Infection Prevention and Control

Steve Barclay Excerpts

Tuesday 15th May 2018 Westminster Hall

[The Minister for Health (Stephen Barclay)]

As always, Mr Howarth, it is a pleasure to serve under your chairmanship.

I join the shadow Minister, the hon. Member for Ellesmere Port and Neston (Justin Madders), in congratulating the hon. Member for Strangford (Jim Shannon) on securing the debate, which provides an opportunity for the House to emphasise the importance of raising standards of infection prevention and control in the NHS. He was kind to pay tribute to the Secretary of State for his work on patient safety, and on putting that front and centre in his priorities. As the hon. Members for Ellesmere Port and Neston and for Central Ayrshire (Dr Whitford) acknowledged, that is a point on which the House is united in a common cause. How we reduce infections is of real importance to our constituents, as my hon. Friend the Member for North East Derbyshire (Lee Rowley) said, and that is reflected in our surgeries, because it impacts on the lives of those we represent. There is therefore a great deal of common cause.

The debate is timely because it was World Hand Hygiene Day on 5 May, which is an initiative that the World Health Organisation started in 2010 to remind us all, including patients and family members, to practise good hand hygiene, to help reduce the spread of infections. The hon. Member for Strangford was right to challenge the Government to reinvigorate our approach to hand hygiene. A number of initiatives are under way in Government to address exactly the points that he raised. Public Health England has been raising awareness, and NHS Improvement has begun a number of initiatives, such as its NHS provider bulletin and a hand hygiene theme in its executive masterclass. Other ways of raising awareness include the Royal College of Nursing’s glove awareness week. As the hon. Member for Central Ayrshire said, that it is all about taking practice from guidance or files and embedding that into the DNA, the culture and the way people operate, who include visiting relatives and staff at all levels, including doctors as well as nursing staff.

A number of hon. Members, including my hon. Friend the Member for Amber Valley (Nigel Mills), raised technology and what more we can do. One theme of the debate was whether the Government are doing enough to drive forward the use of technology. I recognise the limits of direct observation and how behavioural change may respond to those. That is why the Government are actively looking at the extent to which technology can facilitate this area.

We have carried out an initial assessment; indeed, the NHS Improvement director of infection prevention and control, Dr Ruth May, and her team recently visited the Royal Wolverhampton NHS Trust, which has been trialling an electronic monitoring system to make an initial assessment of that. Their feedback is that the system is reliant on existing technology, and that many IT systems would not be able to support that. A number of practical issues need to be addressed before one would have a roll-out of technology. I reassure the House that Dr May and her team are actively looking at that issue. We all recognise the impact, not just on patient safety, but on the cost of infections and unnecessary deaths. We are actively looking at the issue of technology.

The hon. Member for Strangford also asked if we could publish more. To pick up on the remarks of the hon. Member for Central Ayrshire on the way information is published in NHS Scotland, dialogues are already taking place. I am happy to ask officials to ensure that, as part of the collaboration that is already under way in NHS Improvement with colleagues in the Scotland and England NHS, we look at best practice to ensure that we are working with and maximising the learning from both sets of NHS.

Public Health England has carried out some initial analysis of the available data to determine the suitability of the data available for publishing. Currently, the data is incomplete and will not truly reflect the usage of hand gel. We are exploring how to improve that data. The hon. Member for Central Ayrshire commented that transparency on what is being done and on variance in performance around infection rates is a key driver of prevention.

[Dr Whitford]

The Minister may know that as a breast cancer surgeon, I was involved in developing the breast cancer standards for Scotland. The only action was peer review—putting everyone’s performance up at an annual conference. No one wants to be at the back of the class; in actual fact, seeing genuine performance drives up quality.

[Stephen Barclay]

The hon. Lady is right that peer review is always a powerful motivator. That sort of transparency drives behaviour, so we need to ensure that we do that in an effective way that does not alarm patient families, because of the publication of data that could be misrepresented by those who have different objectives. The need to get more publication of data is an important point, which the hon. Member for Strangford and others raised, on which we need to do further work.

The hon. Member for Upper Bann (David Simpson) asked in his intervention about the specific issue of patients going outside to smoke, and whether there was an associated infection risk, for example through drips. I am advised that there is no additional risk of infection, as long as the drip is well managed. If colleagues have specific issues about the infection risk associated with that, that is the nature of the debate and helpful to know.

My hon. Friend the Member for Moray (Douglas Ross) spoke of the pain and distress to patients caused by infections, and the important link to buildings. Although that is relevant in Scotland, to which he referred, I accept that the point would also apply to the England NHS. The state of the buildings and the maintenance programme have a part to play, not just in the Scottish NHS, but in the England NHS as well.

The hon. Member for Strangford asked whether hand hygiene could be a national marker of care quality. The Department is considering how we could do that effectively. The points he raised were heard and I will ensure that they are addressed. As and when we have any update, I will be very happy to share that with him.

Overall, a great deal of progress has been made. We are committed to reducing the number of infections. Since 2010 we have made excellent progress on MRSA and C. difficile. In the 12 months ending March 2018, MRSA cases were down 54% on the 12 months ending May 2010, and C.diff infections were down 47%. Considerable progress has been made, but as the hon. Member for Central Ayrshire mentioned, although we have made progress in slowing the rate of increase of E. coli infections, there is more to be done to bring that rate down. NHS England has the challenging objective to bring that down by 20% as part of its mandate. As a result of slowing that down, there were 2,400 fewer cases of infections than there would have been with the previous trend.

Clearly, there is more to be done on E. coli and it is an area of considerable focus in the team. Those cases also have a fiscal cost of between £3,000 and £7,000 per infection, but the much more material cost is the patient safety issue and the harm that accrues as a result. NHS Improvement is leading this programme, aimed at a 20% reduction in E. coli bloodstream infections in 2018-19. It is an ambitious but important target. NHS Improvement has begun working with the medical director of NHS England, Steve Powis, on setting up pilots with local health economies across England to engage and assist in the reduction. That may be an issue that my hon. Friend the Member for Morley and Outwood (Andrea Jenkyns) wishes to pick up with me after the debate—how we can work together, given her powerful but extremely sad experience of the events that befell her father.

Colleagues recognised the considerable amount of work on antimicrobial resistance, which is an important factor in treating infections. Our latest estimate is that over five years, there could be an extra 6,000 deaths attributable to pan-antibiotic resistance. Lord O’Neill’s review on AMR said that drug-resistant infections will cost the world 10 million extra deaths a year and $100 trillion by 2050. Those are pretty scary figures, but they underline the importance of preventing infections occurring in the first place.

That brings me on to patient safety. Following the tragic events at Mid Staffordshire and the subsequent public inquiry led by Sir Robert Francis, the NHS embarked on a journey of improvement based upon three strands: better regulation, greater transparency and a culture of learning. Assessing the risk of, and preventing, detecting and controlling the spread of, infections, including those that are healthcare associated, is addressed by the fundamental standards of care, enshrined in regulations, that all Care Quality Commission registered providers are expected to meet. A number of colleagues mentioned the role of the CQC as part of the checks and balances that need to be in place.

In November 2016, the Secretary of State launched new plans to reduce infections in the NHS, including the sepsis commissioning for quality and innovation. Through that, we have incentivised hospitals to improve their sepsis care. Independent CQC inspections have focused on E. coli rates in hospitals and in the community. In addition, we have appointed a national infection prevention lead to ensure a sustained focus at national level, improved training and information sharing, so that NHS staff can cut infection rates and, through the National Institute for Health and Care Excellence’s 2017 guidelines, highlight standard principles and advice on good hygiene.

Considerable progress is being made. Data published in 2017 suggests that four in 10 of all E. coli blood infections cannot be treated with commonly used antibiotics. Infection prevention and control is a key element of tackling antimicrobial resistance, and hand hygiene plays an important part in that. We are working extensively with stakeholders, including the royal colleges, academia and the research community, industry and our expert advisory groups, to inform our next steps.

Several colleagues, including the hon. Member for Ellesmere Port and Neston, mentioned sepsis. We have made significant progress since our focus to improve sepsis practices increased in January 2015. There is new NICE guidance and a new national CQUIN measure to incentivise providers to improve the identification and timely treatment of sepsis. The hon. Member for Central Ayrshire was absolutely right about the time-critical nature of that treatment. That work is already delivering change. The most recent data, which is for the third quarter of 2017-18, shows that emergency department assessment for sepsis has increased from 52% to 92%, and in-patient assessment has increased from 62% to 84% since April 2016.

Considerable progress has been made, which reflects the renewed focus across the NHS, in England and Scotland, on the time-critical nature of sepsis treatment, but we know there is more to do, which is why a new cross-system action plan was launched in September 2017. That plan outlines a range of activities to ensure that the NHS is on the highest possible alert to tackle that devastating condition. Indeed, just recently, on 25 April, NHS Improvement issued a national early warning score 2 patient safety alert to support providers to adopt the revised NEWS2 to detect deterioration in adult patients, including better identification of patients likely to have sepsis.

My colleague the Minister for Care, my hon. Friend the Member for Gosport (Caroline Dinenage), hosted and gave a speech at the launch of Health Education England’s paediatric sepsis e-learning package, which, again, is about raising awareness at an early stage. That training package was informed by clinicians and by parents whose children sadly passed away from sepsis, so we can learn from those tragic events and ensure that warning signs are better picked up at an earlier stage.

As several Members recognised, hand hygiene plays a key role in infection prevention and control, in supporting patient safety and in our efforts to address antimicrobial resistance. Considerable progress has been made—MRSA has more than halved and C. difficile has reduced by just under half since 2010—but, as the hon. Member for Central Ayrshire rightly said, E. coli remains a key area for renewed focus. We have successfully slowed its growth, but we now need to reduce it significantly. Part of the challenge is that a lot of it occurs outside the hospital setting, in the community.

I look forward to working with colleagues from across the House on this shared objective in an area where shared practice, from both England and Scotland, can help. We can learn from each other and from Members’ experiences in their constituencies. We will continue to embed hand hygiene practice and promote awareness of it in the NHS, not just through World Hand Hygiene Day but through debates such as this one.

Education (Student Support)

Steve Barclay Excerpts

Wednesday 9th May 2018 Commons Chamber

[The Minister for Health (Stephen Barclay)]

I join the hon. Member for Ashton-under-Lyne (Angela Rayner) in welcoming the opportunity to discuss the increase in the number of postgraduate places that will be unlocked as a consequence of the statutory instrument. She ended her speech by saying that there was an “urgent need” to recruit more. The central premise of her opposition to a change that will remove the arbitrary cap imposed by the bursary, and hence unlock additional places for postgraduate students, seems a strange one on which to base her speech, given that we are ensuring that we can continue to increase the number of nurses that the Government have delivered through the postgraduate route, as we have through the undergraduate route.

At present, about 2,500 students gain access to nursing, midwifery and allied healthcare professions through the postgraduate route, a number that is constrained by the cap. The policy that we are discussing has already been applied to the much larger population of about 28,000 undergraduates studying the same subject. The statutory instrument will ensure consistency in the approach to both populations, while enabling both to increase their number by 25%.

This is part of a much wider package of Government measures. We are, for instance, increasing the number of apprenticeships. I know that my right hon. Friend the Member for Harlow (Robert Halfon), as Chair of the Education Committee, has repeatedly championed their importance as a route into nursing for those who do not want to go to university. Similarly, my hon. Friend the Member for Chelmsford (Vicky Ford) has campaigned repeatedly in respect of medical school places. There are five new medical schools and 1,500 new medical places, again as part of the increase in the number of nurses. We have made a commitment through “Agenda for Change”, working with the trade unions, to deliver pay increases and we have programmes such as the return to work programme, which has seen more than 4,000 former nursing staff applying to return to the profession.

[Robert Halfon (Harlow) (Con)]

I will be supporting my hon. Friend this evening. I welcome what he said about apprentices. I think this squares the circle. We need to rocket-boost apprenticeship programmes in the NHS. I intend to say more about that in my speech, but may I ask whether he is committed to that today?

[Stephen Barclay]

I was just taking inspiration. Let me explain the route into nursing through apprenticeships. A four-year package will enable people who do not want to go to university—this is a point that my right hon. Friend has repeatedly made in the Education Committee—to progress to nursing roles by means of what he has often referred to as a ladder. Healthcare assistants tend to feel trapped in roles that do not give them an opportunity to progress. This is at the heart of what the Government stand for: giving people an opportunity to progress at different stages in their lives through the apprenticeship route.

[Sir Desmond Swayne (New Forest West) (Con)]

Will my hon. Friend address the allegation that there are 700 fewer nurses in training?

[Stephen Barclay]

My right hon. Friend will not be surprised to learn that that is a selective picking of the facts because it does not include direct entrants, to cite just one example that was not included. I could go on, but I know the—[Hon. Members: “Go on”.] It does not take account of direct entrants; that is one population that was not included. It also—

[Karen Lee]

rose—

[Stephen Barclay]

Would the hon. Lady like me to go on or to give way?

[Karen Lee]

Would the Minister confirm the number?

[Stephen Barclay]

I am happy to confirm that. We now have 13,100 more nurses on wards since 2010 and we have a commitment to expand the numbers—[Interruption.] It is a new programme and we are expanding the number of apprenticeships. We have committed to 5,000 this year, expanding to 7,500.

It is interesting, is it not? Having routes that give people opportunities to progress—having different choices for people and empowering individuals, not all of whom want to go to university—so that people from different backgrounds can go into the profession is the very essence of what our party stands for. It is shame—

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

Does the Minister therefore challenge the figure of only 30 apprentices and does he recognise that with a four-year course they will not be ready until 2022, and there is a need for nurses now?

[Stephen Barclay]

I absolutely recognise that the apprenticeship route will take four years, but the Government have given a clear commitment to that and that is backed up by significant—[Interruption.] The UCAS figures are embargoed, so I do not have the latest figure. The point is that it is a four-year programme and it will take time to roll out, but it is backed by significant funding: the NHS is contributing £200 million to the apprenticeship levy. That is a signal of this Government’s commitment. The Minister for Apprenticeships and Skills is here, championing the apprenticeship route, as are other Members through the Select Committees. It is a shame that some Opposition Members are not reflecting on the benefits offered by apprenticeships as an alternative route into the nursing profession that will deliver more nurses. That should be welcomed.

[John Howell (Henley) (Con)]

I think my hon. Friend the Minister has forgotten that the Minister for Education, my right hon. Friend the Member for Bognor Regis and Littlehampton (Nick Gibb), is also here, which reinforces the point that the starting point for promoting nursing is at school. Does my hon. Friend agree?

[Stephen Barclay]

I do agree with my hon. Friend. Indeed we have three Ministers from the Department for Education here, which again shows the Government’s joined-up approach. The NHS, as the employer of 1.5 million people, is a standard setter that can provide leadership in the apprenticeships market and looks at doing so not just for nursing apprenticeships, but across a range of apprenticeship routes. The Minister for Apprenticeships and Skills, who is a former Minister in the Department of Health, understands that issue extremely well.

[Layla Moran]

Does the Minister really think that this needs to be an either/or? Could we not do the very good work that is going on with apprenticeships and also maintain this important bursary? Does he have something to say to the chief executive of the Royal College of Nursing, who says these changes are short-sighted? Has the RCN’s position changed?

[Stephen Barclay]

I agree with the hon. Lady that we can do both: we can have the apprenticeship route, but we can also increase the number who do postgraduate training as an entry point into the profession. It is also why we are looking to expand the number of undergraduates. This is also empowering for students because it means that, while they are undertaking their course, they will receive more funding than they would under the existing system. Under the move to the loan system, depending on the circumstances of the course, health students will typically receive up to 25% more in the financial resources available to them for living costs during the time they are at university. For example, a student without dependants living away from home could access £9,256 under the loans system, compared with £6,975 under the NHS bursary system.

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

The Minister is being typically gracious in giving way. He said in his opening remarks that he wanted to unlock additional places but, according to the RCN, far from unlocking additional places, the removal of the bursary has led to a fall of 700 places on nursing degrees and a 3% decline in the number of people starting nursing courses since 2016. Is it his view that the RCN is lying?

[Stephen Barclay]

The hon. Gentleman is quoting selectively. He is right to point to 2016, because the number of nurses in training was at a record high—an achievement by this Government for which little credit was given by the Opposition. The new system will take time to bed in, but it is important to ensure that more places are available and that there are more applicants, and that is our approach.

[Maria Caulfield]

Opposition Members seem to be portraying the bursary system as a panacea, but it was not a well-functioning system. There were more applicants than available places, and it was a real struggle for students from poorer backgrounds, such as myself, to live on £400 a month with no alternative income. The system also only catered for students with an academic background. The new apprenticeship system allows degree-entry nursing, but not necessarily through the academic route.

[Stephen Barclay]

As a nurse, my hon. Friend speaks with great authority and she is right. This is about empowering those who want to be a nurse, not all of whom want to go to university. She is also right to remind the House that many people’s ambitions are choked off by the existing system. Under the bursary system, over 30,000 people who applied to be a nurse were rejected. Too many people were being rejected, and we need more nurses, so we have a package of measures to increase the number of nursing places. Nothing has been said about those who were thwarted in that ambition. Universities, too, have consistently argued that healthcare postgraduate courses were an area prime for growth if we offered suitable loan products.

[Dr Andrew Murrison (South West Wiltshire) (Con)]

The Minister is right to highlight the university sector but has he, like me, recently visited his local further education college? If he has, I am sure that staff will have expressed the same view that I heard in Trowbridge recently: the new apprenticeship route into nursing is good for FE colleges that want to offer nurse training. Some colleges currently feel constrained because they are frozen out by universities but, in setting up such courses, colleges will be able to offer nursing to a much greater range of people than is currently the case.

[Stephen Barclay]

As a medic, my hon. Friend alights on an important point that I am happy to pick up. A number of the professions are degree entry, which precludes the further education college sector, so I will be happy to discuss that with him.

It is worth drawing to the House’s attention that it is not just universities that have been pushing for a change. Professor Dame Jessica Corner, the chair of the Council of Deans of Health, said:

“Our members report receiving a high number of good quality applications for most courses and they will continue to recruit through to the summer. Where courses have historically had a large number of applicants, fewer applicants might well not affect eventual student numbers”.

The key issue is not just how many people apply; it is ensuring that there are sufficient applicants for the places and then increasing the number of places on offer.

[Paul Blomfield (Sheffield Central) (Lab)]

Will the Minister give way?

[Stephen Barclay]

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

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

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

[Dr Sarah Wollaston (Totnes) (Con)]

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

[Stephen Barclay]

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

[Vicky Ford]

I thank the Minister for the announcement that he has just made. At the nursing college in Chelmsford, and also at Cambridge and Peterborough, we have 30% more qualified applicants, but there have been fewer applicants for mental health nursing. This targeted intervention will really help to address that need. Will he confirm that this will be locally based where necessary—that is, in the areas where we need the help most?

[Stephen Barclay]

I am happy to confirm to my hon. Friend that there will be a local element to the targeting of the package. She has been a powerful advocate in helping to secure the new medical school at Chelmsford, which will be a huge boost to the local health economy.

The statutory instrument before the House tonight is part of package being brought forward by this Government, alongside the “Agenda for Change” increase in pay and alongside our ambitions to increase the number of apprenticeships and to encourage people to return to the profession. We have already made this change for the much bigger population of 28,000 undergraduates, and it is right that we should now apply that consistently to the 2,500 postgraduates. We have a targeted measure of support to address any hard-to-recruit areas, and I therefore commend this statutory instrument to the House.

Oral Answers to Questions

Steve Barclay Excerpts

Tuesday 8th May 2018 Commons Chamber

[Grahame Morris (Easington) (Lab)]

10. What assessment he has made of the effect of the withdrawal of NHS bursaries on applications for nursing degrees.

[The Minister for Health (Stephen Barclay)]

Nursing remains a strong career choice, with more than 22,500 students placed during the 2017 UCAS application cycle. Demand for nursing places continues to outstrip the available training places.

[Gill Furniss]

Figures from the Royal College of Nursing show that applications have fallen by 33% since the withdrawal of bursaries. At the same time, the Government’s Brexit shambles has led to a drastic decline in EU nursing applications. How many years of such decline do we have to see before the Secretary of State and the Minister will intervene?

[Stephen Barclay]

What matters is not the number of rejected applicants, but the increase in places—the number of people actually training to be a nurse. The reality is that 5,000 more nurses will be training each year up to 2020 as a result of the changes.

[Stella Creasy]

The NHS already has 34,000 nursing vacancies. Given that there has been a 97% drop in nursing applications from the EU and that studies show that nearly half of all hospital shifts include agency nurses, will the Minister at least admit that cutting the bursary scheme has been a false economy for our NHS?

[Stephen Barclay]

It is not a false economy to increase the supply of nurses, which is what the changes have done. Indeed, they form part of a wider package of measures, including “Agenda for Change”, pay rises and the return to practice scheme, which has seen 4,355 starters returning to the profession. More and more nurses are being trained, which is why we now have over 13,000 more nurses than in 2010.

[Grahame Morris]

I respectfully remind the Minister that this is about recruitment and retention. The RCN says that we can train a postgraduate nurse within 18 months, which is a significant untapped resource, so why are the Government planning to withdraw support from postgraduate nurses training, too?

[Stephen Barclay]

We have a debate involving postgraduate nursing tomorrow, but the intention is to increase the number of such nurses by removing the current cap, which means that many who want to apply for postgraduate courses cannot find the clinical places to do so. That is the nature of tomorrow’s debate, and I look forward to seeing the hon. Gentleman in the Chamber.

[Robert Halfon (Harlow) (Con)]

Will my hon. Friend, on top of the degree nursing apprenticeships, rapidly increase the nursing apprenticeship programme so nurses can earn while they learn, have no debt and get a skill that they and our country need?

[Stephen Barclay]

My right hon. Friend is absolutely right to signpost this as one of a suite of ways to increase the number of nurses in the profession. As he alludes to, there will be 5,000 nursing apprenticeships this year, and we are expanding the programme, with 7,500 starting next year.

[Alex Chalk (Cheltenham) (Con)]

This weekend, I had to take a poorly member of my family to Cheltenham General Hospital, and the skill, concern and good humour of the emergency nurse practitioners were fantastic. Will my hon. Friend join me in paying tribute to Cheltenham’s emergency nurse practitioners? Does he agree that we should be doing everything possible, through their pay scales, to reward and retain them?

[Stephen Barclay]

I am very happy to join my hon. Friend in paying tribute to the nurses at Cheltenham, and elsewhere, for the work they do. As he says, that is exactly why this Government, with the support of the Treasury, have backed nurses with a big pay rise in the “Agenda for Change” programme.

[Stephen Lloyd (Eastbourne) (LD)]

With every reputable independent body showing very clearly that we have a staffing crisis in the NHS nursing profession, can the Minister explain how cutting bursaries actually improves the situation?

[Stephen Barclay]

I am very happy to do so. We are removing the cap on the number of places covered by the bursaries and increasing the number of student places by 25%, which means that there will be 5,000 more nurses in training as a result of these changes.

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

The Secretary of State’s removal of the nursing bursary and introduction of tuition fees have resulted in a 33% drop in applications in England. In Scotland, we have kept the bursary, a carer’s allowance and free tuition, which means that student nurses are up to £18,000 a year better off, and indeed they also earn more once they graduate. Does the Minister recognise that that is why applications in Scotland have remained stable while in England they have dropped by a third?

[Stephen Barclay]

The hon. Lady speaks with great authority on health matters, but, again, she misses the distinction between the number of applicants and the number of nurses in training. It is about how many places are available, and we are increasing by 25% the number of nurses in training. That is what will address the supply and address some of the vacancies in the profession.

[Dr Whitford]

Workforce is a challenge for all four national health services across the UK, but, according to NHS Improvement, there are 36,000 nursing vacancies in England, more than twice the rate in Scotland. The Minister claims that more nurse students are training, but in fact there were 700 fewer in training in England last year, compared with an 8% increase in Scotland. The key difference is that in Scotland we are supporting the finances of student nurses, so will the Government accept that removing the nursing bursary was a mistake and reintroduce it?

[Stephen Barclay]

The distinction the hon. Lady fails to make is that in England we are increasing the number of nurses in training by 25%; we are ensuring that nurses who have left the profession can return through the return-to-work programme; and we are introducing significant additional pay through “Agenda for Change”. As my right hon. Friend the Member for Harlow (Robert Halfon) said, we are also creating new routes so that those who come into the NHS through other routes, such as by joining as a healthcare assistant, are not trapped in those roles but are able to progress, because the Conservative party backs people who want to progress in their careers. Healthcare assistants who want to progress into nursing should have that opportunity.

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

When defending the decision to scrap bursaries, the Secretary of State said that, if done right, it could provide up to 20,000 extra nursing posts by 2020. Well, that figure now looks wildly optimistic, with applications down two years in a row. Is it not time that Ministers admitted they have got this one wrong and joined the Opposition in the Lobby tomorrow to vote against any further extensions to this failed policy?

[Stephen Barclay]

If Members vote against the policy tomorrow, the reality is that they will be voting for a cap on the number of postgraduate nurses going into the system, and therefore they will be saying that more people should be rejected—more people should lose the opportunity to become nurses—because they want to have a cap that restricts the supply of teaching places.

[Jenny Chapman (Darlington) (Lab)]

7. What support GPs provide to mothers experiencing perinatal mental health problems.

--- Later in debate ---

[Robert Halfon (Harlow) (Con)]

T2. The Secretary of State has visited Princess Alexandra Hospital in Harlow on a number of occasions and he will recognise that, despite excellent staff, the hospital is not fit for purpose. Will he confirm that Harlow is at the top of the list for capital funding, and that we will get the new hospital our town desperately needs?

[The Minister for Health (Stephen Barclay)]

We recognise that the Princess Alexandra Hospital estate is in a poor condition. NHS Improvement is working with the trust to develop an estate and capital strategy by summer 2018 to be assessed, with other schemes put forward, for the next capital announcement for sustainability and transformation partnerships. I am very happy to meet my right hon. Friend to have further discussions about it.

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

I thank the Secretary of State for his update on breast cancer screening. I welcome his letter this morning with respect to patient safety in the private sector, but is not the truth that the best quality of care is provided by a public national health service? Is it not time to legislate to ensure that private hospitals improve their patient safety standards, and if he accepts that levels of safety are not acceptable in the private sector, why is the NHS still referring patients to the unsafe private sector? Should there not be a moratorium on those referrals until these issues are sorted out?

--- Later in debate ---

[Mr Philip Dunne (Ludlow) (Con)]

Is my right hon. Friend aware that following his decision to make the capital allocation to Shrewsbury and Telford Hospital NHS Trust before Easter, that trust has had sufficient confidence to successfully appoint five additional consultants in 10 days in April, thereby improving resilience in acute healthcare in Shropshire?

[Stephen Barclay]

I very much welcome the progress that my hon. Friend has shared with the House. Many of us will also want to pay tribute to his leadership during his time at the Department in recognising the opportunity for reconfiguration that the capital would unlock and is now delivering.

[Stella Creasy (Walthamstow) (Lab/Co-op)]

T5. On 21 March, the Secretary of State told the House that he would look at the impact of private finance initiative deals on NHS hospital budgets. What has he done since then? How many meetings has he had about the issue? Will he commit not to use PF2 deals, given the concerns?

Privatisation of NHS Services

Steve Barclay Excerpts

Monday 23rd April 2018 Westminster Hall

[The Minister for Health (Stephen Barclay)]

It is a pleasure once again to serve under your chairmanship, Mr Hosie. I thank all Members who have contributed to this wide-ranging debate, in particular the hon. Member for Hartlepool (Mike Hill) who, as a member of the Petitions Committee, introduced today’s debate on the petition.

I join the shadow Minister, the hon. Member for Ellesmere Port and Neston (Justin Madders), in expressing our condolences for Connor McDade, the constituent of the hon. Member for Hartlepool, especially given Connor’s tender age. That must be extremely traumatic for his family.

“As the NHS moves from a public sector monopoly to a truly patient-led service, exciting opportunities are opening up for hospitals and other providers, whether public, private or not-for-profit”—

those are not my words, but the words of a Labour Secretary of State for Health in 2007. Perhaps, however, I am looking too far in the past and we should look to a more current Labour politician, such as the Mayor of Manchester, who was the last Labour Secretary of State. He said:

“Now the private sector puts its capacity into the NHS for the benefit of NHS patients”,

which I think most people in this country would celebrate. Indeed, the other of the three most recent Labour Secretaries of State, Mr Milburn, joined PwC in 2013 as chair of its UK health industry oversight board, whose objective was to drive change in the health sector and assist PwC in growing its presence in the health market.

As the hon. Member for Hartlepool recognised, from the outset, the NHS has always had a private treatment offer—I think he used those words. The key issue is where the care remains free at the point of access. That is enshrined in the 2012 Act and is reflected in many of the remarks made by Conservative Members.

My hon. Friend the Member for Thirsk and Malton (Kevin Hollinrake) addressed the question of whether, alongside care being free at the point of access, there had been a step change in the number of private suppliers—that seems to have been the suggestion— notwithstanding the clear support from the last three Labour Secretaries of State for Health for such provision. It may surprise you, Mr Hosie, to learn that in the last year for which financial data is available, NHS commissioners purchased 7.7% of total healthcare from the independent sector. In 2010, the figure was just under 5%, so the rates of growth in the use of private providers under this Government are not the same, as my hon. Friend suggested; they are lower than those under the previous Government. We need to put into a degree of context some of the scaremongering that there has been in this debate about privatisation and weaponisation of the NHS.

The hon. Member for Colne Valley (Thelma Walker), who is not in her place, talked about privatisation—in that context, several Members mentioned Carillion. Again, it may be helpful to remind the House that of 13 PFI contracts signed with Carillion for facilities management, 12 were agreed prior to May 2010. The hon. Member for Dewsbury (Paula Sherriff) suggested that she was keen to talk to Ministers about her concerns with Virgin Care. I accept that, just as with care within the NHS, often there are lessons to be learnt in care from a private provider. The hon. Lady is not her place, but I am happy to accept her offer to meet her to learn from any past experience she has. The hon. Member for Crewe and Nantwich (Laura Smith) referred to PFI deals; as I said, many of those were signed by past Governments.

My hon. Friend the Member for South West Bedfordshire (Andrew Selous), in a first class, wide-ranging speech, referred to one of the key themes that came out of the debate: the importance of integrated care. Again, the weaponisation of this debate is highlighted by the fact that sustainability and transformation plans—as he said, they were endorsed by non-political bodies such as the King’s Fund—were characterised at the time by people such as Mrs Pollock as secret Tory privatisation. Indeed, the same person previously characterised Labour’s foundation trusts as privatisation. We have seen this privatisation badge given to successive changes as they have been applied. My hon. Friend is quite right that Simon Stevens was appointed as a special adviser by a Labour Government. His evidence to the Health and Social Care Committee was quite clear when he highlighted how many of these issues have been cited before.

The hon. Member for Hyndburn (Graham P. Jones) spoke of his concerns about fragmentation. I hope that he will welcome the shift to place-based commissioning and a focus on greater integration between commissioners. My hon. Friend the Member for Chichester (Gillian Keegan) identified the fact that patients’ outcomes are uppermost in the approach. That is very much reflected in the example she gave of the better care fund, which is all about how we bring health and social care together. An example of that is the change that the Prime Minister made by bringing the Minister for Care, my hon. Friend the Member for Gosport (Caroline Dinenage), into the Department to look at how we can better integrate.

The hon. Member for Warrington South (Faisal Rashid) suggested that the role of private firms had doubled since 2010. As I said, that is just not correct—the figure has gone from 5% to 7.7%, so the facts dispute that. My hon. Friend the Member for Gloucester (Richard Graham), in a very good speech, correctly highlighted the poor value for money of many PFI deals. That is why the Treasury changed the terms by which those Labour PFI deals are now contracted. It is right that we learn many lessons from them.

The hon. Member for Stroud (Dr Drew) raised a number of very fair, genuine and worthwhile points. I will quickly try to address them, although I refer to a previous debate in this Chamber on subsidiaries, where we aired some of the points that he raised. Subsidiaries are 100% owned by the NHS, so any financial benefit they gain is retained within the NHS family. They are an alternative to having to contract outside the NHS family, so they help to keep money in the NHS. It is also worth bearing in mind that the staff surveys often show, contrary to some of the remarks, that many staff have welcomed them—there was a 15% increase in staff survey responses in one hospital. To take another, Barnsley saw a six-fold increase in the number of applicants to roles, because the better flexibility and up-front salary offset against pension is one of the attractions that many staff feel that subsidiaries offer.

My hon. Friend the Member for Thirsk and Malton spoke about his experience, which underscored a point made by a number of my hon. Friends: the absolute, rock-solid commitment on this side of the House to treatment being free at the point of use. He gave the example of waiting for care—a critical point and something that none of us wishes to see; under this Government we will not see that. My hon. Friend the Member for Cleethorpes (Martin Vickers) very correctly identified how private provision can, when correctly commissioned, bring quicker care. A good example of some of the subsidiaries is diagnostic care, where clearly it is in the interest of patients to get the results of their tests quicker.

I recognise, as the hon. Member for West Lancashire (Rosie Cooper) highlighted, that there needs to be transparency in respect of outsourced contracts. When I was a member of the Public Accounts Committee, a phrase we often referred to was “following the taxpayer’s pound.” That stood then and it stands now. I am very happy to work with the hon. Lady on how we can ensure that we are able to follow the taxpayer’s pound and address areas of variance. Variance applies in the NHS family, but it also applies in the private sector. I am very happy to work with her, just as I am looking forward to a visit, on a cross-party basis, to look at some of the specific issues at the Liverpool Community trust that she correctly identified and brought to the House. The hon. Member for York Central (Rachael Maskell) said that no one wants to work for subsidiary companies; as I said, patients’ survey data suggests that is not the case.

My hon. Friend the Member for Cheltenham (Alex Chalk) highlighted how outsourcing is dressed up as a threat to treatment being free at the point of use; he is right to highlight the way that is being misportrayed and his pride in the fact that there is no payment requirement for treatment. He also highlighted the diverse mix in hospices, with charities such as Macmillan, which are not part of the NHS. No one would suggest that that is privatisation; this petition, which likens all outsourcing to privatisation, is deeply misleading.

I want to allow a minute for the hon. Member for Hartlepool to make his concluding remarks, so I conclude by reaffirming the absolute commitment of this Government to maintain treatment free at the point of use, but also always to put the needs of patients first and to respect value for money for the taxpayer. That has been reflected in many of the remarks from hon. Members across the House, and it is the essence of this Government’s approach.

Health Services in Essex

Steve Barclay Excerpts

Tuesday 17th April 2018 Westminster Hall

[The Minister for Health (Stephen Barclay)]

It is a pleasure to serve under your chairmanship once again, Mr Howarth. I congratulate my right hon. Friend the Member for Witham (Priti Patel) on securing the debate and on her wider commitment to championing Witham and the health issues within her constituency, particularly her work on the health centre in Witham. I am pleased that she is not calling for a new hospital in the constituency, but she is absolutely right to highlight the changing demographics within her constituency—in particular, a growing elderly population—and how that requires local health services to adapt. As both an east of England MP and an MP representing a rural constituency, I recognise many of the issues to which she referred.

I thank my right hon. Friend for acknowledging the additional medical places to train the next generation of Essex doctors. Our hon. Friend the Member for Chelmsford (Vicky Ford) rightly spoke about local demand for the places: there have been 400 applicants already, which signals why it was the right decision to place a medical school in Chelmsford and how important it will be to meeting the health needs of patients in the Essex area.

My right hon. Friend was also right to highlight the importance of developer contributions. As the Government meet the challenge set by the Prime Minister to increase the amount of housing, it is right that developers contribute to meeting health needs. Following a constituency case of my own that brought this issue to light, I commissioned a paper in the Department to ensure that we look again at how NHS England and CCGs secure the right contribution from developers into local health services. My right hon. Friend also mentioned a specific constituency case. I absolutely agree that we need to learn from past issues where they arise. As she will know, the Secretary of State has given great leadership on patient safety. It is something that he has personally challenged within the NHS family, and he is rightly putting it at the heart of the Government’s agenda.

My right hon. Friend also mentioned the ambulance trust. A huge amount of work has gone on to support the East of England Ambulance Trust after issues were raised by a number of our colleagues over the Christmas period, including by the right hon. Member for North Norfolk (Norman Lamb). Members from all parts of the House will wish him a speedy recovery from his recent minor stroke. He held an Adjournment debate on the East of England Ambulance Service and raised issues that we have been addressing, including the risk summit, which I know is a priority for NHS England and NHS Improvement. I have met ambulance bosses, and my own constituency is served by the East of England Ambulance Service. It is right to put on the record that, under this Government, there has been a 30% increase in the number of paramedics, which signals the commitment that we have made to the ambulance service. However, it is also right that we look at issues such as the handover of ambulances and how we get that process working better.

I thank my right hon. Friend for her support for the Witham primary care centre, which will strengthen Witham’s primary care services. I understand that site options appraisals have been completed and agreed by the Mid Essex CCG, and discussions are ongoing with the developer and local practices to secure agreement. The CCG is hoping to finalise the business case by the end of June, although I understand that it is subject to final agreement by the local practices involved. She is absolutely right that local practices need to recognise the way that the constituency and Witham are developing and to adapt with that development in order to meet the growing needs of the town.

The health hub will offer primary care services, community health provision and elective care activity, replacing the majority of current GP facilities in Witham. The hub will use a greater skills mix, which has been identified as key to releasing capacity in general practice. The Government are committed to recruiting more GPs, but we are also looking at the skills mix that supports GPs—those who work with GPs—so that we address the way patients now present. They often present with a number of conditions, which requires a multitude of support and intervention. What matters, therefore, is the recruitment not just of GPs, but of physician assistants, the wider nursing team and the other support alongside GPs that is part of addressing the health needs of constituents in Witham and elsewhere. That is at the heart of what I understand is my right hon. Friend’s vision for the health centre, and is exactly where the Government are trying to take primary care—offering a broader suite of support and services to patients, who, as I said, often present with more than one condition. That requires a wider team.

I understand that the Sidney House and The Laurels practice has expressed a desire to be operationally involved in the scheme, although that option has yet to be fully explored. Funding support has been made available for the Sidney House and The Laurels practice, through the Mid Essex CCG’s primary care sustainability fund, to go towards the cost of additional staff to alleviate pressures. That funding is assisting the practice with a range of initiatives: training clinical staff, increasing the number of clinical staff and providing an additional 20 hours a week of administrative support. That additional support should enable the practice to increase capacity and access for patients. I understand that the new triage appointment system introduced at the practice has been well received by patients and is helping the practice to manage demand. That funding will continue, alongside more funding made available by the CCG through the recently established Primary Care Foundations programme. Mid Essex CCG is also supporting work across mid-Essex to alleviate pressures. That includes the roll-out of decision-making software designed to remove blockages in GP practices’ workflow.

My right hon. Friend raised the issue of GP access more widely in her constituency. We recognise that an ageing population and more people living with long-term conditions mean that primary care is under more pressure than ever, and we are taking steps to address that. That includes the additional funding to which my right hon. Friend referred. Funding will increase by £2.4 billion by 2020-21, going from £9.6 billion in 2015-16 to more than £12 billion by 2020-21. That is a 14% increase in real terms, which has been put in place by this Government. We have announced our ambition to expand the medical workforce, with an extra 5,000 full-time equivalent doctors working in general practice by 2020 as part of a wider increase to the total workforce in general practice of 10,000. We recognise that that is an ambitious target of double the growth of previous years, but it shows the commitment of this Government to our NHS.

As both my hon. Friend the Member for Chelmsford and my right hon. Friend the Member for Witham said, Anglia Ruskin University’s new school of medicine will have 100 publicly funded student places following the announcement by my right hon. Friend the Secretary of State on 20 March. The £20 million school of medicine, currently being built on the Chelmsford campus, is the first in Essex. It not only is a physical representation of the effective lobbying by my right hon. Friend, my hon. Friend and other colleagues from across Essex and the east of England, but shows the physical commitment of this Government to addressing the health needs of constituents in Essex. The building, which is nearing completion, will feature state-of-the-art skills facilities, specialist teaching space, a lecture theatre and an anatomy suite.

Nationally, Health Education England has made 3,250 places in GP specialty training available per year since 2016. A suite of measures is being taken to assist primary care, sitting alongside the work my right hon. Friend has spoken about. I am talking about how we look at the health estate, how we bring services together and how we do that in a hub that adapts to the changing needs of communities such as the ones that she represents. Nationally, 52% of the population are benefiting from extended access to general practice, including evening and weekend appointments. That reflects the fact that many people in Witham and across Essex work and want greater flexibility of access to primary care. In the old model, people might be at home during the day and have time to go to the GP; today, people need a service that is adapting to the current workplace and the way families live and wish to access primary care.

The “General Practice Forward View” committed to investing £45 million in a national programme, to run over three years, to stimulate uptake of online consultations systems for every practice, and taking actions to support practices to offer patients more online self-care and self-management services. The issue is not just the hours of access to primary care, but the channel of access. That may be through the improvements in clinical service offered through the 111 helpline—the doubling of the number of clinicians answering those calls—but it is also about primary care having different ways of serving their constituencies through online platforms.

NHS England and Health Education England are working together to boost recruitment, to address the reasons why GPs are leaving the profession and to encourage GPs to return to practice. Furthermore, the Government have committed to developing the wider primary care workforce and supporting improved access in terms of both GP numbers and how patients can access those services. In Essex, the Witham primary care hub is expanding access within the community for patients, integrating care within the community setting, and the Sidney House and The Laurels practice is using CCG funding to improve its primary care appointments system and its IT.

I commend my right hon. Friend the Member for Witham for raising these issues. She is absolutely right to recognise that, as Witham grows and its health needs evolve, it is important that primary care in the town adapts to the changes in her constituency. In putting these issues on the record today, she has signalled the importance of that to Witham, and how the investment that this Government are making in medical school places at Chelmsford, in primary care nationally and in the ambulance service is addressing the needs that she has articulated today.

Question put and agreed to.

Emergency Services and New Estates

Steve Barclay Excerpts

Tuesday 27th March 2018 Westminster Hall

[The Minister for Health (Stephen Barclay)]

It is a pleasure to serve once again under your chairmanship, Mr Hollobone. I commend the hon. Member for Darlington (Jenny Chapman) for securing this debate. First, I extend my sympathies and, I am sure, the sympathies of all those present, to Charlotte for her loss.

The hon. Lady has used a Westminster Hall debate in the finest tradition, by raising an issue that I was not previously briefed on to the degree that I am now as a consequence. There is ongoing work on it, which I will happily update her and the rest of the House on. She has highlighted an issue that affects all of us in all our constituencies, because as the Government seek to build more housing, this issue will grow across constituencies and have greater reach. Also, as she rightly said, it applies not only to the ambulance service but to the blue-light fraternity as a whole, so I very much commend her for raising the issue.

The hon. Lady showed that she already has an in-depth knowledge of some of the challenges caused by the time lag in how systems are updated. However, I am pleased to reassure her that there is work ongoing in this area specifically. The Department of Health and Social Care is centrally procuring new control room and vehicle communications systems for NHS ambulance trusts, which will be able to update wirelessly. There are questions as to the frequency of those updates, which relates to the point that my hon. Friend the Member for Ayr, Carrick and Cumnock (Bill Grant) made about the flow of information from the Department for Communities and Local Government, the planning system and the Ordnance Survey. The ongoing work in the Department is looking at how the central procurement of information into control rooms can ensure that there is a better supply of data about new housing of the sort that the hon. Member for Darlington referred to.

Although the effective deployment and maintenance of GPS systems is, as I am sure the hon. Lady recognises, an operational matter, they are centrally funded systems. As she said, the Department for Business, Energy and Industrial Strategy sponsors the Ordnance Survey, which owns the public sector mapping agreement. That is a 10-year agreement entered into in 2011, which provides the geographical datasets that are used centrally. That information includes data to advise emergency services of the best locations in which to position their vehicles at any given time of the day, based on historic patterns of where they are most likely to be needed. Updates to those datasets are available every six weeks, and the Ordnance Survey is engaged with the emergency services on their specific needs and on whether increasing the frequency of that supply of information would be useful.

As the hon. Lady may be aware, there has recently been a trial, which concluded at the end of February, and the Ordnance Survey is currently analysing the findings of that work in order to develop options. The North West Ambulance Service—not the north-east service—was part of the initial trial, and it has fed its experience into that process. So there is ongoing work on central procurement and also on that trial, examining the issues that the hon. Lady has brought before the House today.

I recognise that the frequency of the updates has been variable, and the hon. Lady was quite right to draw the House’s attention to that. As part of the ambulance radio programme, a replacement mobilisation application has been procured for use in ambulance vehicles across all the NHS ambulance trusts in England. Under that contract, the supplier is required to provide mapping software and an embedded satellite navigation system to assist ambulance crews with the prompt location of emergency incidents. The contract also requires the supplier to provide automated, over-the-air map and satellite navigation updates on a quarterly basis, and to report the current versions of the maps being used for audit purposes.

I am sure the hon. Lady will join me in welcoming those developments. The new system will make up-to-date map and satellite navigation data more readily available to all emergency crews.

[Melanie Onn]

Has the Minister given any consideration to my hon. Friend’s concern about the lack of data that has been collected, and would there be any benefit to collecting that information, to make sure that the new system that will come on-stream is distinctly preferable to the old system?

[Stephen Barclay]

The hon. Lady makes a pertinent point; I was just going to come on to the issue of timing. There are two aspects to this process: the updating of control systems and the updating of vehicles. Different work is happening on both those things, but she suggests a third point to be considered—the data that feeds into those two systems, and the time period between housing development coming on-stream and the systems being updated. Those are the points that I take from her remarks and they will inform further discussions with Government as part of the pilots and the other work that is already under way.

The North East Ambulance Service has improved the processes for updating its mapping system, and I suspect that much of the credit for that goes to the hon. Member for Darlington for raising the issues that she has raised. The trust has upgraded its computer-aided dispatch system and control room mapping updates, and they can now be installed without affecting the wider system, which was one of the difficulties previously. The upgrade allows for six-weekly additions of notifications received from local authorities when new housing estates are opened, better equipping 999 dispatchers to guide ambulance crews to locations when they need assistance. Other ambulance trusts have similar arrangements for updating the control room systems that are currently in place.

The North East Ambulance Service Trust has also improved the frequency of its updates to its individual vehicle mapping systems, moving from an annual update to one every six months. Again, that is not the timeline that the hon. Lady quite rightly highlighted, but it does show that there is a focus on this area, and it shows the direction of travel on improvements.

We recognise that there is variation in the updating of ambulance vehicle systems. That is driven by the fact that different systems are in place in different services. For example, some trusts are able to update their ambulances through wi-fi, while others require lengthy manual updates to be performed during regularly scheduled vehicle servicing. Following this debate, one of the issues that I will be keen to explore further with officials is what will happen as we procure new vehicles. We will consider what can be done to address the issues that the hon. Lady raised today.

The common ambition among ambulance trusts is to upgrade vehicles in a six-month rotation, and we will improve on that rate further with the new national solution. Some trusts have also taken the approach of providing personal-issue tablets with online-style mapping, which can be used by ambulance crews as a back-up to the vehicle’s satellite navigation system and use the most recent commercially released maps.

A range of work is under way within the ambulance service on changes to how calls are triaged and processed, which will address some of the imbalance between rural and urban areas that we have seen in the past. There is work on changes to control room systems and on upgrades. I will happily take forward the point raised by the hon. Member for Great Grimsby (Melanie Onn) about the timescales and about what work can be done and is being done on that.

The hon. Member for Darlington deserves credit within her own trust area for raising these issues as a consequence of the tragedy that Charlotte has had to endure. There is a focus within ambulance trusts across England on the need to ensure that upgrades are made in a more timely fashion. The hon. Lady has rightly brought that point before the House, and I will continue to take it forward with officials in the weeks and months ahead.

Question put and agreed to.

Leaving the EU: NHS

Steve Barclay Excerpts

Thursday 22nd March 2018 Westminster Hall

[The Minister for Health (Stephen Barclay)]

It is always a pleasure to serve under your chairmanship, Mr Davies. May I begin my joining colleagues in remembering PC Keith Palmer and all those injured in the attack this time last year?

I congratulate the right hon. Member for Exeter (Mr Bradshaw) on securing the debate. He is a former Minister of State for Health. It is always interesting to hear from him both in his capacity on the Committee and with the experience he brings to the House on health issues. I also pay tribute to the Chair of the Health and Social Care Committee for the very informative report that was published this week.

I will start by addressing workers’ rights, which were raised by the shadow Minister. The Government have made it very clear that there is a commitment to protect workers’ rights and to ensure that they keep pace with changing labour markets. We do not need to be part of the EU to have strong protections for workers. The Government have a very strong commitment on that.

One of the key points raised by colleagues during the debate was the workforce. I am happy to respond constructively to the challenge set by the shadow Minister to send a strong message to EU staff within the NHS on how valued and essential they are. Healthcare professionals are internationally mobile. They are a key component of the NHS. There is consensus across the House on how valued they are as a part of the NHS, and that is very much part of the Government’s approach.

The NHS is a people business. Two thirds of what we spend in the NHS is on staff costs, so it is absolutely essential that there is a clear message to NHS staff. That extends to the people who are trying to re-run the referendum debate and go back to past arguments, who ignore the fact that, according to the latest figures, which go up to September 2017, there are 3,200 more EU nationals working in the NHS than at the time of the referendum.

[Dr Paul Williams]

There might be more EU nationals working in the NHS, but the number of EU clinicians has reduced. I believe that our points about doctors, nurses and midwives are still valid.

[Stephen Barclay]

There has been a slight reduction in nurses; the situation is more textured for clinicians as a whole. The hon. Gentleman did not touch on the fact that there are almost twice as many doctors from the rest of the world than from the EU. The NHS recruits internationally, and that will still be the case after Brexit. The Prime Minister has signalled repeatedly that the UK will be open to the brightest and best, and that will continue to be the case regardless of the deal we do.

[John Grogan (Keighley) (Lab)]

Looking to the future, doctors from outside the EU are currently subject to a strict regime, and at the moment the demand for sponsorship certificates showing that an NHS trust wants to employ a doctor seems to exceed the supply. Will doctors from the EU who want to come to our country post Brexit be subject to the same regime, or does the Minister envisage a different regime? What representations is he making to the Home Office about that matter as we look forward to the immigration Bill?

[Stephen Barclay]

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

[Dr Sarah Wollaston (Totnes) (Con)]

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

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

[Stephen Barclay]

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

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

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

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

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

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

[Tom Brake]

Would the Minister like to speculate on when decisions on that investment were made?

[Stephen Barclay]

I do not know the precise date but, having come to the House from a corporate career, I know that decisions can usually be stopped if there is a concern. The gestation is often for a longer period, but that does not mean that the decision cannot be stopped. The right hon. Gentleman may be able to point to one or two decisions, but there have been a number of significant decisions in the life sciences industry. I look at the investment in Oxford and Cambridge and, for example, the commitment of the Bill and Melinda Gates Foundation and its significant investment in the life sciences industry. I also look to the work that my hon. Friend the Member for Mid Norfolk (George Freeman) has done on the life sciences industry in terms of the golden triangle of London, Oxford and Cambridge. This is a sector that we should be championing, not talking down.

There has been significant investment in the life sciences industry in the past 12 months. It is perfectly valid for colleagues to raise concerns and to recognise the need for the Department to reassure and address specific issues as part of our planning for Brexit. However, it is misleading to suggest that this industry is not thriving when we see the highest investment in Europe coming to the UK, we see 3.5% of the global market coming into the UK and we see Oxford and Cambridge—the golden triangle, as it is termed—thriving in the way we have seen in recent months. Kent Council has been getting in on the act with NCL Technology Ventures, which has put further money into forward-looking medical technology. Even local authorities are recognising the benefits of investment in the life sciences. International and domestic investors are coming together in this area. It is beholden on us in these debates to better reflect the reality of what is happening.

I am always keen to listen to the hon. Member for Stockton South (Dr Williams), who always speaks with authority on medical matters, not least as he is a practising clinician. However, on this occasion I fear he strayed into Treasury matters when he started to talk about the UK growth forecast diminishing. As a former Treasury Minister, I was particularly interested in his remarks, and I gently point out that they were at odds with the Office for Budget Responsibility. The OBR is clear that the growth forecast for 2019 and 2020 is 1.3%. That rises to 1.4% in 2021 and to 1.5% in 2022. The OBR recently improved its growth forecast.

[Dr Williams]

I agree that I am straying into Treasury matters, but I have read the IMF’s forecasts for the UK economy for 2019, which were downgraded from 1.6% to 1.5%, when many of our closest partners, including the United States, Germany and Canada, were upgraded. I have also seen that the UK’s economic growth has fallen from the highest in the G7 to the lowest. That has all happened since our decision to leave the European Union. Is it not true that the IMF predicts that our economic growth will be less than it would have been if we had not made that decision?

[Stephen Barclay]

We can see the variability of forecasts, but the OBR’s forecast, which is the one that really matters—there is consensus that the Government rely on it and that Government planning is undertaken on the basis of it—shows a clear trajectory of improvement that is not reflected in much of the doom and gloom that we have heard in recent weeks. The debate is better informed if we tie it into the benchmarking that the Government use when setting fiscal policy.

The hon. Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron) commented on the fact that her constituents are bored by the length of the Brexit debate. I am sure that if anyone is watching the debate, that will resonate with them. That is why it is so important for us to look forward. We should look at the areas of real concern where the Department needs to focus, such as maintaining the regulation and considering the mutual recognition of qualifications, which is a real issue that we want to make progress on with the European Union, because it is of concern to people. To look constructively at how we address some of those issues is far better than having groundhog day on the same areas.

[Dr Cameron]

Given the evidence we heard, and given that I have emphasised how critical the NHS is to the public and that it is a key priority for Brexit, I am perplexed that the Secretary of State for Health and Social Care does not have a place at the Brexit table in Cabinet. Far be it for me to try to elevate him even further, but the NHS is crucial and pivotal and deserves to be at the core of Brexit.

[Stephen Barclay]

The hon. Lady is right to recognise the skills and talent that the Secretary of State brings to this debate as to many others. It is no coincidence that he is the second-longest serving Secretary of State for Health. It would be recognised across the House that it is a demanding job. It is to his great credit that he has been in post for such a period and that he has championed patient safety in the way that he has, which the shadow Minister has generously recognised on occasion.

The Secretary of State’s role in Government was further signalled and underscored by the Prime Minister in the recent reshuffle, when the responsibility for social care was added to the Department. As the debate has reflected, social care, and how we address it from an immigration perspective, and from a training and upskilling perspective, is one of the key legitimate areas of the Brexit debate. We are focused on that in our discussions with the Home Office and others.

The hon. Member for Motherwell and Wishaw (Marion Fellows) picked up on the need for a transition period. That point reflects the fact that the Government are listening and have responded constructively. I know from my previous role in the financial services sector in the City that there is a strong desire for a transitional period. That point was also raised by many in the healthcare sector. It is to the great credit of the Secretary of State for Exiting the European Union that those discussions have been conducted in such a constructive way. There has been a lot of doom-saying and negative commentary—“Nothing will be agreed; it won’t work.”—but he has assiduously stuck to his task. While there are some formal processes still to be completed, significant progress has been made on a transition deal, and there is reasonable consensus that it is constructive.

Several colleagues mentioned the impact of leaving Euratom. I simply remind the House that there is nothing in the Euratom treaty that prevents materials from being exported from an EU member state to countries outside the EU, nor do those materials fall into the category of so-called special fissile material, which is subject to nuclear safeguards. We very much recognise the short half-life of medical radioisotopes and the need for rapid delivery, but again there is much that can be constructively done.

The shadow Minister mentioned subsidiary companies. I do not want to incur your displeasure by straying too far from the subject of Brexit and into subsidiary companies, Mr Davies, but as the shadow Minister raised that point, I feel it is appropriate to address it. He asked what TUPE protections there will be. There are TUPE protections now and the Government have absolutely no intention to change that.

For those who sometimes suggest, as Opposition Members occasionally do, that subsidiary companies within the NHS is a form of privatisation, I merely remind the House that this legislation was passed in 2006 under a Labour Government. I was not in the House at the time, but I do not recall—this may be one for those connoisseurs of Hansard—that it was presented by Labour Ministers as a way of achieving privatisation in the NHS. Subsidiary companies are 100% owned by their parent company, which is the NHS family, so they stay very much within that.

[John Grogan]

Since the Minister has gone in that direction, I ask him again specifically: if it is such a good idea, would it be a good idea for NHS trusts that propose setting up subsidiary companies to publish their business plans so we can see what is happening with that public money?

[Stephen Barclay]

I am a former member of the Public Accounts Committee. The then Chair, the right hon. Member for Barking (Dame Margaret Hodge), would always talk about following the public pound. The National Audit Office has considerable reach in doing that.

My point is that subsidiary companies are within the NHS family. They are 100% owned by the NHS foundation trust that sets them up. They are a better vehicle than the alternative of contracting out, which gives far less grip over how services are provided. The legislation passed by a Labour Government is welcome. We should not re-write history and suggest that legislation that was fine in 2006 should suddenly be presented as privatisation.

That goes to what we sometimes see in the Brexit debate—I will bring this back to the Brexit debate, Mr Davies—in terms of a trade deal with the US. We are sometimes told that a trade deal with the US in a Brexit context is alarming and somehow a threat to the NHS, often by the same people who are very positive about the EU. When TTIP was being debated, the EU lead negotiator said TTIP was not a threat to the NHS.

[Dr Williams]

If there is no threat from a trade deal with the United States, will the Minister rule out the possibility of United States pharmaceutical companies gaining the ability to market directly their products to UK patients in any future trade deal?

[Stephen Barclay]

My point is that we will have control of our trade deal. The Prime Minister has made it clear that there will be no change in the protections afforded to the NHS. The subject of the debate is Brexit, and we are talking about the difference between being inside and outside the EU. The regulatory controls as they would have been under TTIP will be no different in the new landscape.

I remind the hon. Gentleman, who was very critical of Brexit, that more than 61% of people in Stockton voted to leave the EU. He might think that his voters are misguided and wrong, and that they made a huge error in how they voted, but I hope he agrees that it is right that the Government respect that democratic decision and deliver control over our trade policy.

[Martin Docherty-Hughes]

The Minister will appreciate that Northern Ireland voted to remain in the European Union. He seemed to hop, skip and jump over the issue of the border. Will he clarify today, or in writing to Members who are participating in this debate, that the common travel area will extend to a member of NHS staff working in Northern Ireland who happens to be a Romanian or French citizen but lives in the Republic of Ireland, and that they will not be forced to become a citizen of the Republic of Ireland or the United Kingdom after Brexit?

[Stephen Barclay]

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

[Dr Wollaston]

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

[Stephen Barclay]

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

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

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

Oral Answers to Questions

Steve Barclay Excerpts

Tuesday 20th March 2018 Commons Chamber

[Eleanor Smith (Wolverhampton South West) (Lab)]

4. What estimate he has made of the number of NHS trusts that have established wholly owned subsidiary companies.

[The Minister for Health (Stephen Barclay)]

NHS Improvement has informed the Department that 42 foundation trusts have reported consolidated subsidiaries, but there might be a few instances of subsidiaries being too small to be consolidated.

[Eleanor Smith]

What assessment has the Minister made of the impact on staff morale, retention and recruitment where trusts have set up wholly subsidiary companies and introduced a two-tier system whereby new staff terms and conditions are not part of the NHS “Agenda for Change” or the NHS pension scheme? Is this the back door to privatisation?

[Stephen Barclay]

Had the hon. Lady been able to attend the recent Westminster Hall debate on this issue, she would have heard that in the trust under discussion the staff survey showed an improvement in responses as a result of the subsidiary because many staff valued the flexibilities in the new contracts that the subsidiary could offer.

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

The Minister may be in denial about privatisation, but is it not the case that the question-and-answer document from North Tees and Hartlepool Hospitals NHS Foundation Trust said that its subsidiary organisation could be taken over by a private company in the future? If the Minister wants to put these privatisation stories to bed, will he rule out the possibility of any of the subsidiary companies’ being taken over by private organisations in the future?

[Stephen Barclay]

The party that is in denial is the Labour party, which, in 2006, passed the legislation through which subsidiaries could be offered. If the hon. Gentleman does not believe me, perhaps he should listen to NHS Providers, which says:

“It is…inaccurate and misleading to say that the establishment of wholly owned subsidiaries is a new phenomenon or being pursued to avoid VAT, privatise the NHS, or to reduce terms and conditions for NHS staff.”

Labour Members should stop scaremongering over legislation that their party actually passed.

[Dan Carden (Liverpool, Walton) (Lab)]

5. What recent assessment he has made of the level of public satisfaction with the social care system.

--- Later in debate ---

[The Minister for Health (Stephen Barclay)]

My neighbour is correct that I know the hospital, not least because my son was born there, and he is absolutely right to highlight the importance of the work done at King’s Lynn and of the staff there. In the Budget the Chancellor signalled his additional commitment for the “Agenda for Change” staff, and those discussions are ongoing.

[Liz McInnes (Heywood and Middleton) (Lab)]

T3. My constituent, Rebecca, is a podiatrist. Last week she told me that the care that she provides is having to be rationed because of a combination of insufficient funding and staff shortages. What assessment has the Minister made of the impact of the removal of the NHS bursary on the training of future podiatrists, and what action will he take to address the funding shortage?

[Stephen Barclay]

The reality is that the number of places is increasing, even if the number of applications is lower. The Government have signalled their commitment on pay. We have more clinicians, doctors and nurses, and we are treating more people. That is part of the success of the NHS under this Government.

[Mr Philip Hollobone (Kettering) (Con)]

T9. I thank the Secretary of State for visiting Kettering General Hospital recently. In his opinion, on what main issues does the hospital need to concentrate in order to get itself out of special measures?

--- Later in debate ---

[Stephen Barclay]

My hon. Friend always, quite rightly, champions the work of nurses. She is also right to signal the importance of the nursing apprenticeships, which offer a new route, particularly for many healthcare assistants, to progress within the NHS. It is right that we increase the number of pathways for nurses in order to deliver the excellent care that they provide.

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

T6. During the first seven weeks of 2018, 10,375 more people died in hospital than in the same weeks in the previous five years—one extra death every seven minutes. It was not colder than usual and deaths from flu were not up, but our hospitals were under unprecedented pressure. Why did all these extra deaths occur?

[Bim Afolami (Hitchin and Harpenden) (Con)]

Does my right hon. Friend the Secretary of State recognise the strong business case for the merger between Luton and Dunstable University Hospital and Bedford Hospital in terms of delivering value for money for our local health economy?

[Stephen Barclay]

My hon. Friend has been assiduous, as have his neighbours, in lobbying the case for Luton and Dunstable and Bedford. He will be aware that the ongoing business case is being reviewed as part of that, but ultimately this is about the £3.9 billion of additional capital investment that the Government have funded. That is why these cases are being reviewed.

[Alan Brown (Kilmarnock and Loudoun) (SNP)]

T7. Over a third of children in the UK are either overweight or obese. The Royal College of Paediatrics and Child Health has warned that a trade deal with the US could lead to an influx of junk food with high fat, sugar and salt content. Will the Health Secretary make sure that health is put above trade going forward?

--- Later in debate ---

[Thelma Walker (Colne Valley) (Lab)]

T10. The Independent Reconfiguration Panel’s report on the downgrading of Huddersfield Royal Infirmary is sitting on the Secretary of State’s desk, and I have been told that it will be made public “in due course”. May we now have the exact date on which it will be published?

[Stephen Barclay]

I am aware of the issues raised by Kirklees Council, and I understand that local campaigners have referred this to judicial review. Given the imminent legal proceedings, it would not be appropriate to comment further at this stage. A decision on the referral to me by the local council will be made in due course.

[Alex Chalk (Cheltenham) (Con)]

Cheltenham General is a wonderful hospital, but it needs investment in theatres and wards. May I take this opportunity to commend the application for over £30 million of capital funding, which would make a huge difference to my constituents?

--- Later in debate ---

[Frank Field (Birkenhead) (Lab)]

May I thank the Minister for his concern about what is going on at Arrowe Park Hospital? Will he meet Wirral Members shortly so that we can be assured that the existing governance is very short-term and that the issues of bullying and the way the hospital cripples primary care are dealt with effectively?

[Stephen Barclay]

The right hon. Gentleman is right to raise that serious issue. There needs to be a culture change in Wirral, and I am happy to continue to meet him and other Wirral Members to discuss that. He will be aware of the NHS Improvement report on that issue on 5 March.

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

According to Lord O’Neill, diagnostics prior to prescription of antibiotics is the most important of the 10 commandments in the O’Neill review on antimicrobial resistance. Will the Minister update the House on progress towards that very important goal?

--- Later in debate ---

[John Grogan (Keighley) (Lab)]

With a significant amount of public money at stake, should not NHS trusts that are proposing to set up subsidiary companies publish their full business cases?

[Stephen Barclay]

The point is that trusts are 100% owned by the NHS, so any benefit accrued from the subsidiary goes to the NHS, because it is fully owned by the public sector.

Hemel Hempstead Urgent Care Centre

Steve Barclay Excerpts

Tuesday 13th March 2018 Commons Chamber

[The Minister for Health (Stephen Barclay)]

I will do my best to address the issues raised by my right hon. Friend the Member for Hemel Hempstead (Sir Mike Penning) in order to pre-empt the further debate to which he alludes. I congratulate him on securing this debate. I commend him for his continuing and passionate campaign on behalf of his constituents, and for his expertise on health issues, which he has brought once again to the House.

I reiterate the fundamental principle for all service change in the NHS: it should be based on clear evidence that it will deliver better outcomes for patients. That is the framework that is applied. I understand that my right hon. Friend is concerned about the changes proposed in his constituency. He will appreciate, not least as a former Minister, that I cannot say anything that would prejudice the outcome of the ongoing consultation, but he has spoken powerfully about his concerns in the House tonight.

I am sure that my right hon. Friend agrees that any decision should be driven by what is best for the constituency clinically, by what is best for the health service in the area, and by what is of most benefit to the greatest number of people in the area. I shall briefly set out some of the background, as I understand it, to the issues that inform the consultation. As he mentioned, in December 2016, the urgent care centre was temporarily closed overnight because of concerns about patient safety as a result of problems with staffing the GP overnight shifts. The CCG’s advice was that the urgent need to address patient safety issues did not allow time for consultation about that temporary change. I appreciate the concern that he raised about the manner in which that decision was taken.

The local NHS has worked hard to manage the consequences of the decision. I understand from the CCG that the volume of overnight patients at the centre was relatively low, and that the impact that has been felt at Watford General Hospital, notwithstanding the other challenges it faces, has been of the order of one or two patients per night, usually those with relatively minor injuries. As my right hon. Friend will be aware, emergency cases have been sent to Watford since the closure of Hemel Hempstead’s A&E in 2009—he referred to the protest involving a coffin about that decision, which was taken under the previous Labour Government. On provision in the early hours of the morning, he will also be aware that journey times then will be shorter than they would be at the times when the urgent care centres are open.

[Sir Mike Penning]

Let me go back a fraction. If the decision has to be based on clinical advice—I understand the principle—what is the point of consulting the public, who are not clinically trained? We have to consult them, because that is what the law says, so is the law wrong for saying we should consult people who are not clinically trained? If the decision has already been made, what is the point?

[Stephen Barclay]

The public consultation is to inform the discussion with clinicians. If such a decision were taken by Ministers—my right hon. Friend alluded to this in his remarks—it would likewise be informed by public consultation. That is part of running a transparent and open process.

The CCG is now consulting the public on future opening hours, following a broader urgent care strategy review. The consultation seeks views on three options: retaining the current temporary hours; increasing the temporary hours by two hours at the end of the day; or re-opening on a 24-hour basis. As it runs until 28 March, I know that my right hon Friend and his constituents will wish to share their views as part of the process.

I do understand the criticism made by my right hon. Friend’s constituents that the overnight closure has been dragging on for too long and that a final decision needs to be made as soon as possible. The views gathered during the current consultation will inform the CCG’s decisions about the future opening hours for Hemel Hempstead UTC, as well as about the contract for West Herts medical centre. I further understand that the CCG has commissioned an independent research company to review and analyse all the comments received, and the feedback will be compiled into a summary report. That will be presented to the Herts Valleys CCG board meeting, in public, on 26 April, when a decision on both issues will be made.

Turning to the issue of the treatment centre’s status, on 1 December 2017, Hemel Hempstead UCC changed to a UTC, as part of national measures introduced by NHS England. I understand from the CCG that this was a change of name, not of service. The CCG therefore did not carry out a further consultation on the establishment of the UTC as it did not feel that that represented a significant change in service. I understand that no services have been withdrawn from the UTC, but there have been a number of enhancements, including: the introduction of a number of bookable appointments through NHS 111; the addition of near patient testing for some conditions, reducing waiting times and reducing the need for patients to attend Watford General Hospital for some tests; and an improved IT system, meaning that medical staff will be able to access patients’ records if they give consent. The CCG also expects services to expand to include other professionals, such as pharmacists, emergency care practitioners, those providing access to mental health services and community nursing staff.

That also dovetails with some important changes in planned care locally. I understand from the CCG that improvements in the treatment of musculoskeletal disease mean that the single point of access triage at Hemel can direct people on to community physio, where that meets their needs. That is good for the individual patient and also ensures that capacity in the acute settings is able to concentrate on those with more complex needs.

[Sir Mike Penning]

The Minister has just told the House that there has been a complete change in how physiotherapy is provided—it was provided at the hospital and is now provided elsewhere. There was no consultation on that, although I understand that there was a requirement to do so, because this involved a complete change of service in respect of where people go and so on. The point I am trying to make is: when there is no consultation, what do we do? Do we just sit back and say, “Okay”? Some kind of measure has to be taken when consultation continually gets ignored or does not happen at all.

[Stephen Barclay]

The distinction that was being drawn was in respect of services that have been removed, on which my right hon. Friend is right that there is a legal requirement for a consultation. He has expressed to the House his concerns about the process by which that temporary decision on patient safety was taken. The point I was making was that the services that have been brought to the area are bringing a benefit to the local community. I would have thought that they would be welcomed. Indeed, from April, many patients with diabetes in the area will no longer need to travel to Watford to be seen by a consultant, because the consultants will be coming to them by working in the community. Again, that is good for patients and for the system as a whole. It is part of the way in which these systems evolve: some services come closer to the community, while others, as under the decision taken by the Labour Government in 2009, are rationalised into Watford A&E.

I understand my right hon. Friend’s frustration that in his view the local CCG seems out of touch with popular opinion. Given the way in which he champions the community that he represents, I know that he is not out of touch with popular opinion—he always speaks in a well-informed way about his constituents’ needs, and I would expect that to be represented in the consultation responses that the CCG receives. The CCG is accountable to NHS England for fulfilling its functions. It is also a member of the health and wellbeing board, at which local authorities and other partners can challenge how it has been fulfilling its functions. The CCG’s activities are subject to scrutiny by local authorities and to supervision by NHS England. If NHS England believes that the CCG is failing to discharge its functions, it has the power to intervene and issue directions, or to replace the accountable officer.

It is worth reiterating that all proposed service changes should meet the four tests for service change. They should have support from GP commissioners; be based on clinical evidence; demonstrate public and patient engagement; and consider patient choice. It is right that such matters are addressed locally, where local healthcare needs are best understood, rather than in Whitehall. I think my right hon. Friend recognised the point about Ministers not making clinical-led decisions. For those reasons, I am sure that he will appreciate that I am not able to offer the House an opinion on the merits of the proposals, but of course we recognise that changes to health services inspire passionate debate, as they should, from all quarters, as we have seen this evening.

There is no standard approach on what an urgent care centre should offer. The offer varies between different urgent care centres, depending on the services required locally. Urgent care centres can treat a range of injuries, including sprains, strains and broken bones.

[Sir Mike Penning]

I want to help the Minister. The urgent care centre is gone. We do not have an urgent care centre; it is now an urgent treatment centre. This is something that confuses my constituents as well. I was trying to make two points. First, it is not just about the clinical commissioning group on its own. The decision to close over Christmas in 2016 was made by West Hertfordshire Hospitals NHS Trust, and it cannot escape blame, because it was the trust’s chief executive who made that decision and went on and acted. Secondly, it is also about the lack of knowledge and understanding of the community. We have had a churn of people coming through and running the services. They seem to come and go and come and go, never understanding or empathising with the constituency.

[Stephen Barclay]

Before my right hon. Friend’s intervention, I was just coming to the urgent treatment centre, because there is obviously a distinction. Urgent treatment centres are about standardising the range of options and simplifying the system so that patients know where to go and have clarity about which services are on offer. My right hon. Friend made the point about how we direct footfall and constituents into services at the right point to reduce the demand on the A&E at Watford by simplifying what the UTC does, what it offers and how that is understood by constituents.

Patients and the public will be able to access urgent treatment centres that are open for 12 hours a day, and that are GP-led and staffed by a range of clinicians with access to simple diagnostics. They will have a consistent route to access urgent appointments offered within four hours and booked through NHS 111, ambulance services and general practice. A walk-in access option will also be retained. They will increasingly be able to access routine and same-day appointments, and out-of-hours general practice for both urgent and routine appointments at the same facility where geographically appropriate. UTCs are also part of a locally integrated urgent and emergency care service working in conjunction with the ambulance service, NHS 111, local GPs, hospital A&E services and other local providers.

In conclusion, these are important issues, and decisions should not be taken lightly. The location of services is a difficult and often controversial issue, and my right hon. Friend is to be commended for his campaign and the points that he has made on behalf of his constituents.

[Sir Mike Penning]

It is not often that we get more time to speak in this place, so while I have the Minister at the Dispatch Box, can he answer this very simple question: what recourse is there for me, as the MP, and for my constituents when we are misled—I know that I have privilege, but I am using the word “misled”—by a senior NHS management team about what is going to happen to the urgent care service? I am talking about when what the team says turns out to be completely untrue. What recourse is there so that we can start to rebuild some trust in my constituency?

[Stephen Barclay]

As my right hon. Friend knows, it would be inappropriate for a Minister to comment on a specific allegation such as that from the Dispatch Box. I cannot comment on this specific consultation, which is under way as we speak. The point that has come out of this debate is that the decision of December 2016 was taken on patient safety grounds, owing to a difficulty in recruiting GPs at that time. A consultation is now under way, and it is for my right hon. Friend’s constituents to make their case as part of that consultation.

The people affected by these changes need to be involved in the decision; that is what the consultation will seek to achieve. Our starting point for discussing service change is that there will be no changes to the services that people currently receive without proper public consultation. I therefore urge my right hon. Friend and his constituents to make their voices heard as part of that consultation in the usual way.

Question put and agreed to.

NHS Wholly Owned Subsidiary Companies

Steve Barclay Excerpts

Tuesday 6th March 2018 Westminster Hall

[The Minister for Health (Stephen Barclay)]

It is a pleasure to serve under your chairmanship, as always, Mr Hollobone. It is also good to see a number of Members from across the House in the Chamber to debate this important issue. I congratulate the hon. Member for Blaydon (Liz Twist) on securing this debate. I am pleased to be able to join her in discussing an issue that is of concern and interest to many in the House.

I understand that Gateshead Health NHS Foundation Trust established its wholly owned subsidiary company, QE Facilities, in 2014 to provide estates, building and engineering services to the trust and cleaning services to the new emergency care centre building. QE Facilities is a separate legal entity, which operates along commercial lines. It has separate governance arrangements and the ability to employ its own staff and deliver services to other organisations on a commercial basis. As the hon. Lady said, a number of staff from the Queen Elizabeth Hospital in Gateshead transferred under TUPE rules to the new organisation in December 2014. I will respond to her points.

A number of hon. Members raised the concern that what happened amounts to privatisation, but I must point out that the legislation enabling NHS organisations to create subsidiaries of this sort was put in place by the Labour Government in 2006. If it is privatisation, it is privatisation enabled by Labour legislation, and I do not think that is the way Ministers described it to the House at the time. The subsidiaries are also 100% owned by the trust, so they are within the NHS family.

It is right that the board of the Queen Elizabeth Hospital was able to use the powers enacted by the previous Labour Government. It did so because creating a subsidiary is, in its view, the most effective and efficient way of maintaining the trust’s hospital estate, which includes several new buildings. Again, that is consistent with the previous Labour Government’s approach, which was to allow local trusts to determine the best manner of managing their own estates.

[Alex Cunningham]

I do not care which Government provided the enabling legislation. Surely the Minister agrees that the intention was never to undermine the working terms and conditions of people within the NHS just to enable trusts to cut the amount of money they need to spend?

[Stephen Barclay]

I will happily address that. The hon. Member for Bradford South (Judith Cummins) also made that point and said that this is about exploitation. The hon. Member for Stockton North (Alex Cunningham) may not care whether the legislation was introduced by a Labour Government; I was merely drawing hon. Members’ attention to the fact that when the legislation was passed it was not described as privatisation. It is obviously a leap to describe the legislation as enabling privatisation when the subsidiaries are wholly owned by the NHS.

[Alex Cunningham]

I am grateful to the Minister for giving way again. The North Tees and Hartlepool NHS Foundation Trust said in its question and answer document that such an organisation could be taken over by another organisation—in other words, it could be privatised. This is one step along the way to the potential privatisation of all those services.

[Stephen Barclay]

The trust has stressed that the organisation remains in public ownership. Let me deal with the hon. Gentleman’s substantive point—it was also raised by the hon. Member for Bradford South— that this is about exploitation. I discussed that point with the trust ahead of the debate.

Previously, the trust had difficulty in attracting and retaining quality maintenance staff because the salaries paid in the local market were about £19,000 per annum. Under the subsidiary company, multi-skilled craftspeople are employed at about £25,000 per annum, plus a performance bonus, attracting better-qualified staff and ending retention issues, in exchange for the fact that they do not have access to the NHS pension.

[Liz Twist]

rose—

[Stephen Barclay]

I will happily give way to the hon. Lady in due course.

That is not about exploitation; it is about empowering members of staff. They get higher pay in the short term in return for a less generous pension. The hon. Member for Stockton North might disagree—

[Judith Cummins]

Will the Minister give way?

[Stephen Barclay]

I signalled that I will give way to the hon. Member for Blaydon. She called the debate, so she should go first.

It is not accurate to say that this is simply about exploiting people if their base salary is increasing from £19,000 to £25,000, as it is in that trust. One can look at the wider bundled package of benefits and total remuneration, but one cannot describe a salary increase of £6,000 as exploitation.

[Liz Twist]

The Minister is raising an issue of great concern to me, which I have discussed with the chief executive of the foundation trust, so this is not coming as news to him. If we move away from a structured pay system and give additional salary payments over and above allowed recruitment and retention bonuses, we are laying the trust or the organisation open to the claim that they are not providing equal pay for work of equal value. A huge amount of work went into creating “Agenda for Change” to avoid exactly that problem and to address recruitment and retention.

[Stephen Barclay]

The hon. Lady is ignoring the fact that that already happens in the NHS, for existing trust staff: some staff opt out of the NHS pension, and not all the staff who TUPE-ed across in this arrangement were in the NHS pension. Once again, those on the Labour Benches want to deny the choice and options that apply to NHS staff.

[Judith Cummins]

I thank the Minister for giving way, because he has heard me twice now, but I welcome the opportunity. Does he not agree that the difference between then and now is that NHS trusts now are being forced down the path of wholly owned subsidiary companies because of financial constraints? It is not good enough for the Government simply to stand by and watch that happen.

[Stephen Barclay]

Again, that is a complete misrepresentation. The trust itself has pointed to the benefits of the arrangement. Let me give a concrete example of how the arrangement is delivering to the trust savings in the interests of patients.

Under the previous delivery system, local pathology samples were sometimes lost and delayed—that is not in the interests of patients. The QEF brought in a revised system of procuring all sample containers and issuing those to GPs across the region before delivering samples to the hospital pathology laboratory hubs within four hours. The trust forecasts that that will deliver significant benefits—indeed, other trusts are interested in the services. By operating on a more commercial model, therefore, not only has the trust improved how it deals with samples and prevented those samples from being lost as in the past, but it has put in place a system that is better for patients and attractive to GPs in other trusts who now want to contract the services.

[Dr Poulter]

The Minister is slightly at odds about the point being made. The point is not how it is open to the trust to procure the best clinical services but how, later, through a company, staff might be re-employed on a lower salary. Clearly, trusts already have flexibility through “Agenda for Change” to start people on a higher pay point, but I wondered more generally whether my hon. Friend supports national pay bargaining and “Agenda for Change”.

[Stephen Barclay]

The Chancellor made his support for the “Agenda for Change” programme clear in the Budget. My hon. Friend is aware of the commitment that the Chancellor made to fund that outwith the spending review 2015 process. That is a matter of record and one my hon. Friend is well aware of. The point being made, however, is that the flexibilities are popular with staff within the trust. Again, that is not simply a matter of me saying that; it is reflected in the staff survey of those working at the trust.

[Several hon. Members rose—]

[Stephen Barclay]

I will happily take interventions, but first I will finish this point, addressing the previous issue. The recent staff survey was extremely positive: 86% felt part of the Gateshead Health NHS Foundation Trust group. Furthermore, the figure for those with a positive response to the level of pay was 15% higher than the NHS comparator. The idea that the arrangement is exploiting people when the staff survey shows them to be 15% more approving than in other areas is again not a fair representation of the case.

[Karin Smyth (Bristol South) (Lab)]

In the short time remaining, I would like to move the Minister on to the issue of accountability for public money. Following a freedom of information request, in the case of Yeovil we understand that the benefit to the trust is several million pounds-worth of income, which is a lack of income from the Treasury—I have written to the Minister about this and I will be grateful for an answer. Is the Government’s position that they would be happy to forgo the expected income to the Treasury so that those companies can be set up to undercut wages?

[Stephen Barclay]

As I set out in my reply to the hon. Lady, the Department has been clear that setting up a subsidiary is not a vehicle to avoid VAT—that is not acceptable. In the autumn, we sent out guidance to make that clear. As a former Treasury Minister myself, I assure her that Treasury Ministers would take a very close interest if they felt that an abuse of VAT was taking place.

The reality is that commissioners and regulators are responsible for ensuring that NHS providers act in the best interests of patients and taxpayers. We would expect providers to work closely with their employees in any developments.

[John Grogan (Keighley) (Lab)]

Will the Minister give way?

[Stephen Barclay]

I am conscious of the time, but I am very keen to take an intervention from the hon. Gentleman.

[John Grogan]

The Minister is being very generous. Clearly there is a substantial difference of view here, but would he agree that given that public money is involved, it is very much in the public interest that the business plans that the trusts are producing for the wholly owned subsidiaries are published and public, so that they can be scrutinised? In the case of the Airedale trust in my constituency, we discovered that 60% of the savings on purchasing are in VAT. Those figures should be in the public domain, so people can see what is being done with public money in their interests.

[Stephen Barclay]

The slightly puzzling issue here is that the savings accrued from the subsidiaries are for the benefit of the local health economy, of the trust. This is a subsidiary company 100% owned by its host trust. The more efficient the subsidiary is, the better it is at dealing with things such as its pathology—not only do we avoid samples being lost, but we run a more efficient system in a more commercial manner, which brings more money into the healthcare economy and gives the flexibility to compete effectively in the local job market for maintenance staff and others.

The benefits of those arrangements accrue to the trust that owns 100% of the subsidiary. That is why, under legislation of the previous Labour Government—correctly in my view, but clearly not in the view of the Labour Members—the local trust is empowered to empower in turn the local members of staff. That is then reflected in the staff survey, which shows a more favourable result in this trust.

[Rachael Maskell]

I am grateful to the Minister, who has been generous with his time, but does he not acknowledge that the failing finances of the NHS are forcing trusts down that route? I am meeting the Minister next week to talk about York Teaching Hospital’s failed finances. That is the driver of the changes and, therefore, the fundamental issue still has to be addressed.

[Stephen Barclay]

I do not know whether we are moving away from the subject to a wider debate about finance, but the Chancellor’s Budget settlement makes the Government’s finance commitment clear. The fact is that the issue of subsidiary companies is about using the resources of the NHS in the most efficient manner. That is the view not just of the Government and of the previous Labour Government, but of the trust itself. It is delivering a better outcome for patients and delivering savings—I repeat, the savings accrued go to the benefit of the trust that owns 100% of the subsidiary. It is a shame that those on the Labour Benches seem to want to deprive staff of choice and opportunity. Staff are benefiting, and that is reflected in the staff survey.

I hope that in responding to the debate I have allayed a number of the concerns of the hon. Member for Blaydon about the setting up of subsidiary companies by trusts. I am sorry that there is such concern about the legislation put on the statute book by the previous Labour Government and that it is being deemed to be a form of privatisation.

[Alex Cunningham]

Does the Minister think it is fair for one of two different people in an organisation to receive a defined benefit pension scheme with a 50% contribution and the other to get 3% into a defined contribution scheme worth a fraction of the other in pension terms?

[Stephen Barclay]

Within the NHS as a whole—nothing to do with subsidiaries—there is a range of treatment of staff on pensions. First, there are the legacy pension arrangements for staff in previous schemes and, secondly, people opt out of existing pension arrangements in the NHS. Again, it is a complete mischaracterisation of this debate on subsidiaries to suggest that there are differences. The point, however, is that there are also differences in pay, as has come out of this debate: the maintenance staff for whom the trust is paying a premium can be paid so because of the subsidiary.

[Liz Twist]

I thank the Minister for giving way—the only way I can get a response in is by intervening. I have a few separate points. First, on the Labour legislation, is it not strange that the subsidiary companies have only started to appear in this form since 2014? As my colleagues said, that is a reflection of the fact that we have a shortfall in funding for the NHS. Secondly, I want to mention the path lab example the Minister gave. As I said in my speech, there is no reason why existing NHS staff in the NHS trust cannot make the improvements—they do all the time—

Motion lapsed (Standing Order No. 10(6)).