NHS Bursary

Wes Streeting Excerpts

Monday 11th January 2016 Westminster Hall

[Wes Streeting (Ilford North) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Pritchard. I am delighted that, thanks to the response of more than 150,000 people, we are having this important and timely debate, which will allow me to raise some of the issues outstanding from the Adjournment debate that I secured before Christmas and address those that the Government have not yet addressed.

It is encouraging to see three members of the shadow Cabinet here at this debate: the shadow Health Secretary, my hon. Friend the Member for Lewisham East (Heidi Alexander); the shadow Minister for mental health, my hon. Friend the Member for Liverpool, Wavertree (Luciana Berger); and the shadow Foreign Secretary, my right hon. Friend the Member for Leeds Central (Hilary Benn), who has shown an interest during the course of these proceedings. This weekend, the shadow Health Secretary and I, along with other right hon. and hon. Members, joined thousands of students, nurses and supporters marching through the streets of London to raise their concerns about the implications of the Government’s decision. A statement of support from the Leader of the Opposition, my right hon. Friend the Member for Islington North (Jeremy Corbyn), was well received by all in attendance.

I begin by emphasising that, often as shorthand, we have been discussing the implications of the policy changes for student nurses and midwives, but of course the changes extend to a range of allied health professionals, as I said in my Adjournment debate. It is important not to lose sight of that when discussing the Government’s proposed approach.

To recap the Adjournment debate, we are discussing the biggest shake-up in the funding of nursing, midwifery and allied health subjects since the Health Services and Public Health Act 1968. It would mean the end of the non-means-tested grant of up to £1,000, the end of the means-tested NHS bursary of up to £3,191 and the imposition of tuition fees of £9,000 a year, which would burden nurses, midwives and other allied health professionals at the start of their career with huge debts of at least £51,600. Thanks to the repayment threshold, now shamefully frozen at £21,000, they will begin to pay back those debts immediately on starting their career and will face an average pay cut of £900.

Given that such professionals are required to work at least 2,300 more hours across the course of their degree, it is an absolute disgrace that we are seeking to balance the books on the backs of the front-line staff who form the backbone of our NHS. No wonder so many NHS professionals across the board are angered by the Government’s approach. It seems to be a trend under this Government. We are seeing it not just in the treatment of nurses, midwives and allied health professionals but in the Government’s intransigent approach to the junior doctors dispute, in which people could go out on industrial action, not out of choice but out of apparent necessity.

To follow on from the Adjournment debate, a number of questions are still outstanding. My concerns about the Government’s approach involve both the policy content and the process that they are choosing to follow. I asked the Minister during the Adjournment debate whether he could confirm that the Government would consult on the principle of policy changes, not merely their implementation. He told the House that

“we will not consult on the principle, because that has been decided”.—[Official Report, 14 December 2015; Vol. 603, c. 1379.]

Yet, as I will go on to outline, many fundamental aspects of the policy and the detail underpinning it have not yet even been considered by the Government. I am surprised that Ministers are confident embarking on such a radical course of action without having thought through the consequences properly. I have asked the Minister what analysis the Government have conducted of students receiving NHS bursaries for tuition and maintenance costs, but have received no answer. I do not believe that the analysis has yet been conducted. I am sure that it is under way, because he has confirmed that the Government will publish an impact assessment alongside the consultation, which he expects to start next month, but was that impact assessment conducted before the Government embarked on this approach, or is the Chancellor just shooting in the dark to balance his books?

[Louise Haigh (Sheffield, Heeley) (Lab)]

Is my hon. Friend aware of research by the trade union Unison showing that nine out of 10 student nurses surveyed said that they would not have gone into training if the new proposals had been in place? Given that this month London issued a critical alert after its vacancy rate jumped 26% to 10,000, should the impact assessment not cover the impact on the recruitment and retention of nurses in our system?

[Wes Streeting]

Those statistics concern me greatly. I should probably have said at the outset of this debate that I am a member and supporter of Unison. I also draw the House’s attention to my entry in the Register of Members’ Financial Interests. For completeness, I should also say that I am a former president of the National Union of Students and have a long-standing interest in such issues.

It concerns me that there might be a detrimental impact on recruitment, particularly given that my local NHS trust had to fly nurses over from Portugal to fill vacancies. I have no problem with those Portuguese nurses coming over to help plug the gap, but we have plenty of home-grown talent in the form of nurses who would welcome such a job opportunity. That is felt strongly by local people in my area.

[Stella Creasy]

My hon. Friend is a near neighbour to Barts hospital trust, which is currently spending £10 million a year at Whipps Cross university hospital, our local hospital, such is the shortage. A hospital that is £941 million in debt due to its private finance initiative loans clearly needs to save money, yet it is having to pay £10 million for agency nurses. Does he think that the policy will make that easier or harder to deal with?

[Wes Streeting]

I am grateful to my hon. Friend for that intervention, and I believe it will make it harder. That concerns me, because Barking, Havering and Redbridge University Hospitals NHS Trust covers part of my constituency and the other half is served by the Barts Health NHS Trust. Both trusts are in special measures, and one issue that has contributed to that has been the inability of both trusts to recruit and retain the staff necessary to provide the timely and quality care that residents in Ilford North and other parts of north-east London have come to expect.

[Alex Cunningham]

It is clear that the professionals are very worried about this issue. South Tees Hospitals NHS Foundation Trust has told a midwife in my constituency and her nurse colleagues that it wants to extend their breaks from 30 minutes to 60 minutes, which means they will have to work an extra shift every four weeks. Many of them cannot take their 30-minute break now, and they are really worried that they will have to work even more hours because the trust will not be able to get the staff it needs if the bursary scheme does not continue. Does my hon. Friend agree that for that reason, the South Tees trust should rethink its plan, and that the Government should do likewise regarding bursaries?

[Wes Streeting]

I certainly agree with my hon. Friend. The Government and the NHS underestimate the extent to which staff at all levels are both working beyond their allocated shifts to plug gaps in the service and going without breaks. Given the settings that those staff work in, it is not in the interests of patients, let alone good for the welfare of the staff themselves, for them to be tired and not taking the breaks they ought to take.

[Mr Jim Cunningham]

One critical area at the moment is care in the community. Does my hon. Friend agree that the change to bursaries will have a big impact when we try to recruit community nurses for all sorts of illnesses?

[Wes Streeting]

I am grateful to my hon. Friend for raising that point, which I did not raise in the earlier Adjournment debate. Since that debate took place I have seen an article by Crystal Oldman in Independent Nurse magazine, which expressed concern about our ability to recruit nurses into community-based settings. If we are trying to prevent patients from presenting at accident and emergency, which is important to alleviate waiting times and the burden on A&E departments, it is vital that people can access timely care and support in the community. I do not believe the Government have fully considered that, but I look forward to hearing the Minister’s response.

In my Adjournment debate I also asked the Government whether they thought it was fair that students from the most deprived backgrounds should have their grants taken away while some of the wealthiest people in our society received tax cuts. I am not surprised that I did not receive an answer to that question, but it is a fair one. A lot of people wonder how, in straitened times, it is possible for the Government to find money for tax cuts for the wealthiest, but we cannot find money to ensure that people who perform vital functions in the NHS receive the support they need to get them through their training.

I asked the Minister in that debate how much debt the Government expect to write off because those indebted by the reforms are unable to pay their debts in full. That question was not answered. However, we know that in the case of the tuition fees brought in by the coalition Government, the current Government expect that the majority of students will see their debts written off, at cost to the taxpayer, further down the line.

I wonder about the Chancellor. Following him on economic policy at the moment is a bit like following a drunk driver: one minute he tells us that things are fantastic, and then the next minute he tells us that something called “the global economy” might have an impact on our domestic economy. I am glad that he has finally got that point, but I do not believe that he is currently being straight with the House and the public about how he intends to “fix the roof”, whether the sun is shining or not. It will be no good if some poor Chancellor 30 years down the line has to find huge amounts of money for debt write-off. This Chancellor needs to be clearer about where the money is really coming from.

On that point, I asked in the Adjournment debate which Department—the Department of Health or the Department for Business, Innovation and Skills—would meet the cost of servicing the resource accounting and budgeting charge for student loan debt. That question was not answered, although I am sure the Treasury and both those Departments have a view. It seems that the Government have not reached a clear position, and they really ought to have done so before embarking on this course of action.

I also asked the Minister about the Barnett consequentials for health education budgets in Northern Ireland, Scotland and Wales. He told the House that it was a matter for Her Majesty’s Treasury, but I am afraid that we did not get any real detail about what the impact on those nations would be.

Will the Minister also say how clinical placements will be funded under the current loans system? He tells us that he has started discussions with Universities UK about that, but we would have expected the Government to have those discussions before embarking on a policy of this nature.

I also asked the Government whether they were at all concerned that applications from mature students might fall, given the detrimental impact that the coalition Government’s student finance reforms had on mature and part-time student numbers. The Minister did not give a reply, but we have heard in interventions this afternoon that that is a legitimate concern. We keep being told that all has been well since the coalition introduced the new tuition fees regime, and that student numbers in higher education are excellent. It is true that overall student numbers have gone up, but I do not think that there has been the necessary level of analysis about whether people are being deterred from applying. It is all very well saying that the numbers have gone up, but that does not tell me whether the regime deterred people from applying. However, we know for certain that it has had a particularly detrimental impact on the numbers of mature and part-time students. The issue of mature students ought to weigh heavily on the Government’s mind before they decide to proceed down this course on nursing bursaries, because it is clear that there will be big problems for the nursing profession if mature student numbers fall.

[Nic Dakin]

On that point, it is important for areas such as north Lincolnshire, which struggle to attract new graduates, to be able to grow our own graduates, and mature students are a major part of that. A fall in their number will particularly affect areas such as ours, which new graduates do not see as particularly attractive.

[Wes Streeting]

I absolutely agree with my hon. Friend, and I have another concern. In my Adjournment debate I asked the Minister to confirm whether mature students would be eligible to apply for a second loan, and he confirmed that they would be able to do so. However, that does not reassure me that the change to bursaries will not have a detrimental impact. If a mature student has already taken out a significant loan for a first undergraduate degree and still has some of that loan debt outstanding, given that they are closer to retirement than the stereotypical 18-year-old entrant, will they really want to take on additional debt? There are major question marks about that, and again, the Government ought to have done the research and analysis on it before embarking on this policy direction.

I am conscious of the time and the number of Members who wish to speak, so I turn finally to the question of process. This Thursday, a Delegated Legislation Committee will be convened to debate the abolition of student grants for all students, including the cohort we are talking about today. It is absolutely appalling that the Government are seeking to use the device of delegated legislation to put through such a major change to student finance. Whatever disagreements I had with previous Labour Governments about their higher education policy, at least they were courageous enough to bring their policies to the House of Commons, put them through the House of Lords, justify them and put them in the full light of scrutiny by right hon. and hon. Members.

This use of a Delegated Legislation Committee is part of a wider pattern of behaviour by this Government, who seek to ignore scrutiny. They seem to believe that a majority of 12 on a minority of the vote gives them carte blanche to do whatever they like. The level of public outcry, not to mention the concern expressed by Members from all parties in the House, means that the Government ought to behave far more transparently.

I asked the Minister in my adjournment debate to give the House an assurance that students studying nursing, midwifery and allied health subjects would not see their tuition fees and debts hiked up even further than has been suggested, but I was not answered. We know from newspaper speculation that the Government are considering increasing tuition fees above inflation, and we also know that the Cabinet Office is trying to find ways of avoiding a vote in both Houses, which is shameful.

Similarly, I asked the Minister to give the House an assurance that we would have a full debate and a vote if the Government chose to extend tuition fees to nursing, midwifery and allied health subject courses. The Minister told the House that he could not give us a definite answer to that question yet. I hope that he can do so this afternoon, and that he will confirm that we will have a full debate in the House of Commons and in the House of Lords, and that right hon. and hon. Members and noble peers will have the chance to make their voices heard and to put the issue to a vote.

Finally, I asked the Minister to commit to meeting student representatives to discuss their concerns, and he said that he was happy to do so. I spoke this weekend to one of the organisers of the protest, Danielle Tiplady, who has done a remarkable job in campaigning on this issue and in raising awareness among her colleagues. I hope the Minister will commit today to meeting her and other student representatives, so that he can hear at first hand the powerful testimony that we heard at the demonstration at the weekend.

We should all be concerned about the direction of this policy, and I am glad to see so many right hon. and hon. Members here this afternoon. Given that there are other debates taking place, including on Syria, which is a really big matter that concerns all of us, it is great that we have had such a big turnout this afternoon. I hope that helps to encourage the Government to think again.

[Several hon. Members rose—]

--- Later in debate ---

[Ben Gummer]

I was merely making the point that there is a lot of exciting thinking out there, outside the workforce planning that we are doing. Through our reforms, I hope to be able to encourage more of that. I know that there is some very innovative thinking in my part of the country. People want to get on with it in the NHS and university sectors, but at the moment they cannot, because of the constraints on how nurses are trained and recruited.

I turn to the issues raised by my hon. Friend the Member for Sutton and Cheam, who introduced the debate on the petition. He asked four specific questions. One was on specialist courses, and the shadow Minister repeated that point. Some specialist courses have suffered shortages for many years. For several years, the Higher Education Funding Council for England has been dealing with the wider attribution of training funds and university tuition funds across the sector, and it will take on responsibility for making sure that very small and specialist courses are properly funded and promoted. In liberating the universities sector a little, I hope that we will be able to excite interest in some of the more specialist courses, which have been suffering for several years, and better match foundation trusts’ workforce requirements with universities’ ability to deliver.

My hon. Friend asked whether foundation trusts will be able to pay back loans as an inducement. I do not know whether that will be possible for foundation trusts specifically, but they are free to offer pay premiums to aid their recruitment—they have been able to do so for many years. I imagine that will continue.

My hon. Friend asked about the number of placements and the financing of them. That will be determined by the consultation and in discussions with Universities UK. He also asked about the arrangement for placement expenses, and I have heard his point. I know it is a unique problem that is specific to student nurses—although to some extent, it also applies to student teachers—and again, we want to look at that in detail in the consultation to ensure that we get the implementation right. That is why it is not just a matter of pure detail; it is about how the policy works as implemented.

The hon. Member for Ilford North raised a number of points in addition to the ones he raised in his Adjournment debate. I apologise for not having answered all of them previously; I had a short time and he raised a huge number, with his usual eloquence. However, I hope I can answer some of his specific points on this occasion.

The hon. Gentleman asked about the problems of recruiting into community-based settings. There is a shortage in that specialty, which has traditionally suffered from problems in recruiting. I am well aware, just as he is, of the need to improve recruitment into community settings and primary care settings if we are to get the proper integration of primary and secondary care, and more importantly, of social care and the NHS. That is one of the key challenges facing us in the years ahead. Health Education England has a scheme under way called “Transforming nursing for community and primary care”, which it launched just over a year ago, precisely to incentivise nursing applicants into that specialty. Again, I hope that universities will respond positively, as they have in the case of other courses, so that they step up to the workforce demands placed on them as a result of the reforms that we are making.

The hon. Gentleman asked what the amount of debt to be written off was. The long-term loan subsidy—he will understand the phraseology—remains at 30%. That is the figure that the Treasury has set. As a consequence of that and because of, as he put it, reliable reports from newspapers, which he imputed to be fact, he asked whether there would be an increase in student fees above inflation. I can say to him that there are no plans at all to increase student tuition fees above inflation.

The hon. Gentleman asked whether I would be willing to meet those who disagree with my point of view and that of the Government on this matter. I would, of course, and I have done already. I would be delighted to meet anyone whom he wishes to bring to me, including the demonstrators he mentioned.

The hon. Gentleman began his speech, however, by talking about a burden of debt. It is important for all of us here to remember that the loan is an attachment against earnings, which is time-limited and limited according to the ability to earn, so it is not like debt such as a mortgage. We made the same argument back in 2011 and 2012, and it is important that we use language correctly in this place. We saw an uptake in university courses after the 2012 reforms. Once prospective students understood how the financing worked, how they would pay back the tuition fees and that it was not a debt that would saddle them in the same way that a mortgage or hire purchase agreement might, as was suggested at the time, university applications increased significantly. We all have an interest in this place in making sure that the number of people going into nursing increases. It is important, therefore, that even if we disagree with the policy, we do not misrepresent it.

[Wes Streeting]

After leaving the National Union of Students in 2010 when my term in office expired, I worked with Martin Lewis from MoneySavingExpert.com and the coalition Government to try to communicate the facts behind the tuition fees system, so I endorse what the Minister says about getting the facts across. Martin Lewis and I are concerned that the Government are seeking to apply retrospective changes to the terms and conditions of student loans without a parliamentary debate and vote. We would have a much better airing of all the issues, and this issue specifically, if we had that debate and vote in the House of Commons. Will the Minister commit to that process now?

[Ben Gummer]

The hon. Gentleman knows that I cannot commit other Ministers to debates, but I will certainly represent his concerns to the Minister for Universities and Science, my hon. Friend the hon. Member for Orpington (Joseph Johnson). He makes a strong point. It seems that I am the only person in this Chamber not to have a close acquaintance with Martin Lewis, but I will ensure that the hon. Gentleman’s points, including the one about the Delegated Legislation Committee—I sat on such Committees for a few years and never received anything nearly as exciting as student grants—are represented to the Universities Minister, so that he can answer him directly.

I wish also to address the points raised by the hon. Member for Heywood and Middleton (Liz McInnes), who talked about equality impact assessments. We have worked up an assessment of the impact that the changes will have on recruitment into nursing—of course we have—as part of our policy generation. That will culminate in a full equality impact assessment and a business case, which will be published at the time of the consultation, not long from now. I hope that that will inform the discussions that take place, so that we can have a robust and evidence-based debate.

The hon. Lady talked about housing costs, which was reflected in an intervention by the right hon. Member for Oxford East (Mr Smith). Housing costs are a considerable pressure for many students—not only those applying for nursing courses, but those in high-cost parts of the country. That is partly why we want to increase the amount of maintenance we can provide. To return to my central point, within the current spending envelope we can do that by such a considerable amount—25%—only through a reformed system. To do it in other ways would be prohibitively expensive, and I do not believe the Opposition have proposed that.

The hon. Lady asked about NMC registration fees. At the moment, they are incurred at the point of registration when the university course has finished and are tax-deductible. They have risen in the last year, which I know has caused disquiet among nurses. I have spoken to the regulators, including the NMC, and implored them to keep their fees at a sensible level and to avoid rises whenever possible. The NMC has had to deal with a considerable increase in fitness-to-practise cases, but I hope that with internal cost savings it will be able to mitigate further rises. I have certainly asked it to do that, although it is an independent body.

The hon. Lady cited someone she had spoken to who was, if I understood her correctly, halfway through a degree. It is important to state that the change is for new students only, so those on existing courses will not be affected.

Student Nursing (Finance)

Wes Streeting Excerpts

Monday 14th December 2015 Commons Chamber

[Wes Streeting (Ilford North) (Lab)]

I am grateful for this opportunity to lead my first Adjournment debate on the serious issue of finance for student nurses and midwives.

I have a long-standing interest in the issues. I spent much of my career outside this place working for a number of charities to widen access to higher education and to tackle broader educational disadvantage. As deputy leader and cabinet member for health and wellbeing in the London borough of Redbridge, I became acutely aware of the challenges facing frontline staff and managers in both of the NHS trusts that serve my constituents in Ilford North. I am also a proud supporter of Unison and draw Members’ attention to my declaration of interests. I am grateful to Unison, the National Union of Students, of which I am a former president, and many other organisations for their assistance in drawing together the evidence for this evening’s debate.

With just a few lines in the autumn statement, the Chancellor announced the biggest shake-up in the funding of nursing, midwifery and allied health subjects since the Health Services and Public Health Act 1968. By scrapping student bursaries and charging them tuition fees, the Chancellor is passing on the full cost of training to these essential frontline staff for the first time. The scale and potential consequences of his decisions merit further parliamentary scrutiny and public debate, and I hope that tonight will provide the first of many opportunities for that debate to take place.

Nursing and midwifery students currently pay no tuition fees for their studies and receive a non-means-tested grant of up to £1,000 and a means-tested bursary of up to £3,191 to help with the costs of living while they study and train. That is significant because students on both courses are required to work throughout their degrees in clinical practice, where they are subject to the full 24-hour care cycle. They work evenings, nights and weekends. Many will spend 60% of their degree doing that, with nurses required to work at least 2,300 hours across their degree. Even with the current levels of financial support in place, many struggle to make ends meet. Their courses are longer, their holidays are shorter and their placements are demanding. Those who do paid work outside their course can end up working more than 60 hours a week as a result, and they should not be expected to do so.

There has been a public outcry at the planned loss of the NHS bursary, but the Government’s plans go even further. Nursing and midwifery students will not only lose their grant and bursaries for maintenance; they will be expected to take out loans to pay for their tuition fees for the first time. These changes will burden students with eye-watering debts of at least £51,600, which they will begin to pay back as soon as they graduate, because nurses currently earn a starting salary just above the repayment threshold, which, shamefully, is now to be frozen at £21,000. As a result, nurses will on average take a pay cut of £900 a year to meet their debt repayments. That is no way for Ministers to treat the people who form the backbone of the NHS.

Given that the Government see fit to charge students for the cost of their tuition, will the Minister confirm whether he intends to pay student midwives and nurses for the hours they have to put into staffing our hospitals? If a private sector company tried to get workers to work long shifts and to pay for the privilege of working those long shifts while training, they would rightly be condemned. We should be no less outraged by what Ministers propose for nurses and midwives.

The impact of the changes will be felt beyond nurses and midwives; physiotherapists, occupational therapists, dieticians, chiropodists, podiatrists, radiographers, paramedics, prosthetists and other allied health professionals stand to lose out. We are not talking about the highest-paid people in this land; this assault on the living standards of key public sector workers is rightly causing outrage among NHS staff and members of the public who cherish the work they do on our behalf.

Given the scale and significance of the reforms, it is outrageous that the Government chose to sneak them out in the autumn statement. The Chancellor’s statement made an oblique reference to replacing

“direct funding with loans for new students”.—[Official Report, 25 November 2015; Vol. 602, c. 1363.]

The policy decision on page 126 of the Blue Book merely says:

“Students studying nursing, midwifery and allied health subjects from September 2017 will be moved on to the standard student support system, with the details subject to consultation.”

As the Government have placed so little information in the public domain so far and higher education institutions and potential applicants are already turning their minds to the 2017 admissions round, I hope that the Minister can shed some light on the details this evening. Will he confirm that the Government will consult on the principle of the policy changes, not merely on their implementation? What is the full timetable for the decision from consultation through to implementation?

What analysis have the Government conducted of students in receipt of NHS bursaries for tuition and maintenance costs? Will they publish an equality impact assessment for the proposals? What research have the Government conducted into the financial hardship facing existing nursery and midwifery students and students of allied health subjects?

Why do the Government think it is fair that students from the most deprived backgrounds should have their grants taken away while some of the wealthiest people in our society receive tax cuts? How much of this debt do the Government expect to write off because those indebted by these reforms are unable to repay them in full?

Which Department will meet the cost of servicing the RAB—resource accounting and budgeting—charge for the student loan debt: the Department of Health or the Department for Business, Innovation and Skills? What are the Barnett consequentials for health education budgets in Northern Ireland, Scotland and Wales, where different arrangements are in place?

[Jim Shannon (Strangford) (DUP)]

I thank the hon. Gentleman for bringing this issue before the House. I understand that 56,000 students on the mainland, including Scotland and Wales, may be in debt as a result of this change. In Northern Ireland, the Health Minister has committed himself to continuing the bursary. We are doing that in Northern Ireland; perhaps the rest of the United Kingdom should do the same.

--- Later in debate ---

[Wes Streeting]

I wholeheartedly agree with the hon. Gentleman. He rightly points out that this change will open up a postcode lottery across the United Kingdom, as its different parts choose to treat nurses and trainee nurses and midwives in different ways.

In the junior doctors dispute—the Government have belatedly seen sense and decided to reflect on their position—we faced the prospect of junior doctors in my constituency flocking to other parts of the United Kingdom because the situation there was more generous. With great respect to all the people represented in Scotland, Wales and Northern Ireland, I want to keep in my constituency the talented trainee doctors, nurses, midwives and other health professionals living in my constituency so that they can serve my constituents when they work at King George and Whipps Cross hospitals. These are very serious issues.

[Alison Thewliss (Glasgow Central) (SNP)]

The hon. Gentleman is making an excellent speech and excellent points on the significance of nursing to the whole country. He might like to know that the students I have met in Scotland send a message of solidarity to their colleagues in England. They do not want to see bursaries cut, because nurses are under enough pressure as it is. I congratulate him on securing this debate.

[Wes Streeting]

I am very grateful for that intervention and I wholeheartedly concur with the hon. Lady.

Government Members may wear the NHS badge on their lapel, but they are quick to attack the conditions of NHS staff when it comes to taking difficult decisions. [Interruption.] They ask how I would fund it. When we were in government, even when we made changes to higher education student finance, we did not do this. We will take no lessons from the Conservative party on spending plans. It attacked Labour’s spending plans at the 2010 general election because we wanted to halve the deficit and it was promising to eliminate it. Then what did it do? It halved the deficit. When it comes to their record on spending plans, the Government are in no position to hector other parties.

[Angela Rayner (Ashton-under-Lyne) (Lab)]

Does my hon. Friend agree that what is so devastating about these plans is that people from my constituency and from my background—I am a former Unison activist who looked after NHS staff—will not be able to go into the nursing profession? We are crying out for nurses and for people to fill the positions. The NHS has been burdened by the use of agency staff because the staff are not available. This policy will put people from my constituency off going into those positions.

[Wes Streeting]

My hon. Friend speaks with great experience. The Government should heed the points she makes.

I will turn to the other questions I have for the Minister. How will clinical placements be funded under the student loans system? The Government talk about the number of places they can expand, but it is not like expanding a history undergraduate course because occupational placements need to be arranged. The Government should explain how they intend to fund them.

Given the number of mature applicants for nursing, midwifery and allied health subjects, what assessment have the Government made of the likely impact of the reforms on applications from mature students? Are the Government at all concerned that applications from mature students may fall, given the detrimental impact that the coalition Government’s student finance reforms had on mature and part-time student numbers? Given that many people choose healthcare as a second degree and may not be willing to take on more than £100,000 of debt, how will the Government ensure that this route is not closed to such students? Have the Government conducted any evaluation at all that might give us a clue as to the extent of the risk that these reforms pose to recruitment?

The Government suggested in the spending review that half of all applicants to nursing courses are turned away. Do they have any evidence of what stage they are turned away at? If it is really the case that people are flocking to these professions, will the Minister explain why my local NHS trust has been so reliant on temporary and agency staff, including nurses who have been flown over from Portugal, to address the recruitment and retention challenges facing the NHS?

Additional allowances are currently available for students with different circumstances. Will the Minister inform the House whether any changes will be made to additional allowances, such as the extra weeks allowance or the dependants allowance? If so, what are those planned changes and what assessment have the Government made of their potential impact?

Given the press speculation over the weekend that the Government plan to increase the overall cap on university tuition fees, what assurance can the Minister give the House that students studying nursing, midwifery and allied health subjects will not see their tuition fees and debts hiked up even further than is being suggested? Given that the Government seem content to shift the goalposts for existing students and graduates, does the Minister really expect current or future students to believe that the terms and conditions they sign up to will not be changed and applied retrospectively further down the line? At the very least, I hope the Minister will confirm this evening that the NHS will continue to fund the tuition fees for existing students for the remainder of their studies.

When the coalition Government chose to increase tuition fees in 2010, the move was subject to a debate and a vote in this House. Given the media speculation that Cabinet Office Ministers are busy trying to find ways to avoid proper debate and scrutiny of a possible increase in the overall cap on tuition fees, will the Minister give the House an assurance that we will have a full debate and a vote should the Government choose to extend tuition fees to nursing, midwifery and allied health subject courses? Many students have already written to Ministers in the Department of Health and are awaiting a reply. Will the Minister commit to meeting student representatives to discuss their concerns?

It is not hard to understand why the Government’s shift in policy is generating so much concern and anxiety. In recent days I have heard representations from, among others, Unison, the Royal College of Nursing, the National Union of Students, the University of Hertfordshire, the Royal College of Speech and Language Therapists, and the Chartered Society of Physiotherapy. I have been contacted by student nurses and midwives in my constituency, and received messages of support for this debate from those in the constituencies of other right hon. and hon. Members.

Before I conclude, I would like to share with the House some of the stories that I have heard, and I will finish by making a few points about nursing and midwifery students. These are exceptional people and their dedication to others is truly remarkable. They work long hours, often in difficult situations, and they take a direct role in caring for patients when they are at their most vulnerable. Nursing students have told me how immensely challenging their work can be. They hold the hands of patients in their final moments, and comfort them as they pass. They are the face of reassurance to patients, and a bedrock of support for families.

[Jess Phillips (Birmingham, Yardley) (Lab)]

My hon. Friend is making a powerful speech, and I wanted to share my thoughts as someone whose son’s life, and whose own life, was saved by a student midwife. Does he agree that making those people not just work for free but even pay to save the lives of people like me and my son, is simply despicable?

[Wes Streeting]

I wholeheartedly agree with my hon. Friend, and I am grateful to her for sharing her difficult personal experiences.

Nurses care for us in some of our darkest and most painful moments, and the weight of their responsibility carries with it a heavy physical and emotional load. The same is true for our nation’s midwives. One spoke of the difficulties that she faced when a baby was stillborn and she had to comfort the mother, while also taking hand and foot prints so that the parents would have memories of the baby they lost. She will never forget the shift when she spent 12 and a half hours with a mother who miscarried twins. She had five hours of rest, and then came back to do another 12 and a half hours with the same woman. She has supported the delivery of 10 babies, and she feels immense pride in being part of the wondrous moment of childbirth.

As the saying goes “Save one life and you’re a hero; save 100 lives and you’re a nurse.” These people are seeking to qualify into these difficult professions and form the NHS of tomorrow. They deserve our respect, admiration and support, as well as the right incentives to continue or even commence study in the first place. Ministers should listen to the students who are protesting, and to the nearly 150,000 people who have signed the petition to keep the NHS bursary. The Government owe it to patients and students to think their proposals through properly, and I ask them to pause this process. It would be a tragedy if the next Florence Nightingale or Edith Cavell were discouraged from the profession because of these changes. I look forward to the Minister’s response, and I hope that in the coming days, weeks and months, he will listen carefully to the voices of those who form the backbone of our national health service.

[The Parliamentary Under-Secretary of State for Health (Ben Gummer)]

It is a privilege to respond to this debate, and the hon. Member for Ilford North (Wes Streeting) made a powerful speech. I know that he has experience and expertise in student finance. He was on the front line when we had discussions in this place some years ago, albeit outside the Chamber, and he brings passion and knowledge to this debate. He may feel that I am rehearsing points that he has heard previously, but before I address some of the specific and detailed questions that he rightly raised, I hope he will not mind if I run through some of the issues and reasons why the Government feel that this measure is the right thing to do at this time.

The hon. Gentleman will be aware that nursing remains one of the few subjects not within the purview of the current student finance system. To our mind, the current system is not delivering as it should for either students or patients. Simply put, nursing is one of the most oversubscribed subjects in the whole academic range, and the fifth most popular subject that UCAS offers. Last year, there were 57,000 applicants for the 20,000 nursing places available.

I do not wish to go down the route of discussing NHS finance, because it will lead us to a place that is not easy for the hon. Gentleman’s argument and not particularly realistic. There is no way that any Government of any stripe would be able to offer a place to every single person with the necessary qualifications who wished under the current funding system to apply for a nursing place. The question for us is this: how do we change the system to give more people the opportunity to study nursing, and do so in a way that we are able better to supply the nurses and the nursing positions required in the NHS?

The hon. Gentleman asked a very important and pertinent question, which is why in his hospital, which I know from having gone there and from discussing this with him in other debates in this place, he should be seeing a shortage of filled nursing places. It is a function of parts of London that there are problems in recruiting—I was in Hull last week where they have a similar problem, albeit for different reasons—and yet there is an oversubscription for places. He could have added that we almost have a record number of nurses in training at the moment. So how does that add up?

Under the Government, we have seen a significant expansion in the number of nurses in the workplace. The response to the tragic events at Mid Staffs, the subsequent Francis report and the results of the Morecambe Bay inquiry led us to the conclusion that had eluded previous Governments: we needed safe staffing levels on wards that were not, in some parts of the country and in some hospitals, safely staffed. That required a significant increase in nursing numbers, which could be provided in the short term only by agency nurses. That is why we have not only increased the number of nurses in training—clearly, they take a while to come through—but have been required to take action on the cost of agencies taking advantage of the situation. That does not change the fact that it is simply not possible, within the current funding set-up, to satisfy either the demand for or the supply of nursing places.

There are other reasons. Even if we did not need to do something to get a better match between the number of nursing places and what the NHS requires and students want, I would want to push this reform. It is for that reason that I directly disagree with the hon. Gentleman’s assessment of student finance reform. I disagreed with him when we had this discussion in 2011, albeit not in this Chamber. If I may gently put it, I think those on the Conservative side of the House were proved right by those reforms. The simple fact is that we now have more applications from disadvantaged students to higher education than ever before in the history of higher education. We have seen a significant expansion in the number of students full stop going into higher education. Eighteen-year-olds from the most disadvantaged areas were 72% more likely to apply to higher education in 2015 than they were in 2006. It has happened in precisely the opposite way to what he and his friends on the Labour Benches, when they were making the argument in 2011, expected to happen.

[Wes Streeting]

The Minister should look more carefully at what happened to mature student applications following the reforms—they plummeted—and think about the profile of the people applying to be nurses and midwives. Does he accept that the majority of loan debt will never be paid back, including by graduates who will earn far more than nurses?

[Ben Gummer]

I will turn to mature students, but I hope the hon. Gentleman will concede my central point. The significant majority of students going into nursing are doing so at an undergraduate point at 18 or 19 years of age. For that cohort across the rest of the higher education sector, we have seen the most spectacular expansion in opportunity than at any time since higher education was opened up more broadly to people after the second world war. That is something that Members on both sides of the House should celebrate. I know that those on the sensible wing of the Labour party also embrace the reforms and see why they were a good thing.

I disagree with many in the Opposition, but to be direct with the hon. Gentleman, I want to bring those advantages to student nursing. I want to expand the number of places available to people from all backgrounds to give them the opportunity to enter nursing, and I want to secure the advantages that come from bringing people from non-traditional and disadvantaged backgrounds into nursing, in the same way as we achieved in the rest of the higher education sector. I believe passionately in that. Even if the NHS and the students themselves—the 37,000 who applied but did not get a place last year—did not require this change, I would still be making it, because it is the right thing to do for those who otherwise would not have an opportunity. Under the new student financing arrangements, they will have that opportunity.

--- Later in debate ---

[Ben Gummer]

I expect to be held account for this significant reform right the way through the changes that are envisaged. I hope to be able to return to provide good news about progress, as has happened in other student areas. That is why we want to be very deliberative about the way in which we form this consultation, because it is important to get it right.

I have taken note of the careful questioning of the hon. Member for Ilford North, who clearly understands the full gamut of the issues that need to be addressed in this consultation. Let me answer some of the questions he raised, and I shall write to him about any that I do not answer.

The hon. Gentleman asked about the funding of clinical placements. We have already started discussions with Universities UK about that, and it will form part of the wider consultations. The Barnett consequentials will be a matter for Her Majesty’s Treasury, as is the case for everything else connected to Barnett consequentials. I know that BIS officials are discussing the issue in the normal way.

The hon. Gentleman asked about research into financial hardship, and I know that that will form part of the consultation. The Government will be open to any further research beyond the economic impact assessment.

I was asked whether I would be happy to meet students. Of course I would. I have already met Unison and the Royal College of Nursing to discuss the changes I wish to make. I should not pretend to answer for them, but I have had productive discussions with both, especially about the apprenticeship route. I know that we will disagree with both Unison and the RCN about bursaries, but I think there is an understanding, particularly on the part of Unison, of how we are trying to open up different routes to nursing for different parts of the workforce. If we get it right, the apprenticeship model will be a strong one.

The hon. Member for Ashton-under-Lyne (Angela Rayner) made an important point in her intervention about agency nurses, so let me answer that as I am passing. As I alluded to earlier, part of the reason we are looking at that issue is to ensure that we provide a more sustainable workforce throughput, so that we do not need to rely on agencies and bank staff for the peaks in NHS demand. That is why we need to do something about numbers, and I hope that, as a result of the Chancellor’s announcement, we will increase the number by 10,000 over the course of this Parliament—a very significant increase in the establishment of student nurses. In fact, it will be the largest increase in student nurses under any Government since 1948.

I hope I have answered the majority of the questions put by the hon. Member for Ilford North—

[Wes Streeting]

rose—

[Ben Gummer]

Clearly I have not. I will allow him an opportunity to intervene once more, but I do not want to detain the House much longer.

[Wes Streeting]

I particularly welcome what the Minister said about treading carefully and thoughtfully around the consultation. The one issue he has not addressed, however, is whether extending the tuition fees regime to nursing, midwifery and other allied health subject students will be subject to a full and thoughtful debate followed by a vote in this House and the other place.

[Ben Gummer]

I cannot give the hon. Gentleman a definitive answer to that question yet. Let us wait and see the outcome of the consultation, so that the House can be best informed. I imagine that there will be ample opportunities in Backbench Business Committee debates and indeed Opposition day debates, and I know that the hon. Gentleman and his colleagues will want to bring these issues up for further debate. I will reflect the hon. Gentleman’s concerns to the Secretary of State and to the Leader of the House, and I am sure they will receive them with interest.

I genuinely thank the hon. Gentleman for bringing forward this debate, which has provided an opportunity for the Government to explain our plans and the rationale behind them. There will be points on which we will disagree, but I hope the hon. Gentleman will see the force of our arguments about wanting to expand the nursing workforce, to provide different routes into nursing and to provide the sort of opportunities to 18 and 19-year-old undergraduate nurses that have been extended to other parts of the higher education sphere. These are big proposals. They could mean a remarkable and rapid transformation of the NHS workforce, and a significant expansion in the number of nursing students. We need to get it right, and I hope that, through a constructive discussion across the House, drawing on the kind of expertise we have heard from Members in this short Adjournment debate, we will indeed get it right.

Question put and agreed to.

Junior Doctors Contract

Wes Streeting Excerpts

Friday 20th November 2015 Commons Chamber

[Alistair Burt]

As the House is well aware, the Commonwealth Fund said recently that the NHS was the best in the world. NHS staff, by implication, are the best in the world. They do an extraordinary job and junior hospital doctors do a fantastic job. Patient satisfaction is extremely high. We want that to continue. There is no reason to believe that NHS Employers, which is also calling for negotiations to continue and for the strike action not to take place, is not in full view of what staffing it needs to create an even safer health service. Its judgment is that the contract set out by the Secretary of State to be negotiated on provides the best basis for the employment of doctors in the health service.

[Wes Streeting (Ilford North) (Lab)]

The Minister’s statements, even this morning, imply that people have been misled by the BMA. How is it conceivable that 15 heads of royal colleges and 98% of junior doctors have been so badly misled that this unprecedented strike action has been proposed? Instead of patronising people, why will he not accept that trust has broken down, cut out the middle man and go straight to ACAS, so that there can be proper negotiations and a resolution to the dispute? People do not trust the Government.

[Alistair Burt]

I take the hon. Gentleman’s point. One example of why the Secretary of State believes that he is entitled to talk about misleading is that of the pay calculator that the BMA put on its website, which indicated that all doctors would suffer a 30% to 40% reduction in their salary, or something like that. The BMA was forced to take that calculator down when it realised that it did not reflect the truth. As we have seen, the Secretary of State has said that no doctor currently working legal hours will suffer a reduction in pay. There is an 11% pay increase on basic hours, and that is why he feels that there was an element of misleading. The hon. Gentleman is right about cutting out the middle man, which is why negotiations should restart. I am delighted that he supports that approach, and if that does not work, conciliation is there.

Gay Conversion Therapies

Wes Streeting Excerpts

Tuesday 3rd November 2015 Westminster Hall

[Wes Streeting (Ilford North) (Lab)]

I am grateful to the hon. Gentleman for securing the debate and for all the work he does to champion LGBT equality. I am sure that many of us received the Core Issues Trust’s interesting briefing, which suggested a link between homosexuality and same-sex attraction and mental ill health and other forms of physical illness. Has it not got that the wrong way around? It is discrimination and the suggestion that there could be a gay cure that makes all LGBT people, and young people in particular, feel that they are different and somehow alien. That is what causes them mental ill health, not their homosexuality.

[Mike Freer]

The hon. Gentleman has a track record in this area even though he is new to the House and I am sure that he will be extremely vocal on these issues. He is absolutely right. It is the suggestion that homosexuality is a disease or illness that can be cured that drives mental health problems, not the other way around. Frankly, I wasted no time on reading the Core Issues briefing.

I will finish with a couple of comments from esteemed colleagues. On 29 April, in an interview with Pink News, the Prime Minister said, on banning such therapies,

“if we need to go further…we will.”

As far as I am concerned, we do need to go further. The Secretary of State for Education and Minister for Women and Equalities said a couple of weeks ago to Pink News:

“Let me be clear: gay cure therapies have no place in our countries and we must stamp them out.”

I ask my very good friend the Minister if she will agree to explore how stipulated aversion therapies can be banned and whether the voluntary memorandum of understanding should and can be reviewed to put it on a statutory footing.

[The Parliamentary Under-Secretary of State for Health (Jane Ellison)]

I thank my hon. Friend the Member for Finchley and Golders Green (Mike Freer) for initiating this debate on this important issue. Let me start by wholeheartedly agreeing with his opening premise. The Government do not believe that being lesbian, gay or bisexual is an illness to be treated or cured. We are concerned, therefore, about the issue of so-called gay-to-straight conversion therapy and we have consistently spoken out against the need for that practice.

I will outline some of the background to the work my hon. Friend touched on and try to respond to some of his concerns, but I suspect that this is the beginning of an ongoing conversation—I am happy to say that at the outset. The UK Council for Psychotherapy first raised its concerns about the perceived increase in this type of therapy with the Department of Health in late 2013. Department officials met with the council to discuss those concerns and agreed to work with it and others to identify ways to eradicate the practice. At that time, we also welcomed the fact that the key professional counselling and psychotherapeutic bodies had already made public statements on the issue.

As a result of the UK Council for Psychotherapy’s approach, the Department agreed to support the publication of a statement that made clear that the major therapy bodies in the UK were united in speaking out against conversion therapy, because they believe that that particular approach is based on the assumption that homosexuality is a mental disorder or that it begins from the preconceived view that the client should change their sexual orientation. As homosexuality is not an illness, as my hon. Friend said, the professional bodies argue that it is both logically and ethically flawed to offer any kind of treatment. The House may be interested to know that the American Psychiatric Association removed homosexuality from its diagnostic glossary of mental disorders in 1973 and the international classification of diseases produced by the World Health Organisation eventually followed suit in 1992.

A consensus statement was published in February 2014 as a result of the exercise we convened. It was initially signed by eight organisations and others added their support later on. The statement is clear: those bodies believe there is no good evidence that such therapy works and that, actually, it has great potential to cause harm. It goes on to say that such approaches are often based on religious interpretations of sexuality rather than on a researched and informed understanding of sexual orientation.

As my hon. Friend said, the Department agreed to host a roundtable event on 2 April 2014 to which we invited a range of interested organisations comprising signatories to the consensus statement as well as royal colleges, the Association of Christian Counsellors, regulators and other counselling bodies. The right hon. Member for North Norfolk (Norman Lamb), who was then the Minister responsible for equalities, was fully supportive of the work and attended and contributed.

I am pleased to say that the meeting was positive and that out of the discussions came agreement that more could and should be done by those present to prevent this kind of therapy from being offered. The participants agreed to develop the memorandum of understanding, which has been referred to. The UK Council for Psychotherapy agreed to lead on the work, in partnership with other bodies and the Department.

The memorandum was published in January and launched at a second roundtable event at the Department. Once again, my former colleague the right hon. Member for North Norfolk was present and publicly made clear his support for the memorandum and its commitments. Its purpose was to set out an agreed framework for activities for all the parties concerned to help address the issues raised by this practice. One such aim is to ensure that the public are well informed about the lack of evidence and the risks of so-called conversion therapy. There are a range of other important professional objectives.

Professionals from throughout the healthcare and psychological professions committed to work together to promote the public interest. Each of the signatory organisations committed to actions appropriate to their function and purpose. To give one example, those with practitioner members agreed to review their statements of ethical practice and consider whether there was a need to publish a specific ethical statement on conversion therapy. Secondly, those with a responsibility for training committed to work together to ensure that training prepares therapists sufficiently, so that they can work effectively with their lesbian, gay or bisexual clients.

The memorandum is owned by the organisations who signed it. They have continued to meet together and to work on those commitments throughout the year. The Department fully supports that work.

My hon. Friend drew attention to the NHS’s part in such therapies. Discussions with the sector uncovered the fact that there were no reliable, up-to-date figures on the use of conversion therapy. However, a 2009 survey of 1,300 mental health professionals found that more than 200 had tried to help at least one client to reduce the attraction they felt for someone of the same sex. A third of those clients were said to have been referred for therapy by a GP and 40% were reportedly treated in the NHS.

The Government are clear that moneys from the public purse should not be used to fund such therapy. Ministers in the previous Administration wrote to NHS England in March 2014 seeking confirmation that such treatment was not taking place on the NHS and I am pleased that we received a robust and supportive response from Simon Stevens. Not everyone in the House may be aware of his response, which was that

“so-called gay-to-straight conversion therapy is harmful nonsense and the NHS should never be funding it.”

[Wes Streeting]

Clearly, the memorandum has been effective since it was introduced, but it concerns me that the briefing from Stonewall suggests the Nursing & Midwifery Council, the Care Quality Commission, the General Medical Council and the Health and Care Professions Council are not yet signatories. Does the Minister agree that they should sign up? It has clearly been helpful for other organisations and is a powerful statement of intent.

[Jane Ellison]

The hon. Gentleman will see, when I propose some next steps, that I might be able to respond to his point.

Simon Stevens went on to say that he would direct NHS England to make that position—that the NHS should never fund such therapy—clear and explicit in all public statements on the issue in future. I cannot be clearer than that. If Members have examples of the NHS funding such therapy, I would be particularly interested to know about them.

Junior Doctors’ Contracts

Wes Streeting Excerpts

Wednesday 28th October 2015 Commons Chamber

[Heidi Alexander]

My hon. Friend makes an important point. The junior doctors I have met are genuinely worried that the proposals make it more likely, not less, that they will be forced to work even more punishing hours. The removal of financial penalties for hospitals that force junior doctors to work beyond their rostered hours concerns them. They are right to be concerned.

[Wes Streeting (Ilford North) (Lab)]

A junior doctor in my constituency made precisely that point. She was an A&E doctor. My hon. Friend knows that there is an A&E crisis in London. The Health Secretary needs to understand that while there is indecision and no conclusion to the negotiations, junior doctors are making decisions about where they are going—and they are not staying in England. That is the point.

[Heidi Alexander]

I am grateful to my hon. Friend. He makes a very valid point about the impact on recruitment and retention of doctors in the capital.

NHS: Financial Performance

Wes Streeting Excerpts

Monday 12th October 2015 Commons Chamber

[Wes Streeting (Ilford North) (Lab)]

The House of Commons Library estimates the cost to the NHS from falls this year at around £2.45 billion. At a round table that I chaired last week with our local NHS trust it was clear that although the will is there to tackle the cost of falls, the resources are not. Is that a good example of how the under-resourcing of the NHS is harming patient outcomes and undermining the efficiencies that the Minister hopes to achieve? How will he address that and wider inefficiency in the NHS?

[Ben Gummer]

I point the hon. Gentleman to parts of the country such as Torbay, Greenwich and the soon-to-be-devolved Greater Manchester authority where the relationship and integration between social care and hospitals is producing exactly the kind of linked up action that he identifies for falls. If we can achieve that at local level we will have a truly integrated health and social care system that is not imposed from above but created by those who deliver care on the front line.

NHS Reform

Wes Streeting Excerpts

Thursday 16th July 2015 Commons Chamber

[Mr Hunt]

I absolutely agree. I commend the Royal Derby, which is an excellent hospital, and thank my hon. Friend for mentioning it. It is really interesting: around the country the number of people per thousand who use A&E varies from 166 to 355—a dramatic variation—and a lot of that relates to the availability of good primary care services, which is why our plans for seven-day GP appointments are also a very important part of the programme.

[Wes Streeting (Ilford North) (Lab)]

I welcome the partnership on patient safety that is being announced today between Queen’s hospital in Romford and King George hospital in Ilford and the Virginia Mason Institute, and echo some of the comments made by my hon. Friends about the Government taking staff with them and looking at issues around pay and workforce. May I gently point out to the Secretary of State that it is now two months since I wrote to him about pressures in our local health economy and the future of our A&E department. Can he offset my disappointment by agreeing to meet me and my hon. Friend the Member for Ilford South (Mike Gapes) and other local MPs to discuss those issues?

[Mr Hunt]

I know that the hon. Member for Ilford South (Mike Gapes) secured a Westminster Hall debate on this yesterday, during which I hope the hon. Member for Ilford North (Wes Streeting) covered most of the issues he wants to address, but I am happy to arrange to meet him or to get the Under-Secretary of State for Health with responsibility for hospitals, my hon. Friend the Member for Ipswich (Ben Gummer), to meet him to discuss those issues in more detail. The hospital trust that the hon. Gentleman talks about—Queen’s and King George are covered by the same trust—has been through a very challenging period. It is a big trust; it is going through special measures, but I think it has good new management. I think they have really turned things around, and that staff are to be absolutely commended. The link with Virginia Mason in Seattle will be as inspirational for them as it has been for me to see what is possible.

Barking, Havering and Redbridge University Hospitals NHS Trust

Wes Streeting Excerpts

Wednesday 15th July 2015 Westminster Hall

[Wes Streeting (Ilford North) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Davies. I congratulate my hon. Friend the Member for Ilford South (Mike Gapes) on securing this important debate and on opening it in the way he did, setting out the chequered history of the trust and the particular challenges we face right across our borough of Redbridge and the wider north-east London health economy.

I will not repeat the points made by my hon. Friend and my right hon. Friend the Member for Barking (Margaret Hodge). I want to express my concern about the outstanding problem that the CQC has identified with the trust and the impact that is having on patient care in a wide variety of areas. I share the concerns expressed by both my colleagues that the CQC inspectors rated the trust as “requires improvement” on most measures, and the responsiveness of service at the trust was deemed “inadequate”, but it is also important to highlight some of the areas that were identified as having outstanding practice—in particular, the values of the trust and how they have been embedded in the culture of the staff.

Like my colleagues, I congratulate the NHS staff who work in the trust on the hard work they do in difficult circumstances. I commend the fact that the radiotherapy unit was one of the top five in the country. There are good outcomes for stroke, and the genito-urinary medicine clinic had

“excellent service with appropriate protocols”.

Significant improvements have been made, so while it is disappointing that the trust remains in special measures, the improvements described in the report are encouraging and reflect well on the NHS staff and the reinvigoration of the trust leadership. They can take genuine pride in their teamwork. I have no doubt that the trust will emerge from special measures sooner rather than later.

My right hon. Friend spoke about the high level of agency spend. One of the problems that the trust has suffered from for a number of years—frankly, some of the trust’s challenges were well known before the inspectors put the trust into special measures—is that when a trust has a poor reputation, it is hard to recruit and retain the best staff. While I am disappointed that we are not yet out of the woods, I hope that when people are thinking about their careers, they identify not only that the trust requires improvement, but that it is improving and is a good place for good people to be at this point in its journey.

I want to speak briefly about the wider north-east London health economy. Until May, I was chair of the Redbridge health and wellbeing board, deputy leader of Redbridge Council and the cabinet member for health and wellbeing. It is fair to say that the challenges in the north-east London health economy—the challenge in primary care has already been touched on—are not just restricted to the trust. I was the first chair of the primary care transformation board, which is trying to change how primary care is delivered and bring about genuine service improvements. In the very first meeting, I asked GPs about their experiences, and they described primary care as being in crisis. They know that they are not providing a good enough service to their patients. They work hard to do so, but the pressures are immense. That relates to the quantity and quality of GP provision. My right hon. Friend talked about the wider concerns about the number of GPs who are past or nearing retirement and the workforce pipeline. Combined with the fact that Redbridge has one of the lowest levels of public health spending in London, that gives me cause for great concern. I am concerned not only about the level of public health funding but about the fact that the Government are seeking to give councils new responsibilities —for example, for health visiting—without sufficient funding. The in-year cut that my council will experience will place even greater pressure on services. On that note, I should probably declare that I am still a member of Redbridge Council, albeit an unpaid one.

Finally, I want to talk about A&E. Since January, there have been some improvements in A&E performance at both King George and Queen’s. In January, King George’s performance standard was 92.67% and at Queen’s it was 79.15%. As of June, King George had improved, up to 96.56%, but Queen’s was still lagging behind at 93.31%. I have seen absolutely nothing in either the CQC’s inspection report or the performance data for our local A&E departments to alter my view that the loss of the A&E department at King George hospital would be a disaster for patients.

Since the decision to close the A&E department at King George, much has changed in terms of both the population pressures and the immense strain on the whole health economy in our part of London, which I have already described. In that context, it is really not unreasonable to ask Ministers to intervene, to look at the A&E closure with a fresh pair of eyes, and to ask the clinical commissioning group to reopen the A&E closure decision and reconsider its position. Previously—this always happens at the height of elections, particularly local elections—my local Conservative association put out a statement claiming that there had been some sort of reprieve and the A&E would not be closing, but nothing of the sort has happened. Thousands of residents across Redbridge will never forgive the Conservatives if they do not at least look at this matter with a fresh pair of eyes.

We all heard what my right hon. Friend the Member for Barking said about the financial issues at the trust. There is absolutely no doubt in my mind that those issues and the difficulties in recruiting staff across two A&E departments are what are really driving the closure of King George’s A&E. It is being driven not by what is in the best interests of patients or what good A&E configuration in our part of London would look like, but by the inability to get the right staff and to rescue the trust from its very difficult and precarious financial position. That is not good enough. I hope that, when he responds, the Minister will at least assure residents that the Government will look at this matter with a fresh pair of eyes and ask the CCG to do the same.

A&E Services

Wes Streeting Excerpts

Wednesday 24th June 2015 Commons Chamber

[Andy Slaughter (Hammersmith) (Lab)]

I hope, Madam Deputy Speaker, that you and the House will indulge me if I spend my six minutes giving an update on the “Shaping a healthier future” programme, which afflicts west and north-west London. I have done so several times during the three years since—to the consternation and disbelief of 2 million people in those areas—the programme was announced, although there was something of a hiatus over the election period.

I do not want to be self-indulgent, but I think that the subject of “Shaping a healthier future” is one to which all Members will wish to pay attention, because it is the biggest closure programme in the history of the NHS. Four out of nine A&E departments and two major hospitals have been substantially downgraded. Many see the programme as a prototype for the Keogh review of urgent and emergency care. I wonder what has happened to the latest stage of that review; we heard nothing about it from the Under-Secretary of State. It was put on ice last year because a proposal for the downgrading of most of the type 1 A&E departments in the country was seen as political suicide, but it now seems to have disappeared completely. I hope that there are good clinical reasons for that.

Reference has already been made to the excellent briefing with which Members were provided yesterday by the Royal College of Emergency Medicine. Here are three of the statistics that the college came up with. The increase in A&E attendances last year was equivalent to the workload of seven large A&E departments; only 2% of A&E attendances involve major trauma, stroke and heart attack patients; and a maximum of 15% of patients who attend A&E departments could be seen in a non-hospital setting. Even that must be subject to a caveat, because I suspect that a fair number of the people who go to A&E departments are not knowingly accelerating their symptoms or time-wasting, but have genuine concerns, perhaps for a child with a fever that might be a symptom of flu but, again, might be due to meningitis.

The solution proposed by the Royal College of Emergency Medicine is co-location. Its briefing states:

“Costly and time-consuming efforts to encourage patients to seek advice on urgent care by telephone or to attend elsewhere…have not reduced A&E attendances. Rather than blaming patients for attending A&E, when we know they have great difficulty accessing supposed alternatives, RCEM advocates a completely new approach. We believe that the issue should be dealt with by collocating”.

However, many hospitals in west London are already co-located, so that cannot be a solution for them.

There have been a number of developments in the past three or four months. Chelsea and Westminster hospital is about to take over West Middlesex University hospital. That new trust will believe that it can maintain two fully functioning type 1 A&E departments—unless another is to close in the area. Why, then, is Imperial College Healthcare NHS Trust expected to manage with only one major A&E service in its three hospitals?

Ealing hospital’s maternity unit will close on 1 July. My hon. Friend the Member for Ealing, Southall (Mr Sharma), who could not stay for this part of the debate, asked me specifically to mention that, because it is a matter of great concern, not least because it will have an impact on other maternity services in the area.

We are still suffering the effects of the closure of the A&E departments at Hammersmith and Central Middlesex hospitals last September, including four-hour waiting times at other hospitals such as Charing Cross hospital in my constituency, which is persistently below target. At the same time, stroke services are being centralised at Charing Cross for at least the next five years, having been transferred from St Mary’s hospital, although the plan is to move them away in due course.

In the last two years, £33 million has been spent on consultants just for the purposes of the “Shaping a healthier future” programme, of which £12.5 million was spent on a single consultant, McKinsey. That is £27,000 a day, and it could pay for 300 new nurses. Imperial College Healthcare NHS Trust is spending one eighth of its staffing budget on bank and agency staff, and the most recent figures show that it had an £18.5 million deficit.

Against this crisis—and it is a crisis—in A&E, the proposal in relation to Charing Cross, a major emergency hospital in my constituency, is that all its buildings be demolished, that its beds be reduced from 360 to 24, and that it lose all consultant emergency services. The population of London, and of west London in particular, is going to go up massively over the next 10 years. That is unprecedented. This is a very poor scheme, not just clinically for the reasons that the Royal College of Emergency Medicine gives, but logistically, spatially and financially.

I am grateful to the Minister and the Secretary of State for the opportunity, at last, before the summer recess to meet and discuss these matters in depth. I will therefore say no more about them today. I look forward to that opportunity, and I know the Minister will attend in good faith and look at the concerns we all have about the “Shaping a healthier future” programme. These are not idle concerns. It is obviously in the Whips’ brief for Government Members to say, “Let’s not make the NHS a political football,” but I do not think any Opposition Member is doing so. We are not in an election period.

[Wes Streeting (Ilford North) (Lab)]

It is a bit rich for Government Members to accuse us of using the NHS as a party political football, when prior to the 2014 local elections the Ilford North Conservative Association put out a leaflet claiming that King George hospital’s A&E would not close, when before the general election we were told its closure would be reprieved, and when the NHS trust chief executive has now told us that the closure plan will be published in the next six to nine months. That was playing party politics with the NHS, cynically.

[Andy Slaughter]

My hon. Friend makes a very good point. I make sure that every time I refer to what is happening in my local NHS now, I look into the voluminous papers on “Shaping a healthier future”, or what the Imperial College Healthcare NHS Trust actually says, so that I am clear that I am describing what is happening, not giving my opinion or saying something that has come from a party political standpoint. I simply wish that the Government would listen and respond in kind.