Health and Care Bill (Twenty First sitting)

Debate between Sarah Owen and Edward Argar

Committee stage
Thursday 28th October 2021 Public Bill Committees

[Edward Argar]

The new clause would require ICBs to provide specialist domestic violence and abuse training, support and referral programmes to all GPs, with the aim of strengthening the health response to domestic abuse and improving links between the NHS and voluntary sector support for victims. We have concerns about the new clause, which is why we cannot accept it, but I hope that I can set out to the shadow Minister my reasoning.

Domestic abuse, as we discussed yesterday when considering another proposed new clause, is a terrible crime, and it can have a devastating impact on victims and survivors. It is also important that we remember that children are often just as much victims as the victims themselves, through the experiences that they have of domestic abuse and domestic violence. The Government are clear that there is absolutely no excuse for abuse. Tackling domestic abuse and supporting victims, survivors and their children is a key priority for Government, now more than ever.

The Domestic Abuse Act 2021 and the forthcoming domestic abuse strategy will help to provide a whole-system approach to protect and support victims and their children. The measures in the 2021 Act seek to promote awareness by introducing a statutory definition of domestic abuse, and to recognise children, as I alluded to, as victims in their own right, in order to protect and support both, tackle perpetrators, transform the justice response, and drive consistency and better performance in the response to domestic abuse.

The 2021 Act also sets out the convening of local domestic abuse partnership boards, with healthcare representation. We recognise the key role that healthcare services play within a whole-system approach to tackling domestic violence. Healthcare services must identify signs of risk and harm, enable victims and survivors to come forward, and provide timely integrated care and support. We know how important it is that statutory agencies and professionals properly understand and react to domestic abuse. However, I hope that I can reassure the Committee that placing in the Bill a formal duty on ICBs to ensure that specialist domestic violence and abuse training, support and referral programmes are universally available to all GPs is not necessary.

General practice is delivered by multidisciplinary teams, rather than just GPs, and existing Care Quality Commission registration requirements include a review of practices’ safeguarding processes. In addition, NHSEI’s ICS people guidance sets an expectation that ICBs will foster learning and continuing professional development. Going further, the Bill, in proposed new section 14Z41 of the National Health Service Act 2006, imposes a duty that each ICB

“must, in exercising its functions, have regard to the need to promote education and training for the persons mentioned in section 1F(1)”

of the 2006 Act.

[Sarah Owen (Luton North) (Lab)]

Again, I break the convention that Whips do not speak, because this issue is close to my heart. I listened carefully to the discussions yesterday, and to what the shadow Minister, my hon. Friend the Member for Nottingham North, and the Minister have said on the new clause, but if we looked at domestic abuse as a disease or virus, given the fact that it kills women, it kills people in their homes, and has mental and economic impacts that affect people’s overall health, we would certainly ensure that GPs were trained on it. Why can we not do the same thing with domestic abuse?

[Edward Argar]

I am grateful to the hon. Lady. In part, the reason is because this is sadly not a well drafted new clause. It is very narrowly drafted to GPs, not recognising the multidisciplinary nature of how healthcare is delivered in GP practices. I suspect that we all have correspondence from constituents—whether happy or unhappy—going to doctor associates, practice nurses and others. That is one of my key concerns, but let me articulate a little more what is already being done. I see where she is coming from. As I mentioned yesterday, I was the Minister with responsibility for victims of domestic violence, and of crime in general, when I was in the Ministry of Justice, so it is something that I am very familiar with. It is about raising awareness not just with GPs, but within the police and a range of agencies. My challenge, just before she intervened, was partly about the way the new clause is drawn, but let me articulate a little further our views on it. I am keen to do so before the business possibly collapses early in the House, and we have to adjourn in order that I can respond to the Adjournment debate.

Section 1F of the 2006 Act defines a wide group of people, covering persons who are employed, or who are considering becoming employed, in an activity that involves or is connected with the provision of services as part of the health service in England. That duty on ICBs would already cover general practitioners, but it goes wider. I appreciate that the new clause goes beyond training, so I will also discuss the support and referral elements that the hon. Member for Nottingham North talked about.

The NHS provides care and support to victims of domestic abuse through a range of healthcare services. This response is centred around ensuring that healthcare professionals are trained to spot the signs of domestic abuse and those at risk; to make safe and sensitive enquiry of the issue; to know where to refer people to get further support, and to know when and how to share information appropriately with colleagues and other organisations.

All NHS staff must undertake annual mandatory safeguarding training, which includes focus on domestic abuse. NHS England, NHS Improvement and Health Education England are reviewing mandatory safeguarding training for all health professionals to ensure that they are fully equipped with the key skills, knowledge and principles to protect all citizens. The Government published an online domestic abuse resource for health professionals and have developed a number of training modules with the Institute of Health Professionals, the Royal College of Nursing and the Royal College of General Practitioners.

From 2018 to 2020, the Department managed £2 million of funding for the domestic abuse pathfinder programme, which created a model health response for survivors of domestic violence and abuse in acute, community and mental health services. The pathfinder toolkit was published in 2020 as the result of emerging promising practice at our pilot sites, coupled with the expertise of the pathfinder consortium of specialist domestic abuse organisations, to encourage best practice across the health system. Pathfinder has given us a model for our response to domestic abuse in healthcare. It is a model for integrated, joined-up and trauma-informed care and support, with healthcare settings and the voluntary sector working together.

As the shadow Minister mentioned, the Department of Health and Social Care has also funded the IRIS programme, to which I pay tribute. IRIS is a training, referral and advocacy model to support clinicians in better supporting patients who are affected by domestic violence and abuse, and to increase the awareness of domestic violence and abuse within general practice. IRIS is recognised by the DHSC as good practice, and via the National Institute for Health Research we funded a study that demonstrated the effectiveness of the IRIS programme at scale. I am delighted to note that the study won the 2020 Royal College of General Practitioners research paper of the year award.

I am proud that the Government have championed the building of that evidence base. I believe that it would not be best or appropriate, however, for the legislation to require local health and care systems to adopt specific programmes. Indeed, such detailed requirements would reduce local health and care partners’ flexibility to meet the needs of their local populations or to engage with particular local organisations and expertise in delivering their programmes.

Beyond ICBs, I see a huge opportunity for integrated care partnerships to support improved services for victims of domestic abuse, sexual violence and other forms of harm, through better partnership working and joint planning of services. The Government have also developed a cross-Government strategy for tackling violence against women and girls, and will develop a cross-Government domestic abuse strategy.

As committed to in the tackling violence against women and girls strategy, the DHSC will continue to work closely with NHS England and NHS Improvement to promote evidence-based approaches to tackling violence and abuse through guidance and engagement with the new system.

Health and Care Bill (Ninth sitting)

Debate between Sarah Owen and Edward Argar

Committee stage
Tuesday 21st September 2021 Public Bill Committees

[Sarah Owen (Luton North) (Lab)]

I know it is not the done thing for Whips to contribute to debates, but because I have been a care worker, this part of the Bill is close to home for me. I wanted to touch on the word that the Minister used when he spoke about “assumptions” about workforce planning. Does he agree that actual independence takes away the need for Ministers to make assumptions, and that is why the amendment is important? Otherwise, Ministers are in danger of marking their own homework when it comes to whether they have met the workforce projections that they say they have met.

[Edward Argar]

The hon. Lady alludes to it not being normal form for a Whip to intervene, but her contribution is, as ever, extremely valuable in this context—particularly given the work that she did before she became a Member of this House—and I am grateful to her. My counterpoint would be that we need to be cautious about a separation of projections and planning from the reality of day-to-day delivery. The system, as envisaged, will bring together an actual knowledge of what is going on on the ground with those projections and data delivery.

I suspect that I will not convince the hon. Lady, but I recognise and acknowledge the expertise that she brings to the area. Back in my days as a councillor, I was a cabinet member for adult social care and saw at first hand the amazing work done by care professionals and by volunteers in the care sector. Notwithstanding any political disagreements we might have, I pay tribute to her for that.

Finally, regarding the consultation requirements in amendments 94 and 41, I assure the Committee that consultation already happens throughout the workforce planning and delivery process. To give a recent example of such engagement, HEE completed a call for evidence as part of its refreshed “Framework 15”. That call for evidence closed on 6 September and received responses from a wide variety of bodies. Between October and April of next year, engagement and consultation will continue through various events led by HEE. I am sure that as I assume my new responsibilities, I will occasionally be questioned on those by the shadow Minister, either across the Dispatch Box or in written questions and letters, as is his wont and, indeed, his right.

At local level, ICBs will be under various workforce-related responsibilities and obligations, as I have set out. As part of that work, we can expect ICBs to work with local stakeholders in their area. We expect all this stakeholder consultation to continue, but we want engagement to be flexible, in keeping with one of the principles—the permissive principle—behind the Bill.

Let me turn to the issue of safe staffing. Amendment 42 would significantly amend our proposed workforce accountability report so that it would have to cover an assessment by the Secretary of State of safe staffing levels for the health service in England and whether those were being met. The effect of the amendment in reality would be to require the Secretary of State to make such an assessment but, in so doing, risk detracting from the responsibility of clinical and other leaders at local level for ensuring safe staffing, reflecting their expertise and local knowledge, supported by guidance and regulated by the Care Quality Commission. We do not support the amendment as drafted, for various reasons.

First, there is no single ratio or formula that can calculate the answer to what represents safe staffing in a particular context, and therefore against which the Secretary of State could make an objective assessment. It will, as we have seen over the past year and a half, differ across and within an organisation. Reaching the right mix, for the right circumstances and the right clinical outcomes, requires the use of evidence-based tools, the exercise of professional judgment and a multi-professional approach. Consequently, in England, we think that the responsibility for staffing levels should remain with clinical and other leaders at local level, responding to local needs, utilising their expertise, supported by guidelines from national bodies and professional organisations, and all overseen and regulated by the CQC.

Secondly, the amendment would require the formulation of safe staffing levels against which the NHS workforce could be assessed. I fear that that would be a retrograde step, as it would inhibit the development of the more productive skill mixes that are needed for a more innovative and flexible workforce for the future. That new workforce is crucial to successful implementation of the new models of integrated care that the Bill is intended to support.

The specific wording of the amendment is incredibly broad and would require the Secretary of State to assess safe staffing levels across all healthcare settings, across the whole of England, for all medical and clinical staff. Such a duty would be burdensome not only for the national system but, potentially, locally—for local clinical leaders. It would move us away from that local accountability and expertise.

I assure the Committee that we will continue to engage with stakeholders and hon. Members, including my right hon. Friend the Member for Kingswood, to look closely at this area. I want to reassure Members, including Opposition Members, that we have heard their concerns and the views that they have expressed in relation to workforce in today’s debate and reflecting the evidence of witnesses. I am grateful, as ever, for the tone in which the shadow Minister has raised his concerns and put his points. We will carefully consider these issues and continue to ensure, and to reflect on ensuring, that we work to address them through the Department’s wider work on workforce.

Let me just say, before concluding, that while we were doing the changeover between clauses, I did a very quick check and I believe I was correct in my answer to the shadow Minister that no applications were currently pending for foundation trusts. I wanted to clarify that it turns out I was right—I suspect he thinks he was right in his assumption as well.

For the reasons that I have set out, I encourage hon. Members not to push these amendments to a Division but to continue engaging with me and other Ministers.

Coronavirus

Debate between Sarah Owen and Edward Argar

Wednesday 16th June 2021 Commons Chamber

[The Minister for Health (Edward Argar)]

At the outset, I associate myself with the shadow Minister’s remarks in respect of our late colleague, Jo Cox. As we stand at this Dispatch Box, we can see the coat of arms above the Opposition Benches. I pay tribute to her and to all the work that she did while she was in this place, and before.

I would much rather I were not standing here today urging and encouraging colleagues to vote for this motion. I know that colleagues would wish that it were not necessary, but I regret to say that it is. We have made huge progress—progress that has been made possible by our phenomenal vaccine roll-out programme. The tribute for that goes to the scientists who developed the vaccine, those who procured it, the NHS, all the volunteers, the charities, the military, The Sun’s jabs army and everyone who has played their part in helping to deliver this programme. That progress has also been made possible by the incredible efforts of the British people, and by the dedication of everyone who works in our health and care system. I know the shadow Minister will join me in expressing our joint gratitude to them all.

As the Prime Minister set out on Monday, this vaccine remains our route out of the pandemic. With every day that goes by, we are better protected by our vaccines, but the delta variant has made the race between virus and vaccine much tighter. Cases continue to grow rapidly each week in the worst-affected areas. The number of people being admitted to hospital in England has begun to rise, and the number of people in ICUs is also rising, but the vaccine remains our way out.

Data published this week shows that two doses of the jab are just as effective against hospital admission with the delta variant, compared with the alpha variant, and indeed they may even be more effective against the delta variant. That underlines the importance of that second jab and the need for more of us to have the chance to get its life-saving protection.

My right hon. Friend the Member for North Somerset (Dr Fox) put it far more effectively than I dare say I will be able to do. He was absolutely right to highlight the crucial importance, over the next few weeks, of getting those second jabs—particularly the AstraZeneca vaccine—into people’s arms. He is right to highlight that after one jab, the Pfizer vaccine is highly effective, but we need two jabs of the AstraZeneca vaccine to provide that level of protection. It is important, in that context, to remember that the AZ vaccine is the workhorse of our vaccination programme. More than 30 million people have now received their second jab, and in one month’s time that number could stand as high as 40 million. My right hon. Friend the Secretary of State highlighted in his remarks an important factor in getting those second doses into people’s arms. There are still 1.2 million over-50s who have had their first dose—they are not declining the vaccine; they have had the first dose—but who need the second dose to provide that high level of protection. Similarly, there are 4.4 million over-40s who need their second dose. With the delta variant now making up nine in 10 of the cases across the UK, it is vital we bridge the gap and get many more people that life-saving second jab.

This extra time will allow us to get more needles into more arms, getting us the protection that we need and enabling us to see restrictions fall away on 19 July. In that vein, I would remind colleagues of the quote from the Prime Minister on Monday, when he was very clear:

“As things stand, and on the evidence that I can see right now, I am confident that we will not need more than four weeks and that we won’t need to go beyond 19 July.”

[Sarah Owen]

The Minister just said that the Prime Minister has given assurances about another four weeks, but we have had this time and time again. Why should the British people believe the Prime Minister now?

[Edward Argar]

The short answer is that the British people do believe the Prime Minister now.

We face a difficult choice, and my hon. Friend the Member for Bosworth (Dr Evans) set it out extremely clearly. It reflects the underlying debate about risk. I am clear that we must learn to live with this disease, without the sort of restrictions we have seen. We cannot eradicate it. I have to say that, rather than relying on the views of the hon. Member for Leeds East (Richard Burgon), I am inclined to rely on the views of my right hon. Friend the Member for North Somerset, who made that point very clear. Those who advocate zero covid must realise that that is impractical and unachievable, and I consistently do not subscribe to the logic of those who argue for that course.

I am sure the House will agree that, to get to the point where we can learn to live with this disease, an extra few weeks are a price worth paying. I therefore urge the House to support these regulations today. No one can fail to be sympathetic to those who will be affected by this delay, including those couples who want to start their married lives together but have had to change or delay their plans. This weighs on me greatly, as it will on all hon. Members, and in this case I was pleased that we could ease the restrictions on weddings. Equally, I am mindful of those whose livelihoods will be affected by any delay in our road map. I urge the House to support this motion. It provides a short-term delay that significantly strengthens our position for the longer term.

My right hon. Friend the Member for Forest of Dean (Mr Harper) raised a couple of specific points which I will try to answer here; they relate to each other. He mentioned paragraph 7.7 of the explanatory memorandum and his concern that the first review date was on 19 July. I can clarify that the first review date is due by Monday 19 July and will be in advance of that point. That is a legal end point. I would anticipate an announcement coming probably a week before that on the decision and the data. I hope that gives him some reassurance about people having notice of what is coming.

In closing, I wish to express my sincere thanks to all those who have contributed to today’s debate. I am sorry that so few on the Opposition Benches chose to take part, but I pay tribute to those who did and to those on this side of the House for the sincerity, the strength of feeling and the integrity that they have shown. I hope the House recognises that I have a deep-seated respect for all the views I have heard this afternoon. Hon. Members all want the same thing, which is to save lives and to see us exit these restrictions and return to normality as soon as possible. Difficult as it may be, I urge hon. Members across the House to vote for these measures to give ourselves that short extra time to vaccinate more people—crucially, with that second dose—and take us forward to the stronger, more confident future that we all seek, which I know is just around the corner and which I am confident the Prime Minister will take us to. I commend the motion to the House.

Question put.

Covid Contracts: Judicial Review

Debate between Sarah Owen and Edward Argar

Wednesday 24th February 2021 Commons Chamber

[Sarah Owen (Luton North) (Lab) [V]]

Covid contracts continue to be literally a matter of life and death, so the public are right to expect accountability and transparency. While nurses wore bin bags instead of proper PPE, contracts were handed out to Ministers’ mates. Will the Minister do the right thing and, at the very least, reveal the 29 businesses Serco outsourced operations to?

[Edward Argar]

We have been clear, and as I highlighted earlier, the NAO has been exceptionally clear, that there are no suggestions of Ministers behaving inappropriately in any way in the awarding of these contracts. The judge did not find that in this case; it was not a factor. On the hon. Lady’s broader point, we have been clear that we believe in and fully respect transparency requirements, and the Department is publishing—as I illustrated with those latest figures that I put out earlier—the contracts it has. I once again come back to the judge’s saying that the Secretary of State is

“moving close to complete compliance.”

That is exactly what we will continue to do.