Vaccination: Condition of Deployment

Baroness Winterton of Doncaster Excerpts

Monday 31st January 2022 Commons Chamber

[Sajid Javid]

I am pleased that my hon. Friend and I agree on what has been set out today, but he is right to raise what he has said in the way that he has. Language is vitally important, especially on issues of this great significance, when we are asking people to be injected with something, to put a needle to themselves and to get vaccinated, for all the right reasons. Of course some people will be more resistant than others to doing that, for whatever reason, and will have some kind of hesitancy. It is our duty to work with them. I am sure my hon. Friend will agree that when we reach for a statute in relation to vaccination, there needs to be a very, very high bar. He has heard me say at this Dispatch Box more than once that I would never support universal vaccination or any kind of statute. This policy I have talked about today required a very high bar to be reached. At the time we introduced the policy, I believed that the bar was reached, for the reasons I have set out about protecting vulnerable people. Now I believe it would be disproportionate, and that is why I have set this change out today. What has not changed is the importance of vaccination, and for those people who can get vaccinated and who are not medically exempt from it for some reason, we should continue to work together across this House to encourage them to do so and work with them in the most positive way possible, because they would be better off and we would all be better off.

[Madam Deputy Speaker (Dame Rosie Winterton)]

I thank the Secretary of State for his statement.

Public Health

Baroness Winterton of Doncaster Excerpts

Tuesday 14th December 2021 Commons Chamber

[Andrew Bridgen]

rose—

[Madam Deputy Speaker (Dame Rosie Winterton)]

Order. Just before the Secretary of State makes further progress, it is absolutely right that he should be taking a lot of interventions—there are a lot of questions to be asked—but people who have already made one intervention should not be making a second or a third intervention and certainly not if they also wish to be called to speak later in the day. I have too many people who wish to speak and there is not going to be enough time for everybody. Be sure—if you keep intervening, you do not get to speak. Let us have a little consideration for others.

[Sajid Javid]

I shall indulge my hon. Friend the Member for North West Leicestershire (Andrew Bridgen) because he is going to be really short.

--- Later in debate ---

[Several hon. Members rose—]

[Madam Deputy Speaker (Dame Rosie Winterton)]

Order. To accommodate everybody, I am reducing the time limit to three minutes. I was able to warn the next speaker of that change.

--- Later in debate ---

[Several hon. Members rose—]

[Madam Deputy Speaker (Dame Rosie Winterton)]

Order. We will get everybody in as long as Members do not take interventions—or if they do, they still stick to three minutes.

--- Later in debate ---

[Anthony Mangnall (Totnes) (Con)]

It is a pleasure to follow my hon. Friend the Member for Don Valley (Nick Fletcher) and I thank him for his reassurance that the Whips have not pushed him in that direction.

The Government have done an extraordinary job over the last two years. Rolling out the vaccine so quickly has been an extraordinary achievement as is producing a booster programme in the way we have. There is a remarkable book by Adam Grant called “Think Again”—the title is perhaps apposite for the Government right now—which talks about how we persuade people to take vaccinations and it gives the two case studies of Canada and Germany, where people are not mandatorily required to get vaccinated or pushed in that direction but ways are found to persuade them. We would do well to follow the guidance to be found in that book.

I will vote against the masks measure in SI No. 1400 and support the self-isolation measure in SI No. 1415. In relation to the masks, the legislation is shoddy; it seems ill thought through if, as I said the other day, we can sing, eat or drink with a colleague but not have to go to work with them, and yet masks are introduced in the certain settings. A Government and their legislation have a responsibility to be good and comprehensive; that is not what this is doing.

When it comes to vaccine passports, I will not support them. As countless colleagues have said, there is little evidence to show that they work. I am sorry that no SNP Members are here, because the 70-page report produced by Nicola Sturgeon adds to that point. A very important point was made earlier about the lack of enforceability now that we have the lateral flow tests, because of this slightly dodgy deal that has been done with the Opposition to get their support. The scope for abuse and obfuscation on that is far too great.

When it comes to mandatory vaccinations, I cannot and will not support them. The problem I have with this is that the Government have yet to release the data on how many people have left care homes since we introduced that policy. We need to have the data to be able to review that, because if 60,000, 20,000 or 30,000 people in the NHS decide to walk out, how on earth will we have the capacity to support those who get infected? We need more information before we make those decisions.

Over the last two weeks, the ghost of Christmas past has appeared, and he brings with him fear and uncertainty. We cannot continue to flip-flop and change tack, nor should we be cherry-picking information from South Africa to support the Government’s agenda. I appreciate that the evidence coming out this morning shows that two Pfizer vaccinations do well and that the virus is milder, but we cannot continue to terrify people. I am staggered by the Government’s approach over the last two weeks, during which we have used fear to persuade people. I believe that no Government should ever use fear as a tool to try to persuade their citizens, and that it is what has happened. We must build up our resilience and reduce our restrictions.

[Madam Deputy Speaker (Dame Rosie Winterton)]

Order. We must move quickly on.

--- Later in debate ---

[Miriam Cates (Penistone and Stocksbridge) (Con)]

I think most people understood that vaccination was the route back to normality. Despite the fact that 95% of adults in the UK now have antibodies—I accept that there may be some reduction in the protection from antibodies, but there is certainly no evidence for any reduction in T-cell protection—we are being asked to impose more restrictions on lives and livelihoods.

I have looked in detail at the modelling done by the London School of Hygiene and Tropical Medicine. We need to be clear that they are models, as my hon. Friend the Member for East Worthing and Shoreham (Tim Loughton) said, not forecasts or predictions. They are based on some pretty major assumptions, such as that omicron causes the same severity of disease as delta and that the length of hospital stay is the same. Those assumptions are becoming more out of date by the day. There is no known benefit to the measures that we are trying to implement, but there will be inevitable harms.

On working from home, we saw research last week that suggests that those working from home are 11 times more likely to experience domestic abuse. Masks sound innocuous in their own right, but they send a signal across society, including in schools, that people should panic and fear. We have already seen schools close today and say that they may not return in the new year. That 100,000 ghost children have not returned to schools since lockdown should be a warning to us of the unintended consequences of potentially small measures.

I cannot support vaccine passports. As my hon. Friend the Member for Runnymede and Weybridge (Dr Spencer) said, they are discriminatory and segregate people. We have a proud tradition in this country of standing up for minority views, even when we do not agree with them. In the rush to get jabs in arms, we should not throw that tolerance and respect to the wind.

I completely agree with my hon. Friend the Member for East Worthing and Shoreham about the mandatory vaccination of NHS staff. It is about not the ideology of whether people should be vaccinated but the pragmatic reality that we will lose tens of thousands of staff at a time when we can least afford it.

This is no longer really a debate about whether masks work or who should have a vaccine. It is about who we are and what kind of society we are creating for our children. Do we really care about the freedoms that we all took for granted before 2020? People roll their eyes when Conservatives and libertarians start talking about civil liberties and freedoms, but freedom is not an abstract ideology.

Freedom is what enables my constituents to see their family, comfort the dying, go to school and go to work. That is what freedom looks like. After 20 months in and out of restrictions, we have to accept that there has been a permanent change in the understanding of what liberty is in this country, which is why I cannot support these measures. I urge the Government to return to a society of freedom and responsibility. Our constituents deserve that and they will rise to the challenge.

[Madam Deputy Speaker (Dame Rosie Winterton)]

I call Bob Seely.

--- Later in debate ---

[Steve Barclay]

I am not sure whether the hon. Member has been in the Chamber for the whole debate, but throughout the day there has been consensus across the House on the importance of being vaccinated and of boosters; that has been a point of agreement. Obviously, the management of the House is a matter for Mr Speaker, not for me. As my hon. Friend the Member for Bexhill and Battle (Huw Merriman) correctly highlighted, he and our constituents will continue to be able to access all facilities, as before. I point out to the hon. Member for Brent Central (Dawn Butler) that it is still possible to go to nightclubs, just as it is possible to vote, and these measures will not prevent that.

As well as omicron’s transmissibility, we are also beginning to learn more about the effectiveness of our vaccines against it. Boosters were important before omicron, but they are now critical and, as of this evening, we have delivered 24 million across the United Kingdom. Boosters are, without question, the single most effective thing we can do and plan B buys us more time to get more boosters into more arms. I pay tribute to my hon. Friend the Member for Bosworth (Dr Evans), who, as a GP himself, highlighted the importance of addressing the 15-minute wait period to increase the flow of boosters—a decision that the chief medical officers across the UK have supported. I also concur with my right hon. Friend the Member for North Somerset (Dr Fox), who rightly highlighted that the second dose is important alongside the booster.

The early evidence suggests that a booster dose is extremely effective; analysis by the UK Health Security Agency shows that a booster dose is 70% to 75% effective at preventing symptomatic infection. That is particularly important given the speed at which this infection is spreading, which means that the increase will be sharper, and its impact more concentrated, over a shorter period of time.

The hon. Member for Rhondda (Chris Bryant) raised an issue. The Health Secretary flagged up in opening the debate that he intended to remove all 11 remaining countries from England’s red list as of 4 am tomorrow. The Health Secretary has urgently considered the issue of releasing people from managed quarantine before they have completed the 10-day isolation—a point also raised by the right hon. Member for Exeter (Mr Bradshaw) and a number of Members from across the House. The Government’s decision is that we should permit early release of those who went into managed quarantine before the changes to the red list and require them to follow the relevant rules as if they had arrived from a non-red list country. Anyone who has tested positive will need to continue to stay in managed quarantine. That will require changes to regulations. We will look to implement that as quickly as possible and we will set out further specific guidance for affected individuals imminently.

I turn now to the statutory instruments before the House. The weight of scientific evidence shows that face coverings can make a difference, even if, as my right hon. Friend the Member for South West Wiltshire (Dr Murrison) said—he is a clinician himself—it is the least that we can do to wear these wretched things. Regulation 1400, which extends the use of face coverings, is a simple step to help slow the spread and I welcome the support of Members. Even those with concerns, such as my hon. Friend the Member for Winchester (Steve Brine), said that they would not oppose such a measure.

It is vital that we draw on our testing capacity to keep Britain moving. Regulation 1415 enables close contacts of confirmed or suspected covid cases who are fully vaccinated to take lateral flow tests every day for seven days. In response to my right hon. Friend the Member for Tunbridge Wells (Greg Clark), the lateral flow tests will be self-reported.

Regulation 1416 regarding entry to venues and events is one I know that hon. Members have given considerable attention. But this is very far from what has been described as a vaccine passport—a point that the Health Secretary made in opening the debate. This measure will mean that a negative lateral flow test is required to get into nightclubs and large events, with an exemption for the double vaccinated. Once all adults have had a reasonable chance to get their booster jab, we intend to change this exemption to require a booster.

Vaccination has been and remains our best line of defence. We have heard many contributions from across the House on making vaccination a condition of deployment for staff in health and wider social care settings. I recognise how emotive this issue is. Whether it is our care homes, our hospitals or other health settings, everyone working in health and social care is there to avoid preventable harm to the people for whom they care. As the chief medical officer has rightly said, people who are looking after other people who are vulnerable have a professional responsibility to get vaccinated, which was a point that another clinician—my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter)—made.

In closing, I am grateful for all the contributions today. The measures before us will help us to buy time and deliver boosters, which will provide the best protection against this variant. Vaccination, which was already so important before omicron, is now doubly important, especially in those settings with some of our most vulnerable people. I commend the regulations to the House.

[Madam Deputy Speaker (Dame Rosie Winterton)]

Order. To address the point raised by the hon. Member for Brent Central (Dawn Butler), in the event of Divisions, it is likely that there could be a large number of Members voting in one Lobby this evening, so Mr Speaker has agreed that 12 minutes should be allowed before I call for the doors to be locked. Members should accordingly be aware that they do not need to crowd into the Lobby at the beginning of the vote, as there will be more time to vote than usual.

6.30 pm

The Deputy Speaker put the Question (Order, this day).

Covid-19 Update

Baroness Winterton of Doncaster Excerpts

Monday 6th December 2021 Commons Chamber

[Sajid Javid]

My right hon. Friend makes a very important set of points. She is right about what the early data suggests about transmissibility. We are certainly seeing that here in the UK, and we are also seeing it in the reports from our friends across the world.

On the severity of the variant, we should not jump to any conclusions. We just do not have enough data. Most of the data that is available at this point in time is coming from South Africa. That is where most of the world’s cases are, but it is important to remember that it has a younger population. South Africa also had the beta wave, and beta as a variant is much closer to the omicron variant. While it is quite possible that there will be a difference in clinical outcomes from infection, it is too early to jump to conclusions.

None the less, my right hon. Friend is right in her final point. Of course we must learn to live with this virus; it is not going away, as she says, for many, many years, and perhaps it will lead to annual vaccinations. We have to find ways to continue with life as normal.

[Madam Deputy Speaker (Dame Rosie Winterton)]

Order. Colleagues will be aware that there is a further statement and quite a lot of business to get through this evening. If I am to get everybody in, I will be looking for brief questions and brief answers.

--- Later in debate ---

[Steve Brine (Winchester) (Con)]

As of last week, as feared, my constituency—like many others, I am sure—is seeing Christmas events cancelled and moved online, including all manner of festive performances in schools. Local authority guidance is often what is cited. Given that last week national Government went out of their way to ask schools to go ahead with Christmas performances such as nativity plays, I am keen to understand who head teachers and other event organisers should follow—the town hall or this place.

[Madam Deputy Speaker (Dame Rosie Winterton)]

Can I once again urge the need for brevity if we want to get everybody in?

[Sajid Javid]

I would encourage everyone to look seriously at the national Government guidance. Our guidance is clear. Even before the emergence of the new variant, we all knew that covid-19 likes the colder, darker days that winter brings. There is plenty of guidance. I would encourage people to go ahead whether with nativity plays or Christmas parties, but to continue to follow the guidance that was always there.

Health and Social Care

Baroness Winterton of Doncaster Excerpts

Friday 3rd December 2021 Commons Chamber

[Edward Argar]

Charming as ever.

We are the party of our NHS. We are backing it with the resources and support that it needs to get through this winter.

[Madam Deputy Speaker (Dame Rosie Winterton)]

Order. I thank the Minister for his undertaking about brief answers, and I urge Members to ask brief questions as well. Otherwise we will not get everyone in, because we do need to return to the private Member’s Bills.

[Sir Bernard Jenkin (Harwich and North Essex) (Con)]

I thank my hon. Friend for his statement. Can he confirm that it is the Government’s policy to encourage the reopening of mass vaccination centres to get through the bulge of booster jabs that we need? In that regard, will he congratulate the South Suffolk & North East Essex integrated care system, which has once again secured facilities at Harwich international port, and will he thank the port for offering those facilities again? We are hoping for a mass vaccination session on 19 and 20 December, and further sessions in January. Is that not the way to take the pressure off GPs?

--- Later in debate ---

[Ruth Edwards (Rushcliffe) (Con)]

I welcome the £131 million for the midlands that the Minister has announced today. I am very aware, though, that my constituents in East Leake are being served by a health centre that is the oldest in Nottinghamshire and which is far too small for the population growth that we have seen in recent years. Twenty months ago, the then Parliamentary Under-Secretary of State for Health and Social Care—my hon. Friend the Member for Bury St Edmunds (Jo Churchill)—promised at the Dispatch Box that we would have a ministerial visit to East Leake so that the Department could see what we were dealing with. I completely understand that that was impossible at the height of the pandemic, but that has long passed, so will the Minister recommit to that visit today and take that request back to his Department, because despite repeated chasing by me and my office staff, we cannot get a date from it in the diary?

[Madam Deputy Speaker]

Order. It is very important that we do not go off the boil in terms of briefness of questions. The Minister is being very good at being brief in his answers.

[Edward Argar]

It would be easy to commit the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Lewes (Maria Caulfield), to a visit because she is not here. Equally, I am conscious that East Leake is just up the road from my constituency, so it may be that my hon. Friend gets me instead. I will certainly look into that visit.

--- Later in debate ---

[Edward Argar]

Absolutely, I can give my hon. Friend that assurance. He rightly alludes to the fact that the inputs are important, but for those of us on the Government Benches, it is the results they bring—the outputs—and what we do with the money that matter. We will ensure that that money is well spent, harnesses innovation and delivers even better patient care and access to his constituents and many others.

[Madam Deputy Speaker]

I thank the Minister for his statement. We return to debate on the private Member’s Bill.

NICE-Approved Products: Patient Access

Baroness Winterton of Doncaster Excerpts

Tuesday 30th November 2021 Commons Chamber

[Anne Marie Morris]

I could not agree more. It is crucial to realise we are talking not just about medicines and drugs but also devices and, as the hon. Gentleman says, the processes, which are often the connection between the medicine, the device and the patient.

Within these health bodies, there is no training and nobody specifically focused on monitoring innovation, and there is no obligation to prescribe. Even more peculiarly, for these drugs there is an agreement between the industry and the NHS, the voluntary payment scheme or VPAS, under which manufacturers that are members of the scheme effectively agree with Government when the medicine or device is approved that it will be supplied at a well-discounted price. In addition, there is an agreement that sets a cap so that if, as it happens, more prescriptions are written for that particular drug, it is agreed that the extra cost that the NHS has incurred will be reimbursed by the manufacturer.

So if there is excessive prescribing—we assume that is why there is an attempt to limit how much goes on to formularies—why is that a problem when we have the VPAS scheme? It is a problem because the scheme does not the pass the benefit, other than the reduced price, down to the local health authority. The money is put into a separate pot, and that pot is then used generally to support the NHS writ broadly; it is not ringfenced, either for medicines or to be used, as it could be, to support local health authorities—integrated care systems—when their budgets are put under pressure, which is why they do not want too many things on their formularies. This would help them pay the price.

It seems to me, Minister, that there are some solutions here. You will be aware that I raised three of them in proceedings on the Health and Care Bill. To deal with the imperfections of the current arrangements, if those drugs that were approved by NICE—we are talking about the most cost-effective drugs—were mandated to be on formularies within 28 days automatically, so no one had to decide whether they went on or not, that would be a good system. It would also ensure that the decision was in the hands of the clinician and not of the bureaucracy of the health authority.

It seems to me, Minister, that the second suggestion I made—

[Madam Deputy Speaker (Dame Rosie Winterton)]

Order. It is quite important not to address the Minister directly; he should be addressed through me.

[Anne Marie Morris]

Thank you for the correction, Madam Deputy Speaker.

My second proposal is that there should be an innovation officer specifically appointed to look at and manage these issues. Failing all else, there should be a final provision that specifically puts an obligation on the health authority to provide any NICE-approved medicine. Then, as a matter of practicality that is not a matter for the Health and Care Bill, there should be a new arrangement under which the NHS would agree that this pot, rather than going into the general NHS coffers, is put aside specifically to reimburse local authorities.

What about the second category—those drugs that are approved by NICE but not used for the most cost-effective indication? That is called off-label prescribing. We know that a drug in that category does what it says on the tin and we know that it is cost-effective, but it is not sufficiently cost-effective to have got a tick in the box from NICE. Access then is a matter for negotiation between the integrated care system, the NHS and the manufacturer. Often, the starting point will be the list price, but bear in mind that that list price is a lot more than the NHS is paying. The result is that in different health authorities and different hospitals, different patients are offered different costs to be able to access the drug.

There is a real problem on top of all this. To ensure that there is no gaming of the system between access to private healthcare and state healthcare, someone cannot mix the two—quite rightly, we do not want gaming of the system so that people can effectively jump waiting lists—so there is an agreement to enable people to do a bit privately and then jump straight back into the NHS. If there is an episode where someone takes a drug and pays for it privately, technically they cannot then have the ongoing monitoring of their cancer—screening and so on—on the NHS. Individual health authorities recognise that that is rather absurd when we are talking not about a private patient with health insurance but about someone for whom the only way to get the drug is to pay for it, but that recognition is not universal.

So what is the solution for this one?

We need to look at NICE, supported by NHS England, accepting multi-indication approvals. That means a drug company can take a drug and apply, at the same time, for the drug to be approved for different health issues that have different ranges of health benefit. Clearly, the NHS will say, “Hold on a minute. I am not going to pay the same price for something which delivers less health benefit.” That means we need a system of differential pricing, so that a different amount is paid by the NHS for the drug, depending on the use to which it is to be put. That is entirely possible. It is done all over the world.

The Office of Health Economics put out a report, an international study, just this month on “Payment Models for Multi-Indication Therapies”. It concluded:

“Inflexible uniform pricing does not optimally support innovation and access. The most important consequence is lost treatment opportunities for patients.”

I respectfully suggest that the NHS and the Department of Health and Social Care might sensibly look at that. I also suggest, given the clear importance of payment support through industry, that as we move to the next iteration and renegotiation of VPAS, the agreement under which the industry agrees reduced pricing for mass purchase above a certain cap, it will reimburse the Government. That renegotiation needs to include provision for the multi-indication approvals process and differential pricing. 2023 is not very far away and I urge the NHS and the Government to take it forward very quickly. Meanwhile, there should be agreed standard pricing which is effectively paid for and underwritten by the pot set aside as a result of the cap.

There is one final area that needs to be addressed: drugs approved by NICE through a managed access agreement. For some treatments—typically gene therapy, where you are taking body fluids out, effectively changing the genetic make-up, and then putting them back in again—a hub needs to be set up in a hospital. Often, when drugs are approved, exactly how they are going to be delivered is not approved at the same time. Those drugs and processes need to be agreed not just in principle, but together with a package that ensures they can be implemented. As things stand, it can often take three years and much argument before hubs are established and the funding can then flow.

In summary, I ask for a number of things. First, my three new clauses to the Health and Care Bill would require local health system formularies to include NICE-approved drugs within 28 days. Secondly, there ought to be included in the Bill an absolute obligation to provide NICE drugs. It would then be for the individual health authority to work out how to provide them, but there should be an underpinning payment mechanism provided by the NHS. Thirdly—again, I have tabled a new clause on this—we need an innovation officer to ensure the system runs smoothly and that the things that would give best benefit are put on those formularies.

Fourthly—forgive me, Madam Deputy Speaker, there are eight of these—I would like the Government to look very closely at a multi-indication approval system, fifthly, at a differential pricing system and, sixthly, at an appropriate VPAS agreement for 2023. My last asks are about how the money is used. Seventhly, the pot of money, an accumulation of money paid by industry because more of the drug was prescribed, should be made available to local health systems, the integrated care systems, to cover the costs that are not in their mainstream budget. Finally, we should put in place a formal delivery mechanism for every managed access treatment to ensure that it is not just a promise, but actuality. I wonder whether it might therefore be appropriate for this Minister, the life sciences Minister—the Under-Secretary of State for Business, Energy and Industrial Strategy, my hon. Friend the Member for Mid Norfolk (George Freeman)—and the innovation Minister, Lord Kamall, to meet me, because all three have a critical role, given their involvement in access, industry and licensing. I wonder whether it might be possible to persuade them to accept my three amendments to the Health and Care Bill.

It might also be helpful if these matters were raised with the National Audit Office, which could review the current system and look at whether it offers value for money. That would be a very good use of their time. I am sure that the doughty hon. Member for Hackney South and Shoreditch (Dame Meg Hillier), who chairs the Public Accounts Committee, might also be interested in looking at this issue. After all, value for money is critical.

In conclusion, we have a world-beating system but, as it currently stands, it does not provide value for money for all. It does not serve the best interests of all patients, and it does not serve the best interests of delivering the UK life sciences strategy. Indeed, I have one constituent who moved house from Devon to Southampton so that he could get a medical treatment.

Health and Care Bill

Baroness Winterton of Doncaster Excerpts

Report stage
Tuesday 23rd November 2021 Commons Chamber

[Fiona Bruce]

My right hon. Friend makes exactly the right point.

Our law needs to be updated. The current 24-week limit was set over 30 years ago, in 1990. That legislation removed the previous time limit of 28 weeks. In 1990, 24 weeks was considered the point of viability outside the womb, but the scientific advances in those 31 years have been enormous. The latest guidance from the British Association of Perinatal Medicine establishes 22 weeks gestation to be the point of viability and enables doctors to intervene to save premature babies from 22 weeks. A study from a neonatal intensive care unit in London found that survival rates for babies born at 22 and 23 weeks gestation went from zero in the period from 1981 to 1985 to 19% in the period from 1986 to 1990, and then up to 54% in the years from 1996 to 2000. We would no doubt find that the figures had increased substantially since then, were those figures available. Just in the past few weeks, we have seen the incredible story from the American state of Alabama of the birth of a baby boy at just 21 weeks old. Weighing just 14.8 ounces, Curtis Means needs oxygen support and a feeding tube, but he is in good health. New clause 31 is a probing amendment, so I will not be pressing it to a vote on this occasion. However, I would welcome the Minister’s views and I look forward to a greater debate on this issue.

I also want to take a few moments to give my support to new clause 51, in the name of the hon. Member for Upper Bann (Carla Lockhart), which would clarify that abortion on the ground of the sex of the foetus is illegal. This relates to the truly awful exploitative practice whereby women can be pressurised into abortions based on the sex of their unborn child. I also support new clause 52, also in the name of the hon. Member for Upper Bann, which seeks to bring parity to the law in equalising time limits on abortions that take place on the ground of disability, so that they would be equal to the limits on most other abortions. The current law permits abortions up to birth if the baby is deemed likely to be born seriously handicapped. This is interpreted to include entirely non-fatal disabilities such as Down’s syndrome and easily surgically rectifiable conditions such as cleft palate and club foot. One of my sons was born with club foot, and I know how rectifiable it is. The law is plainly inconsistent with the disability discrimination legislation that applies after birth, and it sends a dreadful message to people who are living and thriving with disabilities about how little their lives are valued under abortion law. Again, I look forward to hearing the Minister’s views.

[Madam Deputy Speaker (Dame Rosie Winterton)]

In order to try to get as many people in as possible, I am going to put on a three-minute time limit.

[Ms Marie Rimmer (St Helens South and Whiston) (Lab)]

Forced organ harvesting in China is one of the worst crimes against humanity of the 21st century. That is why I wish to speak to new clauses 24 and 25 in my name. It is a crime that no British citizens should be taking part in, and a crime that humanity has a duty to stop. New clause 24 aims to put a dent in the forced organ harvesting trade. It would prohibit UK citizens from receiving a transplant abroad without the clear consent of the donor. The forced organ trade is a big money business. The organs of a young healthy adult are worth in the region of half to three quarters of a million US dollars. That is money that people would, and do, kill for.

China started with political prisoners, with the religious Falun Gong group being the main source. Now it has moved on to Uyghur Muslims, some Christians and other minority groups. Evidence was heard at the China and Uyghur tribunals that mass DNA testing is taking place in the internment camps in Xinjiang, enough to compile a Uyghur organ database and bank ready for withdrawals on demand. The world might believe that China had an ethnical organ donation system based on the World Health Organisation’s assessment, yet that assessment from the WHO is based on a country’s self-assessment—in this case by the Chinese Communist party. It is a barbaric practice, and every democracy in the world should be looking at what it can do to stop it.

I am grateful to Members from every party across this House for supporting my new clause. It will not stop the trade, but it will show that we in Britain are doing our part and helping to influence other countries to do the same. I thank my hon. Friend the Member for Nottingham North (Alex Norris) for raising these new clauses in Committee. The Minister sympathised, but expressed certain concerns. He was worried that countries could have a deemed consent system in which everyone was automatically a donor. Deemed consent is acceptable only if people can opt out. Under a new provision, the Secretary of State will assess the deemed consent of each country. The Minister was also concerned that the recipient of an organ could face criminal consequences. It is the duty of a Government to ensure that people are aware of what is a crime, and supporting or funding a crime against humanity must be illegal.

New clause 25 would make imported cadavers require the same consent as bodies sourced from within the UK. The Minister claimed that a revised code of practice covered this, but a code of practice is not law. Surely the sanctity and dignity of the human body demand the power of legislation. I call on the House and this Government to step up and do their part to stop this crime against humanity.

--- Later in debate ---

[Jim Shannon]

Does my hon. Friend share my concerns that a large number of people throughout the whole United Kingdom object to this? We have had hundreds and hundreds of emails from my constituents about this issue. I commend my hon. Friend and the hon. Member for Congleton (Fiona Bruce) and totally oppose new clause 50—

[Madam Deputy Speaker (Dame Rosie Winterton)]

Order. That intervention is quite long enough.

[Carla Lockhart]

I will not push either of my new clauses to a vote. However, legal clarification on sex-selective abortion is urgently needed for the sake of women and the missing girls who are the victims of this abhorrent practice.

I commend the hon. Member for Congleton (Fiona Bruce). As evidence changes, so should the law, and 22 weeks’ gestation is the point of foetal viability. At heart, this is a debate about human rights, and the most basic human right is the right to life.

--- Later in debate ---

[Several hon. Members rose—]

[Madam Deputy Speaker (Dame Rosie Winterton)]

Order. Before I call the shadow Secretary of State, I should say that I will probably introduce a three-minute time limit after the shadow Secretary of State and that I am unlikely to call anybody who intervened on the Secretary of State during his opening speech.

Health and Care Bill

Baroness Winterton of Doncaster Excerpts

Report stage
Monday 22nd November 2021 Commons Chamber

[Edward Argar]

I beg to move, That the clause be read a Second time.

[Madam Deputy Speaker (Dame Rosie Winterton)]

With this it will be convenient to discuss the following:

New clause 33—Support provided by the NHS to victims of domestic abuse—

“(1) Each Integrated Care Board must—

(a) assess, or make arrangements for the assessment of, the need for support for victims of domestic abuse using their services;

(b) prepare and publish a strategy for the provision of such support in its area;

(c) monitor and evaluate the effectiveness of the strategy;

(d) designate a domestic abuse and sexual violence lead; and

(e) publish an annual report on how it has discharged its duties relating to the provision of services to victims of domestic violence under the Care Act 2014.

(2) An Integrated Care Board that publishes a strategy under this section must, in carrying out its functions, give effect to the strategy.

(3) Before publishing a strategy under this section, an Integrated Care Board must consult—

(a) any local authority for an area within the relevant Integrated Care Board’s area;

(b) the domestic abuse local partnership board appointed by the local authority for an area within the relevant clinical commissioning group’s area under section 58 of the Domestic Abuse Act 2021; and

(c) such other persons as the relevant local authority considers appropriate.

(4) For the purposes of subsection (4), ‘local authority’ means—

(a) a county council or district council in England; or

(b) a London borough council.

(5) An Integrated Care Board that publishes a strategy under this section—

(a) must keep the strategy under review;

(b) may alter or replace the strategy; and

(c) must publish any altered or replacement strategy.

(6) The Secretary of State may by regulations make provision about the preparation and publication of strategies under this section.

(7) The power to make regulations under subsection (7) may, in particular, be exercised to make provision about—

(a) the procedure to be followed by an Integrated Care Board in preparing a strategy;

(b) matters to which an Integrated Care Board must have regard in preparing a strategy;

(c) how an Integrated Care Board must publish a strategy;

(d) the date by which an Integrated Care Board must first publish a strategy; and

(e) the frequency with which an Integrated Care Board must review its strategy or any effect of the strategy on the provision of other provision in its area.

(8) Before making regulations under this section, the Secretary of State must consult—

(a) all Integrated Care Boards; and

(b) such other persons as the Secretary of State considers appropriate.”

This new clause would require Integrated Care Boards to publish a strategy for the provision of support for victims of domestic abuse using their services and designate a domestic abuse and sexual violence lead.

New clause 55—Guidance for babies, children and young people—

“(1) The Secretary of State must publish guidance on how integrated care systems should meet the needs of babies, children and young people aged 0-25.

(2) Integrated care systems must act in accordance with the guidance in subsection (1).”

This new clause would require the Secretary of State to publish guidance on how integrated care systems should meet the needs of babies, children and young people aged 0-25 and would require integrated care systems to act in accordance with the guidance.

New clause 57—NHS England’s duty as to reducing inequalities—

“Section 13G of the National Health Service Act (duty as to reducing inequalities), is amended by the addition of the following subsections—

‘(2) NHS England must publish guidance about the collection, analysis, reporting and publication of performance data by relevant NHS bodies with respect to factors or indicators relevant to health inequalities.

(3) Relevant NHS bodies must have regard to guidance published by NHS England under this section.

(4) In this section “relevant NHS bodies” means—

(a) NHS England,

(b) integrated care boards,

(c) integrated care partnerships established under section 116ZA of the Local Government and Public Involvement in Health Act 2007,

(d) NHS trusts established under section 25, and

(e) NHS foundation trusts.’”

Amendment 47, in clause 6,  page 4, line 11, at end insert—

“(5) In paragraph 1(a) ‘relevant public body’ means a public authority listed under the title ‘Health, social care and social security’ in Part 1 of Schedule 19 to the Equality Act 2010 or an NHS Trust.”

This amendment provides that NHS England resources for supporting or assisting organisations that are providing or planning to provide health services may only be directed to public sector bodies.

Amendment 58, in clause 12, page 8, line 6, at end insert—

“(2) An integrated care board may not—

(a) delegate that function; and

(b) exercise that function to enter into an integrated care provider contract with any body other than a statutory NHS body.

(3) In paragraph (2)(b) an ‘integrated care provider contract’ has the same meaning as in Schedule 3A of the National Health Service (General Medical Services Contracts) Regulations 2015.”

This amendment is designed to ensure that an organisation carrying out the functions of an ICB on its behalf is a statutory NHS body.

Amendment 59, page 12, line 29 at end insert—

“(3A) Nothing in——

(a) the rules referred to in subsection (1),

(b) this Act, or

(c) any regulations made under this Act

(none) shall entitle any provider of health services to withhold provision of those services from any individual on the basis of the integrated care board to which that individual has been allocated.”

This amendment is to ensure that any providers of health services cannot withhold provision of those services from any individual because of the integrated care board that they have been allocated to.

Amendment 66, in clause 15, page 13, line 44, at end insert—

“(j) palliative care services.”

This amendment adds a requirement for the commissioning of palliative and end of life care services.

Amendment 21, page 14, line 43, at end insert—

“3AA Duty of integrated care boards to commission approved treatments

‘(1) This section applies where—

(a) a treatment has been approved by the National Institute for Health and Care Excellence, and

(b) an integrated care board has not arranged for the provision of that treatment under section 3 or 3A of this Act, and

(c) a clinician has recommended that treatment for a person for whom that integrated care board has responsibility.

(2) The integrated care board referred to in subsection (1) must arrange for the provision of that treatment to the person for whom it has responsibility.

(3) In subsection (1) “clinician” means a medical professional employed by or acting on behalf of an NHS Trust, NHS Foundation Trust or primary care service from whom the integrated care board has arranged for the provision of services.’”

This amendment would require an integrated care board to arrange for the provision of a NICE-approved treatment to any patient whose NHS clinician has recommended it, even if that treatment is not otherwise available to patients in that ICB area.

Amendment 48, in clause 19,  page 16, line 6, leave out “promotes” and insert

“secures the rights set out in”.

This amendment requires ICBs to act to ensure that health services are provided in a way which secures the rights set out in the NHS Constitution.

Amendment 99, page 16, line 34, at end insert—

“(2) In fulfilling their duties under this section, integrated care boards must have particular regard to the need to reduce inequalities between migrant and non-migrant users of health services.”

Amendment 49, page 16, line 37, leave out “promote” and insert “enable”.

This amendment, together with Amendment 50 provides that ICBs enable the involvement of patients, their paid and unpaid carers, and their representatives in decisions relating to the prevention or diagnosis of illness, care or treatment, rather than promoting their involvement.

Amendment 50, page 16, line 37, after “their”, insert “paid and unpaid”.

This amendment, together with the Amendment 49, provides that ICBs enable the involvement of patients, their paid and unpaid carers, and their representatives in decisions relating to the prevention or diagnosis of illness, care or treatment.

Amendment 22, page 17, line 4, at end insert—

“14Z37A Obligation on integrated care boards to ensure appropriate uptake of all NICE approved products according to population need

‘(1) Each integrated care board must promote uptake of all NICE approved medicines and medical devices in accordance with the need of the population it serves.

(2) An integrated care board must, in each financial year, prepare a report on the uptake of all NICE approved medicines and medical devices, including the number of patients that have accessed each product.’”

This amendment would require ICBs to ensure that all NICE approvals are available and promoted to their population, and report on this uptake annually.

Amendment 19, page 17, line 14, at end insert—

“14Z39A Duty to review latest innovations with a view to local commissioning

(1) Integrated care boards must review all new—

(a) medicines,

(b) medical devices, and

(c) other health care solutions that may benefit the local population.

(2) Integrated care boards must—

(d) appoint a dedicated innovation officer to their board, and

(e) develop and maintain a system to keep up to date with medicines and devices innovation and review suitability for patient usage, including engagement with the relevant—

(i) academic health science network, and

(ii) local pharmaceutical committee.”

This amendment would mandate integrated care boards to monitor and assess innovation for the benefit of the local population.

Amendment 16, page 17, line 19, at end insert—

“(2) Each integrated care board must each year prepare, consult on and adopt a research strategy for patient benefit which—

(a) meets local need;

(b) meets national research undertakings.

(3) In developing a strategy under subsection (2), an integrated care board must engage with—

(a) the National Institute for Health Research,

(b) academic health science networks, and

(c) all other relevant regional and national health research organisations.”

This amendment would require ICBs to establish a research strategy and other connected measures.

Amendment 91, page 18, line 18, after first “the” insert “physical and mental”.

This amendment will require Integrated Care Boards to prioritise both the physical and mental health and well-being of the people of England and to work towards the prevention, diagnosis or treatment of both physical and mental illness replicating the parity of esteem duty as introduced in the Health and Social Care Act 2012.

Amendment 92, page 18, line 23, after first “of” insert “physical and mental”.

This amendment will require Integrated Care Boards to prioritise both the physical and mental health and well-being of the people of England and to work towards the prevention, diagnosis or treatment of both physical and mental illness replicating the parity of esteem duty as introduced in the Health and Social Care Act 2012.

Amendment 68, page 18, line 26, at end insert—

“(d) health inequalities.”

This amendment would modify the triple aim to explicitly require integrated care boards to take account of health inequalities when making decisions.

Amendment 17, page 18, line 38, at end insert—

“14Z43A Duty on integrated care boards to consider requests to engage in clinical trials, and patient participation

(1) An integrated care board must consider any request from the organiser of an authorised clinical trial for the ICB to engage in that trial.

(2) If such a request is accepted, the integrated care board must offer the ability to participate in the trial to any patient within their area who is eligible to take part.”

This amendment would require integrated care boards to consider any requests to engage in clinical trials and offer patients the opportunity to participate.

Amendment 20, page 18, line 38, at end insert—

“14Z43A Duty to update formularies to include all NICE-approved products

(1) Within 28 days of any medicine or device receiving market authorisation from NICE, an integrated care board must update its formulary to include that medicine or device.

(2) On receipt of notice of the market authorisation by NICE of any medicine or device, an integrated care board must immediately instruct providers of health and care services commissioned by the board to update their formularies in such a way that all NICE-approved medicines and devices are available to patients on the recommendation of a healthcare practitioner within 28 days of market authorisation.

(3) An integrated care board must report annually all medicines and devices that have been added and removed from their formulary over the previous year.”

This amendment would mandate integrated care boards and healthcare providers (e.g. hospital trusts) to update their formularies to include all NICE-approved medicines or devices within 28 days of market authorisation to ensure they are available for healthcare practitioners (e.g. physician or prescribing pharmacist) to make available for suitable patients.

Amendment 102, page 21, line 25, at end insert—

“(c) set out any steps that the integrated care board proposes to take to address the particular needs of victims of abuse (including domestic abuse and sexual abuse, whether of children or adults).”

This amendment requires the joint forward plan for an integrated care board and its partners to set out any steps it proposes to take to address the particular needs of victims of abuse (including domestic abuse and sexual abuse, whether of children or adults).

Amendment 51, page 22, line 23, leave out

“in a way that they consider to be significant.”

This amendment requires ICBs and partner NHS Trusts and NHS Foundation Trusts to consult on all revisions to their forward plans.

Amendment 52, page 23, line 42, at end add “on its website”.

This amendment is to require capital resource use plans to be made publicly available on the internet.

Amendment 53, page 24, line 22, leave out

“in a way that they consider to be significant”.

The purpose of this amendment is to require all revisions of capital resource use plans to be published.

Amendment 18, page 25, line 6, at end insert—

“(d) explain what research activity it undertook during the year, including

(i) research to meet local health issues, and

(ii) research to support national research projects.

‘(2A) The annual report prepared by the Secretary of State under section 247D of this Act must include a section which reproduces, and comments on, the sections of the annual reports of each integrated care board prepared under paragraph (1)(d).’”

This amendment would require integrated care boards to publish an account of their research activity, and require the report the Secretary of State must prepare and lay before Parliament under section 247D of the National Health Service Act 2006 to include a section which reproduces, and comments on, the research activity of all ICBs.

Amendment 23, page 25, line 14, at end insert—

“14Z56A Report on assessing and meeting parity of physical and mental health outcomes

(1) An integrated care board must annually set out in a report the steps it has taken to fulfil its obligations to deliver parity of esteem between physical and mental health to its local population.

‘(1) The report must set out—

(a) the number of patients presenting with mental health conditions,

(b) the number of patients presenting with physical health conditions,

(c) the number of mental health patients waiting for initial assessment,

(d) the number of physical health patients waiting for initial assessment,

(e) the number of mental health patients waiting for treatment,

(f) the number of physical health patients waiting for treatment,

(g) the number of mental health patients receiving treatment,

(h) the number of physical health patients receiving treatment,

(i) the number of patients readmitted to mental healthcare settings, and

(j) the number of patients readmitted to physical healthcare settings.

(2) The report must set out performance against nationally set standards in both physical and mental health.

(3) Each year the Secretary of State must lay before Parliament a consolidated report of all the reports made by integrated care boards under this section, and make a statement to each House of Parliament on the report.’”

This amendment would require an ICB to report on assessing and meeting parity of physical and mental health outcomes.

Amendment 15, in clause 20,  page 29, line 20, at end insert—

“(2A) The Secretary of State may by regulations make provision about representation of particular health, social care, and local interests, clinical fields, and types of health or care provision in the membership of integrated care partnerships.”

This amendment would enable the Secretary of State to make provision about the membership of integrated care partnerships.

Amendment 100, page 29, line 22, at end insert—

“(4) A member of the Integrated Care Partnership may not work for, be the representative of or hold financial interest in any private company delivering or seeking to deliver health and care services or services supporting the health and care sector or producing or seeking to produce health and care products, with the exception of general practitioners.”

This amendment seeks to ensure that Integrated Care Partnerships are made up wholly of representatives from public sector organisations and that private companies are not represented on them.

Amendment 1, page 29, line 45, at end insert—

“(c) fully integrate the promotion of everyday wellbeing, self-care for minor ailments and the management of long-term conditions into local health systems.”

This amendment would ensure that everyday wellbeing, self-care for minor ailment and management of long term conditions are integrated and promoted into local health systems.

Amendment 2, page 30, line 3, after “services” insert

“including services provided by pharmacists for minor ailments”.

This amendment would ensure that integrated care partnerships include in a strategy its views on how health-related services, including provision for self-treatable conditions, are integrated into health and social care services in that area.

Amendment 69, in clause 23,  page 35, line 32, at end insert—

“(5) NHS England must publish guidance on the means by which an integrated care board, NHS trust or NHS foundation trust which believes its capital resource limit or revenue resource limit risks compromising patient safety may object to the limit set.”

Amendment 114, in clause 25,  page 37, line 27, at end insert—

“(2A) The priorities set by the Secretary of State under subsection (2)(a) must include priorities relating to leadership, the integration of services and the quality and safety of services.”

The Secretary of State has the function of setting priorities for the Care Quality Commission in carrying out assessments in relation to integrated care systems. This amendment requires the Secretary of State to set priorities relating to certain matters.

Amendment 61, in clause 64, page 59, line 27, leave out from beginning to end of line 28.

This amendment is to ensure that a commissioner cannot also be a provider.

Amendment 62, in clause 69, page 63, line 30, leave out “may” and insert “must”.

This amendment makes it a requirement that regulations make provision in relation to the procurement by relevant authorities of (a) health care services for the purposes of the health service in England, and (b) other goods or services that are procured together with those health care services.

Amendment 63, page 63, line 36, leave out “may” and insert “must”.

This amendment makes it a requirement that regulations make provision in relation to (a) general objectives of procurement, and (b) procurement processes.

Amendment 64, page 63, line 39, leave out “may” and insert “must”.

This amendment along with Amendment 65 makes it a requirement that regulations make provision for the purposes of (a) ensuring transparency and fairness in relation to procurement, and (b) ensuring that compliance can be verified, or managing conflicts of interest.

Amendment 65, page 63, line 41, leave out “or” and insert “and”.

This amendment is to make it a requirement for regulations to make provision to ensure both transparency and fairness in relation to procurement.

Amendment 9, page 64, line 1, at end insert—

“(3A) The regulations must provide that—

(a) there is a presumption—

(i) in favour of contracts being awarded to NHS trusts and NHS foundation trusts, and

(ii) that integrated care provider contracts will not be awarded to a body other than to an NHS trust or an NHS foundation trust, except for under the provisions of paragraph (b);

(b) if an NHS trust or an NHS foundation trust does not consider that it is able, or does not wish, to provide certain services under a contract, it must publish its reasons;

(c) if paragraph (b) applies, the integrated care board must consult the public if it proposes to award any contract for those services to any body other than an NHS trust or NHS foundation trust;

(d) a consultation under paragraph (c) must—

(i) set out the responses of the integrated care provider to the reasons given by the NHS trust or NHS foundation trust under paragraph (b),

(ii) specify the proposed parties to and the full terms and conditions of the proposed contract, and

(iii) specify that the terms and conditions for staff under the proposed contract must be at least equivalent to NHS terms and conditions.”

This amendment would make NHS trusts and foundation trusts the default providers of NHS services.

Amendment 72, page 64, line 1, at end insert—

“(3A) The regulations must make provision in relation to the procurement of the services referred to in paragraph (1)(a) (other than primary medical services, primary dental services and primary ophthalmology services) that before any contract for a service with an annual value in excess of £5m may be awarded to an organisation that is not an NHS trust or NHS foundation trust—

(a) the business case for the award of the contract must be published;

(b) any responses to the proposal in the business case must be considered and published;

(c) the process for awarding the contract must be open and transparent and non-discriminatory at every stage, including (but not limited to)—

(i) procurement strategy and plan,

(ii) invitation to tender,

(iii) responses to invitations,

(iv) evaluation of tenders,

(v) decision to award, and

(vi) contract awarded;

(d) the process for awarding the contract must demonstrate due regard to the principles established in the Public Contracts Regulations 2015 (S.I.2015/102) or any regulations which may supersede them;

(e) in any case where it is claimed that an emergency justifies an award without the process being used then the responsible body must within 14 days publish the business case for the award of the contract and the record of the decision.”

Amendment 101, in schedule 2,  page 125, line 26, at end insert—

“(3) Members of an Integrated Care Board may not work for, be the representative of or hold financial interest in any private company delivering or seeking to deliver health and care services or services supporting the health and care sector or producing or seeking to produce health and care products, with the exception of general practitioners.”

This amendment seeks to ensure that ICBs are made up wholly of representatives from public sector organisations and that private companies, their employees and representatives, and those with financial interests in them, are not represented on ICBs.

Government amendments 25 to 28.

Amendment 76, page 126, line 26, at end insert—

“(d) at least one member nominated by the mental health trust or trusts that provide mental health services within the integrated care board’s area;

(e) at least one member nominated by the Directors of Public Health that serve each local authority within the integrated care board’s area;

(f) at least one member nominated jointly by any NHS trust, NHS foundation trust and local authority that provides social care services within the integrated care board’s area;

(g) at least one member nominated by the trade unions representing the health and social care workforce that serves the integrated care board’s area;

(h) at least one member appointed to represent the voice of patients and carers in the integrated care board’s area.”

Amendment 77, page 126, line 26, at end insert—

“(2A) The constitution must prohibit representatives of GP practices with active Alternative Provider Medical Services contracts from becoming members.”

This amendment would mean that the only GPs able to participate in Integrated Care Boards would be those whose practices are on the standard General Medical Services (GMS) contract.

Amendment 78, page 126, line 26, at end insert—

“(2A) Representatives of private providers of healthcare services, other than general practitioners who hold a contract for the provision of primary medical services in the area, may not be appointed to NHS decision-making boards, integrated care boards, or any place-based committee or sub-committee of the boards.”

Amendment 81, in schedule 2,  page 130, line 14, at end insert—

“(7) An integrated care board may enter into an externally financed development agreement in respect of any Local Improvement Finance Trust relevant to the area for which it has responsibility and receive the income related to that agreement.

(8) An integrated care board may enter into an externally financed development agreement in respect of any proposed Local Improvement Finance Trust relevant to the area for which it has responsibility.”

This amendment would enable integrated care boards to participate in existing and future LIFT schemes and to receive the income that would come to the local area from the local investment in such schemes.

Amendment 79, in schedule 3,  page 132, line 28, leave out “person” and insert

“general practitioner, GP partnership or social enterprise providing primary medical services”.

This amendment would prevent an integrated care board from entering into or renewing any Alternative Provider Medical Services (APMS) contract.

Amendment 80, page 132, line 32, leave out “person” and insert

“general practitioner, GP partnership or social enterprise providing primary medical services”.

This amendment would prevent NHS England from entering into or renewing any Alternative Provider Medical Services (APMS) contract.

Government amendments 29 and 30.

[Edward Argar]

New clause 49 has attracted a slightly fuller House than my previous speech did. This additional clause relates to the cap on care costs for charging purposes.

On 7 September, my right hon. Friend the Prime Minister took the bold step of publishing “Build Back Better: Our Plan for Health and Adult Social Care”. Successive Governments over decades have failed to tackle the reform of social care. This Government are delivering a package—package is the key—of reforms that will not only tackle the wider challenges faced by the adult social care system but reform how social care is funded to ensure that everyone, regardless of where they live or their level of assets, is protected from catastrophic costs. Let me remove all doubt on this issue: no one will lose from these reforms, compared with the system we have now, and the overwhelming majority will win.

Underpinning the reforms set out in the plan is an additional £5.4 billion over the next three years. That funding will end wholly unpredictable care costs and include at least £500 million to support the adult social care workforce. The reforms will make a real difference to the frontline of adult social care, including care users and the dedicated care workforce who have performed heroics throughout the pandemic. A crucial element of the reforms in the plan are the proposals to reform the existing social care charging rules.

--- Later in debate ---

[Several hon. Members rose—]

[Madam Deputy Speaker (Dame Rosie Winterton)]

Order. It will be obvious to Members that a large number of colleagues want to contribute to the debate. I urge brevity, so that others can participate. I call the Chair of the Health and Social Care Committee, Jeremy Hunt.

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

Madam Deputy Speaker, I think on this occasion I can oblige you, because I will be very brief. I wish to speak to amendment 114, which may seem a rather technical amendment—as is evidenced by the fact that, out of 650 colleagues, only one has actually signed it, and that is me—but it makes up in quality for what it does not have in quantity. It is about making sure that the new integrated care boards focus their energy on the safety and quality of care of patients. That is very important, because the new integrated care boards will have enormous power. In effect, they will be the local governing bodies of our NHS.

Although the statutory structures matter, what the people running those care boards focus their attention on is incredibly important to all our constituents. The amendment will make sure that when care boards consider their priorities, the things that matter to patients—the safety and quality of care—are put at the very top of their list. We know the way the NHS works. It is the fifth-largest bureaucracy in the world, and there is a plethora of internal NHS—

Giving Every Baby the Best Start in Life

Baroness Winterton of Doncaster Excerpts

Tuesday 9th November 2021 Commons Chamber

[Tim Loughton (East Worthing and Shoreham) (Con)]

I pay tribute to the hon. Member for Richmond Park (Sarah Olney) and the other colleagues who secured the debate. It is great to be having a debate about early years again; we are having a few of them these days. It never happened when I first became a Member of the House and has not for much of my 24 years here. It is really fantastic that such a relevant and important subject to so many of our constituents is now commonplace in the Chamber and that there is real, concerted action. We may disagree over the extent or detail of that, or the amount of money that is going into it, but I think we all agree about the direction and emphasis.

It is a great pleasure to follow the hon. Member for Newcastle upon Tyne North (Catherine McKinnell), and I agree with much of what she said. It is also a great pleasure—but a great challenge—to follow my right hon. Friend the Member for South Northamptonshire (Dame Andrea Leadsom), who is such a guru on this subject that anything the rest of us say subsequently will pale into relative irrelevance, but I will give it a bash anyway.

I want to recount an episode that happened when I was Children’s Minister 11 years ago. I used to spend a week of the summer recess going out on the frontline with some of the workforce, without any fuss and without any cameras, just to see what their job involved at first hand. I remember my first time: I spent a week in Stockport going out with social workers, knocking on doors, seeing cases at first hand, manning the overnight emergency helplines, sitting in on morning meetings and liaising with police and others. It was a fascinating experience, which I recommend to any other Member. I think it should be compulsory for all Ministers and their officials to spend time with the professionals over whose regulations that Department has responsibility. That is where we find out the most. I used to find out most of my information from sitting down with groups of children in care, as the Minister responsible for children in care; that is where we find out what is really going on.

A really good social worker took me to my first case, and I think that she deliberately chose the most challenging case in the most run-down, depressing part of the town. We went into a house that was a complete mess. There was a young mum with three young boys. There were no carpets on the floor. There was virtually no furniture, other than what had been dumped in the garden. There was no food in the house—the fridge was bare—other than what the kids literally were eating off the floor. There were bare mattresses for beds and piles of dirty clothing.

One of the kids had had a really dire toothache for some weeks, and the social worker had gone on at the mum about getting the child some treatment for it. On the day that we visited, the mum had had a toothache problem. On the previous day, she had gone down to the emergency dentist and had her tooth fixed, but she did not have the presence of mind to take her son who was suffering from toothache along with her.

What does someone do with a family like that? Plenty of professionals had been going in and out of that house to offer different bits of help, but that mum required some serious support. She had been abused as a child, as is so often the case. The father was not on the scene and she had been subject to domestic abuse, as is so often the case. We all know, extraordinarily, that about a third of domestic violence starts during pregnancy. So there she was, highly vulnerable and desperately in need of support, but her life was not improving and the life chances of her children were certainly not. So what does someone do?

Those children could have been taken into care. They probably would have been split up, going to different families across the area and perhaps beyond. The mum would have been completely distraught at that prospect. Inadequate though she was, for whatever reason, in the care that she provided, she absolutely doted on those kids and they doted on her, so what was the solution? That is the sort of judgment of Solomon that our social workers have to make day in, day out when dealing with those really complex, challenging cases.

That case, which I will remember for the rest of the time that I am involved in these areas, encapsulates all the challenges that we face in children’s social care and all the challenges relating to the whole issue of the best start in life and the project that the Government have undertaken, thanks to my right hon. Friend the Member for South Northamptonshire. That is why it is so important. One of the answers is to have a joined-up approach locally, with all the different professionals working together as a team to encapsulate mum and family. It is about having somebody who can literally take her by the arm and march her down to a children’s centre to get family support and advice or march her down to the dentist with little Johnny to make sure that he gets dental treatment—somebody to take control of people’s lives and get them on the straight and narrow until they can fend for themselves and their family again. We need local professionals working as one, with a lead person who has responsibility, who has all the joined-up knowledge about what needs to happen, and who has the force and confidence to make it happen.

We also need the Government to be joined up at the centre. I remember that when we were trying to get the early intervention grant sorted, we were getting the run- around from officials because the fund would affect various Departments. We were told, “Oh, we can book you an appointment with the Minister in that Department in a few weeks’ time, and then perhaps you can have another meeting with that Minister.” In the end, the only way my co-Minister Sarah Teather and I got the problem sorted was by ringing up all the Housing, Health, Home Office and other Ministers responsible. We all had pizza in the Adjournment, agreed what the strategy should be, went back to our Departments the following morning and told our civil servants, “This is what we want to happen.” All the civil servants said, “That’s not the way we do things here, Minister,” to which we all said, “Tough. Do it.”

The problem is that government does not work in a joined-up way, which is why the approach that my right hon. Friend the Member for South Northamptonshire has taken is really pioneering. I pay tribute to her for the way she has brought things together, forcing Departments to sit down, work together and have a strategy that works as one. That is the only way we will sort the problem sustainably for the future, which is key to the whole approach.

The hon. Member for Richmond Park has set out the problems: the £8.1 billion that perinatal mental illness costs each year; the £15 billion that we spend each year in this country on child neglect, particularly in relation to younger children; the £6 billion that childhood obesity costs each year, which is likely to rise to £9 billion within the next few years. As well as the cost of domestic abuse and safeguarding, we are spending £20 billion to £30 billion-plus each year as the cost of getting it wrong for some of the most vulnerable children and their families. Spending a fraction of that on solutions to get it right will be absolutely transformational.

Let us look at some research from the Institute of Health Visiting. I will always speak up for health visitors; in my view, frankly, they are one of our emergency services. They have been diverted too often during the pandemic to other parts of the health service, and their absence has been greatly felt. There is a shortage of several thousand: the institute says that we need at least 3,000 additional health visitors over the next three years, and I completely agree. One of the great achievements of the Cameron Government was building up the health visitor workforce, which has since diminished, alas. A survey of health visitors shows that 81% have seen an increase in perinatal mental illness, 80% have seen an increase in domestic abuse, 80% have seen an increase in child behaviour problems, 72% have seen an increase in poverty affecting families and 71% have seen an increase in child safeguarding.

The hon. Member for Newcastle upon Tyne North is right, too. Research from Action for Children shows that

“only 57% of children from poorer backgrounds were ready for school at age five, compared to 74% of their better-off peers…82% of parents of 0-5s in England struggled, or were unable, to access vital non-childcare early years services…78% of parents who were unable to access a service were worried about potential impacts on themselves or their children. The most common concerns were children’s development, and parents’ own mental health and wellbeing.”

That is the cost of failure, and that is why it is so important to have a co-ordinated, joined-up approach. One statistic that has always stayed in my mind is that if a 15 or 16-year-old at school suffers from depression or some form of mental illness, there is a 99% likelihood that their mum suffered from some form of perinatal mental illness or depression—the link is that close. We should be spending so much more time and resources on looking at the pre-school period, particularly from conception to age two, because that is where it all goes pear-shaped. We see the consequences throughout childhood, and they so often carry on into adulthood and stay with the person for the rest of their life. So of course we should be doing more about this, and I am glad that at last the Government have recognised that that is where all the action—or a lot more of the action —needs to be focused.

On health visitors, I agree with the Local Government Association, which has said it is important for the Government to work

“on a children’s workforce strategy to support the development of a well-qualified, well-resourced workforce with the appropriate knowledge, skills and experience to work in a preventative way. This needs to be an integrated strategy between local authorities, health, education and community and voluntary sector partners, which links effectively with established programmes, such as Supporting Families, Sure Start and Family Hubs and puts the child’s journey at the centre.”

That strategy, it adds, needs to be properly resourced. Well, we are having a lot of extra resource. We could all argue that it is not enough, and the more Opposition Members argue that it is not enough the more I will welcome that, because we could always do with more money; but I think this has been a good start.

Let us look briefly at some of the action areas. One of them is the provision of seamless support for families. As my right hon. Friend the Member for South Northamptonshire has said, we need to have a lead person who knows all the facts and history of the family involved, and who has the power to say, “This is what needs to happen for that family”, and make sure that it happens. Then there is the welcoming hub for families. I can answer the earlier question from the hon. Member for Newcastle upon Tyne North by saying that 75 family hubs have been identified, in about half the number of local authority areas. I hope very much that the other 75 will follow very quickly, so that there is at least one per authority.

Can we get away from the idea that these hubs are a challenge to, or in place of, children’s centres? They are building on the experience of children’s centres and are complementary to them, but they are not just about bricks and mortar; they are about services. I think that in the past we have been too hung up about the amount of bricks and mortar that we have rather than the quality of the services provided, whether as outreach or within children’s centres, and, most important, the outcomes that they are creating for the children for whom they exist and their families.

It is important to ensure that families have the right information at the time when they need it. When people are reluctant to cross the threshold of a children’s centre or a family hub, as my family in Stockport were, they need to have other ways of obtaining that information. It may be a night-time call line, or it may be online, on the internet. It may mean having another professional to call on, or even volunteers—even members of another family who are looking out for vulnerable families. What those people need is a trusted source of information that they can access, rely on and then act on to their benefit.

I think we have all learnt in the past that a top- down approach, with all the geeks in the civil service coming up with whizzy new schemes and trying to impose the same scheme in Newcastle as in a village in South Northamptonshire or a coastal town like Worthing, rarely works. We need national frameworks and national quality thresholds, and we need local design and local implementation. We need to hold people’s feet to the fire. Every local authority needs to come up with a best start in life plan. That local plan needs to meet the thresholds for children’s outcomes, and then the centre needs to ensure that authorities go ahead with those plans and achieve those outcomes. In that way we can have local ownership, local design and local flexibility that are in the best interests of children and their families.

I welcome the “best start in life” programme, and I congratulate all who have made it possible. This has been a huge joint effort. It has been a false economy not to look at those initial few pre-school years, because that is when we can have the biggest impact on the nurturing value of parents and the attachment that is so essential between a parent or parents and their children, when a child’s brain is growing exponentially—and will be impacted on for the rest of his or her life. At last we have a programme that realises that. Let us ensure that we make it a success for our future generations.

[Madam Deputy Speaker (Dame Rosie Winterton)]

Before I call the next speaker, I must tell the House that we have another debate following this one in which 11 Members have put in to speak so far, so we must be conscious that there are slight time pressures.

--- Later in debate ---

[Madam Deputy Speaker (Dame Rosie Winterton)]

I call Sarah Olney for a very brief wind-up.

Health Incentives Scheme

Baroness Winterton of Doncaster Excerpts

Friday 22nd October 2021 Commons Chamber

[Scott Benton (Blackpool South) (Con)]

As the Prime Minister pointed out at the Conservative party conference, life expectancy in Blackpool is 15 years lower than it is in some areas just a few miles away. This scheme will help to reduce those disparities. Does the Minister agree that Blackpool would be the ideal location for this pilot scheme?

[Madam Deputy Speaker (Dame Rosie Winterton)]

Just say yes.

[Maggie Throup]

I am not going to give a one-word answer on this occasion, but obviously the location will be chosen carefully and will be announced in due course.

[Maggie Throup]

Obviously we will be looking at ways in which we can engage people, and ensure that they are fully aware of the pilot and have ready access to it.

[Madam Deputy Speaker (Dame Rosie Winterton)]

I thank the Minister for her statement. We now return to the debate on the Bill.

Covid-19: Government Response

Baroness Winterton of Doncaster Excerpts

Thursday 21st October 2021 Commons Chamber

[Maggie Throup]

I thank the hon. Gentleman for his question. I reassure him that a lot of investment is being put into the health service, as I am sure he is aware, to ensure that we can tackle the backlog that has been created because of the pandemic.

[Madam Deputy Speaker (Dame Rosie Winterton)]

I gather there may be a point of order. Did somebody wish to raise a point of order? We need to move on. There should be a statement from the Secretary of State.

[Emily Thornberry (Islington South and Finsbury) (Lab)]

On a point of order, Madam Deputy Speaker.

[Madam Deputy Speaker]

Ah—a point of order!

[Emily Thornberry]

Can you advise me how best to deal with the stress levels created by this morning’s timetable? I do not mean to complain—I am a big girl—but, quite frankly, I had departmental questions this morning, we heard on the grapevine that there was going to be a statement on the Trade and Agriculture Commission, for which we have been waiting for more than six months, and we also heard last night that there was going to be a deal with New Zealand.

I got a copy of the Government statement on the deal with New Zealand at six minutes past 10 this morning, when I was obviously on my feet dealing with departmental questions here. I do not complain about where my office is, as I have a wonderful office, but it does take quite a long time to get to it. I need to get to it, pick up the statement that has been given to me by the Government, read it, write what I am going to say, make sure that it is only half the length of the statement and then come back.

I also want to make reference, of course, to the Trade and Agriculture Commission, which the Government have said is a really important part of any future deal that they negotiate, because of the grave concerns that farmers have about their future business, to which the TAC is supposed to be part of the remedy. We got a written ministerial statement, which I received 20 minutes ago while running back from my office. [Laughter.] I got a ministerial statement at six minutes past 10. We have to put all those things together. Although in many ways it is funny, if I was a frontline farmer I would not find this funny at all.

[Madam Deputy Speaker]

I thank the right hon. Lady for that point of order. I very much suspect that the Secretary of State should also thank the right hon. Lady for that point of order. We have had some examples this morning of the way in which not to do business in this House. It is vital that Secretaries of State ensure that they are here in good time for their statements. I think that expresses the opinion of all in this House. Stress levels have been raised by this, so the best thing now is to move on as quickly as possible. I am sure that the International Trade Secretary will want to apologise—I call her to make her statement.