12 DEC 2018

UK Fishing Industry

Sarah Wollaston Chair, Health and Social Care Committee, Chair, Liaison Committee (Commons)

I thank my hon. Friend for making that really important point. In Brixham, in my constituency, fishermen are very worried about choke species with cod, which they cannot avoid catching. I wonder whether she feels the same about cod fisheries?

.....

Sarah Wollaston Chair, Health and Social Care Committee, Chair, Liaison Committee (Commons)

Does the hon. Gentleman share my concern about the catastrophic implications of our crashing out with no deal and no transition, particularly because of the extreme friction that would cause at the borders? It would certainly affect my fishermen and I wonder whether he feels the same.

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11 DEC 2018

European Union (Withdrawal) Act 2018: Statutory Obligations on Ministers

Sarah Wollaston Chair, Health and Social Care Committee, Chair, Liaison Committee (Commons)

In 108 days we run out of road, and the only red line that has not been laid down is the one in front of the cliff's edge, over which we would fall into a chaotic no deal. I urge the Minister and the Government to bring forward the meaningful vote to next week, because by then at least we will know what cosmetic changes have been made in Brussels.

Robin Walker The Parliamentary Under-Secretary of State for Exiting the European Union

I say gently to my hon. Friend that we should make sure the Prime Minister has the opportunity that she seeks to get the best deal in front of this House, and that we have the assurances we need so that the whole House can get behind the deal. My hon. Friend is a great champion of working across party lines; we ought to be taking this matter forward in a cross-party manner that delivers for the whole country. I do not believe that it would be right to rush into having a vote of this nature before we had sought those assurances.

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10 DEC 2018

Exiting the European Union

Sarah Wollaston Chair, Health and Social Care Committee, Chair, Liaison Committee (Commons)

The Prime Minister rightly talks about listening to young people and first-time voters. Does she accept that they voted overwhelmingly to remain? They look at what is happening in this House and they see that this deal is Brexit, warts and all—this is as good as it gets. Is it not time, now that we know what Brexit actually looks like as opposed to some fantasy version of Brexit, that those people get the chance to vote on Brexit reality rather than Brexit fantasy?

Theresa May The Prime Minister, Leader of the Conservative Party

I think my hon. Friend has heard my response in relation to a people's vote, a second referendum, before. I genuinely believe that we should recognise that the referendum in 2016 was the biggest exercise in democracy in our history. We should respect the many people who went out to vote, including many who had not voted before. I believe that if we then go back to people and say, "Have another think, think again," they will question the value of democracy and the value of the vote.

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05 DEC 2018

Immigration (Time Limit on Detention):

 Sarah Wollaston Chair, Health and Social Care Committee, Chair, Liaison Committee (Commons)

Further to the point made by my right hon. Friend Justine Greening, will the Home Secretary commit to looking at the extra costs and the bureaucracy that will fall on our health service and our care sector? As she has said, because of the salary threshold that applies, many of the key staff who enable our health service and care sector to function will fall below that salary threshold, and the extra costs that will fall on the care sector in particular are quite extraordinary. Will he commit to reducing bureaucracy and tackling that cost?

Sajid Javid The Secretary of State for the Home Department

Again, a very important point has been raised by one of my colleagues. I absolutely make that commitment. My hon. Friend is quite right to raise it, because we have to recognise that as we move from the current system of freedom of movement, in which there is virtually no bureaucracy to speak of, to a system under which we will require visas for every worker, we must keep an eye on the paperwork and bureaucratic requirements and keep the system as simple and light-touch as possible. That applies not just to larger employers, such as hospitals or NHS trusts, but to the smaller employers that may be looking for skills but perhaps taking only one or two people a year, and we should keep that in our minds as well.

.......

Sarah Wollaston Chair, Health and Social Care Committee, Chair, Liaison Committee (Commons)

It is a pleasure to follow Mr Sharma, and I agree with him that we are stronger when we work with our neighbours. No one doubts the commitment of the Prime Minister to try to deliver on the wishes of the 52%. The trouble is that no one really knows which version of Brexit she was mandated to deliver. There are so many possible alternatives, with everything from Norway, the European Economic Area, the European Free Trade Association and Norway plus a customs union through to a Canada-style free trade agreement and Canada plus plus plus. There are so many options, but after two years of hard slog, we now know what this looks like. We know what the withdrawal agreement looks like, for example. It is a legally binding agreement with more than 500 pages, but worryingly, it has only 26 pages describing what will actually happen after the transition period. That is nothing more than a wish list of asks and it is very sketchy. We are heading for a blindfold Brexit.

I also fear that we are being forced into a binary false choice in which we accept either a bad deal or something even worse: no deal. Unfortunately, the Prime Minister has set down red lines all around herself for the various options. The one area in which she has not put down a red line is the worst deal of all, which is no deal. I am afraid that I do not agree with my right hon. Friend John Redwood when he talks about "Project Fear". I think that very shortly, possibly in as little as 114 days, we will be up against "Project Reality". In the context of no deal, "Project Reality" would be very serious indeed for patients who use our national health service. We are talking about major interruptions in the supply chain of vital medicines and medical supplies. We are talking about insecurity in the supply of vital diagnostic test materials such as medical radioisotopes, which cannot be stockpiled. We are talking about supply chain issues for complex biological drugs, including those that we use to stop transplant rejection and to treat cancers.

We are also talking about products that cannot easily be switched from one brand to another in cases of shortage, such as medication for epilepsy. We are talking about difficulty in guaranteeing sufficient refrigeration capacity for stockpiling. Nobody voted in the referendum because they wanted to see the stockpiling of medicines and the extra costs involved, or the difficulties that the NHS and our care services will face in providing the workforce that we need. The truth is that there is no version of Brexit that would be positive for our NHS, for our care services, for science and research or for public health, and we need to be honest with people about that.

We also need to be honest and have a reality check about what is happening in this place. It seems to me that even the dogs in the street know that the Prime Minister's deal is not going to pass this House next week. That is the truth of it. We should now be thinking about plan B, and we need to be honest about that. To my mind, plan B must not involve no deal. No responsible Government could inflict no deal on the United Kingdom in 114 days' time. We are absolutely not prepared for that. So what is the alternative? There is no majority in this House for any of the other options, so the alternative is to look at going back to the British people and saying to them, "This is what Brexit looks like. This is the best that could be negotiated. Is this the Brexit you voted for, or do you want to stick with the deal that we have?" I would say that there was no consent to being dragged into Brexit without asking the people.

Before coming to this place, I was privileged to work in the health service for 24 years, and to teach junior doctors and medical students. In medicine, there is the really important principle of informed consent. We should apply it to Brexit, because Brexit is major constitutional, economic and social surgery. To give informed consent, one has to know what the operation involves. Two years ago, there were many possible versions of that operation, but now that we know what the surgery involves, it is time for proper discussion about the risks and benefits, and to allow people to weigh them up for themselves.

James Heappey Conservative, Wells

My hon. Friend knows that I respect her enormously. I agree that being very candid with the electorate is the right thing to do right now. Should we also be candid with them about the mechanism for delivering a second referendum—about the fact that it would require an Act of Parliament; about the European Union (Withdrawal) Bill taking 348 days to get through the Houses of Parliament; and about there being absolutely no expectation that a Bill as controversial as a second referendum Bill would be able to progress through this place any quicker?

Sarah Wollaston Chair, Health and Social Care Committee, Chair, Liaison Committee (Commons)

I ask my hon. Friend to have a look at the work of the Constitution Unit and others, who estimate that we could get a referendum Bill through the House in 22 weeks. We would first need to extend article 50. That is what I hope that the Prime Minister does. I hope that she looks at the reality of the situation, extends article 50, and asks the British people, "Is this the Brexit you voted for, or do you want to stay with the deal we have?"—the one that has served us well for decades. That question has to go back to the British people.

None of us in this House should be forced into a false choice—into choosing a bad deal because we are told that the only alternative is no deal. That is simply not the case, and I believe that the House will reject the deal. That is why I support the amendment in the name of Hilary Benn rejecting no deal, and urge colleagues to do the same. The House should ask to extend article 50, so that we have the time to consider where we go from here. Otherwise, in 114 days, we run out of road and fall off a cliff. What is needed now—this message is for the Opposition Front Benchers as well as ours—is a BFO: a blinding flash of the obvious. We need to think again. Delivering on a people's vote will require the Opposition Front Benchers not to cling to the idea that they will force a general election; we know that will not happen, either.

We do not have any time to waste. We need Members on both Front Benches to give a free vote, or deliver support for a people's vote. That is the way forward. This House would decide the exact question. I believe that the choice should be between this deal and remain; I know others feel that the question should be more complex. We do not have to decide that now—it is something that the House could decide later—but we must not run out of road; we must extend article 50.

............

Sarah Wollaston Chair, Health and Social Care Committee, Chair, Liaison Committee (Commons)

Does the Secretary of State agree, however, that another option would be to extend article 50, and that it is incorrect to present the House with a false choice in which we would automatically fall out on 29 March?

Jeremy Hunt Secretary of State for Foreign and Commonwealth Affairs

I had a conversation with my hon. Friend earlier this evening about how lively things are in her constituency. I think that if any of us asked our own constituents whether the right solution to the dilemmas we face would be to extend the agony by postponing the article 50 due date, they would be absolutely horrified. They want to get this over with. They want to get it resolved.

I mentioned the risks of a no-deal situation to our security, which were recognised by my right hon. Friend Stephen Crabb and my hon. Friends the Members for Ludlow (Mr Dunne) and for Banbury (Victoria Prentis). They all alluded to that issue.

In conclusion, when it comes to defence and security, irrespective of our membership of the EU, the lesson of history is clear. When Britain and Europe stand together against common foes, our combined strength deters our adversaries and keeps the peace. If we did not do that, our common security would be placed at risk in a way that would be wholly unnecessary. So let us grasp this opportunity for a new and different partnership, post Brexit, based on the essential truth that British and European security are indivisible and, whether inside or outside the legal structures of the EU, our common interests are best served by working together to protect the values we all cherish.

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04 DEC 2018

Personal Independence Payment: Mental Illness

Written Answers

Sarah Wollaston Chair, Health and Social Care Committee, Chair, Liaison Committee (Commons)

  • To ask the Secretary of State for Work and Pensions, what proportion of successful personal independence payment applicants have a diagnosed serious mental health condition.
  • To ask the Secretary of State for Work and Pensions, what proportion of personal independence payment claimants are diagnosed with schizophrenia.

Sarah Newton The Minister of State, Department for Work and Pensions

Statistics on Personal Independence Payment (PIP) claim outcomes (clearances) at disability level are not readily available and have not previously been published as Official Statistics. We are producing the statistics requested and issuing them in an Official Statistics release on 11th December 2018 in accordance with the Code of Practice for Official Statistics.

Statistics on the number of individuals in receipt of PIP payments broken down by disability are already available on Stat Xplore:

https://stat-xplore.dwp.gov.uk

Guidance for users is available at:

https://sw.stat-xplore.dwp.gov.uk/webapi/online-help/Getting-Started.html.

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04 DEC 2018

European Union (Withdrawal) Act

Sarah Wollaston Chair, Health and Social Care Committee, Chair, Liaison Committee (Commons)

I welcome the Prime Minister's commitment to engage further with the Select Committees. When she came to the Liaison Committeelast week, she will have heard one Committee Chair after another pointing out to her the catastrophic consequences of no deal and asking whether she would rule that out, if and when the House rejects this deal, because we cannot inflict that kind of catastrophe on our people.

Theresa May The Prime Minister, Leader of the Conservative Party

If my hon. Friend is concerned about no deal, the way to ensure that there is a deal is to support the deal that is on the table.

.........

Sarah Wollaston Chair, Health and Social Care Committee, Chair, Liaison Committee (Commons)

Does my right hon. Friend agree that this is exemplified in article 107 of the future framework document? It just says:

"The Parties should consider appropriate arrangements for cooperation on space"— and that is it.

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27 NOV 2018

Health and Social Care: Community Hospitals

Sarah Wollaston Chair, Health and Social Care Committee, Chair, Liaison Committee (Commons)

Dartmouth has lost its much-loved community hospital. Unfortunately, that loss has been compounded by the closure of River View nursing home, which had been due to house some replacement facilities. The total loss of community beds in isolated coastal communities such as Dartmouth is causing a collapse of trust in such programmes. Will the Minister meet me to discuss the situation in Dartmouth and the loss of nursing home and community beds?

Caroline Dinenage Minister of State (Department of Health and Social Care)

I will of course meet my hon. Friend. She is right that we need to keep such valuable local resources right in the community, where they are most needed and where they keep people out of acute hospital services and surrounded by their friends and family.

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26 NOV 2018

Green Nonprofit Organisations

Thanks to Devon representatives from Devon Wildlife Trust, RSPB South West, Woodland Trust and National Trust for coming to Parliament to discuss environmental issues, the Agriculture Bill and the Fisheries Bill.

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22 NOV 2018

Progress on EU Negotiations

Sarah Wollaston Chair, Health and Social Care Committee, Chair, Liaison Committee (Commons)

Without informed consent, there is no valid consent. Following the publication of the withdrawal agreement and the political declaration, we now have a much clearer idea of what Brexit looks like, which allows people to weigh up the risks and the benefits. That is what informed consent is all about. Does the Prime Minister accept that we have reached an impasse in the House, and that now that we are in a position to ask people for their informed consent, it really is time for a people's vote on this final deal?

Theresa May The Prime Minister, Leader of the Conservative Party

As I have indicated to a number of Members—obviously I have answered the question about a people's vote before—I strongly believe that having asked people in this country to determine whether or not this country should remain in the European Union, we, as their elected representatives, should recognise the feeling that was expressed in that vote and should deliver for people on that vote, and that means delivering leaving the European Union.

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21 NOV 2018

Fisheries Bill

Sarah Wollaston Chair, Health and Social Care Committee, Chair, Liaison Committee (Commons)

Further to the Secretary of State's earlier point about expanding fishing opportunities, I am happy to report that Brixham in my constituency has had another record year and in 2017 landed over £40 million-worth of fish, but it is now limited because it is at full stretch. Brixham is anxiously waiting to hear what my right hon. Friend will do to guarantee that it can have access to funds such as the European maritime and fisheries funds to allow it to expand. Brixham is really keen to get on with it.

Michael Gove The Secretary of State for Environment, Food and Rural Affairs

My hon. Friend makes a good point. I congratulate her on championing her constituency so successfully, and I thank the fishermen of Brixham for their work. In the EU we have the EMFF, which provides support for individual fishing communities, and this Bill makes provision for a replacement so that grants and loans can be provided for just such investment.

.....

Sarah Wollaston Chair, Health and Social Care Committee, Chair, Liaison Committee (Commons)

Further to the point about zonal attachment, does my hon. Friend agree with Brixham fishermen that sprats would be an ideal kind of species to look at, because 90% of them are caught within the 12-mile limit but we have only 52% of the total allowable catch? Does he agree that that would be a much more sensible way to proceed?

Neil Parish Chair, Environment, Food and Rural Affairs Committee

My hon. Friend makes an interesting point. By moving to a different system, we perhaps remove ourselves from some of the existing quota restrictions. Because those are historical, and because we did not necessarily get a good deal—far from it—when we went into the common fisheries policy, we have the opportunity to do this.

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21 NOV 2018

Gosport Independent Panel

Sarah Wollaston Chair, Health and Social Care Committee, Chair, Liaison Committee (Commons)

I welcome the Secretary of State's statement and commitment to introduce legislation to compel trusts to report on how they handle staff complaints and concerns, but will he assure the House that trusts will not be penalised if they have more staff concerns raised, because it might be an indicator that they have introduced the culture change necessary for staff to feel able to come forward? Will he also clarify how rapidly we will be rolling out the very welcome introduction of medical examiners?

Matthew Hancock Secretary of State for Health and Social Care

My hon. Friend is absolutely right that the number of complaints and concerns raised is not the material factor. A complaint that is actively welcomed and then acted on by management is merely part of the improvement process of any organisation. We should be open to them, welcome them and see them as an important part of the continuous improvement of NHS trusts, which is how many successful organisations see them. As I set out in the statement, medical examiners will be introduced from next April, but I am happy to give her more details of that whole policy.

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20 NOV 2018

Road Safety and the Legal Framework

Sarah Wollaston Chair, Health and Social Care Committee, Chair, Liaison Committee (Commons)

Inactivity is far more dangerous to people's health than cycling or walking. We need to get the message out loud and clear that cycling and walking are great for our health, and we need to get Britain moving. One of the greatest deterrents, however, particularly for parents, is fear of the danger of our roads.

I will add to points made by other hon. Members by speaking about those drivers who escape all consequences. I suggest to the Ministerthat we need to get across the immediacy and certainty of consequences. The line between careless and dangerous driving is a very blurred one; today's careless driver is tomorrow's dangerous driver. We need to ensure that people do not entirely escape consequences and that they know what will follow. I agree that we need to close the exceptional hardship loophole. Merely inconveniencing and fining those who are at the beginning of their journey to becoming dangerous drivers is not enough.

I also ask the Minister to consider the role of restorative justice. To give an example, I got the phone call that no parent wants to get, telling me that my daughter was unconscious in the back of an ambulance. While wearing hi-vis in a cycle lane, she had been knocked off her bicycle by a careless or even dangerous driver who was in a hurry and was turning into a side road. If my daughter had not been wearing a cycle helmet, she would undoubtedly have been killed or very seriously injured. I was shocked that she was interviewed in the casualty department while she was still concussed.

There were no consequences whatever for the driver. My daughter is not a vindictive person and nor am I, but at the very least I would have expected someone to investigate the incident. Witnesses came forward and were happy to testify, but nothing happened. When someone has been very seriously injured in such a collision, restorative justice could play a role. I hope the Minister will consider how we can ensure that drivers meet the person whom they have injured. Until that takes place, they should face some immediate consequences—a ban, at least.

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20 NOV 2018

Health and Social Care Committee

The Health and Social Care Committee met today to discuss the implications of the Budget for health and social care.

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19 NOV 2018

Second Homes

Thank you to Cllr Ian Bramble and Lisa from South Hams District Council for coming to Parliament to meet Rishi Sunak MP, Minister for Local Government to discuss fair contribution from second home owners and the business rates 'loophole' which could be costing councils millions in lost Council Tax. Currently, second-home owners pay Council Tax on their properties including when the property is available to rent infrequently during the year.

Properties are valued for business rates when owners declare their property is available to let as 'holiday accommodation' for 140 days or more in a year. Any property registered for business rates, rather than Council Tax, is likely to qualify for small business rate relief. This provides 100% relief from business rates, so no tax is due on properties with a rateable value of £12,000 or less. Around 47,000 holiday lets in England are liable for business rates, of which circa 96% have rateable values of £12,000 or less. Currently there is no requirement for evidence to be produced that a property has actually been commercially let.

Genuine businesses can claim the relief to which they are entitled. However, there are concerns that owners of second homes which do not fall into this category, could exploit the system by not paying Council Tax, whilst still using local services.

A consultation is seeking views on whether to strengthen the checks that are already in place to ensure second-home owners have to pay Council Tax, while ensuring genuine holiday let businesses are able to demonstrate they are eligible for business rates relief. The consultation closes on 16th January 2019

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19 NOV 2018

Finance (No. 3) Bill: Carbon Emissions Tax

Sarah Wollaston Chair, Health and Social Care Committee, Chair, Liaison Committee (Commons)

Does the hon. Gentleman agree that this issue relates not just to future forecasting? The Health and Social Care Committee has been hearing that hundreds of millions of pounds are already being spent by pharmaceutical companies on no deal contingency planning—money that would be far better invested in our NHS.

Chuka Umunna Labour, Streatham

I could not agree more with the hon. Lady.

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15 NOV 2018

EU Exit Negotiations

Sarah Wollaston Chair, Health and Social Care Committee, Chair, Liaison Committee (Commons)

It will be blindingly obvious to the entire country that the Prime Minister's deal cannot pass this House. People will find it unforgivable that we are running out of road and that in 134 days we will be crashing out of the European Union with no deal and no transition, with catastrophic consequences for all the communities that we represent in this House. May I urge her to think again about whether at this stage we should go back to the people and present them with the options, rather than just stumbling on regardless into something that will have such profound implications for all of our lives?

Theresa May The Prime Minister, Leader of the Conservative Party

The nature of Brexit and our future relationship with the European Union will be a matter that will come before this House in the vote that the House will take. Members of the House will have various issues to consider when they take that vote. I say to my hon. Friend, as I have said to other hon. and right hon. Members, that I firmly believe that, having given the choice as to whether we should leave the EU to the British people, it is right and proper, and indeed our duty as a Parliament and a Government, to deliver on that vote.

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14 NOV 2018

Healthcare (International Arrangements) Bill

Sarah Wollaston Chair, Health and Social Care Committee, Chair, Liaison Committee (Commons)

Does my hon. Friend accept, though, that the majority of the difference is due to the disproportionate number of British pensioners living abroad compared to the number of EEA foreign nationals living here as pensioners?

......

Sarah Wollaston Chair, Health and Social Care Committee, Chair, Liaison Committee (Commons)

I will be supporting the Bill today. I am only sorry it is necessary. There is no version of Brexit that will benefit people who rely on the NHS, social care, scientific research or public health; there are only varying degrees of harm. The Bill seeks to address one of those harms, and that is around our reciprocal healthcare arrangements, which have made such a difference to people's lives both here and across the EU. As Martyn Day pointed out, 190,000 UK expats live in the EU and 27 million people hold an active European health insurance card, which covers about a quarter of a million treatments every year, but we are also talking about British citizens who travel or live in the EU to work and the 1,300 people who benefit from planned medical treatments in the EU under the S2route.

I will turn first to the 190,000 British expatriates, mostly pensioners, living in the EU. Incidentally, 90% of them live in Ireland, Spain, France and Cyprus. They face a desperately worrying future. In the event of a deal, they will be covered by transitional arrangements until 2020, but in the event of a chaotic exit, with no deal and no transition, in just 135 days, they could be left stranded, many of them with access only to very basic medical care. Some of them will be uninsurable and many will have no easy path to return to the UK.

The Minister will know that, as I mentioned to my hon. Friend Sir Robert Syms, 75%—£468 million of the total £630 million in 2016-17—of the cost of our reciprocal healthcare arrangement relates to pensioners. When he sums up, will the Minister please respond to the updated estimated cost of those pensioners having to return to the UK and the net effect on the NHS? The Health and Social Care Select Committee heard that the current average cost of treating a UK pensioner in Spain was €3,500, but the average cost of treating pensioners in the UK was £4,500, and again the discrepancy between the pounds and euros makes that even greater.

In the future, the costs associated with EHIC— £156 million—and the S2 route for planned medical treatments will be borne directly by the 50 million UK nationals who visit the EU every year, but those costs will not be distributed evenly. The costs will fall disproportionately on those with pre-existing medical conditions. They will be exceptionally hard hit. As we heard from Justin Madders, many individuals will be effectively uninsurable and unable to travel. Will the Minister tell us what clear advice the Government are giving to people with pre-existing medical conditions who are thinking of making travel arrangements after 29 March? Is he being explicit with them, and telling them that they need to check now whether they may find themselves left stranded without medical insurance in the event of our crashing out in a chaotic exit with no deal whatsoever?

I recognise and welcome the fact that the Bill gives the Minister power to put in place an equivalent scheme, but that scheme will have to involve a dispute resolution process. In the deal that is about to be published, has the Minister seen what that process would be? Another thing that he needs to be very clear about when he sums up the debate is that if we crash out with no deal and no transition, we will not be making these reciprocal arrangements with a single body; we will be making them with 27 different European states, three European economic area states, and Switzerland. Is it even conceivable that we could complete negotiations on that scale with 135 days to go? We need to be really clear with Members throughout the House, and to the public, about what that means, so that people can make plans accordingly. May I also ask whether the Minister is setting aside, within the contingency fund, a sum of money that we could use to assist British nationals who find themselves in difficulties on the wrong side of the channel in the event of no deal and no transition? Those are all important points about which we must be very clear with people.

Does the Minister agree that during the referendum campaign there were very many different versions of Brexit? The Brexit reality with which we are about to be presented is very different from the fantasy version that was presented during the campaign. People will remember the "easiest deal in history" and the "financial bonanza" for the NHS, but the Brexit reality is that there will be a significant Brexit penalty, from the most damaging form of Brexit in particular. We are looking at effects across the entire health, care and research system. Yesterday I met representatives of the Royal College of Nursing to discuss their grave concern about the future workforce. While the overall number of registrants has increased, there has been a very worrying decrease in the number of joiners in the past year. The number of joiners from EEA countries has dropped by nearly 20%.

......

Sarah Wollaston Chair, Health and Social Care Committee, Chair, Liaison Committee (Commons)

That is, indeed, a question that I have been addressing. What will happen to expats in Europe? What we absolutely must focus on, however, is what will happen 135 days from now if we do not have a deal and people are left high and dry. It is a very worrying situation.

The issue of the workforce does not just affect nursing staff. We should bear in mind that 5% of members of the regulated nursing profession, 16% of dentists, 5% of allied health professionals and 9% of doctors are EEA nationals. We cannot afford to lose any more of that workforce, or to demoralise them further. I think it shames us all that the Health and Social Care Committee heard from nursing staff from across the European Union some of whom were in tears when reporting that they no longer felt welcome here. That is a terrible Brexit penalty, and no one voted for it when they went to the polls.

This does not just affect the workforce either. The Brexit penalty applies to the entire supply chain of medicines and medical devices, from research and development to clinical trials, to the safety testing of batches of medicines, and right through to the pharmacy shelf and the hospital. There are many unanswered questions about the issue of stockpiling, and about contingency plans for products that may require refrigeration, or products with very short shelf lives that cannot be stockpiled. There may also be brand-switching issues: for people who suffer from conditions such as epilepsy, switching brands is not easy.

I am sorry, Madam Deputy Speaker. I will bring my remarks to a close shortly. [Interruption.] I understand that you were merely coughing, Madam Deputy Speaker, so I will continue.

Refrigerated warehousing and special air freight do not come cheap. The companies whom we met, represented by the Association of the British Pharmaceutical Industry, made it clear that they were already having to spend hundreds of millions of pounds on contingency planning. The Government have said that they intend to reimburse companies, but the smaller companies need to know how quickly they will be reimbursed, because they may have cash-flow issues. They need to know the details of how the scheme will work, but they simply do not have the information that would enable them to make plans for the future. I hope that the Minister will be very mindful of that.

As I said earlier, the simple truth is that the many versions of Brexit have very different implications for the NHS, for social care, for public health and for research. Once this deal is published, we will have an opportunity to set out what this means, but, most important, to set all the risks and benefits of the deal that is on offer for the NHS and social care. The Minister will be aware of the important principle of informed consent in healthcare. No one would dream of going into an operating theatre and having an operation without someone telling them what is involved and setting out the risks and benefits so that they could weigh them up for themselves. That is called informed consent, and without informed consent, there is no valid consent.

Let me say to the Minister that we are all being wheeled into the operating theatre for major constitutional, economic and social surgery without informed consent, and let me ask him please to consider how things will be 136 days from now, after we crash out with no deal and when the serious consequences of that start to unfold and unravel and hit real people's lives. What will he be saying to his constituents and the House if we have proceeded without informed consent?

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12 NOV 2018

UK Statistics Authority

Always a pleasure to catch up with Ed Humpherson of UK Statistics Authority, to discuss the importance of Government publishing accurate data, presented in a timely and meaningful way.

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12 NOV 2018

Epilepsy

Thank you to the Daisy Garland, SUDEP Action and the Epilepsy Society for coming to Parliament today to meet with Sarah Marsh, Deputy Head of Clinical Policy NHS England, Professor Adrian Williams, Consultant Neurologist and Charlie Fairhurst, Consultant in Children's Neurodisability to discuss service review for epilepsy, and the research and implications of Brexit

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06 NOV 2018

National Guardian

I met today with Dr Henrietta Hughes, the National Guardian and we spoke about how the work of the National Guardian Office and how Freedom to Speak Up Guardians are supporting NHS workers to speak up.

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06 NOV 2018

Assessment and Treatment Units: Vulnerable People

Sarah Wollaston Chair, Health and Social Care Committee, Chair, Liaison Committee (Commons)

Does the Minister accept that, fundamentally, far too many people are ending up in terrible conditions in secure settings because of the inadequacy of social care? Will she commit to include in the Green Paper, which is to be brought forward before Christmas, the Green Paper for young adults as well as for older people? Will she absolutely commit to that coming forward before Christmas?

Caroline Dinenage Minister of State (Department of Health and Social Care)

My hon. Friend is absolutely right to recognise that the cases in which people end up in a long-term residential setting often reveal a failure of joint working—of the wraparound services that people need to keep them in the community. We are looking at working-age adults as part of the social care Green Paper, and it will be published before Christmas.

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05 NOV 2018

Road Safety

Sarah Wollaston Chair, Health and Social Care Committee, Chair, Liaison Committee (Commons)

I am really glad to hear the Minister talk about close passing, but it is also about the speed of passing, which he has not mentioned. Will he also look closely at 20-mph limits and how they can be enforced?


Jesse Norman Parliamentary Under-Secretary (Department for Transport)

I am happy to let my hon. Friend know—or she may know—that we already have a consultation out on this, and we expect to report on that later this year.

Many factors go into making our roads safer, including the road environment, the vehicles we drive and behaviour, but so does enforcement. Last October, the Ministry of Justice published its response to a consultation on the penalties for the most dangerous drivers, and Ministers announced that they will introduce life sentences for killer drivers—an increase on the current 14 years. The Government have said that they will create a new offence of causing serious injury by careless driving, and that Ministers will introduce new legislation as soon as parliamentary time allows.

I welcome this debate. As the House will see, the Government remain energetic, focused and determined in their efforts to improve road safety.

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05 NOV 2018

Bullying and Harassment: Cox Report

Sarah Wollaston Chair, Health and Social Care Committee, Chair, Liaison Committee (Commons)

Dame Laura Cox refers in her report to the Parliamentary Health and Wellbeing Service helping staff who have been subject to bullying and harassment, and she comments that the service is

"overworked, under resourced, under promoted and undervalued by the senior administration."

Will my right hon. Friend meet Dr Madan, who heads up the service as the leading occupational physician? She has a unique insight into the culture and sees staff who might not feel confident to come forward.

Andrea Leadsom Lord President of the Council and Leader of the House of Commons

I would be delighted to meet the head of the Parliamentary Health and Wellbeing Service. My hon. Friend is right to point out that the service has been overworked. As part of the new complaints and grievance procedure, resources will be made available, but nevertheless I would be very happy to meet the lady she mentions.

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05 NOV 2018

Universal Credit: Prevention of Ill Health: Government Vision

Sarah Wollaston Chair, Health and Social Care Committee, Chair, Liaison Committee (Commons)

In the Secretary of State's vision for prevention he rightly points out that £14 of social benefit accrues from every £1 spent in public health. Therefore it is going to be much more challenging for him to deliver on his objectives if there is a further transfer from the public health budgets into NHS England budgets. However, I recognise that this requires action across all Departments, so will he set out what he is going to do to encourage cross-government action on physical activity, because we all know that that is a vital part of public health and prevention?

Matthew Hancock Secretary of State for Health and Social Care

I agree with my hon. Friend the Chair of the Select Committee on that. Of course, the public health budgets for local authorities and Public Health England will be settled as part of the spending review, and there was no change to them in the Budget last week. There are also much wider responsibilities on activity—on cycling and walking—on which I am working with the Department for Transport. The document is all about the cross-government action, and the NHS will come forward with its long-term plan for the NHS-specific action. If there are aspects of cross-departmental working that she suggests we have not yet taken up, I will be looking forward to listening to her on that.

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01 NOV 2018

Fixed Odds Betting Terminals

Sarah Wollaston Chair, Health and Social Care Committee, Chair, Liaison Committee (Commons)

In his Budget statement, the Chancellor referred specifically to wanting to reduce the tragedy of lives being lost to suicide. This is clearly a measure that could be taken; the industry has had ample time to prepare for it. May I urge the Secretary of State to reconsider and to bring forward the date on which remote gambling duty is brought in, so that it can cover the costs that he has mentioned in relation to protecting public services? The tragedy of lives being lost to suicide has to be our absolute priority here, and there is good evidence for this measure. I urge him to think again and to bring it in.

Jeremy Wright The Secretary of State for Digital, Culture, Media and Sport

I have huge respect for my hon. Friend's passion on this subject, and for the approach that she takes to issues such as this. I hope she will accept that there is no lack of enthusiasm on my part for countering the harms that she has described. The reason that we are making this decision is not because we believe it is important to pacify the betting lobby. Had that been the case, we would not have made this change at all. We have made this change because we believe that it is necessary to make it, but it is also necessary to make this decision in the most rational way that we can and to balance out a number of factors that we have no choice but to properly consider in order to achieve the objective that she and I share.

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01 NOV 2018

Shipping: Exhaust Emissions

Written Answers

Sarah Wollaston Chair, Health and Social Care Committee, Chair, Liaison Committee (Commons)

To ask the Secretary of State for Transport, what discussions he has had with the (a) Secretary of State for Environment, Food and Rural Affairs, (b) Marine Management Organisation and (c) Maritime and Coastguard Agency on assessing and mitigating the risks that scrubber technology poses to UK waters and coastlines.

Nusrat Ghani Parliamentary Under-Secretary (Department for Transport), Assistant Whip (HM Treasury)

Exhaust Gas Cleaning Systems (EGCS), or 'scrubbers' as they are commonly known, are an internationally recognised technology which ships can use to comply with sulphur limits, providing an alternative to using low sulphur marine fuel. The systems are subject to controls at an international level through the adopted International Maritime Organization (IMO) Guidelines, which are mandatory.

The Guidelines ensure sulphur dioxide emissions from scrubbers are equivalent or better than would be obtained from using compliant fuel. They also address water quality and environmental impacts, in order to mitigate risks to the marine environment.

The Department and the Maritime and Coastguard Agency, played an active role in the development of the Guidelines at both European and international level with input from the Marine Management Organisation, the Department for Environment, Food and Rural Affairs, system manufacturers, as well as approval organisations and industry stakeholders.

Ships' installed scrubbers must be approved in accordance with the Guidelines before operating in UK waters.

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01 NOV 2018

Health and Social Care Committee

Sarah Wollaston Chair, Health and Social Care Committee, Chair, Liaison Committee (Commons)

I thank the hon. Lady for making that point. We did not look at devolved issues, because the remit of the Health and Social Care Committee is England only, but the hon. Lady makes a very important point. As the Justice Committee has an ongoing interest in this issue, there might be an opportunity for that Committee to take the matter up more quickly than we would be able to, but I would be very interested if the hon. Lady wanted to write to me about it.

I again thank all those who contributed to the inquiry, and I look forward to hearing the ongoing thoughts of the Justice Committee.

Jackie Doyle-Price The Parliamentary Under-Secretary for Health and Social Care

I really welcome the report. My hon. Friend Dr Wollastonalluded to the fact that this issue lies within the bailiwicks of both the Department of Health and Social Care and the Ministry of Justice; I am glad that the Under-Secretary of State for Justice, my hon. Friend Edward Argar, is here beside me. We are seized of the importance of this issue and recognise that silo culture is often the enemy of good policy making. Rest assured that we will take away the report and reflect on it. We are very grateful for the interest that the Health and Social Care Committee has shown in this very important subject, because we do need to do a whole lot better.

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01 NOV 2018

Prison Health

Sarah Wollaston Chair, Health and Social Care Committee, Chair, Liaison Committee (Commons)

I would like to present a report on "Prison health" by the Select Committee on Health and Social Care. I start by thanking my fellow Committee members and the Committee staff, particularly Huw Yardley and Lewis Pickett. I also particularly thank all those who gave evidence to our inquiry, both in person and in writing. We visited HMP Isis, HMP Belmarsh and HMP Thameside, and I thank the staff, healthcare staff and all the people in prison who spoke to us about their experiences.

A prison sentence is a deprivation of liberty, not a sentence to poorer health or healthcare, yet sadly that was the picture that we found in our inquiry. Too many prisoners are still in overcrowded, unsanitary prisons with overstretched workforces. Those poor conditions contribute to even worse outcomes and health for those who arrive in prison, who are often from very deprived backgrounds and suffering from serious health inequalities. Violence and self-harm are at record highs, and most prisons exceed their certified normal accommodation level, with a quarter of prisoners living in overcrowded cells over the last two years. Staffing shortages have led to restricted regimes that severely limit prisoner activity, as well as their access to health and care services, both in and outside our prisons.

Too many prisoners still die in custody or shortly after their release. Although deaths in custody have fallen slightly since peaking in 2016 as a result of increased suicides, so-called natural-cause deaths are the highest cause of mortality in prisons and, I am afraid, reflect serious lapses in care. Every suicide should be regarded as preventable. It is simply unacceptable that those known to be at risk face unacceptable delays while awaiting transfer to more appropriate settings. We see that happen time and again, without appropriate action being taken.

Our report refers to the impact of the increasingly widespread use of novel psychoactive substances, not just on prisoners but on prison staff; dealing with violent incidents takes time away from the work that we would otherwise expect prison staff to do. We heard time and again from people in prison who we met of not being able to attend appointments, either within or outside the prison, because there simply were not the staff there, because they had been diverted to other cases.

We have made recommendations for the National Prison Healthcare Board. We would like it to agree a definition of equivalent care, and to tackle the health inequalities that we know prisoners face. It also needs to take a more comprehensive and robust approach to identifying and dealing with the healthcare needs of people in prison. However, many of our recommendations will not be met until sufficient prison officers are in post. That is an overriding issue, because the cut in prison officer numbers—I know the Government are starting to address that—lies at the root of so many problems in our jails.

Health, wellbeing, care and recovery need to be a core part of the Government's plans for prison reform. It is in all our interests to care about the health and wellbeing of prisoners, because they will later be back in our communities. If more of them become dependent on drugs during their time in prison, and these problems worsen, they will come back into our communities with even worse health issues, health inequalities and mental health problems. I know it is difficult, because it sometimes seems that the public do not care about our prisoners, but it is absolutely in everybody's interest to care about the health and wellbeing of our prison population.

I am afraid that our report highlights a system in which, time and again, reports from Her Majesty's inspectorate of prisons are not acted on. We need those reports to have real teeth, and for people to be able to take action, or to be held accountable for not taking action. We heard time and again of governors not having the levers—even if they had the financial powers—to take the necessary action.

We call on the Government to regard the health of our prison population as a serious public health crisis requiring a whole-systems approach that takes root in sentencing and release, making sure that people are only in prison if absolutely necessary, that those with serious mental health problems are transferred in a timely manner and that sees time in prison as an opportunity to act and to address serious health inequalities. That is not only in their interest but in all our interests.

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31 OCT 2018

Shipping: Exhaust Emissions

Written Answers

Sarah Wollaston Chair, Health and Social Care Committee, Chair, Liaison Committee (Commons)

To ask the Secretary of State for Transport, what assessment he has made of the potential effects of the use of scrubber technology and marine sulphur dumping on UK coastlines.

To ask the Secretary of State for Transport, what assessment he has made on the potential effects of the use of scrubber technology and marine sulphur dumping on the English channel.

To ask the Secretary of State for Transport, what assessment he has made of the potential effects of the use of scrubber technology and marine sulphur dumping on marine life and biodiversity in UK waters.

To ask the Secretary of State for Transport, what assessment he has made of the potential effects of the use of scrubber technology and marine nitrate dumping on algae build up on UK coastlines.

Nusrat Ghani Parliamentary Under-Secretary (Department for Transport), Assistant Whip (HM Treasury)

The Government has not seen any evidence that the use of scrubbing technology would have any significant effect on marine environment.

All scrubbers must comply with mandatory Guidelines, which were developed by the International Maritime Organization, before they are allowed to become operational. The potential effects of the use of scrubber technologies on the marine environment was taken into consideration when developing the Guidelines. To be compliant, the systems collect and store any sulphur residue and solid particulate matter on-board the vessel, to be deposited at a port waste reception facility.

Some scrubbers discharge treated wash water back into the sea – which is also controlled under the IMO Guidelines. There are ongoing studies which are looking at the impact of wash water discharges within European waters, which we are monitoring. At this stage, we are not aware of any significant issues which have been found. However, we will respond appropriately at international level, if these or any other studies, conclude that further controls are needed.

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30 OCT 2018

DEFRA Fisheries

Written Answer

Sarah Wollaston Chair, Health and Social Care Committee, Chair, Liaison Committee (Commons)

To ask the Secretary of State for Environment, Food and Rural Affairs, what assessment his Department has made of the (a) location and (b) scale of bycatch in inshore fisheries; and when he plans to publish that assessment.

George Eustice The Minister of State, Department for Environment, Food and Rural Affairs

The Government funds the UK bycatch monitoring programme which provides essential observer data on incidents of bycatch. Bycatch levels are broken down by gear type and area. We do not have information on the exact numbers of bycaught individuals in inshore fisheries but estimates derived from observer data can be found here

The Sea Mammal Research Unit has undertaken work to identify potential marine mammal bycatch hotspots in the UK and the viability of the deployment of acoustic deterrent devices in the southwest of England. This report will be published following peer review.

We are currently working with stakeholders to develop a UK Cetacean Bycatch Strategy to address the issue of unintentional capture of dolphins, whales and porpoises. The Strategy will focus on implementing practical solutions in areas where there are high levels of bycatch, initially focussing on the southwest of England.

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30 OCT 2018

Budget Resolutions - Income Tax (Charge)

Sarah Wollaston Chair, Health and Social Care Committee, Chair, Liaison Committee (Commons)

May I start by apologising for being absent for much of this debate because I was chairing the Health and Social Care Committee? I also declare a personal interest, as three members of my immediate family are employed as NHS doctors.

We need to take a whole-system approach to health— to think of it not just as the NHS, but as a system including social care, public health, the prevention arm and training budgets. I return to a point that I made in an intervention: I wholly welcome the uplift in the NHS budget, but the increase in the NHS England budget that will take place between 2018-19 and 2019-20 is £7.2 billion, whereas the uplift in the wider health budget in the Red Book is only £6.3 billion. It concerns me that this might indicate that some of the uplift in the NHS England budget will come by way of being taken out of other aspects of the health budget, particularly the Public Health Englandbudget, as we have seen in previous years. I hope that the Ministerwill touch on that in his response.

Jon Ashworth Shadow Secretary of State for Health

I think that the hon. Lady may have left the debate to attend her Committee when I re-emphasised her point directly to the Secretary of State, who told us that we would have to wait for the spending review. Would she share my disappointment if the Government tried to pull the same trick that they pulled three years ago, and actually misled us or gave us bogus figures for NHS spending that did not include public health expenditure, capital and training?

Sarah Wollaston Chair, Health and Social Care Committee, Chair, Liaison Committee (Commons)

We need absolute transparency around health spending, and to take not only a whole-system approach but a long-term view.

Public health is the prevention arm of the system, and taking money out of public health has a serious impact on future spending and our ability to tackle health inequalities. It would be very troubling indeed if much of this uplift came directly from a public health cut. We need to be specific about that, and it is not sufficient to wait for the spending review to clarify that point; I hope that the Minister will be able to tell us further about what it means. People need to plan for the future, so if £900 million is going to be taken out of public health grants, we need to know that now.

When we ask the public which parts of the system they prioritise, public health tends to be at the bottom of the list. It is up to the Government to look at the evidence, and they must be clear that the evidence shows that we must focus unrelentingly on the prevention arm of healthcare. That is the right thing to do, and it is where we have the greatest chance of tackling the burning injustices of health inequality, so it is an important point to address.

The other aspect I want to touch on is social care. The Health and Social Care Committee has just had a sitting with the Care Quality Commission on its excellent "State of Care" report. The report comments on "fragility," and the report of a couple of years ago talked about "a tipping point." The CQC told us that that tipping point has been passed for many people in social care. The interaction between social care and the health service is so close that, if we do not focus on social care, we are simply tipping more costs on to the health service.

Of course it is welcome that there will be an in-year increase for adult social care of £240 million this year and £650 million next year, but it is widely recognised that, because of the extraordinary increase in demand and pressure—driven not just by the welcome fact that we are living longer but by the great increase in the number of people with multiple long-term conditions living to an older age and by younger, working-age adults living with multiple complex needs—social care needs more than £1 billion a year just to stand still, so we need to go further.

I recognise that much of this will come alongside next year's social care Green Paper, which we are all looking forward to, but the system is under considerable challenge. I hope the Minister will recognise in his closing remarks that we are not there yet on social care. He needs to say what we are going to do in the long term to address our social care needs. As I have said before, we will require an approach that involves the Labour Front Benchers, too. We need to see political consensus, otherwise the politically difficult decisions on funding will not get through the House.

If there are to be cuts to public health, the Government will have an even greater responsibility to provide other levers in their public health policy to reduce demand in the system. The Chancellorspecifically referred to wanting to reduce the tragedy of lives lost to suicide. Unfortunately, at the same time, the delay in the reduction of the maximum stake for fixed odds betting terminals means that we have passed up on an important opportunity to address the misery of gambling addiction. That is a hugely wasted opportunity. Likewise, there is a missed opportunity to look at what has happened in Scotland on minimum unit pricing to make sure we are addressing some of the key drivers of public health problems. The Government cannot duck that if we are to see cuts to the public health grant.

Finally, there is the impact of Brexit. The Chancellor has said that there will be £4.2 billion for preparations for a no-deal Brexit. I am afraid that the costs will be far higher. The Health and Social Care Committee recently heard from the pharmaceutical industry that it is having to plough hundreds of millions of pounds into preparing for no deal. That is phenomenal and inexcusable waste; it is money down the drain. I hope the Government will rethink their policy, because no version of Brexit will provide more money for the NHS. There is a Brexit penalty, not a Brexit dividend, and I hope both Front-Bench teams will come together and agree that, ultimately, we need the informed consent of the British people for whatever version of Brexit we come up with, with the option to remain and properly use the money instead for tackling austerity and improving the lives and the health of our nation.

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26 OCT 2018

DEFRA Fisheries

Written Answer

Sarah Wollaston Chair, Health and Social Care Committee, Chair, Liaison Committee (Commons)

To ask the Secretary of State for Environment, Food and Rural Affairs, what discussions the Marine Management Organisation has had with Wildlife Trusts on the use of pingers on vessels in inshore fisheries.

George Eustice The Minister of State, Department for Environment, Food and Rural Affairs

The Marine Management Organisation recently held very constructive discussions with Cornwall Wildlife Trust on the use of pingers in the South West of England and the requirements of wildlife licences for activities that may harm marine species protected under EU and UK legislation.

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25 OCT 2018

Immigration: DNA Tests

Sarah Wollaston Chair, Health and Social Care Committee, Chair, Liaison Committee (Commons)

Mandatory DNA testing is not only illegal but unethical, and it can put lives at risk. I therefore welcome the statement, but does my right hon. Friend agree that in building a fair and humane system, we must also recognise the importance of the confidentiality of medical records? Will he look at a letter that I received from NHS Digital on 22 October, in my capacity as Chair of the Health and Social Care Committee, expressing concern about revised guidance that followed assurances given in the House about the importance of confidentiality earlier this year?

Sajid Javid The Secretary of State for the Home Department

My hon. Friend speaks with experience of these issues, and I strongly agree with her that mandatory DNA testing is not only unlawful but unethical. She raised the issue of confidentiality and mentioned a letter that she was sent as Chair of the Health and Social Care Committee. I should be happy to look at that and to respond to her fully.

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24 OCT 2018

Northern Ireland (Executive Formation and Exercise of Functions) Bill

Sarah Wollaston Chair, Health and Social Care Committee, Chair, Liaison Committee (Commons)

My hon. Friend appears to be arguing for the continuation of a human rights border down the Irish sea.

 

Fiona Bruce Conservative, Congleton

What I am arguing—reluctantly, I need to repeat many of the points I made in the Chamber yesterday—is that this key issue does merit reconsideration, but reconsideration in the right legislative chamber, namely the Northern Ireland Assembly. Elected officials there should be making such decisions while accountable to the people they represent.

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23 OCT 2018

Health and Social Care: NHS Innovation

Sarah Wollaston Chair, Health and Social Care Committee, Chair, Liaison Committee (Commons)

Digital health tools, including decision-support software, have a great potential to increase the quality, safety and cost-effectiveness of care for patients, and nowhere is that more important than in reducing antimicrobial resistance. Will my right hon. Friend respond to the points that we on the Health and Social Care Committee make in our report about the variation in roll-out, which is wholly unacceptable, and what measures will he take to make sure that it is clear where the responsibility for this lies?

Matthew Hancock Secretary of State for Health and Social Care

I pay tribute to the Select Committee for the report on AMR that was published yesterday. Of course, digital tools such as the one that my hon. Friend mentions are important in making sure that we make the best use of antibiotics and counter antimicrobial resistance as much as possible.

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22 OCT 2018

Nick Hurd

I met today with Policing Minister, Nick Hurd to discuss police funding.

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18 OCT 2018

Scallops: Fisheries

Written Answers

Sarah Wollaston Chair, Health and Social Care Committee, Chair, Liaison Committee (Commons)

To ask the Secretary of State for Environment, Food and Rural Affairs, whether he has had discussions with his French counterpart on ensuring that information resulting from the toxicity testing of scallop fishing areas in the English Channel is made available to British fishermen in a timely manner or at the same time as to French fishermen; and if he will make a statement.

George EusticeThe Minister of State, Department for Environment, Food and Rural Affairs

As the responsible UK body, the Food Standards Agency has reiterated to the French Authorities the importance of ensuring that communications about the opening of fisheries, where raised toxin levels in scallops have resulted in their closure, are made to all of those affected at the same time.

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17 OCT 2018

Social Care Funding

Sarah Wollaston Chair, Health and Social Care Committee, Chair, Liaison Committee (Commons)

The very troubling case that the hon. Lady has described illustrates why we, as a House, must get this right. Does she accept that there has been political failure to resolve the issue of how we fund social care, and will she commit herself to taking a constructive, cross-party approach to getting it right?

Barbara Keeley Shadow Minister (Mental Health and Social Care)

The hon. Lady has asked me that question a number of times, and I always find it difficult to answer. She will know that my party really tried, but when we produced that White Paper in 2010—when we had a way forward and a set of funding proposals—all that we heard was "death tax". In last year's Budget, the Chancellor raised the issue of the "death tax" again: he said that it was not an option. I wonder how the hon. Lady thinks that Labour Members can talk to a party whose Chancellor has ruled out one of the options right at the start, before anyone sits down and discusses anything. I think that that is impossible. I valued the hon. Lady's role as Chair of the Health Committee, of which I used to be a member. Perhaps she will write to the Chancellor, and ask him to stop doing that.

Sarah Wollaston Chair, Health and Social Care Committee, Chair, Liaison Committee (Commons)

As the hon. Lady will know, this is a pattern that has pinged backwards and forwards with successive Administrations. I repeat that we must get it right. We cannot continue these cycles of political failure. We will only solve the problem—particularly in a hung Parliament—with a constructive, cross-party approach.

Barbara Keeley Shadow Minister (Mental Health and Social Care)

I am constantly astonished when Conservative Members talk about a cross-party approach. It is up to their party to come up with some proposals. When it has some proposals, there will be something to talk about. All that we have seen the Conservatives do is abandon all the proposals that they have previously had. We legislated, in the Care Act 2014, for a cap on care costs and a lifting of the ceiling—the asset threshold—but the Conservatives have abandoned that now. They had a set of policies at the time of the election last year, but they have abandoned that. The hon. Lady needs to speak to her own Secretary of State, and I hope that she can have a constructive conversation with the Chancellor as well.

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17 OCT 2018

Universal Credit

Sarah Wollaston Chair, Health and Social Care Committee, Chair, Liaison Committee (Commons)

Totnes has a vibrant arts sector. My hon. Friend will know that many self-employed artists take longer to establish themselves as a business, and there may be great variation, month to month, in what they are paid. In the light of her detailed work, does my hon. Friend have any suggestions about how we can improve the situation for self-employed artists?

Heidi Allen Conservative, South Cambridgeshire

My hon. Friend is absolutely right: it is a fact that universal credit was not built for self-employed people, and it shows. The monthly assessments do not work and the minimum income floor needs to be looked at again because it typically takes more than a year for people's businesses to settle down.

To make the existing system really fly, I suspect that we need a boost to IT and admin man and womanpower behind the scenes, because let us make no mistake: universal credit is not yet fully automated. Claiming for childcare costs is a prime example of the manual work that is still being done. That brings me on to how we move legacy claimants across and the regulations that we have still to vote for—in November, I suspect. I am pleased that migration will start a lot later than originally planned, but I and many others still have concerns about the regulations. As a Government, we are choosing, for all the right reasons, to move people—that is people—across to a new system. I fail to see why that should be the complete and utter responsibility of those claimants. I have led on IT transformation projects in business and it would be unheard of for there not to be some kind of automated population of data from the old system to the new. We need to look really seriously into doing that, because it would save us hardship in the long run. Let us not forget that a third of migrated claimants are on ESA—the most vulnerable in society who have some kind of illness or disability—and we should look after them and not let them drop off the system. The population of data should be automatic and there should be no break in those people's payments at all.

Finally, when people arrive safe and sound on universal credit, the work allowances need to be what they should have been prior to 2015. How in this fair Great Britain that we call home can we have two families in identical circumstances living next to each other, but one has been protected across through migration and their next-door neighbours are £2,500 worse off a year? That is not Great Britain.

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15 OCT 2018

EU Exit Negotiations

Sarah Wollaston Chair, Health and Social Care Committee, Chair, Liaison Committee (Commons)

Here is some Brexit reality: AstraZeneca has announced just this afternoon that it is stopping investing in the United Kingdom. We have just 165 days to go until we leave the EU and we still have no deal, with disastrous consequences. The Prime Minister says that we cannot have a people's vote, but is not the truth here that the people were not able to see—there is no consensus about this—which of the many versions of Brexit we will be heading towards? Once we know that final deal, would it not be reasonable to go back to the British people, present them with what is involved and what the consequences are—both positive and negative—and then allow them to give their informed consent to moving forward?

Theresa May The Prime Minister, Leader of the Conservative Party

I have answered this question on a number of occasions before this afternoon in relation to the fact that I believe it is imperative for Members of Parliament across the House to deliver on the decision that we freely gave to the people of the United Kingdom and to deliver on the vote that they took in relation to leaving the EU. My hon. Friend references the fact that there is no deal yet, but we are continuing to work for that deal. We continue in those negotiations and look forward to continuing to work with the member states of the EU and the European Commission towards that end.

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10 OCT 2018

Agriculture Bill

Sarah Wollaston Chair, Health and Social Care Committee, Chair, Liaison Committee (Commons)

The chief medical officer, Dame Sally Davies, has described antimicrobial resistance as a "catastrophic threat", and the Secretary of State will know that it is not only in human healthcare but sometimes in farming that we see inappropriate use of antimicrobials, thus increasing the risk that we will lose their benefit to human health. Will he use the Bill as a vehicle to drive down further inappropriate antimicrobial prescribing in agriculture and to incentivise farmers who do the right thing? Will he also make sure that we are not exposed to products from places around the world where antimicrobials are used wholly inappropriately, including with environmental contamination?

Michael Gove The Secretary of State for Environment, Food and Rural Affairs

The Chair of the Select Committee on Health and Social Care makes an absolutely important point. I have had the opportunity to talk to Dame Sally Davies, who has written a brilliant short book about the vital importance of dealing with antimicrobial resistance. I should also pay tribute to Lord O'Neill, who led work under Prime MinisterDavid Cameron on this. My hon. Friend is absolutely right to say that the Bill contains provisions to provide support and payments to farmers who take the appropriate animal health and welfare measures to ensure that we can fight the overuse of antibiotics, which is both a threat to human and animal health, and an environmental danger.

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09 OCT 2018

Government Overseas Aid Commitment: Private Investment: EU Exit Negotiations

Sarah Wollaston Chair, Health and Social Care Committee, Chair, Liaison Committee (Commons)

The Secretary of State will have heard the clear intention of many colleagues on our Benches to vote down the Prime Minister's pragmatic deal. Meanwhile, the clock ticks down to 29 March and there is a serious risk that we could crash out with no deal and no transition. The consequences of that would be disastrous and very different from the dodgy prospectus that was set out in the referendum. Particularly if that is the case, will the Secretary of State commit to giving the British people the opportunity to give their informed consent to that final deal? It is not about obstructing the referendum; it is checking that we have informed consent, and no decent surgeon would proceed without it. 

Dominic Raab The Secretary of State for Exiting the European Union

I certainly agree with my hon. Friend about the need to pursue a good deal with the EU, and all our efforts are focused on achieving that. I do not accept the premise of her suggestion of a second referendum. I think it would inevitably be aimed at trying to reverse Brexit, and that would create democratic outrage and a huge amount of mistrust in the establishment and the political system.

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09 OCT 2018

Dangerous Waste and Body Parts Disposal

Sarah Wollaston Chair, Health and Social Care Committee, Chair, Liaison Committee (Commons)

I thank the Minister for the prompt action that he has taken since being notified of this situation. Will he reassure people in the community and in community settings that this issue will not affect their safety?

 

 

Stephen Barclay Minister of State (Department of Health and Social Care)

The Chair of the Health Committee raises an important point regarding residents in the areas where the sites are located, and I see Yvette Cooper in her place. The Environment Agency has confirmed that the waste is being stored safely; it is the amount of waste that is the issue. Many of our constituents are waiting for operations on these sites and will want reassurance that those operations can continue in a timely fashion. That has been a key focus of the Department, and I pay tribute to the work of officials in the NHS, the Department of Health, DEFRA and the Environment Agency, who have ensured that that strategic objective has been maintained.

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13 SEP 2018

Scallop Fishing: Bay of Seine

Sarah Wollaston Chair, Health and Social Care Committee, Chair, Liaison Committee (Commons)

UK vessels have no access to scallops anywhere within French waters inside the 12-mile limit, which is very much in contrast to the position of French vessels that have access to waters within the six to 12-mile limit in the UK. Will the Minister reiterate—there has been some misunderstanding about this—that our vessels were fishing absolutely legally at the time of these disgraceful attacks? I welcome his assurance and talks with his opposite number, as well as his offer of assistance, but Brixham fishermen would like further reassurance that, when they fish in those waters, perfectly legally, measures will be in place to ensure their safety.

George Eustice The Minister of State, Department for Environment, Food and Rural Affairs

I entirely agree with and understand my hon. Friend's point. Much of the scallop fishing industry is based in Brixham in her constituency. She is right to say that the contested grounds are outside the 12-nautical mile limit—they are approximately 20 miles off the French coast and therefore not in French territorial waters. She is also right to say that in some areas the French fishing industry is able to fish in the UK's six to 12-mile zone. She will be aware that the Government have already given notice, under the terms of the London fisheries convention, to withdraw from that agreement and negotiate access arrangements afresh.

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11 SEP 2018

Home Care Services: Living Wage

Written Answers

Sarah Wollaston Chair, Health and Social Care Committee, Chair, Liaison Committee (Commons)

To ask the Secretary of State for Business, Energy and Industrial Strategy, with reference to the Court of Appeal judgment on Royal Mencap Society v Tomlinson-Blake and Shannon v Rampersad made on 13 July 2018, what plans the Government has to bring forward proposals to ensure that overnight care is subject to the National Living Wage.

Sarah Wollaston Chair, Health and Social Care Committee, Chair, Liaison Committee (Commons)

To ask the Secretary of State for Business, Energy and Industrial Strategy, what the (a) status and (b) liability for care providers that enrolled in HMRC's Social Care Compliance Scheme.

Sarah Wollaston Chair, Health and Social Care Committee, Chair, Liaison Committee (Commons)

To ask the Secretary of State for Business, Energy and Industrial Strategy, what steps he is taking to issue guidance on rates for sleep-in shifts; and what discussions he has had with Cabinet colleagues on the adequacy of funding for local authorities to meet those rates.

Sarah Wollaston Chair, Health and Social Care Committee, Chair, Liaison Committee (Commons)

To ask the Secretary of State for Business, Energy and Industrial Strategy, with reference to the Court of Appeal judgment on Royal Mencap Society v Tomlinson-Blake and Shannon v Rampersad made on 13 July 2018, what guidance the Government has issued on rates of pay for sleep in shifts to (a) local authorities and (b) care commissioners.

Sarah Wollaston Chair, Health and Social Care Committee, Chair, Liaison Committee (Commons)

To ask the Secretary of State for Business, Energy and Industrial Strategy, with reference to the Court of Appeal judgment on Royal Mencap Society v Tomlinson-Blake and Shannon v Rampersad made on 13 July 2018, what plans the Government has to bring forward legislative proposals of the pay rates for care workers on sleep-in shifts.

Kelly Tolhurst Parliamentary Under-Secretary (Department for Business, Energy and Industrial Strategy)

The Court of Appeal judgment overturns the previous interpretation of the law and means that "sleep-in" shifts, as defined by the Court of Appeal, no longer attract the National Minimum Wage. The Court of Appeal judgment applies both retrospectively and going forward. Government guidance on when "sleep-in" shifts should attract the National Minimum Wage has been updated to confirm that the Government has noted the judgment. That guidance will be updated shortly once Ministers have fully considered the implications the Court of Appeal judgment.

Over the past year Ministers from across the Government have been working closely on how "sleep-in" shifts are remunerated and will continue to do so.

Ministers from BEIS and the Department of Health and Social Care are liaising with local authorities and care commissioners to ensure that they have clarity on the legal position and on their responsibilities when commissioning care services.

HMRC's voluntary Social Care Compliance Scheme remains open. Employers participating on the scheme should take note of the Court of Appeal judgment and review their pay practices accordingly. HMRC officers have been in contact directly with all employers enrolled on the scheme to set out next steps.

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10 SEP 2018

Ministry of Justice: Prisons: Staff

Written Answers

Sarah Wollaston Chair, Health and Social Care Committee, Chair, Liaison Committee (Commons)

To ask the Secretary of State for Justice, what steps his Department and HM Prison and Probation Service are taking to speed up security clearance for health and social care staff commencing employment in prisons.

Rory Stewart The Minister of State, Ministry of Justice

The last year has seen a significant increase in the level of recruitment with a target of deploying an additional 2,500 prison officers in post by the end of 2018. This has impacted the overall volume of cases handled by our shared services provider, due to significant increases in the number of applications handled. This has resulted in backlogs in processing across all of the business.

The right balance needs to be struck between having staff appropriately security cleared and the speed at which they can begin employment with HMPPS. Steps have been taken to review the whole recruitment end-to-end procedure to look at the points in which delays have or can take place. Action has been taken to address these and the backlog of cases has been reduced significantly from last year. This in turn, has also resulted in speedier processing times in security vetting for all staff.

Sarah Wollaston Chair, Health and Social Care Committee, Chair, Liaison Committee (Commons)

To ask the Secretary of State for Justice, what the average number of days taken was to gain security clearance for health and social care professionals seeking to commence employment in prisons in each of the last five financial years.

Rory Stewart The Minister of State, Ministry of Justice

The average number of days taken to complete security clearance for health and social care professionals seeking employment within HMPPS from 2016 has been provided in the table below.

We are unable to provide this information for cases prior to 2016, as a different operating system was used and to which the now service provider to HMPPS does not have access.

Financial Year
Average days
 2016-2017  56
 2017-2018  71
 April 2018 to present
 37

Please note - that the information in the table for health and social care professionals has been collated based on the job title of the campaign and may be subject to slight variations.

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06 SEP 2018

Integrated Care

Sarah Wollaston Chair, Health and Social Care Committee, Chair, Liaison Committee (Commons)

I beg to move, That this House has considered the Seventh Report of the Health and Social Care Committee, Integrated care: organisations, partnerships and systems, HC 650, and the Government Response, Cm 9695.

It is a pleasure to serve under your chairmanship, Dame Cheryl. I thank all those who contributed to our inquiry in writing and in person, my fellow Select Committee members, and the Select Committee team, which was ably led by our Clerk, Huw Yardley, with special input from Lewis Pickett. I also thank our special advisers, Professor Sir Chris Ham, Dr Anna Charles and Professor Pauline Allen.

We are all immensely grateful to the South Yorkshire and Bassetlaw sustainability and transformation partnership, the Doncaster Royal Infirmary and the Larwood practice, not only for allowing us to meet them and their teams, but for facilitating the Committee's meetings with local and national leaders from across the healthcare system, the third sector and many other providers to hear evidence during our inquiry. Without them, the report would not have been possible.

I will start by setting out what we are talking about, and why it matters. It is one of the greatest triumphs of our age that we are living longer but, as that happens, many more of us are living with complex, long-term conditions that require support and input not only from dedicated family and formal carer networks, but from across the health and social care system. If those systems do not join up, if they do not share information, or if they are poorly co-ordinated or inaccessible, patients' care is poorer and everyone has a worse experience. Don Redding from National Voices, said that patients and the public "want to feel that their care is co-ordinated, that the professionals and services they meet join up around them, that they are known where they go, that they do not have to explain themselves every single time, and...that their records are available and visible." That is essentially what we mean by integrated care.

Integrated care can happen at three levels. It can happen directly, in the teams around the patient who deliver care in the patient's home—for example, through joint assessments. It can happen at the service level—for example, with services brought together in a one-stop clinic. It can happen at an organisational level—for example, in commissioning or the pooling of budgets. We should all be clear, however, that none of that matters unless we keep the patient at the front and centre of those discussions. If the result is not delivering better care for patients and their families, it is not worth doing.

Integration does not save money in the short term or, sometimes, in the medium term, which acts as a key barrier to putting in place integrated systems for the long-term benefit of patients. Unfortunately, particularly with the current financial pressures, we have a system that is sometimes dictated and hampered by short-term pressures to deliver financial savings—I will come on to that later. In essence, we have to keep sight of the fact that integration is about people and families. Although our report focuses on organisations, partnerships and systems, we have tried to relate it back at every stage to why it matters to patients, rather than it being a dry discussion about systems.

.......

Sarah Wollaston Chair, Health and Social Care Committee, Chair, Liaison Committee (Commons)

I thank the hon. Lady, my fellow Committee member, for her input. We on the Committee heard that there is a complex spaghetti of acronyms—STPs, ICPs, ACOs—and nobody knows what they mean. Even those working in the system struggle to keep pace with them and with the changes. We have to keep bringing it back to plain English and why it matters to people and hold our attention there.

The integration of health and social care has been a long-term goal for successive Governments for decades, so we might ask why it is not happening everywhere if we have been striving for it for so long. We saw and heard about many fantastic examples of good integrated care, but they sometimes felt like oases in a desert of inactivity. It is also possible to have an area that does some things very well but others not so well.

.......

Sarah Wollaston Chair, Health and Social Care Committee, Chair, Liaison Committee (Commons)

I will respond further to the hon. Lady's remarks when I comment on legislative change and how we can get legislative change through a hung Parliament. I will also comment on the importance of engaging with the service and why that needs to come bottom-up from the service, and the importance of politicians from across the House listening to the service and being focusing on its message and the message from patients and patient representative groups. I thank her for her constructive input. The Committee has been successful in building consensus about how this should go forward. I hope the Minister has heard that intervention and that he will respond specifically to that point in his closing remarks.

........

Sarah Wollaston Chair, Health and Social Care Committee, Chair, Liaison Committee (Commons)

Coming back to why integrated care does not happen, there are many deeply ingrained structural divides. Since the inception of the NHS 70 years ago, we have had a system that is free at the point of use for the NHS, but means-tested for social care. That presents an extraordinary hurdle when systems are trying to join up. It is not just that; it is different contractual arrangements and working practices. Good integration comes down to individuals and teams being prepared to work together, but it often feels like they are working together to achieve integration despite the systems around them, not because of them.

We need a system where everybody is focused on helping the right kind of integration to take place, and we need to go back and look at that fundamental structural divide between the systems. I ask the Minister to look again at the joint report, "Long-term funding of adult social care", because that is an important issue that goes to the heart of the barriers to joining up services. It is about contractual differences, different legal accountabilities and payment systems that work against the pooling of budgets, and financial pressures within the NHS.

A certain amount of financial pressure can encourage systems to come together to pool their arrangements and provide a more efficient service, but as the Minister will know, when the elastic is stretched too tight and the financial strain becomes critical, we see the opposite—systems are forced apart. I have seen that happen in my area, where people suddenly feel that they have to retreat to their organisational silos to fulfil their legal obligations. There is no doubt that, for the process to work effectively, we need the right amount of funding—and sufficient funding—and tweaks to the legislative arrangements to allow people to come together, so it does not feel as if they are working together despite the system.

.........

Sarah Wollaston Chair, Health and Social Care Committee, Chair, Liaison Committee (Commons)

I thank the hon. Member for that intervention and for her own service to the Committee previously—she is very much missed. Her remarks are typical of the constructive input that she has always made to the health debate in emphasising the need to take the long view. Financial pressures so often force us into short-term solutions, not only in the way she set out but through the salami-slicing of services.

One of the points that our Committee feels strongly about and that I was going to make to the Minister is the need to ring-fence transformation funding, because it is so easy for that funding to get lost. I welcome the uplift in funding—a 3.4% increase will be very helpful—alongside a 10-year plan. However, we have to be realistic about what that uplift can achieve, because there are very many demands on that budget, as the Minister will know and as we have seen in the past. We saw it with the sustainability and transformation fund, which tended to get sucked into sustainability and not into transformation. That has been the pattern of recent decades. There is good intention to ring-fence money for transformation, but that money disappears because of other priorities around deficits and, as I have said, the many other calls on the funds available.

That is why we feel that, in order to prevent the continuation of that cycle of past mistakes, it is important that the pattern is recognised and that funding is earmarked for transformation—not only for capital projects but for things such as double-running.

I will give an example from my area. There will be a complete destruction of public trust in new models of care if money is not set aside for double-running. The community was prepared to accept that there would be a new facility—nobody wanted the closure of the local community hospital in Dartmouth, but there was an assurance that there would be a new facility. Unfortunately, despite many of us opposing the closure of the old facility, what happened was that it was closed and then there was a breakdown in the arrangements for the new facility. The community was left with nothing and there has been a huge destruction of public trust in the process, which unfortunately will have ripple effects across other communities. Had we received the money to keep the existing service while the new service was built and got up and running, it would have left us in an entirely different situation. I am afraid that we see that too often across health and social care. There is good intention, but without double-running, which is part of having a ring-fenced transformation fund, I am afraid that the system has broken down too often in the past. I would like the Minister to focus on that when he makes his remarks.

The Committee is also looking forward to the 10-year plan—we look forward to working alongside both NHS England and the Department of Health and Social Care to examine how that plan emerges—but is important to draw attention to legislative changes. Our Committee made a recommendation that legislative proposals should come from the service itself rather top-down from the Department, which would immediately run into difficulties. However, as a Committee we also offered to subject such proposals from the service to pre-legislative scrutiny.

As Diana Johnson pointed out in her intervention, we need to build cross-party consensus at every point. As it has not been covered in the formal response to the Committee's report, will the Minister say in his closing marks whether the Government would support the Committee conducting pre-legislative scrutiny?

I am pleased to have had a conversation with Simon Stevens, the chief executive of NHS England, who has confirmed that, as it emerges, the NHS assembly will consider that within its remit—NHS England hopes to produce proposals in draft form before Easter 2019. Nevertheless, as I have said, it would be helpful to receive the Minister's assurance that proposals will come to our Committee for pre-legislative scrutiny as part of the process of building consensus.
............

Sarah Wollaston Chair, Health and Social Care Committee, Chair, Liaison Committee (Commons)

Hon. Members know that a lack of proper pre-legislative scrutiny that responded to concerns expressed led to many of the barriers. We have to go back and address them when they could have been addressed in a more collaborative process during the passage of the Health and Social Care Act 2012. I am thinking of the need to reconsider the legal basis for merging NHS England and NHS Improvement, and how we establish a better statutory basis for the process so that provider partnerships do not always have to go back to separate boards to gain their approval. It is about considering how we address issues such as geographical arrangements so that they make more sense to local communities. The Committee could play a constructive role in a host of areas but—I say this to the Minister—unless proposals are subjected to pre-legislative scrutiny and unless a cross-party consensus is established, proposals are likely to fail.

My final point—other Committee colleagues will probably want to develop it further—is this: what will happen around establishing a legal basis for integrated care providers? For two reasons, the Committee welcomes the change of name from "accountable care organisations" to "integrated care partnerships". First, the original name confused the debate about Americanisation. The "accountable care organisations" proposed were not the same as those organisations in the States, and the original name caused a great deal of unnecessary anxiety. We do not see the process as Americanisation.

A concern raised with the Committee was that the process will be a vehicle for privatisation. We did not agree. In fact, we thought the opposite: we agreed with the witnesses who told us that the process provided an opportunity to row back from the internal market and away from endless contracting rounds, and move towards much more collaborative working. We would like that change to be properly reinforced within the legal status of health bodies, and are disappointed that the Government have not agreed to say categorically that these bodies would be classed as NHS bodies. When the Minister sums up the debate, I would like him to reflect on whether any form of wording can put the matter beyond doubt and ensure that these health bodies will not be taken over by large, too-big-to-fail private sector organisations.

It is not a concern that groups of GPs might want a leading role in the bodies. The Minister will know that the public concern is more about them being taken over by very large too-big-to-fail private sector organisations. It should be possible to come up with a solution. The Committee heard—the Minister knows this—that those working in the service have the view that that the bodies are not likely in practice to be taken over by private sector providers. However, that public concern exists and is a barrier to change. If we can put this matter beyond doubt, we should try to do so.

........

Sarah Wollaston Chair, Health and Social Care Committee, Chair, Liaison Committee (Commons)

I thank the hon. Lady for her helpful clarification. I was trying to distinguish GPs, who are private contractors to the NHS. Sometimes that status is used as a reason why integration cannot be done. I do not think there is concern about that level of leadership involvement but, as she rightly points out, there is concern about other aspects of the private sector. It is acting as an unhelpful distraction when there should be a consensual approach to ensure, as I said at the beginning, that we keep focused on the purpose, which is to provide better services for patients. Anything we can do to facilitate making it easier for that to happen—rather than feeling like we are wading through treacle—will be a positive way forward.

I thank my colleagues and all who helped with the inquiry.

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06 SEP 2018

Cystic Fibrosis

I met today with Matt Hancock and the Cystic Fibrosis Trust to discuss the deadlock on CFTR modulators on behalf of those living with the devastating consequences of Cystic Fibrosis and for whom delay increases disability and costs lives.

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Public Whip


 

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