Healthcare: East Midlands

Stephen Hammond Excerpts

Tuesday 30th April 2019 Westminster Hall

[Mrs Sharon Hodgson (Washington and Sunderland West) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Hollobone. I thank my hon. Friend the Member for Lincoln (Karen Lee) for securing this important debate. She is a passionate advocate for the NHS in her area and made a passionate speech. I also thank the other hon. Members who spoke—the hon. Members for Bosworth (David Tredinnick) and for Sleaford and North Hykeham (Dr Johnson), my hon. Friend the Member for High Peak (Ruth George) and, of course, the hon. Member for Strangford (Jim Shannon), who has just left the Chamber—for their excellent speeches and interventions.

Although I am pleased to respond on behalf of Labour, it is with sadness that Members come here time and again to explain the impact on their constituents of the crisis in the NHS. Sadly, as we have heard, standards are slipping across the board. It was a mild winter, but despite the thankfully lower levels of flu and vomiting virus, we saw the worst performance against the four-hour A&E target since records began. [Interruption.] If the Minister cares to—

[The Minister for Health (Stephen Hammond)]

It was an improvement on last year, so it was not the worst.

[Mrs Hodgson]

Oh, right—it was the second-worst, then. Anyway, bed occupancy also rose to 95.2% this winter, well above the 85% deemed to be safe, and patients are waiting almost 4% longer in A&Es than they were two years ago. In Nottingham they are waiting 14% longer than in 2017, and in Leicester they are waiting almost 4% longer than two years ago. East Midlands Ambulance Service NHS Trust has missed its targets for responding to patients in life-threatening situations. We have heard countless stories today that demonstrate how the crisis happening in our NHS both locally and nationally is real.

It is clear that the Tories’ plans for NHS funding fall short of what is needed. The autumn Budget announcement of a cash injection for health services excluded public health budgets, training and capital, which means an increase of just 3% for health services when we have a childhood obesity crisis, cuts to sexual health and addiction services, workforce shortages and a backlog of nearly £6 billion in repairs. It is not even enough to wipe out hospital deficits.

Nottingham University Hospitals NHS Trust alone predicted a deficit of more than £40 million by the end of the financial year, and it has declared 15 black alerts since December. How will the Government’s settlement help trusts like that become more sustainable? Where is the funding to guarantee sustainable health services in the face of ever-increasing demand from a complex and changing demographic? For example, in the east midlands, the number of preventable deaths from liver disease has increased by 37%. Obesity is also a growing problem, 66% of the population being overweight. People in the east midlands are more likely to have had a depressive episode than those in the rest of the country—3.9% compared with 2.2%. In 2013-15, the average life expectancy at birth across the east midlands was 79.3 years for males and 82.9 years for females, both of which are significantly below the national average. There is also considerable variation in preventable mortality from the major causes of death across the east midlands local authorities, with an urban-rural divide. The urban areas of Nottingham, Leicester and Derby have significantly lower life expectancy than the average for England.

Money is, of course, only one of the issues surrounding the crisis in the NHS. There is a staff recruitment and retention issue, too. NHS figures show that there are 100,000 vacancies across the health service, including 31,000 across the midlands and the east of England. Therefore, 9.3% of posts in the midlands and the east—about one in 11—are unfilled.

Constituents will also be worried about the integration of services in the east midlands. In recent years, councils have distanced themselves from sustainability and transformation plans and the integrated care systems in some areas, due to a lack of democratic accountability and scrutiny from stakeholders, including concerns over cuts and privatisation. Nottinghamshire’s ICS is an interesting case: the city council suspended its membership for six months last year for those very reasons, rejoining only in April 2019 after assurances were given to improve accountability and shared decision-making processes. I am sure that Members will be keen to hear from the Minister how democratic accountability and transparency is being improved in such cases.

Residents will also be concerned about the number of community hospitals that have closed or are under threat of closure. Residents of Bakewell and Bolsover have to travel to Chesterfield or Derby for their appointments, after their hospitals closed. The loss of those community hospitals impacts on rural areas of the east midlands, isolating people further because not only will they have to travel further to appointments, but so will any visitors, so patients are suffering.

The Government have spent nine years running down the NHS, imposing the biggest funding squeeze in its history, with swingeing cuts to public health services, and social care has been slashed by £7 billion since 2010. As we have heard, the NHS is clearly buckling under the pressure as a result, and standards of care continue to plummet. I would appreciate assurances from the Minister about how the Government will get a grip on the situation in the east midlands and across the country as a whole, to reverse the extremely worrying statistics and tackle the issues we have heard about.

[The Minister for Health (Stephen Hammond)]

It is a pleasure to serve under your chairmanship, Mr Hollobone. As you know, I have met the chief executive of the team from Kettering, I have visited Kettering and I have responded to you on the Floor of the House about Kettering. Kettering and its requirements for the A&E are therefore not far from the forefront of my mind.

I congratulate the hon. Member for Lincoln (Karen Lee) on securing the debate and I thank all hon. Members for their contributions. I intend to spend some time going through a number of the areas raised this morning. I am bound to say that the long-term plan, which a number of Members welcomed, is a substantial step forward, and the funding commitment—the biggest ever in peacetime—is a key to ensuring that that can be delivered. The number 100,000 has been trotted out, but clearly that does not represent posts unfilled, nor does it take any account of the actions that the Government are undertaking. More than that, the simple fact is that, compared with eight years ago, there are 14,700—over 15%—more doctors, 10,300 more nurses, midwives and health visitors and, in addition, over 15,900 more nurses on our wards.

I also point out that of those vacancies that several hon. Members mentioned, well over 80% are being filled by a combination of bank and agency nurses. Of course no one wants that situation to persist, but there has been a consistent decline in the number of agency staff, and since the transfer from the bursary to the loan system, much has been done working with nurses to ensure that courses are filled. We are seeing more applications than previously: this time around UCAS reported over 4,000 more applicants. Last year, my predecessor announced a fund to provide an increased package for postgraduate nursing students starting courses in 2018-19 in terms of employment in learning disability, mental health and district nursing roles, which are the key vacancies that need to be filled.

I will try to answer a couple of specific points raised by the hon. Member for Lincoln. She rightly voiced concerns about the closure of Skellingthorpe health centre in her constituency. As she pointed out, were there to be a closure, the CCG would be required to conduct a proper consultation. I spoke to the CCG yesterday and I understand that as yet—she may wish to correct me—there has been no formal request for closure. Equally, the CCG tells me—I hope this is right—that it will meet the hon. Lady later in May to discuss this matter, and that, were there to be a request, it would immediately inform her and offer her a meeting with it and the lead GP at Skellingthorpe to see what action could be undertaken. The CCG has also confirmed —she will understand this—that it appreciates that this is a rural community, and that there are additional challenges for local residents, so it is working not only with Skellingthorpe to understand the challenges and how they may be met, but to ensure that the rural network of GPs might work together.

The hon. Lady rightly expressed concern about CQC inspections, and I will go on to speak about those if I have time. She mentioned the recent inspection that took place on 25 February at Pilgrim Hospital, with a report published on 3 April. Although “requires improvement” remains the rating, there were marked improvements in certain areas, including in the standard of care, numbers of staff and nursing provision for children, and a real improvement in the triage time. She will appreciate that the trust is receiving substantial support from NHS England, including to help the hospital get out of special measures.

My hon. Friend the Member for Bosworth (David Tredinnick), chair of the all-party parliamentary group for integrated healthcare, spoke passionately about the health and wellbeing partnership. He is absolutely right, and the Government support the integration of healthcare services and recognise the good work being done by that partnership in Hinckley and Bosworth. The Secretary of State enjoyed his visit to Hinckley, and was particularly pleased to get a real impression on the ground of the improvement in services that will come from the £8 million investment. My hon. Friend reminded me of his Christmas present to me, and I was pleased to read some—although not all—of his report over the Christmas period. You will not be surprised to hear, Mr Hollobone, that I was also intrigued to hear his comments about India. I sometimes think that the “Ministry of Calm” in India could benefit many people in this place.

The hon. Member for High Peak (Ruth George) spoke about “Better Care Closer to Home”. That reminded me of when I was a councillor 18 years ago and a different Government wanted to do to local services in my area the things that she described. The issue was only resolved some years later, in 2015, when a new medical centre was built. She rightly mentioned the East Midlands ambulance service and—most importantly —its paramedics. I visited that service earlier this year, and spoke not only to the management but to the medics who deliver those services. There are clearly challenges regarding location, and not all the standards have been met. It is also true, however, that there are 67 new ambulances—an increase of 27—and response times have improved, which is to be welcomed. I recognise the problems with CAMHS that the hon. Lady raised. That is clearly an issue nationally as well as in the east midlands, and it is right for the long-term plan to recognise that. The commitment to mental health diagnosis and treatment times is a significant change from the previous situation.

[Ruth George]

Mental health services were allocated £1.2 billion, but that money was not ring-fenced. That is the problem that CAMHS has had with the cuts. Will the Minister commit that any additional funding for mental health services will be ring-fenced, so that it goes where it is needed?

[Stephen Hammond]

There is a commitment to treatment and the funding that backs it in the long-term plan, and that money is dedicated to that commitment. That is pretty clear.

[Ruth George]

indicated dissent.

[Stephen Hammond]

The hon. Lady is asking me to use the word “ring-fenced”, but if I say that the money is there and allocated for that matter, then it is specifically ring-fenced for it.

My hon. Friend the Member for Sleaford and North Hykeham (Dr Johnson) gave us a valuable insight into the NHS, given her experience as a consultant. She is right to say that we must tackle a number of workforce issues, and morale is undoubtedly key to that. I was pleased to see that set out in the initial workforce plan; and Baroness Harding, chair of NHS Improvement, has been asked to consider a stream of work about making the NHS the best employer. That work will consider a number of issues about retention and the culture and morale of staff. I look forward to the publication of that report, and I hope my hon. Friend will join me in welcoming the new ideas it contains.

My hon. Friend was right to mention the pensions of a number of GPs and other NHS staff. She will not be surprised to hear that I am continuing to persuade Treasury colleagues to accept the Department’s proposed solution for that issue, and I hope we can make progress and make an announcement on that soon, which will be reassuring to many. I encourage my hon. Friend to write to me about the dispensing service she mentioned, and I will consider what issues we can take up. Finally, she was right to talk about the orthopaedic services at Grantham. “Getting It Right First Time”—GIRFT—is led nationally by Professor Tim Briggs, who was lead clinician at the Royal National Orthopaedic Hospital. That is making a huge difference, not only to the concentration, specialisation and number of operations being undertaken, but—equally importantly—the great improvement in safety and reduction in infections is leading to hugely better care for patients.

The hon. Member for Washington and Sunderland West (Mrs Hodgson) mentioned A&E performance, and she is right to say that it fails to meet the target. However, she is wrong to say that this year has seen the worst performance ever, as there has been an improvement on last year. Over the past months, United Lincolnshire Hospitals NHS Trust has seen a huge increase in attendances compared with the previous year. That reflects the wider NHS, where demand is up by 6%, yet more than 4,700 patients per day are treated within the four-hour waiting limit. The hon. Lady mentioned Public Health England and Health Education England, but funding for those bodies was designed to be dealt with in the comprehensive spending review that will take place in the autumn. It was never intended to be tackled inside the long-term plan and spending commitment.

The hon. Lady mentioned money, but this is a transitional year for funding. The funding provided is enough to work on the deficit, and given the analysis being done, the Government’s commitments, and the work on efficiency in the health service, it is surprising that Labour Members who recognise the benefits of much of the long-term plan are not prepared to welcome the financial settlement that backs it up and will deliver it.

Briefly, let me mention another east midlands MP, my hon. Friend the Member for Erewash (Maggie Throup). She was not able to speak today as she is my Parliamentary Private Secretary, but she has done great work in pointing out the benefits of Ilkestone Community Hospital, which I intend to visit in the near future. May I just say that—

[Mr Philip Hollobone (in the Chair)]

Order. I do not think the Minister can just say it. He must allow time for Karen Lee to sum up the debate, so perhaps he will bring his remarks to a close.

[Stephen Hammond]

Thank you Mr Hollobone. I will not just say anything other than that I wanted to address a number of issues about east midlands care, so I will put them in a letter and write to Members who have participated in this debate. It is important to address the huge number of issues raised by colleagues and ensure that the context is clearly understood. This Government wish to thank all hard-working professionals in the NHS for their work. We will do everything we can to continue that support, with a plan and the money to back it up, so that, both nationally and locally, the NHS can deliver for patients.

Government Mandate for the NHS

Stephen Hammond Excerpts

Thursday 25th April 2019 Commons Chamber

[Jonathan Ashworth (Leicester South) (Lab/Co-op)]

(Urgent Question): To ask the Secretary of State for Health and Social Care if he will make a statement on the Government’s failure to lay before Parliament the NHS mandate for the current financial year.

[The Minister for Health (Stephen Hammond)]

I am grateful to have the opportunity to set out the Government’s approach to setting a mandate for NHS England for 2019-20. The Government’s annual mandate to NHS England for 2019-20 will, for the first time, be a joint document with the annual NHS Improvement remit letter, called an accountability framework. This signals the importance of these two arm’s-length bodies working increasingly closely to maximise their collective impact. It will set one-year transitional objectives to allow the NHS time to implement the long-term plan, and it has been developed to meet the needs of patients, families and staff.

We are committed to the NHS and are funding its long-term plan to ensure that it is fit for the future for patients, their families and NHS staff. The accountability framework sets the expectations that will make that long-term plan a reality. The Government have continued to prioritise funding the NHS, with a five-year budget settlement for the NHS announced in summer 2018 that will see the NHS budget rise by £33.9 billion a year by 2023-24.

The funding settlement and the implementation of the long-term plan are not affected in any way by the short delay in the publication of the accountability framework. We are all engaged to ensure that the accountability framework is published and laid as soon as possible, and I and my ministerial colleagues and officials are working closely with NHS England and Healthwatch England, as statutory consultees, to ensure accountability, improvement and progress to deliver world- class care for patients.

[Jonathan Ashworth]

It is a pleasure to see the Minister of State, as always, but the Secretary of State should be here to defend his failure to produce the NHS mandate. In every previous year, in accordance with section 23 of the Health and Social Care Act 2012—an Act that he supported and voted for despite everyone telling the Government not to support it—the Government have published the NHS mandate before the beginning of the financial year. This mandate outlines the Secretary of State’s priorities for the NHS given the financial settlement, yet this is the first time a Secretary of State has failed to lay before Parliament the Government’s mandate to the NHS for the forthcoming financial year. Is this a failure of leadership or the latest piece of stealth dismantling of the Health and Social Care Act? If it is the latter, why not just take our advice and bin the whole thing and so end the wasteful contracting, tendering and marketisation it ushered in?

The Minister talks of the 10-year long-term plan, but it is no good his telling us he endorses Simon Steven’s vision of the NHS in a decade’s time, when Ministers cannot even tell us what they expect the NHS to achieve in a year’s time. He boasts of the new revenue funding settlement for the NHS but seemingly has not got a clue what he wants the NHS to spend it on in the next 12 months, and at the same time he does not talk about the cuts to public health budgets, training budgets and capital investment.

Will the new accountability framework deliver for patients in the next 12 months? Last year’s mandate pledged that A&E aggregate performance in England would hit 95% in 2018. That pledge was broken, so can the Minister tell us whether, for those A&E departments not trialling the new access standard, the four-hour A&E standard will be met this year, or will the target not be met for the fourth year running?

Or how about the 18-week referral to treatment target? More than half a million people are now waiting more than 18 weeks for treatment. The target that 92% of people on the waiting list should be waiting less than 18 weeks has not been met since 2016. Will that target be met in the next 12 months, or has it also been abandoned? What about cancer waits? Some 28,000 patients are now waiting beyond two months for treatment. The target for 85% of cancer patients to be seen within two months for their first cancer treatment after an urgent referral has been missed in every month but one since April 2014. Will that target be met this year, or will cancer patients be expected to wait longer and longer?

On staffing and pay, will funding be made available in the next 12 months, as it was last year, for a pay rise for health staff employed on agenda for change terms and conditions working in the public health sector for local authorities and social enterprises?

We have no NHS mandate, even though it is mandatory. We have no social care Green Paper, even though it has been promised five times. The big issue has been ducked again. We have no workforce plan, even though we have 100,000 vacancies across the NHS, and the interim plan, which should have been published today, has been delayed again. The Secretary of State parades his leadership credentials around right-wing think-tanks, yet on this record he could not run a whelk stall, never mind the Tory party. It is clearer than ever that only Labour will fully fund our NHS and deliver the quality of care patients deserve.

[Stephen Hammond]

Anyone listening to that will have realised that the hon. Gentleman is more concerned with political points scoring and process than with the substance and funding of the NHS. [Interruption.] The hon. Member for Dewsbury (Paula Sherriff) shouts at me, but she will want to remember that the shadow Secretary of State welcomed the long-term plan—or much of it—back in January.

It is absolutely clear—evidence was provided to the Public Accounts Select Committee yesterday by the permanent secretary and the chief executive of NHS England—that while obviously it would be better to publish by the deadline, it is more important that the mandate be right than published on a particular day. It is more important that we get this document on the long-term strategy of the NHS correct. As Simon Stevens, the chief executive of the NHS, said, there is no problem with this short delay to the mandate. It is an important document, but it is causing him no problems. It is causing no problems.

The hon. Gentleman mentioned access to treatment and treatment times. This winter, more than 7 million patients were seen in under four hours. That is an increase of nearly 6% in attendances. I would have hoped that the Opposition Front Bench might have praised the NHS and its hard-working staff—

[Paula Sherriff (Dewsbury) (Lab)]

Always do. I worked in it for 17 years.

[Stephen Hammond]

Rather than shouting political points across the Dispatch Box.

The hon. Gentleman says there are no targets. He is of course wrong.

[Jonathan Ashworth]

I said you were not meeting them.

[Stephen Hammond]

No, the hon. Gentleman said there were no targets likely to be set for the NHS this year. The accountability framework will include detailed and specific annual deliverables and set out in detail a process for delivering future implementation as well as some of the early delivery goals for 2019-20. He is wrong therefore to say that the framework will not have deliverables attached to it. It will. He also mentioned the Green Paper—

[Jonathan Ashworth]

Where is it?

[Stephen Hammond]

I have said, as the hon. Gentleman has heard many times, that we are finalising that. Again, it is more important to get it right. On the long-term plan for workforce implementation, a draft plan is being produced and I expect that plan to be published in the very near future—[Interruption.]

[Mr Speaker]

Order. The shadow Secretary of State exceeded his time on his feet. He must not now chunter in borderline delinquent fashion from his seat.

[Mr Speaker]

No one is ever too old to behave in a delinquent fashion.

[Stephen Hammond]

There are all sorts of lines I could follow that with, Mr Speaker.

It is clear that it is this side of the House that is putting in the funding to make sure that the NHS can deliver for the patients, staff and families.

[Sir Peter Bottomley (Worthing West) (Con)]

Most of us will remember that the NHS Confederation said four years ago that it wanted

“a manageable number of objectives, which…focus on long-term outcomes for patients and populations rather than measures of how services are delivered”—

and—

“encourage collective responsibility for patient outcomes rather than silo working – particularly the expected outcomes from integrated care”.

Most people in the NHS will welcome the short delay if the result is that it makes it more possible for them to achieve the objective of the NHS, which is serving patients together.

--- Later in debate ---

[Stephen Hammond]

My hon. Friend will have noted, as I said in my opening remarks, that this is an accountability framework because it brings together both the mandate for NHS England and the remit letter to NHS Improvement. It is a sign of more collaborative working which, as he says, almost everybody in the NHS and the healthcare arena would welcome.

[Ms Eagle]

The Minister will know the funding pressures that the NHS has been under, despite the 10-year plan: we still await the actual money being delivered, even though it has been announced. In the Wirral, a great deal of inefficiency is caused by the chronic underfunding of social care, for which the Government are responsible, which puts enormous pressure on health services. When it finally arrives, will the plan for the next year offer some proper relief in that area?

[Stephen Hammond]

The hon. Lady will know that the Government have committed £33.9 billion up to 2023-24, and the first element of that has arrived this year. There will be, as I said earlier, publication of a Green Paper on social care and, combined with the comprehensive spending review, that will ensure that the Government will provide for the social care funding that is necessary.

[John Howell (Henley) (Con)]

Will the Minister recognise that the commitment under the long-term plan to ambulatory care, which is supported by the Royal College of Physicians, is helping patients receive the best form of care service in their own homes?

[Stephen Hammond]

My hon. Friend is right. At the heart of the long-term plan is the emphasis on primary care and prevention. Providing care for people in their own homes undoubtedly achieves better outcomes for patients and he is right to welcome it.

[Dr Paul Williams (Stockton South) (Lab)]

The Minister will know that NHS England is currently consulting on proposals to change the law to remove mandatory competition, but billions of pounds’-worth of NHS services are currently out to tender. Has he considered, as part of the mandate, issuing clear guidance to CCGs that while the consultation is taking place they do not need to put many services out to the market? Or is he happy for that privatisation to continue on his watch?

[Stephen Hammond]

The hon. Gentleman is right to point out that a consultation is being undertaken on various aspects of the long-term plan and the legal framework that needs to be put in place. It is entirely up to local CCGs to make decisions on their procurement policy.

[Mr Philip Hollobone (Kettering) (Con)]

Record investment is going into Kettering General Hospital and a record number of patients are being treated, but the best way that the Minister can deliver the NHS mandate and long-term plan for the people of Kettering is by providing the funding for a new urgent care hub, the site of which he has visited at Kettering General Hospital, and by working with the Ministry of Housing, Communities and Local Government to take advantage of local government reorganisation in Northamptonshire to create a health and social care pilot. Will he commit to both?

--- Later in debate ---

[Stephen Hammond]

My hon. Friend and I have sometimes disagreed on certain things, but one thing we agree on is his advocacy for his constituents, and he is right that I have been to see for myself the issues in Kettering in terms of the current configuration of the accident and emergency department. He is right to press for that urgent care centre, and he knows that he has impressed the case on my mind.

[Mr Speaker]

Everybody in Kettering must be aware of the hon. Member for Kettering (Mr Hollobone). It is beyond my vivid imagination to suppose that there is any resident of the area who is not aware of him.

[Dr Sarah Wollaston (Totnes) (Change UK)]

The truth is that it is very difficult for the NHS to make plans without knowing what the Government’s plans are for social care. We know, following a response to a question in yesterday’s debate, that the Green Paper has actually been written. There is simply no excuse for the continued delay in its publication which would allow the House to scrutinise it and the NHS to be able to provide a truly integrated approach to health and social care. Just saying that it will be published soon is no longer acceptable. Will the Minister set out when we can expect to see this vital document, so that we can scrutinise the Government’s plans?

[Stephen Hammond]

The hon. Lady knows that the House and her Committee will have the fullest opportunity to scrutinise the document as and when it is published. She also knows that there is a commitment to publish it soon. She also rightly points out that it will deliver on the need to ensure that health and social care are integrated.

[Karin Smyth (Bristol South) (Lab)]

For most of my professional life, I was an NHS planner. I assure the Minister that the great expectation and anticipation of NHS planners for planning guidance in the mandate is very real. They are public servants who expect to be held accountable and do what the Government ask them to do. It is unacceptable to leave them in the dark. It is an insult to patients—taxpayers who pay for services and expect to know what they can receive locally. The delay is inexcusable.

The Minister says he has a plan and the Government say they have the money, so why cannot they publish it? What are they trying to hide?

[Stephen Hammond]

The Government are not trying to hide anything. The hon. Lady is right that it is an important document, and it is important therefore that we get it absolutely correct. I refer her to what the chief executive of NHS England said yesterday. He said:

“We have an agreed direction in the long-term plan…We have the budget set for the next year, and we have the NHS annual planning process…wrapped up…2019-20 is…a transition year…stepping into the new five-year long-term plan.”

The chief executive of the NHS thinks that the process is working acceptably.

[Diana Johnson (Kingston upon Hull North) (Lab)]

I am really not following the Minister on why this mandate has not been published. I wonder whether it is because of the paralysis in Government caused by the Brexit shambles or because, as the Health Service Journal reports, the Secretary of State is focused on an anticipated leadership race and his thoughts are elsewhere.

[Stephen Hammond]

The hon. Lady does a great injustice to my right hon. Friend. He is today—

[Paula Sherriff]

Writing his speech for the leadership!

[Stephen Hammond]

In the hon. Lady’s fantasy world, that may be true, but my right hon. Friend is in fact addressing a conference in Manchester, talking about the gender pay gap and how this side will close it in the NHS. I would have thought she would welcome that, rather than shouting at me.

[Dr Wollaston]

On a point of order, Mr Speaker. When the Secretary of State comes to the Dispatch Box and makes a clear commitment that the publication date of the Green Paper will be before Christmas, and we know that the document has been written, what are the consequences of an absolute failure to honour such a commitment made at the Dispatch Box by a Secretary of State?

Draft Food Additives, Flavourings, Enzymes and Extraction Solvents (amendment etc.) (EU Exit) Regulations 2019

Stephen Hammond Excerpts

Monday 1st April 2019 General Committees

[The Minister for Health (Stephen Hammond)]

I beg to move,

That the Committee has considered the draft Food Additives, Flavourings, Enzymes and Extraction Solvents (Amendment etc.) (EU Exit) Regulations 2019.

I think I can say on behalf of the whole Committee without reservation that it is a pleasure to see you in the Chair, Sir Roger.

The Government’s priority is to ensure that the high standards of food safety and consumer protection that we enjoy in this country are maintained when the UK leaves the European Union. This instrument is crucial to meeting our objective of a functioning statute book after exit day. Food additives, flavouring enzymes and extraction solvents are important substances referred to collectively as food improvement agents.

--- Later in debate ---

On resuming—

[Stephen Hammond]

These substances perform technological functions in or on food during its production or storage. Examples include preservatives, which are highly effective in protecting consumers from dangerous pathogens. They are used to improve the taste, texture and appearance of food. Common examples are artificial sweeteners and flavourings. In general, they are not sold to the final consumer but are traded between businesses.

As all hon. Members know, the Government’s top priority is to secure a deal, but at the same time it is the responsibility of a responsible Government to prepare for all possible scenarios. An extension to article 50 does not rule out no deal as a possible scenario. It is therefore absolutely right that the Government continue to prepare for no deal, and this instrument is part of that preparation. We are committed to ensuring that the UK’s legislation and policies function effectively in a no-deal scenario. It is for that scenario that these draft regulations have been laid before Parliament.

The instrument is to be made under the powers in the European Union (Withdrawal) Act 2018. It makes the minimum necessary amendments to retained legislation that governs the use of food improvement agents. It was due to be debated on Tuesday 19 March, alongside four other instruments on regulated products in food. Minor drafting errors were identified and have now been rectified.

The Government remain committed to ensuring high standards of food and feed safety and consumer protection. We will ensure that what we enjoy now is maintained in any deal or no-deal scenario. The instrument will ensure that the controls contained in the 11 retained regulations that govern food improvement agents continue to function effectively after exit day.

There will be no change in how food businesses are regulated or run. All existing food improvement agents permitted for use in the UK prior to exit day will continue to be permitted immediately after exit, and conditions and requirements attached to their use will be preserved. That will ensure continuity and clarity for UK food businesses and for those exporting their food products to the UK, and will maintain existing levels of public health protection and food safety.

I wish to make it clear to the Committee that, as with previous statutory instruments presented to the House by the former Minister, my hon. Friend the Member for Winchester (Steve Brine), the instrument makes no policy changes. It makes only essential changes that are necessary to ensure that we have an effective and fully operative statute book on exit day. The instrument’s primary purpose is to ensure that legislation continues to function effectively after exit day. The amendments are critical to ensure minimal disruption to food controls in the event that we leave the EU without a deal. The changes also ensure that a robust system of controls will underpin the ability of domestic businesses to trade, both in the UK and internationally.

I stress that food safety will not be affected by the short delay caused by the instrument’s withdrawal and re-laying before Parliament. The existing list of permitted substances, along with their specifications and conditions of use, will be retained by virtue of the European Union (Withdrawal) Act 2018. The Food Additives, Flavourings, Enzymes and Extraction Solvents (England) Regulations 2013, which provide for the enforcement of provisions relating to those products, remain operable.

In the unlikely event that urgent action is required on unsafe foods in any short interim period between exit and the coming into force of the instrument, the Food Safety Act 1990 and retained EU food law will continue to provide food safety protections for consumers. That legislation, which has already been corrected, allows for enforcement action to be taken against placing any unsafe food on the market.

The instrument makes no changes to policy, beyond the minor and technical amendments to correct deficiencies arising as a consequence of the UK leaving the EU. Those deficiencies concern the assignment of functions to EU institutions on processes to which the UK will no longer have access and on which it can no longer rely. The instrument assigns powers and responsibilities that are currently incumbent on EU entities to the appropriate UK entities.

Under EU legislation, the European Commission currently holds a range of powers and functions to enable new substances to come on to the market, to amend the current conditions of use and purity criteria, and to remove substances from the permitted lists. The instrument transfers those powers from the Commission to Ministers in England, Scotland and Wales, and to the devolved authority in Northern Ireland. It also transfers responsibility for risk assessment from the European Food Safety Authority to UK risk assessors. The Committee should note that all powers in that category relate to technical, scientific and administrative adjustments that may be necessary to respond to changing circumstances.

Risk assessment and the oversight of food controls will be essential to ensure that food remains safe, whether it is imported or produced in the UK. The Food Standards Agency and Food Standards Scotland are responsible for protecting public health in relation to food, and will continue to be independent science and evidence-based Government departments. Those functions will be delivered through an increased risk assessment capacity that has already been put in place.

The instrument will revoke EU regulation 257/2010, which places no obligations on the UK. That regulation established a programme for the European Food Safety Authority to re-evaluate the authorised food additives that were assessed for safety prior to 2009, which ensured that those substances remained safe for the general population in the light of the latest scientific data and technological developments. To date, re-evaluations for all colours, preservatives, antioxidants and aspartame have been completed, while re-evaluations for remaining food additives are ongoing. The official deadline for the completion of the re-evaluation programme is the end of 2020. All the EFSA’s re-evaluations are published online and will remain accessible to the UK after it exits the EU. Through the Foods Standards Agency and Food Standards Scotland, the UK will continue to scrutinise the European Food Safety Authority reports as we do now, alongside other robust scientific evidence, and will consider if action on the UK authorised list is necessary.

By way of further assistance, the Committee may wish to know that article 26 of regulation (EC) 1333/2008 will be retained on exit day. It preserves the duty placed on producers or users of a food additive to immediately notify the UK of any new scientific or technological information that may affect the safety assessment of a food additive. The UK has sufficient safeguards and expertise in the Food Standards Agency and Food Standards Scotland to ensure that food additives on the UK authorised list are actively kept under review on an ongoing basis. Consequently, there is no need to establish a UK re-evaluation programme and replicate work already far advanced by the EFSA.

This instrument will have no impact on the food industry, as there are no changes to the controls on the use of substances. There are also no changes to the authorisation process for any new substances, except that the roles of the European Commission and the European Food Safety Authority will be replaced by relevant UK entities. To support the changes, the Food Standards Agency intends to publish detailed guidance on the UK authorisation processes. Scientific data requirements in support of applications will remain the same, and the same package of data can be submitted to the UK and the EU, avoiding any unnecessary additional burden.

This instrument is a necessary measure to ensure that the high standard of food safety and consumer protection we enjoy in this country is maintained, and that the relevant regulations continue to function effectively after exit day. Due to the instrument being laid under the European Union (Withdrawal) Act 2018, the scope of its amendments is limited to achieving that objective. At an appropriate point in future, the Department will review whether the UK’s exit from the EU offers us opportunities to re-appraise current regulations while continuing to ensure that we protect the nation’s health and food safety standards. I urge hon. Members to support the instrument, which I commend to the Committee.

--- Later in debate ---

[Stephen Hammond]

Let me try to address hon. Members’ questions and comments. The hon. Member for Washington and Sunderland West asked what errors were identified in the SI and what has been done to rectify them. As I said in my opening remarks, they were relatively minor drafting errors, mainly due to style rather than content. For instance, there was a drafting error in regulation 16(b), where an obligation to inform the Food Standards Agency and Food Standards Scotland of the receipt of an application for a product to be included on a list was not included for smoke flavourings. That has been corrected.

There was a comment about the failure to comply with proper legislative practice, which related to whether some text should have been prepared and presented as a footnote instead. Although it was considered that we did not have to follow that practice, we have followed it. I hope the hon. Lady will be satisfied that they were relatively minor drafting errors. She was right to make the supposition that the original explanatory memorandum still applies to this, as it did to the other three regulations that were introduced in this batch.

The hon. Lady asked about the impact on industry. As I hope she took from my words, the instrument will have no impact on the food industry. There are no changes to the controls on the use of substances or to the authorisation process for new substances, except, as we have said and as I tried to explain—I hope she took the point—that the roles of the European Commission and the European Food Safety Authority will be replaced by the relevant UK entities. I have also made the point that scientific data requirements in support of applications remain the same, so the package of data that must be submitted remains the same. Therefore, there should be no unnecessary additional burdens.

The consultation that took place with industry was open for six weeks between 4 September and 14 October, but, because it is so important that food safety and standards are maintained, it was left open for another week so that any latecomers could be included in the analysis. In total, 50 responses were received, of which some 82% supported the Government’s approach. I hope the hon. Lady is reassured that industry has been consulted, that it understands the impact on it—that is, that there is very little impact—and that it is satisfied.

The hon. Lady asked about aspartame and the PKU impact. No changes are being made to labelling. Therefore, PKU sufferers will continue to see labelling as they do now.

Both the hon. Lady and the hon. Member for Argyll and Bute raised the subject of the European Food Safety Authority. As I said at the beginning, the instrument will not change the FSA’s top priority in the UK, which is to ensure that UK food remains safe. The FSA has strengthened its risk analysis. The hon. Gentleman asked whether capacity has been strengthened, and I can tell him that capacity and resource for risk assessment and risk management have been strengthened. The FSA is also expanding its access to scientific experts who can provide the necessary scientific advice and other scientific services to meet any potential increased need for risk assessments.

[Brendan O'Hara]

On a point of clarification, are the Food Standards Agency and Food Standards Scotland expected to take over all the existing functions of the EFSA?

[Stephen Hammond]

As I pointed out, the UK will still have access to the re-evaluation programme until the end of 2020. All those re-evaluations will be undertaken through the Food Standards Agency and Food Standards Scotland. The draft regulations, along with other instruments, will transfer the functions of the EFSA to those bodies—[Interruption.] Inspiration has reached me to confirm that point.

The hon. Gentleman asked how we will ensure that we have the required expertise and resource to maintain standards in the UK. As I said, we have already put in place extra capacity and access to extra scientific advice. We are also looking at expanding the role of scientific advisory committees, to help us to uphold the principles of protecting public health and maintaining consumer confidence through openness and transparency.

Question put and agreed to.

Resolved,

That the Committee has considered the draft Food Additives, Flavourings, Enzymes and Extraction Solvents (Amendment etc.) (EU Exit) Regulations 2019.

Healthcare (International Arrangements) Bill (Changed to Healthcare (European Economic Area and Switzerland Arrangements) Bill)

Stephen Hammond Excerpts

Ping Pong: House of Commons
Tuesday 26th March 2019 Commons Chamber

[The Minister for Health (Stephen Hammond)]

I beg to move, That this House agrees with Lords amendment 1.

[Mr Deputy Speaker (Sir Lindsay Hoyle)]

With this it will be convenient to discuss Lords amendments 2, 8 to 10, 18 to 20, 3 to 7 and 11 to 17.

[Stephen Hammond]

It is a pleasure to be in the Chamber this afternoon. We now have the opportunity to turn our attention to an issue of great importance which, I know, commands the support of the House: the issue of reciprocal healthcare. As Members know, our ability to fund healthcare abroad brings invaluable benefits to people, and it is our responsibility to ensure that we continue to make them available to the public. I thank Members on both sides of the House for their work in considering the Bill so far, including those who have spoken to me about it outside the Chamber.

The amendments deal with the global scope of the Bill. It was intended to provide the Secretary of State with powers to fund healthcare outside the UK, to give effect to healthcare arrangements and healthcare agreements between the United Kingdom and other countries or international organisations—such as the European Union—and to make provision in relation to data processing, which is necessary to underpin these arrangements and agreements. Although it was introduced as a result of the UK’s exit from the EU, it was intended to be forward-facing and not to deal only with EU exit. It offered an opportunity to implement new comprehensive reciprocal healthcare agreements with countries outside the EU.

[Tom Brake (Carshalton and Wallington) (LD)]

I am sorry that the Minister was not able to join us at St Helier Hospital yesterday. I understand the reasons for that perfectly, but I hope that he will back the plan for the hospital.

The Minister mentioned the international scope of the Bill. Does he accept that that was a mistake in view of the concerns that people have expressed about, for instance, the opening up of the NHS in future international trade deals with countries such as the United States?

[Stephen Hammond]

I thank the right hon. Gentleman for his words about why I was unable to go to St Helier Hospital. He knows that, as a Minister, it would have been inappropriate, but as a constituency Member of Parliament, I have no doubt that I will be visiting there again soon. I do not accept his criticism. That was never the point of the Bill. We made that argument consistently both in this House and in the Lords. But we have listened carefully to what has been said about the scope of the Bill and I am about to address that now.

As we prepare for our imminent exit from the EU, the global scope of this Bill has been the source of much discussion in here, outside this House and in the other place. I am pleased that the noble lords did not fundamentally disagree with the idea of reciprocal healthcare arrangements outside the EU. However, it was strongly felt that this was not the time to provide for it. Although the Government would have welcomed that opportunity to provide for it, they have recognised that through this group of amendments their lordships voted to restrict the scope of the Bill to making provision only for EU/EEA countries and Switzerland.

The Government believe it is disappointing to lose at this particular time the opportunity to be able to help UK nationals to obtain healthcare when they visit countries outside the EU, such as when they are travelling, studying or working abroad, or if they want to give birth or obtain treatment. It remains the Government’s view that international arrangements on these issues could promote more life options for our citizens outside the EU, offer greater personalisation of care and assist further in the fostering of international healthcare co-operation. However, it must be our foremost priority to ensure that the Bill receives Royal Assent and is in place so we can respond to the different scenarios without delay and assist, as appropriate, the people who rely on these vital healthcare arrangements.

[Mr Barry Sheerman (Huddersfield) (Lab/Co-op)]

The Minister and I have form on this, in that we were in a Statutory Instrument Committee only yesterday when I was trying to get over to him the need to be very clear to our constituents that, when we leave the EU, the EHIC—the European health insurance card—will disappear and when our constituents go to anywhere in Europe the full bank of healthcare will disappear. Yesterday, the Minister suggested people should take out private insurance instead. Is it not his job as a Minister to tell his constituents and my constituents the truth about this?

[Stephen Hammond]

It absolutely is my job to tell my constituents and the whole of the country the truth, and I did that yesterday in Committee and will do it again now. If the hon. Gentleman votes for the withdrawal agreement and it passes, the EHIC will remain in place, as I said yesterday. As I also said yesterday it has always been the Government’s advice that people should purchase travel insurance. None of that has changed and that is exactly what I said yesterday and it is exactly what I am saying today.

[Kevin Foster (Torbay) (Con)]

Does my hon. Friend agree that we need to be very clear that, with the EHIC, people will get treated as if they are a local; it is not the NHS on tour, so to speak, so we can still face some charges? Particular note should be taken of repatriation costs. If going abroad on something like a skiing holiday, people would be foolish not to take out full travel insurance.

[Stephen Hammond]

My hon. Friend is right. I made that point yesterday; I made it when I was speaking at the Dispatch Box on Report; and I am happy to make that commitment again today.

It must be our foremost priority to ensure that the Bill receives Royal Assent and is in place so that we can respond to different scenarios. We take this decision with regard for the people who currently rely on the EU reciprocal healthcare arrangements and, only with that in mind, we are choosing not to disagree with the Lords amendments.

[Mr Sheerman]

Will the Minister give way?

[Stephen Hammond]

One last time because the hon. Gentleman and I had form on this yesterday.

[Mr Sheerman]

This is an important issue. If the Minister wants me to make a series of points of order, I will because this is so important. Yesterday in a Committee Room, none of us could understand this. At one point, the Minister said, “This is transitional. This will only cover the transition until we are out of the EU. After we have left the EU, EHIC won’t apply.” That is what he said yesterday. I am still not sure whether EHIC will apply only in the transition period, or will go on forever. He has not been clear about this.

[Stephen Hammond]

I have been clear. One can say these things as many times as one likes, but if someone won’t hear, they won’t hear. I will say one more time to the hon. Gentleman—I am happy to take his interventions if he is going to move on to other points—that, as I made clear yesterday, if the withdrawal Bill passes, the current arrangements for reciprocal healthcare will continue throughout the implementation period. During that implementation period, it is the express intention of the Government and the EU to secure continuing reciprocal healthcare arrangements.

[Mr Sheerman]

There is no guarantee.

[Stephen Hammond]

The hon. Gentleman chunters that there is no guarantee. I have given him the guarantee that it is the express intention of both the UK and the EU to ensure reciprocal healthcare arrangements for our citizens post EU exit. I have set out clearly that, in the event of the withdrawal Bill passing and the implementation period starting, EHIC will continue and I think—

[Mr Sheerman]

On a point of order, Mr Deputy Speaker. The Minister and I were in an SI Committee yesterday and you will know how pressurised they are. Four SIs were all blended together, so it was very difficult to separate them and do our job of scrutinising the legislation going through this place, which is our prime responsibility. What we could not get from the Minister was absolute clarity, speaking out to the public and saying that actually the likelihood of keeping EHIC after we leave the EU is on a wing and a prayer—there is no certainty at all.

--- Later in debate ---

[Stephen Hammond]

The hon. Gentleman put that on the record yesterday. I answered the question yesterday. I did so with clarity, in a way that I think almost any member of the public could have understood, and I hope that with that we can move on.

The next amendment I wish to discuss is Lords amendment 3. Their lordships have amended clause 2 to limit the regulation-making powers at clause 2(1). Clause 2(2) was intended to be an illustrative list setting out examples of the type of provision that may be included in regulations made under clause 2(1). It is not, on its own, a delegated power. The effect of amendment 3 is to make the list at clause 2(2) exhaustive. Regulations made under clause 2(1) can now only provide for those things on the list at clause 2(2). The intention of the Government has always been to be prudent and transparent in the use of the Bill’s delegated powers and the list was included to be helpful by demonstrating the types of provision that the regulation-making powers at clause 2(1) could include.

[Mr Sheerman]

On a point of order, Mr Deputy Speaker. I like the Minister—he is a nice man—but he is reading a brief that for most of my constituents and his is absolute gobbledegook—brackets, references here and sub-clauses there. Surely his job as a Minister is to tell this House in plain English what the dangers are to their future travel—their holidays and business in Europe?

--- Later in debate ---

[Mr Deputy Speaker]

The hon. Gentleman not making another point of order might be helpful as well. Let’s just get on and move forward because it is in everybody’s best interests to hear what the Minister has to say.

[Stephen Hammond]

Much of what we discuss in this House is clearly of a technical nature, and sometimes its language is impenetrable to others who are watching. However, as the hon. Members for Burnley (Julie Cooper) and for Ellesmere Port and Neston (Justin Madders) will know, the House has had a chance to look at this in a fairly exhaustive way. They will know exactly what I am referring to, and I am sure that they will wish to refer to it in their speeches.

Using “for example” to introduce an illustrative list of things that can be done under a regulation-making power can be found in a number of other pieces of legislation. Section 11(2) of the Automated and Electric Vehicles Act 2018 states:

“Regulations under subsection (1) may, for example”.

Section 48G(2) of the Banking Act 2009 says:

“An order may, for example”.

Using “for example” is not unknown. However, we acknowledge the concerns raised about the breadth of the delegated powers in the Bill, and the Government have taken considerable steps to address those concerns via a number of Government amendments that were accepted in the other place, which I will come to shortly. In addition, we are choosing not to disagree to this amendment, to give further reassurance that the delegated powers in the Bill are no wider than necessary.

[Mr Sheerman]

The Minister knows that I have also been on another, similar Statutory Instrument Committee, which looked at the use of the green card that gives our constituents the assurance when they travel to Europe that if they are hit by an uninsured driver they will be covered by the insurance industry. That will be lost when we leave the European Union. I used that example yesterday, but the Minister did not come back on it. That is a right and privilege that our constituents expect, and now they are going to lose a similar one relating to healthcare. Is it not clear that these are both examples of the real damage that leaving the European Union will do to us?

[Stephen Hammond]

The hon. Gentleman has confused various clauses of the Bill, but I will not trouble to explain that. I simply say that the green card is clearly an issue for another Department. I also say again, as I said to him yesterday, that citizens are not going to lose the benefits they enjoy under the EHIC if the withdrawal agreement is passed and the implementation period starts. I would guide him by saying that the easiest way to ensure that all the good burghers of Huddersfield whom he so ably represents can continue to enjoy those rights is to vote for the withdrawal agreement.

As I was saying, the Government have taken considerable steps to address these concerns via a series of Government amendments that were accepted in the other place. In addition, we are choosing not to disagree to this amendment, to give further reassurance that the delegated powers in the Bill are no wider than necessary. Our primary concern, as I have said, is to ensure that the Bill is in place so we have the legal mechanism to support people who rely on these vital healthcare arrangements, as may be necessary.

I would now like to turn to the Government amendments in this group. The Government have also sought to restrict the regulation-making powers in clause 2(1). Amendments 4, 5, and 6 will ensure that, if we confer or delegate functions, this will only be to public authorities. The Government have listened closely to the concerns that the regulations could be used to confer functions on “anyone, anywhere”. The hon. Member for Ellesmere Port and Neston argued in Committee that this wide-ranging scope was unacceptable. As I said to him, there has never been an intention to confer functions on private bodies in order to implement reciprocal healthcare arrangements, but, given the concerns that have been raised, we were prepared to make this restriction clear through these amendments to clause 2.

The Government have also brought forward amendment 7. Arguably the most persistent criticism in both Houses has concerned the Bill’s delegated powers. The Delegated Powers and Regulatory Reform Committee and the Constitution Committee both raised particular concerns about the breadth of the powers. The powers in the Bill were sought to provide options in the event of no deal to mitigate the detrimental effects of a sudden change in healthcare overseas for UK nationals living in the EU. In particular, the regulation-making powers in clause 2 (1)(a) and 2(1)(b) provide a means for dealing with situations where there is no bilateral or multilateral agreement in place.

The Government listened carefully to the concerns raised by parliamentarians across both Houses about the scope of the Bill’s regulation-making powers and concluded that the powers used to establish unilateral healthcare arrangements outside of reciprocal healthcare agreements should be sunset for a period of five years following the UK’s exit from the EU. During the five years before the sunset, we will have the ability to use regulations under clause 2(1) as appropriate. These powers can be used to support UK nationals in the EU in different EU exit scenarios. After the sunset, making use of the regulation-making powers under clause 2(1) would be limited to clause 2(1)(c) only. This provides the Government with a mechanism to give effect to future complex healthcare agreements with the EU, individual EEA member states and/or Switzerland.

[Mr Sheerman]

Will the Minister give a crystal clear guarantee to all those people who are related to our constituents and who live across Europe and have perhaps retired there that, if they have a long-term health need, the benefits they enjoy under the EHIC at the moment will continue? I do not want to hear anything about the difference between transitional and long term; can he assure those people that they will continue to get those health benefits in the long term?

[Stephen Hammond]

If the hon. Gentleman votes for the withdrawal agreement, he will be able to give them that reassurance.

I want to turn now to Government amendment 11. The matter of financial reporting and parliamentary scrutiny has also been a matter of legitimate concern to this House and the other place, and amendment 11 speaks to this concern. As I explained in Committee, the Government are firmly committed to transparency in the use of public money. We have made this commitment plain in the Bill with a duty on the Secretary of State to lay a report before Parliament each year. This report will outline all payments made during the preceding financial year in respect of healthcare arrangements implemented by the Bill. I believe that this amendment directly addresses the concerns raised by hon. Members in Committee, particularly those raised by the hon. Member for Burnley. The nature and implementation of future reciprocal healthcare agreements is a matter for future negotiations. However, we envisage that through this reporting mechanism we would also be able to provide Parliament with further information on the operation of future agreements. For example, we anticipate that this report would include details of both expenditure and income to reflect the reciprocal nature of the agreements.

Before I speak to Government amendment 12, I am pleased to report that we have secured legislative consent motions from both the Scottish and Welsh Governments, in addition to having positive and productive engagement with colleagues in the Northern Ireland Department of Health and the Northern Ireland Office. I want to put on record my thanks to all of them. We have amended the Bill to reflect the outcome of our productive discussions, and the Secretary of State must now consult the relevant devolved authority before making regulations under clause 2(1) that contain any provision that is within the legislative competence of a devolved legislature. To underpin and facilitate this consultation, we have developed and agreed a memorandum of understanding with the devolved Administrations. The MOU sets out a practical and mutually beneficial working relationship that will ensure that the devolved Administrations continue to play a vital role in delivering reciprocal healthcare for the benefit of all UK nationals. We believe that this practical and pragmatic agreement allows us to move forward in a collaborative way with all our colleagues in the devolved Administrations.

[Mr Sheerman]

The Minister will remember that, in our previous encounter on this matter in Committee, we asked him how far he had spread his discussions about the impact of this Bill in Northern Ireland. He was very honest and said that he had spoken mainly to officials and civil servants, and not to the politicians who represent the constituents there. Has he changed his mind about that, because that seems like a strangely narrow sort of consultation?

[Stephen Hammond]

I do not think that it was narrow in the slightest. We have discussed matters with the Welsh and Scottish Governments and, given the situation in Northern Ireland, which the hon. Gentleman well knows, with the Northern Ireland civil service, the Northern Ireland Department of Health and the Northern Ireland Office here. I think that that is exactly what I said yesterday, and I am happy to repeat it.

Turning to amendment 15 and transparency, we have also amended the Bill to allow for further parliamentary scrutiny of the list of persons who can lawfully process data as a part of implementing new reciprocal healthcare arrangements under the Bill.

--- Later in debate ---

[Mr Sheerman]

The Minister is being generous in giving way. He will be aware that even Henry VIII in his full pomp would not have got away with stealing the right to health cover of British citizens travelling on holiday to Europe or visiting on business without full democratic scrutiny of the decision. Henry VIII would have been pleased to have had that privilege. This Government have been smuggling the decision through, both in Committee and here in this empty Chamber, and they are stealing the rights of British people.

[Stephen Hammond]

Given that I just said that we have accepted the amendment that would remove the powers, that argument is hardly powerful. I also suspect that the Opposition spokesperson and the other members of the Committee will be surprised to hear that they had not fulfilled their role when they sat through the hours of scrutiny in Committee.

In conclusion, I offer my thanks to hon. Members from across the House and to the Lords for its constructive work in scrutinising and improving this Bill. We share a common goal in wanting to ensure that we can continue to benefit from the current reciprocal healthcare schemes and benefit from similar arrangements in the future. This Bill is an important and necessary piece of legislation that seeks to ensure that the Government are ready and able to respond to different EU-exit scenarios and that we are in a position to support, as appropriate, people who rely on current EU reciprocal healthcare arrangements. For that reason, it is critical that we take those steps and that the Bill can become law.

[Julie Cooper (Burnley) (Lab)]

I rise to support the Lords amendments before us. I thank all the Members who have worked on the Bill at various stages and the staff of the House, who have provided invaluable support. I also put on record my particular thanks to my hon. Friend the Member for Ellesmere Port and Neston (Justin Madders) for his great work during the Bill’s earlier stages. I also thank those in the lords for their exceptional work on this Bill. Thanks to their endeavours, we now have a Bill that is fit for purpose. I am pleased that the Government have decided to listen to our noble friends and give full support to the amended Bill, which marks a welcome, if rather belated, climbdown by the Government.

As we prepare to leave the European Union, it is vital that the Government are able to respond to the widest range of possible EU-exit outcomes in relation to reciprocal healthcare. So many people are reliant on the continuation of reciprocal arrangements and the Government are quite right to seek to secure such arrangements as we leave the EU. The Opposition have supported the principle of this Bill from the outset. but our concerns have been around the scope and the wide-ranging powers that were originally proposed. We were not happy to give the Government a blank cheque to enter into any number of health agreements, with anyone anywhere in world, with no requirement to report back to Parliament, and with little or no opportunity for parliamentary scrutiny. These amendments have addressed our concerns, and I again thank those in the lords for their work.

Turning to amendments 1, 2, 8, 10 and 18 to 20, I want to stress to the House the scale of the issue before us, as pointed out by my hon. Friend the Member for Huddersfield (Mr Sheerman), who is no longer in his seat. Under the existing arrangements, 190,000 UK state pensioners and their dependants who live abroad, principally in Ireland, Spain, France and Cyprus, enjoy the benefits of reciprocal health agreements. The current arrangements also provide full access through the EHIC to healthcare and emergency treatment for UK residents who visit the EU on holiday, to study or to work. The same protections are extended on a reciprocal basis to EU nationals who reside in the UK or who seek to visit. For the sake of those people, I am glad that the Government have come to their senses. These arrangements, which give full peace of mind for healthcare, must be protected.

I remind the House of the evidence given by representatives of Kidney Care UK. We heard that 29,000 people in the UK are dependent on dialysis, which involves three five-hour sessions per week to ensure survival. Under the current arrangements, if those people choose to holiday in the EU, they can easily pre-book slots for dialysis, with Kidney Care UK saying that that

“means that people are able to go away with the confidence that they will be able to be supported and receive the treatment they need.”––[Official Report, Healthcare (International Arrangements) Public Bill Committee, 27 November 2018; c. 12, Q39.]

That also means that they and their families are able to get a much-needed break. Kidney Care UK also made the point that

“it is easier to go away for two weeks in Europe and take a break in that way than it is to get two weeks in a UK unit”––[Official Report, Healthcare (International Arrangements) Public Bill Committee, 27 November 2018; c. 14, Q43.]

Perhaps there is a learning point for us there.

Based on that evidence, the Minister concluded at the time that without a continuation of these arrangements it would be more or less impossible for sufferers of kidney disease to travel. I totally agree, and I am delighted that the Government appreciate the urgency of the situation in which we find ourselves and are giving their full support to this amended Bill. That is important because we may yet leave the EU with no deal, and there will be many British citizens listening nervously to this debate because they have already booked holidays—some of them will be departing at the weekend or in the coming weeks. However, they can now be reassured that the legislation will pass without further delay.

I reassure Baroness Chisholm that the main Opposition priority is always to ensure that those who need care get it. Further to that, we are right in the first instance to protect the rights that UK citizens already enjoy. In short, we must protect our rights to reciprocal healthcare in Europe before we seek to acquire global healthcare provision. Similarly, those UK citizens who have retired to the EU will be relieved to know that treatment for chronic health conditions and ongoing health support will continue to be provided for them, as it is now, without interruption.

If that was not the case because the Bill was unable to receive Royal Assent in a timely fashion, there would have been much understandable consternation and anger among UK citizens currently residing in the EU. A significant proportion of these citizens are pensioners, and they would have been personally liable for healthcare costs after exit day unless a new agreement with the EU or new bilateral agreements with member states were in place. We must also consider the fact that if there is an interruption in provision, many British expats would have no alternative but to return to the UK, which would of course add to the pressures on our already overstretched NHS.

At every stage, both here and in the other place, concerns have been raised about what those in the lords described as the breathtaking powers sought in this Bill. Lords amendments 3 to 7 serve in part to restrict the powers to those that are clearly defined and to those that are necessary for the purpose of protecting reciprocal health arrangements. In amendment 3, just removing the words “for example” assists in terms of essential accountability issues by restricting the powers of the Secretary of State to those regulations specifically listed. The powers listed remain extensive, and the lords was assured that they give the Government everything they need to take forward the negotiations on reciprocal healthcare. We welcome amendments 5 and 6, which ensure that the power to deliver functions is conferred only to a public authority. We are happy that the powers conferred by clause 2 should also be subject to a five-year sunset clause.

We support amendment 11, which provides an important and necessary requirement to consult with the devolved authorities, namely the Scottish Parliament, the Welsh Assembly and the Northern Ireland Assembly. We fully support the vital role that the devolved Administrations play in delivering reciprocal healthcare arrangements, and we welcome the memorandum of understanding that has already been achieved.

Amendment 12, which requires the Secretary of State to report on repayments made under this Bill, is also welcome. This amendment reasonably calls for annual reports to be published after the end of each financial year as soon as is reasonably practicable. It is anticipated that these reports will include details of both expenditure and income. This will facilitate transparency on the Government’s use of public money. I am especially pleased that the Minister has withdrawn his former opposition to that procedure.

On a wider point, in connection with repayments, it is important that we do not overlook the fact that many hospital trusts are struggling to recoup moneys owed under current EU arrangements. Indeed, some costs are never recovered. The UK recovers less than £50 million a year for the cost of treating European patients, while paying £675 million for the care of Britons in Europe.

Oral Answers to Questions

Stephen Hammond Excerpts

Tuesday 26th March 2019 Commons Chamber

[Derek Thomas (St Ives) (Con)]

2. What steps his Department is taking to ensure that the NHS has the workforce that it needs to meet the objectives of its 10-year plan.

[The Minister for Health (Stephen Hammond)]

The long-term plan sets out how we will make the NHS a world-class employer and ensure that the NHS has the people that it needs. The NHS, led by Baroness Harding, is engaging with people across the sector to develop a people plan. That plan will set out how the challenges of supply and demand reform can be met, and it will be published in the spring.

[Derek Thomas]

I thank the Minister for that response. In Cornwall, we have set up the Health and Social Care Academy, and we use the apprenticeship levy to enable local people to train within the NHS service or social care wherever they want to. However, there are many restrictions around the levy, and I wonder if the Minister will meet me and others to discuss how the levy can actually be about training and supporting people into the NHS, rather than just restrictions about paying fees.

[Stephen Hammond]

The apprenticeship levy was obviously introduced to cover the training and assessment costs of apprenticeships at a rate that would meet employee demand. I recognise some of the challenges that there are, and I would be delighted to meet my hon. Friend to discuss the issues that he has raised.

[Luke Pollard (Plymouth, Sutton and Devonport) (Lab/Co-op)]

19.   The NHS 10-year plan in Plymouth will be delivered not only by NHS staff but by social enterprise staff. Those staff who work for social enterprise Livewell in Plymouth have had difficulty accessing the NHS pay rise and the NHS pension uplift. Will the Minister agree to meet me and Livewell’s staff so that we can resolve this issue, to ensure that all staff who work for a social enterprise receive the pensions they deserve?

[Stephen Hammond]

The hon. Gentleman knows that I wrote to him on 20 March on this issue, and I outlined that officials from DHSC had contacted the scheme administrator about the issues with Livewell. I can confirm that the members there would still be dealt with in the way set out prior to the implementation date, and I am happy to meet him.

[Mr Philip Hollobone (Kettering) (Con)]

The best way that Kettering General Hospital could deliver the NHS’s 10-year plan would be to have the funding for an urgent care hub. I thank the Hospitals Minister for visiting recently. What can he do to ensure that that project is delivered?

[Stephen Hammond]

I was delighted to visit Kettering and to meet the chief executive and the chairman of the trust again. They made very strong representations. The representations by my hon. Friend and the trust have been heard, and he knows that they are at the forefront of my mind.

[Carol Monaghan (Glasgow North West) (SNP)]

Changes to the pensions allowance are particularly impacting consultants in their willingness to do additional shifts, or indeed stay in their roles, so what discussions has the Minister had with the Chancellor about the effect of the changes to pension allowances on the retention of consultants in the NHS?

[Stephen Hammond]

My right hon. Friend the Secretary of State and I have both had conversations with the Treasury and the Chancellor, and there are ongoing discussions.

[Andrew Selous (South West Bedfordshire) (Con)]

The Government have done well to get more medical students into general practice, but we are not doing quite so well at retaining GPs later on. What more can we do to make sure that GPs stay in general practice, so that more of our constituents can go and see a doctor more easily?

[Stephen Hammond]

NHS Improvement has a number of retention schemes in place, for GPs and for nurses, to look at why some people are leaving. The interim plan being developed by Baroness Harding has an employer of excellence work stream, which will report on a number of potential issues.

[Jonathan Ashworth (Leicester South) (Lab/Co-op)]

May I just take a moment, on behalf of the Opposition Front Bench team, to thank the hon. Member for Winchester (Steve Brine) for all his work? We found him a decent, fair-minded Minister, and I wish to pass on my personal thanks for the work that he did on the children of alcoholics agenda.

We have 100,000 vacancies across the NHS. The Brexit mess means that we have fewer EU nurses and health visitors. Across the NHS, voluntary resignations are up 55% since 2011, and the professional development budgets have been cut by £250 million. Does the Minister agree that for Dido Harding’s review to be taken seriously, those cuts to continuing professional development must be reversed?

[Stephen Hammond]

As the hon. Gentleman heard me say earlier, Baroness Harding is developing the implementation plan, which will then feed into the final implementation plan published after the comprehensive spending review. The cuts, as he describes them, are not cuts. He knows that we are increasing the budget for the NHS in real terms and in cash terms up to 2023-24.

[Jonathan Ashworth]

The Minister is responsible for workforce, but does not seem to understand that training budgets have been cut. Baroness Harding’s review will only be taken seriously if it is backed up by real investment.

Outsourcing and transferring of staff, whether to wholly owned subsidiaries or the privatisation of clinical services, further undermines staff morale and creates a more fragmented workforce. The Secretary of State went to the Health and Social Care Committee and said no more privatisations on his watch, yet cancer scanning services in Oxford are being privatised. Will the Minister reverse those privatisations, or can we simply not believe a word the Secretary of State says?

[Stephen Hammond]

The hon. Gentleman can believe everything my right hon. Friend the Secretary of State says. He has delivered on his promise to work with the NHS to deliver a long-term plan, to deliver the funding that will make it possible, and to deliver the workforce that will ensure the plan is not undermined.

[Liz Twist (Blaydon) (Lab)]

3. What assessment he has made of the effect on life expectancy projections of health inequalities; and if he will make a statement.

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[Andrew Lewer (Northampton South) (Con)]

8. What steps he is taking to increase the number of NHS nursing associates.

[The Minister for Health (Stephen Hammond)]

Health Education England is leading a national nursing associate expansion plan to train 7,500 apprentice associates in 2019, building on the 5,000 who were trained in 2018.

[Mr Speaker]

Will the Minister face the House, please? Andrew Lewer.

[Andrew Lewer]

The University of Northampton successfully carried out its partnership with Northampton General Hospital in training the first wave of nursing associates in the United Kingdom, as the Secretary of State saw when he visited the hospital recently. What can he and his team do to encourage other universities and local hospitals to form partnerships to deliver similar results?

[Stephen Hammond]

I know that the Secretary of State enjoyed his visit and was very impressed by what he saw. Health Education England has led the establishment of test site partnerships across England. There were 11 test sites in the first wave and a further 24 in April 2017, and the programme is now being rolled out all over the country.

[Mr Jim Cunningham (Coventry South) (Lab)]

What discussions has the Minister had with nursing associations and the Home Secretary about the recruitment of nurses and social care workers from the European Union after we leave and about how it can be made easier?

[Stephen Hammond]

I know that my hon. Friend the Minister for Care met the Home Secretary last week and that there are ongoing discussions.

[Sir Hugo Swire (East Devon) (Con)]

9. What support his Department provides for the (a) study and (b) treatment of Lyme disease.

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[Jeff Smith (Manchester, Withington) (Lab)]

13. What guidance the Government have issued to sustainability and transformation partnerships on drafting their five-year workforce plans.

[The Minister for Health (Stephen Hammond)]

Workforce is a key priority for the Government, which is why my right hon. Friend the Secretary of State asked Baroness Dido Harding to develop an interim workforce implementation plan for the spring, including a 2019-20 action plan. It is right that local leaders and clinicians should be empowered to shape the services they need, which is why NHS Improvement has written to all system leaders in England to ask for their views on the vision that is coming forward.

[Jeff Smith]

The all-party parliamentary group on mental health’s recent report found that workforce is the biggest challenge to delivering improvements to mental health care. Given that there are 4,000 fewer mental health nurses than there were in 2010, what additional guidance and funding will the Government provide to ensure that local partnerships can recruit mental health nurses, and what are they doing to expand medical school places so that we can train more doctors, particularly in psychiatric specialties?

[Stephen Hammond]

The hon. Gentleman asked a number of questions there. It is true that the NHS has recently asked all sustainability and transformation partnerships and integrated care systems to create new five-year plans by autumn 2019 setting out how they are going to transform services. He will know that mental health is a priority in the long-term plan and that we are expanding the number of places for clinicians.

[Jeremy Lefroy (Stafford) (Con)]

Will my hon. Friend meet me to discuss the severe shortage of pathologists to carry out post mortems? Professor Peter Hutton’s report referenced some ideas that we could take forward.

[Stephen Hammond]

My hon. Friend has already mentioned several such ideas and I would be happy to meet him to discuss them.

[Christian Matheson (City of Chester) (Lab)]

16. Cancer Research UK estimates that by 2035 there will be over half a million new cancer cases—up by 150,000 a year on 2015 levels. To meet the Government’s ambition of diagnosing 75% of cancers at an early stage, does the Minister accept that the NHS will need a proper training and recruitment plan for its cancer workforce, which must be fully funded in the upcoming spending review?

[Stephen Hammond]

The hon. Gentleman is right: early diagnosis of cancer is vital for successful outcomes. The Government are absolutely committed to a cancer workforce with the skills and expertise to ensure that 75% of all cancers are diagnosed early, not just the top 10. As I have said several times, that is why we asked Baroness Dido Harding to develop a detailed workforce plan to ensure that that can be delivered.

[Henry Smith (Crawley) (Con)]

Blood cancer is the fifth most common and the third biggest killer in the UK. What assurances can I get that the workforce in that area will be increased?

[Stephen Hammond]

My hon. Friend has been a champion of this cause for a long time, raising the matter on the Floor of the House several times. He can be assured that, as I said to the hon. Member for City of Chester (Christian Matheson), Baroness Harding has been asked to bring forward detailed plans for the cancer workforce in her implementation plan.

[Paula Sherriff (Dewsbury) (Lab)]

Mental health nurse numbers have fallen for the second month running, and learning disability nurse numbers have fallen by 40% since this Government came to power. Nearly 13,000 mental health staff left their roles between May and October 2018, and the vacancy rate is now almost 10%. The King’s Fund, the Nuffield Trust and the Health Foundation say that

“Urgent action is now required to avoid a vicious cycle of growing shortages and declining quality.”

Is it not time for Ministers to start taking such advice, rather than giving it?

[Stephen Hammond]

The Department of course takes such things seriously. My hon. Friend the Minister of State for Care met Baroness Harding last week to discuss how to ensure that there are nurses and carers to help people with learning disabilities. The money that has been promised to make that possible comes in the new financial year, which starts next week.

[Vicky Foxcroft (Lewisham, Deptford) (Lab)]

14. What progress his Department has made on the implementation of a public health approach to tackling violence.

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[Kevin Hollinrake (Thirsk and Malton) (Con)]

T9. Breast cancer oncology is the most recent service to be closed at Scarborough Hospital. It follows the closure of the pain clinic, dermatology, the eye clinic and physiotherapy. These are not cuts, but a contrived centralisation by the trust in York. Will the Secretary of State intervene to ensure that there is a full range of service right across my constituency?

[The Minister for Health (Stephen Hammond)]

I commend my hon. Friend for his commitment to raising the local priorities of his constituents and for the campaigning he does on behalf of the local NHS. I think that these plans are best worked through by the local NHS. However, if he would like, I would be happy to meet him to discuss the concerns that he has on behalf of his constituents.

[Lloyd Russell-Moyle (Brighton, Kemptown) (Lab/Co-op)]

T7. Possability People is a disability charity in my constituency that has operated consistently for the last 30 years. Some 85% of its funding comes from the clinical commissioning group, but on 12 March it received a letter saying that the funding would stop in April. That follows the CCG’s decision last year to stop all funding for the low-vision clinic in my constituency. From April onwards, disabled people will have to go to their GP to access these services, which will cost more for the health service. Will the Minister meet me to discuss how we can save money?

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[Tim Farron (Westmorland and Lonsdale) (LD)]

The north-west of England has only half the number of ambulances per head of population as London. In rural Cumbria, the situation is far worse. Will the Secretary of State agree to our proposal for an additional two ambulances for Westmorland so that we can keep our communities safe?

[Stephen Hammond]

The hon. Gentleman will know that, in the winter funding round, extra ambulances were provided across the whole country. I am happy to meet him and discuss his proposals, which I will then consider carefully.

[Nicky Morgan (Loughborough) (Con)]

ADHD Solutions is a community interest company based in the constituency of the shadow Health Secretary that serves children and young people with ADHD across Leicester and Leicestershire. Fifty per cent. of its referrals come from the NHS, yet it does not get funding for those referrals; however, those NHS services are able to meet NICE guidelines because ADHD Solutions is doing the job. Will the Health Secretary meet me and the shadow Health Secretary to discuss that?

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

Stephen Hammond Excerpts

Monday 25th March 2019 General Committees

[The Chair]

The instruments will be debated together.

[The Minister for Health (Stephen Hammond)]

I beg to move,

That the Committee has considered the draft Social Security Coordination (Reciprocal Healthcare) (Amendment etc) (EU Exit) Regulations 2019.

[The Chair]

With this it will be convenient to consider the draft National Health Service (Cross-Border Healthcare and Miscellaneous Amendments etc.) (EU Exit) Regulations 2019 and the draft Health Services (Cross-Border Health Care and Miscellaneous Amendments) (Northern Ireland) (EU Exit) Regulations 2019.

[Stephen Hammond]

It is a great pleasure to serve under your chairmanship, Sir David. I am grateful to the Committee for agreeing to discuss these regulations together, which seems logical to me. I welcome the hon. Member for Dewsbury, who is debating with me. I want to put on record at the start that the hon. Member for Ellesmere Port and Neston (Justin Madders), who is no longer on the Labour Front Bench, conducted himself in a helpful and constructive way in this particular part of our discussions about EU exit, which is about reciprocal healthcare and the good of all our constituents.

I would also like to put on record my thanks to the Scottish Government and the Welsh Assembly, and the Labour Government there, for their help with the Healthcare (International Arrangements) Bill, on which we have had legislative consent motions. That is a record, because it is the only piece of EU exit legislation to which we have a legislative consent motion. It will mean, hopefully, that some of the things that we are discussing tonight will be easier to implement when that Bill comes through, either tomorrow or some other time.

[Mr Barry Sheerman (Huddersfield) (Lab/Co-op)]

Will the Minister give way?

[Stephen Hammond]

I have hardly got started, but of course I will give way.

[Mr Sheerman]

Before the Minister gets into full flow, I would like to say that I have been to lots of these Committees—I do not know if someone up there loves me or the Whips have a grudge—but I have never come across one that is such a rag-bag of things. As a Member of Parliament, I am supposed to give parliamentary scrutiny to this whole rag-bag of very important pieces of delegated legislation. Is that just because the Minister is in a hurry? This disaster of Brexit is coming and we are throwing everything at it. Up until now, we have had one statutory instrument, debated it in some detail and, by and large, felt that we have led some accountability. This looks like a total mess. How can we do our job properly with this large number of documents in front of us?

[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.

[Mr Sheerman]

I have to explain this accountability and scrutiny work I am doing to my constituents, so before the Minister sets sail—I wish him a really nice journey, with no problems—will he be putting the SIs into layman’s language, carefully going through them and saying what they really mean in the sort of language his constituents, along with mine and yours, Sir David, could understand?

[Stephen Hammond]

The hon. Gentleman can only test that and prove whether he has done his work on accountability after he has heard what I have to say, so I hope he will allow me to say it. I read this speech last week and it went back for re-writing, so I hope that it is now in the sort of language that both he and I and, importantly, our constituents will be able to understand.

[Michael Tomlinson (Mid Dorset and North Poole) (Con)]

Let’s hear it.

[Stephen Hammond]

Here we go.

The Government are introducing these three statutory instruments under section 8 of the European Union (Withdrawal) Act 2018, to correct deficiencies in retained EU law relating to reciprocal and cross-border healthcare, and to ensure that the law is operable on exit day. When the UK leaves the EU, that Act will automatically retain the relevant EU legislation and the domestic implementing legislation in UK law. In a no-deal scenario, however, if we did not legislate further, the regulations would be incoherent and unworkable without reciprocity from member states. There would be a lack of clarity about patients’ rights to UK-funded healthcare in EU and European Free Trade Association countries.

Current EU reciprocal healthcare arrangements enable people to access healthcare when they live, study, work or travel in EU and EFTA countries, and in the UK. They give people retiring abroad more security, they support tourism and business, and they facilitate healthcare co-operation. The Government intend to continue those reciprocal and cross-border healthcare arrangements, as they are now, in any exit scenario until at least December 2020.

In a deal scenario, the in principle agreement we have reached with the EU under the withdrawal agreement is that during the implementation period—until 31 December 2020—all reciprocal and cross-border healthcare entitlements will continue. There will be no changes to healthcare for UK pensioners, workers, students, tourists and other visitors, and the European health insurance card scheme and planned treatment will continue. That would all be legislated for in the European Union (Withdrawal Agreement) Bill. The Government want to secure a wider reciprocal healthcare agreement with EU and EFTA states following the end of the implementation period, which will support a broad range of people. We will negotiate that with our European partners during phase 2 of the talks on our future relationship.

In a no-deal scenario, our proposal to all EU and EFTA countries is to maintain the current reciprocal healthcare arrangements for at least a transitional period lasting until December 2020, to ensure that UK nationals can continue to access affordable healthcare when in the EU.

[Mr Sheerman]

When we get our EHIC card and go across to anywhere in Europe, we are sure that if we need medical attention it is covered by those reciprocal agreements. Is the Minister saying that for a short transitional period the continuity of that process will be maintained but that it will all end when we leave the European Union?

[Stephen Hammond]

No, that is not at all what I am saying. I am sure that the hon. Gentleman was listening carefully. I was saying that in a deal scenario all current arrangements will continue and in a no-deal scenario we are seeking to put in place interim arrangements. In both scenarios we seek to have an arrangement that will continue reciprocal healthcare after the implementation period. Were he to vote for the withdrawal agreement, the EHIC card he was talking about would continue to be used, certainly until December 2020 and possibly much later depending upon what we negotiate. These regulations seek to ensure that UK law is consistent, so that the arrangements that are in place in a potential no-deal scenario can allow reciprocal healthcare arrangements to continue.

[Mr Sheerman]

rose—

[Stephen Hammond]

For the very last time.

[Mr Sheerman]

When I discussed the subject with a junior Transport Minister, who is a good colleague of the Minister’s, he said that the green card—which ensures that UK drivers who are hit by an uninsured driver when driving in Europe, whether they are in their own car which they have taken to the EU or one they have hired there, are insured—will disappear as we leave the European Union and it will no longer work. He was very final about that. The hon. Gentleman is now saying that he is not sure if that is final. It is the end of a reciprocal relationship and after 2020 everyone will be uninsured when they travel abroad.

[Stephen Hammond]

The hon. Gentleman is putting words into my mouth that I did not say. What I said was that in a deal scenario all reciprocal arrangements will continue as per now until 31 December 2020. As I have pointed out, during that period clearly the Government will seek to negotiate an EU and EFTA states-wide continuing reciprocal arrangement. Everything we have now will immediately go into that transitional period when we negotiate. If there were a no-deal scenario, we would have to put in place interim arrangements to ensure that the current arrangements pertain. Again, during the transitional period it is the Government’s intention to seek to negotiate an EU and EFTA states-wide continuing reciprocal healthcare arrangement. However, we might also have to do that on a bilateral basis with individual states. There is no intention or expectation from the Government—or from the EU or EFTA states—that 31 December 2020 is a break point. I hope that I have satisfied the hon. Gentleman on that point.

[Mr Sheerman]

It is all a bit of a wing and a prayer.

[Stephen Hammond]

I am not going to respond to the chuntering from the floor, other than to note very clearly what—

[Mr Sheerman]

Just in case it does not get on the record, may I—

[Stephen Hammond]

No, I am going to plough on—

[Mr Sheerman]

rose—

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[Stephen Hammond]

The Government want to secure a wider reciprocal healthcare agreement with EU and EFTA states following the end of the implementation period, which supports a broad range of people. That is what I have just explained. In a no-deal scenario, our proposal to all EU and EFTA countries is to maintain the current reciprocal healthcare arrangements for at least a transitional period to ensure that UK nationals can continue to access affordable healthcare when they are in the EU.

The statutory instruments we consider today will support us to do that with the countries we are able to negotiate those agreements with. However, our proposal depends on reciprocity from other European countries and we are in advanced discussions with member states to ensure continuity. In the event that an agreement cannot be reached, healthcare cover for those nationals may change.

We have approached and are in discussion with other member states and are prioritising those that are the major pensioner, worker and tourist destinations. The UK and Irish Governments are committed to continuing access to healthcare arrangements within the common travel area and both Governments are taking legislative steps to ensure we can implement the arrangements in time for exit day.

The Government welcome the action by EU member states who have prepared their own legislation for a no-deal scenario, including, but not limited to, Spain, France, Portugal, and Belgium. Depending on the decisions by other member states, it is important to acknowledge that access to healthcare could change.

[Mr Sheerman]

Did I hear the Minister right? Forgive me for another intervention, Sir David. Did the Minister say that he thanks those other European states, because they are negotiating this? It is not final, is it? As I said earlier, this is a “coming home on a wing and a prayer” policy. Our constituents should know the position, surely. We are Members of Parliament; we are paid to come here and represent our constituents. The Minister is telling me that this legislation will mean that after 2020 they will not be insured for their healthcare when they travel abroad. That is what he is saying, because there is no certainty in what he says.

[Stephen Hammond]

The hon. Gentleman is completely wrong: that is not what I am saying. I will say this once again for him. If the withdrawal agreement is signed—I urge him to vote for it, because that would provide certainty for his constituents—the current arrangements will continue, and it is the Government’s intention, during the transitional period, the implementation period, to negotiate an EU and EFTA states continuing arrangement. In a no-deal scenario, we will have to put in place interim arrangements, and that is what we are discussing now. It would still be the intention—it is a very clear expectation of the Government and is very clear from the stated ambitions and comments of the EU—that reciprocal healthcare would be the subject of a negotiation, either on an EU-wide basis or by individual member states.

I accept that there is some element of uncertainty, but I hope that I can now reassure the hon. Gentleman. Each of the 27 EU member states is a country with universal healthcare, and in general people have good options for obtaining healthcare, provided that they take the appropriate steps. Depending on the country, it will be possible to access healthcare through legal residency, current or previous employment, or by joining a social insurance scheme. Less frequently, people may need to purchase private insurance. It is always the advice when people travel overseas, including to Europe, that they should purchase appropriate travel insurance. People have always been encouraged to do that. However, I appreciate that it can be difficult for some people with long-term conditions, and it is important that people make the best decisions for their circumstances when choosing to travel.

As is the case now, UK nationals who return to live permanently in the UK will be able to access NHS care. UK nationals who currently have their healthcare funded by the UK and are resident in the EU on exit day can use NHS services in England without charge when they temporarily visit England. We recognise that that might mean change, and in some circumstances additional expense, for UK nationals living abroad. It is to avoid that that we are bringing forward these statutory instruments.

I would like to reassure the Committee that the Government have issued advice, via Government and NHS websites, to UK nationals living in and travelling to EU and EFTA states and to EU citizens living in the UK. The advice to UK nationals explains how the UK is working to maintain reciprocal healthcare arrangements, but that their continuation depends on decisions by member states. It also sets out what options people might have to access healthcare under local laws in the country that they live in if we do not have bilateral arrangements in place, and what people can do to prepare.

[Mr Sheerman]

The Minister has lifted the lid on this. It is horrific news for our constituents—for people who live in Huddersfield and Dewsbury and all the constituents we represent. It is, in stark terms, the end of the assurance that people can travel around Europe. We all had our little card and we knew that we did not have to go out and get private health insurance; we would be covered. We had that peace of mind. What the Minister is saying today, in plain language, is that that peace of mind will end. He has just read that out. It will end unless by luck, some wing and a prayer policy that arrives from this incompetent Government actually delivers something that they cannot promise and cannot deliver.

[Stephen Hammond]

The hon. Gentleman is a noble exponent of the art of opposition, but he is sensationalising and misunderstanding what I say. I have not said that the arrangements are not going to continue; what I have said is that in a no-deal scenario there may be some circumstances where people have to consider different arrangements from what they have already. It is the Government’s intention, in both a deal and a no-deal scenario, that these arrangements should continue, and that is what we will put in place this afternoon, if we ever get there.

[Mr Marcus Jones (Nuneaton) (Con)]

The hon. Member for Huddersfield seems to be trying to imply that if someone goes on holiday in the EU area at the moment, they do not need to have travel insurance. Now, from my experience of travelling to the EU area, it has always been advisable to have travel insurance, because in my experience, when I have had to access services, the first thing that the hospital in an EU country has asked is, “Where is your health insurance? Where is your credit card?” So it is not necessarily just a given that the card that people can obtain covers them in all eventualities.

[Stephen Hammond]

Where my hon. Friend is absolutely right is that, of course, it has always been the advice that people should purchase travel insurance when they travel, wherever they travel, including within the EU. The EHIC card is clearly in place. If the withdrawal agreement is signed, that arrangement will continue, but it has always been the Government’s advice that people should take out the appropriate travel insurance when travelling abroad, and he is absolutely right to make that point.

[Neil Coyle (Bermondsey and Old Southwark) (Lab)]

I thank the Minister for giving way; he is being very generous in doing so. There are particular British expatriates living in other countries. As he said, some people have long-term conditions, including skin conditions that are temperature-sensitive and lung issues, for example. Just to be absolutely clear, he has said that there may be circumstances in which some of those people with long-term conditions may have to make other arrangements. So there is a direct disadvantage for disabled British people who are supported under the current framework who may not be supported, even under the Government’s plan. Is that correct?

[Stephen Hammond]

It is correct only in the unlikely circumstance of a no-deal scenario, and only in that there may not be interim arrangements put in place immediately after exit in a no-deal scenario. That is why I am setting out what the possibility might be, but I stressed that this is not what the Government hope for. Neither is it something that the Government expect or that is the Government’s ambition. What I have said is that, in the unlikely circumstance of a no-deal scenario, there may be some changes that some people need to make.

[Mr Sheerman]

On a point of order, Sir David. I know this Minister to be a very honest man, but I think he is in danger of misleading the Committee, only in this sense—that he keeps saying “only if we crash out without a deal”. I am sorry, but as I read the documents and listen to him when he reads from them, that does not appear to be the case. It seems to me that, whatever happens when we leave the EU, the security of being insured as people travel around Europe will disappear, whether we crash out or whether we achieve a deal.

[The Chair]

As a Member of 40 years’ standing, the hon. Gentleman knows perfectly well that no one can be accused of misleading anyone, so I am sure that he did not mean to say that. And as far as the point of order is concerned, it was not a point of order; it was a point of exasperation.

[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.

[Mr Sheerman]

Will the Minister give way? This is a constitutional point—

[Stephen Hammond]

It is not a constitutional point. I will not take the hon. Gentleman’s intervention.

[Mr Sheerman]

rose—

[The Chair]

Order. We can have only one person on their feet at a time. Is it the case that the Minister is not giving way?

[Stephen Hammond]

I have given way on a number of occasions. I am bound to say to the hon. Member for Huddersfield that I have been clear about the legal position and the legal certainty. I have given clarity that the Northern Ireland civil service and the Northern Ireland Department of Health are clear and are consenting to what we are doing.

[Mr Sheerman]

That is the point I wanted to ask the Minister about.

[Stephen Hammond]

Then the hon. Gentleman does not need to ask me, because I have just answered his question.

In addition, I am pleased to report that we have the legislative consent motions for our Healthcare (International Arrangements) Bill. To underpin and facilitate the consultation, we have developed and agreed a memorandum of understanding with the devolved Administrations, which sets out a practical and mutually beneficial working relationship. That will ensure that the devolved Administrations will continue to play a vital role in delivering reciprocal healthcare for the benefit of all United Kingdom nationals.

[Mr Sheerman]

rose—

[Stephen Hammond]

I will give way for the last time.

[Mr Sheerman]

The Minister is a little grudging, but it is an important issue. He has gone through all the people whom he has consulted in Northern Ireland, and they all sounded like bureaucrats and civil servants to me. I did not hear him once say that he had confronted the facts of what is happening, through the statutory instruments, to our parliamentary colleagues or that he had put it to them. For all these years, their constituents have felt that they could go all over Europe and carry with them an extension or a bubble of the national health service that delivered the NHS promise, even though they were travelling. Did they get the picture? Were they told in blunt terms that that will no longer exist for their constituents? For people who are travelling, it is the old Tory dream of privatising the health service.

[Stephen Hammond]

I was going to say that I can see why the Speaker regards the hon. Gentleman as a national treasure, but after his final remarks, it is difficult to agree.

In closing, I make it clear that the instruments make miscellaneous amendments to EU references in retained EU law—for example, by removing references to EU concepts. Moreover, together with the Healthcare (International Arrangements) Bill, the instruments are necessary to ensure that the UK Government are ready to deal with reciprocal and cross-border healthcare in any EU exit scenario. They provide us with an efficient and effective mechanism to ensure that there will be no interruption to people’s healthcare in a no-deal scenario.

I thank members of the Committee for their valuable contributions.

--- Later in debate ---

[Mr Sheerman]

I do not want to speak for more than half an hour, but I must make the point about this bundling. I have been on many Delegated Legislation Committees and have become quite an expert on statutory instruments.

[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.

[Stella Creasy]

Will the Minister give way?

[The Chair]

Order. We cannot have interventions on interventions. The Minister is intervening on Mr Sheerman.

[Stephen Hammond]

I recognise the concerns of the hon. Gentleman and the hon. Lady and I will address their points, but the Government asked the Committee to agree, and the Committee agreed to the bundling of the statutory instruments.

[Mr Sheerman]

I take that point. There has been honest confusion, because when the Minister introduced the statutory instruments, I did not realise that, because they had all been bundled, I could not have a responsible view and single out the statutory instrument relating to Northern Ireland. I would not want to vote against that, but I want to vote against the others. I did not realise that was what would happen; I thought we would vote on each one.

--- Later in debate ---

[Stephen Hammond]

Of course I do not take umbrage at the hon. Gentleman’s criticism or scrutiny. After all, that is what he is here to do. I would just say to him, though, that his characterisation of what the Government are putting in place is wrong. He can say to his constituents that if the withdrawal agreement is passed, there will be no interruption to their healthcare. In a no-deal situation, these instruments will allow—

[Neil Coyle]

For a fixed period.

[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]

Will the Minister give way?

[Stephen Hammond]

For the very last time.

[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—

[Neil Coyle]

Bermondsey and Old Southwark.

[Stephen Hammond]

I’ll get there in the end. The hon. Gentleman asked about a number of chronic conditions. The statutory instruments allow the Government to fund the treatment of UK nationals who are in the middle of treatment on exit day or who have pre-authorised treatment in another member state. That could include the chronic conditions he mentioned.

Finally, I am not sure which part of the website the hon. Member for Dewsbury was looking at, but I am happy to ensure that we guide her to the right place. There is advice on www.gov.uk and www.nhs.uk to UK nationals living in the EU, to UK residents travelling to the EU and to EU nationals living in the UK. That advice explains how the UK is working to maintain reciprocal healthcare arrangements and sets out the options people might have to access healthcare under local laws in member states that they live in. I am happy to ensure that the hon. Member for Dewsbury can see that guidance.

[Richard Graham (Gloucester) (Con)]

The Minister has done an outstanding job in explaining a complex matter fairly concisely and taking innumerable interventions, mostly the same ones. Could we now move to a vote?

[Stephen Hammond]

I understand my hon. Friend’s entreaty.

These three instruments, together with the Healthcare (International Arrangements) Bill, give us the best possible opportunity to ensure that there is no loss of reciprocal healthcare arrangements for UK nationals in the EU and EFTA states. I commend the regulations to the Committee.

Question put.

Valproate Pregnancy Prevention Programme

Stephen Hammond Excerpts

Thursday 21st March 2019 Commons Chamber

[The Minister for Health (Stephen Hammond)]

It is a pleasure to respond to this debate on behalf of the Government, and it is an honour to follow the hon. Member for Lancaster and Fleetwood (Cat Smith), who has secured an important debate. I wish to pay tribute to her and her constituents from INFACT, whom she mentioned.

The hon. Lady has rightly set out that, as Members of this House will be aware, valproate is a very effective treatment for epilepsy and bipolar disorder. For a few women with epilepsy, it may be the only effective treatment, and she rightly recognised that in her speech. However, its use is associated with serious side effects in children exposed to it during pregnancy; there is a 40% risk of persistent developmental disorders and a 10% risk of physical birth defects. Valproate should therefore be used to treat women of childbearing age only if alternative drugs are ineffective or not tolerated.

In April 2018, strengthened regulatory measures for valproate were introduced. They include a pregnancy prevention programme that aims to rapidly reduce and eventually eliminate pregnancies exposed to valproate. The hon. Lady asked a number of questions about the PPP. The challenge is to ensure that valproate is used by only those who need it, that they are fully informed about the risks in pregnancy and that treatment is closely monitored. Let me emphasise that it is vital that no woman stops taking valproate or any other antiepileptic without discussing it with her doctor.

Valproate has always been known, since the time it was first licensed, to carry serious risks if taken during pregnancy. However, important questions have been raised about the extent to which women have been informed about the nature and magnitude of those risks over the decades. At the time valproate was first marketed in 1974, animal studies had shown that there may be a risk of birth defects. Health professionals were made aware of that and were expected to weigh the benefits against the risks. They were expected to prescribe valproate only in severe cases or those where there was resistance to other treatments. Difficult prescribing decisions sometimes had to be made.

Campaigners have highlighted minutes of a meeting of the Committee on Safety of Medicines in 1973—the hon. Lady referred to that—where it concluded that it would be best not to mention the risk of birth defects following the use of anticonvulsants in the information supplied with the medicine, but that doctors should be informed. At that time, it would have been the doctor’s responsibility to pass on information on side effects. Today, patients and doctors are expected to make decisions jointly, based on open communication about all the risks and benefits of a treatment.

Over the years, warnings have been issued to prescribers by the regulator when new evidence on risks in pregnancy has become available. In 1983 and 1993, communications went out to update prescribers on the growing evidence of the risks in pregnancy. In 2003 prescribers were warned about a possible risk of developmental delay in children exposed to valproate during pregnancy. Warnings were extended to include a risk of autism in 2010, and a further bulletin was issued in 2013. It was around that time that the full magnitude and nature of the risks of valproate in pregnancy first became known, following the long-term follow-up of cases of affected children.

Given the seriousness of the accumulating evidence, the Medicines and Healthcare Products Regulatory Agency initiated a major Europe-wide safety review of valproate in pregnancy, which was completed in November 2014. The conclusion was that the balance of the benefits and risks of valproate in epilepsy and bipolar disorder remained favourable in women of childbearing potential only when other drugs were ineffective. The MHRA went further than updating the statutory information, as required by the EU review, and developed the valproate toolkit for healthcare professionals and women, which consists of a set of clear and informative materials. More than 100,000 healthcare professionals have received the toolkit.

As the hon. Lady referred to in her speech, in the autumn of 2015, given the importance of the issue, the then Life Sciences Minister, my hon. Friend the Member for Mid Norfolk (George Freeman), brought together all the relevant healthcare bodies to support the promotion of the toolkit and ensure that co-ordinated messaging was given out to health professionals and patients. The MHRA further developed this group into a 39-strong stakeholder network of health system organisations, health professional bodies, charities and campaign groups, which has been convened 11 times to date, to raise awareness and to help to embed the new measures in practice.

Despite extensive work to communicate the risks of valproate, concerns about the limited impact of the action in the UK and other member states led to a further EU review, which in 2018 resulted in a strengthened regulatory position stating that valproate must not be used in women of childbearing age unless they comply with the requirements of a pregnancy prevention programme. All healthcare professionals who prescribe valproate to female patients must ensure that they are enrolled in the pregnancy prevention programme. That ensures that women must use effective contraception throughout their valproate treatment and have an annual review with a specialist, which includes the consideration of alternative treatments, and must sign an annual risk acknowledgement form.

I am sure the hon. Lady will know that in February 2018 the then Secretary of State, my right hon. Friend the Member for South West Surrey (Mr Hunt), announced that he had asked Baroness Cumberlege to lead the independent medicines and medical devices safety review, which is exploring what happened in the cases of valproate, Primodos and mesh and considering the robustness of processes, the quality of engagement with and response to patients’ concerns, and any wider lessons. As I am sure the hon. Lady does, I welcome that important work and look forward to seeing the recommendations from the review. It is vital, though, not to wait for the outcome of the review. Much work is being done, and will continue to be done, to ensure compliance with the valproate pregnancy prevention programme. We expect the review to report later this year. It has been consulting in a detailed and patient-orientated manner throughout the UK, with patients and relevant patient and healthcare organisations.

The hon. Lady raised a number of issues with the pregnancy prevention programme. The MHRA has monitored the impact of the programme closely since its introduction last year. Monitoring is being done via data from the clinical practice research datalink and national databases, which link data from community drug dispensing and maternity services. The MHRA is also accessing data from clinical audits run by healthcare professional organisations and information on patient experience via surveys.

Patient input and engagement with the patient group INFACT, to which the hon. Lady referred and which was started by her two constituents, has been invaluable throughout the process, as a source of both evidence and feedback on the implementation of action. The data shows a decline in the use of valproate in women of childbearing age, but we recognise that there is local variability. I am also aware of evidence of non-compliance by some healthcare professionals, which is of great concern. Non-compliance with the pregnancy prevention programme is not acceptable, and those concerns are being investigated to ensure that people are brought back into compliance. I can inform the hon. Lady that enforcement action will be taken as and when necessary.

The concerns that were raised in the survey that the hon. Lady referred to have led the UK chief pharmaceutical officers to contact all pharmacists to stress their responsibilities when dispensing valproate. This was reinforced by messages from professional regulators to their members and by articles in the MHRA’s electronic bulletin “Drug Safety Update” in September and again in December, making sure that all healthcare professionals recognise that they need to examine whether they are prescribing in compliance with the new measures.

Achieving full compliance with the valproate pregnancy prevention programme will require concerted action across the healthcare system. I recognise that there is more to do, but I stress again that healthcare professionals who prescribe the drug must make sure that their female patients are enrolled in the pregnancy prevention programme. As I have said, non-compliance is not acceptable.

The hon. Lady asked a number of other questions, some of which I hope I have answered during my speech. My noble Friend Baroness Blackwood specialises in this area and will take the lead in it. I know that she would be delighted to meet the hon. Lady and members from INFACT.

I thank the hon. Lady for highlighting this issue and pay tribute not only to her constituents, but to many other women who have spoken powerfully about the effects that valproate has had on their lives and the lives of their children. Their tireless campaigning has been vital in highlighting the further action that is needed to ensure that women know the risks and are helped to make an appropriate judgment about their treatment. It is vital, therefore, that all healthcare professionals work together rapidly to reduce and eliminate the exposure of pregnancies to valproate.

I hope that the action I have outlined today shows that steps are being taken to ensure that the necessary assessment, monitoring and, where necessary, enforcement action will be taken. In commending the hon. Lady, I hope that she, like me, will look forward to Baroness Cumberlege’s review, which, as I said, should be published later this year. I thank her once again for raising this important matter this afternoon.

Question put and agreed to.

Leaving the EU: Health and Social Care

Stephen Hammond Excerpts

Tuesday 19th March 2019 Westminster Hall

[The Minister for Health (Stephen Hammond)]

The hon. Gentleman ought to be absolutely clear: we are not advising people to stockpile medicines. That is alarmist, and he should not be saying it. That is not what the Government are doing.

[Brendan O'Hara]

I will rephrase that. The Government are advising the stockpiling of medicines—perhaps not by individuals, but the Minister and the Government have advised the stockpiling of medicines.

--- Later in debate ---

[The Minister for Health (Stephen Hammond)]

It is a pleasure to see you in the Chair this morning, Mr Bone. I will start by addressing the remark by the hon. Member for Burnley (Julie Cooper). She should know that the whole of the Department of Health and Social Care, and indeed the whole of the Government, are absolutely committed to ensuring that there are in place detailed plans, which I hope I will be able to outline and reassure hon. Members about, to ensure that in any post-Brexit scenario the health and social care of our country’s citizens is our top priority.

I thank the hon. Member for Argyll and Bute (Brendan O'Hara) for securing the debate and commend him for his private Member’s Bill. He will know that the Government do not support his Bill—although we support the spirit of it—in part because, as the contribution from the SNP Front Bench showed, it is unnecessary. He is arguing for an independent evaluation and careful analysis of Brexit, but I thought the contribution from the hon. Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron), frequently citing the Health and Social Care Committee, proved that there is a huge amount of independent evaluation, accountability and scrutiny of the plans.

The hon. Member for Argyll and Bute raised a number of questions. I have with me a prepared speech, but I am not sure I will get on to it, because I want to address as fully as I can some of the concerns that hon. Members have raised. He raised a number of concerns about the social care sector, and he is right to do so. Brexit or no Brexit, it is a fragile sector and any event could hinder care provision. That is why, in the light of Brexit, we are working with the sector and local authorities to ensure that we have contingency plans in place.

I will speak more, if I have time, about what we have done regarding EU nationals in the short term, but I want to stress, as the hon. Member for Burnley did, my thanks to all EU nationals who work in either the healthcare system or the social care system. They play a crucial role in delivering high-quality health and social care, and we all recognise that. It is a fact, of course, that the number of EU nationals in adult social care has increased each year, from about 5% in 2012-13 to 8% in 2017-18, but that is no reason to be complacent. That is why we have put in mitigations regarding the EU settlement scheme and are implementing long-term policies to deliver the workforce and address the supply-demand gap that exists.

The hon. Member for Argyll and Bute will of course have noticed the recent recruitment plan, Every Day is Different, which started only last month. As he challenged me directly on this, I can say that we are currently in discussions with the Home Office about the salary threshold for social care.

My hon. Friend the Member for Henley (John Howell) spoke eloquently, as he always does—I have heard him speak in several of these debates—about Henley and other matters. He challenged me to visit Henley, which I would be delighted to do—perhaps on a Friday in July, when other events are on as well.

The hon. Member for North Ayrshire and Arran (Patricia Gibson) asked a number of questions. I made this clear at the start of my speech, and I will make it clear again directly to her: we value all the professionals who work in the national health service and the social care sector. We are putting plans in place, both short term and long term, to ensure that our words are followed by actions and there is practical support, and to ensure that people know how much they are valued. I heard her charge of arrogance, but she might like to reflect on the fact that some might consider it arrogant to suggest in any way that this Government are not putting in place all the necessary preparations to protect the NHS.

[Patricia Gibson]

Will the Minister give way?

[Stephen Hammond]

I will not take an intervention. If the hon. Lady listens carefully to my remarks, she will understand why some of us feel that her charge was unfair.

[Patricia Gibson]

Well, explain it.

[Stephen Hammond]

I am about to, if the hon. Lady will give me time, which is why I will not take her intervention.

The hon. Member for Strangford (Jim Shannon) asked about NHS investment. He knows, of course, about the increase in cash terms of £33.9 billion by 2023-24, which reflects, as I said at the outset, our top priority. He also challenged me about the cancer workforce. Baroness Dido Harding, the chair of NHS Improvement, is carrying out a rapid programme of work for the Secretary of State, engaging with relevant stakeholders across the system to build a workforce implementation plan, which the hon. Gentleman mentioned. We have charged her with making sure that her plan matches the long-term plan’s ambitions. The hon. Gentleman will know that the long-term plan superseded previous plans to establish a larger cancer workforce, and Health Education England is now working with Baroness Harding to make sure that is in place.

I listened carefully to the hon. Member for Glasgow East (David Linden), who asked important questions about insulin and the financial impact of leaving the EU on cancer patients. My officials spoke this morning to insulin suppliers, who have increased their buffer stocks so that they will hold 16 weeks of additional stocks over and above their normal supply. [Interruption.] Yes, it is stockpiling, but it is stockpiling that we have asked the whole pharmaceutical industry to undertake. As the hon. Member for Burnley rightly pointed out, there should be no stockpiling by individuals or pharmacists. I will explain the whole stockpiling issue and why we are rightly putting in place buffer stocks to ensure continuity of supply. The hon. Gentleman asked me whether buffer stocks of insulin are in place, and I can confirm that they are.

The hon. Gentleman also asked me what assessment has been made of the financial impact of EU exit on cancer patients, and what measures are in place to protect services. He will know that the long-term plan contains clear proposals for improving cancer diagnoses. That plan is fully costed. As I just said in response to the hon. Member for Strangford, the workforce implementation plan is putting in place the cancer workforce.

I also listened carefully to the hon. Member for East Kilbride, Strathaven and Lesmahagow, who asked whether my door was open to chairs of all-party parliamentary groups. The answer is yes, of course. If she wishes to contact me, I would be delighted to engage with her, and with chairs of other all-party parliamentary groups.

It is also worth putting on the record the relationship that we are likely to have with the European Medicines Agency post Brexit. The Government are clearly striving for a deal, and in the light of the withdrawal agreement being signed, the political declaration sets out that it is the UK’s intention to explore the possibility of EMA co-operation during negotiations on the future framework. In the event of no deal, we would clearly no longer be any part of the EMA, and the Medicines and Healthcare products Regulatory Agency is ready to carry out EMA functions as a sovereign regulator.

To ensure the continuity of supply, the UK will continue to accept batch testing of human medicines carried out in countries named on a list by the MHRA, including EU, European economic area and European Free Trade Agreement countries, and most third countries with which the EU already has in place a mutual recognition agreement.

[Patricia Gibson]

I thank the Minister for giving way; I know there is a lot that he wants to say. As he is talking about ensuring the supply of medicines, can he reassure the House that that includes medical isotopes?

[Stephen Hammond]

I reassure the hon. Lady that we have been working since last August to ensure that companies understand the routes available to maintain continuity of supply, including air freight routes. We will ensure the potential use of those alternative shipping or air freight routes because, as she rightly points out, these are short-life products. The worst-case scenario—no deal—has been looked at, and routes will be available to ensure that medical isotopes can continue to come into this country.

The hon. Lady referred in her speech to the operationalisation of those plans, which is relevant. Normally, if sea routes are used, it can be ensured that medical isotopes or short-life products are at hospitals by 9 am. She referred to the likelihood that, if air freight routes are used, those products would not arrive until midday, which the NHS advises us would mean that some clinics would be likely to be rescheduled to later in the day. People’s opportunities to undergo treatment will not be interrupted.

[Julie Cooper]

Will the Minister very quickly give way on that point?

[Stephen Hammond]

Very quickly.

[Julie Cooper]

I hear what the Minister says about making his best efforts to ensure that there is no interruption of supply. However, does he accept that, as of yesterday, health professionals who deal with this were not reassured? We could be in a no-deal situation in just over a week’s time. Will these arrangements hold good in a no-deal situation? Will he assure us that those vital isotopes will be in the places where they need to be?

[Stephen Hammond]

Had the hon. Lady joined me in walking through the Lobby to vote for the withdrawal agreement—so that Brexit would happen on 29 March and leaving without a deal would be impossible—she would know that all the arrangements currently in place would pertain. We are talking about arrangements for a no-deal situation, which I and the Government certainly hope will not happen. These arrangements are specifically designed to ensure that arrangements are in place for no deal.

In the short time I have left, I will stress the continuity of supply. It is essential that any responsible Government, even if they wish for a different outcome, should prepare for the outcome that they do not want, which in this case is no deal.

[Brendan O'Hara]

Will the Minister give way on that very quickly?

[Stephen Hammond]

Very quickly.

[Brendan O'Hara]

I want to give the Minister the opportunity to answer the question I asked about the long-term plan to fill those hundreds of thousands of vacancies now and in future, and to reassure supporters of my Bill that health and social care will not be adversely affected by the UK leaving the EU. I would be hugely grateful if he did so in the next three minutes.

[Stephen Hammond]

There are so many issues that I could tackle in the next three minutes. However, as the hon. Gentleman will have seen, the long-term plan has ambitions to ensure that there are new routes into nursing and that there are extra doctor training places. I said in response to the hon. Member for Strangford that we have commissioned Baroness Harding to start a workforce implementation plan. I assure the hon. Member for Argyll and Bute that driving down the number of vacancies is a priority for the Government. However, he will recognise that several of those vacancies are not necessarily unfilled posts, because they are usually filled by staff from the temporary staff bank. We need to be clear about what we are talking about. Recruitment into our national health service and our social care system is absolutely a key priority.

My Department has overall responsibility, on behalf of the devolved Administrations, for ensuring the continuity of supply of medicines and medical products. All supply arrangements take into account the whole of the United Kingdom. We have had significant support from, have given reassurance to and are constantly working with the pharmaceutical industry, the whole of the medical supply industry, clinicians and patients, and I am delighted to say that last week we held a roundtable with the devolved Administrations, so that their concerns could be listened to and directly addressed.

Several Members commented on stockpiling. We recognise that if we leave the EU without a deal, the medical supply chain will come under a lot of pressure. Around three quarters of the medicines and more than half the clinical consumables that we use come from the EU. Since last August we have been working with the industry to ensure that, before 29 March, there is at least an additional six weeks of stock over and above the usual buffer stocks in the UK.

We have also advised companies that if they are likely to face difficulties in their supply routes, there are ways of bringing in supplies outside the normal short straits route, either by using existing services or by making use of the additional capacity that the Government have procured. We are reliant on transport and freight being re-routed, but I am confident that, if everyone—including suppliers, freight companies, the health and care system and international partners, all of whom we have worked with since last August—does what they need to do and have committed to doing, the supply of medicines and other medical products will be uninterrupted.

I had intended to deliver a rather longer speech this morning, but I thought it was important to try to answer directly the questions put to me by hon. Members. There is no doubt that many areas of the health and care system will be directly affected by EU exit. We do not have time to address those today. However, it is important that the country knows that the Government are committed to ensuring that, whether we leave with or without a deal, we have in place the contingency plans needed to meet those challenges.

Health and Social Care Update

Stephen Hammond Excerpts

Tuesday 19th March 2019 Written Statements

[The Minister for Health (Stephen Hammond)]

Today, I am updating the House on the Department for Health and Social Care’s plans for the continuity of reciprocal healthcare arrangements in the event we exit the EU without a deal.

Under current EU-based entitlements, the UK pays for the healthcare costs of 180,000 UK nationals, mostly pensioners, in health systems across the EU. There are around 50 million UK tourist visits to the EU annually; the European healthcare insurance card (EHIC) is used in around 0.5% of these visits. Moreover, approximately 50,000 posted workers are protected through the current arrangements.

The current EU healthcare arrangements operate on a reciprocal basis. The UK, EU member states and EFTA states (Iceland, Norway, Liechtenstein and Switzerland) reimburse each other for the healthcare of those who remain covered by their respective social security schemes when living in, working in or visiting each other’s country. These arrangements are a function of EU membership that also applies to the EFTA countries, and are an exception to the arrangements that apply to the rest of the world. As a result, extending these functions in the event of the UK leaving the EU without a deal is subject to agreement and cannot be done by the UK alone.

Separately, the UK and Irish Governments are committed to continuing to facilitate access to healthcare services within the common travel area (CTA). Discussions to continue reciprocal healthcare arrangements are under way between the UK and Ireland and both Governments are taking legislative steps to enable us to implement these arrangements by exit day. Additional guidance for those living and working in the CTA has been published on the gov.uk website.

While EU reciprocal healthcare is funded and administered on a UK-wide basis, the devolved Administrations have responsibility for healthcare provision in Scotland, Wales and Northern Ireland. We are working closely with all parts of the UK on our approach.

My Department has published country specific guidance on gov.uk and nhs.uk about healthcare arrangements if the UK leaves the EU without a deal and has been working closely with EU member states and EFTA states to protect existing healthcare arrangements for these and other groups.

The UK Government’s proposal

Subject to Parliament ratifying the withdrawal agreement, in a deal scenario current reciprocal healthcare rights will continue during the implementation period until 31 December 2020. The withdrawal agreement and EFTA agreements also give longer term reciprocal healthcare rights to those who are living in or previously worked in the other country on exit day.

We have proposed to EU member states and EFTA states that we should maintain the existing healthcare arrangements in a no-deal scenario until 31 December 2020, with the aim of minimising disruption to UK nationals and EU and EFTA state citizens’ healthcare provision.

This would mean that we will continue to pay for healthcare costs for current or former UK residents for whom the UK has responsibility who are living or working in or visiting the EU and EFTA states, where individuals are not covered by the EFTA citizens’ rights agreements. We are hopeful that we will reach such agreements.

We have brought forward legislation to enable us to implement new reciprocal healthcare arrangements. The Healthcare (International Arrangements) Bill was introduced in Parliament on 26 October 2018 and passed Report stage in the House of Lords on 12 March 2019. It will provide us with the power to fund and implement comprehensive reciprocal healthcare arrangements after we leave the EU. We have also laid three statutory instruments which will give us the specific legal basis to implement our proposal.

Minimising disruption in the event of no deal

As outlined above, we want to work with EU partners to protect existing healthcare arrangements beyond exit day. If that is not possible, healthcare arrangements in many EU member states would revert to those which apply to the rest of the world. Whenever travelling abroad, individuals are always responsible for ensuring they have travel insurance. It is already the case that we advise people to obtain comprehensive travel insurance when working, studying or travelling to the EU and the rest of the world. This will remain our advice in all circumstances.

Many people rely on EHICs. In a no-deal scenario, these may no longer be valid in EU member states (and in EFTA states for those visitors not in scope of the EFTA citizens’ rights agreements and travelling after exit day). UK nationals living in or travelling to EU member states should check up to date information gov.uk and nhs.uk and ensure they have taken the necessary steps to prepare.

Although we are hopeful that we can agree reciprocal healthcare arrangements, as a responsible Government we have developed a multi-layered approach to minimise disruption to healthcare provision to UK nationals currently in or travelling to the EU member states and to those UK nationals not covered by the EFTA citizens’ rights agreements:

1. We welcome action from those EU member states who have prepared their own legislation for a no-deal scenario. EU member states such as Spain have made public commitments that they will enable resident UK nationals and visitors to access healthcare in the same way they do now.

2. As noted above, the UK and Irish Governments are committed to continuing to facilitate access to healthcare services within the common travel area (CTA). Discussions to continue reciprocal healthcare arrangements are underway between the UK and Ireland and both Governments are taking legislative steps to enable us to implement these arrangements by exit day. Additional guidance for those living and working in the CTA has been published on the gov.uk website.

3. The UK Government have already agreed with Iceland, Norway, Liechtenstein, Switzerland (EFTA) to protect citizens’ rights. This means that UK nationals already living in EFTA states and vice versa will be able to access healthcare as they do now. However, in line with the arrangements we are seeking with EU member states, we would like to protect the healthcare cover of visitors not in scope of the citizens’ rights agreements travelling between the EFTA states and the UK after exit day to enable them to continue to be covered for needs-arising healthcare (currently facilitated under the EHIC system).

4. The UK Government have committed to fund healthcare for UK nationals (and others for whom the UK is responsible) who have applied for, or are undergoing, treatments in the EU prior to and on exit day, for up to one year, to protect the most vulnerable. The statutory instruments introduced on 11 February would also enable some UK residents to recover costs if they are charged. For UK nationals who are visitors, we will refund costs directly. For UK nationals who are resident in another member state, this commitment requires us to reach an arrangement with individual EU member states. We are hopeful that they will remain willing to treat patients and accept reimbursement and are in discussions to seek such an agreement.

5. We have published guidance profiles on gov.uk and nhs.uk and will update the guidance with further developments.

6. Should UK nationals face changes in how they can access healthcare, they may use NHS services if they return to live in the UK. As is currently the case, UK nationals living in the EU will have an entitlement to NHS services as soon as they take up ordinary residence in England. We will continue to work closely with the NHS in England and across the devolved Administrations in the UK to ensure returners can appropriately access NHS services. A British citizen who moves to the UK can be considered ordinarily resident upon arrival if it is clear that they are here to reside on a properly settled basis for the time being. British citizens who return to live in the UK part way through their treatment will be able to access NHS services.

7. Those who have their healthcare funded by the UK under current EU arrangements and are resident in EU member states on exit day can use NHS services in England without charge when on a temporary visit to England.

8. The Association of British Insurers (ABI) has advised that travel insurance policies will cover emergency medical treatment costs as standard that could have been reclaimed through the EHIC, although some routine treatments would not be covered. People should be aware that there are a small number of policies in the market that state they will only provide cover if you have and use an EHIC. The ABI have advised that all individuals should check their current travel insurance thoroughly to ensure they have the correct amount of cover for their requirements. Additional guidance has been published on the ABI website here.

Advice for citizens of EU member states and EFTA states

We have confirmed that, in a no-deal scenario, we will protect the healthcare rights of citizens from EU member states and EFTA states, who are living lawfully in the UK on exit day, and this includes their entitlements to NHS cover.

Advice for UK nationals

In the event that we cannot reach an agreement with EU member states and EFTA states for those nationals not in scope of the EFTA citizens’ rights agreements, it is not possible for the UK Government to guarantee access unilaterally to healthcare abroad, beyond the situations set out above. We will be employing a small number of overseas healthcare advisers in UK missions across Europe who will be able to provide advice where individuals have particular need for support. However, it is vital that all UK nationals who are currently or planning to reside in, travel to, work or study in EU member states and EFTA states take the following actions now:

Residents: The UK Government have published advice setting out options to access healthcare under local laws in EU member states and EFTA states and what people can do to prepare. We have analysed 31 countries and strongly advise that all affected UK nationals check the latest country specific guidance on gov.uk and nhs.uk.

Substantial numbers of UK nationals will already be eligible for or enrolled in the relevant health authorities locally, either because of their residency, benefits or employment status. There is no reason to think that a no-deal scenario will affect these arrangements where EU countries offer equal access to healthcare.

For some people it may be advisable to register their healthcare entitlement with their relevant health authority locally. This may mean that they will need to join a social insurance scheme and contribute as other residents do. Others will need to buy private healthcare insurance.

Visitors: The Government always advise UK nationals to take out travel insurance when going overseas, both to EU and non-EU destinations. UK nationals, including those with pre-existing conditions, planning to visit an EU member state or EFTA states on or after exit day should continue to buy travel insurance.

As with any policy, UK nationals are advised to make sure they understand the terms and conditions of any travel insurance policy and that the policy is sufficient to cover healthcare needs. Most travel insurance policies will cover emergency treatment as standard but we advise all travellers to check their policies as some treatments may not be covered in the countries they are visiting.

Any questions regarding individual travel insurance policies should be directed to the relevant insurance companies or refer to guidance published on the ABI website here.

If we do not reach an agreement with EU member states and EFTA states for those nationals not in scope of the EFTA citizens’ rights agreements, EHIC may no longer be valid after exit day. ABI advice is that, while almost all insurance policies will remain valid, some insurance policies may be affected. There are a small number of insurance policies which are dependent on having an EHIC, so if you have purchased one of these policies it is recommended you speak to your provider to ensure you are fully protected before you leave the UK.

Workers: We have published country specific guidance on gov.uk and nhs.uk to help UK workers make the necessary preparations for a no-deal scenario. We strongly advise that workers ensure they have comprehensive healthcare insurance for the full period of their stay.

Students: Currently, students residing in the UK who are going on a placement abroad are entitled to a UK-issued EHIC to cover healthcare costs for the duration of their placement.

We cannot guarantee that this will continue for all EU member states in the event of a no-deal scenario where the existing arrangements are not extended. We strongly advise that students check the country specific guidance that we have published on gov.uk and nhs.uk and make the necessary preparations for a no-deal scenario.

The EFTA citizens’ rights agreements protect the rights of UK nationals who are studying in an EFTA state over exit day, and who are entitled to a UK EHIC, to continue to benefit from the EHIC scheme for the duration of their course.

Returners: As is currently the case, UK nationals who return to live in the UK and meet the ordinarily resident test will be able to access NHS care on the same basis as other UK residents. If these people return to live in the UK partway through their treatment, they will be treated by the NHS in a fair and equitable way.

UK nationals who have their healthcare funded by the UK under current EU arrangements and are resident in the EU on exit day can use NHS services in England without charge when on a temporary visit to England.

UK nationals who are resident in an EU country, who do not have their healthcare funded by the UK under current EU arrangements and who do not wish to return to the UK, should seek to formalise their current residency status if they are eligible. Guidance has been made available on gov.uk and nhs.uk.

The UK is taking steps to protect individuals whose healthcare it is responsible for under current EU arrangements, but who are not UK nationals. Where this paper refers to UK nationals, it includes non-nationals for whom the UK is responsible.

[HCWS1429]

Health and Social Care

Stephen Hammond Excerpts

Tuesday 19th March 2019 Ministerial Corrections

The following is an extract from the debate on the Amendments Relating to the Provision of Integrated Care Regulations 2019 on 18 March 2019.

[Stephen Hammond]

It is important to recognise that NHS England has taken measures to build a clearer narrative around integrated care. The long-term plan, which will be backed by £20.5 billion extra by 2023-24, will introduce integrated care for patients in England over the next decade.

[Official Report, 18 March 2019, Vol. 656, c. 878.]

Letter of correction from the Minister for Health:

An error has been identified in my contribution to the debate.

The correct information should have been:

[Stephen Hammond]

It is important to recognise that NHS England has taken measures to build a clearer narrative around integrated care. The long-term plan, which will be backed by an extra £33.9 billion in cash terms by 2023-24, will introduce integrated care for patients in England over the next decade.