NHS Dentistry

Baroness Winterton of Doncaster Excerpts

Thursday 20th October 2022 Commons Chamber

[Several hon. Members rose—]

[Madam Deputy Speaker (Dame Rosie Winterton)]

Order. As colleagues will see, there is substantial interest in this debate. I do not want to put on a time limit, but I suggest that contributions are confined to about 10 minutes.

Dental Training College: East Anglia

Baroness Winterton of Doncaster Excerpts

Tuesday 11th October 2022 Commons Chamber

[Jerome Mayhew (Broadland) (Con)]

It would be all too easy to focus any speech on dentistry on a call for the renegotiation of the NHS—[Interruption.]

[Madam Deputy Speaker (Dame Rosie Winterton)]

Order. Could colleagues leave quietly? Otherwise we will not be able to hear what the hon. Gentleman is saying.

[Jerome Mayhew]

As I was saying, it would be all too easy to focus any speech on dentistry on a call for the renegotiation of the NHS dental contract. Every Member of Parliament will know from their postbag the suffering that ordinary people are experiencing every day because they are simply unable to see a dentist.

The pandemic has caused the loss of 40 million dental appointments—more than an entire year’s worth of standard pre-covid treatment—but covid is not the cause of our problems. Ever since Labour imposed its NHS dental contract on the profession back in 2006, trouble has been brewing. Dentists have been voting with their feet, moving in their thousands away from NHS treatment into private work.

That trend has only accelerated through covid. Between the start of the pandemic and May 2022, 3,000 dentists have stopped doing any NHS work. Three quarters of those who are left say that they are likely to reduce their coverage further over the next year, so we simply cannot ignore the problem any longer. The pain and suffering are too great. Labour may have created this bad system, which fails to pay for the cost of complex work, but our job is to fix it, and the sooner the better.

The purpose of this debate, however, is not to moan about the state of NHS dental provision, but to put forward a positive case for solving the long-term problems in Norfolk and the east. Put simply, we have a desperate shortage of dentists of any description. Too few dentists and too few dental technicians—whether NHS or private—are choosing to work in East Anglia.

Nationally, the General Dental Council says that we have more dentists than ever before, with a national average of 43 for every 100,000 of the population, but in Norfolk and Waveney, that figure is just 38. That is the fifth lowest ratio of the 106 clinical commissioning groups around the country. Dental practices are crying out for new staff, but they simply cannot get them.

In the town of Fakenham in my constituency, I lobbied successfully for the NHS to award a brand-new NHS dental contract to increase local NHS provision. That was the Government being prepared to pour new money into increasing NHS provision. However, when that contract was advertised, not a single company bid for the work. There simply was not the staff to supply the need.

That is not just an NHS issue. In the same town, a private dental practice has been advertising for a private dentist for two years, but without success. In the constituency of my hon. Friend the Member for North Norfolk (Duncan Baker), there is a dentist in Sheringham who operates practices both in London and Norfolk. He has not had a newly qualified dentist come to work in his Sheringham practice for 10 years. Job vacancies in London are snapped up, but he simply cannot get them to take the jobs in Norfolk.

Why can we not produce dentists in East Anglia? The answer is that there is nowhere for them to train. If someone who lives in East Anglia wants to become a dentist, the nearest place they can train is Birmingham or London. None of the 10 training facilities around England is in the east of England.

That has to change. We know from our experience with the University of East Anglia that graduates tend to stay and build their lives close to where they have studied. Each year, the UEA does a survey of its graduates to see where they go to accept their first employment. If we look at that survey for doctors coming through the medical school of the University of East Anglia, we see that more than 40% end up taking jobs locally every year. That is great for us in relation to doctors and particularly for the Norfolk and Norwich University Hospital, which is based in Norwich. Unfortunately, however, the same problem is true in dentistry.

Let us look at the number of dentists working near existing dental training schools. As I said, Norfolk has 38 dentists per 100,000 of the population. Devon is a broadly similar county—it is largely rural, with coastal communities and one major conurbation, Plymouth—but there is a big difference: Plymouth has a dental school, which was installed in 2005, and Devon’s ratio of dentists per 100,000 of the population is not 38, but 49.6. If we look at the north-east, where there is a school in Newcastle, we see that its ratio of dentists to the general public is 56 per 100,000 of the population. In Cheshire and Merseyside, there is a school in Liverpool, so the whole area benefits from 58 dentists per 100,000 of the population. We can see from the hard data that people tend to settle down where they have trained.

So if that is the data, surely the solution to East Anglia’s problems is obvious: first, we need to open a dental school in East Anglia. I raised that need directly with the University of East Anglia some months ago and I have been enormously encouraged and impressed by their response, strongly supported by the NNUH, the region’s training hospital. The University of East Anglia has developed an innovative solution to our dental training problems that would minimise cost and get students out into the workplace from the start of their training, helping with capacity in the short term and dealing with the training deficit in the long run.

Ambulance Pressures

Baroness Winterton of Doncaster Excerpts

Monday 18th July 2022 Commons Chamber

[Steve Barclay]

Let me start with the area on which the hon. Lady was correct, which is that I recognise the increased pressure on ambulances and hospitals. That is why we put in place the long-established contingency plans. Since the heatwave in Paris in 2003, it is the case that each year in May, we put in place our heatwave plans. That is what has been activated. Those plans were refreshed as recently as two months ago and sit alongside the work that has been done on urgent and emergency care, including the 10-point action plan that was set out last September.

The hon. Lady is right: the House as a whole will recognise the significant pressure on the system, which is why we are taking the steps from our contingency plans. It is also why we have put in specific funding, such as: the additional £150 million of support targeted at the ambulance service; an additional £50 million for 111 calls to build capacity; and as she said, an additional £30 million for auxiliary ambulances, which is what the Minister of State, my hon. Friend the Member for Lewes (Maria Caulfield), was referring to in the House last week.

The Met Office and the UK Health Security Agency went to level 4 on Friday. As you will know, Madam Deputy Speaker, I updated the House on the first available sitting day after that. The irony will not be lost on the House that this issue is seen as so important that the shadow Secretary of State for Health and Social Care has failed to turn up to this statement in the middle of a heatwave. [Interruption.] Well, he is not here, which speaks for itself.

The hon. Lady also suggested that these challenges, which are being faced across Europe as a whole, were in some way due to the overall investment in the NHS. I remind the House that, to take the resource departmental expenditure limit alone, RDEL in 2010 was just under £99 billion and last year it was £150 billion. That is a good indication of the significant funding. We could also come on to capital investment, not least with the 40 hospitals programme, part of a £22 billion package to 2030, which underscores this Government’s commitment to investing in our NHS—an investment that, most recently, the Labour party voted against when we brought it to the House.

The hon. Lady asks about an apology for operational levels of performance. I do not know whether she is asking for that apology from the Welsh Government or just from the English Government. She may want to clarify that, given the performance of the Welsh ambulance service under the Welsh Government.

On the hon. Lady’s point about auxiliary, the Minister of State, Department for Health and Social Care, my hon. Friend the Member for Lewes, said in her statement that we had seen improvements in May. I referred to that as context, but on auxiliary in particular I can clarify for the House that a contract is being procured for auxiliary ambulance services and is expected to be concluded shortly.

Finally, the hon. Lady asked what meetings I have held over the less than two weeks that I have been in post. I am happy to share with the House that I have been on visits to four different hospitals, in Whipps Cross, Hillingdon, King’s Lynn and Bedford; I have been out on two different ambulance shifts, been to three different ambulance centres, been out to see GPs to look at boosting access to their services and been to look at life sciences. I have been engaging, and that sits alongside, for example, the meeting with chief execs of ambulance trusts on Saturday, Cobra on Saturday and other such meetings that I have had in the course of my duties.

Finally, the hon. Lady asked about the Prime Minister’s engagement. Just as the Chancellor of the Duchy of Lancaster set out that he was engaging with the Prime Minister in his role chairing Cobra as Minister for the Cabinet Office, I am happy to confirm to the House that I also engaged with the Prime Minister over the weekend, updating him on the health plans we have put in place. He has been closely engaged on the contingency we have put in place.

[Madam Deputy Speaker (Dame Rosie Winterton)]

I call the Chair of the Health and Social Care Committee, Jeremy Hunt.

[Jeremy Hunt (South West Surrey) (Con)]

I congratulate my right hon. Friend on taking up his post as Health Secretary. Since no one ever thanks you for doing that job, I thank him for doing this tough job. I am delighted that someone with ministerial experience in the Department of Health, who therefore knows what he is talking about from the outset, is doing the job. I welcome his saying in his statement that the ambulance service is under pressure not just because of the heatwave. Does he agree that one of the main reasons for that pressure is that hospitals find it difficult to discharge patients who are fit to discharge into the social care system, and that it is financial madness to look after someone in a hospital at £300 a day when the social care system can often do it at £50 a day? Will he, in his new role, finish the job and put in place a 10-year plan for the social care system and the funding for local authorities needed to go with it?

Heart and Circulatory Diseases (Covid-19)

Baroness Winterton of Doncaster Excerpts

Thursday 23rd June 2022 Commons Chamber

[Jim Shannon]

The hon. Lady is right. There are some remarkable consultants, and we should be greatly encouraged by that, but I want to highlight some of the shortfalls and look to the Minister and the Government for how we can take that forward. I mentioned a timescale of three, four or five years, but I accept that 10 or 15 years is more realistic.

We greatly underestimate the number of heart failure specialist nurses required to deliver the NHS long-term plan. The recommendations do not consider the full extent of covid-19 backlogs and national recovery targets, meaning the shortages are likely to be even more pronounced now than they would have been before.

More generally, the number of full-time, fully qualified GPs in England decreased by about 6% in the five years between 2016 and 2021. Full-time equivalent district nurses have reduced by 45% between 2010 and 2021. Seven out of 10 practice nurses work less than full time, and around a third are aged over 55.

I accept that the Government have committed to recruitment, but the issue is how the shortfall can be made up. Without a workforce capable of meeting demand, heart patients are at risk across the entire patient pathway, from the moment they dial 999 to when they find themselves in limbo waiting for specialist treatment. The NHS is publishing its long-term workforce plan in the autumn, and that must address shortages at specialty level. We need to know where the gaps in the cardiac workforce are so that we can address them. Perhaps the Minister can give us some idea of where we are in relation to that.

I am also interested, as a Northern Ireland MP who is principally based in this House, in the discussions that take place with the regional Administrations. The shadow Minister from the SNP will speak shortly and I am sure she will give us—as she always does—good information and the evidential base for what is happening in Scotland. I am always keen that all the Administrations come together with their knowledge and information, whether from Scotland, Wales, Northern Ireland or England, so that we can swap ideas on how to do things better. I am keen to hear what is happening in that regard.

We also need to know where the gaps are regionally. While one postcode area may be exceptional, others may not be. While there might be a shortfall in England, we need to know what is happening in Northern Ireland, Scotland and Wales. The number and type of cardiac health workers is not spread evenly across the UK. The greatest number and range of workers is concentrated in large urban areas in England, meaning that many rural areas find themselves at a disadvantage. I hope the Minister can give us some idea of what can be done to improve the situation. The areas with the most workers are not necessarily the areas with the highest rate of cardiovascular diseases, or the poorest outcomes. We need to reappraise how that is done.

The British Heart Foundation is conducting a research project designed to further pinpoint gaps in the cardiac workforce and predict where they may come in future. I wish the BHF all the best as it carries out this vital informative work. That research project might be helpful to the Department; I hope the Minister will be able to tell us what discussions she has had with the BHF on that.

If we address the issue of workforce, we can start addressing waiting lists, primary care and ambulances, and start saving more lives. Let us not forget that the NHS long-term plan identified cardiovascular disease as the single biggest area in which the NHS can save lives over the next decade. We all want to save lives and if there is a way of doing so, the Government need to grasp that. This House and our constituents need to see a clear plan.

So there we have it—I have encapsulated the debate over a bit longer time than I thought I might, but it is an important issue. We need a UK Government strategy specific to cardiovascular disease that addresses the cardiac workforce crisis, the disparity across the United Kingdom and provides sufficient resources for the delivery of cardiac services.

Cardiac care cannot wait, because those suffering from cardiovascular diseases deserve better. In this place, every one of us can be a part of life-changing post-covid changes for the better. I hope that today’s debate is another step in that programme to change things. I look forward to the contributions from other Members. I thank those who have already intervened. I look forward to the responses from the shadow Ministers and especially to that from the Minister.

[Madam Deputy Speaker (Dame Rosie Winterton)]

We come to the SNP spokesperson, Marion Fellows.

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[Madam Deputy Speaker (Dame Rosie Winterton)]

I call the shadow Minister, Andrew Gwynne.

Childhood Cancer Outcomes

Baroness Winterton of Doncaster Excerpts

Tuesday 26th April 2022 Commons Chamber

[Several hon. Members rose—]

[Madam Deputy Speaker (Dame Rosie Winterton)]

Order. I am sure colleagues will understand that, as this is a two-hour debate, I will have to set a time limit. I shall start with a four-minute limit, of which I have advised the first speakers.

Health and Care Bill

Baroness Winterton of Doncaster Excerpts

Consideration of Lords amendments
Monday 25th April 2022 Commons Chamber

Consideration of Lords message

[Madam Deputy Speaker (Dame Rosie Winterton)]

I must draw the House’s attention to the fact that financial privilege is engaged by Lords amendments 80, 80P and 80Q. If they are agreed to, I will cause the customary entry waiving Commons financial privilege to be entered in the Journal.

Clause 35

Report on assessing and meeting workforce needs

[The Minister for Health (Edward Argar)]

I beg to move, That this House disagrees with Lords amendment 29B in lieu.

[Madam Deputy Speaker]

With this it will be convenient to consider the following:

Lords amendments 30B and 108B to words restored to the Bill, Government motion to disagree, and Government amendments (a) to (i) in lieu.

Lords amendment 48B in lieu, Government motion to disagree and Government amendment (a) in lieu.

Government motion to insist on disagreement with Lords amendment 80, insist on Commons amendments 80A to 80N in lieu, and disagree with Lords amendments 80P and 80Q.

[Edward Argar]

The Lords amendments before the House today relate to the NHS workforce, reconfigurations, modern slavery and the adult social care cap. In respect of amendments 30B and 108B on reconfigurations, I am grateful for the constructive debate on these issue across both Houses. This House has twice voted strongly in favour of the ability for the Secretary of State to call in reconfiguration proposals when needed, and it remains a key principle that decisions on how services are delivered should be subject to ministerial oversight. However, my right hon. Friend the Secretary of State and I have listened carefully to the debates throughout the Bill’s passage, and as a result we have proposed a series of amendments to minimise bureaucracy and ensure transparency.

The first set of changes would mean that the NHS had to notify the Secretary of State only about those reconfiguration proposals that were deemed notifiable, which we will define through regulations. We intend to align that definition with the existing duty on NHS commissioners to consult local authorities where there is a substantial development of variation in the health service. We also propose to remove the requirement for commissioners and providers to inform Ministers of

“circumstances that are likely to result in the need for the reconfiguration of NHS services”.

Taken together, these changes will mean that the NHS will need to notify the Secretary of State only about proposals that are substantive and of great importance to people.

Secondly, we will give local authorities, NHS commissioners and anyone else the Secretary of State considers appropriate a right to make representations to the Secretary of State when he has called in a proposal for reconsideration. We expect this to include any relevant provider. The Secretary of State will be required to publish a summary of the representations he receives, and we will set out in statutory guidance further detail on how local bodies, including providers, will be engaged.

Thirdly, transparency is vital to ensure that these powers are always used by Ministers in the clear interest of the people we all serve. We will therefore require the Secretary of State to provide the reasons for his decisions and directions when he makes them. Finally, we have heard throughout these debates that it is vital that decisions are made expeditiously and expediently in order to give certainty to local bodies so that reconfigurations can be made quickly to improve the quality of services received by patients. We are therefore introducing a requirement that, once a reconfiguration proposal has been called in, the Secretary of State must make any decisions within six months. We believe that this set of changes addresses the key concerns raised in this House and the other place, and I commend it to the House.

I turn to Lords amendment 48B, and the Government’s amendment in lieu, on modern slavery. We share the strength of feeling expressed in both Houses on ensuring that the NHS is in no way inadvertently linked with modern slavery and human trafficking through its supply chain. That is why the Government brought forward an amendment in the first round of ping-pong to create a duty on the Secretary of State to undertake a thorough review of NHS supply chains. I am pleased to announce today that we are going further. The Government’s amendment in lieu of Lords amendment 48B will require the Secretary of State to make regulations with a view to eradicating the use by the NHS in England of goods or services tainted by slavery or human trafficking. The regulations can set out steps the NHS should be taking to assess the level of risk associated with individual suppliers, and the basis on which the NHS should exclude them from a tendering process.

I particularly commend my right hon. Friend the Member for Chingford and Woodford Green (Sir Iain Duncan Smith) for his consistent and vocal campaigning on this issue. I am delighted that he has confirmed his support for the amendment in lieu. I look forward to working further with him and his supporters to bring these measures forward.

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[Several hon. Members rose—]

[Madam Deputy Speaker (Dame Rosie Winterton)]

The problem we have is that this debate has to finish at 7.55 pm. This means that, after the shadow Minister has spoken, I will have to impose a time limit to get in a lot of Back Benchers. The time limit will start at four minutes.

I call the shadow Minister, Karin Smyth.

[Karin Smyth (Bristol South) (Lab)]

Thank you, Madam Deputy Speaker. This Bill has been significantly improved. It delivers changes to the 2012 legalisation the NHS called for. Some other issues have been addressed by ministerial assurances and many valuable new clauses have been added. I am pleased that much of what we argued for in the six weeks of the Bill Committee has finally been accepted. On two issues—the Secretary of State’s powers on reconfiguration, and procurement and modern slavery—the Lords have wrestled important concessions that we support. As a former senior NHS manager, I know that reconfiguration is necessary, important and often difficult; it is often wrongly associated purely with cuts and taking something away. We are interested in improving outcomes for people, and that sometimes requires difficult change. For two decades, a comprehensive process has existed, which includes local people, is informed by expert assessments and operates pretty well. Throughout Committee, and during numerous debates, I have heard no sound argument to change it, but the Government seemed hellbent on doing so, and it is only at the eleventh hour that they have finally agreed to some changes.

If I listened to the Minister correctly, he says that now the NHS will have to notify the Secretary of State when there is something notifiable. That is going to be as clear as mud for everybody, isn’t it? We look forward to the regulations. The point is that the Government’s initial plan inhibits improvement. If NHS managers and, in particular, clinical leaders know that the Secretary of State is hovering, they will be less likely to promote changes that may be clinically necessary but politically difficult. It appears now that the Secretary of State finally agrees and does not want this big pile on his desk, and although the amendment is far from perfect, it does enough for now. On the procurement issue, I commend the work of many people from across both these Houses and the excellent case that has been put forward. Labour has been pushing for measures such as these for many months, and I think the intentions of the Government appear to be aligned to a shared view of what is required.

However, there remain two substantial issues, workforce and the care cap, where I hope the Government, even at this late hour, will listen to reason. Many experts have spoken, and many ideas, alternatives and suggestions have been put forward, but we have had very little engagement from the Government. On these two matters, we speak for the stakeholders, experts and Members from all parties, who are united in opposing the Government’s proposals. Workforce planning is a huge issue in its own right, but it is also fundamental and cuts through everything we are talking about on health and social care. Chiefly, the problem is that unless we face up to the scale of the workforce challenge, the Government will not deliver the shorter waiting times that patients need. Until this Government break out of their straitjacket—unless somebody can make the Chancellor see reason—nothing is going to change for all our constituents. The Government should start today—otherwise patients will be left wondering why they are paying more and more in taxes but waiting longer for care.

Time precludes my repeating all the arguments. I could simply repeat what the Chair of the Select Committee said last time or I could offer the wise words of the previous chief executive of the NHS and more—who can add to the variety and strength of the evidence? The logic of this approach escapes me. Every MP knows that our family, friends and constituents are now in a cycle of long waits in pain and discomfort, with worry. All that is asked for in this Lords amendment is a proper report that sets out the system to address the likely staffing requirements—that is so obviously necessary. If this amendment falls, we, as legislators, have failed. If the Secretary of State will not show leadership, NHS England must step up and produce its own requirements and projections. Additionally, the Local Government Association could commission work across the country, in every local authority, on the needs for social care and public health staff. I suggest that every MP asks their own integrated care system and local authority what workforce requirements and projections they have, and how credible these plans are. Unless we do that, how can anyone have confidence in the delivery for the people we are elected to represent?

Finally, we come to the proposed changes to the care cap calculations. Those were snuck in at the last moment and were not subject to any scrutiny in our six weeks in the Bill Committee. They have not been discussed in any detail at all. The proposals are a less generous version of what was in the Care Act 2014 and this is a massive step backwards. Once again, I could read out a ring binder full of analysis and evidence provided by the legion of stakeholders, none of it complimentary. We hear the repeated claim, “This solves the problem of social care. It is fixed.” It simply is not. Let us leave aside the deeply insulting attitude that the care and support of people in need, who could live better more fulfilled lives, is a “problem” to solve; we should be celebrating the fact that people can live better, for many years longer, with multiple conditions, with decent support and care. We all know that to be true.

The proposals the Government have put forward do not deliver any more care; they just change who pays for it. Money will go to those with assets, and the less you have, the more they will take. The proposals will have no real impact for years, but we all know that people need help now. They will not improve the quality of care by anything like what is needed and will not stop those 15-minute visits. The proposals do nothing to assist working-age adults who have a disability. They do not stabilise the collapsing market for care home place provision. They do not shorten any wait for care or reduce any waiting list. They will have no impact on improving access to care for hundreds of thousands of people currently excluded. They do not address the issues around a care workforce with many vacancies and poor terms and conditions. They do nothing to address the catastrophe of the past decade of cuts to local government. This is not a solution to social care. This ill-thought-out idea should not have been pasted into the Bill. Some more informed Conservative Members have also recognised the unfair impact on the poorest, especially those in parts of the north; levelling up this certainly is not.

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In conclusion, my colleagues and I will be supporting the Lords amendments on workforce and the care cap. The time for politics is over; we just need common sense and the will to listen and look objectively at the evidence to find a way forward for the good of everyone.

[Madam Deputy Speaker (Dame Rosie Winterton)]

I call the Chair of the Select Committee, Jeremy Hunt.

[Jeremy Hunt (South West Surrey) (Con)]

Thank you, Madam Deputy Speaker. I rise to speak in support of Lords amendment 29B. Even though I believe the Government will reject it today and this may be the last time this House can debate it, I will try to make my comments with the customary courtesy that the Minister for Health attributed to me just now, with his customary courtesy. He said that this amendment was unnecessary, but I wish to ask the House: what precisely is unnecessary about an amendment that simply requires independent, regular estimates of the numbers of doctors and nurses we should be training? What could drive the Government to want to vote down such a harmless amendment, not once, not twice, but, including today, three times? I will tell the House why the Government are going to vote this amendment down. They will do so because they know that any such independent estimate would conclude that we need to be training more doctors and nurses. Why on earth would we not want to train more doctors and nurses, if we looked objectively at the challenges facing the NHS today? We last debated this on the day the Ockenden report was published in Parliament. That report talked about more than 200 babies’ lives that would probably have been saved with better care. The key recommendation in that report was for 2,000 more midwives and 500 more obstetricians, and that would not have been necessary had this amendment been in place. We can put this right.

I immensely respect the work done by the Minister for Health and the Secretary of State, and I am grateful for their engagement, but I say to them, from the bottom of my heart, that not training enough doctors and nurses is a false economy. It costs patients’ lives, it costs taxpayers’ money, it demoralises the workforce and it lets down the people who are waiting for their NHS operation. The Health Minister’s argument is that we will have 50,000 more nurses by the end of this Parliament and we are training more doctors than ever, but today’s report by the King’s Fund shows that that is a hollow claim, because even though we are on track for our 50,000 nurses, the number of vacancies is still not going down. In other words, more nurses does not mean enough nurses, and we can never know what enough is unless we are honest enough to ask ourselves the hard questions.

The lesson of Mid Staffs, Morecambe Bay, Southern Health and Telford is that the first step in dealing with poor care is to be honest about the issue. We now have in the NHS a workforce issue of enormous proportions, which is why Lords amendment 29 is supported by every NHS leader, every royal college, every health think-tank, every union and more than 100 NHS organisations in total. I am afraid that, by voting down a simple request for independent estimates of the number of doctors and nurses we should be training, the Government are actively choosing to sweep the problem under the carpet. I say to Ministers, who have listened to my arguments genuinely and in good faith, that NHS and care staff deserve better after two years of the pandemic, and the people waiting for their NHS operations deserve better, too.

[Madam Deputy Speaker (Dame Rosie Winterton)]

I call the SNP spokesperson.

[Martyn Day (Linlithgow and East Falkirk) (SNP)]

I will be brief, Madam Deputy Speaker.

Operational procurement is a devolved matter but, given our interest in trade policies, we welcome the progress on procurement to ensure that healthcare supply chains are not linked to modern slavery and human trafficking. We support UK Government amendment 48A in lieu of Lords amendment 48, and we also support Lords amendment 48B in lieu. It is perhaps worth reflecting on the fact that in Scotland half of all PPE is now produced locally and that the overall costs of pandemic procurement were a third less than those of the UK. Such measures can, then, be cost-effective and help to safeguard against global supply chain issues.

NHS Capital Spend and Health Inequalities

Baroness Winterton of Doncaster Excerpts

Tuesday 22nd March 2022 Commons Chamber

[Lucy Allan (Telford) (Con)]

It is a great privilege to secure this debate and to have the excellent Minister responsible for hospitals, my hon. Friend the Member for Charnwood (Edward Argar), on the Front Bench for it. I wish to speak about an issue that has been uppermost in the minds of my constituents for the past nine years, causing much anxiety and uncertainty. All MPs want better health for their constituents and better access to healthcare. That is all the more true for MPs who represent communities that experience the highest levels of deprivation.

As the Secretary of State for Health and Social Care set out earlier this month in an important speech at the Royal College of Physicians, the poorer a person is, the greater the proportion of their life spent in poor health will be. He referred to the 20-year difference in healthy life expectancy between the richest and poorest communities. If someone lives in an area in the bottom decile for deprivation, they can expect to have 20 fewer years of healthy life than someone who lives in an area in the most affluent decile. If someone is poor, not only is their life expectancy lower, but more of their life is spent in ill health.

Telford has some of the poorest communities in England. In our area, 30,000 people live in the bottom decile for deprivation, and the impact is seen in health outcomes across every measure. The Secretary of State was therefore right to say that

“poor health is economically destructive and socially unjust.”

I applaud him for focusing attention on this issue.

If Members look at a map of areas of deprivation in the whole of Shropshire, they will see in Telford, splashed in red, a cluster of 18 lower super output areas in the bottom decile for deprivation. That compares with only two such areas in the whole of the rest of the county. On every health measure, people in Telford have worse outcomes than people in Shropshire. For example, cancer incidence, cancer mortality and later-stage diagnosis are all much higher in Telford than they are in Shropshire. In Shropshire, the mortality rate is 8% below the national average, whereas in Telford it is 15% above the national average.

The problem in Telford is getting worse, not better. This is what we should be talking about in Telford, but we do not. Instead, for the last nine years, the health bodies in Shropshire—the clinical commissioning group, the hospital trust, the sustainability and transformation plan, the integrated care system—have all being talking about a capital spending plan that was once called “Future Fit” but is now referred to as a hospital transformation plan. This plan is expensive and controversial.

The Government made £312 million available to Shropshire health bodies to improve Shropshire’s healthcare, which was great news. The local health bodies set about coming up with a plan. The plan they devised involved a brand-new, state-of-the-art, cutting-edge critical care centre, which was to be built in the west of the county, in Shrewsbury. The plan was controversial because it proposed that Telford’s A&E, in the poorer, urban east of the county, become an urgent care centre, and that Telford’s women’s and children’s specialist centre relocate to Shrewsbury. In effect, the greater part of this significant sum of taxpayers’ money would be invested in Shrewsbury, and specialist services would be removed from Telford, a rapidly growing new town to which people come in their thousands every year to build a better life.

Among the reasons given for choosing Shrewsbury as the location for this new specialist centre was that the consultants and management would rather live and work there than in Telford, and that it would make recruitment easier. Perhaps the initial decision makers, who are long gone, thought they could ride out the criticism. They talked of twisting the arm of local clinicians, but they overlooked something fundamental. Telford has a unique identity and demographic. It is a rapidly growing new town in an area that has historically been perceived as the poor relation to the affluent shires. Telford is made to feel like a town of incomers, surrounded by a rural hinterland to which it does not belong.

Given Telford’s history, identity, and demographics, concerns should have sounded loud and clear about the plan, under which an area with significant deprivation lost out in NHS healthcare investment to its more affluent neighbour. But nobody wanted to listen. No one wanted to hear. My greatest frustration as Telford’s MP was that I could not get the voice of the communities that I represent—the communities with the fewest years of healthy life—heard. I was talked at, talked over, dismissed and disregarded. The plan was going ahead, and that was that.

I know that all politicians will want shiny new hospitals in their constituency, and that this desire may trump proper concern for improving the health of disadvantaged communities in neighbouring constituencies. I also know that the Labour leader of Telford and Wrekin Council, Councillor Shaun Davies, exploited the situation politically and deliberately misled local people by claiming that all A&E services would be closed in Telford thanks to a Tory Government. I therefore understand health bodies’ scepticism when politicians try to make a case. However, the partisan behaviour of some local politicians does not mean that all reasonable objections to the plan should be ignored; but that is what happened here. Nobody would listen to a contrary view.

The data is clear. If local decision makers had been driven by considerations of healthcare need and health inequality, as they should be, the plan would not have been formulated or proposed in the way that it was. What followed was predictable: there were protests, petitions, angry public meetings, endless futile private meetings and marches. There was legal action, and there were pages of newsprint at every election and by-election—at parish council elections, borough council elections, and three general elections. On every leaflet that came through every door, anger and rage was whipped up against the Government by those who sought to profit electorally, as year after year, ordinary people were told that they would lose all their A&E services to their better-off neighbours.

The decision makers could not, or would not, distinguish between confected political outrage and genuine concerns about their plan. They ploughed on regardless, but they did not get far. Nine years on, nothing has been built, and costs have spiralled. As of July 2020, the plan was £221 million over budget—and that was when inflation was below 1%; no one knows what the price tag would be today.

Last month, local health bodies were still talking about how they were

“continuing to work closely and collaboratively with NHSE and our local health system partners…continuing to explore the outputs of the public consultation”—

which had been held four years ago, back in 2018—

“continuing to develop more detailed plans and continuing to develop business cases.”

Nine years on, this is where we are: continuing on the same path, immune to changing circumstances and continuing to ignore the underlying health inequality across our area. So much management time, so many consultants, so many accountants, and so many highly paid staff tied up year after year, involved in a massive distraction project. They were not able to articulate how my constituents would benefit or to focus on what really matters—patient care, patient safety, and improving the health of people in the poorest areas.

I am very grateful to the former Secretary of State who, in 2019, made it clear that Telford would have a local A&E 24/7 with same-day emergency care. I am grateful, too, to the current Secretary of State for his help in getting confirmation of that position earlier in the year. This is a significant win and I am grateful for it. Ministers have always been willing to listen, including my hon. Friend the Minister for Health, who is on the Front Bench tonight.

It is now clear that the project cannot happen anywhere close to budget, and given all the other significant challenges that we face in delivering healthcare in Shropshire, this costly plan from a different era has run out of road. My plea to NHS England now is to call time. After nine years, all organisations are doing things differently. The NHS is doing things differently; it has evolved and moved on. It is no longer about increasing hospital capacity, but about tackling the causes of poor health.

This plan does not address increasing demand for healthcare. It does not address improving access to healthcare for those who need it. The plan is treating the symptoms, not the causes. It is time to tackle the causes of poor health. The NHS recognises this and the Health Secretary is prioritising this, so local health bodies in Shropshire cannot go on ignoring this.

The NHS website says it very clearly. It says that health inequalities are

“the preventable, unfair and unjust differences in health…that arise from the unequal distribution of social…and economic conditions…which determine the risk of people getting ill…and impact on their ability to prevent illness and their ability to access treatment when ill.”

The NHS today cares about prevention. It cares about keeping people out of hospital and delivering more care and more services close to those with the greatest need. It is not about pumping more and more money into shiny new buildings in areas miles away from the county’s most deprived communities.

The overall health ecosystem in Shropshire faces many challenges. Plans for its future need to be considered in that context. The hospital trust has been in special measures since 2018. Senior management have come and gone at record rates. Repeated critical incidents are declared—three in the past months—because A&E is overwhelmed.

This is the same trust that, in one day last week, had waiting times to unload ambulances that added up to the equivalent of 25 ambulances and paramedic teams being off the road for a day. This is the same trust that has the Ockenden maternity review, reporting next week, into poor and negligent care resulting in death, injury and trauma to women and their children, and it is the same trust that did not listen to them.

In spite of these challenges, our health leaders devoted their time to the unaffordable business cases and strategic outline plans for this undeliverable project. I do not blame the current postholders, who are trying their best, but there is someone, somewhere in NHS England who needs to take stock. This is an Alice in Wonderland plan—more and more money being funnelled into a capital project that does not solve the healthcare challenges and does not deliver on NHS objectives.

I take this opportunity to ask NHS England to think again; maybe the Minister can kindly help to get that message through. I understand that sunk costs and time will be written off, but this plan is at least £221 million over budget and does not address the health needs of those whose health is poorest. It must be time to focus on patient care, patient safety, prevention, diagnostics, access to primary care and tackling preventable conditions early so that people can live more healthily for longer.

As an MP, how am I to ask my constituents to pay more for the NHS, if all they see is more and more of their cash being shovelled into a state-of-the-art building the other side of the county? It is those same constituents who experience the worst health outcomes, the lowest life expectancy and the most years in poor health, not just in Shropshire, but nationally. How can we plan to spend more than a billion pounds and make no mention of how we are improving their health and their access to healthcare?

I have two asks of the Minister. First, I ask him to stand firm on the agreed £312 million budget for this transformation plan and, if there is an extra £221 million down the back of the sofa—I am assured by Treasury that there is not—to use the additional capital spend, if available to Shropshire, to improve health and access to healthcare where it is needed most, on local diagnostics, screening and prevention services, so that we can narrow the gap of healthy life expectancy. Secondly, I ask him to confirm for the record that, whatever the outcome of this nine-year saga, Telford, with its cluster of 18 areas in the bottom decile for deprivation, will have a local, 24/7 A&E, capable of same-day emergency care.

This Government are rightly committed to prevention and tackling health inequalities, and I welcome that. Local health bodies should focus on that too, particularly when embarking on significant capital spend projects. They must be able to say how the poorest communities with the poorest health will benefit before just expecting more and more of taxpayers’ cash.

[Madam Deputy Speaker (Dame Rosie Winterton)]

I call the Minister, Edward Argar.

Irish Diaspora in Britain

Baroness Winterton of Doncaster Excerpts

Thursday 17th March 2022 Commons Chamber

[Andy Slaughter (Hammersmith) (Lab)]

I thank my hon. Friend the Member for Rochdale (Tony Lloyd) for initiating the debate and I look forward to the closing speech from my hon. Friend the Member for St Helens North (Conor McGinn), who has so often represented the diaspora in this country and done so very well indeed. I am proud to represent one of the largest and longest-settled Irish communities in Britain. The Irish presence in Shepherds Bush, Hammersmith and Fulham goes back many years before the 60 years that I have lived there, so it is not only first and second generation, but third and fourth generation Irish people who continue to make their home in that part of west London.

It goes without saying that despite the difficult times rightly mentioned by the hon. Member for Rutherglen and Hamilton West (Margaret Ferrier) and my hon. Friend the Member for Bristol South (Karin Smyth), this has overall been an enriching and successful coming together of the British and Irish communities, and not just those communities but many other migrant communities. I often feel that the Irish presence in Britain was a pioneer and acted as somewhat of a glue and an enabler of integration across many different cultures. That is certainly true where I am.

I want briefly to highlight two organisations that have not featured much in the debate so far, but they are key to the success of the diaspora. One is the network of community, cultural and social centres across the country and the other is the Government of Ireland and the embassy here. In Hammersmith Broadway, I have the Irish Cultural Centre, which is

“the premier centre in the UK dedicated to the promotion and welfare of Irish art and culture abroad”

and

“the home of its best cultural events and Irish performances, films, music and theatre”,

and I know that is true because I read it on the front of its website only a few moments ago—those are the centre’s words, before Members start intervening on me.

Getting a building as prestigious and beautiful as that was a long struggle for the Irish community and their supporters. It goes back to the mid-1990s—we celebrated the 25th anniversary recently—and the foresight of my predecessor as MP and leader of the council, Iain Coleman, and Councillor Sean Reddin, who put together the funding. They built it, we enjoyed it for 10 years and then we did it all over again because a different council wanted to knock it down and sell off the land for profit. It was only through the intervention of the Shepherds Bush Housing Association, which put up the money for a housing development, that the centre was rebuilt bigger and better than it was before. It has been a huge success as a result of an alliance between the wider community, the council, others and the embassy, with the Government of Ireland putting in money at a time when money was extremely short during the financial crisis.

Above all, it has all been about the local Irish community. I am tempting fate by naming individuals, as inevitably one forgets someone, but there have been many heroes in establishing and keeping that centre and bringing it to life. I must mention Jim O’Hara, who chaired the trustees through many difficult years, and his successor, Peter Power-Hynes, the vice-chair Michael Kingston, Seamus McGarry, Ivan Gibbons and the wonderful centre managers we have had, the cultural director Ros Scanlon, and David O’Keefe who sadly died too young and was replaced by William Foote, who stepped into the breach as the manager. I should also mention—I am namedropping in a big way—that among the patrons of the Irish Cultural Centre are Adrian Dunbar, Fergal Keane, Edna O’Brien, Dara Ó Briain, the noble Lord Dubs and the former President of Ireland, Mary McAleese. That is not a bad list for a local centre, but indeed it is not just a local centre.

Of course, built on the beauty and success of the centre and what it has to offer, we have had a whole procession of Taoisigh and Tánaistí and Government Ministers from both sides as visitors over the years, but something a bit special happened this week when His Royal Highness Prince Charles and the Duchess of Cornwall came to visit. I do not often recommend the Daily Mail website, but if Members go to the website they will see the heir to the throne trying out his hand at Irish dancing, drum playing and drinking a pint of Guinness. That is well worth going to see.

The centre is a great success, but let us pay tribute to all those who have made it a success over many years. I have mentioned the Irish Government, and of course one of the visitors we had for Their Royal Highnesses was Adrian O’Neill, the current ambassador, who is sadly ending his five-year posting quite soon. He and his predecessors, Daniel Mulhall and Bobby McDonagh, have been huge supporters, not just in their presence—Irish diplomats are in a different league, which is one reason why Ireland punches so much above its weight; it has the most brilliant representatives abroad who really engage in that way—but in practical and financial support and encouragement, which has been fantastic over that time.

The hon. Member for West Dunbartonshire (Martin Docherty-Hughes) quite rightly mentioned the Irish Traveller community, and he does a very good job chairing the all-party parliamentary group for Gypsies, Travellers and Roma. Unfortunately, we have seen in recent legislation, such as the Police, Crime, Sentencing and Courts Bill, that the Government wish to make things more difficult for Gypsies and Travellers in this country, which is shameful.

By contrast, the Irish embassy supports the Traveller community, by inviting them to the embassy and visiting them around the country. Some years ago, I went on a visit to the Dale Farm site with a secretary from the Irish embassy. I cannot imagine many other countries doing that and extending their hand in that way. The Irish embassy is making sure that the entire Irish population in this country, whatever its roots, is dealt with in that way.

I thank everybody who has come together to make the Irish community in Hammersmith such a success, most of all the community members themselves. Let us not forget those who have enabled and supported them in doing so, including people outside the community, the Irish Government and the Irish embassy. We are grateful for all that they continue to do.

[Madam Deputy Speaker (Dame Rosie Winterton)]

I call SNP spokesperson, Patricia Gibson.

[Patricia Gibson (North Ayrshire and Arran) (SNP)]

I begin by thanking and congratulating the hon. Member for Rochdale (Tony Lloyd) on bringing this debate forward, about which we had an interesting chat in the Tea Room. I am delighted to lead for the Scottish National Party on this debate on the Irish in Britain. I lead as a person born in Scotland of two Irish parents, although both now sadly deceased. I am proud of my Irish heritage and of the fact that I am first-generation Scottish.

Like others who have spoken in this debate, I was reflecting beforehand on the huge and often overlooked influence of the good people of Ireland on the UK. As Irish immigration echoes through the generations, there are a huge number of distinguished people who have Irish ancestry. It is really quite impressive when we think of people such as Daniel Day Lewis, A J Cronin, Matt Busby, Lorraine Kelly and Jim Kerr from the band Simple Minds. There are also people such as the late Sean Connery, Gerard Butler, Tom Conti, Susan Boyle and even Billy Connolly.

There is an impressive list of those who have found success in their respective fields in the UK who, like me, have two Irish parents, such as the singer Morrissey and the late Caroline Aherne, or those who have one Irish parent, such as Steve Coogan, Paul Merton, Julie Walters and Boy George. The list could go on and on. The UK would be a very different place without the contribution of so much Irish influence in a range of important fields. The depth and range of that talent is truly remarkable.

Irish emigration, especially to the UK, has been a feature of Ireland’s society for hundreds of years, so it is no surprise that the influence of the Irish diaspora is woven into the very fabric of life in every part of the UK, as well as further afield. We can see that influence has been hugely positive because of the lists of names that I and others have read out today. We can see it in the fields of singing and song writing, literature, cinema and even, dare I say it, politics.

Many Members of the House have spoken of their pride in their Irish roots. Ireland has suffered the loss of some of its brightest and best to emigration, a sad feature of Scottish society as well. However, emigration from Ireland has reduced. Increasingly we see Ireland becoming an attractive place for immigrants and its population has been growing for some years, albeit slowly.

My own parents came over from Malin Head in Donegal, which is the most northerly part of Ireland yet still in the south of the country, in the 1950s, like so many others in search of work and a better life in Glasgow. They settled in Govan, where I grew up. My father worked as a labourer while my mother devoted her life to raising her eight children, of whom I am the youngest. Sadly, in the 1950s the atmosphere and attitude the Irish encountered was not always as welcoming as it could have been, as the hon. Member for Bury North (James Daly) and others have pointed out. Thankfully, things have improved. But my mother applied for a council house in 1954, and it was not until 1982 that her patience was finally rewarded.

The poverty in which my parents lived and raised their family was scarring, as poverty so often is. Ultimately, it destroyed their health and led to their premature deaths. My father died when I was 15 months old and my mother died at the age of 54, 32 years ago. My parents could never have imagined that their daughter—the youngest of their eight children—would grow up to have the enormous privilege of securing a university education. They could never have envisaged that I would become an English teacher for 23 years and they could absolutely never have believed that I would be elected to serve the good people of North Ayrshire and Arran—in this, or indeed any other Parliament.

Like the hon. Member for Bristol South (Karin Smyth), I recall going to school with a St Patrick’s day medal and shamrock pinned to my school uniform—a ritual faithfully observed every year. But my story, like those of so many others in this House, is not unusual. Across much of the UK, those with Irish roots have sought to contribute and make their mark on the nations in which their parents, grandparents and great-grandparents settled—whether Scotland, England or anywhere else in the world. As my hon. Friend the Member for Angus (Dave Doogan) said, the strong bonds between Scotland and Ireland are well known. Scotland can look to Ireland—a small, independent country—for both example and inspiration.

This year, 2022, is significant for Ireland as it marks 100 years of an independent, self-governing free state of Ireland. There is no doubt that the first steps of Ireland as an independent nation brought their own challenges, but surely no one can doubt that the journey, despite its challenges, has been worth it. The value of the destination has undoubtedly made the challenges of that journey worth bearing. I say that because, since her independence, Ireland has grown into a confident, prosperous country—one of the richest in Europe. Independent of the UK, it has prospered. It has a real sense of national pride and has found its place on the world stage as a confident, outward-looking, liberal, democratic, modern, prosperous and internationally respected independent nation of a similar size to Scotland. I very much echo the sentiments of the right hon. Member for Hackney North and Stoke Newington (Ms Abbott): prosperity and freedom are indeed linked. I look forward to her extending that sentiment to Scotland as well.

Those of us in Scotland who believe that Scotland, too, should become an independent nation see this modern island as a beacon—an example of the possibilities and potential that await Scotland when we take our future in our own hands. When Scotland does so, as I sincerely believe it will, we will, like Ireland, cultivate good relations with England, our near neighbour. We will cultivate that relationship as friends, allies and trading partners, I am sure.

Just as my Irish parents could never have imagined that their eighth child would go to university, become an English teacher and be elected to serve in Parliament, so too many would never have envisioned how far an independent Ireland has come in 100 years—how it has grown, prospered and earned the respect of its neighbours in the European Union and the wider international family of nations. Scotland can indeed learn much from Ireland’s economic and social journey to the nation that it has become.

I thank the hon. Member for Rochdale for securing the debate and I wish everyone in Ireland, all those with Irish parentage in this House and beyond, and all those with Irish roots a happy St Patrick’s day.

[Madam Deputy Speaker (Dame Rosie Winterton)]

I call the shadow Minister without Portfolio, Conor McGinn.

--- Later in debate ---

[Tony Lloyd]

This has been a great debate. It has been a celebration—not simply of people who are very proud of their own claim to part of Ireland but, much more than that, of the role that the Irish have played. As the hon. Member for North Ayrshire and Arran (Patricia Gibson), who spoke on behalf of the SNP, rightly said: what would we be had the Irish not been here? Ours would have been a very different country.

People have rightly touched on the difficult times—the “No Irish, no blacks, no dogs” signs that were part of my city and my upbringing. Fortunately, we are now a long way from that. I say to my right hon. Friend the Member for Hackney North and Stoke Newington (Ms Abbott) that I have a friend, whose father was Jamaican and mother was Irish, who once said to me, “You know, the Jamaicans and the Irish are very similar—it’s just that on the Jamaican side of me I’ve got sunshine.” The rain in Ireland keeps it green, as it keeps large parts of Britain green.

This is a day of celebration, as St Patrick’s day always is. I will not speak for too much longer, as I do not want to keep my hon. Friend the Member for St Helens North (Conor McGinn) away from either the Guinness or the races.

I join the appeal of the hon. Member for West Dunbartonshire (Martin Docherty-Hughes) in respect of the specific problems faced by Irish Travellers. It is an important issue that we should recognise on this day of celebration.

I say to my hon. Friend the Member for Liverpool, Riverside (Kim Johnson) that it was of course the Irish who built the Manchester ship canal, which enabled the Guinness boat to travel up from Dublin. That made sure that for a long time we had Dublin Guinness in Manchester, not simply that from London.

My final point is simply this. My hon. Friend the Member for Hammersmith (Andy Slaughter) made an important point about the role of the Irish embassy, as did my hon. Friend the Member for St Helens North. I pay tribute to the current ambassador, Adrian O’Neill. He has had a difficult time with covid and, without getting into the issues of Brexit, it has been a rocky few years since the referendum. It is in all our interests to make sure that we re-establish that good relationship. It is good for the Irish in Ireland, good for the British in Britain and good for the Irish in Britain. On this day of celebration, let us look forward to better times for all.

[Madam Deputy Speaker (Dame Rosie Winterton)]

It has been a real pleasure to be in the Chair for this debate and to hear so many good friends spoken of in such warm terms—especially Sir Patrick Duffy who, as the shadow Cabinet member and hon. Member for St Helens North (Conor McGinn) said, is the oldest living former MP. He is my constituent and a very dear friend. I spoke to him this morning and he was in fine form. He received a lovely letter from Mr Speaker on his 101st birthday last year. I wish him and everyone else a very happy St Patrick’s day. I also wish Sir Patrick a very happy birthday for his forthcoming 102nd birthday.

That was probably a complete abuse of my position, but nevertheless I wanted to do it.

Question put and agreed to.

Resolved,

That this House has considered the Irish diaspora in Britain.

[Madam Deputy Speaker]

Before we come to the next Backbench Business debate, I reiterate that the statement from the Transport Minister will come immediately after that debate. If the debate finishes before 5 o’clock, the statement will be not at 5 o’clock but immediately after the debate.

Integration White Paper

Baroness Winterton of Doncaster Excerpts

Wednesday 9th February 2022 Commons Chamber

[Edward Argar]

As I mentioned in my earlier answers, this White Paper needs to be taken in conjunction with what we announced yesterday in respect of waiting list recovery, the September social care White Paper and, more broadly, our approach to growing our nursing profession, through increasing the skills and numbers in that profession. We are already well on target for 50,000 more nurses in the profession.

This White Paper looks at the specific aspect of the integration of social care and health and permissive ways for local areas to come up with their most effective place-based arrangements, many of which are already in development. It is, quite rightly, not specific about any individual profession, nor do we believe it should be, because it is for local places to develop their own local plans to reflect their local needs.

[Madam Deputy Speaker]

I thank the Minister for his statement.

Children’s Mental Health

Baroness Winterton of Doncaster Excerpts

Tuesday 8th February 2022 Commons Chamber

[Several hon. Members rose—]

[Madam Deputy Speaker (Dame Rosie Winterton)]

Order. If I am going to manage to get everybody in, I will have to take the time limit down to three minutes after the next speaker.

--- Later in debate ---

[Several hon. Members rose—]

[Madam Deputy Speaker (Dame Rosie Winterton)]

Order. We will try to get everyone in.