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Commons Chamber

Volume 652: debated on Tuesday 15 January 2019

House of Commons

Tuesday 15 January 2019

The House met at half-past Eleven o’clock


[Mr Speaker in the Chair]

Oral Answers to Questions

Health and Social Care

The Secretary of State was asked—

NHS Workforce Shortages

Good morning, Mr Speaker. The NHS employs more staff now than at any time in its 70-year history, with a significant growth in newly qualified staff since 2012. We have increased the number of available training places for doctors, nurses and midwives, and taken further actions to boost the supply of nurses, including offering new routes into the profession and encouraging those who have left nursing to return. The long-term plan, which was announced last week, sets out the framework to ensure that the NHS has the staff it needs.

Guy’s and St Thomas’s, which is based in my constituency, offers globally renowned, first-class healthcare, but the trust has seen a massive drop in applications from other EU member states, including of almost 90% in midwives alone. All vacant posts across the NHS present the risk of longer waiting times and risk patient safety, so why did the Government not publish the workforce strategy in the so-called long-term plan? When will it appear? Will the Government reinstate nursing bursaries to address the shocking staff shortfall across the NHS?

As I said a moment ago, the long-term plan sets out a framework to ensure that, over the next 10 years, the NHS will have the staff it needs. To ensure that we have the detailed plan the hon. Gentleman wants, my right hon. Friend the Secretary of State has commissioned Baroness Harding to lead a rapid and inclusive programme of work to set out a detailed workforce implementation plan, which will be published in the spring.

Fifty per cent. of the staff the NHS will need in 15 years’ time are working there now, yet one in 10 nurses is leaving, 80% of junior doctors report excessive stress and six out of 10 consultants want to retire at 60 or before. Does the Minister not accept that this Government have presided over a disastrous decline in morale in the NHS, and will he say what the workforce plan will do to address it?

Nurses are at the absolute heart of our NHS. There are 13,400 more nurses since May 2010. We have announced the biggest expansion of nurse training places, with 5,000 more available from 2018. Alongside that, we are opening up new routes. As the hon. Lady will know, the workforce is at the heart of the long-term plan and, as I have just said, a detailed workforce implementation plan will be published in the spring.

Last week, a 14-year-old boy lost his life in my local community, yet in September, when the Department wrote to my local community asking for ideas about mental health provision, I wrote back to Ministers asking for an urgent meeting to talk about how we could get mental health workers into our schools to work with young people who might be at risk of being involved in gang violence and youth violence. With the shortage of mental health workers at a rate of one in 10, can I finally have that meeting with Ministers so that we can talk urgently about how to support such young people and save not only money, but lives?

The answer to that question is yes. The Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Thurrock (Jackie Doyle-Price), will be delighted to meet the hon. Lady.

The most recent Care Quality Commission inspection of the Royal Oldham Hospital said that it failed to meet safe staffing numbers in maternity and it only had 85% of the required staffing contingent in surgery. There is a human cost to that. We see list after list where people have died, including children, because of unsafe staffing numbers in that hospital. Where is the urgency that is required to address that? Will the Minister meet me about this particular hospital to see what more can be done?

The hon. Gentleman is right. I recognise that the overall CQC rating was that the hospital requires improvement. I understand that the funding that has gone into it has been more than adequate and that it is improving. However, I recognise the concerns he raises and I would be delighted to meet him to discuss them.

Will my hon. Friend congratulate Conservative-controlled Hinckley and Bosworth Borough Council’s health and wellbeing board, and its approach to NHS workforce shortages? It has, for several years, been working on collaboration between GPs and community services, which is in line with the 10-year plan. Will he look at the registers of the Professional Standards Authority, which are not mentioned in the long-term plan, and see if he can make better use of the 80,000 properly regulated practitioners on those registers?

My hon. Friend is right to recognise that community provision lies at the heart of the long-term plan, and that a number of health service professionals make up that community provision. If he wishes to write to me about registers, I will be delighted to respond.

The Minister knows about our difficulties in recruiting obstetricians, which has led to what we very much hope is the temporary closure of the full obstetrics service at Horton General Hospital in Banbury. We are doing everything we can locally to rectify that situation. What more can the Minister do to help us nationally?

I pay tribute to my hon. Friend’s campaign and her tireless work on behalf of her constituents. Figures from the Royal College of Midwives show that there are over 2,000 more midwives on our wards since 2010. The NHS plans to train 3,000 more midwives over the next four years, and as of last September there are over 5,000 more doctors in obstetrics and gynaecology than there were in May 2010. The NHS is hoping to fulfil what my hon. Friend wants to see.

Will the Minister confirm that since the Brexit referendum in June 2016 there has been an increase of 4,000 EU nationals working in our NHS?

My hon. Friend and I do not always agree on everything about the EU, but numbers and statistics show that he is correct on that matter.

Clearly, it is important as we move forward with the NHS to train more doctors and nurses. What is the Minister doing to encourage young people to start training to become nurses, doctors, and for other positions in the health service?

My hon. Friend is right, and we are ensuring more routes into the nursing profession, such as nursing apprenticeships and nursing associates. We are training more GPs, and we are determined to get 5,000 extra GPs into general practice. A record 3,400 doctors have been recruited into GP training and, as part of the long-term plan, newly qualified doctors and nurses entering general practice will be offered a two-year fellowship to support them to stay there.

The long-term plan admits that staffing shortfalls are “unsustainable”, yet incredibly there is no mention anywhere in the document of the damage done by the abolition of the nursing bursary. The plan contains an ambition to double the number of volunteers within three years, and although we should rightly celebrate the fantastic contribution made by volunteers, is it not damning that, with a record 100,000 vacancies in the NHS, the main plank of the Government’s strategy to tackle the workforce crisis is to rely on volunteers?

The hon. Gentleman is right to say that volunteers in the NHS provide an invaluable service, but he is completely wrong to suggest that any part of the long-term plan relies on volunteers. There is an expansion in numbers of nursing associates to deal with those vacancies and, as I have said to other hon. Members, we have seen an increase in the number of doctors in GP training. Obviously, he will welcome the £20.5 billion a year that is going into the national health service. That will inevitably mean more doctors and nurses, which is why we are making more training places available.

Leaving the EU: Contingency Planning

2. What progress his Department has made on contingency planning for the UK leaving the EU without a deal. (908557)

3. What progress his Department has made on contingency planning for the UK leaving the EU without a deal. (908558)

We do not want a no-deal scenario in our exit from the European Union, but it is incumbent on us to prepare in case. We asked medical suppliers to stockpile a further six-week supply over and above normal levels, and that work is going well. We will continue to work to ensure the unhindered supply of medicines in all Brexit scenarios.

The Prime Minister’s threatening of this Parliament and the country with no deal is entirely reckless, irresponsible and unnecessary. It is also causing unnecessary fear and anxiety among a range of clinicians and patients who rely on the consistent supply of life-saving drugs. The Secretary of State says that the Government are stockpiling medicines for up to six weeks. Will he do the right thing and commission an independent assessment of those plans so that patients can be reassured? Better still, will he go back to the Cabinet and say that no responsible Health Secretary would allow no deal to take place, no responsible Prime Minister would allow no deal to take place, and this House will not allow no deal to take place?

It is incumbent on me as Health Secretary and on my team to ensure that we prepare for all potential scenarios. Of course, because of the overwhelming vote of the House in favour of the withdrawal Bill, no deal is the law of the land unless the House does anything else. If the hon. Gentleman is so worried, the best thing that he and all his friends can do is vote for the deal tonight.

Would it not have been a better use of taxpayers’ money to have spent hundreds of millions of pounds on frontline patient care rather than on no-deal planning? The Secretary of State has just said to my hon. Friend the Member for Ilford North (Wes Streeting) that the Government have to prepare for all possible scenarios. A responsible Secretary of State would rule out one of those scenarios, which is no deal.

As I said, thanks to the votes of Members in all parts of the House, no deal is a matter of the law of the land. They can’t get away from it: if they don’t like no deal, they need to join me in the Lobby tonight, and vote for the Prime Minister’s deal.

In Scotland, 6% of all social care staff are nationals of European countries. In England the figure is 8%. In Scotland, despite the Scottish Government paying the real living wage of £9 an hour, that comes nowhere near the £30,000 threshold proposed for a tier 2 visa. Can the Minister tell us here today what action he will take to avert a staffing crisis in social care?

We have brought into place already the EU settlement scheme to ensure that those EU workers who are working in social care and in the NHS can and should remain here and continue to contribute, as they do so valuably.

I know the Secretary of State wants to avoid a no-deal scenario, but can he look at the case of prescription foods, which my constituent Cait, who has PKU, relies on for keeping her life, and make sure they are also covered by no-deal planning?

We are working to ensure that the prioritisation of not just medicines, but medical products and other things needed for the health of the nation, is taken into consideration. There is detailed work under way that is clinically led; the medical director of the NHS is heavily engaged in that work and works very closely with the Department on it. I am very happy to go through the details of my hon. Friend’s constituency case to make sure that that is also being dealt with appropriately. I am glad that, because she does not want no deal, she will be voting with the Government tonight.

Legislation was passed two years ago so that the Secretary of State could end profiteering by some drug companies. Now drug shortages after a no-deal Brexit could mean soaring costs across UK health services, so why have the Government not set the regulations from this legislation so that we can use the powers and avoid a black market in medication?

We have already taken action to ensure that the cost of drugs is reduced. I am very happy to write to the hon. Lady with the extensive details of the agreements that have been made. The legislation is indeed important; so, too, is working with the drugs companies to make sure that we keep those costs down and yet also get the drugs that people need.

As the precursors of medical radioisotopes have a half-life of less than three days, they cannot be stockpiled. I have frequently asked the Government how they will maintain a steady supply if there is a no-deal Brexit. Can the Secretary of State answer—and please don’t say “Seaborne Freight”?

No, absolutely, we have ensured that there will be aircraft available, and air freight, to make sure that we can get those isotopes that have a short shelf life and cannot be stockpiled, and that there is unhindered supply. I make the following point to the hon. Lady and her colleagues, with an open mind and in a spirit of collaboration: if she is worried about no deal, which she seems to be, she and her party should support the Government tonight.

The Secretary of State boasts of being the world’s biggest buyer of fridges to stockpile medicines, but if sterling drops because of the Government’s mishandling of Brexit, the parallel trade in medicines could mean that stockpiles rapidly deplete as medicines are quickly exported back into the EU. Will he impose restrictions and suspend the necessary export licences that he is responsible for? Otherwise, he risks his fridges standing empty.

Of course, we have the legislative tools and powers the hon. Gentleman describes at our disposal; we know that. Nevertheless, stockpiling is going according to plan—it is going well—and the pharmaceutical industry has responded very well, with great responsibility. But I say, rather like a broken record—[Hon. Members: “You are.”] Yes, and it is important that I say it again and again and again. There is one route open to the House to avoid no deal, which Opposition Members purport to be worried about. They cannot complain about no deal unless they are prepared to do something about no deal, and to do something about no deal, they need to vote with the Government tonight.

If the Secretary of State has those powers, he should use them now. This is going to be the biggest disruption to patient safety we have ever seen. He is also proposing emergency legislation that means patients might not get access to the medicines their GPs prescribe. Can he tell us whether an insulin patient will be able to get their prescription within a day of presenting at a pharmacy? He is the Secretary of State for Health; why will he not do the responsible thing and rule out no deal, which will do so much damage to the NHS and patients?

Because of the votes of most of us in the House, including the hon. Gentleman, no deal of course is the law of the land unless the House passes something else. He is a reasonable man. He is a mentor of the old Blairite moderate wing of his party. He is absolutely a centrist. I do not believe that, privately, he believes in the hard-left guff that comes from other Opposition Front Benchers. He is a very sensible man and I like him an awful lot, so after this session and before 7 o’clock tonight, why does he not take a look in the mirror and ask himself, “In the national interest, is it best to vote for the deal and avoid no deal, or is it best to play politics?”

Order. Let me say very gently to the Secretary of State, who is renowned for his charm in all parts of the House, that his likes and dislikes are a matter of immense fascination to colleagues, including the Chair, but what is of greater interest is his brevity.

Fibromyalgia: Diagnosis

4. What recent assessment he has made of the effectiveness of primary care in diagnosing fibromyalgia; and if he will make a statement. (908559)

Diagnosing fibromyalgia can be difficult because there is no specific diagnostic test and symptoms can vary. A range of support exists to help GPs, including an e-learning course developed by the Royal College of General Practitioners and Versus Arthritis, and a medical guide on diagnosis and treatment developed by Fibromyalgia Action UK.

I am grateful to the Minister for that answer. I just hot-footed it here from Westminster Hall, where an excellent debate on fibromyalgia took place this morning. We heard a huge amount of evidence about people who suffer with fibromyalgia having waited more than a year to be diagnosed and having received treatments irrelevant to their condition. Clearly, diagnosis is not working at the moment. What more can the Minister tell us about investment in research to improve diagnosis and to try to get better outcomes for fibromyalgia sufferers?

I feel that my colleague the Secretary of State has set the bar for compliments to Members this morning. On that basis, I congratulate the hon. Gentleman on his Westminster Hall debate, which raised a key issue. The Department’s National Institute for Health Research welcomes funding applications for research into any aspect of human health, including fibromyalgia. Its support for that research over the past five years includes £1.8 million funding for research projects and £0.6 million funding for clinical trials through the clinical research network.

Will the Minister endorse the excellent work by Sue Worrall and her team at Walsall Fibro and ME Link, whose monthly meetings seek to tackle the isolation frequently associated with those conditions?

I warmly welcome the organisation that my hon. Friend mentioned. There are some outstanding voluntary community-led organisations up and down the country that provide invaluable support for people who suffer from this condition. We know that symptoms can vary and that it can be incredibly distressing, so that support is enormously valuable.

The effectiveness of primary care in this and many other areas is undermined for the most vulnerable and poorest communities by this Government’s insistence on putting out GP contracts for competitive tender, even when there is no competition to serve poor communities. The Watson review of GP partnerships was published today. Will the Minister commit to reviewing the requirement for competitive tender for GP partnerships?

We do of course support the recommendations that were part of that review. We have announced massive investment in primary and community services and spend on those services will grow as the NHS budget grows.

Cannabis-based Products: Medicinal Use

5. What guidance his Department has issued to clinicians on the prescription of cannabis-based products for medicinal use. (908560)

The Government acted swiftly to change the law to allow cannabis-based products to be prescribed for those patients who might benefit, with advice from the chief medical officer and the Advisory Council on the Misuse of Drugs. NHS England and the CMO have written to clinicians in England highlighting the interim clinical guidance available.

When the Government announced that they were prepared to allow medical cannabis under prescription, the decision was welcomed by many people throughout the United Kingdom who suffer from a range of conditions, but the process that has been adopted has failed to deliver. When will the Government take steps to facilitate GPs to prescribe and pharmacists to provide the appropriate effective forms of medical cannabis?

We commissioned the National Institute for Health and Care Excellence to produce further guidance that should be out by October. Doctors are right to be cautious when the evidence base remains limited and further research in this area is vital. The change to the law will facilitate that. The National Institute for Health Research has called for research proposals to enhance our knowledge in the area and I think that that is absolutely right.

I call Alistair Carmichael. Where is the fellow? I hope that he is not in Orkney and Shetland because that would be a pity. Never mind, I am sure that we will see him ere long.

NHS Facilities

In September, we announced £145 million to upgrade NHS facilities for winter and, last month, £1 billion as part of the NHS long-term plan. Future capital spending decisions will be for the spending review.

I am grateful to my right hon. Friend for his answer. He will know the importance of Stepping Hill Hospital to my constituents. Will he work with me and others to ensure that the hospital can secure additional capital investment to expand accident and emergency, improve outpatient facilities and provide additional car parking?

I look forward to working with my hon. Friend and his local colleagues on what we can do to support Stepping Hill Hospital further. He is an assiduous representative for Hazel Grove who makes the argument very clearly, both to me and to the NHS Minister, who has already heard from him on several occasions. We did manage to provide £1 million for upgrades to Stepping Hill Hospital ahead of this winter and we understand the case that they make.

Since 1980, Aberdeen University has been at the forefront of MRI development. May I invite the Secretary of State to visit Aberdeen medical facilities to see the fast field-cycling scanner, a development of national importance to stroke diagnosis?

Yes, I love going to Aberdeen and look forward to another reason for going to the north-east. Of course, Aberdeen University and the UK have been at the cutting edge of this innovation for years and must be for years to come.

I first thank the Department for supporting me in my case for upgrading the theatres at Musgrove Park Hospital.

Having skilled staff to work in these places is really important and the University Centre Somerset is one of just two places piloting the nursing associates programme. It is growing really well and it is a vital stepping stone between healthcare assistant and nurse. Will the Secretary of State join me in congratulating the college on how well the programme is going and meet me to discuss the option of a degree course?

Yes, absolutely. We support nursing associates and I am delighted to see the rapid expansion that is taking place. We want more universities and higher education institutes to come to the fore to provide that sort of education. I cannot wait to meet my hon. Friend.

Including, of course, as the right hon. Gentleman knows from his recent meeting with me, the University of Buckingham in my constituency.

One of my constituents, who is 17, seriously ill with breathing difficulties and in need of urgent specialist care, is waiting for a room to be available at the Royal Brompton. Is the Secretary of State aware of any delays and whether these have been caused by not having sufficient NHS facilities at the Royal Brompton to meet such urgent demand?

I have not heard any of the details of that case before now. If the hon. Lady will write to me, I will be very happy to talk to her and engage with her on what we can do for her constituent.

It is 12 long months since the Government closed their consultation on whether to upgrade NHS radiotherapy facilities. Meanwhile, in south Cumbria, cancer patients have to make daily round trips of up to four hours for weeks on end to receive treatment. When will the Government respond to the consultation and when will they invest in satellite radiotherapy provision in places such as Westmorland General Hospital?

We will respond to the consultation very soon. We wanted to get the NHS long-term plan published first, because clearly the two are strongly linked. I pay tribute to the hon. Gentleman’s work chairing the all-party group on radiotherapy and I look forward to working with him.

Plymouth is pioneering health and wellbeing hubs—a new type of NHS facility. I am most excited about the new one in Plymouth city centre, which will include directly employed GPs and mental health, sexual health and dentistry services. We have submitted a funding application to the Minister. When will he be able to fund and support that pioneering project, a new type of NHS facility delivering in some of our poorest communities?

The hon. Gentleman’s neighbour in Plymouth has already brought this to my attention and made the case very strongly for it. I am still waiting for the “Thank you” for the new facilities at Derriford Hospital, but I am a massive supporter of the work that is going on in the local area and the NHS in Plymouth will go from strength to strength under this Government.

The maintenance backlog across the NHS is deeply worrying. It affects equipment as well as buildings. Two of the 10 operating theatres at Torbay Hospital remain out of action. Would the Secretary of State meet me to discuss the impact that that is having on patient care? It is increasing waiting lists and leading to very short-notice cancellations to make way for emergency cases. Torbay Hospital has a £34 million maintenance backlog. It is deeply worrying.

I am very happy to meet my hon. Friend, who makes a very important point. Of course, future allocations of capital are for the spending review. I look forward to working with her to try to sort out the problems in Torbay and across the board.

A consultation is taking place about the closure of Faith House GP practice on Beverley Road in Hull. It is partly about the premises being less suitable for delivering modern healthcare, but also about how difficult it is to recruit GPs. What will the Secretary of State do about GP services being removed from communities? How will he support the development of GP services in those areas?

The £4.5 billion extra in the long-term plan that is going to primary and community care is absolutely targeted at solving problems like that. As it happens, I know Beverley Road in Hull quite well; I had family who lived there. It is very important that the services in primary care and in the community are there and are available to people to ensure that that crucial element of our prevention agenda is strengthened to keep the pressure off hospitals, too.

23. Fareham Community Hospital is seeing increased usage these days, thanks to local GPs working together to provide a same-day access scheme. However, patients are disappointed about the lack of a mobile breast screening unit on site. Will my right hon. Friend join me in calling on community health partnerships and Portsmouth Hospitals NHS Trust to explore ways of providing that vital service, which could help hundreds of people every day? (908579)

Yes, I would love to do that. I will raise it with Mike Richards, who is running a review of the future of screening services. I am sure that the whole House will want to join me in congratulating my hon. Friend on her forthcoming use of maternity services in the NHS.

Registered Nurses: Staffing Levels

7. What recent assessment he has made of trends in the staffing levels of registered nurses in hospitals. (908562)

Our policies have allowed the NHS to recruit over 13,400 more nurses into all wards since 2010. Additionally, we have increased the number of available nurse training places, offering new routes into the profession and encouraging those who have left nursing to return to practice, alongside retaining more of the staff that we have now.

With your permission, Mr Speaker, I was so enthusiastic about the number of extra staff in the national health service, I might have inadvertently misled my hon. Friend the Member for Banbury (Victoria Prentis): it is 500 obs and gynae doctors since 2010.

You are very kind, Mr Speaker. The latest Care Quality Commission report on Lincoln County Hospital found sufficient nursing staff on only four of the 28 days reviewed and a heavy reliance on agency staff. As people know, I was a cardiac nurse for 12 years, and I can tell the House that agency nurses are expensive and create extra work—often they cannot do IVs and they are not familiar with paperwork, so the regular nurses end up doing half their jobs for them. Will the Secretary of State explain to the House why the NHS long-term plan has no policy on effectively tackling understaffing and no mention of reinstating the nursing bursary, which enabled nurses like me to train?

The hon. Lady is right: we want to see more nurses in the NHS. That is why we have provided funding to increase nurse training places by 25% and why the long-term plan will have a detailed workforce implementation plan. She talked about the bursary, but since that was replaced nurses on current training schemes are typically 25% better off. Alongside that, additional funds support learning.

I welcome the fact that my local trust has 94 more nurses than in 2010. What is the Minister doing to ensure greater retention of nurses at my local hospitals, so that they have their own nurses instead of relying so much on agency nurses?

As I said earlier, nurses are absolutely the heart of our NHS, and my hon. Friend is right about the extra number of nurses at her hospitals. She is also right that retention is one of our big issues. That is why the Agenda for Change pay award was put through last year, why we are working with Health Education England to look at other retention methods and why we are increasing the number of training places to ensure that we not only retain nurses but recruit more into the national health service.

I join you, Mr Speaker, in wishing my colleague a happy birthday. I acknowledge that no one knows better than she does about the crisis in nursing staff levels. At the same time, the shortfall in GPs has risen to 6,000, and a third of all practices have been unable to fill vacancies for over three months. Unsurprisingly, waiting times for GP appointments are at an all-time high. As ever under this Government, it is patients who suffer. The situation is set to get worse, with more practices destined to close this year. Why are the Government not taking urgent action to tackle that? When will we finally see the workforce implementation plan that has been promised?

The hon. Lady asks about GPs. As she would want to acknowledge, a record number of doctors are being recruited into GP training. We are determined to deliver an extra 5,000 doctors into general practice. NHS England and Health Education England have a number of schemes in place to recruit more GPs and to boost retention—the GP retention scheme and the GP retention fund—and she will know, as I have said it twice this morning, that the workforce implementation plan, which is part of the long-term plan, will be published in the spring.


This Government are taking bold, world-leading action on child obesity that meets the scale of the challenge that we face. We have a soft drinks industry levy, a sugar reduction programme already working, measures on banning energy drinks, calorie labelling consulted on, and a consultation on restricting price and location promotions of sugary and fatty foods which I launched on Saturday.

The introduction of a 9 pm watershed on the marketing of junk food to children is the No. 1 ask of the Obesity Health Alliance, supported by Cancer Research UK, Diabetes UK and many of the royal colleges. When will we see that consultation launched?

I am glad that my hon. Friend mentions CRUK, which has launched a powerful new marketing campaign that Members will see around Westminster and in the media over the rest of this month. We will launch the consultation on further advertising that was in chapter 2 of the child obesity plan, including the 9 pm watershed, very shortly. We are working hard to ensure that the remaining consultations announced in the second chapter are right. I want to get them right and, when they are ready and we are satisfied that they are the right tools to do the job that we want to face this enormous challenge, we will publish them.

With recent Northern Ireland figures showing that at least 25% of young people and 40% of teens are classed as overweight or obese, will the Minister outline what cross-departmental discussions have taken place on the strategies to improve the health of young people through co-ordination and interaction with parents and the provision of healthy eating schemes?

Of course, health is devolved, but we talk to our opposite numbers all the time, as do our officials. Our north star ambition to halve child obesity by 2030 is right and it is shared and matched by our colleagues in Scotland, and we look to our colleagues in Northern Ireland to do the same. Any advice and support that they want from our world-leading plan is more than on offer.

Does the Minister agree with the campaign being advanced by Jamie Oliver to ensure that doctors in training are given more extensive training in nutrition and its benefits for health?

Yes, I do. I was fortunate enough to visit Southend pier before Christmas to talk to Jamie and Jimmy about this. Nutrition training and the understanding of what is involved in achieving and maintaining a healthy weight varies between medical schools. Some courses have only eight hours over what can be a five or six-year degree. Together with the professional bodies and the universities, we will—as we said in the long-term plan—ensure that nutrition has a greater place in professional education training.

We are all very impressed by how well connected the Minister is. He is obviously on first-name terms with these illustrious individuals—[Interruption.] Indeed, I am sure they are thrilled to befriend the Minister—no reason to doubt it.

Scotland’s childhood obesity plan recognises breastfeeding as the best start to life for babies. Will he look at that in his plans and ensure that the support is available to allow women to breastfeed for as long as they wish to?

Yes, we will. We recognise that it gives a good start in life. Working with my colleague the Under-Secretary of State for Health and Social Care, the hon. Member for Thurrock (Jackie Doyle-Price), I will meet one of the groups in that area to talk about it shortly. I know the hon. Lady chairs the infant feeding all-party group, and I am happy to talk to her about that at any time. We see it as an essential start in life.

Mental Health Support Teams

10. What the aims are of the new mental health support teams to be placed in schools and colleges; and what steps those teams will take to improve mental health for young people. (908565)

The new mental health support teams will deliver evidence-based interventions in or close to schools and colleges for children and young people with mild to moderate mental health issues. In December, we announced the first 25 trailblazer areas in England, and 12 sites will pilot a four-week waiting time to speed up children and young people’s access to NHS mental health services, including in Hertfordshire, serving my hon. Friend’s constituents.

I thank the Minister for that response. She will appreciate that the answer is not just spending more money on mental health—it is how that money is spent. Can the Minister explain in further detail the nature and scope of the research, scientific and otherwise, that has underpinned the Department’s response to the increase in poor mental health in our young people?

My hon. Friend is right: it is important that we get the best value from any investment we make in improving the nation’s mental health by making sure that it is evidence-based. On that basis, the Government engaged extensively with a range of expert organisations and individuals, including children and young people, to inform our proposals to improve mental health support, including through a consultation. We also commissioned academics to undertake a systematic review of the evidence which directly informed our proposals and we will, of course, learn from the trailblazers as we commission additional services later this year.

The Minister will know that the Health and Social Care Committee interrogated the Government’s plans on mental health for our young people. We found a massive gap: many schools that are passionate about their students’ mental health have had to cut the provision that they previously provided, including the educational psychologists, the councillors, the pastoral care workers and the peer mentors. Can she tell us—as the Education Minister could not tell us—what her plans will replace? We know that an army of those professionals are no longer working in our schools.

I know that the hon. Lady is very passionate about all this, and I can say to her that, in rolling out this additional support, we do not want to crowd out anything that is there already. It should genuinely be working in partnership with the provision that has already been undertaken, but we recognise that we need to be rolling out further investment. We are introducing a new workforce that will have 300,000 people when it is fully rolled out, but we must ensure that we invest in the training in such a way that it will be effective.[Official Report, 16 January 2019, Vol. 652, c. 8MC.]

Mental Health Services

11. What steps he is taking to ensure the adequacy of mental health service provision in the long term. (908566)

16. What steps he is taking to ensure the adequacy of mental health service provision in the long term. (908571)

Under the NHS long-term plan, there will be a comprehensive expansion of mental health services with an additional £2.3 billion in real terms by 2023-24. This will give 380,000 more adults access to psychological therapies and 345,000 more children and young people greater support in the next five years. The NHS will also roll out new waiting times to ensure rapid access to mental health services in the community and through the expansion of crisis care.

I thank my hon. Friend for her answer. She will be aware of the long-running and substantial problems that we have had in our main mental health trust, the Norfolk and Suffolk NHS Foundation Trust. Will she update the House on the latest position there, and in particular, will she tell us what steps the Government are taking to finally turn around this failing trust?

My hon. Friend is quite right: I have stood at this Dispatch Box a number of times to address concerns from all the local MPs in Norfolk and Suffolk. I can advise him and the House that the trust is receiving increased oversight and enhanced support from NHS Improvement. It is in special measures for quality reasons. It is also receiving peer support from the East London NHS Foundation Trust, which is an excellent and outstanding trust. We will continue to take a close interest in developments, but I can assure him that the trust is receiving every possible attention to improve its performance.

Will the Minister also set out what steps will be taken to ensure that care for someone experiencing a mental health crisis is available 24 hours a day, seven days a week?

I am grateful to my hon. Friend for his question, because this was top of my list of asks as we were developing the forward plan. The NHS has reiterated its commitment to ensure that a 24-hours-a-day, seven-days-a-week community-based mental health crisis response for all adults is in place across England by 2020-21. All adults experiencing a mental health crisis will be able to be directed to support via NHS 111. This is based on best practice as shown by the Cambridgeshire and Peterborough NHS Foundation Trust. I am grateful to my hon. Friend for his interest in this, and I can assure him that NHS England, all the commissioners and I are very much on it.

Half of all women who experience depression or anxiety in the perinatal period say that their problem was not asked about by health services. There are some genuinely positive things to say about the NHS long-term plan’s proposals for specialist services, but what is the point in having services if half the people with a problem do not have it diagnosed? What are we going to do about that?

The hon. Gentleman has quizzed me about this a number of times, and I know that he cares very deeply about it. One of the specific issues he has raised with me is the awareness of GPs and their involvement in diagnosing these problems. Obviously we are taking that forward as part of the GP contract. I can also advise him that there is a significant expansion in perinatal services. We are confident of achieving the national trajectory of 2,000 more women accessing specialist care this year, and more than 7,000 additional women accessed such care as of March 2018.

Recent analysis of NHS digital mental health workforce statistics reveals that NHS England is not on course to meet its targets of 21,000 additional mental health staff by 2021. This means that it is unlikely to meet the goals set in the five year forward view and the recent long-term plan. Mental health services are in real danger of further decline, so may we have an absolute guarantee from the Secretary of State that these targets will be met, and if they are not, will he resign?

I have to advise the hon. Lady that we are on course to meet the targets in the five year forward view, but she is right to raise concerns about the workforce. Frankly, that keeps me awake at night. We are investing in a significant expansion of mental health services and that requires appropriate staff to deliver them. I can assure her, however, that we are in productive discussions with clinical leads in NHS England. We need to be much more imaginative about how we deliver services, and we are seeing substantial gains and improvements in performance through the increased use of peer support workers, who provide the therapeutic care from which many can benefit. However, the hon. Lady is right to hold me to account.

Rare Diseases and Cancer

12. What steps he is taking to improve the diagnosis and treatment for patients with rare diseases and cancer. (908567)

The blood cancer charity Bloodwise launched its “Hear our voice” report in Parliament last week. Will the Minister ensure that NHS England works with the charity to ensure that blood cancer is included in the 75% target?

Yes, I will. I spoke at the launch of Bloodwise’s excellent report at its parliamentary reception last week. I have been clear since the new ambition was announced that the 75% target applies to all cancers, and we will not achieve it unless we focus on harder-to-diagnose cancers, such as blood cancer.

Given that the number of people suffering from rare diseases in any one country is always likely to be small, and given our changing relationship with the European Medicines Agency and the European medicines market, what is the Minister doing to ensure that the future development of orphan drugs in this country is safeguarded?

The hon. Gentleman will know that the draft withdrawal agreement hopefully sets us on a relationship with the EMA, but the UK’s strategy for rare diseases, which was published in 2013, sets out our commitment to improve the diagnosis and treatment of patients with rare diseases and to end the diagnostic odyssey that has been referred to throughout the past few years.

People with Autism and Learning Disabilities

14. What steps he is taking to increase support for people with autism and learning disabilities. (908569)

Autism and learning disabilities are clinical priorities in the NHS long-term plan. We are committed to improving the quality of care provided to people with a learning disability or autism and to addressing the persistent health inequalities they face.

I thank the Minister for her response. The commitment to reducing diagnosis waiting times for children and young people is welcome, but what are the Government doing in this 10th anniversary year of the Autism Act 2009 to tackle diagnosis waiting times for all people?

I congratulate my hon. Friend on his active involvement in the all-party parliamentary groups on learning disability and on autism. Over the next three years, we will be testing and implementing the most effective ways to reduce waiting times for specialist services. We are developing guidance to support commissioners to develop the necessary services to support all autistic people, and we have launched a review of our autism strategy.

As a former governor of a school for children with autism, I thank the Minister for her response. It is well known that people with ASD suffer premature morbidity due to worse rates of heart disease, cancer and death through epilepsy. What is the Minister doing to ensure that fewer people with autism die early?

These are key elements of the NHS long-term plan, and we will shortly start consulting on mandatory learning disability and autism training for health and social care staff. We will work to improve uptake of the existing annual health checks for people with learning disabilities and will pilot the introduction of specific health checks for autistic people.

The Minister knows of my interest in access to healthcare as chair of the Westminster Commission on Autism. She will also know that a real barrier is having enough people with the skills not only to identify autism, but to support families dealing with it.

The hon. Gentleman is right, and I pay tribute to his hard work in this area. Training is so important, and we want to ensure that all staff, whether clinical, medical or perhaps just on reception, have the necessary training to be able to help to support people with learning disabilities or autism.

What are the Government going to do about people who have suffered acquired brain injury? One in four major trauma centres have no neurorehabilitation consultant, meaning that such people all too often fall between the cracks and do not get proper support. Will the Government change that?

The hon. Gentleman chairs the all-party group on acquired brain injury, and we are working on the recommendations of his report. This is such an important issue, and we want to make sure that nobody falls through the gaps.

Order. We are running late, but I do not think Health questions would be complete without the right hon. Member for North Norfolk (Norman Lamb).

Local Authority Public Health Budgets: Prevention Vision

20. What assessment he has made of the effect of changes to local authority public health budgets in 2019-20 on his Department’s ability to achieve its “Prevention is better than cure” vision. (908575)

Local authorities will receive £3 billion in 2019-20, ring-fenced exclusively for use on public health, but our ambitions for prevention go far beyond any one pot of money. “Prevention is better than cure” was widely welcomed, and we will build on it with a comprehensive Green Paper later this year.

The number of people attending sexual health clinics is up 13% over four years, and the number with gonorrhoea and syphilis is up 20% over the last year, yet the Health Foundation says that funding for sexual health is down 25%. Will the Secretary of State and the Minister be making a powerful case, as part of the spending review, for proper investment in public health, and particularly in sexual health, given their commitment to prevention?

Yes, of course. Matters for the spending review are just that, but one thing that the right hon. Gentleman, as a former Health Minister, will have noticed—and probably welcomed—in the long-term plan is that we are going to look at the commissioning of, and therefore the funding flow for, sexual health services as part of the long-term plan.

Topical Questions

Last week we launched the NHS long-term plan, which delivers on the vision for how the extra £20.5 billion that we are putting into the health service will be spent to get the best return for the taxpayer. The long-term plan is built on the principle that prevention is better than cure, and there will be a new focus on personal responsibility that reflects and complements the responsibility that the NHS has to us all.

Looking to the last financial year, I am sure that the Secretary of State has seen a National Audit Office report that says that auditors gave a qualified opinion on 38% of local NHS bodies, expressing concerns about overspending and value for money. The Comptroller and Auditor General said:

“A qualification is a judgment that something is seriously wrong”.

Does the Secretary of State accept that many of these problems are down to local bodies struggling with the effects of austerity and real-terms cuts to their funding? Does he also accept that he is ultimately responsible for spending in the NHS, and does he accept responsibility for the totally unsatisfactory state of affairs that the NAO has identified?

That is a very big question, and the very big answer comes in the form of the £20.5 billion that is going in, but it is not just about the money. We also need to ensure that, at all levels, we strengthen the leadership capacity in the NHS, because the best hospitals that deliver the best services, that hit their targets and that are the best clinically are also the ones that have the best financial results. Strengthening leadership, making sure that the money is available, as appropriate, and ensuring that we deliver for patients are at the core of the long-term plan.

T4. Before Christmas we had the brilliant news that £40 million of capital funding has been allocated for a new state-of-the-art A&E facility at Scarborough Hospital, which will transform emergency care for my constituents. Can the Minister update me on similar ambitious plans for Whitby Hospital? (908584)

My right hon. Friend is right to welcome the announcement for Scarborough Hospital, and I understand that the full business case for the redevelopment of Whitby Hospital is going through the Hambleton, Richmondshire and Whitby governing body for approval on 24 January. I am assured that the clinical commissioning group remains supportive of the redevelopment of Whitby Hospital and, if it is helpful, I would obviously be delighted to meet him after 24 January.

This Government’s cuts to council budgets have meant that 100,000 fewer people received publicly funded social care over the past three years, and 90 people a day died while waiting for social care last year. What does the Secretary of State think it says to their families that the social care Green Paper and the meaningful funding settlement have been delayed again?

The hon. Lady knows that we have given councils access to nearly £10 billion over a three-year period to address this very issue, but she is right to highlight the issues at the heart of social care. We will be publishing the Green Paper very shortly.

T8. Perhaps the worst private finance initiative contract in the country was awarded in 2001 to Shaw Healthcare for the rehabilitation of elderly people coming out of hospital. Northamptonshire County Council has been paying Shaw for a service in which more than 50% of beds have been lying empty. What steps can the Department take to manage the problems that have arisen from this and other PFI contracts? (908588)

Departmental officials have worked alongside the council to engage with Shaw Healthcare to identify the causes and explore the solutions to minimise the number of empty beds under the PFI. Through improved contract management and regular meetings with Shaw, significant improvements are being made, and contract changes are under discussion to further improve performance. This aligns with the Department’s best practice centre for PFI contracts, as the Chancellor announced in the Budget—

Order. I appreciate the natural courtesy of the Minister in looking in the direction of the person questioning him, but the House wants the benefit of his mellifluous tones, so he should face the House. We are grateful to him.

T2. The closure of ward 6 at Bishop Auckland Hospital will mean the loss of 24 beds, which is why 14,000 people have signed a petition to keep it. Will the Minister now step in to ensure that we keep ward 6? (908582)

The hon. Lady will know that in the long-term plan we have committed to ensuring that more people are treated and that more money is spent in hospitals. The decision on closure is for local organisations, as she will know, but, as I have said to other hon. Members, my door remains open and I would be delighted to meet her.

T9. As we heard earlier, obesity is a major health problem in Britain. Nationally, 1,100 people per 100,000 are admitted to hospital because of obesity-related problems. This is a particular problem in Sittingbourne and Sheppey, where 1,700 people per 100,000 are affected. That is the highest rate in the whole of Kent and Medway. Does the Minister recognise the huge strain that such a statistic puts on the budget of the Swale clinical commissioning group, and, if so, what steps will he take to provide the funds needed to solve the problem? (908589)

Yes, of course we recognise the economic strain that obesity puts on the NHS, which is why we are taking the action we are, including with our renewed focus on prevention. The measures in the plan include doubling the capacity of the diabetes prevention programme and the further 1,000 children a year we hope to treat for severe complications relating to their obesity. That should help my hon. Friend’s CCG, as well as mine and those of all Members.

T3. A senior Bedford GP was told by the East of England Ambulance Service that a patient who required urgent admission would have to wait 10 hours for an ambulance. I am deeply concerned about this response time. Will the Minister urgently investigate why patients are being deliberately downgraded when an ambulance is called from a GP surgery? (908583)

A number of MPs, including the hon. Gentleman, have raised issues about the trust’s performance, and a range of actions have been put in place. He will be pleased to know that I met the performance director in December. I have been discussing several support mechanisms involving both the NHS and the Department, and I continue to receive reports. He will also be pleased to hear that the trust’s performance improved over December.

Children’s hospices provide vital support for children with life-limiting conditions and their families at the most difficult of times. I welcome the £25 million of extra investment in these services, but what more can be done to support children’s hospices across the UK?

My hon. Friend is absolutely right to highlight the incredible work of children’s hospices across the country. Up until now, there has been a disparity between their funding and that of their adult counterparts, which is why I was delighted when, as part of the NHS long-term plan, we announced plans to increase funding for children’s hospices by as much as £25 million a year over the next five years. We can always do more, however, and we are always open to suggestions.

T5. I have recently been contacted by constituents who have faced long waits in A&E at Wigan Infirmary. Figures show that one in four patients have waited longer than four hours. Can the Minister explain how removing waiting time targets will improve the situation? (908585)

The hon. Lady is absolutely right that these waiting time targets need to be improved upon, which is one reason why we are putting so much extra taxpayers’ money into the NHS. Of course, waiting times also need to follow clinical need, and we are taking advice on that.

Genome sequencing and other fourth industrial revolution techniques play a key role in the detection and treatment of cancer and other diseases. How is the NHS adopting those new techniques?

The use of new technologies is drilled through the new NHS long-term plan. Genome sequencing holds great opportunities to improve the health of the nation, and my hon. Friend is a great advocate for it.

T6. As I have seen recently in my own constituency, access to mental health services is sometimes deplorable. Notwithstanding what the Under-Secretary of State for Health and Social Care, the hon. Member for Thurrock (Jackie Doyle-Price), said earlier about all the plans, how long will people have to wait before those services actually get better? (908586)

The biggest proportional increase in spending in the NHS—it has taken place faster than the average rate, over a five-year period—is in mental health services, alongside the increase in primary care and community care. That money will come on stream with a £6 billion cash injection for the NHS overall in April, in just over two months’ time. So we are getting on with it, but there is a lot of work to be done.

NHS Property realised £43 million when it sold St George’s Hospital in my constituency, yet a £17 million bid for a new health centre there has not been successful. Will my right hon. Friend commit himself to looking at that again in order to convince communities that they benefit when local NHS assets are sold?

Absolutely. I look forward to working on that with my hon. Friend and local commissioners, and also to working with my hon. Friend before the spending review, when the next round of the capital allocations will be set.

T7. In line with the long-term plan, leaders in St Helens have integrated health and social care teams and budgets, and there is a joint role for an accountable officer and director of social services. Can the Secretary of State assure me that that successful place working will not be put at risk by restructuring in NHS England and NHS Improvement, and indications in the long-term plan that integrated care systems need to be formed on sustainability and transformation plan footprints? (908587)

Yes, 100%. That is exactly what is in the plan, and I am delighted to have such support. This is precisely the direction in which we need to go in integrating care to ensure that patients are served better, whoever is the ultimate funder of the service.

In the event of an out-of-hospital cardiac arrest, access to a defibrillator can make the difference between life and death. Although there are tens of thousands of defibs across the United Kingdom, the majority are not known to the ambulance service, so will the Minister join me in welcoming the British Heart Foundation’s efforts to map the location of all defibs so that ambulance services can direct people to their nearest heart restarter in an emergency and, hopefully, we can save more lives?

Yes, I will. We work closely with partners such as the BHF to harness new technology. Ultimately, this is about using data—big data—to ensure that patients benefit, and that is at the heart of the health service.

T10. We have an excellent advocate for those with motor neurone disease in north Wales, one Vincent Ryan. He has drawn my attention to the fact that the social care Green Paper was expected before the new year, but the Health Secretary has now said that it will be published before April, more than two years after it was first announced. Can the Secretary of State confirm that, whenever the Green Paper does arrive, it will address social care provision for adults of working age living with a disability as well as older people? (908590)

What advice can the Minister give to elderly and vulnerable people who missed out on the first wave of flu jabs? Are they still available?

Yes, they are still very much available. People should make an appointment through their GP or their wonderful pharmacist.

While working a night shift in A&E this weekend, I was struck by the fact that I was working alongside so many members of staff from our EU—Italian, Irish and Spanish. I am proud that St George’s Hospital is paying for the visas of those vital staff post Brexit, but can the Secretary of State tell me why the financial burden of retaining them and improving their morale is falling on NHS trusts and not the Government?

I welcome what St George’s is doing, and I welcome all the people from the EU who are working in our NHS—in greater numbers than on the day of the referendum. They are welcome here, and I look forward to their working here long into the future.

Each month I hold my memory cafés for those suffering with memory loss, dementia and Alzheimer’s, and their carers, families and friends. What support are the Government providing for those suffering with such memory loss conditions?

We remain absolutely committed to delivering the challenge under dementia 2020 and to making England the best country in the world for dementia care by 2020. As part of that, we are more than happy to do everything we can to support steps such as the memory cafés of which my hon. Friend speaks, which are such a valuable local community resource.

The Secretary of State has been very fond today of talking about the long-term plan. I am 86 years of age, and the reason I am able to ask this question is because under Labour—is he listening?—the money that went in was trebled from £33 billion to £100 billion, an increase of £67 billion. That is why I am still here: I had my operation for cancer, and it was successful; I had an operation for a bypass, and it was successful; and I had a hip replacement, and I can still walk backwards. That is the Labour story—just remember it!

Order. Before the Secretary of State responds, let me say that the ferocity and eloquence of the hon. Member for Bolsover (Mr Skinner) are legendary, but all he is really telling us is what the Chair already knew, namely that the hon. Gentleman is indestructible.

The hon. Member for Bolsover (Mr Skinner) and I both come from Nottinghamshire mining stock, and we both support the NHS, which was first proposed from this Dispatch Box by a Conservative Minister under a Conservative Prime Minister, and has been presided over by a Conservative Secretary of State for most of its life. I am delighted that those operations, including under a Conservative-led Administration, kept the hon. Gentleman ticking, because what an adornment he is—I look forward to voting with him this evening.

Order. As I am often moved to observe at Health questions, demand tends to exceed supply, as in the health service under whichever Government, but we must now move on.

Points of Order

On a point of order, Mr Speaker. Just before Christmas I wrote a letter to the Prime Minister asking if she would be respectful of the mandate in the Scottish Parliament for a second independence referendum by agreeing to a section 30 order. The response came about a month later, and I have to say that it was not respectful of UK member Parliaments at all—in contrast, of course, to the European Union. Indeed, the response was not from the Prime Minister, but from the Secretary of State for Scotland. This is an example of the Government arbitrarily changing the rules—something they complained about last week. Should the Prime Minister herself not be responding to these things or, in an innovation, has she passed to the Secretary of State for Scotland the power to grant a section 30 order for a second independence referendum?

I thank the hon. Gentleman both for his point of order and for his characteristic courtesy in giving me advance notice of it. However, what I have to say to the hon. Gentleman might disappoint him. The hon. Gentleman is perfectly at liberty to put his inquiry to the Government Department of his choice, and indeed the most senior Minister of all, but it is the entitlement, constitutionally and procedurally, of the Government to decide by what route a reply is provided. Although there is some consternation etched upon the contours of the hon. Gentleman’s face that he got a reply from the source he did not want and not the source he did want, I am afraid that he will have to live with that and bear it with such stoicism and fortitude as he can muster.

On a point of order, Mr Speaker. Yesterday you said you would adhere to the advice of the late Lord Whitelaw and cross bridges only when we come to them. I think we would all agree with you on that, but in the interests of knowing what bridges might be crossed, you were asked yesterday to confirm that only a Minister of the Crown could move a motion to extend article 50, and I wonder if you have any update on what you described at the time as being a holding response.

No, I do not, for the simple reason that although I am extremely delighted that the hon. Gentleman has been willing to learn from me and, more particularly, from Lord Whitelaw, that point has not been reached. I appreciate the assiduity of the hon. Gentleman and his nimbleness in being ready to spring to his feet to raise a matter of immediate concern and preoccupation to him, but that crucial point at which some ruling might be required, though of great interest to him, has not yet arrived. So there we are. [Interruption.] The hon. Gentleman chunters cheekily from a sedentary position, “When might it be?” The hon. Gentleman has to learn the art of patience. If he is patient and deploys Zen, he will find that it is ultimately to everybody’s advantage.

Further to that point of order, Mr Speaker. You said yesterday that you were very “happy to reflect”. Can you give the House a sense of when you might have had the chance to reflect, and reassure me that it will be before such a motion is proposed?

What I would say to the hon. Lady is that at the point I am ready to say something on important matters of procedure that require a statement, I hope she will trust that, on the strength of nine and a half years in the Chair, I do know when that point is. Much as I appreciate the diligence and commitment in the Chamber of the hon. Lady, and recognise that there is a desire on the part of many Members, often at short notice, and sometimes on a co-ordinated basis and sometimes not, to raise points of order with great enthusiasm, there is no need for it now. At the point at which a ruling is required, it will be proffered to the House by, if I may say so, an experienced Chair. I think it would be regarded as a courtesy by the House if we could proceed to the presentation of a Bill, for which the hon. Member for Grantham and Stamford (Nick Boles) has been patiently waiting.

Bill Presented

European Union (Withdrawal) (No. 2) Bill

Presentation and First Reading (Standing Order No. 57)

Nick Boles, supported by Liz Kendall, Norman Lamb, Yvette Cooper, Nicky Morgan, Hilary Benn and Sir Oliver Letwin, presented a Bill to make provision in connection with the withdrawal of the United Kingdom from the European Union.

Bill read the First time; to be read a Second time tomorrow, and to be printed (Bill 314).

Public Sector Supply Chains (Project Bank Accounts)

Motion for leave to bring in a Bill (Standing Order No. 23)

I beg to move,

That leave be given to bring in a Bill to require public authorities to pay certain suppliers using project bank accounts; and for connected purposes.

It is exactly a year ago today since the construction giant Carillion announced it was going into liquidation. At the time, there was widespread concern about what that would mean for the completion of major public sector projects already under way, including hospitals and HS2, which Carillion was also working on as part of a consortium. There were also real worries for the 30,000 or so small businesses that, as part of Carillion’s supply chain, were also working on these projects. After Carillion’s collapse, thousands of those subcontractors lost major contracts and were left reeling with substantial debts. A survey of building, engineering and electrical firms showed that small businesses were, on average, owed £141,000 by Carillion, out of a total of £2 billion owed to suppliers. The vast majority of those suppliers never received any recompense. Following on from those losses, it has been estimated that 780 small building firms went into insolvency in the first quarter of 2018 as a direct consequence of Carillion’s collapse—that is a 20% increase in insolvencies on the previous year.

Neil Skinner, whose construction firm Johnson Bros. is based in my constituency, and who is here today, was one of Carillion’s suppliers and lost £176,000. Neil told me:

“Carillion often went over sixty days”

before it paid him,

“with a lot of chasing, and once the job for a particular customer was finished our sanction, to stop working, was gone and their payments just stopped”,

even though Carillion still owed money for the job that Johnson Bros. had done for it.

“They resorted to using all the familiar late payment tactics, from finding fault with an invoice, referring us to their India accounts office, statement queries, disputed invoices paid, and so on.

Then, lastly, they imposed a 15% non-negotiable discount on our work or they would send all unpaid invoices back to their quantity surveyor’s (QS) department. We reluctantly signed this contract and then they went ‘bump’ the Monday after signing and 10 days before the first part payment was due.

As a result of Carillion’s late payment tactics small enterprises like mine have been suffering greatly, if not terminally.”

Neil added:

“Large companies know late payment can destroy small businesses like us, but they rely on these tactics to ‘cook the books’ and be seen to be profitable themselves. Carillion went under owing us well over 15% of our annual turnover and, following a difficult year last year, this money is much needed to help us survive.”

By ensuring that all public sector projects over £500,000 use project bank accounts, my Bill would not only protect small businesses from losing money owed to them should the tier 1 supplier become insolvent, as Carillion did, but stop small businesses being paid late by large companies. PBAs are ring-fenced bank accounts into which monies due to firms providing construction or other works are paid. The accounts are ring-fenced in a trust arrangement so that if a tier 1 contractor becomes insolvent, the monies for the subcontractors are protected. They do not disrupt contractual arrangements, but instead of public bodies paying tier 1 contractors directly, the public body pays money directly into the PBA. The tier 1 contractor and suppliers are then all paid simultaneously, usually within 15 to 18 days.

The Government are already using PBAs successfully in many areas. For example, Highways England uses them for all its works, and by 2020, £20 billion of highways work will have been paid through PBAs. They have also been used in building projects in Scotland, Wales and Northern Ireland. Even some local authorities are using them. Internationally, many Australian states mandate for PBAs to be used in construction projects, and last year the European Commission agreed to use PBAs for European projects.

In addition to payments to small business suppliers being protected and being received more quickly, there is also a reduction in disputes and disruption, as suppliers are less likely to suspend their work when paid promptly. The costs of public sector projects are reduced as well, as the greater security of payment provided by PBAs is factored into suppliers’ pricing. PBAs are a practical, tried and tested measure to protect small businesses and make sure that they are paid promptly.

I have been campaigning against late payments since 2011, when a haulier in my Oldham East and Saddleworth constituency came to me and told me that he was struggling to survive because a mainstream supermarket chain was delaying payments. He was scared that he was going to go under. When I investigated the problem, I was staggered to see how endemic it is right across the country. Four out of five companies across all sectors experience late payments and are owed money, with 68% having to write off bad debt. One in three small businesses admit that late payments are forcing them to rely on bank overdrafts to keep up with their overheads, and more than a quarter say that late payments are forcing them to pay their own suppliers late.

It is shocking that, collectively, small businesses were owed £14 billion in late payments last year. Although late payments have come down from their height in 2013, just under half of small and medium-sized enterprises spend around £4.4 billion in admin costs alone on chasing late payments, and more than one in 10 businesses struggling with overdue invoices have to employ someone to chase for payment. Although the private sector tends to be worse for paying late than the public sector, some Government Departments are also failing to meet their commitment to pay 80% of undisputed invoices within five working days. In addition, Bacs research on existing measures to tackle late payments said:

“When it comes to government initiatives…about a quarter…say they are aware of measures to oblige large and listed companies to publish payment practices. However, three quarters…don’t feel these measures improve the speed their companies are paid.”

In 2013, I held an all-party inquiry to look into the issues associated with late payments and what could be done about them. The evidence we took from small businesses was incredibly powerful. Our key finding was that late payment reflects the culture in the company, and as we know the culture of a company, or a society, ultimately reflects its leadership. It was clear that late payment was used as a form of corporate bullying, with large companies exerting their power over their smaller suppliers just because they could. There was also evidence that many large companies are trying to rebuild their balance sheets on the backs of small businesses, and even have business models that rely on delaying payments to their suppliers. For some tier 1 suppliers, they are little more than a funding repository. Late payment like this is unethical and needs to be seen to be as unacceptable as tax evasion.

Before Christmas, I followed up on my inquiry with a roundtable with representatives from small businesses, including the Specialist Engineering Contractors’ Group and the Federation of Small Businesses. Although some of my inquiry recommendations had been implemented, it was clear that there was still much to do, and PBAs were seen as a practical next step.

Our small business sector is the powerhouse of our economy, contributing £2 trillion of annual turnover—more than half of all private sector turnover—and providing 60% of all private sector jobs. Small businesses are critical to boosting aggregate levels of productivity in the UK, which, as we know from last week’s figures, is at its lowest point in a decade. For a sustainable recovery and healthy growth, we need to support and nurture our entrepreneurs and small businesses. There is so much that needs to be done to tackle late payments and protect small businesses; my Bill is just one step in that process.

Question put and agreed to.


That Debbie Abrahams, Alex Cunningham, Toby Perkins, Anna McMorrin, Diana Johnson, Rachel Reeves, Peter Aldous, Andrea Jenkyns, Marion Fellows, Caroline Lucas, Stephen Lloyd and Jim Shannon present the Bill.

Debbie Abrahams accordingly presented the Bill.

Bill read the First time; to be read a Second time on Friday 1 March, and to be printed (Bill 315).

European Union (Withdrawal) Act

[9th Allotted Day]

Debate resumed (Orders, 4 December and 9 January).

Question again proposed,

That this House approves for the purposes of section 13(1)(b) of the European Union (Withdrawal) Act 2018, the negotiated withdrawal agreement laid before the House on Monday 26 November 2018 with the title ‘Agreement on the withdrawal of the United Kingdom of Great Britain and Northern Ireland from the European Union and the European Atomic Energy Community’ and the framework for the future relationship laid before the House on Monday 26 November 2018 with the title ‘Political Declaration setting out the framework for the future relationship between the European Union and the United Kingdom’.

Under the order of 4 December, as varied on 9 January, I am now permitted to select amendments. I have provisionally selected the following four amendments: (a), in the name of the Leader of the Opposition, Jeremy Corbyn; (k), in the name of the right hon. Member for Ross, Skye and Lochaber (Ian Blackford); (b), in the name of the right hon. Member for Gainsborough (Sir Edward Leigh); and (f), in the name of the hon. Member for Basildon and Billericay (Mr Baron). If amendment (b) is agreed to, amendment (f) falls. Reference may be made in debate to any of the amendments on the Order Paper, including those which I have not selected.

For the benefit of Members and those observing our proceedings, let me set out concisely what will happen at the end of today’s debate. This will be of interest to Members of the House and, I think, to those beyond the Chamber, whether within the Palace of Westminster or further afield, attending to our proceedings. At 7 o’clock, I shall first invite the Leader of the Opposition to move his amendment. If it is agreed to, I will then put to the House the original question, as amended. If it is disagreed to, I shall invite the right hon. Member for Ross, Skye and Lochaber to move his amendment. If that is agreed to, I will then put to the House the original question, as amended. If it is disagreed to, I shall invite the right hon. Member for Gainsborough to move his amendment. If that is agreed to, I will then put to the House the original question, as amended. If it is disagreed to, I shall then invite the hon. Member for Basildon and Billericay to move his amendment. If that is agreed to, I will then put to the House the original question, as amended. If it is disagreed to, I will then put to the House the original question in the name of the Prime Minister.

That having been explained, I invite the Attorney General, Sir Geoffrey Cox, to open today’s debate.

I am extremely obliged to you for promoting me, Mr Speaker. Perhaps I can take that as a hint to my right hon. Friend the Prime Minister.

I will suggest the next office you could perhaps promote me to, Mr Speaker.

I am more than conscious that last time I had a prolonged outing in this House the verdict did not go well. [Laughter.] On this occasion, I intend, if I may, to adopt an approach that I hope will be more to the House’s taste. I want to listen to the House’s views, and I shall be as accommodating as possible to the interventions of Members of this House, knowing as I do that many of them have very strong views upon this subject.

I have listened with care to the speeches of Members of this House during the course of last week’s proceedings, and I have been struck by the heartfelt and eloquent expressions of principled opinion that hon. Members have made. I was particularly struck, though I do not think he is in his place this morning, by the speech late last night—I commend you, Mr Speaker, and those who remained here until after 1 o’clock in the morning to complete yesterday’s proceedings—by the hon. Member for Gedling (Vernon Coaker). He waited, I think, until midnight or shortly thereafter to begin his speech, and made the most passionate appeal to Members of this House to understand the value of compromise. He told the House that the membership of this place confers on us not only the great privilege of participation in the Government but the responsibilities that go with it.

In the past, when this country has faced these kinds of grave obstacles and impediments to finding a way forward, Members of this place have found the resource within themselves to achieve a compromise and to subordinate their ideal preference—the solution that they would like to see—to that which commands a degree of consensus. It is precisely for that reason that I support the withdrawal agreement—not because I like every element of it but for wholly pragmatic reasons: it is the necessary means to secure our orderly departure and unlock our future outside the European Union.

Since 23 June 2016, we have been on a road that has led us ineluctably to this point. One after another, this House has taken the steps, often by overwhelming majorities, necessary to bring us to the brink of departure, and there are now but two steps to take. The first is this withdrawal agreement. It is the first of the two keys that will unlock our future outside the European Union. It is sometimes said in various circles, I understand, Mr Speaker, that if you are moving from one pressurised atmosphere or environment to another, it is necessary to have an airlock. This withdrawal agreement is the first key that will unlock the airlock and take us into the next stage, where the second key will be the permanent relationship treaty.

I appreciate the point that the Attorney General has made with regard to the value of compromise. Anyone involved in any significant negotiation knows that compromise, and the timing of it, is absolutely essential. Is he aware of the most recent comments by the retired former Irish ambassador to the EU, a man who worked on behalf of the Republic of Ireland on the Belfast agreement, who said in The Sunday Business Post: “We”—the Irish Government—“were wrong to insist on the backstop—and softening our stance is the only way to prevent ‘no deal’”? Is the Attorney General pushing for that outcome?

Well, of course I would have been infinitely happier if the European Union had not laid down as one of its cardinal negotiating points and principles that there should be a backstop, but it has done that. On the basis of its own guidance to its own negotiating principles, it would have been a demand that it always sought, and we are faced with the position as it now is.

If we take this step of entering this withdrawal agreement, we will then enter a stage where we are to negotiate the second key to unlock our future outside the European Union. What I am commending to the House is that we take this key and we unlock the door to that first chamber—that airlock where we can then settle the permanent relationship that is set out in the political declaration.

The Attorney General’s use of the airlock analogy is very striking, but does he realise that the reason many of us will vote against the deal tonight is that on the other side of the second airlock is a complete vacuum about our future relationship with our biggest, nearest and most important trading partner?

I intend to address the very point that the right hon. Gentleman raises, because it is important to distinguish between the withdrawal agreement and the political declaration and the permanent treaties in which the long-term relationship between this country and the European Union will be settled. The political declaration sets the boundaries within which those permanent arrangements will be negotiated. The aims of the withdrawal agreement are to settle the outstanding issues that our departure creates. These are two separate and, importantly, distinguishable functions.

The withdrawal agreement commands across the House, I would submit, with the exception of two areas—the backstop and the political declaration—widespread consensus as to its necessity and its wisdom.

Might I draw the Attorney General’s attention to amendment (n) in my name, which calls on him to be a servant of the House and give his legal judgment on whether undertakings about the backstop and our ability to limit it are binding in law, and therefore actionable in law, internationally? Might he draw our attention to the letter he wrote in consequence—maybe in consequence—to the Prime Minister saying that we actually had that legal basis from the Council’s conclusions on 13 December?

The right hon. Gentleman is of course right to say that I published that letter in the spirit of the conversation I had with him—in the spirit of the Government’s desire to make clear as much information as this House needs to make its judgments.

On the backstop, can the Attorney General confirm that fish from Northern Ireland will have tariff-free access into the EU and tariff-free access back to the UK, but fish from Scotland will be subject to tariffs going into the EU, and that therefore Northern Ireland is going to be treated differently from Scotland in the backstop? The Scottish Secretary talked about responsibilities. He said that he would resign if Northern Ireland were given different conditions from Scotland. Is that not the case, and should not the Scottish Secretary consider his position?

As I understand what the hon. Gentleman said, he has misunderstood. The backstop does not deal with the question of fish at all. It has no policy arrangements—

Order. The hon. Member for Kilmarnock and Loudoun (Alan Brown) is rather excitable today. The Attorney General yields to none in his courtesy in the House, but it is not reasonable to expect of him, even with his formidable intellect, the capacity to try to respond to an intervention that he has not heard when he is dealing with one that he has.

Does my right hon. and learned Friend agree that the non-selection of the amendment in my name and the amendment in the name of my hon. Friend the Member for South West Wiltshire (Dr Murrison), the Chairman of the Northern Ireland Affairs Committee, makes harder the Government’s challenge this afternoon to convince those of us who are still concerned about the implications of the backstop? What does he think can replace those two amendments?

I am grateful to my right hon. Friend for his question. I have never underestimated the challenge that I face today or the one that the Government face. As I shall come on to say in due course, I have reflected deeply, as he knows, upon the question of the backstop. I have reached the conclusion that it is a risk that it is acceptable to take, even having regard to the perils that it involves if it were to become permanent and the questions that it unquestionably raises in connection with the Union with Northern Ireland.