NHS England Funding: Announcement to Media

Steve Brine Excerpts

Monday 25th October 2021 Commons Chamber

[Edward Argar]

The hon. Lady knows that I have a huge amount of respect for her and her work in this House. She is absolutely right to highlight the need for parity of esteem not just to be a phrase, but to be made a reality in our constituencies and on our streets. That is why we have significantly increased funding for mental health not just in revenue terms, but in the capital terms about which we are speaking today—as I alluded to in response to the shadow Secretary of State, in terms of investing in eliminating mental health dormitories, but also in terms of new hospitals. I suspect that the hon. Lady was possibly alluding to child and adolescent mental health services. I am always happy to discuss that issue with her, as is the Minister for Care and Mental Health, my hon. Friend the Member for Chichester (Gillian Keegan).

[Steve Brine (Winchester) (Con)]

My good friend and the very excellent Minister is going to help me out here, because he said that we will hold the NHS to account for these plans. He knows that I have raised this matter in the House before, when we announced the £12 billion of funding. I know that there is a plan for the catch-up; I know that it has been agreed with the Department and I know that it has been agreed with the Treasury, because a Treasury Minister has told me from the Dispatch Box. How can we all hold our local health trusts to account when we have not seen that plan? Please can it be published?

[Edward Argar]

My hon. Friend asks a key question. I can reassure him that he will see that plan published in the coming weeks. I know that he will both study it carefully and hold me and the NHS to account on what is in it.

Covid-19: Government Response

Steve Brine Excerpts

Thursday 21st October 2021 Commons Chamber

[Maggie Throup]

Plan A outlines the guidance that is in place and that is the guidance that people should be following. It is up to individuals to work out what works for them and what is best for them. Plan B incorporates the mandatory wearing of masks, but we are on plan A.

[Steve Brine (Winchester) (Con)]

The news of the new antiviral treatments that we heard about yesterday is very welcome, as is, of course, the fastest vaccine roll-out programme in the world.

We voted to break our manifesto commitment in order to give the NHS billions of pounds more of our constituents’ money, primarily to deal with the covid backlog, yet there is a depressingly familiar drumbeat on moving towards plan B and plan B+, and plan C is in the papers today—as mentioned by the shadow Secretary of State, the right hon. Member for Leicester South (Jonathan Ashworth)—without mention of a penny of that new money.

May I ask the Minister about jabbing our young people? The Joint Committee on Vaccination and Immunisation came up with one piece of advice and the chief medical officer was asked to come with another one, until we got the answer that we wanted from him; does the Minister think that has something to do with why parents are confused? What more can she and her office do to convince the parents of teenagers that vaccination is in the interests of the young person? That will hopefully then drive up vaccination rates as vaccines go online according to the schedule in schools.

[Maggie Throup]

I reassure my hon. Friend that there is a lot of communication through schools and directly to parents and children to ensure that they understand the importance of 12 to 15-year-olds receiving their jabs, which will protect not only them but their loved ones.

Covid-19 Update

Steve Brine Excerpts

Tuesday 14th September 2021 Commons Chamber

[Sajid Javid]

May I suggest that the hon. Lady reads the plan before she comments on it?

[Steve Brine (Winchester) (Con)]

I welcome much of what is a sensible plan from the Secretary of State, although I have a creeping feeling that we are preparing to treat flu like covid, more than the other way round. Before we start extending the vaccine programme and boosters, will the Secretary of State get a grip on the creeping issue of people who have had one vaccination in England and another in Scotland, or the other way round, but the two systems are not talking to each other, and people are not getting the benefits of having been fully jabbed? We need to deliver for those who have done what we asked them to do before we deliver vaccines to others.

[Sajid Javid]

My hon. Friend is right to make that point—indeed, people in my family had that very issue. I know that the Minister for Covid Vaccine Deployment is looking at that matter, and I have discussed it with the health Minister in Scotland. We are working to see what more we can do.

Covid-19 Vaccinations: 12 to 15-year-olds

Steve Brine Excerpts

Monday 13th September 2021 Commons Chamber

[Nadhim Zahawi]

Just as we published the JCVI’s interim advice on 30 June, we will absolutely do the same with the final advice. We have now delivered more than 9 million doses, through COVAX or bilaterally, out of the 100 million that we planned to deliver. We went further when we received a request from our Australian colleagues: we delivered 4 million doses of the Pfizer vaccine that they needed immediately, and we can take that back when we think we need it for our booster programme. The hon. Lady quite rightly highlights the issue of vaccinating with the rest of the world, which is an important part of our work with the vaccines taskforce.

I reassure the House and families listening at home that, as far as the interim advice or any final advice allows, I am confident that we will have vaccines available to boost all those whom the JCVI recommends we should boost.

[Steve Brine (Winchester) (Con)]

I am deeply uncomfortable with this decision. I think that when the JCVI made a decision on the application of the vaccine on clinical grounds it was in the right place—but the Government now have the answer that they want from the experts, so we are where we are.

Parents like me and our constituents will have many, many questions asked of them by their children, probably at bedtime. What will be their route for answering those questions? Where will they get the information? Just saying that the MHRA is the best regulator in the world will not cut it with my daughter. Will people be able to have conversations with their family doctor? At the moment—let’s face it—that is quite challenging. Can the Minister guarantee that we will be able to ring up and have a real-life conversation, not with an answerphone but with our family doctor, to ask questions about the very, very big move announced today?

Covid-19 Update

Steve Brine Excerpts

Monday 6th September 2021 Commons Chamber

[Nadhim Zahawi]

I am grateful for the right hon. Gentleman’s question. It is an important question that I want to address head-on, because it is about statements on Twitter; I understand that I am “trending” on Twitter.

I was asked about this by Tom Swarbrick, who replayed to me my February interview. I said to him that the difference between then and now was first that the Delta variant is so much more infections than the previous variants—it takes only a very few particles for someone to be infected—and secondly that we have learnt from the experience of other countries which attempted to reopen sectors such as the nightclub sector and then had to close them rapidly because of super-spreader events. We do know that 60% of people who have had two jabs will not become infected with the Delta variant and therefore cannot infect someone else, although 40% will and can. This is a relative risk that we want to avoid: what we do not want to do is open the industry and then have to shut it down again because of those super-spreader events.

I hope that I have explained myself to the House. It is important that when politicians have new evidence—new data—they are able to change their minds.

[Steve Brine (Winchester) (Con)]

All UK adults have now been offered a first dose, and I think it is worth reflecting on what a remarkable achievement that is on the part of the country, the volunteers and indeed the Minister, who deserves a great deal of credit. We have long since protected the vulnerable, and surely very soon we will offer them that booster jab.

Until this point I thought I had understood the strategy completely, but now I am not so sure. What is it? Is it about case numbers, which we still broadcast every day? We never did that when I was in the Minister’s Department and influenza was having a bad year.

My question goes to the heart of the stuff about covid status certification, and about vaccinating healthy children. In short, what is the strategy now? What do the Government mean when they say we must learn to live with covid? Could the Minister give us his view?

[Nadhim Zahawi]

I am grateful for my hon. Friend’s important and thoughtful question, and for his words of encouragement as well.

Let us look at what the vaccines have achieved. We have achieved a situation in which we have weakened—severely weakened—the link between cases going up rapidly, serious infection, hospitalisation and death. We are in a very different place today. This new equilibrium is where we want to be able to head to in steady state. The challenge that will come over the next few weeks and months is that there will be upward pressure on that equilibrium. We may break it in the wrong way because schools are reopening, there will be a higher number of infections, and those infections could seep through to the older age groups who are much more vulnerable. The booster campaign would help to push it the right way, with the infection rates being forced up but not leaking into the most vulnerable. That is why the JCVI stressed that we should boost the most vulnerable first.

I hope that this next challenge will enable us to demonstrate to the world that we are one of the first major economies in the world to bring about the transition of this virus from pandemic to endemic and then live with it over the years to come, through an annual vaccination or inoculation programme.

Covid-19 Update

Steve Brine Excerpts

Thursday 22nd July 2021 Commons Chamber

[Nadhim Zahawi]

The MHRA, our regulator the EMA and, of course, officials are working with the Commission. Wherever we spot these inaccuracies we address them—we have addressed them with Malta and now France. I am assured, as of last night, that pretty much the whole of Europe, other than the Italian authorities—which we are working with—will accept the AstraZeneca vaccine from any batch, because all batches, all factories, are approved by our regulator before they enter the United Kingdom.

[Steve Brine (Winchester) (Con)]

Today you could go to the Latitude Festival with a negative test or two jabs, and you could go to the open golf last weekend with the same, yet you cannot report for work in the NHS or put food on supermarket shelves. We are rightly worried about the 3 million healthy 18 to 30-year-olds who have yet to get a vaccine, but let us put ourselves in their shoes: they see us all get a jab and wonder what they get in return. So I ask the Minister: do we believe in our vaccine or not, and what is the scientific evidence to explain the difference between 19 July and 16 August when it comes to isolation for the double jab?

[Nadhim Zahawi]

I thank my hon. Friend, who always asks important yet challenging questions. The 18-year-olds can now look forward to travelling to 33 countries that have accepted double-jabbed Brits who can demonstrate that. If they have their jab now, they can go to those countries from mid-September. They can look forward to clubbing by the end of September as well—enjoying the Winchester nightlife. I hope I have made it clear to the House that giving ourselves that additional few weeks, given that self-isolation is probably the second most effective tool after vaccines, makes a huge difference as we transition this virus. It is not easy, but I certainly think we are doing the right thing by giving ourselves the space and time to transition this virus from pandemic to endemic status.

Covid-19 Update

Steve Brine Excerpts

Monday 19th July 2021 Commons Chamber

[Steve Brine (Winchester) (Con) [V]]

I am obviously pleased that we have reached step 4a of the road map, but I am keen to understand what lies behind the month-long gap between 19 July, when it feels as if we do not believe in our vaccines as much as we might, and 16 August when we do. What is the scientific basis for the decision to give my fully vaccinated constituents their real freedom after the middle of next month, but not now?

[Nadhim Zahawi]

I thank my hon. Friend for his excellent question, as always. Most restrictions have been lifted and many people have now been vaccinated, but it is still possible to catch and spread covid even if you are fully vaccinated. Introducing the exemption in August will allow more people to be fully vaccinated, as I mentioned earlier. Unlike in previous waves, the rise in cases driven by the delta variant is not translating into significant increases in hospitalisation and death. This is due to the effectiveness of the vaccine in reducing the risk of transition into severe illness.

Health and Care Bill

Steve Brine Excerpts

2nd reading
Wednesday 14th July 2021 Commons Chamber

[Jonathan Ashworth]

I have. The hon. Gentleman is a dogged advocate for that proposal for social care, and he is quite right: he always raises it with me. I am unpersuaded but I am more than happy to sit down with the Secretary of State and with my hon. Friend the Member for Leicester West to discuss a solution to social care. We keep being told that there are going to be cross-party talks, but I think I missed the Zoom link, because they have not happened so far.

As I was saying, these committees do permit a seat, if the committees want it, for the independent sector. In Bath, in Somerset, we have seen Virgin Care get a seat on the shadow ICS. The Opposition think that is unacceptable and we shall table amendments to prohibit it.

I welcome the removal of the section 75 competition and procurement rules, finally scraping the remnants of the Lansley competition rules off the boots of the NHS. We did warn him and others that this compulsory competitive tendering would lead to billions going to the private sector, would be wasteful and bureaucratic, and would be distracting—and it even led to the NHS getting sued by Virgin Care when it did not win a contract. But this is not the end of contracting with the private sector. Without clauses to make the NHS the default provider, it would be possible for ICBs to award and extend contracts for healthcare services of unlimited value without advertising, including to private companies. Given the past year, when huge multibillion-pound contracts have been handed out for duff personal protective equipment and testing, we naturally have concerns about that and will seek safeguards in Committee. We are worried about further cronyism.

We are particularly concerned about the Bill because of the power grab clauses for the Secretary of State. He is creating 138 new powers, including seven allowing him in effect to rewrite the law through secondary legislation, to transfer functions between arm’s length bodies without any proper scrutiny. He has not explained why he needs these powers or given any guidance on how he expects to use them. These powers also include a requirement that Ministers be informed of every single service change, every single reconfiguration, and the Secretary of State will then decide whether or not to call them in for ministerial decision. Are you sure you want that power, Secretary of State?

The Government have gone from wanting to liberate the NHS under Lansley to now listening out for the clang of every dropped bedpan echoing through Whitehall. This is not a plan for service modernisation; it is a “Back to the Future” plan and it will mean more inertia. Instead of powers to interfere at every level, resetting the mandate for the NHS within years, we instead would want the duties on the Health Secretary, and therefore on the 42 ICSs to which he delegates those responsibilities, to continue the promotion in England of a comprehensive health service, as per the National Health Service Act 2006, to be fully reinstated and made explicit.

[Steve Brine (Winchester) (Con)]

As ever, I have listened carefully to the right hon. Gentleman. If this is the “Back to the Future” Bill, presumably it puts right what once went wrong. Does he support the clauses on foods that are high in fat, salt and sugar, and the watershed proposals for advertising?

[Jonathan Ashworth]

Yes, although I am disappointed that they are in this particular Bill. I think they should be part of a stand-alone Bill. In my concluding remarks, I will make a point or two about other public health interventions, which I imagine and hope that the hon. Member, as a great champion of public health, would support.

It is crucial that the Secretary of State’s duty to provide comprehensive healthcare is reinstated, rather than the duty to meddle in the NHS at any time he wants, because there is a lack of clarity about how the funding flows work in this system. The talk is of moving to capitated budgets for an area to provide holistic care to meet the complicated care needs of individual. But when waiting lists are increasing at the current rate, and when cancer waits and mental health referrals are going up, how is an area going to fund the episodic care for each unit of extra care that is needed—often care that is expensive and more complicated because it needs to be done in the acute sector?

We have worries. Clauses 21 to 24 on the financial duties on ICS boards, NHS trusts and NHS foundation trusts are alarming, because they put in place a duty to ensure financial balance across the ICS area, but there is no clarification of how that balance should be achieved and enforced. Local health budgets have been stretched to breaking point after years of underfunding, so what does this duty mean for existing deficits? At the moment, trusts have a combined deficit of £910 million. King’s has a deficit of £111 million. Worcestershire has a deficit of £81 million. University Hospitals of Leicester NHS Trust has a deficit of £80 million. Will the ICBs need to fill this £900 million black hole before they are even up and running How exactly will trust and ICS board deficits be dealt with at the end of each financial year?

This could well be a return to the days that we saw in the ’80s, which some Members in the House may recall, when health authorities would close beds and put off paying bills from January onwards in order to hit financial balance. If health authorities have to hit this financial balance year by year, will it result in a postcode lottery of more rationing and an even longer list of treatments being removed from the NHS through the decisions of ICBs because they have to hit balance, effectively forcing patients either to go private or go without? I hope that the Minister, in summing up, can clarify what the situation will be.

If a set of providers, trusts and an ICB feel that the financial settlement they have been given by NHS England will not allow them to deliver the levels of care to bring down the waiting lists, which the Secretary of State said is one of his top priorities, or to improve mental health outcomes, which he has also said is one of his top priorities, what is their appeal process? How will the arbitration process work on an area’s financial settlement under the current plans to bring together NHS England and NHS Improvement, not split them out?

The Bill is spun as an attempt to integrate health and social care, but there is nothing in it actually to integrate health and social care, because there is nothing in it to fix social care. If it is about integrating health and social care, where is the long-promised Bill to reform social care? The Bill will repeal provisions in the Care Act 2014 that require patients to be assessed for their social care needs before they are discharged from hospital. Without long-term funding in place, that could mean a patient being sent home, left out without support and waiting for an assessment. Will the Secretary of State, or the Minister who responds to the debate, guarantee that that will not be the case? Will they put in place the necessary funding alongside the Bill?

A number of royal colleges and health bodies have said today that the biggest challenge facing the NHS is workforce. The Bill proposes a duty on the Secretary of State to report on workforce once every five years. That is simply not good enough. We need a solution to workforce now; we need a solution to recruitment now; staff need a fair pay rise now; we need more investment in training and professional development budgets now; and we need safe staffing legislation now. We will therefore look to amend the Bill, hopefully on a cross-party basis and perhaps working with others who put forward proposals to improve the workforce sections of the Bill.

As my hon. Friend the Member for York Central (Rachael Maskell) asked the Secretary of State, what does the Bill mean for “Agenda for Change”? The Bill suggests that an integrated care system will be able to change “Agenda for Change” terms; we disagree with that.

Finally, on public health, the Bill introduces restrictions on the advertising of less healthy food and drink. We welcome this step—it, too, was in our 2017 manifesto, which the Secretary of State has been reading—but we would go further. Why can we not have more restrictions on the advertising of unhealthy food around schools? Our public health crisis is about not just obesity but smoking and alcohol, so why are there no provisions in the Bill on smoking services and to ensure alcohol calorie labelling? We will table amendments on those issues in Committee.

This is the wrong Bill at the wrong time. Will the person with learning difficulties or the older person who needs social care experience improved care? No. Will social care be brought back in from the wilderness? No. Will the cancer backlog be tackled more effectively? No. Will health inequalities be narrowed? No. Will parity of esteem for mental health be delivered? No.

Instead of this being a simple Bill to end competition and foster local collaboration, NHS staff will be left trying to second-guess where the Secretary of State will interfere next in the safe running of their local NHS with his in-year changing mandate. The rules on funding could result in more rationing and cuts, so we cannot possibly support the Bill. We have championed integrated care for many years, but the Bill does not deliver it and we urge the House to accept our reasoned amendment.

--- Later in debate ---

[Steve Brine]

It is unquestionable that we have a challenge with the GP workforce. It is about numbers, yes, but does my right hon. Friend agree that constituents have a big challenge with access to general practice? We currently do not have the right balance between telemedicine and in-person medicine.

[Jeremy Hunt]

There is a big issue, and my hon. Friend is aware from his time at the Department of Health that its root cause is capacity in the system. These capacity issues taken together are why the Health Foundation says that, in just over a decade, we risk a workforce gap in the NHS of about half a million people. That is why this is such a big issue. I urge the Secretary of State to think about that during the Bill’s passage.

--- Later in debate ---

[Steve Brine (Winchester) (Con)]

Health Bills, rightly, do not come around too often, so when they do there needs to be good reason. My conclusion, from the necessary establishment of integrated care systems to the so-called triple aim, the removal of the competition aspect and the new power of direction, is that there is good reason for legislation at this time. This is obviously a vast Bill, but because Health Bills do not come around very often, it is understandable that colleagues and officials will use the opportunity to give legislative cover to things that they have been working on for a long time. The Healthcare Safety Investigation Branch is a very welcome example of that.

I want to focus on workforce and then on primary care, and in doing so I refer the House to my entries in the Register of Members’ Financial Interests. On workforce, I remember publishing the cancer strategy in 2018. The issue then was not our ambition but having the cancer workforce to meet it. Obviously, the chances of surviving cancer have improved significantly in recent years. There are many reasons for that, but detecting 75% of cancers at stage 1 or early stage, which must happen, needs the radiographers in post and demands an endoscopy workforce that can properly execute the FIT screening for the bowel cancer programme, as one example.

[Christine Jardine (Edinburgh West) (LD)]

The hon. Gentleman is making an excellent point about the necessary workforce in the NHS. Does he agree that if we were perhaps to offer indefinite leave to remain to the many thousands of frontline NHS workers in all departments who are here on visas and have worked hard through this pandemic, we would help to fill the gap that so desperately needs closing?

[Steve Brine]

The hon. Lady makes a sensible point. There is obviously a process in place whereby that can happen, but if she is asking whether I agree with a liberal immigration policy to help our health service, then absolutely, yes I do. Addressing the cancer workforce and the wider NHS staffing picture is not an omission from the Bill—we cannot legislate staff shortages out of existence—but if we do not address that issue and face up to our long-term structural gaps, many of the reforms around tackling the backlog and building back better will not amount to a row of beans.

[Jeremy Hunt]

I congratulate my hon. Friend on the extraordinary work he did when he was a Minister on early diagnosis of cancer. Is he aware that the Health and Social Care Committee has just opened an inquiry—we had our opening session yesterday—into that issue, and into how we can get the right workforce in place to deal with those important matters?

[Steve Brine]

I was aware of that, and I am pleased to hear it. The Select Committee will soon have Cally Palmer before it—she is the national cancer director and one of the best in the business—and I look forward to following what she says. In advance of the comprehensive spending review, the Bill should include a requirement on the Government to publish modelling of the future supply of the entire healthcare workforce.

On primary care, I welcome the formal creation of integrated care systems, but we need them to realise their potential, and to do so fast. If they are going to work, general practice needs to embrace the wider primary care family, which means finally to recognise the potential of community pharmacy, ophthalmology and dental services as vehicles of prevention as much as of treatment.

Finally, if we move upstream of the Bill, what we do must be about prevention. We hear talk this weekend of a waiting list touching 13 million people. Let us tackle that for sure, but let us also get behind the food and drink clauses in part 5, and think about the future and our children as much as about the present. Several years ago I was fortunate to write up the high fat, sugar and/or salt proposals as part of chapter 2 of the child obesity plan, and I am pleased that the 9 pm watershed is legislated for in the Bill. I pay tribute to Jamie Oliver and his Bite Back 2030 campaign, and the young people involved with that, as well as to Cancer Research UK for its support. I realise that not everyone on these Benches, or perhaps outside, supports that move, and I agree that it will have little impact if that is its grand sum. Ministers need to take the tackling obesity strategy that was published last year, implement it all, and then go again.

I welcome the clauses on the fluoridation of water supplies. Let us stop debating whether we do that and —to borrow a phrase—follow the science.

In conclusion, the Bill is worthy of support on Second Reading. There will be an awful lot of work to do in Committee and the other place, but I will certainly support it this evening.

National Health Service

Steve Brine Excerpts

Tuesday 13th July 2021 Commons Chamber

[Steve Brine (Winchester) (Con)]

I hear what the hon. Lady is saying. My first instinct on persuasion, months and months ago, was exactly the same, but more than seven months on, it has not happened. I am tempted to ask, “If not now, when?”, to coin a phrase. What is her response to that?

[Dr Allin-Khan]

My response is that the Government have not gone far enough to have these conversations. A real effort has not been made to engage with the communities that have been hit the hardest and for whom vaccine hesitancy is at its highest. Trust being so low creates the hesitancy that I have just spoken of. This hesitancy can be overcome through effective communication, but that has not yet happened under this Government’s watch.

Covid-19 Update

Steve Brine Excerpts

Monday 12th July 2021 Commons Chamber

[Sajid Javid]

I can tell the hon. Lady that there are currently about 30,000 infections a day. In the last 24 hours in England, we have seen about 400 people being hospitalised. The last time that infections were around the same level—at 30,000 cases a day—I believe that more than 2,000 people a day were being hospitalised. That is what I mean when I say that the link has been severely weakened, and for that we have the vaccines to thank.

[Steve Brine (Winchester) (Con)]

I look forward to having a look at and scrutinising the new road map when it is published this afternoon. Further to the point raised by my right hon. Friend the Member for Forest of Dean (Mr Harper), I am just trying to get clear the data on hospitalisations. I was told today of a lady admitted this weekend to a hospital in my region to give birth. She was, of course, tested on admission and was positive, so she is a covid-positive person in hospital. Given the advice that the Secretary of State has just confirmed to the House that he has sought, when does he think he will be able to advise us of the figures for those admitted with covid versus those admitted for covid?

[Sajid Javid]

I know that my hon. Friend speaks with experience, and I am glad he has raised this point again. I have asked for that advice, because it is important that we try to analyse better the primary diagnosis of anyone coming into hospital. I can understand why that was not easily possible in the early days of the pandemic, but I think we have now reached the stage at which we can provide better data, and I hope I can get that done as quickly as possible.