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The National Health Service

Speaker’s Statement – in the House of Commons at 2:26 pm on 23rd October 2019.

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Votes in this debate

  • Division number 9
    A majority of MPs voted to continue to empower GPs to commission services, retain a strong Care Quality Commission, to retain Healthwatch England, and not to reverse a decision to seek to cut admin costs for example by abolishing Primary Care Trusts.

Debate resumed.

Photo of Philippa Whitford Philippa Whitford Shadow SNP Spokesperson (Health and Social Care) 3:21 pm, 23rd October 2019

Before I start my speech, I would like to factually correct the Secretary of State, who claimed that Barnett consequentials in Scotland are not passed on. I reassure him they are all passed on. He talks about the figures as a percentage. Scotland spends £185 a head more on healthcare and £157 a head more on social care. Of course it is a smaller percentage but, in actual cash, Barnett consequentials are all passed on. I would be grateful if he would either improve his maths or stop repeating this narrative.

I really welcome some elements of the Queen’s Speech, particularly the Health Service Safety Investigations Bill. I was asked to serve on the Joint Committee, which I felt did an incredible job, but we completed that job last July; approaching a year and a half on, sadly, the Bill has still not come forward. I hope it will not be too tardy from this point.

Photo of Philippa Whitford Philippa Whitford Shadow SNP Spokesperson (Health and Social Care)

Okay; I welcome that. However, I would suggest that the Healthcare Safety Investigations Bill is about looking at mistakes after they have happened. I invite the Secretary of State again to look at the Scottish patient safety programme, which is more than 10 years old and has reduced hospital deaths, including post-surgical deaths, by over a third because the aim is to prevent harm in the first place.

I welcome the Secretary of State’s reference to whistleblowers, but it is not just about having guardians in hospitals. It is critical that the Public Interest Disclosure Act 1998 is reformed. Only 3% of employment tribunals are successful. All Members who have dealt with any cases on this issue will know that the wreckage of whistleblowers’ careers acts as an absolute brake on people coming forward. You can say what you like, but they are faced with the question, “Do I speak up and risk my career, my family income and my home?” It is not just a matter of paying lip service to this issue; we actually need change.

I welcome the ending of the private finance initiative, which was originally brought under a Conservative Government, but was really accelerated, I am afraid, under Gordon Brown. We are now facing the fact that £13 billion-worth of hospitals in England will have cost £80 billion by the time they are paid off. I call on the Secretary of State not just to end the PFI going forward, but to look at whether these contracts could be ended and renationalised to avoid another £55 billion having to be paid over the next 30 years. This problem is UK-wide, so we were saddled with these contracts in Scotland as well. There are health boards across England that are spending up to 16% of their income on their PFI contracts, and that obviously undermines patient care.

Photo of Mike Penning Mike Penning Conservative, Hemel Hempstead

The hon. Lady is making a perfect point. I had the honour of being the roads Minister, and I desperately asked my officials to look at the PFI contracts on motorways around the country, including the M25. They found that the cost of coming out of these contracts is so formidable—simply because these companies’ lawyers were frankly a lot better than Gordon Brown’s lawyers when the contracts were written—that no Government would do it, so we are trapped. Some trusts—not least the trust in Romford, which also has a polyclinic—are trapped in debt from the private sector, which makes them completely inefficient.

Photo of Philippa Whitford Philippa Whitford Shadow SNP Spokesperson (Health and Social Care)

I thank the right hon. Gentleman for that point. Of course, Governments can borrow at a much lower interest rate than any private business. Money is being sucked out of the NHS through the PFI across the UK, but there are also other ways in which money is being sucked out of the NHS, particularly NHS England—for example, through outsourcing under the Health and Social Care Act 2012. Private companies have to make a profit. Their chief executive is bound to make profit for the shareholders. They are not bound to deliver quality of care. We have seen clinical commissioning groups get trapped in this way. Six commissioning groups in Surrey tried to bring community care back into the NHS—they were not breaking a contract—but Virgin did what Virgin always does if it does not get a franchise renewed. It sued the CCGs. It is all hidden behind a commercial veil, but we know that at least one of those commissioning groups paid over £300,000 to settle out of court, and six groups together means that the figure was likely to be well over £2 million.

Photo of Barry Sheerman Barry Sheerman Labour/Co-operative, Huddersfield

I agree with almost everything the hon. Lady says about PFI contracts. We got a terrible PFI contract in Halifax and Calderdale. It is still a millstone around our necks. When I chaired the Education and Skills Committee, we looked at PFI contracts. The fact is that they are financial agreements, and some were better than others. But a lot of very clever City types came to places like Halifax and ran rings around the trust, so it got a bad deal. That is the truth of the matter.

Photo of Philippa Whitford Philippa Whitford Shadow SNP Spokesperson (Health and Social Care)

That is true, and this obviously applies to the process of bidding and tendering for delivering services. An NHS orthopaedic department will not be able to compete with a major multinational with regards to its bid team, its tendering team and its ability to put in loss leaders. The problem is that all this money is being lost in a circular reorganisation that has been going on in NHS England literally for the last 25-plus years, with people being made redundant and given a big package, but then someone quite similar being re-employed or the same person being re-employed somewhere else with a different title—health authorities to primary care trusts to clinical commissioning groups. It is a huge waste of money, which is being sucked away from patient care, and that is where we want the money actually to go.

Photo of Mike Gapes Mike Gapes Independent, Ilford South

Sir Mike Penning mentioned the Barking, Havering and Redbridge University Hospitals NHS Trust in Romford. Queen’s Hospital in Romford is part of that trust, as is King George Hospital in my constituency. There is an independent treatment centre on the site of King George Hospital, and several years ago it was proposed that the centre be brought back in-house. But the company involved went to court and the NHS had to concede that it would remain as an independent treatment centre. These things are very damaging to the finances and integrity of our NHS.

Photo of Philippa Whitford Philippa Whitford Shadow SNP Spokesperson (Health and Social Care)

Well, I am afraid that it was the Labour party that set up independent treatment centres. I am a surgeon, and one of the issues was that such centres were sucking away the routine elective work that contributes to training future surgeons, and leaving the NHS to deal with the complex, chronic, expensive cases. Before the Health and Social Care Act, the NHS usually managed to find enough money down the back of the sofa that, at the end of each year, it would have about £500 million left. After the changes, it was £100 million in debt, £800 million in debt, and then £2.5 billion in debt. That is because money is sucked out in all these different ways, leaving a lack of funding that leads to rationing, which is pushing people to have to pay for more of their own care. We are hearing about that with co-payments—paying for a second cataract operation or for a second hearing aid. My Choice, which the Health and Social Care Act also brought in, raised the cap from 2% to 49% of income that an NHS hospital could earn through private patients. The highest amount at the moment is over 27%.

The idea that that does not impact on NHS patients is nonsense, because surgeons have limited capacity in terms of who they can operate on during the day, so if someone is able to jump the queue within the NHS, they are taking someone else’s place. As we saw with Warrington and Halton Hospitals NHS Foundation Trust, price lists have been pinned up in clinics suggesting to people that they might want to pay £7,000 or £8,000 for a hip or knee replacement, and there were also a lot of cosmetic and minor operations. I would gently suggest, as a surgeon, that surgery is not a sport. Either the patient needs an operation clinically, in which case it should be provided by the NHS, or they do not, in which case they should not be able to buy it from the NHS. Under the principle of My Choice, hugely high thresholds are being set. In the case of some CCGs, a person has to have had two falls before they can have a cataract operation, or they have to be in pain, even in bed, to get their hip done. That is driving families to club together to address that. That is not right. If someone needs it, the NHS is meant to provide it free at the point of need, and if they do not, every single operation is a risk and should never be done to attract income for an NHS trust.

Photo of Bill Grant Bill Grant Conservative, Ayr, Carrick and Cumnock

I value the hon. Lady’s comments about how money is being sucked out of the NHS. In Scotland, we have a particular issue with a large showpiece hospital in Edinburgh that should have been opened in 2012, seven years ago, that is sucking money from the NHS—millions of pounds annually over the past six or seven years. She may wish to comment on that.

Photo of Philippa Whitford Philippa Whitford Shadow SNP Spokesperson (Health and Social Care)

Well, it has not been sucking money for the past six or seven years because it was only declared open in February. I totally agree that it is a huge setback that, due to a failure within the health board’s tendering process for the build, it did not recognise the need for the level of ventilation in an intensive care unit. I would gently suggest to the hon. Gentleman that I do not think he would have wanted our Cabinet Secretary to simply go ahead putting babies and children in an intensive care unit where the ventilation was not considered safe.

In Scotland, so far our funding for the NHS has doubled in the past 10 years and will actually increase further next year. But it is not just about funding; it is about structure. What is happening in NHS England is fragmentation. It is not just that NHS hospitals are competing with private companies; they are competing with each other, and that undermines collaboration. We need to have collaboration, with the patient at the centre. Anything that fragments or undermines that collaboration is weakening the quality and safety of care.

Photo of Thomas Tugendhat Thomas Tugendhat Chair, Foreign Affairs Committee

The hon. Lady is speaking very powerfully on many issues, as usual. I would be interested in her point of view on other health providers, because as she knows, having worked around the world, many of them do things differently, particularly around Europe, for example, where many of the hospitals are not owned by the state. Many of those hospitals compete and services are provided by different bodies—private companies, charities or community groups. Will she comment on how that works, because the French and Germans seem extremely happy with their healthcare?

Photo of Philippa Whitford Philippa Whitford Shadow SNP Spokesperson (Health and Social Care)

As people in the Chamber may know, my husband is German and therefore I know that system in Germany relatively well. I would point out that the hospitals do not collaborate there either. As it is about income for the hospital, surgeons and clinicians will not always refer a patient on even though they know there is an expert down the road. I would not particularly defend that. I lost my sister-in-law two years ago, and the bills were still coming in for almost a year. That is quite a stressful and upsetting system. Not everything is covered. Patients still, as in many insurance systems, have to cover a gap, which can be significant and quite painful for them. These systems could not generate the epidemiological data, or anything like the treatment and outcome data, that is generatable in all four of the UK health services, because they do not have a nationwide system.

When I was back on the Health Committee for a short time this spring, we heard talk about the changes to the Health and Social Care Act. It is critically important that those go ahead, because there are perverse incentives within that legislation. At the moment, the tariff is paid to a trust only if patients are admitted. That is a perverse incentive against managing people in the community, or even prevention. It is important that section 75 is done away with completely so that there is not pressure on commissioning groups to put things out to tender, because that is a wasteful process. I remember reading about £500 million wasted in Nottingham, where there were preparations for a tender, then the private company did not go ahead and then it did go ahead.

All this is taking money away from patient care. That is the basis of the argument about publicly provided services. I am sorry, but the quips about drugs and so on by the Secretary of State were childish. Was he suggesting that nurses and doctors go into the North sea to drill for oil, or that that is the suggestion from the Opposition Benches? It is not the suggestion from anyone on the Opposition Benches that drugs would not be purchased. It was just a childish response. Having private companies pulling NHS England apart undermines it, fragments it and makes it not patient-centred, and being patient-centred should be the goal of every single health service across the UK.

Several hon. Members:

rose—

Photo of Eleanor Laing Eleanor Laing Deputy Speaker (First Deputy Chairman of Ways and Means)

Order. We will begin with a time limit of seven minutes, but I would expect that to reduce as the day goes on.

Photo of James Brokenshire James Brokenshire Conservative, Old Bexley and Sidcup 3:36 pm, 23rd October 2019

It is a huge privilege to be able to speak from the Back Benches for the first time since my change in role and position. I cannot think of a better topic to be speaking on than our wonderful NHS. It will not surprise many in this House to hear me champion the NHS in those terms given the experiences that I have had, in a very positive way, within it over the past two years.

In some ways I very much welcome the opportunity of this debate, but there is also a part of me that does not welcome it, because we should have been debating something else today. However, even though we are not able to do so, I remain confident that we will secure a Brexit deal and get it through this House, and that the Prime Minister will remain focused on seeing that we leave with that deal.

This Queen’s Speech is profoundly about responding to the concerns of our constituents out there across the country. It has many good and positive measures, whether on violent crime or on things like building safety, which I care about enormously. I welcome the commitment to follow through with Dame Judith Hackitt’s review by ensuring that there are measures in place to promote safety, so that people are safe and feel safe in their homes. I also welcome the Domestic Abuse Bill and the new statutory duty, which I am sure will raise the standard and provide the level of care and support needed.

I appreciate the emphasis placed on our NHS in the Queen’s Speech, with measures such as the Health Service Safety Investigations Bill and the medicines and medical devices Bill, which I hope and firmly believe will continue to drive the changes we need in outcomes for people with cancer. The NHS long-term plan rightly set out an ambition and intent to diagnose more people with cancer at stage 1 and stage 2, to ensure that we get more people living well with and beyond cancer. That is critical if we are to see, as the NHS long-term plan says, 55,000 more people each year surviving cancer for at least five years after diagnosis. We must give that focus through these measures and further investment to achieve not only the numerical targets but to profoundly change people’s lives. After my diagnosis just under two years ago, I did not know whether I would even be here today to be able to give this speech. That is what we are talking about—this is about saving people’s lives, and with early diagnosis and earlier treatment, we can do that.

I was looking at a report published in the last couple of weeks by the UK Lung Cancer Coalition about the need for speedier diagnosis, and I commend it to the Secretary of State. I welcome the effort being made through the lung health check programme, which I hope to return to during Lung Cancer Awareness Month next month, and the optimal lung cancer pathway, to ensure that people get speedier treatment. In its report, the UKLCC included a profound and very pertinent quote from Sir Mike Richards, the former national cancer director, who said:

“When you receive a diagnosis of suspected lung cancer, it’s not about the number of days until you get access to treatment, but about the number of sleepless nights until you do.”

We need to focus on the overall impact of people receiving a diagnosis and ensure that we make it as effective and speedy as we can, knowing the burden on not just the individual but their loved ones and the pressures it brings. That needs our attention.

If we are to meet the ambition in the NHS long-term plan, we have to shift the dial in relation to lung cancer. There are 47,000 cases of lung cancer diagnosed each year. Sadly, it is the biggest cancer killer, with around 35,000 people dying from lung cancer every year in the UK, equating to nearly 100 people every single day. Only 15% of people diagnosed with lung cancer will survive their disease for five years. That is an unacceptable figure. Why is it the case? Because far too many people are diagnosed in the late stage, when the disease has spread and the options are more limited.

I welcome the innovative drugs that are coming through, which I hope the new legislation will support, and the £200 million investment in CT scanners that the Health Secretary has announced, which is so important. It is crucial that we shift the dial. Over half of us here today will get cancer at some stage in our lives. That is why we need to change the terms of the debate and focus on getting earlier diagnosis and speedier treatment. We also need to be more open and honest. Rather than talking about “the big C”, we should be looking at ways to discuss this far more openly. Through our investment, our plan and the steps set out today, we can turn the debate into one about cancer being a chronic disease that we can live well with and beyond. I hope that the measures we are debating today will help to achieve that.

Several hon. Members:

rose—

Photo of Eleanor Laing Eleanor Laing Deputy Speaker (First Deputy Chairman of Ways and Means)

Order. I am very sorry, but after the next speaker, the time limit will have to be reduced to five minutes. If Members who wait to the end are annoyed about that, they will have to speak to all those who intervened on the Minister and the Front-Bench spokespeople at the beginning of the debate; I do not blame the Minister or the Front-Bench spokespeople.

Photo of Sarah Wollaston Sarah Wollaston Chair, Health and Social Care Committee, Chair, Liaison Committee (Commons), Chair, Liaison Committee Sub-committee on the effectiveness and influence of the select committee system 3:44 pm, 23rd October 2019

It is a pleasure to follow James Brokenshire, who spoke so powerfully about his experience of the NHS and the importance of early diagnosis of cancer. He said in his opening remarks that we should have been discussing Brexit. I say to him and his colleagues that there is no version of Brexit that would benefit the NHS, social care, science and research or public health, so I urge him to look again at the way he has voted over recent days. That is something we heard compellingly and repeatedly—

Photo of Sarah Wollaston Sarah Wollaston Chair, Health and Social Care Committee, Chair, Liaison Committee (Commons), Chair, Liaison Committee Sub-committee on the effectiveness and influence of the select committee system

I will not give way, simply because of Madam Deputy Speaker’s comments about time pressures.

We heard those views on Brexit powerfully and consistently from all those who gave evidence to the Health and Social Care Committee, so I again urge the right hon. Gentleman to reconsider.

No debate about the NHS can take place without considering alongside it social care and public health. I start by thanking all those who work in all those sectors, who are working under pressure as never before. I reiterate the powerful points raised by the shadow Secretary of State for Health and Social Care. I will not repeat his points about the pressures, including the financial pressures, because I agree with him. However, as parties write, structure and frame their manifestos, I urge all colleagues to look at the evidence and at the asks of the NHS’s workforce and leaders.

I welcome an NHS Bill in the Queen’s Speech—I was going to ask the Secretary of State this, but unfortunately he has left his place, so I hope it will be addressed in the summing up—but have the Government looked carefully at the work that was done by the NHS, alongside the Select Committee, to frame those asks? People in the NHS were clear that they did not want another top-down administrative disorganisation of the NHS; they wanted something targeted. As was set out by my former colleague on the Select Committee, Dr Whitford, they want the scrapping of section 75. They want a common-sense approach to getting rid of the endless and wasteful procurement rounds. They want an approach that allows all parts of the NHS and partner organisations to work together more closely. I want to hear from the Minister in his summing up that the Government have heard that loud and clear, and that it will all be adopted, because it has cross-party support in the Select Committee and a very clear evidence base. That would help us to implement the long-term plan much more quickly.

I would also like the Minister to say more about when we will hear the Government’s proposals for social care, because the knock-on pressures from social care on the NHS are enormous. Far too many people end up in far more expensive settings, where they do not want to be and where they are put at greater risk, for the want of good social care in our communities. This is a political failure. Two Select Committees—the Health and Social Care Committee and the Housing, Communities and Local Government Committee—worked alongside a citizens’ assembly to come up with a consensus approach. We have to get away from the back and forth of, “Is it a death tax?”, “Is it a dementia tax?” The fact is that we already have a dementia tax in the NHS and social care. The result of the failure to grasp this issue and come up with a long-term solution is that 1.4 million people are going without the care they need. It is a failure on the part of all of us to grasp this problem and come up with something long term and sustainable.

We need to take a far more evidence-based approach to public health and prevention. To give an example of that, today the Health and Social Care Committee published our “Drugs policy” report. Last year, 2,670 people died as a direct result of drug use. That is an increase of 16% on the year before. That figure can be doubled if we include all the causes of preventable early death among people who use drugs. Again, we know what works. I urge the Government to look at the international evidence, to be bold and to consider making this a health responsibility—to say that we will help addicts and that we will radically improve treatment facilities.

There has been a 27% cut in resources for drug treatments, and as a result people are dying unnecessarily. I am afraid that we are not being bold enough in saying that we can save these lives and benefit people’s wider communities if we are just prepared to take the step of destigmatising drugs and seeing drug use as an illness rather than something for which, for personal possession, people should be banged up in jail. We should allow our police forces to continue to go after the dealers—the Mr Bigs—rather than criminalise people, especially given that, frankly, we saw competitive drug-taking stories during the Conservative leadership election. I would ask whether any of those people would have been in the position they were had they had a criminal record.

The point is that people are dying completely unnecessarily because of our current policies. Our drug policies are failing, and they are particularly failing those who are dying, their families and all the wider communities that are being subjected to the harms of unnecessary acquisitive crime, discarded dirty needles and so forth. Let us look at the evidence, and let us be bold—not just on drugs policy, but on so many of the other things that are leading to serious health inequalities, such as childhood obesity. Let us be evidence-led in our policy and let us try to get away from the party divisions.

In closing, I would just like to express again my sincere thanks to all those who are helping us out there in our emergency services.

Several hon. Members:

rose—

Photo of Bernard Jenkin Bernard Jenkin Chair, Public Administration and Constitutional Affairs Committee 3:51 pm, 23rd October 2019

I join Dr Wollaston on that last point. We pay tribute to all those who are serving in the NHS and our emergency services. In particular, if I may, I pay tribute to those serving in North East Essex.

Recent years have seen a significant turnaround in the health service in my constituency. Colchester General Hospital was for years in some considerable difficulties, but it is now commanding the confidence of the Care Quality Commission. It has newly merged with Ipswich Hospital in the East Suffolk and North Essex NHS Foundation Trust. It exemplifies the importance of the inspirational and strong leadership that we have in Nick Hulme, who is the chief executive of that trust.

I also commend the strategic transformation plan, which was greeted with great suspicion when such plans were first talked about. It is looking strategically at things such as GP capacity—for example, we need a new surgery on Mersea island—and at providing more services locally, such as at the Fryatt Hospital in Harwich, where we are maintaining and developing the excellent minor injuries unit and developing local access to other satellite services that would otherwise have to be at Colchester General Hospital.

All this underlines the importance of leadership, and I do hope the Secretary of State and his Ministers will continue emphasising the importance of leadership and staff engagement. I have to say to the colleague who served with me on the Joint Committee, Dr Whitford, that all this is much harder to achieve in Essex on 40% less funding per head than is available to the NHS in Scotland.

I want to concentrate on the Health Service Safety Investigations Bill, which originates from a report that my Committee—the Public Administration and Constitutional Affairs Committee—produced in 2015. We were dealing with the aftermath of all the problems of Mid Staffordshire, with 80% of the complaints coming through from the Parliamentary and Health Service Ombudsman, in an atmosphere where we were asking how complaints could be better handled and how incidents could be better investigated.

People such as Martin Bromiley, whose wife died on the operating table in 2005 and who set up the Clinical Human Factors Group, inspired me, as did papers by people such as Carl Macrae and Charles Vincent—they published a paper in the Journal of the Royal Society of Medicine in 2014, called “Learning from failure: the need for independent safety investigation in healthcare”—and that led my Committee to establishing our inquiry.

In a context of the then Secretary of State telling us there were 12,000 avoidable hospital deaths, 10,000 serious incidents, 338 “never” incidents and 170,000 written complaints about healthcare in the NHS every year, and with the NHS Litigation Authority reporting a potential liability for clinical negligence of £26 billion—the figure today is much larger—we were determined to find a better way to investigate clinical incidents so that there could be learning and no blame. The fundamental conclusion we published was that there is

“a need for a new, permanent, simplified, functioning, trusted system for swift and effective local clinical incident investigation conducted by trained staff, so that facts and evidence are established early, without the need to find blame, and regardless of whether a complaint has been raised.”

With the Bill that the Government introduced in the House of Lords last week, we are now progressing towards legislation for a safe space, so that the conversations can happen, without fear of litigation, through a properly independent body that is not a regulator, is not part of the political apparatus and is not beholden to the spending and politics of the NHS, much like safety bodies in other industries such as the air accidents investigation branch.

The Joint Committee considered the legislation last week, and the Select Committee produced another report in August 2018, “Draft Health Service Safety Investigations Bill: A new capability for investigating patient safety incidents.” I look forward to its being one of the Government’s most important achievements when they set up this body under statutory authority.

Photo of Helen Goodman Helen Goodman Shadow Minister (Foreign and Commonwealth Affairs) 3:56 pm, 23rd October 2019

It is a pleasure to follow Sir Bernard Jenkin.

One of my constituents had a stoma operation in the summer, and he received a letter a fortnight ago from the private company that supplies his stoma bags. This letter said that, in the event of a no-deal Brexit, the company hoped to be able to continue the supply—not guaranteed but hoped. This is completely unacceptable. He had his operation under the NHS on medical advice, but the stoma bags are supplied by a private company. In other words, the aftercare is privatised.

Ministers must accept responsibility for these essential supplies. I do not know how many thousands of people would be affected if these companies were not able to supply the stoma bags, and I cannot imagine how awful it would be for them to sit with faeces oozing from their stomachs if Ministers cannot make sure this is properly sorted out.

The Government simply have to get a grip. They must stop the constant process of privatisation, undermining and attrition of the NHS. The last nine years have seen a constant stream of salami-slicing in my constituency. NHS managers struggle with inadequate resources, recruitment difficulties and inadequate funds. Staff are doing an excellent job, but they are under huge pressure at the moment.

To deal with this, managers constantly reorganise services in the hope of squeezing more money out of the system. None of the 20 refurbishments announced by the Secretary of State will benefit my constituents, not in Bishop and not when they go to Darlington or Durham. Darlington Memorial Hospital, in particular, needs proper attention. It is a collapsing building with huge problems, and it needs to be rebuilt.

In 2013 we lost the maternity ward from Bishop Hospital. In 2017 the CCG had to launch a fundraising campaign to raise money for an MRI scanner. The public responded very generously, but we cannot only have new kit if the public get the campaign funds together. That way, we will have much better healthcare in wealthy areas than in poor areas.

Last year, there was a proposal to close ward 6 at Bishop Auckland Hospital, which through energetic campaigning we have staved off. Now, the closure of Bishop’s stroke rehab wards is proposed. No doubt some of their work would be done in the community, but other patients would have to go to Durham hospital, which is already crowded. All the time, we see my constituents having to travel further—to Durham, to Darlington, sometimes to Stockton, with journeys taking an hour. This debate is not about buses, but the fact is that Ministers must get their heads around the reality of delivering healthcare in rural areas. The rhetoric simply does not match the reality. We have also lost one of the two wards at the Richardson Hospital in Barnard Castle, and I have not begun to talk about the problems of getting GP appointments and the terrible difficulties young people have getting the mental healthcare they need.

All this takes place against a background of deprivation and poverty. In one part of my constituency, male healthy life expectancy is 68; in another, it is 54, yet the Government are cutting Durham’s public health budget by £19 million. I was really disappointed—no, angered—when the Prime Minister, during his campaign to become Tory leader, said that he wanted to cut taxes for the top-earning 3 million people, putting £6,000 into the back pockets of people earning £80,000 while my constituents have to go to one of the seven food banks that have opened in recent years.

Photo of Stephen Hammond Stephen Hammond Independent, Wimbledon 4:01 pm, 23rd October 2019

It is an honour, a pleasure and a surprise to be called in this debate, Madam Deputy Speaker. I confess that I had forgotten I put in for it, but I am none the less delighted to speak and to follow Helen Goodman. She knows how much I oppose no deal, but I say gently to her that I spent more hours of my life than I care to remember between December last year and July ensuring that in the event of a no-deal Brexit the NHS would have the supplies it needs, and I am confident that my successor as the Minister for Health, my hon. Friend Edward Argar, will be able to reassure her from the Dispatch Box that the NHS is putting in place all the preparations she wants.

For me, the most important line in the Queen’s Speech was that new laws would be introduced to implement the NHS long-term plan. I say that because I think the long-term plan is likely to be one of those documents that define healthcare and the way we deliver it for many years to come. It appears that real thinking has been put into creating a joined-up framework, but as the Chair of the Health Committee, Dr Wollaston, will recognise, it is not just a central diktat document. It is a document that was formulated working upwards with NHS staff and that makes them integral to the whole system.

The Opposition spokesman, Jonathan Ashworth, was right to identify that there are staffing problems, but he was wrong not to accept the absolute priority the long-term plan attaches to staffing and the work that is being done. The Health Secretary spoke about the number of extra GPs being recruited into training this year; what he did not say was that while recruitment is a problem, retention is even more fundamental. A number of the training places are in new medical schools in areas that are likely to retain the new doctors because they trained in the area. Equally, in nursing, which everyone rightly talks about, retention is as important as recruitment, and efforts are being made through new routes back into nursing. When I visited Great Ormond Street Hospital, I was struck by the introduction of 10 to 2 shifts, enabling mothers who want to return to nursing to continue to practise on child-friendly shifts. It is true that flexible rostering is coming on and we should avail ourselves of such opportunities, because if we cure our retention problem, we halve our recruitment problem.

I am pleased to see the work being done on the NHS infrastructure plan. Inevitably, everybody has said that the 40 hospitals are not there, but anyone who has been in business or in any form of charity work that requires forward planning knows that 40 hospitals or 40 projects are not brought on just like that. They need business plans. We can commit to six hospitals so quickly because the process has been worked through and they are ready to go. It is encouraging that 21 plans are in procedure and are starting now. It is much more likely that those hospitals will come forward more quickly.

It would be remiss of me not to take this opportunity to bring forward one constituency case, which I think highlights a problem that a number of hon. Members have already spoken about today: the use of medical cannabis by people with severe epilepsy. The case concerns my constituent Kayleigh Morris, whose Aunt Dee spends an extraordinary amount of her time and her life ensuring that her niece is able to live. She appreciates that the Health Secretary saw them seven months ago. What she would like, however, is for the Health Secretary to—if I can put it colloquially—put a rocket up the health system. I have spent the past three months writing letters to the chief executive of the hospital just to get him to respond to my constituent on this matter. If the Health Secretary could put that proverbial rocket through the system, it would be greatly appreciated.

I see that I have 18 seconds left, which is probably a relief to the House. I will just say that I am particularly pleased to see that the Government are, along with the long-term plan, going to bring forward reforms to mental health.

Photo of Ann Clwyd Ann Clwyd Labour, Cynon Valley 4:06 pm, 23rd October 2019

Madam Deputy Speaker, you were in the Chair when I was granted an Adjournment debate by Mr Speaker on a subject which I will discuss again today. I was a patient at the time and I came out of hospital to speak.

I have a very long involvement with the health service. I sat on a royal commission on the NHS, having been appointed by Barbara Castle 40 years ago. For me, it is incredible, 40 years on, to still hear the same arguments over and over again. I wish the Health Secretary was in his place. I enjoyed writing a report on hospital complaints in England for the Department of Health when David Cameron was Prime Minister. I was very much hoping to get assurances today that the recommendations we made then have all been acted on. I do not believe that they have been.

I was also on the Welsh hospital board many years ago with Aneurin Bevan’s sister. It is quite useful to have people in this place who are a bit older, who have long memories and who can remember what has been said and done and promised. I remember going to the United States, talking to health professionals there and realising that two thirds of all personal bankruptcies in the US were because of inadequate health insurance. I think that that was still the case when I last checked. I very much hope that that does not become the norm in this country.

As a recent patient, I would like to thank everybody in the English health service and the Welsh health service for their care, because I would not be here today were it not for them.

Photo of Gerald Jones Gerald Jones Shadow Minister (Defence)

Would my right hon. Friend like to pay tribute to the NHS in Wales? As my constituency neighbour, I am sure she appreciates all the good work done in Wales.

Photo of Ann Clwyd Ann Clwyd Labour, Cynon Valley

I have been a critic of the health service in Wales, as my colleagues know, but I am also an admirer of much of the good work it carries out, particularly in my hon. Friend’s constituency at the Prince Charles hospital in Merthyr Tydfil and at University Hospital Llandough in Cardiff, where I apparently almost died in August. I am grateful to be alive, and I thank all the doctors and nurses involved.

Over 200,000 people in Britain suffer from venous leg ulcers, a form of chronic wound. It is highly painful, I can tell you, and socially isolating. For most, treatment involves managing the symptom—the ulcer—rather than addressing the underlying cause, yet proven surgical interventions are available to treat this underlying condition. Clinical guidance is comprehensive, but the evidence shows that local-level implementation is extremely patchy.

The UK spends between £940 million and £1.3 billion every year managing venous leg ulcers. Most of that comes from the need for community nurse visits to support patients in managing their conditions. Seventy-five per cent. of costs alone can be attributed to community nursing, placing a huge strain on community care, yet evidence shows that where clinically appropriate, a surgical intervention approach is cost-neutral in year one, and that is what I would like to hear about from the Secretary of State.

While early intervention incurs high initial costs, these are quickly offset by lower one-year community nursing costs. The issue is that most cases are simply never referred to a specialist vascular service. Seventy-five per cent. of venous leg ulcers do not receive a comprehensive vascular assessment, as enshrined in National Institute for Health and Care Excellence guidance. Sixty-four per cent. of clinical commissioning groups’ commissioning policies were found to be non-compliant with NICE guidelines for the treatment of the problems responsible for venous leg ulcers.

The opportunity to provide cost-neutral treatment, proven to heal ulcers faster and help to prevent recurrence, is missed, causing unnecessary pain and suffering for thousands. I can tell the House that it is the most painful thing that has ever happened to me. I know many, many people who are living in this pain now. How can we ensure that primary and secondary care providers, commissioners and local authorities are brought together, made aware of the benefits and able to deliver early intervention in venous leg ulcers? Quite simply, it will save NHS funds and save the suffering of so many people.

Photo of Philip Dunne Philip Dunne Conservative, Ludlow 4:12 pm, 23rd October 2019

It is a particular honour to follow Ann Clwyd and to hear of her recent experience, which highlights her continued diligence in serving her constituents after 35 years in this House. I am also pleased to follow my hon. Friend Stephen Hammond, who has just left his place. He was one of the four successors that there have been to my post in the Department of Health and Social Care since I left it less than two years ago. As a result, he has covered many issues that I want to focus on today, which offsets the fact that I have only four minutes left for my remarks.

I am particularly pleased that this Queen’s Speech has had a significant focus on health. It has been a while since the first Conservative Government came in and enacted the Health and Social Care Act 2012. There is legislative capacity in the Queen’s Speech and in the period that will hopefully follow to allow the Department to put through its legislation. The measures on social care are so vital for many of us. With many of our adult and children’s social care providers running into a brick wall on funding, it is becoming increasingly urgent that we find solutions to the social care issue. It is particularly satisfying to see that mental health has its rightful place in the Queen’s Speech. Implementing the long-term plan is the key plank of the legislation, and the legislative capacity gives the Department the opportunity to ensure that it can fulfil the promise of the long-term plan with any statutory obstacles removed through legislation, as necessary.

I will touch on two specific measures, beginning with the health service safety investigations body, which my hon. Friend Sir Bernard Jenkin was so instrumental in supporting through the Public Administration and Constitutional Affairs Committee. This is a world-first body introducing a statutory underpinning to health safety and providing a safe space in legislation so that people can have confidence that its investigations will remain confidential in appropriate circumstances. I very much welcome that, having started that process myself.

Secondly, the medicines and medical devices Bill will provide an opportunity for innovation to come to the fore. The Secretary of State has a particular enthusiasm for technology and introducing a modern, 21st-century digital era into the NHS, which is long overdue. I anticipate that the Bill will provide significant capacity to beef up the accelerated access collaborative to allow productivity through technology to be adopted across the NHS. We have had some excellent work from Professor Eric Topol highlighting how the introduction of artificial intelligence, particularly in diagnostics, can greatly increase the productivity of the NHS workforce, on whom the demands being placed by our demographics are increasing all the time.

On workforce, I am very proud that in the time I was at the Department we increased the percentage of doctors and nurses in training by 25%, and I was delighted to hear the Secretary of State refer to the record number of GPs in training, but we have to sort out the pensions issue, which has been affecting many senior clinicians in general practice and in our hospitals. The measures announced earlier this year are only a stopgap. I was in a GP surgery last week. One of the practitioners works half time, another three quarters time; they cannot afford to work full time because of the tax implications for their pensions.

On nurses, the continuous professional development offer of an extra £1,000 per nurse is vital. When I was going round hospitals, the matrons in every ward I went to said that this problem was making it more difficult for staff to progress through the career structure, so that offer is very welcome.

I will make one final point on workforce. Shrewsbury and Telford Hospital is not one of the trusts receiving the extra and very welcome capital investment, but that is because it got it 18 months ago, and I am delighted that decision has gone through. This week, it hired 179 nurses from India to fill vacancies. When we allocate capital, we need to think about encouraging training opportunities for clinicians where the capital is being deployed.

Photo of Barry Sheerman Barry Sheerman Labour/Co-operative, Huddersfield 4:17 pm, 23rd October 2019

I shall rattle through my speech. I always like to speak in the Queen’s Speech debate. I thought I was going to be robbed this time, but here we are, back with the opportunity.

I am not an expert on health, but I do take a great interest in it, and I have a real interest in management, so I want to say something about the big issue in health. We have a brilliant national health service, and we will all, politically speaking, keep on fighting about it, but I agree with Rory Stewart: at some stage, we will need a royal commission, especially on social care, which will become very expensive as people live longer and as the challenge of providing decent care increases. Furthermore, everyone loves the NHS, but not many people want to pay much more in their taxation. We have to crack that and find a way to fund the NHS properly.

Not only that, but we are getting cleverer all the time. I had the pleasure of a breakfast meeting with Professor Topol, who wrote an innovative paper for the Government about new technology, science and our ability to identify cancers and diagnose earlier. It is all so exciting, and it is going to happen, but it will cost money.

Where our health service is severely deficient is in the quality of management. I spent some time in hospital a couple of years ago. It was not serious, but I had the chance to look at how a hospital was run, and the more I looked, the more I realised that people were not trained properly: doctors do not get trained as managers. We often promote highly skilled medical people to manage our health service, but there is no great institution educating the best administrators and managers in the health service. They have them in some parts of the United States and in other countries, such as France, but we do not have that very high-quality management, and we need to do something about it, because the future needs high-quality people.

May I strike a slightly discordant note at this point? What causes ill health is poverty. We all know about the relationship between the two. We know about it in my constituency, and we know about it everywhere. The fact is that poorer people get ill, and in the last few years austerity has made a lot of people ill. One of the indicators of poverty and ill health that I have noticed is dentistry: in this country, people have to be really, really poor to get any free dentistry. There are very few NHS dentists in my constituency, and we are beginning to see people with awful-looking teeth. You need wealth these days to afford good dentistry. It is a dreadful, dreadful thing that we have pushed dentistry out of the national health service. It is unacceptable to so many people.

On the other hand, I believe that there are very exciting signs. We now need a new model of hospital and a new model of GP surgery, and some of the very best that I have visited are top-class. I think we have learnt that big, big hospitals are no longer the most appropriate for most communities. I am delighted that, after a massive campaign in Huddersfield, we have money for a new A&E service in our old hospital that Harold Wilson opened, but that hospital is out of date. We need a new build, and I can tell the Secretary of State and his ministerial team that we would build a modern, techie, innovative, wonderful hospital on that Harold Wilson site. We already have some money for the A&E, but we could go further and build a wonderful, futurist hospital.

I have done a lot in public health. I organised the seat-belt legislation that banned people from allowing children to be unrestrained in cars. That is one of the things that I have done with the World Health Organisation on an international basis. Every year, 1,780 people are killed on the roads and 10 times that number are seriously injured, and the impact on our hospitals is massive.

We need much better public health education. Where has it gone? People talk about it, but then they turn it off. Local authorities do not have the money to deliver it, and to deal with the problems of obesity, drug addiction—which was mentioned earlier by Dr Wollaston—alcohol addiction and smoking. We could make such changes if there were more relevant public education on those matters, and on matters such as atrial fibrillation: half the people in this country do not know that they have an irregular pulse and are likely to have a stroke.

There are all sorts of things that we can do in our wonderful health service. We just need the time and the resources.

Photo of Mike Penning Mike Penning Conservative, Hemel Hempstead 4:22 pm, 23rd October 2019

It is a pleasure to follow Mr Sheerman. I fully agree with many of the points that he made, and I think that everyone in the House would agree with them.

I am not usually confrontational politically, so I will do only a tiny bit of that. This fear thing that is being thrown around about a privatisation of the NHS is very damaging. It is not particularly damaging to my party, but it is damaging across politics. I was at the Opposition Dispatch Box as a shadow health Minister for four and a half years, and during that time all those PFIs went through. Under the private finance initiative, private companies were being paid for surgery that was not even carried out. They were contracted for 1,000 knee operations or 1,000 hip replacements which did not take place, and they were still paid. That is what happened under the previous Labour Administration.

We need to admit that we make mistakes when we are in government. We have made mistakes before. I made mistakes as a Minister when I was in seven different Departments—it will probably not be eight now. Governments sometimes make mistakes for the best of reasons. One of the great mistakes was that era of privatisation, with PFI deals that were off the balance sheets, and Darzi clinics. Lord Darzi was a great surgeon, a great medical man; I just happened to disagree completely with many of his proposals which were implemented by the Government, and which, frankly, have not worked. There are still many clinics out there to which trusts have to pay huge amounts of money, not to get out of their contracts but just so that they can carry on. That is something that we need to admit. So, in this House, let us admit that Governments make mistakes and that the PFI privatisation carried out by the Labour party was wrong, although it was probably done for the best of reasons. A PFI hospital was promised to my constituents; it never came even though the Labour party closed the A&E at Hemel Hempstead hospital, in the largest town in Hertfordshire. We were promised that that would be looked after, because St Albans had had its hospital closed. However, it was closed and the whole thing moved to a Victorian hospital in the middle of Watford, which cannot cope today and has not been able to cope since then.

Adding little bits to hospitals, as Mr Sheerman said, and putting a new A&E on the front can sometimes work, but when there is serious funding around, which is what we are talking about now, a modern, new, environmentally proper hospital that can actually have sufficient footfall to enable the medics to work in their specialties is what we need.

I am one of the few Conservative MPs to have been offered the £400 million for a new hospital. I have said to the Secretary of State and to my trust that it is not a new hospital; it is a refurbishment of a Victorian hospital in the middle of Watford next to a football ground, and my community does not want that. The people of Watford might, but if they thought outside the box—I am not being rude to them—I am sure they would agree that it would be better to have a brand spanking new hospital that looks after the communities of Watford and the surrounding areas of Hemel Hempstead and St Albans in that massive growing area just north of the M25?

So I do not want my old hospital reopened. It is still sitting there boarded up; it is just sitting there like a running sore in my constituency. It was a wonderful new hospital when the new town was built, but there she sits now with two wards, outpatient facilities and a minor injuries unit that does not even open for 24 hours even though we were promised it would.

What we want is a tiny bit more money—the Secretary of State knows this; I am not saying anything to the Minister that he does not know. We should not keep frightening people by saying it will cost £750 million or £1 billion to build a new acute hospital on a greenfield site, because we know it will not. We have the experts working for the new hospital action group and I am going to meet the experts in the Department in the next couple of days. So I am saying to the Department, “Hold back for a second on this new hospital for us, because if you hold back a second, we might get a completely different result.”

Photo of Barry Gardiner Barry Gardiner Shadow Minister (Department for Business, Energy and Industrial Strategy) (Energy and Climate Change), Shadow Secretary of State for International Trade

The right hon. Gentleman is speaking very candidly and with great integrity. My mother died in the Hemel Hempstead hospital that he speaks of many years ago. He talked about PFI and some of his remarks are absolutely spot on, but does he now recognise that the money owed on the PFI liabilities is actually £9 billion, as opposed to the £11 billion, which is the backlog of what hospitals are paying to the Department itself because of the borrowings they have had to take out as a result of the financial problems they are facing?

Photo of Mike Penning Mike Penning Conservative, Hemel Hempstead

As was said in debate with the Scottish National party spokesman earlier, the Government can borrow money much cheaper than any private organisation.

I am thrilled that there is some honesty in the Chamber, because we have argued about PFI for donkey’s years; it was a way of getting things off balance sheet, and let us move on from that. There is no more PFI—we can all agree on that—but actually we are not privatising the NHS, as everybody with an ounce of common sense knows. The NHS is perfectly safe; it has been safe under this party for the majority of its time since inception, and it will stay perfectly safe. There are massive demands on it, however, and I cannot allow all this money—taxpayers’ money—to be put into a Victorian hospital next to a football stadium in the middle of Watford. Anybody who knows our part of the world knows that Watford football club is in the premiership. It might be struggling a little bit at the moment, although it did very well against Spurs the other evening. Let us pause, get the experts around the table and stop scaring people with costs that are completely unrealistic—new hospitals were built in Birmingham for £425 million and a new one can almost certainly be built in Harlow for similar amount. Let us have a 21st century hospital. Let us be honest with each other and move that forward.

Photo of Brendan O'Hara Brendan O'Hara Shadow SNP Spokesperson (Inclusive Society) 4:29 pm, 23rd October 2019

It is a pleasure to follow Sir Mike Penning. Indeed, there have been many good contributions this afternoon, and I particularly want to point out the contribution of my hon. Friend Dr Whitford.

I would like to repeat the call that I made earlier in the year through the publication of my private Member’s Bill, which asked the UK Government to make provision for an independent evaluation of the effects on the health and social care sector, should the United Kingdom leave the European Union. After working with Scottish Ministers, Welsh Ministers and the relevant Departments in Northern Ireland, I asked the Government, in the Bill, to undertake an evaluation of the sustainability of funding and the position of the workforce, as well as the

“efficiency and effectiveness of the health and social care sectors”.

The concern among those working in the sector about the harm Brexit could do can be measured by the fact that no fewer than 103 third sector organisations, trade unions and charities from every part of the United Kingdom have signed up publicly to support the measures in the Bill. I can assure all those who have supported the Bill up to now that it is my intention to re-present it to the House at the earliest opportunity. I will do that not just to highlight the issues facing the sector but to ensure that, in the months to come, should Brexit happen, no one in UK Government will ever be able to claim that they did not know what was happening or that they were unaware of the effect Brexit would have on the sector or the service user.

Earlier today, the Secretary of State said that his Bill had health and social care at its heart. I am therefore surprised and disappointed that something akin to what I am suggesting was not in the Queen’s Speech, but I can assure the Government that if they were minded to take my Bill on board, they would find that I and, I am sure, Members from across the House and the entire health and social care sector would work with them constructively to get it through the House.

Every one of us knows that there is already a crisis in health and social care, and I believe sincerely that Brexit will simply deepen that crisis. I am not alone, and I know that the Government know this, because the British Medical Association wrote to the then Prime Minister in February to say that

“there is no clearer immediate threat to the nation’s health than the impact of Brexit.”

The Department’s figures show that around three quarters of the medicines that we use in the UK come from, or through, the European Union. There are well-founded and genuine fears about the availability of medicines and, just as importantly, supplies of vital medical equipment, post Brexit. When we add to that the fact that our population is ageing and living with increasingly complex care needs, we find that there is a challenge of care. That challenge is to recruit and keep the workforce needed to look after those with complex medical needs. That situation will undoubtedly worsen as the UK, for reasons known only to itself, is intent on deliberately cutting itself off from that pool of labour, on which we have come to rely so heavily. The House does need to accept my word for this. Professor Ian Cumming of Health Education England said almost two years ago:

“Our biggest risk in the short term, as a result of Brexit, may be in the non-professionally qualified workforce across health and social care”.

It is simply not enough for the Government to say, “Trust us, it will be all right on the night,” because frankly, no one believes that it will be all right on the night. The Government have to show that they have thought of absolutely everything and that they are leaving no stone unturned in ensuring that everything will be all right. I passionately believe that the Government should look favourably on my private Member’s Bill, which 103 organisations have signed up to, and accept that an independent evaluation of the impact of Brexit on the sector is an essential part of restoring and retaining public trust. They would have nothing to lose by taking this on board and accepting that this evaluation will help everyone across these islands when it comes to health and social care.

Photo of Mike Wood Mike Wood Conservative, Dudley South 4:34 pm, 23rd October 2019

Like Members on both sides of the House, my family and I rely on our national health service, and it has always been there when we needed it most. It was there when my two children were born in local hospitals, caring for them when they were at their most vulnerable and looking after my wife through complications and immediately after their births. Then, at the start of 2017, the NHS was there for me when I unexpectedly became ill very quickly and developed severe septic shock.

Sepsis is a nasty condition. It is fast, devastating and indiscriminate. It affects people irrespective of wealth, gender, or age. In my case, I came back to Parliament after the Christmas recess with a cold, an experience with which most Members will be familiar, and the cold developed into a sore throat. Within days, I was at Russells Hall Hospital A&E and then in intensive care. Within a few hours, I was in an induced coma, where I would remain for the next 11 days.

I received incredible treatment and care from our national health service, from doctors, from nurses, from ancillary staff, from every single member of team, and I will always owe them everything. I was also incredibly lucky. At one point when I was unconscious, the doctors had called in my parents to explain that I probably had about a 10% chance of waking up. Even with the incredible skills and dedication of the hospital staff, there was also a huge amount of luck involved in my pulling through.

Of course, not everyone is as lucky. Of the 250,000 cases of sepsis in the United Kingdom each year, at least 52,000 people lose their lives—a little more than are killed by breast cancer, bowel cancer and prostate cancer combined. It amounts to about 80 deaths in each of our constituencies. Indeed, 13 people somewhere in the United Kingdom have probably lost their lives to sepsis since the start of this debate. Each year tens of thousands more people suffer permanent and life-changing after effects that may leave them with permanent disabilities or health conditions.

A report presented to the European Society of Intensive Care Medicine last year found that sepsis mortality rates in Britain had not fallen as quickly as those in some other countries between 1985 and 2015, and there are many possible contributory factors. Some of it may be down to genuine differences in how sepsis is diagnosed and how causes of death recorded in the United Kingdom. On top of the roll-out of the second generation of the national early warning score system, I urge the Minister to consider a national registry to measure the extent of sepsis so that we can properly rate how effective we are in tackling the causes. Some of the differences may also be down to some clinicians being slow to follow the new systems and procedures. We have seen that in my local hospital, where I was treated so well, because CQC reports have made it clear that cultural resistance to change has been a problem, so we need better commissioning levers to incentivise best practice.

I am delighted to see measures in this Queen’s Speech that will we hope address one of the big causes of avoidable deaths: human error. The Health Service Safety Investigations Bill will help to discover the truth rather than to apportion blame. It will provide for the world’s first independent body that will investigate patient safety concerns to ensure that we do not have repeated mistakes that can cause further unnecessary deaths.

Photo of Mary Glindon Mary Glindon Shadow Minister (Environment, Food and Rural Affairs) (Farming and Rural Communities) 4:39 pm, 23rd October 2019

It is an honour to follow Mike Wood. I think the whole House wishes him all the best of health in the future, having recovered from that terrible illness.

I congratulate all the staff at Northumbria Healthcare NHS Foundation Trust because, for the second time in a row, they have received a rating of outstanding from the CQC. I have to declare an interest, as members of my family work for the trust, but it was great news to know that the organisation is providing outstanding services to my constituents, despite all the cuts that have been imposed over the years.

I must turn from a message of congratulations to the trust to complaining to the Government about an issue that people have already highlighted: the problem being faced by all those who desperately need access to medical cannabis, including my constituent, Lara Smith, who is known to people in here for courageously highlighting the problems she has faced in recent years in accessing the medicine Bedrocan.

Lara was a paediatric nurse and a county fencing coach before her health deteriorated because of cervical and lumber spondylosis. She has been on 35 different medications and had several operations for her condition. Unfortunately, she has been left with permanent nerve damage, limited mobility and a constant tremor in her right hand. Her quality of life has been impaired, not just because of her medical condition, but, particularly, because of the drugs she was prescribed for it.

Lara’s pain management consultant prescribed her Bedrocan and the transformation was such that she was able to come off all her other medications, but the downside is that she can access the drug only by travelling to a Dutch pharmacy to collect it. That is an expensive, arduous journey by ferry, which she makes every three months and has done so for four years. She always notifies the UK Border Agency of all the details it needs to know of her prescription and travel details, but, sadly, and most embarrassingly for her, on her last trip she was pulled aside by the agency, which wanted to check her medication. Of course, she was mortified and she worries it might happen again.

Lara’s message to the Minister is that she is more than fed up with having to travel 300 miles to a Dutch pharmacy to get her medication. Can the Minister give her any reassurance that things will change soon, as he promised when he met patients’ families from the End Our Pain campaign in March this year? Access to medical cannabis was legalised last November, so why has nothing has happened to help patients since then?

I also wish to thank Dr Azzabi and the all the staff at the northern cancer care centre who have looked after my husband Ray since he was diagnosed with incurable prostate cancer four years ago. I give special thanks to the staff on ward 36, who are now seeing him through his chemotherapy. Ray was very lucky because when he was diagnosed he received instant treatment, which was a massive blessing for us. However, other cancer patients are not so lucky, and once they are diagnosed—a terrible blow to the family—as we know from the targets, treatment is now taking longer and longer. It is hard enough to be diagnosed with cancer, but knowing you have to wait for your treatment is unbearable.

Our staff in the health service are under pressure and services are lacking. Our precious health service deserves more. I hope that the Government will heed all the messages today and have taken note.

Photo of Andrew Lewer Andrew Lewer Conservative, Northampton South 4:43 pm, 23rd October 2019

I am pleased to follow Mary Glindon and my hon. Friend Mike Wood, who gave very personal examples of how this debate touches us all, and our families, in the most intimate and moving way possible. I am glad to be in the Chamber to speak on a subject that I have long believed needed more focus, and I am pleased that it has been given the attention it deserves in the Queen’s Speech.

Demand is steadily growing and pressure will continue to rise in our health services. In in particular, we must focus on addressing the issues that social care brings up, in respect of both adult social care and children’s social care, which I shall touch on shortly. That is why I am glad that the Government have committed an extra £1 billion, in addition to the existing £2.5 billion that they have ring-fenced for adult and children’s social care. Why is that so important? Because adult social care and support enables people of all ages to live the lives that they want and deserve to lead. It helps people to maintain their own health, wellbeing and independence and, importantly, it reduces pressure on the NHS and the need for NHS services.

The Government launched the better care fund, which aims to join up the NHS and social care at local level, with almost £6.5 billion in 2019-20 and £2 billion pooled voluntarily last year to make sure that services are more joined up for patients. That joined-up approach at a local level is something I really believe in. If it is carried out in the right way, it can help to take some pressure away from the NHS and help to deliver a better service to local communities.

Although welcome, more money like that in the short term is not the ultimate answer. I have spoken many times in the House, including at Prime Minister questions, about the adult care Green Paper, so I welcome the pledges to get on with that and perhaps even move directly to a White Paper, informed by the work done in the joint report by the Housing, Communities and Local Government Committee and the Health and Social Care Committee. I was involved in that report and many of its recommendations are very worth while.

In line with my speaking about adult care and the importance of local government working with the NHS on overall outcomes for health, I have a recent example from my constituency that demonstrates the importance of the whole public sector taking a holistic approach to health. The left hand needs to know what the right hand is doing. Earlier this month in Northampton South, I met some truly inspirational parents, Jamie Shellard, Susan Underwood and Olivia Anderson, along with Councillor Julie Davenport. They had been fighting to secure local school transport for their children with special educational needs and health issues and disabilities. The scheme proposed by the county council wanted a pick-up and drop-off point for their children, but that would have meant that children who currently get picked up by many buses or taxis from their homes might instead have had to walk up to a mile to be picked up from unknown bus stops instead. That does not make any sense. It is an example of a disjointed approach when, as I say, it is more important for the left hand and the right hand to know what they are doing.

In addition to paying tribute to those inspirational parents and the tireless work that they have championed, let me explain why I have mentioned them. Their case underlines how, even in a single local authority with significant health responsibilities, there can be an inability to see at the bigger picture. It is good news that Northamptonshire County Council has now postponed that plan. I hope it will not come back at all. That case demonstrates how even highways and transport policies can have a direct impact on health and health services, which is why an integrated health and social care approach is important, and why we need all parts of local government and NHS services to work together in greater harmony, so that we can have the result we want for all our constituents who rely on those services.

Photo of Lisa Cameron Lisa Cameron Shadow SNP Spokesperson (Mental Health) 4:48 pm, 23rd October 2019

It is an absolute privilege to speak in this debate on the Queen’s Speech and the NHS. I basically committed most of my adult life to working in the NHS. I heard the poignant speeches from the hon. Members for Dudley South (Mike Wood) and for North Tyneside (Mary Glindon) regarding their very personal experiences. That goes to show that the NHS is part of us all—it is part of our families—and therefore we owe it a debt of gratitude. We owe it everything we have in terms of supporting it going forward.

I am pleased that, as the debate has progressed, it has seemed much more cross-party and consensual. When I worked in the NHS, I would have said that having it pelted about like a political football was no good. It might seem like something we can all banter about in this place, but for staff working in the NHS and watching it, it is very serious, and they want it and the issues to be taken seriously. I am therefore pleased that, as the debate has continued, we seem to be coming together on many issues and to be able to take them forward consensually.

I pay particular tribute to the staff who work in the NHS and to the staff who work in social care because that role is largely undervalued in today’s society. However, it is absolutely crucial. To be honest, the NHS just does not function without the integration with social care that we are trying to achieve. Fifteen minutes of care is not enough. This needs to be appropriately funded. I know that from personal experience, as a carer for my own grandmother. We had to bring her to live with us because we felt that the social care system left her feeling quite lonely; she had only certain episodes of care each day. She needed mental stimulation as well as practical physical care. So I hope the Government will consider those issues and make sure that we look at social care in a holistic way and that we look at people’s mental health and loneliness alongside their physical health needs, because 15 minutes of care, as it has been tagged, is certainly not enough.

I am delighted that mental health is a key focus. Had I been elected 20 years ago, when I started my career in the NHS—beyond that now, if I am honest—that would have been a closed door. We have come quite a long way in terms of mental health. There is a long way still to go but I am pleased that it has been prioritised. I ask that there is investment for child and adolescent mental health services. As awareness of the need grows, young people are coming forward, but they need to be seen and treated very quickly.

In particular, I want to ask the Minister about training in autism diagnosis for staff in CAMHS. It is not about providing new staff to CAMHS; it is about providing training for existing staff, so that there is no postcode lottery anywhere in the NHS. For a family with a young child reaching those developmental milestones or losing one or two developmental milestones, waiting for a diagnosis and adequate support is far too long a time to wait.

I pay tribute to the Thalidomide Campaign, which had its 60th anniversary event at Speaker’s House just last week. My constituent, Jerry Cleary, has battled for years for justice. I ask the Minister to consider meeting me, members of the campaign and Members who have constituents who are affected because they told me last week that they feel like the forgotten campaign—the forgotten tragedy—and that really cannot happen in today’s society.

Like other Members, I would like to mention medicinal cannabis. I have a tragic case in my constituency. Lisa Quarrell has a young son, Cole Thomson, who has now been prescribed medicinal cannabis, but they have to pay for this prescription at great cost. It will not be prescribed in the UK, so they are having to travel back and forward. Can she be included in the medical trials going forward? She came down to meet the Secretary of State and he promised that she would be included, yet she has not been. She needs to know what the outcome is and we really urge him to see this through.

I thank everyone who has taken part in the debate in a consensual way. I hope that we continue to build on that because, as I have said, the NHS is there for us all in our time of need. We must be there for the NHS.

Photo of Henry Smith Henry Smith Conservative, Crawley 4:53 pm, 23rd October 2019

It is a pleasure to follow Dr Cameron. This is indeed a very important debate. I am glad that we have had the opportunity to re-emphasise this Government’s commitment to the national health service, not least through record amounts of investment—an additional £33.9 billion is going in between now and 2024—and to discuss the emphasis on putting mental health on a par with physical health. I am delighted that schools in my constituency are part of a pilot in which mental health professionals are in schools to help young and adolescent pupils to deal with those sorts of issues.

I am glad that my right hon. Friend the Secretary of State for Health reconfirmed today—this cannot be emphasised enough—that the NHS is off the negotiating table when it comes to the post-Brexit international trade deals, and that it will remain free at the point of use, regardless of people’s ability to pay.

Let me re-emphasise that this Government’s record on the NHS is a good one, but sadly it has not always been under previous Labour Governments. The A&E and maternity units at Crawley Hospital in my constituency closed last decade. Services have now started to return, including a 24/7 urgent treatment centre, a new ward, new beds and primary care services. Mention was made of the NHS being a political football, but it is worth stating that all parties in this House can do better when it comes to supporting our health service.

On my right hon. Friend the Prime Minister’s first full day in office, I was pleased to seek a commitment for better support for primary care. One challenge in my constituency is that some GP practices are at or even over capacity for a number of reasons, including increased housing in the area and some doctors retiring early. We need to address this issue, particularly as more and more services—such as scans and minor surgery—are provided in GP surgeries, which is better for the patient experience.

I am standing down as chair of the all-party parliamentary group on heart and circulatory diseases, but I am glad that we were able to publish a report on artificial intelligence in the healthcare sector earlier this year. It is a crucial issue that I know the Department of Health takes very seriously, so I was delighted that the Health Secretary attended the launch of the report.

I am pleased to say that I have just been reappointed as chair of the all-party parliamentary group on blood cancer. I very much support the Government’s commitment, in the long-term plan for the NHS, to ensure that 75% of cancers are diagnosed at stages 1 and 2 by 2028. But blood cancer is different from solid tumour cancers, and is much more difficult to detect. I therefore put in a plea and a bid for the diagnosis of blood cancer to be considered. Blood cancer is the country’s fifth most common and it is the third biggest cancer killer in the UK, but because of the vagueness of symptoms it is often very difficult to detect in GP surgeries. Indeed, some 28% of people with a blood cancer are first diagnosed when they present at an accident and emergency department, so it is an area that needs a lot more focus.

In the brief time I have left to speak, let me touch on the importance of developing policy on children’s social care. Regrettably, West Sussex County Council, which covers children’s social care in my constituency, has been judged very poorly in this area and a lot of remedial work needs to be done. As with adult social care, the issue of children’s social care urgently needs to be addressed. It is often treated as the poor relation to healthcare, so it is very important that we place emphasis on the importance of better supporting social care when we talk about the NHS.

I urge the House to reject the amendment because I do not want to see the nationalisation of the production of medicines, which the Health Secretary mentioned earlier. In the context of blood cancer, that would mean that innovative CAR T-cell therapy would not be available.

Photo of Tim Farron Tim Farron Liberal Democrat Lords Spokesperson (Communities and Local Government), Liberal Democrat Spokesperson (Work and Pensions), Liberal Democrat Spokesperson (Housing, Communities and Local Government), Liberal Democrat Spokesperson (North of England) (Northern Powerhouse) 4:58 pm, 23rd October 2019

It is an honour to follow Henry Smith, who made some excellent points. I am not alone in this debate in wanting to peddle a manifesto, but in my case it is the manifesto of the all-party parliamentary group on radiotherapy, which I hope I can encourage Members of all parties to take very seriously. Fifty per cent. of people with cancer—which we have already established is going to be half of us at some point during our lives—need radiotherapy, yet only 5% of the cancer budget is spent on radiotherapy. As the hon. Gentleman mentioned, the NHS long-term plan rightly identifies the need to diagnose more cancers earlier. Early diagnosis is massively important. The United Kingdom stands below average among European countries for cancer survival for nine out of 10 cancers, and has the second-worst survival rate in Europe for lung cancer. Only in September, The Lancet demonstrated that we have the worst survival rate for cancers across a range of comparable countries.

Poor survival rates are, in part, down to late diagnosis, but they also are down to poor access. The increase in early diagnosis that I hope will result from the NHS long-term plan’s success will of course increase demand for radiotherapy. There is no provision within the NHS long-term plan to provide that radiotherapy to deal with the extra demand that ought to be created if it is successful.

Radiotherapy is used for curative purposes eight times more than chemotherapy, yet, as I said, it gets only a fraction of the investment. The all-party group discovered during our inquiry that 20,000 people in the United Kingdom who would benefit from radiotherapy treatment are not getting it, and nor are 24% of people living with stage 1 lung cancer. That is largely down to poor geographical access to radiotherapy treatment. Despite the fact that all 52 cancer centres in England are enabled for precise SABR—stereotactic ablative radiotherapy—technology, only 25 of them are commissioned to deliver it. That means that 27 of the cancer centres in England using the tariff are being rewarded for using less effective radiotherapy and penalised for using more effective radiotherapy. Fixing that would be free, by the way, but for months and months NHS England has been refusing to deal with it.

The all-party group found that, when new satellite centres from existing large cancer centres are built, there is an average 20% increase in demand for them. That proves that there is unmet demand in our communities for radiotherapy. People live too far from the radiotherapy centre. I therefore ask Ministers to consider our local proposal in South Lakes for a satellite centre at Westmorland General Hospital in Kendal. We have been campaigning for that for many years. We have an excellent cancer treatment centre at the Rosemere centre in Preston. There is nothing wrong with the Rosemere centre whatsoever; it treated my dear late mother. The only problem is that it is too flipping far away for those of us who live in the Lake district and the Yorkshire dales.

I accompanied a young woman called Kate on one of her many trips to Preston to get treatment. It was a three-hour round trip, and she lives at the south end of my constituency. Only last week, I went to a prostate pals meeting in a pub in Kendal, where there were several men who are making four-hour round trips every day for six weeks, which is often debilitating financially as well as physically. That is why we desperately need that cancer centre at Westmorland General Hospital in Kendal, linked to the Rosemere satellite. Longer journeys mean that people have shorter lives. An older lady called Liz diagnosed with skin cancer told me, again not very long ago, that she was choosing to decline the radiotherapy treatment that had been recommended by her oncologist. Why? Because of her age, she just could not cope with the journey. So Liz made the conscious choice to have a shorter life because the journey that she would have to take to get the treatment was too long.

Will the Minister accept the radiotherapy manifesto in full to enact all the things that are set out within it, as agreed cross-party? I am bound to ask, on behalf of the people of my communities in South Lakes, that we invest now to end the long, long wait for people to have a radiotherapy satellite unit at our hospital, the Westmorland General in Kendal.

Photo of Lucy Allan Lucy Allan Conservative, Telford 5:03 pm, 23rd October 2019

It is a privilege to speak in this debate. I particularly want to pay tribute to Dr Cameron, because if we could all speak about this issue in the way that she did, we would have a much more constructive and productive debate.

We have spent so long in this place listening to the same people talking about Brexit, dominating the agenda and crowding out those of us who want to speak for our constituents on other issues, so I am delighted that today we are discussing the Queen’s Speech and the NHS.

Unlike Stephen Hammond, who forgot that he had put in to speak in today’s debate, I have long been anticipating this opportunity and writing long speeches that will not get heard today, but I know I will have an opportunity on other occasions. I want to speak about the fears and concerns of the people of Telford. For the last six years there has been an ongoing debate about the future of our A&E and our women and children’s unit. I accept that this issue is not of the Secretary of State’s making and that a revolving door of senior executives has set the agenda. I am glad to see that the Secretary of State is trying to help out on this issue and that discussions are ongoing about keeping our A&E in Telford. I am grateful for his efforts.

In the blizzard that is Brexit, it has inevitably been impossible for senior Cabinet Ministers to properly focus on the day job. Mistakes will happen, and I think that this is one such case. This summer, we watched with mounting excitement as the new Prime Minister set out an energising domestic agenda with the NHS at its heart. We heard about his genuine desire to tackle the concerns of leave-voting, left-behind communities and their sense of being ignored. In August, as plans were unveiled for 20 hospital upgrades and 40 hospital new builds, we saw genuinely touching videos of the Prime Minister visiting hospitals across the country, from Boston to Harlow. There was something moving about the way he acknowledged the sense of identity that people have when talking about the NHS—the sacred promise between the people and the state—and talked about levelling up.

As summer rolled into autumn, on 2 October, just 70 days into the new Prime Minister’s premiership, he stood on the stage at our conference in Manchester and made a brilliant and inspiring speech. I heard him speak of his clear understanding that opportunity is not being evenly distributed and that it is the job of Government to unlock potential, level up, narrow inequality and deliver on the priorities of the people. He spoke about his mother, who taught him about the equal dignity and equal worth of every human being, and said that the NHS sums up that idea, because it does not matter who we are or where we come from; the NHS is there for us. My spirits were lifted by that vision, which my constituents would inherit under the new Conservative Government.

The Health Secretary was sitting in the front row watching that speech, and he too was surely moved by what he heard. But within hours, he was back in his office in London and, with a stroke of his pen, he was signing his approval for a scheme that we in Telford have been fighting for the last six years. As is the way with these things, it was the outpouring of rage on social media that reached me first. It seemed that the Secretary of State had approved a decision that would see Telford lose its A&E and women and children’s centre.

I know that the Secretary of State wanted to get this right for Telford; he told me so. He knew how important that centre was for our community, because he had visited, yet when that decision was made, there was no press release, no announcement and no briefing for MPs. There was no attempt to justify to my community why this was good for them. What member of Government makes a difficult decision that undermines the credibility of the central plank of the Government’s domestic agenda on the very same day that the Prime Minister sets it out?

I understand that, in this crazy environment, mistakes are made, and it takes a little humility and bravery to admit when they have been made. It is not enough to wear the badge, echo the platitudes, stand on a stage and say, “I love the NHS”. The Secretary of State needs to show that he cares about the people who use the NHS, no matter where they come from. In this case, it seems that the people of Telford were forgotten. This is a great Queen’s Speech, but it must not just be words. We have to mean it if we are to be the party of the NHS, and there is work to do in Telford to demonstrate that that is the case.

Photo of Eleanor Smith Eleanor Smith Labour, Wolverhampton South West 5:08 pm, 23rd October 2019

I am pleased to follow the amazing speech from Lucy Allan. In the Queen’s Speech, the Government did not mention the long-awaited social care Green Paper or lay down any plans for how they would tackle the social care crisis. Instead, they simply said that they would

“bring forward proposals to reform adult social care in England to ensure dignity in old age”, failing to mention working-age adults, people with mental illness and carers, who also rely on care. Everyone in this House knows that the current social care system is in crisis. It faces serious challenges as more people need care, but chronic underfunding means that fewer people receive it, and for those who need it, every day is a struggle.

Recently, the Care & Support Alliance conducted a survey of more than 3,000 people with social care needs. It found that one in five respondents went without meals due to lack of care and support; one in four struggled without basic support to do things such as get out of bed in the morning, get dressed or go to the toilet; and more than one in three felt lonely and isolated because of the lack of care and support.

Social care plays an important part in managing hospital admissions for people with mental illness. According to the independent review of the Mental Health Act 1983, around half of all delayed discharges from mental health wards are the result of difficulties in securing appropriate housing and care packages.

Photo of Jim Shannon Jim Shannon Shadow DUP Spokesperson (Human Rights), Shadow DUP Spokesperson (Health)

I wonder whether the hon. Lady is aware of the figures that I have received. Some 850,000 children and young people have a clinically significant mental health problem; one in 10 children between the ages of five and 16—three in every classroom—has a diagnosable mental health problem; and 75% of mental health trusts do not have enough in their budget to look after them. Does she agree that in his response the Minister should deal with the massive issue of children’s mental health? It needs to be addressed.

Photo of Eleanor Smith Eleanor Smith Labour, Wolverhampton South West

I do agree with that. The Royal College of Psychiatrists would back up the hon. Gentleman as well.

Organisations such as the Royal College of Psychiatrists have said that the ambition in the long-term plan to reduce the length of stay in adult acute in-patient mental health settings cannot be achieved without improved social care.

It is important to acknowledge the role of carers in supporting people with social care needs. Their own mental health can be at stake due to the pressure, the lack of support and the lack of information. According to a report by Rethink Mental Illness, only one in four carers—23%—feels well informed and respected as a partner in care. A similar proportion, 24%, receive no carer’s assessment, despite it being mandated under the Care Act 2014.

When the social care of patients is not met, not only does their independence suffer; so too does their health, which has a detrimental effect on the NHS. If the NHS is to deliver the ambitions of the long-term plan, a stable and effective social care system is needed. That is why we need to join up services from home to hospital and have a properly integrated NHS and social care service. It is a fact that if the integration of health and social care services did take place, more would be achieved and money would be saved, as the resources would be used jointly. That would ease the access and workforce pressures that continue to present significant challenges across all care sectors.

If the Government really want to tackle this crisis, they must reinstate the levels of access to care that we had before 2010 under the last Labour Administration.

Photo of Neil O'Brien Neil O'Brien Conservative, Harborough 5:15 pm, 23rd October 2019

I thank Ministers and everybody at University Hospitals of Leicester for the role they played in securing the fantastic £450 million investment in our local hospitals that was announced the other day. I also thank Ministers for the role they have played in today’s announcement that there will be a new £46 million investment in an urgent care hub at Kettering General. That means that constituents at both ends of my constituency will benefit from huge new investments. I am incredibly grateful.

Those are not the only pieces of good news my constituency has had recently. We have the gleaming new treatment centre at St Luke’s in Market Harborough. We have had the wonderful news that we will be keeping the world-leading children’s heart unit at Glenfield—a service that is not just brilliant for everybody in this country, but through the charity Healing Little Hearts provides help for people across the entire world. We also have the futuristic new A&E at Leicester Royal Infirmary. Those things are all great, but the investment we are about to receive will be even more transformational.

The Secretary of State came to the Royal Infirmary the other day. As we walked around, we heard about both the challenges and the opportunities that we have locally. We saw the difficulty of working in maternity when it is split across two sites. When my son was born just two weeks ago, I saw how having two different sites meant that the staff had to work all day without breaks to fit us in. Their lives and patients’ lives will be much better when we have a single new maternity hospital. As we walked around with the Secretary of State, we saw the brilliance of our intensive care staff, but we also saw that they were working in fundamentally out-of-date facilities. We saw the brilliant work that the A&E team were doing, particularly in enhancing data to improve services, but we also saw the incredible growth in demand for those services.

The investment we are about to get means a new maternity hospital, a new children’s hospital, two super-intensive care units with 100 beds in total and a planned new major treatment centre at Glenfield Hospital, as well as modernised wards, new operating theatres, new imaging facilities and, brilliantly, new additional car parking. Anybody who has ever tried to park at Leicester Royal Infirmary will realise that that is a huge boon. These local improvements are part of a wider series of improvements we are making across the NHS. It is great that we now have a long-term plan for the NHS, with a long-term budget for the NHS that allows NHS managers and staff to plan for the future.

Photo of Jim Shannon Jim Shannon Shadow DUP Spokesperson (Human Rights), Shadow DUP Spokesperson (Health)

I very much welcome the Government’s commitment and the money they have set aside, but is the hon. Gentleman aware that 16 million people in England live with the pain of a musculoskeletal condition? How will the Government ensure that people with arthritis are able to access the interventions that need to be in place—from joint replacement operations to physiotherapy—in a timely fashion? I think there is an opportunity to address those issues. I have the same problems in my constituency, but it is a devolved matter. I have been made aware of this issue in England. Does he agree that it is time for that?

Photo of Neil O'Brien Neil O'Brien Conservative, Harborough

The hon. Gentleman raises an important point, and I was about to come on to it. It is great that we are making record investment in services such as mental health and spending more than we did before. It is great that we are introducing new targets, such as basic standards for help with eating disorders. It is great that we have more doctors, more nurses and more money. However, we are conscious, as we speak to people in the NHS, that unless we can deal with the sources of demand, fundamentally we will never be able to spend enough on all the priorities, including musculoskeletal services.

What do we need to tackle those causes of demand? We of course need the long-term plan for social care. The Minister needs to stick to his guns on public health: the sugar tax has worked. Things like the campaign against the anti-vaxxers and their pseudo-science are incredibly important, as is action on preventive social care. We should keep going with things such as the migrant health charge, which is raising money for the NHS; we could increase it. We should keep going on technology. It is so important for Ministers to help GPs to upgrade their telephone triage facilities, which would make the experience of using primary care so much better and reduce the burden.

Some of the things in the Queen’s Speech are incredibly important to help deal with these growing burdens. We need new technologies, which is why it is important to get more clinical trials going more quickly. That is why I welcome the measures in the Queen’s Speech. This is about building on the life sciences review—the Bell review—and it is very important to build on the work that the academic health science networks are doing. The potential advantage of our NHS is that it should be one of the best places in the world to do clinical trials—we have the scale—but at the moment there are too many gatekeepers and too many things stopping them.

Last but not least, there is the wonderful improvement in the NHS safety body that we are creating. From personal experience, I can say that when my daughter was born some things went wrong. We had a wonderful junior registrar who did lots of things right, but a few things went wrong, and my wife gave birth without anaesthetic. After that, unfortunately, her placenta did not deliver and the consultant—we never found out who this was—removed the placenta manually with no anaesthetic, and it was incredibly painful for my wife.

It is important, as my hon. Friend Sir Bernard Jenkin said, that we learn lessons in the NHS without attributing blame. Not attributing blame was one of the fundamental recommendations following the Mid Staffs inquiry: we have got to be able to learn lessons. When we started to complain about what happened to my wife, people closed ranks. My wife is a doctor, and we would never in a million years have sued the NHS, but they did not know that. We never even found out who the consultant was who had got things wrong, so I do not know whether the lessons were learned from that mistake; I hope they were.

Having a no-blame culture, having this new body and learning from the experiences of painful things such as the Bawa-Garba case are the ways in which we can have truth and reconciliation, with a system that learns. One of the most important things we could ever do to improve the NHS is to make it a self-improving system that is constantly learning and constantly getting better.

Photo of Chi Onwurah Chi Onwurah Shadow Minister (Department for Business, Energy and Industrial Strategy) (Industrial Strategy) 5:19 pm, 23rd October 2019

I start by thanking all the NHS workers, wherever in the world they come from, who do such fantastic work for the health and wellbeing of my constituents in Newcastle. I reiterate all that has been said about the devastating impact that any Brexit, but particularly a no-deal or a hard-right Brexit, will have on the NHS and on our European Union brothers and sisters who work in the NHS in Newcastle and across the country.

The labour movement fought for the NHS because working people understand the terrible consequences of ill health for those without means. Just as, under this Government, the gig economy is bringing back types of job insecurity that we thought the labour movement had banished from modern society, so this Government’s back-door privatisation is undermining our NHS. My hon. Friend Jonathan Ashworth emphasised how that is driven by a right-wing ideology, and I want to highlight a particular area in which it is particularly obvious: the requirement for competition in primary care, and particularly for GP surgeries in poorer areas.

There has been a rise in poverty under this Government, and with poverty comes increased health problems. GPs working in areas with higher levels of deprivation have higher workloads and patients with more complex needs. GPs are choosing to work elsewhere because of the lack of support offered by the Government, which exacerbates vicious cycles of health inequality.

There are requirements for competition on GP contracts, even when no one is willing to compete. This means contracts are returned early, after two or three years, and my constituents do not have the continuity of high-quality care they deserve. The Government are requiring competition, even where the private sector cannot make enough profit to be interested in competing.

I also highlight the growing health inequalities that mean there is less access to healthcare in more socioeconomically deprived areas. In Newcastle, for example, we have cervical screening rates of 85% in Gosforth, a wealthier area, and of only 23% in Westgate, one of the poorer areas.

The north-east has the highest level of epilepsy in the country, with poorer people more likely to die from epilepsy. As today is Sudden Unexpected Death in Epilepsy Action Day, I want to highlight the work of SUDEP Action in combating rates of epilepsy. Higher health inequalities under this Government mean that more people are dying and suffering unnecessarily.

Briefly, on the privatisation of NHS data, I understand that the Office for Life Sciences is currently assessing the value of NHS data as part of the life sciences industrial strategy. The absence of a regulatory framework to give patients control over their own data leaves it open to being sold off as part of a future trade deal, which the public are completely against. The fact that the Department of Health and Social Care did not take up the great north care record, which was an opt-in rather than an opt-out record, means these dangers are all too obvious.

I finish with two areas that, in themselves, deserve hours of debate: mental health and social care. Mental health, particularly for young people, is a rising issue in Newcastle. It is raised with me by police, schools and housing, and we have yet to see real parity of esteem.

Photo of David Simpson David Simpson Shadow DUP Spokesperson (Environment, Food and Rural Affairs), Shadow DUP Spokesperson (Business, Energy and Industrial Strategy)

It is devolved in Northern Ireland but, across the United Kingdom we need more trained mental health nurses, especially for young people. The figures are startling: just over 10,000 young people in the United Kingdom under the age of 10 are manic depressive.

Photo of Chi Onwurah Chi Onwurah Shadow Minister (Department for Business, Energy and Industrial Strategy) (Industrial Strategy)

That is why mental health is consistently raised with me by youth groups and youth organisations, and why the cuts to mental health provision, particularly mental health nurses, are especially regrettable. We need much greater choice and autonomy in mental health services, so that they are designed with users in mind and by users.

Until the Government realise that high-quality social care given by properly paid professionals is not a cost bucket but an enabler of a more equal economy and a fairer society, I fear I will continue to see constituents’ friends and families having to face devastating choices because their loved ones are deprived of the dignity they deserve in old age by the lack of a fair and consistent social care policy in this country.

Several hon. Members:

rose—

Photo of Rosie Winterton Rosie Winterton Deputy Speaker (Second Deputy Chairman of Ways and Means)

Order. I have good news. Because some colleagues have indicated that they will not attend the debate, I can put the time limit back up to six minutes.

Photo of Andrew Selous Andrew Selous Conservative, South West Bedfordshire 5:26 pm, 23rd October 2019

Thank you very much indeed, Madam Deputy Speaker. Although I wish the House were completing the necessary Brexit legislation today, it is always a particular pleasure and, indeed, a responsibility to speak on the important subject of the NHS.

I, too, start by thanking every member of NHS staff —including two members of my own family—for what they do. The pressures on them are unrelenting, day in, day out, as all of us in this House must acknowledge. I, too, have a personal reason to be grateful to the NHS: when I was 24, I had a haemopneumothorax in the middle of the night, and the NHS saved my life with an emergency operation carried out in the hospital just over the river. Had it not been for the brilliant care I got some 30 years ago, I would not be here today making this speech.

When I met a number of presidents of royal colleges last month, they told me that they thought we needed to double the number of medical students in training. It is brilliant news that we recently increased their number by a quarter, but the ongoing NHS people review shows that demand is such that a doubling is needed. Another area we need to consider is highlighted by evidence that one to three hours a day of a doctor’s work could be done by non-clinical healthcare staff. Are we using our staff as effectively and appropriately as possible? I am worried by how many medical students we lose: having trained in this country at public expense, too many then go off to Australia, Dubai or elsewhere. Are there perverse incentives in the system? Where is the value for money for the taxpayer?

I hear from staff that sometimes they work with computers that take half an hour to warm up. Yes, we want to get rid of the fax machines and to use the latest technology, but computers that are just turned on and then work are vital for NHS staff under pressure. We need to put more nurses into care homes to curb inappropriate calls on accident and emergency services for residents. We need to make sure there are enough practice nurse courses in rural areas, where there are gaps that lead to poaching. Perhaps we could use the apprenticeship route.

I understand that 27% of medical school students who graduate go into general practice, yet the Royal College of General Practitioners says the percentage needs to be nearer 50% to meet the acute need for doctors in GP practices up and down the country. There is also great variation in the proportion of medical school students who go into general practice. We need to learn how to increase the proportion going into general practice, so acute is the need. I am also concerned that we do not have a proper career path for associate specialists, particularly in surgery, in our hospitals. They are valuable members of staff, but they can drift around the system a bit, and I understand that about 20% of them are leaving. We need to look after them better and plan for them more appropriately.

We need to link our health visitors more closely with the new primary care networks. Health visitors do invaluable work, but their national child measurement data is not transferred to GPs. That leads to problems and to childhood obesity not being tackled. As co-chair of the all-party group on obesity, it is great that we have chapter three of the childhood obesity plan, but I would just remind the Minister that the actions from chapter two, on watershed promotions and point of sale, have not yet been implemented. We need them to be implemented.

We also have a very bizarre issue in that the equality and outcomes framework does not cover children’s weight. In fact, it specifically excludes it—it covers only adults. Come on! We need to vary the contract to make sure it measures children’s weight.

We must do better on foetal alcohol syndrome disorder. It needs to be included in personal, social, health and economic education, and we need a massive public campaign. I am awaiting a letter back from the Secretary of State on that. It is a huge and growing issue that we do not talk about enough in this House.

We live in an obesogenic polluted environment, with unacceptably low levels of active travel. We need to design the healthy environments of the future if we are to relieve the NHS of the pressures that are otherwise going to overwhelm it.

We also need to be aware of the opportunities that NHS staff have to spot incidents of modern slavery. I would like to commend a very alert healthcare worker who last week, on the eve of Anti-Slavery Day, spotted the first victim of modern slavery in her hospital. She was alert to the symptoms and had done the training. NHS staff have a unique opportunity to bear down on modern slavery, and that is so important.

I was staggered to hear from the Scottish National party’s spokesman that the taxpayer is paying out £80 billion for £30 billion-worth of hospitals.

Photo of Andrew Selous Andrew Selous Conservative, South West Bedfordshire

It is even worse, then. Some trusts are paying up to 16% of their income on PFI payments. We really must learn from that and do much better.

Photo of Alex Norris Alex Norris Labour/Co-operative, Nottingham North 5:32 pm, 23rd October 2019

It is a pleasure to follow Andrew Selous, whose personal leadership on tackling modern slavery is something we very much appreciate in this place. We may well have seen a reminder today of why that is more necessary than ever.

I made my maiden speech in a Queen’s Speech debate. Google tells me it was 848 days ago, which feels very strange. It simultaneously feels like a lifetime ago and like yesterday. These have been very strange and tumultuous times. If I had been told then about things that have happened subsequently, I would have been sceptical, but no more sceptical than at the idea that we would still not have a social care Green Paper. We have had five delays and, despite it not being a laughing matter at all, it has become a long-running joke and a focus of derision.

The ever-delayed social care Green Paper is absolutely critical, because we know that up and down the country millions of people, paid and unpaid carers, are getting up in the dark, coming home from work in the dark, working split shifts and double shifts, and working for poor pay on insecure contracts. They are the backbone of not only the social care system, but the NHS and all public services. If only 10% of our social carers, whether paid or unpaid, walked away tomorrow, all our public services would come to a grinding halt. We need to do much, much better by them. I hope the Government, in showing movement on this issue, intend to bring forward their plans quickly.

In its latest annual assessment, the CQC highlighted concerns about cultural and geographic barriers to access to care, deficient regional staffing, a lack of stability in the adult social care market, and the Government’s failure to implement a sustainable long-term plan to fund social care. It said that that directly impacts nearly 1.4 million older people and millions of people with disabilities or illness who do not have access to the care and support they need. It is time for us to act.

The Government need to be brave and honest. If they are worried about the reaction of current service users to their proposals, I would remind them that the current service users have lived experience of the fact that the current system does not work, so they have no need to be afraid of them when it comes to change. When it comes to millennials like me, we are realistic. We know that the system that cares for our grandparents and our parents will not be the same for us. Let us be honest about that. There are profound and difficult decisions that have to be taken—let us get to that point. We do not need to be afraid.

I know that the Minister for Health, Edward Argar is a good and honest man, but when it comes to funding for social care—this is a really important point—we always see the Secretary of State or the Prime Minister use phrases such as, “We have given access to an extra £11 billion”. The Government should be honest about where that money comes from, because the bulk of it is from a social care precept on the local ratepayer. There is a political argument—I disagree with it fundamentally—that says, “Well, the Government believe that there should be a transition of the burden for social care from the national taxpayer to the local taxpayer”. I disagree, but if that is the belief on funding the social care system, the Government ought to say so, because that is very important.

Similarly, I know that this is a health debate, but I will not miss the opportunity to say that we must all reflect for a moment on the BBC and the removal of the free TV licence. As part of someone’s care, and as part of someone’s life in their 70s and beyond, we know that television plays an important part. We should be honest about why this has happened because that cut lands at the door of the Government, despite what they might say.

We know that failures in social care have a profound impact not only on the individual, but on the national health service. I have a real passion for integrated care—I cannot quite see the shadow Secretary of State from where I am standing, but when I was his Parliamentary Private Secretary, I used to bore him at great length about the virtues of integrated social care. When I was health and social care lead in Nottingham for three years, it was by far the least popular thing I did and I had campaign groups at my door weekly talking about my enthusiasm for certain models. There were flaws in the models for sustainability and transformation plans, accountable care organisations and accountable care systems—whatever re-branding we are on at that moment —but, fundamentally, integrating the national health service with our local authority social care is a very good thing and, if we did it properly, it would lead to people not having to ring up multiple agencies to sort out their loved one’s care. It would lead to proper, seamless care that, rather than being based around organisations, would be based around individuals. Again, I say: Ed, let’s be bold on integrated care. Let’s be brave —[Interruption.] Madam Deputy Speaker wasn’t concentrating, I got away with it. Let’s be bold about this. If you are, you will see the best of politics working and a lot of consensus building.

I want to use the limited time available to me to refer to public health. I am proud of what I said on integrated health and what we did in Nottingham—we did good things. One area from my time in local government that I reflect on without pride is public health. We did good things on trying to be more innovative with the public health grant, but fundamentally, because of the nature of the cuts that have come down the line over the last nine years, we made cuts to public health services. I made cuts to smoking cessation services—a terrible public policy decision—because there simply was not enough money.

Photo of Norman Lamb Norman Lamb Chair, Science and Technology Committee (Commons)

Is the hon. Gentleman aware of the Health and Social Care Committee report today that highlights the fact that there has been a 30% cut in funding for drug treatment services over just the last three years, which is catastrophic for the people involved?

Photo of Alex Norris Alex Norris Labour/Co-operative, Nottingham North

Having had a long four-and-a-bit hour vigil in the Chamber, I have not had chance to see that, but I certainly will. That is the picture up and down the country, including in Nottingham. The key thing is that as well as being absolutely dreadful for the individuals affected, it is terrible for the system not to have those good, often early, interventions on drugs and alcohol. If we let those things spiral, the impact on the individual and the costs related to the system grow exponentially. These are really bad value choices and we could do much better on public health.

I will finish with a point about cannabis on prescription. We have had important conversations on this today, and it is good that both Sir Mike Penning and my hon. Friend Tonia Antoniazzi are here. Their leadership on this has been absolutely crucial. I heeded what the right hon. Gentleman said about how to describe it, and I changed my speech from saying “medicinal cannabis” to “cannabis on prescription” as a result. I have had a case in my constituency, as many have, with a very, very frustrated parent who could not understand why their child did not fit the criteria.

Photo of Mike Penning Mike Penning Conservative, Hemel Hempstead

The hon. Gentleman is making a really important point, and I thank him for changing his speech slightly. The reason why it is so important is that we need the observational trials. We need to know about the THCs and the chemicals that come from the cannabis oil; we need to know the strengths and what it is. That is why talking about the prescribed medical use of cannabis oil is crucial when we make this argument; otherwise, we will lose the public will.

Photo of Alex Norris Alex Norris Labour/Co-operative, Nottingham North

I am grateful to the right hon. Gentleman for improving the quality of my speech by adding that to it. I am very confident about this matter, and this afternoon has only increased my confidence. He will have heard the shadow Secretary of State say that if primary legislation is needed—

Photo of Alex Norris Alex Norris Labour/Co-operative, Nottingham North

Clearly not. Whether it is regulations, or whatever, we are very capable in this place of having a grown-up conversation on this and finding a solution. That is what my constituent and her mother are desperate for us to do.

We are very grateful in Nottingham for our excellent health and social care staff. They do an incredible job, keeping our communities going and bringing hope and enjoyment of life to many people struggling with profound challenges, but they want us to do better. The social care Green Paper would be a good chance to do that, and I hope we can do it quickly. Integrated health and social care promises many virtues. We just need to get around the table and have a proper conversation about it. I hope we can do that.

Photo of Mark Pritchard Mark Pritchard Conservative, The Wrekin 5:40 pm, 23rd October 2019

I don’t know about you, Madam Deputy Speaker, but I am delighted that the age of austerity is over. We have heard from the Government today a commitment to record investment in the NHS. In my political lifetime, I cannot think of any Government of any political colour that was so committed to the NHS or a Prime Minister and Secretary of State similarly committed. And of course that must come on the back of a strong economy, not the magic money tree we hear about so often in politics.

I am also delighted that we are talking about something other than Brexit. I hope that we can get the withdrawal agreement and Bill through so that we can pass the Queen’s Speech and legislate to make sure that these improvements to the NHS actually take place.

I want to go local for a moment and thank the Minister and all the team at the Department for ensuring that Shropshire and the borough of Telford and Wrekin have not lost out in this record investment in the NHS. In fact, in Shropshire we are seeing the largest investment in the NHS in its 70-year history: £312 million. That is fantastic news. What does it mean locally? For my constituents, it means that most of the planned surgery—the majority—will take place at the Princess Royal University Hospital in Telford. My constituents will no longer have to take a journey to Shrewsbury for the majority of their visits to their local hospital trust. That is good news.

There is a debate about the accident and emergency award, but I am delighted that today we have heard from the Secretary of State that the A&E has been saved at the hospital in Telford. In fact, it will be the very latest in modern thinking on how A&E services are provided, under the banner of “A&E local”. Of course, some cynics say, “Maybe that’s ‘A&E lite’”. Well, it will not be as long as I and my hon. Friend Lucy Allan are on the case, working in tandem for local people to ensure that we have an A&E that provides what local people need.

I am glad that the Secretary of State, in releasing the £312 million to Shropshire and the borough of Telford and Wrekin, said it was conditional upon the A&E at the Princess Royal University Hospital being adequately run and sufficiently resourced, with the right staffing levels and expertise and with the clinical and medical cover it requires to service the people of Telford and Wrekin. I and, more importantly, my constituents welcome that commitment.

I am also delighted that new services will be coming into the hospital. There is a lot of doom and gloom in some parts of the local media in Shropshire, which one would expect from Opposition voices in other parties, but the good news is that we are going to see a new cancer unit; the good news is that we are going to see a new MRI scanner; the good news is that we are going to see an extra £7 million spent on a completely modernised radiology service; the good news is that we have just recruited 180 nurses to the trust; the good news, further to that other good news, is that we have now recruited 17 extra A&E doctors to the trust.

May I digress for a moment and raise the issue of recruitment, which overlaps with that of social care? I hope that the Ministers will work closely with Home Office Ministers on the points-based migration system to ensure that we attract not just highly skilled doctors from around the world, but others with fewer qualifications and skills— whether it be from India, the Philippines, or other Commonwealth and non-Commonwealth countries —so that we can provide that expanded social care service. Indeed, I hope that we will continue to retain and recruit the very best from the European Union, when we cannot recruit domestically.

Many positive developments are resulting from the Future Fit programme in Shropshire. Let me also say briefly that I am delighted by the Secretary of State’s announcement today of the immediate provision of an additional £400 million, which will enable us to expand our women and children’s unit and ensure that we have a high-quality, modernised, midwife-led unit. That is good news as well.

Finally, let me issue an appeal to Ministers on the subject of mental health, which I raised earlier today. Can we ensure that veterans who are leaving the military and making the transition into civilian life have a pathway of care?

Photo of Mike Penning Mike Penning Conservative, Hemel Hempstead

My hon. Friend has touched on an issue that I did not have time to raise because of the time limits which, understandably, have been imposed. The danger of putting ex-military personnel into one box is that, as I mentioned earlier, some will react almost immediately to what they have seen and done, while it will take others years and years. I have close friends who fought in the Falklands war and who are only now being diagnosed with post-traumatic stress. It is important that in local communities around the country, and particularly in The Wrekin, the NHS understands the mental health needs of those who may have served in the armed forces many years ago

Photo of Mark Pritchard Mark Pritchard Conservative, The Wrekin

My right hon. Friend is absolutely right to underline that. He has served in the armed forces himself, and has been a shadow Health Minister and a Minister in many other Departments. I also think that serving doctors should be given more encouragement to go into the reserves to help to stop this problem. As my right hon. Friend says, if post-traumatic stress is not dealt with by means of early intervention, it can turn into the much more difficult and complex condition of post-traumatic stress disorder.

I am sure that my right hon. Friend will, like me and like other Members on both sides of the House, pay tribute to Combat Stress, which has a unit in my constituency and which does a great job, and to Help for Heroes, whose current campaign is intended to ensure that people who are leaving the military under medical discharge with mental health conditions in particular, but with other conditions as well, have the pathway of care that I mentioned through local NHS trusts in all our constituencies.

This is good news for Shropshire. There are still some battles with the Minister ahead, and I will fight those battles with my hon. Friend the Member for Telford, but overall, this is good news.

Photo of Mike Hill Mike Hill Labour, Hartlepool 5:47 pm, 23rd October 2019

It is an honour to follow Mark Pritchard. Let me begin by praising all the healthcare workers employed by the NHS and in social care for the work that they do—including my own daughter-in-law, who recently qualified as a nurse. In the face of austerity, in difficult and arduous circumstances, with diminishing resources and never-ending cuts, they have worked tirelessly to provide the best healthcare outcomes for the people of my constituency.

As a Labour MP, I am proud to say that the best traditions of our NHS, established by a Labour Government, are alive and kicking in Hartlepool: alive because the people of the town, together with healthcare workers, campaigners and the trade unions, have kept public health and NHS provision high on the agenda, fighting to keep our local hospital, demanding improvements in GP services and protesting against attempts to water down NHS and public health provision throughout the town, and kicking because they have been swimming against the tide for far too long, with wave after wave of cuts hitting them squarely in the face and threatening to drag them under. The people of Hartlepool will have none of that.

We lost our A&E in 2010, and we have stood our ground ever since. The plan was to build housing on hospital grounds; the people said no. The plan was to run our maternity unit down; the people said no. The people stood strong and said: “Our children should have the right to be born and registered as such in their own town.” They are fiercely protective of their NHS and rightly so.

What can the people expect from the Queen’s Speech? Is it the return of A&E to Hartlepool hospital? Not a cat in hell’s chance. Will it give more money to invest and improve our hospital? No way, and no way, too, for any hospital trust across the Tees valley, where in excess of £10 million is required to cover high-risk repairs, £5 million of which is needed in my own trust of North Tees and Hartlepool.

The truth is that the pledges on NHS funding in the Queen’s Speech will have little impact on hard-pressed NHS acute services in Hartlepool, nor will they plug the gap in mental health funding, and in regard to social care the Queen’s Speech simply dodges the bullet by kicking the can down the road and fails to tackle the growing crisis in adult social care head-on. And despite a continued 2% precept being placed by the Government on council tax to cover adult social care, this is offset by a reduction of funding to our local council of almost £21 million, or 45%, since 2013-14.

The wanton, in-your-face, upfront daylight robbery of public services funding has to stop, and stop now, if we are to tackle serious health inequalities and growing social care needs in places such as Hartlepool, and the Queen’s Speech simply does not do that.

Photo of Luciana Berger Luciana Berger Liberal Democrat Spokesperson (Health and Social Care) 5:51 pm, 23rd October 2019

It is a pleasure to follow Mike Hill and I share a number of the assessments that he made in his contribution, because as the House pursues our debate on the Queen’s Speech, it is becoming ever more apparent that the casualty of a Tory Brexit will be Britain’s national health service.

The NHS is our greatest national asset; it is the product of the fusion of radical and enlightened minds in the last century that gave us healthcare for all based on need, not means. But now, in this century, the NHS is in great peril from a toxic combination of chronic underfunding and withdrawal from the EU, and responding to very different challenges from those when it was first created so long ago.

Notwithstanding the announcements in the Queen’s Speech, let us be very clear that the NHS is not in receipt of the resources that it needs to be effective. That was discussed only yesterday at the Health and Social Care Committee, when we had with us the Secretary of State and we talked about the backlog of £6 billion in NHS repairs alone, so an announcement of half that really is no cause for celebration. We heard from the Health Foundation, and its assessment of the Queen’s Speech funding announcement says that

“it falls well short of the scale of the challenge.”

We have a Prime Minister who announced 40 new hospitals, which then was downgraded to six within days, and we see demand for healthcare from our growing and ageing population outstripping the availability and quality of services, which means rationing and a diminution of quality of care; many right hon. and hon. Members from both sides of the House have referred to that in the debate this afternoon.

Photo of Norman Lamb Norman Lamb Chair, Science and Technology Committee (Commons)

Does my hon. Friend agree that another sign of a system under unacceptable strain is the fact that teenagers around the country are often waiting a year or more for access to mental health treatment? I know of two teenagers who have recently had their first appointment after a year of waiting, which seems to me to be utterly intolerable.

Photo of Luciana Berger Luciana Berger Liberal Democrat Spokesperson (Health and Social Care)

I thank my right hon. Friend for making that really important contribution, and waiting times are a particular issue in our NHS, especially in the Cinderella of all Cinderella services, our CAMHS. Too many young people right across our country are struggling to get a referral and then, if they do get that referral, having to wait months on end. Frankly, it is unacceptable.

Photo of Mike Gapes Mike Gapes Independent, Ilford South

There is a further problem with teenagers when they reach the age of 18, because there is a gap between the CAMHS and adult services. Far too often, young people who have been given help when they are 16, 17 and 18 suddenly fall off the cliff and there is no support for them.

Photo of Luciana Berger Luciana Berger Liberal Democrat Spokesperson (Health and Social Care)

I thank my hon. Friend for making that important contribution. There is a cliff edge in our young people’s mental health services when they transition into adult mental health services. They have to start all over again and repeat themselves. There are a few places across the country that are creating mental health services for young people up to the age of 25, and that is welcome, but it is the exception rather than the rule. We need to do everything possible to ensure that young people have continuity of support in their mental health services at that fragile moment in their life, because not receiving that critical support can have a detrimental impact on their ability to access education, to maintain relationships with family and friends and to get into employment.

I am particularly concerned that we have seen a serious reduction in the state of our services in the past year. I refer to the Care Quality Commission’s “State of Care” report, which came out this month. It looked at acute wards for adults of working age, psychiatric intensive care units, child and adolescent mental health in-patient services and in-patient services for people with learning disabilities or autism, and it found a significant increase in the number of those services that are now rated inadequate. Those are services for some of the most vulnerable people in our country, and we should be improving them rather than seeing an increase in inadequate ratings from 2% to 8%, 9% or 10%. That is unacceptable, and I hope the Minister will address that serious point in his response. In particular, we know that this is as a result of too many of the people using mental health and learning disability services being looked after by staff who, according to the CQC,

“lack the skills, training, experience or support from clinical staff to care for people with complex needs.”

Again, I hope the Minister will respond to this important point.

This is not just about care for people with mental illness or disability. We are seeing that same story right across our NHS, with patients waiting far too long. We have heard significant figures, with millions of people across the country struggling to access services. They are also having to travel too far for the treatment they need, and too many areas still have too few staff and not enough resources. That is reflected in the 2019 British social attitudes survey, which shows overall satisfaction in our NHS falling by 3% in the last year to 53%. The main reasons given for that include long waiting times, staff shortages and a lack of funding.

Notwithstanding the announcements in the Queen’s Speech on patient safety and changes to mental health legislation, which I welcome, I want to reinforce the point I made to the Secretary of State that this is not just about changing the Mental Health Act and that we need to have the resources for the capital infrastructure to ensure that we raise the standard of mental health in-patient settings to the same standard as physical health in-patient settings, along the lines of the recommendations given by Sir Simon Wessely, who conducted that important review for the Government.

Let us be clear that the pressures on our NHS are urgent and that they demand action, before we even contemplate the existential threat to our NHS because of Brexit. I want to talk about Brexit, because we did not hear about it today from the Front Benches. We had a reference to it from the Secretary of State, but not an actual analysis of how Brexit will impact on the provision of our national health service. We know that the impact on our economy so far from Brexit has been between 1.5% and 2.5% of GDP since 2016, and by the Government’s own assessment, Brexit will impact on our GDP by up to 9.3% over the next 15 years. We are still waiting for those further economic impact assessments on the withdrawal Bill that we have seen in the past week.

We have already discussed the impact of Brexit on our NHS workforce. We know that 63,000 EU nationals work in our NHS and that 104,000 work in adult social care. We should be lining up to thank each and every one of them for the role they play and the contribution they make to our national health service, instead of making them feel like unwanted strangers. I am surely not the only MP who has received representations from people who are serving our NHS and social care service, who go above and beyond under incredible pressure to provide the best possible levels of care and who are feeling worried about what the future holds. They are particularly concerned about the Home Secretary’s proposed immigration rules and the damage that they will inflict on our ability to recruit doctors, nurses and social care workers from the EU and the rest of the world.

I could talk about the threat of access to medicines, the creation of a new medicines approval regime, which will lead to further delays, and the impact on medical research.

Photo of Luciana Berger Luciana Berger Liberal Democrat Spokesperson (Health and Social Care)

Forgive me, but I only have 18 seconds, so I will not give way.

We should be addressing all that as a nation, and how we keep people well was missing from the Queen’s Speech. Other people have talked about prevention, and the lack of focus on public health in the Queen’s Speech is pitiful. We could be doing so much more, and I urge the Minister to refer to that in his response.

Photo of Gerald Jones Gerald Jones Shadow Minister (Defence) 6:00 pm, 23rd October 2019

It is a pleasure to follow Luciana Berger, and I pay tribute to all her work over many years on mental health. The need for investment in our NHS across the UK has never been so crucial, and I pay tribute to the Welsh Government’s innovation and passion in preserving and investing in our Welsh NHS and to all those who work in health and social care not just in my constituency, but right across the country.

Public health decisions should be made based on the health needs the people of this country, not on private profit. The past decade has been incredibly tough, and Tory austerity has continued to bite hard, but the Welsh Labour Government have set an example to follow. They have been able to meet their commitment to invest more per head in health and social care services than in England. The NHS in Wales still operates based on the needs of those who rely on it and has not been offered up to private companies. I understand that a third of contracts have been awarded to private providers since the passing of the Health and Social Care Act 2012, but the Welsh Labour Government have stayed true to NHS principles, leading the way in contract reform, investment in community pharmacies, social care and much more.

Under the Welsh Labour Government, the Welsh NHS is leading the way in many areas, with ambitious targets and investments, such as keeping prescriptions free of charge for those who cannot afford the English prices of the medicines they need, maintaining a bursary for those studying to become healthcare professionals, making new advanced drugs available to patients after an average of just 12 days, compared with 90 days in England, and much more.

Photo of Chris Elmore Chris Elmore Opposition Whip (Commons)

It is great to see Welsh Members championing the NHS in Wales, because it is a shame that Government Members spend too much time attacking it. In addition to free prescriptions and the rest of the list, does my hon. Friend agree that free car parking makes a huge difference at hospitals in his constituency and mine for both patients and visitors, by ensuring that they do not incur huge charges when receiving treatment or visiting family?

Photo of Gerald Jones Gerald Jones Shadow Minister (Defence)

My hon. Friend makes an important point. The NHS in Wales has a good story to tell about the provision of parking, which I know from visiting my dad in hospital over recent weeks at the Prince Charles Hospital in Merthyr Tydfil.

Photo of Chris Ruane Chris Ruane Shadow Minister (Wales)

Before we leave this list of Welsh firsts, does my hon. Friend agree that Wales pioneered presumed consent for organ donation, being one of the first nations in Europe to do so? The Conservatives criticised the policy, but they have now adopted it.

Photo of Gerald Jones Gerald Jones Shadow Minister (Defence)

Wales is leading the way in many areas in health. Despite the bluff and bluster that we hear from the Conservatives, the Welsh NHS has many positive attributes. We must continue to be vigilant to ensure that our NHS is not subject to the vagaries of a Trump-style trade deal with the US. The Welsh Labour Government have stated emphatically that our NHS is not for sale, and that should be the case right across the UK.

At this point, I make a plea for the Government to do more to find a solution between the NHS and the pharmaceutical companies with regard to Orkambi—a drug for cystic fibrosis sufferers, including eight-year-old Sofia from my constituency. We need progress on this issue across the UK. I appreciate that progress made by this Government will apply in England, but any attempts to break the deadlock, wherever it is in the UK, will help CF sufferers right across the UK.

We all know that not only health, but public services generally have been under pressure for a decade due to hard Tory austerity. The Tories are certainly not the party of the NHS, as they claim to be, and the neglect shown by the Government in the Queen’s Speech to other areas, including social care, mental health and education, is a real cause for concern. The Queen’s Speech was a missed opportunity by this Government to tackle the hardship felt as a result of continued austerity measures, with cuts to things such as social care and local government funding. It is important to recognise that local government has an important role to play in public health and social care, and it has been significantly underfunded in recent years. Time and again, we have been promised an end to austerity, yet there was little in the Queen’s Speech to give us any evidence of the fact that this policy has come to an end. Our local councils are suffering. They are able to provide visible services that we are aware of, which people sometimes take for granted, but the opportunity to deliver those services is held back by the austerity measures to which they are subjected.

This Tory Government have starved our local authorities of resources for almost a decade, and although in the early years some councils were able to stretch their budgets to keep some of the vital services going, all that is left to cut now are jobs and services that are closest to the people. Although local government in Wales is devolved to the Welsh Government, we know that the budget given to Wales by this Government is some £4 billion less per annum now than it was in 2010, which has had a huge knock-on impact on public services across Wales. That is wholly wrong, and this Government must act to show that austerity really is coming to an end. For this Government, as they have done in recent weeks, to use the police as a political propaganda tool, after almost a decade of slashing budgets and making constant cuts to policing and preventive public services, while violent crime has soared and conviction rates have reached record lows, is shameful.

In the closing moments available to me, I wish to raise something that was not in the Queen’s Speech, and that was an error. The theme for today is the NHS, but we are talking about the Queen’s Speech more widely. One of the missed opportunities was that there was no mention of the Government’s plans to put right the cruel injustice felt by women born in the 1950s and address the anger felt by so many thousands of 1950s women in our country, many of whom would have worked in the NHS, social care and health services. It is more than two years on from the last Queen’s Speech, which also failed to make any mention of this issue, which at that time had already been a huge injustice for too many years. This shows just how long this Tory Government have failed to act on this issue. So they must act, to get a fairer deal for the many thousands of 1950s women and bring an end to this shameful legacy of state pension inequality. We all know—I include many Government Members—that this issue will not go away until justice is done.

We do not know how long this Government have left—I hope for the sake of the country that is not too long—but it is clear from this Queen’s Speech that the Government are out of touch and out of ideas.

Photo of Chris Stephens Chris Stephens Shadow SNP Spokesperson (Fair Work and Employment) 6:08 pm, 23rd October 2019

It is a pleasure to follow Gerald Jones. I assure him that I, too, will be referring to the ongoing injustice to the 1950s-born women. However, as this is themed as an NHS debate, I want to pay particular tribute to all the healthcare staff at the Queen Elizabeth University Hospital and the Southern General Hospital in my constituency. Indeed, I want also to thank the healthcare staff at St Thomas’ Hospital, just over the bridge, because I know they provide healthcare support to Members from across this House.

What a fascinating debate this has been so far. I was particularly interested in the view we received from Conservative Members that austerity is over—I have been getting told that austerity is over at every Queen’s Speech and every Finance Bill since I got here in 2015—but the best moment was when the Secretary of State decided he was shocked and dismayed that Opposition Members would not trust the Government not to privatise the NHS or to make it part of an international trade deal. Why would we suggest that? Would it be, perhaps, because there are senior members of the Government whose political inclinations are not too dissimilar to President Trump’s? [Hon. Members: “Oh!”] Well, it is a fact—or would it be because some of them give away by their personalities that, to use that Glaswegian expression, they would sell their grannies for a tanner, as the Democratic Unionist party has no doubt found in the past week?

Photo of Chris Green Chris Green Conservative, Bolton West

We frequently hear scaremongering about the privatisation of the NHS, which I think is wrong. We heard the same in respect of the proposals for the Transatlantic Trade and Investment Partnership that the EU tried to negotiate with the United States of America, and that scaremongering was unfounded, too. Does the hon. Gentleman agree that the first and only example of the privatisation of an NHS hospital is Hinchingbrooke, and that was instigated by the Labour party?

Photo of Chris Stephens Chris Stephens Shadow SNP Spokesperson (Fair Work and Employment)

That may very well be the case, but if the hon. Gentleman thinks that the concerns around TTIP were scaremongering, I disagree with him most strongly. Many of us thought that TTIP would have been Thatcherism’s ultimate triumph. I am glad that it did not proceed.

I will vote for the Opposition amendment because there are those of us in the House who do not trust the Government and who have real concerns about future trade deals and what they would mean for the NHS. Everyone in the House has a responsibility to support that amendment.

Photo of Philippa Whitford Philippa Whitford Shadow SNP Spokesperson (Health and Social Care)

It is the case that Trump cannot change the NHS into an insurance system, but there are at least 19 Conservative Members who have expressed that view at some time in their career. What Trump has promised is to drive up the drugs bill by at least two and a half times.

Photo of Chris Stephens Chris Stephens Shadow SNP Spokesperson (Fair Work and Employment)

As usual, my hon. Friend makes her case excellently. There are few people in the House who could match her knowledge of healthcare.

Photo of Chris Stephens Chris Stephens Shadow SNP Spokesperson (Fair Work and Employment)

The hon. Gentleman seems desperate, so I will allow him to intervene before he falls over.

Photo of Bim Afolami Bim Afolami Conservative, Hitchin and Harpenden

The hon. Gentleman is generous in giving way. On the subject of trade deals and the NHS, I have listened to him. Am I right in thinking that he believes that the European Union should negotiate trade deals on behalf of this country and that being in a customs union with the European Union is therefore his preferred outcome, if Brexit were to happen at all, which I accept is against his party’s policy?

Photo of Chris Stephens Chris Stephens Shadow SNP Spokesperson (Fair Work and Employment)

I do not want Brexit to happen at all because of my real fear that health services in this country could very well find their way into a trade deal with the Donald Trumps of the world. [Interruption.] Bill Grant might mumble “Nonsense”, but many of us have a real fear that that is the case, so we have an opportunity in supporting the Opposition amendment.

I wish now to touch on the Pension Schemes Bill and to follow on from some of the comments by the hon. Member for Merthyr Tydfil and Rhymney. First, let me welcome the measure on collective defined contribution pensions that will be in the Bill. Such a measure, which we have discussed in the Work and Pensions Committee, is long overdue. It is another example of trade union pressure and trade union lobbying. We should congratulate the University and College Union and the Communication Workers Union, which have campaigned long and hard to ensure that collective defined contribution pensions become a reality.

I also welcome the fact that we are going to see the Pensions Regulator get increased powers. The Pensions Regulator was asleep while Carillion was paying out more in dividends to its shareholders than it was putting into its pension scheme. Clear evidence of that came out in the Carillion inquiry, so I welcome that change, just as I welcome the move towards pensions dashboards, which increases transparency.

I come back to the point made by the hon. Member for Merthyr Tydfil and Rhymney—the scandalous injustice that is not being dealt with. We are talking about women born in the 1950s growing up and discovering that they could not get access to a cheque book unless they got the permission of their father or their husband—[Interruption.] I am not joking. It was in 1980 that the law was changed; I would have thought that someone sitting on the Minister’s Bench would know that it was the Thatcher Government who actually stopped that. It was also the case that women could not obtain credit without permission from male relatives. They went through that during their lives and they are then told at some point that they cannot retire when they thought that they were going to retire. Many women tell me that they did not receive correspondence or a letter from the Department for Work and Pensions saying that their retirement age had changed. In fact, I suggest that, in my experience, we would be more likely to find someone who has the six numbers than a woman who has received a letter telling them that their pension age has changed.

Photo of Faisal Rashid Faisal Rashid Labour, Warrington South

Does the hon. Gentleman agree that these women born in the 1950s are against not equality in the retirement age, but the way the matter has been handled by this Government?

Photo of Chris Stephens Chris Stephens Shadow SNP Spokesperson (Fair Work and Employment)

Well, it has been handled by various Governments quite disgracefully, but Parliament has an opportunity now to address that injustice and it really needs to do so—it has to do so—because we are now faced with the sad situation where women seeking this justice are dying and that number is increasing every year.

There is another reason why we need to address the issue. We keep getting told that a general election is coming. Every Member of this House should realise that the average number of 1950s-born women in each constituency is 5,000. That is not counting their relatives and friends. They have the power, if this Government do not do something about this injustice, to vote for other candidates and other political parties that will.

Photo of Preet Kaur Gill Preet Kaur Gill Shadow Minister (International Development) 6:16 pm, 23rd October 2019

It is an honour to follow Chris Stephens, who made a passionate speech, especially in respect of the women born in the 1950s who have been denied their pension rights.

I was disappointed to see only one reference to mental health in the Queen’s Speech, and even then it was a reference only to the Mental Health Act. I was disappointed to see in the attached background briefing that the Government’s much vaunted parity of esteem does not stretch to any new funding for mental health services. One in 10 children and young people in the UK suffers at some point with mental ill health. In Birmingham, nearly 40% of the population are under 25. Mr Deputy Speaker, I am sure that you will be horrified to learn that, despite that, for the whole of Birmingham, there is only one early intervention counselling service for young people.

The most recent count of the counselling service waiting list saw 400 young people waiting for a service—that is 400 young people in desperate need of support who require treatment urgently; that is 400 young people who will have to wait months to see someone; and that is 400 young people and families who, in most cases, have nowhere else to turn. This unwillingness to recognise or properly fund vital prevention is yet another example of the Conservative Government failing our children and young people.

Is the Secretary of State surprised that more and more young people are ending up in A&E when we neglect early intervention care? We need to listen to young people themselves about the growing needs that they have. The Government are not doing that, which is why I have launched a young people’s mental health working group, supported by Open Door, which is a local counselling charity in my constituency, and the Centre for Mental Health. This group will use its unique perspective to help to shape the services that young people use for the better.

Young people have a voice that we need to listen to, so what steps are the Government taking to ensure that they work closely with young people with lived experience of mental health when developing legislative and non-legislative actions related to mental health? Cuts have consequences. Slashing budgets removes safety nets for the most vulnerable in our society and has knock-on effects. I am sure that the Secretary of State knows that excluded students are 10 times more likely to suffer from mental health problems. What steps is he taking alongside his colleague in the Department for Education to support those students, rather than just hanging them out to dry?

An inquiry by Birmingham and Solihull Mental Health NHS Foundation Trust into 11 deaths found that they were probably avoidable. That is unacceptable, and it is vital that lessons are learnt. With one of the highest levels of beds occupied by patients with complex needs and one of the lowest numbers of beds per 100,000—coupled with cuts and underinvestment under the Conservatives—what steps is the Secretary of State taking to ensure that my constituents will be properly looked after, and that no more families will be forced to go through the pain and heartbreak of being told that a loved one’s death was probably avoidable?

I will touch briefly on the Secretary of State’s favourite private healthcare company—or at least the one he talks about the most and publicly endorses while simultaneously insisting that there will be no more privatisation of the NHS under him. The Secretary of State is not alone in his support for Babylon and, as I am sure the House is well aware, the most senior member of the Prime Minister’s team advised Babylon as recently as last year. The reason that hospitals such as the Queen Elizabeth in my constituency are being forced to take risks in using totally unproven private technical solutions is that they are not receiving sufficient support from this Government. Over the past nine years, the Tories have stripped the NHS and made it about profit, rather than patients.

My constituents are rightly worried about the continued growth of companies such as Babylon, as its tentacles in Birmingham reach out beyond the GP at hand. The Secretary of State holds this company up as a beacon of light for replacing face-to-face services, but 94% of enrolled patients are under the age of 45 and two thirds live in more affluent areas. Can he tell me how it will work for my more vulnerable constituents, and will he give us answers to the myriad other justified concerns of GPs, CCGs and professional bodies?

I conclude by paying tribute to the magnificent practitioners and staff who work day in, day out across our various health services. I thank those who come from around the world to support us when we need it—due to mental health problems, physical ailments, old age or any other issue. These people deserve to be supported, properly resourced and treated with respect, and they deserve a Government who give them more than empty rhetoric. I am sorry that, over the last nine years, under the coalition and then the Conservative Government, they have not been treated in the way in which they deserve.

Photo of Mike Gapes Mike Gapes Independent, Ilford South 6:21 pm, 23rd October 2019

Let me begin by taking everybody back to the summer of 2012 and Danny Boyle’s fantastic ceremony at the start of the Olympic games. At that time, everybody was saying that the NHS was our secular religion, and in many senses that is true. It has been good to have cross-party support from everybody; no one in this House today has challenged the fundamentals of our NHS. But we all know that there is a long-term funding challenge. Social care is dealt with not by the NHS, but mainly by local government, and there is crisis in social care because local government budgets have been slashed. This Queen’s Speech goes a little way towards addressing the underfunding problems, but we have to be honest and realise that we must deal with this urgent issue of social care.

A week ago, I went to a conference organised by the East London Health and Care Partnership. One of the speakers there pointed out that there have been no fewer than nine plans or proposals for solving the social care problem, yet it is always put in the “too difficult” box, so those plans do not happen. Proposals are denounced as a death tax or a dementia tax. We need grown-up politics and we have to deal with this problem.

The same conference brought together all the NHS bodies in east London, with representatives from the boroughs of Waltham Forest, Tower Hamlets, Redbridge, Newham, Havering, City and Hackney, and Barking and Dagenham, and the provider trusts of Barking, Havering and Redbridge University Hospitals NHS Trust, Barts Health NHS Trust, Homerton University Hospital NHS Foundation Trust, East London NHS Foundation Trust and North East London NHS Foundation Trust. The clinical commissioning groups for the areas I have listed were also reflected by the local authorities there. However, there is no integration. My borough, Redbridge, has integrated care with the north-east London foundation trust, and they do good work in a joined-up way, but each borough does different things. The NHS institutions do different things.

We have had some criticism here of what people have done in the past. I want to criticise the Labour Government for their PFI; there has been a major problem in terms of the costs at the Barking, Havering and Redbridge trust due to the PFI at Queen’s Hospital. I also want to criticise the fact that we were not allowed to take the intermediate care centre at King George Hospital back into the NHS because there was a company that took the NHS to court and won the legal challenge. But I also want to criticise, and this is why I am going to vote for the Opposition’s amendment tonight, the fragmentation of the NHS brought in by the Lansley Health and Social Care Act of the Liberal Democrats—do not forget it—and the Conservatives. If we are all doing mea culpas, we need to be honest, rather than trying to score points. What we are seeing in north-east and east London is a move back towards integration, away from what Lansley proposed.

I have been here for 27 years. I have seen all this stuff before. When I came in, there was an FHSA—a family health service authority. There was then a trust model. I had an integrated trust; mental health and acute services were in the same trust. Then it was divided. Then there were further divisions and further fragmentation. Then it was reorganised back again. That is very costly and expensive and we get the rotation of individuals. Bill Grant referred to this. People are getting huge amounts in redundancy payments and then reinventing themselves and coming back in another NHS organisation.

This cannot go on. It is really ridiculous. The public do not understand the terms. People who come to us as constituency MPs about an NHS issue do not know what a CCG is. They have no idea how to make a complaint through the system. MPs are acting as gatekeepers and advocates for our constituents to try to get through this minefield. We hear that there are going to be consultations, but most of them are predetermined shams.

I have led a campaign to save the A&E in my constituency. The former Member for Ilford North, Lee Scott, and I joined with the local paper on this campaign. The current Member for Ilford North was with me over more recent years. It took from 2006 until July this year, when the then Minister, Stephen Hammond confirmed in a parliamentary answer to me that the A&E at King George Hospital was saved, and that is in the draft response to the NHS plan. That is a fantastic victory for our community, but why did it have to take so long?

Photo of Matt Rodda Matt Rodda Shadow Minister (Transport) (Buses) 6:27 pm, 23rd October 2019

I am grateful for the opportunity to speak in this important debate.

With the rising number of patients—particularly frail elderly people—the cost of treatments increasing, and also, very importantly, the severe lack of funding, our much loved health service is under truly severe pressure. I pay tribute to NHS staff for the vital work they do despite that enormous pressure. I would very much like to record my appreciation for them tonight.

I will address three issues: first, the scale of the challenge in health; secondly, the Government’s damaging approach; and thirdly, the need for real change. It is no exaggeration to say that the scale of the challenge facing our health service is quite simply enormous. This is partly because of the considerable changes taking place as our population gets older and people live longer. It is a very good thing that life expectancy is increasing, and we are all obviously grateful for that. However, a growing number of frail older people need appropriate care and support, and that care must be properly funded. In addition, medical science is advancing very rapidly, offering wonderful new and life-changing treatments, but again, those new treatments need to be supported by the necessary level of funding.

There are additional local challenges in some parts of the country. For example, in my constituency of Reading East we face particularly intense pressure in terms of staff recruitment and retention because of the high cost of housing and as more people move into our part of the Thames valley. NHS staff in our area face higher than average living costs—arguably similar to costs for people living in outer London, but with no London weighting. I want to return to that important point about resources.

Secondly, I am afraid that the Government are quite simply failing to respond to the scale of the challenge. Ministers have offered warm words, but fundamentally, they are failing to provide the necessary investment. My hon. Friend Jonathan Ashworth is right when he talks about the crisis in the NHS and the fact that every single measure of NHS performance is going the wrong way. For example, in my seat, A&E waits have risen dramatically—and they are A&E waits of more than 12 hours; I am not even going into waits that breached the four-hour target. In the Royal Berkshire Hospital, those waits increased by around five times in one year, between 2016-17 and 2017-18, which are the latest recorded figures. Conveniently for the Government, Ministers have decided to move the target rather than measure it.

We have also lost two GP surgeries, which is the tip of a very big iceberg in primary care in our area and across the country. These are surgeries where GPs are retiring, and there is a lack of new GPs coming on stream to replace them. In one case, local residents have had to move to a GP surgery in a different county, several miles away. Others have had to move to surgeries across our town. For frail, elderly people, that can involve a change of bus routes, difficulties in getting to see their GP and considerable additional problems in accessing primary care.

On top of that, many other services are under enormous pressure. To make things even worse, there is a deeply damaging privatisation agenda, which I heard about from my hon. Friend Anneliese Dodds, affecting Reading and many neighbouring towns in our area. To make matters even worse than that, we have a ridiculous situation where the Government are pressing ahead with a hard Brexit—or something that resembles it closely—which is driving away highly skilled NHS staff. Around 14% of the staff at my local hospital are from the EU. Can anyone imagine how difficult recruitment could be in a very short space of time?

Thirdly, we need real change. That means significant long-term increases in investment, not just warm words and playing with statistics to create a misleading impression about the level of funding. If the Government really believe in the NHS, they need to demonstrate that with their actions and policy choices, rather than just making vague promises that they are unlikely to deliver.

Photo of Matt Rodda Matt Rodda Shadow Minister (Transport) (Buses)

I am afraid I am pushed for time.

Other Members have highlighted many of the changes needed, but I want to pick up on a few crucial points. First and foremost, the Government must ensure that the NHS responds to the needs of patients and staff on the ground, and not just spout management jargon about changes that sounds convincing. That means a much greater focus from Ministers and officials on the needs of local communities. In high-cost areas such as Berkshire, it means looking at new measures to support recruitment and retention, including the cost of living. Ministers should consider proposals for increasing overall pay in the three counties in the Thames valley, with increased weighting for other high-cost areas, to help recruit and retain staff in towns such as Reading and Woodley.

To sum up, the NHS remains one of our most precious institutions. Staff are obviously working tirelessly in a very difficult and trying situation, yet their dedication is not being matched remotely by Government funding. What is needed now is a complete and utter rethink of Government health policy. We need real change, and only Labour will deliver that change, through the funding and support that we desperately need for our NHS.

Photo of Tonia Antoniazzi Tonia Antoniazzi Labour, Gower 6:33 pm, 23rd October 2019

It is an honour to follow my hon. Friend Matt Rodda. I have listened to much of the debate, and it is clear that the NHS is a treasured institution under threat from a hard Tory Brexit, and that having a Labour Government is the only way to secure its future and keep it wholly in public hands.

Today I want to speak about a specific issue that I have been involved with since I was elected in 2017, when I was approached by families in my constituency about getting access to medical cannabis—a medicine that could change the lives of children living with intractable epilepsy. I really could not understand what the problem was until I spoke to my late friend Paul Flynn, who had done a lot of work on this issue, and he explained how it has been an uphill struggle.

Photo of Jon Ashworth Jon Ashworth Shadow Secretary of State for Health

It was remiss of me earlier in the debate not to pay tribute to the leadership my hon. Friend has shown on this campaign, as well as Sir Mike Penning. She brought a group of campaigners to see me earlier in the year. I put on record our thanks for the tremendous work she has put into the campaign.

Photo of Tonia Antoniazzi Tonia Antoniazzi Labour, Gower

I thank my hon. Friend; I look forward to keeping on working with him.

It has been an uphill struggle. While thousands of people across the world have access to medicinal cannabis, the law was preventing patients in the UK from accessing it.

We have worked with the amazing families of the End Our Pain campaign, spearheaded by the amazing Hannah Deacon, who is mum to Alfie Dingley. Hannah’s campaigning meant that she got a special licence for Alfie to continue to use the cannabis that had transformed his life in the Netherlands. Then Sophia Gibson and Billy Caldwell were given prescriptions for medical cannabis. The highlight came last year, on 1 November, when there was a change in the law to reclassify cannabis so that it was available for medical use.

At the time, we thought that would mean that the children who were suffering would be able to have cannabis prescribed by specialist consultants. It turned out that that was not the case, so many other children were not given access to this life-changing medicine. Children from all over the UK continue to suffer because the Government are dragging their feet. The medicine is proven to work for many types of sufferers, but children are still being pumped full of steroids and unlicensed drugs that leave them severely impaired. The effect on the families has been terrible—on the children, the siblings and the parents. It is just not fair.

No one claims that this is a miracle drug. It is not a cure for epilepsy, but it does make a huge difference to the quality of children’s lives. Everyone has a right to live their best life.

I have worked closely with the parents of Bailey Williams from Cardiff, Rachel and Craig. I have seen at first hand the difference that this medicine has made to their son. When I called at their house one evening, Bailey got out of the chair, picked up a bunch of flowers and brought them to me. I actually cried to see a child who previously could not get out of bed get up out of a chair and give me a gift of thanks.

A lot of other children have the same story. Alfie has been riding a bike and a horse—something that would never have happened when he was on his previous drugs. The problem is that Alfie is getting to a point where the efficacy of this type of medicinal cannabis is dulling. As with all long-term medication, he needs a review and to be put on a new strain. However, the strict restrictions mean that even Alfie will not be able to access a new strain. As his tolerance to his medication builds, he is beginning to have more seizures. What next for Alfie? What will the Secretary of State do?

As we approach the anniversary of the law change, I want to reflect on what has happened to the lives of the families I have worked with, as co-chair of the all-party group on medical cannabis under prescription along with Sir Mike Penning. At the End Our Pain campaign event on 19 March, the Secretary of State told the families that he would make sure they got the medicine they needed. However, more than six months on from that promise and nearly a year on from the law change, not one new NHS prescription has been made, not one child has benefited from medical cannabis, and not one family have been able to move on with their lives.

Photo of Tonia Antoniazzi Tonia Antoniazzi Labour, Gower

I will give way, but I will not take the extra time.

Photo of Mike Penning Mike Penning Conservative, Hemel Hempstead

This issue shows the House how people from different parties, with very diverse views on politics, can work together for the good of children. There are children who are getting medical cannabis on prescription, but their parents or grandparents are paying for it. The NHS is free at the point of delivery. Surely that is how it should be.

Photo of Tonia Antoniazzi Tonia Antoniazzi Labour, Gower

I absolutely agree with the right hon. Gentleman.

I made a personal choice to go to the Netherlands with some of the parents to pick up the cannabis they need for their children—parents such as Emma Appleby who has a prescription for her daughter, Teagan, that costs thousands of pounds. She can afford to fly to the Netherlands to get the prescription because it costs less over there. The Government have created a two-tier system. Parents are forced to fundraise for medicines. One mother has put her house up for sale to pay for the next round of drugs. These families have run out of time, run out of money and run out of patience. All 20 families will go on hunger strike because they are at the end of the line.

I will move on swiftly. On 19 September, six months after the Secretary of State had made his promises, the families were continuing to fight for their kids. They took a bill to the Secretary of State showing the money they had spent on their private prescriptions, and they have delivered letters to the Prime Minister begging him to do something, but they have been ignored. They have not had a response, and that is absolutely disgraceful.

These families are being pushed to the end of their tether, and I honestly believe that it is time for the Secretary of State either to consider his position or to get this sorted. As a mother, if I was faced with this inaction, I would be fighting and fighting to get these life-saving drugs from the NHS—for free. I would be doing everything I could, and that is why I will continue to do everything I can to help these children who are needlessly suffering. I will raise this at every opportunity, and I will not stop until we have the good news that we need.

Photo of Barry Gardiner Barry Gardiner Shadow Minister (Department for Business, Energy and Industrial Strategy) (Energy and Climate Change), Shadow Secretary of State for International Trade 6:40 pm, 23rd October 2019

At the opening of the London Olympics, Danny Boyle wanted to show the world what it meant to be British, and he chose the NHS because it illustrates all that is best in our country. Watching on TV, millions marvelled at our nurses, our doctors and our carers, and in the stadium, thousands cheered. That is how proud we are of our NHS. All the people who work in it—cleaners, consultants, nurses, night porters, radiographers and receptionists—play a vital role in caring for our society. They are our national symbol of community and our model of selfless service.

This debate has reflected that, with 34 speeches and 49 interventions. There have been some wonderful speeches, including personal testimonies from James Brokenshire, Mike Wood and my hon. Friend Mary Glindon—my dear friend—who if she did not quite move herself to tears, certainly moved the rest of us.

However, millions now worry that the NHS could be up for grabs in a future free trade agreement. At the heart of those fears is the Health and Social Care Act 2012, passed by the Conservative and Liberal Democrat coalition. It puts costs before quality and commercial competition at the heart of health commissioning. Just after the Act was passed, our local 111 service in Brent North was outsourced to a private company, the majority of the directors of which sat on the local clinical commissioning group—the very group that had awarded them the contract.

The Health and Social Care Act has allowed perverse commissioning decisions like that up and down the country. Today, our local CCG in north-west London faces not the £51 million deficit at year-end set out in its operational plan, but £112 million—an additional £61 million overspend as a result of an increase in acute activity of 18% against a population increase of 5%. When Conservative Members and their Liberal Democrat partners told us that the NHS was not for sale, those assurances were worthless. People may not be able to buy it, but privatisation is tearing it apart. My CCG has announced the closure of the 24-hour service at the urgent care centre in Middlesex Hospital.

Photo of Barry Gardiner Barry Gardiner Shadow Minister (Department for Business, Energy and Industrial Strategy) (Energy and Climate Change), Shadow Secretary of State for International Trade

I cannot give way because of time.

It is this legislation that now exposes our NHS to foreign competition and undermines our public healthcare system. It is Donald’s door into our NHS. Some 170,000 people already know this, and they have signed a parliamentary e-petition calling on this Government to introduce safeguards that will protect it from new trade deals. Trade agreements lock in privatisation, and open up access to foreign investors and speculators. That is why we need safeguards.

Photo of Matt Western Matt Western Labour, Warwick and Leamington

Does my hon. Friend agree with me that one of the great threats to our NHS is a trade deal with the US that, as happened in Australia 10 years ago, will drive up the price of medicines significantly?

Photo of Barry Gardiner Barry Gardiner Shadow Minister (Department for Business, Energy and Industrial Strategy) (Energy and Climate Change), Shadow Secretary of State for International Trade

I agree with my hon. Friend.

In 2007, Slovakia wanted to move from a private health system, modelled on the USA’s, to a system more like ours. Slovakia was sued for millions of euros by a Dutch company that thought the move might affect its future profits. Trade deals often contain clauses that give foreign investors the right to sue Governments for decisions that might affect their profits. These investor-state dispute settlement—ISDS—clauses are common in modern free trade agreements.

Policy decisions such as legislating for the plain packaging of cigarettes have been subject to ISDS claims. Labour believes the UK should be free to make public health policy based on the health needs of the British people. We should not have to bend to some company that is profiting from keeping our people ill, whether from tobacco, polluted air or too much sugar.

More than 750 cases are known to have been brought under ISDS clauses in other countries, and more than half resulted in compensation for foreign investors or in financial settlements out of court. Labour will not sign up to any free trade agreement that uses these ISDS-style rules, which are wrong in principle and, even where they are not used, can lead to regulatory chill.

Incredibly, the right to sue the Government under these ISDS clauses does not extend to our own UK companies, only to foreign companies in separate private courts. Labour has confidence in our courts and thinks foreign companies should have no greater rights of redress than British companies.

Free trade agreements also typically include market access clauses and national treatment provisions. These would set out the extent to which overseas businesses can operate in our markets, and they would insist that we afford at least the same treatment to foreign businesses as we do to our own businesses. In the past that was done by listing all those services that had been agreed. If an NHS service was not on the list, it could not be the subject of foreign competition. Agreements used to set out only those services that we were prepared to open up to competition, but modern trade agreements do not work that way.

Instead, modern trade agreements adopt a negative list system that says every service is opened up to competition unless it is placed on the negative list. Anything missed off the list is automatically open to competition. Once missed, a service can never be put back on the list. Any new service that comes as a result of technological or scientific breakthrough, if it is not on the list, is automatically open to foreign competition.

Imagine if we had agreed a negative list before the age of the internet and before digital technology had changed how patients can be screened and tested. If we lose our capacity and skill to provide these services directly, we will become a captive market and vulnerable to the abuse of private monopoly and spiralling costs.

Governments cannot intervene where there has been a clear failure in the sector or where patient health has been compromised. We need legal guarantees that no such negative list trade agreement will be concluded. That is why Opposition Members sought to introduce measures into the Trade Bill to achieve this protection. Conservative Members voted down every single one.

When their lordships secured essential provisions for proper scrutiny of trade agreements and a defined parliamentary procedure for ratification, what did the Government do? They abandoned the Bill entirely. Now they want to bring back the same legislation, but without those safeguards.

A potential deal with the US is of major concern to those who care about our health service. The American model is renowned for its pursuit of profit and its indifference to the poor. The US ambassador told national TV that the NHS would be on the table and that the US had already looked at all the components of the deal. President Trump confirmed it, and the Office of the US Trade Representative has published its list of negotiating objectives for any such deal. One objective is to stop the NHS using its bulk purchasing power to negotiate lower drug prices. The US Secretary of Health and Human Services actually said that the US would “pressure” other countries in trade negotiations so that Americans pay less and we pay more.

The USA wants to stop the UK regulating the pharmaceutical industry unless the US industry has agreed. So much for taking back control. In one of their first acts after establishing the Department for International Trade, this Government opened three new offices in the US, in Raleigh, in Minneapolis and in San Diego—biopharma hubs where major healthcare providers, biotech, pharmaceutical manufacturers and health insurers are headquartered. What made those cities so attractive if it was not an attempt to attract players from those sectors into our NHS? The Labour party created the NHS. We will not allow this Government’s trade agreements to damage it. Under Labour, the NHS will remain a universal service, free at the point of use, and based on medical need, not ability to pay.

Photo of Edward Argar Edward Argar Minister of State (Department of Health and Social Care) 6:50 pm, 23rd October 2019

It is a privilege to wind up this important debate on behalf of the Government, especially in the light of the many excellent and measured contributions by Members on both sides of the House. It is also a pleasure to respond to a debate in which both the shadow Secretary of State for Health and Social Care and the shadow Secretary of State for International Trade have spoken. I have great regard for them both, although unlike the shadow Secretary of State for International Trade, I intend to focus rather more on health and the NHS, given that they are what the debate is about.

That the debate has been so well attended reflects the importance of the NHS and the pride in it felt by all Members and our constituents, by Government and Opposition alike. The NHS rightly occupies a special place for us all, and the debate gives me an opportunity, standing at the Dispatch Box, to pay tribute to all who work in our NHS. My right hon. Friend the Secretary of State for Health and Social Care, in a marathon speech opening the debate, set out the five major reforms that place health and social care at the heart of the Queen’s Speech: our long-term plan, the medicines and medical devices Bill, the Health Service Safety Investigations Bill, adult social care reform and the Mental Health Act reform. Those measures come on top of record investment by this Government in our NHS, with £33.9 billion extra through the long-term plan; 40 new hospitals being built, with six ready to go now, and more doctors—a real commitment to ensuring our NHS is fit for the future.

Before I deal with the Opposition amendment, I will touch on as many of the speeches made by right hon. and hon. Members as possible. I will start with the incredibly moving, powerful and brave speeches made by my right hon. Friend James Brokenshire, my hon. Friend Mike Wood, Mary Glindon and Ann Clwyd. All, rightly, paid tribute to the NHS and set out their personal debt to the service, and I think it is right that on behalf of the House and the Government I echo that tribute, because it is thanks to the amazing NHS that those four wonderful colleagues are still with us. We should be extremely grateful for that.

I also highlight the contributions by my right hon. Friend Mr Dunne and my hon. Friend Stephen Hammond, both distinguished predecessors of mine in this role. If I manage to stay for another week, I will have exceeded the tenure of my immediate predecessor, but I have a long way to go before serving as long as my right hon. and hon. Friends. I pay tribute to them for their commitment to the NHS, for all they did for it as Ministers, and for the central role they played in putting in place the building blocks for the long-term plan and the investment we have been able to announce today.

Dr Wollaston, in a typically measured, well informed and reasonable speech, highlighted the importance of listening to partnership and engagement. In the context of the long-term plan, she is absolutely right to highlight that we are listening to the NHS, and the NHS has, in turn, listened to the public and to her Committee, as we all do. I have yet to be summoned to appear before the Health and Social Care Committee, but I suspect it is only a matter of time.

My hon. Friend Andrew Selous made an important speech in which he highlighted the importance of workforce, medical schools and new places. I am very pleased that the Government have set up five new medical schools. I had the privilege of visiting the new medical school in Lincoln on its first day for students. Our colleague, the former hon. Member for Lincoln, Karl McCartney, campaigned passionately for it to be set up. It was a privilege to meet those students on their first day.

Tim Farron touched on radiotherapy, in which I know he takes a particular interest. Grahame Morris has already raised this issue privately with me. I am very happy to meet both of them to discuss it further if that is helpful.

My hon. Friend Neil O’Brien, my constituency neighbour, spoke positively and passionately about the impact the investment we are putting into our local hospital trust in Leicester will have on our constituents. I am sure that the constituents of the shadow Secretary of State will be just as pleased as ours. I hope he might evince a certain degree of positivity about that.

I thank Dr Cameron for her tone, which again emphasised the need for us to be measured in our language in this debate. There will always be political passions and differences, but it is right that we seek to be measured. She mentioned her work on thalidomide. I believe my hon. Friend Simon Hoare has also been very much involved in this issue. Again, with the appropriate Minister I am very happy to meet her to discuss that.

We heard powerful speeches from many colleagues on both sides of the House advocating for their constituents, which is as it should be: my hon. Friend Lucy Allan, my right hon. Friend Sir Mike Penning, my hon. Friend Mark Pritchard and Mike Hill. Alex Norris highlighted the importance of social care, as did so many other Members. It is absolutely right that we focus on that.

Turning to the shadow Minister and the Opposition amendment, I say once again to this House, because repetition is never a sin in this place, that, as my right hon. Friend the Prime Minister and the Secretary of State have set out clearly, our NHS is not for sale. Our NHS has never been for sale and our NHS will never be for sale. No trade agreement will ever change that: our NHS is not on the table in any trade talks.

As my right hon. Friend the Secretary of State set out, those on the Opposition Front Bench knowingly push scaremongering nonsense. They push it because they do not want to talk about Brexit, given their non-policy in this area, which is characterised by dither, delay and dodge. Given that position, I do not blame them for not wanting to talk about it, but they should know better than to seek to scare vulnerable people with talk of things that are not going to happen.

The Opposition may speak about their commitment to the NHS, but the difference is that those of us in the Government actually deliver on our commitment, with the longest and largest cash settlement in the history of the NHS, the biggest and boldest hospital-building programme in a generation, new treatments and new technologies to deliver world-class and cutting-edge care, and by addressing the injustices in social care and the inequalities in mental health. It is clear that the Conservatives are the real party of the NHS. We have protected and prioritised the NHS for each of the 44 years of its 71-year history when we have been in government. Under this Government and this Prime Minister, we will continue to do so, helping our doctors and nurses do their jobs and putting the NHS on a secure and stable footing for the future—a publicly funded NHS, free at the point of use, accessible according to need, not ability to pay—so that our NHS can continue to be—

Photo of Nick Brown Nick Brown Opposition Chief Whip (Commons)

claimed to move the closure (Standing Order No. 36).

Question put forthwith, That the Question be now put.

Question agreed to.

Question put, That the amendment be made.

Division number 9 Queen's Speech — Programme for Government — National Health Service

A majority of MPs voted to continue to empower GPs to commission services, retain a strong Care Quality Commission, to retain Healthwatch England, and not to reverse a decision to seek to cut admin costs for example by abolishing Primary Care Trusts.

Aye: 282 MPs

No: 310 MPs

Ayes: A-Z by last name

Tellers

Nos: A-Z by last name

Tellers

Absent: 54 MPs

Absents: A-Z by last name

The House divided: Ayes 282, Noes 310.

Question accordingly negatived.

The debate stood adjourned (Standing Order No. 9(3)).

Ordered, That the debate be resumed tomorrow.

Photo of Sarah Wollaston Sarah Wollaston Chair, Health and Social Care Committee, Chair, Liaison Committee (Commons), Chair, Liaison Committee Sub-committee on the effectiveness and influence of the select committee system 7:15 pm, 23rd October 2019

On a point of order, Mr Deputy Speaker. Frankly, I am astonished that at such short notice the Prime Minister has sent a note to the Liaison Committee refusing to appear before us in the morning. This is the only Committee that can call the Prime Minister to account, and it allows us to ask detailed questions with follow up on behalf of the public. This is now the third occasion on which the Prime Minister has cancelled. May I seek your guidance, Mr Deputy Speaker, because this is entirely unacceptable?

Photo of Lindsay Hoyle Lindsay Hoyle Deputy Speaker and Chairman of Ways and Means, Chair, Panel of Chairs, Chair, Standing Orders Committee

I recognise that three times is very difficult, and quite rightly we have to hold all officers, even the Prime Minister, to account. However, I also recognise that these are very difficult times at the moment, and I would hope that the point of order has been listened to by Ministers and that we can come forward with a date for the Prime Minister to appear, but, more importantly, that the Liaison Committee can get that meeting in—and, as Chair, I recognise the need to do so. So, both ways, there is a need to try to make sure we can make this happen.

Photo of Patrick McLoughlin Patrick McLoughlin Chair, European Statutory Instruments Committee

Further to that point of order, Mr Deputy Speaker. As a member of the Liaison Committee as well, I can say that of course the Liaison Committee is disappointed that the Prime Minister is unable to appear before it tomorrow, but the truth is that the Prime Minister is held to account in the Chamber by all Members of Parliament every week for over an hour, so it is simply not true that the Prime Minister is not being held to account.

Photo of Lindsay Hoyle Lindsay Hoyle Deputy Speaker and Chairman of Ways and Means, Chair, Panel of Chairs, Chair, Standing Orders Committee

I can see that tensions are running high. I have given a very honest answer that I think is fair to both sides.

Photo of Yvette Cooper Yvette Cooper Chair, Home Affairs Committee

Further to that point of order, Mr Deputy Speaker. As the Chair of the Liaison Committee, Dr Wollaston, has said, this is now the third time, and the purpose of the Liaison Committee is to take more detailed evidence and scrutinise the Prime Minister in a more detailed way. The Prime Minister has said that he does not want to come now until five or six months after his initial appointment; that means in December or January. At such a time when there are so many important decisions to be made for the country, surely it is utterly irresponsible for the Prime Minister to refuse to answer detailed scrutiny questions from the Committee, and if he has done this three times before, how on earth can we have any confidence in a December or January date either?

Photo of Lindsay Hoyle Lindsay Hoyle Deputy Speaker and Chairman of Ways and Means, Chair, Panel of Chairs, Chair, Standing Orders Committee

Well, if we can get to January and February that is more than I am expecting at the moment. I hope that the message has gone out that three times the frustration has quite rightly been there. I do not know the reason for the decision tomorrow, but I do know we are in very serious and dangerous times in the future of this present Parliament. I am sure, as I said earlier, that that message will go back, and I would like to think that the earliest possible date will be proposed—sooner rather than later; this year, not next year, unless other events overtake us.

Photo of Steven Baker Steven Baker Conservative, Wycombe

Further to that point of order, Mr Deputy Speaker. Can you advise me whether there is any way we can highlight in this House the profound injustice whereby some Members can achieve high office in the Committee system by virtue of their party affiliation, yet continue to hold high office after they have abandoned their party?

Photo of Lindsay Hoyle Lindsay Hoyle Deputy Speaker and Chairman of Ways and Means, Chair, Panel of Chairs, Chair, Standing Orders Committee

I am not going to get into that argument. I have enough on my plate without going down that road.

Photo of Mary Creagh Mary Creagh Chair, Environmental Audit Committee

Further to that point of order, Mr Deputy Speaker. I think that that last comment was unworthy of Mr Baker. The Prime Minister got out of the first date by, I believe, proroguing Parliament. Clearly, the programming of the business for this week, which would have seen us on the Report stage on the withdrawal agreement Bill, would have meant that the Prime Minister, quite rightly, would have had to be in the Chamber. Is it in order for the Prime Minister to use smoke and mirrors to pretend that he is coming to the Liaison Committee but always find a way to wriggle out of the back door and never be accountable?

Photo of Lindsay Hoyle Lindsay Hoyle Deputy Speaker and Chairman of Ways and Means, Chair, Panel of Chairs, Chair, Standing Orders Committee

I am not going to enter into speculation. I have been very clear, and I have made the point. I am not going to change any more.

Photo of Seema Malhotra Seema Malhotra Labour/Co-operative, Feltham and Heston

Further to that point of order, Mr Deputy Speaker. Further to some of the comments that have been made, may I seek your advice about the accountability of the Prime Minister? Truly, he is accountable to the Liaison Committee as well as to the House, and in other matters—

Photo of Lindsay Hoyle Lindsay Hoyle Deputy Speaker and Chairman of Ways and Means, Chair, Panel of Chairs, Chair, Standing Orders Committee

Order. I have been down that road already, and I am not going to change what I have said.

Photo of Sarah Wollaston Sarah Wollaston Chair, Health and Social Care Committee, Chair, Liaison Committee (Commons), Chair, Liaison Committee Sub-committee on the effectiveness and influence of the select committee system

Further to the point of order made by Mr Baker, Mr Deputy Speaker. May I seek your confirmation that Select Committee Chairs are elected by the whole House of Commons because they are trusted not to take a tribal party political viewpoint in their role as Select Committee Chairs?

Photo of Philippa Whitford Philippa Whitford Shadow SNP Spokesperson (Health and Social Care)

On a point of order, Mr Deputy Speaker. In response to my question this morning about compensation for the victims of the contaminated blood scandal, the Minister for the Cabinet Office and Paymaster General suggested that the Government were waiting for

“the determination of legal liability, to which the inquiry’s deliberations relate”, but surely he must recognise that under the Inquiries Act 2005 a public inquiry cannot determine liability, so how can I call for the Minister for the Cabinet Office to correct the answer that he gave?