Article 50 Extension

Debate between Sarah Wollaston and Steve Barclay

Wednesday 20th March 2019 Commons Chamber

[Stephen Barclay]

My right hon. Friend is right in that the suggestion that this House has not had sufficient time—that was one of the points made earlier—self-evidently does not reflect the extensive debates we have held. The idea that the House has not had the opportunity to express its will, when it has done so repeatedly on the issues, including last Thursday, is simply not credible.

[Dr Sarah Wollaston (Totnes) (Ind)]

Will the Secretary of State give way?

[Stephen Barclay]

I should make some progress, and I am conscious, Mr Speaker, that you will no doubt say I am taking too many interventions, but given it is the hon. Lady, I will give way.

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[Dr Wollaston]

The Secretary of State will know that this House has rejected the Prime Minister’s deal twice by historic margins now—it is neither the will of the House nor the will of the public—and it has also rejected very resoundingly leaving with no deal. However, we have not yet had in Government time an opportunity to do just what he asks, which is for the House to give an indication of what it would support. Will he support bringing forward the opportunity to give an opinion on indicative votes in the next week, preferably on Saturday?

[Stephen Barclay]

I am not sure that Saturday would be the most popular of responses with colleagues across the House, but we have given a commitment, as the hon. Lady knows, to a meaningful vote on Monday and, following that, there will obviously be opportunities for the House to have its say. Let me make some progress.

Any extension is the means, not the end, but any extension of whatever length does not allow this House to escape its responsibilities to decide where it stands: whether to keep its commitment to deliver on the decision it gave to the British people or to walk away from doing so. Nor should an extension mean that a guerrilla campaign can be run to overturn the result of the referendum and frustrate the will of those who voted to leave.

I disagree with the suggestion of the shadow Chancellor, who is not in his place, that any extension should be open ended. I think he said that it should be “as long as necessary”. Indeed, he was at odds with other Labour Front Benchers. The right hon. Member for Islington South and Finsbury (Emily Thornberry) said only the day before that the Labour party would back an extension just to July because

“it would be inappropriate for us to stand for the European Parliament”.

An open-ended delay would be likely to mean no Brexit and disregarding the votes of the 17.4 million people who voted to leave.

We now need to use any additional time to ensure that an orderly Brexit is delivered. The Leader of the Opposition has not said to date how long an extension he seeks. I do not know whether Labour Front Benchers wish to use the opportunity of this emergency debate to put on record exactly how long an extension they support.

Dangerous Waste and Body Parts Disposal: NHS

Debate between Sarah Wollaston and Steve Barclay

Tuesday 9th October 2018 Commons Chamber

[Stephen Barclay]

Let me pick up on the various points that the hon. Gentleman has raised. On when Parliament was told, as I said in my statement, the partial suspension notice was served on the company on 3 October and new contracts were put in place over the weekend. This is, therefore, the first opportunity, following what had been commercially sensitive negotiations, to notify the House. It is also right to remind Members that the key strategic objective throughout has been to maintain operations at NHS hospitals to ensure that clinical waste is being collected. That strategic objective has been maintained at all times.

The hon. Gentleman asked a number of other questions, including whether there is enough incinerator capacity in the system. The answer to that is, yes there is. There are 24 incinerators. The Department for Environment, Food and Rural Affairs estimates that there is more than 30,000 tonnes of spare capacity in the system, and that there is significant capacity over and above that required by HES to perform its contract, so I can be very clear to the House that, moving forward, there is sufficient incinerator capacity.

The hon. Gentleman used some inflammatory language. It is worth reminding the House that just 1.1% of this clinical waste is anatomical, so some of the media headlines are slightly out of step with reality. The partial suspension that has been served on Normanton is solely in respect of the incinerator; it does not apply to the other sites under HES contractual arrangements with the trust.

The hon. Gentleman asked whether the waste was being secured safely. The answer is yes; the Environment Agency has been inspecting the situation. The issue is the overstorage of waste, not that the waste is not being stored in a safe manner. [Interruption.] Well, that is the legal remit of the Environment Agency, which is an independent body. It is right that the law is applied; the hon. Gentleman may not like to apply the law, but this is the legal process. Officials from the Department of Health have been to the major trauma sites to see the contingency plans at first hand, and the storage and capacity is in place at those sites.

The reality is that there was a contractual arrangement with a supplier that stored the waste correctly, but stored too much of it. The Environment Agency is enforcing against that. We have put in place contingency plans within the trusts and set up alternative provision in the form of a contract with Mitie. The key strategic objective of ensuring that NHS operations continue has been secured.

[Dr Sarah Wollaston (Totnes) (Con)]

I thank the Minister for the prompt action that he has taken since being notified of this situation. Will he reassure people in the community and in community settings that this issue will not affect their safety?

[Stephen Barclay]

The Chair of the Health Committee raises an important point regarding residents in the areas where the sites are located, and I see the right hon. Member for Normanton, Pontefract and Castleford (Yvette Cooper) in her place. The Environment Agency has confirmed that the waste is being stored safely; it is the amount of waste that is the issue. Many of our constituents are waiting for operations on these sites and will want reassurance that those operations can continue in a timely fashion. That has been a key focus of the Department, and I pay tribute to the work of officials in the NHS, the Department of Health, DEFRA and the Environment Agency, who have ensured that that strategic objective has been maintained.

Integrated Care

Debate between Sarah Wollaston and Steve Barclay

Thursday 6th September 2018 Westminster Hall

[The Minister for Health (Stephen Barclay)]

indicated assent.

[Dr Wollaston]

Coming back to why integrated care does not happen, there are many deeply ingrained structural divides. Since the inception of the NHS 70 years ago, we have had a system that is free at the point of use for the NHS, but means-tested for social care. That presents an extraordinary hurdle when systems are trying to join up. It is not just that; it is different contractual arrangements and working practices. Good integration comes down to individuals and teams being prepared to work together, but it often feels like they are working together to achieve integration despite the systems around them, not because of them.

We need a system where everybody is focused on helping the right kind of integration to take place, and we need to go back and look at that fundamental structural divide between the systems. I ask the Minister to look again at the joint report, “Long-term funding of adult social care”, because that is an important issue that goes to the heart of the barriers to joining up services. It is about contractual differences, different legal accountabilities and payment systems that work against the pooling of budgets, and financial pressures within the NHS.

A certain amount of financial pressure can encourage systems to come together to pool their arrangements and provide a more efficient service, but as the Minister will know, when the elastic is stretched too tight and the financial strain becomes critical, we see the opposite—systems are forced apart. I have seen that happen in my area, where people suddenly feel that they have to retreat to their organisational silos to fulfil their legal obligations. There is no doubt that, for the process to work effectively, we need the right amount of funding—and sufficient funding—and tweaks to the legislative arrangements to allow people to come together, so it does not feel as if they are working together despite the system.

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[The Minister for Health (Stephen Barclay)]

Thank you, Dame Cheryl, it is a pleasure once again to serve under your chairmanship. I join the hon. Member for Ellesmere Port and Neston (Justin Madders) in paying tribute to my hon. Friend the Member for Totnes (Dr Wollaston) as Chair of the Health and Social Care Committee, and to all the members of the Committee, for a very good report and for raising important issues regularly on behalf of the NHS and the wider health fraternity.

As a country, we are living longer, which clearly is to be celebrated. However, it means that people live with multiple long-term and more complex conditions. For the NHS to continue to deliver high-quality care as it has done for the last 70 years, it is increasingly important for NHS services to work closely with social care. We got a flavour of that from a number of the remarks made in the debate.

I very much welcome the Committee’s conclusion that fears that integration might lead to privatisation are unfounded. Indeed, the Chair of the Committee said,

“The evidence to our inquiry was that ACOs,”—

now referred to as integrated care partnerships—

“and other efforts to integrate health systems and social care, will not extend the scope of NHS privatisation and may effectively do the opposite.”

That relates to some of the points I will make on pre-legislative scrutiny and points to the value of the work done by the Health and Social Care Committee to provide a cross-party view of proposals, which has allowed us to address some of the myths built up in the past. The Committee has done the House a service by slaying some of those misconceptions.

[Dr Wollaston]

I thank the Minister for referring to my remarks, but does he accept that the Committee went on to say that we felt the issue of privatisation should be put beyond doubt in legislation?

Education (Student Support)

Debate between Sarah Wollaston and Steve Barclay

Wednesday 9th May 2018 Commons Chamber

[Stephen Barclay]

I have given way quite a lot, so I will make a little progress.

In addressing the Opposition’s points, we have moved slightly outside the scope of the SI before the House, which concerns postgraduates, into a discussion about undergraduates, and the Chair of the Health Committee, my hon. Friend the Member for Totnes (Dr Wollaston), made the point that the postgraduate market has certain features that are distinct from the undergraduate market. In certain disciplines, such as mental health and learning and disability, some older applicants may be more risk averse about taking on a student loan, depending on when they did their first degree. If it was before 1998, they probably will not have a student loan, but let us not forget that the Labour party introduced tuition fees, so many who studied after 1998 will have a loan.

Working in conjunction with colleagues in the Department for Education, and taking some of the lessons about targeted support that have been learned in teaching, we intend to offer £10,000 golden hellos to postgraduate students in specific hard-to-recruit disciplines—mental health, learning and disability, and district nursing—to reflect the fact that those disciplines often have particular recruitment difficulties. That £9.1 million package will be supplemented by a further £900,000 to mitigate a particular challenge with recruiting in any geographical areas. For example, if an area such as Cornwall suddenly found itself having difficulty in recruiting speech and language therapy recruits, a targeted measure—perhaps at a different quantum from £10,000—could be implemented in order to reflect those geographical issues.

[Dr Sarah Wollaston (Totnes) (Con)]

I thank the Minister for meeting me to discuss the concerns raised by the Health Committee in our nursing workforce inquiry. As he has stated, applicants for learning disability and mental health nursing tend to be older, and those applicants are more likely to stay. They are particularly affected, so I am grateful to the Minister for listening to our concerns. Putting the needs of patients first by allowing for these targeted extra packages is very welcome.

[Stephen Barclay]

I am grateful for that support from the Chair of the Health Committee. Having spent four years on the Committee myself, I know the value that members of Select Committees bring to the House. The Health Committee, particularly under her chairmanship, is hugely valued in the Department. The mitigation package that has been put before the House tonight reflects the constructive engagement that we have had with the Committee. We realise the importance of having consistency between undergraduates and postgraduates, and of expanding the supply of places, but it is also important to recognise that there might be specific areas in which there are recruitment challenges, and that targeted action to mitigate those challenges is appropriate.

Leaving the EU: NHS

Debate between Sarah Wollaston and Steve Barclay

Thursday 22nd March 2018 Westminster Hall

[Stephen Barclay]

Of course we are making representations to the Home Office, but the Prime Minister has signalled our commitment to attracting the brightest and best, and that will continue. What has been negotiated so far probably gives the hon. Gentleman the best signal. What the Prime Minister announced in December and what my right hon. Friend the Secretary of State for Exiting the European Union announced this week about a transition deal actually protects the rights of EU citizens. That underscores the Government’s commitment to ensuring that a positive message is sent to EU staff in the NHS.

[Dr Sarah Wollaston (Totnes) (Con)]

I thank the Minister for giving way and apologise for not making a fuller contribution to this important debate; I had a long-standing commitment as Chair of the Health and Social Care Committee that could not be delayed.

On the workforce, will the Minister comment on a small area that the Committee highlighted in its report but which many people are not aware of: the role of qualified persons? That is the individuals who are legally responsible for batch-testing drugs before they are released on to the market or made available for clinical trials. Will he pay close attention to the problems that will arise and the impact on clinical trials and the safety of medicines if qualified persons are no longer recognised in the UK after it leaves the European Union? That workforce is in great demand, and there is clear evidence that many of them will have to leave to the EU if that happens, leaving Britain short.

[Stephen Barclay]

I am very happy to recognise my hon. Friend’s point, which is well made. As she knows, I am keen to have close discussions with her about such issues. However, through our adoption of the acquis into UK law, our desire for a transition deal, our protection of workers’ rights and our clear signal to EU citizens, the Government have signalled that we are committed to working collaboratively with the EU and to maintaining high standards. Indeed, science and healthcare is one of the areas where collaboration is best and where the EU has the strongest desire to maintain that collaboration. We work from firm foundations as we take on some of these specific issues, which the Department will continue to explore.

At the same time as attracting talent from overseas—from both the EU and beyond—we should not lose sight of the importance of growing our own workforce. Again, the Government have clearly signalled our intention in that regard, with a 25% expansion of undergraduate places for nursing and our announcement earlier this week of five new medical training centres, in Sunderland, Lincoln, Lancashire, Chelmsford and Canterbury. There is a clear desire to strengthen training for the existing workforce.

That sits alongside other initiatives, such as apprenticeships and ensuring that there are different pathways for people to progress in the NHS. That will ensure that people can develop their careers at different stages, so that someone who enters the system as a healthcare assistant, for example, is not trapped in that role but is able to progress through the nursing associate route and go on to be a qualified nurse. There are myriad ways in which we need to ensure that the NHS has the right skills.

That brings me to my hon. Friend the Member for Bosworth (David Tredinnick), who talked about broadening the base of practitioners, an issue on which he has campaigned assiduously for many years. I agree that we do need to broaden the base. That must always be addressed in an evidence-based manner. He cited an interesting BMJ report. However, initiatives are already under way to look at how we have a broader base and more of a multidisciplinary team, for example with physician assistants working alongside GPs in addition to nurses. The issues he raised speak to that.

The hon. Member for Hammersmith (Andy Slaughter) referred to people leaving. In fact, he said that people are voting with their feet, but that is slightly at odds with the fact that there is a net increase in EU staff. It is important that we in this House do not give a sense of negativity or rerunning past arguments on the referendum but start to look forward and reassure people on how much they are welcomed.

A point that came out of remarks by the right hon. Member for Exeter and a number of colleagues in the debate was about the life sciences industry. Again, one did not really get a sense of the reality. The reality is that last year London secured the most investment of any city in Europe—that is post-referendum. Therefore, the doom and gloom and sense that everything is drifting from our life science industry—

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[Stephen Barclay]

I am very happy to write to the hon. Gentleman about that. The question of the border is for deep negotiation with our European partners. There is a desire on both sides for us to get it right, particularly given the sensitivities in Northern Ireland.

[Dr Wollaston]

Will the Minister comment on the need for contingency planning, which is one of the central themes of our report? As he knows, nothing is agreed until everything is agreed, and there is genuine concern that we could have a last-minute no-deal scenario, which would have major implications for supply chains in the life sciences industry. Will he confirm whether he will publish a detailed list of the areas in which contingency planning is taking place? Will he also publish the detailed contingency planning?

[Stephen Barclay]

The Chair of the Committee is absolutely right about the importance of contingency planning. In the Scottish context, on the steps of No. 10 recently, a critic of the Government as fierce as the First Minister praised the level of discussion between the devolved Government in Scotland and the UK, and her discussions with the Prime Minister.

It may reassure my hon. Friend to hear that the Department has secured additional funding from the Treasury—more than £20 million—as part of our preparation for Brexit. The right hon. Member for Exeter has previously asked in the House whether the Department’s preparation and staff resource are at the level that he and other colleagues seek. That is a fair observation, and the situation is continually being improved. Alongside that, considerable work is going on within the wider NHS family—in NHS England, NHS Improvement and elsewhere.

Like the Prime Minister and the Secretary of State, I emphasise once again the importance of EU staff within the NHS. They are hugely valued and will continue to be so, and we are keen to protect their workers’ rights. That is reflected in the agreements reached by the Prime Minister in December and those reached earlier this week by the Secretary of State for Exiting the European Union. Alongside that, considerable work is going on within the Department to address a number of these issues as part of our contingency planning. We continue to seek a very close co-operative deal with our partners in the European Union. In areas such as science, there is a long and strong tradition of working in such a collaborative manner. As part of continuing those preparations, this debate and the Committee’s informed report provide much material on which we can work.

Acute and Community Health

Debate between Sarah Wollaston and Steve Barclay

Thursday 8th February 2018 Commons Chamber

[Stephen Barclay]

I thank the shadow Minister for his questions and the manner in which he put them before the House. His first key question was to what extent measures are in place to address this sort of issue, should it arise again. Post Francis, and following Sir Bruce Keogh’s review of 14 trusts with high mortality rates, a new regime has been put in place. There is a new chief inspector of hospitals, Professor Ted Baker, and a specific regime involving NHS Improvement, which commissioned this report. NHS Improvement has a new chair, Dido Harding, a very senior figure from the business community.

That regime has put 37 hospitals into special measures so far. The methodology that is used to alert regulators to areas of concern has also been revised. For example, far more importance is now placed on staff and patient surveys. However, it remains to be explained why a trust could pay so many compromise agreements, for example, in response to so many staff disciplinary issues. I assume that many concerns were raised by trade unions locally, as no doubt the hon. Gentleman is aware. We must also consider the extent to which earlier reports, such as the Capsticks report, raised concerns that should have been addressed. That is why, in my statement, I signalled my desire to look at those issues and ensure that they are addressed by the fit and proper person test in particular. As he will be aware, though, that test pertains only to board-level appointments in the NHS, not to all roles. We will need to look at that scope, at the effectiveness of the investigation and particularly at the revolving door element of the problem, which he recognised.

Turning to the other issues that the shadow Minister raised, we clearly need to ensure that due process is followed. I do not need to remind the House of the difficulties of any enforcement against for instance, Fred Goodwin in financial services or Sharon Shoesmith in child services. People rightly expect due process, and all hon. Members would ask for that. The victims will rightly ask, “How can the chief executive, with this catalogue of issues, move within the NHS rather than be fired?” I know that the hon. Member for West Lancashire (Rosie Cooper) has many concerns about that, as do the Health Committee and many other Members.

I look forward to working with the hon. Member for Ellesmere Port and Neston (Justin Madders) in the spirit in which he raised these issues. We share concerns, and I know the House as a whole wants us to get to the heart of them.

[Dr Sarah Wollaston (Totnes) (Con)]

I pay tribute to my colleague on the Health Committee, the hon. Member for West Lancashire (Rosie Cooper). She is a remarkable parliamentarian and advocate for patient safety. All of us on the Committee look forward to working alongside her to examine in full the Kirkup report’s recommendations, and I welcome the Minister’s commitment to a review of the fit and proper person test.

On the wider issues that the report raises, it is clear that when staff and funding continue to be cut from community services, there are terrible consequences for patient care. Will the Minister assure the House that he will work closely alongside the Care Quality Commission to identify other trusts in which issues such as this are likely to arise because of the workforce and funding pressures that are now being faced?

[Stephen Barclay]

I am very happy to work with my hon. Friend on this. As she will be aware from reading the report, it is explicit that the finances were there for the existing service. That is stated at the outset of the report. What drove the problems was a wholly unrealistic attempt to seek foundation trust status, with a cost improvement plan that was simply undeliverable. There was a massive reduction, without any attempt to reconcile that with serious issues on staff levels and vacancies. As the report explicitly sets out, when staff raised those concerns, they were bullied, harassed and on occasion suspended without due cause. The culture has changed significantly, and measures have been put in place for how the regime involving NHS Improvement would address such issues and look at cost improvement plans.

On the extent to which the culture was driving the problems, I refer to the remarks I made in my statement. According to the report, the interim chief executive went in and found a significant underspend—£3 million—in the district nursing budget, at the same time as there were significant vacancies and patient harm. That culture was driving the issue, and that culture is what we need to put an end to.

NHS Winter Crisis

Debate between Sarah Wollaston and Steve Barclay

Monday 5th February 2018 Commons Chamber

[Stephen Barclay]

If the hon. Gentleman would like to compare with the performance of the NHS in Wales, we will undertake a comparison. The reality is that this year, we have had pressure on the NHS as a result of flu. The difference is that in 2009, the Conservative party did not play politics with the flu pressures. This year, the hon. Member for Leicester South has done so. He should compare it with the pressure in Wales and see the excellent performance we have had in comparison.

[Dr Sarah Wollaston (Totnes) (Con)]

The Minister will know that pressures in the NHS cannot be viewed in isolation from pressures in the community. It is great to see that he is now part of a Department of Health and Social Care. Will he say what is being done about making beds available in the community, to free up pressures in the NHS?

[Stephen Barclay]

My hon. Friend, the Chair of the Health Select Committee, makes a valid point about the need for much more integration in our approach to the NHS. That is reflected in the appointment of my hon. Friend the Member for Gosport (Caroline Dinenage) as the Minister for Care, to look at that exact point.

Part of it is also looking at how we address other areas to deliver better outcomes. For example, 43% of bed occupancy at present is from just 5% of patients—those staying over 21 days. One key issue is how we bring down the current average stay from 40 days to, say, 35 days. That alone would unlock around 5,000 beds. We are looking at a more integrated model to address the pathways that I know my hon. Friend has highlighted in the Health Committee as a key priority.