Integrated Care Regulations

Stephen Hammond Excerpts

Monday 18th March 2019 Commons Chamber

[The Minister for Health (Stephen Hammond)]

Although we oppose the motion, I welcome the opportunity to debate the regulations. The NHS long-term plan, which was published in January, set out a clear blueprint for fully integrated community health in the NHS for the first time in its history. The plan highlighted the intention to dissolve the historical distinction between primary and community health services and to break down the traditional barriers between care institutions, teams and funding streams, so as to support the increasing number of people with long-term health conditions, rather than viewing each encounter with the health service as a single unconnected episode of care.

NHS organisations will increasingly focus on population health by delivering the so-called triple integration of primary and specialist care, physical and mental health services, and health with social care, which is consistent with what doctors have consistently reported they need. I obviously welcome the commitment from the shadow Secretary of State, the hon. Member for Leicester South (Jonathan Ashworth), to integration. Today, the integration of services can take place through collaboration and co-operation, including some local alliance arrangements. However, in some areas, people working on the ground have told us that it would be better to have a lead provider to take responsibility for the integration of services for a population through an integrated care provider contract.

It is worth making the distinction between integrated care providers, which we are discussing tonight, and integrated care systems. An integrated care system growing out of the current network of sustainability and transformation partnerships will provide a platform on which commissioners can make shared decisions with providers about how to use resources, design services and improve population health. The long-term plan has set out an ambition for all STPs to evolve into ICSs. Integrated care providers, or ICPs, will be a new way of integrating health and care services so that people’s care is co-ordinated around them.

NHS England has developed the ICP contract to enable local areas to commission local health and care services, including primary medical services through a single contract. The intention is to establish the right organisational and financial incentives for providers to collaborate in order to deliver preventive, proactive and co-ordinated care. It is important to underline that ICPs are not new types of legal entity, but provider organisations that have been awarded ICP contracts. In the long-term plan, NHS England underlined that, when the contract is made available for use, it expects ICP contracts to be held by public statutory providers, and I want to discuss that a bit more in my remarks later.

Turning to the particular statutory instrument we are discussing tonight, we have identified a number of regulations that need to be amended to allow the first ICP contract to be awarded.

[Thelma Walker (Colne Valley) (Lab)]

In the last year, I have been on numerous Delegated Legislation Committees, and I have been shocked by the complex and far-reaching changes the Government have forced through without appropriate scrutiny. Can the Minister justify why substantive change to existing regulations should not be part of a Bill and subject to parliamentary scrutiny?

[Stephen Hammond]

As the hon. Lady knows, this has been subject to considerable scrutiny. It has been scrutinised by the Health and Social Care Committee, as she has already heard from its Chairman. She will also have heard that it has been subject to a number of other scrutiny processes, including judicial reviews.

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

The Minister is correct in saying that there has been some analysis of integrated care partnerships by the Health and Social Care Committee, but it has not scrutinised this statutory instrument. The Select Committee actually recommended very clearly that ACOs or ICPs should be NHS organisations. Will the Minister say why he should not accept the Committee’s recommendation?

[Stephen Hammond]

As the hon. Gentleman knows, the long-term plan has set out that the ICP contracts will be held by public statutory providers. That point has been made and reiterated several times not only in the Select Committee’s scrutiny, but in the remarks that the Committee and a number of people have made about privatisation. The Chairman of the Health and Social Care Committee has already intervened on the shadow Secretary of State, but she has said:

“The evidence to our inquiry was that ACOs, and other efforts to integrate health systems and social care, will not extend the scope of NHS privatisation and may effectively do the opposite.”

[Dr Wollaston]

Will the Minister assure the House that only public statutory providers will hold these contracts? That would be reassuring, as the language on this is not completely clear. Will he also give some assurance regarding the Select Committee’s other proposal, which is that the policy should be carefully piloted and evaluated? If it is done first in Dudley, followed by careful evaluation, I would be prepared to support it. If he cannot give reassurance on those points, it would be difficult for me to support the regulations.

[Stephen Hammond]

I can give the Chair of the Select Committee the assurance that the ICP contract will be made available in a controlled and incremental way, conditional on the successful completion of NHS England and NHS Improvement assurance through the integrated support and assurance process. That incremental process is, I think, in line with what she and her Committee recommended.

[Jonathan Ashworth]

Will the Minister confirm that, because of the competition and procurement rules and the regime brought in by the Andrew Lansley Act, he cannot rule out the possibility of an independent provider winning a contract? He might say it is unlikely, but he cannot rule out the possibility, so why does he not introduce a measure—a simple one-clause Bill, perhaps—to give the assurances that many campaigners want?

[Stephen Hammond]

The hon. Gentleman is right: it is highly unlikely. More than that, it is stated and restated in the long-term plan that NHS England has the clear expectation that the ICP contracts will be held by public statutory providers. He knows that, and others who have discussed this point have made it clear.

[Justin Madders]

I have a simple question and we would like a simple answer. Yes or no: do the Government intend to repeal section 75 of the Health and Social Care Act 2012?

[Stephen Hammond]

As the hon. Gentleman knows, the NHS has proposed in a recent legislative document that it looks at a number of issues. It is important that that round of engagements takes place, and the Government will consider what is said.

The majority of the amendments we propose simply ensure that the regulatory framework that applies to contractual arrangements for the provision of healthcare services continues to apply where services are provided under the new ICP contract and to those organisations that hold a contract. That is an important safeguard that, in simple terms, helps to ensure that care provided under an ICP contract is subject to all the same rules as care provided under existing and other NHS contracts, such as those governing the handling of complaints and the reimbursement of travel expenses.

The shadow Secretary of State has asked me to comment on the substantive change being proposed, underpinning the existing contractual arrangements for the provision of NHS GP services. The regulations will allow GPs who are currently providing services under existing contractual general medical services or personal medical services arrangements to suspend, rather than terminate, those arrangements in order to provide services under an ICP in what is known as a fully integrated arrangement. The British Medical Association has underlined that GPs should not be pressured into joining an ICP arrangement, and we want to make it clear to the House tonight that the participation of any individual GP practice is entirely voluntary. Any role in any ICP will be for them to decide. Allowing the suspension of GP contracts allows GPs to take part in an ICP arrangement but keeps the option available to them of returning to their previous contract.

The hon. Gentleman expressed a number of concerns about the ICPs. He implied that they had been brought in by stealth. In fact, the proposals have been subject to significant scrutiny by Parliament and the public, particularly in the past year. We have already discussed the examination of the evidence by the Health and Social Care Committee, which published a report last summer, which is, I believe, largely supportive of ICPs, recognises potential benefits and sets out helpful recommendations on introducing them in England. I have described the consultation processes previous iterations of the ICP contract and the regulations have gone through.

Moreover, as the Health and Social Care Committee was promised, NHS England has completed a full public consultation on the ICP contract and announced through the long-term plan that the ICP contract will be available for use. NHS England’s full response to the consultation was published on 15 March.

Various people have made points tonight about the privatisation of the NHS and said that ICPs are a route to privatising the NHS. They are clearly not.

[Lyn Brown (West Ham) (Lab)]

Yes they are!

[Stephen Hammond]

The NHS has stated clearly that NHS England’s expectation is that these contracts will be held by public statutory providers. The hon. Lady, who is making a number of points—[Interruption.] She says she is not making them, but shouting at me. Indeed, she is shouting at me.

[Lyn Brown]

Chuntering.

[Stephen Hammond]

Oh, she is chuntering at me. While she is chuntering at me, she might like to consider what the King’s Fund has said about the claims of mass privatisation, which is that they are “hugely overstated”. I have already quoted the Chair of the Select Committee, who said that the evidence to its inquiry was that ICPs and

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

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, 19 March 2019, Vol. 656, c. 6MC.] Where local commissioners propose to use ICP contracts, they will have to ensure that it is an effective and beneficial option for the local area. The regulations will ensure that the healthcare of this country is improved by integrated care providers. I commend them to the House.

Health and Care Professions Council: Registration Fees

Stephen Hammond Excerpts

Thursday 14th March 2019 Westminster Hall

[The Minister for Health (Stephen Hammond)]

It is a pleasure to serve under your chairmanship, Mr McCabe. Like everyone else, I congratulate the hon. Member for Coventry South (Mr Cunningham) on securing this debate. He made an impassioned speech that aired his campaign, which he has led with style and impact. The Health and Care Professions Council is one of nine UK-wide regulators. It performs an important role in the health and care sectors across all four countries of the UK, acting in patients’ and service users’ interest to ensure the professional standards we need to guarantee safety and quality.

Right at the start of my speech, I pay tribute to all the dedicated professionals who work in the professions governed by the HCPC. It is also right to respond to the Opposition spokesman, the hon. Member for Ellesmere Port and Neston (Justin Madders). He said, if I heard him correctly, that it was irresponsible of the Government not to intervene. There is an important point of principle here: the HCPC is independent of the Government. It is funded by registrants’ fees on a cost-recovery basis. It is therefore not the Government’s role to tell the HCPC what its fees should be. It is not a question of hiding or a lack of political will; it is a matter of law. As the hon. Gentleman knows, there is a mechanism for oversight of the HCPC, which is the Professional Standards Authority. It oversees the HCPC and its setting of fees.

It has been an excellent debate with lots of useful and informed contributions. I have been in a number of debates with the hon. Member for Strangford (Jim Shannon), and he spoke with his usual passion not only on behalf of the people of Strangford, but in the wider context as well. I want to pick up on what the hon. Member for Heywood and Middleton (Liz McInnes) said; I was listening carefully to her contribution. She is right that the vast majority of registrants have very little contact with the regulator between renewals of their registration. That may be a frustration and not seen as value for money, but from the other point of view, the HCPC’s largest expenditure is on delivering the fitness-to-practise function. It is therefore inevitable that it concentrates on the very small number of registrants whose performance or conduct has fallen below the expected level.

The key thing is the need for regulatory reform, which the hon. Member for Ellesmere Port and Neston was challenging me on a moment ago. We have recognised that regulators have inherited a complex and restrictive registration practice that is often bureaucratic and administratively burdensome. As he rightly pointed out, the four UK Governments consulted on proposals for reforming the legislative structure of professional regulation. That consultation finished last year.

The reforms that we are looking to make, and are still committed to, will shift the balance in professional regulation, freeing up the regulators to concentrate more on prevention and to work directly with registrants, rather than just on fitness to practise. I assure the hon. Gentleman that it is not our intention to hide that. We intend to bring it forward, and we will do so in the near future.

I was listening carefully to the hon. Member for York Central (Rachael Maskell). She made a point about the need for registration and also for the system to be updated. The Government are committed to that. I also listened carefully to the hon. Member for Blaydon (Liz Twist). She spoke with knowledge and mentioned a number of the fitness-to-practise cases she has been involved with. She was right to point out that the vast majority of those have been social care cases over a number of years. That brings me to a key point. A number of Members raised the issue of the HCPC’s costs potentially going down as a result of social workers moving out of that regulatory process. I have not looked at that in great depth, but it is highly likely that variable costs will decline for the HCPC. As a number of Members have pointed out, social workers make up the vast majority of the professions that are regulated—more than 25%—so there is an element of fixed costs. They are being helped by the establishment of Social Care England, and the costs are being met by the Government.

The HCPC currently regulates 16 professions. The hon. Members for Coventry South and for Ellesmere Port and Neston read out the list of professions, so I will not rehearse them all over again, but I reiterate my point: these valued professionals are performing crucial roles across the NHS and the wider health and care system. It is important that the public have assurance that those professionals are regulated. If they are regulated by the HCPC, the public knows that they are appropriately trained and hold the relevant qualifications, and that they meet the expected standards of conduct, performance and ethics. Where a professional falls below these standards, it is important that the HCPC is able to protect the interests of patients.

I take the point made by a number of hon. Members that the HCPC currently has the lowest registration fees of any UK-wide regulator in the health and care professions. It is clearly not right to look at that in comparison with some of the more highly paid professions, but it is true that the current annual registration is lower than that for a number of others, such as nurses and midwives. I also take the point that the proposal is for a large, one-off increase, but there has not been an increase for two years, and the registration fees are tax-deductible, so the increase will amount to about £1 a month.

A number of Members mentioned the disparity between the fees that are payable by part-time and full-time staff. I have listened carefully to that argument, and I will write to the HCPC to ask it to look at that more carefully. That seems to me to be a fair point.

A number of Members raised points about the consultation. The legislation that founded the HCPC required it to consult on any fee increase. Accordingly, it ran a public consultation, to which it received 2,396 responses. Some 95% of those responses were from professionals whom it regulates. It also engaged extensively with professional bodies, trade unions and other bodies ahead of and during its consultation. The draft response to the fees consultation was published with the HCPC’s council papers of 14 February. It is right that 90% of the respondents did not support a proposed fee rise.

However, it is fair to note that the majority of respondents also wanted HCPC to invest more in prevention and improved services, in increasing capacity, and in improving the quality and timeliness of the fitness-to-practise services that it delivers. Everybody accepts that no fee rise is popular, but the HCPC has been clear that the principal reason for this one is to allow it to deliver the services identified by registrants in the consultation.

[Dr Drew]

The Minister will have heard my earlier intervention. Will he assure us that he will ask for complete transparency and accountability, so that we know what the additional costs will go towards?

[Stephen Hammond]

I listened to the hon. Gentleman, and I will make a promise to him. As I pointed out at the beginning of my speech, it is not the Government’s role to tell the regulator how to set its fees or what to set them for. However, I see no reason why the Professional Standards Authority should not ask the HCPC to give that reassurance and to publish that information. I will write to the hon. Gentleman when I have spoken to the PSA to ensure that it can do that within its remit. Given that it has oversight, I am sure that that will be possible.

[Liz McInnes]

It is my understanding that the changes to the HCPC rules will be subject to parliamentary approval. The Minister says that the Government will not be able to have any influence, so by what mechanism will the rule change be approved by Parliament?

[Stephen Hammond]

On oversight of the fee change, there is effectively accountability to Parliament through an order of the Privy Council. The Government will need to introduce an order of the Privy Council, which will be subject to the negative resolution procedure. The financial oversight is done by the PSA. The Government have to lay the order, but the oversight is done via the Privy Council.

As I said, there has rightly been much discussion this afternoon about the reason for the proposed fee rise. The HCPC makes the point that it has not raised its fees since 2015. It also rightly makes the point that the vast bulk of the fee rise is for the services that its registrants want. I promised to write to the hon. Member for Stroud (Dr Drew) about that.

I thank the hon. Member for Coventry South for raising this issue. The debate has highlighted his campaign. I have no doubt that the HCPC and the PSA will have listened, and will take regard of this afternoon’s debate. I hope that my remarks, the promise I made to the hon. Member for Stroud, and my commitment to write to the HCPC will help the campaign of the hon. Member for Coventry South. I am clear that registrants should continue to benefit from a regulator that provides value for money and services to its registrants; I know that the PSA will ensure that they do so.

Acute NHS Care: South-west Hertfordshire

Stephen Hammond Excerpts

Wednesday 13th March 2019 Westminster Hall

[The Minister for Health (Stephen Hammond)]

It is a pleasure to serve under your chairmanship, Sir David, and to respond to my right hon. Friend. I want to say at the outset that one thing we absolutely agree on is what he said in his opening remarks. He expressed, in bringing forward this important matter for debate on behalf of his constituents, recognition of and admiration for the frontline staff. Even though I do not know the frontline staff in his area, I know from my visits in my short time as Minister and from my constituency experience that the professional care they deliver is admirable and extraordinary. We should never forget the effort they put in, and my right hon. Friend is right to acknowledge that.

Before I address specifics, and before what I suspect will be an iterative debate, I want to deal with two fundamental points, which I know my right hon. Friend knows, but are worth putting on the record. First, any service change in the NHS must clearly be based on clear evidence. Secondly, before any substantive change is made, patients and the public should be consulted. My right hon. Friend raised two interesting subjects on which we could have a debate of an hour and a half, or probably even three hours. One was local accountability in the NHS, in its wider sense and form, and how he is accountable as the Member of Parliament. The other was funding criteria.

My right hon. Friend has, I think, addressed two other Ministers on his passion for the longstanding need to improve the quality of hospital infrastructure in west Hertfordshire. That has been a stated aim of the Hertfordshire and West Essex sustainability and transformation plan since its inception. I know it is engaging in the process of looking at how a redevelopment and redesign of the hospital provision in west Hertfordshire can be achieved, working alongside NHS England and NHS Improvement.

I recognise that my right hon. Friend has real concerns and real scepticism about the work of the CCG. I hope he will recognise the work that the sustainability and transformation partnership is involved in in the hospital development process, and the fact that the director of strategy took part in a process and evaluation meeting in February 2019, at which a shortlist of our options was discussed. The STP is also due to take part in the next evaluation event.

I understand what my right hon. Friend says about the capital. I hear his criticism and scepticism of the West Hertfordshire hospitals trust, but it has been taking the lead in developing the strategic outline case for change. I understand that it and NHS Improvement had dialogue, and feedback was provided on the strategic outline case for the acute hospital redesign submitted by the trust. I also understand, as he will, that the feedback made two key points: it was clear, first, about the need for funding, and secondly, that the overall public money for hospital redevelopment is relatively limited.

My right hon. Friend has raised the issue of the £350 million; he knows that the turnover figure is a key criterion and a key threshold for capital investment, and that any options that significantly exceed the £350 million capital cost have been excluded from the current shortlist. He is obviously aware of a £750 million figure being used locally, but I must confess I am not aware of that figure. I would be delighted to offer him a chance to sit down and try to work out with me where that figure came in—recognising, as he rightly points out, that it will not be a Minister who makes any decision. If it is helpful to him, I am happy to have that discussion.

[Sir Mike Penning]

I had that discussion with the Secretary of State, a couple of days after he was appointed. It is not just Ministers that I pick on—Secretaries of State get it in the ear as well. There are two points I would like to touch on. First, how can it be fair to a community that, if it is just based on the turnover of a trust and that trust happens to be a very small one, the provision we get locally is second class? We cannot even go to that territory. Secondly, on the £750 million, I will ask the Minister to step in, because that is the figure being used locally to rule out the greenfield site. There was an evaluation panel, and members of the panel asked for the greenfield site to be put in, and fundamentally, it appears to me, they have been completely ignored.

[Stephen Hammond]

I made the point a moment ago that, because the cost of that greenfield site exceeds the £350 million threshold, it has currently been dropped from the shortlist of options. My right hon. Friend repeats a point that he made during his speech, questioning the criteria; he will know that I have heard what he has said. As he has just informed me, he has made a representation to the Secretary of State about that figure, and I have offered to have a meeting with him so that we can both explore it.

I do not think that, in the relatively short time available, I should get into the debate about the loan criteria, as I said at the beginning. We can have that debate at some other stage if my right hon. Friend wishes to put it forward, but he knows that at the moment the key threshold for capital investment would be the turnover, and therefore options that significantly exceed a £350 million capital cost have been excluded. As part of the option appraisal process, senior leaders and clinicians, as well as expert analysts, were involved in information gathering to put together the option evaluation. He will know that that included demand and capacity analysis based on population, hospital activity and operational planning.

With regard to reviewing that process, my right hon. Friend, as he said, wrote to both NHS England and NHS Improvement concerning the approval process. As he referenced in his speech, he forwarded to them an email from Professor Ron Glatter of the New Hospital Campaign. I understand that in that email, the professor requested a full statement of the outcomes of NHS Improvement’s review of the trust’s acute transformation strategic outline case.

In its answer, NHS Improvement has so far said that it has not started its formal review because the Treasury and the Department have not yet decided whether the proposal represents a scheme that can in principle be supported by central Government. I recognise the strength and effort of the campaigning for the new hospital option and I acknowledge the expert views that have been sought. While it is obviously not right for me to prejudge the answer from NHS Improvement, I know my right hon. Friend will recognise that I and the Department must take a wider view and that decisions made on capital funding must be the same for everyone across the country.

There has clearly been a huge amount of public engagement throughout the process, and I understand that further public engagement is planned for this month. Notwithstanding my right hon. Friend’s scepticism, I understand that the results of those consultations, in terms of the preferred way forward, will be taken to the trust board and the CCG in June 2019.

I recognise my right hon. Friend’s commitment to improving services; I assure him that the information provided by the New Hospital Campaign is being considered and will be considered as part of the review. As I said, it is not appropriate for Ministers to comment on specific decisions but, as he knows, the Government are determined to encourage innovation and to ensure that all patients have access to high-quality services. The updated proposal will clearly help to inform both the Department and the Treasury about capital allocations in the next spending review. I will not rehearse the arguments about the extra £33.9 billion of cash to support the NHS, or the additional capital and the bid we are putting forward in the comprehensive spending review.

[Sir Mike Penning]

If we accept that the rules at the moment are that any bid cannot be over the revenue income, which is the £350 million, can the Minister explain to me why, in Birmingham, the new build for 750,000 people cost between £300 million and £350 million, which we know because of the Carillion contract that collapsed, and the Royal Liverpool cost £335 million, yet we have been ruled out of having any new build on land that is actually owned by us—one of the sites is on Crown Estate land, public land—because it would exceed £350 million? I know he probably will not have the ability to answer that this second, but a letter in the next few weeks would be very helpful.

[Stephen Hammond]

As my right hon. Friend knows, all Ministers can make an attempt at an answer, but I am sure he would prefer a detailed answer. Therefore, I will make that detailed response to him, as he has asked, in a letter. I also know that he would like me to commit to the spending now, but he will know that I am unable to do so at this stage. I have listened carefully to his points about what might be the cost of the redevelopment that he believes should happen, and he will know that I have heard that. He will also know that I have heard the differences that he has pointed out between the supposed or quoted cost and the cost of build in other areas. He knows that I will have taken that on board.

At this stage, with just 30 seconds to go, I thank my right hon. Friend for bringing this matter to the Chamber and for making the case yet again for his constituents. He should know that the Minister and the Department have listened, and I will respond to him and have that meeting with him.

[Sir Mike Penning]

rose—

No-deal EU Exit: Medicines and Medical Products

Stephen Hammond Excerpts

Monday 25th February 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 medicines and medical products in the event we exit the EU without a deal.

My Department has been working closely with trade bodies, product suppliers, the health and care system in England, the Devolved Administrations (DAs) and the Crown Dependencies, to ensure the continuation of the supply of medicines and medical products to the whole of the UK in the event of a no deal EU Exit. This includes the NHS, social care and the independent sector and covers medicines (prescription, pharmacy and general sales list medicines); medical devices and clinical consumables (such as needles and syringes); supplies for clinical trials; vaccines and countermeasures; and blood, tissue and transplant materials.

Together with industry and the health and care system, my Department has analysed the supply chains of 12,300 medicines, close to half a million product lines of medical devices and clinical consumables, vaccines used in national and local programmes, and essential non-clinical goods on which the health and care system relies, such as linen, scrubs and food.

We have also assessed contract risks associated with potential no-deal EU exit in the broader NHS and social care sector in England and within the DAs and are working with suppliers to ensure adequate mitigations are in place for non-clinical goods and services (e.g. hospital food, laundry, IT contracts, etc.).

This has been a very large undertaking but we are grateful for the excellent engagement from all parties—our plans are well advanced as a result.

While we never give guarantees, we are confident that, if everyone—including suppliers, freight companies, international partners and the health and care system—does what they need to do, the supply of medicines and medical products should be uninterrupted in the event of exiting the EU without a deal.

My Department has well established routine procedures to deal with medicine shortages, from whatever cause, and works closely with the MHRA, the pharmaceutical industry, NHS England and others operating in the supply chain to help prevent shortages and to ensure that the risks to patients are minimised when they do arise.

There is no hard evidence to date to suggest current issues are increasing as a result of EU exit.

My Department has overall responsibility on behalf of the Devolved Administrations for ensuring the continuity of supply of medicines, and they have opted to utilise our contingency arrangements so we can work together to ensure the supply of medical devices and clinical consumables. Therefore, all supply arrangements take into account the whole of the UK, reflecting the engagement and co-operation of our colleagues in the DAs.

Around three quarters of the registered medicines and over half the clinical consumables the UK uses come from (or via) the EU. Government estimate that the key risk to supply is reduced traffic flow at the short straits crossing (ie between Calais and Dover or Folkestone).

My Department has put in place a multi-layered approach to minimise any supply disruption:

Building up buffer stocks and stockpiling before 29 March in the following areas:

Medicines: We have analysed 12,300 licensed medicines products. Around 1,800 of these were determined to not be relevant as no longer marketed in the UK.

For the remaining approximately 7,000 ‘POM’ (prescription-only medicines) and ‘P’ (pharmacy only medicines, that can be purchased only from a pharmacy without a prescription) with an EU/EEA touchpoint, we have been working with suppliers to ensure they increase their buffer stocks to hold at least an additional six weeks of stock (over and above usual buffer stock) in the UK before 29 March. The vast majority of companies have confirmed stockpiling plans are in place. For those medicines that cannot be stockpiled because, for example, they have short shelf-lives, such as medical radioisotopes, we have asked suppliers to make alternative routes using airfreight, which some suppliers already do now.

For general sales list (GSL medicines—also known as over-the-counter or OTC products), 500 of which have a EU touchpoint, we have worked with NHS England to identify those which are important for the management of specific health conditions, and are working with suppliers to assure contingency plans for those products.

Medical devices and clinical consumables: My Department has placed extra orders for the medical devices and clinical consumables which NHS supply chain routinely stocks. Although the NHS supply chain organisation normally only covers England, we have worked closely with the national procurement and logistics services in Scotland, Wales and Northern Ireland, to ensure their demand levels for the UK are covered. Not all suppliers have the capability to hold stock of their full product range in the UK and routinely supply product directly from EU distribution centres to care providers or patients. These suppliers are working on their own contingency measures; however, we have also put in place national contingency measures to provide a reliable and responsive means of moving product into the UK, including additional daily air freight capacity from Maastricht to Birmingham.

Blood, tissues and transplants: NHSBT manages the blood supply in England and is working to ensure there is no disruption to this. We are largely self-sufficient in blood and blood components and do not export or import these products in large quantities. In exceptional cases we export or import very rare blood for urgent clinical need, usually in single unit quantities. NHSBT has put in place stockpiles and other contingency arrangements to ensure a continuous supply of blood (including frozen plasma) and transplant materials. NHSBT has been collaborating with the other UK blood services and is working with its EU counterparts to ensure that the current organ exchange arrangements can continue post exit. The regulators are working with licensed establishments so the import of tissues and cells from EU countries can continue.

Vaccines and countermeasures: My Department is taking the same approach to the supply of vaccines and countermeasures as we are for the supply of medicines (in terms of stockpiling, warehousing and replenishment). Public Health England (PHE) manages significant stockpiles of vaccines for the national immunisation programme across the whole of the UK, as part of their business as usual planning. PHE is working with vaccine suppliers to ensure replenishment of these existing stockpiles continues in the event of supply disruption in the UK.

Supplies for clinical trials: We are working with organisations running clinical trials and have requested these organisations to consider their supply chains for clinical trials ahead of 29 March. We have requested that they ensure contingency arrangements are in place for their supplies. Supplies of clinical trials are transported in small quantities and usually via airfreight.

Non-clinical goods and services: We have been working closely with a range of NHS and social care providers and suppliers to ensure mitigations are in place for non-clinical goods and services (e.g. hospital food, laundry, IT contracts).

Buying extra warehouse space: To ensure sufficient space to store these products, we have agreed contracts for additional warehouse space, including ambient, refrigerated and controlled drug storage. Last week we updated industry on how they can access this additional storage.

Securing, via the Department of Transport (DfT), additional roll on, roll off freight capacity (away from the short straits) from 29 March.

Contracts have been signed by DfT with two ferry companies for the next six months. These routes are away from the Dover Straits where most goods flow from the EU and will run from the following routes: Cherbourg—Poole, Le Havre—Portsmouth, Roscoff—Plymouth, Caen—Portsmouth, Vlaardingen—Immingham, Cuxhaven—Immingham and Vlaardingen—Felixstowe. The Government have purchased the tickets from the shipping freight operators, and these will be sold on at market rate.

There is cross-Government agreement that all medicines and medical products will be prioritised on these alternative routes to ensure the flow of all these products may continue unimpeded.

Companies which supply medicines or medical goods will be offered the option of buying tickets on these routes and my Department is currently engaging with industry to ascertain the likely uptake levels.

We have worked with the pharmaceutical industry to ensure that planes are contracted to bring in medical radioisotopes under the appropriate specialist conditions.

Making changes to, or clarifications of, certain regulatory requirements so that companies can continue to sell their products in the UK even if we have no deal. The MHRA has for this scenario consulted on, and published, further guidance on how medicines, medical devices and clinical trials will be regulated. This guidance can be found at: https://www.gov.uk/government/publications/further-guidance-note-on-the-regulation-of-medicines-medical-devices-and-clinical-trials-if-theres-no-brexit-deal.

In August, the Government also published a dedicated technical notice on the unilateral recognition of batch testing of medicines, if there is no deal. This can be found at:

https://www.gov.uk/government/publications/batch-testing-medicines-if-theres-no-brexit-deal.

Strengthening the processes and resources used to deal with shortages. My Department has put in place legislation to enable Ministers to issue serious shortage protocols that, where appropriate, enable community pharmacies to supply against a protocol instead of a prescription without going back to the prescriber first. We are working closely with the DAs to ensure a common approach across the UK.

This multi-layered approach is essential: A combination of securing freight, buffer stocks, stockpiling and warehousing, and regulatory requirements, will be needed to help ensure the continuation of medicines and medical supplies in the event of a no-deal exit.

Local stockpiling is unnecessary and could cause shortages in other areas, which could put patient care at risk. It is important that patients order their repeat prescriptions as normal and keep taking their medicines as normal.

[HCWS1358]

Oral Answers to Questions

Stephen Hammond Excerpts

Tuesday 19th February 2019 Commons Chamber

[Gavin Newlands (Paisley and Renfrewshire North) (SNP)]

11. What steps he is taking to ensure a sustainable workforce in the health and social care sector.

[The Minister for Health (Stephen Hammond)]

The long-term plan explicitly recognises the importance of the workforce, and my right hon. Friend the Secretary of State has commissioned the chair of NHS Improvement to work closely with the chair of Health Education England in leading detailed work programmes to deliver an implementation plan. Social care plays a vital role in the forthcoming adult social care Green Paper, in which we will set out our plans to recruit, train and retain good people.

[Gavin Newlands]

The Minister is right about the workforce challenge for all four health services in the UK, but the number of students in England taking nursing degree courses in the past two years has dropped by 900; and at over 11%, NHS England’s nursing vacancy rate is more than twice that in Scotland. With a 90% drop in the number of EU nurses coming to the UK because of Brexit and fewer students starting degree courses because of the cost, is it not time to follow Scotland by reintroducing the nursing bursary and ending tuition fees?

[Stephen Hammond]

I am sure the hon. Gentleman will want to recognise the latest UCAS data for this year’s application cycle, which shows that, compared to the same time last year, there has been a 4.5% increase in the number of applicants for undergraduate nursing and midwifery courses. This is a significant improvement. He will also want to recognise that the loans system provides an extra £1,000. [Interruption.]

[Mr Speaker]

Order. Mr Luke Graham, calm yourself. You aspire to statesmanship, and I wish to cultivate and hone that legitimate aspiration—calm, Zen, statesmanship!

[Derek Thomas (St Ives) (Con)]

On Friday, I was privileged to take part in the launch of the health and social care academy in Cornwall. Cornwall NHS and social care providers have come together to train local students, including mature students, within the local health and social care provision without student tuition fees so that they can secure a job in Cornwall. May I invite the Minister to come and see the work we are doing and welcome this local innovation that is helping to address the NHS workforce challenge?

[Stephen Hammond]

My hon. Friend rightly points out that there are several routes into healthcare professions, and I am delighted by what is happening in Cornwall. I understand that my right hon. Friend the Secretary of State will be visiting him in the very near future.

[Justin Madders (Ellesmere Port and Neston) (Lab)]

We are in the midst of the worst-ever NHS workforce crisis, with more than 100,000 vacancies. The situation is unsustainable. Well-respected think-tanks say the figure could rise to 350,000 vacancies within a decade. What does the Minister consider a sustainable vacancy level both now and in a decade’s time?

[Stephen Hammond]

The hon. Gentleman will recognise that the £20.5 billion in real terms that we are investing in the NHS under the long-term plan will make a significant difference. He will also want to recognise the roll-out of medical places, the fact that more people are applying for nursing places now than they were last year and the detailed implementation plans that my right hon. Friend the Secretary of State has commissioned. These will deliver a sustainable workforce.

--- Later in debate ---

[Robert Halfon (Harlow) (Con)]

14. What plans he has to allocate additional funding to NHS hospitals to replace revenue raised by car parking charges.

[The Minister for Health (Stephen Hammond)]

My right hon. Friend is aware of—and, indeed, welcomes— the Government’s commitment to providing an extra £20.5 billion in real terms for patient care over the next five years. Car parking charges are a matter for local NHS organisations, but most hospitals give concessions to some groups of users, such as patients who need extended or frequent access to hospitals.

[Robert Halfon]

Last year, the brain injury charity Headway said that it had paid a family £374 for hospital car parking charges. These charges are unacceptable. They are a stealth tax on patients, a stealth tax on the vulnerable and a stealth tax on staff. Will my hon. Friend scrap them once and for all?

[Stephen Hammond]

I commend my right hon. Friend for being a tireless campaigner on this matter. We have always made clear that staff, patients and their families should not have to deal with the stress of complex and unfair charges, and we introduced tougher guidelines in 2014, but I must stress that this is a local matter.

[Tommy Sheppard (Edinburgh East) (SNP)]

T1. If he will make a statement on his departmental responsibilities.

--- Later in debate ---

[Tom Tugendhat (Tonbridge and Malling) (Con)]

T8. Mr Speaker, you will be aware of the fantastic work by the Edenbridge War Memorial Hospital in the town just near me, and you will also be aware of the fantastic news that we are having a new clinic built there. Does my hon. Friend the Minister agree that the money from the initial site, which was given by public subscription 100 years ago in memory of the young men who died in the first world war, should now be spent on medical facilities in the town?

[The Minister for Health (Stephen Hammond)]

My hon. Friend has been absolutely passionate about securing the best possible outcome for his constituents. As he knows, the Edenbridge War Memorial Hospital is held by NHS Property Services on behalf of my right hon. Friend the Secretary of State. Local NHS bodies in Kent are considering the future of services in the Sevenoaks area, including their nature and possible funding. I am sure that my hon. Friend will recognise that I cannot intervene directly, but I would be happy to meet him to discuss this further.

[Stephen Timms (East Ham) (Lab)]

T9. The Central and East London breast screening service was performing well until last April, when it was transferred from Barts Health NHS Trust to the Royal Free London NHS Foundation Trust, even though the Royal Free and did not have enough staff. The number of women invited plummeted from 3,000 a month to 1,000 a month. Why was that transfer allowed to go ahead, given the clear warnings about what the consequences would be? Who is responsible for this failure?

--- Later in debate ---

[Stephen Hammond]

I pay tribute to the hon. Lady for her courageous campaigning on this issue. There have been several reports looking into the events at the trust, and we understand that further detail would be helpful to realising her wish that those in senior positions be held accountable. I hope she agrees that the Kirkup report has provided the basis for that, and I am happy to meet her to discuss how the matter may be advanced.

[Ben Bradley (Mansfield) (Con)]

We all want a pipeline of talented staff entering our NHS. In many areas, the health service is a key local employer. Would the Minister welcome proposals for a specialist school in Mansfield, run in conjunction with our hospital trust, to ensure that we equip young people with skills and an aspiration to join our health service? May I meet him to discuss the matter further?

[Stephen Hammond]

My hon. Friend will have heard the answer that my right hon. Friend the Secretary of State gave about missed appointments, and I would be happy to meet my hon. Friend to discuss the situation in Mansfield. We encourage everybody to use technology to ensure that cancelled appointments are used for the benefit of others.

[Stephen Morgan (Portsmouth South) (Lab)]

Mental health services need proper staffing, but 2,000 mental health staff are leaving the NHS every month. How do the Government expect to achieve any ambitions in the long-term plan without adequate staff?

NHS 10-Year Plan

Stephen Hammond Excerpts

Tuesday 19th February 2019 Commons Chamber

[The Minister for Health (Stephen Hammond)]

I beg to move,

That this House has considered the NHS Ten Year Plan.

Thank you, Madam Deputy Speaker. You will understand that I am pleased not to have to follow my predecessor’s responsibilities.

As last year’s 70th anniversary celebrations proved, the NHS is one of this country’s proudest achievements. That is clear from the number of people who want to contribute to the debate this evening, so I shall be as brief as I possibly can. The Government’s top funding priority is the NHS. By 2023-24, the NHS budget will increase by £33.9 billion in cash terms, which is the equivalent of £20.5 billion in real terms. This means that in five years’ time the total NHS budget will be £148.5 billion.

In January this year, the NHS published the long-term plan, which sets out the priorities for the next 10 years of the service. The additional funding has given the NHS the stability and certainty it needs to make that plan for the decade ahead. The plan represents a historic moment for patients across the country. It was developed by NHS leaders and clinicians, in consultation with patients and the public, and Members can be assured that it focuses on the biggest priorities for patients in the next decade.

[John Redwood (Wokingham) (Con)]

Will the plan ensure that areas such as mine, which has fast growth and lots of new housing, will receive adequate resources to put in new surgeries and additional capacity, which has not happened in the past?

[Stephen Hammond]

My right hon. Friend will note that the plan includes the transformation that we will bring to primary care, which will look not only at how primary care will be developed and delivered, but at ensuring that there is enough money to deliver the changes.

The plan sets out a scheme that will provide the best support for patients throughout their lives—from getting the best start in life to being supported into old age. The plan sets out the transformation needed at every level of the health system to ensure that it can continue to provide world-class care. Part of that, as I have just said to my right hon. Friend, is a fundamental shift towards primary care and prevention. The plan will keep people healthy and out of hospital by boosting services closer to home.

--- Later in debate ---

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

Very good question.

[Stephen Hammond]

I am sure that there will be a number of excellent questions and interventions, but it was a good question. The plan sets out that all local health systems will be expected to outline this year how they will reduce health inequalities by 2023-24, and the intention is that that process will consider exactly the health inequalities that the hon. Member for Sheffield, Heeley (Louise Haigh) mentions.

Additional money for the primary sector will ensure that funding for primary medical and community health services, such as GPs, nurses and physiotherapists, increases by £4.5 billion in real terms in the next five years. That will mean up to 20,000 extra health professionals working in GP practices, with more trained social prescribing link workers within primary care networks. By 2021, all patients will be offered a digital-first option when accessing primary care. The plan also considers the future of the health system, and the new proposals for integration are the deepest and most sophisticated ever proposed by the NHS.

[Dr Dan Poulter (Central Suffolk and North Ipswich) (Con)]

The plan recognises that some proposals in the Health and Social Care Act 2012 were made in error when it comes to the transference of powers to public health bodies and local authorities. However, based on my reading of the plan, the omission from that list relates to addiction services. If we are serious about mental health and about improving care and reducing health inequalities in areas such as Sheffield, which was just mentioned, we need to get the commissioning of addiction services right and transfer that back to the NHS. Such services deal with some of the most vulnerable patients, but they are underfunded and failing to treat people, and the taxpayer is paying the price. Patients badly need those services, so will my hon. Friend take the matter up and give it a push?

[Stephen Hammond]

My hon. Friend makes a good point and urges me to take up the issue, which I will. He is obviously an expert in this field and will know that the Government have asked the NHS to come forward with proposals for legislative reform to support the long-term plan’s ambitions, and I will reflect on his comments in my thinking.

By 2021, every part of the country will be covered by integrated care systems, which will bring together local organisations, including local authorities, to redesign care and improve population health. They will become the driving force for co-ordination and integration across primary and secondary care. Any claim that such reforms might lead to privatisation are misleading. In fact, the Chair of the Health and Social Care Committee said that the proposals

“will not extend the scope of NHS privatisation and may effectively do the opposite”.

The NHS will invest more in preventing ill health and stopping health problems getting worse. That includes offering tobacco treatment services to all in-patients and pregnant women who smoke, establishing new alcohol care teams, and offering preventive treatments to more people with high blood pressure and other risk factors for heart disease.

[Sir Paul Beresford (Mole Valley) (Con)]

As my hon. Friend is probably aware, I have a part-time job in which I deal with a preventable disease: caries. In dentistry we spend £34 million to £38 million on this preventable disease. Will he consider looking seriously at how we could persuade local authorities to put fluoride in the water supply to prevent caries?

[Stephen Hammond]

My hon. Friend will know that the plan has much on prevention in primary care and public health. I offer to meet him, and I will listen carefully. He tempts me down a line that I would rather not go down tonight.

The long-term plan marks a huge step towards parity of esteem between mental and physical health. In the next five years, the budget for mental health services will increase by at least £2.3 billion in real terms. This additional funding will be used to fund a major expansion of mental health services for both children and adults. In addition to piloting four-week waits for children and young people, we will test waiting times for adult and older adult community mental health teams, and clear standards will then be set. Specific waiting times for emergency mental health services will take effect for the first time from 2020 and will be set to align with the equivalent targets for emergency physical health services.

[Layla Moran (Oxford West and Abingdon) (LD)]

The mental health budget is 10.2% of the current NHS budget. If the overall budget increases, will there be an equivalent rise in the mental health budget? The mental health budget has risen because the overall budget has increased, but the proportion allocated to mental health has not risen. If we are serious about tackling mental health in this country, why is the proportion allocated to mental health not higher?

[Stephen Hammond]

The hon. Lady will know that, as I said a moment ago, the long-term plan, for the first time, sets a parity between mental health and physical health. The mental health budget will increase by £2.3 billion by 2023-24.

Of course, everything we have been talking about here needs to be supported by new innovations and new technology. Patients can expect a radical reshaping of how the NHS delivers its healthcare using technology, so that services and users can benefit from the opportunities of advances in digital technologies. That includes making care safer, enabling earlier diagnosis and giving more independence to those managing different health conditions.

Additionally, it is vital that we build a more innovative NHS, which will help patients to be among the first in the world to benefit from life-changing new technologies. Last year, the Secretary of State announced his ambition to sequence 5 million genomes in the next five years, making the NHS the first national healthcare system to offer whole genome sequencing as part of routine care.

Most importantly, none of that will be possible without dedicated staff who are properly trained and supported throughout their career. The long-term plan sets out a strategic framework to ensure that, over the next 10 years, the NHS will have the staff it needs to ensure that the detailed plan can be implemented. Baroness Harding is leading an inclusive programme of work to set out a detailed workforce implementation plan, which will be published in the spring, but the plan is not about numbers.

[Vicky Ford (Chelmsford) (Con)]

On the future workforce, I thank the Government for investing in our new medical schools. We are enormously proud of the new medical school in Chelmsford, which is training 100 doctors a year—I understand it is 12 times oversubscribed for next year. I am also pleased to hear that nursing numbers are up, but what will the Government do to target support at areas such as mental health nursing and adult nursing, where we have seen numbers drop?

[Stephen Hammond]

My hon. Friend is right that we need targeted support, which is why we have looked not only at increasing the recruitment of nurses but at the retention packages that might be offered, particularly for certain specialties—she mentioned mental health nurses. We have looked at the possibility of issuing golden hellos, and we have looked at targeted support for childcare and travel.

[Mr Philip Dunne (Ludlow) (Con)]

My hon. Friend has been generous in giving way. I welcome the workforce implementation plan, and I welcome the fact that Baroness Harding, the chair of NHS Improvement, will be taking this work forward. Will my hon. Friend ensure that Baroness Harding looks at the retention of senior, experienced general practitioners under the general practice forward view? That issue has been raised in a number of areas. We are losing too many of them too early in their career, and the situation is similar with experienced consultants in our hospitals. A contributing factor is the annual allowance for pension contributions, where tax payments take away the extra gross income staff receive as they progress through their later years. Will my hon. Friend pick that up with the Treasury?

[Stephen Hammond]

I have listened carefully to my right hon. Friend’s intervention, and he will be pleased to know that discussions with the Treasury are ongoing about certain potential incentives to senior serving staff.

The plan is not just about numbers; it focuses on getting the right people with the right skills in the right place, ensuring that our dedicated staff are supported, valued and empowered to do their best. It has clear commitments to tackle bullying, discrimination and violence, and a programme of work to sustain the physical and mental health of staff who work under pressure every day and every night.

[Grahame Morris (Easington) (Lab)]

All good policies should be evidence-based, so let me ask the Minister about the national cancer advisory group, which prepares an annual report detailing the progress of the cancer strategy each year. That report was expected in October/November but it has been delayed. When will it be published? It may well inform the work of the 10-year plan.

[Stephen Hammond]

The publication date has not yet been finalised. I understand that it will be soon, but I will write to the hon. Gentleman to confirm the date of publication.

Through the long-term plan, we will ensure that the NHS continues to strive to be a world leader. It will continue to push the boundaries between health and social care, and between prevention and cure. It will be at the cutting edge of technology and innovation, while providing high-quality service for all patients. More importantly, it will always be there in our hour of need, free at the point of use and based on clinical need, not on the ability to pay. I commend the long-term plan to the House.

NHS Funding: Essex

Stephen Hammond Excerpts

Wednesday 13th February 2019 Westminster Hall

[The Minister for Health (Stephen Hammond)]

Sir Christopher, it is good to see you in your place and to take part in this important debate. I start, as I should, by congratulating my right hon. Friend the Member for Harlow (Robert Halfon) on securing another debate—his fourth—on this matter. He is well known for his tireless work on matters of healthcare in Harlow and across the whole of Essex. My right hon. Friend the Member for Witham (Priti Patel) described him a moment ago as a “warrior for Harlow”; I think that was in response to the compliment he paid her of being a “champion for Essex”. I listened to her speech and her earlier intervention, and I will say that, should she wish to, I would be delighted if she joined me in a debate next Tuesday on the 10-year plan.

My right hon. Friend the Member for Witham is of course right that this is an opportunity. We have set out a comprehensive plan, full of ambitions to link up healthcare, backed up by an implementation plan. I am hopeful, because this is the first time that has been seen. Layer on to that the integration of health and social care in the Green Paper, and I hope she will agree that those are steps forward.

My right hon. Friend the Member for Harlow has not only secured debates, but has had a number of meetings with my predecessor on a number of issues relating to the Princess Alexandra Hospital NHS Trust. I notice that today he welcomed the visit of my right hon. Friend the Secretary of State, who visited the trust two weeks ago. I know the Secretary of State was hugely impressed by the outstanding staff and the good work they do, and I have noted the kind invitation extended by my right hon. Friend the Member for Harlow to come to Harlow, which I accept; I look forward to coming later in the year.

On a number of occasions, my right hon. Friend has raised the proposal to build a new hospital, which demonstrates his commitment to what he and I both recognise as the most important issue in his constituency. The Government recognise that a number of trusts face estates challenges; that is why there is a commitment to upgrade the NHS estate, with £3.9 billion in capital investment for buildings and facilities by 2022-23. I will come on to the comprehensive spending review in a second.

I noted, of course, the interventions from other hon. Members. My hon. Friend the Member for Hertford and Stortford (Mr Prisk) made the point about Harlow’s importance to the wider health economy in Hertford and Stortford, and my hon. Friend the Member for Clacton (Giles Watling) reminded me that we must have the staff in the hospitals. The workforce section of the 10-year plan sets that out.

My right hon. Friend the Member for Harlow knows that the NHS’s buildings and services are being modernised and transformed through the sustainability and transformation fund investment. That money is going toward a range of programmes. I recognise that in July 2018 the trust put forward a revised bid for around £330 million, with potential for that to be funded through sustainability and transformation partnerships funding, private finance contributions and some land disposals.

I know that the bid was well supported and attracted a lot of careful attention but, as my right hon. Friend will recognise, there was strong competition from a range of schemes across the country; the fund was heavily over-subscribed and there was some rigorous prioritisation. I hope he will recognise that officials from both NHS England and NHS Improvement are working closely with the trust. They are supportive of the capital bid that has been put forward and are working with the trust on the programme to look at that bid for the future. They continue to develop the options to tackle the challenges that the people of Harlow and the wider economy face, and to secure that best outcome. I guarantee him that that work will continue, and that I will ensure that I take an interest in his scheme.

I know that my right hon. Friend will have recognised and welcomed a number of tranche 4 bids that did secure some money for the trust for additional bed capacity, improving emergency department performance and patient flow and reducing bed occupancy. That scheme represents a key part of the NHS trust’s plan to dramatically improve and transform the emergency care pathways. I acknowledge that that was not the scheme he wanted, but I hope he will recognise that it has been extremely helpful, and that the trust has made excellent use of that capital.

I know that my right hon. Friend will wish to acknowledge that there has also been wider recognition of bids from across Essex; there was money for Hertfordshire and West Essex in Luton, in the Hertfordshire and West Essex vascular surgery network and in West Hertfordshire hospitals. I hope he will agree that there is continued commitment from the Government to the NHS and to the patients in the wider region.

I will directly address the point that my right hon. Friend raised with the Chancellor of the Duchy of Lancaster. There will be further opportunities to access capital. As my right hon. Friend the Member for Witham pointed out, there will be a comprehensive spending review this year, in which we clearly have the chance to link up those things she mentioned; I entirely take her point on board. My right hon. Friend the Member for Harlow will recognise that the CSR will be when decisions on future capital allocations will be made for the next five years. The 2015 CSR first did that, and that has continued, and we expect it to happen in the next CSR. I assure my right hon. Friend that I have no doubt that the Chancellor of the Exchequer and the Chief Secretary to the Treasury will listen to his financial appeals for his constituents.

I hope that my right hon. Friend recognises the wave 1 and 2 capital funding secured during 2017-18 to support the redesign of the emergency department at the hospital. That was targeted very much at improving those facilities. I hope that he also recognises that that was on top of what I referred to earlier. I am sure he will support, as I do, the fact that that has gone into championing excellence in the paediatric emergency department.

My right hon. Friend mentioned the Harlow science hub and campus programme. Partly owing to his campaigning, there will be a new public health campus in Harlow, and I pay tribute to his efforts. I am pleased to say to him—as I am sure he knows—that that is still on schedule. A phased opening from 2021 will ultimately see approximately 2,700 people based there from 2024. Public Health England and the Princess Alexandra Hospital have discussed what other opportunities for Harlow’s wider health economy might arise from basing the campus there. I hope to be able to share with him more details on that in the near future.

I commend my right hon. Friend’s work in raising support for the Princess Alexandra Hospital NHS Trust’s bigger capital bid. I reassure him that there will be opportunities to access that capital in the spending review process in the latter part of this year. He challenged me on the timeline of that. As someone once closely associated with the former Chancellor, he will know that the Treasury does not easily give out its timelines. “Soon” or “this autumn” are probably appropriate answers to his inquiry.

On numerous occasions, my right hon. Friend has raised the estate issues facing the trust, in the House, in meetings with my predecessors and with the current Secretary of State. I look forward to accepting his invitation to continue working with him on this issue for the people of Harlow and for the NHS in Essex.

Question put and agreed to.

Kark Review

Stephen Hammond Excerpts

Wednesday 6th February 2019 Written Statements

[The Minister for Health (Stephen Hammond)]

On 23 May 2018, the House was informed that the Government had asked Tom Kark QC to carry out a review of the scope, operation and purpose of the fit and proper person requirement. Tom Kark has now completed his review having engaged on these issues with a range of interested parties, including the Care Quality Commission, NHS improvement, NHS England, and parliamentarians who had expressed an interest. We are today publishing his report on the review of the fit and proper person test as it applies to directors within the health services in England.

Our senior leaders are critical to the delivery of high quality and safe care in the NHS. We owe them our thanks and respect and we need to support them and ensure that they have the right skills and competencies to do these most challenging roles. The review underlines the importance of supporting the vast majority of NHS directors to do a good job and what more could be done in strengthening the leadership in the NHS.

Tom Kark has made seven recommendations and the Government accept in principle the recommendations to develop specified standards of competence that all directors who sit on the board of any health providing organisation should meet, and to create a central database of directors. We will consider all other recommendations including a mandatory reference requirement and a recommendation to introduce a power to disbar directors for serious misconduct. Tom Kark has also recommended that the fit and proper person test should be extended to clinical commissioning groups and appropriate arm’s length bodies.

It is important we consider this review alongside other proposals on leadership and development for NHS managers. I have therefore asked Baroness Harding to look at how best to implement these recommendations through the system wide workforce implementation process which she is chairing and which is set out in the NHS long term plan. We have asked Baroness Harding to consider a range of options and to ensure that she draws on the views of key partners.

I am keen to see the NHS open up to a diverse range of talented individuals from outside the NHS, beyond the traditional NHS background, and more with clinical backgrounds. Excellent NHS directors are vital to delivering a high standard of care and are committed to serving the needs of patients and service users. It is important that we focus on leadership and enhancing the strength of NHS managers as a profession, while dealing appropriately with the small minority of directors whose conduct raises concerns about their suitability for their post.

I would like to thank Tom Kark and his team for their work in delivering this important report.

A copy of the report has been deposited in the Library of both Houses.

[HCWS1301]

Leaving the EU: Reciprocal Healthcare Legislation

Stephen Hammond Excerpts

Wednesday 6th February 2019 Written Statements

[The Minister for Health (Stephen Hammond)]

Current European Union (EU) reciprocal healthcare arrangements enable UK nationals¹ to access healthcare when they live, study, work, or travel in the EU and vice versa for EU citizens² when in the UK. They give people retiring abroad more security; they support tourism and businesses and facilitate healthcare co-operation.

These arrangements ensure that UK nationals living and working in the EU, European Economic Area (EEA) and Switzerland can access healthcare in exchange for paying taxes and social security contributions. The UK also funds healthcare abroad for a number of current or former UK residents. This includes healthcare for UK state pensioners who spend their retirement in the EU and needs arising healthcare when UK residents visit the EU for holiday or study through the European healthcare insurance card (EHIC) scheme.

The Government’s priority is to secure a withdrawal agreement with the EU. However, as a responsible Government, we are preparing for all eventualities, including the possibility the UK leaves the EU without a deal. If necessary, the UK would like to make arrangements with individual EU member states to ensure that there are no immediate changes to people’s access to healthcare after exit day and that there is a strong basis for ongoing co-operation on health issues. The UK is therefore seeking to maintain reciprocal healthcare rights for pensioners, workers, students, tourists and other visitors in line with the current EU arrangements, including reimbursement of healthcare costs, for a transitional period lasting until 31 December 2020. This is only possible with agreement from other member states and we have commenced discussions on this issue.

The Healthcare (International Arrangements) Bill (the Bill) is being brought forward as a result of the UK’s exit from the EU; however, it is forward-facing and not intended to deal only with EU exit. The Bill is intended to support the implementation of comprehensive reciprocal healthcare arrangements with countries both within and outside the EU to enable possible future partnerships.

The Bill can be used to implement complex bilateral arrangements with a member state that may differ to current EU arrangements, or to make unilateral arrangements to assist UK nationals to access healthcare abroad in exceptional circumstances and in the interests of patient safety. The Bill also provides the legal basis to fund and process data relating to healthcare outside of the United Kingdom.

The European Union (Withdrawal) Act 2018 will convert EU law as it stands on exit day into UK domestic law and preserve the laws made in the UK to implement EU obligations. This means that EU regulations providing for EU reciprocal healthcare arrangements will become part of the UK’s statute book on exit day. Without further legislation, in a no-deal scenario the regulations would not be coherent or workable without reciprocity from member states. Therefore, on 7 February, the Government will bring forward two statutory instruments under section 8 of the European Union (Withdrawal) Act 2018, to prevent, remedy or mitigate deficiencies in retained EU law relating to reciprocal healthcare.

These instruments also afford the UK an additional mechanism for ensuring there is no interruption to healthcare arrangements for UK nationals³ after exit day in those member states who agree to maintain the current arrangements for a transitional period. Through these instruments, the UK can transitionally maintain current EU reciprocal healthcare arrangements for countries where we have established reciprocity during an interim period lasting until 31 December 2020 and no later. The arrangements would not apply to member states who do not agree to maintain the current reciprocal arrangements with us.

Together with the Bill, these instruments are focused on supporting a smooth transition as we exit the EU. Both of these legislative vehicles are necessary to ensure the UK Government are ready to deal with reciprocal and cross-border healthcare in any scenario. They afford the UK Government flexibility of action and ensure the UK is able to respond quickly to protect people’s healthcare.

The Bill and the forthcoming statutory instruments are intended to support further preparations the UK Government are making with regard to reciprocal healthcare arrangements. The Government have issued advice via the Government and NHS websites to UK nationals living in the EU, to UK residents travelling to the EU and to EU nationals living in the UK. This advice explains how the UK is working to maintain reciprocal healthcare arrangements, but that their continuation depends on decisions by member states. It sets out what options people might have to access healthcare under local laws in the member state they live in if we do not have bilateral arrangements in place, and what people can do to prepare. Our advice to people travelling abroad after exit day is to purchase travel insurance, as we already recommend now. These webpages will be updated as more information becomes available.

The Bill and the statutory instruments feed into a broader body of work by the Department of Health and Social Care and across the UK Government, to ensure health and social care systems are well prepared as we exit the EU.

¹ This is a short-hand term for persons who are the responsibility of the UK. They may or may not be UK nationals.

² This is a short-hand term for EU27/EEA/Swiss-insured individuals i.e. persons who are the responsibility of an EU or EEA member state or Switzerland.

³ Please see footnote 1.

[HCWS1304]

Draft European Qualifications (Health and Social Care Professions) (Amendment etc.) (EU Exit) Regulations 2018 Draft European Qualifications (Pharmacists) (Amendment etc.) (EU Exit) Regulations (Northern Ireland) 2018

Stephen Hammond Excerpts

Tuesday 29th January 2019 General Committees

[The Minister for Health (Stephen Hammond)]

I beg to move,

That the Committee has considered the draft European Qualifications (Health and Social Care Professions) (Amendment etc.) (EU Exit) Regulations 2018.

[The Chair]

With this it will be convenient to consider the draft European Qualifications (Pharmacists) (Amendment etc.) (EU Exit) Regulations (Northern Ireland) 2018.

[Stephen Hammond]

It is a great pleasure to see you in the Chair, Mr Howarth.

The draft regulations aim to ensure continuity in the recognition of European economic area and Swiss health and care professional qualifications in the United Kingdom in a no-deal European exit scenario. The statutory instrument relating to Northern Ireland, which has been introduced here because the Northern Ireland Assembly is suspended, ensures that the approach to recognising health and care professional qualifications is consistent throughout the United Kingdom.

European health and care professionals make a major contribution to the national health service and the wider health and care system. Since 1997, more than 100,000 EEA and Swiss-qualified health and care professionals have applied to have their qualifications recognised in the United Kingdom, and more than 77,000 of them have been dentists, doctors, midwives, nurses and pharmacists. The Government have been clear that European health and care professionals will continue to be welcome after the UK leaves the EU, and the statutory instruments are part of ensuring that.

Arrangements for the recognition of professional qualifications within the EU is provided for by the directive on the recognition of professional qualifications, which will cease to apply if the UK leaves the EU without a deal. Changes to the domestic legislation that implements the directive are therefore needed to ensure that recognition of those EEA and Swiss qualifications can continue after EU exit, in the case of no deal. The directive provides for mutual recognition of EEA and Swiss professional qualifications within the EU and makes provision for harmonised education and training standards in seven professions, five of which are in health—doctors, dentists, nurses, midwives and pharmacists. The directive allows for recognition of listed qualifications that meet the harmonised education and training standards and provides for recognition under a general system for qualifications that do not meet those harmonised requirements. The directive also covers Switzerland and EEA nations.

It is worth noting, as I have said, that the UK has been a major beneficiary of the arrangements under the directive. Since 1997, the UK has recognised 77,000 EU qualifications in the automatically recognised professions. In contrast, fewer than 7,000 UK qualifications have been recognised in other EU states. The directive has helped with the recruitment of skilled professionals to the UK’s health and care sector and it is important that the arrangements that allow for continued recognition of health and care professional qualifications are in place if the UK leaves the EU in a no-deal scenario.

The two instruments that we are debating have three main effects. First, they put in place arrangements for the recognition of those EEA and Swiss professional qualifications that are currently recognised and provide for the continuation of recognition arrangements for those qualifications that are covered by the general system. Secondly, they ensure that applications for recognition that are ongoing at exit day can be completed under the current legal arrangements and, finally, they remove a number of provisions that would not be appropriate to maintain in the event of a no-deal Brexit.

I will set out the changes in a little more detail. The instruments put in place new arrangements for the recognition of professional qualifications that are currently automatically recognised. Such qualifications will become recognised overseas qualifications, or “relevant European qualifications” in the case of pharmacist qualifications in Northern Ireland. As such, they will continue to be recognised without additional testing, other than the checks for an applicant’s language skills and on whether there are concerns about their fitness to practise.

The regulations give UK regulators a new power to designate a qualification that is currently recognised automatically.

[Vernon Coaker (Gedling) (Lab)]

The Minister has just announced a major change, in that a UK regulator would determine whether qualifications were acceptable. Who sets the criteria for the regulator to determine that?

[Stephen Hammond]

I have said two things: that there will be new arrangements, so that professional qualifications that are currently automatically recognised will continue to be recognised without additional testing, other than checks for language; and that the regulations give powers to designate a qualification that is currently recognised. As yet, I have not said that there will be a new designation system.

[Vernon Coaker]

My understanding is that the regulator will determine whether a qualification is regarded as comparable. Is that the case? If so, who determines the criteria on which the regulator will make that decision?

[Stephen Hammond]

I will come to that a little later, if I may. The hon. Gentleman is right that we need to come on to that point, because some qualifications will be comparable and we need to ensure that the right regulatory system is in place.

As I was saying, designating a qualification will allow UK regulators to stop the automatic qualification, which is not possible under the directive. That is an important additional measure, which will enhance public protection. Such designation will be subject to Privy Council consent, or the agreement of the Department of Health in Northern Ireland in relation to pharmacists’ qualifications there.

The Secretary of State for Health and Social Care will review the arrangement for the continued recognition of automatic qualifications no later than two years after the regulations come into force. The review clause is important because it means that the arrangements put in place by the regulations will not remain indefinitely. It would be reasonable for hon. Members to ask what the review will cover. In short, it will cover whether it is appropriate for the near-automatic recognition of European qualifications to continue. It would not be right for me to predict what key factors there might be at that point in two years’ time, but I guess that hon. Members will make a judgement about which factors ought to be included in the review.

[Vernon Coaker]

The point I am trying to make is about the difference between automatic acceptance and the regulator determining that certain qualifications are not acceptable. I am trying to tease out from the Minister how that difference will be determined, between automatically accepted qualifications and those that are regarded as non-comparable. Who sets those criteria? That is the question for the Minister.

[Stephen Hammond]

It is the question. There is a system currently in place, as the hon. Gentleman knows, in which the regulator has powers to automatically accept qualifications. There is also a system in place for professionals from outside the EU and the EEA, which looks at regulatory qualifications and ensures that they comply with UK standards, which, at the moment, is the EU directive. Therefore, there is already a regulatory system for non-EU/EEA/Swiss citizens that sets those standards. If we were considering different standards to the current automatic recognition, it would be appropriate to use that process of regulation to give the regulator his authority to decide whether a qualification was acceptable. I hope that answers the hon. Gentleman’s question.

What I can say about the two-year review period is that it is important to have a widespread and encompassing review of the arrangements for recognition of all international healthcare. That will ensure that the process of recognising all the qualifications is effective and proportionate. If and when the arrangements for the recognition of relevant EEA and Swiss qualifications come to an end, a parliamentary review to determine the time when that happens will be appropriate.

The regulations, as I hope I explained in more detail in answer to the hon. Gentleman’s question, enable qualifications that are not covered by the automatic system to be considered by the relevant UK regulator and compared with the equivalent UK qualifications standard, as currently happens. They allow applications made before exit date to be concluded under the current arrangements, as far as practically possible. They allow individuals practising under temporary and occasional status, or under the EU professional card, to continue to do so until such registration expires.

The regulations also remove obligations and administrative arrangements that will no longer apply to UK domestic regulators when the UK leaves the EU. Those changes include the removal of provisions relating to cross-border temporary provision of services, which currently allow professionals in a member state to practise in another member state on a temporary and occasional basis without having to register fully; the removal of the requirement to share information through the European Commission’s internal market information system, to which UK regulators will no longer have access; and the ending of arrangements that allow professionals to practise in the EU using the European professional card. That card is underpinned by European Commission systems that will no longer be available to UK regulators.

Finally, the regulations remove the requirement on UK regulators to set professional education and training standards that comply with the standards set out in the directive. That will provide UK regulators with greater flexibility to set education and training standards that meet the needs of the UK’s health and care professions.

In conclusion, the regulations put in place a system for the recognition of EEA and Swiss health and care professionals if the UK exits the EU without a deal. They also ensure that applications that are in progress at exit day will be concluded under current arrangements as far as practically possible.

As I said at the outset, the UK places enormous value on the contribution of the EEA and Swiss-qualified professionals who work in the UK health and care sector. The regulations will facilitate the continued recognition of EEA and Swiss professional qualifications after the UK leaves the EU. I look forward to hearing the contributions of other hon. Members. The effect of the regulations is to ensure continuity of recognition of qualifications in the event of a non-deal EU exit.

--- Later in debate ---

[Vernon Coaker]

It is a pleasure to serve under your chairmanship, Mr Howarth. I wish to reinforce a couple of important points made by my hon. Friend the Member for Ellesmere Port and Neston from the Front Bench in his excellent contribution.

The hon. Member for Linlithgow and East Falkirk, who speaks for the SNP, talked about this, but these SIs are incredibly important. Tucked away in these regulations are all sorts of policy changes that will have huge implications for our constituents and our country. I want to mention a couple. Hon. Members might not have read all these regulations—I have not read all of the pages, but I have read some—but if, in a few weeks’ or a few months’ time, a no deal happens, we will have people coming to our constituency offices asking what has happened to change their working arrangements in this country. We will have to say, “We’re not quite sure; we’ll go back and have a look and see where that happened.” And it will have happened in Committees such as this.

I say this as an aside—I know that we have all said it—but one of the problems with SIs is that we cannot amend them. Let me give one example. My hon. Friend the Member for Ellesmere Port and Neston mentioned this, but one really significant change tucked away in these regulations is the removal of the right of EU and Swiss nationals who are working here on a temporary or occasional basis to do so. My hon. Friend set out how many people that covers. What will we say when a Swiss or EEA national turns up at our surgeries and says, “I am working here on an occasional or temporary basis”—or says that they wish to do so—“and my local hospital needs me”? The figures are there: 42 General Medical Council registrants, 88 other professionals, and so on. If one of those people comes to us and says, “I am no longer able to work here,” it will be this Committee that agreed that regulation.

I agree with my hon. Friend that we will not vote this measure, but why on earth is the Minister doing this? Why on earth are we saying to EEA and Swiss nationals who are working here on an occasional or temporary basis that they cannot do so?

[Stephen Hammond]

rose—

[Vernon Coaker]

I will of course give way to the Minister, but the House of Lords Select Committee raised that point, so is he going to tell me that that has been changed?

[Stephen Hammond]

The hon. Gentleman is raising a number of serious and important points, as did the Opposition Front-Bench spokesperson—he was right to do so, and I will answer those points. However, the hon. Gentleman will be aware that at the moment the number of social and healthcare professionals working under the regime that he is describing is fewer than 160. Does he not agree that if people wish to work, or to continue to work, on a temporary or occasional basis, it might be more sensible, in the interests of public safety, for them to seek full registration? We are talking about a very small number. Surely full registration is the way forward.

[Vernon Coaker]

The implication of what the Minister has just said is that those people have been working in the NHS at the present time with sub-standard qualifications.

[Stephen Hammond]

indicated dissent.

[Vernon Coaker]

That is exactly the implication of what the Minister has just said.

[Stephen Hammond]

It is not. The hon. Gentleman was citing the example of someone who wanted to work here on a more permanent basis and to use that regime to achieve that. If someone wishes to work under that regime, would it not be sensible to have full UK regulatory recognition?

[Vernon Coaker]

The Minister will give his answer, but this question has been raised by NHS professionals and by the cross-party House of Lords Select Committee that looks into these matters. Indeed, that Committee specifically said that the Minister should be questioned about the change, because it has serious concerns about the detriment to the NHS from removing the right of those people to work in this country under the occasional and temporary arrangements. The Minister may say it is only a small number, but if there is a no-deal scenario, let us see whether that small number start appearing at our surgeries and whether we have to explain why the current arrangements no longer apply.

I think the change is unnecessary. The system works very well now and allows people to move backwards and forwards. As my hon. Friend the Member for Ellesmere Port and Neston pointed out, this is a reciprocal arrangement. People from this country benefit from exactly the same arrangements when they go to other countries across Europe. It will be interesting to hear the Minister’s answer to my hon. Friend’s question about what he expects the reciprocal arrangements to be and how other European countries will respond to our doctors, nurses and other healthcare professionals seeking to broaden and extend their experience by working in other countries in Europe.

The Minister started to answer my earlier questions about qualifications that are not regarded as comparable. In his response to the House of Lords Committee, he said it would be a matter to be determined by the regulator. My hon. Friend has already raised this point, but given that different regulators will determine which qualifications are not comparable, will they all have different criteria? How on earth will there be any consistency? The bureaucracy will be enormous. What are the costs of that? What will the staffing arrangements be? Again, the House of Lords Committee, in response to what the Minister said, raised serious concerns about how that will be done. My hon. Friend is right: the Minister needs to lay out more clearly how he believes the NHS will not be detrimentally affected by the changes introduced by these regulations, should that be necessary in a no-deal scenario, given the numbers he pointed to—3,200 people being automatically registered and 1,500 being registered under the general system. Will the Minister also confirm, as I think he said earlier, that the language tests will remain exactly the same?

My final point refers to Northern Ireland. It is a general point for the Minister to take away and one that he should perhaps ask the Secretary of State to discuss in Cabinet. There is no Assembly in Northern Ireland. The explanatory memorandum says that, under the legislation passed by this House, the Government talk with officials in Northern Ireland to determine whether these or other regulations are acceptable. Without getting into the arguments about why that is occurring or not, the democratic deficit is quite significant. I wonder whether there might be a better, more informative way of proceeding than just to include a few lines saying, “We’ve consulted with Northern Ireland officials about whether these regulations will apply appropriately in Northern Ireland,” given the responsibility on us all, in the absence of a Northern Ireland legislature, to consider the impact of regulations on that part of the United Kingdom in a more appropriate way.

These are significant changes. The Minister says that a small number of people will be affected, but those receiving treatment from someone who will no longer be able to register under the temporary or occasional scheme will be asking how this Parliament passed legislation that is potentially detrimental to their healthcare. That is not the Minister’s intention, but these are appropriate questions for this Committee and the House to ask the Minister as we move into the unknown.

[Stephen Hammond]

I would like to reassure hon. Members that, while it is essential to the public’s protection that we put in place this legislation, I recognise that a number of important and significant issues have been raised. I also recognise the potential impact on patients and citizens of the whole of the United Kingdom of not getting this right. There have been a lot of questions, which I shall try to address in some sort of order, perhaps lumping together some of the points put to me.

Initially there was a lot of talk about the impact on the numbers. From the overall number of EU, EEA and Swiss health and care professionals practising in the United Kingdom, the number working in NHS trusts in England increased by over 3,500 in the 12 months following the referendum. That includes an extra 600 doctors. As of June 2017, over 21,000 EEA doctors were registered with a licence to practise with the GMC. The number of joiners from the EEA has remained steady since 2016; therefore, these regulations would allow that to continue. The hon. Members for Ellesmere Port and Neston and for Gedling might like to point out that there has clearly been a decline in registered nurses. That is a significant concern to the Department, and we have looked not only at the number of current vacancies resulting from EU nationals not coming forward but, as importantly, at the need to train, recruit and retain UK nurses, which is why there are a number of routes into nursing.

There are language issues. One reason for the nursing staff shortage in respect of EEA applications is down to the language controls introduced by the NMC, which took full effect in July 2016. Although some people might concentrate on the referendum as the contributory factor, the language testing is also judged to have had an impact. Therefore, since November 2017 the NMC has introduced a number of changes to the language requirements for nurses and midwives trained outside the UK, which has increased the options available to such applicants to demonstrate their language ability. The changes appear to be having a positive effect on international recruitment, with 2,500 more overseas joiners to the register between January and December 2018.

The hon. Member for Gedling asked about a slightly different language issue. I will confirm this in writing, but it is my understanding that we do not intend to change the language tests.

The temporary permissions argument is clearly of concern, and I have tried to address the hon. Gentleman’s questions about that. The numbers currently working under the regime are relatively small; however, that does not mean that they do not have a positive impact. It is right that under a new regulatory system people should seek full registration. However, over the EU exit day period and the period post that, the regime will continue. As temporary and occasional permissions last for up to 18 months, there will be plenty of time for those working under the regime to decide to apply for full registration.

The hon. Member for Ellesmere Port and Neston asked about the impact on UK professionals wishing to practise in the EU after exit day. I said in my opening remarks that it is the UK that is the main beneficiary of mutual recognitions. After exit day, professional qualifications awarded in the UK will no longer be covered by the directive, and the EU has agreed that holders of UK qualifications who have been registered in EEA countries and Switzerland will continue to be registered. However, in the absence of an agreement with the EU, recognition of UK qualifications after exit day will be determined by the national policy of the individual member state.

The hon. Gentleman and I have discussed reciprocal international healthcare arrangements on several occasions, both on the Floor of the House and in Committee, and he will recognise that the Government hope that a widespread and encompassing international healthcare reciprocal agreement will be in place with the whole EU after exit day—that is our ambition. In the event of a deal, during the implementation period the current arrangements will pertain and we can look to put in place such a treaty.

[Justin Madders]

Will the Minister give way?

[Stephen Hammond]

One moment, and then I will. As the hon. Gentleman rightly knows, in the event of a no-deal EU exit—which is a lot of what we are talking about this morning—it is the Government’s ambition first to put memorandums of understanding in place and then hopefully to have a widespread agreement with the whole EU or, if not, individual arrangements with member states.

[Justin Madders]

We all hope that arrangements will be in place, but my question was: have any discussions been entered into yet with individual member states about the arrangements in a no-deal scenario?

[Stephen Hammond]

There are ongoing and widespread discussions with the Commission and with member states. A number of member states are of high priority because the numbers of UK nationals currently living there make reciprocal international healthcare arrangements particularly important. A number of issues are being discussed. Given the nature of the discussions, I hope the hon. Gentleman will accept that reassurance.

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

Is it not the case that the guidance issued yesterday says that in some cases the European health insurance card may not be valid or guarantee access to healthcare after 29 March and that it is the responsibility of individuals to check the healthcare arrangements with the countries they are visiting?

[Stephen Hammond]

The hon. Gentleman is correct. That is why we discussed in depth the reciprocal healthcare arrangements under the Healthcare (International Arrangements) Bill. Although it is absolutely the Government’s intention, in either a deal or no-deal scenario, to ensure continuity of international arrangements, at the moment that cannot be absolutely guaranteed. I hope the hon. Gentleman heard me say to the hon. Member for Ellesmere Port and Neston that it is the Government’s intention to ensure that, in the event of a no-deal scenario, memorandums of understanding will be put in place. We have already stated that anyone seeking emergency medical care, from wherever they come, will be treated by the NHS. We hope to ensure the continuity of current arrangements in a deal or a no-deal scenario.

To give Members a bit more flavour and depth, let me say, in response to both the initial inquiry, from the hon. Member for Ellesmere Port and Neston, and the inquiry from the hon. Member for Stockton South, that there is understandably a widespread agreement in this area that the current arrangements are to the mutual benefit of the healthcare systems of both the UK and the whole EU and should continue. In that light, very positive discussions are taking place, particularly with the countries where most UK nationals currently reside.

I do not need to write to the hon. Member for Gedling; I can confirm that the regulators will continue to apply the language tests as currently set out.

The hon. Member for Ellesmere Port and Neston talked about the loss of the internal market information system. If the UK exits the EU without a deal, it will no longer have automatic access to the EU systems, including the internal market information system, which regulators across the EU use to exchange information. We hope that the discussion about international healthcare arrangements will continue, but it may well be the case that UK regulators have to seek information from their European counterparts directly, rather than from the Commission. UK regulators are aware of that and are preparing for it, although, as I have said, that may well be part of the discussions about international arrangements and encompassed in a future bilateral or EU-wide international healthcare arrangements agreement. However, the regulations mean that UK regulators will not be required to carry out more assessments of European qualifications than they do now and they will allow bilateral applications for information.

[Justin Madders]

The Minister has been very generous in giving way. We should be clear that, as things stand, the early warning system will not be in operation. It is important to express our concern about that and our sincere wish to put in place an arrangement to avoid it.

[Stephen Hammond]

The hon. Gentleman is absolutely right to raise that concern, but as I have sought to reassure him, it will be perfectly possible for UK regulators and EU regulators, either in whole or individually, to exchange information. It will be possible under this arrangement for UK regulators to seek that information from their individual European counterparts, should they need to do so.

The hon. Gentleman asked about the capacity of regulators to check qualifications. Although it is not the Government’s intention or desire to have a no-deal outcome, regulators have been preparing for that possible scenario. These regulations will ensure that there will be little additional work for regulators in recognising EEA and Swiss qualifications at exit date. Under the regulations, the regulator can choose to review automatic qualifications that it was previously obliged to accept and to designate those qualifications where there are patient and public safety concerns. An applicant will be obliged to supply the regulator with the relevant documents, and if the regulator is not satisfied, it can reject the application. My point is that there is no extra administrative burden on regulators.

On the potential for an additional financial burden, the UK and the regulators have been preparing for a possible no-deal outcome. As the regulations seek to maintain the current systems as far as possible, for at least two years from their coming into force after the expected exit day until the review, there should be little extra cost or impact. There is, as the hon. Gentleman pointed out, the potential for regulators to recover those costs through additional fees, and that is true of current regulatory systems, in many cases.

The hon. Members for Ellesmere Port and Neston and for Linlithgow and East Falkirk asked whether the regulations reduce the ability to safeguard public and patient safety, making the health service less safe. At the heart of these instruments is the recognition that public protection and patient safety must be the foremost ambition; therefore, public protection is the key purpose of regulating health and care professionals. The instruments provide the regulators with the necessary powers to protect the public by introducing the power to designate EEA and Swiss professionals, who they are currently obliged to accept automatically. In addition, they will still be able to check applicants’ language skills and, as I confirmed to the hon. Member for Gedling a moment ago, the language tests will not change.

I was asked about the review process. It is appropriate that a two-year review of the regulations is put in place, which will potentially be wide-ranging and encompassing. The regulations are intended to be subject to review two years after they come into force. As I said earlier, it would be wrong of me either to limit the scope of the review or to predict the factors that may be in place at the time. I am often asked by the hon. Member for Ellesmere Port and Neston and others to commit to reviews of regulations and other legislation, and, as we are committing to a review after two years, I hope that he will accept my assurance on that.

Several hon. Members, including the hon. Member for Linlithgow and East Falkirk, asked me about the impact assessment. There is no significant impact. The impact for the instrument falls below the £5 million threshold of the annual net direct cost to business, as detailed by the business impact target. There is no significant impact on business, and no significant direct impacts have been identified as a result of the changes. Hon. Members have asked about the potential impact regarding allowing recognition so that EEA and Swiss professionals who are valued in the health service can continue to practise in the UK post-EU exit day in a no-deal scenario. That is the impact, and the regulations seek to minimise it. They put in place sensible measures to ensure that that recognition can happen.

Finally, I was asked about whether the regulations support cross-border co-operation between Northern Ireland and the Republic of Ireland. The regulations ensure the continued recognition of Irish professional qualifications in the UK for at least two years after exit day. They allow professionals practising under an existing and temporary or occasional status to continue until the end of that—

[Vernon Coaker]

Will the Minister give way? I think he misunderstood what I asked.

[Stephen Hammond]

I will give way but I think I might be about to predict that as well.

[Vernon Coaker]

To clarify, I was not talking about the cross-border arrangements. I was making the point about whether, in the absence of the legislative Assembly in Northern Ireland, instead of having two or three lines saying, “We’ve discussed this with Northern Ireland officials and that’s fine,” we need to give more detail to our discussions about that.

[Stephen Hammond]

The hon. Gentleman predicts what I was about to say.

[Vernon Coaker]

Apologies.

[Stephen Hammond]

Not at all. The hon. Gentleman is right to ask whether, in the absence of an Assembly in Northern Ireland, the Pharmaceutical Society of Northern Ireland can assess EEA and Swiss pharmacist qualifications that are not covered by automatic recognition—he recognises, of course, that the automatic recognition system is there. These regulations will ensure there should be little change in those. The PSNI will continue to recognise pharmacist qualifications that are within the scope of the automatic system at exit day. Those who do not hold a qualification currently within that scope will be registered with the General Pharmaceutical Council before registering with the PSNI. That is a continuation of the current practice. I am happy to keep this issue under review and to make it part of the discussion with Northern Ireland officials.

With those remarks, I hope that I have managed to satisfy hon. Members’ inquiries, and I commend both sets of regulations to the Committee.

Question put.