Clinical Waste Incineration

Debate between Steve Barclay and Jonathan Ashworth

Tuesday 16th October 2018 Commons Chamber

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

(Urgent Question): To ask the Secretary of State for Health and Social Care to update the House on clinical waste incineration across the NHS.

[The Minister for Health (Stephen Barclay)]

Yesterday evening, the hon. Gentleman, in a point of order, repeated claims made by Healthcare Environmental Services regarding incineration capacity, and the right hon. Member for Normanton, Pontefract and Castleford (Yvette Cooper) raised a point of order on the capability of Mitie to deliver waste management services for the NHS and on TUPE arrangements for staff employed by Healthcare Environmental Services. I would like to clarify why the statement that there is sufficient incinerator capacity is correct, and why the claims made by the company, which is currently subject to criminal investigation, should not be taken at face value, as appears to have been the case yesterday.

With regard to incinerator capacity, there have been quotes from Environment Agency and NHS Improvement officials, cited in the Health Service Journal in May and August 2018, suggesting that there is a shortage of clinical waste incinerator capacity. By the time of my statement on 9 October, far more due diligence had been conducted on the claims made by Healthcare Environmental Services. Analysis carried out by NHSI identified 2,269 tonnes of incinerator capacity in October. The trusts served by Healthcare Environmental Services produced 595 tonnes. The analysis shows that there is sufficient incinerator capacity for clinical waste and that the statement made to the House was therefore correct. The issue is whether HES is willing to pay for that capacity. The fact that Mitie has secured 1,000 tonnes of incinerator capacity demonstrates that it is available.

The right hon. Member for Normanton, Pontefract and Castleford questioned whether Mitie was capable of delivering waste management for the NHS. The Mitie contract was put in place rapidly on 5 October to ensure continuity of service following trusts exercising their step-in and then termination rights to end their contracts with Healthcare Environmental Services. Over that weekend, Mitie visited the NHS sites to understand their business needs and the frequency of collections required, and responded immediately to trusts where waste needed to be collected. It also located bins on those sites so that the collections could start. Putting a new contract in place so quickly clearly means that there needs to be a phased approach to Mitie providing 100% of the service previously provided by Healthcare Environmental Services.

Mitie is working closely with NHSI to ensure that the needs of the trusts are being met, and regular collection schedules are in place at sufficient levels to maintain all patient services safely. The trusts also have additional contingency storage in place on site, with the waste being collected correctly stored so that the NHS can contain its services. This storage contingency will remain in place until Mitie meets 100% of the waste collection frequency required by the trusts. There is no risk to public safety through the action taken by the trusts.

As regards TUPE, Mitie has written to Healthcare Environmental Services and its legal representatives to request complete information, to assess the situation with regard to the potential transferring of employees and to minimise disruption for those employees. Mitie has also set up a dedicated helpline and email address to support Healthcare Environmental Services staff at this uncertain time.

It continues to be the case that there is no risk to public safety through the action taken by these trusts and that all NHS trusts have been able to continue to provide operations in line with meeting our key objective.

[Jonathan Ashworth]

All we are asking for from the Minister is full transparency. Last week, he told the House with great confidence that

“the suggestion in some quarters that this is an issue of a lack of capacity is simply not valid.”—[Official Report, 9 October 2018; Vol. 647, c. 39.]

Subsequently, we read in the Health Service Journal, as he mentioned, that NHS Improvement had concerns about capacity back in August and acknowledged that there were “national market capacity issues”. He has told us today that due diligence has been done since then. Why did he decide not to reveal in his statement last week that concerns were raised with him back in August? Was he aware when he came to the House and made his statement that these concerns had been raised in August? He tells us that extra due diligence has been carried out. Can he explain what that extra due diligence actually is?

The Minister has tried to reassure us again today that there are no public health implications to the measures that have been put in place since HES lost these contracts. Can he therefore explain his view of the various allegations currently circulating on social media, with photos and videos suggesting that waste is not being picked up from a health centre in Keighley, that hospital staff in Leeds are shifting waste in inappropriate overalls, that hazardous waste at Dewsbury is being stored in inappropriate shipping containers and that up to 15 trusts across Yorkshire are storing waste illegally? Has he checked each and every one of those allegations? Can he tell us what his inquiries have revealed about them? If he has not looked into each and every one of those allegations, why not?

Can the Minister assure us that incineration sites to which tonnes of waste from HES facilities are now taken are big enough to safely manage this waste, that the drivers transporting the waste are suitably qualified and that the incinerators now being used are designed to deal with hazardous waste? Last week, I asked him to give us a cast-iron guarantee that there is no risk to public health at any of those sites, or where the waste is currently being incinerated. Will he give us that absolute guarantee today? All we want from the Minister is complete and utter transparency. We have not had that so far.

[Stephen Barclay]

The hon. Gentleman seems to be spending a lot of time on social media and not looking at the data on what is being done. There was a time when Opposition Members were used to the complexity of legal agreements and contracts and would have understood that mobilising 17 NHS contracts and maintaining NHS operations on those sites requires a significant amount of work. It takes time for Mitie to mobilise that contract—[Interruption.] If he gives me a moment, I will address directly the different concerns that he raised.

The hon. Gentleman’s first concern was that a statement given in October, with up-to-date information based on the work done leading up to it, was in some way incorrect because it did not pick up on early discussions within NHSI, which was only notified on 31 July. Obviously the concerns raised by HES about a lack of incinerators needed to be looked into. Having been looked into, those concerns were found not to have merit. The evidence for that is the fact that the new supplier, Mitie, has been able to secure 1,000 tonnes of incinerator capacity. If the hon. Gentleman’s central charge is correct, he will need to explain how Mitie has been able to find available incineration capacity when HES was unable to do so.

The hon. Gentleman asked when I was notified. I was not notified of the internal discussions among officials in August; I was not dealing with the issue at that point. The issue is what the House was informed of when the statement was made.

On the allegations on social media, I have not checked every single tweet that the hon. Gentleman has looked at, but the fact is that of the 17 trusts, three have had the stock of waste on their sites cleared and 12 are due to have theirs cleared by the end of the week, with two remaining, as Mitie mobilises from around 80% of service delivery now to 100% in the coming weeks.

The right hon. Member for Normanton, Pontefract and Castleford has made some legitimate points about TUPE and about Mitie scaling up, which I am sure she will come on to. Those points were not addressed, surprisingly, in the shadow Secretary of State’s comments, but I am happy to pick them up in due course. One of the advantages of Mitie is that it should deliver greater resilience, because it is not looking to deliver all the elements of the contract in the way that HES is. It is bringing in other firms, such as logistics suppliers and disposal firms, so there will be greater resilience in the contract, but we can address any specific concerns that the right hon. Lady has, given her constituency interest.

Dangerous Waste and Body Parts Disposal: NHS

Debate between Steve Barclay and Jonathan Ashworth

Tuesday 9th October 2018 Commons Chamber

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

(Urgent Question): To ask the Secretary of State for Health and Social Care to make a statement on the accumulation of hundreds of tonnes of dangerous waste.

[The Minister for Health (Stephen Barclay)]

As I set out in the written statement published this morning, on 31 July the Environment Agency notified central Government of an issue concerning clinical waste disposal. The primary concern was that too much waste was being held by a contractor, Healthcare Environment Services, in a number of waste storage and treatment sites. This included waste collected from hospitals and other public services. Although the waste was stored securely, it was not being disposed of within the correct regulatory timescales.

The Department of Health and Social Care, the NHS, the Department for Environment, Food and Rural Affairs, the Environment Agency and the Cabinet Office have worked together to resolve the issues. Our priority throughout has been to ensure that proper measures were put in place to enable trusts to continue to operate as normal. A major part of the contingency plans concerned commercially sensitive contractual discussions with HES and other providers.

Following the Environment Agency’s partial suspension of HES’s Normanton site, which came into force on 3 October 2018, NHS Improvement wrote to HES to raise its concerns. NHSI gave HES an opportunity to set out how it was complying with its legal and contractual obligations; HES failed to provide that assurance. As a result, 15 NHS trusts served contract termination notices on Sunday 7 October. As part of our contingency arrangements, we ran a tender process with the clinical waste sector before awarding a new contract to Mitie. As contracts with HES were terminated over the weekend, Mitie stepped in and, from Monday morning, provided continuing waste collection and incineration across all of these organisations.

In September, officials from the Department of Health and Social Care visited each of the major trauma centres affected and confirmed that waste was being stored correctly and that contingency plans were in place.

In addition, visits have been undertaken to each of the sites by the Environment Agency this weekend and this week, alongside earlier visits. The Environment Agency is continuing its enforcement action against HES. This includes ensuring that excess waste is cleared from non-compliant sites. The Government are working with the Environment Agency and the NHS to ensure that lessons are learned, and we are reviewing how contracts will be awarded in the future. I have updated the House on this situation today as new contracts were implemented on Sunday following the conclusion of this commercially sensitive process. Our priority throughout has been to ensure that measures were put in place so that the NHS could continue operating as normal. No gap in service provision has been reported and we are working to ensure that that remains the case.

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[Jonathan Ashworth]

This is an absolutely horrific scandal. A private contractor has failed in its responsibilities to a quite staggering degree. Three hundred and fifty tonnes of waste, including human body parts, amputated limbs, infectious fluid and substances of cancer, was left effectively stockpiled and not safely disposed of; it is an absolute scandal. How on earth did we get to this? If the Environment Agency first raised concerns in March, if Ministers were formally informed in July, and if Cobra was convened and chaired by the Health Secretary last month—by the way, I really think that the Health Secretary should be answering questions at the Dispatch Box today—why was the decision taken not to inform Parliament and the public sooner? Given that concerns were raised in March, why did the NHS not intervene earlier? In fact, concerns were raised with NHS England last year, so can the Minister tell us what monitoring, if any, of the HES contract was put in place by the Department and Ministers?

The Minister referred to 15 trusts having terminated their contracts. The Health Service Journal reported that up to 50 trusts were affected. Will he clarify what the status is of the contracts with the remaining 35 trusts? Where Mitie has taken over the contracts, what regulation and oversight of Mitie and its subcontractors is now in place? Is he confident that there are enough incinerators across the country to dispose of waste in a timely manner?

Let me turn now to the public health implications. At the Normanton site, we were told that waste is now in refrigerators, but where was it before if not in refrigerators? Hospitals are now using temporary containers, but questions have been raised about the public safety implications of those containers. Can the Minister give us an absolute guarantee that those containers are safe and that there is no public health risk?

We are picking up the pieces, yet again, of another disastrous procurement of an outsourced contract by a private firm going wrong. What plans are now in place to ensure that something like this never happens again?

[Stephen Barclay]

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

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

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

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

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

Oral Answers to Questions

Debate between Steve Barclay and Jonathan Ashworth

Tuesday 19th June 2018 Commons Chamber

[Stephen Barclay]

The hon. Lady’s supplementary question really reinforces the answer that I gave a moment ago: the essence of why we need a long-term plan is so that we anticipate these issues. We are addressing that through the Green Paper on social care, and that is part of the investment that the Prime Minister announced yesterday.

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

Yesterday the Prime Minister said that

“current workloads are not sustainable”—

is that any wonder after eight years of Tory cuts and austerity? The Minister knows that the number of health visitors in the workforce is falling, and that health visitors are vital to improving child health and wellbeing outcomes. No new public health money was announced yesterday; new money will come in 2020. Can the Minister guarantee that health visitor numbers will not continue to fall and that the public health budget will be ring-fenced?

[Stephen Barclay]

I am grateful that the shadow Secretary of State has drawn attention to public health because the Government have been making significant progress in that area. We have the lowest ever number of teenagers smoking and the lowest ever teenage pregnancy rate. Binge drinking is down and we are addressing child obesity with the sugar tax, which is among a number of measures that the Government have been bringing forward. We are making progress on public health and the hon. Gentleman is right to draw that to the attention of the House.

[Jonathan Ashworth]

This Government are breaking the Tory manifesto promise and raising taxes, yet they cannot even answer basic questions about health visitor numbers. The NHS workforce deliver the constitutional performance targets, including the 18-week referral-to-treatment target, and targets for accident and emergency and cancer treatment. Will the Minister reassure patients and the taxpayers whose taxes are going up that he will rule out dropping those essential targets?

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[Stephen Barclay]

I have met the hon. Lady, and she made her case in a characteristically powerful fashion. The matter is being looked at actively.

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

On a point of order, Mr Speaker.

Education (Student Support)

Debate between Steve Barclay and Jonathan Ashworth

Wednesday 9th May 2018 Commons Chamber

[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.

Oral Answers to Questions

Debate between Steve Barclay and Jonathan Ashworth

Tuesday 8th May 2018 Commons Chamber

[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?

NHS Winter Crisis

Debate between Steve Barclay and Jonathan Ashworth

Monday 5th February 2018 Commons Chamber

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

(Urgent Question): To ask the Secretary of State for Health if he will make a statement on the Government’s response to the resolution of the House of 10 January on the NHS winter crisis.

[The Minister of State, Department of Health and Social Care (Stephen Barclay)]

Winter is challenging for health services worldwide. With a high number of flu cases this year, we have seen an increase of about 35% in accident and emergency attendances for flu—triple what it was last year—with about 3,000 hospital beds occupied as a result of flu and a further 700 because of norovirus. The NHS saw 1,200 more patients at A&E compared with this time last year. The guidance issued by the national emergency pressures panel sought to free up capacity for emergencies given the high number of flu cases, including from two dominant strains of flu co-circulating this year.

It is important to remind the House that the deferment of operations referred to in that guidance applies to about 13% of hospital beds dealing with elective patients, of which about half were protected within the guidance in respect of cancer and other urgent elective treatments. The guidance was updated on 26 January to confirm that further deferment of hospital operations is no longer needed. In terms of the impact that the guidance has had on operations, we will not know that until mid-March, when that data will be published and placed in the Library for the benefit of those on both sides of the House.

[Jonathan Ashworth]

I welcome the new Minister to his place. However, the Secretary of State should have been here giving an oral statement, because those were the terms of the motion endorsed by the whole House.

The reason that motion was endorsed is that this winter, in recent weeks, over 95% of hospital beds have been full, we have seen the highest-ever number of A&E diverts, 50,000 elective operations have been cancelled, and urgent operations have been cancelled too. The crisis that our NHS is now in is so deep, and the underfunding so severe, that on Friday NHS England was forced to announce that the target of seeing 95% of A&E patients within four hours is now effectively abandoned until March 2019. If the Secretary of State had come to the House last Thursday, he could have been questioned on the NHS guidance.

Last year, more than 2.5 million patients waited longer than they should have done in A&E. Does the Minister expect that number to rise or fall this year? The 18-week target has already been abandoned. Is it not unprecedented that patients will have to accept, even before the financial year starts, that the NHS will not deliver on key constitutional standards of care? The waiting time standards are legal duties contained in the NHS constitution. What legal advice have Ministers received, or will they be seeking to amend the NHS constitution?

On Saturday, thousands of us took to the streets to demand a fully-funded, universal public national health service—and by the way, we will take no lessons from Donald Trump, who wants to deny healthcare to millions with a system that checks your purse before it checks your pulse. The NHS model is not broke but it does need funding. If this Government will not give it the funding it needs, then the next Labour Government will.

[Stephen Barclay]

A party preparing for a run on the pound will be in no place to give funding to the NHS. It is the agreed convention of the House that responses to Opposition day debates are provided by the Department within 12 weeks. The Secretary of State will of course do that within that period, and there is a good reason for that. As I set out in my opening remarks, the data will not be available until mid-March, so the hon. Member for Leicester South (Jonathan Ashworth) is premature in asking this urgent question.

The facts are that the NHS was better prepared for winter this year. The number of 111 calls dealt with by a clinician has doubled compared with last year. Over 1 million more people have been vaccinated for the flu virus, 99% of A&Es have GP streaming and over 3,000 more beds have been made available since November, reflecting the extent of the plan.