Draft Social Security Coordination (Reciprocal Healthcare) (Amendment etc) (EU Exit) Regulations 2019
Draft National Health Service (Cross-Border Healthcare and Miscellaneous Amendments etc.) (EU Exit) Regulations 2019
Draft Health Services (Cross-Border Health Care and Miscellaneous Amendments) (Northern Ireland) (EU Exit) Regulations 2019
Stella Creasy Excerpts(5 years, 1 month ago)
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Stephen Hammond
The hon. Gentleman has been in the House much longer than I have. He will know that it is not unusual to have statutory instruments grouped together. In fact, last week a number of SIs from the Department for Environment, Food and Rural Affairs were grouped together and discussed on the Floor of the House, and then voted on individually.
The rationale for this evening’s grouping is simple: they are all to do with reciprocal healthcare, ensuring that our citizens—in either a deal or, particularly, a no-deal situation—have the potential to have the rights that they currently enjoy, which is the Government’s aim. That is why I have asked for them to be grouped together. I am grateful to the Committee for allowing that. Had the hon. Gentleman chosen to do so, we could have discussed them individually. If he allows me the time to progress with my speech, I hope he will see the logic of why we have grouped them this evening.
Stella Creasy (Walthamstow) (Lab/Co-op)
I have a slightly different question for the Minister. He just spoke about his gratitude to the Scottish Parliament and the Welsh Assembly Government for their work on the legislative consent motions that these statutory instruments require. I note that in the explanatory memorandum it says that consent has also been sought from Northern Ireland. For the record, I would like the process by which consent has been sought from Northern Ireland on the measures to be set out.
Stephen Hammond
If the hon. Lady will allow me, I will tackle that in my speech. I will set out the arrangements that are in place with the Northern Ireland Executive, and if she is then not happy I will try to answer any questions at the end.
Stephen Hammond
Exasperation is something that many of us feel, Sir David. However, in some circumstances these instruments enable the Government to protect individuals irrespective of reciprocity with other countries. The issue was raised during the Lords’ consideration of the Healthcare (International Arrangements) Bill and has been misreported in the press.
I want to be absolutely clear, or at least I will try to be absolutely clear, and hopefully the hon. Member for Huddersfield will accept what I say. Through these instruments, we can finish funding healthcare for people in a transitional situation. That would cover those who are in the middle of a treatment on exit day, those who have already had treatment and are receiving post-treatment care, and those who have applied for or been given authorisation for the treatment before exit day. That will apply for a year, or for the period of authorisation, whichever is later. That, of course, assumes that the member state is willing to provide the treatment and accept reimbursement from the United Kingdom. The offer that the Government are making through these instruments is to continue to fund healthcare through the current reciprocal and cross-border healthcare arrangements until 31 December 2020 in those member states that agree to reciprocate. It is not feasible to directly fund healthcare for hundreds of thousands of people living in, or visiting, the EU without the cooperation of the member states.
Many hon. Members will know that the Government have also brought forward a Bill focused on reciprocal healthcare arrangements, the Healthcare (International Arrangements) Bill. That Bill will ensure that the UK can respond to all exit scenarios, and complements the approach we are taking in these instruments. It provides powers to give effect to comprehensive healthcare arrangements that are bespoke, or are different in any way from the current arrangements provided by the EU regulations. That Bill will also provide the legislative framework to implement long-term, complex reciprocal healthcare arrangements with the EU or bilateral agreements with individual member states.
We are also exploring whether there is a need to further fund healthcare for limited numbers of people in exceptional circumstances in which there would otherwise be a very serious risk to their health. The Healthcare (International Arrangements) Bill will give us the powers to do that, and to respond to an unpredictable situation. Clearly, we need to prioritise support for those individuals who most need it, and those in countries where there are actual challenges in obtaining healthcare. It is our hope that that will not be necessary at all. I recognise the difficulty of the current situation, and assure the Committee that we are doing all we can to minimise changes in the way that care is accessed. Of course, if the withdrawal agreement is passed, there will be certainty.
I will try to pre-empt a number of questions about why these instruments are subject to the affirmative procedure and regulations under the Healthcare (International Arrangements) Bill are subject to the negative procedure, although I am sure there will be other questions. As has been explained during the course of debates on that Bill, regulations that are made under it will give effect to healthcare agreements and are most likely to focus on procedural, administrative and technical details, such as the types of documents or forms used to administer the reciprocal healthcare arrangements. The Government therefore believe that the negative procedure offers parliamentary scrutiny and proper checks on the use of delegated powers, and balances those against the appropriate use of parliamentary time. The withdrawal Act statutory instruments that we are debating prevent, remedy or mitigate deficiencies in the retained EU law relating to reciprocal healthcare, and in doing so amend powers to legislate, which is one of the triggers for the affirmative procedure under that Act.
I clarify that the instruments we are considering do not make any changes to welfare benefits policy; the Department for Work and Pensions is bringing forward separate legislation on welfare benefits. I also reassure hon. Members that, as I said at the outset, we have been working closely with our colleagues in the devolved Administrations, who have provided consent for these instruments. I am pleased to acknowledge those Administrations’ co-operation on securing the legislative consent motions, and thank them for it. I also thank colleagues in the Northern Ireland Department of Health and in the Northern Ireland Office for the productive engagement we have had with them. We have amended the Bill to reflect the outcome of those discussions: the Secretary of State must now consult the relevant devolved Authority before making regulations under clause 2(1) containing provisions that are within the legislative competence of a devolved legislature.
Stella Creasy
For the avoidance of doubt, could the Minister set out what he believes to be the relevant devolved Authority for giving consent? He has said that in addition to the legislative consent motion, the Northern Ireland Department of Health and the Northern Ireland Office had been consulted, and had given consent. I do not want to get this wrong, so could the Minister clarify which bits which Departments have given consent to, and which relevant devolved Authority he believes will give consent to this motion at this point in time?
Stephen Hammond
What I actually said was that we have had productive and positive engagement with colleagues in the Northern Ireland Department of Health and the Northern Ireland Office, and Northern Ireland officials have agreed that they are content for the Department of Health and Social Care to lay the draft Health Services (Cross-Border Health Care and Miscellaneous Amendments) (Northern Ireland) (EU Exit) Regulations 2019. That follows a decision by UK Ministers that, in the interest of securing legal certainty in Northern Ireland, the UK Government will progress the necessary secondary legislation for Northern Ireland at Westminster, in close consultation with Northern Ireland officials and the relevant Northern Ireland Departments. I hope that satisfies the hon. Lady.
Stella Creasy
I beg the Minister’s indulgence. For the avoidance of doubt, is he saying that consent to the orders will be given in Westminster for the specific Northern Ireland elements of the statutory instrument? Can he confirm that that is what he is telling us about the legislation?
Stephen Hammond
What I am telling the hon. Lady about the specific statutory instrument, the Health Services (Cross-Border Health Care and Miscellaneous Amendments) (Northern Ireland) (EU Exit) Regulations 2019, is that consent was sought from the Northern Ireland civil service, and was provided by the permanent secretary for the Department of Health for Northern Ireland. The Northern Ireland civil service may make decisions in the public interest under the Northern Ireland (Executive Formation and Exercise of Functions) Act 2018. Again, following decisions by UK Government Ministers, in the interest of securing legal certainty in Northern Ireland, the UK Government will progress the necessary secondary legislation in close consultation. As I have said, consent was sought from the Northern Ireland civil service, and was granted.
Stella Creasy
It is always a pleasure to serve under your august chairmanship, Sir David. I rise simply to put on record a concern that many of us have, having heard what the Minister has said about this matter. We recognise that we are hampered by the fact that many SIs are being bundled together. With many of these SIs, as the hon. Member for Linlithgow and East Falkirk pointed out, we do not want to be in this situation at all, because many of us have such concerns about Brexit. However, we understand that the necessary legislation needs to be there should the worst happen, and therefore we cannot unbundle these SIs to express our concerns in particular about the SI relating to Northern Ireland.
I want to put on record that the Minister has essentially admitted that, by the process he has set out, we are facing direct rule in Northern Ireland. He talked about the Northern Ireland (Executive Formation and Exercise of Functions) Act 2018 and laying an SI, and he said clearly that consent has been given for this legislation not by elected representatives of the people of Northern Ireland, as the legislation sought to do under traditional legislative consent motions, but in fact by bureaucrats and by people here in Westminster.
The Minister will know that healthcare is a devolved issue; that is why I asked him all those questions about how the Government are using the 2018 Act. It is clear from this SI that their concept of the national interest is being stretched to cover bureaucrats and people in this place making decisions on behalf of the people of Northern Ireland. He may say to me, “Well, there isn’t a functioning Assembly in Northern Ireland”—many of us know that all too well—but he owes the people of Northern Ireland the honesty and decency to admit that, since the Government are using that piece of legislation on measures such as this and claiming a very broad interpretation of the national interest, we now have direct rule in this place for the people of Northern Ireland.
If the motions were unbundled, it might be a different matter, because those of us who believe in democracy believe that the people of Northern Ireland have a right to that truth. Because they are not unbundled, we cannot do that, so I am putting on record the Labour party’s concerns about the way in which the people of Northern Ireland have been treated in this statutory instrument.
Stephen Hammond
If the hon. Gentleman and the hon. Member for Walthamstow did not want the statutory instruments to be bundled, they could have said so at the beginning of the Committee. The Government did nothing other than seek the permission of the Committee to bundle them. Should the Committee have wished, I would have been perfectly happy to unbundle them.
The Chair
Order. We cannot have interventions on interventions. The Minister is intervening on Mr Sheerman.
Stephen Hammond
I made it very clear that it is the intention—the expectation—of both the UK Government and the EU and EFTA states that there will be an agreement about reciprocal healthcare.
The hon. Member for Walthamstow raised a number issues about Northern Ireland. As she rightly pointed out, healthcare is fully devolved to Northern Ireland. These statutory instruments would normally be dealt with by the Northern Ireland Assembly. In the absence of the Northern Ireland Assembly, and in the absence of a Northern Ireland Executive, statutory instruments under the European Union (Withdrawal) Act 2018 have to be laid in Westminster to allow for debate and scrutiny. She has heard that that Act was consented to by the Secretary of State for Northern Ireland. The Northern Ireland consent for social security regulations was provided by the permanent secretary for the Northern Ireland Department of Health, which is the appropriate place in the absence of the Northern Ireland Assembly. Her characterisation of direct rule is incorrect.
Stella Creasy
The Northern Ireland (Executive Formation and Exercise of Functions) Act 2018 explicitly sets out that Ministers must also have regard to representations made by Members of the Northern Ireland Assembly. What efforts has the Minister made to seek the views of Members of the Northern Ireland Assembly on these particular statutory instruments? Even if the Assembly is not sitting, it is written into that Act that its Members should be able to make representations. Can he clarify what he has done in that respect, please?
Stephen Hammond
I can clarify that the permanent secretary for the Northern Ireland Department of Health was consulted, as I said.
The hon. Member for Dewsbury asked about arrangements for cancer and paediatric heart surgery. The north-south arrangements provide that services such as paediatric heart surgery on the island of Ireland are not impacted by the UK’s withdrawal from the EU or these statutory instruments. Those arrangements operate under memorandums of understanding and service level agreements between the Irish and Northern Irish health authorities, which will continue to operate after exit day. The UK and Irish Governments are committed to continuing access to healthcare services within the common travel area, and both Governments are taking steps to enable us to implement these arrangements in time for exit day.
The hon. Member for Southwark and Old Bermondsey asked me about—sorry, Old Bermondsey and Southwark—
Oral Answers to Questions
Stella Creasy Excerpts(5 years, 3 months ago)
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Helen Jones (Warrington North) (Lab)
Stella Creasy (Walthamstow) (Lab/Co-op)
Jim McMahon (Oldham West and Royton) (Lab/Co-op)
Stephen Hammond
Nurses are at the absolute heart of our NHS. There are 13,400 more nurses since May 2010. We have announced the biggest expansion of nurse training places, with 5,000 more available from 2018. Alongside that, we are opening up new routes. As the hon. Lady will know, the workforce is at the heart of the long-term plan and, as I have just said, a detailed workforce implementation plan will be published in the spring.
Stella Creasy
Last week, a 14-year-old boy lost his life in my local community, yet in September, when the Department wrote to my local community asking for ideas about mental health provision, I wrote back to Ministers asking for an urgent meeting to talk about how we could get mental health workers into our schools to work with young people who might be at risk of being involved in gang violence and youth violence. With the shortage of mental health workers at a rate of one in 10, can I finally have that meeting with Ministers so that we can talk urgently about how to support such young people and save not only money, but lives?
Stephen Hammond
The answer to that question is yes. The Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Thurrock (Jackie Doyle-Price), will be delighted to meet the hon. Lady.
Oral Answers to Questions
Stella Creasy Excerpts(5 years, 10 months ago)
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Steve Brine
I am aware of that campaign. Something that we want to see in schools across the country, including in Stoke, is the Golden Mile. I see good examples in schools in my constituency and across the country when I travel. We are interested to learn more about what Stoke has done on this subject.
Stella Creasy (Walthamstow) (Lab/Co-op)
The Parliamentary Under-Secretary of State for Health and Social Care (Jackie Doyle-Price)
NHS England has a legal duty to commission services to meet local need, which includes people who are homeless, and we are very clear that a patient should not be turned away from a GP if they cannot produce any supporting documentation. If they state that they reside within the boundaries for the practice, the GP is expected to accept the registration. The same applies for dentistry, and training is in place to remind people of their obligations.
Stella Creasy
Mags Drummond is a Walthamstow woman on a mission, to try to help our many rough sleepers get decent quality healthcare, but she, like me, has hit a brick wall with our local dentists and doctors. It is little wonder that one study shows that 15% of homeless people have pulled out their own teeth because they cannot get access to services. Will the Minister meet Mags and me to look at what we can do to change that and make sure that her promises are not toothless?
Jackie Doyle-Price
Very good—I commend the hon. Lady for her wit, and I agree with her. Notwithstanding our expectations of GPs and dentists in this regard, it is quite clear that homeless people do not always have access to the treatment they should have. The hon. Lady will be aware of the work that we are doing to support rough sleepers, and I would be delighted to meet her and Mags Drummond to see what insight they can provide on how we can improve services in this area.
NHS Long-Term Plan
Stella Creasy Excerpts(5 years, 10 months ago)
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Mr Hunt
My hon. Friend asks a profoundly important question. The medical school students who are going to medical school this year will become consultants in 2031 at the earliest, so we have to make sure that we update the way people are trained for the totally different world that they will be facing in terms of technology, medical innovation and the demarcations and roles inside hospitals and community care. This is very much part of the long-term workforce plan that will be announced alongside the NHS long-term plan later this year—it is what that will be about.
Stella Creasy (Walthamstow) (Lab/Co-op)
I can understand why some in Government think that there is a Brexit dividend. After all, we know that the Health Secretary’s colleagues in the Home Office have been given enough money from Brexit to cover the cost of 20,000 nurses. His colleagues in the Department for Environment, Food and Rural Affairs have been given 14,000 nurses’ worth of money and even his colleagues in the taxman’s office have been given 11,000 nurses’ worth of money. I am sure that the Secretary of State would not want to betray the good will of a single doctor, nurse, cancer patient or future patient by making promises that he cannot keep, so can he tell us, once and for all, whether he personally believes that there is a Brexit dividend—yes or no?
Oral Answers to Questions
Stella Creasy Excerpts(6 years ago)
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Gill Furniss (Sheffield, Brightside and Hillsborough) (Lab)
Stella Creasy (Walthamstow) (Lab/Co-op)
Grahame Morris (Easington) (Lab)
Stella Creasy
The NHS already has 34,000 nursing vacancies. Given that there has been a 97% drop in nursing applications from the EU and that studies show that nearly half of all hospital shifts include agency nurses, will the Minister at least admit that cutting the bursary scheme has been a false economy for our NHS?
Stephen Barclay
It is not a false economy to increase the supply of nurses, which is what the changes have done. Indeed, they form part of a wider package of measures, including “Agenda for Change”, pay rises and the return to practice scheme, which has seen 4,355 starters returning to the profession. More and more nurses are being trained, which is why we now have over 13,000 more nurses than in 2010.
Stephen Barclay
I very much welcome the progress that my hon. Friend has shared with the House. Many of us will also want to pay tribute to his leadership during his time at the Department in recognising the opportunity for reconfiguration that the capital would unlock and is now delivering.
Stella Creasy (Walthamstow) (Lab/Co-op)
Mr Hunt
I can absolutely commit that we are very conscious of the failings of PFI when we have any discussion about NHS capital funding, including the previous question. We are very conscious of the need not to make the mistakes that saddled the NHS with £71 billion of PFI debt.
NHS Staff Pay
Stella Creasy Excerpts(6 years, 1 month ago)
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Mr Hunt
First, I want to pay tribute to my hon. Friend as one of the practising nurses in the House and someone who always makes sure that the voice of nursing is heard loud and proud in this place. I very much hope that the devolved Governments will follow suit with this deal, although for every additional pound per head we have put into the NHS in England, Labour in Wales has put in only 57p.
Stella Creasy (Walthamstow) (Lab/Co-op)
Further to the question from my hon. Friend the Member for Enfield, Southgate (Bambos Charalambous), we all know how much agency nurses cost the NHS, and the same goes for private finance initiatives. These companies are making £1 billion in profits, which is money that will not touch any of our hospital budgets, including that of my own, Whipps Cross Hospital, which has a 17% agency rate and tried to deal with its PFI debt by downgrading the pay of nurses to save money. What is the Secretary of State doing to cut the PFI bill for our hospitals and prevent them from balancing their books off the backs of hard-working staff?
Mr Hunt
The hon. Lady is right to draw attention to that problem. We have certainly stopped doing any new PFI deals of the disastrous kind that lead to the consequences she talks about. We have given some relief to a number of hospitals in that area, but I will look again at her local hospital, because it is clearly totally unacceptable if that is happening.
Orkambi and Cystic Fibrosis
Stella Creasy Excerpts(6 years, 1 month ago)
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Tulip Siddiq (Hampstead and Kilburn) (Lab)
It is a pleasure to serve under your chairmanship, Sir Roger. I pay tribute to the hon. Member for Sutton and Cheam (Paul Scully). I usually apply to speak in Westminster Hall rather than in the main Chamber because the waiting time tends to be shorter, but I have had to wait today because of the huge turnout, which is testament to his tenacity in securing this important debate. Many constituents have emailed us about how their condition has affected their lives. I will cut straight to the chase and say that all the people who emailed me were unanimous in their desire to see Orkambi made available on the NHS.
In all the representations I have received, whether from families who have been affected by the disease or from world class medical professionals in Hampstead and Kilburn, there is one clear message: cystic fibrosis patients do not have time to waste. I put this bluntly not because I want to state the obvious about a life-limiting condition, which has been made clear by all the contributors so far, nor to suggest that Ministers object to introducing the precision medicines that could extend life chances. I say it because it is the key message that must weigh upon all our contributions today.
I presume that most Members have received a briefing from the Cystic Fibrosis Trust, which does exceptional work in advocating for those suffering from the condition. I am proud to say that I have a constituent, Ffyona Dawber, who is a trustee and is passionate about this debate and patient education more broadly. Ffyona and her colleagues at the trust have told me over and over again about the possible benefits of Orkambi. They say that medicines such as Orkambi have been proven to add years to a patient’s life. They point to the fact that Orkambi has been shown to slow decline in lung function by 42% and to cut the number of infections requiring hospitalisation by 61%. As has been quoted many times, they point to the NICE appraisal of 2016 that said that Orkambi is both “important and effective”. Given that the possible benefits of Orkambi seem to be settled, it is necessary to spell out why the Government should act now and agree a sustainable solution over the cost.
It is also important to highlight the voices of those whose futures depend on the introduction of that important drug. My hon. Friend the Member for Erith and Thamesmead (Teresa Pearce), who is sitting next to me, talked about how we have to speak up for residents and constituents who cannot come here and speak for themselves. Many who have the condition cannot travel to Parliament to witness the debate.
I echo the words of a resident of mine, Caroline Brown, who wrote to me about her treatment for cystic fibrosis. She told my office that she felt “well supported” by the NHS. She paid specific tribute to the doctors and nurses at the Royal Brompton Hospital on the Fulham Road, saying that
“they are utterly amazing. I have had the best care there and I cannot fault them.”
Her tribute to the staff at the Royal Brompton reflects those paid by other local residents, especially those whose children rely on the specialist cystic fibrosis centre at Great Ormond Street. For patients such as Caroline, my constituent, the debate over Orkambi is about enabling our world-leading medical community to focus their efforts more sharply on those with advanced symptoms, and for pharmaceutical companies to get on with investing in research for aspects of the condition where the breakthrough represented by Orkambi still evades us.
It will come as no surprise to anyone to learn how Caroline felt about the situation surrounding Orkambi. As expected, she was clear in her support for its immediate roll-out. She said:
“When I look to the future it would be very comforting to know that, if I was to need it, there would be medication there that would help me. I can’t bear the thought of knowing that there is something out there that could potentially save my life, and that I am not able to take that as I couldn’t afford it. Being symptom free for someone with Cystic Fibrosis would be life changing.”
She went on to underline the consensus that exists among cystic fibrosis sufferers. A lot of them cannot meet and be in the same room for the reasons outlined by other Members, but there is one benefit of social media—I stress one benefit—which is that it has enabled a network of people with cystic fibrosis to discuss and reflect upon the key debates in the community and to share the experience of their treatments. She knows that fellow patients are unanimous:
“They all agree it should 100% be made available on the NHS. It should be available to everyone that needs it...it is sad that money is getting in the way of people's health improving.”
Stella Creasy (Walthamstow) (Lab/Co-op)
My hon. Friend is making an incredibly powerful speech. May I add the voice of my six-year-old constituent? She would not benefit from Orkambi, but we must recognise that, if we do not get this right, the other treatments that might help her will be subject to similar delays. She is only six years old, but she does not need any delay. Does my hon. Friend agree that this matter is not only about Orkambi, but about how we deal with life-changing drugs and whether we understand the power of them to make such a difference?
Tulip Siddiq
I absolutely agree with my hon. Friend. There are lots of heart-breaking stories from people who are six and even younger who share the frustrations of the people I am speaking for today.
Caroline, my constituent, was adamant that Orkambi is just one frustration that those with cystic fibrosis have over how the current range of treatments are made available. What aggravates my constituent is the fact that cystic fibrosis is the only incurable life-threatening disease where people have to pay for their prescriptions. I greatly sympathise with her view that charging patients for medication, in light of the fact that they often undertake between three to five hours of treatment a day, does not seem to square up to the rhetoric of Ministers who pledge their support for the cystic fibrosis community. As my constituent concludes, some people have to take thousands of pills over their lifetime, so paying for them makes life very difficult. Why should cystic fibrosis be an exception when people with other diseases do not have to pay?
I will close with three questions that I want the Minister to answer. Do the Government accept responsibility for the pace at which negotiations are being conducted, and will they apologise for the anxieties that patients are experiencing as a result? Secondly, what steps are Ministers taking to ensure that pharmaceutical companies will ensure that fair and responsible pricing for a deal can always be agreed when treatments are required on the NHS? Finally, will the Minister acknowledge the importance of finding a solution that guarantees we are never put in this position again for the future pipeline of treatments for cystic fibrosis and many other life-threatening conditions?
Mental Health Act: CQC Report
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Jackie Doyle-Price
We absolutely should do that. I often think that when we are challenging each other in this place about things that are poor, we end up talking our services down, but it remains the case that the NHS is the best health service in the world, and we should always celebrate that fact. Also, the fact that we are putting mental health services under such scrutiny is in itself driving an improvement in performance, because, as we all know, sunlight is the best disinfectant.
Stella Creasy (Walthamstow) (Lab/Co-op)
Further to that response, the CQC says that it has seen limited or no improvement in the key concerns that it has raised in previous years. The problems are long-standing and they have been raised by the quality regulator in previous reports to Parliament. Does the Minister not understand, when she tries to tell us that sunlight is the best disinfectant, that all we are seeing in our mental health services right now is clouds?
Jackie Doyle-Price
I would say to the hon. Lady that this report represents sunlight, not clouds. It is very transparent, and these are exactly the things that I will be holding myself and NHS England to deliver to address these points.
Oral Answers to Questions
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Jackie Doyle-Price
As my right hon. Friend identifies, training is key, and another central point is GPs’ ability to signpost people to appropriate treatments and therapies, which is exactly why we are investing in specialist care.
Stella Creasy (Walthamstow) (Lab/Co-op)
Jackie Doyle-Price
The hon. Lady raises exactly the point that we are trying to address through the Green Paper. We are committed to delivering on the four-week waiting time by 2020, which will make sure that we treat over 70,000 more children with mental health issues that need to be addressed. I will be quite honest: this is not where I want us to be, but that is exactly why the Government have made it a priority and we will deliver by 2020.
North-east London STP
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Mike Gapes (Ilford South) (Lab/Co-op)
Changes to our national health service are being planned all over the country, which are going to have profound implications for the quality of health, the availability of both primary and secondary services and for the size and location of our hospitals. There has been justified criticism of the secrecy with which this process of producing so-called sustainability and transformation plans has been carried out. The Department of Health has produced a five year forward view and a very large number of plans. I want to focus on the north-east London sustainability and transformation plan draft, which was published on 21 October, and on the eight delivery plans supposedly to implement it.
Stella Creasy (Walthamstow) (Lab/Co-op)
I want to put on record my personal gratitude to my hon. Friend on behalf of all the residents of Walthamstow, because we know that these plans are not going to be subject to parliamentary scrutiny. The fact that my hon. Friend has secured this debate today might be the only opportunity we have in Parliament to look at something that will fundamentally transform their local healthcare services.
Mike Gapes
I am grateful to my hon. Friend, who spends a great deal of time, as I do, campaigning with her local council to improve the NHS locally. Throughout our sub-region of north-east London, we are all concerned about what we are facing.
The King’s Fund reported in November that the speed of development of these plans means that
“patients and the public have been largely absent”
from the process and that NHS England has instructed that freedom of information requests should be “actively rejected”. Locally in north-east London a freedom of information request for the financial and working detail of the STP was rejected in November on the basis that:
“Disclosure would be likely to inhibit the ability of public authority staff…to express themselves openly...and explore extreme options…Deliberation needs to be made in a ‘safe space’ to develop ideas and to reach decisions away from external interference which may occur if there is premature public or media involvement.”
My local council, Redbridge Council, has been concerned that it has not been adequately involved in the process. It has made it clear that it will act in the interests of our local community and that Redbridge will not be signing off or endorsing the STP unless we are satisfied that it is in the interests of Redbridge residents
I understand that the STP programme boards are not required to hold meetings in public, and no agenda or minutes are published. The secrecy surrounding this process has not been helpful in building public trust and has caused suspicion within communities all over the country—I speak particularly from local experience—as to the intentions of the proposals. In many respects what could be a reasonable response in the circumstances to the crisis we face in terms of future funding, the ageing population and other challenges to the NHS, is being undermined because of process issues. The NHS needs to learn from these experiences about how better to engage with the public and key stakeholders, including elected local representatives.
We are fortunate in Redbridge and north-east London because there are good working relationships within the NHS and local government, and there is already a model of collaborative working. However, the problem with the STP is that it brings a top-down process into this situation and potentially undermines the joint-working that has been voluntarily established over recent years.
Redbridge along with neighbouring authorities will be strongly arguing that the developing STP governance structures should not stifle or negatively impact the local work that is happening. Redbridge and its partners in Barking and Dagenham and in Havering have over a number of years been developing cross-borough, collaborative approaches on the integration of health and social care. Redbridge is arguing that STP governance needs to ensure that this subsidiarity to the local level is taken as a model for the future, and is not undermined by the STP approach. We need to ensure democratic accountability if we are to get public buy-in, and we do not have that at present. Public engagement needs to be enhanced and improved.
The north-east London October STP draft is subtitled “transformation underpinned by system thinking and local action”. It says, however, that
“the system partners may not be able to work together collaboratively to deliver the plans.”
Today we have seen news about the reality we face in our NHS: large numbers of hospitals with dangerously high bed-occupancy levels and little or no flexibility. The CQC’s chief executive recently talked about hospitals being dangerously full. On 26 November, a leaked memo from NHS England revealed that hospitals were being banned from declaring so-called “black alerts” and told to prepare for the winter crisis by passing on scheduled surgery to private hospitals and discharging thousands of patients to get bed occupancy down from a national average of 89% to 85%.
However, north-east London’s population is massively increasing. The report states that the population of north-east London boroughs will increase by 18% over the next 15 years—equivalent to a new city—and yet there is no plan for an additional hospital to cope with that change. In fact, page 20 of the draft policy states that building an additional hospital is “not practical or realistic.” Indeed, the situation is worse than that. Not only is there no extra hospital, there is the planned closure of the A&E at King George hospital in my constituency. The plan is to stop overnight ambulances sometime next year, with a total closure in 2019. The STP is calling for that not only because it would meet some savings and restructuring requirements, but also because there are unsustainable costs. The previous Health Secretary announced in 2011 that the A&E at King George would close in “around two years”. That has not happened because it was deemed unsafe and because there is insufficient capacity at Queen’s hospital in Romford or at Whipps Cross university hospital in Waltham Forest to cope with the increased demand.
Despite our excellent and hard-working staff, all the hospitals in north-east London are in crisis. With pressure for early discharges, but inadequate social care and community support, we have large-scale bed blocking and delayed discharges. Sick patients then get readmitted because they cannot get GP appointments due to the pressures that exist in that sector. The STP sees out-of-hospital and integrated community care as the way forward. However, Dame Julie Moore, who in 2014 chaired a commission on hospital care for frail elderly people, said:
“As much as it suits us all to have one nice neat solution to the problem of our growing, ageing population… the truth is that as a catch-all answer it is simply wishful thinking. Integrated community care is a good thing… but this can never be a substitution for hospital care.”
We still need hospitals and acute care. Plans to transform care in the community are good, but that requires a transformation of primary care, which needs resourcing. The STP projects a 30% shortfall in nurses by 2021, and we know that many GPs plan to retire over the next few years. Both are difficult issues.
Problems also exist in the potential financial situation, and one such issue is the estates strategy. The STP delivery plan highlights sites such as Goodmayes hospital, which is a large mental health hospital, and King George hospital as places where land could be sold. Contractual issues and other matters mean that that is probably an optimistic approach.
Stella Creasy
My hon. Friend is making an incredibly powerful case about why we must involve the public in some incredibly difficult decisions. We know that the financial situation we are facing is particularly dire. He has just mentioned the sites at Goodmayes, but in addition Whipps Cross has a large private finance initiative debt, where it is paying out a huge amount of money. No wonder the suggestion is being made that we need £578 million to bridge the gap.
Mike Gapes
My hon. Friend has given the figure I was about to cite. The STP executive summary states:
“Our total financial challenge in a ‘do nothing’ scenario would be £578m by 2021. Achieving ambitious ‘business as usual’ cost improvements as we have done in the past would still leave us with a funding gap of £336m by 2021.”
Those are eye-watering figures. The claim is made that
“we have identified a range of opportunities and interventions to help reduce the gap significantly”.
However, the £240 million gap between the “business as usual” case model and the actual predicted figure requires a series of other measures, including significant funding from the sustainability and transformation fund, reductions and changes in specialised commissioning, and what is called
“potential support for excess Public Finance Initiative (PFI) costs.”
That covers Whipps Cross hospital, Queen’s hospital, Romford, and, to some extent, King George hospital. “Potential”, what a lovely word. So this is not real and it is not even planned—it is just “potential”.
These plans are based on unrealistic, heroic, Soviet-style assumptions. This is a truly Stakhanovite model of over-estimation of potential, yet the STP still proposes it can transform a deficit of £578 million in 2021 into a potential surplus of £37 million—and improve the services. That will not happen. The plans are also predicated on totally unrealistic assumptions about savings from closing the A&E services at King George hospital, and there is a lack of clarity as to when this will happen and how much we are talking about. I have been told that tens of millions would be invested in the sites at Queen’s and Whipps Cross, but I have been told that at least £75 million is needed to do that, and there is no sign of where this capital is coming from in the Department of Health. So wards are being closed in one hospital and then millions are being invested in rebuilding wards or constructing wards at other hospitals, for no real net gain.
There is also a problem about what process will be involved in this closure at King George hospital. I am conscious that I do not have limitless time, but let me say that my local Redbridge Council is very concerned about this, because King George is supposed to be transformed from an acute hospital into an urgent care centre and so the local community needs to be involved. Redbridge is requesting that it should be involved, and I note that it has recently been agreed that it will be involved on the transformation board. However, Redbridge wants an independent chair of that board, because it is important to involve a person of public trust so that there is no controversy. There needs to be a transparent, open process as we discuss the options for the future of King George hospital, so that we can challenge the business case and take account of the fact that the assumptions on which this model is based are 10 years old. They go back to the misnamed “Fit for the Future” plans of 2006. The population growth that we have had and the growth that is yet to come, the young population that we have in the area and the movement in population means we have to look at these issues with great doubt and concern.
We need to assess the implications of all those issues. As Redbridge says, it wants to know how the reconfiguration to an urgent care centre assists primary care, community health services, adult social care, public health, and public health prevention and education. An opportunity exists in the changes, but we need public engagement in those changes, and we do not have that at the moment.
There will be enormous pressure on my local council because of budget problems, and I am worried about the situation. I am glad that the STP highlights the social care challenge, but it needs to be taken seriously by the Government if we are truly to have an effective health and social care system. The statement in this House yesterday did not offer a solution to my borough. It did not answer the challenge that boroughs such as Redbridge are facing. These boroughs are already ahead of the game in the integration of health and adult social services and are working with neighbours to take up the challenge by being a pilot for the development of an accountable care system.
Yet with all that transformation, Redbridge still faces a huge social care challenge. That is made worse by a triple whammy of public sector funding reductions to local government—my borough has lost 40% of its income since 2010—chronic underfunding of adult social care by the Government and the fact that Redbridge does not get a fair funding level in the first place. There is, potentially, a major problem. We face a shortfall of about £4 million in social care and the 1% extra on council tax raises less than £1 million. The responses that we have heard from the Government in recent days have been inadequate—indeed they have been worse even than the silence from the Chancellor in the autumn statement. They offer no real solutions to the growing crisis that will impact on some of the most vulnerable in our society.
I conclude with this plea: please will the Government look at the situation in north-east London and will the Minister meet me to discuss the fact that this plan is unrealistic, incredible, unachievable and will lead to disaster?
Stella Creasy
It is good to hear the Minister say that she wants to see local people involved in these plans. Will she therefore commit not just to a conversation but a consultation with teeth to give people confidence that the very difficult decisions that we all know have to be made about changing the NHS can be done with their consent, and not simply given to them as a fait accompli?
Nicola Blackwood
Perhaps if the hon. Lady lets me continue with my speech, she will hear a little more about how the process will go forward.
The geographies have been determined not by central bodies, but by what local areas have decided makes the most sense to them. In the case of the constituency of the hon. Member for Ilford South, that has involved five providers, seven CCGs and eight local authorities covering the whole of north-east London. Each area has also identified a senior leader, who has agreed to chair and lead the STP process on behalf of their peers. In north-east London it is Jane Milligan, the chief officer of Tower Hamlets CCG, who is co-ordinating the development of the plan.
I was concerned to hear what the hon. Gentleman said about local authorities not feeling as involved as they should. It is important to emphasise that local authorities must play a role in developing these plans. Reflecting the social care needs of an area, which councils are obviously best placed to represent, will be key to the success of the NHS in the coming years, so they must be closely involved.
The plans offer the NHS an opportunity to think strategically and open up the public discussion about how we will meet the challenges facing the NHS in terms of demand and rising costs. It is inevitable that debate will become heated; it is simply a reflection of how important local NHS services are for us all. By planning across multiple organisations—both commissioners and providers—STP footprints can seek to address in an holistic way the health needs of an area and all the people within it in a way that we have never had the opportunity to have before.
We all know that the NHS faces tough choices about how we will design future services to meet rising demand, rising costs, and more chronic and complex illnesses. Choices have often previously been postponed again and again because they were too hard and because the discussions are too uncomfortable. I do not think anyone in the Chamber would think it is fair or safe for our local populations for us to keep putting them off in this way.
In north-east London, as elsewhere, that has meant having an honest conversation about the best way forward for services that are unsustainable as well as how to integrate services to give patients a clearer route through the system. All those conversations will help ensure that patients maintain access to high-quality care.
As I understand it, the north-east London October STP draft looks at these challenges in a number of different ways. The hon. Gentleman has described some of them. It also proposes embracing integrated services, from urgent and emergency care to mental health care and support as well as public health, which is important to me as the Minister for Public Health. The STP is also exploring how to improve patient outcomes through community-based care and preventive measures, which must be important if we are to manage demand. For example, the proposals include utilising initiatives to provide adequate housing in the area, and using new models of care to give health education. It also highlights three enablers for change for the area—workforce, digital enablement and infrastructure—and investigates how to improve its position with each.
I share the view of the hon. Gentleman and the hon. Lady that the public, key stakeholders and elected representatives should be closely involved in the development of STPs. With the plans now published, preparation for STP implementation must begin in the new year. Now is the time for STP leaders to reach out actively and engage patients and the wider public, and I expect nothing less. That means having frank, engaging and iterative conversations across areas, as well as some potentially difficult conversations about what the NHS could and should look like. Simon Stevens and Jim Mackey—the heads of NHS England and NHS Improvement—have written an open letter to STP leaders making that expectation absolutely clear. The letter reiterated that now is the time for local engagement to help develop the proposals and for those involved to make it clear that these plans must have a real benefit to patients.
I should also be clear that, nationally, all reconfigurations must meet the four tests mandated by the Government to NHS England in 2010, which require all local reconfiguration plans to demonstrate support from GP commissioners, strong public and patient engagement, clarity on the clinical evidence base, and support for patient choice. We would not expect any proposal to move forward that has not met all four tests. Patients must be at the heart of the NHS, and no plan can be successful unless they are fully engaged.
I close by saying that the hon. Gentleman has raised some very serious questions around details of his local STP plan and the quality of public consultation. I will ask the Minister responsible for community health—the Under-Secretary of State for Health, my hon. Friend the Member for Warrington South (David Mowat)—to meet him and the hon. Lady to discuss the details to ensure that they are properly ironed out and that the public consultation and discussion are of the highest possible quality.
Question put and agreed to.