promotion and refusing to take on the extra duties that are required in the NHS, such as becoming an education director, a manager of junior doctors or a clinical lead, because anything that could bring in extra income for extra work could suddenly push them over the threshold. Doctors cannot see in advance whether they will be hit, so they cannot manage things over the year.

Some of the bills that arrive have been absolutely horrendous. The average bill is £18,500, but many are getting towards £100,000. No one has that kind of amount lying around in their bank account, however much they are paid. Even trying to pay the bill has caused terrible problems. People are paying it either from already taxed income or by taking a loan on which they will have to pay interest—or they are using scheme pays, borrowing from their pension pot to pay off their bill and then having to pay the money back at non-commercial rates. That still reduces their final pension pot, because the money has technically not been in it for the same length of time.

[Sir Robert Syms]

A BMA consultant told me that an actuary has done some modelling and found that the penalties are so severe that somebody who works 48 hours a week and has to borrow money from their pot at the end will have a lower pension than someone who works 24 hours a week.

[Dr Whitford]

I thank the hon. Gentleman for securing the debate and for making that point. I have not seen that actuarial working, but it highlights how completely bonkers the scheme is. People are trying not to do anything extra; they are doing everything to stay below the threshold, because once they are over it, they get sucked into a Kafkaesque spiral that pulls them down to ridiculous levels.

Another problem for GPs in England is that they are not getting their pension statements because of issues with the system; I think Capita runs it at the moment, and we know how well it runs some of the other services that it has been asked to manage. Non-pensionable income is counted, which seems very weird for pension tax allowances. The notional growth in someone’s pension pot is also being counted as income. I am sorry, but income is income; it is what someone earns or receives, not what might be sitting in their pension pot for them to gain in 10 years. All these problems are catching doctors out, because they cannot see them. As they have begun to suffer, all they can do is ensure that they stay below the threshold.

The former junior Health Minister—the hon. Member for Winchester (Steve Brine), with whom I have spent many hours in this Chamber—highlighted the fact that 80% of people affected will change practice. That is leading people to refuse anything that will lift up their income—not only promotion and extra duties, but extra sessions. Many of those who are in their early to mid-50s are talking about retiring, which would be cataclysmic. The survey that he mentioned shows that some 30% are already considering doing so.

Between six and seven years ago, we were suddenly hit with a doubling of our pension contributions—from about 6% to about 14%—which meant that my take-home pay went down. Here we are, six or seven years later, being punished because our pension pots are too big. It is completely bizarre.

The problem is that we cannot afford for those who are affected to retire. Every time we discuss workforce, we talk about recruitment and retention. These people are the ones who will train the new recruits, and we need to hold on to them. As has been mentioned, the measure is not devolved but its impact is devolved in health. Only this place can sort out the pensions mess.

I am really disappointed that we do not have a Treasury Minister listening to this debate, and I hope that at some point we will have a debate to which a Treasury Minister responds. The Minister for Health, who is here today, will have to gather our comments and take them to the Treasury, and we would rather communicate directly with the Treasury. This issue has to be sorted, or there will be an absolute workforce meltdown within the next two years.

--- Later in debate ---

[Sir Robert Syms]

The lifetime allowance and the annual allowance have not created the crisis. The reduction in the limits has not created the crisis. If all we had at the moment was an annual allowance of £40,000, or a lifetime allowance of just over £1 million, the NHS would be living with that. What has caused the problem is the taper, and the taper’s impact on the way in which people do their business. Initially, it is changing behaviour. If it is not fixed, it will do real damage to the NHS. I know the Department of Health understands that and I hope the Minister will make representations to the Treasury. If he gets moved and promoted soon, perhaps he will leave a note to his successor and send a note to the Treasury saying that unless they fix it soon, the cost of fixing it for taxpayers and for patients will be far higher. I thank everyone for contributing.

Question put and agreed to.

Resolved,

That this House has considered NHS pensions, annual and lifetime allowances .

Healthcare (International Arrangements) Bill

Robert Syms Excerpts

Wednesday 14th November 2018 Commons Chamber

[Sir Robert Syms (Poole) (Con)]

I welcome the Government bringing forward the Bill. This is clearly part of a suite of legislation to prepare for the changes that Brexit will bring about. It is also pretty critical that at the end of the day, a deal is done to allow this to work in a smooth and effective fashion.

Brits like to travel; over 50 million go abroad. Most of them go with family members, and many retire abroad. Those who do not come to Poole may go to the Costa Blanca or elsewhere, and health for older residents is one of the big concerns. The European health insurance card system has worked pretty well. There is no point, just because we object to some aspects of European integration, objecting to other aspects that may be beneficial to our citizens and those of the EU, so the Government’s intent to try to replicate the system—whatever happens with Brexit—is very sensible and good. The fact that a quarter of a million people used the EHIC card last year indicates how important that is for many people.

I welcome what the Government are doing. It is a necessary precaution. I do not begrudge spending a bit of time in this House dealing with the concerns of older people retired abroad or of Brits who want to travel, so it is important to get the Bill through today. This measure will only be for two or three years and then there will be further legislation. Some Opposition Members talk about the Secretary of State being given powers, but we are living in slightly extraordinary times, and I suspect that we will come back to legislation in this area in a couple of years.

The Government are doing a very sensible thing. I hope that it is part of an overall agreement, because that would be the easiest way to do it. Clearly, if we have to do this on a bilateral basis, that will take longer and there may well be cliff edges that cause problems for some pensioners. Therefore, when Members sometimes say that there must be a deal when they are already somewhat committed to voting against a deal, I wonder whether they ought to look at the detail of what will happen if we have no deal. This is one of the areas that will cause problems for Brits who live abroad and travel abroad and for some EU people who come to the UK as tourists. We should understand that this country benefits greatly from the tourist trade. We have only to walk around London—around Leicester Square and other areas not far from here—to see the many thousands of people who travel. They, too, need peace of mind.

This is a good piece of legislation, then, but I agree with my hon. Friend the Member for Crawley (Henry Smith) that the ethos of the NHS is such that it does not like taking money off people, even when it should. I once stood in A&E and watched an American take out a credit card, only to be told, “You don’t need to do that here.” Sometimes people are busy and want to get on with their jobs and deal with backlogs, but there is an issue with us getting proper recompense. The former Health Secretary made a good point: it is a national health service, not an international health service.

Some years ago, when I was serving on the Health Select Committee, we interviewed chief executives of trusts, and they said there was a problem sometimes with the disproportionate cost of pursuing fees and that some people actually come to London on holiday who happen to be pregnant and who end up in London hospitals at a cost to the British taxpayer, so the health service does sometimes attract people who try to take advantage of the system as well.

The figures from the Library are stark. We pay out 10 times more than we claim back from the EU and the other states in the scheme. Although some of that is because there are older people abroad and Poles tend to have six jobs and be younger, some of the figures are still quite remarkable.

[Dr Sarah Wollaston (Totnes) (Con)]

Does my hon. Friend accept, though, that the majority of the difference is due to the disproportionate number of British pensioners living abroad compared to the number of EEA foreign nationals living here as pensioners?

[Sir Robert Syms]

That is a factor, but I still think that a 10:1 ratio is quite high. London has the second-largest French population, behind only Paris, yet we claim back only £5.3 million from France. That is quite a stark figure, and one wonders why we are not claiming back rather more. I gently make that point. I know the Minister is aware of it. When we redo this, we have to emphasise to trusts the requirement to recoup money, because that means more money for British people using the service and for other services, but sometimes it falls down the priority list. I am not sure there is a magic bullet. It probably requires drilling lots of people in A&Es up and down the land to focus on whether people should be paying or getting free treatment.

In conclusion, I welcome the Bill. It is a good step forward. It will help to reassure those concerned about what the future will bring, and I look forward to seeing what the Government bring back on Third Reading.

Budget Resolutions

Robert Syms Excerpts

Tuesday 30th October 2018 Commons Chamber

[Kirsty Blackman]

Absolutely. The potential benefits of CCS are unquestionable and, as my hon. Friend says, we need to get ahead of the curve again. We need the UK Government to commit to putting the money in now. That is especially important because their pulling the plug means there is now a lack of trust among the companies that are developing CCS. The UK Government need to make a clear and unequivocal commitment.

On evolving technologies, Scotland is a global leader in tidal, and the UK Government must work with the Scottish Government on the contract for difference process to support the technology journey from development to commercialisation, which is particularly important for tidal.

On solar power, we have been contacted by so many individuals who are concerned about what is happening to export tariffs for homes, small businesses and community energy projects from next April. The tariff is a vital support that encourages people to invest in solar power, and it must continue.

Lastly, in order to reduce climate change and to increase the use of healthier methods of transport, this Budget was an opportunity to reduce VAT on bikes. Just as we would like to see VAT removed from digital books, reducing VAT on bikes would make them cheaper for all and would be a real statement of intent from the Government on reducing climate change.

[Sir Robert Syms (Poole) (Con)]

Is the hon. Lady not aware that reducing VAT is very difficult while we are a member of the European Union, but it is something that we might be able to do after Brexit?

[Kirsty Blackman]

Actually, reducing VAT is quite possible for a member of the EU. Zero rating things is a problem, but reducing VAT is fine.

The Scottish fire and rescue service and Police Scotland are still owed £175 million of VAT. The UK Government have recognised that the system they had in place was unfair, yet they have refused to pay back the £175 million they owe our two vital life-saving industries. It would be incredibly useful if they could see their way to giving us back that £175 million.

On the subject of the UK Government reallocating funds that should rightly have gone to Scotland, the convergence uplift of £160 million should have been paid to Scottish farmers. The Secretary of State for Environment, Food and Rural Affairs has admitted that the money has been spent elsewhere. We need a commitment that this money will come to Scotland in future years, and we need the previous years’ money to come to Scotland now, so that our farmers can have the cash they have been allocated.

I am pleased that the Budget includes measures to ensure that companies pay their fair share of tax in the digital sphere, but the reality is that this is a consultation and the measures are not going to be in place yet. We also do not have a solid idea of what those measures will be. The Scottish National party would therefore like to propose two measures on digital taxation, and we hope that the Government will take them into account. First, we believe that online retailers should be held liable for tax fraud committed by their suppliers. Sometimes when people order a product from a well-known online retailer it is delivered from China with a customs declaration and a stamp that says “gift”. Large online retailers should be held responsible for ensuring that those who use their platform pay the correct customs duties. We also believe that in order to combat tech firms that avoid corporation tax by registering implausibly low UK profits, the Chancellor should levy corporation tax on an assumed UK share of worldwide profits that is equal to their UK share of worldwide revenue. That could be subject to a dispute tribunal process to ensure fairness. The SNP will submit these suggestions in the consultation process, and we hope that they will be considered seriously.

Scotland’s cities have received city deal funding from both the UK and Scottish Governments. That is welcome, but what is not welcome is the fact that the UK Government have contributed far less to those deals than the Scottish Government. In total, the Tories have failed to match more than £350 million of Scottish Government funding for city deals and growth deals in Glasgow, Aberdeen, Inverness, Stirling and Clackmannanshire, Tay Cities and Edinburgh. We believe that they should match our contribution, and we call on the Chancellor to make that commitment, as well as to fulfill the Chief Secretary to the Treasury’s commitment to provide each part of Scotland with a regional deal.

I come to an ask, for the NHS, that would require only a small financial contribution but would have significant positive benefits. The UK Government could have used this Budget to follow Scotland’s lead on PrEP—pre-exposure prophylaxis. In Scotland, PrEP is available on the NHS, but England has been dragging its heels on making it available. The benefits in terms of the reduction in new cases of HIV are unchallengeable, and it is not fair that those in England cannot currently access the drug on the NHS. That change would not cost a huge amount of money, but it would make a massive difference to people’s lives.

If the UK Government are serious about taking their place on the global stage, they need to reform the immigration system. Countries will be looking for a more flexible immigration policy before signing trade deals with us, and we should start by getting rid of the fees that EU citizens will be expected to pay to acquire settled status. The OBR mentions the ageing population at many points throughout the Blue Book. The UK Government must recognise this challenge, and recognise that we need and want people to come to live and work in our communities. Last year’s Red Book said that a reduction in net migration of 20,000 would reduce GDP by about 0.2% by 2022. The Government need to be honest about the benefits of immigration and be clear that it is good for our country. They need to be clear that, with an ageing population, it is incredibly important that we get people to come to work here, particularly in the care sector and in the NHS. We also need a more flexible working visa policy that gives those who are seeking asylum the right to work, as the current system is dehumanising and unsustainable. Lastly, we should scrap the fees paid that families have to pay to get their children citizenship, which are ridiculously high and are yet another tax on families.

On health spending, the UK Government gave commitment after commitment that they would pass the full Barnett consequentials of the increased health spending on to Scotland, but they have chosen not to do so. They have chosen to short-change Scotland by £50 million. This comes on top of the fact that the Scottish Government’s fiscal resource block grant allocation will be almost £2 billion—or 6.9%—lower in real terms than it was in 2010-11. Despite the addition of consequentials and other non-Barnett allocations in 2019-20 that the Chancellor announced, Scotland’s fiscal resource block grant is still lower in real terms than it was in 2010-11 and at the start of the current spending review in 2015-16.

The Chancellor had the chance to make a real difference. He had political choices to make and at almost every turn he chose the wrong path. Is it any wonder that people do not trust the Tories? This Government need to follow the lead of the Scottish Government, who have put dignity and respect at the heart of decision making, rather than punishing those who are not born rich. The reality is that people in Scotland are faced with a choice of two futures: they can choose to continue to have a Westminster Government, who make political choices that disadvantage those who can least afford it; or they can fight for a fairer Scotland, where our Parliament has the powers and the responsibility to make choices on behalf of our citizens—choices that will make our country fairer, not create further inequality.

--- Later in debate ---

[Sir Robert Syms (Poole) (Con)]

I have been in the House long enough to remember lots of Labour Budgets, and I remember the claim that boom and bust had been abolished—only to be followed by the biggest bust that we have had in our history. It must have been a big bust, because only that would have made the Conservative party and the Liberal Democrats work together. We normally fight like ferrets in a sack, but in the context of 2010, a real crisis had to be dealt with.

If we look at what has occurred over the long term, we can see that we have made a great success of it. First, we have reduced the deficit from 10% to about 1%. That is a good thing, because if we borrow lots of money, we pay interest, which means that taxpayers’ money goes to pay bondholders and shareholders, not on the things that people want. I think that a compassionate Government is one who balance the books, because that means they can devote resources to the priorities that people have.

We have managed to do that without crashing the economy. Despite the calls that were often made about the economy going into recession, we have had eight years of a growing economy, which is actually pretty good. On top of that, we have created 3 million jobs. We all know that the best way to deal with poverty, to give people life chances and an opportunity to train, and the best thing for families is employment. If there is a challenge now it is to get wage levels and take-home pay up. When we compare our performance on employment with the EU and most of our neighbours, we can see that we have done a pretty good job. I am pleased there are signs that pay is picking up and that British workers will be paid more.

There is a lot of good to be said about the Budget yesterday. I do not think that Budgets in themselves make much of a difference. What makes a difference is long-term economic success and planning. If we look at Germany and other countries, we can see that they have pretty sane policies year after year—over seven, 10 or 15 years—which grow the economy gradually. Certainly since 2010, we have made pretty good progress, and there is more progress to be made as we exit from the European Union.

I welcome what the Chancellor has done on public spending. We all know that there are pressures with an ageing population and with mental health, and the Government have started to address some of those pressures. They have been able to do so because of careful management of the public finances. I also welcome the additional spending on defence. I am one of those who have always felt we have cut defence too much, perhaps because of the economic crisis. I think that Britain, as a world power and as a member of the United Nations Security Council, does need to spend sufficient resources on defence, so the £2 billion announced in the Budget is to be welcomed.

I think we have made good progress, and all that the Government need to do now is to keep that progress up year on year. We have a decent balance in this Budget because not only have we been able to spend more on public services—with the proviso that we need reform, and the proviso that we need productivity to rise because spending money will not necessarily in itself produce better outcomes—but we have managed to reduce taxation. Since 2010, we have doubled the allowance to £12,500 for those who pay tax, which is pretty good, and it massively increases the incentive for people to get into work. It is no accident that we have record employment, because we have made raising the tax allowances to help people get a job a very critical part of our employment strategy. It is also quite right for the upper rate of tax to go up as well, because that lifts all the tax bands for many middle earners. The fact of the matter is that, as a country, we tax people too much too early, and we need to increase incentives. There has to be a balance between incentives and extra spending, and on this occasion we have got that right.

We have a key task over the next few months in getting a good deal on Brexit. I note that the shadow Chancellor criticised the Government for contemplating leaving without a deal, yet as far as I know the Labour party are going to vote against the deal, so there seems to be a slight double standard.

[John McDonnell]

What deal?

[Sir Robert Syms]

Well, we shall see what comes back in the next few months.

The reality is that the Government have actually managed the economy well, and because of that, despite the level of uncertainty, we are still creating jobs and we are still growing. The interesting point is that, despite the soft patch earlier this year, the third quarter growth figures show that we are now growing more than the EU, so we are starting to pick up again.

I am confident that we have a good team at the Treasury and that they are listening to what colleagues are saying about their constituency concerns. I think we have had a really decent Budget, which has balanced sensible spending with reform and a sensible reduction of taxation. We are also maintaining a sensible management of the economy, certainly in the plans to have a 1% deficit, which is a massive reduction. I hope that we over-perform, and that if we do, we can reduce that further. The reality is that this Government have done well, and the country is doing well. We need not run down the country; the country’s best years are still ahead of us.

End of Life Care

Robert Syms Excerpts

Wednesday 2nd March 2016 Commons Chamber

[Mr Robert Syms (Poole) (Con)]

This is a timely debate. We do not discuss this matter regularly, and I pay tribute to the Health Committee for producing its report. Having looked at the Official Report, I understand that the last debate on the subject took place in 2011. That debate concentrated on Great Yarmouth and Waveney. The subject deserves a lot more discussion because it affects many of our constituents and their families. If things go wrong at the end of life, it can leave the surviving partner and the family with a great sense of guilt. All of us have had people come into our surgeries who cannot get over the way in which a relative has been treated in these circumstances. It is absolutely vital for the wellbeing of the families that the Government get this policy right, so that they can move on and recover from the experience. Over the years, I have observed fantastic fundraisers for hospices in the community, and this is one area where the charity sector comes into its own, with rugby matches, cricket matches and jamborees. These things do get public support but it is sometimes a hard ask to keep raising the sort of money that they do. I therefore welcome the fact that the Government have increased the funding, although I think it is right and proper that they do not overdo it, because sometimes Government money can drive out money raised by the private sector.

[Julian Knight (Solihull) (Con)]

My hon. Friend is making a powerful contribution. Will he reflect on the importance of not only the care of the patient, but the care of the patient’s family at this most difficult time? The new state-of-the-art Marie Curie hospice in Solihull provides not only very good patient care, but a real home from home for relatives and patients at this most acute time.

--- Later in debate ---

[Mr Syms]

My hon. Friend makes a good point. What I have also noticed about the hospice movement is that many people go in for one or two days a week when they start to become ill. That not only makes them familiar with the hospice, but gives respite to the rest of the family, allowing the carer to do all the jobs they would otherwise have done if they were not caring for their relative. It means that they get more used to the environment, so when the final days come things are much easier for the family. Dealing with this situation and how the families feel is important. My hon. Friend the Member for Totnes (Dr Wollaston) mentioned the Liverpool pathway. All of us have constituents who have been worried about how their relatives were being treated at the end of their life, so I am glad that we have decided to phase that pathway out.

My principal point is to pay tribute to the wonderful fundraisers, the wonderful nurses and the charity organisations that do so much in our constituencies to make families feel at ease at this difficult time. I welcome the “Choice” review, which the Government have set up. It has come up with some sensible recommendations and I hope the Government respond to them soon, so that people can spend their final days with dignity, respect and a degree of privacy.

Over the years, I have been impressed by how people deal with the difficulties at the end of life. It is up to us, as politicians, to give people the maximum possible choice, so that they have the maximum possible control over those final few days and can discuss with their family what is going to happen. My hon. Friend made a good point about putting legal provision in place where people have dementia or Alzheimer’s—provision to do with wills and businesses—and all these things are important. Of course most people want to stay at home, and I perfectly understand that, but people often end up in hospital because the ambulance service picks them up in the last few days of their life.

A relatively small number of people die in hospices. As I say, the main benefit of the hospice movement is the day care and outreach it provides to the community, and the reassurance, support and experience it gives to the NHS. The charity sector and this sector are perfect examples of where private and charity bodies can work with the NHS, and may well sometimes be a model for other areas. This is Britain at its best. Tremendous people in all our constituencies are doing terribly well. However, I leave the Minister with the point that we have to respect individuals and families at this difficult time, and if we pick up some of the suggestions of the “Choice” review, we will be taking a real step forward on how people face a challenging occasion.