International Thalassaemia Day

Stewart Hosie Excerpts

Wednesday 27th April 2022 Westminster Hall

[Stewart Hosie (in the Chair)]

I will call Bambos Charalambous to move the motion and then the Minister to respond. There will not be an opportunity for the Member in charge to wind up, as is the convention in 30-minute debates.

[Bambos Charalambous (Enfield, Southgate) (Lab)]

I beg to move,

That this House has considered International Thalassaemia Day 2022.

It is a pleasure to serve under your chairmanship, Mr Hosie.

International Thalassaemia Day is on 8 May, and this year’s message is “Be Aware. Share. Care.” The first part of the message is about raising awareness, so what is thalassaemia? Thalassaemias are inherited blood disorders that lower, alter or stop the production of haemoglobin in the blood. That leads to anaemia, which might be severe or life-threatening if not managed appropriately. There are several types of thalassaemia, depending on the severity of the mutation inherited. The most severe type is beta thalassaemia major, or transfusion-dependent thalassaemia, followed by beta thalassaemia intermedia and haemoglobin H disease.

Those living with transfusion-dependent thalassaemia receive blood transfusions every three weeks for life and daily iron chelation therapy. All patients develop secondary conditions and complications due to thalassaemia and iron overload. Sadly, they develop conditions such as diabetes, heart failure, osteoporosis and liver failure. Patients therefore have to spend a lot of time in hospital, whether it is for blood transfusions for thalassemia, or for the treatment and monitoring of secondary conditions.

Thalassaemia is not transmitted by transfusion, infection, environmental conditions or other factors, but is recessively inherited. It is more prevalent in individuals with Caribbean, South American, African, Mediterranean, south Asian, south-east Asian and middle eastern ancestry. Due to migration over centuries, it is found throughout the world, and it is estimated that there are 100 million people worldwide with a thalassaemia trait who are asymptomatic.

The prevalence of thalassaemia varies across different regions in the UK. Data published in 2020 by the National Haemoglobinopathy Registry—the NHR—indicates that there were more than 900 people living with beta thalassaemia major in the UK, 238 living with beta thalassaemia intermedia, 280 with beta thalassaemia/Hb E disease, and 300 with haemoglobin H disease.

The majority of patients with thalassaemia in the UK come from a British Pakistani or British Asian community. Each year, around 20 to 30 couples in the UK are identified as being at high risk of having a baby with a form of thalassaemia. My constituency of Enfield, Southgate has the highest number of people with thalassaemia in the UK and is home to the UK Thalassaemia Society, which campaigns for greater awareness and better health outcomes for people with thalassaemia. It has also given me advice and shared its findings for this debate.

The second part of the message for International Thalassaemia Day is about sharing—sharing essential information and knowledge to support the best health and social care outcomes for people with thalassaemia. The Department of Health and Social Care published its UK rare diseases framework last year, which acknowledged a number of challenges and set out the Government’s four priorities, which include increasing awareness of rare diseases among healthcare professionals, better co-ordination of care, and improving access to specialist care treatments and drugs, all of which I and the thalassaemia community very much support.

I want to focus on the last point about improving access to specialist care treatments and drugs. Thalassaemia is a rare disease and there are very few treatments for the condition. Some gene therapies have been developed, but have often not been able to progress beyond the National Institute for Health and Care Excellence’s criteria because either the formula for quality-adjusted life years is loaded against people with rare diseases or there is a smaller sample of people upon whom the gene therapy trials have been conducted. That is primarily because people with rare diseases are often few in number, and that limits who the therapy can be trialled on.

I note that NICE has done its methods and processes review, but I ask the Minister to ensure that the highly specialised technology and standard technology appraisal pathways are both fit for purpose for people with rare diseases, and that the uncertainty of cost effectiveness due to small population sizes is a serious consideration for NICE in assessing the appraisal of new gene-therapy technologies. Gene therapy and other technologies for people with rare diseases are literally a matter of life and death, and much more work needs to be done by the Government to ensure that people with rare diseases are not disadvantaged by the bureaucratic processes that fail to take into account the unique nature and impact of rare diseases on those who have to live with them.

The final part of the message is about care. This is about the experience of people with thalassaemia when receiving healthcare. I have met a number of people with thalassaemia who have shared their experiences with me. They require regular blood transfusions, and they told me about their pain and suffering following transfusions and how debilitating that can be. I have also read testimonies of people with thalassaemia who have experienced differing levels of treatment by health professionals. Because the condition tends to be extremely specific to a particular ethnic group in the UK and there are very small numbers of patients, the UKTS has found a huge disparity in services throughout the country with regard to the accessibility of thalassaemia care.

--- Later in debate ---

On resuming—

[Stewart Hosie (in the Chair)]

We now resume the suspended debate. I call the Minister.

[Maria Caulfield]

To go back to where we were, the Government are determined to address long-standing health disparities, particularly for those with thalassaemia. The NHS Race and Health Observatory was established just over a year ago with a remit to tackle some of the issues that minority communities face, particularly in health inequalities. Last year, the Government launched the Office for Health Improvement and Disparities, or OHID, which is doing huge amounts of work in these areas.

Health features quite heavily in the levelling-up White Paper. We want to reduce the gap in life expectancy between the areas with the highest and lowest, and by 2035 we want life expectancy to have risen by five years. Tackling the issues raised is key to that, particularly for the groups most at risk. I am mindful that the right hon. Member for Wolverhampton South East raised the “No One’s Listening” report, which features issues that those with thalassaemia face—the lack of understanding of the condition among healthcare staff and the treatment that patients need to receive. Those receiving blood transfusions might look well compared with a typical patient receiving a blood transfusion, but a three-weekly blood transfusion for life is very difficult even if things go smoothly. I want to reassure the right hon. Gentleman that we are trying to improve the experience of those with thalassaemia in a number of areas.

In 2019, NHS England concluded the review of haemoglobinopathy services, which resulted in the development of the new model that we now have, based on haemoglobinopathy co-ordinating centres and the national panel. That brings specialist services together to improve the experience of those using the services, and addresses health inequalities and improves outcomes for those with haemoglobinopathies, which includes thalassaemia patients.

To touch on thalassaemia in particular, four specific centres, alongside 10 sickle cell centres, have been commissioned to provide clinical expertise. We hope that even if patients cannot access those, the experience and good practice will ripple out across the country and improve the service and experience for patients and improve standards of care.

One of the main treatments for thalassaemia is, as the hon. Member for Enfield, Southgate touched on, regular blood transfusions. We need people to donate blood, and I want to use this afternoon’s debate as an opportunity to encourage people to come forward not only to give blood but to think about stem-cell donation as well, which can be used as a treatment. Anyone interested can go on the Anthony Nolan website, which can register people and give them information about what is involved.

We also need to touch on the issue of training for healthcare staff. I am encouraged that the training curriculum for haematology set by the Joint Royal Colleges of Physicians Training Board has now included sickle cell and thalassaemia as core competencies, so we can make sure that healthcare professionals are informed. Even though these are rare diseases, they affect a significant proportion of people, particularly in certain communities.

In addition, Health Education England now provides two relevant e-learning healthcare programmes on the NHS screening programme, including sickle cell and thalassaemia and the maternity support work programme. That is important because of the breakthroughs we are making in screening everyone for both sickle cell and thalassaemia. All women should now be screened during pregnancy for thalassaemia, along with partners’ screening, and an affected pregnancy could be identified at the 12-week gestation period. That helps not just to prepare parents for their child, but to make sure that services are in place as soon as the child is born.

Nearly all sickle cell affected children born in England and the majority of thalassaemia babies will be identified by the NHS sickle cell and thalassemia screening programme, which will make a difference to the outcome for people. It will help us to co-ordinate and develop services to make sure that there is a better experience for patients going forward.

The hon. Gentleman raised the issue of treatment. I am keen to look at that because although blood transfusions are a treatment for some, ideally gene therapy is potentially curative for the affected population. I know there are ongoing issues with NICE approval for a number of drugs, and I am happy to meet him to discuss that further after this debate. I am really keen that, where we can make significant drug developments, which are available in other countries and not necessarily here, we make progress and discuss with NICE the issues that might be preventing approval or slowing down progress at the moment.

I want to also touch on some of the research being done, because that is the key to improving treatment outcomes for patients to make sure that their life chances and their experience in the health service are improved. There are a number of research studies going on. I am hopeful that we can improve their outcomes and make sure that access to research is available for patients, too.

The disease is rare; as the hon. Member for Enfield, Southgate pointed out, there is only a small group of patients. We are making sure we take part in international studies and speak to bodies such as NICE to say that, although there will only ever be a small number of patients, that should not deter approval for drugs because of the difference they may make overall.

I very much take the points made by the hon. Gentleman. Following on from the recent debate on sickle cell patients, which raised very similar issues, I suggest that I meet both him and the right hon. Member for Wolverhampton South East to see whether we can pin down some of those issues, particularly as the health disparities White Paper is coming forward shortly. It presents a good opportunity for the communities affected by both diseases to try to iron out some of those problems.

I thank the hon. Member for Enfield, Southgate for tabling today’s debate, as well as all the Members who are interested in this issue. We had a big turnout in the sickle cell debate a few weeks ago, where very similar points were made. I reassure colleagues that progress is being made, whether that is in screening, which will be a game-changer for patients; the gene therapy treatments that will come through online; or the general experience of patients being treated with dignity, respect and knowledge of their condition. I place on the record my thanks to all those working hard behind the scenes in specialist units to improve care for thalassaemia patients, and I look forward to working with the hon. Gentleman to see if we can make a difference for those patients.

Question put and agreed to.

Queen Elizabeth Hospital, King’s Lynn

Stewart Hosie Excerpts

Wednesday 23rd March 2022 Westminster Hall

[Stewart Hosie (in the Chair)]

I will call James Wild to move the motion and then call the Minister to respond. The Member in charge will not have the opportunity to wind up, as is the convention in 30-minute debates.

[James Wild (North West Norfolk) (Con)]

I beg to move,

That this House has considered quality of care and the estate at the Queen Elizabeth Hospital, King’s Lynn.

It is a pleasure to serve under your chairmanship, Mr Hosie. I am grateful to Mr Speaker for granting this important debate, which gives me the opportunity to highlight the significant improvements at Queen Elizabeth Hospital, while once again making the compelling case for it to be one of the new hospital schemes that the Government have committed to building. I also want to recognise the close interest that my hon. Friend the Minister has taken in QEH and to thank him for the many meetings and discussions we have had about it so far. Of course, I also encourage him to back the bid.

QEH serves 330,000 people across Norfolk, Lincolnshire and Cambridgeshire, providing a comprehensive range of specialist, acute and community-based services. It is a busy hospital, with 55,000 in-patient admissions, a quarter of a million out-patient appointments and 70,000 emergency department admissions last year. However, QEH has suffered from poor Care Quality Commission ratings and an historic lack of investment, and has therefore been in special measures for some time. However, under the leadership of Caroline Shaw, the chief executive, and the chairman, Steve Barnett—who is moving on shortly, having done a lot of good work—things have changed.

In the last three years, there have been significant improvements in care. However, you do not have to take my word for it, Mr Hosie; that was the verdict of the CQC’s report a month ago. The core services it inspected—medicine, urgent and emergency care, and critical care—were all rated good overall. Indeed, critical care was recognised as having outstanding elements in many areas. That means that QEH is now rated good in three domains: caring, well led and effective. The CQC found that

“Staff provided good care and treatment…treated patients with compassion and kindness, respected their privacy and dignity, took account of…individual needs…and made it easy for people to give feedback.”

The report shows how far QEH has come. As a result, the Care Quality Commission’s chief inspector of hospitals has recommended that QEH come out of special measures, which is very welcome for the area.

It is frankly remarkable that all this has been achieved during a period when covid posed such huge challenges to QEH and other hospitals, and to other parts of the health and social care sector. This has not happened by luck; it is due to the leadership, hard work and commitment of all the staff at QEH. I have seen that dedication at first hand when I have met doctors, nurses, the infection control teams, the porters and all the others who make up the hospital during my regular visits. I commend them for all that they have achieved in the report. As the CQC said, staff were

“passionate about…providing the best possible care for patients”,

and leaders understood

“the priorities and issues the trust faced”

and were

“visible and approachable…for patients and staff.”

Clearly further improvements are required, as the hospital recognises, but it is important that we acknowledge the huge step forward that has been taken, as reflected in the report.

Those improvements have been made despite the decaying and ageing buildings that staff and patients have to experience and operate in. As my hon. Friend the Minister knows, QEH is one of the best-buy hospitals and has major issues with reinforced autoclaved aerated concrete planks—which I think we should refer to as RAAC planks for the rest of the debate—which are structurally deficient. The hospital was built with a 30-year design life, but it is now in its 42nd year. Some 79% of hospital estate buildings have RAAC planks, and I am sorry to say that it is the most propped hospital in the country, with 470 steel and timber supports across 56 parts of the hospital.

Being in a ward or another part of the hospital, surrounded by props holding up the roof, is a poor experience for patients. It makes it harder for staff to care for them. It is not something that we should accept, and we do not. This is a serious situation, and the trust’s risk register has a red rating for direct risk to life and the safety of patients, visitors and staff, due to the potentially catastrophic risk of failure of the roof structure. Last year, the critical care unit had to close for some weeks due to precisely those safety issues. The urgent need for a new hospital, and the strength of that case, is underlined by the fact that over a third of all reported RAAC issues in the east of England were at QEH in the last year.

I know that my hon. Friend recognises the seriousness of the situation, and the £20.6 million of emergency capital funding that he approved last year is very welcome. That is making a difference: a new endoscopy unit is taking shape to modernise facilities, and to create space to enable installation of fail-safe roof supports. In addition, there is £3 million of funding for a west Norfolk eye centre, which along with other projects, including digital, means that QEH is currently delivering a more than £30 million capital programme.

Access to Salbutamol Inhalers

Stewart Hosie Excerpts

Monday 29th November 2021 Westminster Hall

[Stewart Hosie (in the Chair)]

Before we begin, I remind Members that they are expected to wear face coverings when they are not speaking in the debate, in line with current UK Government guidance and that of the House of Commons Commission. I also remind Members that they are asked by the House to have a covid lateral flow test twice a week if coming on to the estate, which can be done at the testing centre in Portcullis House or at home. Please also give each other and members of staff space when seated, and when entering and leaving the room.

[Nick Fletcher (Don Valley) (Con)]

I beg to move,

That this House has considered e-petition 578676, relating to access to salbutamol inhalers.

It is a pleasure to serve under your chairmanship, Mr Hosie. I begin by thanking the creator of the petition, Brian McElderry, who took the time to speak with me recently, and Elaine Cunningham, whose daughter Lauren Reid died as a result of suffering an asthma attack while working in a commercial kitchen because she did not have access to her inhaler. I am also grateful to Asthma UK, which supports the petition and provided many of the statistics that I will reference.

More than anything else, Lauren was known for her generosity. On the day she died, she called her gran to say that she was buying lunch for 10 of her co-workers. She was a beloved Rangers fan and she loved music and, of course, cooking. She was devoted to her job and worked so hard that she finished her apprenticeship a year early. She was only 19 years old.

Lauren had suffered from asthma since she was an infant. At 16, she became an apprentice at a restaurant in Glasgow and, three years later, she was a fully qualified chef. Her mum has talked about how Lauren kept her inhaler with her almost everywhere she went; but with severe asthma, one attack can have life-changing consequences.

We do not know why Lauren did not have her inhaler with her, or what triggered the attack, but on this occasion she did not have it when her asthma flared up. The first Elaine knew of the incident was when she received a call from Lauren’s boss to say that Lauren was struggling to breathe and needed her inhaler. The asthma attack led to cardiac arrest and, although her manager gave her CPR, she could not be revived.

Lauren was hospitalised with severe brain damage. Her friends and family stayed by her bedside round the clock but, a few days later, Elaine had to make the heartbreaking decision to turn off her daughter’s life support after doctors said that she would never recover. Since then, Elaine has been campaigning for Lauren’s law, which would legally require salbutamol inhalers to be stored in commercial kitchens.

The UK has one of the highest rates of asthma in Europe, which costs the NHS £3 billion every year. Sadly, we also have one of the highest asthma death rates generally—nearly 50% higher than the European average—and for people aged 10 to 24, it is the highest. Unfortunately, the rates of asthma nationally are going up, not down.

In the UK, 200,000 people suffer from severe asthma. In Scotland, where Lauren lived, one in 14 people receive treatment for asthma and in England, the figure is one in 11. Those statistics demonstrate that asthma is a relatively common condition and, although it is manageable for most people, it remains a serious risk for those who have it. Most people with asthma are acutely aware of that and carry their inhalers with them, but Lauren’s story shows that one attack without an inhaler on hand is enough to cause serious harm or even death. We have all forgotten something in our time.

Working in a commercial kitchen poses more of a risk for people with severe asthma than most other settings, which is why the inhalers would be only for staff, not restaurant customers. Asthma UK considers a high-risk environment to be one where the triggers for an asthma attack on the respiratory system are exponentially greater than in normal environments.

In commercial kitchens, that includes the presence of inhalable materials such as powder, flour, dust and sometimes toxic fumes. Heat and humidity are also known to cause asthma attacks. Compounding those issues is the fact that stress can make a person more likely to react to asthma triggers; I think most people would agree that professional kitchens are not known as a calm environment. One might be tempted to argue that if kitchens are such a dangerous place, perhaps people with asthma should not work in them, but I do not think that is the only or best solution to the problem.

Inhalers are an effective way to treat asthma attacks. They are self-administered and do not require any previous training. Adding one to the first aid kit that professional kitchens already have would be an easy way to make them a safe environment for employees with asthma. At the same time, salbutamol inhalers are a prescription medicine, so keeping an emergency one on hand is not as simple as picking up a spare one from Boots. Keeping asthma inhalers in commercial kitchens would require an exemption from prescription control, which would have to be granted by passing legislation.

The salbutamol inhalers currently in use have been licensed for more than two decades. Their risks are well known. Side effects are typically mild and do not last long. When the Medicines and Healthcare products Regulatory Agency, whose representatives I met last week, looked at the effect of salbutamol inhalers on children, for instance, it found that they would not cause serious harm if accidentally given to a child without asthma or one whose sudden breathing difficulties were not caused by asthma.

Although overuse of salbutamol inhalers can sometimes cause problems, the petition seeks to keep them in kitchens only for emergency use, and their stocks could be easily monitored. We have a precedent for this already. Since 2014, an amendment to the human medicines legislation has allowed schools to store emergency inhalers for asthmatic students.

Asthma is not an uncommon condition, and working in the food industry should not be impossible for people with asthma. Keeping asthma inhalers in commercial kitchens would be a simple, inexpensive way of reducing the chance that anyone else will suffer the same experience as Lauren. I am therefore asking my hon. Friend the Minister whether the Government will commission research on the benefits and risks of requiring salbutamol inhalers to be kept in professional kitchens. That research could then be reviewed by the MHRA, which would make its own recommendation on whether to change the law. I know that that is a long process and today’s debate will not cause any immediate change, but I do hope that it raises awareness and is the first step towards creating Lauren’s law.

Covid Vaccine Passports

Stewart Hosie Excerpts

Wednesday 8th September 2021 Commons Chamber

[Nadhim Zahawi]

My right hon. Friend asks about my previous position. I addressed it a few days ago from this Dispatch Box. Back in January and February, we did not have the level of evidence on the Delta variant, which he mentioned. That variant is far more infectious—it requires only a few particles of Delta for a person to be infectious. Let me repeat the data that I cited earlier: 60% of people who are double vaccinated will not be infected by Delta and therefore will not spread it, but 40% could be infected and then spread it.

As for the policy being discriminatory, there will, of course, be exemptions—for example, in exceptional circumstances where a clinician recommends vaccine deferral, where that vaccine is not appropriate, and where testing is also not recommended on clinical grounds. Then there are those who have received a trial vaccine, including those who have been blinded or given a placebo as part of the formally approved covid vaccine trials in the United Kingdom.

This is not something that we enter into lightly, but it is part of our armoury to help us transition over the winter months from pandemic to endemic status. I hope to be able to stand at this Dispatch Box very soon after that and be able to share with the House that we do not need to do this any more as we will be dealing with the virus through an annual vaccination programme.

[Stewart Hosie (Dundee East) (SNP)]

I pay tribute to all those involved in the vaccination programme. It has been extraordinary. In Scotland, we have 4.1 million adults with a first dose and almost 4 million with a second dose, which means that north of 90% of all adults have had at least one dose. It is a fantastic result across the UK since last December, but the pandemic is not over. Lives are still at risk and the pressures on the NHS are very real, so we in Scotland are introducing a vaccine passport, but, broadly, it will be limited to nightclubs, outdoor standing events with more than 4,000 people and any event with more than 10,000 people. While the rules in England may be slightly different, I hope that they are as proportionate as that.

May I go back to the issue of essential services? It is not enough simply to say that a person will not need a vaccine passport to get an essential service. It has to be any setting where a person’s attendance is unavoidable—shops, public transport, medical services and education. We need the confirmation that no setting where a person’s attendance is unavoidable will require a vaccine passport.

[Nadhim Zahawi]

I am grateful to the hon. Gentleman for his excellent citation of the vaccine success in Scotland. NHS Scotland has done a tremendous job, as has the NHS in Wales, Northern Ireland and, of course, England. He raises an important point about essential services. In the process of parliamentary engagement and scrutiny, we will be able to share the detail of that in due course.

NHS Pay

Stewart Hosie Excerpts

Wednesday 24th March 2021 Westminster Hall

[Stewart Hosie (in the Chair)]

I remind hon. Members that there have been some changes to the normal practice in order to support the new hybrid arrangements. The timings of debates have been amended to allow technical arrangements to be made for the next debate. There will be suspensions between debates. I remind Members participating, physically and virtually, that they must arrive for the start of a debate in Westminster Hall and are expected to remain for the entire debate. I must remind Members participating virtually that they are visible at all times, both to one another and to us in the Boothroyd Room. If Members attending virtually have any technical problems, they should email the Westminster Hall Clerks’ email address. Members attending physically should clean their spaces before using them and before leaving the room. I remind Members that Mr Speaker has stated that masks should be worn in Westminster Hall. Members attending physically who are speaking in the latter stages of the call list should use the seats in the Public Gallery initially and move on to the horseshoe when seats become available there. Members can speak from the horseshoe only where there are microphones. Sadly, because this is a very well subscribed debate, there will be a three-minute time limit for all Back-Bench speakers.

--- Later in debate ---

[Rachel Hopkins (Luton South) (Lab) [V]]

It is a pleasure to serve under your chairmanship, Mr Hosie. I am very pleased to have secured today’s debate alongside my hon. Friends the Members for Liverpool, Wavertree (Paula Barker) and for Birkenhead (Mick Whitley).

Workers across the public sector have faced unprecedented challenges during the pandemic, and NHS staff have been at the forefront of our response to the coronavirus, spending long hours in suffocating PPE in overwhelming environments. A nurse described to me that it felt like they were part of a horror movie. Frontline NHS staff at Luton and Dunstable hospital have told me that colleagues have broken down on many occasions, and that the past year has had a severe psychological impact on them owing to stress associated with separation from their families, sleep deprivation and heavy workloads. The whole of society is extremely thankful for their work in protecting us, looking after our loved ones and keeping the country going.

The country came together to clap for our carers, but claps do not pay the bills and NHS workers deserve to be rewarded for their dedication. The Government’s recommendation of a 1% increase for NHS staff in England is truly shameful. After a decade of austerity, TUC research shows that if the 1% increase goes through for 2021-22, nurses’ pay will be £2,500 less than in 2010 when adjusted for inflation, with an equivalent fall of £3,330 for paramedics and £850 for porters. Experienced nurses will take home only an extra £3.50 a week. Not only does the 1% pay proposal reflect the Conservative party’s complete undervaluing of NHS staff, but it even breaks their previous measly promise of a 2.1% pay increase set out in the NHS long-term plan.

The British Medical Association, the Royal College of Nursing, the Royal College of Midwives and Unison have all told the Government to reconsider the pay offer. A recent poll from Opinium found that 72% of UK adults believe the Government’s 1% pay proposal is too low.

We have heard already that there is a nursing vacancy crisis that is compromising staff safety. Although the Government state that they are recruiting more nurses, there are still more than 36,000 nursing vacancies, including 3,314 in the eastern region where my constituency is, which has barely changed over the past year. The issue is retention. How do the Government expect to retain experienced nursing staff who have suffered a sustained real-terms pay cut over the past decade? How can the Government expect people to aspire to a future career in the profession when there are reports of nurses having to access support from food banks?

A nurse at Luton and Dunstable hospital told me that they deserve proper recognition of the level of skill and responsibility needed for the roles that they do. They also said that there is no motivation, no incentive, no value or appreciation.

The latest figures from the NHS staff survey show that more than 300,000 staff worked unpaid over the past year. That is 13,000 more staff working overtime than in 2019. The Government might point to the uncertain financial situation and current low inflation for the real-terms pay cut, but that is economically illiterate. If affordability is the Government’s main contention, they should consider the knock-on benefits. The Government hope—

[Stewart Hosie (in the Chair)]

Order. I am afraid the three minutes are up. You can have half a sentence.

[Rachel Hopkins]

Apologies. We know the NHS staff will spend pay rises in their local economy, and that will help to rebuild as well.

Covid-19: Government’s Publication of Contracts

Stewart Hosie Excerpts

Tuesday 9th March 2021 Commons Chamber

[Edward Argar]

My hon. Friend highlights the situation we faced at the time. He also, quite rightly, highlights the importance of transparency and complying with all transparency processes. The Government invoked regulation 32, which recognised the exceptional circumstances that allowed for procurement without the usual tendering process. I believe that the usual tendering process could take, at a minimum, 25 days. My hon. Friend recalls the situation at the time. The Government did what we felt was right to ensure that we got the PPE that our frontline needed. The court case also found that there was no policy to deprioritise compliance with transparency regulations. I give him the assurance he seeks: the Government are doing everything possible to ensure that we fully comply with those regulations going forward.

[Stewart Hosie (Dundee East) (SNP) [V]]

Some 94% of contracts awarded before 7 October were, unlawfully, not published in time and, as of late last week, 100 are still not published. Some 58% were awarded without a competitive tendering process. There are conflicts of interest, inadequate documentation, a high-priority crony lane and then the Prime Minister announcing that all of the contracts were,

“on the record for everybody to see”—[Official Report, 22 February 2021; Vol. 689, c. 631.]

When he said that, it was simply not correct. Is the Minister not concerned that this failure in transparency, the potential conflicts of interest and a Prime Minister who does not even appear to know what is going on, simply feeds a perception of a Government doing profitable deals with friends and cronies, rather than delivering meaningful transparency that will drive value for money for the taxpayer?

[Edward Argar]

The right hon. Gentleman highlights quite accurately the 94%, which was cited in the subsequent judgment and the order that flowed from it, of the contracts that were late in publication. We accept that that is a statement of fact. The Department has published 100% of the CANs that it is obliged to publish that are related to this matter. He talked about a percentage that were procured without following a normal competitive tendering process—I think he referred to 58% as the percentage that were procured. That is entirely appropriate under regulation 32, recognising the situation we faced at the time and the priority of this Government to make sure that, at pace, we got the PPE that our frontline needed to keep it safe.

On his final two points, I do not see in the judgments in this case or in any of the other scrutiny of this issue by Committees of this House or other organisations anything that asserts or finds that inappropriate conflicts of interest influenced how these contracts were awarded. I am proud to serve in a Government led by a Prime Minister who leads from the front and has done whatever is necessary to make sure this country gets through this pandemic.

Covid Contracts: Judicial Review

Stewart Hosie Excerpts

Wednesday 24th February 2021 Commons Chamber

[Edward Argar]

I am grateful to my hon. Friend. In answer to his first question, at the start of the pandemic, roughly 1% of the PPE used in these settings was produced in this country. Due to the incredible efforts of businesses and individuals across the country—and, I must say, of civil servants and officials in Government, who are often the unsung heroes of the pandemic—up to 70% is now being supplied by this country. He is absolutely right that transparency is important. It is hugely important, and we respect it and take it very seriously, but I make no apologies for what I and the Secretary of State consider to be the most important thing, which is doing whatever is necessary to save lives in the course of this pandemic.

[Stewart Hosie (Dundee East) (SNP) [V]]

I am glad the Minister mentioned transparency, because of the £15 billion PPE contracts awarded up until last October, barely £3 billion were properly published, and we had £252 million given to a finance company, £108 million to a confectionery supplier and £345 million to a pest control company—a catalogue of cronyism, described variously as a “wholesale failure”, a “dismal failure” and a “historic failure”. It was a process that deprioritised compliance and has ended up with the taxpayer, in some cases, buying expensive and unusable PPE. Ultimately, the Cabinet Office is responsible for the co-ordination of the cross-Government response to covid-19. So let me ask the Minister when the Minister for the Cabinet Office and, indeed, the Prime Minister were first made aware that failure to properly publish details of PPE contracts might be unlawful?

[Edward Argar]

I am grateful to the right hon. Gentleman. He will appreciate that some of the contracts which some colleagues have alluded to remain subject to separate litigation before the courts, including some by the Good Law Project, which I will refer to as the GLP as I suspect it may come up a number of times and it might save a few minutes in my answers. I hope he will understand that I will avoid straying into something that may still be before the courts, because I do not want to show any disrespect for the legal process. He talked about the number published and where we have got to now. That will be some of the information put before the judge on Friday as per his request, but for the latest figures that are in the public domain, which were covered in the judgment and indeed more broadly, I think 100% of the contract award notices have been published, and we are up to 99% under regulation 108 on the latest figures I have. As the judge said, the overall picture does show the Secretary of State

“moving close to complete compliance.”

In respect of the right hon. Gentleman’s broader point, I would expect that Ministers in my Department—which is why I am here—as well as Ministers in the Cabinet Office, will have followed the process very closely.

National Security and Investment Bill

Stewart Hosie Excerpts

Report stage & 3rd reading & 3rd reading: House of Commons & Report stage: House of Commons
Wednesday 20th January 2021 Commons Chamber

[Stewart Hosie (Dundee East) (SNP) [V]]

I beg to move, That the clause be read a Second time.

[Madam Deputy Speaker (Dame Rosie Winterton)]

With this it will be convenient to discuss the following:

New clause 2—Report on impact on Small to Medium Enterprises—

‘Not later than 18 months after the day on which this Act receives Royal Assent, the Secretary of State must lay before Parliament—

(a) a report setting out the impacts the Act has had on Small to Medium Enterprises and early-stage ventures, and

(b) guidance for Small to Medium Enterprises and early-stage ventures on complying with the provisions of this Act.’

This new clause would require the Government to produce a report setting out the impacts of this legislation on Small to Medium Enterprises and early-stage ventures, and to produce relevant guidance.

New clause 3—Grace period for Small and Medium Enterprises—

‘For the purposes of section 32, a person has a reasonable excuse if—

(a) the entity concerned is a Small to Medium Enterprise;

(b) this Act has been in force for less than six months.’

This new clause creates a grace period whereby – for alleged offences committed under Section 32 – Small to Medium Enterprises would have a ‘reasonable excuse’ if the alleged offence was committed within the first six months after the Bill’s passage.

New clause 4—Framework for understanding national security—

‘When assessing a risk to national security for the purposes of this Act, the Secretary of State must have regard to factors including, but not restricted to—

(a) the potential impact of the trigger event on the UK’s defence capabilities and interests;

(b) whether the trigger event risks enabling a hostile actor to—

(i) gain control or significant influence of a part of a critical supply chain, critical national infrastructure, or natural resource;

(ii) conduct espionage via or exert undue leverage over the target entity;

(iii) obtain access to sensitive sites or to corrupt processes or systems;

(c) the characteristics of the acquirer, including whether it is effectively directly or indirectly under the control, or subject to the direction, of a foreign government;

(d) whether the trigger event adversely impacts the UK’s capability and capacity to maintain security of supply or strategic capability in sectors critical to the UK’s economy or creates a situation of significant economic dependency;

(e) the potential impact of the trigger event on the transfer of sensitive data, technology or potentially sensitive intellectual property in strategically important sectors, outside of the UK;

(f) the potential impact of the trigger event on the UK’s international interests and obligations, including compliance with UK legislation on modern slavery and compliance with the UN Genocide Convention;

(g) the potential of the trigger event to involve or facilitate significant illicit or subversive activities, including terrorism, organised crime, money laundering and tax evasion; and

(h) whether the trigger event may adversely impact the safety and security of UK citizens or the UK.’

The new clause provides a non-exclusive framework of factors which the Secretary of State is obliged to have regard to when assessing a risk to national security.

New clause 5—National Security Definition—

‘When assessing a risk to national security for the purposes of this Act, the Secretary of State must have regard to factors including, but not restricted to—

(a) the potential impact of the trigger event on the UK’s defence capabilities and interests;

(b) whether the trigger event risks enabling a hostile actor to—

(i) gain control or significant influence of a critical supply chain, critical national infrastructure, or natural resource;

(ii) conduct espionage or exert undue leverage over the target entity;

(iii) obtain access to sensitive sites; or

(iv) to corrupt processes or systems.

(c) the characteristics of the acquirer, including whether it is effectively directly or indirectly under the control, or subject to the direction, of a foreign government;

(d) whether the trigger event adversely impacts the UK’s capability and capacity to maintain security of supply or strategic capability in sectors critical to the UK’s economy or creates a situation of significant economic dependency;

(e) the potential impact of the trigger event on the transfer of sensitive data, technology or potentially sensitive intellectual property in strategically important sectors, outside of the UK;

(f) the potential impact of the trigger event on the UK’s international interests and obligations, including compliance with UK legislation on modern slavery and compliance with the UN Genocide Convention;

(g) the potential of the trigger event to involve or facilitate significant illicit or subversive activities, including terrorism, organised crime, money laundering and tax evasion; and

(h) whether the trigger event may adversely impact the safety and security of UK citizens or the UK.’

This new clause establishes factors which the Secretary of State must have regard to when assessing a risk to national security.

New clause 6—Dedicated Small to Medium Enterprise support—

‘(1) Within 3 months of this Act receiving Royal Assent the Secretary of State must set up, a specific division focused on engagement with Small to Medium enterprises (SMEs) engaged in any provisions of this Act.

(2) The division must focus on four functions—

(a) providing updated, efficient and accessible guidance specific to SMEs on compliance with the terms of this Act;

(b) engaging with SMEs in advance of formal notification that can allow efficient notice and assessment periods, including through use of regulatory sandboxes where beneficial for innovation and national security;

(c) providing regular engagement with and assistance to SMEs throughout the assessment periods for SMEs;

(d) seeking to deliver prompt, proportionate resolution of complaints by SMEs relating to the provisions of this Bill;

(e) monitor the impact on access to investment for SMEs and report to the Secretary of State.’

This new clause would require the Secretary of State to set up a Small to Medium Enterprise (SME) engagement unit to assist and support SMEs through the national security screening process.

New clause 7—Reports to the Intelligence and Security Committee of Parliament—

‘(1) The Secretary of State must, in relation to each relevant period—

(a) prepare a report in accordance with this section, and

(b) provide a copy of it to the Intelligence and Security Committee of Parliament as soon as is practicable after the end of that period.

(2) Each report must provide, in respect of mandatory and voluntary notifications, call-in notices, and final orders made under this Act, details of—

(a) the jurisdiction of the acquirer and its incorporation;

(b) the number of state-owned entities and details of states of such entities;

(c) the nature of national security risks posed in transactions for which there were final orders;

(d) details of particular technological or sectoral expertise that were being targeted; and

(e) any other information the Secretary of State may deem instructive on the nature of national security threats uncovered through review undertaken under this Act.’

This new clause would require the Government to publish an ‘Annual Security Report’ to the Intelligence and Security Committee of Parliament.

Amendment 3, in clause 3, page 3, line 10, leave out subsection (4) and insert—

‘(4) The Secretary of State must review a statement published under this section within one year after the publication of the first such statement, and thereafter at least once every 5 years.’

This amendment would require the Secretary of State to review the statement about exercise of call-in power to be reviewed one year after they are made, and once every five years thereafter.

Amendment 1, in clause 6, page 5, line 3, at end insert—

‘(10) Notifiable acquisition regulations must be reviewed one year after they are made, and once every five years thereafter.’

This amendment would require notifiable acquisition regulations (including which sectors are covered) to be reviewed one year after they are made, and once every five years thereafter.

Amendment 6, page 5, line 3, at end insert—

‘(10) Notifiable acquisition regulations must bring broadcast, print and social media companies within the scope of the mandatory notification regime.’

Amendment 2, in clause 8, page 6, line 38, at end insert—

‘(8A) The fifth case is where a person becomes a major debt holder and therefore gains influence over the entity’s operation and policy decisions.

(8B) For the purposes of subsection (8A), a major debt holder is a person who holds at least 25% of the entity’s total debt.

(8C) The sixth case is where a person becomes a supplier to the entity of goods, services, infrastructure or resources to such an extent that the withholding of the supply would seriously undermine the entity’s ability to continue its operations.’

This amendment would mean that a person becoming a major debt holder or a major supplier would count as a person gaining control of a qualifying entity.

Amendment 4, in clause 30, page 20, line 3, after ‘period’ insert ‘or any calendar year’

This amendment would make it mandatory for the Government to inform Parliament if financial assistance given in any financial year, or in any calendar year, exceeds £100 million.

Amendment 5, in clause 54, page 33, line 42, at end insert—

‘(aa) whether the law of the country or territory to whose authority the disclosure would be made contains provisions and prohibit any use or disclosure of the information contrary to subsection (4),

(ab) whether the Secretary of State considers that disclosing the information to that authority would in itself pose a threat to national security, and’

This amendment would add to the list of factors the Secretary of State takes into consideration a sub-clause to ensure that a country or territory making a disclosure request has sufficient safeguarding in place to prevent any action that would be considered unlawful in the UK.

Amendment 7, in clause 61, page 36, line 20, at end insert—

‘(m) the average number of days taken to assess a trigger event called in under the Act;

(n) the average number of days taken for acceptance decisions in respect of mandatory and voluntary notices;

(o) the average staff resource allocated to the operation of reviews of notices made under sections 14 and 18 over the relevant period;

(p) the number and proportion of notices and call-in notices concerning the acquisition of a Small to Medium Enterprise; and

(q) in respect of the transactions stated subsection (p), the sectors of the economy in relation to which call-in notices were given.’

This amendment would require the Secretary of State to report on the time taken to process notices, the resource allocated to the new Unit and the extent to which Small to Medium Enterprises are being called-in under the new regime.

[Stewart Hosie]

The new clause is in my name and the names of my hon. Friends, as are new clauses 2 and 3 and amendments 1 to 6.

On Second Reading of this Bill, I described how it was designed to bring additional scrutiny of foreign investment that may have an impact on national security. I agreed that not only was there nothing wrong with having a national security eye on investments in critical areas, but it was in fact absolutely vital. During that debate, the House appeared to acknowledge the concern about the national security implication from investments that are shared globally and that a number of other countries had been tightening up their investment security regimes in response to changing national security-related threats to enabling technology, to intellectual property and so on. The debate also saw descriptions of the tightening of these regulations in Japan, Canada, Sweden, Germany and elsewhere. There was little disagreement on the Government’s proposals where, if the trigger and threshold were both met, an individual investment could be called in by the Secretary of State for approval, the powers could be retrospective, and an investment could be called in after it had occurred. There was some concern about the time to conduct the national security assessments—30 days with potentially an extra 45, which might actually be deemed a little short and it still prompts the question of whether 75 days was actually sufficient. There was, however, broad agreement about the mandatory notification process where investment interests in certain sectors and asset types must be pre-emptively or retrospectively declared. There were real concerns that this may lead to a very large number of notifications from businesses erring on the side of caution.

The Bill also introduced new powers to increase screening in respect of health and preventing hostile acquisition through strategic buying of health supplies, and I welcome that, with the warning that the scope of activities that may be caught is very wide. That is because the statement of policy intent, which describes the core areas as including such things as advanced technology, is perfectly reasonable, but it also contains a much wider definition of national infrastructure.

That debate did focus on the impact assessment for the Bill, which estimated that the new regime would result in somewhere between 1,000 and 1,800 transactions being notified each year—a very high number given that only 12 transactions were reviewed on national security grounds since the current regime was introduced 17 years ago. It does also remain the case that we still need to carefully assess the impact of the Bill—the impact that it will have on sectors and on infrastructure not just in the UK as a whole, but in the devolved nations and in the English regions. On Second Reading, I asked the Minister to take a little time to convince himself that there were no unintended consequences either for the UK or, indeed, for the Scottish Government’s inward investment plans when Government agencies of all sorts are actively seeking investment in some areas, which may be deemed to be critical national infrastructure. That is an issue that I do hope he will still address today. How do we ensure collectively that this Bill does not impede growth or investment in such areas.

The key concern I had was about implementation. The Bill is set to radically overhaul the UK’s approach to foreign investment at a time of significant economic uncertainty. On leaving the EU, the UK Government cannot afford to get their global Britain approach wrong and suffer what has been described as the potentially chilling effect on investment if the measures in the Bill appear to be heavy-handed. That is a concern across the board, given that even microbusinesses are in scope.

I take this brief opportunity to thank my hon. Friends the Members for Glenrothes (Peter Grant) and for Aberdeen South (Stephen Flynn), who served on the Bill Committee. They raised a large number of concerns, including the impact on academic research spin-offs, SMEs and early-stage ventures. They called for a grace period for SMEs falling foul of this new legislation, a review of exercisable call-ins and a review of the notifiable acquisition regulations. They suggested that broadcast, print and social media companies should be in scope. They suggested that major debt holders should be defined as a person gaining control of a qualifying asset and they suggested a requirement to report if financial compensation from Government exceeded £100 million in either a calendar or financial year.

All those amendments and contributions were made for very good reasons. The Scottish National party has long argued that it is right to have this legislation and for it to be made. In some ways it is long overdue, but that does not mean there are no concerns, which is why we have tabled new clauses 1 to 3 and amendments 1 to 6.

New clause 1 would require the Secretary of State to assess the impact of the Bill on academic research spin-off enterprises. New clause 2 would require the Government to produce a report setting out the impacts of the legislation on small and medium enterprises and on early-stage ventures and to produce relevant guidance. New clause 3 would create a grace period whereby for alleged offences committed under clause 32, SMEs would have a reasonable excuse if the alleged offence was committed within the first six months of the Bill being in operation.

I will turn briefly to the amendments. Amendment 1 would require notifiable acquisition regulations, including the sectors to be covered, to be reviewed one year after they are made and five years thereafter. Amendment 2 would mean that a person becoming a major debt holder or a major supplier would count as a person gaining control of a qualifying asset. Amendment 3 would require the Secretary of State to review statements about the exercise of call-in power one year after they are made, and once every five years thereafter. Amendment 4 would make it mandatory for the Government to inform Parliament if financial assistance given in any financial or calendar year exceeded £100 million. Amendment 5 would add to the list of factors the Secretary of State has to take into account. They would have to ensure that a country or territory making a disclosure request had sufficient safeguarding in place to prevent any action that would be considered unlawful in the UK. Amendment 6 would ensure that notifiable acquisition regulations bring broadcast, print and social media companies into the scope of the mandatory notification regime.

All those new clauses and amendments in essence are designed to ensure that the scope of the legislation is appropriate, but that the impact, particularly on investment, is proportionate. I have not determined yet whether to press any of them to a vote. What I would prefer is for the Minister to give a commitment, not simply to have infrequent if regular reviews of parts of this Bill, but to keep the Bill under permanent review to ensure that the scope remains valid—not too wide and not too narrow—and that the impact on investment and risk, particularly in small and medium-sized enterprises, academia and research, is proportionate. Through that, we can ensure that we quite rightly protect national security, but do not suffer from the investment chill that some fear could be the consequence if we get this wrong. With those brief remarks, I commend the new clauses and amendments to the House.

--- Later in debate ---

[Nadhim Zahawi]

I will not give way. There is a lot to get through and time is short.

The Government will more generally monitor the operation of the regime and regularly review the contents of the annual reports, including in relation to academic research, spin-off enterprise or SMEs, and we will pay close attention to the resourcing and the timelines of the regime.

If, during any financial year, the assistance given under clause 30 totals £100 million or more, the Bill requires the Secretary of State to lay a report of the amount before the House. Requiring him to lay what would likely be a very similar report for every calendar year as well as for every financial year, which is in amendment 4, appears to be excessive in our view. He would likely have to give Parliament two very similar reports only a few months apart.

On amendment 5, I can reassure the House that, under clause 54, the Secretary of State would be subject to public law duties when deciding whether to share information with an overseas public authority. That includes a requirement to take all relevant considerations into account in making decisions. These are therefore considerations that the Secretary of State would already need to take into account in order to comply with public law duties.

Moving on to new clause 6, I want to be clear that we do not expect the regime to disproportionately affect SMEs, although we will of course closely monitor its impact. The Government have been happy to provide support to businesses both large and small through the contact address available on gov.uk. Furthermore, the factsheets make it clear what the measures in the proposed legislation are and to whom they apply, so there is real clarity on this. It would therefore not be necessary to provide the grace period for SMEs proposed under new clause 3 and neither would it be appropriate. Notifiable acquisitions by SMEs may well present national security concerns and this proposed new clause would, I am afraid, create a substantial loophole.

To conclude, although I am very grateful for the constructive and collegiate engagement from hon. and right hon. Members across the House, for the reasons that I have mentioned I cannot accept the amendments and new clauses tabled for this debate and therefore hope that they will agree to withdraw them.

[Stewart Hosie [V]]

This has been a detailed and considered debate. I thought there were some particularly thoughtful contributions from the Chair of the ISC and from the right hon. Member for North Durham (Mr Jones) in relation to the oversight of sensitive and confidential information that should fall within the remit of the ISC. It was disappointing to hear the Minister’s response in his last contribution. My main concern, however, was to ensure that the scope of the Bill was appropriate and that the impact of the measures was proportionate, particularly for smaller businesses and for academia. Given what the Minister has just said about the regulations and procedures being under constant watch, with the Secretary of State having the flexibility to update them at any time, I am satisfied that, should we identify an overly burdensome course of action being taken in relation to small businesses or academia in the future, the Minister would respond swiftly. I therefore beg to ask leave to withdraw the motion.

Clause, by leave, withdrawn.

New Clause 4

Framework for understanding national security

“When assessing a risk to national security for the purposes of this Act, the Secretary of State must have regard to factors including, but not restricted to—

(a) the potential impact of the trigger event on the UK’s defence capabilities and interests;

(b) whether the trigger event risks enabling a hostile actor to—

(i) gain control or significant influence of a part of a critical supply chain, critical national infrastructure, or natural resource;

(ii) conduct espionage via or exert undue leverage over the target entity;

(iii) obtain access to sensitive sites or to corrupt processes or systems;

(c) the characteristics of the acquirer, including whether it is effectively directly or indirectly under the control, or subject to the direction, of a foreign government;

(d) whether the trigger event adversely impacts the UK’s capability and capacity to maintain security of supply or strategic capability in sectors critical to the UK’s economy or creates a situation of significant economic dependency;

(e) the potential impact of the trigger event on the transfer of sensitive data, technology or potentially sensitive intellectual property in strategically important sectors, outside of the UK;

(f) the potential impact of the trigger event on the UK’s international interests and obligations, including compliance with UK legislation on modern slavery and compliance with the UN Genocide Convention;

(g) the potential of the trigger event to involve or facilitate significant illicit or subversive activities, including terrorism, organised crime, money laundering and tax evasion; and

(h) whether the trigger event may adversely impact the safety and security of UK citizens or the UK.”—(Tom Tugendhat.)

Brought up, and read the First time.

Question put, That the clause be read a Second time.

--- Later in debate ---

[Stewart Hosie (Dundee East) (SNP) [V]]

I also offer my congratulations to the Secretary of State on his promotion. I thank all the staff who have worked on the Bill so far and the businesses, trade bodies and others that advised on what might or might not be good about the legislation as it has gone through its stages. Finally, I thank Members from all parties—not just those who took part in the set piece debates, but those who put in a shift in Committee as well. They did a fantastic job.

In this short Third Reading speech, I should say briefly that I share the general agreement that this legislation is not just necessary—it is—but overdue. There is a broad consensus that that is the case. Changes may yet be made in the other place—including, I hope, as we just heard from the Chair of the Intelligence and Security Committee, a formal role for the ISC—but whether those changes happen or not, we must now all hope that this legislation will go on to deliver the anticipated additional national security benefits. As that happens, the Government must also step in quickly if the impact of the Bill starts to chill vital investment across different areas of the economy.

I am sure that the first part will happen: that the national security benefits will be there and obvious for all to see. We must all, however, be on our guard and realise that the burdens that we are placing on businesses —to notify when investment is happening or to have investment called in subsequently—may chill investment. We must all guard against that to make sure that, as well as there being additional security for those in the UK, businesses can continue to grow, thrive and seek the investment they need.

NHS 70th Anniversary

Stewart Hosie Excerpts

Wednesday 16th May 2018 Westminster Hall

[Nick Smith]

I thank my hon. Friend for supporting parkrun. Perhaps we should have a south Wales eastern region parkrun championship at some point in the coming months. He is absolutely right about volunteers and the running club supporters who are out there at 9 o’clock on a Saturday morning, or sometimes on a Sunday morning for the junior parkrun, in parks all across the country. They do a great job in all weather. It is brilliant to see. More than 30,000 runners took part in parkruns in Wales alone last year. It is that sort of activity with cross-body support and backing from our community role models that can make a big difference to making such schemes stick.

When Nye wanted to Tredegar-ise the national health service, he wanted a service built on community where we all bought in and all had a stake. In that spirit the public health challenges we face 70 years on should not be tackled alone. To truly take care of ourselves, we need a society that sets us up for success, a system that has our backs, a public service that recognises what needs to be changed and how to do it. The Government have a real chance to honour the anniversary of the national health service in the months ahead, not with pomp and ceremony, but with the sort of action that people will celebrate another 70 years from now.

[Stewart Hosie (in the Chair)]

Numerous Members wish to speak and I intend to start the summing-up speeches at about 10.30. Members are not particularly time limited, but speeches of six or seven minutes will get everybody in.

Privatisation of NHS Services

Stewart Hosie Excerpts

Monday 23rd April 2018 Westminster Hall

[Andrew Selous]

We have 35 minutes left.

[Stewart Hosie (in the Chair)]

Order. The hon. Lady will decide what interventions she wants to take.

[Dr Whitford]

I have only just started, and there is not much time left. It is repeatedly mentioned in this House that patients and carers in England have to pay significant car parking charges. That should not be seen as a benefit.

The Conservatives introduced the internal market in 1990. That introduced competition between NHS hospitals, and even at that point created an “us and them” mentality in my local area. It created divisions between the GPs and the hospital through the purchaser-provider split. Sometimes, if a patient was sent to me but had a problem that I diagnosed as pertaining to a different department, I could not refer them on, because the GP would not fund it. They had to go back to the GP and start again. That was both inefficient and, at times, dangerous.

Unfortunately, I have to criticise official Opposition Members, because I remember in 1997 when Labour got in and talked about going back to one NHS. Those of us who worked in the NHS were delighted. Sadly, we soon started to hear about foundation trusts and, in essence, we were back to the same policy. It was Labour that introduced independent treatment centres, initially with block contracts for common operations such as those on hips and knees. Most of those contracts were not met, and were therefore of incredibly poor value. GPs were being pushed to refer their patients to the ITCs. That was eventually recognised, and the move was made towards payment by results, which eventually led to the tariff. Capital funding was also kept off the books, leading to the private finance initiative, which we have discussed many times in this place. PFI has been shown to result in between £150 million and £200 million of profit per year for the companies that hold the contracts. That is putting a huge strain on many trusts.

In the 2010 election, the Conservatives promised no top-down reorganisation. Unfortunately, just a couple of years later, with the introduction of the Health and Social Care Act 2012, we saw that that was not true. The Act came into force in April 2013, and section 75 in particular pushed commissioning groups to put contracts out for tender. That has created relentless pressure to bring independent sector providers into the NHS. As the hon. Member for Thirsk and Malton (Kevin Hollinrake) mentioned, it has risen from £2.2 billion in 2006 to £9 billion in 2016-17, more than 10 years later. That is approximately the same cost as providing all GP services, so it is not a minor cost; it is significant. The independent treatment sector in 2015-16 won approximately 34% of contracts—a figure that rose to 43% in 2016-17. However, as the independent treatment sector has moved towards more community services, it is now winning approximately 60% of contracts. There is no question but that there is greater involvement of private companies in providing healthcare.

We hear all the time about waste in the NHS, but we have had circular reorganisation throughout my career—from 100 health authorities to 300 primary care trusts, to 150 primary care trusts and to a little more than 200 clinical commissioning groups. CCGs were described as putting power into GPs’ hands, but less than half of CCGs have a majority of clinicians on them, and less than 18% have a majority of GPs. We are now going to go through another change, with the introduction of 44 sustainability and transformation plans or accountable care organisations. The costs associated with the redesign, the redundancies, the new organisations, the external consultants and the change managers are all described as one-offs, but this has been repeated relentlessly over the past 30 years and has resulted in huge waste. Much smaller organisations, such as hospital trust and ambulance trusts, are now run by very senior managers with six-figure salaries—the same size as those received by the people who ran health authorities at the start of all this. That is a waste.

Then there are the running costs of the market itself—the contracting design, the tendering, the bid teams, the corporate lawyers, the billing and the profits. The costs of the system are utterly opaque. It is not possible to penetrate the veil of commercial sensitivity, and the Department of Health does absolutely nothing to show where public money is spent. It is estimated that the cost of the English healthcare market is between £5 billion and £20 billion—no one really knows. We have no evidence of precisely how high the costs are, and there is absolutely no evidence of a benefit, so it is not possible to do a cost-benefit analysis.

--- Later in debate ---

[Richard Graham]

I was struck by how the hon. Member for York Central (Rachael Maskell), while talking about the need to find cross-party consensus on these issues, took no interventions from anyone on the Government Benches—[Interruption.]

[Stewart Hosie (in the Chair)]

Order.

[Richard Graham]

Furthermore, she made no recognition of the fact that issues such as subsidiary companies and so on are separate from the points she was making and absolutely not about privatisation.